Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The aim of this study was to describe type and rate of complications in a series of patients with liver tumors treated by the radiofrequency (RF) expandable system. A total of 166 patients, 114 with hepatocellular carcinoma (HCC; 92 small HCC, 22 large) and 52 with liver metastasis, were treated by the percutaneous RF expandable system. In large HCCs, RF ablation was performed after tumor ischemia (TAE or balloon stop flow of the hepatic artery). Major complications were those that delayed hospital discharge, with or without additional medical procedures or treatments. Minor complications did not require an additional hospital stay. No deaths occurred. Among 151 patients followed, there were 7 (4.6%) early major complications-severe pain with session interruption in 3 cases, capsular necrosis in 1 case, 1 abdominal wall necrosis, 1 dorsal burning, 1 peritoneal hemorrhage-and 3 (1.9%) delayed major complications: sterile fluid collection at the site of the treated tumor in 2 cases and cutaneous seeding in 1 case. There were 49 (32.5%) minor complications. The complication rate is similar to that observed after percutaneous alcohol injection (PEI). With the cooled system, the complication rate is seemingly lower but that may well be due to a different definition of major complications. The seeding rate after expandable system ablation is lower than after PEI. It is the same as or lower than that in other series of patients treated by the cooled system.
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PMID:Radiofrequency thermal ablation with expandable needle of focal liver malignancies: complication report. 1456 70

This article has reviewed indications, methods, and results of PVE and TACE for hepatobiliary tumors. PVE is applied mainly to increase the safety of major hepatic resection in patients with hilar cholangiocarcinoma, HCC, or metastatic liver tumors. Hepatic arterial embolization causes selective ischemia of the liver tumor and enhances the cytotoxicity of the chemotherapeutic agent administered concomitantly. A survival benefit of TACE in patients with unresectable or recurrent HCC has been demonstrated. The significance of preoperative TACE is still controversial. TACE is routinely performed before PVE in HCC patients.
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PMID:Current role of portal vein embolization/hepatic artery chemoembolization. 1506 66

Organ shortage has driven many transplant centers to extend their criteria for organ acceptance. Graft allocation policies have been modified accordingly. This report focuses on the impact of applying the so-called rescue allocation (RA) strategy for liver transplantation (LT) in a single center within the Eurotransplant (ET) area. Liver grafts are considered for RA when the regular organ allocation is declined by at least three centers or is averted because of donor instability/unfavorable logistical reasons, thus entering a competitive or a single-recipient rescue organ offer procedure, respectively. The accepting center has the advantage to select a recipient from its own waiting list for these RA grafts. Among 253 livers accepted at the University of Heidelberg between January 2004 and December 2006, we transplanted 85 (34%) rescue-allocated livers. The indications for LT were hepatocellular carcinoma (HCC, 43%), chronic liver disease (55%), and acute liver failure (2%). Median cold ischemia time for RA grafts was 10 h (range: 4-17). The MELD score (mean +/- SD) was 13 +/- 7 (range: 6-40) and was 12 +/- 7 for recipients with HCC. Three (3.5%) primary non-functions (PNF) occurred after transplantation of RA livers. One-year patient and graft survival were 84% and 75%, respectively. A comparison between the recipients of RA livers and regularly allocated livers revealed no significant difference regarding initial poor function (IPF), PNF, and surgical complications. Furthermore, a median follow-up of 16 months revealed no significant difference regarding patient and graft survival between the two groups. The use of RA organs has increased the donor pool and transplantation dynamics with satisfying results. The unique possibility to match livers with recipients, which is left to the discretion of accepting center, should be judged according to the center's experience to decrease the waiting times for a timely rescue of organs/recipients while avoiding futile transplantations.
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PMID:Rescue allocation for liver transplantation within Eurotransplant: the Heidelberg experience. 1993 Mar 16

Breast cancer progression depends upon the elaboration of a vasculature sufficient for the nourishment of the developing tumor. Breast tumor cells frequently contain a mutant form of p53 (mtp53), a protein which promotes their survival. The aim of this study was to determine whether combination therapy targeting mtp53 and anionic phospholipids (AP) on tumor blood vessels might be an effective therapeutic strategy for suppressing advanced breast cancer. We examined the therapeutic effects, singly, or in combination, of p53 reactivation and induction of massive apoptosis (PRIMA-1), which reactivates mtp53 and induces tumor cell apoptosis, and 2aG4, a monoclonal antibody that disrupts tumor vasculature by targeting AP on the surface of tumor endothelial cells and causes antibody-dependent destruction of tumor blood vessels, leading to ischemia and tumor cell death. Xenografts from two tumor cell lines containing mtp53, BT-474 and HCC-1428, were grown in nude mice to provide models of advanced breast tumors. After treatment with PRIMA-1 and/or 2aG4, regressing tumors were analyzed for vascular endothelial growth factor (VEGF) expression, blood vessel loss, and apoptotic markers. Individual drug treatment led to partial suppression of breast cancer progression. In contrast, combined treatment with PRIMA-1 and 2aG4 was extremely effective in suppressing tumor growth in both models and completely eradicated approximately 30% of tumors in the BT-474 model. Importantly, no toxic effects were observed in any treatment group. Mechanistic studies determined that PRIMA-1 reactivated mtp53 and also exposed AP on the surface of tumor cells as determined by enhanced 2aG4 binding. Combination treatment led to significant induction of tumor cell apoptosis, loss of VEGF expression, as well as destruction of tumor blood vessels. Furthermore, combination treatment severely disrupted tumor blood vessel perfusion in both tumor models. The observed in vitro PRIMA-1-induced exposure of tumor epithelial cell AP might provide a target for 2aG4 and contribute to the increased effectiveness of such combination therapy in vivo. We conclude that the combined targeting of mtp53 and the tumor vasculature is a novel effective strategy for combating advanced breast tumors.
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PMID:Targeting mutant p53 protein and the tumor vasculature: an effective combination therapy for advanced breast tumors. 2034 29

Liver transplantation is the best treatment of patients with unresectable early hepatocellular carcinoma, allowing disease-free survival rates of 60-80% at 5 years. Despite these good results, some 10% of recipients experience a posttransplant HCC recurrence, which leads to death in almost all patients. Recurrence is either due to the growth of occult metastases or to the engraftment of circulating tumor cells. It can be hypothesized that strategies to decrease the engraftment of circulating tumor cells could decrease the risk of recurrence and, in addition, extend access to transplantation to patients with more advanced HCC. These potential strategies can be schematized into five steps, including (1) selecting recipients with low baseline levels of circulating HCC cells, by adding biological markers (such as alpha fetoprotein or molecular signatures) to the accepted combination of morphological criteria; (2) decreasing the perioperative release of HCC cells, with careful perioperative handling of the tumors; (3) preventing the engraftment of circulating HCC cells by decreasing liver graft ischemia-reperfusion injury, which has been shown to promote cancer cell engraftment and growth; (4) using anticancer drugs, including mammalian target of rapamycin inhibitors and (5) tuning immunity toward HCC clearance.
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PMID:Liver transplantation for hepatocellular carcinoma: five steps to prevent recurrence. 2183 Nov 54

The cardiovascular effects of cyclooxygenase (COX) inhibition remain controversial, especially in the setting of cardiovascular comorbidities. We examined the effects of nonselective and selective COX inhibition on cardiovascular function in a hypercholesterolemic swine model of chronic ischemia. Twenty-four intact male Yorkshire swine underwent left circumflex ameroid constrictor placement and were subsequently given either no drug (HCC; n = 8), a nonselective COX inhibitor (440 mg/day naproxen; HCNS; n = 8), or a selective COX-2 inhibitor (200 mg/day celecoxib; HCCX; n = 8). After 7 wk, myocardial functional was measured and myocardium from the nonischemic ventricle and ischemic area-at-risk (AAR) were analyzed. Regional function as measured by segmental shortening was improved in the AAR of HCCX compared with HCC. There was no significant difference in perfusion to the nonischemic ventricle between groups, but myocardial perfusion in the AAR was significantly improved in the HCCX group compared with controls at rest and during pacing. Endothelium-dependent microvessel relaxation was diminished by ischemia in HCC animals, but both naproxen and celecoxib improved vessel relaxation in the AAR compared with controls, and also decreased the vasoconstrictive response to serotonin. Thromboxane levels in the AAR were decreased in both HCNS and HCCX compared with HCC, whereas prostacyclin levels were decreased only in HCNS, corresponding to a decrease in prostacyclin synthase expression. Chronic ischemia increased apoptosis in Troponin T negative cells and intramyocardial fibrosis, both of which were reduced by celecoxib administration in the AAR. Capillary density was decreased in both the HCNS and HCCX groups. Protein oxidative stress was decreased in both HCNS and HCCX, whereas lipid oxidative stress was decreased only in the HCCX group. Thus nonselective and especially selective COX inhibition may have beneficial myocardial effects in the setting of hypercholesterolemia and chronic ischemia. Whether these effects modulate cardiovascular risk in patients taking these drugs remains to be seen, but evidence to date suggests that they do not.
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PMID:Effects of cyclooxygenase inhibition on cardiovascular function in a hypercholesterolemic swine model of chronic ischemia. 2203 94