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Sample records for liquid embolic agents

  1. Two Microcatheter Technique for Embolization of Arteriovenous Fistula with Liquid Embolic Agent

    PubMed Central

    Zhao, Lin-Bo; Shim, Jae Ho; Lee, Dong-geun

    2014-01-01

    Problem with embolization of arteriovenous fistula (AVF) with liquid embolic agent is its over-penetration into the veins or regurgitation to the proximal feeder without reaching the shunt point. We present a technique that controls the flow of AVF during embolization. Two microcatheter technique consists of positioning one microcatheter close to the AVF for embolization, and with another microcatheter at the proximal feeding artery to control the AVF flow by coiling. Selective angiograms obtained using a distally positioned microcatheter before and after coiling, were compared how much stagnant effect was achieved. Using two microcatheter technique, AVF occlusion was achieved with good penetration of glue to the venous side of the AVF. Its advantage is the ability to push glue into the shunt without causing over-penetration of glue or its reflux along the feeder. Two microcatheter technique was safe and effective in glue embolization of AVF and also expected to be applied with other liquid embolic agent like Onyx. PMID:24642961

  2. Development and evaluation of liquid embolic agents based on liquid crystalline material of glyceryl monooleate.

    PubMed

    Du, Ling-Ran; Lu, Xiao-Jing; Guan, Hai-Tao; Yang, Yong-Jie; Gu, Meng-Jie; Zheng, Zhuo-Zhao; Lv, Tian-Shi; Yan, Zi-Guang; Song, Li; Zou, Ying-Hua; Fu, Nai-Qi; Qi, Xian-Rong; Fan, Tian-Yuan

    2014-08-25

    New type of liquid embolic agents based on a liquid crystalline material of glyceryl monooleate (GMO) was developed and evaluated in this study. Ternary phase diagram of GMO, water and ethanol was constructed and three isotropic liquids (ILs, GMO:ethanol:water=49:21:30, 60:20:20 and 72:18:10 (w/w/w)) were selected as potential liquid embolic agents, which could spontaneously form viscous gel cast when contacting with water or physiological fluid. The ILs exhibited excellent microcatheter deliverability due to low viscosity, and were proved to successfully block the saline flow when performed in a device to simulate embolization in vitro. The ILs also showed good cytocompatibility on L929 mouse fibroblast cell line. The embolization of ILs to rabbit kidneys was performed successfully under monitoring of digital subtraction angiography (DSA), and embolic degree was affected by the initial formulation composition and used volume. At 5th week after embolization, DSA and computed tomography (CT) confirmed the renal arteries embolized with IL did not recanalize in follow-up period, and an obvious atrophy of the embolized kidney was observed. Therefore, the GMO-based liquid embolic agents showed feasible and effective to embolize, and potential use in clinical interventional embolization therapy. PMID:24858389

  3. [Preparation and in vitro embolic efficiency evaluation of hydroxycamptothecine-loaded liquid embolic agent].

    PubMed

    Qin, Ling-Zhen; Zhang, Xuan; Wu, Lin-Na; Zhang, Jin; Pan, Xin; Li, Ge; Wu, Chuan-Bin

    2014-07-01

    The purpose of this study is to investigate the preparation of hydroxycamptothecine (HCPT)-loaded cubic crystal liquid embolic precursor solution, and evaluate its in vitro embolic efficiency. Phytantriol was used as cubic crystal liquid embolic material, and the optimal formulation was selected according to ternary phase diagram. Polarized light microscopy, differential scanning calorimetry, and small angle X-ray scattering (SAXS) were used to characterize the cubic crystal structure. High performance liquid chromatography and X-ray diffraction analysis were used to investigate the lactone ring of HCPT. In vitro dissolution was preliminary evaluated, and the simulation embolic model was constructed to evaluate the embolic efficiency of precursor solution. Meanwhile, the gelation time and adhesion force were investigated. The results showed that HCPT-loaded precursor solution for embolization had been successfully prepared with low viscosity which was injectable. The precursor solution could transform into Pn3m structure liquid crystal phase gel rapidly when contracting with excess water. The formed HPCT gel remained its lactone form as the same in precursor solution, and expressed the good ability to block the saline flow, and HCPT could keep sustained releasing drug over 30 days. The prepared drug-loaded embolic precursor solution showed a promising potential for vascular embolization and application in clinical treatment of tumor. PMID:25233642

  4. Endovascular Treatment of Experimental Cerebral Aneurysms Using Thermoreversible Liquid Embolic Agents

    PubMed Central

    Takao, H.; Murayama, Y.; Saguchi, T.; Ishibashi, T.; Ebara, M.; Irie, K.; Yoshioka, H.; Mori, Y.; Ohtsubo, S.; Viñuela, F.; Abe, T.

    2006-01-01

    Summary We have developed a new embolic agent, thermoreversible gelation polymer (TGP). This polymer is unique in that solidification occurs at body temperature. The utility of this new liquid embolic agent for the treatment of large experimental aneurysms was evaluated angiographically TGP remains liquid at temperatures below the sol-gel transition temperature (TT) and becomes gelatinous above the TT. TGP can also be used to slowly deliver biologically active substances such as growth factors or engineered cells. In this study, TGP was mixed with radiopaque material without solvent. Bilateral common carotid arteries of swine (n=5) were used for surgical creation of lateral aneurysms, then 1 aneurysm in each animal was embolized using TGP without any protection device. The remaining untreated aneurysm in each animal was used as a control. All aneurysms were successfully embolized using TGP. No distal migration of TGP was observed when aneurysms were embolized without using protection devices. TGP can be safely used to embolize experimental aneurysms. Embolization of aneurysms with a protection device needs to be evaluated. Further modifications such as mechanical stability and use as a drug delivery system will be necessary prior to the clinical application of TGP. PMID:20569622

  5. Volume Changes of Experimental Carotid Sidewall Aneurysms Due to Embolization with Liquid Embolic Agents: A Multidetector CT Angiography Study

    SciTech Connect

    Dudeck, O. Okuducu, A. F.; Jordan, O.; Tesmer, K.; Pech, M.; Weigang, E.; Ruefenacht, D. A.; Doelker, E.; Felix, R.

    2006-12-15

    Iodine-containing polyvinyl alcohol polymer (I-PVAL) is a novel precipitating liquid embolic that allows for artifact-free evaluation of CT angiography (CTA). As accurate aneurysm volumetry can be performed with multidetector CTA, we determined volumes of experimental aneurysms before, immediately after, and 4 weeks after embolization of 14 porcine experimental carotid sidewall aneurysms with this liquid embolic. An automated three-dimensional software measurement tool was used for volumetric analysis of volume-rendering CTA data. Furthermore, intra-aneurysmal pressure changes during liquid embolization were measured in four silicone aneurysms and potential polymer volume changes within 4 weeks were assessed in vitro. Liquid embolic injection was performed during temporary balloon occlusion of the aneurysm neck, resulting in a mean occlusion rate of 98.3%. Aneurysms enlarged significantly during embolization by 61.1 {+-} 28.9%, whereas a significant shrinkage of 5.6 {+-} 2.7% was observed within the follow-up period. Histologic analysis revealed an inflammatory foreign body reaction with partial polymer degradation. In silicone aneurysm models, intra-aneurysmal pressure remained unchanged during liquid embolic injection, whereas balloon inflation resulted in a mean pressure increase of 31.2 {+-} 0.7%. No polymer shrinkage was observed in vitro. The aneurysm enlargement noted was presumably due to pressure elevation after balloon inflation, which resulted in dilatation of the weak venous wall of the newly constructed aneurysm-another shortcoming of this experimental aneurysm model. The volume decrease after 4 weeks expressed partial polymer degradation.

  6. Phytantriol based liquid crystal provide sustained release of anticancer drug as a novel embolic agent.

    PubMed

    Qin, Lingzhen; Mei, Liling; Shan, Ziyun; Huang, Ying; Pan, Xin; Li, Ge; Gu, Yukun; Wu, Chuanbin

    2016-01-01

    Phytantriol has received increasing amount of attention in drug delivery system, however, the ability of the phytantriol based liquid crystal as a novel embolic agent to provide a sustained release delivery system is yet to be comprehensively demonstrated. The purpose of this study was to prepare a phytantriol-based cubic phase precursor solution loaded with anticancer drug hydroxycamptothecine (HCPT) and evaluate its embolization properties, in vitro drug release and cytotoxicity. Phase behavior of the phytantriol-solvent-water system was investigated by visual inspection and polarized light microscopy, and no phase transition was observed in the presence of HCPT within the studied dose range. Water uptake by the phytantriol matrices was determined gravimetrically, suggesting that the swelling complied with the second order kinetics. In vitro evaluation of embolic efficacy indicated that the isotropic solution displayed a satisfactory embolization effect. In vitro drug release results showed a sustained-release up to 30 days and the release behavior was affected by the initial composition and drug loading. Moreover, the in vitro cytotoxicity and anticancer activity were evaluated by MTT assay. No appreciable mortality was observed for NIH 3T3 cells after 48 h exposure to blank formulations, and the anticancer activity of HCPT-loaded formulations to HepG2 and SMMC7721 cells was strongly dependent on the drug loading and treatment time. Taken together, these results indicate that phytantriol-based cubic phase embolic gelling solution is a promising potential carrier for HCPT delivery to achieve a sustained drug release by vascular embolization, and this technology may be potential for clinical applications. PMID:26035332

  7. A Nonadhesive Liquid Embolic Agent of Ethylene Vinyl Alcohol Copolymer and Ethanol Mixture for Cerebral Arteriovenous Malformations

    PubMed Central

    Hamada, JI.; Kai, Y.; Mizuno, T.; Morioka, M.; Kazekawa, K.; Iwata, H.; Ushio, Y.

    2004-01-01

    Summary We report our experience using our new non-adhesive liquid embolic agent, an ethylene vinyl alcohol copolymer (EVAL)/Ethanol mixture, to treat human arteriovenous malformations (AVM). Between June 1995 and April 2001, 57 patients with confirmed AVM underwent embolization with the EVAL/Ethanol mixture. Using 87 procedures consisting of one to three stages, we embolized 185 feeding arteries to occlude as much of the AVM as possible. Repeated injections under fluoroscopic control could be performed smoothly without encountering cementing of the catheter in the vessel wall. Among 87 procedures undertaken in 57 patients, seven (8.0%) procedures in six patients produced new postembolization symptoms. Resolution of these symptoms occurred within hours or days following four of the seven procedures; permanent neurological deficits remained after three embolization procedures (3.4%). Of the 57 patients, three underwent postembolization radiosurgery, 54 were radically treated with microsurgical extirpation. Histopathological examinations of the 54 specimens disclosed mild inflammation within the embolized lumen without inflammatory reactions in the media or adventitia. Follow-up angiograms obtained three years after they underwent radiosurgery showed that in all three patients the nidus had completely disappeared. The EVAL/Ethanol mixture is handled easily and appears to be an effective and safe embolic agent for the preoperative embolization of AVM. PMID:20587289

  8. Onyx, a New Liquid Embolic Material for Peripheral Interventions: Preliminary Experience in Aneurysm, Pseudoaneurysm, and Pulmonary Arteriovenous Malformation Embolization

    SciTech Connect

    Vanninen, Ritva L. Manninen, I.

    2007-04-15

    Purpose. To describe our preliminary experience with a new liquid embolization agent, Onyx, in peripheral interventions. Methods and results. We successfully treated two peripheral aneurysms (one in an internal iliac artery, one in a thoracic collateral artery of an aortic coarctation), two peripheral pseudoaneurysms (one in a lumbar artery, one in a renal artery), and one pulmonary arteriovenous malformation. Conclusion. Onyx is a promising alternative embolic material for peripheral interventions. It can be combined with coils in selected cases, and balloon catheters can be effectively used during slow injection of embolic material to control flow and protect the aneurysm neck.

  9. Novel Hydrogel Material as a Potential Embolic Agent in Embolization Treatments.

    PubMed

    Zhou, Feng; Chen, Liming; An, Qingzhu; Chen, Liang; Wen, Ying; Fang, Fang; Zhu, Wei; Yi, Tao

    2016-01-01

    We report a novel graphene-oxide (GO) enhanced polymer hydrogel (GPH) as a promising embolic agent capable of treating cerebrovascular diseases and malignant tumors, using the trans-catheter arterial embolization (TAE) technique. Simply composed of GO and generation five poly(amidoamine) dendrimers (PAMAM-5), our rheology experiments reveal that GPH exhibits satisfactory mechanical strength, which resist the high pressures of blood flow. Subcutaneous experiments on Sprague-Dawley (SD) rats demonstrate the qualified biocompatibility of GPH. Finally, our in vivo experiments on New Zealand rabbits, which mix GPH with the X-ray absorbing contrast agent, Iohexol, reveal complete embolization of the artery. We also note that GPH shortens embolization time and exhibits low toxicity in follow-up experiments. Altogether, our study demonstrates that GPH has many advantages over the currently used embolic agents and has potential applications in clinical practice. PMID:27561915

  10. Novel Hydrogel Material as a Potential Embolic Agent in Embolization Treatments

    PubMed Central

    Zhou, Feng; Chen, Liming; An, Qingzhu; Chen, Liang; Wen, Ying; Fang, Fang; Zhu, Wei; Yi, Tao

    2016-01-01

    We report a novel graphene-oxide (GO) enhanced polymer hydrogel (GPH) as a promising embolic agent capable of treating cerebrovascular diseases and malignant tumors, using the trans-catheter arterial embolization (TAE) technique. Simply composed of GO and generation five poly(amidoamine) dendrimers (PAMAM-5), our rheology experiments reveal that GPH exhibits satisfactory mechanical strength, which resist the high pressures of blood flow. Subcutaneous experiments on Sprague-Dawley (SD) rats demonstrate the qualified biocompatibility of GPH. Finally, our in vivo experiments on New Zealand rabbits, which mix GPH with the X-ray absorbing contrast agent, Iohexol, reveal complete embolization of the artery. We also note that GPH shortens embolization time and exhibits low toxicity in follow-up experiments. Altogether, our study demonstrates that GPH has many advantages over the currently used embolic agents and has potential applications in clinical practice. PMID:27561915

  11. (D, L) polylactide microspheres as embolic agent. A preliminary study.

    PubMed

    Flandroy, P; Grandfils, C; Collignon, J; Thibaut, A; Nihant, N; Barbette, S; Jerome, R; Teyssie, P

    1990-01-01

    Owing to their shape, accurately calibrated microspheres appear to be very suitable material for distal embolization. Moreover, the biocompatible (D, L) polyactide (PLA) microspheres possess two other valuable advantages: easy adjustment of their biodegradation rate, and incorporation of chemotherapeutic agents during their production. The authors describe the preparation of these (D, L) PLA microspheres and their clinical applications as a preliminary step to arterial chemoembolization. PMID:2234391

  12. Biocompatibility of Bletilla striata Microspheres as a Novel Embolic Agent

    PubMed Central

    Luo, ShiHua; Song, SongLin; Zheng, ChuanSheng; Wang, Yong; Xia, XiangWen; Liang, Bin; Feng, GanSheng

    2015-01-01

    We have prepared Chinese traditional herb Bletilla striata into microspheres as a novel embolic agent for decades. The aim of this study was to evaluate the biocompatibility of Bletilla striata microspheres (BSMs). After a thermal test of BSMs in vitro, the cell biocompatibility of BSMs was investigated in mouse fibroblasts and human umbilical vein endothelial cells using the methyl tetrazolium (MTT) assay. In addition, blood biocompatibility was evaluated. In vivo intramuscular implantation and renal artery embolization in rabbits with BSMs were used to examine the inflammatory response. The experimental rabbits did not develop any fever symptoms after injection of BSMs, and BSMs exhibited no cytotoxicity in cultured mouse fibroblasts and human umbilical vein endothelial cells. Additionally, BSMs exhibited high compatibility with red blood cells and no hemolysis activity. Intramuscular implantation with BSMs resulted in a gradually lessened mild inflammatory reaction that disappeared after eight weeks. The occlusion of small renal vessels was associated with a mild perivascular inflammatory reaction without significant renal and liver function damage. In conclusion, we believe that BSMs exhibit high biocompatibility and are a promising embolic agent. PMID:26472985

  13. Comparison of efficacy of different embolic agents on uterine leiomyoma.

    PubMed

    Mu, Y; Wang, Y; Li, M; Hu, Y; Hao, Z

    2016-01-01

    The aim of this study was to explore the efficacies, postoperative side effects, and complications of uterine artery embolization (UAE) treatments for uterine leiomyoma (UL) with different embolic agents. The study included 107 patients with UL that were treated with UAE with polyvinyl alcohol (PVA group) or pingyangmycin lipiodol emulsion and silk-segment (PLES group). Six months later, the improvement rate of anaemia, the menstrual improvement rate, the incidence rate of fever, the disappearance rates of compression symptoms and abdominal symptoms in the PVA group were 93.8%, 94.7%, 22.0%, 60.0%, and 88.9%, respectively, which showed no significant difference from those in the PLES group (90.5%, 92.3%, 84.8%, 53.3%, and 8 1.3%, respectively). The incidence rate of fever after embolization in PVA group was significantly lower than that in PLES group (c² = 41.958, p = 0.000). However, the efficacy, improvement rate of symptoms, and postoperative side effects of two groups showed no significant difference (p > 0.05). PVA and PLES have significant efficacy for UAE treatment on patients with UL. PMID:27048030

  14. Application of the Liquid Coil as an Embolic Material for Arteriovenous Malformations

    PubMed Central

    Kurata, A.; Suzuki, S.; Ozawa, H.; Yuzawa, I.; Yamda, M.; Fujii, K.; Kan, S.; Kitahara, T.; Ohmomo, T.; Miyasaka, Y.

    2005-01-01

    Summary The purpose of this paper is to clarify advantages and disadvantages of platinum liquid coils as an embolic material for AVMs. During the last eight years, 50 endovascular procedures using liquid coils were conducted in our institute for 19 cases with AVMs, 15 of which were located in the eloquent area. All but one presented with haemorrhage, the exception demonstrating repeated ischemic symptoms. Only liquid coils were used as the embolic material to obliterate the nidus and feeders. In ten of the 15 patients with AVMs located in the eloquent area and one case rejecting surgery, liquid coil embolization was applied one to 11 times (average 3.5 times) to achieve decrease in size and this was then followed by radiosurgery. The remaining eight AVM patients underwent total removal after liquid coil embolization. No complications were encountered during the peri-embolization period. In all cases, the purpose of embolization was to diminish the size to facilitate radiosurgery and decrease bleeding during surgery. The liquid coil has advantages as a material for embolization of AVMs; it is non-toxic and bioinart material; it seldom occludes normal minute vascular channels; when it used in a nidus, it seldom to migrates in the venous direction, and it has good radio-opacity and offers good marking for surgery. Appropriate applications include preoperative embolization or pre-radiosurgical embolization of AVMs, especially when staged embolizations are performed to reduce risk of perfusion pressure breakthrough in patients which are large or located in the eloquent area. PMID:20584489

  15. Transcatheter Arterial Embolization With Spherical Embolic Agent for Pulmonary Metastases From Renal Cell Carcinoma

    SciTech Connect

    Seki, Akihiko Hori, Shinichi Sueyoshi, Satoru Hori, Atsushi Kono, Michihiko Murata, Shinichi Maeda, Masahiko

    2013-12-15

    Purpose: This retrospective study aimed to evaluate the safety and local efficacy of transcatheter arterial embolization (TAE) with superabsorbent polymer microspheres (SAP-MS) in patients with pulmonary metastases from renal cell carcinoma (RCC). Methods: Sixteen patients with unresectable pulmonary metastases from RCC refractory to standard therapy were enrolled to undergo TAE with the purpose of mass reduction and/or palliation. The prepared SAP-MS swell to approximately two times larger than their dry-state size (100-150 {mu}m [n = 14], 50-100 {mu}m [n = 2]). Forty-nine pulmonary nodules (lung n = 22, mediastinal lymph node n = 17, and hilar lymph node n = 10) were selected as target lesions for evaluation. Local tumor response was evaluated 3 months after TAE according to Response Evaluation Criteria in Solid Tumors (RECIST; version 1.1). The relationship between tumor enhancement ratio by CT during selective angiography and local tumor response was evaluated. Results: The number of TAE sessions per patient ranged from 1 to 5 (median 2.9). Embolized arteries at initial TAE were bronchial arteries in 14 patients (87.5 %) and nonbronchial systemic arteries in 11 patients (68.8 %). Nodule-based evaluation showed that 5 (10.2 %) nodules had complete response, 17 (34.7 %) had partial response, 15 (30.6 %) had stable disease, and 12 (24.5 %) had progressive disease. The response rate was significantly greater in 22 lesions that had a high tumor enhancement ratio than in 27 lesions that had a slight or moderate ratio (90.9 vs. 7.4 %, p = 0.01). Severe TAE-related adverse events did not occur. Conclusion: TAE with SAP-MS might be a well-tolerated and locally efficacious palliative option for patients with pulmonary metastases from RCC.

  16. Effects of embolic agents with different particle sizes on interventional treatment of uterine fibroids

    PubMed Central

    Wang, Xigong; Zhang, Zhengfu; Pan, Jirong; Zhang, Weizhong

    2015-01-01

    Objective: To compare the effects of embolic agents with different particle sizes on interventional treatment of uterine fibroids (UFs). Methods: One-hundred and thirty patients with UFs were divided into a treatment group and a control group (n=65) by random draw. All patients were treated by uterine artery embolization, with the treatment group using 200 μm polyvinyl alcohol (PVA) particles and the control group using 500 μm PVA particles. Results: The success rate of embolization was 100%. After intervention, the treatment group was significantly less prone to complications such as lower abdominal pain, fever, nausea, vomiting and bleeding than the control group (P<0.05). The follicle-stimulating hormone levels of both groups were similar before and after intervention, and there were also no significant inter-group differences. The uterine and UF volumes of both groups significantly decreased six months after intervention (P<0.05), and those of the treatment group were significantly lower (P<0.05). The two groups had similar physical function, role-physical, bodily pain and general health scores before intervention, but the treatment group scored significantly higher than the control group did six months after intervention (P<0.05). Conclusion: Interventional embolization can well treat UFs, without apparently affecting ovarian functions. Small-sized PVA particles can improve the quality of life by shrinking the uterus and UFs as well as by reducing the risks of complications. PMID:26870122

  17. Preoperative embolization versus local hemostatic agents in surgery of hypervascular spinal tumors

    PubMed Central

    Ptashnikov, Dmitry; Mikhaylov, Dmitry; Masevnin, Sergei

    2014-01-01

    Background Currently, there is no consensus about how to reduce the intraoperative risk of hemorrhage in spinal decompression surgery of hypervascular spinal tumors, such as aggressive hemangioma, multiple myeloma, plasmacytoma, metastasis of renal cell carcinoma. Methods A retrospective study of 110 patients, operated in our institute was held in the period between 2003 and 2013. There were 69 male and 41 female patients with extradural hypervascular spinal tumor. The study included 61 patients with metastasis of renal cell carcinoma, 27 with multiple myeloma, 15 with plasmacytoma and 7 with aggressive hemangioma. The first group included 57 patients who underwent preoperative tumor embolization. The second group consisted of 53 patients, which were treated surgically using intraoperative local hemostatic agents. We performed 2 types of treatment options: palliative decompression and total spondylectomy. The first group was divided into two subgroups: 30 patients with palliative decompression (1PD) and 27 with total spondylectomy (1TS). In the second group there were: 28 patients with palliative decompression (2PD) and 25 with total spondylectomy (2TS). The parameters under evaluation were the blood loss volume, drainage loss, operation time, hemoglobin level, possible complications and time of hospital stay. Results The average intraoperative blood loss for all embolized patients was slightly less than in subgroups with local hemostatic agents. No significant difference in blood loss volume was found between groups 1PD and 2PD (p > 0.05). In groups 1TS and 2TS, we did get significant difference (p < 0.05). Statistically significant difference in the average drainage loss was found between two methods of hemostasis in both subgroups (p < 0.05). The operation time was not significantly different between groups. Postoperative hemoglobin level reduce is almost equal in both groups of patients. Postoperative complications were also nearly equal in the groups. The

  18. Biomaterials used in injectable implants (liquid embolics) for percutaneous filling of vascular spaces.

    PubMed

    Jordan, Olivier; Doelker, Eric; Rüfenacht, Daniel A

    2005-01-01

    The biomaterials currently used in injectable implants (liquid embolics) for minimally invasive image-guided treatment of vascular lesions undergo, once injected in situ, a phase transition based on a variety of physicochemical principles. The mechanisms leading to the formation of a solid implant include polymerization, precipitation and cross-linking through ionic or thermal process. The biomaterial characteristics have to meet the requirements of a variety of treatment conditions. The viscosity of the liquid is adapted to the access instrument, which can range from 0.2 mm to 3 mm in diameter and from a few centimeters up to 200 cm in length. Once such liquid embolics reach the vascular space, they are designed to become occlusive by inducing thrombosis or directly blocking the lesion when hardening of the embolics occurs. The safe delivery of such implants critically depends on their visibility and their hardening mechanism. Once delivered, the safety and effectiveness issues are related to implant functions such as biocompatibility, biodegradability or biomechanical properties. We review here the available and the experimental products with respect to the nature of the polymer, the mechanism of gel cast formation and the key characteristics that govern the choice of effective injectable implants. PMID:15959697

  19. Biomaterials Used in Injectable Implants (Liquid Embolics) for Percutaneous Filling of Vascular Spaces

    SciTech Connect

    Jordan, Olivier Doelker, Eric; Ruefenacht, Daniel A.

    2005-06-15

    The biomaterials currently used in injectable implants (liquid embolics) for minimally invasive image-guided treatment of vascular lesions undergo, once injected in situ, a phase transition based on a variety of physicochemical principles. The mechanisms leading to the formation of a solid implant include polymerization, precipitation and cross-linking through ionic or thermal process. The biomaterial characteristics have to meet the requirements of a variety of treatment conditions. The viscosity of the liquid is adapted to the access instrument, which can range from 0.2 mm to 3 mm in diameter and from a few centimeters up to 200 cm in length. Once such liquid embolics reach the vascular space, they are designed to become occlusive by inducing thrombosis or directly blocking the lesion when hardening of the embolics occurs. The safe delivery of such implants critically depends on their visibility and their hardening mechanism. Once delivered, the safety and effectiveness issues are related to implant functions such as biocompatibility, biodegradability or biomechanical properties. We review here the available and the experimental products with respect to the nature of the polymer, the mechanism of gel cast formation and the key characteristics that govern the choice of effective injectable implants.

  20. An in situ forming biodegradable hydrogel-based embolic agent for interventional therapies.

    PubMed

    Weng, Lihui; Rostambeigi, Nassir; Zantek, Nicole D; Rostamzadeh, Parinaz; Bravo, Mike; Carey, John; Golzarian, Jafar

    2013-09-01

    We present here the characteristics of an in situ forming hydrogel prepared from carboxymethyl chitosan and oxidized carboxymethyl cellulose for interventional therapies. Gelation, owing to the formation of Schiff bases, occurred both with and without the presence of a radiographic contrast agent. The hydrogel exhibited a highly porous internal structure (pore diameter 17±4 μm), no cytotoxicity to human umbilical vein endothelial cells, hemocompatibility with human blood, and degradability in lysozyme solutions. Drug release from hydrogels loaded with a sclerosant, tetracycline, was measured at pH 7.4, 6 and 2 at 37°C. The results showed that tetracycline was more stable under acidic conditions, with a lower release rate observed at pH 6. An anticancer drug, doxorubicin, was loaded into the hydrogel and a cumulative release of 30% was observed over 78 h in phosphate-buffered saline at 37°C. Injection of the hydrogel precursor through a 5-F catheter into a fusiform aneurysm model was feasible, leading to complete filling of the aneurysmal sac, which was visualized by fluoroscopy. The levels of occlusion by hydrogel precursors (1.8% and 2.1%) and calibrated microspheres (100-300 μm) in a rabbit renal model were compared. Embolization with hydrogel precursors was performed without clogging and the hydrogel achieved effective occlusion in more distal arteries than calibrated microspheres. In conclusion, this hydrogel possesses promising characteristics potentially beneficial for a wide range of vascular intervention procedures that involve embolization and drug delivery. PMID:23791672

  1. 12 CFR 709.2 - NCUA Board as liquidating agent.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 7 2012-01-01 2012-01-01 false NCUA Board as liquidating agent. 709.2 Section... INSURED CREDIT UNIONS IN LIQUIDATION § 709.2 NCUA Board as liquidating agent. (a) The Board, as... connection with any assets or property of any nature of the credit union. (b) The Board, as liquidating...

  2. Embolization biomaterial reinforced with nanotechnology for an in-situ release of anti-angiogenic agent in the treatment of hyper-vascularized tumors and arteriovenous malformations.

    PubMed

    Jubeli, E; Yagoubi, N; Pascale, F; Bédouet, L; Slimani, K; Labarre, D; Saint-Maurice, J P; Laurent, A; Moine, L

    2015-10-01

    A polymer based material was developed to act as an embolic agent and drug reservoir for the treatment of arteriovenous malformations (AVM) and hyper vascularized solid tumors. The aim was to combine the blocking of blood supply to the target region and the inhibition of the embolization-stimulated angiogenesis. The material is composed of an ethanolic solution of a linear acrylate based copolymer and acrylate calibrated microparticles containing nanospheres loaded with sunitinib, an anti-angiogenic agent. The precipitation of the linear copolymer in aqueous environment after injection through microcatheter results in the formation of an in-situ embolization gel whereas the microparticles serve to increase the cohesive properties of the embolization agent and to form a reservoir from which the sunitinib-loaded nanospheres are released post-embolization. The swollen state of the microparticles in contact with aqueous medium results in the release of the nanospheres out of microparticles macromolecular structure. After the synthesis, the formulation and the characterization of the different components of the material, anti-angiogenic activity was evaluated in vitro using endothelial cells and in vivo using corneal neovascularization model in rabbit. The efficiency of the arterial embolization was tested in vivo in a sheep model. Results proved the feasibility of this new system for vascular embolization in association with an in situ delivery of anti-angiogenic drug. This combination is a promising strategy for the management of arteriovenous malformations and solid tumors. PMID:26386355

  3. Transarterial Embolization of Type II Endoleaks after EVAR: The Role of Ethylene Vinyl Alcohol Copolymer (Onyx)

    SciTech Connect

    Mueller-Wille, Rene Wohlgemuth, Walter A. Heiss, Peter Wiggermann, Philipp Guentner, Oliver Schreyer, Andreas G. Hoffstetter, Patrick Stroszczynski, Christian; Zorger, Niels

    2013-10-15

    Purpose: To determine the feasibility and efficacy of transarterial endoleak embolization using the liquid embolic agent ethylene vinyl alcohol copolymer (Onyx). Methods: Over a 7-year period eleven patients (6 women, 5 men; mean age 68 years, range 37-83 years) underwent transarterial embolization of a type II endoleak after endovascular aortic aneurysm repair using the liquid embolic agent Onyx. Two patients (18 %) had a simple type II endoleak with only one artery in communication with the aneurysm sac, whereas 9 patients (82 %) had a complex type II endoleak with multiple communicating vessels. We retrospectively analyzed the technical and clinical success of transarterial type II endoleak embolization with Onyx. Complete embolization of the nidus was defined as technical success. Embolization was considered clinically successful when volume of the aneurysm sac was stable or decreased on follow-up CT scans. Result: Mean follow-up time was 26.0 (range 6-50) months. Clinical success was achieved in 8 of 11 patients (73 %). Transarterial nidus embolization with Onyx was technically successful in 6 of 11 patients (55 %). In three cases the nidus was embolized without direct catheterization from a more distal access through the network of collateral vessels. Conclusion: Onyx is a favorable embolic agent for transarterial endoleak embolization. To achieve the best clinical results, complete occlusion of the nidus is mandatory.

  4. Organic solvents for pharmaceutical parenterals and embolic liquids: a review of toxicity data.

    PubMed

    Mottu, F; Laurent, A; Rufenacht, D A; Doelker, E

    2000-01-01

    Non-aqueous solvents have long been used in subcutaneous or intramuscular pharmaceutical formulations to dissolve water-insoluble drugs. In recent years, the need for these vehicles was increased since the drug discovery process has yielded many poorly water-soluble drugs. Besides, preparations containing embolic materials dissolved in undiluted non-aqueous water-miscible solvents have been proposed for the intravascular treatment of aneurysms, arteriovenous malformations, or tumors. These organic solvents, regarded as chemically and biologically inert, may show pharmacological and toxicological effects. Therefore, knowledge of tolerance and activity of non-aqueous solvents is essential before they can be administered, especially when given undiluted. This paper focuses on thirteen organic solvents reported as possible vehicles for injectable products and details toxicological data when they have been administered intravascularly. These solvents can be subdivided into three groups according to their description in the literature either for intravenous pharmaceutical parenterals or for intravascular embolic liquids: well-documented organic solvents (propylene glycol, polyethylene glycols, ethanol), solvents described in specific applications (dimethyl sulfoxide, N-methyl-2-pyrrolidone, glycofurol, Solketal, glycerol formal, acetone), and solvents not reported in intravascular applications but potentially useful (tetrahydrofurfuryl alcohol, diglyme, dimethyl isosorbide, ethyl lactate). This review of the literature shows that toxicity data on intravascular organic solvents are insufficient because they concern solvents diluted with water and because of the lack of comparative evaluation using the same methodologies. PMID:11107838

  5. Amplatzer vascular plug as an embolic agent in different vascular pathologies: A pictorial essay.

    PubMed

    Tresley, Jonathan; Bhatia, Shivank; Kably, Issam; Poozhikunnath Mohan, Prasoon; Salsamendi, Jason; Narayanan, Govindarajan

    2016-01-01

    The Amplatzer Vascular Plug (AVP) is a cylindrical plug made of self-expanding nitinol wire mesh with precise delivery control, which can be used for a variety of vascular pathologies. An AVP is an ideal vascular occlusion device particularly in high-flow vessels, where there is high risk of migration and systemic embolization with traditional occlusion devices. We performed 28 embolizations using the AVP from 2009 to 2014 and achieved complete occlusion without complications. PMID:27413276

  6. Amplatzer vascular plug as an embolic agent in different vascular pathologies: A pictorial essay

    PubMed Central

    Tresley, Jonathan; Bhatia, Shivank; Kably, Issam; Poozhikunnath Mohan, Prasoon; Salsamendi, Jason; Narayanan, Govindarajan

    2016-01-01

    The Amplatzer Vascular Plug (AVP) is a cylindrical plug made of self-expanding nitinol wire mesh with precise delivery control, which can be used for a variety of vascular pathologies. An AVP is an ideal vascular occlusion device particularly in high-flow vessels, where there is high risk of migration and systemic embolization with traditional occlusion devices. We performed 28 embolizations using the AVP from 2009 to 2014 and achieved complete occlusion without complications. PMID:27413276

  7. A new technology for revascularization of cerebral embolism using liquid jet impact

    NASA Astrophysics Data System (ADS)

    Kodama, Tetsuya; Takayama, Kazuyoshi; Uenohara, Hiroshi

    1997-12-01

    Revascularization time is the dominant factor in the treatment of acute cerebral embolism. In this paper we describe a rapid revascularization therapy using liquid jets generated by the interaction of gas bubbles with shock waves, which impact on the thrombi. The interaction of a shock wave with a gas bubble attached to an artificial thrombus which was inserted into a tube model of a cerebral artery was investigated. The shock wave was generated by detonating a microexplosive pellet. The overpressure of the shock wave was (n = 7) and (n = 3). The initial air bubble radii were varied from 0.87 mm to 2.18 mm. The subsequent collapse of the bubble was photographed using a high-speed framing camera, and the liquid jet penetrating into the artificial thrombus was visualized using x-ray photography. The penetration depth of the liquid jet increased with increasing bubble size. There was an optimal separation distance between the bubble and the shock wave source to obtain the maximum penetration depth. Liquid jets have the potential to penetrate through thrombi in as little as a few microseconds, and with very efficient ablation.

  8. 12 CFR 709.2 - NCUA Board as liquidating agent.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... INSURED CREDIT UNIONS IN LIQUIDATION § 709.2 NCUA Board as liquidating agent. (a) The Board, as... 12 Banks and Banking 7 2013-01-01 2013-01-01 false NCUA Board as liquidating agent. 709.2 Section..., or directors, shall not thereafter have or exercise any such rights, powers, or privileges or act...

  9. Experimental study of temperature-sensitive chitosan/β-glycerophosphate embolic material in embolizing the basicranial rete mirabile in swines

    PubMed Central

    NING, XIANBIN; ZHAO, CHANGFU; PANG, JINFENG; DING, ZHAOYI; WANG, YUBO; XU, KAN; CHEN, HAO; LI, BINGWEI; LUO, QI

    2015-01-01

    The aim of the present study was to evaluate the feasibility of the non-adhesive temperature-sensitive liquid embolic material, chitosan/β-glycerophosphate (C/GP), in embolizing the basicranial rete mirabile (REM) in a swine model of cerebral arteriovenous malformation (cAVM). A total of 24 domestic swines were used as the experimental animals, among which 12 pigs underwent direct embolization of one side of the REM, while the other 12 pigs underwent embolization of the bilateral REM following anastomosis of the carotid artery and jugular vein. A super-selective microcatheter was introduced into the REM during the embolization procedure, and the C/GP hydrogel was injected until an image of the REM disappeared in the angiography examination. Further angiography examinations were performed after 2 and 6 weeks, and histological examination of the REM was performed after 6 weeks. Of the 24 domestic swines, 23 cases underwent successful thrombosis. Convulsions occurred in one case and that pig died during the embolization procedure. Following embolization, the angiography observations revealed that the embolized REM was no longer able to be developed, and adhesion of the microcatheter tip with the embolic agent did not occur. In addition, no apparent revascularization was observed in the angiography examinations performed at weeks 2 and 6. Therefore, the current preliminary study indicated that use of the non-adhesive temperature-sensitive embolic material was feasible for the embolization of cAVM; thus, C/GP may be used as an ideal embolic material for the treatment of cAVM. PMID:26170955

  10. Comparison of the Efficacy of the Embolic Agents Acrylamido Polyvinyl Alcohol Microspheres and Tris-Acryl Gelatin Microspheres for Uterine Artery Embolization for Leiomyomas: A Prospective Randomized Controlled Trial

    SciTech Connect

    Worthington-Kirsch, Robert L.; Chesnick, Richard

    2011-06-15

    Objective: To evaluate the efficacy of acrylamido polyvinyl alcohol microspheres (a-PVAM) as an embolic agent for uterine artery embolization (UAE) compared with Tris-acryl gelatin microspheres (TAGM).Design, Setting, ParticipantsProspective randomized double-blind noninferiority trial. Conducted at two sites both with regional UAE practices. Forty-six women with symptomatic leiomyomas.InterventionUAE procedure was performed with either of the two embolic agents. Either 700-900-{mu}m a-PVAM or 500-700-{mu}m TAGM was used.Main Outcome MeasuresChanges in leiomyoma perfusion, overall uterine volume, and dominant leiomyomas volume measured by contrast-enhanced magnetic resonance imaging at 1 week, 3 months, and 6 months after UAE by a reader blinded to the embolic agent used. Changes in Uterine Fibroid Symptoms and Quality of Life questionnaire scores were measured at 3, 6, and 12 months after UAE. Results: Forty-six patients were randomized and treated under the study protocol (a-PVAM n = 22, TAGM n = 24). There were no procedure-related complications. Two patients were excluded from analysis (one technical failure of the procedure, one withdrawal from study). Successful (>90%) leiomyoma devascularization was observed in 81% of subjects at 1 week after UAE, 97% at 3 months after UAE, and 95% at 6 months after UAE. No significant differences were observed in 14 of 15 outcome measurements, consistent with noninferiority. TAGM was slightly superior to a-PVAM on one comparison (overall quality of life at 3 months after UAE).

  11. Endovascular embolization

    MedlinePlus

    Treatment - endovascular embolism; Coil embolization; Cerebral aneurysm - endovascular; Coiling - endovascular; Saccular aneurysm - endovascular; Berry aneurysm - endovascular repair; Fusiform aneurysm repair - endovascular; Aneurysm repair - endovascular

  12. Diphosphonium Ionic Liquids as Broad Spectrum Antimicrobial Agents

    PubMed Central

    O’Toole, George A.; Wathier, Michel; Zegans, Michael E.; Shanks, Robert M.Q.; Kowalski, Regis; Grinstaff, Mark W.

    2011-01-01

    Purpose One of the most disturbing trends in recent years is the growth of resistant strains of bacteria with the simultaneous dearth of new antimicrobial agents. Thus, new antimicrobial agents for use on the ocular surface are needed. Methods We synthesized a variety of ionic liquid compounds, which possess two positively charged phosphonium groups separated by ten methylene units in a “bola” type configuration. We tested these compounds for antimicrobial activity versus a variety of ocular pathogens, as well as their cytoxicity in vitro in a corneal cell line and in vivo in mice. Results The ionic liquid Di-Hex C10 demonstrated broad in vitro antimicrobial activity at the low micromolar concentrations versus Gram-negative and Gram-positive organisms, including methicillin-resistant Staphylococcus aureus strains, as well as ocular fungal pathogens. Treatment with Di-Hex C10 resulted in bacterial killing in as little as 15 minutes in vitro. Di-Hex C10 showed little cytotoxicity at 1 μM versus a corneal epithelial cell line or at 10 μM in a mouse corneal wound model. We also show that this bis-phosphonium ionic liquid structure is key, as a comparable mono phosphonium ionic liquid is cytotoxic to both bacteria and corneal epithelial cells. Conclusions Here we report the first use of dicationic bis-phosphonium ionic liquids as antimicrobial agents. Our data suggest that diphosphonium ionic liquids may represent a new class of broad-spectrum antimicrobial agents for use on the ocular surface. PMID:22236790

  13. Transcatheter embolization of pancreatic arteriovenous malformation associated with recurrent acute pancreatitis

    PubMed Central

    Rajesh, S; Mukund, Amar; Bhatia, Vikram; Arora, Ankur

    2016-01-01

    Pancreatic arteriovenous malformation (PAVM) is extremely rare; even rarer is its association with pancreatitis. The authors report a case of PAVM causing recurrent episodes of acute pancreatitis in a 46-year-old male. Patient refused surgery and was treated with transcatheter arterial embolization using liquid embolic agent (mixture of n-butyl-2-cyanoacrylate glue and lipiodol), which resulted in a significant decrease in the size of the PAVM. PMID:27081231

  14. Animal Models for Therapeutic Embolization

    SciTech Connect

    Moreira, Patricia L.; An, Yuehuei H.

    2003-04-15

    Embolization techniques have been performed in different animals to accumulate basic data before a clinical trial.Choosing the right embolization model for a specific project is critical. However, there are several variables when defining the best model for embolization research such as the size of the animal to be used, the target organs, the route of introducing the embolization agent, and the feasible methods of evaluation. Commonly used research animals for endovascular embolization include rabbits, dogs, and rats. Frequently used target organs are the kidney and the liver. Most models use a transcatheter for introducing the embolus and occasionally open surgery and direct arterial injection are used. Basic methods of evaluation are straightforward, and commonly include macro observation of the embolized organs, angiogram, and histology. This article concisely reviews the available animal models and their evaluation for embolization research to help researchers to choose the appropriate model.

  15. Occurrence and Management Strategies for Catheter Entrapment with Onyx Liquid Embolization

    PubMed Central

    Qureshi, Adnan I.; Mian, Nidaullah; Siddiqi, Harris; Qureshi, Mushtaq H.; Malik, Adil M; Rauf Afzal, Mohammad; Khan, Asif A.; Suri, M. Fareed K.

    2015-01-01

    In June 2012, Food and Drug Administration (FDA) issued a warning about the risk of catheter entrapment associated with Onyx embolization. We used our experience, literature review, and FDA Manufacturer and User Facility Device Experience (MAUDE) data review to identify five strategies to address catheter entrapment: 1/. Surgical resection of vessel at point of entrapment of catheter and retraction from exterior portion at the femoral region; 2/. Advancing and closing the loop of snare over the entrapped catheter followed by retraction; 3/. Advancing the distal access catheter over the entrapped catheter and retraction with forward movement of the distal access catheters; 4/. Inflation of balloon catheter coaxial to the entrapped catheter with subsequent retraction; and 5/. Intravascular retention and internalization of microcatheter. In the MAUDE data, there were 77 reports of catheter entrapment with Onyx embolization; microcatheter was retracted by surgical excision in 15, endovascular snare or other retriever devices in 5, deliberately entrapped inside the vessel using stent in 1, and left without intervention within intravascular compartment in 27 patients. PMID:26301030

  16. Liquid contents verification for explosives, chemical agents, and dissolved narcotics

    NASA Astrophysics Data System (ADS)

    Kumar, Sankaran; McMichael, W. Casey; Magnuson, Erik E.; Lee, Young K.; Moeller, Charles R.; Czipott, Peter V.; Rayner, Timothy J.; Newman, David E.; Wroblewski, Dariusz

    2001-02-01

    An increasingly important need today is to guard against terrorist attacks at key locations such as airports and public buildings. Liquid explosives can avoid detection at security checkpoints by being concealed as beverages or other benign liquids. Magnetic resonance (MR) offers a safe, non-invasive technology for probing and classifying the liquid contents inside sealed non-metallic containers or packages. Quantum Magnetics has developed a Liquid Explosives Screening System or `Bottle Scanner' to screen for liquid explosives and flammables, described at an earlier SPIE conference in 1996. Since then, the Bottle Scanner's performance has been significantly improved by the incorporation of neural network-based liquid classification. Recently we have shown that the incorporation of additional discrimination parameters can further enhance liquid classification. In addition to screening for explosives and flammables, the Bottle Scanner can be effective against chemical agents, many of which contain fluorine or phosphorous, both of which have MR signatures. Finally, we have evidence that the Bottle Scanner may also be able to detect narcotics dissolved in beverages, one of the methods used to smuggle narcotics across international borders. The development of the Bottle Scanner has been funded by the Federal Aviation Administration.

  17. Pulmonary Embolism

    MedlinePlus

    ... pulmonary embolism is a sudden blockage in a lung artery. The cause is usually a blood clot ... loose and travels through the bloodstream to the lung. Pulmonary embolism is a serious condition that can ...

  18. Pulmonary Embolism.

    PubMed

    Rali, Parth; Gandhi, Viral; Malik, Khalid

    2016-01-01

    Pulmonary embolism covers a wide spectrum of presentation from an asymptomatic individual to a life-threatening medical emergency. It is of paramount importance to appropriately risk stratify patients with pulmonary embolism, particularly with those who present without hypotension. Right ventricular dysfunction can evolve after a patient has received a diagnosis of pulmonary embolism, necessitating aggressive measures rather than simple anticoagulation. In this review, we discuss definition, risk stratification, pathogenesis, diagnostic approach, and management, with particular focus on massive pulmonary embolism. PMID:26919674

  19. An experimental study for syndiotactic polyvinyl alcohol spheres as an embolic agent: can it maintain spherical shape in vivo?

    PubMed

    Chun, Ho Jong; Lee, Hae Giu; Lyoo, Won Seok; Lee, Ji Youl; Kim, Jina

    2014-01-01

    Syndiotactic polyvinyl alcohol (PVA) had been developed to overcome the drawbacks of atactic PVA spheres that deform easily, which can lead to non-target embolization. This study was performed to evaluate the in vivo stability of spherical shape of the syndiotactic PVA spheres. Selective arteriography and transarterial embolization (TAE) were performed in the main renal arteries of eight New Zealand white rabbits using syndiotactic PVA sphere that consisted of syndiotactic PVA skin and a copolymer core of vinyl acetate/vinyl pivalate. The size of the syndiotactic PVA spheres used for the TAE was 212-355 μm. The rabbits were sacrificed 12-14 days after TAE. Gross and microscopic examinations of each kidney were performed. The microscopic examination showed infarction of all embolized kidneys. Syndiotactic PVA spheres were seen uniformly within the arterial lumen and appeared as round ring-like structures without any deformity. The syndiotactic PVA spheres exclusively occupied the arterial lumen. As a conclusion, syndiotactic PVA spheres maintained their spherical shape without significant deformation in this in vivo short-term experimental study. Further investigation is necessary for evaluation of detailed effects of physical stability in tumor embolization. PMID:24948458

  20. 12 CFR 709.4 - Powers and duties of liquidating agent.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... desirable or expedient in its discretion to wind up the affairs of the credit union including, but not... power to: (1) Pay all costs and expenses of the liquidation as determined by the liquidating agent; (2... performance of their duties. (e) Assets, claims, and contracts. The liquidating agent shall have power to:...

  1. 12 CFR 709.4 - Powers and duties of liquidating agent.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... desirable or expedient in its discretion to wind up the affairs of the credit union including, but not... power to: (1) Pay all costs and expenses of the liquidation as determined by the liquidating agent; (2... performance of their duties. (e) Assets, claims, and contracts. The liquidating agent shall have power to:...

  2. 12 CFR 709.4 - Powers and duties of liquidating agent.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... desirable or expedient in its discretion to wind up the affairs of the credit union including, but not... power to: (1) Pay all costs and expenses of the liquidation as determined by the liquidating agent; (2... performance of their duties. (e) Assets, claims, and contracts. The liquidating agent shall have power to:...

  3. 12 CFR 709.4 - Powers and duties of liquidating agent.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... desirable or expedient in its discretion to wind up the affairs of the credit union including, but not... power to: (1) Pay all costs and expenses of the liquidation as determined by the liquidating agent; (2... performance of their duties. (e) Assets, claims, and contracts. The liquidating agent shall have power to:...

  4. 12 CFR 709.4 - Powers and duties of liquidating agent.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... desirable or expedient in its discretion to wind up the affairs of the credit union including, but not... power to: (1) Pay all costs and expenses of the liquidation as determined by the liquidating agent; (2... performance of their duties. (e) Assets, claims, and contracts. The liquidating agent shall have power to:...

  5. Renal Artery Embolization

    PubMed Central

    Sauk, Steven; Zuckerman, Darryl A.

    2011-01-01

    Renal artery embolization (RAE) is an effective minimally invasive alternative procedure for the treatment of a variety of conditions. Since the 1970s when RAE was first developed, technical advances and growing experience have expanded the indications to not only include treatment of conditions such as symptomatic hematuria and palliation for metastatic renal cancer, but also preoperative infarction of renal tumors, treatment of angiomyolipomas, vascular malformations, medical renal disease, and complications following renal transplantation. With the drastically improved morbidity associated with this technique in part due to the introduction of more precise embolic agents and smaller delivery catheters, RAE continues to gain popularity for various urologic conditions. The indications and techniques for renal artery embolization are reviewed in the following sections. PMID:23204638

  6. Properties of agents that effectively entrap liquid lipids.

    PubMed

    Imagi, J; Yamanouchi, T; Okada, K; Tanimoto, M; Matsuno, R

    1992-03-01

    A droplet of an oil-in-water emulsion of methyl linoleate in a saccharide or protein solution that contained with a surfactant, a stabilizer, or both was dehydrated by drying equipment for a single droplet that resembled a spray drier. The lipid exposed on the surface of dehydated samples was extracted and measured by gas chromatography. Gum arabic or gelatin without additives resulted in little lipid being exposed; they were good entrapping agents. Little lipid was exposed with a pullulan solution containing lecithin, sugar ester, carboxymethylcellulose, or sodium caseinate but much was exposed with a maltodextrin solution containing any of the surfactants tested. When both the surfactant lecithin and the stabilizer xanthan gum were added to the emulsion prepared in a maltodextrin solution, lipid was not detected. The results suggested that effective entrapping agents of liquid lipids cause much emulsification, stabilize the emulsion (that is, they cause the continuous phase to be very viscous), and create a dehydrated matrix of fine, dense network layers. PMID:1368332

  7. Pulmonary Embolism

    MedlinePlus

    ... is a sudden blockage in a lung artery. The cause is usually a blood clot in the leg called a deep vein thrombosis that breaks loose and travels through the bloodstream to the lung. Pulmonary embolism is a ...

  8. CT and radiographic appearance of extracranial Onyx(®) embolization.

    PubMed

    Jia, J B; Green, C S; Cohen, A J; Helmy, M

    2015-03-01

    Onyx(®) (ev3, Irvine, CA, USA) is a liquid embolic agent composed of ethylene vinyl alcohol copolymer dissolved in dimethyl sulphoxide used for the treatment of intracranial arteriovenous malformations. Onyx is a preferred embolizing agent due to its unique properties, non-adhesive nature, and durability. In addition to its approved intracranial application, Onyx is also being used successfully in extracranial embolization in areas including extracranial aneurisms and vascular malformations, trauma, gastrointestinal bleeding, and neoplasms. Because of its increasing utilization, it is important for reporting radiologists to be able to recognize its extracranial appearance across different imaging techniques and to be familiar with its uses. The goal of this review is to describe the extracranial uses of Onyx and its appearance in various extracranial locations at radiography and CT, while providing didactic examples. Onyx appears radiodense at CT and plain radiography and has a curvilinear pattern following the expected path of the vessel embolized. At CT, Onyx creates streak artefact that may obstruct the view of surrounding tissues consistent with descriptions of other tantalum devices. PMID:25481053

  9. Pulmonary embolism

    SciTech Connect

    Dunnick, N.R.; Newman, G.E.; Perlmutt, L.M.; Braun, S.D.

    1988-11-01

    Pulmonary embolism is a common medical problem whose incidence is likely to increase in our aging population. Although it is life-threatening, effective therapy exists. The treatment is not, however, without significant complications. Thus, accurate diagnosis is important. Unfortunately, the clinical manifestations of pulmonary embolism are nonspecific. Furthermore, in many patients the symptoms of an acute embolism are superimposed on underlying chronic heart or lung disease. Thus, a high index of suspicion is needed to identify pulmonary emboli. Laboratory parameters, including arterial oxygen tensions and electrocardiography, are as nonspecific as the clinical signs. They may be more useful in excluding another process than in diagnosing pulmonary embolism. The first radiologic examination is the chest radiograph, but the clinical symptoms are frequently out of proportion to the findings on the chest films. Classic manifestations of pulmonary embolism on the chest radiograph include a wedge-shaped peripheral opacity and a segmental or lobar diminution in vascularity with prominent central arteries. However, these findings are not commonly seen and, even when present, are not specific. Even less specific findings include cardiomegaly, pulmonary infiltrate, elevation of a hemidiaphragm, and pleural effusion. Many patients with pulmonary embolism may have a normal chest radiograph. The chest radiograph is essential, however, for two purposes. First, it may identify another cause of the patient's symptoms, such as a rib fracture, dissecting aortic aneurysm, or pneumothorax. Second, a chest radiograph is essential to interpretation of the radionuclide V/Q scan. The perfusion scan accurately reflects the perfusion of the lung. However, a perfusion defect may result from a variety of etiologies. Any process such as vascular stenosis or compression by tumor may restrict blood flow. 84 references.

  10. Liquid cultivation techniques for enhancing the effectiveness of yeast biocontrol agents

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Biocontrol agents will gain broader acceptance into integrated pest management programs if products with enhanced efficacy and consistency of performance are developed. Though given comparatively little research attention, liquid cultivation environments and protocols can and should be optimized to...

  11. Forward-Osmosis Desalination with Poly(Ionic Liquid) Hydrogels as Smart Draw Agents.

    PubMed

    Fan, Xuelin; Liu, Huili; Gao, Yating; Zou, Zhu; Craig, Vincent S J; Zhang, Guangzhao; Liu, Guangming

    2016-06-01

    The combination of high desalination efficiency, negligible draw-solute leakage, nontoxicity, ease of regeneration, and effective separation to produce liquid water makes the smart draw agents developed here highly suited for forward-osmosis desalination. PMID:27007083

  12. Can Ionic Liquids Be Used As Templating Agents For Controlled Design of Uranium-Containing Nanomaterials?

    SciTech Connect

    Visser, A.; Bridges, N.; Tosten, M.

    2013-04-09

    Nanostructured uranium oxides have been prepared in ionic liquids as templating agents. Using the ionic liquids as reaction media for inorganic nanomaterials takes advantage of the pre-organized structure of the ionic liquids which in turn controls the morphology of the inorganic nanomaterials. Variation of ionic liquid cation structure was investigated to determine the impact on the uranium oxide morphologies. For two ionic liquid cations, increasing the alkyl chain length increases the aspect ratio of the resulting nanostructured oxides. Understanding the resulting metal oxide morphologies could enhance fuel stability and design.

  13. Embolization Therapy for Traumatic Splenic Lacerations

    SciTech Connect

    Dasgupta, Niloy; Matsumoto, Alan H. Arslan, Bulent; Turba, Ulku C.; Sabri, Saher; Angle, John F.

    2012-08-15

    Purpose: This study was designed to evaluate the clinical success, complications, and transfusion requirements based on the location of and agents used for splenic artery embolization in patients with splenic trauma. Methods: A retrospective study was performed of patients with splenic trauma who underwent angiography and embolization from September 2000 to January 2010 at a level I trauma center. Electronic medical records were reviewed for demographics, imaging data, technical aspects of the procedure, and clinical outcomes. Results: Fifty patients were identified (34 men and 16 women), with an average age of 48 (range, 16-80) years. Extravasation was seen on initial angiography in 27 (54%) and was absent in 23 (46%). All 27 patients with extravasation were embolized, and 18 of 23 (78.2%) without extravasation were embolized empirically. Primary clinical success was similar (>75%) across all embolization locations, embolic agents, and grades of laceration treated. Of 45 patients treated, 9 patients (20%) were embolized in the main splenic artery, 34 (75.6%) in the splenic hilum, and 2 (4.4%) were embolized in both locations. Partial splenic infarctions developed in 47.3% treated in the splenic hilum compared with 12.5% treated in the main splenic artery. There were four (8.9%) mortalities: two occurred in patients with multiple critical injuries and two from nonbleeding etiologies. Conclusions: Embolization of traumatic splenic artery injuries is safe and effective, regardless of the location of treatment. Embolization in splenic hilar branches may have a higher incidence of infarction. The grade of laceration and agents used for embolotherapy did not impact the outcomes.

  14. Successful embolization of a suprascapular artery aneurysm.

    PubMed

    Bucci, Federico; P, Plagnol; B, Salvati; R, Capoano; L, Fiengo; A, Redler

    2014-01-01

    A 45-year-old woman was referred to our service because 9 months earlier she had developed a pulsating mass on the right supraclavicular fossa and torticollis. Ultrasounds and computed tomographic arteriography showed the presence of a subclavian collateral artery aneurysm with a diameter of 21 mm. On selective arteriography, an aneurysm of a suprascapular artery arising directly from the right subclavian artery was reported. The presence of thoracic outlet syndrome was excluded. The aneurysm was successfully treated with ethylene-vinyl alcohol polymer, a liquid embolic agent. The patient was discharged on postoperative day 1 in good general condition. After 12 months, control ultrasounds confirmed the complete thrombosis of the aneurysm sac. PMID:21620668

  15. Systemic thrombolysis for acute pulmonary embolism.

    PubMed

    Bartel, Billie

    2015-01-01

    Acute pulmonary embolism is a frequent cause of hospitalization and is associated with a wide range of symptom severity. Anticoagulants are the mainstay of treatment for acute pulmonary embolism; however, in patients with massive or submassive pulmonary embolism, advanced therapy with thrombolytics may be considered. The decision to use thrombolytic therapy for acute pulmonary embolism should be based on careful risk-benefit analysis for each patient, including risk of morbidity and mortality associated with the embolism and risk of bleeding associated with the thrombolytic. Alteplase is currently the thrombolytic agent most studied and with the most clinical experience for this indication, although the most appropriate dose remains controversial, especially in patients with low body weight. When considering thrombolysis, unfractionated heparin is the preferred initial anticoagulant due to its short duration of action and its reversibility should bleeding occur. PMID:25559613

  16. [Pulmonary embolism].

    PubMed

    Söffker, Gerold; Kluge, Stefan

    2015-01-01

    Acute pulmonary embolism is an important differential diagnosis of acute chest pain. The clinical signs are often non-specific. However, diagnosis and therapy must be done quickly in order to reduce morbidity and mortality. The new (2014) European guidelines for acute pulmonary embolism (PE) focus on risk-adapted diagnostic algorithms and prognosis adapted therapy concepts. According to the hemodynamic presentation the division in a high-risk group (unstable patient with persistent hypotension or shock) or in non-high-risk groups (hemodynamically stable) was proposed. In the high-risk group the immediate diagnosis is usually done by multidetector spiral computed tomography (MDCT) and primarily the medical therapy of right ventricular dysfunction and thrombolysis is recommended.In the non-high-risk group, this is subdivided into an intermediate-risk group and low-risk group, the diagnosis algorithm based on the PE-pretest probability--determined by validated scores. Moreover, the diagnosis is usually secured by MDCT--the new gold standard in the PE-diagnosis, scores, or it can be primarily ruled out due to the high negative predictive value of D-dimer determination. To improve the prognostic risk stratification in non-high-risk group patients the additional detection of right ventricular dysfunction (MDCT, echocardiography), cardiac biomarkers (troponin, NT proBNP) and validated scores (e.g. Pulmonary Embolism Severity Index) is recommended. Therefore, the intermediate-risk group can be further subdivided. For treatment of non-high-risk group patients, the initial anticoagulation (except those with severe renal insufficiency) using low molecular weight heparin/fondaparinux and conversion to vitamin-K antagonists or alternatively with direct oral anticoagulants (DOAK) is recommended. Hemodynamically stable patients with right ventricular dysfunction and myocardial ischemia (Intermediate-high-risk group patients) but with clinically progressive hemodynamic

  17. Can ionic liquids be used as templating agents for controlled design of uranium-containing nanomaterials?

    SciTech Connect

    Visser, Ann E. Bridges, Nicholas J.; Tosten, Michael H.

    2013-09-01

    Graphical abstract: - Highlights: • Uranium oxides nanoparticles prepared using ionic liquids. • IL cation alkyl length impacts oxide morphology. • Low temperature UO{sub 2} synthesis. - Abstract: Nanostructured uranium oxides have been prepared in ionic liquids as templating agents. Using the ionic liquids as reaction media for inorganic nanomaterials takes advantage of the pre-organized structure of the ionic liquids which in turn controls the morphology of the inorganic nanomaterials. Variation of ionic liquid cation structure was investigated to determine the impact on the uranium oxide morphologies. For two ionic liquid cations, increasing the alkyl chain length increases the aspect ratio of the resulting nanostructured oxides. Understanding the resulting metal oxide morphologies could enhance fuel stability and design.

  18. Laser-induced chemical liquid phase deposition of copper from aqueous solutions without reducing agents

    SciTech Connect

    Kochemirovsky, V A; Tumkin, I I; Logunov, L S; Safonov, S V; Menchikov, Leonid G

    2012-08-31

    Laser-induced chemical liquid phase deposition of copper without a traditional reducing agent has been used for the first time to obtain conductive patterns on a dielectric surface having a reducing ability. It is shown that phenol-formaldehyde binder of the dielectric (glass fibre) can successfully play the role of a reducing agent in this process. The resulting copper sediments have low electrical resistance and good topology. (interaction of laser radiation with matter. laser plasmas)

  19. Raidiation-Induced Fragmentation of Diamide Extraction Agents in Ionic Liquid Diluents

    SciTech Connect

    Bell, Jason R; Dai, Sheng; Shkrob, Ilya A.; Marin, Timothy W.; Luo, Huimin; Hatcher, Jasmine; Rimmer, R. Dale; Wishart, James F.

    2012-01-01

    N,N,N',N'-Tetraalkyldiglycolamides are extracting agents that are used for liquid-liquid extraction of trivalent metal ions in wet processing of spent nuclear fuel. This application places such agents in contact with the decaying radionuclides, causing radiolysis of the agent in the organic diluent. Recent research seeks to replace common molecular diluents (such as n-dodecane) with hydrophobic room-temperature ionic liquids (ILs), which have superior solvation properties. In alkane diluents, rapid radiolytic deterioration of diglycolamide agents can be inhibited by addition of an aromatic cosolvent that scavenges highly reactive alkane radical cations before these oxidize the extracting agent. Do aromatic ILs exhibit a similar radioprotective effect? To answer this question, we used electron paramagnetic resonance spectroscopy to study the fragmentation pathways in radiolysis of neat diglycolamides, their model compounds, and their solutions in the ILs. Our study indicates that aromatic ILs do not protect these types of solutes from extensive radiolytic damage. Previous research indicated a similar lack of protection for crown ethers, whereas the ILs readily protected di- and trialkyl phosphates (another large class of metal-extracting agents). Our analysis of these unanticipated failures suggests that new types of organic anions are required in order to formulate ILs capable of radioprotection for these classes of solutes. This study is a cautionary tale of the fallacy of analogical thinking when applied to an entirely new and insufficiently understood class of chemical materials.

  20. Pulmonary embolism

    PubMed Central

    Tarbox, Abigail K.; Swaroop, Mamta

    2013-01-01

    Pulmonary embolism (PE) is responsible for approximately 100,000 to 200,000 deaths in the United States each year. With a diverse range of clinical presentations from asymptomatic to death, diagnosing PE can be challenging. Various resources are available, such as clinical scoring systems, laboratory data, and imaging studies which help guide clinicians in their work-up of PE. Prompt recognition and treatment are essential for minimizing the mortality and morbidity associated with PE. Advances in recognition and treatment have also enabled treatment of some patients in the home setting and limited the amount of time spent in the hospital. This article will review the risk factors, pathophysiology, clinical presentation, evaluation, and treatment of PE. PMID:23724389

  1. Endovascular Embolization of Visceral Artery Aneurysms with Ethylene-vinyl Alcohol (Onyx): A Case Series

    SciTech Connect

    Bratby, M.J.; Lehmann, E.D.; Bottomley, J.; Kessel, D.O.; Nicholson, A.A.; McPherson, S.J.; Morgan, R.A.; Belli, A.-M.

    2006-12-15

    We report the application of the liquid embolic agent ethylene-vinyl alcohol (Onyx; MicroTherapeutics, Irvine, CA, USA) in the management of visceral artery aneurysms. The technique and indications for using Onyx are discussed with emphasis on the management of wide-necked aneurysms and maintenance of patency of the parent vessel. None of the cases was considered suitable for stent-grafting or embolization with conventional agents. Two aneurysms of the renal artery bifurcation and one aneurysm of the inferior pancreaticoduodenal artery were treated. Following treatment there was complete exclusion of all aneurysms. There was no evidence of end-organ infarction. Follow-up with intervals up to 6 months has shown sustained aneurysm exclusion. Onyx is known to be effective in the management of intracranial aneurysms. Our experience demonstrates the efficacy and applicability of the use of Onyx in the treatment of complex visceral artery aneurysms.

  2. Fat embolism syndrome

    PubMed Central

    George, Jacob; George, Reeba; Dixit, R.; Gupta, R. C.; Gupta, N.

    2013-01-01

    Fat embolism syndrome is an often overlooked cause of breathlessness in trauma wards. Presenting in a wide range of clinical signs of varying severity, fat embolism is usually diagnosed by a physician who keeps a high degree of suspicion. The clinical background, chronology of symptoms and corroborative laboratory findings are instrumental in a diagnosis of fat embolism syndrome. There are a few diagnostic criteria which are helpful in making a diagnosis of fat embolism syndrome. Management is mainly prevention of fat embolism syndrome, and organ supportive care. Except in fulminant fat embolism syndrome, the prognosis is usually good. PMID:23661916

  3. Rate and extent of leakage of a magnetic resonance contrast agent tend to be lower under isoflurane anesthesia in comparison to halothane in a rat model of embolic stroke.

    PubMed

    Bezerra, Francisco J; Brown, Morris; Alarcon, William; Karki, Kishor; Knight, Robert A; Keenan, Kelly A; Nagaraja, Tavarekere N

    2014-09-01

    Cerebral blood flow (CBF) and blood-brain barrier (BBB) permeability by arterial spin labeling (ASL)- and dynamic contrast enhanced (DCE)-magnetic resonance imaging (MRI), respectively were repeatedly measured under either halothane (N  =  5) or isoflurane (N  =  5) anesthesia in a rat stroke model of embolic occlusion of middle cerebral artery (MCA). Cerebral blood flow measurements were made after MCA embolization, following intravenous recombinant tissue plasminogen activator (rtPA) treatment at 3 hours post-ictus and again at 48 hours. Blood-brain barrier opening was examined after rtPA infusion and again at 48 hours. Data were analyzed using paired t-tests and significance considered at P < 0·05. The extent and magnitude of CBF reduction due to stroke did not differ between the two groups. Blood-to-brain forward rate constant, K(trans), a measure of BBB permeability, for an MRI contrast agent gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA), was elevated in the ipsilateral hemisphere in both cohorts. However, isoflurane-anesthetized rats exhibited a trend of lower K(trans) values at 48 hours (P  =  0·06) indicating reduced BBB damage in the ipsilateral hemisphere. The area of BBB opening followed a similar trend with the isoflurane-anesthetized group exhibiting a smaller area of BBB damage acutely and at 48 hours compared to the halothane-anesthetized group. PMID:24601723

  4. Catheter fracture and embolization from totally implanted venous access ports--case reports.

    PubMed

    Vadlamani, P; Dawn, B; Perry, M C

    1998-12-01

    Totally implanted venous access ports are excellent devices for delivering chemotherapeutic agents and prolonged intravenous infusions in patients with cancer. Catheter fracture and embolization are rare and potentially serious complications of these widely used devices. Retrieval of the embolized fragment is generally indicated but may not be possible. The authors report three cases of catheter embolization in their center over a period of 9 years. Catheter "pinch-off," fracture, embolization, and retrieval are discussed. PMID:9855376

  5. Alternative Treatment for Bleeding Peristomal Varices: Percutaneous Parastomal Embolization

    SciTech Connect

    Pabon-Ramos, Waleska M.; Niemeyer, Matthew M.; Dasika, Narasimham L.

    2013-10-15

    Purpose: To describe how peristomal varices can be successfully embolized via a percutaneous parastomal approach. Methods: The medical records of patients who underwent this procedure between December 1, 2000, and May 31, 2008, were retrospectively reviewed. Procedural details were recorded. Median fluoroscopy time and bleeding-free interval were calculated. Results: Seven patients underwent eight parastomal embolizations. The technical success rate was 88 % (one failure). All embolizations were performed with coils combined with a sclerosant, another embolizing agent, or both. Of the seven successful parastomal embolizations, there were three cases of recurrent bleeding; the median time to rebleeding was 45 days (range 26-313 days). The remaining four patients did not develop recurrent bleeding during the follow-up period; their median bleeding-free interval was 131 days (range 40-659 days). Conclusion: This case review demonstrated that percutaneous parastomal embolization is a feasible technique to treat bleeding peristomal varices.

  6. Analysis of nerve agent metabolites from nail clippings by liquid chromatography tandem mass spectrometry.

    PubMed

    Appel, Amanda S; Logue, Brian A

    2016-09-15

    While several methods for the bioanalysis of nerve agents or their metabolites have been developed for the verification of nerve agent exposure, these methods are generally limited in the amount of time after an exposure that markers of exposure can be detected (due to rapid metabolism from biological matrices). In this study, a method for the analysis of nerve agent hydrolysis products from nail clippings was developed to allow evaluation of nails as a long-term repository of these markers. Pinacolyl methylphosphonic acid (PMPA) and isopropyl methylphosphonic acid (IMPA) were extracted from nail samples with N,N-dimethylformamide and subsequently analyzed by liquid chromatography-tandem mass spectrometry. Limits of detection for PMPA and IMPA were 0.3μg/kg and 7.5μg/kg and linear ranges were 0.75-300μg/kg and 30-1500μg/kg, respectively. Precision was within 10% and 8% for PMPA and IMPA, respectively, and accuracy was 100±12% for both analytes. The approach presented here is complementary to current methods for nerve agent exposure verification, and should allow for long-term determination of nerve agent poisoning. PMID:27474780

  7. Transcatheter arterial embolization - major complications and their prevention

    SciTech Connect

    Miller, F.J. Jr.; Mineau, D.E.

    1983-08-01

    A thorough account is given of the complications of embolization techniques in nonneurovascular areas, including hepatic infarction, renal and splenic abscess formation. Infarction of the urinary bladder, gallbladder, stomach, and bowel are discussed. Suggestions are offered to prevent complications from embolization where possible. Specific agents for embolization are detailed and their relative merits are compared; ethyl alcohol has recently gained popularity for treating esophageal varices and infarcting renal tumors. Care is advocated when using alcohol in the renal arteries; employing this agent is currently contraindicated in the celiac and mesenteric arteries. Coils and balloon systems are also described along with their potential complications.

  8. 12 CFR 709.10 - Treatment by conservator or liquidating agent of financial assets transferred in connection with...

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Treatment by conservator or liquidating agent of financial assets transferred in connection with a securitization or participation. 709.10 Section 709.10 Banks and Banking NATIONAL CREDIT UNION ADMINISTRATION REGULATIONS AFFECTING CREDIT UNIONS INVOLUNTARY LIQUIDATION OF FEDERAL CREDIT UNIONS...

  9. Crural Artery Traumatic Injuries: Treatment with Embolization

    SciTech Connect

    Lopera, Jorge E. Suri, Rajeev; Cura, Marco; Kroma, Ghazwan; El-Merhi, Fadi

    2008-05-15

    The purpose of this paper is to report our experience with the endovascular treatment of crural arterial injuries using transcatheter and direct embolization techniques. A total of eight consecutive patients have been treated during a 7-year period. Six males and two females, mean age 32 years (range, 15-56 years), presented with penetrating trauma to the lower extremities. Mechanisms of injuries were stab wounds in six patients, gun shot wound in one patient, and iatrogenic injury in one patient. Five patients presented with acute trauma, while three patients presented with delayed injuries. Crural arterial injuries encountered included pseudoaneurysms with arteriovenous fistulas (n = 6), pseudoaneurysms with vessel transections (n = 2), and pseudoaneurysm (n = 1). Proximal and distal embolization with coils was used in three cases, proximal embolization with coils in three cases, percutaneous thrombin injection in one case, and liquid n-butyl cyanoacrylate in one case. Complete exclusion of the lesions was accomplished by sacrifice of one crural vessel in seven cases and of two crural vessels in one case. Two cases of delayed injuries required combined coil and liquid embolization techniques for lesion exclusion. A minor complication (groin hematoma) occurred in one patient, no distal ischemia was seen, and no amputations were required. Mean follow-up was 61 days (range, 1-180 days). One pseudoaneurysm treated with thrombin injection recurred and required surgical excision. We conclude that transcatheter embolization alone or in combination with different endovascular techniques is useful in the treatment of traumatic crural vessel injuries.

  10. Liquid-liquid-solid microextraction and detection of nerve agent simulants by on-membrane Fourier transform infrared spectroscopy.

    PubMed

    Garg, Prabhat; Purohit, Ajay; Tak, Vijay K; Kumar, Ajeet; Dubey, D K

    2012-11-01

    A coupling of novel liquid-liquid-solid microextraction (LLSME) technique based on porous hydrophobic membrane and Fourier-transform infrared spectroscopy has been presented for the detection, identification and quantification of markers and simulants of nerve agents. Two isomers O,O'-dihexyl methylphosphonate (DHMP) and O,O'-dipentyl isopropylphosphonate (DPIPP) were chosen as model analytes for the study. In the present technique, organic phase was immobilised within the pores of membrane after fixing it in an assembly, which was then immersed into aqueous sample of target analytes for extraction. The analytes were directly determined on the surface of membrane by FTIR spectroscopy without elution. On comparison with solid phase microextraction (SPME), LLSME was found to be much more efficient. The method was optimised and quantitative analyses were performed using calibration curves obtained via Beer's law and employing processing of spectra obtained, via a multivariate calibration technique partial least square (PLS). Relative standard deviations (RSDs) for intraday repeatability and interday reproducibility were found to be in the range of 0.20-0.50% and 0.20-0.60%, respectively. Limit of detection (LOD) was achieved up to 15 ng mL(-1). Applicability of the method was tested with an unknown real sample obtained in an international official proficiency test (OPT). PMID:23084054

  11. Strategic and Technical Considerations for the Endovascular Embolization of Intracranial Meningiomas.

    PubMed

    James, Robert F; Kramer, Daniel R; Page, Paul S; Gaughen, John R; Martin, Lacey B; Mack, William J

    2016-04-01

    Endovascular embolization is a frequently used adjunct to operative resection of meningiomas. Embolization may decrease intraoperative blood loss, operative time, and surgical difficulty associated with resection. The specific clinical applications of this treatment have not been defined clearly. Procedural indications, preferred embolic agent, and latency until tumor resection all differ across operators. It is clear that strategic patient selection, comprehensive anatomic understanding, and sound operative technique are critical to the success of the embolization procedure. This article reviews the management and technical considerations associated with preoperative meningioma embolization. PMID:27012380

  12. Efficacy of liquid and foam decontamination technologies for chemical warfare agents on indoor surfaces.

    PubMed

    Love, Adam H; Bailey, Christopher G; Hanna, M Leslie; Hok, Saphon; Vu, Alex K; Reutter, Dennis J; Raber, Ellen

    2011-11-30

    Bench-scale testing was used to evaluate the efficacy of four decontamination formulations on typical indoor surfaces following exposure to the liquid chemical warfare agents sarin (GB), soman (GD), sulfur mustard (HD), and VX. Residual surface contamination on coupons was periodically measured for up to 24h after applying one of four selected decontamination technologies [0.5% bleach solution with trisodium phosphate, Allen Vanguard Surface Decontamination Foam (SDF™), U.S. military Decon Green™, and Modec Inc. and EnviroFoam Technologies Sandia Decontamination Foam (DF-200)]. All decontamination technologies tested, except for the bleach solution, performed well on nonporous and nonpermeable glass and stainless-steel surfaces. However, chemical agent residual contamination typically remained on porous and permeable surfaces, especially for the more persistent agents, HD and VX. Solvent-based Decon Green™ performed better than aqueous-based bleach or foams on polymeric surfaces, possibly because the solvent is able to penetrate the polymer matrix. Bleach and foams out-performed Decon Green for penetrating the highly polar concrete surface. Results suggest that the different characteristics needed for an ideal and universal decontamination technology may be incompatible in a single formulation and a strategy for decontaminating a complex facility will require a range of technologies. PMID:21944706

  13. Preliminary experience with precipitating hydrophobic injectable liquid in brain arteriovenous malformations.

    PubMed

    Koçer, Naci; Hanımoğlu, Hakan; Batur, Şebnem; Kandemirli, Sedat Giray; Kızılkılıç, Osman; Sanus, Zihni; Öz, Büge; Işlak, Civan; Kaynar, Mehmet Yaşar

    2016-01-01

    Advancement in microcatheter design and emergence of new embolic agents offer better results in endovascular treatment of brain arteriovenous malformations (AVMs). Precipitating hydrophobic injectable liquid (PHIL) (Microvention) is a newly introduced dimethyl sulfoxide-based embolic agent for endovascular use. Herein, we present three patients who underwent endovascular treatment of brain AVMs with PHIL, followed by surgical resection. Endovascular features and same-day surgical handling of the new embolic agent PHIL are presented along with histopathologic changes in the acute stage in brain AVMs are presented, and its major differences from Onyx. In our series, PHIL had moderate inflammatory reaction in the acute stage without any associated angionecrosis that is different than Onyx which cause mild inflammatory reaction with angionecrosis. Smallest vessel containing PHIL was 2.9 μm compared to 5 μm with Onyx, which suggests better penetration. PMID:26782157

  14. Preliminary experience with precipitating hydrophobic injectable liquid in brain arteriovenous malformations

    PubMed Central

    Koçer, Naci; Hanımoğlu, Hakan; Batur, Şebnem; Kandemirli, Sedat Giray; Kızılkılıç, Osman; Sanus, Zihni; Öz, Büge; Işlak, Civan; Kaynar, Mehmet Yaşar

    2016-01-01

    Advancement in microcatheter design and emergence of new embolic agents offer better results in endovascular treatment of brain arteriovenous malformations (AVMs). Precipitating hydrophobic injectable liquid (PHIL) (Microvention) is a newly introduced dimethyl sulfoxide-based embolic agent for endovascular use. Herein, we present three patients who underwent endovascular treatment of brain AVMs with PHIL, followed by surgical resection. Endovascular features and same-day surgical handling of the new embolic agent PHIL are presented along with histopathologic changes in the acute stage in brain AVMs are presented, and its major differences from Onyx. In our series, PHIL had moderate inflammatory reaction in the acute stage without any associated angionecrosis that is different than Onyx which cause mild inflammatory reaction with angionecrosis. Smallest vessel containing PHIL was 2.9 μm compared to 5 μm with Onyx, which suggests better penetration. PMID:26782157

  15. Ionic liquid as a mobile phase additive in high-performance liquid chromatography for the simultaneous determination of eleven fluorescent whitening agents in paper materials.

    PubMed

    Wang, Qing; Chen, Xianbo; Qiu, Bin; Zhou, Liang; Zhang, Hui; Xie, Juan; Luo, Yan; Wang, Bin

    2016-04-01

    In the present study, 11 4,4'-diaminostilbene-2,2'-disulfonic acid based fluorescent whitening agents with different numbers of sulfonic acid groups were separated by using an ionic liquid as a mobile phase additive in high-performance liquid chromatography with fluorescence detection. The effects of ionic liquid concentration, pH of mobile phase B, and composition of mobile phase A on the separation of fluorescent whitening agents were systematically investigated. The ionic liquid tetrabutylammonium tetrafluoroborate is superior to tetrabutylammomnium bromide for the separation of the fluorescent whitening agents. The optimal separation conditions were an ionic liquid concentration at 8 mM and the pH of mobile phase B at 8.5 with methanol as mobile phase A. The established method exhibited low limits of detection (0.04-0.07 ng/mL) and wide linearity ranges (0.30-20 ng/mL) with high linear correlation coefficients from 0.9994 to 0.9998. The optimized procedure was applied to analyze target analytes in paper samples with satisfactory results. Eleven target analytes were quantified, and the recoveries of spiked paper samples were in the range of 85-105% with the relative standard deviations from 2.1 to 5.1%. The obtained results indicated that the method was efficient for detection of 11 fluorescent whitening agents. PMID:26843408

  16. Endovascular Embolization of Spontaneous Retroperitoneal Hemorrhage Secondary to Anticoagulant Treatment

    SciTech Connect

    Isokangas, Juha-Matti Peraelae, Jukka M.

    2004-11-15

    The purpose of this study was to report a single hospital's experience of endovascular treatment of patients with retroperitoneal hemorrhage (RPH) secondary to anticoagulant treatment. Ten consecutive patients treated in an intensive care unit and needing blood transfusions due to RPH secondary to anticoagulation were referred for digital subtraction angiography (DSA) to detect the bleeding site(s) and to evaluate the possibilities of treating them by transcatheter embolization. DSA revealed bleeding site(s) in all 10 patients: 1 lumbar artery in 4 patients, 1 branch of internal iliac artery in 3 patients and multiple bleeding sites in 3 patients. Embolization could be performed in 9 of them. Coils, gelatin and/or polyvinyl alcohol were used as embolic agents. Bleeding stopped or markedly decreased after embolization in 8 of the 9 (89%) patients. Four patients were operated on prior to embolization, but surgery failed to control the bleeding in any of these cases. Abdominal compartment syndrome requiring surgical or radiological intervention after embolization developed in 5 patients. One patient died, and 2 had sequelae due to RPH. All 7 patients whose bleeding stopped after embolization had a good clinical outcome. Embolization seems to be an effective and safe method to control the bleeding in patients with RPH secondary to anticoagulant treatment when conservative treatment is insufficient.

  17. Detection of warfare agents in liquid foods using the brine shrimp lethality assay.

    PubMed

    Lumor, Stephen E; Diez-Gonzalez, Francisco; Labuza, Theodore P

    2011-01-01

    The brine shrimp lethality assay (BSLA) was used for rapid and non-specific detection of biological and chemical warfare agents at concentrations considerably below that which will cause harm to humans. Warfare agents detected include T-2 toxin, trimethylsilyl cyanide, and commercially available pesticides such as dichlorvos, diazinon, dursban, malathion, and parathion. The assay was performed by introducing 50 μL of milk or orange juice contaminated with each analyte into vials containing 10 freshly hatched brine shrimp nauplii in seawater. This was incubated at 28 °C for 24 h, after which mortality was determined. Mortality was converted to probits and the LC(50) was determined for each analyte by plotting probits of mortality against analyte concentration (log(10)). Our findings were the following: (1) the lethal effects of toxins dissolved in milk were observed, with T-2 toxin being the most lethal and malathion being the least, (2) except for parathion, the dosage (based on LC(50)) of analyte in a cup of milk (200 mL) consumed by a 6-y-old (20 kg) was less than the respective published rat LD(50) values, and (3) the BSLA was only suitable for detecting toxins dissolved in orange juice if incubation time was reduced to 6 h. Our results support the application of the BSLA for routine, rapid, and non-specific prescreening of liquid foods for possible sabotage by an employee or an intentional bioterrorist act. Practical Application: The findings of this study strongly indicate that the brine shrimp lethality assay can be adapted for nonspecific detection of warfare agents or toxins in food at any point during food production and distribution. PMID:21535725

  18. Foreign body pulmonary embolism.

    PubMed

    Rief, Peter; Belaj, Klara; Smaczny, Nicole; Augustin, Michael; Eller, Philipp; Brodmann, Marianne; Pilger, Ernst

    2013-06-01

    We report a case of a foreign body embolism caused by a tip of an explanted port-a-cath system. The embolus could be removed with a gooseneck snare catheter, the patient fully recovered. PMID:23765525

  19. Embolization of Brain Aneurysms and Fistulas

    MedlinePlus

    ... Professions Site Index A-Z Embolization of Brain Aneurysms and Arteriovenous Malformations/Fistulas Embolization of brain aneurysms ... Aneurysms and Fistulas? What is Embolization of Brain Aneurysms and Fistulas? Embolization of brain aneurysms and arteriovenous ...

  20. Devascularization of Head and Neck Paragangliomas by Direct Percutaneous Embolization

    SciTech Connect

    Ozyer, Umut Harman, Ali; Yildirim, Erkan; Aytekin, Cuneyt; Akay, Tankut Hakki; Boyvat, Fatih

    2010-10-15

    Preoperative transarterial embolization of head and neck paragangliomas using particulate agents has proven beneficial for decreasing intraoperative blood loss. However, the procedure is often incomplete owing to extensive vascular structure and arteriovenous shunts. We report our experience with embolization of these lesions by means of direct puncture and intratumoral injection of n-butyl cyanoacrylate (NBCA) or Onyx. Ten patients aged 32-82 years who were referred for preoperative embolization of seven carotid body tumors and three jugular paragangliomas were retrospectively analyzed. Intratumoral injections were primarily performed in four cases with multiple small-caliber arterial feeders and adjunctive to transarterial embolization in six cases with incomplete devascularization. Punctures were performed under ultrasound and injections were performed under roadmap fluoroscopic guidance. Detailed angiographies were performed before and after embolization procedures. Control angiograms showed complete or near-complete devascularization in all tumors. Three tumors with multiple small-caliber arterial feeders were treated with primary NBCA injections. One tumor necessitated transarterial embolization after primary injection of Onyx. Six tumors showed regional vascularization from the vasa vasorum or small-caliber branches of the external carotid artery following the transarterial approach. These regions were embolized with NBCA injections. No technical or clinical complications related to embolization procedures occurred. All except one of the tumors were surgically removed following embolization. In conclusion, preoperative devascularization with percutaneous direct injection of NBCA or Onyx is feasible, safe, and effective in head and neck paragangliomas with multiple small-caliber arterial feeders and in cases of incomplete devascularization following transarterial embolization.

  1. Pulmonary embolism and amniotic fluid embolism in pregnancy.

    PubMed

    Brennan, Matthew C; Moore, Lisa E

    2013-03-01

    Amniotic fluid embolism and pulmonary embolism are 2 of the most common causes of maternal mortality in the developed world. Symptoms of pulmonary embolism include tachycardia, tachypnea, and shortness of breath, all of which are common complaints in pregnancy. Heightened awareness leads to rapid diagnosis and institution of therapy. Amniotic fluid embolism is associated with maternal collapse. There are currently no proven therapies, although rapid initiation of supportive care may decrease the risk of mortality. PMID:23466134

  2. [Determination of fluorescent whitening agents in disposable sanitary products by high performance liquid chromatography].

    PubMed

    Wei, Feng; Wu, Song; Yu, Xi; Yin, Xianggang; Ge, Mingqiao

    2015-02-01

    A method for the determination of four fluorescent whitening agents (FWAs) (FWA 357, FWA 220, FWA 204 and FWA 113) in disposable sanitary products by high performance liquid chromatography with diode array detection (HPLC-DAD) was developed. The sample was extracted with a 20 mL ultrapure water by sonication for 30 min at 80 °C. The HPLC method was performed on an SB Phenyl column (250 mm x 4. 6 mm, 5 µm) by gradient elution using 5 mmol/L ammonium acetate and acetonitrile as mobile phases, which can separate the target analytes successfully. The target analytes showed good linearity in the range of 0. 025-400 mg/L with the correlation coefficients (r2) greater than 0. 999 9. The limits of detection (LODs, S/N =3) were 0.02-0. 1 mg/L, and the method limits of quantification (MLOQs) were 1. 0 - 5. 0 mg/kg for the target analytes. The feasibility of this method was demonstrated by the determination of FWAs in samples with spiked recoveries. The recoveries were in the range between 83. 7% and 101. 0%, and the relative standard deviations (RSDs) (n=6) ranged from 2. 4% to 7. 0%. This method is simple, and has high recoveries for the determination of FWAs in disposable sanitary products. PMID:25989688

  3. Utilization of Ionic Liquids in Lignocellulose Biorefineries as Agents for Separation, Derivatization, Fractionation, or Pretreatment.

    PubMed

    Peleteiro, Susana; Rivas, Sandra; Alonso, José L; Santos, Valentín; Parajó, Juan C

    2015-09-23

    Ionic liquids (ILs) can play multiple roles in lignocellulose biorefineries, including utilization as agents for the separation of selected compounds or as reaction media for processing lignocellulosic materials (LCM). Imidazolium-based ILs have been proposed for separating target components from LCM biorefinery streams, for example, the dehydration of ethanol-water mixtures or the extractive separation of biofuels (ethanol, butanol) or lactic acid from the respective fermentation broths. As in other industries, ILs are potentially suitable for removing volatile organic compounds or carbon dioxide from gaseous biorefinery effluents. On the other hand, cellulose dissolution in ILs allows homogeneous derivatization reactions to be carried out, opening new ways for product design or for improving the quality of the products. Imidazolium-based ILs are also suitable for processing native LCM, allowing the integral benefit of the feedstocks via separation of polysaccharides and lignin. Even strongly lignified materials can yield cellulose-enriched substrates highly susceptible to enzymatic hydrolysis upon ILs processing. Recent developments in enzymatic hydrolysis include the identification of ILs causing limited enzyme inhibition and the utilization of enzymes with improved performance in the presence of ILs. PMID:26335846

  4. Bronchial Artery Aneurysm Embolization with NBCA

    SciTech Connect

    Aburano, Hiroyuki Kawamori, Yasuhiro; Horiti, Yasushi; Kitagawa, Kiyohide; Sanada, Junichiro; Matsui, Osamu

    2006-12-15

    We present a case of asymptomatic bronchial artery aneurysm that formed a fistula with part of the pulmonary artery (there was no definite fistula with the pulmonary vein). We were able to catheterize the feeding vessel but could not reach the aneurysm. We therefore injected a mixture of N-butyl-2-cyanoacrylate (NBCA; Histoacryl, B. Braun, Melsungen, Germany) and iodized oil (Lipiodol; Guerbet, Aulnay-sous-Bois, France) from the feeding vessel. The fistula, aneurysm, and feeding vessel were almost totally occluded. After embolization, the patient coughed a little; there were no other definite side effects or complications. One and 3 months later, on chest CT, the aneurysm was almost completely occupied with hyperattenuating NBCA-Lipiodol embolization. NBCA is a liquid embolization material whose time to coagulation after injection can be controlled by diluting it with Lipiodol. It is therefore possible to embolize an aneurysm, feeding vessels, and efferent vessels (in our case, it was a fistula) by using an NBCA-Lipiodol mixture of an appropriate concentration, regardless of whether the catheter can reach the aneurysm or not.

  5. The role of lung imaging in pulmonary embolism

    PubMed Central

    Mishkin, Fred S.; Johnson, Philip M.

    1973-01-01

    The advantages of lung scanning in suspected pulmonary embolism are its diagnostic sensitivity, simplicity and safety. The ability to delineate regional pulmonary ischaemia, to quantitate its extent and to follow its response to therapy provides valuable clinical data available by no other simple means. The negative scan effectively excludes pulmonary embolism but, although certain of its features favour the diagnosis of embolism, the positive scan inherently lacks specificity and requires angiographic confirmation when embolectomy, caval plication or infusion of a thrombolytic agent are contemplated. The addition of simple ventilation imaging techniques with radioxenon overcomes this limitation by providing accurate analog estimation or digital quantitation of regional ventilation: perfusion (V/Q) ratios fundamental to understanding the pathophysiologic consequences of embolism and other diseases of the lung. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5Fig. 6Fig. 7p495-bFig. 8Fig. 9Fig. 10Fig. 11Fig. 12Fig. 13 PMID:4602128

  6. Fat embolism syndrome.

    PubMed

    Taviloglu, Korhan; Yanar, Hakan

    2007-01-01

    Fat embolism syndrome (FES) was first described in 1862, but its frequency today is still unclear. A diagnosis of FES is often missed because of a subclinical illness or coexisting confusing injuries or disease. Fat embolism syndrome develops most commonly after orthopedic injuries, but it has also been reported after other forms of trauma such as severe burns, liver injury, closed-chest cardiac massage, bone marrow transplantation, and liposuction. Although FES usually presents as a multisystem disorder, the most seriously affected organs are the lung, brain, cardiovascular system, and skin. Fat embolism syndrome is a self-limiting disease and treatment should be mainly supportive. Many drugs have been used to treat FES, but the results are inconclusive. PMID:17186337

  7. Fat embolism syndrome

    PubMed Central

    Kwiatt, Michael E.; Seamon, Mark J.

    2013-01-01

    Fat embolism syndrome (FES) is an ill-defined clinical entity that arises from the systemic manifestations of fat emboli within the microcirculation. Embolized fat within capillary beds cause direct tissue damage as well as induce a systemic inflammatory response resulting in pulmonary, cutaneous, neurological, and retinal symptoms. This is most commonly seen following orthopedic trauma; however, patients with many clinical conditions including bone marrow transplant, pancreatitis, and following liposuction. No definitive diagnostic criteria or tests have been developed, making the diagnosis of FES difficult. While treatment for FES is largely supportive, early operative fixation of long bone fractures decreases the likelihood of a patient developing FES. PMID:23724388

  8. Fat embolism after liposuction.

    PubMed

    Ross, R M; Johnson, G W

    1988-06-01

    We present a case of adult respiratory distress syndrome (ARDS) after extensive liposuction. On the basis of fever, tachypnea, hypoxia, and ARDS occurring within 48 hours after surgery without evidence of cardiogenic pulmonary edema or sepsis, the etiology is believed to be fat embolism. Although liposuction is generally an effective and safe procedure, awareness of this life-threatening complication is important in order to institute prompt and appropriate treatment. Fat embolism must be differentiated from thromboembolism, as the treatment is different, and heparin is not indicated. It is recommended that training standards and guidelines be devised in order to reduce morbidity and mortality associated with this procedure. PMID:3371109

  9. Dielectric relaxations of polyether-based polyurethanes containing ionic liquids as antistatic agents.

    PubMed

    Tsurumaki, Akiko; Bertasi, Federico; Vezzù, Keti; Negro, Enrico; Di Noto, Vito; Ohno, Hiroyuki

    2016-01-28

    Dielectric properties of polyurethanes containing poly(propylene oxide) (PO) and poly(ethylene oxide) (EO) units are discussed, along with the results of direct current (DC) measurements and broadband electrical spectroscopy (BES) studies. The dielectric properties of polyether-containing polyurethanes (PUs) are compared to those of PUs containing 1000 ppm of ionic liquids (ILs) as antistatic agents. The effects of the chemical environment of these ILs, including anion-fixed polymers (PU-AF), cation-fixed polymers (PU-CF), and a simple mixture of IL with the PUs (PU-IL), are compared and discussed on the basis of ion mobility. DC measurements suggest that the charge current is attributed not only to the electrode polarization but also to continuous dielectric relaxation. BES studies elucidate that both fast and slow relaxations are taking place in EO-rich domains in pristine PU and PU-AF. The activation energies of the slow relaxation and of the ionic conductivity are similar, suggesting that the ionic conductivity of these materials is attributed to the ion exchange reaction in EO/ion complexes. In contrast, only fast relaxations are observed in the domains mostly comprised of ion-depleted EO in the PUs containing "free" anions, i.e., PU-CF and PU-IL. This suggests that [Tf2N](-) ligands are weakly interacting with the EO chains and contribute effectively to the ion conduction. Thus, enhanced ionic conductivity is observed in PU-CF and PU-IL, yielding sufficient antistatic effects. Taking into account its long shelf life, arising from the lack of IL bleed-out, PU-CF is concluded to be the most promising candidate. PMID:26700822

  10. Determination of anabolic agents in dietary supplements by liquid chromatography-high-resolution mass spectrometry.

    PubMed

    Odoardi, Sara; Castrignanò, Erika; Martello, Simona; Chiarotti, Marcello; Strano-Rossi, Sabina

    2015-01-01

    A sensitive method for the identification and quantification of anabolic steroids and clenbuterol at trace levels in dietary supplements by liquid chromatography-high-resolution mass spectrometry (LC-HRMS) in atmospheric pressure ionisation (APCI) mode using a single-stage Orbitrap analyser operating at a resolution power of 100 000 full width at half maximum (FWHM) was developed and validated. A total of 1 g of dietary supplement was added with testosterone-d3 as internal standard, dissolved in methanol, evaporated to dryness, diluted in sodium hydroxide solution and extracted with a mixture of pentane/ethyl ether 9:1. The extract was directly injected into the LC-HRMS system. The method was fully validated. Limits of detection (LODs) obtained for anabolic androgenic steroids (AASs) varied from 1 to 25 ng g(-1) and the limit of quantitation (LOQ) was 50 ng g(-1) for all analytes. The calibration was linear for all compounds in the range from the LOQ to 2000 ng g(-1), with correlation coefficients always higher than 0.99. Accuracy (intended as %E) and repeatability (%CV) were always lower than 15%. Good values of matrix effect and recovery were achieved. The ease of the sample preparation together with a fast run time of only 16 min permitted rapid identification of the analytes. The method was applied to the analysis of 30 dietary supplements in order to check for the presence of anabolic agents not labelled as being present in these supplements. Many AASs were often detected in the same sample: indeed, androstenedione was detected in nine supplements, 5-androsten-3β-ol-17-one (DHEA) in 12, methandienone in three, stanozolol in one, testosterone in seven and testosterone esters in four of them. A retrospective analysis of suspected compounds not included at the beginning of the method development was also possible by means of the full acquisition spectra obtained with the HRMS technique. PMID:25719897

  11. Looking for the Ideal Particle: An Experimental Embolization Study

    SciTech Connect

    Senturk, Cagin; Cakir, Volkan; Yorukoglu, Kutsal; Yilmaz, Osman; Goktay, A. Yigit

    2010-04-15

    infarction than the other embolic agents. We conclude that EXMs are less efficient due to a high recanalization rate and lesser volume of infarct compared with the other embolic agents in the rabbit kidney model. The most efficient embolization was seen in kidneys embolized with TGMs.

  12. Screening of commercial and pecan shell-extracted liquid smoke agents as natural antimicrobials against foodborne pathogens.

    PubMed

    Van Loo, Ellen J; Babu, D; Crandall, Philip G; Ricke, Steven C

    2012-06-01

    Liquid smoke extracts have traditionally been used as flavoring agents, are known to possess antioxidant properties, and serve as natural alternatives to conventional antimicrobials. The antimicrobial efficacies of commercial liquid smoke samples may vary depending on their source and composition and the methods used to extract and concentrate the smoke. We investigated the MICs of eight commercial liquid smoke samples against Salmonella Enteritidis, Staphylococcus aureus, and Escherichia coli . The commercial liquid smoke samples purchased were supplied by the manufacturer as water-based or concentrated extracts of smoke from different wood sources. The MICs of the commercial smokes to inhibit the growth of foodborne pathogens ranged from 0.5 to 6.0% for E. coli, 0.5 to 8.0% for Salmonella, and 0.38 to 6% for S. aureus. The MIC for each liquid smoke sample was similar in its effect on both E. coli and Salmonella. Solvent-extracted antimicrobials prepared using pecan shells displayed significant differences between their inhibitory concentrations depending on the type of solvent used for extraction. The results indicated that the liquid smoke samples tested in this study could serve as effective natural antimicrobials and that their inhibitory effects depended more on the solvents used for extraction than the wood source. PMID:22691487

  13. Uterine artery embolization

    MedlinePlus

    ... the procedure. UAE is less invasive than surgical treatments for uterine fibroids. Many women may return more quickly to activities ... SC, Spies JB, Worthington-Kirsch R, et al. Uterine artery embolization for ... from the FIBROID registry. Obstet Gynecol . 2008; 111:22-33. Munro ...

  14. Detection of harmful vapors and biological agents by means of liquid crystals

    NASA Astrophysics Data System (ADS)

    Gustafson, Jon; Shibaev, Petr

    2014-03-01

    Orientation of liquid crystals is determined by surface energy and molecular orientation at the surface. This opens a possibility of exploring liquid crystals as gas sensors. In this work the simple model that takes into account gas concentration, absorption rate and material characteristics of liquid crystals (MBBA and pentylcyanobiphenyl) is experimentally tested in order to determine the sensitivity of the method. Thin films and droplets of chiral and non-chiral liquid crystals were used to detect vapors of volatile organic solvents. It was found that sensitivity of the method depends on the chemical nature of gas and structure of liquid crystal. Modification of liquid crystalline composition by means of additions of specifically tailored compounds (for example, hydrogen bonded acids) can lead to significant increase in sensitivity of liquid crystal to harmful vapors. The method was also tested for detection of biological molecules.

  15. Quantitation of five organophosphorus nerve agent metabolites in serum using hydrophilic interaction liquid chromatography and tandem mass spectrometry

    PubMed Central

    Hamelin, Elizabeth I.; Schulze, Nicholas D.; Shaner, Rebecca L.; Coleman, Rebecca M.; Lawrence, Richard J.; Crow, Brian S.; Jakubowski, E. M.; Johnson, Rudolph C.

    2015-01-01

    Although nerve agent use is prohibited, concerns remain for human exposure to nerve agents during decommissioning, research, and warfare. Exposure can be detected through the analysis of the hydrolysis products in urine as well as blood. An analytical method to detect exposure to five nerve agents, including VX, VR (Russian VX), GB (sarin), GD (soman) and GF (cyclosarin), through the analysis of the hydrolysis products, which are the primary metabolites, in serum has been developed and characterized. This method uses solid phase extraction coupled with high performance liquid chromatography for separation and isotopic dilution tandem mass spectrometry for detection. An uncommon buffer of ammonium fluoride was used to enhance ionization and improve sensitivity when coupled with hydrophilic interaction liquid chromatography resulting in detection limits from 0.3–0.5 ng/mL. The assessment of two quality control samples demonstrated high accuracy (101–105%) and high precision (5–8%) for the detection of these five nerve agent hydrolysis products in serum. PMID:24633507

  16. Quantitation of five organophosphorus nerve agent metabolites in serum using hydrophilic interaction liquid chromatography and tandem mass spectrometry.

    PubMed

    Hamelin, Elizabeth I; Schulze, Nicholas D; Shaner, Rebecca L; Coleman, Rebecca M; Lawrence, Richard J; Crow, Brian S; Jakubowski, E M; Johnson, Rudolph C

    2014-08-01

    Although nerve agent use is prohibited, concerns remain for human exposure to nerve agents during decommissioning, research, and warfare. Exposure can be detected through the analysis of hydrolysis products in urine as well as blood. An analytical method to detect exposure to five nerve agents, including VX, VR (Russian VX), GB (sarin), GD (soman), and GF (cyclosarin), through the analysis of the hydrolysis products, which are the primary metabolites, in serum has been developed and characterized. This method uses solid-phase extraction coupled with high-performance liquid chromatography for separation and isotopic dilution tandem mass spectrometry for detection. An uncommon buffer of ammonium fluoride was used to enhance ionization and improve sensitivity when coupled with hydrophilic interaction liquid chromatography resulting in detection limits from 0.3 to 0.5 ng/mL. The assessment of two quality control samples demonstrated high accuracy (101-105%) and high precision (5-8%) for the detection of these five nerve agent hydrolysis products in serum. PMID:24633507

  17. Arterial air embolism

    PubMed Central

    Nicks, Rowan

    1967-01-01

    The incidence and the outcome of systemic air embolism in 340 consecutive patients who underwent cardiac surgery under cardiopulmonary bypass in this unit for congenital defects of the cardiac septa and diseases involving the aortic and mitral valves have been studied. This was thought to have occurred in 40 patients, of whom 10 died. The distribution of air embolism according to the types of operation undertaken was as follows: six of 127 for atrial septal defect; six of 36 for ventricular septal defect; seven of 42 for mitral valve replacement; seven of 47 for aortic valve débridement; and 14 of 55 for aortic valve replacement. The cause was considered to have been systolic ejection of air into the aorta which, following cardiotomy, had been trapped in the pulmonary veins, the left atrium, the ventricular trabeculae, and the aortic root. Since the adoption of a more rigid `debubbling' routine, air embolism has not occurred. The incidence of pulmonary complications occurring in these patients after bypass was studied. Unilateral atelectasis, which occurred in five patients, resulted from retained bronchial secretions in all and was cured by bronchoscopic aspiration in all. The cause of bilateral atelectases, occurring in nine patients and fatal in eight of these, appeared to be related to cardiopulmonary factors and not to air embolism. Acute air injection made into the pulmonary artery of a dog resulted in pulmonary hypertension and a grossly deficient pulmonary circulation, but changes were largely resolved within a week. In view of this, it is considered that pulmonary air embolism may temporarily embarrass the right heart after the repair of a ventricular septal defect in a patient with an elevated pulmonary vascular resistance and diminished pulmonary vascular bed. Images PMID:6035795

  18. Preoperative Embolization of Extra-axial Hypervascular Tumors with Onyx

    PubMed Central

    Fusco, Matthew R.; Salem, Mohamed M.; Reddy, Arra S.; Ogilvy, Christopher S.; Kasper, Ekkehard M.; Thomas, Ajith J.

    2016-01-01

    Objective Preoperative endovascular embolization of intracranial tumors is performed to mitigate anticipated intraoperative blood loss. Although the usage of a wide array of embolic agents, particularly polyvinyl alcohol (PVA), has been described for a variety of tumors, literature detailing the efficacy, safety and complication rates for the usage of Onyx is relatively sparse. Materials and Methods We reviewed our single institutional experience with pre-surgical Onyx embolization of extra-axial tumors to evaluate its efficacy and safety and highlight nuances of individualized cases. Results Five patients underwent pre-surgical Onyx embolization of large or giant extra-axial tumors within 24 hours of surgical resection. Four patients harbored falcine or convexity meningiomas (grade I in 2 patients, grade II in 1 patient and grade III in one patient), and one patient had a grade II hemangiopericytoma. Embolization proceeded uneventfully in all cases and there were no complications. Conclusion This series augments the expanding literature confirming the safety and efficacy of Onyx in the preoperative embolization of extra-axial tumors, underscoring its advantage of being able to attain extensive devascularization via only one supplying pedicle. PMID:27114961

  19. Emergency Transcatheter Arterial Embolization for Acute Renal Hemorrhage

    PubMed Central

    Wang, Hong Liang; Xu, Chun Yang; Wang, Hong Hui; Xu, Wei

    2015-01-01

    Abstract The aims of this study were to identify arteriographic manifestations of acute renal hemorrhage and to evaluate the efficacy of emergency embolization. Emergency renal artery angiography was performed on 83 patients with acute renal hemorrhage. As soon as bleeding arteries were identified, emergency embolization was performed using gelatin sponge, polyvinyl alcohol particles, and coils. The arteriographic presentation and the effect of the treatment for acute renal hemorrhage were analyzed retrospectively. Contrast extravasation was observed in 41 patients. Renal arteriovenous fistulas were found in 12 of the 41 patients. In all, 8 other patients had a renal pseudoaneurysm, 5 had pseudoaneurysm rupture complicated by a renal arteriovenous fistula, and 1 had pseudoaneurysm rupture complicated by a renal artery-calyceal fistula. Another 16 patients had tumor vasculature seen on arteriography. Before the procedure, 35 patients underwent renal artery computed tomography angiography (CTA). Following emergency embolization, complete hemostasis was achieved in 80 patients, although persistent hematuria was present in 3 renal trauma patients and 1 patient who had undergone percutaneous nephrolithotomy (justifying surgical removal of the ipsilateral kidney in this patient). Two-year follow-up revealed an overall effective rate of 95.18 % (79/83) for emergency embolization. There were no serious complications. Emergency embolization is a safe, effective, minimally invasive treatment for renal hemorrhage. Because of the diversified arteriographic presentation of acute renal hemorrhage, proper selection of the embolic agent is a key to successful hemostasis. Preoperative renal CTA plays an important role in diagnosing and localizing the bleeding artery. PMID:26496273

  20. Endovascular Embolization of Brain Arteriovenous Malformations with Eudragit-E

    PubMed Central

    TAMURA, Goichiro; KATO, Noriyuki; YAMAZAKI, Tomosato; AKUTSU, Yoshimitsu; HOSOO, Hisayuki; KASUYA, Hiromichi; SONOBE, Makoto

    2015-01-01

    Eudragit-E was originally developed as a non-adhesive liquid embolic material in the late 1990s and is a copolymer of methyl and butyl methacrylate and dimethylaminoethyl methacrylate that is dissolved in ethanol and iopamidol. This material has been used for endovascular embolization of brain arteriovenous malformations (AVMs) for some time but is currently not widely used. Because safety and feasibility of Eudragit-E has not been well documented, we here report our experience using this material for treating 22 human brain AVMs. From June 1998 to February 2014, 30 endovascular procedures using Eudragit-E were performed to treat 22 patients, including 14 men and 8 women with a mean age of 41.1 years (15–70 years). The mean follow-up period was 56 months (12–129 months), and the Spetzler-Martin grades were I (4 patients), II (9 patients), III (5 patients), and IV (4 patients). Residual AVMs were treated with stereotactic radiosurgery or surgery. The rate of complete obliteration with embolization alone was 27.3%. The overall obliteration rate after endovascular embolization with/without subsequent stereotactic radiosurgery or surgery was 72.7%. Eudragit-E caused two cases of cerebral infarction. One case of intracerebral hemorrhage due to postoperative hemodynamic changes also occurred. The rate of complications directly related to embolization was 10.0%. The safety and effectiveness of Eudragit-E embolization were satisfactory. PMID:25739432

  1. Endovascular embolization of brain arteriovenous malformations with Eudragit-E.

    PubMed

    Tamura, Goichiro; Kato, Noriyuki; Yamazaki, Tomosato; Akutsu, Yoshimitsu; Hosoo, Hisayuki; Kasuya, Hiromichi; Sonobe, Makoto

    2015-01-01

    Eudragit-E was originally developed as a non-adhesive liquid embolic material in the late 1990s and is a copolymer of methyl and butyl methacrylate and dimethylaminoethyl methacrylate that is dissolved in ethanol and iopamidol. This material has been used for endovascular embolization of brain arteriovenous malformations (AVMs) for some time but is currently not widely used. Because safety and feasibility of Eudragit-E has not been well documented, we here report our experience using this material for treating 22 human brain AVMs. From June 1998 to February 2014, 30 endovascular procedures using Eudragit-E were performed to treat 22 patients, including 14 men and 8 women with a mean age of 41.1 years (15-70 years). The mean follow-up period was 56 months (12-129 months), and the Spetzler-Martin grades were I (4 patients), II (9 patients), III (5 patients), and IV (4 patients). Residual AVMs were treated with stereotactic radiosurgery or surgery. The rate of complete obliteration with embolization alone was 27.3%. The overall obliteration rate after endovascular embolization with/without subsequent stereotactic radiosurgery or surgery was 72.7%. Eudragit-E caused two cases of cerebral infarction. One case of intracerebral hemorrhage due to postoperative hemodynamic changes also occurred. The rate of complications directly related to embolization was 10.0%. The safety and effectiveness of Eudragit-E embolization were satisfactory. PMID:25739432

  2. Ethylene-vinyl alcohol copolymer (Onyx®) transarterial embolization for post-traumatic high-flow priapism

    PubMed Central

    Chevallier, Olivier; Gehin, Sophie; Foahom-Kamwa, Alain; Pottecher, Pierre; Favelier, Sylvain

    2016-01-01

    We report a case of high-flow priapism treated successfully with superselective embolization of the cavernous artery. A 16-year-old male developed post-traumatic priapism subsequent to a fall causing blunt perineal trauma. He presented to our hospital four days after trauma. Immediately after the injury, he suffered painless sustained incomplete erection. High-flow priapism was diagnosed on the basis of color doppler ultrasonography findings. Computed tomography scan showed a high-flow arterio-venous fistula with feeders from branches of the right internal iliac artery. Selective arteriography of the right internal pudendal artery demonstrated an arterio-cavernous fistula. The fistula was superselectively embolized with ethylene-vinyl alcohol copolymer (Onyx®) liquid agent and disappeared completely. Improvement was noted, with significant detumescence on table. This was later confirmed on repeat color Doppler imaging. At follow-up 3 months later, he had normal erectile function. To our knowledge, transarterial embolization of high-flow priapism with Onyx® has never been reported and appears to be a safe and effective treatment for managing patients with such a condition. PMID:27429919

  3. Ethylene-vinyl alcohol copolymer (Onyx(®)) transarterial embolization for post-traumatic high-flow priapism.

    PubMed

    Chevallier, Olivier; Gehin, Sophie; Foahom-Kamwa, Alain; Pottecher, Pierre; Favelier, Sylvain; Loffroy, Romaric

    2016-06-01

    We report a case of high-flow priapism treated successfully with superselective embolization of the cavernous artery. A 16-year-old male developed post-traumatic priapism subsequent to a fall causing blunt perineal trauma. He presented to our hospital four days after trauma. Immediately after the injury, he suffered painless sustained incomplete erection. High-flow priapism was diagnosed on the basis of color doppler ultrasonography findings. Computed tomography scan showed a high-flow arterio-venous fistula with feeders from branches of the right internal iliac artery. Selective arteriography of the right internal pudendal artery demonstrated an arterio-cavernous fistula. The fistula was superselectively embolized with ethylene-vinyl alcohol copolymer (Onyx(®)) liquid agent and disappeared completely. Improvement was noted, with significant detumescence on table. This was later confirmed on repeat color Doppler imaging. At follow-up 3 months later, he had normal erectile function. To our knowledge, transarterial embolization of high-flow priapism with Onyx(®) has never been reported and appears to be a safe and effective treatment for managing patients with such a condition. PMID:27429919

  4. An interesting septic embolism

    PubMed Central

    Uluorman, Funda; Tanrıverdi, Zülkif; Sevinç, Can; Badak, Özer; Çatalyürek, Hüdai

    2014-01-01

    Septic pulmonary embolism is a rare disease but mortality and morbidity of it is high. Septic pulmonary emboli comes from infected heart valves, thrombophlebitis, and pulmonary artery catheter or infected pacemaker wires as many sources [1,2]. In recent years, pacemaker is a common treatment of the bradiarrhythmia that is persisted in the etiology of septic embolism, its applications has started to pick up [3]. There is the growing number of patients with pacemaker, according to this the frequency of pacemaker lead infection and the number of patients at risk for right-sided endocarditis increase [4]. The patients don't have specific clinical and radiological features because of this it is very difficult to define, so the diagnosis is often delayed [5]. A detailed medical history, a detailed physical examination in diagnosis and evaluation of good additional imaging methods is very important. Early diagnosis and proper treatment, the implementation of the management, can provide good results. PMID:26029562

  5. Anticoagulant treatment for acute pulmonary embolism: a pathophysiology-based clinical approach.

    PubMed

    Agnelli, Giancarlo; Becattini, Cecilia

    2015-04-01

    The management of patients with acute pulmonary embolism is made challenging by its wide spectrum of clinical presentation and outcome, which is mainly related to patient haemodynamic status and right ventricular overload. Mechanical embolic obstruction and neurohumorally mediated pulmonary vasoconstriction are responsible for right ventricular overload. The pathophysiology of acute pulmonary embolism is the basis for risk stratification of patients as being at high, intermediate and low risk of adverse outcomes. This risk stratification has been advocated to tailor clinical management according to the severity of pulmonary embolism. Anticoagulation is the mainstay of the treatment of acute pulmonary embolism. New direct oral anticoagulants, which are easier to use than conventional anticoagulants, have been compared with conventional anticoagulation in five randomised clinical trials including >11 000 patients with pulmonary embolism. Patients at high risk of pulmonary embolism (those with haemodynamic compromise) were excluded from these studies. Direct oral anticoagulants have been shown to be as effective and at least as safe as conventional anticoagulation in patients with pulmonary embolism without haemodynamic compromise, who are the majority of patients with this disease. Whether these agents are appropriate for the acute-phase treatment of patients at intermediate-high risk pulmonary embolism (those with both right ventricle dysfunction and injury) regardless of any risk stratification remains undefined. PMID:25700388

  6. Preventing, Recognizing, Treating Pulmonary Embolism

    PubMed Central

    Selzer, Arthur

    1965-01-01

    Pulmonary embolism occurs in three forms: (1) Asymptomatic “silent” embolization of lungs; (2) pulmonary infarction; and (3) massive pulmonary embolization leading to acute cor pulmonale. The commonest source of emboli are veins of the lower extremities and of the pelvic organs. The prevention and the treatment of pulmonary embolism overlap, for except for the heroic procedure of pulmonary embolectomy, treatment is equivalent to the prevention of further emboli. The diagnosis may be easy in typical cases and very difficult in others. PMID:14341314

  7. Comparison of three different embolic materials for varicocele embolization: retrospective study of tolerance, radiation and recurrence rate

    PubMed Central

    Favard, Nicolas; Moulin, Morgan; Fauque, Patricia; Bertaut, Aurélie; Favelier, Sylvain; Estivalet, Louis; Michel, Frédéric; Cormier, Luc; Sagot, Paul

    2015-01-01

    Background To evaluate pain, radiation and recurrence rates in patients undergoing varicocele embolization with three different embolic materials. Methods Retrospective study of 182 consecutive patients who underwent transcatheter retrograde varicocele embolization from July 2011 to May 2015 with glue (Glubran®2) (group 1, n=63), mechanical agents (coils and/or plugs) (group 2, n=53) or a sclerosing agent (polidocanol) (group 3, n=66). Patients were asked by telephone interview to evaluate pain during embolization and at 1, 7 and 30 days using a quantitative pain scale ranging from 0 to 10. Duration of scopy, kinetic energy released per unit mass (kerma) and dose area product (DAP) were assessed as radiation parameters during embolization procedures. Recurrence rates after treatment were also evaluated. Statistical analyses were performed using parametric and non-parametric tests. Results Patients in the three study groups were comparable for age, clinical indication and embolization side. No difference was noted for significant pain (pain score ≥3) during embolization and at 1, 7 and 30 days after treatment. Discomfort (pain score <3) was more frequent in group 1 than in groups 2 and 3 at 7 days after the procedure (P=0.049). No difference in discomfort was noted during embolization or at 1 and 30 days. Duration of scopy was shorter (P<0.0001) and kerma was lower (P=0.0087) in group 1 than in groups 2 and 3. DAP was lower in group 1 than in group 2 (P=0.04) but no difference was noted between groups 1 and 3, and groups 2 and 3. The recurrence rate at a mean follow-up of 24.4 months (range, 2-53 months) was significantly lower in group 1 than in the two other groups (P=0.032). Conclusions The use of Glubran®2 acrylic glue for varicocele embolization is safe and leads to less radiation and lower recurrence rates than is the case for other embolic materials without any more significant pain. PMID:26807362

  8. Amniotic fluid embolism

    PubMed Central

    Kaur, Kiranpreet; Bhardwaj, Mamta; Kumar, Prashant; Singhal, Suresh; Singh, Tarandeep; Hooda, Sarla

    2016-01-01

    Amniotic fluid embolism (AFE) is one of the catastrophic complications of pregnancy in which amniotic fluid, fetal cells, hair, or other debris enters into the maternal pulmonary circulation, causing cardiovascular collapse. Etiology largely remains unknown, but may occur in healthy women during labour, during cesarean section, after abnormal vaginal delivery, or during the second trimester of pregnancy. It may also occur up to 48 hours post-delivery. It can also occur during abortion, after abdominal trauma, and during amnio-infusion. The pathophysiology of AFE is not completely understood. Possible historical cause is that any breach of the barrier between maternal blood and amniotic fluid forces the entry of amniotic fluid into the systemic circulation and results in a physical obstruction of the pulmonary circulation. The presenting signs and symptoms of AFE involve many organ systems. Clinical signs and symptoms are acute dyspnea, cough, hypotension, cyanosis, fetal bradycardia, encephalopathy, acute pulmonary hypertension, coagulopathy etc. Besides basic investigations lung scan, serum tryptase levels, serum levels of C3 and C4 complements, zinc coproporphyrin, serum sialyl Tn etc are helpful in establishing the diagnosis. Treatment is mainly supportive, but exchange transfusion, extracorporeal membrane oxygenation, and uterine artery embolization have been tried from time to time. The maternal prognosis after amniotic fluid embolism is very poor though infant survival rate is around 70%. PMID:27275041

  9. Amniotic fluid embolism.

    PubMed

    Clark, Steven L

    2014-02-01

    Amniotic fluid embolism remains one of the most devastating conditions in obstetric practice with an incidence of approximately 1 in 40,000 deliveries and a reported mortality rate ranging from 20% to 60%. The pathophysiology appears to involve an abnormal maternal response to fetal tissue exposure associated with breaches of the maternal-fetal physiologic barrier during parturition. This response and its subsequent injury appear to involve activation of proinflammatory mediators similar to that seen with the classic systemic inflammatory response syndrome. Progress in our understanding of this syndrome continues to be hampered by a lack of universally acknowledged diagnostic criteria, the clinical similarities of this condition to other types of acute critical maternal illness, and the presence of a broad spectrum of disease severity. Clinical series based on population or administrative databases that do not include individual chart review by individuals with expertise in critical care obstetrics are likely to both overestimate the incidence and underestimate the mortality of this condition by the inclusion of women who did not have amniotic fluid embolism. Data regarding the presence of risk factors for amniotic fluid embolism are inconsistent and contradictory; at present, no putative risk factor has been identified that would justify modification of standard obstetric practice to reduce the risk of this condition. Maternal treatment is primarily supportive, whereas prompt delivery of the mother who has sustained cardiopulmonary arrest is critical for improved newborn outcome. PMID:24402585

  10. Amniotic fluid embolism.

    PubMed

    Kaur, Kiranpreet; Bhardwaj, Mamta; Kumar, Prashant; Singhal, Suresh; Singh, Tarandeep; Hooda, Sarla

    2016-01-01

    Amniotic fluid embolism (AFE) is one of the catastrophic complications of pregnancy in which amniotic fluid, fetal cells, hair, or other debris enters into the maternal pulmonary circulation, causing cardiovascular collapse. Etiology largely remains unknown, but may occur in healthy women during labour, during cesarean section, after abnormal vaginal delivery, or during the second trimester of pregnancy. It may also occur up to 48 hours post-delivery. It can also occur during abortion, after abdominal trauma, and during amnio-infusion. The pathophysiology of AFE is not completely understood. Possible historical cause is that any breach of the barrier between maternal blood and amniotic fluid forces the entry of amniotic fluid into the systemic circulation and results in a physical obstruction of the pulmonary circulation. The presenting signs and symptoms of AFE involve many organ systems. Clinical signs and symptoms are acute dyspnea, cough, hypotension, cyanosis, fetal bradycardia, encephalopathy, acute pulmonary hypertension, coagulopathy etc. Besides basic investigations lung scan, serum tryptase levels, serum levels of C3 and C4 complements, zinc coproporphyrin, serum sialyl Tn etc are helpful in establishing the diagnosis. Treatment is mainly supportive, but exchange transfusion, extracorporeal membrane oxygenation, and uterine artery embolization have been tried from time to time. The maternal prognosis after amniotic fluid embolism is very poor though infant survival rate is around 70%. PMID:27275041

  11. Benzyl and Methyl Fatty Hydroxamic Acids Based on Palm Kernel Oil as Chelating Agent for Liquid-Liquid Iron(III) Extraction

    PubMed Central

    Haron, Md Jelas; Jahangirian, Hossein; Silong, Sidik; Yusof, Nor Azah; Kassim, Anuar; Rafiee-Moghaddam, Roshanak; Mahdavi, Behnam; Peyda, Mazyar; Abdollahi, Yadollah; Amin, Jamileh

    2012-01-01

    Liquid-liquid iron(III) extraction was investigated using benzyl fatty hydroxamic acids (BFHAs) and methyl fatty hydroxamic acids (MFHAs) as chelating agents through the formation of iron(III) methyl fatty hydroxamate (Fe-MFHs) or iron(III) benzyl fatty hydroxamate (Fe-BFHs) in the organic phase. The results obtained under optimized conditions, showed that the chelating agents in hexane extract iron(III) at pH 1.9 were realized effectively with a high percentage of extraction (97.2% and 98.1% for MFHAs and BFHAs, respectively). The presence of a large amount of Mg(II), Ni(II), Al(III), Mn(II) and Co(II) ions did affect the iron(III) extraction. Finally stripping studies for recovering iron(III) from organic phase (Fe-MFHs or Fe-BFHs dissolved in hexane) were carried out at various concentrations of HCl, HNO3 and H2SO4. The results showed that the desired acid for recovery of iron(III) was 5 M HCl and quantitative recovery of iron(III) was achieved from Fe(III)-MFHs and Fe(III)-BFHs solutions in hexane containing 5 mg/L of Fe(III). PMID:22408444

  12. Cerebral Lipiodol Embolism after Lymphatic Embolization for Plastic Bronchitis.

    PubMed

    Kirschen, Matthew P; Dori, Yoav; Itkin, Maxim; Licht, Daniel J; Ichord, Rebecca; Vossough, Arastoo

    2016-09-01

    An adolescent with plastic bronchitis due to congenital heart disease had altered mental status after an interventional lymphatic procedure in which lipiodol contrast was used. Neuroimaging revealed cerebral lipiodol embolization due to direct shunting between lymphatic channels and pulmonary veins. Cerebral lipiodol embolization is a potential neurologic morbidity associated with interventional lymphatic procedures. PMID:27297208

  13. Cerebral Lipiodol Embolism after Lymphatic Embolization for Plastic Bronchitis

    PubMed Central

    Kirschen, Matthew P.; Dori, Yoav; Itkin, Maxim; Licht, Daniel J.; Ichord, Rebecca; Vossough, Arastoo

    2016-01-01

    An adolescent with plastic bronchitis due to congenital heart disease had altered mental status after an interventional lymphatic procedure in which lipiodol contrast was used. Neuroimaging revealed cerebral lipiodol embolization due to direct shunting between lymphatic channels and pulmonary veins. Cerebral lipiodol embolization is a potential neurologic morbidity associated with interventional lymphatic procedures. PMID:27297208

  14. Effect of complexing agent on transport of lanthanoid elements across versatic acid liquid membrane

    SciTech Connect

    Nakamura, Shigeto; Ohashi, Sinichi; Akiba, Kenichi )

    1992-06-01

    Transport of several trivalent lanthanoids (La, Nd, Sm, Eu, Tb, Tm, and Lu) was examined across a supported liquid membrane (SLM) containing Versatic 10 (VA10) in kerosene. Lanthanoids in the feed solution can be effectively transported and concentrated into the product solution. Separation factors obtained from the transport rates for lighter lanthanoids were larger than those for heavier lanthanoids, in agreement with the result on the distribution ratios in liquid-liquid extraction. The separation factors for heavier lanthanoids were enhanced by the addition of citrate to the feed solution. The transport rate was controlled by the extraction process from the feed solution to the SLM and the diffusion process of lanthanoid VA10 complexes in SLM.

  15. Traumatic fat embolism syndrome.

    PubMed

    Al-Khuwaitir, Tarig S; Al-Moghairi, Abdurahman M; Sherbeeni, Suphia M; Subh, Hamed M

    2002-12-01

    Traumatic fat embolism syndrome occurs most often following fractures of long bones sustained in road traffic accidents and is a common cause of medical consultation from the orthopedic surgery department. The sub-clinical presentation is subtle and expresses itself by the presence of hypoxemia, while the full clinical syndrome compromises respiratory insufficiency, an altered consciousness and a characteristic petechial rash. Recognition is simple once the patient is viewed in the context of his or her clinical setting. Diagnosis is aided further by the presence of hematological and biochemical abnormalities including anemia, thrombocytopenia, an elevated erythrocyte sedimentation rate and fat macroglobulinemia. Imaging by chest radiograph, computed tomography or magnetic resonance of the brain is used to confirm the extent of the respective organ involvement and to exclude alternative pathologies. The release of free fatty acids into the circulation and their subsequent effects is the key pathological event. Treatment is based on supportive care and high-dose corticosteroid therapy. We report a patient with traumatic fat embolism syndrome who developed the syndromes classical symptoms and signs following fracture of the long bones of his left lower leg. Admission to an intensive care unit, mechanical ventilatory support with positive end-expiratory pressure and corticosteroid therapy lead to his improvement and allowed eventual open reduction and internal fixation and discharge of our patient. Modern therapy offers a relatively good prognosis for patients with traumatic fat embolism syndrome; the optimal dose and timing of corticosteroid therapy in prophylaxis and treatment however, remain the subject of intense debate. PMID:12518208

  16. Ionic Liquids as templating agents in formation of uranium-containing nanomaterials

    DOEpatents

    Visser, Ann E; Bridges, Nicholas J

    2014-06-10

    A method for forming nanoparticles containing uranium oxide is described. The method includes combining a uranium-containing feedstock with an ionic liquid to form a mixture and holding the mixture at an elevated temperature for a period of time to form the product nanoparticles. The method can be carried out at low temperatures, for instance less than about 300.degree. C.

  17. Paradoxical embolism interrupted.

    PubMed

    Desai, Ravi; Ayub, Bilal; Martinez, Matthew W

    2014-02-01

    A 41 year-old African-American male presented with syncope preceded by shortness of breath at outside facility and transferred to us for management of extensive pulmonary embolism with unstable vital signs. Electrocardiogram showed sinus tachycardia with S1Q3T3 pattern. A transthoracic echocardiogram revealed a freely mobile strand like mass in the left atrium. A transoesophageal echocardiogram showed a very large freely mobile thrombus extending from a patent foramen ovale in to the left atrium. He underwent emergent surgery for the extraction of clot followed by thromboembolectomy from both pulmonary arteries. He made a remarkable recovery and was discharged after seven days of hospital stay. PMID:23764146

  18. [Amniotic fluid embolism].

    PubMed

    António, Carlos; Marçal, Nelson; Lopes, Carlos; Tortosa, Francisco; Acevedo, Pilar; Monteiro, Jorge; Monteiro, Filipe; Correia, Llurdes; Brum, Ganriela; De Almeida, A Bugalho

    2011-01-01

    Amniotic fluid embolism (AFE) is a rare pathological syndrome, sometimes fatal that arises as an obstetric complication during vaginal delivery, caesarean, immediate postpartum or during pregnancy. It remains as an important cause of fetal and maternal morbidity and mortality. The authors present a clinical report of a young woman who developed an acute respiratory failure during labour demanding invasive mechanical ventilation and an urgent caesarean. In spite of early medical intensive therapy, hypoxemia was refractory and had a progressive worsening leading to multi-organ failure and ultimately to death. Diagnosis was confirmed through the identification of fetal material in the lumen of maternal pulmonary microcirculation. PMID:22713206

  19. Fat embolism syndrome.

    PubMed

    Williams, A G; Mettler, F A; Christie, J H; Gordon, R E

    1986-07-01

    The fat embolism syndrome is clinically evident in approximately 0.5-2.0% of patients with long bone fractures. The clinical signs and symptoms are evident in 60% of patients within 24 hours and 85% of patients within 48 hours after trauma. A patient is reported who complained of dyspnea and hemoptysis approximately 72 hours after sustaining a fracture to the distal tibia and fibula. Radionuclide ventilation/perfusion imaging was obtained to rule out pulmonary thromboemboli. Perfusion imaging demonstrated the characteristic diffuse, subsegmental ("mottled") appearance of fatty emboli to the lung. PMID:3731649

  20. Unrecognized stent embolization causing recurrent chest pain.

    PubMed

    Levisay, Justin P; Vaitkus, Paul

    2006-01-01

    Numerous methods have been described for retrieving or addressing stents that have embolized in the coronary arteries. Almost all of these prior reports address the "freshly" embolized stent with retrieval or deployment occurring during the same index procedure during which the embolization occurred. We describe a case of a thrombosed, chronically embolized coronary stent. PMID:16404788

  1. [Determination of fluorescent whitening agents in plastic food contact materials by high performance liquid chromatography with fluorescence detector].

    PubMed

    Jiao, Yanna; Ding, Li; Zhu, Shaohua; Fu, Shanliang; Gong, Qiang; Li, Hui; Wang, Libing

    2013-01-01

    A method for the determination of fluorescent whitening agents in plastic food contact materials by high performance liquid chromatography (HPLC) with fluorescence detector was developed. The samples were extracted with trichloromethane by sonication for 30 min at 40 degrees C. The HPLC method was performed on a column of Eclipse XDB-C18 (250 mm x 4.6 mm, 5 microm) by gradient elution using 5 mmol/L ammonium acetate and acetonitrile as the mobile phases, and detected by the fluorescence detector at an excitation wavelength of 350 nm and an emission wavelength of 430 nm. The experimental results indicated that the four fluorescent whitening agents were separated well. The limits of detection (LOD) (S/N = 3) were 0.3, 0.1, 0.05, 0.14 mg/L, and the limits of quantification (LOQ) (S/N = 10) were 1.0, 0.4, 0.2, 0.5 mg/L for 1,4-bis (4-cyanostyryl) benzene (C. I. 199), 1,4-bis (2-benzoxazolyl) naphthalene (C. I. 367), 4,4'-bis(2-methoxystyryl) biphenyl (C. I. 378) and 2,5-thiophenediylbis (5-tert-butyl-1,3-benzoxazole) (C. I. 184), respectively. Good linearities with correlation coefficients (r2) not less than 0.991 were obtained. The proposed method is simple, accurate, sensitive and can meet the requirements of the routine determination of fluorescent whitening agents in entry-exit products. PMID:23667995

  2. Efficacy and Limitations of Transarterial Acrylic Glue Embolization for Intracranial Dural Arteriovenous Fistulas

    PubMed Central

    MIYAMOTO, Naoko; NAITO, Isao; SHIMIZU, Tatsuya; YOSHIMOTO, Yuhei

    2015-01-01

    The efficacy and limitations of transarterial acrylic glue embolization for the treatment of intracranial dural arteriovenous fistulas (DAVFs) were investigated. Thirty-four DAVFs treated by transarterial embolization using n-butyl cyanoacrylate were retrospectively reviewed. The locations of DAVFs were the transverse-sigmoid sinus in 11, tentorium in 10, cranial vault in 9, and superior sagittal sinus, jugular bulb, foramen magnum, and middle cranial fossa in 1 each. Borden classification was type I in 7, type II in 3, and type III in 24. Eight patients had undergone prior transvenous coil embolization. Complete obliteration rate was 56% immediately after embolization, 71% at follow-up angiography, and 85% after additional treatments (1 transvenous embolization and 4 direct surgery). Complications occurred in three patients, consisting of asymptomatic vessel perforations during cannulation in two patients and leakage of contrast medium resulting in medullary infarction in one patient. Transarterial glue embolization is highly effective for Borden type III DAVF with direct cortical venous drainage, but has limitations for Borden type I and II DAVFs in which the affected sinus is part of the normal venous circulation. Onyx is a new liquid embolic material and is becoming the treatment of choice for DAVF. The benefits of glue embolization compared to Onyx embolization are high thrombogenicity, and relatively low risks of cranial nerve palsies and of excessive migration into the draining veins of high flow fistula. Transarterial glue embolization continues to be useful for selected patients, and complete cure can be expected in most patients with fewer complications if combined with transvenous embolization or direct surgery. PMID:25746311

  3. Xanthan Gum-a lyotropic, liquid crystalline polymer and its properties as a suspending agent

    SciTech Connect

    Salamone, J.C.; Clough, S.B.; Jamison, D.E.; Reid, K.I.G.; Salamone, A.B.

    1982-08-01

    Studies a variety of xanthan solutions of various polymer concentrations in the presence and absence of various salts under a polarized light microscope (100X) in order to test xanthan gum for liquid crystalline order. Xanthan gum, a polysaccharide used in drilling fluids and in tertiary recovery, has relatively stable viscosity properties as a function of salt concentration, pH, temperature, and shear degradation. With solutions from 2 to 10% (wt/vol) xanthan gum in distilled water at room temperature, birefringent, ordered domains were observed at 10% concentration, with a decrease in birefringence as the polymer concentration decreased. When the xanthan solution is sheared between a glass slide and a cover slip, the optic axis (chain direction) aligns using the shear direction (as determined by the colors displayed using a first-order red plate). Examines liquid crystalline behavior of other naturally occurring polymers.

  4. [Posttraumatic fat embolism].

    PubMed

    Bouffard, Y; Guillaume, C; Perrot, D; Delafosse, B; Motin, J

    1984-01-01

    Between 1977 and 1982, fifty cases of post-traumatic fat embolism were treated in a general intensive care unit. Average age of patients was 25.5 +/- 13 years; there was no male majority. Mean free interval was 39 +/- 27 h. 12 cases (24%) had single fractures and 38 (76%) multiple fractures. Forty-four patients had a fractured femur. Thirty-two patients presented the complete clinical syndrome with general, respiratory, neurological and cutaneous signs. Thrombocytopaenia and hypocholesterolaemia were the biological signs most often seen. In forty-four patients, orthopaedic treatment consisted of immediate immobilization, usually with traction. Twenty-six patients were reoperated on: intramedullary nail for twenty patients, plate for the other six. Fat embolism appeared in spite of surgery in six cases; it worsened after surgery in six others. Seven patients had per- or postanaesthetic problems. Fourteen per cent of patients died. The decrease in mortality was mainly due to an improvement in mechanical ventilation techniques. Early surgical fixation remained the rule if there was no serious respiratory distress or haemodynamic instability, although it did not seem to change the mortality rate in this group of patients. PMID:6497076

  5. Embolization Materials Made of Gelatin: Comparison Between Gelpart and Gelatin Microspheres

    SciTech Connect

    Ohta, Shinichi Nitta, Norihisa; Sonoda, Akinaga; Seko, Ayumi; Tanaka, Toyohiko; Takazakura, Ryutaro; Furukawa, Akira; Takahashi, Masashi; Sakamoto, Tsutomu; Tabata, Yasuhiko; Murata, Kiyoshi

    2010-02-15

    Purpose:The object of this study was to assess the level of embolization in the embolized artery and the degradation period of these two embolic agents in the renal arteries using rabbit models.Materials and Methods: The renal artery was embolized using 5 mg of gelatin microspheres (GMSs; diameter, 35-100 {mu}m; group 1) or 1 mg of Gelpart (diameter, 1 mm; group 2). For each group, angiographies were performed on two kidneys immediately after the embolic procedure and on days 3, 7, and 14 after embolization. This was followed by histopathological examinations of the kidneys.Results:Follow-up angiograms on each day revealed the persistence of poorly enhanced wedge-shaped areas in the parenchymal phase in all cases. In group 1, four of six cases showed poorly enhanced small areas in the follow-up angiograms. In group 2, all cases showed poorly enhanced large areas. In the histopathological specimens, it was observed that immediately after embolization, the particles reached the interlobular arteries in group 1 and the interlobar arteries in group 2. In all cases in group 1, the particles were histologically identified even on day 14. In one case in group 2 on day 14, the particles were not identified.Conclusion:In conclusion, although GMSs and Gelpart were similar in the point of gelatin particles, the level of embolization and the degradation period were different between GMSs and Gelpart.

  6. The watering of tall trees--embolization and recovery.

    PubMed

    Gouin, Henri

    2015-03-21

    We can propound a thermo-mechanical understanding of the ascent of sap to the top of tall trees thanks to a comparison between experiments associated with the cohesion-tension theory and the disjoining pressure concept for liquid thin-films. When a segment of xylem is tight-filled with crude sap, the liquid pressure can be negative although the pressure in embolized vessels remains positive. Examples are given that illustrate how embolized vessels can be refilled and why the ascent of sap is possible even in the tallest trees avoiding the problem due to cavitation. However, the maximum height of trees is limited by the stability domain of liquid thin-films. PMID:25602527

  7. UV-vis spectrophotometric determination of trinitrotoluene (TNT) with trioctylmethylammonium chloride as ion pair assisted and disperser agent after dispersive liquid-liquid microextraction.

    PubMed

    Larki, Arash; Nasrabadi, Mehdi Rahimi; Pourreza, Nahid

    2015-06-01

    In the present study, a simple, fast and inexpensive method based on dispersive liquid-liquid microextraction (DLLME) prior to microvolume UV-vis spectrophotometry was developed for the preconcentration and determination of trinitrotoluene (TNT). The procedure is based on the color reaction of TNT in alkaline medium and extraction into CCl4 as an ion pair assisted by trioctylmethylammonium chloride, which also acts as a disperser agent. Experimental parameters affecting the DLLME method such as pH, concentration of sodium hydroxide, amount of trioctylmethylammonium chloride, type and volume of extraction solvent were investigated and optimized. Under the optimum conditions, the limit of detection (LOD) was 0.9ng/mL and the calibration curve was linear in the range of 3-200ng/mL. The relative standard deviation for 25 and 100ng/mL of TNT were 3.7% and 1.5% (n=6), respectively. The developed DLLME method was applied for the determination of TNT in different water and soil samples. PMID:25863701

  8. The diagnosis of pulmonary embolism

    PubMed Central

    Talbot, S.; Griffiths, P. D.

    1974-01-01

    A blind assessment of abnormalities of pulmonary scintiscans in patients with pulmonary emboli and other clinical conditions showed that there was no abnormality specific for pulmonary embolism. However, a normal lung scan virtually excluded pulmonary embolism and an area, or areas, of absent perfusion was confirmatory evidence of embolism, without infarction, if the chest radiograph was normal, and of embolism with infarction if the clinical and radiographic findings were compatible. A controlled analysis of biochemical and electrocardiographic abnormalities associated with pulmonary embolism showed that abnormalities of liver function and blood urea were more frequent than in a group of patients suspected of, but not having, emboli. A similar analysis of the electrocardiograms showed that a Q3R3S1 with T wave inversion over the right ventricular leads and lead III (±avf) that developed or regressed was pathognomonic of embolism, but other features were of little value. It is suggested that all hospital patients should have an electrocardiogram performed on admission so that serial changes may be assessed and that lung scanning should be used as a screening test in patients suspected of having pulmonary embolism. PMID:4467868

  9. Therapeutic embolization: enhanced radiolabeled monitoring.

    PubMed

    duCret, R P; Adkins, M C; Hunter, D W; Yedlicka, J W; Engeler, C M; Castaneda-Zuniga, W R; Amplatz, K; Sirr, S A; Boudreau, R J; Kuni, C C

    1990-11-01

    Radiolabeling of Ivalon (polyvinyl alcohol sponge) particles permits localization of injected particles during embolization through the use of a portable gamma camera and provides a means to prevent potentially fatal complications such as pulmonary embolization. A more efficient technique of labeling Ivalon particles with technetium-99m sulfur colloid was developed. An increase in labeling efficiency allowed more accurate determination of the distribution of injected Ivalon particles. Scanning electron microscopy demonstrated the stability of the Ivalon particles during this new labeling process. Two patients with arteriovenous malformations underwent therapeutic embolization with radiolabeled Ivalon particles; gamma camera imaging of the lesion and chest was performed throughout the procedure. PMID:2217800

  10. Amino acids as chiral auxiliaries in cyanuric chloride-based chiral derivatizing agents for enantioseparation by liquid chromatography.

    PubMed

    Batra, Sonika; Bhushan, Ravi

    2014-11-01

    This review summarizes and critically evaluates the recent research on application of amino acids and amino acid amides as chiral auxiliaries in cyanuric chloride (CC) based chiral derivatizing agents (CDRs), used in the indirect approach for enantiomeric resolution. Methods of synthesis of such CDRs, methods for synthesis of diastereomers of a variety of racemic compounds and parameters of liquid chromatographic separation, along with their prospects and their limitations in indirect enantioresolution, are discussed. Application of the said CDR(s) and the technical approach to be used that are discussed should be beneficial for control of enantiomeric purity in pharmaceutical industry, verification of enantiomeric ratio of commercial formulations and the development of methods for indirect resolution of a variety of chiral compounds. Derivatization methods are particularly required when a chromophore is to be introduced in low UV absorbing molecules, for their detection. PMID:25137358

  11. [Determination of antidangdruff agent salicylic acid, zinc pyrithione, octopirox, climbazole and ketoconazole in shampoo by high performance liquid chromatography].

    PubMed

    Yang, Yan-Wei; Zhu, Ying; Su, Xiao-Qing

    2005-09-01

    A high performance liquid chromatography method was established for determination of antidangdruff agent salicylic acid,zinc pyrithione, octopirox, climbazole and ketoconazole in shampoo on a C18 column using acetonitrile-metholaqueous solution (10 mmol/L KH2 PO4 and 5 mmol/L EDTANa2, pH is adjusted to 4.0 with H3 PO4) (50:10:40) as mobile phase at a flow rate of 1.0 ml/min, with the column temperature 25 degrees C and detection wave 230nm. The precision was less than 3.8% and recovery varied from 92.7% to 104.9%. The experimental results showed that the method was simple, precise and accurate. PMID:16329615

  12. A Multiplex PCR-coupled Liquid Bead Array for the Simultaneous Detection of Four Biothreat Agents

    SciTech Connect

    Wilson, W J; Erler, A M; Nasarabadi, S L; Skowronski, E W; McCready, P M

    2004-02-04

    We have developed a 10-plexed PCR assay coupled to a 12-plexed liquid bead array to rapidly screen environmental samples for B. anthracis, Y. pestis, F. tularensis, and B. melitensis. Highly validated species -specific primer sets were used to simultaneously amplify multiple diagnostic regions unique to each individual pathogen. Resolution of the mix of amplified products was achieved by PCR product hybridization to corresponding probe sequences, attached to unique sets of fluorescent beads. The hybridized beads were processed through a flow cytometer, which detected presence and quantity of each PCR product. The assay was optimized to allow for maximum sensitivity in a multiplexed format. A high- throughput demonstration was performed where 384 simulated environmental samples were spiked with different amounts of B. thuringensis spores and pathogen DNA. The samples were robotically processed to extract DNA and arrayed for multiplexed PCR-liquid bead detection. The assay correctly identified the presence or absence of each pathogen and collected over 3,000 individual data points within a single 8-hour shift for approximately $1.20 per sample in a 10-plexed assay.

  13. A high-throughput method to measure the sensitivity of yeast cells to genotoxic agents in liquid cultures.

    PubMed

    Toussaint, Martin; Levasseur, Geneviève; Gervais-Bird, Julien; Wellinger, Raymund J; Elela, Sherif Abou; Conconi, Antonio

    2006-07-14

    The sensitivity of yeast Saccharomyces cerevisiae to DNA damaging agents is better represented when cells are grown in liquid media than on solid plates. However, systematic assessment of several strains that are grown in different conditions is a cumbersome undertaking. We report an assay to determine cell growth based on automatic measurements of optical densities of very small (100 microl) liquid cell cultures. Furthermore, an algorithm was elaborated to analyze large data files obtained from the cell growth curves, which are described by the growth rate--that starts at zero and accelerates to the maximal rate (mu(m))--and by the lag time (lambda). Cell dilution spot test for colony formation on solid media and the growth curve assay were used in parallel to analyze the phenotypes of cells after treatments with three different classes of DNA damaging agents (methyl methanesulfonate, bleomycin, and ultraviolet light). In these experiments the survival of the WT (wild type) and a number of DNA repair-deficient strains were compared. The results show that only the cell growth curve assay could uncover subtle phenotypes when WT cells, or mutant strains that are only weakly affected in DNA repair proficiency, were treated with low doses of cytotoxic compounds. The growth curve assay was also applied to establish whether histone acetyltransferases and deacetylases affect the resistance of yeast cells to UV irradiation. Out of 20 strains tested the sir2delta and rpd3delta cells were found to be more resistant than the WT, while gcn5delta and spt10delta cells were found to be more sensitive. This new protocol is sensitive, provides quantifiable data, offers increased screening capability and speed compared to the colony formation test. PMID:16713735

  14. Three-phase hollow fiber liquid-phase microextraction of organophosphorous nerve agent degradation products from complex samples.

    PubMed

    Desoubries, Charlotte; Chapuis-Hugon, Florence; Bossée, Anne; Pichon, Valérie

    2012-07-01

    Degradation products of chemical warfare agents are considered as important environmental and biological markers of chemical attacks. Alkyl methylphosphonic acids (AMPAs), resulting from the fast hydrolysis of nerve agents, such as sarin and soman, and the methylphosphonic acid (MPA), final degradation product of AMPAs, were determined from complex matrices by using an emergent and miniaturized extraction technique, the hollow fiber liquid-phase microextraction (HF-LPME), before their analysis by liquid chromatography coupled to mass spectrometry (LC-MS). After studying different conditions of separation in the reversed phase LC-MS analysis, the sample treatment method was set up. The three-phase HF-LPME was carried out by using a porous polypropylene (PP) hollow fiber impregnated with 1-octanol that separates the donor and acceptor aqueous media. Various extraction parameters were evaluated such as the volume of the sample, the effect of the pH and the salt addition to the sample, the pH of the acceptor phase, the extraction temperature, the stirring speed of the sample, the immersion time in the organic solvent and the time of extraction. The optimum conditions were applied to the determination of MPA and five AMPAs in real samples, such as surface waters and urine. Compounds were extracted from a 3 mL acidified sample into only 6 μL of alkaline water without any other pretreatment of the complex matrices. Enrichment factors (EFs) higher than 170 were obtained for three less polar AMPAs. Limits of quantification (LOQs) in the 0.013-5.3 ng mL(-1) range were obtained after microextraction of AMPAs from river water and in the range of 0.056-4.8 ng mL(-1) from urine samples with RSD values between 1 and 9%. PMID:22705170

  15. Diagnosis of pulmonary embolism.

    PubMed

    Iber, C; Sirr, S

    1988-09-01

    Pulmonary embolism (PE) is often unrecognized or misdiagnosed because of the lack of specificity of clinical signs and symptoms. PE shares many of the clinical features of pneumonia and is therefore often unrecognized in elderly patients who present with low-grade fever, modest leukocytosis, and pulmonary infiltrates. Assessment of clinical risk factors increases the usefulness of diagnostic tests. The accuracy of diagnosis is improved if specific tests are performed. Ventilation-perfusion lung scans, noninvasive or contrast venography, and pulmonary angiography increase the likelihood of correct diagnosis. Since pulmonary angiography is a relatively low-risk procedure, it should be performed in most patients suspected of having PE who have nondiagnostic lung scans and negative lower extremity venous studies. PMID:3055112

  16. Amniotic fluid embolism.

    PubMed

    Thongrong, Cattleya; Kasemsiri, Pornthep; Hofmann, James P; Bergese, Sergio D; Papadimos, Thomas J; Gracias, Vicente H; Adolph, Michael D; Stawicki, Stanislaw P A

    2013-01-01

    Amniotic fluid embolism (AFE) is an unpredictable and as-of-yet unpreventable complication of maternity. With its low incidence it is unlikely that any given practitioner will be confronted with a case of AFE. However, this rare occurrence carries a high probability of serious sequelae including cardiac arrest, ARDS, coagulopathy with massive hemorrhage, encephalopathy, seizures, and both maternal and infant mortality. In this review the current state of medical knowledge about AFE is outlined including its incidence, risk factors, diagnosis, pathophysiology, and clinical manifestations. Special attention is paid to the modern aggressive supportive care that resulted in an overall reduction in the still alarmingly high mortality rate of this devastating entity. The key factors for successful management and resolution of this disease process continue to be sharp vigilance, a high level of clinical suspicion, and rapid all-out resuscitative efforts on the part of all clinicians involved in the medical care of the parturient. PMID:23724386

  17. [Pulmogenic air embolism].

    PubMed

    Adebahr, G

    1985-01-01

    Interstitial emphysema and pulmonic hemorrhage alone are not the causes of pulmonic air embolism. The conditions making the entrance of air from the lungs to the vessels of pulmonary circulation are obviously present only if the expiration pressure is suddenly strongly elevated. Based on this point of view, investigations were performed in autopsy cases--falls from a height, being run over, a gunshot in the abdomen. We have succeeded in proving the entrance of air into capillaries and branches of the pulmonary vein. The precipitation of thrombocytes at the margin of large air bubbles in pulmonary veins shows the finding of air in the vessels as a vital or supravital reaction. PMID:4090761

  18. Amniotic fluid embolism

    PubMed Central

    Thongrong, Cattleya; Kasemsiri, Pornthep; Hofmann, James P.; Bergese, Sergio D.; Papadimos, Thomas J.; Gracias, Vicente H.; Adolph, Michael D.; Stawicki, Stanislaw P. A.

    2013-01-01

    Amniotic fluid embolism (AFE) is an unpredictable and as-of-yet unpreventable complication of maternity. With its low incidence it is unlikely that any given practitioner will be confronted with a case of AFE. However, this rare occurrence carries a high probability of serious sequelae including cardiac arrest, ARDS, coagulopathy with massive hemorrhage, encephalopathy, seizures, and both maternal and infant mortality. In this review the current state of medical knowledge about AFE is outlined including its incidence, risk factors, diagnosis, pathophysiology, and clinical manifestations. Special attention is paid to the modern aggressive supportive care that resulted in an overall reduction in the still alarmingly high mortality rate of this devastating entity. The key factors for successful management and resolution of this disease process continue to be sharp vigilance, a high level of clinical suspicion, and rapid all-out resuscitative efforts on the part of all clinicians involved in the medical care of the parturient. PMID:23724386

  19. Photo-stimulated electro-optic response of liquid-crystalline system with trans-cis photo-isomerizable agent

    NASA Astrophysics Data System (ADS)

    Hadjichristov, G. B.; Marinov, Y. G.; Yelamaggad, C. V.

    2014-12-01

    A rather strong photo-stimulated enhancement of photo-induced bend flexoelectric effect based on trans-cis photoisomerization of azo bond was found in a guest-host system formed from the nematic liquid crystal (LC) N-(4-methoxybenzylidene)-4-butylaniline (MBBA) as a host, and the azobenzene LC 4-hexyloxybenzoloxy-4'-cyanoazobenzene, as a guest photoactive agent at 1 wt.% concentration. Upon application of electric field, thin homeotropic layers of thickness 100 pm containing this photo-sensitized LC mixture were investigated as subjected to a relatively weak illumination with UV light (λ = 375 nm, from narrow-band light-emitting diode, LED). The stimulation of the photoactive electro-optic response of azobenzene-doped MBBA (owing to enhanced photo-induced bend flexoelectric effect driven by the photo-isomerizable dopants) was achieved by pre-resonant excitation of the photoactive agent. The degree of the effect measured is of potential interest for thin-film photoactive electro-optic applications. The UV light-induced effect in azobenzene-doped MBBA was reversible; the back (relaxation) process was stimulated by light in the blue from a LED with broadband spectrum centered at 455 nm.

  20. Broad-Spectrum Liquid- and Gas-Phase Decontamination of Chemical Warfare Agents by One-Dimensional Heteropolyniobates.

    PubMed

    Guo, Weiwei; Lv, Hongjin; Sullivan, Kevin P; Gordon, Wesley O; Balboa, Alex; Wagner, George W; Musaev, Djamaladdin G; Bacsa, John; Hill, Craig L

    2016-06-20

    A wide range of chemical warfare agents and their simulants are catalytically decontaminated by a new one-dimensional polymeric polyniobate (P-PONb), K12 [Ti2 O2 ][GeNb12 O40 ]⋅19 H2 O (KGeNb) under mild conditions and in the dark. Uniquely, KGeNb facilitates hydrolysis of nerve agents Sarin (GB) and Soman (GD) (and their less reactive simulants, dimethyl methylphosphonate (DMMP)) as well as mustard (HD) in both liquid and gas phases at ambient temperature and in the absence of neutralizing bases or illumination. Three lines of evidence establish that KGeNb removes DMMP, and thus likely GB/GD, by general base catalysis: a) the k(H2 O)/k(D2 O) solvent isotope effect is 1.4; b) the rate law (hydrolysis at the same pH depends on the amount of P-PONb present); and c) hydroxide is far less active against the above simulants at the same pH than the P-PONbs themselves, a critical control experiment. PMID:27061963

  1. Quantification of nerve agent adducts with albumin in rat plasma using liquid chromatography-isotope dilution tandem mass spectrometry.

    PubMed

    Bao, Yi; Liu, Qin; Chen, Jia; Lin, Ying; Wu, Bidong; Xie, Jianwei

    2012-03-16

    A sensitive method for the determination of the organophosphorus nerve agents sarin, soman and VX adducts with tyrosine residue of albumin in rat plasma has been developed and validated using liquid chromatography-isotope dilution tandem mass spectrometry (LC-IDMS/MS). O-(O-Alkyl methylphosphonyl) tyrosine adducts and their deuterated products that were used as the internal standards were synthesised to establish the quantitative isotope-dilution method. Protein purification and solid-phase extraction (SPE) were applied to improve the recovery efficiency, reduce interference and achieve high sensitivity. The method provided a detection limit of 0.01 ng/mL for sarin and soman adducts and 0.05 ng/mL for the VX adduct. The value of the intra-day relative standard deviation over the calibration range was less than 6.16% (n=6), and that of the inter-day was less than 12.7% (n=6). The recovery varied from 86% to 111%. This sensitive method was successfully applied to the analysis of adducts in rat plasma after nerve agent exposure, and the results demonstrated the dose-effect relationships. PMID:22305360

  2. Amniotic fluid embolism: review.

    PubMed

    Pantaleo, Greco; Luigi, Nappi; Federica, Trezza; Paola, Storelli; Margherita, Neri; Tahir, Mahmood

    2014-01-01

    Amniotic fluid embolism is a rare but dreadful syndrome in Obstetrics, which happens, in most of the cases, in the peripartum period. The actual "embolisation" of the pulmonary vessels does not explain the whole picture of the syndrome. An immune mechanism, similar to an anaphylactic reaction, is more convincingly the background of the event, but the pathogenesis is still ill-defined. Similarly the initial symptoms are difficult to interpret and distinguish from other acute and life-threatening emergencies (i.e. pulmonary embolism, placental abruption, septic shock, stroke, myocardial ischemia, etc.), therefore the diagnosis is one of exclusion, very often on postmortem report. Thus the prevalence of the disease is difficult to establish, most of the reports being postmortem cases or National Registries data. These data, based either on autopsy series or on registries, are non representative of the true prevalence of the event and obviously confusing for the correct understanding of the disease process. Risk factors are all those conditions or manouvres, which contemplate a breech in the maternal-fetal barrier. Again, given the rarity of the syndrome, no single event is clearly identifiable as a case-effect risk factor. Prognosis, which is obviously biased by the reporting system, is particularly grim both in terms of survival and morbidity. The symptoms being often elusive at the beginning, but rapidly and progressively catastrophic, a multidisciplinary team approach is warranted in order to provide the best chance of survival both for mother and baby. Immediate and aggressive resuscitation is, therefore, advised whenever a mother in labour or in the early postpartum period experiences a sudden collapse. PMID:24804726

  3. Periprocedural Bleeding Complications of Brain AVM Embolization with Onyx

    PubMed Central

    Liu, L.; Jiang, C.; He, H.; Li, Y.; Wu, Z.

    2010-01-01

    Summary The advent of Onyx has provided a new method for neurointerventional therapists to treat brain AVMs. Although some retrospective studies have reported complications for AVM embolization with Onyx, periprocedural bleeding complications with Onyx embolization have not yet been described in detail. The aim of this retrospective study was to analyze the factors of Onyx-related bleeding complications and to find a way to avoid and manage these complications. From January 2003, patients with AVMs recruited in our institution started to be treated by Onyx embolization. From January 2007 to July 2009, 143 consecutive interventions were performed in 126 patients using flow-independent microcatheters and Onyx as embolic agents. Seven patients encountered bleeding complications (5.4% per patients and 4.7% per procedures) during or after the endovascular procedures. Among them, five bleeding episodes occurred during procedures, the other two after procedures. Details of the seven patients' clinical presentations, imaging presentations, speculative reasons and management of these complications were recorded. Follow-up data, including postoperative course, clinical symptoms and duration of follow-up were documented. The five active bleedings discovered in procedures were managed in time, and the patients recovered without any new neurological symptoms compared with preoperation. However, of the two bleeding episodes that occurred after interventional procedures, one was detected half an hour later: the patient was remained comatose two months later after resection of right occipital hematoma; the other who encountered intraventricular and midbrain hemorrhage was treated conservatively and suffered Parinaud syndrome and hemianesthesia. Conclusion: Periprocedural bleeding of AVMs embolization is considered a severe and devastating complication. The clinical course and prognosis of bleeding mostly depends on prompt detection and management. Interventional embolization is an

  4. Crisis management during anaesthesia: embolism

    PubMed Central

    Williamson, J; Helps, S; Westhorpe, R; Mackay, P

    2005-01-01

    Background: Embolism with gas, thrombus, fat, amniotic fluid, or particulate matter may occur suddenly and unexpectedly during anaesthesia, posing a diagnostic and management problem for the anaesthetist. Objectives: To examine the role of a previously described core algorithm "COVER ABCD–A SWIFT CHECK" supplemented by a specific sub-algorithm for embolism, in the management of embolism occurring in association with anaesthesia. Methods: The potential performance of this structured approach for each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved. Results: Among the first 4000 incidents reported to AIMS, 38 reports of embolism were found. A sudden fall in end-tidal carbon dioxide and oxygen saturation were the cardinal signs of embolism, each occurring in about two thirds of cases, with hypotension and electrocardiographic changes each occurring in about one third of cases. Conclusion: The potential value of an explicit structured approach to the diagnosis and management of embolism was assessed in the light of AIMS reports. It was considered that, correctly applied, it potentially would have led to earlier recognition of the problem and/or better management in over 40% of cases. PMID:15933290

  5. Experimental research of Fuaile medical adhesive for portal vein embolization in white rabbit models

    PubMed Central

    JIANG, TIANPENG; WANG, LIZHOU; LI, XING; SONG, JIE; WU, XIAOPING; AN, TIANZHI; ZHOU, SHI

    2015-01-01

    The aim of the present study was to investigate the feasibility and efficacy of Fuaile medical adhesive for portal vein embolization in the treatment of a rabbit model. This study used 26 white rabbits, 14 of which were selected and assigned into seven groups (n=2) for the preliminary experiment. Fuaile medical adhesive was mixed with lipiodol at different ratios of 1:0, 1:1, 1:2, 1:3, 1:4, 1:5 and 0:1, respectively, and administered via the portal trunk. The remaining 12 white rabbits were randomly divided into two groups (n=6). The evaluation of the results included the degree of adhesion to the vessels, the extent of embolization and the reaction of the rabbit. Hepatic and renal functions were detected prior to and at 1, 7 and 14 days post-embolization, respectively. Angiography, CT scans and pathological examinations were conducted at post-embolization. Histological examinations revealed that the topical swollen lesions were darker. Light microscopy showed embolic agents in the portal venous blood vessels and the formation of a secondary thrombus. Hepatic necrosis appeared surrounding the embolization area. Inflammatory cell infiltration of different degrees occurred in the early stage and inflammatory fibroplasia occurred in the late stage. Alanine aminotransferase and aspartate aminotransferase levels increased at 1 day post-embolization, peaked at 7 days and was in the normal range at 14 days. The levels of blood urea nitrogen and ceruloplasmin were elevated at 1 day post-embolization and lowered to normal at 7 days. Fuaile medical adhesive is an effective, safe and inexpensive agent, used for effectively inducing embolization in the portal trunk, and the first and second branches of rabbit portal veins. The use of Fuaile therefore merits widespread application in clinical practice. PMID:26137115

  6. A Preclinical Study of the Safety and Efficacy of Occlusin Trade-Mark-Sign 500 Artificial Embolization Device in Sheep

    SciTech Connect

    Owen, Richard J.; Nation, Patrick N.; Polakowski, Robert; Biliske, Jennifer A.; Tiege, Paul B.

    2012-06-15

    Introduction: This study evaluated the safety, effectiveness, and biodegradation of a new embolic agent, Occlusin Trade-Mark-Sign 503 Artificial Embolization Device (OCL 503). The agent consists of biodegradable poly-lactic-co-glycolic acid microspheres (150-212 {mu}m) coated with type I bovine collagen and was compared with Embosphere{sup Registered-Sign} Microspheres (300-500 {mu}m) in this controlled study of uterine artery embolization (UAE) in sheep. Methods: Unilateral UAE was performed in 32 adult ewes randomly assigned. Vessels were embolized to effective stasis. The cohort was divided into four groups, which were sacrificed at 1, 3, 6, and 12 months. Results: Both agents were 100% effective in achieving stasis. At 6 months, all OCL 503-treated arteries were occluded, the microspheres degraded with time, and at 12 months all four animals examined demonstrated recanalization. OCL 503 was found in the untreated uterine artery in one animal with no other evidence of non target embolization. In the Embosphere-treated group, all vessels remained occluded and microspheres were detected in the contralateral uterine artery in 6 of 15 examined vessels and in 10 vaginal, 2 ovarian, and 1 vesical artery. No procedural-related complications were seen in either group. Conclusions: OCL 503 is as effective an embolic agent as Embosphere{sup Registered-Sign} Microspheres when embolizing ovine uterine arteries and resorbs with time, allowing recanalization of the treated arteries. No device-related issues or adverse events were observed.

  7. Current Evidence on Uterine Embolization for Fibroids

    PubMed Central

    Spies, James B.

    2013-01-01

    Strong evidence for both safety and effectiveness of uterine fibroid embolization has been generated since the procedure's introduction. This review will focus on the key articles representing the best evidence to summarize the outcomes from uterine embolization. This review will attempt to answer three important questions associated with uterine embolization. First, does uterine embolization relieve symptoms caused by uterine fibroids? Second, how well does the improvement in symptoms and quality of life after uterine embolization compare with standard surgical options for fibroids? Finally, how durable is the improvement in fibroid-related symptoms and quality of life after embolization? PMID:24436560

  8. Agent-based models for latent liquidity and concave price impact.

    PubMed

    Mastromatteo, Iacopo; Tóth, Bence; Bouchaud, Jean-Philippe

    2014-04-01

    We revisit the "ɛ-intelligence" model of Tóth et al. [Phys. Rev. X 1, 021006 (2011)], which was proposed as a minimal framework to understand the square-root dependence of the impact of meta-orders on volume in financial markets. The basic idea is that most of the daily liquidity is "latent" and furthermore vanishes linearly around the current price, as a consequence of the diffusion of the price itself. However, the numerical implementation of Tóth et al. (2011) was criticized as being unrealistic, in particular because all the "intelligence" was conferred to market orders, while limit orders were passive and random. In this work, we study various alternative specifications of the model, for example, allowing limit orders to react to the order flow or changing the execution protocols. By and large, our study lends strong support to the idea that the square-root impact law is a very generic and robust property that requires very few ingredients to be valid. We also show that the transition from superdiffusion to subdiffusion reported in Tóth et al. (2011) is in fact a crossover but that the original model can be slightly altered in order to give rise to a genuine phase transition, which is of interest on its own. We finally propose a general theoretical framework to understand how a nonlinear impact may appear even in the limit where the bias in the order flow is vanishingly small. PMID:24827291

  9. Agent-based models for latent liquidity and concave price impact

    NASA Astrophysics Data System (ADS)

    Mastromatteo, Iacopo; Tóth, Bence; Bouchaud, Jean-Philippe

    2014-04-01

    We revisit the "ɛ-intelligence" model of Tóth et al. [Phys. Rev. X 1, 021006 (2011), 10.1103/PhysRevX.1.021006], which was proposed as a minimal framework to understand the square-root dependence of the impact of meta-orders on volume in financial markets. The basic idea is that most of the daily liquidity is "latent" and furthermore vanishes linearly around the current price, as a consequence of the diffusion of the price itself. However, the numerical implementation of Tóth et al. (2011) was criticized as being unrealistic, in particular because all the "intelligence" was conferred to market orders, while limit orders were passive and random. In this work, we study various alternative specifications of the model, for example, allowing limit orders to react to the order flow or changing the execution protocols. By and large, our study lends strong support to the idea that the square-root impact law is a very generic and robust property that requires very few ingredients to be valid. We also show that the transition from superdiffusion to subdiffusion reported in Tóth et al. (2011) is in fact a crossover but that the original model can be slightly altered in order to give rise to a genuine phase transition, which is of interest on its own. We finally propose a general theoretical framework to understand how a nonlinear impact may appear even in the limit where the bias in the order flow is vanishingly small.

  10. Embolization of Life-Threatening Arterial Rupture in Patients with Vascular Ehlers–Danlos Syndrome

    SciTech Connect

    Okada, Takuya; Frank, Michael; Pellerin, Olivier Primio, Massimiliano Di Angelopoulos, Georgios; Boughenou, Marie-Fazia; Pagny, Jean-Yves; Messas, Emmanuel; Sapoval, Marc

    2013-05-09

    PurposeTo evaluate the safety and efficacy of transarterial embolization of life-threatening arterial rupture in patients with vascular Ehlers–Danlos syndrome (vEDS) in a single tertiary referral center.MethodsWe retrospectively analyzed transarterial embolization for vEDS performed at our institution from 2000 to 2012. The indication of embolization was spontaneous arterial rupture or pseudoaneurysm with acute bleeding. All interventions used a percutaneous approach through a 5F or less introducer sheath. Embolic agents were microcoils and glue in 3 procedures, glue alone in 2, and microcoils alone in 2.ResultsFive consecutive vEDS patients were treated by 7 embolization procedures (4 women, mean age 29.8 years). All procedures were successfully performed. Two patients required a second procedure for newly arterial lesions at a different site from the first procedure. Four of the five patients were still alive after a mean follow-up of 19.4 (range 1–74.7) months. One patient died of multiple organ failure 2 days after procedure. Minor procedural complications were observed in 3 procedures (43 %), all directly managed during the same session. Remote arterial lesions occurred after 3 procedures (43 %); one underwent a second embolization, and the other 2 were observed conservatively. Puncture site complication was observed in only one procedure (14 %).ConclusionEmbolization for vEDS is a safe and effective method to manage life-threatening arterial rupture.

  11. Treatment of pulmonary embolism.

    PubMed

    Décousus, Hervé; Mismetti, Patrick; Couturaud, Francis; Ageno, Walter; Bauersachs, Rupert

    2015-12-01

    The treatment of pulmonary embolism is going to be deeply modified by the development of Direct Oral Anticoagulants (DOACs). There are currently three anti-Xa factors (rivaroxaban, apixaban, edoxaban) and one anti-IIa factor (dabigatran) labeled by the FDA and the EMA. All these drugs are direct anticoagulant, orally effective, without the need for adaptation to hemostasis test. As kidney excretion is involved for all of them, they are contra-indicated in patients with severe renal failure (creatinine clearance < 30 mL/min according to Cockcroft & Gault formula). All the anti-Xa factor drugs are metabolized by liver cytochromes and then contra-indicated in case of liver insufficiency. Of note, the four DOACS have been evaluated in non-inferiority trials, including one open-label trial (the EINSTEIN program with the rivaroxaban). Moreover, two of them (rivaroxaban and apixaban) were evaluated in a single drug approach (provided initial increased doses: 15 mg bid during 21 days for rivaroxaban and 10 mg bid during 7 days for apixaban) whereas the two others (edoxaban and dabigatran) were evaluated after at least 5 days of parenteral heparin. They were found to be non-inferior to the conventional treatment, but also seem to be associated with a decreased risk of major bleeding, in a quite young and without significant comorbidities population. The risk/benefit ratio of DOACs in specific subgroups deserves prospective validations. PMID:26547678

  12. Submassive pulmonary embolism.

    PubMed

    Piazza, Gregory

    2013-01-01

    The US Surgeon General estimates that 100,000 to 180,000 deaths occur annually from acute pulmonary embolism (PE) in the United States. The case of Ms A, a 60-year-old woman with acute PE and right ventricular dysfunction (submassive PE), illustrates the clinical challenge of identifying this high-risk patient population and determining when more aggressive immediate therapy should be pursued in addition to standard anticoagulation. The clinical examination, electrocardiogram, cardiac biomarkers, chest computed tomography, and echocardiography can be used to risk stratify patients with acute PE. Current options for more aggressive intervention in the treatment of patients with acute PE who are at increased risk of an adverse clinical course include systemic fibrinolysis, pharmacomechanical catheter-directed therapy, surgical pulmonary embolectomy, and inferior vena cava filter insertion. Determination of the optimal duration of anticoagulation and lifestyle modification to reduce overall cardiovascular risk are critical components of the long-term therapy of patients with acute PE. PMID:23299609

  13. Reflex Anuria After Renal Tumor Embolization

    SciTech Connect

    Kervancioglu, Selim Sirikci, Akif; Erbagci, Ahmet

    2007-04-15

    We report a case of reflex anuria after transarterial embolization of a renal tumor. Anuria developed immediately after embolization and resolved 74 hr following the procedure. We postulate that reflux anuria in our case was related to mechanoreceptors, chemoreceptors, or both, as these are stimulated by the occluded blood vessels, ischemia, and edema of the normal renal tissue of an embolized kidney.

  14. Indications for embolization in a French level 1 trauma center.

    PubMed

    Frandon, J; Arvieux, C; Thony, F

    2016-08-01

    Abdominal trauma accounts for nearly 20% of all traumatic injuries. It often involves young patients sustaining multiple injuries, with a high associated mortality rate. Management should begin at the scene of injury and relies on a structured chain of care in order to transport the trauma patient to the appropriate hospital center. Management is multi-disciplinary, involving intensive care specialists, surgeons and radiologists. Imaging to precisely define injury is best performed with whole body dual phase computed tomography, which can also identify the source of bleeding. Non-operative management has developed considerably over the years: this includes selective embolization in case of active bleeding or vascular anomalies in stable or stabilized patients after resuscitation. Embolization has become one of the corner stones of abdominal trauma management and interventional radiologists must play an active role on the trauma team. This overview details the different embolization procedures according to the involved organ and embolic agent used. PMID:27374109

  15. Pulmonary Embolism Following Outpatient Vasectomy

    PubMed Central

    Mott, Frank E.; Farooqi, Bilal; Moore, Harry

    2016-01-01

    Venous thromboembolic events have several known major risk factors such as prolonged immobilization or major surgery. Pulmonary embolism has rarely been reported after an outpatient vasectomy was completed. We present the rare case of a healthy 32-year-old Caucasian male with no known risk factors who presented with pleuritic chest pain 26 days after his outpatient vasectomy was performed. Subsequently, he was found to have a pulmonary embolism as per radiological imaging. We explore the association between outpatient vasectomies and venous thromboembolic events. A review of the literature is also included. PMID:26989373

  16. Pulmonary Embolism Following Outpatient Vasectomy.

    PubMed

    Mott, Frank E; Farooqi, Bilal; Moore, Harry

    2016-02-01

    Venous thromboembolic events have several known major risk factors such as prolonged immobilization or major surgery. Pulmonary embolism has rarely been reported after an outpatient vasectomy was completed. We present the rare case of a healthy 32-year-old Caucasian male with no known risk factors who presented with pleuritic chest pain 26 days after his outpatient vasectomy was performed. Subsequently, he was found to have a pulmonary embolism as per radiological imaging. We explore the association between outpatient vasectomies and venous thromboembolic events. A review of the literature is also included. PMID:26989373

  17. Portal Vein Embolization Using a Nitinol Plug (Amplatzer Vascular Plug) in Combination with Histoacryl Glue and Iodinized Oil: Adequate Hypertrophy with a Reduced Risk of Nontarget Embolization

    SciTech Connect

    Bent, Clare L. Low, Deborah; Matson, Matthew B.; Renfrew, Ian; Fotheringham, Tim

    2009-05-15

    The purpose of this study was to assess whether portal vein embolization (PVE) using a nitinol vascular plug in combination with histoacryl glue and iodinized oil minimizes the risk of nontarget embolization while obtaining good levels of future liver remnant (FLR) hypertrophy. Between November 2005 and August 2008, 16 patients (8 females, 8 males; mean age, 63 {+-} 3.6 years), each with a small FLR, underwent right ipsilateral transhepatic PVE prior to major hepatectomy. Proximal PVE was initially performed by placement of a nitinol vascular plug, followed by distal embolization using a mixture of histoacryl glue and iodinized oil. Pre- and 6 weeks postprocedural FLR volumes were calculated using computed tomographic imaging. Selection for surgery required an FLR of 0.5% of the patient's body mass. Clinical course and outcome of surgical resection for all patients were recorded. At surgery, the ease of hepatectomy was subjectively assessed in comparison to previous experience following PVE with alternative embolic agents. PVE was successful in all patients. Mean procedure time was 30.4 {+-} 2.5 min. Mean absolute increase in FLR volume was 68.9% {+-} 12.0% (p = 0.00005). There was no evidence of nontarget embolization during the procedure or on subsequent imaging. Nine patients proceeded to extended hepatectomy. Six patients demonstrated disease progression. One patient did not achieve sufficient hypertrophy in relation to body mass to undergo hepatic resection. At surgery, the hepatobiliary surgeons observed less periportal inflammation compared to previous experience with alternative embolic agents, facilitating dissection at extended hepatectomy. In conclusion, ipsilateral transhepatic PVE using a single nitinol plug in combination with histoacryl glue and iodinized oil simplifies the procedure, offering short procedural times with minimal risk of nontarget embolization. Excellent levels of FLR hypertrophy are achieved enabling safe extended hepatectomy.

  18. Splenic artery embolization with Ankaferd blood stopper in a sheep model

    PubMed Central

    Koç, Osman; Acar, Kadir; Özbek, Orhan; Güler, İbrahim; Sarıtaş, Kadir; Erdem, Tuba Bera; Solak, Yalçın; Toy, Hatice; Küçükapan, Ahmet; Özbek, Seda; Gaipov, Abduzhappar; Haznedaroğlu, İbrahim C.

    2016-01-01

    PURPOSE Splenic artery embolization is a minimally invasive therapeutic procedure utilized in a number of disorders. Ankaferd blood stopper (ABS) is a novel hemostatic agent with a new mechanism of action independent of clotting factors. We aimed to investigate the safety and efficiency of ABS for splenic artery embolization in a sheep model. METHODS Seven adult female sheep were included in the study. Selective celiac angiography was performed using a 5F diagnostic catheter and then a 2.7F hydrophilic coating microcatheter was advanced coaxially to the distal part of the main splenic artery. Under fluoroscopic guidance, 6 mL mixture composed of half-and-half ABS and contrast agent was slowly injected. Fluoroscopy was used to observe the deceleration and stagnation of the flow. Control celiac angiograms were obtained immediately after the embolization. After the procedure, the animals were observed for one day and then sacrificed with intravenous sodium thiopental. RESULTS Technical success rate was 100%. None of the animals died or experienced a major systemic adverse event during the procedure. All of the spleens appeared dark on macroscopic examination due to excessive thrombosis. Microscopically, the majority of the splenic sinusoids (90%–95%) were necrotic. CONCLUSION In our study, splenic artery embolization by ABS was found to be safe and effective in the shortterm. Further studies are needed to better understand the embolizing potential of this novel hemostatic agent. PMID:27306661

  19. [Morphological diagnostics of fat embolism].

    PubMed

    Dorosevich, A E; Dmitriev, I V

    2016-01-01

    The present review of the literature concerns the problem of morphological diagnostics of fat embolism, i.e. mechanical obturation of multiple blood vessels with fat globules, that can be detected by a variety of methods including polarization microscopy, staining of native, frozen, and paraffin-embedded histological sections with the use of immunohistochemical techniques, electron microscopy, etc. PMID:27144263

  20. [Cyanoacrylate pulmonary embolism after embolization of a cerebral arteriovenous malformation. Report of one case].

    PubMed

    Fernández, Patricia; Loayza, Patricio; Sabbagh, Eduardo; Badilla, Lautaro; Rojas, David; Verschae, Gregorio; Milet, Beatriz

    2004-04-01

    Arterial embolization with cyanoacrylate is commonly used for the treatment of arteriovenous malformations. We report the case of a 40 years old man who four days after an embolization with cyanoacrylate, begins with cough, bloody sputum, and right hemithorax pleuritic pain. Pulmonary embolism was confirmed with chest X ray, CT scan and scyntigraphy. The patient received anticoagulation, with adequate response. The most common complications of cerebral embolization are related to central nervous system and pulmonary embolism is exceptional. Considering the high number of embolization procedures done nowadays, this complication must be borne in mind. PMID:15382522

  1. Simultaneous Measurement of Serum Chemical Castration Agents and Testosterone Levels Using Ultra-Performance Liquid Chromatography-Tandem Mass Spectrometry.

    PubMed

    Ko, Dae-Hyun; Lee, Kyunghoon; Jeon, Sun-Hee; Song, Sang Hoon; Yun, Yeo-Min; Chun, Sail; Kim, Hee Seung; Kim, Jin Young; In, Moon Kyo; Song, Junghan

    2016-05-01

    Chemical castration involves administration of drugs to prevent pathological sexual behavior, reduce abnormal sexual drive and treat hormone-dependent cancers. Various drugs have been used for chemical castration; however, substantial interindividual variability and side effects are often observed. In this study, we proposed a useful monitoring method for the application of chemical castration agents using ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS-MS). Testosterone, cyproterone acetate, medroxyprogesterone, goserelin acetate, leuprolide acetate and triptorelin acetate were analyzed by UPLC-MS-MS. The target drugs were extracted from serum samples by double protein precipitation using methanol. Testosterone-1,2-d2 and buserelin acetate were used as internal standards. Parameters of analytical performance were evaluated, including imprecision, linearity, ion suppression and detection capabilities. Testosterone measurements were compared with the results of immunoassays. Serum specimens from 51 subjects who underwent chemical castration were analyzed. All drugs and testosterone were well extracted and separated using our method. The method was essentially free from potential interferences and ion suppression. Within-run and between-run imprecision values were <15%. The lower limits of quantification were 0.125 and 0.5-1.0 ng/mL for testosterone and other drugs, respectively. Good correlations with pre-existing immunoassays for testosterone measurement were observed. Sera from subjects who underwent androgen deprivation therapy showed variable levels of drugs. We successfully developed a UPLC-MS-MS-based monitoring method for chemical castration. The performance of our method was generally acceptable. This method may provide a novel monitoring strategy for chemical castration to enhance expected effects while reducing unwanted side effects. PMID:26989223

  2. Targeted Delivery of Chemotherapeutic Agents Using Improved Radiosensitive Liquid Core Microcapsules and Assessment of Their Antitumor Effect

    SciTech Connect

    Harada, Satoshi Ehara, Shigeru; Ishii, Keizo; Yamazaki, Hiromichi; Matsuyama, Shigeo; Sato, Takahiro; Oikawa, Shyoichi; Kamiya, Tomihiro; Arakawa, Kazuo; Yokota, Wataru; Sera, Koichiro; Ito, Jyun

    2009-10-01

    Purpose: Radiation-sensitive microcapsules composed of alginate and hyaluronic acid are being developed. We report the development of improved microcapsules that were prepared using calcium- and yttrium-induced polymerization. We previously reported on the combined antitumor effect of carboplatin-containing microcapsules and radiotherapy. Methods and Materials: We mixed a 0.1% (wt/vol) solution of hyaluronic acid with a 0.2% alginate solution. Carboplatin (l mg) and indocyanine green (12.5 {mu}g) were added to this mixture, and the resultant material was used for capsule preparation. The capsules were prepared by spraying the material into a mixture containing a 4.34% CaCl{sub 2} solution supplemented with 0-0.01% yttrium. These capsules were irradiated with single doses of 0.5, 1.0, 1.5, or 2 Gy {sup 60}Co {gamma}-rays. Immediately after irradiation, the frequency of microcapsule decomposition was determined using a microparticle-induced X-ray emission camera. The amount of core content released was estimated by particle-induced X-ray emission and colorimetric analysis with 0.25% indocyanine green. The antitumor effect of the combined therapy was determined by monitoring its effects on the diameter of an inoculated Meth A fibrosarcoma. Results: Microcapsules that had been polymerized using a 4.34% CaCl{sub 2} solution supplemented with 5.0 x 10{sup -3}% (10{sup -3}% meant or 10%{sup -3}) yttrium exhibited the maximal decomposition, and the optimal release of core content occurred after 2-Gy irradiation. The microcapsules exhibited a synergistic antitumor effect combined with 2-Gy irradiation and were associated with reduced adverse effects. Conclusion: The results of our study have shown that our liquid core microcapsules can be used in radiotherapy for targeted delivery of chemotherapeutic agents.

  3. Determination of detergent-derived fluorescent whitening agent isomers in lake sediments and surface waters by liquid chromatography.

    PubMed

    Stoll, J M; Giger, W

    1997-07-01

    A method for the quantitative determination of three different fluorescent whitening agents (FWAs) in lake sediments and surface waters is described. Stereoisomers of the two main laundry detergent FWAs of the diaminostilbene type (DAS 1) and of the distyrylbiphenyl type (DSBP), as well as total BLS (a compound contained in detergents until a few years ago), were quantitated in sediments and water from Greifensee, a small lake in Switzerland. The freeze-dried sediments were extracted in an ultrasonic bath using methanol with tetrabutylammonium hydrogen sulfate as an ion-pairing reagent. Aqueous samples were extracted with C18 extraction disks, which were subsequently eluted by methanol with tetrabutylammonium hydrogen sulfate. Both extracts from solid and aqueous samples were analyzed by reversed-phase high-performance liquid chromatography. Fluorescence detection was applied after postcolumn UV irradiation. Analytical reproducibility ranged from 1 to 12% (relative standard deviation). Limits of quantitation were 1-11 μg/kg of dry matter and 0.2-3 ng/L for solid and aqueous samples, respectively. Recoveries ranged from 93 to 100% and from 87 to 95% in solid and aqueous samples, respectively. Concentrations of DAS 1 and DSBP ranged from 0.4 to 1.4 mg/kg of dry matter in top sediment layers and from 12 to 98 ng/L in lake water. Concentrations of BLS were between 0.02 and 0.08 mg/kg of dry matter in top sediment layers and <0.2 ng/L in lake water. PMID:21639395

  4. Maghemite based silicone composite for arterial embolization hyperthermia.

    PubMed

    Smolkova, Ilona S; Kazantseva, Natalia E; Makoveckaya, Kira N; Smolka, Petr; Saha, Petr; Granov, Anatoly M

    2015-03-01

    Maghemite nanoparticle based silicone composite for application in arterial embolization hyperthermia is developed. It possesses embolization ability, high heating efficiency in alternating magnetic fields and radiopaque property. The initial components of the composite are selected so that the material stays liquid for 20min, providing the opportunity for transcatheter transportation and filling of the tumour vascular system. After this induction period the viscosity increases rapidly and soft embolus is formed which is able to occlude the tumour blood vessels. The composite is thermally stable up to 225°C, displays rubber-elastic properties and has a thermal expansion coefficient higher than that of blood. Maghemite nanoparticles uniformly distributed in the composite provide its rapid heating (tens of °Cmin(-1)) due to Neel magnetization relaxation. Required X-ray contrast of composite is achieved by addition of potassium iodide. PMID:25579966

  5. Transcatheter Arterial Embolization for Upper Gastrointestinal Nonvariceal Hemorrhage: Is Empiric Embolization Warranted?

    SciTech Connect

    Arrayeh, Elnasif; Fidelman, Nicholas Gordon, Roy L.; LaBerge, Jeanne M.; Kerlan, Robert K.; Klimov, Alexander; Bloom, Allan I.

    2012-12-15

    Purpose: To determine whether transcatheter arterial embolization performed in the setting of active gastric or duodenal nonvariceal hemorrhage is efficacious when the bleeding source cannot be identified angiographically. Methods: Records of 115 adult patients who underwent visceral angiography for endoscopically documented gastric (50 patients) or duodenal (65 patients) nonvariceal hemorrhage were retrospectively reviewed. Patients were subdivided into three groups according to whether angiographic evidence of arterial hemorrhage was present and whether embolization was performed (group 1 = no abnormality, no embolization; group 2 = no abnormality, embolization performed [empiric embolization]; and group 3 = abnormality present, embolization performed). Thirty-day rates and duration of primary hemostasis and survival were compared.ResultsFor patients with gastric sources of hemorrhage, the rate of primary hemostasis at 30 days after embolization was greater when embolization was performed in the setting of a documented angiographic abnormality than when empiric embolization was performed (67% vs. 42%). The rate of primary hemostasis at 30 days after angiography was greater for patients with duodenal bleeding who either underwent empiric embolization (60%) or embolization in the setting of angiographically documented arterial hemorrhage (58%) compared with patients who only underwent diagnostic angiogram (33%). Patients with duodenal hemorrhage who underwent embolization were less likely to require additional invasive procedures to control rebleeding (p = 0.006). Conclusion: Empiric arterial embolization may be advantageous in patients with a duodenal source of hemorrhage but not in patients with gastric hemorrhage.

  6. Refined Model of Heat Transfer in Composite Bodies Reinforced with Tubes with a Liquid Heat-Transfer Agent Moving in a Developed Turbulent Regime

    NASA Astrophysics Data System (ADS)

    Yankovskii, A. P.

    2015-07-01

    The author has obtained equations describing thermal conductivity of composite bodies spatially reinforced with a system of smooth tubes in which an incompressible liquid heat-transfer agent is pumped in a developed turbulent regime. The corresponding boundary-value heat-conduction problem was formulated and its qualitative analysis was made. Specific calculations were performed for steady-state temperature fields in cylindrical concrete shells spirally reinforced with steel tubes through which a heat-transfer agent (air) is pumped. A study has been made of the influence of the reinforcement parameters and of the velocity and direction of the heat-transfer agent in the tubes and the dimensions of their cross sections on the temperature field. It has been established that variation of these characteristics enables one to substantially change the intensity of heat removal from the shells, opening up wide opportunities for efficient control of the heat transfer in them.

  7. Trisacryl Gelatin Microspheres Versus Polyvinyl Alcohol Particles in the Preoperative Embolization of Bone Neoplasms

    SciTech Connect

    Basile, Antonio; Rand, Thomas; Lomoschitz, Fritz; Toma, Cyril; Lupattelli, Tommaso; Kettenbach, Joachim; Lammer, Johannes

    2004-09-15

    The aim of this study was to compare the efficacy of trisacryl gelatin microspheres versus polyvinyl alcohol particles (PVA) in the preoperative embolization of bone neoplasms, on the basis of intraoperative blood loss quantified by the differences in preoperative and postoperative hematic levels of hemoglobin, hematocrit and erythrocytes count. From January 1997 to December 2002, preoperative embolization of bone tumors (either primary or secondary) was carried out in 49 patients (age range 12/78), 20 of whom were treated with trysacril gelatin microspheres (group A) and 29 with PVA particles (group B). The delay between embolization and surgery ranged from 1 to 13 days in group A and 1 to 4 days in group B. As used in international protocols, we considered hematic levels of hemoglobin, hematocrit and erythrocytes count for the measurement of intraoperative blood loss then the differences in pre- and postoperative levels were used as statistical comparative parameters. We compared the values of patients treated with embospheres (n = 10) and PVA (n = 18) alone, and patients treated with (group A = 10; group B = 11) versus patients treated without other additional embolic materials in each group (group A = 10; group B = 18). According to the Student's t-test (p < 0.05), the difference of hematic parameters between patients treated by embospheres and PVA alone were significant; otherwise there was no significant difference between patients treated with only one embolic material (embospheres and PVA) versus those treated with other additional embolic agents in each group. The patients treated with microspheres had a minor quantification of intraoperative blood loss compared to those who received PVA particles. Furthermore, they had a minor increase of bleeding related to the delay time between embolization and surgery. The use of additional embolic material did not improve the efficacy of the procedure in either group of patients.

  8. Glue embolism: a rare cause of pulmonary embolism.

    PubMed

    Ashraf, Pervez; Haqqi, Syed Afzal-ul-Haq; Shaikh, Hafeezullah; Wakani, Asif J

    2011-09-01

    N-butyl-2-cyanoacrylate is widely used to sclerose bleeding gastric varices. We report the case of a 65-year-old lady, known case of cirrhosis secondary to hepatitis C infection, who presented to the emergency department with coffee ground vomiting and melena for four days. Gastroscopy showed non-bleeding small esophageal varices, mild portal hypertensive gastropathy and a large gastric fundal varix. Injection sclerotherapy was completed successfully and haemostasis was secured. During the procedure, she was hemodynamically stable with an oxygen saturation of 98%. Immediately after the procedure, she went into cardiopulmonary arrest; cardiopulmonary resuscitation (CPR) was started, but she could not be revived. A provisional diagnosis of pulmonary embolism was made. X-ray chest showed linear hyperdense shadows in both pulmonary arteries and in some of their branches, which were not seen on pre-procedural chest X-ray. The patient died of massive pulmonary embolism as confirmed on X-ray chest. PMID:21914421

  9. Management of Pulmonary Embolism: An Update.

    PubMed

    Konstantinides, Stavros V; Barco, Stefano; Lankeit, Mareike; Meyer, Guy

    2016-03-01

    Pulmonary embolism (PE) remains a major contributor to global disease burden. Risk-adapted treatment and follow-up contributes to a favorable outcome. Age-adjusted cutoff levels increase D-dimer specificity and may decrease overuse of imaging procedures and overdiagnosis of PE. Primary systemic fibrinolysis has an unfavorable risk-benefit ratio in intermediate-risk PE; catheter-directed techniques are an option for patients with hemodynamic decompensation and high bleeding risk. New oral anticoagulant agents are effective and safe alternatives to standard anticoagulation regimens. Recent trial data do not support insertion of cava filters in patients who can receive anticoagulant treatments. Remaining areas of uncertainty include the therapeutic implications of subsegmental PE, the optimal diagnostic approach to the pregnant patient with suspected PE, and the efficacy and safety of new oral anticoagulant agents in patients with cancer. Campaigns to increase awareness combined with strategies to implement guideline recommendations will be crucial steps towards further optimizing management of acute PE. PMID:26916489

  10. Nonfatal air embolism during shoulder arthroscopy.

    PubMed

    Pandey, Vivek; Varghese, Elsa; Rao, Madhu; Srinivasan, Nataraj M; Mathew, Neethu; Acharya, Kiran K V; Rao, P Sripathi

    2013-06-01

    An air embolism is a rare but potentially fatal complication of shoulder arthroscopy. In this article, we report the case of a patient who developed a nonfatal air embolism during shoulder arthroscopy for an acute bony Bankart lesion and a greater tuberosity avulsion fracture. The venous air embolism occurred immediately after the joint was insufflated with air for diagnostic air arthroscopy. The diagnosis was based on a drop in end-tidal carbon dioxide and blood pressure and presence of mill wheel (waterwheel) murmur over the right heart. Supportive treatment was initiated immediately. The patient recovered fully and had no further complications of air embolism. This patient's case emphasizes the importance of being aware that air embolisms can occur during shoulder arthroscopy performed for acute intra-articular fractures of the shoulder. Monitoring end tidal carbon dioxide can be very useful in early detection of air embolisms. PMID:23805421

  11. In vitro and in vivo evaluation of biodegradable embolic microspheres with tunable anticancer drug release.

    PubMed

    Weng, Lihui; Rostamzadeh, Parinaz; Nooryshokry, Navid; Le, Hung C; Golzarian, Jafar

    2013-06-01

    Natural polymer-derived materials have attracted increasing interest in the biomedical field. Polysaccharides have obvious advantages over other polymers employed for biomedical applications due to their exceptional biocompatibility and biodegradability. None of the spherical embolic agents used clinically is biodegradable. In the current study, microspheres prepared from chitosan and carboxymethyl cellulose (CMC) were investigated as a biodegradable embolic agent for arterial embolization applications. Aside from the enzymatic degradability of chitosan units, the cross-linking bonds in the matrix, Schiff bases, are susceptible to hydrolytic cleavage in aqueous conditions, which would overcome the possible shortage of enzymes inside the arteries. The size distribution, morphology, water retention capacity and degradability of the microspheres were found to be affected by the modification degree of CMC. An anticancer drug, doxorubicin, was successfully incorporated into these microspheres for local release and thus for killing cancerous cells. These microspheres demonstrated controllable degradation time, variable swelling and tunable drug release profiles. Co-culture with human umbilical vein endothelial cells revealed non-cytotoxic nature of these microspheres compared to monolayer control (P>0.95). In addition, a preliminary study on the in vivo degradation of the microspheres (100-300μm) was performed in a rabbit renal embolization model, which demonstrated that the microspheres were compatible with microcatheters for delivery, capable of occluding the arteries, and biodegradable inside arteries. These microspheres with biodegradability would be promising for embolization therapies. PMID:23419554

  12. Investigation of the persistence of nerve agent degradation analytes on surfaces through wipe sampling and detection with ultrahigh performance liquid chromatography-tandem mass spectrometry.

    PubMed

    Willison, Stuart A

    2015-01-20

    The persistence of chemical warfare nerve agent degradation analytes on surfaces is important, from indicating the presence of nerve agent on a surface to guiding environmental restoration of a site after a release. Persistence was investigated for several chemical warfare nerve agent degradation analytes on indoor surfaces and presents an approach for wipe sampling of surfaces, followed by wipe extraction and liquid chromatography-tandem mass spectrometry detection. Commercially available wipe materials were investigated to determine optimal wipe recoveries. Tested surfaces included porous/permeable (vinyl tile, painted drywall, and wood) and largely nonporous/impermeable (laminate, galvanized steel, and glass) surfaces. Wipe extracts were analyzed by ultrahigh performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). UPLC provides a separation of targeted degradation analytes in addition to being nearly four times faster than high-performance liquid chromatography, allowing for greater throughput after a large-scale contamination incident and subsequent remediation events. Percent recoveries from nonporous/impermeable surfaces were 60-103% for isopropyl methylphosphonate (IMPA), GB degradate; 61-91% for ethyl methylphosphonate (EMPA), VX degradate; and 60-98% for pinacolyl methylphosphonate (PMPA), GD degradate. Recovery efficiencies for methyl phosphonate (MPA), nerve agent degradate, and ethylhydrogen dimethylphosphonate (EHDMAP), GA degradate, were lower, perhaps due to matrix effects. Diisopropyl methylphosphonate, GB impurity, was not recovered from surfaces. The resulting detection limits for wipe extracts were 0.065 ng/cm(2) for IMPA, 0.079 ng/cm(2) for MPA, 0.040 ng/cm(2) for EMPA, 0.078 ng/cm(2) for EHDMAP, and 0.013 ng/cm(2) for PMPA. The data indicate that laboratories may hold wipe samples for up to 30 days prior to analysis. Target analytes were observed to persist on surfaces for at least 6 weeks. PMID:25495198

  13. Liquid chromatography and supercritical fluid chromatography as alternative techniques to gas chromatography for the rapid screening of anabolic agents in urine.

    PubMed

    Desfontaine, Vincent; Nováková, Lucie; Ponzetto, Federico; Nicoli, Raul; Saugy, Martial; Veuthey, Jean-Luc; Guillarme, Davy

    2016-06-17

    This work describes the development of two methods involving supported liquid extraction (SLE) sample treatment followed by ultra-high performance liquid chromatography or ultra-high performance supercritical fluid chromatography coupled to tandem mass spectrometry (UHPLC-MS/MS and UHPSFC-MS/MS) for the screening of 43 anabolic agents in human urine. After evaluating different stationary phases, a polar-embedded C18 and a diol columns were selected for UHPLC-MS/MS and UHPSFC-MS/MS, respectively. Sample preparation, mobile phases and MS conditions were also finely tuned to achieve highest selectivity, chromatographic resolution and sensitivity. Then, the performance of these two methods was compared to the reference routine procedure for steroid analyses in anti-doping laboratories, which combines liquid-liquid extraction (LLE) followed by gas chromatography coupled to tandem mass spectrometry (GC-MS/MS). For this purpose, urine samples spiked with the compounds of interest at five different concentrations were analyzed using the three analytical platforms. The retention and selectivity of the three techniques were very different, ensuring a good complementarity. However, the two new methods displayed numerous advantages. The overall procedure was much faster thanks to high throughput SLE sample treatment using 48-well plates and faster chromatographic analysis. Moreover, the highest sensitivity was attained using UHPLC-MS/MS with 98% of the doping agents detected at the lowest concentration level (0.1ng/mL), against 76% for UHPSFC-MS/MS and only 14% for GC-MS/MS. Finally, the weakest matrix effects were obtained with UHPSFC-MS/MS with 76% of the analytes displaying relative matrix effect between -20 and 20%, while the GC-MS/MS reference method displayed very strong matrix effects (over 100%) for all of the anabolic agents. PMID:27185056

  14. Embolization of uterine arteriovenous malformation

    PubMed Central

    Chen, Yan; Wang, Guoyun; Xie, Fubo; Wang, Bo; Tao, Guowei; Kong, Beihua

    2013-01-01

    Background: Uterine arteriovenous malformation is a rare but potential life-threatening source of bleeding. A high index of suspicion and accurate diagnosis of the condition in a timely manor are essential because instrumentation that is often used for other sources of uterine bleeding can be lead to massive hemorrhage. Case: We describe here a case of uterine arteriovenous malformation. A 32-year-old woman presented abnormal vaginal bleeding following the induced abortion. A diagnosis of uterine arteriovenous malformation made on the basis of Doppler ultrasonraphy was confirmed through pelvic angiography. The embolization of bilateral uterine arteries was performed successfully. Conclusion: Uterine arteriovenous malformation should be suspected in patient with abnormal vaginal bleeding, especially who had the past medical history incluing cesarean section, induced abortion, or Dillation and Curethage and so on. Although angiography remains the gold standard, Doppler ultrasonography is also a good noninvasive technique. The transcatheter uterine artery embolization offers a safe and effective treatment PMID:24639742

  15. Left Gastric Artery Aneurysm: Successful Embolization with Ethylene Vinyl Alcohol Copolymer (Onyx)

    SciTech Connect

    Vargas, Hebert Alberto Cousins, Claire; Higgins, J. Nicholas; See, Teik Choon

    2008-03-15

    Patients with left gastric artery aneurysms present with hemorrhagic shock due to rupture or occasionally it is an incidental finding on abdominal CT examinations. Due to the increased morbidity and mortality from this condition, adequate diagnosis and treatment are essential. In this article we present a patient with a left gastric artery aneurysm treated with a new embolization agent, ethylene vinyl alcohol copolymer (Onyx)

  16. Successful Control of Liver Metastases From Pancreatic Solid-Pseudopapillary Neoplasm (SPN) Using Hepatic Arterial Embolization

    SciTech Connect

    Violari, Elena G. Brody, Lynn A.; Covey, Anne M.; Erinjeri, Joseph P.; Getrajdman, George I.; Sofocleous, Constantinos T.; Reidy, Diane L.; Jarnagin, William R.; Brown, Karen T.

    2015-04-15

    No systemic agents that are known to be effective for the treatment of solid-pseudopapillary neoplasm (SPN) are available. We report the prolonged and sustained control of metastatic pancreatic SPN to the liver using hepatic arterial embolization (HAE), where a total of 13 HAE sessions were performed over a 6-year period.

  17. Fat embolism: a clinical diagnosis.

    PubMed

    Miller, J D

    1987-01-01

    Fat embolism causes a distinctive clinical syndrome usually seen in trauma victims with long bone fractures. Clinical findings include hyperthermia, respiratory distress, petechiae and retinal fat emboli. Neurologic changes include decreased sensorium, decerebrate posturing and seizure activity. Chest radiographs commonly demonstrate bilateral fluffy infiltrates. Laboratory abnormalities include hypoxemia, respiratory alkalosis, anemia and hypocalcemia. Treatment consists of general supportive care with vigorous pulmonary therapy. Most patients have a good recovery. PMID:3799415

  18. Intra-procedural aneurysm rupture treated with n-butyl cyanoacrylate embolization: technical note.

    PubMed

    Patsalides, A; Smith, M; Gobin, Y P

    2010-06-01

    A case is described of utilizing liquid polymer and stent placement to treat a procedural rupture of intracranial aneurysm during coil embolization. Although this technique is challenging, it seals the rupture immediately and can be used when additional coil placement is not possible. PMID:21990595

  19. 21 CFR 882.5950 - Neurovascular embolization device.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... embolization device. (a) Identification. A neurovascular embolization device is an intravascular implant intended to permanently occlude blood flow to cerebral aneurysms and cerebral ateriovenous...

  20. Short-Term Effects of Ankaferd Hemostat for Renal Artery Embolization: An Experimental Study

    SciTech Connect

    Ozbek, Orhan; Acar, Kadir; Koc, Osman; Saritas, Kadir; Toy, Hatice; Solak, Yalcin; Ozbek, Seda; Kucukapan, Ahmet; Guler, Ibrahim; Gaipov, Abduzhappar; Turk, Suleyman; Haznedaroglu, Ibrahim Celaleddin

    2013-04-15

    Renal artery embolization (RAE) is a minimally invasive therapeutic technique that is utilized in a number of disorders. Ankaferd is a novel hemostatic agent with a new mechanism of action independent of clotting factors. We used Ankaferd for RAE in a sheep model. Seven adult female sheep were included in the study. Selective renal arteriogram using 5-F diagnostic catheter was performed to make sure that each kidney was fed by a single renal artery and the animal had normal renal vasculature. Coaxial 2.7-F microcatheter was advanced to the distal main renal artery. Under fluoroscopic guidance, 2 mL of Ankaferd mixed with 2 mL of nonionic iodinated contrast agent was slowly injected. Fluoroscopy was used to observe the deceleration of flow and stagnation. Control renal angiograms were performed just after embolization. After the procedure, the animals were observed for 1 day and then sacrificed with intravenous sodium thiopental. The technical success was observed in seven of the seven animals.. After embolization procedure, none of the animals died or experienced a major systemic adverse event. On macroscopic examination of the embolized kidneys, thrombus at the level of main renal artery formed after Ankaferd embolization was more compact compared with the thrombi that was not Ankaferd-associated, which was observed elsewhere. Microscopically, majority of the renal tubular cells (80-90 %) were necrotic, and there was epithelial cell damage in a small portion of the cells (10-20 %). RAE was safe and effective in the short-term with Ankaferd in studied animals. Further studies should be conducted to better delineate the embolizing potential of this novel hemostatic agent.

  1. Management of venous thrombo-embolism: an update.

    PubMed

    Konstantinides, Stavros; Torbicki, Adam

    2014-11-01

    Venous thrombo-embolism is the third most frequent acute cardiovascular syndrome after myocardial infarction and stroke. Recently published landmark trials paved the way for significant progress in the management of the disease and provided the evidence for the ESC Pulmonary Embolism (PE) Guidelines 2014 update. Risk stratification strategies for non-high-risk PE continue to evolve, with an increasing emphasis on clinical prediction rules and right ventricular (RV) assessment on computed tomographic pulmonary angiography. In the field of anticoagulation treatment, pharmacogenetic testing for vitamin K antagonists on top of clinical parameters was not found to offer a significant benefit during the initiation phase; on the other hand, dosing based on the patient's clinical data seems superior to fixed loading regimens. The phase 3 trial programme of new oral anticoagulants in the treatment of venous thrombo-embolism has been completed, and the results indicate that these agents are at least as effective and probably cause less major bleeding than currently standard treatment. A multicentre prospective phase 4 trial will determine whether early discharge and out-of-hospital treatment of low-risk PE with the oral factor Xa inhibitor rivaroxaban is feasible, effective, and safe. For intermediate-risk PE defined on the basis of imaging tests and laboratory biomarkers, the bleeding risks of full-dose thrombolytic treatment appear too high to justify its use, unless clinical signs of haemodynamic decompensation appear. Patients in whom PE has resulted in chronic thrombo-embolic pulmonary hypertension and who are not suitable for pulmonary endarterectomy, may be expected to benefit from emerging pharmaceutical and interventional treatment options. PMID:25179762

  2. Management of Liver Hemangioma Using Trans-Catheter Arterial Embolization

    PubMed Central

    Firouznia, Kavous; Ghanaati, Hossein; Alavian, Seyed Moayed; Nassiri Toosi, Mohssen; Ebrahimi Daryani, Nasser; Jalali, Amir Hossein; Shakiba, Madjid; Hosseinverdi, Sima

    2014-01-01

    Background: Hemangioma, a congenital vascular malformation, is the most common benign liver lesion that is usually remain stable subsequently requiring not treatment; however, complications such as abdominal pain or fullness, coagulation disturbances, and inflammatory syndrome may occur, demanding a specific treatment of hemangioma. Objectives: To assess the safety, feasibility and efficacy of trans-catheter arterial embolization (TAE) for the treatment of Liver hemangioma Patients and Methods: TAE was performed on 20 patients with liver hemangioma. The embolic agent used was polyvinyl alcohol (PVA) particles (300-400 micron, Jonson and Johnson Cordis, USA). All patients were followed up for 6 months. Imaging was carried out and patients were also evaluated symptomatically through telephone interview by a physician. Results: Twenty patients aged from 21 to 63 years (mean: 46.8, SD: 10.26) were included in this study. Post embolization syndrome, including abdominal pain, fever, and leukocytosis occurred in one patient 1 week after TAE and lasted for 3 days. No serious adverse event and TAE-related death was observed. None of the patient underwent another intervention including surgery. During follow up interval, decreased episode of abdominal pain was documented in all patients who had pain. Tumor enlargement was also stopped during the follow up. The average diameter of tumors was 97.00 mm (range: 25-200 SD: 47.85) and 88.95 mm (range: 23-195 SD: 43.27) before and after embolization, respectively. Comparison of images before and after TAE revealed statistically significant decrease in the size of lesion (P value: 0.004, t: 3.31). Conclusions: Our findings indicate that TAE is a safe and efficient procedure for the treatment of liver hemangioma. Further studies with larger sample sizes are required to support therapeutic effects of TAE. PMID:25737731

  3. Current role of portal vein embolization/hepatic artery chemoembolization.

    PubMed

    Kokudo, Norihiro; Makuuchi, Masatoshi

    2004-04-01

    This article has reviewed indications, methods, and results of PVE and TACE for hepatobiliary tumors. PVE is applied mainly to increase the safety of major hepatic resection in patients with hilar cholangiocarcinoma, HCC, or metastatic liver tumors. Hepatic arterial embolization causes selective ischemia of the liver tumor and enhances the cytotoxicity of the chemotherapeutic agent administered concomitantly. A survival benefit of TACE in patients with unresectable or recurrent HCC has been demonstrated. The significance of preoperative TACE is still controversial. TACE is routinely performed before PVE in HCC patients. PMID:15062666

  4. Membrane filtration of the liquid fraction from a solid-liquid separator for swine manure using a cationic polymer as flocculating agent.

    PubMed

    Masse, L; Mondor, M; Dubreuil, J

    2013-01-01

    The liquid fraction from a solid-liquid separator for swine manure, which used a cationic polymer to promote particle flocculation, was processed by one nanofiltration and two reverse osmosis spiral-wound membranes. Eight different liquid fraction batches (750 to 1750 L) were concentrated at volumetric concentration ratios (VCRs, initial to final volumes) ranging from 2.3 to 4.2. Membrane fouling intensity was highly variable, as water flux recovery after concentration cycles ranged from 13% to 88%. The most severe fouling was caused by a liquid fraction that had relatively low suspended solids (SS) (774 mg/L) and was concentrated at a low VCR of 2.6. Raw manure collected the same day also contained low SS, suggesting that fewer sites were available for polymer adsorption and thus more polymer remained in the liquid. However, because of the high opacity of the samples, residual polymer could not be detected in any feed or concentrate samples. Fouling was not totally irreversible as over 97% of membrane flux could be recovered by cleaning with acidic and alkaline solutions. Further tests with spiked liquid fractions indicated that fouling due to residual polymer in solution started to occur at a polymer concentration of 3 and 11 mg/L in initial and concentrated effluents, respectively. If a cationic polymer is used to pretreat manure, the amount of added polymer would have to be closely related to SS content as opposed to manure volume, in order to leave very little residual polymer in solution. PMID:23837317

  5. Development of a new method for the identification of degradation products of V-type nerve agents by liquid chromatography-tandem mass spectrometry.

    PubMed

    Lee, Jin Young; Lee, Yong Han

    2014-01-01

    Degradation products of V-type nerve agents are important markers of these toxic chemical warfare agents; hence their detection and identification are of high importance from verification point of view of Chemical Weapons Convention. The new analytical technique using quantitation-enhanced data-dependent (QED) method has been developed for the analysis of the degradation products, 2-(N,N-dialkylamino)ethanesulfonic acids of V-type nerve agents, by using liquid chromatography-tandem mass spectrometry (Thermo-Scientific Vantage triple stage quadrupole mass spectrometer, Thermo Finnigan Surveyor, San Jose, CA, USA) via an atmospheric pressure ionization source/interface operated in eletrospray ionization mode. With a single analytical run, we could perform the quantitative analysis of the 2-(N,N-dialkylamino)ethanesulfonic acids by the selected reaction monitoring scan mode with limit of detection at 0.1 ng/mL and identify their isomeric compounds by product ion scan mode, simultaneously. The QED method will be applicable to the trace analysis of degradation products of V-type nerve agents in the environmental matrices in the Organisation for the Prohibition of Chemical Weapons proficiency test. PMID:24470166

  6. [From alcohol to liquid ecstasy (GHB)--a survey of old and modern knockout agents. Part 3: gamma-hydroxybutyric acid ("liquid ecstasy")].

    PubMed

    Schütz, Harald; Jansen, Malin; Verhoff, Marcel A

    2011-01-01

    Currently, gamma-hydroxybutyric acid (GHB/"liquid ecstasy") is frequently abused as a knockout substance. Its detection and the interpretation of the results present numerous problems which are illustrated by case reports. In this context, hair analysis and the increasing significance of gamma-butyrolactone (GBL) are also discussed. PMID:22276366

  7. Transcatheter Coil Embolization of Splenic Artery Aneurysm

    SciTech Connect

    Yamamoto, Satoshi Hirota, Shozo; Maeda, Hiroaki; Achiwa, Sachiko Arai, Keisuke; Kobayashi, Kaoru; Nakao, Norio

    2008-05-15

    The purpose of this study was to evaluate clinical results and technical problems of transcatheter coil embolization for splenic artery aneurysm. Subjects were 16 patients (8 men, 8 women; age range, 40-80 years) who underwent transcatheter embolization for splenic artery aneurysm (14 true aneurysms, 2 false aneurysms) at one of our hospitals during the period January 1997 through July 2005. Two aneurysms (12.5%) were diagnosed at the time of rupture. Multiple splenic aneurysms were found in seven patients. Aneurysms were classified by site as proximal (or strictly ostial) (n = 3), middle (n = 3), or hilar (n = 10). The indication for transcatheter arterial embolization was a false or true aneurysm 20 mm in diameter. Embolic materials were fibered coils and interlocking detachable coils. Embolization was performed by the isolation technique, the packing technique, or both. Technically, all aneurysms were devascularized without severe complications. Embolized aneurysms were 6-40 mm in diameter (mean, 25 mm). Overall, the primary technical success rate was 88% (14 of 16 patients). In the remaining 2 patients (12.5%), partial recanalization occurred, and re-embolization was performed. The secondary technical success rate was 100%. Seven (44%) of the 16 study patients suffered partial splenic infarction. Intrasplenic branching originating from the aneurysm was observed in five patients. We conclude that transcatheter coil embolization should be the initial treatment of choice for splenic artery aneurysm.

  8. [Polycitemia vera and pulmonary embolism: case report].

    PubMed

    Nugara, Cinzia; Carità, Patrizia; Coppola, Giuseppe; Mignano, Antonino; Ajello, Laura; Rotolo, Antonino; Assennato, Pasquale; Novo, Salvatore; Corrado, Egle

    2013-12-01

    Pulmonary embolism is a rare clinical onset of chronic myeloproliferative diseases. Early diagnosis is very important because medical therapy reduces both mortality and morbility. We describe a case of pulmonary embolism as clinical onset of an unknown myeloproliferative disorder. On the basis of our experience is very important early diagnosis and therapy to reduce incidence of later major thrombotic complications. PMID:24362834

  9. The Medusa Multi-Coil Versus Alternative Vascular Plugs for Iliac Artery Aneurysm Embolization (MVP-EMBO) Study.

    PubMed

    George, Jon C; Varghese, Vincent; Kovach, Richard

    2016-01-01

    Transcatheter embolization has evolved from the use of autologous clot as the embolic agent, to stainless-steel coils, to braided-nitinol vascular plugs. However, there are disadvantages to platinum and metal coils, including procedural time, radiation exposure, mass effect, risk of distal embolization, recanalization, imaging artifacts, and cost. Therefore, a large vessel-occluding device is needed to mitigate these current disadvantages. The Medusa Multi-Coil (MMC; EndoShape, Inc) is a Food and Drug Administration (FDA)-approved embolization device constructed primarily of radioopaque coils with synthetic fibers to promote thrombogenicity, and a unique delivery platform with both proximal and distal attachment to assist with precise placement. We report our experience with the endovascular treatment of internal iliac artery aneurysms using platinum coils vs MMCs. PMID:26716591

  10. Molecular Imaging of Activated Platelets Allows the Detection of Pulmonary Embolism with Magnetic Resonance Imaging

    PubMed Central

    Heidt, Timo; Ehrismann, Simon; Hövener, Jan-Bernd; Neudorfer, Irene; Hilgendorf, Ingo; Reisert, Marco; Hagemeyer, Christoph E.; Zirlik, Andreas; Reinöhl, Jochen; Bode, Christoph; Peter, Karlheinz; von Elverfeldt, Dominik; von zur Muhlen, Constantin

    2016-01-01

    Early and reliable detection of pulmonary embolism (PE) is critical for improving patient morbidity and mortality. The desire for low-threshold screening for pulmonary embolism is contradicted by unfavorable radiation of currently used computed tomography or nuclear techniques, while standard magnetic resonance imaging still struggles to provide sufficient diagnostic sensitivity in the lung. In this study we evaluate a molecular-targeted contrast agent against activated platelets for non-invasive detection of murine pulmonary thromboembolism using magnetic resonance imaging. By intravenous injection of human thrombin, pulmonary thromboembolism were consistently induced as confirmed by immunohistochemistry of the lung. Magnetic resonance imaging after thrombin injection showed local tissue edema in weighted images which co-localized with the histological presence of pulmonary thromboembolism. Furthermore, injection of a functionalized contrast agent targeting activated platelets provided sensitive evidence of focal accumulation of activated platelets within the edematous area, which, ex vivo, correlated well with the size of the pulmonary embolism. In summary, we here show delivery and specific binding of a functionalized molecular contrast agent against activated platelets for targeting pulmonary thromboembolism. Going forward, molecular imaging may provide new opportunities to increase sensitivity of magnetic resonance imaging for detection of pulmonary embolism. PMID:27138487

  11. Molecular Imaging of Activated Platelets Allows the Detection of Pulmonary Embolism with Magnetic Resonance Imaging.

    PubMed

    Heidt, Timo; Ehrismann, Simon; Hövener, Jan-Bernd; Neudorfer, Irene; Hilgendorf, Ingo; Reisert, Marco; Hagemeyer, Christoph E; Zirlik, Andreas; Reinöhl, Jochen; Bode, Christoph; Peter, Karlheinz; von Elverfeldt, Dominik; von Zur Muhlen, Constantin

    2016-01-01

    Early and reliable detection of pulmonary embolism (PE) is critical for improving patient morbidity and mortality. The desire for low-threshold screening for pulmonary embolism is contradicted by unfavorable radiation of currently used computed tomography or nuclear techniques, while standard magnetic resonance imaging still struggles to provide sufficient diagnostic sensitivity in the lung. In this study we evaluate a molecular-targeted contrast agent against activated platelets for non-invasive detection of murine pulmonary thromboembolism using magnetic resonance imaging. By intravenous injection of human thrombin, pulmonary thromboembolism were consistently induced as confirmed by immunohistochemistry of the lung. Magnetic resonance imaging after thrombin injection showed local tissue edema in weighted images which co-localized with the histological presence of pulmonary thromboembolism. Furthermore, injection of a functionalized contrast agent targeting activated platelets provided sensitive evidence of focal accumulation of activated platelets within the edematous area, which, ex vivo, correlated well with the size of the pulmonary embolism. In summary, we here show delivery and specific binding of a functionalized molecular contrast agent against activated platelets for targeting pulmonary thromboembolism. Going forward, molecular imaging may provide new opportunities to increase sensitivity of magnetic resonance imaging for detection of pulmonary embolism. PMID:27138487

  12. Transcatheter Embolization of Pseudoaneurysms Complicating Pancreatitis

    SciTech Connect

    Golzarian, Jafar; Nicaise, Nicole; Deviere, Jacques; Ghysels, Marc; Wery, Didier; Dussaussois, Luc; Gansbeke, Daniel van; Struyven, Julien

    1997-11-15

    Purpose: To evaluate the therapeutic role of angiography in patients with pseudoaneurysms complicating pancreatitis. Methods: Thirteen symptomatic pseudoaneurysms were treated in nine patients with pancreatitis. Eight patients had chronic pancreatitis and pseudocyst and one had acute pancreatitis. Clinical presentation included gastrointestinal bleeding in seven patients and epigastric pain without bleeding in two. All patients underwent transcatheter embolization. Results: Transcatheter embolization resulted in symptomatic resolution in all patients. Rebleeding occurred in two patients, 18 and 28 days after embolization respectively, and was successfully treated by repeated emnbolization. One patient with severe pancreatitis died from sepsis 28 days after embolization. Follow-up was then available for eight patients with no relapse of bleeding after a mean follow-up of 32 months (range 9-48 months). Conclusion: Transcatheter embolization is safe and effective in the management of pseudoaneurysms complicating pancreatitis.

  13. Hyperfibrinolysis diagnosed by rotational thromboelastometry in a case of suspected amniotic fluid embolism.

    PubMed

    Collins, N F; Bloor, M; McDonnell, N J

    2013-01-01

    Rotational thromboelastometry is a viscoelastomeric, point-of-care method for testing haemostasis in whole blood which can be visualised rapidly, in real time, in the operating theatre. Advantages over traditional coagulation tests relate to the rapid feedback of results and the ability to visualise hyperfibrinolysis. We present a case of suspected amniotic fluid embolism that presented with sudden respiratory arrest associated with haemodynamic compromise during a non-elective caesarean delivery. Soon after the collapse, coagulopathy developed. Rotational thromboelastometry showed hyperfibrinolysis and hypofibrinogenaemia, which allowed targeted coagulation factor replacement therapy and the use of tranexamic acid. Hyperfibrinolysis may be a contributor to the coagulopathy associated with amniotic fluid embolism but has been infrequently reported, perhaps due to limited diagnosis with traditional coagulation tests. Treatment of the coagulopathy associated with a suspected amniotic fluid embolism with antifibrinolytic agents may deserve greater consideration. PMID:23159521

  14. Patients with Life-Threatening Arterial Renal Hemorrhage: CT Angiography and Catheter Angiography with Subsequent Superselective Embolization

    SciTech Connect

    Sommer, C. M. Stampfl, U.; Bellemann, N.; Ramsauer, S.; Loenard, B. M.; Haferkamp, A.; Hallscheidt, P.; Richter, G. M.; Kauczor, H. U.; Radeleff, B. A.

    2010-06-15

    The purpose of this study was to evaluate the technical and clinical success of superselective embolization in patients with life-threatening arterial renal hemorrhage undergoing preinterventional CT angiography. Forty-three patients with clinical signs of life-threatening arterial renal hemorrhage underwent CT angiography and catheter angiography. Superselective embolization was indicated in the case of a positive catheter angiography. Primary study goals were technical and clinical success of superselective embolization. Secondary study goals were CT angiographic and catheter angiographic image findings and clinical follow-up. The mean time interval between CT angiography and catheter angiography was 8.3 {+-} 10.3 h (range, 0.2-34.1 h). Arterial renal hemorrhage was identified with CT angiography in 42 of 43 patients (98%) and catheter angiography in 39 of 43 patients (91%) (overview angiography in 4 of 43 patients [9%], selective angiography in 16 of 43 patients [37%], and superselective angiography in 39 of 43 patients [91%]). Superselective embolization was performed in 39 of 43 patients (91%) and technically successful in 37 of 39 patients (95%). Therefore, coil embolization was performed in 13 of 37 patients (35%), liquid embolization in 9 of 37 patients (24%), particulate embolization in 1 of 37 patients (3%), and a combination in 14 of 37 patients (38%). Clinical failure occurred in 8 of 39 patients (21%) and procedure-related complications in 2 of 39 patients (5%). The 30-day mortality rate was 3%. Hemoglobin decreased significantly prior to intervention (P < 0.001) and increased significantly after intervention (P < 0.005). In conclusion, superselective embolization is effective, reliable, and safe in patients with life-threatening arterial renal hemorrhage. In contrast to overview and selective angiography, only superselective angiography allows reliable detection of arterial renal hemorrhage. Preinterventional CT angiography is excellent for detection

  15. Preoperative Embolization of Hypervascular Thoracic, Lumbar, and Sacral Spinal Column Tumors: Technique and Outcomes from a Single Center

    PubMed Central

    Nair, Sreejit; Gobin, Y. Pierre; Leng, Lewis Z.; Marcus, Joshua D.; Bilsky, Mark; Laufer, Ilya; Patsalides, Athos

    2013-01-01

    Summary The existing literature on preoperative spine tumor embolization is limited in size of patient cohorts and diversity of tumor histologies. This report presents our experience with preoperative embolization of hypervascular thoracic, lumbar, and sacral spinal column tumors in the largest series to date. We conducted a retrospective review of 228 angiograms and 188 pre-operative embolizations for tumors involving thoracic, lumbar and sacral spinal column. Tumor vascularity was evaluated with conventional spinal angiography and was graded from 0 (same as normal adjacent vertebral body) to 3 (severe tumor blush with arteriovenous shunting). Embolic materials included poly vinyl alcohol (PVA) particles and detachable platinum coils and rarely, liquid embolics. The degree of embolization was graded as complete, near-complete, or partial. Anesthesia records were reviewed to document blood loss during surgery. Renal cell carcinoma (44.2%), thyroid carcinoma (9.2%), and leiomyosarcoma (6.6%) were the most common tumors out of a total of 40 tumor histologies. Hemangiopericytoma had the highest mean vascularity (2.6) of all tumor types with at least five representative cases followed by renal cell carcinoma (2.0) and thyroid carcinoma (2.0). PVA particles were used in 100% of cases. Detachable platinum coils were used in 51.6% of cases. Complete, near-complete, and partial embolizations were achieved in 86.1%, 12.7%, and 1.2% of all cases, respectively. There were no new post-procedure neurologic deficits or other complications with long-term morbidity. The mean intra-operative blood loss for the hypervascular tumors treated with pre-operative embolization was 1745 cc. Preoperative embolization of hypervascular thoracic, lumbar, and sacral spine tumors can be performed with high success rates and a high degree of safety at high volume centers. PMID:24070089

  16. Dose response of surfactants to attenuate gas embolism related platelet aggregation

    NASA Astrophysics Data System (ADS)

    Eckmann, David M.; Eckmann, Yonaton Y.; Tomczyk, Nancy

    2014-03-01

    Intravascular gas embolism promotes blood clot formation, cellular activation, and adhesion events, particularly with platelets. Populating the interface with surfactants is a chemical-based intervention to reduce injury from gas embolism. We studied platelet activation and platelet aggregation, prominent adverse responses to blood contact with bubbles. We examined dose-response relationships for two chemically distinct surfactants to attenuate the rise in platelet function stimulated by exposure to microbubbles. Significant reduction in platelet aggregation and platelet activation occurred with increasing concentration of the surfactants, indicating presence of a saturable system. A population balance model for platelet aggregation in the presence of embolism bubbles and surfactants was developed. Monte Carlo simulations for platelet aggregation were performed. Results agree qualitatively with experimental findings. Surfactant dose-dependent reductions in platelet activation and aggregation indicate inhibition of the gas/liquid interface's ability to stimulate cellular activation mechanically.

  17. Pulmonary embolism, part II: Management

    PubMed Central

    Bĕlohlávek, Jan; Dytrych, Vladimír; Linhart, Aleš

    2013-01-01

    Acute pulmonary embolism (PE) bears a significant burden on health and survival. Rapid and accurate risk stratification and management are of paramount importance to ensure the highest quality of care. This present article summarizes currently available and emerging management strategies for the disease. The authors not only review current evidence regarding early therapy of acute PE, including supportive care, anticoagulation, thrombolysis, surgical and catheter-based treatment, but also the possible role of mechanical circulatory support in PE. The authors also discuss complications related to PE and its management. PMID:23940439

  18. Pulmonary Artery Cement Embolism after a Vertebroplasty

    PubMed Central

    Nooh, Anas; Abduljabbar, Fahad H.; Abduljabbar, Ahmed H.; Jarzem, Peter

    2015-01-01

    Background Context. Vertebroplasty is a minimally invasive procedure most commonly used for the treatment of vertebral compression fractures. Although it is relatively safe, complications have been reported over time. Among those complications, massive cement pulmonary embolism is considered a rare complication. Here we report a case of massive diffuse cement pulmonary embolism following percutaneous vertebroplasty for a vertebral compression fracture. Study Design. Case report. Methods. This is a 70-year-old female who underwent vertebroplasty for T11 and T12 vertebral compression fracture. Results. CT-scan revealed an incidental finding of cement embolism in the pulmonary trunk and both pulmonary arteries. Since the patient was asymptomatic, she was monitored closely and she did not need any intervention. Conclusion. Vertebroplasty is a minimally invasive procedure used for treatment of vertebral compression fracture. Despite the low rate of complications, a pulmonary cement embolism can occur. The consequences of cement embolism range widely from being asymptomatic to embolism that can cause paralysis, radiculopathy, or a fatal pulmonary embolism. PMID:26221556

  19. Encapsulating Ionic Liquid and Fe₃O₄ Nanoparticles in Gelatin Microcapsules as Microwave Susceptible Agent for MR Imaging-guided Tumor Thermotherapy.

    PubMed

    Du, Qijun; Ma, Tengchuang; Fu, Changhui; Liu, Tianlong; Huang, Zhongbing; Ren, Jun; Shao, Haibo; Xu, Ke; Tang, Fangqiong; Meng, Xianwei

    2015-06-24

    The combination of therapies and monitoring the treatment process has become a new concept in cancer therapy. Herein, gelatin-based microcapsules have been first reported to be used as microwave (MW) susceptible agent and magnetic resonance (MR) imaging contrast agent for cancer MW thermotherapy. Using the simple coacervation methods, ionic liquid (IL) and Fe3O4 nanoparticles (NPs) were wrapped in microcapsules, and these microcapsules showed good heating efficacy in vitro under MW irradiation. The results of cell tests indicated that gelatin/IL@Fe3O4 microcapsules possessed excellent compatibility in physiological environments, and they could effectively kill cancer cells with exposure to MW. The ICR mice bearing H22 tumors treated with gelatin/IL@Fe3O4 microcapsules were obtained an outstanding MW thermotherapy efficacy with 100% tumor elimination under ultralow density irradiation (1.8 W/cm(2), 450 MHz). In addition, the applicability of the microcapsules as an efficient contrast agent for MR imaging in vivo was evident. Therefore, these multifunctional microcapsules have a great potential for MR imaging-guided MW thermotherapy. PMID:26031508

  20. Microcatheter Embolization of Intractable Idiopathic Epistaxis

    SciTech Connect

    Leppaenen, Martti; Seppaenen, Seppo; Laranne, Jussi; Kuoppala, Katriina

    1999-11-15

    Purpose: To assess the efficacy and safety of microcatheter embolization in the treatment of intractable idiopathic epistaxis. Methods: Thirty-seven patients underwent microcatheter embolization in 1991-1998. We evaluated retrospectively the technical and clinical outcome, the number of complications, the duration of embolization in each case, and the number of blood transfusions needed. All embolizations were done with biplane digital subtraction angiography (DSA) equipment. The procedure was carried out under local anesthesia using transfemoral catheterization, except in one case where the translumbar route was used. Tracker 18 or 10 microcatheters were advanced as far as possible to the distal branches of the sphenopalatine artery. Polyvinyl alcohol (PVA) particles were used for embolization in most cases, while platinum coils or a combination of these two materials were occasionally used. The primary outcome was always assessed immediately by angiography. Follow-up data were obtained from patient records, by interviewing patients on the telephone or by postal questionnaires when necessary. The mean follow-up time was 21 months. Results: The embolization was technically successful in all 37 cases. A curative outcome was achieved in 33 cases (89%). The mean duration of the procedure was 110 min. Four patients (8%) had mild transient complications, but no severe or persistent complications were encountered. Twenty-three patients needed a blood transfusion. Slight rebleeding occurred in three patients during the follow-up; all responded to conservative treatment. One patient suffered two episodes of rebleeding within 2 months after primary embolization. Re-embolizations successfully stopped the bleeding. Conclusion: Embolization is the primary invasive modality for treating intractable idiopathic epistaxis. It proved both safe and effective over a relatively long follow-up.

  1. Massive pulmonary embolism: the place for embolectomy

    PubMed Central

    Buckels, N J; Mulholland, C; Galvin, I; Gladstone, D; Cleland, J

    1988-01-01

    Untreated massive pulmonary embolism is associated with a high mortality. Pulmonary embolectomy has been largely superceded by thrombolytic therapy, but there are cases in which pulmonary embolectomy remains the treatment of choice. We present three case reports and discuss the merits of the various treatments available for massive pulmonary embolism. The primary treatment of massive pulmonary embolism should be thrombolytic therapy, but for patients who are at risk of haemorrhage following surgery, who are in cardiogenic shock despite medical treatment, or fail to improve following cardiac arrest, then pulmonary embolectomy remains the treatment of choice. ImagesFig 1Fig 2Fig 3 PMID:3232251

  2. Role of Embolization for Cerebral Arteriovenous Malformations

    PubMed Central

    Ellis, Jason A.; Lavine, Sean D.

    2014-01-01

    Cerebral arteriovenous malformations (AVMs) are complex high-flow lesions that can result in devastating neurological injury when they hemorrhage. Embolization is a critical component in the management of many patients with cerebral AVMs. Embolization may be used as an independent curative therapy or more commonly in an adjuvant fashion prior to either micro- or radiosurgery. Although the treatment-related morbidity and mortality for AVMs—including that due to microsurgery, embolization, and radiosurgery—can be substantial, its natural history offers little solace. Fortunately, care by a multidisciplinary team experienced in the comprehensive management of AVMs can offer excellent results in most cases. PMID:25624978

  3. [Hydatid disease diagnosed following a pulmonary embolism].

    PubMed

    Menassa-Moussa, L; Braidy, C; Riachy, M; Tabet, G; Smayra, T; Haddad-Zebouni, S; Ghossain, M; Aoun, N

    2009-11-01

    Hydatidosis is a parasitic disease found worldwide, particularly in Mediterranean countries, caused by Echinococcus granulosis infection. Humans are an intermediate and accidental host in the cycle of this parasite. The hydatid pulmonary arterial embolism is extremely rare, usually arising in the heart or the liver. We report a case of hydatid pulmonary embolism explored with multidetector scanner and MRI, and confirmed at pathology of the operative specimen. To our knowledge, this is the first case of inaugural hydatid pulmonary arterial embolism found on CT scan establishing the diagnosis of the disease in a patient who had no other location of hydatid cyst. PMID:19615835

  4. A New Flow Control Technique Using Diluted Epinephrine in the N-butyl-2-cyanoacrylate Embolization of Visceral Artery Pseudoaneurysms Secondary to Chronic Pancreatitis

    SciTech Connect

    Morishita, Hiroyuki; Yamagami, Takuji; Takeuchi, Yoshito; Matsumoto, Tomohiro; Asai, Shunsuke; Masui, Koji; Sato, Hideki; Taniguchi, Fumihiro; Sato, Osamu; Nishimura, Tsunehiko

    2012-08-15

    Although n-butyl-2-cyanoacrylate (NBCA) has been used as an effective liquid embolization material, its indication for pseudoaneurysms has seemingly been limited because of the technical difficulties of using NBCA, such as reflux to the parent artery and causing significant infarction. Thus, considerable skill in using NBCA or a device to control blood flow during its polymerization is required to achieve embolization without severe complications. We report our new technique for controlling blood flow using diluted epinephrine in transcatheter arterial NBCA embolization of five pseudoaneurysms in four cases secondary to hemosuccus pancreaticus.

  5. Initial Experience of Uterine Fibroid Embolization Using Porous Gelatin Sponge Particles

    SciTech Connect

    Katsumori, Tetsuya Kasahara, Toshiyuki; Oda, Minori; Kotani, Tomoya

    2011-06-15

    The purpose of this study was to prospectively assess the safety and effectiveness of uterine artery embolization (UAE) using porous gelatin particle (PGP; Gelpart; Asuterasu, Tokyo, Japan) for symptomatic uterine fibroids. Twenty-five consecutive premenopausal women underwent UAE with PGP. The angiographic end point of embolization was near stasis of the ascending uterine artery. Pelvic magnetic resonance imaging (MRI) was obtained before and after the procedure. Complications were assessed. The outcomes of technique, infarction rates of all fibroid tissue after UAE with contrast-enhanced MRI, change in symptoms and quality of life using serial Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaires, and additional interventions were evaluated. Bilateral UAE was successfully performed in all patients. Enhanced MRI 1 week after UAE showed that 100% infarction of all fibroid tissue was achieved in 65% (15 of 23) of patients; 90-99% infarction was achieved in 35% (8 of 23) of patients. Mean follow-up was 12 months (range 1-20). Symptom and QOL scores at baseline were 47.2 and 61.7, respectively. Both scores significantly improved to 26.3 (P < 0.001) and 82.4 (P < 0.001) at 4 months and to 20.4 (P < 0.001) and 77.6 (P < 0.001) at 1 year, respectively. No additional gynecologic interventions were performed in any patient. There were no major complications. Minor complications occurred in two patients. UAE using PGP is a safe and effective procedure and shows that outcomes after UAE, as measured with enhanced MRI and UFS-QOL questionnaires, seem comparable with those of UAE using other embolic agents. PGP is a promising embolic agent used for UAE to treat symptomatic uterine fibroids. Further comparative study between PGP and other established embolic agents is required.

  6. Simultaneous derivatization and solid-based disperser liquid-liquid microextraction for extraction and preconcentration of some antidepressants and an antiarrhythmic agent in urine and plasma samples followed by GC-FID.

    PubMed

    Farajzadeh, Mir Ali; Khorram, Parisa; Ghorbanpour, Houshang

    2015-03-01

    The present work is based on a one-step method including derivatization and solid-based disperser liquid-liquid microextraction followed by gas chromatography-flame ionization detection (GC-FID) for the determination of four antidepressants (fluoxetine, fluvoxamine, tranylcypromine, and nortriptyline) and an antiarrhythmic agent (mexiletine) in human urine and plasma samples. In this method, a mixture of 1,1,2,2-tetrachloroethane (extraction solvent) and butylchloroformate (derivatizing reagent) is added on a sugar cube (solid disperser) and it is introduced into an aqueous sample containing the analytes and a catalyst, e.g. 3-methylpyridine (picoline). During dissolving the sugar cube by manual shaking, the extractant and derivatization agent are gradually released into the sample as very fine droplets. Then the resulted cloudy solution is centrifuged and the sedimented phase is analyzed by GC-FID. The influence of several variables on the efficiency of derivatization/microextraction procedure such as kind and volume of extraction solvent, type and amount of disperser, amount of derivatization agent, and catalyst volume are optimized. Under the optimum conditions the calibration curves are linear in the range of 8-100,000μgL(-1) (coefficient of determination ≥0.994). The relative standard deviations are obtained in the range of 3.0-6.0% for all compounds. Moreover, the detection limits and enrichment factors of the target analytes are obtained in the ranges 1-15μgL(-1) and 228-268, respectively, for both plasma and urine samples. The relative recoveries obtained for the spiked plasma and urine samples are between 70 and 91%. The results show that the proposed method is simple, reliable, low cost, and applicable to determine trace amounts of the studied drugs in biological samples. PMID:25618251

  7. [Determination of four fluorescent whitening agents in laundry detergents by solid phase extraction combined with ultra-high performance liquid chromatography].

    PubMed

    Xian, Yanping; Guo, Xindong; Luo, Haiying; Wu, Yuluan; Chen, Yiguang; Luo, Donghui; Wu, Wenhai

    2013-02-01

    A new method was established to determine three stilbene-type disulfonate and one distyrylbiphenyl-type fluorescent whitening agents (FWA351, FWA85, FWA28 and FWA71) in laundry detergents by solid phase extraction (SPE) and ultra-high performance liquid chromatography with a diode array detector (UPLC-DAD). The fluorescent whitening agents were extracted from laundry detergents with 2% formic acid aqueous solution and methanol, and purified by WAX SPE column, and analyzed by UPLC-DAD on a Phenomenex Synergi Max-RP column (150 mm x 2.0 mm), employing acetonitrile-10 mmol/L ammonium acetate as the mobile phase in a gradient elution mode. The fluorescent whitening agents were qualitatively determined by retention time, and confirmed by the ultraviolet spectrum. The results indicated that the target analytes were in the range of 0.05-180 mg/L with the correlation coefficients (r) greater than 0. 999 3, and the method limits of quantification (MLOQ) of target analytes were ranged from 1.5 mg/kg to 15 mg/kg (S/N = 10). The feasibility of this method was demonstrated by the determination of FWAs in samples with spiked recoveries. The recoveries were in the range between 84.9% and 105%, and the precision (relative standard deviation, RSD) ranged from 3.2% to 6.1% (n = 6). Among the 15 samples analyzed, the rate of positive samples was 53.3%, over 1 000 mg/kg of FWA351 and FWA71 were detected. The method is simple, precise and has high recoveries for the determination of fluorescent whitening agents in laundry detergent samples. PMID:23697183

  8. Brain AVM Embolization with Onyx®: Analysis of Treatment in 34 Patients

    PubMed Central

    Leonardi, M.; Simonetti, L.; Cenni, P.; Raffi, L.

    2005-01-01

    Summary The endovascular approach to arteriovenous malformations (AVM) using different embolizing agents is a well-established treatment option. This report assesses the results of our experience using a non "glueing" embolic material available for several years, commercially known as Onyx®. We used Onyx to treat 34 consecutive patients in the last four years. All patients were treated in the same department by the same neuroradiological team, with a strictly repetitive technical strategy and procedural protocol. All our patients presented AVMs with Spetzler Grade 3 or more, because in our Institution Grade 1 or 2 AVMs are directly treated by surgical approach. We adopt a multidisciplinary treatment approach (embolization, surgery, radiotherapy) by which embolization is construed as work in progress offering definitive treatment of AVMs without severe risks. Embolization is mainly undertaken as the first step before surgery, to reduce flow and size of the AVM by a "targeted" technique. In addition to reducing lesion size, endovascular treatment aims to seal off AVM areas anatomically or haemodynamically complex for surgical treatment. Occasionally, the reduction in size allows a radiosurgical approach. Embolization seldom results in a definitive cure of AVMs. At the end of multimodal approach, we obtained the complete and definitive cure of AVM in 21/34 patients (two complete obliteration with interventional technique, 19 in combination with surgery); to these were added 5/34 patients who received radiosurgical therapy. No major complications arose during endovascular treatment. One patient had transitory (36 hour) impaired right arm pronation. The CT scan disclosed an asymptomatic mild SAH in the left sylvian fissure but no ischaemic areas. One patient still in treatment died from fatal rebleeding (the clinical onset had been with haemorrhage two weeks before the session) 12 days after the embolization. Excellent or good clinical outcome was obtained in 23

  9. Fat embolism syndromes following liposuction.

    PubMed

    Wang, Hui-Dong; Zheng, Jiang-Hong; Deng, Chen-Liang; Liu, Qin-Yang; Yang, Song-Lin

    2008-09-01

    Fat embolism syndrome (FES) after liposuction is likely a life-threatening disorder, though its incidence is low. The three chief clinical manifestations include respiratory insufficiency, cerebral involvement, and petechial rash. Although FES is a multisystem disorder, the most seriously affected organs are the lungs, brain, cardiavascular system, and skin. Many laboratory findings are characteristic but nonspecific. The pathogenesis of FES after liposuction has been looked at both mechanically and biochemically. Diagnosis is difficult; Gurd and Wilson's diagnostic criteria based on clinical examination is still extensively used in clinics at present. There is no specific therapy for FES after liposuction for the moment, so prevention, early diagnosis, and supportive therapies are important. In this article we discuss the clinical presentation, pathogensis, and current methods to prevent FES and, if possible, ways to treat this complication. PMID:18509699

  10. Coil Embolization for Intracranial Aneurysms

    PubMed Central

    2006-01-01

    Executive Summary Objective To determine the effectiveness and cost-effectiveness of coil embolization compared with surgical clipping to treat intracranial aneurysms. The Technology Endovascular coil embolization is a percutaneous approach to treat an intracranial aneurysm from within the blood vessel without the need of a craniotomy. In this procedure, a microcatheter is inserted into the femoral artery near the groin and navigated to the site of the aneurysm. Small helical platinum coils are deployed through the microcatheter to fill the aneurysm, and prevent it from further expansion and rupture. Health Canada has approved numerous types of coils and coil delivery systems to treat intracranial aneurysms. The most favoured are controlled detachable coils. Coil embolization may be used with other adjunct endovascular devices such as stents and balloons. Background Intracranial Aneurysms Intracranial aneurysms are the dilation or ballooning of part of a blood vessel in the brain. Intracranial aneurysms range in size from small (<12 mm in diameter) to large (12–25 mm), and to giant (>25 mm). There are 3 main types of aneurysms. Fusiform aneurysms involve the entire circumference of the artery; saccular aneurysms have outpouchings; and dissecting aneurysms have tears in the arterial wall. Berry aneurysms are saccular aneurysms with well-defined necks. Intracranial aneurysms may occur in any blood vessel of the brain; however, they are most commonly found at the branch points of large arteries that form the circle of Willis at the base of the brain. In 85% to 95% of patients, they are found in the anterior circulation. Aneurysms in the posterior circulation are less frequent, and are more difficult to treat surgically due to inaccessibility. Most intracranial aneurysms are small and asymptomatic. Large aneurysms may have a mass effect, causing compression on the brain and cranial nerves and neurological deficits. When an intracranial aneurysm ruptures and bleeds

  11. Clinical update on pulmonary embolism

    PubMed Central

    Keleşoğlu, Arif; Ardıç, Sadık

    2013-01-01

    Pulmonary embolism (PE) is a major cause of cardiovascular mortality and financial burden that affects the community. The diagnosis of PE can be difficult because of the nonspecific symptoms, which include cough, dyspnea, hemoptysis and pleuritic chest pain. Hereditary and acquired risk factors are associated with PE. Incidence of PE is increasing, associated with the development in the diagnostic methods. Evidence-based algorithms can help clinicians diagnose PE. Serum D-dimer level, computed tomography pulmonary angiogram (CTPA), ventilation-perfusion scintigraphy or echocardiography help to establish clinical probability and the severity of PE. Anticoagulation is the standard treatment for PE. However, thrombolytic treatment is a significant alternative in high risk of PE as it provides rapid clot resolution. This article reviews the risk factors, diagnostic algorithms, and methods of treatment in PE in the light of current information. PMID:25097588

  12. Pulmonary imaging in fat embolism syndrome.

    PubMed

    Park, H M; Ducret, R P; Brindley, D C

    1986-07-01

    Ventilation/perfusion lung scanning can be used to effectively detect fat embolism following skeletal trauma. Typical ventilation/perfusion findings may be present when the chest radiograph is normal, and clinical findings are equivocal. PMID:3731656

  13. Pathophysiology of spontaneous venous gas embolism

    NASA Technical Reports Server (NTRS)

    Lambertsen, C. J.; Albertine, K. H.; Pisarello, J. B.; Flores, N. D.

    1991-01-01

    The use of controllable degrees and durations of continuous isobaric counterdiffusion venous gas embolism to investigate effects of venous gas embolism upon blood, cardiovascular, and respiratory gas exchange function, as well as pathological effects upon the lung and its microcirculation is discussed. Use of N2O/He counterdiffusion permitted performance of the pathophysiologic and pulmonary microstructural effects at one ATA without hyperbaric or hypobaric exposures.

  14. Mortality and Embolic Potential of Cardiac Tumors

    PubMed Central

    Dias, Ricardo Ribeiro; Fernandes, Fábio; Ramires, Félix José Alvarez; Mady, Charles; Albuquerque, Cícero Piva; Jatene, Fábio Biscegli

    2014-01-01

    Background Cardiac tumors are rare, mostly benign with high embolic potential. Objectives To correlate the histological type of cardiac masses with their embolic potential, implantation site and long term follow up in patients undergoing surgery. Methods Between January 1986 and December 2011, we retrospectively analyzed 185 consecutive patients who underwent excision of intracardiac mass (119 females, mean age 48±20 years). In 145 patients, the left atrium was the origin site. 72% were asymptomatic and prior embolization was often observed (19.8%). The diagnosis was established by echocardiography, magnetic resonance and histological examination. Results Most tumors were located in the left side of the heart. Myxoma was the most common (72.6%), followed by fibromas (6.9%), thrombi (6.4%) and sarcomas (6.4%). Ranging from 0.6cm to 15cm (mean 4.6 ± 2.5cm) 37 (19.8%) patients had prior embolization, stroke 10.2%, coronary 4.8%, peripheral 4.3% 5.4% of hospital death, with a predominance of malignant tumors (40% p < 0.0001). The histological type was a predictor of mortality (rhabdomyomas and sarcomas p = 0.002) and embolic event (sarcoma, lipoma and fibroelastoma p = 0.006), but not recurrence. Tumor size, atrial fibrillation, cavity and valve impairment were not associated with the embolic event. During follow-up (mean 80±63 months), there were 2 deaths (1.1%) and two recurrences 1 and 11 years after the operation, to the same cavity. Conclusion Most tumors were located in the left side of the heart. The histological type was predictor of death and preoperative embolic event, while the implantation site carries no relation with mortality or to embolic event. PMID:25029470

  15. Fat embolism syndrome following bone marrow harvesting.

    PubMed

    Baselga, J; Reich, L; Doherty, M; Gulati, S

    1991-06-01

    A case of fat embolism syndrome is reported following an uncomplicated bone marrow harvest. The presenting symptoms were restlessness, shortness of breath and arterial hypoxemia. A lung perfusion scan ruled out the presence of a lung thromboembolism. The patient received supportive therapy and recovered within a few hours. We speculate that the larger gauge needle (13 vs 15) used to aspirate the bone marrow may have represented increased trauma to the iliac crest leading to fat embolism. PMID:1873595

  16. Pulmonary embolism--the role of thrombolytic therapy in its management.

    PubMed Central

    More, R. S.; Chauhan, A.

    1996-01-01

    In massive pulmonary embolism where there may be evidence of right ventricular dysfunction and acute pulmonary hypertension, anticoagulation therapy alone may prove inadequate. In such situations use of thrombolytic agents produces an improvement in haemodynamics compared to anticoagulants alone, although studies to date have been too small to address the issue of mortality benefit. It would appear that all age groups gain benefit from the use of thrombolytics. Studies that have compared thrombolytic agents and anticoagulants are discussed. In addition, the issues of the choice of thrombolytic agent and the different modes of delivery of therapy are addressed. Images Figure PMID:8731706

  17. Analysis of paralytic shellfish toxins, potential chemical threat agents, in food using hydrophilic interaction liquid chromatography-mass spectrometry.

    PubMed

    Jansson, Daniel; Åstot, Crister

    2015-10-23

    A novel method for determining paralytic shellfish toxin (PST) profiles in food was developed using a combination of silica and strong cation exchange (SCX) solid phase extraction (SPE) coupled to hydrophilic interaction liquid chromatography-tandem mass spectrometry (HILIC-MS/MS). Besides the risk for natural contamination of seafood and drinking water, PSTs also pose potent threats through intentional contamination of food, due to their high toxicity and the wide distributions of toxin-producing algae. The new preparation method aim to maintain the samples' original toxin profiles by avoiding conditions known to induce interconversion or degradation of the PSTs. The method was evaluated for PST extraction from water, milk, orange juice, apple purée, baby food, and blue mussels (Mytilus edulis). The extracts were found to produce reproducible retention times in HILIC-MS/MS analysis. When an authentic toxic mussel sample was analyzed using the novel method, saxitoxin and gonyautoxin-3 were identified, in agreement with data acquired using the Lawrence pre-column oxidation high-performance liquid chromatography-fluorescence detection (HPLC-FLD) method. Overall recoveries of the PSTs from tested foods by the novel method ranged from 36% to 111%. PMID:26404910

  18. Electrophoretic deposition of multi-walled carbon nanotubes on porous anodic aluminum oxide using ionic liquid as a dispersing agent

    NASA Astrophysics Data System (ADS)

    Hekmat, F.; Sohrabi, B.; Rahmanifar, M. S.; Jalali, A.

    2015-06-01

    Multi-wall carbon nanotubes (MW-CNTs) have been arranged in nanochannels of anodic aluminum oxide template (AAO) by electrophoretic deposition (EPD) to make a vertically-aligned carbon nanotube (VA-CNT) based electrode. Well ordered AAO templates were prepared by a two-step anodizing process by applying a constant voltage of 45 V in oxalic acid solution. The stabilized CNTs in a water-soluble room temperature ionic liquid (1-methyl-3-octadecylimidazolium bromide), were deposited in the pores of AAO templates which were conductive by deposition of Ni nanoparticles in the bottom of pores. In order to obtain ideal results, different EPD parameters, such as concentration of MWCNTs and ionic liquid on stability of MWCNT suspensions, deposition time and voltage which are applied in EPD process and also optimal conditions for anodizing of template were investigated. The capacitive performance of prepared electrodes was analyzed by measuring the specific capacitance from cyclic voltammograms and the charge-discharge curves. A maximum value of 50 Fg-1 at the scan rate of 20 mV s-1was achieved for the specific capacitance.

  19. FEMIC (Fibromes Embolises aux MICrospheres calibrees): Uterine Fibroid Embolization using Tris-acryl Microspheres. A French Multicenter Study

    SciTech Connect

    Joffre, Francis; Tubiana, Jean-Michel; Pelage, Jean-Pierre

    2004-11-15

    Purpose: A French multicenter registry was set up to confirm the safety and efficacy of large calibrated tris-acryl gelatin microspheres for embolization of symptomatic fibroids. Methods: Technical recommendations included embolization using large microspheres (>500 {mu}m) with no secondary embolization agent. Postprocedural pain, clinical improvement and adverse events were prospectively evaluated during a follow-up period of at least 6 months.Results: Eighty-five women complaining of fibroid-related symptoms entered the study. In seven women, a secondary embolization agent was used in addition to microspheres. Complete resolution of menorrhagia was achieved in 84% of women at 24 months and significant uterine and fibroid volume reductions were noted after 6 months (37% and 73%, respectively). Three women experienced definitive amenorrhea (4%) and two women required hysteroscopic resection of a fibroid. Eight women were treated by hysterectomy because of treatment failure. In seven of these women, treatment failure was explained by an additional cause of symptoms including diffuse adenomyosis, endometrial hyperplasia or ovarian artery supply to the fibroids.Conclusion: Limited uterine artery embolization using large microspheres has good clinical success rate with low postprocedural pain and complications. Women can expect excellent midterm results with a high level of symptom control and significant fibroid volume reduction. Confidence in the end-point recommended here may require the experience of several cases.

  20. Dosimetric measurements of an n-butyl cyanoacrylate embolization material for arteriovenous malformations

    SciTech Connect

    Labby, Zacariah E.; Chaudhary, Neeraj; Gemmete, Joseph J.; Pandey, Aditya S.; Roberts, Donald A.

    2015-04-15

    Purpose: The therapeutic regimen for cranial arteriovenous malformations often involves both stereotactic radiosurgery and endovascular embolization. Embolization agents may contain tantalum or other contrast agents to assist the neurointerventionalists, leading to concerns regarding the dosimetric effects of these agents. This study investigated dosimetric properties of n-butyl cyanoacrylate (n-BCA) plus lipiodol with and without tantalum powder. Methods: The embolization agents were provided cured from the manufacturer with and without added tantalum. Attenuation measurements were made for the samples and compared to the attenuation of a solid water substitute using a 6 MV photon beam. Effective linear attenuation coefficients (ELAC) were derived from attenuation measurements made using a portal imager and derived sample thickness maps projected in an identical geometry. Probable dosimetric errors for calculations in which the embolized regions are overridden with the properties of water were calculated using the ELAC values. Interface effects were investigated using a parallel plate ion chamber placed at set distances below fixed samples. Finally, Hounsfield units (HU) were measured using a stereotactic radiosurgery CT protocol, and more appropriate HU values were derived from the ELAC results and the CT scanner’s HU calibration curve. Results: The ELAC was 0.0516 ± 0.0063 cm{sup −1} and 0.0580 ± 0.0091 cm{sup −1} for n-BCA without and with tantalum, respectively, compared to 0.0487 ± 0.0009 cm{sup −1} for the water substitute. Dose calculations with the embolized region set to be water equivalent in the treatment planning system would result in errors of −0.29% and −0.93% per cm thickness of n-BCA without and with tantalum, respectively. Interface effects compared to water were small in magnitude and limited in distance for both embolization materials. CT values at 120 kVp were 2082 and 2358 HU for n-BCA without and with tantalum, respectively

  1. Determination of six chemotherapeutic agents in municipal wastewater using online solid-phase extraction coupled to liquid chromatography-tandem mass spectrometry.

    PubMed

    Rabii, Farida W; Segura, Pedro A; Fayad, Paul B; Sauvé, Sébastien

    2014-07-15

    Due to the increased consumption of chemotherapeutic agents, their high toxicity, carcinogenicity, their occurrence in the aquatic environment must be properly evaluated. An analytical method based on online solid-phase extraction coupled to liquid chromatography-tandem mass spectrometry was developed and validated. A 1 mL injection volume was used to quantify six of the most widely used cytotoxic drugs (cyclophosphamide, gemcitabine, ifosfamide, methotrexate, irinotecan and epirubicin) in municipal wastewater. The method was validated using standard additions. The validation results in wastewater influent had coefficients of determination (R(2)) between 0.983 and 0.998 and intra-day precision ranging from 7 to 13% (expressed as relative standard deviation %RSD), and from 9 to 23% for inter-day precision. Limits of detection ranged from 4 to 20 ng L(-1) while recovery values were greater than 70% except for gemcitabine, which is the most hydrophilic compound in the selected group and had a recovery of 47%. Matrix effects were interpreted by signal suppression and ranged from 55 to 118% with cyclophosphamide having the highest value. Two of the target anticancer drugs (cyclophosphamide and methotrexate) were detected and quantified in wastewater (effluent and influent) and ranged from 13 to 60 ng L(-1). The proposed method thus allows proper monitoring of potential environmental releases of chemotherapy agents. PMID:24388503

  2. Qualitative screening of veterinary anti-microbial agents in tissues, milk, and eggs of food-producing animals using liquid chromatography coupled with tandem mass spectrometry.

    PubMed

    Chen, Dongmei; Yu, Jie; Tao, Yanfei; Pan, Yuanhu; Xie, Shuyu; Huang, Lingli; Peng, Dapeng; Wang, Xu; Wang, Yulian; Liu, Zhenli; Yuan, Zonghui

    2016-04-01

    A method for the analysis of 120 drugs in animal derived food was developed using liquid chromatography-tandem mass spectrometry (LC-MS/MS). These analytes belong to 12 families of veterinary anti-microbial agents (quinolones, macrolides, β-lactams, nitroimidazoles, sulfonamides, lincomycines, chloramphenicols, quinoxalines, tetracyclines, polypeptides, and antibacterial synergists) as well as other compounds not assigned to a particular drug family. The animal derived food samples include muscle and liver of swine, bovine, sheep, and chicken, as well as hen eggs and dairy milk. The sample preparation included ultrasound-assisted extraction (UAE) with acetonitrile-water and a final clean-up with auto solid-phase extraction (SPE) on HLB cartridges. The detection and quantification of 120 anti-microbial agents was performed using LC-MS/MS in positive and negative ion mode. The chromatographic separation was performed on a C18 column using acetonitrile and 0.1% formic acid as the mobile phase. The limit of detection (LOD) and limit of quantification (LOQ) of all drugs in food-producing animals were 0.5-3.0μg/kg and 1.5-10.0μg/kg, respectively. The developed method was successfully utilized to monitor real samples, which demonstrated that it is a simple, fast, and robust method, and could be used as a regulatory to screen for the presence of residues from veterinary anti-microbial drugs in animal-derived foods. PMID:26950031

  3. Development of a liquid chromatography-multiple reaction monitoring procedure for concurrent verification of exposure to different forms of mustard agents.

    PubMed

    Yeo, Thong-Hiang; Ho, Mer-Lin; Loke, Weng-Keong

    2008-01-01

    A novel liquid chromatography-multiple reaction monitoring (LC-MRM) procedure has been developed for retrospective diagnosis of exposure to different forms of mustard agents. This concise method is able to validate prior exposure to nitrogen mustards (HN-1, HN-2, and HN-3) or sulfur mustard (HD) in a single run, which significantly reduces analysis time compared to separate runs to screen for different mustards' biomarkers based on tandem mass spectrometry. Belonging to one of the more toxic classes of chemical warfare agents, these potent vesicants bind covalently to the cysteine-34 residue of human serum albumin. This results in the formation of stable adducts whose identities were confirmed by a de novo sequencing bioinformatics software package. Our developed technique tracks these albumin-derived adduct biomarkers in blood samples which persist in vitro following exposure, enabling a detection limit of 200 nM of HN-1, 100 nM of HN-2, 200 nM of HN-3, or 50 nM of HD in human blood. The CWA-adducts formed in blood samples can be conveniently and sensitively analyzed by this MRM technique to allow rapid and reliable screening. PMID:18269793

  4. Characterization of aromatase binding agents from the dichloromethane extract of Corydalis yanhusuo using ultrafiltration and liquid chromatography tandem mass spectrometry.

    PubMed

    Shi, Jing; Zhang, Xiaoyu; Ma, Zhongjun; Zhang, Min; Sun, Fang

    2010-05-01

    Aromatase represents an important target for the treatment of hormone-dependent breast cancer. In the present study, nine alkaloids from the dichloromethane extract of Corydalis yanhusuo were identified by liquid chromatography tandem mass spectrometry (LC-MS/MS) and tested for their aromatase binding activities using an ultrafiltration LC-MS method by investigating the differences of peak areas of compounds before and after incubations with aromatase. It was demonstrated that the quaternary protoberberine alkaloids and the tertiary protoberberine alkaloids exhibited potent aromatase binding activities. The quaternary ammonium group and the methyl group at C-13 position of tertiary protoberberine alkaloids might be necessary for the activity. The findings should provide guidance for the discovery of potential aromatase inhibitors from natural products. PMID:20657498

  5. Wipe selection for the analysis of surface materials containing chemical warfare agent nitrogen mustard degradation products by ultra-high pressure liquid chromatography-tandem mass spectrometry.

    PubMed

    Willison, Stuart A

    2012-12-28

    Degradation products arising from nitrogen mustard chemical warfare agent were deposited on common urban surfaces and determined via surface wiping, wipe extraction, and liquid chromatography–tandem mass spectrometry detection. Wipes investigated included cotton gauze, glass fiber filter, non-woven polyester fiber and filter paper, and surfaces included several porous (vinyl tile, painted drywall, wood) and mostly non-porous (laminate, galvanized steel, glass) surfaces. Wipe extracts were analyzed by ultra-high pressure liquid chromatography–tandem mass spectrometry (UPLC–MS/MS) and compared with high performance liquid chromatography–tandem mass spectrometry (HPLC–MS/MS) results. An evaluation of both techniques suggests UPLC–MS/MS provides a quick and sensitive analysis of targeted degradation products in addition to being nearly four times faster than a single HPLC run, allowing for greater throughput during a wide-spread release concerning large-scale contamination and subsequent remediation events. Based on the overall performance of all tested wipes, filter paper wipes were selected over other wipes because they did not contain interferences or native species (TEA and DEA) associated with the target analytes, resulting in high percent recoveries and low background levels during sample analysis. Other wipes, including cotton gauze, would require a pre-cleaning step due to the presence of large quantities of native species or interferences of the targeted analytes. Percent recoveries obtained from a laminate surface were 47–99% for all nitrogen mustard degradation products. The resulting detection limits achieved from wipes were 0.2 ng/cm(2) for triethanolamine (TEA), 0.03 ng/cm(2) for N-ethyldiethanolamine (EDEA), 0.1 ng/cm(2) for N-methyldiethanolamine (MDEA), and 0.1 ng/cm(2) for diethanolamine (DEA). PMID:23218189

  6. Fate of the chemical warfare agent O-ethyl S-2-diisopropylaminoethyl methylphosphonothiolate (VX) on soil following accelerant-based fire and liquid decontamination.

    PubMed

    Gravett, M R; Hopkins, F B; Self, A J; Webb, A J; Timperley, C M; Riches, J R

    2014-08-01

    In the event of alleged use of organophosphorus nerve agents, all kinds of environmental samples can be received for analysis. These might include decontaminated and charred matter collected from the site of a suspected chemical attack. In other scenarios, such matter might be sampled to confirm the site of a chemical weapon test or clandestine laboratory decontaminated and burned to prevent discovery. To provide an analytical capability for these contingencies, we present a preliminary investigation of the effect of accelerant-based fire and liquid decontamination on soil contaminated with the nerve agent O-ethyl S-2-diisopropylaminoethyl methylphosphonothiolate (VX). The objectives were (a) to determine if VX or its degradation products were detectable in soil after an accelerant-based fire promoted by aviation fuel, including following decontamination with Decontamination Solution 2 (DS2) or aqueous sodium hypochlorite, (b) to develop analytical methods to support forensic analysis of accelerant-soaked, decontaminated and charred soil and (c) to inform the design of future experiments of this type to improve analytical fidelity. Our results show for the first time that modern analytical techniques can be used to identify residual VX and its degradation products in contaminated soil after an accelerant-based fire and after chemical decontamination and then fire. Comparison of the gas chromatography-mass spectrometry (GC-MS) profiles of VX and its impurities/degradation products from contaminated burnt soil, and burnt soil spiked with VX, indicated that the fire resulted in the production of diethyl methylphosphonate and O,S-diethyl methylphosphonothiolate (by an unknown mechanism). Other products identified were indicative of chemical decontamination, and some of these provided evidence of the decontaminant used, for example, ethyl 2-methoxyethyl methylphosphonate and bis(2-methoxyethyl) methylphosphonate following decontamination with DS2. Sample preparation

  7. Dispersive liquid-liquid microextraction using diethyldithiocarbamate as a chelating agent and the dried-spot technique for the determination of Fe, Co, Ni, Cu, Zn, Se and Pb by energy-dispersive X-ray fluorescence spectrometry

    NASA Astrophysics Data System (ADS)

    Kocot, Karina; Zawisza, Beata; Sitko, Rafal

    2012-07-01

    Dispersive liquid-liquid microextraction (DLLME) using sodium diethyldithiocarbamate (DDTC) as a chelating agent was investigated for the simultaneous determination of iron, cobalt, nickel, copper, zinc, selenium and lead ions in water samples. The procedure was performed using 5 mL of the sample, 100 μL of a 0.5% solution of DDTC, 30 μL of carbon tetrachloride (extraction phase) and 500 μL of methanol (disperser solvent). The experiments showed that Fe, Co, Ni, Cu, Zn and Pb can be simultaneously extracted at a pH of 5 and that Se can be extracted at a pH of 2-3. The results were compared with those obtained using ammonium pyrrolidine dithiocarbamate as a chelating agent. For all analytes, a linear range was observed up to 0.4 μg mL- 1. If Fe and Zn are present in concentrations 10 times higher than those of the other analytes, then the linearity is observed up to 0.2 μg mL- 1. In the present study, the organic phase that contained preconcentrated elements was deposited onto a Millipore filter and measured using energy-dispersive X-ray fluorescence spectrometry. The obtained detection limits were 2.9, 1.5, 2.0, 2.3, 2.5, 2.0 and 3.9 ng mL- 1 for Fe, Co, Ni, Cu, Zn, Se and Pb, respectively. This combination of DLLME and the dried-spot technique is promising for multielement analyses using other spectroscopy techniques, such as laser ablation-inductively coupled plasma-mass spectrometry, laser-induced breakdown spectroscopy or total-reflection X-ray fluorescence spectrometry.

  8. Amniotic fluid embolism: pathophysiology and new strategies for management.

    PubMed

    Kanayama, Naohiro; Tamura, Naoaki

    2014-06-01

    The registry program of amniotic fluid embolism (AFE) in Japan started in 2003. More than 400 hundred clinical diagnosed amniotic fluid embolism has been accumulated. Those data showed that there were two etiologies of AFE: the fetal materials create physical obstructions in the maternal microvessels in various organs, such as the lung; and (ii) the liquids cause an anaphylactoid reaction that leads to pulmonary vasospasm and activation of platelets, white blood cells and/or complements. The clinical findings showed that AFE was characterized mainly by cardiopulmonary collapse, the other involves the presence of disseminated intravascular coagulation (DIC) and atonic bleeding. Zinc coproporphyrin-1, sialyl Tn antigen (STN), complement C3, C4 and interleukin-8 have been used as serum markers of AFE. The levels of zinc coproporphyrin-1 and STN were increased in cardiopulmonary collapse type AFE, and a marked reduction of C3 and C4 was observed in DIC type AFE. At the primary medical institution, initial treatments for shock airway management, vascular management, fluid replacement, administration of anti-DIC therapy such as antithrombin, and administration of fresh frozen plasma should be provided. C1 esterase inhibitor activity in AFE cases was significantly lower than those of normal pregnant women. C1 esterase inhibitor may be a promising candidate of treatment of AFE. PMID:24888909

  9. Characterization of chemopreventive agents from the dichloromethane extract of Eurycorymbus cavaleriei by liquid chromatography-ion trap mass spectrometry.

    PubMed

    Cheng, Lin; Zhang, Xiaoyu; Zhang, Min; Zhang, Peng; Song, Zhihang; Ma, Zhongjun; Cheng, Yiyu; Qu, Haibin

    2009-06-12

    In the present study, we examined the potential chemopreventive activity of dichloromethane extract of Eurycorymbus cavaleriei by investigating the change of constitutions after incubation with glutathione (GSH). The major constitutions in the dichloromethane extract of E. cavaleriei were cumarin compounds and their cleavage pattern was examined by LC-MS-MS and the characteristic product ions at m/z 206 and 207 were helpful to determine the substitutions of coumarinolignoid compounds. The mechanism of conjugations of 5'-demethylaquillochin and its isomer with GSH was discussed and validated through analysis of the conjugations of reference compound 6-hydroxy-7-methoxycoumarin with GSH by LC-MS-MS and NMR spectrum. The relative ability to induce the detoxification enzyme, NAD(P)H:quinone oxidoreductase 1 (NQO1) of nine coumarin compounds was tested which also showed 5'-demethylaquillochin exhibited the most potential chemopreventive ability. These observations suggest that 5'-demethylaquillochin and its isomer from the dichloromethane extract of E. cavaleriei have potential as chemopreventive agents through induction of detoxification enzymes. PMID:19439309

  10. Potential Application of Biohydrogen Production Liquid Waste as Phosphate Solubilizing Agent-A Study Using Soybean Plants.

    PubMed

    Sarma, Saurabh Jyoti; Brar, Satinder Kaur; LeBihan, Yann; Buelna, Gerardo

    2016-03-01

    With CO2 free emission and a gravimetric energy density higher than gasoline, diesel, biodiesel, and bioethanol, biohydrogen is a promising green renewable energy carrier. During fermentative hydrogen production, 60-70 % of the feedstock is converted to different by-products, dominated by organic acids. In the present investigation, a simple approach for value addition of hydrogen production liquid waste (HPLW) containing these compounds has been demonstrated. In soil, organic acids produced by phosphate solubilizing bacteria chelate the cations of insoluble inorganic phosphates (e.g., Ca3 (PO4)2) and make the phosphorus available to the plants. Organic acid-rich HPLW, therefore, has been evaluated as soil phosphate solubilizer. Application of HPLW as soil phosphate solubilizer was found to improve the phosphorus uptake of soybean plants by 2.18- to 2.74-folds. Additionally, 33-100 % increase in seed germination rate was also observed. Therefore, HPLW has the potential to be an alternative for phosphate solubilizing biofertilizers available in the market. Moreover, the strategy can be useful for phytoremediation of phosphorus-rich soil. PMID:26541163

  11. Nontraumatic Fat Embolism Found Following Maternal Death after Cesarean Delivery

    PubMed Central

    Schrufer-Poland, Tabitha; Singh, Paul; Jodicke, Cristiano; Reynolds, Sara; Maulik, Dev

    2014-01-01

    Introduction Fat embolism is a rare form of nonthrombotic embolization. Limited literature exists regarding the diagnosis of fat embolism during the perinatal period. We present the first case of maternal death that resulted from nontraumatic fat embolization following Cesarean delivery. Case Description A 29-year-old gravida 1 with a complex medical and surgical history underwent a primary Cesarean delivery at term. On postoperative day 2 the patient was found to be unresponsive. Despite resuscitative efforts, the patient succumbed. Autopsy findings were remarkable for diffuse pulmonary fat emboli. Furthermore, there was no histological evidence of either amniotic fluid embolism or thromboembolism. The primary cause of death was attributed to nontraumatic fat embolization. Discussion Multiple risk factors may have contributed to the development of nontraumatic fat embolization in our patient. Obstetricians should maintain a high level of suspicion for nontraumatic fat embolization in cases of maternal respiratory decompression and sudden maternal mortality. PMID:26199788

  12. Nontraumatic Fat Embolism Found Following Maternal Death after Cesarean Delivery.

    PubMed

    Schrufer-Poland, Tabitha; Singh, Paul; Jodicke, Cristiano; Reynolds, Sara; Maulik, Dev

    2015-04-01

    Introduction Fat embolism is a rare form of nonthrombotic embolization. Limited literature exists regarding the diagnosis of fat embolism during the perinatal period. We present the first case of maternal death that resulted from nontraumatic fat embolization following Cesarean delivery. Case Description A 29-year-old gravida 1 with a complex medical and surgical history underwent a primary Cesarean delivery at term. On postoperative day 2 the patient was found to be unresponsive. Despite resuscitative efforts, the patient succumbed. Autopsy findings were remarkable for diffuse pulmonary fat emboli. Furthermore, there was no histological evidence of either amniotic fluid embolism or thromboembolism. The primary cause of death was attributed to nontraumatic fat embolization. Discussion Multiple risk factors may have contributed to the development of nontraumatic fat embolization in our patient. Obstetricians should maintain a high level of suspicion for nontraumatic fat embolization in cases of maternal respiratory decompression and sudden maternal mortality. PMID:26199788

  13. Pulmonary Artery Perforation Repair During Thrombectomy Using Microcoil Embolization

    SciTech Connect

    Tajima, Hiroyuki Murata, Satoru; Kumazaki, Tatsuo; Abe, Yutaka; Takano, Teruo

    2006-02-15

    A distal pulmonary artery perforation was successfully occluded by percutaneous microcoil embolization via a microcatheter. Microcoil embolization is a reasonable alternative therapeutic approach for this rare complication of pulmonary interventional procedures.

  14. Transcatheter arterial embolization in patients with kidney diseases: an overview of the technical aspects and clinical indications.

    PubMed

    Loffroy, Romaric; Rao, Pramod; Kwak, Byung-Kook; Ota, Shinichi; De Lin, Ming; Liapi, Eleni; Geschwind, Jean-François

    2010-01-01

    Therapeutic embolization is defined as the voluntary occlusion of one or several vessels, and this is achieved by inserting material into the lumen to obtain transient or permanent thrombosis in the downstream vascular bed. There are a number of indications for this approach in urological practice, in particular for the patients with parenchymatous or vascular kidney disease. In this review, we present the different embolization techniques and the principally employed occluding agents, and then we present the principal clinical indications and we discuss other pathologies that may benefit from this non-invasive therapy. The complications, side effects and main precautions associated with this approach are also described. PMID:20461179

  15. [Amniotic fluid embolism: an update].

    PubMed

    Legrand, M; Rossignol, M; Muller, F; Payen, D

    2013-03-01

    Amniotic fluid embolism (AFE) results from the passage of fœtal and amniotic fragments into the maternal circulation, occurring mostly within minutes before or after delivery. Although maternal and fœtal mortality of AFE remains high (about 40%), AFE should no longer be considered as having an ineluctable fatal course. Diagnosis is often made upon clinical presentation but histological confirmation is difficult owing favorable outcome and because an autopsy has not been performed. Identification of squamous cells in the maternal circulation could not confirm the diagnosis because of their possible maternal origin. High plasma level of insulin-like growth factor-binding protein-1 (IGFBP-1) has recently been identified as a biomarker of amniotic fluid passage into the maternal circulation and might therefore be used to confirm the diagnosis when lung tissue histology is not available. Treatment of AFE remains supportive with a special focus on correction of the coagulopathy and search for acute core pulmonale. In this later case, physicians should consider initiating an extracorporeal life support when facing a patient with refractory shock. Finally, caution is needed with the use of recombinant factor VIIa in this context. PMID:23422343

  16. Complications and Their Management During NBCA Embolization of Craniospinal Lesions

    PubMed Central

    Niimi, Y.; Berenstein, A.; Setton, A.

    2003-01-01

    Summary Technical complications during embolization of craniospinal lesions using NBCA may be classified as nonspecific catheterization-related or specific embolization-related. Catheterization-related complications include vessel injuries such as spasm, dissection or perforation, catheter injuries and thrombus formation. Embolization-related complications include occlusion of normal territories, migration of the embolic material to the venous side, and catheter gluing to the vessel wall. Causes, prevention and management of each complication are discussed with presentation of demonstrative cases. PMID:20591246

  17. Quantitative determination of the anticancer agent tubeimoside I in rat plasma by liquid chromatography coupled with mass spectrometry.

    PubMed

    Liang, Ming-Jin; Zhang, Wei-Dong; Zhang, Chuan; Liu, Run-Hui; Shen, Yun-Heng; Li, Hui-Liang; Wang, Xiao-Lin; Wang, Xiang-Wei; Zhu, Jian-Bao; Chen, Chun-Lin

    2007-01-01

    Tubeimoside I is an important component isolated from Bolbostemma paniculatum. Tubeimoside I has been demonstrated to possess many pharmacological activities, including anti-inflammatory, antitumor, and antitumor-promoting effects. The purpose of the present study was to examine in vivo pharmacokinetics and bioavailability of tubeimoside I in rats by using a liquid chromatography coupled with mass spectrometry quantitative detection method (LC/MS). The plasma samples were deproteinated, evaporated and reconstituted in 100 microl methanol prior to analysis. The separation was performed by Waters Symmetry C18 reversed-phase column (3.5 microm, 150 mm x 2.1mm, Waters Inc., USA) and a SB-C18 guard column (5 microm, 20 mm x 4.0mm). The mobile phase was a mixture of acetonitrile and water containing 5 microM NaAc (60:40, v/v). The method was validated within the concentration range 20-5000 ng/ml, and the calibration curves were linear with correlation coefficients >0.999. The lowest limit of quantitation (LLOQ) for tubeimoside I was 20 ng/ml in 0.1 ml rat plasma. The intra-assay accuracy and precision ranged from 92.4 to 104.9% and from 5.8 to 10.5%, respectively, while inter-assay accuracy and precision ranged from 94.2 to 95.0% and from 5.1 to 8.8%, respectively. The method was further applied to assess pharmacokinetics and oral bioavailability of tubeimoside I after intravenous and oral administration to rats. The oral bioavailability of tubeimoside I is only 0.23%, which indicates that tubeimoside I has poor absorption or undergoes acid-induced degradation. Practical utility of this new LC/MS method was confirmed in pilot pharmacokinetic studies in rats following both intravenous and oral administration. PMID:16931181

  18. Distal Embolic Protection for Renal Arterial Interventions

    SciTech Connect

    Dubel, Gregory J. Murphy, Timothy P.

    2008-01-15

    Distal or embolic protection has intuitive appeal for its potential to prevent embolization of materials generated during interventional procedures. Distal protection devices (DPDs) have been most widely used in the coronary and carotid vascular beds, where they have demonstrated the ability to trap embolic materials and, in some cases, to reduce complications. Given the frequency of chronic kidney disease in patients with renal artery stenosis undergoing stent placement, it is reasonable to propose that these devices may play an important role in limiting distal embolization in the renal vasculature. Careful review of the literature reveals that atheroembolization does occur during renal arterial interventions, although it often goes undetected. Early experience with DPDs in the renal arteries in patients with suitable anatomy suggests retrieval of embolic materials in approximately 71% of cases and renal functional improvement/stabilization in 98% of cases. The combination of platelet inhibition and a DPD may provide even greater benefit. Given the critical importance of renal functional preservation, it follows that everything that can be done to prevent atheroembolism should be undertaken including the use of DPDs when anatomically feasible. The data available at this time support a beneficial role for these devices.

  19. 21 CFR 868.2025 - Ultrasonic air embolism monitor.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Ultrasonic air embolism monitor. 868.2025 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Monitoring Devices § 868.2025 Ultrasonic air embolism monitor. (a) Identification. An ultrasonic air embolism monitor is a device used to detect air bubbles...

  20. 21 CFR 868.2025 - Ultrasonic air embolism monitor.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Ultrasonic air embolism monitor. 868.2025 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Monitoring Devices § 868.2025 Ultrasonic air embolism monitor. (a) Identification. An ultrasonic air embolism monitor is a device used to detect air bubbles...

  1. 21 CFR 868.2025 - Ultrasonic air embolism monitor.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Ultrasonic air embolism monitor. 868.2025 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Monitoring Devices § 868.2025 Ultrasonic air embolism monitor. (a) Identification. An ultrasonic air embolism monitor is a device used to detect air bubbles...

  2. Uterine artery embolization for the treatment of adenomyosis.

    PubMed

    Englander, Meridith J

    2008-12-01

    Adenomyosis is a benign uterine disorder that causes menorrhagia and dysmenorrhea. Although it was once considered a contraindication to uterine artery embolization, several authors have examined whether adenomyosis can be treated with uterine artery embolization. This article reviews the pathophysiology of adenomyosis, its imaging characteristics, as well as recent studies evaluating the efficacy of uterine artery embolization for treatment of adenomyosis. PMID:21326580

  3. 21 CFR 870.3300 - Vascular embolization device.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3300 Vascular embolization device. (a) Identification. A vascular embolization device is an intravascular implant intended to... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Vascular embolization device. 870.3300 Section...

  4. 21 CFR 870.3300 - Vascular embolization device.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3300 Vascular embolization device. (a) Identification. A vascular embolization device is an intravascular implant intended to... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Vascular embolization device. 870.3300 Section...

  5. 21 CFR 868.2025 - Ultrasonic air embolism monitor.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ultrasonic air embolism monitor. 868.2025 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Monitoring Devices § 868.2025 Ultrasonic air embolism monitor. (a) Identification. An ultrasonic air embolism monitor is a device used to detect air bubbles...

  6. 21 CFR 870.3300 - Vascular embolization device.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3300 Vascular embolization device. (a) Identification. A vascular embolization device is an intravascular implant intended to... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Vascular embolization device. 870.3300 Section...

  7. Effectiveness and pitfall of embolization of cerebral arteriovenous malformations.

    PubMed

    Miyachi, S; Negoro, M; Okamoto, T; Suzuki, O; Yoshida, J

    1999-11-01

    We studied the course ofperisurgical complications of 66 AVMs and discussed the approapriate precautions. Of 66 patients with AVMs, 14 underwent postembolization surgical removal, and 43 underwent radiosurgery. Four patients were cured with total occlusion of their AVM by embolization alone. 48 patients achieved a more than 70% occlusion of the nidus. We observed 12 complications including 3 permanent and 9 temporary. Four complications occurred immediately after the embolization due to overembolization or thromboembolism, and 7 were observed several hours later which might have been caused by retrograde thrombosis or a chemical reaction to the glue. While presurgical embolization deepseated feeders must be embolized along with fistulous or high-flow feeders, 4 cases of 2nd embolization following radiosurgery showed that meningeal feeders developed or recanalized in cases embolized with absorbable particles. Thus, preradiosurgically, fistulous and meningeal feeders should be treated, and the nidus must be packed with embolic materials with no risk of recanalization. Successful nidus packing performed in 10 AVMs yielded a further nidus reduction before radiosurgery. The intranidal aneurysms which pose a high risk of rebleeding were also embolized. In order to avoid complications in the embolization of AVM, the angioarchitecture, hemodynamics and the relationship to brain function should be well recognized by preoperative functional imaging and superselective angiograms, and adequate embolic materials should be properly injected. As an embolization strategy, the priority of the target feeders should depend on the treatment to follow, and aggressive embolization of risky feeders or causing abrupt hemodynamic change should be avoided. PMID:20670557

  8. In vitro evaluation of cashew nut shell liquid as a methane-inhibiting and propionate-enhancing agent for ruminants.

    PubMed

    Watanabe, Y; Suzuki, R; Koike, S; Nagashima, K; Mochizuki, M; Forster, R J; Kobayashi, Y

    2010-11-01

    Cashew nut shell liquid (CNSL) containing antibacterial phenolic compounds was evaluated for its potency as a feed additive for ruminants. In experiment 1, ruminal responses to CNSL supplementation were assessed using a batch culture system. Rumen fluid from cattle was diluted with artificial saliva and incubated for 18h in a batch culture with a mixed diet containing a 30:70 hay:concentrate diet to which raw or heated CNSL was added at a final concentration of 500 μg/mL. In experiment 2, a Rusitec, using rumen fluid from the same cattle, was operated over a period of 7 d during which only raw CNSL was tested at concentrations of 0, 50, 100, or 200 μg/mL, and variations in fermentation and bacterial population were assessed. In experiment 3, a pure culture study was conducted using selected bacteria to determine their susceptibility to CNSL. In experiment 1, methane production was inhibited by raw CNSL (56.9% inhibition) but not by heated CNSL. Total volatile fatty acid concentration was not affected, whereas increased concentrations of propionate and decreased concentrations of acetate and butyrate were observed using either raw or heated CNSL. These changes were more obvious when raw CNSL was tested. In experiment 2, raw CNSL inhibited methanogenesis and increased propionate production in a dose-dependent manner, showing maximum methane inhibition (70.1%) and propionate enhancement (44.4%) at 200 μg/mL supplementation. Raw CNSL increased total volatile fatty acid concentration and dry matter digestibility. Raw CNSL also appeared to induce a dramatic shift in the population of rumen microbiota, based on decreased protozoa numbers and changes in quantitative PCR assay values for representative bacterial species. In experiment 3, using pure cultures, raw CNSL prevented the growth of hydrogen-, formate-, and butyrate-producing rumen bacteria, but not the growth of bacteria involved in propionate production. Based on these data, raw CNSL, rich in the antibacterial

  9. Analysis of xylem sap from functional (nonembolized) and nonfunctional (embolized) vessels of Populus nigra: chemistry of refilling.

    PubMed

    Secchi, Francesca; Zwieniecki, Maciej A

    2012-10-01

    It is assumed that the refilling of drought-induced embolism requires the creation of an osmotic gradient between xylem parenchyma cells and vessel lumens to generate the water efflux needed to fill the void. To assess the mechanism of embolism repair, it is crucial to determine if plants can up-regulate the efflux of osmotically active substances into embolized vessels and identify the major components of the released osmoticum. Here, we introduce a new approach of sap collection designed to separate water from nonembolized (functional) and embolized (nonfunctional) vessels. This new approach made possible the chemical analysis of liquid collected from both types of vessels in plants subjected to different levels of water stress. The technique also allowed us to determine the water volumes in nonfunctional vessels as a function of stress level. Overall, with the increase of water stress in plants, the osmotic potential of liquid collected from nonfunctional vessels increased while its volume decreased. These results revealed the presence of both sugars and ions in nonfunctional vessels at elevated levels in comparison with liquid collected from functional vessels, in which only traces of sugars were found. The increased sugar concentration was accompanied by decreased xylem sap pH. These results provide new insight into the biology of refilling, underlining the role of sugar and sugar transporters, and imply that a large degree of hydraulic compartmentalization must exist in the xylem during the refilling process. PMID:22837359

  10. Nitration of the Birch Pollen Allergen Bet v 1.0101: Efficiency and Site-Selectivity of Liquid and Gaseous Nitrating Agents

    PubMed Central

    2014-01-01

    Nitration of the major birch pollen allergen Bet v 1 alters the immune responses toward this protein, but the underlying chemical mechanisms are not yet understood. Here we address the efficiency and site-selectivity of the nitration reaction of recombinant protein samples of Bet v 1.0101 with different nitrating agents relevant for laboratory investigations (tetranitromethane, TNM), for physiological processes (peroxynitrite, ONOO–), and for the health effects of environmental pollutants (nitrogen dioxide and ozone, O3/NO2). We determined the total tyrosine nitration degrees (ND) and the NDs of individual tyrosine residues (NDY). High-performance liquid chromatography coupled to diode array detection and HPLC coupled to high-resolution mass spectrometry analysis of intact proteins, HPLC coupled to tandem mass spectrometry analysis of tryptic peptides, and amino acid analysis of hydrolyzed samples were performed. The preferred reaction sites were tyrosine residues at the following positions in the polypeptide chain: Y83 and Y81 for TNM, Y150 for ONOO–, and Y83 and Y158 for O3/NO2. The tyrosine residues Y83 and Y81 are located in a hydrophobic cavity, while Y150 and Y158 are located in solvent-accessible and flexible structures of the C-terminal region. The heterogeneous reaction with O3/NO2 was found to be strongly dependent on the phase state of the protein. Nitration rates were about one order of magnitude higher for aqueous protein solutions (∼20% per day) than for protein filter samples (∼2% per day). Overall, our findings show that the kinetics and site-selectivity of nitration strongly depend on the nitrating agent and reaction conditions, which may also affect the biological function and adverse health effects of the nitrated protein. PMID:24517313

  11. Nitration of the birch pollen allergen Bet v 1.0101: efficiency and site-selectivity of liquid and gaseous nitrating agents.

    PubMed

    Reinmuth-Selzle, Kathrin; Ackaert, Chloé; Kampf, Christopher J; Samonig, Martin; Shiraiwa, Manabu; Kofler, Stefan; Yang, Hong; Gadermaier, Gabriele; Brandstetter, Hans; Huber, Christian G; Duschl, Albert; Oostingh, Gertie J; Pöschl, Ulrich

    2014-03-01

    Nitration of the major birch pollen allergen Bet v 1 alters the immune responses toward this protein, but the underlying chemical mechanisms are not yet understood. Here we address the efficiency and site-selectivity of the nitration reaction of recombinant protein samples of Bet v 1.0101 with different nitrating agents relevant for laboratory investigations (tetranitromethane, TNM), for physiological processes (peroxynitrite, ONOO(-)), and for the health effects of environmental pollutants (nitrogen dioxide and ozone, O₃/NO₂). We determined the total tyrosine nitration degrees (ND) and the NDs of individual tyrosine residues (NDY). High-performance liquid chromatography coupled to diode array detection and HPLC coupled to high-resolution mass spectrometry analysis of intact proteins, HPLC coupled to tandem mass spectrometry analysis of tryptic peptides, and amino acid analysis of hydrolyzed samples were performed. The preferred reaction sites were tyrosine residues at the following positions in the polypeptide chain: Y83 and Y81 for TNM, Y150 for ONOO(-), and Y83 and Y158 for O₃/NO₂. The tyrosine residues Y83 and Y81 are located in a hydrophobic cavity, while Y150 and Y158 are located in solvent-accessible and flexible structures of the C-terminal region. The heterogeneous reaction with O₃/NO₂ was found to be strongly dependent on the phase state of the protein. Nitration rates were about one order of magnitude higher for aqueous protein solutions (∼20% per day) than for protein filter samples (∼2% per day). Overall, our findings show that the kinetics and site-selectivity of nitration strongly depend on the nitrating agent and reaction conditions, which may also affect the biological function and adverse health effects of the nitrated protein. PMID:24517313

  12. Permanent Cortical Blindness After Bronchial Artery Embolization

    SciTech Connect

    Doorn, Colette S. van De Boo, Diederick W.; Weersink, Els J. M.; Delden, Otto M. van Reekers, Jim A. Lienden, Krijn P. van

    2013-12-15

    A 35-year-old female with a known medical history of cystic fibrosis was admitted to our institution for massive hemoptysis. CTA depicted a hypertrophied bronchial artery to the right upper lobe and showed signs of recent bleeding at that location. Bronchial artery embolization (BAE) was performed with gelfoam slurry, because pronounced shunting to the pulmonary artery was present. Immediately after BAE, the patient developed bilateral cortical blindness. Control angiography showed an initially not opacified anastomosis between the embolized bronchial artery and the right subclavian artery, near to the origin of the right vertebral artery. Cessation of outflow in the bronchial circulation reversed the flow through the anastomosis and allowed for spill of embolization material into the posterior circulation. Unfortunately the cortical blindness presented was permanent.

  13. Embolic protection devices in percutaneous coronary intervention.

    PubMed

    Meneguz Moreno, Rafael A; Costa, José R; Costa, Ricardo A; Abizaid, Alexandre

    2016-06-01

    Clinical benefit of percutaneous coronary intervention (PCI) depends on both angiographic success at lesion site as well as the restoration of adequate macro and microvascular perfusion. The pathophysiology of embolization from coronary lesions during PCI is multifactorial, being more frequently observed in patients with acute coronary syndrome and in those with lesions at saphenous vein graft (SVG). In this population, despite successful epicardial intervention, distal tissue perfusion may still be absent in up to a quarter of all PCI. Multiple devices and pharmacologic regimens have been developed and refined in an attempt to protect the microvascular circulation during PCI. Among them, embolic protection devices have raised as an attractive adjunctive toll due to their ability to retain debris and potentially prevent distal embolization, reducing major adverse cardiac events. Currently, their use has been validated for the treatment of SVG lesions but failed to show effectiveness in the percutaneous approach of acute coronary syndrome patients, including those with ST elevation myocardial infarction. PMID:27007782

  14. [Cerebral fat embolism after closed leg injury].

    PubMed

    Wiel, E; Fleyfel, M; Onimus, J; Godefroy, O; Leclerc, X; Adnet, P

    1997-01-01

    A 21-year-old man sustained a closed fracture of the leg from an industrial accident, without associated head trauma. The orthopaedic treatment consisted of immediate immobilization by setting leg in plaster. Two hours after admission, the Glasgow coma scale score was 10. Four hours after admission he developed a coma (Glasgow coma scale score = 7) with repetitive seizures. No lesion was visible on cerebral CT scan. Chest X-ray was unremarkable. Petechiae on the anterior chest wall and abdomen with bilateral mydriasis occurred. Thrombocytopenia with prothrombine time increase were observed. Magnetic resonance imaging, 27 hours after admission, showed high-intensity areas on T2 weighted views due to fat embolism. Retinal haemorrhages were observed. The bronchoalveolar lavage showing fat staining of tracheal aspirates confirmed the diagnosis of fat embolism. This case report emphasizes the possibility of predominant neurologic manifestations of a fat embolism and the diagnostic help of cerebral magnetic resonance imaging. PMID:9750647

  15. Coronary embolism in valvular heart disease.

    PubMed

    Charles, R G; Epstein, E J; Holt, S; Coulshed, N

    1982-01-01

    Coronary embolism is considered to be rare but recent evidence suggests that it may be underdiagnosed, and implicated in acute myocardial infarction associated with angiographically normal coronary arteries. Twenty-six patients were studied. In six, coronary embolism was a primary cause of death confirmed at autopsy. In 20 patients, 23 episodes of coronary embolism were diagnosed clinically. The left coronary system was occluded in 65 per cent, transient electrocardiographic changes occurred in 30 per cent, and either no history or an atypical history of acute myocardial infarction occurred in 29 per cent. Other systemic emboli occurred in 25 per cent. Aortic valve lesions were present in 70 per cent and combined mitral and aortic valve disease in 55 per cent of the patients. The incidence of coronary risk factors was low. Sequelae included increased dyspnoea (35 per cent), ventricular aneurysm (25 per cent) and cardiac failure (12 per cent). Angina rarely followed acute myocardial infarction. PMID:7111677

  16. Management of massive and nonmassive pulmonary embolism

    PubMed Central

    Sekhri, Vishal; Mehta, Nimeshkumar; Rawat, Naveen; Lehrman, Stuart G.

    2012-01-01

    Massive pulmonary embolism (PE) is characterized by systemic hypotension (defined as a systolic arterial pressure < 90 mm Hg or a drop in systolic arterial pressure of at least 40 mm Hg for at least 15 min which is not caused by new onset arrhythmias) or shock (manifested by evidence of tissue hypoperfusion and hypoxia, including an altered level of consciousness, oliguria, or cool, clammy extremities). Massive pulmonary embolism has a high mortality rate despite advances in diagnosis and therapy. A subgroup of patients with nonmassive PE who are hemodynamically stable but with right ventricular (RV) dysfunction or hypokinesis confirmed by echocardiography is classified as submassive PE. Their prognosis is different from that of others with non-massive PE and normal RV function. This article attempts to review the evidence-based risk stratification, diagnosis, initial stabilization, and management of massive and nonmassive pulmonary embolism. PMID:23319967

  17. DVT and pulmonary embolism: Part I. Diagnosis.

    PubMed

    Ramzi, Dino W; Leeper, Kenneth V

    2004-06-15

    The incidence of venous thromboembolic diseases is increasing as the U.S. population ages. At least one established risk factor is present in approximately 75 percent of patients who develop these diseases. Hospitalized patients and nursing home residents account for one half of all cases of deep venous thrombosis. A well-validated clinical prediction rule can be used for risk stratification of patients with suspected deep venous thrombosis. Used in combination with D-dimer or Doppler ultrasound tests, the prediction rule can reduce the need for contrast venography, as well as the likelihood of false-positive or false-negative test results. The inclusion of helical computed tomographic venography (i.e., a below-the-pelvis component) in pulmonary embolism protocols remains under evaluation. Specific combinations of a clinical prediction rule, ventilation-perfusion scanning, and D-dimer testing can rule out pulmonary embolism without an invasive or expensive investigation. A clinical prediction rule for pulmonary embolism is most helpful when it is used with subsequent evaluations such as ventilation-perfusion scanning, D-dimer testing, or computed tomography. Technologic advances are improving the resolution of helical computed tomography to allow detection of smaller emboli; however, further study is needed to provide definitive evidence supporting the role of this imaging technique in the diagnosis of pulmonary embolism. D-dimer testing is helpful clinically only when the result is negative. A negative D-dimer test can be used in combination with a clinical decision rule, ventilation-perfusion scanning, and/or helical computed tomography to lower the probability of pulmonary embolism to the point that aggressive treatment is not required. Evidence-based algorithms help guide the diagnosis of deep venous thrombosis and pulmonary embolism. PMID:15222648

  18. The Usefulness of Subcutaneous Infiltration of Epinephrine-Containing Lidocaine for Curative Transarterial Embolization of Dural Arteriovenous Fistula

    PubMed Central

    Yamauchi, Shigeru; Nishio, Akimasa; Takahashi, Yoshinobu; Mitsuhashi, Yutaka; Terakawa, Yuzo; Kawakami, Taichiro; Ohata, Kenji

    2014-01-01

    Summary Recently, transarterial embolization (TAE) with liquid embolic materials has been recognized as one of the curative therapeutic options for non-sinus type dural arteriovenous fistula (d-AVF). To prevent glue fragmentation and incomplete obliteration, flow reduction of transosseous high-flow feeders is one of the key points of this therapy. However, flow reduction of transosseous feeders is sometimes difficult with previously reported techniques such as particle embolization, manual compression, or proximal balloon occlusion. This report introduces a new technique to reduce the flow of transosseous feeders using epinephrine-containing lidocaine, and describes a case of intracranial d-AVF successfully treated with this technique. The usefulness and efficacy of the technique are discussed. PMID:24556305

  19. Pulmonary embolism: a clinician's perspective.

    PubMed

    Wells, Philip S

    2008-11-01

    Recent advances in the management of patients with suspected pulmonary embolism (PE) have both improved diagnostic accuracy as well as made management algorithms safer and more accessible. Physicians need to more frequently consider PE in patients with chest pain or dyspnea and should be aware of the proper diagnostic approach. Diagnostic strategies should include pretest clinical probability, D-dimer assays, and imaging tests. Although it has been proven that the use of algorithms result in better outcomes, there are patient-specific issues that must be considered. Approaches that use computed tomographic pulmonary angiography or ventilation-perfusion (V/Q) scanning appear equally safe, but each approach has advantages and disadvantages that should be appreciated to provide the best care. Ongoing clinical trials are evaluating whether these diagnostic processes can be made even easier and less expensive. Importantly, patients at low risk with a negative D-dimer can avoid imaging tests and those at moderate risk with a negative high sensitivity D-dimer can have venous thromboembolism excluded without the need for imaging. However, these patients also represent those most likely to have false-positive tests and clinically irrelevant PE. V/Q scanning may be more appropriate in premenopausal women, in those with renal dysfunction or diabetes, in those with known contrast allergies, and perhaps in patients with known family history of breast cancer. As with any illness, there is room for improvement in the management of PE, but it remains unknown whether preventive measures, diagnosis, treatment modalities, or physician or patient education should be the focus. PMID:19331834

  20. Lifesaving Embolization of Coronary Artery Perforation

    SciTech Connect

    Katsanos, Konstantinos; Patel, Sundip; Dourado, Renato; Sabharwal, Tarun

    2009-09-15

    Coronary artery perforation remains one of the most fearsome complications during cardiac catheterization procedures. Although emergent bypass surgery is the preferred treatment for cases with uncontrollable perforation, endovascular vessel sealing and arrest of bleeding with a combination of balloons, covered stents, or embolic materials have also been proposed. The authors describe a case of emergent lifesaving microcoil embolization of the distal right coronary artery in a patient with uncontrollable grade III guidewire perforation resulting in cardiac tamponade. The relevant literature is reviewed and the merits and limitations of the endovascular approach are highlighted.

  1. Fat embolism syndrome after combined aesthetic surgery.

    PubMed

    Erba, Paolo; Farhadi, Jian; Schaefer, Dirk Johannes; Pierer, Gerhard

    2011-02-01

    Fat embolism syndrome is a rare complication that develops after extended soft tissue disruption by liposuction, in particular if combined with time consuming, multiple procedures. Early signs are non-specific and often not considered, so that diagnosis and correct management may be delayed. We report a case in which liposuction combined with other aesthetic surgical procedures caused a fat embolism syndrome in a 46-year-old woman, which was followed by multiple organ failure and the development of sepsis with perimammary abscesses. Extended liposuction of the abdomen and thighs, bilateral augmentation mammaplasty, and stripping of both greater saphenous veins were combined. PMID:20158423

  2. Pulmonary endarterectomy after pulmonary infectious embolisms

    PubMed Central

    Heiberg, Johan; Ilkjær, Lars B.

    2013-01-01

    Pulmonary endarterectomy (PEA) is a well-established procedure in the treatment of chronic thromboembolic pulmonary hypertension (CTPH). The procedure is known to increase functional outcome and to raise the 5-year survival rate. We report 2 cases of pulmonary valve endocarditis and secondary embolisms causing sustained pulmonary hypertension. Both were treated with PEA. In none of the cases, a cleavage between the thrombotic masses and the vessel wall was obtainable, and both attempts were therefore inadequate. Based on our reports, we recommend not attempting PEA in cases of CTPH after infectious embolisms. PMID:23248168

  3. The fat embolism syndrome. A review.

    PubMed

    Levy, D

    1990-12-01

    While fat embolism occurs in most (more than 90%) patients with traumatic injury, the fat embolism syndrome (FES) occurs in only 3%-4% of patients with long-bone fractures. FES involves multiple organ systems and can cause a devastating clinical deterioration within hours. The major clinical features of FES include hypoxia, pulmonary edema, central nervous system depression, and axillary or subconjunctive petechiae. Improvements have been made in supporting the respiratory compromise and adult respiratory distress syndrome that these patients develop. Aggressive measures to improve the pulmonary function, i.e., positive pressure ventilation and effective fluid management, are important and expedite fixation of bone fractures. PMID:2245559

  4. MRI traceability of superparamagnetic iron oxide nanoparticle-embedded chitosan microspheres as an embolic material in rabbit uterus

    PubMed Central

    Choi, Sun Young; Kwak, Byung Kook; Shim, Hyung Jin; Lee, Jaehwi; Hong, Soon Uk; Kim, Kyung Ah

    2015-01-01

    PURPOSE We aimed to compare polyvinyl alcohol (PVA) particles with calibrated superparamagnetic iron oxide (SPIO) nanoparticle-loaded chitosan microspheres in a rabbit model, specifically regarding the relative distribution of embolic agents within the uterus based on magnetic resonance imaging (MRI) and pathological evaluation. METHODS Twelve New Zealand white rabbits underwent uterine artery embolization using either standard PVA particles (45–150 µm or 350–500 µm) or calibrated SPIO-embedded chitosan microspheres (45–150 µm or 300–500 µm). MRI and histopathological findings were compared one week after embolization. RESULTS Calibrated SPIO-loaded chitosan microspheres 45–150 µm in size were detected on T2-weighted images. On histological analysis, calibrated SPIO-embedded chitosan microspheres were found in both myometrium and endometrium, whereas PVA particles were found only in the perimyometrium or extrauterine fat pads. A proportional relationship was noted between the calibrated SPIO-embedded chitosan microsphere size and the size of the occluded artery. CONCLUSION Calibrated SPIO-embedded chitosan microspheres induced greater segmental arterial occlusion than PVA particles and showed great potential as a new embolic material. SPIO-embedded chitosan microspheres can be used to follow distribution of embolic particles through MRI studies. PMID:25333216

  5. Pulmonary and Cerebral Fat Embolism Syndrome After Total Knee Replacement

    PubMed Central

    Yeo, Soo Hyun; Chang, Hyuk Won; Sohn, Sung Il; Cho, Chul Hyun; Bae, Ki-Cheor

    2013-01-01

    Fat embolism occurs after long bone fracture or orthopedic surgery and usually shows mild symptom. But it rarely results in fat embolism syndrome, presenting as multiorgan dysfunction such as lung, brain and skin. Although the diagnosis of fat embolism syndrome is mostly based on clinical features, we experienced fat embolism syndrome involving lung and brain, showing typical imaging findings in pulmonary computed tomography and brain magnetic resonance image. So we present interesting case about fat embolism syndrome after total knee replacement with reviewing associated literatures including imaging findings. PMID:23671550

  6. Transcatheter Embolization of a Renal Artery Aneurysm Using Ethylene Vinyl Alcohol Copolymer

    SciTech Connect

    Rautio, Riitta Haapanen, Arto

    2007-04-15

    Our aim was to treat a clinically silent renal artery aneurysm. The patient was a 76-year-old man with elevated prostate-specific antigen and prostata biopsies with a gradus II-III adenocarcinoma who was incidentally found to have an aneurysm in his right renal artery. We performed a successful transcatheter embolization of the aneurysm using ethylene vinyl alcohol copolymer (Onyx). To avoid migration of the liquid material into the parent artery, a balloon was inflated in the orifice of the neck of the aneurysm while the liquid was injected. Five-month follow-up computed tomography (CT) imaging confirmed total occlusion of the aneurysm.

  7. Analysis of sulfate metabolites of the doping agents oxandrolone and danazol using high performance liquid chromatography coupled to tandem mass spectrometry.

    PubMed

    Rzeppa, S; Viet, L

    2016-09-01

    The direct detection of sulfate conjugates of anabolic androgenic steroids (AAS) can be a powerful tool in doping control analysis. By skipping the solvolysis step analysis time can be reduced, and due to long term sulfate metabolites the detection time can be significantly extended as demonstrated for some AAS. This study presents the successful identification of sulfate metabolites of the doping agents oxandrolone and danazol in excretion urines by high performance liquid chromatography coupled to tandem mass spectrometry (HPLC-MS/MS). The sulfate conjugate of 17β-hydroxymethyl-17α-methyl-18-nor-2-oxa-5α-androsta-13-en-3-one could be identified as a new metabolite of oxandrolone. Sulfate conjugates of the danazol metabolites ethisterone and 2α-hydroxymethylethisterone were identified in an excretion urine for the first time. In addition, these sulfate conjugates were synthesized successfully. For a confirmation analysis, the number of analytes can be increased by additional sulfate conjugates of danazol metabolites (2-hydroxymethyl-1,2-dehydroethisterone and 6β-hydroxy-2-hydroxymethylethisterone), which were also identified for the first time. The presented validation data underline the suitability of the identified sulfate conjugates for doping analysis with regard to the criteria given by the technical documents of the World Anti-Doping Agency (WADA). PMID:27394004

  8. Analysis by liquid chromatography-electrospray ionization tandem mass spectrometry and acute toxicity evaluation for beta-blockers and lipid-regulating agents in wastewater samples.

    PubMed

    Hernando, M D; Petrovic, M; Fernández-Alba, A R; Barceló, D

    2004-08-13

    This paper describes a multiresidue method for the extraction and determination of two therapeutic groups of pharmaceuticals, lipid-regulating agents (clofibric acid, bezafibrate, gemfibrocil, fenofibrate) and beta-blockers (atenolol, sotalol, metoprolol, betaxolol) in waters by solid-phase extraction followed by liquid chromatography-electrospray ionization tandem mass spectrometry (LC-ESI-MS-MS). Recoveries obtained from spiked HPLC water, as well as, from spiked real samples (sewage treatment plants influent and effluents, river and tap water) were all above 60%, with the exception of betaxolol with a 52% recovery. The quantitative MS analysis was performed using a multiple reaction monitoring. The LC-MS-MS method gave detection limits ranging from 0.017 to 1.25 microg/l in spiked effluent. Precision of the method, calculated as relative standard deviation, ranged from 3.7 to 18.5%. Individual and combined effects on Daphnia magna were evaluated for both therapeutic groups. Individual effects in culture medium showed these compounds as not harmful and not toxic, an exception is fenofibrate that was found to be harmful, but at high, in the environment unrealistic concentrations (EC50 of 50 mg/l). Combined effect in wastewater showed synergistic toxic effects at low concentration level (2 microg/l). PMID:15387181

  9. Examples of doping control analysis by liquid chromatography-tandem mass spectrometry: ephedrines, beta-receptor blocking agents, diuretics, sympathomimetics, and cross-linked hemoglobins.

    PubMed

    Thevis, Mario; Schänzer, Wilhelm

    2005-01-01

    The application of modern and powerful analytical instruments consisting of liquid chromatographs (LCs), sophisticated atmospheric pressure ion sources, and sensitive mass analyzers has improved quality as well as speed of doping control analyses markedly during the last 5 years. Numerous compounds such as beta-receptor blocking agents or diuretics require derivatization prior to gas chromatographic (GC) and mass spectrometric (MS) measurement, which is the reason for extended sample preparation periods. In addition, several substances demonstrate poor GC-MS properties even after chemical modification, and peptide hormones such as cross-linked hemoglobins cannot be analyzed at all by means of GC-MS. With the availability of electrospray ionization and robust tandem MSs (e.g., triple-stage quadrupole or ion trap instruments) many new or complementary screening and confirmation assays have been developed, providing detailed qualitative and quantitative information on prohibited drugs. With selected categories of compounds (ephedrines, beta-blockers, b2-agonists, diuretics, and bovine hemoglobin-based oxygen therapeutics) that are banned according to the rules of the World Anti-Doping Agency and International Olympic Committee, the advantages of LC-MS-MS procedures over conventional GC-MS assays are demonstrated, such as enhanced separation of analytes, shorter sample pretreatment, and identification of substances that are not identified by GC-MS. PMID:15808003

  10. Simultaneous determination of 11 fluorescent whitening agents in food-contact paper and board by ion-pairing high-performance liquid chromatography with fluorescence detection.

    PubMed

    Jiang, Dingguo; Chen, Lisong; Fu, Wusheng; Qiu, Hanquan

    2015-02-01

    4,4'-Diaminostilbene-2,2'-disulfonic acid based fluorescent whitening agents (DSD-FWAs) are prohibited in food-contact paper and board in many countries. In this work, a reliable high-performance liquid chromatography method was developed for the simultaneous determination of 11 common DSD-FWAs in paper material. Sample preparation and extraction as well as chromatographic separation of multicomponent DSD-FWAs were successfully optimized. DSD-FWAs in prepared samples were ultrasonically extracted with acetonitrile/water/triethylamine (40:60:1, v/v/v), separated on the C(18) column with the mobile phase containing tetrabutylammonium bromide, and then detected by a fluorescence detector. The limits of detection were 0.12-0.24 mg/kg, and the calibration curves showed the linear correlation (R(2) ≥ 0.9994) within the range of 8.0-100 ng/mL, which was equivalent to the range of 0.80-10 mg/kg in the sample. The average recoveries and the RSDs were 81-106% and 2-9% at two fortification levels (1.0 and 5.0 mg/kg) in paper bowls, respectively. The successful determination of 11 DSD-FWAs in food-contact paper and board obtained from local markets indicated that the newly developed method was rapid, accurate, and highly selective. PMID:25492053

  11. Determination of fluorescent whitening agents in environmental waters by solid-phase extraction and ion pair liquid chromatography-tandem mass spectrometry.

    PubMed

    Chen, Hsin-Chang; Wang, Shu-Ping; Ding, Wang-Hsien

    2006-01-13

    A comprehensive method for the trace determination of four stilbene-type disulfonate and one distyrylbiphenyl-type fluorescent whitening agents (FWAs) in environmental water samples was developed and validated. Various solid-phase extraction (SPE) cartridges were investigated. The newly developed Oasis WAX (weak mixed-mode anion exchange and reversed-phase sorbent) SPE cartridge provides the optimal sample extraction results. The analytes were then identified and quantitated by liquid chromatography-electrospray ionization tandem mass spectrometry (HPLC-ESI-MS-MS) in negative ionization mode, applying di-n-hexylammonium acetate (DHAA) as the ion-pairing reagent in mobile phase. Limits of quantitation (LOQs) were established between 4 and 18 ng/l in 50 ml of water samples. Intrabatch and interbatch precision with their accuracy at two concentration levels were also investigated. Precision for these five FWAs, as indicated by RSD, proved to be less than 13 and 11%, respectively, for intra- and interbatch. Accuracy, expressed as the mean recovery, was between 68 and 97%. The method was finally applied to environmental water samples, showing the occurrence of five FWAs in both river water and wastewater treatment plant (WWTP) effluent samples. PMID:16288762

  12. Determination of fluorescent whitening agents in laundry detergents and surface waters by solid-phase extraction and ion-pair high-performance liquid chromatography.

    PubMed

    Shu, Wei-Chuan; Ding, Wang-Hsien

    2005-09-23

    A simple method was developed to detect four stilbene-type disulfonate and one distyrylbiphenyl-type fluorescent whitening agents (FWAs) in household laundry detergents and surface waters by ion-pair high-performance liquid chromatography. The FWA concentrations in detergents were measured directly. The contents of FWAs in water samples were extracted by solid-phase extraction (C18-SPE) with ion-pairing reagent, and were then determined by an isocratic ion-pair chromatography (IPC) using a C18 column, applying tetrabutylammonium hydrogensulfate (TBA) as the ion-pairing reagent in mobile phase, and equipped with fluorescence detection. Water samples at various pH conditions for SPE were evaluated. Experimental results indicate that the proposed method is precise and sensitive in analyzing FWAs, and enables quantitation of 0.01-0.1 microg/l in 100 ml water samples. The recovery rates of FWAs in spiked water samples were between 73 and 89%, and the precision (RSD) ranged from 2.6 to 8.9%. Over 7200 microg/g of 4,4'-bis(2-sulfostryl)-biphenyl (DSBP) and 2320 microg/g of 4,4'-bis[(4-anilino-6-morpholino-1,3,5-triazine-2-yl)-amino]stilbene-2,2'-disulfonate (DAS1) were detected in household laundry detergents. Trace amounts of DSBP were detected in surface water samples ranging from 0.2 to 3.7 microg/l. PMID:16130754

  13. On-line solid phase extraction-liquid chromatography-mass spectrometry for trace determination of nerve agent degradation products in water samples.

    PubMed

    Røen, Bent T; Sellevåg, Stig R; Lundanes, Elsa

    2013-01-25

    Three primary nerve agent degradation products (ethyl-, isopropyl- and pinacolyl methylphosphonic acid) have been determined in water samples using on-line solid phase extraction-liquid chromatography and mass spectrometry (SPE-LC-MS) with electrospray ionisation. Porous graphitic carbon was employed for analyte enrichment followed by hydrophilic interaction chromatography. Diethylphosphate was applied as internal standard for quantitative determination of the alkyl methylphosphonic acids (AMPAs). By treating the samples with strong cation-exhange columns on Ba, Ag and H form, the major inorganic anions in water were removed by precipitation prior to the SPE-LC-MS determination. The AMPAs could be determined in tap water with limits of detection of 0.01-0.07 μg L(-1) with the [M-H](-) ions extracted at an accuracy of ±5 mDa. The within and between assay precisions at analyte concentrations of 5 μg L(-1) were 2-3%, and 5-9% relative standard deviation, respectively. The developed method was employed for determination of the AMPAs in three natural waters and a simulated waste water sample, spiked at 5 μg L(-1). Recoveries of ethyl-, isopropyl- and pinacolyl methylphosphonic acid were 80-91%, 92-103% and 99-106%, respectively, proving the applicability of the technique for natural waters of various origins. PMID:23312321

  14. Signature-Discovery Approach for Sample Matching of a Nerve-Agent Precursor using Liquid Chromatography–Mass Spectrometry, XCMS, and Chemometrics

    SciTech Connect

    Fraga, Carlos G.; Clowers, Brian H.; Moore, Ronald J.; Zink, Erika M.

    2010-05-15

    This report demonstrates the use of bioinformatic and chemometric tools on liquid chromatography mass spectrometry (LC-MS) data for the discovery of ultra-trace forensic signatures for sample matching of various stocks of the nerve-agent precursor known as methylphosphonic dichloride (dichlor). The use of the bioinformatic tool known as XCMS was used to comprehensively search and find candidate LC-MS peaks in a known set of dichlor samples. These candidate peaks were down selected to a group of 34 impurity peaks. Hierarchal cluster analysis and factor analysis demonstrated the potential of these 34 impurities peaks for matching samples based on their stock source. Only one pair of dichlor stocks was not differentiated from one another. An acceptable chemometric approach for sample matching was determined to be variance scaling and signal averaging of normalized duplicate impurity profiles prior to classification by k-nearest neighbors. Using this approach, a test set of dichlor samples were all correctly matched to their source stock. The sample preparation and LC-MS method permitted the detection of dichlor impurities presumably in the parts-per-trillion (w/w). The detection of a common impurity in all dichlor stocks that were synthesized over a 14-year period and by different manufacturers was an unexpected discovery. Our described signature-discovery approach should be useful in the development of a forensic capability to help in criminal investigations following chemical attacks.

  15. Cinnamaldehyde Characterization as an Antibacterial Agent toward E. coli Metabolic Profile Using 96-Blade Solid-Phase Microextraction Coupled to Liquid Chromatography-Mass Spectrometry.

    PubMed

    Mousavi, Fatemeh; Bojko, Barbara; Bessonneau, Vincent; Pawliszyn, Janusz

    2016-03-01

    Sampling and sample preparation plays an important role in untargeted analysis as it influences final composition of the analyzed extract and consequently reflection of the metabolome. In the current work, mechanism of bactericidal action of cinnamaldehyde (CA) against Escherichia coli (E. coli) during bacteria growth applying high-throughput solid-phase microextraction in direct immersion mode coupled to a high-performance liquid chromatography-mass spectrometry system was investigated. Numerous discriminant metabolites due to CA addition to the bacteria culture were mapped in the E. coli metabolic pathways. We propose new metabolic pathways confirming that CA acts as an oxidative stress agent against E. coli. The results of the current research have successfully demonstrated that CA changes the bacterial metabolism through interactions with different biochemical families such as proteins, nucleic acids, lipids, and carbohydrates, which needs further validation by proteomics and transcriptomics studies. The results presented here show the great potential of the novel approach in drug discovery and food safety. PMID:26811002

  16. Outcome of pelvic arterial embolization for postpartum hemorrhage: A retrospective review of 117 cases

    PubMed Central

    Cheong, Ji Yoon; Kong, Tae Wook; Son, Joo Hyuk; Won, Je Hwan; Yang, Jeong In

    2014-01-01

    Objective The aim of this study was to evaluate indications, efficacy, and complications associated with pelvic arterial embolization (PAE) for postpartum hemorrhage (PPH). Methods We retrospectively reviewed the medical records of 117 consecutive patients who underwent PAE for PPH between January 2006 and June 2013. Results In our single-center study, 117 women underwent PAE to control PPH refractory to conservative management including uterine massage, use of uterotonic agents, surgical repair of genital tract lacerations, and removal of retained placental tissues. Among 117 patients, 69 had a vaginal delivery and 48 had a Cesarean section. The major indication for embolization was uterine atony (54.7%). Other causes were low genital tract lacerations (21.4%) and abnormal placentation (14.5%). The procedure showed a clinical success rate of 88.0% with 14 cases of PAE failure; there were 4 hemostatic hysterectomies and 10 re-embolizations. On univariate analysis, PAE failure was associated with overt disseminated intravascular coagulation (P=0.009), transfusion of more than 10 red blood cell units (RBCUs, P=0.002) and embolization of both uterine and ovarian arteries (P=0.003). Multivariate analysis showed that PAE failure was only associated with transfusions of more than 10 RBCUs (odds ratio, 8.011; 95% confidence interval, 1.531-41.912; P=0.014) and embolization of both uterine and ovarian arteries (odds ratio, 20.472; 95% confidence interval, 2.715-154.365; P=0.003), which were not predictive factors, but rather, were the results of longer time for PAE. Three patients showed uterine necrosis and underwent hysterectomy. Conclusion PAE showed high success rates, mostly without procedure-related complications. Thus, it is a safe and effective adjunct or alternative to hemostatic hysterectomy, when primary management fails to control PPH. PMID:24596814

  17. Does preoperative transarterial embolization decrease blood loss during spine tumor surgery?

    PubMed Central

    Qiao, Zhihong; He, Qian

    2015-01-01

    This paper aimed to evaluate the effect of preoperative transarterial embolization (TAE) on estimated blood loss (EBL) during surgical excision of the vertebral tumors. Three hundred and forty-eight patients with spinal tumors were retrospectively analyzed. The preoperative TAE group consisted of 190 patients and the control group consisted of 158 patients. Gelatin sponge particles mixed withy contrast agent were used in the TAE group to embolize the tumor-feeding artery. The factors evaluated included: the time interval between embolism and surgery; the number of vertebrae involved by the tumor; pathological type of tumor; surgical approach; extent of excision and instrumental fixation. The time interval (P = 0.4669)between embolism and surgery had no significant correlation with EBL during surgery. The pathological diagnosis of vertebral tumor such as plasma cell myeloma, giant cell tumor, chondrosarcoma, hemangioma and metastasis had no significant correlation with EBL between the TAE group and control group during surgery, while the EBL of chordoma in the TAE group was significantly higher than that in the control group (p = 0.0254). The number of vertebrae involved (p = 0.4669, 0.6804, 0.6677), posterior approach (p = 0.3015), anterior approach (p = 0.2446), partial excision (p = 0.1911) and instrumental fixation (p = 0.1789) had no significant correlation with EBL during surgery between the TAE group and the control group. This study showed that preoperative TAE of the spinal tumor had no significant effect on intra-operative blood loss during surgical excision of the spinal tumor. In view of the risk of embolism, this method should be carefully considered. PMID:25934787

  18. Successful Transcatheter Embolotherapy with a New Platinum Microcoil: The Berenstein Liquid Coil

    SciTech Connect

    Ha-Kawa, Sang Kil; Kariya, Hideji; Murata, Takashi; Tanaka, Yoshimasa

    1998-07-15

    Purpose: To determine the usefulness of a new platinum microcoil, the Berenstein Liquid Coil for vascular embolization. Methods: Nine patients underwent transcatheter arterial embolization with liquid coils. The occluded vessels included the splenic artery in four patients, gastroduodenal artery in two, arteriovenous malformation or fistula in two, and middle hepatic artery in one. All coils were delivered with a saline flush through a Tracker-18 catheter. Results: All arteries except one were successfully occluded in a one-stage procedure using liquid coils. No friction was observed between the liquid coils and the microcatheter regardless of the tortuosity of the artery. Platelet counts in all patients had increased after splenic embolization. In two patients with liver tumors, perfusion to the inappropriate area during intraarterial chemotherapy was prevented by selective embolization. Life-threatening bleeding was successfully treated by gastroduodenal artery occlusion. No complications were encountered. Conclusion: The Berenstein Liquid Coil provides easy, safe, and rapid vascular occlusion.

  19. Selective Arterial Embolization of Idiopathic Priapism

    SciTech Connect

    Cohen, Gary S.; Braunstein, Larry; Ball, David S.; Roberto, Paul J.; Reich, Jeffrey; Hanno, Phillip

    1996-11-15

    We report a case of idiopathic priapism that was only identified as high-flow or arterial priapism after drainage of the corpora cavernosa. Following failure of conservative and surgical treatment attempts, two consecutive embolizations of a unilateral penile artery were performed with gelgoam particles.

  20. Venous air embolism during a craniofacial procedure.

    PubMed

    Phillips, R J; Mulliken, J B

    1988-07-01

    The possibility of venous air embolism exists whenever the craniofacial operative field is above the level of the heart. Craniotomy with the high-torque craniotome is hypothesized to have produced venous air embolism in the patient described in this report. The diagnosis of venous air embolism is determined by transesophageal Doppler probe, transesophageal echocardiogram or external echocardiogram, and end-tidal N2 and CO2 determinations. Treatment includes control of the air entry sites, aspiration of air from the right atrium via a catheter placed prior to operation, and discontinuing nitrous oxide. If these measures are unsuccessful, the operative field should be transposed below heart level and the procedure terminated. In the event of significant hemodynamic compromise, closed cardiac massage should be tried; if that fails, open cardiac massage and direct aspiration are necessary. The true incidence of venous air embolism in craniofacial operations may be much higher than previously suspected. We therefore recommend placement of appropriate monitoring equipment to detect intracardiac air in those major craniofacial procedures in which there is a potential for intravascular air ingress. PMID:3289061

  1. Acute Thrombo-embolic Renal Infarction.

    PubMed

    Zhou, Haijiang; Yan, Yong; Li, Chunsheng; Guo, Shubin

    2016-07-01

    A 65-year-old woman was admitted for acute onset of right lower abdominal pain. She was taking anticoagulant medication regularly for rheumatic valvular disease and atrial fibrillation. Physical examination revealed no obvious abdominal or flank tenderness. Right thrombo-embolic renal infarction was diagnosed after performing computed tomography angiography (CTA). PMID:27335786

  2. Cerebral Air Embolism from Angioinvasive Cavitary Aspergillosis

    PubMed Central

    Lin, Chen; Barrio, George A.; Hurwitz, Lynne M.; Kranz, Peter G.

    2014-01-01

    Background. Nontraumatic cerebral air embolism cases are rare. We report a case of an air embolism resulting in cerebral infarction related to angioinvasive cavitary aspergillosis. To our knowledge, there have been no previous reports associating these two conditions together. Case Presentation. A 32-year-old female was admitted for treatment of acute lymphoblastic leukemia (ALL). Her hospital course was complicated by pulmonary aspergillosis. On hospital day 55, she acutely developed severe global aphasia with right hemiplegia. A CT and CT-angiogram of her head and neck were obtained demonstrating intravascular air emboli within the left middle cerebral artery (MCA) branches. She was emergently taken for hyperbaric oxygen therapy (HBOT). Evaluation for origin of the air embolus revealed an air focus along the left lower pulmonary vein. Over the course of 48 hours, her symptoms significantly improved. Conclusion. This unique case details an immunocompromised patient with pulmonary aspergillosis cavitary lesions that invaded into a pulmonary vein and caused a cerebral air embolism. With cerebral air embolisms, the acute treatment option differs from the typical ischemic stroke pathway and the provider should consider emergent HBOT. This case highlights the importance of considering atypical causes of acute ischemic stroke. PMID:25197589

  3. Acute Renal Failure after Uterine Artery Embolization

    SciTech Connect

    Rastogi, Sachin; Wu, Yu-Hsin; Shlansky-Goldberg, Richard D.; Stavropoulos, S. William

    2004-09-15

    Renal failure is a potential complication of any endovascular procedure using iodinated contrast, including uterine artery embolization (UAE). In this report we present a case of acute renal failure (ARF) following UAE performed as a treatment for uterine fibroids. The likely causes of ARF in this patient are explored and the possible etiologies of renal failure in patients undergoing UAE are reviewed.

  4. A validated liquid chromatographic method for the determination of polycyclic aromatic hydrocarbons in honey after homogeneous liquid-liquid extraction using hydrophilic acetonitrile and sodium chloride as mass separating agent.

    PubMed

    Koltsakidou, Anastasia; Zacharis, Constantinos K; Fytianos, Konstantinos

    2015-01-16

    In the present report, a simple and cost-effective method for the determination of twelve US EPA priority polycyclic aromatic hydrocarbons (PAHs) in honey samples after salting-assisted liquid-liquid extraction and UHPLC with fluorescence detection is proposed. The sample treatment is based on the usage of hydrophilic acetonitrile as extraction solvent and its phase separation under high salinity conditions. Due to the high sugar content of the samples the phase separation is promoted effortlessly. Several parameters affecting the extraction efficiency and method sensitivity including the concentration of the honey samples, the type and volume of the extraction solvent, the type and quantity of the inorganic salt, extraction time and centrifugation time was systematically investigated. The method was validated in-house according to the Commission Decision 2002/657/EC guidelines. The limit of detection (LOD) of the method lay between 0.02 and 0.04ngmL(-1) (corresponding to 0.08 and 0.16ngg(-1)) which are close to the quality criteria established by European Regulation (EC) 836/2011 concerning the PAHs in foodstuffs. The mean analytical bias (expressed as relative recoveries) in all spiking levels was acceptable being in the range of 54-118% while the relative standard deviation (RSD) was lower than 19%. The proposed method has been satisfactorily applied for the analysis of the selected PAHs residues in various honey samples obtained from Greek region. PMID:25543304

  5. [Case of repeated hemoptysis successfully treated with bronchial artery embolization with N-butyl cyanoacrylate].

    PubMed

    Tamiya, Hiroyuki; Hirano, Satoshi; Morii, Sakae; Hanada, Shigeo; Beika, Yuka; Ishii, Satoru; Miyano, Shinsuke; Naka, Go; Izumi, Shinyu; Takeda, Yuichiro; Yoshizawa, Atsuto; Hojo, Masayuki; Sugiyama, Haruhito; Kobayashi, Nobuyuki; Kudo, Koichiro

    2009-05-01

    We report a case of repeated hemoptysis successfully treated with bronchial artery embolization (BAE) with N-butyl cyanoacrylate (NBCA). A 75-year-old woman with non-tuberculous mycobacteriosis and pulmonary aspergillosis was admitted with recurrent hemoptysis despite repeated BAE. Considering the ineffectiveness of BAE with Spongel or polyvinyl alcohol, BAE with NBCA was selected. Immediate cessation of hemoptysis was obtained and it has not been seen for 2 years. Although NBCA is the most widely used liquid embolic material to treat brain aneurysm, arteriovenous malformations or gastric varices, there are only a few cases are reported in the treatment of hemoptysis. It seems to be a possible useful treatment for patients with repeated hemoptysis. PMID:19514507

  6. Fat embolism in patients with fractured hips.

    PubMed

    Sevitt, S

    1972-04-29

    Fat embolism was assessed at necropsy and correlated with clinical findings in the patients who died among 854 with fractured hips admitted to hospital between 1967 and August 1971. Sixteen cases of clinical importance were found, eight of which were judged to have been fatal or to have seriously contributed to death. Frequencies were as follows: 2.4 to 3.3% among 424 patients with subcapital fractures; 0.7 to 0.8% in the 405 with trochanteric fractures; 4.1 to 7% among subjects treated without operation, representing 30% of those who died within seven days; and 0.9 to 1.1% among patients treated by pinning, nailing, or nail-plating. The higher frequency in the conservatively treated group is probably related to selection of poor-risk subjects. Fat embolism was found in 6.8 to 8.0% of those with subcapital fractures treated by primary Thompson's arthroplasty which utilizes acrylic cement, and in none of those given Moore's prostheses for which cement is not used. Study of a larger group after Moore's prosthesis is required to establish its lack of special risk. Fat embolism accounted for all the deaths within seven days of Thompson's arthroplasty and for most within 14 days; it was clearly related to surgery in some cases.A possible explanation of the hazard of Thompson's arthroplasty is that fat globule entry is enhanced by a rise of intramedullary pressure due to proximal occlusion of the reamed marrow cavity. A controlled trial of the effect of venting the marrow cavity on the frequency of fat embolism is warranted. It is possible that the acrylic monomer may also contribute to venous entry of medullary fat. The higher-age group of those with subcapital fractures and associated chronic cardiac and pulmonary disease might make them more susceptible to fat embolization than those in whom arthroplasty is also carried out for chronic hip disease. PMID:5022012

  7. Fat Embolism in Patients with Fractured Hips

    PubMed Central

    Sevitt, Simon

    1972-01-01

    Fat embolism was assessed at necropsy and correlated with clinical findings in the patients who died among 854 with fractured hips admitted to hospital between 1967 and August 1971. Sixteen cases of clinical importance were found, eight of which were judged to have been fatal or to have seriously contributed to death. Frequencies were as follows: 2·4 to 3·3% among 424 patients with subcapital fractures; 0·7 to 0·8% in the 405 with trochanteric fractures; 4·1 to 7% among subjects treated without operation, representing 30% of those who died within seven days; and 0·9 to 1·1% among patients treated by pinning, nailing, or nail-plating. The higher frequency in the conservatively treated group is probably related to selection of poor-risk subjects. Fat embolism was found in 6·8 to 8·0% of those with subcapital fractures treated by primary Thompson's arthroplasty which utilizes acrylic cement, and in none of those given Moore's prostheses for which cement is not used. Study of a larger group after Moore's prosthesis is required to establish its lack of special risk. Fat embolism accounted for all the deaths within seven days of Thompson's arthroplasty and for most within 14 days; it was clearly related to surgery in some cases. A possible explanation of the hazard of Thompson's arthroplasty is that fat globule entry is enhanced by a rise of intramedullary pressure due to proximal occlusion of the reamed marrow cavity. A controlled trial of the effect of venting the marrow cavity on the frequency of fat embolism is warranted. It is possible that the acrylic monomer may also contribute to venous entry of medullary fat. The higher-age group of those with subcapital fractures and associated chronic cardiac and pulmonary disease might make them more susceptible to fat embolization than those in whom arthroplasty is also carried out for chronic hip disease. PMID:5022012

  8. Associations and Outcomes of Septic Pulmonary Embolism

    PubMed Central

    Goswami, Umesh; Brenes, Jorge A; Punjabi, Gopal V; LeClaire, Michele M; Williams, David N

    2014-01-01

    Background: Septic pulmonary embolism is a serious but uncommon syndrome posing diagnostic challenges because of its broad range of clinical presentation and etiologies. Objective: To understand the clinical and radiographic associations of septic pulmonary embolism in patients presenting to an acute care safety net hospital. Methods: We conducted a retrospective analysis of imaging and electronic health records of all patients diagnosed with septic pulmonary embolism in our hospital between January 2000 and January 2013. Results: 41 episodes of septic pulmonary embolism were identified in 40 patients aged 17 to 71 years (median 46); 29 (72%) were men. Presenting symptoms included: febrile illness (85%); pulmonary complaints (66%) including pleuritic chest pain (22%), cough (19%) and dyspnea (15%); and those related to the peripheral foci of infection (24%) and shock (19%). Sources of infection included: skin and soft tissue (44%); infective endocarditis (27%); and infected peripheral deep venous thrombosis (17%). 35/41 (85%) were bacteremic with staphylococcus aureus. All patients had peripheral nodular lesions on chest CT scan. Treatment included intravenous antibiotics in all patients. Twenty six (63%) patients required pleural drainage and/or drainage of peripheral abscesses. Seven (17%) patients received systemic anticoagulants. Eight (20%) patients died due to various complications. Conclusion: The epidemiology of septic pulmonary embolism has broadened over the past decade with an increase in identified extrapulmonary, non-cardiac sources. In the context of an extrapulmonary infection, clinical features of persistent fever, bacteremia and pulmonary complaints should raise suspicion for this syndrome, and typical findings on the chest CT scans confirm the diagnosis. Antibiotics, local drainage procedures and increasingly, anticoagulation are keys to successful outcomes. PMID:25184008

  9. Microcoil Embolization for Acute Lower Gastrointestinal Bleeding

    SciTech Connect

    D'Othee, Bertrand Janne Surapaneni, Padmaja; Rabkin, Dmitry; Nasser, Imad; Clouse, Melvin

    2006-02-15

    Purpose. To assess outcomes after microcoil embolization for active lower gastrointestinal (GI) bleeding. Methods. We retrospectively studied all consecutive patients in whom microcoil embolization was attempted to treat acute lower GI bleeding over 88 months. Baseline, procedural, and outcome parameters were recorded following current Society of Interventional Radiology guidelines. Outcomes included technical success, clinical success (rebleeding within 30 days), delayed rebleeding (>30 days), and major and minor complication rates. Follow-up consisted of clinical, endoscopic, and pathologic data. Results. Nineteen patients (13 men, 6 women; mean age {+-} 95% confidence interval = 70 {+-} 6 years) requiring blood transfusion (10 {+-} 3 units) had angiography-proven bleeding distal to the marginal artery. Main comorbidities were malignancy (42%), coagulopathy (28%), and renal failure (26%). Bleeding was located in the small bowel (n = 5), colon (n 13) or rectum (n = 1). Technical success was obtained in 17 patients (89%); 2 patients could not be embolized due to vessel tortuosity and stenoses. Clinical follow-up length was 145 {+-} 75 days. Clinical success was complete in 13 (68%), partial in 3 (16%), and failed in 2 patients (11%). Delayed rebleeding (3 patients, 27%) was always due to a different lesion in another bowel segment (0 late rebleeding in embolized area). Two patients experienced colonic ischemia (11%) and underwent uneventful colectomy. Two minor complications were noted. Conclusion. Microcoil embolization for active lower GI bleeding is safe and effective in most patients, with high technical and clinical success rates, no procedure-related mortality, and a low risk of bowel ischemia and late rebleeding.

  10. Analysis of chemical warfare agents in organic liquid samples with magnetic dispersive solid phase extraction and gas chromatography mass spectrometry for verification of the chemical weapons convention.

    PubMed

    Singh, Varoon; Purohit, Ajay Kumar; Chinthakindi, Sridhar; Goud, Raghavender D; Tak, Vijay; Pardasani, Deepak; Shrivastava, Anchal Roy; Dubey, Devendra Kumar

    2016-05-27

    A simple, sensitive and low temperature sample preparation method is developed for detection and identification of Chemical Warfare Agents (CWAs) and scheduled esters in organic liquid using magnetic dispersive solid phase extraction (MDSPE) followed by gas chromatography-mass spectrometry analysis. The method utilizes Iron oxide@Poly(methacrylic acid-co-ethylene glycol dimethacrylate) resin (Fe2O3@Poly(MAA-co-EGDMA)) as sorbent. Variants of these sorbents were prepared by precipitation polymerization of methacrylic acid-co-ethylene glycol dimethacrylate (MAA-co-EGDMA) onto Fe2O3 nanoparticles. Fe2O3@poly(MAA-co-EGDMA) with 20% MAA showed highest recovery of analytes. Extractions were performed with magnetic microspheres by MDSPE. Parameters affecting the extraction efficiency were studied and optimized. Under the optimized conditions, method showed linearity in the range of 0.1-3.0μgmL(-1) (r(2)=0.9966-0.9987). The repeatability and reproducibility (relative standard deviations (RSDs) %) were in the range of 4.5-7.6% and 3.4-6.2% respectively for organophosphorous esters in dodecane. Limits of detection (S/N=3/1) and limit of quantification (S/N=10/1) were found to be in the range of 0.05-0.1μgmL(-1) and 0.1-0.12μgmL(-1) respectively in SIM mode for selected analytes. The method was successfully validated and applied to the extraction and identification of targeted analytes from three different organic liquids i.e. n-hexane, dodecane and silicon oil. Recoveries ranged from 58.7 to 97.3% and 53.8 to 95.5% at 3μgmL(-1) and 1μgmL(-1) spiking concentrations. Detection of diethyl methylphosphonate (DEMP) and O-Ethyl S-2-diisopropylaminoethyl methylphosphonothiolate (VX) in samples provided by the Organization for Prohibition of Chemical Weapons Proficiency Test (OPCW-PT) proved the utility of the developed method for the off-site analysis of CWC relevant chemicals. PMID:27113675

  11. Transarterial and Transvenous Embolization for Cavernous Sinus Dural Arteriovenous Fistulae

    PubMed Central

    Zhang, J.; Lv, X.; Jiang, C.; Li, Y.; Yang, X.; Wu, Z.

    2010-01-01

    Summary We report on the safety and efficacy of transarterial and transvenous Onyx embolization in the treatment of dural arteriovenous fistulae (DAVFs) of the cavernous sinus. We reviewed the findings from a retrospectively database for 22 patients with cavernous sinus DAVFs who were treated with either transarterial Onyx embolization alone (n = 8) or transarterial and transvenous Onyx embolization (n = 14) over a four year period. The mean follow-up period after endovascular treatment was 21.6 months (range 3-42 mths). Total number of embolizations was 27 for 22 patients. Two patients were treated transvenously after transarterial embolization. All 22 patients (100%) experienced improvement of their clinical symptoms. All 22 patients (100%) experienced total obliteration of their DAVFs, as documented by angiography performed at a mean follow-up of 5.8 months after the last treatment. No patient experienced a recurrence of symptoms after angiography showed DAVF obliteration. One patient exhibited temporary deterioration of ocular symptoms secondary to venous hypertension after near total obliteration; one had transient V cranial nerve deficit related to transarterial embolization, and two patients exhibited transient III and VI cranial nerve weakness related to transvenous embolization. Two patients experienced recurrent symptoms after incomplete transarterial embolization and underwent transvenous embolization at three and four months. Both patients achieved clinical and angiographic cures. Transarterial and transvenous embolization with Onyx, whenever possible, proved to be a safe and effective management for patients with cavernous sinus DAVFs. PMID:20977859

  12. A liquid chromatography tandem mass spectrometric method on in vitro nerve agents poisoning characterization and reactivator efficacy evaluation by determination of specific peptide adducts in acetylcholinesterase.

    PubMed

    Yan, Long; Chen, Jia; Xu, Bin; Guo, Lei; Xie, Yan; Tang, Jijun; Xie, Jianwei

    2016-06-10

    The terroristic availability of highly toxic nerve agents (NAs) highlights the necessity for a deep understanding of their toxicities and effective medical treatments. A liquid chromatography tandem mass spectrometry (LC-MS/MS) method for a characterization of the NAs poisoning and an evaluation on the efficacy of reactivators in in vitro was developed for the first time. After exposure to sarin or VX and pepsin digestion, the specific peptides of acetylcholinesterase (AChE) in a purified status, i.e. undecapeptide "GESAGAASVGM" in free, unaged, or aged status was identified and quantified. A key termination procedure is focused to make the reaction system "frozen" and precisely "capture" the poisoning, aging and spontaneous reactivation status of AChE, and the abundance of such specific peptides can thus be simultaneously measured. In our established method, as low as 0.72% and 0.84% inhibition level of AChE induced by 0.5nM sarin and VX can be detected from the measurement of peptide adducts, which benefits a confirmation of NAs exposure, especially at extremely low levels. Comparing with conventional colorimetric Ellman assays, our method provides not only enzyme activity and inhibition rate, but also the precise poisoning status of NAs exposed AChE. Based on the full information provided by this method, the efficacy of reactivators, such as HI-6, obidoxime and pralidoxime, in the typical treatment of NAs poisoned AChE in in vitro was further evaluated. Our results showed that this method is a promising tool for the characterization of NAs poisoning and the evaluation of reactivator efficacy. PMID:27179675

  13. Analytics of nonpeptidic erythropoietin mimetic agents in sports drug testing employing high-resolution/high-accuracy liquid chromatography-mass spectrometry.

    PubMed

    Vogel, Matthias; Dib, Josef; Tretzel, Laura; Piper, Thomas; Thomas, Andreas; Schänzer, Wilhelm; Thevis, Mario

    2016-09-01

    Since its release as anti-anemic drug, recombinant erythropoietin (rEPO) gradually entered the illicit way to sports competitions as endurance-enhancing drug. Novel modifications biopharmaceutically introduced into the rEPO molecule in the form of carbohydrate or polyethylene glycol moieties made robust and sensitive test methods vital to doping controls in order to provide the necessary tools enabling the conviction of dishonest athletes. Modern protein analysis by means of gel electrophoretic separation and western blotting represents the status quo in rEPO anti-doping analysis. However, new therapeutically promising erythropoietin receptor activating compounds have been developed that exhibit cytokine hormone-mimicking properties but lack any protein structure. Progression to evade parenteral application and substitute for rEPO by low molecular mass and orally available compounds is still one of the major objectives in pharmaceutical research. In this approach, four promising in-house synthesized nonpeptidic erythropoietin mimetic agents, namely compound 129, compound 163, A1B10C1, and A5B10C4 were thoroughly evaluated by employing high-resolution/high-accuracy liquid chromatography tandem mass spectrometry experiments. Characteristic product ions were determined supporting the identification of these drugs and putative metabolites as well as related compounds in future doping controls. Test methods employing direct urine injection and receptor affinity purification strategies were assessed, which demonstrated that EPO receptor purification is of limited utility for nonpeptidic EPOR agonists while direct urine injection allowed for comprehensive method characterization. Thereby, achieved limits of detection were 1 ng/mL for compounds 129/163 and 5 ng/mL for A1B10C1/A5B10C4. PMID:27438721

  14. Process and device for injecting a liquid agent used for treating a geological formation in the vicinity of a well bore traversing this formation

    SciTech Connect

    Colonna, J.; Fitremann, Jm.; Genin, R.; Sarda, Jp.

    1984-02-14

    A technique is disclosed for liquid treating a geological formation. It comprises spraying the liquid with a pressurized carrier gas, using a spraying pipe whose length and diameter are adjusted as a function of the pressure prevailing at the level of the formation and of the characteristics of the injected liquid and the pressurized carrier gas, so that the size of the liquid droplets at the outlet of the spraying pipe has a narrow range of distribution about a single preselected value.

  15. In Situ Visualization of the Dynamics in Xylem Embolism Formation and Removal in the Absence of Root Pressure: A Study on Excised Grapevine Stems.

    PubMed

    Knipfer, Thorsten; Cuneo, Italo F; Brodersen, Craig R; McElrone, Andrew J

    2016-06-01

    Gas embolisms formed during drought can disrupt long-distance water transport through plant xylem vessels, but some species have the ability to remove these blockages. Despite evidence suggesting that embolism removal is linked to the presence of vessel-associated parenchyma, the underlying mechanism remains controversial and is thought to involve positive pressure generated by roots. Here, we used in situ x-ray microtomography on excised grapevine stems to determine if embolism removal is possible without root pressure, and if the embolism formation/removal affects vessel functional status after sample excision. Our data show that embolism removal in excised stems was driven by water droplet growth and was qualitatively identical to refilling in intact plants. When stem segments were rehydrated with H2O after excision, vessel refilling occurred rapidly (<1 h). The refilling process was substantially slower when polyethylene glycol was added to the H2O source, thereby providing new support for an osmotically driven refilling mechanism. In contrast, segments not supplied with H2O showed no refilling and increased embolism formation. Dynamic changes in liquid/wall contact angles indicated that the processes of embolism removal (i.e. vessel refilling) by water influx and embolism formation by water efflux were directly linked to the activity of vessel-associated living tissue. Overall, our results emphasize that root pressure is not required as a driving force for vessel refilling, and care should be taken when performing hydraulics measurements on excised plant organs containing living vessel-associated tissue, because the vessel behavior may not be static. PMID:27208267

  16. In Situ Visualization of the Dynamics in Xylem Embolism Formation and Removal in the Absence of Root Pressure: A Study on Excised Grapevine Stems1[OPEN

    PubMed Central

    Knipfer, Thorsten; Cuneo, Italo F.; Brodersen, Craig R.; McElrone, Andrew J.

    2016-01-01

    Gas embolisms formed during drought can disrupt long-distance water transport through plant xylem vessels, but some species have the ability to remove these blockages. Despite evidence suggesting that embolism removal is linked to the presence of vessel-associated parenchyma, the underlying mechanism remains controversial and is thought to involve positive pressure generated by roots. Here, we used in situ x-ray microtomography on excised grapevine stems to determine if embolism removal is possible without root pressure, and if the embolism formation/removal affects vessel functional status after sample excision. Our data show that embolism removal in excised stems was driven by water droplet growth and was qualitatively identical to refilling in intact plants. When stem segments were rehydrated with H2O after excision, vessel refilling occurred rapidly (<1 h). The refilling process was substantially slower when polyethylene glycol was added to the H2O source, thereby providing new support for an osmotically driven refilling mechanism. In contrast, segments not supplied with H2O showed no refilling and increased embolism formation. Dynamic changes in liquid/wall contact angles indicated that the processes of embolism removal (i.e. vessel refilling) by water influx and embolism formation by water efflux were directly linked to the activity of vessel-associated living tissue. Overall, our results emphasize that root pressure is not required as a driving force for vessel refilling, and care should be taken when performing hydraulics measurements on excised plant organs containing living vessel-associated tissue, because the vessel behavior may not be static. PMID:27208267

  17. Transcatheter Arterial Embolization as a Treatment for Medial Knee Pain in Patients with Mild to Moderate Osteoarthritis

    SciTech Connect

    Okuno, Yuji; Korchi, Amine Mohamed; Shinjo, Takuma; Kato, Shojiro

    2015-04-15

    PurposeOsteoarthritis is a common cause of pain and disability. Mild to moderate knee osteoarthritis that is resistant to nonsurgical options and not severe enough to warrant joint replacement represents a challenge in its management. On the basis of the hypothesis that neovessels and accompanying nerves are possible sources of pain, previous work demonstrated that transcatheter arterial embolization for chronic painful conditions resulted in excellent pain relief. We hypothesized that transcatheter arterial embolization can relieve pain associated with knee osteoarthritis.MethodsTranscatheter arterial embolization for mild to moderate knee osteoarthritis using imipenem/cilastatin sodium or 75 μm calibrated Embozene microspheres as an embolic agent has been performed in 11 and three patients, respectively. We assessed adverse events and changes in Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores.ResultsAbnormal neovessels were identified within soft tissue surrounding knee joint in all cases by arteriography. No major adverse events were related to the procedures. Transcatheter arterial embolization rapidly improved WOMAC pain scores from 12.2 ± 1.9 to 3.3 ± 2.1 at 1 month after the procedure, with further improvement at 4 months (1.7 ± 2.2) and WOMAC total scores from 47.3 ± 5.8 to 11.6 ± 5.4 at 1 month, and to 6.3 ± 6.0 at 4 months. These improvements were maintained in most cases at the final follow-up examination at a mean of 12 ± 5 months (range 4–19 months).ConclusionTranscatheter arterial embolization for mild to moderate knee osteoarthritis was feasible, rapidly relieved resistant pain, and restored knee function.

  18. Spontaneous Hemothorax in Neurofibromatosis Treated with Percutaneous Embolization

    SciTech Connect

    Arai, Kazunori; Sanada, Junichiro Kurozumi, Akiko; Watanabe, Toshio; Matsui, Osamu

    2007-06-15

    We evaluated the effectiveness of transcatheter arterial coil embolization therapy for the treatment of spontaneous hemothorax followed by aneurysm rupture in neurofibromatosis patients. Three patients were treated for massive hemothorax caused by arterial lesions associated with neurofibromatosis. Bleeding episodes were secondary to ascending cervical artery aneurysm and dissection of vertebral artery in 1 patient, and intercostal artery aneurysm with or without arteriovenous fistula in 2 patients. Patients were treated by transarterial coil embolization combined with chest drainage. In 1 patient, the ruptured ascending cervical artery aneurysm was well embolized but, shortly after the embolization, fatal hemorrhage induced by dissection of the vertebral artery occurred and the patient died. In the other 2 patients, the ruptured intercostal artery aneurysm was well embolized and they were successfully treated and discharged. Transcatheter arterial coil embolization therapy is an effective method for the treatment of spontaneous hemothorax followed by aneurysm rupture in neurofibromatosis patients.

  19. Massive Pulmonary Calculi Embolism: A Novel Complication of Pneumatic Lithotripsy

    PubMed Central

    Zhang, Lin; Zhou, Yiwu

    2015-01-01

    Abstract Pneumatic lithotripsy is a minimally invasive technique mainly for the treatment of urinary staghorn stones. Previous literatures have reported some therapeutic complications during or after this procedure, but calculi embolism has not been mentioned before. We report here a fatal case of calculi-induced pulmonary embolism in an adult woman who underwent pneumatic lithotripsy. An autopsy did not reveal any evidence of pulmonary embolism. However, light microscopy revealed noticeable presence of calculi in pulmonary arterioles and capillaries, as evidenced by environmental scanning electron microscope and energy dispersive X-ray analysis. The primary determinants of calculi embolism include intrarenal pressure, and volume and viscosity of the calculi fragments formation. Vascular intravasation of smashed calculi might increase pulmonary vascular resistance and hypoxemia and decrease cardiac output. This case report intends to provide information for clinicians to consider the probability of intraoperative calculi embolism during lithotripsies when patients develop typical symptoms of acute pulmonary embolism. PMID:26222867

  20. Serum and urinary enzyme activities in renal artery embolism.

    PubMed

    Donadio, C; Auner, I; Giordani, R; Lucchetti, A; Pentimone, F

    1986-10-31

    Renal artery embolism is not a rare occurrence, especially in patients with valvular heart disease, but the early diagnosis of this condition is infrequently accomplished. We report the clinical and laboratory data of 2 patients with valvular heart disease who presented with unilateral renal artery embolization. The usefulness of the determination of serum and urinary enzymes and renal function tests is discussed. We propose that these parameters support an earlier and more accurate diagnosis of renal artery embolism. PMID:2877758

  1. Venous air embolism following insufflation of the urethra.

    PubMed

    Vanlinthout, L; Boghaert, A; Thienpont, L

    1986-01-01

    Venous air embolism following urethral inflation only scarcely documented: an extensive search of the literature yielded four papers relating to this subject. We report a new case of venous air embolism due to this uncommon etiology. Careful study revealed some common pathogenetic features with previously reported cases. Some important precautions can diminish the likelihood of gas embolism and reduce its fatal outcome in situations, similar to the kind mentioned. PMID:3564882

  2. Successful Embolization of an Ovarian Artery Pseudoaneurysm Complicating Obstetric Hysterectomy

    SciTech Connect

    Rathod, Krantikumar R Deshmukh, Hemant L; Asrani, Ashwin; Salvi, Vinita S; Prabhu, Santoshi

    2005-01-15

    Transcatheter arterial embolization is becoming the therapy of choice for controlling obstetric hemorrhage, affording the ability to control persistent bleeding from pelvic vessels while avoiding the morbidity of surgical exploration. The clinicians are left with little choice if pelvic hemorrhage continues after hysterectomy and ligation of anterior division of both internal iliac arteries. We present one such case of intractable post-obstetric hysterectomy hemorrhage in which an ovarian artery pseudoaneurysm was diagnosed angiographically and successfully embolized, highlighting the role of transcatheter embolization.

  3. Postoperative hypoxemia due to fat embolism

    PubMed Central

    Bhalla, Tarun; Sawardekar, Amod; Klingele, Kevin; Tobias, Joseph D.

    2011-01-01

    Although the reported incidence of fat embolism syndrome (FES) is low (approximately 1%), it is likely that microscopic fat emboli are showered during manipulation of long bone fractures. Even though there continues to be debate regarding the etiology and proposed mechanism responsible for FES, significant systemic manifestations may occur. Treatment is generally symptomatic based on the clinical presentations. We report a 10-year-old girl who developed hypoxemia following treatment of a displaced Salter-Harris type II fracture of the distal tibia. The subsequent evaluation and hospital course pointed to fat embolism as the most likely etiology for the hypoxemia. We discuss the etiology for FES, review the proposed pathophysiological mechanisms responsible for its clinical manifestations, present currently accepted diagnostic criteria, and discuss its treatment. PMID:21957420

  4. Embolic protection devices in saphenous percutaneous intervention.

    PubMed

    Morís, Cesar; Lozano, Iñigo; Martín, María; Rondán, Juán; Avanzas, Pablo

    2009-05-01

    Saphenous veins remain a source of conduit for use in surgical coronary bypass graft revascularisation procedures. Saphenous vein grafts have a progressive closure rate estimated to be 12% to 20% at the end of the first year, and approximately 50% by 10 years. Regarding secondary revascularisation in these cases, reoperation carries substantially increased morbidity and mortality rates, making saphenous coronary intervention, in particular stent implantation, a more attractive means of revascularisation. However, this procedure carries a significant risk of major adverse clinical events, predominantly myocardial infarction or reduced antegrade flow (non-reflow phenomenon), mainly due to distal embolisation of atherothrombotic debris and distal microvascular occlusion. Embolic protection devices are used to reduce the risk of distal embolisation. There are two different designs: filter and occlusion-aspiration devices. In this article we present the different systems of embolic protection devices in saphenous percutaneous intervention and the previously published information is reviewed. PMID:19736070

  5. Coronary Embolism After Iatrogenic Radial Endarterectomy.

    PubMed

    Rozado, Jose; Pascual, Isaac; Avanzas, Pablo; Moris, Cesar

    2016-06-01

    A 55-year-old man with double-vessel coronary artery disease was revascularized by percutaneous coronary intervention three years ago. Elective coronary angiography was indicated for angina with positive stress test. During the procedure, severe radial spasm occurred; after the first injection, we detected loss in pressure trace in the diagnostic catheter and acute distal circumflex occlusion. Suspecting catheter thrombosis with coronary embolization, the entire system was exchanged and inspected; inside, we discovered a 2 x 50 mm white biological cylinder. Histological study of this material was compatible with endarterectomy. We present a rare complication of severe radial artery spasm and endarterectomy, with occlusion of the diagnostic catheter and coronary embolization. PMID:27236012

  6. Amniotic fluid embolism: A diagnostic dilemma.

    PubMed

    Kulshrestha, Ashish; Mathur, Megha

    2011-01-01

    Amniotic fluid embolism (AFE) is a rare obstetric catastrophe with an incidence of 7.7 per 100 000 deliveries and mortality as high as 60% to 80%. We describe a case of perioperative cardiac arrest in a young parturient undergoing an emergent cesarean section. Just after delivery of live healthy male baby, patient developed disseminated intravascular coagulation not responding to resuscitation with fluids and blood products. Her autopsy revealed edematous lungs with amniotic fluid debris within pulmonary vessels thus establishing the diagnosis of AFE. Amniotic fluid embolism is life threatening and difficult to predict or prevent condition, which should be always be kept in mind in a parturient with sudden cardiovascular collapse, so that resuscitation commences immediately, as early intervention is essential for a positive outcome. PMID:25885396

  7. Amniotic fluid embolism: Then and now

    PubMed Central

    Rafael, A

    2014-01-01

    Background The first case report to describe amniotic fluid embolism that appeared in 1926 in Basil-Medico is translated from Portuguese to English. Case A patient with a dead fetus for several weeks, presented in labor and died suddenly with fetal squames evident in the maternal pulmonary vasculature at autopsy. Conclusion As can be seen from the translation, this case report is remarkably similar in many of its features to some of the eight patients described 15 years later in the first English language discussion of the disease by Steiner and Luschbaugh in JAMA. An enigma presented by this first case remains today: fetal material in the maternal pulmonary vasculature appears specific for amniotic fluid embolism at autopsy but not in living patients. PMID:27512417

  8. Portal Vein Embolization: What Do We Know?

    SciTech Connect

    Denys, Alban; Prior, John; Bize, Pierre; Duran, Rafael; Baere, Thierry De; Halkic, Nermin; Demartines, Nicolas

    2012-10-15

    Portal vein embolization (PVE) has been developed to increase the size of the future remnant liver (FRL) left in place after major hepatectomy, thus reducing the risk of postoperative liver insufficiency. PVE consist in embolizing preoperatively portal branches of the segments that will be resected. Indication is based on preoperative measurements of the FRL by computed tomography and its ratio with either the theoretical liver volume or by direct measurement of the functional liver volume. After PVE, the volume and function of the FRL increases in 3 to 6 weeks, permitting extensive resections in patients otherwise contraindicated for liver resection. The PVE technique is variable from one center to another; however n-butyl-cyano-acrylate provides an interesting compromise between hypertrophy rate and procedure risk.

  9. Therapeutic aspects of fat embolism syndrome.

    PubMed

    Habashi, Nader M; Andrews, Penny L; Scalea, Thomas M

    2006-10-01

    Signs and symptoms of clinical fat embolism syndrome (FES) usually begin within 24-48 hours after trauma. The classic triad involves pulmonary changes, cerebral dysfunction, and petechial rash. Clinical diagnosis is key because laboratory and radiographic diagnosis is not specific and can be inconsistent. The duration of FES is difficult to predict because it is often subclinical or may be overshadowed by other illnesses or injuries. Medical care is prophylactic or supportive, including early fixation and general ICU management to ensure adequate oxygenation and ventilation, hemodynamic stability, prophylaxis of deep venous thrombosis, stress-related gastrointestinal bleeding, and nutrition. Studies support early fracture fixation as a method to reduce recurrent fat embolism and FES. The main therapeutic interventions once FES has been clinically diagnosed are directed towards support of pulmonary and neurological manifestations and management of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). PMID:16990063

  10. Arterial Embolization of Giant Hepatic Hemangiomas

    SciTech Connect

    Giavroglou, Constantinos; Economou, Hippolete; Ioannidis, Ioannis

    2003-02-15

    Hepatic cavernous hemangiomas are usually small and asymptomatic. They are usually discovered incidentally and only a few require treatment. However, giant hemangiomas may cause symptoms,which are indications for treatment. We describe four cases of symptomatic giant hepatic hemangiomas successfully treated with transcatheter arterial embolization, performed with polyvinyl alcohol particles. There were no complications. Follow-up with clinical and imaging examinations showed disappearance of symptoms and decrease in size of lesions.

  11. Nonsurgical retrieval of embolized coronary stents.

    PubMed

    Eggebrecht, H; Haude, M; von Birgelen, C; Oldenburg, O; Baumgart, D; Herrmann, J; Welge, D; Bartel, T; Dagres, N; Erbel, R

    2000-12-01

    Embolization of coronary stents before deployment is a rare but challenging complication of coronary stenting. Different methods for nonsurgical stent retrieval have been suggested. There were 20 cases (0.90%) of intracoronary stent embolization among 2,211 patients who underwent implantation of 4,066 stents. Twelve of 1,147 manually crimped stents (1.04%) and eight of 2,919 premounted stents were lost (0.27%, P < 0.01) during retraction of the delivery system, because the target lesion could not be either reached or crossed. Percutaneous retrieval was successfully carried out in 10 of 14 patients (71%) in whom retrieval was attempted. In 10 patients, stent retrieval was tried with 1.5-mm low-profile angioplasty balloon catheters (success in 7/10) and in seven cases with myocardial biopsy forceps or a gooseneck snare (success in 3/7). Three patients (15%) underwent urgent coronary artery bypass surgery after failed percutaneous retrieval, but their outcomes were fatal. In two patients, stents were compressed against the vessel wall by another stent, without compromising coronary blood flow. In two patients, a stent was lost to the periphery without clinical side effects; treatment was conservative in these cases. Embolization of stents before deployment is a rare but serious complication of coronary stenting, with hazardous potential for the patient. Manual mounting of stents is associated with a significantly higher risk of stent embolization. Stent retrieval from the coronary circulation with low-profile angioplasty balloon catheters is a readily available and technically familiar approach that has a relatively high success rate. PMID:11108675

  12. Pulmonary embolism during delivery--treatment and outcome.

    PubMed

    Zamurović, M; Damnjanović, D

    2015-01-01

    Pulmonary embolism during delivery is not a frequent occurrence. It is often impossible to ascertain whether it is a case of embolism by amniotic fluid or thromboembolism. Diagnostics of pulmonary embolism in labor is based solely on clinical symptoms. Immediate interdisciplinary treatment with cardiopulmonary resuscitation, hemodynamic stabilization, and correction of haemostasis disorders play a decisive role in prognosis. This paper presents diagnostics, treatment, and consequences of pulmonary embolism in expulsion phase during delivery in epidural anesthesia of a multiparous patient aged 37. PMID:26753499

  13. Stent-assisted coil embolization of coronary artery aneurysm.

    PubMed

    Terasawa, Akihiro; Yokoi, Tuyoshi; Kondo, Keita

    2013-08-01

    Coronary artery aneurysms are uncommon diseases with potential complications including rupture and ischemia from embolic events or thrombosis. No consensus has been established regarding the optimal therapy for coronary artery aneurysms. Percutaneous catheter-based treatments using membrane-covered stents and coil embolization have been described. However, only few reports of stent-assisted coil embolization for coronary artery aneurysms have been published to date. Therefore, we report a case of coronary artery aneurysm successfully treated with stent-assisted coil embolization. PMID:23913616

  14. Angiographic embolization for epistaxis: a review of 114 cases.

    PubMed

    Tseng, E Y; Narducci, C A; Willing, S J; Sillers, M J

    1998-04-01

    Angiography with selective embolization has become an accepted method of treating posterior epistaxis that is not controlled with conservative measures. The authors reviewed 112 cases of patients who had received selective angiographic embolization for refractory epistaxis from January 1990 to December 1995. There were 114 embolizations over this 5-year period. The immediate success rate was 93%, with long-term success achieved in 88% of patients. The overall complication rate was 17%, with the long-term morbidity rate less than 1%. Selective angiographic embolization is a safe and effective method that should be considered in the treatment of refractory epistaxis. PMID:9546280

  15. Acute tumor lysis syndrome after proximal splenic artery embolization.

    PubMed

    Salsamendi, Jason T; Doshi, Mehul H; Gortes, Francisco J; Levi, Joe U; Narayanan, Govindarajan

    2016-06-01

    Preoperative splenic artery embolization for massive splenomegaly has been shown to reduce intraoperative hemorrhage during splenectomy. We describe a case of tumor lysis syndrome after proximal splenic artery embolization in a patient with advanced mantle cell lymphoma and splenic involvement. The patient presented initially with hyperkalemia two days after embolization that worsened during splenectomy. He was stabilized, but developed laboratory tumor lysis syndrome with renal failure and expired. High clinical suspicion of tumor lysis syndrome in this setting is advised. Treatment must be started early to avoid serious renal injury and death. Lastly, same day splenectomy and embolization should be considered to decrease the likelihood of developing tumor lysis syndrome. PMID:27257458

  16. [Fulminant course of amniotic fluid embolism].

    PubMed

    Bermejo-Alvarez, M A; Fervienza, P; Corte-Torres, M G; Cosío, F; Jiménez-Gómez, L J; Hevía, A

    2006-02-01

    Amniotic fluid embolism is an obstetric complication that can present during pregnancy or labor and is associated with high rates of morbidity and mortality. The incidence is low but the mortality rates for both mother and fetus are high. A 34-year-old woman in the 41st week of gestation was admitted for induction of labor. While still in the labor room, she complained of pruritus around the mouth and tongue. Tonic-clonic convulsions, hypotension, and loss of consciousness followed. Cardiopulmonary resuscitation maneuvers were started and an immediate cesarean section under general anesthesia was performed to deliver a live infant boy. The Apgar score at 5 minutes was 8. The mother was transferred for recovery to the intensive care unit (ICU), where rapid cardiocirculatory and pulmonary decline continued. After 2 episodes of electromechanical dissociation, exitus occurred 2 hours after ICU admission. The autopsy confirmed the diagnosis of amniotic fluid embolism. Keratin squames were found in the capillaries of both lungs and polymorphonuclear cells and proteinaceous material were observed in alveoli. Mechanical obstruction is not the only cause of amniotic fluid embolism. Circulating substances that affect myocardial contractility and coagulation are also implicated and the cause may even be an allergic reaction. The usual signs are acute respiratory failure, cardiovascular collapse, and occasionally convulsions and coagulopathy. Cardiac arrest occurs in 80% of the cases. Treatment is symptomatic to provide life-sustaining measures in response to the clinical picture as it develops. PMID:16553345

  17. Arteriovenous Fistula Embolization in Suspected Parauterine Choriocarcinoma.

    PubMed

    Alturkistani, Husain; Almarzooqi, Mohamed-Karji; Oliva, Vincent; Gilbert, Patrick

    2016-01-01

    This is a case of choriocarcinoma that did not regress after chemotherapy treatment. A 30-year-old female patient (gravida 2, para 2), presented to our ER with stroke and persistent mild pelvic pain 2 months after a Caesarean section. Computed tomography (CT) revealed an ischemic left hemicerebellar region and a hypervascular mass in the pelvic region. This mass was not present on routine fetal ultrasound during pregnancy. The lesion was treated by chemotherapy after closure of a foramen ovale and insertion of an inferior vena cava (IVC) filter. After that, 2 courses of EMACO (Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide, and Vincristine) chemotherapy regimen were given. Posttreatment CT showed the hypervascular mass without any changes. Arteriography showed the arteriovenous fistulae that were embolized successfully with plugs, coils, and glue. Embolization was considered due to the risk of acute hemorrhagic life-threatening complications. Eight chemotherapy courses were added after embolization. Treatment by endovascular approach and reduction of the hypervascular mass can be a valuable adjunct to chemotherapy treatment of choriocarcinoma. PMID:27403360

  18. Hypoxemia in pulmonary embolism, a clinical study

    PubMed Central

    Wilson, James E.; Pierce, Alan K.; Johnson, Robert L.; Winga, Edward R.; Harrell, W. Ross; Curry, George C.; Mullins, Charles B.

    1971-01-01

    The cause of hypoxemia was studied in 21 patients with no previous heart or lung disease shortly after an episode of acute pulmonary embolism. The diagnosis was based on pulmonary angiography demonstrating distinct vascular filling defects or “cutoffs.” It was found that virtually all of the hypoxemia in patients with previously normal heart and lungs could be accounted for on the basis of shunt-like effect. The magnitude of the shunting did not correlate with the percent of the pulmonary vascular bed occluded nor with the mean pulmonary artery pressure. The shunts tended to gradually recede over about a month after embolism. Patients without pulmonary infarction were able to inspire 80-111% of their predicted inspiratory capacities, and this maneuver temporarily diminished the observed shunt. Patients with pulmonary infarcts were able to inhale only to 60-69% of predicted inspiratory capacity, and this did not reverse shunting. These data suggest that the cause of right-to-left shunting in patients with pulmonary emboli is predominantly atelectasis. When the elevation of mean pulmonary artery pressure was compared to cardiac index per unit of unoccluded lung, it fell within the range of pulmonary hypertension predicted from published data obtained in patients with exercise in all except one case. This observation suggests that pulmonary vasoconstriction following embolism is not important in humans, although these data are applicable only during the time interval in which our patients were studied and in patients receiving heparin. PMID:5101776

  19. Renal artery embolization in severe nephrotic syndrome.

    PubMed

    Solak, Yalcin; Koc, Osman; Ucar, Ramazan; Ozbek, Orhan; Ergenc, Hasan; Gaipov, Abduzhappar; Turk, Suleyman

    2016-07-01

    Introduction Severe nephrotic syndrome is associated with increased morbidity and mortality. Renal artery embolization (RAE) has been used in a number of renal diseases such as renal tumors, arteriovenous fistulas etc. However, data regarding benefits of RAE in patients with symptomatic severe proteinuria is limited. We decided to evaluate role of RAE in the setting of severe symptomatic nephrotic syndrome. Methods Eight patients who had undergone transcatheter renal artery embolization with polyvinyl alcohol (PVA) were included. Clinico-demographic characteristics as well as baseline laboratory data including level of proteinuria, serum albumin, C-reactive protein and LDL cholesterol levels were recorded for each patient. After RAE, outpatient clinic control laboratory values were also assessed. Findings All patients except one underwent bilateral RAE (four simultaneous or three sequential). Two patients experienced postembolization syndrome characterized by flank pain, fever, and leukocytosis, which was self-limited and responded to analgesics in all patients. There was no technical complications associated with RAE procedure. All patients became anuric except one. Serum albumin levels increased and serum LDL-cholesterol levels decreased considerably in treated patients. Discussion Renal artery embolization with the purpose of amelioration in nephrotic syndrome complications was effective and free of major technical complications in our patients. PMID:26833695

  20. Carbon dioxide embolism during laparoscopic sleeve gastrectomy

    PubMed Central

    Zikry, Amir Abu; DeSousa, Kalindi; Alanezi, Khaled H

    2011-01-01

    Bariatric restrictive and malabsorptive operations are being carried out in most countries laparoscopically. Carbon dioxide or gas embolism has never been reported in obese patients undergoing bariatric surgery. We report a case of carbon dioxide embolism during laparoscopic sleeve gastrectomy (LSG) in a young super obese female patient. Early diagnosis and successful management of this complication are discussed. An 18-year-old super obese female patient with enlarged fatty liver underwent LSG under general anesthesia. During initial intra-peritoneal insufflation with CO2 at high flows through upper left quadrant of the abdomen, she had precipitous fall of end-tidal CO2 and SaO2 % accompanied with tachycardia. Early suspicion led to stoppage of further insufflation. Clinical parameters were stabilized after almost 30 min, while the blood gas analysis was restored to normal levels after 1 h. The area of gas entrainment on the damaged liver was recognized by the surgeon and sealed and the surgery was successfully carried out uneventfully. Like any other laparoscopic surgery, carbon dioxide embolism can occur during bariatric laparoscopic surgery also. Caution should be exercised when Veress needle is inserted through upper left quadrant of the abdomen in patients with enlarged liver. A high degree of suspicion and prompt collaboration between the surgeon and anesthetist can lead to complete recovery from this potentially fatal complication. PMID:21772696

  1. Permcath Catheter Embolization: a Case Report

    PubMed Central

    Yousefshahi, Hadi; Bina, Payvand; Yousefshahi, Fardin

    2015-01-01

    Introduction: Nowadays, many types of intravascular devices and catheters are used in order to diagnose and treat diseases. Complications related to these instruments are the costs that doctors and patients have to pay to benefit from their advantages. Catheter embolization is one of these side effects. Patients with devices in their cardiopulmonary system are at risk for severe complications such as arrhythmias, pulmonary embolism, myocardial injuries, hemoptysis, thrombosis and perforation. Case Presentation: A 50-years-old woman, with a history of breast cancer, had a PermCath emplacement in right subclavian vein for a course of chemotherapy. The treatment for cancer seemed to be successful and the PermCath had remained in its position without complication, for a couple of years however, the catheter was founded broken and embolized to the right ventricle and the main left pulmonary artery, diagnosed by a chest X-ray study incidentally. Conclusions: It is better to remove the unused devices safely to prevent and decrease their possible complications. PMID:25964881

  2. Amniotic fluid embolism after intrauterine fetal demise.

    PubMed

    Kristensen, Karl; Langdana, Fali; Clentworth, Howard; Hansby, Chu; Dalley, Paul

    2016-01-01

    We present a case of the successful treatment of severe amniotic fluid embolism in a 41-year-old woman undergoing emergency caesarean section at 36 weeks of gestation for placental abruption and intrauterine fetal demise. The treatment included prolonged cardiopulmonary resuscitation, emergency hysterectomy, re-operation with intra-abdominal packing and intra-aortic balloon pump insertion. The patient made a remarkable recovery and to date has minimal residual morbidity. Amniotic fluid embolism syndrome (AFES) is a rare and often fatal obstetric condition that remains one of the main causes of maternal mortality in developed countries. The incidence varies from 2 to 6 per 100,000 and suggested mortality rates exceed 60%.1-2 The classic triad of sudden hypoxia, hypotension and coagulopathy with acute onset during labour or immediately after delivery forms the hallmark of the AFES diagnosis, however AFES is primarily a clinical diagnosis of exclusion. We present a case of successful maternal outcome following severe amniotic fluid embolism after placental abruption and intrauterine fetal demise. PMID:27607089

  3. Arteriovenous Fistula Embolization in Suspected Parauterine Choriocarcinoma

    PubMed Central

    Almarzooqi, Mohamed-Karji; Oliva, Vincent; Gilbert, Patrick

    2016-01-01

    This is a case of choriocarcinoma that did not regress after chemotherapy treatment. A 30-year-old female patient (gravida 2, para 2), presented to our ER with stroke and persistent mild pelvic pain 2 months after a Caesarean section. Computed tomography (CT) revealed an ischemic left hemicerebellar region and a hypervascular mass in the pelvic region. This mass was not present on routine fetal ultrasound during pregnancy. The lesion was treated by chemotherapy after closure of a foramen ovale and insertion of an inferior vena cava (IVC) filter. After that, 2 courses of EMACO (Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide, and Vincristine) chemotherapy regimen were given. Posttreatment CT showed the hypervascular mass without any changes. Arteriography showed the arteriovenous fistulae that were embolized successfully with plugs, coils, and glue. Embolization was considered due to the risk of acute hemorrhagic life-threatening complications. Eight chemotherapy courses were added after embolization. Treatment by endovascular approach and reduction of the hypervascular mass can be a valuable adjunct to chemotherapy treatment of choriocarcinoma. PMID:27403360

  4. [Pulmonary circulation in embolic pulmonary edema].

    PubMed

    Sanotskaia, N V; Polikarpov, V V; Matsievskiĭ, D D

    1989-02-01

    The ultrasonic method was used in acute experiments on cats with open chest under artificial lung ventilation to obtain blood flow in low-lobar pulmonary artery and vein, the blood pressure in pulmonary artery, as well as the left atrial pressure in fat (olive oil) and mechanical (Lycopodium spores) pulmonary embolism. It is shown that pulmonary embolism produces the decrease in the blood flow in pulmonary artery and vein, the increase of the pressure in pulmonary artery and left atria, the increase of lung vessels resistance. The decrease is observed of systemic arterial pressure, bradycardia, and extrasystole. After 5-10 min the restoration of arterial pressure and heart rhythm occur and partial restoration of blood flow in pulmonary artery and vein. In many experiments the blood flow in vein outdoes that in the artery--it allows to suppose the increase of the blood flow in bronchial artery. After 60-90 min there occur sudden decrease of systemic arterial pressure, the decrease of the blood flow in pulmonary artery and vein. The pressure in pulmonary artery and resistance of pulmonary vessels remain high. Pulmonary edema developed in all animals. The death occurs in 60-100 min after the beginning of embolism. PMID:2923969

  5. Partial splenic artery embolization in cirrhotic patients

    PubMed Central

    Hadduck, Tyson A; McWilliams, Justin P

    2014-01-01

    Splenomegaly is a common sequela of cirrhosis, and is frequently associated with decreased hematologic indices including thrombocytopenia and leukopenia. Partial splenic artery embolization (PSE) has been demonstrated to effectively increase hematologic indices in cirrhotic patients with splenomegaly. This is particularly valuable amongst those cirrhotic patients who are not viable candidates for splenectomy. Although PSE was originally developed decades ago, it has recently received increased attention. Presently, PSE is being utilized to address a number of clinical concerns in the setting of cirrhosis, including: decreased hematologic indices, portal hypertension and its associated sequela, and splenic artery steal syndrome. Following PSE patients demonstrate significant increases in platelets and leukocytes. Though progressive decline of hematologic indices occur following PSE, they remain improved as compared to pre-procedural values over long-term follow-up. PSE, however, is not without risk and complications of the procedure may occur. The most common complication of PSE is post-embolization syndrome, which involves a constellation of symptoms including fever, pain, and nausea/vomiting. The rate of complications has been shown to increase as the percent of total splenic volume embolized increases. The purpose of this review is to explore the current literature in regards to PSE in cirrhotic patients and to highlight their techniques, and statistically summarize their results and associated complications. PMID:24876920

  6. Utility of the Amplatzer Vascular Plug in Splenic Artery Embolization: A Comparison Study with Conventional Coil Technique

    SciTech Connect

    Zhu Xiaoli; Tam, Matthew D. B. S.; Pierce, Gregory; McLennan, Gordon; Sands, Mark J.; Lieber, Michael S.; Wang Weiping

    2011-06-15

    Purpose: To retrospectively evaluate the role of the Amplatzer Vascular Plug (AVP) in proximal splenic artery embolization (SAE) compared with coils. Materials and Methods: Forty patients had proximal SAE performed with AVP(s) or coils as the primary embolic agent for splenic artery steal syndrome (n = 23), trauma (n = 5), portal hypertension (n = 5), bleeding due to pancreatic pathology (n = 4), and pre-splenectomy (n = 3). Comparisons were made of occlusion and procedure time, cost, and radiation dose. Results: Eighteen proximal SAE procedures were successfully performed with AVP. Twenty-two procedures were performed with coils, including one failed AVP attempt, which was completed with coils. Precise deployment without migration was achieved in all 18 AVP cases. Seven of 22 (31.8%) coil procedures had distal migration without consequence. There was no statistically significant difference in mean occlusion time (24.4 min for AVP vs. 31.5 min for coils, P = 0.13), procedure time (43.7 min for AVP vs. 53.8 min for coils, P = 0.16), or cost ($1474.13 for AVP vs. $1722.51 for coils, P = 0.69). There was significant difference in radiation dose (842 mGy for AVP vs. 1,309 mGy for coils, P = 0.04). Fourteen of the 18 (78%) AVP devices required additional embolic material. Conclusions: AVP with additional embolic agents is a useful alternative for proximal SAE because of precise deployment, resistance to migration, and radiation reduction. AVP use may be limited by vessel tortuosity. The occlusion time, procedure time, and cost were reduced but this was not statistically significant due to the need for additional embolic material.

  7. Double Bolus Thrombolysis for Suspected Massive Pulmonary Embolism during Cardiac Arrest.

    PubMed

    O'Connor, Gerard; Fitzpatrick, Gareth; El-Gammal, Ayman; Gilligan, Peadar

    2015-01-01

    More than 70% of cardiac arrest cases are caused by acute myocardial infarction (AMI) or pulmonary embolism (PE). Although thrombolytic therapy is a recognised therapy for both AMI and PE, its indiscriminate use is not routinely recommended during cardiopulmonary resuscitation (CPR). We present a case describing the successful use of double dose thrombolysis during cardiac arrest caused by pulmonary embolism. Notwithstanding the relative lack of high-level evidence, this case suggests a scenario in which recombinant tissue Plasminogen Activator (rtPA) may be beneficial in cardiac arrest. In addition to the strong clinical suspicion of pulmonary embolism as the causative agent of the patient's cardiac arrest, the extremely low end-tidal CO2 suggested a massive PE. The absence of dilatation of the right heart on subxiphoid ultrasound argued against the diagnosis of PE, but not conclusively so. In the context of the circulatory collapse induced by cardiac arrest, this aspect was relegated in terms of importance. The second dose of rtPA utilised in this case resulted in return of spontaneous circulation (ROSC) and did not result in haemorrhage or an adverse effect. PMID:26664765

  8. Rare Association of Klippel-Trenaunay Syndrome with Large Pulmonary Embolism and Asymmetrical Emphysematous Bullae.

    PubMed

    Agrawal, Navin; Vasavada, Apurva

    2016-05-01

    Klippel-Trenaunay syndrome is a rarely encountered congenital disease characterized by a triad of enlarged arteries and veins, limb hypertrophy and capillary malformations. We are presenting an interesting case of a 23-year male who had been previously diagnosed to have Klippel-Trenaunay syndrome. The patient presented with large pulmonary embolism after having undergone laser surgery for varicose veins. The diagnostic chest computed tomography (CT) performed also revealed the co-existence of severe destructive pulmonary parenchymal disease involving large areas of the pulmonary parenchyma and formation of large emphysematous bullae having an asymmetric involvement of the left lung field. The patient was managed with thrombolysis with a bolus fibrinolytic agent and subsequently underwent an inferior vena cava (IVC) filter implantation to prevent further episodes of embolism in the presence of a compromised lung. The association of Klippel-Trenaunay syndrome with recurrent pulmonary embolism and unexplained pulmonary parenchymal disease leading to almost complete destruction of large areas of lung fields is interesting and has never been previously described. PMID:27225153

  9. Double Bolus Thrombolysis for Suspected Massive Pulmonary Embolism during Cardiac Arrest

    PubMed Central

    O'Connor, Gerard; Fitzpatrick, Gareth; Gilligan, Peadar

    2015-01-01

    More than 70% of cardiac arrest cases are caused by acute myocardial infarction (AMI) or pulmonary embolism (PE). Although thrombolytic therapy is a recognised therapy for both AMI and PE, its indiscriminate use is not routinely recommended during cardiopulmonary resuscitation (CPR). We present a case describing the successful use of double dose thrombolysis during cardiac arrest caused by pulmonary embolism. Notwithstanding the relative lack of high-level evidence, this case suggests a scenario in which recombinant tissue Plasminogen Activator (rtPA) may be beneficial in cardiac arrest. In addition to the strong clinical suspicion of pulmonary embolism as the causative agent of the patient's cardiac arrest, the extremely low end-tidal CO2 suggested a massive PE. The absence of dilatation of the right heart on subxiphoid ultrasound argued against the diagnosis of PE, but not conclusively so. In the context of the circulatory collapse induced by cardiac arrest, this aspect was relegated in terms of importance. The second dose of rtPA utilised in this case resulted in return of spontaneous circulation (ROSC) and did not result in haemorrhage or an adverse effect. PMID:26664765

  10. Dynamic analysis on cavitation and embolization in vascular plants under tension

    NASA Astrophysics Data System (ADS)

    Ryu, Jeongeun; Hwang, Bae Geun; Kim, Yangmin; Lee, Sang Joon

    2014-11-01

    Plants can transport sap water from the soil to the tip of their leaves using the tensile forces created by leaf transpiration without any mechanical pumps. However, the high tension adversely induces a thermodynamically metastable state in sap water with negative pressure and gas bubbles are prone to be formed in xylem vessels. Cavitation easily breaks down continuous water columns and grows into embolization, which limits water transport through xylem vessels. Meanwhile, the repair process of embolization is closely related to water management and regulation of sap flow in plants. In this study, the cavitation and embolization phenomena of liquid water in vascular plants and a physical model system are experimentally and theoretically investigated in detail under in vivo and in vitro conditions. This study will not only shed light on the understanding of these multiphase flows under tension but also provide a clue to solve cavitation problems in micro-scale conduits and microfluidic network systems. This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) (No. 2008-0061991).

  11. Effects of delayed treatment with nafronyl oxalate on microsphere embolism-induced changes in monoamine levels of rat brain regions.

    PubMed Central

    Takagi, N.; Miyake, K.; Ohiwa, A.; Nukaga, R.; Takeo, S.

    1996-01-01

    1. The present study was undertaken to examine the effects of delayed treatment with nafronyl oxalate (nafronyl), a cerebral vasodilator, on monoamine neurotransmitters of brain regions in the microsphere-embolized rat. 2. Microsphere embolism was induced by injecting 900 microspheres with a diameter of 48 microns into the right internal carotid artery of rats. Microsphere-embolized rats were treated with nafronyl, 15 mg kg-1, i.p., twice daily from the first to the 5th day. Levels of monoamines and their metabolites in the cerebral cortex, striatum, and hippocampus were measured on days 3 and 5 after the operation by a high-performance liquid chromatograph with electrochemical detection. In vivo tyrosine or tryptophan hydroxylation was estimated by measurement of the accumulation of 3, 4-dihydroxyphenylalanine or 5-hydroxy-1-tryptophan after administration of 3-hydroxybenzylhydrazine dihydrochloride, an inhibitor of aromatic L-amino acid decarboxylase. 3. Microsphere embolism induced decreases in dopamine, noradrenaline and 5-hydroxytryptamine in three brain regions of the right hemisphere on days 3 and 5. In the left hemisphere, the monoamines were reduced, but to a lesser degree than in the right hemisphere. On days 3 and 5, the decrease in the monoamines of the right hemisphere was attenuated by nafronyl treatment except for noradrenaline on day 3. The decrease in the monoamines levels in the left hemisphere was almost completely prevented by nafronyl treatment. 4. On day 3 after microsphere embolism, in vivo tyrosine and tryptophan hydroxylation was lower than the pre-embolic value in all three brain regions. Treatment of the embolized rats with nafronyl significantly attenuated the decrease in in vivo tyrosine and tryptophan hydroxylation in the ipsilateral hemisphere, but not hippocampal tryptophan hydroxylation. 5. The results suggested that treatment with nafronyl improves or attenuates changes in monoamine neurotransmitter metabolism of the brain regions

  12. Preoperative portal vein embolization in liver cancer: indications, techniques and outcomes

    PubMed Central

    Favelier, Sylvain; Chevallier, Olivier; Estivalet, Louis; Genson, Pierre-Yves; Pottecher, Pierre; Gehin, Sophie; Krausé, Denis; Cercueil, Jean-Pierre

    2015-01-01

    Postoperative liver failure is a severe complication of major hepatectomies, in particular in patients with a chronic underlying liver disease. Portal vein embolization (PVE) is an approach that is gaining increasing acceptance in the preoperative treatment of selected patients prior to major hepatic resection. Induction of selective hypertrophy of the non-diseased portion of the liver with PVE in patients with either primary or secondary hepatobiliary, malignancy with small estimated future liver remnants (FLR) may result in fewer complications and shorter hospital stays following resection. Additionally, PVE performed in patients initially considered unsuitable for resection due to lack of sufficient remaining normal parenchyma may add to the pool of candidates for surgical treatment. A thorough knowledge of hepatic segmentation and portal venous anatomy is essential before performing PVE. In addition, the indications and contraindications for PVE, the methods for assessing hepatic lobar hypertrophy, the means of determining optimal timing of resection, and the possible complications of PVE need to be fully understood before undertaking the procedure. Technique may vary among operators, but cyanoacrylate glue seems to be the best embolic agent with the highest expected rate of liver regeneration for PVE. The procedure is usually indicated when the remnant liver accounts for less than 25-40% of the total liver volume. Compensatory hypertrophy of the non-embolized segments is maximal during the first 2 weeks and persists, although to a lesser extent during approximately 6 weeks. Liver resection is performed 2 to 6 weeks after embolization. The goal of this article is to discuss the rationale, indications, techniques and outcomes of PVE before major hepatectomy. PMID:26682142

  13. Care of the patient with an acute pulmonary embolism.

    PubMed

    York, Nancy L; Kane, Christy J; Smith, Carol; Minton, Lori A

    2015-01-01

    There are evidence-based prevention strategies known to reduce the risk of pulmonary embolism formation. However, pulmonary emboli remain a leading cause of death in critically ill patients with a 3-month mortality of 10% to 15%. This article addresses patients' risk factors, pulmonary embolism prevention strategies, clinical manifestations, and treatment modalities the interdisciplinary team should understand. PMID:25470260

  14. Episode of massive pulmonary embolism after bilateral breast augmentation

    PubMed Central

    Schonauer, Fabrizio; Nele, Gisella; Di Martino, Annalena; Santoro, Mariangela; Santanelli di Pompeo, Fabio

    2015-01-01

    Pulmonary embolism is a rare postsurgical complication, even more so following breast augmentation. Herein we present a case of a 23-year-old woman who survived an episode of massive pulmonary embolism after breast implant surgery. Current literature about this subject is very scarce.

  15. Pulmonary embolism and acute cytomegalovirus infection in an immunocompetent patient.

    PubMed

    Del Borgo, Cosmo; Gianfreda, Romina; Belvisi, Valeria; Citton, Rita; Soscia, Fabrizio; Notarianni, Ermanno; Tieghi, Tiziana; Mastroianni, Claudio Maria

    2010-12-01

    A case of an immunocompetent man with acute CMV infection associated with a pulmonary embolism is described. Acute CMV infection could be a risk factor for developing thromboembolism. Pulmonary embolism should be included in differential diagnosis in patients with acute CMV infections and pulmonary opacities. PMID:21196823

  16. Intra-arterial Onyx Embolization of Vertebral Body Lesions

    PubMed Central

    Sedora-Roman, Neda I.; Reddy, Arra Suresh; Ogilvy, Christopher S.; Thomas, Ajith J.

    2013-01-01

    While Onyx embolization of cerebrospinal arteriovenous shunts is well-established, clinical researchers continue to broaden applications to other vascular lesions of the neuraxis. This report illustrates the application of Onyx (eV3, Plymouth, MN) embolization to vertebral body lesions, specifically, a vertebral hemangioma and renal cell carcinoma vertebral body metastatic lesion. PMID:24729960

  17. Tunable delivery of niflumic acid from resorbable embolization microspheres for uterine fibroid embolization.

    PubMed

    Bédouet, Laurent; Moine, Laurence; Servais, Emeline; Beilvert, Anne; Labarre, Denis; Laurent, Alexandre

    2016-09-10

    Uterine arteries embolization (UAE) is a recent technique that aims, by means of particles injected percutaneously, to stifle fibroids (leiomyomas). This treatment is non-invasive, compared with uterine ablation, but generates pelvic pain for a few days. A strategy to reduce the post-embolization pain would be to use calibrated embolization microspheres preloaded with a non-steroidal inflammatory drug (NSAID). In this study, we first compared four drugs, all active at low concentration on cyclooxygenase-2, i.e. ketoprofen, sodium diclofenac, flurbiprofen and niflumic acid (NFA), for their capacity to be loaded on resorbable embolization microspheres (REM) 500-700μm. NFA had the highest capacity of loading (5mg/mL) on resorbable microspheres. Then, we evaluated in vitro the NFA release profiles from REM having various degradation times of one, two or five days. NFA release was biphasic, with an initial burst (about 60% of the loading) followed by a sustained release that correlated significantly to REM's hydrolysis (rho=0.761, p<0.0001). For each group of beads, the size distribution was not modified by the loading of NFA and their delivery through microcatheter was not impaired by the drug. NFA eluted from REM inhibited the synthesis of prostaglandin E2 from rabbit uterus explants. In summary, NFA is loadable on REM in significant amount and its delivery can be tuned according to the degradation rate of REM to provide an antalgic effect for a few days after UAE. PMID:27374196

  18. Ovarian Artery: Angiographic Appearance, Embolization and Relevance to Uterine Fibroid Embolization

    SciTech Connect

    Pelage, J.P. Walker, W.J.; Le Dref, O.; Rymer, R.

    2003-06-15

    Purpose: To describe the angiographic appearance of the ovarian artery and its main variations that may be relevant to uterine fibroid embolization. Methods: The flush aortograms of 294 women who had been treated by uterine artery embolization for fibroids were reviewed. Significant arterial supply to the fibroid, and the origin and diameter of identified ovarian arteries were recorded. In patients with additional embolization of the ovarian artery, the follow-up evaluation also included hormonal levels and Doppler imaging of the ovaries. Results: A total of 75 ovarian arteries were identified in 59 women (bilaterally in 16 women and unilaterally in 43 women). All ovarian arteries originated from the aorta below the level of the renal arteries with a characteristic tortuous course. Fifteen women had at least one enlarged ovarian artery supplying the fibroids. Fourteen women (14/15, 93%) presented at least one of the following factors: prior pelvic surgery, tubo-ovarian pathology or large fundal fibroids. Conclusion: We advocate the use of flush aortography in women with prior tubo-ovarian pathology or surgery or in cases of large fundal fibroids. In the case of an ovarian artery supply to the fibroids, superselective catheterization and embolization of the ovarian artery should be considered.

  19. Visual quantification of embolism reveals leaf vulnerability to hydraulic failure.

    PubMed

    Brodribb, Timothy J; Skelton, Robert P; McAdam, Scott A M; Bienaimé, Diane; Lucani, Christopher J; Marmottant, Philippe

    2016-03-01

    Vascular plant mortality during drought has been strongly linked to a failure of the internal water transport system caused by the rapid invasion of air and subsequent blockage of xylem conduits. Quantification of this critical process is greatly complicated by the existence of high water tension in xylem cells making them prone to embolism during experimental manipulation. Here we describe a simple new optical method that can be used to record spatial and temporal patterns of embolism formation in the veins of water-stressed leaves for the first time. Applying this technique in four diverse angiosperm species we found very strong agreement between the dynamics of embolism formation during desiccation and decline of leaf hydraulic conductance. These data connect the failure of the leaf water transport network under drought stress to embolism formation in the leaf xylem, and suggest embolism occurs after stomatal closure under extreme water stress. PMID:26742653

  20. Cerebral air embolism caused by a bronchogenic cyst.

    PubMed

    Jung, Simon; Wiest, Roland; Frigerio, Susanna; Mattle, Heinrich P; Hess, Christian W

    2010-06-01

    An unusual case is presented of a tourist who developed fatal cerebral air embolism, pneumomediastinum and pneumopericardium while ascending from low altitude to Europe's highest railway station. Presumably the air embolism originated from rupture of the unsuspected bronchogenic cyst as a result of pressure changes during the ascent. Cerebral air embolism has been observed during surgery, in scuba diving accidents, submarine escapes and less frequently during exposure to very high altitude. People with known bronchogenic cysts should be informed about the risk of cerebral air embolism and surgical removal should be considered. Cerebral air embolism is a rare cause of coma and stroke in all activities with rapid air pressure changes, including alpine tourism, as our unfortunate tourist illustrates. PMID:20498190

  1. Agent Orange

    MedlinePlus

    ... Index Agent Orange Agent Orange Home Facts about Herbicides Veterans' Diseases Birth Defects Benefits Exposure Locations Provider ... millions of gallons of Agent Orange and other herbicides on trees and vegetation during the Vietnam War. ...

  2. Preoperative embolization of primary bone tumors: A case control study

    PubMed Central

    Jha, Roushan; Sharma, Raju; Rastogi, Shishir; Khan, Shah Alam; Jayaswal, Arvind; Gamanagatti, Shivanand

    2016-01-01

    AIM: To study the safety and effectiveness of preoperative embolization of primary bone tumors in relation to intraoperative blood loss, intraoperative blood transfusion volume and surgical time. METHODS: Thirty-three patients underwent preoperative embolization of primary tumors of extremities, hip or vertebrae before resection and stabilization. The primary osseous tumors included giant cell tumors, aneurysmal bone cyst, osteoblastoma, chondroblastoma and chondrosarcoma. Twenty-six patients were included for the statistical analysis (embolization group) as they were operated within 0-48 h within preoperative embolization. A control group (non-embolization group, n = 28) with bone tumor having similar histological diagnosis and operated without embolization was retrieved from hospital record for statistical comparison. RESULTS: The mean intraoperative blood loss was 1300 mL (250-2900 mL), the mean intraoperative blood transfusion was 700 mL (0-1400 mL) and the mean surgical time was 221 ± 76.7 min for embolization group (group I, n = 26). Non-embolization group (group II, n = 28), the mean intraoperative blood loss was 1800 mL (800-6000 mL), the mean intraoperative blood transfusion was 1400 mL (700-8400 mL) and the mean surgical time was 250 ± 69.7 min. On comparison, statistically significant (P < 0.001) difference was found between embolisation group and non-embolisation group for the amount of blood loss and requirement of blood transfusion. There was no statistical difference between the two groups for the surgical time. No patients developed any angiography or embolization related complications. CONCLUSION: Preoperative embolization of bone tumors is a safe and effective adjunct to the surgical management of primary bone tumors that leads to reduction in intraoperative blood loss and blood transfusion volume. PMID:27158424

  3. Pulmonary cement embolization after vertebroplasty, an uncommon presentation of pulmonary embolism: A case report and literature review

    PubMed Central

    Sinha, Nishant; Padegal, Vivek; Satyanarayana, Satish; Santosh, Hassan Krishnamurthy

    2015-01-01

    Pulmonary Cement Embolization (PCE) is a rare complication of vertebroplasty surgery. There is no clear guideline for management of this entity. There is no definite protocol for anticoagulation in PCE. This is a case report of our patient who was diagnosed to have Pulmonary Cement Embolization, which was quite significant involving both lungs. She was successfully managed without long term anticoagulation. PMID:26664167

  4. Competitive assessments of pulmonary embolism: Noninvasiveness versus the golden standard.

    PubMed

    Ma, Yuxia; Yan, Shi; Zhou, Lin; Yuan, Dong-Tang

    2016-04-01

    Diagnosis of suspected pulmonary embolism (PE) is crucial as undiagnosed and over-diagnosis can both lead to serious consequences. Contemporary diagnostic approach of PE is a sequential combination assessment beginning with clinical assessment, validated with D-dimer measurement and confirmed with pulmonary angiography or imaging. Since the invasive pulmonary angiography is risky and costly, imaging is a warranted tool in the diagnosis procedure. CT pulmonary angiography is a less-invasive method with general availability, studies provide favorable evidences for CT pulmonary angiography as a stand-alone test for excluding PE, and it has become the first choice of tests in emergency department for suspected PE in most centers. Ventilation/perfusion single-photon emission CT signifies a new era in nuclear medicine. It has excellent sensitivity and specificity, fast procedure, low radiation exposure, few complications and contradictions. Besides, MR angiography is another possible and promising approach for diagnosis of suspected PE with much safer contrast agents than CT and no ionizing radiation. With wide availability and less invasive effects, imaging becomes a firsthand tool to obtain optimal accuracy in the diagnosis work up in clinic nowadays. This review summarizes the current methods in diagnosing PE and the update of imaging assessments of the disease. PMID:26038123

  5. Treatment of vertebrobasilar fusiform aneurysms with Pipeline embolization device

    PubMed Central

    Ahmed, Osama; Storey, Christopher; Kalakoti, Piyush; Deep Thakur, Jai; Zhang, Shihao; Nanda, Anil; Guthikonda, Bharat

    2015-01-01

    Object Treatment of complex intracranial aneurysms with Pipeline embolization device (PED) (ev3/Covidien Vascular Therapies) has gained recent popularity. One application of PEDs that is not well described in the literature is the utility and long-term safety in treatment of vertebrobasilar fusiform (VBF) aneurysms. Despite the advancements in endovascular therapy, VBF aneurysms continue to challenging pathology. The authors provide long-term follow-up of VBF aneurysms treated with PEDs. Methods We retrospectively reviewed four patients that were treated at Louisiana State University Health Sciences Center in Shreveport with PEDs for VBFs from 2012 to 2014. Each patient was discussed in a multidisciplinary setting between neurosurgeons and neurointerventionalists. Each patient underwent platelet function tests to ensure responsiveness to anti-platelet agents and was treated by one neurointerventionalist (HC). All patients were placed on aspirin and Plavix and were confirmed for therapeutic response prior to discharge. Results Follow-up ranged from 12 to 25 months, with a mean of 14.25 months. Two cases presented with a recurrence after the initial treatment, both of which required subsequent treatment. Of the four patients treated, one patient developed hemiparesis and three died. Conclusion Despite reports describing successful treatment of VBF aneurysms with PEDs, delayed complications after obliteration and remodeling can occur. We describe our institutional experience of VBFs treated with PEDs. Treatment of holobasilar fusiform aneurysms may carry a worse prognosis after treatment. Further long-term follow-up will provide a better understanding of this pathology. PMID:26089246

  6. Cerebral air embolism after pleural streptokinase instillation.

    PubMed

    Janisch, Thorsten; Siekmann, Ullrich; Kopp, Rüdger

    2013-12-01

    Iatrogenic pulmonary barotrauma and cerebral arterial gas embolism (CAGE) may complicate a variety of medical procedures, such as certain types of surgery, drug administration through thoracic drainage, pneumoperitoneum, cystoscopy, bronchoscopy, etc. Hyperbaric oxygen treatment following the guidelines for CAGE in diving is the treatment of choice. Pleural streptokinase instillation is a common treatment for parapneumonic pleural effusion and may lead to CAGE. We present such a complication in a 79-year-old woman with a left-sided empyema. Neurological recovery was reasonable, but a left hemiparesis persisted. Prompt treatment of CAGE is necessary to avoid permanent injury and severe disability. PMID:24510333

  7. Direct Percutaneous Embolization of Bleeding Stomal Varices

    SciTech Connect

    Naidu, Sailen G.; Castle, Erik P.; Kriegshauser, J. Scott; Huettl, Eric A.

    2010-02-15

    Stomal variceal bleeding can develop in patients with underlying cirrhosis and portal hypertension. Most patients are best treated with transjugular intrahepatic portosystemic shunt (TIPS) creation because this addresses the underlying problem of portal hypertension. However, some patients are not good candidates for TIPS creation because they have end-stage liver disease or encephalopathy. We describe such a patient who presented with recurrent bleeding stomal varices, which was successfully treated with percutaneous coil embolization. The patient had bleeding-free survival for 1 month before death from unrelated causes.

  8. Arterial embolism of the upper extremities.

    PubMed

    Janevski, B

    1986-10-01

    The angiographic signs, the frequency and the site of distribution of acute emboli of the arteries of the upper extremity are described. The conclusions are based on the author's own experience gained from selective studies of acute arterial embolism of the upper limb, during a period of 15 years. A comparison is made with the results of two of the largest series reported in the literature. In addition, a brief review of the aetiology, pathogenesis, the clinical and roentgenological signs of the condition is given. PMID:3022344

  9. Embolic retinopathy due to Corynebacterium minutissimum endocarditis.

    PubMed

    Herschorn, B J; Brucker, A J

    1985-01-01

    Infective embolic retinopathy as a sequela of bacterial endocarditis is described in a 31-year-old woman with mitral valve prolapse. The infective organism, Corynebacterium minutissimum, has not been previously found to cause ocular or multisystem diseases. It is a common mucocutaneous inhabitant which causes erythrasma. In our case report both ocular involvement and septicaemia were present. The infection was confirmed by positive serial blood cultures. Mitral valve prolapse was confirmed by echocardiography. On clinical examination the retinopathy consisted of white intraretinal lesions which resolved with antibiotic therapy. By fluorescein angiography focal areas of hypofluorescence corresponding to the white fundus lesions were present. Optic disc oedema was also seen. PMID:3965026

  10. Patient Presentation and Management of Labial Ulceration Following Uterine Artery Embolization

    SciTech Connect

    Gonsalves, Carin Franciosa, Stefan V.; Shah, Suken; Bonn, Joseph; Wu, Christine

    2007-11-15

    Uterine artery embolization is a safe and effective procedure for the treatment of symptomatic uterine fibroids. Nontarget embolization of adjacent internal iliac artery branches is a reported complication of uterine artery embolization. The following report describes the presentation and management of ulcerations of the labium minora due to nontarget embolization of the internal pudendal artery.

  11. Uterine artery embolization for treatment of symptomatic fibroids; a single institution experience

    PubMed Central

    Laios, A; Baharuddin, N; Iliou, K; Gubara, E; O'Sullivan, G

    2014-01-01

    Background: Uterine fibroids are the most common reproductive tract tumours in females. Uterine artery embolization (UAE) is a fertility-sparing procedure for treatment of symptomatic fibroids. We evaluated the efficacy and safety of UAE in the treatment of 118 patients with symptomatic uterine fibroids in a single Academic Centre in the West of Ireland to determine whether fibroid and uterine size affect clinical outcomes and complications. Methods: This was a retrospective cohort of 118 patients who underwent UAE for treatment of symptomatic fibroids between November 2006 and August 2011. Diagnosis of fibroids in symptomatic patients was established by magnetic resonance imaging (MRI) and/or transabdominal ultrasonography (US). Three different embolic agents were used. All patients had at least one follow-up using MRI, at three and/or 12 months. A non-validated questionnaire was used to report patient satisfaction with regards to symptoms improvement on a yes-or-no basis. Results: Mean fibroid volume, uterine size and dominant fibroid size were significantly reduced at three months and one year follow-up (p = 0.00) and that was tallied with symptoms improvement (p < 0.05). Overall patient satisfaction at three months was 84% falling to 75.9% by 12 months (all p < 0.05). Few complications were reported (2.5%). No significant difference was observed in safety or efficacy for different embolic agents. Conclusion: The study confirms the safety and efficacy of UAE in the treatment of symptomatic fibroids. Hippokratia 2014; 18 (3): 258-261. PMID:25694762

  12. Pattern of Retained Contrast on Immediate Postprocedure Computed tomography (CT) After Particle Embolization of Liver Tumors Predicts Subsequent Treatment Response

    SciTech Connect

    Wang Xiaodong Erinjeri, Joseph P.; Jia Xiaoyu Gonen, Mithat; Brown, Karen T. Sofocleous, Constantinos T. Getrajdman, George I. Brody, Lynn A. Thornton, Raymond H. Maybody, Majid Covey, Ann M. Siegelbaum, Robert H. Alago, William Solomon, Stephen B.

    2013-08-01

    PurposeTo determine if the pattern of retained contrast on immediate postprocedure computed tomography (CT) after particle embolization of hepatic tumors predicts modified Response Evaluation Criteria in Solid Tumors (mRECIST) response.Materials and MethodsThis study was approved by the Institutional Review Board with a waiver of authorization. One hundred four liver tumors were embolized with spherical embolic agents (Embospheres, Bead Block, LC Bead) and polyvinyl alcohol. Noncontrast CT was performed immediately after embolization to assess contrast retention in the targeted tumors, and treatment response was assessed by mRECIST criteria on follow-up CT (average time 9.0 {+-} 7.7 weeks after embolization). Tumor contrast retention (TCR) was determined based on change in Hounsfield units (HUs) of the index tumors between the preprocedure and immediate postprocedure scans; vascular contrast retention (VCR) was rated; and defects in contrast retention (DCR) were also documented. The morphology of residual enhancing tumor on follow-up CT was described as partial, circumferential, or total. Association between TCR variables and tumor response were assessed using multivariate logistic regression.ResultsOf 104 hepatic tumors, 51 (49 %) tumors had complete response (CR) by mRECIST criteria; 23 (22.1 %) had partial response (PR); 21 (20.2 %) had stable disease (SD); and 9 (8.7 %) had progressive disease (PD). By multivariate analysis, TCR, VCR, and tumor size are independent predictors of CR (p = 0.02, 0.05, and 0.005 respectively). In 75 tumors, DCR was found to be an independent predictor of failure to achieve complete response (p < 0.0001) by imaging criteria.ConclusionTCR, VCR, and DCR on immediate posttreatment CT are independent predictors of CR by mRECIST criteria.

  13. Inhaled nitric oxide in acute pulmonary embolism: a systematic review.

    PubMed

    Bhat, Tariq; Neuman, Adi; Tantary, Mohmad; Bhat, Hilal; Glass, Daniel; Mannino, William; Akhtar, Muhammad; Bhat, Alina; Teli, Sumaya; Lafferty, James

    2015-01-01

    Acute pulmonary embolism (PE) is usually a complication secondary to migration of a deep venous clot or thrombi to lungs, but other significant etiologies include air, amniotic fluid, fat, and bone marrow. Regardless of the underlying etiology, little progress has been made in finding an effective pharmacologic intervention for this serious complication. Among the wide spectrum of PE, massive PE is associated with considerable morbidity and mortality, primarily due to severely elevated pulmonary vascular resistance leading to right ventricular failure, hypoxemia, and cardiogenic shock. We currently have limited therapeutic options at our disposal. Inhaled nitric oxide (iNO) has been proposed as a potential therapeutic agent in cases of acute PE in which hemodynamic compromise secondary to increased pulmonary vascular resistance is present, based on iNO's selective dilation of the pulmonary vasculature and antiplatelet activity. A systematic search of studies using the PubMed database was undertaken in order to assess the available literature. Although there are currently no published randomized controlled trials on the subject, except a recently publish phase I trial involving eight patients, several case reports and case series describe and document the use of iNO in acute PE. The majority of published reports have documented improvements in oxygenation and hemodynamic variables, often within minutes of administration of iNO. These reports, when taken together, raise the possibility that iNO may be a potential therapeutic agent in acute PE. However, based on the current literature, it is not possible to conclude definitively whether iNO is safe and effective. These case reports underscore the need for randomized controlled trials to establish the safety and efficacy of iNO in the treatment of massive acute PE. The purpose of this article is to review the current literature in the use of iNO in the setting of PE given how acute PE causes acute onset of pulmonary

  14. Septic Pulmonary Embolism Following Appendectomy Surgery.

    PubMed

    Lardo, Soroy; Ariane, Anna; Chen, Khie

    2015-07-01

    Septic Pulmonary embolism is a rare condition where there were numerous pulmonary infarcts resulting from blood clot emboli that also contains microorganism. This disorder is insidious onset, Its clinical features usually unspecific and the diagnosis usually difficult to establish. A 43 old woman who underwent an appendicitis surgery, reentered the hospital at the sixth day after surgery presented with fever, pain at the surgical site, progressive severe dyspnea and chest tightness. From the physical examination finding there were tachycardia, tachypneu, wet rough basal rhonki on the right rear and tenderness at right lower region of the abdomen. The thorax-abdomen CT scan result was pleuropneumonial with minimal effusion in the right side. A CT angiography scan of the chest and abdomen showed intralumen emboli in medial lobe segmen of right pulmonary artery, right pleuropneumonia with segmental lession in segmen 10 right lobe and inflammation process along right lateral wall of the abdomen. Laboratory results that also supported diagnosis were D dimer 3442 ng/mL and culture result from surgical site pus showed E. Coli ESBL (+). Base on these findings, this case was established as a septic pulmonary embolism. PMID:26586389

  15. Diagnosing pulmonary embolism: new computed tomography applications.

    PubMed

    Nikolaou, Konstantin; Thieme, Sven; Sommer, Wieland; Johnson, Thorsten; Reiser, Maximilian F

    2010-05-01

    Computed tomographic pulmonary angiography has become the standard of care for the evaluation of patients with suspected pulmonary embolism (PE). In addition to the direct depiction or exclusion of a pulmonary embolus in suspected PE, a number of predictive markers have been established to evaluate the patient's prognosis in acute and in chronic PE. An accurate risk stratification based on CT findings is crucial because optimal management, monitoring, and therapeutic strategies depend on the prognosis. With the recent introduction of the so-called "dual-source" CT scanners, that is, a scanner consisting of 2 tubes and 2 detectors mounted orthogonally to each other, different tube voltages can be used simultaneously, resulting in different energies of the emitted x-ray spectra (dual-energy CT; DECT). Initial results have shown that DECT is capable of iodine mapping of the pulmonary parenchyma, reliably depicting the segmental defects in iodine distribution in locations corresponding to embolic vessel occlusions. This study deals with a number of actual topics on PE imaging with multidetector CT and DECT, including the discussion of the relevant imaging findings to assess the patient's prognosis, the potential and additional benefit of dual-energy information on the parenchymal iodine distribution, the optimization of scan protocols including low-radiation dose chest pain protocols, and the discussion on future perspectives of CT in PE patients, such as the role of computer-aided diagnostic tools or the potential of ventilation imaging with DECT. PMID:20463534

  16. Acute management of vascular air embolism

    PubMed Central

    Shaikh, Nissar; Ummunisa, Firdous

    2009-01-01

    Vascular air embolism (VAE) is known since early nineteenth century. It is the entrainment of air or gas from operative field or other communications into the venous or arterial vasculature. Exact incidence of VAE is difficult to estimate. High risk surgeries for VAE are sitting position and posterior fossa neurosurgeries, cesarean section, laparoscopic, orthopedic, surgeries invasive procedures, pulmonary overpressure syndrome, and decompression syndrome. Risk factors for VAE are operative site 5 cm above the heart, creation of pressure gradient which will facilitate entry of air into the circulation, orogenital sex during pregnancy, rapid ascent in scuba (self contained underwater breathing apparatus) divers and barotrauma or chest trauma. Large bolus of air can lead to right ventricular air lock and immediate fatality. In up to 35% patient, the foramen ovale is patent which can cause paradoxical arterial air embolism. VAE affects cardiovascular, pulmonary and central nervous system. High index of clinical suspicion is must to diagnose VAE. The transesophgeal echocardiography is the most sensitive device which will detect smallest amount of air in the circulation. Treatment of VAE is to prevent further entrainment of air, reduce the volume of air entrained and haemodynamic support. Mortality of VAE ranges from 48 to 80%. VAE can be prevented significantly by proper positioning during surgery, optimal hydration, avoiding use of nitrous oxide, meticulous care during insertion, removal of central venous catheter, proper guidance, and training of scuba divers. PMID:20009308

  17. Acute management of vascular air embolism.

    PubMed

    Shaikh, Nissar; Ummunisa, Firdous

    2009-09-01

    Vascular air embolism (VAE) is known since early nineteenth century. It is the entrainment of air or gas from operative field or other communications into the venous or arterial vasculature. Exact incidence of VAE is difficult to estimate. High risk surgeries for VAE are sitting position and posterior fossa neurosurgeries, cesarean section, laparoscopic, orthopedic, surgeries invasive procedures, pulmonary overpressure syndrome, and decompression syndrome. Risk factors for VAE are operative site 5 cm above the heart, creation of pressure gradient which will facilitate entry of air into the circulation, orogenital sex during pregnancy, rapid ascent in scuba (self contained underwater breathing apparatus) divers and barotrauma or chest trauma. Large bolus of air can lead to right ventricular air lock and immediate fatality. In up to 35% patient, the foramen ovale is patent which can cause paradoxical arterial air embolism. VAE affects cardiovascular, pulmonary and central nervous system. High index of clinical suspicion is must to diagnose VAE. The transesophgeal echocardiography is the most sensitive device which will detect smallest amount of air in the circulation. Treatment of VAE is to prevent further entrainment of air, reduce the volume of air entrained and haemodynamic support. Mortality of VAE ranges from 48 to 80%. VAE can be prevented significantly by proper positioning during surgery, optimal hydration, avoiding use of nitrous oxide, meticulous care during insertion, removal of central venous catheter, proper guidance, and training of scuba divers. PMID:20009308

  18. Pulmonary embolism in pregnancy. Consensus and controversies.

    PubMed

    Benson, M D

    2012-10-01

    Venous thrombotic events (VTE) occur 1-2 per 10,000 pregnancies and remain one of the leading causes of maternal mortality in the developed world. The two largest risk factors are a personal history of VTE and heritable thrombophilias. D-dimer tests for VTE in pregnancy have a high false positive rate and at least some false negatives have been reported. Compression ultrasound should be used to evaluate pregnant women for deep venous thrombosis followed by magnetic resonance imaging of the pelvis for a negative test and strong remaining clinical suspicion. For pulmonary embolism, a chest x-ray should be used to triage the patient to either a ventilation/perfusion study after a normal X-ray or a CT pulmonary angiogram after an abnormal one. Treatment generally consists of low molecular weight heparin through a minimum of six weeks post-partum. Thombolysis might have merit in life-threatening, massive pulmonary embolism. VTE prophylaxis in at-risk populations remains a major area of uncertainty. Mechanical prophylaxis for all women undergoing cesarean, in particular, has a paucity of supportive evidence. PMID:23018478

  19. Atypical and ischemic features of embolized meningiomas.

    PubMed

    Matsuda, Ken; Takeuchi, Hiroaki; Arai, Yoshikazu; Kitai, Ryuhei; Hosoda, Tetsuya; Tsunetoshi, Kenzo; Arishima, Hidetaka; Sato, Kazufumi; Kikuta, Ken-Ichiro

    2012-01-01

    Preoperative embolization (POE) of meningiomas is widely used to facilitate surgical removal and to reduce intraoperative blood loss. The resulting necrosis and enhanced proliferation have been reported to affect subsequent histologic grading. However, there was little concern about ischemic features, for example small cells resembling atypical meningiomas, cytoplasmic vacuoles resembling clear cell meningioma, intercellular discohesion resembling rhabdoid meningioma, and perivascular cuffs resembling papillary meningioma. Therefore, the extent of these ischemic features was scored and Ki-67 staining indices were investigated in a POE group composed of 29 specimens of meningiomas treated with POE and compared with equivalent results for a non-POE group composed of 29 meningiomas that were not treated with POE. Small cells with high N/C ratios, cytoplasmic vacuoles, intercellular discohesion, and perivascular cuffs were significantly increased in the POE group (versus the non-POE group, p < 0.05). There were no significant differences of the Ki-67 index between the POE group (2.2%) and the non-POE group (1.9%) (p = 0.49). Our results suggest that small cell change resulting in necrosis may be followed by POE, and that clear cell-like, rhabdoid cell-like, or pseudopapillary pattern identified in meningiomas may also be induced by POE. Therefore, histological findings and determination of grading should be evaluated cautiously in cases of embolized meningiomas. PMID:21789536

  20. Synthesis and characterization of shape-memory poly carbonate urethane microspheres for future vascular embolization.

    PubMed

    Liu, Rongrong; Dai, Honglian; Zhou, Qian; Zhang, Qian; Zhang, Ping

    2016-08-01

    Two types of shape memory poly carbonate urethanes (PCUs) microspheres were synthesized by pre-polymerization and suspension polymerization, based on Polycarbonate diol (PCDL) as the soft segment, Isophorone diisocyanate (IPDI) and 1,6-hexamethylene diisocyanate (HDI) as the hard segments and 1,4-butanediol (BDO) as the chain expanding agent. The structure, crystallinity, and thermal property of the two synthesized PCUs were characterized by Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), Differential scanning calorimetery (DSC), respectively. The results showed that the two types of PCUs exhibited high thermal stability with phase separation and semi-crystallinity. Also, the results of the compression test displayed that the shape fixity and the shape recovery of two PCUs were more than 90% compared to the originals, indicating their similar bio-applicability and shape-memory properties. The tensile strength, elongation at break was enhanced by introducing and increasing content of HDI. The water contact angles of PCUs decreased and their surface tension increased by surface modified with Bovine serum albumin (BSA). Furthermore, the biological study results of two types of PCUs from the platelet adhesion test and the cell proliferation inhibition test indicated they had some biocompatibilites. Hence, the PCU microspheres might represent a smart and shape-memory embolic agent for vascular embolization. PMID:27193120

  1. Evaluation of meteorological and epidemiological characteristics of fatal pulmonary embolism

    NASA Astrophysics Data System (ADS)

    Törő, Klára; Pongrácz, Rita; Bartholy, Judit; Váradi-T, Aletta; Marcsa, Boglárka; Szilágyi, Brigitta; Lovas, Attila; Dunay, György; Sótonyi, Péter

    2016-03-01

    The objective of the present study was to identify risk factors among epidemiological factors and meteorological conditions in connection with fatal pulmonary embolism. Information was collected from forensic autopsy records in sudden unexpected death cases where pulmonary embolism was the exact cause of death between 2001 and 2010 in Budapest. Meteorological parameters were detected during the investigated period. Gender, age, manner of death, cause of death, place of death, post-mortem pathomorphological changes and daily meteorological conditions (i.e. daily mean temperature and atmospheric pressure) were examined. We detected that the number of registered pulmonary embolism (No 467, 211 male) follows power law in time regardless of the manner of death. We first described that the number of registered fatal pulmonary embolism up to the nth day can be expressed as Y( n) = α ṡ n β where Y denotes the number of fatal pulmonary embolisms up to the nth day and α > 0 and β > 1 are model parameters. We found that there is a definite link between the cold temperature and the increasing incidence of fatal pulmonary embolism. Cold temperature and the change of air pressure appear to be predisposing factors for fatal pulmonary embolism. Meteorological parameters should have provided additional information about the predisposing factors of thromboembolism.

  2. Evaluation of meteorological and epidemiological characteristics of fatal pulmonary embolism.

    PubMed

    Törő, Klára; Pongrácz, Rita; Bartholy, Judit; Váradi-T, Aletta; Marcsa, Boglárka; Szilágyi, Brigitta; Lovas, Attila; Dunay, György; Sótonyi, Péter

    2016-03-01

    The objective of the present study was to identify risk factors among epidemiological factors and meteorological conditions in connection with fatal pulmonary embolism. Information was collected from forensic autopsy records in sudden unexpected death cases where pulmonary embolism was the exact cause of death between 2001 and 2010 in Budapest. Meteorological parameters were detected during the investigated period. Gender, age, manner of death, cause of death, place of death, post-mortem pathomorphological changes and daily meteorological conditions (i.e. daily mean temperature and atmospheric pressure) were examined. We detected that the number of registered pulmonary embolism (No 467, 211 male) follows power law in time regardless of the manner of death. We first described that the number of registered fatal pulmonary embolism up to the nth day can be expressed as Y(n) = α ⋅ n (β) where Y denotes the number of fatal pulmonary embolisms up to the nth day and α > 0 and β > 1 are model parameters. We found that there is a definite link between the cold temperature and the increasing incidence of fatal pulmonary embolism. Cold temperature and the change of air pressure appear to be predisposing factors for fatal pulmonary embolism. Meteorological parameters should have provided additional information about the predisposing factors of thromboembolism. PMID:26178756

  3. Percutaneous embolization of varicocele: technique, indications, relative contraindications, and complications

    PubMed Central

    Halpern, Joshua; Mittal, Sameer; Pereira, Keith; Bhatia, Shivank; Ramasamy, Ranjith

    2016-01-01

    There are several options for the treatment of varicocele, including surgical repair either by open or microsurgical approach, laparoscopy, or through percutaneous embolization of the internal spermatic vein. The ultimate goal of varicocele treatment relies on the occlusion of the dilated veins that drain the testis. Percutaneous embolization offers a rapid recovery and can be successfully accomplished in approximately 90% of attempts. However, the technique demands interventional radiologic expertise and has potential serious complications, including vascular perforation, coil migration, and thrombosis of pampiniform plexus. This review discusses the common indications, relative contraindications, technical details, and risks associated with percutaneous embolization of varicocele. PMID:26658060

  4. Crisis management of air embolism in the or.

    PubMed

    Seifert, Patricia C; Yang, Zhao; Munoz, Ruben

    2015-04-01

    An air embolism in the OR is a life-threatening emergency that demands prompt coordinated interventions by all perioperative team members. Specific applications of protocols and guidelines, such as the flowchart provided in this article, provide key components of traditional and effective responses to surgical crises. Successful management of an air embolism event requires critical skills of perioperative nurses who must consider both the risks for VAE or AAE and preventive actions, be aware of the resources available during an air embolism in the OR, and collaborate with their team members through precise and accurate communication. PMID:25835011

  5. Postcoital Hemorrhage of a Recurrent Seminal Vesicle Cyst Requiring Embolization.

    PubMed

    Royston, Eric; Walker, Marc; Ching, Brian; Morilla, Daniel; Sterbis, Joseph; McMann, Leah

    2014-09-01

    Herein is a case of a 23-year-old man with recurrence of a seminal vesicle cyst after percutaneous drainage and laparoscopic excision complicated by hemorrhage requiring embolization. He presented to the emergency department for pain after ejaculation. Computed tomographic scan of his pelvis revealed extravasation of contrast near his cyst and pelvic fluid collection suspicious for a hematoma. The patient had steadily decreasing hemoglobin and hematocrit levels. An interventional radiologist performed an embolization of the left seminal vesicle cystic arteries. Hemoglobin and hematocrit values improved and he was discharged. Hemorrhage resolved with embolization procedure and pain dissipated over the course of follow up care. PMID:26958478

  6. Facial palsy following embolization of a dural arteriovenous fistula.

    PubMed

    Ozluoglu, Levent N; Koycu, A; Jafarov, S; Hizal, E; Boyvat, F

    2016-09-01

    Intracranial arteriovenous malformations are infrequent. Advances in endovascular treatment techniques have promoted the use of endovascular embolization in management of intracranial arteriovenous malformations. Transvenous or transarterial embolization procedures are effective options in the treatment of the arteriovenous fistulas. However, complications such as cranial nerve palsies may occur. Here, we present a case of right-sided lower motor neuron facial paralysis due to embolization of an intracranial dural arteriovenous fistula that have presented with clinical findings on the left eye. Facial functions of the patient improved from total weakness to House-Brackmann grade II, following facial nerve decompression surgery. PMID:26329900

  7. Embolization of Bleeding Stomal Varices by Direct Percutaneous Approach

    SciTech Connect

    Arulraj, Ramakrishnan; Mangat, Kamarjit S.; Tripathi, Dhiraj

    2011-02-15

    Stomal varices can occur in patients with stoma in the presence of portal hypertension. Suture ligation, sclerotherapy, angiographic embolization, stoma revision, beta blockade, portosystemic shunt, and liver transplantation have been described as therapeutic options for bleeding stomal varices. We report the case of a 21-year-old patient with primary sclerosing cholangitis and colectomy with ileostomy for ulcerative colitis, where stomal variceal bleeding was successfully treated by direct percutaneous embolization. We consider percutaneous embolization to be an effective way of treating acute stomal bleeding in decompensated patients while awaiting decisions regarding shunt procedures or liver transplantation.

  8. Renoduodenal Fistula After Transcatheter Embolization of Renal Angiomyolipoma

    SciTech Connect

    Sheth, Rahul A.; Feldman, Adam S.; Walker, T. Gregory

    2015-02-15

    Transcatheter embolization of renal angiomyolipomas is a routinely performed, nephron-sparing procedure with a favorable safety profile. Complications from this procedure are typically minor in severity, with postembolization syndrome the most common minor complication. Abscess formation is a recognized but uncommon major complication of this procedure and is presumably due to superinfection of the infarcted tissue after arterial embolization. In this case report, we describe the formation of a renoduodenal fistula after embolization of an angiomyolipoma, complicated by intracranial abscess formation and requiring multiple percutaneous drainage procedures and eventual partial nephrectomy.

  9. Cerebral infarction following thrombolysis for massive pulmonary embolism.

    PubMed

    Bracey, Tim S; Langrish, Chris; Darby, Mike; Soar, Jasmeet

    2006-01-01

    A 29-year-old male developed a fatal stroke 6 h after successful thrombolysis for massive pulmonary embolism. Autopsy showed thrombus protruding through a patent foramen ovale (PFO). A strand of thrombus extended from the aortic arch into the left common carotid artery. The brain showed extensive infarction of the left fronto-parietal area. Thrombolysis caused initial disintegration of the embolism. It is likely that thrombolysis caused fragments of clot to later break lose and embolise into the cerebral circulation. We discuss the need for risk stratification in patients who present with massive pulmonary embolism and PFO. PMID:16219407

  10. Percutaneous embolization of varicocele: technique, indications, relative contraindications, and complications.

    PubMed

    Halpern, Joshua; Mittal, Sameer; Pereira, Keith; Bhatia, Shivank; Ramasamy, Ranjith

    2016-01-01

    There are several options for the treatment of varicocele, including surgical repair either by open or microsurgical approach, laparoscopy, or through percutaneous embolization of the internal spermatic vein. The ultimate goal of varicocele treatment relies on the occlusion of the dilated veins that drain the testis. Percutaneous embolization offers a rapid recovery and can be successfully accomplished in approximately 90% of attempts. However, the technique demands interventional radiologic expertise and has potential serious complications, including vascular perforation, coil migration, and thrombosis of pampiniform plexus. This review discusses the common indications, relative contraindications, technical details, and risks associated with percutaneous embolization of varicocele. PMID:26658060

  11. Delivery by cesarean section after embolization for vaginal arteriovenous malformation.

    PubMed

    Hasegawa, Toru; Yamakawa, Yoshihiro; Ota, Satoshi; Kamei, Tetsuya; Tateno, Masaya

    2008-01-01

    Vaginal arteriovenous malformation (AVM) can lead to life-threatening complications on delivery. No deliveries have been reported after selective embolization for a vaginal AVM. A 34-year-old nulliparous woman was found to have an arterial pulsatile mass on the left vaginal wall. The findings of magnetic resonance imaging and magnetic resonance angiography were consistent with an AVM. Selective transcatheter embolization for the AVM was done and, afterwards, the patient was found to be pregnant. The prenatal course was uneventful and the patient underwent elective cesarean delivery at term. Vaginal AVM can be successfully treated with selective embolization, with a good obstetric outcome. PMID:17671389

  12. [Role of embolization in the management of uterine fibroids].

    PubMed

    Kahn, V; Fohlen, A; Pelage, J-P

    2011-12-01

    Uterine artery embolization using non spherical PVA particles or calibrated trisacryl microspheres above 500 μm is effective to treat menorrhagia, bulk-related symptoms and pelvic pain in more than 90% of cases in the short-term. In the long-term, embolization is effective in 75% of cases at 5-7 years. At 6 months, uterine volume reduction and dominant fibroid volume reduction varies between 30-60% and 50-80% respectively. During hospital stay, the complication rate is 3%. Secondary hysterectomy for complication is less than 2% at 3 months. Definitive amenorrhea is reported in less than 5% of cases in women of less than 45 years of age. No significant impact of embolization on hormonal function has been reported in women less than 45 years with normal baseline function. Secondary hysterectomy for clinical failure or recurrence is reported in 14-28% of cases at 5 years. Non-spherical PVA particles are associated with more microcatheter occlusion than trisacryl microspheres. No difference between PVA particles and trisacryl microspheres was found in terms of post-embolization pain or analgesic doses. PVA microspheres (Contour SE et Bead Block) are associated with lower clinical success and lower fibroid devascularization using MRI than trisacryl microspheres. No difference between PVA particles and trisacryl microspheres was found in terms of clinical efficacy, uterine volume reduction and complication rate. Randomized studies comparing embolization to hysterectomy demonstrate that reinterventions are more frequently performed after embolization. Secondary hysterectomy is performed in 13 to 24% of cases at 2 years and in up to 28% of cases at 5 years. Hospital stay, duration of recovery and time off work are shorter after embolization compared to hysterectomy. Embolization is cheaper than hysterectomy at 12 and 24 months even taking into consideration the additional costs of imaging and reinterventions. Randomized studies comparing embolization to myomectomy

  13. Experimental Air Embolism: Measurement of Microbubbles Using the Coulter Counter®

    PubMed Central

    Grulke, D. C.; Marsh, N. A.; Hills, B. A.

    1973-01-01

    Microbubbles in the range 20-250 μm were produced with fine hypodermic needles (0·001, 0·002 and 0·003 inch internal diameter) and were measured using a conventional Coulter Counter. Various bubble sizes could be obtained by varying combinations of needle size, gas pressure, liquid surfactant content and liquid flow rate. Bubbles produced and measured in this way were found to have a very narrow size distribution (80% of the bubbles falling within ± 2 μm of the mean radius) and could be generated at relatively constant frequencies. Over the entire bubble size range, the Coulter Counter method correlated well with two other bubble measuring methods: terminal rise velocity and volume flow rate of gas divided by bubble frequency. It is suggested that this method will enable the introduction of a known number of accurately sized microbubbles into the circulation for the purpose of studying experimental gas embolism. ImagesFig. 2 PMID:4783166

  14. Superselective microcoil embolization in severe intractable epistaxis: an analysis of 12 consecutive cases from an otorhinolaryngologic and an interventional neuroradiologic point of view.

    PubMed

    Seidel, D U; Remmert, S; Brassel, F; Schlunz-Hendann, M; Meila, D

    2015-11-01

    From 2006 to 2013, 12 patients with severe epistaxis refractory to prior conservative and surgical therapy were treated by superselective embolization of nasal arteries. Supersoft platinum microcoils with smallest diameters were used as the sole embolic agent in all cases. Coils were applied far distally in a stretched position for obtaining ideal target vessel superselectivity. The objective of this study is to evaluate efficacy and complications of superselective coil embolization for treatment of severe intractable epistaxis and to discuss results from an otorhinolaryngologic and an interventional neuroradiologic point of view. Retrospectively, all epistaxis inpatients between 2006 and 2013 were identified and subdivided by form of treatment: conservative, surgical and interventional therapy. Medical records of interventionally treated patients were reviewed for demographics, medical history, risk factors, clinical data, complications and short-term success, and patients were followed up for long-term success. Mean follow-up was 37 months. In 12 patients, 14 embolizations were carried out, with short-term success in 9 patients (75%), while early post-interventional rebleeding occurred in 3 patients (25%). Of 9 patients with short-term success, 1 died during stay, 1 was lost to follow-up and 1 had minor re-bleeding after 30 months. Six patients had short-term and long-term success. Before the first embolization, 3 ± 1 conservative and/or surgical procedures had been undertaken. Length of stay was 12.8 ± 3.6 days. 8 patients (67%) received red cell concentrates. Most frequent complications were mucosal damage and nasal pain, but these were related to repeated packing and surgery. Typical embolic complications as neurological or visual impairment or soft tissue necrosis were not observed in any patient. From the otorhinolaryngologic point of view, surgery is the treatment of choice in severe refractory epistaxis, but in case of repeated failure, superselective

  15. Iodine-containing cellulose mixed esters as radiopaque polymers for direct embolization of cerebral aneurysms and arteriovenous malformations.

    PubMed

    Mottu, F; Rüfenacht, D A; Laurent, A; Doelker, E

    2002-01-01

    The present study deals with the synthesis and characterization of radiopaque polymers which could, when solubilized in an appropriate water-miscible solvent, be useful embolic materials for the treatment of cerebral aneurysms and arteriovenous malformations. For this purpose cellulose (both microcrystalline and powdered) and partially substituted cellulose acetate (two different viscosity grades) were selected as starting materials to prepare iodine-containing polymers through various synthetic routes. The materials obtained were characterized by IR and NMR spectroscopy, molecular weight, iodine content, radiopacity and solubility in selected injectable organic solvents. The embolic liquids were evaluated for their precipitation behavior in a phosphate buffer solution (pH 7.4) mimicking physiological conditions using an in vitro aneurysm model. A sheep model was also used to assess in vivo the radiopacity and precipitation properties of a highly concentrated solution of a cellulose acetate 2,3,4-triiodobenzoate mixed ester. All materials with 4-iodo- and 2,3,5-triiodobenzoyl groups gave sufficient radiopacity to be regarded as possible embolization materials, whereas iododeoxycellulose and iododeoxycellulose acetate were not radiopaque because of their low iodine content. Esters synthesized using cellulose as starting material were not soluble in the selected organic solvents due to the presence of many residual hydroxyl groups, but could be used for other biomedical applications where insoluble radiopaque materials are used. In contrast, solubility of the materials as well as satisfactory precipitation properties were ensured using cellulose acetate as the starting material. In conclusion, cellulose acetate iodobenzoate mixed esters dissolved in diglyme or dimethyl isosorbide (dimethyl sulfoxide is probably less appropriate because of its toxicity and hemolytic properties) could be useful embolic liquids for the treatment of cerebral aneurysms or arteriovenous

  16. A case of panic to pulmonary embolism.

    PubMed

    Ng, Mansum; Pandya, Nikila; Conry, Brendon; Gale, Richard

    2015-01-01

    Pulmonary embolism (PE) is a rare paediatric diagnosis, but its presence is likely to be underestimated due to the subtle and non-specific nature of its symptoms. Common clinical features of PE include shortness of breath, pleuritic chest pain and acute cardiovascular collapse. Less common symptoms can include persistent unexplained tachycardia, fever or deep vein thrombosis. Rarely do patients present with abdominal pain and self-resolving shortness of breath; symptoms our patient experienced. However, in contrast to popular belief, having normal vital signs does not necessarily lower the probability of PE. D-dimer, a specific fibrin degradation product, has a good negative predictive value for venous thromboembolism diagnosis but its use in children is less clear, with up to 40% of children with PE having a normal D-dimer level. CT pulmonary angiography remains the gold standard in diagnosis. PMID:26071441

  17. Emergency management of fat embolism syndrome

    PubMed Central

    Shaikh, Nissar

    2009-01-01

    Fat emboli occur in all patients with long-bone fractures, but only few patients develop systemic dysfunction, particularly the triad of skin, brain, and lung dysfunction known as the fat embolism syndrome (FES). Here we review the FES literature under different subheadings. The incidence of FES varies from 1–29%. The etiology may be traumatic or, rarely, nontraumatic. Various factors increase the incidence of FES. Mechanical and biochemical theories have been proposed for the pathophysiology of FES. The clinical manifestations include respiratory and cerebral dysfunction and a petechial rash. Diagnosis of FES is difficult. The other causes for the above-mentioned organ dysfunction have to be excluded. The clinical criteria along with imaging studies help in diagnosis. FES can be detected early by continuous pulse oximetry in high-risk patients. Treatment of FES is essentially supportive. Medications, including steroids, heparin, alcohol, and dextran, have been found to be ineffective. PMID:19561953

  18. Management dilemmas in acute pulmonary embolism

    PubMed Central

    Condliffe, Robin; Elliot, Charlie A; Hughes, Rodney J; Hurdman, Judith; Maclean, Rhona M; Sabroe, Ian; van Veen, Joost J; Kiely, David G

    2014-01-01

    Background Physicians treating acute pulmonary embolism (PE) are faced with difficult management decisions while specific guidance from recent guidelines may be absent. Methods Fourteen clinical dilemmas were identified by physicians and haematologists with specific interests in acute and chronic PE. Current evidence was reviewed and a practical approach suggested. Results Management dilemmas discussed include: sub-massive PE, PE following recent stroke or surgery, thrombolysis dosing and use in cardiac arrest, surgical or catheter-based therapy, failure to respond to initial thrombolysis, PE in pregnancy, right atrial thrombus, role of caval filter insertion, incidental and sub-segmental PE, differentiating acute from chronic PE, early discharge and novel oral anticoagulants. Conclusion The suggested approaches are based on a review of the available evidence and guidelines and on our clinical experience. Management in an individual patient requires clinical assessment of risks and benefits and also depends on local availability of therapeutic interventions. PMID:24343784

  19. Pulmonary embolism workup in five steps.

    PubMed

    Smith, Clay B

    2014-07-01

    A workup for pulmonary embolism (PE) is complex, with multiple clinical decision rules to remember. A proper diagnostic workup can safely rule out PE without the use of computed tomography, which is both expensive and exposes patients to radiation and intravenous contrast. However, once PE has been diagnosed, it is important to risk stratify patients according to severity to both treat and disposition them correctly. PQRsTU is a simple, easy-to-remember mnemonic for the workup of PE that considers five phases: PERC phase (PE rule-out criteria), Quantify gestalt phase (to determine proper use of D-dimer or direct to imaging), Risk stratification phase (once PE has been diagnosed), Treatment phase, and Unit or floor (patient disposition). This structured method for evaluating PE will help clinicians develop a systematic, evidence-based approach to this complex and potentially lethal disease. Video is available at https://vimeo.com/91406117 Password: perls. PMID:25040049

  20. Uterine artery embolization for heavy menstrual bleeding.

    PubMed

    Moss, Jonathan; Christie, Andrew

    2016-01-01

    Uterine artery embolization (UAE) as a treatment option for fibroids was first reported by Ravina in 1995. Although rapidly adopted by enthusiasts, many were skeptical and its introduction varied widely across the globe. It was not until randomized controlled trials and registries were published and national guidance statements issued that UAE was accepted as a safe and proven treatment for fibroids. The technique is now established as one of the treatment options to be discussed with patients as an alternative to surgery for fibroid-associated heavy menstrual bleeding. Research is on-going to evaluate the relative merits of UAE compared with other medical and surgical treatment options for heavy menstrual bleeding, particularly for women wishing to maintain their fertility. PMID:26756068

  1. [Pulmonary embolism: an analysis of 25 patients].

    PubMed

    Li, L Y; Lu, G; Zhu, Y J

    1993-09-01

    We reported 25 cases of patients with pulmonary embolism (PE) definitely diagnosed in our hospital from 1983 to 1990. Twenty-one cases of them were found in the last 5 years. This indicated that the discovery rate had increased obviously. Five of these patients were confirmed by autopsy, the other twenty cases were diagnosed by clinical manifestations combined with perfusion-inspiration lung scans and chest roentgenogram. Due to the prompt diagnosis and the appropriate use of anticoagulants, 72% of the patients survived after treatment. We suggest that all the patients with suspected PE should take perfusion-inspiration lung scans, because this is a noninvasive and reliable method. Digital subtraction angiography is necessary for some patients. Routine chest radiography, arterial blood gas analysis, intrapulmonary shunt test, deep venography or nuclide scan of lower extremities are also useful methods for the diagnosis of PE. PMID:8112138

  2. Management of Severe Hemoptysis from Pulmonary Aspergilloma Using Endovascular Embolization

    SciTech Connect

    Corr, Peter

    2006-10-15

    Purpose. To determine the effectiveness of endovascular embolization as a temporizing measure in the management of severe hemoptysis caused by intracavitary pulmonary aspergilloma. Methods. Patients presenting with hemoptysis, estimated to be more than 300 ml in the preceding 24 hr, in whom a radiological diagnosis of pulmonary aspergilloma was made on chest radiographs and/or computed tomography of the chest were subjected to bronchial and systemic arteriography and embolization using triacryl microspheres. Results. Twelve patients with upper lobe intracavitary aspergillomas were managed with embolization. In 11 patients hemoptysis stopped within 24 hr and with no recurrence over the next 4 weeks. In 1 patient hemoptysis persisted and an upper lobe lobectomy was performed. Conclusion. Embolization of bronchial and systemic arteries is an effective method for treating acute severe hemoptysis from intracavitary aspergillomas, allowing the patient time to recover for definitive surgical management.

  3. Embolization with the Amplatzer Vascular Plug in TIPS Patients

    SciTech Connect

    Pattynama, Peter M. T. Wils, Alexandra; Linden, Edwin van der; Dijk, Lukas C. van

    2007-11-15

    Vessel embolization can be a valuable adjunct procedure in transjugular intrahepatic portosystemic shunt (TIPS). During the creation of a TIPS, embolization of portal vein collaterals supplying esophageal varices may lower the risk of secondary rebleeding. And after creation of a TIPS, closure of the TIPS itself may be indicated if the resulting hepatic encephalopathy severely impairs mental functioning. The Amplatzer Vascular Plug (AVP; AGA Medical, Golden Valley, MN) is well suited for embolization of large-diameter vessels and has been employed in a variety of vascular lesions including congenital arteriovenous shunts. Here we describe the use of the AVP in the context of TIPS to embolize portal vein collaterals (n = 8) or to occlude the TIPS (n = 2)

  4. Embolization of Spontaneous Hemarthrosis Post Total Knee Replacement

    SciTech Connect

    Given, M. F. Smith, P.; Lyon, S. M.; Robertson, D.; Thomson, K. R.

    2008-09-15

    Spontaneous nonhemophiliac hemarthrosis is an unusual entity, which has been little described. We present three cases of spontaneous recurrent hemarthrosis post total knee replacement (TKR) and successful management with embolization. Three male patients were referred to our service for angiography and treatment of recurrent hemarthrosis post TKR. In all three patients antegrade ipsilateral common femoral artery punctures and selective angiography of the geniculate branches were performed with a microcatheter. Abnormal vasculature was noted in all cases. Subsequent embolization was performed with Contour (Boston Scientific, Target Vascular, Cork, Ireland) embolization particles (150-250 and 250-355 {mu}m) in two patients and microcoils in the third (TornadoR; Cook Inc., Bloomington, IN, USA). Technical success was 100%. One patient had a recurrence of symptoms requiring a repeat procedure 6 months later. No complications were encountered. Selective angiography and particle embolization is an effective technique for management of this unusual but problematic postoperative sequelae.

  5. Fat embolism due to bilateral femoral fracture: a case report

    PubMed Central

    Porpodis, Konstantinos; Karanikas, Michael; Zarogoulidis, Paul; Konoglou, Maria; Domvri, Kalliopi; Mitrakas, Alexandros; Boglou, Panagiotis; Bakali, Stamatia; Iordanidis, Alkis; Zervas, Vasilis; Courcoutsakis, Nikolaos; Katsikogiannis, Nikolaos; Zarogoulidis, Konstantinos

    2012-01-01

    Fat embolism syndrome is usually associated with surgery for large bone fractures. Symptoms usually occur within 36 hours of hospitalization after traumatic injury. We present a case with fat embolism syndrome due to femur fracture. Prompt supportive treatment of the patient’s respiratory system and additional pharmaceutical treatment provided the positive clinical outcome. There is no specific therapy for fat embolism syndrome; prevention, early diagnosis, and adequate symptomatic treatment are very important. Most of the studies in the last 20 years have shown that the incidence of fat embolism syndrome is reduced by early stabilization of the fractures and the risk is even further decreased with surgical correction rather than conservative management. PMID:22287848

  6. Patent foramen ovale and paradoxical embolization: a historical perspective.

    PubMed Central

    Lippmann, H.; Rafferty, T.

    1993-01-01

    The use of transesophageal echocardiography for intraoperative management of critically ill patients allows for routine evaluation of foramen ovale patency. The high prevalence of preoperatively unrecognized flow-patency of this structure has led investigators to emphasize the potential for paradoxical embolization in any patient undergoing anesthesia. This perspective led us to research earliest documentation of paradoxical embolization through a patent foramen ovale as a historical issue with present day relevance. This report examines the 1877 text of Julius Cohnheim in which he described a fatal case of paradoxical embolization to the middle meningeal artery. The 1880 manuscript of Moritz Litten documenting paradoxical embolization to the lower extremity is also presented. Both translations, to our knowledge, represent the first such representations of both the original 1877 edition of Cohnheim's work and Litten's journal article. Images FIG. 1 FIG. 2 FIG. 3 FIG. 4 PMID:8256459

  7. Transvenous embolization: a report of 4 pediatric cases.

    PubMed

    Renieri, Leonardo; Limbucci, Nicola; Consoli, Arturo; Rosi, Andrea; Nappini, Sergio; Giordano, Flavio; Genitori, Lorenzo; Mangiafico, Salvatore

    2015-04-01

    The treatment of brain arteriovenous malformations (AVMs) in children has always been a challenge for interventionalists, neurosurgeons, and radiosurgeons. Endovascular embolization is usually performed through transarterial access, but in selected cases the transvenous approach can be considered. The authors of this report aimed to evaluate the efficacy of transvenous embolization in very selected pediatric cases. They describe 4 children treated using transvenous embolization for AVMs that were small, had a single drainage vein, and were deeply located or had a difficult arterial access. The 6-month angiographic and clinical follow-ups are reported as well. In all cases, complete occlusion of the AVM was achieved with no side effects for the patient. Transvenous embolization may represent a promising alternative therapeutic option in very selected cases. PMID:25634817

  8. Selective Embolization of Large Symptomatic Iatrogenic Renal Transplant Arteriovenous Fistula

    SciTech Connect

    Barley, Fay L.; Kessel, David Nicholson, Tony; Robertson, Iain

    2006-12-15

    We report on the successful treatment of hypertension by occlusion of a large iatrogenic renal transplant arteriovenous fistula using detachable embolization coils with concomitant flow reduction by occlusion balloon in two patients.

  9. Embolic Protection Devices in Transcatheter Aortic Valve Replacement.

    PubMed

    Steinvil, Arie; Benson, Richard T; Waksman, Ron

    2016-03-01

    The initially reported periprocedural neurological events rates associated with transcatheter aortic valve replacement raised concerns that ultimately led to the development and to the clinical research of novel embolic protection devices. Although the reduction of clinical stroke is a desired goal, the current research design of embolic protection devices focuses on surrogate markers of the clinical disease, primarily on silent central nervous system lesions observed in postprocedural diffuse-weighted magnetic resonance imaging and cognitive function testing. As the mere presence of particulate debris in brain matter may not correlate with the extent of brain injury, cognitive function, or quality of life, the clinical significance of embolic protection devices has yet to be determined, and interpretation of study results with regard to real-life clinical use should be viewed accordingly. The purpose of this article is to provide an overview of the updated ongoing clinical research on embolic protection devices and present its major caveats. PMID:26951618

  10. Treatment of Hypersplenism by Partial Splenic Embolization Through Gastric Collaterals

    PubMed Central

    Saddekni, Souheil; Moustafa, Amr Soliman; Tahoon, Hany A; Setita, Mostafa; Abdel-Aal, Ahmed Kamel

    2016-01-01

    We report a case of Chronic lymphocytic leukemia (CLL) with associated hypersplenism, that was referred to us for partial splenic embolization (PSE) as the patient was not a surgical candidate for splenectomy. Initially, we were not successful in catheterizing the splenic artery from the celiac trunk due to significant atherosclerotic disease. Therefore, we successfully managed to access the distal splenic artery through patent gastro-epiploic collateral circulation along the greater curvature of the stomach. Partial splenic embolization was successfully performed and resulted in improvement of the patient’s peripheral blood cell count as well as 60–70% reduction in the size of the spleen on follow up. Our case highlights an alternative pathway for splenic artery embolization when catheterization of the splenic artery is not feasible. To our knowledge, the use of gastro-epiploic collaterals to embolize the spleen has not been previously reported in literature. PMID:27200164

  11. High frequency jet ventilation in fat embolism syndrome.

    PubMed

    Lee, A; Simpson, D

    1986-11-01

    The use of high frequency jet ventilation in the management of a patient with fat embolism syndrome is described. Its principal advantage over conventional intermittent positive pressure ventilation is a reduction in the amount of sedation necessary. PMID:3789371

  12. Modeling the Diagnosis and Treatment of Pulmonary Embolism

    ERIC Educational Resources Information Center

    Pliskin, Nava; And Others

    1978-01-01

    The problem of acute pulmonary embolism is employed to illustrate that medical decision analysis is possible despite some of the difficulties encountered in previous application. The usefulness of computerized decision models is discussed. (LBH)

  13. Bilateral pulmonary arteriovenous fistulae treated with balloon embolization.

    PubMed Central

    Kumar, S.; Ruttley, M. J.; Fisher, D. J.

    1986-01-01

    A patient with bilateral pulmonary arteriovenous fistulae is described who was treated successfully by embolization of the two fistulae with detachable balloons introduced percutaneously through the femoral vein. Images Figure 1 Figure 2 Figure 3 PMID:3714608

  14. Surgical management of chronic pulmonary embolism.

    PubMed Central

    Sabiston, D C; Wolfe, W G; Oldham, H N; Wechsler, A S; Crawford, F A; Jones, K W; Jones, R H

    1977-01-01

    The clinical course of most patients with pulmonary embolism is one of gradual resolution with re-establishment of flow in the pulmonary arteries. In a small but definite group of patients, the emboli do not resolve and a state of chronic pulmonary embolism ensues. The primary thrombotic process in the systemic venous system may persist, and in some instances may be unrecognized. Such patients experience recurrent showers of emboli which may ultimately occlude a large part of the pulmonary arterial circulation with development of severe respiratory insufficiency. Six patients with this syndrome are described, and in each there was a history of dyspnea, cyanoiss, and exercise intolerance associated with a low arterial PO2, right ventricular hypertrophy, and pulmonary hypertension. Pulmonary scans and arteriograms demonstrated that more than half of the major pulmonary arteries were occluded and, in addition, smaller vessels were also obstructed. Pulmonary embolectomy was performed in each patient. Five of the 6 obtained a highly gratifying response, including relief of the dyspnea and cyanosis, an increase in arterial PO2, and a decrease in pulmonary arterial pressure. In each of the five in whom improvement occurred, the back-bleeding from the pulmonary artery at the time of embolectomy was quite good. In the sixth patient, the back-bleeding was very poor, and despite embolectomy, the vessel thrombosed postoperatively with no improvement in the patient's clinical course. Follow-up studies in these patients range up to 8 years with demonstration of continued patency of the pulmonary arteries as well as continued improvement in clinical symptoms and in the arterial PO2. Images Fig. 1. Fig. 2. Fig. 3. Fig. 6. Fig. 6C Fig. 7. Fig. 8. Fig. 9. Fig. 10. Fig. 11. Fig. 11D. Fig. 12. Fig. 12B. Fig. 13 Fig. 1. Fig. 17. Fig. 18. Fig. 19.. PMID:871224

  15. Percutaneous Embolization of Transhepatic Tracks for Biliary Intervention

    SciTech Connect

    Lyon, Stuart M.; Terhaar, Olaf; Given, Mark F.; O'Dwyer, Helena M.; McGrath, Frank P.; Lee, Michael J.

    2006-12-15

    Significant pain can occur after removing transhepatic catheters from biliary access tracks, after percutaneous biliary drainage (PBD) or stenting. We undertook a randomized prospective study to ascertain whether track embolization decreases the amount of pain or analgesic requirement after PBD. Fifty consecutive patients (M:F, 22:28; age range:29-85 years; mean age: 66.3 years) undergoing PBD were randomized to receive track embolization or no track embolization after removal of biliary drainage catheters. A combination of Lipoidol and n-butyl cyanoacrylate were used to embolize transhepatic tracks using an 8F dilator. The patients who did not have track embolization performed had biliary drainage catheters removed over a guide wire. A visual analog scoring (VAS) system was used to grade pain associated with catheter removal, 24 h afterward. A required analgesic score (RAS) was devised to tabulate the analgesia required. No analgesia had a score of 0, oral or rectal nonopiate analgesics had a score of 1, oral opiates had a score of 2, and parenteral opiates had a score of 3. The average VAS and RAS for both groups were calculated and compared.Seven patients were excluded for various reasons, leaving 43 patients in the study group. Twenty-one patients comprised the embolization group and 22 patients comprised the nonembolization group. The mean biliary catheter dwell time was not significantly different (p > 0.05) between the embolization group and nonembolization (mean: 5.4 days vs 6.9 days, respectively). In the nonembolization group, the mean VAS was 3.4. Eight patients required parenteral opiates, three patients required oral opiates, and five patients required oral or rectal analgesics, yielding a mean RAS of 1.6. In the embolization group, the mean VAS was 0.9. No patient required parenteral opiates, six patients required oral opiates, and two patients had oral analgesia. The average RAS was 0.6. Both the VAS and the RAS were significantly lower in the

  16. A concept study on identification and attribution profiling of chemical threat agents using liquid chromatography-mass spectrometry applied to Amanita toxins in food.

    PubMed

    Jansson, Daniel; Fredriksson, Sten-Åke; Herrmann, Anders; Nilsson, Calle

    2012-09-10

    Accidental or deliberate poisoning of food is of great national and international concern. Detecting and identifying potentially toxic agents in food is challenging due to their large chemical diversity and the complexity range of food matrices. A methodology is presented whereby toxic agents are identified and further characterized using a two-step approach. First, generic screening is performed by LC/MS/MS to detect toxins based on a list of selected potential chemical threat agents (CTAs). After identifying the CTAs, a second LC/MS analysis is performed applying accurate mass determination and the generation of an attribution profile. To demonstrate the potential of the methodology, toxins from the mushrooms Amanita phalloides and Amanita virosa were analyzed. These mushrooms are known to produce cyclic peptide toxins, which can be grouped into amatoxins, phallotoxins and virotoxins, where α-amanitin and β-amanitin are regarded as the most potent. To represent a typical complex food sample, mushroom stews containing either A. phalloides or A. virosa were prepared. By combining the screening method with accurate mass analysis, the attribution profile for the identified toxins and related components in each stew was established and used to identify the mushroom species in question. In addition, the analytical data was consistent with the fact that the A. virosa specimens used in this study were of European origin. This adds an important piece of information that enables geographic attribution and strengthens the attribution profile. PMID:22503887

  17. Simple handling of venous air embolism during abdominal myomectomy.

    PubMed

    Basaran, Betül; Basaran, Ahmet; Kozanhan, Betül; Özmen, Sadık; Basaran, Mustafa

    2016-01-01

    We report a case of venous air embolism during abdominal myomectomy. Although true incidence of venous air embolism is not known, in literature most of reported cases are belongs to sitting position craniotomies. Many of those are subclinical, and diagnostic methods have varying degrees of sensitivity and specificity. At time of suspicion, prevention of any subsequent air emboli is the cornerstone of treatment. PMID:27591473

  18. Differential diagnostic dilemma between pulmonary embolism and acute coronary syndrome

    PubMed Central

    Gul, Enes Elvin; Nikus, Kjell C.; Erdogan, Halil I.; Ozdemir, Kurtulus

    2015-01-01

    Acute pulmonary embolism (PE) is a frequent life-threatening condition in emergency departments. Careful diagnosis is important, and different diagnostic tests such as electrocardiogram (ECG), biochemical markers, echocardiogram, and computed tomography are required. Although ECG is a cheap and rapid diagnostic test for pulmonary embolism, it has some limitations in the differential diagnosis of acute coronary syndrome and acute PE. Herein, we report ECG results of a patient diagnosed with acute PE mimicking acute coronary syndrome. PMID:27092202

  19. Superselective Embolization in Posttraumatic Priapism with Glubran 2 Acrylic Glue

    SciTech Connect

    Gandini, Roberto; Spinelli, Alessio; Konda, Daniel Reale, Carlo Andrea; Fabiano, Sebastiano; Pipitone, Vincenzo; Simonetti, Giovanni

    2004-09-15

    Two patients with posttraumatic priapism underwent transcatheter embolization using microcoils, resulting in temporary penile detumescence and an apparent resolution of the artero-venous fistula. In both cases, priapism recurred 24 hours after the procedure and was successfully treated through selective transcatheter embolization of the nidus using acrylic glue (Glubran 2). The patients showed complete recovery of sexual activity within 30 days from the procedure and persistent exclusion of the artero-venous fistula after a 12-month follow-up.

  20. Paradoxical Cerebral Fat Embolism in Revision Hip Surgery

    PubMed Central

    Piuzzi, Nicolás S.; Zanotti, Gerardo; Comba, Fernando M.; Buttaro, Martin A.; Piccaluga, Francisco

    2014-01-01

    The incidence of clinical fat embolism syndrome (FES) is low (<1%) whilst fat embolism (FE) of marrow fat appears to occur more often (Mellor and Soni (2001)). Paradoxical brain FE may occur in patients undergoing hip orthopedic surgery who have an undocumented patent foramen ovale (PFO). We report a case of an eighty-year-old male patient, who underwent a scheduled revision hip surgery suffering a paradoxical cerebral FE. PMID:25184065

  1. Therapeutic failure of uterine fibroid embolization caused by underlying leiomyosarcoma.

    PubMed

    Common, A A; Mocarski, E J; Kolin, A; Pron, G; Soucie, J

    2001-12-01

    The authors describe an unusual case in which continued growth of uterine fibroids in a postmenopausal patient after polyvinyl alcohol embolization therapy prompted hysterectomy, which revealed an underlying leiomyosarcoma. The surgery was nearly fatal as a result of venous bleeding, and parasitization of blood from adjacent bowel by the tumor was noted. The difficulty of preoperative diagnosis of leiomyosarcoma and the need for diligent follow-up after uterine fibroid embolization are discussed. PMID:11742024

  2. Biological Agents

    MedlinePlus

    ... to Z Index Contact Us FAQs What's New Biological Agents This page requires that javascript be enabled ... and Health Topics A-Z Index What's New Biological agents include bacteria, viruses, fungi, other microorganisms and ...

  3. Long-term biocompatibility, imaging appearance and tissue effects associated with delivery of a novel radiopaque embolization bead for image-guided therapy.

    PubMed

    Sharma, Karun V; Bascal, Zainab; Kilpatrick, Hugh; Ashrafi, Koorosh; Willis, Sean L; Dreher, Matthew R; Lewis, Andrew L

    2016-10-01

    The objective of this study was to undertake a comprehensive long-term biocompatibility and imaging assessment of a new intrinsically radiopaque bead (LC Bead LUMI™) for use in transarterial embolization. The sterilized device and its extracts were subjected to the raft of ISO10993 biocompatibility tests that demonstrated safety with respect to cytotoxicity, mutagenicity, blood contact, irritation, sensitization, systemic toxicity and tissue reaction. Intra-arterial administration was performed in a swine model of hepatic arterial embolization in which 0.22-1 mL of sedimented bead volume was administered to the targeted lobe(s) of the liver. The beads could be visualized during the embolization procedure with fluoroscopy, DSA and single X-ray snapshot imaging modalities. CT imaging was performed before and 1 h after embolization and then again at 7, 14, 30 and 90 days. LC Bead LUMI™ could be clearly visualized in the hepatic arteries with or without administration of IV contrast and appeared more dense than soluble contrast agent. The CT density of the beads did not deteriorate during the 90 day evaluation period. The beads embolized predictably and effectively, resulting in areas devoid of contrast enhancement on CT imaging suggesting ischaemia-induced necrosis nearby the sites of occlusion. Instances of off target embolization were easily detected on imaging and confirmed pathologically. Histopathology revealed a classic foreign body response at 14 days, which resolved over time leading to fibrosis and eventual integration of the beads into the tissue, demonstrating excellent long-term tissue compatibility. PMID:27419364

  4. Subacute massive pulmonary embolism treated with plasminogen and streptokinase.

    PubMed Central

    Ellis, D A; Neville, E; Hall, R J

    1983-01-01

    Major pulmonary embolism occurring insidiously over several weeks (subacute massive pulmonary embolism) has a high mortality and may not respond well to standard anticoagulant or thrombolytic treatment. A priming dose of plasminogen was used to enhance thrombolysis produced by a streptokinase infusion in five consecutive patients with subacute massive pulmonary embolism. In each patient a dramatic clinical improvement occurred with a substantial increase in pulmonary blood flow. All five patients survived to leave hospital. Malignant disease was the underlying cause of embolism in three patients, two of whom died of their malignant disease in the six months after treatment of their pulmonary embolism. The third patient with malignant disease had a choriocarcinoma; at least some of the pulmonary obstruction may have been tumour tissue but this obstruction was dramatically cleared by the treatment. The use of a combination of plasminogen with streptokinase should be considered in severely ill patients with subacute massive pulmonary embolism, particularly if other treatment, including streptokinase alone, has failed. Images PMID:6665749

  5. Meteorological parameters and severity of acute pulmonary embolism episodes.

    PubMed

    Staśkiewicz, Grzegorz; Czekajska-Chehab, Elżbieta; Przegaliński, Jerzy; Maciejewski, Marcin; Pachowicz, Marcin; Drop, Andrzej

    2011-01-01

    Frequency of acute pulmonary embolism episodes has been previously shown to correlate significantly with meteorological factors in the period preceding their occurrence. The purpose of the study was to analyze the relation of meteorological factors and the severity of acute pulmonary embolism, expressed by the CT-based pulmonary obstruction score. A retrospective analysis of medical data of 182 consecutive patients with acute pulmonary embolism diagnosed with CT pulmonary angiography was performed. Severity of pulmonary obstruction was assessed by analysis of CT pulmonary angiography examinations, and defined with pulmonary obstruction score by Qanadli et al. The study group was divided into low (L group, 95 patients) and high PE severity (H group, 87 patients), with a cutoff value of 50% of maximum pulmonary obstruction score. Meteorological data collected for the relevant time period were: air temperature, humidity, atmospheric pressure, visibility, wind speed and precipitation. No significant differences in seasonal distribution of pulmonary embolism episodes were observed. Episodes of more severe pulmonary embolism were preceded by periods of lower atmospheric pressure (1,016.35 hPA for group H, vs. 1,016.35 hPa for group L, p = 0.022). No significant relations between other meteorological factors and severity of PE were observed. The reported finding shows the need of further research on the nature of meteorological factors influence on the course of pulmonary embolism, which should be analyzed not ony regarding the frequency, but also severity of PE episodes. PMID:21736277

  6. Role of preoperative embolization for intradural spinal hemangioblastomas.

    PubMed

    Ampie, Leonel; Choy, Winward; Khanna, Ryan; Smith, Zachary A; Dahdaleh, Nader S; Parsa, Andrew T; Bloch, Orin

    2016-02-01

    Spinal hemangioblastomas (HB) are relatively rare neoplasms with a high degree of vascularity. Therapy for symptomatic tumors involves total resection when possible. Due to the enriched blood supply of these neoplasms, there is a high risk of significant intraoperative blood loss, which can lead to perioperative complications. Preoperative embolization of HB has been suggested to reduce blood loss and operative morbidity, but its use remains controversial. Data on the risks and benefits of preoperative embolization for this tumor remains limited. We identified and analyzed all 29 reported cases of preoperative embolization of intradural spinal HB within the literature. There were 18 men and nine women, and patients ranged from 24 to 61 years of age. Mean tumor size was 3.5 cm. Cervical and thoracic location was most common, accounting for 48.3% and 20% of cases, respectively. Complications from embolization and surgery were minimal, with no deaths or permanent neurological morbidity. Minimal intraoperative bleeding and excellent rates of gross total resection were reported with preoperative embolization. However, outcomes from microsurgery alone from historical series have similarly reported excellent outcomes. While there is no established standard, preoperative embolization should be reserved for particularly high risk patients with risk of intraoperative bleeding. PMID:26585384

  7. Embolization followed by surgery for treatment of perimedullary arteriovenous fistula causing acute myelopathy

    PubMed Central

    Hsiao, I-Han; Lee, Han-Chung; Yen, Pao-Sheng; Cho, Der-Yang

    2015-01-01

    Background: Perimedullary arteriovenous fistula (AVF) is rare. There are three subtypes, and the treatment strategies for each are different. Subtype B (multiple fistulas) can be treated by either embolization or surgery. On the basis of a case from our treatment experience, we propose a method for achieving optimal outcome while minimizing nerve injury. Case Description: A 51-year-old female was admitted to our hospital with acute myelopathy caused by a perimedullary AVF. Initially, we treated her by embolization using the chemical agent Onyx. Her symptoms improved immediately but gradually returned beginning 1 week later. Two months later, the symptoms had returned to pretreatment status, so we removed the fistulas surgically. Severe adhesions between nerve and occult venous varices were noted during the operation. Afterward, the patient's symptoms improved significantly. Histopathological sections showed an inflammatory reaction around the varices. Conclusions: We initially considered several possible reasons for the return of symptoms: (a) Hypoperfusion of the spinal cord; (b) mass effect of the occult vein varices; (c) residual AVF or vascular remodeling resulting in recurrent cord hypertension; (d) Onyx-induced perivascular inflammation resulting in nerves adhering to each other and to occult venous varices. Clinical, surgical, and pathological findings ruled out the first three, leaving Onyx-induced perivascular inflammation as the probable reason. Given our treatment experience and the pros and cons of the two methods, we propose that initial embolization followed by surgery after 5 days to remove occult venous varices is the ideal strategy for treating perimedullary AVF of subtype B. PMID:26069849

  8. A New Device for Vascular Embolization: Report on Case of Two Pulmonary Arteriovenous Fistulas Embolization Using the Amplatzer Vascular Plug

    SciTech Connect

    Rossi, Michele; Rebonato, Alberto Greco, Laura; Stefanini, Giulio; Citone, Michele; Speranza, Annnarita; David, Vincenzo

    2006-10-15

    A pulmonary arteriovenous fistula (PAVF) is a rare vascular malformation commonly treated by embolization with coils or balloons to prevent the risk of several serious complications such as cerebral embolism and brain abscess. A 32-year-old female with two PAVFs and neurological ischemic manifestations has been successfully treated by transcatheter embolization of both fistulas using a new device (Amplatzer Vascular Plug). This self-expanding cylindrical nitinol mesh cage with high radial strength allows a chance of relocation until properly positioned. It is preferred to coils or balloons because a large caliber of feeding artery implied high risk of uncontrollable distal embolization. There appear to be no reports in the literature concerning use of this device, which could represent a useful innovative tool in embolotherapies, especially in large vascular areas.

  9. Coil Protruding into the Common Femoral Vein Following Pelvic Venous Embolization

    SciTech Connect

    Marsh, Petra Holdstock, Judith M.; Bacon, Jennifer L.; Lopez, Anthony J.; Whiteley, Mark S.; Price, Barrie A.

    2008-03-15

    Pelvic venous embolization is performed for pelvic congestion syndrome and prior to lower limb varicose vein surgery in females with associated pelvic venous insufficiency. The procedure is analogous to varicocele embolization in males, although refluxing internal iliac vein tributaries may also be embolized. We report a case of inadvertent coil placement in the common femoral vein while embolizing the obturator vein, during pelvic vein embolization for recurrent lower limb varicose veins. There were no clinical consequences and the coil was left in situ. We advise caution when embolizing internal iliac vein tributaries where there is clinically significant communication with veins of the lower limb.

  10. Treating pulmonary embolism in Pacific Asia with direct oral anticoagulants.

    PubMed

    Cohen, Alexander; Jeyaindran, Sinnadurai; Kim, Jae Yeol; Park, Kihyuk; Sompradeekul, Suree; Tambunan, Karmel L; Tran, Huyen; Tsai, I-Chen; Ward, Christopher; Wong, Raymond

    2015-08-01

    Pulmonary embolism (PE) is the principal preventable cause of in-hospital deaths. Prevalence of PE in Asians is uncertain but undoubtedly underestimated. Asians and Caucasians have similar non-genetic risk factors for PE, and there is mounting evidence that PE affects Asians much more commonly than previously supposed; incidence, especially among high-risk patients, may approach that in Caucasians. Furthermore, PE incidence in Asia is increasing, due to both increased ascertainment, and also population ageing and growing numbers of patients with predisposing risk factors. Despite being warranted, thromboprophylaxis for high-risk patients is not routine in Pacific Asian countries/regions. There also appears to be scope to implement venous thromboembolism (VTE) management guidelines more assiduously. Anticoagulants, primarily heparins and warfarin, have been the mainstays of VTE management for years; however, these agents have limitations that complicate routine use. The complexity of current guidelines has been another barrier to applying evidence-based recommendations in everyday practice. Updated management approaches have considerable potential to improve outcomes. New oral anticoagulants that are easier to administer, require no, or much less, monitoring or dose-adjustment and have a favourable risk/benefit profile compared with conventional modalities, may offer an alternative with the potential to simplify VTE management. However, more information is required on practical management and the occurrence and treatment of bleeding complications. Increasing recognition of the burden of PE and new therapeutic modalities are altering the VTE management landscape in Pacific Asia. Consequently, there is a need to further raise awareness and bridge gaps between the latest evidence and clinical practice. PMID:26139085

  11. Managing pulmonary embolism from presentation to extended treatment.

    PubMed

    Cohen, Alexander T; Dobromirski, Mark; Gurwith, Meredith M P

    2014-02-01

    Pulmonary embolism (PE) remains a major healthcare problem. PE presents with a variety of non-specific symptoms, and confirmation of diagnosis involves the use of clinical risk scores, scanning techniques and laboratory tests. Treatment choice is informed by the risk of sudden death, with high-risk patients recommended to receive thrombolytic therapy or thrombectomy. Patients with less severe presentations are given anticoagulant therapy, traditionally with parenteral heparins in the acute phase of treatment, transitioning to oral vitamin K antagonists (VKAs). The limitations of these agents and the introduction of non-VKA oral anticoagulants challenge this paradigm. To date, clinical studies of four non-VKA oral anticoagulants to treat acute thrombosis have been published, and rivaroxaban is now approved for treatment and prevention of PE (and deep vein thrombosis). Rivaroxaban and apixaban alone, and dabigatran and edoxaban after parenteral anticoagulant induction, were non-inferior to enoxaparin/VKA for the prevention of recurrent venous thromboembolism; the risk of major bleeding was similar with dabigatran and edoxaban and significantly reduced with rivaroxaban and apixaban. Patients with an initial PE are recommended to receive continued anticoagulation for 3 months or longer, depending on individual risk factors, and studies of non-VKA oral anticoagulants have shown a continued benefit for up to 2 years, without a significantly increased risk of major bleeding. Given that the non-VKA oral anticoagulants are given at fixed doses without the need for routine coagulation monitoring, their adoption is likely to ease the burden on both PE patients and healthcare practitioners when longer-term or extended anticoagulation is warranted. PMID:24182642

  12. SEPARATING URANIUM CONTAINING SOLIDS SUSPENDED IN A LIQUID

    DOEpatents

    Creutz, E.C.; Wigner, E.P.

    1958-05-01

    A process is described for separating uraniumcontaining solids suspended in a liquid. It consists of adding to the liquid a wetting agent for the U- containing solids in an amount sufficient to form a separate liquid phase, the wetting agent having a density greater than the density of the liquid. Ethyl dibromoacetate is noted as one preferred wetting agent.

  13. Transcatheter embolization therapy in liver cancer: an update of clinical evidences

    PubMed Central

    De Baere, Thierry; Idée, Jean-Marc; Ballet, Sébastien

    2015-01-01

    Transarterial chemoembolization (TACE) is a form of intra-arterial catheter-based chemotherapy that selectively delivers high doses of cytotoxic drug to the tumor bed combining with the effect of ischemic necrosis induced by arterial embolization. Chemoembolization and radioembolization are at the core of the treatment of liver hepatocellular carcinoma (HCC) patients who cannot receive potentially curative therapies such as transplantation, resection or percutaneous ablation. TACE for liver cancer has been proven to be useful in local tumor control, to prevent tumor progression, prolong patients’ life and control patient symptoms. Recent evidence showed in patients with single-nodule HCC of 3 cm or smaller without vascular invasion, the 5-year overall survival (OS) with TACE was similar to that with hepatic resection and radiofrequency ablation. Although being used for decades, Lipiodol® (Lipiodol® Ultra Fluid®, Guerbet, France) remains important as a tumor-seeking and radio-opaque drug delivery vector in interventional oncology. There have been efforts to improve the delivery of chemotherapeutic agents to tumors. Drug-eluting bead (DEB) is a relatively novel drug delivery embolization system which allows for fixed dosing and the ability to release the anticancer agents in a sustained manner. Three DEBs are available, i.e., Tandem® (CeloNova Biosciences Inc., USA), DC-Beads® (BTG, UK) and HepaSphere® (BioSphere Medical, Inc., USA). Transarterial radioembolization (TARE) technique has been developed, and proven to be efficient and safe in advanced liver cancers and those with vascular complications. Two types of radioembolization microspheres are available i.e., SIR-Spheres® (Sirtex Medical Limited, Australia) and TheraSphere® (BTG, UK). This review describes the basic procedure of TACE, properties and efficacy of some chemoembolization systems and radioembolization agents which are commercially available and/or currently under clinical evaluation. The key

  14. Screening of degradation products, impurities and precursors of chemical warfare agents in water and wet or dry organic liquid samples by in-sorbent tube silylation followed by thermal desorption-gas chromatography-mass spectrometry.

    PubMed

    Terzic, Oliver

    2010-07-23

    A standard method used by inspection teams of the Organisation for the Prohibition of Chemical Weapons (OPCW) for preparation of aqueous samples requires several extraction and derivatization steps. This results in tedious and time consuming on-site analysis. A simple thermal desorption-gas chromatography-mass spectrometry (TD-GC-MS) method was developed to analyse for a broad range of degradation products, impurities and precursors of chemical warfare agents (CWA) in water solutions and wet or dry organic liquid samples. The method is fast, sensitive, requires only microliter volumes of sample and enables the simultaneous determination of a wide range of compounds with widely differing polarity, volatility and reactivity. The applicability of the method was demonstrated by successful analysis of five OPCW Official Proficiency Test samples. PMID:20541765

  15. The effect of various antifungal agents on aflatoxin production and growth characteristics of Aspergillus parasiticus and Aspergillus flavus in liquid medium.

    PubMed

    Stewart, R G; Wyatt, R D; Ashmore, M D

    1977-09-01

    Various antifungal agents were added to a medium of 2% yeast extract-4% sucrose. Spores of a toxigenic strain of Aspergillus parasiticus were inoculated into the medium and incubated at 26 degrees C. for 10 days. Growth of the mold and aflatoxin formation were monitored every 48 hours during the experiment. Of the antifungal agents evaluated, propionic acid and crystal violet were the most effective compounds in retarding mold growth. Propionic acid was fungicidal at concentrations greater than 3.0 microgram/ml. whereas crystal violet exhibited a mold retarding activity at levels greater than 2,0 microgram/ml. Crystal violet retarded the growth rate of the mold during the initial stages of growth, however, this retardation was overcome after 10 days of incubation. Crystal violet also retarded aflatoxin production and sporulation of Aspergillus parasiticus; however, aflatoxin production was the most sensitive parameter. A survey involving 12 toxigenic isolates of A. parasiticus and A. flavus indicated that these species vary markedly in susceptibility to crystal violet. PMID:415299

  16. SMTP (Stachybotrys microspora triprenyl phenol) enhances clot clearance in a pulmonary embolism model in rats

    PubMed Central

    2012-01-01

    Background Stachybotrys microspora triprenyl phenols (SMTPs) are a novel family of small molecules that enhance both activation and fibrin-binding of plasminogen. While their effects on fibrinolysis have been characterized in vitro, little is known about their activity in vivo with respect to plasminogen activation and blood clot clearance. Results To select a potent SMTP congener for the evaluation of its action in vitro and in vivo, we tested several SMTP congeners with distinct structural properties for their effects on plasminogen activation. As a result, SMTP-7 (orniplabin) was found to have distinguished activity. Several lines of biochemical evidence supported the idea that SMTP-7 acted as a plasminogen modulator. SMTP-7 elevated plasma level of plasmin-α2-antiplasmin complex, an index of plasmin formation in vivo, 1.5-fold in mice after the intravenous injections at doses of 5 and 10 mg kg-1. In a rat pulmonary embolism model, SMTP-7 (5 mg kg-1) enhanced the rate of clot clearance ~3-fold in the absence of exogenous plasminogen activator. Clot clearance was enhanced further by 5 mg kg-1 of SMTP-7 in combination with single-chain urokinase-type plasminogen activator. Conclusions Our results show that SMTP-7 is a superior plasminogen modulator among the SMTP family compounds and suggest that the agent enhances plasmin generation in vivo, leading to clearance of thrombi in a model of pulmonary embolism. PMID:22230042

  17. Intramedullary nailing and pulmonary embolism: does unreamed nailing prevent embolization? An in vivo study in rabbits.

    PubMed

    Heim, D; Regazzoni, P; Tsakiris, D A; Aebi, T; Schlegel, U; Marbet, G A; Perren, S M

    1995-06-01

    Pulmonary embolism in reamed femoral nailing has been reported and discussed over recent years. Does an unreamed nailing technique with a solid nail prevent this rare but serious complication of intramedullary fixation? In an animal model in rabbits, we studied the pathophysiologic impact on pulmonary function and the impact on hemostasis of reamed and unreamed nailing of intact femora and tibiae, and of femoral fracture in relation to intramedullary pressure. No statistical difference of PaO2, PaCO2, and PCO2et was found in the femur whether a reamed or unreamed procedure was performed. Two of six animals with unreamed femoral nailing, one of six animal with reamed femoral nailing, and one of five animals with a femoral fracture fulfilled four of four or three of four criteria for embolization (increase of the difference of PaCO2 and PCO2et, decrease of PaO2, increase of blast cells in central-venous blood and bone marrow/fat in histologic section of the lungs and bone). Tibial nailing did not alter pulmonary function in either group. Intramedullary pressure was increased in all animals with perioperative impairment of pulmonary function (375 to 676 mbar). Analysis of the hemostatic results showed a significant difference of platelet activation in reamed versus unreamed nailing of the femur 1 hour after nailing (p < 0.01) and a significant decrease of fibrinogen and antithrombin III (p < 0.001/p < 0.01) in reamed femoral nailing. We conclude that unreamed nailing of the femur with a solid rod may also cause bone marrow embolization with alteration of pulmonary function as long as an important increase of the intramedullary pressure is generated during the nailing procedure.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7602632

  18. Interleukin-6 as an early marker for fat embolism

    PubMed Central

    Yoga, R; Theis, JC; Walton, M; Sutherland, W

    2009-01-01

    Background Fat Embolism is a complication of long bone fractures, intramedullary fixation and joint arthroplasty. It may progress to fat embolism syndrome, which is rare but involves significant morbidity and can occasionally be fatal. Fat Embolism can be detected at the time of embolization by transoesophageal echocardiography or atrial blood sampling. Later, a combination of clinical signs and symptoms will point towards fat embolism but there is no specific test to confirm the diagnosis. We investigated serum Interleukin-6 (IL-6) as a possible early marker for fat embolism. Methods An animal study was conducted to simulate a hip replacement in 31 adult male Sprague Dawley rats. The procedure was performed under general anesthesia and the animals divided into 3 groups: control, uncemented and cemented. Following surgery and recovery from anaesthesia, the rats allowed to freely mobilize in their cages. Blood was taken before surgery and at 6 hours, 12 hours and 24 hours to measure serum IL-6 levels. The rats were euthanized at 24 hours and lungs removed and stained for fat. The amount of fat seen was then correlated with serum IL-6 levels. Results No rats in the control group had fat emboli. Numerous fat emboli were seen in both the uncemented and cemented implant groups. The interleukin levels were raised in all groups reaching a peak at 12 hours after surgery reaching 100 pg/ml in the control group and around 250 pg/ml in the uncemented and cemented implant groups. The IL-6 levels in the control group were significantly lower than any of the implant groups at 12 and 24 hours. At these time points, the serum IL-6 correlated with the amount of fat seen on lung histology. Conclusion Serum IL-6 is a possible early marker of fat embolism. PMID:19523233

  19. MR Venography of Deep Veins: Changes with Uterine Fibroid Embolization

    SciTech Connect

    Katsumori, Tetsuya Kasahara, Toshiyuki; Tsuchida, Yoko; Nara, Yoshinori

    2009-03-15

    Deep veins (DVs) can be compressed by a uterus enlarged with fibroids. The purpose of this study was to assess the degree of luminal narrowing of DVs caused by a myomatous uterus, and the change in DV narrowing in women with symptomatic fibroids after embolization using time-of-flight (TOF)-magnetic resonance venography (MRV). Twenty-nine consecutive women with symptomatic uterine fibroids underwent TOF-MRV and pelvic MRI before and 4 months after embolization. Based on the TOF-MRV, we evaluated the luminal narrowing of three DVs, including the inferior vena cava, and the bilateral common and external iliac veins, and divided the findings into three grades. The scores for each DV were added for each patient (lowest, 0; highest, 6). DV scores and symptom severity (SS) scores were compared between the baseline and 4 months after embolization using the paired t-test. The relationship between DV scores and uterine volume was investigated using Pearson's test. DV scores decreased significantly, from 1.52 {+-} 1.70 at baseline to 0.93 {+-} 1.56 at 4 months after embolization (p = 0.004). The uterine volume decreased from 948 {+-} 647 mL at baseline to 617 {+-} 417 mL at 4 months after embolization (p < 0.001). DV score correlated with uterine volume (r = 0.856, p < 0.001). SS scores decreased from 54.5 {+-} 14.6 at baseline to 26.8 {+-} 15.4 at 4 months after embolization (p < 0.001). In conclusion, the degree of luminal narrowing of DVs caused by a uterus with fibroids is correlated with the uterine volume. Uterine artery embolization may induce an improvement of luminal narrowing of DVs due to a reduction of the myomatous uterus volume.

  20. Liquid chromatographic determination of 4,4'-dinitrocarbanilide, the active component of the infertility agent nicarbazin, in chicken, duck, goose, and snake eggs.

    PubMed

    Primus, Thomas M; Kohler, Dennis J; Goodall, Margaret A; Yoder, Christi; Mathies, Thomas; Miller, Lowell; Johnston, John J; Vercauteren, Kurt

    2003-01-01

    4,4'-Dinitrocarbanilide (DNC) was extracted from chicken, duck, goose, and snake eggs and isolated by reversed-phase liquid chromatography. DNC was detected by ultraviolet absorbance at 347 nm and quantitated by comparison with a calibration standard. Recoveries of DNC from fortified control chicken, duck, goose, and snake egg samples were determined for DNC levels of 0.16, 10, and 16 microg/g. The mean recoveries from chicken, duck, goose, and snake eggs were 92 +/- 4, 88 +/- 9, 87 +/- 7, and 95 +/- 6%, respectively. The method limits of detection for DNC in chicken, duck, goose, and snake eggs ranged from 0.015 to 0.035 microg/g. The reported method is much simpler than and equally efficient as previous methods developed for the determination of DNC residues in egg contents. PMID:14979695

  1. Chemical stability of ecomustine, a new antitumor agent in aqueous and biological media as assessed by high-performance liquid chromatography.

    PubMed

    el Abed, I; Roger, P; Gosse, C; Atassi, G; Gouyette, A

    1991-01-01

    Ecomustine, or CY233 (NSC-609224), is a new water-soluble nitrosoureido sugar derived from acosamine. A high-performance liquid chromatographic assay (HPLC) developed to quantify the unchanged drug in aqueous solutions and biological specimens enabled us to study the chemical stability as a function of pH, light, and temperature. In buffered aqueous solutions, the kinetics of degradation of CY233 is a first-order process. The log k-pH profile demonstrated hydroxide ion-catalyzed solvolysis. The drug is most stable at pH 4, more stable than some other nitrosoureas in 5% glucose (t1/2, 62-67 h) and in 0.9% isotonic saline (t1/2, 25-37 h) solutions. Based on these findings, blood samples should be collected in cold tubes (4 degrees C) containing citrate buffer (pH 4) and all manipulations should be protected from heat and light. PMID:1998985

  2. Postpartum Hemorrhage Treated with Gelfoam Slurry Embolization Using the Superselective Technique: Immediate Results and 1-Month MRI Follow-up

    SciTech Connect

    Pellerin, Olivier; Bats, Anne-Sophie; Primio, Massimiliano Di; Palomera-Ricco, Ana; Pinot de Villechenon, Gabrielle; and others

    2013-02-15

    To evaluate the efficacy and safety of superselective embolization of the uterine arteries in a postpartum hemorrhage. Between November 2004 and January 2011, a total of 44 consecutive women (median {+-} standard deviation age 34 {+-} 3 years, range 23-41 years) were referred to our institution for postpartum intractable hemorrhage management. All patients were embolized with a microcatheter that was placed deep into the uterine arteries upstream of the cervical arteries. The embolic agent was a mixture of contrast medium and 5 Multiplication-Sign 5 Multiplication-Sign 5 cm pieces of gelfoam (Gelita-Spon) modified into a gelatin emulsion as follows: rapid mixing through a three-way stopcock with two 2.5-ml syringes. A 1-ml syringe was used for injection. One month after embolization, all patients underwent magnetic resonance imaging and clinical examination. Technical and clinical success was obtained in all cases. Thirty-five patients experienced bleeding related to poor retraction of the uterus, 7 patients because of a tear of the cervix and 2 because of a vaginal hematoma. Pre- and postembolization red blood cell transfusions were (mean {+-} standard deviation [SD]) 6 {+-} 1.2 (range 3-8) U and 2 {+-} 0.7 (range 2-4) U, respectively. One-month magnetic resonance imaging follow-up revealed no sign of ischemic myometrium or necrosis, and no instances of uterine rupture and no pelvic vein thrombosis. Incidental findings included two small intramyometrial hematic collections. All uterine arteries were patent via magnetic resonance angiography. Seventeen patients had concomitant fibroids, all of which appeared hypovascular. This technique permits good, safe clinical results with no marked damage to the uterine arteries or the uterus itself.

  3. Embolization of Acute Nonvariceal Upper Gastrointestinal Hemorrhage Resistant to Endoscopic Treatment: Results and Predictors of Recurrent Bleeding

    SciTech Connect

    Loffroy, Romaric Rao, Pramod; Ota, Shinichi; Lin Mingde; Kwak, Byung-Kook; Geschwind, Jean-Francois

    2010-12-15

    Acute nonvariceal upper gastrointestinal (UGI) hemorrhage is a frequent complication associated with significant morbidity and mortality. The most common cause of UGI bleeding is peptic ulcer disease, but the differential diagnosis is diverse and includes tumors; ischemia; gastritis; arteriovenous malformations, such as Dieulafoy lesions; Mallory-Weiss tears; trauma; and iatrogenic causes. Aggressive treatment with early endoscopic hemostasis is essential for a favorable outcome. However, severe bleeding despite conservative medical treatment or endoscopic intervention occurs in 5-10% of patients, requiring surgery or transcatheter arterial embolization. Surgical intervention is usually an expeditious and gratifying endeavor, but it can be associated with high operative mortality rates. Endovascular management using superselective catheterization of the culprit vessel, < sandwich> occlusion, or blind embolization has emerged as an alternative to emergent operative intervention for high-risk patients and is now considered the first-line therapy for massive UGI bleeding refractory to endoscopic treatment. Indeed, many published studies have confirmed the feasibility of this approach and its high technical and clinical success rates, which range from 69 to 100% and from 63 to 97%, respectively, even if the choice of the best embolic agent among coils, cyanaocrylate glue, gelatin sponge, or calibrated particles remains a matter of debate. However, factors influencing clinical outcome, especially predictors of early rebleeding, are poorly understood, and few studies have addressed this issue. This review of the literature will attempt to define the role of embolotherapy for acute nonvariceal UGI hemorrhage that fails to respond to endoscopic hemostasis and to summarize data on factors predicting angiographic and embolization failure.

  4. Efficacy of recombinant annexin 2 for fibrinolytic therapy in a rat embolic stroke model: A magnetic resonance imaging study

    PubMed Central

    Tanaka, Yoji; Ishii, Hideto; Hiraoka, Megumi; Miyasaka, Naoyuki; Kuroiwa, Toshihiko; Hajjar, Katherine A.; Nagaoka, Tsukasa; Duong, Timothy Q.; Ohno, Kikuo; Yoshida, Masayuki

    2010-01-01

    Efficacy of recombinant annexin 2 (rAN II) in a rat model of embolic stroke was examined using a magnetic resonance imaging (MRI) and histology. The right middle cerebral artery of male Wistar rats was occluded by autologous clots under anesthesia. Four doses of rAN II (0.125, 0.25, 0.5 and 1.0 mg/kg, n = 10 for each group) or saline (1 ml/kg, n = 10) were administrated intravenously within 5 min before clot infusion. Serial changes in apparent diffusion coefficient (ADC) and relative blood flow (CBF) were measured with the use of MRI in half of the animals in each group. The remaining half of the animals in each group was evaluated for hemorrhage and final infarct size by histology at 48 h after embolization. At 3 h after embolization, lesion volumes with ADC were abnormality and CBF in the peripheral lesion was improved in groups treated with 0.25, 0.5 and 1.0 mg/kg, but not 0.125 mg/kg, of rAN II in comparison with the saline-treated group (P < 0.05). Histological analyses were consistent with MRI findings. More importantly, no hemorrhagic transformation was documented in rats treated with 0.125 and 0.25 mg/kg of rAN II, whereas it was observed at higher doses. We concluded that rAN II at 0.25 mg/kg significantly reduced infarct size and improved CBF without hemorrhagic complications. rAN II is a novel compound that has the potential to be a promising fibrinolytic agent to treat embolic stroke. PMID:17651708

  5. Multimodality Imaging of Ethiodized Oil-loaded Radiopaque Microspheres during Transarterial Embolization of Rabbits with VX2 Liver Tumors.

    PubMed

    Tacher, Vania; Duran, Rafael; Lin, MingDe; Sohn, Jae Ho; Sharma, Karun V; Wang, Zhijun; Chapiro, Julius; Gacchina Johnson, Carmen; Bhagat, Nikhil; Dreher, Matthew R; Schäfer, Dirk; Woods, David L; Lewis, Andrew L; Tang, Yiqing; Grass, Michael; Wood, Bradford J; Geschwind, Jean-François

    2016-06-01

    Purpose To assess the visibility of radiopaque microspheres during transarterial embolization (TAE) in the VX2 rabbit liver tumor model by using multimodality imaging, including single-snapshot radiography, cone-beam computed tomography (CT), multidetector CT, and micro-CT. Materials and Methods The study was approved by the institutional animal care and use committee. Fifteen VX2-tumor-bearing rabbits were assigned to three groups depending on the type of embolic agent injected: 70-150-μm radiopaque microspheres in saline (radiopaque microsphere group), 70-150-μm radiopaque microspheres in contrast material (radiopaque microsphere plus contrast material group), and 70-150-μm radiolucent microspheres in contrast material (nonradiopaque microsphere plus contrast material group). Rabbits were imaged with single-snapshot radiography, cone-beam CT, and multidetector CT. Three to 5 weeks after sacrifice, excised livers were imaged with micro-CT and histologic analysis was performed. The visibility of the embolic agent was assessed with all modalities before and after embolization by using a qualitative three-point scale score reading study and a quantitative assessment of the signal-to-noise ratio (SNR) change in various regions of interest, including the tumor and its feeding arteries. The Kruskal-Wallis test was used to compare the rabbit characteristics across groups, and the Wilcoxon signed rank test was used to compare SNR measurements before and after embolization. Results Radiopaque microspheres were qualitatively visualized within tumor feeding arteries and targeted tissue with all imaging modalities (P < .05), and their presence was confirmed with histologic examination. SNRs of radiopaque microsphere deposition increased after TAE on multidetector CT, cone-beam CT, and micro-CT images (P < .05). Similar results were obtained when contrast material was added to radiopaque microspheres, except for additional image attenuation due to tumor enhancement. For the

  6. Rescue N-butyl-2 cyanoacrylate embolectomy using a Solitaire FR device after venous glue migration during arteriovenous malformation embolization: technical note.

    PubMed

    Fahed, Robert; Clarençon, Frédéric; Sourour, Nader-Antoine; Chauvet, Dorian; Le Jean, Lise; Chiras, Jacques; Di Maria, Federico

    2016-07-01

    One of the procedural risks in arteriovenous malformation (AVM) embolization is possible migration of the embolic agent into the venous drainage with an incomplete nidus occlusion, which may lead to severe hemorrhagic complications. This report presents the case of a 29-year-old man who presented with a deep intraparenchymal hematoma on the left side secondary to the spontaneous rupture of a claustral AVM. Upon resorption of the hematoma, the patient underwent an initial therapeutic session of N-butyl-2 cyanoacrylate endovascular embolization, with the purpose of reducing the AVM volume and flow before performing Gamma Knife radiosurgery. After glue injection into one of the arterial feeders, the control angiography showed a partial migration of the glue cast into the straight sinus, with most of the nidus still visible. Because of the bleeding risk due to possible venous hypertension, it was decided to try to retrieve the glue from the vein by using a stent retriever via jugular access. This maneuver allowed a nearly complete removal of the glue cast, thereby restoring normal venous flow drainage. The patient showed no clinical worsening after the procedure. To the authors' knowledge, this is the first report of the use of the Solitaire FR device as a rescue glue retriever. This method should be considered by physicians in cases of unintended glue migration into the venous circulation during AVM embolization. PMID:26613173

  7. Prophylactic Residual Aneurysmal Sac Embolization with Expandable Hydrogel Embolic Devices for Endoleak Prevention: Preliminary Study in Dogs

    SciTech Connect

    Hiraki, Takao; Pavcnik, Dusan Uchida, Barry T.; Timmermans, Hans A.; Yin Qiang; Wu Renghong; Niyyati, Mahtab; Keller, Frederick S.; Roesch, Josef

    2005-05-15

    Objective. To explore the feasibility and efficacy of residual aneurysmal sac (RAS) embolization with the expandable hydrogel embolic device (EHED) in prevention of endoleaks in a surgically created and endoluminally treated abdominal aortic aneurysm (AAA). Methods. In eight dogs, an AAA was created by means of side-to-side anastomosis between the infrarenal abdominal aorta and inferior vena cava (IVC) with ligation of the IVC above and below the anastomotic end, followed by deployment of an endograft with holes. The RAS was then embolized with the EHED. One animal was killed immediately after RAS embolization and one animal died 12 hr after the procedure. Follow-up aortograms were obtained in six animals after 1 day (1 animal), 2 weeks and 6 months (1 animal), and 8 weeks (4 animals). Results. Four animals had no endoleaks on the follow-up aortograms. The remaining two animals with incomplete RAS embolization had moderate type III endoleaks. Type I or II endoleaks were not seen in any animals. Complications included RAS wall penetration by the devices with platinum wires in two animals (nos. 1 and 2), device migration into an aortic circulation through the endograft holes in two animals (nos. 2 and 3) or through distal interstices between the aortic wall and endograft in one animal (no. 8), aortic occlusion in three animals (nos. 3, 7, and 8), and RAS rupture in one animal (no. 7). Histologic examination showed expanded hydrogels occupying the RAS with associated mature or immature organized thrombus, fibrinous thrombus, or degenerate blood cells. Conclusion. RAS embolization was feasible with the EHED, although additional modifications to the device are required to avoid complications. Angiographic and histologic results suggested that RAS embolization with the EHED may help in the prevention of endoleaks.

  8. Incidence of pulmonary embolism during COPD exacerbation*, **

    PubMed Central

    Akpinar, Evrim Eylem; Hoşgün, Derya; Akpýnar, Serdar; Ataç, Gökçe Kaan; Doğanay, Beyza; Gülhan, Meral

    2014-01-01

    OBJECTIVE: Because pulmonary embolism (PE) and COPD exacerbation have similar presentations and symptoms, PE can be overlooked in COPD patients. Our objective was to determine the prevalence of PE during COPD exacerbation and to describe the clinical aspects in COPD patients diagnosed with PE. METHODS: This was a prospective study conducted at a university hospital in the city of Ankara, Turkey. We included all COPD patients who were hospitalized due to acute exacerbation of COPD between May of 2011 and May of 2013. All patients underwent clinical risk assessment, arterial blood gas analysis, chest CT angiography, and Doppler ultrasonography of the lower extremities. In addition, we measured D-dimer levels and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels. RESULTS: We included 172 patients with COPD. The prevalence of PE was 29.1%. The patients with pleuritic chest pain, lower limb asymmetry, and high NT-pro-BNP levels were more likely to develop PE, as were those who were obese or immobile. Obesity and lower limb asymmetry were independent predictors of PE during COPD exacerbation (OR = 4.97; 95% CI, 1.775-13.931 and OR = 2.329; 95% CI, 1.127-7.105, respectively). CONCLUSIONS: The prevalence of PE in patients with COPD exacerbation was higher than expected. The association between PE and COPD exacerbation should be considered, especially in patients who are immobile or obese. PMID:24626268

  9. Uterine artery embolization for primary postpartum hemorrhage

    PubMed Central

    Kim, Tae-Hee; Lee, Hae-Hyeog; Kim, Jun-Mo; Ryu, Ae-Li; Chung, Soo-Ho; Seok Lee, Woo

    2013-01-01

    Background: Postpartum hemorrhage is the leading cause of severe maternal morbidity and death. A prompt management of uterine artery embolization (UAE) is important for a good outcome. UAE is generally accepted to be a safe and reliable procedure. Objective: To estimate critical patient characteristics influencing the success of UAE for the treatment of emergent primary postpartum hemorrhage. Materials and Methods: This was a cross sectional study that reviewed 121 patients who were diagnosed primary postpartum hemorrhage between February 2002 and December 2009 at a tertiary treatment center among 4,022 deliveries. We evaluated patient clinical characteristics associated with a successful surgical outcome of UAE. Results: The success rate for UAE was 96%. For two cases, UAE complication was associated with fever (>38.5oC). Five patients had problems that required admission to the intensive care unit (ICU). Conclusion: To increase the surgical success rate and lower the number of ICU admissions, the decision to treat primary postpartum hemorrhage using UAE should be based on individual patient clinical findings under the direction of obstetrics staff and an interventional radiologist. PMID:24639786

  10. Focal embolic cerebral ischemia in the rat

    PubMed Central

    Zhang, Li; Zhang, Rui Lan; Jiang, Quan; Ding, Guangliang; Chopp, Michael; Zhang, Zheng Gang

    2015-01-01

    Animal models of focal cerebral ischemia are well accepted for investigating the pathogenesis and potential treatment strategies for human stroke. Occlusion of the middle cerebral artery (MCA) with an endovascular filament is a widely used model to induce focal cerebral ischemia. However, this model is not amenable to thrombolytic therapies. As thrombolysis with recombinant tissue plasminogen activator (rtPA) is a standard of care within 4.5 hours of human stroke onset, suitable animal models that mimic cellular and molecular mechanisms of thrombosis and thrombolysis of stroke are required. By occluding the MCA with a fibrin-rich allogeneic clot, we have developed an embolic model of MCA occlusion in the rat, which recapitulates the key components of thrombotic development and of thrombolytic therapy of rtPA observed from human ischemic stroke. The surgical procedures of our model can be typically completed within approximately 30 min and are highly adaptable to other strains of rats as well as mice for both genders. Thus, this model provides a powerful tool for translational stroke research. PMID:25741989

  11. It Is Not Always the Pulmonary Embolism.

    PubMed

    Daheshpour, Sepehr; Shenoy, Sundeep

    2016-01-01

    One of the leading reasons for emergency department visits happens to be chest pain and shortness of breath with estimated 6.3 million visits for chest pain and 3 million visits for shortness of breath. Over the years, there has been an upward trend in these demographics. The primary workup is usually toward cardio pulmonary causes. Paraesophageal hernia is a term to describe the herniation of gastroesophageal junction and the gastric fundus through the paraesophageal membrane. Paraesophageal hernias account for 5% of all the hiatal hernias, and patients are usually asymptomatic or have complaints of gastroesophageal reflux. However, on rare occasions, they are notorious to develop complications such as incarceration, gangrene, obstruction of intrathoracic stomach, collapse of the lung, and even death. We take this opportunity to present a 49-year-old man who presented with shortness of breath and chest pain. The initial workup revealed a pulmonary embolism on a computerized tomography scan. However, with better clinical judgment and more imaging, he was diagnosed with a paraesophageal hernia with gastric obstruction and early strangulation causing his symptoms. PMID:25789913

  12. Perfusion visualization and analysis for pulmonary embolism

    NASA Astrophysics Data System (ADS)

    Vaz, Michael S.; Kiraly, Atilla P.; Naidich, David P.; Novak, Carol L.

    2005-04-01

    Given the nature of pulmonary embolism (PE), timely and accurate diagnosis is critical. Contrast enhanced high-resolution CT images allow physicians to accurately identify segmental and sub-segmental emboli. However, it is also important to assess the effect of such emboli on the blood flow in the lungs. Expanding upon previous research, we propose a method for 3D visualization of lung perfusion. The proposed method allows users to examine perfusion throughout the entire lung volume at a single glance, with areas of diminished perfusion highlighted so that they are visible independent of the viewing location. This may be particularly valuable for better accuracy in assessing the extent of hemodynamic alterations resulting from pulmonary emboli. The method also facilitates user interaction and may help identify small peripheral sub-segmental emboli otherwise overlooked. 19 patients referred for possible PE were evaluated by CT following the administration of IV contrast media. An experienced thoracic radiologist assessed the 19 datasets with 17 diagnosed as being positive for PE with multiple emboli. Since anomalies in lung perfusion due to PE can alter the distribution of parenchymal densities, we analyzed features collected from histograms of the computed perfusion maps and demonstrate their potential usefulness as a preliminary test to suggest the presence of PE. These histogram features also offer the possibility of distinguishing distinct patterns associated with chronic PE and may even be useful for further characterization of changes in perfusion or overall density resulting from associated conditions such as pneumonia or diffuse lung disease.

  13. SPECT/CT and pulmonary embolism.

    PubMed

    Mortensen, Jann; Gutte, Henrik

    2014-05-01

    Acute pulmonary embolism (PE) is diagnosed either by ventilation/perfusion (V/P) scintigraphy or pulmonary CT angiography (CTPA). In recent years both techniques have improved. Many nuclear medicine centres have adopted the single photon emission CT (SPECT) technique as opposed to the planar technique for diagnosing PE. SPECT has been shown to have fewer indeterminate results and a higher diagnostic value. The latest improvement is the combination of a low-dose CT scan with a V/P SPECT scan in a hybrid tomograph. In a study comparing CTPA, planar scintigraphy and SPECT alone, SPECT/CT had the best diagnostic accuracy for PE. In addition, recent developments in the CTPA technique have made it possible to image the pulmonary arteries of the lungs in one breath-hold. This development is based on the change from a single-detector to multidetector CT technology with an increase in volume coverage per rotation and faster rotation. Furthermore, the dual energy CT technique is a promising modality that can provide functional imaging in combination with anatomical information. Newer high-end CT scanners and SPECT systems are able to visualize smaller subsegmental emboli. However, consensus is lacking regarding the clinical impact and treatment. In the present review, SPECT and SPECT in combination with low-dose CT, CTPA and dual energy CT are discussed in the context of diagnosing PE. PMID:24213621

  14. Isolated Pulmonary Embolism following Shoulder Arthroscopy

    PubMed Central

    Goldhaber, Nicole H.; Lee, Christopher S.

    2014-01-01

    Pulmonary embolism (PE) following shoulder arthroscopy is a rare complication. We present a unique case report of a 43-year-old right-hand dominant female who developed a PE 41 days postoperatively with no associated upper or lower extremity DVT. The patient had minimal preoperative and intraoperative risk factors. Additionally, she had no thromboembolic symptoms postoperatively until 41 days following surgery when she developed sudden right-hand swelling, labored breathing, and abdominal pain. A stat pulmonary computed tomography (CT) angiogram of the chest revealed an acute PE in the right lower lobe, and subsequent extremity ultrasounds showed no upper or lower extremity deep vein thrombosis. After a thorough review of the literature, we present the first documented isolated PE following shoulder arthroscopy. Although rare, sudden development of an isolated PE is possible, and symptoms such as sudden hand swelling, trouble breathing, and systemic symptoms should be evaluated aggressively with a pulmonary CT angiogram given the fact that an extremity ultrasound may be negative for deep vein thrombosis. PMID:25548699

  15. Uterine artery embolization immediately preceding laparoscopic myomectomy

    PubMed Central

    Goldman, Kara N.; Hirshfeld-Cytron, Jennifer E.; Pavone, Mary-Ellen; Thomas, Andrew P.; Vogelzang, Robert L.; Milad, Magdy P.

    2014-01-01

    Objective To determine whether performing uterine artery embolization (UAE) immediately before laparoscopic myomectomy can facilitate a minimally invasive surgical approach for larger uterine fibroids. Methods In a retrospective case–control study, laparoscopic myomectomy with and without preoperative UAE was examined. Data were analyzed from 26 laparoscopic myomectomies performed by a single surgeon at Northwestern University Feinberg School of Medicine between 2004 and 2010. Controls were matched for age, calendar year, surgeon, and number of fibroids removed. Surgical outcomes included preoperative clinical uterine size, operative time, operative blood loss, and postoperative myoma specimen weight. Data were analyzed via 2-tailed Student t test. Results Twelve women underwent laparoscopic myomectomy within 169±16 minutes (mean±SEM) of preoperative UAE. Fourteen control patients underwent laparoscopic myomectomy alone. The UAE group had a greater mean preoperative clinical uterine size (19.7 versus 12.4 weeks, P<0.001) and a greater mean myoma specimen weight measured postoperatively (595.3 versus 153.6 grams, P<0.05). There were no significant differences in operative time or blood loss, and there were no intra-operative complications. Conclusion UAE performed immediately before laparoscopic myomectomy facilitated minimally invasive surgery for larger uteri and larger uterine myomas, with no differences in operative time or blood loss. PMID:22098788

  16. Septic Coronary Artery Embolism Treated with Aspiration Thrombectomy: Case Report and Review of Literature

    PubMed Central

    Sarwar, Nosheen; Eftekhari, Hossein; Lotfi, Amir

    2014-01-01

    Coronary embolization is a potentially fatal sequela of endocarditis. We report a case of Candida endocarditis with septic embolism to the left anterior descending coronary artery. This embolism was successfully treated with aspiration thrombectomy followed by balloon angioplasty. The treatment of acute coronary syndrome in the presence of septic embolism is controversial. Aspiration thrombectomy has been performed in this situation before, and it appears to be safer and more feasible than is thrombolysis or percutaneous transluminal angioplasty. PMID:25120402

  17. Echocardiography and pulmonary embolism severity index have independent prognostic roles in pulmonary embolism.

    PubMed

    Sanchez, Olivier; Trinquart, Ludovic; Planquette, Benjamin; Couturaud, Francis; Verschuren, Franck; Caille, Vincent; Meneveau, Nicolas; Pacouret, Gérard; Roy, Pierre-Marie; Righini, Marc; Perrier, Arnaud; Bertoletti, Laurent; Parent, Florence; Lorut, Christine; Meyer, Guy

    2013-09-01

    We analysed a cohort of patients with normotensive pulmonary embolism (PE) in order to assess whether combining echocardiography and biomarkers with the pulmonary embolism severity index (PESI) improves the risk stratification in comparison to the PESI alone. The PESI was calculated in normotensive patients with PE who also underwent echocardiography and assays of cardiac troponin I and brain natriuretic peptide. 30-day adverse outcome was defined as death, recurrent PE or shock. 529 patients were included, 25 (4.7%, 95% CI 3.2-6.9%) had at least one outcome event. The proportion of patients with adverse events increased from 2.1% in PESI class I-II to 8.4% in PESI class III-IV, and to 14.3% in PESI class V (p<0.001). In PESI class I-II, the rate of outcome events was significantly higher in patients with abnormal values of biomarkers or right ventricular dilatation. In multivariate analysis, the PESI (class III-IV versus I-II, OR 3.1, 95% CI 1.2-8.3; class V versus I-II, OR 5.5, 95% CI 1.5-25.5 and echocardiography (right ventricular/left ventricular ratio, OR (for an increase of 0.1) 1.3, 95% CI 1.1-1.5) were independent predictors of an adverse outcome. In patients with normotensive PE, biomarkers and echocardiography provided additional prognostic information to the PESI. PMID:23258789

  18. Absolute Ethanol Embolization of Arteriovenous Malformations in the Periorbital Region

    SciTech Connect

    Su, Li-xin; Jia, Ren-Bing; Wang, De-Ming Lv, Ming-Ming Fan, Xin-dong

    2015-06-15

    ObjectiveArteriovenous malformations (AVMs) involving the periorbital region are technically challenging clinical entities to manage. The purpose of the present study was to present our initial experience of ethanol embolization in a series of 16 patients with auricular AVMs and assess the outcomes of this treatment.MethodsTranscatheter arterial embolization and/or direct percutaneous puncture embolization were performed in the 16 patients. Pure or diluted ethanol was manually injected. The follow-up evaluations included physical examination and angiography at 1- to 6-month intervals.ResultsDuring the 28 ethanol embolization sessions, the amount of ethanol used ranged from 2 to 65 mL. The obliteration of ulceration, hemorrhage, pain, infection, pulsation, and bruit in most of the patients was obtained. The reduction of redness, swelling, and warmth was achieved in all the 16 patients, with down-staging of the Schobinger status for each patient. AVMs were devascularized 100 % in 3 patients, 76–99 % in 7 patients, and 50–75 % in 6 patients, according to the angiographic findings. The most common complications were necrosis and reversible blister. No permanent visual abnormality was found in any of the cases.ConclusionEthanol embolization is efficacious and safe in the treatment of AVMs in the periorbital region and has the potential to be accepted as the primary mode of therapy in the management of these lesions.

  19. Pulmonary fat and bone marrow embolism in aircraft accident victims.

    PubMed

    Bierre, A R; Koelmeyer, T D

    1983-04-01

    On 28 November 1979, an Air New Zealand DC10 aircraft crashed into Mt Erebus, Antarctica with the loss of 257 passengers and crew. Postmortem examinations were carried out on 231 victims in Auckland, 4641 kilometres north of the crash site, and lung tissue was present in 205 cases. Pulmonary fat emboli were present in 134 cases (65%), pulmonary bone marrow emboli in 60 (29%) and pulmonary edema in 76 cases (37%). Clear relationships were demonstrated, firstly between the extent of fat and bone marrow embolism, secondly between the extent of fat and bone marrow embolism and the presence of pulmonary edema, and thirdly between the extent of fat and bone marrow embolism and the extent of cardiovascular damage. It was apparent that death had occurred immediately following impact, and the extent of fat and bone marrow embolism varied inversely with the severity of the injuries found. The most severely injured victims were those seated in the rear cabin of the aircraft suggesting that this was the site of impact with the ground. Our studies show that pulmonary fat embolism occurs very rapidly after severe injury and is followed by increasing numbers of fat and bone marrow emboli depending on the nature of the mortal injuries. PMID:6888959

  20. Acute ischemic colitis secondary to air embolism after diving

    PubMed Central

    Payor, Austin Daniel; Tucci, Veronica

    2011-01-01

    Ischemic colitis (IC) secondary to air embolism from decompression sickness or barotrauma during diving is an extremely rare condition. After extensive review of the available literature, we found that there has been only one reported case of IC secondary to air embolism from diving. Although air embolization from diving and the various medical complications that follow have been well documented, the clinical manifestation of IC from an air embolism during diving is very rare and thus far unstudied. Common symptoms of IC include abdominal pain, bloody or non-bloody diarrhea or nausea or vomiting or any combination. Emergency physicians and Critical Care specialists should consider IC as a potential diagnosis for a patient with the above-mentioned symptoms and a history of recent diving. We report a case of IC from air embolism after a routine dive to 75 feet below sea level in a 53-year-old White female who presented to a community Emergency Department complaining of a 2-day history of diffuse abdominal pain and nausea. She was diagnosed by colonoscopy with biopsies and treated conservatively with antibiotics, bowel rest, and a slow advancement in diet. PMID:22096777

  1. Patent Foramen Ovale: Is Stroke Due to Paradoxical Embolism?

    NASA Technical Reports Server (NTRS)

    Ranoux, D.; Cohen, A.; Cabanes, L.; Amarenco, P.; Bousser, M. G.; Mas, J. L.

    1993-01-01

    Background and Purpose: A patent foramen ovale has been reported to be significantly more frequent in young stroke patients than in matched control subjects, and paradoxical embolism has been suggested as the main mechanism of stroke in-this situation. The present study was designed to test this hypothesis. Methods: Sixty-eight consecutive patients under 55 years of age presenting with an ischemic stroke had an extensive workup, including transesophageal echocardiography with contrast. We compared the prevalence of criteria for the diagnosis of paradoxical embolism in patients with and without a patent foramen ovale. Results: A patent foramen ovale was found in 32 patients (47%). A Valsalva-provoking activity was present at stroke onset in six patients with a patent foramen ovale and in eight patients with no patent foramen ovale (X(sup 2)=0.1, nonsignificant). Clinical/radiological features suggestive of an embolic mechanism were not more frequent in patients with a patent foramen ovale. Clinical evidence of deep vein thrombosis was present in one patient with a patent foramen ovale and in none of the others. No occult venous thrombosis was found in a subgroup of patients with a patent foramen ovale and no definite cause for stroke who underwent venography (n=13). Conclusions. Our results do not support the hypothesis that paradoxical embolism is the primary mechanism of stroke in patients with a patent foramen ovale. (Stroke 1993;24:31-34) KEY WORDS e cerebral ischemia e embolism foramen ovale, patent

  2. Multidisciplinary management of placenta percreta complicated by embolic phenomena.

    PubMed

    Styron, A G; George, R B; Allen, T K; Peterson-Layne, C; Muir, H A

    2008-07-01

    Hemorrhage and thrombosis are major causes of maternal mortality. This case discusses the management of a woman with placenta percreta complicated by intraoperative pulmonary embolism. A 39-year-old gravida 3 with two previous cesarean deliveries presented at 34 weeks of gestation with an antepartum hemorrhage. Magnetic resonance imaging confirmed placenta percreta. The multidisciplinary group including obstetricians, gynecological oncologists, interventional radiologists and anesthesiologists developed a delivery plan. Cesarean delivery was performed with internal iliac artery occlusion and embolization catheters in place. After the uterine incision our patient experienced acute hypotension and hypoxia associated with a drop in the end-tidal carbon dioxide and sinus tachycardia. She was resuscitated and the uterus closed with the placenta in situ. Postoperatively, uterine bleeding was arrested by immediate uterine artery embolization. With initiation of embolization, hypotension and hypoxia recurred. Oxygenation and hemodynamics slowly improved, the case continued and the patient was extubated uneventfully at the end of the procedure. Computed tomography revealed multiple pulmonary emboli. The patient was anticoagulated with low-molecular-weight heparin and returned six weeks later for hysterectomy. Placenta percreta with invasion into the bladder can be catastrophic if not recognized before delivery. The chronology of events suggests that this may have been amniotic fluid emboli. An intact placenta with abnormal architecture, such as placenta percreta, may increase the risk of amniotic fluid embolus. The clinical findings and co-existing filling defects on computed tomography may represent a spectrum of amniotic fluid embolism syndrome. PMID:18501584

  3. Embolization of Isolated Lumbar Artery Injuries in Trauma Patients

    SciTech Connect

    Sofocleous, Constantinos T. Hinrichs, Clay R.; Hubbi, Basil; Doddakashi, Satish; Bahramipour, Philip; Schubert, Johanna

    2005-12-15

    Purpose. The purpose of the study was to evaluate the angiographic findings and results of embolotherapy in the management of lumbar artery trauma. Methods. All patients with lumbar artery injury who underwent angiography and percutaneous embolization in a state trauma center within a 10-year period were retrospectively reviewed. Radiological information and procedural reports were reviewed to assess immediate angiographic findings and embolization results. Long-term clinical outcome was obtained by communication with the trauma physicians as well as with chart review. Results. In a 10-year period, 255 trauma patients underwent abdominal aortography. Eleven of these patients (three women and eight men) suffered a lumbar artery injury. Angiography demonstrated active extravasation (in nine) and/or pseudoaneurysm (in four). Successful selective embolization of abnormal vessel(s) was performed in all patients. Coils were used in six patients, particles in one and gelfoam in five patients. Complications included one retroperitoneal abscess, which was treated successfully. One patient returned for embolization of an adjacent lumbar artery due to late pseudoaneurysm formation. Conclusions. In hemodynamically stable patients, selective embolization is a safe and effective method for immediate control of active extravasation, as well as to prevent future hemorrhage from an injured lumbar artery.

  4. Spontaneous fracture and embolization of an inferior vena cava cannula: is it possible?

    PubMed

    Velasco Garcia de Sierra, Carlos; Marini Díaz, Milagros; Fernández Arias, Laura; Estévez Cid, Francisco

    2016-06-01

    We present a case of spontaneous fracture and embolization of the distal part of a cannula into the left inferior lobar artery. The embolized fragment was captured with an angioplasty balloon and extracted through the right atrium appendage. No adverse event related to the embolization was observed and the patient was discharged with no sequelae. PMID:26503726

  5. Treatment of Acute Massive Pulmonary Embolism by Streptokinase during Labour and Delivery

    PubMed Central

    Hall, R. J. C.; Young, C.; Sutton, G. C.; Cambell, S.

    1972-01-01

    A 29-year-old woman sustained an acute massive pulmonary embolism in the 32nd week of pregnancy. Rapid clinical improvement followed the use of streptokinase. Treatment was continued for 41 hours, including labour and the first three hours after delivery. There was slow but severe postpartum haemorrhage. Partial uterine atony occurred, and may have been due, at least in part, to fibrin degradation products arising from thrombolysis. No adverse effects were noted in the baby. Our experience suggests that streptokinase may be given during labour but that an oxytocic agent may be needed; and that reversal of fibrinolysis before delivery is best achieved by the use of aprotinin (Trasylol) rather than aminocaproic acid. Imagesp647-a PMID:4539533

  6. Effect of Rivaroxaban on Fibrinolytic Therapy in Massive Pulmonary Embolism: Two Cases

    PubMed Central

    Kim, Hye-Jin; Koo, So-My; Ham, Nam-Suk; Kim, Ki-Up; Uh, Soo-taek

    2014-01-01

    The risk of dying from a pulmonary embolism (PE) is estimated to be about 30% if inotropic support is required and no cardiopulmonary arrest occurs. Fibrinolysis in massive PE is regarded as a life-saving intervention, unless there is a high risk of bleeding following the use of the fibrinolytic therapy. Rivaroxaban is an oral factor Xa inhibitor, however its anticoagulation effects before or after administration of fibrinolytics in massive PE are still unknown. Two patents were admitted: 61-year-old woman with repeated syncope, and a 73-year-old woman was admitted with dyspnea and poor oral intake. Systemic arterial hypotension with radiologic confirmation led to a diagnosis of massive PE in both patients. Rivaroxaban was administered before in one, and after firbrinolytic therapy in the other. One showed similar efficacy of rivaroxaban with currently used anticoagulants after successful fibrinolysis, and the other one without antecedent administration of the fibrinolytic agent showed unfavorable efficacy of rivaroxaban. PMID:24734100

  7. Determination of the antifungal agent voriconazole in human plasma using a simple column-switching high-performance liquid chromatography and its application to a pharmacokinetic study.

    PubMed

    Nakagawa, Saori; Suzuki, Riho; Yamazaki, Reiko; Kusuhara, Yoko; Mitsumoto, Shoko; Kobayashi, Hikaru; Shimoeda, Sadahiko; Ohta, Shin; Yamato, Susumu

    2008-03-01

    A simple column-switching high performance liquid chromatographic (HPLC) method that does not require any complicated pretreatment has been developed to determine voriconazole in human plasma samples. An internal standard (IS) and borate buffer (pH 9.0) were added to plasma samples, which were then injected directly into the column-switching HPLC system using MAYI-ODS as a pre-column. The calibration curve for voriconazole showed good linearity in the range of 0.2-10 mug/ml in human plasma. The mean RSD (%) value of intra-day (n=6) and inter-day (n=5) precision were less than 5.4% and 8.2%, respectively. This system could make more than three hundred successive, accurate measurements when a washing step with ammonium acetate solution was added. This method was successfully applied to measure the therapeutic voriconazole level in patients' plasma, and was used in a study of voriconazole pharmacokinetics after oral administration. PMID:18310944

  8. Stability-Indicating Liquid Chromatographic Method for the Quantification of the New Antipsychotic Agent Asenapine in Bulk and in Pharmaceutical Formulation

    PubMed Central

    Chhalotiya, Usmangani K.; Bhatt, Kashyap K.; Shah, Dimal A.; Patel, Jigar R.

    2012-01-01

    A simple, specific and stability-indicating reversed phase high performance liquid chromatographic method was developed for the quantitative determination of asenapine in tablet dosage form. A SunFire C18, 5 μm column having 250×4.6 mm i.d. in isocratic mode, with mobile phase containing 0.02 M potassium dihydrogen phosphate: acetonitrile (95:05, v/v, pH 3.5 adjusted with 1% o-phosphoric acid) was used. The flow rate was 1.0 mL min−1 and effluents were monitored at 232 nm. The retention time of asenapine was 5.51 min. The linearity for asenapine was in the range of 0.1–20 μg/ml. The recoveries obtained for asenapine were 98.31–101.51%. Asenapine stock solutions were subjected to acid and alkali hydrolysis, chemical oxidation, sunlight and dry heat degradation. The degraded product peaks were well resolved from the pure drug peak with significant difference in their retention time values. Stressed samples were assayed using developed LC method. The proposed method was validated with respect to linearity, accuracy, precision and robustness. The method was successfully applied to the estimation of asenapine in tablet dosage form. PMID:22896826

  9. Pulmonary embolism: whom to discharge and whom to thrombolyze?

    PubMed

    Meyer, G; Planquette, B; Sanchez, O

    2015-06-01

    Patients with pulmonary embolism can be divided in two groups according to their risk of death or major complication: a small group of high-risk patients defined by the presence of systemic hypotension or cardiogenic shock and a large group of normotensive patients. Among normotensive patients, further risk stratification, based on clinical grounds alone or on the combination of clinical data, biomarkers, and imaging tests, allows selection of low-risk patients and intermediate-risk patients. The safety of outpatient treatment for low-risk patients has been established mainly on the basis of retrospective and prospective cohorts using different selection tools. In most studies, about 50% of the patients have been safely treated at home. Although thrombolytic therapy has a favorable benefit to risk profile in patients with high-risk pulmonary embolism, the risk of major and especially intracranial bleeding outweighs the benefits in terms of hemodynamic decompensation in patients with intermediate-risk pulmonary embolism. PMID:26149032

  10. Paradoxical brain embolism associated with Kimura disease mimics watershed infarction.

    PubMed

    Tanaka, Yasutaka; Ueno, Yuji; Shimada, Yoshiaki; Yamashiro, Kazuo; Tanaka, Ryota; Urabe, Takao; Hattori, Nobutaka

    2015-02-01

    Kimura disease (KD) is an uncommon chronic inflammatory disease presenting as subcutaneous lymphadenopathy with eosinophilia. To date, only a single case of brain embolism caused by fibroblastic endocarditis associated with KD has been reported. Watershed infarction was seen in patients with episodes of severe hypotension or cardiac surgery. We here report a young case of KD who developed ischemic stroke and showed multiple small infarcts in the border zones between the territories of major cerebral arteries, mimicking watershed infarction. Transesophageal echocardiography revealed patent foramen ovale and atrial septal aneurysm. Concurrently, deep venous thrombus in the femoral vein was found on duplex ultrasonography. Our case supports the notion that paradoxical brain embolism associated with KD can cause multiple small embolisms and mimic watershed infarction. PMID:25447210

  11. Pulmonary embolism in an immunocompetent patient with acute cytomegalovirus colitis

    PubMed Central

    Chou, Jen-Wei

    2016-01-01

    Acute cytomegalovirus (CMV) infection occurs commonly in immunocompromised and immunocompetent patients, but is usually asymptomatic in the latter. Vascular events associated with acute CMV infection have been described, but are rare. Hence, such events are rarely reported in the literature. We report a case of pulmonary embolism secondary to acute CMV colitis in an immunocompetent 78-year-old man. The patient presented with fever and diarrhea. Colonic ulcers were diagnosed based on colonoscopy findings, and CMV was the proven etiology on pathological examination. The patient subsequently experienced acute respiratory failure. Pulmonary embolism was diagnosed based on the chest radiography and computed tomography findings. A diagnosis of acute CMV colitis complicated by pulmonary embolism was made. The patient was successfully treated with intravenous administration of unfractionated heparin and intravenous ganciclovir. PMID:27175121

  12. A liquid chromatography-tandem mass spectrometric assay for the antihypertensive agent azelnidipine in human plasma with application to clinical pharmacokinetics studies.

    PubMed

    Gao, Yanhui; Li, Baoqiu; Zhu, Baomeng; Liu, Dongming; Zhao, Hengli; Fang, Zengjun; Wang, Haisheng; Lou, Hongxiang

    2015-07-01

    A robust and sensitive high-performance liquid chromatographic-tandem mass spectrometric (HPLC-MS/MS) assay for the high-throughput quantification of the antihypertensive drug azelnidipine in human plasma was developed and validated following bioanalytical validation guidelines. Azelnidipine and internal standard (IS), telmisartan, were extracted from human plasma by precipitation protein and separated on a C18 column using acetonitrile-methanol-ammonium formate with 0.1% formic acid as mobile phase. Detection was performed on a turbo-spray ionization source (ESI) and mass spectrometric positive multiple reaction monitoring mode (+MRM) using the respective transitions m/z 583.3 → 167.2 for azelnidipine and m/z 515.3 → 497.2 for IS. The method has a wide analytical measuring range from 0.0125 to 25 ng/mL. For the lowest limit of quantitation, low, medium and high quality controls, intra- and interassay precisions (relative standard deviation) were 3.30-7.01% and 1.78-8.09%, respectively. The drug was sufficiently stable under all relevant analytical conditions. The main metabolite of azelnidipine, M-1 (aromatized form), was monitored semiquantitatively using the typical transition m/z 581.3 → 167.2. Finally, the method was successfully applied to a clinical pharmacokinetic study in human after a single oral administration of azelnidipine 8 mg. The assay meets criteria for the analysis of samples from large research trials. PMID:25472837

  13. Direct transcranial puncture for Onyx embolization of a cerebellar hemangioblastoma.

    PubMed

    Ding, Dale; Starke, Robert M; Evans, Avery J; Liu, Kenneth C

    2014-06-01

    Intracranial hemangioblastomas are benign but hypervascular tumors, most commonly located in the cerebellum, which are difficult to resect without significant operative blood loss. While preoperative embolization may decrease the amount of operative bleeding, the vascular supply of cerebellar hemangioblastomas frequently precludes safe embolization by an endovascular route due to the risk of thromboembolic vertebrobasilar infarction. Direct puncture embolization overcomes many of the limitations of endovascular embolization but its safety and feasibility for intracranial tumors is unknown. We report a 48-year-old man who was diagnosed with a large cerebellar mass after presenting with headaches and gait ataxia. Based on diagnostic angiography, which demonstrated a highly vascular tumor supplied by the posterior inferior cerebellar and posterior meningeal arteries, we decided to embolize the tumor by a direct transcranial puncture approach. After trephinating the skull in a standard fashion, a catheter-needle construct, composed of an Echelon 10 microcatheter (ev3 Endovascular, Plymouth, MN, USA) placed into a 21-gauge spinal needle, was inserted into the tumor under biplanar angiographic guidance. Using continuous angiographic monitoring, 9cc of Onyx 34 (ev3 Endovascular) was injected through the catheter, resulting in 75% tumor devascularization without evidence of complications. The patient was taken directly to surgery where a gross total resection of the hemangioblastoma was achieved with an acceptable operative blood loss. At his 2 year follow-up, the patient was neurologically intact without neuroimaging evidence of residual tumor. We describe, to our knowledge, the first case of direct transcranial puncture for preoperative embolization of a cerebellar hemangioblastoma. PMID:24370504

  14. Embolized meningiomas: risk of overgrading and neo-angiogenesis.

    PubMed

    Barresi, Valeria; Branca, Giovanni; Granata, Francesca; Alafaci, Concetta; Caffo, Maria; Tuccari, Giovanni

    2013-06-01

    Pre-operative embolization (POE) of meningiomas may induce histological changes which simulate malignancy, possibly resulting in overgrading. Aims of the present study were to identify clues to distinguish malignancy-related features from POE-related changes and to test for overgrading the grading scheme currently in use, in embolized meningiomas. In addition, we aimed to analyze whether the POE procedure may stimulate neo-angiogenesis in meningiomas. The histological features of a series of embolized meningiomas were evaluated and considered for grading assessment. In the same cases neo-angiogenesis was quantified by the evaluation of microvessel density (MVD) and correlated with the interval between POE and surgery. Necrosis and macronucleoli represented common findings in embolized meningiomas. Nonetheless, in most of the cases, necrosis showed an abrupt line of demarcation from the viable tumour tissue, and macronucleoli were restricted to peri-necrotic areas. Suggesting that these were POE-associated changes, exclusion of necrotic areas with an abrupt line of transition and focal macronucleoli from grading assessment resulted in increased specificity and positive predictive value in the identification of recurring meningiomas. In our cohort, MVD significantly increased with the time between POE and surgery, suggesting that POE procedure may induce neo-angiogenesis in meningiomas. In conclusion, a risk of overgrading there exists in embolized meningiomas, as a consequence of the frequent evidence of necrosis and prominent nucleoli in these tumours. In order to avoid overgrading, we suggest that necrosis showing an abrupt line of demarcation and focal peri-necrotic macronucleoli are not included in grading assessment. Also, caution should be used in the interpretation of MVD as a prognostic factor in embolized meningioma, as it may also result from POE procedure. PMID:23504284

  15. Silk-Elastinlike Protein Polymer Liquid Chemoembolic for Localized Release of Doxorubicin and Sorafenib.

    PubMed

    Poursaid, Azadeh; Jensen, Mark Martin; Nourbakhsh, Ida; Weisenberger, Mitchell; Hellgeth, John W; Sampath, Sujatha; Cappello, Joseph; Ghandehari, Hamidreza

    2016-08-01

    Locoregional therapies for cancer are minimally invasive procedures in which the treatment is administered directly into cancerous tissue. Transarterial chemoembolization (TACE) is used to treat intermediate stage hepatocellular carcinoma (HCC). TACE uses an embolic material to block blood flow while coadministering a chemotherapeutic to the neoplastic tissue. Liquid embolics capable of drug loading are at the forefront of development as they allow for deeper permeation of tumor vasculature, increase neoplasm exposure to therapeutics, and resist revascularization by occupying both large and small diameter vessels. In this work, two chemotherapeutics used in the treatment of HCC, doxorubicin and sorafenib, were incorporated into the in situ gelling liquid embolic composed of a silk-elastinlike protein polymer (SELP-815 K). The base forms of the drugs had no significant effect on the viscosity, the gelation kinetics, and the gel stiffness of the SELP: all properties essential for the successful performance of an injectable liquid embolic. In vitro release studies indicated that the SELP liquid embolic delivered doxorubicin and sorafenib, either alone or in combination, at therapeutically relevant concentrations for a minimum of 14 and 30 days, respectively. PMID:27295352

  16. Surgical embolectomy for acute massive pulmonary embolism

    PubMed Central

    Yavuz, Senol; Toktas, Faruk; Goncu, Tugrul; Eris, Cuneyt; Gucu, Arif; Ay, Derih; Erdolu, Burak; Tenekecioglu, Erhan; Karaagac, Kemal; Vural, Hakan; Ozyazicioglu, Ahmet

    2014-01-01

    Objective: Acute massive pulmonary embolism (PE) is associated with significant mortality rate despite diagnostic and therapeutic advances. The aim of this study was to analyze our clinical outcomes of patients with acute massive PE who underwent emergency surgical pulmonary embolectomy. Methods: This retrospective study included 13 consecutive patients undergoing emergency surgical pulmonary embolectomy for acute massive PE at our institution from March 2000 to November 2013. The medical records of all patients were reviewed for demograhic and preoperative data and postoperative outcomes. All patients presented with cardiogenic shock with severe right ventricular dysfunction confirmed by echocardiography, where 4 (30.8%) of the patients experienced cardiac arrest requiring cardiopulmonary resuscitation before surgery. Results: The mean age of patients was 61.8 ± 14 years (range, 38 to 82 years) with 8 (61.5%) males. The most common risk factors for PE was the history of prior deep venous thrombosis (n = 9, 69.2%). There were 3 (23.1%) in-hospital deaths including operative mortality of 7.7% (n = 1). Ten (76.9%) patients survived and were discharged from the hospital. The mean follow-up was 25 months; follow-up was 100% complete in surviving patients. There was one case (7.7%) of late death 12 months after surgery due to renal carcinoma. Postoperative echocardiographic pressure measurements demonstrated a significant reduction (P < 0.001). At final follow-up, all patients were in New York Heart Association class I and no readmission for a recurrent of PE was observed. Conclusion: Surgical pulmonary embolectomy is a reasonable option and could be performed with acceptable results, if it is performed early in patients with acute massive PE who have not reached the profound cardiogenic shock or cardiac arrest. PMID:25664045

  17. [Postbiopsy giant pseudoaneurysm in renal transplant: treatment with embolization].

    PubMed

    Zaragozano Guillén, R; García Díez, A I; Cobos Hernández, M V; Yagüe Romeo, D

    1998-03-01

    Pseudoaneurism in renal grafts is a well known complication of the percutaneous biopsy. Colour Doppler has been shown to be the choice technique for their diagnosis and subsequent control, the most effective treatment being embolization. This paper presents an unusual form of pseudoaneurism in terms of its size (up to 8 cm diameter) in a renal graft, following performance of a percutaneous biopsy with automatic needle. The findings of the colour Doppler study and the angiography are shown and discussed, as well as the treatment by embolization with metal spirals which achieved the stable, complete occlusion of the lesion after six months control. PMID:9616940

  18. Pulmonary embolism following celiac plexus block and neurolysis.

    PubMed

    McAninch, Scott A; Raizada, Miles S; Kelly, Seth M

    2016-07-01

    Treatment of acute pain in chronic disease requires the physician to choose from an arsenal of pain management techniques tailored to the individual patient. Celiac plexus block and neurolysis are commonly employed for the management of chronic abdominal pain, especially in debilitating conditions such as cancer or chronic pancreatitis. The procedure is safe, well tolerated, and produces few complications. We present a case of pulmonary embolism following a celiac plexus block and neurolysis procedure. Further study is required to determine if celiac plexus ablation, alone or in combination with other risk factors, may contribute to increased risk for pulmonary embolism in patients seeking treatment for chronic upper abdominal pain conditions. PMID:27365890

  19. Pulmonary embolism following celiac plexus block and neurolysis

    PubMed Central

    Raizada, Miles S.; Kelly, Seth M.

    2016-01-01

    Treatment of acute pain in chronic disease requires the physician to choose from an arsenal of pain management techniques tailored to the individual patient. Celiac plexus block and neurolysis are commonly employed for the management of chronic abdominal pain, especially in debilitating conditions such as cancer or chronic pancreatitis. The procedure is safe, well tolerated, and produces few complications. We present a case of pulmonary embolism following a celiac plexus block and neurolysis procedure. Further study is required to determine if celiac plexus ablation, alone or in combination with other risk factors, may contribute to increased risk for pulmonary embolism in patients seeking treatment for chronic upper abdominal pain conditions. PMID:27365890

  20. Endovascular strategies for treatment of embolizing thoracoabdominal aortic lesions

    PubMed Central

    Jeyabalan, Geetha; Wallace, Justin R.; Chaer, Rabih Antoine; Leers, Steven A.; Marone, Luke Keith; Makaroun, Michel S.

    2014-01-01

    Objective Aortic sources of peripheral and visceral embolization remain challenging to treat. The safety of stent graft coverage continues to be debated. This study reports the outcomes of stent coverage of these complex lesions. Methods Hospital records were retrospectively reviewed for patients undergoing aortic stenting between 2006 and 2013 for visceral and peripheral embolic disease. Renal function, method of coverage, and mortality after stent grafting were reviewed. Results Twenty-five cases of embolizing aortic lesions treated with an endovascular approach were identified. The mean age was 65 ± 13 years (range, 45–87 years), and 64% were female. Sixteen (64%) patients presented with peripheral embolic events, six with concomitant renal embolization. Five patients presented with abdominal or flank pain, and two were discovered incidentally. Three patients had undergone an endovascular procedure for other indications within the preceding 6 months of presentation. Nineteen patients had existing chronic kidney disease (stage II or higher), but only three had stage IV disease. Of the eight patients tested, four had a diagnosed hypercoagulable state. Eight of the patients had lesions identified in multiple aortic segments, and aortic aneurysm disease was present in 24%. Coverage of both abdominal and thoracic sources occurred in eight patients, whereas 17 had only one segment covered. Minimal intraluminal catheter and wire manipulation was paired with the use of intravascular ultrasound in an effort to reduce embolization and contrast use. Intravascular ultrasound was used in the majority of cases and transesophageal echo in 28% of patients. Two patients with stage IV kidney disease became dialysis-dependent within 3 months of the procedure. No other patients had an increase in their postoperative or predischarge serum creatinine levels. No embolic events were precipitated during the procedure, nor were there any recurrent embolic events detected on follow

  1. Transarterial chemoembolization and bland embolization for hepatocellular carcinoma.

    PubMed

    Tsochatzis, Emmanuel A; Fatourou, Evangelia; O'Beirne, James; Meyer, Tim; Burroughs, Andrew K

    2014-03-28

    Transarterial chemoembolization (TACE) is the first line treatment for patients with intermediate stage hepatocellular carcinoma but is also increasingly being used for patients on the transplant waiting list to prevent further tumor growth. Despite its widespread use, TACE remains an unstandardized procedure, with variation in type and size of embolizing particles, type and dose of chemotherapy and interval between therapies. Existing evidence from randomized controlled trials suggest that bland transarterial embolization (TAE) has the same efficacy with TACE. In the current article, we review the use of TACE and TAE for hepatocellular carcinoma and we focus on the evidence for their use. PMID:24695579

  2. Trans-arterial Onyx Embolization of a Functional Thoracic Paraganglioma

    PubMed Central

    Chacón-Quesada, Tatiana; Maud, Alberto; Ramos-Duran, Luis; Torabi, Alireza; Fitzgerald, Tamara; Akle, Nassim; Cruz Flores, Salvador; Trier, Todd

    2015-01-01

    Paragangliomas are rare tumors of the endocrine system. They are highly vascular and in some cases hormonally active, making their management challenging. Although there is strong evidence of the safety and effectiveness of preoperative embolization in the management of spinal tumors, only five cases have been reported in the setting of thoracic paragangliomas. We present the case of a 19-year-old man with a large, primary, functional, malignant paraganglioma of the thoracic spine causing a vertebral fracture and spinal cord compression. To our knowledge this is the first report of preoperative trans-arterial balloon augmented Onyx embolization of a thoracic paraganglioma. PMID:25763296

  3. The incidence, pathogenesis, diagnosis, and treatment of fat embolism.

    PubMed

    Müller, C; Rahn, B A; Pfister, U; Meinig, R P

    1994-02-01

    Fat embolism syndrome is a potentially serious and life threatening complication of long bone trauma, blunt trauma, and intramedullary manipulation. In long bone fractures, fat embolism is encountered in 0.9% to 2.2% of cases. During intramedullary manipulations, such as prosthetic stem insertion or reaming, the incidence is typically lower (range, 0.5% to 0.8%). Diagnosis is dependent upon the clinical recognition of dyspnea, petechiae, and cognitive dysfunction in the first several days following fracture, trauma, or intramedullary surgery. Treatment consists of pulmonary support and aggressive resuscitation. Studies support early fracture fixation, but the role of systemic steroids, heparin, and other modalities remains speculative. PMID:8196970

  4. Anterior spinal cord infarction owing to possible fibrocartilaginous embolism.

    PubMed

    Raghavan, Ashok; Onikul, Ella; Ryan, Monique M; Prelog, Kristina; Taranath, Ajay; Chennapragada, Murthy

    2004-06-01

    Anterior spinal artery syndrome is characterised by acute flaccid quadriparesis or paraparesis, disturbance of pain and temperature sensation, and loss of sphincter control. Fibrocartilaginous embolism is a rarely recognised, but important cause of spinal cord infarction. Fibrocartilaginous embolisation usually occurs after minor trauma without major bony lesions, typically with an intervening symptom-free interval and progressive 'stroke-in-evolution' course. There is evidence that the embolus originates from the intervertebral disc, but the mechanism whereby disc fragments enter the spinal vessels is not well understood. We describe the evolution of MRI findings in a case of anterior spinal artery territory infarction thought to be secondary to fibrocartilaginous embolism. PMID:14747876

  5. Paradoxical coronary artery embolism - a rare cause of myocardial infarction.

    PubMed

    Hakim, Fayaz A; Kransdorf, Evan P; Abudiab, Muaz M; Sweeney, John P

    2014-01-01

    Paradoxical coronary artery embolism is a rare, but often an underdiagnosed cause of acute myocardial infarction. It should be considered in patient who presents with chest pain and otherwise having a low risk profile for atherosclerosis coronary artery disease. We describe a case of paradoxical coronary artery embolism causing ST segment elevation myocardial infarction in a patient with upper extremity venous thrombosis. Echocardiography demonstrated a patent foramen ovale (PFO) with bidirectional shunt. In addition to treatment of acute coronary event closure of the PFO should be considered to prevent a recurrence. PMID:25774255

  6. Paradoxical Coronary Artery Embolism - A Rare Cause of Myocardial Infarction

    PubMed Central

    Hakim, Fayaz A.; Kransdorf, Evan P.; Abudiab, Muaz M.; Sweeney, John P.

    2014-01-01

    Paradoxical coronary artery embolism is a rare, but often an underdiagnosed cause of acute myocardial infarction. It should be considered in patient who presents with chest pain and otherwise having a low risk profile for atherosclerosis coronary artery disease. We describe a case of paradoxical coronary artery embolism causing ST segment elevation myocardial infarction in a patient with upper extremity venous thrombosis. Echocardiography demonstrated a patent foramen ovale (PFO) with bidirectional shunt. In addition to treatment of acute coronary event closure of the PFO should be considered to prevent a recurrence. PMID:25774255

  7. Systemic Air Embolism Associated with Pleural Pigtail Chest Tube Insertion

    PubMed Central

    Alkhankan, Emad; Nusair, Ahmad; Mazagri, Rida

    2016-01-01

    Pleural pigtail catheter placement is associated with many complications including pneumothorax, hemorrhage, and chest pain. Air embolism is a known but rare complication of pleural pigtail catheter insertion and has a high risk of occurrence with positive pressure ventilation. In this case report, we present a 50-year-old male with bilateral pneumonia who developed a pneumothorax while on mechanical ventilation with continuous positive airway pressure mode. During the placement of the pleural pigtail catheter to correct the pneumothorax, the patient developed a sudden left sided body weakness and became unresponsive. An air embolism was identified in the right main cerebral artery, which was fatal.

  8. Fast heating induced impulse halogenation of refractory sample components in electrothermal atomic absorption spectrometry by direct injection of a liquid halogenating agent.

    PubMed

    György, Krisztina; Ajtony, Zsolt; Van Meel, Katleen; Van Grieken, René; Czitrovszky, Aladár; Bencs, László

    2011-09-15

    A novel electrothermal atomic absorption spectrometry (ETAAS) method was developed for the halogenation of refractory sample components (Er, Nd and Nb) of lithium niobate (LiNbO(3)) and bismuth tellurite (Bi(2)TeO(5)) optical single crystals to overcome memory effects and carry-over. For this purpose, the cleaning step of a regular graphite furnace heating program was replaced with a halogenation cycle. In this cycle, after the graphite tube cooled to room temperature, a 20 μL aliquot of liquid carbon tetrachloride (CCl(4)) was dispensed with a conventional autosampler into the graphite tube. The CCl(4) was partially dried at 80°C under the mini-flow (40 cm(3) min(-1)) condition of the Ar internal furnace gas (IFG), then the residue was decomposed (pyrolyzed) by fast furnace heating at 1900-2100°C under interrupted flow of the IFG. This step was followed by a clean-out stage at 2100°C under the maximum flow of the IFG. The advantage of the present method is that it does not require any alteration to the graphite furnace gas supply system in contrast to most of the formerly introduced halogenation techniques. The effectiveness of the halogenation method was verified with the determination of Er and Nd dopants in the optical crystals. In these analyses, a sensitivity decrease was observed, which was likely due to the enhanced deterioration of the graphite tube surface. Therefore, the application of mathematical correction (resloping) of the calibration was also required. The calibration curves were linear up to 1.5 and 10 μmol L(-1) for Er and Nd, respectively. Characteristic masses of 18 and 241 pg and the limit of detection (LOD) values of 0.017 and 0.27 μmol L(-1) were found for Er and Nd, respectively. These LOD data correspond to 0.68 μmol mol(-1) Er and 11 μmol mol(-1) Nd in solid bismuth tellurite samples. The analytical results were compared with those obtained by a conventional ETAAS method and validated with X-ray fluorescence spectrometry analysis

  9. The prognostic value of pulmonary embolism severity index in acute pulmonary embolism: a meta-analysis

    PubMed Central

    2012-01-01

    Background Prognostic assessment is important for the management of patients with acute pulmonary embolism (APE). Pulmonary Embolism Severity Index (PESI) and simple PESI (sPESI) are new emerged prognostic assessment tools for APE. The aim of this meta-analysis is to assess the accuracy of the PESI and the sPESI to predict prognostic outcomes (all-cause and PE-related mortality, serious adverse events) in APE patients, and compare between these two PESIs. Methods MEDLINE and EMBASE database were searched up to June 2012 using the terms “Pulmonary Embolism Severity Index” and “pulmonary embolism”. Summary odds ratio (OR) with 95% confidence intervals (CIs) for prognostic outcomes in low risk PESI versus high risk PESI were calculated. Summary receiver operating characteristic curve (SROC) used to estimate overall predicting accuracies of prognostic outcomes. Results Twenty-one studies were included in this meta-analysis. The results showed low-risk PESI was significantly associated with lower all-cause mortality (OR 0.13; 95% CI 0.12 to 0.15), PE-related mortality (OR 0.09; 95% CI 0.05 to 0.17) and serious adverse events (OR 0.34; 95% CI 0.29 to 0.41), with no homogeneity across studies. In sPESI subgroup, the OR of all-cause mortality, PE-related mortality, and serious adverse events was 0.10 (95% CI 0.08 to 0.14), 0.09 (95% CI 0.03 to 0.26) and 0.40 (95% CI 0.31 to 0.51), respectively; while in PESI subgroup, the OR was 0.14 (95% CI 0.13 to 0.16), 0.09 (95% CI 0.04 to 0.21), and 0.30 (95% CI 0.23 to 0.38), respectively. For accuracy analysis, the pooled sensitivity, the pooled specificity, and the overall weighted AUC for PESI predicting all-cause mortality was 0.909 (95% CI: 0.900 to 0.916), 0.411 (95% CI: 0.407 to 0.415), and 0.7853±0.0058, respectively; for PE-related mortality, it was 0.953 (95% CI: 0.913 to 0.978), 0.374 (95% CI: 0.360 to 0.388), and 0.8218±0.0349, respectively; for serious adverse events, it was 0.821 (95% CI: 0.795 to 0.845), 0

  10. Simultaneous detection and identification of precursors, degradation and co-products of chemical warfare agents in drinking water by ultra-high performance liquid chromatography-quadrupole time-of-flight mass spectrometry.

    PubMed

    Tak, Vijay; Purohit, Ajay; Pardasani, Deepak; Goud, D Raghavender; Jain, Rajeev; Dubey, D K

    2014-11-28

    Environmental markers of chemical warfare agents (CWAs) comprise millions of chemical structures. The simultaneous detection and identification of these environmental markers poses difficulty due to their diverse chemical properties. In this work, by using ultra-high performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UHPLC-QTOF), a generic analytical method for the detection and identification of wide range of environmental markers of CWAs (including precursors, degradation and co-products of nerve agents and sesqui-mustards) in drinking water, was developed. The chromatographic analysis of 55 environmental markers of CWAs including isomeric and isobaric compounds was accomplished within 20 min, using 1.8 μm particle size column. Subsequent identification of the compounds was achieved by the accurate mass measurement of either protonated molecule [M+H](+) or ammonium adduct [M+NH4](+) and fragment ions. Isomeric and isobaric compounds were distinguished by chromatographic retention time, characteristic fragment ions generated by both in-source collision induced dissociation (CID) and CID in the collision cell by MS/MS experiments. The exact mass measurement errors for all ions were observed less than 3 ppm with internal calibration. The method limits of detection (LODs) and limits of quantification (LOQs) were determined in drinking water and found to be 1-50 ng mL(-1) and 5-125 ng mL(-1), respectively. Applicability of the proposed method was proved by determining the environmental markers of CWAs in aqueous samples provided by Organization for the Prohibition of Chemical Weapons during 34th official proficiency test. PMID:25454132

  11. Pulmonary embolism, part I: Epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism

    PubMed Central

    Bĕlohlávek, Jan; Dytrych, Vladimír; Linhart, Aleš

    2013-01-01

    Pulmonary embolism is an important clinical entity with considerable mortality despite advances in diagnosis and treatment. In the present article, the authors offer a comprehensive review focused mainly on epidemiology, risk factors, risk stratification, pathophysiological considerations and clinical presentation. Diagnosis based on assessment of clinical likelihood, electrocardiography, chest x-ray, D-dimer levels, markers of myocardial injury and overload, and blood gases is discussed in detail. Special attention is devoted to the clinical use of computed tomography, pulmonary angiography and echocardiography in the setting of pulmonary embolism. PMID:23940438

  12. Pulmonary Artery Access Embolization in Patients with Massive Hemoptysis in Whom Bronchial and/or Nonbronchial Systemic Artery Embolization Is Contraindicated

    SciTech Connect

    Tamashiro, Alberto; Miceli, Marisa H.; Rando, Cristian; Tamashiro, Gustavo A.; Villegas, Miguel O.; Dini, Andres E.; Balestrin, Aristobulo E.; Diaz, Jose A.

    2008-05-15

    The objective of this paper is to present an alternative therapeutic approach for the treatment of patients with massive hemoptysis in whom bronchial and/or nonbronchial systemic arterial embolization is not possible. We describe a percutaneous procedure for pulmonary segmental artery embolization. Between May 2000 and July 2006, 27 adult patients with hemoptysis underwent percutaneous treatment at our department; 20 of 27 patients were embolized via bronchial and or nonbronchial systemic arteries and 7 patients were embolized via pulmonary artery. Femoral arterial access for systemic artery catheterization and femoral vein access for pulmonary arterial catheterization were used. Gelfoam particles and coils were used for embolization. In this study, we report on three cases of massive hemoptysis from a systemic arterial source in whom bronchial and/or nonbronchial arteries embolization was not possible. Percutaneous embolization via the pulmonary artery access was successful in all three patients. In conclusion, embolization via pulmonary artery is presented as an alternative approach for the management of hemoptysis in patients in whom bronchial arterial embolization is not possible.

  13. Combined Effects of Embolization and Hypofractionated Conformal Stereotactic Radiotherapy in Arteriovenous Malformations of the Brain

    PubMed Central

    Lindvall, P.; Wikholm, G.; Bergström, P.; Löfroth, P.; Bergenheim, A.T.

    2005-01-01

    Summary There are three major treatment options for cerebral AVMs; surgery, embolization and radiosurgery. Embolization may be effective to reduce the size and density but completely obliterates AVMs only in a minority of cases. Radiosurgery may be an alternative to resection, especially in smaller AVMs. Large AVMs have been considered difficult to treat safely and effectively with single fraction radiosurgery. Hypofractionated conformal stereotactic radiotherapy (HCSRT) alone or in combination with embolization may be an alternative treatment. Embolization may reduce the volume and density of AVMs, followed by HCSRT, allowing a safe delivery of a higher total dose of radiation than possible with a single fraction. Sixteen patients with AVMs were treated with embolization and HCSRT. Embolization was performed in 1-6 (median 2) sessions. HCSRT was delivered in 5 fractions with 6-7 Gy each to the total dose of 30-35 Gy. Cerebral angiographies before and after embolization were digitally compared for calculation of volume reduction and luminescence as a measure of AVM density. The mean AVM volume in 15 patients was reduced from 11.9 ± 2.1 (1-29, median 10.0) ml to 6.5 ± 2.0 (0.5-28, median 3) ml by embolization. The luminescence for all AVMs was significantly higher after than before embolization, indicating that all AVMs were less dense after embolization. Thirteen out of 16 patients (13/16, 81%) treated with embolization and HCSRT have so far shown obliteration of their AVMs 2-9 (median 4) years after HCSRT. Three patients experienced neurological sequele after embolization, and three patients developed radionecrosis after HCSRT. Using a new method to compare cerebral angiographies in AVMs we report reduction in density and volume after embolization. The obliteration rate of a combined treatment with embolization and HCSRT seems comparable with single fraction radiosurgery although the AVMs in our series are larger than reported in most series treated with single

  14. Percutaneous and Endovascular Embolization of Ruptured Hepatic Artery Aneurysm

    SciTech Connect

    Little, Andrew F.; Lee, Wai Kit

    2002-06-15

    A 72-year-old woman presented with an intraperitoneal hemorrhage from a ruptured intrahepatic arteryaneurysm, with an associated pseudoaneurysm developing a high-flow arteriovenous fistula. Persistent coagulopathy and a median arcuate ligament stenosis of the celiac axis further complicated endovascular management. Aneurysm thrombosis required percutaneous embolization with coils, a removable core guidewire and polyvinyl alcohol particles.

  15. Hepatic Artery Angiography and Embolization for Hemobilia Following Laparoscopic Cholecystectomy

    SciTech Connect

    Nicholson, Tony; Travis, Simon; Ettles, Duncan; Dyet, John; Sedman, Peter; Wedgewood, Kevin; Royston, Christopher

    1999-01-15

    Purpose: The effectiveness of angiography and embolization in diagnosis and treatment were assessed in a cohort of patients presenting with upper gastrointestinal hemorrhage secondary to hepatic artery pseudoaneurysm following laparoscopic cholecystectomy. Methods: Over a 6-year period 1513 laparoscopic cholecystectomies were carried out in our region. Nine of these patients (0.6%) developed significant upper gastrointestinal bleeding, 5-43 days after surgery. All underwent emergency celiac and selective right hepatic artery angiography. All were treated by coil embolization of the right hepatic artery proximal and distal to the bleeding point. Results: Pseudoaneurysms of the hepatic artery adjacent to cholecystectomy clips were demonstrated in all nine patients at selective right hepatic angiography. In three patients celiac axis angiography alone failed to demonstrate the pseudoaneurysm. Embolization controlled hemorrhage in all patients with no further bleeding and no further intervention. One patient developed a candidal liver abscess in the post-procedure period. All patients are alive and well at follow-up. Conclusion: Selective right hepatic angiography is vital in the diagnosis of upper gastrointestinal hemorrhage following laparoscopic cholecystectomy. Embolization offers the advantage of minimally invasive treatment in unstable patients, does not disrupt recent biliary reconstruction, allows distal as well as proximal control of the hepatic artery, and is an effective treatment for this potentially life-threatening complication.

  16. Superselective Embolization with Coils in High-Flow Priapism

    SciTech Connect

    Kress, Oliver; Heidenreich, A.; Klose, Klaus Jochen; Wagner, Hans-Joachim; Alfke, Heiko

    2002-08-15

    Priapism can be divided into 'low-flow' veno-occlusive priapism and, especially in children, rare 'high-flow' arterial priapism. We report a 5-year-old boy who developed arterial priapism after blunt perineal trauma that was successfully treated by superselective embolization with microcoils.

  17. Cholesterol crystal embolization diagnosed on bladder transurethral resection.

    PubMed

    Chatelain, Denis; Cordonnier, Carole; Brevet, Marie; Petit, Jacques; Sevestre, Henri

    2005-08-01

    Cholesterol crystal embolization (CCE) is a severe systemic disorder caused by vascular migration of cholesterol crystals originating from ulcerative atherosclerotic plaques located in large arteries. We report 2 cases of CCE diagnosed on bladder transurethral resection in 2 men aged 94 and 72 years. Both patients had atherosclerosis disease. One patient had been treated by heparin 1 month before for pulmonary embolism and the other had had a coronary angiography and bypass graft surgery 5 months before for silent myocardial infarction. One patient presented with hematuria and the other with acute renal failure. Cystoscopy showed multiple papillary tumors of the bladder wall. Bladder transurethral resections showed transitional cell carcinoma with cholesterol crystals occluding the lumen of small arterioles in the submucosa. Eight cases of CCE in the bladder wall have been reported in the literature in 3 women and 5 men aged 56 to 79 years. Cholesterol crystal embolization is often discovered in the bladder wall on necropsy specimens. Only 2 cases have been fortuitously discovered on bladder transurethral resection performed for transitional cell carcinoma. Cholesterol crystal embolization in the bladder wall is often a marker of severe disease although the evolution is quite favorable in our patients, still alive 1 and 2 years after diagnosis. PMID:16084459

  18. Distal embolization as a presenting symptom of aortic aneurysms.

    PubMed

    Baxter, B T; McGee, G S; Flinn, W R; McCarthy, W J; Pearce, W H; Yao, J S

    1990-08-01

    The records of 302 patients who underwent abdominal aortic aneurysm (AAA) repair between 1985 and 1990 were reviewed. Two hundred and forty-eight patients (82%) were asymptomatic, while 32 patients (11%) had ruptured aneurysms. During this period, 15 patients (5%) presented with distal embolization as the first manifestation of their AAA. The preoperative embolic event resulted in limb-threatening ischemia in 3 patients, digital ischemia in 11, and calf myonecrosis in 1. CT scan was performed in 14 of 15 patients demonstrating irregular, heterogeneous thrombus within the AAA. Only two of the AAAs were larger than 5 cm. Angiography demonstrated occlusive lesions but was not diagnostic for AAA in seven patients and resulted in three episodes of embolization. AAA was repaired with a tube graft in 4 patients while a bifurcated graft was required in 11 patients for aneurysmal (in 4 patients) and occlusive disease (in 7 patients) of the iliac arteries. All cases employed a transperitoneal approach, systemic heparin, and distal occlusion prior to aortic clamping. Complications included three major (below-knee) and five minor amputations, developing or worsening renal failure in five patients (33%), and death in two (13%). In comparison, mortality was 5% for elective repair and 66% for rupture during this same period. CT scan was safer and more informative than angiography. The morbidity of patients with AAA presenting with emboli is comparable with rupture. The risk of embolization does not correlate with size and indicates the potentially dangerous nature of small AAAs. PMID:2200293

  19. Fat embolism after liposuction in Klippel-Trenaunay syndrome.

    PubMed

    Zeidman, Michael; Durand, Paul; Kundu, Neilendu; Doumit, Gaby

    2013-07-01

    Fat embolism syndrome (FES) is a rare but potentially fatal postoperative complication from liposuction. We present the case of a 24-year-old woman with Klippel-Trenaunay syndrome who developed FES as a complication of lower extremity liposuction. There may be an increased risk of FES in patients with vascular malformations undergoing liposuction. PMID:23851798

  20. Cerebral arterial air embolism in a child after intraosseous infusion

    PubMed Central

    Knoester, H.; Maes, A.; van der Wal, A. C.; Kubat, B.

    2008-01-01

    Cerebral arterial air embolism (CAAE) has been reported as a rare complication of medical intervention. There has been one reported case of CAAE after the use of an intraosseous infusion (IO) system. We report on a case of CAAE after tibial IO infusion in a 7-month-old girl during resuscitation. PMID:18247071

  1. Embolization of nonvariceal portosystemic collaterals in transjugular intrahepatic portosystemic shunts

    SciTech Connect

    Bilbao, Jose Ignacio; Arias, Mercedes; Longo, Jesus Maria; Alejandre, Pedro Luis; Betes, Maria Teresa; Elizalde, Arlette Maria

    1997-03-15

    Percutaneous embolization of large portosystemic collaterals was performed in three patients following placement of a transjugular intrahepatic portosystemic shunt in order to improve hepatopetal portal flow. Improved hepatic portal perfusion was achieved in these cases, thereby theoretically reducing the risk of chronic hepatic encephalopathy.

  2. I Can See Clearly Now - Embolism in Leaves.

    PubMed

    Scoffoni, Christine; Jansen, Steven

    2016-09-01

    Deciphering how air enters the plant hydraulic transport tissues represents a major challenge to understanding plant drought responses. Using a non-invasive and cheap visualization technique applied to leaves, the spread of embolism is found to initiate in the midrib, increase with vein order, and is seemingly influenced by vein topology. PMID:27423303

  3. 21 CFR 868.2025 - Ultrasonic air embolism monitor.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Ultrasonic air embolism monitor. 868.2025 Section 868.2025 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Monitoring Devices § 868.2025 Ultrasonic air...

  4. Coil Embolization of Arterioportal Fistula That Developed After Partial Gastrectomy

    SciTech Connect

    Ishigami, Kousei; Yoshimitsu, Kengo; Honda, Hiroshi; Kuroiwa, Toshiro; Irie, Hiroyuki; Aibe, Hitoshi; Tajima, Tsuyoshi; Hashizume, Makoto; Masuda, Kouji

    1999-07-15

    A 51-year-old man suffered from bleeding esophageal varices. He had undergone partial gastrectomy for gastric cancer 1 year before. An extrahepatic arterioportal fistula and resultant portal hypertension were found. We successfully performed transarterial embolization of the fistula using stainless steel coils. Portal hypertension improved dramatically. RID='''' ID='''' Correspondence to: K. Ishigami, M.D.

  5. [Amniotic fluid embolism as a cause of maternal death].

    PubMed

    Nadeev, A P; Zhukova, V A; Ageeva, T A; Drobinskaya, A N; Travin, M A; Karpov, M A; Savchenko, S V; Chikinev, Yu V; Polyakevich, A S

    2015-01-01

    This article reports the case of death of a puerperal woman resulting from amniotic fluid embolism. The diagnosis was established based on the results of the pathohistological study that revealed the presence of mucoproteides and epithelial scales in pulmonary blood vessels and capillaries. PMID:26856060

  6. Antepartum embolization in management of labor induction in placenta previa.

    PubMed

    Huang, L L; Tang, H; Awale, R; Zeng, Z S; Li, F R; Chen, Y

    2013-01-01

    The authors present a case of a 29-year-old woman, gravid 2 para 1, who experienced complete placenta previa and underwent vaginal delivery, after performing antepartum uterine artery embolization and rivanol amniotic injection due to contraindication of obstetric surgery. In this case, treatment was successful despite thromboembolism. Hypercoagulability in pregnancy needs to be addressed. PMID:24283189

  7. 'Low-dose' corticosteroid prophylaxis against fat embolism.

    PubMed

    Kallenbach, J; Lewis, M; Zaltzman, M; Feldman, C; Orford, A; Zwi, S

    1987-10-01

    The effect of 'low-dose' corticosteroids (9 mg/kg methylprednisolone), given after skeletal trauma, on the incidence of the fat embolism syndrome and isolated arterial hypoxemia was studied in 42 controls and 40 steroid-treated subjects. Fat embolism occurred in ten controls (23.8%) and one steroid-treated subject (2.5%) (p = 0.01). A further 44 subjects developed isolated hypoxemia. This was severe (PaO2 less than 50 mm Hg) in seven of 32 controls (21.9%) and one of 39 steroid-treated subjects (2.6%) (p = 0.01). The overall incidence of hypoxemia was 67.1%, affecting 33 controls (78.6%) and 22 steroid-treated patients (55%) (p less than 0.05). The degree of hypoxemia was severe (PaO2 less than 50 mm Hg) in 12 controls (28.6%) and two (5%) of the steroid-treated subjects (p = 0.005). No control subject died or required mechanical ventilation. One steroid-treated subject without fat embolism died of a fulminant infection. Although methylprednisolone in a relatively low dose provides protection against fat embolism and pulmonary dysfunction after skeletal trauma, the safety of this therapy requires further evaluation. PMID:3312625

  8. A Pregnant Woman with Acute Massive Pulmonary Embolism

    PubMed Central

    Yang, Yuan Po; Lin, Li-Sian

    2014-01-01

    A 30-year-old pregnant woman who suffered from massive pulmonary embolism presented in an unstable hemodynamic status. Angiojet catheter embolectomy and extracorporeal membrane oxygenation (ECMO) were performed, which caused the patient’s condition to improve. Use of ECMO was continued during the weaning program, but the patient died of intracranial hemorrhage, a complication of ECMO. PMID:27122772

  9. [Acute upper limb embolism in a severely burned patient].

    PubMed

    Wiebringhaus, P; Pierson, T; Menke, H

    2014-12-01

    Thrombosis and pulmonary embolisms are the most common complications in the hospital. The need for anticoagulation during hospital stay is obligatory. Arterial embolisms are rare. They often take place in patients with a pre-existing peripheral artery occlusive disease or in patients with atrial fibrillation. The most common complications in burn patients are wound infection, pneumonia, catheter-associated infections and paralytic ileus. There are almost no data available regarding arterial embolism in burn patients. Therefore we would like to present the case of a 60-year-old woman who was injured by a fire at home and was transported to our special burn unit. She sustained partial thickness burns of both legs and buttocks. The TBSA was 15%. During the first days of clinical stay the patient suffered from a pain induced movement reduction of the left hand. There were no peripheral pulses palpable or by pulsed-wave Doppler detectable. An urgent selected angiography of the left arm was performed and a arterial embolism of the proximal part of the a. brachialis was detected. The patient was operated immediately. After debridement and split-skin graft of the burn wounds the patient was taken to rehabiliation after 35 days. PMID:25564950

  10. Preoperative Uterine Artery Embolization (PUAE) Before Uterine Fibroid Myomectomy

    SciTech Connect

    Dumousset, E.; Chabrot, P.; Rabischong, B.; Mazet, N.; Nasser, S.; Darcha, C.; Garcier, J.M.; Mage, G.; Boyer, L.

    2008-05-15

    Purpose. To evaluate the potential of uterine artery embolization to minimize blood loss and facilitate easier removal of fibroids during subsequent myomectomy. Methods. This retrospective study included 22 patients (median age 37 years), of whom at least 15 wished to preserve their fertility. They presented with at least one fibroid (mean diameter 85.6 mm) and had undergone preoperative uterine artery embolization (PUAE) with resorbable gelatin sponge. Results. No complication or technical failure of embolization was identified. Myomectomies were performed during laparoscopy (12 cases) and laparotomy (9 cases). One hysterectomy was performed. The following were noted: easier dissection of fibroids (mean 5.6 per patient, range 1-30); mean intervention time 113 min (range 25-210 min); almost bloodless surgery, with a mean peroperative blood loss of 90 ml (range 0-806 ml); mean hemoglobin pretherapeutically 12.3 g/dl (range 5.9-15.2 g/dl) and post-therapeutically 10.3 g/dl (range 5.6-13.3 g/dl), with no blood transfusion needed. Patients were discharged on day 4 on average and the mean sick leave was 1 month. Conclusion. Preoperative embolization is associated with minimal intraoperative blood loss. It does not increase the complication rate or impair operative dissection, and improves the chances of performing conservative surgery.

  11. Risk factors for hemorrhage requiring embolization after percutaneous nephrolithotomy

    PubMed Central

    Un, Sitki; Cakir, Volkan; Kara, Cengiz; Turk, Hakan; Kose, Osman; Balli, Omur; Yilmaz, Yuksel

    2015-01-01

    Introduction: Percutaneous nephrolithotomy (PCNL) is the primary surgical intervention in kidney stone management. Even though it is performed quite often, the complication rates are also high. Arteriovenous fistulas following extended hemorrhages after PCNL are one of the most serious complications of this operation. Our main objective was to review the data of patients who required angiography and embolization. Methods: In total, we included 1405 patients who underwent PCNL between 2007 and 2014. All patient data were retrospectively reviewed. All patients went under PCNL using fluoroscopy. Following informed consent, all hemorrhagic patients underwent angiography in the interventional radiology department and embolization was performed in patients with a hemorrhage focus point. Results: A total of 147 patients (10.4%) required transfusion for post-PCNL hemorrhages. Of them, 14 (0.99%) underwent angiography and embolization (9 [64.2%] were male and 5 [35.8%] were female, with a mean age of 39.4 ± 10.2). The remaining 133 patients were conservatively managed (81 [60.9%] males and 52 [39.1%] females, with a mean age of 42.3 ± 12.4). When the predicting factors for angiography and embolization were reviewed, renal abnormalities and the mean size of stones were significant in both univariate and multivariate analysis (p < 0.001). Conclusion: Patients with extended and intermittent hematuria should be monitored closely for hemodynamics; if there is an ongoing necessity for transfusion, angiography should be considered. PMID:26425220

  12. 21 CFR 870.3300 - Vascular embolization device.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Vascular embolization device. 870.3300 Section 870.3300 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3300 Vascular...

  13. 21 CFR 870.3300 - Vascular embolization device.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Vascular embolization device. 870.3300 Section 870.3300 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3300 Vascular...

  14. JOHNSTON ATOLL CHEMICAL AGENT DISPOSAL SYSTEM (JACADS) CLOSURE PLAN DEVELOPMENT

    EPA Science Inventory

    The JACADS project consists of four incinerators including a liquid chemical agent waste processor, an explosives treatment incinerator and a batch metal parts treatment unit. Its mission was to disassemble and destroy chemcial weapons and bulk chemical agent. This prototypical...

  15. Development of a solid-phase microextraction fiber by the chemical binding of graphene oxide on a silver-coated stainless-steel wire with an ionic liquid as the crosslinking agent.

    PubMed

    Sun, Min; Feng, Juanjuan; Bu, Yanan; Duan, Huimin; Wang, Xiaojiao; Luo, Chuannan

    2014-12-01

    Graphene oxide was bonded onto a silver-coated stainless-steel wire using an ionic liquid as the crosslinking agent by a layer-by-layer strategy. The novel solid-phase microextraction fiber was characterized by scanning electron microscopy, energy-dispersive X-ray spectroscopy and Raman microscopy. A multilayer graphene oxide layer was closely coated onto the supporting substrate. The thickness of the coating was about 4 μm. Coupled with gas chromatography, the fiber was evaluated using five polycyclic aromatic hydrocarbons (fluorene, anthracene, fluoranthene, 1,2-benzophenanthrene, and benzo(a)pyrene) as model analytes in direct-immersion mode. The main conditions (extraction time, extraction temperature, ionic strength, and desorption time) were optimized by a factor-by-factor optimization. The as-established method exhibited a wide linearity range (0.5-200 μg/L) and low limits of determination (0.05-0.10 μg/L). It was applied to analyze environmental water samples of rain and river water. Three kinds of the model analytes were quantified and the recoveries of samples spiked at 10 μg/L were in the range of 92.3-120 and 93.8-115%, respectively. The obtained results indicated the fiber was efficient for solid-phase microextraction analysis. PMID:25283136

  16. Sunscreening Agents

    PubMed Central

    Martis, Jacintha; Shobha, V; Sham Shinde, Rutuja; Bangera, Sudhakar; Krishnankutty, Binny; Bellary, Shantala; Varughese, Sunoj; Rao, Prabhakar; Naveen Kumar, B.R.

    2013-01-01

    The increasing incidence of skin cancers and photodamaging effects caused by ultraviolet radiation has increased the use of sunscreening agents, which have shown beneficial effects in reducing the symptoms and reoccurrence of these problems. Many sunscreen compounds are in use, but their safety and efficacy are still in question. Efficacy is measured through indices, such as sun protection factor, persistent pigment darkening protection factor, and COLIPA guidelines. The United States Food and Drug Administration and European Union have incorporated changes in their guidelines to help consumers select products based on their sun protection factor and protection against ultraviolet radiation, whereas the Indian regulatory agency has not yet issued any special guidance on sunscreening agents, as they are classified under cosmetics. In this article, the authors discuss the pharmacological actions of sunscreening agents as well as the available formulations, their benefits, possible health hazards, safety, challenges, and proper application technique. New technologies and scope for the development of sunscreening agents are also discussed as well as the role of the physician in patient education about the use of these agents. PMID:23320122

  17. Asparagus polysaccharide and gum with hepatic artery embolization induces tumor growth and inhibits angiogenesis in an orthotopic hepatocellular carcinoma model.

    PubMed

    Weng, Ling-Ling; Xiang, Jian-Feng; Lin, Jin-Bo; Yi, Shang-Hui; Yang, Li-Tao; Li, Yi-Sheng; Zeng, Hao-Tao; Lin, Sheng-Ming; Xin, Dong-Wei; Zhao, Hai-Liang; Qiu, Shu-Qi; Chen, Tao; Zhang, Min-Guang

    2014-01-01

    Liver cancer is one of leading digestive malignancies with high morbidity and mortality. There is an urgent need for the development of novel therapies for this deadly disease. It has been proven that asparagus polysaccharide, one of the most active derivates from the traditional medicine asparagus, possesses notable antitumor properties. However, little is known about the efficacy of asparagus polysaccharide as an adjuvant for liver cancer chemotherapy. Herein, we reported that asparagus polysaccharide and its embolic agent form, asparagus gum, significantly inhibited liver tumor growth with transcatheter arterial chemoembolization (TACE) therapy in an orthotopic hepatocellular carcinoma (HCC) tumor model, while significantly inhibiting angiogenesis and promoting tumor cell apoptosis. Moreover, asparagine gelatinous possessed immunomodulatory functions and showed little toxicity to the host. These results highlight the chemotherapeutic potential of asparagus polysaccharide and warrant a future focus on development as novel chemotherapeutic agent for liver cancer TACE therapy. PMID:25605207

  18. Treatment of Venous Thromboembolism With New Anticoagulant Agents.

    PubMed

    Becattini, Cecilia; Agnelli, Giancarlo

    2016-04-26

    Venous thromboembolism (VTE) is a common disease associated with high risk for recurrences, death, and late sequelae, accounting for substantial health care costs. Anticoagulant agents are the mainstay of treatment for deep vein thrombosis and pulmonary embolism. The recent availability of oral anticoagulant agents that can be administered in fixed doses, without laboratory monitoring and dose adjustment, is a landmark change in the treatment of VTE. In Phase III trials, rivaroxaban, apixaban, edoxaban (antifactor Xa agents), and dabigatran (an antithrombin agent) were noninferior and probably safer than conventional anticoagulation therapy (low-molecular-weight heparin followed by vitamin K antagonists). These favorable results were confirmed in specific patient subgroups, such as the elderly and fragile. However, some patients, such as those with cancer or with intermediate- to high-risk pulmonary embolism, were underrepresented in the Phase III trials. Further clinical research is required before new oral anticoagulant agents can be considered standard of care for the full spectrum of patients with VTE. PMID:27102510

  19. A New Soluble Gelatin Sponge for Transcatheter Hepatic Arterial Embolization

    SciTech Connect

    Takasaka, Isao; Kawai, Nobuyuki; Sato, Morio Sahara, Shinya; Minamiguchi, Hiroyuki; Nakai, Motoki; Ikoma, Akira; Nakata, Kouhei; Sonomura, Tetsuo

    2010-12-15

    To prepare a soluble gelatin sponge (GS) and to explore the GS particles (GSPs) that inhibit development of collateral pathways when transcatheter hepatic arterial embolization is performed. The approval of the Institutional Committee on Research Animal Care of our institution was obtained. By means of 50 and 100 kDa of regenerative medicine-gelatin (RM-G), RM-G sponges were prepared by freeze-drying and heating to temperatures of 110-150{sup o}C for cross-linkage. The soluble times of RM-GSPs were measured in vitro. Eight swine for transcatheter hepatic arterial embolization were assigned into two groups: six received 135{sup o}C/50RM-GSPs, 125{sup o}C/100RM-GSPs, and 138{sup o}C/50RM-GSPs, with soluble time of 48 h or more in vitro; two swine received Gelpart GSPs (G-GSPs) with insoluble time of 14 days as a control. Transarterial chemoembolization was performed on two branches of the hepatic artery per swine. RM-GSPs heated at temperatures of 110-138{sup o}C were soluble. Mean soluble times of the RM-GSPs increased with higher temperature. Hepatic branches embolized with G-GSP remained occluded after 6 days, and development of collateral pathways was observed after 3 days. Hepatic branches embolized with 135{sup o}C/50RM-GSP and 125{sup o}C/100RM-GSP remained occluded for 4 h, and recanalization was observed after 1 day. Hepatic branches embolized with 138{sup o}C/50RM-GS remained occluded for 1 day, and recanalization was observed after 2 days with no development of collateral pathways. In RM-GSs with various soluble times that were prepared by modulating the heating temperature, 138{sup o}C/50RM-GSP was the soluble GSP with the longest occlusion time without inducing development of collateral pathways.

  20. Outcomes After Unilateral Uterine Artery Embolization: A Retrospective Review

    SciTech Connect

    Bratby, M. J.; Hussain, F. F.; Walker, W. J.

    2008-03-15

    Purpose. Bilateral uterine artery embolization (UAE) is considered necessary to provide effective treatment for symptomatic uterine fibroids. Occasionally, only unilateral embolization is performed, and this study evaluates these outcomes. Materials and Methods. As part of a prospective observational study of more than 1600 patients treated with UAE since 1996, there have been 48 patients in whom unilateral embolization has been performed. This study retrospectively reviews clinical response as assessed by our standard questionnaire and radiological response assessed by either magnetic resonance imaging or ultrasound. Results. Two principal groups emerged: the largest, where only the dominant unilateral arterial supply was electively embolized (30 patients); and the second, where there was technical failure to catheterize the second uterine artery as a result of anatomical constraints (12 patients). Favorable clinical response with a reduction in menorrhagia at 1 year was seen in 85.7% (18/21) of those patients with a dominant arterial supply to the fibroid(s). In contrast, in those patients where there was technical failure to embolize one uterine artery, there was a high rate of clinical failure requiring further intervention in 58.3% (7/12). Comparison of the technical failure group with the dominant uterine artery group demonstrated a statistically significant (Fisher's exact test) difference in the proportion of patients with evidence of persistent fibroid vascularity (p < 0.001) and requiring repeat intervention (p < 0.01). Conclusion. We conclude that unilateral UAE can achieve a positive clinical result in the group of patients where there is a dominant unilateral artery supplying the fibroid(s), in contrast to the poor results seen following technical failure.