Chemoembolization with drug-eluting microspheres (DEM-TACE) for hepatocellular carcinoma: single-center review of safety and efficacy

VL Bishay,1 K Maglione,1 R Khanna,2 KM Lee,1 AM Fischman,1 RA Lookstein,1 E Kim1 1Department of Radiology, Icahn School of Medicine at the Mount Sinai Hospital, New York, NY, USA; 2Department of Radiology, Queens Hospital Center, Jamaica, NY, USA Purpose: This study examines the safety and efficacy of transarterial chemoembolization using doxorubicin-loaded 30–60 µm QuadraSphere microspheres (DEM-TACE) for the treatment of hepatocellular carcinoma. Materials and methods: Over 10 weeks, patients with hepatocellular carcinoma. (Child–Pugh A/B: 65%/35%) were embolized with 30–60 µm QuadraSphere microspheres. Excluded patients had previous locoregional therapy, macrovascular invasion, extrahepatic disease, Child–Pugh score >B7, ECOG performance status >0, and total bilirubin >3 mg/dL. Technical success, minor and major complications, 30-day hospital readmission rate, and 30-day mortality were assessed. α-Fetoprotein levels before and after treatment were compared. Local response was evaluated by radiologic tumor response per modified Response Evaluation Criteria in Solid Tumors 1 month after treatment. Results: Thirty tumors (mean size, 2.3 cm; range, 1.0–4.9 cm) were treated in 20 patients (16 male and 4 female; mean age, 64.7 years). There were no major complications. Thirty-day mortality was 0%. Minor complications included postembolization syndrome in 16.7% of cases and transient rise in liver enzymes requiring no therapy. Mean a-fetoprotein levels trended down following treatment (71.8±201.9 ng/mL vs 53.4±116.7 ng/mL), but were not statistically significant. Complete response was achieved in 30% of patients, partial response in 35%, stable disease in 30%, and progression of disease in 5%. Overall objective response was 65%. Mean follow-up was 10.4 months (range, 2–16.4 months). Conclusion: DEM-TACE with doxorubicin-loaded 30–60 µm QuadraSpheres is feasible, well tolerated, and associated with promising tumor response in early and intermediate stage disease. Keywords: microspheres, carcinoma, liver, tumo

Novel Management of Complicated Renal Artery Aneurysm: Laparoscopic Nephrectomy and Ex-Vivo

Background and Purpose: Renal artery aneurysm (RAA) is an infrequently seen disease entity but one with the potential for significant morbidity and mortality. Complications related to RAA include pain, hematuria, hypertension, and, rarely, rupture. Management is often based on symptomatology or, if symptoms are not present, the potential for rupture with increased size. Treatment options include observation, endovascular methods, or open surgical approaches, including aneurysm repair or nephrectomy. Complex cases often preclude endovascular approaches. We report our initial experience with laparoscopic nephrectomy, ex vivo back-table repair of the aneurysm, and iliac fossa autotransplant in cases of complex RAA. Patients and Methods: Two patients underwent laparoscopic nephrectomy with RAA repair and heterotopic autotransplant from May 2006 to November 2008. Etiology of the RAA was atherosclerosis in one patient and idiopathic in the second. Laparoscopic nephrectomy and back-table arterial reconstruction was performed, including aneurysmectomy and ostial closure. Patient 2 needed a gonadal vein graft for arterial reconstruction. Both patients had autotransplant into the right iliac fossa. Results: Both patients were women. Mean age was 52.5 years (range 39–66 yrs). Mean operative blood loss was 550 mL (range 350–750 mL). Mean length of stay was 5.5 days (range 5–6 d). Mean discharge creatinine level was 0.8 mg/dL (range 0.5–1.1 mg/dL). No perioperative complications were reported. At last follow-up, all patients are alive with functioning autotransplant and no evidence of functional impairment. Conclusion: Management of complex RAA with laparoscopic nephrectomy, extracorporeal repair, and autotransplant is a feasible and successful method with minimal morbidity

Kristallnacht in Context: Jewish War Veterans in America And Britain and the Crisis of German Jewry

Based on work conducted by scholars as part of a Summer Research Workshop organized bythe Center for Advanced Holocaust Studies/United States Holocaust ..