Chemoembolization in the treatment of metastatic ileocolic carcinoid

Carcinoid tumours are enigmatic, slow growing malignancies, which occur most frequently (74%) in the gastrointestinal tract. Symptoms of the carcinoid syndrome (flushing and diarrhoea) are infrequent, occurring in approximately 10% of the patients with small bowel carcinoid. A 45-year-old patient with multiple liver metastases, diagnosed in 1994 with nonHodgkin's lymphoma after undergoing surgery for a distal ileal tumour, was referred to us by the Department of Haematology. At that moment the issue of a differential diagnosis with a carcinoid tumour arose, due to the long evolution and lack of evidence to support the initial diagnosis. The carcinoid syndrome was in fact present (the patient experiencing flush after small amounts of alcohol and emotions) and also we identified elevated values of 5HIAA. Reevaluation of the histologic sections of the ileal tumour as well as an ultrasound guided fine needle aspiration of an intrahepatic lesion confirmed the diagnosis of "carcinoid tumour". This conclusion lead to new therapeutic options for this patient. One of the main therapeutic options used in treating multiple liver metastases from a carcinoid tumour is chemoembolization and this case offered an excellent opportunity to present this therapy.     

The effect of 2,6-bis(diethanolamino)-4-piperidinopyrimido [5,4-d]-pyrimidine (RA233) on growth,metastases and lung colony formation of B16 melanoma

The dissemination of malignant cells from a primary tumor to distant host sites appears to be influenced by blood platelets of the hemostatic system. Under conditions that did not inhibit primary tumor growth, RA233 decreased both the incidence and frequency of spontaneous lung metastases by 66% and 69%, respectively. Although RA 233 effectively inhibited the formation of spontaneous metastases, oral administration of RA233 prior to and after the intravenous inoculation of 1 × 10⁵ B16F10 murine melanoma cells failed to inhibit subsequent lung colony formation. These findings indicate that RA233 has antimetastatic activity, and that inhibition of platelet aggregation is not the sole determinant of this action.     

An automated method for generating analogic signals that embody the Markov kinetics of model ionic channels

In this work we present an automated method for generating electrical signals which reflect the kinetics of ionic channels that have custom-tailored intermediate sub-states and intermediate reaction constants. The concept of our virtual single-channel waveform generator makes use of two software platforms, one for the numerical generation of single channel traces stemming from a pre-defined model and another for the digital-to-analog conversion of such numerical generated single channel traces. This technique of continuous generation and recording of the activity of a model ionic channel provides an efficient protocol to teach neophytes in the field of single-channel electrophysiology about its major phenomenological facets. Random analogic signals generated by using our technique can be successfully employed in a number of applications, such us: assisted learning of the single-molecule kinetic investigation via electrical recordings, impedance spectroscopy, the evaluation of linear frequency response of neurons and the study of stochastic resonance of ion channels.     

Complications of missile craniocerebral injuries during the Croatian Homeland War

OBJECTIVE: Complications of penetrating craniocerebral injuries in war can be early (during the first week after wounding) or late (after that period). Postoperative hematomas, infections, seizures, and cerebrospinal fluid fistulas (CSFFs) are counted among the early complications, whereas foreign bodies migrating intracranially, seizures, infections, and posttraumatic hydrocephalus represent late complications. A total of 176 patients with well-defined head injuries from missiles, sustained during the Croatian Homeland War (1991-1995), developed a total of 61 (34.5%) complications. METHODS: A retrospective statistical analysis of the medical records of the patients in our series was performed to determine the risk factors for the onset of complications, which have unfavorable effects on outcomes. RESULTS: There were a total of 28 (15.9%) infections (deep or superficial), 21 (11.9%) cases of CSFFs, 9 (5.11%) cases of early epilepsy, and 3 cases of post-traumatic hydrocephalus. A total of 47.6% of patients with CSFFs developed intracranial infections. Of eight patients with meningoencephalitis, five had CSFFs and four had intracranially retained foreign bodies. Only one patient developed a cerebral abscess. Two patients died because of infectious complications (13.3%). Post-traumatic hydrocephalus (1.7%) required shunt placement. For 60% of patients with deep-seated intracranial infectious complications and 76% of patients with CSFFs, reoperations had to be performed, whereas this was the case for only 8% of patients without infections (chi2 = 43.6, p = 0.00001). CONCLUSIONS: Intracranially retained foreign bodies, wound age, wound site, and operations performed outside the neurosurgical services were the main risk factors for the development of complications. Complications themselves exerted a very unfavorable influence on outcomes. The development of complications reflects very reliably the neurosurgical technique applied.     

MR arthrography of the knee: how, why, when

MR arthrography combines the techniques of arthrography with MR imaging to benefit from the added imaging information afforded by intra-articular distention. This article reviews technical considerations for MR arthrography, potential complications, indications, pitfalls in imaging diagnosis, and commonly encountered pathology. It is an elegant study that can offer precise diagnostic information in the appropriate clinical setting.     

Bronchoscopic lung volume reduction in patients with severe emphysema: anesthetic management

Bronchoscopic lung volume reduction is a novel approach to the treatment of severe emphysema. Its objective is to achieve the same improvements in lung function and exercise tolerance as lung volume reduction surgery while avoiding the surgical morbidity and mortality. We describe the anesthetic experience in a series of seven patients who underwent a total of eight procedures (one patient underwent a second procedure on the contralateral side). The technique used was one of total IV anesthesia using remifentanil and propofol, with a ventilatory strategy aimed at avoiding gas trapping and dynamic hyperinflation. To achieve this pressure, limited ventilation with a prolonged expiratory phase was provided by a Draeger Evita 2 ventilator. This technique resulted in intraoperative hypercapnia (Paco(2) 6.75 kPa) compared with baseline values (median Paco(2) 5.1 kPa; P < 0.05), but 2 h postoperatively the arterial partial pressure of CO(2) was returning to baseline (median Paco(2) 5.6 kPa; P < 0.01 compared with intraoperative data). There were no deaths or admissions to the intensive care unit after the procedure. One patient developed a pneumothorax that required drainage, three patients had acute exacerbations of chronic obstructive pulmonary disease, and one patient developed a cough that resolved spontaneously. Total hospital stay did not exceed 5 days for any of these patients.     

Meniscal tears: role of axial MRI alone and in combination with other imaging planes

OBJECTIVE: The purpose of this study was to determine the reliability of standard axial MR images alone in the diagnosis of meniscal tears of the knee and in combination with other imaging planes. MATERIALS AND METHODS: Sixty-two patients (55 men, seven women; age range, 23-68 years) with a prior MRI examination who underwent arthroscopic surgery of the knee during a 1-year period were included in the study group. Images were independently reviewed for identification of meniscal tears by two musculoskeletal radiologists blinded to arthroscopic findings. Sequences for meniscal evaluation included axial fat-saturated fast spin-echo proton density, coronal fat-saturated fast spin-echo proton density, and sagittal fast spin-echo proton density with 4- to 5-mm slice thicknesses. Imaging groups for evaluation were axial, coronal, sagittal, axial and sagittal, axial and coronal, and coronal and sagittal. Observers reported a confidence level for the presence or absence of meniscal tear in all imaging groups based on a 5-point scale. Statistical analysis considered medial and lateral menisci separately. RESULTS: Forty patients had medial meniscal tears, and 16 had lateral meniscal tears at arthroscopy. For medial and lateral meniscal tears, the accuracy (79% and 71%, respectively) of imaging in the axial plane was comparable to other imaging groups but the mean confidence levels (2.82 and 3.00, respectively) were low. In one patient, the axial plane alone correctly showed that no tear was present. No statistically significant difference was observed between imaging plane groups of both menisci in the diagnosis of meniscal tears (p > 0.05). The axial plane increased the accuracy of sagittal and coronal planes of lateral meniscus when combined. CONCLUSION: In standard knee MRI examinations, the axial imaging plane may be valuable for the detection and characterization of meniscal tears.