Single-dose toxicity study of hepatic intra-arterial infusion of doxorubicin coupled to a novel magnetically targeted drug carrier.

The toxicity of a single hepatic intra-arterial administration of doxorubicin (DOX) coupled to a magnetically targeted drug carrier (MTC) was evaluated in a swine model. MTC is a microparticle composite of elemental iron and activated carbon. MTC-DOX is a new formulation of doxorubicin absorbed to the MTC and is designed for site-specific delivery to a solid tumor in the presence of an externally applied magnetic field. The magnetic field induces extravasation of MTCs through the vascular wall, leading to localization and retention in the tissue at the targeted site. Eighteen swine were assigned to 6 treatment groups, including 3 control groups (vehicle control, doxorubicin, MTC), and 3 experimental groups that received the MTC-DOX preparation. Animals were given a single administration of test article, evaluated over 28 days, and then sacrificed. Signs of toxicity were monitored via clinical status, total body weight, gross and microscopic pathology, and serum chemistries. Angiography was used to determine the extent of any embolization present. There were no adverse effects observed in the DOX-alone group. Biologically significant, treatment-related gross and microscopic lesions were limited to the targeted area of the liver only in groups receiving > or =75 mg of MTC (with or without doxorubicin). The severity of liver necrosis correlated to the severity of embolization following treatment. Doxorubicin was not freely circulating in any of the MTC-DOX groups, suggesting successful localization to the targeted site. The no-adverse-effect level (NOAEL) was determined to be the MTC-DOX low-dose group.

Endovascular management of iliac vein compression (May-Thurner) syndrome.

PURPOSE: To evaluate the feasibility of endovascular techniques in treating venous outflow obstruction resulting from compression of the iliac vein by the iliac artery of the left lower extremity (May-Thurner syndrome). MATERIALS AND METHODS: A retrospective analysis of 39 patients (29 women, 10 men; median age, 46 years) with iliac vein compression syndrome (IVCS) was performed. Nineteen patients presented with acute deep vein thrombosis (DVT) and 20 patients presented with chronic symptoms. All patients presented with leg edema or pain. In the acute group, patients were treated with catheter-directed thrombolysis (120,000-180,000 IU urokinase/h) and angioplasty followed by stent placement. In the chronic group, patients were treated with use of angioplasty and stent placement alone (n = 8), or in combination with thrombolysis (n = 12). Patients were then followed-up with duplex ultrasound and a quality-of-life assessment. RESULTS: Initial technical success was achieved in 34 of 39 patients (87%). The overall patency rate at 1 year was 79%. Symptomatically, 85% of patients were completely or partially improved compared with findings before treatment. Thirty-five of 39 patients received stents. The 1-year patency rate for patients with acute symptoms who received stents was 91.6%; for patients with chronic symptoms who received stents, the 1-year patency rate was 93.9%. Five technical failures occurred. Major complications included acute iliac vein rethrombosis (< 24 hours) requiring reintervention (n = 2). Minor complications included perisheath hematomas (n = 4) and minor bleeding (n = 1). There were no deaths, pulmonary embolus, cerebral hemorrhage, or major bleeding complications. CONCLUSION: Endovascular reconstruction of occluded iliac veins secondary to IVCS (May-Thurner) appears to be safe and effective.

Technique for reduction of bile peritonitis after T-tube removal in liver transplant patients.

PURPOSE: The purpose of this work was to evaluate the incidence of bile peritonitis following T-tube removal in liver transplant patients as a function of the method of T-tube removal. Removal at the bedside was compared to removal in the interventional radiology department with subsequent placement of a temporary drainage catheter. MATERIALS AND METHODS: From June 1987 through July 1993, 1,105 patients underwent orthotopic liver transplantation at the UCLA Medical Center. Three hundred patients were randomly selected from this group and their charts were reviewed. Two hundred sixty-three patients who had choledocho-choledochostomies over a T tube, and adequate documentation of the method of T-tube removal and subsequent clinical course were included in the study. Forty-one patients had their drainage catheter removed at the bedside, and 222 patients had their T-tube removed over a wire in the interventional radiology department with subsequent placement of a temporary drainage catheter. RESULTS: Among all patients included in this study, 10.3% had bile peritonitis. Of the patients who had their T-tube removed at the bedside, 19.5% had bile peritonitis, whereas only 8.6% of the patients who had their T-tube removed in the interventional radiology department had bile peritonitis. This result is statistically significant (P < .05). CONCLUSION: Placing a temporary drain at the time of T-tube removal in the interventional radiology department results in a significant reduction in the incidence of bile peritonitis in liver transplant patients. The procedure is relatively simple, quickly mastered, and well tolerated by patients.

Fine needle aspiration cytology of the pancreas. A retrospective study of 73 cases.

Retrospective review of pancreatic fine needle aspiration (FNA) biopsy specimens collected with computed tomographic guidance from 73 patients between 1980 and 1985 at the Medical Center of Delaware was performed to determine the accuracy of the procedure in our hands and to identify possible problem areas for cytologic diagnosis. When compared with clinical data or tissue diagnosis, FNA had a sensitivity for the detection of pancreatic carcinoma of 67.7%. The predictive value of a negative result was only 23.1%. When compared to the cytologic diagnosis made at the time of review, FNA had a sensitivity of 100%, but a single false-positive case was identified. In addition to the majority of probable pancreatic ductal carcinomas, a hepatoma and a lymphoma were detected. Cases of primary pancreatic carcinoma were classified by cytologic features, but all groups had dismal three-to-six-month median survivals, regardless of the degree of tumor differentiation. Survival times were similarly low for patients with negative pancreatic FNAs. The low patient survival times, regardless of FNA diagnosis, support the value of avoiding laparotomy in these patients and confirm the high false-negative rate of the procedure.