Evaluation of Inlet Design and Flow Rate Effect on Current Density Distribution in a Microbial Electrolysis Cell Using Computational Simulation Techniques, Coupling Hydrodynamics and Bioanode Kinetics

A theoretical model that describe the effect of design and operational conditions on current density distribution in a bioelectrochemical reactor used as microbial electrolysis cell (MEC) is described in this study. This model is proposed considering an approach where a direct electron transfer mechanism from the biofilm to the electrode surface takes place (mechanism present in most of microbial systems) and is governed by a dual donor-acceptor Nernst-Monod bioelectrochemical kinetic expression. The bioelectrochemical reactor is modelled considering two flow electrochemical reactor designs (a reactor design based in literature reports and a modified system proposed by the authors) operating at different flow inlet velocities and electrical overpotentials.

Results obtained from the numerical solution shows that flow distribution is an essential aspect that impact the reactor performance, since concentration profiles and electrical potential-current distributions are strongly dependent on flow regime. Modified inlet configuration displays a more homogeneous fluid distribution and this behavior directly affects the mass transport and current density performance, as a result higher current density values are obtained for such configuration. Finally, it is expected that the information obtained from the analysis carried out in this report will provide us with a theoretical basis to realize the construction of a bioelectrochemical reactor prototype to develop the MEC concept.

Therapeutic enquiries about biological agents as a tool to identify safety aspects and patterns of use

Background

Biotechnological agents (BA) are increasingly being used in clinical practice. We aimed to determine, whether enquiries about them to a therapeutic consultation service have also become more frequent, and to describe the information requested in these consultations.

Methods

We retrospectively reviewed 14 104 therapeutic consultations collected in a computerised database between 2000 and 2014. Enquiries about BA (monoclonal antibodies, fusion proteins or cytokine antagonists) were chosen. Information on the type of BA, underlying condition, type of enquiry and affiliation of the enquirer was retrieved and compared with data from consultations about other agents.

Results

During the study period, 365 enquiries about 30 different BA were received. Only 4% of them were received before 2004, while 48.8% were received after 2010. Rituximab, infliximab, adalimumab and etanercept were most frequently enquired about. Agent selection (n=184) and/or adverse effects (n=174) were the most frequent reasons for making an enquiry. Most enquiries about an agent selection were made about an off-label use (n=164), mainly for systemic autoimmune diseases (n=61). Over half of the enquiries about adverse effects were about their teratogenic potential (n=96). Enquiries about BA more often requested an opinion (87.7% vs 77.7%) were made by physicians (89.9% vs 76.9%), from a hospital (81.6% vs 44.5%) and regarded a specific patient (87.4% vs 74.5%).

Conclusions

Therapeutic consultations about BA are increasing. Most of them are related to uncertainties of health professionals regarding any new medicine: their off-label use, actual adverse effects or the teratogenic potential of the involved agents.

A long term inventory of medium and large mammals with camera-traps in Las Tablas Protected Zone, Costa Rica

Large mammals are a critical component of tropical ecosystems, especially for the tropics (Terborgh 1988, Cardillo et al. 2005). Nevertheless, is not until recently that with the emergence and widespread use of non-invasive techniques such as camera-traps, that we are getting a large amount ofinformation on medium and large-size mammal assemblages.

Renewing hope: the rediscovery of Atelopus varius in Costa Rica

More than 90% of harlequin frog species (Atelopus spp.), endemic to the Americas, are currently threatened with extinction. We report the discovery of the only currently known breeding population of the Critically Endangered A. varius in Costa Rica. This population was located in 2008 on a private property in Las Tablas Protected Zone near San Vito, Coto Brus at 1300 m elevation. Previously, the only known remaining/remnant population of this species and genus was a single location near Manuel Antonio, Puntarenas, Costa Rica, where two individuals were documented in 2004. Subsequent searches at this location have yielded no additional sightings. Delineating the spatial limits of this population, quantifying demographics and resource use, and implementing conservation actions are necessary to ensure persistence of this population. Conducting additional surveys in this region to ascertain occurrence of additional populations is warranted.

Differences in the crystal structures of two dialkyl diester triphenylphosphonium ylids

Hydrogen bonding and crystal packing play major roles in determining the conformations of ethyl methyl 2-(triphenylphosphoranylidene)malonate, Ph(3)P=C(CO(2)CH(3))CO(2)CH(2)CH(3) or C(24)H(23)O(4)P, (I), and dimethyl 2-(triphenylphosphoranylidene)malonate, Ph(3)P=C(CO(2)CH(3))(2) or C(23)H(21)O(4)P, (II). In (I), the acyl O atom of the ethyl ester group is anti to the P atom, while the O atom of the methyl ester group is syn. In (II), the dimethyl diester is a 1:1 mixture of anti-anti and syn-anti conformers.

Cyano-stabilized triphenylphosphonium ylids

Crystalline cyano-stabilized triphenylphosphonium ylids with keto or ester groups give rise to an extended electronic delocalization. In methyl 2-cyano-2-(trimethylphosphonio)ethenoate, Ph3P=C(CN)CO2CH3 or C22H18NO2P, (I), and 1-cyano-1-(trimethylphosphonio)prop-1-en-2-olate, Ph3P=C(CN)CO-CH3 or C22H18NOP, (II), the carbonyl groups are oriented toward the cationoid P atom. Bond lengths and angles, torsion angles and P...O contact distances are consistent with a dominant coplanar conformation where the molecular structures are the result of a balance between intra- and intermolecular interactions. The main interactions presented by cyano-ester (I) and cyano-keto (II) are intramolecular interactions between the carbonyl O and the P atoms. In addition, both compounds show other less important intramolecular interactions between the carbonyl O and phenyl H atoms, which could contribute to form a preferred conformation in the crystal structure.

3-(Triphenylphosphoranylidene)pentane-2,4-dione and diethyl 2-(triphenylphosphoranylidene)malonate

The title ylides, 3-(triphenylphosphoranylidene)pentane-2,4-dione, C23H21O2P, (I), and diethyl 2-(triphenylphosphoranylidene)malonate, C25H25O4P, (II), differ in the conformations adopted by their extended ylide moieties. In (I), one carbonyl O atom is syn and the other is anti with respect to the P atom, the ylide group is nearly planar, with a maximum P-C-(C=O) angle of 18.2 (2)degrees, and the P-C, C-C and C=O bond lengths are consistent with electronic delocalization involving the O atoms. In (II), both carbonyl O atoms are anti and the ester groups are twisted out of the plane of the near trigonal ylide C atom, reducing delocalization, the largest P-C-(C=O) angle being 30.2 (2)degrees.

Preparation ofEntamoeba histolyticaantigens without enzymatic inhibitors

The goal of this work is to report a novel assay that preserves antigenicity of extracts with high protease content without using enzymatic inhibitors. A great reduction of proteolytic activity in the insoluble chloroform/methanol and heated amoebic fraction (IC[ratio ]MC) was obtained by this method, even in the presence of sodium dodecyl sulphate and 2-mercaptoethanol. The substrates azo-casein and the hide powder azure were used to determine the reduction of proteolytic activity of IC[ratio ]MC compared with the activity of crude extract and crude extract with iodoacetamide. The IC[ratio ]MC SDS-PAGE pattern shows a higher quantity of bands than extract with the inhibitor iodoacetamide or than crude extract. In addition, anti-Entamoeba histolyticaantibodies from amoebic liver abscess patients recognized a richer antigenic Western blot pattern in the IC[ratio ]MC fraction than in crude extract alone or with inhibitor. The described method has proved to be suitable to preserve amoebic antigens for its use in diagnostic tests and it can be used for immunological response studies againstE. histolyticaantigens. Furthermore we propose that this method to obtain the IC[ratio ]MC fraction can be applied for the study of other microorganisms or cells with high enzymatic content.

Apoptosis induced in HepG2 cells by short exposure to millimolar concentrations of ethanol involves the Fas-receptor pathway

PURPOSE

We previously found that ethanol-induced apoptosis is associated with an activation of caspase-3. However, the initial triggering of this process is yet unknown. Therefore, the present study was designed to determine whether the Fas-receptor pathway plays a role in the initiation by ethanol of human hepatocellular carcinoma (HepG2) cell apoptosis.

METHODS

HepG2 cells were incubated with or without 1 mM ethanol for 24 h. Apoptosis was assessed by DNA fragmentation and caspase-8 activity. Selective inhibitors of caspase-8 and caspase-9 were used to analyze the role of both caspases on apoptosis. Soluble human Fas ligand (Fas-L) was determined by enzyme-linked immunosorbent assay (ELISA). A fluorescent dye was used to investigate the permeability of the mitochondrial outer membrane. A recombinant Fas fusion protein was used to inhibit the activation of Fas receptors. Human anti-Fas-L antibody was employed to neutralize Fas-L released from the cells.

RESULTS

Caspase-8 activity increased significantly threefold (P < 0.005) after 12 h incubation of HepG2 cells with 1 mM ethanol whereas no change was observed in control cells. Incubation with caspase-8 inhibitor completely prevented apoptosis induced by ethanol (P < 0.001). In contrast, a caspase-9 inhibitor did not significantly reduce apoptosis. The permeability of the outer mitochondrial membrane was not altered. Neutralization of Fas-receptors by Fas fusion proteins completely attenuated ethanol-induced apoptosis in HepG2 cells treated with ethanol.

CONCLUSIONS

These findings show that apoptosis induced by low concentrations of ethanol in human HepG2 cells is associated with Fas-receptor activation and subsequent caspase-8 activation. Triggering of apoptosis through Fas-receptors represents a mechanism of action different from that observed with high concentrations of ethanol.

Comparison of three mechanical thrombus removal devices in thrombosed canine iliac arteries

PURPOSE

To assess and compare intimal and medial vascular damage caused by three mechanical wall-contact thrombectomy devices: Fogarty embolectomy catheter, Arrow-Trerotola peripheral thrombectomy device, and MTI-Castañeda over-the-wire brush.

MATERIALS AND METHODS

Bilateral external iliac arteries of 15 canines were thrombosed before mechanical thrombolysis. Ten thrombosed arteries were randomly assigned to receive each device. Animals were sacrificed immediately, and histologic assessment of endothelial and medial damage in the vessels was performed.

RESULTS

The vascular damage found with all devices extended into the tunica media. The Fogarty embolectomy catheter and the Arrow-Trerotola device caused significantly more damage than the Castañeda brush.

CONCLUSION

All devices caused lesions extending into the media. Previous research has shown that the extent and depth of the vascular lesion may be contributing factors in promoting early atherosclerotic and accelerated hyperplastic intimal and medial changes. These findings warrant further study of these devices in an atherosclerotic model with longer follow-up.

Transcatheter intraarterial infusion of rt-PA for acute lower limb ischemia: results and complications

PURPOSE

To determine the success and complication rates of intraarterial recombinant tissue-type plasminogen activator (rt-PA) infusion for the treatment of acute lower extremity artery and bypass graft occlusions.

MATERIALS AND METHODS

The results of 74 limbs in 70 patients (mean age, 66 y) treated with catheter-directed rt-PA infusion for the treatment of acute lower extremity ischemia were retrospectively evaluated. The group included 42 bypass grafts and 32 native arteries. All limbs were viable at presentation. The mean duration of symptoms was 11.9 days. rt-PA was infused for a mean of 27.9 hours for a mean total dose of 38.7 mg. Initial infusion rates of 3-6 mg/h were lowered to a preferred rate of 1.5 mg/h. Thrombolytic success was defined as 95% thrombolysis of an occluded segment with return of antegrade flow. Major bleeding complications were defined as any hemorrhagic event leading to surgery, extended or unexpected hospitalization, transfusion, death, intracranial hemorrhage, or a decrease in hemoglobin of 5 g/dL or in hematocrit of 15%. Thirty-day mortality and amputation rates were calculated. Patient characteristics and infusion parameters were evaluated as to whether they contributed to thrombolytic success or major bleeding events.

RESULTS

Thrombolytic success was achieved in 64 limbs (86%). Major bleeding complications occurred in 33 (47%) patients. In 22 of these patients, bleeding occurred at a vascular puncture site, whereas remote bleeding occurred in seven patients. Remote bleeding complications included two retroperitoneal hematomas, two rectus sheath hematomas, one lower gastrointestinal hemorrhage, one episode of hemoptysis, and one dehiscence of a femoral-popliteal bypass graft revision. No parameters were found to be predictive of thrombolytic success, whereas a negative history of smoking, increasing duration of infusion, and a low preprocedural ankle-brachial index (ABI) were found to be associated with major hemorrhagic events. Four patients (6%) underwent amputation and one patient (1%) died, resulting in a 30-day amputation-free survival rate of 93%.

CONCLUSION

Catheter-directed rt-PA infusion is effective in achieving thrombolysis. Despite a significant number of bleeding complications, 30-day mortality and amputation rates were favorable. Nonetheless, complication rates related to bleeding were not trivial and further evaluation with use of variable dosing regimens is indicated.

Assessment of a polyester-covered nitinol stent in the canine aorta and iliac arteries

PURPOSE

To evaluate the patency and healing characteristics of a woven polyester fabric-covered stent in the canine model.

METHODS

Twenty-four self-expanding covered stents were placed in the infrarenal aorta and bilateral common iliac arteries of eight dogs and evaluated at 1 (n = 2), 3 (n = 2), and 6 (n = 4) months. Stent assessment was done using angiography prior to euthanasia, and light and scanning electron microscopy.

RESULTS

Angiographically, just prior to euthanasia, 8 of 8 aortic and 14 of 16 iliac endovascular covered stents were patent. Histologically, the stented regions showed complete endothelialization 6 months after graft implantation. A neointima had formed inside the stented vessel regions resulting in complete encasement of the fabric-covered stent by 3 months after graft implantation. Medial compression with smooth muscle cell atrophy was present in all stented regions. Explanted stent wires, examined by scanning electron microscopy, showed pitting but no cracks or breakage.

CONCLUSION

The covered stent demonstrated predictable healing and is effective in preventing stenosis in vessels 10.0 mm or greater in diameter but does not completely preclude stenosis in vessels 6.0 mm or less in diameter.

Cytotoxicity of millimolar concentrations of ethanol on HepG2 human tumor cell line compared to normal rat hepatocytes in vitro

PURPOSE

The antiproliferative effect of high concentrations of ethanol (80-100 mmol) on liver carcinoma is well known. However, the high concentrations of ethanol affect both tumor cells and normal hepatocytes. The present study was designed to determine the effect of low ethanol concentrations (0-10 mmol) on cell proliferation and cell death (apoptosis and necrosis) in a human tumor cell line HepG2 and in normal rat hepatocytes.

METHODS

Primary cultures of normal rat hepatocytes and HepG2 cells cultures were used. Cells were incubated with increasing ethanol concentrations or without ethanol (control group) for 24 h and analyzed immediately (group I) or after an additional incubation time of 48 h without additional ethanol application (group II). Cell proliferation was determined by assessing 5-bromo-2'-deoxyuridine (BrdU) incorporation. Apoptosis was assessed by means of DNA fragmentation and cysteine aspartate-specific protease (caspase-3) activity. Necrosis was analyzed by quantification of lactate dehydrogenase (LDH) release into culture medium.

RESULTS

Twenty-four h exposure to 1 mmol ethanol inhibited cell proliferation in HepG2 cells by 75% (P < 0.05), while it remained unaltered in rat hepatocytes. The effect of ethanol persisted for another 48 h where cell proliferation was 5% of control in HepG2 cells and 70% of control in rat hepatocytes (P < 0.005). After 24 h incubation with 1 mmol ethanol 28% of HepG2 cells and 12% of rat hepatocytes showed DNA fragmentation as sign of apoptosis (P < 0.001). In group II 39% of HepG2 cells and 26% of rat hepatocytes were apoptotic (P < 0.001). Caspase-3 activation progressively increased after ethanol treatment in HepG2 cells and rat hepatocytes. The first significant difference was observed after 4 h (activity in HepG2 was 68% higher than in rat hepatocytes) and was maximum after 10 to 12 h where the activity in HepG2 was 180% of the activity in rat hepatocytes. Lactate dehydrogenase release into culture medium as an indicator of necrosis in HepG2 cells, increased from 0.5% in group I to 12% in group II, and from 0.1% to 8% in rat hepatocytes (P < 0.005). Increasing ethanol concentration to 10 mmol increased necrosis to 75% in HepG2 cells, and to 45% in rat hepatocytes (P < 0.05) whereas the effects on cell proliferation and apoptosis were not significantly different.

CONCLUSIONS

Small ethanol concentrations (equivalent to 1 mmol) inhibit cell proliferation and increase apoptosis more strongly in HepG2 cells than in normal rat hepatocytes. These findings suggest the use of 1 mmol ethanol as a treatment for hepatocellular carcinoma because this mainly affects tumor cells but not surrounding normal tissue.

Short exposure to millimolar concentrations of ethanol induces apoptotic cell death in multicellular HepG2 spheroids

PURPOSE

We have shown previously that 1 mM ethanol reduces cell proliferation and increases apoptosis in monolayers of human hepatocellular carcinoma (HepG2) cells. However, in vivo liver tumors are usually three-dimensional and multicellular. The purpose of this study was therefore to determine the effect of ethanol in multicellular tumor spheroids (MCTS) as a model system in vitro.

METHODS

After the application of 1 mM ethanol for 24 h and 48 h, viable, apoptotic and necrotic cells within MCTS were stained with specific fluorescent dyes, and their amount and distribution within the MCTS were assessed by confocal laser scanning microscopy. To evaluate the effect on HepG2 cell migration and cell proliferation, the outgrowth potential after 1 week in culture was evaluated.

RESULTS

As assessed by YO-PRO-1 staining, ethanol increased the number of apoptotic cells from 21.5 units (U) in control spheroids to 364 U and 482.2 U after 24 h and 48 h in ethanol-treated spheroids, respectively (P < 0.001). Merocyanine staining fluorescence increased from 10.7 U in the control to 122 U after 24 h and 293.2 U after 48 h (P < 0.001). Cell viability, as determined by staining with the acetoxymethyl ester of calcein, decreased from 578.5 U in the control to 236 U and 73.4 U after 24 h and 48 h of ethanol exposure respectively (P < 0.001). Necrosis showed an increase from 2 U in control to 24.9 after 24 h and 54 U after 48 h. MCTS treated with ethanol showed almost complete inhibition of outgrowth potential after 1 week in culture, compared to controls (P < 0.005).

CONCLUSIONS

Small concentrations of ethanol (1 mM) induced apoptosis in HepG2 MCTS with a concomitant inhibition on outgrowth potential, accompanied with a low degree of necrosis. These findings suggest that low concentrations of ethanol may already be sufficient for the treatment of hepatocellular carcinoma.

Pharmacomechanical thrombolysis with use of the brush catheter in canine thrombosed femoropopliteal arterial PTFE bypass grafts

PURPOSE

To assess the efficacy, acute endothelial changes, and distal arterial emboli after use of the Cragg thrombolytic brush catheter in mature thrombosed polytetrafluoroethylene (PTFE) femoropopliteal arterial grafts in canines.

MATERIALS AND METHODS

PTFE femoropopliteal arterial grafts were implanted in 10 canines and were allowed to mature for approximately 4 weeks. The grafts were thrombosed by mechanical means and allowed to remain thrombosed for 24-72 hours. Through a left carotid cut-down, standard Seldinger arterial puncture was performed, followed by catheterization of the thrombosed graft. A soft, low-speed, brush (6 mm in diameter) aided by preprocedure pulse-spray urokinase infusion was utilized for thrombolysis. The native vessels, just proximal and distal to the anastomosis, were evaluated microscopically for endothelial damage. Arteriography was used for assessment of distal embolus.

RESULTS

All grafts were successfully thrombosed before thrombolysis. One graft could not be traversed with a wire and catheter and was, therefore, not treated. Immediate preprocedure pulse-spray urokinase infusion in the remaining nine grafts did not reconstitute antegrade flow in any instance and left significant amounts of residual thrombus in all treated grafts. Mechanical brush thrombolysis reconstituted antegrade flow in all nine treated grafts and complete graft thrombolysis was obtained in most. This was accomplished in a mean time of less than 4 minutes. Emboli were noted angiographically in 67% of cases. Histologic studies showed vessel wall damage limited to the intima or media in 67% of anastomoses.

CONCLUSION

This method offers a simple and rapid means of recanalizing thrombosed PTFE femoropopliteal arterial grafts in the studied model. This technique provides a means of rapidly "debulking" most intragraft thrombi. This may result in a shorter course of thrombolytic infusion. Potential benefits may include shortening the total treatment time and decreasing morbidity and cost associated with percutaneous thrombolysis. The occurrence of distal emboli in a majority of cases is a concerning limitation of this technique.

Assessment of a polyester-covered nitinol stent in an atherosclerotic swine model

PURPOSE

To evaluate the short-term patency and healing characteristics of the Cragg EndoPro covered stent in an atherosclerotic model as one of the Food and Drug Administration requirements before possible approval of the device for human use in the United States.

MATERIALS AND METHODS

Seventeen self-expanding stent-grafts were placed in the aorta and right and left iliac arteries of six Yucatan microswine exposed to a regimen of accelerated atherosclerosis. The stent-grafts were constructed from nitinol wire formed into a tubular zigzag configuration. The stent frame was covered by a thin woven polyester fabric tube, with medium permeability, available in multiple diameters and lengths. The animals were killed at 24 hours, 3 months, and 6 months. Assessment was done by angiography and histology.

RESULTS

All stents were patent immediately after deployment. Two stents were occluded at follow-up, indicating an 88% patency rate. Minor lumen narrowing was found at the follow-up intervals. Histologic examination revealed a mixture of mature and immature endothelial cells lining both the native and stented regions in all vessels examined. The new endoluminal surface was composed primarily of fibrocollagen and elastic fibers and smooth muscle cells. Intimal thickness was inversely correlated to medial thickness. Medial compression with atrophy was observed routinely with rare necrosis. Complete tissue ingrowth was seen by 3 months. The degree of vascular inflammation increased over time, as well as the foreign body giant cell reaction to the polyester fabric.

CONCLUSION

The patency rate does not appear to be better than that with angioplasty or noncovered stent placement in the studied time frame. The progressive vascular inflammatory changes noted should be further investigated in longer-term animal trials to ensure its safety in humans because this device is meant to be permanent.

Effects of doxorubicin, mitomycin C, and ethanol on Hep-G2 cells in vitro

There are conflicting results for experiments aimed at determining whether anticancer drug therapy of human hepatocellular carcinoma prolongs the survival rate effectively. The purpose of this study was to assess the effect of low concentrations of doxorubicin, mitomycin C, and ethanol on cell replication (cell number and proliferation), and cell apoptosis of cultured human hepatocellular carcinoma (Hep-G2) cells. After 1 day of exposure doxorubicin inhibited cell replication initially by 72%, but a partial recovery of the cell number was observed. Mitomycin C inhibited to the same extent but without recovery. Ethanol reduced the cell number even further, the maximum inhibition (12 days after exposure) being 96.4%. After 3 days of exposure all three agents stopped cell replication at a level of 2%-4% of the control (P < 0.001). Cell apoptosis was activated most strikingly by mitomycin C (5 microg/ml) after 1 day of exposure and by ethanol (150 microl/ml) after 3 days of exposure. Two-way repeated-measures analysis of variance showed statistically significant differences, with ethanol being the most significant followed by mitomycin C doxorubicin, and the control (P < 0.01). Thus, a low dose of ethanol combined with an exposure time of up to 3 days appears to be an effective regimen to control growth of human hepatocellular carcinoma cells in vitro. The strong induction of apoptosis by ethanol might be of additional benefit for a local application in vivo.

New thrombolytic brush catheter in thrombosed polytetrafluoroethylene dialysis grafts: preclinical animal study

PURPOSE

To assess the safety, efficacy, endothelial changes, and risks of pulmonary embolic events after the use of a new thrombolytic brush catheter in mature thrombosed polytetrafluoroethylene (PTFE) dialysis grafts in an animal model.

MATERIALS AND METHODS

Loop configuration PTFE grafts were implanted in the femoral vessels of 12 canines 4 weeks before mechanical thrombosis was performed. The thrombus was allowed to consolidate for 24 hours in 10 animals, 72 hours in one animal, and 7 days in one animal. Standard percutaneous criss-cross catheter access was performed, and a soft, low-speed, brush (6 mm in diameter), aided by 250,000 U of periprocedural urokinase, was utilized for thrombolysis. The native vessels, just distal to the anastomosis, and lungs were evaluated macro- and microscopically.

RESULTS

Thrombolysis was complete in all grafts with the exception of a small segment between the crossing of the access vascular sheaths. The total thrombolysis time ranged from 8 to 12 minutes; this included 5 minutes of pulse-spray lacing. No difference in thrombolysis time was found with regard to the age or amount of thrombus. Minimal endothelial changes were noted and no evidence of acute pulmonary embolus was found on necropsy or histologic studies.

CONCLUSION

This method offers a simple, safe, and efficient means of recanalization of thrombosed PTFE dialysis grafts in this canine model.

Sequential transarterial chemoembolization for unresectable advanced hepatocellular carcinoma

PURPOSE

The aim of this prospective study was to evaluate the feasibility, safety, and efficacy of sequential transarterial chemoembolization (TACE) for patients with unresectable advanced hepatocellular carcinoma (HCC).

METHODS

Twenty-one consecutive patients with unresectable T3 and T4 HCC were treated by sequential TACE (median time interval between treatments 7 weeks) up to six times with an emulsion of lipiodol, epirubicin, and cisplatin. All TACE procedures were performed as unilobar or whole-liver chemoembolization.

RESULTS

An average of 3.9 TACE procedures were performed per patient. One primary and two secondary technical failures occurred. No procedural death was observed. After exclusion of the patient with the primary technical failure and 3 patients with extrahepatic disease, the survival rates for the remaining 17 patients at 6, 12, 18, and 24 months were 70.6%, 52.9%, 44.1%, and 33.1%, respectively.

CONCLUSION

Sequential TACE is a safe procedure in patients with unresectable advanced HCC and feasible in most cases. It seems to prolong the survival time compared with historical series of untreated patients.

Angioplasty-induced pseudoaneurysm successfully treated with a Palmaz stent. A case report

Pseudoaneurysm formation and vessel rupture are considered rare complications of percutaneous transluminal angioplasty (PTA), and few reported cases exist in the literature. The true incidence of pseudoaneurysm formation is unknown, for follow-up angiography is not routinely performed unless symptoms recur or persist. Currently, the only intervention widely accepted for angioplasty-induced pseudoaneurysm involves surgical excision or repair. The authors describe a case of successfully treated pseudoaneurysm with a noncovered stent.

Interventional radiology of the lower urinary tract and its relationship to surgical treatment

Interventional radiological techniques of the lower genitourinary (GU) tract are large and varied and continue to expand because of technological advances and also because budgetary restraints are being placed on our medical society. This has stimulated continuous search for alternative ways of treating disease in a more cost-effective fashion. As a result, there has been an overall decrease in morbidity and mortality, as well as postprocedural incapacity. We review the most important and newest modalities and provide some background of the processes affecting the lower GU tract.

Prostatic urethroplasty with balloon catheter as a nonsurgical alternative for prostatic hyperplasia

Prostatic urethroplasty with balloon catheter is a new interventional uroradiological procedure that appears promising in treating benign prostatic hyperplasia in selected patients. As with many of the interventional radiographic procedures, it reduces the cost of therapy, it is associated with very low morbidity in an outpatient setting, and it can be performed in almost any patient, regardless of their medical condition. The recovery period is minimal. The procedure is easy to perform, but certain guidelines have to be followed to avoid complications. The workup of these patients is relatively the same as a patient undergoing surgical intervention. The patient needs to be thoroughly assessed to exclude the possibility of prostatic malignancy.

The importance of separation of prostatic lobes in relief of prostatic obstruction by balloon catheter urethroplasty: studies in dogs and humans

We performed balloon urethroplasty in six older normal dogs and 10 patients with benign prostatic hypertrophy to establish the mechanism by which this technique results in relief of bladder outlet obstruction. Thirty-millimeter balloon catheters were used in both the animal and human studies. Autopsy studies showed disruption of the anterior prostatic commissure in four of the six dogs, disruption of both anterior and posterior commissures in one dog, and no disruption in the remaining dog. In all 10 patients, cystoscopy and urethrography showed disruption of the anterior commissure. Separation of the prostatic lobes by disruption of the prostatic commissures may be the most important mechanism by which balloon urethroplasty relieves urethral obstruction.

Balloon dilatation of the prostate for treatment of benign hyperplasia

Trasurethral balloon dilatation of the prostate is a safe and simple procedure. It can be performed on an outpatient basis using topical anesthesia and sedation. The morbidity is minimal. The short-term results are encouraging. Prospective randomized studies are needed to determine the role of transurethral dilatation in the treatment of benign prostatic hyperplasia.