Acetic acid injection

FIGURE 12-6. Example of reverse-phase separation of an APC tablet. Column Resolve Ci8 column (5 jam) 3.9 mm x 15 cm. Mobile phase percent methanol noted on chromatogram and remaining percentage is 4% aqueous acetic acid. Injection volume 5 jaL. Flow rate 1 mL/min. Detector 254 nm, 1.0 AUFS. (Note Actual separation will depend upon the quality of the mobile phase and column packing.)... 

Percutaneous acetic acid injection (PAI) Injection of acetic acid (40-50%, 2-5 ml, 2-4 sessions) into the tumour also resulted in necrotic destruction of the tumour tissue (M. Imamura et al., 1995). PAI is considered to be just as effective as PEI the success was most evident when the intratumoural retention of acetic acid persisted for about three days after completion of the treatment. (66,102,132)... 

Huo, T.I., Huang, Y.H., Wu, XC., Lee, P.C., Chang, F.Y., Lee, S.D. Persistent retention of acetic acid is associated with complete tumour necrosis in patients with hepatocellular carcinoma undergoing percutaneous acetic acid injection. Scand. X. Gastroenterol. 2004 39 168-173... 

Ohnishi, K., Yoshioka, H., Kosaka, K., Toshima, K., Nishiyama, J., Kameda, C., Ito, S., Fujiwara, K. Treatment of hypervascular small hepatocellular carcinoma with ultrasound-guided percutaneous acetic acid injection comparison with segmental transcatheter arterial embolization. Amer. J. Gastroenterol. 1996 91 2574-2579... 

Platelet-activating factor Para-aminohippuric acid Percutaneous acetic acid injection Punction/Aspiration/Injection/Re-Aspiration Perinuclear antineutrophihc cytoplasmic antibody... 

FIGURE 3. FTIR difference spectra between acetic acid sorbed on dry H+ZSM-5 and dry H+ZSM-5 (held at 150°C under N2). Spectrum A was recorded 30s after acetic acid injection, spectrum B after 12 min. and spectrum C,2 hours later. 

Sample preparation 1 mL Plasma -t- 1 mL saturated potassium carbonate -i- 5 mL ethyl acetate, mix, centrifuge. Remove the organic layer and add it to 1 mL saturated NaCl solution and 1 mL 1 M HCl, centrifuge. Remove the aqueous phase and add it to 1 mL saturated potassium carbonate solution and 3 mL ethyl acetate, extract. Remove a 2.5 mL aliquot of the organic layer and evaporate it to dryness under reduced pressure, reconstitute the residue with 400 p,L 250 p,M phenanthrenequinone in MeOH, evaporate to dryness under reduced pressure, reconstitute with 40 p,L DMF and 40 p,L 2 M NaOH, heat at 60° for 15 min, cool on ice, neutralize with 5 M acetic acid, inject a 20 p,L aliquot. 

Lin SM, Lin CJ, Lin CC, Hsu CW, Chen YC (2005) Randomised controlled trial comparing percutaneous radiofrequency thermal ablation, percutaneous ethanol injection, and percutaneous acetic acid injection to treat hepatocellular carcinoma of 3cm or less. Gut 54 1151-1156 Eivraghi T (1998) Percutaneous ethanol injection in the treatment of hepatocellular carcinoma in cirrhosis. Hepatogastroenterology 45 1248-1253 Eivraghi T, Giorgio A, Marin G, Salmi A, Sio I de, Bolondi... 

All of the percutaneous techniques are limited by the size and number of the lesions (up to three lesions each measuring up to 4 cm) as well as their location. Subdiaphragmatic lesions may be percutaneously inaccessible, and lesions close to large vascular structures respond poorly to thermal ablation techniques (RFA, MCT, Cryo, and LIPC). On the contrary, intra-arterial techniques are not limited by the number, size, or location of the lesions rather by the hepatic function reserve, as shown in Table 10.2. TACE, trans-arterial chemo-embolization TARE, trans-arterial radio-embolization MCT, microwave coagulation therapy RFA, radio frequency ablation LIPC, laser interstitial photocoagulation Cryo, cryo-ablation PEI, percutaneous ethanol injection PAAI, percutaneous acetic acid injection PCI, percutaneous chemotherapy injection... 

As indicated above, response and recurrence rates are inversely proportional to lesion size. Up to three separate lesions of up to 4 cm each can be treated with RFA, TACE, or both for that matter with good results. Lesions larger than 5 cm or more than three lesions of any size should preferentially be treated with TACE. Percutaneous ethanol or acetic acid injection has similar response rates to RFA and suffers from the same limitations pertaining to lesion size and number... 

Sample preparation Mix plasma with 5 vol of MeOH, cool to -20°, centrifuge at 4°, evaporate the supernatant to dr3mess under reduced pressure, reconstitute the residue with MeCNilO mM ammonium acetate 40 60 containing 1% acetic acid, inject an aliquot. Mix 1 mL ( ) microsomal incubation with 1.5 mL ice-cold EtOH, cool at <5° for 1 h, centrifuge, evaporate the supernatant to dr5Uiess under reduced pressure, reconstitute the residue with MeCNilO mM ammonium acetate 40 60 containing 1% acetic acid, inject an aliquot. Dilute bile twofold with 10 mM ammonium acetate, centrifuge, inject an aliquot. 

Sample preparation Condition a Sep-Pak C18 SPE cartridge with 2 mL 80% acetic acid and 4 mL 10 mM trifluoroacetic acid. Mix 1 mL plasma with 200 iiL 1 M trifluoroacetic acid, place on ice, add to the SPE cartridge, wash with 3 mL 100 mM trifluoroacetic acid, pass 20 mL air through the cartridge, elute with 3 mL 80% acetic acid, inject an aliquot. 

Lee JM, Lee YH, Kim YK, et al (2004) Combined treatment of radiofrequency ablation and acetic acid injection an in vivo feasibility study in rabbit liver. Eur Radiol 14 1303-1310... 

Other methods of percutaneous ablation have been clinically tested over the past few years. One group compared percutaneous acetic acid injection and PEI (Ohnishi et al. 1998). Sixty patients with one to four HCC lesions smaller than 3 cm were entered into a randomized trial. All original tumors were treated successfully by either therapy. However, 8% of 38 tumors treated with percutaneous acetic acid injection and 37% of 35 tumors treated with PEI developed a local recurrence (p<0.001) during the follow-up. The 1- and 2-year survival rates were 100% and 92% in the percutaneous acetic acid injection group and 83% and 63% in the PEI group (p=0.0017). A multivariate analysis of prognostic factors revealed that treatment was an independent predictor of survival. The authors concluded that percutaneous acetic acid injection was superior to PEI in the treatment of small HCC. However, the results of acetic acid injection were not established in large series of patients. 

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