ICG Test Research Articles

Diagnostic Accuracy of Indocyanine Green Clearance Test for Different Stages of Liver Fibrosis and Cirrhosis.

(1) Background: This study aimed to correlate the indocyanine green clearance (ICG) test with histopathological grades of liver fibrosis and liver cirrhosis to assess its diagnostic accuracy in differentiating normal liver parenchyma from liver fibrosis and liver cirrhosis. (2) Methods: A total of 82 patients who received a histopathological liver examination, imaging, and ICG test within three months were included in this retrospective study. The histopathological level of fibrosis was graded using the Ishak scoring system, and the patients were divided into five categories: no liver fibrosis (NLF), mild liver fibrosis (MLF), advanced liver fibrosis (ALF), severe liver fibrosis (SLF), and liver cirrhosis (LC). The non-parametric Kruskal-Wallis test with post hoc pairwise comparison utilizing Mann-Whitney U tests and Bonferroni adjustment was used to analyze differences in the ICG test results between the patient groups. Cross correlation between the individual fibrosis/cirrhosis stages and the score of the ICG test was performed, and the sensitivity, specificity, and positive and negative predictive values were calculated for each model predicting liver fibrosis/cirrhosis. (3) Results: A significant difference (p ≤ 0.001) between stages of NLF, LF, and LC was found for the ICG parameters (ICG plasma disappearance rate (ICG-PDR) and ICG retention percentage at 15 min (ICG-R15)). The post hoc analysis revealed that NLF significantly differed from SLF (ICG-PDR: p = 0.001; ICG-R15: p = 0.001) and LC (ICG-PDR: p = 0.001; ICG-R15: p = 0.001). ALF also significantly differed from SLF (ICG-PDR: p = 0.033; ICG-R15: p = 0.034) and LC (ICG-PDR: p = 0.014; ICG-R15: p = 0.014). The sensitivity for detection of an initial stage of liver fibrosis compared to no liver fibrosis (Ishak ≥ 1) was 0.40; the corresponding specificity was 0.80. The differentiation of advanced liver fibrosis or cirrhosis (Ishak ≥ 4) compared to other stages of liver fibrosis was 0.75, with a specificity of 0.81. (4) Conclusions: This study shows that the ICG test, as a non-invasive diagnostic test, is able to differentiate patients with no liver fibrosis from patients with advanced liver fibrosis and liver cirrhosis. The ICG test seems to be helpful in monitoring patients with liver fibrosis regarding compensation levels, thus potentially enabling physicians to both detect progression from compensated liver fibrosis to advanced liver fibrosis and cirrhosis and to initiate antifibrotic treatment at an earlier stage.

Quantitative liver SPECT/CT is a novel tool to assess liver function, prognosis, and response to treatment in cirrhosis.

Functional liver reserve is an important determinant of survival in cirrhosis. The traditional indocyanine green test (ICG) is cumbersome. Hence, we developed and validated a novel liver imaging, a hybrid of SPECT and CT (Q-SPECT/CT), for evaluating disease severity, outcomes, and response to treatment in decompensated cirrhosis (DC). We recruited a cohort of DC patients at a tertiary institute between 2016-2019. First, we standardized the Q-SPECT/CT across a predefined range of volumes through phantom experiments. Then we performed clinical and laboratory evaluations, ICG test (retention at 15 min), and Q-SPECT/CT at baseline and 12 months of granulocyte colony-stimulating factor (G-CSF) and standard medical treatment (SMT). In 109 DC patients, 87.1% males, aged 51 ± 10 years, MELD: 14 (7-21), the percent quantitative liver uptake (%QLU) on Q-SPECT/CT exhibited a strong correlation with CTP (r = -0.728, p < 0.001), MELD (r = -0.743; p < 0.001) and ICG-R-15 (r = -0.720, p < 0.001) at baseline. %QLU had the maximum discrimination (AUC: 0.890-0.920), sensitivity (88.9-90.3%), specificity (81.2-90.7%), and accuracy (85.8-89.4%) than liver volumes on Q-SPECT/CT or ICG test for classifying patients in CTP/MELD based prognostic categories. A significant increase in %QLU (26.09 ± 10.06 to 31.2 ± 12.19, p = 0.001) and improvement in CTP/MELD correlated with better survival of G-CSF treated DC patients (p < 0.05). SMT did not show any improvement in Q-SPECT/CT or clinical severity scores (p > 0.05). %QLU > 25 (adj.H.R.: 0.234, p = 0.003) and G-CSF treatment (adj.H.R.: 0.414, p = 0.009) were independent predictors of better 12-months survival in DC. Q-SPECT/CT (%QLU) is a novel non-invasive, diagnostic, prognostic, and theragnostic marker of liver reserve and its functions in cirrhosis patients. Clinicaltrials.gov, NCT02451033 and NCT03415698.

Multimodal perioperative assessment of liver function and volume in patients undergoing hepatectomy for colorectal liver metastasis: a comparison of the indocyanine green retention test, 99mTc mebrofenin hepatobiliary scintigraphy and gadoxetic acid enhanced MRI.

To compare the dynamic changes in future liver remnant (FLR) function and volume after hepatectomy and to evaluate the associations between three modalities in assessment of liver function. Liver function and volume were quantified pre-operatively, at post-operative day (POD) 7 and POD 28 in 10 patients with colorectal liver metastases undergoing hemihepatectomy using the indocyanine green retention (ICG) test, hepatobiliary scintigraphy (HBS) and gadoxetic acid-enhanced MRI. The 99mTc mebrofenin uptake rate in the FLR was applied as a reference of liver function. MRI-derived parameters including liver-to-muscle ratio (LMR), liver-to-spleen ratio (LSR) and hepatocellular uptake index (HUI) were used for liver function assessment. Spearman's correlation analysis was used to evaluate the associations. Increase in liver function ranged from 13 to 152% (median 92%) and in volume from 37 to 134% (median 79%). There was no significant discrepancy in increase between FLR function and volume during the first month following hepatectomy. LMR showed a significant correlation to ICG test (r = -0.66, p < 0.05) while LSR had an association with standardized FLR function obtained by HBS (r = -0.71, p < 0.05). During the first week after hepatectomy, pre-operative HUI and LMR showed the strongest correlation to the FLR growth in function and volume respectively (p < 0.05). The observed growth in FLR volume is closely related to the functional increase within 1 month after hepatectomy. Gadoxetic acid-enhanced MRI might substitute HBS for regional liver function assessment and provide an imaging tool for liver growth prediction. Liver function growth was parallel with liver volume increase during the perioperative period. Liver function assessment with gadoxetic acid-enhanced MRI was comparable with that of HBS indicating that gadoxetic acid-enhanced MRI could substitute HBS for regional liver function evaluation.

Clinical implication of ICG test in major hepatectomy for biliary tract cancer.

Major hepatectomy with bile duct resection (BDR) is associated with severe postoperative complications; therefore, evaluation of preoperative liver function is important. However, little is known about mechanisms of increased severe complications in patients with poor liver function. The aim of this study was to evaluate whether indocyanine green retention rate after 15 minutes of injection (ICG-R15) is useful for predicting the risk of severe postoperative complications in this operation, and to reveal the mechanisms of increasing severe complications by focusing on immune function and liver regeneration after hepatectomy. Patients receiving major hepatectomy with BDR between 2000 and 2017 were retrospectively reviewed. Severe postoperative complications were defined as Clavien-Dindo grade ≥IV. In 284 patients undergoing major hepatectomy with BDR, ICG-R15 was correlated with severe postoperative complications, with cut-off value of 11.8%. In brief, the incidences of hyperbilirubinemia, coagulopathy, liver failure, respiratory failure, severe complications, and mortality were higher in the high ICG-R15 group. Moreover, high ICG-R15 (≥11.8%) was an independent factor for predicting severe complications after major hepatectomy with BDR. Immune dysfunction in the early phase after operation, prolonged postoperative immunosuppression, and delayed liver regeneration were reasons for increasing severe postoperative complications in patients with high ICG-R15. High ICG-R15 is an independent risk factor for severe complications after major hepatectomy with BDR, and its cut-off value is 11.8%. Compromised condition and delayed liver regeneration induced by immune dysfunction are reasons of increased severe postoperative complications in patients with high ICG-R15.

Role of Integrated Functional Assessment Pathway Using 99m Tc -Mebrofinate SPECT-CT Scan, ICG, Elastography and HVPG in Patients at Risk of Post Hepatectomy Liver Failure

Introduction: The study hypothesized that pre-operative integrated functional assessment pathway including liver function tests, ICG test, elastography and HVPG measurements, 99m Technetium -Mebrofinate scan, allow identification of patients at risk of PHLF and to improve post-operative outcomes.

Preoperative assessment with functional studies of the liver

Background: Postoperative liver failure is the major cause of mortality and morbidity after partial liver resection, and develops as a result of insufficient remnant liver function. The aim of study was to sum up our experience on the most clinically relevant and novel liver function tests used for the assessment of hepatic function before liver surgery. Materials and Methods: ICG-test,methacetin breath test and 99mTc-technephyt hepatobiliary scintigraphy (HBS) were performed prior to major resection in 60 high-risk patients with liver tumors, including 15 patients with hepatocellular carcinoma. Liver function determined with HBS was compared with methacetin breath and ICG test by unified scale. Results: Passive liver function tests, including biochemical parameters and clinical grading systems, are not accurate enough in predicting outcome after liver surgery. Dynamic quantitative liver function tests such as the ICG test is more accurate as it measures the elimination process of a substance that is cleared and metabolized almost exclusively by the liver. However, this test only measure global liver function. Nuclear imaging techniques such as 99mTc-HBS can measure both total and future remnant liver function, and potentially identify patients at risk for postresectional liver failure. Meanwhile,13C-methacetin breath test measures the microsomal capacity of the liver. In fact, a strong positive association (r 0.73, p<0.01) was found between 13C-methacetin breath test determined with HBS, a positive moderate uphill relationship between Results of ICG & breath test (r 0.53, p<0.01)and ICG& HBS(r 0.6, p<0.01) Conclusions: As there is not one test that can measure all components of liver function, liver functional reserve remains to be estimated from combination of quantitative liver function tests. Presently, combination of 99mTc-technephyt HBS, ICG and 13C-methacetin breath test seems to be the most valuable liver function estimate, as its can measure multiple aspects of liver function in specifically the future remnant liver.

Advanced liver function assessment in patients with intestinal failure on long-term parenteral nutrition

Intestinal failure associated liver disease (IFALD) is one of the leading complications and causes of deaths in adult patients receiving home parenteral nutrition for chronic intestinal failure (CIF). Early diagnosis of IFALD is key to alleviate the progression of hepatic dysfunction. The aim of this study was to evaluate the capability of noninvasive liver function tests. 90 adult patients with CIF receiving long-term home parenteral nutrition were included in a prospective cross-sectional study at our department between 2014 and 2017. All participants underwent dynamic liver function assessment (maximum liver function capacity [LiMAx] test, indocyanine green [ICG] test), transient elastography (FibroScan), blood tests and comprehensive nutritional status assessment. Univariate and multivariable analysis were performed to identify predictors of liver function. LiMAx, ICG test, and FibroScan highly correlated with standard liver function tests. Multivariable analysis identified intact ileum (B=520.895; p=0.010), digestive anatomy type 3 (B=75.612; p=0.025), citrulline level (B=3.428; p=0.040), parenteral olive oil intake (B=-0.570; p=0.043), and oral intake (B=182.227; p=0.040) as independent risk factors affecting liver function determined by LiMAx test. ICG test and FibroScan showed no correlation with gastrointestinal and nutrition-related parameters. The LiMAx test is significantly associated with widely accepted risk factors for IFALD by multivariable analysis, whereas ICG test and FibroScan failed to show significant correlations. Liver function assessment by LiMAx test may therefore have the potential to detect alterations in liver function and identify patients at risk for the development of IFALD. Longitudinal studies are needed to investigate the impact of liver function determined by LiMAx test on long-term outcome in patients with CIF.

The role of functional liver tests in liver cancer surgery

Background: The aim of this study was to sum up our experience on the most clinically relevant and novel liver function tests used for the assessment of hepatic function before liver surgery with the ultimate goal to design a method to identify patients at risk of liver failure (and hence mortality) following liver resection. Methods: ICG-test, methacetin breath test and 99mTc-technephyt hepatobiliary scintigraphy (HBS) were performed prior to major resection in 30 high-risk patients with primary and metastatic liver tumors. Liver function determined with HBS was compared with 13C-methacetin breath and ICG test by unified scale. Results: ICG test is more accurate as it measures the elimination process of a substance that is cleared and metabolized all most exclusively by the liver. Nuclear imaging techniques such as 99mTc-technephyt HBS can measure both total and FLR function. 13C-methacetin breath test measures the microsomal capacity of the liver. A strong positive association (r 0.73, p<0.01) was found between 13C-methacetin test determined with 99mTc-technephyt HBS, a positive moderate uphill relationship between results of ICG & breath test (r 0.53, p<0.01) and ICG& HBS(r 0.6, p<0.01). Conclusion: Presently, combination of 99mTc- technephyt HBS, ICG and 13C-methacetin breath test seems to be the most valuable liver function estimate, as its can measure multiple aspects of liver function in specifically the future remnant liver.

Tips for junior HBP surgeon to perform laparoscopic anatomic S3 hepatectomy in a regional hospital

Summary: Purpose: Laparoscopic anatomic hepatectomy is an advanced procedure for HBP surgeons, and most junior HBP surgeons would perform laparoscopic left lateral segmentectomy or wedge resection as their initial experience for laparoscopic hepatectomy. Miaoli General Hospital is a regional hospital in alliance with Far-Eastern Memorial Hospital, and it provides surgical service majorly laparoscopic appendectomy, cholecystectomy or colectomy. Laparoscopic anatomic hepatectomy had never been performed in this hospital before, and some special devices for laparoscopic hepatectomy, such as laparoscopic ultrasound transducer or CUSA, are not available. This video would present a junior HBP surgeon to perform laparoscopic anatomic hepatectomy for hepatocellular carcinoma (HCC) at S3. Materials and Methods: A 78-year-old man, an HBV carrier, was diagnosed with a new hepatic nodule at lateral segment of liver under routine sonographic survey. Further abdominal CT and MR scan showed a solitary 1.9cm HCC at S3. As ICG test was not available in this hospital, laparoscopic anatomic S3 hepatectomy was indicated for this elderly patient with Child A cirrhosis, attempt to preserve normal liver parenchyma as much as possible. Results: Total operation time was 186 minutes, and blood loss was about 70ml. The intracorporeal Pringle maneuver was prepared with Fr. 16 foley catheter (Huang’s loop) but never applied during hepatectomy. Harmonic scalpel and monopolar coagulation were the major energy devices during hepatectomy. The patient had uneventful postoperative course and was discharged 7 days after operation. The final pathology report showed well differentiated HCC, pT1b, without margin, perineural or lymphovascular invasion. Conclusion: Laparoscopic anatomic hepatectomy is possible for junior HBP surgeons to do in a resource-limited hospital with basic energy devices and easy inflow control method. However, the operators should prepare to gain experience in hepatectomy during residency, observe plenty live laparoscopic hepatectomies and participate in hand-on laparoscopic skill workshop.

PS02.226: PREDICTIVE FACTORS FOR EARLY RECOVERY OF ORAL INTAKE IN PATIENTS WHO UNDERWENT CURATIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER

Abstract Background Evaluating swallowing function by Videoendoscopic evaluation of swallowing (VE) and Videofluorography (VF) is vital in reintroducing oral diet to patients who underwent esophagectomy. However, performing VE and VF requires specific facility and experts. So, the aim of this study is to evaluate predictive factors for early recovery of oral intake. Methods One-hundred and thirty-six patients who underwent minimally invasive esophagectomy for thoracic esophageal cancer with three-field-lymph node dissection were enrolled. Patients’ characteristics, surgical and pathological factors, postoperative complications, duration from surgery to reintroducing oral intake, results of repetitive saliva swallowing test (RSST) and maximum phonation time (MPT) on seventh postoperative day (7POD) were analyzed. We classified patients that duration of reintroducing oral intake is shorter than 10 days into Normal-intake (N) group and patients that duration of oral intake is longer than 11 days into Delayed-intake (D) group. Results The average age of all patients was 64 ± 9 years old and average hospital stay of them was 30 ± 15 days. Three-field-lymph node dissection was performed in 96% of the cases and all patients have been performed cervical esophagogastrostomy. N group had significantly many patients who completed neoadjuvant chemo(radio)therapy (neo-C(R)Tx)) compared to D group (74% vs. 51%, P = 0.01). Also, patients in N group had significantly low level of preoperative indocyanine green test (ICG test; determined by colorimetric method at 15 minutes after injection of indocyanine green solution) and maximum postoperative serum C-reactive protein level until 7POD (max-CRP) compared to D group (P = 0.047, P = 0.001, respectively). Moreover, average time of MPT on 7POD was long in N group compared to D group (P = 0.05). In multivariate analysis, completion of neo-C(R)Tx, ICG ≤ 9, max-CRP ≤ 14.5 mg/dL was independent predictive factor of early recovery of oral intake (OR: 2.6 P = 0.023, OR: 4.6 P = 0.003, OR: 1.7 P = 0.008, respectively). Conclusion Preoperative good liver function, completion of neoadjuvant treatment and relatively low postoperative inflammation were considered to be predictive factors for early recovery of oral intake in patients who underwent curative esophagectomy for esophageal cancer. Disclosure All authors have declared no conflicts of interest.

Intraoperative ICG test predicts postoperative complications in patients undergoing a staged hepatic resection

Introduction: Sufficient function of the future liver remnant is requisite to avoid post-hepatectomy liver failure (PHLF). Different diagnostic tools help to estimate the volume and function. However, a tool to evaluate reliably the functional capacity of future liver remnant (FLR) is missing. Methods: Between September 2015 and May 2017, all consecutive patients undergoing staged hepatectomies received MRI or CT-scans to assess sFLR; 99mTc-Iodida scan was performed to assess the functional capacity. Pre- and intraoperative Indocyaningreen tests (ICGTest) were performed to compare the different tests and with the outcome. Postoperative complications were graded and calculated according to Clavien-Dindo and Comprehensive Complication Index (CCI). Results: 15 patients were included, median age 57. 9 patients hat major complications (≥ grade III); median CCI was 22.6. One patient died postoperatively. Median preoperative R15 was 5 [IQR 2.2 - 8.8]. No significant correlation was found between sFLR, 99mTc-Iodida scan and R15. Preoperative R15, 99mTc-Iodida scan and sFLR did not correlate to CCI. Intraoperative R15 was median 11.4 [IQR 5.3 - 17]; it correlated to end-of hospitalization CCI (p=0.05) and to 90 day CCI (p=0.0036). ROC curve analysis revealed that a cutoff value of 11.4 for intraoperative R15 was able to identify postoperative major complications. Discussion: Intraoperative ICGtesting allows real-time monitoring of the functional capacity of future remnant liver by clamping of arterial and porto-venous inflow of the part to be resected. We herewith propose a cutoff of intraoperative ICG that will be validated in a larger cohort. It could help to prevent disastrous postoperative consequences.

Study of complicated grief, in methadone consumers, in cessation drug centers in Iran, in 2015

Background Complicated grief causes clearly functional disorders, and grief signs lasts at least a month after six months going through unfortunate incident. Researches about grief and complicated grief, requires a deeper understanding in etiology of creation and several therapeutic procedures. In this study we want to evaluate the relationship between the use of methadone and complicated grief. Methods Among methadone consumers in cessation drug centers in Mashhad in 2015 a sample of 285 person's were chosen randomly to answer ICG test (Inventory of Complicated Grief) and demographic questionnaire. Analysis performed by SPSS18. Findings The results showed that 35% of methadone consumers had grief. Complicated grief is more frequent in men than women ( P =0.01), and more in middle-aged people than the other ages ( P =0.002). The most frequent complicated grief among those with postgraduate diploma and the lowest rate is among MA ( P =0.003). People who have lost their first-grade relatives have more complicated grief than those who lost the other ones ( P =0.000). The individuals who have lost someone due to disease are more frequent than those who have lost someone suddenly ( P =0.00). Among the ICG test questions, hallucinations (seeing deceased) has the lowest frequency, and tendency to the places and things related to the deceased, has the greatest frequency. Conclusion Finding of this research showed that, Men, people with postgraduate diploma and people who have lost their first-grade relatives have experienced more complicated grief. Gender of deceased and marital status do not effect on the frequency of complicated grief.

Preoperative Estimation of Future Remnant Liver Function Following Portal Vein Embolization Using Relative Enhancement on Gadoxetic Acid Disodium-Enhanced Magnetic Resonance Imaging

ObjectiveTo retrospectively evaluate relative enhancement (RE) in the hepatobiliary phase of gadoxetic acid disodium-enhanced magnetic resonance (MR) imaging as a preoperative estimation of future remnant liver (FRL) function in a patients who underwent portal vein embolization (PVE).Materials and MethodsIn 53 patients, the correlation between the indocyanine green clearance (ICG-K) and RE imaging was analyzed before hepatectomy (first analysis). Twenty-three of the 53 patients underwent PVE followed by a repeat RE imaging and ICG test before an extended hepatectomy and their results were further analyzed (second analysis). Whole liver function and FRL function were calculated on the MR imaging as follows: RE x total liver volume (RE Index) and FRL-RE x FRL volume (Rem RE Index), respectively. Regarding clinical outcome, posthepatectomy liver failure (PHLF) was evaluated in patients undergoing PVE.ResultsIndocyanine green clearance correlated with the RE Index (r = 0.365, p = 0.007), and ICG-K of FRL (ICG-Krem) strongly correlated with the Rem RE Index (r = 0.738, p < 0.001) in the first analysis. Both the ICG-Krem and the Rem RE Index were significantly correlated after PVE (r = 0.508, p = 0.013) at the second analysis. The rate of improvement of the Rem RE Index from before PVE to after PVE was significantly higher than that of ICG-Krem (p = 0.014). Patients with PHLF had a significantly lower Rem RE Index than patients without PHLF (p = 0.023).ConclusionRelative enhancement imaging can be used to estimate FRL function after PVE.

Early diagnosis of liver failure in septic patients using the maximal liver function capacity test (LiMAx test): comparison with conventional methods

Patients with bacterial sepsis often suffer from multiorgan failure. No reliable parameter exists for the exact estimation of the liver function. The indocyaningreen test (ICG test) showed a correlation between liver function and mortality rate. The new maximal liver function capacity test (LiMAx test) is a real-time method to investigate the liver function.

Abnormal muscle vascular responses during exercise in myocardial infarction patients

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ICG試験とBSP試験に著明な解離を示した1症例 (体質性ICG排泄異常症) 特にその血中消失曲線における特異性について

ICG試験とBSP試験に著明な解離を示した1症例 (体質性ICG排泄異常症) 特にその血中消失曲線における特異性について

Combined indocyanine green test and standard remnant liver volume to predict post-hepatectomy hepatic insufficiency for the patients with hepatocellular carcinoma

To discuss the safety line to avoid the post-hepatectomy hepatic insufficiency by combining indocyanine green test by pulse dye-densitometry (PDD-ICG) and standard remnant liver volume (SRLV). Seventy-five hepatic cancer patients undergone hepatectomy from March 2007 to February 2008 were included. According to the liver function decompensatory grades after operation, the relationship between ICG retention rate at 15 min (ICGR15) and standard remnant liver volume by linear regression were analyzed. There were 60 cases with slight hepatic insufficiency, 12 cases with moderate hepatic insufficiency, and 3 cases with severe hepatic insufficiency. There were no difference in age [(50 +/- 13) years old and (53 +/- 9) years old], prothrombin time [(13.6 +/- 1.0) s and (13.5 +/- 1.0) s], international normalized ratio (1.09 +/- 0.10 and 1.06 +/- 0.10) between slight hepatic insufficiency group and moderate and severe hepatic insufficiency group (P > 0.05). And there were difference in K value (0.20 +/- 0.04 and 0.17 +/- 0.03), ICGR15 (6 +/- 4 and 9 +/- 4), SRLV [(545 +/- 93) ml and (398 +/- 82) ml] between two groups (P < 0.05). Compared ICG test and standard remnant liver volume of the patients with moderate hepatic insufficiency after operation, the liner relationship was found (R = 0.640, P = 0.025), and the regression equation was: standard remnant liver volume (ml/m(2)) = 1594.6 x ICGR15 + 265. PDD-ICG test and standard remnant liver volume are effective to estimate hepatic function reserve of patient undergone hepatectomy.

Assessment of liver function for safe hepatic resection

The preoperative assessment of liver function is extremely important for preventing postoperative liver failure and mortality after hepatic resection. Liver function tests may be divided into three types; conventional liver function tests, general scores, and quantitative liver function tests. General scores are based on selected clinical symptoms and conventional test results. Child-Turcotte-Pugh score has been the gold standard for four decades, but the Child-Turcotte-Pugh score has difficulty discriminating a good risk from a poor risk in patients with mild to moderate liver dysfunction. The model for end-stage liver disease score has also been applied to predict short-term outcome after hepatectomy, but it is only useful in patients with advanced cirrhosis. Quantitative liver function tests overcome the drawbacks of general scores. The indocyanine green retention rate at 15 minutes (ICG R15) has been reported to be a significant predictor of postoperative liver failure and mortality. The safety limit of the hepatic parenchymal resection rate can be estimated using the ICG R15, and a decision tree (known as the Makuuchi criteria) for selecting patients and hepatectomy procedures has been proposed. Hepatic resection can be performed with a mortality rate of nearly zero using this decision tree. If the future remnant liver volume does not fulfill the Makuuchi criteria, preoperative portal vein embolization should be performed to prevent postoperative liver failure. Galactosyl human serum albumin-diethylenetriamine-pentaacetic acid scintigraphy also provides data that complement the ICG test. Other quantitative liver function tests, however, require further validation and simplification.

Diagnostic rapide des infections à rotavirus : étude prospective comparative de deux techniques de détection d'antigènes dans les selles

The ability of two commercially available diagnosis rapid assays in detecting rotavirus antigen was compared in a prospective study conducted from September 2002 to May 2003. Five hundred and twelve faecal specimens were studied by IDEIA TM Rotavirus enzyme immunoassay test (EIA) and Diarlex ® MB immunochromatographic test (ICG). Specimens giving discrepant results were examined by electron microscopy (EM) and clinical data reconsidered. Out of 512 stool specimens, 155 (30.3%) were positive and 332 (64.8%) negative with the two assays. Discrepant results were obtained for 25 (4.88%) specimens (24 children, 1 adult), with EIA giving more positive results. The retrospective examination by EM, possible for fifteen stools on the 25 that gave discrepant results, confirmed the presence of rotavirus in 7/14 stools which were positive only by EIA and in the stool specimen that was found positive only by ICG. The 25 clinical observations re-examination showed the presence of GEA signs in all cases. The statistical analysis shows an excellent concordance between the EIA and the ICG tests (kappa = 0.89, IC 95% = [0.85–0.93]) in spite of the underestimation of ICG test in comparison with EIA test ( P < 0.0001).

Local recurrence is an important prognostic factor of hepatocellular carcinoma

To clarify the importance of complete treatment by PEIT. A total of 140 previously untreated cases of HCC were enrolled in this study from 1988 to 2002. The inclusion criteria were: a solitary tumor less than 4 cm in diameter or multiple tumors, fewer than four in number and less than 3 cm in diameter, without extrahepatic metastasis or vessel invasion. As general principles for the treatment of HCC, the patients underwent transcatheter arterial chemoembolization (TACE) prior to PEIT. After the initial treatment of the patients, ultrasonography and computed tomography were performed, and measurement of serum levels of alpha-fetoprotein (AFP) was determined. When tumor recurrences were detected, PEIT and/or TACE were repeated whenever the hepatic functional reserve of the patient permitted. We then analyzed the variables that could influence prognosis, including tumor size and number, the serum levels of AFP, the parameters of hepatic function (albumin, bilirubin, ALT, hepaplastin test, platelet number, and indocyanine green retention at 15 min (ICG-R15)), combined therapy with TACE, distant recurrence, and local recurrence. Univariate analysis identified the ICG test, serum levels of AFP and albumin, tumor size and number, and local recurrence, but not distant recurrence, as significant prognostic variables. In multivariate analysis using those five parameters, the ICG test, tumor size, tumor number, and local recurrence were identified as significant prognostic factors. In both univariate and multivariate analyses, the relative risk for the ICG test was the highest, followed by local recurrence. We found that local recurrence is an independent prognostic factor of HCC, indicating that achieving complete treatment for HCC on first treatment is important for improving the prognosis of patients with HCC.