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Objective To investigate the cost-effect of transarterial chemoembolization (TACE) with CalliSpheres beads loaded with arsenic trioxide (ATO) (CBATO) versus ATO iodized oil emulsion (conventional TACE, cTACE) in the treatment of unresectable liver cancer. Methods A total of 100 patients with advanced liver cancer who attended The First Affiliated Hospital of Zhengzhou University from May 2017 to December 2018 were enrolled and divided into CBATO group( n =45) and cTACE group( n =55) according to the treatment regimen. Progression-free survival (PFS) was used to evaluate the efficacy of quality-adjusted life year (QALY), and European Quality of Life-5 Dimensions (EQ-5D) index was used to evaluate quality of life. The t -test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups; the number of surgeries, length of hospital stay, treatment cost, and incremental cost-effectiveness ratio (ICER) were calculated for the two groups, and then a cost-effect analysis was performed. Results Within the PFS time, the per capita hospital cost was 96 446 yuan in the CBATO group and 91 230.43 yuan in the cTACE group. There were significant differences between the two groups in the mean number of surgeries (2.5±0.7 vs 3.4±0.8, t =16.911, P < 0.01) and mean hospital stay (5.8±1.2 days vs 7.5±1.8 days, t =12.459, P < 0.01). The CBATO group had a significantly higher QALY than the cTACE group (0.804 vs 0.512). Compared with the cTACE group, the CBATO group had an ICER of 17 861.53 yuan/QALY for unresectable liver cancer. Conclusion Although CBATO has a higher surgery cost than cTACE, CBATO has a better clinical effect than cTACE and can reduce the number of surgeries and length of hospital stay, with a better postoperative quality of life than cTACE, suggesting that CBATO has marked cost-effect advantages.
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Ultraselective conventional transarterial chemoembolization (cTACE), defined as cTACE at the most distal portion of the subsubsegmental hepatic artery, is mainly performed for hepatocellular carcinoma (HCC) ≤5 cm. Distal advancement of a microcatheter enables injection of a larger volume of iodized oil into the portal vein in the limited area under non-physiological hemodynamics. As a result, the reversed portal flow into the tumor through the drainage route of the tumor that occurs when the hepatic artery is embolized is temporarily blocked. By adding gelatin sponge slurry embolization, both the hepatic artery and portal vein are embolized and not only complete necrosis of can be achieved. Ultraselective cTACE can cure small HCCs including less hypervascular tumor portions and replace surgical resection and radiofrequency ablation in selected patients.
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Humans , Carcinoma, Hepatocellular , Catheter Ablation , Chemoembolization, Therapeutic , Drainage , Gelatin , Gelatin Sponge, Absorbable , Hemodynamics , Hepatic Artery , Iodized Oil , Necrosis , Porifera , Portal VeinABSTRACT
ObjectiveTo investigate the clinical effect and safety of transarterial chemoembolization (TACE) with ultra-liquid iodized oil combined with drug-eluting beads in the treatment of Barcelona Clinic Liver Cancer (BCLC) stage B/C hepatocellular carcinoma (HCC). MethodsA retrospective analysis was performed for the clinical data of 51 patients with BCLC stage B/C HCC who underwent TACE with ultra-liquid iodized oil combined with drug-eluting beads in The First Affiliated Hospital of Soochow University from May 2016 to September 2018. Liver function was observed before treatment and at 3 days, 7 days, and 1 month after treatment, and adverse events and complications were recorded in detail. Modified Response Evaluation Criteria in Solid Tumors was used to evaluate clinical outcome at 1 and 3 months after surgery. The t-test was used for comparison of continuous data between two groups. ResultsSuperselective TACE procedure was completed in all 51 patients. At 1 month after surgery, the target lesions had a disease remission rate of 70.6% and a disease control rate of 96.1%, while at 3 months after surgery, the target lesions had a disease remission rate of 64.0% and a disease control rate of 880%. Of all 51 patients, 5 (9.8%) experienced acute liver injury at 3 days after surgery, and there were significant changes in alanine aminotransferase (ALT), aspartate aminotransferase, total bilirubin (TBil), and albumin (Alb) (t=-5.454, -3.997, -5.346, and 7212, all P＜0.001). There were also significant changes in ALT, TBil, and Alb at 7 days after surgery (t=-3.177, -3.665, and 3194, all P＜0.05). Of all 51 patients, 35 (68.6%) experienced grade 1 or 2 adverse events at 1 month after surgery, and no complications of liver failure, liver abscess, bile tumor, and gastrointestinal bleeding were observed. One patient died of multiple organ failure due to tumor progression on day 61 after surgery. ConclusionTACE with ultra-liquid iodized oil combined with drug-eluting beads is safe and effective in the treatment of BCLC stage B/C HCC, and further studies are needed to observe long-term efficacy and survival benefit.
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Objective To explore the impact of local lipiodol deposition in liver of miniature pigs on the shape and size of the necrotic area after microwave ablation (MWA).Methods Ten healthy miniature pigs were selected and equally divided into experimental group and control group (each n=5).In experimental group,transcatheter hepatic arterial embolization with lipiodol was done before microwave ablation,while only standard microwave ablation was performed in control group.Immediate post-ablation CT images were obtained.Long-axis diameter (LAD),short-axis diameter (SAD),sphericity index (SI=SAD/LAD) and volume of ablation zone were calculated.The size and shape of the ablated areas were compared between two groups.Results The mean LAD,SAD,SI and volume of ablation zone in experimental group ([4.21 ± 0.52]cm,[2.87±0.38]cm,0.69±0.10,[18.72±6.08]cm3) were larger than those in control group ([3.71±0.42]cm,[2.19±0.42]cm,0.60±0.09,[9.44±2.29] cm3;all P＜0.05).Conclusion Local deposition of lipiodol in liver parenchyma of miniature pigs can help to produce larger and rounder necrosis in the ablation zone.
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Objective To evaluate the value of removing intracranial lipiodol by fat emulsion injection.Methods Twelve rabbits were randomly divided into two groups,control group(n=6) and experimental group(n=6).All rabbits were injected lipiodolvia the internal carotid artery(0.06 ml/kg).When lipiodol was found intracranially by CT scan,the model was considered to be successful.The rabbits were then injected with fat emulsions intravenously immediatedly following the CT and at intervals of 24 hours,for a total of 6 times(20 ml/kg).Subsequently,the experimental group of rabbits underwent head CT scan at that time and 144 hours later.The control group without treatment underwent head CT scan at the same time interval.The highest density of 0.01 cm2 was selected as region of interest and the CT value was measured.Comparison between the two groups at different times used repeated measurements of ANOVA.Same time points between the two groups were compared using the two independent-samplesttest.Changes of clinical symptoms were observed in rabbits.Results At 24,48,72,96,120 hours,144 hours post-treatment,the CT values of the ROI in the control group and the experimentalgroupwere(103.8 ±7.1),(91.0±4.2),(79.5 ±5.5),(67.8±6.6),(53.9±5.1),(39.9±3.1)HU respectively and(90.7-±5.4),(74.1±4.6),(62.9±4.5),(48.1±3.1),(39.1±1.3),(38.8± 1.2)HU respectively.The results of the repeated measurementsof ANOVA showed that the CT values difference of the two groups at different time was statistically significant(F=201.30,P＜0.01).The results of the two independent-samples t test showed that the CT values difference of 24 to 120 hours posttreatment of the two groups also was statistically significant(t=3.60,6.64,5.72,6.62,6.89,P＜0.05).After the intra-arterial injection of lipiodol,all animals had different degrees of stroke symptoms.Clinical symptoms disappeared earlier in the experimental group than the control group by 24 hours.Conclusion Fat emulsions can accelerate the intracranial lipiodolclearence.This study provides some theoretical basis for clinical treatment of cerebrallipiodol embolism.
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<p><b>OBJECTIVE</b>To evaluate effect of iodized oil in crossbred cattle suffering from hyperthermia (heat intolerance syndrome) in Punjab, India.</p><p><b>METHODS</b>The present study was conducted in 85 clinical cases of summer hyperthermia in exotic and crossbred cows with rectal temperature of ≥40.56 °C. Haematological examinations of the affected cows (55) showed relatively low haemoglobin, normal differential and total leucocytic count. All the affected cows (85) were treated with three doses of iodized oil (750 mg elemental iodine per dose, 5mL) given at 24 h interval by subcutaneous route in brisket region.</p><p><b>RESULTS</b>Seventy seven (90.58%) cases showed remarkable clinical improvement with temperature coming to normal (38.33 to 38.88 °C) within 5 d of start of treatment. The appetite and milk production was restored by 10th day post treatment.</p><p><b>CONCLUSIONS</b>The findings of this study substantiate that subcutaneous administration of three doses of iodized oil given at 24 h interval is effective in decreasing rectal temperature of hyperthermic cattle.</p>
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Objective To investigate the efficacy of developable iodized oil-fluorouracil polylactic acid microspheres for treatment of New Zealand rabbit liver cancer model. Methods The model rabbits were randomly divided into three groups. The femoral arteries of the right hind limbswere separated, a microcatheter was inserted through the femoral artery to the hepatic artery via a catheter, and the corresponding drugs were injected to the peripheral arteries around the hepatic tumor tissue. The blank control group was not given any medicationi the drug control group was given fluorouracil injection and developable iodized oil injectioni and the experimental group was given self-made iodized oil-fluorouracil polylactic acid microspheres. Regular imaging was used to observe tumor growth and drug embolism status. Results Developable iodized oil-fluorouracil polylactic acid microspheres effectively achieved embolization around the tumor tissues, resulting in notable tumor cell apoptosis, and the effects were developable and durable. Conclusion Developable iodized oil-fluorouracil polylactic acid microspheres have sustained-release property and can be better developed, showing a promising clinical application future.
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Objective To evaluate the therapeutic effectiveness and safety of combining chemoembolization using microspheres with iodized oil in the treatment of patients with hepatocellular cancer.Methods According to the inclusion and exclusion criteria,two reviewers independently completed the whole process of data search,selection,collection and quality assessment.The Medline,Cancer Lit,PUBMED,EMBASE,Cochrane Library,CNKI,CBM,VIP,Wanfang Data and Grey literature were searched for randomized controlled trails (RCTs) on combining chemoembolization using microspheres with iodized oil in the treatment of liver cancer.The search was from January 2005 to December 2012.The software package Rev Man 5.1 (the Cochrane collaboration) was used to conduct the Meta-analysis and to analyze the data.Results Of the 159 trials selected out from January 2005 and December 2012 for review,only five RCT involving 471 patients were finally included into the analysis.When compared with chemoembolization by iodized oil alone,the combination treatment significantly improved the therapeutic effectiveness (CR + PR).However,there was no obvious difference between the two methods of treatment in the incidence of adverse reaction.Conclusions Combining chemoembolization using microspheres with iodized oil for patients with hepatocellular cancer was effective in controlling liver cancer progression.There is still a need to reduce the incidence of adverse reaction in future.
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Objective: To evaluate effect of iodized oil in crossbred cattle suffering from hyperthermia (heat intolerance syndrome) in Punjab, India. Methods: The present study was conducted in 85 clinical cases of summer hyperthermia in exotic and crossbred cows with rectal temperature of ≥40.56 °C. Haematological examinations of the affected cows (55) showed relatively low haemoglobin, normal differential and total leucocytic count. All the affected cows (85) were treated with three doses of iodized oil (750 mg elemental iodine per dose, 5mL) given at 24 h interval by subcutaneous route in brisket region.Results:coming to normal (38.33 to 38.88 °C) within 5 d of start of treatment. The appetite and milk production was restored by 10th day post treatment.Conclusions: The findings of this study substantiate that subcutaneous administration of Seventy seven (90.58%) cases showed remarkable clinical improvement with temperature three doses of iodized oil given at 24 h interval is effective in decreasing rectal temperature of hyperthermic cattle.
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OBJECTIVE: To assess the clinical efficacy, safety, and risk factors influencing local tumor progression, following CT-guided radiofrequency ablation (RFA) of recurrent or residual hepatocellular carcinoma (HCC), around iodized oil retention. MATERIALS AND METHODS: Sixty-four patients (M : F = 51 : 13, 65.0 +/- 8.2 years old) with recurrent or residual HCC (75 index tumors, size = 14.0 +/- 4.6 mm) had been treated by CT-guided RFA, using retained iodized oil as markers for targeting. The technical success, technique effectiveness rate and complications of RFA were then assessed. On pre-ablative and immediate follow-up CT after RFA, we evaluated the size of enhancing index tumors and iodized oil retention, presence of abutting vessels, completeness of ablation of iodized oil retention, and the presence of ablative margins greater than 5 mm. Also, the time interval between transarterial chemoembolization and RFA was assessed. The cumulative local tumor progression rate was calculated using the Kaplan-Meier method, and the Cox proportional hazards model was adopted, to clarify the independent factors affecting local tumor progression. RESULTS: The technical success and technique effectiveness rate was 100% and 98.7%, respectively. Major complications were observed in 5.6%. The cumulative rates of local tumor progression at 1 and 2 years were 17.5% and 37.5%, respectively. In multivariate analyses, partial ablation of the targeted iodized oil retention was the sole independent predictor of a higher local tumor progression rate. CONCLUSION: CT-guided RFA of HCC around iodized oil retention was effective and safe. Local tumor progression can be minimized by complete ablation of not only index tumors, but targeted iodized oil deposits as well.
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Aged , Female , Humans , Male , Middle Aged , Carcinoma, Hepatocellular/diagnostic imaging , Catheter Ablation/methods , Chemoembolization, Therapeutic/methods , Fat Emulsions, Intravenous , Iodized Oil , Liver Neoplasms/mortality , Neoplasm Recurrence, Local/diagnostic imaging , Republic of Korea/epidemiology , Surgery, Computer-Assisted/methods , Survival Rate/trends , Tomography, X-Ray Computed/methods , Treatment OutcomeABSTRACT
Background: Iodine deficiency disorders (IDDs) are the most common cause of preventable brain damage globally. The strategy of prevention and control of iodine deficiency is based on iodine supplementation. Edible salt iodization and iodized oil injections are the two most commonly used vehicles for iodine supplementation. The objective of the study was to conduct a cost-benefit analysis of the two programs of iodine supplementation, i.e., iodized salt program (ISP) and iodized oil program (IOP) against no preventive program (NPP) option. Materials and Methods: The study was conducted in 1990 in the state of Sikkim in India. The costs were calculated on the assumption of universal coverage of ISP and coverage of IOP among all children aged 0-14 years and women in the age group of 15-44 years. Direct and indirect cost of ISP and direct cost of IOP was computed based on the costs of year 1991. The discount rate taken was 10% and all the costs were converted to the year 2010 using wholesale price index (WPI) data. Consequences in terms of health effects, Social/emotional effects, and resource use were included. Results: The discounted cost of ISP and IOP was Rs. 59,225,964 and Rs. 46,145,491, respectively. In ISP, 64.1% of the total cost was required for salt iodization, 17.6% for monitoring, and 18.3% for communication. In IOP, 50.9% of the costs were required for iodized oil; rest was for syringes and needles, manpower expenses, travel, and communication. Total resource saving was Rs. 95,566,220 for ISP and Rs. 92,177,548 for IOP. Incremental benefit for ISP was Rs. 36,340,256 and Rs. 46,032,057 for IOP. The cost-benefit ratio for ISP was 1.61 and 2.00 for IOP. Conclusion: IOP has a higher cost-benefit ratio for prevention of IDDs than ISP in the state of Sikkim, India.
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Background: Edible salt iodization and iodized oil injections are the two most commonly used vehicles for iodine supplementation. In year 1989, the state government of Sikkim was planning to implement Iodine Deficiency Disorder control program in state and had following two options to choose from, based on existing knowledge; a) a salt iodization program, b) an iodized oil injection program. No information was available at that point of time on comparative advantages of the above stated two approaches. Objectives: To identify the most cost-effective alternative for IDD elimination in Sikkim, amongst the following 3 alternatives: a) Iodized salt program (ISP), b) Iodized oil injection program (IOP) to high risk group, c) no preventive program. Materials and Methods: Study population was the general population of state of Sikkim, India in year 1990. Cost- effective analysis was undertaken comparing 3 alternative programs, targeted towards IDD elimination in state of Sikkim. Identification, measurement and valuation of the costs of ISP and IOP and identification and measurement of the consequences of IDD were done to carry out the cost-effective analysis. Visible goiter person years (VGPY), endemic cretinism, IDD attributable death were used to assess the health consequences/disease burden of IDD. Results: The cost per VGPY, endemic cretinism and IDD attributable death were Rs 76.67, Rs 24,469 and Rs 9,720, respectively for ISP. The cost per VGPY, endemic cretinism and IDD attributable death were Rs 75.82, Rs 19,106 and Rs 7,709, respectively for IOP. Conclusion: The results of the analysis showed that iodized oil program is more cost-effective for prevention of irreversible IDDs than the iodated salt program in state of Sikkim, India.
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OBJECTIVE: To assess the technical feasibility and local efficacy of biplane fluoroscopy plus US-guided percutaneous radiofrequency ablation (RFA) for viable hepatocellular carcinoma (HCC) around retained iodized oil after transcatheter arterial chemoembolization (TACE). MATERIALS AND METHODS: Our prospective study was approved by our institutional review board and informed consent was obtained from all participating patients. For patients with viable HCC around retained iodized oil after TACE, biplane fluoroscopy plus US-guided RFA was performed. We evaluated the rate of technical success and major complications on a post-RFA CT examination and local tumor progression with a follow-up CT. RESULTS: Among 40 consecutive patients, 19 were excluded due to one of the following reasons: poorly visible HCC on fluoroscopy (n = 13), high risk location (n = 2), RFA performed under monoplane fluoroscopy and US guidance (n = 2), and poorly identifiable new HCCs on US (n = 2). The remaining 21 patients with 21 viable HCCs were included. The size of total tumors ranged from 1.4 to 5.0 cm (mean: 3.2 cm) in the longest diameter. Technical success was achieved for all 21 HCCs, and major complications were observed in none of the patients. During the follow-up period (mean, 20.3 months; range, 6.5-29.9 months), local tumor progression was found in two patients (2/21, 9.5%). Distant intrahepatic metastasis developed in 76.2% (16/21) of patients. CONCLUSION: When retained iodized oil around the tumor after TACE hampers the targeting of the viable tumor for RFA, biplane fluoroscopy plus US-guided RFA may be performed owing to its technical feasibility and effective treatment for viable HCCs.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Carcinoma, Hepatocellular/diagnostic imaging , Catheter Ablation , Chemoembolization, Therapeutic , Complex Mixtures , Contrast Media , Fluoroscopy/methods , Iodized Oil/administration & dosage , Iohexol/analogs & derivatives , Liver Neoplasms/diagnostic imaging , Ultrasonography, InterventionalABSTRACT
Objective To evaluate the clinical therapeutic effect with microspheres embolization for giant hepatocellular carcinoma(HCC). Methods A prospective study was performed for 156 HCC patients needed for TACE, then randomly signed them into group M (embolized by microspheres alone), group L (embolized by lipiodol alone) and group M + L (embolized by microspheres combined with lipiodol). TACE of group M was performed by 300-700 μm microspheres. Group L selected lipiodol alone to embolize. While group M + L were embolized by about 1/3-1/2 lipiodol of total embolized volume and then microspheres feeding individual tumor vessels. Stoped the procedure when caused terminal vessel blockade. Before and after therapy, patients'liver function, serum α-fetoprotein level (AFP), responses of tumor, complications related to embolization and survive rates of 180 days and 360 days were analyzed among three groups.Enumeration data such as survive rates and positive response were compared by χ2 test, while measurement data were analyzed by one-way classification. Results The positive response (CR + PR) of group M was 38.5% (20/52)and (CR + PR + SD)73. 1% (38/52). Survive rates of 180 days and 360 days were 88. 5% (46/52) and 82. 3% (43/52). While those of group L were 42. 3% (22/52) ,76.9% (40/52),86.5%(45/52), 75.0% (39/52) and group M + L were 55. 8 % (29/52), 88.5 % (46/52), 94. 2% (49/52),86. 5％ (45/52). Significant difference of survival rates and total effective between group M + L and M,M + L and L was found(χ2 = 6. 27,6. 16, P ＜ 0. 05). At the same time adverse responses of incidence and persis time such as febricity, nausea and vomit, hepatic pain were more lower in group M + L and group M.Three groups febricity rate were 63.4% (33/52), 86. 5% (45/52) and 69. 2% (36/52), nausea and vomit were 67.3 % (35/52) ,84. 6% (44/52) and 76. 9% (40/52), hepatic pain were 59. 6% (31/52), 86. 5 %(45/52), 73. 1% (38/52) (χ2 = 6.55, 6. 22, 6. 90, P ＜ 0. 05). Conclusion Embolization with microspheres can get longer and more effective treatment. TACE with microspheres and lipiodol for embolizing HCC was more effective than with Microspheres or lipiodol alone.
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Objective To compare the value of biphasicmulti-detector row helical computed tomogrpahy(MDCT),digital subtraction angiography(DSA)and lipiodol computed tomography(CT)in hypervascular hepatocellular carcinoma(HCC).Methods 80 cases with liver cancer were underwent MDCT、DSA、iodized oil CT scan,then compared detection rates of three methods.Results In detecting hepatic nodules(＞2cm),these three imaging techniques had the same sensitivity;for 1～2cm hepatic nodules,the detecting rate had no significant difference;The MDCT scan＜1cm detected 47 nodules(94.0%),iodized oil CT detected 27 nodules(54.0%),both statistically significant difference in detection rate(χ~2=3.11,P＜0.01),DSA is only detected 16 nodules(32.0%)compared with enhanced dual-phase MDCT scan and iodized oil CT detection rate the differences were statistically significant(χ~2=9.09,9.03,all P＜0.01).Conclusion MDCT is able to better show feeding arteries of hepatocellular carcinoma,The imaging examination of liver cancer before treatment can be used as a comprehensive evaluation.
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Objective: To prepare visualized iodized oil-5-fluorouracil loaded polylactic acid(PLA) micropheres for hepatic artery embolism treatment. Methods: Biocompatible and biodegradable material PLA was used as vector and iodized oil was used as positive contrast agent to prepare 5-fluorouracil loaded microspheres using double emulsion method. The preparation technology of the microspheres was developed through optimization of appearance, size distribution, drug loading, and encapsulation efficiency by orthogonal-designing method. Results: The prepared PLA microspheres were round in shape and had a homogenous diameter distribution. Scanning electron microscope (SEM) showed a pored surface, with an average diameter of 100 μm. The encapsulation efficiency and drug content of microspheres were (63.34%±0.54%) and (10.78%±0.14%), respectively. Conclusion: We have successfully prepared the visualized iodized oil-5-fluorouracil PLA microspheres, which can release 5-fluorouracil in a controlled manner.
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Objective To evaluate the effect of transcatheter hepatic artery embolization with lipiodol on perfused radiofrequency ablation (PRFA) on mini-porcine.Methods Ten Chinese mini-porcine were randomly divided into embolization group and control group (each n=5) .A standard PRFA with infusing cooling procedure was done in control group,while transcatheter hepatic artery embolization with lipiodol was done before PRFA in embolization group.CT and MR scan were performed after PRFA.Then a comparative analysis of the shape and volume of the lesions in the liver were performed.Resuits In both two groups,distinct spherical margin of the PRFA lesions was obtained.The minimal diameter was (31.76±3.43) mm in embolization group and (27.23±3.49) mm in control group (t=2.675,P＜0.05) .The average volume of the embolization group was (54.47±9.98) cm~3,while in the control group was (20.90±5.68) cm~3 (t=10.424,P＜0.05) .Conclusion Transcatheter hepatic artery embolization with lipiodol before PRFA can enlarge the ablation size of mini-porcine's liver.
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Objective To evaluate the long-term effect of hepatic arterial embolization with pingyangmycin-lipiodol emulsion (PLE) in patients with cavernous hemangiomas of the liver (CHL)and its influence factors.Methods One hundred and fifty-six hemangiomas that were diagnosed by imaging examinations or confirmed pathologically by surgery in 105 patients with integral follow-up data were analyzed retrospectively in this paper.All hemangiomas were divided into 4 groups according to their size (the largest size of hemangioma)by the authors as follows; A group(≤3 cm, n=25); B group(>3 cm and<5 cm, n =32) ;C group(≥5 cm and<10 cm, n=58); and D group(> 10 cm, n=41) .According to the number of abnormal sinusoids filled with the contrast medium in the angiography, 156 hemangiomas of this series were further classified as three types: abundant type (n=90) ; sparse type (n=9) and the middle type (n=57) .Hepatic arterial embolization with PLE was performed in the 105 patients with total 135 procedures (including single procedure in 75 patients, twice procedures in 30 patients).All of the 105 patients were followed up 3 to 8 years(mean 4 years) using US, CT or MRI or DSA.The criteria for the evaluation of curative effect were classified as best, good, recovery and no change in this series, and the sum of best and good effects were defined as the total effective rate.Then, the total effective rate of single procedure between the A, B groups and C, D groups; and the total effective rate of single procedure and twice procedures in the D groups, were compared statistically by X~2 test respectively.And the influence factors, included of the variant size of hemangiomas, abundant or sparse of abnormal sinusoids and the number of treatment procedures, were also analyzed and evaluated respectively.Results The total effective rate of the 156 hemangiomas in 105 patients was 92.95% (145/156).After single procedure of hepatic arterial embolization with PLE, the total effective rate of A and B groups were 100% (57/57), that of C and D groups were 85.86% (85/99), and the difference reach significant (X ~2=8.8553, P<0.01).In the D group, the total effective rate in group with twice procedures (100.00%,30/30) was significant higher (X~2 =5.2642,P<0.05) than those of group with single procedure (72.73%,8/11).Of this series, during the period of following-up, no recurrent or severe complications were observed.Conclusions A best long-term curative effect (complete cure) is usually obtained in the small hemangiomas with abundant abnormal sinusoids, and a satisfactory long-term curative effect can also be achieved in the larger or multiple hemangiomas, particularly in those hemangiomas with abundant abnormal sinusoids by using the repeat procedures of hepatic arterial embolization with PLE.
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Objective To study the efficacy of different anti-adhesion agents used in preventing tubal obstruction after recanalization.Methods Five hundred and eight patients with tubal obstruction were divided into 245 cases in control group,108 cases in chitosan group;113 cases in sodium hyaluronate group and 42 cases in lipiodol group.The patients in control group were injected with anti-inflammation agents after recanalizatian,while other groups were injected with chitosan,sodium hyaluronate or lipiodol at dose of 2-3 ml in every therapeutic group.The rate of location of tubal obstruction and tubal recanalization were recorded during operation.Then patients in every group were followed up on tubal patency after 3 months,and pregnancy rate after 12 months.Results Among 1016 fallopian tubes in 508 patients,there were 330 tubes occlusion at isthmus portion and 563 tubes occlusion at interstitial portion of fallopian tube.Thirtyseven fallopian tubes were ablated because of ectopic pregnancy,86 fallopian tubes were unobstructed.(1)The recanalization rate were 95.7% (179/187) in chitosan group,97.9% (191/195) in sodium hyaluronate group,98.7% (75/76) in lipiodol group and 97.7% (425/435) in control group,which did not show statistical difference (P＞0.05).(2) The rates of tubal patency after 3 months of 91.7% (99/108) in chitosan group and 88.5% (100/113) in sodium hyaluronate group were significantly higher than 71.4% (30/42) in lipiodol group and 74.3% (182/245) in control group (P ＜0.05).(3)The rates of intrauterine pregnancy after 12 months were 48.1% (52/108) in chitosan group and 41.6% (47/113) in sodium hyaluronate group,which were significantly higher than 23.8% (10/42) in lipiodol group and 24.1% (59/245) in control group (P ＜ 0.05).Conclusion Chitosan and sodium hyaluronate could be effective to prevent tubal obstruction after interventional recanalization and increase pregnancy rate.
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Despite remarkable advancement in the surveillance and treatment of hepatocellular carcinoma (HCC) and the availability of novel curative options, a great proportion of HCC patients are still not eligible for curative treatment due to an advanced tumor stage or poor hepatic functional reserve. Therefore, there is a continuing need for effective palliative treatments. Although practiced widely, it has only recently been demonstrated that the use of transarterial chemoembolization (TACE) provides a survival benefit based on randomized controlled studies. Hence, TACE has become standard treatment in selected patients. TACE combines the effect of targeted chemotherapy with the effect of ischemic necrosis induced by arterial embolization. Most of the TACE procedures have been based on iodized oil utilizing the microembolic and drug-carrying characteristic of iodized oil. Recently, there have been efforts to improve the delivery of chemotherapeutic agents to a tumor. In this review, the basic principles, technical issues and complications of TACE are reviewed and recent advancement in TACE technique and clinical applicability are briefed.