AimsThe purpose of the present study was to compare the efficacies of transarterial chemoembolization (TACE) combined with sorafenib versus TACE monotherapy for treating patients with advanced hepatocellular carcinoma (HCC).MethodsWe enrolled 321 patients and selected 280 with advanced HCC (Barcelona Clinic Liver Cancer stage C) who underwent TACE therapy between February 2009 and February 2013. TACE alone (monotherapy group) was administered to 198 patients (70.7%), and the remaining 82 (29.3%) underwent repeat combined TACE and sorafenib therapy (combined group). To minimize selection bias, these latter 82 patients were matched using propensity-score matching at a 1∶2 ratio with 164 patients who received TACE monotherapy. The primary endpoints were overall survival (OS) and related subgroup analysis. The secondary endpoints were time to progression (TTP) and treatment-related adverse events.ResultsOf the respective patients in the combined and monotherapy groups, 64.6% and 49.2% had vascular invasion, 87.8% and 91.1% had extrahepatic metastasis, and 54.3% and 47.1% had both. In the propensity-score–matched cohort, the OS survival of the combined group was significantly higher compared with the monotherapy group (7.0 months vs. 4.9 months, respectively, P = 0.003). The TTP was significantly longer in the combined group (2.6 months vs. 1.9 months, respectively, P = 0.001). Subgroup analysis showed that the outcomes of patients with advanced HCC without main portal vein invasion who were treated with combined therapy were significantly better compared with those who received monotherapy (P<0.05). Univariate and subsequent multivariate analyses revealed that the addition of sorafenib was an independent predictor of favorable OS and TTP (adjusted hazard ratios, 0.63 and 0.62, respectively; P<0.05 for both).ConclusionSorafenib plus TACE was more effective than TACE monotherapy for treating patients with advanced HCC without main portal vein invasion. Future trials with larger samples are required to validate these preliminary findings.

SummaryCongenital or acquired forms of the long Q±T syndrome may result in ventricular tachycardia known as torsade de pointes. Many drugs including volatile anaesthetics modify the Q±T interval. Sevoflurane is known to prolong of the rate-corrected Q±T interval (Q±Tc). The objective of this study was to determine whether the sevoflurane-associated Q±Tc prolongation is rapidly reversible when propofol is substituted for sevoflurane. Thirty-two female patients were allocated to two groups. All patients received sevoflurane induction and anaesthesia for 15 min. In one group, sevoflurane was then discontinued and anaesthesia maintained on propofol for another 15 min. The second group received sevoflurane anaesthesia for 30 min. Measurements were taken before, and 15, 20, 25 and 30 min after induction. Q±Tc prolongation was significantly reduced 5, 10 and 15 min after propofol had been substituted for sevoflurane. We conclude that the sevoflurane-associated Q± Tc prolongation is fully reversible within 15 min when propofol is substituted for sevoflurane. Long Q±T syndromes represent ECG-abnormalities that may result in recurrent syncopal attacks and sudden death due to ventricular tachyarrhythmia known as torsade de pointes [1]. These abnormalities may be caused by mutated genes encoding for myocardial sodium and potassium ion channels (congenital long Q±T syndrome, CLQTS), metabolic or electrolyte abnormalities, or by drugs (acquired long Q±T syndrome, ALQTS). The CLQTS is based on a malfunction of ion channels at the myocardial cell membrane, resulting in an inadequate outflow of potassium or excessive inflow of sodium [2]. Prolongation of myocardial repolarisation delays the inactivation of calcium channels resulting in late calcium inflow, which in turn contributes to the formation of early after-depolarisations (EADs) [2]. EADs may reach threshold amplitude and trigger ventricular arrhythmia [2, 3]. Many factors contribute to the development of ALQTS. Hypokalaemia [4], age and sex [5], obesity [6], and many drugs have been shown to be associated with a prolonged Q±T interval [2]. Among the drugs currently used in anaesthesia, volatile anaesthetics are known to alter the Q±T interval. Prolongation of the Q±T interval by isoflurane [7, 8] and sevoflurane [9] and shortening of the Q±T interval by halothane has been already described [7, 8]. It has also been reported that induction of anaesthesia using propofol tends to shorten the Q±Tc interval in patients with an already prolonged Q±Tc interval [10]. Prolongation of Q±Tc by sevoflurane in such patients is alarming and may force the anaesthetist to consider an alternative anaesthetic.The aim of this study was to determine whether intraoperative sevoflurane-associated Q±Tc prolongation can rapidly be reversed when propofol is substituted for sevoflurane. MethodsAfter approval of the institutional ethics committee and after obtaining written informed consent, 32 otherwise Only women were selected, as women are per se prone to a prolonged Q±T interval [11]. Patien...

Osteoblastic osteitis is a rare kind of bone infection typified by a proliferative reaction of the periosteum and by exuberant bone formation. In the maxillary sinus, it occurs as a consequence of chronic or recurrent sinusitis. It usually manifests with a vague facial discomfort, followed by complications in the deep facial spaces or fossae. The diagnosis is a radiological one. Eradication of this bone infection necessitates removal of the precipitating condition as well as the long-term administration of appropriate anti-biotics. In the case of a deep facial fossae abscess, drainage is mandatory.

CIPA is a severe autosomal recessive condition that leads to self-mutilation early in life and to fractures, osteomyelitis and limb amputation in older children. Mental retardation is common. Death from hyperpyrexia occurs in almost 20 % of patients in the first 3 years of life.