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Corvino F, Giurazza F, Marra P, Ierardi AM, Corvino A, Basile A, Galia M, Inzerillo A, Niola R. Damage Control Interventional Radiology in Liver Trauma: A Comprehensive Review. J Pers Med 2024; 14:365. [PMID: 38672992 PMCID: PMC11051275 DOI: 10.3390/jpm14040365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 03/16/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
The liver is the second most common solid organ injured in blunt and penetrating abdominal trauma. Non-operative management (NOM) has become the standard of care for liver injuries in stable patients, where transarterial embolization (TAE) represents the main treatment, increasing success rates and avoiding invasive surgical procedures. In hemodynamically (HD) unstable patients, operative management (OM) is the standard of care. To date, there are no consensus guidelines about the endovascular treatment of patients with HD instability or in ones that responded to initial infusion therapy. A review of the literature was performed for published papers addressing the outcome of using TAE as the primary treatment for HD unstable/transient responder trauma liver patients with hemorrhagic vascular lesions, both as a single treatment and in combination with surgical treatment, focusing additionally on the different definitions used in the literature of unstable and transient responder patients. Our review demonstrated a good outcome in HD unstable/transient responder liver trauma patients treated with TAE but there still remains much debate about the definition of unstable and transient responder patients.
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Affiliation(s)
- Fabio Corvino
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital “Paolo Giaccone”, 90127 Palermo, Italy; (M.G.); (A.I.)
- Interventional Radiology Department, AORN “A. Cardarelli”, 80131 Naples, Italy; (F.G.); (R.N.)
| | - Francesco Giurazza
- Interventional Radiology Department, AORN “A. Cardarelli”, 80131 Naples, Italy; (F.G.); (R.N.)
| | - Paolo Marra
- Department of Radiology, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy;
| | - Anna Maria Ierardi
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda—Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Antonio Corvino
- Medical, Movement and Wellbeing Sciences Department, University of Naples “Parthenope”, 80133 Naples, Italy;
| | - Antonio Basile
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital “Policlinico-San Marco”, University of Catania, 95123 Catania, Italy;
| | - Massimo Galia
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital “Paolo Giaccone”, 90127 Palermo, Italy; (M.G.); (A.I.)
| | - Agostino Inzerillo
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital “Paolo Giaccone”, 90127 Palermo, Italy; (M.G.); (A.I.)
| | - Raffaella Niola
- Interventional Radiology Department, AORN “A. Cardarelli”, 80131 Naples, Italy; (F.G.); (R.N.)
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Xhepa G, Vanzulli A, Sciacqua LV, Inzerillo A, Faerber P, Ierardi AM, Carrafiello G, Del Grande F, Ricoeur A. Advancements in Treatment Strategies for Chronic Mesenteric Ischemia: A Comprehensive Review. J Clin Med 2023; 12:7112. [PMID: 38002726 PMCID: PMC10672107 DOI: 10.3390/jcm12227112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
Chronic mesenteric ischemia (CMI) arises from the inability to achieve adequate intestinal blood flow after meals, leading to an imbalance between oxygen and metabolite supply and demand. The true incidence of CMI remains uncertain. However, the occurrence of mesenteric artery occlusive disease (MAOD) is relatively common among the elderly population. Delays in diagnosing CMI can often be attributed to several factors, including the variability in patient symptoms and the range of potential causes for chronic abdominal pain with weight loss. Mikkelson pioneered the introduction of a surgical treatment for occlusive lesions of the superior mesenteric artery (SMA) in 1957. The inaugural performance of endovascular revascularization (ER) for visceral vessels took place in 1980. The literature has documented two types of endovascular revascularization (ER) methods: percutaneous transluminal angioplasty (PTA) and primary stenting (PMAS). Despite the limited quality of available evidence, the consensus among experts is strongly in favor of PMAS over PTA alone for the treatment of atherosclerotic mesenteric artery stenosis. There are several key areas of focus for chronic mesenteric ischemia (CMI) treatment. Randomized controlled trials comparing different stent types, such as covered stents versus bare metal stents, are needed to evaluate efficacy, patency rates, and long-term outcomes in CMI patients.
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Affiliation(s)
- Genti Xhepa
- Istituto Di Imaging ella Svizzera Italiana (IIMSI), Clinica Di Radiologia, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland;
- Interventional Radiology Unit, University Hospital of Geneva (HUG), 1205 Geneva, Switzerland; (A.I.); (P.F.); (A.R.)
| | - Andrea Vanzulli
- Residency Program in Diagnostic and Interventional Radiology, Università degli Studi di Milano, 20126 Milan, Italy; (A.V.); (L.V.S.)
| | - Lucilla Violetta Sciacqua
- Residency Program in Diagnostic and Interventional Radiology, Università degli Studi di Milano, 20126 Milan, Italy; (A.V.); (L.V.S.)
| | - Agostino Inzerillo
- Interventional Radiology Unit, University Hospital of Geneva (HUG), 1205 Geneva, Switzerland; (A.I.); (P.F.); (A.R.)
| | - Pierre Faerber
- Interventional Radiology Unit, University Hospital of Geneva (HUG), 1205 Geneva, Switzerland; (A.I.); (P.F.); (A.R.)
| | - Anna Maria Ierardi
- Department of Radiology, Foundation IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, University of Milan, 20122 Milan, Italy;
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology Department, IRCCS Ca’ Granda Fondazione Ospedale Maggiore Policlinico, Università degli Studi di Milano, 20126 Milan, Italy;
| | - Filippo Del Grande
- Istituto Di Imaging ella Svizzera Italiana (IIMSI), Clinica Di Radiologia, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland;
- Facoltà Di Scienze Biomediche, Campus Est, Università Della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Alexis Ricoeur
- Interventional Radiology Unit, University Hospital of Geneva (HUG), 1205 Geneva, Switzerland; (A.I.); (P.F.); (A.R.)
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Inzerillo A, Meloni MF, Taibbi A, Bartolotta TV. Loco-regional treatment of hepatocellular carcinoma: Role of contrast-enhanced ultrasonography. World J Hepatol 2022; 14:911-922. [PMID: 35721286 PMCID: PMC9157715 DOI: 10.4254/wjh.v14.i5.911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/26/2021] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the few cancers for which locoregional treatments (LRTs) are included in international guidelines and are considered as a valid alternative to conventional surgery. According to Barcelona Clinic Liver Cancer classification, percutaneous treatments such as percutaneous ethanol injection, radiofrequency ablation and microwave ablation are the therapy of choice among curative treatments in patients categorized as very early and early stage, while transcatheter arterial chemoembolization is considered the better option for intermediate stage HCC. A precise assessment of treatment efficacy and surveillance is essential to optimize survival rate, whereas residual tumor requires additional treatment. Imaging modalities play a key role in this task. Currently, contrast-enhanced computed tomography/magnetic resonance imaging are considered the standard imaging modalities for this purpose. Contrast enhanced ultrasound (CEUS), using second generation contrast agents, plays an increasingly important role in detecting residual disease after LRTs. CEUS is a straightforward to perform, repeatable and cost-effective imaging modality for patients with renal failure or iodine allergies. Due to the ability to focus on single regions, CEUS can also provide high temporal resolution. Moreover, several studies have reported the same or better diagnostic accuracy as contrast-enhanced computed tomography for assessing tumor vascularity 1 mo after LRTs, and recently three-dimensional (3D)-CEUS has been reported as a promising technique to improve the evaluation of tumor response to therapy. Furthermore, CEUS could be used early after procedures in monitoring HCC treatments, but nowadays this indication is still debated, and data from literature are conflicting, especially after transcatheter arterial chemoembolization procedure.
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Affiliation(s)
- Agostino Inzerillo
- Department of Radiology, University Hospital "Paolo Giaccone", Palermo 90127, Italy
| | | | - Adele Taibbi
- Department of Radiology, University Hospital "Paolo Giaccone", Palermo 90127, Italy
| | - Tommaso Vincenzo Bartolotta
- Department of Radiology, University Hospital "Paolo Giaccone", Palermo 90127, Italy
- Department of Radiology, Fondazione Istituto G. Giglio Hospital, Cefalù 90015, Italy
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Moonga BS, Adebanjo OA, Wang HJ, Li S, Wu XB, Troen B, Inzerillo A, Abe E, Minkin C, Huang CLH, Zaidi M. Differential effects of interleukin-6 receptor activation on intracellular signaling and bone resorption by isolated rat osteoclasts. J Endocrinol 2002; 173:395-405. [PMID: 12065229 DOI: 10.1677/joe.0.1730395] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The effects of the related cytokines interleukin-6 (IL-6), leukemia inhibitory factor (LIF) and oncostatin-M on bone resorption and cytosolic Ca(2+) signaling were compared in isolated rat osteoclasts. In the traditional disaggregated osteoclast (pit) assay, IL-6 and LIF, but not oncostatin-M, conserved the bone resorption otherwise inhibited by high extracellular [Ca(2+)] (15 mM). It produced a paradoxical, concentration-dependent stimulation of resorption by elevated extracellular Ca(2+). In the micro-isolated single osteoclast resorption assay, IL-6, high [Ca(2+)] or IL-6 plus high [Ca(2+)] all increased pit formation. In contrast, the IL-6 receptor (IL-6R)-specific agonist antibody MT-18 inhibited bone resorption in a concentration-dependent manner (1:500 to 1:500 000). MT-18 triggered cytosolic Ca(2+) signals in fura 2-loaded osteoclasts within approximately 10 min of application. Each cytosolic Ca(2+) transient began with a peak deflection that persisted in Ca(2+)-free, EGTA-containing extracellular medium, consistent with a release of intracellularly stored Ca(2+). This was followed by a sustained elevation of cytosolic [Ca(2+)] that was abolished in Ca(2+)-free medium, as expected from an entry of extracellular Ca(2+), and by the Ca(2+) channel antagonist Ni(2+). The inclusion of either IL-6 or soluble human (sh) IL-6R specifically reversed both the above effects of MT-18, confirming that both effects were specific for the IL-6R. The findings suggest that IL-6R activation by IL-6 stimulates osteoclastic bone resorption either by reversing the inhibitory effect of high extracellular Ca(2+) in stromal-containing systems or itself stimulating bone resorption along with Ca(2+) by micro-isolated osteoclasts. In contrast, activation of the IL-6R by an agonist antibody produces an inhibition of bone resorption and an associated triggering of the cytosolic Ca(2+) signals previously associated with regulation of bone resorptive function in other situations.
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Affiliation(s)
- B S Moonga
- The Mount Sinai Bone Program and the Division of Endocrinology, Diabetes and Bone Diseases, Mount Sinai School of Medicine, New York, NY 10029, USA
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