Combination of cisplatin plus fluoropyrimidine chemotherapy effective against liver metastases from carcinoma of the anal canal.
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Aged↗
Biomedical subjects
S Wallace
Publications and source records attributed to S Wallace.
Gastrointestinal and pancreatic endocrine tumours.
The radiological diagnosis and interventional management of neuroendocrine tumours of the gastrointestinal tract and pancreas are challenging, demanding the complete gamut of available resources. Carcinoid tumours are most commonly found in the appendix and small bowel. Barium studies usually disclose a small solitary mucosal or submucosal mass in the distal ileum at times associated with smooth muscle hypertrophy and thickening of the mucosal folds. Intussusception and bowel obstruction may be the presenting finding. Mesenteric involvement may evoke a desmoplastic reaction with rigidity, fixation, angulation and tethering of small bowel loops. Angiography may demonstrate a hypervascular primary neoplasm but more frequently reveals vascular encasement and distortion from the mesenteric desmoplastic reaction. Pancreatic islet cell tumour is best defined radiologically by angiography and computed tomography as a well circumscribed hypervascular mass which enhances with contrast material. Portal venous sampling is of considerable assistance in localizing insulinoma. Metastases from neuroendocrine tumours to lymph nodes and to the liver are usually hypervascular. In the evaluation of the liver by CT scanning prior to contrast as well as dynamic scanning during the bolus intravenous injection of contrast material are necessary. At times the precontrast scan is more revealing. Computed tomography with the catheter in the superior mesenteric artery followed by selective hepatic arteriography is the most accurate combination for the detection of hepatic metastases. Interventional radiological management by sequential hepatic arterial embolization is the treatment of choice for multiple hepatic metastases from neuroendocrine tumours. Thus far, the maximum number of embolic episodes in a single patient has been 13. The carcinoid syndrome has been controlled in 87% while 79% of islet cell tumour hepatic metastases have responded. Contraindications to HAE includes a combination of all of the following: (i) replacement of more than 50% of the liver by tumour, (ii) serum lactic dehydrogenase above 425 mU/ml, (iii) serum glutamic oxaloacetic transaminase above 100 mU/ml, and (iv) bilirubin above 2 mg/dl. In the face of occlusion of the portal vein by intravascular neoplasm, HAE is contraindicated only if portal flow through collateral vein is away from the liver.
Diagnostic Imaging↗
Differential tumor regression in patients with bilobar hepatic metastases and dual arterial supply: evidence supporting the advantage of intra-arterial over intravenous route of drug delivery.
Two patients with bilobar liver metastases were characterized by dual arterial blood supply to the liver. Treatment of both patients by the administration of chemotherapy, selectively via the arterial branches supplying the respective hepatic lobes bearing the metastases, resulted in differential tumor regression/progression. Thus, while the metastases borne by the arterially infused lobe regressed, the counterpart in the other (systemically infused) lobe showed marked progression. This phenomenon lends strong support to the notion that arterial infusion of chemotherapy in cases of regionally predominant (or confined) neoplastic disease, i.e., in the liver, is superior to the intravenous administration of similar drugs.
Adult↗
Randomized comparison of viral oncolysate plus radiation and radiation alone in uterine cervix carcinoma.
A randomized, controlled study was performed in patients with high-risk, untreated squamous cell carcinoma of the uterine cervix to evaluate the adjunctive use of viral oncolysate (VO) prepared from the SW756 cell line. Seventy-five patients were stratified by tumor volume and randomized to receive radiation therapy (RT) alone or RT plus intradermal immunization with VO. Fifty-one (68%) patients relapsed with a median survival (MS) of 29.1 months and a median progression-free interval (MPFI) of 18.0 months. No differences in MS or median PFI were observed by treatment arm or site of relapse, although a trend toward improved MS and median PFI in patients with small-volume primary lesions was suggested. Serum surface-binding antibody activity (greater than or equal to 1:8) to the SW756 cell line was detected in 14 of 41 unselected patients prior to therapy. Virus hemagglutination inhibitory activity (greater than or equal to 1:8) was detected in 37 of 41 patients before treatment. four-fold increases in titer were observed to the SW756 cell line in 83% and to influenza in 74% of patients tested after immunization. Preirradiation measurements of phytohemagglutinin-induced blastogenesis by the relative proliferation index (RPI) method in 39 patients revealed RPI values less than 0.58 in nine patients, eight of whom relapsed. At 3-6 months after the initiation of irradiation, 32 of 39 patients had values less than 0.58. Patients in the RT group with values less than 0.58 had significantly more relapses than those who received RT plus VO.
Adult↗
A new device for transcatheter closure of the patent ductus arteriosus. A feasibility study in dogs.
A new device for transcatheter closure of the patent ductus arteriosus was developed and initially evaluated in the vasculature of adult mongrel dogs. The device consists of a nylon sack that can be made in various sizes and shapes. A small flexible crossbar attached to the distal end maintains the position of the sack while it is filled with a segment of modified guide wire. The device is delivered coaxially through a 10-Fr Teflon catheter and is easily repositioned or retrieved before release. The expansile force of the sack against the vessel wall can be varied, and its stability is easily checked prior to detachment. The device produced immediate and permanent vascular occlusion without inflammation or erosion. Over time, the entire unit became incorporated into the vessel wall by neointimal encasement. Nylon sacks offer a simple, unique method of closing virtually any ductus arteriosus without general anesthesia and major surgery.
Animals↗
Osteosarcoma: angiographic assessment of response to preoperative chemotherapy.
Adjuvant chemotherapy prolongs the survival of patients with high-grade osteosarcoma. Preoperative chemotherapy allows identification of effective agents for adjuvant chemotherapy based on response of the primary tumor. Preoperative determination of tumor response has therapeutic implications, and angiography offers a less subjective means of assessing it than do conventional radiography or computed tomography. Changes in tumor vascularity, as seen angiographically, after two courses and at the time of the last of several courses of preoperative chemotherapy were correlated with histologic tumor necrosis of resected specimens in 81 patients. Angiographically, 40% of the histologic responders and 91% of the nonresponders were identified after two courses of preoperative chemotherapy. After a median of four courses of chemotherapy, 91% of the responders but only 50% of the nonresponders were identified angiographically. Angiographic assessment of tumor vascularity, although not of absolute value, offers a useful guideline for determining the preoperative chemotherapy strategy.
Adult↗
Percutaneously placed endovascular grafts for aortic aneurysms: feasibility study.
This limited study addressed the feasibility of treating aneurysms with a new transcatheter endoprosthesis. Aortic aneurysms were experimentally created in six dogs and subsequently bridged with nylon-covered, self-expanding metallic stents. The dogs were followed up for as long as 7 months (median, 22 weeks). In each dog, the graft effectively reconstituted the aortic lumen, excluding the aneurysm. One dog exhibited minimal (less than 1-mm) residual dilatation at the site of the aneurysm 7 months after graft placement. The nylon material acted as a support and template for neointimal encasement, enabling the formation of a new vascular lumen. It also remained porous at the origin of aortic side branches, preserving the visceral blood supply. One of the endovascular grafts failed to expand completely at its distal end, which promoted thrombus formation within the graft and resulted in the occlusion of both renal arteries. The dog was found comatose 48 hours after graft placement and was killed at that time.
Animals↗
Percutaneous drainage and feeding gastrostomies in 100 patients.
Percutaneous gastrostomy was performed in 100 cancer patients. In 67 patients with bowel obstruction, the procedure was performed for gastric drainage with 24-28-F Malecot catheters inserted in one sitting. The remaining 33 patients had supragastric obstructions or fistulas and required 10-14-F pigtail catheters for feeding purposes. Average postgastrostomy hospitalization was 3.6 days. Drainage gastrostomies were ready for use immediately after the procedure, whereas use of feeding gastrostomies started on average within 2 days of tube insertion. There were no major complications or deaths related to the procedure. Percutaneous gastrostomy is a simple and safe procedure even when large-caliber catheters are used, and it does not require gastric fixation to the abdominal wall to prevent spillage into the peritoneum.
Adult↗
Chemotherapy and embolization via the inferior epigastric artery for the treatment of primary and metastatic cancer.
We evaluated the results of arterial chemotherapy and embolization via the inferior epigastric artery and its branches in 10 patients with a variety of primary and metastatic neoplasms supplied by that vessel. A total of 15 infusions and five occlusions were performed. There were no complications related to arteriography, indwelling catheters, or arterial occlusion. The effects on tumor bulk ranged from complete necrosis in one patient to partial necrosis in three patients. Surgical resection was facilitated in four of six patients. Local recurrence of tumor occurred in two of these patients. Three of four patients with intractable pain had effective relief. Our experience suggests that transarterial therapy of tumors supplied by the inferior epigastric artery or its branches is a safe procedure and may be useful in tumor management.
Abdominal Neoplasms↗
The radiologic manifestations of alveolar soft-part sarcoma.
Alveolar soft-part sarcoma is a rare soft-tissue tumor of unknown cellular origin that is characterized histologically by its organized "pseudoalveolar" pattern. The radiologic findings in 11 patients with this neoplasm were reviewed. The six men and five women were 16-48 years old (mean, 27 years). Nine patients had untreated primary tumors (thigh, four; forearm, two; and buttock, rectus abdominis muscle, and infratemporal fossa, one each) and two had locally recurrent masses (one each in the retroperitoneum and retrocrural space). All patients were evaluated by conventional radiography, two by sonography, eight by CT, five by angiography, and three by MR. Conventional radiographs showed the soft-tissue mass in only four patients; four lesions caused destruction of adjacent bone and two had soft-tissue calcification. Unenhanced CT showed low-attenuation lesions in four of five patients. The lesions were hypervascular on contrast-enhanced CT or angiography in each of nine patients studied. Prominent draining veins were shown by CT or angiography in five patients. Three lesions had a prolonged capillary stain on angiography. Alveolar soft-part sarcoma should be considered in the differential diagnosis of a hypervascular soft-tissue mass, particularly in the thigh of a young adult.
Adolescent↗
The clinical and radiologic manifestations of hemangiopericytoma.
The clinical and radiologic findings in nine patients with hemangiopericytoma were reviewed. There were eight women and one man with a mean age of 46 years. Seven of the neoplasms, including two locally recurrent tumors, were in the pelvis and two were in the thigh. Conventional radiographs were available for all patients. Five patients were evaluated by sonography, four by CT, three by angiography, and two by MR imaging. There was evidence of compression of adjacent viscera by six of the seven pelvic tumors with associated hydronephrosis in one patient. One thigh lesion had focal areas of speckled calcification. All five neoplasms evaluated by sonography showed a well-circumscribed hypoechoic lesion and three had significant sound through-transmission. Hypervascularity was documented by contrast-enhanced CT or angiography in each of three patients in whom these procedures were performed. Surgical resection of the pelvic neoplasms was complicated by marked hemorrhage. Hemangiopericytoma should be considered in the differential diagnosis of well-circumscribed hypervascular tumors in a middle-aged patient.
Adult↗
The effects of enalapril on hypertension and quality of life. A large multicenter study in Belgium.
Belgian general practitioners studied the effect of enalapril over a period of 6 months on hypertension and quality of life in 4988 patients, whose hypertensive condition remained uncontrolled by previous treatments and/or in whom this previous drug regimen was not tolerated. Blood pressure was reduced from an average of 170/101 mm Hg at the onset of the trial to 145/85.5 mm Hg after 24 weeks. The treatment with enalapril was well tolerated and tolerance improved remarkably in the patients, whose previous treatment had caused intolerance. Quality of life, determined by means of the Nottingham Health Profile questionnaire, was favourably influenced in the patients participating in this study.
Adult↗
Systemic and regional therapy of advanced islet cell tumors.
Asymptomatic patients with islet cell tumors should be observed every 3 to 6 months. Once symptomatic, many therapeutic choices exist. First choice would be symptomatic management resulting in minimum side effects. More aggressive approaches include systemic therapy with cytotoxic or biologic agents. Vascular occlusion provides useful palliation of liver metastases.
Adenoma, Islet Cell↗
Variable patterns of technetium-99m MAA perfusion in the therapeutically embolized liver.
Hepatic perfusion studies using 99mTc macroaggregate albumin (MAA) particles have been utilized to document arterial catheter position and flow distribution in patients who are to undergo hepatic arterial chemotherapy infusion (HAI). We have recently been treating nonresectable hepatic neoplasms with transcatheter hepatic arterial chemoembolization (HAE) followed by HAI. The MAA perfusion studies in these patients show variable patterns. For this reason, we have reviewed our recent experience with 15 patients who underwent 21 HAEs and HAIs. The arteriograms and the MAA perfusion studies were reviewed and correlated. Early (within 4 hr of embolization) perfusion studies revealed flow reversal, or MAA reflux into an undesirable location in 11 cases. Two selected follow-up scans in 24 hr revealed restoration of flow to the embolized lobe, confirming the proper position of the catheter for HAI. Knowledge of both the hepatic arterial anatomy, and of the specific embolization procedure will allow accurate interpretation of the MAA perfusion study. Initial flow reversal, or MAA reflux, should not be interpretated as a malpositioned catheter, but prompt reevaluation after a period of 24 hr to document restoration of antegrade flow is suggested.
Antineoplastic Agents↗
Regression of ocular melanoma metastatic to the liver after hepatic arterial chemoembolization with cisplatin and polyvinyl sponge.
Thirty patients with ocular melanoma metastatic to the liver were treated by hepatic arterial chemoembolization using an admixture of cisplatin and polyvinyl sponge. Tumor regression was complete in one patient and partial (greater than 50%) in 13 patients. The total response rate was 46%. The median survival for the entire group was 11 months (95% confidence interval, nine to 18 months). Treatment-related morbidity was short-lived and included primarily severe upper right quadrant abdominal pain, transient paralytic ileus, and nonicteric hepatitis. Hepatic arterial chemoembolization provided effective palliation, with good-quality survival among 46% of patients with ocular melanoma metastatic to the liver.
Adult↗
Elastic characteristics of the self-expanding metallic stents.
We measured elastic properties of the self-expanding metallic (Gianturco) stent using Hooke's law to characterize the stent with respect to its caliber, length, and radius by a coefficient of stiffness. Although this coefficient was independent of the radius of the stent, we found that it was directly dependent on caliber. For a stent of a particular caliber and length, the fractional change in radius determined the force exerted by the stent. For small radial displacements of the stent, the force required to compress it was directly proportional to the radial displacements; for large displacements, the force depended on a power series of the fractional radial displacement. A hyperbolic function was empirically introduced to approximate this type of relationship between force and radial displacement. We calculated tension and pressure exerted by the stent and suggest the use of our findings with normal vessels.
Angioplasty, Balloon↗
Postoperative infection with the automatic implantable cardioverter defibrillator: clinical presentation and use of the gallium scan in diagnosis.
This report describes three patients with infection involving an automatic implantable cardioverter defibrillator. All three patients presented with fever, fluid in the pulse generator pocket, leukocytosis and an elevated erythrocyte sedimentation rate. A gallium scan, together with aspiration and culture of the fluid from the pocket, confirmed the diagnosis in each case.
Candidiasis↗
Atrophy with compensatory hypertrophy of the liver in hepatic neoplasms: radiographic findings.
Focal hepatic atrophy has numerous causes and in many cases is associated with compensatory hypertrophy. We have observed this phenomenon on CT in patients with hepatic neoplasms. Of 12 patients studied, eight had hepatic metastases, two had hepatocellular carcinoma, and two had bile-duct carcinoma. Focal changes in liver morphology (i.e., atrophy with compensatory hypertrophy) were found in five patients at presentation and developed after treatment with systemic or intraarterial chemotherapy in the others. Atrophic changes affected the right lobe in eight patients, the left lobe in three, and part of both lobes in one. Compensatory hypertrophy of part or all of the unaffected liver was found. Ten patients had obstruction of the portal vein branch to the atrophic segment, four of these 10 also had hepatic vein obstruction, and two of these 10 also had bile duct obstruction. Portal vein obstruction appears to be the most important element in the production of focal hepatic atrophy in patients with hepatic neoplasms. After treatment with chemotherapy, tumor regression and atrophy may be associated with compensatory hypertrophy and enlargement of the uninvolved part of the liver. This must not be mistaken for progression of disease.
Adaptation, Physiological↗