Curative treatments which include surgical resection percuta

Curative treatments, which include surgical resection, percutaneous ablation and liver transplantation, were considered as the optimal treatment for patients with very early/early stage HCC by BCLC criteria. Furthermore, advances in liver surgery make the resection of large and/or multifocal HCC possible. Therefore, surgical resection may be a safe and effective therapy for a certain segment of intermediate stage HCC patients. A previous study of intermediate stage HCC, CTP class A cirrhotic patients reported that Biotin-azide patients receiving surgical resection had better survival than those with TACE. In our study, most patients (97%) who received surgical resection had CTP class A cirrhosis. Similar to previous studies, our results showed that patients with surgical resection had significantly higher long-term survival rates than patients with TACE. In addition, CTP class B cirrhosis was identified as independent risk factors associated with poor prognosis. Taken together, the selection of ideal candidates with preserved liver function for surgical resection should improve long-term survival of intermediate stage HCC. In our study, AFP level >400 ng/ml was a risk factor associated with poor prognosis. Serum AFP level has been recognized as a poor prognostic factor through poor tumor biological behavior, such as tumor multiplicity, poor differentiation and carcinoma cell embolus, as well as moderate/severe cirrhosis. Therefore, incorporation of AFP level to current HCC staging systems is recommended in evaluating prognosis and subclassification for intermediate stage HCC patients to tailor optimal therapeutic modality.
Conflict of interest
Acknowledgments The study was supported by grants from the Taipei City Hospital (96001-62-009).
Introduction The first transcranial operation on a pituitary adenoma was performed by Victor Horsley in 1904; 3 years later, the first trans-sphenoidal operation was performed by Hermann Schloffer. A direct endonasal approach to the sella, requiring removal of the middle turbinate and part of the nasal septum, was first described by Hirsch in 1910. In 1912, Cushing introduced the sublabial trans-sphenoidal approach, which Dott, Guiot, and Hardy repopularized in the 1950s and 60s. Although the sublabial approach has been the favored surgical route to the sella for many years, an endonasal approach with the operating microscope, and more recently with the endoscope alone or an endoscope-assisted approach, has gained popularity, both for neurosurgeons and their patients. The endonasal approach, currently used by many pituitary surgeons, was first described by Griffith in 1987 as a refinement of Hirsch\'s original approach. Instead of three mucosal tunnels, as in the sublabial route, or one mucosal tunnel, as utilized in the transseptal approach, the direct endonasal approach requires no mucosal tunnels and only one mucosal incision in the posterior nasal cavity (Fig. 1) (Fig. 2). We have been using the direct endonasal approach for all pituitary tumors for many years. This report documents our experiences with 39 patients who underwent endonasal resection of a pituitary adenoma or other sellar lesions and 9 patients who received craniotomy removal of a pituitary tumor.
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Conflict of interest
Introduction Mastocytosis indicates a group of disorders characterized by excessive mast cell accumulation in one or multiple organs and is a type of myeloproliferative neoplasm disorder, according to the 2008 World Health Organization (WHO) classification of tumors of hematopoietic and lymphoid tissues Non-Hodgkin lymphoma. Mastocytosis is heterogeneous and can involve multiple sites, ranging from skin lesions, which may spontaneously resolve to highly aggressive mast cell leukemia associated with multiple organ failure. It is a rare disease and its exact incidence is unknown. Subtypes of mastocytosis are recognized primarily through clinical presentation and distribution of disease. Mast cell infiltration confined to the skin is cutaneous mastocytosis, whereas systemic mastocytosis (SM) is regarded as involvement of at least one extra-cutaneous organ with or without the presence of skin lesions. Clinically, SM is classified as indolent SM (ISM), aggressive SM (ASA), SM with associated clonal hematological non-mast cell lineage disease (SM-AHMND), and mast cell leukemia (MCL). ISM, the most common subgroup among SM, usually refers to symptoms resulting from mast cell degranulation, mediator release, allergies or anaphylaxis and no evidence of extra-cutaneous organ dysfunction or failure, while ASM indicates the presence of extra-cutaneous organ dysfunction or failure caused by mast cell infiltration. On the other hand, SM-AHNMD is the second most common SM subgroup and myeloid neoplasm is reported most frequently as hematological non-mast cell lineage disease. Bone marrow (BM) examination is suggested as part of the initial diagnostic work-up for SM, because BM is almost universally involved in adult mastocytosis. Furthermore, BM examination also allows for the detection of a second hematological neoplasm. Since SM is an uncommon disease, SM coexistent with lymphoid neoplasm is extremely rare. Here, we present an interesting case of SM coexistent with diffuse large B cell lymphoma (DLBCL).