Combined therapy with conventional trans-arterial chemoembolization (cTACE) and microwave ablation (MWA) for hepatocellular carcinoma >3-<5 cm.

PURPOSE: To compare safety and efficacy of combined therapy with conventional transarterial chemoembolization (cTACE)+microwave ablation (MWA) versus only TACE or MWA for treatment of hepatocellular carcinoma (HCC) >3-<5 cm. METHODS: This randomized controlled trial (NCT04721470) screened 278 patients with HCC >3-<5 cm. Patients were randomized into three groups: 90 underwent TACE (Group 1); 95 underwent MWA (Group 2); and 93 underwent combined therapy (Group 3). Patients were followed-up with contrast-enhanced CT or MRI. Images were evaluated and compared for treatment response and adverse events based on modified response evaluation criteria in solid tumor. Serum alpha-fetoprotein (AFP) concentration was measured at baseline and during every follow-up visit. RESULTS: Final analysis included 265 patients (154 men, 111 women; mean age = 54.5 ± 11.8 years; range = 38-76 years). Complete response was achieved by 86.5% of patients who received combined therapy compared with 54.8% with only TACE and 56.5% with only MWA (p = 0.0002). The recurrence rate after 12 months was significantly lower in Group 3 (22.47%) than Groups 1 (60.7%) and 2 (51.1%) (p = 0.0001). The overall survival rate (three years after therapy) was significantly higher in Group 3 (69.6%) than Groups 1 (54.7%) and 2 (54.3%) (p = 0.02). The mean progression-free survival was significantly higher in Group 3 than groups 1 and 2 (p < 0.001). A decrease in AFP concentration was seen in 75%, 63%, and 48% patients of Group 3, 2, and 1, respectively. CONCLUSIONS: Combined therapy with cTACE + MWA is safe, well-tolerated, and more effective than TACE or MWA alone for treatment of HCC >3-<5 cm.

Diagnostic Performance of Multidetector Computed Tomography (MDCT) in Diagnosis of Sinus Variations.

BACKGROUND: In this prospective study, we looked for correlations between anatomic variants of paranasal sinuses and chronic or recurrent sinusitis. MATERIAL/METHODS: Two hundred and forty (240) patients with clinical features of chronic rhinosinusitis were examined; patients with first-onset or allergic sinusitis and pregnant females were excluded. Routine multi-slice CT of the paranasal sinuses was performed to look for mucosal disease of the paranasal sinuses, drainage pathways, and presence of anatomical variations and their relation to known sinus drainage pathways. RESULTS: Anatomic variations were very frequent, and we classified them into four easily recognized groups: nasal septum variations, middle turbinate variations, uncinate process variations, and ethmoidal variations. Deviated nasal septum was the most frequent variation in patients with chronic or recurrent sinusitis, and it was detected in 48.8% of cases. Agger nasi cells and concha bullosa were equally frequent (30.6%), and Haller cells were detected in 11.2%. Uncinate process variations were detected in 18.1%, and the large ethmoid bulla was detected in 10%. CONCLUSIONS: The importance of anatomic variations is that they can compromise drainage pathway of the related sinus, which results in inflammatory sinus disease. Anatomical variations are not diseases on their own and may be present as incidental findings in patient with chronic sinusitis.

Multidetector Computed Tomography (CT) in Evaluation of Congenital Cyanotic Heart Diseases.

BACKGROUND: The aim of the study is to emphasize the role of 128 MSCT angiography in the diagnosis of congenital cyanotic heart diseases. MATERIAL/METHODS: This study included sixty patients and was conducted from December 2014 to July 2016 in the Multidetector CT unit of Zagazig University hospitals. All images included axial, MPR, MIP, and VRT and were interpreted in one session. Pulmonary veins were assessed for PAPVR or TAPVR, PDA, cardiac apex and heart chambers, interatrial or interventricular septal defects, pericardium, and site and size of the great veins (IVC and SVC). RESULTS: This study included 60 patients. Thirty-four were boys (56.7%), and 26 were girls (43.3%). The age ranged from nine months to five years, and the mean age was 34.5 months. We found the following anomalies: tetralogy of Fallot (15 patients, 25%), tricuspid atresia (12 patients, 20%), Ebstein's anomaly (4 patients, 6.5%), pulmonic atresia or stenosis (7 patients, 11.5%), truncus arteriosus (6 patients, 10%), TGA (10 patients, 17%), and TAPVR (6 patients, 10%). CONCLUSIONS: MDCT proved to be an important modality for decision-making in patients with congenital cyanotic heart diseases.