Intra-arterial hepatic chemotherapy: management of liver tumors by percutaneous port-a-cath positioning.

In the past, intrahepatic arterial locoregional chemotherapy was performed by surgical approach via gastroduodenal artery; early use of percutaneously placed arterial port was complicated by clotting and bleeding in 50% of pts. More recently, permanent catheters were positioned percutaneously in GDA by Japanese group and fixed to the artery by means of bucrylate in order to reduce dislocation. We present the technique and the preliminary results of percutaneous implantation of intraarterial catheters connected to a subcutaneous infusion reservoir for prolonged regional chemotherapy of hepatic tumors. Two hundred patients underwent to percutaneous arterial port implant, for loco-regional chemotherapy for liver primary or metastatic tumors. Catheter dislodgments were observed in 14,5%, but in 90% the catheters could be reinserted. No case of catheter related mortality was registered. Percutaneous positioning of arterial port is a safe and effective technique to deliver loco-regional treatment for hepatic tumors. Complication rates are similar to the surgical series and to other percutaneous interventional radiological reports. This percutaneous approach in the hands of a skilled team allows intra-arterial infusion in a wide percentage of pts, improving the accuracy of clinical trials by a faster and optimal balanced comparison between systemic and arterial arm.

[Computerized tomography of cerebrovascular disorders in old age]. / La tomografia computerizzata (TC) nelle vasculopatie cerebrali dell'anziano.

The authors present and demonstrate the more typical CT patterns of cerebrovascular diseases in old age, on the basis of literature and of personal experience of more than 1000 CT examinations of old patients in 1991-1992. They stress the basic role of CT in differential diagnosis between hemorrhagic and ischemic lesions. Finally, they propose a protocol for the better use of CT in the early diagnosis and the outcome of cerebrovascular diseases.