Experience of Lymphangiography as a Therapeutic Tool for Lymphatic Leakage After Kidney Transplantation.

INTRODUCTION: Lymphatic leakage after kidney transplantation is a relatively frequent complication but sometimes resistant to treatment, and there is no fixed treatment algorithm. The effectiveness of therapeutic lymphangiography for postoperative lymphatic or chyle leakage has been reported, but few reports are available regarding patients who have undergone kidney transplantation. In this study, we report our experience with lymphangiography as a therapeutic tool for lymphatic leakage after kidney transplantation. PATIENTS AND METHODS: Intranodal lymphangiography for lymphatic leakage was performed in 4 patients (3 male, 1 female; age range, 38 to 70 years old) after living kidney transplantation at the Osaka City University Hospital in Japan. The amount of drainage before lymphangiography was 169 to 361 mL/day. The procedure for intranodal lymphangiography was as follows: the inguinal lymph node was punctured under ultrasound guidance, and the tip of the needle was instilled at the junction between the cortex and the hilum, after which Lipiodol was slowly and manually injected. RESULTS: Lymphangiography was technically successful in 3 out of the 4 patients. In all successful cases, the amount of drainage decreased and leakage finally stopped without additional therapy such as sclerotherapy or fenestration. In 2 cases, we were able to directly detect the leakage site using lymphangiography. The time between lymphangiography and leakage resolution ranged from 8 to 13 days. There were neither complications of lymphangiography nor recurrence of lymphatic leakage in the successful cases. CONCLUSIONS: Intranodal lymphangiography may be not only a diagnostic tool but also an effective, minimally-invasive, and safe method for treatment of lymphatic leakage resistant to drainage after kidney transplantation.

Development of a highly efficient implanted thermal ablation device: in vivo experiment in rat liver.

OBJECTIVES: To evaluate an implanted thermal ablation device that can be heated with high efficiency using a resonant circuit as the implant. METHODS: 16 rats were used. The implants, adjusted at a resonance frequency of 4 MHz, were fixed on the surface of the liver of rats under laparotomy. In 14 of 16 rats, an alternating magnetic field (AMF) was applied for 6 min with an output of 300 W from outside the body using a ferrite core applicator. The implant temperature during AMF exposure was measured. The 14 rats were divided into 5 groups, depending on time from AMF application until they were sacrificed (1 h, 1 day, 3 days, 7 days and 1 month after application). Two rats not exposed to AMF were used as controls. Livers were removed and evaluated; the cross-sectional area and width of the ablated region were measured. RESULTS: During AMF exposure, the implant temperature rose to 127.8±39.3 °C (mean±standard deviation). The cross-sectional area of the ablated region was largest after 1 day and tended to decrease with time. The widths of the ablated region were 4.87±0.22 mm, 4.15±0.36 mm, 3.67±0.58 mm and 3.24±0.16 mm in the 1 day, 3 day, 7 day and 1 month groups, respectively. No significant differences (p<0.05) were seen in either cross-sectional area or width of the ablated region. CONCLUSION: Sufficient heat for ablation was obtained in vivo using a newly developed implanted thermal ablation device. This device may be a new option for thermal ablation therapy.

Influence of stent edge angle on endothelialization in an in vitro model.

PURPOSE: To investigate the influence of topographic features in the path of migrating endothelial cells, specifically the effect of edge angle of intravascular metallic material on endothelialization. MATERIALS AND METHODS: Flat 1-cm x 1-cm 316-L pieces of stainless steel were placed on confluent monolayers of human aortic endothelial cells. The thickness of each metal piece was ground to achieve an edge angle of 35 degrees, 70 degrees, 90 degrees, or 140 degrees (n = 6 each) in relation to the endothelial surface. Migration distance and density of endothelial cell coverage on the metal pieces were measured in groups of six each under static conditions at 4, 7, and 11 days and flow conditions (16 dynes/cm(2)) at 4 days. RESULTS: Endothelial cell migration distance along the surface of the pieces with edge angles of 35 degrees was significantly greater than that with those with larger angles (P < .05) under static and flow conditions. The migration distances on the 35 degrees piece were 87.5%, 47.3%, 57.1%, and 66.1% greater than those on the 90 degrees piece at the upstream, downstream, right, and left edges, respectively. There were no significant differences in cell density among different angle groups under flow or static conditions. CONCLUSION: The edge angle of intravascular metallic material has an influence on the rate of endothelialization. A smaller edge angle facilitates endothelialization over metallic material when compared to a larger angle. These results demonstrate the importance of metallic stent profile on endothelialization rate.

Proton MR spectroscopy of the brain in patients treated with TIPS.

PURPOSE: To evaluate the utility of proton MR spectroscopy (MRS) for the early detection of hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunting (TIPS). MATERIAL AND METHODS: Six patients, who underwent TIPS for treatment of portal hypertension, were examined by MRS I week before and 1 week after TIPS. They were simultaneously clinically examined for number connection test, blood NH3 level, liver function test and the Fischer ratio. RESULT: Three of 6 patients showed overt HE 1 to 5 weeks after TIPS and the other 3 patients did not show overt HE. The overt HE group showed the larger ratio of the amounts of glutamine and glutamate/myo-inositol (Glx/MI) than that of non-overt HE group (p<0.05). CONCLUSION: The Glx/MI ratio estimated by MRS was useful for early detection of HE after TIPS.

Embolotherapy for venous impotence: use of ethanol.

PURPOSE: To evaluate the usefulness of embolotherapy with ethanol for the treatment of venous impotence. MATERIALS AND METHODS: Twenty-three patients with venous impotence underwent embolotherapy. The diagnosis of venous impotence was made by means of pharmacocavernosometry and cavernosography. After exposure of the deep dorsal penile vein, a intravenous catheter was inserted directly into the deep dorsal penile vein and advanced into just front of the preprostatic plexus. Fifty percent ethanol was injected through the catheter and the endpoint of the procedure was determined based on results of venography immediately after injection. The procedure was finished when lack of venous leakage was confirmed. RESULTS: In all patients, the deep dorsal penile vein was successfully exposed surgically, the sclerosing agent successfully injected, and the endpoint successfully achieved. Immediate clinical therapeutic effect (restoration of erection) was obtained in 20 cases (87%). No severe complications were observed during or after the procedure. The follow-up period was 6-50 months. Long-term therapeutic effect was confirmed for 18 of 23 patients (78%). CONCLUSION: The authors' findings suggest that this treatment had satisfactory short-term and long-term clinical results and that longer follow-up is necessary to confirm its safety.

[Long-term results of TIPS].

The long-term results of transjugular intrahepatic portosystemic shunt(TIPS) were analyzed in 48 patients between February 1992 and December 1998, for treatment of esophageal varices and ascites caused by portal hypertension. The procedure was successful in 42 patients. Portal vein pressure was reduced from 29 mmHg +/- 7.9 to 19 mmHg +/- 7.3 immediately after TIPS and to 17 mmHg +/- 6.5 one year later. Varices were controlled in 82% (23/28) of patients after one year and in 78% (7/9) of patients after five years. Ascites disappeared or decreased in 79% (11/14) after one year. Primary shunt patency was 12%, with a secondary patency rate of 79% after five years. The overall incidence of new or worsened encephalopathy was 31% (13/42). Long-term follow-up showed one-, three-, and five-year survival rates of 82%, 68%, and 59%, respectively. TIPS is an effective means of lowering portal hypertension, and it controls varices and ascites with little risk of hepatic encephalopathy.

Hepatocellular carcinoma extending into the portal vein: restoration of extended-term patency by placement of uncovered Wallstents.

A 74-year-old man presented with hepatocellular carcinoma extending into the main portal vein. Two bare Wallstents were placed to maintain portal vein patency. The main portal vein remained patent for 6 months after treatment. No serious complications were observed during or after treatment.

New oily agents for targeting chemoembolization for hepatocellular carcinoma.

PURPOSE: The evaluation of new oily agents for targeting chemoembolization for hepatocellular carcinoma. METHODS: Five types of oily preparation were injected into the hepatic artery of 54 rabbits inoculated with VX2 carcinoma cells in order to evaluate (1) the safety of these preparations, (2) their histologic distribution and the amount of agents remaining at tumor sites, and (3) computed tomographic (CT) images obtained. Of these preparations, three were made by mixing non-iodinated poppy seed oil and a thickener and then adjusted to have a viscosity lower than, equal to, or higher than that of lipiodol. A fourth preparation was a mixture of lipiodol and a thickener with a higher viscosity than lipiodol alone, and the fifth preparation was lipiodol alone. RESULTS: (1) No injury to the hepatic parenchyma was observed hematologically or histologically. (2) With increase in the viscosity, a significantly larger amount of agent remained at the tumor site. No agent was present at normal sites 14 days after intraarterial injection, regardless of which preparation was given. (3) On CT scans following intraarterial injection, tumor cells were visibly deeply stained in the non-iodinated preparation groups, while the lipiodol groups were not evaluable because of excessively high attenuation. CONCLUSION: The non-iodinated oily preparations and highly viscous oily preparations developed in the present study were more useful than lipiodol for treatment of hepatic tumors.

[Development of non-iodized oily agent in targeting chemoembolization for hepatocellular carcinoma].

The purpose of this study was to evaluate a new oily agent in targeting chemoembilization for hepatocellular carcinoma. The oily preparation was made by mixing non-iodinated poppy seed oil and a thickener to obtain the same viscosity as Lipiodol. The oily preparation and Lipiodol were compared by injecting them into the hepatic artery of rabbits inoculated with VX 2 carcinoma in their liver. On the CT scan following intra-arterial injection, tumors were visibly stained in the non-iodinated preparation group, whereas the Lipiodol group was not evaluable because of excessively high attenuation. The non-iodinated oily preparation was concluded to be of clinical significance.

Assessment of aortic invasion by esophageal carcinoma using intraaortic endovascular sonography.

OBJECTIVE: Accurate preoperative assessment of aortic invasion by esophageal carcinoma is of great importance for planning surgery. We compared the accuracy of intraaortic endovascular sonography with that of CT in the diagnosis of aortic invasion by esophageal carcinoma. CONCLUSION: In this study, intraaortic endovascular sonography was sensitive in detecting aortic invasion; both sensitivity and specificity were 100%. Intraaortic endovascular sonography proved useful in detecting aortic invasion by esophageal carcinoma.

[Transjugular intrahepatic portosystemic shunt: a new therapy for portal hypertension].

Thirty-five patients with portal hypertension due to liver cirrhosis secondary to chronic viral hepatitis underwent transjuglar intrahepatic portosystemic shunt for the last 3-year period. Shunts were successfully completed in 31 of 35 patients at 89%. Portal vein pressure was markedly reduced on average in the all cases until 6 months after TIPS. The endoscopic findings of varices much improved in 90% of the patients. Long-term patency rates of TIPS were 97% after 4 weeks, 79% after 6 months, 76% after a year and 55% after 2 years, respectively. The authors concluded that TIPS was an effective and reliable means of lowering portal pressure, improving endoscopic findings of varices and controlling of refractory ascites.