Inversion of spatio-temporal distribution heat flux and reconstruction of transient temperature field of three-layered skin tissue during hyperthermia.

Hyperthermia (for example, high-intensity focused ultrasound, laser, radio-frequency) of cancerous cells from in vitro to in vivo requires accurately obtaining the heat distribution induced by external heating into the three-layered skin tissue. Obtaining the boundary heat flux into the three-layered skin tissue is a necessary condition to realize the measurement of tissue heat distribution. Considering the complexity of multiple boundary heat fluxes in spatio-temporal distribution, this study proposes an inversion scheme to predict the spatio-temporal distribution of multiple boundary heat fluxes into the three-layered skin tissue. In the inversion scheme, a multivariable prediction model is established to solve the spatio-temporal coupling problem between the inversed boundary heat flux and measurement temperature information. Furthermore, based on the dependence between the predicted temperature and inversed boundary heat flux, the inversion system is constructed to realize the simultaneous optimization inversion of multiple boundary heat fluxes in spatio-temporal distribution. To examine the feasibility and effectiveness of inversion scheme, numerical experiments are carried out to discuss the influence of future time steps and measurement errors on the inversion results of boundary heat flux. In addition, the transient temperature field of three-layered skin tissue is reconstructed by inversed boundary heat flux, which could provide an economical, effective, and non-invasive solution for the measurement of thermal field of three-layered skin tissue during hyperthermia.

TACE plus percutaneous chemotherapy-lipiodol treatment of unresectable pedunculated hepatocellular carcinoma.

Pedunculated hepatocellular carcinoma (P-HCC) is rare type of HCC. The study aimed to evaluate the clinical features and outcomes of unresectable P-HCC treated with transcatheter arterial chemoembolization (TACE) and percutaneous chemotherapeutic agents lipiodol emulsion (CALE) injection. The clinical features and outcomes of 25 patients with unresectable P-HCC treated with TACE plus percutaneous CALE injection were retrospectively reviewed, and factors associated with outcomes were analyzed. Comparison with nonpedunculated unresectable HCC was also performed. Patients underwent a median of 4 TACE sessions and received a median of 2 percutaneous CALE injections. The 1-, 2-, 3-, and 5-year actuarial survival rates were 78.9%, 52.6%, 42.1%, and 12.0%, respectively, for patients with P-HCC, and median survival was 27 months (95% confidence interval, 22.6-43.2 months). Patients with P-HCC had better overall survival than those with nonpedunculated HCC (NP-HCC) (P = .002). Vascular invasion and abdominal lymph node metastasis were poor prognostic factors for overall survival in patients with P-HCC. TACE plus percutaneous CALE injection is a safe and effective treatment for unresectable P-HCC. Patients with unresectable P-HCC might have better overall survival than those with NP-HCC after TACE plus percutaneous CALE injection. However, their prognosis remains poor.

Polyvinyl alcohol terminal chemoembolization for hepatocellular carcinoma with hepatic arteriovenous shunts: Safety, efficacy, and prognostic factors.

PURPOSE: To evaluate the safety and efficacy of polyvinyl alcohol (PVA) terminal chemoembolization and to identify the prognostic factors associated with survival in hepatocellular carcinoma (HCC) patients with hepatic arteriovenous shunts (HAVS). MATERIALS AND METHODS: Of 133 patients' managements were retrospectively analyzed. HAVS was classified into three types: slow-flow, intermediate-flow and high-flow. The size of the PVA used was determined following the scheme: slow-flow HAVS: 300-500µm PVA; intermediate-flow HAVS: 500-710µm PVA; high-flow HAVS: 710-1000µm PVA. The HCCs with slow-flow and intermediate-flow HAVS were embolized by PVA plus chemotherapeutic agents lipiodol emulsion, while the high-flow HAVS were treated by PVA with chemotherapeutic agents. Survival curves were calculated by Kaplan-Meier method and compared by log-rank test. The influence of possible prognostic factors on survival were analyzed by multivariate Cox proportional-hazards method. RESULTS: The median overall survival (OS) of 133 patients was 9.1 months. The median OS of the slow-flow type, intermediate-flow type and high-flow type patients were 10.8, 9.1 and 7.3 months, respectively. There was no statistically significant difference among different HAVS types (P=0.239). The 30-day mortality was 3.8%. Cox multivariate survival analysis revealed that initial preoperative AFP value≥400ng/ml (HR=2.105, P=0.006) was an independent risk factor. While multiple embolization (HR=0.482, P=0.011), tumor remission (HR=0.431, P=0.041) and multimodality therapy (HR=0.416, P=0.004) were independent protection factors. CONCLUSION: It is safe and effective for HCCs with HAVS treated by terminal chemoembolization therapy with PVA plus chemotherapeutic agents lipiodol emulsion (or PVA plus chemotherapeutic agents). The HCCs with HAVS achieves good prognosis with multiple embolization, tumor remission and multimodality therapy, while achieves poor prognosis with inital preoperative high AFP value (≥400ng/ml).

Image-guided percutaneous lipiodol-pingyangmycin suspension injection therapy for sacral chordoma.

A 74-year-old man presented with a progressively worsening pain in sacrum and was diagnosed to have a sacral chordoma by biopsy in May, 2004. Percutaneous intratumoral injection with lipiodol-pingyangmycin suspension (LPS) was carried out under image guidance and repeated when the pain in sacrum recurred and the tumor increased. During a 6-year follow-up period, three sessions of this treatment were executed. CT imaging and Karnofsky Performance Score were used to evaluate the size of tumor and quality of life, respectively. The patient was free of pain after each procedure and had a high quality of life with a Karnofsky Performance Score above 80 points. The tumor lesion in sacral area was effectively controlled. No complications were observed. Percutaneous intratumoral injection with LPS under image guidance may be an effective and safe alternative for the patients with sacral chordoma.

Transarterial embolization using pingyangmycin lipiodol emulsion and polyvinyl alcohol for the treatment of focal nodular hyperplasia of the liver.

BACKGROUND/AIMS: Surgical resection is the current treatment for focal nodular hyperplasia of the liver (FNH) when indicated. However, tumor location and size, patient comorbidities, and risk of complications may limit surgical options in some cases. Our goal was to evaluate the therapeutic effect of transarterial embolization (TAE) using pingyangmycin lipiodol emulsion (PLE) and polyvinyl alcohol particles to treat FNH. METHODOLOGY: Four patients with FNH, who experienced dull pain in the upper abdomen or liver area and confirmed by biopsy, were treated by TAE with PLE and polyvinyl alcohol (diameter: 500µm-700µm). Therapeutic effects including changes in lesion diameter and symptomatic improvement, and occurrence of complications, were evaluated for a follow-up period ranging from 12 to 42 months after the procedure. RESULTS: All of four patients were successfully treated with PLE and polyvinyl alcohol embolization. One month after the procedure, dull pain in the upper abdomen or liver area vanished completely. Follow-up examination by CT or MRI revealed complete resolution in two cases and an obvious decrease in the other two cases. No immediate or delayed postembolization complications were encountered. CONCLUSION: Transarterial embolization using PLE and polyvinyl alcohol should be considered as a safe and effective method for the treatment of FNH.

Percutaneous intratumoral injection with pingyangmycin lipiodol emulsion for the treatment of recurrent sacrococcygeal chordomas.

This study describes fluoroscopy-guided percutaneous intratumoral injection therapy (PIIT) with a pingyangmycin lipiodol emulsion in the management of recurrent sacrococcygeal chordomas after surgical excision. Seven patients underwent a total of 22 treatment sessions (3-4 sessions per patient); treatment responses were evaluated clinically, and lesion size was determined using computed tomography (CT). Over 10-26 months of follow-up, tumor sizes and visual analogue scale (VAS) scores of all patients were decreased. No patients had complications during the follow-up period. Preliminary results showed that PIIT with pingyangmycin lipiodol emulsion under fluoroscopic guidance is effective and safe and may be considered as a treatment option.

[Effect of percutaneous intratumoral injection of lipiodol emulsion of chemotherapie agents on implanted VX2 tumor in rabbits].

OBJECTIVE: To assess the therapeutic effect of percutaneous intratumoral injection with lipiodol emulsion of chemotherapie agents (CALE) on implanted VX2 tumor in rabbits. METHODS: Twelve New Zealand rabbits with implanted VX2 tumor (24 models) were divided into lipiodol group, chemotherapeutic agent group and CALE group with intratumoral injections of the corresponding agents. The pathological changes of all the lesions were observed and the expression of proliferating cell nuclear antigen (PCNA) and vascular endothelial growth factor (VEGF) were evaluated 7 days after the operation. RESULTS: Compared with the lipiodol group and chemotherapie agent group, intratumoral injection of CALE resulted in the highest tumor necrosis rate and greatest tumor necrosis (P<0.01). The labeling indices of PCNA and VEGF expressions in CALE group were markedly lower than those in the other two groups (P<0.01). CONCLUSION: Percutaneous intratumoral injection of CALE is an effective ablation approach for treatment of malignant solid tumors.

[Percutaneous intratumoral injection with pingyangmycin lipiodol emulsion for treatment of recurrent sacrococcygeal chordomas].

OBJECTIVE: To evaluate the effectiveness and safety of fluoroscopy-guided percutaneous intratumor injection of pingyangmycin lipiodol emulsion (PLE) in the management of recurrent sacrococcygeal chordomas. METHODS: Seven patients with recurrent sacrococcygeal chordomas presenting with severe local pain with visual analogue score (VAS)≥8 received treatment sessions of fluoroscopy-guided percutaneous intratumor injection of PLE. The patients were followed up every 3 months after the last session to assess their clinical responses and observe the changes in the tumor size measured by computed tomography. The changes in the VAS, tumor necrosis and pain relief as well as the adverse events were recorded. RESULTS: A total of 22 sessions of fluoroscopy-guided percutaneous intratumoral PLE injection was performed in these cases (3 or 4 sessions in each case). The total average pingyangmycin dose delivered was 48.0 mg and the average lipiodol dose was 40.0 ml in each case. Five patients showed low fever and vomiting 48 after the injection. During the follow-up (median time of 21.7 months, range 10-26 months), all the patients showed obviously reduced tumor size and VAS, and partial remission was achieved in 6 patients and stable disease (SD) in 1 patient. None of the patients had complications during the follow-up. CONCLUSION: Fluoroscopy-guided percutaneous intratumoral injection of PLE can be effective and safe and may serve as a alternative for treatment of recurrent sacrococcygeal chordomas.

Fluoroscopic intralesional injection with pingyangmycin lipiodol emulsion for the treatment of orbital venous malformations.

OBJECTIVE: The objective of our study was to evaluate the efficacy and safety of percutaneous intralesional injection under fluoroscopy with pingyangmycin Lipiodol emulsion (PLE) for the treatment of orbital venous malformations. MATERIALS AND METHOD: . This study is a retrospective analysis of 19 consecutive patients with distensible orbital venous malformations. Of the 19 patients, two had diffuse lesions. These patients presented with proptosis (n = 19), pain and orbital swelling (n = 11), reduction in visual acuity (n = 4), diplopia (n = 2), disk swelling (n = 5), and motility disturbance (n = 3). RESULTS: All 19 patients underwent technically successful percutaneous intralesional PLE injection under fluoroscopy. Complete resolution of proptosis, swelling, and pain was achieved in 17 patients 3-9 months after the procedure. In the other two patients with diffuse lesions, light proptosis was still present after the first procedure. A second procedure was performed in these two patients, and the symptom disappeared 3 months later. All four patients with reduced visual acuity recovered their vision, and diplopia in two patients disappeared. Examinations of the fundus revealed normal findings in the five patients with preprocedural disk swelling. None of the patients presented with a motility disturbance after the procedure. Local swelling in the eyelid and epiphora were present for 1 month in one patient and disappeared after treatment. No other complications, including acute orbital compartment syndrome, were observed during follow-up periods. The mean follow-up was 23 months. CONCLUSION: PLE sclerotherapy under fluoroscopic guidance is safe and effective for the treatment of orbital venous malformations and can be used as one of the treatment alternatives.

Gigantic cavernous hemangioma of the liver treated by intra-arterial embolization with pingyangmycin-lipiodol emulsion: a multi-center study.

PURPOSE: To evaluate the therapeutic effect and safety of pingyangmycin-lipiodol emulsion (PLE) intra-arterial embolization for treating gigantic cavernous hemangioma of the liver (CHL). METHODS: Three hospitals (Nanfang Hospital, Inner Mongolia Autonomous Region's Hospital and Huai He Hospital) participated in the study during 1997-2001. A total of 98 patients with CHL were embolized with PLE via the hepatic artery. The therapeutic effects including changes in tumor diameter, symptomatic improvement and occurrence of complications were evaluated for a period of 12 months after the procedure. RESULTS: The tumor diameters decreased significantly from 9.7 +/- 2.3 cm to 5.6 +/- 1.6 cm 6 months after the treatment ( P < 0.01), and then to 3.0 +/- 1.2 cm at 12 months ( P < 0.01). Transient impairment of liver function was found in 77 cases after embolization, 69 cases of which returned to normal in 2 weeks, and the other eight cases of which recovered 1 month later. The clinical symptoms were significantly relieved in all 53 symptomatic patients. Persistent pain in the hepatic region was found in two cases, and these two patients resorted to surgery eventually. CONCLUSION: Intra-arterial PLE embolization proves to be effective and safe in treating patients with CHL.