A high-performance liquid chromatographic method for simultaneous determination of free catecholamines, their basic metabolites and serotonin in human urine was developed. The compounds were separated on a precolumn of cation-exchange resin and a mixed-mode (C18/cation-exchange) column and determined by an eight-channel electrochemical detector. By this method, free norepinephrine (NE), epinephrine (E), dopamine (DA), normetanephrine (NMN), metanephrine (MN), 3-methoxy-tyramine (3-MT) and serotonin (5-HT) were determined in 40 min with inter-assay precision of 1.9, 3.2, 1.2, 1.6, 1.6, 5.5 and 3.2%, respectively. Detection limits were between 0.05 (E) and 0.3 (3-MT) pmol. The mean values of analytical recovery for NE, E, DA, NMN, MN, 3-MT, 5-HT were 99, 104, 104, 99, 102, 109 and 99%, respectively.

Buffers↗

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Treatment of malignant tracheobronchial stenosis by Dacron mesh-covered Z-stents.

Z-stents partially covered with an expandable Dacron mesh into which epinephrine and thrombin were infiltrated, were used to reopen both mainstem bronchi, stenosed by bronchogenic carcinoma and to deliver hemostatic agents to the lesion. On follow-up 4 and 6 weeks later, airway patency was retained, the tumor surface was compressed, and the glossy surface of the stent suggested that it was covered with mucosa. For treatment of airway stenosis due to cancer invasion, a stent covered with a Dacron mesh sheet is thought to be effective in compressing the tumor and preventing tumor ingrowth into the stent.

Aged↗

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Transcatheter arterial chemoembolization (TACE) in the treatment of unresectable liver cancer.

Basis, techniques, and recent strategies and results of interventional treatments for hepatoma were reviewed. The basic experimental researches indispensable to justify clinical technique and dosage have been accomplished. A total of 1310 unresectable cases underwent transcatheter arterial chemoembolization (TACE) and/or related therapies. The related therapies are several modified or strengthened TACE such as Lipiodol-TACE and subsegmental TACE. The therapies for unembolizable cases are balloon occluded arterial infusion, Lipiodol-SMANCS infusion and percutaneous direct injection chemotherapy, that reinforces the effect of TACE. As for the resectable cases, postoperative TACE was proved to be beneficial because it increased survival rates; however, preoperative TACE was not beneficial. The TACE and related interventional radiologic therapies for the hepatoma can be an equal or superior therapy by virtue of targeting chemotherapy.

Chemoembolization, Therapeutic↗

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Post-TIPS hepatic encephalopathy treated by occlusion balloon-assisted retrograde embolization of a coexisting spontaneous splenorenal shunt.

A 51-year-old man with posthepatitis cirrhosis underwent a transjugular intrahepatic portosystemic shunt (TIPS) for bleeding of recurrent esophageal varices. The patient had a coexisting, spontaneous, splenorenal shunt. He subsequently developed hepatic encephalopathy, presumably due to excessive portosystemic shunting. Since medical management resulted in no significant improvement, the splenorenal shunt was embolized from the jugular vein approach via renal vein access during temporary balloon occlusion. Within a few days, the patient's hepatic encephalopathy resolved. Twelve months later the patient showed no recurrence of encephalopathy and had maintained a patent TIPS.

Catheterization↗

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Pulmonary thromboembolism following angioplasty for membranous occlusion of the vena cava: case report.

Pulmonary thromboembolism following percutaneous transluminal angioplasty for membranous occlusion of the inferior vena cava is reported. Scintigraphy following angioplasty showed a pulmonary perfusion defect with mild hypoxia. The patient recovered after anticoagulant therapy. Pulmonary thromboembolism may be a complication of angioplasty in patients who have membranous occlusions accompanying intracaval thrombus.

Aged↗

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Transcatheter arterial embolization in unresectable hepatocellular carcinoma.

Seven hundred thirty-nine patients with unresectable hepatocellular carcinoma have been treated by transcatheter arterial chemoembolization using gelatin sponge particles soaked in a solution of Mitomycin C and Adriamycin. This therapy can be equal or superior to surgical resection and serves both as embolic therapy and targeted chemotherapy.

Antineoplastic Agents↗

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Percutaneous transluminal angioplasty in segmental obstruction of the hepatic inferior vena cava: long-term results.

Percutaneous transluminal angioplasty (PTA) was performed in 8 patients with segmental obstruction of the hepatic inferior vena cava. Using Grüntzig balloon catheters, canalization and dilatation were initially successful in all 8 patients without any complications. In long-term observation of 12-48 months, recurrence of obstruction was confirmed in 5 patients. These were recanalized easily by repeat PTA. Long-term patency was obtained in 3 patients in whom the lumen was opened to 13 mm or more in diameter as seen in lateral views of the vena cavogram.

Adult↗

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Efficacy of Doppler ultrasonography for assessment of transjugular intrahepatic portosystemic shunt patency.

PURPOSE: To assess the efficacy of Doppler ultrasonography (US) as a noninvasive method for monitoring patency of the transjugular intrahepatic portosystemic shunt (TIPS). METHODS: Twenty-nine patients who had received TIPS for bleeding esophagogastric varices and/or refractory ascites with portal hypertension underwent Doppler US studies within 2 weeks after TIPS. Further studies were performed in 15 of them at 6 months, in 9 at 1 year, and in 4 at 2 years for a total of 57 US studies. The US findings were compared with the angiographic findings obtained at the same time. RESULTS: In 45 of the 57 studies, shunt patency was found by Doppler US, correlating to 44 patencies and one occlusion on angiography. Doppler signal in the shunt could not be detected in 12 studies resulting in the diagnosis of shunt occlusion. This correlated with angiographic occlusion in 8 studies and patency in the remaining 4. All angiographically patent shunts that were occluded by Doppler US had various degrees of stenosis. A number of technical factors were found to be responsible for Doppler US false-positive or false-negative diagnoses, some related to the type of stent used. The Doppler US sensitivity was therefore 92%, the specificity 89%. CONCLUSION: Doppler US is a reliable noninvasive method to evaluate patency of TIPS.

Adult↗

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Effects of hepatic artery embolization with Lipiodol and gelatin sponge particles on normal swine liver.

In order to evaluate the effects of hepatic artery embolization (HAE) with Lipiodol (Lp) and gelatin sponge particles (GSP) on swine liver tissue, we embolized the hepatic arteries of 3 pigs with GSP, 9 with Lp, and 9 with Lp + GSP. None of the pigs embolized with GSP died spontaneously during the 4-week experimental period. One pig embolized with 1 ml/kg Lp and three pigs with 2 ml/kg Lp died within 2 h. Two pigs embolized with 0.5 ml/kg Lp + GSP died the following day. The portal vein pressure (PVP) and wedge hepatic vein pressure (WHVP) values before HAE, immediately after, 1 h after, and 4 weeks after HAE showed no remarkable change in the GSP group. Remarkable and temporary elevation was observed in the more than 0.2 ml/kg Lp group. Remarkable and continuous elevation was observed in the 0.2 ml/kg Lp + GSP and 0.5 ml/kg Lp + GSP groups. Gross and histological studies demonstrated no liver damage in the GSP and Lp group. Liver infarction, circular coagulation necrosis with pseudocapsule, and liver atrophy were found in the Lp + GSP group 4 weeks after HAE. The incidence of infarction, circular coagulation necrosis, and liver atrophy in the livers embolized with 0.2 ml/kg Lp + GSP and 0.5 ml/kg Lp + GSP were 67%, 100%, and 75%, respectively. In conclusion, when the hepatic artery is embolized with Lp + GSP, the volume of Lp should be limited to less than 0.1 ml/kg.

Animals↗

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A triple coaxial catheter system for subselective visceral artery catheterization and embolization: preliminary clinical experience.

We developed a triple coaxial catheter system (TCCS) which consists of a 6.1 Fr outer, a 4.1 Fr intermediate, and a 3.0 Fr inner catheter, all coated with a lubricant. The TCCS was used in seven patients with hepatic tumors, after several attempts to access a targeted vessel with conventional catheters and guidewires failed to reach the targeted vessel. No complications were encountered with the use of this system. TCCS may be a useful device for selective abdominal arteriography.

Aged↗

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Endoluminal treatment of ruptured abdominal aortic aneurysm with small intestinal submucosa sandwich endografts: a pilot study in sheep.

PURPOSE: To evaluate efficacy of small intestinal submucosa (SIS) Sandwich endografts for the treatment of acute rupture of abdominal aortic aneurysms (AAA) and to explore the short-term reaction of the aorta to this material. METHODS: In eight adult sheep, an infrarenal AAA was created transluminally by dilation of a short Palmaz stent. In six sheep, the aneurysm was then ruptured by overdilation of the stent with a large angioplasty balloon. Two sheep with AAAs that were not ruptured served as controls. A SIS Sandwich endograft, consisting of a Z stent frame with 5 bodies and covered inside and out with SIS, was used to exclude the ruptured and non-ruptured AAAs. Follow-up aortography was done immediately after the procedure and before sacrifice at 4, 8, or 12 weeks. Autopsy and histologic studies followed. RESULTS: Endograft placement was successful in all eight sheep. Both ruptured and non-ruptured AAAs were successfully excluded. Three animals with AAA rupture developed hind leg paralysis due to compromise of the arterial supply to the lower spinal cord and were sacrificed 1 day after the procedure. In five animals, three with rupture and two controls, follow-up aortograms revealed no aortic stenoses and no perigraft leaks. Gross and histologic studies revealed incorporation of the endografts into the aortic wall with replacement of SIS by dense neointima that was completely endothelialized in areas where the endograft was in direct contact with the aortic wall. In central portions of the endograft, in contact with the thrombosed aneurysm, endothelialization was incomplete even at 12 weeks. CONCLUSION: The SIS Sandwich endografts effectively excluded simple AAAs and ruptured AAAs. They were rapidly incorporated into the aortic wall. A detailed long-term study is warranted.

Angioplasty↗

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Dependency of tissue necrosis on gelatin sponge particle size after canine hepatic artery embolization.

PURPOSE: To determine the optimal size of gelatin sponge particles (GSPs) to produce maximum tumor necrosis with minimum side effects after canine hepatic artery embolization (HAE). METHODS: GSPs were separated into four size ranges: A, up to 200 microns (mean 152) as Gelfoam powder; B, 200-500 microns (mean 336) as Gelfoam powder; C, 500-1000 microns (mean 649) as Spongel; and D, 1000-2000 microns (mean 1382) as Spongel. Three mongrel dogs were assigned randomly to HAE with each particle size. On day 7 after HAE, the livers were removed and subjected to pathological examination. RESULTS: The mean volume of liver necrosis was 11% after embolization, with particle size A, 36.3% with B, 0% with C, and 1% with D. Coagulation necrosis was found in all livers with particles of sizes A and B, and in 1 of 6 with sizes C and D. Bile duct injury was found in five of six dogs with sizes A and B and in none with sizes C and D. Gallbladder necrosis was found in one dog with size B and pancreas necrosis in one with size A. CONCLUSION: GSPs of 500 microns are considered optimally effective for tissue necrosis according to this model.

Animals↗

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A dedicated Z-stent for acquired saber-sheath tracheobronchomalacia.

The tracheobronchial lumen has a continuous horseshoe arch morphology. We formed Z-stents accordingly to support the weakened cartilagenous portions. With this type of stent we treated a patient with acquired saber-sheath type tracheobronchomalacia (TBM), Rayl's type II, Johnson's grade III, whose condition was aggravated even under positive end expiratory pressure (PEEP) therapy. The patient improved gradually. No immediate complication was observed. Bronchofiberscopic examination revealed that the tracheobronchial arcade was closely strut-braced and showed no expiratory collapse. Six months later, when the patient was intubated due to asthmatic attacks, tissue ingrowth through the stent was found and removed. There was no recurrence of TBM. The patient died 2 years later of pneumoconiosis.

Aged↗