Treatment of hepatocellular carcinoma associated with cirrhosis by ultrasonograhic guided percutaneous ethanol injection

This study aimed to evaluate the short-term response to ultrasonographic guided percutaneous ethanol injection [PEI] for hepatocellular carcinoma [HCC] in cirrhotic patients. The study included 20 cirrhotic patients with HHC. Cases with severe liver impairment [Child's class C], severe bleeding tendency, impaired prothrombin concentration, thrombocytopenia, big tumors [more than 5 cm] or more than one tumor were excluded from the study. The patients were treated with percutaneous injection of ethanol 95% under guidance with ultrasound. The total amount of injected ethanol per session was between 5-20 ml. One to nine administrations were performed for each lesion according to its size. No serious complications occurred during or after treatment. The patients were followed up for 9-12 months. All lesions had post treatment sonographic structured changes of fibronecrotic echopattern. All patients were followed up by aspiration cytology at the end of treatment and at three and six months and yielded negative results for malignancy in all cases, except one who responded adequately to re-injection, with a significant reduction in the tumor size. Alpha fetoprotein level dropped significantly. No biochemical changes or untoward clinical sequelae were detected

Hemodynamic changes in patients with liver cirrhosis and tense ascites after large volume paracentesis

The aim of this study was to assess the short-term effects of a single 5-L paracentesis without albumin replacement on the systemic and portal hemodynamics. Thirty patients with liver cirrhosis and tense, diuretic resistant ascites were studied before and 24 hr after a single 5-L paracentesis without albumin infusion. An abdominal duplex Doppler examination and echocardiographic study were carried out for all patients. Heart rate and blood pressure were measured. The mean arterial pressure was calculated. Serum sodium, potassium, blood urea and creatinine were also measured. There were no significant changes from the baseline values for heart rate, mean arterial pressure and cardiac output. As regards portal hemodynamics, there were no significant changes in portal vein diameter, portal flow velocity and portal blood flow before and 24 hr after large volume paracentesis. The study concluded that single large volume paracentesis without albumin replacement is safe and satisfactory short-term option for the management of patients with cirrhosis and tense, diuretic resistant ascites