Percutaneous Radiofrequency Assisted Liver Partition with Portal Vein Embolization for Staged Hepatectomy (PRALPPS)

BACKGROUND: When a major hepatic resection is necessary, sometimes the future liver remnant is not enough to maintain sufficient liver function and patients are more likely to develop liver failure after surgery. AIM: To test the hypothesis that performing a percutaneous radiofrecuency liver partition plus percutaneous portal vein embolization (PRALPPS) for stage hepatectomy in pigs is feasible. METHODS: Four pigs (Sus scrofa domesticus) both sexes with weights between 25 to 35 kg underwent percutaneous portal vein embolization with coils of the left portal vein. By contrasted CT, the difference between the liver parenchyma corresponding to the embolized zone and the normal one was identified. Immediately, using the fusion of images between ultrasound and CT as a guide, radiofrequency needles were placed percutaneouslyand then ablated until the liver partition was complete. Finally, hepatectomy was completed with a laparoscopic approach. RESULTS: All animals have survived the procedures, with no reported complications. The successful portal embolization process was confirmed both by portography and CT. In the macroscopic analysis of the pieces, the depth of the ablation was analyzed. The hepatic hilum was respected. On the other hand, the correct position of the embolization material on the left portal vein could be also observed. CONCLUSION: "Percutaneous radiofrequency assisted liver partition with portal vein embolization" (PRALLPS) is a feasible procedure (AU)

Associations between thrombophilic risk factors and determinants of atherosclerosis and inflammation in patients with non-arteritic anterior ischaemic optic neuropathy.

UNLABELLED: Non-arteritic anterior ischaemic optic neuropathy (NAION) is caused by ischaemia of the optic nerve head. The pathophysiology of NAION is unclear, and no proven effective treatment exists. PATIENTS, METHODS: We analyzed thrombophilic risk factors and determinants of atherosclerosis and inflammation in 109 consecutive patients and 109 age- and sex-matched volunteers using a case-control design. RESULTS: High levels of fibrinogen (>384 mg/dl; OR 3.2, p = 0.003), factors VIII:C (>183%; OR 2.6, p = 0.02), IX (>153%; OR 2.6, p = 0.026), XI (>142%; OR 3.4, p = 0.006), von Willebrand factor (activity >205%; OR 3.1, p = 0.005; antigen >194%; OR 3.5, p = 0.002), and triglycerides (>228 mg/dl; OR 2.8, p = 0.026), higher platelet counts (>294,000/µl; OR 2.5, p = 0.04), low levels of HDL cholesterol (<40 mg/dl; OR 2.7, p = 0.032), and an accelerated erythrocyte sedimentation rate (>20 mm/h; OR 4.4, p = 0.003) were associated with NAION. CONCLUSION: Our findings support the contention of a complex pathogenesis of NAION resulting from the coincidence of proatherogenic, prothrombotic and proinflammatory processes. The alterations described could be causative, side effects, or just coincidental findings.

Computed tomography assessment of lung volume changes after bronchial valve treatment.

The aim of the present study was to correlate clinical outcome measures following treatment with bronchial valves with regional lung volume. Computed tomography (CT) scan data from 57 subjects with severe emphysema were obtained from nine North American clinical trial sites. IBV(R) Valves (Spiration, Inc., Redmond, WA, USA) were placed to occlude segmental and subsegmental bronchi in right and left upper lobes using a flexible bronchoscope. Subjects completed a St George's Respiratory Questionnaire (SGRQ), pulmonary function test (PFT) and exercise capacity test. CT scans were analysed at baseline and at 1, 3 or 6 months after treatment to measure total and lobar lung density, volume and mass. Total lung volumes measured using CT were strongly correlated with PFT and did not change with treatment. However, the treated upper lobes significantly decreased in volume in 88% of the observations, by mean+/-sd 335+/-444 mL, or a decrease of 10.2% in the 6 month data. The untreated lobes had an 11.6% increase in volume. Changes in regional lung volume were associated with clinically meaningful improvements in SGRQ (-8.95+/-16.22), but not clinically meaningful PFT changes. The significant health status improvements reported by subjects following bilateral bronchial valve treatment are associated with regional lung volume changes and interlobar shift measured using computed tomography.

Moyamoya disease associated with renovascular disease in a young African-Brazilian patient.

Moyamoya is a rare disease characterized by fibrous dysplasia of the internal carotid and proximal cerebral arteries, which has been described mainly in young Japanese. We present a case of Moyamoya disease with renal artery involvement in a young male patient with an African origin. A 15-year-old boy was referred to our hospital due to uncontrolled blood pressure, headache, somnolence, cognitive deficit and multiple lacunar infarcts in the computed tomography. Cerebral arteriography showed the absence of the normal vascular anatomy at the level of the circle of Willis. The intracranial vessels presented severe stenosis or were occluded and replaced by an extensive network of ectasic collateral vessels. Abdominal ultrasound examination identified asymmetric kidneys, and renal arteriography showed a tight stenosis of the ostium and proximal segment of right main artery, which was only partially relieved by balloon angioplasty. A saphenous bypass from aorta to the right renal artery re-established the renal blood flow. Blood pressure dropped after surgery and was controlled with low doses of diuretic and beta-blocker. After arteriography he presented right hemiplegia, with partial recovering in the following months. In conclusion, we described the first case of Moyamoya disease with concomitant renovascular disease in a young adult of African origin, an association that may be more frequent than usually suspected in clinical practice.

[Managed care--a possibility for German Health Insurance?]. / Managed care--eine Perspektive für die GKV?

Health services systems in nearly all developed countries face similar problems. This fact raises the question whether concepts used in different countries can be changed without affecting the historically grown foundations of national health services as have been accepted by majority. A group of experts of the German Medical Services of the Statutory Health Insurance were asked to analyse whether the managed care approach could play a substantial role in reforming the German "Bismarck model", given that the advisory responsibility of the social medical service for the sick funds is respected in such a consideration and that basic essentials of the system are maintained. The group concludes, in brief, that managed care and the "German model" are contradictory in respect of preconditions, aims and assumed results. Furthermore, the experts share the view that the "German model" incorporates sufficient to cope with its problems without changing the nature of health services, based on principles of solidarity in Germany. The system needs structural reforms rather than changes in monetary mechanisms.

[Clinical follow-up studies on the prognostic significance of immunohistochemical estrogen receptor determination of breast cancer]. / Klinische Verlaufsuntersuchungen zur prognostischen Bedeutung der immunhistochemischen Ostrogenrezeptorbestimmung am Mammakarzinom (ER-ICA).

We investigated the oestrogen-receptor content (ER-ICA) of 614 tissue samples taken from breast carcinomas (all obtained from patients at the Universitäts-Frauenklinik, Mainz FRG) using immunohistochemical procedures. Since the findings of follow-up studies as well as estimates of survival probability (according to the procedure of Kaplan-Meier) for 334 of the primary breast carcinomas were available, it was possible, to assess the prognostic value of the immunohistochemical results. The percentage of receptor-positive tumour cell nuclei (i.e. the heterogeneity of the tumour), as opposed to the staining intensity, proved to be the most useful criterion of the IRS, whose cut off level was determined as being IRS 1. Regardless of their lymph node status, mammary carcinomas which were immunohistochemically positive for estrogen receptors, were found to have a significantly better short-term prognosis, than breast tumours which were negative for such receptors. In the case of certain breast carcinomas exhibiting contradictory findings (i.e. ER-ICA positive but biochemically negative for oestrogen receptors), the present immunohistochemical method provided the most accurate assessment of the biological behaviour and development of the tumor. Therefore, ER-ICA represents a valuable prognostic criterion, which when complemented with PR-ICA, should facilitate attaining optimal selection of patients suitable for endocrine therapy.

[Recommendation for standardized selection of sociomedical (insurance medical) assessment of work disability]. / Vorschlag für eine standardisierte Auswahl zur sozialmedizinischen (vertrauensärztlichen) Begutachtung bei Arbeitsunfähigkeit.

Two study populations were examined, one for obtaining a frequency distribution of incapacity for work periods, the other for tracing the qualitative aspects of incapacity for work cases. Quantitative appraisal showed that 16% of all cases accounted for 49% of total incapacity time. Qualitative (microanalytic) appraisal of these 16% traced but a few disease groups responsible, amply dealt with in literature on chronic conditions. A shortcoming of apparently rather minor relevance in the individual case, has moreover been found to be systematic: prolonged incapacity for work periods inadequately explained by the diagnoses given on the incapacity certificate. Not least for this reason, appraisal by the insurance medical examination service should occur after three months at the latest. The criteria for initial selection are outlined in terms of three months incapacity for work, frequent recurrence of incapacity periods, and a catalogue of a few diagnostic groups.