RESUMO
AIM: Sorafenib is the standard of care in advanced hepatocellular carcinoma. This study was aimed to identify clinical parameters that may predict survival in these patients. MATERIALS & METHODS: In this observational study, a training (226 patients) and validation cohorts (54 patients) were analyzed for evaluating pretreatment and on-treatment parameters. RESULTS: At multivariate analysis, only on-treatment variables (skin toxicity, diarrhea and arterial hypertension - sorafenib off-target effects), alphafetoprotein and radiological responses predicted survival. Using the occurrence of off-target effects, a prognostic index able to distinguish three groups of patients with different survival was constructed and externally validated. CONCLUSION: In hepatocellular carcinoma patients, on-treatment variables are the best predictors of survival. Among these, sorafenib off-target effects may be the most useful indicators for prognostication in field practice.
Assuntos
Antineoplásicos/uso terapêutico , Carcinoma Hepatocelular/tratamento farmacológico , Carcinoma Hepatocelular/mortalidade , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/mortalidade , Niacinamida/análogos & derivados , Compostos de Fenilureia/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Carcinoma Hepatocelular/patologia , Estudos de Coortes , Feminino , Humanos , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Niacinamida/administração & dosagem , Niacinamida/efeitos adversos , Niacinamida/uso terapêutico , Compostos de Fenilureia/administração & dosagem , Compostos de Fenilureia/efeitos adversos , Prognóstico , Fatores de Risco , Sorafenibe , Resultado do TratamentoRESUMO
BACKGROUND/AIMS: To investigate the effectiveness and safety of sorafenib after radiofrequency ablation (RFA) in patients with hepatocellular carcinoma (HCC). METHODOLOGY: 44 intermediate or advanced HCC patients received sorafenib treatment after debulking with RFA therapy. Time to progression (TTP), response rate (RR), duration of sorafenib treatment and adverse effects were evaluated. An explorative comparison was performed with patients treated with sorafenib only. RESULTS: At 12 months, TTP was 10.3 months (range: 1-32). RR was 61% with 2 complete responses, and duration of sorafenib therapy was 10.9 months (1-32). No new safety concerns were report-ed. With sorafenib only, TTP was 7.2 months (range: 0-38) and RR was 40%, with one complete response; duration of therapy was 7.3 months (0-38). CONCLUSIONS: The sequence of RFA and sorafenib appears effective and safe in HCC patients. These findings could support the use of a sequential treatment with RFA and sorafenib in HCC patients.
Assuntos
Antineoplásicos/administração & dosagem , Carcinoma Hepatocelular/cirurgia , Ablação por Cateter , Neoplasias Hepáticas/cirurgia , Niacinamida/análogos & derivados , Compostos de Fenilureia/administração & dosagem , Inibidores de Proteínas Quinases/administração & dosagem , Idoso , Antineoplásicos/efeitos adversos , Carcinoma Hepatocelular/enzimologia , Carcinoma Hepatocelular/patologia , Ablação por Cateter/efeitos adversos , Quimioterapia Adjuvante , Progressão da Doença , Esquema de Medicação , Estudos de Viabilidade , Feminino , Humanos , Neoplasias Hepáticas/enzimologia , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Niacinamida/administração & dosagem , Niacinamida/efeitos adversos , Compostos de Fenilureia/efeitos adversos , Projetos Piloto , Estudos Prospectivos , Inibidores de Proteínas Quinases/efeitos adversos , Sorafenibe , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Portal vein tumor thrombosis (PVTT) is a common complication of hepatocellular carcinoma and is one of the most negative prognostic factors. The management of patients with PVTT is challenging. The aim of the study was to develop a score predictive of tumor thrombosis. METHODS: Data from a large cohort of 2243 hepatocellular carcinoma patients (all stages) recorded in the Progetto Epatocarcinoma Campania (January 2013-April 2021) database were analyzed. To construct the score, univariate generalized estimated equation models, the bootstrap approach for internal validation, and a regression coefficient-based scoring system were used. RESULTS: PVTT (any location) was found in 14.4% of cases and was related to shorter survival. Males, younger patients, and symptomatic cases were more prevalent among the PVTT group. At multivariate analysis, size ≥5â cm, massive or infiltrative hepatocellular carcinoma growth, and alpha-fetoprotein ≥400â ng/mL were significantly associated with PVTT. A risk prediction score of PVTT based on eight variables was developed. Using a continuous score, the risk was associated with an odds ratio (OR) of 1.30 (1.27-1.34; P â <â 0.001). Considering a dichotomous score >8 versus a score ≤8 the OR for PVTT was 11.33 (8.55-15.00; P â <â 0.001). CONCLUSION: The risk score for PVTT might be useful for clinicians to optimize hepatocellular carcinoma management by picking out patients with more aggressive cancers and higher mortality rates. Prospective validation of the score is needed before its application in daily clinical practice.
Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Trombose , Trombose Venosa , Masculino , Humanos , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/diagnóstico , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/diagnóstico , Veia Porta/patologia , Trombose Venosa/etiologia , Trombose Venosa/complicações , Trombose/complicações , Trombose/patologia , Fatores de Risco , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: The present paper evaluates the genetic variability of HCV in patients with hepatocellular carcinoma (HCC). METHODS: Amino acid substitutions (aas) in NS3, NS5A and core regions were analyzed in 17 patients with HCC (Cases) and 13 without HCC (Controls), all naïve to DAAs. For the Cases, a sample of neoplastic liver tissue, non-neoplastic liver tissue and a serum sample were collected; for the Controls, a sample of liver tissue was collected. Sanger sequencing of three regions was performed using homemade protocols. RESULTS: Phylogenetic trees showed that there was no difference in the virus populations in the three compartments analyzed for the three HCV regions in patients with HCC. Low variability and no difference between the Cases and Controls were observed in the core and NS5A regions; however, in the NS3 region, a higher variability was observed in the Cases. No difference was observed in the core region between Cases and Controls. In NS3, aa substitutions at positions 103 and 122 were more frequently found in Cases than Controls (in both cases 50% vs 9.1%, p<0.05); moreover, aas in positions 32, 44 (p=0.035 for both), 79 (p=0.008) and 121 (p=0.018) were observed in the Cases and absent in the Controls. Finally, considering the NS5A region, aa substitutions at positions 37 and 54 were more frequently identified in the Cases than the Controls, but without statistical significance. CONCLUSION: These data may suggest a higher aa variability in patients with HCC than in those without, especially in the NS3 region.
RESUMO
To describe epidemiological and clinical features of patients confirmed as having SARS-CoV-2 infection and managed in isolation at home. We performed a multicenter retrospective study enrolling all SARS-CoV-2-positive adults evaluated from 28 February to 31 May 2020 at one of nine COVID-19 Units in southern Italy: we included patients receiving care at home and those admitted to hospital. We defined patients with not-severe disease if they were asymptomatic or experienced a mild infection that did not need oxygen (O2) therapy and those with a severe infection if hospitalized and required O2 therapy. We enrolled 415 patients with SARS-CoV-2 infection: 77 were managed in isolation at home, 338 required hospital management. The 77 patients in home isolation were less frequently male than hospitalized patients (55% vs. 64%; <0.01) and were younger (median age 45 years (IQR:19) vs. 62 (IQR 22); p < 0.01), had a lower Charlson comorbidity index (median 0 (IQR2) vs. 6 (IQR 3); p < 0.01), and included fewer subjects with an underlying chronic disease (36% vs. 59%; p < 0.01). According to a binomial logistic regression analysis, a younger age (OR: 0.96 (95% IC: 0.94-0.98), p < 0.01) and a low Charlson comorbidity index (OR: 0.66 (95% IC: 0.54-0.83); p < 0.01) were independent factors associated with at-home management. The identification of subjects with SARS-CoV-2 infection who could be managed in home isolation is useful in clinical practice. A younger age and no comorbidities were identified as factors independently associated with home management.
RESUMO
OBJECTIVE: The purpose of this study was to examine the results of percutaneous radiofrequency ablation of both medium-sized hepatocellular carcinoma (HCC) and the accompanying main portal venous tumor thrombus in patients with cirrhosis. SUBJECTS AND METHODS: From January 2005 to January 2008, among 1,837 consecutively registered patients with HCC seen at our institution, 412 had HCC and portal venous invasion; 27 of the 412 had a single HCC nodule accompanied by main portal venous tumor thrombus. Thirteen patients (10 men, three women; mean age, 70 years; range, 66-74 years) with 13 HCC nodules 3.7-5 cm in diameter extending into the main portal trunk underwent percutaneous radiofrequency ablation. Fourteen matched patients (10 men, four women; mean age, 69 years; range, 67-73 years) with 14 HCC nodules 3.6-4.8 cm in diameter extending into the main portal trunk refused radiofrequency ablation and composed the control group. Diagnosis of main portal venous tumor thrombus was made with fine-needle biopsy in all cases. Radiofrequency ablation was performed first on the main portal venous tumor thrombus and then on the HCC nodule. Efficacy of radiofrequency was defined as complete necrosis of HCC and complete recanalization of the main portal trunk and its branches. HCC necrosis was evaluated with enhanced CT. Recanalization of portal vessels was analyzed with color Doppler and contrast-enhanced ultrasound. Radiofrequency ablation was performed under ultrasound guidance with a perfused needle electrode. RESULTS: Complete necrosis of the HCC associated with complete recanalization of the main portal vein and its branches was achieved in 10 patients (efficacy, 77%). In the other three patients, necrosis of the HCC ranged from 70% to 90%, and recanalization of the main portal trunk was not complete. No major complications occurred. In three cases, mild to moderate ascites and increased aspartate aminotransferase and alanine aminotransferase levels were found. The follow-up periods ranged from 3 to 36 months among the treated patients and 2 to 10 months among the untreated patients. The cumulative survival rate was 77% 6, 12, and 36 months after procedure in the treated group and 43% and 0% 6 and 12 months after diagnosis in the untreated group (p < 0.0001). All 10 successfully treated patients were alive and the portal system was patent at the end of the follow-up period. All three untreated patients died of progressive disease within 5 months of diagnosis. CONCLUSION: Radiofrequency ablation can destroy both single intraparenchymal medium-sized HCCs and the accompanying main portal venous tumor thrombus with high efficacy and safety and a low rate of complications.
Assuntos
Carcinoma Hepatocelular/cirurgia , Ablação por Cateter/métodos , Cirrose Hepática/cirurgia , Veia Porta/cirurgia , Trombose Venosa/cirurgia , Idoso , Carcinoma Hepatocelular/complicações , Feminino , Humanos , Cirrose Hepática/complicações , Masculino , Invasividade Neoplásica , Resultado do Tratamento , Trombose Venosa/etiologiaRESUMO
OBJECTIVE: The objective of our study was to report our 19-year experience with sonography and the clinical outcome of viable hydatid liver cysts treated with double percutaneous aspiration and ethanol injection as first-line therapy. CONCLUSION: Viable hydatid liver cysts can be safely and successfully managed with double percutaneous aspiration and ethanol injection as first-line-therapy.
Assuntos
Equinococose Hepática/diagnóstico por imagem , Equinococose Hepática/terapia , Etanol/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Helmínticos/uso terapêutico , Terapia Combinada , Drenagem/métodos , Equinococose Hepática/classificação , Feminino , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , UltrassonografiaRESUMO
AIMS: To evaluate the correlation between the hepatic expression pattern of hsa-miR-125a-5p and HBV-DNA and the progression of fibrosis in patients with overt or occult HBV infection. METHODS: We enrolled all the HBsAg-positive treatment naive patients (overt HBV group) and all the HBsAg-negative patients with hepatocellular carcinoma and with a positive HBV-DNA in their hepatic tissue (occult HBV group), who underwent a diagnostic liver biopsy between April 2007 and April 2015. Tissue concentrations of HBV-DNA and hsa-miR-125a-5p were then analyzed by real-time quantitative PCR. Necroinflammatory activity and fibrosis were evaluated according to the Ishak score. RESULTS: During the study period, we enrolled 64 patients with overt and 10 patients with occult HBV infection. In the overt HBV group, 35 of 64 (54.7%) showed a mild fibrosis (staging 0-2), 17 (26.6%) a moderate fibrosis (staging 3-4), while the remaining 12 (18.7%) had a cirrhosis. All patients in the occult HBV group were cirrhotic. Patients with more advanced fibrosis stage showed a higher mean age when compared with those with mild (p < 0.00001) or moderate fibrosis (p < 0.00001) and were more frequently male than patients with staging 0-2 (p = 0.04). Similarly, patients with occult B infection were older than HBsAg-positive patients. Liver concentrations of miR-125a-5p were significantly higher in patients with cirrhosis (9.75 ± 4.42 AU) when compared with patients with mild (1.39 ± 0.94, p = 0.0002) or moderate fibrosis (2.43 ± 2.18, p = 0.0006) and were moderately higher in occult than in overt HBV infection (p = 0.09). Moreover, we found an inverse correlation, although not statistically significant, between the tissue HBV-DNA levels and the staging of fibrosis. CONCLUSION: This study suggests a correlation between the tissue expression of hsa-miR-125a-5p and the progression of liver damage in a group of patients with occult or overt HBV infection. If confirmed, these data suggest the hsa-miR-125a-5p may be a novel biomarker of hepatic damage.
RESUMO
INTRODUCTION: Although sorafenib is the upfront standard of care for advanced hepatocellular carcinoma (HCC), molecular predictors of efficacy have not been identified yet. In the ALICE-1 study, rs2010963 of VEGF-A and VEGF-C proved to be independent predictive factors for progression-free survival (PFS) and overall survival (OS) in multivariate analysis. The ALICE-1 study results were confirmed in the ALICE-2 study, in which VEGF and VEGFR SNPs were analyzed. In the ePHAS study we analyzed the SNPs of eNOS. In univariate analysis, patients homozygous for an eNOS haplotype (HT1: T-4b at eNOS-786/eNOS VNTR) had significantly shorter median PFS and OS than those with other haplotypes. These data were confirmed in the validation set. METHODS: This nonpharmacological, interventional, prospective multicenter study aims to determine whether eNOS, HIF-1, VEGF, Ang2 and VEGFR polymorphisms play a role in predicting the objective response rate, PFS, and OS of advanced HCC patients treated with sorafenib. The study will involve 160 advanced HCC patients with Child-Pugh class A disease. The primary aim is to validate the prognostic or predictive roles of eNOS, Ang2, HIF-1, VEGF and VEGFR polymorphisms in relation to the clinical outcome (PFS) of HCC patients treated with sorafenib. CONCLUSIONS: Overall, our data may suggest that polymorphism analysis of the VEGF, VEGFR-2, HIF and eNOS genes can identify HCC patients who are more likely to benefit from sorafenib.
Assuntos
Carcinoma Hepatocelular/tratamento farmacológico , Carcinoma Hepatocelular/genética , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/genética , Neovascularização Patológica/genética , Polimorfismo de Nucleotídeo Único/genética , Sorafenibe/uso terapêutico , Adolescente , Angiopoietina-2/genética , Antineoplásicos/uso terapêutico , Intervalo Livre de Doença , Feminino , Humanos , Fator 1 Induzível por Hipóxia/genética , Masculino , Óxido Nítrico Sintase Tipo III/genética , Estudos Prospectivos , Receptores de Fatores de Crescimento do Endotélio Vascular/genética , Fator A de Crescimento do Endotélio VascularRESUMO
Human microRNA-125a-5p (miR-125a) is expressed in most tissues where it downregulates the expression of membrane receptors or intracellular transductors of mitogenic signals, thus limiting cell proliferation. Expression of this miRNA generally increases with cell differentiation whereas it is downregulated in several types of tumors, such as breast, lung, ovarian, gastric, colon, and cervical cancers, neuroblastoma, medulloblastoma, glioblastoma, and retinoblastoma. In this study, we focused on hepatocellular carcinoma and used real-time quantitative PCR to measure miR-125a expression in 55 tumor biopsies and in matched adjacent non-tumor liver tissues. This analysis showed a downregulation of miR-125a in 80 % of patients, with a mean decrease of 4.7-fold. Comparison of miRNA downregulation with clinicopathological parameters of patients didn't yield significant correlations except for serum bilirubin. We then evaluated the expression of known targets of miR-125a and found that sirtuin-7, matrix metalloproteinase-11, and c-Raf were up-regulated in tumor tissue by 2.2-, 3-, and 1.7-fold, respectively. Overall, these data support a tumor suppressor role for miR-125a and encourage further studies aimed at the comprehension of the molecular mechanisms governing its expression, eventually leading to treatments to restore its expression in tumor cells.
Assuntos
Carcinoma Hepatocelular/genética , Neoplasias Hepáticas/genética , Metaloproteinase 11 da Matriz/metabolismo , MicroRNAs/biossíntese , Proteínas Proto-Oncogênicas c-raf/metabolismo , Sirtuínas/metabolismo , Idoso , Carcinoma Hepatocelular/metabolismo , Carcinoma Hepatocelular/patologia , Proliferação de Células/fisiologia , Regulação para Baixo , Feminino , Humanos , Neoplasias Hepáticas/metabolismo , Neoplasias Hepáticas/patologia , Masculino , Metaloproteinase 11 da Matriz/genética , MicroRNAs/genética , MicroRNAs/metabolismo , Proteínas Proto-Oncogênicas c-raf/genética , Sirtuínas/genética , Transfecção , Regulação para CimaRESUMO
Accurate lymph node characterization is important in a large number of clinical settings. We evaluated the usefulness of Contrast Enhanced Ultrasound (CEUS) in distinguishing between benign and malignant lymph nodes compared with conventional ultrasonography in the differential diagnosis of superficial lymphadenopathy.We present our experience for 111 patients enrolled in a single center.111 superficial lymph nodes were selected and only 1 lymph node per patient underwent CEUS. A definitive diagnosis for all lymph nodes was obtained by ultrasonographically guided biopsy and/or excision biopsy.The size of the lymph nodes, the site (neck, axilla, inguinal region) being easily accessible for biopsy, and the US and color Doppler US characteristics guided us in selecting the nodes to be evaluated by CEUS.In our study we identified different enhancement patterns in benign and malignant lymph nodes, with a high degree of diagnostic accuracy for superficial lymphadenopathy in comparison with conventional US.
Assuntos
Linfonodos/diagnóstico por imagem , Linfadenopatia/diagnóstico por imagem , Metástase Linfática/diagnóstico por imagem , Ultrassonografia Doppler em Cores/métodos , Adolescente , Adulto , Idoso , Meios de Contraste , Feminino , Humanos , Aumento da Imagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto JovemRESUMO
AIM: To evaluate the virological and clinical characteristics of occult HBV infection (OBI) in 68 consecutive HBsAg-negative patients with biopsy-proven cirrhosis and HCC. METHODS: HBV DNA was sought and sequenced in plasma, HCC tissue and non-HCC liver tissue by PCRs using primers for HBV core, surface and x regions. OBI was identified by the presence of HBV DNA in at least two different PCRs. RESULTS: OBI was detected in HCC tissue of 13 (20%) patients and in non-HCC liver tissue of 3 of these 13. OBI was detected in HCC tissue of 54.5% of 11 anti-HBs- negative/anti-HBc-positive patients, in 29.4% of 17 anti-HBs/anti-HBc-positive and in 5% of 40 anti-HBs/anti-HBc-negative (p < 0.0005). The 13 patients with OBI in HCC tissue more frequently than the 55 without showed Child-B or -C cirrhosis (53.9% vs. 5.5%, p < 0.0001) and BCLC-B or -C stages (46.1% vs. 1.8%, p < 0.0001). The pre-S1, pre-S2 and S region sequences in HCC tissue showed amino acid (AA) substitutions (F19L, P24L, S59F, T131I, Q129H) and deletions (in positions 4,8, 17 and 86) in the S region, AA substitutions (T40S, P124K, L54P, G76A, N222T and I273L) in pre-S1 region and AA substitutions in pre-S2 region (P41H and P66L). In the 3 patients showing OBI also in non-HCC liver tissue the S, pre-S1 and pre-S2 sequencing displayed patterns of mutations different. CONCLUSIONS: The study showed a significant correlation between OBI and the severity of liver damage, several patterns of mutations in the S, pre-S1 and pre-S2 regions in HCC tissue, some at their first description.
Assuntos
Carcinoma Hepatocelular/virologia , Antígenos de Superfície da Hepatite B/sangue , Hepatite B/complicações , Neoplasias Hepáticas/virologia , Idoso , Biópsia , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/genética , DNA Viral/sangue , Feminino , Deleção de Genes , Genótipo , Vírus da Hepatite B/genética , Humanos , Fígado/patologia , Cirrose Hepática/complicações , Cirrose Hepática/virologia , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/genética , Masculino , Pessoa de Meia-Idade , Mutação , Reação em Cadeia da PolimeraseRESUMO
AIM: To check the safety and efficacy of boceprevir/telaprevir with peginterferon/ribavirin for hepatitis C virus (HCV) genotype 1 in the real-world settings. METHODS: This study was a non-randomized, observational, prospective, multicenter. This study involved 47 centers in Italy. A database was prepared for the homogenous collection of the data, was used by all of the centers for data collection, and was updated continuously. All of the patients enrolled in this study were older than 18 years of age and were diagnosed with chronic infection due to HCV genotype 1. The HCV RNA testing was performed using COBAS-TaqMan2.0 (Roche, LLQ 25 IU/mL). RESULTS: All consecutively treated patients were included. Forty-seven centers enrolled 834 patients as follows: Male 64%; median age 57 (range 18-78), of whom 18.3% were over 65; mean body mass index 25.6 (range 16-39); genotype 1b (79.4%); diagnosis of cirrhosis (38.2%); and fibrosis F3/4 (71.2%). The following drugs were used: Telaprevir (66.2%) and PEG-IFN-alpha2a (67.6%). Patients were naïve (24.4%), relapsers (30.5%), partial responders (14.8%) and null responders (30.3%). Overall, adverse events (AEs) occurred in 617 patients (73.9%) during the treatment. Anemia was the most frequent AE (52.9% of cases), especially in cirrhotic. The therapy was stopped for 14.6% of the patients because of adverse events or virological failure (15%). Sustained virological response was achieved in 62.7% of the cases, but was 43.8% in cirrhotic patients over 65 years of age. CONCLUSION: In everyday practice, triple therapy is safe but has moderate efficacy, especially for patients over 65 years of age, with advanced fibrosis, non-responders to peginterferon + ribavirin.
RESUMO
Liver hydatidosis is the most common clinical presentation of cystic echinococcosis. Although liver cystic hydatidosis is considered a benign disease and many patients do not develop symptoms for years, its complications can be severe and life threatening (usually as a consequence of rupture in the biliary tree, in the peritoneum, in the bronchi, and of anaphylactic shock), thus, treatment is recommended for all viable and active hydatid liver cysts. Among the therapeutical options available for this disease, such as open and laparoscopic surgery and chemotherapy, percutaneous treatments have gained considerable interest over the last two decades, due to their efficacy, safety and high patient acceptability. Percutaneous treatments for liver cystic hydatidosis were once discouraged due to the risk of anaphylaxis following cyst puncture. Following the first uneventful attempts in the mid '80's, these treatments were increasingly used and techniques such as PAIR (Puncture, Aspiration, Injection, Re-aspiration) and its variants were developed and implemented in clinical practice. Although the evidence currently available is not sufficient to support or refuse the superiority of PAIR in terms of efficacy, numerous studies have demonstrated that it carries lower rates of morbidity, mortality, and disease recurrence and is associated with shorter hospital stays compared with surgery. The present review provides a brief history of percutaneous treatments for liver cystic hydatidosis, summarizes the currently available evidence on the subject, gives a brief overview of potential future developments in this field focusing on radiofrequency ablation techniques and presents some new patents on the issue.
Assuntos
Ablação por Cateter/métodos , Equinococose Hepática/diagnóstico , Equinococose Hepática/terapia , Punções/métodos , Animais , Ablação por Cateter/tendências , Humanos , Punções/tendências , Resultado do TratamentoRESUMO
PURPOSE: To evaluate the usefulness and safety of radiofrequency ablation for primary and recurrent intrahepatic cholangiocarcinoma (ICC) in our single centre experience. MATERIALS AND METHODS: Ten patients with ICC refusing or not eligible for surgery underwent radiofrequency ablation for their tumor. The ICC was primary in 9 cases and recurrent, after 2 previous resections, in 1 patient. Radiofrequency ablation was performed percutaneously under ultrasound guidance using a 15G perfused electrode. Technical success of the procedure was assessed by contrast-enhanced ultrasound (CEUS). Technical effectiveness was evaluated by CEUS and contrast enhanced CT 1 month after the last course of a defined ablation protocol. Follow-up contrast enhanced CT or MRI were performed every 3-6 months. RESULTS: RFA was always technically successful and effective for ICC lesions ≤3.4 cm and ineffective for lesion ≥4 cm. After a median follow-up of 19.5 months (range 9-64 months), 8 patients were still alive while 2 had died due to tumor progression. The 1-, 3- and 5-year overall survival rate of all patients with ICC of our series were 100%, 83.3% and 83.3%. No major complication was observed. CONCLUSION: Radiofrequency ablation seems to be a safe and effective option for small (≤3.4 cm) ICC nodules. In addition it may be considered as a palliative treatment for larger tumors.
Assuntos
Ablação por Cateter/métodos , Colangiocarcinoma/radioterapia , Neoplasias Hepáticas/radioterapia , Idoso , Neoplasias dos Ductos Biliares , Ductos Biliares Intra-Hepáticos , Colangiocarcinoma/imunologia , Meios de Contraste/farmacologia , Progressão da Doença , Feminino , Fibrose , Humanos , Neoplasias Hepáticas/imunologia , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/métodos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodosRESUMO
BACKGROUND: During the progression from low-grade dysplastic nodule (DN) to progressed hepatocellular carcinoma (HCC), intranodular portal tracts gradually disappear, while unpaired arteries develop increasingly. Contrast-enhanced ultrasound (CEUS) is highly accurate in depicting intranodular vascularity. This study evaluates the usefulness of CEUS in the characterization of DN, early HCC and progressed HCC in cirrhotic livers. MATERIALS AND METHODS: Forty consecutive patients with cirrhosis and a single hepatic nodule ≤2 cm underwent CEUS and subsequent ultrasound-guided biopsy of the nodule. Imaging and pathological findings of DN and HCC were compared. RESULTS: The homogeneous pattern of hypervascularization during the arterial phase identified progressed HCC with a sensitivity of 90.9% and a specificity of 100%, whereas the inhomogeneous and reticular pattern identified early HCC with a sensitivity of 85.7% and a specificity of 96.1%. CONCLUSION: DN, early HCC and progressed HCC can be accurately differentiated with CEUS on the basis of the vascularization pattern during the arterial phase.
Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/etiologia , Meios de Contraste , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/etiologia , Idoso , Carcinoma Hepatocelular/irrigação sanguínea , Humanos , Cirrose Hepática/patologia , Neoplasias Hepáticas/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Neovascularização Patológica , Prognóstico , Estudos Prospectivos , Ultrassom , UltrassonografiaRESUMO
Percutaneous treatment of Hydatid Liver Cyst (HLC) with scolicidal agent under ultrasound guidance is now worldwide used after the advent of Percutaneous-Aspiration-Injection and Re-Aspiration (PAIR) and its modifications. Although HLC represent a benign disease, treatment has to be considered mandatory in symptomatic cysts and recommended in viable cysts because of the risk of severe complications. In this article, clinical indications, PAIR technique with results and complications are discussed. Finally, clinical flow-chart of active and inactive HLCs is reported. The present article is a review of some patents in the Hydatid liver cyst.
Assuntos
Equinococose Hepática/terapia , Ablação por Cateter , Equinococose Hepática/diagnóstico por imagem , Etanol/administração & dosagem , Humanos , Injeções Intralesionais , Sucção , UltrassonografiaRESUMO
OBJECTIVE: To verify the role of sonography in screening of acute appendicitis in patients admitted to an infectious disease unit for suspected acute infectious enteritis. METHODS: One hundred eighty consecutive patients (102 male and 78 female; age range, 5-72 years; mean age, 31 years) admitted for suspected infectious enteritis or typhoid fever were prospectively studied with abdominal sonography within 48 hours after admission. None of the patients had peritoneal irritation. Forty-six patients (25%) had white blood cell counts of more than 10,000/mm3 (range, 10,300-18,000/mm3). The diagnosis of acute appendicitis was made when a detectable appendix with an anteroposterior diameter of greater than 7 mm could be seen on sonography. RESULTS: Eleven (6%) of 180 patients had thickened appendixes (anteroposterior diameter range, 7-14 mm); 2 of them had periappendiceal abscesses. Four (36%) of 11 patients with acute appendicitis had high white blood cell counts. All sonographic diagnoses of acute appendicitis and periappendiceal abscesses were confirmed at surgery. Sonography ruled out acute appendicitis in 169 patients. In all of them, clinical and sonographic follow-up excluded the diagnosis of acute appendicitis. Normal appendixes were shown on sonography in 38 (22%) of 169 cases and were not detectable in 131 (78%) of 169. CONCLUSIONS: Sonography of the appendix is a useful method for early assessment of acute appendicitis in patients thought to have enteritis or typhoid fever.
Assuntos
Apendicite/diagnóstico por imagem , Abdome Agudo/diagnóstico por imagem , Doença Aguda , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Diagnóstico Diferencial , Enterite/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , UltrassonografiaRESUMO
OBJECTIVE: To analyze the complications of diagnostic and therapeutic sonographically guided interventional procedures of focal liver lesions observed during a 22-year period in a single center. METHODS: Complications of sonographically guided diagnostic and therapeutic procedures on focal liver lesions, observed during a 22-year period in a single center, were reviewed. From 1979 to 2001, 13,222 patients (age range, 7-89 years; mean, 59 years; 8,688 male and 4,534 female) with 13,777 focal liver lesions underwent 16,648 sonographically guided biopsies and 3,035 therapeutic procedures: pyogenic and amebic abscess aspiration, ethanol injection of hydatid liver cysts, and percutaneous ablative treatments (ethanol injection in either multiple or one-shot sessions, radio frequency ablation, and interstitial laser photocoagulation) of primary and secondary liver tumors. RESULTS: The overall mortality was 0.06%. No death or major complication occurred after diagnostic procedures and liver abscess drainage. In the therapeutic group mortality was 0.6%: 1 patient died of anaphylactic shock during treatment of a hydatid cyst; 7 patients died after liver tumor ablation with ethanol injection (6 after one-shot treatments and 1 after multisession treatments). Major complications after liver tumor ablative procedures included 10 cases of acute liver failure, 2 cases of acute tubular necrosis, 2 cases of self-limiting hemoperitoneum, 2 cases of paralytic ileum, 2 abscesses, and 1 case of cholangitis. One case of a biliary cyst fistula and 1 case of intracystic hemorrhage occurred after treatment of hydatid liver cysts. CONCLUSIONS: Sonographically guided diagnostic biopsy of focal liver lesions and liver abscess drainage are safe procedures. In contrast, liver tumor ablation procedures have a low but definite risk of mortality and major complications. Puncture of hydatid cysts must be performed only in institutions that can treat anaphylactic shock.