ABSTRACT
BACKGROUND: Radiofrequency thermal ablation is the first therapeutic option in percutaneous treatment of hepatocellular carcinoma but data on its long-term efficacy and safety are not conclusive. AIM: This study reports a prospective survey on radiofrequency thermal ablation in north-east Italy. METHODS: Data were collected on 401 patients with hepatocellular carcinoma (males 301, mean age: 68 years) treated by radiofrequency thermal ablation in 13 centres. Indication to treatment was: single nodule not eligible for surgery in 77% of patients, 2-3 nodes in 18% and multiple lesions in 5%. Mean size was 3 cm (1-8 cm). Treatment response was assessed at 1 month by spiral computerized tomography and then with ultrasound examination and new spiral computerized tomography. RESULTS: Complete response was obtained in 67% of patients and in 27% response was 75-99%. Complete response raised to 77% in lesions smaller than 3 cm. The morbidity rate was 34%; the mortality was 0.5%, seeding was observed in four patients. Ten patients presented an unexpected rapid disease progression. CONCLUSION: The above data show that by radiofrequency thermal ablation, complete response can be achieved only in about two-third of the cases, clearly less than expected, and that, beyond seeding, unexpected progression can be observed.
Subject(s)
Carcinoma, Hepatocellular/surgery , Liver Neoplasms/surgery , Aged , Carcinoma, Hepatocellular/diagnostic imaging , Disease-Free Survival , Female , Humans , Italy , Liver Neoplasms/diagnostic imaging , Male , Prospective Studies , Tomography, X-Ray Computed/methods , Treatment OutcomeSubject(s)
Carcinoma, Hepatocellular/surgery , Catheter Ablation/adverse effects , Liver Neoplasms/surgery , Aged , Carcinoma, Hepatocellular/pathology , Disease Progression , Female , Humans , Liver Neoplasms/pathology , Male , Middle Aged , Neoplasm Seeding , Prospective Studies , Tomography, X-Ray ComputedABSTRACT
METHODS: Personal experience with fine-needle aspiration biopsy (FNAB) performed in 114 patients (42 males and 72 females) with hepatic angiomas, in whom imaging techniques did not allow a definite diagnosis, is reported. FNAB was made on 57.9% of the cases for atypical US pattern of the nodule, on 52.6% for a previous cancer history, with both conditions on 10.5%. The procedure was carried out by cyto-assistance for collecting material and a rapid stain diagnosis with an average of 2 biopsies per patient. Diagnostic accuracy was evaluated with following laparoscopy in 25 cases; surgery in 4 cases; angiography in 6 cases and US follow-up for 1 year at least in 78 cases (1 drop-out). RESULTS: One false-negative and 4 false-positives were detected with an overall accuracy of 96%. Two minor accidents were observed, due to a profuse bleeding of giant angiomas and resolved with medical care. CONCLUSIONS: Therefore, in case of angiomas larger than 5 cm, the use of laparoscopy after FNAB to control the bleeding and to confirm the diagnosis is suggested.
Subject(s)
Biopsy, Needle/methods , Hemangioma/pathology , Liver Neoplasms/pathology , Liver/pathology , Ultrasonography, Interventional , Biopsy, Needle/adverse effects , Biopsy, Needle/instrumentation , Biopsy, Needle/statistics & numerical data , Cytodiagnosis , Female , Follow-Up Studies , Hemangioma/diagnostic imaging , Humans , Liver/diagnostic imaging , Liver Neoplasms/diagnostic imaging , Male , Middle Aged , Risk Factors , Sensitivity and SpecificityABSTRACT
The authors report their experience from 136 fine needle ultrasound (FN-US)-guided biopsies and laparoscopies. The pancreatic diseases considered by these methods were as follows: 9 cases of Pancreatitis, 11 cases of Pancreatic cysts, 5 cases of endocrine cancer, 109 cases of Exocrine cancer and 2 not conclusive cases. Diagnostic accuracy of FNB and laparoscopy was evaluated for each group and, in particular, for cancer patients. In the latter group, FNB helped to detect abdominal diffusion in 25 cases (33%) while laparoscopy, including laparoscopic washing, revealed a micro-diffusion in 31 cases (55%), the latter not shown previously by CT, RNM and US. The combination of these methods allows us to confirm the advanced stage of the majority of pancreatic cancers at onset. Furthermore, this seems to be a very reliable method to select resectable patients, thus avoiding useless, sometimes hazardous and expensive further investigation.
Subject(s)
Pancreatic Diseases/diagnostic imaging , Pancreatic Diseases/diagnosis , Biopsy, Needle , Diagnosis, Differential , Female , Humans , Laparoscopy , Male , Middle Aged , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/diagnostic imaging , UltrasonographyABSTRACT
A randomized, double-blind trial on the effects of GM1 ganglioside in cerebrovascular diseases was done on 40 patients; the treatment (40 mg/day i.m. injection) began after the acute phase and lasted 6 weeks. 18 cases took the drug and 16 the placebo. The evaluation of the cases was made by graduating the severity of the clinical signs, and some neurophysiological and morphological parameters, i.e., EEGs, flash-evoked potentials and computer tomography scans. We found that the drug, in comparison with the placebo treatment, improved the clinical signs and also the neurophysiological parameters, whereas it was ineffective for the morphological damage. These data seem of some interest in relation to the action of GM1 ganglioside in the processes of neurotransmission and neuronal plasticity as described in the experimental animal.
