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PubMed1980

Results of stapes surgery - subjective and objective.

A review of subjective and objective results of stapes surgery performed by one general otolaryngologist shows excellent correlation between the two. However, hearing results are poorer, and the complication rate higher than is usually reported. We recommend that patients be informed pre-operatively of the success rate and complication rate in the practice of their surgeon rather than the excellent results reported in the literature. Patients with unilateral hearing loss should be discouraged from undergoing stapes surgery. Approximately half of these patients do not obtain binaural hearing, and thus the success rate does not justify the risk of a complication. Further studies are required to determine whether stapes surgery should be performed only by otologists doing a high volume of such surgery.

Follow-Up Studies↗
PubMed1994

Transarterial oily chemoembolization for the treatment of hepatocellular carcinoma: a multivariate analysis of prognostic factors.

A total of 84 patients with hepatocellular carcinoma and cirrhosis were analyzed retrospectively to investigate prognostic factors. All patients received transarterial oily chemoembolization as the only anticancer therapy. The follow-up range was 1 to 39 mo (median, 9.5 mo). The overall actuarial survival rates at 12, 24 and 30 mo were 62%, 31% and 24%, respectively. According to univariate analysis, variables significantly associated with survival were age, Child-Pugh grade, total serum bilirubin, Okuda stage, tumor size, degree of labeling of the tumor with Lipiodol, gelatin foam use, changes with treatment in tumor size and changes with treatment in alpha-fetoprotein concentration. Two multivariate analyses were performed. When pretreatment and treatment variables were considered, parameters with independent prognostic value were age, Child-Pugh grade, total serum bilirubin, tumor size and degree of Lipiodol labeling of the tumor. When follow-up variables were also considered, we (a) confirmed the prognostic significance of all these parameters (age, Child-Pugh grade, total serum bilirubin, tumor size) and (b) found the independent prognostic value of the change in tumor size (or change in alpha-fetoprotein concentration). Both models yielded different risk coefficients for each class of each variable. Two simple prognostic indexes, based on these coefficients, are proposed: an "initial" index (including pretreatment and treatment variables) and a "follow-up" index (also including follow-up variables). According to the two indexes, the patients were classified into three groups with different prognoses: good (93% and 100% actuarial survival at 1 yr for the initial and follow-up indexes, respectively), intermediate (65% and 53%, respectively) and poor (27% for both indexes).

Actuarial Analysis↗
PubMed1995

[Treatment of maxillofacial vascular malformation by arterial embolism and application of sclerosing agent].

30 cases of large cavernous and racemose hemangioma of the maxillofacial were treated selectively with arterial embolism of the tumor and inject Xiaozhiling into the tumor, from November 1990 to November 1993. This method has exact effect either to racemose or to cavernous hemangioma, without facial defect and functional damage. All the patients were followed up 6 months to 3 years. 27 cases were cured, 1 failed, 1 gave up treatment, 1 died of complication. Its mechanism, indications, prevention of complications and recurrence were discussed.

Adolescent↗
PubMed1995

[Double embolization of bronchial artery to control massive hemoptysis].

Bronchial arteriography and double embolization is to block the peripheral bronches of the bronchial artery with micro-gelatin particles and then the trunk of the artery with sponge gelatin. The blood flow from the artery trunk and from the rich arterial bronches which forms B-P bypass is blocked. By this way the embolization is more complete. Clinical observation of 93 cases shows that the success rate reached 91% which indicate that the massive hemoptysis could stopped by this method.

Adult↗
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↗
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

Management of unilateral vocal fold paralysis.

Management of unilateral vocal fold paralysis continues to generate controversy. Polytetrafluoroethylene (Teflon) injection remains the most popular procedure for medialization; however, there are problems involved with its use. Endoscopic assessment of patients treated with medialization laryngoplasty revealed a normal mucosal wave form in contrast to the stiff vocal fold observed with Teflon injection. Medialization laryngoplasty is also considered a reversible procedure. Based on these findings, medialization laryngoplasty should be considered the procedure of choice for unilateral vocal fold paralysis.

Adolescent↗
PubMed1976

Some fundamental applications of the Law of La Place in Neurosurgery.

The Law of La Place is a simple principle of physics, applicable to any fluid-filled vessel, relating stress on the wall of the vessel to the radius and transmural pressure. This principle has major implications for neurosurgery and examples are provided relating La Place's Principle to the genesis and treatment of hydrocephalus, the surgical clipping of cerebral aneurysms and the technic of surgical sponge hemostatis.

Biophysical Phenomena↗
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↗
PubMed1994

Hints for hemostasis.

As dermatologists perform more complex and extensive surgical procedures, persistent bleeding and hematoma formation may be encountered more frequently. Several hints for hemostasis are presented that will help dermatologists prevent uncontrolled hemorrhage and manage bleeding complications. Employing these techniques will ease patient and surgeon anxiety and help avoid unwanted surgical complications.

Aspirin↗
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

Lipiodol-CT in the detection of tumor persistence in hepatocellular carcinoma treated with percutaneous ethanol injection.

Our purpose was to investigate the usefulness of Lipiodol-CT for detection of residual viable neoplastic tissue in hepatocellular carcinoma (HCC) lesions treated by means of percutaneous ethanol injection (PEI). An emulsion of 5 to 20 ml iodized oil and 50 to 70 mg doxorubicin hydrochloride was intraarterially injected in 18 patients with 25 HCC lesions treated by means of PEI one to 24 months before. At CT performed 3 to 5 weeks after injection, retention of Lipiodol was observed in 9 of 13 tumors that still contained viable neoplastic tissue and in 2 of 12 tumors proven to have undergone complete necrosis after PEI. The sensitivity and specificity of Lipiodol-CT were 69.2% and 83.3%, respectively. Thus, Lipiodol-CT seems to have limited diagnostic value after PEI, probably as a consequence of the alcohol-induced vascular damage, accounting for both false-negative and false-positive results.

Aged↗
PubMed1994

[Optimal size of embolic material in transcatheter arterial embolization of the liver].

The purpose is to determine the optimal size of gelatin sponge, less toxic and more effective, in transcatheter arterial embolization (TAE) of the liver. In experimental study on toxicity, gelatin sponge particles (GSP) were divided by their size into four groups, 0-200 microns, 200-500 microns, 500-1000 microns and 1000-2000 microns. In each group, three mongrel dogs underwent TAE. After a week, the livers were investigated pathologically, and the rate of liver necrosis was measured. The average rate was 23.7 percent with GSP of 0-500 microns, while 0.5 percent with 500-2000 microns. Microscopically, coagulation necrosis was found in 6 of 6 dogs with 0-500 microns, while in 2 of 6 with 500-2000 microns and bile duct injury was found in 5 of 6 dogs with 0-500 microns, while none with 500-2000 microns. In clinical study on effectiveness, ten patients with hepatocellular carcinomas underwent TAE with GSP of 0-500 microns, 500-1000 microns and 1000-2000 microns respectively. After a week, the rate of tumor necrosis was measured by CT. The average rate was 94.8 percent with 0-500 microns, 93.5 percent with 500-1000 microns and 86.8 percent with 1000-2000 microns. These results suggest that the optimal size of GSP is 500-1000 microns.

Animals↗
PubMed1994

Chemoembolization in liver malignant involvement. Experiences on 17 cases.

INTRODUCTION: Liver invasion is the major cause of organ failure in patients with primary liver cancer and metastatic large bowel cancer. Furthermore it causes high morbidity in many other carcinomas. The normal liver presents a double circulation: 75% from portal circulation and 25% from hepatic artery. In malignant primary and secondary lesions the blood support is given by hepatic artery. Antineoplastic drugs mixed to selectively injecting embolic particles, such as polyvinyl alcohol and gelatin powder (Gelfoam), can be injected to infarct tumors and to obtain a therapeutical advantage. Chemoembolization using an emulsion of Lipiodol ultra-fluid (LUF) and drugs is a recent tool in liver regional therapy. LUF has been shown to be taken up hepatocellular carcinoma and retained for a long period of time in the tumor bed. Chemoembolization causes massive shrinkage due to ischemia and increasing the local drug intensity and drug exposure. Our study reports the results of multi-agents chemoembolization (MACHEM) in 17 patients bearing massive liver involvement. MATERIAL AND METHODS: From January 1988 we treated 17 patients (5 HCCs, 7 large bowell carcinomas, 1 gastric cancer, 1 ocular melanoma, 1 pancreas, 1 soft tissue sarcoma, 1 carcinoid) using a transfemoral approach to cannulate the celiac axis and then the hepatic artery. The catheter was advanced into the vessel responsible for the majority of the tumor blood supply and a mixture of Gelfoam, radiopaque contrast media, followed by chemotherapy (mitomycin 10 mg/sqm, cisplatin 20 mg/sqm, epirubicin 20 mg/sqm) mixed to LUF was injected until vascular stasis occurred. After chemoembolization, analgesics and anti-pyretics were administered. Liver function tests were monitored daily. RESULTS: Objective tumor regression was observed in 11 out 15 full evaluable patients; the median duration of survival was 9.5 months. Within 8 weeks shrinkage, due to development of necrosis, appeared in the tumors. One patient with high levels of 5-HIAA due to carcinoid, demonstrated more than 75% decreasing in urinary excretion. In 6 patients out 8 with CEA elevation a clear reduction was documented as well in 2 HCCs out 5 with alfa-fetoprotein elevation. DISCUSSION: The palliation of HCC and metastatic liver disease have been extremely disappointing. Systemic chemotherapy produces in HCC a response rate of no more than 20% and does not increase the median survival. Venook obtained 24% of PRs and liquefaction in 35 out 50 HCC treated with chemoembolization. Some results have been also demonstrated in the treatment of metastatic liver tumors by Carrasco, Daniels and Modiano. Moertel stressed that chemoembolization could be incorporated in the initial management of carcinoid. Because of the difference in chemoembolization protocols it is difficult to compare the relative efficacy of this tool, although encouraging response rates have been reported in palliation of bulky tumors. In our study Gelfoam given before LUF and antineoplastic agents mixture produce a distal arteriolar occlusion and this would facilitate the migration of the polychemotherapy emulsion toward the tumor. Our MACHEM program has been shown to have significant activity even in heavily pretreated patients with an acceptable toxicity. We conclude that hepatic arterial chemoembolization will be improved by mean of better combination of chemotherapy with embolizing agents in well selected patients.

Adult↗
PubMed1994

Lipiodolization with or without gelatin sponge in hepatic arterial chemoembolization for hepatocellular carcinoma.

Fifty-two patients with unresectable hepatocellular carcinoma were divided into 2 groups. Group A (n = 24) received lipiodolization with gelatin sponge and group B (n = 28) lipiodolization alone. Angiography after hepatic arterial chemoembolization revealed a satisfactory accumulation of lipiodol and obliteration of the microvasculature in the tumors in both groups. However, prolonged obliteration of proximal hepatic arteries was noted in 70%-80% of patients in group A, in contrast to the patency of the arteries in group B. Collateral circulation was found more frequently in group A than in group B, in which recanalization of tumor vessels and phenomenon of iodized oil "wash-out" were seen. There were no significant differences in therapeutic effects in patients with low risk. In those with high risk, the response rates were 28.6% and 64.2%. The half-year survival rates were 28.5% and 62.8%, 1-year survival rates 7.1% and 27.5%, and 2-year survival rates 0% and 13.7% in group A and B respectively. The differences were significant (P < 0.05). Serious complications occurred more frequently in group A than in group B. The therapeutic effects of lipiodolization without gelatin sponge for patients with high risk were significantly superior to those of lipiodolization with gelatin sponge. We conclude that the modality of hepatic arterial chemoembolization should be chosen according to the patient's clinical conditions.

Adult↗
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↗
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↗