A diagnostic dilemma: acute abdomen presenting as segmental arterial mediolysis masked by a ruptured hepatocellular carcinoma.

A 65-year-old male was brought to our hospital with right upper abdominal fullness sensation and recent body weight loss of about 3 kg. The patient had developed episodes of melena following progressive abdominal muscular guarding and drop of haemoglobin level to 6.3 g/dL. An abdominal computed tomography scan disclosed a ruptured hepatocellular cell carcinoma. A segmental arterial mediolysis was found on the superior mesenteric artery in the process of repairing the ruptured right hepatic artery with the assistance of angiography. Transarterial embolization was carried out and permanent haemostasis was achieved.

Novel Investigations of Flavonoids as Chemopreventive Agents for Hepatocellular Carcinoma.

We would like to highlight the application of natural products to hepatocellular carcinoma (HCC). We will focus on the natural products known as flavonoids, which target this disease at different stages of hepatocarcinogenesis. In spite of the use of chemotherapy and radiotherapy in treating HCC, patients with HCC still face poor prognosis because of the nature of multidrug resistance and toxicity derived from chemotherapy and radiotherapy. Flavonoids can be found in many vegetables, fruits, and herbal medicines that exert their different anticancer effects via different intracellular signaling pathways and serve as antioxidants. In this review, we will discuss seven common flavonoids that exert different biological effects against HCC via different pathways.

Non-Hodgkin's lymphoma of the stomach: treatment outcomes for 57 patients over a 20-year period.

BACKGROUND: Gastric non-Hodgkin's lymphoma (NHL) is a rare subtype of malignancy, for which no consensus exists about treatment. In this study, the treatment outcomes of gastric NHL in 57 patients were retrospectively evaluated for a period of 20 years at a single institute. METHODS: Clinical stages were classified according to the Ann Arbor staging system: 29 patients were stage 1, 17 stage II, two stage III, and nine stage IV. The 46 stage I/II patients received aggressive, multimodal therapy: 24 of these (group A) were treated with surgery-based management, which included surgery alone (n = 6), surgery + chemotherapy (CT; n = 14), surgery + radiotherapy (RT; n = 2), and surgery + CT + RT (n = 2); 22 patients (group B) did not receive surgery, but received CT alone (n = 11), CT + RT (n = 5), or, in patients with low-grade mucosa-associated lymphoid tissue (MALT) lymphoma, an oral anti-Helicobacter pylori regimen (n = 6). The 11 stage III/IV patients received CT and/or RT with regimens similar to those for stage I/III patients. RESULTS: Except for 1 patient with an initial surgical diagnosis, 56 patients underwent gastric endoscopic examination, which proved that 42 had NHL. The rate of diagnostic accuracy by gastroscopy was 75%. After multimodal treatment (n = 46) and a median follow-up of 54 months (range, 1-210 months), the 5-year survival rate was 40.3%. The 5-year survival rates for stage 1, II and III/IV patients were 57.2%, 47% and 0%, respectively (p < 0.005). Of the 24 surgical patients (group A) who received sequential CT, with or without RT, 12 remained disease-free after a median follow-up of 98 months (range, 1-210 months); three patients died because of postoperative complications. Of the 22 non-surgical patients (group B) who received CT, alone or combined with RT, 14 remained disease-free after a median follow-up of 40 months (range, 4-189 months); 1 patient died because of massive gastric hemorrhage after CT. All stage III and IV patients died after a median survival of 4 months (range, 1-8 months). CONCLUSION: Clinical stage is the most important factor predicting the long-term survival of patients with gastric NHL. Surgery may still be necessary in cases of failed gastroscopic diagnosis. In early-stage gastric NHL, non-surgical treatment seems able to achieve the aims of improved long-term survival and, in some instances, cure.

Catastrophic heparin-induced thrombocytopenia/thrombosis syndrome related to the use of a Port-A-Cath in a breast cancer patient receiving chemotherapy.

Heparin-induced thrombocytopenia and thrombosis (HIT/T) syndrome is usually triggered by an immune response after repeated administration of heparin. The syndrome is strongly associated with limb deep vein thrombosis and is potentially life-threatening if unrecognized. We describe the case of a patient with compartment syndrome of the left forearm complicated by HIT/T that developed after Port-A-Cath implantation through the left subclavian vein. Prompt recognition of HIT/T, immediate withdrawal of heparin, and timely institution of thrombolytic therapy successfully prevented limb loss.

Epstein-Barr virus and lymphoid hematological disorders.

BACKGROUND: To study the role of Epstein-Barr virus (EBV) in the carcinogenesis of various lymphoid neoplasms in Taiwan, a nonisotopic in situ hybridization (ISH) technique was used to detect the expression of EBV-encoded small RNAs (EBERs) in various lymphoid neoplasms. METHODS: We obtained the paraffin-embedded tissues of various hematological malignancies from the Department of Pathology, Tri-Service General Hospital. Nonisotopic ISH technique was employed to detect EBERs and immunohistochemical staining was performed to confirm the cell lineage. RESULTS: Our data showed the frequency of EBV infection on various lymphoid malignancies as followed: Burkitt's lymphoma (BL) (10/18); non-Burkitt's Non-Hodgkin's lymphoma (3/42); non-Hodgkin's lymphoma, T cell type, nasal (NHLTN) (5/5); Hodgkin's disease (2/9); acute lymphocytic leukemia (1/24); chronic lymphocytic leukemia (1/15); and multiple myeloma (2/18). In the control group, none of the specimens from patients of acute myelocytic leukemia and myelodysplastic syndrome was positive for EBERs. CONCLUSIONS: Among the various lymphoid neoplasms we studied, only BL (p < 0.05) and NHLTN (p < 0.05) were found to have an association with EBV statistically.