Physician-modified aortic cuff to "stabilize" paravisceral aortic thrombus and minimize risk of distal embolization during pararenal aneurysm repair with fenestrated stent graft.

As technology and surgeon experience evolve, endovascular repair of complex abdominal aortic aneurysms is often preferred in appropriately selected patients. However, the presence of pedunculated aortic thrombus represents a relative contraindication for endoluminal therapy due embolization risks. Here, we present a 68-year-old woman with a 5.8-cm pararenal aortic aneurysm associated with pedunculated aortic thrombus. She was treated with a modified Cook-Zenith aortic cuff to first entrap the aortic thrombus, followed by treatment of the aneurysm with a modified Z-FEN graft. This cuff modification provides a novel approach to deal with such luminal thrombus.

Effect on examination ordering by physician attitude, common knowledge, and practice behavior regarding CT radiation exposure.

PURPOSE: We surveyed ordering physician attitudes, knowledge, and behavior with regard to computed tomography (CT)-related radiation exposure at a large medical center. METHODS: Sixteen questions were sent via electronic survey to 350 physicians. RESULTS AND CONCLUSION: The ability to quickly rule in or rule out conditions effectively strongly influenced the decision to order CT (85%-99%). Fear of litigation influenced CT ordering for those with less experience [odds ratio (OR)=2.3, P<.05]. Residents and primary care physicians were less likely to discuss risks/benefits of CT with patients (P ≤.03) compared to those with >5 years of experience (OR=4.0, P=.04).

Minimally invasive treatment of metastatic pheochromocytoma and paraganglioma: efficacy and safety of radiofrequency ablation and cryoablation therapy.

PURPOSE: To evaluate the safety and efficacy of percutaneous ablation methods for the treatment of metastatic pheochromocytomas (PCCs) and paragangliomas (PGLs). MATERIALS AND METHODS: From May 2001 to November 2009, 10 patients (mean age 45 years) with metastatic PCCs and PGLs were identified and treated with percutaneous ablation. All patients were given appropriate medication before the ablation procedure. Vital signs were monitored before, during, and after the procedure. There were 47 tumor ablations performed using radiofrequency (RF) ablation, cryoablation, or ethanol injection as determined by tumor location. RESULTS: In all patients, all metastatic lesions amendable to percutaneous ablation were treated; for 2 of 10 patients, all known metastases were treated. Successful ablation without evidence of recurrence was achieved in 56% (15 of 27) of primarily treated lesions in patients with available follow-up imaging. The time to disease progression after ablation was 7.2 months ± 4.0. Amelioration of breakthrough hypertensive symptoms or metastasis-related pain was achieved in two of two patients and four of four patients, respectively, at clinical follow-up. Comparison of intra-arterial blood pressure before, during, and after the procedures showed statistically significant differences in these median blood pressures (P = .004-.05). Major complications occurred after 2 of 18 (11%) ablation sessions, including one unplanned increase in level of patient care and one periprocedural death from complications related to bowel perforation. CONCLUSIONS: Local control of metastatic PCCs and PGLs with percutaneous ablation can play an important role in disease management when the lesions are unresectable surgically, and there is potential for prolongation of patient function or amelioration of metastasis-related symptoms.

Salvage therapy for liver-dominant colorectal metastatic adenocarcinoma: comparison between transcatheter arterial chemoembolization versus yttrium-90 radioembolization.

PURPOSE: To compare transarterial chemoembolization (CE) versus yttrium-90 ((90)Y) radioembolization (RE) for liver-dominant metastatic colorectal adenocarcinoma as salvage therapy. MATERIALS AND METHODS: Of 36 patients, 21 underwent CE (37 procedures; 11 men; mean age, 67 years; 16 with Child-Pugh class A disease) and 15 underwent (90)Y RE (19 procedures; 11 men; mean age, 64 years; 13 with Child-Pugh class A disease) for liver-dominant colorectal adenocarcinoma. Mean index dominant lesion sizes were 9.3 cm and 8.2 cm in the CE and RE groups, respectively. Multilobar disease was seen in 67% and 87% of the respective groups, and extrahepatic metastases were seen in 43% and 33%, respectively. Mean times from diagnosis of liver metastasis to CE or RE were 17.6 months and 22.6 months, respectively. RESULTS: A total of 37 CE procedures with cisplatin, doxorubicin, and mitomycin were performed, and 19 RE procedures with (90)Y were performed; 43% of patients in the CE group and 20% in the RE group received multiple treatment sessions, and 100% of procedures were technically successful. Median survival times were 7.7 months for the CE group and 6.9 months for the RE group (P = .27). The 1-, 2-, and 5-year survival rates were 43%, 10%, and 0%, respectively, in the CE group; and 34%, 18%, and 0%, respectively, in the RE group. There was one major complication (2.7%) in the CE group (pulmonary embolism), with a 30-day mortality rate of 5.4% (n = 2). There were no major complications in the RE group, with a 30-day mortality rate of 5.2% (n = 1). CONCLUSIONS: Patients with unresectable liver colorectal metastases that progress despite systemic chemotherapy can undergo palliative treatment with CE or RE with similar survival benefit.

Tail profile: a more accurate system for analyzing DNA damage using the Comet assay.

The Comet assay (single cell gel electrophoresis assay) measures DNA strand breaks in individual cells. In the assay cells are embedded in agarose, lysed, and electrophoresed under low voltage, allowing migration of damaged DNA. The DNA is stained and subsequently viewed with an epifluorescent microscope. If DNA damage has occurred the electrophoresed DNA fragments appear as a diffuse tail behind the nucleus known as a "comet". Many computer-aided analysis systems are currently in use to quantify the amount of DNA damage that is represented by a comet image. Here, we present a novel method of analysis known as "tail profile". This method of analysis provides several advantages over currently employed methods, which rely primarily on the "tail moment" method of analysis. We compared the amount of DNA damage reported from both the tail profile and tail moment methods of analysis and observed a 26% (P<0.0001) increase in damage detected by tail profile across the 10-25 microm range of tail length, where the majority of the relevant comet data is concentrated. We further report that this increase in sensitivity is not only limited to assessing DNA damage, but also to gathering data from DNA repair assays. Furthermore, we demonstrate increased functionality and extended data analysis capabilities with the use of a compressed collection of images called a "comet chip" and through a visual representation of data called a "profile plot". Use of the custom macros enabled us to detect an unexpected characteristic of the electrophoretic profile, giving us novel insight into the nature of comet analysis. In addition to the increased analytical sensitivity proffered by this system, the tail profile macros are upgradeable and platform independent.