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Biomedical subjects

C H Carrasco

Publications and source records attributed to C H Carrasco.

At least 73 records · Page 4Linked to original sources
PubMed1989

Chemotherapy and embolization via the inferior epigastric artery for the treatment of primary and metastatic cancer.

We evaluated the results of arterial chemotherapy and embolization via the inferior epigastric artery and its branches in 10 patients with a variety of primary and metastatic neoplasms supplied by that vessel. A total of 15 infusions and five occlusions were performed. There were no complications related to arteriography, indwelling catheters, or arterial occlusion. The effects on tumor bulk ranged from complete necrosis in one patient to partial necrosis in three patients. Surgical resection was facilitated in four of six patients. Local recurrence of tumor occurred in two of these patients. Three of four patients with intractable pain had effective relief. Our experience suggests that transarterial therapy of tumors supplied by the inferior epigastric artery or its branches is a safe procedure and may be useful in tumor management.

Abdominal Neoplasms↗
PubMed1989

Giant cell tumors.

This article presents an overview of the giant cell tumor, its treatment and results of treatment. Some topics included are biopsy, pathology, histology, technical considerations, and recurrence.

Bone Neoplasms↗
PubMed1988

Osteosarcoma and the role of fine-needle aspiration. A study of 51 cases.

Fifty-one patients were evaluated by fine-needle aspiration (FNA) as part of the diagnosis, staging, and management of osteosarcoma. All patients had histologic confirmation of osteosarcoma. Five patients underwent two aspirations each; thus, the total number of aspirates reviewed was 56. Aspirations were performed by interventional radiologists using fluoroscopic guidance. The cytologic features of osteosarcoma were divided into five groups: (1) pleomorphic (malignant fibrous histiocytoma-like); (2) epithelioid; (3) chondroblastic; (4) small cell; and (5) mixed. Although osteoid-like material was seen, it could not be distinguished readily from dense collagen. The chondroid matrix of chondroblastic osteosarcoma was recognized as a granular film with scattered clear bubbles. Fine-needle aspiration was diagnostic of sarcoma in 45 of 56 aspirates (80.4%). In eight aspirates, the cellularity of the smears was insufficient for diagnosis due to extensively osteoblastic tumors (six), necrotic tumor (one), and undetermined causes (one). In three aspirates, failure was attributed to poor cellular preservation due to unknown factors. The authors conclude that FNA is a useful tool in the multidisciplinary diagnosis and management of osteosarcoma. Aspirates should only be evaluated with full knowledge of the clinical and radiographic findings. The most significant limitation of FNA is the inability to detect osteoid.

Adult↗
PubMed1988

Regression of ocular melanoma metastatic to the liver after hepatic arterial chemoembolization with cisplatin and polyvinyl sponge.

Thirty patients with ocular melanoma metastatic to the liver were treated by hepatic arterial chemoembolization using an admixture of cisplatin and polyvinyl sponge. Tumor regression was complete in one patient and partial (greater than 50%) in 13 patients. The total response rate was 46%. The median survival for the entire group was 11 months (95% confidence interval, nine to 18 months). Treatment-related morbidity was short-lived and included primarily severe upper right quadrant abdominal pain, transient paralytic ileus, and nonicteric hepatitis. Hepatic arterial chemoembolization provided effective palliation, with good-quality survival among 46% of patients with ocular melanoma metastatic to the liver.

Adult↗
PubMed1988

Percutaneous hepatic arterial infusion of cisplatin-vinblastine for refractory breast carcinoma metastatic to the liver.

We treated 34 patients with breast carcinoma metastatic to the liver and refractory to prior chemotherapy with sequential hepatic arterial infusion of cisplatin and vinblastine in an attempt to enhance their antitumor activity. Following the administration of cisplatin at 100 mg/m2 i.v., the patients received a continuous arterial infusion of vinblastine at 1.7 mg/m2 daily for 5 consecutive days. Of 33 patients evaluable for response, eleven (33%) achieved partial responses and eight (24%) had minor responses. Median time to progression for responding patients was 31 weeks (range, 6+ to 74), and median survival was 11 months (range, 5-19). The adverse effects of the regimen were considerable, and seven failures were related to treatment intolerance or major toxicity. One patient who received vinblastine 2.0 mg/m2 daily developed a transient inappropriate secretion of antidiuretic hormone. Percutaneous hepatic arterial infusion of cisplatin and vinblastine has significant activity in the treatment of breast cancer metastatic to the liver, but subjective and objective treatment intolerance hamper the therapeutic value.

Adult↗
PubMed1988

Atrophy with compensatory hypertrophy of the liver in hepatic neoplasms: radiographic findings.

Focal hepatic atrophy has numerous causes and in many cases is associated with compensatory hypertrophy. We have observed this phenomenon on CT in patients with hepatic neoplasms. Of 12 patients studied, eight had hepatic metastases, two had hepatocellular carcinoma, and two had bile-duct carcinoma. Focal changes in liver morphology (i.e., atrophy with compensatory hypertrophy) were found in five patients at presentation and developed after treatment with systemic or intraarterial chemotherapy in the others. Atrophic changes affected the right lobe in eight patients, the left lobe in three, and part of both lobes in one. Compensatory hypertrophy of part or all of the unaffected liver was found. Ten patients had obstruction of the portal vein branch to the atrophic segment, four of these 10 also had hepatic vein obstruction, and two of these 10 also had bile duct obstruction. Portal vein obstruction appears to be the most important element in the production of focal hepatic atrophy in patients with hepatic neoplasms. After treatment with chemotherapy, tumor regression and atrophy may be associated with compensatory hypertrophy and enlargement of the uninvolved part of the liver. This must not be mistaken for progression of disease.

Adaptation, Physiological↗
PubMed1988

Arterial embolization of adrenal tumors: results in nine cases.

Adrenal arterial embolization was performed in nine patients, four with inoperable adrenal cortical carcinoma and five with metastatic adrenal tumors. Embolic agents used were polyvinyl alcohol foam (Ivalon) in seven patients, stainless steel coils in four, ethanol in three, and surgical gelatin (Gelfoam) in two. In eight patients, embolization was performed for palliation, either to decrease tumor bulk (all patients), suppress tumor hormonal function (three patients), or relieve pain (four patients). One patient had an embolization to facilitate subsequent adrenalectomy. In four patients in whom it was possible to assess the effect of embolization on tumor bulk by follow-up CT, a striking reduction in size has occurred in one, the lesions remained stable in size for 12 months in two, and the tumor continued to increase in size in the fourth. A striking reduction in the production of the cortisol for 12 months was seen in two of three patients with Cushing syndrome. This reduction was considered due at least in part to embolization. Adrenal embolization resulted in effective palliation of pain in three of four patients and may have contributed to palliation in the fourth. Apart from a hypertensive episode in one patient, the cause of which was unclear, no serious side effects occurred. Adrenal arterial embolization may play an effective role without serious side effects in palliation of pain and reduction of hormone production in inoperable adrenal lesions.

Adrenal Gland Neoplasms↗
PubMed1988

Islet cell tumors metastatic to the liver: effective palliation by sequential hepatic artery embolization.

The value of sequential percutaneous hepatic artery embolization with polyvinyl alcohol particles was examined in 22 patients with islet cell carcinoma metastatic to the liver. Nine patients had gastrinoma, 2 had glucagonoma, and 11 had no discernible hormonal secretions or syndromes. Ninety-seven embolizations were done with a median number of 4 (range, 1 to 12) per patient. The interval between embolizations ranged from 1 to 8 months. Twelve of twenty evaluable patients had a partial remission, frequently associated with subjective improvement and decrease in hormone levels. The projected median survival of all 22 patients from the initiation of embolization is 33.7 months (range, 1 to 72). Nausea, vomiting, fever, and abdominal pain occurred with each embolization and subsided usually by day 10 (range, 3 to 35). Sequential hepatic artery occlusion is an effective method for prolonged palliation in this selected group of patients.

Adenoma, Islet Cell↗
PubMed1987

Intrahepatic infusional therapy for metastatic ovarian carcinoma.

Twenty-four women with ovarian carcinoma that had metastasized to the liver were treated with intrahepatic infusional therapy. No consistent drug regimen was used. There were no complete responders; however, 33% had a partial response. All responses were noticed after the first course of therapy. The median length of response was 6.3 months. The median survival from the time of the first hepatic infusion was 7.5 months for all patients. In this series, there were two treatment-related deaths, one secondary to the chemotherapy, the other to improper catheter placement. Because of the multiplicity of chemotherapy regimens employed, no definite conclusions can be made concerning the efficacy of intrahepatic infusional therapy for metastatic ovarian carcinoma. It is suggested that its future use be restricted to patients with disease limited to the liver and who are being treated according to a study protocol.

Adolescent↗
PubMed1987

Repositioning misplaced central venous catheters.

Central venous catheters inserted through the subclavian or basilic veins may be misplaced in the internal jugular vein. A simple technique employing a deflector guide wire allows catheter reposition in a very short time without the need for catheter withdrawal. In this manner, radiation exposure, the risk of catheter contamination, and patient discomfort are lessened.

Catheterization, Central Venous↗
PubMed1987

Hepatic arterial flow distribution with hepatic neoplasms: significance in infusion chemotherapy.

Hepatic artery radionuclide flow studies and hepatic angiography in eight patients with various hepatic neoplasms were evaluated to determine the patterns of arterial flow distribution in the presence of portal vein occlusion. Increased hepatic arterial blood flow to the lobe or segment supplied by the occluded portal vein was observed in all patients. This phenomenon must be taken into account when positioning catheters for hepatic artery infusion chemotherapy; while it may improve the flow of chemotherapeutic agents to tumors located in the area of an occluded portal vein branch, it may also result in diversion of flow to the normal hepatic parenchyma away from tumors occupying the hepatic segments with patent portal venous flow. Hepatic angiography and radionuclide flow studies provide the necessary information for correct positioning of hepatic artery infusion catheters.

Adenocarcinoma↗
PubMed1987

Osteosarcoma chemotherapy effect: a prognostic factor.

Chemotherapy has become a routine part of the treatment of osteosarcoma. However, the precise role of preoperative chemotherapy remains in question. Between 1979 and 1982, a group of 40 patients were treated by multimodality therapy consisting of preoperative chemotherapy (intra-arterial cis-platinum and systemic adriamycin), surgery, and postoperative chemotherapy. Survival in this group is 64%, while continuous disease-free survival is 58%. Although age, sex, tumor size, site, and classification were found to be prognostic factors, histologic evidence of response to preoperative chemotherapy, measured as percent tumor necrosis, was found to be the most significant prognostic factor. When continuous disease-free survival was calculated as a function of tumor necrosis it was 91% in patients with greater than or equal to 90% tumor necrosis, while it was 14% in patients with less than 90% tumor necrosis. At initial presentation, 7% of patients were judged limb-salvage candidates. But due to the local effects of preoperative chemotherapy, 60% ultimately underwent limb-salvage surgery. Preoperative arteriograms were a reliable means of monitoring response to chemotherapy and served as an indicator of residual viable tumor. Using arteriogram directed planes of section, postchemotherapy, specimens were "mapped" and analyzed for chemotherapy effect. When present, residual viable tumor was preferentially found at the interface of tumor and normal anatomic structures; "sanctuary sites." It is necessary that standard methods for analyzing postchemotherapy specimens be developed; a technique is described.

Bone Neoplasms↗
PubMed1987

Continuous 5-day infusion of vinblastine for percutaneous hepatic arterial chemotherapy for metastatic breast cancer.

We assessed the therapeutic efficacy and toxicity of continuous hepatic infusion of vinblastine in the treatment of breast cancer predominantly metastatic to the liver. Twenty-six patients previously treated with one or more chemotherapeutic regimens received vinblastine at a dose of 2.0 mg/m2 daily for 5 days, via percutaneously inserted intra-arterial catheters, at 3-4-week intervals. Nine of 25 evaluable patients (36%) achieved partial response and four (16%) had minor response. For responding patients, the median time to disease progression was 21 weeks (range, 12-99), with a median survival of 11 months (range, 4-29) from the beginning of hepatic arterial infusion. The toxicity of the treatment was acceptable, and drug-related effects were comparable to those seen in patients with breast cancer treated by iv continuous infusion of vinblastine at slightly lower doses. We observed two episodes of transient inappropriate antidiuretic hormone secretion. Percutaneous hepatic arterial infusion of vinblastine had significant activity in the treatment of breast cancer metastatic to the liver.

Adult↗
PubMed1987

Percutaneous hepatic arterial infusion of cisplatin for metastatic breast cancer.

We treated 31 patients with breast cancer metastatic to the liver and refractory to prior chemotherapy with percutaneous hepatic arterial infusion of cisplatin (DDP) (120 mg/m2) at 4-week intervals. Partial responses occurred in five of 26 evaluable patients, with a median time to disease progression of 15+ weeks (range, 8+ to 55) and a median duration of survival of 11 months (range, 8-22). Toxic effects were acceptable and, except for catheter-related complications, were essentially similar to those encountered when DDP was given iv. Percutaneous hepatic arterial infusion of DDP has modest activity in the treatment of breast cancer metastatic to the liver.

Adult↗