小肝癌に対する肝動脈化学塞栓術併用定位放射線治療 1)小肝癌に対する肝動脈化学塞栓術併用定位放射線治療 2)小肝癌に対する肝動脈化学塞栓術併用定位放射線治療に関するパイロットスタディ

内容の要旨 , 審査の要旨広島大学(Hiroshima University)博士(医学)Doctor of Philosophy in Medical Sciencedoctora

Portosystemic Encephalopathy without Liver Disease Masquerading as Dementia

An 84-year-old woman was hospitalized due to consciousness disorder as hyperammonemia. She had no etiology of liver disease. Twelve months before the current admission, she had been diagnosed with dementia based on her low level of daily perception and physical activity. Abdominal computed tomography revealed a large portosystemic shunt between the medial branch of the portal vein and middle hepatic vein. After the improvement of her consciousness disturbance by medical treatment, percutaneous shunt embolization was electively performed. The patient showed a remarkable clinical improvement. Consciousness disturbance caused by hyper-ammonemia might be underlying in dementia patients. Increase of hepatopetal portal blood flow might have contributed to the improvement of her consciousness disturbance. Embolization of the portosystemic shunt might be more effective for patients without liver disease as in the present case

Familial Occurrence of a Congenital Portosystemic Shunt of the Portal Vein

A congenital portosystemic shunt of the portal vein is a very rare vascular anomaly associated with the liver. We report the case of a 5-year-old girl with a patent ductus venosus and her 31-year-old mother with a congenital portosystemic shunt. The child presented with a history of an extremely low birth weight in addition to an atrial septal defect and a patent ductus venosus. At the age of 2, she underwent ligation of the ductus venosus. Her mother was also diagnosed with a congenital vascular anomaly at the age of 16. We have followed up and evaluated her asymptomatic mother for 15 years. To our knowledge, this is the first report describing the occurrence of a congenital portosystemic shunt in both a mother and her child

Efficacy of radiofrequency ablation for initial recurrent hepatocellular carcinoma after curative treatment: Comparison with primary cases

a b s t r a c t Objective: To determine the efficacy of radiofrequency ablation (RFA) for initial recurrence of small hepatocellular carcinoma (HCC; ≤3 nodules, each nodule ≤3 cm in diameter) after curative treatment and identify prognostic factors affecting therapeutic outcome, we compared clinical and outcome factors between patients with primary HCC and those with initial recurrent HCC who underwent RFA. Methods: In this retrospective cohort study, 211 HCC patients who underwent RFA were enrolled and comprised two groups: primary group (n = 139) and initial recurrent group (n = 72). We compared local tumor progression, overall survival (OS), disease-free survival (DFS), and RFA safety between the groups. Results: Median follow-up was 53 months. Local tumor progression rate was 5.8% in the primary group and 4.2% in the recurrent group. OS rates at 5 years and 10 years were 63.2% and 25.5% in the primary group and 54.5% and 33.4% in the recurrent group, respectively. Corresponding DFS rates were 30.7% and 14.6% and 19.2% and 11.0%. DFS was significantly shorter in the recurrent group (hazard ratio [HR] = 1.81; 95% confidence interval [CI], 1.27-2.57; P = 0.001). In the recurrent group, time from primary HCC development to recurrence was a determinant of OS (≤2 years; HR = 3.42; 95% CI, 1.52-7.72; P = 0.003). Conclusion: Although local tumor control and OS were similar between the groups, the recurrent group had shorter DFS than the primary group. Time from primary HCC development to recurrence was a prognostic factor for recurrence of HCC

Background of dynamic CT appearance of radiation injury according to previous therapy.

<p>* TACE; transcatheter arterial chemoembolization</p><p>Background of dynamic CT appearance of radiation injury according to previous therapy.</p

A typical case belonging to Child–Pugh class A that changed from type 3 after 3 months to type 1 after 9 months (case 36).

<p>Dose distribution b) Plain c) Arterial phase d) Portal phase e) Venous phase.</p

The dynamic CT appearance of focal liver injury following SBRT for HCC was classified into 3 types.

<p><b>A</b>) Type 1 (case 12, 10 months following SBRT). a) Dose distribution b) Plain c) Arterial phase d) Portal phase e) Venous phase. Hypodensity in plain CT and hyperdensity in all enhanced phases. B) Type 2 (case 39, 2 months following SBRT). a) Dose distribution b) Plain c) Arterial phase d) Portal phase e) Venous phase. Hypodensity in the arterial and portal phases and isodensity in the venous phase. C) Type 3 (case 51, 2 months following SBRT). a) Dose distribution b) Plain c) Arterial phase d) Portal phase e) Venous phase. Isodensity in the enhanced phases.</p