Comparison of adrenal vein sampling value between aldosterone producing adrenal adenoma and non-functioning adrenal adenoma: evaluation using receiver operating characteristic analysis.

PURPOSE: To evaluate adequate criteria for adrenal vein sampling values in patients with aldosterone producing adrenal adenoma (APA), retrospectively. MATERIAL AND METHODS: Between 1988 and 2002, 59 hypertensive patients (15 M and 44 F, aged 47.58 +/- 9.45 years) were referred to our hospital and diagnosed with APA based on established criteria. During the same period, 23 patients with non-functioning adrenal adenoma (11 M and 12 F aged 53.56 +/- 11.76 years) were diagnosed based on computed tomography and laboratory data. RESULTS: All 82 patients were enrolled in the present study. Bilateral adrenal vein sampling (AVS) for measurement of plasma aldosterone (A) and cortisol (C) was performed, and a receiver operating characteristics (ROC) analysis was conducted to establish the best criteria from the AVS-derived index in patients with APA. A (APA side)/A (contralateral side) was confirmed to provide the best diagnostic accuracy {(>2.5: right APA, sensitivity 83.3%, specificity 79.5%), (> 3: left APA, sensitivity 84.2%, specificity 76.9)}. The Az values for A (APA side)/A (contralateral side) were 0.8948 and 0.9260 for right and left APA, respectively. CONCLUSION: The A (APA side)/A (contralateral side) value was the best compromise for sensitivity and false-positive rate for lateralization of APA.

Visualization of the internal mammary artery via the hepatic falciform artery in a patient with hepatocellular carcinoma.

The hepatic falciform artery is a small vessel that arises as a terminal branch of the middle or left hepatic artery. Its anatomy and clinical importance have been described in several recent reports. During dissection of a cadaver, this artery is generally found connected with the ensiform branch of the internal mammary artery. However, to our knowledge, anastomosis has not previously been described radiologically.

Discrimination value of the new western prognostic system (CLIP score) for hepatocellular carcinoma in 662 Japanese patients. Cancer of the Liver Italian Program.

To reliably estimate the prognoses of patients with hepatocellular carcinoma (HCC), both liver function and tumor-related factors should be accounted for. However, there are few worldwide staging systems that assess prognostic value in the context of selecting individual patients for randomized stratification in therapeutic and clinical trials. We investigated the value of known prognostic systems and verified the usefulness of the new scoring system proposed by the Cancer of the Liver Italian Program (CLIP), as determined from 662 Japanese patients. A retrospective analysis of the HCC diagnoses at 4 Japanese institutions from 1990 and 1998 was performed. Overall survival was the only end point used in the analysis. Discriminatory ability and predictive power of the CLIP score were compared with those of Okuda stage and AJCC TNM stage. Compared with the Okuda and AJCC staging systems, the CLIP score's enhanced discriminatory capacity, which was tested by the linear trend test and Harrels' c-index, revealed a class of patients with an impressively more favorable prognosis and another class with a relatively shorter life expectancy. Moreover, the likelihood ratio test showed that the CLIP score had additional homogeneity of survival within each score above that of the Okuda stage or the AJCC stage. This was true for 3 subgroups of patients who received surgery, transcatheter arterial chemoembolizations, and percutaneous ethanol injections. Collectively, these findings indicate that the CLIP score has the highest stratification ability with regard to prognosis in patients with HCC. The CLIP score could be used internationally to stratify randomization groups in therapeutic and clinical trials.

Pain palliation by percutaneous acetabular osteoplasty for metastatic hepatocellular carcinoma.

A 68-year-old man with hepatocellular carcinoma and known skeletal metastasis developed right hip pain and gait disturbance due to an osteolytic metastasis in the right acetabulum. This was treated initially with chemoembolization and radiation therapy. When these procedures proved unsuccessful percutaneous injection of acrylic bone cement into the acetabulum was undertaken. Immediately after this procedure, he obtained sufficient pain relief and improved walking ability, which continued for 3 months until he died of hepatic insufficiency.

Non-surgical therapy of primary aldosteronism: transcatheter arterial infusion of ethanol into an aldosteronoma.

Primary aldosteronism due to an adrenocortical adenoma can be cured by ablation of the adenoma, which produces an excess of aldosterone (aldosteronoma). This has traditionally been performed by surgical removal of the adenoma. However, some patients with aldosteronomas refuse surgical removal. Therefore, we developed a therapeutic method to ablate an aldosteronoma by transcatheter arterial infusion of ethanol. This method ablated the aldosteronoma in 27 (82%) of 33 treated cases and produced no serious complications, and may be one of the therapeutic choices for aldosteronomas.

[Percutaneous mechanical thrombectomy for thrombosed vessels with a hydrolyser (hydrodynamic thrombectomy catheter): clinical experience].

A hydrodynamic thrombectomy catheter was prospectively evaluated for the treatment of thrombosed vessels. Seven patients (7 males: age range from 56 to 82 years; mean age: 79 years) presenting with acute or chronic occlusion of peripheral native arteries (n = 6) and dialysis shunt (n = 1) were treated with the hydrolyser (Cordis, Johnson and Johnson, Japan). Mean occlusion time was 135 days (range: 2-300 days), and mean thrombus length 16 cm (range: 5-20 cm). Removal of the thrombus was successful in five patients (71%), regardless of the length of the thrombus. Mean procedure time was 20 minutes (range: 15-30 minutes). No major complications occurred. Adjunctive thrombolysis was required for persistence of the residual thrombosed distal vessel in one patient. Adjunctive balloon angioplasty was performed in two patients (one native vessel and one dialysis shunt), and stent placement was performed in one patient (dialysis shunt). In two unsuccessful cases, the hydrolyser could not be advanced to the distal side because of the solid thrombus. Therefore, thrombolytic therapy was chosen. However, this therapy failed because the guidewire did not pass within the thrombus. Surgery was performed in these two patients. We conclude from this clinical experience that percutaneous thrombectomy with a hydrolyser is a promising technique for the treatment of thrombosed vessels. Especially in the acute stage of thrombosed occlusion, percutaneous thrombectomy with a hydrolyser is superior to thrombectomy with a Fogarty balloon catheter because of its shorter procedure time and fewer complications.

Transcatheter adrenal arterial embolization of cortisol-producing tumors. Two cases of Cushing's syndrome.

Transcatheter arterial embolization (TAE) was performed in 2 patients with Cushing's syndrome caused by adrenal adenoma by using a mixture of absolute ethanol and iohexol. In 1 patient successful suppression of the hypersecretion of cortisol has continued for 9 months after TAE without complications. However, in the other patient, TAE was discontinued due to marked hypertension and tachycardia induced by a massive release of catecholamines from the embolized "normal" part of the tumor-bearing adrenal gland during the procedure. These results suggest that it is important to perform TAE of only the arterial branches feeding the tumor.

Focal enhanced areas of the liver on computed tomography in a patient with superior vena cava obstruction.

We present a patient with superior vena cava (SVC) obstruction in whom two areas of increased hepatic enhancement within the left lobe were seen on abdominal computed tomography (CT). The significance of this case is that abnormal enhancements of the liver on abdominal CT in the regions described should be suggestive of an SVC obstruction on this basis alone.

Transcatheter arterial ablation of aldosteronomas with high-concentration ethanol: preliminary and long-term results.

OBJECTIVE: The purpose of this study was to evaluate the efficacy of transcatheter arterial ablation (TAA) of aldosteronomas with high-concentration ethanol (HCE). MATERIALS AND METHODS: From August 1992 to August 1995, 18 patients with unilateral aldosteronoma, three men and 15 women, 28-65 years old, were treated by TAA with HCE. A single dose (0.2-7.0 ml) of HCE was selectively infused into the feeding arterial branches of the aldosteronoma using a microcatheter and the coaxial technique. The 18 patients underwent 31 TAA procedures. RESULTS: Ablation of the aldosteronoma was monitored by measuring plasma levels of aldosterone and was successful in 15 (83%) of 18 patients. The remaining three patients underwent surgery because results of TAA were insufficient. The destructive effect of ablation by HCE has persisted for 7-38 months (mean, 20 months) in 14 patients. Although one patient had recurrence of symptoms 15 months after the initial TAA, normalization of plasma levels of aldosterone continued for 3 months after TAA was repeated. No severe complications occurred in any of the 18 patients. However, back pain (18 of 18), slight fever (nine of 18), pleural effusion (two of 18), and labile changes in blood pressure (one of 18) were noted in patients 1-7 days after the procedure. CONCLUSION: TAA of aldosteronoma with HCE is an alternative to open adrenalectomy.

[Percutaneous vertebroplasty for osteolytic metastasis: a case report].

Percutaneous vertebroplasty is a radiologically guided therapeutic procedure that consists of percutaneous injection of surgical cement into a vertebral osteolytic metastatic lesion. This procedure has the advantage of providing rapid pain relief and bone strengthening. We report a 46-year-old male patient with osteolytic L3 vertebral metastasis from lung adenocarcinoma treated by percutaneous vertebroplasty under CT and fluoroscopic guidance. After this treatment, definite pain relief and stabilization of the vertebra were achieved. Vertebroplasty for osteolytic metastasis may be a minimally invasive procedure that provides immediate, long-term pain relief and contributes to spinal stabilization.

Transcatheter arterial renal and adrenal embolization with iohexol-ethanol solutions. Animal experimental study and clinical application.

RATIONALE AND OBJECTIVES: The authors compared the embolic effect of radiolucent absolute ethanol (AE) with that of a radiopaque iohexol-ethanol (IES) solution for renal ablation in dogs and for the destruction of human aldosteronomas by the technique of transcatheter arterial embolization (TAE) to test whether IES can be an alternative to AE. METHODS: The embolic agents were infused through a balloon catheter into the renal arteries of 17 dogs (9 infused with 0.3 mL/kg AE; 8 infused with IES). The immediate and parenchyma were compared between the two groups. Transcatheter arterial embolization with IES also was performed in three humans with unilateral aldosteronoma. RESULTS: The IES was visualized faintly under fluoroscopy in all dogs. There were no significant differences in embolic effects between the AE and IES. Three patients with aldosteronoma were treated successfully by TAE with IES. CONCLUSIONS: The IES can be used as a "visible ethanol" to improve the safety and ease of ethanol embolization.

Successful therapeutic embolization of aldosteronoma using absolute ethanol.

Adrenal arterial infusion of absolute ethanol (AE) was successfully performed to treat a hyperfunctioning aldosteronoma. One milliliter of AE was infused into the branches of the inferior adrenal artery using a microcatheter with coaxial technique. No severe complications occurred during the procedure. The patient has experienced no recurrence of symptoms, and laboratory values have remained normal for eight months after therapy.

[Hepatocellular carcinoma treated by intraarterial injection of adriamycin/mitomycin C oil suspension alone or combined with cis-diaminodichloroplatinum].

One hundred thirty-five patients with hepatocellular carcinoma (HCC) were treated by intraarterial injection of adriamycin/mitomycin C oil suspension (ADMOS) alone (59 cases) and ADMOS plus cis-diaminodichloroplatinum (CDDP) (76 cases). Tumor size was reduced by over 25% in 13 of 38 patients (35%) in the ADMOS alone group and in 39 of 76 patients (50%) in the ADMOS plus CDDP group. Serum alpha-fetoprotein (AFP) levels decreased by more than 50% in 7/17 (59%) in the ADMOS alone group and in 23/32 (70%) in the ADMOS plus CDDP group. The overall 1- and 2-year survival rates were 68% and 41% by the Kaplan-Meier method. However, no significant difference in the survival rates was observed between the two groups.