Volume 63 - 2000 - Fasc.2 - Symposium
Percutaneous treatment of liver metastases
Hepatic resection is the mainstay in the curative...
Stenting of upper and lower GI tract obstruction
Hepatic chemoembolization : clinical and experimental correlation
Chemoembolization has become the preferred treatment for patients with inoperable, hypervascular hepatic malignancies in the Far East, but controversial elsewhere. In vivo microscopy in addition to other experimental procedures are used in this presentation to better understand the mechanisms involved in chemoembolization. In chemoembolization Lipiodol acts as a contrast material, a vehicle for chemotherapy and an embolic agent. Although not optimal, Lipiodol injected into the hepatic artery, traverses the peribiliary plexus to the portal veins resulting in a dual embolization. Chemoembolization creates ischemia, slows arterial flow and increases the contact time between the infusate and the neoplasms, increasing the tumor cell kill. However, the vascular occlusion also produces infarction and fibrosis compounding the already existing cirrhosis frequently associated with hepatocellular carcinoma. Lipiodol/ethanol (3:1) injected into the segmental or lobar hepatic artery supplying the neoplasm also gains access to the associated portal venous branches causing focal ablation. This preoperative approach is easier to perform than direct portal vein occlusion, with less parenchymal damage and comparable hypertrophy of the remnant liver frequently necessary for adequate hepatic function following resection. Polymer-drug conjugates, e.g. PG-TXL, have considerable potential for intra-arterial delivery especially with the dramatic increase in concentration of the drug in the tumor and its efficacy. Using in vivo microscopy especially with green fluorescent protein (GFP) gene as an efficient and non-toxic tumor cell marker, the events leading to hepatic metastases can be documented which will serve to better evaluate these varied techniques of chemoembolization.
TIPS : follow-up imaging and revision procedure
TIPS patency can be assessed by different imaging techniques angiography, color Doppler sonography, CT angiography, scintigraphy. Percutaneous angiography with measurement of the portocaval pressure gradient is the gold standard in the diagnosis of shunt failure, but, because its invasive nature and the necessity of frequent control of the shunt function, a noninvasive procedure is preferable for routine checkup. Color Doppler sonography in intervals of 3 to 6 months, with the use of different criteria, is considered as an accurate imaging technique with a high degree of sensitivity and specificity to evaluate TIPS patency. Angiography is indicated when CDs is not successful or in each clinical recurrence. Revision procedure may restore shunt efficiency and is indicated when the TIPS patency is compromised.
Editorial introduction
Viral hepatitis is a major public health problem world-wide. It has been estimated that more than 300 million people are suffering from this infectious disease with a significant morbidity and mortality rate. In the last decade, there have been tremendous progresses in the discoveries, understanding of disease pathogenesis, diagnostic, prevention and the treatment of...
Hepatitis B virus receptor : the role of human annexin V
S gene variation of HBV
An overview on a novel adjuvanted prophylactic hepatitis B vaccine
Treatment for chronic hepatitis B: interferon What we have learned after so many years ?
Treatment of chronic hepatitis B : Lamivudine
New nucleoside analogues for chronic hepatitis B
Immune therapy of hepatitis B virus (HBV) chronic infection. European experience
Hepatitis B virus and liver transplantation
Hepatitis C : virology, clinical aspects and the relation to cryoglobulinemia
HCV, HDV and autoimmunity
Hepatitis Program, Innogenetics, Gent, Belgium; (1) BPRC, Rijswijk, The Netherlands; (2) Lab. Histo- and Cytochemistry, KULeuven, Belgium; (3) DDL, Delft, Tne Netherlands ; (4) EMBL, Heidelberg, Germany.
Improvement of chronic active hepatitis C in chronically infected chimpanzees after therapeutic vaccination with the HCV E1 protein
Treatment of chronic hepatitis C with interferon in combination with other compounds
Prognostic factors determining the outcome of treatment in chronic hepatitis C
After a brief introduction in terminology and a distinction between predictors and determinants or response to therapy in chronic hepatitis C, a review of the wide literature on this topic is presented. None of the pretreatment variables or combination of them can be used as an absolute predictor of response in individual patients. Prognostic factors can help in clinical practice for informing and counseting patients of the likelihood of response. Information on pretreatment HCV RNA levels and HCV genotype can improve the cost benefit of therapy. Predictors of response should be properly evaluated in terms of positive predictive value, negative predictive value and accuracy. The strongest hitherto predictor of sustained response to any therapeutic regimen in chronic hepatitis is the clearance of HCV RNA during treatment. Recent data suggest that sequencing of several regions of the HCV genome may provide important prognostic information on the outcome of therapy. In complex and difficult to treat subsets of patients with chronic HCV infection, available data on predictors and determinants of the outcome of treatment are limited.
Development of novel anti-HCV therapies : HCV protease, helicase, and polymerase as therapeutic targets
In vitro assays for drug testing : continuous cell lines
Infectious synthetic HCV transcripts
Hepatitis C virus and transplantation
Hepatitis D : virology, clinical and epidemiological aspects
New agent to cause acute fulminant hepatitis ?
Epidemiology of hepatocellular carcinoma and its viral risk factors
HCV-infection and hepatocellular carcinoma
Non-surgical treatment of hepatocellular carcinoma (HCC)
