High-dose percutaneous ethanol injection therapy of liver tumors. Patient acceptance and complications.

PURPOSE: To study the safety of high-dose ethanol injections in liver tumors and their acceptability as out-patient procedures under local anesthesia. MATERIAL AND METHODS: Twenty-nine patients received 20-95 ml of 95% ethanol by 62 percutaneous injections under local anesthesia. Pain was assessed by a visual analogue scale from 1 to 10 for 33 of the sessions. Side effects, complications, post-treatment requirement of parenteral analgesics, and hospital stay (discharge the same day or later) were recorded. The sessions were compared to 80 injections of <20 ml of ethanol in 18 patients. RESULTS: High-dose injections with an average volume of 39 ml gave a mean pain score of 5.1, with a weak relationship between pain and volume. Other side effects and complications were unrelated to the ethanol dose. They comprised 1 syncopation, 1 occasion of hypoventilation requiring antidote to opiates, 12 short episodes of nausea or vomiting without need for i.v. fluids, 2 instances of sepsis, and 1 abscess that was drained percutaneously. Thirty-nine of the 62 sessions were performed in day care. Ethanol was given in high doses without apparent complications after or shortly before liver resections (3 patients in each group), and on 4 occasions in 2 HIV carriers. Low-dose injections resulted in a mean pain score of 4.7 with the same requirement of i.v. analgesics as high doses, fewer instances of nausea and no infectious complications. CONCLUSION: High-dose ethanol injections in patients with liver malignancy had no mortality and a reasonable complication rate. They could be given without general anesthesia, often in day care.

A modified technique for ethanol injection of liver tumors: preliminary results.

The technique for ethanol injection of liver tumors was modified in order to obtain less reflux with a better intratumoral distribution of ethanol, leading to more extensive necrosis and to a reduction of pain. The needle was stopped just before its entrance into the tumor and ethanol was injected while the needle was advanced a little beyond the distant border of the tumor. Pain and change in echogenicity during and immediately after each injection were evaluated in 11 patients with 38 malignant lesions who received 90 injections with the new or 46 with the conventional technique. Computed tomography and biopsies were used for later follow-up. With the new technique the injected tissue volume converted much more markedly to high echogenicity (p < 0.005), the pain was significantly reduced (p < 0.001), and posttreatment biopsies significantly less often contained viable cells (p < 0.05). These preliminary results suggest that the modified injections were more effective and less painful, and have enabled us to inject a larger volume of ethanol at each session to reduce the number of treatments.

Potent effect of recombinant growth hormone on bone mineral density and body composition in adults with panhypopituitarism.

Six patients (21-50 years) with growth hormone deficiency and panhypopituitarism were given recombinant growth hormone, somatotropin, 0.04-0.1 U.kg.body wt-1.day-1, for 12 months. All patients reported improved well-being with increased working capacity. Bone mineral density, as measured by single photon absorptiometry at two sites on the forearm, showed increased values in 5/6 patients after 12 months when measured at the most distal site (predominantly trabecular bone) and in 4/6 at the more proximal site (predominantly cortical bone). Five patients continued therapy for an additional year and after 18 months a significant increase in bone mineral density was seen at both the distal and proximal sites. The mean annual increase in bone mineral density was 12.0 +/- 0.6 (SEM)% and 3.8 +/- 1.3% at the distal and proximal sites, respectively. In a growth hormone deficient control group without growth hormone therapy, the corresponding values were -2.4 +/- 0.6% and -1.9 +/- 0.4%, respectively. Lean body mass, estimated anthropometrically, increased significantly after 12 months and total body potassium, measured by whole body counting technique, increased in 4/6 patients. During growth hormone treatment, the IGF-1 values were above the mean values for age and 50% of the values were above the mean +2 SD. B-glucose, P-insulin, serum IGF-2, procollagen-III peptide and phosphate increased and urea, creatinine and IGF-binding protein-1 decreased during treatment. The beneficial effects of growth hormone substitution, especially on bone mineral density, indicate that growth hormone substitution should be considered in all patients with hypopituitarism and growth hormone deficiency, irrespective of age.

Radiographic spectrum of rectocolonic calcification from schistosomiasis.

Rectocolonic calcification was detected radiographically in 17 sites in 14 patients undergoing excretory urography for the assessment of urinary schistosomiasis. The right colon was involved in 11 sites, the rectum in four, and the left colon in two. The pattern of calcification varied according to the degree of bowel distension. A laminar pattern was common to all sites and occurred when the rectum or colon was distended with air, feces, or barium. A laminar or irregular amorphous density was found in the empty colon, whereas the calcified, empty rectum had a corrugated pattern. Rectocolonic calcification is probably the most common radiographic manifestation of schistosomal infestation of the gastrointestinal tract.

Evaluation of marketed and formulated furosemide tablets.

Five commercial brands of furosemide tablets were evaluated using the official and non-official tests of U.S.P. XIX. These tests include: uniformity of weight, hardness, friability and disintegration time. The results obtained showed that most of these brands failed to attain the U.S.P. requirements. The inclusion of different surface active agents in some of the new suggested formulae was proposed for improving the poor properties of such commercial furosemide tablets. In addition to the above quality control tests, dissolution rate studies of the new formulated tablets were carried out. The addition of 11.4% dioctyl sodium sulphosuccinate increased the dissolution rate up to 48.5% after 60 min. On the other hand, the same concentration of sodium lauryl sulphate caused complete tablet dissolution within 45 min. The effect of a higher concentration of sodium lauryl sulphate on the dissolution rate of furosemide has also been examined.