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PubMed1999

[Arterial lipiodol chemoembolization of a left liver metastasis through the right internal thoracic artery].

The purpose of this article is to illustrate the efficacy of the chemoembolization in patients with hypervascular metastases and to describe the post-embolization change in vascularization pattern. Unusual collaterals may develop following embolization. A 59-year-old woman, followed for unresectable small bowel carcinoid tumor since 1991, underwent successful chemoembolization of several liver metastases. Only one liver lesion, located in segment IV, showed interval increase in size. This lesion was supplied by the right internal mammary artery. A branch of the right internal mammary artery was catheterized using a microcatheter and embolization was performed using doxorubicine-Lipiodol (Adriblastine, Lipiodol) and gelfoam (Spongel). No complications occurred after the procedure. The right internal mammary artery should be considered as a possible source of collateral arterial supply to the liver and should be evaluated in patients with local progression of disease.

Antibiotics, Antineoplastic↗
PubMed2000

Endovascular embolization of intractable epistaxis.

BACKGROUND: We undertook this study to define the role of angiography and endovascular embolization in the treatment of patients with intractable epistaxis. METHODS: A series of 19 patients with massive intractable epistaxis, all treated with endovascular embolization were reviewed. There were 15 males and four females ranging in age from 18 to 70 years, with a mean age of 38 years. The predisposing factors of intractable epistaxis were head and neck tumors (n = 11), idiopathic symptoms (n = 3), surgical complications (n = 2), arteriovenous malformation of the face (n = 1), thrombocytopenia (n = 1) and trauma (n = 1). Polyvinyl alcohol (PVA) particles and gelfoam plugs were used as embolic agents in 11 patients for devascularization; detachable balloons with N-butyl-2-cyanoacrylate (NBCA) were used in four patients for vascular occlusion; NBCA and/or coils were used in four patients in the carotid and subclavian arteries for obliteration of pseudoaneurysms. RESULTS: Complete cessation of epistaxis was achieved in all 19 patients immediately after embolization. Seven patients had also undergone surgical tumor removal at two to five days after embolization. Two patients experienced mild to moderate facial pain on the first day after the procedure, but the symptoms later subsided. No significant complication or recurrence was observed in 18 patients. One patient with advanced hypopharyngeal carcinoma died two weeks after embolization due to another episode of massive epistaxis. Clinical follow-up for these patients was 15 days to eight years, with a mean of 41 months. CONCLUSIONS: Therapeutic endovascular embolization of intractable epistaxis is both efficient and safe. It should be considered as the primary treatment modality in intractable epistaxis.

Adolescent↗
PubMed2000

Lipiodol enhanced CT scanning of malignant hepatic tumors.

From August 1984 to March 1991, 41 patients with malignant liver tumors, 30 males and 11 females, aged 30-75 years were treated at Ramathibodi Hospital with injection of mitomycin-C lipiodol emulsion into the tumor via the feeding artery followed by embolization of the feeding artery with gelfoam particles. The patients comprised 30 cases of hepatocellular carcinoma, 4 cases of cholangiocarcinoma and 7 cases of metastatic tumors of which one was from CA stomach, three were from CA breast, and three from CA colon. The vascularity of the tumor was assessed in angiogram obtained prior to treatment and retention pattern of lipiodol in the tumor was evaluated in lipiodol-enhanced CT scan images taken 2-4 weeks following therapy. The results showed that lipiodol CT scan images exhibited four patterns of lipiodol retention in the tumor appearing as opacity as follows (1) homogenous (2) heterogeneous (3) ring-like and (4) none. Lipiodol retention pattern appeared to be somewhat related to vascularity of the tumor. Most of the hypervascular tumors such as hepatocellular carcinoma had homogeneous lipiodol accumulation pattern if the tumor size was less than 5 cm. Metastatic tumors and cholangiocarcinoma showed heterogeneous or ring-like pattern of lipiodol accumulation because they were relatively hypovascular. Hypervascular hepatocellular carcinoma may exhibit heterogeneous or ring-like pattern if they are larger than 5 cms, and have multiple feeding arteries, necrosis or AV shunting. Hepatocellular carcinoma with AV shunting may not show any lipiodol accumulation at all.

Adult↗
PubMed1976

Selective arterial embolization in duodenal bleeding.

Severe, unremitting bleeding of the upper gastrointestinal tract could be controlled by Gelfoam embolization of the posterior pancreaticoduodenal artery. The technique and indications of the method are presented.

Catheterization↗
PubMed2000

A case of barotrauma-induced pneumolabyrinth secondary to perilymphatic fistula.

We report the case of a 62-year-old woman who experienced pneumolabyrinth associated with a perilymphatic fistula. Her condition was diagnosed with the help of computed tomography, which detected the presence of an air bubble in the labyrinth, and middle ear exploration, which revealed that clear fluid was emanating from the round window niche in a manner consistent with the presence of a perilymphatic fistula. The niche was repaired with tragal perichondrium and bolstered with Gelfoam.

Barotrauma↗
PubMed2000

Bronchial artery embolization for hemoptysis.

BACKGROUND: Massive hemoptysis is a life-threatening condition. Since treatment from surgery has high mortality, bronchial artery embolization (BAE) is now safer and may be good for chronic hemoptysis as well. MATERIAL AND METHOD: Ten patients (6 male, 4 female) with hemoptysis underwent BAE. Five patients had massive life-threatening hemoptysis (4 tuberculosis and 1 bronchogenic carcinoma) and 5 had chronic hemoptysis (4 tuberculosis and 1 bronchogenic carcinoma). All patients received BAE by transfemoral arterial approach using gelfoam particles and Ivalon as the embolized materials. Bronchial arteries were abnormal in all cases except one patient who had bronchogenic carcinoma supplied by the acromiothoracic artery to the left upper lobe. RESULTS AND CONCLUSION: Chest radiograph may correlate well with angiographic findings if there is one lobar lesion, but multiple lobar lesions showed no correlation between the two modalities. Hypervascularity was a universal findings in all patients. Other angiographic findings were enlarged bronchial or nonbronchial arteries, systemic to pulmonary anastomosis, pseudoaneurysm, and extravasation of contrast media. The immediate result of BAE achieved 100 per cent but follow-up showed only a 70 per cent success rate with one mortality from recurrent massive hemoptysis and two recurrent cases due to complications. Ivalon which is a permanent embolized material may be useful for recurrent hemoptysis.

Adult↗
PubMed2000

Incidence and clinical significance of frontal sinus or orbital entry during pterional (frontotemporal) craniotomy.

BACKGROUND AND PURPOSE: Frontal sinus entry, orbital entry, or both may occur during pterional craniotomy for microsurgical clipping of aneurysms. We sought to determine the incidence and clinical significance of these findings on postoperative CT scans. METHODS: Eighty-two postoperative CT scans of the head obtained from 81 patients (64 women, 17 men; age range, 25-80 years) were retrospectively reviewed over a 1-year period. These scans were reviewed independently by two blinded neuroradiologists for the presence and degree of orbit and frontal sinus entry that may have occurred during craniotomy. Clinical charts, operative notes, and discussions with the patients' neurosurgeons were reviewed to determine the clinical management and significance of these findings. RESULTS: Of the total 82 craniotomies reviewed, 77 (94%) had been performed via the pterional approach (43 right, 34 left). Twenty-three (30%) of these 77 studies revealed some evidence of penetration into the orbit or frontal sinus (orbit=65.2% [15/23]; frontal sinus=30.4% [7/23]; both=4.4% [1/23]). Only five of 16 patients with radiographic orbital penetration had evidence of involvement of intraorbital contents (ie, thickened lateral rectus, fat herniation, intraorbital air). Chart review revealed no complication or change in management. Of the seven patients with frontal sinus entry, three had mucosal exenteration and packing with antibiotic-coated gelfoam. No delayed complications (ie, persistent fever, mucocele, cerebrospinal fluid leak, air leak, or meningitis) were identified (follow-up period, 18-29 months). CONCLUSION: Frontal sinus or orbital entry is not uncommon after pterional craniotomy, but the incidence of immediate complications is rare.

Adult↗
PubMed2000

Selective arterial embolization for post-traumatic high flow priapism.

We report on a 23 year old patient with high flow priapism following blunt perineal trauma in which arterial-cavernosal fistula was missed by penile Doppler ultrasonography but was successfully localized by arteriography and embolized using Gelfoam pledgets. Detumescence was complete in 2 days and sexual function returned to the premorbid state after 4 weeks. The diagnosis, pathophysiology, and treatment of high flow priapism and review of the literature are discussed.

Adult↗
PubMed2000

Post-traumatic, high-flow priapism treated with selective cavernous artery embolization and intracavernous streptokinase irrigation: a case report.

A 54-year-old man developed priapism shortly after a blunt perineal trauma. An arteriocavernous fistula caused the high-flow priapism, and was detected on both color Doppler sonography and selective phaloarteriography. Selective embolization of the left cavernous artery with Gelfoam was performed to seal the fistula, resulting in immediate detumescence. However, the penis remained firm despite returning to almost normal size. No fistula was detected by subsequent color Doppler sonography and phaloarteriography examination. Intracavernous irrigation with 200,000 U streptokinase was applied to treat residual firmness 2 weeks after embolization. Successful sexual intercourse was reported 3 months later. The combination of selective cavernous artery embolization and intracavernous streptokinase irrigation was effective for the treatment of the high-flow priapism in this case.

Arteries↗
PubMed2001

[Use of oxicellulose in neurosurgery--technical comments].

In different surgical disciplines preparations which promote haemostasis are widely used. The latter comprise in particular preparations on the basis of collagen (e.g. Actifoam, Avitene), gelatin (Gelfoam, Spongostan) and oxidized celluloses (Traumacel, Surgicel). The application of these preparations in neurosurgery is very specific and has its laws. At the Neurosurgical Clinic, Faculty Hospital Brno the authors used since 1995 for brain surgery in particular Traumacel, i.e. oxidized cellulose in powder form. Since 1996 the author uses in brain surgery Surgical, extradurally Spongostan. The author summarizes his experience with the use of Surgical in 114 operations of the brain. He analyzes specific features of the use of Surgical in different diagnoses and its effectiveness in the prevention of haemorrhagic complications. At present the use of Surgical is an integral part of haemostasis in the majority of open operations of the brain in the author's department.

Brain↗
PubMed2001

Hepatic arterial collaterals after transcatheter oily chemoembolization of hepatocellular carcinoma.

From July 1989 to June 1999, 100 patients, 76 male and 24 female, were admitted for treatment of hepatocellular carcinoma (HCC) with transcatheter oily chemoembolization (TOCE) using lipiodol 10 ml mixed with an anticancer drug (mitomycin C 20 ml) and gelfoam particles, described by Nakamura H et al. The periodic follow-up angiogram showed hepatic collaterals which developed according to the mode of embolization. For peripheral hepatic arterial embolization such as segmental or lobar arterial embolization, the intrahepatic collaterals were commonly demonstrated. However, for more proximal hepatic arterial embolization of the tumor feeder arteries such as the proper hepatic artery and the common hepatic artery, the extrahepatic collaterals were commonly demonstrated with fine, small tortuous vasculatures, rendering a repeat TOCE more difficult. The hepatic collaterals are presented.

Adolescent↗
PubMed1975

Management and prevention of primary perilymph fistula in otosclerosis surgery.

Management of 10 cases of primary perilymph fistula is described. The modified technique of stapedectomy described in this article, seems to prevent primary perilymph fistula; time will tell if it will prevent secondary fistula. The hearing gain obtained with this technique is slightly inferior to the gain obtained with Gelfoam-wire prosthesis, but most significant is the fact that discrimination score is excellent in all cases. The author is convinced that the extra time and dexterity required to perform this procedure are well justified by the safety provided and the results obtained.

Adult↗
PubMed1998

Angiographic management of pseudoaneurysm and arteriocalyceal fistula following blunt trauma: case report and review of the literature.

We report a case of blunt trauma causing both a pseudoaneurysm and an arteriocalyceal fistula. These 2 lesions have not previously been reported occurring simultaneously as a complication of renal trauma. Pathophysiology, clinical presentation, and management options are discussed. Angiography in this case was both diagnostic and therapeutic. Selective and superselective gelfoam embolization led to immediate resolution of both injuries.

Journal Article↗
PubMedDate not supplied

Amifostine (Ethyol) as modulator of hepatic and biliary toxicity from intraarterial hepatic chemoembolization: results of a phase I study.

BACKGROUND/AIMS: Hepatic and biliary toxicity are still significant problems after intraarterial hepatic chemoembolization for liver metastases from large bowel cancers. In about 30-60% of the patients hepatic and biliary toxicity are the limiting aspects of intraarterial hepatic chemoembolization and exclude a lot of patients from a repeated beneficial treatment. Amifostine (Ethyol) is a prodrug that must be dephosphorylated to the free thiol in which form it can detoxify free oxygen radicals generated by radiation, hypoxia and by drugs such anthracyclines, platinum analogues and alkylating agents. Amifostine as inactive prodrug is primarily metabolized at the tissue site by membrane alkaline phosphatase, which is highly active in the cell membranes of normal endothelial cells and biliary tree cells but not in the cell membranes and neovascular capillaries of tumor. When dephosphorylated to WR-1065, amifostine is rapidly taken up into normal liver cells by a carrier-mediated facilitated diffusion transport process. The resulting high thiol content in normal liver tissue (biliary cells and hepatocytes) compared with the negligible concentration in liver metastases from large bowel cancers probably provides for selective drug resistance to intraarterial hepatic chemoembolization protecting normal tissue and allowing full therapeutic effect on tumor. METHODOLOGY: From May 1997 we planned a phase I study in patients receiving intraarterial hepatic chemoembolization for liver metastases from large bowel cancers. We started at 200 mg/m2 dissolved in 250 cc of normal saline given in 15 min in the intrahepatic artery 20 min before an intraarterial hepatic chemoembolization consisting of mitomycin 10 mg/m2, epirubicin-50, cisplatin-60 diluted in 10 mL of contrast media, mixed in 15 mL of lipiodol UF followed by a gelfoam powder solution until stagnation of the flow. The escalating dose, every 3 patients, was: 200 mg/m2, 250 mg/m2, 300 mg/m2, 350 mg/m2. RESULTS: Toxicity has been observed at 350 mg/m2: 1 patient reported transient hypotension (Blood pressure 70/50 mm Hg), 1 patient had skin flushing and dyspnoea. 300 mg/m2 are well tolerated and seem to reduce the level of transaminases, lactic acid dehydrogenase, and gamma-glutamyl transferase. Also the duration of necrotic damage, always observed after intraarterial hepatic chemoembolization, seems shorter compared with historical controls. CONCLUSIONS: Amifostine can be certainly administered at 300 mg/m2 as intraarterial infusion and could be a significant step to ameliorate the therapeutic ratio of intraarterial hepatic chemoembolization.

Amifostine↗
PubMed2001

[Transcatheter arterial embolization in intractable postpartum hemorrhage].

OBJECTIVE: To asses the value of transcatheter arterial embolization treatment in intractable postpartum hemorrhage. METHODS: Fourteen patients of postpartum hemorrhage failed to the drugs treatment were performed transcatheter arterial embolization (TAE). Superselective catheterization to the bilateral uterial arteries or anterior branches of internal iliac arteries was carried out after intubation to single-side femoral artery by Seldinger's technique. When the catheter tip was proved in right place by digital substraction angiography (DSA) techniques, antibiotic solution was poured into arteries and then the arterial embolization with gelfoam particles was followed. RESULTS: All the patients were performed TAE successfully. The duration of TAE was 30-50 minutes [mean (41.8 +/- 6.4) minutes]. Bleeding was found in DSA mostly as diffuse intrauterine flow outward sign from one side or both side of uterial artery branches. After one time of TAE, the vaginal bleeding of all patients was stopped in 3-10 minutes [mean (6.1 +/- 3.6) minutes]. The follow-up showed that all patients had normal menstrual periods in 2-60 months and no serious complications were found. CONCLUSION: With the characteristic of fast homeostasis and less complications, TAE was proved to be an effective method for intractable postpartum hemorrhage.

Adult↗
PubMed2002

[Clinical analysis of 42 cases uterine myoma by uterine arterial embolization].

OBJECTIVE: To assess the clinical effects and side effects of uterine arterial embolization (UAE) on uterine myoma. METHODS: UAE was performed in 42 patients with uterine myoma. The 4 approximately 5 F cobra catheters were insered into the uterine arteries for treatment. Gelfoam particles mixed with antibiotics were used to embolize the arteries. All patients were followed upto 18 monthes post operation. RESULTS: Arteriography showed that uterine myoma was mainly supplied by uterine arteries and partly by ovarian arteries. All clinical symptoms of 42 patients were relieved. Menorrhagia was reduced 26.3% approximately 75.2%. The volume of uterus myoma decreased 77.7% and 83.0% 12 and 18 months after UAE, respectively and the volume of uterine decreased 54.9% and 62.7%. CONCLUSIONS: UAE was an effective and satisfactory method for the treatment of uterine myoma. Further effects of it should be observed continuously and periodically.

Adult↗
PubMed2002

[Uterine arterial embolization in the treatment of adenomyosis].

OBJECTIVE: To assess the clinical efficacy of uterine arterial embolization (UAE) in the treatment of adenomyosis. METHODS: UAE procedures were performed in 23 patients with adenomyosis. Two 3.0 F FASTRACKER-325 tubes were placed into bilateral uterine arteries respectively and the fresh gelfoam particles mixed with antibiotic drugs were used to embolise the arteries. After treatment the symptoms and uterine volume of all patients were investigated. RESULTS: All clinical symptoms of 23 patients relieved. Dysmenorrhea completely disappeared in 19 patients, significantly alleviated in 2 patients. But in other 2 recurred. The uterine volume shrunk significantly [(50 +/- 18)%] vs [(100 +/- 0)%]. The blood flow within the uterine and lesions detect by color doppler flow imaging decreased immediately after UAE. Low-abdominal pain and slight fever were seen after treatment and recovered within 1 - 2 weeks. CONCLUSION: UAE is an effective and safe method in the treatment of adenomyosis.

Abdominal Pain↗
PubMed2002

TrkC overexpression enhances survival and migration of neural stem cell transplants in the rat spinal cord.

Although CNS axons have the capacity to regenerate after spinal cord injury when provided with a permissive substrate, the lack of appropriate synaptic target sites for regenerating fibers may limit restoration of spinal circuitry. Studies in our laboratory are focused on utilizing neural stem cells to provide new synaptic target sites for regenerating spinal axons following injury. As an initial step, rat neural precursor cells genetically engineered to overexpress the tyrosine kinase C (trkC) neurotrophin receptor were transplanted into the intact rat spinal cord to evaluate their survival and differentiation. Cells were either pretreated in vitro prior to transplantation with trkC ligand neurotrophin-3 (NT-3) to initiate differentiation or exposed to NT-3 in vivo following transplantation via gelfoam or Oxycel. Both treatments enhanced survival of trkC-overexpressing stem cells to nearly 100%, in comparison with approximately 30-50% when either NT-3 or trkC was omitted. In addition, increased migration of trkC-overexpressing cells throughout the spinal gray matter was noted, particularly following in vivo NT-3 exposure. The combined trkC expression and NT-3 treatment appeared to reduce astrocytic differentiation of transplanted neural precursors. Decreased cavitation and increased beta-tubulin fibers were noted in the vicinity of transplanted cells, although the majority of transplanted cells appeared to remain in an undifferentiated state. These findings suggest that genetically engineered neural stem cells in combination with neurotrophin treatment may be a useful addition to strategies for repair of spinal neurocircuitry following injury.

Animals↗