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PubMed2003

[Basic study of biodegradable controlled release chemotherapy].

This study sought to assess the biocompatibility of P(DA-SA)-Adriamycin, a new controlled-release chemotherapy system, in rabbit brain, and to examine its controlled release effect both in vitro and in vivo and its curative effects in vitro. The reaction of animal brain to the implanted P(DA-SA) or P(DA-SA)-Adriamycin was observed. The controlled-release profiles in phosphate buffer solutions and in rabbit brain were measured by UV spectrometry. Then, through flow cytometer, the rate of apoptosis in cultured glioma cells was tested. The reaction of rabbit brain to P(DA-SA) polymer was moderate and not significantly different from that to Gelfoam. The controlled-release rate of P(DA-SA)-Adriamycin in vitro and in vivo was stable and the duration of controlled-release of P(DA-SA)-Adriamycin spanned three weeks. The rate for apoptosis of glioma cells of P(DA-SA)-Adriamycin group was 69.9%, which was significantly higher than that of the control group. In conclusion, P (DA-SA)-Adriamycin controlled release chemotherapy system that bears curative effect has favorable controlled-release effect and good biocompatibility in rabbit brain. This system has potential value in treatment of malignant brain tumor.

Animals↗
PubMed2004

Bone growth into a ceramic-filled defect around an implant. The response to transforming growth factor beta1.

Synthetic bone substitutes provide an alternative to autograft but do not give equivalent clinical results. Their performance may be enhanced by adding osteogenic growth factors. In this study, TGFbeta1 was absorbed on to a carrier of beta tricalcium phosphate and Gelfoam and used to fill a defect around a tibial implant in a rat model of revision arthoplasty. We added 0.0, 0.02 microg, 0.1 microg or 1.0 microg of TGFbeta1 to the carrier and then implanted it around an hydroxyapatite-coated stainless-steel pin in the proximal tibia of rats. The tibiae were harvested at three, six or 26 weeks and the amount of bone formation and ceramic resorption were assessed. TGFbeta1 had no effect on the amount of bone in the defect, the amount of fluorescent label incorporated or the rate of mineral apposition. The growth factor did not significantly affect the amount of betaTCP remaining in the tissue at any of the time points.

Animals↗
PubMed1951

Surgical principles of incising the renal parenchyma.

Attention, at nephrotomy, to the anatomy of the kidney will guide incision into a less vascular area and will result in less destruction of tissue. Complete exposure and gentleness of control of the renal pedicle are mandatory. Conservative surgery-removing renal lesions and preserving the remaining functioning tissue - is successful when the proper techniques of incision and hemostasis are employed. With proper drainage and control of infection, nephrostomy is not necessary. Three illustrative cases are presented. Full use of the operating room x-ray machine is helpful. Mattress sutures in the plane of the arteries is the commonest method of parenchymal hemostasis. Although helpful, Gelfoam(R) and Oxycel(R) probably predispose to infection which is the commonest cause of secondary hemorrhage.

Arteries↗
PubMed2004

Clinical application of transarterial embolization for massive hemorrhage in the nasopharyngeal and maxillofacial regions.

OBJECTIVE: To study the effect and safety of transarterial embolization (TAE) in the management of massive hemorrhage in the nasopharyngeal and maxillofacial regions. METHODS: Forty-two cases of massive hemorrhage in the nasopharyngeal and maxillofacial regions were treated by TAE. Gelfoam particles, polyvinyl acohol particles, and metallic coil were used to for embolism of the external carotid artery, maxillary artery, facial artery, occipital artery, sphenopalatine artery and ascending pharyngeal artery respectively according to the angiographic findings and the region of hemorrhage sites. RESULTS: TAE was successfully performed in all the cases, and no recurrence or serious complications were observed in the 3 to 12-month follow-up. CONCLUSION: TAE is safe and effective in the treatment of massive hemorrhage in the nasopharyngeal and maxillofacial regions.

Adolescent↗
PubMedDate not supplied

Outcome of transcatheter oily chemoembolization in patients with hepatocellular carcinoma.

BACKGROUND/AIMS: From July 1989 to June 1999, eighty-one patients with hepatocellular carcinoma, 63 males and 18 females, aged 18 to 82 years, were treated with transcatheter oily chemoembolization (TOCE) with an emulsion comprising 10 mL lipiodol and 20 mg mitomycin-C and final embolization with gelfoam particles. METHODOLOGY: Management began with angiography to identify tumor vascularity followed by TOCE via hepatic artery as peripheral as possible. Initial angiography prior to TOCE revealed both hepatic and extrahepatic collaterals in 11 patients with tumors larger than 10 cm. Following initial TOCE, 48 patients developed intrahepatic collaterals. The remaining 22 patients developed extrahepatic collaterals after 4 sessions of TOCE over a period of about 5 months. Following TOCE, all patients were followed monthly for residual or recurrent tumor. If residual or recurrent tumor was found, TOCE would be repeated at 6-week intervals. The survival of the patients was retrospectively analyzed with respect to the type of hepatic collaterals and completeness of TOCE of extrahepatic collaterals. RESULTS: The results of the analysis show that the survival times were significantly shorter in patients with both hepatic and extrahepatic collaterals than patients with either extrahepatic collaterals or intrahepatic collaterals; their respective median values (ranges) in months were 8 (4-24), 12.8 (3-48) and 12.5 (13-36). The significant differences in survival times were apparently due to differences in tumor size and stage of disease; their respective tumor sizes (means +/- SD, cm) were 13.6+/-3.9, 9.4+/-4.3 and 10.0+/-3.9. Patients with extrahepatic collaterals and patients with intrahepatic collaterals had similar tumor sizes and survival times. In patients with extrahepatic collaterals, complete TOCE resulted in longer survival time, albeit not statistically significant, than incomplete TOCE. CONCLUSIONS: outcome of TOCE in patients with hepatocellular carcinoma is dependent on tumor size, the stage of disease and completeness of TOCE of extrahepatic collateral vessels.

Adolescent↗
PubMed2004

[Percutaneous management of hemorrhages in pelvic fractures].

PURPOSE: To report our experience in the control of haemorrhage with the transcatheter embolisation technique. MATERIALS AND METHODS: Between 1999-2001, we treated 56 patients with important pelvic trauma. Forty-two were victims of car accidents and 14 of falls from great altitudes. Twenty presented acute symptoms due to blunt pelvic trauma, with massive bleeding, not treatable by drugs and blood transfusion. Diagnosis of pelvic haemorrhage was made with CT. When high-flow haemorrhage was found, the patient was referred for angiography. Embolisation was achieved after a diagnostic arteriography, with bilateral transfemoral approach and selective catheterisation of the internal iliac arteries. RESULTS: Technical success was achieved in 100% of cases: all the haemorragic sites were found and embolised. In only one patient with severe shock was it impossible to locate the site of contrast material extravasation on the first day; the patient was successfully treated on the second day with improvement of the clinical conditions. The obturator artery was involved in five cases, the gluteal artery in eleven. In eighteen patients, use of an angiographic catheter was sufficient to treat the haemorragic sites. Percutaneous control of the haemorrhage was obtained by using Gelfoam, Ivalon and coils. CONCLUSIONS: Percutaneous haemorrhage control is safe and effective, and not as costly or dangerous as the surgical option. We regard it as the treatment of choice in multiple trauma patients with important and high-flow pelvic haemorrhage.

Adolescent↗
PubMed2004

[Post-traumatic high-flow priapism: a case report].

A 48-year-old man, who previously had normal erectile function, visited our hospital complaining of a painless erection that had persisted for 6 days. He had suffered perineal trauma in a traffic accident 9 days earlier. A diagnosis of post-traumatic high-flow priapism was suggested from the findings on penile blood gas analysis. Selective internal pudendal arteriography showed an arterial blush along the bilateral cavernous arteries. Subsequently, embolization of a cavernous fistula was performed with an autologous clot. However, the embolus was removed within a minute, so the procedure was repeated with Gelfoam. This patient had normal erectile function after 11 months, with no recurrence of priapism.

Accidents, Traffic↗
PubMed1992

A review of dry socket: a double-blind study on the effectiveness of clindamycin in reducing the incidence of dry socket.

This double blind clinical study was undertaken to evaluate the effectiveness of locally applied clindamycin in Gelfoam in reducing the incidence of dry socket formation after third molar surgery. A total of 1,021 third molar extractions were performed, and 520 mandibular third molar extractions of varied surgical difficulty were evaluated. The results indicated that this technique was effective. This study also demonstrates that the incidence of dry socket after third molar surgery is significantly higher in the mandible than the maxilla, in smokers than in non-smokers, and in females currently on oral contraceptives.

Adult↗
PubMed2004

[Superior sagittal sinus occlusion caused by a compound depressed skull fracture: a case treated by emergency surgery].

Depressed skull fractures compressing major venous sinuses are rare, and the treatment is a matter of controversy. The majority of depressed fractures are treated conservatively for fear of bleeding from venous sinuses, but surgical intervention was conducted in a few cases. We report a case of a 59-year-old man with a compound depressed fracture occluding the superior sagittal sinus (SSS). The patient was struck on the head by a heavy iron bar and admitted to our emergency center because of deterioration of consciousness. A computed tomographic scan showed depressed skull fracture overlying the SSS with hemorrhagic lesions in the bilateral parietal lobes and an acute epidural hematoma at the right temporoparietal convexity. Digital subtraction angiography (DSA) showed an occlusion of the SSS and compensatory venous drainage associated with poor capillary filling in the left parietal lobe. On an emergency basis, bone fragments compressing the SSS were surgically removed piece-by-piece to resolve severe venous congestion and to avoid infection. A small tear in the SSS was treated by head elevation and compressing the SSS with Gelfoam. Postoperative DSA confirmed the patency of the SSS and normal blood flow in the left parietal lobe. The patient exhibited slight disorientation and was transferred to another hospital for further rehabilitation. Because of symptomatic severe venous congestion, we had to perform emergency surgical decompression and removal of bone fragments. Treatment strategy for depressed skull fracture with SSS involvement was discussed with review of the literature.

Decompression, Surgical↗
PubMed1992

Short-term and long-term results of experimental wrapping techniques for bronchial anastomosis.

Major complications of bronchial anastomoses for either transplantation or sleeve resection include early leak, fistula formation, granulation tissue, and stenosis. To evaluate the impact of technique on these complications, we designed a nonimmunocompromised canine model with a totally ischemic bronchial segment. We wished to discover the prevalence of early and late complications of a telescoping anastomosis and if wrapping techniques modify them. We autotransplanted 25 mm of left main-stem bronchus by telescoping 1 mm of proximal into distal bronchus sutured with interrupted 4-0 polyglactin sutures. The animals were divided into four groups: no wrap; omental pedicle wrap; detached-free omental wrap; and Gelfoam sponge soaked in porcine omental extract. Weekly bronchoscopic studies assessed airway patency. After the animals were put to death at 70 days, the luminal areas of the proximal anastomoses were compared with the origin of the left main bronchus. No air leak, bronchial disruption, or infection occurred in any group at any time. Luminal narrowing occurred in all four groups but was most pronounced in the three groups in which wrapping techniques were used. We conclude that wrapping of a telescoped anastomosis is not necessary to prevent early complications. However, no method completely eliminates stenosis. Further experiments should determine the effects of immunomodulation in this model.

Anastomosis, Surgical↗
PubMed2004

Pulmonary functional MRI: an animal model study of oxygen-enhanced ventilation combined with Gd-DTPA-enhanced perfusion.

BACKGROUND: The assessment of regional pulmonary ventilation and perfusion is essential for the evaluation of a variety of lung disorders. Pulmonary ventilation MRI using inhaled oxygen as a contrast medium can be obtained with a clinical MR scanner, without additional equipment, and has been demonstrated to be a feasible means of assessing ventilation in animal models and some clinical patients. However, few studies have reported on MR ventilation-perfusion imaging. In this study, we evaluated the usefulness of oxygen-enhanced ventilation in combination with first-pass Gd-DTPA-enhanced perfusion MRI in a canine model of pulmonary embolism and airway obstruction. METHODS: Peripheral pulmonary embolisms were produced in eight dogs by intravenous injection of gelfoam strips at the pulmonary segmental arterial level, and airway obstructions were created in five of the dogs by inserting a self-designed balloon catheter into a secondary bronchus. Oxygen-enhanced MR ventilation images were produced by subtracting images from before and after inhalation of pure oxygen. Pulmonary perfusion MR images were acquired with a dynamic three-dimensional fast gradient-echo sequence. MR ventilation and perfusion images were read and contrasted with results from general examinations of pathological anatomy, ventilation-perfusion scintigraphy, and pulmonary angiography. RESULTS: Regions identified as having airway obstructions matched using both MR ventilation and perfusion imaging, but regions of pulmonary embolisms were mismatched. The area of airway obstruction defects was smaller using MR ventilation imagery than that using ventilation scintigraphy. Abnormal perfusion regions due to pulmonary embolisms were divided into defective regions and reduced regions based on the time course of signal intensity changes. In the diagnosis of pulmonary embolisms with the technique of ventilation and perfusion MRI, sensitivity and specificity were 75.0% and 98.1%, respectively, and the diagnostic results of this MRI technique were in agreement with the results of ventilation-perfusion scintigraphy and pulmonary angiography (K: 0.899, 0.743). CONCLUSIONS: Oxygen-enhanced ventilation in combination with pulmonary perfusion MRI can be used to diagnose abnormalities of airways and blood vessels in the lungs, and can provide regional functional information with high spatial and temporal resolution. This method possesses great potential value for clinical applications.

Airway Obstruction↗
PubMed1997

[The carcinogenesis of human cytomegalovirus to mouse cervix].

We plugged the gelfoam impregnated with virus stock solution into mouse cervix with ophthalmic forceps. Mice of Kun-Ming strain were infected with UV-inactivated HCMV (human cytomegalovirus). After 31 weeks, cervical carcinomas were induced in 15% of the infected mice. In another group, infected with UV-inactivated HCMV adding croton oil, the carcinogenesis was 18.8%, but incontrol group, it was 0%. HCMV IE (immediate early) antigen in 12 cancer tissues of UV-inactivated HCMV treated group were all positive, and HCMV IE antibody geometrical average titre in mouse serum of the same group was 1:167.2, but the same two parameters in control group were both negative. The ANAE positive rate of lymphocytes in mouse peripheral blood of UV-inactivated HCMV treated group was 38.9 +/- 6.8%, and of control group was 67.8 +/- 8.0%.

Animals↗
PubMed2005

[External radiation and combined transcatheter arterial chemoembolization for unresectable primary liver cancer].

BACKGROUND & OBJECTIVE: Transcatheter arterial chemoembolization (TACE) is the routine treatment for unresectable primary liver cancer, but 3-year survival rate of patients received TACE alone is only about 20%. This research was to evaluate efficacy of external radiotherapy (RT) combined with TACE on unresectable primary live cancer. METHODS: From Jun. 1994 to Apr. 2002, 114 patients with unresectable primary liver cancer were non-randomized to receive TACE plus RT (54 patients), or TACE alone (60 patients) as control. For TACE, after skiagram confirmed catheterization, suspension of 300 mg of carboplatin, 50-60 mg of epirubicin, 14-20 mg of mitomycin, and 10-30 ml of iodized oil was perfused into hepatic arteries, 1-2 mm of Gelfoam particles was given to embolize hepatic arteries according to blood supply conditions of tumors, this process was repeated every 4-8 weeks. Either group was treated with 1-4 sessions of TACE. In TACE+RT group, patients received radiation on tumor and generous margin 21-28 days after TACE. The radiation dose was 46-60 Gy in daily 2 Gy fractions. RESULTS: In TACE+RT group, response rate (AFP titer decrease of >50%) was 61.1%, and 1-, 2-, 3-year survival rates of TACE+RT group were significantly higher than those of TACE group (66.5% vs. 53.9%, 48.4% vs. 37.2%, and 37.4% vs. 17.8%, P<0.05). Three-year survival rate correlated with tumor size, liver function grade, and portal vein embolus. CONCLUSION: TACE combined with RT may prolong survival time of patients with unresectable primary live cancer.

Adult↗
PubMed1992

[An infant case of spinal arteriovenous malformation with a large venous aneurysm].

An 18-month-old boy was admitted to our hospital with sudden onset of paraplegia, analgesia of the lower limbs, dysuria and constipation. His gestational and birth histories were unremarkable. Past history revealed he had lymphangioma in his left inguinal region, and had been treated in another hospital. Neurological examination revealed flaccid paraplegia, analgesia below Th12 dermatome and dysuria. MRI revealed an intramedullary high intensity lesion surrounded by round low intensity areas located from TH11 to L2 vertebral levels, suggesting the existence of vascular tumor or spinal AVM. Spinal angiogram revealed arteriovenous fistula with large intramedullary aneurysmal vascular dilatation from T12 to L2 vertebral level. The feeder was the Adamkiewicz artery which branched from the left Th12 intercostal artery. First, artificial embolization with thrombin gelfoam was performed successfully. However, follow-up MRI showed an image of flow void in the aneurysm again, indicating recanalization of the AVF. Therefore, an operation was undertaken on October 24th, 1988. The patient was placed in prone position and osteoplastic laminotomy from Th10-L2 was performed. The thrombus and wall of the aneurysm were mostly removed through the lumbosacral midline myelotomy for decompression. Then, the feeder and drainers were ligated. Postoperative course was uneventful. 2.5 years after the operation, he still had flaccid paralysis at the ankle joints bilaterally, analgesia below L4 dermatome, neurogenic bladder and constipation.(ABSTRACT TRUNCATED AT 250 WORDS)

Aneurysm↗
PubMed2004

[Roles of epidermal growth factor and its receptor on the chronic tympanic membrane perforations].

OBJECTIVE: To evaluate the possible roles of epidermal growth factor(EGF) and its receptor (EGFR) on the chronic tympanic membrane perforations. METHODS: A phosphate buffer saline of EGFR was administered to a Gelfoam pledget placed over chronic tympanic membrane perforations in guinea pigs. The EGFR of 10 specimens from the acquired middle ear cholesteatoma of the adjacent skin around perforation was examined by immunohistochemical SP method and computer image analysis. Results Complete closure of the tympanic membrane perforations was observed in 82.6% of EGF-treated ears, but only 33.3% in the controls(P < 0. 01). No case was led to middle ear cholesteatoma in the experiment group (0/23). The positive expression in the adjacent skin around perforation was (39.3 -/+ 7.4)%; and the normal external ear skin was (25.4 +/- 3.7)%; There were distinctly significant differences between the adjacent skin around perforation and the normal external ear skin (P < 0. 01). CONCLUSIONS: EGF is effective on closing chronic tympanic membrane perforations in the guinea pigs. Present data suggests that EGF-treated may induce the occurrence of middle ear cholesteatoma.

Animals↗
PubMed2005

Evaluation of selective hepatic angiography and embolization in patients with massive hemobilia.

BACKGROUND: Massive hemobilia is a rare but potentially life-threatening cause of upper gastrointestinal hemorrhage. Transarterial embolization is considered the first line of intervention to stop the bleeding for most causes of hemobilia. This study was conducted to evaluate selective hepatic angiography and embolization in the diagnosis and treatment of patients with massive hemobilia. METHODS: The clinical data of 16 patients with massive hemobilia were analyzed retrospectively. These patients underwent emergency celiac and selective right or left hepatic artery angiography and treated by embolization using Gelfoam particles and/or coils. RESULTS: Hepatic artery angiography revealed hepatic artery pseudoaneurysms in 6 patients, cystic artery pseudoaneurysms in 2, diffuse hemorrhage of hepatic artery branches in 5, and right hepatic artery-bile duct fistulae in 3. The patients were diagnosed rapidly by angiography and treated successfully by embolization of the hepatic artery branch proximal to the bleeding point, and hemorrhage was stopped immediately. Two patients were embolized the second time for rebleeding. Neither recurrence of bleeding nor serious complication was found during the follow-up for 3 months to 2 years. The other 2 patients whose hemorrhage failed to be controlled died several days later. CONCLUSION: Being safe, reliable and minimally invasive, selective hepatic artery angiography and embolization are effective in the diagnosis and treatment of massive hemobilia.

Adolescent↗
PubMed2005

[Transnasal optic nerve decompression for optic nerve injury].

OBJECTIVE: To investigate the feasibility, techniques and advantages of the treatment of optic nerve injury by intranasal endoscopic surgery. METHOD: This retrospective study presents the results of 39 cases (40 optic nerves) of indirect optic neuropathy where surgical decompression represented the primary mode of treatment within 2-18 days after trauma. The surgery is performed using the transethmoidal or trans-sphenoid technique. The optic nerve canal and fracture line are located in Onodi cells or lateral wall of sphenoid sinus. The optic nerve and its sheath are exposed, and the nose is packed by gelfoam; The medication and Hyperbaric oxygen are used after surgical. RESULT: The following up period is at least 3 months. The total effective rate of visual improvement was 60%, and the effective rate operating within 2-7 days or 8-18 days after trauma turned out to be 66.7% and 30%. CONCLUSION: The endoscopic technique offers several advantages over other surgical approaches. It provides excellent visualization of the surgical site, avoids the morbidity associated with intracranial and external exeracranial approaches and offers the best option for recovery of useful vision. With the development of this technique, the indication should be extended. The prognosis had correlated with the degree of trauma, days until surgery and surgical technique.

Adolescent↗
PubMed1992

[Hemostasis in neurosurgical operations. A comparative study between collagen fleece (Lyostypt) and a gelatine sponge (Marbagelan)].

A study of 100 patients each with neurosurgical operations is reported, in which a prospective randomized and controlled investigation compares two haemostyptic agents, Marbagelan and Lyostypt. Collagen fleece was found superior to gelfoam as to haemostasis although slightly less convenient in application. Postoperative complications specific to the haemostyptic agents were not seen.

Adolescent↗