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

Duodenofiberscopy with endoscopic retrograde cholangiopancreatography (ERCP) was performed in 102 patients with obstructive jaundice. Peritoneoscopy and peritoneoscopic cholecystocholangiography were done in patients whose ERCP was inconclusive. The causes of obstructive jaundice were carcinoma of the pancreas in 14 cases, carcinoma of the papilla of Vater in 12 cases, choledocholithiasis in 37 cases, carcinoma of the common bile duct in seven cases, hepatocellular carcinoma (HCC) in seven cases, intrahepatic cholestasis in three cases and miscellaneous causes in eight cases. No final diagnosis was made in 14 patients. The duodenofiberscopic examination with biopsy revealed the cause of obstructive jaundice directly in eight cases, when carcinoma of the pancreas or papilla of Vater extended to the duodenal mucosal surface. In 34 of the 37 patients with choledocholithiasis, ERCP alone was successful in making the diagnosis. Percutaneous transhepatic cholangiography and ERCP were used together to reach a diagnosis in the remaining three patients. We propose a classification for HCC on ERCP which may be useful for the study of icteric type HCC.
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PMID:Endoscopic approaches in the diagnosis of obstructive jaundice--with special reference to endoscopic retrograde cholangiopancreatography. 136 12

Alcoholic liver disease includes steatosis, alcoholic hepatitis and cirrhosis. Other liver diseases of genetic origin, but with a curious association with alcohol intake, are hemochromatosis and porphyria cutanea tarda. The attribution of chronic hepatitis to alcohol intake remains speculative, and the association may reflect hepatitis C infection. Hepatic injury attributed to alcohol includes the changes reported in the fetal alcohol syndrome. Steatosis, the characteristic consequence of excess alcohol intake, is usually macrovesicular and rarely microvesicular. Acute intrahepatic cholestasis, which in rare instances accompanies steatosis, must be distinguished from other causes of intrahepatic cholestasis (e.g., drug-induced) and from mechanical obstruction of the intrahepatic bile ducts (e.g., pancreatitis, choledocholithiasis) before being accepted. Alcoholic hepatitis (steatonecrosis) is characterized by a constellation of lesions: steatosis, Mallory bodies (with or without a neutrophilic inflammatory response), megamitochondria, occlusive lesions of terminal hepatic venules, and a lattice-like pattern of pericellular fibrosis. All these lesions mainly affect zone 3 of the hepatic acinus. Other changes, observed at the ultrastructural level, are of importance in progression of the disease. They include widespread cytoplasmic shedding, and capillarization and defenestration of sinusoids. Progressive fibrosis complicating alcoholic hepatitis eventually leads to cirrhosis that is typically micronodular but can evolve to a mixed or macronodular pattern. Hepatocellular carcinoma occurs in 5 to 15% of patients with alcoholic liver disease. The clinical syndrome of alcoholic liver disease is the result of three factors--parenchymal insufficiency, portal hypertension and the clinical consequences of extrahepatic damage produced by alcohol. At the several phases of the life history of alcoholic liver disease, the individual factors play a different role. The clinical manifestations of alcoholic steatosis are mainly extrahepatic in origin. Those of alcoholic hepatitis reflect mainly parenchymal insufficiency and those of cirrhosis are mainly those of portal hypertension. Alcoholic liver injury appears to be generated by the effects of ethanol metabolism and the toxic effects of acetaldehyde, perhaps the immune responses to alcohol- or acetaldehyde-altered proteins, and questionably enhanced by viral hepatitis. Alcoholic hepatitis may be mimicked histologically, and to a varying degree clinically, by a number of conditions (obesity, diabetes, several drug-induced injuries, jejunoileal bypass, and related "shortcircuiting" of the bowel). Perhaps the most important facet of the hepatotoxicity of alcohol is its enhancement of the effects of a number of other hepatotoxic agents, among which acetaminophen is the prime example.
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PMID:Alcoholic liver disease: pathologic, pathogenetic and clinical aspects. 205 45

Attenuation characteristics of portal vein thrombi on nonenhanced computed tomographic (CT) scans were assessed in 122 patients with proved portal vein thrombosis. Portal vein thrombi of high attenuation were found in four patients with hepatocellular carcinoma. From pathologic and radiologic studies, it was concluded that the high attenuation was caused by blood clots of recent onset formed at the tip of tumor thrombus. Differentiation from choledocholithiasis, hematobilia, and calcification of thrombi could be easily made by means of ultrasonography (US). Although plain CT is usually considered noncontributory in the diagnosis of venous thrombosis, it enabled the differentiation of recent thrombus in these four patients. Tumor thrombus in the major branches or main trunk of the portal vein is indicative of poor prognosis. When hepatic mass and high-attenuation portal vein thrombi are demonstrated with plain CT and substantiated by US, enhanced CT and angiography may be unnecessary for treatment of patients with advanced hepatocellular carcinoma.
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PMID:High-attenuation recent thrombus of the portal vein: CT demonstration and clinical significance. 303 25

To investigate the efficacy of long term administration of salt-poor albumin in the prognosis of cirrhotic patients with ascites, we administered albumin for more than six months at regular intervals to nine cirrhotic patients who had been confirmed to have ascites for the first time, and maintained their serum albumin levels above 3.0 g/dl. The other 11 cirrhotic patients who had also developed ascites for the first time were treated with diuretics only, as a control group. In the albumin treated group, one patient developed a hepatoma, and another had acute viral hepatitis after transfusion during splenectomy, and they were excluded. In the control group, one developed chronic liver failure after an operation for choledocholithiasis, and she was excluded from the study. All seven patients who had been administered albumin survived for more than two years, whereas three out of 10 in the control group died of chronic liver failure within two years. In the patients who showed a B.S.P. retention rate of more than 35% at the beginning of the study, all five treated with albumin survived for more than two years, whereas three out of four in the control group died within two years (P less than 0.025). In the albumin treated patients, the increase in serum albumin level was generally accompanied by an increase in the choline-esterase level. Long term administration of serum albumin to cirrhotic patients with ascites appears to lead to a better prognosis.
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PMID:Influence of long-term administration of serum albumin on the prognosis of liver cirrhosis in man. 661 54

Experience with and the impressions of adopting intraoperative abdominal echography in eighteen patients, aged 26 to 73 years, 9 men and 9 women, are shared. The distribution of patients by pattern of diseases is as follows: colorectal carcinoma--4 cases, liver echinococcus--one, gastric carcinoma--one, hepatocellular carcinoma--one, cholangitis acuta purulenta-one, echinococcus of lung and liver--one, calculous cholecystitis with choledocholithiasis--five, and carcinoma of ductus choledochus--one. Fifty intraoperative abdominal echographies and one intrathoracic supradiaphragmatic echography of the liver are performed. Intraoperative abdominal echography of tumors involving organs of the digestive tract contributes to specify the staging of the neoplastic process. In liver echinococcus it determines precisely the number of cysts and diagnoses impalpable cystic formations, while in choledocholithiasis it documents the presence of calculi in the biliary tracts and eventual dilatation of intrahepatic ones. In five patients intraoperative abdominal echographic is done in conjunction with intraoperative fiber choledochoscopy.
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PMID:[Intraoperative abdominal echography]. 899 60

Icteric-type hepatocellular carcinoma, which initially presents as jaundice, is known to be rare. Furthermore, the number of such cases that undergo hepatic resection is also very small. The purpose of this study was to clarify the characteristics of icteric type hepatocellular carcinoma and discuss the efficacy of hepatic resection in this condition. Herein, we present five cases of icteric type hepatocellular carcinoma which were among a study of 438 patients who underwent hepatic resection. Most of these cases were in the advanced stages, and a high incidence of early death was recognized. However, two patients are doing well, without further recurrence (8 years and 7 months, and 13 months, respectively). It is important to consider icteric type hepatocellular carcinoma whenever a patient has a potential risk for hepatocellular carcinoma. In addition, it is also important to understand that in diagnosing icteric type HCC, sometimes neither choledocholithiasis nor cholangiocellular carcinoma can be clearly ruled out. Extensive examinations of the biliary tract, including percutaneous transhepatic cholangiography as well as endoscopic retrograde cholangiography are indicated for such patients when they exhibit either temporary cholangitis or jaundice, as well as when there is biliary dilatation within the liver. Furthermore, hepatic resection is also considered to be a viable alternative for such cases.
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PMID:Hepatic resection for icteric type hepatocellular carcinoma. 935 68

We present 3 patients who developed choledocholithiasis 10, 13, and 12 months after percutaneous ethanol injection and/or transcatheter arterial chemoembolization for hepatocellular carcinoma. Since none of these patients had stones in the gallbladder or in the bile ducts before treatment, bile duct stones might have resulted from local injury in the bile ducts by percutaneous ethanol injection and/or transcatheter arterial chemoembolization. Choledocholithiasis may be a late complication of nonresectional and local therapies for hepatocellular carcinoma tumors.
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PMID:Is choledocholithiasis a late complication of nonresectional therapies for hepatocellular carcinoma? 1062 67

Ageing of the liver mainly affects the sinusoids and the Kupffer cells. Pseudocapillarization, manifested by reduced sinusoidal fenestration and subendothelial collagen deposition, causes a reduction in oxygen-dependent hepatocyte functions such as oxidative drug metabolism. The liver mass in old people is somewhat reduced and the liver blood flow is diminished. This causes a reduction in the clearance of rapidly cleared drugs, but the clearance of slowly cleared drugs is not affected. The overall capacity of the liver to regenerate is maintained in old people. Therefore, hepatic resections for hepatocellular carcinoma can be carried out in non-cirrhotic elderly people. For liver transplantations, biological age is more important than calendar age. Transplantations in frail old people and in elderly people with very poor liver function are associated with increased morbidity and limited survival. In relatively healthy old people, the results are as good as those in younger age groups. An increased prevalence of hepatitis C associated cirrhosis and hepatocellular carcinoma in the elderly population is to be expected, at least in the next 20 years. There is a high prevalence of gallstones among old people, in particular among females. For symptomatic choledocholithiasis in elderly patients, endoscopic bile duct clearance does not necessarily need to be followed by cholecystectomy.
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PMID:Liver disease in the elderly. 1197 34

Intra-hepatic cholangiocarcinoma (IHCC) is a rare tumor which arises from the epithelial cells of the intra-hepatic bile ducts; it may develop in a healthy liver and bile ducts or in bile ducts with malignant predisposition (Caroli's syndrome, primary sclerosing cholangitis). It has the worst prognosis of any tumor arising in the liver. Unlike hepatocellular carcinoma, no predisposing factors or high-risk populations have been demonstrated for cholangiocarcinoma other than intraphepatic choledocholithiasis such as is seen in east Asian populations. The most common clinical sign is a palpable tumor mass emphasizing that the tumor is usually detected at an advanced stage. CT scanning yields much clinical information but ultrasound-guided needle biopsy is necessary for diagnosis. Aggressive surgical resection is the only treatment modality which has afforded even slight prolongation of survival; hepatic resection must be large with uninvolved resection margins. When an IHCC is deemed resectable (localized tumor without hepatic metastases or intrahepatic or extrahepatic lymph node spread), pre-operative tumor embolization may be useful; when jaundice is present, percutaneous drainage of the dilated biliary system of the liver to be spared may also be necessary. Neither adjuvant nor neo-adjuvant chemotherapy or radiotherapy have shown proof of efficacity. Cholangiocarcinoma complicates sclerosing cholangitis in 10-15% of cases and is very difficult to diagnose. IHCC may also develop in Caroli's syndrome, where it is commonly found incidentally on pathologic examination of a resection specimen after surgery for a complication of the disease.
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PMID:[Intra-hepatic cholangiocarcinoma]. 1549 65

Spontaneous regression of hepatocellular carcinoma is rare phenomenon. A 74-year-old man was found to have a hepatocellular carcinoma with intrahepatic metastases in the lateral segment of the liver. Before surgery, he developed severe cholangitis due to choledocholithiasis and was treated endoscopically. The tumor marker level decreased markedly, and hepatectomy was performed. The resected tumor demonstrated complete necrosis.
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PMID:Spontaneous regression of hepatocellular carcinoma with complete necrosis: case report. 1625 50


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