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At least 325 records · Page 18Linked to original sources
PubMed2004

3DCT angiography for detection of vascular complications in pediatric liver transplantation.

UNLABELLED: Catheter angiography for early diagnosis of vascular complications in pediatric liver transplant yields excellent results but remains an extremely invasive examination for younger children, precluding its routine use. We assessed the efficacy of three-dimensional multislice computed tomographic angiography (3DCTA) as an alternative option in these patients. METHODS: Twenty children suspected of vascular complications on clinical grounds, laboratory findings, or Doppler ultrasound underwent 3DCTA between April 2000 and April 2003. Interventional procedures via conventional angiography were subsequently performed in 5 cases, thrombolytic therapy in 4, surgical in 1, and conservative treatment in 10. RESULTS: Two hepatic artery stenosis,1 hepatic artery thrombosis, 5 hepatic vein stenosis, 4 portal vein occlusion, 1 portal vein stenosis, and 7 non-vascular lesions were detected, all of which paralleled the findings of catheter angiography, Doppler ultrasound, and operations. The diagnostic accuracy for vascular complication was 90%. The sensitivity and specificity were 86.7% and 100%, respectively. The positive and negative predictive values were 100% and 71.4%, respectively. To date 19 patients are alive, with a median follow-up period of 24.8 months. In conclusion, 3DCTA is accurate and efficient in the identification of pathological vascular insults and offers essential information for major decision on further management of the vascular complications in pediatric recipients of liver transplant.

Angiography↗
PubMed2002

Hepatobiliary disease in inflammatory bowel disease.

Many hepatobiliary diseases are seen in IBD. PSC is the most common, occurring in 7.5% of patients with UC. The cause of PSC is not well understood, but PSC seems to be associated with genetic susceptibility, sharing some immunologic abnormalities with UC. A characteristic cholangiogram in a patient with abnormal liver function tests usually establishes the diagnosis. Liver biopsy is not essential but can help make the diagnosis of small duct PSC in patients with a normal cholangiogram. There are no medications that treat PSC effectively. Endoscopic dilation of dominant strictures reduces the frequency of cholangitis and may improve survival. OLT remains the only proven treatment of advanced PSC. Cholangiocarcinoma is a feared complication of PSC that is difficult to diagnose. Cholelithiasis, PBC, portal vein thrombosis, and hepatic abscess are hepatobiliary disorders that occur less frequently in IBD patients.

Biliary Tract Diseases↗
PubMed1999

Long-term effects of interstitial laser coagulation in porcine liver with portal inflow occlusion: central versus peripheral lesions.

PURPOSE: Interstitial laser coagulation (ILC) is an attractive modality for local destruction of unresectable hepatic metastases. Portal inflow occlusion considerably increases its destructive capacity, resulting in lesions 5 cm in diameter; however, effects on adjoining major intrahepatic structures are unknown. Therefore, the purpose of this study was to assess the effects of ILC with portal inflow occlusion on the central portion of the liver as compared to the peripheral portions. MATERIALS AND METHODS: ILC was performed in pigs with portal inflow occlusion. Each animal received a single laser application with Nd:YAG light guided simultaneously through four interstitial fibers with 5 W per fiber during 6 minutes. Location of treatment was randomized to either central (n = 8) or peripheral (n = 8). Follow-up was for 1, 2, or 3 months with evaluation of liver functions and weight, as well as macroscopic and microscopic assessment of coagulated lesions and surrounding parenchyma. RESULTS: There was no treatment-related morbidity or mortality. No obstructive cholestasis or bile leakage was found. At every moment of evaluation, coagulated volumes in the central group were smaller than in the peripheral lesions (P = .03). Large vessels contiguous to the lesions in the central group were always intact and indications of portal hypertension or thrombosis of hepatic veins were not found. There were no significant differences between the two groups (liver functions [P > or = .15] and weight [P = .69]). CONCLUSION: ILC with portal inflow occlusion is a safe technique in the vicinity of vital structures in the liver of healthy pigs. These results justify studies to the feasibility and complication rate of portal inflow occlusion in patients with hepatic malignancies.

Animals↗
PubMedDate not supplied

Phase II trial of vinorelbine and estramustine in the treatment of metastatic hormone-resistant prostate cancer.

The purpose of this study was to investigate the efficacy and safety of combination chemotherapy using estramustine and vinorelbine in chemotherapy-naïve patients with hormone-resistant prostate cancer (HRPC). The patients (n = 54) received oral estramustine 840 mg/day on Days 1 to 14 and IV vinorelbine 25 mg/m(2) on Days 1 and 8 of every 3 wk cycle. The median number of cycles per patient was 9 (range, 1 to 27). Fifty-three patients were evaluable for toxicity and survival and 52 for prostate specific antigen (PSA) response. Median age was 68 (range, 46-80). PSA sustained decrease >50% was seen in 52% of patients (95% CI: 38-66%). A complete response was seen in 3 and a partial response in 12 of 25 patients with measurable disease, for an overall objective response of 60% (95% CI: 41-79%). Improvement in performance status was observed in 30 out of 43 evaluable for clinical benefit response. The median duration of response was 7 mo and median time to progression was 6 mo. The median survival time was 15 mo. The most common adverse event was mild gastrointestinal toxicity. In general, toxicity G3-4 was low: granulocytopenia Grade 3-4 (8%), thrombocytopenia Grade 3 (6%), and anemia Grade 3 (13%). Other Grade 3 toxicities included deep vein thrombosis (4%), hepatic (2%), cardiac ischemia (2%), fatigue (6%), and sensory neuropathy (2%). There were 2 treatment-related deaths (4%). We conclude that vinorelbine and estramustine as used in this trial is an efficacious and well-tolerated therapeutic regimen in the management of HRPC.

Antineoplastic Agents↗
PubMed2000

Intraarterial HCC therapy with I-131-Lipiodol.

We report on our 2-year experience with intraarterial liver therapy with I-131-Lipiodol in patients with hepatocellular carcinoma in Germany. 30 therapies with intraarterial delivery of I-131-labeled Lipiodol were performed in 14 patients with hepatocellular carcinoma (HCC) with or without portal vein thrombosis during hepatic angiography. The patients were monitored for 1) distribution of Lipiodol by CT, 2) distribution of applied activity by planar scintigraphy and SPECT, and 3) tumor response by CT, MRT and 18-FDG-PET. In 5 patients the tumor size was reduced after the first treatment (responder). Eight patients, primarily with big tumors (> 7 cm), had stable (4) or progressive disease (4), and 1 patient died because of renal failure. CT and SPECT showed pronounced I-131-lipiodol accumulation in the tumor tissue in all patients with variable distribution patterns. One patient had an acute pancreatitis like syndrome together with elevation of liver enzymes, probably due to arterial spasm. 9 patients had transient and mild symptoms in the upper abdomen, fever to 40 degrees C, and a leukocytosis. Two patients had a transient mild elevation of pancreatic enzymes. All patients had a transient rise in liver enzymes. In conclusion, therapeutic efficacy was dependent on the tumor mass. Side effects due to the radiopharmaceutical were tolerable, and other side effects may result from the angiography procedure related manipulations. These results are encouraging for tumors up to a moderate mass.

Aged↗