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PubMed1993

[Treatment of hepatocellular carcinoma by transarterial approach].

125 cases of hepatocellular carcinoma (HCC) were treated by transarterial approach. Of these cases, 25 cases were treated by transarterial infusion of anticarcinogens (TAI), 44 by transarterial infusion of the emulsion of anticarcinogens and ultra fluid lipiodol (LP-TAE), 57 by LP-TAE combined with gelfoam sponge particle embolization (LP-TAE + GS), and 4 by LP-TAE plus surgical resection (LP-TAE + SU), and 41 cases (32.8%) survived more than 2 years, and 28 (22%) were alive with nonviable tumors. The survival rate (SR) of small expansive tumors was 75%, large expansive tumors 39%, diffusive (multifocal and infiltrative) tumors 0%, expansive tumors with diameter of 5-10cm 44%, > 10cm 31%. The SR of hypervascular tumors was 38% and hypovascular tumor 5%. The SR of the tumors with numerous small caliber vessels and deep staining 83%, with draining vein of wide caliber 28%, and with A-V shunt 0%. The SR of the tumors with portal venous tumor thrombi was 2.7% and those without 78%. The SR of the patients classified as grade A of Child's system was 58%, B 32% and C 0%, and that of the patients treated with LP-TAE + GS and LP-TAE + Su wa 65% and 75.0% respectively. The SR of the patients treated 1, 2 and 3 times was 33%, 74% and 75% respectively.

Adolescent↗
PubMed1993

[Transcatheter arterial chemoembolization to hepatic metastases from colorectal cancer].

Response of transcatheter arterial chemoembolization (TAE) and transcatheter arterial infusion chemotherapy to hepatic metastases was reported in 25 cases of colorectal cancer. The severity of liver metastases was H1 in 12 cases, H2 in 9 cases, and H3 in 4 cases. Liver metastases were found during surgery in 12 of these patients, and 13 showed metastases or recurrence in the liver after resections of primary lesions. Catheters were inserted selectively to the proper hepatic artery by Seldinger's method, followed by injection of embolizing agents (gelfoam particles of Lipiodol) with adriamycin or 5-FU + leucovorin in most cases. Response was assessed by blood CEA levels, diagnostic imaging, and period of survival. In 5 cases in whom liver resections were performed following TAE, response was assessed by histopathological findings of the resected specimens. Two patients showed partial response (PR), 12 no change (NC) and 11 progressive disease (PD) by diagnostic imaging. Blood CEA levels fell to less than 50% of pre-treatment levels in 26% of cases. Histological changes by TAE were confirmed in 4 of 5 cases after liver resections, but viable cancer cells were observed in all cases. A case of mucinous cancer showed no change histologically. As the other case of mucinous cancer showed PD by diagnostic imaging, TAE was not suggested to be suitable to treat cases of mucinous cancer. More improvements in the dosage, drugs and times of treatment were suggested to yield a better response rate in TAE therapy for liver metastases from colorectal cancer.

Adult↗
PubMed1977

Embolization of the hypogastric arteries in the control of massive vaginal hemorrhage.

Percutaneous, transcatheter Gelfoam embolization of the hypogastric arteries was utilized in a patient to control vaginal hemorrhage secondary to far-advanced carcinoma of the cervix. The advantages of this method are outlined, and consideration of its use is recommended for patients in similar situations. The various types of particulate material used in transcatheter embolization and the situations in which they have been used are reviewed.

Adult↗
PubMed1993

[Embolization of the internal maxillary artery for severe epistaxis--including an experience of the approach from the superficial temporal artery].

Six cases of severe epistaxis were treated with the super-selective intraarterial embolization of the internal maxillary artery. Tens of fragments of Gelfoam were delivered into the distal internal maxillary artery and, additionally, embolized by several pieces of the coils. In a case with cerebral infraction, catheter was inserted via the superficial temporal artery. There were no complications due to these procedures in all cases of this study. It is considered that therapeutic intraarterial embolization of the internal maxillary artery is an effective therapy for severe epistaxis and the superficial temporal artery approach is useful for selected cases.

Aged↗
PubMedDate not supplied

MR of the pituitary gland postsurgery: serial MR studies following transsphenoidal resection.

PURPOSE: To determine the MR appearance of the pituitary gland in the early and late postoperative periods in order to distinguish operative complications more effectively and to establish a postoperative baseline. METHODS: Ten patients were prospectively studied with MR following transsphenoidal resection of a pituitary tumor. Early postoperative studies were obtained at 2 to 8 days following surgery, late studies at 4 to 9 months in all patients and also at 12 to 16 months in five. Major observations were height of the pituitary mass and appearance of the surgical packing. RESULTS: Within 8 days following surgery, the height of the pituitary mass was unchanged in two cases, increased in three, and only minimally decreased in five. All decreased in height (average 54%) by 4 to 9 months. Gelfoam packing completely (five) or nearly completely (three) resorbed leaving a normal-size, although deformed, pituitary gland. Fat-packed resection defects persisted (two). CONCLUSIONS: In the early postoperative period, the appearance of the pituitary gland is similar in size to its preoperative appearance. Subsequent involution with packing resorption yields a smaller, deformed pituitary gland.

Adenoma↗
PubMed1977

[Successful intra-arterial embolization of bleeding carcinoma of the prostate (author's transl)].

The very first case of successful therapeutic embolization for hematuria from carcinoma of the prostate is presented. In a 76-year-old patient with necrotic carcinoma of the prostate, stage D transurethral operations showed no success. By selective intra-arterial embolization via the internal iliac arteries (using Gelfoam), hematuria could be stopped definitely and did not occur any more. Follow-up study showed no complications or necrosis in this procedure.

Aged↗
PubMed1995

Embolisation of bleeding pelvic lesions from benign origin--long-term results.

Long-term outcome and survival after emergency embolisation of life-threatening bleeding caused by non-malignant small pelvic lesions were analysed and related to the techniques and embolisation materials used. Emergency transcatheter embolisation was performed in 11 patients, heavily bleeding from uterine arteriovenous malformations (4 patients), pelvic fractures (4 patients), Endoxan induced cystitis (1 patient), haemorrhoids (1 patient) and polyposis recti (1 patient) using GAW-coils. Ethibloc and Gelfoam strips as embolisation materials, alone or in combination. Follow-up was obtained up to 7.5 years with analysis of survival. Only in one patient, with terminal hepatic insufficiency and severe disturbance of coagulation, recurrent bleeding occurred 1 month after embolisation. Two other patients died during follow-up for other reasons (cardiac insufficiency at 17 months, ileus at 52 months). Complications in relation to the embolisation therapy did not occur. In conclusion, percutaneous transcatheter embolisation is a safe and effective procedure in severe hemorrhage resulting from non-malignant lesions of the pelvis.

Adult↗
PubMed1995

[Treatment of iatrogenic renal vascular lesions using selective renal embolization].

Two patients--one man (62 years) and one woman (69 years) with a iatrogenic renal arterial lesion were treated by percutaneous embolization. Both patients had undergone percutaneous nephrolitholapaxy. Both developed massive haematuria after surgery. Because haematuria could not be controlled by conservative means, angiography was indicated and subsequent superselective embolization of the bleeding artery. In both patients Gelfoam particles were used. The operation was without complications in both patients and produced a prompt effect. Within 4 months after operation no relapse developed. The authors did not observe an adverse effect associated with embolization.

Aged↗
PubMed1996

Cochlear fistula in chronic otitis media with cholesteatoma.

Labyrinthine fistula in chronic otitis media with cholesteatoma most commonly involves the horizontal semicircular canal. We report three cases of cochlear fistula in chronic otitis media with cholesteatoma. All of them had a long history of otorrhea. One patient had total hearing loss of the affected side. The other two patients had conductive hearing loss. Radical mastoidectomy had been done in all cases. Cholesteatoma in the tympanic cavity destroyed the basal turn of the cochlea. These fistulas were sealed with muscle or Gelfoam with streptomycin. We found no fistula in the semicircular canal in any of the three cases. We report three cases of cochlear fistula in chronic otitis media with cholesteatoma, and review the literature.

Cholesteatoma↗
PubMed1996

Vein graft in stapes surgery.

Sealing the opening of the oval window during stapes surgery is essential; it prevents postoperative complications, such as perilymph fistula and sensorineural hearing loss. In this small series of 269 cases with otosclerosis, tympanosclerosis, and congenital ossicular abnormality, vein grafting was used to seal the opening of the footplate. Hearing improvement after surgery was acceptable, and none had total hearing loss or perilymphatic fistula. World literature from the last half of this century on grafting the oval window is reviewed. Absorbable gelatin sponge (Gelfoam) seems to be causing more complications, so its use is highly discouraged. Temporalis fascia, fat, and perivenous loose areolar tissue have been used by different authors at different times in footplate surgery. The opening created in the oval window during stapes surgery must not be left uncovered.

Audiometry, Pure-Tone↗
PubMed1996

[Oral surgical procedures during anticoagulant therapy].

Minor oral surgery, in patients being treated with anticoagulant therapy, constitutes a problem for the oral and maxillofacial surgeon. 77 patients getting coumarin underwent 168 oral surgical procedures (tooth extraction, apicoectomy, crown-lengthening, excision of lesions) without lowering the dose of anticoagulant. Local hemostasis was achieved in all cases by silk suture. For tooth extraction gelfoam was used as well. In 12 patients who presented with postoperative bleeding, it was controlled in all by gauze pressure with tranexamic acid and/or biologic glue and/or surgical splinting. Postoperative bleeding was not correlated with the international normalized ratio (INR), but with degree of local inflammation. The study shows that interruption of anticoagulant therapy in such cases is not justified, and the use of tranexamic acid or biological glue can control bleeding.

Adult↗
PubMedDate not supplied

A comparison of chemoembolization with conventional chemotherapy and symptomatic treatment in cirrhotic patients with hepatocellular carcinoma.

BACKGROUND/AIMS: The results of transcatheter arterial chemoembolization (TACE) in 28 cirrhotic patients with advanced hepatocellular carcinoma (HCC) were compared to those obtained in 15 cirrhotic patients with HCC treated with systemic chemotherapy, and 14 patients with HCC receiving no specific anti-cancer treatment. MATERIALS AND METHODS: From November, 1986 through May 1994, 235 patients with HCC were seen by the investigators. Twenty eight of these patients actually received TACE. The chemotherapeutic agent used was mitomycin C mixed with Lipiodol and arterial embolization was achieved using Gelfoam. In 19 of 28 cases treated with TACE, the embolization was limited to an artery feeding the tumor, thereby avoiding liver cell injury in non-tumor tissue. In 9 others, the main left or right hepatic artery was embolized. The results obtained in these 28 cases were compared to those obtained in 15 patients with HCC larger than 5 cm. who received systemic mitomycin C and doxorubicin chemotherapy and with those obtained in 14 patients who received no specific anti-tumor therapy. RESULTS: One patient died of liver failure related to the TACE and three patients died of bleeding from esophageal varices within weeks of the TACE procedure. Two of the remaining 24 patients are alive with a follow-up of 6 and 22 months. Twenty-six of the 28 patients treated with TACE died within 1 and 28 months of the initiation of the TACE therapy. The mean survival of those receiving TACE was 13.0 months. Chemotherapy without embolization yielded a mean survival of 7.2 months. The mean survival of the patients receiving no specific anti-cancer treatment was only 6.9 months. There was no statistical differences between the survival of those receiving systemic chemotherapy and those receiving no specific treatment. In contrast, the mean survival of the group receiving TACE was significantly greater than that of either of the other two groups (p < 0.005). CONCLUSIONS: These data suggest that TACE provides the best survival for individuals with larger hepatocellular carcinomas (> 5 cm) not eligible for surgery or percutaneous ethanol injection (PEI).

Antibiotics, Antineoplastic↗
PubMed1996

Intratympanic steroid treatment of inner ear disease and tinnitus (preliminary report).

Intratympanic instillation of Depo-Medrol (80 mg/cc), dexamethasone ophthalmic solution (1 mg/cc), or dexamethasone intravenous (4 mg/cc) solution produces improvement of cochlear function in certain patients with Meniere's disease, autoimmune inner ear disease and sudden sensorineural deafness. Tinnitus improved in 47%, most often in patients with Meniere's disease (9 of 15; 60%). The SRT improvement of greater than 10 dB or SD greater than 15% was documented in 41% (average improvement in SRT: 15 dB; SD: 24%). Patients with tinnitus and bilateral sensorineural hearing loss (i.e., presbycusis) did not benefit from the treatment. Prior to treatment with intratympanic medication, laser assisted tympanostomy with middle ear exploration, using otoendoscopy to determine the status of the round window niche and remove mucosal folds, helps in making the round window membrane accessible to local application of drops. Placing Gelfoam into the round window niche under direct vision, and using a Venturi Bobbin tube in the tympanic membrane, appears to be a satisfactory method for delivering medication to the inner ear fluids. The medication can be injected by the physician through the tube into the middle ear, or the patient can perform self-treatment at home, placing medication in the external auditory canal. A double-blind, cross-over study in patients with Meniere's disease is now in progress with Institutional Review Board (IRB) approval, which will be reported at a later date. This preliminary study has shown that intratympanic steroids may affect the symptoms of hearing loss and tinnitus in patients with various inner ear problems. Patients with Meniere's disease appear to respond in the highest percentage of cases. Hopefully, additional research will suggest the appropriate drugs which can be used to treat inner ear disease. Direct application of the drug to the round window membrane may increase the concentration in the inner ear fluids, thus avoiding the systemic effects.

Aged↗
PubMed1996

Treatment of chronic tympanic-membrane perforations with a platelet-derived releasate.

PURPOSE: Tympanic membrane perforations are very common and often require surgical treatment. Recent studies have suggested that growth factors may be an effective nonsurgical alternative for treating chronic perforations. The purpose of this study was to assess the efficacy of a platelet releasate in the treatment of chronic nonhealing perforations in the chinchilla model. METHODS: Bilateral perforations were created in 47 chinchillas by excising 80% of the tympanic membrane with a thermal myringotomy knife. Bilateral perforations > 50% of its surface area persisted for 10 weeks in 34 animals, and unilateral perforations > 50% of its surface area, in nine animals. Only animals with bilateral chronic perforations were included in this study. After deepithelializing the perforation and packing the middle ear and external ear canals with Gelfoam, we treated the perforations with either platelet releasate or buffered saline. Each animal served as its own control. RESULTS: The tympanic membranes were evaluated over a 12-week period by microscopy, photography, tympanometry, and histology. No statistical difference between treated and control ears in the incidence of perforation closure was evident. Histologically, the treated tympanic membranes consistently had a thicker fibrous layer than the controls. CONCLUSIONS: These data suggest that platelet releasate is not effective in enhancing closure of chronic tympanic membrane perforations in the chinchilla model.

Animals↗
PubMed1996

[Arterial embolization in chronic hemorrhage from uterine neoplasms].

Transcatheter embolization of the internal iliac arteries because of chronic bleeding from unresectable carcinoma of the uterus was performed in 8 patients aged 36-67. Hemorrhage was brought under control in all cases by application of a spectrum of procedures: bilateral combined, distal and proximal occlusion using autoblood clots, Gelfoam, Ivalon and steel coils although there was one recurrence 5 months after treatment, no bleeding occurred during an 11 month-4 year follow-up. Trancatheter embolization proved effective in the management of chronic bleeding from unresectable carcinoma of the uterus.

Adult↗
PubMed1996

Transcatheter arterial embolization for the control of life-threatening pelvic hemorrhage in a patient with locally advanced cervix carcinoma.

A woman with a refractory locally advanced recurrent cervical cancer was brought to the emergency room because of a life-threatening vaginal hemorrhage from the tumor. She presented with a compromised hemodynamic status that necessitated multiple blood transfusions and large volume of fluid resuscitation. An arteriogram revealed the site of bleeding from the uterine branch of the right internal iliac artery. The branches of anterior and posterior internal iliac artery were embolized with Gelfoam, Ivalon and coils. This emobolization successfully controlled the bleeding and stabilized the hemodynamic status of the patient. The treatment options in patients with massive pelvic hemorrhage are reviewed and discussed.

Angiography↗
PubMedDate not supplied

Arterial chemoembolization in hepatocellular carcinoma suitable for resective surgery.

BACKGROUND/AIMS: Authors examined transcatheter arterial embolization (TAE) reliability in modifying diagnosis, staging, choice of treatment after a common instrumental evaluation and in increasing results in patients with hepatocarcinoma(s) potentially suitable for surgery; this value was compared to TAE-related mortality and morbidity. MATERIALS AND METHODS: Thirty-nine patients underwent TAE. Diagnostic value, reduction in tumor size and necrosis' percentage after treatment were computed. Immediate and long term results were compared to those obtained by primary liver resection in 62 patients. RESULTS: TAE showed more lesions than any other diagnostic tool, thus excluding 4 patients (10.2%) from surgery. TAE-related mortality (1 patient) and severe morbidity (11 patients) excluded 4 more patients. Complications were correlated to Gelfoam embolization (p < 0.01). After TAE tumor size reduction was sporadic; tumor necrosis > 70% was present in 13/29 resected tumors. Intraoperatively 16/25 patients had TAE-related anatomical alterations; a choledochus' wall necrosis and a tumor' explosion must be mentioned. TAE and intraoperative echography had an equivalent diagnostic value. Immediate and long term results were comparable to those obtained by primary liver resection. CONCLUSIONS: TAE has a high diagnostic accuracy but the capacity in changing the final judgment after a good instrumental evaluation is low. The specific risk-benefit ratio is not favourable, in particular after mechanical embolization, and clinical benefit is not evident.

Aged↗
PubMed1997

Grafting of cultured microglial cells into the lesioned spinal cord of adult rats enhances neurite outgrowth.

There is contrasting in vitro and in vivo evidence regarding glial cell involvement in central nervous system (CNS) regeneration. This study has investigated the histological events that follow implantation of either microglia, mixed microglia/astrocytes, or astrocytes into the injured adult rat spinal cord. We have conducted an immunohistochemical characterization of the cellular profiles within and neuritic extension into various grafts consisting of gelfoam (GF) matrices impregnated with cultured microglia and/or astrocytes. After 2-5 weeks, prominent neuritic growth was observed into OX-42-immunoreactive (IR) microglial implants. These grafts were infiltrated by numerous host cellular elements including microvasculature and Schwann cells, and they demonstrated conspicuous laminin IR. Often, the patterns for laminin and OX-42 IR in microglial grafts were overlapping, suggesting partial expression of laminin on transplanted microglial cells. Mixed grafts of microglia and astrocytes demonstrated presence of neurites and laminin-IR elements with similar intensity as microglial grafts, while astroglial implants showed the least amount of neurite ingrowth. Some control implants consisting of cell-free GF showed marginal in-growth of neurites in areas of infiltrating OX-42-IR host cells. Collectively, our findings support a neurite growth-promoting role of activated microglia and suggest that microglia may counteract mechanisms that inhibit CNS regeneration. It remains to be determined whether the observed neurite growth-promoting effects are mediated directly by grafted and/or endogenous microglia, or whether this occurs via the recruitment of host Schwann cells.

Animals↗