These preliminary results indicate that diffusion-weighted MR imaging can be useful in characterizing focal liver masses. With the exception of cystic metastatic tumors, the technique may be especially useful in tumors that appear markedly hyperintense on T2-weighted images due to a long T2.

From January 1986 to December 1988, a prospective trial of transcatheter arterial treatment was carried out for hepatocellular carcinoma (HCC). Two hundred seventy-five patients were included. Okuda's staging system was employed. Patients with Stage I and II HCC were treated by transcatheter arterial embolization (TAE) with a gelatin sponge containing an anti-cancer agent (protocol 1a); a gelatin sponge and iodized oil mixed with an anti-cancer agent (protocol 1b); or iodized oil mixed with an anti-cancer agent (protocol 2). Patients with Stage III HCC were treated with iodized oil with anti-cancer agent (protocol 2). As an exception, patients with an unsuccessful superselective catheterization into the proper hepatic artery by Seldinger technique or obstruction of the main trunk of the portal vein were treated with percutaneous transcatheter arterial infusion into the common hepatic artery regardless of stage (protocol 3). Tumor type and extension, area of tumor involvement, portal vein involvement, method of treatment, and presence of ascites and icterus were found to be the significant factors for an initial response to therapy. Treatment method was the most important factor. Respective survival rates at 1 and 2 years were 70.9% and 55.3% for protocol 1a; 62.3% and 43.8% for protocol 1b; 37.8% and 18.3% for protocol 2; and 16.5% and 0% for protocol 3. Many factors proved to significantly influenced prognosis; however, tumor type had the most important prognostic significance followed by AFP value, ascites, treatment protocol, and area of tumor involvement.

No abstract

37 patients with intractable idiopathic epistaxis were treated with superselective embolisation between 1995 and 1999. A total of 40 embolisations was performed, including three procedures for recurrence. The embolic material was gelatin sponge in 27 procedures, microcoils in 9 and both gelatin sponge and microcoils in 4. Immediate cessation of nasal bleeding was obtained in all patients after embolisation. Recurrent epistaxis occurred in 2 (5.4%) of the 37 patients within 7 days after initial embolisation, giving a short-term success rate of 94.6%. The long-term follow-up ranged from 1-51 months (mean 21.6 months). Late re-bleeding occurred in two patients, giving a long-term success rate of 94.6%. Two patients underwent re-embolisation; it was necessary to embolise the ipsilateral facial artery and/or the contralateral internal maxillary as well as the ipsilateral maxillary artery. Although the overall complication rate was 45.0%, no major complications occurred. Superselective embolisation with gelatin sponge is an effective and safe treatment technique for intractable idiopathic epistaxis.

No abstract

OBJECTIVE. Thepurpose of thisstudywastoevaluate thechanges intreated lesions andsurroundingparenchymaof the liver aswell asassociated findingson CT in patientswho un derwent microwave coagulation therapy for hepatic tumors. MATERIALS AND METHODS. We retrospectively reviewedthe findingson helicaldynamic CT scansobtained before and after percutaneousor intraoperative microwave coag ulationtherapyfor 74 lesions in 63 patients withhepatocellular carcinoma or metastatic he patictumors.Indicationsfor microwavecoagulationtherapyincludedprimaryhepatictumors in 54 patients and hepatic metastasis in nine patients. Sixty percent nonionic contrast material, infusedat 3 ml/sec,wasfollowed by sequential arterialphase,portalvenousphase,andequi librium phasehelical CT of the entire liver in all patients. RESULTS. All lesionswerehypodense andextended to the liver capsule. The lesionstreated with percutaneous microwave coagulation therapy were teardrop-shaped, whereas those treated with intraoperative microwave coagulation therapy were round. Peripheral en hancement was seen on contrast-enhanced CT in 93% of the treated lesions immediately after microwave coagulation therapy; however, such enhancement disappeared on follow-up CT. Hemorrhage within the lesions and pleural effusion were found in nine patients. Complica tions detected on CT included intratumoral abscess (n = 4), subcapsular hematoma (n = 2), tu mor dissemination (n = 3), ascites(n = 5), andportalvein thrombosis(n = 1). CONCLUSION. CT of theliverin patients undergoing microwave coagulation therapyshowed findings that were dependent on the technique of therapy. Thus, CT scans must be carefully analyzed to avoid confusing results of therapy with findings that indicate complica tionsrequiringfurthertreatment. Microwave coagulation therapy has been usedto treat hepaticmalig nant tumors such as hepatocellular carcinomas and metastatic tumors [1â€"6]. Mi crowave coagulation therapy is a noveltreat ment for hepatic malignant tumors that makes possible a potentially curative treatment for patients who would not be candidates for tradi tional hepatic resection. The localized nature of microwave coagulation therapy allows the preservation of surrounding normal liver tis sueâ€"unlike traditional segmentectomy or lobectomyâ€"which is animportant advantage in patients with primary hepatic tumors such as hepatocellular carcinomas, who occasion ally do not qualify for traditional hepaticresec tion because of multiplicity of lesions and associated advanced liver dysfunction. Al though transcatheterarterial embolization ther apy with iodized oil has been widely used to treat hepatocellular carcinomas [7], the thera tion therapy have not been reported. Therefore, the purpose of this study was to evaluate the CT appearance of lesions after microwave co agulation therapy. Associated findings after treatmentalso were analyzed. Materials and Methods PatientsWe retrospectivelyreviewedthe recordsof 74 Ic sionsin 63 patientswho underwent microwave co agulation therapy at our institution betw...

In addition to variceal bleeding, haematemesis may occur due to haemorrhagic gastritis in patients with portal hypertension. This has been known as portal hypertensive gastropathy (PHG). We have evaluated the effects of the transjugular intrahepatic portosystemic shunt (TIPS) on portal venous pressure (PVP) and endoscopic gastric mucosal changes observed in patients with portal hypertension. We performed TIPS in 12 patients with complications due to portal hypertension as follows: variceal bleeding in nine patients (bleeding from oesophageal varices in seven and gastric varices in two), refractory ascites in three and haemorrhage from severe PHG in one. Endoscopic examinations were performed before and after TIPS for all patients. Changes of PVP and gastric mucosal findings on endoscopy were analysed. Before TIPS, PHG was seen in 10 patients. Portal venous pressure decreased from an average of 25.1+/-8.8 to 17.1+/-6.2 mmHg after TIPS (P<0.005). On endoscopy, PHG improved in nine of 10 patients. Oesophagogastric varices improved in eight of 11 patients. In one patient with massive haematemesis, haemorrhage from severe PHG completely stopped after TIPS. Because TIPS effectively reduced PVP, this procedure appeared to be effective for the treatment of uncontrollable PHG.

No abstract