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PubMed1983

Organ explant culture of adult Syrian golden hamster pancreas.

An organ explant culture system has been developed for long term maintenance of adult pancreatic tissue from the Syrian golden hamster. Gastric and duodenal lobe explants of up to 0.5 cm2 size were placed in tissue culture dishes (60 mm2) on Gelfoam sponge rafts to which was added 5 ml of CMRL medium 1066 supplemented with heat inactivated newborn bovine serum, L-glutamine, hydrocortisone, insulin, and antibiotics. Dishes were placed in a controlled atmosphere chamber, which was gassed with 45% O2, 50% N2, and 5% CO2 and incubated at 36.5 degrees C. Viability of the tissues was determined by light and electron microscopy as well as by [3]thymidine incorporation. Explants were viable for up to 70 d. Zymogen granule-containing cells characteristic of acinar cells and mucus-containing cells characteristic of ductal cells were present throughout this period. However, endocrine cells were only present for the 1st wk in culture.

Animals↗
PubMed1987

Hamster tracheal organ culture in serum-free media: a quantitative comparison of in vitro epithelial morphology with that of in vivo controls.

The epithelial morphology of the hamster trachea in serum-free organ culture was compared with that of age-matched in vivo control tissues by collecting and statistically analyzing several quantifiable parameters. By this technique it was possible to detect both subtle and dramatic epithelial alterations. Midtracheal tissues from 6-wk-old male Syrian golden hamsters were used as the explants. Explants were placed on Gelfoam sponges and cultured for 1,2, and 3 wk in CMRL 1066 alone and in CMRL 1066 to which seven factors were added: insulin and transferrin (5 micrograms/ml); hydrocortisone (5 X 10(-7) M); epidermal growth factor (5 ng/ml); bovine pituitary extract (0.5%); and phosphoethanolamine and ethanolamine (5 X 10(-5) M). The following data were collected and statistically analyzed for each tracheal ring: number of epithelial cells; proportion and number of each cell type; basement membrane length; linear density of epithelial cells; epithelial height; and mitotic index. Compared to controls, ciliated cells decreased by 52% during washes in Leibovitz (L15) medium and tissue manipulation performed before culture and this loss persisted after culture for 1 wk. Explants cultured without the factors showed marked changes after 2 and 3 wk including epithelial thickening and folding, which was associated with increased linear density. Many cells in these specimens could not be categorized by type (22% were unidentifiable after 3 wk). Epithelial migration onto the outside of the explant was inhibited. In contrast, explants cultured with the factors maintained a morphology similar to controls at 2 and 3 wk and epithelial migration onto the outside of the explant was supported. This study shows that explants in CMRL 1066 with the seven factors provide a useful biological model for the in vitro study of mucociliary respiratory epithelium.

Animals↗
PubMed1993

Enhanced in vitro hair growth at the air-liquid interface: minoxidil preserves the root sheath in cultured whisker follicles.

Inasmuch as hair follicles are difficult to maintain in culture, the study of hair biology using cultured hair follicles has met with only limited success. In our attempts to solve the problem of follicle degeneration, we cultured follicles at the air-surface interface on a modified collagen matrix (Gelfoam). In follicles cultured at the air-surface or submerged, we examined follicular morphology, hair shaft growth, sulfotransferase levels, cysteine incorporation, an expression of a tissue inhibitor of metalloproteinase (TIMP), and ultra-high sulfur keratin (UHSK). Follicles cultured at the air-liquid interface produced a 2.7-fold increase in hair growth and maintained an anagen-like morphology. Substrates such as nylon mesh seeded with fibroblasts, Full Thickness Skin, or 5-microns polycarbonate filter also supported hair growth, whereas Gelfilm, GF-A glass filter, filter paper, or 1-micron polycarbonate filter did not. The UHSK expression was significantly higher in the air-liquid interface cultures compared to the submerged culture. Several potassium channel openers, including minoxidil, a minoxidil analog, and the pinacidil analog (P-1075), all stimulated significant cysteine incorporation in follicles. Minoxidil and its analog specifically preserved the follicular root sheath, in contrast to P-1075 which did not, indicating a difference in the two drug types. The preservation of the root sheath was measured by increased TIMP expression and sulfotransferase activity and indicates that the root sheath is a target tissue for minoxidil. Our results show that follicles cultured at the air-liquid interface maintain a better morphology and produced greater hair growth than follicles cultured on tissue culture plastic.

Air↗
PubMedDate not supplied

Embolization of a ruptured middle colic artery aneurysm.

Middle colic artery aneurysms are very uncommon. A few cases of occlusion of superior mesenteric artery aneurysms without bowel ischemia are reported. We describe successful uncomplicated embolization of a ruptured middle colic artery aneurysm with a Gelfoam plug.

Aged↗
PubMed1981

Technique and complications of renal carcinoma infarction.

The technique of renal arterial embolization in 150 patients with renal carcinoma using Gelfoam, Ivalon particles, and coils is described. The complications of the procedure and the morbidity and mortality following embolization are presented. The details of the postinfarction syndrome in the first 100 patients are analyzed. The prevention of these complications is discussed.

Embolization, Therapeutic↗
PubMedDate not supplied

Arterial embolization for Dieulafoy bleeding.

BACKGROUND: Dieulafoy's lesion is a rare cause of gastrointestinal haemorrhage. It has traditionally been treated either endoscopically or with open surgery. AIM: To describe a case treated by arterial embolization. RESULTS: Initially the patient was embolized with Gelfoam pledgets but re-bled at 7 days, the procedure was repeated with fibre coils, there was no further bleeding. CONCLUSION: Arterial embolization is being used increasingly as a first line of treatment as it is fast and minimally invasive with few complications.

Aged↗
PubMed2001

Intracoronary autologous blood to seal a coronary perforation.

BACKGROUND: Coronary artery perforation is a rare but serious complication of percutaneous coronary interventions. CASE REPORT: We report on the treatment of a coronary perforation during percutaneous transluminal coronary angioplasty (PTCA) of the left anterior descending (LAD) coronary artery in a patient suffering from post infarction angina complicated by cardiogenic shock. The perforation was treated successfully with intracoronary administration of the patient's own blood. CONCLUSION: This new technique may be used as adjunctive therapy to prolonged balloon inflation, coronary stenting, coronary microcoil and gelfoam embolization in the treatment of severe and hemodynamically compromising perforations.

Angioplasty, Balloon, Coronary↗
PubMed1996

[Preoperative angiographic embolization of carotid glomus tumors. A method for improving operability].

During surgical resections carotid body tumors may bleed profusely due to their vascularity. Preoperative angiographic embolization of tumor-supplying arteries has reduced intraoperative blood loss significantly. The present study reviews our clinical experiences with 13 paragangliomas of the carotid bifurcation in 12 patients during the past 5 years. In 6 patients (46.1%) computed tomography and magnetic resonance imaging demonstrated extensive spread of the tumor up to the base of the skull. Tumors of this size were initially assessed as being inoperable but curative surgical resections were performed after embolization of tumor-supplying arteries by intravascular injections of Gelfoam and implantations of microcoils. Vascular reconstruction of the internal carotid artery by a saphenous vein graft was required in 4 patients (30.7%). In 3 malignant paragangliomas (23.0%) adjuvant radiotherapy of 50-60 Gy was administered to the tumor site after surgery. During an average follow-up of 29 months, one malignant paraganglioma was found to have recurred locally 13 months after initial therapy.

Adult↗
PubMed2000

Intrahepatic chemoembolization in unresectable pediatric liver malignancies.

OBJECTIVE: To determine the effectiveness of a new multidisciplinary approach using neoadjuvant intrahepatic chemoembolization (IHCE) and liver transplant (OLTx) in patients with unresectable hepatic tumors who have failed systemic chemotherapy. MATERIALS AND METHODS: From November 1989 to April 1998, 14 children (2-15 years old) were treated with 50 courses of intra-arterial chemotherapy. Baseline and post-treatment contrast-enhanced CT and alpha-fetoprotein levels were performed. Seven had hepatoblastoma, and 7 had hepatocellular carcinoma (1 fibrolamellar variant). All patients had subselective hepatic angiography and infusion of cisplatin and/or adriamycin (36 courses were followed by gelfoam embolization). The procedure was repeated every 3-4 weeks based on hepatic function and patency of the hepatic artery. RESULTS: Six of 14 children received orthotopic liver transplants (31 courses of IHC). Pretransplant, 3 of 6 showed a significant decrease in alpha-fetoprotein, while only 1 demonstrated a significant further reduction in tumor size). Three of 6 patients are disease free at this time. Three of 6 patients died of metastatic tumor 6, 38, and 58 months, respectively post-transplant. One of 14 is currently undergoing treatment, has demonstrated a positive response, and is awaiting OLTx. Three of 14 withdrew from the program and died. Four of 14 patients developed an increase in tumor size, developed metastatic disease, and were not transplant candidates. Two hepatic arteries thrombosed, and one child had a small sealed-off gastric ulcer as complications of intrahepatic chemoembolization. CONCLUSION: The results of intrahepatic chemoembolization are promising and suggest that some children who do not respond to systemic therapy can be eventually cured by a combination of intrahepatic chemoembolization orthotopic liver transplant. Alpha-fetoprotein and cross-sectional imaging appear to be complementary in evaluating tumor response. IHCE does not appear to convert an anatomically unresectable lesion to a candidate for partial hepatectomy.

Adolescent↗
PubMedDate not supplied

Transcatheter arterial embolization in the treatment of symptomatic cavernous hemangiomas of the liver: a prospective study.

BACKGROUND: This prospective study evaluated the clinical and radiologic results of transcatheter arterial embolization (TAE) for the treatment of symptomatic cavernous hemangiomas of the liver. The technique, its complications, and effectiveness also were analyzed. METHODS: Eight patients (five male, three female; mean age +/- SD = 47.75 +/- 8.59 years) with symptomatic cavernous hemangiomas of the liver were treated by TAE with polyvinyl alcohol particles or gelfoam and steel coils (single session) followed by supportive treatment. Tumor characterization (including the extent and number of lesions) was done on triple-phase helical computed tomography or gadolinium-enhanced dynamic magnetic resonance imaging. RESULTS: The lesions were located in the right lobe in five patients, left lobe in one, and both lobes in two. The largest diameter of the lesions was 6-18 cm (9.28 +/- 5.13 cm). The treatment response was assessed on follow-up ultrasound and color Doppler and/or contrast-enhanced helical computed tomography. There were no treatment-related deaths and morbidity was minimal. Embolization was the only method of treatment in seven patients; however, one patient had surgery after TAE because the symptoms were only partly relieved. Indications for embolization were abdominal pain (eight patients), rapid tumor enlargement (four of eight), and recurrent jaundice (one of eight). Symptomatic improvement was documented in all patients after embolization. Symptoms did not worsen in any patient. The mean size of the tumor did not show any statistically significant change on follow-up radiologic examinations. However, in one patient, the tumor significantly regressed in size after embolization. CONCLUSION: TAE of hepatic cavernous hemangioma is a useful procedure in the therapy of symptomatic hemangiomas.

Embolization, Therapeutic↗
PubMedDate not supplied

Transcatheter arterial embolization in the management of hemobilia.

BACKGROUND: This retrospective analysis evaluated the clinical and radiologic results of transcatheter arterial embolization (TAE) in the treatment of significant hemobilia. The imaging findings, embolization technique, complications, and efficacy are described. METHODS: Thirty-two consecutive patients (21 male, 11 female, age range 8-61 years) who were referred to the radiology department for severe or recurrent hemobilia were treated by TAE. Causes of hemobilia were liver trauma (n = 19; iatrogenic in six and road traffic accident in 13), vasculitis (n = 6), vascular malformations (n = 2), and hepatobiliary tumors (n = 5). Iatrogenic liver trauma was secondary to cholecystectomy in those six patients. Four of five hepatobiliary tumors were inoperable malignant tumors and one was a giant cavernous hemangioma. Arterial embolization was done after placing appropriate catheters as close as possible to the bleeding site. Embolizing materials used were Gelfoam, polyvinyl alcohol particles or steel coils, alone or in combination. Postembolization angiography was performed in all cases to confirm adequacy of embolization. Follow-up color Doppler ultrasound and contrast-enhanced computed tomography was done in all patients. RESULTS: Ultrasonic, computed tomographic, and angiographic appearances of significant hemobilia were assessed. Angiogram showed the cause of bleeding in all cases. Three patients with liver trauma due to accidents required repeat embolization. Eight patients required surgery due to failed embolization (continuous or repeat bleeding in four patients, involvement of the large extrahepatic portion of hepatic artery in two, and coexisting solid organ injuries in two). Severity of hemobilia did not correlate with grade of liver injury. All 13 patients with blunt hepatic trauma showed the cause of hemobilia in the right lobe. No patient with traumatic hemobilia showed an identifiable cause in the left lobe. There were no clinically significant side effects or complications associated with TAE except one gallbladder infarction, which was noted at surgery, and cholecystectomy was performed with excision of the hepatic artery aneurysm. CONCLUSION: TAE is a safe and effective interventional radiologic procedure in the nonoperative management of patients who have significant hemobilia.

Adolescent↗
PubMed2001

Embolization for hemoptysis: a six -year review.

PURPOSE: To review our method of embolization for hemoptysis. METHODS: Between 1993 and 1999, 134 patients were treated in our department for hemoptysis. One hundred and sixteen patients were followed up (18 were lost to follow-up) over a period ranging from 1 to 66 months (median 9.5 months, SD 14.81 months). Most cases were due to tuberculosis (83.6%) and malignancy (9.5%). One hundred and three required embolization. Vascular access was obtained via the femoral route but two cases required a brachial approach for abnormal branches of the subclavian artery. All abnormal vessels found were embolized using polyvinyl alcohol particles alone or in combination with gelfoam. RESULTS: Bronchial artery hypertrophy was found in 88.3% of cases; about a third of which had a nonbronchial systemic contribution. No angiographic abnormalities were found in 11.2%. Our failure rate was 18.4% (58% required surgery while 42% died from massive hemoptysis). Sixteen cases required multiple embolization sessions. No major complications were encountered. CONCLUSION: Embolization is effective for treatment of moderate to massive hemoptysis. The majority of our cases were due to tuberculosis. Approximately one third had nonbronchial systemic artery contributions, indicating that a concerted search for these is mandatory.

Angiography↗
PubMed2002

Acute small bowel hemorrhage in three patients with end-stage renal disease: diagnosis and management by angiographic intervention.

Three patients who had undergone hemodialysis for end-stage renal disease, presented with acute small bowel hemorrhage, and were treated with superselective transcatheter arterial embolization via coaxial microcatheters. In all patients pre-procedure upper gastrointestinal (GI) endoscopy and colonoscopy had failed to demonstrate the source of the hemorrhage. Selective diagnostic angiography revealed frank extravasations of contrast from the small bowel arteries (one jejunal artery and two ileal arteries). After superselection of feeding arteries with a microcatheter, transcatheter embolization using Gelfoam and microcoils was performed in all three patients. Immediate hemostasis was achieved in all patients and the patients were discharged free from symptoms 3-5 days after embolization. No evidence of intestinal ischemia or infarction was noted, with the time from procedure to last follow-up ranging from 4 to 12 months. We conclude that superselective angiography is a valuable tool for diagnosing and treating acute small bowel hemorrhage in patients with end-stage renal disease when endoscopic evaluation has failed.

Acute Disease↗
PubMed2003

Transcatheter arterial chemoembolization of liver tumors: effects of embolization protocol on injectable volume of chemotherapy and subsequent arterial patency.

The purpose of this study was to determine whether transcatheter arterial chemoembolization (TACE) protocol affects the total volume of chemotherapy injected into the liver as well as subsequent arterial patency. A total of 160 patients with primary or secondary liver cancer were treated with 3 different chemoembolization protocols at a single institution. Data were analyzed retrospectively. Group 1 (n = 36) consisted of slurry of chemotherapy, oil and polyvinyl alcohol particles (PVA), group 2 (n = 91), chemotherapy and oil followed by PVA, and group 3 (n = 33), chemotherapy and oil followed by Gelfoam pledgets. The total volume of chemotherapy injected into the liver was recorded. Arterial patency was determined during subsequent chemoembolizations. The mean percentage of total intended chemotherapy dose administered was 54.6% for group 1, 75.3% for group 2, and 80.6% for group 3. Arterial patency at follow-up angiography was 56% for group 1, 74% for group 2, and 81% for group 3. The slurry protocol (group 1) significantly reduced arterial patency and injectable volume of chemotherapy during TACE.

Angiography, Digital Subtraction↗
PubMedDate not supplied

Endovascular therapy of traumatic vascular lesions of the head and neck.

Pseudoaneurysm and fistula formation are well-documented complications of arterial vascular injury and may be associated with significant morbidity and mortality. The purpose of this manuscript is to review the presentation and therapy of patients with traumatic vascular injuries of the head and neck. Eight patients were admitted to a Level 1 Trauma Center and diagnostic angiography of the carotid artery and vertebral circulation was performed. The mechanisms of injury included motor vehicle accident, gunshot wound, stab wound and aggravated assault. Cause of trauma, vascular lesion, endovascular therapy and outcome were analyzed retrospectively. The angiographic findings, clinical presentation and hospital course were reviewed. There were eight patients, seven males and one female, aged 17-65. Four patients (50%) had multiple lesions; four had pseudoaneurysms, two with fistula formation and two with active arterial hemorrhage. A total of 17 lesions were embolized using coils. Polyvinyl Alcohol (PVA), Gelfoam or a combination. Two of the 17 lesions received stents. Six of the eight patients remained clinically improved or stable at varying follow-up intervals. One of the four patients who presented with penetrating trauma and neurological deficits had resolution of right hemiplegia at the 8th month follow-up. One of the four patients who sustained blunt trauma and carotid-cavernous fistula presented with a new pseudoaneurysm at the 2-month post-embolization follow-up. The evolution of diagnostic neuroangiographic techniques provides opportunities for endovascular therapy of traumatic vascular lesions of the head and neck that are minimally invasive, attractive options in selected cases.

Accidents, Traffic↗
PubMedDate not supplied

Embolization of isolated lumbar artery injuries in trauma patients.

PURPOSE: The purpose of the study was to evaluate the angiographic findings and results of embolotherapy in the management of lumbar artery trauma. METHODS: All patients with lumbar artery injury who underwent angiography and percutaneous embolization in a state trauma center within a 10-year period were retrospectively reviewed. Radiological information and procedural reports were reviewed to assess immediate angiographic findings and embolization results. Long-term clinical outcome was obtained by communication with the trauma physicians as well as with chart review. RESULTS: In a 10-year period, 255 trauma patients underwent abdominal aortography. Eleven of these patients (three women and eight men) suffered a lumbar artery injury. Angiography demonstrated active extravasation (in nine) and/or pseudoaneurysm (in four). Successful selective embolization of abnormal vessel(s) was performed in all patients. Coils were used in six patients, particles in one and gelfoam in five patients. Complications included one retroperitoneal abscess, which was treated successfully. One patient returned for embolization of an adjacent lumbar artery due to late pseudoaneurysm formation. CONCLUSIONS: In hemodynamically stable patients, selective embolization is a safe and effective method for immediate control of active extravasation, as well as to prevent future hemorrhage from an injured lumbar artery.

Adolescent↗
PubMedDate not supplied

A new porcine sponge material for temporary embolization: an experimental short-term pilot study in swine.

PURPOSE: To evaluate the safety and efficacy of a porcine-derived gelfoam, Curaspon, for the temporary occlusion of the visceral arteries. METHODS: Curaspon was used for the selective embolization of segmentary hepatic, unilateral polar renal, and single lumbar arteries of 10 pigs under general anesthesia. Sequential angiographic checks were carried out and the pigs killed between 3 days and 2 weeks later. Macroscopic and microscopic studies using standard techniques were used to evaluate the immediate efficacy of embolization, duration of and completeness of recanalization on angiography, macroscopic appearance of target-organ ischemia, and microscopic analysis of inflammatory reaction. RESULTS: Immediate arterial occlusion was obtained in all cases. Renal arteries showed a total recanalization in 63% of cases on day 7 and 100% on day 14. Total hepatic recanalization was obtained in 100% of animals on day 7. All lumbar arteries were recanalized on day 14. Microscopic analysis in the kidney revealed a mild inflammatory reaction and a progressive lysis of the Curaspon (87% of samples at day 3 showed a persistence of Curaspon and 5% at day 14). In some cases, localized and partial destruction of the arterial wall was visualized. In the liver the same patterns were observed but resolved more completely and more rapidly. CONCLUSIONS: Curaspon is an efficient material for the temporary occlusion of visceral and parietal arteries in pigs. However, arterial aneurysms were observed and a relationship of these with the material cannot be excluded.

Animals↗
PubMedDate not supplied

An arteriovenous fistula between the internal mammary artery and the pulmonary vein following blunt chest trauma.

A 67-year-old man suffered a traffic accident and was transferred to an emergency hospital close to the scene. He was diagnosed to have bilateral pneumohemothorax with a lung contusion, an anterior fracture dislocation of the C6-vertebra and a cervical cord injury at the level of C7. On the 48th day, massive hemoptysis was suddenly recognized. He was transferred in a state of shock to our hospital to undergo hemostasis for the bleeding. On the day of admission, a selective arteriogram showed extravasation from the left bronchial artery, for which embolization was carried out using Gelfoam. In spite of this treatment, his hemoptysis continued. On the next day, a selective left internal mammary arteriogram showed an arteriovenous fistula between the left internal mammary artery and the left pulmonary vein without any apparent extravasation. The arteriovenous fistula was successfully embolized using platinum fiber coils. The patient no longer demonstrated any hemoptysis after embolization.

Accidents, Traffic↗