Comparison of contrast-enhanced ultrasound and contrast-enhanced computed tomography in evaluating the treatment response to transcatheter arterial chemoembolization of hepatocellular carcinoma using modified RECIST.

PURPOSE: We aimed to compare contrast-enhanced ultrasound (CEUS) with contrast-enhanced computed tomography (CECT) for evaluating the treatment response to transcatheter arterial chemoembolization (TACE) of hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Treatment responses of 130 patients who underwent TACE were evaluated by CEUS and CECT. We initially compared the abilities of CEUS and CECT to detect residual tumour, which were confirmed by histology or angiography. Then, we compared the tumour response to TACE assessed by CEUS and CECT, according to Modified Response Evaluation Criteria in Solid Tumours (mRECIST). RESULTS: The sensitivity and accuracy of detecting residual tumour by CEUS vs. CECT were 95.9 % vs. 76.2 % (p < 0.001) and 96.2 % vs. 77.7 % (p < 0.001), respectively. For target lesions, 13 patients were observed as complete response (CR) by CEUS, compared to 36 by CECT (p < 0.001). For nontarget lesions, 12 patients were observed as CR by CEUS, compared to 22 by CECT (p = 0.006). For overall response, eight patients were observed as CR by CEUS, compared to 31 by CECT (p < 0.001). CONCLUSION: The diagnostic performance of CEUS was superior to CECT for detecting residual tumour after TACE. In clinical, CEUS should be recommended as an optional procedure for assessing the tumour response to TACE. KEY POINTS: • The mRECIST are widely applied for evaluating the response of HCC. • Imaging method has been applied to assess the therapeutic response to TACE. • The diagnostic performance of CEUS was superior to CECT for residual tumours. • CEUS can be a valuable method for assessing tumour response to TACE.

A pilot study of uterine artery embolization with tris-acryl gelatin microspheres in guinea pigs.

OBJECTIVE: This study was designed to establish guinea pigs as an animal model for uterine artery embolization (UAE) with tris-acryl gelatin microspheres (TAGM). METHODS: Twenty-five female adult guinea pigs were randomly divided into two groups, including a uterine artery casting mould group (n=10) and a UAE group (n=15). Pelvic angiography and vascular casting mould were performed in the first group. The anatomical characters of the pelvic cavity in guinea pigs were described. In the second group, the technical feasibility of performing UAE with TAGM in guinea pigs was investigated. The histopathological slides of the uterus of guinea pigs after UAE were examined to inspect the outcomes of UAE. RESULTS: The uterine artery springs from the internal iliac artery, ascends tortuously along the cervix, and gives off vertically 8-10 branches to the cervix uteri and uterine horns. The diameters of the trunk of the uterine artery and its first branch were 0.32±0.027 mm and 0.14±0.01 mm, respectively. For UAE animals, the dosages of 40-120 and 100-300 µm TAGM were 0.033±0.003 ml and 0.015±0.002 ml, respectively. On histopathological slides, embosphere particles were found in the first branches of the uterine artery, the subserous arteries, and the intramural arteries. Inflammatory reactions in the uterus were common in guinea pigs after UAE. Local or dispersed areas of necrosis in uterus also were observed in a few guinea pigs. CONCLUSIONS: Guinea pigs are an appropriate and feasible model for UAE with TAGM.

[Amenorrhea after uterine fibroid embolization: a report of six cases].

BACKGROUND & OBJECTIVE: Uterine fibroid embolization is an effective treatment alternative for uterine fibroids. However, amenorrhea after uterine fibroid embolization occurs in some patients. This study was to investigate the causes of amenorrhea after uterine fibroid embolization. METHODS: Bilateral transcatheter uterine artery embolization was performed in 487 patients with uterine fibroids. Pingyangmycin (6-16 mg) dispersed in lipiodol (8-15 mL) was used as embolic agent in 104 patients; polyvinyl alcohol (80-150 mg) was used in 158 patients; absorbable gelatin sponge (1-2 g) was used in 225 patients. All patients had been followed up for 1 year to observe amenorrhea occurrence. RESULTS: Uterine fibroid embolization was effective in 483 (98.97%) patients, but failed in five (1.03%) patients. Amenorrhea after embolization was found in six (1.23%) patients. Of the six patients, three were in lipiodol plus pingyangmycin group with lipiodol deposited in the ovarian region, one was in polyvinyl alcohol group and the other two were in absorbable gelatin group. Except for one patient in absorbable gelatin group, the rest five patients had estradiol (E2) decreasing and follicle stimulating hormone (FSH) rising due to ovarian function failure. In absorbable gelatin group, multiple ultrasonography examinations revealed that the endometrium was only 3 mm thick in one amenorrhea patient who had normal levels of E2 and FSH, and hysteroscope examination confirmed endometrial atrophy in this patient. CONCLUSIONS: Routine embolic agents have the chance in inducing amenorrhea after uterine fibroid embolization. The occurrence rate of amenorrhea after uterine fibroid embolization is about 1.23%. Ovarian function failure and endometrial atrophy are the most related factors.

[Impact of sirolimus on collagen synthesis in vascular smooth muscle cells: experiment with rat].

OBJECTIVE: To evaluate effects of sirolimus on collagen synthesis and collagen type I and type III mRNA expression in vascular smooth muscle cells (VSMCs). METHODS: Rat VSMCs from thoracic aorta were cultured and added with sirolimus of the concentrations of 0, 0.1, 1.0, 10, and 100 ng/ml respectively for 24 h, then co-cultured with L-(3)H-proline for 12 h. L-(3)H-proline incorporation was monitored by liquid scintillation counting. RT-PCR was used to detect the mRNA expression of collagen type I and collagen type III. Logarithmic phase VSMC were treated with sirolimus by 0 ng/ml, 0.1 ng/ml, 1 ng/ml, 10 ng/ml and 100 ng/ml respectively for 24 h prior to 12 h exposure to L-(3)H-proline. RESULTS: The proline incorporation values were 1369 +/- 186, 1211 +/- 157, 1037 +/- 139, 910 +/- 144, and 741 +/- 160 cpm respectively of the 0, 0.1, 1, 10, and 100 ng/ml sirolimus groups. Paired t-test analysis showed that the proline incorporation value of the group with higher sirolimus concentration was significantly lower than that of the group with lower sirolimus concentration (F = 18.936, P < 0.001), except between the 0.1 ng/ml group and 0 ng/ml group (control group) and between the 1 ng/ml group and 10 ng/ml group (P = 0.057, P = 0.12). RT-PCR showed that the collagen I levels were 112 +/- 23, 140 +/- 23, 152 +/- 12, 166 +/- 22, and 179 +/- 18 respectively in the groups of sirolimus of the concentrations of 100, 10, 1, 0.1, and 0 ng/ml respectively, the higher the concentration of sirolimus the lower the collagen I level (all P < 0.05), however, there was no significant difference in the collagen I level between the 0.1 mg/ml group and the control group (P = 0.236). There was no significant difference in the collagen III level among the groups of sirolimus of different concentrations (F = 2.409, P = 0.070). CONCLUSION: Sirolimus inhibits the collagen synthesis in the VSMCs and attenuates the mRNA expression of type I collagen concentration-dependently.

Clinicopathologic features and results of transcatheter arterial chemoembolization for osteosarcoma.

PURPOSE: To evaluate the effect of transcatheter arterial chemoembolization (TACE) for osteosarcoma and to describe the clinicopathologic features produced by TACE as well as the effect of different embolic materials. METHODS: From January 1998 to December 2003, preoperative TACE was carried out in 32 patients. The preoperative and postoperative clinical response, levels of alkaline phosphatase (AKP), leukocyte count, and clinicopathologic features were recorded. We also compared the effect of different embolic materials: adriblastine gelatin microspheres, anhydrous alcohol, common bletilla tuber, and gelatin sponge particles. RESULTS: The levels of AKP were significantly decreased after treatment (p < 0.05), but there was no significant difference in the leukocyte count. Large areas of necrosis were found histologically within 85.5% tumors after TACE. Embolic agents such as adriblastine microspheres, anhydrous alcohol, and common bletilla tuber have better clinical effects than gelatin sponge particles, but there was no significant difference among the first three embolic materials. After treatment, no serious complications were noted. During successful follow-up for 86 months, the survival rate after TACE at 1, 2, and 5 years was 95.5%, 72%, and 42% respectively. CONCLUSION: TACE accelerated tumor necrosis and shrank the tumor volume, thus making adequate tumor resection possible. The optimal time to operate is 10-14 days after TACE. TACE in combination with limb salvage surgery and postoperative periodical chemotherapy may be beneficial for increasing local control rates.

Endovascular stent placement for the treatment of nutcracker phenomenon in three pediatric patients.

Invasive treatment for nutcracker syndrome is controversial, especially in patients with a pediatric onset. Most patients are treated conservatively for a relatively long time, but severe hematuria with an intermittent exacerbation remained unchanged. Three pediatric patients presented with hematuria associated with or without mild proteinuria and were diagnosed as having nutcracker syndrome. The authors performed self-expandable endovascular stent placement across the left renal vein in these pediatric patients. Severe gross hematuria completely subsided after treatment and no serious complications are noted during 2- or 3-year follow-up; moreover, all patients have good physical development.

Endovascular stent-graft repair of aortic dissection.

Between October 2000 and January 2002, 9 consecutive male patients with subacute or chronic aortic dissection underwent stent-graft placement. The indication for surgery was continuous pain or aneurysm development. One patient had a type A dissecting aortic aneurysm with a primary tear in the ascending thoracic aorta; the other 8 had type B dissection. Placement of an endovascular stent-graft was technically successful in 8 patients, and one underwent an open procedure for abdominal aortic fenestration. The entry site was sealed and the false lumen disappeared in 8 cases, and thrombosis of the false lumen was obtained. Rupture of an iliac artery dissecting aneurysm occurred in one patient 2 days after stent-graft placement; abdominal aortic fenestration with prosthetic replacement of the distal abdominal aorta was performed. One patient died of myocardial infarction 3 days after the stent-graft procedure. During a mean follow-up period of 7 months (1-16 months), one patient died of acute myocardial infarction at 11 months. It was concluded on the basis of these short-term results that endovascular repair of aortic dissection is a promising treatment, and abdominal aortic fenestration is a useful adjuvant procedure.

[Endovascular stent-graft exclusion on aortic dissection and dissecting aneurysm].

OBJECTIVE: To study the techniques and therapeutic effects of endovascular stent-graft exclusion in aortic dissection and dissecting aneurysm. METHODS: The clinical data of 20 cases with aortic dissection and(or) dissecting aneurysm were analysed. Stanford A dissection was found in 2 cases, in which one had a tear entry on ascending aorta. Stanford B dissection was found in 18 cases. Five patients had two or more tear entries in different sites. Endovascular polyester-covered stent-graft exclusion was performed in all cases, of which, one case was also given fenestration and graft replacement and one subjected to Y graft bypass from ascending aorta to the left common carotid artery and left subclavian artery before endovascular stent-graft exclusion. RESULTS: No one died in operation. One patient died of heart infarction on the third day after operation. During the followup of 1 - 20 months, 19 patients were alive well (95%). The aortic dissections and(or) dissecting aneurysms of all the patients disappeared without endoleaks and organ or limb ischemia. CONCLUSION: Endovascular stent-graft exclusion with high successful rate, low mortality and high survival rate, is simple, safe and effective in treating aortic dissection and dissecting aneurysm.