Subcapsular hepatic hematoma with right hepatic vein thrombosis: a complication of shock wave lithotripsy

Extracorporeal shock wave lithotripsy (ESWL) is a well-established, safe and effective therapeutic modality for surgical treatment of urolithiasis. Hematoma is a rare complication of ESWL and, when it occurs, typically involves the kidney. We report the case of a 71-year-old woman who developed severe, persistent abdominal pain after ESWL for a 9-mm stone at the ureteropelvic junction. Post-treatment CT scan demonstrated a 13 × 6–cm subcapsular hepatic hematoma. A follow-up CT scan showed expansion of the hematoma and development of hepatic vein thrombosis. This finding, along with persistent abdominal pain and rising liver transaminases, led to surgical intervention. The patient''s symptoms resolved and liver function returned to baseline following liver decompression.     

Effective treatment of established human breast tumor xenografts in immunodeficient mice with a single dose of the alpha-emitting radioisotope astatine-211 conjugated to anti-HER2/neu diabodies.

PURPOSE: Successful radioimmunotherapy strategies depend on selecting radioisotopes with physical properties complementary to the biological properties of the targeting vehicle. Small, engineered antitumor antibody fragments are capable of rapid, highly specific tumor targeting in immunodeficient mouse models. We hypothesized that the C6.5 diabody, a noncovalent anti-HER2 single-chain Fv dimer, would be an ideal radioisotope carrier for the radioimmunotherapy of established tumors using the short-lived alpha-emitting radioisotope (211)At. EXPERIMENTAL DESIGN: Immunodeficient nude mice bearing established HER2/neu-positive MDA-MB-361/DYT2 tumors treated with N-succinimidyl N-(4-[(211)At]astatophenethyl)succinamate ((211)At-SAPS)-C6.5 diabody. Additional cohorts of mice were treated with (211)At-SAPS T84.66 diabody targeting the carcinoembryonic antigen or (211)At-SAPS on a diabody specific for the Müllerian inhibiting substance type II receptor, which is minimally expressed on this tumor cell line. RESULTS: A single i.v. injection of (211)At-SAPS C6.5 diabody led to a 30-day delay in tumor growth when a 20 muCi dose was administered and a 57-day delay in tumor growth (60% tumor-free after 1 year) when a 45 muCi dose was used. Treatment of mice bearing the same tumors with (211)At-SAPS T84.66 diabody at the same doses led to a delay in tumor growth, but no complete responses, likely due to substantially lower expression of this antigen on the MDA-MB-361/DYT2 tumors. In contrast, a dose of 20 muCi of (211)At-SAPS on the anti-Müllerian-inhibiting substance type II receptor diabody did not affect tumor growth rate, demonstrating specificity of the therapeutic effect. CONCLUSIONS: These findings indicate that diabody molecules can be effective agents for targeted radioimmunotherapy of solid tumors using powerful, short-lived alpha-emitting radioisotopes.     

Multimodality therapy: potentiation of high linear energy transfer radiation with paclitaxel for the treatment of disseminated peritoneal disease

PURPOSE: Studies herein explore paclitaxel enhancement of the therapeutic efficacy of alpha-particle-targeted radiation therapy. EXPERIMENTAL DESIGN: Athymic mice bearing 3 day i.p. LS-174T xenografts were treated with 300 or 600 microg paclitaxel at 24 h before, concurrently, or 24 h after [213Bi] or [212Pb]trastuzumab. RESULTS: Paclitaxel (300 or 600 microg) followed 24 h later with [213Bi]trastuzumab (500 microCi) provided no therapeutic enhancement. Paclitaxel (300 microg) administered concurrently with [213Bi]trastuzumab or [213Bi]HuIgG resulted in median survival of 93 and 37 days, respectively; no difference was observed with 600 microg paclitaxel. Mice receiving just [213Bi]trastuzumab or [213Bi]HuIgG or left untreated had a median survival of 31, 21, and 15 days, respectively, 23 days for just either paclitaxel dose alone. Paclitaxel (300 or 600 microg) given 24 h after [213Bi]trastuzumab increased median survival to 100 and 135 days, respectively. The greatest improvement in median survival (198 days) was obtained with two weekly doses of paclitaxel (600 microg) followed by [213Bi]trastuzumab. Studies were also conducted investigating paclitaxel administered 24 h before, concurrently, or 24 h after [212Pb]trastuzumab (10 microCi). The 300 microg paclitaxel 24 h before radioimmunotherapy (RIT) failed to provide benefit, whereas 600 microg extended the median survival from 44 to 171 days. CONCLUSIONS: These results suggest that regimens combining chemotherapeutics and high linear energy transfer (LET) RIT may have tremendous potential in the management and treatment of cancer patients. Dose dependency and administration order appear to be critical factors requiring careful investigation.     

The effect of graded unilateral testicular biopsy on the reproductive capacity of male rats

Fifty adult rats were subjected to unilateral testicular biopsy removing either 0.01, 0.1, 0.2 or 0.3 cc of testicular parenchyma. In addition, 20 rats underwent either hemicastration or sham surgery. After a 30-day recovery period each male was housed with two cycling females for 20 days. At the end of this breeding trial the percentage of fertile males, percentage of pregnant females and resulting embryo scores (no. of embryos X size of embryos) were determined for each group of male rats. After an additional 30 days (60 days post-biopsy) a second breeding trial was performed so as to note any long-term changes in fertility. In addition to the fertility parameters, mean seminiferous tubule diameters and serum testosterone levels were noted. After the first breeding trial the percentage of fertile males and percentage of pregnant females were inversely proportional to the amount of biopsy material removed (p less than 0.05). However, the hemicastrate and sham-operated groups did not differ from the O cc control animals. The results of the second breeding trial showed a significant improvement in the percentage of females becoming pregnant (p less than 0.05) and a tendency for improvement in the percentage of fertile males when compared to data of the first breeding trial. In addition, we found the mean seminiferous tubular diameter of the biopsied testes to be inversely proportional to the size of the biopsy (p less than 0.01) with no apparent effect on the contralateral testes. We conclude that removing relatively large amounts of testicular parenchyma during unilateral testicular biopsy transiently affects male reproductive capacity, at least in the healthy animal model studied here.