Treatment of Hepatocellular Carcinomas by Hepatic Transarterial Chemoembolization, Case Presentation and Review of the Literature

AbstractHepatocellular carcinoma is one of the most common liver tumours. At the time of diagnosis, only 20% of patients are suitable for liver resection for curative purposes. In patients who are not suitable for surgical resection, chemoembolization of the hepatic artery is a viable therapeutic option. We present the case of a 60-year-old male patient being admitted with a diagnosis of liver tumour in the right liver lobe. Abdominal angio-CT examination revealed the existence of a tumour formation of 9x10 cm in the liver segments IV, VIII. Given the large size of the tumour, as well as the patient’s comorbidities, it was decided to practice hepatic chemoembolization with Irinotecan. The clinical evolution was favourable, the patient being discharged 48 hours after the intervention. Hepatic transarterial chemoembolization is a viable alternative in the treatment of patients with unresectable hepatocellular carcinomas, which may improve the prognosis of these patients.

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Single hepatocellular carcinomas (HCCs) larger than 4 cm usually occur in the right liver lobe in the absence of cirrhosis

Gastroenterology ◽

10.1016/s0016-5085(01)81292-0 ◽

2001 ◽

Vol 120 (5) ◽

pp. A261-A261

Author(s):

F CETTA ◽

M ZUCKERMANN ◽

G ERCOLANI ◽

G MONTALTO ◽

M GORI ◽

...

Keyword(s):

Liver Lobe ◽

Hepatocellular Carcinomas ◽

The Right

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A foreign body lodged in the sub-mental space through to the retro-pharyngeal area: a review of anatomical risks and surgical approaches

The Egyptian Journal of Otolaryngology ◽

10.1186/s43163-021-00184-9 ◽

2021 ◽

Vol 37 (1) ◽

Author(s):

Kaoutar Cherrabi ◽

Zouheir Zaki ◽

Mohamed Noureddine El Alami

Keyword(s):

Foreign Body ◽

Head And Neck ◽

Oral Exam ◽

Surgical Approaches ◽

Case Presentation ◽

Cervical Approach ◽

Angio Ct ◽

The Right ◽

Pharyngeal Area ◽

Base Of The Tongue

Abstract Background Foreign body inclusions are rare in head and neck. They are challenging in regard to anatomical risks and surgical approaches. This is the case of a particular foreign body with a curious trajectory, associated with a brief review of anatomical risks and surgical approaches. Case presentation This is the case of a 25-year-old male who has been attacked with a sharp object, which caused an inclusion of a part of the foreign body in the sub-mental and pharyngeal areas. The clinical exam showed a painful bulging in the sub-mental area, with moderately hemorrhagic sputum and difficulty while swallowing. The intra-oral exam showed a foreign body that was located at the right side of the base of the tongue, and which goes backwards and outwards to penetrate retro-pharyngeal mucosa. The patients underwent an angio-CT scan, which showed a curious fine and sharp metallic object, without direct signs of lesions to the jugular vein or carotid artery or any collateral branches. The patient underwent extraction through cervical approach, with satisfying bleeding control. Intra-oral exploration showed a retro-pharyngeal lesion of 2 cm, without particular bleeding. The cervical lesion and retro-pharyngeal lesions were closed. The lesion at the base of the tongue was of 1 cm, palpable but not accessible to sutures, and a naso-pharyngeal tube was inserted. The patient presented very satisfying post-operative outcome, without any complications. Conclusion When dealing with foreign bodies of head and neck, physicians must be precocious and prepared for the risk of bleeding after extraction. Thorough radiological exploration is necessary as long as the patient is stable. Direct and indirect radiological signs allow the clinician to understand the nature and the trajectory of the object, as well as the damage to collateral structures.

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Single hepatocellular carcinomas (HCCs) larger than 4 cm usually occur in the right liver lobe in the absence of cirrhosis

Gastroenterology ◽

10.1016/s0016-5085(08)81292-9 ◽

2001 ◽

Vol 120 (5) ◽

pp. A261

Author(s):

Francesco Cetta ◽

Michele Zuckermann ◽

Giorgio Ercolani ◽

Giulia Montalto ◽

Monica Gori ◽

...

Keyword(s):

Liver Lobe ◽

Hepatocellular Carcinomas ◽

The Right

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Large unionodular hepatocellular carcinomas (HCCS) of the right liver lobe associated with child a cirrhosis: a distinct pathologic entity from virus related multifocal HCC?

Gastroenterology ◽

10.1016/s0016-5085(00)81410-9 ◽

2000 ◽

Vol 118 (4) ◽

pp. A1383

Author(s):

Francesco Cetta ◽

Maria Teresa Del Vecchio ◽

Michele Zuckermann ◽

Giulia Montalto ◽

Andrea Cariati ◽

...

Keyword(s):

Liver Lobe ◽

Hepatocellular Carcinomas ◽

The Right

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A case of Bochdalek hernia with anomalous hepatic lobe heterotopia-case report

Egyptian Pediatric Association Gazette ◽

10.1186/s43054-021-00075-x ◽

2021 ◽

Vol 69 (1) ◽

Author(s):

Wajiha Khan ◽

Adnan Safi ◽

Asrar Ahmad ◽

Mehwish Mooghal

Keyword(s):

Case Report ◽

Common Type ◽

Diaphragmatic Defect ◽

Bochdalek Hernia ◽

Good Recovery ◽

Liver Lobe ◽

Case Presentation ◽

Hepatic Lobe ◽

The Right ◽

Ladd’S Procedure

Abstract Background Bochdalek hernia is the most common type of congenital diaphragmatic hernia (CDH) resulting from postero-lateral diaphragmatic defect. Hepatic heterotopia is very rarely associated with CDH, and hepatic herniation favors the worst prognosis. Case presentation We present a case of a neonate diagnosed with right Bochdalek hernia (BH) with anomalous hepatic lobe heterotopia. Intra operatively, mal-rotated loops were also found to be herniating in the right hemithorax. The mal-rotated loops were reduced back into abdomen after performing Ladd’s procedure and diaphragmatic defect was repaired over the anomalous liver lobe. Baby was discharged on 7th postoperative day and follow-ups showed good recovery. Conclusion This case report discusses the presentation, classification, and significance of this association. Our case report is noteworthy as Bochdalek hernia is very rarely associated with anomalous hepatic lobe.

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Tumor Compression–Induced Portal Obstruction and Selective Transarterial Chemoembolization Increase Functional Liver Volume in the Unobstructed Area, Facilitating Successful Resection of a Large HCC

International Surgery ◽

10.9738/intsurg-d-13-00013.1 ◽

2013 ◽

Vol 98 (4) ◽

pp. 388-391 ◽

Cited By ~ 1

Author(s):

Ryuma Tokunaga ◽

Hiromitsu Hayashi ◽

Toshiro Masuda ◽

Kosuke Mima ◽

Akira Chikamoto ◽

...

Keyword(s):

Transarterial Chemoembolization ◽

Liver Volume ◽

Remnant Liver ◽

Preoperative Management ◽

Hepatocellular Carcinomas ◽

Large Hepatocellular Carcinoma ◽

Right Lobe ◽

Functional Liver Volume ◽

The Right ◽

Curative Hepatectomy

Abstract A 62-year-old man with hepatitis B was admitted for treatment of a large hepatocellular carcinoma. The right portal vein was completely obstructed by tumor compression. Although we initially planned a right trisectionectomy as curative hepatectomy, the percentage of future remnant liver volume (%RLV) and the percentage of functional liver volume (%RFLV) were 31.2% and 41.3%, respectively. Because %RFLV showed marginal tolerability for curative hepatectomy and %RLV was very low, we opted for transarterial chemoembolization of segment IV and the right lobe containing the tumor as an approach to selectively reduce liver volume and abolish liver function. One month later, %RLV and %RFLV had dramatically increased to 46.6% and 67.2%, resulting in curative hepatectomy. Our results suggest that tumor compression–induced portal obstruction and selective transarterial chemoembolization increase %RFLV much more than %RLV. This may represent a useful approach in preoperative management in patients with large hepatocellular carcinomas to improve %RFLV for hepatic resection.

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Single hepatocellular carcinomas larger than 4 CM mainly occur in the right liver lobe in the absence of cirrhosis or viral disease

Journal of Hepatology ◽

10.1016/s0168-8278(02)80297-5 ◽

2002 ◽

Vol 36 ◽

pp. 86

Author(s):

Michele Zuckermann ◽

Francesco Cetta ◽

Maria Teresa Del Vecchio ◽

Loreta Pergola ◽

Monica Piccini ◽

...

Keyword(s):

Viral Disease ◽

Liver Lobe ◽

Hepatocellular Carcinomas ◽

The Right

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Adult-to-Adult Living-Donor Liver Transplantation

Swiss Surgery ◽

10.1024/1023-9332.9.5.227 ◽

2003 ◽

Vol 9 (5) ◽

pp. 227-236 ◽

Cited By ~ 3

Author(s):

Majno ◽

Mentha ◽

Berney ◽

Bühler ◽

Giostra ◽

...

Keyword(s):

Liver Transplantation ◽

Living Donor ◽

Living Donor Liver Transplantation ◽

Therapeutic Option ◽

Donor Liver ◽

Donor Liver Transplantation ◽

Multidisciplinary Program ◽

First Case ◽

Living Donor Transplantation ◽

The Right

Living donor liver transplantation is a relatively new procedure in which the right side of the liver is harvested in a healthy donor and transplanted into a recipient. After the first case in 1994, over 3000 cases have been done worldwide. This review summarizes the reasons why the procedure is needed, describes its main technical aspects, highlights the boundaries in which it can be done safely, summarizes the current experience worldwide and describes the main points of the program in our unit. We argue that living-donor transplantation is a viable alternative to a long time on the waiting list for several patients, and it can be performed safely and successfully provided that all precautions are undertaken to minimize the risks in the donor and to increase the chances of a good outcome in the recipients. If these prerequisites are met, and within the framework of a structured multidisciplinary program, we believe that living-donor liver transplantation should be funded by health insurances as a recognized therapeutic option.

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Off-Pump Supraarterial Decompression Myotomy for Myocardial Bridging

The Heart Surgery Forum ◽

10.1532/hsf98.20041116 ◽

2005 ◽

Vol 8 (1) ◽

pp. 49 ◽

Cited By ~ 7

Author(s):

Mersa M. Baryalei ◽

Theodorus Tirilomis ◽

Wolfgang Buhre ◽

Stephan Kazmaier ◽

Friedrich A. Schoendube ◽

...

Keyword(s):

Myocardial Infarction ◽

Exercise Testing ◽

Clinical Symptoms ◽

Therapeutic Option ◽

Median Sternotomy ◽

Myocardial Bridging ◽

Off Pump ◽

Hemodynamic Compromise ◽

Artery Disease ◽

The Right

Background: Myocardial bridging of the left anterior descending (LAD) artery may result in clinical symptoms. Surgery with cardiopulmonary bypass (CPB) is a therapeutic option with considerable risk. We hypothesized that off-pump supraarterial myotomy could be an effective treatment modality. Methods: Between October 1998 and May 2000, 13 patients were referred for surgery. All were symptomatic despite medical therapy. Anteroseptal ischemia had been proven by thallium scintigraphy in all 13 patients, exercise testing was positive in 11. All patients were operated on with an off-pump approach after median sternotomy. Results: Mean patient age was 61 8 years (range, 43-71 years). Coronary artery disease mandating additional bypasses was present in 3 patients. The bypasses were done off pump in 2 patients. Conversion to on-pump surgery was necessary in 3 of 13 patients (23%) because of hemodynamic compromise (1 patient), opening of the right ventricle (1 patient), and injury to the LAD (1 patient). Supraarterial myotomy was performed in all patients. One patient who underwent surgery with CPB developed postoperative anteroseptal myocardial infarction. Postoperative exercise testing was performed in all patients and did not reveal any persistent ischemia. Mortality was 0%. All patients were free from symptoms and had not undergone repeat interventions after an average of 51 7 months of follow-up. Conclusions: Off-pump supraarterial myotomy effectively relieves coronary obstruction but has a certain periprocedural risk as evidenced by 1 myocardial infarction, 1 right ventricular injury, and 1 LAD injury. Long-term freedom from symptoms and from reintervention favor further investigation of this surgical therapy.

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Embolization of the false lumen using IMPEDE-FX embolization plugs as part of treatment of an infrarenal post-dissection aneurysm: a case report

CVIR Endovascular ◽

10.1186/s42155-020-00183-6 ◽

2020 ◽

Vol 3 (1) ◽

Author(s):

Anne-Jet S. Jansen ◽

Paul M. van Schaik ◽

Jasper M. Martens ◽

Michel M. P. J. Reijnen

Keyword(s):

Case Report ◽

Mesenteric Artery ◽

Inferior Mesenteric Artery ◽

False Lumen ◽

True Lumen ◽

Case Presentation ◽

Type A Dissection ◽

Prospective Trials ◽

The Right ◽

Embolization Procedure

Abstract Background This case report demonstrates the value of IMPEDE-FX plugs in an embolization procedure of a false lumen of an infrarenal post-dissection aneurysm. Case presentation A 69-year-old patient was treated with mitral valve replacement, complicated by a Stanford type-A dissection. After 9 years he presented with an enlarging infrarenal post-dissection aneurysm. The false lumen was embolized using multiple IMPEDE-FX plugs as part of the treatment in addition to embolization of the inferior mesenteric artery and overstenting of the re-entry in the right iliac artery. At 15 months the CTA showed a fully thrombosed false lumen and remodeling of the true lumen. Conclusions The false lumen of an infrarenal post-dissection aneurysm can successfully be embolized using IMPEDE-FX embolization plugs as part of the treatment strategy. Prospective trials on patients with non-thrombosed false lumina are indicated.

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