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Isolated limb perfusion

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https://www.readbyqxmd.com/read/28251494/the-role-of-surgery-for-melanoma-in-an-era-of-effective-systemic-therapy
#1
REVIEW
Siavash Raigani, Sonia Cohen, Genevieve M Boland
PURPOSE OF REVIEW: The recent discovery of effective systemic treatments for melanoma has dramatically improved the prognosis for patients with advanced disease. As a result, the multidisciplinary management of melanoma has evolved significantly. In the past decades surgery was reserved for symptomatic palliation in patients with metastatic melanoma. Today surgical treatment of patients responding to systemic therapies has become an integral part of disease control. RECENT FINDINGS: Current efforts are focused on minimizing the morbidity of surgery (laparoscopic inguinal lymph node dissection, selective completion lymphadenectomy) as well as combining surgery with systemic therapy in novel ways (neoadjuvant targeted and/or immunotherapy, isolated limb infusion/perfusion with systemic immunotherapy)...
March 2017: Current Oncology Reports
https://www.readbyqxmd.com/read/28240525/infrapopliteal-calcification-patterns-in-critical-limb-ischemia-diagnostic-pathologic-and-therapeutic-implications-in-the-search-for-the-endovascular-holy-grail
#2
Jihad A Mustapha, Larry J Diaz-Sandoval, Fadi Saab
Critical limb ischemia (CLI) represents the terminal stage of peripheral arterial disease (PAD) and is characterized by multilevel and multivessel disease. Amongst patients with infrainguinal disease, approximately one third have predominantly isolated infrapopliteal disease and the remaining two thirds, a combination of femoropopliteal and infrapopliteal disease. Isolated infrapopliteal disease is mainly seen in the elderly, diabetic, or dialysis-dependent patients. These patients have higher risk of amputation and shorter amputation-free survival...
February 27, 2017: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/28209728/evaluation-of-cell-therapy-on-exercise-performance-and-limb-perfusion-in-peripheral-artery-disease-the-cctrn-patients-with-intermittent-claudication-injected-with-aldh-bright-cells-pace-trial
#3
Emerson C Perin, Michael P Murphy, Keith L March, Roberto Bolli, John Loughran, Phillip C Yang, Nicholas J Leeper, Ronald L Dalman, Jason Q Alexander, Timothy D Henry, Jay H Traverse, Carl J Pepine, R David Anderson, Scott Berceli, James T Willerson, Raja Muthupillai, Amir A Gahremanpour, Ganesh Raveendran, Omaida C Velazquez, Joshua M Hare, Ivonne H Schulman, Vijaykumar S Kasi, William R Hiatt, Bharath Ambale-Venkatesh, João A Lima, Doris A Taylor, Micheline M Resende, Adrian P Gee, April G Durett, Jeannette Bloom, Sara Richman, Patricia G'Sell, Shari Williams, Fouzia Khan, Elsie G Ross, Michelle R Santoso, JoAnne Goldman, Dana Leach, Eileen Handberg, Benjamin Y C Cheong, Nichole A Piece, Darcy DiFede, Barb Bruhn-Ding, Emily Caldwell, Judy Bettencourt, Dejian Lai, Linda B Piller, Lara M Simpson, Michelle Cohen, Shelly L Sayre, Rachel W Vojvodic, Lem Moyé, Ray F Ebert, Robert D Simari, Alan T Hirsch
Background -Atherosclerotic peripheral artery disease (PAD) affects 8-12% of Americans over 65 and is associated with a major decline in functional status, increased myocardial infarction and stroke rates, and increased risk of ischemic amputation. Current treatment strategies for claudication have limitations. PACE is an NHLBI-sponsored, randomized, double-blind, placebo-controlled phase 2, exploratory clinical trial designed to assess safety and efficacy of autologous bone marrow-derived aldehyde dehydrogenase bright (ALDHbr) cells in PAD patients and to explore associated claudication physiologic mechanisms...
February 16, 2017: Circulation
https://www.readbyqxmd.com/read/28193783/remote-ischemic-preconditioning-triggers-changes-in-autonomic-nervous-system-activity-implications-for-cardioprotection
#4
Safa Abdul-Ghani, Arnold N Fleishman, Igor Khaliulin, Marco Meloni, Gianni D Angelini, M-Saadeh Suleiman
Cardioprotective efficacy of remote ischemic preconditioning (RIPC) remains controversial. Experimental studies investigating RIPC have largely monitored cardiovascular changes during index ischemia and reperfusion with little work investigating changes during RIPC application. This work aims to identify cardiovascular changes associated with autonomic nervous system (ANS) activity during RIPC and prior to index ischemia. RIPC was induced in anesthetized male C57/Bl6 mice by four cycles of 5 min of hindlimb ischemia using inflated cuff (200 mmHg) followed by 5 min reperfusion...
February 2017: Physiological Reports
https://www.readbyqxmd.com/read/28188500/isolated-limb-perfusion-for-melanoma-is-safe-and-effective-in-elderly-patients
#5
Max F Madu, Marion M Deken, Jos A van der Hage, Katarzyna Jóźwiak, Michel W J M Wouters, Alexander C J van Akkooi
BACKGROUND: Data on isolated limb perfusion (ILP) in elderly melanoma patients are scarce. We aimed to evaluate the efficacy and safety of ILP in our institutional cohort of melanoma patients. METHODS: We performed retrospective analysis of stage IIIB/C melanoma patients who underwent ILP for melanoma in-transit metastases (ITMs) in our institution between 2000 and 2016. Normothermic ILP was performed with either melphalan or melphalan and tumor necrosis factor...
February 10, 2017: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/28174542/p2x-receptors-inhibit-nacl-absorption-in-mtal-independently-of-nitric-oxide
#6
Samuel L Svendsen, Søren Isidor, Helle A Praetorius, Jens Leipziger
Activation of basolateral P2X receptors markedly reduces NaCl absorption in mouse medullary thick ascending limb (mTAL). Here we tested the role of nitric oxide (NO) in the ATP-mediated (P2X) transport inhibition. We used isolated, perfused mTALs from mice to electrically measure NaCl absorption. By microelectrodes we determined the transepithelial voltage (Vte) and transepithelial resistance (Rte). Via these two parameters, we calculated the equivalent short circuit current, I'sc as a measure of the transepithelial Na(+) absorption...
2017: Frontiers in Physiology
https://www.readbyqxmd.com/read/28131184/confined-anterior-cerebral-artery-infarction-manifesting-as-isolated-unilateral-axial-weakness
#7
Asaf Honig, Ruth Eliahou, Eitan Auriel
We describe isolated unilateral axial weakness in three patients eventually diagnosed with anterior cerebral artery infarction (ACAI), a new clinical observation. Files of three ACAI patients (2 females, 1 male, ages 55-80) were retrospectively reviewed. All three presented to the ED with sudden unsteadiness. On initial neurological examination, all three patients manifested unilateral truncal deviation to the side contralateral to the weakness, even while seated. There was significant unilateral hypotonia due to substantial paravertebral weakness...
February 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/28129609/treatment-of-intimal-sarcoma-of-peripheral-veins
#8
Javier López-Gómez, Erwin R Flores-Vázquez, Ma Alejandra Salazar-Álvarez, Rodrigo Y Adame, Dorian Y Garcia-Ortega, Mario Cuellar-Hübbe
INTRODUCTION: Intimal sarcoma is an extremely rare group of undifferentiated pleomorphic sarcoma arising from the intimal layer of vessels accounting for only 1% of all sarcomas, intimal sarcoma of large veins are even less common. CASES PRESENTATION: We present two cases of intima sarcoma, one originated form the basilar vein and the other from the cephalic vein, the first one was treated with surgery and postoperative chemotherapy followed by Radiotherapy (RT), the second case was treated with isolated limb perfusion followed by marginal resection and RT...
January 16, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/27987195/new-does-not-always-mean-better-isolated-limb-perfusion-still-has-a-role-in-the-management-of-in-transit-melanoma-metastases
#9
Igor Puzanov, Joseph Skitzki
No abstract text is available yet for this article.
December 15, 2016: Oncology (Williston Park, NY)
https://www.readbyqxmd.com/read/27987194/isolated-limb-perfusion-for-stage-iii-melanoma-does-it-still-have-a-role-in-the-present-era-of-effective-systemic-therapy
#10
REVIEW
Dirk J Grünhagen, Cornelis Verhoef
The management of advanced-stage melanoma has changed dramatically with the introduction of systemic targeted therapy and immunotherapy. Patients with stage IV melanoma currently benefit from agents that are extremely effective, especially when compared with classic chemotherapeutic agents. The field is still evolving, and these newer agents are now used in patients with stage III disease, in the setting of adjuvant trials after resection of the disease bulk. Patients with bulky and numerous in-transit metastases form a very distinct subset of melanoma patients...
December 15, 2016: Oncology (Williston Park, NY)
https://www.readbyqxmd.com/read/27924355/avp-dynamically-increases-paracellular-na-permeability-and-transcellular-nacl-transport-in-the-medullary-thick-ascending-limb-of-henle-s-loop
#11
REVIEW
Nina Himmerkus, Allein Plain, Rita D Marques, Svenja R Sonntag, Alexander Paliege, Jens Leipziger, Markus Bleich
The medullary thick ascending limb of Henle's loop (mTAL) is crucial for urine-concentrating ability of the kidney. It is water tight and able to dilute the luminal fluid by active transcellular NaCl transport, fueling the counter current mechanism by increasing interstitial osmolality. While chloride is exclusively transported transcellularly, approx. 50% of sodium transport occurs via the paracellular route, driven by the lumen-positive transepithelial potential. Antidiuretic hormone (AVP) is known to increase active NaCl transport to support collecting duct water reabsorption...
January 2017: Pflügers Archiv: European Journal of Physiology
https://www.readbyqxmd.com/read/27890347/isolated-limb-perfusion-for-the-management-limb-threatening-soft-tissue-sarcomas-the-role-of-histological-type-on-clinical-outcomes
#12
M Rastrelli, S Mocellin, R Stramare, A Brunello, M Maruzzo, U Basso, G Scarzello, M S Buzzaccarini, P Pilati, L M Saadeh, S P Del Fiore, A Tosi, C Montesco, L G Campana, S Tropea, C R Rossi
BACKGROUND: Hyperthermic isolated limb perfusion (HILP) is an effective neoadjuvant treatment to avoid amputation in patients with locally advanced extremity soft tissue sarcomas (STS). We aimed to investigate whether STS histological type plays a role in predicting clinical outcomes. METHODS: This study reports a retrospective analysis of 125 patients with limb threatening STS (liposarcoma, n = 41; malignant peripheral nerve sheath tumor, n = 20; leiomyosarcoma, n = 20; miscellany, n = 44), who underwent HILP from 1990 through 2015 at our institution...
February 2017: European Journal of Surgical Oncology
https://www.readbyqxmd.com/read/27859767/mechanisms-for-the-control-of-local-tissue-blood-flow-during-thermal-interventions-influence-of-temperature-dependent-atp-release-from-human-blood-and-endothelial-cells
#13
Kameljit K Kalsi, Scott T Chiesa, Steven J Trangmar, Leena Ali, Makrand D Lotlikar, José González-Alonso
What is the central question of this study? Skin and muscle blood flow increases with heating and decreases with cooling, but the temperature-sensitive mechanisms underlying these responses are not fully elucidated. What is the main finding and its importance? We found that local tissue hyperaemia was related to elevations in ATP release from erythrocytes. Increasing intravascular ATP augmented skin and tissue perfusion to levels equal or above thermal hyperaemia. ATP release from isolated erythrocytes was altered by heating and cooling...
February 1, 2017: Experimental Physiology
https://www.readbyqxmd.com/read/27832863/endothelial-progenitor-cells-from-human-fetal-aorta-cure-diabetic-foot-in-a-rat-model
#14
Wan-Ni Zhao, Shi-Qing Xu, Jian-Feng Liang, Liang Peng, Hong-Lin Liu, Zai Wang, Qing Fang, Meng Wang, Wei-Qin Yin, Wen-Jian Zhang, Jin-Ning Lou
OBJECTIVE: Recent evidence has suggested that circulating endothelial progenitor cells (EPCs) can repair the arterial endothelium during vascular injury. However, a reliable source of human EPCs is needed for therapeutic applications. In this study, we isolated human fetal aorta (HFA)-derived EPCs and analyzed the capacity of EPCs to differentiate into endothelial cells. In addition, because microvascular dysfunction is considered to be the major cause of diabetic foot (DF), we investigated whether transplantation of HFA-derived EPCs could treat DF in a rat model...
December 2016: Metabolism: Clinical and Experimental
https://www.readbyqxmd.com/read/27783991/oncolytic-vaccinia-virus-combined-with-radiotherapy-induces-apoptotic-cell-death-in-sarcoma-cells-by-down-regulating-the-inhibitors-of-apoptosis
#15
Michelle J Wilkinson, Henry G Smith, Gráinne McEntee, Joan Kyula-Currie, Tim D Pencavel, David C Mansfield, Aadil A Khan, Victoria Roulstone, Andrew J Hayes, Kevin J Harrington
Advanced extremity melanoma and sarcoma present a significant therapeutic challenge, requiring multimodality therapy to treat or even palliate disease. These aggressive tumours are relatively chemo-resistant, therefore new treatment approaches are urgently required. We have previously reported on the efficacy of oncolytic virotherapy (OV) delivered by isolated limb perfusion. In this report, we have improved therapeutic outcomes by combining OV with radiotherapy. In vitro, the combination of oncolytic vaccinia virus (GLV-1h68) and radiotherapy demonstrated synergistic cytotoxicity...
October 22, 2016: Oncotarget
https://www.readbyqxmd.com/read/27752734/investigating-the-involvement-of-trpv1-ion-channels-in-remote-hind-limb-preconditioning-induced-cardioprotection-in-rats
#16
Puneet Kaur Randhawa, Amteshwar Singh Jaggi
Remote ischemic preconditioning (RIPC) treatment strategy is a breakthrough in the field of cardiovascular pharmacology as it has the potential to attenuate myocardial ischemia-reperfusion injury. However, the underlying intracellular pathways have not been widely explored. The present study intends to explore the possible role of TRPV1 channels in mediating remote hind limb preconditioning-induced cardioprotection. Remote hind limb preconditioning stimulus (4 cycles in succession) was delivered by tying the blood pressure cuff at the inguinal level of the rat...
February 2017: Naunyn-Schmiedeberg's Archives of Pharmacology
https://www.readbyqxmd.com/read/27746000/supplementing-essential-amino-acids-with-the-nitric-oxide-precursor-l-arginine-enhances-skeletal-muscle-perfusion-without-impacting-anabolism-in-older-men
#17
W Kyle Mitchell, Bethan E Phillips, Daniel J Wilkinson, John P Williams, Debbie Rankin, Jonathan N Lund, Kenneth Smith, Philip J Atherton
Postprandial limb blood flow and skeletal muscle microvascular perfusion reduce with aging. Here we tested the impact of providing bolus essential amino acids (EAA) in the presence and absence of the nitric oxide precursor, l-Arginine (ARG), upon skeletal muscle blood flow and anabolism in older men. Healthy young (YOUNG: 19.7 ± 0.5 y, N = 8) and older men (OLD, 70 ± 0.8 y, N = 8) received 15 g EAA or (older only) 15 g EAA +3 g ARG (OLD-ARG, 69.2 ± 1.2 y, N = 8). We quantified responses in muscle protein synthesis (MPS; incorporation of (13)C phenylalanine into myofibrillar proteins), leg and muscle microvascular blood flow (Doppler/contrast enhanced ultrasound (CEUS)) and insulin/EAA in response to EEA ± ARG...
October 6, 2016: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/27739318/-hyperthermic-isolated-limb-perfusion-combined-with-tasonermin-a-perfusion-leakage-monitoring-technique
#18
J Trnka, M Špaček, V Šírová, P Mitáš, G Hodková, J Kubinyi, R Špunda, J Lindner
BACKGROUND: Hyperthermic isolated limb perfusion is used to treat irresectable extremity malignancies. It is based on the following principle - the perfusion of the extremity is isolated from systemic circulation and connected to an extra-corporal circuit via which a very high concentration of a chemotherapeutic agent is administered into the blood compartment of the extremity. In some cases, treatment efficiency can be improved using tasonermin (a TNF-α agent). By itself, tasonermin can cause severe health complications in patients if leakage into systemic circulation results in a level that exceeds the maximally tolerated dose...
2016: Klinická Onkologie: Casopis Ceské a Slovenské Onkologické Spolecnosti
https://www.readbyqxmd.com/read/27684571/effect-of-dose-on-intra-articular-amikacin-sulfate-concentrations-following-intravenous-regional-limb-perfusion-in-horses
#19
Alison Harvey, Isabelle Kilcoyne, Barbara A Byrne, Jorge Nieto
OBJECTIVE: To compare synovial concentrations of amikacin following intravenous regional limb perfusion (IVRLP) with two different doses, and to compare their ability to reach target concentrations for bacterial isolates from common orthopedic conditions. STUDY DESIGN: Randomized crossover experiment. ANIMALS: Six adult horses. METHODS: Horses received IVRLP with 2 and 3 g of amikacin in the cephalic vein of alternate limbs (20 minutes tourniquet application and ≥14 days washout period)...
November 2016: Veterinary Surgery: VS
https://www.readbyqxmd.com/read/27681558/vasopressin-lowers-renal-epoxyeicosatrienoic-acid-levels-by-activating-soluble-epoxide-hydrolase
#20
Christin Boldt, Tom Röschel, Nina Himmerkus, Allein Plain, Markus Bleich, Robert Labes, Maximilian Blum, Hans Krause, Ahmed Magheli, Torsten Giesecke, Kerim Mutig, Michael Rothe, Steven M Weldon, Duska Dragun, Wolf-Hagen Schunck, Sebastian Bachmann, Alexander Paliege
Activation of the thick ascending limb (TAL) Na(+)-K(+)-2Cl(-) cotransporter (NKCC2) by the antidiuretic hormone arginine vasopressin (AVP) is an essential mechanism of renal urine concentration and contributes to extracellular fluid and electrolyte homeostasis. AVP effects in the kidney are modulated by locally and/or by systemically produced epoxyeicosatrienoic acid derivates (EET). The relation between AVP and EET metabolism has not been determined. Here, we show that chronic treatment of AVP-deficient Brattleboro rats with the AVP V2 receptor analog desmopressin (dDAVP; 5 ng/h, 3 days) significantly lowered renal EET levels (-56 ± 3% for 5,6-EET, -50 ± 3...
December 1, 2016: American Journal of Physiology. Renal Physiology
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