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PubMed1999

Effective hepatic artery chemoembolization for advanced hepatocellular carcinoma with extensive tumour thrombus through the hepatic vein.

BACKGROUND AND AIMS: Advanced hepatocellular carcinoma (HCC) with extensive tumour growth through the hepatic vein still has an extremely poor prognosis, even after cancer chemotherapy and/or transarterial embolization. Although aggressive surgical treatments using extracorporeal circulation and liver transplantation have been performed by some authors, the reported results were still unsatisfactory. In this study, we report the favourable result of hepatic artery chemoembolization and subsequent surgical resection in three patients with advanced HCC with extensive tumour thrombus through the hepatic vein. METHODS AND RESULTS: Three irresectable patients with HCC with extensive tumour thrombus through the hepatic vein underwent hepatic artery chemoembolization with aclarubicin, mitomycin C, lipiodol and/or Gelfoam. After the reduction of tumour extent with hepatic artery chemoembolization, two of the three patients underwent surgical resection. These two patients are still alive at 59 and 21 postoperative months, respectively. In the other case, the extent of the tumour and functional reserve of the liver prevented us from performing surgical resection, but the patient is doing well 62 months after the initial treatment. CONCLUSIONS: Hepatic artery chemoembolization with aclarubicin, mitomycin C, lipiodol and/or Gelfoam might be an effective treatment for irresectable advanced HCC with extensive tumour thrombus into the inferior vena cava or the right atrium through the hepatic vein. Radical surgical resection might be applicable for selected patients without high surgical risk after reducing tumour extent by hepatic artery chemoembolization.

Aclarubicin↗
PubMed2001

Sciatic inflammatory neuritis (SIN): behavioral allodynia is paralleled by peri-sciatic proinflammatory cytokine and superoxide production.

We have recently developed a model of sciatic inflammatory neuritis (SIN) to assess how immune activation near peripheral nerves influences somatosensory processing. Administration of zymosan (yeast cell walls) around a single sciatic nerve produces dose-dependent low-threshold mechanical allodynia without thermal hyperalgesia. Low (4 microg) doses produce both territorial and extraterritorial allodynia restricted to the injected hindleg. In contrast, higher (40 microg) doses produce territorial and extraterritorial allodynias of both hindlegs, an effect not accounted for by systemic spread of the zymosan. The aim of these experiments was to determine whether these behavioral allodynias were correlated with immunological and/or anatomical changes in or around the sciatic nerve. These experiments reveal that zymosan-induced bilateral allodynia was associated with the following: (a) increased release of both interleukin-1beta and tumor necrosis factor-alpha from peri-sciatic immune cells; (b) increased release of reactive oxygen species from perisciatic immune cells; (c) no change in circulating levels of proinflammatory cytokine; (d) no apparent zymosan-induced influx of immune cells into the sciatic nerve from the endoneurial blood vessels; (e) mild edema of the sciatic, which was predominantly restricted to superficial regions closest to the peri-sciatic immune cells; and (f) no anatomic evidence of changes in either the ipsilateral saphenous nerve or contralateral sciatic nerve that could account for the appearance of extraterritorial or contralateral ("mirror") allodynia, respectively. No reliable differences were found when the low-dose zymosan was compared with vehicle controls. Taken together, these data suggest that substances released by peri-sciatic immune cells may induce changes in the sciatic nerve, leading to the appearance of bilateral allodynia.

Animals↗
PubMed2002

Uterine leiomyoma after embolization by means of gelatin sponge particles alone: report of a case with histopathologic features.

We describe the histopathologic features of uterine leiomyoma after uterine artery embolization (UAE) in a 42-year-old woman. This patient, who was taking antiplatelet drugs for the treatment of cerebral disease, successfully underwent UAE using only gelatin sponge particles for a symptomatic uterine leiomyoma. Although menorrhagia improved moderately after the procedure, she underwent abdominal hysterectomy 11 months later because of recurrent uterine bleeding. Histopathology revealed that most of the area of the uterine leiomyoma was characterized by extensive coagulation necrosis, which support the positive result of the procedure. No significant abnormalities were noted in either the myometrium or endometrium, which also suggested that UAE using only gelatin sponge particles is an appropriate procedure to preserve the uterus. The histologic and radiologic features of this case are discussed. To the best of our knowledge, this is the first reported case of uterine leiomyoma after UAE using only gelatin sponge particles as a primary embolic agent.

Adult↗
PubMed2001

Hemoperitoneum in a continuous ambulatory peritoneal dialysis patient caused by a hepatocarcinoma treated with percutaneous embolization.

Hemoperitoneum is an infrequent but normally benign complication in continuous ambulatory peritoneal dialysis (CAPD) patients. It can occur at any time during peritoneal dialytic treatment. Hemoperitoneum is not associated with a specific disease and usually disappears spontaneously. In 20% of cases, however, hemoperitoneum is severe and requires specific investigation and emergency therapy. We report a case of hemoperitoneum in a 70-year-old, anti-hepatitic C virus-positive woman. After 48 months of CAPD treatment, a bloody peritoneal effluent developed, with severe anemia (hematocrit decreased from 30% to 20%). An abdominal computed tomography scan showed three hepatic lesions with signs of hepatic neoplasms; selective hepatic arteriography confirmed the diagnosis. Chemoembolization of the three lesions was performed, and hemoperitoneum disappeared within a few hours.

Aged↗
PubMed1999

Direct round window membrane application of gentamicin in the treatment of Meniere's disease.

OBJECTIVE: To evaluate the effectiveness of the round window membrane (RWM) Gelfoam gentamicin technique in patients with Meniere's disease who were unresponsive to medical management or in whom surgical therapy failed. STUDY DESIGN: Protocol 1, single intratympanic gentamicin infusion; protocol 2 (the best method), 2 infusions, 5 days apart with reevaluation at 1 month; and protocol 3, multiple infusions 1 to 4 weeks apart. PATIENTS: In total, 32 patients (19 male, 13 female) were enrolled in the study. The mean age was 65 years (range 34 to 94 years). Seven of these patients were surgical salvage cases. INTERVENTIONS: Laser-assisted otoendoscopy with a 1.7-mm otoendoscope (Smith-Nephew Richards, Memphis, TN) was performed first. If the RWM was obscured by mucosa or adhesions, these were cleared before placing a 2 x 3 mm piece of dry Gelfoam against the RWM. Buffered gentamicin (26.7 mg/mL) was then injected into the middle ear (0.2 to 0.3 mL). RESULTS: Overall, vertigo was controlled in 75% of the patients after the completion of the treatment, with subtotal vestibular ablation in two thirds of patients. Hearing was preserved in 90% of the patients (within 15 dB pure-tone average or 15% speech discrimination score), tinnitus improved in 48%, and aural pressure improved in 62.5%.

Adult↗
PubMed1996

Preoperative portal vein embolization for extension of hepatectomy indications.

To render hepatectomy feasible in patients with an initially deficient volume of the future remnant liver (FRL), we redistributed portal blood flow rich in hepatotrophic substances toward the FRL. Redistribution was achieved with preoperative portal vein embolization (POPE) feeding the future resected liver. POPE was performed in 31 patients, under fluoroscopic guidance, via a percutaneous access. POPE was well tolerated and surgery was practicable in 24 patients without severe postoperative liver failure. Seven operations were cancelled, but only one due to insufficient hypertrophy of the FRL. FRL volume values were 90 to 560 mL (mean 260 mL) before POPE and 160-783 mL (mean 443 mL) after POPE, which represents a median increase of 79% +/- 50%. Hypertrophy of the FRL was 90% +/- 52% after 30 days with cyanoacrylate, 53% +/- 6% after 43 days with Gelfoam, and 44% +/- 30% after 35 days with coils. Slight shrinkage was obtained in the volume of the embolized liver, for which resection was planned. Overall survival was 2-62 months (mean 26 months), disease-free survival was 0-60 months (mean 19 months), and 7 patients are disease-free and alive 14 to 60 months (mean 43 months) after surgery. Although exclusively applicable in a limited subset of patients, POPE widens the possibilities of curative hepatectomies, because it induces sound hypertrophy of unembolized liver segments. Cyanoacrylate seems to ensure better and faster hypertrophy.

Adolescent↗
PubMed2002

Reduction in the incidence of alveolar osteitis in patients treated with the SaliCept patch, containing Acemannan hydrogel.

PURPOSE: In the present study, we compared the incidence of alveolar osteitis (AO) in patients treated with either clindamycin-soaked Gelfoam (Pharmacia and Upjohn Co, Kalamazoo, MI) or SaliCept Patches (Carrington Laboratories, Inc, Irving, TX). The SaliCept Patch is a freeze-dried pledget that contains Acemannan Hydrogel (Carrington Laboratories) obtained from the clear inner gel of Aloe vera L. PATIENTS AND METHODS: A retrospective evaluation was performed of the records of 587 patients (1,031 sockets) whose extraction sites had been treated with clindamycin-soaked Gelfoam. A prospective trial was conducted in which 607 patients (1,064 sockets) had 2 SaliCept Patches placed immediately after extraction. The same surgeon treated all patients. RESULTS: Analysis restricted to mandibular third molar sites showed that 78 of 975 sites (8.0%) in the Gelfoam group developed AO, whereas only 11 of 958 sites (1.1%) in the SaliCept group developed AO (P <.0001). Further analysis of all extraction sites revealed that the incidence of AO in the Gelfoam group was 7.6% compared with 1.1% in the SaliCept-treated group (P <.0001). CONCLUSIONS: The study results suggest that the SaliCept Patch significantly reduces the incidence of AO compared with clindamycin-soaked Gelfoam.

Adolescent↗
PubMed2002

Splenic rupture in a newborn.

Traumatic rupture of the spleen in the newborn is a rare event and is seldom reported in the literature. It can occur to an abnormally enlarged spleen or to a normal spleen. In the latter, it usually is associated with difficult delivery. Previously, the majority of patients died probably because of delayed or missed diagnoses. The classic presentation is a triad of bleeding, abdominal distension, and hemoperitoneum. High index of suspicion and improvement in diagnostic tools like ultrasonography and computed tomography are important contributions in early diagnosis so that appropriate treatment can be implemented. Splenectomy is no longer the standard treatment because it increases the chance of postsplenectomy sepsis. Instead, treatment should aim for hemostasis and preservation of spleen. The authors present a case of traumatic rupture of spleen in a normal newborn with normal labor and delivery. The first symptom began at 16 hours of age and evolved to a full-blown classic picture. The baby was saved without splenectomy, and the recovery was smooth and uneventful. This is probably the first reported case of a patient treated without splenectomy in this locality. Discussion of the condition and review of the literature also are presented.

Birth Injuries↗
PubMed2002

Treatment of hepatocellular carcinoma with sub-selective transcatheter arterial oily chemoinfusion.

Transarterial therapy for primary liver cancer is gaining more acceptance. The technique of transarterial treatment of such cancers is, however, quite varied. To determine the value of our approach, we analyzed our experience with transarterial oily chemoinfusion (TOCI) of primary liver cancer over a 4.9-year period. Since 1997, over 300 such procedures have been performed at our institution. We report the results of the first 253 procedures, which were performed using a subsegmental technique with a mixture of doxorubicin, cisplatin, ethiodol, with selective Gelfoam embolization. Actuarial survival rates at 1, 2, and 3 years were calculated with Kaplan-Meier and multivariate analysis was performed by Cox regression. The median overall survival was 28.6 +/- 4.5 months following diagnosis. By univariate analysis, TNM clinical stage I or II, Karnofsky score above 80%, absence of extrahepatic disease, absence of vascular invasion, unifocal disease, pretreatment alpha-fetoprotein levels less than 500 ng/ml, hypervascularity of lesions, and lesion size less than 5 cm were all strong predictors of favorable patient survival at 1, 2, and 3 years (75%, 60%, and 50% respectively). Based on our experience, TOCI with selective embolization has similar survival benefit as the traditional chemoembolization but is associated with fewer complications.

Adult↗
PubMed2001

Dental extractions in patients maintained on oral anticoagulant therapy: comparison of INR value with occurrence of postoperative bleeding.

The purpose of this study was to evaluate the incidence of postoperative bleeding in patients treated with oral anticoagulant medication who underwent dental extractions without interruption of the treatment and to analyze the incidence of postoperative bleeding according to the International Normalized Ratio (INR) value. The 249 patients who underwent 543 dental extractions were divided into five groups: Group 1 with INRs of 1.5-1.99, Group 2 with INRs of 2-2.49, Group 3 with INRs of 2.5-2.99, Group 4 with INRs of 3-3.49 and Group 5 with INRs>3.5. The INR was measured on the day of the procedure. Local haemostasis was carried out with gelatin sponge and multiple silk sutures. Of the 249 patients, 30 presented with postoperative bleeding (12%): Group 1, three patients presented with bleeding (5%), Group 2, 10 patients (12.8%), Group 3, nine patients (15.2%), Group 4, five patients (16.6%) and Group 5, three patients (13%). The incidence of postoperative bleeding was not significantly different among the five groups. The value of the INR at the therapeutic dose did not significantly influence the incidence of postoperative bleeding. Thus, dental extractions can be performed without modification of oral anticoagulant treatment. Local haemostasis with gelatin sponge and sutures appears to be sufficient to prevent postoperative bleeding.

Administration, Oral↗
PubMed1976

[Embolisation of malignant renal tumours (author's transl)].

We have carried out embolisation of malignant renal tumours using homogenised muscle in a number of patients. Since October 1974, this has been done 22 times; in six cases the tumour was inoperable. Pre-operative embolisation of resectable renal tumours makes the operative procedures easier and reduces operative risks in older patients. Haematuria, which can cause bladder obstruction, is considered a particular indication in the presence of an inoperable tumour. Tumour growth can be reduced or there may even be regression. There were no significant complications as a result of embolisation of renal tumours with autologous homogenised muscle.

Adenocarcinoma↗
PubMed1976

Current angiographic approach to diagnosis and therapy of acute gastrointestinal bleeding.

The author's current angiographic approach to the diagnosis and therapy of acute gastrointestinal (GI) bleeding is summarized and discussed. It is based on the authors' experience with diagnostic studies in more than 300 acute GI bleeders and the use of various angiotherapeutic techniques in 138 of them as well as the experience of others. A "moderately aggressive angiographic approach" is advocated for the diagnosis of acute GI bleeding in most patients with angiography used as needed after emergency endoscopy and preliminary medical therapy. Vasoconstrictive angiotherapy with selective intraarterial use of vasopressin is partially giving way to low dose, intravenous infusion of vasopressin and, where possible, to direct vascular occlusion. Selective transcatheter embolic occlusion of bleeding vessels is in indicated cases an accepted method for controlling arterial bleeding. Medical gelatin (Gelfoam) is the current authors' embolization material of choice. Selective variceal occlusion offers promising means for management of bleeding from gastroesophageal varices. Its possible combination with transcatheter intrahepatic portosystemic shunting might also provide non-surgical relief of portal hypertension.

Acute Disease↗
PubMed1977

[Embolisation techniques for renal tumors (author's transl)].

We have performed ten embolisations in nine patients with vascular renal tumours, eight of these pre-operatively. One patient had an inoperable hypernephroma which was embolised twice. We have used gelatine sponge particles (Gelaspon). In every patient it was possible to occlude the arterial supply. There were no complications.

Adenocarcinoma↗
PubMed1978

Which embolic material is best suited for which embolization procedure?

Various embolization cases are described, and these require certain embolization materials. In our experience Gelfoam particles are very well suited for gastrointestinal tract lesions. Ivalon shavings gave excellent results in congenital arteriovenous malformations with permanent occlusions. Bristle brushes are a new device for larger artery occlusion. Stainless steel coils in combination with silk tufts proved thrombosis of large AV fistuals or of aneurysms particularly of the splenic artery.

Abdominal Injuries↗
PubMed2001

Basic fibroblast growth factor induced angiogenesis and prefabricated flap survival.

Prefabrication of a latissimus dorsi myocutaneous flap was performed in adult male Landrace pigs. Gelfoam sponges were used as a delivery system for basic fibroblast growth factor (bFGF) at the muscle-subcutaneous tissue interface. Skin survival and angiogenesis were augmented in the growth-factor-treated animals. These data support the use of basic fibroblast growth factor to enhance flap prefabrication.

Animals↗
PubMed2006

[Sealing of percutaneous nephrolithotomy access after complete stone removal with a hemostyptic gelatin powder (Spongostan)].

PURPOSES: Parallel to the pilot project of Lee et al. which was published in February 2004, we also considered the possibility to seal the percutaneous nephrolithotomy (PCNL) access after complete stone removal via the local amplatz sheath. We started our project with the aims of increasing postoperative patient comfort, minimizing the risk of bleeding, and reducing postoperative cost and length of the hospital stay by performing this minimally invasive technique in 7 patients with medium stone burden. MATERIALS AND METHODS: All patients were treated by removing stones via a working channel passing through the lower pole calix. After complete stone removal a hemostyptic gelatin powder (Spongostan, Johnson & Johnson) was prepared to a doughy paste, some drops of contrast medium were added and the whole material was introduced through the amplatz sheath into the working channel under imaging control. Imaging-controlled insertion of the doughy gelatin clot through the amplatz sheath into the parenchymal part of the channel alone resulted in immediate hemostasis in all patients. The amplatz sheath was retracted over a 28 Fr. rectal tube which was used to push the gelatin forward. There was no need for an additional tamponade of the renal fat capsule or the abdominal wall. After 2 minutes when no channel bleeding was apparent, the skin sutures were placed. RESULTS: Bleeding of the nephrostomy tract did not occur in any of the 7 patients. Average operating time was 50 minutes which was not significantly reduced by performing the new procedure. However, the hospital stay was reduced by 2 days. Two of the patients showed a single fever episode during the second postoperative evening. All patients presented with steady postoperative laboratory values without evidence of bleeding. Free urinary flow from the collecting system was controlled by means of ultrasound and urography. CONCLUSIONS: Similar to the recent usage of FloSeal/Baxter reported by Lee et al. we can confirm very reliable and immediate hemostasis using a pasty preparation of Spongostan (Johnson and Johnson) gelatin powder which was classified as being less toxic by the FDA in 2003 due to the lack of glutaraldehyde and bovine thrombin. Therefore, tubeless PCNL can be used for complete percutaneous clearance of stones without bleeding.

Administration, Topical↗