Direct Injection Of Ethanol Research Articles

Tumor devascularization by intratumoral ethanol injection during surgery. Technical note.

Preoperative reduction in tumor vascularity has been accomplished previously by selective catheterization of tumor vessels and delivery of occlusive materials. The results of percutaneous infusion of vertebral hemangiomas and other vascular lesions led the authors to speculate that rapid devascularization of tumors by direct injection of ethanol (ETOH) could be used to reduce bleeding and facilitate resection during surgery. Thus, the use of intratumoral injection of ETOH and its effects on tumor hemostasis and resectability were examined. Four patients received direct injection of ETOH into either a spinal epidural (two renal cell carcinomas and one rhabdomyosarcoma) or a large cerebellar neoplasm (hemangioblastoma). Intraoperative perfusion of the tumors with ETOH produced immediate blanching and devascularization and enhanced visualization and resection. Incremental tumor devascularization is achieved by careful injection of small amounts of ETOH directly into the lesion, producing immediate and complete regional tumor devascularization. Use of this technique reduces intratumoral bleeding and enhances the ease and effectiveness of resection.

Efficacy of direct injection of ethanol into the myocardium to control aconitine-induced ventricular tachycardia in anesthetized dogs.

The effect of injecting ethanol directly into the myocardium to control aconitine-induced ventricular tachycardia (VT) was evaluated in anesthetized dogs. In 17 dogs, VT was induced by injecting aconitine (1.0 microgram, median dose) directly into the epicardium. After inducing persistent VT for up to 3 min, 0.6 ml (median volume) of 96% ethanol was injected into the same epicardial region. Regular sinus rhythm reappeared in 15 dogs with no change in systolic blood pressure; the other 2 dogs died of ventricular fibrillation (VF). In another 13 dogs, VT was induced by injecting aconitine directly into the endocardium using a Variocath needle catheter. After persistent VT for up to 3 min, a regular sinus rhythm was restored in 7 dogs by injecting 2.0 ml (median volume) of 96% ethanol; the remaining 6 dogs died of VF. Histology showed no transmural necrosis and the subendocardial necrotic areas were essentially the same in the dogs that recovered from VT as in those that died. There was no statistically significant relationship between doses of ethanol and VT duration. These preliminary results suggest that the injection of ethanol into the myocardium may efficiently terminate VT when other techniques fail.

口腔顎顔面領域の血管腫に対するエタノール局注意法の経験

Many treatments have been recommended for the management of hemangiomas. However, postoperative esthetics and function of the organs are often the problems for lesions in the oral and maxillofacial region. Absolute ethanol is an effective agent in the treatment of hemagiomas which may not be resectable.Two patients with hemangiomas in the oral and maxillofacial region which were treated by direct ethanol injection are described. Case 1 was an 82-year-old female with a cavernous hemangioma of the mouthfloor. Case 2 was a 64-year-old female with a venous angioma of the cheek. Both patients were admitted to our hospital because of gross swelling.However, resection of these extensive hemangiomas would most likely lead to gross disfigurement and dysfunction. We therefore tried direct ethanol injection therapy. Initially the lesions demonstrated a reactive inflammatory edema which was followed by slow resolution over several days with subsequent mild fibrosis. The lesion in case 1 required 4 ethanol injections (2ml×4) during 4 months, and the lesion in case 2 was controlled solely by a single injection (5ml). Direct ethanol injection therapy provided the greatest opportunity for preserving the surrounding normal tissue and obtaining improved cosmetic and functional results.

Clinical evaluation of endoscopic hemostasis for bleeding gastric and duodenal ulcers

The present study shows the excellent efficacy of endoscopic hemostatic therapy by ethanol injection. At the same time, the results emphasize the significant efficacy of intensive pharmaceutical treatment for peptic ulcer patients with clinical symptoms of hematemesis and/or melena. Concerning endoscopic hemostatic therapy, we prefer ethanol injection therapy to most other methods, such as laser irradiation, microtase or heat probe, because the ethanol injection method is the most simple, inexpensive, safe, technically easy, can be performed any time and in any place, and is more effective than other methods. In rare cases where direct ethanol injection into the exposed blood vessels is difficult, we do not hesitate to select other contact methods such as heat probe or microtase.

Direct intratumoral injection of ethanol in the patients with obstruction of major bronchus.

Background: For the relief of the occlusion of major bronchi, laser therapy, radiation therapy or combined therapy is generally used. But the effect of radiation therapy is very slow and not consistent and laser therapy requires expensive equipments and technical expertise with occasional serious side effects. Direct ethanol injection has been widely used for the control of bleeding in gastrointestinal lesion, esophageal varices or renal cell carcinoma with good results. So we tried direct injection of ethanol into the tumor to relieve the obstruction of major bronchus in 11 patients. Method: All procedures were done under the fiberoptic bronchoscopy with continuous oxygen supplement and aliquoted 0.5-1.0 ml of absolute ethanol directly into the tumor through the endobronchial aspiration needle. The tumor was endoscopically removed with a biopsy forceps immediately after ethanol injection. The whole procedure was repeated 3-4 days interval until the lumen opens. Usually after 2-3 trials of ethanol injection, the lumen opened up. Results: The immediate effect of ethanol injection was whitening of the mucosa and prompt cessation of bleeding. The late effect was necrosis of the tumor. The final results of this procedure were improvement of symptoms and reexpnasion of the lung in all patients. and FVC were improved and was increased from mmHg to mmHg, : from to , and was reduced from mmHg to mmHg. Conclusion: Direct ethanol injection into the tumor tissue is a rapid, cheap and relatively safe method of relieving the complete occlusion of major bronchus.