Abstract:

Aim: was to study the efficacy and functionality of the Yukon Chrome PC stent in clinical practice.

Materials and methods: in 2021, a prospective, observational study of the safety, effectiveness of the Yukon Chrome PC stent, as well as its functionality during implantation in clinical practice, was launched on the basis of 25 domestic clinics. The study included 364 patients who underwent implantation of 495 Yukon Chrome PC stents. Mean age of patients was 62,8 years (from 33 to 89 years). Men were 263 (72,3%). The vast majority (82,4%) of patients were diagnosed with acute coronary syndrome (ACS): without ST segment elevation - 180 (49,45%) patients; with ST segment elevation - 120 (32,9%) patients. Unstable angina was verified in 22 (6%) patients. There were 42 (11,5%) patients with stable angina class 2-3.

Moderate tortuosity of vessels occurred in 27,7% of cases, while severe tortuosity of vessels occurred in 3,57% of cases. Moderate calcification was noted in 115 (31,5%) patients, severe/massive - in 23 (6,3%) cases. A complex lesion combining severe/moderate calcification and severe/moderate tortuosity of the target artery occurred in 79 (21,7%) patients.

Results: technical success of the procedure was achieved in 97,5% of cases. In one patient with severe calcification, the Yukon Chrome PC stent could not be inserted into the affected area. Attempts to implant another stent were also unsuccessful.

Depending on the number of implanted stents, the patients were distributed as follows: 3 stents were inplanted in 31 (8,5%) patients; 2 stents - 102 (28%) patients, 1 stent - 231 (63,5%) patients.

Bifurcation stenting using a two-stent technique was performed in 69 (19%) patients. Stenting of the left main was performed in 11 (3%) cases. Predilation was performed in 245 (67%) patients; postdilation - in 179 (49%) patients.

Conclusion: analysis of hospital results of implantation of Yukon Chrome PC stents indicates good flexibility and deliverability of stents even in patients with moderate and severe sheath calcification.

The overall assessment of the functional characteristics of the stent among endovascular surgeons who performed stenting is quite high.

Abstract:

Introduction: treatment of patients with bilobar metastatic liver disease remains an unsolved problem. Among methods of regional chemotherapy, the least studied is isolated liver chemoperfusion, which is an unpopular technique due to its high trauma and difficult reproducibility.

Aim: was to demonstrate the method of endovascular isolated liver chemoperfusion (EILHP) developed by us.

Case report: EILCP was performed using a heart-lung machine (HLM) in a patient with cancer of the rectum, stage 2 (pT3N0M0), after combined treatment (radiation therapy (SOD 60 Gy) + anterior resection of the rectum in 2007). Disease progression. Isolated metastatic liver disease (01.2021). Isolated chemoperfusion was performed endovascularly using 2-balloon catheters, which provided vascular isolation of the liver and its isolated perfusion during the procedure. Posi- tioning of balloon catheters was performed in an open way through femoral artery and vein. Perfusion was carried out for 30 minutes with chemotherapy drugs (CtD) oxaliplatin 42,5 mg/m² and irinotecan 82,5 mg/m² injected directly into the circuit.

Results: the duration of intervention was 160 minutes, intraoperative blood loss was 50 ml. During insertion and positioning of aortic balloon, a limited dissection of the aorta developed in area of left common iliac artery deviation, which did not require any intervention in postoperative period. Duration of intensive care unit stay was 1 day. There were no complications associated with aortic dissection during 3-month follow-up. Level of ALT and AST remained within reference values during entire postoperative period. No hematological toxicity was observed. Patient was discharged on the 7th day after operation in satisfactory condition.

Patient underwent control CT scan of abdominal organs, 30 days after endovascular isolated chemoperfusion of the liver. According to the RECIST scale, stabilization of tumor process was noted.

Conclusions: proposed technique of endovascular isolated liver chemoperfusion is technically feasible and safe. The use of this method may be appropriate in treatment of patients with isolated liver metastases who require dose reduction of chemotherapeutic agents due to their severe toxicity or high patient comorbidity.

Abstract:

Aim: was to develop a score scale for the prediction of complete tumor necrosis to assess the potential effectiveness of radiofrequency ablation of colorectal cancer focals in liver, on the base of results of the use of radiological diagnostic methods.

Materials and methods: a comparative analysis of results of radiological diagnosis of solitary colorectal cancer metastases in liver was carried out in 51 patients, depending on their characteristics before and at different times after radiofrequency ablation (RFA).

The survey and interventions were carried out between 2014 and 2020 in accordance with standards of treatment approved in Belarus. Ultrasound and CT with bolus contrast enhancement were used as radiation diagnostic methods.

The initial morphological parameters of tumor focals were evaluated according to results of ultrasound examination. CT with bolus contrast was used to control the effectiveness of RFA (determining the frequency of complete tumor necrosis): on the day of discharge of patients from the hospital, after 1 month, and then - once every 3 months (quarterly) during the year.

Results: the dependence of the effectiveness of RFA (frequency of complete tumor necrosis) on initial characteristics of solitary focals of colorectal cancer in liver was revealed and confirmed by results of a comparative statistical analysis. On the basis of obtained data, a score scale for predicting the effectiveness of RFA was developed and validated. The sensitivity of the new technique was 80,0%; specificity - 82,9%.

Conclusion: for the first time, a scale for the prediction of complete tumor necrosis was developed to assess the potential effectiveness of radiofrequency ablation of solitary colorectal cancer focals in liver.

ROC-analysis of the scale validation results showed that the sensitivity and specificity of the model are sufficient for its application in practice: 80,0% and 82,93%, respectively.

References

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https://doi.org/10.1148/rg.345140054

18.   Pierre A, Roberto LC, Guillaume K, et al. Percutaneous tumor ablation. Presse. Med. 2019; 48(10): 1146-1155.

https://doi.org/10.1016/j.lpm.2019.10.011

19.   Fan Z, Hongying S, Xiangjun H, et al. Tumor Thermal Ablation Enhancement by Micromaterials. Curr. Drug. Deliv. 2017; 14(3): 323-333.

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20.   Mehta A, Oklu R, Sheth RA. Thermal Ablative Therapies and Immune Checkpoint Modulation: Can Locoregional Approaches Effect a Systemic Response? Gastroenterol. Res. Pract. 2016; 9251375.

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Abstract:

This case describes successful combined treatment of patient with large hepatocellular carcinoma BCLC «B», occupying the entire right lobe of the liver, extending to the fourth segment and occupying the right lateral flank till small pelvis. As the first stage, selective tumor chemoembolization, mechanical chemoembolization of right portal vein branches with the aim of vicarious hypertrophy of remaining liver segments were performed. One and half months after performed procedure, the volume of remnant parenchyma was 31% of the total volume. According to the test with indocyanine green, the plasma elimination rate (ICG-PDR) was 12,2%/min, and the residual concentration at 15 minutes was 16%. Subsequently, was performed surgical intervention: Starzl laparotomy, revision of abdominal organs, cholecystectomy, right-sided hemihepatectomy + SI, drainage of the common bile duct according to Vishnevsky, lymphadenectomy of the hepatoduodenal ligament, drainage of abdominal cavity. Postoperative period was complicated by formation of an external biliary fistula and hepatic failure, regarded as class «B» according to criteria of the International Research Group for Liver Surgery (ISGLS), which required medical correction of patient's condition without use of extracorporeal detoxification methods. Later, patient was diagnosed with foci of recurrence of disease in the remaining parenchyma of the liver, for which endovascular treatment was carried out. Currently, patient is alive (6 years after surgery) and is receiving systemic treatment for the extrahepatic spread of the underlying disease.

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Abstract:

Introduction: treatment of gastric cancer (GC) remains an urgent problem in oncology. One of the unsolved problems in treatment of gastric cancer remains the treatment of patients with liver metastases. With the development of interventional radiology, it became possible to treat gastric cancer patients with liver metastases.

Aim: was to improve results of treatment of gastric cancer patients with liver metastases by using of trans-arterial chemoembolization (TACE).

Material and methods: we analyzed results of 60 patients for the period 2008-2020, who suffered for metastatic liver disease, previously they received combined treatment for stomach cancer at various times. The average age of patients was 58,1 ± 5,8 years. When planning TACE, all patients had a general condition above 80% according to Karnovsky, according to ECOG 1-2. All TACE patients with liver metastatic foci were treated with Lipiodol 6-8ml + Doxorubicin 25mg/m². The interval between TACE cycles was 1,5-2 months. Each patient received 5-6 TACE courses.

Results: immediate results showed the effectiveness of treatment after 2 courses of TACE in 49 (81,7%) patients: partial regression was noted in 36 (60%) patients, and significant regression of the process was noted in 13 (21,6%) patients, stabilization of the process was noted in 11(18,3%) patients. With dynamic follow-up 37 (61,7%) patients lived 6 months, 24 (40%) patients lived 12 months, 11 (18,3%) patients lived 18 months, 8 (13,3%) patients lived 24 months, only 3 (5,0%) patients lived 36 months. The median survival rate was 15,5 ± 1,2 months.

Conclusions: immediate and long-term results of the study, carrying out TACE in patients with metastases of gastric cancer to the liver was effective in 50% of patients. Currently, to improve the survival rate and quality of life of patients with metastases of gastric cancer, the technique of trans-arterial chemoembolization can be considered as an effective, low-toxic method of treatment and it can be the method of choice.

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Abstract:

Introduction: arterial complications after orthotopic liver transplantation are common cause of graft loss (10-40%).

Aim: was to estimate efficiency of endovascular interventions in correction of revealed arterial complications in patients after OLT.

Material and methods: for the period of 2015-2020, arterial complications after 104 OLT were revealed in 24(23%) pts and were divided into 4 groups: «steal»-syndrome (n=8), hepatic artery thrombosis (n=7), combination of hepatic artery stenosis and «steal» syndrome (n=6), hepatic artery stenosis (n=3). Endovascular interventios such as splenic artery embolization, direct thrombolysis, stenting and balloon plastic were performed for correction of these complications.

Results: using of endovascular treatment, we successfully identified and correct complications with saving of the graft in 14 pts (58%), 10 pts died because of biliary necrosis, sepsis and graft loss.

Conclusion: early detection and elimination of emerging arterial complications after OLT play a keyrole in saving of organs and patients’ life.

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Abstract:

Aim: was to analyze domestic and foreign literature sources, reflecting the possibility of applying local ablation methods of focal liver tumors.

Material and methods: article presents an analysis of domestic and foreign 37 publications containing information on the use of methods of local ablation of nodular pathology of liver, deposited in resources of PubMed and information portal eLIBRARY.RU.

Results: most important aspects of performing of methods of chemical, cryo-, microwave, and radiofrequency ablations, used in treatment of local liver tumors were presented.

Conclusion: analysis of various publications on methods of local destruction of tumors does not give a clear answer to the question of which method is preferred, however, article describes each of ablation methods, highlighting positive and negative aspects of their effect on lesions of the liver. The question of the inclusion of minimally invasive methods in schemes of combined and complex antitumor therapy for focal liver lesions also remains open.

Modern approaches and improving techniques of treatment of liver malignancies, expand indications for the use of minimally invasive techniques. Competent selection of patients, selection of the optimal method of local ablation of tumor and subsequent dynamic monitoring of patients reduce the number of relapses, increase the percentage of overall survival of patients and improve their quality of life.

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21.   Hinshaw JL, Lubner MG, Ziemlewicz TJ, et al. Percutaneous tumor ablation tools: microwave, radiofrequency, or cryoablation – what should you use and why? Radiographics. 2014; 34(5): 1344-1362.

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Abstract:

A 57-year-old woman was on the waiting list of Orthotopic Liver Transplantation (OLT) due to cirrhosis of viral etiology MSCT with contrast enhancement showed two aneurysms of the splenic artery, stenosis of the celiac trunk with aneurysm of the pancreaticoduodenal artery Taking into account asymptomatic course, we decided to eradicate vascular changes during the forthcoming OLT OLT performed 6 month later, was technically difficult and complicated by massive blood loss and episodes of unstable hemodynamics, so surgical correction of aneurysms was not performed because of high risk. The patient was well and asymptomatic for 2 years after the OLT, but then she developed abdominal pain. MSCT showed progression of vascular changes. Successful endovascular treatment included celiac trunk stenting and embolization of aneurysms. 

References

1.      Unger L, Stork T, Bucsics T, et al. The role of TIPS in the management of liver transplant candidates. United Eur. Gastroenterol. J. 2017; 5 (8): 1100-1107.

2.      Garcia-Pagan JC, Caca K, Bureau C, et al. Early use of TIPS in patients with cirrhosis and variceal bleeding. N. Engl. J. Med. 2010; 362 (25): 2370-2379.

3.      Bacalbasa N, Balescu I, Brasoveanu V. Celiac Trunk Stenosis Treated by Resection and Splenic Patch Reconstruction - A Case Report and Literature Review. In Vivo. 2018; 32 (3): 699-702.

4.      Degheili J., Chediak A., Dergham M, et al. Pancreaticoduodenal Artery Aneurysm Associated with Celiac Trunk Stenosis: Case Illustration and Literature Review. Hindawi. Case reports in radiology. Volume 2017, Article ID 6989673,7 pages.

5.      Uchida H, Sakamoto S, Matsunami M., et al. Hepatic artery reconstruction preserving the pancreaticoduodenal arcade in pediatric liver transplantation with celiac axis compression syndrome: report of a case. Pediatr. Transplant. 2014; 18 (7): 232-235.

6.      Katsura M, Gushimiyagi M, Takara H, et al. True aneurysm of the pancreaticoduodenal arteries: a single institution experience. Journal of Gastrointestinal Surgery. 2010; 14 (9): 1409-1413.

7.      Chiang K, Johnson C, McKusick M, et al. Management of inferior pancreaticoduodenal artery aneurysms: a 4-year, single centre experience. CardioVascular and Interventional Radiology. 1994; 17 (4): 217-221.

8.      Koganemaru M, Abe T, Nonoshita M, et al. Follow-up of true visceral artery aneurysm after coil embolization by three-dimensional contrast-enhanced MR angiography. Diagnostic and Interventional Radiology. 2014; 20 (2): 129-135.

9.      Bastante D, Raya M, Rabelo V., et al. Analysis of ischemic cholangiopathy after treatment of arterial thrombosis in liver transplantation in our series. Transplant Proc. 2018; 50 (2): 628-630.

10.    Polikarpov AA, Tarazov PG, Granov DA, Polysalov VN. Arterial aneurysm of internal organs: the role of angiography and transcatheter embolization. Regional blood circulation and microcirculation. 2002; 1 (2): 30-36 [In Russ].

11.    Tien Y-W, Kao H-L, Wang H-P. Celiac artery stenting: a new strategy for patients with pancreaticoduodenal artery aneurysm associated with stenosis of the celiac artery. Journal of Gastroenterology. 2004; 39 (1): 81-85.

12.    Granov AM, Granov DA, Zherebcov FK, Polysalov VN, Gerasimova OA et al. Experience of 100 liver transplantation in RSCRST. Herald of surgery I.I. Grekov. 2012; 171 (2): 74-77 [In Russ].

13.    Gautier SV, Moysuk YG, Homyakov SM. Organ donation and transplantation in Russian Federation in 2014. 7-th report of National Register. Russian Journal of Transplantology and Artificial Organs. 2015; 17 (2): 7-22 [In Russ].

14.    Tarazov PG, Granov DA, Polikarpov AA, Generalov MI. Orthotopic liver transplantation: The role of interventional radiology. Herald of transplantology and artificial organs. 2009; 3: 42-50 [In Russ]. 

Abstract:

Background: most accurate visualization of tumor, determination of stage and spread of tumor process is substantially significant for children who undergo treatment in accordance to protocols of the international SIOPEL group. According to SIOPEL criteria, patients with hepatoblastoma are stratified into risk groups based on diagnostic results. The allocation of patients into risk groups is based on the definition of the stage of the disease in the PRETEXT system (Pre-Treatment Extent of Disease - the spread of the tumor before treatment) and the level of alpha-fetoprotein (AFP)

Aim: was to present the main criteria of PRETEXT hepatoblastoma staging, based on results of magnetic resonance imaging (MRI).

Material and methods: study includes 74 patients with diagnosed hepatoblastoma aged 1 month to 14 years (median 3.1 years). All patients underwent MRI of the abdominal cavity before and after polychemotherapy (PCT) courses. MRI studies were performed on the scaner Magnetom Avanto (Siemens Healthcare) with a magnetic field strength of 1.5T

Results: hepatoblastoma staging was performed according to PRETEXT criteria. Stage I of the Pretext with lesion of one liver sector was revealed in 3 (4%) cases. Stage II of the Pretext - the presence of a tumor in two adjacent sectors was revealed in 26(35,1%) cases. Pretext III - the presence of a tumor in three adjacent sectors of the liver or in two non-adjacent liver sectors was identified in 23(31%) cases. Pretext IV - lesion of all liver sectors, was revealed in 22(29,7%) cases. Conclusions: MRI is a significantly informative method that allows to achieve data not only location, size, prevalence of the tumor process, but it also enables to give an accurate pre-operative stage evaluation using the PRETEXT system. Surgical removal of the tumor is the only way to achieve a complete cure, thus it is important to get an accurate image of the tumor, its anatomical location and determine the prevalence of the tumor process.

References  

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2.      Kaprin A.D., Starinskij V.V., Petrova G.V.. Zlokachestvennye novoobrazovanija v Rossii v 2015 godu (zabolevaemost' i smertnost') [Malignant neoplasms in Russian Federation in 2015 (morbidity and mortality)]. MNIOI im. P. A. Gercena. 2017; 250 s [In Russ]

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5.      Tomlinson G.E., Kappler R. Genetics and epigenetics of hepatoblastoma. Pediatr Blood Cancer. 2012;59: 785-792

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7.      Meyers R.L. Tumors of the liver in children. Surgical Oncology. 2007;16:195-203.

8.      Jon Pritchard, Julia Brown, Elizabeth Shafford, Giorgio Perilongo, Penelope Brock, Claire Dicks-Mireaux, Jean Keeling, Angela Phillips, Anton Vos, Jack Plaschkes . Predictive Value of the Pretreatment Extent of Disease System in Hepatoblastoma: Results From the International Society of Pediatric Oncology Liver Tumor Study Group SIOPEL-1 Study. Journal of Clinical Oncology. 2005; 23(6):1245-52.

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10.    Roebuck D.J., Aronson D., Clapuyt Pet al.; International Childrhood Liver Tumor Strategy Group. 2005 PRETEXT: a revised staging system for primary malignant liver tumours of childhood developed by the SIOPEL group. PediatrRadiol. 2007; 37(2):123-32.

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13.    Kim Je. F., Filin A. V., Semenkov A. V. i dr. Hirurgija ochagovyh obrazovanij pecheni u detej: organosohranjajushhaja operacija ili transplantacija?[ Surgery of focal lesions of liver in children: organ-preserving intervention or transplantology?.] Klinicheskaja i jeksperimental'naja hirurgija. 2017;1:22-30. 

Abstract:

Between May 2005 and March 2007, catheter-port systems were placed in 20 pts for continuous hepatic artery infusion chemotherapy in the treatment of unresectable colorectal liver metastases. Carboplatin (or oxaliplatin) plus 5-fluorouracil and systemic leucovorin were administered. No complications occurred during the implantation procedures. The mean number of intrahepatic chemotherapy cycles per patient was 10 (4-25). The mean follow-up period was 412 (100-853) days. During the follow-up period, complications occurred in 9 patients (45%), but surgical or interventional radiological correction was successful in all but one case. At present, 14 patients are alive within 4 and 41 months and continue to receive intraarterial chemotherapy, while 6 patients died in 5 to 21 months from tumor progression. The common 1 -year survival is 90% (18 patients). Percutaneous implantation is potentially effective treatment for patients with CLM.

Reference 

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Abstract:

The basis of computed tomography diagnosis is the definition of densitometric parameters at different phases of the study.

Aim. Was to perform comparative analysis of computed tomography features of focal nodular hyperplasia and hepatocellular carcinoma.

Materials and methods. During the reseach clinical and morphological comparisons were performed on the base of 36 patients’ CT’s results: 21 patient with hepatocellular carcinoma (HCC) and 15 patient with focal nodular hyperplasia of the liver without associated liver cirrhosis. At the preoperative stage all patients underwent spiral computed tomography with bolus contrast enhancement (on the four phases of the study).

Results. During native phase of computed tomography HCC nodes are more often hipodense irrespective of the degree of histological differentiation and focal nodular hyperplasia - izodense. After intravenous injection of contrast agent, computed tomography picture of hepatocellular carcinoma and focal nodular hyperplasia depended on the phase of the study During the arterial phase tissue of focal nodular hyperplasia in the vast majority of cases was hiperdense relative to the surrounding liver parenchyma. Hepatocellular carcinoma had similar values much less frequently in contrast to the focal nodular hyperplasia. The venous phase was characterized by the presence of hiperdense characteristics in focal nodular hyperplasia areas and, conversely, in hepatocellular carcinoma tissue signs of hiperdense were not observed. Hyperdence formations in delayed phase of computed tomography indicate the presence of focal nodular hyperplasia, and vice versa, hypodense are sufficient to prevent its presence.

Conclusion. Estimation of densitometric parameters of focal nodular hyperplasia and hepatocellular carcinoma allows to determine features of computed tomography imaging of tumors at different phases of the examination, and this allows to make a differential diagnosis between them.

Abstract:

Purpose. Was to evaluate possibilities of FDCTA as a method of colorectal liver metastases (CLM) detection and differentional diagnostics.

Materials and methods. FD-CT-A was performed to examine 41 patients. Patients with lobe CLM (n =15) were included into the 1-st group. Purpose was to exclude metastatic lesions of contralateral lobe before surgical treatment. Patients with bilobar metastatic spread (n = 26) were included into the 2-nd group. Purpose was to detect metastases before and during regional therapy. Scanning was performed on the hybryde angiographic system Innova-4100 «GЕ Нealthcare, USA» with 5 sec scanning time, fov 23 × 23 cm, delay from 10 to 22 sec during hepatic arteriography 15–40 ml Ultravist-370 «Bayer Schering Pharma, Germany» with rate 2–4 ml/sec.

Results. In the first group 40 CLM were detected. The number of metastases in each patient ranged from 1 to 12 (mean – 3). The size of metastases ranged from 9,1 mm to 150,0 mm (mean – 36,7 mm, median – 30,2 mm). 14 of all CLM (35%) were 20 mm and less. Right hemyhepatectomy was provided for 6 patients, left hemyhepatectomy – for one. In the second group 282 CLM were detected. The number of metastases in each patient ranged from 2 to 31 (mean – 11). The size of metastases ranged from 3,2 mm to 81,0 mm (mean – 17,4 mm, median – 12,7 mm). 209 of all CLM (74%) were equal or smaller then 20 mm in diameter.

Conclusion. FD-CT-A is the perspective method for detection and differentional diagnostics of CLM.
 

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Abstract:

Recently one can see higher incidence rate of fatty liver. The purpose of our study was to examine the abilities of raiodiagnostics (computed tomography and bolus contrast-enhanced CT angiography) in patients with different stages of non-alcoholic hepatic steatosis. Seventy four patients with morphologically verified diagnosis of non-alcoholic hepatic steatosis were included into the study. Hepatic parenchyma density was assessed quantitatively, as well as blood flow parameters at time-dencity curve in stages 1 (initial), 2 (moderate), and 3 (severe) of the disease. It was shown that hepatic time-dencity curve in patients with fatty liver was lower than splenic one. Thus, computed tomography and CT angiography are highly informative methods in diagnostics of hepatic steatosis, defying not only presence of the disease, but differentiating its stage and optimizing the therapeutic strategy.

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Abstract:

Aim: a case report of a 5-year experience of regional (arterial chemoembolization) treatment of a patient with isolated liver metastases of skin melanoma.

Materials and Methods: in 1994, the patient performed excision of melanoma in the right scapular region. Patient didn't undergo another treatment. During examination in 2006 metastasis in the liver was revealed. Patient recieved five rounds of chemotherapy Aranoza, Temodal, Kanglite. Metastatic tumer, sized 16,5 х14,5 х18,5 cm, occupied right liver lobe with deformation of it. After gaining this data - patient received 2 courses of liver chemoembolization in 2008.

Results: during the 5 years follow-up - progression of tumor lesion is not noticed.

Conclusion: the optimal transarterial chemoembolization creates possibilities for an efficient delivery of drugs and tumor embolization particles in the affected organ, particularly in the liver. In addition to surgery (with resectable formations) and systemic chemotherapy, above capabilities regional transarterial therapy can provide long term as new palliative treatment of patients with metastatic melanoma.

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Abstract:

Aim: was to evaluate the use of intraoperative ultrasound in examination of patients with liver cancer compared with preoperative diagnostic methods.

Materials and methods: the study involved 650 patients who received surgical treatment for the period 1998-2013 years. During surgical intervention, all patients underwent intraoperative ultrasonography (IOUS) of the liver.

Results: results of preoperative examination methods were compared with intraoperative data, IOUS and histological examination. Sensitivity and accuracy of IOUS is above all methods of preoperative diagnosis, surgical palpation and is 99.7% and 94.9%, respectively Analyzed causes of mistakes of preoperative methods. These related: long time interval before surgical intervention, diameter of formations less then 2 cm, chemotherapy, presence of concomitant cirrhosis, different location of lesions (subcapsular, on the capsular and on the diaphragm of the liver), benign or non-tumorous liver lesions. Changes of operation volume occurred in 38 % cases, 20 % of them - on the base IOUS data.

Conclusions: IOUS provides decisive diagnostic information for the surgeon during the operation which may lead to changes of operation volume, and thus affect outcomes of the disease. Contrast resolution IOUS is actual when oncological operations on the liver are made. Ultrasound professionals should be master of IOUS techniques due to the increasing necessity of its use in clinics dealing with oncological surgery of the liver. 

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Abstract:

Hepatocellular carcinoma (HCC) of liver is a widespread oncologic disease. The main risk factor of HCC development is liver cirrhosis. The aim of this article is to describe findings of HCCs in diagnostic imaging, including ultrasound, computed tomography, and magnetic resonance imaging. 

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Abstract:

Aim: was to estimate first own results of arterial radioembolization (RE) in patients with primary or metastatic liver malignancy.

Materials and methods: in 2009, RE of the right (n=3) or left (n=1) hepatic artery using Yttrium-90 glass microspheres (Therasphere) was performed in 4 patients: 3 with hepatocellular carcinoma on cirrhosis complicated by portal vein branch thrombosis (contraindication for chemoembolization), and 1 patient with colorectal liver metastases.

Results: all RE procedures were technically successful. The radiation dose to the tumor was 1 20-150 Gy The post embolization syndrome was minimal and uncomplicated. After RE, partial tumor response and stabilization were noted in 2 patients each. Patients survived from 14 to 32 months.

Conclusion: RE is well-tolerated and safe procedure causing significant local damage of liver tumor. According to our first experience, RE is a very promising method for treatment of hepatic malignancies. 

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2.     Lewandowski R.J., Geschwind J.-F., Liapi E., Salem R. Transcatheter intraarterial therapies: Rationale and overview. Radiology. 2011; 259(3): 641-657.

3.     Powerski M.J., Scheurig-Muenkel C., Banzen J., Schnappauff D., Hamm B., Gebauer B. Clinical practice in radioembolization of hepatic malignancies: A survey among interventional centers in Europe. Eur. J. Radiol. 2012; 81(7): e804-e811.

4.     Seidensticker R., Seidensticker M., Damm R., Mohnike K., Schutte K., Malfwertheiner P., Van Buskirk M., Pech M., Amthauer H., Ricke J. Hepatic toxicity after radioembolization of the liver using 90Y-micro- spheres: Sequential lobar versus whole liver approach. Cardiovasc. Intervent. Radiol. 2012; 35(5): 1109-1118.

5.     Garin E. Radioembolisation of hepatocellular carcinoma patients using 90Y-labelled microspheres: Towards a diffusion of the technique? Eur. J. Nucl. Med. Mol. Imaging. 2011; 38(12): 2114-2116.

6.     Atassi B., Bangash A.K., Lewandowski R.J., Ibrahim, Kulik L., Mulcahy M.F., Ryu R.K., Sato K.T., Miller F.H., Omary R.A., Salem R. Biliary sequelae following radioembolization with Yttrium-90 microspheres. J. Vasc. Interv. Radiol. 2008; 19(5): 691-697.

7.     Jakobs T.F., Saleem S., Atassi B., Reda E., Lewandowski R.J., Yaghmai V., Miller F., Ryu R.K., Ibrahim

5.,    Sato K.T., Kulik L.M., Mulcahy M.F., Omary R., Murthy R., Reiser M.F., Salem R. Fibrosis, portal hypertension, and hepatic volume changes induced by intra-arterial radiotherapy with 90Yttrium microspheres. Dig. Dis. Sci. 2008; 53(9): 2556-2563.

8.     Naymagon S., Warner R.R.P., Patel K., Harpaz N., Machac J., Weintraub J.L., Kim M.K. Gastroduodenal ulceration associated with radioembolization for the treatment of hepatic tumors: An institutional experience and review of the literature. Dig. Dis. Sci. 2010; 55(9): 24502458.

9.     Salem R., Lewandowski R.J., Mulcahy M.F., Riaz A., Ryu R.K., Ibrahim S., Atassi B., Baker T., Gates V., Miller F.H., Sato K.T., Wang E., Gupta R., Benson A.B., Newman S.B., Omary R.A., Abecassis M., Kulik L. Radioembolization for hepatocellular carcinoma using Yttrium-90 microspheres: A comprehensive report of long-term outcomes. Gastroenterology. 2010; 138(1): 52-64.

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Abstract:

In patients with severe multiple trauma, posttraumatic period is often complicated by the development of polyorgan insufficiency, development of which is connected with morpho-functional changes of the liver parenchyma.

Aim: was to identify dynamics of ultrasound signs of morphological and functional changes of liver in patients with multiple trauma.

Materials and methods: performed analysis of ultrasound data obtained in dynamics, in 28 patients with severe multiple trauma. From the analysis, we excluded patients with blunt abdominal trauma with injury of liver. In first 2 days, 21 patients underwent surgical operations in treatment of craniocerebral trauma and trauma of musculoskeletal system. All patients underwent ultrasound examination of the abdominal cavity and retroperitoneal space to exclude possibility of appearance of free liquid; also estimated condition of liver, spleen, functional and morphological condition of the gastrointestinal tract. In first days after trauma, ultrasound examination was performed 2-3 times. Color duplex scanning of vessels of liver and spleen was performed once a day or every other day for 2-3 weeks of a traumatic period. Evaluated arterial and venous blood flow of liver by measuring the linear blood flow velocity (LBFV) and resistance index (RI), portal blood flow by measurement of linear and volumetric flow rate.

Results: in all patients on admission to hospital, liver and spleen sizes had normal size. On the 3rd day after the injury, was revealed an increase in the cranio-caudal liver size by 2-4 cm and increased length of spleen by 5-8 cm, which lasts for 10-20 days. During dynamical ultrasound, 8 patients with 10-20 days against a background of increasing level of bilirubin and transaminases, in addition to increasing size of liver and spleen, we marked infiltration of tissues along hepatic veins with their narrowing and along branches of the portal vein with thickness from 0,25 to 0,7 cm. We marked LBFV decreasement by portal vein to 10-13 cm/sec and a volume flow to 250-400 ml / min, increased RI by hepatic artery In 3 patients in the liver parenchyma, we revealed avascular tissue regions with decreased echogenicity, indicating the formation of ischemic regions.

Conclusion: during dynamical ultrasound in patients with severe multiple trauma, on day 3 after injury, were diagnosed morphological changes in liver parenchyma with violation of its hemodynamics. Further progression of the process observed for 10-20 days from the date of trauma: the growth of intrahepatic portal hypertension, increased peripheral resistance in arteries of liver parenchyma, the appearance of ischemic areas of liver parenchyma. The totality of above ultrasonic signs of hemodynamic disorders of liver, characterize organic hepatocellular insufficiency, which is a poor prognostic sign in the development of polyorgan insufficiency.

References

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Abstract:

Diffuse liver lesion is one of the leading positions in the structure of hepatobiliary pathology Dispite the large number of available diagnostic methods biopsy followed by histological examination is a «gold standart» untill now. Bioimpedancemetry is a potential method of evaluation of morpho-functional analysys of the organ.

Aim: was to clarify dependence of indices of an electrical impedance of liver tissue on its morfo-functional status and to define general valuation principles of absolute and relative measures of an electrical impedance of an organ in case of liver diffusion pathology in an experiment.

Metarials and methods: the experimental study was carried out on 66 Wistar rats 180-230 g. The diffuse liver failure was modeled by using 0,02% solution of N-nitrozodiethylamin with water that animals were drinking during all the period of experiment (120 days). Bioimpedancemetry and morphological investigation as a next step were performed on 14, 30, 60, 90, 120 days in parallel with biochemical blood analysis, sonography of the liver and morphological analysis.

Results: biophysical parameters of liver's parenchyma in cases of toxic hepatitis were characterized by increasing of absolute bioimpedance indices more than 50% and increasing of impedance dispersion coefficient of 16%. But in cases of drrhosis of the liver biophysical paremeters were characterized by decreasing of absolute indices of electrical impedance and increasing of heterogeneity coefficient of the liver of 50 to 100% at different measurement frequencies.

Conclusion: obtained data confirm the diagnostic value of bioimpedancemetry and give prerequisites for further studying of parameters of an electric impedance of liver parenchyma in clinical practice.  

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