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PubMed1984

[Microvascular decompression of the trigeminal nerve - a causal therapy of trigeminal neuralgia?].

Preliminary experiences with the microvascular decompression of the trigeminal nerve within the cerebello-pontine angle ("Jannetta's operation") in ten patients are reported. All nine patients with typical tic douloureux were found to have a cross-compression of the nerve by the superior cerebellar artery. This vessel was separated from the nerve and held in place by a piece of Gelfoam. All nine patients were painfree immediately following surgery. Their sensation within the trigeminal area was unchanged compared to the preoperative state. The remaining patient suffered of atypical facial pain and did not reveal a cross-compression of the trigeminal nerve neither by an artery nor by a vein. Microvascular decompression seems to be a causal therapy in trigeminal neuralgia and is a non-destructive operation. Although our period of postoperative observation is short (up to five months), the results are very promising and correspond to the experiences reported by other authors. Advantages and disadvantages compared to the radiofrequency lesion (electro- and thermocoagulation) of the trigeminal nerve are discussed.

Humans↗
PubMedDate not supplied

Microembolization techniques of vascular occlusion: radiologic, pathologic, and clinical correlation.

Vascular occlusion is described using microemboli of a predetermined size for the treatment of neoplastic conditions with a "capillary barrier." Particulated microemboli of either 40--60 micron Gelfoam powder or 200--1,000 micron polyvinyl alcohol foam (PVA) are best. Fluid embolic agents such as silicone fluid are used in lesions without a capillary barrier. The radiographic, pathologic, and clinical results in three patients are described in detail. Microembolization is useful in the treatment of neoplastic conditions for it produces tumor necrosis in addition to hemostasis.

Adult↗
PubMed1983

Palliative embolization in gynaecological patients.

Palliative embolization in patients with gynaecological malignancies is indicated, if other methods of treatment like irradiation, surgery and chemotherapy are impossible or contra-indicated. The experience in 9 patients is reported, with embolization of one renal artery because of metastasis in the kidney and in eight patients the hypogastric arteries uni- or bilaterally by means of Gelfoam and/or Gianturco coils because of inoperable bleeding malignancies.

Adult↗
PubMed1978

Selective arterial embolization in renal tumors.

Selective arterial embolization with Gelfoam was performed in 45 cases of hypernephroma. In 33 cases this technique has been utilized as preoperative procedure and almost always (97%) nephrectomy was facilitated: 97% of the cases had slight or moderate operative bleeding; in 82% of the cases separation of the tumor-containing kidney from adjacent tissues was easy. Embolization has been employed in 12 inoperable patients and was effective mainly in management of bleeding. Angiographic controls after embolization (from 13 to 162 days) were performed 8 times and it was assessed that the efficacy of the procedure on primary tumor growth is limited in time by renal artery revascularization. The embolized patients never presented severe complications, except several episodes of transitory renal failure.

Adenocarcinoma↗
PubMed1983

A comparison of three-dimensional growth characteristics of cultured primitive marrow stroma derived from genetically anemic and normal mice.

This study examines the ultrastructure of mouse defective marrow stroma when cultured as a three-dimensional organization of cells. Gelfoam sponges impregnated with agar medium allowed the three-dimensional organization of newly formed stromal cells derived from the crevices of marrow-depleted bones of Steel mutant mice (Sl/Sld) with defective stroma and also from mice with normal stroma (Sl +/+, W/Wv, and W +/+. Ultrastructural comparisons of 5- to 14-day cultures revealed that the mutant defective stromal cells developed normally, viz. i) proliferated and formed a three-dimensional organization of stroma, ii) stimulated residual hemopoietic precursors to form myeloid cells, and iii) formed a variety of stromal cell types characterized by variable quantities of Golgi bodies and ER, glycogen, filaments, and round cytoplasmic granules. The Steel-Dickie strain, however, included bacilliform electron-dense granules in both normal and mutant stroma. The only ultrastructural deficiency in Sl/Sld stroma was the absence of a category of "activated" cells that occurred within normal cell populations.

Anemia↗
PubMed1980

Embolization of pelvic arteries for control of postpartum hemorrhage.

Two cases are presented in which postpartum hemorrhage was controlled by Gelfoam embolization via an angiographic catheter. The advantages of embolization over surgery are discussed. It is suggested that an attempt be made to control severe postpartum hemorrhage by this means before resorting to surgery.

Adult↗
PubMed1981

Arterial embolisation in the treatment of malignant tumours.

Arterial embolisation is performed in order to interfere with the blood supply and growth of tumours and also to palliate the pain produced by them. In the present study 5 patients with liver metastases, 6 patients with renal tumours and 1 patient with bleeding from the rectum were treated by arterial embolisation with gelatin (Gelfoam). Before embolisation angiography was performed in all and computerized tomography in some of the patients. The control examinations and repetitive procedures were performed 2-4 weeks afterwards and there after according to the response. The effectiveness of the embolisation was assessed by angiography as good in 70% of the cases. Out of 5 patients examined with CT in 4 the tumour was found to have become smaller. The procedure eliminated pain caused by the enlarged liver in all 5 patients, stopped the rectal bleeding, and the subjective condition of all patients improved. Pain produced by the postembolisation syndrome occurred in all cases, but repeated embolisations did not result in further pain. Serious complications did not occur.

Adenocarcinoma↗
PubMed1982

An evaluation of 99mTc-labeled red blood cell scintigraphy for the detection and localization of gastrointestinal bleeding sites.

99mTechnetium-labeled red blood cell scintigraphy was performed upon 39 patients with clinical evidence for acute lower gastrointestinal bleeding from an unknown source. Seventeen of 39 patients (44%) had a scan became positive 6 or more h after injection, consistent with intermittent bleeding, in 8 of 17 patients (47%). In the 11 patients in whom the bleeding site was definitely identified by arteriography, surgery, or colonoscopy, scintigraphy correctly localized the bleeding site in 10 of 11 patients (91%). Four of 11 patients (36%) had an active bleeding site identified by arteriography. Ten of 17 patients (58%) with a positive scan required either gelfoam embolization (4 patients) or surgery (6 patients) to control the bleeding, whereas only 1 of 22 patients (5%) required surgery when the scan was negative. Six deaths occurred in the scan-positive patients compared with no deaths in the scan-negative patients. None of the 8 patients who had arteriography and no active bleeding site by scintigraphy had arteriographically demonstrable active bleeding. Scintigraphy provides a reliable noninvasive test to screen patients in whom arteriography is being considered to localize active bleeding sites. If the arteriogram is negative, the scintigraphic findings alone may guide the surgical or arteriographic intervention. In addition, scintigraphy identifies two patient populations which have considerably different morbidity and mortality.

Adult↗
PubMed1982

Effects of oxidized cellulose and microfibrillar collagen on infection.

Topical hemostatic agents may be used to control bleeding from a variety of surgical sites. Oxidized cellulose (Surgicel), gelatin sponge (Gelfoam), and microfibrillar collagen (Avitene) are the hemostatic agents in widest use. Oxidized cellulose has previously been shown to be superior to gelatin sponge with respect to infection. Microfibrillar collagen has not been studied in this regard. Contamination of experimental wounds with an inoculum of 3.2 to 3.6 X 10(4) colony-forming units of Staphylococcus aureus did not produce any infection. The addition of 20 mg of oxidized cellulose to wounds that received the same level of bacterial contamination resulted in nine infected wounds of 20 (45%). When the wounds were treated with 20 mg of microfibrillar collagen prior to contamination, 18 of 20 (90%) developed infection. The observed difference between the two hemostatic agents was significant (P less than 0.008). When 5 and 10 mg of oxidized cellulose was added to experimentally contaminated wounds, infection did not ensue. The incidence of infection increased strikingly when the amount of oxidized cellulose employed was increased to 20 and 30 mg. No such dose effect was observed for microfibrillar collagen. Infection developed even when very small quantities of the agent were used. Both oxidized cellulose and microfibrillar collagen may promote infection. The present study, in which a subcutaneous wound model was used, suggests an advantage of oxidized cellulose as compared with microfibrillar collagen from the standpoint of infection. Further studies with these agents in other body sites seem warranted.

Animals↗
PubMed1982

Assessment of postoperative hearing in 528 middle ear and mastoid surgery cases in Tokai University Hospital.

The postoperative hearing results in cases of tympanoplasty, radical mastoidectomy, modified radical mastoidectomy and tympanoplasty combined with modified radical mastoidectomy on 528 ears, performed in the Tokai University Hospital between 1975 and 1980 were assessed. The assessment was based on pure-tone audiograms taken 3 months to 5 years after the operation. Out of 528 cases 70.5% gained better postoperative hearing, 6% showed no change of hearing and 23.5% showed deterioration of hearing. Auditory success of those who attained social hearing, air-bone gap closure to within 20dB or gained hearing of 20 dB or more was 53.4%. The results in cholesteatoma cases were poorer than those of non-cholesteatoma cases. In 44% of the cases, ossiculoplasty was performed, and the most successful ossiculoplasty results were obtained when the malleus was repositioned to the head of the stapes. Fairly good results were achieved when an artificial prosthesis, such as a Teflon-piston, Gelfoam-wire or platinum-piston, was used. The least successful results were found when the incus was transpositioned. In the non-ossiculoplasty group, type I tympanoplasty produced 59.5% auditory success whereas 37.3% auditory success was achieved in radical mastoidectomy. Better auditory success rates were obtained when the bony bridge was preserved than when it was removed. The results were identical in cases where the mastoid cavity was obliterated or when it was kept open. A new technique, "scutumplasty", was used for reconstructing the scutum. Revision surgery was required in only 3.4% of the cases.

Hearing↗
PubMed1980

[Therapeutic embolization in the external carotid artery region (author's transl)].

UNLABELLED: This paper reports our experience of therapeutic embolization in the external carotid artery region. Therapeutic embolization was done for the purpose of decreasing hemorrhage during operation. MATERIAL AND METHOD: Therapeutic embolization was done in 6 cases of meningioma, 1 case of capillary hemangioma of the cheek and one case of olfactory neuroblastoma. Catheterization was done through the common carotid artery in adults and done through the femoral artery in an infant. Small pieces of Gelfoam were used as emboli. Emboli, 1 X 1 X 0.5 mm in size, were instilled with normal saline. One embolus was used in one instillation as a rule. A larger embolus was used for occlusion of a larger artery. Heparin was not used through entire procedure. Four illustrative cases are presented. when a feeder of a tumor is occluded by artificial emboli, two kinds of effect can be resulted. when emboli lodge within the tumor or in a feeding artery distal to arterial anastomoses, blood is no longer supplied to the tumor (embolization effect). On the other hand, when a feeding artery is occluded by emboli at the point proximal to arterial anastomoses, blood supply to the tumor is transiently reduced but it is soon restored through arterial anastomoses (ligation effect). To minimize bleeding during surgery it is very important to gain embolization effect. For this purpose small emboli should be instilled repeatedly until embolization effect is established. Then ligation effect should be obtained, if necessary, by injection lower emboli. Operation was performed on the day following embolization in cases of meningioma. In a case of capillary hemangioma of the cheek operation was performed three days after embolization and in a case of olfactory neuroblastoma surgery was performed two days after embolization. In all cases the primary purpose to minimize bleeding during operation was achieved. No untoward side effects were encountered in this series. The ophthalmic artery may arise from the middle meningeal artery. The vertebral artery might be visualized through the collateral from the occipital artery. We should pay attention to these vascular anomalies before embolization to prevent possible catastrophe.

Aged↗
PubMed1980

Fatal outcome from emergency embolization of an intrahepatic aneurysm: a case report.

A 73-year-old man with a cholangiocarcinoma obstructing the hepatic duct is described. The patient was treated with percutaneous transhepatic catheter and bile duct endoprosthesis for internal drainage. This was complicated by an aneurysm of the liver, which was treated by embolization of the hepatic arteries with Gelfoam, causing an extensive liver necrosis which proved to be fatal.

Adenocarcinoma↗
PubMed1980

Paper patch repair of blast rupture of the tympanic membrane.

An hotel explosion provided a need to treat five blast ruptured tympanic membranes in four firemen. Treatment consisted of early debridement and eversion of tympanic membrane flaps, Gelfoam to support these flaps and the placement of a paper patch for immediate closure of the drumhead defect and to provide a plane for epithelial growth. Pre and postsurgical audiometry demonstrate the immediate rehabilitation of conductive hearing in these patients. In all cases, immediate improvement in symptoms of aural fullness occurred. Tympanic membrane defects healed with minimal scarring in each case. Early debridement and paper patch repair are recommended for blast-ruptured tympanic membranes.

Adult↗
PubMed1980

Therapeutic embolization in angiomas and tumors.

With reference to 4 treated patients, the possibilities of embolization are discussed. Gelfoam is the substance that can be used most easily, but it has only limited possibilities of application because of the chance of resorption. On several of the patients discussed, other substances were used, which appeared to have had a favorable effect on the result. To prevent nerve failure due to embolization, the vascularization of the nerves involved should be borne in mind.

Bucrylate↗
PubMed1980

[Angiographic embolization of renal tumors (author's transl)].

The authors present their experience with 38 cases of renal tumors which had angiographic embolization. Embolization is electively indicated as a preoperative procedure: the 4 divided by 5 days time lapse before the operation give rise to tissue modifications which permit a better resectability of the mass. Thus embolization achieves a good demarcation of the neoplastic mass from the surrounding tissues and reduces intraoperative bleeding. Emboli may be made of different materials like: fibrin sponge (Gelfoam), acrylic resin (Bucrylate) or steel (Gianturco coil). The association of both the steel coil and one of the other two types of emboli may be the method of choice. The metallic device is indicated for main vessel occlusion, while the others are more suitable for more peripheral branches. Selective or superselective catheterization in required for emboli introduction and care must be taken when occluding the renal artery to avoid reflux and to permit surgical clamping.

Catheterization↗
PubMedDate not supplied

Effect of heparin-binding growth factor-1 on bronchial healing in canine lung allograft transplantation.

Failure of airway healing complicates lung transplantation. Local application of heparin-binding growth factor-1 induces neovascularization in vivo. To determine the effect of direct application of heparin-binding growth factor-1 on bronchial healing, we performed single left lung allotransplantations in 12 dogs, and wrapped the bronchial anastomosis with Gelfoam impregnated with either recombinant heparin-binding growth factor-1 (100 micrograms, n = 6) or saline solution (n = 6) in a blinded fashion. After 21 days, the bronchial anastomosis was studied by gross examination, light and electron microscopy, bromodeoxyuridine uptake, measurement of bronchial breaking strength, and high-speed computerized tomography to assess bronchial cross-sectional area and distensibility. The transplanted lung was examined histologically for concomitant lung rejection. No significant difference was found between the two groups in histologic bronchial healing scores, proliferation index, bronchial breaking strength, cross-sectional area, anastomotic distensibility, or local blood flow as estimated by high-speed computerized tomography scan. In the growth factor group, both increased neovascularization and lung rejection were found at histologic evaluation. We conclude that, although the use of heparin-binding growth factor-1 increased perianastomotic neovascularization, it did not contribute to improved bronchial healing, possibly because of increased lung rejection.

Anastomosis, Surgical↗
PubMed1995

[Intrasellar arachnoid cyst: a case report].

Intrasellar arachnoid cyst is very rare. We report a case of intrasellar arachnoid cyst. A 44-year-old male was admitted for evaluation of his headache and visual disturbance on August 6, 1993. Neurological examination revealed bilateral decreased visual acuity and visual field defect. Endocrinological examination showed panhypopituitarism. Other neurological findings were normal. X-ray film of the skull showed a ballooning dilation of the sella turcica with thinning of the sellar floor. CT scan showed a cystic lesion with CSF-density occupied the sella. After intravenous administration of contrast medium, the cyst showed no enhancement. MRI showed the intrasellar mass had the same characteristics as the surrounding subarachnoid space. Bilateral carotid angiographies demonstrated that the carotid siphons were stretched and displaced laterally, and the A1 portions of the anterior cerebral arteries were raised. We made a diagnosis of intrasellar cystic lesion. On August 18, the sella turcica was opened via the transsphenoidal rhinoseptal approach. The cyst contained CSF-like fluid, and a part of the cyst wall was resected. The cavity was filled with Gelfoam and the sellar floor was repaired with bone flap. Postoperatively, the patient's visual disturbance improved, but diabetis insipidus appeared and required hormonal replacement. The patient was discharged on September 27 with improvement of visual acuity and visual field. Histological examination demonstrated that the cyst wall consisted of thick arachnoidal cells with fibrous connective tissue. The arachnoidal cells with oval nuclei was stained with epithelial membrane antigen. Symptoms, signs and radiological findings of intrasellar arachnoid cyst are similar to those of various sellar lesions including pituitary adenoma, craniopharyngioma, empty sella, Rathke's cleft cyst, epidermoid et al.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗