Unresectable hilar cholangiocarcinoma: multimodality treatment with percutaneous and intraluminal plus external radiotherapy.

The efficacy of multimodality treatment for unresectable hilar cholangiocarcinoma was evaluated in terms of outcome, survival and quality of life. Eleven patients were enrolled in the following protocol: percutaneous drainage of both right and left biliary systems; Iridium-192 intraluminal brachytherapy; replacement of the drainages with endoprotheses; external radiotherapy. Six patients completed the protocol and 5 were treated with brachytherapy alone. Mean survival was 10.5 months, similar to surgical results and higher than the control group treated with percutaneous stenting (2.75 months) or biliary drainage alone (1.75 months), with an average hospital stay of 10-15 days and no procedure-related mortality.

Endovascular repair as first-choice treatment for anastomotic and true iliac aneurysms.

PURPOSE: To report our experience with the endovascular repair of iliac aneurysms secondary to aortoiliac bypass grafting. METHODS: Thirteen patients (12 men; age range 62-86 years) with histories of aortoiliac reconstructions were treated with endovascular stent-grafts for 11 false and 2 true iliac aneurysms that averaged 5.2 cm in diameter (range 3.0-7.0). Via a percutaneous access and 9-F or 12-F sheaths, Passager or Wallgraft stent-grafts were delivered to exclude the aneurysms. RESULTS: Twelve (92%) of 13 interventions were completed satisfactorily; 1 procedure for a true iliac aneurysm was converted to traditional bypass grafting. Two patients underwent additional surgical procedures. The average hospital stay for the patients with endovascular repairs only was 3 days (range 2-5). After a mean follow-up of 28 months (range 17-40), no complication or endoleak has been detected in any patient, and all endografts are patent. CONCLUSIONS: Endovascular repair is an effective treatment for secondary aneurysms arising after aortoiliac surgery. It is less invasive and involves a shorter hospital stay. Endovascular repair should be the first choice treatment for iliac aneurysms.

Short- and long-term hemodynamic response to octreotide in portal hypertensive patients: a double-blind, controlled study.

This randomized, double-blind, placebo-controlled study on the hemodynamic effect of two different doses of octreotide administered subcutaneously was conducted among 20 cirrhotic portal hypertensive patients. The wedged hepatic venous pressure, the hepatic venous pressure gradient, the mean portal venous flow velocity, the resistive index of the superior mesenteric artery, the heart rate and the mean arterial pressure were simultaneously evaluated by hepatic vein catheterization and Doppler flowmetry at baseline, 30 and 45 min after a subcutaneous injection of octreotide [0.10 mg (7 patients), 0.05 mg (7 patients)] and of a placebo (6 patients). The portal blood flow velocity, the resistive index of the superior mesenteric artery, the heart rate and the mean arterial pressure were also measured 2, 4, 6 and 8 h after the injection. The hemodynamic changes observed 30 min after the injection did not differ from those at 45 min and the changes at 2, 4, and 6 h were similar to those at 8 h. A statistically significant decrease, in comparison to the placebo group, was observed 45 min after the injection of the two doses of octreotide in the wedged hepatic venous pressure (cumulative median decrease: -10%, p < 0.005), in the hepatic venous pressure gradient (cumulative median decrease: -10%, p < 0.005) and in the mean portal flow velocity (cumulative median decrease: -11%, p < 0.005). A significant increase in the resistive index of the superior mesenteric artery was observed 45 min after the injection of the two doses of octreotide (cumulative median increase: +10%, p < 0.005). Lower, but significant changes in the mean portal flow velocity and in the resistive index of the superior mesenteric artery persisted until 8 h after the injection of the two doses of octreotide (cumulative median decrease of mean portal flow velocity: -7%, p < 0.005 and cumulative median increase of resistive index of the superior mesenteric artery: +4%, p < 0.005). Changes in the wedged hepatic venous pressure, the hepatic venous pressure gradient, the mean portal flow velocity and the resistive index of the superior mesenteric artery showed a great variability among patients. These changes were more pronounced in patients injected with the lower dose with no relationship with the plasma drug concentrations. Responder patients showed a significant higher baseline mean portal flow velocity in comparison with nonresponders (15.2 +/- 1.7 cm/s vs 11.3 +/- 1.3 cm/s; p < 0.005).