Successful Endoscopic Ultrasound-Guided Alcohol Ablation of Sporadic Insulinoma Using Three-Dimensional Targeting (with Video)

Surgical resection is considered the standard of care in the management of symptomatic insulinoma. In this video, we describe the successful management of a symptomatic insulinoma by using linear array endoscopic ultrasound (EUS)-guided ethanol ablation in a poor surgical candidate. EUS-guided ethanol ablation of insulinoma offers a safer, effective, and less invasive alternative to surgery.

Alternativa no quirúrgica para el tratamiento del adenoma de glándula paratiroides Ablación percutánea con alcohol guiada con ultrasonido / A nonsurgical alternative for the treatment of parathyroid adenoma Ultrasound-guided percutaneous alcohol ablation

El adenoma de paratiroides es generalmente identificado por hallazgos incidentales de hormona paratiroidea (PTH) y calcio elevados asociado a niveles de fósforo disminuido. Las imágenes diagnósticas identifican la posición de la glándula respecto al parénquima tiroideo y visualizan la lesión por tratar. El manejo de esta patología va desde la extirpación completa (paratiroidectomía) hasta la realización de procedimientos mínimamente invasivos como la ablación del adenoma. En esta revisión, se describe el caso de una paciente mayor quien es llevada a urgencias por alteración del estado de conciencia. Los estudios realizados evidencian aumento en los niveles de PTH y calcio junto a imágenes sugestivas de adenoma de glándula paratiroides. Fue manejada con ablación percutánea con alcohol en tres oportunidades con lo que se normalizaron los parámetros de hormonas en sangre y recuperó el nivel de conciencia sin secuelas (Acta Med Colomb 2011; 36: 41-44).

Parathyroid adenoma is generally detected by the incidental finding of high blood levels of parathyroid hormone (PTH) and calcium, in association with decreased phosphorus. Diagnostic imaging is useful in order to establish the location of the parathyroid gland with regard to the thyroid parenchyma, and to visualize the lesion that is to be treated. The management of this disease has changed from complete extirpation of the parathyroid gland to minimally invasive procedures, such as ethanol ablation of the adenoma. In this review, the case is described of an elderly woman who is taken to the emergency department because of an alteration in consciousness. Her workup gave evidence of increased PTH and calcium levels. Imaging studies were suggestive of parathyroid adenoma. The patient was treated with percutaneous ethanol ablation, which was performed three times. The levels of hormones and calcium returned to normality, and the patient recovered her level of consciousness with no apparent sequels (Acta Med Colomb 2011; 36: 41-44).

Long-term Results of Percutaneous Ethanol Injection for the Treatment of Hepatocellular Carcinoma in Korea

OBJECTIVE: To evaluate the long-term follow-up results of percutaneous ethanol injection (PEI) for the treatment of hepatocellular carcinoma (HCC) in Korea. MATERIALS AND METHODS: Sixty-eight nodular HCCs initially detected in 64 patients, were subjected to US-guided PEI as a first-line treatment. Long-term survival rates, local tumor progression rates, and complications were evaluated, as were the influences of tumor size and Child-Pugh class on these variables. RESULTS: No major complications occurred. The overall survival rates of the 64 patients at three and five years were 71% and 39%, and their cancer-free survival rates were 22% and 15%, respectively. The overall survival rate of patients with a small HCC (< or = 2 cm) was significantly higher (p = 0.014) than that of patients with a medium-sized HCC (< or = 2 cm). The overall survival rate of patients with Child-Pugh class A was significantly higher (p = 0.049) than that of patients with Child-Pugh class B. Of 59 cases with no residual tumor, local tumor progression was observed in ablation zones in 18, and this was not found to be significantly influenced by tumor size or Child-Pugh class. CONCLUSION: The results of our investigation of the long-term survival rates of PEI in HCC patients in Korea (a hepatitis B virus-endemic area) were consistent with those reported previously in hepatitis C endemic areas. Patients with a smaller tumor or a better liver function exhibited superior survival rates.

Successful Management with Intra-abdominal Alcohol Ablation of Acardiac Twin and Amniodrainage in Twin Reversed Arterial Perfusion Sequence with Severe Polyhydramnios / 대한산부인과학회잡지

Twin reversed arterial perfusion (TRAP) sequence is a unique complication of monochorionic twinning, in which normal pump or donor twin paradoxically perfuses the recipient or acardiac twin through arterial- arterial anastomoses. This results in reversed flow of poorly oxygenated blood through the recipient twin and is usually associated with partial or complete lack of heart development. The pump twin has a mortality rate of 50% as a result of high-output heart failure, preterm labor, and polyhydramnios. We present here a case of twin reversed arterial perfusion (TRAP) sequence complicated by severe polyhydramnios during the second trimester. The blood supply to acardiac twin was interrupted successfully at 25 weeks of gestation by injecting 1.5 mL of absolute alcohol into the intra-abdominal portion of the single umbilical artery, under ultrasound guidance. Serial ultrasound showed normal growth and normal amniotic fluid volume in normal pump twin, but arrest of growth in femur length and decrease in amniotic fluid volume in acardiac twin. The normal pump twin was delivered at 384 weeks of gestation and had uneventful neonatal course.