Liver-directed treatments of liver-dominant metastatic leiomyosarcoma

PURPOSEThe purpose of this study was to determine the safety and efficacy of liver-directed therapies in patients with unresectable metastatic leiomyosarcoma to the liver. Liver-directed therapies included in this study were transarterial chemoembolization with doxorubicin eluting beads (DEB-TACE), yttrium-90 (Y90) radioembolization, and percutaneous microwave ablation.METHODSThis is a single institution retrospective study of unresectable metastatic leiomyosarcoma to the liver treated with DEB-TACE, radioembolization, or microwave ablation. DEB-TACE was performed using 70–150 or 100–300 µ doxorubicin-loaded drug-eluting LC beads. Radioembolization was performed using Y90 glass microspheres. Electronic medical records were retrospectively reviewed to evaluate clinical and biochemical toxicities, tumor response on imaging, overall survival (OS), and liver progression-free survival (PFS).RESULTSA total of 24 patients with metastatic leiomyosarcoma to the liver who underwent liver-directed treatment were identified (8 males, 16 females; average age, 62.8±11.4 years). Of these patients, 13 underwent DEB-TACE, 6 underwent Y90, and 5 underwent ablation. Three patients received a combination of treatments: one received Y90 followed by DEB-TACE, one received ablation followed by DEB-TACE, and one received ablation followed by Y90. Of the 24 patients, 19 received prior chemotherapy. At 3-month follow-up, grade 1 or 2 lab toxicities were found in 20 patients; 3 patients had grade 3 toxicities. A grade 3 clinical toxicity was reported in one patient. MELD score was 7.5±1.89 at baseline and 8.8±4.2 at 3 months. Median OS was 59 months (95% CI, 39.8–78.2) from diagnosis, 27 months (95% CI, 22.9–31.0) from development of liver metastasis, and 9 months (95% CI, 0–21.4) from first liver-directed treatment. Median liver PFS was 9 months (95% CI, 1.4–16.6).CONCLUSIONTreatment with liver-directed therapies for patients with unresectable metastatic leiomyosarcoma to the liver is safe and can improve overall survival, with OS after liver-directed therapy being similar to patients who underwent surgical resection

A one step procedure for the mono-acylation of symmetrical 1,2-diols

A series of lanthanide (III) salts have been shown to catalyze the monoacylation of symmetrical 1,2-diols by carboxylic acid anhydrides with surprisingly high selectivity

A method for digitized flow-volume curves and expiratory resistance measurements using standard ventilatory equipment

Pulmonary resistance may be assessed in ventilated patients by analysis of passive expiratory pressure and flow properties of the respiratory system. Such measurements are generally complex and require specialized equipment. To facilitate expiratory airway mechanics measurements, we have developed a method for automatically recording and analyzing expiratory pressure flow curves in mechanically ventilated patients using standard ventilatory equipment and a personal computer. Simultaneous digital pressure, flow, and volume recordings are obtained with this system during exhalation. These values allow continuous calculation of ventilator circuitry and total system resistance, which could be used for assessing expiratory airway resistance in intubated patients. The accuracy of these methods was tested by comparison to standard analog recorder pressure-flow methods using two lung models as well as by testing in normal volunteers ventilated through a mouthpiece. In all situations (flows, pressures, and volumes) there was excellent correlation between data generated from the automatic digital method and standard analog methods (all r values > .9, slopes 0.9 to 1.02, P < .001, flow bias -0.02 L/min, flow precision 0.08 L/min, volume bias 0.008 L, volume precision 0.027 L). Expiratory resistance (using expiratory time-constant cord methods) also correlated well between automatic digital and standard analog analyses (r = .9, slope 0.98, P < .001). We found that expiratory flow limb resistances (airway, tubing, filters, and valves) were substantial (range, 5.5 to 14.0 cm H2O/L/s) and are varied throughout the expiratory cycle. Therefore, measurement of expiratory-flow limb resistance is necessary for accurate clinical assessment of pulmonary resistance for any system analyzing expiratory flow mechanics in ventilated patients. We conclude that this simple and convenient method allows automatic and accurate construction of pulmonary expiratory flow properties and may enable measurement of passive expiratory resistance. Rapid and accurate measurements of expiratory lung mechanics may be possible at the bedside of ventilated patients using standard ventilatory equipment with these methods. © 1992

A method for digitized flow-volume curves and expiratory resistance measurements using standard ventilatory equipment

Pulmonary resistance may be assessed in ventilated patients by analysis of passive expiratory pressure and flow properties of the respiratory system. Such measurements are generally complex and require specialized equipment. To facilitate expiratory airway mechanics measurements, we have developed a method for automatically recording and analyzing expiratory pressure flow curves in mechanically ventilated patients using standard ventilatory equipment and a personal computer. Simultaneous digital pressure, flow, and volume recordings are obtained with this system during exhalation. These values allow continuous calculation of ventilator circuitry and total system resistance, which could be used for assessing expiratory airway resistance in intubated patients. The accuracy of these methods was tested by comparison to standard analog recorder pressure-flow methods using two lung models as well as by testing in normal volunteers ventilated through a mouthpiece. In all situations (flows, pressures, and volumes) there was excellent correlation between data generated from the automatic digital method and standard analog methods (all r values > .9, slopes 0.9 to 1.02, P < .001, flow bias -0.02 L/min, flow precision 0.08 L/min, volume bias 0.008 L, volume precision 0.027 L). Expiratory resistance (using expiratory time-constant cord methods) also correlated well between automatic digital and standard analog analyses (r = .9, slope 0.98, P < .001). We found that expiratory flow limb resistances (airway, tubing, filters, and valves) were substantial (range, 5.5 to 14.0 cm H O/L/s) and are varied throughout the expiratory cycle. Therefore, measurement of expiratory-flow limb resistance is necessary for accurate clinical assessment of pulmonary resistance for any system analyzing expiratory flow mechanics in ventilated patients. We conclude that this simple and convenient method allows automatic and accurate construction of pulmonary expiratory flow properties and may enable measurement of passive expiratory resistance. Rapid and accurate measurements of expiratory lung mechanics may be possible at the bedside of ventilated patients using standard ventilatory equipment with these methods. © 1992.

Thoracoscopic carbon dioxide laser treatment of bullous emphysema.

A new technique of thoracoscopic laser ablation of pulmonary bullae suitable for patients with multiple bullae and diffuse emphysema was developed and assessed in 22 patients. 20 of 22 patients survived. Pre-operative and postoperative functional evaluation is available for the 11 patients followed up for more than a month; at 1 to 3 months postoperatively there were increases in FVC (mean 2.0 litres pre-operatively to 2.7 litres postoperatively, p less than 0.001), in FEV1 (0.74 to 1.06 litres, p = 0.01), and in maximum exercise treadmill times (5.4 min to 8.0 min, p less than 0.01). Postoperative air leaks lasted a mean of 13 days and usually resolved spontaneously. Other complications were bleeding (1 patient) and unilateral acute lung injury (1 patient). These results suggest that selected patients with diffuse emphysema and pulmonary bullae may benefit from thoracoscopic carbon dioxide laser ablation