Qingle Zeng

Gigantic Cavernous Hemangioma of the Liver Treated by Intra-Arterial Embolization with Pingyangmycin-Lipiodol Emulsion: A Multi-Center Study

AbstractPurpose: To evaluate the therapeutic effect and safety of pingyangmycin-lipiodol emulsion (PLE) intra-arterial embolization for treating gigantic cavernous hemangioma of the liver (CHL). Methods: Three hospitals (Nanfang Hospital, Inner Mongolia Autonomous Region’s Hospital and Huai He Hospital) participated in the study during 1997–2001. A total of 98 patients with CHL were embolized with PLE via the hepatic artery. The therapeutic effects including changes in tumor diameter, symptomatic improvement and occurrence of complications were evaluated for a period of 12 months after the procedure. Results: The tumor diameters decreased significantly from 9.7 ± 2.3 cm to 5.6 ± 1.6 cm 6 months after the treatment (P < 0.01), and then to 3.0 ± 1.2 cm at 12 months (P < 0.01). Transient impairment of liver function was found in 77 cases after embolization, 69 cases of which returned to normal in 2 weeks, and the other eight cases of which recovered 1 month later. The clinical symptoms were significantly relieved in all 53 symptomatic patients. Persistent pain in the hepatic region was found in two cases, and these two patients resorted to surgery eventually. Conclusion: Intra-arterial PLE embolization proves to be effective and safe in treating patients with CHL.

Fluoroscopic Intralesional Injection with Pingyangmycin Lipiodol Emulsion for the Treatment of Orbital Venous Malformations

OBJECTIVE The objective of our study was to evaluate the efficacy and safety of percutaneous intralesional injection under fluoroscopy with pingyangmycin Lipiodol emulsion (PLE) for the treatment of orbital venous malformations. MATERIALS AND METHOD . This study is a retrospective analysis of 19 consecutive patients with distensible orbital venous malformations. Of the 19 patients, two had diffuse lesions. These patients presented with proptosis (n = 19), pain and orbital swelling (n = 11), reduction in visual acuity (n = 4), diplopia (n = 2), disk swelling (n = 5), and motility disturbance (n = 3). RESULTS All 19 patients underwent technically successful percutaneous intralesional PLE injection under fluoroscopy. Complete resolution of proptosis, swelling, and pain was achieved in 17 patients 3-9 months after the procedure. In the other two patients with diffuse lesions, light proptosis was still present after the first procedure. A second procedure was performed in these two patients, and the symptom disappeared 3 months later. All four patients with reduced visual acuity recovered their vision, and diplopia in two patients disappeared. Examinations of the fundus revealed normal findings in the five patients with preprocedural disk swelling. None of the patients presented with a motility disturbance after the procedure. Local swelling in the eyelid and epiphora were present for 1 month in one patient and disappeared after treatment. No other complications, including acute orbital compartment syndrome, were observed during follow-up periods. The mean follow-up was 23 months. CONCLUSION PLE sclerotherapy under fluoroscopic guidance is safe and effective for the treatment of orbital venous malformations and can be used as one of the treatment alternatives.

Percutaneous implantation of a Port-Catheter System using the left subclavian artery

AbstractPurpose: To evaluate the safety and feasibility of a percutaneous Port-Catheter System (PCS) implanted via the subclavian artery (SCA) for regional chemotherapy or chemoembolization of thoracic, abdominal, and pelvic malignant tumors. Methods: Percutaneous puncture of the SCA was performed in 256 patients with thoracic, abdominal, or pelvic malignant tumors; then a catheter was inserted into the target artery. After the first transcatheter chemotherapy or chemoembolization with an emulsion of lipiodol and anticancer agents, an indwelling catheter was introduced with its tip placed in the target artery and its end subcutaneously connected to a port. Results: The procedure was successfully completed in all 256 cases (100%). The indwelling catheter tip was satisfactorily placed in the target arteries in 242 cases (98%). Complications attributable to the procedure occurred in 20 (7.8%) cases, including pneumothorax (n=10, 4%), hemothorax (n=1, 0.4%), infections in the pocket (n=4, 1.6%), and hematoma at the puncture site (n=5, 2%). There were no severe sequelae or deaths. The duration of PCS usage was 1–36 months (median 9.5 months), During the course of treatment, occlusion of the target artery occurred in 20 cases (7.8%). Dislocation of the tip of the indwelling catheter occurred in 12 cases (4.7%); in 10 of the 12, the tip of the indwelling catheter was repositioned into the target artery. In all 10 cases no large symptomatic hematomas developed after the PCS was removed. Conclusion: Percutaneous PCS implantation via the left SCA, a relatively new procedure, is a safe and less invasive treatment approach than surgical placement for malignancies.

Percutaneous Intratumoral Injection With Pingyangmycin Lipiodol Emulsion for the Treatment of Recurrent Sacrococcygeal Chordomas

This study describes fluoroscopy-guided percutaneous intratumoral injection therapy (PIIT) with a pingyangmycin lipiodol emulsion in the management of recurrent sacrococcygeal chordomas after surgical excision. Seven patients underwent a total of 22 treatment sessions (3-4 sessions per patient); treatment responses were evaluated clinically, and lesion size was determined using computed tomography (CT). Over 10-26 months of follow-up, tumor sizes and visual analogue scale (VAS) scores of all patients were decreased. No patients had complications during the follow-up period. Preliminary results showed that PIIT with pingyangmycin lipiodol emulsion under fluoroscopic guidance is effective and safe and may be considered as a treatment option.

Transarterial embolization using pingyangmycin lipiodol emulsion and polyvinyl alcohol for the treatment of focal nodular hyperplasia of the liver.

BACKGROUND/AIMS Surgical resection is the current treatment for focal nodular hyperplasia of the liver (FNH) when indicated. However, tumor location and size, patient comorbidities, and risk of complications may limit surgical options in some cases. Our goal was to evaluate the therapeutic effect of transarterial embolization (TAE) using pingyangmycin lipiodol emulsion (PLE) and polyvinyl alcohol particles to treat FNH. METHODOLOGY Four patients with FNH, who experienced dull pain in the upper abdomen or liver area and confirmed by biopsy, were treated by TAE with PLE and polyvinyl alcohol (diameter: 500µm-700µm). Therapeutic effects including changes in lesion diameter and symptomatic improvement, and occurrence of complications, were evaluated for a follow-up period ranging from 12 to 42 months after the procedure. RESULTS All of four patients were successfully treated with PLE and polyvinyl alcohol embolization. One month after the procedure, dull pain in the upper abdomen or liver area vanished completely. Follow-up examination by CT or MRI revealed complete resolution in two cases and an obvious decrease in the other two cases. No immediate or delayed postembolization complications were encountered. CONCLUSION Transarterial embolization using PLE and polyvinyl alcohol should be considered as a safe and effective method for the treatment of FNH.

Percutaneous extraction of deeply-embedded radiopaque foreign bodies using a less-invasive technique under image guidance.

Background: Radiopaque foreign bodies (RFBs) retained in soft tissue are a common clinical problem. Image-guided extraction plays a great role in this realm. We describe our experience in the management of RFBs imbedded deeply in soft tissue using a percutaneous less-invasive technique under fluoroscopic guidance. Methods: In all, 76 patients with 251 RFBs including gun pellets (n = 223), needle fragments (n = 4), and irregular metallic splinters (n = 24) underwent percutaneous extraction of RFBs with the modified technique, which consists of: (1) percutaneously gaining access to the RFB using an 18-gauge needle, several tapered dilators, and an outer cannula and (2) grasping and withdrawal of RFB using a forceps through the cannula. The following periods were 6 months to 6 years. Results: The direct distance between RFB and skin was from 2.5 cm to 8.5 cm (average 4.8 cm). Every RFB was successfully removed with technique success rate of 100%. The RFBs measured 0.2 cm to 3.0 cm in length and 0.1 cm to 0.5 cm in width. The procedural time and exposure time of X-ray for each RFB extraction were 8 minutes to 15 minutes and 1 minute to 4 minutes (mean, 10 minutes and 2 minutes, respectively). The radiation doses for each RFB and patient were 15.64 mGy to 62.56 mGy and 15.64 mGy to 500.48 mGy (mean, 30.26 mGy and 72.47 mGy, respectively). Blood lead concentration decreased to normal one month after the procedures in four patients with preprocedural high level. No complications were observed during the procedures and the following periods. Conclusion: Percutaneous extraction of RFBs from deep soft tissue with the present technique is safe, effective, and minimally invasive.

Ozone promotes regeneration by regulating the inflammatory response in zebrafish

Ozone is thought to advance wound healing by inhibiting inflammation, but the mechanism of this phenomenon has not been determined. Although the zebrafish is often used in regeneration experiments, there has been no report of zebrafish treated with ozonated water. We successfully established a zebrafish model of ozonated water treatment and demonstrate that ozonated water stimulates the regeneration of the zebrafish caudal fin, its mechanism, and time dependence. The growth rate of the caudal fin and the number of neutrophils migrating to the caudal fin wound after resection were higher in the experimental (ozonated) group than in the control group, preliminarily confirming that ozone-promoted regeneration is related to the stimulation of an early inflammatory response by ozone. Ozone modulated the expression of tumor necrosis factor-α (TNF-α) in two ways by regulating interleukin 10 (IL-10) expression. Therefore, ozone promotes tissue regeneration by regulating the inflammatory pathways. This effect of ozone in an experimental zebrafish model is demonstrated for the first time, confirming its promotion of wound healing and the mechanism of its effect in tissue regeneration. These results will open up new directions for ozone and regeneration research.

Image-guided percutaneous lipiodol-pingyangmycin suspension injection therapy for sacral chordoma.

A 74-year-old man presented with a progressively worsening pain in sacrum and was diagnosed to have a sacral chordoma by biopsy in May, 2004. Percutaneous intratumoral injection with lipiodol-pingyangmycin suspension (LPS) was carried out under image guidance and repeated when the pain in sacrum recurred and the tumor increased. During a 6-year follow-up period, three sessions of this treatment were executed. CT imaging and Karnofsky Performance Score were used to evaluate the size of tumor and quality of life, respectively. The patient was free of pain after each procedure and had a high quality of life with a Karnofsky Performance Score above 80 points. The tumor lesion in sacral area was effectively controlled. No complications were observed. Percutaneous intratumoral injection with LPS under image guidance may be an effective and safe alternative for the patients with sacral chordoma.

Fluoroscopy-guided percutaneous aspiration of metallic mercury in soft tissues

Subcutaneous injection of metallic mercury is rare and may produce mercury poisoning. Rapid diagnosis and aggressive treatment are usually required. Removal of mercury deposited in soft tissue is a challenging clinical problem. Surgery is usually performed to remove the mercury together with the affected tissue.1e6 However, surgical removal is laborious, invasive, and may fail, even under fluoroscopic guidance, because the mercury tends to disperse over a wide area.1 In this report, we describe a fluoroscopy-guided percutaneous aspiration technique for removing mercury deposited in soft tissue from a broken thermometer.

Blood supply characteristics of pedunculated hepatocellular carcinoma prior to and following transcatheter arterial chemoembolization treatment: An angiographic demonstration

Pedunculated hepatocellular carcinoma (P-HCC) is a rare type of HCC, defined as a carcinoma protruding from the liver with or without a pedicle with a low degree of liver invasion. The present study aimed to evaluate the characteristics of blood supply of P-HCC prior to and following transcatheter arterial chemoembolization (TACE) treatment. Angiographic findings prior to and following TACE treatment in 39 patients with P-HCC were analyzed retrospectively. Angiography performed at the first TACE session revealed 70 tumor-feeding arteries collectively in all patients, including 31/70 (44.0%) extrahepatic parasitic arteries in 23/39 patients (59.0%). The intrahepatic arteries served as the main blood supply to P-HCC in all patients. Extrahepatic collateral blood supplies to P-HCCs were significantly associated with larger tumor diameter (χ2=164.000, P<0.001), but not tumor location (χ2=7.358, P=0.061). Following repeated TACE treatment, all angiographies revealed a total of 131 tumor feeding arteries collectively in all patients, including intrahepatic arteries (54/131) and extrahepatic collateral arteries (78/131) in 31 patients (79.5%). Compared with angiographies performed at the initial TACE treatment, these results also demonstrated an increase in the number of extrahepatic collateral arteries, which produced 47 new blood vessels (χ2=4.278, P=0.039). P-HCC tumor lesions readily acquired a parasitic blood supply from adjacent vessels following repeated TACE. Intrahepatic arteries functioned as the main blood supply for P-HCC, whereas extrahepatic collateral arteries were complementary to P-HCC, regardless of whether the patient was pre- or post-TACE. Extrahepatic collateral supplies to P-HCCs that originated from adjacent vessels were rich, were closely associated with tumor size, and were prone to be newly established following repeated TACE.