Pingyangmycin-lipiodol Emulsion Research Articles

Transcatheter Arterial Sclerosing Embolization for the Treatment of Giant Propranolol-Resistant Infantile Hemangiomas in the Parotid Region

PurposeTo report the effectiveness and safety of transcatheter arterial sclerosing embolization (TASE) for the treatment of parotid infantile hemangiomas that did not respond appreciably to propranolol. Materials and MethodsA total of 21 infants (12 male and 9 female) with large propranolol-resistant infantile hemangiomas in the parotid region were enrolled in this study. During TASE, the feeding arteries of the lesions were embolized using pingyangmycin-lipiodol emulsion and polyvinyl alcohol particles (300–500 μm) to reduce the blood flow rate. All children were followed up as outpatients at 2 weeks and monthly thereafter. The curative effect was evaluated at the 1- and 3-month follow-up visits. ResultsNine lesions were located on the right side of the parotid gland, whereas 12 were located on the left side. The feeding arteries in all patients originated from branches of the external carotid artery. TASE was technically successful in all patients. The mean (± SD) maximal diameter of the hemangiomas significantly decreased from 6.50 cm ± 2.28 before treatment to 3.56 cm ± 1.84 at 1 month after TASE (P <. 05). Three months after TASE, the mean maximal diameter further significantly decreased to 1.94 cm ± 1.58 (P <. 05). During the follow-up period, 16 cases were rated as excellent and 5 as good; no recurrence or serious complications were noted. Minor side effects, such as slight pain, mild fever, and tissue swelling, were observed. ConclusionsTASE significantly decreased the size of the parotid hemangiomas with minor side effects during a short follow-up period.

Analysis of therapeutic efficacy and treatment model of interventional treatment in hepatic hemangiomas with poor blood supply

Objective To analyze the efficacy and complications of interventional treatment in hepatic hemangiomas with poor blood supply, and to explore the mode of treatment. Methods From May 2013 to October 2016, at Tianjin Third Central Hospital, 82 patients with hepatic hemangiomas with poor blood supply were enrolled and divided into intervention group, puncture group and combination group. Conventional hepatic artery intubation was performed in intervention group, using a microcatheter to superselect to hemangioma and injecting pingyangmycin-lipiodol emulsion into the tumor of hemangioma. Patients of puncture group underwent the ultrasound-guided percutaneous liver puncture, and the pingyangmycin-lipiodol emulsion was injected into the tumor. The patients of combination group first received intervention treatment, and the pingyangmycin-lipiodol emulsion were injected again into the tumor area lacking of iodized oil deposition through percutaneous transhepatic puncture. After treatment, the complications and clinical efficacy of patients in three groups were evaluated and the reasons of patients lost to follow-up were analyzed. The analysis of variance, Chi-square test and Fisher′s exact test were performed for statistical analysis. For patients lost to follow up, intention-to-treat (ITT) analysis and per protocol (PP) analysis were used. Results Among 82 patients with hepatic hemangiomas with poor blood supply, there were 27 in intervention group, 24 in puncture group and 31 in combination group. Seven patients developed serious complications such as liver failure. At three months after the treatment, the overall efficacy of combination group (20.9%, 9/31) was higher than that of intervention group (7.4%, 2/27) and puncture group (4.2%, 1/24), and the differences were statistically significant (χ2=6.296, P=0.014; χ2=5.622, P=0.031). At six months after the treatment, the overall efficacy of combination group (ITT analysis 70.3%, 26/37; PP analysis 71.0%, 22/31) was still higher than that of intervention group (40.9%, 9/22) and puncture group (7/18), and the differences were statistically significant (ITT analysis χ2=4.929 and 4.969, PP analysis χ2=4.789 and 4.851; all P<0.05). At twelve months after the treatment, a total of 41 patients of three group were lost. Among them, the patients with ineffective treatment by clinical effect evaluation accounted for 63.4% (26/41), which was higher than those with significantly effective treatment (12.2%, 5/41) and those with effective treatment (24.4%, 10/41), and the differences were statistically significant (χ2=22.873 and 12.676, both P<0.01). Conclusions The efficacy of the interventional treatment alone for hepatic hemangiomas with poor blood supply is poor and the complications should be considered when selecting the appropriate treatment methods. Key words: Liver hemangioma; Poor blood supply type; Treatment model; Analysis of therapeutic effect; Psychological factor

Comparison of efficacy of different embolic agents on uterine leiomyoma

The aim of this study was to explore the efficacies, postoperative side effects, and complications of uterine artery embolization (UAE) treatments for uterine leiomyoma (UL) with different embolic agents. The study included 107 patients with UL that were treated with UAE with polyvinyl alcohol (PVA group) or pingyangmycin lipiodol emulsion and silk-segment (PLES group). Six months later, the improvement rate of anaemia, the menstrual improvement rate, the incidence rate of fever, the disappearance rates of compression symptoms and abdominal symptoms in the PVA group were 93.8%, 94.7%, 22.0%, 60.0%, and 88.9%, respectively, which showed no significant difference from those in the PLES group (90.5%, 92.3%, 84.8%, 53.3%, and 81.3%, respectively). The incidence rate of fever after embolization in PVA group was significantly lower than that in PLES group (c2=41.958, p = 0.000). However, the efficacy, improvement rate of symptoms, and postoperative side effects of two groups showed no significant difference (p > 0.05). PVA and PLES have significant efficacy for UAE treatment on patients with UL.

Transarterial Chemoembolization of Giant Liver Haemangioma: A Multi-center Study with 836 Cases.

The purpose of the study is to evaluate the effectiveness and safety of transarterial chemoembolization (TACE) with pingyangmycin-lipiodol emulsion for the treatment of symptomatic giant hepatic haemangioma. Four hospitals (The Second Hospital of Shandong University, Qilu Hospital of Shandong University, Shandong Provincial Hospital and Jinan Municipal Hospital) participated in this study during 2002-2012. A total of 836 patients with symptomatic giant haemangioma were treated with pingyangmycin-lipiodol emulsion via selective TACE. The patients were followed-up for 12months-10years. The effectiveness of the treatment was evaluated by symptom assessments and upper abdominal magnetic resonance imaging or computed tomography. TACE was successfully performed for a total of 1120 lesions in 836 patients. Success rate of the procedure was 100%. The mean diameter of the haemangiomas was significantly reduced after the interventional therapy (mean diameter 9.6±0.8 vs. 3.6±0.5cm; P<0.05). Symptom relief was achieved in all the patients during the follow-up period. No mortality was identified. TACE with pingyangmycin-lipiodol emulsion is a safe, feasible, and effective treatment for the giant symptomatic hepatic haemangioma.

Transarterial Embolization Using Pingyangmycin-Lipiodol Emulsion (PLE) for Treatment of Focal Nodular Hyperplasia of the Liver and 1-Year Follow-Up: A Case Report and Literature Review

Focal nodular hyperplasia (FNH) is a common benign hepatic tumor which is often treated non-operatively until it appears apparent symptoms such as pain and upper abdominal distension. We report here a case of trans-catheter arterial embolization (TAE) using pingyangmycin-lipiodol emulsion (PLE) for blocking a fatal bleeding originated from percutaneous biopsy as well as for FNH treatment. After embolization by means of the mixture of PLE and particles of gelfoam, the bleeding was stopped and the FNH was apparently shrinked 1 year later. TAE using PLE may be considered as a safe and effective method for the treatment of FNH.

Effects of transcatheter arterial chemoembolization with pingyangmycin-lipiodol emulsion on VX2 liver tumors in rabbits

To evaluate the changes induced in tumor tissue, the feeding artery, and neovascularization upon pingyangmycin-lipiodol emulsion treatment via transcatheter arterial chemoembolization (TACE) using the rabbit VX2 liver cancer model. The VX2 liver tumor model was established in 28 rabbits, and baseline tumor volume (V1, in mm3) was measured by spiral scan computed tomography (CT). Then, the rabbits were randomly divided into four groups (n = 7 each) and administered intraarterial therapies of: ultrafluid lipoidol embolization (group A); pingyangmycin (group B); pingyangmycin-lipiodol emulsion (group C); or saline (group D). All rabbits were sacrificed seven days later, and the response to therapy was determined by measuring the tumor volume (V2, in mm3), calculating the tumor growth rate, detecting expression of the vascular endothelial growth factor (VEGF) tumor biomarker, and performing histological analysis of the microvessel density (MVD) in the liver. Prior to therapy, the average V1 of the groups was statistically similar (A: 389.8+/-167.3, B: 404.1+/-184.9, C: 355.1+/-158.3, D: 378.1+/-189.0; (F = 0.257, P more than 0.05). In contrast, after therapy the average V2 of the groups was significantly different (A: 922.6+/-32.9, B: 665.9+/-99.9, C: 349.5+/-177.8, D: 1403.5+/-411.2; F = 26.23, P less than 0.05), as was the tumor growth ratio (A: 1.4, B: 0.6, C: -0.02, D: 2.7) and the mean positive ratio of VEGF (A: 57.1%, B: 42.9%, C: 28.6%, D: 100%; F = 8.407, P less than 0.05). MVD was highest in group D and lowest in group C (all, P less than 0.05). Bivariate correlation analysis revealed a positive correlation between VEGF expression and MVD (r = 0.743, P less than 0.01). Pingyangmycin exerts anti-tumor effects in the rabbit VX2 liver cancer model, but is more effective when administered as the combination therapy of pingyangmycin-lipiodol emulsion with TACE.

Transarterial Embolization Using Pingyangmycin Lipiodol Emulsion and Polyvinyl Alcohol for the Treatment of Focal Nodular Hyperplasia of the Liver

Surgical resection is the current treatment for focal nodular hyperplasia of the liver (FNH) when indicated. However, tumor location and size, patient comorbidities, and risk of complications may limit surgical options in some cases. Our goal was to evaluate the therapeutic effect of transarterial embolization (TAE) using pingyangmycin lipiodol emulsion (PLE) and polyvinyl alcohol particles to treat FNH. Four patients with FNH, who experienced dull pain in the upper abdomen or liver area and confirmed by biopsy, were treated by TAE with PLE and polyvinyl alcohol (diameter: 500µm-700µm). Therapeutic effects including changes in lesion diameter and symptomatic improvement, and occurrence of complications, were evaluated for a follow-up period ranging from 12 to 42 months after the procedure. All of four patients were successfully treated with PLE and polyvinyl alcohol embolization. One month after the procedure, dull pain in the upper abdomen or liver area vanished completely. Follow-up examination by CT or MRI revealed complete resolution in two cases and an obvious decrease in the other two cases. No immediate or delayed postembolization complications were encountered. Transarterial embolization using PLE and polyvinyl alcohol should be considered as a safe and effective method for the treatment of FNH.

Percutaneous Intratumoral Injection With Pingyangmycin Lipiodol Emulsion for the Treatment of Recurrent Sacrococcygeal Chordomas

This study describes fluoroscopy-guided percutaneous intratumoral injection therapy (PIIT) with a pingyangmycin lipiodol emulsion in the management of recurrent sacrococcygeal chordomas after surgical excision. Seven patients underwent a total of 22 treatment sessions (3–4 sessions per patient); treatment responses were evaluated clinically, and lesion size was determined using computed tomography (CT). Over 10–26 months of follow-up, tumor sizes and visual analogue scale (VAS) scores of all patients were decreased. No patients had complications during the follow-up period. Preliminary results showed that PIIT with pingyangmycin lipiodol emulsion under fluoroscopic guidance is effective and safe and may be considered as a treatment option.

Evaluation of long-term effect of hepatic arterial embolization with pingyangmycin-lipiodol emulsion in patients with hepatic cavernous hemangiomas

Objective To evaluate the long-term effect of hepatic arterial embolization with pingyangmycin-lipiodol emulsion (PLE) in patients with cavernous hemangiomas of the liver (CHL)and its influence factors.Methods One hundred and fifty-six hemangiomas that were diagnosed by imaging examinations or confirmed pathologically by surgery in 105 patients with integral follow-up data were analyzed retrospectively in this paper.All hemangiomas were divided into 4 groups according to their size (the largest size of hemangioma)by the authors as follows; A group(≤3 cm, n=25); B group(>3 cm and 10 cm, n=41) .According to the number of abnormal sinusoids filled with the contrast medium in the angiography, 156 hemangiomas of this series were further classified as three types: abundant type (n=90) ; sparse type (n=9) and the middle type (n=57) .Hepatic arterial embolization with PLE was performed in the 105 patients with total 135 procedures (including single procedure in 75 patients, twice procedures in 30 patients).All of the 105 patients were followed up 3 to 8 years(mean 4 years) using US, CT or MRI or DSA.The criteria for the evaluation of curative effect were classified as best, good, recovery and no change in this series, and the sum of best and good effects were defined as the total effective rate.Then, the total effective rate of single procedure between the A, B groups and C, D groups; and the total effective rate of single procedure and twice procedures in the D groups, were compared statistically by X~2 test respectively.And the influence factors, included of the variant size of hemangiomas, abundant or sparse of abnormal sinusoids and the number of treatment procedures, were also analyzed and evaluated respectively.Results The total effective rate of the 156 hemangiomas in 105 patients was 92.95% (145/156).After single procedure of hepatic arterial embolization with PLE, the total effective rate of A and B groups were 100% (57/57), that of C and D groups were 85.86% (85/99), and the difference reach significant (X ~2=8.8553, P<0.01).In the D group, the total effective rate in group with twice procedures (100.00%,30/30) was significant higher (X~2 =5.2642,P<0.05) than those of group with single procedure (72.73%,8/11).Of this series, during the period of following-up, no recurrent or severe complications were observed.Conclusions A best long-term curative effect (complete cure) is usually obtained in the small hemangiomas with abundant abnormal sinusoids, and a satisfactory long-term curative effect can also be achieved in the larger or multiple hemangiomas, particularly in those hemangiomas with abundant abnormal sinusoids by using the repeat procedures of hepatic arterial embolization with PLE. Key words: Hemangioma, cavernous; Iodized oil; Embolization, therapeatic; Treatment outcome

Fluoroscopic Intralesional Injection with Pingyangmycin Lipiodol Emulsion for the Treatment of Orbital Venous Malformations

The objective of our study was to evaluate the efficacy and safety of percutaneous intralesional injection under fluoroscopy with pingyangmycin Lipiodol emulsion (PLE) for the treatment of orbital venous malformations. . This study is a retrospective analysis of 19 consecutive patients with distensible orbital venous malformations. Of the 19 patients, two had diffuse lesions. These patients presented with proptosis (n = 19), pain and orbital swelling (n = 11), reduction in visual acuity (n = 4), diplopia (n = 2), disk swelling (n = 5), and motility disturbance (n = 3). All 19 patients underwent technically successful percutaneous intralesional PLE injection under fluoroscopy. Complete resolution of proptosis, swelling, and pain was achieved in 17 patients 3-9 months after the procedure. In the other two patients with diffuse lesions, light proptosis was still present after the first procedure. A second procedure was performed in these two patients, and the symptom disappeared 3 months later. All four patients with reduced visual acuity recovered their vision, and diplopia in two patients disappeared. Examinations of the fundus revealed normal findings in the five patients with preprocedural disk swelling. None of the patients presented with a motility disturbance after the procedure. Local swelling in the eyelid and epiphora were present for 1 month in one patient and disappeared after treatment. No other complications, including acute orbital compartment syndrome, were observed during follow-up periods. The mean follow-up was 23 months. PLE sclerotherapy under fluoroscopic guidance is safe and effective for the treatment of orbital venous malformations and can be used as one of the treatment alternatives.

Clinical research on pingyangmycin lipiodol emulsion hepatic arterial embolization for primary hepatocellular carcinoma

目的 评价平阳霉素(PYM)+丝裂霉素超乳化碘油乳剂(PMLE)介入栓塞对原发性大肝癌的临床疗效.方法对34例原发性大肝癌肝动脉注入PMLE,以前期56例原发性大肝癌以丝裂霉素超乳化碘油乳剂(MLE)作对照,比较两组栓塞后肿瘤体积变化.结果栓塞后1～3个月两组肿瘤体积均明显缩小,PMLE组显著于MLE组(P＜0.05).结论平阳霉素介入治疗原发性大肝癌有显著疗效。

The therapeutic effect of Pingyangmycin lipiodol emulsion embolization for hepatic cavernous hemangioma

目的 评价平阳霉素碘油乳剂栓塞肝海绵状血管瘤的临床疗效.方法对18例患者采用Seldinger技术股动脉插管,将导管超选择至肿瘤供血动脉,缓慢注入利多卡因5～10 ml及平阳霉素碘油乳剂5～20 ml.栓塞前常规肌内注射杜冷丁50～100 mg;病变巨大、多支血供、病人年龄＞60岁者,分次介入治疗.术后3～48个月CT、B超随访观察栓塞前后肿瘤直径大小变化、临床症状缓解情况及并发症.结果18例肝海绵状血管瘤均见平阳霉素碘油完全充填.病灶完全消失9例,缩小50%以上7例,病灶缩小25%～50%2例.其中6例血管造影复查见病灶血管完全消失,载瘤动脉闭塞.临床症状好转率89%,无严重并发症.结论平阳霉素碘油乳剂动脉栓塞肝海绵状血管瘤疗效良好,微创、安全、副作用少,可作为首选的治疗方法。

Treatment of giant cavernous hemangioma of liver by local sclerosis

目的 评价平阳霉素碘油乳剂(PLE)局部给药治疗5 cm以上肝海绵状血管瘤(CHL)的临床疗效及安全性.方法对156例CHL行PLE局部治疗,其途径包括:经肝动脉154例,经门静脉1例、经皮直接瘤内注射1例.分别观察其治疗前后肿瘤大小变化、临床症状的缓解和并发症的情况.结果经肝动脉154例,除2例治疗后仍手术切除者外,其余152例栓塞前肿瘤直径(8.7±2.4) cm,栓塞后3个月为(4.8±1.8) cm(P<0.01),栓塞后6个月为(1.9±1.6) cm(P<0.01).经门静脉和直接穿刺各1例治疗后瘤体均缩小.临床症状大部缓解.结论 CHL的局部PLE硬化治疗是疗效良好且安全的方法。