[Transhepatic arterial chemoembolization with gemcitabine and carboplatin for the treatment of stage III hepatocellular carcinoma].

OBJECTIVE: To evaluate the efficiency and safety of transhepatic arterial chemoembolization (TACE) with gemcitabine and carboplatin for the treatment of stage III hepatocellular carcinoma (HCC). METHODS: Sixty-one HCC patients were treated by TACE. During TACE, At first, intra-arterial infusion of carboplatin 300 mg/m2, then gemcitabine 1000 mg/m2 with 5-30 ml of ultra-lipoidal iodide oil emulsion was used for arterial embolization. The toxicity and hepatic damage were observed according to WHO anticancer drug toxicity criteria and Child-Pugh classification criteria, respectively. The survival time was also observed during follow-up. RESULTS: The blood toxicity was bone marrow suppression presented as grade I leucopenia in 39.3%, grade II in 29.5%, grade III-IV in 18.0%. Grade II-III nausea and vomiting developed in 96.8% of the patients. Hepatic function damage became aggravated in 16 patients from A to B class, in 2 from A to C class, and in 6 from B to C class according to Child-Pugh classification criteria. The median survival time was 20 months with a range of 5 to 3 5 months. CONCLUSION: Transhepatic arterial chemoembolization using carboplatin and mixture of gemcitabine with ultra-lipoidal iodide oil emulsion is safe and effective in the management of stage III hepatocellular carcinoma. This regimen can also improve their quality of life.

Association between vascular endothelial growth factor and metastasis after transcatheter arterial chemoembolization in patients with hepatocellular carcinoma.

BACKGROUND: Hypoxia up-regulates vascular endothelial growth factor (VEGF) and stimulates the growth of hepatocellular carcinoma (HCC) cells. This study was designed to investigate the association between changes in plasma VEGF levels after transcatheter arterial chemoembolization (TACE) and HCC progression, especially in relation to metastasis. METHODS: Plasma VEGF levels were measured by quantitative sandwich enzyme-linked immunosorbent assay (ELISA R&D system). Plasma VEGF levels were measured before, 3 days and 4 weeks after TACE in 30 patients with HCC. The development of metastasis was evaluated at the end of the third month after TACE. RESULTS: The plasma VEGF levels of the 30 patients with HCC were 154.47+/-90.17 pg/ml. The total plasma VEGF levels after TACE increased compared with their basal levels (P<0.05), and the plasma VEGF levels had a tendency to increase in patients with heterogeneous uptake of iodizdoil and portal vein thrombosis. Follow-up for six months showed metastatic foci in 20 patients (74%) with increased plasma VEGF, but none of the patients with decreased plasma VEGF developed metastasis. CONCLUSION: Increased plasma VEGF expression is associated with the development of metastasis in HCC after TACE.

[Relation between vascular endothelial growth factor and reoccurence-metastasis after transcatheter arterial chemoembolization in hepatocellar carcinoma].

OBJECTIVE: To investigate the relation between changes in serum vascular endothelial growth factor (VEGF) level after transcatheter arterial chemoembolization (TACE) and hepatocellular carcinoma (HCC) progression, especially in relation to metastasis. METHODS: Serum VEGF expression level, measured by quatitative sandwich enzyme-linked immunosorbent assay (ELISA, R&D system), was measured before, 3 days and 4 weeks after TACE in 30 patients with HCC. The development of metastasis was evaluated at the end of the third month after TACE. RESULTS: 1. The serum VEGF level in 30 patients was 154.47 +/- 90.17 pg/ml, 2. Post-TACE total serum VEGF level increased as compared with their basal level in 30 patients (P < 0.05) and serum VEGF level had a tendency to increase in patients with heterogeneous uptake of iodized oil and portal vein thrombosis. During the follow-up of 1 - 2 years, metastatic foci were found in 74% (20) patients with SVEGF increase, while none of the patients showing SVEGF decrease developed metastasis. CONCLUSION: Serum VEGF expression increase is associated with the development of metastasis in hepatocellular carcinoma after TACE.

[Acute respiratory tract obstruction during thyroid operation: analysis of 10 cases].

OBJECTIVE: To explore the causes and management of acute respiratory tract obstruction in patients undergoing thyroid operation. METHODS: A retrospective review was conducted in 10 such cases that we encountered in our 11 years' experience with thyroid operation. RESULTS: Respiratory tract obstructions occurred in 10(0.31%) of 3,186 cases during thyroid operation. The causes for the obstructions included tracheomalacia in 2 cases, hematoma compression in 5 cases, trachea convulsion in 2 cases and phlegm obstruction in 1 case. Tracheotomy or intratracheal intubation was performed in 6 cases and hematoma removal in 4 cases, with the occurrence of death in 1 case. CONCLUSION: Hematoma compression and tracheomalacia etc. are among the most common causes of acute respiratory tract obstruction during thyroid operation, the occasion of which demands immediate implementation of tracheotomy or intratracheal intubation.