[Interstitial photocoagulation with laser in the treatment of liver metastasis]. / La fotocoagulazione interstiziale con laser nel trattamento delle metastasi epatiche.

Interstitial laser photocoagulation (ILP) causes tumor necrosis with local hyperthermia produced by laser light energy. We treated with US-guided ILP 14 patients (7 men and 7 women; mean age: 67 years) and 20 metastases: 9 of them were < 3 cm in max. diameter and 11 were > 3 cm (mean diameter: 2.9 cm); 14 metastases were from colon carcinoma, 5 from breast cancer and 1 from lung cancer. ILP was performed with 300 and 600 microns quartz fiberoptic guides advanced in 21-18G Chiba needles and a continuous-wave Nd: YAG laser with 1064 nm wavelength. We used single expositions of 5-6 minutes with an irradiation power of 5 watts and scheduled 3 treatment sessions, performing CT scans and biopsies at the end of each session. The extent of induced necrosis was classified as follows on the basis of CT findings: grade 1 = 100% necrosis; grade 2 = necrosis > 50%; grade 3 = necrosis < 50%. The average follow-up was 6 months. After the 3 scheduled treatment sessions, CT showed grade 1 necrosis in all the lesions < 3 cm in diameter and in 4/9 (44%) lesions > 3 cm and grade 2 and 3 necrosis in the remaining cases (necrosis > 50% in 95% of the lesions and 92% of the patients). The cytologic findings were in agreement with CT results in all grade 2 and 3 cases, but in one grade 1 necrosis cytology showed residual viable tumor. To conclude, ILP is a safe and well-tolerated procedure. Maximum efficacy was observed in the lesions < 3 cm, while lesion volume was markedly reduced in the lesions > 3 cm. US is a useful tool in the real-time monitoring of this procedure and CT is the most accurate imaging technique to assess treatment efficacy.

Evaluation of risk of thrombosis during use of low-dose ethinylestradiol-desogestrel oral contraceptive.

Thirty healthy young women, non-smokers and of normal weight, used a combined oral contraceptive consisting of 20 micrograms ethinylestradiol and 150 micrograms desogestrel for 9 cycles. Before and during the 3rd, 6th and 9th cycles of contraceptive use, the following parameters were measured: triglycerides, total cholesterol, HDL-cholesterol, apolipoprotein A and B, prothrombin time, partial thromboplastin time, fibrinogen, antithrombin III, protein C, plasminogen, antiplasmin, tissue plasminogen activator, platelet count, platelet aggregation, beta-thromboglobulin and platelet factor 4. The ratios of total cholesterol/HDL-cholesterol and apolipoprotein A/B remained constant or showed only a slight increase. The clotting/fibrinolytic balance showed a similar trend. There was however, an inconstant but significant increase in antithrombin III and protein C. Platelet count and platelet function parameters were unmodified. Hence the contraceptive induced no substantial changes in lipid balance or blood clotting, at least during the study period.