Arterial Therapies of Non-Colorectal Liver Metastases.

BACKGROUND: The unique situation of the liver with arterial and venous blood supply and the dependency of the tumor on the arterial blood flow make this organ an ideal target for intrahepatic catheter-based therapies. Main forms of treatment are classical bland embolization (TAE) cutting the blood flow to the tumors, chemoembolization (TACE) inducing high chemotherapy concentration in tumors, and radioembolization (TARE) without embolizing effect but very high local radiation. These different forms of therapies are used in different centers with different protocols. This overview summarizes the different forms of treatment, their indications and protocols, possible side effects, and available data in patients with non-colorectal liver tumors. METHODS: A research in PubMed was performed. Mainly clinical controlled trials were reviewed. The search terms were 'embolization liver', 'TAE', 'chemoembolization liver', 'TACE', 'radioembolization liver', and 'TARE' as well as 'chemosaturation' and 'TACP' in the indications 'breast cancer', 'neuroendocrine', and 'melanoma'. All reported studies were analyzed for impact and reported according to their clinical relevance. RESULTS: The main search criteria revealed the following results: 'embolization liver + breast cancer', 122 results, subgroup clinical trials 16; 'chemoembolization liver + breast cancer', 62 results, subgroup clinical trials 11; 'radioembolization liver + breast cancer', 37 results, subgroup clinical trials 3; 'embolization liver + neuroendocrine', 283 results, subgroup clinical trials 20; 'chemoembolization liver + neuroendocrine', 202 results, subgroup clinical trials 9; 'radioembolization liver + neuroendocrine', 64 results, subgroup clinical trials 9; 'embolization liver + melanoma', 79 results, subgroup clinical trials 15; 'chemoembolization liver + melanoma', 60 results, subgroup clinical trials 14; 'radioembolization liver + melanoma', 18 results, subgroup clinical trials 3. The term 'chemosaturation liver' was tested without indication since only few publications exist and provided us with five results and only one clinical trial. CONCLUSION: Despite many years of clinical use and documented efficacy on intra-arterial treatments of the liver, there are still only a few prospective multicenter trials with many different protocols. To guarantee the future use of these efficacious therapies, especially in the light of many systemic or surgical therapies in the treatment of non-colorectal liver metastases, further large randomized trials and transparent guidelines need to be established

Use of the STAT (Sutureless Telescoping Anastomosis Technique) to facilitate supraaortic revascularization: Mid-term Results

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Long-term results of simplified frozen elephant trunk technique in complicated acute type A aortic dissection: A case–control study

Aim: To describe the long-term experience of a simplified frozen elephant trunk technique (sFETT) used in complicated acute type A aortic dissection (AAAD) treatment. Methods and results: Between January 2001 and December 2012, 34 patients (mean age 59.9 ± 11.0 years) with complicated AAAD (DeBakey I) underwent an emergency surgery including sFETT. sFETT consisted in gluing the dissected aortic arch wall layers with gelatine-resorcinol adhesive and video-assisted antegrade open arch aortic stent-graft deployment in the arch or proximal descending aorta. In addition to sFETT, the aortic root was addressed with standard techniques. A 30-day mortality was 14.7% (five patients) due to bleeding (1), multiple organ failure (2), and colon ischemia (2). Postoperative morbidity included neurological (2), renal (1) and cardio-pulmonary complications (4), as well as wound infection (1). Mean follow-up was 74.4 ± 45.0 months. Actual survival rates were 73.5% at 1 year, 70.2% at 5 years, and 58.5% at 13 years of follow-up. Six patients died during long-term follow-up from heart failure (1) and unknown reasons (5). Five patients required reoperation for aortic arch (3) or aorto-iliac (2) progression of aneurysm during the mid- and long-term follow-up. The remaining patients showed favorable evolution of the dissected aorta with false lumen occlusion in most cases and stable aortic diameters. Conclusions: In AAAD patients, sFETT as used in our series is an easy and safe technique to repair the aortic arch. Long-term results after sFETT showed false lumen occlusion and stable aortic diameter in up to 13 years of follow-up

Load sensitive stable current source for complex precision pulsed electroplating

Electrodeposition is a highly versatile and well explored technology. However, it also depends strongly on the experience level of the operator. This experience includes the pretreatment of the sample, and the composition of the electrolyte settings of the plating parameters. Accurate control over the electroplating current is needed especially for the formation of small structures, where pulsed electrodeposition has proven to reduce many unwanted effects. To bring precision into the formation of optimal recipes, a highly flexible current source based on a microcontroller was developed. It allows a large variety of pulse waveforms, as well as maintaining a feedback loop that controls the current and monitors the output voltage, allowing for both galvanostatic (current driven) and potentiostatic (voltage driven) electrodeposition. The system has been implemented with multiple channels, permitting the simultaneous electrodeposition of multiple substrates in parallel. Being based on a microcomputer, the system can be programmed using predefined recipes individually for each channel, or even adapt the recipes during plating. All measurement values are continuously recorded for the purpose of documentation and diagnosis. The current source is based on a high power operational amplifier in a modified Howland current source configuration. This paper describes the functionality of the electrodeposition system, with a focus on the stability of the source current under different electrodeposition current densities and frequencies. The performance and high capability of the system is demonstrated by performing and analyzing two nontrivial plating applications

Akute komplizierte Typ-B-Dissektion – was leistet die endovaskuläre Therapie?

BACKGROUND Acute aortic dissection type B is a severe and life-threatening vascular emergency. Complications such as rupture and/or malperfusion of organs are the main reasons for early mortality. OBJECTIVES The aim is to provide an overview on important diagnostic radiological findings, conservative as well as endovascular therapeutic options for patients presenting with rupture or malperfusion syndromes. RESULTS Medical treatment consisting of blood pressure and heart rate control as well las adequate analgesia remains the cornerstone therapy of all type B aortic dissections. In case of organ malperfusion, various endovascular therapies, e. g., endoluminal fenestration of dissection flap, thoracic stent-graft implantation (TEVAR) or branch vessel stenting, are available. In the case of aortic rupture, TEVAR has become the standard owing to its lower mortality compared to open surgical repair. DISCUSSION For the treatment of complicated type B aortic dissection, a number of endovascular options are available. For optimal treatment, profound knowledge of the disease, of the diagnostic workup, and of the interventional procedures is mandatory

Prospective morphologic and dynamic assessment of deep flexor tendon healing in zone II by high-frequency ultrasound: Preliminary experience

Preliminary data of this study indicate a better clinical outcome if a sutured tendon maintains a spindlelike shape and increased power Doppler signal. This might indicate a predominantly intrinsic healing pattern with reduced adhesion formation. Ultrasound morphology, power Doppler signal, and tendon excursion may be helpful tools to rate tendon healing and to establish individually modified rehabilitation protocols

Thoraco-abdominal high-pitch dual-source CT angiography: Experimental evaluation of injection protocols with an anatomical human vascular phantom

OBJECTIVE: To experimentally evaluate three different contrast injection protocols at thoraco-abdominal high-pitch dual-source computed tomography angiography (CTA), with regard to level and homogeneity of vascular enhancement at different cardiac outputs. MATERIALS AND METHODS: A uniphasic, a biphasic as well as an individually tailored contrast protocol were tested using a human vascular phantom. Each protocol was scanned at 5 different cardiac outputs (3-5L/min, steps of 0.5L/min) using an extracorporeal cardiac pump. Vascular enhancement of the thoraco-abdominal aorta was measured every 5cm. Overall mean enhancement of each protocol and mean enhancement for each cardiac output within each protocol were calculated. Enhancement homogeneity along the z-axis was evaluated for each cardiac output and protocol. RESULTS: Overall mean enhancement was significantly higher in the uniphasic than in the other two protocols (all p<.05), whereas the difference between the biphasic and tailored protocol was not significant (p=.76). Mean enhancement among each of the 5 cardiac outputs within each protocol was significantly different (all p<.05). Only within the tailored protocol mean enhancement differed not significantly at cardiac outputs of 3.5L/min vs. 5L/min (484±25HU vs. 476±19HU, p=.14) and 4 vs. 5L/min (443±49HU vs. 476±19HU, p=.05). Both, uniphasic and tailored protocol yielded homogenous enhancement at all cardiac outputs, whereas the biphasic protocol failed to achieve homogenous enhancement. CONCLUSION: This phantom study suggests that diagnostic and homogenous enhancement at thoraco-abdominal high-pitch dual-source CTA is feasible with either a uniphasic or an individually tailored contrast protocol

Diffusion tensor imaging of the median nerve: intra-, inter-reader agreement, and agreement between two software packages

Objective To assess intra-, inter-reader agreement, and the agreement between two software packages for magnetic resonance diffusion tensor imaging (DTI) measurements of the median nerve. Materials and methods Fifteen healthy volunteers (seven men, eight women; mean age, 31.2 years) underwent DTI of both wrists at 1.5 T. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of the median nerve were measured by three readers using two commonly used software packages. Measurements were repeated by two readers after 6 weeks. Intraclass correlation coefficients (ICC) and Bland-Altman analysis were used for statistical analysis. Results ICCs for intra-reader agreement ranged from 0.87 to 0.99, for inter-reader agreement from 0.62 to 0.83, and between the two software packages from 0.63 to 0.82. Bland-Altman analysis showed no differences for intra- and inter-reader agreement and agreement between software packages. Conclusion The intra-, inter-reader, and agreement between software packages for DTI measurements of the median nerve were moderate to substantial suggesting that userand software-dependent factors contribute little to variance in DTI measurements

Outpatient Yttrium-90 microsphere radioembolization: assessment of radiation safety and quantification of post-treatment adverse events causing hospitalization.

Quantification of post-interventional adverse events of outpatient SIRT leading to hospitalization and quantification of radiation exposure. In this single-center, retrospective cohort study, we reviewed 212 patients treated with SIRT ( &lt;sup&gt;90&lt;/sup&gt; Y-microspheres) for primary and secondary liver malignancies. We searched for adverse events (AEs) and serious adverse events (SAEs), defined as AE's causing hospitalization. Additionally, radiation exposure was measured in 36 patients. Seven patients had an SAE (3.3%), four patients had AE without readmission/hospitalization (1.9%) and 201 patients had no complications (94.8%). The mean ambient dose rate at 1 m distance from the source after administration of &lt;sup&gt;90&lt;/sup&gt; Y-microspheres was 1.88 µSv/h ± 0.74 (± SD) with a range from 4.3 to 0.2 µSv/h. Outpatient radioembolization with &lt;sup&gt;90&lt;/sup&gt; Y-microspheres is safe and requires hospitalization only in a very small number of patients. The mean dose rate was low and met the national conditions for outpatient treatment (&lt; 5 µSv/h)