Purpose: Chemosaturation with percutaneous hepatic perfusion (PHP; Hepatic CHEMOSAT? Delivery System; Delcath Systems Inc, USA) is a minimally invasive, repeatable regional therapy for unresectable hepatic metastases. It uses a system of catheters and filters to isolate hepatic venous blood from the systemic circulation, allowing delivery of high-dose chemotherapy to the hepatic artery. Effluent hepatic venous blood is filtered before being returned to the systemic circulation, thereby reducing exposure to chemotherapy. We describe our experiences with chemosaturation-PHP at 2 European centers. Materials and Methods: 14 patients presented unresectable hepatic metastases from solid tumors; 13 received 1???3 sessions of chemosaturation-PHP. Melphalan 2.0 (n?=?1) or 3.0 (n?=?12) mg/kg was given as a 30-minute infusion into the hepatic artery. 12 patients were evaluable for tumor response. Results: One complete (cholangiocarcinoma, n?=?1) and 6 partial responses (ocular, n?=?3 or cutaneous melanoma, n?=?3) were observed, 5 patients had stable disease (ocular melanoma, n?=?3; breast cancer, n?=?1; gastric cancer, n?=?1). Mild to moderate filter-related toxicity (i.?e. thrombocytopenia, anemia) was observed immediately post-procedure. Grade 3/4 melphalan-related pancytopenia developed after 1???2 weeks. All hematological events were managed effectively with transfusions and/or other supportive measures. The new high-efficiency filter showed milder toxicity and faster recovery. In one case, chemosaturation-PHP was abandoned prematurely due to heparin-induced vaginal bleeding, and one patient died due to retroperitoneal hemorrhage from heparin anti-coagulation. Conclusion: Chemosaturation-PHP for non-resectable liver metastases is a feasible treatment option when performed by an experienced multi-disciplinary team. It may be a promising regional therapy for patients with no effective treatment options. Citation Format: ??Vogl TJ, Zangos S, Scholtz JE et?al. Chemosaturation with Percutaneous Hepatic Perfusions of Melphalan for Hepatic Metastases: Experience from Two European Centers. Fortschr R?ntgenstr 2014; 186: 937???944

No abstract

The colonial tunicate Clavelina lepadiformis is a recent invader to the northwest Atlantic and has the potential to cause ecological and economic harm. This paper provides a review of the biological and ecological characteristics of C. lepadiformis, and hypothesizes the likely mechanisms of introduction, establishment and future expansion. The intent of this paper is to provide a consolidated source of information for marine ecosystem managers and provide a starting point for developing a management strategy, should one be desired. Although C. lepadiformis is not currently a management challenge because of the limited range of the invasion in North America; the similarities between C. lepadiformis and other tunicate invaders, and the proximity of incipient populations to boating, shipping, aquaculture, and energy infrastructure suggest future economic burden of this new invader. Other regions such as the west coast of North America and New Zealand may be at risk for invasion by C. lepadiformis.

No abstract

No abstract