Endoscopic injection sclerotherapy was given to 155 patients with esophageal varices mainly related to non-alcoholic liver cirrhosis. The formation of a superficial ulcer in the lower esophagus was achieved in 141 (91.0%) of the 155 patients, with an average of 4.1 sessions of endoscopic injection sclerotherapy during an average time of 4.9 weeks. The average volume of 5% ethanolamine oleate sclerosant used was 24.8, 19.2, 12.3 and 6.5 ml for the initial to fourth sessions of endoscopic injection sclerotherapy, respectively. For 14 patients, a sufficient number of sessions of endoscopic injection sclerotherapy could not be given: 10 early deaths (5 hepatoma, 4 liver failure and 1 gastric bleeding), and 4 refused further sessions. When the esophageal mucosa had been eliminated and a superficial ulcer had formed, episodes of recurrent bleeding or recurrence of esophageal varices were nil over a median follow-up of 14.6 months, with a range of 1 to 27 months. In seven patients, bleeding recurred before elimination of the mucosa could be achieved, but these bleeding episodes were well controlled with an additional session of endoscopic injection sclerotherapy. At the time of analysis, there were 36 deaths (20 hepatoma, 14 liver failure and 2 gastric bleeding) among these 155 patients. Thus, the mean follow-up was 16.3 months (range: 7 to 27 months) in the 119 survivors, with no recurrence of the varices. We propose that removal of the esophageal mucosa may well be the endpoint of repeated endoscopic injection sclerotherapy in the management of patients on injection sclerotherapy.

Endoscopy↗

PubMedDate not supplied

Successful treatment of early hepatocellular carcinoma and concomitant esophageal varices.

Twenty-two cirrhotic patients with hepatocellular carcinoma (HCC) and concomitant esophageal varices underwent aggressive hepatic resection accompanied by simultaneous devascularization, perioperative endoscopic injection sclerotherapy, or both (group A). To evaluate this treatment, 37 cirrhotic patients without esophageal varices who underwent hepatic resection for small HCC (2 cm or less) during the same period (group B) were studied to compare clinical data, preoperative laboratory data, pathologic findings, disease-free rates, and survival rates. The operative time, blood loss, and resected liver weight did not differ between the two groups; however, the tumor size of group A (2.7 +/- 1.6 cm, mean +/- SD) was significantly larger than that of group B (1.5 +/- 0.3 cm). The preoperative liver function of group A was also more severe than that of group B except for prothrombin time. Despite these disadvantages, the 1-, 3-, and 5-year disease-free rates of the two groups were 72% versus 94%, 48% versus 54%, and 38% versus 45%, respectively, and the 1-, 3-, and 5-year survival rates were 91% versus 97%, 79% versus 79%, and 54% versus 67% (group A versus group B), respectively, which showed no significant differences. Furthermore, there was no variceal bleeding in group A after treatment. Based on the above findings, for treatment of HCC and concomitant esophageal varices, aggressive hepatic resection accompanied by simultaneous devascularization, perioperative endoscopic injection sclerotherapy, or both is the preferred form of treatment.

Adult↗

PubMedDate not supplied

Hepatocellular carcinoma invading the gallbladder: CT, arteriography and MRI findings.

Hepatocellular carcinoma (HCC) seldom invades the gallbladder. We report a case of HCC invading the gallbladder that resembled gallbladder carcinoma invading the liver. The diagnosis was confirmed by surgical biopsy. The arteriographic, computed tomography and magnetic resonance imaging findings are presented.

Adult↗

PubMedDate not supplied

Health effects of volcanic ash: a repeat study.

The Mount Sakurajima volcano in Kyushu, Japan, is proximal to a large residential area, and it emits an enormous amount of volcanic ash during frequent eruptions. In our previous study, we investigated, for the first time, respiratory effects of chronic exposure to volcanic ash. The study demonstrated a low prevalence of respiratory symptoms, even in the area of highest exposure; only a slight excess prevalence of symptoms appeared to be associated with exposure to volcanic ash. To confirm the findings of our previous study, the prevalence study of chronic respiratory symptoms for residents was repeated in Kanoya and Tashiro, which are located 25 and 50 km, respectively, from the crater of Mt. Sakurajima. The concentration of suspended particulate matter in Kanoya frequently exceeded the national environmental quality standards and, during summer and winter, was 2-3 times higher than that found in Tashiro. Women who were 30-59 y of age and who had resided in Kanoya or Tashiro for more than 3 y completed a modified ATS-DLD questionnaire. The prevalence of nonspecific respiratory disease was low, i.e., 6.5% in Kanoya and 6.2% in Tashiro; similar prevalences were found in women who had never smoked. When we restricted the analysis to individuals without a history of occupational exposure to dusts and who had no exposure to passive smoking, there was a slightly higher prevalence of nonspecific respiratory disease in Kanoya than Tashiro, but the difference was not significant. Eye symptoms were equally prevalent in the two areas.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗