RESUMO
BACKGROUND: As a new radiotherapy for malignant tumor, brachytherapy of radioactive seed implantation enables the inter-tissue implantation of radioactive seeds to be applied further with the appearance of seed implantation treatment planning system (TPS), and the gradual consummation of ultrasound and CT-guided precise positioning system.OBJECTIVE: To evaluate the methods, feasibility, safety and efficacy of CT-guided iodine-125 (125I) implantation for malignant tumors.DESIGN: A controlled observation before and after implantation.SETTING: The First People's Hospital of Hefei City.PARTICIPANTS: Twenty-one patients with malignant tumors, who were not suitable for surgical treatments of operation,were selected from the First People's Hospital of Hefei City from January 2004 to March 2005. There were 26 lesions, including 9 lesions of primary unresectable carcinoma and 17 lesions of metastasis tumors.METHODS: Under CT guidance, 125I seeds were implanted into malignant tumor according to TPS, the radioactivity quantum were 22, 26, 30 and 33 MBq per granule. Larger radiation 125I wes suitable for the implantation in the center of a lesion and smaller ones were for the margin of the lesion and the peripheral region of some important organisms such as vessels and nerves. The interval between larger seeds was about 1.5 cm whereas the interval between smaller ones was about 1.0 cm.MAIN OUTCOME MEASURES: The seed distribution, existence of complication and changes of the size of lesion after implantation were observed.RESULTS: ① The seeds were implanted successfully in all the 21 cases. No complication was observed. The practical distribution of the implanted seeds was basically the same as the scheduled scheme before implantation. All the 21 patients were involved in the analysis of results. ② The number of seeds implanted in one lesion was 5 to 40 (mean 14).Pain relief was obtained in all 10 cases of malignant tumors of bone after implantation. Follow-up CT reexamination demonstrated that 18 lesions were obviously diminished, necrosis was found in 4 lesions and remaining 4 lesions had no significant changes in size. ③ The average sizes of 14 lesions in 11 patients at 5-7 months after implantation were obviously smaller than those before implantation (1.84 cm vs 3.41 cm, t =5.7237, P ＜ 0.001). The average sizes of 12 lesions in 10 patients at 8-10 months after implantation were also obviously smaller than those before implantation (1.96 cm vs 3.43 cm, t =5.577 8, P ＜ 0.002).CONCLUSION: CT-guided 125I implantation is a safe, effective and feasible method for the treatment of malignant tumor.
RESUMO
Objective To study the tactics, methods and relevant factors of transcatheter embolization for acute gastrointestinal hemorrhage.Methods Fifteen patients with acute gastrointestinal hemorrhage were embolized by one of the methods of Polyvinyl Alcohol (PVA), gelfoam or metal coils. Four of the fifteen patients were upper gastrointestinal hemorrhage, the other cases were lower gastrointestinal hemorrhage which were embolized using coaxial microcatheter. Results Fourteen of the fifteen patients were treated successfully by these methods. There were total 17 times of embolization for 16 parts, the success rate reached 94.1%. The other one reveaded an infarction of intestine after the embolization and was cured by resection. One of the fifteen patients appeared a recurrent hemorrhage 3 months later, and confirmed to be a hemangiolymphangioma. Two patients with malignant tumor were operated upon selectively. The other patient of intestinal hemorrhage was embolized successfully by using a metal coil after shock. Leiomyoma complicated with large area of bleeding was finally proven by operation.Conclusions Transcatheter embolization for acute massive gastrointestinal hemorrhage is safe and efficient under different choice of methods. The key of success is the right selection of embolized target artery and dosage of emboli.