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At least 19 recordsLinked to original sources
PubMedDate not supplied

Renal artery embolization using a new liquid embolic material obtained by partial hydrolysis of polyvinyl acetate (Embol): initial experience in six patients.

OBJECTIVE: To evaluate the therapeutic efficacy of a new liquid embolic material, Embol, in embolization of the renal artery. MATERIALS AND METHODS: Embol is a new embolic material obtained by partial hydrolysis of polyvinyl acetate mixed in absolute ethanol and Iopromide 370 and manufactured by Schering Korea, Kyonggido, Korea. Six patients who underwent embolization of the renal artery using Embol were evaluated. Four were male and two were female and their ages ranged from 11 to 70 (mean, 53) years. Clinical and radiologic diagnoses referred for renal artery embolization were renal cell carcinoma (n = 3), renal angiomyolipoma (n = 2) and pseudoaneurysm of the renal artery (n = 1). After selective renal angiography, Embol was injected through various catheters, either with or without a balloon occlusion catheter. Changes in symptoms and blood chemistry which may have been related to renal artery embolization with Embol were analyzed. RESULTS: The six patients showed immediate total occlusion of their renal vascular lesions. One of the three in whom renal cell carcinoma was embolized with Embol underwent radical nephrectomy, and the specimen thus obtained revealed 40% tumor necrosis. In the two patients with angiomyolipomas, the tumors decreased in size and abdominal pain subsided. Bleeding from pseudoaneurysm of the renal artery was successfully controlled. Four patients showed symptoms of post-embolization syndrome, and one of these also showed increased levels of blood urea nitrogen and creatinine. One patient experienced transient hypertension. CONCLUSION: Embol is easy to use, its radiopacity is adequate and it is a safe and effective embolic material which provides immediate and total occlusion of renal vascular lesions.

Aged↗
PubMed2003

Coil embolization of a tuboovarian anastomosis before uterine artery embolization to prevent nontarget particle embolization of the ovary.

Uterine artery embolization (UAE) is being used more frequently as a primary treatment for uterine leiomyoma. Performing UAE in women who desire future fertility is controversial because of the risks of premature menopause and the undetermined effects on pregnancy. The etiology of ovarian failure after UAE is not yet clearly defined, but one of the leading possibilities is nontarget embolization of the ovaries. In this case report, the authors describe a technique of selective coil embolization of a uterine artery-to-ovarian artery communication before UAE performed specifically to protect the ovary from nontarget embolization.

Adult↗
PubMed1989

[The hemodynamics of the lung circulation of minipigs after experimentally-caused Sedlarik's pulmonary embolism. I. Sedlarik's pulmonary embolism model in comparison to existing embolism models].

The necessity of a clinical relevant pulmonary embolism model is described because of the international importance and the consequence for certain special branches. The multifarious pathophysiologic mechanism in the human requires an approximation of the model. The pulmonary embolism model according to Sedlarik approaches these demands and it became the basis of this study.

Animals↗
PubMed1992

A study of embolizing materials for chemo-embolization therapy of hepatocellular carcinoma: embolic effect of cisplatin albumin microspheres using chitin and chitosan in dogs, and changes of cisplatin content in blood and tissue.

Hepatic artery of dogs was embolized with cisplatin (CDDP) albumin microspheres containing chitin and chitosan to investigate the in vivo CDDP release kinetics from CDDP albumin microspheres, the CDDP cumulative characteristics in the liver, and the influence of microsphere administration on hepatic tissue. Results showed that changes in blood CDDP content were dependent on CDDP albumin microsphere type and that release kinetics were better sustained when chitin was added to the microspheres or when the microspheres were treated with chitosan. In particular, the administration of CDDP in the chitin-containing CDDP chitosan albumin microspheres showed a blood CDDP content of approximately 0.26 micrograms Pt/ml 14 d after administration. The administration of chitin-containing or chitosan treated CDDP microspheres showed a CDDP content in the hepatic tissue of 0.14 to 0.23 micrograms Pt/g 28 d after administration. They also showed better control of CDDP release than those without chitin or chitosan treatment. No CDDP influence on hepatic tissue was observed. We conclude that, even in vivo, chitin and chitosan are effective embolic materials.

Animals↗
PubMed2002

Evaluation of the stability of aneurysms after embolization using detachable coils: correlation between stability of aneurysms and embolized volume of aneurysms.

BACKGROUND AND PURPOSE: The long-term outcome of aneurysmal coil embolization has not been determined. We retrospectively analyzed the results of our cases treated with detachable coils and evaluated the long-term stability of embolized aneurysms. METHODS: This study involved 100 aneurysms in 93 patients who underwent follow-up angiography > or = 3 months after initial treatment between December 1993 and December 1999. The percentage of the coil volume occupying the aneurysm lumen (embolized volume) was used as an index to evaluate the stability of embolized aneurysms. The reliability of the embolized volume was also evaluated by comparing angiographic percentage occlusion. RESULTS: Follow-up angiographic assessment was conducted 12 +/- 8.5 months after initial treatment. Angiographic evaluation of percentage occlusion at initial treatment did not always predict long-term stability of embolized aneurysms. Of 49 aneurysms judged as being totally occluded at initial treatment, 44 remained unchanged and five showed recanalization. The embolized volume of unchanged aneurysms was 30.8 +/- 10.2%, and that of recanalized aneurysms was 19.9 +/- 10.6%. There was a significant difference between these two groups (P=.03). Of 29 subtotally occluded aneurysms, nine had further thrombosis (embolized volume = 31.8 +/- 12.7%), nine remained unchanged (embolized volume = 23.2 +/- 10.3%), and 11 had recanalization (embolized volume = 14.1 +/- 6.1%). The mean embolized volume of 11 recanalized aneurysms was significantly lower than in the thrombosed group and the unchanged group (P=.002 and P <.001, respectively). Large aneurysms tended to have recanalization more frequently (59%) than did small aneurysms (15%). CONCLUSION: There is a significant correlation between embolized volume and stability of embolized aneurysms. Embolized volume is a more objective index than is subjectively angiographic percentage occlusion. In addition to angiographic assessment, measurement of embolized volume could be useful to predict angiographic changes of aneurysms.

Adult↗
PubMed2000

Heparin, low molecular weight heparin and physical methods for preventing deep vein thrombosis and pulmonary embolism following surgery for hip fractures.

BACKGROUND: Hip fracture patients have a high risk of thromboembolic complications following surgical management. OBJECTIVES: To examine the effects of heparin (unfractionated (U), and low molecular weight (LMW) heparins), and physical methods (compression stockings, calf or foot pumps) for prevention of deep venous thrombosis (DVT) and pulmonary embolism after surgery for hip fracture in the elderly. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register, Medline, Embase, and reference lists of published papers and books. We contacted trialists and other workers in the field. Date of most recent search: September 1996. SELECTION CRITERIA: Randomised and quasi-randomised trials evaluating the use of heparins and physical agents for prevention of DVT and pulmonary embolism in patients undergoing surgery for hip fracture. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed methodological quality and extracted data. Trials were grouped into four categories (heparin versus control, mechanical versus control, LMW heparin versus U heparin, and miscellaneous) and results pooled where possible. MAIN RESULTS: The 26 included trials involved 2600 predominantly female and elderly patients. Overall, trial quality was disappointing. Ten trials involving 826 patients which compared U heparin with control, and four trials of 471 patients which compared LMW heparin with control, showed a reduction in the incidence of lower limb DVT (121/511 (24%) versus 203/519 (39%); Peto odds ratio 0.41; 95% confidence interval 0.31 to 0.55). There were insufficient data to confirm the efficacy of either agent in the prevention of pulmonary embolism. There was a non significant increase in overall mortality in the heparin group (46/420 (11%) versus 35/423 (8%); Peto odds ratio 1.39; 95% confidence interval 0. 86 to 2.23). Data were inadequate for all other outcomes including wound complications. There is insufficient evidence from five trials, involving 644 patients, to establish if LMW heparin was superior to U heparin. Most trials evaluating heparins had methodological defects. Four trials, involving 442 patients, testing mechanical pumping devices were also methodologically flawed, and so pooled results need to be viewed cautiously. Mechanical pumping devices may protect against DVT (12/202 (6%) versus 42/212 (19%); Peto odds ratio 0.24; 95% confidence interval 0.13 to 0.44). Although the limited data indicated a potential benefit, they were inadequate to establish any effect on the incidence of pulmonary embolism and overall mortality. Problems with skin abrasion and compliance were reported. REVIEWER'S CONCLUSIONS: U and LMW heparins protect against lower limb DVT. There is insufficient evidence to confirm either protection against pulmonary embolism or overall benefit, or to distinguish between various applications of heparin. Foot and calf pumping devices appear to prevent DVT, may protect against pulmonary embolism, and reduce mortality, but compliance remains a problem. Good quality trials of mechanical methods as well as direct comparisons with heparin should be considered.

Anticoagulants↗
PubMed2004

Bronchial artery dilatation on MDCT scans of patients with acute pulmonary embolism: comparison with chronic or recurrent pulmonary embolism.

OBJECTIVE: The purpose of our study was to compare the bronchial arteries of patients with acute pulmonary embolism with those of patients with chronic or recurrent pulmonary embolism. MATERIALS AND METHODS: Twenty-seven patients with acute pulmonary embolism and 14 patients with chronic or recurrent pulmonary embolism were retrospectively identified from 700 consecutive patients with suspected pulmonary embolism. The case data for the patients were assessed by two thoracic radiologists whose final judgments were reached by consensus. On the MDCT pulmonary angiograms obtained in these patients, the bronchial arteries were assessed by finding enhancing, small, round or curvilinear structures within the mediastinum and tracing their paths along the bilateral main bronchi. Bronchial arteries with a diameter greater than 1.5 mm were considered to be dilated. RESULTS: The diameters of the bronchial arteries in the group with chronic or recurrent pulmonary embolism were significantly larger than diameters of the bronchial arteries in the group with acute pulmonary embolism (p = 0.0002). Dilatation of bronchial arteries was observed in two of the 27 patients with acute pulmonary embolism and in seven of 14 patients with chronic or recurrent pulmonary embolism. This difference was statistically significant (p = 0.004). No dilated bronchial arteries were seen in patients who had acute pulmonary embolism but had no a history of deep venous thrombosis. CONCLUSION: Acute pulmonary embolism did not appear to cause dilatation of bronchial arteries, whereas chronic or recurrent pulmonary embolism was frequently associated with dilated bronchial arteries. In patients in whom the distinction between acute and chronic or recurrent pulmonary embolism on MDCT pulmonary angiography is clinically unclear and in whom the bronchial arteries are dilated, a diagnosis of chronic or recurrent pulmonary embolism should be favored.

Acute Disease↗
PubMed2001

Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer.

BACKGROUND: The limitations of the current diagnostic standard, ventilation-perfusion lung scanning, complicate the management of patients with suspected pulmonary embolism. We previously demonstrated that determining the pretest probability can assist with management and that the high negative predictive value of certain D -dimer assays may simplify the diagnostic process. OBJECTIVE: To determine the safety of using a simple clinical model combined with D -dimer assay to manage patients presenting to the emergency department with suspected pulmonary embolism. DESIGN: Prospective cohort study. SETTING: Emergency departments at four tertiary care hospitals in Canada. PATIENTS: 930 consecutive patients with suspected pulmonary embolism. INTERVENTIONS: Physicians first used a clinical model to determine patients' pretest probability of pulmonary embolism and then performed a D -dimer test. Patients with low pretest probability and a negative D -dimer result had no further tests and were considered to have a diagnosis of pulmonary embolism excluded. All other patients underwent ventilation-perfusion lung scanning. If the scan was nondiagnostic, bilateral deep venous ultrasonography was done. Whether further testing (by serial ultrasonography or angiography) was done depended on the patients' pretest probability and the lung scanning results. MEASUREMENTS: Patients received a diagnosis of pulmonary embolism if they had a high-probability ventilation-perfusion scan, an abnormal result on ultrasonography or pulmonary angiography, or a venous thromboembolic event during follow-up. Patients for whom the diagnosis was considered excluded were followed up for 3 months for the development of thromboembolic events. RESULTS: The pretest probability of pulmonary embolism was low, moderate, and high in 527, 339, and 64 patients (1.3%, 16.2%, and 37.5% had pulmonary embolism), respectively. Of 849 patients in whom a diagnosis of pulmonary-embolism had initially been excluded, 5 (0.6% [95% CI, 0.2% to 1.4%]) developed pulmonary embolism or deep venous thrombosis during follow-up. However, 4 of these patients had not undergone the proper diagnostic testing protocol. In 7 of the patients who received a diagnosis of pulmonary embolism, the physician had performed more diagnostic tests than were called for by the algorithm. In 759 of the 849 patients in whom pulmonary embolism was not found on initial evaluation, the diagnostic protocol was followed correctly. Only 1 (0.1% [CI, 0.0% to 0.7%]) of these 759 patients developed thromboembolic events during follow-up. Of the 437 patients with a negative D -dimer result and low clinical probability, only 1 developed pulmonary embolism during follow-up; thus, the negative predictive value for the combined strategy of using the clinical model with D -dimer testing in these patients was 99.5% (CI, 99.1% to 100%). CONCLUSION: Managing patients for suspected pulmonary embolism on the basis of pretest probability and D -dimer result is safe and decreases the need for diagnostic imaging.

Adolescent↗
PubMedDate not supplied

Experimental studies of new embolizing material for portal vein embolization.

BACKGROUND/AIMS: Preoperative portal vein embolization induces hypertrophy of the future remnant liver and atrophy of the liver to be resected. This procedure has been used recently to avoid hepatic failure in extensive hepatic resection, but an adequate embolizing material has not been developed. This experimental study investigated the embolization effect of a newly devised embolizing material in dogs. METHODOLOGY: The left branch of the portal vein was embolized with an emulsion of polidocanol and gelatin sponge. We studied the changes in liver weight and biochemical data up to 8 weeks after embolization. Pathological examination of the embolized portal vein and radiological study of the embolizing effect were performed. RESULTS: Complete obstruction of the portal vein was maintained until 8 weeks after embolization. Sufficient hypertrophy of the non-embolized liver and atrophy of the embolized liver were obtained during this examination. No serious complication was observed. CONCLUSIONS: The mixture of polidocanol and gelatin sponge seems to ensure perfect portal embolization without recanalization. This embolizing material is suitable for portal embolization.

Animals↗
PubMed1997

Regeneration of the un-embolized liver parenchyma following portal vein embolization.

BACKGROUND/AIMS: Portal vein embolization (PVE) induces atrophy of the embolized hepatic parenchyma and hypertrophy of the un-embolized liver. It is important to predict hypertrophy of un-embolized liver following PVE to decide a subsequent tactics in patients with liver tumors. The hypertrophy following PVE was evaluated in reference to embolized liver volume and a preceding use of transcatheter hepatic arterial chemoembolization (HACE) in this study. METHODS: Thirty patients with liver tumors were studied. PVE was performed transhepatically. Ethanol (15-65 ml) was injected into portal veins, which perfused the liver segment bearing the tumor until occlusion. Embolization was performed at subsegmental portal branches in five patients, segmental branches in 11 patients and right portal veins in 14 patients. Twenty-three patients with underlying chronic liver disease and hepatocellular carcinoma (HCC) underwent PVE 2-6 weeks after HACE. The remaining seven patients without underlying chronic liver disease had bile duct cancer (6) or liver metastasis (1), and underwent PVE alone. Segmental volume in the liver was measured with computed tomography before and 4 weeks after PVE. RESULTS: The degree of hypertrophy showed a significant correlation with embolized liver volume (r=0.685, p<0.001). Increase in un-embolized liver volume was 2.4+/-5.8% with subsegmental embolization (NS), 15.2+/-6.4% with segmental embolization (p<0.01) and 46.5+/-18.8% with right PVE (p<0.001). In 14 patients with right PVE, degree of hypertrophy in seven patients with HACE was greater than that in seven patients without HACE (56.7+/-21.6% vs 36.4+/-7.4%; p<0.03). CONCLUSIONS: Hypertrophy of the un-embolized liver parenchyma following PVE was correlated with embolized liver volume and was augmented with combined use of HACE.

Adult↗
PubMed1994

Pulmonary embolism. The implications of prospective investigation of pulmonary embolism diagnosis.

PIOPED represents a milestone in the study of pulmonary embolism diagnosis because of its well-designed protocol, proper execution, and the large number of patients enrolled. The most important conclusions of the study are 1. Interobserver agreement is good for classifying ventilation-perfusion scans either as normal or as high probability for pulmonary embolism, but interobserver agreement is lower for classifying scans as intermediate or low probability. 2. About 40% of patients with pulmonary embolism have high probability ventilation-perfusion scans, 40% have intermediate probability scans, and 20% have low probability scans. Few (less than 1%) patients with normal perfusion scans have pulmonary embolism. 3. Eighty-seven percent of patients with high probability scans have pulmonary embolism, and 30% of patients with intermediate probability scans have embolism. Unfortunately, 14% of patients with low probability scans have pulmonary embolism. 4. Clinical suspicion can be combined with the ventilation-perfusion scan results to improve the accuracy of diagnosis of pulmonary embolism. About 90% of patients with high probability scans and high or intermediate clinical suspicion for pulmonary embolism indeed have embolism. At the other extreme, only 4% of patients with both low probability scans and low clinical suspicion have embolism. In the remaining combinations of categories 6% to 66% of patients have embolism. 5. Suggested modifications of the original PIOPED criteria for classifying ventilation-perfusion scans make the analysis simpler and more useful. New studies have examined subgroups from PIOPED to refine guidelines for clinical practice further and to incorporate the results of tests for deep venous thrombosis into the diagnostic evaluation.(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy, Needle↗
PubMed1996

Value of perfusion lung scan in the diagnosis of pulmonary embolism: results of the Prospective Investigative Study of Acute Pulmonary Embolism Diagnosis (PISA-PED).

To assess the value of perfusion lung scan in the diagnosis of pulmonary embolism, we prospectively evaluated 890 consecutive patients with suspected pulmonary embolism. Prior to lung scanning, each patient was assigned a clinical probability of pulmonary embolism (very likely, possible, unlikely). Perfusion scans were independently classified as follows: (1) normal, (2) near-normal, (3) abnormal compatible with pulmonary embolism (PE+: single or multiple wedge-shaped perfusion defects), or (4) abnormal not compatible with pulmonary embolism (PE-: perfusion defects other than wedge-shaped). The study design required pulmonary angiography and clinical and scintigraphic follow-up in all patients with abnormal scans. Of 890 scans, 220 were classified as normal/or near-normal and 670 as abnormal. A definitive diagnosis was established in 563 (84%) patients with abnormal scans. The overall prevalence of pulmonary embolism was 39%. Most patients with angiographically proven pulmonary embolism had PE+ scans (sensitivity: 92%). Conversely, most patients without emboli on angiography had PE- scans (specificity: 87%). A PE+ scan associated with a very likely or possible clinical presentation of pulmonary embolism had positive predictive values of 99 and 92%, respectively. A PE- scan paired with an unlikely clinical presentation had a negative predictive value of 97%. Clinical assessment combined with perfusion-scan evaluation established or excluded pulmonary embolism in the majority of patients with abnormal scans. Our data indicate that accurate diagnosis of pulmonary embolism is possible by perfusion scanning alone, without ventilation imaging. Combining perfusion scanning with clinical assessment helps to restrict the need for angiography to a minority of patients with suspected pulmonary embolism.

Adolescent↗
PubMed2003

Preoperative portal vein embolization with a new liquid embolic agent.

PURPOSE: To evaluate the effectiveness and safety of a new liquid embolic agent in preoperative portal vein embolization. MATERIALS AND METHODS: Embol-78 was obtained by means of hydrolysis of polyvinyl acetate and was dissolved in a mixture of ethanol and nonionic water-soluble contrast medium. After percutaneous puncture of the portal vein, embolization of the right portal vein was performed in 22 patients with hepatocellular carcinoma and in 29 patients with nonhepatocellular carcinoma. In each group, changes in volume of the future liver remnant, portal venous pressure, and liver enzymes were evaluated both before and after embolization. Complications were also evaluated. RESULTS: Portal vein embolization was successful in all patients, without major complications. The mean volumes of the future liver remnant before and 2 weeks after embolization were 385 mL +/- 138 and 533 mL +/- 140, respectively, in the hepatocellular carcinoma group and 517 mL +/- 348 and 755 mL +/- 197, respectively, in the nonhepatocellular carcinoma group. There were only transient elevations in liver enzyme levels after embolization. Mean portal venous pressures before and after the procedure were 16.7 mm Hg +/- 3.8 and 20.3 mm Hg +/- 3.6, respectively, in the hepatocellular carcinoma group and 11.7 mm Hg +/- 3.5 and 14.6 mm Hg +/- 3.6, respectively, in the nonhepatocellular carcinoma group. In each group, changes in volume of the future liver remnant and portal venous pressure were statistically significant (P <.001). CONCLUSION: The liquid embolic material Embol-78 seems to be effective and safe for preoperative portal vein embolization.

Adult↗
PubMed1998

Transesophageal echocardiography to assess embolic risk in patients with atrial fibrillation. ELAT Study Group. Embolism in Left Atrial Thrombi.

BACKGROUND: Transesophageal echocardiography visualizes the left atrium and its appendage, thrombi, and spontaneous echocardiographic contrast. OBJECTIVE: To assess the association of transesophageal echocardiographic characteristics with stroke or embolism in atrial fibrillation. DESIGN: Multicenter observational follow-up study. SETTING: Hospitals in Austria and Slovakia. PATIENTS: 409 outpatients with nonrheumatic atrial fibrillation and without recent stroke. INTERVENTION: Patients with thrombi received anticoagulation, and patients without thrombi received aspirin. MEASUREMENTS: Primary events were stroke or embolism. Secondary events were death not caused by stroke or embolism and need for anticoagulation. RESULTS: In the left atrium or left atrial appendage, 10 patients (2.5%) had thrombi and 47 (12%) had spontaneous echocardiographic contrast. The appendage had a mean (+/- SD) length of 44+/-10 mm, a mean width of 23+/-6 mm, and a mean area of 5.8+/-2.5 cm2. Follow-up ranged from 1 to 74 months (mean, 58 months). Fifty patients had stroke or embolism, 53 died of a cause other than stroke or embolism, and 38 required anticoagulation. On univariate analysis, thrombi (risk ratio, 3.9 [95% CI, 1.4 to 10.1]; P = 0.009), length of the left atrial appendage (risk ratio, 1.6 [CI, 1.05 to 2.5]; P = 0.03), and width of the left atrial appendage (risk ratio, 2.4 [CI, 1.2 to 4.81; P = 0.01) were associated with stroke or embolism. Multivariate analysis identified hypertension (risk ratio, 3.6 [CI, 1.8 to 8.4]; P = 0.001), previous stroke (risk ratio, 3.7 [CI, 1.5 to 7.5]; P = 0.002), and age (risk ratio, 1.1 [CI, 1.0 to 1.11; P < 0.001) as risk factors for stroke or embolism and provided evidence of an association between thrombi and stroke or embolism (risk ratio, 2.4 [CI, 0.9 to 6.9]; P = 0.09). CONCLUSIONS: In outpatients with atrial fibrillation and without recent stroke, thrombi of the left atrium or left atrial appendage and length and width of the left atrial appendage were associated with stroke or embolism in univariate analysis. In a multivariate analysis, age, hypertension, and previous stroke were risk factors for stroke or embolism, and thrombi of the left atrium or left atrial appendage were possible risk factors. In these patients, history may be more useful than transesophageal echocardiography for the assessment of embolic risk.

Atrial Fibrillation↗
PubMed1989

[Experimental studies of intrahepatic portal vein embolization and embolic materials].

The author has developed the intrahepatic portal vein embolization for the treatment of liver cancers. The purposes of this new method are 1) extension of indications for surgery by causing compensatory hypertrophy of non-embolized lobe, 2) prevention of dissemination of the tumor cells via the portal vein, 3) causing complete ischemic necrosis of the tumor together with arterial embolization, and 4) blockade of centripetal extension of tumor thrombus. The feasibility and safety of this method were studied experimentally. Three kings of materials were prepared for embolization of the portal vein; a Lipiodol-thrombin mixture (Lp-T), a Lipiodol-fibrin adhesive mixture (Lp-F), and a mixture of Lipiodol with isobutyl-2-cyanoacrylate (Lp-IBC). The portal vein was embolized in 31 dogs, 6 with Lp-T, 14 with Lp-F, and 11 with Lp-IBC. Lp-F was used 30 to 90 seconds after preparation, which had been found to be best in an in vitro study. Lp-T and Lp-IBC could be used at any time after preparation. Embolization was done safely and reliably, except in two cases of Lp-F, by use of a balloon catheter for Lp-T or Lp-F and a coaxial catheter for Lp-IBC. Follow-up portography showed recanalization in one week in the dogs embolized with Lp-T. The obstruction was maintained for two to four weeks in the dogs embolized with Lp-F, and for four weeks in all dogs embolized with Lp-IBC. Damage in the liver was slight both macroscopically and histologically. Changes in liver function and elevation of the pressure of the portal vein were transient. The author concluded that the intrahepatic portal vein embolization was both feasible and safe when the materials tested were used, and could be an effective method for liver cancers. In clinical cases, Lp-T would be suitable for short-term occlusion, Lp-F for a moderate term, and Lp-IBC for long-term. The material should be selected with regard to the purpose.

Animals↗
PubMed1989

[Intraoperative detection of air embolism and corpuscular embolism using pulse oximetry and capnometry. Comparative studies with transesophageal echocardiography].

19 patients undergoing total hip replacement in general anesthesia because of transcervical femur fractures were continuously monitored throughout surgery to detect any embolic events. Aside from the standard monitoring with ECG and control of arterial pressure in regular short intervals, the pulse-oximetry and capnography were applied for a comparative examination of their sensitivity in detecting gas and corpuscular embolisms. Transesophageal echocardiography (TEE) which allows an extensive assessment regarding the extent and differentiation between gaseous and corpuscular embolisms was chosen as a reference method. The examination concentrated on the implantation of the acetabulum and femur prosthesis since this phase of the operation has been associated with a high incidence of embolisms. The TEE monitoring revealed corpuscular as well as gaseous emboli during surgery. In the 36 cases of echocardiographic detectable embolisms prospectively defined changes of the heart rate were observed in 17%, of the mean arterial pressure in 56%, of the end-expiratory CO2 partial pressure in 47% and of the arterial O2 saturation in 31% of the cases. The embolisms which had been categorized by means of TEE according to their severity reflected a decrease of the end-expiratory CO2 partial pressure in 25% of the cases with light, in 45% of the cases with moderate and in 69% of the cases with severe embolisms, whereas a decrease in arterial O2 saturation was detected in 8% with light, 27% with moderate and in 54% of the cases with severe embolisms. Corpuscular embolism had no stronger influence on the frequency of relevant changes of end-expiratory CO2 partial pressure and the arterial O2 saturation than did the gaseous emboli.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED).

To determine the sensitivities and specificities of ventilation/perfusion lung scans for acute pulmonary embolism, a random sample of 933 of 1493 patients was studied prospectively. Nine hundred thirty-one underwent scintigraphy and 755 underwent pulmonary angiography; 251 (33%) of 755 demonstrated pulmonary embolism. Almost all patients with pulmonary embolism had abnormal scans of high, intermediate, or low probability, but so did most without pulmonary embolism (sensitivity, 98%; specificity, 10%). Of 116 patients with high-probability scans and definitive angiograms, 102 (88%) had pulmonary embolism, but only a minority with pulmonary embolism had high-probability scans (sensitivity, 41%; specificity, 97%). Of 322 with intermediate-probability scans and definitive angiograms, 105 (33%) had pulmonary embolism. Follow-up and angiography together suggest pulmonary embolism occurred among 12% of patients with low-probability scans. Clinical assessment combined with the ventilation/perfusion scan established the diagnosis or exclusion of pulmonary embolism only for a minority of patients--those with clear and concordant clinical and ventilation/perfusion scan findings.

Acute Disease↗
PubMedDate not supplied

Preoperative transarterial embolization of spinal tumor: embolization techniques and results.

BACKGROUND AND PURPOSE: The techniques of preoperative embolization of hypervascular spinal tumors, which has been known to be helpful for completing tumor resection, have not been described in detail. The purpose of this study was to analyze the technique and to evaluate the safety and value of preoperative transarterial embolization of hypervascular spinal tumors. METHODS: Eighteen patients with hypervascular spinal tumors underwent transarterial embolization before surgery. The lesions were located between the upper cervical and lower lumbar spine: C1-T1 (n = 6), T5-L3 (n = 11), and L5 (n = 1); they arose intradurally in six patients and extradurally in 12. Thirty-one arteries were embolized with polyvinyl alcohol (PVA) particles (150-500 microm), and, in 18 of these, pieces of gelatin sponge were added for proximal pedicular embolization. The criteria for judging the effectiveness of embolization were completeness of tumor removal and estimated blood loss during surgery. RESULTS: Tumor embolization was total in eight patients, nearly total in seven, subtotal in one, and partial in two. There were no symptomatic complications associated with embolization. Tumors were totally removed in 17 patients and nearly totally removed in one. The average estimated blood loss during surgery was 1100 mL (range, 200-6000 mL) for all 18 patients, and 1540 mL in patients with extradural tumors. CONCLUSION: Preoperative embolization of hypervascular spinal tumors is safe and effective. It can make complete resection of a tumor possible and can make an unresectable tumor resectable. Superselection or flow control is necessary to achieve effective devascularization and to avoid complications.

Adolescent↗