Abstract Objective The aim of this study was to determine the effectiveness and safety of percutaneous laser ablation for the treatment of cirrhotic patients with hepatocellular carcinoma awaiting ...liver transplantation. Materials and methods The data of 9 male cirrhotic patients (mean age 50 years, range 45–60 years) with 12 biopsy proven nodules of hepatocellular carcinoma (mean diameter 2.0 cm, range 1.0–3.0 cm) treated by laser ablation before liver transplantation between June 2000 and January 2006 were retrospectively reviewed. Laser ablation was carried out by inserting 300 nm optical fibers through 21-Gauge needles (from two to four) positioned under ultrasound guidance into the target lesions. A continuous wave Neodymium:Yttrium Aluminium Garnet laser was used. Transarterial chemoembolization prior to liver transplantation was performed in two incompletely ablated tumors. Results No procedure-related major complications were recorded. During the waiting time to liver transplantation local tumor progression after ablation occurred in 3 nodules (25%). At histological examination of the explanted livers complete necrosis was found in 8 nodules (66.7%, all treated exclusively with laser ablation), partial necrosis >50% in 3 nodules (25%), and partial necrosis <50% in 1 nodule. Conclusion In patients with cirrhotic livers awaiting liver transplantation, percutaneous laser ablation is safe and effective for the management of small hepatocellular carcinoma.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Summary
A 64‐year‐old man with HBV‐related cirrhosis presented with a liver nodule measuring 2.8 cm revealed by a routine ultrasound and concomitant increased alpha‐fetoprotein (AFP) up to 400 UI/l. ...Contrast‐enhanced CT was suggestive of hepatocellular carcinoma (HCC) and the patient underwent laser ablation procedure. Five months later, because of raised AFP up to 1600 UI/l, ultrasonography and abdominal CT were repeated, showing an increased diameter of liver nodule, measuring 3.8 cm. The patient underwent down‐staged trans‐arterial chemoembolization (TACE) and then was entered into the active liver transplant (LT) list. Lamivudine was already started and the patient underwent LT showing HBV‐DNA serum levels <103 log/copies at the time of surgery. Pathological analysis performed on the explanted liver showed, instead of the suspected HCC, hepatic yolk sac tumor with the presence of typical ‘Schiller‐Duval bodies’. The first 12 months of postoperative follow‐up were excellent, with no evidence of tumor recurrence.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
A case of multifocal epithelioid angiosarcoma of the femur, tibia, fibula, and astragalus in a 54-year-old man is reported. The tumor was composed of nests and cords of malignant cells with ...epithelioid morphology, with foci of vascular differentiation, necrosis, and hemorrhage. By immunohistochemistry, the neoplastic cells showed positivity for endothelial cell markers (CD31, CD34, factor VIII-related antigen, and Ulex europaeus agglutinin I), epithelial markers (cytokeratins and epithelial membrane antigen), and vimentin. The authors' findings point out the need for a panel of antibodies for the careful search of histologic features of vascular differentiation to correctly diagnose vascular bone tumors with epithelioid features, especially in evaluating small core biopsy specimens in which a sheetlike rather than obviously vasoformative architecture may lead to an erroneous diagnosis of metastatic carcinoma.
Purpose
It is under debate how white matter hyperintensities (WMH) affects the brain connectivity. The objective of this research study is to validate the hypothesis, if and how the WMH influences ...brain connectivity in a population with carotid artery stenosis (CAS), which are eligible for carotid endarterectomy (CEA). We used resting state functional connectivity (rs-fc) magnetic resonance (MR) to validate our hypothesis, focusing on the effects of the total number of WMH (TNWMH) and of the WMH Burden (WMHB).
Methods
Twenty-three patients (sixteen males and seven females, mean age 74.34 years) with mono or bilateral carotid stenosis eligible for carotid endarterectomy (CEA), underwent an MR examination on a 1.5-T scanner. The protocol included a morphologic T1-3D isotropic, an EPI functional sequence for rs-fc MR analysis, and a 3D isotropic FLAIR sequence. For each patient, the TNWMH and the WMHB were obtained using two online tools—volBrain and lesionBrain. The rs-fc region-of-interest to region-of-interest (ROI-to-ROI) analysis was performed with the CONN toolbox v18a: two different multiple regression analyses including both WMHB and TNWMH as second-level covariates evaluated the individual effects of WMHB (Analysis A) and TNWMH (Analysis B), adopting a
p
value corrected for false discovery rate (p-FDR) < 0.05 to identify statistically significant values.
Results
Both analyses A and B identified several statistically significant positive and negative correlations associated with WMHB and TNWMH.
Conclusion
WMH influence functional connectivity in patients with carotid artery stenosis eligible for CEA; further, WMHB and TNWMH influence differently functional connectivity.
To assess whether there is mid-term reorganization in brain networks connectivity after Carotid Endarterectomy (CEA) using resting state functional connectivity Magnetic Resonance (fc-rsMR), with a ...special focus on the Default Mode Network (DMN).
In this prospective exploratory study, 14 asymptomatic consecutive patients (10 males and 4 females, mean age 73.5) with unilateral, significant ICA stenosis eligible for CEA according to European Society for Vascular Surgery guidelines were prospectively recruited. The week before CEA procedure, each patient underwent both neurocognitive and rs-fcMR evaluations on the same day; the neurocognitive test consisted on a Mini Mental State Examination (MMSE). The same neurocognitive test and rs-fcMR examination were repeated on follow-up between 3–6 months after CEA. MMSE scores were compared using paired T-Student Test. Rs-fcMR Region Of Interest (ROI-to-ROI) and Seed-to-voxel group analysis were conducted using the CONN toolbox v18 and the SPM 12 software.
Patients showed improvements in MMSE scores from before to after CEA (p-value = 0.0001). ROI-to-ROI analysis revealed several statistically significant connectivity changes following CEA, both in terms of positive and negative correlations; Seed-to-Voxel focusing on DMN revealed increased connectivity between medial prefrontal cortex (mPFC) and three different clusters of voxels.
CEA procedure is associated with an improvement in neurocognitive performance (according to MMSE testing) and reorganization of functional connectivity, including the DMN. These results represent a starting point in order to design further studies for a better understanding of the reorganization of brain networks following CEA, and to investigate the potential role of CEA as a therapeutic procedure for cognitive impairments in selected patients with critical ICA stenosis.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
This research investigated local brain connectivity changes following Carotid Endarterectomy (CEA) by connectometry. Seventeen subjects (15 males and 2 females, mean age 74.1 years), all eligible for ...CEA, were prospectively recruited in this exploratory study. On the same day within the week before the CEA, each patient underwent a cognitive evaluation with a Mini Mental State Examination (MMSE) and a Magnetic Resonance Imaging (MRI) exam that included a DTI sequence for the connectometry analysis. A second MMSE and the same MRI protocol were performed on follow-up, 3–6 months after CEA. The MMSE scores were analyzed using T-Student tests. The connectometry analysis was performed using a multiple regression model to consider the effect of CEA, choosing three different T-score threshold (T-threshold) values (1, 2 and 3). Results were considered statistically valid for
p
value adjusted for False Discovery Rate (p-FDR) < 0.05. Comparison of pre-CEA and post-CEA MMSE scores showed improvement of MMSE scores after CEA. Connectometry analysis revealed no areas of statistically significant increased connectivity related to CEA for T-threshold value = 1 and 2, but showed statistically significant increase of connectivity after CEA in both cerebellar hemispheres and corpus callosum for T-threshold value = 3 (p-FDR = 0.0106667). The network property analysis showed improved small worldness (2.14%), clustering coefficient (1.64%), local (1.94%) and global efficiency (0.56%), and reduced characteristic path length (−0.52%) after CEA. These results suggest that CEA is associated both with cognitive performance improvement and changes in interhemispheric local connectivity in the corpus callosum and cerebellum.
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