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PubMed1994

Splenorrhaphy versus splenectomy.

Splenorrhaphy is considered a safety procedure in the traumatic splenic injury and should be attempted in all patients except when the spleen is shattered, or avulsed and in multiple concomitant injuries where splenectomy is advised. We report on 16 patients of traumatic splenic injuries from January 1988 to December 1988. In 10 patients (62.2%) splenorrhaphy was performed with catgut and omental patch reinforcement in addition to topical haemostatic synthetic material "Gelfoam" application with mortality of 10% due to unrelated causes. Splenectomy was performed in 6 patients (37.8%) with mortality of 2 patients (33.3%) due to multiple associated intra-abdominal injuries.

Adolescent↗
PubMed1993

Palliative treatment of hepatocellular carcinoma with transcatheter arterial embolization.

Thirty-three consecutive patients with previously untreated hepatocellular carcinoma (HCC) and 6 patients with recurrent HCC were treated with transcatheter arterial embolization (TAE). The patients were not eligible for surgical resection or percutaneous ethanol injection. TAE was performed with Lipiodol Ultra-Fluid, epidoxorubicin and Gelfoam, with a mean of 1.7 treatments per patient. CT was performed 15 days after TAE. The mean cumulative survival was 14.2 months in patients with previously untreated HCC. The survival of patients stages Okuda I and II did not differ significantly (p > 0.05); tumor size did not affect survival (p > 0.05). Two patients with recurrent HCC died 7.0 and 9.3 months after the diagnosis of tumor recurrence; the remaining 4 patients are still alive with a maximum follow-up of 22.5 months from the diagnosis of HCC recurrence. Ten complications occurred in 8 patients, and were controlled by medical therapy. Eleven patients died during the study; no death was related to TAE. The series was not randomized, but comparison with the natural history of HCC suggests that TAE is effective as palliative treatment of advanced or recurrent HCC.

Aged↗
PubMed1994

[Hepatic arterial infusion chemotherapy and embolization in the treatment of hepatic carcinoma].

From September 1988 to Dec. 1991, 160 patients, in moderate and advanced stages of hepatic carcinoma were treated with hepatic arterial infusion chemotherapy and embolization. Among them, 64.3% was of massive type, 26.5% of nodular type and 9.1% of diffuse infiltrating type. In most of the cases, the tumor was rich in blood vasculature. Tumor thrombus in the portal vessels and artero--venous fistula were common. The size of tumors were 3cm to 24cm. Most of the tumors decreased in size after treatment. In 132 pts followed-up for six to fifty-one months the one-year survival rate was 10.8% in the Hepatic Artery Infusion group, and 41.9% in the Hepatic Artery Infusion+Hepatic Artery Embolization Iodized Oil Gelfoam group. The longest survival period was 51 months after initial Hepatic Artery Iodized Oil and Hepatic Artery Embolization. Factors influencing therapeutic effects were; (1) stage of the tumor. (2) tumor thrombus in the portal vein. (3) methods of Hepatic Artery Infusion and Hepatic Artery Embolization. (4) selection of embolic material. (5) development of collateral circulation.

Adult↗
PubMed1995

Laparoscopic liver biopsy in patients with coagulopathy, portal hypertension, and ascites.

The safety, reliability, and technique of laparoscopic liver biopsy were evaluated in 22 consecutive patients with coagulation abnormalities who were considered high risk for standard percutaneous liver biopsy. Fifty-eight biopsies were performed in 15 men and seven women. All patients had a prolonged prothrombin time (> 13.5 seconds), bleeding time (> 9 minutes), or thrombocytopenia (< 100,000 TH/UL). Ten patients (45%) had more pronounced coagulation abnormalities defined as a prolonged PT > 2.5 seconds or < or = 30% control, platelet count < 50,000 TH/UL, or bleeding time twice normal. Thirteen patients (59%) had both thrombocytopenia and a prolonged PT. Ascites was present in 19 patients (86%) and portal hypertension in 16 (73%). Laparoscopic liver biopsy was performed under general anesthesia, most commonly using two trocar sites and an open laparoscopic technique. Hemostasis was most effectively obtained by application of direct pressure and topical gelfoam and thrombin. A postoperative drop in hemoglobin of > or = 1 gm per cent occurred in four patients. One patient required laparotomy for postoperative bleeding and was the only patient requiring transfusion of red blood cells. Other complications included two minor ascitic leaks, one small subcapsular hematoma, and one wound infection. In conclusion, laparoscopic liver biopsy can be performed safely and reliably in patients with conditions contraindicating percutaneous biopsy.

Adult↗
PubMed1995

Retrievable, replaceable, macroencapsulated pancreatic islet xenografts. Long-term engraftment without immunosuppression.

Prevention of rejection and prolongation of graft survival are critical to achieving successful islet cell transplantation. Various techniques have been utilized to prolong graft survival. Recently, protection of pancreatic islets from host immune mechanisms by isolating the islets in artificial membranes has emerged as an attractive alternative to the use of immunosuppression. In this Rapid Communication, we describe a novel method for macroencapsulation of rat islets in hydrophilic macrobeads made with various combinations of agarose, collagen, and Gelfoam. Encapsulated xenotypic islets were placed intraperitoneally in mice in which diabetes was induced by streptozotocin. The encapsulated xenografts maintained normoglycemia > 170 days. Recipients mice had normal glucose tolerance tests, which indicates that the islets in the macrobeads were functioning as they would in an intact pancreas. Macrobeads retrieved up to 103 days after transplantation showed no evidence of tissue reaction or local inflammation. These retrieved macrobeads could also be retransplanted and replaced. Our studies indicate that the agarose-collagen/Gelfoam macrobeads we have developed serve both to protect islet xenografts from rejection and to provide a microenvironment in which the islets maintain and support their normal function in vivo. Because they may be retrieved after implantation and replaced, these macrobeads may be suitable for human clinical islet cell xenotransplantation.

Animals↗
PubMed1995

Regulation of astrocyte proliferation by FGF-2 and heparan sulfate in vivo.

The goal of this study was to examine the ability of basic fibroblast growth factor (FGF-2) to promote reactivity and/or proliferation of astrocytes in vivo following brain injury, and the possible mechanisms involved. A small bilateral lesion in the motor-sensory cortex was performed, and either FGF-2, FGF-2 plus heparan sulfate, heparan sulfate, or saline was applied unilaterally in a piece of Gelfoam within the wound cavity. Following lesions, there was an increase in FGF-2 and FGF receptor (FGFR) immunoreactivities in the area surrounding the lesion in all the treatment groups. Rats that received treatment with recombinant FGF-2 alone showed an increase in the density of astrocytes as compared to the control group. The same group of rats exhibited an increase in the density of cells displaying FGF-2 immunoreactivity and cells displaying FGFR-1 immunoreactivity and cells displaying FGFR-1 immunoreactivity, and also an induction of FGF-2 mRNA in the tissue surrounding the lesion. The group of rats that received FGF-2 combined with heparan sulfate showed a larger increase in the same cellular parameters. Our results suggest that the FGF-2/FGFR system is involved in the regulation of astrocytic reactivity and/or proliferation in the brain and its action is potentiated by heparan sulfate. The action of FGF-2 on CNS injury appears to be part of an autocrine cascade that involves induction of FGF-2 and its receptor, thereby enhancing the ability of astrocytes to respond to FGF-2.

Animals↗
PubMed1994

[Chemoembolization and posterior liver transplantation as therapeutic strategy for hepatocarcinoma].

Orthotopic Liver Transplantation (OLT) is the only surgical approach to non-resectable hepatocellular carcinoma (HCC) but, so far its results has been poor. During 41 months 112 patients underwent 123 OLT, nine of them had HCC over cirrhosis with a mean age 60 years. The etiology of cirrhosis was: alcohol in 1 and viral hepatitis in 8. Child's grade: A in 4, B in 5. HCC was: 5 cm or less in 5 and more in 4. According pTNM staging: I in one, II in 5, II in 2 and IVb in 1. Differentiation degree: low in 1, moderate in 4, and well in 3 (one case with complete necrosis after embolization). Eight patients were previously embolized with lipiodol, adriamycin and gelfoam, obtaining central necrosis without viable features in periphery. There were no postoperative deaths, and all the patients were discharged from the hospital. During follow up, 3 recurrences were observed, one massive with death of the patient after 6 months, and the other was surgically removed (segmentectomy V, VI) after 4 months after OLT without recurrence at 18 months of resection. In the third case a focal lesions was detected in the U.S. and T.C. study, 4 months after OLT, but in wasn't possible to obtain a biopsy because its posterior location; no treatment was made, and she's alive today. In conclusion, OLT is a good surgical option for non resectable HCC complicating cirrhosis if the patient is adequately selected. Chemoembolization has a good local effect, obtaining tumoral necrosis, but it does not decrease the posterior growth of the tumor in other localizations.

Aged↗
PubMed1994

[A case of fistula-cancer response to arterial chemoembolization].

Arterial chemoembolization was performed three times preoperatively for cancer associated with fistula-in-ano for diminishing the postoperative surgical tissue defect of the perineum. Partial response of the tumor to this treatment was confirmed by computed tomography. A sixty-two-year-old male patient recognized a mass in the perineum one and a half years ago. He had suffered from fistula-in-ano for thirty years. The mass increased its size and formed a tumor in the bilateral buttocks (12 x 9 cm and 9 x 9 cm in diameter). Biopsy specimen showed a moderately differentiated adenocarcinoma. Angiography showed a hypervascular tumor stain. The main feeders to the tumor were the superior rectal artery and bilateral internal iliac artery. Arterial chemoembolization was performed three times through the right and left internal iliac artery with Gelfoam particle. Arterial infusion chemotherapy was added through inferior mesenteric artery and bilateral internal iliac artery with a total 120 mg of adriamycin and 1,500 mg of 5-FU simultaneously. The tumor decreased in size to 44% of the preoperative size by the treatment. A radical operation was performed following the preoperative treatment. Preoperative arterial chemoembolization for cancer associated fistula-in-ano was considered to be helpful for local control.

Adenocarcinoma↗
PubMed1994

Ultrastructural changes of the vestibular sensory organs after streptomycin application on the lateral canal.

Early changes in the vestibular sense organs resulting from the application of a streptomycin sulfate soaked Gelfoam pledget on the fenestra of the lateral semicircular canal were studied by transmission and scanning electron microscopy. Three days after the application, lesions were present in the central part of the lateral crista. The type I sensory cells were more affected than the type II cells. These sensory cells showed mitochondrial swelling, cytoplasm protrusion at the cell apex, inclusion of multiple vacuoles, fusion or loss of stereocilia, and pyknotic nuclei. Seven days after the drug application, the sensory cell damage extended to all three cristae and macula utriculi. The lesions were very extensive after ten days and the sensory cells had almost equally disappeared in all three cristae; the lesion in the macula utriculi was smaller and the macula sacculi was unaffected. At fourteen days, the lesions appeared less severe. Thus, a single application of a small amount of streptomycin on the lateral canal fenestra affected all vestibular sense organs, except the saccule, in a short time. The strong affinity of aminoglycosides for the cristae suggests possible entrapment of the drug at the ampullae. This local drug application technique to the canal will be useful in studying vestibular function in animals, and it is applicable to controlling severe vestibular symptoms in human patients.

Animals↗
PubMed1994

[The treatment of hepatocellular carcinoma by chemoembolization].

One hundred and fourteen consecutive patients with unresectable hepatocellular carcinoma were treated by chemoembolization using ethiodized oil (Lipiodol), anticancer agents. Ninety patients had concomitant chronic liver disease. Hepatocellular carcinoma (HCC) was diagnosed by US, contrast enhanced CT, fine needle biopsy and alpha-feto-protein level. Admission criteria were as follows: tumor confined to the liver with or without hilar nodal involvement, Child class A or B, white blood cell count above 2.000/mmc and platelet count above 75,000/mmc. All the patients underwent angiographic chemoembolization with Lipiodol and anticancer agents. In 98 patients we performed transcatheter hepatic arterial embolization (TAE) with Gelfoam or for Ivalon sponge. In 16 patients TAE was not performed because of portal thrombosis (7 cases) or technical reasons (9 cases). Mitomycin was used in 40 patients and dihydroxyanthracenedione (DADH) in 58 patients. In the TAE group 83 patients were Child A and 15 Child B. In 27 patients HCC was mononodular whereas in 71 it was multinodular. In 41 patients the tumor was more than 5 cm in diameter (in multinodular tumors only the larger lesion was taken into account). In 56 patients chemoembolization plus TAE was repeated. Seven patients died within one month after treatment: two from myocardial infarction, two from liver failure, two from digestive haemorrhage and one from necrotizing pancreatitis. Long-term survival rates were investigated in relation to prognostic factors: anti-cancer agent, number of nodes, tumor size and Child stage using Kaplan-Meier method. Survival rate at 12, 24 and 36 months are 64%, 38%, and 30% respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetamides↗
PubMed1994

Update of reparative granuloma: survey of the American Otological Society and the American Neurotology Society.

Members of the American Otological Society and the American Neurotology Society were polled regarding stapes surgery and reparative granuloma. Of 467 questionnaires, 176 (38%) were returned, and 319,410 stapes cases were statistically analyzed: 329 reparative granulomas were reported after stapedectomy (incidence = 0.1%) and 29 after stapedotomy (incidence = 0.07%); 77 surgeons reported having encountered at least one reparative granuloma; and 50 surgeons related the occurrence of a reparative granuloma to a specific graft material. Gelfoam was the most common graft material reported when a reparative granuloma was encountered, followed by fat, and vertigo was the most frequently reported presenting symptom. Reported operative techniques as well as manifestations, management, and outcome are discussed.

Adult↗
PubMed1994

A technique of measuring the precision of an MR-guided stereotaxic installation using anatomic specimens.

PURPOSE: To develop a method for direct measurement, using anatomic specimens, of the precision of MR-guided stereotaxic location and to describe its application to a 1.5-T MR unit with a Leksell stereotaxic frame. METHODS: Small pieces of gelfoam (1 X 1 X 1 mm), soaked in gadopentetate dimeglumine, were stereotaxically introduced into formalin-fixed human heads using a Leksell D (three experiments) or G (nine experiments) stereotaxic frame. The head and the frame were then introduced into a 1.5-T MR unit. The target coordinates (as set on the stereotaxic frame by one investigator) were then compared with the MR-determined stereotaxic coordinates (calculated independently by another investigator). The imprecisions Ex, Ey, and Ez in each direction were defined as the differences between the calculated and the chosen coordinates. RESULTS: Regarding the three targets studied with the D frame, mean imprecision Ex was 1.08 +/- 0.50 mm (mean +/- SEM), Ey 0.83 +/- 0.58 mm, and Ez 0.75 +/- 0.25 mm. For the nine targets studied with the G frame, Ex was 0.48 +/- 0.17 mm, Ey 0.69 +/- 0.14 mm, and Ez 0.82 +/- 0.13 mm. Statistical analysis of the results showed no significant difference between Ex or Ey and half the size of a pixel, indicating that, in the axial plane, stereotaxic MR precision is limited only by pixel size. A statistically significant difference was observed in the coronal plane between Ez and half the size of a pixel, but it must be stressed that Ez remained smaller than 1 mm. CONCLUSION: MR-guided stereotaxic location can be used with confidence for most diagnostic, functional, and therapeutic procedures.

Calibration↗
PubMed1993

[Congenital arteriovenous malformation of the kidney: report of two cases--detection by digital subtraction angiography with carbon dioxide].

Two cases of arteriovenous malformation of the kidney were reported. The first case was a 19-year-old female, complaining of right flank pain and gross hematuria. Right selective renal arteriography revealed a 2 x 1.5 cm large cisoid type arteriovenous malformation at the most distal region of the lower branch of the renal artery. Transcatheter embolization, using Gelfoam and absolute ethanol, was successfully done, which was confirmed with repeated digital subtraction angiography with carbon dioxide (CO2-DSA). The second patient was a 55-year-old female with past history of right idiopathic renal bleeding, complaining of right flank colicky pain and gross hematuria. Right selective renal arteriography was done without any pathological findings, while CO2-DSA documented an arteriovenous malformation in the hilar region. Transcatheter embolization was not done, because the malformation seemed to be proximally located. Thus CO2-DSA was thought to be a reliable method in the diagnosis of arteriovenous fistula.

Adult↗
PubMed1993

[A simplified technique for decerebrating rats].

A simple and effective technique is described for decerebration of rat. The brain tissue at the precollicular level was gently and slowly aspirated. The two cut surfaces of the brainstem were covered with small pieces of gelfoam sponge or cotton balls soaked in thrombin solution. No ligation or clamp of the common carotid arteries of their branches was performed. After decerebration with this technique, the respiration rate, the heart rate and the mean femoral arterial pressure of the animals were stable for more than 10 hours. Successful intracellular recordings and labelings of medullary respiratory neurons were obtained from this type of preparation of rat. The technique for decerebrating rats described here may be used for acute experiments in which brainstem regulatory functions are investigated.

Animals↗
PubMed1993

[Lipiodol chemoembolization in the treatment of hepatic carcinoma. Our experience].

Of the alternative methods of treatment to surgery in the treatment of liver cancer, chemoembolization with Lipiodol appears to have obtained encouraging results. After a preoperative study to confirm the diagnosis and staging of the tumour, lipiodolisation is performed: a mix of Adriamycin, Iopamidol and Lipiodol is injected using selective catheterism of the hepatic artery; gelfoam is then added. Lipiodol selectively localises in the hepatocarcinoma and has a distal embolising effect on the vessels of the tumour, thus necrotising it, acting as a carrier for chemotherapy. Since july 1990 a total of 15 hepatocarcinoma have been observed: 6 in healthy livers and 9 in cirrhotic livers; 3 patients recovered after radical surgery, 1 patient underwent associated surgery and chemoembolization, whereas in 11 the only therapy was chemoembolization, at six monthly intervals. Lipiodolisation enabled a better diagnosis to be made and was found to be a valuable therapeutic aid both when used alone in Inoperable patients and in association with non-radical surgery.

Carcinoma, Hepatocellular↗
PubMedDate not supplied

Efficacy of emulsion containing Gd-DTPA and lipiodol in hepatic transcatheter arterial embolization.

We evaluated the clinical efficacy of an embolizing emulsion produced by mixing lipiodol and Gd-DTPA, in transcatheter arterial chemoembolization (TAE). Subjects were 10 patients with hepatocellular carcinoma (HCC). The emulsion used was produced by mixing 3 ml of lipiodol and anticancer agents (mitomycin-C 10 mg and adriamycin 20 mg) dissolved in Gd-DTPA. This emulsion was infused into the proper hepatic artery. Subsequent embolization by Gelfoam was performed in eight patients. MRI and CT examinations were performed soon after TAE (1 or 2 days after) and two weeks afterwards. The position of lipiodol accumulation dipicted on CT at two weeks after TAE did not differ from the site of change in signal intensity induced by Gd-DTPA on MR images soon after TAE in any case. In almost all cases, the washout of Gd-DTPA occurred earlier than that of lipiodol. It might be suggested that Gd-DTPA, which is water-soluble, shows in vivo dynamics similar to anticancer agents rather than to lipiodol, which is oil-soluble. Since the normal tissues showed no definite signal changes, we could easily detect the site of tumors by using the emulsion containing Gd-DTPA even on MR studies immediately after TAE. In addition, the deposits of Gd-DTPA depicted on MR images created fewer artifacts than the lipiodol deposits on CT.

Adult↗
PubMed1993

Stapedectomy technique.

This article reviews the evolution of the author's stapedectomy technique from total footplate removal with single loop wire prosthesis and Gelfoam seal to small fenestra stapedectomy with platinum ribbon piston prosthesis and blood seal. The author concludes that the microdrill is effective, safe, and cost effective for performing this procedure. Since using this technique, the author has had no cases of sensorineural hearing loss and few complaints of dizziness or vertigo.

Fenestration, Labyrinth↗
PubMed1993

Debulking surgery and arterial embolization for unresectable liver cancer.

Hepatocellular carcinomas measuring less than 5 cm in diameter became completely necrotic after arterial chemoembolization with Lipiodol, doxorubicin, and gelfoam more often than larger lesions. In 60 patients, we surgically debulked large unresectable tumors, with the aim of subsequently embolizing residual small tumors transarterially. Forty-seven patients were actually embolized. The rate of major non-fatal complications was similar to that seen after radical resections, but the hospital mortality rate was 30%, as compared with 4%. Stage I disease, including non-embolized patients and hospital mortality, had an estimated 5-year survival rate of 27%. This result approached that obtained after curative resections, and was better than that seen after embolization only. Stage II disease had no five-year survivors and its survival curve was intermediate, lying between those of curatively resected and embolization patients. No stage I patients with tumor growth in the portal trunk or lobar branches survived for 2 years. The results warrant further study of this treatment strategy.

Adult↗