J.S. Lee

Effectiveness of Elective Unilateral Uterine Artery Embolization: A Case-control Study

PURPOSE To evaluate the effectiveness of elective unilateral uterine artery embolization (UAE) in limited fibroid disease. MATERIALS AND METHODS A review of 1,431 UAE recipients at a single institution identified 76 who underwent unilateral embolization, most in the setting of anatomic variants or technical failure. A total of 28 had intentional unilateral UAE because of unilateral disease on magnetic resonance (MR) imaging with supply from only the ipsilateral uterine artery on angiography. These 28 case-group patients were compared with a control group of 28 patients who underwent bilateral UAE contemporaneously. Outcome measures included a chief symptom resolution score, fluoroscopy time, tumor infarction rate, patient satisfaction, analgesia requirements, and maximum pain score. Baseline characteristics and outcome measures were compared with t tests, Pearson χ(2) tests, analyses of variance, and nonparametric tests. RESULTS Three-month clinical follow-up and postprocedure MR imaging were available for 25 of the case-group patients. The unilateral UAE group had fewer analgesia doses demanded (28.8 vs 57.5; P = .049), lower total analgesia dose (22.8 mg vs 34.5 mg; P = .029), shorter fluoroscopy time (10.9 min vs 13.4 min; P = .013), and lower maximum pain score (3.7 vs 5.7; P = .003). There were no differences in chief symptom resolution score (2.1 vs 1.9; P = .27), satisfaction score (4.0 vs 4.0; P = .72), or complete tumor infarction (92% vs 88%; P = .64). CONCLUSIONS Unilateral UAE in appropriately selected patients has similar clinical results as standard bilateral UAE and is associated with reduced fluoroscopy time and postprocedural pain.

Computerized Tomographic and Magnetic Resonance Angiography for Perforator-Based Free Flaps: Technical Considerations

Perforator-based free flaps rely on the appropriate dominant vessel supplying the vascular territory of the flap. Preoperative knowledge of the vascular anatomy can improve outcome and diminish surgical time. Several preoperative imaging techniques exist for surgical planning. Computed tomographic and magnetic resonance angiography are two emerging modalities that provide exceptional anatomic detail. Despite the growing utilization of cross-sectional imaging for preoperative planning, each modality has specific technical considerations that are necessary to consider in order to produce a quality study.

Yttrium-90 Radioembolization in Patients with Hepatocellular Carcinoma Who have Previously Received Sorafenib

Purpose: Yttrium-90 radioembolization (RE) is a locoregional therapy option for hepatocellular carcinoma (HCC). Sorafenib is a multikinase inhibitor used in HCC that can potentially affect the efficacy of RE by altering tumor vascularity or suppressing post-irradiation angiogenesis. The safety and efficacy of sorafenib followed by RE has not been previously reported. Materials and Methods: Patients with HCC who received RE after sorafenib were included in this retrospective review. Overall survival, toxicity, and maximal radiographic response and necrosis criteria were examined. Results: Ten patients (15 RE administrations) fit the inclusion criteria. All were Barcelona Clinic Liver Cancer (BCLC) stage C. Median follow-up was 16.5 weeks. Median overall survival and radiographic progression-free survival were 30 and 28 weeks, respectively. Significant differences in overall survival were seen based on Child-Pugh class (p = 0.002) and radiographic response (p = 0.009). Three patients had partial response, six had stable disease, and one had progressive disease. Grade 1 or 2 acute fatigue, anorexia, and abdominal pain were common. Three patients had Grade 3 ascites in the setting of disease progression. Two patients had Grade 3 biochemical toxicity. One patient was sufficiently downstaged following RE and sorafenib to receive a partial hepatectomy. Conclusion: Yttrium-90 RE in patients with HCC who have received sorafenib demonstrate acceptable toxicity and rates of radiographic response. However, the overall survival is lower than that reported in the literature on RE alone or sorafenib alone. This may be due in part to more patients in this study having advanced disease compared to these other study populations. Larger prospective studies are needed to determine whether the combination of RE and sorafenib is superior to either therapy alone.

Transdermal scopolamine patch with odansetron for the control of nausea after uterine artery embolization compared with odansetron alone: results of a randomized placebo-controlled trial.

PURPOSE To determine whether the transdermal scopolamine patch in combination with odansetron is more effective than odansetron alone at reducing the nausea that occurs after uterine artery embolization (UAE). MATERIALS AND METHODS Patients undergoing UAE at a single university medical center were randomly assigned to receive either a scopolamine patch (containing 1.5 mg of scopolamine) or a placebo. All participants and study personnel were blinded as to group assignment. The primary outcome was the degree of nausea in the first 24 hours after UAE as measured on a visual analog scale from 0 to 10. Nausea and pain at 24 and 72 hours after UAE and medication use were recorded. Baseline characteristics and outcomes were also analyzed. RESULTS A total of 74 patients were enrolled; 37 were randomly assigned to receive scopolamine, and 37 received placebo. Although the overall level of nausea after UAE was low (mean score of 2.6 out of 10), there was a lower level of nausea with those treated with scopolamine compared with placebo during the first 24 hours after embolization; the difference was statistically significant (1.8 vs 3.4, P = .03). Adverse events were more common with the patch, with two patients experiencing episodes of profound disorientation and 71% reporting substantial dry mouth. The only predictor of greater nausea was the increasing severity of pain. CONCLUSIONS The scopolamine patch provides a moderate reduction in the nausea associated with UAE but is associated with infrequent but notable episodes of patient disorientation.

Phantom evaluation of an image-guided navigation system based on electromagnetic tracking and open source software

We have developed an image-guided navigation system using electromagnetically-tracked tools, with potential applications for abdominal procedures such as biopsies, radiofrequency ablations, and radioactive seed placements. We present the results of two phantom studies using our navigation system in a clinical environment. In the first study, a physician and medical resident performed a total of 18 targeting passes in the abdomen of an anthropomorphic phantom based solely upon image guidance. The distance between the target and needle tip location was measured based on confirmatory scans which gave an average of 3.56 mm. In the second study, three foam nodules were placed at different depths in a gelatin phantom. Ten targeting passes were attempted in each of the three depths. Final distances between the target and needle tip were measured which gave an average of 3.00 mm. In addition to these targeting studies, we discuss our refinement to the standard four-quadrant image-guided navigation user interface, based on clinician preferences. We believe these refinements increase the usability of our system while decreasing targeting error.