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)

Emergency distal splenorenal shunt was prospectively carried out on 14 patients presenting with active bleeding from esophagogastric varices which was not controllable by medical treatment. Patients were composed of nine males and five females. Age ranged from 34 to 76 years with an average of 56.2. Underlying liver disease were cirrhosis of the liver in seven, cirrhosis and hepatocellular carcinoma (HCC) in five, primary biliary cirrhosis in one, and chronic hepatitis in one instance. Preoperatively, the Child's classification was A in one, B in five, and C in eight patient. Two patients underwent the original Warren shunt but the remaining 12 were treated by modified distal splenorenal shunts using Gore-Tex interposition. Three patients with Child's class C disease died within one month (operative mortality 21.4%). An oldest woman transiently had hepatic encephalopathy but recurrent variceal bleeding was not observed in any of the patients. Distal splenorenal shunt is a safe and reliable means in the treatment of medically intractable variceal hemorrhage.
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PMID:Emergency distal splenorenal shunt for medically uncontrollable variceal haemorrhage. 326 Oct 67

Gastrointestinal bleeding due to portal hypertension is a severe complication in patients with cirrhosis. Recurrent hemorrhage occurs in 75% of patients at 2 years, and medical treatment aims to induce a permanent decrease in portal pressure. A controlled study demonstrated that continuous administration of propranolol significantly decreased the risk of recurrent gastrointestinal bleeding in selected cirrhotic patients in good health. This efficacy was not found in unselected patients. The risk of recurrent gastrointestinal bleeding correlates with the development of hepatocellular carcinoma and poor compliance. Sclerotherapy of esophageal varices consists in obstruction of the varicosities. It has been demonstrated that esophageal sclerotherapy significantly reduces recurrent gastrointestinal bleeding, although a number of complications may occur.
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PMID:[Prevention of recurrent hemorrhage due to portal hypertension]. 348 12

Endoscopic injection sclerotherapy was given to 155 patients with esophageal varices mainly related to non-alcoholic liver cirrhosis. The formation of a superficial ulcer in the lower esophagus was achieved in 141 (91.0%) of the 155 patients, with an average of 4.1 sessions of endoscopic injection sclerotherapy during an average time of 4.9 weeks. The average volume of 5% ethanolamine oleate sclerosant used was 24.8, 19.2, 12.3 and 6.5 ml for the initial to fourth sessions of endoscopic injection sclerotherapy, respectively. For 14 patients, a sufficient number of sessions of endoscopic injection sclerotherapy could not be given: 10 early deaths (5 hepatoma, 4 liver failure and 1 gastric bleeding), and 4 refused further sessions. When the esophageal mucosa had been eliminated and a superficial ulcer had formed, episodes of recurrent bleeding or recurrence of esophageal varices were nil over a median follow-up of 14.6 months, with a range of 1 to 27 months. In seven patients, bleeding recurred before elimination of the mucosa could be achieved, but these bleeding episodes were well controlled with an additional session of endoscopic injection sclerotherapy. At the time of analysis, there were 36 deaths (20 hepatoma, 14 liver failure and 2 gastric bleeding) among these 155 patients. Thus, the mean follow-up was 16.3 months (range: 7 to 27 months) in the 119 survivors, with no recurrence of the varices. We propose that removal of the esophageal mucosa may well be the endpoint of repeated endoscopic injection sclerotherapy in the management of patients on injection sclerotherapy.
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PMID:Prevention of recurrence of esophageal varices after endoscopic injection sclerotherapy with ethanolamine oleate. 349 73

Two types of modified distal splenorenal shunt with expanded polytetrafluoroethylene (Gore-Tex; WL Gore & Associates Inc., Elkton, Md.) interposition were performed in 18 consecutive patients with esophageal or esophagogastric varices. There were 12 men and six women ranging in age from 32 to 76 years. The causes of portal hypertension were cirrhosis of the liver in 15 patients, chronic hepatitis in two, and idiopathic portal hypertension in one. In five patients the left gastric vein branched off from the splenic vein; bilateral gastric venous decompression was achieved by preserving the splenic vein. Porta-azygos disconnection was routinely performed by confirming repeated intraoperative direct splenoportography. The operations were elective in seven and were emergencies in five patients. Six patients underwent a prophylactic shunt; all patients had "red color signs" endoscopically, and three of them had concomitant hepatocellular carcinoma. Postoperative morbidity was minimal and there was no mortality. Shunt patency was confirmed angiographically in all patients 14 to 56 days after surgery. The varices disappeared or significantly improved in all patients. No patients had variceal bleeding postoperatively. Hepatic encephalopathy was transiently seen in one (the oldest) patient.
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PMID:Modified distal splenorenal shunt with expanded polytetrafluoroethylene interposition. 406 65

This report describes 636 patients with portal hypertension in whom esophageal transections with paraesophagogastric devascularization were performed for the management of esophageal varices. The procedure was a prophylactic measure in 185 patients, elective surgery in 349, and an emergency procedure in 102. Portal hypertension was due to cirrhosis of the liver in 464 patients (40 alcoholic and 424 cryptogenic), idiopathic portal hypertension in 99, extrahepatic portal vein occlusion in 38, hepatoma in 22, and other causes in 13. The operative mortality rates were as follows: emergency 13.7%, elective cases 3.2%, prophylactic cases 4.3%, and overall 5.2%. There were no deaths in the 233 patients in Child's clinical class A; 232 class B patients had a 2% mortality rate, and 171 class C patients had a 17% mortality rate. The 10-year actuarial survival rates in patients with cirrhosis of the liver were 55% in emergency cases and 72% in both prophylactic and elective cases. In patients without cirrhosis the survival rates were 90%, 96%, and 95%, respectively. Recurrence of variceal bleeding or varices was less than 5%. We conclude that the Sugiura procedure is safe and effective in controlling esophageal varices and prolongs the long-term survival of patients with portal hypertension.
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PMID:Results of six hundred thirty-six esophageal transections with paraesophagogastric devascularization in the treatment of esophageal varices. 609 Jul 15

To assess the natural history of non-alcoholic liver cirrhosis, one hundred and eighty medically treated Japanese cases, including 110 accompanied by esophageal varices were investigated retrospectively. Among those patients with varices fifty-one (46.4%) bled from the upper gastrointestinal (GI) tract and thirty-two (29.1%) from esophageal varices, while GI bleeding was found in only six out of 70 patients without varices. The GI bleeding rate was the highest in patients with varices and concomitant hepatoma (76.5%). The mortality rate of the GI bleeders was 68.6% in patients with varices and 33.3% in patients without varices. The mortality on the first variceal bleeding episode was 65.6%, and another 25.0% had rebleeding from varices, resulting in a one-year survival of 9.4%. The ten-year cumulative percentage of variceal bleeding was 61.2% in patients with varices, and that of occurrence of hepatoma was 50.7% in total of 180 patients. This study revealed that the non-alcoholic cirrhotic patients have a highly rate of complication by hepatoma and that the development of hepatoma doubles the risk of varix rupture.
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PMID:The natural history of non-alcoholic cirrhosis. 609 96

In attempts to obtain complete control of bleeding esophageal varices, terminal esophago-proximal gastrectomy (TEPG) and its modification proximal gastric transection (PGT) were performed, under endoscopic assistance, in 42 patients with cirrhotic portal hypertension. Complete disappearance of varices was confirmed in all patients at surgery and 4 weeks after surgery, and this condition was maintained for up to 60 months in 15 patients of TEPG and 16 of PGT. Recurrent varices in 3 (17 per cent) TEPG and 8 (34 per cent) PGT were attributed to the advance in the liver cirrhosis in 7, hepatoma in 3 and portal vein thrombosis in 1. In 8 of 11 recurrences, type C variceal blood circulation drained into the cervical veins. Endoscopic assistance during surgical treatment for bleeding esophageal varices plays a decisive role.
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PMID:Endoscope assisted surgery for the treatment of bleeding esophageal varices. 633 68

The results of transthoracic esophageal transection in 100 patients with esophageal varices are described. There were 11 operative deaths in this series, and the majority of patients died from hepatic failure. Esophageal varices disappeared completely in 81 percent of the patients and faded in 18 percent. Post-transection rebleeding was observed in six cases. There were 16 late deaths, caused mainly by hepatic failure and hepatoma. The 3 year and 5 year survival rates includine mortality rate, the efficacy in eliminating varices and the sufficient survival rate, it is presumed that esophageal transection is the most suitable operation for esophageal varices, even in poor risk patients.
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PMID:Results of esophageal transection for esophageal varices: experience in 100 cases. 696 70

A 78-year-old female presented with swelling and severe pain in the left forehead secondary to a simple head injury received 1 month previously. On admission, neurological examination was normal. Plain skull x-ray films and computed tomography showed an osteolytic and well-defined mass in the left frontal bone. Bone scintigraphy showed high-uptake areas in the right lower ribs and fifth lumbar vertebra. Blood tests showed slight liver dysfunction and a high alpha-fetoprotein level. Abdominal computed tomography showed a huge mass within the liver. Left common carotid angiography disclosed the enlargement of several feeding arteries arising from the external carotid artery with tumor staining. The bone tumor was removed for histological diagnosis and to reduce the localized pain. The histological diagnosis was a cranial metastasis from hepatocellular carcinoma. She died of ruptured varicose veins of the esophagus approximately 8 months after surgery. Surgery for cranial metastasis from hepatic cancer is only indicated when localized pain or hemorrhage threaten the quality of life.
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PMID:Cranial metastasis of hepatocellular carcinoma in a female--case report. 751 32

A 68-year-old male patient with liver cirrhosis and bilateral diffuse hepatoma presented with massive upper gastrointestinal bleeding caused by rupture of duodenal varices. Surgery had to be performed after sclerotherapy failed to stop the bleeding. A mesocaval shunt with graft interposition controlled the hemorrhage. Follow-up endoscopic examination showed complete disappearance of the varices. After surgery, the patient had two episodes of mild hepatic encephalopathy, which easily responded to treatment. There was no rebleeding, and he died of hepatic malignancy ten months after the shunt procedure.
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PMID:Duodenal variceal bleeding--successfully treated by mesocaval shunt after failure of sclerotherapy. 778 38


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