- Email: [email protected]
IMO 1906 Local therapy with octreotide (Sandostatin) in acute necrotizing pancreatitis, pancreatic pseudocysts and fistulas
S36
Ultrasound
in Medicine
and Biolc ’ fzY
IMO 1904 ULTRASOUND-GUIDED LAPAROSCOPIC THERMAL ABLATION OF HEPATIC TUMORS. Stanley J. Rogers, Paul D. Hansen, Kristen Engle, Tamara Ryan, Allan E. Siperstein, Department of Surgery. University of California, San Francisco I Mt. Zion Medical Center.
Objectives:
The technology of radiofrequency thermal ablation of primary and metastatic liver tumors may be applied intraoperatively using minimally invasive surgery and laparoscopic ultrasound guidance. Methods: Radiofrequency electrical energy is delivered to tissues via a specially designed 4-prong catheter to result in heating of tissues to 60-70 “C and cell death (RITA Medical Systems,, Inc.). Porcine studies were conducted to define appropriate parameters for energy delivery. Laparoscope; techmques, mcluding intraoperative ultrasonography, core bio sy and radiofrequency thermal ablation, were then app P.led to 10 patients with hver tumor. Results: In the porcine model, 3.5-4 cm lesions were reproducibly created in I5 minutes using 30-50 watts of ower The ablation process was monitored via temperature f eedback from thermocouples in the tips of the catheter rongs and by the development of a hyperechoic blush noted E y dynamic ultrasonography. Thirty-one lesions. including both primary (hepatoma) and metastatic (colorecral adenocarcinoma, non-secreting islet-cell cancer, gastrinoma. carcinoid, sarcoma, papillary thyroid cancer and esophageal adenocarcinoma primaries) liver tumors in ten patients were then targeted usmg laparoscopic ultrasound, allowing core biopsy and placement of the ablation catheter. Dynamic ultrasound was used to guide de loyment of the probes and to actively monitor the ongoing ab atIon process. There were no intraoperative complications, and all patients were discharged the next day. Successful ablation was confirmed by serial spiral liver-CT scanning and by symptomatic and fiochemlcal improvement. Quality of life was also serially assessed. Conclusions: Ultrasound-guided laparosco ic thermal ablation of hepatic tumors is a novel, minima P.ly Invasive method of providing effective cytoreduction of liver tumors with minimal morbidity. Survival studies will be needed for comparison with conventional surgical techniques.
f,
IMO 1905 ULTRASOUND-GUIDED RADIOFREQUENCY ABLATION PANCREATIC ADENOCARCINOMA. Emma J. Patterson, Chartes H. Scudamore, Andtzej K. Buczkowski, David A. Owen’. Departments of Surgery, (L Pathology and Laboratory Medicine*, University of British Columbia, Vancouver, Canada.
Volume 23, Supplement
IMO 1906 LOCAL THERAPY (SANDOSTATIN) PANCREATITIS, AND FISTULAS
N.Grigorov, University
1, 1997
WITH
OCTREOTIDE
IN ACUTE PANCREATIC
NECROTIZING PSEUDOCYSTS
A. Mendisova, St. Nikolova
Hospital
“Queen
Joanna”,
Sofia, Bulgaria
Abstract 15 patients with acute and subacute necrotizing pancreatitis, 29 patients with formed pancreatic pseudocysts and 12 pancreatic fBtu1a.s have been treated locally with Sandostatin applied 0.2 mg once or several times. This treatment has been performed on a background of the perceived by us as a routine percutaneous drainage and lavage under US-control and Sandostatin (0.1 - 0.3 mg daily s.c.). The combined parenteral and local treatment coupled with percutaneous drainage reduces the healing period significantly with 10 out of 15 patients in the I group (66.7%) and 23 out of 29 patients in the II group (79.3%). This effect is also confirmed by the fact, that in 11 patients, who did not have a significant improvement (US and CT control) from the perceived until now basic therapy, the additional local application (via the catheter) of Sandostatin sharply improved the clinical state and shortened the healing period. The pathogenic mechanism is probably connected with a direct influence on difficulty closing tistulas, which complicate this mechanism and make ineffective the basic procedures. A confirmation about that are the cured 8 out of 12 patients (66.7%) with pancreatic fistulas proved by x-ray. With the exception of one patient (transitory flush and slight dyspepsia), the other did not show side effects. The local application of Sandostatin can be added to the therapeutic approach in acute necrotic pancreatitis and pancreatic pseudocysts, especially in protracted cases.
IMO 1907 OF
Ductal adenocarcinoma of the pancreas accounts for approximately 90% of exocrine tumors, and is a characteristically aggressive lesion. At the time of diagnosis, fewer than 10% of tumors are confined to the pancreas, and more than 95% of patients eventually die of their disease. Even after resection for attempted cure, the median length of survival is only 18 to 20 months, thus alternative treatments are sought. At laparotomy, 6 patients with pancreatic adenocarcinoma were treated with radiofrequency ablation (RFA) of the head of the pancreas, immediately prior to pancreaticoduodenectomy with curative intent. The 15 gauge quadruple-hook radiofrequency (RF) probe was inserted under ultrasound (US) guidance. Radiofrequency energy (460 kliz) was applied (maximum 50 watts) until the temperature at all thermistors was >70°C for 10 minutes. The planned operation was then performed and the resected specimen was sent for pathologic examination. Using intraoperative ultrasound, tumors in the head of the pancreas were easily imagable, probes were inserted accurately, and the RF treatments were monitored in real-time. On gross pathologic examination, RF lesions were Identifiable as a pale area of dry necrosis compared with surrounding normal pancreatic tissue. India ink preferentially stained necrotic pancreas, increasing the contrast between normal and necrotic tissue. Pancreatic RF lesions were also stained with hematoxylin and eosin and NADH stains, and a zone of coagulative necrosis coinciding with the gross lesion was thus confirmed histochemically. In conclusion, RFA appean to be a promising new technique for inducing a well-controlled focal area of necrosis in the head of the pancreas.
DIAGNOSTIC USEFULNESS ENDOANAL ULTASOUND IN THE BENIGN ANAL :&EASE Hae Jeona Jean, Hyeon Joon Shin, Young Chill Choi, Jeong Hee Park, Ung Chae ParkI’, Jin Young Cho?. Department of Diagnostic Radiology, General Surgery’. Neurologyz, College of Medicine, Konknk University. Seoul. Korea. Purpose: The objective of this study was to evaluate the usefulness of endoanal ultrasonography and to find the characteristic images of the patients with fecal incontinence, anal abscess and anal fistula. Materials and Method: 25 patients with benign anal disease underwent endoanal ulttasonography from October 1995 to July 1996 (mean age: 37 yrs. male: 17, female: 8). Of the 25 patients, ten patients had fetal incontinence, eight had anal abscess and seven had anal fistula. We observed structures of upper middle and lower anal sphincters and also echo characteristics by using rotating radial scanning endoanal probe 7MHZ (type 1850, Brucl and Kjaer medical, Gcntoft, Denma@. We compared the images of each group to those of the control group after classifying patients into group Al (n=lO): neurogenic or idiopathic incontinence, group A2 (n=3): myogenic incontinence. group Bl (n=8): anal abscess and group B2 (n=7): fistula In pup A, we used IGS (Incontinence Grading Scale) for clinical grading of fecal incontinence and pudendal nerve terminal motor latency (PNTML) for pudendal nerve injury. In group B, endoanal ultrasonographic features and operative tindings were reviewed retrospectively. Results: The defects of sphincteric muscles were found in all the three patients with myogenic fecal incontinence by using anal endosonoeranhv. No evidence. of defti of s~hincteric muscle was revealed -in’ & out of seven cases w&h neurogenic fecal incontinence. Endoanal ultrasonography showed statistically significant different findings of myogenic incontinence from neurogcnic incontinence (P=O.O33). Accuracy of the cndoanal ultrasonography was 88% in the site, size and types of the anal abscess compared with operative findmgs and 86% in the presence of tract, internal and external opening of anal fistula. Conclusion: Endoanal ultrasonography with PNTML was very useful for the detection of site and severity of sphincteric muscle defect and the diagnosis of the etiology of fecal incontinence. abscess and tistula by analyzing the [email protected] of the lesion.
Ultrasound
in Medicine
and Biolc ’ fzY
IMO 1904 ULTRASOUND-GUIDED LAPAROSCOPIC THERMAL ABLATION OF HEPATIC TUMORS. Stanley J. Rogers, Paul D. Hansen, Kristen Engle, Tamara Ryan, Allan E. Siperstein, Department of Surgery. University of California, San Francisco I Mt. Zion Medical Center.
Objectives:
The technology of radiofrequency thermal ablation of primary and metastatic liver tumors may be applied intraoperatively using minimally invasive surgery and laparoscopic ultrasound guidance. Methods: Radiofrequency electrical energy is delivered to tissues via a specially designed 4-prong catheter to result in heating of tissues to 60-70 “C and cell death (RITA Medical Systems,, Inc.). Porcine studies were conducted to define appropriate parameters for energy delivery. Laparoscope; techmques, mcluding intraoperative ultrasonography, core bio sy and radiofrequency thermal ablation, were then app P.led to 10 patients with hver tumor. Results: In the porcine model, 3.5-4 cm lesions were reproducibly created in I5 minutes using 30-50 watts of ower The ablation process was monitored via temperature f eedback from thermocouples in the tips of the catheter rongs and by the development of a hyperechoic blush noted E y dynamic ultrasonography. Thirty-one lesions. including both primary (hepatoma) and metastatic (colorecral adenocarcinoma, non-secreting islet-cell cancer, gastrinoma. carcinoid, sarcoma, papillary thyroid cancer and esophageal adenocarcinoma primaries) liver tumors in ten patients were then targeted usmg laparoscopic ultrasound, allowing core biopsy and placement of the ablation catheter. Dynamic ultrasound was used to guide de loyment of the probes and to actively monitor the ongoing ab atIon process. There were no intraoperative complications, and all patients were discharged the next day. Successful ablation was confirmed by serial spiral liver-CT scanning and by symptomatic and fiochemlcal improvement. Quality of life was also serially assessed. Conclusions: Ultrasound-guided laparosco ic thermal ablation of hepatic tumors is a novel, minima P.ly Invasive method of providing effective cytoreduction of liver tumors with minimal morbidity. Survival studies will be needed for comparison with conventional surgical techniques.
f,
IMO 1905 ULTRASOUND-GUIDED RADIOFREQUENCY ABLATION PANCREATIC ADENOCARCINOMA. Emma J. Patterson, Chartes H. Scudamore, Andtzej K. Buczkowski, David A. Owen’. Departments of Surgery, (L Pathology and Laboratory Medicine*, University of British Columbia, Vancouver, Canada.
Volume 23, Supplement
IMO 1906 LOCAL THERAPY (SANDOSTATIN) PANCREATITIS, AND FISTULAS
N.Grigorov, University
1, 1997
WITH
OCTREOTIDE
IN ACUTE PANCREATIC
NECROTIZING PSEUDOCYSTS
A. Mendisova, St. Nikolova
Hospital
“Queen
Joanna”,
Sofia, Bulgaria
Abstract 15 patients with acute and subacute necrotizing pancreatitis, 29 patients with formed pancreatic pseudocysts and 12 pancreatic fBtu1a.s have been treated locally with Sandostatin applied 0.2 mg once or several times. This treatment has been performed on a background of the perceived by us as a routine percutaneous drainage and lavage under US-control and Sandostatin (0.1 - 0.3 mg daily s.c.). The combined parenteral and local treatment coupled with percutaneous drainage reduces the healing period significantly with 10 out of 15 patients in the I group (66.7%) and 23 out of 29 patients in the II group (79.3%). This effect is also confirmed by the fact, that in 11 patients, who did not have a significant improvement (US and CT control) from the perceived until now basic therapy, the additional local application (via the catheter) of Sandostatin sharply improved the clinical state and shortened the healing period. The pathogenic mechanism is probably connected with a direct influence on difficulty closing tistulas, which complicate this mechanism and make ineffective the basic procedures. A confirmation about that are the cured 8 out of 12 patients (66.7%) with pancreatic fistulas proved by x-ray. With the exception of one patient (transitory flush and slight dyspepsia), the other did not show side effects. The local application of Sandostatin can be added to the therapeutic approach in acute necrotic pancreatitis and pancreatic pseudocysts, especially in protracted cases.
IMO 1907 OF
Ductal adenocarcinoma of the pancreas accounts for approximately 90% of exocrine tumors, and is a characteristically aggressive lesion. At the time of diagnosis, fewer than 10% of tumors are confined to the pancreas, and more than 95% of patients eventually die of their disease. Even after resection for attempted cure, the median length of survival is only 18 to 20 months, thus alternative treatments are sought. At laparotomy, 6 patients with pancreatic adenocarcinoma were treated with radiofrequency ablation (RFA) of the head of the pancreas, immediately prior to pancreaticoduodenectomy with curative intent. The 15 gauge quadruple-hook radiofrequency (RF) probe was inserted under ultrasound (US) guidance. Radiofrequency energy (460 kliz) was applied (maximum 50 watts) until the temperature at all thermistors was >70°C for 10 minutes. The planned operation was then performed and the resected specimen was sent for pathologic examination. Using intraoperative ultrasound, tumors in the head of the pancreas were easily imagable, probes were inserted accurately, and the RF treatments were monitored in real-time. On gross pathologic examination, RF lesions were Identifiable as a pale area of dry necrosis compared with surrounding normal pancreatic tissue. India ink preferentially stained necrotic pancreas, increasing the contrast between normal and necrotic tissue. Pancreatic RF lesions were also stained with hematoxylin and eosin and NADH stains, and a zone of coagulative necrosis coinciding with the gross lesion was thus confirmed histochemically. In conclusion, RFA appean to be a promising new technique for inducing a well-controlled focal area of necrosis in the head of the pancreas.
DIAGNOSTIC USEFULNESS ENDOANAL ULTASOUND IN THE BENIGN ANAL :&EASE Hae Jeona Jean, Hyeon Joon Shin, Young Chill Choi, Jeong Hee Park, Ung Chae ParkI’, Jin Young Cho?. Department of Diagnostic Radiology, General Surgery’. Neurologyz, College of Medicine, Konknk University. Seoul. Korea. Purpose: The objective of this study was to evaluate the usefulness of endoanal ultrasonography and to find the characteristic images of the patients with fecal incontinence, anal abscess and anal fistula. Materials and Method: 25 patients with benign anal disease underwent endoanal ulttasonography from October 1995 to July 1996 (mean age: 37 yrs. male: 17, female: 8). Of the 25 patients, ten patients had fetal incontinence, eight had anal abscess and seven had anal fistula. We observed structures of upper middle and lower anal sphincters and also echo characteristics by using rotating radial scanning endoanal probe 7MHZ (type 1850, Brucl and Kjaer medical, Gcntoft, Denma@. We compared the images of each group to those of the control group after classifying patients into group Al (n=lO): neurogenic or idiopathic incontinence, group A2 (n=3): myogenic incontinence. group Bl (n=8): anal abscess and group B2 (n=7): fistula In pup A, we used IGS (Incontinence Grading Scale) for clinical grading of fecal incontinence and pudendal nerve terminal motor latency (PNTML) for pudendal nerve injury. In group B, endoanal ultrasonographic features and operative tindings were reviewed retrospectively. Results: The defects of sphincteric muscles were found in all the three patients with myogenic fecal incontinence by using anal endosonoeranhv. No evidence. of defti of s~hincteric muscle was revealed -in’ & out of seven cases w&h neurogenic fecal incontinence. Endoanal ultrasonography showed statistically significant different findings of myogenic incontinence from neurogcnic incontinence (P=O.O33). Accuracy of the cndoanal ultrasonography was 88% in the site, size and types of the anal abscess compared with operative findmgs and 86% in the presence of tract, internal and external opening of anal fistula. Conclusion: Endoanal ultrasonography with PNTML was very useful for the detection of site and severity of sphincteric muscle defect and the diagnosis of the etiology of fecal incontinence. abscess and tistula by analyzing the [email protected] of the lesion.