Transarterial chemoembolisation of liver tumours is typically followed by elevated body temperature and liver transaminase enzymes. This has often been considered to indicate successful embolisation. The present study questions whether this syndrome reflects damage to tumour cells or to the normal hepatic tissue. The responses to 256 embolisations undertaken in 145 patients subdivided into those with hepatocyte-derived (primary hepatocellular carcinoma) and nonhepatocyte-derived tumours (secondary metastases) were analysed to assess the relative effects of tumour necrosis and damage to normal hepatocytes in each group. Cytolysis, measured by elevated alanine aminotransferase, was detected in 85% of patients, and there was no difference in the abnormalities in liver function tests measured between the two groups. Furthermore, cytolysis was associated with a higher rate of postprocedure symptoms and side effects, and elevated temperature was associated with a worse survival on univariate analysis. Multivariate analysis demonstrated that there was no benefit in terms of survival from having elevated temperature or cytolysis following embolisation. Cytolysis after chemoembolisation is probably due to damage to normal hepatocytes. Temperature changes may reflect tumour necrosis or necrosis of the healthy tissue. There is no evidence that either a postchemoembolisation fever or cytolysis is associated with an enhanced tumour response or improved long-term survival in patients with primary or secondary liver cancer.
A 51-year-old man presented to the emergency department shortly after a fall from an eighth story window. His vital signs upon arrival were a blood pressure of 60/40 mm Hg, heart rate of 124 bpm and Glasgow Coma Scale of 9. A physical examination revealed crepitus of the chest and pelvic instability. After initial resuscitation, his blood pressure was increased to a systolic pressure of 70 mm Hg. The pericardial view of the focused abdominal sonography for trauma did not show pericardial effusion, but revealed a large amount of pleural effusion that had not been visualized on the chest radiograph. An immediate right tube thoracostomy was performed, evacuating more than 2000 cc of blood.To address the massive haemothorax with hemodynamic instability, a right anterolateral thoracotomy was performed in the emergency department (Fig. 1). Resuscitation with surgical repair was unsuccessful and the patient died of profound shock.Pericardial rupture and concomitant cardiac injury are rare after a blunt injury, 1 but have high mortality. Early prompt surgical intervention is the key to survival, but a diagnosis of this type of injury is difficult due to decompression of the pericardial blood into the pleural space, resulting in a negative echocardiographic study and also the mimicking massive haemothorax. 2 A radiology examination normally does not provide sufficient information unless it is complicated with cardiac herniation. 3 Although an emergency department thoracotomy is not commonly performed for blunt trauma, the suspicion of cardiac and pericardial rupture may justify its consideration in highly selected patients who present to the hospital alive.
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