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PubMed1995

Evaluation of embolization effect of hepatocellular carcinoma by hepatic arterial flow study with Tc-99m MAA SPECT.

The degree of hepatocellular carcinoma vascularity in eight patients was assessed with Tc-99m MAA radionuclide angiography before and after treatment. For chemoembolization therapy, lipiodol and doxorubicin hydrochloride were administered intraarterially along with Gelfoam particles. The ratio of radioactivity in the hepatocellular carcinoma compared to that in the surrounding uninvolved tissue before therapy was 6.5-19.0 with a mean of 12.0. After therapy, the ratio dropped to 0.5-1.3. Because survival improved significantly after the therapeutic regimen used in these patients, radionuclide Tc-99m MAA angiography appears to be an accurate method for demonstrating successful embolization of the vascular supply in hepatocellular carcinoma.

Adult↗
PubMedDate not supplied

Control of experimental traumatic hepatic hemorrhage by transcatheter embolization.

The feasibility of control of traumatic hepatic hemorrhage by angiographic transcatheter embolization was investigated. Bleeding sites were created in the livers of each of twelve dogs, and the hepatic artery was occluded with Gelfoam. Successful control of bleeding was demonstrated by postembolization angiography in all twelve animals. Initial elevations in alkaline phosphatase and serum glutamic pyruvic transaminase values returned to their baseline in four weeks. Recanalization of the hepatic artery in the five surviving animals was shown by follow-up angiograms. Transcatheter embolic control of traumatic hepatic hemorrhage may be a useful adjunct to surgical therapy.

Animals↗
PubMedDate not supplied

Therapeutic angioinfarction of renal carcinoma: CT follow-up.

Computed tomographic findings in nine patients after renal tumor embolization are reported. All tumors were ablated using absolute alcohol, Gelfoam particles, and occlusion coils. A rim of peripheral enhancement surrounding a central low density area presumed to represent the necrotic infarcted tumor was a constant CT appearance. Intratumoral gas was seen in three patients, persisting for up to 6 months, with eventual resolution. Mild postinfarction syndrome was experienced in all patients. The exact role of preoperative or palliative renal embolization is still controversial, but if the procedure is performed, the natural course of the neoplasm can be best evaluated and followed by serial CT scans.

Adult↗
PubMed1985

Extrahepatic portal venous thrombosis: frequent recognition of associated diseases.

Twelve patients with obstruction of the extrahepatic portal venous system were seen at the Tufts-New England Medical Center between 1970 and 1979; a cause for the portal vein thrombosis was detected in 11. These included pancreatic disease (4); hematologic disorders (2); postoperative complications of laparotomy (3); transhepatic gelfoam embolization of the portal vein (1); and exchange transfusion via the umbilical vein (1). Clinical features included frequent self-limited episodes of bleeding from esophageal or gastric varices; and no characteristic or clinically helpful laboratory findings. The diagnosis was usually made in patients by identifying clots in the portal vein on selective angiography of the celiac and/or superior mesenteric arteries in which the venous phase was examined. Attempts at surgical correction were largely unsuccessful. Further thrombotic episodes occurred in three patients, and led to death in one. Two patients were given chronic anticoagulation with Coumadin and Persantin for 1 and 11/2 years, respectively without further thrombosis or gastrointestinal bleeding. However, it not yet possible to assess the risks and benefits of such therapy.

Adolescent↗
PubMed2003

Treatment of unresectable hepatocellular carcinoma less than 2 centimeters by transcatheter arterial chemoembolization with autologous blood clot.

GOALS: To assess the efficacy of transcatheter arterial chemoembolization using autologous blood clot as an embolizing agent (short-TAE [S-TAE]) for the treatment of unresectable hepatocellular carcinoma less than 2 cm. STUDY: Twenty-eight consecutive patients with unresectable hepatocellular carcinoma less than 2 cm in diameter were treated by S-TAE alone. All patients had documented cirrhosis (Child class B:C = 20:8). S-TAE was performed by injecting a mixture of iodized oil and anticancer drugs followed by embolization of hepatic arteries with autologous blood clot. RESULTS: A total of 147 sessions of embolization with clots were performed. S-TAE maintained patency of hepatic arteries. The overall survival rates at 1, 3, 5, and 8 years were estimated to be 89%, 52%, 34%, and 17%, respectively, which were better compared with prior records for the gelfoam method. The survival rates for Child class B patients were significantly better than that for Child class C patients (P < 0.05). The Cox proportional hazard model also demonstrated that Child staging of cirrhosis was the sole factor significantly predicting the survival (P < 0.05). CONCLUSIONS: The long-term outcomes of S-TAE for unresectable hepatocellular carcinoma less than 2 cm are satisfactory. Prognosis of these patients was significantly dependent on clinical stages of coexisting liver cirrhosis.

Adult↗
PubMed2000

Use of intrahepatic chemotherapy to treat advanced pediatric hepatic malignancies.

BACKGROUND: To evaluate the effect of intrahepatic arterial chemotherapy (IAC) on children with primary hepatic malignancies. METHOD: A nonrandomized inception cohort of 11 pediatric patients was referred for treatment of advanced primary hepatic malignancies at Children's Hospital of Pittsburgh. None of the patients was a candidate for resection before the initiation of IAC. Tumor response to treatment was observed by determining serum alpha-fetoprotein (AFP) levels and by abdominal computed tomographic scan. The patients received hepatic artery infusions of cisplatin and/or doxorubicin. The last five also received gelfoam embolization. RESULTS: Eight of 11 patients had multiple IAC treatments. Eight patients had AFP-producing tumors, and five of the eight had dramatic reductions in serum levels after IAC treatment. Five of the 11 patients underwent successful orthotopic liver transplantation after receiving IAC therapy, and the five explanted specimens showed varying degrees of tumor necrosis. One-year survival in patients in the authors' center is 67% for those with hepatoblastoma and 40% for those with hepatocellular carcinoma. Three-year survival is 60% and 30% for patients with hepatoblastoma and hepatocellular carcinoma, respectively. CONCLUSION: Intrahepatic arterial chemotherapy therapy can halt the progression and possibly down-stage advanced pediatric hepatic malignancies. This therapy can also be used as a successful adjunct in altering a patient's chance for successful liver transplantation.

Adolescent↗
PubMed1998

Endovascular treatment of intractable oronasal bleeding associated with severe craniofacial injury.

BACKGROUND: Severe craniofacial injury may cause intractable oronasal bleeding, which is refractory to conventional treatments. This study will evaluate the efficacy of endovascular treatment for such oronasal bleeding. METHODS: Nine males between the ages of 19 and 62 years who had intractable oronasal bleeding resulting from severe craniofacial injuries received treatments of transarterial embolization using Gelfoam pledgets, polyvinyl alcohol particles, or platinum coils. We then reviewed their clinical and neuroradiologic characteristics retrospectively. RESULTS: In all but one case, angiography demonstrated bleeding points as extravasation. These bleeding points were multiple in seven cases. Except for bleeding from ethmoidal arteries, selective embolization was successful. In all cases, intractable oronasal bleeding was controlled. Patient survival was not directly related to oronasal bleeding, but rather was strongly correlated with associated brain injuries. CONCLUSION: Endovascular treatment is an acceptable treatment for intractable oronasal bleeding associated with severe craniofacial injuries when conventional treatments have failed.

Adult↗
PubMed1996

Indirect larynx and pharynx surgery: a replacement for direct laryngoscopy.

During a 2-year period, 192 indirect surgeries on the laryngopharynx were performed in an outpatient videoendoscopy laboratory under topical anesthesia with or without intravenous sedation. These procedures included cancer staging and biopsy; vocal fold injections of Teflon, Gelfoam, botulinum toxin, or steroids; glottic web lysis; and granuloma removal. The techniques used to perform these procedures are elucidated. Careful chart review of these patients shows that indirect surgery was performed successfully in 96% of cases. Intravenous conscious sedation was utilized in 39% of patients. No significant complications were encountered. By avoiding the need for an operating room, hospitalization, or general anesthesia, this technique was clearly as safe or safer, more convenient for surgeon and patient, and more cost-effective than the same procedure would have been via the traditional direct laryngoscopy. As the authors have already done in their practices, the indirect method should therefore be reinstated as the preferred approach to the clinical circumstances described here.

Adult↗
PubMed1997

Intraotic administration of gentamicin: a new method to study ototoxicity in the crista ampullaris of the bullfrog.

A new method of local gentamicin administration was tested in the bullfrog inner ear to achieve ototoxic-induced hair cell destruction. Gelfoam pledgets soaked with known amounts of gentamicin were inserted into the perilymphatic cisterna of the bullfrog through a ventral surgical approach. A dose of 1.20 mg gentamicin, consistent with a perilymphatic concentration of 65 microg/ml, resulted in the desired ototoxic-induced hair cell damage, that is, complete hair cell destruction with minimal disruption of other components of the sensory epithelium. This study demonstrates that this is a useful and simple method to investigate the process of vestibular ototoxicity and hair cell regeneration, including aspects of hair cell destruction and repair.

Administration, Topical↗
PubMed1998

Viscosities of implantable biomaterials in vocal fold augmentation surgery.

Vocal fold vibration depends critically on the viscoelasticity of vocal fold tissues. For instance, phonation threshold pressure, a measure of the "ease" of phonation, has been shown to be directly related to the viscosity of the vibrating mucosa. Various implantable biomaterials have been used in vocal fold augmentation surgery, with implantation sites sometimes close to or inside the mucosa. Yet their viscosities or other mechanical properties are seldom known. This study attempts to provide data on viscosities of commonly used phonosurgical biomaterials. Using a parallel-plate rotational rheometer, oscillatory shear experiments were performed on implantable polytetrafluoroethylene (Teflon or Polytef; Mentor Inc., Hingham, MA), collagen (Zyderm; Collagen Corp., Palo Alto, CA), glutaraldehyde crosslinked (GAX) collagen (Phonagel or Zyplast; Collagen Corp.), absorbable gelatin (Gelfoam; Upjohn Co., Kalamazoo, MI), and human abdominal subcutaneous fat. Samples of human vocal fold mucosal tissues were also tested. Under sinusoidal oscillatory shear at 10 Hz and at 37 degrees C, the dynamic viscosity was 116 Pascal-seconds (Pa-s) for polytetrafluoroethylene, 21 Pa-s for gelatin, 8-13 Pa-s for the two types of collagen, 3 Pa-s for fat, and 1 to 3 Pa-s for vocal fold mucosa. Results extrapolated to 100 Hz also show similar differences among the biomaterials, but all values are an order of magnitude lower because of the typical inverse frequency relation (shear thinning effect) for polymeric and biologic materials. The data suggest that the use of fat for vocal fold augmentation may be more conducive to the "ease" of phonation because of its relatively low viscosity, which is closest to physiologic levels. This implication is probably the most relevant in predicting initial outcome of the postoperative voice before there is any significant assimilation (e.g., resorption and fibrosis) of the implanted biomaterial.

Abdomen↗
PubMed1999

Glutamate-like immunoreactivity during hair cell recovery after gentamicin exposure in the chinchilla vestibular sensory periphery.

OBJECTIVE: Determine the expression of glutamate by immunohistochemistry in normal and recovering vestibular hair cells in the chinchilla crista ampullaris after gentamicin ototoxicity. STUDY DESIGN: In five groups of three animals each, ototoxicity was produced by placing gentamicin (50 microg)-impregnated Gelfoam pellets within the perilymphatic space of the superior semicircular canal. Animals were sacrificed at 1, 2, 4, 8, and 16 weeks after treatment. A group of normal (n=3) animals was also processed. METHODS: For the detection of glutamate the inner ears of these animals were dissected, and the horizontal cristae ampullaris embedded in plastic. Two-micron-thick tissue sections were obtained and incubated with monoclonal antibodies against glutamate. The immunoreaction was detected using the avidinbiotinylated-complex technique and diaminobenzidine was the chromogen. RESULTS: Normal sensory epithelia demonstrated type I and type II hair cells with moderate glutamate-like immunoreactivity. Supporting cells demonstrated no glutamate-like immunoreactivity. Afferent nerve fibers and calyxes surrounding type I hair cells demonstrated strong glutamate-like immunoreactivity. At 1 and 2 weeks after treatment the few type II hair cells surviving ototoxic treatment (15%-18%) contained moderate glutamate-like immunoreactivity, supporting cells showed no immunoreactivity, and nerve terminals and fibers displayed strong immunoreactivity. At 4 and 8 weeks after treatment, recovered hair cells (80%) had greater glutamate-like immunoreactivity when compared with normal hair cells, supporting cells displayed no glutamate-like immunoreactivity, and afferent fibers contained strong glutamate-like immunoreactivity. At 16 weeks, glutamate-like immunoreactivity in hair cells returned to normal level. CONCLUSION: Glutamate may be used as an indicator of hair cell differentiation and as an index of the molecular recovery of hair cells after ototoxicity.

Animals↗
PubMed2000

Vocal fold paralysis after anterior cervical diskectomy and fusion.

OBJECTIVE: The anterior approach to the cervical spine now serves as the surgical access of choice for cervical spine disease. Vocal fold paralysis (VFP) may follow the procedure as a complication. The authors describe their experience with patients having VFP after anterior cervical diskectomy and fusion (ACDF), with an emphasis on outcome and prognosis. STUDY DESIGN: Retrospective. METHODS: Medical records of patients who underwent ACDF between January 1987 and February 1998 were reviewed. Further detailed review of the patients with documented VFP after surgery was then performed. RESULTS: Over the given time period 411 ACDFs were performed and 21 patients with this complication were identified (5%). All 21 patients had right-sided approaches. Eighteen patients had right VFP, 2 had left VFP, and 1 had bilateral VFP. Symptoms included hoarseness (18), persistent cough (7), aspiration (13), and dysphagia (7). The patient with bilateral VFP presented with stridor and respiratory distress requiring tracheotomy. The complete records of 17 patients with 18 VFPs were available for review. Fifteen of 18 VFPs (83.3%) had complete resolution within 12 months. One patient had recovery after 15 months. All patients were treated conservatively with speech and swallowing therapy. One patient required Gelfoam injection and another medialization thyroplasty, both for aspiration symptoms. CONCLUSIONS: The data suggest that at least 80% of VFP after ACDF will recover within 12 months of the procedure. The authors recommend regular follow-up and speech therapy for symptomatic patients. Medialization should be considered in patients with aspiration or persistent problems.

Adolescent↗
PubMed2000

Role of topical steroids in reducing dysfunction after nerve injury.

OBJECTIVE: To determine the efficacy of topical dexamethasone in reducing nerve dysfunction after axonotmesis injury. STUDY DESIGN: A three-armed, blinded study including sham, control, and test groups was designed using the rat sciatic nerve crush injury model. METHODS: Twenty-two rats were randomly assigned to a control group or a topical steroid group. A standardized sciatic nerve crush injury was performed under sterile conditions on each animal. A separate group of five rats underwent a sham operation to isolate the crush injury as the source of postoperative dysfunction in the control and steroid groups. All animals underwent walking track analysis with calculation of the sciatic functional index (SFI) before surgery and through the postoperative recovery period. Dexamethasone saturated Gelfoam was placed at the site of injury in the topical steroid group. The functional performance of each group was compared throughout the recovery period. RESULTS: No morbidity associated with topical application of steroids at the injury site was noted. The topical steroid group had improved recovery at postoperative days 14, 18, and 22. This difference was statistically significant at day 14. At the termination of the study, there was a clear trend toward superior recovery for the steroid group compared with controls (90% vs. 73%), but this difference did not reach statistical significance. CONCLUSIONS: Clinical use of topical steroids to reduce postoperative nerve dysfunction warrants further study.

Administration, Topical↗
PubMed2002

The fate of mastoid obliteration tissue: a histopathological study.

OBJECTIVES: To demonstrate the histopathological fate of tissues used for mastoid obliteration over a period of 30 years. STUDY DESIGN: Retrospective histopathological analysis of archival temporal bone microscopic sections. METHODS: From the database of the laboratory, the 17 temporal bones from subjects who had undergone mastoid obliteration procedures were identified. The microscopic appearance of the obliteration tissue was described, and microphotographs made of significant findings. RESULTS: Fat and bone chips, or paté, retained their bulk in the obliterated space, whereas subcutaneous tissue and muscle lost bulk but seemed to promote healing. Some substances, such as bone wax, used for hemostasis and buried under obliteration tissue, were found to produce a subclinical inflammatory reaction, but other materials, such as Surgicel and Gelfoam, did not. CONCLUSIONS: Fat and bone chips, or paté, used as mastoid obliteration tissue, retained their bulk and identity, whereas subcutaneous tissue and muscle did not.

Adipose Tissue↗
PubMed2002

Hearing results with a hydroxylapatite/titanium bell partial ossicular replacement prosthesis.

OBJECTIVES/HYPOTHESIS: To study the preliminary hearing results in patients receiving a hybrid hydroxylapatite/titanium bell partial ossicular replacement prosthesis (PORP) and compare these with a cohort of patients receiving a HAPEX PORP. We hypothesized that the design of the hybrid PORP would enhance its acoustic properties. In particular, the titanium bell, which allows the prosthesis to be freestanding, would obviate the need for Gelfoam, preventing fibrosis. STUDY DESIGN: A retrospective study was made of two cohorts of patients. METHODS: A computerized otologic database was used to identify all patients implanted with either PORP. The four-frequency (500, 1000, 2000, and 3000 Hz) pure-tone average air-bone gap (PTA-ABG) and ABG values for individual frequencies were compared using the Student test. RESULTS: The PTA-ABG for the titanium bell prosthesis was 9.8 +/- 5.7 dB, compared with 13.2 +/- 8.3 dB for the HAPEX PORP, which was statistically significant ( P<.05). The average ABG values at 500 and 1000 Hz were also statistically significantly improved with the titanium bell PORP ( P<.05). CONCLUSIONS: The titanium bell PORP showed improved postoperative results for the PTA-ABG and at 500 Hz and 1000 Hz. The prosthesis is freestanding and may provide better coupling with the capitulum, factors which may lead to improved hearing results in the lower frequencies.

Adolescent↗
PubMed2003

Candidate's thesis: Platelet-activating factor-induced hearing loss: mediated by nitric oxide?

OBJECTIVES/HYPOTHESIS: Platelet-activating factor (PAF)in middle ear effusion is thought to induce hearing loss. The purpose of this study is to investigate the role of nitric oxide (NO) in the mechanism of PAF-induced hearing loss by studying the effects of PAF application on the round window membrane (RWM) with and without PAF-antagonist NO-blocker. STUDY DESIGN: Longitudinal study on randomized guinea pigs using PAF to induce hearing loss. METHODS Guinea pigs were divided into four groups: PBS, PAF, PAF-antagonist, and L-NAME. The PBS group received phosphate buffered saline (PBS) and the PAF groups received 10, 20, and 40 microg of PAF soaked into gelfoam and placed on the RWM. PAF-antagonist (WEB 2170) and NOS inhibitor NG-nitro-l-arginine-methylester (L-NAME) were injected intraperitoneally prior to PAF 20 microg application on the RWM. The following three tests were performed on each animal group: Hearing was tested with an auditory brainstem response (ABR) test over 24 hours. At the end of 24 hours, cochlear hair cells were examined by scanning electron microscopy (SEM) and immunohistochemistry was carried out on the cochlea to test the expression of inducible nitric oxide synthase (iNOS). RESULTS: The PAF group developed significant elevation of ABR threshold and cochlear hair cell damage in the SEM group as compared with the PBS control group. The PAF-antagonist (WEB 2170) and the L-NAME groups did not show significant elevation of ABR threshold and cochlear hair cell damage compared with the group administered PAF 20 microg, but in the PAF-antagonist group, the elevation of ABR threshold was significant compared with that of the PBS control group, whereas it was not significant compared with the PBS group in the L-NAME group. Strong expression of iNOS on cochlea was observed in the PAF group and lighter expression was seen in PBS, WEB 2170, and L-NAME groups. CONCLUSIONS: This study demonstrated that PAF placed on the RWM induced hearing loss and cochlear hair cell damage. The PAF-antagonists and L-NAME prevented the PAF-induced hearing loss and inhibited iNOS expression in the cochlea. These findings suggest that the PAF-induced hearing loss caused by cochlear hair cell damage may have been mediated by NO. PAF-antagonists and L-NAME may have future therapeutic implications in preventing sensorineural hearing loss associated with chronic otitis media. The results of this study have significant potential clinical application.

Animals↗
PubMed2004

Dimensional stability of the free fascia grafts: a human study.

OBJECTIVES/HYPOTHESIS: In animals it has been shown that autologous free fascia grafts (fascia lata and temporal fascia) change dimensions during the vital first 5 days of healing. Poor dimensional stability of these grafts can be an important reason for failure of complete closure of tympanic membrane perforations in tympanoplasty operations, particularly in large perforations. Dimensional stability of these fascias has been studied in humans. STUDY DESIGN: Prospectively, 11 patients were studied. METHODS: Patients who were subjected to open mastoid cavity surgery were included in the study. The mastoid cavity was exteriorized, and the fascia graft was used to seal the perforation and cover a part of the bare mastoid bone in the routine way. At this stage, equally cut pieces of temporal fascia and fascia lata were laid on the remaining part of the bare mastoid bone. The mastoid cavity was then packed with Gelfoam and wound sutured. The pieces of graft material under study were removed after 5 days, leaving the graft used to seal the tympanic membrane perforation undisturbed. The harvested grafts were measured for their dimensional variations, if any. RESULTS: It was observed that free autologous temporal fascia grafts exhibited poor dimensional stability as compared with free autologous fascia lata grafts. CONCLUSION: Poor dimensional stability of free temporal fascia grafts as seen in animals was confirmed in the present human study. This poor dimensional stability of temporal fascia grafts might be contributing to failure of closure of tympanic membrane perforations in tympanoplasty.

Cholesteatoma↗
PubMed2004

Effect of edaravone on streptomycin-induced vestibulotoxicity in the Guinea pig.

OBJECTIVES/HYPOTHESIS: The effect of topical administration of edaravone to the inner ear was investigated in guinea pigs with streptomycin-induced vestibulotoxicity. METHODS: Vestibulotoxicity was induced in 20 animals by delivery of streptomycin into the inner ear through osmotic pump for 24 hours. Edaravone (n = 8, systemic administration group) or saline (n = 6, control group) was injected intraperitoneally once a day for 7 days or edaravone-soaked Gelfoam was placed on the round window before wound closure (n = 6, topical administration group). RESULTS: Yaw head tilt and spontaneous nystagmus were observed in all animals after the operation. The number of spontaneous nystagmus beats in the topical administration group was statistically less than that in other two groups at 12, 18, and 24 hours after the operation. CONCLUSION: The study results suggest that topical administration of edaravone better suppresses streptomycin-induced vestibulotoxicity than systemic administration.

Administration, Topical↗