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PubMed1994

[Oily contrast medium used for chemoembolization in the palliative treatment of extensive inoperable primary hepatocellular carcinomas].

Transcatheter arterial oily chemoembolization using cytostatics mixed with lymphographic contrast agent with or without Gelfoam embolization seems currently to be the most suitable treatment for unresectable hepatocellular carcinomas (HCC). 5 patients with inoperable, biopsy proven huge HCC (average size 404 cm2) were treated by multiple cycles (3-7, average 4.6 cycles) of a triple drug combination including doxorubicin, cisplatin and mitomycin-C together with Lipiodol. In 13/23 cycles the lipiodolization was complemented by Gelfoam embolization increasing the efficacy of treatment. The hypervascular HCC-s showed marked reduction in size (degree of regression was 33-66%, average 55%). The median follow-up was 1918 (13-36 months). Three patients are still alive with follow-up ranging from 15-36 months (average 23 months) despite the progression of the disease. One patient died of tumorous cachexia 13 months after initial treatment, while another one, who developed partial remission, lost his life in a road accident 17 months after his first cycle.

Adult↗
PubMed1994

Selective vascular embolization in benign gynecologic conditions.

Eight patients with benign obstetric and gynecologic conditions required embolization. There was a total of 11 embolizations, and embolizing agents were chosen depending on the abnormality requiring embolization. Gelfoam, Ivalon and alcohol were used to treat vascular malformations. Ovarian veins were embolized with coils. Postoperative bleeding was managed with Gelfoam, coils and/or Ivalon. Four patients had bleeding after hysterectomy or vaginal suspension. One patient had postdelivery bleeding. All the bleeding was controlled after embolization. A uterine arteriovenous malformation was managed with embolization, allowing the patient to carry her next pregnancy to term. The symptoms of a vulvar hemangioma and ovarian syndrome were controlled with vascular embolization. Morbidity was minimal. Embolization is the primary treatment of choice in obstetric and gynecologic patients with postoperative bleeding or symptomatic vascular malformation.

Angiography↗
PubMed1976

[Studies on neurinomas and neurofibromas in tissue culture (author's transl)].

10 acoustic neurinomas, 2 spinal cord neurinomas and 3 neurofibromas of von Recklinghausen's disease were elaborately studied by monolayer tissue culture method and Gelfoam organ culture method. Four morphological types were found in the acoustic and spinal cord neurinoma. (1) multinucleated cells (type I), dividing into bipolar spindle-shaped cells. (2) bipolar spindle-shaped cells (type II), forming of palisade fashion in the monolayer tissue culture method. (3) fibroblastic cells (type III), tending to predominate in the long-term cultures. (4) round cells (type IV), gathering to the Gelfoam mesh in the organ culture method. Neurofibroma of von Recklinghausen's disease was divided into cells of two types in the tissue culture. (1) spindle-shaped cells, rarely observed, and have been thinking that the cells originated from schwann cells. (2) round cells, having the macrophagic character, are predominant in the long-term culture.

Culture Techniques↗
PubMed1995

[Experimental study on embolic materials for simultaneous segmental embolization through transarterial route].

To determine suitable embolic materials for simultaneous arterioportal embolization through the arterial route, transcatheter arterial embolization (TAE) using iodized oil (Lipiodol) mixed with monomeric n-butyl-2-cyanoacrylate, with absolute ethanol, or mixed with Gelfoam powder was carried out in 14 dogs. Following TAE, the distribution of Lipiodol in hepatic artery, peribiliary plexus, and portal vein was analyzed by soft tissue x-ray radiography and en bloc silver impregnation. As a result, Lipiodol mixed with absolute ethanol, and Gelfoam powder was considered to be the most reasonable embolic materials for this purpose.

Animals↗
PubMed1996

Evaluation of efficient chemoembolization mixtures by magnetic resonance imaging therapy monitoring: an experimental study on the VX2 tumor in the rabbit liver.

To find effective chemoembolization mixtures, we tested combinations of carboplatin with the embolizates Spherex and Gelfoam in comparison to a therapy with NaCl-solution, a treatment with the cytostatic drug only, and a therapy with each of the embolizates alone. The experiments were carried out using as a model the VX2 tumor in the liver of male chinchilla rabbits (five for each group). Carboplatin was revealed by the 3-(4,5-dimethylthiazole-2)-yl-2,5-diphenyltetrazolium bromide test to be a potent cytostatic drug for VX2 rabbit tumor cells. We used magnetic resonance imaging to examine the tumor volume and signal intensity enhancement up to 15 min after Gd-DTPA administration within the tumor and liver before and after the different therapies. These parameters allowed us to evaluate tumor growth and vitality as well as liver injury for the different therapy types. The results found by magnetic resonance imaging corresponded very well to those obtained by histological analysis of the tumors. The chemoembolization therapies were significantly more efficient than the other therapies, as indicated by the reduction of signal intensity enhancement after contrast agent administration within the tumor and by the histologically determined necrotic fraction after therapy. In addition, we found a significant decrease of the tumor volume and no significant live injury for a therapy with Carboplat and Gelfoam.

Animals↗
PubMed1996

Pharmacokinetic, angiographic, and histologic comparison of catheter-directed chemoembolization versus systemic chemotherapy in a canine model.

Chemotherapy with selective intraarterial embolization may promote sustained contact of the drug with the tumor and thus could be more effective in the treatment. In this phenomenon, pharmacokinetics of a drug such as mitomycin C (MMC) play a significant role in guiding the therapy. Therefore, we have compared the pharmacokinetics of MMC and assessed angiographic, morphologic, and histologic changes in the kidney following intravenous MMC versus renal artery infusion with and without embolization with embolic agents, Rhizoma Bletillae (RB) and Gelfoam (GF). Dogs randomly divided into four groups underwent selective infusion protocols. Blood samples from renal and common iliac veins were analyzed for MMC levels. Angiography and pathology were performed at 4 days. Intravenous MMC (IV-MMC) caused significantly lower renal vein MMC levels than intraarterial MMC (IA-MMC) and GF + MMC. RB + MMC produced the lowest MMC levels in both veins (p < 0.05). Common iliac MMC levels were not significantly different after IV-MMC, IA-MMC, or GF + MMC. Angiographic and histologic studies showed extensive bleeding, necrosis, and vasculitis with thrombosis of the target kidneys after RB + MMC, GF + MMC, or IA-MMC, but not IV-MMC. Selective Rhizoma Bletillae chemoembolization can decrease systemic levels of MMC. Gelfoam does not provide sustained local release of MMC or decrease systemic levels of MMC compared with intravenous infusion. Selective renal MMC infusion without an effective embolic agent does not reduce systemic levels compared with intravenous delivery.

Adjuvants, Pharmaceutic↗
PubMed1986

Treatment of a lingual hemangioma by superselective embolization.

A large hemangioma of the tongue was initially treated with superselective embolization using polyvinyl alcohol foam (Ivalon) and absorbable gelatin sponge (Gelfoam) particulates. A marked reduction in vascularity with deflation of the lesion occurred. Subsequent surgery to ablate the residual tumor was canceled due to the patient's request and satisfaction with the initial procedure. Evaluation over the following year revealed no regrowth or symptomatology. This case demonstrates that, in selected cases, large hemangiomas may respond satisfactorily to superselective embolization and may obviate the need for surgical intervention.

Adult↗
PubMed1992

Effects of endothelial cell growth factor on vascular compromised skin flaps.

Angiogenic growth factors have the potential to accelerate vascularization in soft tissue. This study explored the vascular effects of endothelial cell growth factor (1800 micrograms/mL) with heparin (7 micrograms/mL) in gelatin sponge (Gelfoam) in two settings of vascular compromise. On days 2 and 3 ligated skin flaps in the rabbit ear model, peripheral neovascularization, and flap viability were quantitatively documented by digital angiographic analysis and by polar planimetry. The mean flap viability of the treated flaps was two times greater than their controls in the day 2 (N = 24) and day 3 ligation groups (N = 22). The angiograms among the treated flaps in the day 2 ligation group also demonstrated a quantitative increase in vascularization compared with their controls. These results suggest a provocative means for accelerating neovascularization and enhancing viability to vascular compromised skin flaps.

Administration, Topical↗
PubMed2002

A polymeric sealant inhibits anastomotic suture hole bleeding more rapidly than gelfoam/thrombin: results of a randomized controlled trial.

HYPOTHESIS: An experimental polymeric sealant (CoSeal [Cohesion Technologies, Palo Alto, Calif]) provides equivalent anastomotic sealing to Gelfoam (Upjohn, Kalamazoo, Mich)/thrombin during surgical placement of prosthetic vascular grafts. DESIGN: Randomized controlled trial. SETTING: Nine university-affiliated medical centers. PATIENTS: One hundred forty-eight patients scheduled for implantation of polytetrafluoroethylene grafts, mainly for infrainguinal revascularization procedures or the creation of dialysis access shunts, who were treated randomly with either an experimental intervention (n = 74) or control (n = 74). INTERVENTION: Following polytetrafluoroethylene graft placement, anastomotic suture hole bleeding was treated intraoperatively in all control subjects with Gelfoam/thrombin. Subjects in the experimental group had the polymeric sealant applied directly to the suture lines without concomitant manual compression. MAIN OUTCOME MEASURES: Primary treatment success was defined as the proportion of subjects in each group that achieved complete anastomotic sealing within 10 minutes. The proportion of subjects that achieved immediate sealing and the time required to fully inhibit suture hole bleeding also were compared between treatment groups. RESULTS: Overall 10-minute sealing success was equivalent (86% vs 80%; P =.29) between experimental and control subjects, respectively. However, subjects treated with CoSeal achieved immediate anastomotic sealing at more than twice the rate of subjects treated with Gelfoam/thrombin (47% vs 20%; P<.001). Consequently, the median time needed to inhibit bleeding in control subjects was more than 10 times longer than for experimental subjects (16.5 seconds vs 189.0 seconds; P =.01). Strikingly similar findings for all comparisons were observed separately for subgroups of subjects having infrainguinal bypass grafting and for those undergoing placement of dialysis access shunts. CONCLUSIONS: The experimental sealant offers equivalent anastomotic sealing performance compared with Gelfoam/thrombin, but it provides this desired effect in a significantly more rapid time frame.

Anastomosis, Surgical↗
PubMed1983

Comparative tissue reactivity to topical hemostatic agents in the periureteral area.

Application of the topical hemostatic agents microfibrillar collagen hemostat (Avitene), oxidized cellulose (Surgicel), and absorbable gelatin sponge (Gelfoam) to the periureteral regions in dogs did not incite an adverse inflammatory or fibrotic reaction when used in standard, recommended fashion. No instances of ureteral obstruction resulted from such application. The addition of a small amount of sterile urine in the same area with the topical agent did not influence the degree of reaction. We concluded that these useful hemostatic agents, when used properly, are absorbed with only slight or no residual tissue reaction. The adverse tissue reaction occasionally reported probably can be ascribed to either improper use of the hemostatic agent, other concomitant noxious influences such as infection, or admixture with abnormal collections of body fluids.

Administration, Topical↗
PubMed1984

Massive hematuria following percutaneous biopsy of renal allograft. Successful control by selective embolization.

We report on a patient who underwent a percutaneous needle biopsy of a renal allograft for evaluation of compromised function. Gross hematuria occurred immediately and persisted for three weeks, interrupted only by long intervals of anuria due to obstruction by a clot. The bleeding was controlled successfully by selective transcatheter embolization with a coli and an absorbable gelatin sponge (Gelfoam). The techniques and complications of allograft biopsy procedures are reviewed, and the management of hematuria occurring after a percutaneous needle biopsy is discussed. A percutaneous needle biopsy is the preferred method of sampling the transplanted kidney, with an adequate specimen obtained in 96% of cases. Hematuria, that has been reported to complicate 7% of percutaneous biopsy procedures, is usually transient, and only rarely is intervention required. Angiographically directed selective embolization is an effective technique for controlling massive or prolonged urinary hemorrhage after renal allograft biopsy.

Adolescent↗
PubMed1997

Differential distribution of (GABA)A receptor subunits on bulbospinal serotonergic and nonserotonergic neurons of the ventromedial medulla of the rat.

Spinally projecting neurons of the ventromedial medulla (VMM) compose an important efferent pathway for the modulation of nociception. These neurons receive a substantial gamma-aminobutyric acid (GABA)-ergic input, but the GABA receptor that mediates this input is unknown. This study examined the distribution of GABA(A) receptor alpha1 and alpha3 subunits in serotonergic and nonserotonergic neurons of the VMM that project to the dorsal horn in the rat. A pledget of Gelfoam soaked in Fluoro-Gold was placed at the thoracolumbar junction of the spinal cord to label spinally projecting neurons. Alternate sections of the medulla were then incubated with a mixture of antisera to either serotonin and the alpha1 subunit, or to serotonin and the alpha3 subunit of the GABA(A) receptor. Nearly 30% of spinally projecting neurons in the VMM were immunoreactive for the alpha1 subunit. A similar percentage of spinally projecting neurons in the VMM were immunoreactive for the alpha3 subunit, although diffuse cellular labeling combined with intense staining of processes in the neuropil precluded a rigorous semi-quantitative estimation of this population. No alpha1-subunit-immunoreactive neurons colocalized serotonin. In contrast, serotonergic neurons were immunoreactive for the alpha3 subunit. However, these double-labeled neurons were a modest percentage of the serotonergic population. A small percentage of spinally projecting serotonergic neurons was immunoreactive for the alpha3 subunit. These results suggest that significant numbers of spinally projecting serotonergic and nonserotonergic neurons of the VMM possess GABA(A) receptors that differ in their respective subunit compositions and that both classes of neurons may mediate the antinociception produced by the microinjection of GABA(A) receptor antagonists in the VMM.

Animals↗
PubMed1979

Arterial occlusion of pelvic bone tumors.

Arterial occlusion of the internal iliac artery was successful in the relief of pain due to primary and secondary neoplasms of the bony pelvis in 8 of 9 patients. These included 3 giant cell tumors, 1 aneurysmal bone cyst, 1 recurrent chondrosarcoma, 3 metastatic renal cell carcinoma and 1 metastatic clear cell sarcoma. Calcification of the margin of the lesion occurred in 3 of 4 primary neoplasms after infarction. The transcatheter arterial occlusion was accomplished utilizing Gelfoam and stainless steel coils. Although most patients experienced pain and fever for several days following the procedure, no permanent sequelae or complications were encountered.

Adenocarcinoma↗
PubMed1982

Preoperative embolization of retroperitoneal hemangiopericytomas as an aid in their removal.

The first reported cases of preoperatively embolized hemangiopericytomas are presented. Both lesions presented in the retroperitoneum where most lesions are now considered to be malignant. In the past, the highly vascular nature of these tumors has made resection in these areas difficult. Since the angiographic picture of hemangiopericytomas is now thought to be specific, it became feasible to add preoperative embolization to the overall management of these cases. In the first case, the diagnosis had been established 15 years previously. When first seen at Thomas Jefferson University Hospital, extensive bone destruction of the sacrum and lumbar vertebrae were present. Preoperative Gelfoam embolization aided in the palliative debulking of the tumor at operation. With this experience, preoperative embolization became part of the management in the second case and aided in the complete surgical removal of the tumor. Radiation therapy in the dosage of 5000 rad was given postoperatively in this case and should also be part of the treatment plan for these lesions.

Adult↗
PubMed1983

Treatment of hepatic metastases by transaxillary hepatic artery chemotherapy using an implanted drug pump.

The objective of this study was to evaluate the feasibility of integrating an implantable, refillable drug infusion pump with transaxillary angiographic hepatic arterial catheterization. The implantation is performed under local anesthesia in the radiology suite. A 2-3 cm incision in the left upper arm is made through skin and subcutaneous tissue. Through an axillary artery puncture, a 5.3F polyethylene catheter is fluoroscopically placed into the hepatic artery. To minimize gastroduodenitis, the gastroduodenal artery is occluded with a Gianturco coil and Gelfoam. The Model 400 Infusaid pump is implanted in the upper chest and attached subcutaneously to the angiography catheter using a friction connector. Patients are discharged 2-3 days later. Over a two-year period, 20 such implants have been performed. Floxyuridine (FUdR) has been used by continuous infusion; mitomycin-C (MMC) and 1,3-bis-(2-chloroethyl)-1-nitrosourea (BCNU) by intermittent intra-arterial infusion. The pump/catheter system has been left in place for as long as 18 months. Partial responses in the colorectal cases are as follows: FUdR four of nine patients, MMC two of three, FUdR + MMC one of one, and FUdR + MMC + BCNU three of three. No arm vascular complications, hepatic arterial occlusions, peripheral emboli, pump malfunctions, or catheter occlusions took place over a total experience of 3210 patient days. Three catheter migrations occurred requiring repositioning in two patients, and three cracked catheters required replacement. This innovative approach offers a comfortable, convenient method for long-term ambulatory hepatic arterial chemotherapy obviating both laparotomy and extra-corporeal pumps.

Antineoplastic Agents↗
PubMed1983

Hypertension with renal carcinoma. An effect of arterial embolization.

A patient presented with mediastinal metastases from renal adenocarcinoma. Palliative therapy included Gelfoam and steel coil embolization of the right renal artery. Six weeks later he was found to have developed severe hypertension. Arteriogram revealed collateral vessels which supplied the tumor; the renal vein renin activity was four times higher on the right than on the left. We suspect that infarction of the kidney was not complete because of collateral arterial supply, and renin-dependent hypertension was the result. Thus, it may be hazardous to embolize large hypernephromas without subsequent nephrectomy.

Adenocarcinoma↗
PubMed1984

Transcatheter chemo-embolization effective for treating hepatocellular carcinoma. A histopathologic study.

A histopathologic study was done on livers from 14 patients who underwent surgery for hepatocellular carcinoma and who had been pretreated by a combination of intra-arterial embolization of Gelfoam (Upjohn) plus intra-arterial chemotherapy. This technique was effective as the excess vascularity of the tumor and the tumor bulk were reduced and resection was readily facilitated. For solitary tumors of less than 4 cm in diameter, this approach was particularly effective. As this combined treatment almost invariably leads to liquefaction and necrosis of the tumor, the likelihood of metastases is diminished.

Aged↗
PubMed1987

A new approach to chemoembolization therapy for hepatoma using ethiodized oil, cisplatin, and gelatin sponge.

This article reports on a new approach to hepatic arterial chemoembolization therapy using ethiodized oil (Lipiodol, Ultra Fluide), cisplatin, and gelatin sponge (Gelfoam, Upjohn, Kalamazoo, MI) for hepatocellular carcinoma (HCC). The anticancer effects of this therapy on 20 patients who underwent subsequent hepatic resection were evaluated mainly by histologic examination. All main tumors were reduced in size following this therapy. It is notable that in 65% of the patients the tumor size was reduced to less than 50% of that before therapy. All the values of serum alpha-fetoprotein (AFP) in the patients who exhibited pretreatment levels exceeding 100 ng/ml dropped by more than 50%, and in 55% of them it fell below 20 ng/ml. The concentration of platinum in the tumor tissue was significantly higher than that in the nontumorous tissue. In 15 of 20 patients (75%), the main nodules were completely necrotic. Thirteen of the patients had daughter nodules and/or small intrahepatic metastases (Group A); nine had tumor emboli in the portal (hepatic) vein (Group B); 17 had intracapsular invasions (Group C); and ten had extracapsular invasions (Group D). The ratios of patients with completely necrotic cancer cells in Group A were nine of 13 (69%); in Group B, seven of nine (78%), in Group C, 11/17 (65%); and in Group D, four of 10 (40%). In eight of the 20 patients (40%) no viable cancer cells were recognized at any foci. Lesions other than those with extracapsular invasion could be considerably eliminated with this form of therapy. It is expected that this method will become the therapy of choice not only for palliative treatment but also for preoperative treatment.

Adult↗