[Research progress of adjuvant TACE therapy for liver cancer after radical resection].

Transcatheter arterial chemoembolization (TACE) is the most commonly used method for non-surgical treatment of liver cancer, and it is usually used as an adjuvant therapy in patients who have not developed intrahepatic metastases after surgical resection. Postoperative adjuvant TACE therapy may provide a prognostic benefit in liver cancer patients with high recurrence risk. This article reviews the research progress of adjuvant TACE therapy for liver cancer after radical resection.

[Analysis of the effect of percutaneous vertebroplasty combined with (125)I seed implantation in the treatment of spinal metastatic epidural spinal cord compression].

Objective: To investigate the clinical efficacy of percutaneous vertebroplasty (PVP) combined with iodine-125 ((125)I) seed brachytherapy in the treatment of spinal metastatic epidural spinal cord compression (MESCC) and toassess the changes inthe grade of epidural spinal cord compression (ESCC) by magnetic resonance imaging (MRI). Methods: A total of 37 MESCC patients treated with PVP combined with (125)I seed brachytherapy in the interventional and vascular surgery department of Zhongda Hospital affiliated to Southeast University from January 2014 to June 2019 were retrospectively analyzed, including 23 cases of bilateral lower limbs paralysis. Total diseased vertebrae are 39 segments. Visual analogue scale (VAS) and paralysis of lower extremities were evaluated regularly before and after treatment, and VAS values at different follow-up time points were compared. At the same time, MRI was used to evaluate the changes of ESCC grade in the spinal canal and calculate the local lesion efficiency after operation. The postoperative local lesion efficiency at different follow-up times was compared. Results: PVP combined with (125)I seed implantation in all diseased vertebral bodies was successful. The average injection volume of polymethylmethacrylate (PMMA) was (3.2±1.3) ml/segment, the average number of (125)I seed implanted was (25.0±8.6) seeds/segment and the average radiation dose was (15.0±5.1) mCi/segment. The VAS before operation was 8.5, and postoperative VAS were respectively 3.6±1.3, 3.8±1.5, 3.4±1.4, 5.5±1.0, 5.9±1.4 at 5 days, 1 month, 3 months, 6 months, and 1 year after operation. The differences between all follow-up time points and preoperative VAS values were statistically significant (all P<0.001). Compared with 5 days, 1 month and 3 months after operation, VAS increased significantly at 6 months and 1 year after operation, and the difference was statistically significant (all P<0.001); there was no significant difference between the VAS value at 6 months after operation and 1 year after operation (P=0.405). At a follow-up of 3 months, 22 of 23 patients with paralysis of bilateral lower limbs regained the functions of autonomous walking and voiding; the effective rates of MESCC local lesions evaluated by MRI at 1 month, 3 months, 6 months, and>1 year were 89.7%, 91.9%, 90.6%, and 94.7%, respectively, and there was no statistically significant differences among those follow-up time points (all P>0.05). Conclusions: PVP combined with (125)I seed brachytherapy in the treatment of MESCC has significant improvement in immediate pain relief and spinal cord function. After combined treatment, MRI showed that the tumors around the spinal cord regressed dramatically, which could considerably reduce the MESCC grade and remain stable for a long time.

[Evaluation of neurovascular function in mouse cortex using multispectral optical imaging after ischemic stroke].

Objective: To acquire the signal of neuron excitability and blood oxygen in mouse cortex after ischemic stroke, and to clarify the relationship between the change of neurovascular function and the degree of cerebral infarction. Methods: The male C57BL/6 mouse(n=20) about 6-8 weeks and 20 g weight were produced the embolic stroke modal by photochemical injury. The mouse cortex was scanned by the multispectral optical imaging while using electric stimulation in 1, 3 and 7 d after operation. Then several data around the infarction were acquired including neuron excitability, the total hemoglobin concentration and deoxygenated hemoglobin concentration. The ischemic cerebral infarction size was analyzed by TTC staining. Plasma TNF-α concentration was measured by enzyme-linked immunosorbent assay(ELISA). And modified neurological severity score (mNSS) was recorded after ischemic stroke(n=30). Then correlativity analysis was used between the optical signals and three indicators of cerebral infarction degree. Results: The changes of neuron excitability signals were 1.15%±0.28%, 2.84%±1.06%, 2.21%±0.55%. The total hemoglobin concentration signals were 3.71%±2.76%,3.19%±2.70%,4.27%±3.05%. The deoxygenated hemoglobin concentration signals were 2.93%±2.33%, 3.60%±1.74%, 2.08%±1.28%. The neural signal was correlated to cerebral infarction size, plasma TNF-α concentration and mNSS(r=-0.441, -0.449,-0.404, all P<0.05), and mNSS had a great effect on neuron excitability(ß=-0.169,P<0.05). Meanwhile, the total hemoglobin concentration was correlated to cerebral infarction size(r=0.440,P<0.05). Conclusion: The signal of neuron and blood oxygen is able to represent the change of neurovascular function and evaluate the progression of ischemic stroke.

Factors associated with overall survival and relief of dysphagia in advanced esophageal cancer patients after 125I seed-loaded stent placement: a multicenter retrospective analysis.

Iodine-125 (125I) seed-loaded stent placement has served as an effective palliation for malignant esophageal strictures in China. We performed a retrospective study to identify the prognostic factors of this irradiation stent placement in advanced esophageal cancer patients. A total of 201 patients who underwent 125I seed-loaded stent placement were included in this study from June 2012 to March 2016 at five hospitals in China. The Cox regression models adjusted for stratification factors were used, and a stepwise multivariate analysis was performed to predict the overall survival and relief of dysphagia on the basis of pretreatment clinical characteristics, respectively. Three independent prognostic factors were identified for overall survival: histopathological subtype (squamous cell carcinoma vs. adenocarcinoma, hazard ratio [HR] 1.45, 95% confidence interval [CI95%]: 1.01-2.09, P = 0.046), serum total protein (≥66 g/L vs. <66 g/L, HR 0.61, CI95%: 0.48-0.59, P = 0.023), and performance status (<2 vs. ≥2, HR 1.57, CI95%: 1.09-2.08, P = 0.013). Four factors were significantly associated with the relief of dysphagia: T stage (T3 vs. T4, P = 0.003), tumor location (superior vs. inferior, P = 0.049), tumor-node-metastasis classification (IV vs. II, P = 0.025), and age (≥71 years vs. <71 years, P = 0.029). Prognostic factors identified from this analysis can be used to aid clinical decision-making and design future clinical trials.

[Cement augmentation for vertebral osteolytic metastatic lesions: an evaluation on postoperative CT].

Objective: To evaluate the effectiveness of cement augmentation on the osteolytic lesion in patients with vertebral metastasis. Methods: A total of consecutive 132 patients with 268 vertebral metastatic lesions treated with PVP from January 2008 to December 2016 in Zhongda Hospital were enrolled in this study. Retrospective analysis of preoperative, postoperative 3 days, 3 months, 6 months, 12 months and ≥ 18 months imaging data on CT, the local control and progression of the tumor were evaluated by MDA response criteria. The local control rates were compared between the groups with the different rate of cement filling by Chi2-test. Results: Vertebroplasty procedures were performed successfully in all 268 vertebrae under DSA guidance, and the mean volume of PMMA injected in each vertebra was 0.7-8.5(3.9±1.5)ml.The rate of local control at 3 months, 6 months, 12 months and ≥18 months after PVP was respectively 98.9%, 95.1%, 91.8%, and 85.2%, the difference was statistically significant(all P<0.05). The local control rate showed a statistically significant relationship to the groups with the rate of cement filling at 6 months, 12 months and ≥18 months after PVP, but there was no statistical difference at postoperative 3 months. The rate of local control was higher in 68 patients with lung or gastrointestinal cancer than in 17 patients with liver or kidney cancer at 3 months, 6 months and 12 months, the difference was statistically significant (P<0.05). Conclusion: Cement augmentation has a local anti-tumor effect on vertebral osteolytic metastatic lesion, and the anti-tumor effect will decrease as the follow-up time extended.

[Follow-up of resting-state brain function with magnetic resonance imaging in patients with type 2 diabetes mellitus].

Objective: To investigate the changes of resting brain function with time in patients with type 2 diabetes mellitus (T2DM) by using regional homogeneity (ReHo) with resting-state functional magnetic resonance imaging (rs-fMRI). Methods: Multidimensional cognitive function tests and rs-fMRI scans were performed in 21 T2DM patients and 12 healthy controls in 2012 and 2015 respectively.The differences in clinical variables and the ReHo values before and after were measured by paired sample t test, and the correlation between the change of ReHo value and the change of clinical variables was measured by Pearson correlation analysis based on voxel. Results: The delayed score (14±6) of the T2DM patients in 2015 was significantly lower than that in 2012 (18±6) (t=-2.88, P=0.009); while the value of ReHo in the bilateral occipital lobe and right middle frontal gyrus was significantly lower than that in 2012 (P<0.01, Alphasim correction). And the decreased ReHo value in the left occipital lobe was significantly correlated with the change of complex figure test (CFT) delay score and the trail making test-B (TMT-B)(r=0.52, -0.46, both P<0.05). No significant change in cognitive function tests in the healthy control group was found between the two years, ReHo value in right cuneus decreased significantly (P<0.01, Alphasim correction), but it increased significantly in superior frontal gyrus (P<0.01, Alphasim correction) in 2015.No significant correlation between the changes of the ReHo values in the right cuneus and right superior frontal gyrus and the changes of cognitive function scores was found in the healthy controls. Conclusions: The visual memory is significantly declined in T2DM patients within 3 years.The reduced neural activity areas in T2DM patients are in the bilateral occipitai lobes and the right middle frontal lobe. Decreased neural activity in the left occipital area is related to visual impairment, information processing speed and attention drops.

Disrupted Brain Connectivity Patterns in Patients with Type 2 Diabetes.

BACKGROUND AND PURPOSE: Type 2 diabetes is associated with an increased risk of dementia. This study investigated the global connectivity patterns in the brains of patients with type 2 diabetes by using a functional MR imaging technique. MATERIALS AND METHODS: Forty patients and 43 age-, sex-, and education-matched healthy controls underwent resting-state functional imaging in a 3T MR imaging unit. Degree centrality, a commonly used measurement of global connectivity, was computed for a full-brain exploration of the regions influenced by type 2 diabetes. We then examined the functional connectivity of each region by using the seed-based approach. Finally, voxelwise correlation analyses were performed to explore the relationship among the connectivity changes, cognitive performance, and diabetes-related variables. RESULTS: Patients exhibited decreased degree centrality in the left lingual gyrus and increased centrality in the right insula and dorsal anterior cingulate cortex (corrected P < .05). The occipital network anchored in the lingual gyrus showed extensively reduced connectivity, while the network connectivity of the insula and cingulate cortex (mostly included in the salience network) was significantly elevated (corrected P < .05). Correlational analyses revealed that in the diabetic group, impaired visual memory and executive function performance were correlated with occipital hypoconnectivity, while higher fasting plasma glucose levels and better executive functioning were related to anterior cingulate cortex hyperconnectivity (all corrected P values < .05). Similar effects were not detected in the controls. CONCLUSIONS: This preliminary study shows that network connectivity is altered in patients with type 2 diabetes, which may provide critical insight into the neural substrate of diabetes-related cognitive decline.

[Calculation of the surface radial dose distribution of radioactive biliary stent loaded with 125I seeds by treatment planning system].

OBJECTIVE: To study the surface radial dose distribution of different length radioactive biliary stents in different activity of (125)I seeds by treatment planning system. METHODS: After a radioactive biliary stent was positioned in measurement phantom, which were made of solid paraffin and polymethyl methacrylate, a CT scan was performed to get the stent images. The images were then transferred to the treatment planning system for planning. The maximum dose level slice nearest to the center of the stent was selected to calculate the surface radial dose distribution. RESULTS: The length of the stents (F=3 189.160, P<0.01) and the activity of the (125)I seeds (F= 811.509, P<0.01) can both significantly affect the cumulative radial dose distribution of the radioactive stent. Radial cumulative dose dose (Gy), stent length (cm), (125)I seeds activity (mCi) and distance from the stent surface (cm) meet the regression equation: ln dose =2.565+ 0.208 length+ 1.502 activity-0.738 distance (F=4 929.279, P<0.05). CONCLUSIONS: The choice of suitable activity of radioactive (125)I should be based on treatment purpose in combination with the length and diameter of lesion and also with reference to the dose table. The measurement results are with smaller uncertainty, which can provide reference for the clinical application of dosimetry.

Changes of the directional brain networks related with brain plasticity in patients with long-term unilateral sensorineural hearing loss.

Previous studies often report that early auditory deprivation or congenital deafness contributes to cross-modal reorganization in the auditory-deprived cortex, and this cross-modal reorganization limits clinical benefit from cochlear prosthetics. However, there are inconsistencies among study results on cortical reorganization in those subjects with long-term unilateral sensorineural hearing loss (USNHL). It is also unclear whether there exists a similar cross-modal plasticity of the auditory cortex for acquired monaural deafness and early or congenital deafness. To address this issue, we constructed the directional brain functional networks based on entropy connectivity of resting-state functional MRI and researched changes of the networks. Thirty-four long-term USNHL individuals and seventeen normally hearing individuals participated in the test, and all USNHL patients had acquired deafness. We found that certain brain regions of the sensorimotor and visual networks presented enhanced synchronous output entropy connectivity with the left primary auditory cortex in the left long-term USNHL individuals as compared with normally hearing individuals. Especially, the left USNHL showed more significant changes of entropy connectivity than the right USNHL. No significant plastic changes were observed in the right USNHL. Our results indicate that the left primary auditory cortex (non-auditory-deprived cortex) in patients with left USNHL has been reorganized by visual and sensorimotor modalities through cross-modal plasticity. Furthermore, the cross-modal reorganization also alters the directional brain functional networks. The auditory deprivation from the left or right side generates different influences on the human brain.

Changes in the default mode networks of individuals with long-term unilateral sensorineural hearing loss.

Hearing impairment contributes to cognitive dysfunction. Previous studies have found changes of functional connectivity in the default mode network (DMN) associated with cognitive processing in individuals with sensorineural hearing loss (SNHL). Whereas the changes in the DMN in patients with long-term unilateral SNHL (USNHL) is still not entirely clear. In this work, we analyzed resting-state functional magnetic resonance imaging (fMRI) data and neuropsychological test scores from normal hearing subjects (n = 11) and patients (n = 21) with long-term USNHL. Functional connectivity and nodal topological properties were computed for every brain region in the DMN. Analysis of covariance (ANCOVA) and post hoc analyses were conducted to identify differences between normal controls and patients for each measure. Results indicated that the left USNHL presented enhanced connectivity (p < 0.05, false discovery rate (FDR) corrected), and significant changes (p < 0.05, Bonferroni corrected) of the nodal topological properties in the DMN compared with the control. More changes in the DMN have been found in the left than right long-term USNHL (RUSNHL). However, the neuropsychological tests did not show significant differences between the USNHL and the control. These findings suggest that long-term USNHL contributes to changes in the DMN, and these changes might affect cognitive abilities in patients with long-term USNHL. Left hearing loss affects the DMN more than the right hearing loss does. The fMRI measures might be more sensitive for observing cognitive changes in patients with hearing loss than clinical neuropsychological tests. This study provides some insights into the mechanisms of the association between hearing loss and cognitive function.

Identification of minimal hepatic encephalopathy in patients with cirrhosis based on white matter imaging and Bayesian data mining.

BACKGROUND AND PURPOSE: White matter abnormalities have been demonstrated to play an important role in minimal hepatic encephalopathy. In this study, we aimed to evaluate whether WM diffusion tensor imaging can be used to identify minimal hepatic encephalopathy among patients with cirrhosis. MATERIALS AND METHODS: Our study included 65 patients with cirrhosis with covert hepatic encephalopathy (29 with minimal hepatic encephalopathy and 36 without hepatic encephalopathy). Participants underwent DTI, from which we generated mean diffusivity and fractional anisotropy maps. We used a Bayesian machine-learning technique, called Graphical-Model-based Multivariate Analysis, to determine WM regions that characterize group differences. To further test the clinical significance of these potential biomarkers, we performed Cox regression analysis to assess the potential of these WM regions in predicting survival. RESULTS: In mean diffusivity or fractional anisotropy maps, 2 spatially distributed WM regions (predominantly located in the bilateral frontal lobes, corpus callosum, and parietal lobes) were consistently identified as differentiating minimal hepatic encephalopathy from no hepatic encephalopathy and yielded 75.4%-81.5% and 83.1%-92.3% classification accuracy, respectively. We were able to follow 55 of 65 patients (median = 18 months), and 15 of these patients eventually died of liver-related causes. Survival analysis indicated that mean diffusivity and fractional anisotropy values in WM regions were predictive of survival, in addition to the Child-Pugh score. CONCLUSIONS: Our findings indicate that WM DTI can provide useful biomarkers differentiating minimal hepatic encephalopathy from no hepatic encephalopathy, which would be helpful for minimal hepatic encephalopathy detection and subsequent treatment.

The renoprotective effect of bone marrow-derived endothelial progenitor cell transplantation on acute ischemia-reperfusion injury in rats.

OBJECTIVE: To investigate the renoprotective effects of exogenous endothelial progenitor cells (EPCs) on acute renal ischemia-reperfusion (I/R) injury in rats. METHODS: EPCs were collected by in vitro culture of mononuclear cells derived from rat bone marrow. The EPC labeling was performed using chloromethyl-benzamidodialkylcarbocyanine (CM-Dil). Sprague-Dawley rats were equally randomized into an I/R, an EPC, and a control group. We evaluated blood urea nitrogen (BUN) and serum creatinine (Scr), kidney morphology, apoptosis and microvessel density. EPC homing into I/R injured kidneys was observed using a fluorescence microscope. RESULTS: After EPC transplantation, CM-Dil-labeled EPCs were noted at the corticomedullary junction of injured kidneys. The levels of BUN and Scr were markedly lower among the EPC than the I/R group (P < .05). The histopathologic score was higher in the I/R than the EPC group (P < .05). Apoptosis of tubular epithelial cells was substantially reduced among EPC-treated rats (P < .01). In addition, more CD34(+) microvessels were documented among the EPC than the other two groups (P < .01). The expression levels of vascular endothelial growth factor (VEGF) were also increased greatly in the EPC group (P < .05). CONCLUSION: Transplanted exogenous EPCs exert protective effects on renal function by maintaining the integrity of peritubular capillaries after I/R injury.

Gastric calcifying fibrous pseudotumour associated with an ulcer: report of one case with a literature review.

Calcifying fibrous pseudotumour (CFPT) is a rare lesion that has only recently been reported in the literature. Usually, the lesion develops in subcutaneous tissue, deep soft tissues or viscera. It appears as a uniform, hypocellular and well-circumscribed mass without a capsule. Only nine cases of gastric CFPT have been reported in the literature so far. Here, we report a new case of gastric CFPT, which was, surprisingly, associated with an ulcer. To our knowledge, a gastric CFPT with an ulcer has not been previously reported in the literature. The patient (a healthy 49-year-old man) had vomited approximately 300 g brown liquid and developed syncope once. CT scan and gastroscopy revealed a polypoid mass at the great curvature of the gastric body with a larger ulcer on its top. The mass was removed by surgery. During a follow-up of 5 months, the patient was asymptomatic with no recurrence. We discuss the imaging findings, as well as the clinicopathological features of this unusual case and review the related literature.

Anhedonia and activity deficits in rats: impact of post-stroke depression.

Animal models may allow investigation into the aetiology and treatment of various human disorders. In the present study, a rat model for post-stroke depression (PSD) has been developed using middle cerebral artery occlusion (MCAO), followed by an 18-day chronic mild stress (CMS) paradigm in conjuncture with isolation rearing. The open-field test (OFT) and the sucrose consumption test were used to assess depression-like behaviour and the effects of the antidepressant citalopram. CMS induced behavioural changes in the ischemic animals, including decreased locomotor and rearing activity and reduced sucrose preference (compared with baseline, control and stroke groups respectively), all these behaviours were reversed by chronic administration of citalopram. During the recovery period for the PSD models, the open-field activity and preference for sweet sucrose solution decreased continually, opposed to rats subjected to stress only. Decreased locomotor and rearing represents activity deficits, whereas reduced sucrose preference may indicate desensitisation of the brain reward mechanism (anhedonia). Our findings suggest that anhedonia, one of the core symptoms in patients with PSD, and activity deficits can be found in the MCAO+CMS group of animals. Furthermore, citalopram can ameliorate the behavioural abnormalities observed in these animals. With high validity, good operability and repeatability, our findings suggest that the ischemic rat CMS model is an appropriate model for further PSD research.

Comparison of a new stent and Wallstent for transjugular intrahepatic portosystemic shunt in a porcine model.

AIM: To evaluate a new balloon-expandable stainless steel stent (Cordis stent) in a transjugular intrahepatic portosystemic shunt (TIPS) porcine model and compared with Wallstent. METHODS: TIPS was performed in 26 normal domestic pigs weighing 20 kg-30 kg using a Cordis stent or Wallstent (13 pigs in each stent). All pigs were sacrificed at the 14th day after TIPS. The stent deployment delivery system, stent patency, and stent recoil after placement were evaluated. Proliferative response in representative histological sections from the center,hepatic and portal regions of the two stent designs were quantified. RESULTS: The shunt was widely patent in 4 pigs in the Cordis stent group (4/12, premature dead in 1 pig), and in 5 pigs in the Wallstent group (5/13). All remaining stents of both designs were occluded or stenotic. The mean quantified proliferation including thickness of the proliferation and the ratio of proliferation: total area in three assayed regions in Cordis stent and Wallstent was 2.18 mm:2.00 mm, and 59.18 mm2:51.66 mm2, respectively (P > 0.05). The delivery system and mechanical properties of the Cordis stent functioned well. CONCLUSION: The new Cordis stent is appropriate for TIPS procedure.

Transjugular intrahepatic portosystemic shunt: effect of bile leak on smooth muscle cell proliferation.

PURPOSE: To evaluate the effect of bile on smooth muscle cell (SMC) proliferation in vitro and in vivo in a porcine transjugular intrahepatic portosystemic shunt (TIPS) model. MATERIALS AND METHODS: In vitro, SMCs explanted from porcine thoracic aorta were cultured with standard techniques. After initial pilot studies, they were subcultured in one of three groups: 1% porcine serum plus 1% bile, 10% porcine serum plus 1% bile, and 10% porcine serum. Cells were harvested at 3, 10, or 14 days, and DNA, protein, and disintegrations per minute (an indicator of proliferation) were measured. In vivo, TIPS creation was successful in 45 swine. All pigs were euthanized at 10-16 days. The proliferative response within the stent was histologically quantified and correlated for evidence of bile leak. RESULTS: In pilot studies, 2.5%-10.0% bile solutions caused 100% SMC mortality by 3 days. In the presence of 1% bile (with or without porcine serum), both DNA and protein production decreased significantly compared with that in porcine serum alone (P < .05). In vivo, 13 of 45 specimens (29%) showed bile leak at gross or microscopic examination. SMC proliferation was less overall in animals with versus those without bile leak (difference not significant). CONCLUSION: These data suggest that the proliferative response in a TIPS is not primarily due to bile leak. Bile leak may promote thrombosis, but it appears to inhibit myointimal proliferation.

Transjugular intrahepatic portosystemic shunt in a porcine model: histologic characteristics at the early stage.

RATIONALE AND OBJECTIVES: The authors attempted to determine the histologic processes that take place during development of stenosis after transjugular intrahepatic portosystemic shunt (TIPS) creation. MATERIALS AND METHODS: TIPS were created with metallic stents in 20 healthy domestic pigs (tantalum stents in 10, stainless steel stents in 10). The animals were sacrificed 2-16 days later. All the shunts were examined by means of venography both immediately after placement of the stents and before sacrifice. All histologic sections were assessed with modified Giemsa and basic fuchsin stains. Anti-smooth-muscle-cell alpha-actin stain was used in three specimens. The stenotic reaction was quantified by using standard planimetry techniques and a computerized image-analysis system. RESULTS: Within 16 days after TIPS placement, 15 (75%) of the 20 shunts were completely occluded, four (20%) of 20 shunts were partially occluded, and one (5%) of 20 shunts remained widely patent (animal died of unknown cause 2 days after the TIPS procedure). Stent occlusion was caused primarily by pseudointimal hyperplasia, which was similar morphologically in the portal, middle, and hepatic portions of the stent. Myofibroblastic proliferation was the most striking feature of the pseudointimal hyperplasia. The average thickness of the proliferation was 2.14 mm, which was 67% of the total diameter of the stent. A mild fibrous or lymphocytic reaction occurred around the stent wires and between the pseudointimal hyperplasia and the liver parenchyma. CONCLUSION: The histologic features of pseudointimal formation in this swine TIPS model closely resemble those in humans. This model may prove useful for evaluating stents and other devices and improving the understanding of restenosis after vascular interventions.

Automated percutaneous lumbar discectomy: a prospective multi-institutional study.

PURPOSE: A prospective study in 10 independent hospitals from 1992 to 1994 evaluated automated percutaneous lumbar discectomy (APLD) with a newly designed percutaneous instrument. MATERIALS AND METHODS: One thousand five hundred eighty-two APLD procedures were performed in 1,525 patients with disc herniation or back pain. Mean follow-up after APLD was 18.3 months. Follow-up of at least 1 year was available in 1,474 patients. One thousand two hundred eighty-nine patients had sciatic pain and 185 had back pain only. Eight hundred twenty-two patients had symptoms for less than 2 years, 652 for more than 2 years. One thousand two hundred sixty-two patients were older than 60 years, 212 were younger than 60 years. Nine hundred fifty patients had disc protrusion, and 357 had sequestration. Forty-eight patients had disc or longitudinal ligament calcification. Twenty-two had previous surgical discectomy. All discectomies were done with use of a straight needle with the patient in the lateral decubitus position. RESULTS: Success rate (measured by Hijikata's criteria) was 83% at 1 year. Success was significantly greater for protrusion versus sequestration (86% vs 72%, P < .001); for back pain alone versus leg and back pain (89% vs 80%, P < .005); for duration of symptoms less than 2 years versus more than 2 years (85% vs 79%, P < .005); and for age younger than 60 years versus older than 60 years (84% vs 76%, P < .01). Among postsurgical patients, success rate was 77% (17 of 22 patients). The only complication was discitis (0.06%, nine patients). Technical success at L5-S1 was 99% (795 of 800). CONCLUSION: APLD with Teng's instrument has excellent results. Indications may include back pain alone. A straight needle can be used at L5-S1 in most patients, with proper positioning.

Preoperative transcatheter hepatic arterial embolization for hepatic malignancy.

RATIONALE AND OBJECTIVES: This retrospective study was undertaken to determine clinically and histopathologically the efficacy of preoperative transcatheter hepatic arterial embolization (PTHAE) in liver malignancies. METHODS: Ten patients underwent either single or multiple episodes of PTHAE with lipiodol in an emulsion with chemotherapeutic agents. Four of the patients were thought to be unresectable before embolotherapy. Eight patients had hepatocellular carcinoma, one had cholangiocarcinoma, and one metastatic colon carcinoma. All patients subsequently underwent surgical resection. Histologic observations were made in all resected specimens. RESULTS: No viable tumor cells were recognized in three of the ten specimens, whereas extensive necrosis (70%-95%) was seen in the remaining seven patients. The four patients with tumors that were that to be unresectable before PTHAE had significant reduction in tumor burden (60%-80%) and were thought to be resectable after their embolization. Effectiveness on satellite nodules, thrombi in the portal veins, and intracapsular infiltration was histologically verified. The mean and median survival times to date have been 24.8 and 24.5 months, respectively. CONCLUSIONS: Preoperative transcatheter hepatic arterial embolization is a useful procedure that, in this small patient series, converted unresectable liver tumors into potentially resectable lesions.