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Stable expression of varied levels of inducible nitric oxide synthase in primary cultures of endothelial cells.

Nitric oxide (NO*), generated by nitric oxide synthase (NOS II) from immunostimulated cells during infection, plays an important role in host immune defense against microbial invasion. The impact of different rates of NO* production on host cell function has not been defined. Herein, we describe the development of a method to express varied levels of murine NOS II in bovine pulmonary artery endothelial cells. A retroviral vector (pMFGSNOS) encoding NOS II was used to transduce primary cultures of endothelial cells. Bovine endothelial cells were susceptible to this transduction and up to 18% of the cells expressed immunodetectable murine NOS II. The NOS II-transduced endothelial cells were cultured on the three-dimensional matrix, Gelfoam, for 8-10 days. Stable expression of NOS II was assessed by measuring nitrite accumulation in media every 2 days. By day 10, endothelial cells on Gelfoam were found to secrete NO* at a rate exceeding 1.0 microM/h/10(6) cells, concomitant with an enhanced level of NOS II activity. Argininosuccinate synthetase, a key enzyme in the metabolism of l-citrulline to l-arginine, increased as well, perhaps in response to dimunition of the intracellular arginine pool corresponding to the observed high output of NO*. In spite of the continuous flux of NO*, endothelial cell viability was not effected. This system provides the opportunity to assess the impact of different levels of sustained NO* production on endothelial cell physiology.

Animals↗

Effects of adrenal medulla transplantation into the third ventricle on the onset of puberty in female rhesus monkeys.

To test the hypothesis that prepubertal exposure of LHRH neurons to a source of catecholamines and neuropeptides accelerates the onset of puberty, we examined the effects of autologous adrenal transplantation into the base of the third ventricle of the brain in juvenile female rhesus monkeys at 11-13 months of age. The adrenal medulla, which contains catecholamines and neuropeptide Y (NPY), was cut into small pieces and mixed with gelfoam in artificial CSF and injected into the third ventricle, adjacent to LHRH neurons and their neuroterminals. Sham control monkeys received artificial CSF with gelfoam alone. Animals were monitored for signs of pubertal development. While menarche was not altered by adrenal transplantation, the timing of first and second ovulations occurred significantly (P < 0.05) earlier in adrenal-transplanted monkeys. Histological examination indicated that the grafts survived in all transplanted monkeys. The presence of catecholamines and NPY in graft tissue was confirmed by tyrosine-hydroxylase-positive, dopamine beta-hydroxylase-positive, and NPY-positive cells. Endogenous LHRH fibers were observed innervating the graft tissue. We conclude that: (1) adrenal medulla transplantation into the third ventricle accelerates the age of first ovulation; (2) this is likely due to neuroactive substances (e.g., catecholamines and NPY) from the graft tissue; and (3) grafted adrenal medulla tissue can survive for at least 30-40 months. However, the age of menarche was not accelerated by this grafting, suggesting that an additional mechanism (e.g., removal of tonic inhibition) may be necessary for the onset of puberty.

Adrenal Medulla↗

Comparative in vitro analysis of topical hemostatic agents.

Hemostatic agents are broadly utilized across the surgical specialties. While specific characteristics desirable for individual applications may vary, these agents generally are expected to aid the patient's coagulation system in the rapid development of an occlusive clot. Six commonly utilized hemostatic agents were quantitatively compared in terms of their ability to mediate platelet aggregation, deposition and activation, and initiate gross clot formation in a series of in vitro tests. Three types of collagen sponges (Actifoam, Helistat, Instat), microfibrillar collagen (Avitene), a gelatin sponge (Gelfoam), and oxidized regenerated cellulose (Surgicel) were studied. Platelet aggregation: Citrated platelet rich plasma (PRP) was contacted with hemostatic agents both with and without thrombin in a stirred cuvette and the platelet count was measured over 5 min. Platelet deposition: To approximate arterial wounds, PRP was perfused in a controlled manner through hemostatic agents, and the effluent platelet count was measured over time. Platelet activation: ATP secretion from PRP contacted with hemostatic agents in a stirred cuvette was measured at 1 and 5 min. Clot formation: The clotting time of nonanticoagulated whole blood contacted with the hemostatic agents was measured. Materials which depleted platelets most rapidly and effectively in the perfusion system (Avitene, Helistat, and Actifoam) were also the most effective inducers of platelet aggregation and secretion. Clot formation (likely to be platelet dependent) was also more rapid in this group. An overall activity ranking combined the relative performance of each hemostatic agent on the various tests: Actifoam approximately Avitene > Helistat >> Gelfoam > Instat > Surgicel. The activity ranking generally reflects the materials used in these agents (collagen > gelatin > oxidized regenerated cellulose), as well as their processing (chemical crosslinking in collagen sponges may lower activity). Such in vitro assessment of the relative platelet and coagulation activities of hemostatic agents might serve as a useful screening tool before investigating properties which require more expensive animal or clinical testing.

Adenosine Triphosphate↗

Astrocytes secrete a factor inducing the expression of HT7-protein and neurothelin in endothelial cells of chorioallantoic vessels.

Among the most specific markers of the blood-brain barrier phenotype of endothelial cells are the well-characterized immunoglobulin-like surface glycoprotein HT7 and the probably related or identical glycoprotein neurothelin. Both can be induced in chorioallantoic vessels by transplants of embryonic mouse brain. Other blood-brain barrier markers have been shown to be inducible by type-1 astrocytes in endothelial cells of non-neural origin. In the present work we tested the hypothesis that this cellular interaction between astrocytes and endothelial cells is mediated by a soluble factor(s). Chorioallantoic vessels of embryonic day 9 chick embryos were exposed for 4 or 10 days to a constant and localized delivery of astrocyte-conditioned medium by using a piece of gelfoam posed onto the chorioallantoic membrane, as a localized reservoir, which was connected to a miniosmotic pump system delivering astrocyte-conditioned medium at a steady rate. We found that in a significant number of chorioallantoic vessels located near the gelfoam, endothelial cells exposed to astrocyte-conditioned medium for a period of 4 or 10 days, but not to glioma-, fibroblast- or endothelial cell-derived conditioned medium, expressed the HT7 antigen and neurothelin. These results provide evidence that type-1-astrocytes are capable of inducing blood-brain barrier related properties in endothelial cells of non-neural origin through a soluble factor(s).

Allantois↗

Liver parenchymal changes after transcatheter arterial embolization therapy for hepatoma: CT evaluation.

We retrospectively reviewed computed tomographic (CT) findings of 118 patients with hepatoma who received sequential follow-up CT after transcatheter arterial embolization (TAE). Thirty-five patients received TAE using Gelfoam particles with cisplatin, 37 patients using Gelfoam particles and iodized oil (Lipiodol) with cisplatin, and 46 patients using iodized oil with cisplatin. Liver atrophy was observed in 33 patients, lobarly or focally, depending on the embolized area. It was frequently associated with portal vein occlusion by the tumor, usage of iodized oil, and repeated embolization therapy. The lobar atrophy was seen in patients who had portal vein occlusion and/or received repeated embolization therapy. The focal atrophy was observed in patients who were administered iodized oil. Infarction developed in four patients who had a thrombus in the portal vein and received peripheral embolization therapy using iodized oil. We conclude that liver parenchymal changes occur frequently in patients who have portal vein occlusion and/or receive peripheral embolization using iodized oil.

Adult↗

Evaluation of different types of emboli in transcatheter embolization of rat kidney.

The properties and characteristics of a variety of embolic materials (Clots--surgicel--gelfoam--barium--cyanoacrylates) were investigated by transcatheter embolization of the rat kidney. Clots and surgicel result in temporary embolization, with return of normal renal function. Gelfoam barium and cyanoacrylates produce definitive embolization. Only barium was found in veins.

Animals↗

MRI changes in embolized meningiomas.

Study of the MRI changes that occur after superselective embolization of hypervascular meningiomas with Gelfoam powder (5 cases) and polyvinyl alcohol (PVA) particles 150-250 microns in size (4 cases) has indicated that, after embolization, meningiomas showed loss of the signal void, decrease in gadolinium-DTPA contrast enhancement, and prolonged T1 and T2. Shortening of T1 and T2 was seen in two patients with Gelfoam-embolized meningiomas in whom CT showed pooling of iodinated contrast medium in the tissue. In vitro experimental data demonstrated that the shortening of T1 and T2 was due to the iodinated contrast medium.

Aged↗

Transcatheter arterial embolization using iodized oil (lipiodol) mixed with an anticancer drug for the treatment of hepatocellular carcinoma.

The therapeutic results of Lp-TAE (transcatheter arterial embolization with Gelfoam particles preceded by the infusion of a mixture of lipiodol and an anticancer drug via the proper hepatic artery) were evaluated in hepatocellular carcinomas (523 non-resected and 24 resected cases). Excellent therapeutic effects were confirmed not only for the main tumor but also for the daughter nodules by a histological examination of the liver tissues resected after Lp-TAE. The cumulative 1-year, 2-year and 3-year survival rates in the 523 non-resected cases were 60.4%, 42.9% and 28.0% respectively. These survival rates were all higher than those achieved by Gelfoam TAE. The above results suggest the usefulness of Lp-TAE in the treatment of hepatocellular carcinoma.

Carcinoma, Hepatocellular↗

Efficacy of CO2-DSA in embolization.

Intra-arterial digital subtraction angiography using CO2 (CO2-IA-DSA) is effective for detecting arteriovenous and arterioportal shunts in the liver. We carried out CO2-IA-DSA in addition to selective arteriography using a iodinated contrast medium in 31 patients with unresectable hepatocellular carcinoma (HCC). As a result, CO2-IA-DSA detected an AV shunt in 4/31 patients and an AP shunt in 16/31 patients for a total of 20 cases of shunt, whereas conventional hepatic IA-DSA detected only AP (AV shunt) shunts in 3/31 patients. For HCC without any shunt, Gelfoam embolization was carried out after injection of Lipiodol and Farmorubicin (FARM). In patients with an AP shunt, injection of Lipiodol and FARM was performed after the shunt had been embolized with Gelfoam. In patients with an AV shunt, Lipiodol and FARM were injected after the shunt had been embolized with a metallic coil. In conclusion, detection of shunts by CO2-IA-DSA is useful for determining the optimal approach for transcatheter arterial injection.

Adult↗

Effectiveness of Lipiodol in transcatheter arterial embolization of hepatocellular carcinoma.

The effectiveness of Lipiodol (iodized oil) in transcatheter arterial embolization (TAE) of hepatocellular carcinoma (HCC) was retrospectively evaluated using statistical analysis. A total of 343 HCC patients who underwent TAE at 5 institutions between 1984 and 1989 were divided into 2 groups: the GS-TAE group underwent TAE with Gelfoam sponge alone, whereas the LP-TAE group was given Lipiodol (LP) immediately before GS-TAE. The statistical T value calculated for the LP-TAE group showed that the administration of LP, the tumor size, intrahepatic metastasis, portal vein infiltration, and serum total bilirubin and alpha-fetoprotein levels significantly (P < 0.01) affected the patients' survival. Both the cumulative survival determined using the Kaplan-Meier model and the cumulative hazard calculated using Cox's proportional hazard model differed significantly (P < 0.01) between the GS-TAE group and the LP-TAE group (log-rank test). These results confirmed the effectiveness of LP used in combination with Gelfoam sponge for TAE of HCC.

Aged↗

Congenital ossicular anomalies without malformations of the external ear.

Eighteen ears of congenital ossicular malformation without deformities of the external ear were presented. They were classified into three groups; eight incudostapedial joint separations, three malleus and/or incus fixations, and seven stapes fixations. The surgical correction for the first group was to connect the malleus handle to the stapes using a silicon tube specially designed or a gelfoam wire in the uncustomary way. This group showed the best surgical results with 35.4 dB of the average hearing gain in speech frequencies. In the second group, removal of the fixed part of the ossicles yielded satisfactory results, but mobilization failed to improve the hearing. For the group of stapes fixation, stapedectomy and the gelfoam wire prosthesis were performed. The result was not satisfactory in some cases with the undeveloped oval window. The embryological consideration leads us to the following conjecture; the incudostapedial joint separation results from the failure in build-up of "the secondary continuity", the malleus and/or incus fixation is the result of disturbances in separation process by the undifferentiated mesenchyme, and the stapes fixation is due to maldevelopment of the stapedial lamina. This classification for the congenital ossicular malformation is practically valid as it would suggest the maldeveloped point in ossicular genesis and results of surgical correction.

Adolescent↗

Emergent embolotherapy of small intestine hemorrhage.

The efficacy of emergent embolotherapy was evaluated in six patients suffering hemorrhage from the small intestine. Hemorrhage was from the jejunum in four patients, from the ileum in one, and from Meckel's diverticulum in one. Superselective embolization of the arcade of the small intestine artery branch was performed in all patients with a coaxial catheter. Embolic materials used were Gelfoam particles alone or Gelfoam particles plus coils in earlier cases and microcoils in recent cases. Complete hemostasis was immediately achieved in all patients, but one patient died of disseminated intravascular coagulation. After stabilization of the patient's condition by hemostasis, elective surgery was performed on three patients suffering small intestine ulcer. Histopathologically, no bowel infarction was noted but mild mucosal inflammation with submucosal edema was found in the jejunum of two patients. We recommend embolization for life-threatening small intestine hemorrhage, preferentially in situations where the blood vessel involved can be super-selectively occluded at the nearest level of the arcade of the vasa recta, lest the vasa recta should be occluded.

Adolescent↗

The treatment of hyperparathyroidism by transcatheter techniques.

Gelfoam embolization of parathyroid adenomas causes temporary remission of hypercalcemia, but collateral circulation revascularizes the gland. Embolization with silicone permanently infarcts the gland, but is associated with all the risks of capillary bed occlusion. The staining of parathyroid adenomas with contrast material avoids the risks of particulate embolization and appears to produce permanent ablation. We carried out embolization or staining procedures in 14 parathyroid adenomas. In three of the four cases in which Gelfoam embolization was performed, hypercalcemia recurred within six months to two years; in the fourth case, in which persistent normocalcemia has been found, intense staining had been demonstrated before embolization. In eight of the remaining 10 cases, adequate staining was achieved, and normocalcemia has been maintained in all up to 36 months.

Adenoma↗

Transcatheter arterial chemoembolization with anticancer drug in iodized oil for primary hepatic carcinoma.

Transcatheter arterial chemoembolization using a suspension of anticancer drug in iodized oil combined with Gelfoam embolization was performed in 85 patients with advanced primary hepatic carcinoma. Long-term retention of iodized oil in the tumor was observed in 90% of the cases, and changes in tumor size were observable by abdominal X-ray film on follow-up studies. There was a decrease of tumor size in all cases and the overall 1-year survival rate was 43%. In tumors whose diameter was less than 20 cm and in patients without portal vein thrombosis the survival rate was nearly 60%. Combined treatment with anticancer drug in iodized oil and Gelfoam embolization of the proper hepatic artery was superior to use of the suspension alone. There was also better detection of small cancer nodules by the suspension as compared to conventional angiography.

Adult↗

Hemobilia: transcatheter occlusive therapy and long-term follow-up.

Eight patients with life-threatening hemobilia were treated by percutaneous transcatheter occlusive therapy. The bleeding was caused by a traumatic pseudoaneurysm of the hepatic artery in 6 cases (auto accident in 4, surgery in 1, biliary drainage in 1) and a true aneurysm of the hepatic artery in 2 (unknown etiology in 1 and mycotic in 1). Arterial catheterization was used in all cases except for one in which a direct percutaneous puncture was performed. Gelfoam alone was used as embolic material in 3 patients. In 1 patient each, the material used was gelfoam plus coils, coils alone, blood clot, n-butyl-cyanoacrylate and an occluding balloon catheter. In all cases the bleeding stopped and did not recur during the follow-up period which ranged from 9 months to 14 years. This experience indicates that transcatheter occlusive therapy is an effective method for the treatment of severe hemobilia.

Adolescent↗

Segmental embolotherapy for hepatic cancer: keys to success.

Transcatheter chemoembolization using Lipiodol (Lp) mixed with chemotherapeutic agents followed by Gelfoam particle injection only to the tumor-bearing hepatic segment (segmental Lp transcatheter hepatic artery embolization) (TAE) was applied to more than 100 patients with hepatocellular carcinoma and metastatic liver cancer. For segmental Lp-TAE, knowledge of the variations of intrahepatic arterial anatomy is important. Furthermore, the catheters and guidewires, volume of Lp, kinds and dose of chemotherapy, preparation of the mixture of Lp and chemotherapy (Lp-emulsion), method of injection of Lp-emulsion and Gelfoam particles, as well as the follow-up computed tomography examination are key items to the success of the procedure and are reviewed.

Antineoplastic Agents↗

Transcatheter arterial embolization as a method of cisplatin-retention enhancement on the VX2 tumor uterus transplants.

PURPOSE: Enhanced cisplatin (Pt) retention using transcatheter arterial chemoembolization (TAE) with Gelfoam particles was studied in rabbit uterine tumors. METHODS: Ten rabbit uteri were inoculated with 5 x 10(7) cells of VX2 carcinoma. Three to four weeks later cisplatin, 1 mg/kg, was injected, either with (TAE group) or without (IA group) being mixed with small Gelfoam particles, into the aortic bifurcation over 5 s. Blood and tissue concentration of cisplatin were determined. RESULTS: Slower arterial blood clearance of Pt was observed in the TAE group compared with the IA group, whereas the venous blood Pt clearance curves were similar for both groups. The uterine tumor Pt concentration at 80 min was found to be 2.52-fold higher after TAE compared with IA (p < 0.01). In the pelvic metastatic lymph nodes, the Pt concentration was 4.63 times higher after TAE than after IA (p < 0.01). CONCLUSION: These data indicate that TAE is an effective means of increasing tissue concentration in uterine tumors.

Animals↗

[Experimental studies of embolization of different hepatotropic blood vessels using Bletilla striata in dogs].

Bletilla striata and gelfoam were used as embolizing agents for the embolization of various hepatotropic vessels in dogs. The results proved that Bletilla striata was superior to gelfoam. The mechanisms of embolization by Bletilla striata are attributable to following factors: non--absobent property, mechanical obstruction; effects on coagulative and anticoagulative systems and secondary obstruction resulted from the injury to wall of blood vessels.

Animals↗