An Update on Overview of Cellulose, Its Structure and Applications

Cellulose (C6H10O5)n is one of the most ubiquitous organic polymers on the planet. It is a significant structural component of the primary cell wall of green plants, various forms of algae and oomycetes. It is a polysaccharide consisting of a linear chain of several hundred to many thousands of β(1 → 4) linked d-glucose units. There are various extraction procedures for cellulose developed by using different processes like oxidation, etherification and esterification which convert the prepared celluloses in to cellulose derivatives. Since it is a non-toxic, bio-degradable polymer with high tensile and compressive strength, it has widespread use in various fields such as nanotechnology, pharmaceutical industry, food industry, cosmetics, textile and paper industry, drug-delivery systems in treating cancer and other diseases. Micro-crystalline cellulose in particular is among the most frequently used cellulose derivatives in the food, cosmetics, pharma industry, etc. and is an important excipient due to its binding and tableting properties, characterized by its plasticity and cohesiveness when wet. Bacterial cellulose’s high dispensability, tasteless and odourless nature provides it with lot of industrial applications. Currently, about half of the waste produced in India contains about 50% cellulose which can be used productively. This chapter deals with the chemistry of cellulose, its extraction and its properties which help various industries to make the most of it

Percutaneous Approach to Irreversible Electroporation of the Pancreas: Miami Protocol

Despite advances in the treatment of unresectable locally advanced pancreatic cancer, outcomes remain poor. Irreversible electroporation is a nonthermal ablative modality whose role in the management of locally advanced pancreatic cancer is being studied. This review highlights patient selection, preparation, and follow-up as well as discusses the techniques to achieve safe and effective tumor ablation in this challenging location

Colorectal Liver Metastasis: Overview of Treatment Paradigm Highlighting the Role of Ablation

The objective of this article is to discuss the current treatment options for colorectal cancer (CRC) liver metastases and the role of ablation.A randomized control trial of ablation combined with chemotherapy showed improved overall survival compared with chemotherapy alone. Local recurrence rates are comparable to those associated with resection when ablative margins of more than 5 mm are achieved and target lesions are smaller than 3 cm. In patients with unresectable disease, ablation for curative intent should be considered

Congenital absence of the portal vein complicated by hepatocellular carcinoma in the liver of an adult woman: review of imaging, literature and management

We present a case of absence of the portal vein and Laennec’s cirrhosis in a 51-year-old female who was diagnosed with hepatocellular carcinoma (HCC). Only 101 cases of this malformation of the splanchnic vasculature have been reported of which 4 were reported to have HCC. Patient had disease progression while waiting for a liver transplant. Patient was treated with 3 separate conventional transarterial chemoembolization procedures at an outside hospital. At our institution, radioembolization of the right hepatic lobe was performed. She succumbed to liver insufficiency 8 years after being diagnosed with HCC. The features of this patient’s clinical course are reviewed

Malignant Ascites: An Overview of Management With Tunneled Peritoneal Drainage Catheters

Malignant ascites is a common and debilitating condition. Treatment options favoring palliative approach are preferred. A discussion of tunneled peritoneal catheters as a management option is included in the following review

Transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC) with a novel radiopaque (RO) drug eluting bead (DEB)

366 Background: Preclinical studies have suggested that RO beads may offer advantages over standard microspheres used for TACE of HCC. The ability to image bead distribution during the procedure is expected to improve the coverage of the tumor minimizing off-target delivery. We conducted a retrospective analysis of efficacy and safety of RO DEB-TACE in patients with HCC. Methods: Forty-eight patients (38 males and 10 females, median age 64 years) with nodular, noninvasive HCC unsuitable for curative treatments, Child-Pugh A (n = 29) or B (n = 19) liver functional status, and ECOG PS 0-1 received DEB-TACE with injection of 2-4 ml of 70-150-micron RO microspheres (LC Bead LUMI; BTG-Biocompatibles) loaded with 37.5 mg/ml doxorubicin. Thirty-seven of 48 patients (77%) had unilobar disease and 11 of 48 (23%) bilobar tumors. The baseline sum tumor diameter was 5.3±2.6 cm (range, 1.2-14.5 cm). The primary endpoint was tumor response by mRECIST. Secondary endpoints were time to progression (TTP), overall survival (OS), and safety. Results: The number of treatments was 1 in 28 patients (58%), 2 in 16 (33%), and 3 in 4 (8%). The mean doxorubicin dose per treatment was 43.9±34.4mg (range, 3.3-150 mg). Best response was CR, PR, SD, and PD in 32, 10, 4 and 2 patients, respectively, for an objective response rate (ORR) of 87.5%. Median TTP was 8.5 months (95% CI, 6.7-not reached). Median OS was not reached in Child class A patients; in class B patients it was 19.5 months (95% CI, 6.0-not reached). There was one treatment-emergent grade 5 AE unrelated to treatment. Grade 3/4 AEs included pain (n = 4), fatigue (n = 2), and fever (n = 1). Grade 3/4 laboratory abnormalities were thrombocytopenia (n = 9), leukopenia (n = 3), elevation of transaminases (n = 3) or bilirubin (n = 3), and anemia (n = 2). Conclusions: In this first clinical study, treatment with RO DEB-TACE resulted in a high ORR and was well tolerated. The encouraging efficacy signal requires confirmation with long-term survival data

Liver Function Tests Following Irreversible Electroporation of Liver Tumors: Experience in 174 Procedures

Irreversible electroporation (IRE) is a relatively new ablation modality that uses electric currents to cause cell death. It is commonly used to treat primary and secondary liver tumors in patients with normal liver function and preexisting cirrhosis. Retrospective analysis of 205 procedures sought to evaluate changes in liver function after IRE. Liver function tests (LFTs) results before and after IRE were evaluated from 174 procedures in 124 patients. Aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase (ALKP), and total bilirubin levels were analyzed. The study was Health Insurance Portability and Accountability Act compliant and institutional review board approved. Informed consent was waived. Changes in LFT results after IRE were compared with baseline and were followed up over time to see if they resolved. Changes were compared with volume of ablation. The greatest perturbations were in transaminase levels. The levels increased sharply within 24 hours after IRE in 129 (74.1%) procedures to extreme levels (more than 20 times the upper limit of normal in one-third of cases). Resolution occurred in 95% and was demonstrated to have occurred by a mean of approximately 10 weeks, many documented as early as 7 days after procedure. ALKP levels elevated in 10% procedures, was slower to increase, and was less likely to resolve. Total bilirubin level demonstrated 2 different patterns of elevation--early and late--and similar to ALKP, it was more likely to remain elevated. There was no increased risk in patients with cirrhosis or cholangiocarcinoma. There was no correlation of levels with volume of ablation. IRE results in significant abnormalities in LFT results, but in most of the cases, these are self-limiting, do not preclude treatment, and are similar to the changes seen after radiofrequency and cryoablation in the liver