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PubMedDate not supplied

MR imaging appearance of intraperitoneal gelatin sponge in mice.

Intraperitoneal gelatin sponge can mimic a mass lesion on magnetic resonance (MR) images. To determine the MR imaging characteristics of gelatin sponge over time, a 15 x 10 x 4-mm piece of gelatin sponge soaked in saline was surgically implanted in the peritoneal cavity of 14 mice. Two mice underwent a sham operation. Contiguous axial spin-echo images of the abdomen were obtained with T1-weighted, spin-density, and T2-weighted sequences preoperatively and over a 6-week period postoperatively. Gelatin sponge initially appears as a heterogeneous mass of low signal intensity on T1-weighted images and increasing intensity on spin-density and T2-weighted images, containing multiple round foci of very low signal intensity, attributable to air, at all sequences. Over time, signal intensity further increases and becomes more homogeneous on spin-density and T2-weighted images, although foci of air persist to 3 weeks. By 2-4 weeks, the mass is no longer discrete. Foci of air should help differentiate gelatin sponge from tumor and add gelatin sponge to the differential diagnosis of abscess.

Animals↗
PubMed1989

New intraoperative brachytherapy techniques for positive or close surgical margins.

Tumors attached or adjacent to critical structures can often not be completely resected or resected with adequate surgical margins. Sites involving major blood vessels, the paravertebral spaces, or critical abdominal structures often present technical difficulties for standard brachytherapy procedures using I-125 or Ir-192 implants. These techniques allow for a high-dose delivery to the tumor bed with minimal normal tissue toxicity. A relatively simple and accurate method is described using I-125 seeds in Vicryl suture threaded through Gelfoam. These permanent implant procedures with radioactive I-125 seeds effectively treat small residual tumors or suspicious margins where standard brachytherapy techniques may be unsatisfactory and technically difficult to perform.

Adult↗
PubMed1993

Preoperative chemoembolization for hepatocellular carcinoma.

In a group of 396 patients who had chemoembolization for hepatocellular carcinoma (HCC) between 1984 and 1991, 67 underwent surgery (segmentary/subsegmentary resections: 31; or transplantation: 36). Morbidity was limited to hepatic insufficiency (seven), arterial thrombosis (two), vasculitis (five), cholecystitis (two), and hepatic abscess (one). Perioperative mortality was 5.5% for transplantation and 6.7% for resection. Histological examination of resected specimens showed a total or subtotal tumor necrosis in 58% of the cases, and a necrosis between 50% and 80% in another 18%. Data on recurrence and long-term survival are not significant if retrospectively compared with non-chemoembolized surgically treated patients. Chemoembolization is known to be an effective palliative treatment of HCC. Its role in the preoperative setting is sustained by a 58% of total or subtotal histological necrosis. A multicentric prospective trial to evaluate the role of preoperative chemoembolization for long-term survival and recurrence of HCC is advocated.

Adolescent↗
PubMed1993

Efficacy of chemoembolization for hepatocellular carcinomas: experience from the Gustave Roussy Institute and the Bicêtre Hospital.

Chemoembolization (CE) has been used for more than 10 years to treat hepatocellular carcinoma (HCC) in our departments, and three studies have been done. The first was a retrospective study on 232 patients in which CE was performed with doxorubicin and Gelfoam with or without Lipiodol; the response rate was 41% (34.7-47.3%) and survival was better for Okuda stage I disease than for stages II and III (2-year survival 82, 29, and 0% respectively); for patients with Lipiodol retention the response rate was over 50%. The second study compared CE with doxorubicin and Gelfoam to symptomatic treatment in a randomized manner; it included 42 patients and failed to demonstrate a survival advantage (1-year survival: CE 24% vs. control 31%; NS). The third study is ongoing and tests CE with cis-platinum, Lipiodol, and Gelfoam. According to our experience prospective randomized studies are warranted to define clearly the best indications for CE in HCC.

Carcinoma, Hepatocellular↗
PubMed1995

Intraoperative brachytherapy using Gelfoam radioactive plaque implants for resected stage III non-small cell lung cancer with positive margin: a pilot study.

Complete surgical resection of stage III non-small cell lung cancer (NSCLC) is at times impossible. Adjuvant radiation therapy is required to sterilize the residual tumor. This study is to investigate the safety, reproducibility, and effectiveness of intraoperative I-125 or Pd-103 Gelfoam plaque implant technique as an adjuvant treatment for resected stage III NSCLC with positive surgical margin. Between 1989 and 1993, 12 patients with stage III NSCLC received intraoperative lung implant with radioactive I-125 or Pd-103 pellets. All 12 patients underwent tumor resection, but either gross or microscopic positive margin was found during operation. Radioactive I-125 or Pd-103 seeds were embedded in the Gelfoam plaque. After surgical resection was completed, the radioactive Gelfoam plaque was secured onto the tumor bed either by clips or suture. Either preoperative or postoperative external beam radiation of 45-60 Gy was given to all of the 12 patients. Four patients received chemotherapy. No patient has developed any early or late complications attributable to implant procedure or radiation. The local control rate at last follow-up is 82%. The 2-year overall and cause-specific survival rates are 45% and 56%, respectively. The intraoperative Gelfoam I-125 or Pd-103 planar implant technique is a safe, reproducible, and effective technique of treatment for stage III NSCLC with a positive surgical margin. Encouraging local control and survival are achieved in patients treated with this technique. This technique will compliment standard adjuvant treatments to further improve local control in resected state III lung cancer.

Adult↗
PubMed1979

Percutaneous embolization to control intractable epistaxis.

Recurrent epistaxis is a common manifestation of patients with a bleeding diathesis. Two patients with epistaxis secondary to a bleeding diathesis managed by local conservative techniques are reviewed. (A case of polycythemia vera and a case of liver failure secondary to hepatoma are reviewed.) Recently bilateral, percutaneous carotid angiography examination was performed on a patient with a bleeding diathesis and intractable epistaxis. At the time of the angiographic examination, embolization of both internal maxillary arteries with Gelfoam particles was accomplished and dramatic control of the epistaxis was achieved. In a patient with severe epistaxis secondary to a bleeding diathesis that is unresponsive to local measures, percutaneous Gelfoam embolization offers substantial advantages over surgical intervention.

Adult↗
PubMed1982

A comparison of hemostatic agents in microvascular surgery.

The hemostatic abilities of oxidized cellulose, gelatin powder, microfibrillar collagen, and expanded polytetrafluoroethylene cuffs were compared on anastomoses of the femoral vessels in rats. The intraoperative hemostatic time and patency were recorded. Vessels that were patent intraoperatively were examined at various intervals postoperatively to determine patency and to detect the development of abnormalities, and specimens for examination under a scanning electron microscope were obtained. Microfibrillar collagen was found to be superior in maintaining patency and in ease of use. The PTFE cuffs demonstrated the shortest hemostatic times, but they produced distortion of the vessels several weeks after surgery. The authors conclude that microfibrillar collagen is the best overall hemostatic agent and have continued to use it experimentally and clinically with no complications.

Animals↗
PubMed1996

Traumatized rat striatum produces neurite-promoting and neurotrophic activities in vitro.

We have previously reported that ciliary neurotrophic factor (CNTF) mRNA is upregulated in the rat striatum following trauma and that its peak is coincident with a peak in the number of GFAP-positive astrocytes. CNTF, or other neurotrophic factors present in the traumatized striatum, may be involved in the dopaminergic fiber sprouting seen following cavitation or graft implantation in animal models of Parkinson's disease. This study was undertaken in order to further characterize the neurotrophic activity present following trauma through the use of bioassays. Adult rats underwent stereotaxic biopsy of the right striatum, and gelatin sponge [gelfoam (GF)] was placed in the resultant cavity. GF was collected from 1 to 30 days following trauma and homogenized. GF extracts (with equal protein concentrations) were assayed using dorsal root ganglion (DRG) explants, dissociated ciliary ganglia (CG), and human dopaminergic neuroblastoma cell (SH-SY5Y) cultures. The GF extracts had significant neurite-promoting activity (NPA) for DRG, CG, and SH-SY5Y cells, with the maximum effect seen 7 days after trauma. NPA was not blocked by anti-nerve growth factor (NGF) Ab, but anti-brain-derived neurotrophic factor (BDNF) Ab significantly blocked the activity for DRG. The GF extracts protected the SH-SY5Y cells from the neurotoxins 6-OHDA and MPP+, as did NGF and BDNF. This neuroprotective effect of GF was not blocked by anti-NGF Ab. This study suggests that the neurotrophic activity in GF extracts has CNTF-like and BDNF-like components as well as another, undefined component.

Animals↗
PubMed2001

Endothelial implants provide long-term control of vascular repair in a porcine model of arterial injury.

Cell culture and animal data support the role of endothelial cells and endothelial-based compounds in regulating vascular repair after injury. We describe a long-term study in pigs in which the biological and immunological responses to endothelial cell implants were investigated 3 months after angioplasty, approximately 2 months after the implants have degraded. Confluent porcine or bovine endothelial cells grown in polymer matrices were implanted adjacent to 28 injured porcine carotid arteries. Porcine and bovine endothelial cell implants significantly reduced experimental restenosis compared to control by 56 and 31%, respectively. Host humoral responses were investigated by detection of an increase in serum antibodies that bind to the bovine or porcine cell strains used for implantation. A significant increase in titer of circulating antibodies to the bovine cells was observed after 4 days in all animals implanted with xenogeneic cells. Detected antibodies returned to presurgery levels after Day 40. No significant increase in titer of antibodies to the porcine cells was observed during the time course of the experiment in animals implanted with porcine endothelial cells. No implanted cells, Gelfoam, or focal inflammatory reaction could be detected histologically at any of the implant sites at 90 days. These data suggest that tissue-engineered endothelial cell implants may provide long-term control of vascular repair after injury, rather than simply delaying lesion formation and that allogeneic implants are able to provide a greater benefit than xenogeneic implants.

Animals↗
PubMed1996

Angiographic embolization of intrahepatic arterioportal fistula.

We report the case of a posttraumatic arteriovenous fistula between the right hepatic artery and the right portal vein remarkable in that clinical manifestations, including portal hypertension and mesenteric insufficiency findings, appeared latently and progressively worsened. This hepatoportal fistula was diagnosed by Doppler sonography and successfully treated by transcatheter embolization of feeding hepatic artery branch with steel coils. We emphasize the interest of pulsed Doppler in the diagnosis of hepatoportal fistula, in assessment of hemodynamic changes related to the fistula and in follow-up after treatment.

Angiography↗
PubMedDate not supplied

Determination of the optimum dose level of lipiodol in transcatheter arterial embolization of primary hepatocellular carcinoma based on retrospective multivariate analysis.

PURPOSE: Multivariate analysis was used to study the effectiveness and optimum dose level of Lipiodol (LP) in transcatheter arterial embolization (TAE) of hepatocellular carcinoma (HCC). METHODS: A total of 219 cases of nodular type HCC, with a tumor diameter less than 7 cm, were studied. TAE was performed using both Gelfoam sponge (GS) and LP in 158 cases; in the remaining 61 cases only GS was used. RESULTS: Statistical stepwise variable selection revealed that only LP had a negative T-value, suggesting that LP is a useful factor for prognosis. The most favorable effect on patient prognosis was obtained with an LP dose level (expressed in mm) of 1-1.5 times the absolute value of the tumor diameter (expressed in cm). CONCLUSION: A significant difference (p < 0.01, log-rank test) in survival was found between the GS with LP group and the GS only group, using Cox's proportional hazard model.

Carcinoma, Hepatocellular↗
PubMed1992

Aneurysmal bone cysts treated by superselective embolization.

A series of 7 cases of aneurysmal bone cysts (ABC), all but 1 located in the pelvic bones, which were treated by transcatheter embolization is presented. Five embolizations were performed for primary treatment, while in 2 patients they were performed preoperatively. In all patients a definite histological diagnosis was established by open biopsy, and plain radiographs as well as computerized tomography (CT) were applied for evaluation of the results. The embolizing materials were tissue adhesive for permanent, and Gelfoam for preoperative vessel occlusions. Of 5 lesions treated for the purpose of definitive embolization, 3 (all located in the superior pubic ramus) showed complete ossification; in one, partial remineralization and progression occurred. In a further patient with a secondary ABC, partial reconstitution was recorded. Both preoperative embolizations resulted in successful en bloc resection with minimal blood loss. Transcatheter embolization is the treatment of choice for the highly vascular ABC in unfavorable anatomical locations.

Adolescent↗
PubMed1977

Evaluation of different types of emboli in transcatheter embolization of rat kidney.

The properties and characteristics of a variety of embolic materials (Clots--surgicel--gelfoam--barium--cyanoacrylates) were investigated by transcatheter embolization of the rat kidney. Clots and surgicel result in temporary embolization, with return of normal renal function. Gelfoam barium and cyanoacrylates produce definitive embolization. Only barium was found in veins.

Animals↗
PubMed1985

Aneurysmal bone cyst of the ischium.

The treatment of a patient with an aneurysmal bone cyst involving the pelvis by selective arterial embolism is described. After one year pain relief is complete and radiologically the lesion is healing with increased density of the cyst wall and intracystic trabecular bone formation.

Adolescent↗
PubMed1995

Epidural scar tissue formation after spinal surgery: an experimental study.

Extensive epidural scar formation is a well-known complication after spine surgery. Fibrous adhesions around nerve roots are a major reason for recurrent neurological symptoms following lumbar discectomy. A large variety of materials, implanted onto the dura, have been used to prevent or reduce laminectomy membrane, with conflicting results. We therefore carried out an experimental study in dogs to compare those materials that seemed to be most suitable. In each of 30 adult beagles, three lumbar laminectomies were performed. Each level was covered with a different material--free autologous fat graft, cellulose mesh, Gelfoam or triamcinolone suspension. In a control group nothing was implanted. After 7 days or 1, 3 or 6 months the animals were killed. The lumbar vertebral columns were harvested and prepared for further histological examination. To compare the results, we designed a new classification scheme (scar index). The data were obtained without knowledge of implanted material or time since operation. We found that free autologous fat grafts are able to reduce epidural scar formation in a high proportion of cases, especially after 3 and 6 months; cellulose mesh showed the worst results. We conclude that free autologous fat grafts are superior to other materials because of simple operative handling, good compatibility and effective prevention of laminectomy membrane.

Adipose Tissue↗