Complications associated with transcatheter arterial embolization for hepatic tumors.

Transcatheter arterial embolization (TAE) is widely used in the treatment of hepatic tumors. A total of 2,300 TAE procedures were performed with a 2-15-mL injection of a mixture or suspension of anticancer drugs and iodized oil, followed by administration of gelatin sponge particles. One or two chemotherapeutic drugs, including doxorubicin hydrochloride (10-30 mg), epirubicin hydrochloride (10-30 mg), mitomycin C (10-20 mg), and cisplatin (25-100 mg), were used for each procedure. Complications were encountered in 4.4% of cases (n = 102) and were related to the use of chemoembolic agents or the manipulation of a catheter or guide wire. These complications included acute hepatic failure (n = 6), liver infarction (n = 4) or abscess (n = 5), intrahepatic biloma (n = 20), multiple intrahepatic aneurysms (n = 6), cholecystitis (n = 7), splenic infarction (n = 2), gastrointestinal mucosal lesions (n = 5), pulmonary embolism or infarction (n = 4), tumor rupture (n = 1), variceal bleeding (n = 3), and iatrogenic dissection (n = 35) or perforation (n = 4) of the celiac artery and its branches. Knowledge of these complications is important for correct diagnosis and appropriate management.

Therapeutic efficacy of transcatheter arterial chemoembolization for hepatocellular carcinoma: MRI and pathology.

OBJECTIVE: Our goal was to evaluate the usefulness of multisection dynamic MRI with gadopentetate dimeglumine in the assessment of the therapeutic efficacy of transcatheter arterial chemoembolization (TAE) with iodized oil for hepatocellular carcinomas (HCCs). MATERIALS AND METHODS: Findings on multisection dynamic MRI images were compared with gross appearance and histologic findings in 13 patients with HCCs after TAE with iodized oil. Arterial dominant phase images of the entire liver were obtained 20 s after the start of administration of gadopentetate dimeglumine. RESULTS: In 3 of the 13 patients, no enhancing areas within the tumors were detected. In the remaining 10 patients, enhancing portions were detected within the tumor on arterial dominant phase images. Histologically, viable tumor cells were present in the rapidly enhancing portions, while necrotic tissues were present in nonenhancing areas, irrespective of the accumulation of iodized oil on CT scans. However, in one patient in whom no enhancing portion was seen in the tumor, a small number of viable tumor cells within the capsule were identified on pathologic examination. CONCLUSION: Multisection dynamic MRI is helpful for evaluating the therapeutic efficacy of TAE with iodized oil for HCCs by revealing the hemodynamics of the tumor irrespective of accumulation of iodized oil.

Multiple intrahepatic aneurysms following transcatheter arterial embolization. Work in progress.

PURPOSE: To discuss the mechanism of multiple intrahepatic aneurysm formation after transcatheter arterial embolization (TAE) performed in five patients with hepatocellular carcinoma. MATERIALS AND METHODS: TAE was performed with gelatin sponge particles and iodized oil as embolic materials. Mitomycin C was also used in four cases. RESULTS: Three to 14 aneurysms 1-6 mm in diameter were found in third-to sixth-order branches of the hepatic arteries at repeat angiography performed 25-45 days after TAE. Follow-up angiograms in three cases revealed that most aneurysms were no longer apparent except in one patient in whom two aneurysms remained and were larger than before. In none of the five cases were any signs of aneurysm rupture noted. CONCLUSION: Radiologists should be aware of this complication of TAE. It is speculated that the main cause of aneurysm formation in these patients was the embolic agents used.

Therapeutic ethanol injection of hepatocellular carcinomas undetectable by angiography and Lipiodol computed tomography.

Seven smaller than 2 cm in diameter hepatocellular carcinomas (HCC) undetectable by hepatic arteriography and computed tomography (CT) after intraarterial injection of iodized oil (Lipiodol CT) were diagnosed by ultrasonography-guided fine-needle biopsy in 6 patients. All lesions were treated by percutaneous ethanol injection (PEI) in 1-3 weekly intervals. No recurrences have been demonstrated after 7-15 months. The treatment of HCCs undetectable by angiography and Lipiodol CT presents a problem as transcatheter arterial embolization is considered ineffective due to poor vascularity. PEI appears to be an excellent treatment for these small HCCs.

Intraarterial injection therapy of newly developed cisplatin-phosphatidyl choline-lipiodol suspension for hepatocellular carcinoma.

Twenty-seven patients with hepatocellular carcinoma were treated by intraarterial injection of a suspension of cisplatin powder and iodized oil using phosphatidyl choline as a dispersing stabilizer. A reduction in tumor size of over 25% was obtained in 23 patients (85%) and a reduction of more than 50% was obtained in 17 patients (63%). In all of 14 patients with a high serum alpha-fetoprotein level (more than 200 ng/ml), 27% to 99% reduction in the level was obtained. The one-, two-, and three-year survival rates were 74%, 50%, and 35%, respectively. As for side effects, digestive symptoms were rather frequently observed. Liver abscess and cholangitis were observed in one patient each in patients combined with embolization using gelatin sponge particles. Injection of the suspension with embolization was superior to injection only in therapeutic effect, but was associated with a higher frequency of side effects. The therapeutic effect was better in cases of higher Lipiodol retention in the tumor on follow-up CT.

Insulin-like growth factor-I, GH, insulin and glucagon concentrations in bovine colostrum and in plasma of dairy cows and neonatal calves around parturition.

1. The IGF-I concentrations in colostrum on days 1 and 2 after parturition were higher than those in cow and neonate plasma. 2. The modest increase in GH concentrations in cow plasma around parturition would not be enough to stimulate IGF-I release by tissues. 3. The concentrations of insulin, GH and glucagon in colostrum were substantially lower than those in plasma.