1/172. Solitary hepatic hemangioma in a newborn infant complicated by cardiac failure, consumption coagulopathy, microangiopathic hemolytic anemia, and obstructive jaundice. Case report and review of the literature.A newborn infant with a large hepatic hemangioma developed congestive heart failure, consumption coagulopathy, microangiopathic hemolytic anemia, and obstructive jaundice. The patient was mildly heparinized (250 units per kg and day) and underwent successful resection of the tumor without lobectomy at the age of 3 days. blood volume increased from 93.9 ml/kg at the age of 5 h to 124.2 ml/kg prior to surgery. Red-cell mass simultaneously decreased from 53.8 to 39.4 ml/kg. The increase of blood volume is explained by congestive heart failure, the decrease of red-cell mass by intravascular coagulation within the tumor resulting in formation of thrombi and microangiopathic hemolytic anemia. A review of the literature on infants with symptoms caused by an intrahepatic hemangioma during the first month of life confirms that surgical intervention is the treatment of choice for infants with giant solitary hemangioma of the liver.- - - - - - - - - - ranking = 1keywords = consumption coagulopathy, intravascular coagulation, coagulopathy, consumption, coagulation, intravascular (Clic here for more details about this article) |
2/172. Severe thyrotoxicosis due to hyperfunctioning liver metastasis from follicular carcinoma: treatment with (131)I and interstitial laser ablation.Liver metastases from differentiated thyroid tumors are unusual clinical findings, and are only rarely hyperfunctioning. We report a case of thyrotoxicosis caused by a huge and surgically unresectable liver metastasis from follicular thyroid cancer, unresponsive to treatment with large doses of thionamides. To avoid the hazardous side effects of (131)I treatment in a severely thyrotoxic patient, a preliminary debulking of the liver mass was performed by means of percutaneous interstitial laser photocoagulation. Three treatments (total energy delivery: 7200 J) were performed under ultrasound guidance, with no serious complications, during a 2-week period. One month later, serum thyroid hormones had decreased, general condition was improved, and magnetic resonance evaluation revealed large and well-defined areas of necrosis of metastatic tissue. During the following 10 months, the patient underwent 3 radioiodine treatments. Eighteen months after diagnosis, thyroid hormones were within normal levels, liver mass decreased, and the clinical condition markedly improved. The combination of percutaneous interstitial laser photocoagulation treatment and radioiodine therapy made possible the effective management of a hyperfunctioning and surgically untreatable liver metastasis from thyroid follicular carcinoma, avoiding the side effects of (131)I therapy in a thyrotoxic patient and increasing the effectiveness of radioiodine-induced neoplastic tissue ablation.- - - - - - - - - - ranking = 0.0013630570433098keywords = coagulation (Clic here for more details about this article) |
3/172. Thrombelastographic patterns during cryotherapy for recurrent hepatocellular carcinoma.A cirrhotic patient with recurrent hepatocellular carcinoma and thrombocytopenia undergoing cryotherapy showed: 1) transient hyperfibrinolysis shortly after platelet transfusion, and 2) evidence of activation of coagulation after freezing and thawing of tumor as measured on the thrombelastography. No anti-fibrinolytic treatment was required for the hyperfibrinolysis which subsided spontaneously in this patient. This case report highlights that: 1) in patients with chronic liver disease, platelet transfusion might potentially worsen rather than improve the hemostatic function by activation of fibrinolysis, and 2) activation of coagulation may underlie the perioperative coagulation changes seen in cryotherapy.- - - - - - - - - - ranking = 0.0020445855649647keywords = coagulation (Clic here for more details about this article) |
4/172. The non-surgical treatments of hepatocellular carcinomas in a patient with severe hemophilia a.We recently treated a patient with multiple hepatocellular carcinomas (HCC) who had severe hemophilia a and thrombocytopenia secondary to cirrhosis. He was not a candidate for surgery because of his liver failure. Transcatheter arterial chemoembolization and percutaneous ethanol injection therapy were successfully performed without complications by maintaining factor viii levels above 40%. We believe that the non-surgical treatment of HCC can be performed safely in patients with coagulation disorders, by the appropriate administration of coagulation factors, despite thrombocytopenia and/or elongation of the prothrombin time from cirrhosis.- - - - - - - - - - ranking = 0.0013630570433098keywords = coagulation (Clic here for more details about this article) |
5/172. Acquired inhibitors to the coagulation factor xii associated with liver disease.Three patients with liver disease and prolonged activated partial thromboplastine time (APTT) on routine tests are presented. One woman had metastatic liver disease from gastric carcinoma, a second woman had autoimmune hepatitis, and one man had severe chronic hepatitis b. APTT was not corrected after mixing experiments with 25%, 50%, and 75% of normal pool plasma, indicating the presence of an acquired inhibitor. In all three cases, factor xii coagulant activity was reduced: <1%, <1%, and 3%, respectively, while all of the other coagulation factors were normal. In all three cases no other auto-antibody was detected. In the first patient, APTT was normalized after a left liver lobectomy, whereas the primary lesion remained unresected. In the second patient, the FXII activity was improved after corticosteroid therapy but never returned to normal values. In the third patient, the APTT was improved after hydroxychloroquine therapy. None of the patients had hemorrhagic or thrombotic phenomena.- - - - - - - - - - ranking = 0.0034076426082746keywords = coagulation (Clic here for more details about this article) |
6/172. Percutaneous microwave coagulation therapy for superficial hepatocellular carcinoma.We report a 67 year-old man with residual hepatocellular carcinoma after arterial embolization therapy, which was located on both the anterior and inferior surfaces of segment 6 of the liver. Percutaneous microwave coagulation therapy could be performed safely and the treated tumor became non-enhancing on contrast computed tomography. Two years after treatment, the tumor remains non-enhancing on contrast computed tomography and has decreased in size. Percutaneous microwave coagulation therapy appears to be useful even in patients who have superficial liver tumors associated with cirrhosis.- - - - - - - - - - ranking = 0.0040891711299295keywords = coagulation (Clic here for more details about this article) |
7/172. Generalized intraperitoneal seeding of hepatocellular carcinoma after microwave coagulation therapy: a case report.We first describe a case of generalized intraperitoneal seeding of hepatocellular carcinoma (HCC) after microwave coagulation therapy (MCT). A 61 year-old man underwent operative MCT for an exophytic HCC, 60 mm in diameter, in segment IV of his cirrhotic liver. Despite successful tumor ablation, the serum alpha-fetoprotein levels continuously rose after MCT. Five months later, radiographic examinations delineated several perihepatic masses with hypervascularity, and the patient presented with constipation. At the second laparotomy, there were numerous small peritoneal metastases involving the entire peritoneal cavity and slightly bloody ascites. An omental mass, 50 mm in diameter, involved the transverse colon. Most of these intraabdominal masses were removed together with the involved colon. Histologically, the initial tumor was a moderately differentiated HCC, and the peritoneal masses were poorly differentiated HCCs. The patient died of rapid tumor progression and bleeding 2 months later. In conclusion, we should be aware of the possible occurrence of peritoneal seeding after MCT for HCC. Every effort should be made to prevent this serious complication, particularly in cases of superficial, large, and less differentiated HCCs.- - - - - - - - - - ranking = 0.0034076426082746keywords = coagulation (Clic here for more details about this article) |
8/172. Correction of both prothrombin time and primary haemostasis by recombinant factor VII during therapeutic alcohol injection of hepatocellular cancer in liver cirrhosis.We evaluated the efficacy of recombinant factor VII to correct impaired haemostasis in a patient with liver cirrhosis requiring an invasive procedure. A test intravenous bolus of 80 microg/kg of recombinant factor VII was given to a Jehovah's Witness, with a solitary 4.4-cm hepatocellular carcinoma and underlying hepatitis c virus cirrhosis, in an attempt to correct his haemostatic disorders and safely inject the tumour with alcohol. An extensive portal block had precluded consideration of liver transplantation. Haemostasis was evaluated by clotting assays, bleeding time and thromboelastography 10 min before and 10 min and 1, 2, 4, 8 and 24 h after factor VII infusion. Parameters of both coagulation (prothrombin time) and platelet function (bleeding time and the alpha and ma parameters of thrombelastography) were improved 10 min after factor VII infusion; improvements lasted 4 to 8 h or more. platelet count did not change and there was no evidence of disseminated intravascular coagulation. The improvements in haemostatic parameters correlated significantly with the increases in factor VII plasma concentrations (p<0.04). Factor VII clearance was 25.1 U/h/kg and its half-life was 5.8 h. The same dose of recombinant factor VII was given to the patient 1 week later, just before the alcohol injections. The patient had no subsequent bleeding or other complication, with no change in haemoglobin levels over 24 h. Thus, recombinant factor VII represents a therapeutic advance, as it can correct fully both coagulation and platelet function defects in cirrhosis and allow invasive procedures to be performed safely.- - - - - - - - - - ranking = 0.0047438000977731keywords = intravascular coagulation, coagulation, intravascular (Clic here for more details about this article) |
9/172. A long-term survivor undergoing extensive microwave coagulation for unresectable hepatocellular carcinoma.Surgery for advanced hepatocellular carcinomas (HCCs) has not been standardized. We report on a long-term tumor-free survivor who underwent extensive microwave coagulation therapy (MCT) for multiple bilobar HCCs. A 61 year-old woman was diagnosed to have bilobar HCCs, including a large tumor, 9 cm in diameter, and 4 small satellite nodules, associated with chronic hepatitis b. The patient had received repeated chemoembolizations using iodized oil, but the increased alpha-fetoprotein level did not fall to normal. The main tumor was unresectable because the tumor involved the caval vein and hepatic veins. The patient underwent extensive MCT with a total of 134 electrode insertions. The paracaval portion of the main tumor was meticulously coagulated under sonographic guidance to avoid vascular injury. The post-operative course was uneventful. Post-operative computed tomography (CT) showed complete necrosis of all tumors. The patient is alive without tumor recurrence for 4 years after MCT. This case proves that extensive MCT can provide a chance of cure in selected patients with multiple bilobar HCCs and centrally located HCCs near the caval vein.- - - - - - - - - - ranking = 0.0034076426082746keywords = coagulation (Clic here for more details about this article) |
10/172. Application of intravascular ultrasonography for intracaval tumor thrombectomies in adrenal metastasis from hepatocellular carcinoma: report of two cases.Intracaval tumor thrombus is one of the characteristic features of advanced hepatocellular carcinoma. To formulate an appropriate operative strategy for removing intracaval tumor thrombi, it is of great importance to accurately diagnose the location, any invasion into the wall of the vena cava, and the extent of intracaval tumor spread. Intravascular ultrasonographic imaging is a novel technology that enables the precise catheter-based assessment of the dimensions and morphology of the vascular structure and any lesions. We have applied this technology to the diagnosis of intracaval tumor thrombi originating from adrenal metastasis secondary to hepatocellular carcinomas. This modality was thus found to be useful in determining the best operative procedure for removing tumor thrombi in the inferior vena cava.- - - - - - - - - - ranking = 0.0018476519684085keywords = intravascular (Clic here for more details about this article) |
| | Next -> |