Some observations and experiences with stapedectomy.
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The method of occlusion of the draining bronchus in combination with a one-step percutaneous drainage of the purulent cavity by the Monaldi principle was used in 12 children for the treatment of giant pulmonary abscesses. It was shown that the proposed method unlike traditional procedures allows effective sanitation to be performed. It relieves symptoms of intrathoracic strain and thereby allows avoiding operations at the height of purulent intoxication. No complications and lethality followed the treatment.
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Experimental studies have suggested that oxidized cellulose and the combined use of gelatin sponge and dextran 70 may prevent intraperitoneal adhesion formation. Peritoneal adhesions were produced in 50 rats by a standardized caecal trauma. In 10 rats the injured caecum was covered by oxidized cellulose, in 10 by gelatin sponge, and in 10 by a mixture of gelatin sponge and dextran 70. Twenty rats served as controls. Neither oxidized cellulose, gelatin sponge, nor the combination of gelatin sponge and dextran 70 was found to be effective in preventing peritoneal adhesions. However, neither oxidized cellulose nor gelatin sponge resulted in an increased adhesion formation.
Our experience with nine patients in whom percutaneous transcatheter embolization was utilized in the extremities is presented. These include three patients with peripheral hemangiomas who were successfully embolized as the primary therapy; two patients who were embolized prior to surgery to minimize blood loss and shorten anesthesia time; two patients with neoplasm of an extremity as a means of palliation; and two patients with traumatic vascular lesions. Indications and potential complications are discussed, and the various embolic agents available are reviewed to define the options available to the angiographer and surgeons in planning therapy.
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In renal disease, therapeutic procedures performed by radiologists include embolisation, cystography with obliteration and percutaneous nephrostomy. More than 72 therapeutic occlusions of the renal artery by balloon, coil, and gelfoam are presented. Basic differences in technique of application and in the mechanism of Ethibloc in comparison to other kinds of embolisation material are pointed out. In 61 diagnostic punctures of renal cysts, guided by sonograpny, 31 were treated by injection of Lipiodol. As in cystography, the combination of sonography and radiology proved to be highly valuable in 37 percutaneous nephrostomies. Technique, indication, contraindication, and complication of renal embolisation, renal cystography and percutaneous nephrostomy are briefly discussed.
Transcatheter chemo-embolization is a technique for achieving a marked antitumor effect by embolizing the hepatic artery with a gelatin sponge immediately after infusion of adriamycin 60 mg into the same artery. Chemo-embolization was performed in 212 cases of hepatocellular carcinoma and 23 cases of metastatic liver cancer, a total of 235 patients. Of this population, 19 patients with hepatocellular carcinoma underwent hepatectomy, and in 7 of them, complete necrosis of tumors having thick capsules and less than 4 cm in diameter was confirmed. The cumulative survival rate of patients with unresected hepatocellular carcinoma was 75.6% at 6 months, 52.6% at 1 year, and 20.3% at 2 years. The longest survival time was 3 years and a half, and this patient is now living. As regards metastatic liver cancer, complete necrosis could be achieved in 1 of 2 patients undergoing resection, whereas the cumulative survival rate of unresected cases was 55% at 6 months and 44% at 1 year: only two patients survived for more than 1 year. Technically, the use of a balloon catheter (7F) resulted in the virtual elimination of unsuccessful cases and the prevention of adverse effects due to migration of the gelatin sponge.
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A 66-year-old man was admitted because of right lower abdominal pain and was operated on for acute appendicitis on March 12, 1983. It was found that his appendix was not inflamed, but a bleeding tumor was encountered in the posterior segment of the liver. Bleeding was controlled by suturing the liver above the tumor. Postoperative celiac angiography revealed many daughter tumors scattered in, but restricted to, the right lobe of the liver. The patient was treated by transcatheter arterial embolization combined with transcatheter arterial infusion of lipiodol and Adriamycin on April 25. Subsequently, a curative operation (right hemihepatectomy) was performed on May 24. The patient is still alive without recurrence 6 months after the resection. In case of ruptured hepatocellular carcinoma, it appears to be better to perform a two-stage operation with careful estimation of functional reserve of the liver, and to conduct transcatheter arterial embolization between operations to prevent the growth of the tumor during that period.
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Twenty-nine rabbits with 12- to 14-day-old VX2 tumors in the hind leg were injected intraarterially with technetium-99m (99mTc) DTPA and various combinations of biodegradable starch microspheres, Spherex (Pharmacia, Sweden), to evaluate the efficacy of the microspheres in enhancing tumor retention of 99mTc DTPA. A gamma camera and nuclear medicine computer were used to generate time activity curves of 99mTc DTPA concentration in the tumors. Blood flow to the tumor and various muscles was also measured at intervals by left ventricular injection of 15 micron radiolabeled plastic microspheres. Ninety minutes following the administration of 99mTc DTPA, specimens from the tumor, plasma and different muscles were counted in a NaI well counter connected to a multichannel analyzer. When biodegradable microspheres mixed with 99mTc DTPA were injected and followed by a slow infusion of plain starch microspheres, the 99mTc DTPA was retained in the tumor at concentrations up to 11 times that seen when 99mTc DTPA alone was injected; the corresponding biological half-time was 13 times longer than control values. Additionally, the degree of drug retention was inversely related to blood flow, with retention increasing as blood flow decreased. The results have possible applications to the use of biodegradable microspheres in the intraarterial delivery of chemotherapeutic agents to solid tumors.
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Gelfoam and polyvinyl alcohol foam particles each have advantages and disadvantages for therapeutic embolization. It was theorized and confirmed that a mixture of the two retains the advantages and eliminates the disadvantages of each. Two mixtures were prepared, tested in animals, and used successfully in 14 patients. It was found that the mixtures of Gelfoam and polyvinyl alcohol foam particles fulfilled the expectations and needs for particulate embolic materials.
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