Efficacy of transarterial chemoembolization on lesion reduction in colorectal liver metastases.

Following failure of systemic chemotherapy, transarterial chemoembolization (TACE) is an available method to control unresectable liver metastases from colorectal carcinoma (CRC). The aim of present study was to evaluate the efficacy of chemoembolization for inoperable metastatic liver lesions from CRC. Forty-five CRC patients with liver metastases resistant to systemic chemotherapy were enrolled in our study. For each patient, three session of TACE were conducted with 45 days interval. A combination of mitomycin, doxorubicin, and lipiodol were used for TACE. A tri-phasic computed tomography scan and biochemical laboratory tests were performed for all patients at baseline and 30 days after each TACE. Image analysis included measurement of lesion diameters as well as contrast enhancement. Eleven patients deceased before completing three session and the final analyses were performed on the remaining 34 patients. Evaluation of a total 93 lesions in all patients after chemoembolization sessions revealed a 25.88% reduction in anteroposterior (AP) diameter, 33.92% transverse (T) diameter, and 42.22% in product of APxT diameter of lesions (P<0.001 for all instances). CT scan showed a total disappearance of 33% of lesions and evident reduction in contrast enhancement in 16% of them. There were no changes in contrast enhancement in 51% of lesions. Evaluation of single largest lesion in each patient revealed 57.32% reduction in AP diameter, 59.66% in T diameter, and 62.17% in product of APxT diameters (P<0.001 for all diameters). TACE offers a viable option for CRC patients with unresectable liver metastases by significantly reducing lesion size and contrast enhancement.

Diagnostic performance of multislice CT coronary angiography in the assessment of significant coronary artery disease.

The use of noninvasive assessment tools such as multi-slice CT coronary angiography (MSCT-CA-CA) is recently considered mainly because it offers safety, patient convenience, and faster performance. The aim of the present study was to determine the ability of MSCT-CA-CA for the detection of significant stenoses in the coronary arteries, in comparison to conventional invasive coronary angiography (ICA). A total of 58 consecutive patients who were candidate for coronary angiography, with the diagnosis of acute coronary syndrome, from September 2006 to March 2006 were entered into the study. They underwent both coronary MSCT-CA-CA and ICA. The findings of each coronary segment were compared to MSCT-CA-CA in comparison with ICA. Based on artery analysis, sensitivity and specificity of MSCT-CA for the detection of involvement in RCA were 90.0% and 92.8%, in LAD were 71.8% and 92.9% and in LCX were 67.9% and 92.6%, respectively. On a per-segment basis, the sensitivity of MSCT-CA in the detection of injured segments ranged between 33.3% (for segment 11) and 100% (for segments 1, 2 and 12). Also, specificity ranged from 63.6% (for segment 15) and 98.1% (for segment 6). The presence of hypertension, hyperlipidemia, and smoking led to the reduction of the specificity and accuracy of MSCT-CA, whereas history of diabetes mellitus could increase the specificity and accuracy of this tool. MSCT-CA has high diagnostic performance in the assessment of significant coronary artery disease. Risk factors for coronary artery disease may influence this performance.

Arterial damage accompanying supracondylar fractures of the humerus.

BACKGROUND: Arterial damage is sometimes associated with supracondylar fractures of the humerus. Diagnosis and careful management of the fracture and arterial repair is crucial. OBJECTIVES: The aim of this study was to determine the prevalence and outcome of supracondylar fractures of the humerus with signs and symptoms of limb ischemia, before and after arterial decompression or arterial reconstruction. MATERIALS AND METHODS: From September 2004 to July 2010, 225 consecutive patients with supracondylar fracture of the humerus were prospectively recruited. RESULTS: From among 75 cases with Gartland type III fractures, 22 were found to have vascular injury.. Of the 22 cases with vascular injury, 7 patients underwent arterial reconstruction. The other 15 received arterial decompression. All patients had a satisfactory outcome. CONCLUSIONS: A high level of suspicion and careful clinical evaluation leading to an early diagnosis and management of vascular injury accompanying supracondylar fracture is very important to prevent unnecessary sequelae ranging from limb claudication, and compartment syndrome to more severe complications like Volkmann's contracture and even limb loss.

Vascular lesions in intravascular drug abusers in Guilan, north of Iran.

Intravenous drug abuse is an increasing social and health problem. Repeated injuries to the veins, injection of some types of insoluble substances, and needle sharing habits result in various complications. Increasing incidence of major vascular complications has been reported worldwide. The objective of this study was to determine the epidemiology of vascular lesions in drug abusers. Medical records of 50 patients who were consecutively admitted to the surgical wards, presenting with a pulsatile mass, infection of the injection site, or venous thrombosis in the groin or cubital fossa were retrospectively reviewed. Of 50 patients studied, 88% were males and 12% were females. Most of the drug abusers were young. Eighty percent of the patients had an infected injection site in the groin, 12% in the cubital fossa, and 8% in other sites. Seventy-six percent of the patients had been injecting drugs for 10 years and the remaining 24% for more than 10 years. Pseudo-aneurysm was the final diagnosis in 27 (54%) patients. In females, the vascular lesions diagnosed were pseudo-aneurysm in four, deep venous thrombosis in one, and arterio-venous fistula in another patient. Among male patients, pseudo-aneurysm was present in 23 (52%), venous thrombosis in eight (18%), necrotizing fasciitis in three (7%), vascular abscess in two, and arterio-venous fistula in one (5%). Most of the vascular lesions involved the groin or cubital fossa and presented as a pulsatile mass. They may benefit from early referral to a vascular surgery unit. Infected pseudo-aneurysm is the most common pathology in our population and the best management for all infected pseudo-aneurysms is the ligation of the artery.