RESUMEN
OBJECTIVE: The treatment of hyperthyroidism associated with severe liver dysfunction (LD) is a clinical challenge, and there has been no unified examination of this problem. The objective of this study was to assess the efficacy and safety of radioiodine (131I) in combination with a molecular adsorbent recirculating system (MARS) for the treatment of hyperthyroidism complicated by severe liver LD. METHODS: A total of 116 hyperthyroidism patients with concomitant LD who received MARS treatment were studied retrospectively. The patients were grouped according to whether or not they also received 131I treatment: Group 1 (59 patients) received 131I following MARS treatment, while Group 2 (57 cases) received only MARS. Clinical outcomes, including thyroid hormone levels, liver function parameters, and therapeutic efficacy were calculated. RESULTS: The overall response rate was significantly greater in Group 1 than in Group 2 (P<.01). The clinical indicators improved significantly in both groups 3 months after treatment compared with before treatment (P<.05), but Group 1 showed a greater improvement. Compared with Group 1, patients in Group 2 had a longer stay in hospital (P<.05), and received more frequent MARS treatments (P<.05). CONCLUSION: The combination of MARS and 131I for the treatment of hyperthyroidism complicated by severe LD was effective and safe. The use of this system could rapidly improve liver function and metabolism, allowing 131I therapy to be applied as early as possible with a shortened recovery time of liver function. ABBREVIATIONS: ALSS = artificial liver support system ALT = alanine transaminase AST = aspartate transaminase ATD = antithyroid drugs DBil = direct bilirubin FT3 = free tri-iodothyronine FT4 = free thyroxine 131I = radioiodine INR = international normalized ratio LD = liver dysfunction MARS = molecular adsorbent recirculating system MELD = model for end-stage liver disease PT = prothrombin time TBil = total bilirubin TSH = thyroid-stimulating hormone.
Asunto(s)
Hipertiroidismo/complicaciones , Hipertiroidismo/terapia , Radioisótopos de Yodo/uso terapéutico , Hepatopatías/complicaciones , Hepatopatías/terapia , Radiofármacos/uso terapéutico , Diálisis Renal/métodos , Adolescente , Adulto , Niño , Preescolar , Estudios de Cohortes , Terapia Combinada , Enfermedad Hepática en Estado Terminal/complicaciones , Enfermedad Hepática en Estado Terminal/terapia , Medicina Basada en la Evidencia , Femenino , Guías como Asunto , Humanos , Hipertiroidismo/radioterapia , Hepatopatías/radioterapia , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Pruebas de Función de la Tiroides , Hormonas Tiroideas/sangre , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: The objective of this work is to report our experience with (131)I therapy without recent antithyroid drug (ATD) pretreatment for refractory severe hyperthyroidism complicated by hyperbilirubinemia due to hepatic dysfunction. METHODS: Five patients with refractory severe hyperthyroidism were treated with (131)I at 90 to 120 µCi/g-thyroid (total activity, 6.2 to 10.1 mCi). The patients previously had received ATD treatment from 2 months to 12 years and discontinued ATDs from 2 months to 4 years before (131)I treatment due to treatment failure or severe jaundice. Prior to (131)I therapy, the patients were asked to take a low-iodine diet and were treated with bisoprolol fumarate, digoxin, furosemide, S-adenosylmethionine, polyene phosphatidylcholine, and plasma exchange as supportive treatment for related clinical conditions. Four of the patients also received lithium carbonate in conjunction with their (131)I treatment. The patients were followed for 4 to 9 years after (131)I therapy. RESULTS: After (131)I treatment, jaundice disappeared completely within 3 to 4 months in all patients, and liver function tests returned to normal. Concurrent atrial fibrillation and heart failure, leukopenia and thrombocytopenia, or thrombocytopenia and left cardiac enlargement improved remarkably in 3 patients during the follow-up period. Three to 45 months after (131)I treatment, hypothyroidism was noted in the patients and they were treated with L-thyroxine replacement therapy. CONCLUSION: (131)I therapy without recent ATD pretreatment for refractory severe hyperthyroidism complicated by serious jaundice appears to be safe and effective, with good long-term results. It may be the preferred therapy for such patients and should be used as early as possible.
Asunto(s)
Hiperbilirrubinemia/radioterapia , Hipertiroidismo/radioterapia , Radioisótopos de Yodo/uso terapéutico , Hepatopatías/radioterapia , Adulto , Antitiroideos/uso terapéutico , Enfermedad Hepática Inducida por Sustancias y Drogas/complicaciones , Enfermedad Hepática Inducida por Sustancias y Drogas/radioterapia , China , Femenino , Humanos , Hiperbilirrubinemia/etiología , Hipertiroidismo/complicaciones , Ictericia/complicaciones , Ictericia/radioterapia , Hepatopatías/complicaciones , Masculino , Metimazol/efectos adversos , Persona de Mediana Edad , Propiltiouracilo/efectos adversos , Estudios Retrospectivos , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVE: To evaluate the efficiency of predicting radiation induced liver disease (RILD) with an artificial neural network (ANN) model. METHODS AND MATERIALS: From August 2000 to November 2004, a total of 93 primary liver carcinoma (PLC) patients with single lesion and associated with hepatic cirrhosis of Child-Pugh grade A, were treated with hypofractionated three-dimensional conformal radiotherapy (3DCRT). Eight out of 93 patients were diagnosed RILD. Ninety-three patients were randomly divided into two subsets (training set and verification set). In model A, the ratio of patient numbers was 1:1 for training and verification set, and in model B, the ratio was 2:1. RESULTS: The areas under receiver-operating characteristic (ROC) curves were 0.8897 and 0.8831 for model A and B, respectively. Sensitivity, specificity, accuracy, positive prediction value (PPV) and negative prediction value (NPV) were 0.875 (7/8), 0.882 (75/85), 0.882 (82/93), 0.412 (7/17) and 0.987 (75/76) for model A, and 0.750 (6/8), 0.800 (68/85), 0.796 (74/93), 0.261 (6/23) and 0.971 (68/70) for model B. CONCLUSION: ANN was proved high accuracy for prediction of RILD. It could be used together with other models and dosimetric parameters to evaluate hepatic irradiation plans.
Asunto(s)
Hepatopatías/etiología , Redes Neurales de la Computación , Traumatismos por Radiación/etiología , Radioterapia Conformacional/efectos adversos , Algoritmos , Femenino , Humanos , Hepatopatías/radioterapia , Masculino , Persona de Mediana Edad , Pronóstico , Planificación de la Radioterapia Asistida por Computador , Sensibilidad y EspecificidadRESUMEN
PURPOSE: To investigate a method for evaluation of the maximum skin dose (MSD) of radiation in patients undergoing interventional radiology procedures in the liver. MATERIALS AND METHODS: Transarterial chemoembolization, transarterial embolization, portal vein embolization, and biliary interventions were the procedures considered in this study. Ninety procedures in 70 patients were studied. The complexity of the biliary interventions was taken into account during the analysis. The MSD was measured with use of GAF chromic XR type R films, whereas the dose-area product (DAP) was measured by a transmission chamber. RESULTS: The MSD was measured in a group of 19 patients. The coefficient of the interpolation line between the skin dose and the DAP (0.0051 cm(-2)) was determined. An approximated value of MSD from the DAP for the remaining 71 procedures was estimated by means of an interpolation line. The mean MSD in the endovascular procedures was 4.4 Gy; for the three different levels of complexity of the biliary procedures, the mean MSDs were 0.4, 1.2, and 3 Gy, respectively. CONCLUSIONS: Radiochromic films are an easy-to-use and efficient method for measuring skin entrance radiation dose and have the advantage of providing information on the MSD as well as the distribution of radiation to the skin. In light of these results, the authors suggest recording the dose for biliary and endovascular procedures as indicated by the International Commission on Radiological Protection and the United States Food and Drug Administration.
Asunto(s)
Enfermedades de las Vías Biliares/diagnóstico por imagen , Quimioembolización Terapéutica/métodos , Hepatopatías/radioterapia , Monitoreo de Radiación/métodos , Radiografía Intervencional , Adulto , Anciano , Anciano de 80 o más Años , Relación Dosis-Respuesta en la Radiación , Femenino , Fluoroscopía , Humanos , Masculino , Persona de Mediana Edad , Fantasmas de Imagen , Dosis de Radiación , Monitoreo de Radiación/instrumentaciónRESUMEN
Recent advances in optical techniques have created a great range of possibilities for diagnosis and therapeutics in liver related diseases. With the uses of efficient light sources like lasers and LEDs (Light Emitting Diodes) it is possible to employ the light-tissue interaction to promote hepatic tissue regeneration after partial hepatectomy, to detect hepatocarcinoma and steatosis by utilizing optical fluorescence, to evaluate the metabolism of the liver during hepatic transplantation as well as to treat liver tumors. We present here an overview of the technique presently in development at the Ribeirâo Preto Faculty of Medicine - USP in cooperation with the Physics Institute of São Carlos -USP. The results obtained so far have been the subject of a list of publications and are here presented as an overview. A new perspective for modern application of optical techniques in different medical practices related to the liver is presented.
Recentes avanços em técnicas ópticas têm propiciado vasto campo de possibilidades tanto para o diagnóstico quanto para a terapêutica de doenças hepáticas.Com o uso de eficientes fontes de luz como o laser e Light emitting diodes (LED) é possível utilizar a interação luz-tecido para promover a regeneração hepática após hepatectomias parciais,detectar hepatocarcinoma, esteatose e outras alterações do fígado pelo uso da fluorescência óptica,para avaliar o metabolismo hepático durante o transplante de fígado e na abordagem diagnóstica e terapêutica de alterações hepatocelulares. Os autores apresentam uma ampla revisão de técnicas atualmente em desenvolvimento na Divisão de Gastroenterologia Cirúrgica da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo num trabalho cooperativo com o Instituto de Física de São Carlos da USP. Os resultados obtidos até agora têm sido motivo de lista de publicações que são aqui apresentados em forma de revisão. Uma nova perspectiva de moderna aplicação de técnicas ópticas em várias situações clínico-cirúrgicas relacionadas com o fígado é apresentada e amplamente discutida.
Asunto(s)
Humanos , Terapia por Luz de Baja Intensidad/métodos , Hepatopatías/diagnóstico , Hepatopatías/radioterapia , Hígado/efectos de la radiación , Fotoquimioterapia/métodos , Espectrometría de Fluorescencia/métodos , Biopsia , Carcinoma/diagnóstico , Carcinoma/tratamiento farmacológico , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/tratamiento farmacológico , Regeneración Hepática/efectos de la radiación , Trasplante de Hígado/patología , Hígado/patología , Necrosis/patología , Necrosis/radioterapia , Fármacos Fotosensibilizantes/uso terapéutico , Factores de TiempoRESUMEN
BACKGROUND AND OBJECTIVES: The low intensity laser therapy (LILT) has been widely used in all medical fields due to its therapeutic effects in reparative process, pain relief, and biostimulation. Even though there is a therapeutic window of wavelengths for clinical application, little has been done concerning the frequency spectrum response to biological effects. In this work, we investigate the dependence of different wavelengths irradiation in the enhancement of the tissue regeneration after partial hepatectomy in Wistar rats. STUDY DESIGN/MATERIALS AND METHODS: The proliferating cell nuclear antigen (PCNA) labeling index and the respiratory control (oxygen consumption in extracted mitochondria) were the tests used to evaluate the liver regeneration after laser irradiation with different wavelengths. RESULTS AND CONCLUSIONS: The results show a correlated spectral response that can be explained based on the combined effect of light penetration on biological tissues and the biomolecular excitation efficiency for each wavelength used.
Asunto(s)
Hepatectomía , Hepatopatías/radioterapia , Hepatopatías/cirugía , Regeneración Hepática/efectos de la radiación , Terapia por Luz de Baja Intensidad , Análisis Espectral , Animales , Modelos Animales de Enfermedad , Relación Dosis-Respuesta en la Radiación , Masculino , Mitocondrias Hepáticas/efectos de la radiación , Consumo de Oxígeno/efectos de la radiación , Antígeno Nuclear de Célula en Proliferación/efectos de la radiación , Ratas , Ratas Wistar , Factores de TiempoRESUMEN
The use of three-dimensional radiotherapy (RT) and the prospective follow-up of patients for radiation-induced liver disease (RILD) have led to a more quantitative understanding of the partial organ tolerance of the liver compared with previous estimates based on clinical judgment alone. Parameters of both the Lyman normal tissue complication probability (NTCP) model and a local damage-organ injury (D-I) NTCP model have been fit to clinical data from patients who have received hepatic radiation. Based on analyses of over 180 patients, the liver exhibits a large volume effect and a low threshold volume for RILD. Mean liver dose is associated with RILD, and no cases of RILD have been reported in patients with a mean liver dose of less than 31 Gy. Most recent estimates of the partial liver tolerance to RT suggest that if less than 25% of the normal liver is treated with RT, then there may be no upper limit on dose associated with RILD. Estimates of the liver doses associated with a 5% risk of RILD for uniform irradiation of one third, two thirds, and the whole liver are 90 Gy, 47 Gy, and 31 Gy, respectively.
Asunto(s)
Hepatopatías/radioterapia , Neoplasias Hepáticas/radioterapia , Hígado/efectos de la radiación , Enfermedad Hepática Inducida por Sustancias y Drogas , Relación Dosis-Respuesta en la Radiación , Humanos , Tolerancia a RadiaciónRESUMEN
Advances in the understanding of hepatocyte engraftment and repopulation of the host liver have already led to the use of hepatocyte transplantation (HT) with some success in the treatment of inherited and acquired liver diseases. Wider application of HT is severely limited by the unavailability of large number of transplantable hepatocytes and difficulties associated with transplanting an adequate number of cells for achieving therapeutically satisfactory levels of metabolic correction. Therefore, there is a need for preparative regimens that provide a growth advantage to the transplanted (healthy) hepatocytes over the host's own (diseased) hepatocytes so that the former can repopulate the host liver. We have recently shown that when the liver of recipient rats was subjected to radiotherapy and partial hepatectomy before HT, the transplanted hepatocytes engrafted in and massively repopulated the liver, and also ameliorated the adverse clinical and histopathological changes associated with hepatic irradiation. This protocol was then used as a preparative regimen for transplanting normal hepatocytes into jaundice mutant rats (Gunn strain), which lack hepatic bilirubin-uridinediphosphoglucuronate glucuronosyltransferase and is a model of Crigler-Najjar syndrome Type I. The results showed long-term correction of the metabolic abnormality, suggesting that the transplanted hepatocytes repopulated an irradiated liver and were metabolically functional. This strategy could be useful in the treatment of various genetic, metabolic, or malignant diseases of the liver.
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Hepatocitos/trasplante , Hepatopatías/terapia , Hígado/efectos de la radiación , Acondicionamiento Pretrasplante/métodos , Animales , Supervivencia Celular , Predicción , Supervivencia de Injerto , Hepatectomía/métodos , Hepatocitos/fisiología , Hepatocitos/efectos de la radiación , Hepatopatías/radioterapia , Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/terapia , Modelos Animales , Ratas , Ratas Endogámicas F344Asunto(s)
Humanos , Hepatopatías , Hepatopatías/diagnóstico , Hepatopatías/dietoterapia , Hepatopatías/etiología , Hepatopatías/fisiopatología , Hepatopatías/inmunología , Hepatopatías/metabolismo , Hepatopatías/patología , Hepatopatías/tratamiento farmacológico , Hepatopatías , Hepatopatías/radioterapia , Hepatopatías/rehabilitación , Hepatopatías , Hígado , Hepatopatías , Hepatitis A , Hepatitis B , Hepatitis D Crónica , Hepatitis Crónica , Hepatitis/diagnóstico , Hepatitis/fisiopatología , Cirrosis Hepática , Enfermedades MetabólicasRESUMEN
The objective of this study was to describe magnetic resonance (MR) findings with a 1.5T imager for hepatic parenchymal changes after proton beam radiotherapy. Thirty-two patients who received proton radiotherapy with doses of 50-87 Gy underwent MR imaging 1-75 months (mean 22 months) after the start of irradiation. Axial T(2), T(1)-weighted imaging, and a dynamic study after a gadolinium injection were performed. The irradiated areas showed hypointense in T(1)-weighted images, hyperintense in T(2)-weighted images, and intense and prolonged enhancement on the dynamic study (maximum relative enhancement 441.8%+/-263.3 vs. surrounding liver 145.6%+/-67.7, p<0.0001). T(2) values of the irradiated areas were 50.6 to 65.8 msec greater than in the surrounding liver (p<0.005). The values increased with time, being significantly greater 13 months or longer after the beginning of the therapy than after a period of less than 3 months (p<0.05). Pathologic examinations (n = 3) indicated that the irradiated areas were composed of collapsed lobules with hepatic small vein occlusions, and rich extracellular matrices which retained extracellular fluid. MR imaging can demonstrate hepatic parenchymal changes after proton beam radiotherapy, and show the changes are irreversible.
Asunto(s)
Hepatopatías/radioterapia , Hígado/patología , Imagen por Resonancia Magnética/métodos , Adulto , Anciano , Femenino , Humanos , Hígado/efectos de la radiación , Hepatopatías/diagnóstico , Hepatopatías/patología , Masculino , Persona de Mediana Edad , ProtonesRESUMEN
Random setup errors can lead to erroneous prediction of the dose distribution calculated for a patient using a static computed tomography (CT) model. Multiple recomputations of the dose distribution covering the range of expected patient positions provides a way to estimate a course of treatment. However, due to the statistical nature of the setup uncertainties, many courses of treatment must be simulated to calculate a distribution of average dose values delivered to a patient. Thus, direct simulation methods can be time consuming and may be impractical for routine clinical treatment planning applications. Methods have been proposed to efficiently calculate the distribution of average dose values via a convolution of the dose distribution (calculated on a static CT model) with a probability distribution function (generally Gaussian) that describes the nature of the uncertainty. In this paper, we extend the convolution-based calculation to calculate the standard deviation of potential outcomes sigmaD(x,y,z) about the distribution of average dose values, and we characterize the statistical significance of this quantity using the central limit theorem. For an example treatment plan based on a treatment protocol in use at our institution, we found that there is a 68% probability that the actual dose delivered to any point (x,y,z) will be within 3% of the average dose value at that point. The standard deviation also yields confidence limits on the dose distribution, and these may be used to evaluate treatment plan stability.
Asunto(s)
Dosificación Radioterapéutica/normas , Algoritmos , Presentación de Datos , Humanos , Hepatopatías/radioterapia , Modelos Estadísticos , Método de Montecarlo , Planificación de la Radioterapia Asistida por Computador/métodos , Estudios RetrospectivosRESUMEN
The effect of magnetolaser irradiation on the liver in obstructive jaundice was studied in experiments on 500 rats. Magnetolaser irradiation was found to have a favourable effect on the functional morphology of the liver; it levels many morphological signs of hepatic insufficiency and thus provides the grounds for carrying out an operation on the bile ducts under optimal conditions. The suggested method of magnetolaser therapy was applied in 142 patients with hepatic insufficiency in obstructive jaundice. The study showed that magnetolaser therapy applied in complex treatment of hepatic insufficiency promotes active restoration of the function of the organ, significantly raises the efficacy of treatment, and reduces the term of the patient's hospital stay.
Asunto(s)
Colestasis/complicaciones , Terapia por Láser , Hepatopatías/radioterapia , Hígado/efectos de la radiación , Magnetismo , Adulto , Anciano , Anciano de 80 o más Años , Colestasis/cirugía , Femenino , Humanos , Hepatopatías/prevención & control , Masculino , Persona de Mediana Edad , Cuidados PosoperatoriosRESUMEN
The Effect of UV-Irradiation on the Hexachlorobenzene-induced Porphyria in an Experimental Animal Model Hexachlorobenzene is able to induce in humans and different animal species a hepatic porphyria, which is comparable to porphyria cutanea tarda. We studied whether hexachlorobenzene feeding could induce this porphyria also in hairless rats (Rowett-Nude), as these are suitable for photobiologic studies. After development of hepatic porphyria the rats were irradiated either with UV-A or UV-B light. Biochemical effects on the porphyrin metabolism and clinical as well as histologic skin changes were examined. In the liver of the porphyric rats, UV-A and UV-B irradiation induced increased aminolevulinic acid synthase activity accompanied with augmentation of hepatic porphyrin content. UV-A or UV-B irradiation also lead to increased total porphyrin contents in the skin of porphyric compared to non-irradiated animals. Clinically and histologically, however, only UV-A irradiation induced lesions, which were comparable to skin manifestations of porphyria cutanea tarda.
Asunto(s)
Hexaclorobenceno/toxicidad , Hepatopatías/radioterapia , Porfirias/radioterapia , Enfermedades de la Piel/radioterapia , Terapia Ultravioleta , Animales , Enfermedad Hepática Inducida por Sustancias y Drogas , Relación Dosis-Respuesta en la Radiación , Femenino , Hígado/efectos de los fármacos , Hígado/patología , Porfirias/inducido químicamente , Porfirinas/sangre , Ratas , Ratas Desnudas , Enfermedades de la Piel/inducido químicamenteRESUMEN
Based on an investigation of indices of enzymatic spectrum of the blood, cyclic nucleotides, ultrasonic and rheographic examination of the liver the authors confirmed high efficiency of using electromagnetic radiation in the millimeter-wave range in ulcer disease and concomitant diseases of the liver.
Asunto(s)
Hepatopatías/radioterapia , Microondas/uso terapéutico , Úlcera Péptica/radioterapia , Adulto , Femenino , Humanos , Hepatopatías/etiología , Masculino , Persona de Mediana Edad , Úlcera Péptica/complicaciones , Dosificación Radioterapéutica , Inducción de RemisiónRESUMEN
Donor plasma irradiated by ultraviolet rays was administered intravenously to patients with choledocholithiasis, chronic hepatitis and liver cirrhosis. Parameters of the acid-base balance of arterialized capillary blood shifted to alkalosis, were normalized, and tension of carbon dioxide and oxygen in the blood increased to physiological values. Dynamic changes of the biochemical parameters demonstrated alleviation of manifestations of the cholestasis syndrome.
Asunto(s)
Equilibrio Ácido-Base , Sangre/efectos de la radiación , Colestasis/radioterapia , Cálculos Biliares/radioterapia , Hepatopatías/radioterapia , Terapia Ultravioleta , Adulto , Anciano , Colestasis/complicaciones , Colestasis/metabolismo , Femenino , Cálculos Biliares/complicaciones , Cálculos Biliares/metabolismo , Humanos , Hepatopatías/complicaciones , Hepatopatías/metabolismo , Masculino , Persona de Mediana EdadRESUMEN
In a case of spent polycythemia after irradiation of the spleen alone (450 rad in 17 sessions and 28 days) the suppression of any hepatic myeloid metaplasia was observed simultaneously with the regression of myelemia and erythroblastemia and the drop in the number of circulating granulomonocytic stem cells. These observations allow to discuss the mode of action of the splenic radiotherapy and the relationship between myeloid metaplasia and the circulating hematopoietic cells (proliferating granulocytic and erythrocytic cells and stem cells).