Efficacy and safety of shunt surgery in patients with idiopathic normal-pressure hydrocephalus: can we predict shunt response by preoperative magnetic resonance imaging (MRI)?

AIM

The aim of this study was to identify preoperative magnetic resonance imaging (MRI) findings that can predict the shunt responsiveness in idiopathic normal-pressure hydrocephalus (iNPH) patients and to investigate postoperative outcome and complications.

MATERIALS AND METHODS

A total of 192 patients with iNPH who underwent shunt at our hospital between 2000 and 2021 were included to investigate complications. Of these, after exclusion, 127 (1-month postoperative follow-up) and 77 (1-year postoperative follow-up) patients were evaluated. The preoperative MRI features (the presence of tightness of the high-convexity subarachnoid space, Sylvian fissure enlargement, Evans' index, and callosal angle) of the shunt-response and nonresponse groups were compared, and a systematic review was conducted to evaluate whether preoperative MRI findings could predict shunt response.

RESULTS

Postoperative complications within one month after surgery were observed in 6.8% (13/192), and the most common complication was hemorrhage. Changes in corpus callosum were observed in 4.2% (8/192). The shunt-response rates were 83.5% (106/127) in the 1-month follow-up group and 70.1% (54/77) in 1-year follow-up group. In the logistic regression analysis, only Evans' index measuring >0.4 had a significant negative relationship with shunt response at 1-month follow-up; however, no significant relationship was observed at 1-year follow-up. According to our systematic review, it is still controversial whether preoperative MRI findings could predict shunt response.

CONCLUSION

Evans' index measure of >0.4 had a significant relationship with the shunt response in the 1-month follow-up group. In systematic reviews, there is ongoing debate about whether preoperative MRI findings can accurately predict responses to shunt surgery. Postoperative corpus callosal change was observed in 4.2% of iNPH patients.

Compositionally Sequenced Interfacial Layers for High-Energy Li-Metal Batteries

Electrolyte additives with multiple functions enable the interfacial engineering of Li-metal batteries (LMBs). Owing to their unique reduction behavior, additives exhibit a high potential for electrode surface modification that increases the reversibility of Li-metal anodes by enabling the development of a hierarchical solid electrolyte interphase (SEI). This study confirms that an adequately designed SEI facilitates the homogeneous supply of Li+ , nonlocalized Li deposition, and low electrolyte degradation in LMBs while enduring the volume fluctuation of Li-metal anodes on cycling. An in-depth analysis of interfacial engineering mechanisms reveals that multilayered SEI structures comprising mechanically robust LiF-rich species, electron-rich P-O species, and elastic polymeric species enabled the stable charge and discharge of LMBs. The polymeric outer SEI layer in the as-fabricated multilayered SEI could accommodate the volume fluctuation of Li-metal anodes, significantly enhancing the cycling stability Li||LiNi0.8 Co0.1 Mn0.1 O2 full cells with an electrolyte amount of 3.6 g Ah-1 and an areal capacity of 3.2 mAh cm-2 . Therefore, this study confirms the ability of interfacial layers formed by electrolyte additives and fluorinated solvents to advance the performance of LMBs and can open new frontiers in the fabrication of high-performance LMBs through electrolyte-formulation engineering.

Phase II study of a trastuzumab biosimilar in combination with paclitaxel for HER2-positive recurrent or metastatic urothelial carcinoma: KCSG GU18-18

BACKGROUND

Human epidermal growth factor receptor 2 (HER2) is a widely explored therapeutic target in solid tumors. We evaluated the efficacy and safety of trastuzumab-pkrb, a biosimilar of trastuzumab, in combination with paclitaxel, in HER2-positive recurrent or metastatic urothelial carcinoma (UC).

PATIENTS AND METHODS

We enrolled 27 patients; they were administered a loading dose of 8 mg/kg trastuzumab-pkrb on day 1, followed by 6 mg/kg and 175 mg/m2 paclitaxel on day 1 every 3 weeks, intravenously. All patients received six cycles of the combination treatment and continued to receive trastuzumab-pkrb maintenance until disease progression, unacceptable toxicity, or for up to 2 years. HER2 positivity (based on immunohistochemistry analysis) was determined according to the 2013 American Society of Clinical Oncology /College of American Pathologists HER2 testing guidelines. The primary endpoint was objective response rate (ORR); the secondary endpoints were overall survival (OS), progression-free survival (PFS), and safety.

RESULTS

Twenty-six patients were evaluated via primary endpoint analysis. The ORR was 48.1% (1 complete and 12 partial responses) and the duration of response was 6.9 months [95% confidence interval (CI) 4.4-9.3 months]. With a median follow-up of 10.5 months, the median PFS and OS were 8.4 months (95% CI 6.2-8.8 months) and 13.5 months (95% CI 9.8 months-not reached), respectively. The most common treatment-related adverse event (TRAE) of any grade was peripheral neuropathy (88.9%). The most common grade 3/4 TRAEs were neutropenia (25.9%), thrombocytopenia (7.4%), and anemia (7.4%).

CONCLUSIONS

Trastuzumab-pkrb plus paclitaxel demonstrates promising efficacy with manageable toxicity profiles in patients with HER2-positive recurrent or metastatic UC.

Direct thermal injury to the popliteal artery after total knee arthroplasty

Vascular damage after total knee arthroplasty is rare. However, delayed diagnosis and management may cause adverse outcomes for patients. In particular, direct thermal injury to the popliteal artery after total knee arthroplasty is extremely rare. A 74-year-old woman presented to another institution with a left popliteal artery injury after left total knee arthroplasty. Arteriography revealed total occlusion of the popliteal artery, and emergency surgery was performed. Because of the total occlusion of the popliteal artery due to severe direct thermal injury, anastomosis was performed in an end-to-end fashion with a right great saphenous vein graft. At the time of discharge, she had no specific symptoms other than pain at the surgical site, with a palpable left dorsalis pedis pulse. While performing total knee arthroplasty, the anatomical position of the popliteal artery should be carefully considered to prevent injury.

Early mortality and complications associated with catheter ablation of atrial fibrillation: analysis of the entire procedure in Korea from 2007 to 2016

Funding Acknowledgements

Type of funding sources: None.

Background

There is limited data regarding the early mortality and adverse outcomes from catheter ablation of atrial fibrillation (AF) in Korea. The aim of this study was to examine the early mortality and frequency of adverse outcomes associated with AF catheter ablation from 2006 to 2016 in Korea.

Methods

From 2006 to 2016 in the Korean National Health Insurance Service database, 11,893 individuals underwent catheter ablation for AF. We investigated the frequency of complications and early mortality associated with AF ablation and comorbidities that led to adverse outcomes after AF ablation.

Results

Out of all 11,893 procedures, early mortality occurred in 38 cases (0.32%). Annual trends in AF procedural complications occurring during index admission for AF ablation decreased from 9.25% in 2006 to 6.49% in 2016 (P for trend = 0.004). The early mortality rate after AF ablation had remained unchanged between 2006 and 2016. After adjustment for age, comorbidities, and medication, procedural complications (adjusted odds ratio[aOR]: 16.1; P < 0.001), age (aOR: 1.25; P = 0.024), history of hemorrhagic stroke (aOR: 4.74; P = 0.019), and less experience with AF ablation of the hospital (aOR: 2.85; P = 0.024) were associated with early mortality. Among procedural complications, atrioesophageal fistula (aOR: 199.8; P < 0.001), access site complications (aOR: 6.08; P = 0.005), complete heart block (aOR: 11.3; P = 0.029), pneumothorax (aOR: 62.0; P < 0.001), and procedure related pneumonia (aOR: 39.0; P < 0.001) were associated with early mortality.

Conclusions

Procedural complications, history of hemorrhagic stroke, and less experience with AF ablation of the hospital were predictors of early mortality. Out of all complications, atrioesophageal fistual, procedure related pneumonia, and in-hospital stroke were related to early mortality. Adequate management of complications may contribute to reducing the number of early mortalty rates following AF ablation. Abstract Figure. Trend of early mortality after ablation

Rupture of carotid artery pseudoaneurysm in the modern era of definitive chemoradiation for head and neck cancer: Two case reports

BACKGROUND

Carotid blowout syndrome (CBS) is a rupture of the carotid artery and is mainly caused by radiation and resection of head and neck cancers or direct tumor invasion of the carotid artery wall. It is a life-threatening clinical situation. There is no established and effective mode of management of CBS. Furthermore, there is no established preceding sign or symptom; therefore, preventive efforts are not clinically meaningful.

CASE SUMMARY

We described two cases of CBS that occurred in patients with head and neck cancer after definitive chemoradiotherapy (CRT) using three-dimensional conformal intensity-modulated radiation therapy. Two men aged 61 and 56 years with locally advanced head and neck cancer were treated with definitive CRT. After completing CRT, both of them achieved complete remission. Subsequently, they had persistent severe pain in the oropharyngeal mucosal region and the irradiated neck despite the use of opioid analgesics and rehabilitation for relief of contracted skin. However, continuous follow-up imaging studies showed no evidence of cancer recurrence. Eleven to twelve months after completing CRT, the patients visited the emergency room complaining about massive oronasal bleeding. Angiograms showed rupture of carotid artery pseudoaneurysms on the irradiated side. Despite attempting to secure hemostasis with carotid arterial stent insertion and coil embolization, both patients died because of repeated bleeding from the pseudoaneurysms.

CONCLUSION

In patients with persistent pain in irradiated sites, clinicians should be suspicious of progressing or impending CBS, even in the three-dimensional conformal intensity-modulated radiation therapy era.

Use of vertebral body units to locate the cavoatrial junction for optimum central venous catheter tip positioning

BACKGROUND

Central venous catheter (CVC) placement plays an important role in clinical practice; however, optimal positioning of the CVC tip remains a controversial issue. The objective of this study was to evaluate the use of vertebral body unit (VBUs), to locate the cavoatrial junction (CAJ), for optimal CVC tip placement based on chest radiography (CXR) using the carina as a landmark.

METHODS

524 patients who underwent coronary computed tomographic angiography (CTA) and CXR were included. The position of the CAJ was identified using VBUs, and the efficacy of VBUs for locating the CAJ with the carina as a landmark was analysed using multiple regression analysis. A VBU was defined as the distance between two adjacent vertebral bodies, including the inter-vertebral disk space.

RESULTS

The mean (sd) distance from the carina to the superior CAJ was 54.3 (9.7) mm on CTA; the mean distance in VBUs at the level of the carina was 21.4 (1.7) mm on CTA and 22.6 (2.1) mm on CXR. The mean CAJ position was 2.5 VBUs below the carina on CTA and 2.4 VBUs below on CXR with 95% limits of agreement between -0.6 and +0.3.

CONCLUSIONS

The position of the CVC tip in relation to the carina can be described using the thoracic spine as an internal ruler, and the position of the CAJ in adults was reliably estimated to be 2.4 VBUs below the carina.

CLINICAL TRIAL REGISTRATION

KCT0001319.

Metastatic acinar cell carcinoma of the liver from a benign-appearing pancreatic lesion: a mimic of hepatocellular carcinoma

Acinar cell carcinoma (ACC) is a rare pancreatic tumour with a favourable prognosis compared with the more common ductal adenocarcinoma. The radiological findings of this tumour have been described in the literature; however, only limited data are available regarding the metastatic features of ACC of the liver, the most common metastatic site. We report a case of ACC of the pancreas with a hepatic metastasis from a benign-appearing malignant pancreatic lesion.

The effect of gadoxetic acid enhancement on lesion detection and characterisation using T₂ weighted imaging and diffusion weighted imaging of the liver

OBJECTIVES

To evaluate the effect of gadoxetic acid enhancement on the detection and characterisation of focal hepatic lesions on T(2) weighted and diffusion weighted (DW) images.

METHODS

A total of 63 consecutive patients underwent T(2) weighted and DW imaging before and after gadoxetic acid enhancement. Two blinded readers independently identified all of the focal lesions using a five-point confidence scale and characterised each lesion using a three-point scale: 1, non-solid; 2, indeterminate; and 3, solid. For both T(2) weighted and DW imaging, the accuracies for detecting focal lesions were compared using the free-response receiver operating characteristic analysis; the accuracies for lesion characterisation were compared using the McNemar test between non-enhanced and gadoxetic acid-enhanced image sets. For hepatic lesions ≥ 1 cm, the lesion-to-liver contrast-to-noise ratio (CNR) and the apparent diffusion coefficient (ADC) were compared in the non-enhanced and enhanced image sets using the generalised estimating equations.

RESULTS

For both T(2) weighted and DW images, the accuracies for detecting focal lesions (p ≥ 0.52) and those for lesion characterisation (p ≥ 0.63) did not differ significantly between the non-enhanced and enhanced image sets. The lesion-to-liver CNR was significantly higher on enhanced DW images than on non-enhanced DW images (p=0.02), although the difference was not significant for T(2) weighted imaging (p=0.65). The mean ADC values of lesions did not differ significantly on enhanced and non-enhanced DW imaging (p=0.75).

CONCLUSION

The acquisition of T(2) weighted and DW images after administration of gadoxetic acid has no significant effect on the detection or characterisation of focal hepatic lesions, although it improves the lesion-to-liver CNR on DW images.

Characterization of liver metastases: the efficacy of biphasic magnetic resonance imaging with ferucarbotran-enhancement

AIM

To retrospectively evaluate the efficacy of biphasic magnetic resonance imaging (MRI) of the liver with ferucarbotran-enhancement for the characterization of hepatic metastases.

MATERIALS AND METHODS

Thirty-six patients underwent MRI of the liver with separate acquisition of double-contrast enhancement consisting of gadolinium and ferucarbotran. A total of 106 focal hepatic lesions (51 metastases, 31 cysts, 23 haemangiomas, and one eosinophilic abscess) were included. Two sets of MRI were analysed: (1) ferucarbotran set: ferucarbotran-enhanced T1-weighted (T1W) dynamic imaging combined with ferucarbotran-enhanced T2*-weighted (T2*W) delayed imaging and (2) double set: gadolinium-enhanced T1W dynamic imaging combined with ferucarbotran-enhanced T2*W delayed imaging. The diagnostic accuracy of the two sets was evaluated using alternative free-response receiver operating characteristic curve analysis. Sensitivity and specificity were compared using the McNemar test. The enhancement pattern of focal hepatic lesions was analysed on gadolinium and ferucarbotran-enhanced T1W dynamic imaging.

RESULTS

There was no significant difference in the accuracy of characterizing hepatic metastases between the two sets. Sensitivity and specificity were not significantly different between the sets (p>0.05). Peripheral rim enhancement was exhibited in 57% of metastatic lesions on ferucarbotran-enhanced T1W dynamic imaging. The majority (96%) of hepatic haemangiomas demonstrated typical peripheral nodular enhancement with progression on ferucarbotran-enhanced T1W dynamic imaging and were easily differentiated from metastases.

CONCLUSION

Biphasic MRI of the liver with ferucarbotran-enhancement alone provided comparable diagnostic efficacy to double-contrast MRI for the characterization of hepatic metastases.

Pancreatic ductal adenocarcinoma with intratumoral cystic lesions on MRI: correlation with histopathological findings

The purpose of this study was to evaluate intratumoral cystic lesions of pancreatic ductal adenocarcinoma (PDAC) depicted on MRI, and to correlate these cystic lesions with their histopathological findings. This study included 12 patients (7 males and 5 females; mean age, 59 years) with intratumoral cystic lesions of PDAC detected on a retrospective MRI review. We reviewed the histopathological findings of the cystic lesions within PDACs and analysed the MRI findings, focusing on the appearance of the intratumoral cystic lesions, i.e. the size, number, margin and intratumoral location, and on the ancillary findings of PDAC, i.e. peripancreatic infiltration, upstream pancreatic duct dilatation and distal parenchymal atrophy. Intratumoral cystic lesions were classified as neoplastic mucin cysts (n = 7, 58%) or cystic necrosis (n = 5, 42%) according to the histopathological findings; they ranged in greatest dimension from 0.5 cm to 3.4 cm (mean, 1.7 cm). Seven patients had only one cystic lesion each, while the remaining five had multiple cystic lesions. Most of the neoplastic mucin cysts had smooth margins (n = 6, 86%) and eccentric locations (n = 6), whereas most cystic necroses had irregular margins (n = 4, 80%) and centric locations (n = 4). The most common ancillary findings of PDAC were peripancreatic infiltration, distal pancreatic atrophy and upstream pancreatic duct dilatation (92%, 75% and 58%, respectively). The intratumoral cystic lesions of PDACs on MRI were classified as either neoplastic mucin cysts with smooth margins and eccentric locations or cystic necroses with irregular margins and centric locations.

Gastric schwannomas: radiological features with endoscopic and pathological correlation

AIM

To describe the radiological, endoscopic, and pathological findings of gastric schwannomas in 16 patients.

MATERIALS AND METHODS

The radiological, endoscopic, and pathological findings of 16 surgically proven cases of gastric schwannoma were retrospectively reviewed. All patients underwent computed tomography (CT) and four patients were evaluated with upper gastrointestinal series. Two radiologists reviewed the CT and upper gastrointestinal series images by consensus with regard to tumour size, contour, margin, and growth pattern, the presence or absence of ulcer, cystic change, and the CT enhancement pattern. Endoscopy was performed in eight of these 16 patients. Six patients underwent endoscopic ultrasonography. Pathological specimens were obtained from and reviewed in all 16 patients. Immunohistochemistry was performed for c-kit, CD34, smooth muscle actin, and S-100 protein.

RESULTS

On radiographic examination, gastric schwannomas appeared as submucosal tumours with the CT features of well-demarcated, homogeneous, and uncommonly ulcerated masses. Endoscopy with endoscopic ultrasonography demonstrated homogeneous, submucosal masses contiguous with the muscularis propria in all six examined cases. On pathological examination, gastric schwannomas appeared as well-circumscribed and homogeneous tumours in the muscularis propria and consisted microscopically of interlacing bundles of spindle cells. Strong positivity for S-100 protein was demonstrated in all 16 cases on immunohistochemistry.

CONCLUSION

Gastric schwannomas appear as submucosal tumours of the stomach and have well-demarcated and homogeneous features on CT, endoscopic ultrasonography, and gross pathology. Immunohistochemistry consistently reveals positivity for S-100 protein in the tumours.

Duplication of the extrahepatic bile duct with anomalous union of the pancreaticobiliary ductal system revealed by MR cholangiopancreatography

MR cholangiopancreatography (MRCP) is a valuable, non-invasive tool for accurate examination of the biliary system. We report a case in which MRCP played a critical role in the diagnosis of a duplication of the extrahepatic bile duct with anomalous union of the pancreaticobiliary ductal system in a patient with hilar cholangiocarcinoma. This variant of a duplication of the extrahepatic biliary system has not been described previously in the literature.

Status analysis and strategic framework for sanitation management in Asia and Africa

Following rapid population increase and industrial development, the ever increasing environmental pollution and the associated sanitation-related problem are no longer regional or local but have become an issue requiring global-dimensional concern and the provision of problem-solving alternatives. Especially, since most problems result from inappropriate sewerage and the lack of sewage treatment system are in a serious state occurring in economically underdeveloped regions, and as such, their significance is enormous. The United Nations Environment Programme (UNEP) has been making efforts to establish the technology selection methodology applicable in developing countries, through the accurate status, investigation and analysis of the wastewater management state in Asian and African regions, and the sanitation management guideline utilisable by political leaders or decision-makers. As part of this effort, the Korea Institute of Water Environment (KIWE), together with the UNEP, selected China and Vietnam (in Asia) and Kenya and Ethiopia (in Africa) as subject countries to investigate and perform on-site sanitation management investigations and analysis in this research. Results obtained from the on-site investigation were analysed, and in order to be helpful in establishing a strategy for sanitation management in underdeveloped countries, the strategic framework (SF) has been made based on characterised results.

Primary sclerosing lipogranuloma of the rectum: CT findings

Sclerosing lipogranuloma is a rare, benign disease which is a peculiar granulomatous reaction of fatty tissue. This disease affects multiple organs and the majority of cases are secondary to exogenous foreign bodies. The authors report a case of primary sclerosing lipogranuloma of the rectum mimicking a submucosal rectal tumour.

Abdominal cavernous Iymphangiomas: CT findings

Two adult patients with histopathologically proved cavernous lymphangiomas and one adult patient with lymphangiomas of strongly presumed cavernous type by cytologic and computed tomographic findings are reported. On computed tomograms, multiple, aggregated, small, and tiny cysts without a solid portion, along the lymphatic channels are characteristic computed tomographic findings for cavernous lymphangiomas.

Mechanism of gap opening in a triple-band Peierls system: in atomic wires on Si

One dimensional (1D) metals are unstable at low temperature undergoing a metal-insulator transition coupled with a periodic lattice distortion, a Peierls transition. Angle-resolved photoemission study for the 1D metallic chains of In on Si(111), featuring a metal-insulator transition and triple metallic bands, clarifies in detail how the multiple band gaps are formed at low temperature. In addition to the gap opening for a half-filled ideal 1D band with a proper Fermi surface nesting, two other quasi-1D metallic bands are found to merge into a single band, opening a unique but k-dependent energy gap through an interband charge transfer. This result introduces a novel gap-opening mechanism for a multiband Peierls system where the interband interaction is important.

Allogeneic bone marrow transplantation for chronic myeloid leukemia: a retrospective study of busulfan-cytoxan versus total body irradiation-cytoxan as preparative regimen in Koreans

From January 1990 to December 1997, 53 Korean patients with chronic myeloid leukemia (CML) receiving bone marrow transplantation (BMT) from human leucocyte antigen (HLA)-identical sibling donors conditioned with either busulfan and cyclophosphamide (BU/CY regimen) or total body irradiation and cyclophosphamide (TBI/CY regimen) were compared retrospectively. Transplantation-related mortality was 19% in BU/CY and 12% in TBI/CY, and early death (<100 d) occurred in 3 patients conditioned with BU/CY. Grade II-IV acute graft-versus-host disease (GVHD) was 9% of BU/CY and 52% of TBI/CY patients. Overall incidence of chronic GVHD was 50% of BU/CY and 52% of TBI/CY patients. In patients with chronic phase, 5-yr overall survival was 73% in the BU/CY group compared with 87% in the TBI/CY group (p=NS), and overall disease-free survival was 75% in the BU/CY group and 59% in the TBI/CY group (p=NS). So far, with a median follow-up of 45 months, 11 patients have relapsed; three relapses occurred after BU/CY and 8 after TBI/CY. The actuarial 5-yr relapse rate was 15% after BU/CY, 34% after TBI/CY (p=0.46). For patients transplanted in chronic phase within 1 yr after diagnosis, there was a clear trend for a lower relapse rate in the BU/CY group (5-yr relapse rate 0%) compared with the TBI/CY group (5-yr relapse rate 30%). The BU/CY group had similar BMT-related toxicity and similar overall survival and showed a clear trend of low relapse compared with the TBI/CY group. Therefore, BU/CY is an acceptable alternative for patients with CML during HLA-identical sibling allogeneic BMT.

Adjuvant doxorubicin and cyclophosphamide versus cyclophosphamide, methotrexate, and 5-fluorouracil chemotherapy in premenopausal women with axillary lymph node positive breast carcinoma

BACKGROUND

This randomized controlled trial was to determine whether a combination chemotherapy regimen that contains anthracycline (doxorubicin and cyclophosphamide [AC]) is superior to the conventional cyclophosphamide, methotrexate, and 5-fluorouracil [CMF] combination in premenopausal women with axillary lymph node positive Stage II breast carcinoma.

METHODS

Premenopausal women with lymph node positive breast carcinoma were stratified according to age (younger than 35 or 35 years or older) and the number of positive axillary lymph nodes (1-3, 4-9, or >/= 10) and then randomly assigned to receive either doxorubicin 40 mg/m(2) and cyclophosphamide 600 mg/m(2) intravenously (i.v.) every 3 weeks or cyclophosphamide 100 mg/m(2) orally on Days 1 through 14, methotrexate 40 mg/m(2) and 5-fluorouracil 500 mg/m(2) i.v. on Days 1 and 8 every 4 weeks. Both arms were scheduled for six cycles.

RESULTS

The median follow-up was 57 months. Eighteen of the 55 AC patients developed recurrence compared with 16 of the 69 CMF patients. The corresponding 5-year recurrence free survival rates were 64% and 78%, respectively (P = 0.12). The site of the first recurrence for AC patients was locoregional in 7%, distant in 22%, and combined in 4%. The corresponding data for the CMF arm were 4%, 16%, and 3%, respectively. Six AC patients died compared with 9 CMF patients. The corresponding 5-year survival rates were 90% and 86%, respectively (P = 0.96). More leukopenia (52%, mostly Grade 1-2) occurred in the CMF arm than in the AC arm (33%, P = 0.001), but no febrile episode was accompanied with leukopenia.

CONCLUSIONS

This study showed no difference between AC and CMF with respect to both disease free and overall survival rates in premenopausal women with axillary lymph node positive breast carcinoma.

Etiology and outcome of acute viral hepatitis in Korean adults

One hundred and sixteen Korean adults with biopsy-proven acute viral hepatitis were studied to determine the etiology and the outcome of the disease using paired sera obtained during acute and convalescent phases. The prevalence of acute viral hepatitis A, B, D and non-A non-B were 3.4%, 60.3%, 0.9% and 35.3%, respectively: hepatitis B virus infection was the most common cause and the hepatitis D virus superinfection was almost negligible. Only eleven (26.8%) of 41 patients with AVH NANB were negative for all serological markers of HBV. The rest (73.2%) were positive for at least one HBV marker: HBsAg was positive in 31.7%. Therefore, the presence of HBV serologic markers in the sera does not exclude the diagnosis of AVH NANB in Korea. In patients with acute viral hepatitis B, 27% remained positive for HBsAg. Chronic hepatitis developed in 12.8% and 17% patients with acute hepatitis B and non-A non-B, respectively. Progression to chronic hepatitis in patients with acute viral hepatitis B and non-A non-B occurred more commonly, although statistically not significant, in male sex and in patients who did not have clinical jaundice during the acute phase and who showed bridging necrosis in their liver biopsies. Age did not influence the progression to chronic hepatitis.

Natural history and prognostic factors of primary hepatocellular carcinoma: study of 70 untreated patients

We carried out a study of the clinical courses of 70 untreated patients with primary hepatocellular carcinoma (HCC) in order to evaluate their survival period and the prognostic factors. The median survival was two months. We evaluated ten variables of biochemical parameters and findings of hepatic scintigraphy. Among them, six variables were chosen by univariate analysis. They were serum bilirubin (cut-off value 3.0 mg/dl), alkaline phosphatase (150 IU/ml), aspartate aminotransferase (AST) (200 IU/ml), alanine aminotransferase (ALT) (50 IU/ml), reticuloendothelial (RES) dysfunction (grade 1) and multiplicity of space occupying lesions (SOL). Multivariate analysis identified three variables. The RES dysfunction and multiplicity of SOL by hepatic scintigraphy and bilirubin were considered as important prognostic factors. We found that the functional reservoir of the underlying liver and multiplicity of the origin of the tumor were the most important prognostic factors.