Inflammatory Pseudotumor of the Liver Treated by Hepatic Resection: A Case Report

Inflammatory pseudotumor (IPT) of the liver is rare benign tumor. When the diagnosis of IPT is established with biopsy, simple observation or conservative therapy is preferred because of the possibility of regression. But IPT is unresponsive to the conservative treatment, surgical resection should be considered. We experienced a 63-year-old male, who was suspected hepatocellular carcinoma in abdominal computed tomography (CT) and magnetic resonance image (MRI) scan, presented with 2-month history of intermittent fever and weight loss. Percutaneous ultrasound guided core biopsy confirmed IPT of the liver. Non-steroidal anti-inflammatory drugs and antibiotics were administered for 8 and 4 weeks, respectively, but fever continued. So, extended right hepatectomy was performed for IPT of the liver and then fever subsided. The patient remains well during a follow-up period of 12 months.

Inflammatory Pseudotumor of the Liver Treated by Hepatic Resection

An inflammatory pseudotumor of the liver is a rare benign tumor, which is frequently misdiagnosed as malignant. A 63 year-old man presented with a 4-month history of weight loss and a 2-month history of intermittent fever and chills. A computed tomographic (CT) scan and magnetic resonance imaging of the abdomen demonstrated a large tumor in segment 8 of the liver. An ultrasound-guided core biopsy confirmed an inflammatory pseudotumor of the liver. His fever persisted for 3 months, despite the administration of Naproxen and antibiotics. A right trisegmentectomy was carried out, after which the fever subsided. The patient has remaineds well for the last 7 months.

Combined Hepatic Resection and Intraoperative Radio-frequency Ablation for Multiple Hepatocellular Carcinoma

PURPOSE: There have been many trials to find a cure for inoperable multiple hepatocellular carcinomas (HCC), but no effective therapy has been found. As the combined therapy of tumor reductive surgery and intraoperative radio-frequency ablation (RFA) is by far the best known effective treatment modality, the effect of a combined resection and intraoperative RFA for multiple HCC was evaluated. METHODS: Between July 1999 and 2004, a retrograde study was conducted on 8 patients who had undergone combined therapy for HCC, with respect to the number of tumors, location, size, postoperative complications and recurrence. RESULTS: The average age of the patients was 51. A Rt. hepatectomy, Lt. Lateral sectionectomy, bi-segmentectomy, segmentectomy and wedge resection were performed. The total number of tumors and resected tumors were 21 and 8, respectively; with an average size of 6.6 cm. Thirteen tumors, with average size of 2 cm, were treated with RFA. Seven postoperative complications were encountered in 2 patients, with 2 operation related complications biloma and ascites. One patient suffered from pleural effusion and a wound complication. One patient went through a RFA-related complication biliary-cutaneous fistula. Four patients suffered a recurrence one at the RFA site, and the rest at the remnant liver. The treatments used for the recurrences were TACE/ TACI, percutaneous Holmium injection and surgical resection. All patients survived, with an average survival and a median disease free survival time of 15 and 11 months, respectively. CONCLUSION: Until now, surgery has been the least favored choice for the treatment of multiple HCC. However, thinking our opinion, the combined therapy of hepatectomy with intraoperative RFA is beneficial. Our group of patients was small, with a short follow up period, without any definite indication; therefore, it will be necessary to conduct continuous follow up, with the collection of appropriate data.

The Role of Splenectomy in Patients with Hepatocellular Carcinoma and Secondary Hypersplenism

Hypersplenism, secondary to portal hypertension, is common in hepatocellular carcinoma (HCC) with liver cirrhosis. Hepatic resection in the patient with hypersplenic thrombocytopenia (HSTC) may cause a perioperative bleeding episode and sometimes, liver failure. In order to investigate the effect of concomitant splenectomy in HCC patients with HSTC, clinical parameters are retrospectively reviewed for 18 HCC patients who underwent hepatic resection with or without splenectomy. Among 581 HCC patients who underwent hepatic resection during the past 17 years, 18 patients with HSTC were investigated. Twelve of them underwent hepatic resection for HCC and had a concomitant splenectomy and the remaining 6 patients underwent hepatic resection for HCC only. The clinical outcomes and postoperative changes in platelet count, serum albumin level, serum total bilirubin levels, prothrombin time and clinical staging (Child-Pugh Classification) were reviewed. The resected spleen mean weight was 350.7+/-102.9 g. Postoperative platelet counts were significantly increased with albumin levels and clinical staging scores also improved after the splenectomy. Among the 12 patients who had a splenectomy, 6 patients had postoperative complications and one died of recurrent variceal bleeding. According to this data, it is not harmful to perform a concomitant splenectomy and hepatectomy for the HCC patient with severe HSTC, it can even be beneficial in improving both the platelet count and clinical staging.

Prognostic Factors Affecting Survival Rate Following Hepatic Resection for Metastatic Colorectal Cancer

PURPOSE: Hepatic resection for metastatic colorectal cancer has recently become a widely acceptable treatment modality due to its low surgical mortality and the significant improvement of 5 year survival rates seen after resection. However the use of this treatment modality remains controversial. The aim of study was to assess the survival benefits in patients who had undergone a hepatic resection for metastatic colorectal cancer as well as to determine the prognostic factors. METHODS: A retrospective study was conducted of 94 patients who had undergone curative hepatic resection for synchronous or metachronous metastatic colorectal cancer at Department of Surgery, Yonsei University College of Medicine, between June 1989 and June 2000. Cases demonstrating extrahepatic metastasis at the time of initial surgery were excluded. The survival rate was calculated using the Kaplan-Meier and Cox regression hazard model. The mean follow up period was 35 months. RESULTS: There were 58 (61.7%) and 36 (38.3%) cases of synchronous and metachronous metastasis, respectively. The 5 year survival rate was shown to be significantly lower in patients with more than 3 metastases (P=0.05), 4 or more regional lymph node metastases in primary colorectal cancer (P=0.02), bilobar metastasis (P=0.002), extra hepatic recurrence (P=0.03) and recurrence within 1 year after hepatic resection (P=0.001). Bilobar metastasis (P=0.004) and recurrence within I year (P=0.001) has been demonstrated independent factor for 5 year survival. The overall 5 year survival rate was 30.4%. CONCLUSION: Patients with multiple, bilobar hepatic metastasis demonstrated a poor survival rate. Extrahepatic recurrence within 1 year following hepatic resection was also related with a poor outcome. Therefore, in patients with poor prognostic factors, curative surgical resection accompanied by a multimodality treatment is necessary for the improvement of survival.

Age-related Clinical Characteristics and Outcome of Hepatic Resection Therapy in Hepatocellular Carcinoma Patients / 대한암학회지

PURPOSE: A retrospective clinical study of 213 patients who underwent curative resection due to hepatocellular carcinoma was performed in order to compare the mortality and survival rates of elderly patients with those of younger patients following the resection. MATERIALS AND METHODS: All subjects underwent curative resection at Shinchon & Yongdong Severance Hospital between January 1985 to December 1994. The subjects were classified into three age groups: Group I (n=26) under 40, Group II (n=142) between 41 and 60, and Group III (n=45) over 60. Variables considered include sex, family history, accompanied diseases, Hbs Ag, -PF, Child classification, operative method, resection margin, number of mass, size of mass and gross-appearance were evaluated by X2-test (p=0.05). The one, three and five year survival rates were analysed in each group by the Kaplan- Meyer method and survival curves were compared by the log-rank test. A probability of <0.05 was accepted as significant. RESULTS: The results showed that elderly patients have no significant differences from the younger patients in any of the variables considered including postoperative morbidity, survival rate and disease-free survival rate, except for the family history and positive Hbs Ag in which the elderly patients showed significantly lower values. CONCLUSION: These results suggest that hepatocellular carcinoma in the aged can be treated in identical manner as in younger patients.

The prognosis and effect of treatment modalities on recurrent hepatocellular carcinoma after curative resection / 대한간학회지

BACKGROUND/AIMS: The most effective method of improving survival in patients with HCC is early diagnosis and curative hepatic resection. However, longterm survival after curative resection remains low because of high recurrence rate after resection. The purpose of the study is to assess the prognosis and the efficacy of the various treatment modalities on recurrent HCC after curative resection. METHODS: The clinical records of 50 patients with recurrent HCC were reviewed retrospectively who underwent curative surgery in Yonsei University, Severance Hospital from Jan. 1987 through Oct. 1994. The cummulative recurrent rate after resection, the response rate of treatment after resection, the median progression free survival and the survival after recurrence according to the treatment modalities were evaluated. RESULTS: The cummulative recurrent rate after resection was 3.9% at 3 month, 8.3% at 6 month, 14.1% at 12 month, 21.5% at 24 month, 23.4% at 36 month and 24.4% at 60 month. The response rate of treatment after recurrence was 23.7% (9 patients). The median progression free survival of the patient with reoperation and hepatic embolization was 13.9 months, that of conservative treatment group was 6.8 months and that of no treatment group was 4 months(p = 0.004). The survival after recurrence of HCC was 19.7 months in reoperation and hepatic embolization group, 11.4 months in multimodality group, 16.9 months in conservative treatment group and 8.4 months in no treatment group(p=0.0998). CONCLUSION: Reoperation and hepatic embolization for HCC after curative resection was effective in improving progression free survival, but overall survival were not significantly different according to the treatment modalities. This results proposed that reoperation and hepatic embolization for recurrent HCC after curative resection improve progression free survival.

Periampullary cancer and whipple's operation

No abstract available.

Characteristics of tumor infilterating lymphocytes in the patients with stomach cancer

No abstract available.

The abdominal trauma index as a method for quantifying the risk of complication following abdominal trauma

No abstract available.

Serum and Urinary Fibrin/Fibrinogen Degradation Products in Patients with Korean Hemorrhagic Fever; With Particular Reference to Disseminated Intravascular Coagulation and Acute Renal Failure

Korean hemorrhagic fever is a disease with an acute onset of severe hemorrhagic tendency and acute renal failure. Acute renal failure may be produced by inducing intravascular coagulation in experimental animals, and also, coagulation mechanisms may play a pathogenetic role in certain human renal diseases. One of the clinical consequences of DIC is serious ischemic tissue damage due to capillary flow blocking by fibrin deposits. The kidney is particularly vulnerable to ischemic effects. For the detection of intravascular coagulation, FDP assay is known as a more sensitive and reliable test than are other coagulation studies. Therefore, from September, 1973 to January, l974, the serum and the urine of the selected patients with Korean hemorrhagic fever who had a typical clinical course were subjected to study. The alterations of the serum and urinary FDP concentrations, and the other hematologic, blood chemistry, and urinary examinations were studied in a total of 177 examples of each febrile, hypotensive, oliguric, diuretic, and convalescent phase. Both the serum and urinary FDP concentrations were significantly higher than normal. This data indicates that DIC is detected in Korean hemorrhagic fever, where it may play a major pathogenetic role. And the urinary FDP concentration more closely reflects the severity of renal lesions in this disease than does the serum FDP concentration and the blood urea nitrogen level. It can be assumed that the concentration of urinary FDP can be used as a therapeutic criteria, and is correlated to the intensity and the prognosis of the disease. Also the possibility of improvement following anticoagulant treatment may be proposed. It appears that acute renal failure in this disease has a close relationship to DIC. In its pathogenesis it can be assumed that disruption of the renal cortical perfusion plays a major role in this Korean hemorrhagic fever.