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Secondary Hemorrhage after Myomectomy
Published in Rooma Sinha, Arnold P. Advincula, Kurian Joseph, FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
A retrospective review from Korea [20] described the efficacy and safety of uterine artery embolization in eight patients who had hemorrhage after myomectomy. The time interval between myomectomy and the embolization was from 0 to 47 days with a median interval of 1.5 days. Two patients who underwent transcervical and hysteroscopic myomectomy had to be embolized on the very same day as surgery because of persistent vaginal bleeding and low hemoglobin levels. Two patients who underwent open myomectomy were embolized on day 1, and another patient had to undergo embolization on day 2 after surgery. Three patients had secondary hemorrhage after open myomectomy on days 22, 28, and 47. Two of them were hemodynamically unstable. Pelvic angiography of the eight patients revealed hypervascular staining without obvious bleeding focus in five patients, active extravasation of contrast from the uterine artery in two patients, and a pseudoaneurysm in one patient. Peritoneal hematoma was noted on CT in one patient. Uterine artery embolization was technically and clinically successful in all eight patients. Gelatin sponge particles were used in all eight patients. All patients resumed normal menstrual cycles after the procedure.
History of CSF rhinorrhea
Published in Jyotirmay S. Hegde, Hemanth Vamanshankar, CSF Rhinorrhea, 2020
Hemanth Vamanshankar, Jyotirmay S Hegde
For closure of CSF leaks, fascia lata was the primary choice, as described by Dandy. This was similarly described by others like Cushing (1927), McKinney (1932), Cairns (1937), Gissane and Rank (1940), Eden (1942), and Campbell, Howard, and Weary (1942).11–16 Echols and Holcombe (1941)17 described closure by using muscle. German (1944)18 described using flaps of dura covering the crista galli and falx to repair five cases. The use of a free periosteal graft over the cribriform plate was described by Ecker in 1947.19 The use of absorbable gelatin sponge (Gelfoam) was first mentioned by Cloward and Cunningham in 1947.20 The use of wax after stripping the dura on either side of the CSF leak and subsequent suturing was successfully described by Love and Gay.21 Coleman described the release of air and suturing dura over cribriform plate – which he successfully performed in a case of pneumatocele with CSF rhinorrhea following trauma.22
The Application of Organ Culture to the Study of Colon Carcinogenesis
Published in Herman Autrup, Gary M. Williams, Experimental Colon Carcinogenesis, 2019
Betti Reiss, N. Telang, Gary M. Williams
In contrast to these organ culture systems in which the tissue was maintained in a stationary position, rocking cultures have been used by Autrup,13,14,17 Shamsuddin et al.,15 and Reiss and Williams.16 The Autrup-Shamsuddin team used CMRL 1066 medium for their cultures supplemented with 10% FBS15 or 2.5 to 5.0% BSA14 for rat and 5% BSA13,17 for human colon fragments. For rat colon, other supplements to the medium were l-glutamine, insulin, hydrocortisone, and glucose,15 whereas for human colon, tricine buffer, methionine, and β-retinyl acetate were used; insulin and glucose were omitted.14 All of the cultures were gassed with 95% O2:5% CO2. Also, for the human colon fragments, gelatin sponge served as a matrix between the plastic culture dish and the colon to facilitate diffusion of nutrients and oxygen. Using these conditions, the Autrup-Shamsuddin groups obtained prolonged survival of colonic mucosal crypts for up to 6 weeks for rat fragments and 3 weeks for human fragments.
Effects of tract embolization on pneumothorax rate after percutaneous pulmonary microwave ablation: a rabbit study
Published in International Journal of Hyperthermia, 2023
JinZhao Peng, ZhiXin Bie, Fei Su, Jie Sun, XiaoGuang Li
Gelatin sponge particles have good absorbability and safety. The study shows gelatin sponge particles can be degraded and absorbed in vivo. One safety concern for clinicians is the risk of migration of gelatin sponge particles to pulmonary vessels. The risk of migration to pulmonary veins or arteries potentially exists. However, there seems to be no evidence of any sealant material migrating into the pulmonary vessels of any specimen in our study. Such a complication has never been reported in clinical practice [11,13,14,16]. The present study implies that the use of large-size gelatin sponge particles to embolize the needle tract under the pleura may help to decrease the risk of migration. Renier et al. [11] also used the technique of withdrawing the needle tip at a distance of 1 cm from the pleura before embolization to reduce such a complication. The rationale is that vessels become anatomically fewer and smaller in the sub-pleural lung. In addition, confirming that there is no blood return before injecting gelatin sponge particles can reduce the risk of migration [14].
Experimental Evaluation of a New Tissue Factor-Based Topical Hemostat (TT-173) for Treatment of Hepatic Bleeding
Published in Journal of Investigative Surgery, 2020
Alberto Centeno, Santiago Rojas, Belén Arias, Ignasi Miquel, Pilar Sánchez, Claudia Ureta, Esther Rincón, Ramón López, Jesús Murat
Sprague-Dawley rats 260–330 g in weight (n = 72), were distributed into three experimental groups of 24 animals (12 males and 12 females). Rats were anesthetized by inhalation of isoflurane vaporized in O2 at a flow rate of 2 L/min. A concentration of 5% was used for the induction and a 2–3% for anesthesia maintenance. A liver biopsy injury of 2 mm in depth was performed by means of a disposable trocar (5 mm, Ref. B07985, La Bouvet). Immediately after, a 1 cm2 portion of gelatin sponge (Gelitaspon, GS-110, 80 × 50 mm and a thickness of 1 mm) soaked with the respective treatment was applied. Animals in the control group received a portion of sponge impregnated with physiologic saline. The other two groups received a dose of 545 μg/animal or 1090 μg/animal of TT-173 applied in the same way. Groups of 6 animals (3 male and 3 female) were euthanized at 3 hours after surgery, and after 1, 7, and 30 days. Samples of serum and blood were collected at sacrifice and a gross necropsy was conducted, collecting the brain, kidneys, lungs, spleen, liver (lesioned and non-lesioned sites), thymus and reproductive organs. Collected samples were subsequently weighted and processed for histopathological evaluation.
Efficacy of combination therapy with transcatheter arterial chemoembolization and radiofrequency ablation for intermediate-stage hepatocellular carcinoma
Published in Scandinavian Journal of Gastroenterology, 2018
Kei Endo, Hidekatsu Kuroda, Takayoshi Oikawa, Yohei Okada, Yudai Fujiwara, Tamami Abe, Hiroki Sato, Kei Sawara, Yasuhiro Takikawa
We inserted a 5Fr-sheath from the femoral artery using the Seldinger technique. A catheter was advanced to the superior mesenteric artery and CT during hepatic arteriography was performed to investigate the site and size of the HCCs and to confirm patency of the portal vein in all patients. A catheter was then advanced to the celiac artery to perform CT during hepatic arteriography and digital subtraction angiography to obtain information on tumor vascularity and feeding vessels. After the micro catheter was inserted closest (as feasible) to the target branch, an anticancer drug in iodized oil (Lipiodol, Guerbet, Tokyo, Japan) was injected. We used one of the three kinds of anticancer drugs based on the judgment of the operator. Cisplatin powder (50 mg) (IA-Call, Nippon Kayaku Co. Ltd, Tokyo, Japan), Miriplatin (70 mg) (Miripla, Dainippon-Sumitomo Pharmaceutical Co. Ltd, Osaka, Japan), and Epirubicin (30 mg) (Epirubicin, Nippon Kayaku Co. Ltd, Tokyo, Japan) were suspended in 10 mL of iodized oil. The dose of anticancer drug and iodized oil depended upon the size and vascularity of the tumor. After that, 1 mm of gelatin sponge particle (Gelpart, Nippon Kayaku Co. Ltd, Tokyo, Japan) was slowly injected into the feeding arteries. The sites of injection of the gelatin sponge particle were segmental or sub-segmental in all patients. At the end of the procedure, lipiodol deposition was assessed using plain CT.