RESUMEN
The possibility of evaluating the content of hydrogen peroxide in several authentic matrices, such as cosmetic and pharmaceutical formulations, was studied. A new catalase biosensor fabricated using an amperometric gas-diffusion oxygen sensor as electrochemical transducer and the catalase enzyme immobilized in kappa-carrageenan gel and capable of operating in both aqueous and non aqueous solvents was developed and tested for this purpose. Creams, emulsions and disinfectant solutions were analysed. To this end, a preliminary check was needed to establish the best conditions to analyse these matrices; the choice of solvent was one of the most important points studied. The solvents considered included dioxane, water-dioxane mixtures, water saturated chloroform and aqueous solutions. The different solubility properties of the matrices analysed were taken into account.
Asunto(s)
Técnicas Biosensibles/métodos , Catalasa/química , Química Farmacéutica/métodos , Cosméticos/química , Peróxido de Hidrógeno/análisis , Calibración , Volumetría/métodosRESUMEN
PURPOSE: To report our personal experience with the locoregional treatment of breast cancer. MATERIAL AND METHODS: Eighteen patients aged 33-67 years (mean: 54 years) were treated with 31 sessions of intra-arterial antiblastic infusion, 5 of them for neoadjuvant purposes (Group 1), 5 for palliation in unresectable tumors (Group 2) and 8 for cutaneous recurrences after mastectomy (Group 3). RESULTS: 2/5 CR and 3/5 PR were obtained in Group 1; 2/5 lesions were made resectable and 3/5 RP obtained in stage III or unresectable lesions (Group 2). Finally, 3/8 CR, 3/8 PR, 1/8 SD and 1/8 PD were observed in Group 3. An objective response according to WHO criteria was demonstrated in 15/18 cases (88%). We had no post-treatment hematologic complications, but one patient presented focal subcutaneous sclerosis and one cutaneous necrosis. CONCLUSIONS: The morphological efficacy of intraarterial antiblastic infusion in our series was similar to that of other series. No definitive conclusions can be drawn yet about clinical results and long-term survival. This poorly invasive and low risk procedure, which should be combined with other treatments, permits to reduce the extent of surgery and to treat skin recurrences.
Asunto(s)
Antineoplásicos/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Adulto , Anciano , Femenino , Humanos , Infusiones Intraarteriales , Persona de Mediana EdadRESUMEN
PURPOSE: We report the morphological and clinical results in a series of patients with advanced thoracopulmonary, abdominal, pelvic and lower limb tumors treated with stop-flow perfusion (SFP). MATERIAL AND METHODS: We performed 77 SFPs with the percutaneous angiographic technique in 55 patients (25 women and 30 men; mean age: 53 years). Eighteen thoracic perfusions with aortocaval block (ASI) were performed in 11 patients, 33 abdominal hypoxic perfusions (HAP) in 26 patients, 17 hypoxic pelvic perfusion (HPP) in 11 patients and 9 hypoxic lower limb perfusions (HILP) in 7 patients. 42/77 procedures were followed by hemofiltration. RESULTS: No technical complications were observed. Twenty-eight patients in our series are still alive (mean follow-up: 14 months) and 23 have died (mean survival: 8 months), 20/23 of them (87%) for disease progression. Three of 77 patients (3.8%) died within 7 days of the procedure (2 AS, 1 HAP). At CT or MR follow-up, responses > 50% were observed in 56% of the procedures and clinical CR was achieved in 53/77 patients (69%). In the subgroups classified by procedure, positive responses were observed in 56, 48, 59 and 78%, respectively for ASI, HAP, HPP and HLP. Clinical CR was observed in 67, 67, 71 and 78%, respectively. The death rate for disease progression relative to the overall death rate was 100, 86, 75 and 100%. Hematologic toxicity according to WHO criteria (mean: 2) was observed in 77% of the whole of procedures (59/77). Statistical analysis showed no relationship between morphological responses and type of antiblastic drug or previous antiblastic treatments. CONCLUSIONS: SF procedures permit the effective control of many advanced tumors which cannot be treated otherwise, with a high rate of positive morphological and of complete clinical responses. The best results were obtained in hypoxic perfusion of the lower limb. The results were not correlated with previous antiblastic treatments. However, the high rate of sequels and the low hematologic tolerance of those procedures must be emphasized.
Asunto(s)
Quimioterapia del Cáncer por Perfusión Regional/métodos , Neoplasias/tratamiento farmacológico , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de TiempoRESUMEN
PATIENTS AND METHODS: 27 patients (14 men and 13 women aged 35 to 71 years; average: 59 years), with 3-11 months' follow-up (average: 5 months) were treated for hepatic metastases (17/22 from colorectal, 10/22 from other primary tumors) with hypoxic locoregional hepatic perfusion. Sixteen of 22 patients had been pretreated with resection, systemic chemotherapy or freeflow locoregional infusion. Our protocol consists in blocking arterial flow with an occlusion balloon catheter inflated in the hepatic artery; the main catheter channel is connected with a pump system and 250-300 ml saline with 30-40 mg Mitomycin C are perfused in the arterial hepatic system. Embolization with a gelatin sponge is performed after the end of perfusion. RESULTS: 19/27 patients are still alive, and 8/27 are dead but death was caused by the progression of intrahepatic disease in only 2/27 (7%). Iatrogenic lesions of the arterial wall were shown at follow-up DSA in 15/22 patients (56%). Thirteen CR (48%) and 9 PR (33%) were demonstrated at CT follow-up, amounting to 81% of objective responses. Follow-up showed a clinical CR in 12/18 symptomatic patients (66%). No case of hematologic toxicity was observed. Mean CEA values changed from 129 to 10.60. Twelve of 27 patients exhibited mild posttreatment sequels, none of them lasting longer than three days; ischemic cholecystitis was seen in 3/15 cases (14%). CONCLUSIONS: The occlusion catheters on the market are not optimal for this procedure; the axillary percutaneous approach is advantageous. CR rate was very high in our series but the objective response rate doses do not differ from those in the series with free-flow procedures. The highest CR rate was observed in untreated patients and in hypervascularized lesions; the rate of clinical sequels was low, clinical CR rates were high and there was no hematologic toxicity. This well-tolerated procedure provides good local disease control, but the high rate of deaths from extrahepatic progression suggests that systemic chemotherapy and long-step intraarterial perfusion be combined.
Asunto(s)
Quimioembolización Terapéutica , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/terapia , Adulto , Anciano , Hipoxia de la Célula , Femenino , Humanos , Neoplasias Hepáticas/irrigación sanguínea , Masculino , Persona de Mediana EdadRESUMEN
The authors introduce a new technique for performing aortic stop-flow infusion (ASI) or hypoxic abdominal perfusion (HAP) to treat advanced thoracoabdominal tumors, via an angiographic percutaneous approach. To date, the maneuver has always been performed with surgical exposure of vascular sites in the groins. The materials available on the market were initially used and then dedicated materials have been developed, such as 11-F vascular sheaths, 8-F catheters, latex balloons with maximum phi's of 4 cm and maximum capacity of 70 ml. We performed 72 maneuvers in 56 patients during 22 months. No technical or instrumental complications occurred and all treatments were successful. Three patients (6%) died within 12 hours, two because of ARDS following thoracic perfusion and one for acute renal failure and disseminated intravascular coagulation following abdominal perfusion. The percutaneous approach provides the same mechanical-occlusive efficacy for aortocaval occlusion and therefore the same therapeutic results as surgery, but it has fewer risks of technical complications and no technical failures. Moreover, this technique is more repeatable and less expensive than surgery and its hospital stay and recovery time are shorter. To conclude, the ASI/HAP procedure is an interesting therapeutic chance in otherwise untreatable advanced cancer patients offering several prospects of technical and pharmacologic development to further increase its efficacy.
Asunto(s)
Aorta , Quimioterapia del Cáncer por Perfusión Regional/métodos , Neoplasias/tratamiento farmacológico , Venas Cavas , Quimioterapia del Cáncer por Perfusión Regional/instrumentación , Diseño de Equipo , Humanos , Infusiones IntraarterialesRESUMEN
PURPOSE: We report four cases of advanced malignant cancer of the gallbladder treated with hypoxic hepatic perfusion. MATERIAL AND METHODS: Hypoxic hepatic perfusion is currently used to treat diffuse hepatic metastases: the common hepatic artery is occluded with a balloon catheter and then a large amount of antiblastic solution is infused into the liver. Hypoxia and slow flow increase the effect of the drug on neoplastic tissue. Two sessions were performed in three patients with an interval ranging 2-4 months, while one patient underwent a single session. The drug was Mitomycin C, whose dose ranged 20-40 mg (mean: 30 mg). Blood filtration was performed after one of the six procedures only and can be considered unnecessary. RESULTS: Acute gastric bleeding appeared in a patient after the embolization of the right gastric artery with bucrylate during the first session performed to avoid drug reflux into gastric wall arteries. No other technical or clinical complications occurred. An objective morphological response (tumor necrosis or reduction in size > 50%) was observed in all patients after the first session. CT findings were stable in two of three patients submitted to a second session, while local progression was observed in the other patient. Complete clinical response was achieved in all symptomatic patients. No WHO toxicity was observed. DISCUSSION AND CONCLUSIONS: The rate of positive morphological and/or clinical responses after hypoxic perfusion was very high in our experience, even though our series was small. Recurrences were found in two patients some months later, which suggests the need of long-term follow-up. Hypoxic perfusion can be nevertheless considered as a new and interesting therapeutic approach for advanced malignant gallbladder cancer, with a strong short-term effect on the lesion and good results on clinical symptoms.
Asunto(s)
Adenocarcinoma/tratamiento farmacológico , Tumor Carcinoide/tratamiento farmacológico , Quimioterapia del Cáncer por Perfusión Regional/métodos , Neoplasias de la Vesícula Biliar/tratamiento farmacológico , Adenocarcinoma/diagnóstico por imagen , Anciano , Antibióticos Antineoplásicos/administración & dosificación , Antibióticos Antineoplásicos/efectos adversos , Tumor Carcinoide/diagnóstico por imagen , Quimioterapia del Cáncer por Perfusión Regional/efectos adversos , Femenino , Neoplasias de la Vesícula Biliar/diagnóstico por imagen , Humanos , Hipoxia , Hígado/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/secundario , Masculino , Persona de Mediana Edad , Mitomicina/administración & dosificación , Mitomicina/efectos adversos , Cuidados Paliativos , Radiografía Intervencional , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Most patients with hepatocellular carcinoma (HCC) are not suitable for surgical therapy. Systemic chemotherapy, immunotherapy, and hormonotherapy have not had convincingly acceptable results. Therefore, transarterial catheter-targeted therapies such as intraarterial chemotherapy (IAC), possibly followed by transcatheter arterial chemoembolization (TACE), have been proposed. METHODS: A survival analysis curve was drawn using the Kaplan-Meier method for 164 patients, 100 with HCC who underwent TACE (69) or IAC (31), and a matched historic group of 64 who did not receive specific antineoplastic treatment. RESULTS: A significantly more favorable survival was observed for TACE-treated patients compared with IAC-treated patients (P < 0.001); TACE- and IAC-treated patients had a statistically superior survival than that of untreated patients (P < 0.001 and P < 0.025, respectively). This difference was still significant (P < 0.001) when the patients were subdivided into Classes A and B and Stages I and II following Child's and Okuda's criteria. The TACE- and IAC-treated groups had a good relationship between technical efficacy of therapy and survival. Stratifying the patients according to the degree of iodized oil (Lipiodol Ultrafluid, Guerbet, Aulnay-Sous-Bois, France) uptake in the three groups with Group 1 having an uptake greater than 75% of tumor mass, Group 2 having an uptake of 50%-75%, and Group 3 having an uptake less than 50%, survival at 6, 12, 24, 36, and 48 months was calculated as 94%, 88%, 67%, 53%, and 30%, respectively, for Group 1; 86%, 68%, 13%, 13%, and 0% for Group 2, and 43%, 23%, 6%, 6%, and 0% for Group 3 (Group 1 vs. Group 2: P < 0.001; Group 1 vs. Group 3: P < 0.001; Group 2 vs. Group 3: P < 0.001, respectively). The most important side effects after the intraarterial procedure were fever (46.2%), abdominal pain (36.6%), chemical cholecystitis (8%), and pancreatitis (1.7%). Death strictly related to treatment occurred in two patients; one had massive bleeding due to ruptured esophageal varices, and the other had a subphrenic abscess of a superficial HCC of the VIII segment. CONCLUSIONS: Transcatheter arterial chemoembolization and IAC were effective and relatively safe, and the authors believe that they have a primary role in treating patients with unresectable HCC larger than 5 cm; iodized oil uptake can be considered a suitable prognostic marker.
Asunto(s)
Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica , Aceite Yodado/administración & dosificación , Neoplasias Hepáticas/terapia , Dolor Abdominal/etiología , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Hepatocelular/metabolismo , Carcinoma Hepatocelular/patología , Estudios de Casos y Controles , Cateterismo Periférico , Causas de Muerte , Femenino , Fiebre/etiología , Humanos , Inyecciones Intraarteriales , Aceite Yodado/efectos adversos , Aceite Yodado/farmacocinética , Italia , Neoplasias Hepáticas/metabolismo , Neoplasias Hepáticas/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Análisis de SupervivenciaRESUMEN
Two hundred and eight cirrhotic patients with HCC underwent TACE with a standardized technique. Kaplan-Meier survival rates and 12, 24 at 36 months were 62%, 44% and 25%, respectively. Compared with 407 untreated patients, our series had a longer life expectancy, i.e., from 15 months after treatment on. Life experience was statistically different with the L-R test between the groups selected by Child-Pugh cirrhosis staging (p = 0.00000); all 8 Child-Pugh C patients died within 7 months; a high statistical difference was found between Child-Pugh A and B groups (p = 0.00012). Life experience was statistically different with the L-R test between the four groups selected by tumor size and spread (p = 0.012); statistical significance was not reached between contiguous groups in group vs. group comparisons. The patients with monofocal tumors, regardless of size, survive longer than those with multifocal and infiltrative (p = 0.0010) and those with multifocal (p = 0.0029) lesions. Hazard analysis, according to the stratified Cox model, proved tumor-size and Child-Pugh staging to be prognostic factors (p = 0.00027; p = 0.00000) which exhibit a highly significant correlation with each other (p = 0.00000). With the proportional hazard Cox model, tumor characteristics and Child-Pugh stage resulted to be highly significant independent prognostic factors (p = 0.013 and p = 0.000, respectively). Patient survival rates were graphically plotted against literature rates in 407 untreated patients classified by tumor size and by the Child-Pugh method: the two-year survival rates were higher in the subgroups of patients submitted to TACE. To conclude, TACE is an effective treatment not only for multifocal HCCs, but also for large monofocal and infiltrative HCCs. In contrast, TACE is quite useless in the patients with Child-Pugh C cirrhosis.
Asunto(s)
Carcinoma Hepatocelular/mortalidad , Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica/métodos , Cirrosis Hepática/complicaciones , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/terapia , Adulto , Anciano , Carcinoma Hepatocelular/patología , Doxorrubicina/administración & dosificación , Epirrubicina/administración & dosificación , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Hepáticas/patología , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Tasa de Supervivencia , Factores de TiempoAsunto(s)
Quimioembolización Terapéutica , Arteria Hepática , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/terapia , Neoplasias Pancreáticas/patología , Estreptozocina/administración & dosificación , Humanos , Hígado/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
The homogenization of conventional chest radiographs is obtained with mechanical filtration of the X-ray beam and it allows opacity compensation of the different anatomical structures under examination; consequently, more pieces of diagnostic information on the mediastinum can be obtained. The authors used a mechanical device for equalization (Tau-Gil, Gilardoni SpA) with five different X-ray film/rare-earth screen combinations (3M Trimax) to investigate the following problems: a) choice of the best film-screen combination; b) results of the dosimetric comparison of filtered and non-filtered examinations; c) qualitative evaluation of equalization in terms of diagnostic information. One thousand analogic chest studies, 500 with and 500 without hard-filtering equalization, were performed with high-tension technique and statistically evaluated with a dedicated program. The authors concluded that: 1) the best qualitative results are obtained with GTU film/T6 screen combination, which seems to make the most satisfying compromise between sensitivity and spatial resolution and allows low X-ray exposure to be combined with good diagnostic results; 2) dosimetric tests clearly show that in hard-filtered studies the average incident dose to the patient is 12% lower than that given with no filter. Particularly, skin and lung doses decrease, while mediastinum dose doubles to allow the simultaneous visualization of mediastinum and parenchyma; 3) a substantial difference exists between the frequencies of excellent, good and bad results in the comparative series (with and without equalization) for the evaluation of central chest areas, especially for mediastinum, retrocardiac region and carena. The overall rate of poor results was reduced by equalization, ranging 11.6% to 2.8% (mean: 6.3%) in equalized studies, and topping 64.2% (average: 35.5%) in non-equalized studies. Therefore, in the authors' experience, equalization with this type of mechanical device improves the depiction of the mediastinal region, with no significant imaging loss in lung parenchyma demonstration. Moreover, hard-filtering decreases average incident dose to the chest and skin-lung dose, increasing mediastinum dose to allow its correct demonstration.
Asunto(s)
Radiografía Torácica/instrumentación , Película para Rayos X , Pantallas Intensificadoras de Rayos X , Humanos , Radiografía Torácica/métodosRESUMEN
Liver cirrhosis with hypersplenism is often associated with HCC. In many such cases, chemoembolization (TACE) may be very difficult because of the high incidence of hemorrhagic complications due to treatment and/or following portal hypertension, as well as for poor hematologic tolerance to antiblastic drugs in cirrhotic patients. Six patients with nodular HCC and cirrhosis (Child B) with hypersplenism were treated by combined TACE and partial splenic embolization (PSE) to reduce splenic size and to improve hematologic and hepatic function rates. Actual and long-lasting (up to 6 months since TACE/PSE) positive results were observed in splenic size and in hepatic function synthesis, as well as on hematologic and hemocoagulation factors. The clinical-laboratory improvement following TACE/PSE allowed TACE to be completed in all cases, following the usual protocol based on 3 procedures. Therefore, in the patients with advanced/decompensated cirrhosis and hypersplenism associated with HCC, the combined one-step TACE/PSE treatment can be said to improve patients' tolerance to antiblastic drugs and to reduce the risk of hemorrhagic complications due to invasive radiologic procedures and/or to portal hypertension.
Asunto(s)
Carcinoma Hepatocelular/terapia , Embolización Terapéutica , Hiperesplenismo/terapia , Neoplasias Hepáticas/terapia , Carcinoma Hepatocelular/complicaciones , Cateterismo , Quimioembolización Terapéutica , Humanos , Hiperesplenismo/complicaciones , Cirrosis Hepática/complicaciones , Neoplasias Hepáticas/complicacionesRESUMEN
Bone metastases from hepatocellular carcinoma (HCC) are fairly rare, their average occurrence rate being 7.3%. Seven cases of secondary bone lesions (2%) were observed in a series of 347 consecutive cases treated with transcatheter arterial chemoembolization (TACE). The conventional X-ray and the CT patterns of secondary bone involvement were studied, together with histologic features, tumor and cirrhosis stage, and follow-up results. Bone metastases were detected in the early stages of cirrhosis and HCC, which suggested that patients might experience long survival if adequately treated. On the other hand, due to the lower rate of bone metastases in our series than in untreated cases, TACE cannot be said to be of even partial value in the treatment of distant HCC metastases. At any rate, bone metastasis alone is not necessarily a sign of poor prognosis, if it is adequately treated with radio-chemotherapy.
Asunto(s)
Neoplasias Óseas/secundario , Carcinoma Hepatocelular/secundario , Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica/métodos , Neoplasias Hepáticas/terapia , Arterias , Cateterismo , Estudios de Seguimiento , Humanos , Neoplasias Hepáticas/patologíaRESUMEN
Conventional chest radiographs correspond to 50% of the normal workload of a diagnostic radiology department and account for the lengthening of reporting times, thus affecting the profit of a general hospital deeply. The authors describe a software specifically applied to the reporting of chest X-rays which allows "macro" reports for typical or negative findings and which makes reports by sequential questions for more complex conditions. Its value was investigated based on nearly two years' uninterrupted working experience. During four month 7175 examinations were performed: 6480 (90.3%) in the diagnostic room, plus 685 (9.5%) bedside and emergency exams. Computer-assisted reports amounted to 95% of the total figure in the first group and to 46% in the second one. The results follow: 1) waiting times were substantially reduced; 2) administrative workload was markedly decreased; 3) less expert medical staff greatly benefitted from an efficient didactic and learning activity. Thus, good results were obtained, especially relative to the possibility to obtained actual real-time reports of chest radiographs with no loss in diagnostic accuracy.
Asunto(s)
Computadores , Radiografía Torácica , Servicio de Radiología en Hospital/organización & administración , Sistemas de Información Radiológica , Humanos , Radiografía Torácica/estadística & datos numéricos , Sistemas de Información Radiológica/estadística & datos numéricosRESUMEN
Our personal experience is reported with the use of vascular endoprostheses (Strecker and Palmaz stents) in the non-surgical treatment of iliacofemoral steno-occlusive arteriopathy. Over a 15-month period, 56 PTAs were performed in 40 patients; 20 vascular endoprostheses were positioned--17 Strecker and 3 Palmaz stents--in 16 patients, to correct such PTA complications as dissections or to improve the results of a suboptimal PTA maneuver. Venous DSA follow-up was performed at 30 days, and serial color-Doppler US studies were performed every fourth month. Immediate and satisfying clinical results were observed in 15/16 patients (93.7%): only one case of acute thrombosis following the procedure was observed, which could not be treated with intraarterial fibrinolytic therapy and was therefore operated on. Overall long-term patency rate is 100%, mean follow-up is 13.8 months. Finally, the indications for the use of such devices in iliacofemoral arteriopathies are critically discussed, together with the criteria of choice of a type of stent over another one, the immediate and long-term results and the best follow-up protocols.
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Arteriopatías Oclusivas/terapia , Arteria Femoral , Arteria Ilíaca , Stents , Diseño de Equipo , Arteria Femoral/diagnóstico por imagen , Estudios de Seguimiento , Humanos , Arteria Ilíaca/diagnóstico por imagen , Radiografía , Stents/efectos adversosRESUMEN
The congenital absence of pericardium is a rare condition which may determine electrocardiographic ST-T abnormalities. The case of a 16-year-old athlete who presented T-wave abnormalities at standard electrocardiogram performed during a physical checkup is reported. Ventricular repolarization tended to normalize during exercise and in right lateral decubitus. Chest x-ray and echocardiography showed typical signs of complete absence of the left pericardium. The definite diagnosis was made by computer tomography (CT) scan. The importance of a complete investigation of athletes with T-wave abnormalities is emphasized. Diagnostic and therapeutic features of the congenital absence of pericardium are discussed.
Asunto(s)
Electrocardiografía , Cardiopatías Congénitas/complicaciones , Pericardio/anomalías , Taquicardia Ventricular/etiología , Adolescente , Diagnóstico Diferencial , Ecocardiografía , Cardiopatías Congénitas/diagnóstico por imagen , Frecuencia Cardíaca , Humanos , Masculino , Taquicardia Ventricular/fisiopatología , Tomografía Computarizada por Rayos XRESUMEN
Nineteen aneurysmal bone cysts and five angiomas of bone were treated by selective arterial embolization. The median follow-up was 22 months. In 17 patients healing occurred with complete relief of symptoms; in 11 of these almost complete ossification of the lesion resulted. In the remaining cases, little or no ossification was apparent but ossification may take 1 year or more to occur. No recurrence was observed in any of these cases. Recurrence occurred only in two cases. In one, growth of the recurrence stopped after a second embolization, and the X-rays showed no change. Selective arterial embolization represents a treatment of choice in aneurysmal bone cyst and angioma of bone especially of the spine, sacrum, or pelvis. In these sites embolization replaces surgery which might be hazardous due to intraoperative bleeding.
Asunto(s)
Quistes Óseos/terapia , Neoplasias Óseas/terapia , Embolización Terapéutica , Hemangioma/terapia , Adolescente , Adulto , Quistes Óseos/diagnóstico por imagen , Neoplasias Óseas/diagnóstico por imagen , Femenino , Fémur , Hemangioma/diagnóstico por imagen , Humanos , Húmero , Masculino , Persona de Mediana Edad , Osteogénesis , Alcohol Polivinílico/uso terapéutico , Radiografía , Inducción de Remisión , Enfermedades de la Columna Vertebral/terapia , Neoplasias de la Columna Vertebral/terapia , AceroRESUMEN
The authors describe 42 cases of lesions of the musculoskeletal apparatus (traumatic, pseudoneoplastic or tumorous) in which selective arterial transcatheter percutaneous embolization (SAE) was indicated. In 3 patients SAE was not performed because the angiography had shown it to be too dangerous for the spinal cord. Out of 39 patients 2 were embolized in order to stop unrestrainable hemorrhaging (1 post-traumatic and 1 post-bioptic), 7 in order to reduce intraoperative bleeding, while in 7 cases (aneurysmal bone cyst, angioma of bone) the aim was curative. In the remaining 23 patients SAE was performed for adjuvant (8) or palliative (15) purposes in association with radio-and/or chemotherapy (11). In these last 15 cases the clinical results obtained were good in 67% of the cases, with partial or total regression of pain. Healing was obtained in 100% of the patients treated for curative purposes.
Asunto(s)
Embolización Terapéutica/métodos , Enfermedades Musculoesqueléticas/terapia , Adolescente , Adulto , Anciano , Niño , Embolización Terapéutica/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Musculoesqueléticas/diagnóstico por imagen , Enfermedades Musculoesqueléticas/patología , Cuidados Paliativos , RadiografíaRESUMEN
The variability due to age and sex and the reciprocal relations of serum IgG, IgA, IgM, C3, C4, total cholesterol (TC), HDL-cholesterol (HDL-C) and triglycerides (TG) were studied in 87 subjects (46 men and 41 women, aged 20-75 years) selected for the absence of significant atherosclerotic lesions. Serum IgA and C3 were higher in men than in women (P less than 0.05) mainly in the age group 41-60, while IgM and HDL-C were higher in women than in men (P less than 0.05 and P less than 0.01, respectively), especially in the age group 20-40. Direct univariate correlations with age were found for serum TC (P less than 0.0001), IgA (P less than 0.001), and C4 (P less than 0.01) but the latter correlations was confirmed only in women by multivariate analysis. These 3 variables had the major increment in the age group 41-60 in men, while in women the increase associated with age was more progressive or late. Univariate analysis showed a 'ring' of highly significant correlations (P less than 0.0001) involving serum lipids and complement components (TC-C4-C3-TG-TC). The correlation between TC and C4 was present only in men in multivariate analysis and improved with increasing age. These findings might represent a clue to explain the previously reported association between serum C4 and atherosclerosis.
Asunto(s)
Arteriosclerosis/sangre , HDL-Colesterol/sangre , Proteínas del Sistema Complemento/metabolismo , Triglicéridos/sangre , Adulto , Anciano , Arteriosclerosis/metabolismo , HDL-Colesterol/metabolismo , Femenino , Humanos , Inmunoglobulina A/metabolismo , Inmunoglobulina G/metabolismo , Inmunoglobulina M/metabolismo , Masculino , Persona de Mediana Edad , Análisis Multivariante , Triglicéridos/metabolismoRESUMEN
Arterial embolization was performed in 36 patients with tumors of bone and soft tissue. Embolization was the only treatment in seven patients with benign lesions. Fourteen patients underwent embolization before surgery to obtain hemostasis and/or reduce tumor size. Fifteen patients with inoperable primary bone tumors or skeletal metastases underwent palliative embolization. The best results were obtained in aneurysmal bone cysts.
Asunto(s)
Quistes Óseos/terapia , Neoplasias Óseas/terapia , Embolización Terapéutica , Cuidados Paliativos/métodos , Neoplasias de los Tejidos Blandos/terapia , Quistes Óseos/diagnóstico por imagen , Neoplasias Óseas/diagnóstico por imagen , Femenino , Hemostasis Quirúrgica/métodos , Humanos , Masculino , Alcohol Polivinílico , Prótesis e Implantes , Radiografía , Neoplasias de los Tejidos Blandos/diagnóstico por imagenRESUMEN
The authors report their 4-year (1984-1988) experience with TCE in the treatment of primary sacral benign/malignant and vascular bone tumors, after similar preliminary studies on aneurysmal bone cysts. Eleven patients were treated, for a total of 21 procedures: in 85% of the eight cases of palliative embolization, multiple instrumental approaches were needed for late revascularization, up to four consecutive embolizations in the same patients. Severe complications were observed in 19% of the procedures, due to arterial catheterization and/or instrumental maneuvers, but in none of them was surgery required. Technical results--i.e. devascularization of the mass--were optimal/suboptimal in all cases at the end of multiple procedures in the same patient: in 7/8 patients treated for palliation, however, the treatment was repeated, the late venous DSA angiographic control showing recanalization of the great vessels surrounding the lesion and/or revascularization through collateral channels. The analysis of morphological and clinical results (with reference to pain relief, dimension of the mass, and calcification at CT follow up) showed a complete pain relief in 100% of the patients treated preoperatively for palliation. The dimension of the mass was reduced in 12.5% of the cases treated for palliation, and recalcification was demonstrated on CT in 12.5% of cases. In 25.5% the mass had increased in size and in 62.5% its dimensions were unchanged. Effective pain relief was always obtained in the cases treated preoperatively. Thus, in our experience TCE of expansive lesions of the sacral bone can be considered as an effective therapeutical choice, with special reference to pain relief, for use in all inoperable cases, and as a preoperative treatment to minimize blood loss at surgery. Still, embolization materials are not completely satisfying: many of them are expensive, difficult to use and cannot be trusted to permanently occlude the vessels, which forces to intervene more than once to obtain optimal clinicomorphological results. As for malignant lesions, chemo-embolization with cytostatic substances should be used to improve the efficacy of the method. However, even through such negative judgements can be expressed on TCE, both technical and clinical results have been, in our experience, quite satisfactory, which calls for optimization of the methodology.