Neoadjuvant intra-arterial chemotherapy in inflammatory carcinoma of the breast.

From 1982 to 1989, 18 eligible patients (median age 50.5 years, range 30-72 years) with inflammatory breast carcinoma have been treated with neoadjuvant intra-arterial (IA) chemotherapy. The treatment regimen includes IA cisplatin, adriamycin, mytomycin C and thiotepa on Day 1 and intravenous 5-fluorouracil on Days 1 and 2. An objective clinical response rate of 100% (eight complete and 10 partial) has been observed. The median disease-free and overall survivals are 27 months (range 5-85+ months) and 33 months (range 8-85+ months), respectively. With a median follow-up of 21.5 months, six (33.3%) patients remain alive and free of disease and 12 patients have died because of distant metastases. No local recurrences have been observed. Intra-arterial chemotherapy is an attractive technique for the treatment of locally advanced breast carcinoma with mild toxicity and high local control rate.

Splenic embolization prior to myelosuppressive treatment in hepatocarcinoma and active chronic hepatitis.

In the treatment of active chronic hepatitis and hepatocellular carcinoma some effective drugs can produce myelosuppression. Hypersplenism may considerably limit the dosage of such drugs. Splenectomy is an effective treatment for hypersplenism, although it is not without complications. Partial splenic embolization is a good and safe procedure; 15 patients were treated in order to achieve higher platelet and leukocyte counts. Embolization has been performed with gelfoam with local and systemic antibiotics (Spigos' protocol) and 50-75% of the splenic parenchyma was infarcted. All patients could be treated for the underlying hepatopathy with adequate dosages of interferon or chemotherapeutic drugs.

Giant jejunoileal duplication: prenatal diagnosis and complete excision without intestinal resection.

A 7-week-old child presented to the pediatrician after persistent vomiting and abdominal distension developed. Intestinal dilatation had been detected in utero. Emergency ultrasonography showed only small bowel dilatation. There were no signs of intestinal obstruction; however, complete intestinal malrotation was demonstrated by an upper gastrointestinal series and barium enema. Intestinal duplication was also suspected, and emergency laparotomy was performed. A 70-cm-long jejunoileal duplication was found and successfully dissected free from the normal small bowel and excised without intestinal resection-anastomosis. The authors describe this unique case and the surgical technique for the treatment of small bowel duplications.

International monitoring for environmental health surveillance.

This paper offers an overview of existing international monitoring systems with relevance for environmental health surveillance. Representative monitoring systems are described that: address areas of chronic and acute exposure, and diseases and behavioural effects resulting from human-environment interactions; have an ecosystem focus with perhaps a secondary motivation of ascertaining human health impacts that may result from ecosystem conditions; and that incorporate socio-demographic and economic data that may reflect population health determinants. General conclusions on the state of environmental surveillance systems and suites of indicators reviewed are provided in relation to their utility for the development of a generic environmental health surveillance system. This review indicates, among other things, that no obvious short list of core indicators exists which spans "environmental health" to provide a sufficient set applicable in a global context. Through a summary of challenges and limitations in existing systems and indicator sets, recommendations are provided for the discussion of indicator selection and organization, and of developing general and widely applicable environmental health monitoring and surveillance systems.

Adrenal lymphangioma: a case report.

We present a case of a 30-year-old female who was evaluated for right flank pain. Clinical and diagnostic work up revealed a urinary tract infection with focal pyelonephritis of the right kidney. Ultrasound and computed tomography of the abdomen were included in the evaluation and revealed incidental finding of cystic structure at right suprarenal space. Follow-up evaluation for further characterization of cyst was performed with MRI and displayed a 4.8x4.5-cm right adrenal cyst containing dystrophic calcification, septations, and minimal nodularity. Surgical resection and histologic findings were compatible with cystic lymphangioma of the adrenal gland. Adrenal lymphangioma is a rare and benign lesion that is most often identified incidentally during radiological investigation or at autopsy. Diagnostic features of adrenal cysts including lymphangiomas are discussed.

Foraging of Great Kiskadees (Pitangus sulphuratus) and food items offered to nestlings in the Pantanal.

Feeding of Pitangus sulphuratus (Tyrannidae) nestlings have been poorly studied. Here we describe the foraging behavior of a P. sulphuratus pair and the searching and offering time of food items to nestlings in the Pantanal, Brazil. Data collection was carried out over 25 days on the outskirts of the Base de Estudos do Pantanal building, inhabited by insectivorous bats. Records were based on direct observations with the help of binocular. The pair required little time for searching for small insects and fruits, but these items comprised a little amount of food per event of capture. Some large prey was more time-costly for searching, but the long period that these food items were offered to nestlings overcompensated the searching time. Considering the time of feeding nestlings (benefit) in relation to the searching time by the parents (cost), bats and snails are the most advantageous items for P. sulphuratus parents feeding nestlings at the study site.

Platinum wire embolization of an intrahepatic arterioportal fistula.

We report a case of arterioportal fistula in the right hepatic lobe. The lesion was selectively catheterized with an open-ended guidewire and successfully embolized with small pieces of platinum wire.

CT of ruptured aneurysm of aberrant right subclavian artery.

This paper presents the first description of a ruptured aneurysm of an aberrant right subclavian artery. CT clearly demonstrated the vascular malformation as well as the existence of a bilateral hemothorax.

CT demonstration of an aortoesophageal fistula.

A case of aortoesophageal fistula (AEF) is reported in a patient with esophageal bleeding resulting from ingestion of a foreign body. CT showed a saccular aneurysm in close proximity to the esophageal lumen at the level of the bleeding site. AEF has not previously been described on CT.

Direct percutaneous ureteral approach for the treatment of ureteral stenosis or obstruction.

Two cases are presented in which conventional approaches did not permit dilation of and stent placement in obstructed ureters. In patients with iatrogenic ureteral laceration or rigid ureteral kinking, direct percutaneous translumbar puncture may provide a safe alternative. The authors' technique is described.

Pancreatic pseudocyst in a gastrectomized patient: treatment with internalized endoprosthesis.

Direct percutaneous drainage of pancreatic pseudocysts in communication with the duct of Wirsung can lead to pancreaticocutaneous fistula. These patients are safely treated with the percutaneous transgastric approach. In a gastrectomized patient who developed a pseudocyst, we percutaneously placed in internal endoprosthesis from the duct of Wirsung to the afferent loop and gastric pouch.

Embolization of nonvariceal portosystemic collaterals in transjugular intrahepatic portosystemic shunts.

Percutaneous embolization of large portosystemic collaterals was performed in three patients following placement of a transjugular intrahepatic portosystemic shunt in order to improve hepatopetal portal flow. Improved hepatic portal perfusion was achieved in these cases, thereby theoretically reducing the risk of chronic hepatic encephalopathy.

The open-ended guidewire as superselective catheter for intraarterial chemotherapy: experience in 190 procedures.

With intraarterial infusion, high levels of chemotherapeutic agents can be achieved in the tumoral area. We present our experience with open-ended guidewire (OEGW) associated with steerable guidewires (SGW) as superselective catheters for intraarterial chemotherapeutic infusion and embolization. This technique was used successfully in 62 patients (190 procedures) over 15 months.

CT-guided paracoccygeal drainage of pelvic abscesses.

OBJECTIVE: Using the transrectal/transvaginal routes for the drainage of pelvic abscesses complicating colorectal surgery (anterior resection or abdominoperineal resection) is not always possible. The conventional transgluteal approach through the greater sciatic foramen, although proven to be a valuable access route, can have complications (mainly local pain). MATERIALS AND METHODS: To avoid these difficulties, a CT-guided paracoccygeal-infragluteal approach was used in the percutaneous drainage of deep pelvic (presacral and ischiorectal) abscesses presenting after colorectal surgery in six patients. RESULTS: Percutaneous drainage through this approach was successful in preventing the need for surgery in all six patients. No complications or recurrences were noted, and catheters were removed an average of 15 days after insertion. CONCLUSION: In comparison with the classical transgluteal approach, the paracoccygeal-infragluteal approach minimizes patient discomfort and minimizes the risk of potential injury to the sciatic plexus or blood vessels. This initial series shows that a CT-guided paracoccygeal-infragluteal approach is well tolerated, safe, and effective for the percutaneous drainage of pelvic abscesses developing after colorectal surgery.

Transjugular intrahepatic portosystemic shunt: evaluation with Doppler sonography.

To assess the potential role of ultrasound (US) in evaluating transjugularly inserted intrahepatic portosystemic shunts, the authors performed sonographic, including duplex and color Doppler, studies in 23 patients. Imaging was performed before, during the first week after, and 2-3 months after shunt placement. The prostheses were readily visualized and shunt patency was easily determined with Doppler US in all patients. The mean of the maximum blood flow velocity in the main portal vein increased from 7 (range, 3-16) cm/sec before shunting to 24 (range, 18-47) cm/sec 2-3 months after shunting. Flow reversal was detected in the intrahepatic portal branches in 16 (69%) of the 23 patients. US allowed prompt detection and management of two cases of incomplete stent expansion and one case of shunt stenosis due to pseudo-intimal hyperplasia. Sonography is a valuable tool for evaluation of changes in hepatic hemodynamics after transjugular intrahepatic shunt placement.

Percutaneous transgastric cystoduodenostomy in the treatment of a pancreatic pseudocyst: a new approach.

A case of an infected pseudocyst in the head of the pancreas is presented. Due to its small size and fistulization to the duodenum, a drainage catheter was placed through the fistulous tract from a distant transgastric approach. The fistula was balloon dilated to improve its emptying. Sixteen months later the patient remains asymptomatic with no recurrence of the pseudocyst.

Percutaneous transhepatic treatment of a posttransplant portal vein thrombosis and a preexisting spontaneous splenorenal shunt.

Percutaneous transhepatic treatment of portal vein thrombosis after liver transplantation in a patient with a preexisting high volume spontaneous splenorenal shunt is presented. Local thrombolysis with urokinase and balloon angioplasty of the main portal vein stenosis were performed followed by shunt embolization to restore hepatopetal portal blood flow.

Percutaneous transhepatic stenting by Wallstents of portal vein and bile duct stenoses caused by immunoblastic sarcoma in a liver transplantation.

Posttransplant lymphoproliferative disorders are infrequent tumors related to chronic immunosuppressive therapy. We present a liver transplant recipient who developed such a tumor in the porta hepatis that provoked obstruction of the entire portal triad. Treatment consisted of systemic chemotherapy, percutaneous dilatation, and placement of Wallstent endoprostheses across both biliary and portal vein stenoses. The patient died 3 weeks later of pneumonia and sepsis. At necropsy, the tumor was completely necrosed and the prostheses in both the common bile duct and the portal vein were patent.