Echogenicity of experimental liver ethanol injections.

Percutaneous ethanol injection therapy under sonographic guidance suffers from the occasional adverse spread of ethanol. We tried to optimize the technique to obtain the maximal echogenicity of injections. Eight dead pig livers were injected with ethanol and the consequent echogenicity was correlated with the time lapse after the injection, the speed of injection, the injected dose and the concentration of ethanol. For the sake of comparison, ethanol was also injected into processed sour milk. The injected lesions became smaller (P < 0.001), less sharply demarcated and less echogenic (P < 0.001) with time. Speeding up the injection (P < 0.05) and concentrating the ethanol (P < 0.05) increased echogenicity, whereas enlarging the dosage did not. Injections of ethanol into processed sour milk induced hyperechoic zones similar to the liver injections. It is concluded that quick injections of concentrated ethanol would be best detected. Injections should be monitored while they are still taking place, because the echogenicity will soon decrease. This immediate echogenicity seems to be caused by flow and the inherent properties of ethanol.

Ultrasound monitoring of experimental ethanol injection into pig liver.

RATIONALE AND OBJECTIVES: In percutaneous ethanol injection therapy, uncontrolled spread of ethanol sometimes causes complications. This study tested the accuracy of ultrasonography in showing the spread of ethanol during injection in normal postmortem pig livers. METHODS: Methylene blue-stained 96% (vol) ethanol (0.5-2 ml) was injected into pig livers under sonographic control. The volumes of the sonographically determined areas infiltrated by the injections and the corresponding pale lesions seen after dissecting the livers were measured and compared. The locations of the stained areas were determined. RESULTS: Uncontrolled spread of ethanol was often seen sonographically as hyperechoic lines spreading centrifugally from the injection site. After dissection, nearly all vessels and ducts were stained blue, indicating a major escape of ethanol from the injection sites. The volumes of the sonographically determined injection areas were significantly larger (P < 0.001) than the lesions found after dissection. CONCLUSIONS: Ultrasonography may overestimate the spread of ethanol, making the survival of peripheral tumor cells possible.

Effect of injection speed on the spread of ethanol during experimental liver ethanol injections.

RATIONALE AND OBJECTIVES: Percutaneous ethanol injection therapy may cause serious complications, most likely due to the uncontrolled spread of ethanol. The authors changed the speed of the injection into postmortem pig livers and examined the adverse spread of ethanol from the injection site and the shape and size of the resulting lesion. METHODS: One milliliter of 96% ethanol was injected into pig livers under sonographic guidance at different speeds (0.075-0.91 mL/s). The spread (graded from I to III) and the volumes and shapes of the resulting lesions seen after dissection were recorded and correlated with the injection speed. RESULTS: When increasing the speed of the injections the large, grade III spread increased significantly (P < .01). The lesions created by more rapid injection were less spherical than were those created by slower injections (P = .08). The volumes of the lesions were not affected by the injection speed. CONCLUSION: This experimental model suggests that in percutaneous ethanol injection therapy, rapid injection (> 0.3-0.4 mL/s) should be avoided to reduce the uncontrolled spread of ethanol. Spherical spreading of ethanol around the needle tip is best achieved with slow injection.

Structured outpatient peritoneal dialysis catheter insertion is safe and cost-saving.

BACKGROUND: Data about outcomes and costs for peritoneal catheter insertion on an outpatient basis are scarce. METHODS: Using patient files, all peritoneal dialysis (PD) catheter insertions performed between 2004 and 2009 in a single-center tertiary care institution for adult patients were located. Patient demographics, complications, hospitalizations, survival, and treatment modality changes were recorded. Procedure-related expenses were valued as actual production costs. RESULTS: During the study period, 106 PD catheters were inserted. In 46 cases, the patients were admitted electively for catheter insertion; 19 catheters were placed during admission for other medical reasons; and 41 catheters were placed on an outpatient basis. Among the study patients (54.7 ± 16.0 years of age), 45% were diabetic. Early (<30 days) catheter-related complications occurred in 22% of patients. The incidences of technique failure and any complication within 90 days were 10% and 38% respectively. The occurrence of complications was not statistically significantly different for outpatients and electively admitted patients. Average costs for catheter insertion were higher in electively hospitalized patients than in outpatients (€2320 ± €960 vs €1346 ± €208, p < 0.000). CONCLUSIONS: Compared with an inpatient procedure, outpatient insertion of a PD catheter results in similar outcomes at a lower cost.

Complications following high-dose percutaneous ethanol injection into hepatic tumors.

PURPOSE: Percutaneous ethanol injection therapy (PEIT) with a 2-10 ml ethanol dose per session is widely used in the treatment of small hepatocellular carcinoma. Larger doses have been restricted for fear of complications. The aim of the present study was to make a retrospective evaluation of the complications following treatment of hepatic tumors with high doses of ethanol (up to 200 ml). MATERIAL AND METHODS: The medical records of 15 patients treated repeatedly with PEIT were reviewed retrospectively to detect side effects or complications. Eleven of these patients had undergone transarterial chemoembolization (TAE) prior to PEIT. Of 173 ethanol injections in doses of 2-200 ml (mean 49 ml), more than 10 ml had been injected on 138 occasions. The chi-square test was used to evaluate the differences in pain frequency among the various dosage groups. RESULTS: Serious complications did not occur. Pain was a common side effect, occurring in 48% of the procedures. Immediate pain during the treatment was related to the ethanol dose and increased significantly with increasing doses (p < 0.01). Other side effects were rare. CONCLUSION: PEIT with doses higher than previously reported seems to be safe. This should encourage further clinical studies that aim at fully working out the clinical value of such treatment.

Toxicity of ethanol in low concentrations. Experimental evaluation in cell culture.

PURPOSE: To define the threshold ethanol concentration that is toxic to cultured cells. METHODS: Three malignant cell lines and freshly isolated normal rat hepatocytes were exposed to 0-50% (vol.) ethanol (concentrations used were 0, 5, 10, 15, 20, 25, 30, 40 and 50%) on tissue culture plates for 0.25-60 min (exposure times used were 0.25, 5, 10, 20, 30, 40 50 and 60 min). Cytotoxicity was estimated by trypan blue exclusion test and from 3H-thymidine incorporation. RESULTS: All cells were killed by a 15-s exposure to 30-40% ethanol while a concentration as low as 15-20% gave a total response after 5-10-min exposures. After a one-hour exposure of F9 carcinoma cells and hepatocytes, a total or nearly total response was achieved with 10% ethanol. The cytotoxic effect was thus dependent both on the exposure time and on the concentration of ethanol. There were no significant differences in ethanol tolerance among the cell types. CONCLUSION: Ethanol seemed to kill cells in the cell culture effectively in much lower concentrations than those currently used in tumour ablation.