New advances in hepatocellular carcinoma Pascual, Sonia; Herrera, Iván; Irurzun, Javier
World journal of hepatology,
03/2016, Letnik:
8, Številka:
9
Journal Article
Odprti dostop
Hepatocellular carcinoma(HCC)is the leading cause of deaths in cirrhotic patients and the third cause of cancer related deaths.Most HCC are associated withwell known underlying risk factors,in ...fact,HCC arise in cirrhotic patients in up to 90%of cases,mainly due to chronic viral hepatitis and alcohol abuse.The worldwide prevention strategies are conducted to avoid the infection of new subjects and to minimize the risk of liver disease progression in infected patients.HCC is a condition which lends itself to surveillance as at-risk individuals can readily be identified.The American and European guidelines recommended implementation of surveillance programs with ultrasound every six months in patient atrisk for developing HCC.The diagnosis of HCC can be based on non-invasive criteria(only in cirrhotic patient)or pathology.Accurately staging patients is essential to oncology practice.The ideal tumour staging system in HCC needs to account for both tumour characteristics and liver function.Treatment allocation is based on several factors:Liver function,size and number of tumours,macrovascular invasion or extrahepatic spread.The recommendations in terms of selection for different treatment strategies must be based on evidence-based data.Resection,liver transplant and interventional radiology treatment are mainstays of HCC therapy and achieve the best outcomes in well-selected candidates.Chemoembolization is the most widely used treatment for unresectable HCC or progression after curative treatment.Finally,in patients with advanced HCC with preserved liver function,sorafenib is the only approved systemic drug that has demonstrated a survival benefit and is the standard of care in this group of patients.
Bacterial (bact)DNA is an immunogenic product that frequently translocates into the blood in cirrhosis. We evaluated bactDNA clearance in patients undergoing liver transplantation (LT) and its ...association with inflammation and clinically relevant complications. We prospectively included patients consecutively admitted for LT in a one-year follow-up study. We evaluated bactDNA before and during the first month after LT, quantifying cytokine response at 30 days. One hundred patients were included. BactDNA was present in the blood of twenty-six patients undergoing LT. Twenty-four of these showed bactDNA in the portal vein, matching peripheral blood-identified bactDNA in 18 cases. Thirty-four patients showed bactDNA in blood during the first month after LT. Median TNF-α and IL-6 levels one month after LT were significantly increased in patients with versus without bactDNA. Serum TNF-α at baseline was an independent risk factor for bactDNA translocation during the first month after LT in the multivariate analysis (Odds ratio (OR) 1.14 1.04 to 1.29, P = 0.015). One-year readmission was independently associated with the presence of bactDNA during the first month after LT (Hazard ratio (HR) 2.75 1.39 to 5.45, P = 0.004). The presence of bactDNA in the blood of LT recipients was not shown to have any impact on complications such as death, graft rejection, bacterial or CMV infections. The rate of bactDNA translocation persists during the first month after LT and contributes to sustained inflammation. This is associated with an increased rate of readmissions in the one-year clinical outcome after LT.
Idiopathic azygos vein aneurysms are rare and typically present as incidentally discovered mediastinal masses. Treatment is advisable when the aneurysm enlarges or is complicated by compression ...symptoms, rupture, or thromboembolic disease. The authors describe successful endovascular treatment of a symptomatic azygos vein aneurysm by means of embolization with coils at the azygos vein close to the dilated arch but respecting the bulb itself. The patient reported symptoms of cough, wheezing, and persistent hiccups, and the procedure resulted in thrombosis of the azygos vein and aneurysm retraction on imaging, accompanied by resolution of symptoms.
The purpose of this study was to describe a technique for percutaneous bile duct stone clearance by pushing the stones into the small bowel after balloon dilation of the papilla.
During a 2-year ...period, 38 patients were treated percutaneously for stones in the biliary tree. Twenty-one patients were treated through a T tube or transcystic tract. Seventeen patients were treated through a transhepatic tract. Twenty-three patients had one stone each. Eight patients had two stones, and seven patients had three or more calculi. Stone size ranged from 3 to 16 mm in diameter (mean size, 6.7 nm). Balloon diameter based on the transverse diameter of the stones ranged from 7 to 18 mm (mean, 6.7 mm). An 11.5-mm occlusion balloon was used for pushing the stones through a 7- to 9-French vascular introducer. A catheter was left in the common bile duct from 1 to 6 days for external drainage.
The technique was successfully used for clearance of stones in 36 (94.7%) of the 38 patients. With 29 patients, the procedure was performed with only one attempt. Two attempts were necessary for five patients, and three attempts were necessary for four patients. Two major complications were cholangitis and biliary pleural effusion. No deaths were related to the procedure.
Percutaneous bile duct stone clearance by dilation of the papilla and evacuation of the stones in an antegrade fashion with an occlusion balloon is a safe and effective technique. It can be an alternative to basketing stones in selected patients.
BACKGROUNDHepatocellular carcinoma (HCC) appears in most of cases in patients with advanced liver disease and is currently the primary cause of death in this population. Surveillance of HCC has been ...proposed and recommended in clinical guidelines to obtain earlier diagnosis, but it is still controversial and is not accepted worldwide. AIMTo review the actual evidence to support the surveillance programs in patients with cirrhosis as well as the diagnosis procedure. METHODSSystematic review of recent literature of surveillance (tools, interval, cost-benefit, target population) and the role of imaging diagnosis (radiological non-invasive diagnosis, optimal modality and agents) of HCC. RESULTSThe benefits of surveillance of HCC, mainly with ultrasonography, have been assessed in several prospective and retrospective analysis, although the percentage of patients diagnosed in surveillance programs is still low. Surveillance of HCC permits diagnosis in early stages allows better access to curative treatment and increases life expectancy in patients with cirrhosis. HCC is a tumor with special radiological characteristics in computed tomography and magnetic resonance imaging, which allows highly accurate diagnosis without routine biopsy confirmation. The actual recommendation is to perform biopsy only in indeterminate nodules. CONCLUSIONThe evidence supports the recommendation of performing surveillance of HCC in patients with cirrhosis susceptible of treatment, using ultrasonography every 6 mo. The diagnosis evaluation of HCC can be established based on noninvasive imaging criteria in patients with cirrhosis.
Few studies have fully applied an enhanced recovery after surgery (ERAS) protocol to liver transplantation (LT). Our aim was to assess the effects of a comprehensive ERAS protocol in our cohort of ...low- and medium-risk LT patients.
The ERAS protocol included pre-, intra-, and post-operative steps. During the five-year study period, 181 LT were performed in our institution. Two cohorts were identified: low risk patients (n = 101) had a laboratory model for end-stage liver disease (MELD) score of 20 points or less at the time of LT, received a liver from a donor after brain death, and had a balance of risk score of 9 points or less; medium-risk patients (n = 15) had identical characteristics except for a higher MELD score (21–30 points). In addition, we analyzed the remaining patients (n = 65) who were transplanted over the same study period separately using the ERAS protocol.
The low-risk cohort showed a low need for packed red blood cells transfusion (median: 0 units) and renal replacement therapy (1%), as well as a short length of stay both in the intensive care unit (13 h) and in the hospital (4 days); morbidity during one-year follow-up, and probability of surviving to one year (89.30%) and five years (76.99%) were in line with well-established reference data. Similar findings were observed in the medium-risk cohort.
This single-center prospective observational cohort study provides evidence that ERAS is feasible and safe for low- and medium-risk LT.
•Enhanced recovery after low- and middle-risk liver transplantation is feasible and safe.•Adherence to enhanced recovery items is high in both cohorts.•Need for red blood cell transfusion and renal replacement therapy is low.•Length of stay in the intensive care unit and in the hospital are short.•Morbidity and mortality are similar to well established reference data.
The appropriate selection of hepatocellular carcinoma (HCC) patients who are eligible for transarterial chemoembolization (TACE) remains a challenge. The ART score has recently been proposed as a ...method of identifying patients who are eligible or not for a second TACE procedure.
To assess the validity of the Assessment for Retreatment with TACE (ART) score in a cohort of patients treated with drug-eluting bead TACE (DEB-TACE).
to identify clinical determinants associated with overall survival (OS).
A retrospective, multicentre study conducted in Spain in patients with HCC having undergone two or more DEB-TACE procedures between January 2009 and December 2014. The clinical characteristics and OS from the day before the second DEB-TACE of patients with a high ART score (ART≥2.5) and a low ART score (ART 0-1) were compared. Risk factors for mortality were identified using Cox's proportional hazards model.
Of the 102 patients included, 51 scored 0-1.5 and 51 scored ≥2.5. Hepatitis C was more frequent in patients scoring ≥2.5. Median OS from the day before the second DEB-TACE was 21 months (95% CI, 15-28) in the group scoring 0-1.5, and 17 months (95% CI, 10-25) in the group scoring ≥2.5 (P=0.3562). Platelet count and tumour size, but not the ART score, were independent baseline predictors of OS.
The ART score is not suitable for guiding DEB-TACE retreatment according to Spanish clinical practice standards.
Background/Aims: Surveillance programmes (SPs) for hepatocellular carcinoma (HCC) in patients with cirrhosis intend to diagnose the tumour in its early stages when an effective therapy can be ...applied. The aims of this study have been to compare the survival of patients with HCC being diagnosed or not in SPs, and to establish a more accurate profile of the best target population.
Methods: From January 1996 to June 2005, 290 patients with HCC were included. The relationship between being diagnosed or not in an SP and survival has been analysed in a univariate analysis. Pretreatment variables found to be significant predictors of survival in univariate analysis were included in a multivariate analysis.
Results: The mean survival for patients diagnosed in SPs (27 months, 16.6–37.4) was significantly longer than in patients being diagnosed out of these programmes (6 months, 2.6–9.4) (P=0.001). Child–Pugh class A β 1.4, 95% confidence interval (CI) 1.14–1.78; P=0.0002 and being diagnosed in SPs (β 0.4, 95% CI 0.3–0.6; P=0.0003) became the only independent predictive factors of longer survival.
Conclusions: SPs for HCC allow the detection of small tumours and the application of intention‐to‐cure therapies, which improves survival. However, these programmes do not improve prognosis in patients with advanced cirrhosis.
Ultrasound-guided skeletal biopsies GIL-SANCHEZ, Santiago; MARCO-DOMENECH, Santiago F; IRURZUN-LOPEZ, Javier ...
Skeletal radiology,
11/2001, Letnik:
30, Številka:
11
Journal Article
Recenzirano
Percutaneous biopsy of skeletal lesions is a widely used diagnostic technique that involves fluoroscopic or computerized tomography guidance. The objective of this report is to describe the use of ...ultrasonography in the guidance of percutaneous biopsy of skeletal lesions.
We employed ultrasound to guide percutaneous biopsy in 65 skeletal lesions in 63 patients (30 male and 33 female) whose ages ranged from 1 to 82 years (mean 47.2 years ). The lesions were divided into four groups: group 1 ( n=41) were lytic with a soft tissue mass, group 2 ( n=14) were lytic with a disrupted cortex without a soft tissue mass, group 3 ( n=4) were lytic with an intact cortex and group 4 ( n=6) were sclerotic lesions. Different techniques and materials were used in each group.
Cytologic assessment obtained the diagnosis in 50 cases, (success rate 76.9%), histology in 56 cases (86.1%) and a combination of both in 60 cases (92.3%). There were no complications.
Ultrasound is a highly accurate and safe method of guidance in percutaneous biopsy of bone lesions, either lytic or sclerotic, because it can identify subtle changes in the cortical and the associated soft tissue component.
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