Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0019204 (hepatocellular carcinoma)
 71,386 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Low incidence rates of hepatocellular carcinoma and cirrhosis in HCV-antibody-positive patients on chronic hemodialysis are reported. Among the patients, two cases undergoing negative conversion of the anti-HCV-antibody were found. Considering the size of the virus particles and the pore size of the dialysis membrane, it seems the virus does not escape from the membrane pore. Indeed, virus particles may be trapped and destroyed at the membrane surface. The size of HCV-RNA titers in HCV-antibody-positive patients receiving various kinds of chronic blood purification procedures are of interest. The subjects included 15 hemodialysis patients, 10 hemofiltration patients, 9 continuous ambulatory peritoneal dialysis patients, 7 chronic renal failure predialysis patients, and 14 patients with excellent renal function. The concentration of HCV-RNA particles in patients receiving chronic hemofiltration was significantly lower than that in patients of other groups. Hemofiltration, which is routinely performed at over 150 mm Hg TMP, may be an important key to decreasing HCV-RNA particles by a mechanism such as destruction.
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PMID:Hepatitis C virus decreases in patients with maintenance hemofiltration therapy. 1504 33

A 56-year-old man on hemodialysis for 3 years because of chronic renal failure underwent living related donor liver transplantation (LRDLT) and splenectomy using the right hepatic lobe for liver cirrhosis type C (genotype 1b) with hepatocellular carcinoma. At 69 postoperative days (POD), he displayed a high fever and his blood transaminase and total bilirubin were increased. Based on finding in his liver biopsy, we diagnosed rapid recurrence of progressive hepatitis C after LRDLT, so we administered IFNbeta. Thereafter his liver function returned to normal and his HCV-mRNA decreased to 1200 kcopy/mL. We inferred that hemodialysis and splenectomy decreased his immunity, allowing rapidly progressive hepatitis C recurrence after LRDLT.
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PMID:Rapid progressive hepatitis C after liver transplantation: a case report. 1556 Dec 29

Chronic infection with hepatitis B virus (HBV) is one of the most common causes of cirrhosis of the liver and hepatocellular carcinoma worldwide, frequently requiring liver transplantation. Other nonliver organ transplants get infected de novo or through reactivation from previous active or inactive infections. With significant improvements in the surgical techniques and immunosuppressive regimens over the last 20 years, organ transplantation has become the most effective and lifesaving therapy for patients with chronic renal failure, cirrhosis, hepatocarcinoma, and heart failure. Until recently chronic HBV infection was considered a formal contraindication for liver transplantation, since recurrence of infection without prophylaxis occurs in 75% to 90% of the patients, with significant morbidity and mortality and few therapeutic alternatives. However, the introduction of hepatitis B immunoglobulin (HBIG) a decade ago to reduce the risk of reinfection of liver grafts, and more recently the availability of nucleoside analogues with few side effects and easy administration, have led to a dramatic improvement in patient outcomes with a risk of long-term HBV reinfection of less than 10% with combined HBIG and lamivudine prophylaxis. Chronic HBV infection in kidney, heart, and other organs has become a serious long-term problem and one of the most frequent and important comorbidities affecting graft and patient survival. Fortunately the introduction of nucleoside analogues allows significant control of viral replication and prevents progression of liver disease and other organ damage. In the present article we discuss the current indications for HBV prophylaxis and treatment prior to and after organ transplantation, as well as the most cost-effective way to apply different regimens to reduce side effects and improve survival and quality of life after transplantation.
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PMID:Is hepatitis B immunoglobulin prophylaxis needed for liver transplantation in the era of new antivirals? 1596 78

A 65-year-old man with positive anti-hepatitis C antibody and chronic renal failure was diagnosed as having a ruptured hepatocellular carcinoma (HCC) based on computed tomography (CT). The patient underwent transcatheter arterial embolization (TAE) for the HCC. After one more session of TAE, the patient underwent surgery. But HCC seeding peritoneally was pointed out. Vitamin K2 and vitamin E were administered as a conservative treatment. Six months after starting vitamins K2 and E, the primary tumor did not increase in size and intraperitoneal dissemination disappeared on CT with a significant decrease of alpha-fetoprotein. Even though this is only one case, combination therapy of vitamin K2 and E may induce growth suppression of HCC.
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PMID:Hepatocellular carcinoma with peritoneal dissemination which was regressed during vitamin K2 and vitamin E administration. 1754 Dec 21

Hepatitis-B infection is a global health problem. The spectrum of the disease is highly variable ranging from mild disease to chronic liver diseases including hepatocellular carcinoma. There are approximately 350 million chronic Hepatitis-B surface antigen (HBsAg) carriers in the world. Till date there is no effective therapy against this disease. Hence, prevention of the disease through vaccination is the only means to control the disease. Passive immunization is recommended for certain accidental exposures. Hepatitis-B immunoglobulin (HBIG) contains high titers of anti-HBs prepared from pooled plasma. HBIG has been shown to be highly effective in preventing post exposure transmission. HBIG induces immunity for a short period only hence, it is recommended to have a course of active immunization following passive immunization. Active immunization is achieved using vaccination. Two generations of vaccines, 1st generation plasma derived and 2nd generation recombinant DNA vaccines are available. Both these vaccines have been used extensively in all age groups all over the world. The studies have shown that HB vaccines are clinically well tolerated, safe and highly immunogenic. Normally 3 doses of HB vaccines are recommended in 0, 1, 2 and 12 or 0, 1, 6 months schedule. The dosages and schedules may vary in certain special groups, such as infants and neonates, chronic renal failure patients on hemodialysis. Advisory committee on immunization practices (ACIP) has given several guidelines regarding HB vaccination. Universal immunization of all infants and integration of HB Vaccine in the expanded program of immunization has been recommended by World Health Organization. Universal infant immunization is cost effective. Universal immunization of infants is the only strategy that will lead to the control and eradication of HBV infection in all regions of the world. Several countries have adopted this policy. But in India we have several problems in implementation of this policy. The high cost of the presently available vaccine is one of the major factors. The future consideration for hepatitis vaccines are focussed on multivalent combination vaccines with other childhood vaccines, and use of immunomodulators in conjunction with vaccine to increase the efficacy of vaccines in immunocompromised hosts.
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PMID:Immunoprophylaxis of hepatitis B virus infection. 1766 29

Viral hepatitis continues to be a relevant topic for haemodialysis centres, although the number of infected dialysis patients is declining in most countries. Chronic hepatitis B and C lead to detrimental complications such as liver cirrhosis and hepatocellular carcinoma. These complications can be avoided by successful antiviral treatment. In individuals with normal renal function, drug therapy of chronic hepatitis B is evolving quickly. Today there are several options but no agreed standard therapy. In the absence of renal failure, chronic hepatitis C should be treated with a combination of pegylated interferon-alpha and ribavirin. For both infections, there is no general indication to treat all patients; several criteria can be used to predict benefits and downsides. Chronic renal failure severely alters immune function, particularly activation of T lymphocytes and cytokine production by mononuclear cells. Aging further influences the immune system with deviation of T-lymphocyte differentiation. Both effects seem to act additively, leaving the elderly haemodialysis patient with extensive immune dysfunction. While these effects do not put the patient at risk of opportunistic infection, they do have a relevant effect on the clinical course of viral hepatitis. Haemodialysis patients infected with hepatitis B manifest a subclinical, often anicteric disease, and at least 60% of the infections become chronic. These patients usually do not fulfil the criteria for successful antiviral treatment, since they have normal or slightly elevated liver enzyme levels and few histological signs of liver inflammation. In addition, the prognosis in terms of cirrhosis and hepatocellular carcinoma might be more favourable than in individuals with normal renal function. The former standard treatment of chronic hepatitis B with interferon-alpha or its derivate pegylated interferon was badly tolerated in dialysis patients and associated with low efficacy. Indeed, prior to the advent of nucleoside analogues there was a clear recommendation not to treat chronic hepatitis B infection in all except a few dialysis patients. However, the newer treatment options appear to work well. In particular, there is growing evidence for the effectiveness and tolerability of lamivudine in dialysis patients, including the elderly. Use of adefovir and entecavir has also been reported in a few cases. At present, while we still do not recommend treatment, therapy with nucleoside analogues might be an option in selected patients, for example, those planning renal transplantation. The major effort against hepatitis B should be directed at vaccination and hygienic precautions to prevent the infection.Treatment of hepatitis C in patients undergoing haemodialysis is also limited by the poor tolerability of interferons. Ribavirin is contraindicated because of severe haemolytic anaemia, although a few studies have attempted to manage this with administration of high doses of erythropoetin. Those patients who complete the full course of interferon therapy may expect sustained viral responses comparable with healthy individuals, but in most trials, 30-50% of patients were forced to interrupt treatment because of adverse effects. There is no general indication to treat chronic hepatitis C in haemodialysis patients. Arguments in favour of treatment include elevated liver enzymes, histological signs of relevant liver inflammation, younger age, a virus genotype other than 1 and planned renal transplantation.
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PMID:Viral hepatitis in elderly haemodialysis patients: current prevention and management strategies. 1880 7

A 78-year-old female undergoing peritoneal dialysis due to chronic renal failure was admitted to our hospital because of a tumor on her right chest wall. The diagnosis was recurrence of hepatocellular carcinoma in the thoracic wall, and a combined resection of the thoracic wall and diaphragm was performed. Peritoneal dialysis was resumed 7 days after surgery, but a right pleural effusion was observed after 6 days of dialysis. Surgery was performed because failure of sutures related to the excised diaphragm was suspected. A thoracotomy revealed a large defect, about 1 cm in size, caused by injury of the diaphragm by an edge of the resected rib at the another site of a previous resection of the diaphragm. This defect was closed with sutures and the diaphragm was reinforced with a polyglycolic acid felt and fibrin glue. Peritoneal dialysis was resumed 7 days after surgery and has continued to date without recurrence.
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PMID:[Pleuroperitoneal communication due to diaphragmatic injury as a complication of chest wall resection in a peritoneal dialysis patient; report of a case]. 1976 5

Percutaneous radiofrequency thermal ablation (RFA) is considered an effective technique for providing local control in the majority of Hepatocellular carcinoma (HCC) patients. Although RFA is generally well tolerated, recent studies have reported complications associated with RFA. We describe a case of acute gouty arthritis in a 71-year-old man with chronic renal failure who was treated with RFA for a HCC lesion and who had hepatitis B-associated cirrhosis and mild renal insufficiency. Regular surveillance of the patient detected a 3.5 cm HCC lesion. Because the patient had declined surgery, RFA was chosen for therapy. On the third post-procedural day, the laboratory results showed increases in his uric acid and potassium levels, which were compatible with a tumor lysis syndrome. On the 6th post-procedural day, the patient complained of new right knee pain. Subsequent joint aspiration revealed monosodium urate monohydrate crystals. We made the diagnosis of acute gouty arthritis arising from tumor lysis and liver infarction caused by HCC ablation, which was aggravated by acute renal insufficiency. After adequate hydration and administration of oral colchicines, the patient's right knee pain subsided and the uric acid serum level returned to normal. This is the first described case of acute gouty arthritis after RFA for a HCC lesion in a patient with underlying chronic renal insufficiency. To avoid hyperuricemia and an acute attack of gout after RFA therapy for HCC, early identification of patients at risk is warranted, such as those with a large tumor, rapid tumor growth, and renal insufficiency, and preventative measures should be considered.
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PMID:A case of gouty arthritis following percutaneous radiofrequency ablation for hepatocellular carcinoma. 2013 29

Miriplatin is a novel lipophilic platinum complex developed to treat hepatocellular carcinoma (HCC). Although HCC patients frequently have coexisting chronic renal failure, there is no reliable data regarding clinical toxicity of miriplatin in HCC patients with chronic renal failure. We retrospectively evaluated the safety and efficacy of transcatheter arterial chemotherapy with miriplatin in 67 HCC patients with chronic renal failure (estimated glomerular filtration rate [GFR] by the Cockcroft-Gault equation <60ml/min). Estimated GFR within 2 months after miriplatin administration did not decrease significantly by the Wilcoxon signed rank test (pretreatment;46ml/min, 1 month;48ml/min;P=0.019, 2 months;45ml/min;P=0.619 [P<0.003 was significant by the Bonferroni correction]). Complete response in terms of tumor necrosis was achieved in 14 of 67 patients and no serious adverse events were observed. These results suggested that transcatheter arterial chemotherapy with miriplatin can be used safely for HCC patients with chronic renal failure.
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PMID:[Transcatheter arterial chemotherapy with miriplatin for patients with hepatocellular carcinoma and chronic renal failure]. 2205 8

Chronic kidney disease is associated with premature death from cardiovascular disease, which is, in part, driven by high density lipoprotein deficiency and dysfunction. One of the main causes of high density lipoprotein deficiency in chronic kidney disease is diminished plasma apolipoprotein (Apo)A-I level. Plasma ApoA-I is reduced in dialysis patients and hepatic ApoA-I messenger RNA (mRNA) is decreased in the uremic rats. This study explored the mechanism of uremia-induced downregulation of ApoA-I. Human hepatoma derived cells were incubated in media containing whole plasma or plasma subfractionation from normal subjects and patients with end stage renal disease pre- and posthemodialysis. Cells and culture media were isolated to measure ApoA-I protein and mRNA. ApoA-I promoter activity was measured using transfection with a luciferase promoter construct containing the -2096 to +293 segment of ApoA-I gene. Finally, effect of uremic and control plasma was assessed on ApoA-I RNA stability. Exposure to uremic plasma significantly reduced ApoA-I mRNA expression and ApoA-I protein production. These effects were reversed by replacing uremic plasma with normal plasma. Although no difference in ApoA-I promoter activity was found between cells exposed to uremic and normal plasma, uremic plasma significantly reduced ApoA-I RNA stability. Experiments using plasma subfractions revealed that the inhibitory effect of uremic plasma on ApoA-I mRNA expression resides in fractions containing molecules larger but not smaller than 30 kd. The pre- and postdialysis plasma exerted an equally potent inhibitory effect on ApoA-I mRNA abundance. Uremia lowers ApoA-I production by reducing its RNA stability. The inhibitory effect of uremic milieu on ApoA-I mRNA expression is mediated by non-dialyzable molecule(s) larger than 30 kd.
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PMID:Post-transcriptional nature of uremia-induced downregulation of hepatic apolipoprotein A-I production. 2321 99


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