RESUMEN
BACKGROUND: To assess whether the effectiveness of a combination of transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) is superior to PEI alone in the treatment of patients with small hepatocellular carcinoma (HCC), a randomized controlled study was performed. METHODS: Fifty-two patients with one to three HCC tumors measuring < than 3 cm in greatest dimension were enrolled and underwent the combination TACE-PEI therapy (26 patients with 31 nodules) or PEI alone (26 patients with 34 nodules). There were no significant differences in background between the two groups. The mean follow-up was 30.1 months +/- 17.5 months. RESULTS: The cumulative detection rates of local residual disease in the TACE-PEI group (3.7% at 1 year and 19.3% at 3 years) were significantly lower compared with the detection rates in the PEI alone group (34.2% and 39.3%, respectively; P = 0.013). The cumulative new nodular recurrence rates in the TACE-PEI group (8.7% at 1 year and 19.3% at 3 years) tended to be lower compared with the recurrence rates in the PEI alone group (26.9% and 80.1%, respectively; P = 0.057). The cumulative survival rates were not significantly different between the two groups (TACE-PEI group: 100%, 80.8%, and 40.4% at 1 year, 3 years, and 5 years, respectively; PEI alone group: 91.3%, 65.9%, and 37.7%, respectively; P = 0.458). However, among the patients from each group with HCC tumors measuring < 2 cm, the survival rates in the TACE-PEI group were improved compared with the survival rates in the PEI alone group (P < 0.01) in addition to the detection rates of local residual disease and the new nodular recurrence rates (P < 0.01 and P = 0.047, respectively). The frequency of short-term and long-term adverse effects was not significantly different between the groups. However, only two major complications (biloma and ascites with pleural effusion) were observed, both of which occurred in patients in the TACE-PEI group. CONCLUSIONS: Combination therapy with TACE-PEI was superior to PEI alone in the treatment of patients with small HCC tumors, especially for patients with HCC tumors measuring < 2 cm in greatest dimension.
Asunto(s)
Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica , Etanol/administración & dosificación , Neoplasias Hepáticas/terapia , Anciano , Carcinoma Hepatocelular/mortalidad , Terapia Combinada , Femenino , Humanos , Neoplasias Hepáticas/mortalidad , Masculino , Recurrencia Local de NeoplasiaRESUMEN
The case of a 77-year-old woman with hepatitis C virus infection with a 5-year history of muscle weakness and mild disturbance of gait is reported. Steroid therapy did not improve her symptoms. She developed HCV-related liver cirrhosis and hepatocellular carcinoma, and muscle biopsy revealed inclusion body myositis. Immunohistochemistry showed that the nonstructural region of HCV and 8-hydroxy-2'-deoxyguanosine, a marker of DNA damage by reactive oxygen species, were present in striated muscle cells of this patient.
Asunto(s)
Hepatitis C Crónica/patología , Cuerpos de Inclusión Viral/patología , Miositis/patología , Anciano , Carcinoma Hepatocelular/virología , Femenino , Hepatitis C Crónica/complicaciones , Humanos , Cirrosis Hepática/virología , Neoplasias Hepáticas/virología , Miositis/virologíaRESUMEN
Hepatitis virus infection through virus reactivation has a high risk of mortality in patients with hematological malignancies receiving chemotherapy. We examined the incidence of both hepatitis B virus (HBV) and hepatitis C virus (HCV) infection and severe liver dysfunction (alanine aminotransferase >ten times the normal upper limit and total bilirubin >5 mg/dl) during chemotherapy in 268 patients with hematological malignancies. Eight patients (3.0%) were infected with HBV and 22 patients (8.2%) were infected with HCV. One patient (0.4%) was infected with both HBV and HCV. HBV- or HCV-infected patients showed severe liver dysfunction at a significantly higher incidence than non-infected patients (11/31 (35.5%) vs. 0/237 (0%), p<0.0001). Furthermore, the incidence of severe liver dysfunction in HBV-infected patients was significantly higher than in HCV-infected patients (6/8 (75.0%) vs. 4/22 (18.2%), p<0.01). Three of eight HBV-infected patients were initially negative for hepatitis B surface antigen (HBsAg) by latex agglutination and became positive for HBsAg during chemotherapy. Furthermore, all three patients developed severe liver dysfunction and two developed fatal fulminant hepatitis. From an examination of the original stock of serum samples before chemotherapy, two patients were found to be positive for HBV-DNA by polymerase chain reaction (PCR). Although post-transfusion HBV infection was suspected in the one remaining patient, the cause of HBV infection could not be clarified due to the impossibility of examination in blood donors. Since HBV-infected patients develop severe liver dysfunction at a higher incidence than either patients not infected with virus or HCV-infected patients before chemotherapy for hematological malignancies, it is recommended that HBV-DNA should be tested by PCR to detect HBV marker-negative carriers and liver function tests should be carefully monitored.
Asunto(s)
Antineoplásicos/farmacología , Neoplasias Hematológicas/tratamiento farmacológico , Hepacivirus/efectos de los fármacos , Virus de la Hepatitis B/efectos de los fármacos , Hepatitis B/epidemiología , Hepatitis C/epidemiología , Hígado/fisiopatología , Activación Viral/efectos de los fármacos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos/uso terapéutico , ADN Viral/sangre , Femenino , Neoplasias Hematológicas/complicaciones , Hepacivirus/fisiología , Hepatitis B/complicaciones , Hepatitis B/fisiopatología , Hepatitis B/transmisión , Antígenos de Superficie de la Hepatitis B/sangre , Virus de la Hepatitis B/fisiología , Hepatitis C/complicaciones , Hepatitis C/fisiopatología , Humanos , Incidencia , Japón/epidemiología , Fallo Hepático/etiología , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Reacción a la TransfusiónRESUMEN
The aim of the present study is to evaluate whether interferon alpha (IFNalpha) therapy can inhibit intrahepatic recurrence after the curative treatment of small HCC with underlying chronic hepatitis C. Forty patients were enrolled in this study. They had solitary, small HCC
RESUMEN
We report a case of a 41-year-old man with acute myelogenous leukemia who developed fulminant hepatitis from reactivation of trace hepatitis B virus (HBV) 2 months after complete remission. Although he became positive for HB surface antigen at the onset of fulminant hepatitis, he had been negative for HBV serum markers, and only HBV DNA was detected by polymerase chain reaction (PCR) amplification on admission. The original stocks of serum samples from all blood donors were tested again for HBV DNA by PCR, and all samples were negative. This case demonstrates that testing for HBV DNA by PCR is necessary before chemotherapy, because silent HBV carriers are rare and fulminant hepatitis may be induced by chemotherapy in patients with hematologic malignancies.
Asunto(s)
Antineoplásicos/efectos adversos , Hepatitis B/etiología , Leucemia Mieloide Aguda/complicaciones , Fallo Hepático/virología , Adulto , ADN Viral/sangre , Hepatitis B/inducido químicamente , Virus de la Hepatitis B/genética , Virus de la Hepatitis B/crecimiento & desarrollo , Humanos , Terapia de Inmunosupresión/efectos adversos , Leucemia Mieloide Aguda/tratamiento farmacológico , Masculino , Reacción en Cadena de la Polimerasa , Activación Viral/efectos de los fármacosRESUMEN
Information about M6P/IGF2R and p53 genes in hepatocarcinogenesis is limited and controversial. We tested the loss of heterozygosity (LOH) of M6P/IGF2R and p53 genes in cirrhotic and neoplastic foci in surgically resected livers of 30 patients with hepatocellular carcinoma (HCC). The DNAs extracted from microdissected specimens were used for polymerase-chain-reaction (PCR)-based assay. LOH of the M6P/IGF2R gene in the primary HCCs was detected in 10 of 22 informative cases (45%). In five of these 10 cases (50%), LOH was detected in cirrhotic lesions adjacent to the HCCs. The allelic loss patterns of M6P/IGF2R in liver cirrhosis (LC) were identical to those in the corresponding HCC, suggesting that HCC could develop from one of the cells in which M6P/IGF2R had been lost. Furthermore, LOH of the p53 gene in HCC was detected in 10 (43%) of 23 informative cases, and p53 loss in cirrhotic foci adjacent to HCC was shown in one of the 10 cases (10%). The pattern of allelic loss of the p53 gene in the cirrhotic foci was identical with that in the corresponding tumor. The LOH of the M6P/IGF2R and p53 genes occurred independently in HCCs. LOH of the M6P/IGF2R locus was a relatively frequent and possibly early event in hepatocarcinogenesis, and LOH of the M6P/IGF2R gene and LOH of the p53 gene occurred independently.
RESUMEN
We present a case of severe exacerbation of hepatitis after short-term corticosteroid therapy for chronic inflammatory demyelinating polyneuropathy (CIPD) with "latent" chronic hepatitis B showing no HBV-related antigens and antibodies. After corticosteroid pulse therapy for CIPD, the patient had severe exacerbation of hepatitis twice. Although she did not show any hepatitis B virus (HBV)-related antigens or antibodies, sequences of HBV were detected in serum and liver by a nested polymerase chain reaction. A sequence analysis of HBV at the second exacerbation showed that the G-to-A point mutation at nucleotide 1896 that converted codon 28 from tryptophan (TGG) to a stop codon (TAG) in the precore region resulted in amino acid change, which has been frequently observed in fulminant hepatitis and severe hepatitis in Japan.
Asunto(s)
Corticoesteroides/uso terapéutico , Hepatitis B Crónica/complicaciones , Hepatitis B Crónica/patología , Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante/complicaciones , Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante/tratamiento farmacológico , Corticoesteroides/farmacología , Adulto , Antígenos de Superficie/sangre , Antígenos de Superficie/inmunología , Secuencia de Bases , Biopsia , ADN Viral/sangre , ADN Viral/genética , Femenino , Virus de la Hepatitis B/efectos de los fármacos , Virus de la Hepatitis B/genética , Virus de la Hepatitis B/fisiología , Hepatitis B Crónica/virología , Histocitoquímica , Humanos , Hígado/efectos de los fármacos , Hígado/patología , Hígado/virología , Datos de Secuencia Molecular , Mutación Puntual/genética , Reacción en Cadena de la Polimerasa , Análisis de Secuencia de ADN , Factores de TiempoRESUMEN
A 75-year-old cirrhotic man, after undergoing percutaneous acetic acid injection therapy for hepatocellular carcinoma, presented high fever and right hypochondralgia. Computed tomography disclosed an area of low attenuation in the liver and a crescent-shaped intraperitoneal lesion adjacent to it. We diagnosed liver perforation and localized peritonitis due to the leakage of acetic acid following acetic acid injection. It is important to consider this serious complication when evaluating the indications for percutaneous acetic acid injection for hepatocellular carcinoma.
Asunto(s)
Ácido Acético/efectos adversos , Carcinoma Hepatocelular/tratamiento farmacológico , Inyecciones Intralesiones/efectos adversos , Neoplasias Hepáticas/tratamiento farmacológico , Hígado/lesiones , Ácido Acético/administración & dosificación , Anciano , Humanos , Hígado/diagnóstico por imagen , Masculino , Peritonitis/diagnóstico por imagen , Peritonitis/etiología , Tomografía Computarizada por Rayos XRESUMEN
Hepatitis B virus (HBV) genome was reported to be detected in serum or liver tissues in hepatocellular carcinoma (HCC) patients negative for hepatitis B surface antigen (HBsAg). Hepatitis B x (HBx) and p53 protein were reported to play an important role in HBV-related hepatocarcinogenesis. To clarify latent HBV infection in HBsAg- and anti-hepatitis C virus (anti-HCV)-negative HCC in a Japanese population and involvement of HBx and p53 protein in these patients, we performed the sensitive and specific nested polymerase chain reaction (PCR) and immunohistochemical analysis. Of 1,024 HCC patients we saw between 1974 and 1998, 66 (6.4%) were negative for HBsAg and anti-HCV. Serum DNA was amplified by nested PCR by using specific primers of surface (S), core (C) and X regions in 26 patients negative for HBsAg and anti-HCV. Eighteen (69%) patients were positive for either S, C, or X region and the results of PCR were confirmed by Southern blotting. Of 18 PCR-positive patients, 3 were positive for anti-HBs and 9 were positive for anti-HBc, however, one was negative for any HBV markers. In HBsAg-negative and PCR-positive patients, the positive rates of expression of HBx and p53 were 8/13 (62%) and 7/13 (54%), being comparable to those in HBsAg-positive HCC patients. The results of the present study suggest that high prevalence of HBV infection is observed in HBsAg-negative HCC in a Japanese population and expression of HBx and p53 is consistent with a role, in these patients, for the transforming ability of these proteins.
Asunto(s)
Carcinoma Hepatocelular/complicaciones , Hepatitis B/complicaciones , Neoplasias Hepáticas/complicaciones , Transactivadores/metabolismo , Proteína p53 Supresora de Tumor/metabolismo , Anciano , Anciano de 80 o más Años , Carcinoma Hepatocelular/virología , Femenino , Genes p53 , Hepatitis B/virología , Antígenos de Superficie de la Hepatitis B/metabolismo , Virus de la Hepatitis B/genética , Virus de la Hepatitis B/aislamiento & purificación , Humanos , Inmunohistoquímica , Japón , Neoplasias Hepáticas/virología , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Transactivadores/genética , Proteína p53 Supresora de Tumor/genética , Proteínas Reguladoras y Accesorias ViralesRESUMEN
BACKGROUND/AIMS: The aim of this study was to evaluate the effect of interferon alpha on the metabolism of hepatic fibrosis in chronic hepatitis C, monitoring serum tissue inhibitor of matrix metalloproteinase-1(TIMP-1) and N-terminal propeptide of type III procollagen (PIIINP) reflecting fibrolysis and fibrogenesis, respectively. METHODS: Serum levels of TIMP-1 and PIIINP were serially measured in 112 treated and 31 untreated patients with chronic hepatitis C during and after interferon alpha treatment. Furthermore, the relationships between these serum markers and the grades of hepatic fibrosis after interferon therapy were also investigated. RESULTS: Serum pretreatment levels of TIMP-1 and PIIINP in non-responders were significantly higher than those in sustained and transient responders, but these levels were not different in the latter two groups. Serum TIMP-1 levels decreased significantly during and after treatment in sustained responders, and decreased temporarily at the end of treatment in transient responders, although these levels were unchanged during and after treatment in non-responders and untreated patients. In contrast, serum PIIINP levels decreased significantly during and after treatment in all treated groups, but were unchanged in untreated patients. Histological examination 12 months after interferon was completed demonstrated that hepatic fibrosis improved in sustained responders and was unchanged in transient and non-responders, but progressed in untreated patients. CONCLUSION: These results suggest that interferon alpha treatment of chronic hepatitis C may improve hepatic fibrosis in sustained responders by the acceleration of fibrolysis as well as the inhibition of fibrogenesis, and that it may suppress the progression of hepatic fibrosis in non-sustained responders by the inhibition of fibrogenesis.
Asunto(s)
Antivirales/administración & dosificación , Hepatitis C Crónica/sangre , Hepatitis C Crónica/tratamiento farmacológico , Interferón Tipo I/administración & dosificación , Interferón-alfa/administración & dosificación , Fragmentos de Péptidos/sangre , Procolágeno/sangre , Inhibidor Tisular de Metaloproteinasa-1/sangre , Biomarcadores , Femenino , Hepatitis C Crónica/patología , Humanos , Hígado/patología , Masculino , Persona de Mediana Edad , Proteínas RecombinantesRESUMEN
The presence of serum anti-p53 antibody has been reported to be associated with survival of patients with breast cancer, ovarian cancer, and hepatocellular carcinoma. To clarify prognostic significance of p53 antibody in colorectal cancer, serum p53 antibody was measured in patients with colorectal cancer. The 89 patients included 71 with colorectal cancer and 18 with colon polyp. An enzyme-linked immunosorbent assay was used to detect p53 antibodies in serum. Clinicopathological parameters such as age, sex, degree of differentiation of cancer, location of tumor, liver metastasis, stage classification, Dukes classification, CEA, CA19-9, and immunostaining of p53 and anti-p53 antibody were evaluated as prognostic factors of colorectal cancer. p53 antibody was positive in 18 of 71 (25%) with colorectal cancer, whereas it was positive in only 1 of 18 (6%) with colon polyp. The patients with p53 antibody had higher CEA and CA19-9 levels, higher positive rates of p53 protein expression in cancer cells, and higher liver metastasis rates. The p53 antibody positivity at stage classification I-IIIb/ Dukes classification A-C was significantly lower than that at stage classification IV/Dukes classification D. Overall survival in colorectal cancer patients with p53 antibody was significantly shorter than in those without p53 antibody. A Cox regression analysis showed that liver metastasis, stage classification, Dukes classification, CA19-9, and p53 antibody were significant prognostic factors in colorectal cancer. Serum anti-p53 antibody could serve as one of the prognostic factors in patients with colorectal cancer.
Asunto(s)
Anticuerpos Antineoplásicos/sangre , Biomarcadores de Tumor/sangre , Pólipos del Colon/diagnóstico , Neoplasias Colorrectales/diagnóstico , Proteína p53 Supresora de Tumor/inmunología , Anciano , Antígeno CA-19-9/sangre , Antígeno Carcinoembrionario/sangre , Pólipos del Colon/mortalidad , Neoplasias Colorrectales/mortalidad , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Análisis de Regresión , Tasa de SupervivenciaRESUMEN
BACKGROUND: Percutaneous ethanol injection therapy has been used widely for small hepatocellular carcinoma. This study was undertaken to determine factors predictive of local recurrence or new nodular recurrence in patients with small hepatocellular carcinoma treated with percutaneous ethanol injection. METHODS: The authors studied 73 nodules treated with percutaneous ethanol injection in 49 patients with small hepatocellular carcinoma. The usefulness of predictive factors for recurrence was assessed with the Kaplan-Meier method. The clinicopathologic variables examined included age, gender, Child-Pugh classification, number of tumors (single vs. multiple), tumor size, degree of tumor differentiation, ultrasonographic findings such as peripheral hypoechoic band (so-called 'halo'), intratumoral echo pattern, tumor staining on enhanced computed tomography, combination therapy with transcatheter arterial embolization, and serum alpha-fetoprotein level. RESULTS: The local recurrence rates were 19%, 27%, 33%, 33%, and 33%, respectively, and the new nodular recurrence rates were 19%, 51%, 74%, 83%, and 83%, respectively, at 1, 2, 3, 4, and 5 years after percutaneous ethanol injection therapy. The frequency of local recurrence was associated with the histologic differentiation of more than moderately differentiated (P < 0.001), presence of a sonographic halo (P < 0. 005), an intratumoral heterogeneous echo pattern (P < 0.001), and positive tumor staining on enhanced computed tomography (P < 0.01). Multivariate analysis showed that the presence of a halo and an intratumoral heterogeneous echo pattern were the most important variables for predicting local recurrence. The frequency of new nodular recurrences was related to the presence of multiple tumors (P < 0.01) and a high serum alpha-fetoprotein level (P < 0.001). Multivariate analysis showed that a high serum alpha-fetoprotein level was a reliable predictor of new nodular recurrence. CONCLUSIONS: This study showed that the presence of a halo and an intratumoral echo pattern on ultrasonography were useful predictors for local recurrence after percutaneous ethanol injection therapy for small hepatocellular carcinoma, and that a high serum alpha-fetoprotein level was associated with a higher frequency of new nodular recurrences.
Asunto(s)
Antineoplásicos/uso terapéutico , Carcinoma Hepatocelular/patología , Etanol/uso terapéutico , Neoplasias Hepáticas/patología , Recurrencia Local de Neoplasia/etiología , Adulto , Factores de Edad , Anciano , Antineoplásicos/administración & dosificación , Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/tratamiento farmacológico , Diferenciación Celular , Embolización Terapéutica , Etanol/administración & dosificación , Femenino , Predicción , Humanos , Inyecciones Intralesiones , Cirrosis Hepática/clasificación , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Análisis Multivariante , Recurrencia Local de Neoplasia/patología , Reproducibilidad de los Resultados , Factores Sexuales , Tomografía Computarizada por Rayos X , Ultrasonografía , alfa-Fetoproteínas/análisisAsunto(s)
Antivirales/administración & dosificación , Hepatitis C Crónica/tratamiento farmacológico , Interferón-alfa/administración & dosificación , Cirrosis Hepática/patología , Biomarcadores/sangre , Hepatitis C Crónica/sangre , Hepatitis C Crónica/patología , Humanos , Fragmentos de Péptidos/sangre , Procolágeno/sangre , Pronóstico , Sensibilidad y EspecificidadRESUMEN
We retrospectively compared the outcome of 13 patients at our institution and that of 163 reported cases of pedunculated hepatocellular carcinoma (HCC) with that of conventional HCC subdivided by tumor diameter (group A: less than 2 cm; group B: 2-5 cm, group C: more than 5 cm). The survival of patients with pedunculated HCC in the 163 reported cases was no different from that of group B, but less favorable than in group A (p < 0.01) and more favorable than in group C (p < 0.01). Among the 163 patients with pedunculated HCC, the 113 cases of surgically treated patients had higher survival than the 21 patients treated with transcatheter arterial embolization (n = 16) or transcatheter arterial infusion chemotherapy (n = 5) (p < 0.01) and than 29 conservatively treated patients (p < 0.001). A total of 70 patients out of 163 (42%) died within 1 year after diagnosis. Additionally, almost all cases of pedunculated HCC showed histologically moderately or poorly differentiated characteristics according to Edmondson and Stainer's classification or the WHO classification. These results suggest that pedunculated HCC has not a favorable prognosis if appropriate surgical resection has not been performed very early within a few months because of its rapid progressive nature.
Asunto(s)
Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/terapia , Adulto , Anciano , Antineoplásicos/uso terapéutico , Carcinoma Hepatocelular/sangre , Carcinoma Hepatocelular/tratamiento farmacológico , Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/cirugía , Progresión de la Enfermedad , Embolización Terapéutica , Femenino , Humanos , Infusiones Intraarteriales , Neoplasias Hepáticas/sangre , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
Hepatic vitronectin expression was assessed in 27 patients with chronic hepatitis C before and after interferon alpha treatment and in 7 control patients. Before interferon therapy, vitronectin was localized in the hepatocytes and in the portal and central venous regions. A high correlation was found for the vitronectin expression level with the histological grading and staging scores in the hepatocytes as well as in the portal region. After interferon therapy, the hepatic vitronectin was significantly decreased in the sustained and transient responders, but it was not as markedly decreased in the nonresponders and the non-treated group. A good correlation was found for the vitronectin expression with the staging scores but not with the grading scores in the portal region. These findings suggest that hepatic vitronectin is influenced by interferon therapy and that it may play an important role as a hepatic adhesion molecule through the improvement of inflammation, necrosis and fibrogenesis.
Asunto(s)
Antivirales/uso terapéutico , Hepatitis C Crónica/tratamiento farmacológico , Interferón-alfa/uso terapéutico , Hígado/metabolismo , Vitronectina/metabolismo , Femenino , Hepatitis C Crónica/metabolismo , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana EdadRESUMEN
We present 3 patients who developed choledocholithiasis 10, 13, and 12 months after percutaneous ethanol injection and/or transcatheter arterial chemoembolization for hepatocellular carcinoma. Since none of these patients had stones in the gallbladder or in the bile ducts before treatment, bile duct stones might have resulted from local injury in the bile ducts by percutaneous ethanol injection and/or transcatheter arterial chemoembolization. Choledocholithiasis may be a late complication of nonresectional and local therapies for hepatocellular carcinoma tumors.
Asunto(s)
Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica/efectos adversos , Etanol/efectos adversos , Cálculos Biliares/inducido químicamente , Neoplasias Hepáticas/terapia , Anciano , Carcinoma Hepatocelular/diagnóstico por imagen , Colangiografía , Endoscopía del Sistema Digestivo , Etanol/administración & dosificación , Femenino , Cálculos Biliares/diagnóstico por imagen , Cálculos Biliares/terapia , Humanos , Inyecciones Intraarteriales , Litotricia , Neoplasias Hepáticas/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
Portal vein thrombosis as a complication of liver cirrhosis has been reported to be extremely rare in Japan, as compared with European countries. There are few reports discussing the correlation of portal vein thrombosis with refractory ascites. Between January 1994 and December 1995, 20 cases (91%) of 22 patients with liver cirrhosis with ascites admitted to our hospital responded well within 2 months to a combination therapy of diuretics and albumin infusion, and the other two cases (9%) with refractory ascites were associated with portal vein thrombosis. The ascites in the first patient continued for 1 year, despite diuretics and albumin infusion therapy, and portal vein thrombosis was confirmed by autopsy. The ascites in the other patient continued for more than 4 months, and portal vein thrombosis was detected by ultrasound. Portal vein thrombosis was not found in the other 20 cirrhotic patients with ascites. These two cases suggest that portal vein thrombosis may be a contributing factor to refractory ascites in patients with decompensated liver cirrhosis.
Asunto(s)
Ascitis/etiología , Cirrosis Hepática/complicaciones , Vena Porta , Trombosis de la Vena/etiología , Ascitis/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia del TratamientoRESUMEN
Agenesis or hypoplasia of the hepatic lobe and floating gallbladder are both rare. We report an extremely rare case of hypoplasia of the left hepatic lobe accompanied by floating gallbladder. The patient was a 71-year-old woman, with no past history of related symptoms, who was admitted for further evaluation of postprandial epigastralgia, nausea, and diarrhea. Laboratory data on admission showed chronic liver disease with positive anti-hepatitis C virus antibody. Abdominal ultrasonography and computed tomography revealed the absence of the left hepatic lobe and displacement of the gallbladder to the left. On endoscopic retrograde cholangiography, the cystic duct originated from the right side of the bile duct, but the gallbladder was displaced to the left. Poor yolk-induced gallbladder contraction suggested the existence of hypotonic biliary dyskinesia. Angiography demonstrated no middle or left hepatic arteries, indicating congenital hypoplasia of the left hepatic lobe. Open cholecystectomy was carried out, and a diagnosis of hypoplasia of the left hepatic lobe accompanied by floating gallbladder and chronic hepatitis was confirmed. We believe that this is the first reported case of a hypoplasia of the left hepatic lobe coexisting with floating gallbladder.