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PubMed2005

[Bronchial artery embolization with polyvinyl alcohol foam and gelatinum sponge for serious hemoptysis].

OBJECTIVE: To evaluate the effect of bronchial artery embolization (BAE) with polyvinyl alcohol (PVA) foam and gelatinum sponge (GS) for serious hemoptysis. METHOD: Of 46 patients with severe hemoptysis, BAE with only GS was performed in 21 cases and with both PVA and GS in 25 cases. RESULT: The total efficacy rate of BAE was 91.3%; and comparable between PVA+GS and GS groups (92.0%; vs 90.5%;, P>0.05). The total recurrence rate after BAE was 26.2%;, but lower in PVA+GS group than in GS group (11.3%; vs 42.1%;, P<0.05). No serious complications occurred in these patients after BAE. CONCLUSION: BAE is effective and safe for management of serious hemoptysis, and treatment with PVA+GS may effectively lower the recurrence rate.

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↗
PubMedDate not supplied

Long-term effects of FloSeal packing after endoscopic sinus surgery.

BACKGROUND: A previous study by our group showed increased adhesions and granulation tissue in ethmoid cavities packed with FloSeal (FS) compared with those packed with thrombin-soaked gelatin foam after endoscopic sinus surgery (ESS). That study included 20 patients whose cavities were graded 6-8 weeks postoperatively. The goal of this study was to report long-term follow-up on this cohort. METHODS: At least 1 year follow-up was available in 18/20 patients. The number of office procedures required to lyse adhesions during the follow-up period was tabulated also. Pathology was available from one patient who underwent lysis of adhesions on an FS side. The histopathological findings are presented. RESULTS: The mean follow-up period was 21.4 (+/- 2.3) months, and none of the 18 patients required revision ESS during this interval. The overall incidence of adhesions (p = 0.013) and the number requiring lysis of adhesions (p = 0.046) were both greater in the FS group. During the interval between previous study evaluation (6-8 weeks postop) and last follow-up, five FS sides required a total of seven procedures to lyse adhesions. Silent adhesions were observed in an additional five FS sides. Although asymptomatic adhesions were observed in two thrombin-soaked gelatin sides at last examination, none underwent lysis. Biopsy of an adhesion from a patient packed with FS 25 months earlier revealed incorporated foreign material. CONCLUSION: FS appears to be associated with scar tissue formation and may be incorporated into recovering mucosa. Use of FS may increase the degree of postoperative care required after ESS.

Cohort Studies↗
PubMed2005

Dobesilate is an angiogenesis inhibitor.

Aberrant angiogenesis is essential for the progression of solid tumors and hematological malignancies. Antiangiogenic therapy is one of the most promising approaches to treat such diseases. Dobesilate is an oral agent for treatment of vascular complications of diabetic retinopathy. We have examined the possibility that this compound could interfere with the process of angiogenesis in a mouse gelatine sponge assay using acidic fibroblast growth factor (aFGF) as an inducer of neovascularization. According to the results reported here, dobesilate remarkably reduced vessel ingrowth in aFGF-containing subcutaneous sponges in mice. These findings suggest that dobesilate could be an effective agent in the treatment of angiogenesis-dependent diseases involving FGFs.

Angiogenesis Inhibitors↗
PubMed2005

Post-traumatic high flow priapism percutaneously treated with transcatheter embolisation.

PURPOSE: The aim of this paper is to present our experience in the percutaneous management of high-flow priapism with transcatheter embolisation and gelfoam. MATERIALS AND METHODS: We present three clinical cases in which an acute trauma caused the development of high-flow priapism. After differing initial management, all cases underwent arteriography, followed by demonstration of the arterial-lacunar fistula and embolisation with gelfoam. RESULTS: Near immediate detumescence after the procedure confirmed the success of embolisation, which was supported by clinical and instrumental follow-up. DISCUSSION: In high-flow priapism, the best therapeutic solution remains transcatheter arterial embolisation, with ultra-selective catheterisation by microcatheter and embolisation of the pudendal artery only, which is responsible for the post-traumatic arterial-lacunar fistula. This manoeuvre is not always technically easy, and requires experience and remarkable dexterity. Technical failure is always possible owing to the spasm of a peripheral arteriole that cannot be resolved with papaverine, and to the possible rehabilitation by the downstream contralateral circulation. Furthermore, the apprehension of the operator carrying out the procedure in this anatomical context may make the immediate result seem satisfactory, even if it is not optimal. All these considerations stress the need for a rigorous clinical and instrumental follow-up to guide later diagnostic and therapeutic choices.

Adult↗
PubMed1992

[Prevention of peridural fibrosis following laminectomy. Apropos of a case of monoradicular paralysis due to an intracanalar hematoma on Gelfoam].

Gelfoam has routinely been used, according to Larroca and Macnab, to prevent scar formation about the dura mater and the nerve roots after laminectomy. We report a case in which postoperative monoradicular paralysis resulted from compression of the thecal cul-de-sac by a hematoma held in place by the Gelfoam. A review of the literature on prevention of adhesions after laminectomy is included.

Aged↗
PubMed2005

[Uterine artery embolization using gelatin sponge in a miniature pig: a study of arterial size and the distribution of embolic materials].

Uterine artery embolization using gelatin sponge particles was performed in a miniature pig, and the distribution of the particles was investigated. The particles spread in the cervix and proximal portion of the left horn. Histological study revealed embolic material in both the myometrium and endometrium. Several particles were found even in arteries smaller than 100 microm in diameter in the endometrium. Further studies should address the risks of gelatin sponge particles in the peripheral arteries of the uterine endometrium, as they may induce inflammatory processes and evoke complications including infection and menopause.

Animals↗
PubMed2005

[Value of mixed embolus transarterial chemoembolization in the treatment of hepatocellular carcinoma].

OBJECTIVE: To investigate the value of transarterial chemoembolization (TACE) using mixed emboli for hepatocellular carcinoma (HCC). METHODS: 188 patients with HCC were divided into two groups according to the treatment modality: 103 patients in group A treated by routine iodine embolus agent; 85 patients in group B by mixed iodine embolus agent (ultra-liquified iodinized oil + gelatin sponge + chemotherapeutic agents). The pattern of the arrested iodine deposition in the tumor, response, resectability during follow-up, pathological changes, survival and complications in the two groups were analyzed and compared. RESULTS: The pattern of full-and-dense iodine deposition in the tumor and the response rate (CR + PR) were 59.2% and 32.0% in group A, 89.4% and 56.5% in group B. Surgical resection after TACE was possible in 5.8% (6/103) of group A versus 15.3% (13/85) of group B. Complete tumor necrosis was observed in 1.0% and 4.7% in groups A and B, respectively. 1-, 2- and 3-year actual survival rates were 57.7%, 42.8% and 8.4% in group A, and 79.8%, 55.3%, 38.5% in group B. The difference in results between the two groups was statistically significant, however, the incidence of complication in the two groups was similar. CONCLUSION: Transarterial chemoembolization with mixed iodine emboli is more effective than with the routine iodine emboli in the treatment of bulky or nodular hepatocellular carcinoma rich in blood supply. Mixed iodine emboli is tolerable without increase in severe complications.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2006

Inadvertent foreign body embolization in diagnostic and therapeutic cerebral angiography.

BACKGROUND AND PURPOSE: Inadvertent foreign body embolization is a rarely diagnosed and neglected complication of cerebral angiography that has not been studied systematically. METHODS: We undertook a comprehensive 5-year retrospective study of all available postmortem cases of postangiographic neurologic complications, as well as a comprehensive histologic examination of all surgically resected central nervous system arteriovenous malformations, at our institution. RESULTS: Among the autopsy series, we found 3 patients for whom cerebral infarction, sometimes catastrophic, is attributable to inadvertent cotton fiber, Gelfoam, or polyvinyl alcohol particulate emboli during cerebral angiography. All cases described had concurrent atherosclerotic vascular disease. Particulate embolization, which is usually cotton fiber, is present in as many as 25% of resected arteriovenous malformations: the risk of finding such emboli is in part dependent on a history of prior interventional (as opposed to diagnostic) angiographic procedures. It is not surprising that the amount of tissue examined also increases the risk of finding such emboli. CONCLUSIONS: Unintentional foreign body emboli remain common in modern angiographic practice and are probably underappreciated clinically. Although such emboli are usually asymptomatic, they can be clinically devastating, and a high index of suspicion is required for diagnosis. Foreign body emboli should be included in the differential diagnosis of postangiographic ischemia or infarction.

Cerebral Angiography↗
PubMedDate not supplied

Transcatheter oily chemoembolization for the treatment of large hepatocellular carcinoma with an accompanying tumor thrombus in the right main branch of the portal vein and arterioportal shunting: report of one patient still surviving after more than seven years.

A patient having a large hepatocellular carcinoma with an accompanying tumor thrombus in the right main branch of the portal vein and arterioportal shunting was treated with transcatheter oily chemoembolization with adriamycin emulsion in Lipiodol plus Gelfoam. The whole right hepatic lobe regressed together with the tumor, and the tumor thrombus in the portal vein disappeared. The patient is still alive more than seven years after the treatment, with normal levels of alpha-fetoprotein. The response of this patient is interesting in discussing potential indications for therapy.

Atrophy↗
PubMedDate not supplied

Biloma following transcatheter oily chemoembolization.

Hepatic biloma (bile cyst) developed in a patient after transcatheter oily chemoembolization (TOCE) with Lipiodol for hepatocellular carcinoma. The patient was treated conservatively and underwent the next TOCE uneventfully. An inappropriately large dose of Lipiodol, anticancer agent, and Gelfoam can induce biloma; however, it is not reasonable to abstain from TOCE for hepatocellular carcinoma in fear of biloma.

Bile↗
PubMedDate not supplied

[Haemorrhagic complications in thyroid surgery. Control of bleeding from retroneural vessels using collagen and thrombin gelatine granules].

They conclude that numerous factors contribute towards causing haemorragic complications, such as the technique used for haemostasis, the drainage, and the haemorragic risk factors presented by the individual patient. Prevention of bleeding, however, will depend essentially on the surgeon's experience and the precautions he takes. Of particular interest is the use of FloSeal (collagen and thrombin gelatine) to treat bleeding from retroneural arterial vessels, wich has often been seen to pose a serious problem for the surgeon. The results obtained in the case series described confirm the validity of this haemostatic sealant (arrest of bleeding in 100% of treated patients).

Adult↗
PubMed2006

Computed tomography and angiographic interventional features of ruptured hepatocellular carcinoma: pictorial essay.

Spontaneous rupture is an uncommon and potentially fatal complication of hepatocellular carcinoma (HCC), occurring in approximately 15% of patients with HCC in Asia and 3% in the United Kingdom.3 The prognosis for hemorrhage of HCC is poor, particularly in those patients with underlying cirrhosis and severe coagulopathy. Computed tomography (CT) rather than angiography is the first-line modality for the detection of rupture. CT can confirm the diagnosis of ruptured HCC and can also help in assessing other organs if the diagnosis is not clear prior to imaging. It allows for an assessment of the entire liver, including the portal vein, which aids in determining the feasibility of embolization and resection. Since the rate of bleeding must normally exceed 1 mL/min before it can be detected on angiography and the extravasation of contrast is present in less than 20% of cases, CT is a more helpful modality. The optimal CT protocol for this condition is triphasic: the precontrast phase allows for assessment of ethiodized oil (lipiodol) uptake, the arterial phase demonstrates enhancement of the mass, and the portal venous phase allows for assessment of the portal veins. Various treatment options have been proposed: transarterial catheter embolization (TACE), emergency liver resection, and delayed resection. Surgical treatment is difficult, if not impossible. In most cases, rupture is a result of diffuse intrahepatic spread of the tumour and underlying liver cirrhosis. Many authors have concluded that a multidisciplinary management that includes TACE as the primary procedure followed by a delayed resection is the preferred treatment. This pictorial essay reviews the radiologic features of spontaneously ruptured HCC on CT imaging and of treatment by angiography.

Adult↗
PubMed2006

[Arterial injury associated with tension-free vaginal tape procedure successfully treated by radiological embolization: a case report].

A 75-year-old woman underwent a tension-free vaginal tape (TVT) procedure for urinary stress incontinence. The patient complained of lower abdominal pain, a feeling of lower abdominal distension and nausea three hours after the operation. In addition, systolic blood pressure decreased gradually to 80 mmHg. Enhanced computed tomography revealed a retropubic hematoma sized up to 16 cm X 12 cm X 11 cm and bleeding from a vessel running through the posterosuperior aspect of the pubic bone. Successively, arteriography was performed. The arteriogram also confirmed arterial injury, which was successfully treated by selective embolization using a gelatin sponge and pushable coils. Postoperative course was uneventful requiring neither blood transfusion nor surgical removal of the hematoma.

Aged↗
PubMed2007

[New porous gelatin particles for hepatic arterial embolization--investigation of passage through current microcatheters].

Hepatic arterial embolization (HAE) has been widely performed for unresectable hepatocellular carcinoma (HCC) in a selective manner using a microcatheter. Gelatin sponge is exclusively used as an embolic agent, though it has not yet been approved for an arterial blockade. Recently, new porous gelatin particles (GP) have been approved and are clinically available. In this study, passage of GP through microcatheters was investigated, as it is an important requirement for a new agent. Both 1-mm and 2-mm GP were injected through each of six current 2.0 Fr-2.7 Fr microcatheters by five board-certified interventional radiologists. In general, use of a 2.5 mL lock syringe was associated with higher subjective resistance score (5-10/10), longer injection time (20-30 sec), and lower injection pressure (1.0-2.5 MPa) with difficulty. When it was impossible to inject GP with a 2.5-mL lock syringe,injection was retested with a 1 mL lock syringe resulting in lower resistance score (1-6), shorter injection time (6-10 sec), and higher injection pressure (1.5-2.5 MPa) regardless of particle size. Thus,it is recommended to use a 1 mL lock syringe for injection of GP through a microcatheter. After passing through a 2.0 Fr microcatheter, 2 mm particles showed no significant deformation or fragmentation under observation by stereomicroscopy.

Catheterization↗
PubMed1991

[Splenic embolization therapy of idiopathic thrombocytopenic purpura].

21 patients with chronic idiopathic thrombocytopenic purpura (ITP) and 3 patients with Evan's syndrome underwent partial splenic embolization (PSE). 22 patients underwent PSE once, while 2 patients were treated twice, thus a total of 26 procedures were carried out. Follow-up 3 months after embolization was available in all the 24 patients for their response to embolization therapy. 16 patients (67%) achieved complete remission (platelets greater than 100 x 10(9)/L) and 4 (17%) partial remission (platelets greater than 84 x 10(9)/L) after splenic embolization. A total efficacy rate of 83% was observed. This response to embolization after transcatheter vessel occlusion 3 months after is similar to the reported results of splenectomy. Not only may the morbidity and mortality associated with surgical splenectomy be avoided, but also the noninfarcted spleen may continue to provide immunologic functions. The most important experience in this series, however, was the emphasis on partial (60-70%) rather than total splenic arterial embolization. The sequestration site of platelets was associated with the outcome of splenic embolization. More splenic sequestration sites were found in responders, to the therapy.

Adolescent↗