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Cystic echinococcosis of the liver and lung treated by radiofrequency thermal ablation:An ex-vivo pilot experimental study in animal models

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World Journal of Gastroenterology 2009年第26期15卷 3232-3239页

作者： Vincenzo Lamonaca Antonino Virga Marta Ida Minervini Roberta Di Stefano Alessio Provenzani Pietro Tagliareni Giovanna Fleres Angelo Luca Giovanni Vizzini Ugo Palazzo Bruno Gridelli ISMETT (Mediterranean Institute for Transplantation and Advanced Therapies) University of Pittsburgh Medical Center Italy Health Care Department of Region of Sicily Veterinary Service

AIM： To evaluate radiofrequency thermal ablation （RTA） for treatment of cystic echinococcosis in animal models （explanted organs）. METHODS： Infected livers and lungs from slaughtered animals, 10 bovine and two ovine, were collected. Cysts were photographed, and their volume, cyst content, germinal layer adhesion status, wall calcification and presence of daughter or adjacent cysts were evaluated by ultrasound. Some cysts were treated with RTA at 150 W, 80℃, 7 min. Temperature was monitored inside and outside the cyst. A second needle was placed inside the cyst for pressure stabilization. After treatment, all cysts were sectioned and examined by histology. Cysts were defined as alive if a preserved germinal layer at histology was evident, and as successfully treated if the germinal layer was necrotic. RESULTS： The subjects of the study were 17 cysts （nine hepatic and eight pulmonary）, who were treated with RTA. Pathology showed 100% success rate in both hepatic （919） and lung cysts （8/8）; immediate volume reduction of at least 65%; layer of host tissue necrosis outside the cyst, with average extension of 0.64 cm for liver and 1.57 cm for lung; and endocyst attached to the pericystium both in hepatic and lung cysts with small and focal de novo endocyst detachment in just 3/9 hepatic cysts. CONCLUSION： RTA appears to be very effective in killing hydatid cysts of explanted liver and lung. Bile duct and bronchial wall necrosis, persistence of endocyst attached to pericystium, should help avoid or greatly decrease in v/vo post-treatment fistula occurrence and consequent overlapping complications that are common after surgery or percutaneous aspiration, injection and reaspiration. In vivo studies are required to confirm and validate this new therapeutic approach.

关键词： Cystic echinococcosis Hydatid cyst radiofrequency thermal ablation Hepatic hydatidosis Pulmonary hydatidosis

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A case of biliary gastric fistula following percutaneous radiofrequency thermal ablation of hepatocellular carcinoma

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World Journal of Gastroenterology 2007年第5期13卷 804-805页

作者： Angela Falco Dante Orlando Roberto Sciarra Luciano Sergiacomo Department of Internal Medicine "S. Massimo" Civil HospitalPenneItaly Department of Radiology "S. Massimo" Civil Hospital Penne Italy

Percutaneous radiofrequency thermal ablation （RFA） is an effective and safe therapeutic modality in the management of liver malignancies, performed with ultrasound guidance. Potential complications of RFA include liver abscess, ascites, pleural effusion, skin burn, hypoxemia, pneumothorax, subcapsular hematoma, hemoperitoneum, liver failure, tumour seeding, biliary lesions. Here we describe for the first time a case of biliary gastric fistula occurred in a 66-year old man with a Child＇s class A alcoholic liver cirrhosis as a complication of RFA of a large hepatocellular carcinoma lesion in the nl segment. In the light of this case, RFA with injection of saline between the liver and adjacent gastrointestinal tract, as well as laparoscopic RFA, ethanol injection （PEI）, or other techniques such as chemoembolization, appear to be more indicated than percutaneous RFA for large lesions close to the gastrointestinal tract.

关键词： radiofrequency thermal ablation Hepatocellular carcinoma Biliary gastric fistula Complications

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Hepatocellular carcinoma: Therapy and prevention

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World Journal of Gastroenterology 2005年第47期11卷 7391-7400页

作者： Hubert E Blum Department of Medicine Ⅱ University of FreiburgD-79106 FreiburgGermany

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide. The major etiologies and risk factors for the development of HCC are well defined and some of the multiple steps involved in hepatocarcinogenesis have been elucidated in recent years. Despite these scientific advances and the implementation of measures for the early detection of HCC in patients at risk, patient survival has not improved during the last three decades. This is due to the advanced stage of the disease at the time of clinical presentation and limited therapeutic options. The therapeutic options fall into five main categories: surgical interventions including tumor resection and liver transplantation, percutaneous interventions including ethanol injection and radiofrequency thermal ablation, transarterial interventions including embolization and chemoembolization, radiation therapy and drugs as well as gene and immune therapies. These therapeutic strategies have been evaluated in part in randomized controlled clinical trials that are the basis for therapeutic recommendations. Though surgery, percutaneous and transarterial interventions are effective in patients with limited disease (1-3 lesions, ＜5 cm in diameter) and compensated underlying liver disease (cirrhosis Child A), at the time of diagnosis more than 80% patients present with multicentric HCC and advanced liver disease or comorbidities that restrict the therapeutic measures to best supportive care. In order to reduce the morbidity and mortality of HCC, early diagnosis and the development of novel systemic therapies for advanced disease, including drugs, gene and immune therapies as well as primary HCC prevention are of paramount importance. Furthermore, secondary HCC prevention after successful therapeutic interventions needs to be improved in order to make an impact on the survival of patients with HCC. New technologies, including gene expression profiling and proteomic analyses, should allow to further elucida

关键词： HCC resection Liver transplantation Percutaneous ethanol injection radiofrequency thermal ablation Transarterial embolization or chemoembolization Chemotherapy Gene therapy Immune therapy Prevention

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A case of gouty arthritis following percutaneous radiofrequency ablation for hepatocellular carcinoma

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World Journal of Gastroenterology 2010年第6期16卷 778-781页

作者： Dae Hee Choi Hyo-Suk Lee Department of Internal Medicine Kangwon National University College of Medicine Department of Internal Medicine and Liver Research Institute Seoul National University College of Medicine

Percutaneous radiofrequency thermal ablation(RFA) is considered an effective technique for providing local control in the majority of Hepatocellular carcinoma(HCC) *** RFA is generally well tolerated,recent studies have reported complications associated with *** describe a case of acute gouty arthritis in a 71-year-old man with chronic renal failure who was treated with RFA for a HCC lesion and who had hepatitis B-associated cirrhosis and mild renal *** surveillance of the patient detected a 3.5 cm HCC *** the patient had declined surgery,RFA was chosen for *** the third post-procedural day,the laboratory results showed increases in his uric acid and potassium levels,which were compatible with a tumor lysis syndrome. On the 6th post-procedural day,the patient complained of new right knee *** joint aspiration revealed monosodium urate monohydrate *** made the diagnosis of acute gouty arthritis arising from tumor lysis and liver infarction caused by HCC ablation,which was aggravated by acute renal insufficiency. After adequate hydration and administration of oral colchicines,the patient's right knee pain subsided andthe uric acid serum level returned to *** is the first described case of acute gouty arthritis after RFA for a HCC lesion in a patient with underlying chronic renal *** avoid hyperuricemia and an acute attack of gout after RFA therapy for HCC,early identification of patients at risk is warranted,such as those with a large tumor,rapid tumor growth,and renal insufficiency,and preventative measures should be considered.

关键词： radiofrequency thermal ablation Hepatocellular carcinoma Gout Tumor lysis syndrome Complications

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