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Query: UMLS:C0019204 (hepatocellular carcinoma)
 71,386 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Among 108 cases of endoscopic injection sclerotherapy (EIS) performed from January 1984 through September 1989, post-EIS variceal bleeding occurred in 38 case (35%). Death was significantly more frequent among the post-EIS bleeders than non-bleeders (55% v. 27%). Background factors were analyzed for failure to prevent bleeding. The curve of the cumulative non-bleeding rate following emergency EIS (21 cases) was significantly lower (P less than 0.01) than that following elective EIS (22 cases), and there was more frequent rebleeding (13/21 v. 7/22) within a shorter mean period of time (4.9 months v. 14.1 months) in the former; association of hepatocellular carcinoma was also more frequent (13/21 v. 3/22). Continuation of drinking showed no difference between post-EIS bleeders (5/38) and non-bleeders (9/70). After complete variceal eradication the curve of the cumulative non-bleeding rate was significantly higher than after incomplete eradication (P less than 0.001). Following prophylactic EIS (65 cases) there was significantly less frequent bleeding (P less than 0.01) than following EIS performed after variceal rupture (43 cases). The risk of variceal bleeding after EIS can be minimized by complete eradication of varices at the initial EIS. Prophylactic EIS was suggested to contribute to reducing the frequency of post-EIS bleeding.
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PMID:Variceal bleeding after endoscopic injection sclerotherapy: an analysis of 108 subjects undergoing endoscopic injection sclerotherapy. 188 54

To evaluate the possible influence of the trauma of swallowing solids on the outcome and complication rate of endoscopic injection sclerotherapy we carried out a prospective randomized trial in 46 cirrhotics undergoing sclerotherapy because of recent or acute variceal bleeding. The patients were randomly assigned to mashed food (24 = group A) or normal solid food (22 = group B). Both groups were comparable according to age, sex, Child classes, size of the varices and patients undergoing emergency sclerotherapy (8 in each group). Duration of hospital care (A 26.6, B 27.3 days) (means), number of endoscopic studies (A 4.7, B 4.6), number of sclerotherapy sessions (A 2.4, B 2.5) and required amount of Polidicanol in each patient (A 62.7, B 56.4 ml) were not different. Variceal eradication was achieved in 13 cases in A, in 14 in B. III degrees varices remained in 6 patients in A (3 quit against advice before completing ST) and in 1 case in group B. Staple-gun transection and devascularization because of recurrent bleeding were necessary in 2 cases in A and in 1 case in B. Death occurred in 2 cases in A (liver failure), in 4 cases in B (3 cases of liver failure and in 1 case with recurrent bleeding, without operation because of hepatocellular carcinoma). Episodes of acute massive bleeding from varices or esophageal ulcers occurred 9 times in group A and 10 times in group B. Minor bleedings occurred 10 times in A and 9 times in B. Transfusion requirement was 110 units of packed red cells in A and 106 in B.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Effect of food characteristics on rate of hemorrhagic complications and early results of endoscopic sclerosing treatment of esophageal varices]. 190 45

To evaluate the therapeutic effect of glypressin (triglycyl-lysine-vasopressin, C52H74N16O15S2.2C2H4O2.5H2O) in the treatment of oesophageal variceal bleeding, a randomized controlled trial of glypressin and vasopressin was conducted in 54 cirrhotic patients with oesophageal varices bleeding. Bleeding ceased within 24 h in 50% (13/26) of patients treated with glypressin and in 53.6% (15/28) of patients given vasopressin. Re-bleeding within 7 days occurred in 30.8% (4/13) of the glypressin group and in 20.0% (3/15) of the vasopressin group. There was no statistically significant difference in the therapeutic effect between glypressin and vasopressin. In the glypressin group, bleeding was more easily stopped in non-hepatocellular carcinoma (HCC) cirrhotic patients of Pugh's criteria A or B than in patients of Pugh's criterion C or HCC. We conclude that glypressin and vasopressin have similar therapeutic effect. In considering the application convenience, glypressin is an alternative to vasopressin in the treatment of bleeding varices in patients of good liver function reserve.
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PMID:A controlled study of glypressin versus vasopressin in the control of bleeding from oesophageal varices. 196 93

Between April 1984 and October 1988, 10 patients with hepatocellular carcinoma who bled from esophageal varices were included in a polidocanol sclerotherapy program, after the cessation of bleeding. Sixty cirrhotic patients without hepatocellular carcinoma were included as controls in the same sclerotherapy program for the same period. According to Okuda's classification, 1 patient was grade I, and 9 were grade II. At 1 year, 41 percent of patients with hepatocellular carcinoma and 51 percent of controls had rebled (non significant). Varices were obliterated in 7 of 10 patients with hepatocellular carcinoma and in 41 of 60 control patients (non significant). At one year, treatment failed (rebleeding or death) in 54 percent patients with hepatocellular carcinoma and in 59 percent control patients (non significant). Child-Pugh's score was the principal prognostic factor for treatment failure in both groups. Portal vein thrombosis was found in 2 of the 3 hepatocellular carcinoma patients who rebled. Unlike propranolol, elective sclerotherapy treatment might be proposed to patients with hepatocellular carcinoma without portal thrombosis.
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PMID:[Elective sclerotherapy in hepatocellular carcinoma complicated by digestive hemorrhage]. 216 46

Twenty-four patients with hepatocellular carcinoma (HCC) concomitant with esophageal and/or cardial varices concurrently underwent hepatic resection for HCC and various treatments for varices. All patients had cirrhosis of the liver, and had either blue or white varices with "red color signs" endoscopically. These patients were assigned to two groups. Group A patients simultaneously underwent partial hepatectomy and selective shunt or direct interruption procedures (n = 13). Group B patients underwent hepatic resection and devascularization of the upper half of the stomach and/or preoperative or postoperative endoscopic injection sclerotherapy (n = 11). Seven patients in Group A had a tumor recurrence 4 to 58 months postoperatively, while in Group B, one of 11 patients had a tumor recurrence in the remnant liver. There was one patient in Group A with postoperative rebleeding from esophageal varices, and there was neither variceal bleeding nor variceal recurrence after treatment in Group B. Liver failure was the immediate cause of death in five, including three in-hospital deaths in Group A. Survival rates during the first 5 years in Group A were 75%, 67%, 31%, 21% and 10%, while the four-year survival rate in group B was 100%. In the light of this evidence, the treatment given to Group B is to be preferred.
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PMID:Advances in the treatment of hepatocellular carcinoma and concomitant esophageal varices. 217 24

A retrospective study was done on 226 patients with hepatocellular carcinoma and coexisting esophageal varices treated at our institute between 1974 and 1988. The patients were divided into two groups: Group A containing patients treated between 1974 and 1982 (n = 92), and Group B comprising those treated between 1983 and 1988 (n = 134). Surgical treatments were applied to 64 patients (69.6%) and 37 patients (27.6%) in groups A and B, respectively (p less than 0.001). Ninety out of 134 patients (67.2%) in group B were prescribed regional chemotherapy. Forty-nine patients (53.3%) in group A, and 96 (71.6%) in group B had esophageal varices that were about to rupture as indicated endoscopically. Nineteen patients (38.8%) in group A, and 10 (10.4%) in group B were treated surgically (p less than 0.005). The varices in 76 out of 96 patients (79.2%) in group B were treated by endoscopic sclerotherapy. Survival rates during the first 5 years in groups A and B were 28% and 65%, 16% and 43%, 5% and 27%, 4% and 18%, and 4% and 6%, respectively. It would appear that appropriate conservative treatment of the poor surgical candidates will, in general, lead to good clinical results.
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PMID:New approaches to hepatocellular carcinoma and concomitant esophageal varices prolong survival. 217 28

The results of injection sclerotherapy for oesophageal varices which recurred after portal non-decompressive surgery were analysed retrospectively to evaluate its efficacy. We treated 60 consecutive patients with portal hypertension; 19 were treated on an emergency basis, seven electively and 34 on a prophylactic basis. All acute bleeding was controlled with one session of sclerotherapy using a transparent overtube. After eradication by sclerotherapy, no bleeding episodes occurred and there was no recurrence of the varices, except in three uncompliant patients, during a mean follow-up period of 33.1 months. Bleeding from a gastric ulcer and gastritis occurred in one patient each. Oesophageal stenosis occurred in nine (15 per cent) patients and gastric varices developed in two (3 per cent) patients. Twelve patients died, five from liver failure and six with hepatoma, but there was no bleeding from the gastrointestinal tract. The overall 4-year survival rate was 80 per cent. We recommend the use of sclerotherapy as the primary treatment for recurrent oesophageal varices.
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PMID:Eradication of oesophageal varices recurring after portal non-decompressive surgery by injection sclerotherapy. 239 24

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

Clinical, laboratory, and ultrasonographic features of 75 patients of primary hepatocellular carcinoma (PHC) living in the Gizan Area of Saudi Arabia and their follow-up, during a 2-year period, were characterized. Eighty-nine percent of the cases were defined histologically, whereas in the rest, ultrasonographic (US) evidence along with an alphafetoprotein (AFP) level exceeding 480 ng/ml were taken as the positive evidence for PHC. Eighty percent of the cases were male patients, with the peak incidence during the seventh decade. The most common clinical presentations were hepatic enlargement (91%), abdominal pain (76%), splenic enlargement (33%), and acites (33%), followed by bruit, fever, metastases, and varices. Alteration in a liver function test was manifest in 97% of the cases, AFP values greater than 480 ng/ml in 57%, and a hepatitis B virus surface antigen (HBsAg) positivity in 65% of the cases. There was no intersex variation in positivity for HBsAg, antibody to HBsAg (anti-HBs), antibody to hepatitis B virus core antigen (anti-HBc) among the 30 PHC cases studied. Positivity for HBsAg or the overall hepatitis B virus exposure in PHC cases was higher than the normal controls (P less than 0.001). In addition to histologic confirmation of PHC in 67 cases, there was histologic evidence of cirrhosis in 25%, or chronic active hepatitis in 19% of the cases. At the time of diagnosis, the average duration of the presenting illness was less than 2 months, while the mortality in the ensuing 2-month period was 73%. The average span of total illness in the vast majority of cases was 4 to 6 months. Two female patients (one with fibrolamellar carcinoma) however, survived for 2 years. Immunization against hepatitis B virus should be considered for all newborns in such hyperendemic communities. A continuous program should be started in such communities to screen and immunize all those yet unexposed to hepatitis B virus. The established HBsAg carriers should be periodically examined ultrasonographically along with an AFP estimation for initiating the chemotherapeutic and other measures against PHC in fairly early stages of malignancy.
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PMID:A profile of primary hepatocellular carcinoma patients in the Gizan Area of Saudi Arabia. 242 66

Hepatocellular carcinoma is closely associated with cirrhosis, but it also develops, although much less frequently, in a noncirrhotic liver. It is suspected, without supporting evidence, that hepatocellular carcinoma has a different etiology when associated and not associated with chronic liver disease. In this study, 66 noncirrhotic cases found among 618 autopsies for hepatocellular carcinoma (10.7%) were analyzed retrospectively. The noncirrhotic liver was histologically unremarkable in 3 cases and in the histologically evaluable 56 cases it had fibrosis of varying degrees or mild cellular infiltrate, or both, in the portal tract. There was one liver that had portal venous changes compatible with those in idiopathic portal hypertension (Banti's syndrome). In these noncirrhotic livers, the parenchymal cells were generally unremarkable except for liver cell dysplasia that was seen in 26.8%. Serum hepatitis B surface antigen was positive in only 7.4% in contrast to 26.6% in cirrhotic cases. Three histologically unremarkable cases had no clinical or histologic evidence of chronic liver disease; two involved painter-plasterers and one a farmer. The liver weight in these cases ranged from 4400 to 6180 g. In contrast, the average liver weight in cirrhotic cases was 1998 g. Noncirrhotic patients when compared with cirrhotic patients had better liver function tests and much less frequent varices. It was concluded that approximately 11% of hepatocellular carcinoma cases in Japan are noncirrhotic, the majority having some histologic changes in the portal tracts suggestive of past or ongoing chronic liver disease, and that there are rare cases that have no histologic changes in the liver.
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PMID:Hepatocellular carcinoma without cirrhosis in Japanese patients. 254 16


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