Implanted pump concentrates chemotherapy for liver cancer

Prevention and treatment of rethrombosis after liver transplantation with an implantable pump of the portal vein

Implantable pumps have been used to prevent deep vein thrombosis and other diseases. In this article, we report for the first time the prevention and treatment of rethrombosis of the portal vein in liver transplantation with an implantable pump of the portal vein. Four hundred four orthotopic liver transplantation cases were retrospectively reviewed and divided into 3 groups: portal vein thrombosis (PVT) patients with an implantable pump (n = 28), PVT patients without an implantable pump (n = 20), and patients without preexisting PVT (n = 356). The following parameters for the 3 groups of patients were calculated and compared: (1) preoperative parameters, including baseline data of the donors and recipients and times of graft ischemia; (2) intraoperative and postoperative parameters, including surgery time, red blood cell and plasma transfusion, platelet concentrate transfusion, bleeding and primary graft malfunction, and duration of the hospital and intensive care unit stays; and (3) follow-up information for the patency of the portal vein, rethrombosis rate, stenosis and reoperation (relaparotomy or retransplantation), in-hospital mortality, and actuarial 1-year survival rate. Among the 3 groups of recipients, no significant differences were detected in preoperative and intraoperative parameters. However, compared to PVT patients without an implantable pump, PVT patients with an implantable pump showed remarkable reductions in their postoperative hospital stay, rethrombosis, reoperation rate, and in-hospital mortality. An implantable pump of the portal vein in liver transplantation patients can prevent and facilitate the treatment of portal vein rethrombosis and is associated with a reduction of in-hospital mortality.

Clinical evaluation of intermittent arterial infusion chemotherapy with an implanted reservoir for hepatocellular carcinoma

A total of 45 patients with advanced hepatocellular carcinoma were treated at Osaka City University Hospital by intermittent arterial infusion chemotherapy with an implanted reservoir. The treatment consisted of intermittent infusion of doxorubicin (5-20 mg/body), mitomycin C (4-10 mg/body) or degradable starch microspheres (600-1200 mg/body) plus doxorubicin (30 mg/body). In all, 26% of the patients received this treatment for disease recurrence following transcatheter arterial embolization (TAE). Among 43 evaluable patients, 4 showed a complete remission (CR) and 16 showed a partial response (PR) on computed tomograms and angiograms. For all 45 patients, the 1-year survival value was 41% and the 2-year value was 14%. Of the 20 patients who showed a CR or PR, 77% survived for 1 year and 29% survived for 2 years. Tumor regression showed a close relationship with the duration of survival. Intermittent arterial infusion with an implanted reservoir caused the least adverse reactions and seems to be appropriate for use in patients with advanced tumor extension or stenosis of the hepatic artery caused by repeated TAE.

Drug delivery by program or sensor controlled infusion devices

The prolonged controlled administration of drugs could benefit the treatment of several diseases. In some instances variable delivery rates are required, e.g. in the treatment of diabetes. Program controlled externally portable devices and fixed rate implantable pumps are rapidly gaining clinical acceptance. Widespread use of the considerably more complex implantable devices with variable rates for use in diabetes therapy is hampered by the persistant problem of the incompatibility of insulin with the pump at body conditions. The ideal devices, feed-back controlled implants, cannot be realized since long-term implantable sensors, e.g. of glucose, are not yet available. Prospective clinical trials are running for all applications to clarify the cost-benefit-risk relationships.