[Successful Treatment with TACE and RFA for a Hepatocellular Carcinoma Case with Lung Metastasis]

We report a hepatocellular carcinoma(HCC)case with lung metastasis that was successfully treated with transarterial chemoembolization(TACE)and percutaneous radiofrequency ablation(RFA). A man in his 60s took right robe liver resection for HCC after TACE for its rupture. Lung metastasis occurred at S1+2 and S6 in the left lung, and an adverse event interrupted standard molecular target therapies. Because extrahepatic metastasis had been seen only in these two locations for a long time, TACE was performed for both metastases. The feeders for both lesions were each intercostal artery, and controlling the drug inflow was necessary to avoid drug influx into the spinal cord branches when S6 metastasis was treated. The viable lesion remained in the S6 lesion, so RFA was added for both lung metastases. 100% tumor necrosis has been observed since the RFA.

Spontaneous regression of lung metastases after transarterial chemoembolization for hepatocellular carcinoma

Spontaneous regressions of primary and/or metastatic lesions have been rarely reported in hepatocellular carcinoma (HCC). Herein, we report the case of a 71-year-old man with HCC, focusing on shape changes of lung metastases over time. Lung metastasis of HCC was histologically diagnosed by percutaneous computed tomography (CT)-guided needle biopsy after the treatment of primary HCC lesion. Lung lesions had been observed on enhanced contrast computed tomography for >3 years without any local or systemic treatment for them. During this period, treatments including surgical procedure for relapsed bladder cancer and transarterial chemoembolization for HCC were performed. Metastatic lung lesions immediately regressed after these treatments. Therefore, accumulation of such cases may help elucidate spontaneous regression mechanisms in primary HCC or its lung metastases.

Vessel Occlusion using Hydrogel-Coated versus Nonhydrogel Embolization Coils in Peripheral Arterial Applications: A Prospective, Multicenter, Randomized Trial

PURPOSE

To evaluate the safety and effectiveness of hydrogel-coated coils for vessel occlusion in the body trunk.

MATERIALS AND METHODS

A total of 77 patients with various peripheral vascular lesions, treatable by embolization with coils, were randomized (hydrogel group, n = 38; nonhydrogel group, n = 39). In the hydrogel group, embolization of the target vessel was conducted using 0.018-inch hydrogel-coated coils (AZUR 18; Terumo Medical Corporation, Tokyo, Japan) with or without bare platinum coils. The nonhydrogel group received both bare platinum coils and fibered coils without the use of hydrogel-coated coils.

RESULTS

Complete target vessel occlusion was accomplished in 36 patients in the hydrogel group and 37 patients in the nonhydrogel group. No major adverse events were observed in either group. The median number of coils/vessel diameter and the median total coil length/vessel diameter were significantly larger in the nonhydrogel group than in the hydrogel group (P = .005 and P = .004, respectively). The median embolization length was significantly longer in the nonhydrogel group (31.95 mm) than in the hydrogel group (23.43 mm) (P = .002). If no expansion was assumed, the median packing density in the hydrogel group was 44.9%, which was similar to that in the nonhydrogel group (46.5%) (P = .79). With full expansion assumed, the median packing density in the hydrogel group was 125.7%.

CONCLUSIONS

Hydrogel-coated coils can be safely used for peripheral vascular coil embolization, and hydrogel-coated and conventional coils in combination allow for a shorter embolization segment and shorter coil length.

Multiresidue Method for Determination of Algal Toxins in Shellfish: Single-Laboratory Validation and Interlaboratory Study

A method that uses liquid chromatography with tandem mass spectrometry (LC/MS/MS) has been developed for the highly sensitive and specific determination of amnesic shellfish poisoning toxins, diarrhetic shellfish poisoning toxins, and other lipophilic algal toxins and metabolites in shellfish. The method was subjected to a full single-laboratory validation and a limited interlaboratory study. Tissue homogenates are blended with methanol-water (9 + 1), and the centrifuged extract is cleaned up with a hexane wash. LC/MS/MS (triple quadrupole) is used for quantitative analysis with reversed-phase gradient elution (acidic buffer), electrospray ionization (positive and negative ion switching), and multiple-reaction monitoring. Ester forms of dinophysis toxins are detected as the parent toxins after hydrolysis of the methanolic extract. The method is quantitative for 6 key toxins when reference standards are available: azaspiracid-1 (AZA1), domoic acid (DA), gymnodimine (GYM), okadaic acid (OA), pectenotoxin-2 (PTX2), and yessotoxin (YTX). Relative response factors are used to estimate the concentrations of other toxins: azaspiracid-2 and -3 (AZA2 and AZA3), dinophysis toxin-1 and -2 (DTX1 and DTX2), other pectenotoxins (PTX1, PTX6, and PTX11), pectenotoxin secoacid metabolites (PTX2-SA and PTX11-SA) and their 7-epimers, spirolides, and homoYTX and YTX metabolites (45-OHYTX and carboxyYTX). Validation data have been gathered for Greenshell mussel, Pacific oyster, cockle, and scallop roe via fortification and natural contamination. For the 6 key toxins at fortification levels of 0.05–0.20 mg/kg, recoveries were 71–99% and single laboratory reproducibilities, relative standard deviations (RSDs), were 10–24%. Limits of detection were <0.02 mg/kg. Extractability data were also obtained for several toxins by using successive extractions of naturally contaminated mussel samples. A preliminary interlaboratory study was conducted with a set of toxin standards and 4 mussel extracts. The data sets from 8 laboratories for the 6 key toxins plus DTX1 and DTX2 gave within-laboratories repeatability (RSDr) of 8–12%, except for PTX-2. Between-laboratories reproducibility (RSDR) values were compared with the Horwitz criterion and ranged from good to adequate for 7 key toxins (HorRat values of 0.8–2.0).

Multicenter Phase II Clinical Trial of Sorafenib Combined with Transarterial Chemoembolization for Advanced Stage Hepatocellular Carcinomas (Barcelona Clinic Liver Cancer Stage C): STAB Study

PURPOSE

To evaluate safety and efficacy of combining sorafenib with transarterial chemoembolization in patients with advanced stage hepatocellular carcinomas (HCCs).

MATERIALS AND METHODS

Systemic chemotherapy-naïve patients with a Child-Pugh class A liver profile and advanced stage HCCs were enrolled. Sorafenib therapy (daily dose 800 mg) was initiated within 4 weeks after initial conventional transarterial chemoembolization with an allowance of subsequent on-demand conventional chemoembolization. The primary endpoint was rate of protocol treatment completion, which was defined as sorafenib administration for at least 2 months. Secondary endpoints included objective response rate, disease control rate, overall survival, progression-free survival, and incidence of adverse events. Thirty-one patients (24 men, 7 women; median age, 75 years; vascular invasion, n = 19; extrahepatic metastases, n = 18; both, n = 6) who met the inclusion criteria were enrolled.

RESULTS

Protocol treatment was completed in 28 patients (90.3%, 28/31) with median protocol treatment duration of 7.0 months (range, 0.5-30 months) and median of 2 (range, 1-4) transarterial chemoembolization sessions. Objective response rate was 77.4% with median overall and progression-free survival of 17.3 months (95% confidence interval, 11.9-22.6 months) and 5.4 months (95% confidence interval, 4.6-6.2 months), respectively. The most common grade 3 or 4 adverse events were self-limiting elevation of aspartate aminotransferase (54.8%, 17/31) and alanine aminotransferase (45.2%, 14/31).

CONCLUSIONS

This combination therapy is feasible and promising in patients with advanced stage HCCs.

[Radiofrequency Ablation under Computed Tomography during Arterial Portography for Hypovascular Liver Metastases from Advanced Pancreatic Cancer]

A 70's man had been treated with gemcitabine(GEM)and nab-paclitaxel(nabPTX)combination for advanced pancreatic tail cancer with splenic invasion and liver metastases. However, the primary lesion was not controlled, then intensity-modulat- ed radiation therapy(76.5 Gy/17 Fr)was performed for primary lesion. Three grown hypovascular liver metastases were detected by follow-up EOB-MRI and PET-computed tomography(CT)imaging with 18F-FDG. Unfortunately, these lesions were not detected by intravenous injection of contrast media with CT nor ultrasonography. Radiofrequency ablation(RFA) under computed tomography during arterial portography(CTAP)guidance was performed. The patient has been alive for 1 year after RFA with no recurrence. CTAP could be a feasible image guidance for the treatment of hypovascular liver metastases with RFA.

Clinical Assessment of Micro-residual Tumors during Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma

BACKGROUND

This study aimed to assess the need to consider microscopic invasion in terms of treatment planning in stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma and elucidate the appropriate clinical target volume (CTV) margin.

PATIENTS AND METHODS

A total of 121 patients (with 146 liver tumors) who underwent SBRT between July 2007 and August 2016 were analyzed, regarding overall survival and local control (LC).

RESULTS

The 2- and 5-year LC rates were 91.5% and 89.8%, respectively. Planning target volume (PTV) margin <8 mm was associated with poor LC. Of the 77 patients with PTV margin of <8 mm, age <75 years was associated with poor LC, while alpha-fetoprotein (AFP) ≤20 ng/ml was associated with good LC.

CONCLUSION

In patients with high AFP levels, there is a possibility of microscopic invasion around the tumor, suggesting that LC may be improved by adding an additional clinical target volume margin to the gross tumor volume.

Phase II trial of sorafenib combined with on-demand transarterial chemoembolization for advanced stage hepatocellular carcinoma (Barcelona Clinic Liver Cancer stage C): STAB study

e15648

Background: Sorafenib has been acknowledged as a standard treatment for advanced stage hepatocellular carcinoma (HCC). This study was conducted to evaluate the safety and efficacy of combination therapy of sorafenib and on-demand transarterial chemoembolization (TACE) for advanced stage HCC. Methods: Inclusion criteria were advanced stage HCC (Barcelona Clinic Liver Cancer stage C), a systemic chemotherapy native status, an Eastern Cooperative Oncology Group performance status 0–1, and a Child-Pugh grade-A. Sorafenib therapy (800 mg daily) was started 4–28 days after TACE. On-demand TACE was allowed. The primary endpoint was the completion rate of protocol treatment, which was defined as sorafenib administration at least for 2 months from initial TACE. Secondary endpoints were objective response rate (ORR), disease control rate (DCR) based on modified Response Evaluation Criteria in Solid Tumors, overall survival (OS), progression-free survival (PFS), and the incidence of adverse events. Results: From July 2013 to September 2015, a total of 32 patients were registered from 9 institutions, but one patient was excluded because his tumor turned out to be combined hepatocellular carcinoma and cholangiocarcinoma. The protocol treatment was completed in 28 of 31 enrolled patients (90.3%, 28/31). The median treatment duration was 7.0 months (range 0.5–30) with the median number of TACE was 1 (range 1–4) and the median sorafenib dosage of 400 mg daily (range 154-800). The ORR and DCR were 77% and 90%, respectively. Median OS and PFS were 17.3 months [95% confidence interval (CI), 11.9–22.6] and 5.4 months (95% CI, 4.6–6.2), respectively. The most common grade-3 or -4 adverse events were increased aspartate aminotransferase (55%, 17/31), increased alanine aminotransferase (45% 14/31), and hypertension (23%, 7/31). Conclusions: Combination therapy of sorafenib and on-demand TACE was well tolerated and safe. Furthermore, this combination treatment may provide a survival benefit to patients with advanced stage HCC. Clinical trial information: UMIN000014213.

Radiofrequency Ablation Combined with Hepatic Arterial Chemoembolization Using Degradable Starch Microsphere Mixed with Mitomycin C for the Treatment of Liver Metastasis from Colorectal Cancer: A Prospective Multicenter Study

PURPOSE

This phase II prospective study investigates possible benefits of radiofrequency ablation (RFA) combined with hepatic arterial chemoembolization using degradable starch microsphere (DSM) mixed with mitomycin C (MMC) in non-surgical candidates with colorectal liver metastases.

MATERIALS AND METHODS

This study, approved by the respective institutional review board, included non-surgical candidates with 3 or fewer liver tumors of 3 cm or smaller, or a single lesion 5 cm or smaller. Percutaneous RFA was performed immediately after chemoembolization using DSM-MMC. Primary and secondary endpoints were the local tumor control rate, safety, and 2-year recurrence-free and overall survival rates.

RESULTS

This study examined 25 patients (22 males, 3 females) with 38 tumors of mean maximum diameter of 2.2 ± 0.9 cm (standard deviation) (range 1.0-4.2 cm). Their mean age was 70.2 ± 8.2 years (range 55-82 years). Local tumor progression developed in 3 tumors (7.9%, 3/38) of 3 patients (12%, 3/25) during the mean follow-up of 34.9 ± 9.2 months (range 18.3-50.1 months). The 2-year local tumor control rates were 92.0% [95% confidence interval (CI), 81.4-100%] on a patient basis and 94.6% (95% CI, 87.3-100%) on a tumor basis. The respective 2-year overall and recurrence-free survival rates were 88.0% (95% CI, 75.3-98.5%) and 63.3% (95% CI, 44.2-82.5%), with median survival time of 48.4 months. Fever was the only adverse event requiring treatments in 2 patients (8%).

CONCLUSIONS

This combination therapy is safe, exhibiting strong anticancer effects on colorectal liver metastasis, which might contribute to patient survival.

[Liver Metastasis in a Gastric Cancer Patient--A Case of Successful Radiofrequency Ablation Combined with Degradable Starch Microspheres Transcatheter Arterial Chemoembolization]

A 60-year-old male patient underwent curative surgical resection for gastric cancer. After the surgery, the patient was diagnosed with T4b, N3b, ly3, v2, CY0, fStageⅢc gastric cancer, and adjuvant systemic chemotherapy using S-1 and CDDP was administered. However, follow-up computed tomography (CT) scan examination taken 2 months after surgery revealed a pancreatic fistula and retroperitoneal abscess, and percutaneous drainage was performed. After 1 month, the enhanced CT scan detected liver metastasis measuring 25 mm in diameter at segment 7. The CT-guided percutaneous radiofrequency ablation (RFA) combined with transcatheter arterial chemoembolization (TACE) procedure was performed on the liver metastasis using degradable starch microspheres (DSM). Two months after the RFA, a follow-up CT scan revealed local recurrence of the lesion in the medial side of the ablated area in segment 7. A second CT-guided RFA, which was combined with DSM-TACE, was performed on the recurrent lesion. The patient has since survived more than 2 years after the second treatment without any further recurrences. This case report suggests that RFA treatment combined with DSM-TACE might be a safe and feasible treatment for liver metastasis from gastric cancer.

[A Case of Surgical Treatment for Mixed Adenoneuroendocrine Carcinoma of the Ampulla of Vater]

A 56-year-old woman was referred to our hospital because of epigastric discomfort and jaundice. Contrast-enhanced computed tomography and gastrointestinal endoscopy revealed an ampullary tumor. A biopsy specimen showed adenocarcinoma of the ampulla of Vater. The carbohydrate antigen (CA19-9) level was elevated, but insulin and glucagon levels were in the normal range. Based on a diagnosis of adenocarcinoma of the ampulla of Vater, we performed subtotal stomach-preserving pancreatoduodenectomy with regional lymph node dissection. Postoperative histopathological examinations indicated both neuroendocrine carcinoma (40%) and adenocarcinoma (60%) components in the ampulla of Vater and regional lymph node metastasis. According to the 2010 WHO Classification of Tumours of the Digestive System, the diagnosis of mixed adenoneuroendocrine carcinoma (MANEC) of the ampulla of Vater was confirmed. The patient was treated for 6 months with oral administration of TS-1 as adjuvant chemotherapy. Currently, the patient is alive without recurrence 8 months after surgery. MANEC of the ampulla of Vater is rare. It is a highly malignant tumor, and the standardization of its treatment, including surgery, chemotherapy, and radiotherapy requires further study.

[A Case of Intractable Bile Leakage after Surgery for Gallbladder Cancer Successfully Treated by Transcatheter Arterial Embolization]

An 83-year-old man underwent extended cholecystectomy for gallbladder cancer. On postoperative day 13, he developed fever and computed tomography (CT) revealed fluid collection at the cut surface of the liver. Ultrasound-guided fluid drainage was conducted, and he was diagnosed with biliary leakage. Radiological examination using a contrast agent revealed that the anterior branch of the bile duct (B5) was completely interrupted. Simple drainage and ethanol injections into the bile duct proved ineffective. Thus, we performed transcatheter arterial embolization (TAE) in the anterior segmental artery (A5) to stop the production of bile in the injured part of anterior segment. The treatment was effective, and he was discharged 15 days after TAE. TAE might be a useful method for treating intractable interrupted-type bile leakage.

Hepatic arterial infusion chemotherapy with fine-powder cisplatin and iodized-oil suspension in patients with intermediate-stage and advanced-stage (Barcelona Clinic Liver Cancer stage-B or stage-C) hepatocellular carcinoma: multicenter phase-II clinical study

PURPOSE

This single-arm, multicenter, phase-II trial evaluated the efficacy and safety of hepatic arterial infusion chemotherapy (HAIC) using fine-powder cisplatin and iodized-oil suspension in patients with intermediate- and advanced-stage [Barcelona Clinic Liver Cancer (BCLC) stage-B and stage-C] hepatocellular carcinomas (HCCs).

METHODS

The Institutional Review Board approved this study and patients provided written informed consent. Thirty-five patients (24 men and 11 women, mean 74 ± 6 years [range 60-87 years]) with BCLC stage-B (57 %, 20/35) or stage-C (43 %, 15/35) HCCs who were not candidates for other locoregional treatments were enrolled. HAIC was performed using a suspension of fine-powder cisplatin with a maximum dose of 65 mg/m(2) and iodized oil on demand. The primary endpoint was the response rate evaluated based on Response Evaluation Criteria in Solid Tumor (RECIST) and modified RECIST (mRECIST). Secondary endpoints were overall survival, progression-free survival, and safety.

RESULTS

The initial and best overall response rates at 4 weeks and 3 months, respectively, were 14 and 17 % based on RECIST, and 57 and 23 % based on mRECIST. The median overall and progression-free survival times were 18 and 4 months, respectively. The most frequent grade-3 or grade-4 adverse events were elevation of serum alanine (23 %) and aspartate aminotransferase (20 %), and thrombocytopenia (17 %).

CONCLUSION

This HAIC provides promising therapeutic effects with acceptable safety to patients with intermediate-stage and advanced-stage HCCs.

[A case report of surgical treatment for hepatocellular carcinoma with a Hugely swollen lymph node that showed high FDG uptake]

A 74-year-old man with chronic hepatitis C was diagnosed with liver tumors. Contrast-enhanced computed tomography (CT) and ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) revealed hepatocellular carcinomas(HCC) in segments 8 (S8)and 5/8 (S5/8), and detected a lymph node (LN) swelling of 75 mm diameter in the posterior aspect of the pancreatic head. Fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) was positive for the swollen LN (SUVmax 12.3), but negative for the intrahepatic HCCs. The alpha-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist-II (PIVKA-II) values were elevated, and soluble interleukin- 2 receptor levels were also increased (1,440 U/mL). Based on a diagnosis of HCCs with either LN metastasis, or with malignant lymphoma, partial hepatectomy (S8 and S5/8), lymphadenectomy (#13LN), and cholecystectomy were performed. Histopathological examination indicated well differentiated HCC in S5/8, and moderately to poorly differentiated HCC in S8, while poorly differentiated HCC was detected in the LN. Therefore, the final diagnosis was HCCs with metastasis to #13LN originating from the HCC in S8. At present, the patient is alive without further extrahepatic recurrence. The extent of FDG accumulation is related to the degree of differentiation of the HCC; furthermore, there are discrepancies between the FDG uptake in intrahepatic and extrahepatic lesions.

[Brain abscess mediated through a pulmonary arteriovenous malformation in a patient with hereditary hemorrhagic telangiectasia]

The patient is a 66-year-old man with hereditary telangiectasia. He was diagnosed with pulmonary arteriovenous malformation (PAVM), which was revealed by contrast-enhanced chest computed tomography at the age of 65. He developed headache, right homonymous hemianopsia, and right hemiparesis and was admitted to our hospital. Contrast-enhanced magnetic resonance imaging revealed multiple lesions in the left hemisphere, which indicates brain abscesses. Thus, the diagnosis of brain abscess mediated through PAVM was established. Following management with drainage and coil embolization, all neurological symptoms resolved. Therefore, coil embolization should be considered for PAVM at an early stage to prevent brain abscess, even if it is asymptomatic.

Subgrouping of intermediate-stage (BCLC stage B) hepatocellular carcinoma based on tumor number and size and Child-Pugh grade correlated with prognosis after transarterial chemoembolization

PURPOSE

To find a subgroup that benefits most from transarterial chemoembolization (TACE) in terms of tumor number and size and liver profile in patients with intermediate-stage hepatocellular carcinoma (HCC).

MATERIALS AND METHODS

Data of 325 intermediate-stage HCC patients who received TACE as the initial treatment were gathered. Four tumor numbers (3-6 tumors) and five maximum tumor diameters (3-7 cm) as well as all of their combinations but one (3 tumors and 3 cm) and Child-Pugh grade were used as variables to ascertain prognostic factors.

RESULTS

The respective 1-, 3-, and 5-year overall survival rates in all patients were 86.5, 47.0, and 23.7%, respectively. Tumor numbers of 4 (P = 0.00145) and 5 (P = 0.036), and tumor size of 7 cm (P = 0.015), and 12 other combinations of tumor number and size, and Child-Pugh grade (P = 0.0015) were identified as significant prognostic factors in univariate analysis, and 4 tumors of 7 cm (P = 0.0008) and Child-Pugh grade (P = 0.0036) remained significant in the stepwise Cox proportional hazard model. The overall survival was significantly better in a patient subgroup having two factors other than patient subgroups having one or no prognostic factors.

CONCLUSION

A patient subgroup having two prognostic factors benefited most from TACE in intermediate-stage HCC patients.

Long-term outcomes of coil packing for visceral aneurysms: correlation between packing density and incidence of coil compaction or recanalization

PURPOSE

To evaluate the correlation between packing density and the incidence of coil compaction or recanalization of visceral artery aneurysms (VAAs) after coil packing.

MATERIALS AND METHODS

Between July 2004 and April 2012, coil packing was performed for 46 true visceral aneurysms (16 splenic, 11 pancreaticoduodenal, eight renal, six hepatic, three superior mesenteric, one right gastric, and one gastroepiploic) in 42 patients. The size and volume of the aneurysm, packing density, and the incidences of compaction and recanalization were evaluated retrospectively.

RESULTS

The mean follow-up period was 37 months ± 8 (range, 11-80 mo). The mean packing density was 19% ± 8 (range, 5%-42%), mean aneurysm size was 19 mm ± 8 (range, 5-40 mm), and mean volume was 4,108 mm(3) ± 5,435 (range, 72-26,235 mm(3)). Compaction and recanalization occurred in two (4%) and 12 aneurysms (26%), respectively. The mean packing density was significantly lower in aneurysms with compaction or recanalization than in unaffected aneurysms (12% vs 22%; P = .00014). There was a significant difference in mean packing density between small (< 20 mm; 22%) and large (≥ 20 mm) aneurysms (15%; P = .0045). The mean size and volume were significantly larger for coil-compacted or recanalized aneurysms than for unaffected aneurysms (P < .05). In aneurysms with a packing density of at least 24%, no compaction or recanalization occurred.

CONCLUSIONS

Coil compaction or recanalization after coil packing for VAAs more often occurs after insufficient embolization with low packing density and in patients with large aneurysms.

Sandwich ELISA assay for the quantitation of palytoxin and its analogs in natural samples

Palytoxins are potent marine biotoxins that have recently become endemic to the Mediterranean Sea, and are becoming more frequently associated with seafood. Due to their high toxicity, suitable methods to quantify palytoxins are needed. Thus, we developed an indirect sandwich ELISA for palytoxin and 42-hydroxy-palytoxin. An intralaboratory study demonstrated sensitivity (limit of detection, LOD = 1.1 ng/mL; limit of quantitation, LOQ = 2.2 ng/mL), accuracy (bias of 2.1%), repeatability (RSDr = 6% and 9% for intra- and interassay variability, respectively) and specificity: other common marine toxins (okadaic acid, domoic acid, saxitoxin, brevetoxin-3, and yessotoxin) do not cross-react in this assay. It performed well in three different matrices: observed LOQs were 11.0, 9.6, and 2.4 ng/mL for mussel extracts, algal net samples and seawater, respectively, with good accuracy and precision. The LOQ in seafood is 11 μg palytoxin/kg mussel meat, lower than that of the most common detection technique, LC-MS/MS.

Hepatic arterial embolization for unresectable hepatocellular carcinomas: do technical factors affect prognosis?

PURPOSE

To evaluate retrospectively whether technical factors of hepatic arterial embolization affect the prognosis of patients with hepatocellular carcinoma (HCC).

MATERIALS AND METHODS

Inclusion criteria of this study were the following: (1) patients received embolization as the initial treatment during 2003-2004, (2) Child A or B liver profile, (3) five or fewer HCCs with maximum diameter of 7 cm or smaller, and (4) no extrahepatic metastasis. Patient data were gathered from 43 centers. Prognostic factors were evaluated using univariate and multivariate analyses.

RESULTS

Eight hundred fifteen patients were enrolled. The 1-, 3-, 5-, and 7-year overall survival rates were 92.0 % (95 % CI 90.1-93.9), 62.9 % (95 % CI 59.3-66.6), 39.0 % (95 % CI 35.1-43.0), and 26.7 % (95 % CI 22.6-30.8) in all patients. Univariate analysis showed a Child-Pugh class-A, alpha-fetoprotein level lower than 100 ng/ml, tumor size of 3 cm or smaller, tumor number of 3 or fewer, one-lobe tumor distribution, nodular tumor type, within the Milan criteria, stage I or II, no portal venous invasion, use of iodized oil, and selective embolization were significantly better prognostic factors. In the multivariate Cox model, the benefit to survival of selective embolization remained significant (hazard ratio 0.68; 95 % CI 0.48-0.97; p = 0.033).

CONCLUSION

Selective embolization contributes to survival in patients with HCCs.

[Pulmonary arterial infusion therapy for lung metastasis of colorectal cancer]

We have developed a pulmonary arterial infusion therapy for lung metastasis of colorectal cancer. Catheterization into pulmonary artery followed by occlusion with ballooning enabled the stasis of blood flow in the unilateral lung for 30 minutes. CDDP was infused via catheter to occluded pulmonary artery. Although no serious adverse events occurred in 5 cases, a tumor reduction in size was not observed. Loco-regional therapy for lung metastasis of colorectal cancer is limited because of recent progress of systemic therapy. However, a development of the procedure of pulmonary arterial infusion may enable a future success of local therapy for lung metastasis of colorectal cancer with a new drug, which is effective in such a short time disposure to tumor as 30 minutes.

[Two case reports-a control of the bleeding from advanced gastric cancer, unable to undergo resection, but was possible by transcatheter arterial embolization (TAE)]

CASE 1: A 61-year-old man having advanced gastric cancer was presented with massive hematemesis. We could not control bleeding by gastrointestinal endoscopic hemostatic therapy, so we performed a transcatheter arterial embolization (TAE). We performed embolization on the left gastric artery. CASE 2: A 58-year-old man having advanced gastric cancer was presented with hematemesis. We could not control bleeding by gastrointestinal endoscopic procedure, so we conducted TAE. We performed embolization on the left gastric artery and right gastric artery. In both cases, hemostasis was achieved by TAE, and effectively controlled the bleeding from advanced gastric cancer.

Comparative cytotoxicity of gambierol versus other marine neurotoxins

Many microalgae produce compounds that exhibit potent biological activities. Ingestion of marine organisms contaminated with those toxins results in seafood poisonings. In many cases, the lack of toxic material turns out to be an obstacle to make the toxicological investigations needed. In this study, we evaluate the cytotoxicity of several marine toxins on neuroblastoma cells, focusing on gambierol and its effect on cytosolic calcium levels. In addition, we compared the effects of this toxin with ciguatoxin, brevetoxin, and gymnocin-A, with which gambierol shares a similar ladder-like backbone, as well as with polycavernoside A analogue 5, a glycosidic macrolide toxin. For this purpose, different fluorescent dyes were used: Fura-2 to monitor variations in cytosolic calcium levels, Alamar Blue to detect cytotoxicity, and Oregon Green 514 Phalloidin to quantify and visualize modifications in the actin cytoskeleton. Data showed that, while gambierol and ciguatoxin were successful in producing a calcium influx in neuroblastoma cells, gymnocin-A was unable to modify this parameter. Nevertheless, none of the toxins induced morphological changes or alterations in the actin assembly. Although polycavernoside A analogue 5 evoked a sharp reduction of the cellular metabolism of neuroblastoma cells, gambierol scarcely reduced it, and ciguatoxin, brevetoxin, and gymnocin-A failed to produce any signs of cytotoxicity. According to this, sharing a similar polycyclic ether backbone is not enough to produce the same effects on neuroblastoma cells; therefore, more studies should be carried out with these toxins, whose effects may be being underestimated.

[A case report--transarterial embolization for advanced gallbladder carcinoma with hepatic metastasis]

A 75-year-old female presented with appetite and weight loss and epigastralgia. CT revealed a primary gallbladder carcinoma Stage IVb with multiple hepatic metastases. Gastrofiberscopy revealed an invasion to duodenal and bleeding from the tumor. For her poor performance status, it seems to be too difficult to undergo a general chemotherapy. So after gastrojejunostomy, transarterial embolization (TAE) was performed. She underwent 2 times TAE. There was a notable reduction in tumor size. But pulmonary metastases were found in bilateral lung. She died after 8 months. TAE may be useful for advanced gallbladder carcinoma with tumor vascularity.

Percutaneous transcholecystic metallic stent placement for malignant obstruction of the common bile duct: preliminary clinical evaluation

PURPOSE

To evaluate the technical success and clinical effectiveness of percutaneous transcholecystic placement of self-expanding metallic stents for the treatment of malignant obstructions of the common bile duct.

MATERIALS AND METHODS

Fifteen patients with malignant obstruction at the lower level of the common bile duct not amenable to surgery were retrospectively reviewed in this study. In all patients, conventional biliary drainage via transhepatic peripheral duct access or endoscopic retrograde biliary drainage (ERBD) were technically difficult or deemed so at imaging evaluation. The causes of obstruction were cholangiocarcinoma (n = 7), pancreatic carcinoma (n = 6), and metastatic lymphadenopathy from gastric carcinoma in the hepatoduodenal ligament (n = 2). Following percutaneous cholecystostomy, a 5-F catheter was inserted into the common bile duct, duodenum, or the anastomosed jejunum through the cystic duct and the malignant obstruction and metallic stents were placed. The technical success was defined as the removal of the drainage tube after the stent placement for the obstruction. The mean follow-up period was 25.4 months.

RESULTS

Sixteen stents were placed in 15 patients. Technical success was achieved in all patients (100%) without major complications. Minor complications included controllable pain or self-limited hemobilia in six of the 15 patients (40%). Lower bilirubin levels compared with those before the procedure were achieved in 14 of the 15 patients (93%).

CONCLUSIONS

Percutaneous transcholecystic placement of metallic stents is a feasible and effective method to manage malignant obstruction at the lower level of the common bile duct not amenable to surgery when conventional biliary drainage via transhepatic peripheral duct access or ERBD were technically difficult or deemed so at imaging evaluation.

Lemierre syndrome with blepharoptosis

A 51-year-old woman was hospitalized with a high fever, occipital pain, blepharoptosis, and trismus. Enhanced CT showed thrombophlebitis of her left cavernous sinus, maxillary vein, and multiple pulmonary nodular lesions. (18)F-FDG PET/CT showed significant uptakes in the same lesions. Streptococcus constellatus was detected in her blood. Therefore, she was diagnosed as a Lemierre syndrome variant. After administration of antibiotics, all symptoms, inflammatory reactions, and thrombi disappeared. Since Lemierre syndrome has life-threatening potential, early diagnosis and initiation of appropriate therapy are important. In this case, (18)F-FDG PET/CT was useful to detect the focus and extent of infection.

[Radiofrequency ablation combined with transcatheter arterial chemoembolization for the local recurrent tumor after resection of the adrenal metastasis from hepatocellular carcinoma--a case report]

We report a case of local recurrent tumor after a resection of right adrenal metastasis from hepatocellular carcinoma successfully treated with radiofrequency ablation combined with transcatheter arterial chemoembolization. The case is a man in his 80s who had a curative surgical resection and microwave coagulation therapy (MCT) for multiple hepatocellular carcinomas in February 2003. The lesions were judged to be T4, N0, M0 and Stage IV,then, he was treated as an outpatient on a regular schedule. In July 2003, a right adrenal tumor 2 cm in diameter was detected by computed tomography (CT), but the value of the adrenocortical hormones were normal on blood examination, and he was observed at regular intervals. In February 2005, the adrenal lesion enlarged to 5 cm in diameter and the value of PIVKA-II became high on blood examination, so April 2005, a surgical resection was performed, and it was diagnosed as the metastasis from HCC. In July 2008, the recurrent tumor 3 cm in diameter was observed in the right retroperitoneum. It was considered inoperable because of the past operation, and transcatheter arterial chemoembolization of an inferior adrenal artery and a fine branch through a right sub-phrenic artery was performed for the recurrent tumor, and one week after the embolization, radiofrequency ablation was treated by CT fluoroscopy guidance. Ten months after the tumor embolization combined with radiofrequency ablation, there were no local and distant recurrences observed by CT examination. Transcatheter arterial embolization combined with radiofrequency ablation is considered as a feasible and effective method for not only HCC but also for a local recurrent tumor after resection of the adrenal metastasis from hepatocellular carcinoma.

[A case of bile peritonitis caused by jejunal perforation after radiofrequency ablation for the multiple liver metastases from cholangiocarcinoma successfully treated with various interventional radiological procedures after pancreatoduodenectomy]

The case is a man in his 50s who had a curative surgical resection for cholangiocarcinoma in August 2006. The lesion was judged to be T3, N1, H0, P0, M0 and Stage III, and then he received various treatments including thermotherapy, CD3-activated T lymphocyte therapy. Then from June 2007, he was treated for multiple liver metastases by GEM, radiofrequency ablation (RFA), stereotactic radiotherapy, S-1, dendritic cell therapy. But there were multiple liver metastases whose maximum size was 17 mm in diameter and he was introduced to our hospital. In September 2008, ultrasonography and CT fluoroscopy guided RFA was operated on him for the liver tumors with a safety margin. But 2 hours after the ablation, he complained of epigastralgia. CT examination revealed a bile peritonitis caused by perforation of the jejunum which has been anastomosed to the pancreas, and was adjacent to the avascular area caused by RFA in segment 4 of the liver. We treated him by various interventional procedures including percutaneous drainage for bile leakage, pancreatic fistula, abscess in peritoneal cavity, and biloma in segment 3. Fifty days after the ablation, T-tube, with which pancreatic fluid and bile was induced from the cecal portion of the anastomosed jejunum to the anal side slipping through the perforated point, was successfully inserted through right flank, and resulted in complete recovery from a major technical complication of the bile peritonitis.

[A case report of combined hepatocellular-cholangiocarcinoma whose lymph node recurrence effectively treated with UFT]

Primary liver cancer with lymph node metastasis was recognized as poor prognosis. We herein report a case of post operative lymph node recurrence treated with UFT. A 74-year-old man with a huge mass lesion in the right liver with para Aortic lymph node metastasis admitted our hospital in April 2007. Extended right lobe hepatectomy and lymph node dissection were performed in May. A histological examination of the resected specimen showed a combined hepatocellular-cholangiocarcinoma with three lymph node metastasis. Computed tomography(CT)revealed intra hepatic metastasis (S3) and right adrenal grand metastasis 5 months after surgery. Transarterial embolization (TAE) and right adrenalectomy were performed for each metastasis. CT revealed a lymph node metastasis at the right side of infra vena cava 1 year after surgery. He was treated by oral administration of UFT (200 mg/day). The AFP and PIVKA-II value gradually decreased after administration of UFT. The size of lymph node metastasis became small confirmed by CT. But the AFP and PIVKA-II value increased 1 year and 7 months after surgery. TAE was performed against lymph node metastasis 1 year and 9 months after surgery. This case suggests UFT is useful for suppressing the growth of the lymph node metastasis.

[A case of successful combination therapy with trans-arterial embolization, trans-arterial chemotherapy and radiofrequency ablation therapy]

A patient is a 78-year-old male. Abdominal ultrasound tomography revealed hepatic tumors. Abdominal computer tomography (CT) revealed a 5.5 cm-in-diameter low enhanced lesion and a 4.0 cm-in-diameter enhanced lesion at S8, and a 1.8 cm-in-diameter enhanced lesion at S5, a 1.4 cm-in-diameter enhanced lesion at S6, which led to a diagnosis of combined hepatocellular carcinoma with intra-hepatic metastasis (IM2) in July 2007. From August to October 2006, he received a hepatic combination therapy with trans-arterial chemotherapy at a low enhanced lesion and trans-arterial embolization (TAE), and radiofrequency ablation therapy (RFA) at enhanced lesions. As of June 2008, this patient is still alive with no recurrence after 8 months from the beginning of this treatment. In conclusion, it might have been effective and suitable to combine multiple therapies to each of the tumor characteristics for mixed hepatocellular carcinoma.

[A case report of complete remission of relapsed rectal cancer liver metastasis after systemic chemotherapy successfully treated by radiofrequency ablation]

We report a case of complete remission of relapsed rectal cancer liver metastasis after systemic chemotherapy successfully treated by radiofrequency ablation (RFA). A 60-year-old man was diagnosed as having rectal cancer with colonoscopy and as solitary liver metastasis with enhanced CT. After primary tumor was resected, modified FOLFOX6 chemotherapy was performed. A complete response (CR) was observed after the eighth course, and the chemotherapy was finished at the twelfth course. Recurrence of liver metastasis was showed after the chemotherapy for six months, so RFA was performed without any complications. He is living without relapsing for eight months. We basically performed first was systemic chemotherapy to liver metastasis of colorectal cancer, and performed a local treatment including resection, if necessary. We suppose that RFA after systemic chemotherapy is one of the useful treatment strategies for liver metastasis of colorectal cancer, because RFA is less invasive than resection and a discontinuation of the drug is not required for RFA.

[A case of liver metastasis from gastric cancer successfully treated with radio-frequency ablation therapy]

We report a case of liver metastasis from gastric cancer successfully treated with radio-frequency ablation therapy. The patient was a 63-year-old man whom we performed distal gastrectomy with D2 lymphnode dissection for type II gastric cancer on April 2004. A post operative pathological finding was pT2N1M0, Stage II. Therefore, the operation was evaluated to be as curative A. No adjuvant therapy was performed. After 11 months computed tomography showed a space occupied lesion (SOL) in S7 segment of the liver, we thought it to be as liver metastasis. We performed radio-frequency ablation therapy, and complete response was obtained. He is alive without a sign of recurrence for 30 months. We thought that radio -frequency ablation therapy was one of the useful treatments for liver metastasis from gastric cancer.

[Radio-frequency ablation therapy to the liver metastasis from colon cancer which neighbors a hepatic-cyst]

We report a case of liver metastasis from colon cancer successfully treated with radio-frequency ablation therapy. The patient was a 75-year-old man. We performed sigmoidectomy in February 2006, but a metastatic-focus in S5 segment of the liver with the size of 28 mm was discovered by November 2006. Chemotherapy was enforced to the patient but we could not control the metastasis. There were multiple hepatic-cysts in his liver and one with size of 60 mm surrounded the metastatic-focus. RFA therapy was performed after enforcing a percutaneous ethanol sclerosing therapy to the neighboring hepatic-cyst. After 4 months from RFA therapy, the CT showed a good cauterization effect on the metastasis. We thought that RFA therapy after enforcing a percutaneous ethanol sclerosing therapy to the neighboring hepatic-cyst was as good as hepatectomy with low invasiveness.

[Radiofrequency ablation of malignant lung tumors--preliminary report of 12 cases]

Percutaneous CT fluoroscopy-guided radiofrequency ablation (RFA) was performed in 12 patients with 4 primary and 8 metastatic lung cancers as a pilot study. The main complication was a pneumothorax, which occurred in six cases and 2 of them required a chest tube drainage. Four patients died of extrapulmonary tumor progression at 3-17 months after RFA. The remaining 8 patients were alive with the disease and their median follow-up period was 12 months (range, 6-39 months). An overall survival rate was 75% at 6 months, 63% at 1 year and 43% at 2 years. A local progression occurred in 4 cases at 4-17 months after RFA and the cause of relapse was considered as insufficient ablation due to tumor localization close to the trachea, SVC or intrapulmonary vessels and bronchi. A local control rate was 92% at 6 months, 64% at 1 year and 35% at 2 years.

CONCLUSION

RFA of lung tumors is a safe and minimally invasive therapeutic intervention with a good local control for sufficiently ablated lesions. So it appears to be a favorable treatment option for high-risk patients or those with multiple lesions.

Cytoskeletal toxicity of pectenotoxins in hepatic cells

BACKGROUND AND PURPOSE

Pectenotoxins are macrocyclic lactones found in dinoflagellates of the genus Dinophysis, which induce severe liver damage in mice after i.p. injection. Here, we have looked for the mechanism(s) underlying this hepatotoxicity.

EXPERIMENTAL APPROACH

Effects of pectenotoxin (PTX)-1, PTX-2, PTX-2 seco acid (PTX-2SA) and PTX-11 were measured in a hepatocyte cell line with cancer cell characteristics (Clone 9) and in primary cultures of rat hepatocytes. Cell morphology was assessed by confocal microscopy; F- and G-actin were selectively stained and cell viability measured by Alamar Blue fluorescence.

KEY RESULTS

Clone 9 cells and primary hepatocytes showed a marked depolymerization of F-actin with PTX-1, PTX-2 and PTX-11 (1-1000 nM) associated with an increase in G-actin level. However, morphology was only clearly altered in Clone 9 cells. PTX-2SA had no effect on the actin cytoskeleton. Despite the potent F-actin depolymerizing effect, PTX-1, PTX-2 or PTX-11 did not decrease the viability of Clone 9 cells after 24-h treatment. Only prolonged incubation (> 48 h) with PTXs induced a fall in viability, and under these conditions, morphology of both Clone 9 and primary hepatocytes was drastically changed.

CONCLUSIONS AND IMPLICATIONS

Although the actin cytoskeleton was clearly altered by PTX-1, PTX-2 and PTX-11 in the hepatocyte cell line and primary hepatocytes, morphological assessments indicated a higher sensitivity of the cancer-like cell line to these toxins. However, viability of both cell types was not altered.

[A case of multiple liver metastases from rectal cancer in poor performance status successfully treated with hepatic arterial infusion chemotherapy plus CPT-11]

Hepatic arterial infusion (HAI) chemotherapy is one of the strategies for cases in poor performance status. This is a case report of multiple liver metastases from rectal cancer in poor performance status successfully treated with HAI plus CPT-11. A 59-year-old man who had rectal cancer, multiple liver metastases and para-aortic LN metastasis underwent a laparoscopic rectal anterior resection. He denied receiving postoperative chemotherapy and selected alternative therapy at another clinic. Four months later, he visited our hospital. His liver metastasis and performance status got worse, so HAI of 5-FU 1250 mg/m2 for 5-hour weekly (weekly high-dose 5-FU: WHF) was started at first. After 3 courses, his status improved, so systemic chemotherapy was added. HAI (WHF: 1000 mg/m2) plus CPT-11 (100 mg/m2) was effective, and liver metastases showed a significant reduction (PR) on abdominal CT. HAI plus CPT-11 was effective for a patient of the poor performance status with unresectable liver metastasis.

[Two cases of pulmonary metastases from colorectal cancer successfully treated by radiofrequency ablation therapy]

BACKGROUND

To date, several studies have evaluated an efficacy of radiofrequency ablation (RFA) for liver tumor. However, there are few reports on RFA for metastatic pulmonary tumor. We experienced two patients whose pulmonary metastases from colorectal cancer were treated with RFA. Case 1: A 70-year-old man who had undergone surgery for rectal cancer was followed up in our out-patient clinic. Eleven months after the surgery, a pulmonary metastasis 10 mm in diameter at the left S10 segment was found. Systemic chemotherapy started. However, the chemotherapy had to be stopped due to grade 3 neutropenia. So, 17 months after the surgery, RFA was performed for the pulmonary metastasis without any complications. Now, he remains in good condition without any evidence of pulmonary recurrence for 20 months after the RFA. Case 2: A 65-year-old man who had undergone sigmoidectomy for sigmoid colon cancer was followed up in our out-patient clinic. Ten months after the surgery, three pulmonary metastases were found. Systemic chemotherapy started. However, because of adverse events, the chemotherapy had to be stopped. So, 15 months after the surgery, RFA was performed for the pulmonary metastases. Slight pneumothorax, which was observed after RFA, was conservatively treated. Now, he remains in good condition without any evidence of pulmonary recurrence for 3 months after the RFA.

CONCLUSION

RFA could be performed safely. Although a long-term prognosis after RFA remains unclear, it may be an effective and minimally invasive technique for the treatment of pulmonary metastasis.

[Transcatheter arterial embolization for the continuous bleeding from duodenal carcinoma--a case report]

We report a case of duodenal carcinoma with continuous bleeding that was successfully treated with transcatheter arterial embolization using gelatin sponge particles. The case was a woman in her 70's who had a curative surgical resection for sigmoid colon cancer with liver and lung metastases, hepatic arterial infusion chemotherapy and radiofrequency ablation for liver metastasis in the past. She was admitted to our hospital because of liver abscess and anemia. Upper gastrointestinal endoscopy revealed active bleeding from a duodenal tumor. The biopsy of the specimens was made and showed duodenal adenocarcinoma. The patient was considered to be inoperable because of the liver abscess and transcatheter arterial embolization of an anterior superior pancreaticoduodenal artery through an inferior pancreaticoduodenal artery was performed for the continuous bleeding from duodenal carcinoma not completely treated by endoscopic hemostasis or frequent transfusion. After the tumor embolization anemia was improved and partial response was obtained by systemic chemotherapy of mFOLFOX6. Transcatheter arterial embolization for a continuous bleeding from duodenal carcinoma is a feasible and effective method as a noninvasive therapy when it is unabled to be treated by surgical resection or endoscopic therapy.

Extraction and cleaning methods to detect yessotoxins in contaminated mussels

Yessotoxin (YTX) and its analogues are a newly recognized group of toxins with increased presence in shellfish in recent years. They can be quantified by various functional assays due to their interaction with phosphodiesterases (PDEs). One of these assays detects the binding between the YTX and the fluorescently labeled PDE I using fluorescence polarization, a spectroscopic technique based on exciting a fluorescent molecule with plane-polarized light and measuring the polarization degree of the emitted light. The aim of this study was to develop a YTX extraction procedure from mussels that does not interfere with this detection method. YTX concentrations were measured in spiked mussel extracts obtained through use of different extraction methods and cleaning procedures. The percentages of toxin recovery in various steps of the processes were calculated using these concentrations. Six extraction methods and two cleaning steps were used and no matrix effects and high toxin recoveries were obtained in two cases. One case used acetone as extraction solvent followed by three dichloromethane partitions and the other case used methanol. The cleaning procedure includes a silica cartridge and a 10,000 NMWL filter. Finally these two extraction-cleaning-detection methods were applied to a naturally contaminated mussel sample and results showed that not only YTX but also homoYTX and hydroxyYTX can be quantified with a 85-90% recovery.

Changes in Membrane Potential: An Early Signal Triggered by Neurologically Active Phycotoxins

Most common phycotoxin poisoning syndromes have important neurological symptoms. However, little is known of the cellular and molecular targets of many of the phycotoxins that produce those human intoxications. We explore the effect of representative toxins on the membrane potential in human neuroblastoma cells by using a fluorimetric assay. Results presented in this study demonstrate that maitotoxin, palytoxins, brevetoxins, and ciguatoxins triggered a dose-dependent membrane depolarization. Mechanisms responsible for the toxins-induced changes in membrane potential are always related to a direct action of the compounds on membrane ion fluxes. This initial screening of the phycotoxins effect is the starting point to lately develop functional methods of detection.

Assessment of Two 3D MDCT Colonography Protocols for Observation of Colorectal Polyps

OBJECTIVE

The objective of our study was to assess the value of two-way interpretation (i.e., from rectum to cecum and vice versa) compared with one-way interpretation (i.e., from rectum to cecum only) in terms of polyp detection and interpretation time on MDCT colonography.

MATERIALS AND METHODS

Fifty consecutive patients underwent both CT colonography and conventional colonoscopy. Three radiologists independently analyzed the CT colonographic examinations of each patient using a primary 3D method. All examinations were analyzed using two techniques: navigation from rectum to cecum only (one-way) and navigation from rectum to cecum and vice versa (two-way). Sensitivity and positive predictive value were calculated on both a per-polyp basis and a per-patient basis. Alternative free-response receiver operating characteristic (ROC) curve analysis was estimated, and image interpretation time was documented.

RESULTS

One hundred fifty-five polyps were depicted in 45 patients by colonoscopy. The mean sensitivity of CT colonography for polyp detection with two-way (88.4%) was significantly superior to that with one-way (78.1%) (p < 0.01). The mean positive predictive value of each observer with one-way was 66.7%, whereas that with two-way was 65.8%. The mean area under the alternative free-response ROC curve (A(z) value) with two-way (0.827) was higher than that with one-way (0.816), but there was not a statistically significant difference. The average interpretation time of each observer with two-way (39 min) was statistically significantly longer than that with one-way (25 min) (p < 0.01).

CONCLUSION

When using a primary 3D interpretation technique at CT colonography, complete 3D navigation from rectum to cecum and from cecum to rectum is mandatory to maximize polyp detection. The image interpretation time for two-way interpretation is statistically significantly longer than that with one-way interpretation.

Actin cytoskeleton of rabbit intestinal cells is a target for potent marine phycotoxins

Biotoxins produced by harmful marine microalgae (phycotoxins) can be accumulated into seafood, representing a great risk for public health. Some of these phycotoxins are responsible for a variety of gastrointestinal disturbances; however, the relationship between their mechanism of action and toxicity in intestinal cells is still unknown. The actin cytoskeleton is an important and highly complicated structure in intestinal cells, and on that basis our aim has been to investigate the effect of representative phycotoxins on the enterocyte cytoskeleton. We have quantified for the first time the loss of enterocyte microfilament network induced by each toxin and recorded fluorescence images using a laser-scanning cytometer and confocal microscopy. Our data show that pectenotoxin-6, maitotoxin, palytoxin and ostreocin-D cause a significant reduction in the actin cytoskeleton. In addition, we found that the potency of maitotoxin, palytoxin and ostreocin-D to damage filamentous actin is related to Ca2+ influx in enterocytes. Those results identify the cytoskeleton as an early target for the toxic effect of those toxins.