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PubMed1986

[Chemoembolization therapy with cisplatin.lipiodol (CDDP.lipiodol) in primary liver cancer--with special reference to hepatocellular carcinoma].

From Jan., 1985 to Mar., 1986 thirty-six patients with primary liver cancer received transcatheter arterial chemoembolization therapy with Cisplatin (100 mg) blended into Lipiodol (5 ml) and simple embolization therapy with Gelfoam particles. Thirty-three cases out of 36 had hepatocellular carcinoma, one had hepatoblastoma and one had adenocarcinoma. Ten (31%) out of 32 had hepatocellular carcinoma, and showed objective tumor reduction greater than 50% (partial response) regarding the main tumor. Of the 33 there was one sudden death due to intracerebral hemorrhage. Only two out of 25 cases with daughter nodules showed slight reduction. Almost all cases with daughter nodules showed no response to chemoembolization therapy. Five patients died after chemoembolization therapy during the fifteen-month study period. Two patients died of liver abscess or cholecystitis and surrounding abscess, one died of intracerebral hemorrhage, one died of hepatic failure and the remaining case was one of tumor death.

Carcinoma, Hepatocellular↗

PubMed1987

[Usefulness of caerulein in suppressing post-TAE complications of the gallbladder].

While transcatheter hepatic arterial embolization (TAE) has been extensively performed as a form of treatment for nonresectable malignant hepatic tumors, complications, such as abdominal pain, fever or leukocytosis due to gallbladder infarction by embolic materials frequently occur and have not yet been overcome. We devised a new procedure for reducing the incidence of gallbladder infarction by administering caerulein prior to TAE. Between 1984 and 1986, 63 patients with hepatocellular carcinoma were treated by TAE with the use of Gelfoam. These patients were divided into 3 groups. Fourteen patients underwent TAE in which the tip of the catheter was placed in the right hepatic artery distal to the origin of the cystic artery (group A). In the other patients the tip of the catheter was placed proximal to the origin of the cystic artery; 40 patients were not treated by caerulein (group B); 9 patients were administered caerulein 20 micrograms intramuscularly 15 to 30 minutes prior to TAE. The incidence of complications after TAE, such as abdominal pain, fever over 38 degrees C, leukocytosis and ultrasonographical abnormalities of the gallbladder was compared in these 3 groups. The results showed that in group C (TAE after administration of caerulein), the incidence of complications was significantly decreased compared with group B(TAE without caerulein). The authors suggest that post-TAE infarction of the gallbladder is effectively diminished by contracting it with caerulein.

Carcinoma, Hepatocellular↗

PubMed1988

A new hemostatic procedure for percutaneous transhepatic portal vein catheterization.

To avoid major complications, such as intraperitoneal bleeding after percutaneous transhepatic catheterization, a new technique has been developed. In this procedure, a stick-like gelfoam sponge compressed manually and loaded in a cartridge, is inserted through an outer sheath catheter after the removal of the catheter, and the puncture hole is plugged. No bleeding has been experienced in 56 patients with various hepatic diseases since using this method.

Catheterization, Peripheral↗

PubMed1978

Angiography in determining the cause and treatment of gastrointestinal bleeding.

Angiography is useful in the diagnosis of active gastrointestinal bleeding if the rate is greater than 0.5 mL/min. For upper gastrointestinal bleeding, endoscopy is the preferred initial investigation and angiography is used for diagnosis only if the site of bleeding is still obscure. Angiography is the preferred method for investigation of massive lower gastrointestinal bleeding if results of sigmoidoscopy are negative. Vasopressin infusion is most useful for control of bleeding from esophageal varices, erosive gastritis and diverticular disease of the colon. Embolization with Gelfoam or clot is possible for massive hemorrhage from a single source in poor-risk patients. This is most successful for gastric or duodenal bleeding since the collateral blood supply prevents infarction. Some of the methods and complications of embolization are discussed and examples are given. Standard surgical principles should still apply in most cases.

Adult↗

PubMed1988

Hepatic haemangioma: a critical review of diagnosis and management.

Twenty-four adults (10 male; age 27-65 years, median 43.5) with hepatic haemangioma are reviewed. Fifteen had right hypochondrial pain (lesions 8 cm or more in diameter in nine). Six lesions were found incidentally, at ultrasound examination or elective cholecystectomy. Diagnosis, from ultrasonic and angiographic appearances, was confirmed in 12 by percutaneous biopsy without complication. Eleven patients were followed untreated for up to 60 months (median 24 months): lesion size (median 2.5 cm) did not change and all remained well. Surgical resection succeeded in two of three patients; the third and eight other patients (seven with symptoms) with lesions 3 to 30 cm in diameter were selected for Gelfoam embolization. Transient minor side effects preceded improvement in most, but two patients (with lesions of 20 cm or greater in diameter) developed multiple liver abscesses: recovery was protracted. Embolization failed in three; two remain well, untreated, to 24 and 51 months. Two patients had hepatic artery ligation, one with radiotherapy. Further imaging at from eight to 60 months (median 24) showed little change in lesion size or vascularity with any non-resectional technique. Expectant management of small asymptomatic haemangiomas appears appropriate. Embolization may reduce pain but the risk of abscess formation is high for large tumours, and reduction in size or vascularity of lesions is unlikely whatever their initial diameter.

Adult↗

PubMed1986

[Transcatheter arterial embolization therapy of recurrent pelvic cancer].

Embolization of the internal iliac artery with Gelfoam partiles was performed in 14 patients with recurrent pelvic cancer between February 1984 and February 1985. The sites of treatment were the uterus, urinary bladder, sacral mass, vulva and obstrator muscle. Full-dose radiotherapy had been performed as the primary treatment in 10 cases. According to Karnofsky's criteria, the therapeutic effect of embolization was rated as 1-A or better in 71.4% of the patients. Regarding complications of embolization therapy, two cases of vesicovaginal fistula were noted. All these results suggest that embolization is a useful method for the treatment of recurrent pelvic cancer, especially after radiotherapy.

Adenocarcinoma↗

PubMedDate not supplied

Embolization of intramedullary arteriovenous malformations of the spinal cord.

Intramedullary spinal cord arteriovenous malformation (AVM) can be a devastating disease. It is not usually amenable to surgery without producing severe neurologic deficit. Previously, the risk of cord ischemia was considered a contraindication to therapeutic embolization. Three patients with intramedullary spinal cord AVMs were examined and treated using polyvinyl alcohol foam, mixed with Gelfoam in two cases. In all three cases there was marked improvement, in two to complete normalcy and in the other to near-normalcy. Successful therapy involves the appropriate angiographic mapping, choice of embolus size and composition, and challenge of function by either test occlusion or long perfusion with contrast material.

Adult↗

PubMed1979

Uncontrollable postpartum bleeding: a new approach to hemostasis through angiographic arterial embolization.

A case of severe postpartum hemorrhage is reported. Three separate surgical procedures failed to reveal the source of bleeding, and standard surgical techniques, including bilateral ligation of the hypogastric arteries, were unsuccessful in producing hemostasis. However, angiography successfully identified the specific bleeding vessel, and transcatheter embolization with Gelfoam fragments quickly and effectively stopped the hemorrhage. The authors consider angiographic embolization to be an effective alternative approach to the control of pelvic hemorrhage and recommend that the technique be considered prior to surgical intervention.

Adult↗

PubMedDate not supplied

[Preoperative selective embolization of intracranial meningiomas].

The authors report preliminary experiences with preoperative embolization of intracranial meningiomas describing the technique using a specially prepared gelfoam as embolizing material. Embolization was done in 3 cases, in 2 of them transient facial nerve paresis appeared as complication. The effectiveness of embolization was assessed by means of selective control intraoperative angiography and histological examination. In the conclusions the authors stress the effectiveness of preoperative embolization for reducing intraoperative bleeding and indicate the usefulness of the procedure in selected cases of other brain tumours.

Embolization, Therapeutic↗

PubMed1988

Transcatheter embolisation to control severe bleeding in fungating breast cancer.

Severe and recurrent haemorrhage from ulcerating breast or skin lesions was controlled in seven of nine women with breast cancer. Arterial catheterisation and embolisation with a variety of materials (gelfoam, polyvinyl alcohol, steel coils, 50% dextrose) was used. Local anaesthesia only was needed, allowing very ill patients to be treated. This approach is the treatment of choice for severe haemorrhage in breast cancer.

Adenocarcinoma, Papillary↗

PubMed1988

[A case of multiple superficial temporal artery pseudoaneurysms following craniotomy].

A case of multiple superficial temporal artery (STA) pseudoaneurysms following craniotomy is reported and a review of the literature is made. The patient was a 17-year-old male who was hospitalized as he developed right hemiparesis 4 hours after golf ball injury to the left temporal region. He had been diagnosed as hemophilia A one year prior to the injury. CT scan showed right parietal intracranial hematoma with mass effect when he was submitted to emergency craniotomy. At surgery a linear scalp incision was made over the left temporal area after high factor VIII concentrates (con-VIII), 2,000 units, were administered. His postoperative course was uneventful and hemiparesis improved substantially, however two pulsatile masses along the incision scar over the scalp were noticed some 40 days after the hematoma removal. There was another pulsating mass in the left wrist where an arterial cannulation was made at the time of craniotomy. Selective angiograms showed two left STA pseudoaneurysms and left radial pseudoaneurysm was also demonstrated. The left STA was embolized with Gelfoam pieces through catheterization after administration of con-VIII, and the radial artery aneurysm was surgically resected. There was no evidence of recurrence of these lesions during the follow-up period of eight months. Among over 130 cases of STA pseudoaneurysms reported, there was no case with hemophilia and also no such a case described which developed after craniotomy on reviewing the literature. And it was proved that con-VIII has enabled a patient to tolerate embolization procedure through catheterization.

Adolescent↗

PubMed1987

Severe secondary postpartum haemorrhage after caesarean section.

Between January 1982 and April 1985 13 patients with severe secondary postpartum haemorrhage after caesarean section were seen at King Edward VIII Hospital, Durban. The bleeding occurred in the second, third and fourth weeks after delivery, but there were no maternal deaths. Eight of these patients were treated by total abdominal hysterectomy and 1 by revision of the uterine wound and ligation of the bleeding uterine vessels. The last 4 patients, seen in 1985, were treated by selective transcatheter embolisation with Gelfoam pledgets. This method was successful in 3 patients and failed in 1. It is suggested that the latter method has a place in the treatment of these patients.

Cesarean Section↗

PubMed1987

[Importance of locoregional chemotherapy by anthracyclines].

With loco-regional chemotherapy high local concentration of antineoplastic products can be achieved without systemic toxicity. However local toxicity and technical problems are frequent and limit its use. Intra arterial chemotherapy (IAC) is interesting when the drugs used have a high total body clearance. One of the best indication of IAC is the intra-hepatic chemotherapy with anthracyclin for hepatocellularcarcinoma (40-60% objective response) and metastatic carcinoid. Among other IAC the IA limbs perfusions for soft tissue sarcoma have given interesting results. Chemoembolization with lipiodol and/or gelfoam mixed with anthracyclin is an interesting field of investigation in liver tumor and metastases. Intraperitoneal chemotherapy is used essentially for peritoneal carcinomatosis from ovarian origin and gives some positive results. However, intra peritoneal Adriamycin is not well tolerated and other anthracyclines are to be investigated.

Administration, Intravesical↗

PubMed1986

Iatrogenic lumbar pseudomeningocele.

The authors describe two cases of pseudomeningocele after surgery for herniated lumbar disc. In order to prevent this rare complication, they suggest to suture the dura and to put on it oxycel or gelfoam every time there is a fluid leakage. The patient has to be placed in Trendelenburg's position for about seven days.

Adult↗

PubMed1987

Interposition arthroplasty of the trapeziometacarpal joint for osteoarthritis.

Resection arthroplasty of the trapezium with either Gelfoam (Upjohn Co., Kalamazoo, Michigan) or tendon interposition was performed in 28 thumbs. Postoperatively, all thumbs were stable and all patients noted diminished pain and improvement in strength. Adduction contracture and metacarpophalangeal joint hyperextension must be corrected at the time of surgery. Interposition arthroplasty of the trapeziometacarpal joint accomplishes the surgical objectives and obviates the need for an implant. Subsequently, the rare complication of silicone synovitis following implant surgery is avoided.

Aged↗

PubMed1986

[A case of ischias as a complication of internal iliac artery embolization].

A case of severe right radicular ischias following embolization is reported. Gelfoam powder and pledgets were used for right internal iliac artery embolization in the case of intractable bladder cancer hemorrhage. It is supposed that previous radiotherapy and fine embolic material may be the contributing factors to this complication.

Embolization, Therapeutic↗

PubMed1986

[Experimental study on brain tissue of microfibrillar collagen hemostat (Avitene)].

Microfibrillar collagen hemostat (Avitene) is a new absorbable topical hemostatic agent, of which hemostatic mechanisms are adhesion to the bleeding site and platelet aggregation. Avitene was used to obtain hemostasis and compared with Gelfoam or Oxycel in the injured cerebral cortex in a rabbit. The animals were killed and the lesions were examined grossly and microscopically to evaluate its biocompatibility in the cerebral cortex. Histopathological examinations revealed that Avitene was biocompatible with cerebral cortex in a rabbit. Electroencephalographies did not show the epileptogenic focus when Avitene was applied on the cerebral cortex in a rabbit. It has been applied for the bleeding during surgery for several years. Its effectiveness of hemostasis has been well known. This study indicated that Avitene is very effective and safe to use as a topical hemostatic agent during craniotomy in a rabbit. Therefore, this agent may be useful in a patient with minor and diffuse bleeding in the neurosurgical field.

Animals↗

PubMed1987

Autologous tissue seal in myringoplasty.

A prospective, controlled study on the efficacy of autologous tissue seal in myringoplasty was performed. In 29 patients with dry perforations, temporalis fascia was glued with tissue seal. In 30 patients the fascia was fixed with Gelfoam balls. No significant differences in take-rate was found between these two methods.

Evaluation Studies as Topic↗