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Christos S Georgiades

Publications and source records attributed to Christos S Georgiades.

15 recordsLinked to original sources
PubMed2006

Technology insight: Image-guided therapies for hepatocellular carcinoma--intra-arterial and ablative techniques.

Locoregional techniques have become the mainstay of therapy for patients with unresectable hepatocellular carcinoma (HCC). Such image-guided interventions include catheter-based approaches (transarterial chemoembolization and yttrium-90 radiotherapy) and locoregional ablative techniques, either chemical (percutaneous ethanol injection), or thermal (radiofrequency ablation, laser ablation, microwave ablation and cryoablation). These therapies are mainly utilized for palliation, but have also been used with curative intent. In selected cases, percutaneous interventional treatments have shown good results (5-year survival 40-50%), but, even when chosen as first-line treatment, have not been able to achieve the response rates and outcomes achieved by surgical options (resection or transplantation). New promising image-guided therapies are continuously emerging, as we attempt to improve tumor targeting, minimize hepatic toxicity and ultimately improve quality of life and survival of patients with HCC. With new technologies in imaging and drug delivery becoming available, it is likely that, in the future, patients with HCC will be best treated by a multidisciplinary team approach, utilizing a combination of techniques to improve patient survival. This review outlines the current status of the most commonly used image-guided locoregional interventions in the treatment of patients with HCC, and describes recent research and advances related to image-guided interventions for liver cancer.

Carcinoma, Hepatocellular↗
PubMed2006

Prognostic accuracy of 12 liver staging systems in patients with unresectable hepatocellular carcinoma treated with transarterial chemoembolization.

PURPOSE: The objective of the present study was to rank the most common liver staging systems according to prognostic accuracy in patients with unresectable hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE). MATERIALS AND METHODS: Survival of 172 consecutive patients with unresectable HCC treated with TACE was correlated with the pretreatment Child-Pugh (categoric and nominal), Okuda, Cancer of the Liver Italian Program, Barcelona Clinic Liver Cancer, Model for End-stage Liver Disease, Chinese University Prognostic Index (CUPI), Japanese Integrated Staging, Tumor/Node/Metastasis, Group d'Etude de Traitement du Carcinoma Hepatocellulaire, Liver Cancer Study Group of Japan, and Tokyo staging systems. The systems were ranked according to error reduction in predicting median survival (Kaplan-Meier survival curve and Cox regression analysis). The error reduction was normalized to the error in predicting survival in the absence of a staging system. RESULTS: Median survival was 80 weeks. The error in predicting survival of an unstaged population was 51 weeks. The Child-Pugh nominal, CUPI, and Tokyo scores yielded the largest reduction in survival prediction error, at 20.8%, 21.6%, and 19.6%, respectively. Their actual error measurements in predicting survival were 40.4, 40.0, and 41.0 weeks, respectively. CONCLUSIONS: Child-Pugh nominal, CUPI, and Tokyo scores provide the best prognostic accuracy among the systems studied. However, those of the Tokyo and CUPI methods are artificially enhanced because of their greater number of staging levels. The Child-Pugh nominal liver staging system is the most accurate in predicting survival of patients with unresectable HCC treated with TACE, and it is recommended that it be adopted as the standard for HCC staging in such patients.

Carcinoma, Hepatocellular↗
PubMed2005

Case-controlled comparison of a percutaneous collagen arteriotomy closure device versus manual compression after liver chemoembolization.

PURPOSE: To compare complications and outcomes between the use of the Duett collagen closure device after one or multiple deployments and manual compression in patients treated with transcatheter arterial chemoembolization (TACE) for primary or metastatic liver cancer. MATERIALS AND METHODS: A database of 214 patients who underwent a total of 426 TACE procedures between July 2001 and July 2003 was retrospectively analyzed with regard to the use of the Duett closure device to obtain hemostasis. The Duett device was used in 211 cases (121 patients), whereas manual compression was performed in 215 cases (93 patients). Primary endpoints included complications related to hemostasis, time to hemostasis (TTH), time to ambulation (TTA), and time to discharge (TTD). Risk factors were tested for correlation with complications (P < .05). Other endpoints included descriptive data regarding the Duett treatment group. RESULTS: Only minor complications were observed in both groups, without a statistically significant difference (P = .16). The mean TTH and TTA were significantly shorter (P < .0001) in the Duett group, whereas there was no difference in TTD between groups (P = .59). Reaccessing the same arterial site for separate procedures was not a significant risk factor for complications in the Duett group (P < .0001). CONCLUSION: The Duett closure device achieves similar safety and efficacy as manual compression in this distinct group of patients. In addition, this device can be safely and repetitively deployed at the arteriotomy site after each TACE procedure.

Analysis of Variance↗
PubMed2005

Three-dimensional rotational angiography: introduction of an adjunctive tool for successful transarterial chemoembolization.

Transcatheter arterial embolization (TACE) is a minimally invasive procedure that requires precise visualization of the feeding vessels to liver tumors for proper catheter placement and effective therapy. The use of three-dimensional (3D) rotational angiography (RA) can be extremely useful to the interventional radiologist during TACE while the patient is on the catheterization table. This report demonstrates the role of 3D RA in interventional oncology by presenting two cases of hepatocellular carcinoma with complex vascular anatomy successfully treated because of the information provided by this new technology.

Aged↗
PubMed2005

Safety and efficacy of transarterial chemoembolization in patients with unresectable hepatocellular carcinoma and portal vein thrombosis.

PURPOSE: Despite the absence of conclusive data, portal vein (PV) thrombosis is considered a contraindication to transarterial chemoembolization (TACE) in patients with unresectable hepatocellular carcinoma (HCC). The purpose of our study was to establish the safety of TACE in such patients and identify key prognostic factors and survival. MATERIALS AND METHODS: Data were prospectively collected from 32 consecutive patients with unresectable HCC and PV thrombosis who underwent treatment with TACE. History and physical examination, relevant laboratory values, and contrast material-enhanced magnetic resonance (MR) images were obtained before each TACE procedure. Repeated TACE was performed every 6 weeks unless patients developed a contraindication or MR imaging showed complete response. RESULTS: Median overall survival was 9.5 months (range, 3-50 months). Child-Pugh numerical disease stage was the prognostic factor most strongly related to survival. The 30-day mortality rate was zero and there was no evidence of TACE-related hepatic infarction or acute liver failure. The 6-, 9-, 12-, and 18-month survival rates were 60%, 47%, 25%, and 12.5%, respectively. CONCLUSIONS: PV thrombosis should not be considered a contraindication to TACE. Compared with historical control subjects who received traditional forms of treatment, the patients in the present study had extended survival. However, prospective randomized trials are necessary to show this conclusively and to show which subgroups benefit.

Aged↗
PubMed2005

Effects of the type of embolization particles on carboplatin concentration in liver tumors after transcatheter arterial chemoembolization in a rabbit model of liver cancer.

PURPOSE: To study the effect of particle type used during transarterial hepatic chemoembolization (TACE) on carboplatin concentration after TACE in an animal model of liver cancer (VX2) and to determine the concentration of carboplatin within tumor, liver, and plasma. MATERIALS AND METHODS: The VX2 tumors were grown in the livers of 23 rabbits. Carboplatin (5 mg/kg) was selected because of its known potency against VX2 tumor. Group 1 was treated with TACE with tris-acryl gelatin microspheres (100-300 microm), group 2 was treated with TACE with polyvinyl alcohol (PVA; 150-250 microm), group 3 (control) was treated with intraarterial saline solution, and group 4 (pharmacokinetic) was treated with intraarterial carboplatin. Animals were killed after 48 hours, and concentrations of carboplatin were measured by atomic absorption spectroscopy from samples of blood and liver (central and peripheral zones of tumor and nontumorous liver tissue). RESULTS: In group 1 (tris-acryl gelatin microspheres) and group 2 (PVA), the mean carboplatin concentrations were 117 microg/g and 31.8 microg/g, respectively, within the central zone of the tumor and 38.5 mug/g versus 7.9 microg/g, respectively, in the peripheral zone. No carboplatin was detected in nontumorous liver tissue and plasma concentrations were low in both treated groups (<0.079 microg/mL). CONCLUSIONS: Carboplatin concentration was significantly greater (by a factor of two to four) within the central zone of the tumor compared with the peripheral zone in both treated groups. The overall tumor carboplatin concentrations were significantly greater in the tris-acryl gelatin microsphere group than in the PVA group (P < .001), which could translate into greater potency and tumor kill. Administration of tris-acryl gelatin microspheres may be clinically advantageous during TACE, as it contributed to greater delivery of chemotherapy to tumor in the present study.

Acrylic Resins↗
PubMed2004

Recently elucidated energy catabolism pathways provide opportunities for novel treatments in hepatocellular carcinoma.

It has long been known that tumors depend on energy production pathways that are different from those of normal cells. These unique pathways require the expression and function of tumor-specific enzymes. Some of these glycolytic enzymes, as well as other modulators of tumor behavior, have recently been elucidated. In theory, inhibiting such enzymes or appropriately affecting such modulators should deprive tumors of energy, while leaving nontransformed cells unaffected. These factors include certain hexokinases that catalyze glycolysis in tumors and can be inhibited by 3-bromopyruvate. 2-deoxyglucose is another modulator that depletes hexokinase stores and cannot undergo further catabolism, thus depriving tumors of their energy source. Other enzymes or modulators are under scrutiny and have shown promise. Preliminary experiments on animals with hepatocellular carcinoma have indeed shown very encouraging results. It appears that modulating the energy production pathways of tumors is poised to become a substantial research area for cancer treatment. This review will focus on the energy production pathways of transformed cells, highlight the differences between transformed and normal cells in this regard and summarize recent experiments that take advantage of these disparities in cancer treatment.

Animals↗
PubMed2002

Abdominal involvement in tuberculosis.

Rising incidence of disseminated and extrapulmonary tuberculosis (TB), especially in immunocompromised hosts and patients with multi-drug-resistant tuberculosis, has resulted in an increase of unusual clinical and radiographic presentations of TB. With CT being a common part of emergency room (ER) evaluation of abdominal pain, it is imperative that radiologists be able to recognize abdominal presentations of TB. We discuss and illustrate typical and less common CT manifestations of tuberculosis in the abdomen to help ER radiologists in this task.

Journal Article↗
PubMed2002

Percutaneous peritoneal dialysis catheter placement for the management of end-stage renal disease: technique and comparison with the surgical approach.

As the incidence of end-stage renal disease is increasing, so is the pressure on the health care system to promote less expensive and burdensome management solutions. Peritoneal dialysis (PD) has been increasingly used and is especially suited for patients who, in exchange for meticulous care and technique, enjoy more independence and fewer clinic visits than their counterparts on hemodialysis. Both the efficiency and the complication profile of the percutaneously placed PD catheters are comparable to that of surgically implanted ones. Percutaneous procedures have the added advantage of being less expensive and requiring shorter hospitalization. Radiologists are in an advantageous position to provide fluoroscopic placement of PD catheters promptly and safely. We describe this technique step by step and compare its complication profile to that of the surgical approach as reported in the literature.

Catheterization↗
PubMedDate not supplied

Presumed pulmonary embolism following power-pulse spray thrombectomy of upper extremity venous thrombosis.

To achieve more effective thrombolysis in a shorter treatment time, percutaneous mechanical thrombectomy has been increasingly used in the treatment of deep venous thrombosis (DVT). The power-pulse spray is a new technique to combine chemical and rheolytic effects on clots. We present a case of presumed pulmonary embolism following power-pulse spray treatment for upper extremity DVT which necessitated resuscitation and intubation. The power-pulse spray technique should be used with caution when treating DVT.

Adult↗
PubMedDate not supplied

Cross-sectional imaging of amyloidosis: an organ system-based approach.

Systemic amyloidosis--whether primary or secondary--can involve any organ or organ system and imparts significant morbidity and mortality. Unfortunately, imaging findings are only rarely specific, manifesting in a variety of ways (e.g., mass-like lesions, micronodular or diffusely infiltrative process). Sensitivity can be improved by being familiar with these varied image manifestations of amyloidosis and aware of the patient's medical history, because there is a significant association between this and other systemic diseases.

Amyloidosis↗
PubMedDate not supplied

Amyloidosis: review and CT manifestations.

Amyloidosis is a collection of disease entities that produce considerable morbidity and mortality and are increasing in prevalence. The imaging findings are problematically nonspecific and diverse. This lack of specificity is compounded by the fact that amyloidosis is strongly associated with and frequently coexists with many other chronic disease states that have their own imaging findings. Amyloidosis can involve any organ singly or in conjunction with other organs and can do so in the form of a focal, tumorlike lesion or an infiltrative process. In the proper clinical setting, that is, in a patient with chronic inflammatory disease and especially in a patient with multiple myeloma, amyloidosis should be considered as a possible cause of worsening or new symptoms or imaging findings. Occasionally, the radiologic findings may precede the clinical findings, thus providing the radiologist with the opportunity to contribute to the patient's care. However, to make a difference in patient care, the radiologist must be familiar with the diverse imaging findings of amyloidosis as well as the patient's clinical history, which could raise the suspicion of amyloidosis.

Aged↗