Stereotactic body radiation therapy for early-stage hepatocellular carcinoma - a systematic review on outcome.

Background: Hepatocellular carcinoma (HCC) incidence is rising worldwide, especially due to increased detection of early-stage or small-sized tumors. Nevertheless, most of the patients are still not qualified for surgical resection at diagnosis due to the localization of the tumor, underlying liver disease or comorbidities. Stereotactic body radiation therapy (SBRT) is a radiotherapy modality which can deliver a high dose of radiation to the target tissue with a high degree of precision. It shows promise in terms of efficacy and morbidity.Material and methods: The aim of this systematic review is to summarize current knowledge on patient-specific outcomes of SBRT for small HCC including overall survival, local control, the effect of dose escalation and the toxicity of the treatment. The systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). After a comprehensive database search, 16 studies (973 patients with 1034 lesions) were included in qualitative and quantitative analyses; 14 of them were retrospective.Results: Average tumor diameter was 23 mm and 95% of patients were in good general condition. Median BED10 (biologically equivalent dose calculated for α/ß ratio of 10 Gy) was 100 Gy (range 59.5-180 Gy). Mean weighted local control across studies was 94%, 92% and 93% at 1, 2, and 3 years, respectively. Mean weighted overall survival across studies was 90.9%, 67.5% and 73.4% at 1, 2, and 3 years, respectively. There were 171 grade 1-2 toxicities (17.5%) and 53 ≥ grade 3 toxicities (5.3%). There was no treatment-associated mortality.Conclusion: SBRT offers high local control with overall survival that is comparable with radiofrequency ablation and surgery. Quality of findings, especially on toxicities, is decreased by incomplete reporting and retrospective designs of published studies. Therefore, there is a need for better reporting and prospective studies to univocally recommend SBRT as a definitive treatment option in the guidelines for small HCCs.

Eptifibatide infusion versus placebo in high risk patients with non-st segment elevation acute coronary syndromes managed with urgent coronary artery bypass graft surgery. a prospective multicenter randomized placebo-controlled clinical trial.

AIM: This randomized prospective clinical trial aimed to evaluate safety and efficacy of preoperative use of eptifibatide in high risk patients with non--ST--segment elevation acute coronary syndrome (NSTE--ACS), requiring urgent coronary artery bypass graft surgery (CABG). METHODS: A total of 140 patients with NSTE--ACS eligible for urgent surgical revascularization received either eptifibatide (bolus plus infusion) 12--48 hours prior to surgery (n=72 patients) or placebo (normal saline; n=68 patients) followed by routinely administered enoxaparin and aspirin. Patients were regarded as unsuitable for percutaneous coronary intervention by the heart team. CABG was performed 4 hours after discontinuation of eptifibatide or placebo infusion. The primary end point was major adverse cardiac and cerebrovascular events (MACCE) defined as death, nonfatal myocardial infarction (MI), stroke and the need for re--hospitalization due to recurrent ischaemia at 12 months follow--up. Secondary endpoints included MACCE rate at 1 month, bleeding complications, platelet inhibition efficacy and correlation of platelet activity with MACCE rate. RESULTS: Cumulative one year MACCE rate was 35% vs 14% in the control and treated group respectively (p=0.012). Mortality rate at 30 days follow--up was 10% vs 3% (p=0.021) and was not changed at 12 months follow--up. There was a significant difference between both groups regarding perioperative MI (22% vs. 8%, p=0.03). The rates of stroke, blood loss and blood transfusion were similar in both groups. CONCLUSION: Preoperative use of eptifibatide vs. placebo is linked to significantly reduced 12--month MACCE rate in patients with NSTE--ACS requiring urgent CABG, while it simultaneously seems not to confer a greater risk of postoperative bleeding.

Thermopower, figure of merit and spin-transfer torque induced by the temperature gradient in planar tunnel junctions.

The thermopower, charge and thermal conductance, and figure of merit as well as the spin-transfer torque generated by the temperature gradient in the planar tunnel junction consisting of ferromagnetic layers and the nonmagnetic tunnel barrier are investigated in the free-electron-like spin-polarized one-band model. In particular, the influence of the parameters of the junction as well as the influence of the relative orientation of magnetic moments on the studied phenomena are investigated. The thermopower can be related to the voltage drop generated by the temperature difference between electrodes under the condition that the charge current vanishes. It depends on the magnetic configuration of the junction. In junctions with high barriers the thermopower is maximal in the antiparallel configuration and it can be enhanced in junctions with strong spin-splitting of the electron bands. The component of the torque studied in the present paper is oriented in the plane formed by magnetic moments and it appears in the absence of the bias voltage. Its magnitude is insensitive to the sign of the temperature difference in contrast to the bias-induced in-plane torque which strongly depends on the polarization of the bias. The studied torque is usually smaller than the torque generated by the bias: however, it can be significant in junctions with low barriers.

Evaluation of early corneal endothelial cell loss in bimanual microincision cataract surgery (MICS) in comparison with standard phacoemulsification.

PURPOSE: To analyze early corneal endothelial cell loss due to microincision cataract surgery (MICS) in comparison with standard phacoemulsification through the temporal clear corneal incision. METHODS: The examined group consisted of a nonrandomized, consecutive prospective series of 20 eyes of 20 patients who underwent uneventful microincision cataract surgery. Twenty eyes of 20 patients who underwent standard phacoemulsification with foldable intraocular lens (IOL) implantation served as a reference group. Patients with corneal disorders, contact lens wear, previous intraocular surgery, and a history of ocular trauma were excluded from the study. Patients were examined preoperatively and 10 days postoperatively. The following items were evaluated in this study: corneal endothelial cell density, intraoperative phaco power, effective phaco time, as well as pre- and postoperative visual acuity. Corneal endothelial cell counts were done in the central part of the cornea using a non-contact Topcon SP 2000P specular microscope before and 10 days after the surgery. The measurements were performed in a semiautomated, masked manner. Statistical analysis was done using nonparametric tests (Wilcoxon signed-ranks test and Mann-Whitney U test). RESULTS: All patients in the study underwent uneventful surgery. Best-corrected visual acuity (BCVA) examined 10 days postoperatively in the MICS group was 0.94+/-0.094, whereas in the standard phacoemulsification group it was 0.90+/-0.094. There was no significant difference between BCVA in the two groups (Mann Whitney U two-tailed test: p>0.05). In both groups there was a significant decrease in postoperative endothelial cell densities (ECDs) when compared to preoperative values. Mean postoperative ECDs were 2235+/-418 cells/mm2 in the MICS group and 2079+/-399 cells/mm2 in the standard phacoemulsification group; the difference was not statistically significant (Mann-Whitney U test: p>0.05). Patients in the MICS group lost an average of 9.5% of cells, whereas patients after standard phacoemulsification lost about 7.6% of cells. This difference was statistically insignificant. CONCLUSIONS: Microincision cataract surgery induced corneal endothelial cell loss similar to a standard phacoemulsification and allowed excellent visual results in this series of patients. These results support the use of MICS technique for cataract surgery.

[The influence of organic myocardial damage on parameters of signal-averaged electrocardiogram in patients with electrically-induced atrial fibrillation]. / Wplyw organicznego uszkodzenia serca na parametry usrednionego sygnalu przedsionkowego u chorych z wystymulowanym migotaniem przedsionków.

The aim of this study was to assess the effects of myocardium organic damage on time-domain parameters of atrial signal-averaged ECG (ASAECG) in patients with electrically induced paroxysmal atrial fibrillation (PAF). The investigation was done in 120 patients with subjective symptoms of cardiac rhythm disorders suggesting atrial fibrillation and for further analysis were selected 51 patients in whom atrial PAF was induced during transoesophageal pacing (TEP). Patients were divided according to organic damage of myocardium-38 pts (24 male and 14 female, mean age 52.1 +/- 11.6-group I) and without-13 pts (9 male and 4 female, mean age 35.4 +/- 9.9 -group II). In all two dimensional echocardiographic examination, 24-hours Holter monitoring, exercise testing and TEP were made. Recording of ASAECG was done with a commercially available system HIPEC-200 HA Aerotel. The following time-domain parameters of ASAECG were calculated: the root mean square voltage of the terminal 10, 20, 30 ms of the filtered P-wave (RMS 10, 20, 30) and time duration of filtered P-wave (PWD) and also time duration of P-wave from Frank's leads X, Y, Z (XP, YP, ZP). Atrial late potentials (ALP) were defined as the presence of two parameters: RMS 10 < 4 microV and PWD > 123 ms. If we compared time-domain parameters of ASAECG between examined groups it occurred that only the values of PWD attained statistically significant differences, respectively 123.3 +/- 15.4 ms vs 115 +/- 11.2 ms, p < 0.05. In 14 (36.8%) patients from first group and in 2 (15.4%) patients from second ALP were confirmed. We concluded that presence of myocardium organic damage have essentially influenced on time duration of filtered P-wave.

Three-dimensional computed tomography imaging in the evaluation of craniofacial abnormalities.

A retrospective study was undertaken to assess the value of three-dimensional computed tomography (3-D CT) in evaluating craniofacial abnormalities. Over a 2-year period, 145 children evaluated with routine two-dimensional (2-D) CT had 3-D CT reformatted images assessing a variety of anomalies including craniosynostosis, midface clefts, trauma, and craniofacial syndromes. There were 62 females and 83 males ranging in age from 1 month to 17 years (median: 5 months). Both soft-tissue and bone algorithms were used. In all 145 cases, the 3-D CT images confirmed or provided additional information of depth perception, contours, volumes, and extent of an abnormality. This was especially important and useful in the settings of complex anomalies and preoperative planning. We concluded that 3-D CT reconstructed images in conjunction with routine 2-D CT should be an integral part of the examination in evaluating craniofacial abnormalities.

The clinical and radiological evaluation of primary brain neoplasms in children, Part II: Radiological evaluation.

Data collected over the past 8 years on the radiological appearance of common pediatric primary brain neoplasms are presented. An emphasis is placed on the newer radiological imaging modality of magnetic resonance imaging (MRI). Part I of this article emphasized the clinical evaluation of these brain neoplasms. Three hundred eighty-five children with known brain neoplasms ranging in age from newborn to 18 years were evaluated with one or all of the following radiological modalities: MRI, computed tomography (CT), water-soluble myelography (WSM), WSM with CT, and angiography. Contrast-enhanced MRI and CT scans both were accurate in delineating these brain neoplasms although MRI provided better resolution and delineation than CT. Angiography provided information on the vascularity of the neoplasms and their relationship to prominent arterial and venous structures. Water-soluble myelography with CT and gadolinium-enhanced MRI of the spine were equally accurate in demonstrating metastatic spread to the spinal canal and spinal cord. Magnetic resonance imaging with gadolinium was more accurate than CT with contrast in demonstrating recurrent or residual neoplasm at the operative site and metastatic spread to the brain. Magnetic resonance imaging with gadolinium is the best radiological modality to fully evaluate pediatric brain neoplasms.

The clinical and radiological evaluation of primary brain tumors in children, Part I: Clinical evaluation.

In Part I of this article, we present our data collected over the past 8 years on the clinical evaluations of pediatric brain tumors with an emphasis placed on the more common neoplasms. Our data consists of 385 children ranging in age from newborn to 18 years. The majority of children presented with signs of raised intracranial pressure (including nausea, vomiting, and headaches), seizures or other focal neurologic deficits. Five percent of our children presented to outlying hospitals with symptoms that retrospectively turned out to be due to brain neoplasms but were misdiagnosed as "gastroenteritis," "viral upper respiratory tract infection," or even viral meningitis. These delays in diagnosis can cause serious negative outcomes for these patients and can be avoided through more careful neurologic and ophthalmologic examination at the time of first presentation. Central nervous system neoplasms are not uncommon in children and any child presenting with nausea, vomiting, and headaches should raise the suspicion of a primary brain tumor and should receive both a thorough neurologic exam and screening for papilledema. If papilledema is present, these children should be referred for proper neuroradiologic evaluation (which will be addressed in Part II.

Magnetic resonance imaging of the central nervous system in children with a new nonionic gadolinium contrast agent--gadoteridol injection (ProHance).

This article reports the results of clinical testing in pediatric patients of a new contrast agent, gadoteridol injection (ProHance), developed by Squibb Diagnostic as a nonionic gadolinium agent for use in magnetic resonance imaging (MRI). Thirteen children (four girls and nine boys) ranging in age from 10 to 18 years were enrolled in the study. The children had MR studies of the brain and/or spine with T1-weighted, T2-weighted, and postgadoteridol injection T1-weighted sequences. Five children had primary brain or spine neoplasms, three children had metastatic disease to the central nervous system, one child had a recurrent brain neoplasm and spinal canal metastasis, one child had an arteriovenous malformation, and two children were normal on the MRI studies. No minor or major reactions to gadoteridol injection developed in the 13 patients. Gadoteridol injection provided excellent delineation and enhancement of the arteriovenous malformation and all of the primary and secondary neoplasms of the central nervous system except for one case of a grade 1 glioma of the midbrain. Gadoteridol injection is a safe and excellent contrast agent for use in MRI.

Mirizzi syndrome (hepatic duct obstruction).

The Mirizzi syndrome is an uncommon cause of obstructive jaundice. In 1948, Mirizzi characterized a syndrome in which common hepatic duct obstruction occurs because of impacted stones in the gallbladder neck or cystic duct. The authors report a case demonstrating this syndrome. They discuss the radiographic features and report the features found on a computed tomographic cholangiogram that have not been previously described. Computed tomography-cholangiography may be helpful in evaluating patients with suspected Mirizzi syndrome.

Imaging modalities for the pediatric spine.

The role of MR imaging is emphasized in the evaluation of paraspinal and intraspinal soft tissue abnormalities. The technical aspects in performing a high-resolution MR image of the pediatric spine in reference to imaging parameters, sedation protocol, and the use of intravenous gadolinium are detailed. The changes in the normal pediatric spine on MR imaging are demonstrated. The diagnosis and evaluation of specific intraspinal and paraspinal neoplastic disorders in infants and children are outlined in terms of their clinical presentation and MR characteristics.

[Personal observations with application of auto-oxygenation techniques in the surgical management of coronary disease]. / Doswiadczenia wlasne z zastosowaniem techniki autooksygenacji w chirurgicznym leczeniu choroby wiencowej.

There were presented operative technique and clinical results of extracorporeal circulation (ECG) with patients lungs utilization, instead of routinely applied artificial blood oxygenators. Auto-oxygenation method was applied in 12 patients with coronary artery disease treated by coronary artery bypass grafting (CABG). Operative procedure differs from the traditional one in two additional cannulations of pulmonary artery and left atrium. Two peristaltic pumps and incorporated in circulation blood reservoirs. Polystan 892910 allows for temporary substitution of cardiac function without lung disconnection. Lungs functioning during surgery do not render it difficult. Hypothermia enables to decrease respiration rate and tidal volume with no effect on physiological blood oxygenation and CO2 exhalation. Method assessment was based on results comparison with those obtained in patients treated by traditional method using bubble oxygenators-Venotherm 5,000. PO2, PCO2, platelets number and hemolysis extent were assessed before, in 10, 30, 60 min of ECG and just after it. Platelets activity and influence of the method on hemostatic disorders were evaluated based on clotting time by Ivy. Additionally hemostatic disorders were assessed by thoracic blood drainage volume calculated from the moment of protamine administration to drainage tubes withdrawal in average 18 hours after surgery. Laboratory parameters characteristically changing during ECG were also estimated. It was proved, that auto-oxygenation diminished negative effects of ECG. Increased platelets number, faster normalization of clotting time and decreased postoperative drainage were stated in the auto-oxygenation group. Postoperative drainage in this group was 260 +/- 60 ml in comparison with 800 +/- 100 ml of the control group. Authors consider that pulmonary function remaining during ECG positively affects on postoperative hemostasis. This method can be helpful in surgical management of coronary artery disease, especially in patients with primary coagulation disorders.

[The dynamics of the immunocytoadherence test with Trichinella spiralis-antigen in the experimental rabbit trichinellosis (author's transl)]. / Die Dynamik des Immunozytoadherenztestes mit dem Trichinella spiralis-Antigen im Verlauf der experimentellen Trichinellose beim Kaninchen.

The authors analysed the dynamics of the immunozytoadherence test in experimental trichinellosis. The evaluation was carried out by mixing the lymphocytes of the infected rabbits with sheep erythrocytes encoated with antigen Trichinella spiralis. In three groups of infected rabbits (group I - 15 000 larves per rabbit, group II - 20 000 larves per rabbit, group III - 30 000 larves per rabbit) the examinations were performed 3, 6, 10, 20, 47, 82, 110, 140, 170 and 230 days after infection. It was observed that the maximum percentage of rosette occurred 10 days after infection. In the course of the observation the percentage demonstrated a tendency to decrease. The observed dynamics of the immunozytoadherence test indicates its value in diagnostic and prognostic evaluation of trichinellosis.