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PubMed2005

Post-traumatic high flow priapism percutaneously treated with transcatheter embolisation.

PURPOSE: The aim of this paper is to present our experience in the percutaneous management of high-flow priapism with transcatheter embolisation and gelfoam. MATERIALS AND METHODS: We present three clinical cases in which an acute trauma caused the development of high-flow priapism. After differing initial management, all cases underwent arteriography, followed by demonstration of the arterial-lacunar fistula and embolisation with gelfoam. RESULTS: Near immediate detumescence after the procedure confirmed the success of embolisation, which was supported by clinical and instrumental follow-up. DISCUSSION: In high-flow priapism, the best therapeutic solution remains transcatheter arterial embolisation, with ultra-selective catheterisation by microcatheter and embolisation of the pudendal artery only, which is responsible for the post-traumatic arterial-lacunar fistula. This manoeuvre is not always technically easy, and requires experience and remarkable dexterity. Technical failure is always possible owing to the spasm of a peripheral arteriole that cannot be resolved with papaverine, and to the possible rehabilitation by the downstream contralateral circulation. Furthermore, the apprehension of the operator carrying out the procedure in this anatomical context may make the immediate result seem satisfactory, even if it is not optimal. All these considerations stress the need for a rigorous clinical and instrumental follow-up to guide later diagnostic and therapeutic choices.

Adult↗
PubMed1991

[Complications following transcatheter arterial embolization for massive hemorrhage associated with pelvic fracture].

Complications of internal iliac artery embolization were studied in 21 patients. The 9 male and 12 female patients were 12-70 years old (average 39). This procedure was carried out for control of hemorrhage due to pelvic fracture. Embolization was performed using gelfoam cubes (1-2 mm) for main internal iliac artery or its branches subselectively. In the earlier series, steel coils were placed in the internal iliac artery routinely after gelfoam embolization. In the group of 9 men, 4 male had impotence and 5 had no change in sexual function. As a possible post embolization neurological damage, 4 patients had sensory disturbance and 8 patients had gait disturbance. Three patients had dysuria and one of them had also difficulty in defecation. All these complications following internal iliac artery embolization are suspected to be due to associated injuries and varied effect of traumatic pelvic fracture than a result of the vascular occlusion. Percutaneous transcatheter therapeutic embolization is a safe and effective procedure of choice for controlling massive bleeding associated with pelvic fracture.

Adolescent↗
PubMed1990

Treatment of hepatocellular carcinoma by segmental hepatic artery injection of adriamycin-in-oil emulsion with overflow to segmental portal veins.

Hepatocellular carcinoma was treated with slow injection of an emulsion containing 40 to 60 mg of adriamycin and 3.5 to 12 ml of Lipiodol into the portal vein via a segmental hepatic artery. During and after the injection, the portal branches of the segment were demonstrated. Six patients with resectable hepatocellular carcinoma received this treatment, which in 3 of them was followed by embolization with Gelfoam of the segmental artery. In these 3, all main tumors and daughter nodules became completely necrotic, but some infarction developed in the non-tumorous area. Those without Gelfoam had complete necrosis of all daughter nodules, but incomplete response of the main tumor. This combined treatment may be recommended for patients with localized lesions which are nonresectable due to cirrhosis, or for other reasons.

Aged↗
PubMed1990

Angiographic arterial embolization and computed tomography-directed drainage for the management of hemorrhage and infection with abdominal pregnancy.

Hemorrhage during or after surgery, pelvic abscess, bowel obstruction, and prolonged febrile morbidity can complicate the puerperal course of the gravida after removal of an extrauterine fetus with nondisturbance of the extrauterine placenta. In this report we describe the successful angiographic arterial gelfoam embolization of the placental vascular bed to control heavy postoperative hemorrhage in a mother suffering adult respiratory distress syndrome after removal of the fetal portion of her abdominal pregnancy. Six weeks later, computed tomography (CT)-directed drainage by catheter of a placental abscess was performed. Selective angiographic transcatheter embolization with gelfoam is a useful tool for the control of hemorrhage in the gravida who is an unfavorable operative candidate or who may present technical hemostasis problems peculiar to the placenta with abdominal pregnancy. Later use of CT-directed catheter drainage of the infected residual placental mass provided a nonoperative means of treatment.

Abscess↗
PubMed1989

Acute pancreatitis after transcatheter arterial embolization (TAE) for hepatocellular carcinoma.

Transcatheter arterial embolization (TAE) has been widely used for treatment of hepatocellular carcinoma. Acute pancreatitis occasionally occurs as a complication of TAE. We have investigated the possible effects of TAE on the pancreas by monitoring serum pancreatic enzyme activities following TAE with various embolic materials. Serum amylase activity was increased very little in the patients treated with chemotherapy alone or plus TAE with lipiodol, slightly increased in many of the patients treated with chemotherapy plus TAE with gelatin sponge, and increased in all of the patients treated with chemotherapy plus TAE with gelfoam powder. The activity was increased to a level as high as 700 U/dl or more in most individuals of the last category. In one of them acute pancreatitis developed, probably because the gelfoam powder regurgitated into the pancreaticoduodenal artery, and occluded a very peripheral portion of the pancreatic vascular bed, leading to ischemia of the pancreas. These results suggest that choosing the correct particle size is important for prevention of acute pancreatitis.

Acute Disease↗
PubMed1978

[Animal experimental studies on the biocompatibility of resorbable gelatin sponges and dry fibrin foam].

Histologic specimens taken from the implantation site and the regional lymph nodes up to four weeks after subcutaneous implantation of Gelastypt S (Höchst AG), Gelfoam (Upjohn), and Fibrospum (Promonta) into the upper hind leg of guinea pigs were examined. Similar tissue reactions were observed with Gelastypt S and Gelfoam; the reactions did not differ appreciably from those normally occurring in the context of wound healing. The predominance of round cell infiltrate and the appearance of giant cells in connection with Fibrospum may indicate an immunogenetic potency of the substance. No signs of beginning resorption could be observed four weeks later.

Animals↗
PubMed1986

[Multidisciplinary therapy of hepatocellular carcinoma--TAI. TAE treatment by intra-arterial catheterization].

Two hundred sixty-six cases of hepatocellular carcinoma (HCC) were treated between June 1980 and October 1985 (4 years and 4 months) at our hospital. Hepatectomy was performed in 118 patients, 82 of which had received transcatheter arterial embolization with iodized oil (Lipiodol) 58 of then with an intraarterial catheter. HCC tumors were often multiple when they were combined with liver cirrhosis and smaller than 3 cm in diameter. For this reason treatment of HCC by surgery alone has limitations for prolongation of life. A multidisciplinary treatment is therefore necessary. We have found hepatectomy and transarterial embolization to be the most effective treatment for HCC. In order to perform repeated embolizations after hepatectomy, we developed a heparinized catheter with notches to permit safe fixation. This is suitable for long-term intraarterial use. While previous arterial catheters only permitted infusion of drugs due to their small diameters, our new catheter can be used for embolizations with Lipiodol and Gelfoam and for angiography. It is inserted through the right gastroepiploic artery into the gastroduodenal artery so that its tip lies at the level of the hepatic artery. It is brought out through the abdominal skin and flushed at two-week intervals with heparin-urokinase. The indications for the use of the catheter have been repeated embolizations 1) for prevention of tumor recurrence (surgical adjuvant therapy), and 2) after absolutely non-curative operations. For the first indication, we have found that multiple tumors and tumors larger than 5 cm frequently recur within 1 year after surgery. We have, since July 1983, used the catheter treatment to prevent recurrence in 30 such cases. Embolization with Lipiodol + Adriamycin followed by Gelfoam cubes is performed at three-month intervals for one year after surgery, starting one month after surgery, as a rule. The preliminary results indicate an improved survival rate after the treatment.

Aged↗
PubMed1987

[Oily chemoembolization of hepatoma].

Since 1983 we have performed transcatheter oily chemoembolization (TOCE) using adriamycin (40-100 mg), Lipiodol (5-20 ml) and Gelfoam in the treatment of 100 cases with unresectable hepatocellular carcinoma. Adriamycin was dissolved in a fluid equal in specific gravity to Lipiodol and the adriamycin solution was mixed with 3 volumes of Lipiodol, making an adriamycin-in-oil emulsion (AOE). After TOCE, the blood concentration of adriamycin was obviously lower than that after one-shot injection because of the slow release of adriamycin from the AOE. Also, in cases of hepatic resection after TOCE, there was a clear difference in the adriamycin concentration between the tumor and the normal hepatic tissue. The cumulative survival rates for the 100 patients treated by TOCE were: 6 months 81.9%, 1 year 53.8% and 2 years 36.5%. Thus, improvement was found in comparison with the cumulative survival rates for 104 patients who underwent hepatic embolization without Lipiodol, which were 6 months 67.4%, 1 year 45.2% and 2 years 16.3%. AOE retained in the tumor as microemboli brings about the slow-releasing effect of adriamycin. Furthermore, by adding the effect of Gelfoam embolization, TOCE has a strong antitumor effect.

Carcinoma, Hepatocellular↗
PubMed1979

Selective superior mesenteric embolization for small intestinal hemorrhage.

A 25-year-old white woman who had previously undergone two operations for peptic ulcer disease, and was addicted to drugs and alcohol, had massive hemorrhage from the small intestine. Angiography pinpointed the jejunum as the source of bleeding. Because the patient had a coagulopathy she was considered a poor risk for surgery. Bleeding was controlled by embolization with sterile, commercially available Gelfoam (Upjohn) which was injected into the offending branch of the superior mesenteric artery. This is believed to be only the third documented case of embolization of small intestinal vessels. A review of the available literature is presented and the value of Gelfoam embolization as an adjunct in the control of hemorrhage in selected patients is stressed.

Adult↗
PubMed1986

Pigskin as a topical hemostat in arterial, liver, and splenic injuries.

Pigskin made commercially available as porcine-derived dermal collagen (PDC) contains a macrofibrillar collagen surface that initiates platelet aggregation and the intrinsic pathway clotting mechanism. Sterile-irradiated PDC, nonirradiated PDC, and lyophilized PDC were tested for hemostatic effectiveness and cost for hemostasis against each other and Avitene powder, Avitene web, Collastat, Gelfoam, Superstat, and Thrombostat. Canine arterial, liver, and splenic bleeding models were used. In arterial wounds PDC was more effective than Avitene powder, Avitene web, and Gelfoam (p less than 0.05) and also Superstat and Thrombostat (p less than 0.01). First application success rates revealed that PDC agents were more successful overall (85%) than the next three most successful agents: Avitene powder, Avitene web, and Collastat (56%) (p less than 0.01). Differences in success rates of hepatic and splenic wounds were less marked but still significant. Cost of hemostasis was relatively low for PDC agents in comparison to the other agents. PDC is an effective topical hemostatic agent in experimental canine arterial, liver, and splenic wounds when compared with several currently used agents and can also result in cost savings.

Administration, Topical↗
PubMed1986

[Surgical approaches to the cavernous sinus--repair of a C-C fistula at the C5 portion of the internal carotid artery].

It has been generally accepted that the direct approach to the cavernous sinus under the normal temperature is very difficult and dangerous. Bleeding from the cavernous sinus is thought to be very difficult to control. However, when the patient is kept in semi-sitting position during the operation, the venous pressure of the cavernous sinus can be decreased nearly to 0 and the cavernous sinus can be opened without any serious bleeding. Either insertion of Biobond soaked Oxycel or alternative insertion of fibrinogen soaked Gelfoam and thrombin soaked Gelfoam into the opened cavernous sinus is made to control bleeding. In the case of C-C fistula, if the cavernous portion of the carotid artery is trapped by application of temporary clips to the cervical portion of the external and internal carotid artery and the C2 portion of the internal carotid artery, one could perform the operation without any uncontrollable serious bleeding in the same manner. In such cases, in order to prevent ischemia of the brain during interruption of the internal carotid flow, EC-IC bypass is indicated and performed about two weeks prior to the direct attack of the cavernous sinus. The operation consists of subfronto-pterional transsylvian approach, removal of the anterior clinoid process, removal of the superior, lateral and inferior walls of the optic foramen as far anteriorly as possible, opening of the anterior inferior cavity and the medial cavity through the medial triangle in order to isolate the C3 and C4 portions of the internal carotid artery, and then exposure of the C5 portion of the internal carotid artery via the Parkinson's triangle.

Arteriovenous Fistula↗
PubMed1986

[Our postoperative care and surveillance in surgery of stable sequelae of chronic otitis].

After a brief summary of the technique used for myringoplasty (enlarged endaural approach, large flattened aponeurotic graft applied to deep surface of tympano-meatal flap after a "request" for boring) emphasis is given to the need for strict surveillance and postoperative care by the surgeon. Immediate postoperative care starts in the operating room and involves a deep intra-meatal dressing (1 or 2 Popes oto-wicks placed on a thin film of silastic or simply surrounded by Gelfoam) and a superficial dressing. The dressing is renewed on the 3rd day with the patient in bed and involves only the superficial one. Secondary postoperative care extends to the 10th or 15th day and includes exeresis of the deep pope-Gelfoam assemblage under careful binocular microscope control followed by audiometric examination. Hospital stay is a mean of 5 days and medical treatment (antibiotics, vasodilators, corticoids) is given as required. Late postoperative care can be summarized as involving regular surveillance and the application of certain rules that cause little disturbance in the patients life. Various rare and even exceptional incidents, benign in the majority of cases, are reviewed.

Chronic Disease↗
PubMed1985

[Renal arterial embolization for renal cell carcinoma].

Renal arterial embolization is often used in the treatment of patients with renal cell carcinoma, either preoperatively to facilitate nephrectomy or as palliative therapy in advanced cases. Eighteen patients (18/58; 31%) underwent renal arterial embolization in our department since 1979, initial 10 cases with Gelfoam and steel coil (group G) and recent 8 cases with absolute ethanol (group A). Clinical studies of daily changes of symptoms and blood chemistry in both groups after embolization were compared and the results were as follows: Severe flank pain was noted immediately after embolization but thereafter well controlled without analgesics in group A. The patients in group G experienced no pain during the procedure of embolization but have had moderate flank pain of two or three days' duration with nausea and/or vomiting and required surgical procedure within a few days after embolization. Post embolization fever in group A was described as higher than that in group G significantly. Leukocytosis was noted to be persistent for up to seven days and blood chemistry showed transient marked elevations of GOT, GPT and LDH immediately after the procedure without significant value in both groups. Embolization to advanced tumor with many parasitic vessels or massive local invasion may not always be available for remaining of viable-appearing tumor cells in venous lumen, as if palliative treatment. Absolute ethanol may be more useful as the embolizing substance than Gelfoam and steel coil by reason of producing wide severe infarction of diseased kidney. Broad marked infarction due to renal arterial embolization may make pathological diagnosis difficult. Immunological effects of renal arterial embolization were not observed in short term patients survival.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1979

Evaluation of a new method for treating segmental renal disease.

Experimental segmental renal artery embolization was performed to evaluate the feasibility of therapeutic segmental renal embolization. In group 1, a two kidney dog model, segmental embolization of the right kidney was performed in ten dogs using Gelfoam, Silastic elastomer and barium sulfate. In group 2, a one kidney dog model, segmental embolization of left kidney was performed using Gelfoam and Silastic elastomer. In the remaining three dogs of group 2, embolization was not done for control. Sequential blood pressure measurements, plasma renin activities and renal arteriograms were obtained. Three dogs in group 2 died following unintentional complete renal embolization. Seventeen of the 18 dogs of the entire study remained normotensive after embolization. One dog had persistent hypertension develop which was controlled by a second, total renal embolization. The results suggest that therapeutic segmental renal embolization is a feasible method for treating segmental renal disease.

Aneurysm↗
PubMed1983

[Embolization and detached balloon occlusion by the femoral route in craniofacial lesions].

Embolization and detached balloon occlusion by the femoral route were performed in 45 cases: 19 cases of meningiomas, 5 of scalp arteriovenous malformations (AVMs), 4 of dural AVMs, 6 of cerebral AVMs, 8 of facial angiomas and 3 of carotid cavernous sinus fistulas (CCFs); and favorable results were attained. In meningiomas, there is only a short interval between the embolization and the removal of tumor (we usually perform the embolization a couple of days before the removal), and we use Gelfoam as embolus material. We aim at central tumor embolization with small emboli. The embolization reduced bleeding in removing the tumors, simplifying the surgical procedure, and 12 of 19 cases required no blood transfusion. Almost all cases of scalp AVMs, dural AVMs and facial angiomas could most probably be cured only by the embolization without surgery. Gelfoam was the first choice, because it would probably dissolve, and also because it would be relatively safe even if pulmonary embolism might occur as a result of probable passage of its emboli onto the venous side. In recanalized cases, the embolization was performed again with Ivalon, a permanent embolus material. The most important of this procedure is to inject the emboli of the suitable size for each case together with a suitable contrast material at as low a rate as possible under the image intensifier. Embolization by the injection pressure should never be tried, but the emboli be allowed to be carried only on the blood flow to the distal side. And the embolization should be discontinued at the stage when the contrast material has stagnated. CCFs are very good indications for the detached balloon occlusion, while this technic proved to serve for no more than occluding the feeding vessels in cerebral AVMs; in other words, it is indicated in a rather limited range of AVMs. We have encountered no severe complications in any of the cases treated by the embolization and detached balloon occlusion.

Adolescent↗
PubMed1983

Injury-induced neuronotrophic activity in adult rat brain: correlation with survival of delayed implants in the wound cavity.

Mechanical or chemical injury to adult rat brain elicited the accumulation in the affected area of trophic activity for cultured parasympathetic, sympathetic, and sensory neurons. Neuronotrophic activity was relatively low both in noninjured brain tissue extracts and in extracts prepared from the tissue surrounding an injury immediately after the lesion was made. However, trophic titers increased considerably over time, first in the brain tissue that formed the walls of the wound and then in the Gelfoam filling the wound cavity. In the tissue adjacent to the injury, trophic titers began to rise immediately after the lesion, reached a maximum 10 days later, and decayed thereafter. In the wound cavity, occupied by Gelfoam, neuronotrophic activity began to increase 6 days postlesion, reached a maximum at day 16 after injury, and decreased at later times. The levels of induced trophic activity appeared to be proportional to the size of the wound. Injury to various brain areas including temporal, entorhinal, occipital, parietal, and frontal cortices, hippocampus, corpus striatum, and cerebellum, all induced a similar increase in neuronotrophic factor(s). Damage to the myelinated fibers of the corpus callosum did not. High trophic titers decayed rapidly with distance from the wound except in areas heavily deafferented by the lesion, where activity also reached high levels. Extracts from all of the above-mentioned brain areas contained toxic activity for cultured spinal cord neurons. The level of neuronotoxic activity was similar both before the lesion and 15 days postlesion, with the possible exception of the corpus callosum. Intraventricular injections of kainic acid at doses which destroy areas CA4, CA3, and part of CA1 of the hippocampus also induced a time-dependent rise of neuronotrophic activity in this structure, comparable to that achieved by mechanical damage. Both kainic acid treatment and mechanical injury cause extensive glial proliferation in the injured and/or deafferented area. The apparent concurrence of glial reaction and increase in neuronotrophic activity suggests that glial cells may be a major source of the induced trophic activity. As an in vivo correlate of cell culture data, the survival of striatal transplants into host cortical wounds was examined. Fragments of embryonic corpus striatum did not survive when transplanted into a freshly made cavity in the entorhinal/occipital cortex of adult rats. Survival was enhanced by introducing a delay between the time at which the wound cavity was made and that at which the striatal tissue was implanted in it.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1980

Ultrastructural observations on the three-dimensional reorganization and growth of newly-formed candidate stromal cells and residual hemopoietic cells in culture.

Gelfoam sponges were used as three-dimensional culture supports to allow the migration, reorganization and growth of regenerative cells derived from bone fragments previously depleted of marrow by curettage. The explants and sponges, cultured in 0.3% agar-medium, were analysed ultrastructurally throughout a 14 day culture period. By day 5 the gelfoam sponge was infiltrated by large cells with extensive cytoplasmic processes (stromal cells) and primitive round cells. The stromal cells were pleomorphic and varied in their content of rough endoplasmic reticulum, mitochondria, cytoplasmic granules, microfilaments, lipid droplets and glycogen. The cytoplasmic processes made multiple intercellular contacts with other stromal cells thereby forming a stromal network. Close and direct associations of stromal cells with primitive hemopoietic cells and various stages of myeloid cells were identified. The identification of proliferating granulocytes and mononuclear phagocytes on days 7--14 in these unstimulated cultures suggests that the organization of stromal cells is able to maintain primitive cells and supports the proliferation and differentiation of myeloid cells. It is proposed that this three-dimensional culture technique (i) allows the development of primitive stromal precursors and primitive residual hemopoietic cells; (ii) provides a model for the analysis of early stromal cell-hemopoietic cell interactions.

Animals↗
PubMed1982

Control of postoperative renal hemorrhage by embolization with a Gianturco coil.

A 35-year-old woman underwent a left pyelonephrolithotomy for removal of a staghorn calculus. Blood loss was minimal for 5 days. Then there was profuse bleeding from the left kidney that did not respond to conservative management. Angiographic examination demonstrated extravasation of contrast medium from a minor intrarenal artery in the lower pole of the kidney directly into the pelvicalyceal system. An attempt was made to embolize the bleeding vessel with Gelfoam particles but this failed because the Gelfoam passed directly into the collecting system. A Gianturco coil, however, occluded the vessel and immediately the hemorrhage ceased; the patient had no further complications. The authors emphasize that the introduction of a steel coil to control bleeding is advocated only when the use of temporary occlusive agents is unsuccessful.

Adult↗