Ethanol Injection Therapy Research Articles

Whole-liver MR perfusion imaging in rabbit liver VX 2 tumors: early findings of coagulative necrosis after percutaneous ethanol injection therapy

目的 研究全肝MR灌注成像(MRPI)早期监视兔肝VX2瘤经皮酒精注射(PEI)疗效的价值.方法 新西兰大白兔10只,经开腹手术于肝内注射VX2肿瘤细胞悬液0.1 ml,分别在种瘤后第2、3周进行MR T1WI、T2WI检查监视肿瘤生长情况.在种瘤后第3周时,于CT引导下,于肿瘤一侧的早期强化最明显处注射无水乙醇1.0 ml,治疗1周后应用MRPI观察治疗效果.灌注参数包括:对比剂到达时间(TO)和最大上升斜率(SS),应用t检验比较治疗区与肿瘤未治疗区的灌注参数.结果 10只兔肿瘤均种植成功,第3周时肿瘤直径(2.6±0.6)cm.治疗过程中3只兔死亡,PEI治疗1周后的治疗区呈无或低度强化.肿瘤未治区与治疗区的TO分别为(16.0±1.2)、(50.8±5.9)s,SS分别为38.9±2.2、6.0±1.2,差异均有统计学意义(t值分别为15.8、-39.6,P值均＜0.05).常规T1WI、T2WI无法清晰显示治疗区与未治疗区的差异.结论 全肝MRPI可以较敏感的早期监测PEI疗效,早期强化的消失可作为PEI治疗有效的标志。

Characteristics of three cases of hepatocellular carcinoma showing enhanced technetium‐99m‐diethylenetriaminepentaacetic acid‐galactosyl human serum albumin accumulation by single photon emission computed tomography analysis

The asialoglycoprotein receptor (ASGP-R) is abundantly expressed on the sinusoidal surfaces of hepatocytes. However, the majority of hepatocellular carcinomas (HCC) lack ASGP-R on their cell surface membranes. We describe three cases of HCC showing increased expression of ASGP-R in comparison with the surrounding liver tissue. We performed technetium-99m-diethylenetriaminepentaacetic acid-galactosyl human serum albumin ((99m)Tc-GSA) single photon emission computed tomography (SPECT) analysis on patients with HCC. Three cases of HCC showing enhanced accumulation of (99m)Tc-GSA were included in the present study. Histopathological and radiological examinations of the HCC were conducted. The three affected patients were all female and over 60 years old. Computed tomography (CT) angiography or dynamic CT showed hypo-enhancement of the tumors during the hepatic arterial to portal phases. Patient 1 received percutaneous ethanol injection therapy and died 5 years later because of chronic renal failure. Patient 2 underwent surgeryand is currently healthy 5 years after the operation. Patient 3 underwent percutaneous ethanol injection therapy and died 4 years later because of a newly occurred HCC to another part of the liver. Histopathological examination showed well-differentiated HCC in all three cases. Immunohistochemical examination showed that the expression of ASGP-R was higher in the HCC than in the non-tumorous liver tissue. We have named the HCC of this type ASGP-Roma. ASGP-Roma is well-differentiated HCC, shows CT findings that are atypical of HCC, and is diagnosed by (99m)Tc-GSA SPECT analysis. We propose that ASGP-Roma be placed in a special category among well-differentiated HCC.

Percutaneous Ethanol Injection Therapy for Locally Recurrent Papillary Thyroid Carcinoma

Percutaneous ethanol injection therapy (PEIT) has been used to treat various human neoplasms. We evaluated the local therapeutic effect of PEIT in recurrent thyroid cancers. From October 2002 to September 2005, we performed ultrasound-guided PEIT on 24 recurrent lesions (eight in thyroid beds and 16 in neck nodes) of 16 papillary thyroid carcinoma patients. Ethanol was injected at 3-month intervals under sonographic guidance. All patients tolerated PEIT well with only mild local pain, although one patient complained of transient hoarseness after the procedure. The median diameter of lesions was significantly reduced, from 9.9 mm (range, 5.5-25.0 mm) to 5.3 mm (range, 0.0-17.0 mm) by PEIT. Four recurrent lesions disappeared sonographically. PEIT may be an alternative treatment option for locally recurrent thyroid carcinomas in properly selected patients. However, a prospective, long-term follow-up study is necessary to determine the effect of PEIT on patient survival and tumor recurrence.

An application in assessment efficacy of percutaneous ethanol injection therapy for hepatocellular carcinomas(HCC) using Contrast Pulse Sequencing Technique

目的 探讨应用对比脉冲序列(CPS)超声造影成像技术评价PEI治疗疗效的价值.方法 在47例原发性肝癌(HCC)病人PEI治疗后,采用超声造影剂声诺维(SonoVue)、Acuson Sequior 512超声仪和CPS实时造影成像技术进行超声造影显像,观察病灶的血流灌注,并与常规彩超及增强CT进行对照,超声检查后随访半年以上.结果 应用CPS实时造影成像技术,本组的64个病灶PEI治疗后肝肿瘤灭活诊断正确率96.8%,与增强CT检查结果相同,明显高于常规彩超的64.1%.结论 超声造影能于PEI治疗后判断肿瘤坏死情况,可望成为评价肝癌PEI治疗疗效的可靠方法。

Staging Hepatocellular Carcinoma by a Novel Scoring System (BALAD Score) Based on Serum Markers

Previously proposed staging systems for hepatocellular carcinoma (HCC) involve clinical, imaging, or pathologic factors in the evaluation. We established and validated a novel staging system for HCC that is based on simply serum markers. The new scoring system is based on 5 serum markers: bilirubin, albumin, Lens culinaris agglutinin-reactive alpha-fetoprotein (AFP-L3), alpha-fetoprotein (AFP), and des-gamma-carboxy prothrombin (DCP) and thus is termed the BALAD score. The system was validated in 2600 HCC patients from 5 institutions. The power of our system to predict patient survival and its discriminative ability were compared with those of previously reported staging systems. The best tumor marker cutoff values were 400 ng/dL for AFP, 15% for AFP-L3, and 100 milli-arbitrary unit/mL for DCP. The patients were classified into 6 categories on the basis of 5 laboratory values. The categories reflected patient survival well. The discriminative ability was comparable to that of previously reported staging systems. The new staging system for HCC combining serum albumin, serum bilirubin, and 3 tumor markers predicts patient outcomes with excellent discriminative ability. The system is easy to use and objective. In addition, stage can be evaluated with the use of only 1 serum sample. It also allows global comparison of patients with HCC or comparison of patients from different time periods with the same standard.

An Overview of Regular Dialysis Treatment in Japan (as of 31 December 2004)

A statistical survey of 3932 nationwide hemodialysis (hereafter, dialysis) facilities was carried out at the end of 2004, and 3882 facilities (98.73%) responded. The population undergoing dialysis at the end of 2004 was 248 166, an increase of 10 456 patients (4.4%) from that at the end of 2003. The number of dialysis patients per million people was 1943.5. The crude death rate of dialysis patients from the end of 2003 to the end of 2004 was 9.4%. The mean age of patients who underwent dialysis in 2004 was 65.8 years, and that of the total dialysis population was 63.3 years. The percentage distribution of patients who underwent dialysis according to a newly underlying disease showed that 41.3% of patients had diabetic nephropathy and 28.1% had chronic glomerulonephritis. The frequency of calcium carbonate use for dialysis patients was 75.1% and that of sevelamer hydrochloride use was 26.2%. The frequency of sevelamer hydrochloride use does not necessarily have a strong correlation with the dose of calcium carbonate. Patients who received high doses of sevelamer hydrochloride tended to have a low concentration of arterial blood HCO(3-). Approximately 15% of dialysis patients used an intravenous vitamin D preparation, generally maxacalcitol. The longer the patients had been on dialysis, the higher the frequency of use of an intravenous vitamin D preparation. When the concentration of serum intact parathyroid hormone (PTH) was more than 200 pg/mL, the frequency of use of an orally administered vitamin D preparation decreased; but that of intravenous vitamin D preparation increased. The percentage of dialysis patients who received percutaneous ethanol injection therapy (PEIT) was 1.4%. The percentage was more than 50% in the patients who had been on dialysis for more than 10 years. The percentage of patients who received PEIT again was 35.0%. The percentage of patients who had been on hemodialysis for more than 10 years and received PEIT again was more than 50%.

Hepatocellular carcinoma with sarcomatous change arising after eradication of HCV via interferon therapy

A patient was diagnosed with chronic hepatitis C at the age of 63 years. He achieved eradication of HCV via interferon (IFN). Eight years after, a hepatocellular carcinoma (HCC) was detected and treated through transarterial embolization and percutaneous ethanol injection therapy. After about 1 year, a large hypovascular tumor was detected. This tumor was surgically resected and diagnosed as an HCC with sarcomatous change. This is the first case of an HCC with sarcomatous change arising after a sustained response to IFN therapy.

Comparison of Three Different Needles for Percutaneous Injections

Comparison of Three Different Needles for Percutaneous Injections

Efficacy of percutaneous ethanol injection therapy (PEIT) is related to the number of parathyroid glands in haemodialysis patients with secondary hyperparathyroidism

Percutaneous ethanol injection therapy (PEIT) is used for advanced secondary hyperparathyroidism. We investigated the efficacy, remission period and risk of relapse to determine the effect of the number of hyperplastic glands and other factors on the therapeutic effect of PEIT. We studied 321 patients divided into two groups: effective [serum corrected calcium (cCa) level < or =10.5 mg/dl and serum intact parathyroid hormone (iPTH) level < or =250 pg/ml], and ineffective (failed to achieve the target levels). Advanced hyperplasia was defined as an estimated volume > or =0.5 cm(3) on ultrasonography. PEIT was effective in 201 patients (62.6%), in whom serum iPTH levels dropped from 603+/-292 to 183+/-62 pg/ml (ng/l) and serum cCa levels from 10.7+/-0.8 to 10.1+/-0.5 mg/dl. Univariate analysis identified age, the number of hyperplastic glands and iPTH level as factors related to the efficacy of PEIT. The odds ratio for success vs failure by multivariate analysis was 0.55 times for the number of hyperplastic glands > or =0.5 cm(3) (> or =2 vs 0,1) and 0.29 times for iPTH (> or =500 vs <500 pg/ml). Using the Kaplan-Meier method, the number of hyperplastic glands > or =0.5 cm(3) (> or =2 vs 0,1) was a factor affecting the remission period, with a remission significantly longer seen in the group with one hyperplastic gland (P=0.0025). Superior results in efficacy rate, remission period and risk of relapse are obtained when PEIT is restricted to patients with one hyperplastic gland > or =0.5 cm(3).

External beam radiotherapy to treat intra‐ and extra‐hepatic dissemination of hepatocellular carcinoma after radiofrequency thermal ablation

Radiofrequency ablation (RFA) is an alternative to percutaneous ethanol injection therapy (PEIT) for single non-surgical hepatocellular carcinoma. However, the risk of seeding along the needle track has been reported. Seven patients presenting with neoplastic seeding after RFA or PEIT were treated with external beam radiotherapy using conventional fractionation. All patients underwent irradiation with a total dose in the range of 44-61 Gy (median and mode value: 50 Gy). An objective response to treatment was achieved in six of seven patients (86%). A complete response was obtained in two patients (29%). The median survival time was 14.7 months and the actuarial 1- and 2-year survivals were 67% and 50%, respectively. The response to treatment was relatively good without serious complications. Seeding from hepatocellular carcinoma is sensitive to external beam radiotherapy. It is useful in the treatment of these patients with 50 Gy in 25 fractions.

Basic and clinical aspects of parathyroid hyperplasia in chronic kidney disease

Marked parathyroid hyperplasia develops in patients with chronic kidney disease, especially those with long dialysis vintage. Although progression of hyperplasia is associated with downregulation of vitamin D receptor and calcium-sensing receptor, initial abnormality that triggers and maintains parathyroid cell proliferation, as well the critical abnormality for the progression of diffuse hyperplasia to nodular hyperplasia, still remains to be elucidated. It is quite important for the optimal management of renal osteodystrophy to recognize the development of nodular hyperplasia, because the cells in nodular hyperplasia are usually resistant to medical therapy and further treatment of such patients often leads to vascular calcification. For this purpose, size and blood supply of enlarged parathyroid glands have been used as good clinical markers. Furthermore, we have recently shown that the serum fibroblast growth factor 23 level can be used for predicting refractory hyperparathyroidism. Once nodular hyperplasia develops in any of the enlarged parathyroid glands, such patients need to be treated by parathyroid intervention including percutaneous ethanol injection therapy. In addition, as direct vitamin D injection therapy has been shown to induce regression of hyperplasia, it may become possible to reverse or normalize established nodular hyperplasia if we can develop new agents with such effects in the near future.

Diaphragmatic Hernia After Radiofrequency Ablation Therapy for Hepatocellular Carcinoma

3Department of Radiology, Kitasato University School of Medicine, Sagamihara, Kanagawa 228-8555, Japan. ercutaneous radiofrequency ablation is a novel thermal ablation technique for achieving coagulative necrosis of liver tumors with fewer treatment sessions than percutaneous ethanol injection therapy requires [1, 2]. Several recent developments in radiofrequency ablation technology, such as a high-power (150–200 W) radiofrequency generator, a method for conducting radiofrequency ablation during occlusion of hepatic blood flow, and saline-enhanced radiofrequency ablation techniques, have made it possible to necrotize a larger volume of tissue—3 cm or more in diameter—during a single ablation procedure [3]. Most of the complications after radiofrequency ablation have been minor, but some severe and fatal complications have been reported [4, 5]. In a multicenter study in 2,320 patients with 3,554 lesions [4], six patients (0.3%) died after radiofrequency ablation, including two caused by multiorgan failure following intestinal perforation; one case each of septic shock, tumor rupture, liver failure after bile duct stenosis; and sudden death of unknown cause. Fifty cases (2.2%) of additional major complications were also reported, including 12 (0.5%) of peritoneal bleeding, 12 of tumor seeding, six of hepatic abscess, five of gastrointestinal wall perforation, three of hemothorax, two of rapid hepatic decompensation, and one case each of diaphragmatic paresis, common bile duct stenosis, cardiac arrest, pulmonary embolism, pneumothorax, large biloma, multisegmental hepatic infarction, acute cholestasis, and septicemia. Thermal damage has been documented as a specific complication of radiofrequency ablation. We recently encountered a patient with a diaphragmatic hernia due to thermal damage of the diaphragm. A defect of the diaphragm occurred after radiofrequency ablation for hepatocellular carcinoma (HCC) and remained quiescent for 18 months until bowel herniated through it. To our knowledge, this is the first case in the literature to report diaphragmatic hernia as a complication of radiofrequency ablation. The clinical presentation was acute abdominal pain, whereas MDCT clearly indicated a diaphragmatic defect.

3301: Multimode ultrasonography in the diagnosis and microinvasive treatment of parathyroid diseases

Objectives: To delineate the overall ultrasound features of normal and pathological parathyroids on various ultrasound imaging. Also to assess the efficacies and safeties of percutaneous ethanol injection therapy (PEIT) for adenoma, hyperplasia and cyst of parathyroid.

Gastric ulcer triggered after percutaneous ethanol injection therapy for left lobe hepatocellular carcinoma

Gastric ulcer triggered after percutaneous ethanol injection therapy for left lobe hepatocellular carcinoma

Treatment of recurrent chordomas by percutaneous ethanol injection therapy and radiation therapy

We report a case of recurrent sacral chordomas that have been successfully controlled by the combination therapy of percutaneous ethanol injection therapy (PEIT) and radiation therapy in a 71-year-old man. PEIT may be one of the adjuvant therapies for recurrent chordomas.

Combined Ethanol Injection Therapy and Radiofrequency Ablation Therapy in Percutaneous Treatment of Hepatocellular Carcinoma Larger than 4 cm

Optimal treatment of large-sized hepatocellular carcinoma (HCC) is still debated, because percutaneous ablation therapies alone do not always achieve complete necrosis. To report our experience in the treatment of patients with HCC larger than 4 cm in diameter by combined percutaneous ethanol injection and radiofrequency thermal ablation. In a 5-year period there were 40 consecutive patients meeting the inclusion criteria (24 men and 16 women; age range 41-72 years, mean 58 years). These subjects had a single HCC larger than 4 cm. Twelve subjects also had one or two additional nodules smaller than 4 cm (mean 1.2 nodules per patient). Patients were submitted to one to three sessions consisting of ethanol injection at two opposite tumor poles (mean 12 ml) and then of radiofrequency application through one or two electrodes placed at the tumor center (mean treatment duration 30 min). Complete necrosis was obtained in all cases with one to three sessions (mean 1.3 sessions per patient). All patients experienced pain and fever but one only subject had a major complication requiring treatment (abscess development and fistulization). Overall follow-up was 7-69 months. Two patients showed local recurrence and 9 developed new etherotopic HCC nodules. Seven subjects died during follow-up while 33 were free from recurrence 8-69 months after treatment. A combination of ethanol injection and radiofrequency ablation is effective in the treatment of large HCC.

Multiple intrahepatic implantations of hepatocellular carcinoma following percutaneous ethanol injection (PEI) therapy

Multiple intrahepatic implantations of hepatocellular carcinoma following percutaneous ethanol injection (PEI) therapy

Benign Thyroid Teratomas Manifest Painful Cystic and Solid Composite Nodules: Three Case Reports and a Review of the Literature

Benign thyroid teratomas are rare in adolescents and adults. We report on three cases of benign thyroid teratomas that presented as painful tumors in the neck after puberty. The tumor adjacent to the thyroid in each case showed rapid enlargement with predominant cystic lesions within several months. Ultrasonography and computed tomography revealed few findings suggesting the origin of the tumor. Cytological examination and culture of the aspirate failed to show cells originating from the thyroid or infectious findings, but revealed a small population of columnar epithelial cells or squamous epithelial cells. Chemical analysis of the aspirate showed levels of pancreatic enzymes higher than those in serum. The accumulation of cystic fluid in each case was refractory to drainage treatment or percutaneous ethanol injection therapy. The patients subsequently underwent resection of the tumor, and microscopic examination revealed various types of tissue including pancreas, adipose, cartilage, muscle, and skin, and the cystic wall was lined by gastric, intestinal, respiratory, and stratified squamous epithelium. Surgical resection was curative, and subsequent histologic examination revealed mature benign teratomas of the thyroid. The main characteristic of our cases presented the painful tumors due to the enlarged cystic formation lined by a variety of different types of epithelium, which agreed with previous cases of benign thyroid teratomas in adolescents and adults.

Prognostic Significance of Simultaneous Measurement of Three Tumor Markers in Patients With Hepatocellular Carcinoma

We conducted a prospective study to evaluate the significance of simultaneous measurement of 3 currently used tumor markers in the evaluation of tumor progression and prognosis of patients with hepatocellular carcinoma (HCC). Three tumor markers for HCC, alpha-fetoprotein (AFP), Lens culinaris agglutinin A-reactive fraction of AFP (AFP-L3), and des-gamma-carboxy prothrombin (DCP), were measured in the same serum samples obtained from 685 patients at the time of initial diagnosis of HCC. Positivity for AFP >20 ng/dL, AFP-L3 >10% of total AFP, and/or DCP >40 mAU/mL was determined. In addition, tumor markers were measured after treatment of HCC. Of the 685 patients, 337 (55.8%) were positive for AFP, 206 (34.1%) were positive for AFP-L3, and 371 (54.2%) were positive for DCP. In a comparison of patients positive for only 1 tumor marker, patients positive for AFP-L3 alone had a greater number of tumors, whereas patients positive for DCP alone had larger tumors and a higher prevalence of portal vein invasion. When patients were compared according to the number of tumor markers present, the number of markers present clearly reflected the extent of HCC and patient outcomes. The number of markers present significantly decreased after treatment. Tumor markers AFP-L3 and DCP appear to represent different features of tumor progression in patients with HCC. The number of tumor markers present could be useful for the evaluation of tumor progression, prediction of patient outcome, and treatment efficacy.

Current Treatment of Hepatitis C and Hepatocellular Carcinoma

Chronic hepatitis C, attributed to infection with hepatitis C virus (HCV), is a global health problem. The overall prevalence of viral hepatitis C in Japan is estimated to be 1.5∼1.7%. Clinically, HCV can establish a persistent, chronic infection contributing to progressive liver disease, including cirrhosis and hepatocellular carcinoma (HCC), requiring intensive treatment regimens such as transcatheter arterial embolization, radio frequency ablation and percutaneous ethanol injection therapy, and possible liver transplantation. Determination of viral genotype has been identified as one parameter that could provide direction in the clinical management of patients with chronic HCV infections. Occurrence of HCC is another serious problem in the management of chronic HCV infection. Radiofrequency ablation (RFA) provides an effective technique for minimally invasive tissue destruction. Thus image-guided, percutaneous ablation techniques have been developed and widely accepted applications for the treatment of HCC of early cirrhosis or inoperable patients whose hepatic conditions is poor. This article offers background on determination of HCV genotypes and the relevance of viral genome characterization in the current treatment using anti viral agents, and also exemplify recent advance in non-surgical treatment of HCC.