Reduction of porphyrin excretion in porphyria variegata by propranolol. A case report

DL-Propranolol was shown to reduce the elevated urinary excretion of porphyrins and their precursors in a patient with variegate porphyria and to improve the patient's symptoms during attacks of the disease.     

A case with sarcomatoid hepatocellular carcinoma

BACKGROUND AND OBJECTIVES: The goal of the present investigation was to compare the double-segment and the needle-through-needle techniques for combined spinal and epidural anesthesia (CSE) in a prospective, randomized, blinded study. METHODS: With Ethical Committee approval and patient's consent, 120 patients were randomized to receive CSE by the needle-through-needle (SST; n=60) or the double-segment technique (DST; n=60). A blind observer measured the time required from skin disinfection to readiness for surgery (loss of pinprick sensation up to T10), failure of dural puncture, need for epidural top-up before surgery, patient acceptance, and occurrence of complications. RESULTS: No neurologic complications were observed in either group. Time to readiness for surgery was 22.7+/-8.2 minutes in the SST group and 29.8+/-8.31 minutes in the DST one (P < .001). Dural puncture was unsuccessful in three patients in the SST group (5%) and in one patient in the DST group (1.6%) (ns); inadequate spread of spinal anesthesia was observed in five patients in the SST group (8.3%) and in eight patients in the DST group (13.3%) (ns). No difference in the incidence of hypotension, postdural puncture headache, and back pain was observed between the two groups. Acceptance of anesthetic procedure was better in the SST (85%) than in the DST group (66.6%) (P < .05). CONCLUSIONS: The needle-through-needle technique for CSE requires less time, has no greater failure rate, and results in greater patient satisfaction than the double-segment technique. The use of a spinal needle with an adjustable locking mechanism and protruding up to 15 mm beyond the Tuohy needle improved successful spinal block in the needle-through-needle technique compared with previous reports.     

A case of metastatic hepatocellular carcinoma of the sphenoid sinus

A case of hepatocellular carcinoma with a solitary metastasis in the sphenoid sinus is described. The extreme rarity of the tumour and the problems of early diagnosis are underlined. The importance of endoscopic examination as a diagnostic procedure is emphasized.     

A case of giant hepatocellular carcinoma effectively treated with UFT

Marek's disease (MD) and lymphoid leukosis (LL) are two distinct viral diseases that cause tumor mortality in chickens. Marek's disease, being horizontally transmitted, is controlled through biosecurity measures and vaccination. Prevention of early exposure before vaccine immunity is established is most important. Some multi-house growing farms have converted to all single-age placements to break the ongoing cycle of transmission. Vaccination against MD involves either in ovo or day-old administration of live vaccine, including single or multiple serotype products. Field viruses appear to adapt over time and become resistant to the prevalent vaccine. The Rispens vaccine (CVI-988) has shown good efficacy against recently emerging very virulent MD strains in the U.S. Genetic resistance of the host to MD and control of other immunosuppressive diseases also affects MD susceptibility. Lymphoid leukosis is primarily vertically transmitted and therefore controlled by elimination of shedder hens at the primary breeder level. Depending upon the genetic type, commercial performance of laying hens may be greatly improved by eradication of the LL virus from the breeding stock.     

A case report of multiple hepatic hilar cyst associated with hepatocellular carcinoma

Two types of cDNA encoding gonadotropin beta subunits (GTH beta) were isolated from a cDNA library prepared from pituitary gland of Baikal omul (Coregonus autumnalis migratorius Georgi). The nucleotide sequences of cDNA were determined. The CTHI beta and GTHII beta cDNAs code for polypeptides of 137 and 142 amino acids, respectively. Both of them include a putative signal peptide of 24 amino acids. The predicted amino acid structures of omul gonadotropins were compared with those of other vertebrate species.     

A case of hepatocellular carcinoma with reduction of primary tumor and disappearance of multiple lung metastasis

For a number of years not enough attention has been paid to training in practical skills, neither in pre- nor postgraduate medical education. Lack of training and experience poses particular problems for the general practitioner, who often works alone with little opportunity for assessment by and feedback from colleagues. The Clinical Skills Training Centre was established to develop and implement methods for training general practitioners in clinical skills. Its main objective is to develop teaching methods that will encourage doctors to adapt their professional behaviour as and when necessary. The centre has developed a series of short, 2-day courses for small groups of 10-12 participants where focus is on selected clinical topics. The courses are continuously evaluated including assessment by the participants themselves of their procedural proficiency. Results are encouraging, with the majority of doctors reporting implementation of one or more of the relevant procedures at the final evaluation. An interesting new concept is a programme of reciprocal visits among groups of 10 to 12 general practitioners. The intention of the programme is to break the isolation of the consultation and utilize the potential for learning that exists when colleagues are able to observe each other at work and draw on each other's experiences.     

Good response in case of hepatocellular carcinoma; a case report of interdisciplinary local therapy

A 47-year-old male patient with chronic hepatitis had a high AFP level during the follow-up period. Abdominal CT revealed at S5, which led to a diagnosis of hepatocellular carcinoma. In August 1992, partial resection of S5 was performed, and ethanol was injected into the tumor at S2. In July 1993, recurrent tumors were observed at S5 and S3. PEIT was performed for each lesion. In December 1994, multiple recurrence was observed and 4 mg SMANCS was injected through the proper hepatic artery. In July 1995, another 4 mg of SMANCS was injected into the tumors. In June 1996, only a 20 mm lesion at S5 remained while the other lesions disappeared. Under general anesthesia, the patient underwent percutaneous microwave tumor coagulation. In December 1997, the AFP level was normal, and imaging revealed disappearance of the recurrent tumor. Selection of local therapy for hepatocellular carcinoma achieved long survival in our case considering the QOL and frequent therapy administration.     

Fibrolamellar carcinoma of the liver with a mixture of ordinary hepatocellular carcinoma: a case report

Fibrolamellar carcinoma (FLC) of the liver is a rare variant of hepatocellular carcinoma (HCC), and only 13 cases have been reported in Japan up to 1997. We described a histologically unusual case of FLC. A 52-yr-old man was admitted to our hospital for work-up of hepatic mass. Laboratory examinations revealed no abnormalities except elevated serum alpha-fetoprotein (AFP) (2098 ng/ml). A diagnosis of HCC was made by imaging findings, and left lobectomy of the liver was performed. Histologically, the tumor was composed of areas of FLC mixed with ordinary HCC and those of pure ordinary HCC. Staining for AFP was positive in the HCC component and negative in the FLC component. Some cases of such mixed tumors have been reported in Europe and the United States, but not in Japan. We regarded our case as the first of the mixed tumor in Japan.     

Therapy of hepatocellular carcinoma

The therapeutic modalities in patients with hepatocellular carcinoma (HCC) depend on the number, size and location of the lesions as well as the stage of the underlying liver disease and the physical condition of the patient. In patients with small and solitary lesions, resection, liver transplantation and in some cases percutaneous ethanol injection (PEI) can be curative. In more advanced stages of the disease with larger or multiple lesions, PEI and/or transarterial chemotherapy with or without embolization (TACE or TAC) can slow the progression of the disease. In disseminated disease, a radiotherapeutic approach can be taken in selected cases. The therapeutic strategy in patients with HCCs should be individualized, frequently involving a combination of therapeutic modalities. In contrast to the earlier dismal prognosis, for most HCC patients there is today a therapeutic strategy that results in prolongation of life and in some cases even cure.     

A case of hepatocellular carcinoma associated with troublesome hypoglycemia: management by cytoreduction using percutaneous ethanol injection

Hypoglycemia is a well-known paraneoplastic manifestation of hepatocellular carcinoma. However, hypoglycemia as the first presentation is extremely uncommon. We herein report a case of HCC presenting with severe, uncontrollable hypoglycemia that was managed with percutaneous ethanol injection therapy.     

Large granular lymphocyte leukemia associated with hepatocellular carcinoma: a case report

Both primary and metastatic malignancies of the masseter muscle are rare. We report a case of metastatic renal cell carcinoma to the masseter muscle. It was incidentally found as a hypervascular mass in carotid angiography for delineating a recurrent metastatic brain tumour. Prior to surgical removal, intravascular embolization via the left facial artery was performed in order to decrease intra-operative bleeding. The tumour was removed with minimum damage to the muscle fibres by the extraoral method, followed by a transient lower lip palsy. Metastatic intramuscular tumours, which are assumed to be due to haematogenous spread, are generally a sign of poor prognosis.     

Multidisciplinary management of hepatocellular carcinoma

BACKGROUND/AIMS: The continuing poor prognosis for patients with hepatocellular carcinoma drives a search for new adjuvant therapies. Targeted locoregional immuno-chemotherapy is one of the most promising. MATERIALS AND METHODS: From 1990 to 1996, 193 patients who were not eligible for liver resection were treated in a prospective randomized study. Ninety-one patients received locoregional targeted chemotherapy only via an arterial catheter (Group A), and 102 received combined locoregional immuno-chemotherapy via two arterial catheters (Group B). RESULTS: Overall survival was significantly different (10.2 months vs 22.3 months), favoring Group B. Complications and side effects of treatment were minimal in Group B and easily handled. Even in Group A, side effects were less severe than effects normally associated with systemic chemotherapy. CONCLUSIONS: Even though the current prognosis for patients with Hepatocellular Carcinoma remains poor, targeted locoregional immuno-chemotherapy has proven to be of benefit in terms of quality of life and survival.