Predictors of Liver Dysfunction After Transhepatic Arterial Chemo-embolization in Hepatocellular Carcinoma Patients.

BACKGROUND AND AIMS: Although transhepatic arterial chemo-embolization (TACE) is beneficial for the survival of intermediate stage hepatocellular carcinoma (HCC) patients, its cost is the damage of liver reserve. Liver dysfunction is one of factors associated with TACE refractory status and poor prognosis. The study aims to determine the prevalence and predictors of liver dysfunction in HCC patients after TACE.. METHODS: Using the ASUS EMR search 3.0 system, the patients with discharge codes "HCC (C22.0)" plus "TACE" were collected since 2016 till 2021 in Taipei Tzu Chi Hospital. Liver reserve was determined by modified albumin-bilirubin (mALBI) grade. The liver dysfunction was defined as mALBI grade migration within 1-3 months after TACE.. RESULTS: A total of 220 HCC patients with 314 TACE were found in 5-year duration. Those with TACE-experienced tumors, incomplete laboratory data for mALBI grade and incorrect diagnosis coding were excluded. 91 HCC patients (62 male; mean age 65.86 ± 11.61 year-old) were recruited for final analysis. 10 (11%) patients with baseline mALBI grade 3 were excluded. The percentage of mALBI grade migration was 27.2% (22/81) after TACE. Binary logistic regression discovered "up-to-seven out" and "up-to-eleven out" were associated with mALBI grade migration after TACE. CONCLUSION: In this retrospective study, liver dysfunction occurred in 27.2% of HCC patients after TACE. "Up-to-seven out" and "up-to-eleven out" were predictors for liver dysfunction after TACE, suggesting early switch to systemic therapy to reduce the risk of liver dysfunction for HCC patients with high tumor burden.

Hoarseness: an unusual complication of port-A catheter perforation.

BACKGROUND: A port-A catheter implantation for cancer patients is popular as a route for chemotherapy. Potential complications exist, such as perforation during chemotherapeutic agent infusion, especially when the port-A tip is incorrectly positioned or when it is in long-term use. CASE REPORT: We report on a patient who presented with hoarseness as a result of port-A catheter perforation-related mediastinitis subsequent to chemotherapeutic agent infusion through the catheter. CONCLUSIONS: Hoarseness is a rare complication of port-A perforation and extravasation. To avoid perforation, the tip of the catheter should be located in a high-flow vessel, such as the distal superior vena cava rather than higher in the caval vein, to prevent a locally increased concentration of drugs. We also recommend that a venogram be arranged if extravasation is suspected.

Transarterial chemoembolization with or without sorafenib for hepatocellular carcinoma: A real-world propensity score-matched study.

Objectives: Transarterial chemoembolization (TACE) or sorafenib may prolong survival in patients with unresectable hepatocellular carcinoma (HCC); however, whether their combination prolongs survival than TACE alone remains controversial. We aimed to compare the overall survival (OS) of patients with unresectable HCC treated with TACE plus sorafenib (TACE-S) versus TACE alone. Materials and Methods: All patients with unresectable HCC who received TACE as the initial therapy between January 2006 and January 2017 at Taipei Tzu Chi Hospital were enrolled. We matched patients treated with TACE-S and those treated with TACE alone (TACE) by performing propensity score matching at a 1:2 ratio. Our primary outcome was OS during a 10-year follow-up period, and represented as a hazard ratio calculated using Cox proportional hazard regression models. Results: Among 515 patients with unresectable HCC were treated initially with TACE, 56 receiving TACE-S group and 112 receiving TACE alone (TACE group) were included in the primary outcome analysis. The TACE-S group had significantly longer median OS than did the TACE group (1.55 vs. 0.32, years; P < 0.001), and the 5-year OS rates was 10.7% in the TACE-S group and 0.9% in the TACE group (P < 0.001). In multivariate analyses, patients with a lower Child-Pugh score, tumor size ≤5 cm, and no extrahepatic metastasis before treatment and those receiving antiviral agents and receiving TACE-S had longer OS (all P < 0.001). Conclusion: Antiviral agents and the combination of TACE with sorafenib may improve the OS of patients with unresectable HCC.

Splenic infarction and abscess complicating infective endocarditis.

Acute abdominal pain is one of the most common conditions confronted in the emergency department. Clues related to splenic infarction may be obscured, and the diagnosis is quite challenging even for experienced physicians or surgeons. For every patient diagnosed with splenic infarction, a scrutiny on the possible source of emboli should be carried out. In addition, splenic abscess must be suspected in patients of splenic infarction, especially if the infectious signs persist despite appropriate treatment. Rapid diagnosis and treatment are essential as its course can prove fatal. Infective endocarditis is the most common condition predisposing a patient to splenic abscess. Indeed, splenic abscess or infarction may be a disease entity at different stages in patients of infective endocarditis due to septic emboli of the spleen. The treatment of choice has been antibiotics, splenectomy, and valve replacement surgery. Herein, we report a case of splenic abscess and infective endocarditis cured by antibiotic treatment without the aid of drainage or surgery.

Spontaneous Splenic Rupture as a Rare Initial Presentation in an Acute Lymphoblastic Leukemia Patient.

A spontaneous rupture of the spleen is a rare but critical diagnosis of an acute abdomen, which may accompany unspecific symptoms mimicking acute pancreatitis, rupture of aortic aneurism, or acute coronary syndrome, delaying diagnosis and treatment. In patients that have experienced a severe spleen rupture, hypovolemic shock may cause catastrophic clinical outcomes. Therefore, early diagnosis is very important in order for physicians to declare the etiology for prevention and timely correction of the shock status. Several causes of spontaneous splenic rupture have been reported, including infection, vasculitis, pancreatitis, or hematological malignancies. Acute lymphoblastic leukemia (ALL) remains a rare but important cause of non-traumatic splenic rupture that physicians are required to assess for. Here, we describe a case presenting an acute abdomen due to spontaneous spleen rupture as the first manifestation. The purpose of this case report was to highlight the importance of considering spontaneous ruptures of the spleen as a rare but critical differential diagnosis of an acute abdomen, especially in patients with acute lymphoblastic leukemia.

Multiple complete ring-shaped enhanced MRI lesions in acute disseminated encephalomyelitis.

Acute disseminated encephalomyelitis (ADEM) lesions may or may not enhance with contrast material on contrast T1-weighted magnetic resonance images (T1WI). Enhancing ADEM lesions may show varying patterns of contrast enhancement, which include nodular, diffuse nodular, amorphous, gyral, spotty and incomplete ring-like. Multiple, complete ring-shaped enhanced lesions on contrast T1WI is a rare finding in ADEM. We report such a magnetic resonance imaging (MRI) finding in a 36-year-old female patient with this disease.