Efficacy of Cyproheptadine Monotherapy in Hepatocellular Carcinoma With Bone Metastasis: A Case Report.

BACKGROUND: Hepatocellular carcinoma (HCC) is one of the most common causes of cancer-related deaths worldwide. Particularly, cases of bone metastasis have poorer prognoses. CASE PRESENTATION: A 62-year-old woman with suspected advanced HCC accompanied by bone metastasis with severe back pain and sciatica showed disease remission after cyproheptadine monotherapy. Initially, her serum alpha fetal protein (AFP) level was high, reaching up to 17697.62 ng/ml. A dose of 4 mg cyproheptadine, 3 times a day for 17 months was prescribed as the only treatment. Within 3 months, the serum AFP level gradually normalized down to 4.3 ng/ml. Both liver biopsy and bone biopsies were subsequently performed after 2 weeks of cyproheptadine. The results showed no malignancy. During the 34 months of follow-ups, the serum AFP remained normal in the range of 1.05 to 2.86 ng/ml. The patient has survived for 5 years without back pain and sciatica thus far. CONCLUSIONS: This is the first report to investigate a successful clinical approach in cyproheptadine monotherapy for an advanced HCC patient with bone metastasis. We recommend cyproheptadine as a potential anti-HCC agent for the treatment of HCC with bone metastasis, but more related studies such as prospectively clinical trials, and ideally randomized trials are still needed.

Role of three-dimensional rotational venography in evaluation of the left iliac vein in patients with chronic lower limb edema.

The aim of this study was to assess the role of three-dimensional rotational venography (3D RV) supplementary to two-dimensional (2D) digital subtraction venography (DSV) in evaluation of the left iliac vein in patients with chronic lower limb edema. We reviewed 34 patients with chronic lower limb edema who had undergone bilateral iliac 2D DSV and 3D RV of the left common iliac vein and had surgery in our institution. The presence, anatomical location, and size of the venous narrowing were assessed. Stenosis was defined as luminal narrowing of 50% or more compared with the prestenotic or poststenotic lumen by visual assessment. A measured pressure gradient of 2 mm Hg or more at surgery was considered a positive result. The diagnostic accuracy was higher for the 3D images (88.2%) than for the 2D images alone (70.6%). 3D images provided higher sensitivity (90%) than the 2D images alone (66.7%). The 2D images alone had excellent specificity (100%) and positive predictive value (100%) in the diagnosis of venous narrowing. 2D DSV images provide specificity in diagnosis of venous stenosis of the left iliac vein in patients with chronic lower limb edema. In patients with negative 2D images, additional 3D RV leads to higher diagnostic sensitivity, thereby providing a powerful tool for planning surgical and endovascular treatment.

Successful management of double penetrating ocular trauma with retinal detachment and traumatic endophthalmitis in a child.

The prognosis of double penetrating ocular trauma in children is usually guarded. We report the good anatomic and functional outcome in a child with double penetrating ocular trauma associated with retinal detachment and traumatic endophthalmitis. A 5-year-old boy presented to the emergency room with pain and tearing in his left eye after a penetrating ocular injury by a rusted steel wire. After examination under anesthesia, both entrance and exit wounds in the sclera were found, and were complicated with inferior retinal detachment. There were signs of infection such as corneal edema, increased cell, flare and hypopyon in the anterior chamber, and vitreous opacity. The post-traumatic endophthalmitis was successfully treated with prompt intravenous and intravitreal antibiotics injection. The patient subsequently underwent scleral buckling and transpupillary indirect laser photocoagulation operation on the 10th day after trauma. The retina was completely reattached 2 weeks later, and his vision recovered to 6/10 in his left eye after a 6-month follow-up. Prompt use of antibiotics and meticulous surgical intervention are essential in the successful management of such patients.