Imaging characteristics following 90yttrium microsphere treatment for unresectable liver cancer

Selective internal radiation therapy (SIRT) with (90)yttrium microspheres - also known as radioembolisation - is a relatively new interventional radiology technique offering symptomatic and survival advantages for patients with unresectable liver cancer. However, in delivering both beta-particle brachytherapy and embolisation of tumour vasculature, SIRT produces biological sequelae and imaging characteristics distinct from other treatment modalities. Current CT interpretation criteria consistently under-report pathological responses to radioembolisation, diminishing both the prognosis and subsequent treatment choices for responding patients. However, newer criteria incorporating both tumour dimensions and enhancement characteristics improve the correlation with histopathology and provide substantially earlier confirmation of response. CT following radioembolisation may also identify parenchymal features that are often benign but may be mistaken for tumour progression. This review outlines imaging criteria specific to SIRT, including assessment of tumour response and interpretation of both lesion and parenchymal characteristics. The adjunctive role of additional modalities such as positron emission tomography is also addressed.     

Radioembolization for primary and metastatic liver cancer

The incidence of hepatocellular carcinoma is increasing. Most patients present beyond potentially curative options and are usually affected by underlying cirrhosis. In this scenario, transarterial therapies, such as radioembolization, are rapidly gaining acceptance as a potential therapy for hepatocellular carcinoma and liver metastases. Radioembolization is a catheter-based liver-directed therapy that involves the injection of micron-sized embolic particles loaded with a radioisotope by use of percutaneous transarterial techniques. Cancer cells are preferentially supplied by arterial blood and normal hepatocytes by portal venous blood; therefore, radioembolization specifically targets tumor cells with a high dose of lethal radiation and spares healthy hepatocytes. The antitumor effect mostly comes from radiation rather than embolization. The most commonly used radioisotope is yttrium-90. The commercially available devices are TheraSphere (glass based; MDS Nordion, Ottawa, Canada) and SIR-Sphere (resin based; Sirtex, Lane Cove, Australia). The procedure is performed on an outpatient basis. The incidence of complications is comparatively less than other locoregional therapies and may include nausea, fatigue, abdominal pain, hepatic dysfunction, biliary injury, fibrosis, radiation pneumonitis, gastrointestinal ulcers, and vascular injury. However, these complications can be avoided by meticulous pretreatment assessment, careful patient selection, and adequate dosimetry. This article focuses on both the technical and clinical aspects of radioembolization with emphasis on patient selection, uses and complications.     

Comparison of the CobraPLA (Cobra Perilaryngeal Airway) and the Laryngeal Mask Airway Unique in children under pressure controlled ventilation

Background: The Laryngeal Mask Airway‐Unique (LMAU) and CobraPLA^TM (Cobra Perilaryngeal Airway) are supraglottic airway devices. There are no published studies comparing these devices in children breathing with pressure controlled ventilation (PCV). Methods: Eighty pediatric patients, scheduled for elective general surgery of short duration, were randomly assigned to have either a CobraPLA^TM or a LMAU used for airway management using PCV. We compared the devices with respect to (i) ability to form an effective cuff seal, (ii) oxygenation, (iii) endtidal carbon dioxide level, (iv) time to achieve an effective airway, (v) airway interventions required for insertion, (vi) fiberoptic score, (vii) respiratory variables and (vii) adverse events. Results: Cuff seal pressure was significantly higher for CobraPLA^TM (27.08 ± 4.15 cmH₂O) than for LMAU (20.91 ± 2.47 cmH₂O). Oxygenation was similar in both groups while the mean endtidal CO₂ in the CobraPLA^TM group was significantly higher than in the LMAU group (36.47 ± 1.93 mmHg vs 34.71 ± 3.05 mmHg, P = 0.021). Time and ease of insertion were similar, with CobraPLA^TM requiring more frequent jaw lift and LMAU requiring more frequent adjustment of the head and neck to achieve a proper position. Fiberoptic scores were excellent with both devices. Respiratory variables were similar with the exception that the plateau pressure and mean peak pressures were significantly lower with CobraPLA^TM. There was a low rate of blood mucosal staining of the devices. No patient in either group reported a sore throat. Conclusions: Both devices appear to be safe and effective in establishing an adequate airway in healthy children undergoing surgery of short duration with PCV.     

In vivo comparison of knee kinematics for subjects having either a posterior stabilized or cruciate retaining high-flexion total knee arthroplasty

The objective of this study was to determine the in vivo kinematics for subjects having either a fixed posterior stabilized (PS) or cruciate retaining (CR) high-flexion total knee arthroplasty (TKA). Three-dimensional kinematics from full extension to maximum flexion were determined for 30 subjects (15 PS, 15 CR) using fluoroscopy. On average, the PS subjects demonstrated 112 degrees of weight-bearing (WB) flexion, -6.4 mm of posterior femoral rollback, and 2.9 degrees of axial rotation. The CR subjects averaged 117 degrees of WB flexion, -4.9 mm of posterior femoral rollback, and 4.8 degrees of axial rotation. Posterior femoral rollback of the lateral condyle occurred for all PS TKAs and in 93% of the CR TKAs. Only 2 subjects in each group experienced greater than 1.0 mm of condylar lift-off. Subjects in both TKA groups demonstrated excellent WB ranges of motion and kinematic patterns similar to the normal knee, but less in magnitude.     

Antimalarial activity of alkaloids isolated from Stephania rotunda

Stephania rotunda (Menispermaceae) is used in traditional medicine for the treatment of fever. Four major alkaloids: dehydroroemerine, tetrahydropalmatine, xylopinine, cepharanthine as well as aqueous extract (SA), dichloromethane extracts (SD1 and SD2) from this plant were tested against Plasmodium falciparum W2 in vitro. Dehydroroemerine, cepharanthine and SD1 were the most active against W2 with IC(50) of 0.36, 0.61microM and 0.7microg/mL, respectively. Their IC(50) on human monocytic THP1 cells were 10.8, 10.3microM and >250microg/mL, respectively. Cepharanthine, SD1 and SA were selected for in vivo antimalarial test against Plasmodium berghei in mice. The results of SD1 and SA at dose of 150mg/kg showed a decrease of 89 and 74% of parasitaemia by intra-peritoneal injection and 62.5 and 46.5% of parasitaemia by oral administration, respectively. The result of cepharanthine at dose of 10mg/kg showed a decrease of 47% of parasitaemia by intra-peritoneal injection and 50% of parasitaemia by oral administration. Drug interaction of chloroquine and major alkaloids indicates that cepharanthine-chloroquine and tetrahydropalmatine-xylopinine associations are synergistic. These results are in agreement with the use of this plant in the treatment of malaria. This is the first report on in vivo antimalarial investigation for Stephania rotunda.     

Hepatic Abscess After Yttrium-90 Radioembolization for Islet-Cell Tumor Hepatic Metastasis

Infectious complications after yttrium-90 (y-90) radioembolization of hepatic tumors are rare. Most reports describe hepatic abscesses as complications of other locoregional therapies, such as transcatheter arterial embolization or chemoembolization. These usually occur in patients with a history of biliary intervention and present several weeks after treatment. We report a case of hepatic abscess formed immediately after y-90 radioembolization of a hepatic metastasis in a patient who had no history of previous biliary instrumentation.     

Effet de l��huile fixe de la nigelle (Nigella sativa L.) sur le profil des androg��nes chez le rat male

Nigella sativa L. seeds are used as herbal medicine for the treatment and prevention of several diseases. We investigated the effect of Nigella sativa fixed oil on the circulating levels of testosterone (T), follicle stimulating hormone (FSH) and lutenising hormone (LH), and on weight of body and reproductive organs in rats. Twenty male rats were divided into two groups: a vehicle-treated control group and an intraperitoneally treated group with Nigella sativa oil at a dose of 0.5 ml/kg body weight for 30 days. The Nigella sativa oil induced a significant increase in the weight of reproductive organs, and in the circulating levels of T, FSH and LH as compared to control animals (P < 0.05). We concluded that the Nigella sativa fixed oil may stimulate steroidogenesis by activation of hypothalamo-pituitary-testicular axis.