Skin necrosis is a rare complication of heparin administration that is usually localized to injection sites. We report a case of skin necrosis that was caused by minidose intraarterial infusion of porcine heparin which had been used in a touch to prevent coagulation in percutaneous intraarterial cannula. The skin necrosis appeared 35 days after starting heparin use.
Catheters ; Heparin* ; Infusions, Intra-Arterial ; Necrosis* ; Skin

The outcome of surgery alone for advanced gastric cancer is unsatisfactory. Local recurrence rate and distant metastasis rate are still high in postoperative patients. In recent years, people have paid more attention to neo- adjuvant chemotherapy, because it can reduce tumor loading, degrade the staging, increase the surgery excision rate and improve the long-term survival. Preoperative regional arterial infusion chemotherapy can directly act on the tumor endothelial cells with higher local drug concentration, but with fewer systemic side effects. So it may offer an effective treatment for advanced gastric cancer. The indications, complications, therapeutic evaluation, timing of surgery, chemotherapy regimens and pathomorphological changes and so on of the preoperative regional arterial infusion chemotherapy are summarized in this review.
Chemotherapy, Adjuvant ; Humans ; Infusions, Intra-Arterial ; Preoperative Care ; Stomach Neoplasms ; drug therapy ; surgery

OBJECTIVE: To evaluate the prevalence and risk factors of clopidogrel resistance, and association between thromboembolic complications and clopidogrel resistance in patient with stent-assisted angioplasty for atherosclerotic cerebrovascular disease. METHODS: Between September 2006 and June 2008, clopidogrel resistance test was performed on 41 patients who underwent stent-assisted angioplasty for atherosclerotic cerebrovascular disease. It was performed before drug administration and about 12 hours after drug administration (loading dose : 300 mg, maintain dose : 75 mg). Two patients were excluded, and 41 patients were included (mean : 67.59+/-7.10 years, age range : 41-79). Among 41 patients, 18 patients had intracranial lesions, and 23 had extracranial lesions. We evaluated the prevalence, risk factors and complications related to clopidogrel resistance. RESULTS: Twenty-one patients (51.2%) showed clopidogrel resistance [intracranial : 10 patients (55.6%), extracranial : 11 patients (47.8%)] and no clopidogrel resistance was seen in 20 patients. Hypercholesterolemia was an indepedent risk factor of clopidogrel resistance. Stent-assisted angioplasty was technically successful in all patients, but acute in-stent thrombosis occurred in 5 patients with intracranial lesions (4 patients with clopidogrel resistance and 1 without clopidogrel resistance). Acute thrombi were completely lysed after intra-arterial infusion of abciximab. CONCLUSION: There was relatively high prevalence of clopidogrel resistance in patients with atherosclerotic cerebrovascular disease. Hypercholesterolemia was an independent predictive factor of clopidogrel resistance. Acute in-stent thrombosis was more frequently seen in the clopidogrel resistant group. Therefore, clopidogrel resistance test should be performed to avoid thromboembolic complications related to stent-assisted angioplasty for atherosclerotic cerebrovascular disease, especially patients with hypercholeterolemia and intracranial lesion.
Angioplasty ; Humans ; Hypercholesterolemia ; Infusions, Intra-Arterial ; Prevalence ; Risk Factors ; Stents ; Thrombosis ; Ticlopidine

We have done a study for the real-time changes of blood-brain-barrier disruption(BBBD) with brain cortical microdialysis induced by intra-carotid mannitol infusion and of cortical blood flow with laser Doppler flowmetry. A microdialysis probe was established on the right parietal cortex with 99mTc-DTPA(500 Da) as a marker, and two laser Doppler probes on the bilateral frontal cortex. Intra-carotid administration of mannitol was followed in 3 rats and intra-arterial infusion of isotonic saline in 3 control rats. Cortical blood flows were increased dramatically by about 270% to 310% from the preinfusion state within 5 minutes after mannitol infusion as compared to an average of 150% increase in saline controls. BBBd-induced extravascular leakage of 99mTc-DTPA sampled by microdialysis and estimated by high pressure liquid chromatography increased dramatically within 2 minutes, maximally about 10 times that of the pre-infusion state within 5-10 minutes after infusion, and decreased rapidly about next 20 minutes but was still more than 4 times the pre-infusion state, and slowed to near preinfusion state during the next 40-60 minutes. This result suggests the real changes of BBBD estimated by brain cortical microdialysis were relatively comparable to previous radioisotope measurement and the first 20 minutes was significantly valuable for administration of certain molecules using BBBD induced by intra-arterial mannitol infusion.
Animals ; Brain ; Chromatography, Liquid ; Hemodynamics ; Infusions, Intra-Arterial ; Laser-Doppler Flowmetry ; Mannitol ; Microdialysis* ; Rabeprazole ; Rats

To clarify the roles of gonadal steroids on pancreatic exocrine secretion, effects of progesterone and estradiol-17beta on spontaneous and secretagogue-induced exocrine response of isolated perfused rat pancreas were investigated. Intra-arterial infusion of progesterone resulted in significant increase of the spontaneous pancreatic fluid and amylase secretion dose-dependently. However, estradiol-17beta did not exert any influence on spontaneous pancreatic exocrine secretion. Exogenous secretin, cholecystokinin (CCK), and acetylcholine markedly stimulated pancreatic fluid and amylase secretion. Progesterone initially enhanced secretin-induced amylase secretion, but this stimulatory response declined thereafter to basal value. Moreover, secretin-induced fluid secretion was not affected by infusion of progesterone. Therefore, initial increase of secretion-induced amylase secretion by progesterone seems to be a non-specific action by washout effect of secretin. Estradiol-17beta failed to change the secretin-induced fluid and amylase secretion. Both progesterone and estradiol-17beta did not exert any influence on CCK-induced fluid and amylase secretion. Acetylcholine-induced exocrine secretion of isolated perfused pancreas also was not affected by intra-arterial infusion of progesterone or estradiol-17beta. It is concluded from the above results that progesterone could enhance the spontaneous pancreatic fluid and amylase secretion of isolated perfused rat pancreas through non-genomic short- term action, and that these effects could be masked by more potent stimulants such as secretin, CCK, and acetylcholine.
Acetylcholine ; Amylases ; Animals ; Cholecystokinin ; Estradiol ; Gonads* ; Infusions, Intra-Arterial ; Masks ; Pancreas* ; Progesterone ; Rats* ; Secretin ; Steroids*

Objective: To evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE)-hepatic arterial infusion chemotherapy (HAIC)-targeted-immune quadruple therapy in patients with intermediate and advanced-stage hepatocellular carcinoma (HCC). Methods: 101 patients with intermediate and advanced stage HCC were enrolled according to the inclusion and exclusion criteria, and then they were divided into a combination group and a control group. Patients in the combination group was treated with TACE-HAIC-targeted-immune quadruple therapy, while the control group was only treated with TACE therapy. The overall survival (OS), progression-free survival (PFS), and treatment-related adverse reactions were statistically analyzed in the two groups of patients. Statistical analysis was carried out by t-test, χ² test, rank sum test, Kaplan-Meier curve, log-rank test, Cox regression (or proportional hazards model) analysis according to different data. Results: The tumor objective response rate and disease control rate as evaluated by mRECIST 1.1 criteria in the combination group were 80% and 94%, respectively, which were significantly higher than those in the control group, 41.2% (P<0.001) and 74.5% (P=0.007). The OS and PFS of the combination group were 15.6 months [95%CI 11.3-NA ] and 8.8 months [95%CI 6.9-12.0], respectively, which were significantly better than the control group at 6.1 months [95%CI 5.3-6.6] (P<0.001) and 3.2 months [95%CI 3.0-3.6] (P<0.001). Gastric ulcer incidence was significantly higher in the combination group (9/50, 18%) than that in the control group (2/51, 3.9%) (P=0.023). Conclusion TACE-HAIC-targeted-immune quadruple therapy is a more effective treatment mode for intermediate and advanced-stage HCC than TACE alone, and attention should be paid to the monitoring of target immune-related adverse reactions.
Humans ; Carcinoma, Hepatocellular/pathology* ; Chemoembolization, Therapeutic ; Liver Neoplasms/pathology* ; Retrospective Studies ; Infusions, Intra-Arterial ; Treatment Outcome

PURPOSE: Hydrofluoric acid (HFA) causes injury via tissue penetration by the free fluoride ion. Methods for treatment of HFA burns include continuous intra-arterial infusion of calcium gluconate, which is especially useful for patients with dermal burns of the digits caused by HFA. However, no comparative study of tissue injury grade with clinical factors among patients with HFA burns treated with continuous intra-arterial infusion of calcium gluconate has been conducted in Korea. METHODS: We conducted a prospective study at the emergency department of a university teaching hospital between January 2011 and June 2013. The subjects enrolled in this study consisted of 33 patients with HFA burns. After completion of treatment, we divided the patients into three groups according to the type of skin lesions. Patients requiring a skin graft or surgical flap were included in the poor outcome group, those who had to undergo incision and drainage in the moderate outcome group, and those who did not require further treatment in the good outcome group. RESULTS: After completion of all treatments, 22 of the 33 patients were included in the good outcome group and seven in the moderate outcome group; the remaining four patients were included in the poor outcome group, as they met the above-mentioned criteria, experienced longer-lasting pain, and were more frequently treated with injection in comparison with the other patients. CONCLUSION: Patients with HFA burns with long-term pain who need frequent arterial injections despite undergoing intra-arterial calcium gluconate treatment are likely to have poor outcome; therefore, they require more proactive interventions.
Burns* ; Calcium Gluconate* ; Drainage ; Emergency Service, Hospital ; Fluorides ; Hospitals, Teaching ; Humans ; Hydrofluoric Acid* ; Infusions, Intra-Arterial* ; Injections, Intra-Arterial ; Korea ; Prospective Studies ; Skin ; Surgical Flaps ; Transplants

OBJECTIVE: The authors report the safe recanalization after intraarterial injection of abciximab(glycoprotein IIb-IIIa inhibitor) in the acute cerebral vascular occlusion from the thromboembolism. METHODS: Eight patients with acute occlusion of cerebral arteries were treated by using an intraarterial infusion of urokinase and abciximab(Reopro(R)). Six patients had acute thromboembolic complication of endovascular therapy and two patients had acute basilar artery occlusion. Authors used mean 428, 000 units of the urokinase, and mean 6.2mg of the abciximab. In six cases, intraarterial urokinase and abciximab were infused shortly after the event of thrombosis duration endovascular procedure. RESULTS: In all cases, successful recanalization of thrombotic artery was achieved by using intraarterial abciximab and urokinase without bleeding complication. Seven patients recovered without neurologic deficit and one patient remained in locked-in neurological state. CONCLUSION: The authors believe that the intraarterial infusion of abxicimab even in small dose is effective and safe recanalization method in acute thrombotic occlusion of cerebral arteries, but further evaluation and study are needed.
Arteries ; Basilar Artery ; Cerebral Arteries ; Endovascular Procedures ; Hemorrhage ; Humans ; Infusions, Intra-Arterial ; Injections, Intra-Arterial ; Neurologic Manifestations ; Thromboembolism ; Thrombosis ; Urokinase-Type Plasminogen Activator

PURPOSE: Retinoblastoma (RB) is the most common primary malignant intraocular tumor in children. Although systemic chemotherapy has been the primary treatment, intra-arterial chemotherapy (IAC) represents a new treatment option. Here, we performed alternate systemic chemotherapy and IAC and retrospectively reviewed the efficacy and safety of this approach. METHODS: Patients diagnosed with intraocular RB between January 2000 and December 2011 at Severance Children's Hospital, Yonsei University, were reviewed. Before February 2010, the primary treatment for RB was chemotherapy (non-IAC/CTX). Since February 2010, the primary treatment for RB has been IAC (IAC/CTX). External beam radiotherapy or high-dose chemotherapy were used as "last resort" treatments just prior to enucleation at the time of progression or recurrence during primary treatment. Enucleation-free survival (EFS) and progression-free survival were assessed. RESULTS: We examined 19 patients (median age, 11.9 months; range, 1.4 to 75.6 months) with a sum of 25 eyes, of which, 60.0% were at advanced Reese Ellsworth (RE) stages. The enucleation rate was 33.3% at early RE stages and 81.8% at advanced RE stages (P=0.028). At 36 months, EFS was significantly higher in the IAC/CTX group than in the non-IAC/CTX group (100% vs. 40.0%, P=0.016). All 5 patients treated with IAC achieved eye preservation, although most patients were at advanced RE stages (IV-V). CONCLUSION: Despite the limitation of a small sample size, our work shows that an alternative combined approach using IAC and CTX may be safe and effective for eye preservation in advanced RB.
Child ; Disease-Free Survival ; Drug Therapy, Combination ; Eye ; Eye Enucleation ; Humans ; Infusions, Intra-Arterial ; Recurrence ; Retinoblastoma ; Retrospective Studies ; Sample Size

OBJECTIVE: Delayed cerebral ischemia due to vasospasm after aneurysmal subarachnoid hemorrhage (SAH) is a leading cause of morbidity and mortality. Recent reports have confirmed that intra-arterial infusion of calcium-channel blockers, which are widely used to counteract vasospasm, is effective for treating SAH with a low risk of complications. Here we report on our experience with intra-arterial nicardipine angioplasty in a consecutive series of 32 patients with SAH. METHODS: This retrospective review evaluated a series of 32 consecutive patients with symptomatic vasospasm that was treated with intra-arterial nicardipine. The patients included in the study were diagnosed with aneurysmal SAH between January 2007 and February 2011. All the patients underwent microsurgical clipping or endovascular coiling. Angioplasty using intra-arterial nicardipine was performed in those patients who were refractory to medical therapy such as triple H therapy. RESULTS: The 32 patients underwent a total of 55 procedures. The total amount of nicardipine used in each angioplasty procedure did not exceed 12 mg, with a maximum dose of 3 mg for each vessel. The Glasgow Coma Scale (GCS) score improved in all patients with an average improvement of 2.4 (range : 1~5). During angioplasty, there were no complications such as thromboembolic events and/or acute transitory spasm. The clinical results were evaluated using the modified Rankin Scale (mRS). Good outcomes (mRS 0~2) were determined in 19 (63.3%) of the 30 patients. The 11 patients (36.7%) with poor outcomes initially had a high Hunt and Hess grade (III or IV) or they had intra-operative complications (mRS: 3~6). CONCLUSION: Our study results support the effectiveness and safety of low-dose nicardipine when performing intra-arterial angioplasty for the treatment of vasospasm after aneurysmal SAH.
Aneurysm ; Angioplasty ; Brain Ischemia ; Glasgow Coma Scale ; Glycosaminoglycans ; Humans ; Infusions, Intra-Arterial ; Nicardipine ; Retrospective Studies ; Spasm ; Subarachnoid Hemorrhage