Repeat hepatic resection versus radiofrequency ablation for recurrent hepatocellular carcinoma: retrospective multicentre study.

BACKGROUND: The therapeutic value of repeat hepatic resection (rHR) or radiofrequency ablation (RFA) for recurrent hepatocellular carcinoma (HCC) is unknown. This study aimed to investigate the safety and efficacy of rHR or RFA. METHODS: This was a retrospective multicentre study of patients with recurrent HCC within the Milan criteria who underwent rHR or RFA at nine university hospitals in China and Italy between January 2003 and January 2018. Survival after rHR or RFA was examined in unadjusted analyses and after propensity score matching (1 : 1). RESULTS: Of 847 patients included, 307 and 540 underwent rHR and RFA respectively. Median overall survival was 73.5 and 67.0 months after rHR and RFA respectively (hazard ratio 1.01 (95 per cent c.i. 0.81 to 1.26)). Median recurrence-free survival was longer after rHR versus RFA (23.6 versus 15.2 months; hazard ratio 0.76 (95 per cent c.i. 0.65 to 0.89)). These results were confirmed after propensity score matching. RFA was associated with lower morbidity of grade 3 and above (0.6 versus 6.2 per cent; P < 0.001) and shorter hospital stay (8.0 versus 3.0 days, P < 0.001) than rHR. CONCLUSION: rHR was associated with longer recurrence-free survival but not overall survival compared with RFA.

Effect of Polymeric Microparticles Loaded With Catechin on the Physicochemical Properties of an Adhesive System.

The objective of this study was to synthesize and characterize epigallocatechin-3-gallate (EGCG)-loaded/poly(D-L lactide-co-glycolide) acid (PLGA) microparticles, evaluate their effects on degree of conversion and release assay of adhesives, and subsequently to examine the resin-dentin bond strength of two EGCG formulations (free EGCG or loaded into PLGA microparticles) applied as a pretreatment or incorporated into an adhesive system. The formulations were prepared according to a PLGA:EGCG ratio of 16:1 using the spray-drying technique. The size and polydispersity index were determined by light scattering in aqueous dispersion. The degree of conversion (%DC) and release assay were assessed by Fourier transform infrared spectroscopy and ultraviolet-visible spectrophotometer, respectively. Subsequently, 45 third molars were divided into five groups (n=9) according to the different EGCG application modes and prepared for bond strength testing in a universal testing machine. Results demonstrated no statistically significant difference among the DC means after the PLGA microparticles were loaded with EGCG. For the release assay, the 1.0% PLGA/EGCG group presented better results after being elected for use in the bond strength test. The resin-dentin bond strengths of the experimental groups after 12 months of water storage were significantly higher than in the control group. EGCG could improve the durability of the resin-dentin bond over time and promote a new era for adhesive dentistry with the concept of controlled release.

Frequency and determinants of microalbuminuria in mild hypertension: a primary-care-based study.

OBJECTIVE: To evaluate the frequency of microalbuminuria and its relationship with several risk factors and left ventricular mass in a population of mildly hypertensive subjects attended in a primary-care setting. DESIGN: Cross-sectional study. SETTING: Eight primary-care centres. PATIENTS: Two hundred and twenty-three non-diabetic patients recently diagnosed with mild hypertension were included in the study. None of them had clinical evidence of target-organ damage or had received prior antihypertensive treatment. INTERVENTIONS: Subjects included in the study underwent clinical interview, measurement of blood pressure (BP) on three visits, blood analysis, measurement of albumin by immunonephelometry in three overnight urine collections, 24 h BP monitoring and M-mode and Doppler echocardiography. MAIN OUTCOME MEASURES: Tobacco habit, clinic BP, body mass index, serum lipids and uric acid, glycaemia, urinary albumin excretion (UAE), ambulatory BP and left ventricular mass index. RESULTS: The frequency of microalbuminuria was 7.2%. Microalbuminuric patients were more likely to be men and to be characterized by higher ambulatory BP, body mass index and uric acid levels. Regression analysis demonstrated that male sex and 24 h systolic BP were determinants of UAE. Patients with white-coat hypertension showed lower UAE than did subjects with sustained hypertension. Although a certain relationship between UAE and left ventricular mass index was found, these variables were not significantly correlated. CONCLUSIONS: A low proportion of mildly hypertensive patients attended in a primary care setting are microalbuminuric. In this population, UAE is an expression of BP values over 24 h and correlates with several risk factors.

Sedimentation rate and serum thymidine kinase activity: prognostic factors in squamous cell head and neck cancer.

Identification of prognostic factors in squamous cell head and neck cancers involves analysis of highly diverse clinical and biological parameters. This study analyzed the prognostic value of clinical variables (age, sex, tumor site, stage) and biologic parameters (squamous cell carcinoma antigen [SCC], serum thymidine kinase activity [TK], fibrin, sedimentation rate [SR]) at the time of diagnosis of squamous cell carcinoma of the head and neck (oral cavity, oropharynx, hypopharynx) in 189 patients. Among the clinical variables investigated, UICC stage III-IV disease (p < .0002), a hypopharyngeal site (p < .02), and age over 60 years (p < .01) were all associated with a poor prognosis. Similarly, analysis of biological blood variables allowed definition of cut-off values above which the prognosis was poor: SCC 2.5 ng/mL (p < .01), fibrin 3.5 g/L (p < .01), TK 7 IU/L (p < .0005), and SR 15 mm per first hour (p < .0000). Cox regression analysis of overall survival identified the UICC stage (p < .000), the SR (p < .001), and serum TK (p < .02) as the main independent prognostic factors. A separate study on a small number of head and neck cancer patients revealed higher TK levels in malignant squamous cell carcinoma tissue than in adjacent healthy tissue.

Small-signal gain and saturation intensity in dye laser amplifiers.

Small-signal gain and saturation intensity are obtained from input and output intensity measurements in a dye amplifier stage in which amplified spontaneous emission changes the amplifier performance. We demonstrate that these measurements lead to more accurate values for the effective gain of the amplifier than what can be obtained from theoretical calculations by using physical parameters of the dye. Furthermore, this method can be used to optimize the power extraction efficiency for a dye amplifier stage transversely pumped by a copper vapor laser.

[Bilio-digestive fistulas]. / Fístulas bílio-digestivas.

The authors report upon 5 cases of biliary-enteric fistulas, all of them detected preoperatively in a General Surgery Service during a relatively short period of time (6 months). Two cholecysto-duodenal and one cholecysto-ileal fistula were complications of a pre-existent cholelithiasis. A choledocho-duodenal fistula was caused by a penetrating peptic ulcer and a choledocho-colonic fistula was a iatrogenic traumatic one. The review of the literature demonstrates generally a lower incidence of this pathology in different surgical centers, one or two cases a year. More than 50 per cent of the biliary-enteric fistulas were unexpectedly found during operations on the biliary tract or stomach. This forces the surgeon to change his programmed surgical procedure without adequate preoperative preparation. The consequence is a higher morbidity rate in such operations. The continuing refinement of diagnostical procedures have led to a progressive and more frequent preoperative assessment of these fistulas. Adequate diagnostic methods and surgical procedures adopted in different cases of biliary enteric fistulas are discussed, emphasizing the good results obtained and the lower morbidity.

Fistulas bilio-digestivas. / Biliarydigestive fistulas

Sao descritos cinco casos de fistulas bilio-digestivas (F.B.D.) tratadas durante atividade rotineira, em servico de cirurgia geral, em prazo relativamente curto de tempo (seis meses). Tratavam-se de fistulas de etiologias diversas sendo duas fistulas colecisto-duodenais, uma colescistoileal de origem bilio-litiasica, uma coledoco-duodenal sencundaria a ulcera peptica e outra coledoco-colonica de origem traumatica. Todas foram detectadas pre-operatoriamente. Acredita-se que o aprimoramento continuo dos metodos semiotecnicos facilite e torne o diagnostico pre-operatorio destas afeccoes mais frequente, isto, por sua vez, faz com que o preparo pre-operatorio e planejamento cirurgico sejam mais adequados. Sao apresentadas a metodologia semiotecnica e condutas cirurgicas adotadas nos diferentes tipos de F.B.D. da casuistica, ressaltando os bons resultados assim obtidos, com baixa morbilidade

Mastopexy and breast reduction in Asians.

The author describes a method of correcting the ptotic breast in Asians which was first popularised by Dufourmental and Mouly in 1968. This mastopexy by the lateral approach leaves an acceptable scar in the lateral quadrant of the breast. The technique is simple and gives rise to satisfactory results. The author has also employed the same procedure for reduction of moderat breast hypertrophy with or without ptosis.