Surveillance of Hepatitis Viruses in Several Small Islands of Japan by Ship: A Public Health Approach for Elimination of Hepatitis Viruses by 2030.

AIM: In 1990, an epidemiological survey by ship in some Japanese islands revealed high prevalence of hepatitis viruses and human T cell leukemia virus (HTLV). A second prevalence study of these viruses were accomplished in 2018, 28 years after initial survey. Analysis of these studies provide insights about strategies of elimination of hepatitis viruses at remote areas. MATERIALS AND METHODS: In 2018, prevalence of hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), and HTLV was checked in 305 subjects in the islands those covered in 1990's survey. Hepatitis A virus was checked by the presence of anti-HAV IgG in sera; HBV was affirmed when hepatitis B surface antigen (HBsAg) in sera. Hepatitis C virus infection was evaluated by the presence of antibody to HCV (anti-HCV) and infection with HTLV was estimated by immunoassay. The methodology of assessment of different hepatitis viruses were optimized on the basis of present scientific knowhow. RESULTS: In 1990, the prevalence of HAV (presence of anti-HAV), HBV (presence of HBsAg), HCV (positivity for anti-HCV), and HTLV was found in 79.3%, 11.1%, 2.2%, and 3.3% of apparently health subjects of the islands, respectively. The prevalence of HAV, HBV, HCV, and HTLV was 47.9%, 4.6%, 1.0%, and 3.0%, respectively, in 2018. A shift of age of infected persons tilted towards right as the days progressed. CONCLUSION: The study indicates a scenario of elimination of hepatitis viruses in Japan as lower trends of prevalence of HAV, HBV, and HCV have been recorded in 2018 compared with 1990, mainly by preventive measures. The most notable finding is that there are almost no new case below the age of 40 years, indicating an effective containment measure against these viruses. HOW TO CITE THIS ARTICLE: Akao T, Onji M, Kawasaki K, et al. Surveillance of Hepatitis Viruses in Several Small Islands of Japan by Ship: A Public Health Approach for Elimination of Hepatitis Viruses by 2030. Euroasian J Hepato-Gastroenterol 2019;9(2):57-62.

Familial Pancreatic Cancer at Elderly Siblings in Japan.

Two female siblings aged 87 and 90 years were clinically diagnosed as pancreatic cancer by abdominal ultrasonography and abdominal contrast-enhanced CT. Pancreatic cancer of these patients was confirmed during the autopsy. Both patients shared risk factors of pancreatic cancer; old age, diabetes, and passive smoking. Strong family history of pancreatic cancer was found in these two patients as their father and younger brother were also suffering from this cancer. The present study seems to report two eldest cases of familial pancreatic cancer in siblings. How to cite this article: Kashimoto Y, Onji M, et al. Familial Pancreatic Cancer at Elderly Siblings in Japan. Euroasian J Hepatogastroenterol 2019;9(1):52-54.

A Case of Severe Drug-induced Liver Injury Caused by Over the Counter Herb (Cinnamon): Review of Literature.

A case of severe drug-induced liver injury caused by over the counter (OTC) herb medicine, is reported here. A 40-year-old male took herb drugs "Za ga-doKowa®," "Ohta-Isan®." These two drugs contained the same two herb medicines (cinnamon, fennel). About 4 months later after taking medicine, jaundice appeared. Prothrombin time activation (PT) was 45%, aspartate transaminase (AST) was 1104 IU/l, and total bilirubin (T-bil) 14.7 mg/dL. Serum tests for hepatitis viruses (A, B, C, E) were negative. Lymphocyte stimulating test was positive for Za ga-do Kowa ® and Ohta-I Isan®. Liver 3D constructed by construct-CT revealed findings of the potato-like liver. The liver biopsy specimen revealed multilobular hepatic necrosis accompanied by scar formation, severe zonal degeneration and necrosis of hepatocytes mainly in the central area of the lobule. In the reported 13 cases of cinnamon-induced liver diseases, there has been a severe abnormality of PT and T-bil. Biopsy findings of these cases showed wide ranges of necrosis. Liver injury due to cinnamon shows very severe damages, and the possibility of liver failure due to cinnamon may be imminent. How to cite this article: Higaki H, Onji M, Takeji S, Uehara T, Kawasaki K, Kashimoto Y, Murakami T, Yamaguchi T, Miyaike J, Oomoto M, Abe M. A Case of Severe Drug-induced Liver Injury Caused by Over the Counter Herb (Cinnamon): Review of Literature. Euroasian J Hepatogastroenterol, 2018;8(2):167-171.

Submucosal tumor-like lesion originating from colon tuberculosis: a case report and review of the literature.

A 76-year-old male had a solitary submucosal tumor-like lesion in the sigmoid colon originating from tuberculosis. The lesion, up to 1 cm in diameter, was found incidentally during a routine colonoscopy, which revealed a protuberant submucosal growth with a shallow depression of the overlying mucosa in the center of the tumor. Histologically, the endoscopic biopsy revealed caseating granulomas and infiltration of Langhans giant cells and epithelioid cells, consistent with tuberculosis, were also observed. Five reports of similar lesions from colon tuberculosis were found in a literature review, including the present case. In all cases, the submucosal tumor-like lesions which originated from tuberculosis were small and in an active stage of tuberculosis. Five cases of submucosal tumor-like lesions from gastric tuberculosis were also reported, with characteristics very similar to those of the lesions from colon tuberculosis. Therefore, we propose that lesions originating from tuberculosis should be included in the differential diagnosis of submucosal tumor-like lesions in the colon and stomach.

Abdominal imaging findings of a patient with hepatocellular carcinoma associated with glycogen storage disease type 1a.

A hepatic tumor was found in a 57-year-old man with glycogen storage disease type 1a (GSD1a) with a mutation in exon 5 of the glucose-6-phosphatase gene (G727T). Partial hepatectomy was performed, and the tumor was histologically diagnosed as moderately differentiated hepatocellular carcinoma (HCC). On contrast-enhanced ultrasonography, the tumor had a late phase defect. Abdominal imaging with other modalities was also performed. More studies are needed to clarify the differences in imaging findings between GSD1a-associated HCC and other tumors such as adenomas.

Hepatic resection assisted by ablative therapy for advanced hepatocellular carcinoma.

BACKGROUND/AIMS: We attempted combinations of resection and ablative therapies (ethanol injection (EI) or radiofrequency therapy (RFA)) in hepatocellular carcinoma (HCC) patients. METHODOLOGY: Thirty-one patients with naive HCC treated from January 2000 to June 2010 were enrolled. All were tumor node metastasis stage III and the number of tumors was countable (< or = 5). Twelve were treated with resection assisted with an ablative therapy (combination group) and 19 with resection only (resection group). Clinical backgrounds and prognosis were investigated. RESULTS: The total scores for up-to-seven criteria were larger in the combination group than in the resection group (p=0.01), while other clinical background findings were not significantly different between the groups. In the combination group, 10 cases underwent resection combined with RFA and 2 with EI. The 1- and 3-year survival rates were not significantly different between the groups (combination group, 88.2% and 88.2%, respectively; resection group, 90.9% and 80.8%, respectively). There were no severe complications. CONCLUSION: Our results indicate that combination therapy is a therapeutic option for cases with countable HCCs who are difficult to treat by resection only.

Transcatheter arterial chemoembolization with fine-powder cisplatin-lipiodol for HCC.

BACKGROUND/AIMS: Fine-powder cisplatin has recently been developed, allowing the easy manufacture of high-density cisplatin-lipiodol suspensions. The aim of this study is to evaluate the efficacy and toxicity of transcatheter arterial chemoembolization (TACE) with fine-powder cisplatin and lipiodol suspension against advanced hepatocellular carcinoma (HCC). METHODOLOGY: We prospectively analyzed 20 patients (16 men, 4 women) with inoperative advanced HCC without extrahepatic metastases who underwent TACE with fine-powder cisplatin and lipiodol suspension in our hospital between August 2006 and December 2008. All patients were administered a suspension of fine-powder cisplatin at 10 mg/1 cm of tumor diameter. RESULTS: Partial response was seen in 10 cases, with stable disease in 7 cases and progressive disease in 3 cases. Overall response rate was 50%. The 1-year survival rate was 90%. Adverse effects (> or = grade 3) occurred in 40%, with vomiting in 5%, thrombocytopenia in 15%, elevated serum bilirubin in 20%, decreased serum albumin in 5%, fever in 65%, general fatigue in 15% and anorexia in 30%. However, no other life-threatening, adverse events were observed. CONCLUSION: TACE with fine-powder cisplatin suspended in lipiodol provides better therapeutic efficacy, suggesting the potential usefulness of this agent in the treatment of advanced HCC.

Severe hypoglycemia associated with insulin-like growth factor II-producing liver metastasis from gastric carcinoma treated with overnight total parenteral nutrition via a central vein catheter reserve port.

Hypoglycemia caused by insulin-like growth factor II is difficult to control. A 77-year-old woman was diagnosed with gastric cancer and multiple liver metastases in September 2006 and underwent chemotherapy; however, at that time there were no symptoms of hypoglycemia. From January 2007 onwards, hypoglycemic comas and symptoms of hypoglycemia began to appear frequently. Her serum level of insulin was normal; thus, we suspected the presence of big insulin-like growth factor II was causing the hypoglycemia. This was proven by Western immunoblotting and we diagnosed non-islet cell tumor hypoglycemia associated with gastric cancer. Overnight nutrition provided via a central venous catheter port to prevent hypoglycemia allowed the patient to become ambulant and to remain free of hypoglycemic coma at follow-up until her death 7 months later.

Malignant pheochromocytoma with liver metastasis treated by transcatheter arterial chemo-embolization (TACE).

Multiple liver metastatic lesions were shown by computed tomography and scintigraphy with 123I- metaiodobenzylguanidine (MIBG) in a 76-year-old woman 2 years after resection of a pheochromocytoma of the right adrenal gland. Transcatheter arterial chemo-embolization (TACE) was performed for the liver metastasis, with blood pressure strictly controlled by administration of doxazosin and phentolamine for the prevention of hypertensive crisis after TACE. There were no severe adverse events associated with the treatment, and the number and size of the lesions were decreased. TACE with strict blood pressure control was an effective and safe therapy for multiple liver metastatic lesions related to malignant pheochromocytoma.

Amino acid imbalance in patients with chronic liver diseases.

AIM: The aim of this study is to clarify the amino acid imbalance in patients with chronic hepatitis (CH) as well as those with liver cirrhosis (LC). METHODS: We assayed total branched-chain amino acids (BCAA), tyrosine (Tyr) levels and their ratio (BTR) in sera of 101 patients with CH (37 in fibrosis stage F1, 23 in F2, 21 in F3) and 20 with LC (F4) who were diagnosed by liver biopsy. Their levels in relation to the staging of liver fibrosis were analyzed. RESULTS: The percentage of patients whose BTR was less than the normal range was 32.1% in CH and 75.0% in LC. The levels of BTR and BCAA were significantly lower (P < 0.001, P < 0.05, respectively) and that of Tyr was significantly higher (P < 0.001) in patients with LC than those in CH. The levels of BTR decreased according to the staging. The levels of Tyr increased according the staging, whereas the levels of BCAA deceased prominently in F4 (487 +/- 103 in F1, 483 +/- 122 in F2, 487 +/- 111 in F3 and 423 +/- 94 in F4). CONCLUSION: A considerable number of patients not only with LC but also with CH showed lower levels of BTR. It has been clarified that amino acid imbalance of Tyr was found in the early stage of liver disease, whereas decrease of BCAA was found mainly in F4 stage.

Modified technique for determining therapeutic response to radiofrequency ablation therapy for hepatocellular carcinoma using US-volume system.

In radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC), microbubbles appearing during the procedure make it difficult to determine effectiveness with ultrasonography (US) imaging. We developed a modified US-volume system and evaluated its efficacy for demonstrating response to therapeutic RFA. Our US-volume system displays multiplanar reconstruction (MPR) images providing a synchronized view with a US image along with past US-volume data in real-time side-by-side on a personal computer. Seventy-eight patients (94 nodules) were enrolled, of whom 35 (47 nodules) were evaluated using this system (US-volume group) and compared to the other 43 (47 nodules) examined before development of our system (control group). All nodules were clearly depicted by US. If the shortage of margin was predicted with US-volume system, we performed additional needle insertion. Tumor necrosis following RFA was graded by dynamic computed tomography as follows: Grade A, necrotic area surrounded in all directions with an adequate margin (>or=5 mm); Grade B, necrotic area surrounded in all directions, though some margin areas <5 mm; and Grade C, residual tumor or necrotic area smaller than the target tumor. In the US-volume group, the average tumor size was not smaller than that in the control (15.9+/-4.9 vs. 16.0+/-4.3 mm) and adequate margins were obtained (Grade A, B, C, 45/1/1 vs. 35/8/4; P<0.01). Further, there was a significant reduction in numbers of RFA sessions as compared to the control (1.03+/-0.17 vs. 1.12+/-0.32; P<0.01). In HCC patients undergoing RFA, our modified US-volume system accurately demonstrated therapeutic response, which led to a reduced number of RFA sessions.

Clinical translation in the treatment of hepatocellular carcinoma following the introduction of contrast-enhanced ultrasonography with Sonazoid.

Some hepatocellular carcinoma (HCC) nodules are detectable with dynamic computed tomography, but not by conventional B-mode ultrasonography (US). Contrast-enhanced US (CEUS) with Sonazoid, a new injectable contrast agent, has been used in Japan since January 2007. The primary advantage of this agent is the ability to maintain observations continuously in the Kupffer phase. We assessed the clinical role of CEUS with Sonazoid for radiofrequency ablation (RFA). From January 2005 to December 2008, 1142 patients were treated with surgical resection, RFA, percutaneous ethanol injection or transcatheter arterial chemoembolization, following the exclusion of those patients treated with chemotherapy or supportive care. The patients included in the study were divided into the pre-CEUS (n=451, 2005 and 2006) and post-CEUS (n=691, 2007 and 2008) groups. Clinical background (e.g., etiology, Child-Pugh classification, tumor node metastasis stage, percentage of patients matched with Milan criteria and selected therapies) was compared between the two groups. In addition, naïve cases were compared between the groups. There were 130 naïve HCC cases in the pre-CEUS group and 171 in the post-CEUS group. Although there were no significant differences for clinical background, the percentage of RFA cases increased from 21 (n=95) to 32% (n=219) and from 32 (n=41) to 52% (n=89) for total and naïve subjects, respectively, after CEUS was introduced (P<0.01). In naïve cases treated with RFA, tumor numbers in the post-CEUS group were larger than those of the pre-CEUS group (1.15±0.48 vs. 1.40±0.67; P<0.01). CEUS with Sonazoid, therefore, makes it possible to perform RFA in a considerable number of HCC cases that would otherwise be invisible by conventional B-mode US.

Evaluation of contrast-enhanced ultrasonography using perfluorobutane (Sonazoid(®)) in patients with small hepatocellular carcinoma: comparison with dynamic computed tomography.

This study aimed to elucidate the efficacy of contrast-enhanced ultrasonography (CEUS) with perfluorobutane (Sonazoid(®)) in the diagnosis of hepatocellular carcinomas (HCCs), particularly small HCCs, by comparing the results with dynamic computed tomography (Dy-CT). Seventy-nine nodules in 69 patients with chronic liver disease, suspected as HCCs were studied. The nodules were selected based on the results of B-mode ultrasonography and/or Dy-CT conducted between January and August 2007. The nodules were divided into two groups: the S-group with tumors ≤2 cm (49 nodules), and the L-group with tumors >2 cm (30 nodules). Typical HCCs were defined, and the nodules were enhanced and shown as defects in the arterial and late phase of Dy-CT, respectively. Target lesions were scanned using CEUS, and the results were compared with those of Dy-CT. The L-group nodules diagnosed as HCCs using Dy-CT were also diagnosed as HCCs using CEUS. In the S-group, the diagnostic sensitivity of CEUS was 94.7% and the specificity was 81.8%. We diagnosed two liver tumors that were detected by CEUS but not by Dy-CT; biopsies revealed one tumor to be a well-differentiated HCC and the other to be an atypical adenomatous hyperplasia. The sensitivity and specificity of CEUS against HCC were high even in the small-size HCCs. Thus, Sonazoid is useful in the screening for small HCCs.

Diagnostic value of sonazoid for hepatic metastasis: comparison with FDG PET/CT.

BACKGROUND/AIMS: This study was conducted to evaluate the diagnostic efficacy of contrast enhanced ultrasonography (CEUS) with perflubutane (Sonazoid) for hepatic metastasis and compared it with that of 18-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) computed tomography (CT). METHODOLOGY: From January 2007 to July 2009, 109 Japanese patients with gastrointestinal tract cancer were enrolled, of whom 4 had esophageal cancer, 28 gastric cancer, 1 duodenal cancer, and 76 colorectal cancer. After a bolus injection with Sonazoid (0.5 ml/body), the liver was scanned in both arterial and Kupffer phases. The results of PET/CT and other abdominal imaging examinations were not shown to the CEUS operators. We compared diagnostic efficacy between CEUS and PET/CT. RESULTS: Average values for age, body mass index, and maximum diameter of the hepatic metastasis were 68.7 +/- 11.0 years, 21.2 +/- 4.2, and 29.2 +/- 20.5mm, respectively. Hepatic metastasis were suspected in 31 patients based on PET/CT findings and 32 by CEUS. Finally, hepatic metastasis was diagnosed in 30 patients. The sensitivity, specificity, and accuracy rates for CEUS and PET/CT were similar (100% vs. 100%, 97.5% vs. 98.7%, and 95.5% vs. 93.6%, respectively). CONCLUSION: CEUS had a diagnostic value similar to that of PET/CT for hepatic metastasis.

Radiofrequency ablation therapy for hepatocellular carcinoma in elderly patients.

BACKGROUND AND AIM: With the aging of society, the number of elderly patients with hepatocellular carcinoma (HCC) has been increasing in Japan. The Government of Japan defines elderly as being over 65 and has divided the elderly into two stages: the first elderly stage (< 75 years old) and the second elderly stage (> or = 75). We investigated the efficacy and safety of radiofrequency ablation therapy (RFA) in patients in the second elderly stage in comparison with other HCC patients, retrospectively. METHODS: Two hundred six patients with HCC, who were within the Milan criteria, with low-grade performance status (0 or 1) and a Child-Pugh classification of A or B were enrolled. All were treated with RFA from January 2000 to December 2008 as an initial therapy and were divided into elderly HCC group (e-HCC group; > or = 75, n = 63) and non e-HCC group (< 75, n = 143), and their clinical data and survival rates were compared. RESULTS: Age and the level of protein induced by vitamin K absence or antagonist (PIVKA-II) were higher in the e-HCC group as compared with the non e-HCC group (78.3 +/- 3.2 vs 64.2 +/- 7.5 years, 676.3 +/- 2643.7 vs 142.4 +/- 442.2 mAU/mL: P < 0.01, respectively). There were no significant differences for Child-Pugh class, tumor node metastasis stage, and Japan Integrated Stage score and in survival rates after 3, and 5 years between the groups (e-HCC group: 82.5% and 49.7%, respectively; non e-HCC group: 78.3% and 57.5%, respectively). There were no severe complications in the e-HCC group. CONCLUSIONS: Elderly HCC patients, who have good performance status, should be treated in the same manner and with the same strategy as young HCC patients.

Efficacy of laparoscopic radiofrequency ablation for hepatocellular carcinoma compared to percutaneous radiofrequency ablation with artificial ascites.

AIM: Hepatocellular carcinoma (HCC) nodules close to the liver surface exhibit high recurrence compared to those in distal parts of the liver. Moreover, when nodules remain adjacent to the gastrointestinal tract or gallbladder, severe complications such as perforation of those organs may occur due to invasive therapy. Percutaneous radiofrequency ablation (PRFA) with artificial ascites or laparoscopic radiofrequency ablation (LRFA) are used to treat these patients to avoid complications. The purpose of the present study was to assess the efficacy and safety of these two methods. METHODS: Subjects comprised 74 patients (48 men, 26 women; mean age, 68.5 +/- 8.0 years; range, 46-89 years) with 86 HCC nodules. PRFA with artificial ascites was carried out for 37 patients (44 nodules) and LRFA was used for 37 patients (42 nodules). Clinical profiles were compared between groups. RESULTS: No significant differences in clinical profiles were found between patients treated by PRFA or LRFA. Mean number of treatments was significantly lower for LRFA (1.0 +/- 0.0) than for PRFA (2.1 +/- 1.0, P < 0.001). Mean number of PRFA treatments was 2.2 +/- 1.0 in patients with HCC nodules >2 cm in diameter, whereas all tumors were completely ablated with only one session of LRFA. The safety margin was significantly wider for LRFA than for PRFA. CONCLUSION: LRFA is a better treatment option for ablation of HCC nodules >2.0 cm in diameter.

Usefulness of the hyperechoic rim for assessing the therapeutic efficacy of radiofrequency ablation in hepatocellular carcinoma patients.

AIM: During radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC), a hyperechoic rim develops around the HCC nodules. The usefulness of the hyperechoic rim to guide treatment was assessed. METHODS: RFA was first performed in pig livers to determine the significance of the hyperechoic rim. Fifty-five patients with 75 HCC nodules had received RFA for the treatment of HCC. For those patients, we evaluated whether conventional ultrasonography (US) could be used instead of contrast-enhanced computed tomography (CECT) and contrast-enhanced ultrasonography (CEUS) using virtual imaging. Finally, 31 patients with 45 HCC nodules received RFA, and the degree of ablation was assessed based on the hyperechoic rim. Repeated RFA was done when ablation appeared incomplete. RESULTS: In the pig livers, the hyperechoic rim was found to be related to the presence of dead cells. The preliminary study showed that US could be used instead of CECT and CEUS to evaluate the degree of ablation caused by RFA. Because hepatic vessels in the back side of the hyperechoic rim were not clear by the artifact, we used the distance from the surface of the liver to the hyperechoic rim for evaluation. By analyzing the extent of the hyperechoic rim, it was noted that incomplete ablation was achieved in 17 of 31 patients (21 of 45 HCC nodules). These patients were re-treated with RFA within 5-15 min of the first RFA. CONCLUSION: This study shows that the hyperechoic rim is related to the presence of dead and necrotic tissues. Thus, assessment of the hyperechoic rim's characteristics allows one to evaluate the efficacy of RFA.

Treatment of hepatocellular carcinoma using arterial chemoembolization with degradable starch microspheres and continuous arterial infusion of 5-fluorouracil.

OBJECTIVE: Transcatheter arterial embolization (TAE) with gelatin sponge particles and iodized oil often yields poor results when used to treat unresectable multifocal hepatocellular carcinoma (HCC). The present study retrospectively investigated the utility of a novel combination chemotherapy regimen for treating multifocal HCC resistant to TAE. METHODS: Thirteen consecutive patients with unresectable multifocal HCC and resistance to TAE were treated with combination chemotherapy consisting of arterial chemoembolization with degradable starch microspheres (DSM) (150-4500 mg on Day 1), mitomycin-C (4-8 mg on Day 1), continuous arterial infusion of 5-fluorouracil (1250 mg/120 h), cisplatin (25-50 mg/120 h) and l-leucovorin (125 mg/120 h) for 10-19 weeks. RESULTS: The response rate was 84.6%, with complete response in one patient and partial response (PR) in 10 patients. In four of 10 patients with PR, the tumor was not observable, although the tumor marker did not completely decline to the normal range. The 1-, 2- and 3-year survival rates were 100, 28.9 and 9.6% in all, and 100, 33.3 and 0% in six patients with portal vein tumor thrombosis (PVTT). The median survival was 22.1 months in all and 17.1 months in six patients with PVTT. Thrombocytopenia of Grade III or higher was observed in eight patients. Laparoscopic splenectomy was performed before therapy in four patients with platelet counts of <70,000/mm(3), and during therapy in five patients with severe thrombocytopenia. CONCLUSIONS: This novel chemotherapy regimen achieved favorable results and may be useful in treating patients with unresectable multifocal HCC resistant to TAE.

Efficacy of splenectomy for hypersplenic patients with advanced hepatocellular carcinoma.

AIM: Chemotherapy for advanced hepatocellular carcinoma (HCC) patients with hypersplenism is generally unsatisfactory, as a lower-dose therapy is usually administered. Splenectomy may represent a better approach to overcoming the complication due to hypersplenism in patients with advanced HCC. This retrospective study was conducted to evaluate whether HCC patients who undergo splenectomy show improved prognosis. METHODS: We examined 34 HCC patients. Twenty-two had thrombocytopenia and/or leucopenia and underwent laparoscopic splenectomy. The completion rate of full-dose drug regimens, the response rate, the toxicity of chemotherapy and the cumulative survival rate were compared between the splenectomy and non-splenectomy groups. RESULTS: The response rate and the cumulative survival rate in the splenectomy group were significantly better than that in the non-splenectomy group. CONCLUSIONS: Splenectomy is an efficient method for advanced HCC patients with hypersplenism treated by chemotherapy.

Percutaneous ultrasound-guided radiofrequency ablation of hepatocellular carcinoma with artificially induced pleural effusion and ascites.

BACKGROUND: Ultrasound-guided procedures are sometimes of limited use because the tumor is located under the diaphragm or near the surface of the liver. We investigated the safety and efficacy of radiofrequency ablation (RFA) with artificial pleural effusion and/or artificial ascites. METHODS: Between January 2002 and May 2006, 43 lesions in 36 patients with hepatocellular carcinoma (HCC) were treated by RFA with artificial pleural effusion and/or artificial ascites. RESULTS: Artificial pleural effusion allowed visualization of the whole tumor for 36 (83.7%) of the 43 lesions that were otherwise not detectable or poorly visible. Artificial ascites was also helpful in visualizing whole tumors that could not be visualized with only artificial pleural effusion. In all lesions, artificial pleural effusion and/or artificial ascites were helpful in performing percutaneous RFA. Artificial ascites was useful for creating a space between the liver's surface and the skin or diaphragm to avoid burns. Adverse effects after the induction of artificial pleural effusion included pneumonia in one patient and temporary atelectasis in another patient. Severe side effects were not observed. Complete necrosis after RFA was obtained in 43 (100%) of the 43 lesions. During a mean follow-up period of 31.8 +/- 5.8 months, local recurrence at the ablation site was found in none of the 43 lesions. CONCLUSIONS: Percutaneous RFA with artificial pleural effusion and/or artificial ascites was a safe and useful treatment that resulted in good local control of HCC.