Tumoral response factors after radiofrequency ablation of hepatocellular carcinoma in cirrhotic liver.

OBJECTIVE: Hepatocellular carcinoma (HCC) ablation by radiofrequency (RFA) is a novel technique with a great variety of methods whose efficacy and predictive factors have not been completely studied. Some of the main predictive factors in this type of treatment are analyzed in the present study. PATIENTS AND METHODS: Ninety-three patients with hepatocellular carcinoma over cirrhosis, and with no indication for surgical resection were treated by RFA. Two different types of electrodes were used for RFA (refrigerated-"Cool-Tip" and perfusion with saline solution, the approach was percutaneous, by laparoscopy or laparotomy. RESULTS: Overall survival at 1, 2 and 3 years was 88, 81, and 76%, with a free-disease survival (FDS) of 66, 31 and 17%, respectively. For tumors less than 3 cm, FDS at 1,2 and 3 years was 74, 44 and 30%, while for more than 3 cm in size FDS was 55, 12 and 0% (p = 0.02). FDS for HCC with one nodule was 70, 36 and 22%, and for more than one nodule it decreased to 50, 17 and 0% at 1, 2 and 3 years, respectively (p = 0.07). Surprisingly, the method employed for RFA has a main influence in FDS, with 0% at 3 years for perfusion electrodes and 26% for cool-tip electrodes at the same period. CONCLUSIONS: In this series, overall survival at three years was relatively high; however, tumoral size, number of nodules and RFS method were independent variables associated with disease-free survival.

[Hepatoportal sclerosis and liver angiosarcoma: an infrequent association with a possible common etiology]. / Esclerosis hepatoportal y angiosarcoma hepático: una asociación infrecuente y una posible etiología común.

Hepatoportal sclerosis is characterized by fibrosis of the intima of the portal vein and its branches leading to the development of presinusoidal portal hypertension. We describe the case of a 58-year-old woman with idiopathic hepatoportal sclerosis, who was admitted to our service due to impairment of liver function, with rapid clinical worsening and finally the development of multiorgan failure. Autopsy showed a diffuse liver angiosarcoma with splenic metastases. The patient had no history of domestic or occupational exposure to substances involved in the development of hepatoportal sclerosis or liver angiosarcoma. The development of liver angiosarcoma in a patient with hepatoportal sclerosis is exceptional, even though both diseases may have a common etiology.

[Ischemic hepatitis following liver biopsy in a patient with transplanted liver]. / Hepatitis isquémica tras biopsia hepática en paciente transplantada hepática.

We report a case of ischemic hepatitis following a percutaneous liver biopsy in a 51 year old female patient, who had had an orthotopic liver transplant 6 months before. The angiographic study demonstrated a marked stenosis in the hepatic artery at the anastomosis site and a small arterioportal fistula. We suggest that the percutaneous liver biopsy was partially responsible for the ischemic hepatitis, due to the development of a small arterioportal fistula in a previously damaged vascular area with hepatic artery stenosis.

[Resection of recurrent hepatocarcinoma on a transplanted liver]. / Resección de hepatocarcinoma recidivante sobre hígado trasplantado.

Recurrence of hepatocellular carcinoma is rarely treated by surgical resection and has not been reported in the main series of liver transplantation. In this paper we present the case of a patient transplanted for hepatocellular carcinoma on cirrhosis who developed a tumoral recurrence in the transplanted liver four months later. The new tumor was removed by hepatectomy and the patient is free of tumor 24 months after resection. Surgical resection should be considered a treatment of tumoral recurrence after liver transplantation as is done after hepatectomy.

[Hepatic angiosarcoma with splenic metastasis]. / Angiosarcoma hepático con metástasis esplénica.

Angiosarcoma of the liver is an extremely rare tumor with a rapidly fatal course. This report describes the case of a 52-year-old male with an hepatic angiosarcoma not related to any known carcinogen. The hepatosplenic metastases and the brief clinical course, did not let us to complete diagnostic and therapeutic strategies.

[Transjugular hepatic biopsy. Apropos the first 100 cases and a review of the literature]. / Biopsia hepática transyugular: a propósito de los cien primeros casos y revisión de la literatura.

Under certain conditions a percutaneous liver biopsy cannot be carried out. In many of these patients transjugular liver biopsy is the correct option. We present our first hundred biopsies: in 92 cases a liver specimen was obtained; in 80 cases (87%) the tissue specimen allowed the histopathologic diagnosis; in five cases perforation of the hepatic capsule was observed, without producing hemoperitoneum. The mortality in our series was nil. In our experience and the revision of the literature, we consider that transvenous (transjugular) needle biopsy is an efficient and reliable procedure.

[The Budd-Chiari syndrome as the first manifestation of polycythemia vera]. / Síndrome de Budd-Chiari como primera manifestación de policitemia vera.

The case of a 57-year-old male diagnosed as having Budd-Chiari syndrome secondary to a polycythemia vera, which produced a thrombosis of the suprahepatic veins as a first manifestation, is presented. The rarity of this clinical case and the rapidly lethal evolution of the patient, confirms the bad prognosis of this association.

[Colonoscopic approach in the therapy of sigmoid volvulus]. / Abordaje colonscópico en el tratamiento del vólvulo sigmoide.

We present 13 patients with 15 episodes of colonic volvulus, who underwent colonoscopy to decompress and/or devolvulate. Colonoscopic exploration demonstrated a non obstructive dilatation in three cases. In the remaining 10 patients, with 12 episodes of volvulus, decompression was obtained in 83.3% and devoluvulation in 41.6%. There were two failures, due to peritoneal metastases and adhesions which fixed the volvulus. In 40% of the cases there were mild ischemic signs. Forty per cent of the patients were submitted to elective surgery and the two failures (20%) were operated in emergency. The remaining 4 patients declined surgical treatment. At is allows differential diagnosis, we think that, for these patients, colonoscopy should be the first therapeutic approach; it also allows decompression and/or devolvulation and an early diagnosis of the associated ischemia.

[The epidemiological aspects of chronic inflammatory intestinal disease in a catchment area of the Autonomous Community of Madrid]. / Aspectos epidemiológicos de la enfermedad inflamatoria intestinal crónica en un área asistencial de la Comunidad Autónoma de Madrid.

124 cases of chronic inflammatory bowel disease were retrospectively reviewed between 1983 and 1988 (44 affected by Crohn's disease (CD) and 80 by ulcerative colitis (UC)). A median annual incidence of 1.30/100,000 inhabitants/year for CD and 2.37 for UC was found, observing an increase in the incidence of CD and a stabilization of UC.

[Course of cellular immunity in patients with chronic inflammatory intestinal disease]. / Evolución de la inmunidad celular en pacientes con enfermedad inflamatoria intestinal crónica.

In a preliminary study of the immunological aspects of intestinal inflammatory disease we found an immunological deficit of T helper lymphocytes, decreased monocytes and chemotaxis and poor response to nonspecific mitogen stimulus. Based on these findings, the study was repeated in the same patients three years later to confirm the evolution of this deficit. Recuperation was observed in the cases in which the disease evolved favorably, suggesting that certain aspects of the immune disorder might be secondary.