Hepatic arterial embolization and chemoembolization in the management of patients with large-volume liver metastases.

The purpose of this study was to assess the role of hepatic arterial embolization (HAE) and chemoembolization (HACE) in patients with large-volume liver metastases. Patients with metastatic neuroendocrine tumors, melanomas, or gastrointestinal stromal tumors (GISTs) with >75% liver involvement who underwent HAE or HACE were included in the study. Radiologic response, progression-free survival (PFS), overall survival (OS), and postprocedure complications were assessed. Sixty patients underwent 123 treatment sessions. Of the 48 patients for whom follow-up imaging was available, partial response was seen in 12 (25%) patients, minimal response in 6 (12%), stable disease in 22 (46%), and progressive disease in 8 (17%). Median OS and PFS were 9.3 and 4.9 months, respectively. Treatment resulted in radiologic response or disease stabilization in 82% and symptomatic response in 65% of patients with neuroendocrine tumors. Patients with neuroendocrine tumors had higher response rates (44% vs. 27% and 0%; p = 0.31) and longer PFS (9.2 vs. 2.0 and 2.3 months; p < 0.0001) and OS (17.9 vs. 2.4 and 2.3 months; p < 0.0001) compared to patients with melanomas and GISTs. Major complications occurred in 21 patients after 23 (19%) of the 123 sessions. Nine of the 12 patients who developed major complications resulting in death had additional risk factors--carcinoid heart disease, sepsis, rapidly worsening performance status, or anasarca. In conclusion, in patients with neuroendocrine tumors with >75% liver involvement, HAE/HACE resulted in symptom palliation and radiologic response or disease stabilization in the majority of patients. Patients with hepatic metastases from melanomas and GISTs, however, did not show any appreciable benefit from this procedure. Patients with massive liver tumor burden, who have additional risk factors, should not be subjected to HAE/HACE because of the high risk of procedure-related mortality.

Impact of C-arm CT on hepatic arterial interventions for hepatic malignancies.

PURPOSE: To evaluate C-arm computed tomography (CT) and assess its potential impact on hepatic arterial interventions. MATERIALS AND METHODS: Between May 2005 and March 2006, all hepatic arterial interventions for hepatic malignancies were retrospectively reviewed. C-arm CT acquisitions were performed as an adjunct to conventional digital subtraction angiography (DSA). The number of procedures with C-arm CT, the acquisitions per intervention, and the procedure time for all interventions were recorded. The added information provided by C-arm CT was scored as category 1 (no additional information); category 2 (added information without impact on procedure management); or category 3 (added information with impact on procedure management). Intervention types included infusions, radioembolization, embolization, and chemoembolization. A two-sided, two-sample t test was used to compare interventions with and without C-arm CT, and P values less than .05 were considered significant. RESULTS: C-arm CT was used in 86 of 240 interventions (36%) in 135 patients. The mean number of acquisitions per study was 1.9 (range, 1-4). Thirty-five interventions (40.7%) were scored as category 2 and 16 interventions (18.6%) were scored as category 3. Chemoembolization was associated with the highest percentage of C-arm CT investigations classified as category 2 and 3 assessed per intervention. The mean procedure time was significantly longer (18 minutes) when C-arm CT was used (P<.001). CONCLUSIONS: C-arm CT provides additional imaging information beyond DSA during hepatic arterial interventions (approximately 60%), and this information impacted procedure management in 19% of cases. C-arm CT offers the greatest opportunity for additional information during chemoembolization procedures and is responsible for a significant but acceptable increase in procedure time for this type of hepatic intervention.

Demographic characteristics and antisocial personality disorder of early and late onset alcoholics identified in a primary care clinic.

A total of 1,734 persons were prospectively screened in a primary care clinic to examine the demographic characteristics and presence or absence of antisocial personality disorder among early onset alcoholics (EOA) and late onset alcoholics (LOA). A total of 76 EOA (male = 58 and female = 18) and 80 LOA (male = 56 and female = 24), as determined by the Comprehensive Drinking Profile Scale, participated in the study. EOA tended to be single and were younger, in a lower socioeconomic class, raised by non-biological parents, more likely to have antisocial personality disorder, and more likely to commit certain convicted offenses compared to LOA (p

Enteroaggregative Escherichia coli is a cause of acute diarrheal illness: a meta-analysis.

BACKGROUND: Conflicting studies exist regarding the role of enteroaggregative Escherichia coli (EAEC) as a cause of acute diarrheal illness. The objective of this meta-analysis was to determine whether identification of EAEC in stool samples is associated with acute diarrheal illness among different subpopulations, by geographic area. METHODS: A comprehensive search of electronic bibliographic databases (Medline and PubMed) from August 1985 to January 2006, as well as a search of conference proceedings, references of articles, and contacts with investigators of EAEC, yielded 354 studies. RESULTS: Forty-one studies (12%) that met the selection criteria (i.e., that examined the association between acute diarrheal illness and the excretion of EAEC among different subpopulations) were included. In this meta-analysis, presence of EAEC identified with the HEp-2 cell adherence assay was found to be significantly associated with acute diarrheal illness among children residing in developing regions (odds ratio [OR], 1.58; 95% confidence interval [CI], 1.36-1.83) and industrialized regions (OR, 1.23; 95% CI, 1.03-1.48), adults with human immunodeficiency virus infection residing in developing regions (OR, 6.43; 95% CI, 2.91-14.16), adults residing in developing regions (OR, 7.15; 95% CI, 1.96-26.04), and international travelers to developing regions (OR, 6.72; 95% CI, 2.62-17.20). A limited number of studies were available that examined the role of EAEC identified by its virulence genes by a DNA probe. CONCLUSIONS: On the basis of this meta-analysis, we conclude that EAEC is a cause of acute diarrheal illness among many different subpopulations in both developing and industrialized regions, that EAEC strains are very heterogeneous and that additional studies that examine the role of EAEC in acute diarrheal illness are needed.