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PubMed1991

Percutaneous embolization of ruptured splanchnic artery pseudoaneurysms.

The usefulness of emergent embolotherapy was evaluated in 17 patients with life-threatening hemorrhage from 18 ruptured splanchnic artery pseudoaneurysms. Complete hemostasis was obtained in 16 out of 17 patients by embolotherapy. Of the 12 initial embolization procedures with permanent embolic materials including stainless steel coils, microcoils, and Ivalon, complete cessation of bleeding was obtained in 11. On the other hand, 6 out of 9 initial embolization procedures with Gelfoam particles failed to halt bleeding, and additional embolization with permanent embolic materials was required. Emergent embolization with permanent embolic materials using superselective catheterization should be considered the initial treatment of choice for ruptured splanchnic artery pseudoaneurysms.

Adult↗
PubMed1991

[Splenic conservation in gunshot wounds].

The spleen is a frequently injured organ in abdominal trauma. Because of complications, specially post-splenectomy sepsis, conservative treatment is recommended whenever possible, either by adequate medical treatment or by conservative surgery. 65 consecutive cases of proven splenic injuries by bullets or shrapnells were admitted at St George's Hospital between 1978 and 1987. Splenectomy was done in 55 patients with almost always abdominal or thoracic associated lesions. 7 patients had a conservative surgical treatment (suture 3 cases, suture with epiploplasty 2 cases, suture with Gelfoam 1 case, partial resection with epiploplasty 1 case). 3 cases had a conservative medical treatment. Clinical, biological and radiological criterias for a medical or conservative surgical management, are defined.

Adolescent↗
PubMed1991

[Long-term results of transcatheter arterial embolization therapy in cases of recurrent and advanced pelvic cancer].

From April 1983 through April 1989, transcatheter internal iliac arterial embolization therapy (TAE) using Gelfoam particles was performed in 64 cases of recurrent or advanced pelvic cancer. We report here 19 patients who survived for more than one year. After TAE, the patients were followed on an outpatient basis for an average of two years. The condition of the patients was generally good during this period of follow-up. Complete response (CR) to therapy was obtained in five cases, partial response (PR) in nine, minor response (MR) in one and no change (NC) in four. Among the five cases that showed complete response, one case had local control for over five years, two cases for over three years and two cases for over one year. Though the patients had cancer, there were no other complications during the long-term follow-up.

Adult↗
PubMedDate not supplied

Transcatheter oily chemoembolization with high doses of adriamycin in the treatment of large hepatocellular carcinoma (10 cm or more in diameter).

Five patients with large hepatoma (10 cm or more in diameter) underwent transcatheter oily chemoembolization with an emulsion of 100 mg of adriamycin with Lipiodol plus Gelfoam. Myelosuppression related to adriamycin was milder than that associated with bolus injection of the drug, because the drug was released from the emulsion slowly. Partial response was found in one patient, with no change in the others. The duration of survival ranged from four to 16 months (mean, 11.2 months). Response was satisfactory for large hepatoma.

Adult↗
PubMed1991

[Duodenal varices treated successfully by percutaneous transhepatic obliteration: report of a case].

A 73-year-old female with bleeding from duodenal varices treated by percutaneous transhepatic obliteration (PTO) was reported. She was admitted to our hospital because of tarry stool and general malaise. Gastroduodenoscopy revealed tortous elevations in the descending part of the duodenum, and observed intermittent bleeding. Percutaneous transhepatic portography (PTP) was carried out. PTP revealed duodenal varices supplied via the inferior pancreaticoduodenal vein and drained to the inferior vena cava, and continuously obliterated by gelfoam. Duodenal varices disappeared after obliteration and we observed no recurrence of varices for a year endoscopically. In general, it is accepted that the causes of the upper gastrointestinal bleeding secondary to portal hypertension are esophagogastric varices, hemorrhagic gastritis, gastro-duodenal ulcer, and so on. However, we must keep in mind the case with duodenal varices in which bleedings are of unknown origin. We also reviewed duodenal varices reported in Japanese literature from 1968 to 1989.

Aged↗
PubMed1991

Life-threatening post-nephrolithotomy hemorrhage resulting in cessation of kidney function, treated by transcatheter arterial embolization with subsequent restoration of excretory function.

A massive post-nephrolithotomy renal hemorrhage was successfully controlled by selective arterial embolization using Gelfoam particles. Prior to embolization, the kidney showed no excretory function due to complete obstruction of its collecting system by blood clots. Long-term observation revealed restoration of excretory function of the treated kidney and only minimal loss of its parenchyma.

Adult↗
PubMed1990

[Four cases of intracranial AVM successfully treated by radiation therapy].

We have treated three patients with conventional radiotherapy and one with stereotactic radiosurgery and report the follow-up results. Case 1 was of a 63-year-old woman who had a dural AVM in the right cavernous sinus. She was irradiated using 10MV X-rays with a total of 30Gy. Post irradiation angiography showed a complete absence of dural AVM. Case 2 was of a 62-year-old woman who had a dural AVM fed by the left external carotid artery in the right cavernous sinus. Embolization by gelfoam was performed before irradiation. The irradiation was given with a total dose of 30Gy. Post irradiation angiography showed disappearance of the dural AVM. Case 3 was of a 26-year-old woman who had a small AVM (about 20 x 15 x 15mm) in the posterior corpus callosum. An operation was performed but the AVM was not excised completely. We irradiated the residual AVM with a total of 30Gy. The follow-up angiography one year after treatment, showed disappearance of the AVM. She had no neurological deficit two years after the treatment. Case 4 was of a 14-year-old boy who had a small AVM (about 20 x 15 x 10mm) in the left anterior wall of the fourth ventricle. The AVM was located deeply, so an operation was not performed. Radiosurgery was undertaken four months after onset in Buenos Aires. The total dose was 36Gy. The follow-up angiography one year after treatment, showed disappearance of the AVM. He also had no neurological deficit two years after the treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Chemoembolization for liver metastasis from colorectal cancer].

Chemoembolization using Lipiodol, cisplatin, angiotensin II and Gelfoam (modified sandwich therapy) was carried out for the patients with liver metastasis from colorectal cancer. 1. Ten of 30 patients who underwent hepatic resection received TAE before operation, and the remaining 20 underwent surgery without preoperative TAE. Three-year survival of the former was 66%, and that of the latter was 44% (not significant). 2. Twenty-two patients who were assessed as non-resectable were surgically catheterized into the hepatic artery. Thirteen patients received TAE (totally 38 times) and intra-arterial infusion chemotherapy, and the remaining 9 underwent intra-arterial chemotherapy alone. The 50% survival of the former and the latter was 545 and 285 days, respectively. One year survival of the former was significantly better than that of the latter. 3. Fourteen patients had intrahepatic recurrences after hepatic resections. Eight patients received TAE and the remaining 6 did not. The 50% survival of the former was 615 days and that of the latter was 190 days. For one-year survival, the former was significantly better than the latter. These results suggested that TAE is an effective modality for liver metastasis from colorectal cancer.

Angiotensin II↗
PubMedDate not supplied

[Effect of dopamine on lung vascular mechanics. Its study in the isolated canine lobe model embolized with gel foam].

After inducing an increase in pulmonary vascular resistance (Rp) in an isolated in situ lobe (LAIS) embolized with gelfoam (GE), the effect of dopamine infused at 12 mcg/kg/min in eight mongrel dogs was evaluated. We studied the rectilinear pressure-flow (QL/PL) relationship, the hemodynamic and blood gas before (condition A), 15 minutes later GE (condition B) and after dopamine infusion (condition C). After GE a decrease in QL and an increase in inflow (PL) and mean critical closing pressures (PLi) were noticed (p less than 0.01). Also decrease in pulmonary vascular conductance (1/Rp) was noted. At condition C a rise in QL and PL were noticed (p less than 0.01), but 1/Rp and PLi did not change. We concluded that dopamine in the LAIS with increased Rp at the used doses does not have vasoactive action for those vessels responsible for the phenomenons where flow resistance or mean critical closing pressure occurs.

Animals↗
PubMedDate not supplied

[Ultrasound-guided percutaneous plugged biopsy of the liver in patients with coagulation disorders. Preliminary report].

The histopathological study is very useful to establish a correct diagnosis in hepatic diseases, nevertheless conventional percutaneous liver biopsy is contraindicated in patients with abnormal coagulation. For this reason, some other alternatives have been looked for. The purpose of this study was to evaluate the safety and effectivity of gelfoam plugged liver biopsy, like alternative of the conventional biopsy in patients with impaired coagulation. The procedure was done in fourteen patients with prothrombin time longer than twelve seconds over the control and platelet count until 20,000/mm3. Besides that, we used real time ultrasound to guide the biopsy, in order to improve the safety and effectivity of this technique. All were successful, and there were no serious complications. This technique is a good alternative in patients with liver disease and impaired coagulation, in whom the histological diagnosis is essential.

Biopsy, Needle↗
PubMed1990

[Transcatheter arterial embolization therapy in cases of recurrent and advanced pelvic cancer--estimation by Cox's proportional hazard model].

From April 1983 through September 1988, transcatheter internal iliac arterial embolization therapy (TAE) using Gelfoam particles was performed in 36 patients with recurrent pelvic cancer and 18 patients with advanced pelvic cancer. The tumor showed complete response (CR) to the therapy in seven patients, partial response (PR) in 18, minor response (MR) in five, and no change (NC) in 24 patients, with the response rate (CR + PR) of 46.3%. Univariate analysis, using Kaplan-Meier estimates and log-rank test, revealed that overall survival was related to performance status (p = 0.0001) and tumor reduction by TAE (p = 0.0008). Similarly, a multivariate analysis, using Cox's proportional hazard model, revealed a strong relationship between prognosis and performance status and tumor reduction by TAE. These results show that both good general condition and tumor reduction by TAE are significant characteristics for the prognosis of recurrent and advanced pelvic cancer treated by TAE.

Adult↗
PubMed1990

Renal aneurysm and arteriovenous fistula. Management with transcatheter embolization.

Embolization was performed in six patients with renal artery aneurysms (n = 2) and arteriovenous fistulas (AVF) (n = 5). The aneurysms were observed in one patient with fibromuscular dysplasia and in another with Ehlers-Danlos syndrome. All the AVFs were intraparenchymal and secondary to iatrogenic trauma. Elective embolization was performed in five patients with good clinical results at follow-up between 1 and 9 years. Because of rupture of the aneurysm emergency embolization was attempted without success in the patient with Ehlers-Danlos syndrome, and nephrectomy was carried out. A postembolization syndrome complicated three procedures in which Gelfoam and polyvinyl alcohol were used; in two of these cases unexpected reflux of the particulate material occurred, resulting in limited undesired ablation of the ipsilateral renal parenchyma. Embolization is the most reliable and effective treatment for intrarenal vascular abnormalities since it minimizes the parenchymal damage.

Adolescent↗
PubMed1990

[Preoperative therapeutic embolization for massive hemoptysis from bronchial collaterals in tetralogy of Fallot--a case report successfully treated by total correction].

Hemoptysis from bronchial collateral arteries in cyanotic heart diseases is a troublesome complication. We report a case of Tetralogy of Fallot presented with massive hemoptysis which was successfully treated with transcatheter therapeutic embolization prior to the radical operation. A 28-years old man was admitted to our hospital because of hemoptysis and dyspnea. On the day of admission, he had a massive hemoptysis and became asphyxic. Diagnostic cardiac catheterization performed next day revealed Tetralogy of Fallot. Bronchial arteriogram demonstrated large bronchial collateral arteries with heavy staining around the right lower lobe bronchus. Therapeutic embolization with Gelfoam was performed and the hemostasis was obtained. The radical operation was performed 4 months later. Before cardiopulmonary bypass, the right bronchial artery was ligated. He was weaned from the extracorporeal circulation under the stable circulatory condition, and respirator on the first post operative day without any complications, and he was discharged on the 57th day after the operation. We emphasize the efficacy of therapeutic embolization of the well developed bronchial collateral arteries as a pretreatment of hemoptysis in the cyanotic heart disease.

Adult↗
PubMed1990

[Transcatheter embolization of splenic artery aneurysm; a case report].

A 76-year old woman with splenic artery aneurysm was treated by nonsurgical treatment. Surgical treatment has been recommended for the treatment of visceral aneurysms because these aneurysms may rupture and lead to fatal hemorrhage. This report describes the successful interventional coil and Gelfoam occlusion of splenic aneurysm.

Aged↗
PubMed1989

[Embolization of the lumbar artery for pelvic fracture].

Bleeding from the lumbar artery could be a major source of hemorrhage in a patient with massive blood loss associated with pelvic fracture. Embolization of injured lumbar artery should be attempted since hemorrhaging from the lumbar artery could be a cause of potentially life-threatening retroperitoneal hemorrhage. Selective lumbar arteriography is often helpful to diagnose bleeding from a lumbar artery, which is occasionally overlooked in pelvic aortography. We have not experienced any complications from using gelatin sponge (Gelfoam) cubes, cut into 1-2 mm pieces, for embolization of the bleeding artery.

Abdominal Muscles↗
PubMed1989

[Superselective transcatheter-arterial-chemo-embolization in uterine cervical cancer].

Transcatheter-arterial-chemo-embolization (TACE) was performed on 7 cases of uterine cervical cancer from T1b to T3b. The purpose of this approach is to stop the uterine bleeding caused by malignancy and disrupt the cancer cells under the feeding arteries. TACE by Seldinger's method was undertaken selectively on both uterine arteries with suspension of Lipiodol, Adriamycin and Gelfoam. In each case, the bleeding stopped soon after the operation, and the lesion began to necrose within a few days. Though the primary effects were confirmed, complete remission could not be expected, so radiation therapy was performed. The longest survival among these patients was over 6 years. It should be noted that the other major advantage claimed for TACE is to decrease the dose of radiation.

Adult↗
PubMed1989

[Intra-arterial and intraportal therapy combined with decollateralization in unresectable cholangiocellular carcinoma--a case report].

A 45-year-old man was referred to our hospital due to obstructive jaundice by intrahepatic cholangiocellular carcinoma. At laparotomy, he was assessed as unresectable because of multiple foci in both lobes. Therefore, two catheters connected to implantable access devices were placed in both the hepatic artery and the portal vein following decollateralization using silicone rubber sheeting, in addition to choledochectomy and choledocho-jejunostomy. After the surgical procedure, he underwent chemoembolization twice using Lipiodol, cisplatin, and Gelfoam, and two intraportal infusions of cisplatin at a dose of 50 mg. Moreover, a total dose of 4 g of 5-FU and 20 mg of MMC was administered through the arterial and portal catheters, respectively. Administration of G-CSF was remarkably effective for severe thrombocytopenia, and leukopenia resulted from this active chemotherapy. He is still alive 7 months after the surgical procedure with the regression of the lesions.

Adenoma, Bile Duct↗
PubMed1989

[Prognosis of intra-arterial chemo-embolization in metastatic liver cancer].

We treated 63 patients (pts) suffering from metastatic liver cancer with intra-arterial infusion chemotherapy, and analysed 44 of their for survival since the first treatment with regard to the primary foci of cancer and the method of intra-arterial therapy. Via the superficial femoral artery, we performed superselective hepatic catheterization by Seldinger's method. Three types of intraarterial therapy were used: Gelfoam embolization with mitomycin-C (MMC) in 12 pts (GS-TAE), capillary chemo-embolization with MMC-Lipiodol emulsion in 28 pts (LP-TAI) and "one-shot" slow infusion of MMC or cisplatinum in 4 pts. Fifty-percent survival was 189 days in pts with metastases from colo-rectal cancer (n = 20), 109 days from gastric cancer (n = 9), 100 days from pancreatobiliary cancer (n = 5) and 240 days from breast cancer (n = 7). More than one-year survival was obtained in 13 out of the 40 pts (32.5%). Survival of 12 pts, treated with GS-TAE regimen, was not significantly superior to that of 28 pts with LP-TAI regimen. Hence, we conclude that LP-TAI is the treatment of choice in chemo-embolization for unresectable liver metastases, because it causes less damage to the hepatic arterial beds, and facilitates repeat intraarterial therapy in these pts.

Cisplatin↗