Electrochemotherapy: a new technological approach in treatment of metastases in the liver.

Electrochemotherapy is now in development for treatment of deep-seated tumors, like in bones and internal organs, such as liver. The technology is available with a newly developed electric pulse generator and long needle electrodes; however the procedures for the treatment are not standardized yet. In order to describe the treatment procedure, including treatment planning, within the ongoing clinical study, a case of successful treatment of a solitary metastasis in the liver of colorectal cancer is presented. The procedure was performed intraoperatively by inserting long needle electrodes, two in the center of the tumor and four around the tumor into the normal tissue. The insertion of electrodes proved to be feasible and was done according to the treatment plan, prepared by numerical modeling. After intravenous bolus injection of bleomycin the tumor was exposed to electric pulses. The delivery of the electric pulses did not interfere with functioning of the heart, since the pulses were synchronized with electrocardiogram in order to be delivered outside the vulnerable period of the ventricles. Also the post treatment period was uneventful without side effects. Re-operation of the treated metastasis demonstrated feasibility of the reoperation, without secondary effects of electrochemotherapy on normal tissue. Good antitumor effectiveness with complete tumor destruction was confirmed with histological analysis. The patient is disease-free 16 months after the procedure. In conclusion, treatment procedure for electrochemotherapy proved to be a feasible technological approach for treatment of liver metastasis. Due to the absence of the side effects and the first complete destruction of the treated tumor, treatment procedure for electrochemotherapy seems to be a safe method for treatment of liver metastases with good treatment effectiveness even in difficult-to-reach locations.

Recurrent sepsis and seronegative arthritis in a patient with a selective IgG3 deficiency.

In a sixty-one-year-old patient with chronic polyarthritis, two life-threatening septic events were observed over a period of 6 months. The patient also had a selective IgG3 deficiency. The susceptibility to infection and chronic polyarthritis observed in this patient were very likely a consequence of the selective IgG3 deficiency.

Transtelephonic transmission of electrocardiograms in Slovenia.

The transtelephonic transmission of electrocardiograms (ECGs) was introduced in Slovenia in 1996 and has been used regularly since September 1997 by health institutions and patients with cardiovascular diseases. Portable 12-channel ECG equipment weighing less than 200 g is generally used. The diagnostic centre is located in the intensive-care unit at the University Medical Centre Ljubljana. In the first 12 months of regular operation we received 463 calls, 213 of which were diagnostic. The most common reasons for calling were: ischaemic chest pain, atypical chest pain, palpitations and dyspnoea. The most common diagnoses made on the basis of history and the ECG were: acute myocardial infarction, angina pectoris, paroxysmal tachycardias and atypical chest pain. In 40% of cases the cardiologist's advice sufficed; 38% of patients were referred to the emergency room, 29% immediately and 9% only if a suggested therapy did not prove successful; and in 21% of cases new medication or a change of dosage of current medication was suggested. Transtelephonic ECG transmission enables direct communication between general practitioner or patient and cardiologist. With its use, time from onset of symptoms to initiation of treatment is shortened, which reduces disability and mortality due to cardiovascular diseases and improves cost-benefit.

Acute isoniazid neurotoxicity during preventive therapy.

OBJECTIVE: To describe rare side effects of treatment with isoniazid. DESIGN: Descriptive case report. SETTING: Medical intensive care unit in a university medical center. PATIENT: A 14-yr old previously healthy girl receiving preventive isoniazid therapy who suddenly developed generalized tonic-clonic seizures and coma. INTERVENTIONS: Patient was sedated and mechanically ventilated. She also received pyridoxine intravenously. MEASUREMENTS AND MAIN RESULTS: An isoniazid overdose was not confirmed. Computed tomography of the brain and electroencephalogram revealed nothing abnormal. Seizures gradually disappeared within 2 hrs after sedation and treatment with pyridoxine. The patient was discharged on day 14 without consequences and has been well for 10 mos. No seizures reappeared after isoniazid was discontinued. CONCLUSIONS: We caution against possible isoniazid neurotoxicity in healthy individuals using recommended preventive doses.

Transtelephonic ECG in Slovenia.

Transtelephonic ECG has been introduced in Slovenia in 1996. It has been operating on a regular basis since September 1997. Users of the system are health institutions and patients with CV diseases. They use portable 12-channel ECG weighing less then 200 grams. Diagnostic center is located in medical ICU in Clinical Center Ljubljana. In the first 20 months of regular operation we have received 852 calls, 450 of them being diagnostic. The most common reasons for calling were: ischaemic chest pain, atypical chest pain, palpitations and dyspnoea. Most common diagnoses made on the basis of history and ECG were: AMI, angina pectoris, paroxysmal tachycardias and atypical chest pain. In 186 cases the cardiologist's advice sufficed, 171 patients were referred to the ER, 142 immediately and 29 only if suggested therapy hadn't been successful. To 82 patients new medication or changed dosage of previous medication was suggested. With the intent to evaluate accuracy of the diagnoses made on the basis of history and transtelephonic ECG evaluation we followed up the patients who were sent to ER in Ljubljana upon our cardiologists' advice. On the basis of preliminary results we can conclude that TTE is as diagnostic as the conventional ECG and its' use shortens time from onset of symptoms to initiation of treatment, it lowers disability and mortality due to CV diseases and improves cost benefit.

The telemedicine and second medical opinion.

Telemedicine is declared as delivery of care to patients anywhere in the world by combining communications technology, with medical expertise. The well established applications of telemedicine are in the field of teleradiology, pathology, cardiology. In some cases video-conferencing (VC) may be applied. Second medical opinion is an important additional viewpoint on the patient diagnosis and treatment. The established network of consultant hospitals and worldwide Second opinion centers enable a fast (24-72 hours response) second medical opinion consultation service with the telemedicine application. The consultant hospitals at present time are: UCSF--San Franscisco, Stanford Medical Center, Bowman Gray School of Medicine, The Brigham Radiology Foundation, Emory University Hospital, University of Pennsylvania Medical Center. The second opinion centers are located worldwide, just to mention some of them: London, Budapest, Ljubljana, Tel Aviv, Bombay, Athens, Milano, Seoul.

[The role of bronchoscopy with a flexible bronchoscope in the diagnosis of pulmonary tuberculosis]. / Uloga bronhoskopije fleksibilnim bronhoskopom u dijagnozi plucne tuberkuloze.

Bronchoscopy with flexible bronchoscope has been proved as a useful method that has been applied also in the diagnostics of pulmonary tuberculosis during the recent years. In order to evaluate its role and use at the Institute for Diseases of the Chest and Tuberculosis Golnik documentation of 51 patients treated during 1985 and 1986 was surveyed. Prior to the examination from all patients the sputum on Mycobacterium tuberculosis was obtained at least three times and it was negative. Aspirations were obtained from 40 patients and the diagnosis was confirmed in 21 patients by recovery from tubercle bacilli specimens (52.5%). Transbronchial biopsy was performed in 34 patients and it was positive in 27 (79.4%), out of them in 7 patients the biopsy sample of the lungs was bacteriologically (38.9%) and in 23 patients histologically positive (67.6%). By bronchoscopy with flexible bronchoscope the final diagnosis was confirmed in 40 patients (78.4%). Bronchoscopy with flexible bronchoscope as well as transbronchial biopsy have proved to be a successful method in the diagnostics of active pulmonary tuberculosis. It should be used in patients in whom the sputum smear for acid fast bacilli were frequently negative yet there is a suspicion of pulmonary tuberculosis.