Description of patients with midgut carcinoid tumours: clinical database from a Danish centre.

BACKGROUND: We have initiated a clinical database of patients with neuroendocrine tumours (n = 132). Data on patients with well-differentiated endocrine carcinoma (WHO classification) previous classified as midgut carcinoid patients, are presented. PATIENTS AND METHODS: Retrospectively, 56 patients with midgut carcinoid tumours were evaluated with respect to symptoms, primary tumour size, metastases, tumour markers, treatment and survival. RESULTS: Flushing was described in 29%, diarrhoea in 52%, abdominal pain in 34%, bronchial constriction in 2% and carcinoid heart disease in 4% of the patients. Fifty-two percent had liver metastases at referral. Twenty-seven percent were considered to have had radical surgery. Patients not considered for radical surgery and patients with liver metastases had significantly higher tumour marker levels (serum chromogranin A (CgA), serum serotonin and urinary 5-hydroxyindolic acid (5-HIAA)) compared to radically-operated patients and to patients without liver metastases (p<0.05, respectively). For all the midgut carcinoid tumour patients the overall 5-year survival rate was 72%. The radically-operated patients had a 5-year survival rate of 100% (other death causes excluded). The patients with normal CgA or <5 liver metastases at referral had a 100% 5-year survival rate. The patients with <5 liver metastases had a significantly better 5-year survival rate compared to patients with multiple liver metastases (100% vs. 50%, p<0.05). CONCLUSION: This group of patients exhibited the same characteristic clinical features with similar survival as reported from other specialised centres. Radical surgery, normal CgA level and <5 liver metastases indicated a good prognosis and patients with <5 liver metastases had a significantly better survival compared to patients with multiple liver metastases.

[Transjugular intrahepatic portosystemic shunt (TIPS) for the treatment of complications of portal hypertension in patients with liver cirrhosis]. / Transjugulaer intrahepatisk portosystemisk shunt (TIPS) til behandling af komplikationer ved portal hypertension hos patienter med levercirrose.

Portal hypertension is a main cause for the development of esophago-gastric varices, ascites and hepatic nephropathy in liver cirrhosis. Reduction of portal pressure by a transjugular intrahepatic portosystemic shunt (TIPS) procedure has been possible for the last decade. The treatment reduces the risk for variceal bleeding, reduces ascites formation and may improve renal function in hepatic nephropathy. Improved survival, however, has not yet been documented. Complications comprise procedure related events (puncture of liver capsule, bleeding, infection, hemolysis with mortality 1-5%), shunt stenosis (30-80% during the first year but reversible), and encephalopathy (30% intermittent, 10% chronic). Indications for the procedure are primarily variceal bleeding resistant to conventional pharmacologic and endoscopic treatment. Absolute and relative contraindications are severe hepatic failure, a history of hepatic encephalopathy, infections, respiratory failure, and non-hepatic renal insufficiency.

[TIPS--transjugular intrahepatic portosystemic shunt. Experiences from a recently started center]. / TIPS--transjugulaer intrahepatisk portosystemisk shunt. Erfaring fra en nystartet centerfunktion.

The transjugular intrahepatic portosystemic shunt (TIPS) is a percutaneous, minimally invasive, method of creating a portosystemic shunt for the treatment of portal hypertension. The results of the first 54 TIPS procedures are reported. There were no severe procedure-related complications. TIPS implantation was successful in 52 patients. Rebleeding was seen in 13% of the patients. Hepatic encephalopathy developed in 19%, but only in 11% as a chronic complication. Seven out of 9 patients with refractory ascites no longer required paracentesis after six months. The cumulative survival for the whole group was 81% after one year and 62% after three years.

[Radiofrequency ablation of malignant liver tumors]. / Radiofrekvensablation af maligne levertumorer.

INTRODUCTION: Radio-frequency ablation (RFA) is a minimally invasive therapy for malignant liver tumours. In a pilot study, we evaluated the technique and its ability to achieve local tumour control. The treatments were performed either as a percutaneous procedure in inoperable patients or intraoperatively during partial hepatectomy to destroy unresectable metastases. MATERIAL AND METHODS: Fourteen patients with liver metastases from colorectal (11) or endocrine (3) tumours were treated with cooled-needle electrode RFA. The electrodes were placed in the treated tumours under ultrasound guidance. Two patients were excluded from the study and in the remaining 12 patients, 52 metastases (7-50 mm in diameter) were treated in 26 sessions. Procedure efficacy was evaluated with contrast enhanced CT and ultrasound guided biopsy performed 1, 3, and 6 months after treatment. RESULTS: Complete response was achieved in 89% of treated metastases, evaluated after a follow-up of 4-35 months (mean 15 months). Complications were seen in five of 26 treatment sessions, among these the most serious was a gall bladder fistula. DISCUSSION: RFA appears to be a promising therapeutic modality in the treatment of hepatic malignancies. The clinical use of RFA has shown an ability to achieve local tumour control in about 90% of treated metastases. The patients treated were inoperable, but the nevertheless survival data are encouraging. The role of RFA as the treatment of choice has still to be tested against surgery in a large, prospective, randomised series with a long observational period. RFA is a commendable treatment, because of its minimal invasiveness, the low rate of complications, and the low cost.

[Budd-Chiari syndrome illustrated by four case reports]. / Budd-Chiaris syndrom illustreret ved fire sygehistorier.

Budd-Chiari syndrome (BCS) represents obstruction of hepatic venous drainage. Patients with BCS must be managed individually, because the localisation of the obstruction, the cause, and natural history of the specific lesion differ between patients. We report four cases of Budd-Chiari syndrome where the first patient (who was protein C-deficient, took an oral contraceptive, and smoked) was successfully treated with transjugular intrahepatic portosystemic shunt (TIPS), the second patient (with polycythaemia vera) was treated with venesection and anticoagulation, the third patient underwent a successful liver transplantation. The last patient had a congenital vascular web and was treated by stenting.