Comparison of tissue pressure and ablation time between the LeVeen and cool-tip needle methods

BACKGROUND: Radio frequency ablation (RFA) has been accepted clinically as a useful local treatment for hepatocellular carcinoma (HCC). However, intrahepatic recurrence after RFA has been reported which might be attributable to increase in intra-tumor pressure during RFA. To reduce the pressure and ablation time, we developed a novel method of RFA, a multi-step method in which a LeVeen needle, an expansion-type electrode, is incrementally and stepwise expanded. We compared the maximal pressure during ablation and the total ablation time among the multi-step method, single-step method (a standard single-step full expansion with a LeVeen needle), and the method with a cool-tip electrode. Finally, we performed a preliminary comparison of the ablation times for these methods in HCC cases. RESULTS: A block of pig liver sealed in a rigid plastic case was used as a model of an HCC tumor with a capsule. The multi-step method with the LeVeen electrode resulted in the lowest pressure as compared with the single-step or cool-tip methods. There was no significant difference in the ablation time between the multi-step and cool-tip ablation methods, although the single-step methods had longer ablation times than the other ablation procedures. In HCC cases, the multi-step method had a significantly shorter ablation time than the single-step or cool-tip methods. CONCLUSION: We demonstrated that the multi-step method was useful to reduce the ablation time and to suppress the increase in pressure. The multi-step method using a LeVeen needle may be a clinically applicable procedure for RFA

A Case of NASH Exacerbated after Testectomy due to Seminoa

A 41-year-old Japanese male was admitted to our hospital because of the increased levels of serum AST, ALT, and gamma-GTP on December 18, 2002. He was diagnosed with right testis seminoma in 1994 and had recieved right high orchiectomy and radiation therapy. At that time, liver dysfunction was not pointed out. As weight was increased in 2001, liver dysfunction was pointed out. He was diagnosed as left testis seminoma in June, 2002, left high orchiectomy and chemotherapy was performed. Abdominal ultrasonography showed the moderate fatty liver, and hepatic histopathology revealed a typical and remarkable steatohepatitis with lymphocyte infiltration. He had no life history of alcohol-comsuption, and he was diagnosed as non-alcoholic steatohepatitis (NASH). He was treated with a low-calorie diet, which showed favorable effects on his serum levels of AST, ALT, gamma-GTP, and LDH. This case suggests that the altered sex hormone balance might exacerbate NASH because liver dysfunction was particularly worsened after bilateral high orchiectomy

Evaluation of Prognosis and Recurrence of Hepatocellular Carcinoma treated from 1988 to 2002 at Department of Medicine III, Kyushu University Hospital

From a series of 452 consecutive patients with hepatocellular carcinoma (HCC) admitted to the department of Medicine III, Kyushu University Hospital between January 1988 and December 2002, patients were evaluated, who met the following criteria : (a) the patients had not been diagnosed with HCC previously, (b) they had a solitary HCC less than 4 cm in diameter, or had fewer than three tumors with diameters less than 3 cm, and (c) patients with extrahepatic metastasis or vessel invasion were excluded. Five-year survival was more than 60 %, and there were no significant differences in survival among the periods of 1988 1989, 1990 1994, and 1995 2002. There were significant differences in survival among patients with tumors of diameters < 2 cm (80 %), 2 3 cm (60 %), 3 < (40 %) cm, and among those with tumor numbers of 1 (70 %), 2 (50 %) , 3 4 tumors (30 %). The study also analyzed variables that could influence prognosis or recurrence of HCC, including tumor size and number, parameters of hepatic function, combined therapy with transcatheter arterial chemoembolization and local recurrence. Multivariate regression analysis showed that indocyanine green retention at 15 min serum albumin level, and local recurrence were significant independent predictors of survival, and that serum albumin and alanine aminotransferase levels were significant independent predictors of recurrence. In conclusion, achieving complete necrosis of HCC at first treatment to prevent local recurrence is important for improving the prognosis of patients with HCC. In addition, ameliorating hepatitis, by antiviral treatment for example, to maintain hepatic function is also important for improving both the prognosis and the prevention of the recurrence

A Case of Idiopathic Portal Hypertension Complicated with Sepsis Caused by Aeromonas hydrophilia

A 53 years old man with idiopathic portal hypertension (IPH) was admitted because of high fever and diarrhea. Nineteen years before admission, he had received splenic hilar renal shunt operation with proximal flush ligation of splenic vein due to gastric varices. Three months before admission, he had been admitted to our hospital for evaluation of liver dysfunction. Liver biopsy examination had revealed peri-portal fibrosis consistent with IPH. Aeromonas hydrophila was isolated from blood. Although he was treated with antibiotics plus dopamine, glucoseinsulin therapy, and mechanical ventilation, he had severe septic shock, and died 29 days after admission. We have to take notice of A. hydrophila infection in cases of portosystemic shunt because they fall in severe septic shock

Reproducibility, Performance, and Clinical Utility of a Genetic Risk Prediction Model for Prostate Cancer in Japanese

<div><p>Prostate specific antigen (PSA) is widely used as a diagnostic biomarker for prostate cancer (PC). However, due to its low predictive performance, many patients without PC suffer from the harms of unnecessary prostate needle biopsies. The present study aims to evaluate the reproducibility and performance of a genetic risk prediction model in Japanese and estimate its utility as a diagnostic biomarker in a clinical scenario. We created a logistic regression model incorporating 16 SNPs that were significantly associated with PC in a genome-wide association study of Japanese population using 689 cases and 749 male controls. The model was validated by two independent sets of Japanese samples comprising 3,294 cases and 6,281 male controls. The areas under curve (AUC) of the model were 0.679, 0.655, and 0.661 for the samples used to create the model and those used for validation. The AUCs were not significantly altered in samples with PSA 1–10 ng/ml. 24.2% and 9.7% of the patients had odds ratio <0.5 (low risk) or >2 (high risk) in the model. Assuming the overall positive rate of prostate needle biopsies to be 20%, the positive biopsy rates were 10.7% and 42.4% for the low and high genetic risk groups respectively. Our genetic risk prediction model for PC was highly reproducible, and its predictive performance was not influenced by PSA. The model could have a potential to affect clinical decision when it is applied to patients with gray-zone PSA, which should be confirmed in future clinical studies.</p> </div

Probability of positive prostate biopsy in high and low risk patients grouped by the genetic risk model at various cutoffs.

a<p>Percentile of population above the cut-off odds ratio in all the samples in the present study.</p>b<p>Percentile of population below the cutoff odds ratio.</p>C<p>Probability of positive prostate biopsy assuming the overall positive probability of prostate biopsy to be 20%.</p>d<p>The best cutoff determined by the ROC analysis.</p

16 SNPs incorporated in the risk prediction model and their regression coefficients in the model.

a<p><i>P</i> for trend (1-degree of freedom) in GWAS stage 1.</p>b<p>Odds ratio and confidence intervals of risk alleles in multiplicative models in GWAS stage 1.</p>c<p>Regression coefficients of each SNP in the risk prediction model.</p>d<p>Intercept of the risk prediction model.</p

ROC curves for (A) the samples used to create the genetic risk prediction model (<i>AKY</i>), (B)(C) the two validation studies (<i>BBJ</i> and <i>BBJ2</i>), and (D) when all the samples were combined.

<p>The AUCs of the model and 95% confidence intervals are indicated. The AUCs of <i>BBJ</i> and <i>BBJ2</i> are statistically compared with that of <i>AKY</i>, and <i>P</i>-values are reported. (x: the logarithm of odds ratio at the best cut off, Sens: sensitivity of the model at the best cutoff, Spec: specificity of the model at the best cutoff.)</p