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PubMedDate not supplied

Transcatheter intraarterial management of gynecologic tumors.

Intraarterial therapy was performed in 17 women with various gynecologic tumors in order to facilitate surgery (13 patients) and for palliation (4 patients). In the nonsurgery group intraarterial chemotherapy was supplemented by occlusion in 2 patients. In the surgery group 5 women received intraarterial chemotherapy before the occlusion procedure. In the palliation group the result was poor, but 9 of 13 patients in the surgery group had radical surgery. They had all previously been found to be nonresectable at laparotomy (11 patients) or clinically (2 patients). No severe complications of using the intraarterial technique were encountered, though such are frequently reported.

Adult↗
PubMedDate not supplied

Occurrence of an intrahepatic porto-arterial shunt after hepatic artery embolization with Gelfoam powder in rats and rabbits.

Postmortem perfusion studies were carried out following hepatic artery embolization (HAE) with Gelfoam powder in rats (n = 17) and rabbits (n = 10). The inflow of barium particles into the hepatic arteries after portal vein injection (porto-arterial shunt: P-A shunt) was analyzed by stereomicroscopic and histologic examinations. A P-A shunt was observed in 12 of 17 rats (71%) following HAE (embolization group). The difference in occurrence rates of P-A shunt between control (1/12 = 9.2%) and embolization groups was statistically significant (chi 2, p less than 0.01) in rats. In rabbits, a P-A shunt was seen in only one of 10 animals in the embolization group. P-A shunting may have an important role in reconstructing the blood supply to hepatic tumors after HAE, and administration of anticancer drugs via the portal vein following HAE might be effective. However, the differences among different species of animals should be considered before clinical application.

Animals↗
PubMedDate not supplied

Liver damage after transarterial chemoembolization without embolizing agent in unresectable hepatocellular carcinoma.

AIM AND BACKGROUND: Transarterial chemoembolization represents a therapy for hepatocellular carcinoma, but in cirrhotic patients affected by large or multifocal HCC with poor hepatic functional reserve, the procedure can damage normal parenchyma. We analyzed the effects on hepatic function of a modified chemoembolization consisting of ethiodized oil (Lipiodol Ultra Fluid) and epirubicin without gelatine sponge (C-LIP). METHODS: Of 90 patients with hepatocellular carcinoma observed from January 1995 to December 1999, 16 with a diagnosis of advanced (large or multifocal) disease underwent 19 C-LIP. The 30th post-C-LIP day was considered as a checkpoint of the biochemical parameters for a possible hepatic failure. The value of alpha-fetoprotein and the clinical finding of ascites were also considered after 30 days. RESULTS: Postoperative values of serum aspartate aminotrasferases, as well as alanine aminotransferase, were significantly higher than preoperative values (P = 0.002 and P = 0.019, respectively) (Table 1). In all patients, there was a significant increase in postoperative total serum bilirubin (P = 0.003). Statistical analysis showed a significant finding of postoperative ascites (P = 0.035) and the effectiveness of C-LIP on neoplastic tissue by a decrease of alpha-fetoprotein values at 30 days (P = 0.067). CONCLUSIONS: Transcatether arterial chemoembolization could represent an effective therapy against multifocal or advanced hepatocellular carcinoma, and its effectiveness is probably not decreased by using a modified procedure without embolizing agent (C-LIP). However, even when performing such a safe procedure, the hepatic functional reserve of the individual patient needs to be accurately evaluated in order to avoid liver failure.

Adenocarcinoma↗
PubMedDate not supplied

Activity and tolerability of courses of intra-arterial chemotherapy followed by chemoembolization in unresectable hepatocellular carcinoma.

AIMS AND BACKGROUND: We previously reported encouraging response rates and survival with combined intra-arterial (i.a.) chemotherapy and chemoembolization in unresectable hepatocellular carcinoma. We therefore evaluated a new program combining three courses of i.a. chemotherapy with chemoembolization administered every 28 days. PATIENTS AND METHODS: The treatment regimen consisted of L-leucovorin (100 mg/m2 i.v.), fluorouracil (800 mg/m2 i.a.), and carboplatin (250 mg/m2 i.a.). Chemoembolization with mitoxantrone (10 mg/m2) plus ethiodized oil and gelatin sponge was performed immediately after. The same treatment was given every 28 days for 3 times. RESULTS: Twenty-eight patients entered the study and were assessable for response and side effects. There were 24 males and 4 females (median age, 68 yrs; range, 42-75). TNM stage was II-III in 20 and IVA in 8; 17 were Child's A and 11 Child's B. Baseline alpha-fetoprotein was elevated in 15, and there was cirrhosis in 23. Twelve patients had a partial response (43%; 95% confidence interval, 24-63%), 13 had stabilization, and 3 progressive disease. Median survival was 16.6 months (range, 2-24). Sixteen patients had grade I-II pain and 14 grade I-II fever. CONCLUSIONS: Our results indicate that the regimen is safe and well tolerated. Despite 43% objective remissions, our results do not seem better than those obtained with less intensive regimens.

Adult↗
PubMed1984

Ischemic necrosis of the scalp after preoperative embolization of meningeal tumors.

The authors report two patients who suffered ischemic necrosis of their scalps after preoperative therapeutic embolic occlusion of the external carotid artery and its terminal branches for highly vascular meningeal tumors. Local anesthesia, selective catheterization of the external carotid artery, and radiopaque polyvinyl alcohol and Gelfoam as embolic agents were used. The various complications of external carotid artery embolization are reviewed. The importance of preserving normal branches of the external carotid artery (especially the superficial temporal artery) during embolization and of careful design of the scalp flap to avoid ischemic necrosis is emphasized.

Adult↗
PubMed1986

Intraoperative chemical hemostasis in neurosurgery.

Of the various electrical, mechanical, and chemical methods used in neurosurgical hemostasis, the chemical methods are the least well understood. In this review, data concerning seven modern chemical hemostatic agents are presented and special emphasis is placed on their neurosurgical applications. Overall, the general lack of fundamental knowledge concerning these agents at both the scientific and the clinical level was revealed by a relatively small number of publications over the past 4 decades. Several conclusions have been formulated to assist the neurosurgeon in the proper selection and use of these chemical agents. It is our belief that the use of chemical hemostatics in neurosurgery should be based on a thorough knowledge of their mechanism of action and should be supported by continuing laboratory and clinical research.

Aminocaproic Acid↗
PubMed1987

Long term results of ruptured aneurysms treated by coating.

We report the long term results of the treatment of 23 intracranial ruptured aneurysms by coating. Twenty-three patients treated by coating were followed for a mean period of 11.2 years. The mean interval between the last hemorrhage and the operation was 22.4 days. Ten aneurysms underwent total coating, 9 with Biobond and 1 with Aron Alpha. Thirteen aneurysms underwent partial coating, 11 with Biobond and 2 with Aron Alpha. Six aneurysms were reinforced partially by other materials, but no aneurysm was wrapped totally with these materials. Rebleeding occurred in 6 patients, of whom 5 died. The mean interval between coating and rebleeding was 4 years. All patients suffering rebleeding had been treated with Biobond, and 3 patients had undergone total coating of aneurysms. The risk of recurrent hemorrhage after total coating with Biobond was 33%. One rebleeding patient underwent a second operation 10.5 years after total coating of the aneurysm. Biobond was found only at the tip of the aneurysmal sac. From these results, reinforcement of ruptured aneurysms with Biobond seems to be of little value, and a more reliable method must be developed for aneurysms that cannot be clipped.

Adult↗
PubMed1993

Cerebrovascular histopathology after intracarotid infusion of Gelfoam in the rat.

To evaluate the histopathology of Gelfoam on the cerebral vasculature, 42 Sprague-Dawley rats weighing 250 to 300 g received internal carotid artery infusions of 0.3 ml of Gelfoam solution (5 mg/ml) or normal saline (0.9%). The animals were killed at 1 hour, 5 hours, 3 days, 1 week, 2 weeks, and 4 weeks after the infusion. The brains were removed, sectioned, and stained with hematoxylin and eosin. Examination of brain sections revealed Gelfoam emboli lodged primarily in the small leptomeningeal arteries. At 5 hours after infusion, inflammatory cells were noted in the arterial walls with vessel occlusion. Further canalization of vessels was noted at 1 week. At 4 weeks, Gelfoam was not seen in the specimens. This study suggests that Gelfoam acts as an embolic agent in vessels over short periods of time with no residual inflammatory activity postinfusion.

Animals↗
PubMed2003

Local administration of glial cell line-derived neurotrophic factor improves behavioral and histological deficit of neonatal Erb's palsy in rats.

OBJECTIVE: We sought to evaluate from a behavioral and histological viewpoint the effect of local administration of glial cell line-derived neurotrophic factor (GDNF) on neonatal preganglionic Erb's palsy in rats. METHODS: The Erb's palsy model was produced by transecting the anterior and posterior roots of the left C5-C7 nerves of 7-day-old rats. The rats were divided into GDNF-treated (n = 10) and vehicle-treated groups (n = 11). After we transected the roots, contact in the proximal and distal stumps of the transected nerves was maintained, and the transected point and the entire intraspinal portion of the transected roots were enclosed by Gelfoam soaked with 10 micro g GDNF or saline. The behavioral evaluation consisted of a foot-fault test and a forepaw muscle strength test, all of which were performed from the third to the seventh weeks after the operation. Seven weeks after the operation, all rats were killed, the number of anterior horn cells was counted at C5-C7, and the differences on each side were compared. RESULTS: In the vehicle-treated group, the foot-fault test indicated an abnormality in forelimb function on the root transection side. In the GDNF-treated group, however, significant improvement in forelimb function was observed on the basis of the foot-fault test results obtained in the third to sixth weeks after the operation. In the histological evaluation, the number of anterior horn cells from the side in which the operation took place in the vehicle-treated group was significantly less than that taken from the contralateral side at each segment. In the GDNF-treated group, however, there was no difference in any of the segments, regardless of the side from which they were taken. CONCLUSION: Local administration of GDNF in a neonatal preganglionic Erb's palsy model resulted in significant improvement in deficits on the basis of behavioral and histological evaluations.

Administration, Topical↗
PubMed1996

Short communication: the value of embolization therapy in painful osseous metastases from hepatocellular carcinomas; comparative study with radiation therapy.

We evaluated the therapeutic effect of transcatheter arterial embolization therapy (TAE) for painful osseous metastases from hepatocellular carcinoma (HCC) in comparison with radiation therapy (RT). TAE using gelatin sponge particles was performed for seven lesions in seven patients. Selective catheterization and embolization were successfully performed in all lesions. Within 10 days after TAE, complete pain relief (CR), partial relief (PR) and no relief (NR) were attained in 57%, 29% and 14%, respectively. RT was used to treat 34 lesions in 22 patients. The dose fractionation schedules were in the range 28.0-50.4 Gy, with 1.8-4.0 Gy per fraction. CR, PR and NR were attained in 47%, 47% and 6%, respectively. There were no serious complications related to these treatments. Both TAE and RT are effective and the treatment of choice should be selected on an individual basis.

Bone Neoplasms↗
PubMed2000

Superselective embolisation for intractable idiopathic epistaxis.

37 patients with intractable idiopathic epistaxis were treated with superselective embolisation between 1995 and 1999. A total of 40 embolisations was performed, including three procedures for recurrence. The embolic material was gelatin sponge in 27 procedures, microcoils in 9 and both gelatin sponge and microcoils in 4. Immediate cessation of nasal bleeding was obtained in all patients after embolisation. Recurrent epistaxis occurred in 2 (5.4%) of the 37 patients within 7 days after initial embolisation, giving a short-term success rate of 94.6%. The long-term follow-up ranged from 1-51 months (mean 21.6 months). Late re-bleeding occurred in two patients, giving a long-term success rate of 94.6%. Two patients underwent re-embolisation; it was necessary to embolise the ipsilateral facial artery and/or the contralateral internal maxillary as well as the ipsilateral maxillary artery. Although the overall complication rate was 45.0%, no major complications occurred. Superselective embolisation with gelatin sponge is an effective and safe treatment technique for intractable idiopathic epistaxis.

Adult↗
PubMed2006

Three-dimensional conformal radiotherapy for the treatment of arteriovenous shunting in patients with hepatocellular carcinoma.

The objective of this study is to evaluate the efficacy of radiotherapy for the treatment of arteriovenous shunting (AVS) in patients with hepatocellular carcinoma (HCC). Between November 1997 and April 2005, 20 HCC patients with AVS were referred to our department for radiotherapy. The radiation was delivered with 10-15 MV X-ray given 5 days per week at 2 approximately 2.5 Gy per fraction. Total doses ranged from 45 to 64 Gy (median dose 60 Gy). The patients were followed up with color Doppler sonography. When non-invasive imaging suggested obliteration, X-ray angiography was performed to verify the results. Four of the 20 AVS proved to be completely obliterated at X-ray angiography in 1.9, 2.8, 1.8 and 2.9 months after radiotherapy. One of the remaining 16 showed obvious regression on Doppler sonography 0.5 months after radiotherapy, but X-ray angiography was not performed to verify the result. Radiation-related hepatic failure did not occur during the follow-up period. In conclusion, radiotherapy is a treatment alternative for AVS in HCC patients and gives patients with poor prognosis the chance to receive further transcatheter arterial embolization.

Adult↗