INTRODUCTIONThe lung is the most common site of distal metastasis in patients with hepatocellular carcinoma (HCC), as seen in more than half of patients with extrahepatic disease. The incidence of pulmonary metastasis in all patients with HCC, however, remains low (between 4.5% to 20%). Their presence, nevertheless, contraindicates curative locoregional therapies. The role of staging chest computed tomography (CT) before locoregional treatment is not well defined. This study aimed to assess the utility of pre-treatment chest CT prior to locoregional therapy.

MATERIALS AND METHODSRetrospective review of continuous cases of treatment-naïve HCC referred for locoregional therapy from 2004 to 2013 was performed. Patients with pre-treatment chest CT were evaluated for the presence of pulmonary metastases. HCC features (size, numbers, vascular invasion, nodal status and bone metastases) were recorded. Univariate analysis and multivariate logistic regression were performed for significant association.

RESULTSA total of 780 patients were reviewed, of which 135 received staging chest CT. Pulmonary metastases (n = 17, 12.6%), benign lesions (n = 41, 30.4%) and indeterminate lesions (n = 11, 8.1%) were detected. Among the indeterminate lesions, there were losses to follow-up (n = 2) and deaths within the study period (n = 3). All patients with pulmonary metastases were declined locoregional therapy. Univariate analysis showed statistical significant association between pulmonary metastases with the number of intrahepatic lesions (<0.01), primary tumour size (= 0.018) and presence of vascular invasion (<0.01). On multivariate analysis, the number of intrahepatic lesions (OR: 9.7; 95% CI, 1.6 to 57.2;= 0.012) and presence of both hepatic and portal venous invasions (OR: 11.8; 95% CI, 1.1 to 128.8;= 0.043) were the 2 independent positive predictors of pulmonary metastases.

CONCLUSIONThe prevalence of pulmonary metastasis is low in HCC and our study does not support the routine use of staging chest CT in all treatment-naïve patients. It can, however, be considered in cases with multiple lesions or vascular invasion.

This manuscript describes an unusual case of rapid intra-hepatic dissemination of hepatocellular carcinoma with pulmonary metastases occurring 1 month after combined chemoembolization and radiofrequency ablation. Inferior vena cava and portal vein invasion tumor thrombus was also detected, possibly accounting for the mechanism of disease dissemination route of disease.
Aged, 80 and over ; Antineoplastic Agents/administration & dosage/*adverse effects ; Biopsy ; Carcinoma, Hepatocellular/diagnosis/*secondary/therapy ; Catheter Ablation/*adverse effects ; Chemoembolization, Therapeutic/*adverse effects ; Cone-Beam Computed Tomography ; Fatal Outcome ; Humans ; Liver Neoplasms/*pathology/therapy ; Lung Neoplasms/diagnosis/*secondary ; Male

Bezoars ; complications ; Fruit ; adverse effects ; Gallstones ; diagnosis ; pathology ; Humans ; Ileus ; diagnosis ; etiology ; Male ; Middle Aged ; Seeds ; adverse effects ; Tomography, X-Ray Computed

No abstract available.
Carcinoma, Hepatocellular/*surgery ; Electroporation/*methods ; Humans ; Liver Neoplasms/*surgery ; Male ; *Portasystemic Shunt, Transjugular Intrahepatic ; *Stents

No abstract available.
Humans ; Ultrasonography*

Percutaneous access to the surgical bed after pancreaticoduodenectomy can be a challenge, due to the post-operative anatomy alteration. However, immediate complications, such as surgical bed abscess or suspected tumor recurrence, are often best accessed percutaneously, as open surgical or endoscopic approaches are often difficult, if not impossible. We, hereby, describe a safe approach that is highly replicable, in accessing the surgical bed for percutaneous intervention, following pancreaticoduodenectomy.
Abscess/radiography/therapy ; Bile Duct Neoplasms/pathology/radiography ; Biopsy/methods ; Catheterization/*methods ; Cholangiocarcinoma/pathology/radiography ; Drainage/instrumentation/*methods ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local/pathology/radiography ; Pancreatic Diseases/radiography/therapy ; *Pancreaticoduodenectomy ; Postoperative Complications/radiography/*therapy ; Radiography, Interventional/methods ; Retroperitoneal Space

Aged ; Antitubercular Agents ; therapeutic use ; Cholangiocarcinoma ; diagnosis ; pathology ; Diagnosis, Differential ; Humans ; Magnetic Resonance Imaging ; Male ; Tuberculosis, Hepatic ; diagnosis ; drug therapy ; pathology

INTRODUCTIONThe purpose of this retrospective study was to evaluate the short- to mid-term results of the endovascular repair of thoracic aortic disease and to present an overview of our experience with thoracic endovascular aortic repair (TEVAR) in our institution.

MATERIALS AND METHODSA retrospective review of all patients who were treated and underwent TEVAR in our institution between August 2004 and November 2009 was conducted.

RESULTSTechnical success was achieved in 100% of the patients and the 30-day mortality rate was 0%. Perioperative endoleak was visualised at the end of the procedure in 4 patients. Secondary endoleak was observed in 2 patients. Mean hospital length of stay post-TEVAR was 15.4 days. Postoperative major complications were observed in 4 patients. The 30-day mortality rate was 0%, with 2 mortalities (11.1%) during the followup period.

CONCLUSIONThis study adds to the growing body of literature that support TEVAR as an effective procedure in the management of thoracic aortic diseases and reflects its feasibility in our population. Further technical advancement in stent grafts, careful selection of patients and standardised peri-procedural care would contribute to further improvements in clinical outcomes.

Adult ; Aged ; Aged, 80 and over ; Aorta, Thoracic ; surgery ; Aortic Diseases ; mortality ; surgery ; Endovascular Procedures ; adverse effects ; mortality ; Female ; Humans ; Length of Stay ; Male ; Middle Aged ; Postoperative Complications ; etiology ; Retrospective Studies ; Young Adult

Local back pain and radiculopathy can be debilitating for sufferers of these conditions. There are a multitude of treatment modalities, ranging from conservative approaches such as bed rest, physical therapy and chiropractic manipulation, to more invasive options such as percutaneous spinal intervention (PSI) and surgery. We present here the techniques employed in the use of minimally invasive, image-guided percutaneous techniques under computed tomography fluoroscopy in our institutions. The inherent high spatial and tissue contrast resolution not only allows ease of trajectory planning in avoiding critical structures, but also allows precision needle placement. Cervical, lumbosacral, and sacroiliac pain can therefore be evaluated and treated both safely and effectively.
Administration, Cutaneous ; Fluoroscopy ; methods ; Humans ; Pain, Intractable ; drug therapy ; Spine ; physiopathology ; Tomography, X-Ray Computed ; methods