Hepatocellular carcinoma in otherwise sonographically normal liver.

PURPOSE: Hepatocellular carcinoma (HCC) on normal liver is very rare. The goal of this study was to determine the clinical manifestations and the role of ultrasonography (US) in the diagnosis of HCC arising in normal liver. METHODS: The clinical data and US findings in 12 cases of surgically resected HCC in normal liver were retrospectively analyzed. RESULTS: The patients were asymptomatic, had no hepatocarcinogenic factor, and hepatic function tests were almost normal in most cases. HCCs were large, encapsulated, and solitary, and there were predominantly well-differentiated or moderately differentiated in most cases. US showed a hypoechoic rim and lateral shadowing, suggestive of peritumoral capsule formation, and on contrast-enhanced US (CEUS), the tumor was hyperenhanced in arterial phase and washed out in postvascular phase, revealing typical HCC findings. CONCLUSIONS: US raises suspicion of HCC by showing lateral shadowing on grayscale ultrasound and hypervascularity on CEUS of the lesion.

Oral malodorous compound activates mitochondrial pathway inducing apoptosis in human gingival fibroblasts.

Hydrogen sulfide (H(2)S) is a main cause of physiologic halitosis. H(2)S induces apoptosis in human gingival cells, which may play an important role in periodontal pathology. Recently, it has been reported that H(2)S induced apoptosis and DNA damage in human gingival fibroblasts (HGFs) by increasing the levels of reactive oxygen species. However, the mechanisms of H(2)S-induced apoptosis have not been clarified in HGFs. The objective of this study was to determine the apoptotic pathway activated by H(2)S in HGFs. The HGFs were exposed to 50 ng/mL H(2)S, resulting in 18 ng/mL in the culture medium, which is lower than the concentration in periodontal pockets. The number of apoptotic cells after 24 and 48 h incubation was significantly higher than that in the control cultures (p < 0.05). Mitochondrial membrane depolarization and the release of cytochrome c, and caspase-3, and caspase-9 were also significantly increased after both 24- and 48-h incubation (p < 0.05), whereas caspase-8, a key enzyme in the receptor ligand-mediated pathway causing apoptosis, was not activated. The present study shows that H(2)S triggered the mitochondrial pathway causing apoptosis in HGFs but did not activate the receptor ligand-mediated pathway.

CT features of pancreatic fistula after pancreaticoduodenectomy.

OBJECTIVE: Our objective was to establish the CT features that are indicative of pancreatic fistula after pancreaticoduodenectomy. CONCLUSION: A fluid collection seen on CT around the pancreaticojejunostomy site and in the pancreatic bed may be caused by pancreatic fistula in patients who have undergone pancreaticoduodenectomy. CT depiction of air bubbles in the fluid at these sites may strongly suggest the diagnosis of pancreatic fistula.

Efficacy and safety of hepatic artery infusion catheter placement without fixation in the right gastroepiploic artery.

PURPOSE: To evaluate the feasibility of placing the tip of an infusion catheter in the right gastroepiploic artery via the femoral route and whether coil placement in the gastroduodenal artery and around the infusion catheter tip should be performed to avoid gastroduodenal toxicity and catheter dislocation. MATERIALS AND METHODS: Seventy-eight patients (25 women and 53 men; age, 38-79 years; mean, 63 years) underwent implantation of a 5-F chemotherapeutic infusion catheter via the femoral artery, positioned so that the tip was in the right gastroepiploic artery and a side hole was in the common hepatic artery. Patients were randomly divided into two groups: group A included patients with coil placement in the gastroduodenal artery and around the infusion catheter tip and group B included patients without coil placement. RESULTS: Catheter placement via the femoral route was successful in 70 of 78 patients (90%). Mean catheter indwell durations were 250 days (range, 0-962 days) in group A (n = 35) and 230 days (range, 0-834 days) in group B (n = 43; P = .9). Complications relating to long-term catheter duration in the right gastroepiploic artery did not occur in any patient. Two patients in each group had abdominal pain during infusion chemotherapy. Endoscopy revealed acute gastric mucosal lesions. Dislocation of the catheter tip during treatment occurred in one patient in each group. CONCLUSION: Catheter placement in the right gastroepiploic artery is safe and feasible except in patients with a long and caudally oriented celiac trunk. Coil embolization of the gastroduodenal artery and around the catheter tip is unnecessary.