Retrospective study to evaluate local tumor control and survival data after transcatheter arterial chemoembolization with doxorubicin eluting beads in the treatment of hepatocellular carcinoma. Between April 2007 and November 2008, a total of 47 patients (mean age 61,7 years; range 42-84 years) with hepatocellular carcinoma were treated with transcatheter arterial chemoembolization. In total 73 chemoembolization procedures were performed in superselective manner with microcatheter (mean 1,57 procedures per patient). The local chemoembolization protocol consisted of doxorubicin eluting beads mainly 300-500 micra but also 500-700 micra and 700-900 micra, to a maximum dose per session of 150 mg doxorubicin. Tumor response was evaluated with CT imaging. Change in tumor size was calculated and response was evaluated according to the European Association for the Study of the Liver (EASL) criteria. Survival from first chemoembolization was calculated in the subgroup treated between April 2007 and January 2008 (24 patients). Follow-up imaging was performed until January 2009 or patient death. Evaluation of tumor response resulted in complete response in 13 patients (27,7%), partial response in 15 patients (31,9%), stable disease in 9 patients (19,1%) and progressive disease in 10 patients (21,3%). The one year survival rate after chemoembolization in the 24-patient subgroup was 54%. Chemoembolization with doxorubicin eluting beads is a minimally invasive, safe and effective therapy option for palliative treatment of hepatocellular carcinoma.
Introduction: Upper gastrointestinal bleeding caused by hemobilia is rare and a consequence of vascular-biliary fistula. These fistulas are mainly associated with biliary surgeries’ iatrogenic injuries.
Case Report: This case reports of an elderly man with prior history of laparoscopic gallbladder bed resection and portal lymphadenectomy, which presented with hemobilia one month after the surgery. Diagnosis was not straightforward, but the patient was successfully treated with selective arteriography and hepatic artery stenting.
Conclusion: High suspicion for hemobilia in a patient with right upper quadrant pain, jaundice, and blood loss in the stools after biliary surgery and rapid intervention are essential to avoid further complications.
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