Hepatocellular carcinoma associated with other primary malignancies.
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Biomedical subjects
Publications and source records attributed to S Rossi.
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A 14 month old girl was found to have a deletion of the whole of band 5q23. By comparing 19 other cases monosomic for a part of the 5q13-q31 segment, the constitutional 5q interstitial deletions fall into two groups: adult patients with Gardner-like symptoms and mental retardation associated with deletion 5q21-q22, and patients (mostly children) with unspecific signs and symptoms and different deletions.
The fine structure of the pig liver was examined after 30 min of warm ischemia at 37 degrees C, after 2 h of cold ischemia at 4 degrees C and after 30 min of warm ischemia followed by a further 30 min of cold ischemia. After warm ischemia, limited mitochondrial swelling was observed in hepatocytes. After cold ischemia, alone or following warm ischemia, vesiculation and vacuolation of the hepatocyte cytoplasm and appearance of intrasinusoidal blebs deriving from hepatocytes were observed with different intensity among the animals. These findings suggest that cooling and storing the liver at 4 degrees C may lead to injury, which could negatively influence the viability of the organ, with different intensity from case to case.
Four patients with hepatocellular carcinoma (HCC) out of a group of 132 with non-Hodgkin's lymphoma (NHL) are described. HCC was the most common second neoplasm in this series; in contrast, only 2 cases of HCC associated with NHL have been reported in the English literature. The diagnosis of HCC was suggested by ultrasound (US) and confirmed by ultrasonically guided fine-needle biopsy (UG-FNB). The 4 cases of HCC arose from cirrhosis. In this series, 10 out of 132 patients (7.6%) presented cirrhosis. Some considerations concerning the possible role of NHL (and/or the related therapy) in promoting the development of HCC in cirrhotic patients are discussed. The usefulness of US and of UG-FNB in the management of the patient with NHL is emphasized.
This randomized double-blind controlled study analyzed the hemodynamic effects of penbutolol, a new levo-rotatory betablocker, using radionuclide angiography. Twenty cirrhotics with esophageal varices were randomized: 10 received 40 mg/day of penbutolol orally and the others a placebo. Angioscintigraphy was performed before and after an 8-day treatment period. Three cases in the penbutolol group were lost due to software damage, hence the data of 17 patients were analyzed. The two groups were similar for age, sex, etiology of cirrhosis and hepatic function. The index of portal perfusion decreased significantly (-29%; p = 0.018), and the hepatic artery index increased significantly (+23%; p = 0.018), whereas no changes were observed after placebo. The heart rate decreased significantly after penbutolol (-9%; p = 0.021); while neither penbutolol nor placebo modified the ejection fraction. In conclusion, penbutolol decreased portal perfusion index (the compensatory increase of hepatic artery index confirmed this change) without significant modification of total hepatic blood flow and systemic hemodynamics. Angioscintigraphy is reasonably accurate, reproducible, safe and can be considered suitable for routine use in the assessment of liver hemodynamics.
In 481 patients, with sonographically suspected neoplastic involvement of the liver, we performed an ultrasonically guided fine-needle aspiration biopsy with 22-gauge Chiba needle. In the 441 controlled cases, we obtained 68.5% true positive, 26.5% true negative, and 5% false negative, with a sensitivity of 93.2%, specificity of 100%, and overall accuracy of 95%. The true positive include 42.1% hepatocellular carcinomas, 28.1% metastases from known extrahepatic malignancy, 24.5% metastases from unknown primary site, 5% hepatic involvement by non-Hodgkin lymphomas, and 0.3% undetermined malignancy. Also, in a larger series, ultrasonically guided fine-needle biopsy confirms its high specificity and overall accuracy. The cytologic assessment of the obtained material is almost always adequate. The use of immediate cytologic staining reduces the number of passes in each lesion with absence of insufficient sampling. Biopsy with fine cutting needles should be reserved only for cases not diagnosed by cytology.
The study was designed to compare the efficacy of captopril and enalapril, both orally active inhibitors of angiotensin converting enzyme, in the treatment of primary hypertension when administered in a single daily dose. After placebo washout for two weeks, 20 hypertensive patients (I-II class, according to WHO), were admitted to active treatment, in a randomized sequence, with captopril (50 mg) and enalapril (20 mg) once a day in the morning (8 a.m.). Supine and erect blood pressure and heart rate were measured weekly, 24 hours after drug administration by using a mercury standard sphygmomanometer. In all patients ambulatory noninvasive blood pressure monitoring was performed after 4 weeks of treatment. The data confirmed the efficacy of both drugs in lowering blood pressure. However, while the antihypertensive effect of enalapril was prolonged throughout 24 hours, captopril was effective only for about 22 hours, a period longer than previously suggested on the basis of serum ACE inhibition, but not sufficient to cover the whole day. Therefore, if captopril therapy has to be used in a single daily dose an attempt should be made using an increased dosage or by employing the drug in some retarded pharmaceutical form. The need to prolong the antihypertensive effect of captopril to 24 hours is based on the clinical experience according to which the smaller the number of tablets to be taken the better the compliance. This is particularly true for cases of asymptomatic hypertension which nevertheless require lifelong therapy.
The total number of lymphocytes in the bronchoalveolar lavage (BAL) fluids significantly increased in mice injected intravenously with pertussis toxin (PT), while the absolute number of alveolar macrophages markedly decreased. This finding probably reflects the lymphocyte accumulation in interstitial spaces as we previously observed in mice injected with PT. In addition, indomethacin, at lower dosage (0.5 mg/kg) prevented peripheral lymphocytosis and lymphocyte accumulation in the alveolar spaces of the lungs of mice injected with PT. These results provide evidence that PT is responsible for lymphocyte accumulation together with a marked decrease of alveolar macrophages in the lungs of treated mice; moreover, indomethacin is effective in preventing bronchoalveolar changes caused by PT.
In this report we present our preliminary experience using a recently developed sonolaparoscope. The 7.5 MHz rotating transducer, fixed to the tip of the laparoscope, produces a sector scan display of 180 degrees. We have used this technique in nine patients: five with cirrhosis and four with focal lesions of the liver. Laparoscopic sonography (LS) visualized two small nodular lesions in two cases of cirrhosis that did not show up with conventional ultrasonography (US). In one case of small hepatocellular carcinoma (HCC) located in the seventh hepatic segment, the lesion was not revealed. The ultrasound patterns of cirrhosis, hepatic cyst, and hemangioma were typical. We also performed ultrasonically guided biopsies. We concluded that laparoscopic sonography may be useful in the study of cirrhosis and in oncological patients for the screening of small hepatic lesions and that it could, in future, represent a preoperative step for liver surgery.
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This report describes the complications following 10,766 ultrasonically guided fine-needle biopsies performed from 1979 to 1987 in 33 Italian echographic units. The mortality was 0.018%: the two reported deaths were due to hemoperitoneum and occurred in patients with hepatocellular carcinoma arising in a cirrhotic liver. Twenty patients (0.18%) had major complications. This series confirms that abdominal biopsy with fine needles is safe, even though our death rate was higher than in previous reports. Among the other nine fatalities following fine-needle abdominal biopsy reported in the literature, seven were secondary to hemorrhage. The biopsy of pancreatic carcinoma was more dangerous for needle-tract seeding (five of eight reported cases, including one in our series).
Amides of beta-(4-chlorophenoxy)-alpha-phenyl-ethylamines were prepared and tested for their inhibitory activity on cholesterol biosynthesis in vitro. Among the substances prepared, (II e), (II g), (II k) and (II m) had much greater inhibitory activity than clofibrate.
The effect of rokitamycin on human polymorphonuclear leukocyte (PMNL) chemotaxis was studied in vitro and in vivo. It was found that rokitamycin in vitro at a concentration of 20 micrograms/ml caused a diminution of PMNL migration, while at lower concentrations no significant effects on migration was observed. In in-vivo studies before and after the ingestion of rokitamycin by six healthy individuals, no change on PMNL chemotaxis was found.
Epidermal growth factor (EGF-R) estrogen (ER) and progesterone (PR) receptors were evaluated in 89 primary breast cancers and 23 axillary lymph node metastases. About 57% of primary and 72.2% of metastatic tumors were EGF-R positive and median EGF-R levels were higher in metastatic deposits than in primary breast tumors (P less than 0.05). An inverse distribution of EGF-R and steroid hormone receptor positive tumors was found (chi 2 = 10.87; P less than 0.001 for PR and chi 2 = 5.01; P less than 0.05 for ER) and an interesting correlation between EGF-R expression in primary tumor and axillary lymph node involvement was demonstrated (chi 2 = 21.4; P less than 0.001). Immunohistochemical studies with a monoclonal antibody against EGF-R revealed the presence of EGF-R only in malignant cells. Our data suggest that EGF-R could identify a class of more aggressive breast tumors endowed with a higher metastatic potential and may therefore represent an unfavorable prognostic parameter in breast cancer.
Two distinct generations of microfossils occur in silicified carbonates from a previously undescribed locality of the Lower Proterozoic Duck Creek Dolomite, Western Australia. The earlier generation occurs in discrete organic-rich clasts and clots characterized by microquartz anhedra; it contains a variety of filamentous and coccoidal fossils in varying states of preservation. Second generation microfossils consist almost exclusively of well-preserved Gunflintia minuta filaments that drape clasts or appear to float in clear chalcedony. These filaments appear to represent an ecologically distinct assemblage that colonized a substrate containing the partially degraded remains of the first generation community. The two assemblages differ significantly in taxonomic frequency distribution from previously described Duck Creek florules. Taken together, Duck Creek microfossils exhibit a range of assemblage variability comparable to that found in other Lower Proterozoic iron formations and ferruginous carbonates. With increasing severity of post-mortem alteration, Duck Creek microfossils appear to converge morphologically on assemblages of simple microstructures described from early Archean cherts. Two new species are described: Oscillatoriopsis majuscula and O. cuboides; the former is among the largest septate filamentous fossils described from any Proterozoic formation.
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