Balloon dilatation for treatment of hepatic venous outflow obstruction following pediatric liver transplantation.

AIM: To assess the efficacy and safety of balloon dilatation for the treatment of hepatic venous outflow obstruction (HVOO) following pediatric liver transplantation. METHODS: A total of 246 pediatric patients underwent liver transplantation at our hospital between June 2013 and September 2016. Among these patients, five were ultimately diagnosed with HVOO. Seven procedures (two patients underwent two balloon dilatation procedures) were included in this analysis. The demographic data, types of donor and liver transplant, interventional examination and therapeutic outcomes of these five children were analyzed. The median interval time between pediatric liver transplantation and balloon dilatation procedures was 9.8 mo (range: 1-32). RESULTS: Five children with HVOO were successfully treated by balloon angioplasty without stent placement, with seven procedures performed for six stenotic lesions. All children underwent successful percutaneous intervention. Among these five patients, four were treated by single balloon angioplasty, and these patients did not develop recurrent stenosis. In seven episodes of balloon angioplasty across the stenosis, the pressure gradient was 12.0 ± 8.8 mmHg before balloon dilatation and 1.1 ± 1.5 mmHg after the procedures, which revealed a statistically significant reduction (P < 0.05). The overall technical success rate among these seven procedures was 100% (7/7), and clinical success was achieved in all five patients (100%). The patients were followed for 4-33 mo (median: 15 mo). No significant procedural complications or procedure-related deaths occurred. CONCLUSION: Balloon dilatation is an effective and safe therapeutic option for HVOO in children undergoing pediatric liver transplantation. Venous angioplasty is also recommended in cases with recurrent HVOO.

Early Response of Hepatocellular Carcinoma to Chemoembolization: Volume Computed Tomography Liver Perfusion Imaging as a Short-Term Response Predictor.

OBJECTIVE: The aim of this study was to investigate the efficacy of lesion-oriented whole-liver computed tomography (CT) perfusion for predicting transarterial chemoembolization early treatment response in patients with hepatocellular carcinoma (HCC). METHODS: Volume helical shuttle CT perfusion imaging on the whole liver was prospectively performed on 39 patients with 46 independent HCC lesions before target-selected chemoembolization. The therapeutic effects were assessed: responder group included lesions with a complete and partial response, whereas the nonresponder group contained stable and progressive disease. The perfusion parameter value comparison between 2 groups and receiver operating characteristic analyses were performed. RESULTS: The responders demonstrated higher hepatic arterial perfusion (HAP) and hepatic arterial perfusion index (HAPI) and lower hepatic portal perfusion (HPP) compared with the nonresponders among the 34 lesions without Vp3 or Vp4 portal vein thrombosis. In addition, HAP and HAPI had good prognostic values. CONCLUSIONS: Whole-liver CT perfusion allows for hemodynamic evaluation of HCC lesions. The HAP, HAPI, and hepatic portal perfusion values may be useful predictors of short-term therapeutic response after transarterial chemoembolization.

CT-guided localization of small pulmonary nodules using adjacent microcoil implantation prior to video-assisted thoracoscopic surgical resection.

OBJECTIVES: To describe and assess the localization of small peripheral pulmonary nodules prior to video-assisted thoracoscopic surgical (VATS) resection using the implantation of microcoils. METHODS: Ninety-two patients with 101 pulmonary nodules underwent computed tomography (CT)-guided implantation of microcoils proximal to each nodule. Patients were randomly assigned to undergo entire microcoil or leaving-microcoil-end implantations. The complications and efficacy of the two implantation methods were evaluated. VATS resection of lung tissue containing each pulmonary lesion and microcoil were performed in the direction of the microcoil marker. Histopathological analysis was performed for the resected pulmonary lesions. RESULTS: CT-guided microcoil implantation was successful in 99/101 cases, and the placement of microcoils within 1 cm of the nodules was not disruptive. There was no difference in the complications and efficacy associated with the entire implantation method (performed for 51/99 nodules) versus the leaving-microcoil-end implantation method (performed for 48/99 nodules). All nodules were successfully removed using VATS resection. Asymptomatic pneumothorax occurred in 16 patients and mild pulmonary haemorrhage occurred in nine patients. However, none of these patients required further surgical treatment. CONCLUSIONS: Preoperative localization of small pulmonary nodules using a refined percutaneous microcoil implantation method was found to be safe and useful prior to VATS resection. KEY POINTS: • An increasing number of small, indeterminate pulmonary lesions need to be characterized. • Entire microcoil and leaving-microcoil-end implantation methods were described for nodule localization. • Adjacent microcoil localization prior to video-assisted thoracoscopic surgical resection involved minimal intervention. • Preoperative microcoil localization facilitates the definitive resection of small pulmonary nodules.

Hashimoto encephalopathy: a case report with proton MR spectroscopic findings.

A 52-year-old female patient with Hashimoto encephalopathy was admitted to hospital for clinical treatment, and the findings on MR spectroscopy (MRS) and MR imaging (MRI) in the brain were reported. MRS revealed the decreases in N-acetylaspartate (NAA/Cr=1.19) and myo-inositol peaks, and the elevations in lipid, lactate, glutamate/glutamine multiplet and choline (Cho/Cr=1.21) peaks which supported a cerebral inflammatory change, in addition to multifocal hyperintensities on T2WI and fluid-attenuated inversion recovery (FLAIR) images, slight hyperintensities on diffusion weighted imaging (DWI), hypointensities on T1WI. The atrophy of the brain was revealed on follow-up MRI two years later.

Epinephrine increases phosphorylation of MAP-2c in rat pheochromocytoma cells (PC12 Cells) via a protein kinase C- and mitogen activated protein kinase-dependent mechanism.

Adrenoceptors mediate effects of endogenous catecholamines and have been shown to affect the neuronal development. Microtubule-associated protein-2 (MAP-2) is an important cytoskeleton protein whose phosphorylation in response to extracellular signal is involved in the regulation of neurite outgrowth and neuronal plasticity. The present study was designed to determine the effect of activation of adrenoceptor by epinephrine on MAP-2 phosphorylation in differentiation PC12 cells and, if so, to explore the mediating mechanism. We found that epinephrine could significantly increase the phosphorylation of MAP-2c at ser136 in a dose- and time-dependent manner in differentiated PC12 cells as well as microtubule arrays. Differentiated PC12 cells express alpha 2A-adrenoceptor, whose antagonists could block these mentioned effects of epinephrine, and clonidine which is the agonist of alpha 2-adrenoceptor could mimic the effect of epinephrine. Moreover phosphorylation of ERK and PKC was induced by epinephrine, and ERK and PKC specific inhibitors concentration-dependently prevented epinephrine-induced phosphorylation of MAP-2c at ser136. In addition, pretreatment of PC12 cells with epinephrine partly inhibited 30 microM nocodazole induced neurites retraction. These findings suggest that epinephrine induces phosphorylation of MAP-2c at ser136 through a alpha 2-adrenoceptor mediated, ERK/PKC-dependent signaling pathway, which may contribute to the stabilization of neurites.