Prophylactic Embolization of the Cystic Artery Before Radioembolization: Feasibility, Safety, and Outcomes

PurposeTo evaluate the safety and efficacy of two different methods of proximal cystic artery embolization in patients undergoing yttrium-90 radioembolization.Materials and methodsForty-six patients had cystic artery embolization performed immediately before yttrium-90 radioembolization, either by using Gelfoam pledgets (n = 35) or coils (n = 11). Clinical symptomatology during the admission and angiographic findings at 1-month follow-up were retrospectively reviewed. Rates of collateralization or recanalization of the cystic artery were compared, as well as the frequency of postprocedural abdominal pain and need for cholecystectomy.ResultsTechnical success was achieved in all patients, and there were no procedural complications related to cystic artery embolization. Of the 11 coil-embolized patients, 5 (45%) demonstrated collateralization of the cystic artery at 1 month, and 1 (9%) demonstrated recanalization of the cystic artery. Of the 35 Gelfoam-embolized cases, 2 (6%) had collateralized at 1 month, and 14 (40%) had recanalized. Two patients (one from each group) had self-limited right upper quadrant pain after the procedure, and one patient in the coil embolization group required cholecystectomy.ConclusionProximal cystic artery embolization is safe and feasible and may be performed during liver-directed embolotherapy to minimize the exposure of the gallbladder to particulate, chemoembolic, or radioembolic agents

Diet and Hygiene Between Ethics and Medicine: Evidence and the Reception of Alvise Cornaro\u2019s La Vita Sobria in Early Seventeenth-Century England

Alvise Cornaro\u2019s Treatises on the Sober Life (Discorsi della vita sobria) was one of the most popular books on diet and hygiene across the whole of Europe from its publication in the sixteenth century up to the early twentieth century. In this chapter, I show that the reasons for the success of Cornaro\u2019s work in early modern England lie in the fact that two very different communities of practice saw the work\u2019s conclusions as grounded upon a particular configuration of evidence that resonated with them: one spiritual, where it was used as part of an attempt to forge a via media between Puritans and Anglicans; the other medical, where it served as a case study from which more general conclusions about how to prolong life might be extrapolated. The unique context in which the first English translation of the Discorsi was conceived, produced, and published\u2014involving some of the most prominent intellectual figures of the time, such as Francis Bacon, Nicholas Ferrar, and George Herbert\u2014make this an important case study, useful for the reconstruction of a significant chapter of the history of dieting and hygiene, and the history of conceptions of evidence and their relationship to different communities of practice