Intraluminal brachytherapy and selfexpandable stents in nonresectable biliary malignancies--the question of long-term palliation.

BACKGROUND/AIMS: To evaluate the effect of a combination of intraluminal brachytherapy and metallic stent implantation in the treatment of patients with nonresectable biliary tumors. METHODOLOGY: Thirty-two patients aged 41-80 years with nonresectable biliary malignancies--Klatskin's tumor (n = 17), gallbladder carcinoma (n = 11) and carcinoma of papilla Vateri (n = 4)--were treated with a combination of intraluminal brachytherapy (source Ir192, high-dose radiation regimen, total dose 30 Gy) and metallic stent implantation. Intraluminal brachytherapy and stent insertion (metallic, spiral-Z stent) were performed percutaneously in all patients. RESULTS: The mean survival in patients with Klatskin's tumor was 457 days (range: 64-1186; median: 358 days), in patients with gallbladder carcinoma 237 days (range: 92-609; median: 210 days) and in patients with carcinoma of papilla Vateri 850 days (range: 48-1518; median: 1277 days). The rate of 2-year survival in these groups as 27, 0 and 50%, respectively. The survival time differed significantly at the 5% level. The mean time of stent patency was 418, 220 and 850 days, respectively. No complications related directly to intraluminal brachytherapy were observed. CONCLUSIONS: Intraluminal brachytherapy combined with stent implantation is a safe method and appears to prolong survival in inoperable patients with Klatskin's tumor and carcinoma of papilla Vateri compared with nontreated patients in previous studies. In contrast no similar effect should be expected in patients with gallbladder carcinoma.

[Enteroclysis in the diagnosis of tumors of the cecum and ascending colon]. / Prínos enteroklýzy pro diagnostiku nádoru coecum-colon ascendens.

In two patients examination of the small intestine by enteroclysis was indicated on account of haemorrhage into the digestive tract and severe anaemia and in one patient the ultrasonographic picture arousing suspicion of Crohn's disease of the terminal ileum. Although in all instances previously colonoscopy was made, considered complete, in one instance also irrigoscopy, with a negative result, enteroclysis revealed and surgery confirmed extensive carcinomas of the caecum and colon ascendens. The authors discuss the value and problems of the applied diagnostic method.

[Measurement of impedance in liver tissue]. / Zkusenosti s merením impedance v jaterní tkáni.

At the First Medical Clinic (First Medical Faculty, Charles University) a new method of assessment of impedance of hepatic tissue was developed. A special thin injection electrode was designed which makes it possible to take readings in deep tissue. The measurements are made and aimed throughout the procedure under ultrasonographic control. From the sites of assessment specimens were taken for cytological and histological examination. So far 44 operations were completed. In 33 patients according to ultrasonography focal changes were involved, in the remainder the liver parenchyma was homogeneous or there were slight diffuse changes. Based on the results of the histological examination, the group was divided into 11 subgroups some of which are very small and thus difficult to interpret. Therefore this is only a preliminary study. Its objective is to introduce the technique of a new method because even from the small hitherto assessed values of impedance by means of the injection electrode under ultrasonographic control the conclusion can be drawn that the assessed impedance values could provide more detailed information on the character of focal changes.

[Measurement of impedance of hepatic tissue transformed by pathological process. A preliminary communication]. / Mesure de l'impédance des tissus hépatiques transformés par des processus lesionnels. Communication préliminaire.

Intrahepatic impedance was measured using a special electrode in 44 patients, 38 of whom identified abnormalities of the hepatic parenchyma. Impedance values were compared with ultrasound findings and with the histological results of needle biopsy. Impedance was relatively unaffected in the presence of cirrhosis (n = 7) or chronic hepatitis (n = 5). It was markedly decreased in the presence of cysts (n = 4) and of hepatocarcinoma (n = 4). Values were variable in secondary carcinoma of the liver (n = 16). This preliminary study suggests that the measurement of intrahepatic impedance could contribute to the etiological diagnosis of hepatic tumour lesions.