Palliative embolization of renal tumors.

BACKGROUND/AIM: Palliative embolization of renal tumors is the method of choice in the treatment of advanced inoperable renal cell carcinoma in patients with hematuria and pain. Patients with small tumors in the remaining solitary kidney who refuse surgery are suitable for this type of therapy as well as patients with centrally located inoperable tumors. The prerequisite for successful capillary embolization is the closure of the main arterial trunk with metal spirals. METHODS: In the period from 2000 to 2010 we conducted 42 palliative embolizations. The average age of the patients was 75 years, including 26 men and 16 women. In 8 of the patients the intervention was repeated and in one with severe AV shunts embolization was performed 4 times. Embolization was performed with alcohol, Ivalon 150-250 µm and with metal coils. RESULTS: No serious complications were observed during and after the intervention. Fourteen patient were still alive then and among the deceased patients the average survival time was 13.5 ± 10.8 months with the range of 1 to 56 months. The minimal survival time was 1 month with a maximum survival time of 56 months. CONCLUSION: Our results are consistent with data in the literature. Survival in patients without metastases was longer than in those with metastases, as confirmed by the 14 of the patients from the study. An additional therapeutic safety in the treatment of small cancers is provided with a combination therapy of embolization and radiofrequency thermoablation.

Early detection of widespread progressive brain injury after cardiac arrest: a single case DTI and post-mortem histology study.

OBJECTIVE: We tested the hypothesis in sense of a proof of principle that white matter (WM) degeneration after cardiopulmonary arrest (CPA) can be assessed much earlier by diffusion tensor imaging (DTI) than by conventional MRI. METHODS: We performed DTI and T2-weighted FLAIR imaging over four serial acquisitions of a 76-year-old man with unresponsive wakefulness syndrome at day 41, 75, 173 and 284 after CPA. DTI was also performed in ten healthy control subjects. Fractional anisotropy (FA) derived from DTI was assessed in eleven regions of interest within the cerebral white matter (WM) and compared with post-mortem neuropathological findings. RESULTS: In contrast to conventional FLAIR images that revealed only circumscribed WM damage, the first DTI demonstrated significant reduction of FA across the whole WM. The following FLAIR images (MRI 2-4) revealed increasing atrophy and leukoaraiosis paralleled by clinical deterioration with reduction of wakefulness and intractable seizures. Neuropathological findings confirmed the widespread and marked brain injury following CPA. CONCLUSION: DTI may help to evaluate microstructural brain damage following CPA and may have predictive value for further evolution of cerebral degeneration in the chronic phase after CPA.

Preoperative kidney tumor embolization as procedure for therapy of advanced kidney cancer.

INTRODUCTION: Preoperative kidney tumor embolization is standard procedure for therapy in advanced kidney cancer. Preoperative embolization has a goal to reduce intraoperative bleeding and also to shorten the time of surgery. MATERIALS AND METHODS: We retrospectively observed 50 patients between 2000-2011, in which the preoperative embolization was performed. Mean age of patients was 64 years. All patients with preoperative embolization were compared with the group of 51 patients from Urology Sarajevo, who underwent nephrectomy without preoperative embolization. RESULTS: Symptoms that are dominating among patients were haematuria and pain. Analysis of mean size of tumors based on CT evaluation showed statistically significance in between the biggest size of tumors in group from Hamburg (9.11±3cm) and the smallest size of tumors in Sarajevo group (4.94±1.6cm) p=0.0001. Reason for this is difference in selection of patients for treatment in Hamburg from Sarajevo. CONCLUSION: Kidney as functional finishing organ is extremely suitable for transcatheter therapeutic procedures. The gold standard in the treatment of advanced and metastatic tumor is the nephrectomy. As preparation for nephrectomy in metastatic cancer total capillary embolization is performed. After embolization, surgery is shorter, procedure can be done 24-48 hours after embolization or delayed nephrectomy done 2-3 weeks after the intervention.

Percutaneous transarterial kidney embolization.

INTRODUCTION: In advanced stage of renal carcinoma especially in right kidney because of proximity of inferior vena cava in most centers preoperative embolization of kidney is performed in purpose of facilitating surgery and reducing pre- and postoperative complications. In certain number of patients with indication for inoperability, complete embolization is performed in order.to prevent complications like bleeding. After intervention, surgical nephrectomy can be performed. In patients with the absolute contraindication for the surgical treatment, embolization represents the treatment of choice. MATERIAL AND METHODS: Material for period of 7 years in Elbeck-Schoen Klinik and CCUS is presented in this paper. There were 72 patients, age range 3 to 92 years old, treated with 77 performed embolizations. Embolization was performed with PVA particles in order of achieving capillary embolization, while the principal trunk of renal artery was occluded with one or more coils until complete occlusion occurred. RESULTS: Patients were divided in two groups: group A consisted of patients with preoperatively performed embolization, and to patients in group B embolization was performed as form of palliative care. In all patients in group A procedure was a success, and in one patient from group B procedure was needed to be repeated several times. DISCUSSION AND CONCLUSION: As it is known from medical history first embolization was performed by Almgard in 1973 with purpose in providing safer surgical treatment to patient. Nowadays, this procedure got its widespread use in interventional radiology. Our experiences indicate successfulness of this procedure in most cases in preoperative management as well as in palliative treatment of patient. Postembolization syndrome occurred in all patients after intervention has been performed, and was successfully treated with symptomatic therapy. More severe complications were sporadic. In conclusion it might be said that embolization of inoperative tumors may increase both survival rate and quality of patients life.