[Predictive values of the combination of Friedman stage and sleep oximetry done early after surgery in predicting the treatment outcomes of uvulopalatopharyngoplasty].

OBJECTIVE: To explore the predictive values of the combination of preoperative data, including medical history and physical examination, and results of sleep oximetry performed early after the surgery (one week) in predicting the treatment outcomes of uvulopalatopharyngoplasty (UPPP) in adult patients with obstructive sleep apnea hypopnea syndrome (OSAHS). METHODS: All the patients who were diagnosed with OSAHS, underwent UPPP treatment and had complete follow-up data in our institution between Jan 2013 and May 2016 were enrolled in our study. The pre-operative data of these patients, including age, physical examination, and polysomnography (PSG) data, were all exactly collected for analysis. All these patients had received the evaluation of subjective efficacy scale and the sleep oximetry test in early post-operative days (within one week). The long-term efficacy evaluations including PSG and subjective efficacy scale were all finished at least three months after the surgery. RESULTS: In the research 61 patients were finally studied, including 25 responders (41.0%) and 36 non-responders (59.0%). Regression analysis revealed that the pre-operative Friedman stage and early post-operative oxygen desaturation index of ≥4% (ODI4) were found to be independently predictive parameters for the UPPP treatment outcomes (P<0.05). The ROC curve analysis was used to estimate the predictive values of ODI4 to the treatment outcomes, and it was calculated with an area under the curve of 0.822. Using the ODI4 of 15 as the cutoff value, the sensitivity and specificity of that calculated were up to 0.778 and 0.760 respectively. The response rate among the patients with an early post-operative ODI4 of <15 was 70.4%, which was significantly higher than that of the patients with an early post-operative ODI4 of ≥15, whose response rate was 17.6% (P<0.05). The similar results could also be obtained in the patients with pre-operative Friedman stage II (87.5% vs.25.0%) and Friedman stage III (33.3% vs. 6.7%). CONCLUSION: The combination of early post UPPP operation oximetry parameters, especially ODI4, and pre-operative Friedman stage could be used in better evaluating the potential surgical outcomes of UPPP.

Direct observation of magnetic contrast obtained by photoemission electron microscopy with deep ultra-violet laser excitation.

Magnetic circular dichroism (MCD) and magnetic linear dichroism (MLD) have been investigated in a photoemission electron microscopy (PEEM) system excited by a deep ultra-violet (DUV) laser (with λ = 177.3 nm and hυ = 7.0 eV) for the first time. High resolution PEEM magnetic images (down to 43.2 nm) were directly obtained on a (001)-oriented magnetic FePt film surface with a circularly-polarized light under normal incidence. Furthermore, a stepped Cr seeding layer was applied to induce the formation of large-area epitaxial FePt films with (001) and (111) two orientations, where MLD with large asymmetry was observed in the transition area of two phases. It demonstrates that DUV laser can be a powerful source for high resolution magnetic imaging in the laboratory in absence of synchrotron facilities.

Sequential pathological and immunologic analysis of percutaneous microwave coagulation therapy of hepatocellular carcinoma.

PURPOSE: To evaluate sequential pathologic and immunologic changes and their prognostic significance after percutaneous microwave coagulation therapy (PMCT) of hepatocellular carcinoma (HCC). METHODS: Eighty-nine nodules in 82 consecutive patients were studied. The 89 nodules were divided into two groups: a treatment group, with 82 primary nodules (average dimension was 3.4 +/- 1.2 cm) in 82 patients, and a control group, of seven nodules (average dimension was 1.4 +/- 0.6 cm) in seven patients. The criteria for a nodule's inclusion in the control group was that the nodule was one of two nodules in the same patient and that the two nodules were located in different liver lobes. This guarantees that while one nodule is treated by PMCT, the distant one will not be directly affected by the microwave thermal field. The control group nodules were treated after the study was completed. Specimens were taken with ultrasound-guided liver biopsy from the treated nodule and the control nodule, pre- and post-PMCT. Infiltration by T-lymphocytes, B-lymphocytes, NK cells and macrophages in the tumour tissue were observed immunohistochemically using a panel of monoclonal antibodies against CD3, CD45RO, CD20, CD56 and CD68. The extent of immune cell infiltration was compared both before and after PMCT, as well as between the treated and control nodules. The relationship between the prognosis and the extent of immunocyte infiltration was analysed. RESULTS: The patients were followed for 2-26 months (mean 14.6 +/- 6.3) post-treatment. The recurrence rates at 1 and 2 years were 20.4% and 28.1% within the liver in treatment group, respectively. The survival rates at 1 and 2 years were 92.5% and 75.3% for the treatment group. T-cells, NK cells and macrophages increased significantly in both treated and untreated nodules after PMCT, albeit less markedly within untreated nodules when compared to the treated ones. There is a statistically significant correlation between survival outcome and the extent of immunocyte infiltration. CONCLUSIONS: For inoperable HCC patients, PMCT is one of the treatment choices shown to be effective. Apart from its tissue coagulation effect, an increased systemic immune response directed against the tumour may also play an important role in improved survival.

Sonographically guided microwave coagulation treatment of liver cancer: an experimental and clinical study.

OBJECTIVE: Percutaneous microwave coagulation was performed with a modified system in animal experiments and in a clinical study to evaluate this technique as a treatment option for liver cancer. SUBJECTS AND METHODS: As an in vitro study, a microwave electrode was inserted 5-6 cm into separated egg white, homogenate of pig liver, and pig liver, with different power outputs and different lengths of inner conductors. In the animal experiment, the sonographically guided coagulation was performed percutaneously nine times and at laparotomy 43 times on 17 adult dogs. The thermal needles were placed parallel to and 5 mm, 8-12 mm, and 15 mm from the electrode. Clinically, 41 patients with hepatocellular carcinoma and 10 patients with hepatic metastases were treated with a 60-W microwave emission for 240-300 sec. RESULTS: Microwave coagulation using the modified system at 60 W for 300 sec produced a necrosis volume of 3.7 x 2.6 x 2.6 cm. The coagulated volume was elliptic when the exposed inner conductor of the electrode was 27 mm. The temperature at the periphery was 62.0 +/- 5.8 degrees C. During a mean follow-up period of 23 months, in 41 patients with hepatocellular carcinoma, 79% (46/58) of lesions became smaller, and the intratumoral blood flow disappeared in 89% (47/53). All tumors showed decreased density on unenhanced CT, and 84% (32/38) of tumors showed no enhancement on contrast-enhanced CT. In 21 patients with an elevated alpha-fetoprotein level, the level decreased in all 21 and was normalized in 17. A second biopsy on 19 patients showed complete destruction of tumor in 18. In 10 patients with hepatic metastases, the mean follow-up period was 13 months. Shrinkage of lesions occurred in 84% (21/25), and the blood flow inside the tumor disappeared in 75% (12/16) of lesions. Seventy-three percent (8/11) of the nodules showed no enhancement. A second biopsy on six patients showed complete necrosis in five. CONCLUSION: Sonographically guided microwave coagulation performed with this modified system was an effective and safe treatment for liver cancer.

Ultrasound-guided internal radiotherapy using yttrium-90-glass microspheres for liver malignancies.

UNLABELLED: Treatment of liver malignancies, in particular hepatocellular carcinoma, remains a serious problem because of the difficulty of delivering adequate therapeutic agents to the lesions while sparing the surrounding normal tissue. In an attempt to overcome this obstacle, intratumoral injection of 90Y, a beta-emitter, was performed. METHODS: Twenty-seven hepatocellular carcinomas and six liver metastases were studied, most of which had failed other therapeutic modalities. Guided by ultrasound, 90Y-glass microspheres (GMS) were carefully injected into predetermined tumor sites. The procedure was repeated at 3--4-wk intervals where indicated. Echographic, clinical and laboratory follow-up was conducted at regular intervals. RESULTS: Twelve to 32 mo after treatment, 27 patients were still alive, with dramatic improvement of their clinical condition: 90.6% of the tumor foci became smaller, with echogenic or blood flow changes on liver sonograms. Serum titers of alpha-FP in 10 of 13 patients returned to normal levels. Repeat biopsy in nine patients showed complete tumor destruction in eight. Six patients died of either end-stage disease or wide dispersion of the tumor. CONCLUSION: The intratumoral administration of 90Y-GMS under ultrasound guidance yielded a higher cure rate for liver malignancy with no severe side effects. The higher radiation dosage delivered by injected 90Y to the periphery of the lesions (up to 28,215-75,720 cGy) was thought to account for the successful outcome. These results show that intratumoral radionuclide injection is feasible for treatment of malignant lesions inside the body.

Image-directed and color Doppler studies of gallbladder tumors.

Thirteen cases of primary adenocarcinoma of the gallbladder (GB), 1 of malignant fibrous histocytoma, 3 of metastatic adenocarcinoma, 5 of adenoma, 5 of polypus, 2 of xanthogranuloma, 6 of chronic cholecystitis, 4 of acute cholecystitis, and 8 of subacute cholecystitis were studied by image-directed and color Doppler ultrasonography (CDUS). All of the 14 cases of primary GB cancer (10 masses, 4 thickening wall) were found to have a high velocity arterial blood flow signal in the wall of the GB. In contrast, the 3 cases of metastatic cancer of the GB had no blood flow signal in the wall of the GB. For the 30 cases of benign lesions of the GB, only in 12 cases was a low velocity blood flow signal found. Nine of 10 cases of primary GB malignancy were found to have high velocity arterial blood flow signals in the tumor masses. No blood flow signal was observed in the masses of 13 cases (3 of metastatic adenocarcinoma, 5 of adenoma, 5 of polypus). An abnormal high velocity arterial blood flow signal observed within masses in the GB or in the GB wall is a significant feature of primary GB cancer and thus helps to differentiate primary GB cancer from metastatic and benign lesions of the GB.

[Combined treatment of hepatic carcinoma: percutaneous intratumoral injection of Y-90 glass treatment microspheres with sonographic guidance].

Twenty-eight patients with hepatic carcinoma were treated with a percutaneous injection of Y-90 glass treatment microspheres (GTMS) with sonographic guidance. Of these patients, some were also given alcohol around the lesions and intraportal vein chemotherapy alternatively. Diagnoses were confirmed by biopsy in all patients preoperatively. All patients were alive after 2-16 months follow up. In this group, 91% patients had their tumor size reduced. All lesions showed changes in echo pattern on US scans after the treatment, most of them being hyperechogenic, then being mixed echogenic or isoechogenic. Blood flow sign decreased within lesions and at periphery on color Doppler scans. Of the 13 patients with increased AFP level before injection, 11 had AFP titer dropped with 6 falling to normal after treatment. All patients experienced relief of symptoms and improved general conditions. Histopathologic examination performed in 8 patients after treatment showed complete necrosis and fibrosis of the tumor in 7. Small focus of tumor tissue was detected in one patient only. The therapeutic outcome indicated that the percutaneous intratumoral injection of Y-90 is an appropriate first-line treatment for patients with hepatic carcinoma.

Transcutaneous ultrasound of the cervical esophagus in patients with esophageal carcinoma.

Transcutaneous ultrasound of the cervical esophagus was performed in 46 patients with esophageal carcinoma and in 35 controls. The former had 24 upper segmental lesions and 22 lower segmental lesions. The level of the sternoclavicular joint was used to divide the esophagus into the upper segmental (USE) and lower segmental esophagus (LSE). The anterior esophageal wall thickness and luminal dimensions were measured before and immediately after phonation. The mean wall thickness in the controls was 1.8 mm before phonation and 2.1 mm after phonation, with a significant difference (t test, P < 0.05). The mean wall thickness in the USE carcinoma group was 4.3 mm and 4.4 mm before and after phonation respectively. There was a significant difference between the controls and USE carcinoma groups (t test, P < 0.05). The cross sectional area, which was calculated as the product of anterio-posterior and lateral diameters, averaged 28 mm2 before phonation in the controls and increased to 44 mm2 after phonation (t test, P < 0.05). The mean cross sectional area in the USE carcinoma group was significantly smaller before phonation than that in the controls (t test, P < 0.05) and showed little change after phonation. No significant difference was found between LSE carcinoma and control groups. Transcutaneous ultrasound appears to be a promising non-invasive method of investigation for cervical esophageal carcinoma.

In vivo measurements of frequency-dependent attenuation in tumors of the liver.

Ultrasonic frequency-dependent attenuation (FDA) coefficients of the liver obtained from selected regions of interest within the liver were determined in 106 individuals, 40 cases presumed normal based on medical histories and 66 with malignant tumors (hepatocellular carcinoma [HCC] or metastatic liver tumor) or benign tumors (hepatic hemangioma, hepatic adenoma, or focal nodular hyperplasia of the liver). All liver tumors were confirmed histopathologically by ultrasonically guided fine-needle biopsy and/or operation. Mean attenuation of normal liver was 0.53 +/- 0.03 dB/cm/MHz, 0.29 +/- 0.05 dB/cm/MHz in hepatic hemangioma, 0.43 +/- 0.05 dB/cm/MHz in HCC, and 0.41 +/- 0.12 dB/cm/MHz in metastatic liver tumor. Hepatic adenoma and focal nodular hyperplasia of the liver produced higher values, averaging 0.66 +/- 0.09 dB/cm/MHz. This difference between malignant and benign tumors was statistically significant. There was some correlation between the FDA for the hepatic tumor and the histopathology that merits further investigation.

[Ultrasound-guided percutaneous fine-needle puncture cytology in the diagnosis of malignant tumors of the liver].

Results of ultrasound guided percutaneous fine-needle puncture cytology in 142 cases of malignant tumors of the liver are reported. The positive cytology was noted in 118 (83.1%) (10 suspicious). The primary liver cancer comprised 99 cases. In 7 lesions, equal to or less than 3 cm in diameters, 6 were positive in cytology. In 20,3-5 cm in size, 18 were positive. In 15 false-negatives, 12 were larger than 5 cm in diameter. Among 43 cases of metastatic liver cancer, 34 showed positive cytology and 9 false-negative. Among 108 cases of benign hepatic diseases, in 49.1%, it was difficult to arrive at definitive diagnosis by ultrasonography only, but in 97.2% malignancy was excluded by ultrasound guided fine-needle puncture cytology. The suspicious false-positive result occurred only in 3 cases. In this series, there were 250 cases of malignant tumors and benign diseases. The overall accurate diagnostic rate was 89.2%. All the patients had been followed for more than 6 months. The differential diagnosis between malignant and benign tumors, causes of misdiagnosis and complications are discussed.