No abstract available.
Adult ; Budd-Chiari Syndrome/complications/*pathology ; Carcinoma, Hepatocellular/complications/*pathology/therapy ; Humans ; Liver Neoplasms/complications/*pathology/therapy ; Liver Transplantation ; Magnetic Resonance Imaging ; Male ; Tomography, X-Ray Computed

A 66-year-old female patient was diagnosed with hepatocellular carcinoma accompanied by neuropathic pain induced by a metastatic tumor that compromised root and spinal canal. Although her pain was relieved following medical treatment, breakthrough pain occurring 1-2 times a day was still distressing. Neuropathic pain in her right lower limb caused discomfort and irritability and decreased her quality of life. We had limited options to adjust her prescription drug regime, due to the side effect of these drugs. Although acupuncture therapy was only performed at her home once a week, the efficacy was outstanding. The patient did not report any further instances of breakthrough pain, and she did not require additional bolus morphine. She could comfortably live in her familiar surroundings with her family and did not require any emergency room visits or admission into the hospital during the last month of her life. She had excellent quality of life in the terminal period of her life, and could even participate in a family function during this time. The present case report suggests that acupuncture may have a role in treating neuropathic pain induced by bone metastasis in patients with advanced cancer across clinical and in-home settings.
Acupuncture Therapy ; Aged ; Bone Neoplasms ; complications ; secondary ; Carcinoma, Hepatocellular ; pathology ; Female ; Home Care Services ; Humans ; Liver Neoplasms ; pathology ; Neoplasms ; pathology ; Neuralgia ; etiology ; therapy ; Quality of Life

The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing rapidly with the obesity and diabetes mellitus epidemics. It is rapidly becoming the most common cause of liver disease worldwide. NAFLD can progress to serious complications such as cirrhosis, hepatocellular carcinoma and death. Therefore, it is important to recognise this condition so that early intervention can be implemented. Lifestyle modifications and strict control of metabolic risk factors are the mainstay of treatment. As disease progression is slow in the majority of NAFLD patients, most can be managed well by primary care physicians. NAFLD patients with advanced liver fibrosis should be referred to specialist care for further assessment.
Carcinoma, Hepatocellular ; pathology ; Diet ; Disease Progression ; Humans ; Life Style ; Liver ; pathology ; Liver Cirrhosis ; pathology ; Liver Neoplasms ; pathology ; Metabolic Syndrome ; complications ; Non-alcoholic Fatty Liver Disease ; diagnosis ; therapy ; Obesity ; complications ; Prevalence ; Risk Factors ; Treatment Outcome

Despite advances in the treatment of hepatocellular carcinoma (HCC), managing HCC with portal vein thrombosis (PVT) remains challenging. PVT is present in 10-40% of HCC cases at the time of diagnosis and its therapeutic options are very limited. Current guidelines mainly recommend sorafenib for advanced HCC with PVT, but surgery, transarterial chemoemolization, external radiation therapy, radioembolization, transarterial infusion chemotherapy, and combination therapy are also still used. Furthermore, several new emerging therapies such as the administration of immunotherapeutic agents and oncolytic viruses are under investigation. This comprehensive literature review presents current and future management options with their relative advantages and disadvantages and summary data on overall survival.
Carcinoma, Hepatocellular/complications/*pathology/therapy ; Chemoembolization, Therapeutic ; Combined Modality Therapy ; Humans ; Liver Neoplasms/complications/*pathology/therapy ; Niacinamide/administration & dosage/analogs & derivatives ; Phenylurea Compounds/administration & dosage ; Portal Vein ; Protein Kinase Inhibitors/administration & dosage ; Venous Thrombosis/complications/*pathology

OBJECTIVETo explore the therapeutic efficacy of a combined treatment modality using transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) to treat hepatocellular carcinoma (HCC) complicated with main branch intraportal vein tumor thrombosis (PVTT).

METHODSClinical data was collected retrospectively for patients diagnosed with and treated for HCC plus main branch PVTT at our hospital between January 2007 and January 2010. The total study population (n = 51) consisted of 38 males and 13 females, with an average of 50.1 years (range: 24-73). Among these patients, 26 had been treated with TACE + PEI (group A) and 25 had been treated with TACE alone (group B). Short-term changes in PVTT (i.e. disappearance, shrinkage, and/or stability) and tumor (i.e. complete response, partial response, and/or stable disease) were assessed by using the t-test (continuous variables) or the Chi-squared or Fisher's exact tests (categorical variables). Between-group differences in survival time were assessed by the Kaplan-Meier analysis and log-rank test.

RESULTSThe follow-up time ranged from 3-24 months after treatment, and no serious treatment-related complications were recorded for any of the patients (0/51). The time of TACE treatment was significantly longer for the patients receiving the combination therapy (group A: 3.21.4 vs. group B: 2.40.9, t = 2.22, P = 0.032). The patients in group A received between 2-8 PEI treatments. The TACE + PEI combined treatment showed significantly better therapeutic efficacy for PVTT (group A: 19/26 vs. group B: 10/25, X2 = 5.685, P = 0.019). The tumor response was significantly better in patients treated with TACE + PEI at post-treatment month 3 (group A: 20/26 vs. group B: 18/25, X2 = 0.163, P = 0.705) and month 6 (group A: 17/20 vs. 10/19, X2 = 2.58, P = 0.027). Finally, the average survival time was significantly better in patients treated with TACE + PEI (group A: 12.856.02 months (range: 5-23) vs. group B: 8.653.39 months (range: 4-16), t = 3.051, P = 0.004).

CONCLUSIONTACE + PEI combination therapy for main branch PVTT in HCC patients is more efficacious than TACE alone, and is associated with a longer survival time.

Adult ; Aged ; Carcinoma, Hepatocellular ; complications ; pathology ; therapy ; Chemoembolization, Therapeutic ; Combined Modality Therapy ; Ethanol ; administration & dosage ; Female ; Humans ; Injections, Subcutaneous ; Liver Neoplasms ; complications ; pathology ; therapy ; Male ; Middle Aged ; Neoplastic Cells, Circulating ; Portal Vein ; pathology ; Retrospective Studies ; Thrombosis ; complications

Carcinoma, Hepatocellular ; complications ; drug therapy ; pathology ; Chemoembolization, Therapeutic ; methods ; Female ; Humans ; Liver Neoplasms ; complications ; drug therapy ; pathology ; Male ; Neoplastic Cells, Circulating ; Portal Vein ; pathology ; Stents ; Venous Thrombosis ; complications ; pathology

Cells termed myofibroblasts are prominent in the injury response of all epithelial tissues. They exhibit proliferation, migration, production of collagen and other extracellular matrix (ECM) molecules, and contraction, all for containing the injury and closing the wound. When the injury is limited in time, the final stage of the repair involves a dismantling of the cellular apparatus and restoration of normal tissue structure. With multiple cycles of repair, however, there is net accumulation of ECM, to the detriment of tissue structure and function. Repair-related ECM coalesces into fibrous bundles and, over time, undergoes changes that render it resistant to degradation. The result is a scar. In the skin, a scar may have cosmetic importance only. In the liver, however, extensive scarring is the setting for unregulated growth and neoplasia; also, fibrous bands disrupt normal blood flow, leading to portal hypertension and its complications. With regard to therapy for fibrosis, the first consideration is elimination of the injury factor. However, given that many liver diseases do not have effective therapies at present, strategies targeting fibrogenesis per se are under development. The main source of myofibroblast-like cells and ECM production in the liver is the perisinusoidal stellate cell, which responds to injury with a pleiotypic change termed activation. Activation is orchestrated by cytokines and the ECM itself. Among the cytokines involved in this process, transforming growth factor-beta (TGF-beta) is particularly prominent. The early changes in ECM include de novo production of a specific "fetal" isoform of fibronectin, which arises from sinusoidal endothelial cells. It is stimulated by TGF-beta and acts directly on stellate cells to promote their activation. Based on these and other advances in understanding the fundamentals of the injury response, several strategies now exist for altering fibrogenesis, ranging from agents that block TGF-beta to traditional Chinese herbal extracts. Arrest of fibrogenesis, even with underlying cirrhosis, is likely to extend life or prolong the time to transplant. Whether it reduces the risk of hepatocellular carcinoma remains to be proven. Although TGF-beta antagonists are effective anti-fibrogenic agents, they will require detailed safety testing because of the finding that several forms of epithelial neoplasia are associated with altered regulation of TGF-beta.
Animal ; Carcinoma, Hepatocellular/*etiology/pathology ; Chronic Disease ; Extracellular Matrix/metabolism ; Extracellular Matrix Proteins/biosynthesis ; Fibronectins/biosynthesis ; Fibrosis/complications/drug therapy ; Human ; Liver/cytology ; Liver Cirrhosis/*complications/pathology ; Liver Neoplasms ; Transforming Growth Factor beta/*physiology

OBJECTIVETo investigate the therapeutic measures for unresectable primary liver cancer (PLC).

METHODSThe date of 312 unresectable primary liver cancer patients treated from January 1991 to March 2003 were retrospectively analyzed.

RESULTSOf these 312 patients, 73 were treated by cryosurgery-based combined modality therapy, 239 were treated by a TACE-oriented combined modality therapy. 289 patients except 23 were followed for a period of 2 to 156 months. The overall 1-,3- and 5-year survival rate in this series was 74. 0% , 34. 0% and 16. 7% , respectively. The 1-,3-and 5-year survival rate in the cryosurgery group was 64. 4% , 38. 4% and 27. 4% , respectively. The 1-, 3- and 5-year survival rate in the TACE group was 75. 1% , 29. 0% and 10. 0%, respectively.

CONCLUSIONTreatment for the unresectable primary liver cancer should be individualized and combined with suitable therapeutic modalities.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Chemoembolization, Therapeutic ; methods ; Combined Modality Therapy ; Cryosurgery ; Female ; Follow-Up Studies ; Humans ; Liver Cirrhosis ; complications ; therapy ; Liver Neoplasms ; complications ; pathology ; therapy ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Retrospective Studies ; Survival Analysis

No abstract available.
Adenocarcinoma/*complications/*diagnosis/pathology ; Aged, 80 and over ; Colonoscopy ; Ethanol/therapeutic use ; Female ; Gallbladder Neoplasms/*complications/*diagnosis/pathology ; Humans ; Intestinal Obstruction/*etiology ; Liver Neoplasms/complications/drug therapy/secondary ; Tomography, X-Ray Computed

Portal vein invasion is a grave prognostic indicator in the setting of hepatocellular carcinoma (HCC). There is currently no effective method for preventing the invasion of HCC into the main portal vein. We report here a case of advanced HCC with portal vein tumor thrombosis that was effectively treated with percutaneous ethanol injection (PEI), having previously enabled subsequent successive transarterial chemoembolization (TACE). A 60-year-old male patient was diagnosed with a huge HCC, based on computed tomography and angiographic findings. Despite two sessions of TACE, the tumor invaded the right portal vein. PEI was performed on the malignant portal vein thrombosis, and three sessions thereof reduced the extent of tumor thrombi in the portal vein. Successive TACEs were performed to treat the HCC in the hepatic parenchyma. The patient was still living 19 months after the first PEI with no evidence of tumor recurrence, and his liver function remained well preserved.
Carcinoma, Hepatocellular/complications/*diagnosis/pathology ; Chemoembolization, Therapeutic ; Ethanol/*administration & dosage ; Humans ; Injections, Intralesional ; Liver Neoplasms/complications/*diagnosis/pathology ; Male ; Middle Aged ; Neoplasm Invasiveness ; *Portal Vein/pathology ; Tomography, X-Ray Computed ; Venous Thrombosis/complications/diagnosis/*therapy