Acute Gastric Lesions Induced by Transcatheter Arterial Embolization and Intra-arterial Infusion Chemotherapy for Hepatocellular Carcinoma

We performed an endoscopic study of the acute gastric lesions induced by transcatheter arterial embolization (TAE) and infusion chemotherapy (one shot infusion: OSI). Forty-eight patients with primary hepatocellular carcinoma were investigated, and of them, 25 received TAE and 23 were treated with OSI. Endoscopy was performed within 1 week both before and after therapy and any gastric mucosal changes were noted. Before treatment, all patients had gastric lesions such as redness, erosion, hemorrhage and ulcer. These lesions were exacerbated or new lesions appeared after both TAE and OSI in about 50% of the subjects, and no significant difference in the incidence of lesions was observed between these two treatments. Moreover, there was no significant correlation between the exacerbation or new appearance of gastric lesions and the Child's classification, the catheter position, or the presence or absence of A-P shunt or portal thrombus. The appearance and/or exacerbation of these gastric lesions was not prevented by the administration of common antiulcer drugs before treatment. Thus the possibility that these gastric effects of TAE and OSI may occur should always be kept in mind and appropriate preventive or therapeutic measures should be adopted.     

Transcatheter Hepatic Arterial Drug Infusion Therapy for Hepatocellular Carcinoma: Effect on the Arterial Ketone Body Ratio

The arterial ketone body ratio (acetoacetate to β-hydroxybutyrate) was measured in 15 patients with chronic liver disease before and after the infusion of anticancer drugs or embolic agents (gelatin sponge or iodized oil) into the hepatic artery. The arterial ketone body ratio decreased after hepatic angiography and decreased further at 15 min after infusion therapy. When the arterial ketone body ratio decreased to 1.0 or less on at least one occasion after infusion therapy, the ratio after hepatic angiography was always 1.35 or less. Such patients developed marked systemic symptoms like fever and severe liver dysfunction. Ascites also developed in three patients in whom the arterial ketone body ratio was reduced to 0.7 or less at 24 h after infusion therapy. The arterial ketone body ratios improved at 3–7 days after infusion therapy. In the seven patients treated with gelatin sponge embolization, the ratio at 3–7 days after therapy was actually higher than that before angiography.     

Successful Management of Resuscitative Endovascular Balloon Occlusion of the Aorta for Hemorrhagic Shock Due to Ruptured Hepatocellular Carcinoma

A 68-year-old man was transferred to our hospital because of sudden right costal pain with unmeasurable hypotension. Ultrasonography revealed possible hemorrhagic shock due to ruptured hepatocellular carcinoma (HCC). As the patient was not hemodynamically stable after primary treatment, resuscitative endovascular balloon occlusion of the aorta (REBOA) was performed, and hemodynamic stability was then achieved. Contrast-enhanced computed tomography confirmed the diagnosis. Transcatheter artery embolization with gelatin sponge particles and coils eliminated the extravasation. The patient was discharged on day 36 post-procedure. Our observations suggest that REBOA may help achieve hemodynamic stability in cases of ruptured HCC.     

Laparoscopic Microwave Coagulation for the Treatment of Hepatocellular Carcinoma

Abstract: Laparoscopic microwave coagulation (LMC) has recently been indicated for hepatocellular carcinoma (HCC). LMC was performed in 14 patients with a total of 22 HCCs in the 18-month period from November 1996 to April 1998. The size of HCCs ranged from 10 mm to 100 mm, with an average diameter of 29.3 mm. The duration of microwave emission ranged from 8 min to 54 min; average 26.4 mm. Sufficient microwave emission was possible even in cases of multiple HCC large HCC, and HCC located deep within the liver, with the aid of laparoscopy and intraperitoneal ultrasound. Recurrence was observed in 4 out of 22 HCCs, and was treated by transcatheter arterial embolization (TAE) or percutaneous ethanol injection (PEI). LMC facilitates local control of HCC, and is a promising new therapeutic modality for HCC. (Dig Endosc 1999; 11: 137–143)     

Therapeutic Results of Computed-Tomography-Guided Transcatheter Arterial Chemoembolization for Local Recurrence of Hepatocellular Carcinoma After Initial Transcatheter Arterial Chemoembolization: The Results of 85 Recurrent Tumors in 35 Patients

The aim of this study was to retrospectively evaluate the long-term results of transcatheter arterial chemoembolization (TACE) for the treatment of local recurrence of hepatocellular carcinoma (HCC) after the first TACE. Between September 1992 and October 2004, 85 recurrent HCC nodules of 35 patients were treated by TACE. During the median follow-up period of 15.5 months (range 1.9–58.6 months), 58 of the 85 treated tumors developed local recurrence again after the second TACE. The overall 6-, 12-, and 36-month recurrence-free rates of these tumors after the second TACE were 47.0%, 36.2%, and 25.8%, respectively. Local recurrence of HCC after the first TACE was treated by a second TACE with equivalent efficacy as that of the initial TACE, if segmental chemoembolization was achieved. We regard TACE as the treatment of choice for the management of local recurrence of HCC.     

A Rare Case of Megaloblastic Anaemia Caused by Disturbances in the Plasma Cobalamin Binding Proteins in a Patient with Hepatocellular Carcinoma

A patient with hepatocellular carcinoma, megaloblastic anaemia and increased concentration of serum cobalamin is described. Plasma TC I was increased to 10,000 times the normal concentration, thus explaining the increased concentration of serum cobalamin and a false Schilling test. The increase in plasma TC I in concurrence with undetectable amounts of plasma TC II was a likely explanation for the anaemia. The electron microscopic picture of the hepatocellular carcinoma was in accordance with TC I being produced by the tumour cells.     

Malignant Bronchial Carcinoid Tumor Metastatic to the Pituitary in a Thyroid Carcinoma Patient: Successful Treatment with Surgery,Radiotherapy and Somatostatin Analog

A carcinoid pituitary metastasis is very rare, and is reported scarcely in a few patients. We describe an unusual case of metastatic atypical bronchial carcinoid to the anterior pituitary gland in a 47-year-old male who presented with bitemporal hemianopsia and hypopituitarism. His primary bronchial carcinoid was resected two years previously. Foci of metastatic papillary thyroid carcinoma were also identified in the lung resected for the bronchial carcinoid. He thereby underwent total thyroidectomy followed by radioiodine ablative treatment. Transsphenoidal partial removal of the suprasellar mass was performed, and atypical carcinoid metastasis was identified. He received conventional fractionated sellar radiotherapy, which was supplemented with octreotide (Sandostatin LAR) injections following a positive pituitary uptake on octreotide scan. This treatment suppressed his elevated 5-HIAA urinary excretion to a normal level. His vision has returned to normal and the pituitary mass diminished in size.     

Ischemic hepatitis secondary to the spontaneous rupture of a hepatocellular carcinoma in a patient with cirrhosis

Abstract: A patient with alcoholic cirrhosis who developed fatal ischemic hepatitis induced by hemorrhagic shock, due to the spontaneous rupture of a hepatocellular carcinoma, is reported. This was the first manifestation of the hepatic neoplasm. To our knowledge, this is the first case report of ischemic hepatitis of this origin.     

Survival rates according to the Cancer of the Liver Italian Program scores of 345 hepatocellular carcinoma patients after multimodality treatments during a 10-year period in a retrospective study

Background and Aim: The Cancer of the Liver Italian Program (CLIP) score has been demonstrated to have superior prognostic ability in hepatocellular carcinoma (HCC) patients worldwide, but there has never been sufficient assessment of the efficacy of treatment modalities according to the CLIP score. This retrospective cohort study of HCC patients was conducted to assess the efficacy of treatment modalities according to the CLIP score. Methods: We compared the efficacy of hepatic resection (HR) (n = 101), radiofrequency ablation with prior transcatheter arterial chemoembolization (RFA + TACE) (n = 115), percutaneous ethanol injection with prior TACE (PEI + TACE) (n = 43), and TACE (n = 86) as a primary treatment in terms of survival among 345 patients treated at Mie University Hospital between 1995 and 2004, according to CLIP score. Results: The overall survival rates in the RFA + TACE group were significantly higher in the patients with CLIP scores of 1, 2, and 3 or more (5‐year, 70.9%; 3‐year, 73.7%; and 3‐year, 100%, respectively), but they were not significantly different from the 5‐year survival rates of the HR group with a CLIP score of 0 (83.7%). Among the patients with a CLIP score of 0, a significantly higher disease‐free survival rate (5‐year: 33.7%) was obtained in the HR subgroup (n = 35) than in the RFA + TACE subgroup (n = 35), both of which were followed since 2000, but morbidity (21.8%) was highest in the HR group. Conclusion: RFA + TACE is concluded to be a safe treatment modality with better overall survival (5‐year, > 60%) in HCC patients regardless of their CLIP score.     

Transcatheter embolization of a large aneurysm in a congenital coronary cameral fistula from the left coronary artery to the right ventricle

A congenital coronary cameral fistula (CCCF) is characterized by left ventricular dysfunction, electrocardiographic changes due to a reduced left coronary blood flow and impaired physical activity. CCCF's with a giant aneurysm are very rarely seen. The presence of a giant aneurysm imposes even greater health risks. We report a case of a CCCF from the left coronary artery to the right ventricle with a large distal aneurysm in a 20‐year‐old woman that we closed percutaneously with coils for the closure of ventricular septal defects (VSD) and persistent ductus arteriosus (PDA). © 2014 Wiley Periodicals, Inc.