Double radiofrequency ablation is more extensive with a spherical zone shape compared to single ablation in a pig liver model

Objective : We compared the duration of ablation and the area of coagulation necrosis between a single ablation method (SAM) and a double ablation method (DAM) with a ’multitined expandable’ electrode (LeVeen 2cm) for radiofrequency ablation (RFA) using pig liver. Method : In the SAM group, ablation was completed after the first roll-off. In the DAM group, an additional ablation was performed to achieve a second roll-off. The comparison was made of the time required for roll-off and the extent of coagulation necrosis between the both groups. The Ellipticity index (EI) quantitatively describes the shape of the general RF ablation zone in the axial plane. Results : There was no statistically significant difference in the interval until the first roll-off between both groups (SAM group : 100.7±24.7 seconds vs DAM group : 103.2±37.7 seconds, P=0.43). In the DAM group, the interval from the start of the additional ablation until the second roll-off was 154.0±86.9 seconds, longer than the interval for the first roll-off (P=0.023). The extent of coagulation necrosis was significantly more extensive in the DAM group (axial diameter, mean±SD, 26.2±2.8 mm)×(maximal diameter : 29.3±1.6 mm)× (minimal diameter : 26.5±3.6 mm) compared to the SAM group with (23.0±3.3 mm)×(23.7± 3.1 mm)×(20.0±2.5 mm), respectively. Although there was no statistically significant difference in the EI between both groups, macroscopically, the shape of coagulation necrosis tended to be non-spherical in the SAM group and spherical in the DAM group. Conclusions : The DAM with a ’multitined expandable’ electrode was more extensive with a spherical zone shape compared to the SAM

Influence of an artificial pleural effusion technique on cardio-pulmonary function and autonomic activity

Objective : Percutaneous treatment of hepatocellular carcinoma (HCC) located directly under the diaphragm is problematic because ultrasonic imaging is difficult, and the lung may be injured during the procedure. It has been reported that an infusion of 5% glucose solution into the thoracic cavity enables percutaneous treatment in such cases. However, the safety aspects of this have not been investigated. In this study, variations in heart rate and changes in circulatory and respiratory dynamics were examined during the infusion of artificial pleural effusion directly under the diaphragm in patients with HCC. Method : The subjects were 13 patients with an HCC directly under the diaphragm. About 500 ml of a 5% glucose solution was infused into the thoracic cavity, and mean blood pressure, heart rate, and oxygen saturation were measured. Holter electrocardiography was simultaneously recorded to evaluate autonomic nerve function. To analyze variations in heart rate, the low-frequency waves (LF : 0.04-0.15 Hz), high-frequency waves (HF : 0.15-0.40 Hz, an index of parasympathetic nerve activity), and the LF/HF ratio (index of sympathetic nerve activity) were examined. The above parameters were measured before, during (when infusion of the half the planned volume was complete), and after infusion were compared. Results : No significant changes in the mean blood pressure or heart rate were found. Oxygen saturation was significantly decreased during and after the infusion. The HF value was slightly higher after infusion and the LF value was significantly increased during infusion. The LF/HF ratio was significantly increased during infusion, and this increase persisted after infusion. Conclusions : The infusion of artificial pleural effusion had no effect on circulatory dynamics, but transiently affected respiratory functions. It was also revealed that infusion stimulated the parasympathetic nerves

Interferon-α enhances biological defense activities against oxidative stress in cultured rat hepatocytes and hepatic stellate cells

Oxidative stress has been implicated as a cause of hepatic fibrosis, and hepatic stellate cells (HSCs), which are the most important collagen-producing cell types, have been reported to be activated by lipid peroxidation products. Antioxidant enzymes such as superoxide dismutase (SOD) and glutathione peroxidase (GPx) provide a defense system that plays a critical role in protecting the cell from free radical damage, particularly lipid peroxidation. To elucidate the antioxidant activity of interferon-α (IFN-α), the effects of IFN-α on rat hepatocytes undergoing oxidative stress and HSCs in primary culture as well as isolated rat liver mitochondria were examined. IFN-α was observed to dose-dependently increase the immunoreactive protein levels of copper, zinc-and manganese-dependent SOD as well as the enzyme activities of GPx, and decrease the lipid peroxidation product levels and oxidative burst both in stressed hepatocytes and activated HSCs GPx activities, however, were not detected in the latter cells. IFN-α also inhibited HSC activation and lipid peroxidation in liver mitochondria. These findings suggest that IFN-α may enhance biological defense activities against oxidative stress and function as a potent fibrosuppressant by protecting hepatocytes and hepatic stellate cells from lipid peroxidation in vivo

Opposing effects of estradiol and progesterone on the oxidative stress-induced production of chemokine and proinflammatory cytokines in murine peritoneal macrophages

In inflammatory and oxidative liver injury, virus proteins and reactive oxygen species are involved in the regulation of proinflammatory cytokine production by macrophages. This study investigated the effects of estradiol (E2) and progesterone on the unstimulated and oxidative stress-stimulated production of tumor necrosis factor (TNF)-α, interleukin (IL)-1β, macrophage inflammatory protein (MIP)-2, and macrophage chemotactic protein (MCP)-1 by peritoneal macrophages isolated from male and female mice. E2 inhibited the cytokine production of TNF-α, IL-1β, MIP-2, and MCP-1 by the unstimulated macrophages from males and females, which was then further stimulated by progesterone. The exposure to hydrogen peroxide in the macrophages from both sexes induced the production of cytokine. The hydrogen peroxide-stimulated cytokine production was suppressed by E2 and enhanced by progesterone. The sex hormone effects on the unstimulated and stimulated macrophages were blocked by their receptor antagonists and showed no significant difference between male and female subjects. These findings suggest that E2 may play a favorable role in the course of persistent liver injury, by inhibiting proinflammatory cytokine production, which, in addition, progesterone may counteract the favorable E2 effects through their receptors

コウド シンコウ カンサイボウ ガン ニ タイスル ホウシャセン ヘイヨウ ドウチュウ カガク リョウホウ ノ ユウヨウセイ

OBJECTIVE : The purpose of this study is to assess the treatment outcomes and adverse effects of concurrent chemotherapy and radiotherapy for hepatocellular carcinoma with portal vein tumor thrombus. METHODS : Twelve unresectable hepatocellular carcinoma patients with portal vein tumor thrombosis were treated using concurrent chemotherapy and radiation therapy. Four patients received transcatheter arterial chemoembolization using miriplatin-lipiodol suspension. Eight patients received interferon-α (IFN) and 5‐fluorouracil (5‐FU) combination therapy. The total radiation dose was 30‐50Gy. The response rate and overall survival and the toxicity were analyzed. RESULTS : Concurrent chemotherapy and radiotherapy was associated with a 50.0% objective response rate for primary tumors (miriplatin-lipiodol : 50.0%, IFN‐5FU : 50.0%). And a 66.7% objective response rate for portal vein tumor thrombus (miriplatin-lipiodol : 75.0%, IFN‐5FU : 62.5%). The median survival was 273 days (miriplatin-lipiodol : 273 days, IFN‐5FU : 262 days). Myelosuppression was observed in two patients, but no treatment-related deaths were observed. CONCLUSIONS : The present results suggest concurrent chemotherapy and radiotherapy is a practical and safe treatment option in hepatocellular carcinoma patients with extensive portal vein tumor thrombus

トウカ ニオケル ラジオハ ショウシャク リョウホウ オ モチイタ カンシュヨウ チリョウ : preliminary report

Radiofrequency ablation (RFA) has recently been used to treat liver tumors. RFA is a safe and effective treatment of liver tumors and requires fewer treatment sessions. Between June 2000 and April 2003, hepatocellular carcinoma (77 patients with 106 lesions) and metastatic liver tumors (21 patients with 30 lesions) and cholangiocellular carcinoma (1 patient with 1 lesion) were treated with RFA. The liver tumors were treated percutaneously or during surgery under ultrasound guidance using a LeVeen needle (55 lesions) and cool tip RF needle (82 lesions). To evaluate the response, contrast-enhanced CT scans or MRI were obtained. Most patients experienced moderate pain during RFA procedure, especially when the tumor was superficially located. Complete necrosis was achieved in all HCCs with RFA.This result was obtained with an average of 1.12 sessions per HCC. With a median follow-up of 15 months, HCCs have recurred in 6 of 90 treated lesions (6.7%), and metastatic liver tumors have recurred in 2 of 17 treated lesions (11.8%). We are initiating a combining RFA of hepatic malignancies with regional or systemic chemotherapy will reduce hepatic and extrahepatic recurrence rates and enhance long-term survival rates. We believe that RFA will be effective treatment to achieve in patients with unresectable meastatic liver tumors