Transarterial chemoembolization with degradable starch microspheres (DSM-TACE): an alternative option for advanced HCC patients? Preliminary results.

OBJECTIVE: To assess safety, feasibility and effectiveness of transarterial chemoembolization with degradable-starch-microspheres (DSM-TACE) in the treatment of patients with advanced hepatocellular carcinoma (HCC) dismissing or ineligible for multikinase-inhibitor chemotherapy administration (Sorafenib) due to unbearable side effects or clinical contraindications. PATIENTS AND METHODS: Six consecutive advanced HCC patients dismissing Sorafenib because of unbearable side effects or worsened clinical conditions were enrolled in our prospective single-center pilot study. DSM-TACE was performed via a lobar approach, based on extent and distribution of the disease (1 treatment session for every lobe involved, with a 2-week interval in case of bilobar disease). Tumor response based on mRECIST criteria was evaluated on MD-CT performed at 1 month after "complete treatment" and every 3 months thereafter. RESULTS: Eleven treatments were performed, and technical success was achieved in all patients. No intra/peri-procedural death/major complications occurred. No signs of liver failure or systemic toxicity were detected. At one month follow-up, 5 partial responses (83.3%) and 1 progression disease (16.6%) with an overall disease control (ODC) of 83.3% were observed. In two patients with ODC and residual viable tumor higher than 50%, a repeated DSM-TACE treatment was performed. During the mean follow-up of 11 months (range: 4-14 months), an ODC of 66.6% was obtained. Progression-free survival was 5.5 months with a cumulative 6-month and 1-year overall survival rates of 83.3% and 66.6%, respectively. CONCLUSIONS: DSM-TACE seems to be a promising option for advanced HCC patients ineligible for Sorafenib administration or dismissing it due to progressive disease or unbearable side effects.

WITHDRAWN: Telomeres and atherosclerosis.

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Causes of death in patients with unipolar single chamber ventricular pacing: prevalence and circumstances in dependence on arrhythmias leading to pacemaker implantation.

Cardiac pacing improves the prognosis of patients with severe impulse formation and conduction disturbance, though sudden death can occur frequently in paced patients. In the present study, we analyzed the causes and the circumstances of 378 deaths in 2,243 paced patients followed over a 5-year period. Sudden cardiac death occurred in 71 of these 378 patients (18.7%), 56 patients died of stroke (15%), heart failure was the cause of death in 91 subjects (24%). We analyzed the causes of death in two groups with respect to the arrhythmia that had led to pacemaker implantation. The prevalence of cardiac sudden death was higher in patients with AV block than in patients with sick sinus syndrome, while stroke was more frequent in patients with sick sinus syndrome, particularly those with both fast and slow components. Atrial fibrillation is common in patients with sick sinus syndrome and is an important well-known risk factor for stroke. Death from heart failure was frequently reported in our population, but in our study group only a few patients had heart failure at the moment of pacemaker implantation. We conclude that sudden death is a common event in paced patients and the disturbance that led the patient to pacemaker implantation was also a factor in the cause of death.