Ultrasound-guided photodynamic therapy for deep seated pathologies: prospective study.

INTRODUCTION: Interstitial photodynamic therapy remains an attractive remedial option in minimally invasive surgery. Our aim in this prospective study was to evaluate the outcome following ultrasound-guided iPDT of deep-seated pathologies. Patients' reports on quality of life with clinical and radiological evaluation were the main end point parameters used to assess the outcome. MATERIALS AND METHODS: Sixty-eight patients were referred to the UCLH Head and Neck Centre for treatment of various deep-seated pathologies involving the head and neck region, upper and lower limbs. All patients underwent interstitial photodynamic therapy under general anaesthesia, using 0.15 mg/kg mTHPC as the photosensitising agent. Following treatment, patients were followed-up for a mean of 7 months. RESULTS: All three patients who presented with visual problems reported improvement after treatment. Also, 14/17 patients reported improvement of breathing. Improvement of swallowing was reported by 25/30 patients; while speaking improvement was evident in 16/22 patients and 33/40 reported reduction in the disfigurement caused by their pathology. All five patients with impeded limb function reported some degree of improvement. Clinical assessment showed that half of the patients had 'good response' to the treatment and a third reported 'moderate response' with two patients being free of disease. Radiological assessment comparing imaging 6-week post-PDT to the baseline showed stable pathology with no change in size in 13 patients, minimal response in 18 patients, moderate response in 23 patients and significant response in 11 patients. CONCLUSION: This study on 68 patients with deep-seated pathologies undergoing interstitial photodynamic therapy provided evidence that PDT can be the fourth modality in the management of tissue disease.

Interstitial photodynamic therapy for a symptom-targeted treatment of complex vascular malformations in the head and neck region.

BACKGROUND AND OBJECTIVES: Photodynamic therapy is based on an interaction of a drug and light in oxygenated tissue. The photosensitizing drug Foscan is licensed in the EU for the treatment of advanced head and neck cancer. The light can be applied by surface illumination or directly into tumour tissue by optical fibres. One interesting feature of PDT is that it does not cause major damage to nerves and major blood vessels. This raises the possibility of using this therapy in the treatment of benign neoplasms in the head and neck. STUDY DESIGN/MATERIALS AND METHODS: A total of 11 patients with lymphatic [8] or venous malformation [3] were treated on 25 occasions. The treatments were carried out using Temoporphin (Foscan) 0.15 mg/kg; the drug-light-interval was 4 days. Illumination was performed at 652 nm delivered interstitially through bare tip fibres at a total light dose of 20 J per fibre. Multiple fibres were positioned either image guided [13] or clinically [12] to ensure accurate targeting of tissue while avoiding damage of the surrounding and overlying tissue. RESULTS: In all cases there was a significant reduction in the volume of abnormal tissue without damage to the overlying skin; the results were objectified using MRI-imaging, CT-volumetry and surface optical scanning. The best results were obtained with lymphatic malformations, especially for those that had not undergone previous surgery. Post-treatment pain and swelling were successfully controlled with steroids and a variety of analgesics (opioids and non-steroidal anti-inflammatories). No vascular or neurological signs were encountered. CONCLUSION: This minimally invasive approach to treat complex benign neoplasias seems promising. The treatment is safe, effective and repeatable and merits further evaluation.

A comparison of echocardiography and magnetic resonance imaging in cardiovascular screening of adults with Turner syndrome.

The high mortality rate from aortic dissection of women with Turner syndrome (TS) achieving ovum donation pregnancies has highlighted the need for a refinement of cardiac screening protocols. Echocardiography and magnetic resonance imaging (MRI) are used to assess the risk factors, aortic root dilatation, bicuspid aortic valve, and coarctation, but the relative merits of each modality are unclear. Cardiovascular screening was performed in 128 unselected women with TS (mean age +/- SD, 31.1 +/- 8.5 yr) using echocardiography (n = 120) and MRI (n = 115) and in 36 age-matched normal control women. Clinical history, anthropometric measurements, blood pressure, and metabolic parameters were recorded. Echocardiography was normal in 53% of women with TS; MRI was normal in 34%. Aortic root dilatation was identified in 16% of women by echocardiography, 33% on MRI criteria, and 7% by both modalities. Height-adjusted echocardiographic aortic root dimensions were greater in TS than controls (2.90 vs. 2.62 cm; P = 0.010). Bicuspid aortic valve and increasing age were associated with greater aortic dimensions; the latter effect was more marked in TS than controls. On MRI, ascending aortic diameter was greater in TS than control women (2.83 vs. 2.52 cm; P = 0.029), but descending aortic diameter and ascending/descending aortic ratio were not, because these may be affected by the presence of coarctation. The two techniques are complementary and identify different aspects of cardiovascular pathology. Ascending/descending ratio on MRI circumvents issues of stature, but may be influenced by descending aortic abnormalities. We present reference ranges for absolute aortic dimensions in a TS population to aid future interpretation of these measurements.