An 18-year follow-up of primary hepatic carcinoid with carcinoid syndrome.

Primary hepatic carcinoid is extremely rare. Although one of the 18 previously reported cases was accompanied by clinical features of carcinoid syndrome, no patient manifested these features as the presenting complaint, as was true in our case. During the 18 years this patient has been followed, she has been treated with most of the major therapeutic methods, including systemic chemotherapy, hepatic artery chemoembolus injection, extended right hepatic lobectomy, and, eventually, more systemic chemotherapy and octreotide. She continues to be nearly asymptomatic and is still working. We present the results of extensive chemical and hormonal assays, briefly summarize the primary hepatic carcinoids reported previously, and review therapy of this disease.

Control of carcinoid syndrome with hepatic artery embolization.

Eighteen patients with metastatic carcinoid were treated by hepatic artery embolization with Gelfoam or polyvinyl alcohol foam for control of the carcinoid syndrome. Seventeen showed subjective or objective clinical improvement, including less skin flushing, diarrhea, and bronchospasm. Fourteen showed improvement in biochemical indices, including decreased urinary 5-hydroxyindoleacetic acid levels. The mean life span of the treated patients from the first episode of flushing to the time of this report was 5.4 years, and half of the patients are still alive. This survival time compares favorably with previous reports of survival of 3.2 years from the onset of flushing.

Anaesthesia for the carcinoid syndrome: a report of nine cases.

Anaesthesia for nine patients with the carcinoid syndrome is described. With the exception of one case in which severe bronchospasm and hypertension occurred, complications were minor. Steroids, aprotonin and methotrimeprazine appear to be useful agents in the management of such patients. An anaesthetic technique employing thiopentone, pancuronium and nitrous oxide proved satisfactory.