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PubMedDate not supplied

Ablation of tumor and inflammatory tissue with absolute ethanol.

Absolute ethanol was used to ablate tumors, inflammatory lesions, and end-stage nephrosclerotic kidneys in 38 patients. Thirty patients had various types of renal tumors, and 3 had chronic end-stage renal failure with malignant hypertension. One patient had a fibrosarcoma of the right leg and one had a metastasis in the humerus from a renal carcinoma. A large adrenal carcinoma was treated with absolute ethanol in a patient who had liver metastases that were ablated one year after the first procedure. An additional patient had metastatic liver disease from a non-functioning adrenal carcinoma. The remaining patient had an extensive hypervascular inflammatory lesion (tuberculosis and aspergilloma) of the right upper pulmonary lobe. In addition to ethanol, coils were introduced in one patient and Gelfoam in another. The amount of ethanol used ranged from 5 to 50 ml. Twenty-two patients suffered from considerable transient pain during ethanol injection, but sedation was necessary in only 3 of them. Skin necrosis appeared in 2 patients requiring plastic reconstruction in one of them. Two patients died within 5 days of the procedure unrelated to the ablation. Two patients presented upper gastrointestinal bleeding within 2 days of the ethanol injection and one of these died in acute renal failure. One patient suffered from left colonic infarction after left renal tumor ablation, but survived for several months. Absolute ethanol was a useful and efficient sclerosing agent causing extensive tumor destruction and marked reduction of the vascularity in tumor and inflammatory lesions, but caused an 18 per cent complication rate.

Adrenal Gland Neoplasms↗
PubMed1996

Regional Transcatheter Therapy of Hepatic Neoplasms.

BACKGROUND: Surgical resection of hepatocellular carcinomas and metastases to the liver cannot always be performed, and systemic therapies for these entities are of limited value. The techniques of chemoembolization and hepatic artery infusion have been used for patients who are not candidates for surgery. METHODS: Chemoembolization uses percutaneous intra-arterial infusion of chemotherapeutic agents and embolic material. This provides longer contact of the agents with the tumor cells and induces ischemia. Hepatic arterial chemoinfusion uses the knowledge that hepatic cancers are supplied predominantly by the hepatic artery. RESULTS: Chemoembolization using Lipiodol, doxorubicin, and Gelfoam has promoted necrosis of unresectable hepatocellular tumors and may have prolonged patient survival. Hepatic arterial infusion with fluorinated pyrimidines produces more objective responses than systemic chemotherapy but probably does not alter survival. CONCLUSIONS: The nonsurgical treatments of chemoembolization and hepatic arterial infusion of chemotherapy have expanded our armamentarium to manage many primary and metastatic tumors in the liver. Additional approaches are needed.

Journal Article↗
PubMed2004

Intra-arterial hepatic chemoembolization in liver metastases from neuroendocrine tumors: a phase II study.

Neuroendocrine tumors, particularly those of gastrointestinal tract origin, have a predisposition for metastasizing to the liver, causing parenchymal substitution and paraneoplastic syndrome. Lipiodol embolization combined with anticancer drugs is a recent tool in regional therapy. It has been proven that chemoembolization reduces tumor bulk and hormone levels, and that it palliates the symptoms of many patients with liver-dominant neuroendocrine metastases. Beginning in December 1988, ten patients with unresectable and chemotherapy-refractory liver metastatic neuroendocrine tumors were treated with chemoembolization based on a mixture of lipiodol, mitomycin, cisplatin, epirubicin, followed by gelfoam powder and contrast media. Toxicity encountered included: upper right quadrant pain requiring narcotics, elevation of lactate dehydrogenase, alkaline phosphatase, and transaminases. One patient had liver abscess and persistent fever for 2 weeks. We obtained two complete remissions lasting 12 and 34 months and 5 partial remissions. The median survival was 22 months. Four patients had urinary elevation of 5-hydroxyindolacetic acid (5-HIAA). They showed more than a 75% decrease in urinary secretion after treatment. In a patient with transplanted liver we noticed a partial response lasting 7 months. We conclude that chemoembolization will improve the clinical condition of a significant percentage of patients with liver metastases, that future therapy of carcinoid tumors will be based on specific tumor biology and that treatment will be customized for each individual patient combining the use of cytoreductive procedures including radiofrequency ablation, laser treatment and chemoembolization.

Adult↗
PubMed2002

Transjugular renal biopsy in high-risk patients: an American case series.

BACKGROUND: In the United States, transjugular renal biopsies using the Quickcore side cut needle system have previously been described primarily for transjugular renal biopsy in patients with concurrent liver and kidney disease. METHODS: We describe transjugular renal biopsy with the Quickcore trade mark system in 9 patients with nephrotic syndrome and contraindications to percutaneous renal biopsy, who underwent biopsy between 23 October 1996 and 12 April 2001. The most common contraindication was oral anticoagulation with coumadin (40%). Other contraindications included horseshoe kidney, severe renal failure, and spontaneous coagulopathy. A 62 cm straight catheter and 60 cm side-cut Quickcore biopsy needle were used to obtain cortical tissue. Packing of the biopsy tract with Gelfoam was used for venographically identified capsular perforation. RESULTS: Ten procedures were performed on 9 patients with one requiring re-biopsy (5% of all renal biopsies performed at our institution). There were 9 transjugular renal biopsy and one combined liver-kidney biopsy. A mean of 4 +/- 2 passes were made, with a mean of 3 +/- 1 cores obtained per procedure. Histologic diagnosis was made in 90% of biopsies and in 100% of patients. Two patients developed transient hydronephrosis associated with gross hematuria; both required transfusion. Capsular perforation occurred in 90%. One patient died of bacterial sepsis, unrelated to the biopsy, several days after the procedure. CONCLUSIONS: Transjugular renal biopsy appears to be efficacious in high-risk patients, for whom the percutaneous approach is contraindicated, including patients on oral anticoagulation. The transfusion rate in the present study was similar to other American reports using this technique.

Adult↗
PubMed2006

Differential expression of type X collagen in a mechanically active 3-D chondrocyte culture system: a quantitative study.

OBJECTIVE: Mechanical loading of cartilage influences chondrocyte metabolism and gene expression. The gene encoding type X collagen is expressed specifically by hypertrophic chondrocytes and up regulated during osteoarthritis. In this study we tested the hypothesis that the mechanical microenvironment resulting from higher levels of local strain in a three dimensional cell culture construct would lead to an increase in the expression of type X collagen mRNA by chondrocytes in those areas. METHODS: Hypertrophic chondrocytes were isolated from embryonic chick sterna and seeded onto rectangular Gelfoam sponges. Seeded sponges were subjected to various levels of cyclic uniaxial tensile strains at 1 Hz with the computer-controlled Bio-Stretch system. Strain distribution across the sponge was quantified by digital image analysis. After mechanical loading, sponges were cut and the end and center regions were separated according to construct strain distribution. Total RNA was extracted from the cells harvested from these regions, and real-time quantitative RT-PCR was performed to quantify mRNA levels for type X collagen and a housing-keeping gene 18S RNA. RESULTS: Chondrocytes distributed in high (9%) local strain areas produced more than two times type X collagen mRNA compared to the those under no load conditions, while chondrocytes located in low (2.5%) local strain areas had no appreciable difference in type X collagen mRNA production in comparison to non-loaded samples. Increasing local strains above 2.5%, either in the center or end regions of the sponge, resulted in increased expression of Col X mRNA by chondrocytes in that region. CONCLUSION: These findings suggest that the threshold of chondrocyte sensitivity to inducing type X collagen mRNA production is more than 2.5% local strain, and that increased local strains above the threshold results in an increase of Col X mRNA expression. Such quantitative analysis has important implications for our understanding of mechanosensitivity of cartilage and mechanical regulation of chondrocyte gene expression.

Journal Article↗
PubMed1995

Transplantation of the fetal olfactory placode restores reproductive cycles in female rhesus monkeys (Mucaca mulatta) bearing lesions in the medial basal hypothalamus.

The purpose of this study was to determine whether loss of the reproductive cycle after lesions of the medial basal hypothalamus can be reversed by transplantation of the embryonic olfactory placode (OP) into female rhesus monkeys. Seven adult female rhesus monkeys with regular menstrual cycles received bilateral radiofrequency lesions in the arcuate nucleus and the median eminence. After confirmation of anovulation in these monkeys, four monkeys were stereotaxically implanted with the OP obtained from monkey fetuses on embryonic days 35-36. The remaining three monkeys were similarly implanted with embryonic cerebellum (CB) as a control. Fetuses were delivered by cesarean section, and the OP and CB were immediately dissected out using a stereomicroscope. Fetal tissue was then cut into small pieces (< 1 mm3), mixed with artificial cerebrospinal fluid containing small pieces of Gelfoam, and stereotaxically injected into the infundibular recess of the third ventricle. The recovery of ovulatory cycles in recipient monkeys was observed for at least 6 months; sex skin color changes and menstrual records were obtained daily, and serum samples for LH, estrogen, and progesterone were obtained twice a week. Three of four OP-transplanted monkeys resumed their ovulatory cycles within 2 months, whereas the fourth monkey, an elderly female, failed to recover her cycle. In contrast, none of the three CB-transplanted monkeys resumed ovulatory cycles. Histological examination indicated that 1) lesion scars were present in the median eminence-stalk region as well as the medial basal portion of the arcuate nucleus of all seven brains; and 2) cartilage was present in the third ventricles of the OP-implanted brains. Moreover, immunocytochemical staining revealed that in all OP monkeys, small, round, and immature LHRH-positive cells with fine short processes were found in the third ventricle and/or median eminence-stalk region, whereas no similar LHRH cells were found in CB-transplanted monkeys. It is concluded, therefore, that implantation of LHRH neurons derived from the fetal OP can result in resumption of the ovulatory cycle in female monkeys whose own LHRH pulse-generating mechanisms were impaired. Moreover, the results suggest that LHRH neurons derived from embryonic OP possess the physiological functions necessary for the stimulation of gonadotropin secretion.

Animals↗
PubMed1983

Posterior dural arteriovenous malformations in infancy.

A 23-month-old infant with an extensive dural arteriovenous malformation (AVM) developed a heart murmur and cardiomegaly. The AVM involved the occipital and suboccipital dura mater and the tentorium, bilaterally. We embolized the AVM with Gelfoam and polyvinyl alcohol particulates, subtotally resected it, and embolized residual vessels with isobutyl cyanoacrylate. In spite of this extensive therapy, the malformation was not totally eradicated and an occipital pial AVM developed. This infant and the eight infants with posterior dural AVMs reported previously emphasize the difficulty of eradicating these lesions in infancy. We contrast the clinical features and therapy of infants and adults with posterior dural AVMs. Infants develop heart failure and cranial bruits because of arteriovenous shunts, whereas adults complain of headache and intracranial bruits. Infants need therapy to prevent progressive heart failure, intracranial hypertension, and perhaps cerebral ischemia. Ligation of arterial tributaries is inadequate therapy for these lesions. Embolization and resection of the malformation, when feasible, offers the best chance of curing posterior dural AVMs with extensive arterial tributaries.

Dura Mater↗
PubMed1983

Preoperative embolization of intracranial meningiomas.

The operative and histopathological findings in 31 cases of intracranial meningioma after preoperative embolization with Gelfoam and/or lyophilized dura mater are reported. Removal of the tumor after embolization was facilitated in those meningiomas fed exclusively or mainly by branches of the external carotid artery (29 of 31). Large areas of tumor necrosis were never seen on histopathological examination, even when suggested by large regions of decreased density on the postembolization computed tomographic scan. Preoperative embolization of the feeding vessels arising from the external carotid artery system has proven to be a useful adjunct before the resection of intracranial meningiomas.

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↗
PubMed1995

Lumbar discectomy: use of an epidural morphine sponge for postoperative pain control.

A technique for extended ambulatory epidural pain control after lumbar discectomy is described; preliminary results with 45 patients are reported; and alternative methods of narcotic analgesia are reviewed. In this technique, an absorbable gelatin sponge (Gelfoam, Upjohn Co., Kalamazoo, MI) is contoured to the laminotomy defect, placed in methylprednisolone acetate (40-80 mg), and then injected with 2 to 4 mg of preservative-free morphine (a small needle was used to fill the sponge). The sponge is placed over the defect before closure. A review of office and hospital records was conducted. The series consisted of 33 men and 12 women (mean age, 39 yr; range, 24-57 yr); records showed narcotic use in 34 patients (parenteral in 3) and work-related injuries in 14 patients. Thirty-three patients were ambulatory postoperatively on the day of surgery; all were ambulatory by postoperative day (POD) 1. On the day of surgery, 18 patients did not require any postoperative analgesics; on POD 1, 22 patients did not require analgesics. Six patients received parenteral narcotics; four received one dose only, and two had two or more doses. Thirty-one patients were discharged from the hospital on POD 1, and 10 were discharged POD 2. The other patients were discharged from the hospital on POD 3 (three patients) or POD 4 (one patient). When they were discharged, all patients received a limited supply of acetaminophen with codeine for pain control at home. After discharge, phone follow-up (at 1 week) and office follow-ups (at 3-5 weeks) revealed only one patient with more than mild discomfort. Three patients required one-time bladder catheterization, and one patient had presumed discitis 1 month postoperatively. In a control group who had undergone surgery 3 months previously, the average day of discharge had been POD 3.07; no control patient had been discharged on POD 1, and only 20% had been discharged on POD 2. This method provides effective, safe, and extended analgesia after lumbar discectomy.

Adult↗
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↗
PubMed2006

Electrosurgery and bipolar technology.

A major concern in surgery is the prevention or control of bleeding. The ligature and the clip are the hallmarks of the last century of modern surgery. Therapeutic embolization is not really used to stop hemorrhage but to treat aneurysms and so prevent future rupture and bleeding. Blood clotting within the network of coils of the now widely used Guglielmi detachable coils is now progressively becoming the method of choice whenever possible in aneurysm treatment. Simple external compression at a pressure higher than the intravascular pressure can control bleeding, and if continued long enough, may cause clotting in the bleeding vessels. Unfortunately, there are few areas in the central nervous system where such pressure can be applied, although it is a considerable help in opening muscle layers where self-retaining retractors will be used. Low-pressure venous bleeding may be controlled by application of gelfoam, surgically, or a bit of crushed muscle supported temporarily by a wet cottonoid pledget without occlusion of the venous channel. Historically, hot actual cautery or boiling oil were used to achieve hemostasis by forming a large tissue coagulum, which usually prevented bleeding until the entire dead mass sloughed away.

Brain Diseases↗
PubMed2006

Surgical anatomy of dural defects in spontaneous spinal cerebrospinal fluid leaks.

OBJECTIVE: Spontaneous intracranial hypotension is typically caused by a spontaneous spinal cerebrospinal fluid (CSF) leak. The configuration of the related dural defects can be complex. We describe our experience with the surgical anatomy of these defects. METHODS: Thirteen consecutive patients with spontaneous spinal CSF leaks who underwent surgical exploration at Mayo Clinic between 1994 and 2003 were studied. All patients' records, imaging studies, detailed intraoperative findings, and outcomes were reviewed. RESULTS: There were four men and nine women with an average age of 40 years (range, 12-62 yr). Preoperative imaging studies revealed a single site of CSF leak in eight patients, two sites in three patients, and multiple sites in two patients. Intraoperatively, the exact site of leakage could not be found in four patients. Among the other nine patients, primary closure of a meningeal diverticulum was achieved in one patient. Significant regional attenuation of the dura prevented primary repair of the leak site in eight patients. Muscle, fibrin glue, and Gelfoam (Upjohn Co., Kalamazoo, MI) soaked in patient's own blood were commonly used to pack the epidural space in an attempt to seal the site of the leak. Ligation of two nonappendicular nerve roots allowed closure of the leak in one of these patients. Postoperatively, resolution of symptoms occurred in eight patients, significant improvement was noted in three patients, and only transient resolution in two. The mean duration of follow-up was 20.5 months. CONCLUSION: Surgery for closure of spontaneous spinal CSF leaks may not be straightforward. Even when extradural CSF leakage is discovered preoperatively by imaging studies, it may not always be possible to identify the exact site of the leakage intraoperatively. Furthermore, the anatomy of the dural defects may be complex and not amenable to primary closure. In such cases, the use of adjuvant techniques during surgical exploration may be effective.

Adolescent↗
PubMed2002

Effect of KTP laser on implants used in middle-ear surgery.

The present study is intended to explore the effects of the KTP laser on various types of implant, used in middle-ear surgery. A laboratory study was undertaken to evaluate the interaction between the KTP laser (KTP-532 Orion Laser, Laserscope, UK) and individual middle-ear implants. A variety of middle-ear implants were used: a silicone sheet, Teflon, hydroxylapatite, ionomeric cement, gold and titanium prostheses as well as gelfoam. Following exposure to the laser, these implants were studied by direct inspection using an operating microscope. The KTP laser induced no detectable alteration in any of the implants when they were clean and dry. However, in the presence of fresh blood, under the influence of the energy of the absorbed laser, the silicone burnt and melted and the Teflon piston was vaporized. Likewise, a few tiny holes appeared on the surface of the ionomeric implant and then the prosthesis deformed. The hydroxylapatite implant broke into two pieces. However, no detectable alteration could be observed on gold or titanium pistons, even in the presence of blood. The authors conclude, that in the presence of blood, interaction between the KTP laser and both silicone and hydroxylapatite implants needs to be avoided. Teflon prostheses can be cautiously vaporized. Gold and titanium prostheses were unaffected by laser even in the presence of blood.

Blood↗
PubMed1978

Transcatheter embolisation of bone tumour arteriovenous malformations.

Arteriovenous malformations complicating benign bone tumours may not be amenable to surgical treatment either because of their extensive size and likelihood of recurrence or because of their location. Transcatheter embolisation may then be used either as the definitive treatment or as a prelude to safe surgical intervention. Patients presenting with arteriovenous malformations in association with polyostotic fibrous dysplasia and vertebral haemangioma are presented who were treated by transcatheter embolisation, using Oxycel and Gelfoam. A haemodynamically significant shunt was obliterated in one patient and in the other an excellent clinical response was obtained facilitating subsequent surgical management.

Adult↗
PubMed1980

Percutaneous arterial embolization in the kidneys of dogs: a comparative study of eight different materials.

Forty-one dogs were subjected to percutaneous arterial embolization of branches of the renal artery or its main trunk with or without prior injury to the kidney, with eight different materials, i.e., homologous blood clot, muscle, fat, fascia, barium sulphate, plain catgut, gelfoam and polyvinyl alcohol (Ivalon). From the immediate observations made, as well as the haemodynamic, angiographic and histological studies over a period ranging from 24 h to several weeks, it was concluded that Ivalon was the best material for arterial embolization.

Animals↗
PubMed1986

Transcatheter embolisation of arterial aneurysms.

Eleven cases of bleeding aneurysms and pseudoaneurysms, with and without arterio-venous fistula, involving different vascular territories were treated by transcatheter embolisation and the results are reported. Gelfoam was used in two cases and steel coils in the remaining nine cases. Embolisation by the steel-coil technique proved to be very efficient. The experience in these 11 cases shows that it is usually not necessary to embolize the aneurysm cavity but simply to occlude the feeding proximal vessel, consequently sparing the weak aneurysmic wall the risk of rupture and allowing the aneurysms to clot as a result of reduced or occluded blood flow.

Adolescent↗
PubMed2006

Combined therapy of transcatheter arterial chemoembolisation and three-dimensional conformal radiotherapy for hepatocellular carcinoma.

To evaluate the toxicity and efficacy of combined therapy of three-dimensional conformal radiotherapy (3DCRT) and transcatheter arterial chemoembolisation (TACE) for hepatocellular carcinoma (HCC). 50 HCC patients treated by combined TACE and 3DCRT were selected from a patient database. Sequence of treatments was that TACE was performed first, followed by 3DCRT with an interval of about 4 weeks between. TACE was administered by 5-Fu 500-600 mg m(-2), cis-platinum 30-40 mg m(-2), epi-adriamycin 40-60 mg m(-2) mixed with iodized oil and Gelfoam embolisation. A median of two courses of TACE was given. 3DCRT was delivered by 4-6 coplanar or non-coplanar fields. The mean tumour dose was 43.0+/-6.3 Gy by conventional fractionation (2 Gy per fraction, five fractions a week), and mean dose to normal liver, 19.1+/-6.3 Gy. Acute hepatic toxicities were notable in five patients (10%) with Common Toxicity Criteria (CTC) grade 1 in two cases and grade 3 in three patients, but all recovered eventually. Two patients developed radiation-induced liver disease (RILD) and died soon after the onset of RILD. Four patients had Radiation Therapy Oncology Group (RTOG) grade 1 acute gastrointestinal complication and one patient had acute gastrointestinal bleeding. Five patients experienced RTOG Grade 1 leukopenia and Grade 2 in five cases. Nine patients achieved have partial response, and 37 patients were in stable disease. Four patients were observed to have progressive disease. The overall survival rates at 1 year, 2 years and 3 years were 60%, 38% and 28%, respectively, with a median survival period of 17 months. Irradiation dose, T-stage and hepatic cirrhosis were identified as independent predictors for overall survival by Cox proportional regression analysis. The 1 year, 2 years and 3 years local progression-free rates were 74%, 57% and 38%, and the 1 year, 2 years and 3 years distant metastasis rates were 15%, 21% and 40%, respectively. The combined modality of TACE and 3DCRT was tolerable for the majority of HCC patients, resulted in good outcome and warrants for further prospective trial.

Adult↗