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Biomedical subjects

S Wallace

Publications and source records attributed to S Wallace.

At least 379 records · Page 21Linked to original sources
PubMed1981

Hepatic artery embolization in the treatment of hepatic neoplasms.

Seventy-two hepatic artery embolizations were performed in 47 patients to treat hepatic neoplasms. Hepatic artery embolization creates tumor devascularization, but the portal flow prevents infarction of liver parenchyma because of the single vascular supply from the hepatic artery to a neoplasm, in contrast to the dual vascular supply to the liver parenchyma. Indications for the use of hepatic artery embolization are failure of chemotherapy, either systemic or intra-arterial infusion, vascular anomalies requiring combined lobar embolization and lobar infusion, and lack of effective treatment. Three types of embolization were performed: peripheral embolization using Gelfoam, proximal embolization using coils, and combined peripheral and proximal embolization. The complications after embolization were pain, fever, and transient liver function changes. No death or hepatic abscess occurred. The median survival duration of the group was 11.5 months from the time of embolization. Hepatic artery embolization is an effective treatment of hepatic neoplasm.

Adult↗
PubMed1981

Cranial computed tomography of malignant melanoma.

Two hundred seventy-five cranial computed tomography (CT) scans performed on 179 patients with malignant melanoma were reviewed. Of the 101 patients with confirmed cerebral metastases, CT demonstrated lesions in 93. In 72% of these, areas of increased attenuation were present in the precontrast scan. These lesions also enhanced after contrast infusion. There was a direct correlation between the extent of bleeding in the neoplasm and the density of the metastasis, at least 20% red blood cells per high power field were consistently present within lesions of increased attenuation. Cerebral metastases were occasionally associated with subdural or intracranial hemorrhage. Meningeal melanomatosis was recognized by CT only when associated with adjacent parenchymal metastases. In nine (11%) of 74 patients without clinical evidence of brain involvement, CT revealed cerebral metastases; this suggests that a staging CT scan might be useful on patients with diffuse or advanced local extracranial disease prior to definitive therapy.

Adolescent↗
PubMed1981

Therapeutically infarcted tumors: ct findings.

The CT findings in 14 patients who underwent hepatic or renal embolizations are presented. In 11 patients who had postinfarction CT studies, linear, branching air collections were noted within the embolized tumor. In two patients the amount of air increased on later CT studies. This configuration of air suggested an abscess, but in no case was an abscess encountered. This air was located distal to the high density embolization material in four cases. In four cases the infarcted organ appeared denser due to "trapped contrast." The seven embolized livers did not change in size on follow-up examinations, while three renal tumors demonstrated variable size changes after embolization.

Air↗
PubMed1981

Ivalon embolization in abdominal neoplasms.

Polyvinyl alcohol foam (Ivalon) particles were used in arterial embolization of abdominal neoplasms for tumor devascularization. The Ivalon particles are available in two sizes: small (0.25-0.59 mm) and large (0.60-1.0 mm). Twenty-five tumor embolizations in 22 patients (16 hepatic neoplasms, five renal carcinomas, one lumbar metastasis) were performed during a 4 month period. Occlusion of the embolized artery was documented by angiography in 24 procedures and by surgery in the remaining one. The postembolization syndrome was the same as that following Gelfoam embolization. Ivalon particles compared with Gelfoam cubes are advantageous in: (1) being easier to use; (2) reaching smaller arteries; and (3) causing more permanent occlusion.

Abdominal Neoplasms↗
PubMed1981

Metastatic hepatic neoplasms: angiographic features of portal vein involvement.

Hepatic metastases produce a spectrum of angiographic alterations of the portal vein that mimicks that of primary liver neoplasms. In 11 patients with varied primary malignancies, hepatic arteriograms revealed seven instances of opacification of the portal vein from arterioportal shunting, two cases of intraluminal tumor thrombus, and two cases with intrahepatic portal vein occlusion. Another patient with liver metastases developed an arterioportal fistula following percutaneous liver biopsy. Although uncommon, metastatic involvement of the portal vein is not necessarily indicative of a poor prognosis since one patient's arterioportal shunting resolved following intraarterial chemotherapy infusion and tumor regression.

Adult↗
PubMed1981

Myelography of spinal block from epidural tumor: a new approach.

Eleven patients with spinal canal block from metastatic epidural tumor, documented with Pantopague myelography, were given an additional injection of up to 5 cc of air. This technique forced contrast material past the block in 10 of 11 cases. It failed in one case in which symptoms had been present for 19 days. Air injection allowed visualization of more cephalad lesions and defined the superior extent of the initial obstructing lesion without the need for a lateral cervical or cisternal puncture. It caused transient discomfort but no neurologic deterioration. This technique is less painful, requires less patient cooperation, expedites localization, and does not require the special skills needed for cervical puncture.

Adult↗
PubMed1981

Carcinoma of the cervix: lymphangiography and computed tomography.

Twenty-four patients with carcinoma of the uterine cervix examined by lymphangiography followed by computed tomography (CT) were reviewed to assess the findings and their impact on management. The lymphangiogram was of value in detecting metastases in relatively small nodes, (less than 1.5 cm maximum diameter) and in differentiating metastases from reactive hyperplasia in the larger lymph nodes which were opacified. Although as yet unable to define alterations in the internal architecture of lymph nodes. CT detected masses of lymph nodes totally replaced by neoplasm or those not visualized by lymphangiography. In addition, the local extension of the primary neoplasm and distant metastases, such as to the urinary tract, liver, and skeleton, were readily demonstrated by CT. In advanced or recurrent disease, CT provided new information on 10 of 17 patients but resulted in a change in management for only one.

Adult↗
PubMed1981

Hepatic artery infusion chemotherapy: gastroduodenal complications.

Hepatic artery infusion chemotherapy is a recognized treatment of unresectable hepatic neoplasms. Because the arterial supply to the stomach and duodenum originates from the celiac and hepatic arteries, unavoidable infusion of the gastroduodenal and right gastric arteries may result in gastrointestinal complications. Of 174 patients (266 infusions) treated with hepatic artery infusion chemotherapy during a 12 month period, 18 developed severe dyspepsia. Ten of these 18 patients had gastrointestinal pathology documented by either endoscopy or upper gastrointestinal series; six had gastric ulcer and gastritis, two had duodenal ulcer, one pyloroduodenitis, and one pancreatitis. Endoscopically, the hepatic artery infusion chemotherapy-induced ulceration and gastritis were located in the distribution of the infused arteries. Radiographically, the gastric abnormalities ranged from typical benign ulcers to a pattern of multiple ulcerations with nodular fold mimicking malignancy. Angiographic correlation could be made on eight of the 10 patients. Vascular trauma, observed in five of these eight patients, seemed to contribute to gastrointestinal complications in hepatic artery infusion chemotherapy.

Adult↗
PubMed1981

Complications of coil embolization: prevention and management.

From 1975 to 1980, 1,200 steel coils of three different designs were used for vascular occlusion. There were eight significant complications: Two coils were lost and retrieved, one coil was lost and remains in the pulmonary artery, four coils were misplaced to undesired sites, and one coil was fragmented and displaced during surgery. The management and prevention of these complications are described.

Embolization, Therapeutic↗
PubMed1981

Central nervous system leukemia and lymphoma: computed tomographic manifestations.

Computed tomographic (CT) abnormalities in the brain were identified in 31 of 405 patients with leukemia or lymphoma. Abnormalities included neoplastic masses (15), hemorrhage (nine), abscess (two), other brain tumors (four), and methotrexate leukoencephalopathy (one). CT was normal in 374 patients including 148 with meningeal disease diagnosed by cerebrospinal fluid cytologic examination. Prior to treatment, malignant masses were isodense or of greater density with varying amounts of edema. Increase in size or number of the masses indicated worsening. Response to radiation and chemotherapy was manifested by development of a central low density region with an enhancing rim. CT findings correlated with clinical and cerebrospinal fluid findings. The differential diagnosis of the various abnormalities is considered.

Cerebral Hemorrhage↗
PubMed1980

Comparison of ultrasound and computed tomography in the detection of pancreatic malignancy.

A retrospective analysis was performed on 102 patients who were examined by both ultrasound (US) and computed tomography (CT) for known or possible carcinoma of the pancreas. In 38% of the patients, ultrasonography was unsatisfactory due to overlying interfering intestinal gas or ascites, whereas only 2% of CT studies were unsatisfactory due to technical considerations. In comparing the two modalities, CT was found to be more accurate (96% CT vs. 84% US), and this became more significant when nondiagnostic studies were considered in evaluating accuracy (95% CT vs. 54% US). Because of the findings in this analysis, CT is recommended as the initial diagnostic imaging modality for the evaluation of possible pancreatic neoplasm.

Adult↗
PubMed1980

Percutaneous hepatic arterial infusion (HAI) of mitomycin C and floxuridine (FUDR): an effective treatment for metastatic colorectal carcinoma in the liver.

The response rate of metastatic colorectal carcinoma confined to the liver to HAI of FUDR alone is at the range of 50% and to mitomycin C by hepatic arterial infusion (HAI) at the range of 35%. Mitomycin C was added to FUDR by continuous infusion and given by HAI to 12 patients with colorectal cancer confined to the liver. Catheters were placed subselectively in the hepatic artery, and infusion continued for five to six days when the catheter was removed. Cycles were repeated every 30 days. Chemotherapy consisted of mitomycin C 15 mg/m2 administered on day 1 followed by FUDR 100 mg/m2 by continuous infusion daily for five days. Response to treatment was evaluated by serial determinations of plasma CEA and by imaging techniques consisting of a computerized tomography, sonography, and radionuclide scanning of liver as well as by angiography. In 2 patients, complete remission was achieved; in 4 patients a 75% and in another 4 patients a 50% decrease in liver metastasis was observed, while 2 patients had stable disease. Thus, a response rate of 83% with a median duration of six to seven months was achieved. The median survival of the these patients was 16 months. Eight of the 12 patients have failed previous, i.v. 5-FU containing regimens. Complications related to 45 treatment cycles were the following: catheter displacement in 11.1%, an intimal tear, usually in the hepatic artery in 4.4%, gastric ulcerations in 5.4%, and septicemia in 2.7% of the cycles. In addition, aneurysmal dilation of the hepatic artery occurred in 4 patients (8.8% of the treatment cycles), all of whom continued treatment. Chemotherapy-related complications included primarily thrombocytopenia and stomatitis. Mitomycin C + FUDR by hepatic arterial infusion is an effective treatment for colorectal carcinoma metastatic to the liver. The high response rate justifies the adjuvant treatment of Dukes class C colon cancer patients with this treatment.

Adult↗
PubMed1980

Phase I-II trial of percutaneous intra-arterial cis-diamminedichloro platinum (II) for regionally confined malignancy.

Forty-nine patients with regionally confined recurrent malignancy were treated with intra-arterial cis-diamminedichloro platinum II in a Phase I-II trial. A safe starting dose of 120 mg/m2 was established. An overall response rate of 45% was noted with significant responses observed among patients with melanoma, sarcoma, breast carcinoma, and neuroblastoma. Side effects included transient renal and bone marrow toxicity as well as neurotoxicity and ototoxicity (6%), the latter usually with residual damage. The rational basis and advantages of treatment with intra-arterial cis-platinum are discussed.

Adolescent↗