Gel Foam Research Articles

A retrospective analysis of 334 cases of hemoptysis treated by bronchial artery embolization.

To analyze the safety and efficacy of bronchial artery embolization (BAE) in the management of hemoptysis. We conducted a retrospective study of 334 patients who had undergone BAE for hemoptysis from January 2007 to July 2013. Our study included 255 (76.3%) males and 79 (23.7%) females with an age range from five to 81 years old. All relevant arteries were evaluated but only those arteries that showed hypertrophy and significant blush were targeted. Polyvinyl alcohol (PVA) was used in all patients and gel foam was used in combination with PVA where there was significant shunting. Mild hemoptysis was seen in 70 patients, moderate in 195 patients, and severe in 69 patients. On imaging, right side disease was seen in 101 patients, left side involvement in 59 patients, and bilateral involvement in 174 patients. Post-tubercular changes were the predominant pathology seen in 248 patients. Among 334 patients (386 procedures), 42 patients underwent the procedure twice and five patients underwent the procedure thrice. A total of 485 arteries were attempted of which 440 arteries were successfully embolized. Right intercosto-bronchial was the most common culprit artery present in 157 patients, followed by common bronchial (n=97), left bronchial (n=55), and right bronchial (n=45). We embolized a maximum of four arteries in one session. Immediate complications such as dissection and rupture occurred in only nine sessions (2.3%). Twenty-five procedures (6.5%) were repeated within two months, which were due to technical or clinical failure and 27 procedures (7%) were repeated after two months. BAE is a safe and effective procedure with a negligible complication rate. Our approach of targeting hypertrophied arteries was effective.

Abstract No. 356 - Vascular urologic emergencies: image-guided interventions

Modern imaging studies such as computerized topography (CT) and ultrasound (US) provide an advantage for the detection of vascular urological injuries because of their speed, while digital subtraction angiography (DSA) allows for the precision needed for effective intervention. Minimally invasive techniques offer potentially lower complication rates and faster recovery times than traditional methods. This study demonstrates the role of image-guided percutaneous angiography (PCA) in such emergencies through five cases that cover the scope of neoplastic, iatrogenic, post-operative, and traumatic hemorrhages as well as priapism. PCA has revolutionized vascular interventions. DSA provides both a detailed diagnosis and an avenue for precise interventions. Embolization of pathologic vessels or hemorrhage sites can be achieved using embospheres, microcoils or gel foam. These techniques are easily extrapolated in the context of vascular urologic emergencies. One such case was a 57 year-old woman with an acute hemorrhage following surgical resectioning for renal cellular carcinoma (RCC). The postoperative period was complicated by a difficult extubation followed by acute hemorrhagic shock. The patient’s hemoglobin dropped to 6.5 as her surgical drain emptied serosanguineous fluid. After requiring 6 units of PRBC, 4 units FFP and 1 unit of platelets, IR was consulted and emergent renal DSA was performed of the left main renal artery. Subselective left inferior renal segmental branch angiography showed two small pseudoaneurysms peripheral to the site of resectioning. Microcoil embolization of the left inferior segmental branch was performed, successfully occluding perfusion to the pseudoaneurysms. The patient’s hemodynamic status soon stabilized and she was transferred out of the ICU in the following days. The case above demonstrates the application of interventional radiologic techniques in just one urologic vascular emergency. Furthermore, the methods used in the above case are not dissimilar to those used in the following case reviews, which illustrate the unique treatment options image-guided interventions can offer in the urologic setting.

5:18 PM, Abstract No. 318 - Mandibular AVM diagnosis and curative treatment

5:18 PM, Abstract No. 318 - Mandibular AVM diagnosis and curative treatment

Abstract No. 345 - Endovascular management of splenic trauma: a review of principles and techniques

1) Discuss the epidemiology and mechanisms of splenic trauma. 2) Review pertinent imaging findings on CT and the American Association for the Surgery of Trauma (AAST) grading scale for splenic injuries. 3) Highlight techniques and principles for endovascular embolization of acute splenic trauma. 4) Discuss follow-up care, post-embolization imaging, and potential complications. Splenic injuries most commonly occur due to blunt force trauma following motor vehicle accidents. While splenic trauma has been historically managed with splenectomy or splenorrhaphy, splenic arterial embolization has become the principal treatment in hemodynamically stable patients. Because of an extensive network of collateral vessels supplying the spleen, proximal or distal embolization maybe employed for endovascular management of splenic injuries. This exhibit reviews the pertinent anatomy and angiographic evaluation of splenic artery embolization. Depending on the initial angiographic findings, proximal or distal embolization maybe performed each with differing techniques and underlying principles. A variety of factors should be considered when choosing the site of embolization as well as the embolic agent utilized. Case based examples of active extravasation, pseudoaneurysms, and splenic artery aneurysms managed with coiling, microparticle, vascular plug, and gel foam embolization will be highlighted using quality images. Close postprocedure care is essential as delayed splenic rupture, splenic abscess, and other complications may occur. Guidelines for vaccination and timing of follow-up CT will be included. Splenic injuries due to blunt force trauma are being increasingly treated with endovascular embolization forgoing the need for operative management. Appropriate utilization of proximal and distal embolization techniques performed with a variety of embolic agents is essential to achieve safe and effective patient outcomes.

Converting fluid-based cytologic specimens to histologic specimens for immunohistochemistry.

Cavitary effusions are often evaluated cytologically to determine if there is an underlying neoplastic cause. Differentiation of neoplastic epithelial from mesothelial populations within effusions can be difficult using routine cytology. In addition, cytology alone cannot provide information on the immunophenotype of round cell populations. Gel foam techniques can be used to convert effusions into cell blocks for immunohistochemical (IHC) staining which can then be used to differentiate mesothelial from epithelial cell populations, and also allow immunophenotyping of round cell populations within effusions. The aim of this study was to evaluate a gel foam cell block technique for converting potential neoplastic cells in cavitary effusions into cell blocks to characterize these further by IHC. Thirteen canine and 7 feline samples with cohesive cell populations were evaluated using gel foam cell blocks and IHC. Samples evaluated by routine cytology were categorized as (1) epithelial cells, (2) cohesive cell population without cytologic distinction between mesothelial and epithelial cells, and (3) mesothelial cells with signs of atypia. Antibody-mediated staining of vimentin and cytokeratin of the effusion cell blocks yielded further classification of cohesive cell populations. In addition, a total of 4 effusions with malignant round cells were evaluated; they were immunophenotyped as either B- or T-cell lymphoma. The use of cytokeratin and vimentin IHC on gel foam cell blocks from cavitary effusions provided robust staining and allowed characterization of cohesive cells as mesothelial or epithelial and immunophenotyping of lymphoid cell populations. In addition, this method is cost and time effective.

Study of the role of transcatheter arterial chemoembolization using iodized oil with and without gel foam for the management of hepatocellular carcinoma

ObjectiveThe aim of this study was to determine the effectiveness and safety of transcatheter arterial chemoembolization (TACE) using iodized oil with and without gel foam for the management of hepatocellular carcinoma (HCC).BackgroundHCC is one of the most common malignant diseases worldwide, with an increasing incidence in the industrialized countries. The extensive application of surveillance programs for the early detection of HCC in high-risk patients has increased the number of tumors detected at a subclinical stage as well as those that are responsive to effective treatments.Patients and methodsThis study was carried out on 40 patients with HCC; of these, 20 patients were treated with TACE by lipiodol and adriamycin, group I, and 20 patients were treated with TACE by lipiodol and adriamycin, followed by gel foam, group II.ResultsA unique criterion of this study is that all the entire study population of the cirrhotic groups had posthepatitic cirrhosis (hepatitis C virus). After TACE, there was a decrease in tumor size, safe in liver function, and a decrease in α-fetoprotein.ConclusionTACE was safe and effective in the treatment of HCC. We found a trend toward greater survival when gel foam was used as the embolic agent for TACE for HCC, although this was not significant compared with lipiodol.

Synthesis of hybrid polymer blend nanoparticles and incorporation into in situ gel foam spray for controlled release therapy using a versatile synthetic purine nucleoside analogue antiviral drug

Antiviral drug loaded nanoparticles is incorporated intoin situgel for controlled release therapy. Chemical and physical interactions of drug and polymers in the system influenced their characteristics and drug release mechanism.

The Efficacy of Tranexamic Acid in the Reduction of Incidence of Dry Socket: An Institutional Double Blind Study

Alveolar osteitis (AO) is an important postoperative problem with an incidence of 20% to 35% especially prevalent after the removal of mandibular molars. Fibrinolysis with subsequent loss of blood clotting is believed to be the general cause of AO. This study aims to evaluate the efficacy of tranexamic acid, an antifibrinolytic agent in comparison with a placebo with respect to the reduction of incidence of AO after the extraction of mandibular molars by using following parameters: Pain, disintegration of Clot, halitosis. A double blind study consisted of 60 patients, who underwent routine dental extractions of mandibular molar teeth. Group A (30 patients) requiring routine dental extractions of mandibular teeth was randomly selected and was administered a dose of tranexamic acid orally (Pause 500mg) one hour prior to extraction of teeth. Gel foam soaked in tranexamic acid (160mg) was placed into the extraction socket postoperatively. A figure of eight silk suture was placed over the socket to secure the gelfoam. Group B (30 patients); a placebo (crocin) was given orally one hour prior to the extraction and gel foam soaked in saline was placed into the extraction socket postoperatively. A figure of eight silk suture was placed over the socket. Pain was rated individually by each patient at 3(rd), 7(th), 14(th) day after extraction and the results was statistically analysed. This study supports that the use of tranexamic acid both locally and systemically following the removal of the teeth reduces the incidence of AO associated with the extraction of mandibular molars. Tranexamic acid has several advantages also when used for simple dental extractions, namely: low cost and ready availability and therefore we recommend this treatment modality.

Effect of absorbable gelatin sponge in the middle ear: in vitro and in vivo animal model

Conclusion: GelitaSpon gelatin sponge (GS) showed faster reabsorption than gelfoam (GF) in vitro, and GS-packed middle ears resulted in a faster hearing recovery and less inflammation than the ears packed with GF soaked in saline. Soaking GF sponges with boric acid (BA) appeared to offset the inflammatory response of saline-soaked GF, making this inflammatory response comparable to that of GS-packed ears. Objective: To describe the reabsorption and inflammatory effects of absorbable gelatin sponge in the middle ear. Methods: For in vitro evaluation, GF and GS were used as disks immersed in saline solution or 3% BA and placed in gel. Images were captured with a microscope and processed using image processing Toolbox. For in vivo tests, 16 female albino Sprague Dawley rats were divided into four groups: bulla opening; GF + 0.9% saline; GF + BA; and GS + 0.9% saline. An anterior approach to the right bulla was used for surgery. Preoperative and postoperative auditory brainstem response thresholds were measured. Results: In vitro, there was marked degradation of GF by day 14, while GS showed complete degradation by the third day. In vivo, hearing recovery occurred by day 21. GF produced a more severe inflammatory response, which could be reduced by treating the GF with BA.

Curettage and reconstruction by the sandwich technique for giant cell tumours around the knee.

To evaluate outcomes of 36 patients who underwent curettage, use of phenol, and reconstruction using the sandwich technique for giant cell tumour (GCT) of bone around the knee. 22 women and 14 men aged 19 to 46 (mean, 29.6) years underwent intralesional curettage, use of phenol, and reconstruction using the sandwich technique for GCT of the proximal tibia (n=23) or distal femur (n=13). Two of the cases were recurrences. Two, 18, and 16 tumours were classified as grade I, grade II, and grade III, respectively. Five of the grade III tumours were associated with an extra-articular pathological fracture. Patients underwent intralesional curettage, use of phenol, and reconstruction with allograft, gel foam, and cement (the sandwich technique). Pathological fractures were fixed with plates. Functional outcome was evaluated using the Musculoskeletal Tumor Society (MSTS) score. The mean follow-up period was 5 (2.5-11) years. The mean MSTS score was 27.7 out of 30 (standard deviation, 3; range, 16-30). One patient with a grade III tumour in the proximal tibia had a recurrence detected elsewhere after 3 years. Her MSTS score at 2 years was 26. No patient had malignant transformation. Intralesional curettage, use of phenol, and reconstruction with allograft, gel foam, and cement (the sandwich technique) for GCT of bone achieved good functional outcome and a low recurrence rate.

Swim ring method—a cost-effective alternative for prevention and healing of back ulcers

Sir, Traumatic and pressure ulcers on the back are a challenging part of patient care in intensive care units. Decubitus ulcers on the back in bedridden and orthopedically immobilised patients pose a significant challenge to the treating doctor and add great economical burden to the health-care system. It is estimated that the incidence of pressure ulcers in hospitalised elderly patients in the institutions ranges from 3 to 30 % [1–3]. The basic pathogenesis is prolonged pressure loading, leading to decreased skin blood flow causing tissue hypoxia and ischaemia [1–4]. Relieving pressure from areas on and around the ulcer is one of the important aspects of the management of ulcers, especially on the back when the patient is bedridden [1–4]. Specialised support surfaces such as mattresses and cushions with static air, water and foam support have been tried for offloading the pressure. Patient compliance and cost play a key role in choosing the pressure redistribution devices in the treatment of such ulcers [2–5]. Swim rings, also called swimming tubes, are inflated with air to keep the swimmer afloat and are available in various sizes to fit children and adults. The cost of these tubes varies from $5 to $10 (70–150 in India) depending on quality and size. These tubes can effectively offload the pressure on the back ulcers and improve healing. Once the patients have undergone a regular dressing of the ulcers on the back, they are positioned supine in the bed with the swim ring beneath the lower back in such a way that the ulcer-bearing part of the buttock lies inside the inner circle (free area) of the ring and the outer rim engages the lower back, upper thigh and outer most part of the gluteal region (Fig. 1). Two more swim rings are kept, one underneath the head and shoulder and another beneath the legs to ensure that the entire body is at the same level with all three rings underneath for maximum patient comfort and compliance (Fig. 2). Swim rings help to keep around 50 % back area to be contact-free. Air pressure in the swim ring can be adjusted by inflating it with air enough to achieve compressibility of about 1.5–2 in. (half finger depth, ∼12–15 psi) by digital pressure to ensure that it acts as a cushion for the pressure points. Swim rings are checked daily for 1.5–2 in. indentation of the tube by digital pressure before putting the patient over them.A layer of gel pads or foam can be added between the rings and the patient’s body to prevent excoriation caused by contact of plastic with the skin and the interposing sweat and wound discharge. For frequent change of position to lateral side to prevent discomfort, the rings are removed before the postural changes. The tubes are disinfected daily. We have been using these swim rings in our intensive care units for the past 1 year for faster wound healing and to prevent development of new pressure ulcers (Fig. 3a, b). In our experience, the swim tube scores over the other methods of pressure offloading in terms of cost, patient acceptability, easy to use, clean, carry and replace. Informed consent was obtained from all individual participants included in the study. The swim ring has the following advantages:

Three Dimensional Transvaginal Ultrasonography (3D-TVS) and Two Dimensional- Three Dimensional Real-Time Hysterosalpingo-Sonography with Gel Foam (2D-3DHyFoSy): A One-Step Approach for the Follow-Up of Hysteroscopic Tubal Sterilization with Essure Device

Three Dimensional Transvaginal Ultrasonography (3D-TVS) and Two Dimensional- Three Dimensional Real-Time Hysterosalpingo-Sonography with Gel Foam (2D-3DHyFoSy): A One-Step Approach for the Follow-Up of Hysteroscopic Tubal Sterilization with Essure Device

OC22.05: 3D TVS and hysterosalpingo‐sonography with gel foam (HyFoSy): one single examination in the assessment of tubal sterilisation occlusion by Essure device

<scp>OC</scp>22.05: <scp>3D TVS</scp> and hysterosalpingo‐sonography with gel foam (<scp>HyFoSy</scp>): one single examination in the assessment of tubal sterilisation occlusion by Essure device

OC22.06: Hysterosalpingo‐contrast‐sonography with gel foam (HyFoSy) for the assessment of tubal patency can be easier performed by using 3D TVS

<scp>OC</scp>22.06: Hysterosalpingo‐contrast‐sonography with gel foam (<scp>HyFoSy</scp>) for the assessment of tubal patency can be easier performed by using <scp>3D TVS</scp>

Analysis of light scattered by turbid media in cylindrical geometry.

The angle dependence of the transmitted light through a cylindrical turbid sample (latex suspension, developing milk gel, draining/coarsening milk, and protein foams) in a standard light scattering setup was analyzed in terms of the transport mean free path length or scattering length l* (a measure for the turbidity) and the absorption length labs. By variation of the concentration of an absorbing dye, the independence of l* and labs was demonstrated. The resulting value of the specific extinction coefficient of the dye was found to be in fair agreement with direct spectroscopic determination and practically identical in milk and latex suspensions. The validity of this technique for obtaining l* was demonstrated by monitoring the acid-induced gelation of milk. The possibility to simultaneously determine l* and labs was used to follow the time development of a draining and coarsening protein foam which contained an absorbing dye. It was shown that labs can be used as a measure for the volume fraction of air in the foam. This method of monitoring the transmission of multiple light scattering provides an easy way to determine l* and, specifically for foams, quantitative data dominated by the bulk of the foam.

A case of mesenteric angiosarcoma treated by preoperative embolization followed by surgery

We report a case of primary mesenteric angiosarcoma in a 41-year-old man who presented with no subjective symptoms, but exhibited occult blood in a urine sample obtained during a medical checkup. Imaging revealed a soft mass measuring 16 cm in diameter. The tumor was found to have an abundant blood supply; therefore, feeding arteries except for the superior mesenteric artery were preoperatively embolized using a coil and gel foam. Subsequently, surgery was performed. Histopathological examination of the resected specimen revealed angiosarcoma. The preoperative embolization method was effective and easily performed. The patient remains in good health without any evidence of recurrence 4 years after surgery.

Educational ExhibitAbstract No. 347 - Intraluminal brachytherapy for the treatment of malignant biliary obstruction –- the role of the interventional radiologist

No. 348 A retrospective analysis of 334 cases of hemoptysis treated by bronchial artery embolization A.S. Bhalla, D. Kandasamy, P.T. Veedu, A. Mohan, S. Gamanagatti; Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India; Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Science, New Delhi, India Purpose: To analyze the safety, efficacy and outcome of bronchial artery embolization(BAE) in the management of patients with hemoptysis. Materials and Methods: A retrospective study of 334 patients for whom BAE was performed for hemoptysis from January 2007 to July 2013. Study included 255 (76.3%) males and 79 (23.7%) females and age ranged from 5 81yrs (mean 40). Polyvinyl alcohol (PVA, 300-1000μm) was used in all patients and gel foam was used in combination with PVA where there was significant shunting. All relevant arteries were evaluated but only those arteries which showed hypertrophy and significant blush were targeted Results: Mild hemoptysis was seen in 70 patients, moderate in 195 and severe in 69 patients. On imaging right side disease was seen in 101 patients, left side involvement in 59 patients and bilateral involvement in 174 patients. Right upper zone involvement was the most frequent occurrence seen in 229 patients. Post tuberculosis changes were the predominant pathology and it was seen in 248 patients. Among 334 patients (386 procedures) 42 patients underwent the procedure twice and 5 patients underwent thrice. Total of 485 arteries were attempted of which 440 arteries were successfully embolized whereas the rest 42 arteries could not be cannulated because of technical difficulty and 3 arteries went in to spasm. Right intercostobronchial (RICB) was the commonest culprit artery which was present in 157 patients which is followed by common bronchial (97), left bronchial (55), right bronchial (45) and others. We embolized a maximum of 4 arteries in one session. Immediate complications such as dissection and rupture were observed only in 9 sessions (2.3%) in which no intervention was needed. Twenty-five procedures (6.5%) were repeated within 2 months which were due to technical or clinical failure of the procedure. Twenty-seven procedures (7%) were repeated after 2 months which represented clinical recurrence of the disease. Posters and Exhibits ’ JVIR S156 P os te rs an d Ex hi bi ts

Is it time for a new standard?

Is it time for a new standard?

Transcatheter Intervention for Infantile Hepatic Hemangioendothelioma with Amplatzer Duct Occluder II

Introduction: Infantile Hepatic hemangioendothelioma is characterized by multifocal benign vascular dilatations involving the liver. The clinical course depends on tumor size, localization and complications. Case Report: 15 days old neonate with stormy postnatal period was referred for intractable congestive cardiac failure. Transthoracic 2D echocardiography showed multiple vegetations on all the four valves, noncompaction of left ventricle with multiple vascular channels in left lobe of liver. Computed tomography angiogram showed 58x29x50 mm markedly enhancing lesion in left lobe of liver suggestive of infantile hepatic hemangioendothelioma. The neonate was treated for bacterial endocarditis. Later 6x6 Amplatzer duct occluder II was parked in hepatic vein, then gel foam and polyvinyl chloride particles were injected into infantile hepatic hemangioendothelioma. Cardiac failure resolved with marked regression of lesion. Discussion: Infantile hepatic hemangioendothelioma is a rare anomaly causing heart Case Study Vijayalakshmi et al.; CA, 2(4): 317-324, 2014; Article no. CA.2014.4.017 318 failure in neonate causing death in up to 70% of untreated infants without adequate regression of lesion. Therefore aggressive treatment is warranted. For the first time in the world, we report a case of infantile hepatic hemangioendothelioma in a neonate, with pump failure due to noncompaction of left ventricle and vegetations on all four valves, successfully treated by combination of transcatheter deployment of Amplatzer duct occluder II to occlude the venous end and hand injection of gel foam and polyvinly chloride particles from the aortic end to close the feeder artery. Conclusion: The combination of closure of hepatic vein by Amplatzer duct occluder II and injection of gel foam and polyvinyl chloride particles is safe and effective in infantile hepatic hemangioendothelioma in neonate with heart failure.

Selective arterial embolization in hepatic trauma

Blunt abdominal trauma accounts for about (80%) of abdominal injuries seen in the emergency department. The spleen and liver are the most commonly injured solid organs in a blunt abdominal trauma. There has been a change in the trend towards the conservative management of liver injuries with improvement of the imaging techniques. Nowadays non-operative management has been preferred as the treatment of choice in hemodynamically stable cases of liver injuries. Transarterial embolization has been introduced as an effective tool for the management of hemodynamically stable patients with blunt hepatic trauma. This case illustrates the potential benefits of using hepatic artery embolization technique as a treatment modality in patients in whom active surgical intervention was not successful. A 21-year-old male presented to the emergency department with alleged history of fall from a building. On examination the patient was conscious and oriented, hypotensive, tachycardia and generalized abdominal tenderness. Focused assessment with sonography for trauma (FAST) was positive. So an emergency ultrasonography and contrast-enhanced computed tomography (CECT) of the abdomen were done which revealed gross hemoperitoneum with liver lacerations. Patient underwent an exploratory laparotomy, the surgeon was not able control the bleeding. So the patient was shifted to cath lab for an emergency hepatic artery embolization with gel foam. Bleeding was controlled with the procedure and he was discharged after two weeks. The non-operative management of blunt hepatic trauma is considered to be the gold standard care for hemodynamically stable patients. Since angiography can offer both diagnostic and therapeutic benefits, angiography should be considered in localizing the site of hemorrhage and in providing an opportunity for the interventional radiologist to proceed to transcatheter embolization of bleeding sites.