[Clivus metastasis from hepatocarcinoma associated with transarterial hepatic chemoembolization]. / Metástasis en clivus de hepatocarcinoma asociado a quimiembolización transarterial hepática.

Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world, and its incidence has increasing in the latest years. Recent advances in both, diagnosis and treatment, have improved the prognosis. Transarterial chemoembolization (TACE) is a therapeutic option, valid for patients who are not candidates for curative treatments, which has demonstrate to improve survival. Complications of TACE are very frequent and often severe. Postembolization syndrome is extremely frequent. Liver abscess, acute pancreatitis, acute cholecistitis, biloma, intestinal ischemia, gastroduodenal ulcerations and liver failure, are less frequent complications. Recently, it has been described an increasing risk of distant metastasis after transarterial chemoembolization. Most frequent metastasis are in the lung, abdominal lymph nodes, bone, and suprarenal glands. Metastases in nervous system, especially in clivus, are rarely. We report the case of a patient with hepatocellular carcinoma treated with transarterial chemoembolization who was diagnosed with metastasis in clivus.

Daily norfloxacin is more effective than weekly rufloxacin in prevention of spontaneous bacterial peritonitis recurrence.

Our aim was to compare weekly rufloxacin with daily norfloxacin in the secondary prophylaxis of spontaneous bacterial peritonitis and to examine changes in antibiotic susceptibility in fecal Escherichia coli. The method used was an open randomized clinical trial including 79 patients who received either norfloxacin 400 mg/day or rufloxacin 400 mg/week and followed up for one year. E. coli counts, quinolone susceptibility, and drug concentrations in feces were investigated in 12 patients. Cumulative one-year probability of peritonitis recurrence was 26% for patients on norfloxacin and 36% for those on rufloxacin (P = 0.16). Norfloxacin was more effective in the prevention of peritonitis recurrence due to Enterobacteriaceae (0% vs 22%, P = .01). At the end of follow-up, all 12 patients had E. coli resistant to quinolones in their feces. In conclusion, weekly rufloxacin is not an alternative to daily norfloxacin in the prevention of peritonitis recurrence. The development of quinolone-resistant E. coli in feces may be an important problem in patients on long-term quinolone prophylaxis.

Metástasis en clivus de hepatocarcinoma asociado a quimiembolización transarterial hepática / Clivus metastasis from hepatocarcinoma associated with transarterial hepatic chemoembolization

El carcinoma hepatocelular (CHC) es la quinta causa de cáncer en el mundo, con una incidencia creciente. Los avances en el diagnóstico y el tratamiento han mejorado su pronóstico. La quimioembolización transarterial (QET) es una opción terapéutica válida para pacientes no candidatos a tratamientos curativos, que ha demostrado mejorar la supervivencia. Las complicaciones asociadas a la QET son frecuentes y, en ocasiones, graves. El síndrome postembolización es la complicación más frecuente. El absceso hepático, la pancreatitis, la colecistitis, la formación de biloma, la isquemia intestinal, la úlcera gastroduodenal y el fallo hepático son complicaciones menos frecuentes. Recientemente, se ha descrito un aumento en la incidencia de metástasis a distancia en pacientes que previamente recibieron QET. Las metástasis extrahepáticas más frecuentes del CHC se dan en pulmón, ganglios abdominales, sistema óseo y glándulas suprarrenales. Las metástasis cerebrales y, concretamente en clivus, son excepcionales. El caso que presentamos es el de un paciente afectado de CHC al que, tras recibir varias sesiones de QET, se le diagnostica metástasis en clivus

Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world, and its incidence has increasing in the latest years. Recent advances in both, diagnosis and treatment, have improved the prognosis. Transarterial chemoembolization (TACE) is a therapeutic option, valid for patients who are not candidates for curative treatments, which has demonstrate to improve survival. Complications of TACE are very frequent and often severe. Postembolization syndrome is extremely frequent. Liver abscess, acute pancreatitis, acute cholecistitis, biloma, intestinal ischemia, gastroduodenal ulcerations and liver failure, are less frequent complications. Recently, it has been described an increasing risk of distant metastasis after transarterial chemoembolization. Most frequent metastasis are in the lung, abdominal lymph nodes, bone, and suprarenal glands. Metastases in nervous system, especially in clivus, are rarely. We report the case of a patient with hepatocellular carcinoma treated with transarterial chemoembolization who was diagnosed with metastasis in clivus

Metástasis en clivus de hepatocarcinoma asociado a quimiembolización transarterial hepática / Clivus metastasis from hepatocarcinoma associated with transarterial hepatic chemoembolization

El carcinoma hepatocelular (CHC) es la quinta causa de cáncer en el mundo, con una incidencia creciente. Los avances en el diagnóstico y el tratamiento han mejorado su pronóstico. La quimioembolización transarterial (QET) es una opción terapéutica válida para pacientes no candidatos a tratamientos curativos, que ha demostrado mejorar la supervivencia. Las complicaciones asociadas a la QET son frecuentes y, en ocasiones, graves. El síndrome postembolización es la complicación más frecuente. El absceso hepático, la pancreatitis, la colecistitis, la formación de biloma, la isquemia intestinal, la úlcera gastroduodenal y el fallo hepático son complicaciones menos frecuentes. Recientemente, se ha descrito un aumento en la incidencia de metástasis a distancia en pacientes que previamente recibieron QET. Las metástasis extrahepáticas más frecuentes del CHC se dan en pulmón, ganglios abdominales, sistema óseo y glándulas suprarrenales. Las metástasis cerebrales y, concretamente en clivus, son excepcionales. El caso que presentamos es el de un paciente afectado de CHC al que, tras recibir varias sesiones de QET, se le diagnostica metástasis en clivus

Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world, and its incidence has increasing in the latest years. Recent advances in both, diagnosis and treatment, have improved the prognosis. Transarterial chemoembolization (TACE) is a therapeutic option, valid for patients who are not candidates for curative treatments, which has demonstrate to improve survival. Complications of TACE are very frequent and often severe. Postembolization syndrome is extremely frequent. Liver abscess, acute pancreatitis, acute cholecistitis, biloma, intestinal ischemia, gastroduodenal ulcerations and liver failure, are less frequent complications. Recently, it has been described an increasing risk of distant metastasis after transarterial chemoembolization. Most frequent metastasis are in the lung, abdominal lymph nodes, bone, and suprarenal glands. Metastases in nervous system, especially in clivus, are rarely. We report the case of a patient with hepatocellular carcinoma treated with transarterial chemoembolization who was diagnosed with metastasis in clivus