Entrapment of an exchange wire by an inferior vena caval filter: a technique for removal.

The anesthesiology literature does not describe entrapment of a guidewire by an inferior vena caval filter. Because anesthesiologists are involved in central access in various perioperative and intraoperative settings, consideration of this complication is important. A case of guidewire entrapment by an inferior vena caval filter and a unique technique for removal of the entrapped wire is presented.

Peripheral vascular disease and its evaluation.

The occurrence of arterial vascular disease is increasing because of the increasing age of the population. The at-risk population includes diabetics, smokers, patients with heart disease, and those with a family history of heart disease. History and physical examination help delineate two classes of patients: symptomatic and asymptomatic.

Selective tumor irradiation by infusional brachytherapy in nonresectable pancreatic cancer: a phase I study.

PURPOSE: Selective high-dose radiation of solid tumors has been a goal of radiation oncology. The physiological barriers of solid tumors (high interstitial tumor pressure, reduced tumor vascularity, and poor perfusion) have been major barriers in achieving significant tumor dose of systemically infused radioconjugates. Direct tumor infusional brachytherapy overcomes these barriers and leads to selective high tumor doses. METHODS AND MATERIALS: The development of interstitial tumor infusion of macroaggregated albumin (MAA) followed by colloidal chromic phosphate 32P has overcome solid tumor obstacles in 47 patients with nonresectable pancreatic cancer in a Phase I dose escalation study. The colloidal 32P infusion was followed by external radiation and five fluorouracil. RESULTS: Of the 28 patients with cancer limited to the pancreas, 15 of 16 patients retained 86-100% (mean 96%) of the infused colloidal 32P isotope. While the other 12 patients had partial shunting to the liver, shunting to the liver was due to high interstitial resistance with tumor dose deposition of 17-88% (mean 52 %). Of the 19 patients with metastatic pancreas cancer, colloidal 32P tumor deposition ranged from 22 to 100% of the infused dose (mean 79%). The less than optimal tumor deposition led to our increasing the MAA from 600,000 to 1.5-2.5 million particles. Interstitial dexamethasone 2 mg and later 4 mg was infused first and prevented liver shunting by somehow reducing tumor resistance. The median survival in 28 Phase I patients with nonresectable pancreas cancer without metastasis, was 12 months. No significant toxicity occurred when treatment was limited to two infusions with as much as 30 mCi each. The maximum tumor dose was 17,000 Gy (1.700,000 cGy). In 19 nonresectable pancreatic cancer patients with metastasis, a 6.9 months median survival was observed. CONCLUSIONS: Infusional brachytherapy is an outpatient procedure that delivers high-dose radiation selectively to pancreatic cancer. Results of the Phase I study in nonresectable pancreas cancer has led to a national multiinstitutional Phase II trial.

Use of computed tomography guidance and mammographic hook wires to remove displaced, embedded contraceptive rods.

Because of dysfunctional uterine bleeding, a patient requested removal of levonorgestrel contraceptive rods. The patient was referred to a general surgeon by her gynecologist who was unable to palpate the rods in the region of implantation in her left upper arm. Initially, the surgeon was able to locate and remove four of the six previously implanted rods. Because these implants are not visible under convention radiography or fluoroscopy, computed tomography was used to locate the remaining two rods. After localization by use of mammographic hook wires, the remaining two rods were successfully removed surgically.

Preliminary experience of infusional brachytherapy using colloidal 32P.

In the past, we have clinically evaluated radiolabelled antibodies in Hodgkin's disease and hepatocellular cancer. Increased tumour pressure, reduced vascularity and poor diffusion has limited significant radiolabelled antibody tumour dose deposition. Using intratumoural infusion of macroaggregated albumin to blockade exiting vasculature followed by colloidal chromic 32Phosphorous, we have been able to achieve 75% to 100% tumour dose deposition by interstitial tumour infusion under computerised tomographic guidance. Phase I studies in a variety of solid tumours indicate extremely high doses may be achieved without toxicity (i.e. non-resectable pancreas 900,000 cGy to 1.7 million cGy) with tumour control and remission. This is a review of those studies and how the technique was applied.

A new method for delivering radioactive cytotoxic agents in solid cancers.

PURPOSE: Therapeutic agents such as monoclonal antibodies, radiopharmaceuticals, and radioactive growth factors are limited in effectiveness due to the inability to deposit significant quantities of the agents and for limited periods of time in solid cancer. A new technique based on knowledge of the pathophysiology of solid tumors allows for significant concentration of these agents to accumulate and for a prolonged period of time, thus allowing interaction with the tumor for potentially increased effectiveness. METHODS AND MATERIALS: Three agents have been studied: 131I antiferritin monoclonal antibody, colloidal 32P chromic phosphate, and 131I transferrin. The time required for maximal tumor uptake was determined in vitro in tissue culture and was 10 min, 25 min, and 40 min, respectively. The new method of in vivo tumor infusion consisted of a direct intratumoral injection of macroaggregated albumin (MAA) 10,000 particles, followed by the radioactive agents under study. Tumors were infused in vivo using the new technique and compared to intratumoral infused controls. In the instance of radiolabeled antiferritin antibody, intraperitoneal administration and intratumoral infusion were compared to the new technique. In the other two instances, intratumoral infusion was compared to the new method. RESULTS: In all instances the direct vascular blockade caused by MAA led to greater deposition of the agent under study for at least 24 h. These results were clinically applied with MAA followed by 32P colloidal chromic phosphate and were consistent with the experimental findings. CONCLUSION: A new technique is described that may be carried out in the experimental laboratory and clinic by direct tumor infusion of macroaggregated albumin (MAA), followed by other radioactive agents that will remain localized in solid cancers and will allow for high tumor dose deposition for potentially increased therapeutic efficacy.

Fluoride stimulation of the rat parathyroid gland: an ultrastructural study.

The parathyroid glands of rats given 150 ppm fluoride in the drinking water for 10 weeks are evaluated ultrastructurally and compared to the parathyroid glands of untreated rats. As a result of fluoride ingestion, the majority of the parathyroid cells are dark chief cells, indicating that these cells are in the active stages of the secretory cycle. More significantly, in the fluoride-treated rats, the cytoplasmic organelles of the dark chief cells are even more developed that those seen in the dark chief cells of untreated rats. The dark cells contain an electron-dense cytoplasm with abundant lamellar arrays of rough endoplasmic reticulum, spiral aggregations of free ribosomes, multiple dilated Golgi complexes, and increased numbers of secretory granules. The cells are at a minimum dimension with maximum tortuosity of the plasma membranes; and, as a result, large intercellular spaces are often seen between contiguous cells. Based on these observations, it is suggested that, in the fluoride-treated rat, a type of secondary hyperparathyroidism develops resulting in an increase in the organelles involved in protein synthesis and secretion.

Scanning electron microscopy of corpus luteum formation in the golden hamster.

SEM observations of corpus luteum formation in the golden hamster reveal considerable cellular migration occurring in both the newly forming luteal mass and the remaining surface epithelium. During the first 24 h of the 4-day cycle, cells in the luteal mass become aligned into cords which obliterate the crater-like rupture. Individual cords lose their distinct surface profiles as the luteal mass forms a mushroom-like cap, the edges of which overhang surface epithelial cells (SEC) bordering the rupture site. The luteal mass continues to be remodeled as the edges slowly recede during the next 3 days of the cycle, and the follicle assumes a more spherical shape with a slightly sunken apex as regression begins. Covering of the rupture site by the SEC is a slow process which involves two mechanisms. Most of the mass is gradually covered by finger-like columns of SEC which migrate from the collar of cells surrounding the luteal mass to slowly surround, then cover small spherical or oval regions of the slightly sunken mass. In addition, individual SEC migrate out of the collar and move up onto the mass. The entire covering process appears to be random and poorly coordinated until very late in the 4-day cycle. This is attributed to changing surface properties of the luteal mass during the cycle.

Glycogen accumulation in the parathyroid gland of the rat after fluoride ingestion.

The parathyroid glands of young male rats given 150 ppm fluoride in their drinking water for 10 weeks were examined by transmission electron microscopy. As a result of fluoride ingestion, the parathyroid chief cells of the experimental animals accumulated glycogen in excess of that seen in control animals given distilled drinking water for the same time period. In the majority of active chief cells, glycogen granules were diffusely spread throughout the cytoplasm as single granules or in small deposits. Large aggregations of glycogen granules were also seen within intercellular spaces. Accompanying the increase in glycogen was a rise in the number and development of the organelles associated with protein synthesis and secretion. The accumulation of glycogen is similar to that in hyperparathyroidism caused by chronic stimulation and prolonged secretory activity of the parathyroid gland. The results of this study suggest that increased amounts of glycogen occur in hyperactive chief cells of the parathyroid in response to the ingestion of large doses of fluoride.

Ultrastructural observations on the mechanism of secretion in the rat parathyroid after fluoride ingestion.

The secretory mechanism of the parathyroid glands of fluoride-treated rats is evaluated ultrastructurally and compared to that of control rats. The principal difference between the two groups of rats concerns the rate of activity of the chief cells of the gland. In the control animals, these cells are predominantly inactive. In the fluoride-treated rats, they exhibit a more active stage of the secretory cycle. The active chief cells in rats treated with fluoride contain increased numbers of secretory granules. These granules are released into the perivascular spaces within cytoplasmic projections suggesting an apocrine-like mechanism for the secretion of parathyroid hormone. Secretory granules are observed free in the perivascular spaces and within the cytoplasm of capillary endothelial cells in the parathyroid glands.