Peripheral insertion of a central venous access device under fluoroscopic guidance using a peripherally accessed system (PAS) port in the forearm.

PURPOSE: We describe the technique, efficacy, and complications of fluoroscopy-guided implantation of a central venous access device using a peripherally accessed system (PAS) port via the forearm. METHODS: Beginning in July 1994, 105 central venous access devices were implanted in 104 patients for the long-term infusion of antibiotics or antineoplasmic agents, blood products, or parenteral nutrition. The devices was inserted under fluoroscopic guidance with real-time venography from a peripheral route. RESULTS: All ports were successfully implanted. There were no procedure-related complications. No thrombosis or local infection was observed; however, in six patients catheter-related phlebitis occurred. CONCLUSION: Fluoroscopy-guided implantation of a central venous access device using a PAS port via the forearm is safe and efficacious, and injection of contrast medium through a peripheral IV catheter before introduction of the catheter helps to avoid catheter-related phlebitis.

[Radiation therapy for adrenal metastases].

PURPOSE: To evaluate the role of radiation therapy for adrenal metastases. MATERIALS AND METHODS: Fourteen patients, 13 with primary lung carcinoma and one with primary unknown carcinoma, received radiation therapy for adrenal metastases from 1984 to 1995 at the Hyogo Medical Center for Adults. Total dose ranged from 16 Gy to 60 Gy, and fractional dose from 1.6 Gy/ Fr to 3 Gy/Fr. RESULTS: Partial response of the local tumor was recognized in 2 of 7 patients by CT imaging. Pain relief was obtained in 7 of 8 patients. Median survival was 3 months, and 6-month survival was 28.6% in all patients. Among patients in the symptomatic group, who had complaints of pain due to adrenal mass, survival was even worse (12.5% at 6 months). There were no severe complications, but 4 patients (29%) had gastrointestinal symptoms. CONCLUSION: Radiation therapy is useful for the purpose of pain relief in adrenal metastases.

[Intra-arterial chemotherapy for the treatment of advanced hepatocellular carcinoma through implantable port (reservoir)].

In this study, we evaluated the effectiveness of the arterial infusion chemotherapy through an implantable port for the treatment of advanced hepatocellular carcinoma. The chemotherapy comprised weekly or biweekly administrations of epi-ADM combined with 5-FU and MMC. The patients were divided into 4 groups as follows: 1) 37 patients treated mainly by repeat transcatheter arterial embolization (TAE) (TAE group); 2) 16 patients treated by arterial infusion chemotherapy through implantable port after TAE (TAE-RV group); 3) 9 patients with no indication for TAE treated by one-shot arterial infusion chemotherapy (one-shot group); and 4) 13 patients with no indication for TAE treated by arterial infusion chemotherapy through an implantable port (RV group). The median survival after the complete courses of TAE was 23 weeks in the TAE group, and 59 weeks in the TAE-RV group. There was a statistically significant difference in median survival time between the TAE group and the TAE-RV group (p < 0.01). On the other hand, the median survival time after the initial administration of an anticancer agent was 9 weeks in the one-shot group and 24 weeks in the RV group. There was also a statistically significant difference in median survival between the one-shot group and the RV group (p < 0.01). In the RV group, the 30-day mortality after the initial arterial infusion chemotherapy was 23.1% (3 patients). Two of these 3 patients showed a poor clinical status with uncontrollable ascites at the beginning of this study. In conclusion, arterial infusion chemotherapy through implantable port was evaluated as effective for the treatment of advanced hepatocellular carcinoma in patients with no indication for TAE, but the indication of this therapy remained subject for further evaluation.