Direct Injection Of Ethanol Research Articles

Abstract 15111: The Combination of Vagal Nerve Stimulation and Intra-Aortic Balloon Pumping Rapidly Modulates Heart Rate and Cardiac Load While Maintaining Hemodynamics in a Dog Model of Acute Heart Failure

Background: In acute heart failure (AHF) condition, excessive tachycardia increases myocardial oxygen consumption (MVO 2 ). Recently, we have developed an intravenous vagal nerve stimulation (iVNS) catheter which can stimulate right vagal nerve and induce HR reduction (Fig. 1). Since inappropriate bradycardia in AHF condition leads to hemodynamic instability, the use of intra-aortic balloon pumping (IABP) may serve as a beneficial adjunctive therapy for iVNS. Methods: We induced AHF by the direct ethanol injection (0.5-2 ml/kg) to myocardium. The specialized basket catheter was inserted through the right femoral vein and placed in the superior vena cava. The IABP with 20-cc balloon was inserted through left femoral artery. We also calculated MVO 2 by the product of coronary flow and the difference of oxygen saturation between coronary artery and coronary sinus. We compared HR, MVO 2 , and hemodynamics between baseline and 3-min after iVNS (n=11). In addition, we examined the impact of IABP on hemodynamics during iVNS in AHF condition (n=8). Results: The direct ethanol injection increased LAP (+3.6±7.2 mmHg) and decreased left ventricular ejection fraction (-28±9.8%). The iVNS (20Hz, 10-22 V) rapidly reduced HR (-13±6.9%, P<0.01) and MVO2 (-11±8.1%, P<0.05), while slightly decreased CO (-10±7.3%) and increased LAP (+2.0±3.5 mmHg) (Fig. 2). An adding of IABP during iVNS increased CO (1.2±0.24 vs. 1.3±0.30 l/min, P<0.05) and decreased LAP (14±8.6 vs. 13±8.2 mmHg, P<0.05) . Conclusion: The combination of iVNS and IABP shows clinical potential as a novel therapy for effectively modulating excessive cardiac load in cases of unstable hemodynamics.

Ethanol stratified ultra-lean combustion with hydrogen enrichment in a constant volume vessel

An experimental study was conducted to determine the effects of ignition timings, injection pressures, and hydrogen enrichment on ethanol stratified ultra-lean combustion. The combustion chamber was a constant volume vessel with an injection and ignition system. The ignition and combustion characteristics of ethanol spray with different ignition timings (0–50 ms after start of injection), injection pressures (5, 15, and 25 MPa), and hydrogen premixed equivalence ratios (0.05, 0.1, and 0.2) under ambient temperature 353 K and 1 atm. The direct injection of ethanol and hydrogen enrichment results in an increase in the stable ignition limit to an extremely lean condition: a global equivalence ratio of 0.15 (67% ethanol/33% H2). Furthermore, the probability of ignition first increased then decreased with the delay in ignition timings; rose with an increase in the injection pressure and hydrogen ratio. However, the delay in ignition timings and high injection pressures resulting in extremely lean zone in the constant volume vessel, which led to incomplete combustion. The addition of hydrogen not only stabilized ignition process but also improved the combustion characteristics. Stable ignition and combustion were achieved at early ignition timing (2–3 ms), moderate injection pressure (15 MPa), and a minimum global equivalence ratio of 0.2 (50% ethanol/ 50% H2).

Performances and pollutant emissions of spark ignition engine using direct injection for blends of ethanol/ammonia and pure ammonia

Combustion and emissions characteristics of a spark-ignition engine using direct injection of ethanol blended with ammonia and also pure ammonia were investigated in this study. The experiments were conducted using five different fuel compositions of ethanol/ammonia (C2H5OH/NH3): 100/0, 75/25, 50/50, 25/75, and 0/100. Two strategies of injection were conducted to reach homogenous or stratified conditions with three different intake pressures, 0.5, 1.0, and 1.5 bar corresponding to 2.8, 7.9, and 12 bar of IMEP. The performances and the pollutants emissions are compared as a function of fuel compositions at identical IMEP. High stability is observed for all blends and even for pure ammonia. However, operating conditions are more restrictive for pure ammonia: the injection must be executed during the intake phase to be in a fully premixed mode to guarantee engine stability. Delaying the injection time for pure ammonia is not possible and requires the split of injections with 50% of the ammonia amount injected during the intake. The thermal efficiency is improved by adding 25% of NH3 in ethanol but NOx emissions increase. The stratified strategy for blends improves the combustion durations and the addition of ammonia decreases the NOx emission compared to the homogeneous strategy. On the contrary, CO emissions roughly increase for blends. The presence of NH3 in the fuel composition clearly influences the change of formation of NOx and CO between both strategies.

Comparison of ethanol/diesel fuel dual direct injection (DI2) strategy with reactivity controlled compression ignition (RCCI) in a diesel research engine

The dual direct injection (DI2) strategy is expected to cover the advantages of conventional diesel (CDI) mode while avoiding deficiencies of reactivity controlled compression ignition (RCCI) strategy such as high amount of incomplete combustion emissions and extremely high rate of pressure rise. Therefore, the present study focused on the comparison of combustion characteristics of these combustion modes in a diesel research engine, which was firstly operated under CDI mode at varying loadings and a constant speed of 2400 rpm to establish the reference data. Then, a low pressure port fuel injection (PFI) and high pressure gasoline direct injection (GDI) systems were activated to run on RCCI and DI2 modes, respectively, whereas test engine was already equipped with a common-rail direct injection (CRDI) system for conventional diesel fuel injection. Results showed that both direct and port injection methods increased the in-cylinder pressure (up to 9%) compared to conventional mode. In RCCI combustion, the rate of pressure rise increased more than direct injection and conventional mode. CDI exhibited higher thermal efficiency than RCCI and DI2 modes while both advanced modes were successful in reducing NOx and Smoke Opacity. However, significantly higher CO and unburned HC emissions were observed with both advanced modes in comparison to conventional one. Both CO and unburned HC emissions were reduced by direct injection of ethanol (DI2 strategy) at the rates of 16% and 35% compared with port injection method of RCCI strategy. This is an important finding of this study, which shows that the DI2 strategy has a potential to address a deficiency of RCCI and will bring it closer to its application to practical engines.

Influence of ethanol on the combustion process and soot formation in the diesel cylinder

Ethanol is an attractive alternative fuel because it is a renewable bio-based resource and it is oxygenated, thereby providing the potential to reduce particulate emissions in compression–ignition engines. Thus, the use of ethanol in a diesel engine can simultaneously solve two important problems - the replacement of non-renewable diesel fuel and improving the environmental performance of diesel by reducing soot emissions into the atmosphere. Thus, the use of ethanol in a diesel engine can simultaneously solve two important problems - the replacement of non-renewable diesel fuel and improving the environmental performance of diesel by reducing soot emissions into the atmosphere. The presented work considers the main reasons for reducing the formation of solid particles in the diesel cylinder, taking into account the transformation of the combustion process. The article presents the results of experimental studies to reduce the soot content in the exhaust gases by direct injection of ethanol into the combustion chamber with ignition from the burning fuel jet. The implementation of this method somewhat complicates the design of the diesel engine but allows you to control the combustion process and exclude the maximum amount of diesel fuel. The characteristics of the combustion process of alternative fuels in the diesel cylinder and the main patterns of change are described. In conclusion, the main problems of the use of ethanol and promising directions of its use as a fuel for the engine with compression ignition are considered, taking into account the peculiarities of the combustion process and the formation of harmful components of exhaust gases.

Evaporation and mixture formation of gasoline–ethanol sprays in spark ignition engines with pre‐blended injection and dual injection: a comparative study

Evaporation of sprays and mixture formation as injection of pre-blended gasoline–ethanol mixture and as separate injection of the fuels are investigated by means of numerical simulation. Effects of operating conditions and different configurations of injection systems have been examined. Under the same operating conditions, pure gasoline mostly evaporated during the injection period, while pure ethanol evaporated mainly during the compression process. Charge temperature in the cylinder for pure ethanol is ∼60°C lower than that for pure gasoline at the end of the compression process. Independently from injection system, the dual injection results in a higher evaporation rate compared to pre-blended injection. Whether pre-blended injection or dual injection is employed, the evaporation rate is improved for port injection (PI) compared to direct injection (DI). Besides, vapour concentration at the end of the compression process of PI increases with a shift from a single-inlet manifold to double-inlet manifolds. Mixture homogeneity is enhanced with increasing ambience temperature or/and an increasing engine speed with pre-blended injection, while a strong stratified charge mixture is achieved with dual injection using double-inlet manifolds or with DI of ethanol combined with PI of gasoline.

Octane number stratified mixture preparation by gasoline–ethanol dual injection in SI engines

High octane number is one of the attractive properties of ethanol. Appropriate distribution of ethanol vapor concentrations in combustion chamber at the end of the compression process could suppress engine knock phenomena and hence improve performance and reduce pollutants emission of spark ignition engines fueled with gasoline–ethanol. This paper presents numerical simulation results of a new concept of octane number stratified charge mixture via dual injection of ethanol and gasoline. The principle of the concept is the optimization of fuel vapor concentrations distribution in combustion chamber to ensure high ethanol concentrations in zone risk of knock. Two dual-injection schemas have been studied: (1) port inject of gasoline and direct injection of ethanol and (2) separate port injection of gasoline and ethanol through two opposite intake manifolds. In the first case, direct injection of ethanol in axial direction did not result in ethanol concentration stratification. Stratification occurred when direct injection of ethanol in radial direction started later than port injection of gasoline. In the second case, significant stratification of ethanol concentrations occurred when ethanol injection started earlier than gasoline injection. In the combustion chamber, high ethanol concentration was found near the ethanol injection inlet port, whereas high equivalence ratio was found in the opposite side. Thus, the location of the spark plug in the opposite side of ethanol injector is optimal for improving anti-knock performance of engine fueled with ethanol gasoline at a given fuel ratio.

Long-term outcome of treatment of vertebral body hemangiomas with direct ethanol injection and short-segment stabilization

BackgroundVertebral body hemangiomas with myelopathy are difficult to manage. ObjectiveThe objective of this study was to evaluate the role of intraoperative ethanol embolization, surgical decompression, and instrumented short-segment fusion in vertebral hemangioma (VH) with myelopathy and long-term outcome (>24 months). Clinical Materials and MethodsThis prospective study included symptomatic VH with cord compression with myelopathy. Pathologic fractures and deformity or multilevel pathologies were excluded from the study. Surgery consisted of intraoperative bilateral pedicular absolute alcohol (<1% hydrated ethyl alcohol) injection, laminectomy, and cord decompression at the level of pathology followed by a short-segment instrumented fusion using pedicle screws. ResultsThe study included 33 patients (mean 26.9±13.2, range: 10–68 years, 18 females). The clinical features of the study were myelopathy in all patients (5 paraplegic), sphincter involvement (13), and mid back or lower back pain (7). The preoperative American Spinal Injury Association (ASIA) scores were A (7), B (11), C (6), D (8), and E (1). Majority of the patients had single vertebral involvement (30) and three patients had multiple-level involvement. Six patients underwent surgery earlier (one underwent alcohol embolization). The mean surgical time was 124±39 minutes, and the average blood loss was 274±80 cc. The mean amount of absolute alcohol injected was 14.6±5.7 cc (two patients required 20 and 25 cc). Immediate embolization was achieved in all patients, allowing laminectomy and easy removal of soft-tissue hemangioma. Post surgery, one patient had transient deterioration, and the condition of the rest of the patients improved (sphincters improved in nine patients) at a follow-up ranging 28–103 months (mean 47.6±22.3). Follow-up ASIA scores were E (26), D (4), B (2), and C (1). All patients showed evidence of bone sclerosis and relief of cord compression on follow-up imaging. ConclusionsThis is the largest study in literature showing excellent improvement, low reoperation rates after ethanol embolization, and short-segment fixation.

Regeneration of the Fallopian Tube Mucosa Using Bone Marrow Mesenchymal Stem Cell Transplantation After Induced Chemical Injury in a Rat Model.

In this study, we describe a novel insight about the use of bone marrow-derived mesenchymal stem cells (BM-MSCs) for fallopian tube (FT) regeneration. Seventy rats' tubes were involved in this study and divided into 4 groups: control (15), ethanol injured (20), mesenchymal stem cell (MSC)-recipient without injury (15), and MSC recipient after injury (20). The BM-MSCs were isolated from male rats, and their incorporation into the tissues was confirmed by the detection of Sry gene in MSC-recipient rats using RT-PCR. Histological and immunohistological sections of the 4 groups were comparably evaluated. We found that direct injection of ethanol into FT caused structural impairment, which was restored largely after receiving MSCs. We have revealed for the first time that prominin 1 (Prom1, stem cell marker) was expressed in the fimbriated distal tubal end. The MSC transplantation caused (1) significant increase in the tissue level and immunoexpresstion of Prom1 ( P < .001 and P = .017, respectively) and vascular endothelial growth factor (VEGF; vasculogenic marker; P < .001 and P = .004, respectively), (2) significant increase in the immunoexpresstion of proliferating cell nuclear antigen (PCNA; proliferation marker; P < .001), and (3) significant decrease in the immunoexpresstion of caspase 3 (CASP-3; apoptotic marker; P < .001) compared to the injured tissues. In conclusion, MSCs could exhibit its restorative effect on FT through their ability to (1) activate the resident stem cells in the distal tubal end, (2) mediate the expression of VEGF and PCNA, and (3) influence tissue apoptosis. This study laid the foundation for assessing the contribution of stem cells in the distal tubal end in direct repair of the tube when required to assist reproduction.

Full spark authority in a highly boosted ethanol DISI prototype engine

The need for a reversal of the global climatic condition has stimulated the emergence of various agreements in favour of the environment. Among the most famous are the Paris Conference and the 2020–2030 Route, which have the purpose of reducing the emission of pollutant gases in the atmosphere to avoid a possible climatic catastrophe. Therefore, internal combustion engines are undergoing a period of significant change, since the automotive industry must reduce its environmental impact, mainly by reducing fuel consumption and using sustainable and renewable energy matrices instead of fossil fuels. In this sense, the objective of this work is to propose a combustion technique for a 1.0-l turbocharged engine with direct injection of ethanol, in order to reach the limits of its fuel conversion efficiency. For that purpose, the research has involved a variety of calibration strategies, such as homogeneous mixture preparation, the use of split-injection and the adoption of water injection for mitigating any abnormal combustion phenomenon. Moreover, water injection made it possible to push further up to full spark authority. A numerical approach by a 1D model (GT-Power™) was made to predict the engine’s fuel conversion efficiency and investigate its power at high engine speeds. The experimental results demonstrate a downsizing capability of up to 65%, in addition to achieving a fuel conversion efficiency up to 43.0% using a water injection strategy. Furthermore, the numerical results showed the possibility of achieving up to 45.5% fuel conversion efficiency by means of turbo-matching improvements.

Simulation of a Diesel Engine Operating with Ethanol to Reduce Pollutant Emissions

In this study a computational model to simulate the operation of a diesel engine fuelled by blends of 95% diesel oil + 5 % biodiesel (B5) and anhydrous ethanol was developed. The model was developed using the Engineering Equation Solver (EES) software and calculates fuel and air properties and the thermodynamic processes of the engine cycle. Ethanol injection was investigated by two different techniques: direct injection in the combustion chamber, together with B5, and indirect injection in the intake air system, with B5 being directly injected in the combustion chamber. Fuel/air mixture equivalence ratio, compression ratio, and the injected amount of ethanol were varied to obtain the cycle temperature and pressure diagrams, fuel consumption, indicated power, and exhaust gas composition. Fuel/air mixture equivalence ratio was varied from 0.7 to 0.9, compression ratio was varied from 15:1 to 19:1, directly injected ethanol concentration was varied up to 20 % of the total fuel amount injected, and intake system injected ethanol concentration was varied up to 50 % of the total fuel amount injected. The results demonstrate that the use of ethanol can reduce carbon monoxide (CO) and oxides of nitrogen (NOX) emissions, slightly penalizing the net cycle work and increasing fuel consumption. Direct ethanol injection in the combustion chamber was shown to be more advantageous technique than indirect ethanol injection in the intake system.

Clinical features and surgical management of four peculiar cases of intracranial metastases from renal cell carcinoma

Intracranial metastasis from renal cell carcinoma is rare. In this study, four patients (age range 56-72 years) were treated for intracranial metastases from renal cell carcinoma. The metastasis was solitary in all four patients and was located in the temporoparietal region in two patients, cerebellum in one patient, and bilateral lateral ventricles in one patient. Preoperative magnetic resonance imaging showed hemorrhage and necrosis in the tumor in all four patients, and one patient had edema in the region of the tumor. All patients were treated with craniotomy for tumor resection, and histopathologic examination showed clear cell carcinoma. Marked bleeding occurred in all patients during the operation, but preoperative direct injection of ethanol into epidural metastases (2 patients) was effective in decreasing intraoperative blood loss. Prognosis was poor with limited survival time (range 2 weeks-45 months), but prognosis was best in the two patients who were treated with postoperative radiation therapy and chemotherapy (survival times 26 and 45 months). To our knowledge, this is the largest report of four uncommon intracranial metastases from RCC in Chinese patients. In summary, intracranial metastasis from renal cell carcinoma should be considered in the differential diagnosis of intracranial tumor because of the high risk of bleeding and poor prognosis.

Monoparesis of the leg caused by thoracic vertebral hemangioma: a case report

Monoparesis of the leg is usually caused by a lower motor neuron lesion and in rare cases, may contribute to a thoracic hemangioma. The following case is therefore thought to be worth reporting. A 55-year-old woman presented with weakness and numbness of the left leg during the previous 6 months. Neurologic examination showed left leg monoparesis (Grade 3/5) but with brisk reflexes. The findings of all other neurologic and general examinations were normal. After the symptoms progressively worsened during the following week, a magnetic resonance imaging (MRI) examination was performed. The MRI revealed an epidural tumor at the left T10 pedicle (Fig. 1). The patient underwent a T10 laminectomy, which revealed an extra-dural mass compressing the posterolateral spinal cord. Tumoral tissue was removed with, the dura remaining intact. Hemangioma was confirmed by pathological examination (Fig. 2). The postoperative course was uneventful, and the symptoms progressively improved. She was discharged 1 week after surgery, and 6 month follow up revealed no neurologic sequelae. Isolated leg proximal leg paresis can result from lesions in the primary motor cortex, the posterior limb of the internal capsule, the spinal cord or the peripheral nerves [1]. However, monoparesis limited to one lower extremity caused by a vertebral hemangioma is rare. Hemangioma is among the most common benign tumors of the spine with a reported prevalence of 10–12% in the general population [2]. The vast majority of patients with vertebral hemangioma are asymptomatic; only 0.9–1.2% are symptomatic [3]. A clinical presentation of spinal cord compression caused by vertebral hemangioma is extremely insidious. Patients typically experience back pain followed by gradually worsening neurologic symptoms over a course of several weeks to months [3]. The most common site of vertebral hemangiomas is the thoracic spine followed by the lumbar spine [4]. Vertebral hemangiomas are often discovered incidentally when screening radiographs or computed tomography (CT) scans. Histologically, hemangiomas can be classified as cavernous, capillary or mixed. In each type, blood vessels are well differentiated but vary in size [5]. Treatments for symptomatic vertebral hemangiomas, including surgery, transarterial embolization, direct ethanol injection and vertebroplasty, have varying success rates [2]. Although primary treatment with radiotherapy and ethanol injection remains controversial, radiotherapy is effective for pain control [2]. Indications for surgery include significant or progressive neurological deficit, long tract signs, neuroimaging evidence of cord compression, rapid disease progression, ineffective radiotherapy, and uncertain diagnosis [2]. In rare cases, S.-L. Hwang C.-H. Wu (&) T.-H. Tsai C.-W. Chu K.-S. Lee Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, Kaohsiung 807, Taiwan e-mail: myosinpp@yahoo.com.tw

Percutaneous Ablation of Hepatic Tumors

The liver is a common site of both primary and secondary malignancy resulting in significant morbidity and mortality. Careful patient evaluation and triage allows for optimal utilization of all oncologic therapies, including radiation, systemic chemotherapy, surgery, transarterial therapies, and ablation. Although the role of interventional oncologists in the management of hepatic malignancies continues to evolve, the use of percutaneous ablation therapies has proven to be an effective and minimally invasive modality for treatment. Percutaneous ablation therapies have diversified from direct ethanol injection to multiple modalities including radiofrequency ablation (RFA), cryoablation, acetic acid injection, laser ablation, microwave ablation, high-intensity focused ultrasound, and irreversible electroporation. RFA is the most commonly utilized modality for hepatic interventions and has proven efficacy in both hepatocellular carcinoma and colorectal carcinoma metastases. Although tumor size remains a challenge, combination therapies and new device innovations continue to allow for improved ablation zones and more durable results.

Catheter Ablation of Ventricular Tachycardia by Intramyocardial Injection of Ethanol in an Animal Model of Chronic Myocardial Infarction

Direct injection of ethanol into myocardium has been shown to create large, well-demarcated lesions with transmural necrosis in normal ventricular myocardium and in regions of healed myocardial infarction. The aim of this study was to investigate the effects of direct ethanol injection on the inducibility of ventricular tachycardia (VT) in an animal model of chronic myocardial infarction. Eight sheep with reproducibly inducible VT underwent an electrophysiologic study 139 +/- 65 days after myocardial infarction. Noncontact mapping was used to analyze induced VT. Fifteen different VTs were targeted for catheter ablation. Ablation was achieved by catheter-based intramyocardial injection of a mixture of 96% ethanol, glycerine, and iopromide (ratio 3:1:1). Direct intramyocardial ethanol injection resulted in noninducibility of any VT 20 minutes after ablation in 7 of 8 animals. Four of 5 animals with initially successful ablation remained noninducible for any VT at follow-up study at least 2 days after the ablation procedure. Microscopic examination revealed homogeneous lesions with interstitial edema, intramural hemorrhage, and myofibrillar degeneration at the lesion border. The lesions were well demarcated from the surrounding tissue by a border zone of neutrophilic infiltration. Catheter ablation of VT by direct intramyocardial injection of ethanol during the chronic phase of myocardial infarction is feasible. It may be a useful tool for catheter ablation when the area of interest is located deep intramyocardially or subepicardially or when a more regional approach requires ablation of larger amounts of tissue.

The new trend on the treatment of secondary hyperparathyroidism

Recently various treatments for secondary hyperparathyroidism were developed. Those include a cation polymer as phosphate binder, active metabolite of vitamin D and its analogue, and various kinds of calcimimetics as Ca-sensing receptor agonist. For the secondary hyperparathyroidism refractory to those medication, direct injection of ethanol or vitamin D and its analogue is considered. All those treatments may contribute prevention and control of secondary hyperparathyroidism.

Bone Morphogenetic Protein-2 and Growth and Differentiation Factor-5 Enhance the Healing of Necrotic Bone in a Sheep Model

Introduction: Osteotropic growth factors enhance bone repair, but their efficacy in an area of necrotic bone is not known. The purpose of this study was to investigate the effects and potential side effects of an intraosseous application of absorbable bone morphogenetic protein-2 (BMP-2) and growth and differentiation factor-5 (GDF-5) composites in a sheep model for partial necrosis of the femoral head.Materials and methods: The direct injection of ethanol under fluoroscopy into the superior centre of the right femoral head produced histologically documentable necrosis of the central region of the head in a previous study of ten sheep. Another 27 sheep constituted the sample to study the effects of BMP-2 and GDFJ. Necrosis was produced in the same fashion in these animals. Four weeks later nine sheep received 300 μg recombinant BMP-2 and nine sheep 300 μg recombinant GDF-5 on an absorbable carrier by surgical implantation. Nine sheep received the carrier alone (control group). The animals were sacrificed at 3, 6, and 12 weeks after implantation and both femora were harvested.Results: Bone density analysis and microscopic examination indicated that bone formation was noticeably induced as early as 3 weeks postoperatively in the growth factor treated animals. Bone regeneration was enhanced by growth factor composites. This was documented by histological scoring and histomorphometric analysis. No severe local side effects secondary to the growth factors, such as heterotopic ossification or inflammation, were observed in either group.Discussion: The application of an absorbable growth factor composite in combination with established surgical techniques is a promising approach, that may enhance the healing of devitalised bone defects. Based on these results, further studies regarding biodegradation, dosage of the protein and surgical technique are required.

Symptomatic vertebral hemangiomas: treatment by means of direct intralesional injection of ethanol.

To describe the technique and results of injecting ethanol directly into symptomatic vertebral hemangiomas. Eleven patients with paraplegia (n = 6) or radiculopathy (n = 5) due to vertebral hemangioma were treated by means of injecting ethanol (5-50 mL) directly into the lesion with computed tomographic (CT) guidance. CT angiograms were essential prior to treatment to identify functional vascular spaces of the hemangioma and direct needle placement. All hemangiomas were obliterated completely at follow-up angiography and gadolinium-enhanced magnetic resonance imaging. Five of six patients with paraplegia recovered completely: One who was treated recently was walking with assistance. Four of five patients with radiculopathy improved. No immediate complications were associated with ethanol injection. The two patients who received the largest volumes of ethanol, 42 and 50 mL, developed pathologic fractures of the involved vertebrae 4 and 16 weeks after treatment. Direct injection of ethanol into symptomatic vertebral hemangioma is an effective and safe treatment, provided the dose is less than 15 mL.

Successful Removal of a Giant Skull Base Metastasis from Hepatocellular Carcinoma after Direct Ethanol Injection: Case Report

Skull metastases from hepatocellular carcinoma (HCC) are extremely rich in vascularity, which sometimes makes surgery dangerous. For minimally invasive surgery, it is very important to diminish the intratumoral vascular flow preoperatively. We report the case of a 69-year-old man with a giant skull base metastasis from HCC that was successfully removed after two sessions of direct ethanol injection into the tumor as a preoperative treatment to diminish the intratumoral vascular flow. Direct ethanol injection is a modification of percutaneous ethanol injection therapy, which is widely used in the treatment of primary HCC. In this article, we describe in detail the practical procedures and the usefulness of this treatment for a giant skull base metastasis from HCC.

Direct ethanol injection for skull metastasis from hepatocellular carcinoma. The techniques and consequences of a therapeutic trial

The frequency of skull metastasis from hepatocellular carcinoma (HCC) is increasing together with the recent progress in the management of the primary lesion. Cases are often complicated with poor general conditions or metastasis to the other organs, and not readily indicated for surgery. A direct injection of ethanol to the lesion could be one of the therapeutic options to cope with this complicated situation. To evaluate the feasibility of this technique, we planned a therapeutic trial in a patient with HCC associated with lumbar and skull metastasis, the latter metastasis repeated twice during the past one year. A total of 10 ml of ethanol was injected into the skull metastasis percutaneously under ultrasound (US) guidance. US guidance was very useful in determin.ing the sites of injections and the distribution of ethanol as well as monitoring the blood flow within the tumor vessels. The patient transiently.complained. of local.pan at the injection sites, but there were no other adverse effects. Four days after the injection the les of well as resected by surgery, which confirmed the pathologic diagnosis as well as the nearly-total necrosis: of the tumor This technique is simple, safe and repeatable with low cost. The technical details and the histologic effects are described. [Neural Res 1998; 20: 737-741]