Transarterial Chemoembolization (TACE) Leading to Gastric Ulceration After Hepatic Artery Infusion
Notice bibliographique
Résumé
Commonly experienced symptoms post transarterial chemoembolization include abdominal pain, nausea, fever and ileus. There are case reports of non-target embolization. The goal is to describe a unique case of suspected chemotherapy induced gastric ulcers after hepatic artery infusion. A 72-year-old man with hepatitis C-related cirrhosis presented to our tertiary care center for transarterial chemoembolization (TACE) of a known hepatocellular carcinoma (HCC). The patient had initially been treated with the first dose of loco-regional therapy using 50 milligrams (mg) of doxorubicin in DC BeadTM. There were no noted complications from this procedure. Six months later, he was brought to IR for consideration for repeat TACE as a treatment as well as a possible bridge to surgical intervention. During transarterial chemoembolization, a 5-French catheter was advanced to identify the ostium of the celiac artery. An angiogram was performed, demonstrating adequate catheter position. A microcatheter was then advanced into the left hepatic artery. The catheter could not be advanced distally due to the presence of spasm despite giving nitroglycerin. An additional angiogram was performed, which demonstrated the known HCC in the left lobe. Chemoembolization was performed with approximately 70 mg of doxorubicin in DC BeadTM. There was no evidence of nontarget embolization of any adjacent organs including the gastric cardia. The patient experienced persistent nausea and vomiting that prompted admission for two days post-procedure. It was treated conservatively with pharmacologic 5-HT3 receptor antagonists as needed. The symptoms were attributed to the doxorubicin and resolved at time of discharge. 72 hours later, the patient presented to hospital with acute onset hematemesis and suspected upper gastrointestinal bleeding. He was stabilized with blood products and vasopressor therapy. Urgent gastroscopy revealed multiple irregular ulcers. There was a Forrest class 1b ulcer on the lesser curvature and a Forrest class 2c ulcer noted on the incisura. Treatment was applied with both epinephrine and clips with good hemostatic response. Biopsies were taken from the edge of the ulcer. Biopsy samples were reviewed to rule out possible malignancy. The histologic findings included basophilic microspheres on the background of purulent exudate and necrotic debris. The findings were most consistent with gastric ulcers secondary to drug eluting beads. Repeat gastroscopy showed that the previous ulcerations had coalesced to encompass a large portion of the lesser curvature of the stomach. There was no evidence of active bleeding. Subsequently, the patient was treated conservatively and observed until discharge from hospital.Figure 1Figure 2
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».