Treatment of hepatocellular carcinoma: too many options?

1994 ◽  
Vol 12 (6) ◽  
pp. 1323-1334 ◽  
Author(s):  
A P Venook
Keyword(s):  
Patient Outcome ◽  
Hepatocellular Carcinoma ◽  
English Language ◽  
Conformal Radiotherapy ◽  
Therapeutic Interventions ◽  
Intraarterial Infusion ◽  
Alcohol Injection ◽  
Treatment Protocols ◽  
Isolated Hepatic Perfusion ◽  
Styrene Maleic Acid Neocarzinostatin

PURPOSE This study attempts to review the therapeutic interventions being used to treat patients with hepatocellular carcinoma (HCC). DESIGN An English language literature search, including abstracts and original articles, and a review of the bibliographies of such articles, was conducted. RESULTS Surgery is possible in few patients and curative in only a small percentage. Conventional chemotherapy is ineffective in HCC. Modifications of chemotherapy, including intraarterial infusion, chemoembolization, lipiodol, styrene-maleic acid-neocarzinostatin (SMANCS), and isolated hepatic perfusion, have led to improved tumor responses, but have not materially affected patient outcome. Radioimmunotherapy and conformal radiotherapy have had no more than a marginal impact on patient outcome. Surgical innovations such as cryosurgery and percutaneous alcohol injection have not yet been shown to offer any advantage, and liver transplantation, while curative in some patients, requires an enormous expenditure of resources to achieve cure in few patients. CONCLUSION Prevention is the ideal approach to HCC. Surgical cure is rarely possible, and while numerous therapies may palliate symptoms, patient selection and the lack of randomized studies make their impact on median survival difficult to assess. Patients being treated for HCC should be enrolled on treatment protocols testing multimodality or new strategies.

scholarly journals The Trends of Urolithiasis Therapeutic Interventions over the Last 20 Years: A Bibliographic Study

2021 ◽  
Vol 12 (1) ◽  
pp. e14-e14
Author(s):  
Amir Reza Abedi ◽  
Mohammadreza Razzaghi ◽  
Saeed Montazeri ◽  
Farzad Allameh
Keyword(s):  
English Language ◽  
Case Reports ◽  
Minimal Invasive ◽  
Therapeutic Interventions ◽  
Laser Application ◽  
Stone Removal ◽  
Increasing Trend ◽  
Stone Treatment ◽  
English Articles

Introduction: The clinical and economic burden of kidney stones is a challenge for the healthcare system. There is a limited bibliometric project exploring the literature trends on ‘urolithiasis’ and its related management. Methods: A systematic review was conducted to discover the related abstracts regarding each specific issue, investigated year by year from May 2000 to May 2020 (20 years). To make an effective comparison, the statistics resulting from every single study were allocated to two 10-year periods: period 1 (2000 to 2010) and period 2 (2010 to 2020). In this study, we included all English language articles, all non-English articles with English abstracts, and studies in which interventions were used for stone removal, including laser technology. Also, we excluded the studies without a published abstract, an intervention or a laser, animal and in vitro studies, and case reports. Results: These articles are about ureteroscopy (URS) (n=10360, 33.45%), percutaneous nephrolithotomy (PCN) (n =10790, 34.84%) and extra-corporeal shockwave lithotripsy (ESWL) (n=9846, 31.76%). When evaluating the two time periods, there were 9912 studies available in period one, which increased by ×2.12 times (112.71% rise) to 21084 studies in period two (P = 0.001). The increase was 133%, 103.51%, and 70.4% for URS, PCN, and SWL respectively. A total of 855 studies on Laser application via URS were published on PubMed over a 20-year period. There was an increasing trend toward using laser application via URS over the study period. Also, there were 230 articles published in period one, which increased by nearly 2.71 times (rise of 171.73%) to 625 papers in period two (P<0.001). There was an increasing trend toward using laser application via PCN; 126 papers were published in period one, which increased by nearly 3.05 times (rise of 205.5%) to 385 papers in period two (P = 0.002). Conclusion: The minimal invasive interventions for stone removal, including URS and PCN, increased dramatically in the last decade, and the use of lasers in stone treatment increased significantly in the last decade.

Clinical Toxicology of Yew Poisoning

2018 ◽  
Vol 52 (6) ◽  
pp. 591-599 ◽  
Author(s):  
Alexander W. Labossiere ◽  
Dennis F. Thompson
Keyword(s):  
English Language ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Case Reports ◽  
Data Extraction ◽  
Case Series ◽  
Therapeutic Interventions ◽  
Plant Materials ◽  
Search Terms ◽  
Life Threatening

Objectives: Yew plant materials contain highly toxic taxine alkaloids. Serious ingestions can result in life-threatening toxicity. The purpose of this article is to summarize the literature on the treatment of acute yew poisoning. Data Sources: PubMed (January 1946 to November 2017) was searched using the search terms “taxus/po”. EMBASE (1980 to November 2017) was searched using the search terms “taxus/to” and “yew.mp.” Web of Science (1945 to November 2017) was searched using the text words taxus, taxine, and yew. Study Selection and Data Extraction: Available English language articles involving case reports, epidemiology, treatment, and outcomes were included. Data Synthesis: Although not uncommon, unintentional yew poisoning rarely results in significant morbidity or mortality. A total of 26 case reports of yew poisoning were evaluated along with 4 case series articles (totaling 22 additional cases). Only 4 of the 48 total cases (8%) were accidental poisonings, the rest being deliberate ingestions. In 20 patients (42%), it resulted in fatalities. Severe, acute yew poisoning results in symptomatology largely resistant to pharmacotherapy intervention. Conclusions: Most nonintentional ingestions of yew plant constituents are asymptomatic and require little intervention. Severe poisoning can result in life-threatening cardiac toxicity and require aggressive supportive care. Therapeutic interventions, such as sodium bicarbonate, digoxin immune fab, and hemodialysis that have been utilized in case studies and case series in the literature have little proven benefit. Extracorporeal life support should be considered in severe yew poisoning.

scholarly journals Reduced Time to Surgery Improves Patient-Reported Outcome After Achilles Tendon Rupture

2018 ◽  
Vol 46 (12) ◽  
pp. 2929-2934 ◽  
Author(s):  
Simon Svedman ◽  
Robin Juthberg ◽  
Gunnar Edman ◽  
Paul W. Ackermann
Keyword(s):  
Patient Outcome ◽  
Adverse Events ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Patient Reported Outcome ◽  
Evidence Based ◽  
Treatment Protocols ◽  
Good Outcome ◽  
Patient Reported

Background: Patient outcome after an acute Achilles tendon rupture (ATR) continues to be suboptimal and heterogeneous. Thus, prognostic factors are called for to optimize evidence-based ATR treatment protocols; however, the influence of delayed time from injury to surgery (TTS) on patient outcome after ATR remains largely unknown. Purpose: To determine whether patient outcomes and adverse events after surgical repair of acute ATR are related to delayed TTS. Study Design: Cohort study; Level of evidence, 3. Methods: Two hundred twenty-eight patients with ATR who were treated with uniform anesthetic and surgical techniques, within 10 days after injury, were retrospectively assessed. TTS depended on availability of the operating theater, and neither surgeon nor patient could influence the TTS. Patients were assigned to 1 of 3 groups: short TTS (<48 hours), intermediate TTS (48-72 hours), and long TTS (>72 hours). Patient-reported outcome at 1 year was assessed with the validated Achilles tendon Total Rupture Score, with scores higher than 80 on a 0- to 100-point scale indicating an overall good outcome. The incidences of adverse events (perioperative and postoperative) and deep venous thrombosis were assessed. Results: Short TTS was significantly associated with increased rate of good outcome and reduced risk of adverse events. Seventy-one percent (95% CI, 60%-83%) of the patients with short TTS attained a good outcome compared with 44% (95% CI, 33%-56%) of the patients with long TTS ( P = .002), with the intermediate TTS group in between, 63% (95% CI, 47%-78%). The incidence of adverse events was significantly reduced among patients with short TTS, 1.4% (95% CI, 1%-4%) compared with those with intermediate TTS, 11% (95% CI, 2%-21%) ( P = .035) and those with long TTS, 14.8% (95% CI, 7%-23%) ( P = .003). The risk of sustaining a deep venous thrombosis was not statistically significantly different among the 3 groups ( P = .15). Conclusion: Patients with acute ATR undergoing operation within 48 hours after injury had better outcomes and a lower number of adverse events compared with patients undergoing operation after 72 hours. These results align with evidence-based recommendations from other surgical disciplines and should be used as guidelines for optimizing ATR treatment protocols. Registration: NTC01317160 (ClinicalTrials.gov identifier).

scholarly journals Tumor Lysis Syndrome after Combination Therapy of Nivolumab and Sorafenib in a Woman with Advanced Hepatocellular Carcinoma

2020 ◽  
Vol 14 (2) ◽  
pp. 367-372 ◽  
Author(s):  
Tsai-Hung Yen ◽  
Chung-Hsin Chang ◽  
Sz-Iuan  Shiu
Keyword(s):  
Hepatocellular Carcinoma ◽  
Combination Therapy ◽  
Tumor Lysis Syndrome ◽  
Tumor Burden ◽  
Therapeutic Interventions ◽  
Advanced Hepatocellular Carcinoma ◽  
Large Tumor ◽  
Tumor Lysis ◽  
Advanced Hcc ◽  
First Case

Tumor lysis syndrome (TLS) is a life-threatening emergency that usually develops in rapidly proliferating hematologic malignancies or advanced solid tumor following cytotoxic chemotherapy or therapeutic interventions. TLS is especially rare in patients with hepatocellular carcinoma (HCC). Therefore, we present a case of a female patient with newly diagnosed advanced HCC who developed TLS and hepatic failure after receiving combination therapy of nivolumab and sorafenib. To our knowledge, this is the first case of TLS in a patient with advanced HCC owing to combination therapy of nivolumab and sorafenib. We also reviewed the literature and summarized the characteristics of TLS in patients with advanced HCC receiving various therapeutic interventions. The overall mortality rate was 63% and regarding the management, transarterial chemoembolization (TACE) was the most common etiology. TACE-related TLS developed more rapidly than sorafenib-related TLS. Furthermore, the efficacy and safety of combination therapy of nivolumab and sorafenib should be further evaluated, and TLS should still be a concern, especially in patients with large tumor burden.

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