[New embolic material for therapeutic embolization of malignant tumor--gelatin sponge containing carbazilquinone (author's transl)].
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This study evaluated the usefulness of a matrix culture system, the artificial capillary culture system, for the growth of hematopoietic cells, the maintenance of CFUS and the collection of GM-CSF. The system was compared to monolayer, gelfoam sponge and Dexter liquid cultures. Monolayer cultures of adherent lymphohematopoietic stromal cells were prepared from bone fragments, whole bone marrow (Dexter system), spleen, fetal liver and thymus preparations. Morphologically, all the adherent cell populations were similar and tended to accumulate macrophages. Despite these morphological similarities, the ability of bone marrow adherent cell monolayers to maintain CFUS early in the culture period was significantly greater than adherent cells from other sources. Low but significant levels of GM-CSF were detected by bioassay in the supernatants of all but bone marrow adherent cell cultures. However, adherent cells selected from whole marrow cultures by differential trypsinization contained bioassayable levels of CSF suggesting that Dexter cultures contain a supernatant inhibitor/inactivator of GM-CSF. The greatest capability of the artificial capillary culture system was to increase about 500-fold over monolayers the GM-CSF collected from bone fragment derived stromal cells. Unfortunately, CFUS maintenance was poor, the system was more expensive than monolayer cultures and in our hands, suffered many mechanical failures usually resulting in loss of sterility. Histological evaluation suggested there was inadequate matrix for optimal attachment and growth of lymphohematopoietic stromal cells. Even so this system has a much greater potential for development than gelfoam sponges. Overall, Dexter cultures appear to be the most useful system currently available for the study of hematopoiesis and hematopoietic regulatory interactions.
The possibility of application of gel-collagen-hydronic sponge was examined on calf teeth. The action was observed after the 4, 7 , 14, 21 and 28 days. The biological properties of the sponge alone were examined in the close contact to dental pulp. The reaction of dental pulp to this contact was settled. Simultaneously the application of this plastic was examined as a ground of different materials usually applied in the treatment of dental pulp diseases. The reaction of dental pulp to the close contact of gel-collagen-hydronic sponge was compared to the action of the sponge additionally suturated with a 0.5% solution of Cortisone, the sponge mixed with Framycoin powder, or saturated with a mixture of 0.5% solution of Cortisone and Framycoin the collagenic sponge, Caryosan, Calxyd, and to the reaction of uncovered and untreated dental pulp. It was ascertained that gel-collagen-hydronic sponge contacted with calf's dental pulp doesn't impede the composing of osseous-dentinal barrier and its porosity is gradually filled up with a numerous cell elements, later also with strands of tissue. The sponge may be applicated as a ground of examined materials. Within these materials the best composing of osseous-dental barrier was found after the application of Calxyd and then successively after the application of Caryosan, hydronic sponge alone, sponge with Framycoin, sponge saturated with dilution of Cortisone and Framycoin, and collagenic sponge, which gave the worst reaction of calf's dental pulp, similar to the reaction of uncovered and untreated dental pulp.
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Myocardial ischaemia in dog was induced with releasable material in the distal segment of the anterior descending branch of the left coronary artery. Three releasable materials were tested: gel foam, wax microspheres (120-200 micron) and latex balloons, using different methods of introduction. The left carotid route was selected for introduction of a preformed catheter. The gel foam and wax microspheres caused transitory ischaemia, which was proximal for the foam and distal for the microspheres. The balloons made it possible to standardize the ischaemia as its localization and duration could be selected. This material therefore provided a model for stable chronic ischaemia. Nine dogs were observed by means of precordial mapping (36 electrodes) during the phase following ischaemia or for a period of 4 weeks. The results of these experiments are analysed and correlated with histological results for the post-mortem phase.
Gelfoam sponge cultures of stromal cells, derived from guinea pig marrow-depleted bone fragments, support the growth of myeloid precursors in the absence of exogenous stimulants. EM radioautographic studies were undertaken to identify active synthesis and distribution of 3H-fucose-containing glycoproteins within the 3-D organization of cultured hemopoietic tissue. Labeling of 5-14 day cultures with tritiated fucose for 20 min revealed an intracellular localization of silver grains over the endoplasmic reticulum and Golgi bodies of all stromal cells. Cumulative labeling (1-48 h) of similar cultures indicated that (i) silver grains subsequently accumulated in plasma membranes, large cytoplasmic granules and also within lipid droplets, (ii) primitive and myeloid cells were also labeled. Localized extracellular concentrations of silver grains were facilitated by the multiple inter-stromal cell contacts and by the accumulation of fine labeled cytoplasmic processes. Mechanisms whereby stromal cells may actively influence physiochemical changes in the hemopoietic inductive microenvironment are suggested.
Selective catheterization and embolization of both profunda femoris arteries were performed on eight mongrel dogs. In four dogs, Gelfoam alone (one side), and Gelfoam soaked in Sotradecol (contralateral side) was the embolic agent. In the other four dogs, Avitene in saline (one side), and Avitene suspended in Sotradecol (contralateral side) was the embolic agent. Ateriography followed by sacrifice and histologic examination were performed at two weeks (two dogs in each group) and two months (two dogs in each group) following embolization. In all dogs, histology confirmed the arteriographic appearance. In Gelfoam-embolized dogs, arteries embolized with Gelfoam alone were recanalized by two weeks; arteries embolized with Gelfoam/Sotradecol remained occluded at two months. In Avitene-embolized dogs, arteries embolized with Avitene in saline were moderately recanalized by two weeks and totally recanalized by two months; arteries embolized with Avitene/Sotradecol remained occluded at two months. Inflammatory changes were present in the walls of arteries embolized with Sotradecol. Sotradecol greatly increases the duration of arterial occlusion in Gelfoam and Avitene-embolized arteries.
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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.
The effectiveness of a combined approach of embolization and operation for cervical vascular malformations is stressed. Lesions that seem to be inoperable may have their blood flow sufficiently reduced by preoperative embolization to allow surgical extirpation. Polyvinyl alcohol foam is an ideal embolic agent; not only may it be used preoperatively, but its permanency allows it to be used for primary therapy.
A few thoughts of a surgeon who does occasional stapedectomies are presented. A review of 10 years of occasional stapedectomies is reported on a total of 104 cases. A detailed statistical analysis is not attempted. Comparison of several stapedectomy techniques is made to show the evolution of the author's present technique.
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.
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A patient is presented who sustained a duodenal infarction after therapeutic Gelfoam embolization of the gastroduodenal artery for hemorrhage from a duodenal ulcer. Factors that may have contributed to this previously unreported complication included underlying vascular disease, recent surgery, and an associated arteritis possibly related to the Gelfoam. Although ischemic injury of the duodenum has been considered unlikely because of its dual vascular supply, our case suggests that the technique of therapeutic embolization may carry an increased risk in patients with underlying vascular disease or previous surgery within the area of the vascular bed to be embolized.
An osseous spinal angioma presented with severe back pain and cord compression. Severe hemorrhage occurred during surgical decompression, but after preoperative embolisation of the feeding vessels a second operation was successful. Osseous spinal angioma seldom presents backache of a severe nature or medullary compression. In such case, surgical intervention may be attempted without pre-operative embolization of the feeding vessels.