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[Mediastinal cystic lymphangioma as a cause of hydrops fetalis].

This report is upon a case with fetal hydrops on the base of a paracardiac cystic lymphangioma in the mediastinum. The newborn which had hypoplastic lungs and multiple pneumatothoraces died because of a pulmonary insufficiency. An overview is given about the most common causes of the nonimmune fetal hydrops, and the pathomechanisms are discussed.

Female↗
PubMed1992

[Percutaneous CT-guided catheter drainage of intrathoracic fluid accumulations].

To verify the value of percutaneous CT-guided drainage of thoracic fluid collections we studied the outcome in 39 patients retrospectively. 24 (61.5%) of the fluid collections were located in the pleural space, 10 (25.6%) in the lungs and 5 (12.8%) in the mediastinum. 11 CT-guided drainages after a previous attempt were necessary in 9 patients, because of recurrent (n = 6) or residual (n = 5) fluid collections. 70% of the drainage procedures were done using Seldinger's, 30% using trocar technique, mainly with 8.3-12 F catheters. The mean duration of drainage was 10.7 days. In 28 patients (71.8%) the percutaneous CT-guided drainage was curative. In 9 cases (23.1%) the patient's course was stabilised and surgery could be applied electively. 2 patients (5.1%) died because of their underlying end-stage malignancy. None of the drainage procedures changed the patient's course to the worse. There was only 1 pneumothorax with no need of any treatment; no other complication occurred. Our results suggest that percutaneous CT-guided drainage of thoracic fluid collections is a safe and straightforward alternative to surgical treatment.

Adult↗
PubMed1994

Prevention of immunotoxin-mediated vascular leak syndrome in rats with retention of antitumor activity.

Immunotoxins are hybrid molecules composed of a cell-surface binding domain and a protein toxin moiety that together target specific cell populations for elimination. These agents represent a promising approach for the treatment of many human diseases, most notably cancer. However, it has recently become clear that many immunotoxins when used in human clinical trials induce vascular leak syndrome (VLS), restricting the administration of doses necessary to achieve good therapeutic responses. The lack of an appropriate animal model has hindered efforts to understand and prevent immunotoxin-induced VLS. We have found that in rats, intravenous administration of the single-chain immunotoxin BR96 sFv-PE40 results in symptoms that closely resemble VLS seen in human immunotoxin trials. A large fluid accumulation in the thoracic cavity was observed, along with an increase in hematocrit and body weight and a decrease in serum albumin. The VLS was apparent within 24 hr after administration of immunotoxin and was seen in both immunocompetent and athymic rats. Similar symptoms were not found in mice even at lethal doses. Prophylactic administration of the corticosteroid dexamethasone resulted in prevention of VLS and survival of rats injected with what would otherwise be lethal doses of BR96 sFv-PE40. Prophylactic treatment with dexamethasone in rats xenografted with human tumors either did not inhibit or minimally inhibited the antitumor activity of BR96 sFv-PE40. The use of prophylactic corticosteroids should be considered for immunotoxin clinical trials, since it may improve therapeutic efficacy by decreasing the dose-limiting toxicity of VLS.

Animals↗
PubMed2000

Transjugular intrahepatic portosystemic shunt. Experiences at a liver transplantation center.

OBJECTIVE: Transjugular intrahepatic portosystemic shunt (TIPS) placement is an established therapy for portal hypertension that leads to variceal bleeding or refractory ascites. We present experiences of the role of TIPS at a liver transplantation center. MATERIAL AND METHODS: One hundred and ten patients were referred to the Radiological Department for TIPS placement. One of the 110 patients had recurrent cirrhosis after liver transplantation with refractory ascites. Function of the TIPS was controlled with Doppler US at 1 day, 1 week, 4 weeks and 4 months after TIPS placement and subsequently every 3 months. Shunt insufficiency was supposed when the blood flow velocity within the stent tract was under 50 cm/s and was an indication for TIPS revision. RESULTS: TIPS was placed in 101 patients. After TIPS placement, 10 patients underwent liver transplantation. While waiting for the new liver, none of them developed variceal rebleeding, ascites or other complications of portal hypertension. Two of the 101 patients had episodes of rebleeding. The frequency of patients undergoing TIPS revision within the first year after TIPS placement was 67.5%, within the second year 38.0% and within the third year 24.4%. The revisions led to sufficient reduction of the portosystemic pressure gradient. CONCLUSION: In some liver transplant candidates, TIPS can be useful in minimizing the risk of complications of portal hypertension during the waiting time for a liver transplantation. TIPS can be monitored by Doppler US and revised if occlusion occurs.

Adult↗