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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

One hundred and one cases of hepatocellular carcinoma (HCC) treated in Maebashi Red Cross Hospital from May 1984 to August 1987 were classified according to the therapy and progression of the disease and were investigated on their prognosis. Furthermore, "long survived group" in which, patients survived for more than one year were compared with "short survived group" in which patients died within one month after non-surgical treatment. In operated patients, the prognosis was the best, but the rate of operable cases was only 13.9%. In patients with stage IV, one year survival rate was significantly low. In patients with portal trunk invasion (Vp4), or with Child C that was the poorest functional reserve of the liver, one year survival rate was also significantly low in comparison with patients with other stages or other Child's classification. In HCC patients treated with transcatheter arterial embolization (TAE), the prognosis tended to be poor as stage and portal invasion progressed, but in regard to reserve function of the liver, the prognosis was not so poor in patients of Child C significantly as in cases of A or B. The comparisons between long and short survived group were as follows. a) In 17 cases belong to long survived group, mean survival period was 24 months and the longest one was 4 years and 10 months. On the other hand, in 10 cases belong to short survived group, mean survival period was 17 days, the shortest one was 3 days. b) The main reason of inoperability in long survived group was progression of the tumor. Complications such as diabetes mellitus, advanced age and rejection of treatment by the patient were the other reasons of in operability. In almost half of the patients in short survived group, the tumor progression and low functional reserve of liver were found in 4 patients. c) In short survived group, esophageal varices were more common and functional reserve of the liver was poorer than in long survived group. In short survived group, LDH and total bilirubin were significantly higher than those of long survived group, but there was no significant differences in transaminase value and ICG retention in 15 minutes. d) In short survived group, extent of the tumor in liver and portal invasion were advanced. Three cases of this group (30%) had distant metastasis. e) In long survived group, the main reason of death was hepatic failure. Renal failure, or pulmonary complications were also found in short survived group.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Evaluation of non-surgical treatments of hepatocellular carcinoma--investigation of the cases with long and short survivals after treatment]. 216 49

During the recent 5 2/3 years, hepatic resection was performed on 118 patients with hepatocellular carcinoma. Ages ranged from 17 to 78 years with an average of 57 years. There were 101 males and 17 females. Underlying cirrhosis of the liver was found in 101 cases, and chronic hepatitis was found in 16 cases. Before surgery 62 patients had 71 associated conditions such as esophageal varices, diabetes mellitus, cholelithiasis, or peptic ulcer. Operations for the varices and cholelithiasis were performed simultaneously with hepatic resection in 15 and six patients, respectively. The operative mortality rate within 1 month was 7.6%, and the overall in-hospital death rate was 14.4%. In 94 patients with curative resection, the 2-year survival rate was 81.2% in patients without cirrhosis and 55.4% in patients with cirrhosis. The 4-year survival rate was 81.2% in the former and 34.8% in the latter group. The prognosis was significantly better in patients without cirrhosis than in those with cirrhosis. On the contrary, 21 of 24 patients with palliative resection died within 2 years despite extensive chemotherapy. The present results may indicate that the resectability rate of hepatocellular carcinoma is currently increasing, even in the presence of cirrhosis of the liver due to early detection of the tumor by current advances in diagnostic methods and also that major hepatic resection is possible in selected patients with cirrhosis.
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PMID:Clinical experience with 118 hepatic resections for hepatocellular carcinoma. 242 10

In order to evaluate the effect of somatostatin in the treatment of massive upper gastrointestinal bleeding a randomised double blind trial of 95 patients has been undertaken during a 28 months period. Patients with oesophageal varices have been excluded as well as patients with diabetes. All patients were endoscoped within eight hours of admission to the hospital, whereupon the source of bleeding and types of stigmata were assessed. Forty six patients, chosen at random, were given a 72 hour infusion of somatostatin, while the remaining 49 patients received infusion of placebo. The two groups were well matched for sex, age, and source of bleeding. On the day after admission, an additional endoscopy was performed at which eight patients in the somatostatin group and 16 in the placebo group were found to have a persistent bleeding. A total of five patients in the somatostatin group and 14 in the placebo group underwent surgery (Fisher's exact test, 2-tail, p = 0.04). Rebleeding occurred in six patients in the somatostatin group, of whom five experienced rebleeding after completion of the somatostatin treatment. In the placebo group, rebleeding occurred in five patients, of whom four rebled on the day after admission. The need for blood transfusions and the mortality rate did not differ significantly between the two groups. No toxic side effects were found as a result of the infusion of somatostatin. In this study, somatostatin reduced the number of patients needing surgery with massive upper gastrointestinal bleeding.
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PMID:Randomised double blind trial of somatostatin in the treatment of massive upper gastrointestinal haemorrhage. 285 77

Clinical findings, symptoms and predisposing factors were studied in 43 patients with oesophageal candidiasis, 40 patients with peptic oesophagitis and 40 normal controls. Oesophageal candidiasis was confirmed cytologically. 2.4% of patients who had undergone gastroscopy had oesophageal candidiasis; only three of them had simultaneous candidiasis of the oral cavity. Cardiac failure, oesophageal varices, hiatus hernia and gastric ulcer were common associated disorders. 42% of patients with candidal oesophagitis were symptom-free. Most common symptoms were vomiting, retrosternal and epigastric pain. Peptic oesophagitis was more frequently associated with symptoms. Predisposing factors were present in 88% of cases of oesophageal candidiasis: alcoholism, hepatic cirrhosis, diabetes mellitus, malignant tumours and other wasting diseases. 18 patients had had treatment with cimetidine; they included all 13 patients whose candidiasis was first detected at check endoscopy.
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PMID:[Candidiasis of the esophagus. Prospective study of incidence, type of complaints and predisposing factors]. 373 73

The aim of the present study was to evaluate how many cirrhotics may receive propranolol after upper gastrointestinal bleeding. One hundred and twelve patients were consecutively admitted in a digestive intensive care unit during a two-year study, for bleeding of esophageal (63 p. 100) or gastric (4 p. 100) varices, or acute gastric erosions (33 p. 100). Twenty-one per cent of patients were initially class A (Child's classification). 26 p. 100 were B, and 53 p. 100 were C. Eighteen patients (16 p. 100) died within the first 10 days. Eighty patients (71 p. 100) did not receive propranolol because of: a) contraindication for this drug (asthma, heart failure, diabetes, n = 25); b) carcinoma, mainly of the liver (n = 11); c) foreseeable lack of compliance with the treatment (n = 8); d) criteria for which the efficacy of propranolol has not been demonstrated (small esophageal varices, jaundice, or ascites, n = 36). Only 14 patients (13 p. 100) received propranolol therapy: 5 stopped their treatment, 3 because of gastrointestinal rebleeding. Our experience suggests that propranolol can be used only in a few cirrhotics for prevention of recurrent gastrointestinal bleeding.
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PMID:[How many cirrhotic patients may receive propranolol after digestive hemorrhage?]. 387 54

In a prospective study of 70 unselected patients with chronic liver disease, clinical signs of a peripheral neuropathy were observed in 13 patients. Abnormal nerve conduction was demonstrated in nine of these and in one further patient who had no abnormal neurological signs. The occurrence of a neuropathy (in patients with cryptogenic cirrhosis, haemochromatosis, active chronic hepatitis as well as in alcoholic cirrhosis) could not be related to liver function, although it was associated with higher IgA and IgM values. Clinical diabetes was present in six of the 14 patients with neuropathy but there was no relation in the non-diabetic patients between neuropathy and minor impairment of carbohydrate tolerance. Those with neuropathy had a significantly higher incidence of oesophageal varices and there was also a relationship to a history of previous encephalopathy. Sural nerve biopsy was carried out on 14 patients, eight of whom had clinical or electrodiagnostic evidence of neuropathy. Single nerve fibres were examined by teasing and in all nerves histological evidence was found of an indolent process which had damaged whole Schwann cells and which resulted in demyelination and remyelination. Diabetic angiopathy was not seen and axonal degeneration, which was never severe, was found in all disease groups equally.
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PMID:Peripheral neuropathy in chronic liver disease: clinical, electrodiagnostic, and nerve biopsy findings. 433 71

Vasopressin (Pitressin) infusion through peripheral veins is a commonly used modality for control of bleeding esophageal varices. In this report we describe the development of infected gangrene at the site of accidental vasopressin infiltration in a patient with diabetes mellitus, cirrhosis and bleeding esophageal varices. Among the explanations for the development of gangrene are: 1. continuous intravenous administration; 2. diabetic peripheral vascular disease; 3. mechanical compression of extravasated fluid in a closed space. No antagonist has been clinically proven to reverse the vasoconstrictive effects of vasopressin.
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PMID:Infected gangrene. A serious complication of peripheral vasopressin administration. 741 38

Liver cirrhosis is characterized by an increased incidence of glucose intolerance, diabetes and insulin resistance. We report a cirrhotic man (41 years old) who developed glucose intolerance and diabetes with insulin resistance over a period of six years. This patient suffered from severe portal hypertension with oesophageal varices and a enormously increased spleen volume. The subject underwent prophylactic endoscopic sclerotherapy of oesophageal varices. Splenectomy was performed because of severe piastrinopenia with recurrent nose bleeding. During laparotomy, multiple liver biopsies confirmed diagnosis of liver cirrhosis. Intra-operatory exploration revealed a splenic vein thrombosis. For this reason the planned spleno-renal shunting was not performed and the patient was only submitted to splenectomy. Liver function improved in the month following splenectomy and concomitant decrease of insulin resistance was observed (with a reduction in daily insulin dosage from 126 to 10 I.U.). We propose the following explanations of this event: 1) A decrease of portal and pancreatic vein pressure may have induced a proportional decrease (as already reported) of glucagon secretion. 2) The ameliorated liver function may have induced an improvement of liver glucose, insulin and glucagon metabolism. 3) A reduction of insulin circulating level (proved by a decrease of C Peptide value) may have lessened the insulin receptor down-regulation.
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PMID:[Decrease of insulin resistance after splenectomy in a diabetic patient with liver cirrhosis and portal hypertension. Physiopathologic evaluation]. 784 51

By selectively infiltrating and destroying the internal elastica of a major cerebral artery, Aspergillus fungus (Af) induces disruption and incipient dilatation of the vascular wall with or without inflammation. This unique pathogenetic mechanism of forming "true" fungal mycotic aneurysms (FMAs) was clearly demonstrated in a middle-aged adult male who died of a pontine stroke. The latter was secondary to thrombosis in the basilar artery of which the internal elastica was infiltrated and replaced by Af hyphae. The patient had diabetes, liver cirrhosis with oesophageal varices, and received multiple blood transfusions. However, leukopenia was not present and immunosuppressive drugs were not used. This case prompted comparison of the natural history and pathogenesis of bacterial and fungal mycotic aneurysms in cerebral arterial branches. Selective destruction of the internal elastica with progressive dilation at a segment of vascular wall insinuates a potential pathogenetic process involved in the formation of saccular or berry aneurysm. Management and therapeutic approaches for FMA are discussed.
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PMID:A proposed pathogenetic process in the formation of Aspergillus mycotic aneurysm in the central nervous system. 821 10

Endoscopic variceal sclerotherapy, though a safe and effective therapy for esophageal varices, is not devoid of local and distant complications. We report a patient with postnecrotic cirrhosis and diabetes mellitus who developed a splenic abscess while on a sclerotherapy program. The abscess may have been a consequence of retrograde thrombosis of the portal venous system or of bacteremia following sclerotherapy.
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PMID:Splenic abscess--a possible complication of endoscopic variceal sclerotherapy. 834 Jan 43


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