Portal vein thrombosis and arterioportal shunts:Effects on tumor response after chemoembolization of hepatocellular carcinoma

AIM: To evaluate the effect of portal vein thrombosis and arterioportal shunts on local tumor response in advanced cases of unresectable hepatocellular carcinoma treated by transarterial chemoembolization. METHODS: A retrospective study included 39 patients (mean age: 66.4 years, range: 45-79 years, SD: 7) with unresectable hepatocellular carcinoma (HCC) who were treated with repetitive transarterial chemoembolization (TACE) in the period between March 2006 and October 2009. The effect of portal vein thrombosis (PVT) (in 19 out of 39 patients), the presence of arterioportal shunt (APS) (in 7 out of 39), the underlying liver pathology,Child-Pugh score, initial tumor volume, number of tumors and tumor margin definition on imaging were correlated with the local tumor response after TACE. The initial and end therapy local tumor responses were evaluated according to the response evaluation criteria in solid tumors (RECIST) and magnetic resonance imaging volumetric measurements. RESULTS: The treatment protocols were well tolerated by all patients with no major complications. Local tumor response for all patients according to RECIST criteria were partial response in one patient (2.6%), stable disease in 34 patients (87.1%), and progressive disease in 4 patients (10.2%). The MR volumetric measurements showed that the PVT, APS, underlying liver pathology and tumor margin definition were statistically significant prognostic factors for the local tumor response (P = 0.018, P = 0.008, P = 0.034 and P = 0.001, respectively). The overall 6-, 12- and 18-mo survival rates from the initial TACE were 79.5%, 37.5% and 21%, respectively. CONCLUSION: TACE may be exploited safely for palliative tumor control in patients with advanced unresectable HCC; however, tumor response is significantly affected by the presence or absence of PVT and APS.

Spontaneous regression of a giant basilar artery aneurysm in a young adult after surgical injury:case report and literature review

A giant basilar artery aneurysm of young woman with endocrine disturbance was misdiagnosed as a large pituitary adenoma and treated surgically via a trans-sphenoidal approach was planned. But the neurosurgery was finally aborted because of massive bleeding during the procedure. One year later,a cerebral angiography confirmed this basilar artery aneurysm was obviously regressed and then endovascular coiling was successfully performed. No neurological complication occurred post-procedure and the endocrine dysfunction symptom was obviously improved.

Abdominal and gastrointestinal manifestations in COVID-19 patients: Is imaging useful?

Coronavirus disease 2019(COVID-19)can be considered a systemic disease with a specific tropism for the vascular system,in which the alterations of the microcirculation have an important pathogenetic role.The lungs are the main organ involved in COVID-19,and severe progressive respiratory failure is the leading cause of death in the affected patients;however,many other organs can be involved with variable clinical manifestations.Concerning abdominal manifestations,the gastrointestinal tract and the hepatobiliary system are mainly affected,although the pancreas,urinary tract and spleen may also be involved.The most common gastrointestinal symptoms are loss of appetite,followed by nausea and vomiting,diarrhea and abdominal pain.Gastrointestinal imaging findings include bowel wall thickening,sometimes associated with hyperemia and mesenteric thickening,fluid-filled segments of the large bowel and rarely intestinal pneumatosis and ischemia.Hepatic involvement manifests as an increase in the enzymatic levels of alanine aminotransferase,aspartate aminotransferase,serum bilirubin andγ-glutamyl transferase with clinical manifestations in most cases mild and transient.The most frequent radiological features are hepatic steatosis,biliary sludge and gallstones.Edematous acute pancreatitis,kidney infarct and acute kidney injury from acute tubular necrosis have been described more rarely in COVID-19.Lastly,splenic involvement is characterized by splenomegaly and by the development of solitary or multifocal splenic infarcts with classic wedge shaped or even rounded morphology,with irregular or smooth profiles.In summary,the abdominal radiological findings of COVID-19 are nonspecific and with poor pathological correlation reported in the literature.Ultrasound and particularly computed tomography with multiphasic acquisition are the diagnostic methods mainly utilized in COVID-19 patients with abdominal clinical symptoms and signs.Although radiological signs are not specific of abdominal and gastrointestinal involvement,the diagnostic imaging modalities and in particular computed tomography are helpful for the clinician in the management,evaluation of the severity and evolution of the COVID-19 patients.

Ultrasound Role in Diagnosis of Carpal Tunnel Syndrome and Postoperative Evaluation in Endoscopic Carpal Tunnel Release

Carpal tunnel syndrome (CTS) represents about 90% of all entrapment neuropathies and is caused by entrapment of the median nerve while passing in the carpal tunnel. US has revealed equal effectiveness as magnetic resonance imaging (MRI) in diagnosis of CTS;however further attention should be given in case of equivocal results from nerve conduction studies (NCS) and/or before endoscopic surgical intervention. This study was conducted to evaluate the role of US in diagnosis and treatment of CTS which was done by endoscopic release. This is a prospective study including patients having CTS who were treated by endoscopic release between December 2017 and December 2018. All cases were evaluated by electrophysiological studies and US at the preoperative period. US was used to measure the cross sectional area (CSA) of the median nerve. Patients underwent endoscopic carpal tunnel release and were called for follow up after 1, 3, and 6 months for clinical and US assessment of the median nerve. Forty cases were included with mean age of 27.85 years. Numbness was the predominant symptom (92.5%) followed by wrist pain (85%). The mean diameter of median nerve showed a significant decrease at different time points (P < 0.001). The sensitivity of US in diagnosis of CTS was 87.5% in the preoperative assessment as compared to electrophysiological study. The sensitivity of US in detecting the improvement of CTS as compared to clinical examination increased from 28% at 1 month postoperative, 53.4% at 3 months to 92.1% at 6 months. Ultrasonography is a sensitive non-invasive diagnostic tool in diagnosis of CTS preoperative and diagnosis of improvement of the patients postoperatively especially at 6 months.

Predictors of Vascular Calcification in Hemodialysis Patients

Background: The prevalence of both cardiovascular mortality and vascular calcification is much higher in patients with chronic kidney disease (CKD) than in the general population so early detection and intervention of VC may prevent or delay the progression and achieve improved patient outcomes. Objectives: To detect different predictors of vascular calcification in haemodialysis patients. Methods: This was a cross sectional observational study that included 85 patients with end stage renal disease (ESRD) on regular dialysis 47 males and 38 females ranged between 18 and 80 years old selected from Nephrology Unit, Internal Medicine Department, Menoufia University Hospital from April 2019 to May 2020. Serum calcium, phosphorus, alkhaline phosphatase, intact PTH, serum Matrix GLA protein, vitamin D and non-contrast CT for calcium scoring of femoral arteries were performed. Results: There was a significant correlation between age of the patient by years (p value 0.0001), serum calcium (p value 0.0001), phosphate (0.0001), calcium phosphate products (p value 0.0001) and alkhaline phosphatase (0.0001), and vascular calcification score detected by non-contrast CT on femoral arteries and negative correlation between serum Matrix GLA protein p value 0.0001) and the detected calcification score;the lower the MGP level the higher calcification score while there was no correlation between body mass index (BMI) (p value 0.021) intact PTH (p value 0.117), serum vitamin D level (p value 0.643), serum albumin (p value 0.643), serum haemoglobin (p value 0.257) and duration of dialysis (p value 0.260) and the detected score. Serum phosphate and calcium phosphorus product are independent risk factors for vascular calcification severity in haemodialysis patients. Conclusions: serum phosphate, calcium phosphate products are risk factors for vascular calcification while intact PTH vitamin D has no significant role in developing vascular calcification in hemodialysis patients. Matrix GLA protein was inversely correlated with vascular calcification score.

Repurposing Pirfenidone for Nonalcoholic Steatohepatitis-related Cirrhosis:A Case Series

We repurposed the antifibrotic drug pirfenidone—which is approved for treatment of idiopathic lung fibrosis—in a series of patients with nonalcoholic steatohepatitis-related cirrhosis.Our report demonstrates the observed improvements in necroinflammation and regression of cirrhosis with pirfeni-done use for 12-weeks,associated with classical hepatic repair complex features on follow-up liver biopsies.This novel work could help stimulate further randomized trials of pirfe-nidone in patients with nonalcoholic steatohepatitis-related liver fibrosis or cirrhosis,for whom no recommended drug treatments exists currently.

The duration of the conventional chemoembolization for hepatocellular carcinoma:factors affecting the procedural time

Aim:The present study evaluated the duration of chemoembolization in patients with hepatocellular carcinoma,analyzing possible factors affecting the procedural time.Methods:In total,175 patients who underwent chemoembolization have been prospectively enrolled.The procedural length was considered the time between the insertion and the removal of the angiographic sheath.The features related to the tumor burden and angiographic procedures,which could be related to the procedural time,were recorded.Results:The chemoembolization time resulted in a mean of 58.1 min.The longer procedural time was associated with a number of nodules treated per patient≥2(P<0.001),a number of segments with nodules≥2(P<0.001),the presence of more than 1 nodule in the same segment(P<0.001),the location of the tumor in the left lobe(P=0.001),the exclusion from the Milan criteria(P<0.001),and a number of segments treated≥2(P<0.001).Only the number of nodules treated per patient resulted significantly in multivariate analysis(OR 2.927,95%CI:2.015-4.251,P<0.001).Conclusion:The factors related to longer procedural time are the number of nodules treated≥2,the number of segments with nodules≥2,the involvement of the left lobe,the tumor burden outside the Milan criteria,and the number of segments treated≥2.All these characteristics,known in the pre-procedural phase,represent useful tools for a correct planning of the angiographic room’s workflow during the pandemic era as well as in the future to reduce downtime and increase productivity.