Renal angiomyolipoma with extrarenal involvement--in vascular, lymph-node and perirenal tissue. Reports of four cases

Extrarenal involvement was found in four cases of renal angiomyolipoma. In one case the wall of the inferior right bronchial artery was infiltrated, lymph nodes were involved in two cases and the perirenal fat in one case. Extrarenal extension does not seem to alter the prognosis of renal angiomyolipoma. Expectant treatment of this rare condition therefore appears to be warranted.

[Treatment of non-small-cell lung cancer by dual (bronchial and pulmonary) arterial drug infusion]

Since the lung receives blood supply from both the bronchial and pulmonary arteries, chemotherapeutic agents given through both channels would give higher local drug concentration and better therapeutic results in the treatment of lung cancer. In this study, 10 patients with advanced NSCLC were treated by dual arterial infusion (DAI) of carboplatin (300mg/m2) and VP-16 (200-300mg/m2) twice at 3-week interval. From DAI treatment, a response rate of 80% (CR 2, PR 6) was achieved. In 5 patients DAI treatment had made surgical resection of the lung cancer possible. The 1-, 2- and 3-year survivors were 8, 6 and 5 respectively, with a median survival time of 11.5 months.

[Evaluation of new drug delivery system for primary lung cancer: intermittent intra-arterial injection therapy with implantable port system (reservoir)--II. Evaluation of technical methods for cannulation of feeding arteries of lung cancer with implantation of implantable port system]

As mentioned in the first of the present series of reports, lung cancers were fed by various arteries such as bronchial arteries, internal mammary arteries, inter-costal arteries and branches of subclavian arteries such as thyro-cervical truncus or thoraco-dorsal arteries, according to the size and stages of tumors and the processes of therapy. On the basis of these anatomical findings of the feeders of lung cancers, we tried several effective and reasonable ways of cannulation of catheters, which were connected with an implantable port system.

[Double embolization of bronchial artery to control massive hemoptysis]

Bronchial arteriography and double embolization is to block the peripheral bronches of the bronchial artery with micro-gelatin particles and then the trunk of the artery with sponge gelatin. The blood flow from the artery trunk and from the rich arterial bronches which forms B-P bypass is blocked. By this way the embolization is more complete. Clinical observation of 93 cases shows that the success rate reached 91% which indicate that the massive hemoptysis could stopped by this method.

[Evaluation of new style of drug delivery system for primary lung cancer: intermittent intra-arterial injection therapy with subcutaneous infusible port I.--Temporary changes in feeding arteries of lung cancer in processes of intra-arterial injection therapy]

Arterial injection therapy for lung cancers is concentrated on the bronchial arteries, because they are reported by the main feeders of lung cancers. In the present study, we attempted intermittent arterial injection therapy with implantable port system. In the cases of lung cancers, in the present study, tumors were mainly fed by bronchial arteries originating from intercostal-bronchial arteries in right lungs, and those directly originating from aorta in the left lungs. However, in the processes of BAI (Bronchial Arterial Injection Therapy), main feeders often were obstructed and the new feeders originated from branches of subclavian arteries, such as thyro-cervical truncks, internal mammary arteries, thoraco-acromial arteries and intercostal arteries. They formed networks surrounding the lungs. Adequate study of the feeding arteries should be performed in the course of arterial injection therapy of lung cancers.

[Therapeutic results of non-small cell lung cancer in stage III: combined synchronous irradiation with bronchial artery infusion of CDDP]

The present series consisted of 55 patients with non-small cell lung cancer in stage III who underwent radiotherapy from 1986-1989. They were divided into two groups: 35 patients with combined concurrent bronchial artery infusion (BAI) of CDDP (50 mg) and unevenly fractionated radiotherapy (combined group) and 20 with evenly fractionated irradiation (radiation group). The combined therapy was expected to achieve higher local control of disease. The rationale for the combined regime was based on the effects of CDDP, which causes cytostasis following intra-arterial infusion, and increased radiosensitivity from unevenly fractionated irradiation just after BAI. The radiotherapy group was considered a control in this study. The results of the combined group were limited to no CR, PR in 33 patients and NC in two with a period of 30 +/- 13 days for 50% reduction of tumor, superior to the radiation group. There was no difference between the two groups in the rate of local recurrence (combined group: 63%). The combined group showed 28 months of MST in cause-specific survival, a significant difference. Survival rates were 71% at one year, 27% at three years, and 15% at five years, including three survivors without recurrence. Stage III a patients in the combined group showed a better outcome than stage III b patients in the same group, and stage III a patients in the radiation group. Although radiation pneumonitis as a fatal side effect was noted in one patient of the combined group, the combined therapy presented here seemed to improve the prognosis of locally advanced lung cancer if properly indicated.

[A study on the dosage of carboplatin for bronchial arterial infusion in combination with radiation therapy]

Radiation therapy holds an important position as one of the multidisciplinary methods of treating lung cancer (non-small cell carcinoma). As a result of the development of platinum preparations such as cisplatin (CDDP) and wide use of digital subtraction angiography (DSA), selective bronchial arterial infusion (BAI) therapy made possible more effective use of anti-lung cancer drugs. The use of radiation therapy in combination with BAI is now recommended as a more effective method. Meanwhile carboplatin (CBDCA) has recently been developed as a second generation platinum preparation with less side effects, and is being used for BAI, too. However, the maximum tolerated dose (MTD) of CB DCA for BAI to be used in combination with radiation therapy is not known yet. We, therefore, carried out a phase-study to determine MTD of CBD CA for combination with radiation therapy. The results show that the MTD of CBDCA is 400 mg/m2, and that clinically recommendable infusion limit is 350 mg/m2. In an angiographic study performed at the same time, a plural number of tumor affected blood vessels were found in 81.3% of the patients with lung cancer. Therefore, infusion of a drug for such patients should be carefully applied.

[Extrarenal angiomyolipoma: vascular, lymphonodal, and perirenal localization. Report of 4 cases]

Angiomyolipomas are rare renal tumors considered benign even though evidences of occurrence of the disease in lymphnodes and vascular structures as well as in a variety of distant sites, such as the liver, the uterus, the nasal cavity and others, have occasionally been reported. We describe one case of late lesion of angiomyolipoma within the wall of the inferior bronchial artery, two cases of lymphnodes involvement and one case of angiomyolipoma extending into the perirenal fat.

[Targeting therapy for lung cancer]

Many approaches have been developed to targeting therapy for lung cancer. The representatives types have included photodynamic therapy (PDT), bronchial arterial infusion of anticancer agent and/or embolization, intensification of the effect of drugs on tumor tissue and drug delivery systems (DDS) using liposomes. In our hospital, 195 lung cancer patients, including those with 56 early stage lesions, have been treated with PDT, and a CR rate of 65.2% was obtained. Bronchial arterial infusion (BAI) for clinical N2, in-operable non-small cell lung cancer patients has prolonged median survival time compared to the patients treated without BAI. Combined modalities of chemotherapy and low power laser (He-Ne Laser) irradiation in the experimental animal model have been shown. This combined therapy may permit enhancement of the antitumor effects of routine chemotherapy by reducing the side effects of the drug. DDS using liposomes may well be a major targeting therapy for lung cancer. In our data, trans-bronchial injection of chemotherapeutic drugs encapsulated with liposomes will be most effective for mediastinal lymph node metastasis of lung cancer.

Intra-arterial infusion of N-isopropyl-p[123I]iodoamphetamine for assessing effective blood supply to pulmonary and hepatic neoplasms

The biodistribution and pharmacokinetics of intra-arterially administered N-isopropyl-p[123I] iodoamphetamine (123I-IMP) were prospectively evaluated in 38 patients with histologically proven pulmonary or hepatic tumors. Intra-arterially infused 123I-IMP was distributed initially in peripheral tissues in which the blood supply was maintained. Its concentration in malignant neoplasms was demonstrated to be higher than in normal tissues. In pulmonary cancer, the tumor uptake of the administered dose without a tissue attenuation correction (% uptake) of 123I-IMP at 1-2 min after injection was 14.7 +/- 5.7% (s.d.). The tumor to normal tissue ratio was 2.1 +/- 0.7 in hepatocellular carcinoma and 1.4 +/- 0.7 in metastatic tumors. The biodistribution of 123I-IMP was also compared to that of 99mTc-macroaggregated albumin (99mTc-MAA) in 9 cases of hepatic cancer. The distribution of 123I-IMP resembled that of 99mTc-MAA in 5 cases and was different in 4 cases. 123I-IMP was more concentrated in the tumor than 99mTc-MAA. Intra-arterial infusion scintigraphy with 123I-IMP seems to provide information on effective blood supply to neoplasms which are targeted in interventional radiology.

[Chest disease and embolization]

Bronchial artery embolization has become an established technique in the management of massive or recurrent hemoptysis, especially in treating patients who are poor candidates for lung surgical intervention. Nonbronchial systemic collateral arteries and pulmonary arteries may contribute significantly to pulmonary hemorrhage. In recent literature, the former embolization is widely accepted, but embolization of the latter has not been stressed, excluding the patients of AV malformation or pulmonary aneurysm. The recognitions of the precice bronchial artery anatomy and numerous collateral vessels are essential for successful embolotherapy. The much more attention should be given to the character of embolizing material. The clinical background, methods, and results of this procedure are discussed, as are the potential complications and their prevention.

A ruptured thymic branch aneurysm mimicking a ruptured aortic aneurysm, with associated bronchial artery aneurysms: report of a case

A 57-year-old woman who went into shock following an acute left hemothorax was operated on after stabilization under the diagnosis of a ruptured aortic aneurysm. A left fifth intercostal thoracotomy was done which revealed approximately 500 ml of bloody effusion in the extrapleural space and 2,000 g of clotted blood in the pleural cavity. While the aneurysm was initially thought to have originated in the isthmic or descending aorta, intraoperative findings revealed a swollen hematomatous thymus adherent to the aorta. A ruptured thymic branch aneurysm, 3 cm in diameter, was subsequently found in the resected hematomatous thymus. Histological examination also revealed several small aneurysms in the tortured bronchial arteries. Postoperative angiography showed a saccular aneurysm, 1.5 cm in diameter, and several smaller aneurysms in the bronchial artery of the left lung. The aneurysm was successfully treated by a transcatheter arterial embolization, and the patient has had no further symptoms since then. To our knowledge, there has been no other case of a ruptured thymic artery aneurysm reported in the literature, and only a few cases of bronchial artery aneurysms have been documented.

[Interventional treatment of non-operable central lung cancer]

From 1992 Jan. to 1992 Dec. 32 patients with lung cancer which were centrally located and considered to be non-operable were treated by bronchial artery chemoembolization. Each patient received 1-3 times of this interventional therapy. Chest radiographic observation showed that, in 27 cases the lesions were significantly reduced and in 5 cases, the lesions were disappeared. There were 2 cases whose laryngeal nerves were temporally pressed by the lesion resulting in hoarseness were completely recovered. The early results were satisfactory in all of our patients. In this article, the diagnosis of central lung cancer, the techniques of interventional bronchial artery chemoembolization and how to avoid the high level paraplegia resulting from spinal injuries were also discussed.

[Treatment results of small cell lung cancer: referring to the clinical value of BAI combined with radiotherapy]

Results of 65 cases of small cell lung cancer (SCLC) treated from Jan. 1981 to May 1991 were reviewed. There were 58 male and 7 female patients and their age was ranging from 37 to 86 (mean 65). There were 41 limited disease (LD) and 24 extensive disease (ED) cases. According to TNM (UICC 1987) staging system, there were 2 cases of stage I, 4 of stage II, 9 of stage III A, 28 of stage III B and 22 of stage IV. Among 65 cases, 60 cases received radiotherapy and 55 cases of them received radiotherapy for primary site. There were 29 cases received radiotherapy combined with BAI (bronchial artery infusion) and 20 cases received systemic chemotherapy. On survival, the 2-year survival rate was 26% and MST was 13 months in LD patients (n = 41). No 2-year survivors were seen in ED patients and MST was 10 months. Tumor response of primary site was as follows. In systemic chemotherapy group, CR 35%, PR 59%, NC 6% and PD 0% before radiotherapy and CR 59% after radiotherapy were obtained. In BAI group (including BAI + systemic chemotherapy), CR 6% and PR 88% before radiotherapy in BAI group. BAI did not seem to improve response rate compared to systemic chemotherapy. On survival, BAI group did not show significant better survival compared to BAI (-) group in LD cases (n = 31). In responders (evaluable LD cases, n = 24), the MSTs were 25 months in CR cases and 13 months in PR cases. No 2-year survivors were seen in PR cases.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of old pulmonary tuberculosis with repeated hemoptysis which presented therapeutic difficulties]

A 74-year-old male who had been infected with pulmonary tuberculosis since 1938 underwent thoracoplasty in 1955. After the operation, no symptoms manifested until 1988 when he developed hemosputum and hemoptysis in association with a cold with fever. Although he was admitted to a hospital, the symptoms could not be controlled, so he was referred to our department. The lesion causing the hemorrhage was considered to be in the upper lobe of the left lung. However, it would have been difficult to preserve respiratory function in the case of left upper lobectomy, because he had already undergone thoracoplasty on the right side. Therefore, bronchial artery embolization (BAE) using Spongel was performed. Second embolization was performed because hemoptysis referred after one month. However, the hemoptysis recurred again, so that two branches of the left subclavian artery and the left internal thoracic artery were ligated. No hemoptysis and hemosputum occurred for a while, but 2 years and 9 months after the operation, the patient was admitted due to hemoptysis with fever and coughing. Since the bronchial artery was embolized twice with spongel and twice with platinum coil, the patient's course has been good for 5 months.

[Superselective bronchial arterial infusion therapy with cisplatin and epirubicin hydrochloride, mitomycin C-iohexol-Lipiodol emulsion (EMILE) for hilar lung adenocarcinoma: preliminary clinical experience]

A case of hilar lung adenocarcinoma was treated by superselective bronchial arterial infusion therapy with cisplatin and epirubicin hydrochloride, mitomycin C-iohexol-Lipiodol emulsion (EMILE) using Tracker -18 infusion catheter. The tumor size was reduced on follow-up CT scans. However, EMILE was also distributed to nontumorous lung tissues around the tumor, and a shrinkage of the right upper lobe and elevations of the right hilus and diaphragm followed. No major complaints and clinical complications during and after the treatment occurred. This therapy was safe and effective for local tumor reduction in a case of hilar lung adenocarcinoma.

Embolotherapy for persistent hemoptysis: the significance of pleural thickening

Elective embolotherapy for recurrent hemoptysis was evaluated for its effectiveness. Forty embolotherapeutic procedures were performed in 30 patients. In the short term, complete hemostasis was achieved in 16 of 40 procedures (40%) and significant improvement in another 16 procedures (40%). Long-term, complete hemostasis was achieved in 14 of 34 procedures (41%) and significant improvement in 12 (35%). Embolotherapy was consistently more effective in patients who had no pleural abnormalities compared with those with pleural thickening. Long-term complete hemostasis was achieved in 7 of 10 procedures (70%) for the patients without pleural thickening and only 7 of 24 (29%) in patients with pleural thickening. Thus, pleural abnormalities negatively influence long-term effectiveness of embolotherapy.

[Successful embolization of bronchial artery in racemose hemangioma]

A 74-year-old male was admitted to our hospital because of hemoptysis. Bronchoscopic examination showed a polypoid lesion in the right middle lobe bronchus. Biopsy of the polypoid lesion caused a massive bleeding. A massive hemoptysis of about 1,200 ml occurred again on the 13th day after biopsy, angiographic embolization of the right bronchial artery was performed successfully. Dilatation, convolution and hypervascularization of the right bronchial artery were observed, and anastomosis with pulmonary artery was seen. The diagnosis of primary racemose hemangioma of the bronchial artery was made. There was no recurrence of hemoptysis 3 years after the embolization procedure. Bronchial artery embolization is an effective method of treatment of hemoptysis due to racemose hemangioma.

[Esophago-bronchial fistula caused by chemotherapy with bronchial artery infusion for pulmonary metastases from urinary tract cancer]

We treated a patient who had had postchemotherapeutic pulmonary metastases from urinary tract cancer by bronchial artery infusion (BAI) chemotherapy. Pulmonary lesions showed a 33.0% reduction after the treatment. However, esophago-bronchial fistula (EBF) occurred after the second BAI. The patient died of recurrent aspiration pneumonia and sepsis in the sequelae of the repair surgery. The fistula was considered to have resulted from an increase in the blood flow to the esophageal branch originating from the bronchial artery after the first BAI, which had consequently damaged the local tissue due to accumulation of anti-cancer drugs. In order to avoid these complications, the secondary change of blood flow should be examined precisely by preceding angiographical mapping, and the concentration and the infusion speed of the cytotoxic drugs, should be under adequate control.

[Disappearance of lung metastases from hepatocellular carcinoma following bronchial arterial infusion of CDDP and MMC]

A 58-year-old man was admitted to our department because he had been diagnosed as hepatocellular carcinoma, which was located at S6 segment, and posterior segmentectomy was performed. After 6 months, right lung metastases of HCC were found and right bronchial arterial infusion of CDDP and MMC was performed twice. Dramatic effects were obtained such as disappearance of lung metastases. We emphasize the useful effect of CDDP and MMC for metastases of HCC.

[Complications of arterial infusion of CDDP in the treatment of malignant neoplasms]

Arterial infusion of cis-diamminedichloroplatinum (CDDP) is an effective therapy for malignant neoplasms. Severe complications after this therapy in 298 patients with malignant tumors were reviewed in our institute from March 1982 to August 1989. Arteries infused with CDDP and the number of infusions were as follows: bronchial artery (a.) 277, hepatic a. 153, internal iliac a. 51, femoral or popliteal a. 15, lumbar a. 6, pulmonary a. 5, esophageal a. 3 and intercostal a. 3. Eight cases of severe complications were encountered: 3 of esophageal ulcer, 3 of spinal paralysis, and one each of mediastinitis and toe necrosis. The arteries responsible for complications were the bronchial a. in 3 cases of esophageal ulcer and 2 of spinal paralysis, intercostal a. in one of spinal paralysis, esophageal a. in one of mediastinitis and popliteal a. in toe necrosis. Complication rates were 2.7% (8/298 cases) and 1.5% (8/518 infusions). Angiotensin II was infused in 6 of 8 of the cases with complications. The complication rate was 2.9% (6/209 infusions) in the group with CDDP and angiotensin II and 0.6% (2/309 infusions) in the group with CDDP only. Arterial infusion of CDDP, especially combined with angiotensin II, should be done in consideration of the arteries responsible for such complications.

Case report: Therapeutic bronchial artery embolization in a case of Takayasu's arteritis

The pulmonary arteries are frequently involved in Takayasu's arteritis with a reported incidence of 41-100% in affected individuals. Patients are usually asymptomatic, however, often despite extensive pulmonary involvement. We describe a patient with Takayasu's arteritis who presented with haemoptysis caused by bronchial artery hypertrophy secondary to occlusive pulmonary arterial disease, who was treated by bronchial artery embolization. This is, to our knowledge, the first reported case of haemoptysis secondary to Takayasu's arteritis successfully treated by embolization.

Massive hemoptysis from thoracic actinomycosis successfully treated by embolization

Massive hemoptysis, a rare complication of pulmonary actinomycosis, is generally treated surgically. We describe a patient with massive hemoptysis due to pulmonary actinomycosis who was treated successfully by means of selective bronchial artery embolization. The role of BAE is discussed.

Bronchial artery embolization for hemoptysis: immediate and long-term results

The purpose of this study was to evaluate the immediate and long-term results in 63 patients who underwent transarterial embolization for control of hemoptysis. Overall immediate success rate was 86.1%. At long-term follow-up 50% of patients showed complete remission, 22% partial remission, and 28% recurrent hemoptysis. Hemoptysis remained controlled for a mean of 22 months and a median of 14 months. The long-term results among four disease groups differed substantially. Patients with bronchiectasis showed the best results, followed by those with idiopathic disease and with inflammation; patients with neoplasm showed the worst results.