Kouji Kunieda

Percutaneous transhepatic microwave coagulation therapy for hepatocellular carcinoma proliferating in the bile duct.

Hepatocellular carcinoma (HCC) often invades the portal system or hepatic veins. Along with recent increases in the incidence of HCC, there have been several reports of HCC proliferating in the bile duct and causing obstructive jaundice (1-4). Since radical hepatectomy is rarely possible in these cases, conservative therapy is the sole therapeutic modality. Transcatheter arterial embolization (TAE) is reported to be effective in some cases, but the number of studies is limited and the efficacy of the procedure has not been established (5-7). Surgical treatment was not possible and TAE we found to be ineffective in the present case of HCC proliferating in the bile duct. We applied percutaneous ethanol injection therapy (PEIT) (8, 9), percu taneous t ranshepat ic microwave coagulat ion therapy (PTMCT), and radiotherapy, and the combination produced satisfactory clinical results. To our knowledge, this is the first reported case in which local treatment was successfully applied to HCC that had infiltrated the bile duct.

DIFFUSE CALCIFICATION IN GASTRIC CANCER

The progressive expansion of calcification into the wall of the stomach and peritoneal metastatic foci was observed in a 31-year-old female with Borrmann type 4 calcified advanced gastric cancer. Despite treatment with systemic lentinan, uracil tegaful and mitomycin C, together with intraperitoneal injections of mitomycin C, OK-432 and prednisolone, the patient died 27 months after first presentation. The case provided a useful means of studying the mechanism of calcification.

Development of local necrosis and side-effects after hepatic injections of acetic acid solutions

Abstract Acetic acid injection therapy has recently been studied as a treatment for hepatocellular carcinoma. Since trials of this therapy have just begun, both basic and clinical studies of it are presently required. Therefore, the efficacy and safety of this therapy as a treatment for hepatocellular carcinoma were examined in rats. When acetic acid was injected into normal rat liver, the extent of necrosis at the site of injection expanded in a dose-dependent manner. At concentrations of 30% and above, acetic acid began to prove fatal, and mortality increased in a dose-dependent fashion. At a concentration of 45% and above, all rats died within 2 days after injection due to acute multi-organic circulatory failure. On histological examination, distinct thorombus formation was observed in the liver. We conclude that additional detailed examination of the effects of various amounts and concentrations of acetic acid and of the effects of acetic acid injection on other organs should be performed prior to clinical application of this therapy.

Acute Gastric Lesions Induced by Transcatheter Arterial Embolization and Intra-arterial Infusion Chemotherapy for Hepatocellular Carcinoma

We performed an endoscopic study of the acute gastric lesions induced by transcatheter arterial embolization (TAE) and infusion chemotherapy (one shot infusion: OSI). Forty‐eight patients with primary hepatocellular carcinoma were investigated, and of them, 25 received TAE and 23 were treated with OSI. Endoscopy was performed within 1 week both before and after therapy and any gastric mucosal changes were noted. Before treatment, all patients had gastric lesions such as redness, erosion, hemorrhage and ulcer. These lesions were exacerbated or new lesions appeared after both TAE and OSI in about 50% of the subjects, and no significant difference in the incidence of lesions was observed between these two treatments. Moreover, there was no significant correlation between the exacerbation or new appearance of gastric lesions and the Childs classification, the catheter position, or the presence or absence of A‐P shunt or portal thrombus.

Benign Strictures of the Intrahepatic Bile Ducts Managed with Percutaneous Transhepatic Cholangioscopy: A Case Report

Benign strictures of the intrahepatic bile ducts were detected, by percutaneous transhepatic cholangioscopy combined with forceps biopsies, in a patient who presented symptoms suggesting cholangitis. The patient was successfully treated by non‐operative stricture dilation techniques, with the aid of cholangioscopy. In this paper, the usefulness of percutaneous transhepatic cholangioscopy for the management of benign biliary strictures is discussed.