[Dose finding of epirubicin in transcatheter hepatic chemoembolization].
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Biomedical subjects
Publications and source records attributed to T Hosoki.
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The radiologic and histologic findings are presented of the resection of 14 small hepatocellular carcinomas (HCC), less than 2 cm in maximum diameter, after transcatheter arterial chemoembolization (TCE) using iodized oil. The effect of TCE on small HCC depended on the morphologic type of the tumors. When no extracapsular invasion of tumor cells occurred, TCE was extremely effective against encapsulated tumors. However, in nine of the 14 resected specimens, viable tumor cells remained in or around the tumor. The authors suggest that small HCC are not always curable with TCE alone and that a multi-disciplinary approach is necessary for patients with small HCC.
Twenty-one patients with congestive heart failure were examined with duplex sonographic scanning of the portal vein. The Doppler sonographic findings were compared with those of healthy subjects, patients with chronic liver disease, and patients with Budd-Chiari syndrome. Increasing pulsatility of the Doppler signals was demonstrated in 11 patients with severe congestive heart failure. Two patients with severe congestive heart failure showed decreasing pulsatility of portal Doppler signals in response to therapeutic procedures. Portal flow patterns suggestive of severe congestive heart failure include a monophasic forward flow with peak velocity in ventricular diastole and gradual diminution of velocity throughout ventricular systole (n = 5), a reversed flow velocity in ventricular systole (n = 3), and vena cava-like biphasic forward velocity peaks during each cardiac cycle (n = 2). The time-velocity waveform shape of portal flow is, to a large degree, influenced by the mechanical events in the right side of the heart in severe congestive heart failure.
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The article describes a new method for computed tomographic arteriography (CTA) of hepatocellular carcinoma (HCC) using a balloon occlusion catheter in 8 patients. Our dynamic study indicated that: 1) a bolus injection of contrast medium with our method of CTA (CTA-B) produced an attenuation difference between liver and tumor which was about double that obtained with standard methods for CTA, and 2) marked tumor-liver attenuation differences (above 20 HU) persisted for more than 60 s in CTA-B and for not more than 20 s with conventional methods for CTA. The results show that CTA-B is superior to standard methods in enabling multiple scans of the liver during greater and prolonged differential tumor enhancement after administration of a bolus of contrast medium. In conjunction with table incrementation, CTA-B allows scanning of the entire liver at the time of maximal contrast enhancement with two to three injections of contrast medium. Two patients complained of abdominal pain during balloon inflation. No other complications were observed.
Pulsed Doppler sonography was performed in six patients with hepatic outflow obstruction (five with Budd-Chiari syndrome and one with hepatic venocclusive disease) to assess its usefulness in evaluating the altered hemodynamics in this disease. Doppler signals were obtained from the inferior vena cava (IVC) and from hepatic, collateral, and portal veins. Normally, the IVC and hepatic veins show phasic forward (toward the heart) flow. In Budd-Chiari syndrome, the blood flow in the IVC and hepatic veins was absent, reversed, turbulent, or continuous. These Doppler findings were thought to be characteristic of Budd-Chiari syndrome. The portal velocity was reduced (n = 4) or increased (n = 1). The former was considered typical of Budd-Chiari syndrome. In hepatic venocclusive disease the IVC and major hepatic veins showed normal phasic flow; flow velocity in the portal vein was increased. Doppler sonography was found to correlate well with therapeutic results and angiographic findings.
A slippery coaxial, 3-F catheter device was developed for selective angiography, embolization, and infusion of chemotherapeutic agents. The device comprises three parts: an 0.018-inch, plastic-coated guide wire; a 3-F coaxial catheter; and a 6.5-F guiding catheter. Both the guide wire and coaxial catheter are coated with hydrophilic polymer, which becomes slippery when immersed in water. Experience with four patients indicates the new coaxial catheter device is capable of traversing tortuous vessels smoothly and safely, and it permits infusion of chemotherapeutic agents and 1-mm gelatin particles.
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We evaluated histologically the effect of transcatheter arterial embolization (TAE) in five metastatic liver tumors from gastrointestinal cancer, which were resected at surgery or removed at autopsy after TAE. TAE was carried out with cubes of gelatin sponge; in 2 cases, iodized oil was used as peripheral embolic material. Histological examination revealed three tumors to be completely necrotized. Approximately 80% of the remaining two tumors were necrotic. Our data suggest that TAE holds promise in the treatment of metastatic liver tumor from gastrointestinal cancer.
Experience with contrast enhanced computed tomographic (CT) examinations of 13 patients with hepatic tumors using a new cholangiographic contrast material, meglumine iotroxate, is described. After infusion, small density differences between the tumor and liver were accentuated. In 11 cases postcontrast CT using meglumine iotroxate improved visualization of lesions compared with conventional pre-and postcontrast CT using urographic contrast material. Our results indicate that contrast enhanced CT using meglumine iotroxate is a promising alternative to conventional CT in the detection of hepatic tumors.