Percutaneous ethanol injection as a promising and minimally invasive treatment for axillary osmidrosis: Double-blinded randomized controlled trial

Background: Axillary osmidrosis is a common problem with a strong negative impact on the professional and social quality of life. Several options are available for its treatment. But there are no treatment guidelines. The objective of this study was to evaluate efficacy and safety of percutaneous ethanol injection for treatment of axillary osmidrosis. Methods: A randomized, double-blind, placebo-controlled clinical trial to assess clinical efficacy and postoperative complications of percutaneous ethanol injection was performed among 60 patients (12–35 years of age) with axillary osmidrosis. The active agent used in the experimental group (n = 30) was sterile 90% ethanol and the placebo used in the control group (n = 30) was sterile normal saline administered in an identical syringe. The results of malodor elimination were graded by the patients as excellent, good, fair, and poor. All patients were followed-up for 10 months. Results: Malodor elimination was graded as good by 15 (50%) patients treated with percutaneous ethanol injection. A significant difference in the improvement of axillary osmidrosis was found between the experimental and control groups (P < 0.001). The most common post-procedure complication was transient subjective skin stiffness in the experimental group, which regressed spontaneously. There were no serious permanent side effects. Limitations: Relatively short duration of follow-up; and lack of histopathological evidence of destruction of the apocrine glands after treatment in most patients. Conclusions: Percutaneous ethanol injection is an effective and safe treatment method for axillary osmidrosis and does not have permanent side effects.

Present statues and progresses of interventional therapy of hepatocellular carcinoma in caudate lobe / 中国介入影像与治疗学

Recently,with the recognition of blood supply and anatomy of the liver caudate lobe,the intervention therapies of hepatocellular carcinoma in caudate lobe were enriched.However,because of the complex anatomy,the treatment of hepatocellular carcinoma in caudate lobe is still controversial.The interventional methods for hepatocellular carcinoma in caudate lobe were mainly included transcatheter arterial chemoembolization (TACE),percutaneous ethanol injection (PEI),transcatheter arterial embolization (TAE),radioembolization,radiofrequency ablation (RFA) and endoscopic ultrasound-guided ethanol injection.The present statues and progresses of interventional therapy of hepatocellular carcinoma in caudate lobe were reviewed in this article.

Transcatheter arterial chemoembolization in combination with percutaneous ablation therapy for the treatment of hepatocellular carcinoma: a meta-analysis / 介入放射学杂志

Objective To compare the differences in the long-term survival rate and the tumor shrinkage rate of inoperable hepatocellular carcinoma (HCC) between transcatheter arterial chemoembolization (TACE) combined with percutaneous ablation therapy and simple TACE therapy in order to provide the basis for the clinical treatment of HCC.Methods Randomized controlled trials (RCT) for comparing the difference in survival rates between TACE plus PA and simple TACE for inoperable HCC were searched from medical literature database,from which the relevant data were extracted.According to Cochrane manual standard,the quality of inclusion literature was evaluated.Results A total of 15 RCT papers were included in this study,including 859 HCC patients.The results of meta-analysis showed that all the 1-year,2-year and 3-year survival rates in TACE plus PA group were better than those in simple TACE group (RR=1.454,95％CI=1.333and 1.586,Z=8.56,P＜0.001;RR=1.781,95％CI=1.511 and 2.099,Z=6.88,P＜0.001;RR=2.351,95％CI=1.808 and 3.059,Z=6.37,P＜0.001,respectively).The tumor shrinkage rate in TACE plus PA group was also better than that in simple TACE group (RR=1.314,95％CI=1.190 and 1.452,Z=5.38,P＜0.001).The sensitivity analysis indicated that the results of the differences in survival rate and tumor shrinkage rate between the two groups were reliable.Conclusion The 1-year,2-year and 3-year survival rates as well as the tumor shrinkage rate of TACE plus PA group are higher than those of simple TACE group.

Efficacy analysis of transcatheter arterial chemoembolization combined with conventional percutaneous ethanol injection therapy in the treatment of 40 cases of primary liver cancer / 中国综合临床

Objective To study the curative effect of transcatheter arterial chemoembolization( TACE) combined with conventional percutaneous ethanol injection therapy ( PEIT) in the treatment for primary liver cancer?Methods Forty cases patients with primary liver cancer(the diameter was equal or more than 8 cm) who were treat in the Third Hospital of Qinhuangdao from January 2007 to May 2013 were selected,and randomly divided into treatment group(20 cases) and control group(20 cases)?The control group underwent TACE,the treatment group were given TACE combined with PEIT, the clinical effect of the two groups were observed?Results The effective rate of the treatment group was 80%,significantly higher than that of the control group( 50%) ,the difference was statistically significant( P=0?04)?During the follow?up of 3 years,there were 3 cases of portal vein tumor thrombus,5 cases of hepatic metastasis,1 case of upper gastrointestinal bleeding and 2 cases of liver failure in the control group;there were 1 case of liver metastasis,1 case of liver failure and death in the treatment group?Conclusion The test of the curative effect of patients with huge hepatocellular carcinoma after combination therapy with TACE and PEIT proved combination therapy can increase the curative effect, decrease impairment of liver funvtion?It was a palliation road to treat huge hepatocellular carcinoma.

Ultrasonic guided percutaneous ethanol injection with or without combined radiofrequency ablation for hepatocellular carcinomas.

OBJECTIVE: The aim of this retrospective study was to evaluate whether radiofrequency ablation (RFA) combined percutaneous ethanol injection (PEI) in the management of hepatocellular carcinoma (HCC) improves treatment outcomes. PATIENTS AND METHODS: We retrospectively included 66 HCC patients who received RFA or RFA plus PEI from February 2011 to January 2014 in Jingmen No. 1 People’s Hospital. Moreover, 31 cases received RFA plus PEI as the experiment group and 35 subjects treated with RFA aloe as the control group. The overall survival and treatment related complications were compared between the two groups. RESULTS: For RFA group, the 1‑year, 2‑year, and 3‑year survival rate were 82.0%, 69.3%, and 30.7%, respectively, with the median survival time of 27.1 months. For RFA plus PEI group, the 1‑year, 2‑year, and 3‑year survival rate were 97.1%, 73.9%, and 37.5%, respectively, with the median survival time of 33.6 months. The overall survival of the two groups was not statistical different with the hazard ratio of 1.48 (P > 0.05); three cases of treatment associated complications were found in RFA group with 1 abscess, 1 pleural effusion, and 1 portal vein thrombosis. Moreover, 2 cases of complication were recorded in RFA plus PEI group with 1 pleural effusion and 1 portal vein thrombosis. The complicated incidence rate was not statistical different between the two groups (P < 0.05). CONCLUSION: The combination treatment of HCC was safe and had a slightly higher primary effectiveness rate than RFA alone.

Clinical study of PEI combined with HIFU for treating unresectable middle and advanced stages of primary liver cancer / 重庆医学

Objective To investigate whether the percutaneous ethanol injection (PEI)under sedation and analgesia can in-crease the energy deposition and curative efficiency of the high intensity focused ultrsound(HIFU)in treating unresectable middle and advanced stages of primary liver cancer.Methods Thirty-six cases of clinically diagnosed unresectable middle and advanced sta-ges of primary liver cancer were randomly divided into the PEI+ HIFU group(combination group,n = 23)and the simple HIFU group (HIFU group,n=13);10mL of the mixture of 99.7% ethanol and iodized oil (9:1)was given by intratumoral injection at 30 min before ablation in the PEI+HIFU group,while 0.9% physiological saline 10mL was replaced in the simple HIFU group.The ablation energy efficiency factor(EEF)and irradiation time were compared between the two groups.Results The ablation EEF in the PEI+HIFU group and the simple HIFU group were (13.82+4.26)J/mm3 and (25.63+6.31)J/mm3 respectively,the PEI+HIFU group was significantly lower than the simple HIFU group (P <0.05);the irradiation time were (1 468.28+253.21)s and (2 352.56+463.34)s respectively;which in the PEI+ HIFU group was significantly shortened (P <0.05).Conclusion PEI can enhance the HIFU ablation energy deposition and improve the efficiency of HIFU for treating unresectable primary liver cancer.

Vascular endothelial growth factor before and after locoregional treatment and its relation to treatment response in hepatocelluar carcinoma patients

Objective: To evaluate vascular endothelial growth factor (VEGF) levels in hepatocellular carcinoma patients before and after transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) and its relation to treatment response. Methods: A total of 40 patients with unrespectable hepatocelluar carcinoma were assessed clinically. Twenty patients were suitable to be treated by TACE, while other 20 patients were treated with PEI. Serum VEGF levels were measured before and 1 month after each procedure by ELISA. Response was assessed after 1 month according to Union Internationale Contre le Cancer evaluation criteria based on change in tumor size as measured by ultrasound. Results: There was no significant difference between TACE and PEI groups with regard to age, sex, tumor size, response to local therapy, or VEGF and alpha-fetoprotein before and after therapy. VEGF levels after TACE were significantly higher than before TACE [(298.1 ± 123.6) pg/mL vs. (205.8 ± 307.3) pg/mL; P = 0.001]. Also, VEGF levels were significantly higher after PEI than before PEI [(333.8 ± 365.6) pg/mL vs. (245.3 ± 301.8) pg/mL; P = 0.000]. Non-responders of both groups had significantly high VEGF levels than responder's, both before [(985.0 ± 113.2) pg/mL vs. (117.1 ± 75.3) pg/mL; P < 0.001] and after therapy [(1. 330.6 ± 495.7) pg/mL vs. (171.0 ± 94.7) pg/mL; P = 0.000)]. Conclusions: Both TACE and PEI were associated with an increase in serum VEGF in hepatocelluar carcinoma patients. Higher levels of VEGF before and after therapy were found in non-responders, suggesting that VEGF is a useful marker in predicting treatment response.

Therapeutic comparison between radiofrequency ablation and percutaneous ethanol injection in treatment of primary liver cancer: a meta-analysis / 临床肝胆病杂志

ObjectiveTo compare the efficacy of radiofrequency ablation (RFA) versus percutaneous ethanol injection (PEI) in the treatment of primary liver cancer(PLC). MethodsA search of PubMed, EMBASE, CKNI, VIP, and Wanfang Data identified all randomized controlled trials (RCTs) related to therapeutic comparison between RFA and PEI in patients with PLC. Quality of each study was assessed, meta-analysis was performed with Review Manager 5.0 software, and the results were analyzed with fixed effect model and random effect model. ResultsSeven RCTs were included in this study. The results of meta-analysis indicated that, compared with the PEI group, the RFA group had a significantly higher tumor necrosis rate (P=0.008, OR=2.66, 95％CI: 1.29-5.48). The 1-, 2-, and 3-year survival rates and 1- and 3-year tumor-free survival rates of the RFA group were significantly higher than those of the PEI group (P＜005). The RFA group had significantly lower 1-, 2-, and 3-year local recurrence rates in comparison with the PEI group (P＜005). There was no significant difference in 2-year tumor-free survival rate between the two groups (P=0.06). ConclusionThe efficacy of RFA is superior to that of PEI, which is of clinical significance to guide the selection of methods for PLC treatment.

Vascular endothelial growth factor before and after locoregional treatment and its relation to treatment response in hepatocelluar carcinoma patients

Objective: To evaluate vascular endothelial growth factor (VEGF) levels in hepatocel-lular carcinoma patients before and after transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) and its relation to treatment response. Methods: A total of 40 patients with unrespectable hepatocelluar carcinoma were assessed clinically. Twenty patients were suitable to be treated by TACE, while other 20 patients were treated with PEI. Serum VEGF levels were measured before and 1 month after each procedure by ELISA. Response was assessed after 1 month according to Union Internationale Contre le Cancer evaluation criteria based on change in tumor size as measured by ultrasound. Results: There was no significant difference between TACE and PEI groups with regard to age, sex, tumor size, response to local therapy, or VEGF and alpha-fetoprotein before and after therapy. VEGF levels after TACE were significantly higher than before TACE [(298.1 ± 123.6) pg/mL vs. (205.8 ± 307.3) pg/mL;P=0.001]. Also, VEGF levels were significantly higher after PEI than before PEI [(333.8 ± 365.6) pg/mL vs. (245.3 ± 301.8) pg/mL;P=0.000]. Non-responders of both groups had significantly high VEGF levels than responder's, both before [(985.0 ± 113.2) pg/mL vs. (117.1 ± 75.3) pg/mL;P Conclusions: Both TACE and PEI were associated with an increase in serum VEGF in hepatocelluar carcinoma patients. Higher levels of VEGF before and after therapy were found in non-responders, suggesting that VEGF is a useful marker in predicting treatment response.

The recurrent risk factors of ethanol injectio n by interventional ultrasound on treatment of primary liver cancer / 实用肿瘤学杂志

Object ive To find related risk factors after PEIT under ultrasound .Methods We collected the data of 73 clinical PEIT cases from January 2007 to December 2011 .Univariate analysis found the related risk factors of PEIT.Multivariate analysis identified the independent risk factors .Results Single factor analysis showed that the differences between groups of patient′s sex,age,the positive and negative of serum HBsAg ,tumor location,tumor number in survival rates were not statistically significant;the differences in groups of tumor size , serum AFP levels,with or without portal vein tumor thrombus ,liver function(Child)grade,tumor type in survival rates were significant differences .Multivariate and stepwise regression analysis showed that liver function ( Child) grade,tumor type,tumor metastasis,portal vein thrombosis were factors relevant to prognosis ;all chi-square test,χ2=47.763,P<0.01;likelihood ratio test χ2=450.546 ,P<0.01.Conclusion liver function ( Child-pugh grade),pathological type of tumors,tumor′s metastasis,emboli in portal vein are the risk factors after PEIT .

Evaluation of percutaneous ethanol injections in benign thyroid nodules / Avaliação do tratamento com injeção percutânea com etanol em nódulos benignos de tireoide

Objective The objective of this study was to evaluate the efficacy and safety of percutaneous ethanol injection (PEI) in the treatment of benign thyroid nodules. Subjects and methods We evaluated 120 patients with benign thyroid nodules. Patients underwent evaluation of serum TSH and free T4, cervical ultrasound, and thyroid scintigraphy (in those with suppressed TSH levels). The application of sterile ethanol 99% was guided by ultrasound, with the injected volume amounting to one-third of the nodule volume. Response was considered complete (reduction of 90%); partial (reduction between 50 and 90%); or none (reduction of < 50%). Autonomous nodules were evaluated for normalization of TSH levels. Results Among the nodules studied, 30.8% were solid, 56.7% were mixed, 12.5% were cystic, and 21.6% were hyperfunctioning. The initial volume of the treated nodules ranged from 0.9 to 74.8 mL (mean 13.1 ± 12.4 mL). We performed 1-8 sessions of PEI, applying an average of 6.2 mL of ethanol for patient. After 2 years of follow-up, 17% of patients achieved a complete response (94% reduction); 53%, a partial response (70% reduction); and 30%, no response. A reduction in the volume of autonomous nodules was noted in 70% of cases, and 54% had a normalized value of TSH. The main side effect is local pain, lasting less than 24 hours in most cases. Conclusion This study showed that PEI is a safe and effective procedure for treatment of benign, solid or mixed thyroid nodules. Most cases resulted in significant reduction in nodule volume, with normalization of thyroid function. Arq Bras Endocrinol Metab. 2014;58(9):912-7 .

Objetivo O objetivo deste estudo foi avaliar a eficácia e segurança da injeção percutânea de etanol (IPE) no tratamento de nódulos tireoidianos benignos. Sujeitos e métodos Foram avaliados 120 pacientes com nódulos benignos de tireoide. Todos realizaram dosagens de TSH, T4 livre, ecografia cervical (US) e cintilografia de tireoide (em pacientes com TSH suprimido). A aplicação de etanol estéril a 99% foi guiada por US e o volume de etanol injetado correspondeu a um terço do volume nodular calculado. A resposta foi considerada completa (redução de 90%); parcial (redução entre 50 e 90%) ou ausência de resposta (redução menor que 50%). Nos nódulos autônomos, foi avaliada a normalização do TSH. Resultados Entre os nódulos estudados, 30,8% eram sólidos, 56,7% eram mistos, 12,5% eram císticos e 21,6%, nódulos hiperfuncionantes. O volume inicial dos nódulos tratados variou de 0,9 a 74,8 mL (média 13,1 ± 12,4 mL). Foram realizadas de 1 a 8 sessões de IPE (média 2,8), com aplicação média de 6,2 mL de etanol por paciente. Após dois anos de seguimento, 17% dos pacientes obtiveram resposta completa (redução de 94%), 53% obtiveram resposta parcial (redução de 70%) e 30% não responderam. Houve redução de volume nos nódulos autônomos em 70% dos casos, e 54% normalizaram o valor do TSH. Os efeitos colaterais registrados foram decorrentes apenas do desconforto no local de aplicação. Conclusão Este trabalho mostrou que a IPE é um procedimento seguro e eficaz para tratamento de nódulos benignos, sólidos ou mistos de tireoide. ...

Diagnóstico y tratamiento del hepatocarcinoma: puesta a punto del tema y rol del internista / Diagnosis and therapy of hepatocarcinoma: update of the topic and the internist’s role

El carcinoma hepatocelular es el tumor hepático maligno más frecuente, el 5o más prevalente en el mundo y la tercera causa de mortalidad por cáncer. En más de un 90% de los casos está asociado a cirrosis, su incidencia en dicha población es del 3 al 5%, siendo la primera causa de muerte en este grupo de pacientes. Se espera un incremento de esta incidencia en las próximas 2 décadas. En los últimos años se han desarrollado nuevas estrategias diagnósticas y terapéuticas que han modificado radicalmente el pronóstico de esta enfermedad. Al asentar sobre una patología donde el manejo médico es primordial el internista cumple un rol fundamental en el adecuado abordaje de esta neoplasia. Tareas como la prevención, la vigilancia, el diagnostico precoz y el enfoque multi e interdisciplinario, en los distintos estadios evolutivos de la enfermedad, son algunos de los aspectos más relevantes. El accionar con el médico hepatólogo es fundamental, definiendo en conjunto las distintas conductas a seguir en las instancias pre y postratamiento...

Therapeutic Efficacy and Safety of Percutaneous Ethanol Injection with or without Combined Radiofrequency Ablation for Hepatocellular Carcinomas in High Risk Locations

OBJECTIVE: To evaluate the therapeutic efficacy and safety of percutaneous ethanol injection (PEI) alone and combined with radiofrequency ablation (RFA) for hepatocellular carcinomas (HCCs) in high risk locations. MATERIALS AND METHODS: We performed PEI for HCCs in RFA-high risk locations, either alone or in combination with RFA. There were 20 HCCs (1.7 +/- 0.9 cm) in 20 patients (PEI group: n = 12; PEI + RFA group: n = 8). We evaluated technical success, local tumor progression and complications in both groups. RESULTS: Technical success was achieved in all HCCs in both groups. During follow-up, local tumor progression was found in 41.7% (5/12) in the PEI group, whereas 12.5% (1/8) for the PEI + RFA group (p = 0.32). Bile duct dilatation was the most common complication, especially when the tumors were in periportal locations; 55% (5/9) in the PEI group and 50% (2/4) in the PEI + RFA group (p = 1.00). One patient in the PEI group developed severe biliary stricture and upstream dilatation that resulted in atrophy of the left hepatic lobe. One patient treated with PEI + RFA developed cholangitis and an abscess. CONCLUSION: Combined PEI and RFA treatment has a tendency to be more effective than PEI alone for managing HCCs in high risk locations, although the difference is not statistically significant. Even though PEI is generally accepted as a safe procedure, it may cause major biliary complications for managing HCCs adjacent to the portal vein.

Short-term efficacy of ultrasound-guided percutaneous ethanol injection enhanced single needle radiofrequency ablation in the treatment of liver cancer / 中华消化外科杂志

ObjectiveTo investigate the short-tern efficacy of ultrasound-guided percutaneous ethanol injection (PEI) enhanced single needle radiofrequency ablation ( RFA) in the treatment of liver cancer.Methods The clinical data of 71 patients who were admitted to the Xijing Hospital from June 2010 to June 2011 were retrospectively analyzed.All patients were divided into the RFA group (25 patients ) and RFA + PEI group (46 patients).In the RFA group,the needle of RFA was injected into the tumor for coagulation with the guidence of ultrasound.In the RFA + PEI group,95％ ethanol was injected into the tumor with the guidence of ultrasound,and then RFA was performed.The tumor necrosis volumes of the 2 groups were assessed by contrast-enhanced ultrasound at 2 weeks after RFA.The relationship between the average RFA energy and volume of ethanol applied and necrosis volume was analyzed.All data were analyzed by using the chi-square test,t test and Pearson correlation coefficient.ResultsThe volume of coagulative necrosis of the RFA group was (22 ± 17) cm3,which was significantly smaller than (55 ± 44) cm3 of the RFA + PEI group (t =3.85,P ＜ 0.05 ).In the RFA + PEI group,the volume of ethanol injected was positively correlated with the volume of coagulative necrosis (r =0.615,t =5.86,P ＜ 0.05 ),but negatively correlated with the treatment efficacy ( r =- 0.709,t =- 7.52,P ＜ 0.05 ).The amount of required energy was positively correlated with the volume of coagulative necrosis (r =0.884,t =14.13,P ＜0.05 ),whereas no significant correlation was detected between the amount of required energy and the treatment efficacy ( r =- 0.225,t =- 1.72,P ＞ 0.05 ).The equation for calculating the volume of ethanol required was conducted:Y =2.526X - 2.693 [ Y:volume of ethanol required ( ml),X:diameter of the tumor (cm) ].Three patients in the RFA + PEI group were complicated by transient pain,flushing and cardiac acceleration after the operation,and the symptoms were alleviated by symptomatic treatment.The levels of transaninase were increased in the 3 groups,and then back to normal at 2 weeks after the treatment.No complications such as hepatic rupture,intestinal perforation,bile leakage or tumor implantation were detected in the 2 groups.The levels of alphafetoprotein (AFP) were significantly decreased.The AFP expressions of 20 patients (80％) in the RFA group and 39 patients (85％) in the RFA + PEI group changed to negative,with no significant difference between the 2 groups ( x2 =0.42,P ＞ 0.05 ).ConclusionPEI helps to increase the volume of coagulative necrosis and to reduce the energy requirement of routine RFA,and enhances the efficacy of single needle RFA.

The experimental study of synergistic effect of radiofrequency ablation combined with percutaneous ethanol injection / 中华肝胆外科杂志

Objective To evaluate the validity of percutaneous radiofrequency ablation(RFA)combined with percutaneous ethanol injection(PEI) with different style in rabbit liver in vivo.Methods Twenty-four New Zealand white rabbits were included in this study and divided into four groups.Group A:RFA before PEI(n=6),RFA (1 cm mono-electrode,maintain 3 minutes RFA) before PEI 1.5 ml; Group B:PEI before RFA (n=6),PEI 1.5 ml before RFA (1 cm mono-electrode,maintain 3 minutes RFA); Group C:RFA (1 cm mono-electrode,maintain 3 minutes RFA) only (n =6);Group D:PEI (1.5 ml) only(n=6).To analyze the resistance,current and energy requirement per unit of each group including RFA.To observe the size,shape,isoperimetric ratio and volume of coagulated necrosis of each group by enhanced CT.Results The longest diameter and the shortest diameter of group B[respectirely,(24.1±4.4) mmand (21.45±4.0) mm] were significantly larger than group C [respectirely,(12.4 ± 1.6) mm and (11.1 ± 1.4) mm] and group D[respectirely,(7.7 ± 2.3) mm and (5.1 ± 1.5) mm] (P＜0.01).The height diameter and volume of coagulated necrosis of group B [respectirely,(20.3± 4.9) mm3 and (5879 ± 2607) mm3] were significantly larger than the other 3 groups [(14.8± 2.7) mm3 and (3130±1250) mm3,(10.7±1.6) mm3 and (767±173) mm3,(6.7± 1.0) mm3 and (146±83) mm3] in A,C,and a group (P＜0.01).Isoperimetric ratios of ablation zone in group B was the most highest.There were no statistically significant between each group (P＞0.05).The resistance of group B were significantly larger than group A and group C (P＜0.01).The current of group B were significantly lower than group A and group C (P＜0.05).The energy requirement per unit of group A and group B were significantly lower than group C (P＜0.01).Conclusion The volume of coagulated necrosis of group PEI-RFA was significantly larger than the other 3 groups.The energy requirement per unit of group PEI-RFA were the lowest in each group.The isoperimetric ratio of group PEI-RFA was the most highest.

A systematic review of the effect of radiofrequency ablation and percutaneous ethanol injection therapy on small hepatocellular carcinoma / 中华肝胆外科杂志

Objective To evaluate the value of radiofrequency ablation and Percutaneous Ethanol Injection in the treatment of small hepatocellular carcinoma (HCC). Methods We searched MED-LINE (1966-2009), EMBASE (1966-2009), CBMdisc (1978-2009), The Cochrane Library, Evidence Base Medicine Reviews (Ovid Edition), and Cancerlit (1993-2009). Date of last search: 30Jun 2009. There were no restrictions in language. Randomized controlled trials (RCTs) and nonRCTs (NRCT) were both included in this study, and the quality of each study included was assessed.Meta-analysis was performed using RevMan 4.2 software. Results Four RCTs and one NRCT met the inclusion criteria on RFA versus PEI in the treatment of small HCCs. Meta-analysis showed the following: complete tumor response rate, 3-year survival rate, 1-, 3-year tumor-free survival rates and 1-, 3-year local recurrence rates showed statistically significant difference in the RFA group than the PEI group(P＜0.05). The 1-year survival rate and the main complications of the two groups of patients were similar and they were not significantly different (P＞0. 055). Conclusions The results show that RFA resulted in better clinical outcomes than PEI in the treatment of small HCC larger than 2 cm, and no difference small HCC of 2 cm or less. The two modalities were safe and there were vey few adverse effects of the treatments.

Percutaneous ethanol injection efficacy in benign thyroid nodules: a descriptive retrospective study

Background: In benign nodular thyroid diseases, percutaneous ethanol injection (PEI) has been introduced as an alternative to surgery for more than 10 years. Previous studies confirmed the safety and efficacy of PEI in reducing the size of thyroid nodules, including cystic thyroid. PEI can be performed as an out-patient procedure. Objective: To evaluate the efficacy and safety of PEI treatment for reducing the size of benign thyroid nodules. Material and methods: Descriptive retrospective study was made for patients with non-toxic thyroid nodules treated by PEI at Theptarin Hospital (Bangkok, Thailand) during a five year period (Jan 2002 and Dec 2006). The volume of nodules was measured using ultrasound technique before and after PEI treatment. Any complications were also recorded. In the present analysis, the nodules were classified into four groups: solid, cystic, mixed solid-cystic nodules, and multinodular goiters. Results: Of the 167 treated nodules in the study, initial nodule volume was 10.14 ± 12.32 mL, median number of injections was 5 times with total ethanol volume injected 0.99 ± 0.54 mL per mL nodule volume. Percentage volume reduction was 66.67 ± 32.19% at the median time of 14 months follow-up. Overall, 80% of treated nodules achieved ≥ 50% volume reduction. The mean volume reduction in this group was 79.61%. In the subgroup of solid thyroid nodule (65 nodules), the mean volume reduction was 58.73 ± 35.33%. In the subgroup of cystic thyroid (8 nodules), the mean volume reduction was 92.38 ± 6.57%. In the subgroup of mixed solid-cystic nodule (44 nodules), the mean volume reduction was 67.35 ± 35.18%. In the subgroup of multinodular goiters (50 nodules), the mean volume reduction was 72.27 ± 23.76%. Only two patients developed temporary vocal cord paresis. No permanent or serious complications were experienced. Conclusion: PEI proved to be a safe and effective therapeutic procedure for patients with benign thyroid nodules. Recurrent thyroid cysts could be also managed with this treatment.

Is Percutaneous Ethanol Injection Therapy Still Effective for Hepatocellular Carcinoma in the Era of Radiofrequency Ablation?

Percutaneous ethanol injection (PEI) therapy has been replaced by more-effective thermal ablation techniques that have lower local recurrence rates. However, PEI therapy remains useful in certain settings. Since PEI can be performed in any portion of the liver, PEI therapy can be valuable when tumors are located in close proximity to intestinal loops or other positions that are risky for thermal local ablative techniques. PEI therapy is also valuable in other situations where radiofrequency ablation (RFA) is difficult, including technically difficult masses that are not detected with ultrasound (US), are located in the hepatic dome, in the subcapsular area, and exophytically, or are surrounded by large vessels. PEI therapy contributes to combination therapy with transcatheter arterial chemoembolization or RFA in advanced-stage hepatocellular carcinoma (HCC), and also to the treatment of large HCC or extrahepatic metastasis from HCC. These roles of PEI therapy should be stressed for the treatment of HCCs in appropriate clinical situations. This comprehensive review of articles related to PEI therapy illustrates the recent role and indications of this therapy, which is currently valuable for HCC in the era of RFA.

A case of advanced hepatocellular carcinoma with portal vein tumor invasion controlled by percutaneous ethanol injection therapy / 대한간학회지

Portal vein invasion is a grave prognostic indicator in the setting of hepatocellular carcinoma (HCC). There is currently no effective method for preventing the invasion of HCC into the main portal vein. We report here a case of advanced HCC with portal vein tumor thrombosis that was effectively treated with percutaneous ethanol injection (PEI), having previously enabled subsequent successive transarterial chemoembolization (TACE). A 60-year-old male patient was diagnosed with a huge HCC, based on computed tomography and angiographic findings. Despite two sessions of TACE, the tumor invaded the right portal vein. PEI was performed on the malignant portal vein thrombosis, and three sessions thereof reduced the extent of tumor thrombi in the portal vein. Successive TACEs were performed to treat the HCC in the hepatic parenchyma. The patient was still living 19 months after the first PEI with no evidence of tumor recurrence, and his liver function remained well preserved.

Needle Tract Implantation after Percutaneous Interventional Procedures in Hepatocellular Carcinomas: Lessons Learned from a 10-year Experience

Percutaneous interventional procedures under image guidance, such as biopsy, ethanol injection therapy, and radiofrequency ablation play important roles in the management of hepatocellular carcinomas. Although uncommon, the procedures may result in tumor implantation along the needle tract, which is a major delayed complication. Implanted tumors usually appear as one or a few, round or oval-shaped, enhancing nodules along the needle tract on CT, from the intraperitoneum through the intercostal or abdominal muscles to the subcutaneous or cutaneous tissues. Radiologists should understand the mechanisms and risk factors of needle tract implantation, minimize this complication, and also pay attention to the presence of implanted tumors along the needle tract during follow-up.