Objective: Arsenic trioxide (As2O3) can be used as a possible pharmaceutical alternative that augments radiofrequency (RF) ablation by reducing tumor blood flow.The aim of this study was to assess the effect of intraarterial and intravenous administration of As2O3 on RF-induced ablation in an experimentally induced liver tumor.Materials and Methods: VX2 carcinoma was grown in the livers of 30 rabbits.As2O3 (1 mg/kg) was administered through the hepatic artery (n = 10, group A) or ear vein (n = 10, group B), 30 minutes before RF ablation (125 mA ± 35; 90 ± 5°C).As a control group, 10 rabbits were treated with RF ablation alone (group C).RF was intentionally applied to the peripheral margin of the tumor so that ablation can cover the tumor and adjacent hepatic parenchyma.Ablation areas of the tumor and adjacent parenchymal changes among three groups were compared by the Kruskal-Wallis and Mann-Whitney U test. Results:The overall ablation areas were 156 ± 28.9 mm 2 (group A), 119 ± 31.7 (group B), and 92 ± 17.4 (group C, p < 0.04).The ablation area of the tumor was significantly larger in group A (73 ± 19.7 mm 2 ) than both group B (50 ± 19.4, p = 0.02) and group C (28 ± 2.2, p < 0.01).The ratios of the tumoral ablation area to the overall ablation area were larger in group A (47 ± 10.5%) than that of the other groups (42 ± 7.3% in group B and 32 ± 5.6% in group C) (p < 0.03). Conclusion:Radiofrequency-induced ablation area can be increased with intraarterial or intravenous administration of As2O3.The intraarterial administration of As2O3 seems to be helpful for the selective ablation of the tumor.
The purpose of this study was to evaluate the safety and efficacy of N-butyl cyanoacrylate for bronchial and nonbronchial systemic artery embolization in the management of major hemoptysis.From March 2004 through March 2006, 108 patients with major hemoptysis underwent embolization with N-butyl cyanoacrylate. The common conditions causing hemoptysis were bronchiectasis (n = 34), sequelae of tuberculosis (n = 31), active tuberculosis (n = 18), lung cancer (n = 8), and aspergilloma (n = 6). A retrospective analysis of postprocedure outcomes, including immediate success, recurrence of hemoptysis, cause of recurrence, and complications, was performed.Immediate success was achieved in 105 patients (97.2%). During the follow-up period (range, 5 days-63 months; median, 28.5 months), recurrent hemoptysis was found in 21 of the 105 patients (20%). Repeat angiograms (n = 14) revealed incomplete embolization during the initial procedure in seven patients with early recurrence (< 3 months) and revascularization of nonbronchial systemic collateral arteries in seven patients with late recurrence (> 3 months). No recanalization of embolized arteries was found on repeat angiograms or at follow-up CT. The cumulative nonrecurrence rates were 91.4% 1 month, 83.4% 1 year, 76.7% 3 years, and 56.8% 5 years after the initial procedure. The procedure-related complications included transient chest pain (n = 21) and denudation of the bronchial mucosa (n = 3), which was clinically silent but found at bronchoscopy.N-butyl cyanoacrylate is a safe and effective agent for embolization in patients with major hemoptysis.
PURPOSE To describe a newly designed bifurcated modular stent-graft and assess the feasibility and safety of its use in the treatment of abdominal aortic aneurysms (AAA). METHODS Thirteen patients (10 men; mean age 61.2+/-16 years, range 57-78) with AAAs underwent treatment with a bifurcated stent-graft consisting of 4 components: an unsupported bifurcated stent-graft, an inner bare stent, and 2 stent-grafts. The system was placed sequentially through a percutaneously introduced 12-F sheath; the preloaded bifurcated main body of the stent-graft was deployed first, followed by the inner bare stent and individual stent-graft limbs through separate 10-F sheaths. Spiral computed tomography (CT) was performed before treatment and at 1 week, 3 months, and then at 6-month intervals. RESULTS The stent-grafts were successfully deployed in all patients, although 3 types of procedure-related adverse events occurred: left limb kinking in 1, postimplantation syndrome (fever, leukocytosis, and decreased platelet count) in 5, and a small access site arteriovenous fistula in 1. Postprocedural angiography and 1-week follow-up CT scanning did not identify any endoleaks. At a mean 9.2+/-4.6-month follow-up, all devices were intact, with complete exclusion of the aneurysms and no endoleaks. CONCLUSIONS This newly designed bifurcated modular stent-graft appears to be effective for percutaneous AAA repair; further investigation is warranted.
The Efficacy of Metallic Stent Placement in the Treatment of Colorectal ObstructionObjective: To evaluate the efficacy of newly designed covered and non-covered coated colorectal stents for colonic decompression.Materials and Methods: Twenty-six patients, (15 palliative cases and 11 preoperative) underwent treatment for the relief of colorectal obstruction using metallic stents positioned under fluoroscopic guidance.In 24 of the 26, primary colorectal carcinoma was diagnosed, and in the remaining two, recurrent colorectal carcinoma.Twenty-one patients were randomly selected to receive either a type A or type B stent; for the remaining five, type C was used.Type A, an uncovered nitinol wire stent, was lightly coated to ensure structural integrity.Type B (flare type) and C (shoulder type) stents were polyurethane covered and their diameter was 24 and 26mm, respectively.The rates of technical success, clinical success, and complications were analyzed using the chi-square test, and to analyse the mean period of patency, the Kaplan-Meier method was used.Results: Thirty of 31 attempted placements in 26 patients were successful, with a technical success rate of 96.8% (30/31) and a clinical success rate of 80.0% (24/30).After clinically successful stent placement, bowel decompression occurred within 1 4 (mean, 1.58 0.9) days.Five of six clinical failures involved stent migration and one stent did not expand after successful placement.In the preoperative group, 11 stents, one of which migrated, were placed in ten patients, in all of whom bowel preparation was successful.In the palliative group, 19 stents were placed in 15 patients.The mean period of patency was 96.25 105.12 days: 146.25 112.93 for type-A, 78.82 112.26 for type-B, and 94.25 84.21 for type-C.Complications associated with this procedure were migration (n=6, 20%), pain (n=4, 13.3%), minor bleeding (n=5, 16.7%), incomplete expansion (n=1, 3.3%), and tumor ingrowth (n=1, 3.3%).The migration rate was significantly higher in the type-B group than in other groups (p=0.038). Conclusion:Newly designed covered and non-covered metallic stents of a larger diameter are effective for the treatment of colorectal obstruction.The migration rate of covered stents with flaring is higher than that of other types.For evaluation of the ideal stent configuration for the relief of colorectal obstruction, a clinical study involving a larger patient group is warranted.n advanced colorectal cancer, obstruction is a common complication, particularly if the lesion is located in the left colon (1 5).In recent years, some authors have reported favorable results of the nonsurgical treatment of colonic obstruction using an uncovered expandable metallic stent 10 22 mm in diameter (1 12).The placement of an uncovered self-expanding metallic stent, a minimally invasive procedure, can be performed without general anesthesia and reduces the need for colostomy (8).It provides temporary decompression of the colon
Background/Aims Limited options remain for patients with metastatic colorectal cancer (CRC) after failure of standard systemic chemotherapy. Readministration of chemotherapeutic agents by hepatic arterial infusion (HAI) has the rationale of providing higher concentrations of chemotherapeutic agents to hepatic metastases. The present study was conducted to evaluate the efficacy and safety of HAI of fluorouracil with leucovorin (HAI 5-FU/LV) for patients with liver metastases from CRC. Methods Fourteen patients with liver metastases from CRC who received HAI 5-FU/LV after failure of systemic chemotherapy containing fluorouracil and leucovorin were identified and their medical records were reviewed. Results Of 10 patients evaluable for response, one partial response, six stable disease, and three progressive disease were reported. Additionally, the overall response and disease control rates were 7% and 50%, respectively. The median time to progression was 4.3 months (range, 2.9 to 5.6), to hepatic progression was 5.8 months (range, 4.7 to 6.9), and to extrahepatic progression was 5.8 months (range, 2.3 to 9.2). No grade 3/4 hematologic toxicities occurred and one case of abdominal pain and two cases of oral mucositis were the only grade 3 nonhematologic toxicities. Catheter-related complications occurred in three patients: one thrombosis, one infection, and one displacement. Conclusions HAI 5-FU/LV was well tolerated and showed modest efficacy for patients with liver metastases from refractory CRC. Readministration of previously used chemotherapeutic agents via the hepatic artery could be an effective salvage option and warrants further investigation in a prospective trial.
A polyurethane-covered retrievable expandable stent was placed in 13 patients with tracheobronchial strictures. In four patients with benign strictures, the stent was removed with use of a retrieval hook 2–6 months after placement. After stent removal, three of the four patients did not need further treatment. The retrievable stent warrants further investigation in the treatment of tracheobronchial strictures.
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