BackgroundPeritoneovenous shunts (PVS) are widely used for palliation of intractable ascites caused by peritoneal carcinomatosis (PC) or liver cirrhosis (LC). Some patients who need PVS have renal dysfunction. However, renal dysfunction is considered a relative contraindication. Therefore, it is important to assess renal function before PVS placement.PurposeTo evaluate the relationship between PVS and renal function.Material and MethodsBetween October 2007 and July 2015, 60 patients (PC = 47; LC = 10; others = 3) underwent PVS placement for intractable ascites. Changes in estimated glomerular filtration rate (eGFR) and other adverse events (AEs) were retrospectively analyzed.ResultsChanges in eGFR before, one day after, and one week after PVS placement could be evaluated in 46 patients. The median eGFR before, one day after, and one week after was 56.5, 59.1, and 64.7 mL/min/1.73 m2, respectively (P < 0.05). These values were 61.6, 72, and 67.1 mL/min/1.73 m2, respectively, in PC patients (n = 34; P < 0.05) and 28.5, 27, and 37.2 mL/min/1.73 m2, respectively, in LC patients (n = 10; P < 0.05). In 17 patients with moderate to severe renal dysfunction (eGFR < 45), these values were 23.4, 23.7, and 30.5 mL/min/1.73 m2, respectively. The most frequent AE was PVS catheter obstruction, which occurred in 12 patients (20.7%). Clinical disseminated intravascular coagulation occurred in six patients (10.3%) and caused death in three patients (5.2%).ConclusionPVS placement for intractable ascites is associated with various AEs. However, PVS appeared to promote renal function, especially in patients with renal impairment.
The nanoparticles, which releases anticancer drug with response to radiation, were developed. Also, two categories were tested: (i) their ability to release anticancer drug in vitro; and (ii) their kinetics in the body, when they were injected through tail vein of BALB/c mice in vivo. To prepare the particles, hyaluronic acid and protamine were mixed into carboplatin solution, and reacted for 30 min in room temperature. Those particles were exposed to a single dose of 10 Gy of 140 KeV X-ray. Their ability to release carboplatin with response to radiation was expressed as the percentage of ruptured particles, basing on images of particles, using micro PIXE camera. The amount of released carboplatin was measured by quantitative PIXE method. The kinetics of particles in body was assessed by counting the number of particles, which were trapped in lungs, using micro PIXE camera. The mean diameter of particles was 743 ± 34 nm. By irradiation, 59.3 ± 7.23% of particles ruptured, and 95.9 ± 2.3% carboplatin was released from particles. The trapped particles in lungs were significantly reduced, when compared with previous alginate-hyaluronic particles.
Encapsulated protamine-hyaluronic acid particles containing carboplatin were prepared and their ability to release carboplatin was tested in vivo. Protamine–hyaluronic acid particles containing carboplatin were prepared by mixing protamine (1.6 mg) and hyaluronic acid (1.28 mg) into a 5 mg/mL carboplatin solution for 30 min at room temperature. A 1 mL solution of protamine–hyaluronic acid particles was poured into an ampule of COATSOME[Formula: see text] EL-010 (Nichiyu, Tokyo, Japan), shaken three times by hand, and allowed to incubate at room temperature for 15 min. Following that, 10 or 20 Gy of 100 kiloelectronvolt (KeV) soft X-ray was applied. The release of carboplatin was imaged using a microparticle-induced X-ray emission (PIXE) camera. The amount of carboplatin released was expressed as the amount of platinum released and measured via quantitative micro-PIXE analysis. The diameter of the generated encapsulated particles measured [Formula: see text] nm (mean ± standard error). The release of carboplatin from the encapsulated protamine–hyaluronic acid particles was observed under a micro-PIXE camera. The amount of carboplatin released was [Formula: see text] under 10 Gy of radiation, and [Formula: see text] under 20 Gy of radiation, which was a sufficient dose for cancer treatment. However, 10 or 20 Gy of radiation is much greater than the dose used for clinical cancer treatment (2 Gy). Further research to reduce the radiation dose to 2 Gy in order to release sufficient carboplatin for cancer treatment is required.
Lipiodol marking is an effective way of demarcating BC. However, it is necessary to address the comorbidities of elderly patients.
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