[Regional chemotherapy in treatment of patients with unresectable liver metastases of uveal melanoma].

PURPOSE: Retrospective efficacy analysis of transcatheter arterial treatment for unresectable liver metastases of uveal melanoma. MATERIALS AND METHODS: There were performed 38 courses: hepatic arterial chemoembolization with Lipiodol (HACE, n 9) and combination of HACE with hepatic artery infusion (HAI, n = 29). In 9 patients we used the following chemotherapeutic agents: doxorubicin (10-50mg), carboplatin (150 to 450 mg), dacarbazine (200-400mg), mustophoran (360-624mg) and mitomycinum C (5-10mg). RESULTS: There were no mortality or serious complication. According to mRECIST, partial response, stabilization and progression of liver metastases was seen in 1, 3 and 5 patients, retrospectively. The mean survival after arterial treatment was 9,4 (2-34) mo. The 6-, 12- and 18- mo survival rates were 56%, 22% and 11% respectively. CONCLUSION: Transcatheter therapy in unresectable liver metastases of uveal melanoma is safe and can prolong survival of selected patients up to 34 mo.

[The current state of radiologic diagnosis in pancreatic cancer].

The article discusses the role of modalities of radiation imaging in the detection and differential diagnosis of pancreatic cancer. There is presented the problem of diagnosis of pancreatic cancer at the early stages and possible ways of its solving. Analysis of literature finds out that the detection and differential diagnosis of small formations of the pancreas are difficult and require a multimodal approach. None of the modern methods could be considered as the "gold standard" for detection and differential diagnosis of pancreatic cancer.

[Current possibilities of radiodiagnosis in liver tumors].

The report deals with potential of present-day techniques for radiological imaging, differential diagnosis and working out of modalities of treatment for primary and metastatic hepatic tumors. Results of complex examination (ultrasound, CT, MRI, PET using fluorine -18 FDG) of patients with benign and malignant tumors are discussed. Sensitivity and specificity of each procedure have been identified to be used in diagnosis of large-size tumors.

[Follow-up computed tomography in patients operated on for liver malignancies].

UNLABELLED: The aim of the investigation was to study a role of computed tomography (CT) in choosing treatment policy for patients after hepatectomy. In 186 patients with liver malignancies, 558 follow-up studies were performed 3 months to 8 years after surgery and adjuvant treatment. RESULTS: the permanent change of the liver, which is detectable at postoperative CT, is its outline deformity. Inverted (87%), irregular (56%), and, less frequently, convex (13%) outlines were identified. Among 41 patients who had postoperatively undergone adjuvant chemoembolization, 7 (17%) patients were seen to have a local compact lipidiol concentration adjacent to the resection plane. CT carried out in 19 patients with suspected postoperative complications could recognize the cause of complications (liver abscesses, abdominal fluid, bilomas) in 15 (78.9%) cases. In 20 patients, compact lipidiol accumulation in the vicinity of the resection plane was the most common, but not pathognomonic sign of tumor resection in the resection plane. Thus, CT plays an important role in the follow-up of patients after liver resections for malignancies in both the early and late postoperative periods.

[Intraarterial chemotherapy using implantable port-catheter system in patients with colorectal liver metastases].

We evaluated the tentative clinical results of port-catheter system implantation in 32 patients (18 males and 14 females) with liver metastases of colorectal cancer (2001-2006). Laparotomic approach was used in 17 and percutaneous transfemoral implantation - in 15 patients. There were no complications nor technical problems. All patients received a total of 160 cycles of infusion chemotherapy, ranging 2-11 (4 on the average); mean follow-up - 241 (57-730) days . At present, 21 patients have survived for 5-28 months. Three of them (14%) report complete response, 13 (62%) - stabilization and 5 (24%) - tumor progression. One-year survival in all patients was in 76.5%. Eleven patients died through tumor progression unrelated to the liver.

Preoperative portal vein embolization for liver malignancies.

BACKGROUND/AIMS: To study effectiveness of preoperative portal vein embolization before extensive hepatic resection in patients with primary or secondary liver malignancies. METHODOLOGY: Between December 1997 and May 2003, right portal vein embolization was performed in 24 patients. The indication to the procedure was a small amount (< 30%) of the future remnant liver. Ultrasound-guided percutaneous transhepatic puncture of the portal vein and embolization of its right lobar branch with Lipiodol, ethanol, gelatin sponge and/or steel coils were used. RESULTS: There were no complications of the procedure. In 19-56 (mean, 30) days, CT or MRI showed significant increase of the future remnant liver volume from 25% to 35% of the whole liver; the mean increase was 40%. Laparotomy was performed in 15 patients. Right, extended right hepatectomy, and repeated resection were performed in 7, 6, and 1 patient respectively, while one patient underwent only exploration because of tumor progression. Of 14 resected patients, 11 showed no postoperative liver failure. The latter was medically cured in two of three remaining patients, while one patient (future remnant liver < 30% even after the embolization) died from liver failure in 20 days after the surgery. Hepatic resection is planning in 4 of 9 non-operated patients. The 5 patients were not operated because of tumor progression. CONCLUSIONS: Right portal vein embolization is a safe and technically simple procedure that decreases the risk of postoperative hepatic failure after major liver resection.

Ischemic complications of transcatheter arterial chemoembolization in liver malignancies.

OBJECTIVE: To determine the frequency, character, methods of treatment, and outcome of ischemic complications after transcatheter hepatic artery chemoembolization (TACE). MATERIAL AND METHODS: Between 1985 and 1998, 827 sessions of TACE with Doxorubicin mixed with iodized oil, and gelatin sponge particles were performed in 282 patients with primary and metastatic liver cancer. Post-TACE monitoring included clinical observation, US and CT. RESULTS: Ischemic complications appeared in 13 (4.6%) and included the following: hepatic (n=6) and splenic abscess (n= 1), cholecystitis (n=3), and bile duct necrosis (n=3). The treatment was US-guided drainage in 12 cases and systemic antibacterial therapy in 1. No negative influence of these complications on survival of patients was detected. CONCLUSION: Serious ischemic complications of TACE occur in about 5% of patients and can be successfully managed without open surgery. These complications do not worsen the survival of patients.

[Complex radiation diagnosis of post-operative recurrent hepatic tumors]. / Kompleksnaia luchevaia diagnostika posleoperatsionnykh retsidivov opukholei.

The postoperative course of the disease was studied in 63 patients operated on for malignant hepatic lesion in 1990-1998. The pattern of surgical intervention-caused hepatic changes, which is observed at ultrasonography, CT, MRI, angiography, and oil-injected CT is described. Recurrences took place at the site of resection (9.5%) and outside (34.9%). Their largest number (71%) occurred in the first postresectional year. Diagnostic difficulties arose in the differential diagnosis of postoperative inflammatory changes and tumor recurrences at the site of resection (17% false positive results). Contrast MRI and intraarterial iodized oil CT proved to be the most effective radiation diagnostic techniques.

[The role of dynamic contrast magnetic resonance tomography in the complex radiation diagnosis of focal hepatic lesions]. / Rol' dinamicheskoi kontrastnoi magnitno-rezonansnoi tomografii v kompleksnoi luchevoi diagnostike ochagovykh porazhenii pecheni.

The results of complex radiation study of 269 patients with various focal hepatic diseases were analyzed. Present day methods of radiation study were used. Dynamic contrast magnetic resonance imaging (DCMRI) was made in 62 patients. It is concluded that DCMRI is higher sensitive in detecting focal hepatic diseases than other techniques. The time course of changes in signal intensity in different abnormalities greatly differs in quantitative and qualitative parameters, which differentiates the nosological nature of the revealed changes to a high accuracy.

[Computed tomography in the diagnosis of postoperative changes of paranasal sinuses]. / Kompíuternaia tomografiia v diagnostike posleoperatsionnykh izmenenii v okolonosovykh pazukhakh.

Basing on the evidence obtained at examinations of 37 patients within 15-year follow-up after surgery on the maxillary and ethmoidal sinuses, the authors analyse potentialities and techniques of computed tomography in diagnosis of the developments in operated on paranasal sinuses. CT demonstrated advantages in examination of paranasal sinus walls and soft tissue alterations in them.

[Nuclear magnetic tomography in the diagnosis of spinal cord cysts]. / Iaderno-magnitnaia tomografiia v diagnostike kist spinnogo mozga.

Magnetic resonance tomography (MRT) was used in examinations of 172 patients with spinal cord abnormalities. Thirty-eight cysts were detected: 25 in syringomyelia, 5 in intramedullary tumors, 4 posttraumatic and 4 postoperational ones. Based on the MRT patterns, two types of syringomyelia were distinguished, the occlusive and idiopathic ones. The size and site of cyst, as shown by the MRT, did not conform to its neurologic symptoms. A characteristic feature of tumorous cysts was a highly intensive signal originating from their contents. Traumatic cysts were detected against the background of diffuse atrophy of the cord. Computer-aided tomography did not give full-value information in such cases and therefore could not be recommended in cases with suspected intramedullary cysts.