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Transvenous Radiofrequency Ablation of Adrenal Gland: Experimental Study. Cardiovasc Intervent Radiol 2022; 45:1178-1185. [PMID: 35606658 DOI: 10.1007/s00270-022-03155-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/11/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim was to evaluate a flexible device for transvenous adrenal gland radiofrequency ablation in vitro and in an in vivo animal model. MATERIALS AND METHODS A flexible radiofrequency-tip catheter with an inner-cooling mechanism and a guidewire lumen was made. Then, using a polyvinyl alcohol gel model, the ablation diameter was evaluated and how much energy to deliver in vivo was determined. Finally, transvenous radiofrequency ablation of the left adrenal glands of two pigs was performed, delivering 5000 or 7000 J in a single dose to each. The ablation effects were also assessed by histological examination of hematoxylin-eosin-stained sections. RESULTS The mean ablation diameters in the gel model were 20.2 and 21.9 mm in the short axis and 15 and 20 mm in the long axis for 5000 or 7000 J, respectively. The device was inserted into porcine left adrenal vein with no complications. The mean ablation diameters were 10 mm in the shorter axis (whole thickness of porcine left adrenal gland) in the porcine model for 7000 J. Transient increases in blood pressure and heart rate occurred during ablation. Histologically, the adrenal gland showed severe necrosis at ablated area. There was venous congestion upstream in a non-ablated area, and thermal damage to surrounding organs was not observed. CONCLUSIONS A flexible radiofrequency-tip catheter could be inserted successfully into the left adrenal vein. The left adrenal gland was entirely ablated without any thermal damage to surrounding organs. We suggest transvenous adrenal ablation has potential as a therapeutic option for primary aldosteronism.
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Huang KH, Yu CC, Hu YH, Chang CC, Chan CK, Liao SC, Tsai YC, Jeff Chueh SC, Wu VC, Lin YH. Targeted treatment of primary aldosteronism - The consensus of Taiwan Society of Aldosteronism. J Formos Med Assoc 2018; 118:72-82. [PMID: 29506889 DOI: 10.1016/j.jfma.2018.01.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/25/2017] [Accepted: 01/05/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND/PURPOSE Even with the increasing recognition of primary aldosteronism (PA) as a cause of refractory hypertension and an issue of public health, the consensus of its optimal surgical or medical treatment in Taiwan has not been reached. Our objective was to develop a clinical practice guideline that is feasible for real-world management of PA patients in Taiwan. METHODS The Taiwan Society of Aldosteronism (TSA) Task Force recognized the above-mentioned issues and reached this Taiwan PA consensus at its inaugural meeting, in order to provide updated information of internationally acceptable standards, and also to incorporate our local disease characteristics and constraints into PA management. RESULTS In patients with lateralized PA, including aldosterone producing adenoma (APA), laparoscopic adrenalectomy is the 'gold standard' of treatment. Mini-laparoscopic and laparoendoscopic single-site approaches are feasible only in highly experienced surgeons. Patients with bilateral adrenal hyperplasia or those not suitable for surgery should be treated by mineralocorticoid receptor antagonists. The outcome data of PA patient management from the literature, especially from PA patients in Taiwan, are reviewed. Mental health screening is helpful in early detection and management of psychopathology among PA patients. CONCLUSION We hope this consensus will provide a guideline to help medical professionals to manage PA patients in Taiwan to achieve a better quality of care.
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Affiliation(s)
- Kuo-How Huang
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Chin Yu
- Division of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan
| | - Ya-Hui Hu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, Taiwan
| | - Chin-Chen Chang
- Medical Imagine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chieh-Kai Chan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin Chu Branch, Hsinchu County, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shih-Cheng Liao
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-Chou Tsai
- Division of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan; Department of Urology, Tzu Chi University, Hualien, Taiwan.
| | - Shih-Chieh Jeff Chueh
- Glickman Urological and Kidney Institute, and Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Vin-Cent Wu
- Division of Nephrology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Hung Lin
- Division of Cardiology, National Taiwan University Hospital, Taipei, Taiwan
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Salsamendi JT, Gortes FJ, Ayala AR, Palacios JD, Tewari S, Narayanan G. Transarterial embolization of a hyperfunctioning aldosteronoma in a patient with bilateral adrenal nodules. Radiol Case Rep 2017; 12:87-91. [PMID: 28228887 PMCID: PMC5310245 DOI: 10.1016/j.radcr.2016.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 10/18/2016] [Accepted: 10/23/2016] [Indexed: 11/27/2022] Open
Abstract
Primary hyperaldosteronism often results in resistant hypertension and hypokalemia, which may lead to cardiovascular and cerebrovascular complications. Although surgery is first line treatment for unilateral functioning aldosteronomas, minimally invasive therapies may be first line for certain patients such as those who cannot tolerate surgery. We present a case of transarterial embolization (TAE) of an aldosteronoma. The patient presented with a cerebrovascular accident, and subsequently developed uncontrolled hypertension, hypokalemia, and a myocardial infarction. Following TAE, potassium returned to normal levels and blood pressure control was improved. There were no postoperative complications. TAE thus may be a safe and effective alternative to surgery.
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Affiliation(s)
- Jason T Salsamendi
- Department of Vascular and Interventional Radiology, University of Miami Miller School of Medicine, 1611 NW 12th Ave, Miami, FL 33136-1005, USA
| | - Francisco J Gortes
- Department of Vascular and Interventional Radiology, University of Miami Miller School of Medicine, 1611 NW 12th Ave, Miami, FL 33136-1005, USA
| | - Alejandro R Ayala
- Department of Endocrinology, University of Miami Miller School of Medicine, 1400 NW 10th Ave, Miami, FL 33136, USA
| | - Juan D Palacios
- Department of Endocrinology, University of Miami Miller School of Medicine, 1400 NW 10th Ave, Miami, FL 33136, USA
| | - Sanjit Tewari
- Department of Vascular and Interventional Radiology, University of Miami Miller School of Medicine, 1611 NW 12th Ave, Miami, FL 33136-1005, USA
| | - Govindarajan Narayanan
- Department of Vascular and Interventional Radiology, University of Miami Miller School of Medicine, 1611 NW 12th Ave, Miami, FL 33136-1005, USA
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Frenk NE, Sebastianes F, Lerario AM, Fragoso MCBV, Mendonca BB, de Menezes MR. Long-term Results after CT-Guided Percutaneous Ethanol Ablation for the Treatment of Hyperfunctioning Adrenal Disorders. Clinics (Sao Paulo) 2016; 71:600-605. [PMID: 27759849 PMCID: PMC5054768 DOI: 10.6061/clinics/2016(10)08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 07/27/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES: To evaluate the safety and long-term efficacy of computed tomography-guided percutaneous ethanol ablation for benign primary and secondary hyperfunctioning adrenal disorders. METHOD: We retrospectively evaluated the long-term results of nine patients treated with computed tomography-guided percutaneous ethanol ablation: eight subjects who presented with primary adrenal disorders, such as pheochromocytoma, primary macronodular adrenal hyperplasia and aldosterone-producing adenoma, and one subject with Cushing disease refractory to conventional treatment. Eleven sessions were performed for the nine patients. The patient data were reviewed for the clinical outcome and procedure-related complications over ten years. RESULTS: Patients with aldosterone-producing adenoma had clinical improvement: symptoms recurred in one case 96 months after ethanol ablation, and the other patient was still in remission 110 months later. All patients with pheochromocytoma had clinical improvement but were eventually submitted to surgery for complete remission. No significant clinical improvement was seen in patients with hypercortisolism due to primary macronodular adrenal hyperplasia or Cushing disease. Major complications were seen in five of the eleven procedures and included cardiovascular instability and myocardial infarction. Minor complications attributed to sedation were seen in two patients. CONCLUSION: Computed tomography-guided ethanol ablation does not appear to be suitable for the long-term treatment of hyperfunctioning adrenal disorders and is not without risks.
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Affiliation(s)
- Nathan Elie Frenk
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto de Radiologia, Serviço de Intervenção Guiada por Imagem, São Paulo/SP, Brazil
| | - Fernando Sebastianes
- Faculdade de Medicina da Universidade de São Paulo, Disciplina de Endocrinologia, Departamento de Medicina Interna, São Paulo/SP, Brazil
| | - Antonio Marcondes Lerario
- Faculdade de Medicina da Universidade de São Paulo, Disciplina de Endocrinologia, Departamento de Medicina Interna, São Paulo/SP, Brazil
| | | | - Berenice Bilharinho Mendonca
- Faculdade de Medicina da Universidade de São Paulo, Disciplina de Endocrinologia, Departamento de Medicina Interna, São Paulo/SP, Brazil
| | - Marcos Roberto de Menezes
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto de Radiologia, Serviço de Intervenção Guiada por Imagem, São Paulo/SP, Brazil
- Instituto do Câncer do Estado de São Paulo, Serviço de Radiologia e Intervenção Guiada por Imagem, São Paulo/SP, Brazil
- E-mail:
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Lee RK, Liu SY, Tong CS, Lee PS, Ng EK, Ahuja AT. Morphologic Change in Computed Tomography of Aldosterone-Producing Adenoma after Radiofrequency Ablation. Can Assoc Radiol J 2014; 65:86-90. [DOI: 10.1016/j.carj.2012.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 12/18/2012] [Accepted: 12/18/2012] [Indexed: 10/26/2022] Open
Abstract
Objective To evaluate the morphologic changes of aldosterone-producing adenoma (APA) on computed tomography (CT) before and after radiofrequency ablation (RFA) and to assess the factors that are important in determining successful complete ablation of these tumours. Method Between August 2004 and August 2011, 24 consecutive patients with APA undergoing CT-guided percutaneous RFA were identified from our prospective database. The pre-RFA and post-RFA CT appearances of these APAs that showed positive biochemical response were reviewed retrospectively for their 3-dimensional size, tumour volume, and CT attenuation in terms of Hounsfield units (HU). A comparison of these parameters before and after RFA was performed. Results In this study, there were 23 APAs in these 24 patients that showed biochemical cure of primary aldosteronism after RFA. When comparing post-RFA to pre-RFA CTs, there was no significant change in tumour size (14.5 mm vs 14.6 mm: P = .83) and tumour volume (1.55 cm3 vs 1.59 cm3; P = .41) after RFA. In nonenhanced CT images, there was no significant reduction in HU from pre-RFA to post-RFA measurements (4.4 HU vs 7.9 HU; P = .52). In contrast-enhanced CTs, there was a significant drop in HU after RFA (from 48.3 HU to 14.7 HU; P = .03). None of the included cases showed a focal region of contrast enhancement to suggest residual tumour. Conclusion A change in tumour size, tumour volume, and HU in nonenhanced CT were unreliable in defining radiologic treatment success. Only changes in HU in contrast-enhanced CT was useful in confirming a positive treatment response after RFA for APA.
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Affiliation(s)
- Ryan K.L. Lee
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Hong Kong/Chinese University of Hong Kong, Hong Kong
| | | | - Cina S.L. Tong
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Hong Kong/Chinese University of Hong Kong, Hong Kong
| | - Paul S.F. Lee
- Department of Radiology, North District Hospital, Hong Kong
| | - Enders K.W. Ng
- Department of Surgery, Prince of Wales Hospital, Hong Kong
| | - Anil T. Ahuja
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Hong Kong/Chinese University of Hong Kong, Hong Kong
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Chang FC, Liu KL, Huang KH, Wu VC, Lin YH, Chen YM, Wu KD, TAIPAI Study Group. Recurrence of primary aldosteronism after percutaneous ethanol injection. J Formos Med Assoc 2012; 111:176-8. [DOI: 10.1016/j.jfma.2012.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Revised: 06/23/2009] [Accepted: 08/20/2009] [Indexed: 11/17/2022] Open
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Abstract
Successful transcatheter arterial embolization of symptomatic adrenal aldosteronoma in a 56-year-old woman with hypertension and hypokalemia is described. The presentation, diagnosis, and treatment of aldosterone-producing tumors are subsequently discussed.
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Affiliation(s)
- Michael W D'Angelo
- Russell H. Morgan Department of Radiology, The Johns Hopkins Hospital, Baltimore, Maryland
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Pessoa LA, Gurgel F, Avila M, Maior MDCS, Silva VMB. Midterm outcome of ultrasound-guided alcohol gel sclerotherapy for symptomatic leiomyoma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:1323-1330. [PMID: 20733188 DOI: 10.7863/jum.2010.29.9.1323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The purpose of this study was to describe the outcome of ultrasound-guided ethanol gel sclerotherapy of myomatous nodules 1 to 18 months after treatment. METHODS A total of 118 consecutive patients with a diagnosis of symptomatic leiomyomas referred for ethanol gel sclerotherapy were studied between November 2005 and July 2007. Clinical (self-administered symptom questionnaire) and ultrasound follow-ups were done 1 to 2, 6 to 8, and 12 to 18 months after the procedure. RESULTS The mean baseline volumes +/- SD were 223.3 +/- 158.3 cm(3) for the uterus and 68.4 +/- 110.5 cm(3) for the dominant fibroid. The most common adverse reaction in the immediate postoperative period was pelvic pain in 27.1% of the patients, but 58.4% had no reactions. After 12 months, a 29.5% reduction in uterine volume was observed in 64.7% of the patients. A 55.5% reduction in dominant fibroid volume was observed in 82.8% of the patients. Pelvic pain improved in 29.8% of the sample, dysmenorrhea in 51.7%, and menstrual flow in 39%. Most patients (77%) reported being satisfied or very satisfied with the treatment. CONCLUSIONS The results suggest that ethanol gel sclerotherapy is a safe, conservative alternative for treating symptomatic uterine leiomyomas. Further randomized studies are necessary to determine the suitability and indications of this procedure in comparison to other minimally invasive techniques.
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Affiliation(s)
- Lucilo Avila Pessoa
- Department of Ultrasonography, Centro Diagnóstico Lucilo Avila Júnior, Recife, Brazil
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Life-Threatening Complication During Percutaneous Ablation of Adrenal Gland Metastasis: Takotsubo Syndrome. Cardiovasc Intervent Radiol 2009; 33:646-9. [DOI: 10.1007/s00270-009-9612-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Revised: 05/05/2009] [Accepted: 05/07/2009] [Indexed: 10/20/2022]
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Imaging-guided percutaneous radiofrequency ablation of adrenal metastases: preliminary results at a single institution with a single device. Cardiovasc Intervent Radiol 2008; 31:762-7. [PMID: 18421499 DOI: 10.1007/s00270-008-9337-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Revised: 02/28/2008] [Accepted: 03/03/2008] [Indexed: 10/22/2022]
Abstract
The aim of this study was to show the feasibility, safety, imaging appearance, and short-term efficacy of image-guided percutaneous radiofrequency ablation (RFA) of adrenal metastases (AM). Seven imaging-guided percutaneous RFA treatments were performed in six patients (two men and four women; mean age, 67.2 years; range, 55-74 years) with six AM who were referred to our institution from 2003 to 2006. One patient was treated twice for recurrence after first treatment. The average diameter of the treated AM was 29 mm (range, 15-40 mm). In all patients, the diagnosis was obtained with CT current protocols in use at our institution and confirmed by pathology with an image-guided biopsy. No major complications occurred. In one patient shortly after initiation of the procedure, severe hypertension was noted; another patient developed post-RFA syndrome. In five of six lesions, there was no residual enhancement of the treated tumor. In one patient CT examination showed areas of residual enhancement of the tumor after treatment. Our preliminary results suggest that imaging-guided percutaneous RFA is effective for local control of AM, without major complications and with a low morbidity rate related to the procedure. Long-term follow-up will need to be performed and appropriate patient selection criteria will need to be determined in future randomized trials.
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Lo WK, vansonnenberg E, Shankar S, Morrison PR, Silverman SG, Tuncali K, Rabin M. Percutaneous CT–guided Radiofrequency Ablation of Symptomatic Bilateral Adrenal Metastases in a Single Session. J Vasc Interv Radiol 2006; 17:175-9. [PMID: 16415149 DOI: 10.1097/01.rvi.0000188748.51764.ce] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Percutaneous computed tomography (CT)-guided radiofrequency (RF) ablation has been used in the palliative treatment of symptomatic bilateral adrenal tumors, often with each tumor addressed separately over the course of multiple treatment sessions. In the present case, a 71-year-old man with a diagnosis of lung cancer and painful bilateral metastases to the adrenal glands underwent percutaneous CT-guided RF thermal ablation of both adrenal masses in a single session (left adrenal mass, 4.7 cm; right adrenal mass, 4.3 cm), without occurrence of blood pressure instability or other acute complications. Measurement of plasma levels of cortisol, adrenocorticotropic hormone (ACTH), and glucose before and after RF ablation revealed transient changes that suggested preservation of endocrine feedback mechanisms. The patient experienced marked relief in pain bilaterally. By 5 days after the procedure, cortisol, ACTH, and glucose levels returned to preprocedural levels. On further follow-up at 6 months, the patient noted a lack of endocrine sequelae and continued pain relief.
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Affiliation(s)
- Wai-Kit Lo
- Department of Radiology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Minowada S, Fujimura T, Takahashi N, Kishi H, Hasuo K, Minami M. Computed tomography-guided percutaneous acetic acid injection therapy for functioning adrenocortical adenoma. J Clin Endocrinol Metab 2003; 88:5814-7. [PMID: 14671174 DOI: 10.1210/jc.2003-030530] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
We reported the outcomes of computed tomography (CT)-guided percutaneous acetic acid injection therapy for functioning adrenocortical adenomas. With the patient in a prone position, the puncture needle was inserted vertically downward into the adenoma with frequent CT scanning. After confirmation by pilot injection with contrast medium, a small aliquot of 40-50% acetic acid was injected and repeated. Between 1997 and 2002, 18 sessions of CT-guided injection therapy, including one session of ethanol injection, were performed on 10 patients (five patients with primary aldosteronism and five patients with Cushing's or subclinical Cushing's syndrome) without any complications except transient upper abdominal pain during the acetic acid injection. The follow-up period ranged from 5-69 months. The treatment resulted in almost an extirpation of the adrenocortical hyperfunction in seven patients after one or two sessions. CT-guided percutaneous acetic acid injection might be a simple, cost-effective, and far less invasive treatment for small functioning adrenocortical adenomas.
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Affiliation(s)
- Shigeru Minowada
- Department of Urology, International Medical Center of Japan, Tokyo 162-8655, Japan.
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Abstract
PURPOSE To provide an overview of the state of the art of tissue chemoablation in animal and human organs and cancers. We also describe our experience with the feasibility, predictability, and reproducibility of necrosis produced by needle chemoablative therapies including ethanol, hypertonic saline, and acetic acid solutions as well as gels in a porcine renal model. MATERIALS AND METHODS A MEDLINE search was performed for articles on animal and human tissue chemoablation published since 1965. In addition, at Washington University, experimental chemoablation was performed in pigs with 95% ethanol (4 mL), 24% hypertonic saline (4 mL), or 50% acetic acid (4 mL) solutions as well as in gel form. RESULTS There is extensive literature on the use of chemoablation for liver metastases; recently, chemoablation of the prostate has become an area of research. Human studies have been limited to patients who are not surgical candidates or to investigational procedures performed prior to definitive prostatic surgery. Animal studies of renal chemoablation as a sole therapy have produced mixed results. In our studies, only acetic acid provided complete necrosis. CONCLUSIONS To date, ethanol chemoablation has been shown to be feasible and reproducible only for metastatic hepatic carcinoma. In urology, chemoablation is still very much in the investigational stage for both the prostate and the kidney. A significant drawback is that even in the gel form, the spread of the chemoablative substance through the tissue is irregular and unpredictable. In the future, chemoablation may become a more effective modality by combining it with radiofrequency or other energy sources.
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Affiliation(s)
- Jamil Rehman
- Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri 92868, USA
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Hokotate H, Inoue H, Baba Y, Tsuchimochi S, Nakajo M. Aldosteronomas: experience with superselective adrenal arterial embolization in 33 cases. Radiology 2003; 227:401-6. [PMID: 12676966 DOI: 10.1148/radiol.2272011798] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the effectiveness and long-term follow-up results of superselective adrenal arterial embolization (SAAE) of aldosteronomas. MATERIALS AND METHODS Thirty-three patients with unilateral aldosteronomas were treated with SAAE. A 0.2-7.0-mL dose of high-concentration ethanol (HCE) was selectively infused into the feeding arterial branches of the aldosteronoma through a microcatheter by using a coaxial technique. Hormone, electrolyte, and blood pressure levels were evaluated after SAAE. The influence of background factors on SAAE success rate and the influence of age on hypertension in the patients in whom SAAE was successful were assessed with the Fisher exact test and a logistic regression model. RESULTS SAAE was successful in 27 (82%) of 33 patients. SAAE success rate was not influenced by sex, age, hypertension duration, family history of hypertension, adenoma site, type of ethanol used, or number of embolized arteries. The destructive effects of SAAE continued for the 6-94-month (mean, 45 months) follow-up period in all patients in whom SAAE was successful. In one patient, aldosteronoma recurred 15 months after SAAE and the second SAAE was successful. Blood pressure decreased in all 11 (100%) patients aged 45 years or younger and in eight (50%) of 16 patients older than 45 years (P =.008). Blood pressure decreased within 4 weeks after SAAE in 15 (79%) of these 19 patients. The rate of blood pressure reduction after SAAE decreased with increasing age, and the correlation was significant (P =.022). None of the 33 patients had severe complications. CONCLUSION SAAE with HCE is an effective therapy for aldosteronoma.
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Affiliation(s)
- Hirofumi Hokotate
- Department of Radiology, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Japan.
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Maki DD, Haskal ZJ, Matthies A, Langer J, Nisenbaum HL, Vaughn D, Alavi A. Percutaneous ethanol ablation of an adrenal tumor. AJR Am J Roentgenol 2000; 174:1031-2. [PMID: 10749245 DOI: 10.2214/ajr.174.4.1741031] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- D D Maki
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA
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Liang HL, Pan HB, Lee YH, Huang JS, Wu TD, Chang CT, Liang HL, Yang TL, Yang CF. Small functional adrenal cortical adenoma: treatment with CT-guided percutaneous acetic acid injection--report of three cases. Radiology 1999; 213:612-5. [PMID: 10551251 DOI: 10.1148/radiology.213.2.r99nv10612] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Two patients with Conn syndrome and one patient with Cushing syndrome underwent computed tomography (CT)-guided tumor ablation with a total of 5-11 mL of 50% acetic acid injected into their adrenal nodule (1.3-3.3 cm in diameter). No major complications were encountered during or after the procedure. All patients were symptom free with normal laboratory test results for at least 1-year follow-up. CT images showed complete cystic change with tumor size regression. Our preliminary results suggest that percutaneous acetic acid injection is a safe and effective alternative for treatment of small functional adrenal cortical adenoma.
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Affiliation(s)
- H L Liang
- Department of Radiology, Kaohsiung Veterans General Hospital, Taiwan, Republic of China.
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Kloos RT, Korobkin M, Thompson NW, Francis IR, Shapiro B, Gross MD. Incidentally discovered adrenal masses. Cancer Treat Res 1997; 89:263-92. [PMID: 9204197 DOI: 10.1007/978-1-4615-6355-6_13] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- R T Kloos
- Division of Nuclear Medicine, University of Michigan Medical Center, Ann Arbor 48109-0028, USA
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