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Query: UMLS:C0345904 (liver cancer)
 15,188 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Peripheral insulin-resistance and impairment of the hepatocellular function are two major possible causes of diabetes mellitus in liver cirrhosis. The pathogenesis of insulin-resistance (receptorial or post-receptorial) is unknown but it represents an important complication because it has a profound impact on the pathology and natural history of the liver disease. The beta-cell capacity, to compensate the insulin-resistant state to avoid the onset of frank diabetes mellitus plays a critical importance. Many factors may induce a reduction of the beta-cell function in patients with liver cirrhosis: some are due to a predisposition to the development of diabetes: genetic or environmental, unrelated to the hepatic disease; some others are hepatic disease-dependent (excess liver and islet of Langerhans iron deposition, HCV infection rather than other hepatic infections, the co-presence of HCC) and may be crucial because additive to the previous. It is likely that the high prevalence of diabetes in liver cirrhosis is due to the early onset of strong insulin-resistance coupled to a deficient beta-cell function aggravated by hepatic disease-related factors.
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PMID:[Hepatogenic diabetes]. 1182 99

The insulin resistance-associated hepatic iron overload is the first aetiology of iron overload disorders in France. If we do not know its mechanism, the prevalence among type II diabetic patients is around 40%. Hyperferritinaemia is present in all cases, but is not specific of the diagnosis. This pathology features liver fibrosis among 10% of the patients and some cases of primary liver cancer have been described. Moreover, a large body of evidence favors the direct involvement of iron in the development of extra hepatic neoplasia, while therapeutic phlebotomy to maintain low to normal body iron stores can prevent all known complications of insulin resistance-associated hepatic iron overload. In addition, treatment of type II diabetes mellitus and other features of insulin resistance syndrome is essential. In conclusion, it is important to detect this syndrome during type II diabetes mellitus.
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PMID:[Should the insulin resistance associated with hepatic iron overload be researched during diabetes mellitus type II?]. 1244 73

Hereditary haemochromatosis is the prototype disease for primary iron overload. The disorder is very common, especially amongst subjects of Northern European extraction. It is characterized by an autosomal recessive mode of inheritance, and most cases are homozygous for the C282Y mutation in the HFE gene. Haemochromatosis is now recognized to be a complex genetic disease with probable significant environmental and genetic modifying factors. The early diagnosis of individuals at risk for the development of haemochromatosis is important, because survival and morbidity are improved if phlebotomy therapy is instituted before the development of cirrhosis. The cost-effectiveness and utility of large-scale screening for haemochromatosis have been questioned given that many individuals with the homozygous C282Y mutation do not have iron overload or end-organ damage. However, the use of phenotypic tests, such as serum transferrin-iron saturation, for initial screening avoids the problem of the identification of non-expressing homozygotes. Liver biopsy remains important in management to determine the presence or absence of cirrhosis, particularly amongst patients with serum ferritin levels greater than 1000 ng/mL or elevated liver enzymes. Those with non-HFE haemochromatosis who cannot be identified on genotypic testing should have a liver biopsy to establish diagnosis. Patients with end-stage liver disease may develop liver failure or primary liver cancer, and liver transplantation may be required. Liver transplantation for haemochromatosis is associated with a poorer outcome compared with other indications because of infections and cardiac complications.
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PMID:Review article: haemochromatosis. 1245 31

The purpose of this study was to evaluate the diagnostic efficacy of iron-oxide-enhanced MRI vs CT during arterial portography (CTAP) and intraoperative ultrasound (IOUS) in detection of liver neoplasms. Seventeen patients with malignant focal liver lesions (liver metastases, n=7), hepatocellular carcinomas (HCC, n=9), and cholangiocellular carcinoma (CCC, n=1) underwent presurgical Resovist-enhanced MRI and CTAP. Two independent observers (A and B) assessed the blinded images of unenhanced and iron-oxide-enhanced MRI vs CTAP for the presence, number, and location of the liver lesions. These results were compared lesion by lesion and segment by segment with the results of intraoperative ultrasound ( n=17) serving as the reference standard. Eighty lesions were detected by intraoperative ultrasound in 17 patients. In comparison with IOUS (lesion-by-lesion analysis) the sensitivity was 86.8% for CTAP, 65% for combined unenhanced MR imaging, and 86.8% for combined Resovist-enhanced MRI as well as 86.8% for the combination of unenhanced and Resovist-enhanced MRI. Compared with the sensitivity of combined unenhanced MRI the sensitivity of CTAP as well as the sensitivity of combined Resovist-enhanced MRI was significantly higher (p<0.05). False-positive results were much higher in CTAP as compared with combined unenhanced and SPIO-enhanced MRI. Using the segment-by-segment analysis the specificity of combined unenhanced MRI with 100% (96.7-100%) as well as combined Resovist-enhanced MRI with 100% (96.7-100%) was significantly higher (p<0.05) in comparison with the specificity of CTAP with 91.1% (83.2-96.1%). The accuracy of combined unenhanced MRI was 100% (93.2-100%), combined Resovist-enhanced MRI 100% (93.6-100%) and of CTAP 85.2% (72.9-93.4%). In the detection of focal liver lesions iron-oxide-enhanced MR imaging is superior to unenhanced MRI and similar to CTAP.
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PMID:Preoperative evaluation of malignant liver tumors: comparison of unenhanced and SPIO (Resovist)-enhanced MR imaging with biphasic CTAP and intraoperative US. 1259 89

Rabbit liver was loaded with ferrimagnetic particles of gamma -Fe2 O3 (designed for magnetic hyperthermia treatment of liver tumors) by injecting various doses of a suspension of the particles into the hepatic artery in vivo. Proton transverse relaxation rate (R(2)) images of the livers in vivo, excised, and dissected were generated from a series of single spin-echo images. Mean R(2) values for samples of ferrimagnetic-particle-loaded liver dissected into approximate 1 cm cubes were found to linearly correlate with tissue iron concentration over the range from approximately 0.1 to at least 2.7 mg Fe/g dry tissue when measured at room temperature. Changing the temperature of ferrimagnetic-particle-loaded samples of liver from 1 degrees C to 37 degrees C had no observable effect on tissue R(2) values. However, a small but significant decrease in R(2) was found for control samples containing no ferrimagnetic material on raising the temperature from 1 degrees C to 37 degrees C. Both chemically measured iron concentrations and mean R(2) values for rabbit livers with implanted tumors tended to be higher than those measured for tumor-free liver. This study indicates that tissue R(2) measurement and imaging by nuclear magnetic resonance may have a useful role in magnetic hyperthermia therapy protocols for the treatment of liver cancer.
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PMID:A magnetic resonance imaging based method for measurement of tissue iron concentration in liver arterially embolized with ferrimagnetic particles designed for magnetic hyperthermia treatment of tumors. 1287 57

The National Institute on Alcohol Abuse and Alcoholism and the Office of Dietary Supplements, National Institutes of Health, sponsored a symposium on the "Role of Iron in Alcoholic Liver Disease" at Bethesda, Maryland, USA, October 2002. Alcoholic liver disease is a major cause of illness and death in the United States. Oxidative stress plays a key role in the pathogenesis of alcoholic liver disease. Iron can induce oxidative stress by catalyzing the conversion of superoxide and hydrogen peroxide to more potent oxidants such as hydroxyl radicals, which can cause tissue injury by initiating lipid peroxidation and causing oxidation of proteins and nucleic acids. Increasing evidence supports the suggestion that iron plays a significant role in the pathogenesis of alcoholic liver disease by exacerbating oxidative stress. Understanding the underlying mechanisms by which iron participates in the initiation and development of alcoholic liver disease may help design strategies for the treatment and prevention of the disease. For this symposium, nine speakers were invited to address the following issues: (1) iron intake from foods and dietary supplements; (2) hepatic iron overload in alcoholic liver disease; (3) iron-dependent activation of nuclear factor-kappa B (NF-kappaB) in Kupffer cells; (4) iron and cytochrome P450 2E1 (CYP2E1)-dependent oxidative stress and liver toxicity; (5) iron-induced oxidative stress in alcoholic hepatic fibrogenesis; (6) hemochromatosis and alcoholic liver disease; (7) iron as a co-morbid factor in nonhemochromatotic liver diseases; (8) iron and liver cancer; and (9) iron chelators and iron toxicity. On the basis of these presentations, it is concluded that heavy alcohol intake can result in increased accumulation of iron in the liver, in both hepatocytes and Kupffer cells. Iron-induced oxidative stress may promote the severity of alcoholic liver disease by (1) inducing NF-kappaB activation and subsequently increasing transcription of proinflammatory cytokines in Kupffer cells; (2) exacerbating CYP2E1-induced oxidative stress, especially in hepatocytes, through production of more toxic hydroxyl radicals; (3) stimulating hepatic stellate cells to produce excess amount of collagen and other matrix proteins that can lead to fibrosis; and (4) causing DNA damage and mutations that promote the development of liver cancer. Dietary iron supplements may further exacerbate the severity of alcoholic liver disease by increasing the magnitude of oxidative stress. We hope that the studies presented will stimulate further research in this exciting area.
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PMID:Role of iron in alcoholic liver disease: introduction and summary of the symposium. 1295 91

Unlike arsenic, chromium, or nickel, the carcinogenicity of iron is still under debate. In this review, evidence for iron as a carcinogenic metal was summarized from epidemiological, animal, and cell culture studies. The role of iron in various cancers, such as colorectal cancer and liver cancer was presented. Recent advancements on the molecular mechanisms of iron carcinogenesis were also reviewed. These include: (1) iron autoxidation involving only Fe(2+)+O2 in oxidant formation in biological systems and its pH dependency; (2) activation of oxidative responsive transcription factors and pro-inflammatory cytokines; and (3) iron-induced hypoxia signaling.
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PMID:Iron overload and its association with cancer risk in humans: evidence for iron as a carcinogenic metal. 1464 18

Hemochromatosis is a disorder of excess iron deposition in tissues that may cause multiorgan dysfunction. Because the early symptoms of hemochromatosis are nonspecific, the diagnosis is frequently overlooked until significant organ failure has developed. The primary cause of death in these patients is usually liver cancer related to cirrhosis. Patients who are candidates for liver transplantation should be referred for evaluation. For patients with severe cardiomyopathy, in addition to end-stage liver disease, combined transplantation may be performed. Although there is a limited number of combined heart-liver transplantations that have been performed, successful outcomes can be achieved with close monitoring and a multidisciplinary team approach. In this case report, we will discuss the prevalence, pathophysiology, and treatment of hemochromatosis and potential complications of combined heart-liver transplantation.
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PMID:Successful combined heart-liver transplantation in a patient with hemochromatosis. 1507 36

HH is a common inherited disorder of iron metabolism affecting about 1 out of 250 individuals of Northern European decent. Many of these patients do not have evident phenotypic expression and do not develop significant iron loading. Some patients, however, develop progressive iron overload and cirrhosis. These individuals are at risk of developing HCC. Cirrhotics with hemochromatosis should undergo regular screening for HCC. If HCC is identified early, treatment with either resection or liver transplantation is optimal. Palliative measures, including ablative therapy and chemoembolization, can be used. With increasing clinical recognition,hemochromatosis should be diagnosed earlier and progression to cirrhosis and HCC should be minimized.
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PMID:Relation of hemochromatosis with hepatocellular carcinoma: epidemiology, natural history, pathophysiology, screening, treatment, and prevention. 1565 32

MR imaging examination of the liver should use a combination of single-shot T2W and breath-hold T1W images, and include gadolinium enhancement with acquisition of multiple phases. MR provides superior characterization of liver masses than CT, and multi-phase gadolinium enhancement including a properly timed arterial phase is critical. The T1 weighted pre-contrast images must include in-phase/out-of-phase acquisitions, to assess hepatic lipid and or iron content, and dynamically enhanced post-gadolinium images. Timing of the arterial phase images is also critical for demonstration of acute hepatitis. The timing of the venous and equilibrium phase images are less critical, and are important for grading more severe acute hepatitis, demonstration of fibrosis, and for delineating vascular abnormalities. In cirrhosis, dynamic post-gadolinium images are critical for detection and characterization of regenerative or dysplastic nodules, and HCC. The same sequences useful for liver evaluation provide a comprehensive evaluation of all the soft tissues of the abdomen, and allow depiction of most of the important diseases, thus facilitating use of a universal protocol for abdominal imaging.
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PMID:Magnetic resonance imaging of the liver: review of techniques and approach to common diseases. 1598 62


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