Four Chinese patients with extensive smooth muscle tumors of the inferior vena cava (IVC) and right heart are described. Two patients had primary IVC leiomyosarcomas and one had both IVC and cardiac metastases from uterine leiomyosarcoma. The remaining patient had extra-uterine intravenous leiomyomatosis, with extensive tumor calcification. Clinical presentation was variable, consisting of the Budd-Chiari syndrome, a new heart murmur, and signs of cerebral embolism. All the lesions were defined radiologically prior to surgical resection of cardiac tumors.

Adult↗

PubMedDate not supplied

Transcatheter arterial chemoembolization in inoperable hepatocellular carcinoma: four-year follow-up.

PURPOSE: To evaluate the efficacy of repeated chemoembolization in patients with inoperable hepatocellular carcinoma (HCC). PATIENTS AND METHODS: One hundred thirty-two patients with HCC underwent transcatheter arterial chemoembolization with an emulsion of iodized oil and cisplatin. In 104 patients, "light" gelatin sponge embolization was also used. Chemoembolization was repeated every 1.5-3.0 months in most patients (range, one to 18 chemoembolization sessions). RESULTS: In 74 patients, the HCCs became smaller or disappeared after chemoembolization. Decreases in size were seen in 55 of 76 HCCs 9 cm or smaller, 17 of 42 HCCs between 9 and 18 cm, and two of 14 HCCs larger than 18 cm. Use of gelatin sponge pledgets enhanced the response in tumors larger than 9 cm. Seven of 74 HCCs that responded to chemoembolization increased in size later. New daughter nodules that appeared at other sites responded to chemoembolization in 24 of 40 patients. Further new nodules appeared in 14 of 24 patients, and in six patients they responded to therapy. Median survival was 26 months for patients with responsive HCCs and 5 months for those with unresponsive lesions. CONCLUSION: Tumor size at the start of chemoembolization influenced the response to treatment and survival. The addition of gelatin sponge improved results only in tumors larger than 9 cm. Recurrence after an initial response was due more to the appearance of new daughter nodules in new locations rather than recrudescence of the presenting tumor.

Adolescent↗

PubMedDate not supplied

Spinal pseudarthrosis in ankylosing spondylitis.

Spinal pseudarthrosis is an important mechanical complication in longstanding ankylosing spondylitis. Thirty-five patients with 40 lesions were studied. Three lesions through vertebral bodies resulted from complete fractures. The rest occurred at interspaces, more common at the lower thoracic and upper lumbar segments. Double pseudarthrotic lesions were observed in 5 patients. Progressive osteolysis of the anterior elements was prominent, with variable sclerosis, osteophytes, vacuum phenomenon, subluxation and fragmentation. A posterior element weak link, as a bony break or facet joint non-fusion, was an essential component in every lesion, playing an initiating or perpetuating role in its pathogenesis. Mechanical derangement from trauma, severe round kyphosis, spondylodiscitis, hip disease, spinal operation and unusual activities may be contributing factors. Initial treatment is conservative, but 16 patients required operative stabilisation.

Adult↗