Takeo Irie

Extended intraarterial cisplatin infusion for treatment of gynecologic cancer after alteration of intrapelvic blood flow and implantation of a vascular access device

Purpose:Twenty-two patients with advanced gynecologic cancer underwent extended intraarterial cisplatin infusion after alteration of the intrapelvic blood flow and implantation of a vascular access device (VAD).Methods:To maximize concentrations of cisplatin at the target lesion, the superior and inferior gluteal arteries were embolized with steel coils. The tip of the catheter was inserted into the internal iliac artery; the opposite end of the catheter was connected to the VAD.Results:Intensive radioisotope accumulation was demonstrated in the anterior division of the pelvis, seen by scientigraphy performed with technetium 99m macroaggregated albumin via the VAD. Local perfusion in the tumor was well seen by ultrasonographic angiography with CO2 microbubbles via the VAD. Continuous consecutive infusion of cisplatin at a rate of 12.5 mg/day via the VAD minimized the toxicity. The overall response rate was 73%. Radical surgery was possible in 16 of the 22 patients after this intraarterial infusion.Conclusion:This method was useful for treating advanced gynecologic cancer without significant toxicity.

Breast masses: Color Doppler, power Doppler, and spectral analysis findings

To determine the diagnostic efficacy of power Doppler sonography (PDS) with spectral analysis for breast diseases, we retrospectively compared PDS and color Doppler sonography (CDS) in patients with breast lesions.

Traumatic perilymphatic fistula with the luxation of the stapes into the vestibule.

Traumatic perilymphatic fistula due to luxation of the stapes into the vestibule caused by an earpick is an extremely rare situation. In order to treat such an injury, it is necessary to evaluate the extent of the damage and the actual condition of the middle and inner ear. However, it is difficult to obtain such precise information about the condition of the stapes prior to performing surgery. We report on a case of a traumatic perilymphatic fistula with luxation of the stapes into the vestibule that was diagnosed using multislice CT (MSCT). MSCT clearly demonstrated the presence of air in the vestibule (pneumolabyrinth), which indicated the presence of a perilymphatic fistula and the deep depression of the stapes into the vestibule. In order to seal the perilymphatic fistula and prevent middle and inner ear infection, surgery was performed on the portion of the stapes that remained in the vestibule. The patient has been free from vertigo and has exhibited some recovery of his hearing. We discuss the diagnosis along with other therapeutic problems that have been presented in the literature for traumatic perilymphatic fistula.

Intraarterial low-dose cisplatin via an indwelling port and concurrent radiotherapy for invasive bladder cancer.

Thirteen patients with invasive bladder cancer who had residual tumor after transurethral resections, were treated with consecutive intraarterial (IA) cisplatin (15 mg/d; total, 150 mg) and concurrent radiation (1.8 Gy/d; total, 30.6 Gy). All patients received unilateral or bilateral placement of vascular access devices (VAD) to perform daily cisplatin infusion after alteration of intrapelvic blood flow by coil embolizations. Tumor response was evaluated by transurethral biopsy 2 weeks after treatment. Complete response, defined as no viable tumor cell in the biopsy specimen, was achieved in seven patients (54%). After a median follow-up of 30 months (range, 12-48 months), 10 patients (77%) were alive, five (38%) of whom had no recurrence. Two cancer-related deaths were observed. All complete response cases survived with a median follow-up of 35 months (range, 25-48 months). Cause-specific and disease-free survival rates at 4 years were 85% and 28%, respectively. The regimen was well-tolerated, with no dose-limiting toxic events. There were no VAD-related complications. Consecutive IA low-dose cisplatin and concurrent radiation may be an acceptable alternative treatment for patients with bladder cancer who are not suitable for systemic chemotherapy. The use of a VAD contributed to successful consecutive IA infusions.

Vascular access system for continuous arterial infusion of a protease inhibitor in acute necrotizing pancreatitis

We used a vascular access system (VAS) for continuous arterial infusion (CAI) of a protease inhibitor in two patients with acute necrotizing pancreatitis. The infusion catheter was placed into the dorsal pancreatic artery in the first patient and into the gastroduodenal artery in the second, via a femoral artery approach. An implantable port was then connected to the catheter and was secured in a subcutaneous pocket prepared in the right lower abdomen. No complications related to the VAS were encountered. This system provided safe and uncontaminated vascular access for successful CAI for acute pancreatits.