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)

The anesthetic management of orthotopic liver transplantation has become a new problem with special requirements. From the anesthetist's point of view the operation is divided into four phases: the first is the phase of removal of the diseased liver, characterized by heavy bleeding; the second is the anhepatic phase, dominated by a sudden reduction of blood return to the heart due to cross-clamping of inferior vena cava; the third is the phase of partial re-establishment of circulation of the donated liver, marked by a progressive drop in body temperature and great changes in acid-base equilibrium and electrolytes, especially potassium, and disturbances of blood coagulation potassium, and disturbances of blood coagulation; the fourth is the phase of release of the clamps from the inferior vena cava, which causes a rise in the central venous and systolic pressures, and may also aggravate the metabolic acidosis. Eight cases of orthotopic liver transplantation for late-stage unresectable hepatocarcinoma have been operated upon under combined neurolept anesthesia in recent 3 years. The age of the patients is between 29-50 years. We think that neurolept analgesia with the combined use of gamma-OH, diazepam, ketamine and gallamine is one of the safest methods of anesthesia, which has a minimal toxicity to the liver, a smooth induction and rapid recovery of consciousness, and puts little burden on the circulation. The postoperative survival of first seven patients was between 6-264 days. There were no postanesthetic complications in our series. The authors conclude that the proper choice of anesthesia, careful monitoring and judicious management of the patients during the various phases of operation, the maintenance of good condition of the donated liver and skillful surgical technique are the basic requirements for successful transplantation.
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PMID:Anesthesia in orthotopic liver transplantation. Report of 8 cases. 702 97

A laryngeal mask airway (LMA) and epidural analgesia were used for anesthetic management of microwave coagulo-necrotic therapy for multiple hepatoma in a 76-year-old male with a giant bulla and liver cirrhosis. Since bleeding times, PT and APTT were within normal limits, an epidural catheter was inserted between Th9 and 10 interspaces in operating room. After preoxygenation, general anesthesia was induced with propofol 120 mg. After insertion of a LMA, anesthesia was maintained under spontaneous breathing with sevoflurane (1-1.5%) in about 45% oxygen and nitrogen. During the operation, 2% lidocaine was injected continuously into the epidural space. Continuous epidural injection of 2% lidocaine was found to be very effective for obtaining abdominal muscle relaxation and perioperative pain management. Postoperative chest X ray did not show any signs of rupture of the giant bulla, and any neurological abnormalities due to the epidural hematoma were not encountered. We could reduce the risk of rupture of a giant bulla during general anesthesia using a LMA and epidural analgesia.
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PMID:[Anesthetic management of a patient with a giant bulla and liver cirrhosis using a laryngeal mask airway and epidural analgesia]. 1145 73

Superior mesenteric venous thrombosis (SMVT) is an uncommon but potentially life-threatening disorder. We describe a cirrhotic patient with hepatocellular carcinoma who had partial SMVT for at least 28 months. Our experience may help in the management of such patients. The partial SMVT was not treated at the time of discovery because there was no evidence of bowel infarction. Moreover, the patient had a tendency to bleed severely and was in a poor condition. SMVT was followed using regular ultrasonography and the pattern of SMVT did not change significantly during the follow-up period. A symptom that may have been related to SMVT was abdominal colic pain after meals, which was sometimes followed by diarrhea and / or nausea and vomiting. There was no evidence of bowel ischemia or infarction during follow-up. Abdominal discomfort can be successfully treated using anticholinergic drugs with or without analgesia.
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PMID:Long-term follow-up of partial thrombosis of the superior mesenteric vein in a cirrhotic patient with hepatocellular carcinoma: a case report. 1282 80

The endogenous cannabinoid anandamide, a lipid mediator, induces various physiologic events such as vascular relaxation, inhibition of gap-junctions formation, tumor proliferation, neurologic analgesia, and apoptosis. Although increased concentration of anandamide in plasma has been implicated in pathophysiologic states including endotoxin-induced hypotension, the effects of anandamide on hepatocytes still remain unclear. In this study, we present evidence that plasma anandamide concentration is highly increased in severe hepatitis and cirrhosis patients. In addition, concentrations of anandamide within the pathophysiologic range potently induced apoptosis of hepatoma cell line (Hep G2) and primary hepatocytes, suggesting a possible link between increased anandamide level and hepatocyte damage. Anandamide-induced cell death was preceded by G0/G1 cell-cycle arrest, activation of proapoptotic signaling (i.e., p38 MAPK and JNK), and inhibition of antiapoptotic signaling (i.e., PKB/Akt) pathways. Moreover, anandamide increased susceptibility to oxidative stress-induced hepatocyte damage. In this context, methyl-beta-cyclodextrin (MCD), a membrane cholesterol depletor, or mevastatin, an HMG-CoA reductase inhibitor, or N-acetyl cysteine, an antioxidant, potently inhibited the anandamide-induced proapoptotic events and cell death, whereas putative cannabinoid receptor antagonists did not exhibit an inhibitory effect on anandamide-induced cell death. Furthermore, binding assay using polymyxin beads revealed that anandamide could interact with cholesterol. In conclusion, our data suggest that cholesterol present in the cell membrane determines the fate of hepatocytes exposed to anandamide, possibly functioning as an anandamide receptor.
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PMID:Membrane cholesterol but not putative receptors mediates anandamide-induced hepatocyte apoptosis. 1457 55

Although radiotherapy is highly effective in relieving bone pain from cancer invasion, the mechanism of pain relief remains unclear. To explore the mechanism of radiotherapy-induced analgesia, we have developed an animal model of bone pain resulting from cancer invasion. Using this animal model system, radiation-induced pain response and pain-related signals in the spinal cord were analyzed. The hind paw model of bone pain from cancer invasion was developed by injecting transplantable hepatocellular carcinoma, HCa-1, into the periosteal membrane of the foot dorsum in C3H/HeJ mice. Bony invasion from HCa-1 cells was confirmed by histopathological examinations. We also measured the development of pain-associated behaviors. In this model, changes in the objective level of pain response after irradiation of the tumor were analyzed. Expression of pain-related host signals in the spinal cord, such as calcitonin gene-related peptide (CGRP), substance P, and c-fos, was investigated with immunohistochemical staining. In the histopathological examinations, bone invasion from HCa-1 cells was seen from day 7 and was evident at day 14 after injection. Measurable pain-associated behaviors were developed from day 7. In this model, mice treated with radiotherapy showed decreased objective levels of pain with a higher threshold to graded mechanical stimulation than did control mice from day 3 after irradiation. After irradiation of tumors, significant decreases in the expression of CGRP were shown in the spinal cord, whereas neither substance P nor c-fos showed any alteration. We developed a novel hind paw model of bone pain from cancer invasion that was confirmed by histopathological examination and measurable pain-associated behaviors. Radiotherapy decreased the objective level of pain and the underlying mechanism involved in the alteration of pain-related host signal, CGRP, in the spinal cord.
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PMID:Radiation-induced alteration of pain-related signals in an animal model with bone invasion from cancer. 1565 96

Opioids, acting via G-protein coupled membrane receptors, induce analgesia. However their role is not limited to their anti-nociceptive action. They are found in several peripheral tissues acting as negative regulators of cellular processes. Even though that is not fully elucidated, it becomes obvious that opioids exert their effects in close relation to other neuropeptides such as somatostatin. Hepatocellular carcinoma is one tumor, among others, which secrete bioactive peptides while somatostatin analogs exert an inhibitory effect. We have used the human hepatocyte-derived cancer cell line HepG2, in order to examine the effect of opioids on cell growth and their possible mode of action. Our results show that the opioid ethylketocyclazocine (EKC) inhibits cell proliferation and induces apoptosis. This inhibitory effect is not exerted via opioids receptors since it was not reversed by the opioid antagonist diprenorphine and functional opioid receptors were not found on HepG2 cells. On the contrary, we show that EKC binds to somatostatin receptors, and activates a PTP signalling cascade. In this respect, the interaction of opioids with somatostatin receptors on hepatocellular carcinoma cells, and the fact that they are widely used for pain control, may provide some additional clues for the discrepancies during treatment with somatostatin analogues.
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PMID:The inhibitory effect of opioids on HepG2 cells is mediated via interaction with somatostatin receptors. 1711 72

This case report series describes eight patients (four patients with pancreatic carcinoma, one patient with hepatocellular carcinoma, one patient with gastric and rectal carcinoma, one with sigmoid colon cancer, and one with rectal cancer), whose abdominal cancer pain was treated with intravenous phentolamine infusion at 80 mg x day(-1) for 2 days. All but one of the patients had already been treated with opioids. All eight patients complained of severe abdominal pain; in five patients the pain radiated to the back, and there was associated anal pain in two patients. Analgesia was achieved in three patients; pain alleviation was obtained in four patients, but was not sustained in two of these four patients; and the treatment in one patient could not be judged for efficacy because epidural morphine was used together with the phentolamine. Adverse effects of phentolamine were tachycardia and/or hypotension.
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PMID:Intravenous phentolamine infusion alleviates the pain of abdominal visceral cancer, including pancreatic carcinoma. 1768 Jan 99

Even after receiving analgesia, patients with gastric and liver cancer still report moderate levels of postoperative pain. The purpose of the study was to investigate the efficacy of foot reflexotherapy as adjuvant therapy in relieving pain and anxiety in postoperative patients with gastric cancer and hepatocellular cancer. The study design was a randomized controlled trial. Data were collected from 4 surgical wards of a medical center in 2005 in Taipei, Taiwan. Sixty-one patients who had received surgery for gastric cancer or hepatocellular carcinoma were randomly allocated to an intervention (n = 30) or control (n = 31) group. Patients in the intervention group received the usual pain management plus 20 minutes of foot reflexotherapy during postoperative days 2, 3, and 4. Patients in the control group received usual pain management. Outcome measures included the short-form McGill Pain Questionnaire, visual analog scale for pain, summary of the pain medications consumed, and the Hospital Anxiety and Depression Scale. Results demonstrated that studied patients reported moderately high levels of pain and anxiety postoperatively while patients were managed with patient-controlled analgesia. Using generalized estimation equations and controlling for confounding variables, less pain (P < .05) and anxiety (P < .05) over time were reported by the intervention group compared with the control group. In addition, patients in the intervention group received significantly less opioid analgesics than the control group (P < .05). Findings from this study provide nurses with an additional treatment to offer postoperative digestive cancer patients.
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PMID:Effects of reflexotherapy on acute postoperative pain and anxiety among patients with digestive cancer. 1849 Aug 86

Patients with renal failure sometimes develop nephrogenic systemic fibrosis (NSF) following administration of gadolinium, and a few cases have been reported in Japan. There is no definitive cure; the disease is progressive and can be fulminant. We report a case of a 54-year-old woman with multiple pathologies, including lupus nephritis at 23 years, peritoneal dialysis at 34 years, hepatocellular carcinoma at 47 years, a switch to hemodialysis, partial hepatectomy and axillo-femoral bypass grafting for severe aortic stenosis at 52 years, as well as multiple MRI exposures. One month after the last MRI including an intravenous gadolinium contrast agent (Magnevist), she developed thickening of the skin with brownish hyperpigmentation on the lower legs spreading later to all extremities, which limited joint movement and resulted in contractures. She was treated with low-dose prednisolone and cyclosporine, however, she remains at present unable to walk or extend the joints of the upper and lower extremities and needs analgesia for sharp pain in the thickened skin. Various factors including multiple exposures to gadolinium-containing MRI contrast agents, inflammatory burden, and hepatic disease might have played a role in the development of NSF. This is the case of a Japanese patient with gadopenate-dimeglumine (Magnevist) related NSF. Regardless of ethnicity and the type of contrast agent, we should be aware of the potential development of NSF in patients with renal failure.
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PMID:Nephrogenic systemic fibrosis in a patient on long-term hemodialysis. 1920 20

Minimally invasive approaches for small liver tumors are desirable. We describe a single-incision laparoscopic hepatectomy (SILH) using total laparoscopic surgery (TLS) technique. SILH was performed to remove a solitary 2-cm hepatocellular carcinoma located at segment 3. The technique included a one-inch skin incision with three ports (one 12 mm and two of 5 mm each). The liver was sealed and dissected by three different devices: Harmonic scalpel, TissueLink sealing dissector, and Endoclip. Operation time was 70 minutes and blood loss was trivial. The patient required no analgesia postoperatively and walked unaided the next day. Various aspects of the procedure were not different from TLS. SILH is a safe procedure with several advantages. The procedure is promising as minimally invasive liver surgery.
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PMID:A single-incision laparoscopic hepatectomy for hepatocellular carcinoma: initial experience in a Japanese patient. 2094 73


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