RESUMEN
PURPOSE: To evaluate the usefulness of information provided by three-dimensional ultrasound (3D US) and to determine whether 3D US decreased the number of passes required to obtain portal vein (PV) access during creation of transjugular intrahepatic portosystemic shunts (TIPS). MATERIALS AND METHODS: Intermittent 3D US volume acquisitions were obtained during creation of TIPS in 20 patients. Useful information provided by 3D US was tabulated. The number of passes required to achieve PV access was recorded and results were compared retrospectively to 25 patients who underwent TIPS without 3D US. RESULTS: 3D US documented that the operator's opinion of which hepatic vein had been selected was incorrect in nine patients (45%), detected unfavorable PV anatomy that required modification of equipment or technique in seven patients (35%), permitted estimation of the trajectory required to access the targeted PV in all patients (100%), assisted in selecting the optimal point along the hepatic vein for origination of the needle pass in 11 patients (55%), allowed avoidance of a large hepatocellular carcinoma in one patient (5%), and confirmed that access into the main PV was intrahepatic in four patients (20%). The mean number of needle passes decreased from 10.4 in the historic control group to 4.6 in the 3D US group (P = .0001). CONCLUSION: 3D US provided imaging information that detected technical errors and altered anatomy, and provided positional and directional information to significantly improve needle pass efficiency.
Asunto(s)
Monitoreo Intraoperatorio/métodos , Vena Porta/diagnóstico por imagen , Derivación Portosistémica Intrahepática Transyugular/métodos , Ultrasonografía/métodos , Adulto , Anciano , Anciano de 80 o más Años , Várices Esofágicas y Gástricas/diagnóstico por imagen , Várices Esofágicas y Gástricas/cirugía , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Persona de Mediana Edad , Vena Porta/cirugía , Estudios Prospectivos , Reproducibilidad de los ResultadosRESUMEN
PURPOSE: To evaluate the usefulness of information provided by three-dimensional ultrasound (3D US) and to determine whether 3D US decreased the number of passes required to obtain portal vein (PV) access during creation of transjugular intrahepatic portosystemic shunts (TIPS). MATERIALS AND METHODS: Intermittent 3D US volume acquisitions were obtained during creation of TIPS in 20 patients. Useful information provided by 3D US was tabulated. The number of passes required to achieve PV access was recorded and results were compared retrospectively to 25 patients who underwent TIPS without 3D US. RESULTS: 3D US documented that the operator's opinion of which hepatic vein had been selected was incorrect in nine patients (45%), detected unfavorable PV anatomy that required modification of equipment or technique in seven patients (35%), permitted estimation of the trajectory required to access the targeted PV in all patients (100%), assisted in selecting the optimal point along the hepatic vein for origination of the needle pass in 11 patients (55%), allowed avoidance of a large hepatocellular carcinoma in one patient (5%), and confirmed that access into the main PV was intrahepatic in four patients (20%). The mean number of needle passes decreased from 10.4 in the historic control group to 4.6 in the 3D US group (P = .0001). CONCLUSION: 3D US provided imaging information that detected technical errors and altered anatomy, and provided positional and directional information to significantly improve needle pass efficiency.
Asunto(s)
Imagenología Tridimensional , Vena Porta/diagnóstico por imagen , Derivación Portosistémica Intrahepática Transyugular , Ultrasonografía Intervencional/métodos , Adulto , Anciano , Várices Esofágicas y Gástricas/cirugía , Femenino , Fluoroscopía , Venas Hepáticas/diagnóstico por imagen , Humanos , Hígado/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Vena Porta/anatomía & histología , Estadísticas no ParamétricasRESUMEN
PURPOSE: We investigated the relationship between the basal and treatment-induced change in the tumor expression of the drug resistance gene MDR1 and the cellular injury response gene GADD153, and clinical response to paclitaxel treatment. METHODS: MDR1 and GADD153 mRNA levels were measured by reverse transcriptase polymerase chain reaction (RT-PCR) in tumor samples obtained by fine needle aspiration biopsy from 14 patients before and 24 h after paclitaxel infusion. RESULTS: There was no difference between responders and non-responders with respect to either the basal MDR1 mRNA level or the change in MDR1 mRNA level at 24 h after treatment (P = 0.464). Likewise, there was no difference in basal GADD153 mRNA level between responders and non-responders. However, there was a significantly greater increase in GADD153 mRNA at 24 h in responders compared with non-responders (P = 0.005). An increase in GADD153 mRNA level of 1.5-fold or higher predicted response with a sensitivity of 86% and a specificity of 100%. CONCLUSIONS: An increase in GADD153 mRNA level reflects chemotherapy-induced damage sufficient to be manifest as a clinically detectable reduction in tumor volume. Measurement of the change in GADD153 mRNA level successfully identified patients destined to respond as early as 24 h post-treatment.
Asunto(s)
Antineoplásicos Fitogénicos/uso terapéutico , Proteínas Potenciadoras de Unión a CCAAT , Proteínas de Unión al ADN/genética , Neoplasias/tratamiento farmacológico , Paclitaxel/uso terapéutico , ARN Mensajero/análisis , Factores de Transcripción/genética , Miembro 1 de la Subfamilia B de Casetes de Unión a ATP/genética , Femenino , Humanos , Neoplasias/metabolismo , Paclitaxel/farmacología , Factor de Transcripción CHOP , Células Tumorales CultivadasAsunto(s)
Derivación Portosistémica Intrahepática Transyugular/métodos , Ultrasonografía Intervencional/métodos , Angiografía , Ascitis/cirugía , Biopsia , Várices Esofágicas y Gástricas/cirugía , Estudios de Factibilidad , Fluoroscopía , Hemorragia Gastrointestinal/cirugía , Venas Hepáticas/diagnóstico por imagen , Venas Hepáticas/cirugía , Humanos , Hipertensión Portal/cirugía , Hígado/irrigación sanguínea , Cirrosis Hepática/cirugía , Agujas , Sistemas en Línea , Vena Porta/diagnóstico por imagen , Vena Porta/cirugía , Derivación Portosistémica Intrahepática Transyugular/instrumentación , Radiografía Intervencional , Transductores , Ultrasonografía Intervencional/instrumentaciónRESUMEN
Experimental aspiration of water soluble contrast agents was performed on rats via transoral endotracheal injection. Iopamidol, iohexol and diatrizoate were the contrast agents tested. One group of rats received normal saline as a control. Adjusted lung weights were measured at 2 and 24 hours post aspiration. Radiographs were taken at 2 and 24 hours post aspiration and scored for abnormal pulmonary air space density. Diatrizoate alone demonstrated an increase in adjusted lung weights. Diatrizoate, iopamidol and iohexol showed abnormal pulmonary air space disease on radiographs at 2 hours but not at 24 hours. Histopathologic examination of rat lungs following aspiration of all three contrasts showed pulmonary vascular congestion and perivascular edema. Iopamidol showed evidence of acute cellular inflammation. Iohexol provoked a pulmonary alveolar macrophage response.
Asunto(s)
Inhalación , Yohexol/toxicidad , Yopamidol/toxicidad , Pulmón/efectos de los fármacos , Respiración , Animales , Diatrizoato/administración & dosificación , Diatrizoato/toxicidad , Yohexol/administración & dosificación , Yopamidol/administración & dosificación , Pulmón/patología , Masculino , Tamaño de los Órganos/efectos de los fármacos , Ratas , Ratas Endogámicas , Trastornos Respiratorios/inducido químicamente , Trastornos Respiratorios/patologíaRESUMEN
To ascertain whether salmon calcitonin, usually given parenterally, could control active Paget's disease when given by nasal insufflation, intranasal salmon calcitonin (INSC) was given to nine men with Paget's disease whose serum alkaline phosphatase (SAP) levels were elevated twofold or more. Treatment with 100, 200, and 400 IU/day for three to nine months was well tolerated. SAP fell 31%-51% in three patients and more than 20% in two others. Three of four men who had previously received salmon calcitonin (SC) by injection had no response of SAP but had a rise in antibodies to SC. INSC is mildly effective and more convenient than parenteral SC, but dose response and efficacy relative to parenteral SC have not been established, thereby raising questions of cost-effectiveness.