Brain metastasis of hepatocellular carcinoma:A case report and review of the literature

Hepatocellular carcinoma (HCC) is one of the most frequent malignancies in the world. It is more common in far eastern countries and relatively rare in the United States and western European countries where at autopsy it accounts for only 1-2% of malignant rumors, The disease is usually manifested in the the 6^th and 7^th decade of life. HCC is one of the highly malignant neoplasms, Extrahepatic metastases are seen in 64% of patients with HCC. The lungs, regional lymph nodes, kidney, bone marrow and adrenals are common sites of HCC metastasis^[1-3], But, metastasis to brain and skull is extremely rare. Table I shows some of the reported cases of HCC with brain metastasis. These case reports reaffirms the complex and multidisciplinary care of these patients^[4-5].

Effect of interferon and ribavirin combined with amantadine in interferon and ribavirin non-responder patients with chronic hepatitis C (genotype 1)

AIM: To evaluate the efficacy of amantadine plus interferonalpha and ribavirin in non-responder patients with chronic hepatitis C.METHODS: Twenty-six non-responder patients received the regimen of IFN-α-2a at a dose of 6 million units three times a week, 1 000-1 200 mg of ribavirin daily, and 200 mg of amantadine daily in divided doses over 48 wk. After the end of treatment, at the 72nd wk, a sustained viral response rate was determined.RESULTS: An early (after 12 wk of therapy) response was seen in 34.6% (9/26) of patients. Response rate at the 24th wk was 42.3% (11/26). End of treatment response (ETR) was 53.8% (14/26). Sustained viral response (SVR) was 42.3% (11/26). There was a statistically significant difference between 0 and 12 wk (P = 0.04), 0 and 24 wk (P = 0.01), 0 and 48 wk (P = 0.00), and 0 and 72 wk (P = 0.001). No patient had severe adverse effects during the treatment.CONCLUSION: Combination regimen of interferon-α,ribavirin and amantadine can enhance sustained viral response on IFN-α and ribavirin non-responder patients with HCV. Triple therapy with amantadine should be evaluated in further studies.

The relation between differential leukocyte count, neutrophil to lymphocyte ratio and the presence and severity of coronary artery disease

Objectives: Total leukocyte count, a marker of inflammation has long been reported to be related with coronary artery disease (CAD). Recently, differenttial leukocyte count and elevated neutrophil to lymphocyte ratio (N/L) has been shown to indicate an increased long-term risk of mortality in patients with stable CAD, myocardial infarction and undergoing cardiovascular surgery. Thses studies offer incremental prognostic value to total leukocyte count. We sought to determine the relationship between the leukocyte subtypes and N/L ratio and the presence and extent of CAD. Study design: The study consisted of 107 patients [70 (65.4%) men, 37 (34.6%) women, mean age 59.5 ± 10.6 years] referred to coronary angiography with suspected CAD. The subjects were classified into two groups according to the presence of significant CAD and the extent of CAD was determined by the Gensini method. Results: The lymphocyte count was found to be lower (2031 ± 741 cells/μL vs 2392 ± 611 cells/μL, p: 0.010) and the N/L ratio was found to be higher in patients with CAD (2.86 ± 1.57 vs 2.04 ± 1.01, p p: 0.005]. Conclusion: Our findings reveal that N/L ratio, a simple marker which can be derived from a routine complete blood count test was significantly and independently related to presence and severity of coronary atherosclerosis.

Pentamidine in Pneumocystis jirovecii prophylaxis in heart transplant recipients

Despite advances in transplantation techniques and the quality of post-transplantation care, opportunistic infections remain an important cause of complications. Pneumocystis jirovecii(P. jirovecii) is an opportunistic organism, represents an important cause of infections in heart transplantation patients. Almost 2% to 10% of patients undergoing cardiac transplantation have Pneumocystis pneumonia. Prophylaxis is essential after surgery. Various prophylaxis regimes had been defined in past and have different advantages. Trimethoprim/sulfamethoxazole(TMP/SMX) has a key role in prophylaxis against P. jirovecii. Generally, although TMP/SMX is well tolerated, serious side effects have also been reported during its use. Pentamidine is an alternative prophylaxis agent when TMP/SMX cannot be tolerated by the patient. Structurally, pentamidine is an aromatic diamidine compound with antiprotozoal activity. Since it is not effectively absorbed from the gastrointestinal tract, it is frequently administered via the intravenous route. Pentamidine can alternatively be administered through inhalation at a monthly dose in heart transplant recipients. Although, the efficiency and safety of this drug is well studied in other types of solid organ transplantations, there are only few data about pentamidine usage in heart transplantation. We sought to evaluate evidence-based assessment of the use of pentamidine against P. jirovecii after heart transplantation.

An evaluation of the arterial occlusions in peripheral arterial disease by 64-detector multi-slice CT angiography: DSA correlation

Objective: Evaluation of peripheral arterial disease with 64-detector multi-slice CT angiography (MDCT- A) and comparison of the results with the results of digital subtraction angiography (DSA), a standard reference. Materials and Method: The written informed consent of the patients and ethics committee approval were obtained. The retrospective study group consisted of 28 patients with a diagnosis of peripheral arterial disease. Using 64-MDCT-A, the arterial tree of the lower extremity was evaluated for the presence of steno-occlusive lesions that might have led to luminal stenosis. The diagnostic reliability of 64-MDCT- A was calculated and compared with that of DSA. Findings: In the segment-based analysis, the sensitivity, specificity, and reliability rates of 64-MDCT angiography in determining significant stenoses were 97.7%, 97%, and 97.3%, respectively. The Kappa co-efficiency for compatibility between 64-MDCT-A and DSA methods in grading stenosis was calculated as 0.896

Transcutaneous cervical esophagus ultrasound in adults: Relation with ambulatory 24-h pH-monitoring and esophageal manometry

AIM: To determine the gastroesophageal refl uxate in the cervical esophagus (CE) and measure transcutaneous cervical esophageal ultrasound (TCEUS) f indings [anterior wall thickness (WT) of CE, esophageal luminal diameter (ELD), esophageal diameter (ED)]; to compare TCEUS findings in the patient subgroups divided according to 24-h esophageal pH monitoring and manometry; and to investigate possible cut-off values according to the TCEUS f indings as a predictor of gastroesophageal refl ux (GER). METHODS: In 45/500 patients, refl uxate was visualized in TCEUS. 38/45 patients underwent esophagogastroduo denoscopy (EGD), 24-h pH monitoring and manometry. RESULTS: The 38 patients were grouped according to 24-h pH monitoring as follows: Group A: GER-positive (n = 20) [Includes Group B: isolated proximal refl ux (PR) (n = 6), Group C: isolated distal reflux (DR) (n = 6), and Group D: both PR/DR (n = 8)]; Group E: no refl ux (n = 13); and Group F: hypersensitive esophagus (HSE) (n = 5). Groups B + D indicated total PR patients (n = 14), Groups E + F refl ux-negatives with HSE (n = 18), and Groups A + F refl ux-positives with HSE (n = 25). When the 38 patients were grouped according to manometry fi ndings, 24 had normal esophageal manometry; 7 had hypotensive and 2 had hypertensive lower esophageal sphincter (LES); and 5 had ineffective esophageal motility disorder (IEM). The ELD measurement was greater in group A + F than group E (P = 0.023, 5.0 ± 1.3 vs 3.9 ± 1.4 mm). In 27/38 patients, there was at least one pathologic acid refl ux and/or pathologic manometry fi nding. The cut-off value for ELD of 4.83 mm had 79% sensitivity and 61% specificity in predicting the PRbetween Groups B + D and E (AUC = 0.775, P = 0.015). CONCLUSION: Visualizing refluxate in TCEUS was useful as a pre-diagnostic tool for estimating GER or manometric pathology in 71.1% of adults in our study, but it was not diagnostic for CE WT.

Effect of age and plaque morphology on diagnostic accuracy of dual source multidetector computed tomography coronary angiography

BackgroundMultidetector 计算了冠的 angiography 代表的断层摄影术(MDCT ) 在心脏的成像和它的最令人激动的工艺的革命之一逐渐地在冠的动脉疾病的诊断被使用了。这研究的目的是调查年龄的效果， MDCT.MethodsThe 病人的诊断精确性上的冠的匾石灰化被使用双来源的 MDCT 和常规冠的 angiography 检验。MDCT 结果关于严厉被分析(&#x0003e；50% 狭窄) 并且形态学(非钙化，混合，或钙化) 冠的动脉粥样硬化患者，在 16 片断 model.ResultsIn 评估的匾总计，有 2,687 个冠的动脉片断的 181 个病人(94 个男人和 87 个女人) 与 MDCT 被检查。90 三个病人比 65 岁老(组 A， 42 个男人) 并且 88 更年轻(组 B， 52 个男人) 。二 -- 因为小远侧的冠的容器片断或运动人工制品， 109 个冠的动脉片断(7.2%) 被排除。有非诊断的图象质量的片断的全面数字在两组病人是类似的。2,687 个评估片断，(5.8%) 157 是显著地 diseased，并且他们中的 144 个被 MDCT 正确地检测。诊断评估证明敏感，积极预兆的价值，特性，和否定预兆的价值是 89.5% ， 62.5% ， 96.0% ，和 99.2% ，分别地在组 A，并且 95.2% ， 64.8% ， 97.5% ，和 99.8% 在组 B 分别地。另外，在两个组与非钙化的、混合并且钙化的匾在冠的片断详细说明了基于片断的分析是在这研究观察的高诊断的精确性建议的类似的诊断 accuracy.ConclusionsVery 那 MDCT 冠的 angiography 能是为更年轻的病人而且为更老的病人的一个合适的诊断工具不仅。

预测甲状腺功能亢进症阵发性心房颤动发作的一般心电图指标

Background: Hyperthyroidism is a major cause of paroxysmal atrial fibrillation(AF). The purpose of this study was to evaluate the predictors of AF in the patients with clinical and subclinical hyperthyroidism. Methods and Results: The study population consisted of four groups: group I(57 euthyroid healthy persons), group II(33 patients with subclinical hyperthyroidism), group III(69 patients with overt hyperthyroidism) and group IV(31 patients with overt hyperthyroidism and documented paroxysmal AF). The maximum P wave duration(P maximum) in group IV(114±8 ms) was significantly higher than group I(102±7 ms, p< 0.001), group II(106±7 ms, p< 0,001)-and group III(108±9 ms, p< 0.005). The P wave dispersion(PWD) was measured as 46±9 ms in group IV and this was significantly higher than group I(29±8 ms, p< 0.001), group II(36±9 ms, p< 0.001) and grup III(38±8 ms, p=0.001). The P maximum and PWD were higher in the patients with subclinical hyperthyroidism compared to healthy individuals. Univariate regression analysis revealed that age, P maximum and PWD, multivariate analysis showed that P maximum and PWD were significant predictors of paroxysmal AF. A PWD value of 37.5 ms separated group IV from others with a sensitivity of 90%, specificity of 85%, and positive predictive accuracy of 77%. Conclusion: Simply measuring P maximum and PWD values, we could identify the patients with high risk for the development of AF and these simple ECG parameters may help in clinical judgement to determine the requirement for treatment in the patients with subclinical hyperthyroidism.