Chemoembolization for hepatocellular carcinoma fed by right internal thoracic artery.

The purpose of the study was to evaluate the value of transarterial chemoembolization (TACE) via right internal thoracic artery (RITA) for patients with unresectable hepatocellular carcinoma (HCC).From January 2000 to June 2016, a retrospective study was conducted of all patients with unresectable HCC who underwent TACE via RITA across 3 medical centers. The technical success, serum alpha-fetoprotein (AFP) level changes, major complications, disease control rate, and survival were evaluated and analyzed.During the study peroid, in all, 21 patients (men 21; mean age 57.3 ±â€Š7.1 years) were included in this study. Of the 21 patients, all the tumors were located under the capsule of the liver and adjacent to the diaphragm with median tumor diameter of 8.2 cm in 20 patients, and the tumor was located at the surface of the liver due to incisional site metastasis in 1 remaining patient. Lesions fed by the RITA were demonstrated during initial TACE in 2 patients and during repeat TACE therapy in 19 patients. The technical success rate was 100%. The AFP response 1 month after treatment was complete (n = 4) and partial (n = 9) of 13 patients whose AFP was abnormal before the procedure, and the serum levels of AFP reduced significantly 1 month after treatment (1240.1 ±â€Š347.1 vs 175.2 ±â€Š71.8; P < .01). No major complications occurred. The disease control rate was 100% at 3 months after treatment. The median overall survival from the time of TACE therapy via the RITAs was 18.2 months, and 1-year survival after TACE therapy via the RITAs was 76.2%.Chemoembolization via the RITA can improve the therapeutic efficacy of TACE and reduce the presence of residual HCC.

Transarterial embolization/chemoembolization therapy for hepatocellular carcinoma fed by adrenal artery: Preliminary results.

To assess the value of transarterial embolization/chemoembolization (TAE/TACE) therapy via adrenal artery for patients with hepatocellular carcinoma (HCC). Patients with HCC who underwent TAE/TACE therapy via adrenal artery between May 2003 and October 2015 across 4 medical centers were identified. Clinical information, procedural data, and imaging data were analyzed to assess technical success, disease control, and survival rates. A t test was used to compare the differences in serum alpha-fetoprotein before and after treatment. A total of 23 patients (23 men; mean age, 54.6 ±â€Š7.5 years; range, 37-72 years) were included in this study. All tumors were located under the capsule of the liver and adjacent to the adrenal gland (median tumor diameter, 8.2 cm). Lesions fed by the adrenal artery were demonstrated during initial TAE/TACE in 7 patients and during repeat TAE/TACE in 16 patients. The superior, middle, and inferior adrenal arteries were involved in 14, 3, and 6 patients, respectively. The technical success rate was 100%. The disease control rate at 3 months was 100%, with partial tumor response seen in 16 (69.6%) patients and stable disease seen in 7 (30.4%) patients. The cumulative survival rate from the time of TAE/TACE was 100% at 1 year. There were no embolization-related complications. TAE/TACE therapy via the adrenal arteries can improve the therapeutic efficacy of TAE/TACE and reduce the incidence of HCC recurrence and/or presence of residual HCC.

A comparative study of small intestinal perforation secondary to foreign body and other non-traumatic causes.

BACKGROUND: Little was known about gastrointestinal perforation secondary to foreign body in adults, which was only documented by several case series reports. The aim of this study was to characterize it with comparative methods. METHODS: A retrospective study was conducted on twenty patients with the diagnosis of gastrointestinal perforation secondary to foreign body between January 2003 and October 2013. The perforations were all located in the small intestine and compared to eighty-seven patients with non-traumatic small intestinal perforation. RESULTS: 35% of the patients in the foreign body group were over 65 years of age, which is much higher than the local elderly population ratio (p=0.002). In the foreign body group, more patients presented without diffuse abdominal physical signs (p=0.008) and preoperational CT scans had higher accuracy (p=0.027). Perforation repair was performed more often (p=0.024). Mean MPI was 19.9 and the morbidity rate was 35%, significantly lower than in the cases of other causes (p=0.001, 0.041). Mean duration of hospitalization was 11.5 days and was shorter compared to other causes (p=0.038). CONCLUSION: Clinical performance of small intestinal perforation secondary to foreign body is atypical, and preoperative diagnosis relies on CT scans. Primary perforation closure is safe and effective, and relatively better outcomes can be achieved.

DYNA CT arteriographic evaluation of hepatocellular carcinoma for treatment by trans-catheter arterial chemoembolization.

PURPOSE: The aim of our study was to determine whether using C-arm CT (DYNA CT) during hepatic arteriography imaging assists in TACE treatment. MATERIALS AND METHODS: 138 patients with HCC, 69 patients (Group A) underwent DYNA CT and routine digital subtraction angiography (DSA), while another 69 patients (Group B) underwent only DSA, were prospectively studied at a single facility between May 2011 and September 2012. Liver vessels and tumors were displayed by DYNA CT. The superior mesenteric artery (SMA) and the celiac artery shape and branch anatomy were visualized. The number of tumors and arteries which feed these was compared. RESULTS: In Group A, DYNA CT showed that the hepatic artery originated from the celiac artery in 60 patients, while the right hepatic artery originated from the SMA and the left hepatic artery originated from the common hepatic artery in 9 patients. In 10 patients, the phrenic artery provided blood to the tumor. DYNA CT detected 258 lesions, while routine DSA found 178 lesions (P<0.05). CONCLUSION: DYNA CT has substantial advantages over routine DSA in demonstrating the shape and branches of the target hepatic vessels and the number of tumors. DYNA CT provides important guidance for TACE which simplifies selective catheterization and improves the treatment and quality of TACE.

[Catheter aspiration alone or combined with thrombolysis in the treatment of superior mesenteric artery embolism].

OBJECTIVE: To investigate the efficacy of catheter aspiration or combined with thrombolysis in the treatment of superior mesenteric artery embolism(SMAE). METHODS: Clinical and imaging data of 25 SMAE patients who underwent catheter aspiration or combined with urokinase thrombolysis in the First People's Hospital and the Second People's Hospital of Changzhou from January 2005 to July 2013 were retrospectively analyzed. RESULTS: Twenty patients were confirmed as SMA trunk embolism and 5 as SMA branch artery embolism. The embolic SMA trunks were completely recannulated by catheter aspiration in the above 20 cases, but small emboli embolized distal branch artery in 6 cases. These 6 patients plus above 5 patients with branch artery embolism received catheter aspiration combined with thrombolytic therapy. Among these 11 patients, complete open, partial open and non-open of branch arteries were found in 5, 3, 3 cases respectively, while collateral circulation increased significantly in non-open patients. During the follow-up period of (4.1±2.2) months, clinical symptom relief and digestive function recovery were observed in 24 cases. Only one case underwent bowel resection because of intestinal necrosis 24 hours after treatment and developed short bowel syndrome. CONCLUSION: Catheter aspiration or combined with thrombolysis is a safe and effective method in treating SMAE.

[Correlations between serum hypoxia inducible factor-1α, vascular endothelial growth factor and computed tomography perfusion imaging at pre-and post-TACE in patients with primary hepatic carcinoma].

OBJECTIVE: To explore the correlations between the serum levels of hypoxia inducible factor-1α (HIF-1α), vascular endothelial growth factor (VEGF) and computed tomography (CT) perfusion parameters at pre- and post-transcatheter arterial chemoembolization (TACE) in patients with primary hepatic carcinoma (PHC). METHODS: A total of 22 PHC patients were recruited.Their serum levels of HIF-1α and VEGF were measured and CT perfusion imaging (CTPI) was performed at Day 1 pre- and Days 32-40 post-TACE to compare and analyze the relevance of the changes of serum levels of HIF-1α, VEGF, tumor's hepatic artery perfusion (HAP), portal vein perfusion (PVP) and hepatic artery perfusion index (HPI) at pre- and post-TACE. RESULTS: They were divided into stable and tumor residual/recurrent groups according to the efficacy of TACE. No significant differences existed between two groups with respects to serum levels of HIF-1α, VEGF, tumor's HAP, PVP and HPI pre-TACE. The serum levels of HIF-1α and VEGF decreased in stable group and there was significant difference in serum level of VEGF at Days 32-40 post-TACE (P < 0.05). There was no perfusion signal of HAP or PVP in tumor tissue.The serum levels of HIF-1α and VEGF were significantly higher while HAP and HPI were significantly lower than that pre-TACE in tumor residual/recurrent group and had statistical significance (P < 0.05), but PVP had no change.Positive correlations existed between serum levels of HIF-1α, VEGF and tumor's HAP, HPI at 32-40 days post-TACE. CONCLUSION: Serum levels of HIF-1α and VEGF may indirectly reflect the status of neovascularization and CTPI acts as the intuitive and quantitative responses of hemodynamic changes at post-TACE.Positive correlations exist between serum levels of HIF-1α, VEGF, HAP and HPI. In short, a combination of serum levels of HIF-1α, VEGF and CTPI contributes to the efficacy evaluation of TACE and has great reference significance of determining timing of a second therapy.

Computed tomography-guided permanent brachytherapy for locoregional recurrent gastric cancer.

BACKGROUND: Locoregional recurrence is the typical pattern of recurrence in gastric cancer, and cannot be removed by surgery in most of the patients. We aimed to evaluate the feasibility and efficacy of computed tomography (CT)-guided brachytherapy for patients with locoregional recurrent gastric cancer. MATERIALS AND METHODS: We reviewed the case histories of 28 patients with locoregional recurrent gastric cancer that were selected for CT- guided brachytherapy by a multidisciplinary team. The clinical data of the patients including patient characteristics, treatment parameters, short-term effects, and survival data were collected and analyzed. RESULTS: 15-75 125I seeds were implanted into each patient to produce a minimal peripheral dose (MPD) 100-160 Gy. Median day 0 dosimetry was significant for the following: V100 (the volume treated with the prescription dose) 95.8% (90.2-120.5%) and D90 (prescription dose received by at least 90% of the volume) 105.2% (98.0-124.6%) of prescription dose. No serious complications occurred during the study. Two months after brachytherapy, complete response, partial response and progressive disease were observed in 50.0%, 28.6% and 21.4% of patients, respectively. The median survival time was 22.0 ± 5.2 months, and the 1, 2,and 3-year survival rate was 89 ± 6%, 52 ± 10% and 11 ± 7%, respectively. A univariate analysis showed that the tumor size was a significant predictor of overall survival (P = 0.034). Patients with tumors <3 cm had relatively higher complete response rate (66.7%), compared to those with tumors >3 cm (30.8%). The PTV (planning target volume) smaller than 45 cm3 was significantly correlated with achieving complete tumor eradication in the treated region (P = 0.020). CONCLUSIONS: For selected patients with limited locoregional recurrent gastric cancer, CT-guided brachytherapy using 125I seeds implantation can provide a high local control rate, with minimal trauma.