Sorbitol removal by the metastatic liver: a predictor of systemic toxicity of intra-arterial chemotherapy in patients with liver metastases.

Background/aim: Hepatic arteriovenous shunting in the metastatic liver reduces the advantages of intraarterial infusion of chemotherapeutic agents because of the passage of drugs into the systemic circulation. The aim of this study was to quantitatively assess spontaneous functional hepatic arteriovenous shunting in patients with liver metastases and to determine its implication in the increase in systemic toxic effects of intra-arterial infusion chemotherapy with floxuridine.

Methods: Twenty-five patients who underwent implantation of arterial ports for regional chemotherapy of liver metastases were studied.

Extrahepatic regional chemotherapy: use of technetium-99m labeled macroaggregated albumin.

The purpose of this study was to verify the applicability of nuclear techniques with technetium-99m labeled macroaggregated albumin (Tc-99m-MAA) in extrahepatic regional chemotherapy. Of 98 patients in whom arterial Port-a-caths were implanted by transcutaneous access, 13 were treated by regional extrahepatic chemotherapy (breast, one; pancreas, four; kidney, one; uterus, three; vagina, two; bladder, two). In all 13 patients, Tc-99m-MAA was slowly infused intraarterially.

Detection of four novel mutations in the iduronate-2-sulfatase gene. Mutations in brief no. 123. Online.

Hunter disease (mucopolysaccharidosis type II or MPS II) is an X-linked recessive disorder caused by the deficiency of the lysosomal enzyme iduronate-2-sulfatase (IDS) (E.C.3.

Effect of preoperative radiological treatment of hepatocellular carcinoma before liver transplantation: a retrospective study.

Purpose: To assess the results of radiological treatment of patients with hepatocellular carcinoma (HCC) performed before orthotopic liver transplantation (OLT).

Methods: Sixty-two transplanted patients with a total of 89 HCC nodules were studied; 50 lesions in 38 patients had been treated prior to OLT with transcatheter arterial chemoembolization (TACE; n = 29), percutaneous ethanol injection (PEI; n = 10), or combined therapy (TACE + PEI; n = 11). The induced necrosis was pathologically evaluated.

[Computerized tomography with lipiodol in hepatocarcinoma. Assessment of its diagnostic accuracy with anatomo-pathological control].

Purpose: To assess the diagnostic accuracy and predictive value of Lipiodol CT for hepatocellular carcinoma (HCC) before liver transplantation (OLT).

Material And Methods: Seventy-eight cirrhotic patients awaiting OLT underwent Lipiodol CT to demonstrate the presence and extent of possible HCC. Radiologically, focal uptake areas with dense, homogeneous or "mosaic" iodized oil uptake were considered to be neoplastic nodules.

Perianal cutaneous larva migrans in a child.

Cutaneous larva migrans (CLM) is a dermatosis characterized by the presence of parasites which migrate into the skin, forming linear or serpiginous lesions. We report a child with cutaneous larva migrans of interest because of the involvement of an unusual site and the patient's age. We confirm the efficacy of therapy consisting of administration of albendazole by mouth.

[Percutaneous transcatheter therapy of visceral pseudoaneurysms].

Background: The purpose of this work is to show the effectiveness of percutaneous embolization therapy in the treatment of visceral arterial pseudoaneurysms and to propose the method as a valid alternative to surgery.

Methods: Twenty-eight patients with visceral artery pseudoaneurysms were treated: 10 of them were hepatic; 9 renal; 7 duodenal-pancreatic; 1 splenic and 1 of the celiac trunk. Materials employed were: Gianturco metallic coils, Spongostan and Poli-Vinyl-Alcohol.

Short-term effects of transjugular intrahepatic portosystemic shunt (TIPS) on functional liver plasma flow in patients with advanced cirrhosis.

Aims/background: TIPS, an effective procedure applied for the treatment of complications of portal hypertension, is potentially followed by worsening of the hyperdynamic circulation of cirrhosis and the impairment of liver function. The aim of the present study was to evaluate short-term changes of functional liver plasma flow after application of TIPS, using the hepatic (extrarenal) clearance of D-sorbitol (S-HCl).

Methods: Twenty-five cirrhotic patients submitted to TIPS for prevention of variceal rebleeding entered the study.

Arterial-venous shunting in liver cirrhosis.

Controversial data exist in the literature about the presence and clinical relevance of hepatic arterial-venous shunting. An interesting opportunity for reconsidering the problem has been provided by the use, in the study of liver function, of D-sorbitol, a substance whose first-pass hepatic extraction is very high in normal subjects, while being directly related to circulatory alterations in liver cirrhosis. Because of this property, the systemic bioavailability of D-sorbitol during hepatic arterial infusion can be assumed to reflect arterial-venous shunting.

[The percutaneous placement of intra-arterial catheters with "reservoirs" for subcutaneous infusion. The technic and preliminary results].

Introduction: We report our personal technique and the preliminary results of percutaneous implantation of intraarterial catheters connected to a subcutaneous infusion reservoir (Port-a-cath) for the regional chemotherapy of hepatic and extrahepatic tumors. January, 1996, to February, 1997 fifty patients underwent the procedure: 44 had liver cancers (42 had metastases and 2 hepatocellular carcinomas), 4 pelvic tumors (2 bladder carcinomas, one uterine cancer and one vaginal cancer), one had inoperable pancreatic tumor and one breast cancer.

Materials And Methods: The access was the left axillary artery in 45 cases, the femoral artery in 4 and both the femoral and the axillary artery in one case.

Congenital bilateral coronary-to-pulmonary artery fistulas.

Rare, congenital bilateral coronary-to-pulmonary artery fistulas in an older woman, one originating from the proximal right coronary artery and the other from a distal left main coronary artery and draining to the proximal main pulmonary artery, were successfully dissected, identified, and ligated proximally and also closed distally on a beating heart with cardiopulmonary bypass standby.

Hyperdynamic circulation in patients with cirrhosis: direct measurement of nitric oxide levels in hepatic and portal veins.

Background/aims: Peripheral vasodilation represents the main vascular dysfunction associated with the hyperdynamic circulation of liver cirrhosis. This study was intended to measure directly regional and systemic levels of nitric oxide, a potent vasorelaxing mediator, in order to assess its role in the development of hemodynamic changes of cirrhosis.

Methods: We compared nitric oxide levels in the splanchinic and systemic circulation of 25 patients with cirrhosis undergoing transjugular intrahepatic portosystemic stent shunt and in the hepatic vein and peripheral blood of 10 patients without cirrhosis submitted to venous catheterization.

Determination of functional portal-systemic shunting in patients submitted to hepatic angiography.

Angiographic visualization of the hepatic vascular bed by selective angiography can be profitably complemented with the evaluation of functional portal-systemic shunting by D-sorbitol bioavailability. Seventeen patients requiring diagnostic arterial catheterization were studied: most of them had biopsy-proven liver cirrhosis. Patients were studied at rest and after overnight fasting on two subsequent days, in which a sterile pyrogen-free solution (1.

Transaxillary access to perform hepatic artery infusion (HAI) for secondary or primitive hepatic tumors.

There is a renewed interest in locoregional chemotherapy for hepatic tumors; trials in progress are experimenting with new therapeutic protocols with an approach combining different systems of infusion (HAI and systematic) or with the use of HAI as adjuvant or neoadjuvant of the surgical treatment or cryosurgical treatment of the hepatic metastases from colo-rectal cancer. However, HAI is practicable principally with the implantation of a catheter in the hepatic artery (port of Infusaid) by laparotomic access. This intervention limits wide-scale use of the infusion method, traditionally less toxic and more efficient in terms of results than systemic treatment.

Lorazepam and midazolam in the intensive care unit: a randomized, prospective, multicenter study of hemodynamics, oxygen transport, efficacy, and cost.

Objectives: To evaluate and compare the clinical efficacy, impact on hemodynamic and oxygen transport variables, safety profiles, and cost efficiency of sedation and anxiolysis with lorazepam vs. continuous infusion of midazolam in critically ill, intensive care unit patients.

Design: Multicenter, prospective, randomized, open-label study.

[Mutation analysis in Hunter patients].

Mutations of the iduronate-2-sulfatase gene have been identified as responsible of Hunter syndrome or mucopolysaccharidosis type II. About 20% of the patients have deletions of the whole gene or other major structural alterations. The mutations found so far include: 34 missense, 8 nonsense, 11 small deletions from 1 to 3 bp, 2 deletions of 8 pb, 2 insertions of 1 bp and 2 insertions of 14 bp, with most leading to a frameshift and premature chain termination.

Comparison of antegrade with antegrade/retrograde cold blood cardioplegia for myocardial revascularization.

There has been increasing interest in the use of retrograde coronary sinus perfusion for delivery of cardioplegic solution during myocardial revascularization. Despite evidence of improved cardiac protection, it is unclear if a combined antegrade/retrograde approach to myocardial preservation offers significant clinical benefits. One hundred twenty patients undergoing elective 1st-time coronary bypass surgery for 3-or-more-vessel disease received aortic root, antegrade cold blood cardioplegia (Group I, n=52) or combined antegrade/retrograde cardioplegia via coronary sinus cannulation (Group II, n=68).