Fibrinolytic effects of transparietal ultrasound associated with intravenous infusion of an ultrasound contrast agent: study of a rat model of acute cerebral stroke.

The aim of this study was to evaluate the thrombolytic effect of focused transparietal ultrasound in combination with a specific contrast agent (microbubbles) in acute cerebral ischemia. Acute cerebral ischemia was induced in 10 rats by intra-arterial clots injection. Five rats (group 1) were treated with a combination of transparietal ultrasound (probe 2 MHz, acoustic power 500 mW/cm(2)) and intravenous injection of 0.6 mL of the ultrasound contrast agent (UCA) sulfur hexafluoride. Five rats (group 2) were treated by fibrinolytic intravenous infusion (recombinant tissue plasminogen activator). Cerebral cellular energy production was determined by measuring the cellular phosphorylation using phosphorus magnetic spectroscopy before and during ischemia induction and after treatment. Measures were performed on a dedicated 2.35T magnet. The ratio phosphocreatine (P(Cr)) on inorganic phosphate (P(i)), P(Cr)/P(i), estimation of the oxidative phosphorylation metabolism and the intracellular pH (pHi) were measured in the two groups. Compared with the ischemia induction period, both treatments were associated with an increase of P(Cr)/P(i) and pHi values, respectively, +80% and +100% in group 1 (p=0.07) and +100% and +80% in group 2 (p=0.04). There was no significant difference between the two groups for the response treatment. To conclude, treatment with intravenous fibrinolytic infusion and treatment with focused ultrasound in combination with UCA seems to be equally effective in treating acute cerebral ischemia in rats. (E-mail: j.p.tasu@chu-poitiers.fr).

Telebrix Gastro in the management of adhesive small bowel obstruction.

BACKGROUND: This study aimed to determine whether an abdominal radiograph 8 hours after ingesting oral Telebrix Gastro is a reliable marker for non-operative management in patients with adhesive small bowel obstruction. METHODS: During a 5-year period (January 1, 1995, through December 31, 2000), 97 patients were admitted for small bowel occlusion due to adhesion with no indication for immediate surgery. All received 100 mL of Telebrix Gastro via gastric tube for small bowel obstruction due to adhesion. If the contrast reached the colon within 8 hours on plain abdominal radiograph, the test was considered to be negative. RESULTS: 126 cases of small bowel occlusions were analyzed due to recurring episodes for 11 patients. The test was negative in 113 cases (89.7%), and in this group, only two patients underwent surgery, the remaining being managed non-operatively. The 13 cases (10.3%) with a positive test for occlusion underwent surgery. The sensitivity, specificity and accuracy of the finding of contrast media reaching the colon as an indicator for conservative treatment were 98%, 100%, and 98%, respectively. CONCLUSIONS: A water-soluble contrast study can be of significant help in the clinical management of patients suspected of having small bowel obstruction.

A tamponade leading to death after radiofrequency ablation of hepatocellular carcinoma.

A case of hemorrhagic cardiac tamponade after radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) leading to death is presented. The complication occurred during a procedure performed under general anesthesia with an expandable needle system for a 2-cm HCC sited in the second segment of the liver close to the diaphragm. Thermal damage to the organs surrounding the liver are major complications of liver tumor RFA. For lesions that are adjacent to the cardiac cavities, a discussion of better therapeutic options remains necessary and has to take into account the effectiveness and complication rate of each technique.