[Hepatic chemoembolization for the treatment of carcinoid syndrome]. / Quimioembolização hepática para o tratamento da síndrome carcinóide.

Clinical manifestation of carcinoide syndrome are often difficult to control with medical treatment and so present a large problem for doctors. In the majority of cases, such manifestations are seen in patients with hepatic metastases. In such cases the control of the problem can be achieved by local hepatic treatment. A 57 year old patient with carcinoide syndrome for a year, with extensive hepatic tumor from a carcinoide tumor, whose origins were not lokted, had a urinary excretion 5-hidroxi-indolacetic = 73 mg in 24 hours, he used cyproheptadin, loperamida and metisergida without showing improvement. In light of the failure of medical treatment and the impossibility of surgery he was given into hepatic chemoembolization (QEH) with lipiodol, doxorrubicin (1.0 mg/Kg) and mitomicin (10.0 mg) twice. Clinical control with absolute recovery of "flushing" and diarrhea were achieved, a dose of 5-HIAA U (5.5 mg) after the first application. Transitory alterations of the aminotransferasis alkaline phosphates and leucocytosis. Besides the post embolization syndrome that regressed in 20 days, there were no complications recurring after treatment. The period of recovery was more than 9 months. We can then conclude that hepatic chemoembolization is an efficient treatment to control carcinoid syndrome.

Microscopic anatomy of the human vertebro-basilar system.

Concerning the structure of connective-muscular components the authors studied the walls of the terminal segments of the vertebral arteries as well as the basilar artery, utilizing the following staining methods: Azan modified by Heidenheim, Weigert's resorcin-fuchsin, and Weigert modified by van Gieson. It was established that wall of the vertebro-basilar system exhibits a mixed structure, muscular and elastic, by means of which the vessels are adjusted to the specific blood circulation conditions. Thus, vertebral arteries show in the most external layer of tunica media an evident external elastic lamina. In contrast, in the basilar artery the elastic tissue is localized mainly in the tunica media, and is distributed heterogeneously. In its caudal segment the elastic fibers are situated in the most internal layer of tunica media, and in the cranial segment the elastic component is homogeneously distributed in the whole of tunica media.

The "so-called" somatomedin B and growth hormone measured by radioimmunoassay in normal and cirrhotic individuals.

Serum somatomedin B (SmB) levels in cirrhotic individuals, 3.3 +/- 1.5 mg/l, were strikingly lower (P less than 0.001) than in normal subjects, 9.0 +/- 1.7 mg/l. SmB levels were clearly related to the levels of alpha 2-globulins in the cirrhotics (r = + 0.8, P less than 0.002). Serum SmB and growth hormone correlated negatively in a group of normal and cirrhotic individuals (r = -0.67, P less than 0.001). Direct measurements of serum SmB failed to reveal differences between hepatic, renal and peripheral veins. These findings suggest that: 1) SmB is produced by liver and/or normal liver function plays an important role in maintaining normal serum SmB levels; 2) SmB carrier proteins are reduced in the cirrhotics and 3) SmB is part of a negative feed-back system involving growth hormone.