The optimal dose of nicardipine for enhancement of indirect portography.

PURPOSE: To determine the optimal dose of nicardipine (NCR) for enhancement of indirect portography. METHODS: Forty-eight patients underwent conventional film indirect portography via the superior mesenteric artery (SMA) first without and then with preinjection of 1/64-2 mg of NCR into the SMA. RESULTS: NCR (1/8-2 mg) shortened the arterial phase to 50% and the portal appearance time to 60% of control without reflux of contrast medium into the aorta. Portal enhancement was excellent at doses of 1/32 mg or more. Blood pressures and pulse rate showed no significant change at 1/4 mg or less. CONCLUSION: NCR (1/8-1/4 mg) into the SMA is the optimal dose for achieving sufficient contrast enhancement on indirect portography while reducing the transit time of contrast medium and minimizing effects on the systemic circulation.

Indirect portography enhanced by nicardipine versus prostaglandin E1.

PURPOSE: To compare nicardipine (NCR) and prostaglandin E1 (PGE1) for portal venous contrast enhancement on indirect portography in a retrospective study. METHODS: One milligram of NCR, a calcium antagonist, was injected into the superior mesenteric artery just prior to portography in 18 patients who had undergone otherwise identical portography using 20 micrograms PGE1 36-279 (mean 133) days before. All 18 patients had liver tumors and showed no changes in portal vein status in the interim. RESULTS: Using conventional film/screen angiography, NCR provided equally good portograms as PGE1 with respect to image density and image contrast. Systemic effects on blood pressure and heart rate were minimal and no other side effects were observed with NCR. CONCLUSION: NCR is an inexpensive drug and is expected to provide well-contrasted, indirect portograms on conventional film/screen angiography.

Transcatheter oily chemoembolization for the treatment of large hepatocellular carcinoma with an accompanying tumor thrombus in the right main branch of the portal vein and arterioportal shunting: report of one patient still surviving after more than seven years.

A patient having a large hepatocellular carcinoma with an accompanying tumor thrombus in the right main branch of the portal vein and arterioportal shunting was treated with transcatheter oily chemoembolization with adriamycin emulsion in Lipiodol plus Gelfoam. The whole right hepatic lobe regressed together with the tumor, and the tumor thrombus in the portal vein disappeared. The patient is still alive more than seven years after the treatment, with normal levels of alpha-fetoprotein. The response of this patient is interesting in discussing potential indications for therapy.

Disappearance of tumor staining in balloon-occluded proper hepatic angiography.

Intrahepatic tumor staining, which was clearly visualized by common hepatic arteriography, disappeared in balloon-occluded proper hepatic angiography. This finding is interesting in terms of changes in hemodynamics in normal and tumor-bearing livers following hepatic arterial occlusion with balloon catheters.

Study of response to naproxen in patients with hepatocellular carcinoma who developed fever following transcatheter arterial embolization.

Good antipyretic response was obtained when naproxen was given at 600 mg/day for about one week to patients who developed fever after transcatheter arterial embolization (TAE). Fever recurred in several patients, but subsided again when naproxen was given at 300 mg/day. No patients developed gastric mucosal lesions of clinical concern that seemed to be related to naproxen.

Transcatheter oily chemoembolization with high doses of adriamycin in the treatment of large hepatocellular carcinoma (10 cm or more in diameter).

Five patients with large hepatoma (10 cm or more in diameter) underwent transcatheter oily chemoembolization with an emulsion of 100 mg of adriamycin with Lipiodol plus Gelfoam. Myelosuppression related to adriamycin was milder than that associated with bolus injection of the drug, because the drug was released from the emulsion slowly. Partial response was found in one patient, with no change in the others. The duration of survival ranged from four to 16 months (mean, 11.2 months). Response was satisfactory for large hepatoma.

[Combined therapy with transcatheter chemo-embolization and percutaneous ethanol injection].

Transcatheter chemo-embolization is an effective treatment for hepatocellular carcinoma, but some patients do not respond sufficiently. We have also percutaneous ethanol injection in patients who failed to respond to chemo-embolization alone, to improve the results of the treatment. Ten patients received the combined therapy; two had failed to retain Lipiodol in the lesions long enough after oily chemo-embolization, 3 had extrahepatic collateral blood supply, 2 had giant hepatocellular carcinomas 10 cm or more in diameter, which were supplied with blood from both the right and left hepatic arteries, 2 also had obstructive jaundice, and one had intraportal tumor thrombus as well. Ethanol was mixed with Lipiodol at 1/10 to 1/5 the volume of ethanol, and injected under ultrasonic or fluoroscopic control. Five to 10 ml of the mixture was injected until the tumors were filled with Lipiodol. It is difficult to discuss the effectiveness of the combined therapy, but it seemed to provide a safer and more effective treatment.

[Percutaneous ethanol injection therapy for hepatocellular carcinoma].

Percutaneous ethanol injection therapy, a kind of non-vascular intervention, has recently been high-lighted as an effective therapy for small liver cancer. According to our experience, results of this therapy were excellent in cases where the amount of ethanol injected could be elevated over 1.5 times the estimated tumor volume. This result indicates that treatment with ethanol injection alone should be confined to small hepatocellular carcinoma with diameter below 3 cm. In patients with hepatocellular carcinoma who do not sufficiently respond to transcatheter chemoembolization, the combined use of ethanol injection therapy can improve therapeutic results. That is, ethanol injection therapy is indicated in cases where tumor has collateral blood supply other than hepatic artery, cases where hepatic artery has been obstructed, and cases where Lipiodol used for trans-catheter chemoembolization cannot be retained in tumor tissue. Furthermore, cases of giant hepatocellular carcinoma or tumor accompanied by obstructive jaundice have sometimes been treated with a combination of incomplete chemoembolization and ethanol injection therapy. Even in patients showing intraportal tumor thrombus, ethanol injection effectively relieved the thrombus.