A case of protruding eyeballs and diminishing vision.

This case report discusses issues related to a 56-year-old man from Bangalore who presented with complaints of a gradual protrusion of his eyeballs along with diminishing vision for the previous month. The approach to diagnosis and management issues around this unusual presentation is dicussed.

Prognostic factors for chemoembolization in liver metastasis from endocrine tumors.

BACKGROUND/AIMS: The aims of this study were to assess response rates, evaluate side effects and determine prognostic factors for both response and toxicity in patients with liver metastasis from endocrine tumors treated with chemoembolization. METHODOLOGY: Data concerning 64 patients who underwent a total of 186 sessions of chemoembolization were retrospectively evaluated and correlated with response and toxicity after chemoembolization. RESULTS: Overall clinical, morphological and biological response rates were 93%, 74% and 52% respectively. Complete control of hormone-related symptoms was obtained in 59% of patients with a mean duration of response of 15 months. Transient major complications occurred after 5.9% of sessions and 3 patients died. In the univariate and multivariate analyses, a non-pancreatic primary and chemoembolization as first-line non-surgical treatment were prognostic factors for clinical response, and <30% of liver involvement for morphological response. A significant increase in morbidity was noted in patients with more than 70% of liver involvement. CONCLUSIONS: Hormone-related symptoms were controlled in the majority of patients with a non-pancreatic primary and in those treated with chemoembolization as first-line therapy. Morphological response and toxicity were respectively correlated with liver involvement of less than 30% and greater than 70%.

Percutaneous radiofrequency ablation of hepatic tumors during temporary venous occlusion.

OBJECTIVE: We evaluated the feasibility, tolerance, and efficacy of percutaneous hepatic vein or segmental portal branch balloon occlusion during radiofrequency ablation of hepatic malignancies. SUBJECTS AND METHODS: Ten tumors were treated by percutaneous radiofrequency ablation during balloon occlusion of a hepatic vein (n = 8) or a segmental portal branch (n = 2). Venous occlusion was undertaken because the tumor was in contact with a hepatic vein (n = 3) or a portal branch (n = 1); because the tumor exceeded 35 mm in width (mean, 44 mm), which was considered the maximum size amenable to ablation in a single session (n = 2); or because of both large size and contact with a hepatic vein (n = 3) or a portal branch (n = 1). RESULTS: Vascular occlusion was always technically possible. Radiofrequency was delivered to one to three locations (mean, 1.9 locations) with a cluster electrode. The largest axis of radiofrequency-induced lesions after ablation with the cluster needle-between 42 and 51 mm (mean, 49 mm)-was always larger than the targeted tumor. These sizes were statistically larger than in a matched control group of patients who underwent radiofrequency ablation without vascular occlusion (p < 0.0003). After a mean follow-up of 12.6 months, CT and MR imaging revealed complete destruction of nine tumors after a single radiofrequency ablation treatment; one tumor required three treatments to achieve ablation. Five patients are tumor-free 12-18 months (mean, 14.4 months) after the first radiofrequency ablation treatment, and five developed new liver metastases. CONCLUSION: Temporary hepatic vein or portal branch occlusion during radiofrequency ablation can safely facilitate the treatment of large tumors or tumors in contact with the walls of large vessels.