ABSTRACT
Radio-frequency ablation (RFA) is a curative treatment for hepatocellular carcinoma (HCC). Percutaneous RFA has been shown to be beneficial for patients with small renal cell carcinoma (RCC) lacking indications for resection. We experienced the case of a 53-year-old male who had conditions that suggested HCC, RCC, and alcoholic liver cirrhosis. Abdominal contrast-enhanced computed tomography (CT) and magnetic resonance image showed liver cirrhosis with 2.8 cm ill-defined mass in segment 2 of the liver and 1.9 cm hypervascular mass in the left kidney. These findings were compatible with the double primary cancers of HCC and RCC. Transarterial chemoembolization (TACE) was performed to treat the HCC. After the TACE, a focal lipiodol uptake defect was noticed on a follow up CT images and loco-regional treatment was recommended. Therefore, we performed RFAs to treat HCC and RCC. There was no evidence of recurrence in the follow up image after 1 month.
Subject(s)
Carcinoma, Hepatocellular/diagnosis , Carcinoma, Renal Cell/diagnosis , Kidney Neoplasms/diagnosis , Liver Cirrhosis/diagnosis , Liver Neoplasms/diagnosis , Carcinoma, Hepatocellular/complications , Carcinoma, Hepatocellular/therapy , Carcinoma, Renal Cell/complications , Carcinoma, Renal Cell/therapy , Catheter Ablation , Humans , Kidney Neoplasms/complications , Kidney Neoplasms/therapy , Liver Cirrhosis/complications , Liver Neoplasms/complications , Liver Neoplasms/therapy , Magnetic Resonance Imaging , Male , Middle Aged , Tomography, X-Ray ComputedABSTRACT
BACKGROUND AND AIM: The Model for End-Stage Liver Disease (MELD) has been widely used for predicting short-term mortality in patients with cirrhosis in the U.S. A modification of the MELD score was published in 2011. This was validated for Korean patients with cirrhosis. METHODS: The medical records of patients with cirrhosis who were admitted to Konkuk University Hospital from 2006 to 2010 were retrospectively reviewed. The predictive value for 3-month mortality was compared between the Refit MELD, Refit MELD-Na, MELD, MELD-Na, and Child-Pugh score. The comparison was performed by calculating the area under the receiver operating curve (AUROC). RESULTS: A total of 882 patients were enrolled and 77 (8.7%) died within 3 months. The most common etiology was alcohol (45.4%) followed by hepatitis B (34.2%). The AUROCs of the Refit MELD, Refit MELD-Na, MELD, MELD-Na, and Child-Pugh score were 0.842, 0.817, 0.844, 0.848, and 0.831, respectively. The Refit MELD-Na showed a lower value than MELD-Na (P = 0.0005), MELD (P = 0.0190), and the Refit MELD (P = 0.0174). When the patients with hepatitis B, C, and alcoholic cirrhosis were analyzed, the AUROCs were 0.960, 0.920, 0.953, 0.951, 0.896, 0.959, 0.956, 0.947, 0.956, 0.943, and 0.746, 0.707, 0.752, 0.747, 0.755. CONCLUSIONS: The improvement in predictive value for 3-month mortality was not definite. The Refit MELD-Na especially showed the lowest value. This result may have been due to differences in underlying etiology of cirrhosis between Korea and the U.S. Thus, a larger prospective study is warranted.
Subject(s)
End Stage Liver Disease/mortality , Liver Cirrhosis/mortality , Models, Statistical , Aged , Asian People , Cause of Death , Female , Humans , Male , Middle Aged , Republic of Korea/epidemiology , Retrospective Studies , Sensitivity and Specificity , Time FactorsABSTRACT
BACKGROUND/AIMS: The aim of this non-randomized study was to determine the role of photodynamic therapy (PDT) in a multimodal approach for the palliation of advanced esophageal carcinoma. METHODS: Twenty consecutive patients with obstructing esophageal cancer were enrolled in this study. Each subject had dysphagia, and nine could not swallow fluid. External beam radiotherapy or a self-expandable metal stent was used following PDT for dysphagia due to recurrence of the malignancy. RESULTS: At 4 weeks post-PDT, a significant improvement in the dysphagia score was observed in 90% of patients, from 2.75 ± 0.91 to 1.05 ± 0.83 (p < 0.05). Patients with recurrent dysphagia underwent stent insertion at an average of 63 days (range, 37 to 90). The rate of major complications was 10%. Two esophageal strictures occurred, which were treated by placement of a modified expandable stent across the stricture. The median survival in these cases was 7.0 ± 0.6 months. One patient that was treated with PDT and radiotherapy is alive and showed a complete tumor response. CONCLUSIONS: PDT as a multimodality treatment is safe and effective for relieving malignant esophageal obstruction with minimal complications.
Subject(s)
Adenocarcinoma/therapy , Carcinoma, Squamous Cell/therapy , Deglutition Disorders/therapy , Esophageal Neoplasms/therapy , Esophageal Stenosis/therapy , Neoplasm Recurrence, Local , Photochemotherapy , Adenocarcinoma/complications , Adenocarcinoma/mortality , Aged , Aged, 80 and over , Biopsy , Carcinoma, Squamous Cell/complications , Carcinoma, Squamous Cell/mortality , Deglutition Disorders/etiology , Esophageal Neoplasms/complications , Esophageal Neoplasms/mortality , Esophageal Stenosis/etiology , Esophagoscopy , Female , Humans , Kaplan-Meier Estimate , Male , Metals , Middle Aged , Palliative Care , Photochemotherapy/adverse effects , Prospective Studies , Prosthesis Design , Radiotherapy, Adjuvant , Stents , Time Factors , Treatment OutcomeABSTRACT
OBJECTIVE: To investigate the association between mucosal color change and the characteristics of early gastric cancer (EGC). METHODS: Data of consecutive patients with EGC resected between August 2005 and October 2010 at Konkuk University Medical Center were analyzed retrospectively. The characteristics of EGC relative to mucosal color change were analyzed. RESULTS: Whitish discoloration of the cancer was linked to female to male gender ratio (P = 0.009), large tumor size (P < 0.001), deep invasion (P = 0.046) and depressed contours (P < 0.001) compared with EGC without discoloration or with hyperemic change. In addition, a whitish discoloration was also related to signet ring cell carcinoma (P < 0.001) and diffuse type carcinoma based on Lauren's classification (P < 0.001). On multiple linear regression analysis, diffuse type based on Lauren's classification (P = 0.017) and depth of invasion (P = 0.003) were significant independent factors for whitish discoloration. CONCLUSIONS: Mucosal color change is an important clue in the diagnosis of EGC. EGC with whitish discoloration needs more attention due to its link with the diffuse type of Lauren's classification.
