RESUMEN
Background: A spontaneously ruptured hepatocellular carcinoma (HCC) carries an extremely poor prognosis and high mortality. In Thailand, the reported incidence of ruptured HCC was 12.4 % . Objective: To evaluate the computed tomography (CT) findings of ruptured HCC at King Chulalongkorn Memorial Hospital, Thailand. Methods: We reviewed the CT findings of 15 patients who were diagnosed as having a ruptured HCC and underwent CT scan of the upper abdomen. Two experienced radiologists analyzed the CT findings regarding the tumor’s size, tumor’s number, location, hepatic segment involvement, contour protrusion including appearance of the mass and ascites. Results: The study population consisted of 15 men with mean age of 57.4 years (27-78 years). All cases showed liver cirrhosis. All ruptured tumors were located at the periphery of the liver and had a protruding contour. The maximum diameter of the tumors ranged from 2.8-17.2 cm (mean 7.44 cm). Marginal disruption was seen in 9 cases (60 %). Five cases (33 %) presented with hematoma and high attenuation around the ruptured mass. All cases of ruptured HCC had ascites. Conclusion: The peripheral location, protruding contour, marginal disruption of the tumor with the background of a cirrhotic liver are highly suggestive of ruptured HCC.
RESUMEN
In an attempt to investigate the sequential histological changes in the tissue surrounding intracerebral hematoma, an experimental model of intracerebral hematoma was made by an injection of 0.7ml of autologous whole blood, with the stereotaxic frame, into the right basal ganglia of the anesthetized rabbit. The total of 60 adult rabbits weighing 1.6 to 2.5kg were divided into 10 groups and sacrified in 0.5, 3, 6, 9 and 12 hours, and 1, 2, 3, 4 and 7 days after the formation of intracerebral hematomas. The sequential microscopical changes in the brain tissue surrounding hematoma were observed. The results obtained were as follows : 1) At the earlier stages, in 0.5 to 24 hours after hematoma formation, edema, migration of RBCs, perivascular hemorrhage and infiltration of neutrophils were observed in the surrounding brain tissues. These changes began to appear in 3 to 6 hours and were aggravated rapidly in 12 to 24 hours. At the later stages, in 2 to 7 days after hematoma formation, infiltration of macrophage, proliferation of vessels and fibrin were observed in the surrounding brain tissue. These changes in the process of tissue repair seemed to begin in 2 days and promote in 3 to 7 days after hematoma formation. 2) The experimental data suggested that in the clinical practice the removal of intracerebral hematoma might as well be carried out in the early stage of hemorrhage, particularly within 12 hours, before the degree and extent of necrosis in the surrounding brain tissue would be marked.