PURPOSE: To compare the safety and effectiveness of transarterial oily chemoembolization (TOCE) and transar-terial embolization (TAE) with Gelfoam in cases of ruptured hepatocellular carcinoma (HCC), and to describe the most important prognostic factors involved in emergency embolization. MATERIALS AND METHODS: Forty-two consecutive patients with spontaneously ruptured HCC underwent emergency TOCE (n = 22) or TGE (n = 20). In the TOCE group, Lipiodol (3 -10 cc), Adriamycin (20 -50 mg), and Mitomycin (2 -10 mg) were used, and these were followed by blockade of the hepatic arterial flow with gelatin sponge particles. In the TAE group, patients underwent only Gelfoam embolization. Using the Kaplan-Meier method, survival time from the time of embolization was estimated, and to analyze prognostic factors, Cox 's proportional hazard regression model was used. RESULTS: Successful hemostasis was achieved in 41 patients (97.6%). Mean survival time was 201 and 246 days in the TOCE and TAE group, respectively, but the difference was not tatistically significant (p > 0.05). Five of the TOCE group (22.7%) and three of the TAE group (15.0%) died of hepatic failure. Analysis of the prognostic factors showed that portal vein involvement by the tumor was the most important factor influencing survival. CONCLUSION: Although TOCE and TAE effectively controlled hemorrhaging from a ruptured HCC, the procedures involve a high risk of hepatic failure. Their goal should, therefore, be solely to achieve hemostasis, and thus decrease parenchymal injury.
Carcinoma, Hepatocellular* ; Doxorubicin ; Emergencies ; Ethiodized Oil ; Gelatin ; Gelatin Sponge, Absorbable* ; Hemorrhage* ; Hemostasis ; Humans ; Liver Failure ; Mitomycin ; Porifera ; Portal Vein ; Rupture, Spontaneous* ; Survival Rate

Radiologically-guided percutaneous abscess drainage has been preferred as a therapeutic modality for hepatic abscesses, though where these have been septated or multilocular, its success rate has often been low. The results of several clinical and in vitro studies have recently suggested that in difficult cases, where abscesses occur in the peritoneal cavity and retroperitoneum, or multiloculated empyema of the thorax, urokinase may be useful. To our knowledge, however, there has been only one report of a case of liver abscess in which intracavitary urokinase was administered. The authors therefore report a case of multiseptated hepatic abscess occuring in a 53-year-man. Conventional percutaneous tube drainage failed, but the use of transcatheter intracavitary urokinase was successful. Diagnosis and continuing assessment involved a combination of ultrasound and CT scanning.
Abscess ; Diagnosis ; Drainage ; Empyema ; Liver Abscess* ; Liver* ; Peritoneal Cavity ; Thorax ; Tomography, X-Ray Computed ; Ultrasonography ; Urokinase-Type Plasminogen Activator*

PURPOSE: To determine the influence of liver dysfunction on the detection of focal hepatic nodules, and to investigate the loss of signal intensity of hepatic parenchyma occurring after superparamagnetic iron oxide (S-PIO)-induced contrast enhancement in patients with liver cirrhosis. MATERIALS AND METHODS: In 68 patients with liver cirrhosis, we evaluated MR images before and after the administration of SPIO. Clinical information and laboratory data indicated that the liver was normal in ten patients (nine hemangiomas and one hepatic cyst), while Child's A was diagnosed in 25 cases [22 of which were hepatocellular carcinomas (HCCs)], Child's B in 15 (11 HCCs), and Child's C in 18 (10 HCCs). Before and after SPIO administration, conventional T2-weighted spin-echo, respiratory-triggered T2-weighted turbo spin-echo, and breathhold T2-weighted turbo spin-echo images were obtained. After the administration of SPIO, degrees of liver dysfunction and laboratory data were correlated with reductions in signal intensity of the liver, and, in addition, the state of hepatic dysfunction was corelated with inhomogeneous parenchymal change and lesion conspicuity. RESULTS: After the administration of SPIO, percentage signal loss in liver parenchyma was significantly higher on conventional T2-weighted spin-echo images than on T2-weighted turbo spin-echo and breathhold T2-weighted turbo spin-echo (p < 0.05). There was significant correlation between degree of liver dysfunction and of signal loss (p < 0.05), while percentage signal loss of the liver was lower in the Child's C group than in the other three. In addition, there was close correlation between percentage signal loss and laboratory data such as albumin and total bilirubin levels, and prothrombin time (p < 0.05). Qualitative analysis showed that inhomogeneous enhancement due to fibrous septa and a regenerative nodule occurred more often in the Child's B and Child's C group than in the normal and Child's A group (p < 0.0001). In terms of legion conspicuity, there was no statistically significant difference between the groups (p > 0.05). CONCLUSION: SPIO uptake by hepatic parenchyma correlated closely with Child's degree of liver cirrhosis and laboratory data such as albumin and total bilirubin levels, and prothrombin time. In the Child's B and Child's C group, SPIO-enhanced MR imaging revealed inhomogeneous hepatic parenchyma, but the pattern observed did not affect the detection of hepatic nodules.
Bilirubin ; Carcinoma, Hepatocellular ; Hemangioma ; Humans ; Iron* ; Liver ; Liver Cirrhosis ; Liver Diseases ; Magnetic Resonance Imaging* ; Prothrombin Time

Lymphangioma of the stomach is known to be extremely rare, benign tumor, reported only 13 cases now, worldwidely, The lesions are soft, sponge like, and pinkish colored and filled with watery fluid exudates. The histologic examination reveals that lymphangiomas are composed of endothelium-lined spaces that contain a eosinophilic protein-rich fluid. They usually present as polypoid lesions because they are originated from submucosal layer. By endoscopy, they appear as smooth, soft, polypoid submucosal mass. The endoscopic ultrasonographic findings of gastric lyrnphangioma were cystic mass with multi-septation originated from submucosal layer of the stomach. Recently, We experienced a case of lymphangioma associated with early gastric cancer of the stomach. So we report this case with brief review of world literature.
Endoscopy ; Eosinophils ; Exudates and Transudates ; Lymphangioma* ; Porifera ; Stomach ; Stomach Neoplasms

PURPOSE: To assess the role of percutaneous cholecystostomy as a therapeutic maneuver in patients critically ill with acute cholecystitis in community hospitals. MATERIALS AND METHODS: Eighteen patients, 11 with suspected acute calculous cholecystits and seven with acute acalculous cholecystitis underwent emergency percutaneous cholecystostomy. All demonstrated a variety of high risk factors for cholecystectomy: liver cirrhosis (n=2), diabetes mellitus (n=3), cardiac disease (n=3), underlying malignancy (n=2), pulmonary dysfunction (n=1), septic cholangitis (n=5), and old age (n=2). All percutaneous cholecystostomies were performed with ultrasound guidance and preferably using the transhepatic route. RESULTS: All procedures but one were successful, and most cholecystostomies were performed within 5-20 minutes. Technical problems were as follows: guide-wire buckling during catheter insertion (n=2) and procedure failure (n=1). The only major problem was a case of localized bile peritonitis due to procedural failure, but a few minor complications were encountered: catheter dislodgment (n=3), and significant abdominal pain during the procedure (2). After successful cholecystostomy, a dramatic improvement in clinical condition was observed in 16 of 17 patients (94%) within 48 hours. Ten of 16 patients who responded to percutaneous cholecystostomy underwent elective cholecystectomy after the improvement of clinical symptoms, and the remaining six patients improved without other gallbladder interventions. CONCLUSION: Percutaneous cholecystostomy is not only an effective procedure for acute cholecystitis, but also has a definite role in the management of these high-risk patients in community hospitals.
Abdominal Pain ; Acalculous Cholecystitis ; Bile ; Catheters ; Cholangitis ; Cholecystectomy ; Cholecystitis ; Cholecystitis, Acute ; Cholecystostomy* ; Critical Illness ; Diabetes Mellitus ; Emergencies ; Gallbladder ; Heart Diseases ; Hospitals, Community* ; Humans ; Liver Cirrhosis ; Peritonitis ; Risk Factors ; Ultrasonography

PURPOSE: To evaluate the safety and efficacy of CT-guided celiac plexus block (CPB) using an anterior approach, and to determine the role of CT in this procedure. MATERIALS AND METHODS: CPB was attempted in 15 patients (10 men and 5 women; mean age, 62.3 years) with intractable upper abdominal pain due to terminal malignancy of the pancreas, liver, bowel, and kidney. To permit an anterior approach, patients lied supine on the CT scan table during the procedure. One or two 21-guage needles were placed just anterior to the diaphragmatic crus at or between the levels of the celiac and superior mesenteric arteries and 10-40 ml of 99.9% alcohol was injected. Pain relief following the procedure was assessed and pain was graded on a visual analogue scale (VAS) from 0 to 10. RESULTS: There were no technical failures and no neurologic or hemorrhagic complications. Abdominal pain during alcohol injection occurred in all patients, and transient hypotension in three. One patient with recurrent cancer of the pancreatic head died of sepsis five days after the procedure; the cause of sepsis was difficult to determine, but there was thought to be a biliary source of infection. Two days after block, 13 of 15 procedures (86.7%) had produced at least partial pain relief ; in 12 patients, relief was good. With CT guidance, more directed positioning of the needle is possible, allowing alcohol to be deposited in specific ganglion areas. CONCLUSION: CT-guided celiac plexus block using an anterior approach was an easy and effective way of reducing intractable upper abdominal pain due to terminal malignancies. CT guidance allowed precise needle placement and a safer procedure.
Abdominal Pain ; Anesthesia ; Celiac Plexus* ; Ethanol* ; Female ; Ganglion Cysts ; Head ; Humans ; Hypotension ; Kidney ; Liver ; Male ; Mesenteric Artery, Superior ; Needles ; Pancreas ; Sepsis ; Tomography, X-Ray Computed