Percutanous and intraoperative ultrasound-guided radiofrequency ablation of hepatic tumours.

PURPOSE: Ultrasonography (US)-guided Radiofrequency ablation (RFA) is increasingly used to treat liver tumours. The aim of this study was to evaluate the impact of multidisciplinary patient selection on clinical results. MATERIALS AND METHODS: From January 2002 to December 2004, 69 consecutive patients with malignant hepatic tumours were presented to our clinic for RFA-treatment. After a multidisciplinary tumour board decision, 33 patients (47.8%) with 70 liver tumours underwent RFA using a 14-gauge needle electrode via a percutaneous (26) or surgical (7) approach, either alone or combined with resection (3) or chemoembolisation (3). 36 patients (52.2%) were excluded from RFA treatment, mainly because of extensive disease or failure of prior chemotherapy. With a median of 20 months (range 6 - 42 months), all 69 patients were followed clinically to assess survival, and the 33 patients who received additional treatment were examined by contrast-enhanced CT to assess local success. RESULTS: Complete necrosis was obtained in 64/70 of ablated tumours (91.4%).The corresponding mean sizes (ranges) of lesion vs. necrosis achieved were 2.3 cm (0.9 - 5.0) vs. 3.7 cm (2.1 - 5.7). Two complications (6.6%) occurred, including one liver abscess and one postablational syndrome. At the time of the tumour board decision, the RFA (33) and non-RFA (36) group differed in mean sizes of tumours (2.3 vs. 3.5 cm), average tumours per patient (2.1 vs. 3.8), and failure of prior chemotherapy (2/33 vs. 22/36). From 36 patients judged to be ineligible for RFA, 24 (66.6%) underwent RFA at another institution. When comparing survival of patients who underwent RFA at our institution (33) vs. those who underwent RFA outside (24) vs. those who underwent no RFA (12), 1/33 (3%) vs. 9/24 (37.5%) vs. 8/12 (66.6%) died within 6 month and 27/33 (81.2%) vs. 5/24 (29.2%) vs. 2/12 (16.7%) were alive after 20 months median follow up. CONCLUSION: US-guided RFA offers a safe local treatment option to destroy small liver tumours (< 3 cm). Carefully and multidisciplinary selected patients may derive benefit, but uncritical application leads to unsatisfying clinical results.

[Minimally-invasive regional treatment of a symptomatic ischial metastasis using radiofrequency ablation and osteoplasty]. / Minimal-invasive Lokaltherapie einer symptomatischen Sitzbeinmetastase durch Radiofrequenzablation und Osteoplastie.

HISTORY AND ADMISSION FINDINGS: A 46-year-old woman presented with worsening, morphine-resistant pain during the previous 8 weeks in the right ischium which rendered her immobile. The patient refused further surgery, radiotherapy or chemotherapy, as she had been treated for ovarian cancer and recurring rectal carcinoma with peritoneal carcinomatosis for the last three years almost without interruption and experienced several complications. The pelvic region had radiotherapy up to 70,4 Gy. INVESTIGATION: Scintigraphy of the bone showed enhancement in the right ischium. Conventional radiography demonstrated an irregular lesion with destruction of the corticalis 3 x 4 cm in size. Computed tomography revealed numerous microfractures and pseudo-arthritic changes. Needle biopsy confirmed a bone metastasis from the rectal carcinoma. Examination of radiation fields showed a high risk for radiation damage using conventional fractionation. TREATMENT AND COURSE: After achieving an interdisciplinary consensus the metastatic lesion of the patient under analgesia and sedation was thermo-ablated by using radiofrequency percutaneously under ct-control and filled with bone cement. 8 days later the patient was released from hospital pain-free and mobile. Her Karnofsky index rose from 30 % to 90 %. Morphine could be reduced to zero. No complications occurred. 9 month later, though newly appearing lung metastasis, the lesion of the ischium was still asymptomatic and stable and conventional radiography did not indicate local tumor progress or dislocated bone cement. The patient now agreed to further chemotherapy. CONCLUSION: Palliative minimally invasive radiofrequency ablation with concurrent osteoplasty can be effective in individual cases giving a better quality of life and mobility. Benefits and risks should be carefully evaluated in studies examining quality of life, especially in patients without the options of surgical and radiotherapy.

[2-phase contrast for the CT imaging of fistulae]. / 2-Phasen-Kontrast zur Darstellung von Fisteln im CT.

To improve the diagnosis of fistulas in CT by using a new method. 68 CT examination of fistulas from 1990 to 1995 were evaluated retrospectively. The examinations were performed in two phases: The regions of interest were scanned as usual, in the case of abdominal fistulas after filling the bowels with contrast medium. In the second phase, the fistulas were filled with highly concentrated contrast medium and re-examined. The presentation of this examination was carried out in a wide window and a high centre. In 59 of the 68 cases the fistula and a communication with an organ or an abscess was found, in 9 cases only the fistulous tract. The fistula and its surrounding structures can be well defined each with a different and individual density. By means of the chosen method the different density readings are visualised. Therefore, the 2-phase contrast method can improve fistula diagnosis by using CT.

Influence of drug solubility in the vehicle on clinical efficacy of ointments.

In a bilateral paired comparison (randomized double-blind study) 31 dermatitis patients (atopic and contact dermatitis) were tested with two ointments containing 0.0056% betamethasone-17-benzoate. One ointment was applied on each side of the body. The topical formulations differed in their solution capacities for the drug by a factor of about 50 (solution-type: high mutual affinity between drug and vehicle; suspension-type: low affinity). The different antiinflammatory effects were studied visually by assessing five symptoms: erythema, scaling, infiltration, lichenification, and excoriation. On the 5th day, 73% of the patients showed significant differences between the sides in favor of the suspension-type ointment (Wilcoxon test). Blanching tests on 30 volunteers confirmed the result. The in vitro drug release, however, was faster with the solution-type ointment. The efficacy of an ointment can be increased greatly, if the solution capacity for the drug is low, and thus the partition coefficient between the stratum corneum (barrier of the skin) and the vehicle is high. As long as the barrier is not damaged completely, the difference in drug release is not the determining factor for the effect.

[Anaphylactoid reaction to trypsin following local administration of Dontisolon ointment]. / Anaphylaktoide Reaktion auf Trypsin nach lokaler Anwendung von Dontisolon-Salbe.

We report on a female patient with known epicutaneous allergies, who developed type I allergy after oral local application of Dontisolon ointment. Epicutaneous tests with constituents of the ointment proved a positive reaction to trypsin-S-calcium glutaminate. We refer to similar cases of allergy to trypsin and chymotrypsin reported in the literature.