Blutalkohol 2005 - BADS (Bund gegen Alkohol und Drogen im ...

Breitmeier/Verner/Albrecht/Fieguth/Geerlings/Kleemann/Panning/Gebel/Tröger,
Arteriovenous differences (A-V differences) by patients with a hepatocellular carcinoma
Seiten 197–208
in relation to percutaneous ethanol injection therapy (PEIT)
Aus dem Institut für Rechtsmedizin der Medizinischen Hochschule Hannover 1 )
(DIREKTOR: PROFESSOR DR. H. D. TRÖGER)
und der Abteilung Anästhesiologie I der Medizinischen Hochschule Hannover 2 )
(DIREKTOR: PROFESSOR DR. S. PIEPENBROCK)
und dem Institut für Biometrie der Medizinischen Hochschule Hannover 3 )
(KOMMISSARISCHER LEITER: PROFESSOR DR. H. HECKER)
und dem Institut für Rechtsmedizin der Universität Leipzig 4 )
(DIREKTOR: PROFESSOR DR. W. J. KLEEMANN)
und der Abteilung Gastroenterologie und Hepatologie der Medizinischen Hochschule Hannover 5 )
(DIREKTOR: PROFESSOR DR. M. P. MANNS)
DIRK BREITMEIER 1 ), LJILJANA VERNER 2 ), KNUT ALBRECHT 1 ), ARMIN FIEGUTH 1 ),
HEINZ GEERLINGS 3 ), WERNER JOHANN KLEEMANN 4 ), BERNHARD PANNING 2 ),
MICHAEL GEBEL 5 ), HANS DIETER TRÖGER 1 )
Arteriovenous differences (A-V differences) by patients with
a hepatocellular carcinoma in relation to percutaneous ethanol
injection therapy (PEIT)
Arteriovenöse Differenzen bei Patienten mit einem hepatozellulären
Karzinom im Zusammenhang mit der perkutanen
Ethanolinstillationstherapie (PEIT)
Introduction
Hepatocellular carcinoma (HCC) is one of the most common neoplasms in the world [1, 2].
Most patients with HCC have underlying cirrhosis. The impairment of liver function
makes surgical treatment like hepatectomy difficult [3]. A wide variety of other therapy
concepts are described in the literature to treat irresectable HCC [4, 5, 6, 7, 8, 9, 10, 11, 12].
Excluded from any other therapies, PEI as a low-risk technique has been proven to be a
reliable and suitable alternative in patients otherwise treated surgically or with other concepts
who present adverse prognostic factors or risks for these therapies and has several
advantages over multisession therapy [13, 14, 15, 16]. Other advantages seem to be the
shorter treatment time, the possibility to treat larger and more numerous lesions, and the reduction
of the number of therapies that need to be administered, resulting thus in fewer
and/or a shorter stay in the hospitalisation [14,16]. Varying amounts of ethanol (96 vol.%)
are directly injected into the liver tumor after ultrasound-guided percutaneous punction
without any ethanol loss due to resorption deficits or hepatic metabolism effects. Under
general anesthesia it is possible to administer larger doses of alcohol per treatment.
Alcohol distribution in arteries and veins has been investigated in animals. Currently
there are only a few studies available about arterial-venous (A-V) differences regarding
blood alcohol concentration in humans. In this study blood alcohol was determined in various
blood compartments during ethanol injection into the liver within the controlled conditions
of an operation. Literature shows that a significant concentration gradient exists
during ethanol distribution between the portal vein, the peripheral venous circulation, and
the stomach [17, 18, 19]. The literature indicates that A-V differences in blood ethanol concentration
exist only during the distribution phase but are rapidly abolished when the
administration of ethanol is finished [20]. Some authors mentioned that ethanol concen-
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