One case of fulminant hepatic failure related to Dictamnus dasycarpus / 대한내과학회지

We report a case of fulminant hepatic failure related to ingesting Dictamnus dasycarpus. The patient had taken D. dasycarpus for 8 weeks after boiling down the root of D. dasycarpus in water, to promote health. The main symptoms and signs were general weakness and jaundice. Serology found no evidence of hepatitis A, B, or C infections. Imaging studies, including abdominal ultrasonography and abdominal computed tomography, did not reveal any bile duct structural abnormalities. Based on the RUCAM score (8 points), D. dasycarpus was the probable cause for the drug-induced liver injury. Despite meticulous monitoring and supportive care, the patient died by a progression to fulminant hepatic failure. This case indicates that D. dasycarpus can cause lethal outcomes by fulminant hepatic failure.

Comparison of radiofrequency ablation and transarterial chemoembolization for the treatment of a single hepatocellular carcinoma smaller than 4 cm / 대한간학회지

BACKGROUND/AIMS: Radiofrequency ablation (RFA) is an established curative therapeutic modality for unresectable hepatocellular carcinoma (HCC), and transarterial chemoembolization (TACE) has been used as a palliative treatment for inoperable HCC. It is still unknown whether RFA and TACE are equally effective for improving the survival of patients with unresectable HCC that is amenable to either treatment. The aim of this retrospective study was to compare the clinical impacts of two treatments, and analyze the prognostic factors for recurrence and survival. METHODS: Ninety-three patients with a single HCC smaller than 4 cm who showed complete responses (complete ablation or complete lipiodol tagging) after treatment with RFA (n=43) or TACE (n=50) between January 2002 and February 2009 were investigated. Univariate and multivariate analyses were performed for 13 potential prognostic factors using the Cox proportional-hazards model. RESULTS: The time-to-recurrence rates at 1, 2, and 3 years after treatment were 32.9%, 44.3%, and 55.4%, respectively, for the RFA group, and 42%, 68.3%, 71.7% for the TACE group. The probability of survival at 1, 2, and 3 years was 97.7%, 77.4%, and 63.1%, respectively, for the RFA group, and 95.9%, 76.1%, and 60.2% for the TACE group. The time-to-recurrence and overall survival rates did not differ significantly between the two treatment groups. A multivariate Cox proportional-hazards model revealed that a tumor size larger than 3 cm and lower serum albumin levels were independent risk factors for recurrence, and that being male, being seropositive for hepatitis B surface antigen, and having a higher serum albumin level were independent favorable prognostic factors for survival. CONCLUSIONS: TACE and RFA exhibited similar therapeutic effects in terms of recurrence and survival for patients with a single HCC smaller than 4 cm, if they could exhibited complete responses.