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Svarc P, Stroomberg HV, Taudorf M, Brasso K, Lonn L, Røder A. Efficacy of High-Dose Dexamethasone in Reducing the Symptoms of Postembolization Syndrome Following Prostatic Artery Embolization: Results of a Double-Blind Randomized Controlled Trial. Cardiovasc Intervent Radiol 2024; 47:632-639. [PMID: 38233575 PMCID: PMC11074011 DOI: 10.1007/s00270-023-03650-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/11/2023] [Indexed: 01/19/2024]
Abstract
PURPOSE To evaluate the efficacy of a single perioperative dose of dexamethasone in reducing postembolization syndrome following prostatic artery embolization. MATERIALS AND METHODS We conducted a single-center double-blind randomized controlled trial from March 2021 to May 2022 (NCT04588857). Participants were randomized to receive either i.v. 24 mg dexamethasone or saline. The primary outcome measures were temperature, pain, and quality of life in the first 5 days following prostatic artery embolization. Sample size of 60 patients was needed for the assessment of primary outcomes. Participants were followed for 6 months and assessed for a variety of secondary outcome measures including inflammatory markers and lower urinary tract symptoms severity. RESULTS Due to lack of clinical effect and mild symptoms in the control group, the trial was terminated early. 31 participants (16 dexamethasone vs. 15 control) were enrolled and analyzed. A difference in mean temperature was observed on day 1 (37.23 ± 0.64 °C control vs 36.74 ± 0.41 °C dexamethasone, p = 0.02, 95% CI 0.09-0.89). Difference in pain (score out of 10) was seen only on day 5 (1.48 ± 1.2 control vs. 2.9 ± 2.24 dexamethasone, p = 0.04, 95% CI - 2.78-- 0.04). A difference in C-reactive protein values was observed on day 2 (108 [54-161] mg/l control vs 10 [5-33] mg/l dexamethasone, p < 0.01). No significant differences in other outcomes were observed. No side effects were recorded. CONCLUSIONS Twenty-four milligrams of dexamethasone bolus is safe but does not reduce postembolization syndrome following prostatic artery embolization.
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Affiliation(s)
- Petra Svarc
- Department of Radiology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100, Copenhagen, Denmark.
| | - Hein Vincent Stroomberg
- Copenhagen Prostate Cancer Center, Blegdamsvej 9, 2100, RigshospitaletCopenhagen, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Taudorf
- Department of Radiology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100, Copenhagen, Denmark
| | - Klaus Brasso
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100, Copenhagen, Denmark
- Copenhagen Prostate Cancer Center, Blegdamsvej 9, 2100, RigshospitaletCopenhagen, Denmark
| | - Lars Lonn
- Department of Radiology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100, Copenhagen, Denmark
| | - Andreas Røder
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100, Copenhagen, Denmark
- Copenhagen Prostate Cancer Center, Blegdamsvej 9, 2100, RigshospitaletCopenhagen, Denmark
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Alqahtani A, Han K, Kim SY, Kim MD, Kwon JH, Kim GM, Moon S. Efficacy of intra-arterial lidocaine administration on pain and inflammatory response after uterine artery embolization for symptomatic fibroids. Acta Radiol 2024; 65:302-306. [PMID: 36600596 DOI: 10.1177/02841851221146517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND There have been conflicting outcomes regarding the use of lidocaine to reduce pain after uterine artery embolization (UAE). PURPOSE To investigate the efficacy of intra-arterial lidocaine injection for pain and inflammatory response control within 24 h of UAE for symptomatic uterine fibroids. MATERIAL AND METHODS Of 1530 patients who underwent UAE for uterine fibroids in 2007-2021, 5 mL of 1% lidocaine was injected into each uterine artery immediately after UAE in 23 patients. A disease-matched control group (n = 23) who did not receive intra-arterial lidocaine was generated from the same registry. The pain score, white blood cell (WBC) count, C-reactive protein (CRP), neutrophil/lymphocyte ratio (NLR), and fentanyl consumption were compared before and after UAE. Complete infarction of the dominant fibroid was assessed using magnetic resonance imaging. RESULTS Significantly lower WBC count, CRP level, and NLR were noted 24 h after UAE in the lidocaine group. No statistically significant difference was noted in the pain score between groups at 0-24 h. The cumulative fentanyl dose administered during the first 24 h after UAE was not significantly different. After embolization, fibroid-related symptoms resolved in all patients. No significant difference was observed in the rate of complete infarction of the dominant fibroid. CONCLUSION Lidocaine administration immediately after UAE resulted in a significant reduction in the inflammatory response. However, such a difference in the inflammatory reaction did not contribute to significant reductions in pain scores or fentanyl consumption.
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Affiliation(s)
- Abdulrahman Alqahtani
- Vascular Interventional Radiology, Medical Imaging Department, Ministry of National Guard Health Affairs, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Kichang Han
- Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - So Yeon Kim
- Department of Anesthesiology and Pain Medicine, Yonsei College of Medicine, Seoul, Republic of Korea
| | - Man-Deuk Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joon Ho Kwon
- Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gyoung Min Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sungmo Moon
- Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
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3
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Cho Y, Choi JW, Kwon H, Kim KY, Lee BC, Chu HH, Lee DH, Lee HA, Kim GM, Oh JS, Hyun D, Lee IJ, Rhim H. Transarterial chemoembolization for hepatocellular carcinoma: 2023 expert consensus-based practical recommendations of the Korean Liver Cancer Association. JOURNAL OF LIVER CANCER 2023; 23:241-261. [PMID: 37449302 PMCID: PMC10565548 DOI: 10.17998/jlc.2023.05.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 07/18/2023]
Abstract
Transarterial chemoembolization (TACE) was introduced in 1977 with the administration of chemotherapeutic agent to gelatin sponge particles through the hepatic artery in patients with hepatocellular carcinoma (HCC) and was established as conventional TACE using Lipiodol in the 1980s. In the 2000s, drug-eluting beads were developed and applied clinically. Currently, TACE is a commonly used non-surgical treatment modality for patients with HCC who are unsuitable for curative treatment. Considering the vital role of TACE in the management of HCC, it is crucial to organize current knowledge and expert opinions regarding patient preparation, procedural techniques, and post-treatment care in TACE, which can enhance therapeutic efficacy and safety. A group of 12 experts in the fields of interventional radiology and hepatology, convened by the Research Committee of the Korean Liver Cancer Association (KLCA), has developed expert consensus-based practical recommendations in TACE. These recommendations have been endorsed by the Korean Society of Interventional Radiology and provide useful information and direction in performing TACE procedure as well as pre- and post- procedural patient care.
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Affiliation(s)
- Yuri Cho
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
| | - Jin Woo Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Hoon Kwon
- Department of Radiology, Pusan National University Hospital, Busan, Korea
| | - Kun Yung Kim
- Department of Radiology, Jeonbuk National University Hospital, Jeonju, Korea
| | - Byung Chan Lee
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Hee Ho Chu
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Hyeon Lee
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Han Ah Lee
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Gyoung Min Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Suk Oh
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dongho Hyun
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - In Joon Lee
- Department of Radiology, National Cancer Center, Goyang, Korea
| | - Hyunchul Rhim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Research Committee of the Korean Liver Cancer Association
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Pusan National University Hospital, Busan, Korea
- Department of Radiology, Jeonbuk National University Hospital, Jeonju, Korea
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Radiology, National Cancer Center, Goyang, Korea
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4
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Cho Y, Choi JW, Kwon H, Kim KY, Lee BC, Chu HH, Lee DH, Lee HA, Kim GM, Oh JS, Hyun D, Lee IJ, Rhim H. Transarterial chemoembolization for hepatocellular carcinoma: 2023 Expert consensus-based practical recommendations of the Korean Liver Cancer Association. Clin Mol Hepatol 2023; 29:521-541. [PMID: 37482892 PMCID: PMC10366793 DOI: 10.3350/cmh.2023.0202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 07/25/2023] Open
Abstract
Transarterial chemoembolization (TACE) was introduced in 1977 with the administration of chemotherapeutic agent to gelatin sponge particles through the hepatic artery in patients with hepatocellular carcinoma (HCC) and was established as conventional TACE using Lipiodol in the 1980s. In the 2000s, drug-eluting beads were developed and applied clinically. Currently, TACE is a commonly used non-surgical treatment modality for patients with HCC who are unsuitable for curative treatment. Considering the vital role of TACE in the management of HCC, it is crucial to organize current knowledge and expert opinions regarding patient preparation, procedural techniques, and post-treatment care in TACE, which can enhance therapeutic efficacy and safety. A group of 12 experts in the fields of interventional radiology and hepatology, convened by the Research Committee of the Korean Liver Cancer Association (KLCA), has developed expert consensus-based practical recommendations in TACE. These recommendations have been endorsed by the Korean Society of Interventional Radiology and provide useful information and direction in performing TACE procedure as well as pre- and post- procedural patient care.
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Affiliation(s)
- Yuri Cho
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
| | - Jin Woo Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Hoon Kwon
- Department of Radiology, Pusan National University Hospital, Busan, Korea
| | - Kun Yung Kim
- Department of Radiology, Jeonbuk National University Hospital, Jeonju, Korea
| | - Byung Chan Lee
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Hee Ho Chu
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Dong Hyeon Lee
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Han Ah Lee
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Gyoung Min Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Suk Oh
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dongho Hyun
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - In Joon Lee
- Department of Radiology, National Cancer Center, Goyang, Korea
| | - Hyunchul Rhim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Research Committee of the Korean Liver Cancer Association
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Pusan National University Hospital, Busan, Korea
- Department of Radiology, Jeonbuk National University Hospital, Jeonju, Korea
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Radiology, National Cancer Center, Goyang, Korea
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5
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Einerson BD, Sandlin AT, Afshar Y, Sharawi N, Fox KA, Newton JM, Shainker SA, Pezeshkmehr A, Carusi DA, Moroz L. General Management Considerations for Placenta Accreta Spectrum. Am J Perinatol 2023; 40:1026-1032. [PMID: 37336221 DOI: 10.1055/s-0043-1761915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
The ideal management of a patient with placenta accreta spectrum (PAS) includes close antepartum management culminating in a planned and coordinated delivery by an experienced multidisciplinary PAS team. Coordinated team management has been shown to optimize outcomes for mother and infant. This section provides a consensus overview from the Pan-American Society for the Placenta Accreta Spectrum regarding general management of PAS.
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Affiliation(s)
| | - Adam T Sandlin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arizona
| | - Yalda Afshar
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Nadir Sharawi
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, Arizona
| | - Karin A Fox
- Division of Maternal-Fetal Medicine, Department of Obstetric and Gynecology, Baylor College of Medicine (Texas Children's Hospital Pavilion for Women), Houston, Texas
| | - J M Newton
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center Nashville, Tennessee
| | - Scott A Shainker
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Amir Pezeshkmehr
- Department of Radiology Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Daniela A Carusi
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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6
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Cho Y, Choi JW, Kwon H, Kim KY, Lee BC, Chu HH, Lee DH, Lee HA, Kim GM, Oh JS, Hyun D, Lee IJ, Rhim H. Transarterial Chemoembolization for Hepatocellular Carcinoma: 2023 Expert Consensus-Based Practical Recommendations of the Korean Liver Cancer Association. Korean J Radiol 2023; 24:606-625. [PMID: 37404104 DOI: 10.3348/kjr.2023.0385] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/01/2023] [Indexed: 07/06/2023] Open
Abstract
Transarterial chemoembolization (TACE) was introduced in 1977 with the administration of chemotherapeutic agent to gelatin sponge particles through the hepatic artery in patients with hepatocellular carcinoma (HCC) and was established as conventional TACE using Lipiodol in the 1980s. In the 2000s, drug-eluting beads were developed and applied clinically. Currently, TACE is a commonly used non-surgical treatment modality for patients with HCC who are unsuitable for curative treatment. Considering the vital role of TACE in the management of HCC, it is crucial to organize current knowledge and expert opinions regarding patient preparation, procedural techniques, and post-treatment care in TACE, which can enhance therapeutic efficacy and safety. A group of 12 experts in the fields of interventional radiology and hepatology, convened by the Research Committee of the Korean Liver Cancer Association (KLCA), has developed expert consensus-based practical recommendations in TACE. These recommendations have been endorsed by the Korean Society of Interventional Radiology and provide useful information and direction in performing TACE procedure as well as pre- and post-procedural patient care.
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Affiliation(s)
- Yuri Cho
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
| | - Jin Woo Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Hoon Kwon
- Department of Radiology, Pusan National University Hospital, Busan, Korea
| | - Kun Yung Kim
- Department of Radiology, Jeonbuk National University Hospital, Jeonju, Korea
| | - Byung Chan Lee
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Hee Ho Chu
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Hyeon Lee
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Han Ah Lee
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Gyoung Min Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Suk Oh
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dongho Hyun
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - In Joon Lee
- Department of Radiology, National Cancer Center, Goyang, Korea.
| | - Hyunchul Rhim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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7
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Inflammatory Complications of Prostatic Artery Embolization: an Up-to-Date Review. CURRENT BLADDER DYSFUNCTION REPORTS 2023. [DOI: 10.1007/s11884-023-00687-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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Waldron MG, Kassamani YW, O’Mahony AT, O’Mahony SM, O’Sullivan OE, Power SP, Spence L, Maher MM, O’Connor OJ, Buckley MM. Uterine Artery Embolisation of Fibroids and the Phenomenon of Post-Embolisation Syndrome: A Systematic Review. Diagnostics (Basel) 2022; 12:2916. [PMID: 36552922 PMCID: PMC9776929 DOI: 10.3390/diagnostics12122916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 11/25/2022] Open
Abstract
Post-embolisation syndrome (PES) is a prevalent complication that occurs in patients following uterine artery embolisation (UAE) for the treatment of uterine fibroids. The aetiology of PES remains incompletely understood, although postulated to result secondary to tissue infarction resulting in release of inflammatory mediators. We followed PRISMA guidelines and performed a systematic review of studies of PES following UAE from inception to October 2022. Our published protocol was prospectively registered. Our search yielded 54 results. We reviewed 22 full texts, and nine articles were included. Observational studies comprised 6/9 relevant studies, with 5/9 retrospective design. The rate of PES was documented in 5/8 studies (excluding case report) with a reported incidence ranging from 4-34.6%. Five of the nine studies studies postulated that the aetiological basis of PES is inflammatory related. Further research is necessary to advance our understanding of PES to define the biological basis of the syndrome with more certainty and gain a consensus on peri-procedure management to reduce incidence and improve patient outcomes.
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Affiliation(s)
- Michael G. Waldron
- Department of Radiology, University College Cork, T12 AK54 Cork, Ireland
| | | | | | | | | | - Stephen P. Power
- Department of Radiology, Cork University Hospital, T12 DFK4 Cork, Ireland
| | - Liam Spence
- Department of Radiology, Cork University Hospital, T12 DFK4 Cork, Ireland
| | - Michael M. Maher
- Department of Radiology, University College Cork, T12 AK54 Cork, Ireland
- Department of Radiology, Cork University Hospital, T12 DFK4 Cork, Ireland
- Department of Obstetrics and Gynaecology, Cork University Hospital, T12 DFK4 Cork, Ireland
| | - Owen J. O’Connor
- Department of Radiology, University College Cork, T12 AK54 Cork, Ireland
- Department of Radiology, Cork University Hospital, T12 DFK4 Cork, Ireland
| | - Maria M. Buckley
- APC Microbiome Ireland, University College Cork, T12 TP07 Cork, Ireland
- Department of Pharmacology and Therapeutics, University College Cork, T12 XF62 Cork, Ireland
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Jonsdottir G, Beermann M, Lundgren Cronsioe A, Hasselrot K, Kopp Kallner H. Ultrasound guided microwave ablation compared to uterine artery embolization treatment for uterine fibroids - a randomized controlled trial. Int J Hyperthermia 2022; 39:341-347. [PMID: 35134317 DOI: 10.1080/02656736.2022.2034991] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To evaluate the efficacy, feasibility and acceptability of microwave ablation (MWA) compared to uterine artery embolization (UAE) as treatment for uterine fibroids. METHOD A randomized controlled superiority trial, including premenopausal women 30-55 years, with symptomatic uterine fibroids without any single fibroid exceeding mean diameter of eight centimeters. Patients were randomized to receive microwave ablation, performed abdominally or vaginally, or to uterine artery embolization. The primary outcome was volume difference of the three largest fibroids at 6 months post treatment evaluated by magnetic resonance imaging (MRI) by a blinded radiologist analyzed by Mann-Whitney U-test. Secondary outcomes included symptom severity score (SSS), health related quality of life (HR-QoL), amount of menstrual bleeding, postoperative pain, length of hospitalization, need for additional treatment, adverse events and if patients would recommend the treatment to a friend. RESULTS Patients were recruited from 30 January 2017 to 12 September 2019, with a total of 17 patients treated in each group from May 2017 to December 2019. Superiority of MWA could not be established. The volume reduction was 41.8% (Interquartile range, IQR, 14-63) in the MWA group compared to 62.2% (IQR 34.9-80.1) in the UAE group (p = 0.29). Effects on symptoms, HR-QoL and acceptability did not differ between groups. Days of hospitalization and sick leave were significantly fewer in the MWA group (p < 0.001 and p = 0.001). CONCLUSIONS Although superiority of MWA could not be established, it is a promising technique for treating uterine fibroids. It was well tolerated and associated with lower use of health care resources. Trial registration: NCT02942537, www.clincialtrials.gov.
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Affiliation(s)
- Gudny Jonsdottir
- Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden.,Department of Clinical Sciences at, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Marie Beermann
- Department of Clinical Sciences at, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Radiology, Danderyd Hospital, Stockholm, Sweden
| | | | - Klara Hasselrot
- Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden.,Department of Clinical Sciences at, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Helena Kopp Kallner
- Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden.,Department of Clinical Sciences at, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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10
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Pisanie JLD, Commander CW, Burke CT. Management of Postprocedural Uterine Artery Embolization Pain. Semin Intervent Radiol 2021; 38:588-594. [PMID: 34853507 DOI: 10.1055/s-0041-1739161] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Clayton W Commander
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina
| | - Charles T Burke
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina
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11
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Yokoe T, Kita M, Fukuda H, Butsuhara Y, Sumi G, Okada H. Successful minimally invasive surgery for postpartum retroperitoneal hematoma complicated by an infection: Two case reports. Ann Med Surg (Lond) 2021; 71:103025. [PMID: 34840771 PMCID: PMC8606833 DOI: 10.1016/j.amsu.2021.103025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction and importance Postpartum retroperitoneal hematoma is a birth canal injury that is difficult to diagnose because of its invisibility. Secondary infections of these hematomas are rare, and their diagnostic and management strategies have not been fully elucidated. We present two cases of postpartum retroperitoneal hematomas with infection, which were successfully treated with minimally invasive surgery. Case presentation Case 1 was of a 2X-year-old woman who presented with complaints of fever; a provisional diagnosis of chorioamnionitis and Streptococcus pyogenes-induced sepsis was made. Case 2 was of a 3X-year-old woman who underwent uterine artery embolization and manual removal of the placenta for suspected placenta accreta. Both cases were diagnosed with adnexal hematomas, and antibiotic therapy failed in both patients. Therefore, we performed exploratory laparoscopy and made a diagnosis of retroperitoneal hematomas with infection; laparoscopic drainage resulted in rapid resolution of the clinical symptoms and abnormal blood test results. Clinical discussion Once an abscess develops, antibiotic treatment has a limited effect, and surgical drainage should be performed. Management of retroperitoneal hematomas is difficult, especially when complicated by an infection. Conclusion Minimally invasive procedures involving laparoscopy could be beneficial for the management of postpartum retroperitoneal hematomas complicated by an infection. Postpartum retroperitoneal hematoma is difficult to diagnose. Secondary infections of these hematomas are rare. The diagnosis and management strategies have not been fully elucidated. Management of retroperitoneal hematomas complicated by infection is challenging. Laparoscopy helps manage postpartum retroperitoneal hematomas with infection.
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Affiliation(s)
- Takuya Yokoe
- Department of Obstetrics and Gynecology, Kansai Medical University, 2-5-1 Sin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Masato Kita
- Department of Obstetrics and Gynecology, Kansai Medical University, 2-5-1 Sin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Hisato Fukuda
- Department of Obstetrics and Gynecology, Kansai Medical University, 2-5-1 Sin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Yusuke Butsuhara
- Department of Obstetrics and Gynecology, Kansai Medical University, 2-5-1 Sin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Genichiro Sumi
- Department of Obstetrics and Gynecology, Kansai Medical University, 2-5-1 Sin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Hidetaka Okada
- Department of Obstetrics and Gynecology, Kansai Medical University, 2-5-1 Sin-machi, Hirakata, Osaka, 573-1191, Japan
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Svarc P, Stroomberg HV, Juhl Jensen R, Frevert S, Håkan Lindh M, Taudorf M, Brasso K, Lönn L, Røder MA. Efficacy of dexamethasone in reducing the postembolisation syndrome in men undergoing prostatic artery embolisation for benign prostatic hyperplasia: protocol for a single-centre, randomised, double-blind, placebo-controlled trial-the 'DEXAPAE' study. BMJ Open 2021; 11:e047878. [PMID: 34725072 PMCID: PMC8562514 DOI: 10.1136/bmjopen-2020-047878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Postembolisation syndrome (PES) is the most common side effect of vascular embolisation of solid organs. Although prophylactic corticosteroids are known to reduce the incidence and severity of PES, no trials investigating their efficacy have been conducted in men undergoing prostatic artery embolisation (PAE). We postulate that steroids can have a similar effect in reducing PES after PAE. This paper describes the rationale and detailed protocol for a randomised controlled trial evaluating the efficacy of dexamethasone (DEXA) in reducing PES after PAE. METHODS AND ANALYSIS In this single-centre, randomised, double-blind, placebo-controlled trial, we will enrol 60 individuals undergoing PAE for benign prostatic hyperplasia. Participants will be randomised to receive IV DEXA (24 mg) or placebo (saline). The primary outcomes will be postprocedural fever, pain and quality of life. The secondary outcomes will include postprocedural nausea, postprocedural medicine usage, laboratory parameters (C reactive protein, prostate-specific antigen) and early PAE results. ETHICS AND DISSEMINATION Ethics approval was obtained from the Danish Committee on Health Research Ethics in the Capital Region (H-20025910). The results from this trial will be disseminated through publication in peer-reviewed journals and national and international presentations. TRIAL REGISTRATION NUMBER Clinicaltrials.gov identifier: NCT04588857; EudraCT number: 2020-000915-53.
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Affiliation(s)
- Petra Svarc
- Department of Radiology, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hein Vincent Stroomberg
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Prostate Cancer Center (CPC), Department of Urology, Rigshospitalet, Copenhagen, Denmark
| | | | - Susanne Frevert
- Department of Radiology, Rigshospitalet, Copenhagen, Denmark
| | | | - Mikkel Taudorf
- Department of Radiology, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Brasso
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Prostate Cancer Center (CPC), Department of Urology, Rigshospitalet, Copenhagen, Denmark
| | - Lars Lönn
- Department of Radiology, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Martin Andreas Røder
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Prostate Cancer Center (CPC), Department of Urology, Rigshospitalet, Copenhagen, Denmark
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Chan P, Garcia-Reyes K, Cronan J, Newsome J, Bercu Z, Majdalany BS, Resnick N, Gichoya J, Kokabi N. Managing Postembolization Syndrome-Related Pain after Uterine Fibroid Embolization. Semin Intervent Radiol 2021; 38:382-387. [PMID: 34393350 DOI: 10.1055/s-0041-1731406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Patricia Chan
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Kirema Garcia-Reyes
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Julie Cronan
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Janice Newsome
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Zachary Bercu
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Bill S Majdalany
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Neil Resnick
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Judy Gichoya
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Nima Kokabi
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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14
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Dariushnia SR, Redstone EA, Heran MKS, Cramer HR, Ganguli S, Gomes AS, Hogan MJ, Himes EA, Patel S, Schiro BJ, Lewis CA. Society of Interventional Radiology Quality Improvement Standards for Percutaneous Transcatheter Embolization. J Vasc Interv Radiol 2021; 32:476.e1-476.e33. [PMID: 33640083 DOI: 10.1016/j.jvir.2020.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 01/14/2023] Open
Affiliation(s)
- Sean R Dariushnia
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Grady Memorial Hospital, 80 Jesse Hill Dr, SE, Atlanta, GA, 30303.
| | - Ellen A Redstone
- Department of Interventional Radiology, St. Luke's University Health Network, 801 Ostrum St., Bethlehem, PA, 18015
| | - Manraj K S Heran
- Pediatric Interventional Radiology, Diagnostic & Therapeutic Neuroradiology, British Columbia's Children's Hospital, Vancouver General Hospital, University of British Columbia, 899 West 12th Avenue, Vancouver, BC, Canada
| | - Harry R Cramer
- Section of Interventional Radiology, Coastal Vascular and Interventional, PLLC, 3155 Hyde Park Place, Pensacola, FL, 32503
| | - Suvranu Ganguli
- Department of Radiology, Division of Interventional Radiology, Boston Medical Center, Boston University School of Medicine, 820 Harrison Avenue, FGH 4th Floor, Boston, MA, 02118
| | - Antoinette S Gomes
- Department of Radiological Sciences, Ronald Reagan UCLA Medical Center, 757 Westwood Plz Ste 2125, Los Angeles, CA, 90095-8358
| | - Mark J Hogan
- Department of Radiology, Section of Vascular and Interventional Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205
| | - Elizabeth A Himes
- Society of Interventional Radiology, 3975 Fair Ridge Drive, Suite 400 North, Fairfax, VA, 22033
| | - Sheena Patel
- Society of Interventional Radiology, 3975 Fair Ridge Drive, Suite 400 North, Fairfax, VA, 22033
| | - Brian J Schiro
- Department of Vascular & Interventional Radiology, Miami Cardiac & Vascular Institute, 8900 N. Kendall Drive, Miami, FL, 33156, United States
| | - Curtis A Lewis
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Grady Memorial Hospital, 80 Jesse Hill Dr, SE, Atlanta, GA, 30303
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Han K, Kim SY, Kim HJ, Kwon JH, Kim GM, Lee J, Won JY, Shin HJ, Yoon EJ, Kim MD. Nonspherical Polyvinyl Alcohol Particles versus Tris-Acryl Microspheres: Randomized Controlled Trial Comparing Pain after Uterine Artery Embolization for Symptomatic Fibroids. Radiology 2020; 298:458-465. [PMID: 33350893 DOI: 10.1148/radiol.2020201895] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Data are limited regarding comparison between nonspherical polyvinyl alcohol (PVA) particles and tris-acryl gelatin microspheres (TAGM) in uterine artery embolization (UAE). Purpose To compare pain after UAE with PVA versus TAGM for treatment of symptomatic fibroids. Materials and Methods In this randomized clinical trial, participants were assigned to be administered nonspherical PVA (355-550 μm) or TAGM (500-700 μm). Both groups were administered fentanyl-based intravenous patient-controlled analgesia during the first 24 hours after UAE and rescue analgesics. Neutrophil-to-lymphocyte ratio was measured to assess inflammatory response. Contrast-enhanced MRI 1 day after UAE was used to evaluate dominant fibroid necrosis and ischemia of normal myometrium. Symptom severity score and health-related quality-of-life score were assessed before and 3 months after UAE. Variables measured over time were analyzed by using the generalized estimating equation method. Results A total of 54 participants (mean age, 44 years ± 4 [standard deviation]) were evaluated (27 participants in each group). Although pain scores and fentanyl dose were not different during the first 24 hours, use of rescue analgesics was higher in the PVA group (33% vs 11%; P = .049). After embolization, symptom severity score and health-related quality-of-life score were not different between groups (symptom severity score: 16 [interquartile range, 6-22] for PVA vs 19 [interquartile range, 9-34] for TAGM, P = .45; health-related quality-of-life score: 93 [interquartile range, 80-97] for PVA vs 89 [interquartile range, 84-96] for TAGM, P = .41). Changes in neutrophil-to-lymphocyte ratio from before to 24 hours after UAE were greater in the PVA group (3.9 [interquartile range, 2.7-6.8] for PVA and 2.5 [interquartile range, 1.5-4.6] for TAGM; P = .02). Rates of complete dominant fibroid necrosis were not different between groups, but transient global uterine ischemia of normal myometrium was more frequent in the PVA group (44% vs 15%; P = .04). Conclusion When used in uterine artery embolization, polyvinyl alcohol particles and tris-acryl gelatin microspheres resulted in similar pain scores and fentanyl dose. Polyvinyl alcohol resulted in a greater inflammatory response, higher rates of rescue analgesic use, and more frequent transient global uterine ischemia. © RSNA, 2020 See also the editorial by Spies and Frenk in this issue.
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Affiliation(s)
- Kichang Han
- From the Department of Radiology, Severance Hospital (K.H., J.H.K., G.M.K., J.L., J.Y.W., M.D.K.), Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute (S.Y.K., H.J.K., E.J.Y.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (H.J.S.), Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
| | - So Yeon Kim
- From the Department of Radiology, Severance Hospital (K.H., J.H.K., G.M.K., J.L., J.Y.W., M.D.K.), Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute (S.Y.K., H.J.K., E.J.Y.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (H.J.S.), Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
| | - Hyun Joo Kim
- From the Department of Radiology, Severance Hospital (K.H., J.H.K., G.M.K., J.L., J.Y.W., M.D.K.), Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute (S.Y.K., H.J.K., E.J.Y.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (H.J.S.), Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
| | - Joon Ho Kwon
- From the Department of Radiology, Severance Hospital (K.H., J.H.K., G.M.K., J.L., J.Y.W., M.D.K.), Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute (S.Y.K., H.J.K., E.J.Y.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (H.J.S.), Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
| | - Gyoung Min Kim
- From the Department of Radiology, Severance Hospital (K.H., J.H.K., G.M.K., J.L., J.Y.W., M.D.K.), Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute (S.Y.K., H.J.K., E.J.Y.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (H.J.S.), Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
| | - Junhyung Lee
- From the Department of Radiology, Severance Hospital (K.H., J.H.K., G.M.K., J.L., J.Y.W., M.D.K.), Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute (S.Y.K., H.J.K., E.J.Y.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (H.J.S.), Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
| | - Jong Yun Won
- From the Department of Radiology, Severance Hospital (K.H., J.H.K., G.M.K., J.L., J.Y.W., M.D.K.), Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute (S.Y.K., H.J.K., E.J.Y.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (H.J.S.), Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
| | - Hye Jung Shin
- From the Department of Radiology, Severance Hospital (K.H., J.H.K., G.M.K., J.L., J.Y.W., M.D.K.), Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute (S.Y.K., H.J.K., E.J.Y.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (H.J.S.), Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
| | - Eun Jang Yoon
- From the Department of Radiology, Severance Hospital (K.H., J.H.K., G.M.K., J.L., J.Y.W., M.D.K.), Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute (S.Y.K., H.J.K., E.J.Y.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (H.J.S.), Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
| | - Man-Deuk Kim
- From the Department of Radiology, Severance Hospital (K.H., J.H.K., G.M.K., J.L., J.Y.W., M.D.K.), Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute (S.Y.K., H.J.K., E.J.Y.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (H.J.S.), Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
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Svarc P, Taudorf M, Nielsen MB, Stroomberg HV, Røder MA, Lönn L. Postembolization Syndrome after Prostatic Artery Embolization: A Systematic Review. Diagnostics (Basel) 2020; 10:diagnostics10090659. [PMID: 32878325 PMCID: PMC7555179 DOI: 10.3390/diagnostics10090659] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 02/06/2023] Open
Abstract
Postembolization syndrome (PES) is the most common side effect of vascular embolization of solid organs. The aim of this review was to determine the incidence of PES and its individual components after prostatic artery embolization (PAE). A systematic review with a pre-specified search strategy for PubMed, Embase, Web of Science and Cochrane Library was performed according to PRISMA guidelines. Studies in English regarding PAE in humans with 10 or more participants were eligible for inclusion. No restrictions on participant demographics or PAE technique were imposed. The search returned 378 references, of which 32 studies with a total of 2116 patients met the inclusion criteria. The results for overall PES frequency and individual PES components were presented as median (interquartile range, (IQR)). Overall median PES frequency was 25.5% (12.5–45.8). The two most frequent individual PES components were dysuria/urethral burning and local pain, with a median frequency of 21.7% (13.8–33.3) and 20% (5.4–29.4), respectively. Most outcome measures were characterized by a marked lack of uniformity and inconsistency in reporting across studies. Development of a uniform reporting system would help the clinicians recognize and treat PES accordingly.
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Affiliation(s)
- Petra Svarc
- Department of Radiology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark; (M.T.); (M.B.N.); (L.L.)
- Correspondence: ; Tel.: +45-91-87-06-18
| | - Mikkel Taudorf
- Department of Radiology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark; (M.T.); (M.B.N.); (L.L.)
| | - Michael Bachmann Nielsen
- Department of Radiology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark; (M.T.); (M.B.N.); (L.L.)
| | - Hein Vincent Stroomberg
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark; (H.V.S.); (M.A.R.)
| | - Martin Andreas Røder
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark; (H.V.S.); (M.A.R.)
| | - Lars Lönn
- Department of Radiology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark; (M.T.); (M.B.N.); (L.L.)
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Ierardi AM, Piacentino F, Pesapane F, Carnevale A, Curti M, Fontana F, Venturini M, Pinto A, Gentili F, Guerrini S, De Filippo M, Giganti M, Carrafiello G. Basic embolization techniques: tips and tricks. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:71-80. [PMID: 32945281 PMCID: PMC7944672 DOI: 10.23750/abm.v91i8-s.9974] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/12/2020] [Indexed: 12/12/2022]
Abstract
Good knowledge of the various approaches of embolization of peripheral bleedings and different embolic materials available is of paramount importance for successful and safe embolization. We review and illustrate the main endovascular and percutaneous techniques used for embolization, along with the characteristics of the different embolic materials, and the potential complications.
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Affiliation(s)
- Anna Maria Ierardi
- Radiology Department, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy.
| | - Filippo Piacentino
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
| | - Filippo Pesapane
- Breast Imaging Unit, IEO European Institute of Oncology IRCCS, Milan, Italy.
| | - Aldo Carnevale
- University Radiology Unit, Radiology Department, Arcispedale Sant'Anna, Via A. Moro 8, Ferrara, 44123, Italy.
| | - Marco Curti
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
| | - Federico Fontana
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
| | - Massimo Venturini
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
| | - Antonio Pinto
- Department of Radiology, CTO Hospital, Azienda dei Colli, Naples, Italy.
| | - Francesco Gentili
- Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, University of Parma, Parma, Italy.
| | - Susanna Guerrini
- Department of Radiological Sciences, Diagnostic Imaging Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy.
| | - Massimo De Filippo
- Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, University of Parma, Parma, Italy.
| | - Melchiore Giganti
- Department of Morphology, Surgery and Experimental Medicine, Radiology Section, University of Ferrara, Via L. Ariosto 35, Ferrara, 44121, Italy.
| | - Gianpaolo Carrafiello
- Radiology Department, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan and Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.
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Yu Q, Gabriel G, Hoffman M, Sanampudi S, Jassim T, Raissi D. Uterine-sparing management of pyomyoma after uterine fibroid embolization. Radiol Case Rep 2019; 14:1031-1035. [PMID: 31236185 PMCID: PMC6581973 DOI: 10.1016/j.radcr.2019.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 05/07/2019] [Accepted: 05/08/2019] [Indexed: 11/24/2022] Open
Abstract
Uterine fibroid embolization (UFE) is an increasingly popular treatment for uterine fibroids. One extremely rare complication after fibroid embolization is pyomyoma, which is the localized infection of the leiomyoma after embolization. Only 10 cases of pyomyoma after UFE have been reported in the literature. We present a case of delayed submucosal pyomyoma identified on computed tomography after 42 days post-UFE. While the majority of previously reported cases were managed by hysterectomy, our patient was treated with a uterine-sparing hysteroscopic transcervical approach. A high level of clinical suspicion is necessary to diagnose this complication after UFE to avoid major morbidity. Submucosal pyomyomas offer a favorable anatomical location easily accessible by hysteroscopy and a conservative approach may be sufficient to manage this complication.
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Affiliation(s)
- Qian Yu
- University of Kentucky College of Medicine, 800 Rose St MN 150, Lexington, KY 40536, USA
| | - Gaby Gabriel
- University of Kentucky, Department of Radiology, 800 Rose St, Lexington, KY 40536, USA
| | - Mark Hoffman
- University of Kentucky, Department of Obstetrics and Gynecology, 800 Rose St, Lexington, KY 40536, USA
| | - Sreeja Sanampudi
- University of Kentucky College of Medicine, 800 Rose St MN 150, Lexington, KY 40536, USA
| | - Treeva Jassim
- University of Kentucky, Department of Pathology, 800 Rose St, Lexington, KY 40536, USA
| | - Driss Raissi
- University of Kentucky, Department of Radiology, 800 Rose St, Lexington, KY 40536, USA
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Uterine Artery Embolization in Patients With Autoimmune Disease: A Matched Case-Control Study. AJR Am J Roentgenol 2019; 212:1148-1153. [PMID: 30835520 DOI: 10.2214/ajr.18.20432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study is to investigate the safety of uterine artery embolization (UAE) for symptomatic leiomyomas in patients with autoimmune disease. MATERIALS AND METHODS. Of 1183 patients who underwent UAE for symptomatic leiomyomas, nine patients (mean age, 42.6 years; range, 34-49 years) with autoimmune disease were included in this study. An age- and disease-matched control group (n = 8) was randomly generated from our patient registry to compare the effectiveness and safety of UAE in patients with autoimmune disease. Volume reduction rates of the uterus and dominant leiomyoma and the change in C-reactive protein (CRP) levels before and after UAE were compared. RESULTS. Except for one patient who had Takayasu arteritis and indiscernible uterine arteries on angiogram, UAE was technically successful in both groups. All of the patients who underwent technically successful UAE experienced improvement or resolution of symptoms (16/16; 100%). Complete necrosis of dominant fibroids was achieved in all patients (16/16; 100%). Although there was no significant difference in the mean initial CRP level before UAE (0.4 ± 0.14 mg/L vs 1.06 ± 1.26 mg/L; p = 0.067), it was significantly higher in the autoimmune group 1 day after UAE (1.23 ± 0.6 mg/L vs 9.54 ± 6.63 mg/L; p = 0.001). There was no significant difference in the volume reduction rates of uterus and dominant leiomyoma. In the autoimmune group, there was one major adverse event that was not related to underlying disease. CONCLUSION. In patients with autoimmune disease, UAE could be considered for symptomatic leiomyomas, as long as the underlying disease is well controlled.
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Wang Y, Hu C, Pan N, Chen C, Wu R. Prophylactic uterine artery embolization in second-trimester pregnancy termination with complete placenta previa. J Int Med Res 2018; 47:345-352. [PMID: 30318981 PMCID: PMC6384468 DOI: 10.1177/0300060518801455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective This study was performed to assess whether prophylactic uterine artery embolization (UAE) is beneficial for second-trimester abortion with complete placenta previa (CPP). Methods Patients with CPP who underwent second-trimester pregnancy termination by labor induction with or without UAE from January 2010 to January 2018 were retrospectively reviewed. In total, 25 patients were eligible for analysis. The primary outcomes were the abortion success rate and bleeding volume, and the secondary outcomes were the induction-to-abortion time, length of hospital stay, and complications. Results CPP occurred in all 25 patients. Fifteen patients underwent prophylactic UAE (UAE group) and 10 did not (control group). Abortion was successful in 13 of 15 (86.7%) women in the UAE group and in 9 of 10 (90.0%) women in the control group. There was no significant difference in the bleeding volume or induction-to-abortion time between the two groups. The hospital stay was longer and pyrexia was more common in the UAE than control group. Conclusion Prophylactic UAE did not markedly improve the outcomes of second-trimester abortion in patients with CPP. Conversely, it may increase the risk of complications and prolong the hospital stay.
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Affiliation(s)
- Yinfeng Wang
- Department of Obstetrics & Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Changchang Hu
- Department of Obstetrics & Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Ningpin Pan
- Department of Obstetrics & Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Chaolu Chen
- Department of Obstetrics & Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Ruijin Wu
- Department of Obstetrics & Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
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Wang M, Kohi MP. The rationale, design, and methods of a randomized, controlled trial to evaluate the efficacy of single-dose dexamethasone in reducing post-embolization syndrome in patients undergoing uterine artery embolization. Contemp Clin Trials Commun 2018; 12:85-89. [PMID: 30302416 PMCID: PMC6174256 DOI: 10.1016/j.conctc.2018.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 09/12/2018] [Accepted: 09/23/2018] [Indexed: 10/28/2022] Open
Abstract
Background Uterine artery embolization (UAE) is a minimally invasive technique well established for treating symptomatic uterine fibroids. However, the post-procedure recovery for UAE involves a notable inflammatory process in response to ischemia known as post-embolization syndrome (PES). PES encompasses transient leukocytosis, low-grade fever, and can result in readmission of up to 10% of patients. In surgical settings, multiple studies have demonstrated the efficacy of glucocorticoids in reducing inflammation and associated pain. However, this approach has not yet been assessed in predominantly ischemia-driven PES. Methods This paper describes the protocol of a prospective randomized, double-blind, placebo-controlled, multi-center trial to test the efficacy and safety of single-dose dexamethasone on inflammatory responses, pain, nausea, and readmission rates after UAE. The study will enroll pre-menopausal patients between 25 and 55 years (planned enrollment, n = 60) with MRI confirmed symptomatic fibroids. Patients will be randomly allocated into two groups: single-dose intravenous dexamethasone plus standard of care or placebo (normal saline) plus standard of care. Results The primary endpoint is the patient pain score 4 h following the UAE procedure. Secondary endpoints include pain scores at 7 h and 24 h following UAE; narcotic usage in the first 24 h following UAE; and serum inflammatory markers (white blood cell count, C-reactive protein [CRP], interleukin-6 [IL-6], and cortisol) 24 h after UAE. Conclusion Given the high incidence of post-procedure pain and difficulty with pain control after uterine artery embolization, results of this trial may directly influence the standard of care in perioperative management of patients undergoing UAE.
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Affiliation(s)
- Melinda Wang
- Weill Cornell Medical College, New York, NY, United States
| | - Maureen P Kohi
- University of California San Francisco, San Francisco, CA, United States
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Lee YJ, Kim MD, Lee JY, Kim SW, Kim SH, Kim YT, Nam EJ. Transcatheter Arterial Embolization for Severe Secondary Hemorrhage after Hysterectomy. J Minim Invasive Gynecol 2018; 25:180-185. [DOI: 10.1016/j.jmig.2017.06.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/17/2017] [Accepted: 06/05/2017] [Indexed: 11/28/2022]
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Kim SY, Koo BN, Shin CS, Ban M, Han K, Kim MD. The effects of single-dose dexamethasone on inflammatory response and pain after uterine artery embolisation for symptomatic fibroids or adenomyosis: a randomised controlled study. BJOG 2015; 123:580-7. [DOI: 10.1111/1471-0528.13785] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2015] [Indexed: 01/02/2023]
Affiliation(s)
- SY Kim
- Department of Anaesthesiology and Pain Medicine; Anaesthesia and Pain Research Institute; Yonsei University College of Medicine; Seoul Republic of Korea
| | - B-N Koo
- Department of Anaesthesiology and Pain Medicine; Anaesthesia and Pain Research Institute; Yonsei University College of Medicine; Seoul Republic of Korea
| | - CS Shin
- Department of Anaesthesiology and Pain Medicine; Anaesthesia and Pain Research Institute; Yonsei University College of Medicine; Seoul Republic of Korea
| | - M Ban
- Department of Anaesthesiology and Pain Medicine; Anaesthesia and Pain Research Institute; Yonsei University College of Medicine; Seoul Republic of Korea
| | - K Han
- Department of Radiology; Research Institute of Radiological Science; Severance Hospital; Yonsei University College of Medicine; Seoul Republic of Korea
| | - MD Kim
- Department of Radiology; Research Institute of Radiological Science; Severance Hospital; Yonsei University College of Medicine; Seoul Republic of Korea
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Huang SY, Philip A, Richter MD, Gupta S, Lessne ML, Kim CY. Prevention and management of infectious complications of percutaneous interventions. Semin Intervent Radiol 2015; 32:78-88. [PMID: 26038616 DOI: 10.1055/s-0035-1549372] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Infectious complications following interventional radiology (IR) procedures can cause significant patient morbidity and, potentially, mortality. As the number and breadth of IR procedures grow, it becomes increasingly evident that interventional radiologists must possess a thorough understanding of these potential infectious complications. Furthermore, given the increasing incidence of antibiotic-resistant bacteria, emphasis on cost containment, and attention to quality of care, it is critical to have infection control strategies to maximize patient safety. This article reviews infectious complications associated with percutaneous ablation of liver tumors, transarterial embolization of liver tumors, uterine fibroid embolization, percutaneous nephrostomy, percutaneous biliary interventions, central venous catheters, and intravascular stents. Emphasis is placed on incidence, risk factors, prevention, and management. With the use of these strategies, IR procedures can be performed with reduced risk of infectious complications.
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Affiliation(s)
- Steven Y Huang
- Department of Interventional Radiology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Asher Philip
- Department of Interventional Radiology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Michael D Richter
- Department of Interventional Radiology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Sanjay Gupta
- Department of Interventional Radiology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Mark L Lessne
- Vascular and Interventional Specialists of Charlotte Radiology, Charlotte, North Carolina
| | - Charles Y Kim
- Division of Vascular and Interventional Radiology, Duke University Medical Center, Durham, North Carolina
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Gitz L, Picone O, Mas AE, Dagher L, Deffieux X. [Postpartum hemorrhage by vaginal laseration: new case and improved management]. ACTA ACUST UNITED AC 2013; 43:401-6. [PMID: 23706157 DOI: 10.1016/j.jgyn.2013.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Revised: 03/09/2013] [Accepted: 03/22/2013] [Indexed: 10/26/2022]
Abstract
We describe a case of uterine necrosis, following Gelitaspon(®) embolization for postpartum hemorrhage resulting from vaginal laceration. Previous cases published help to improve the safety of this effective method by showing the risk factors, as particles sizes, ultraselective embolization, prevention of infection. Controlling bleeding by surgery is the priority when hemorragy is due to laceration without uterin atony. In case of failure, embolization is an option which should be proposed without delay. Uterine necrosis should be suspected in case of postembolization septic syndrome.
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Affiliation(s)
- L Gitz
- Service de gynécologie obstétrique, hôpital Antoine-Béclère, université Paris-Sud, 157, rue de la Porte-de-Trivaux, 92141 Clamart cedex, France.
| | - O Picone
- Service de gynécologie obstétrique, hôpital Antoine-Béclère, université Paris-Sud, 157, rue de la Porte-de-Trivaux, 92141 Clamart cedex, France
| | - A-E Mas
- Service d'anatomie pathologique, hôpital Antoine-Béclère, université Paris-Sud, 157, rue de la Porte-de-Trivaux, 92141 Clamart cedex, France
| | - L Dagher
- Service de radiologie, hôpital Antoine-Béclère, université Paris-Sud, 157, rue de la Porte-de-Trivaux, 92141 Clamart cedex, France
| | - X Deffieux
- Service de gynécologie obstétrique, hôpital Antoine-Béclère, université Paris-Sud, 157, rue de la Porte-de-Trivaux, 92141 Clamart cedex, France.
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Transcatheter arterial embolisation for the management of obstetric haemorrhage associated with placental abnormality in 40 cases. Eur Radiol 2013; 23:766-73. [PMID: 23300034 DOI: 10.1007/s00330-012-2612-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Revised: 07/08/2012] [Accepted: 07/16/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate pelvic artery embolisation (PAE) in the emergency management of intractable postpartum haemorrhage (PPH) associated with placenta accreta (PA). METHODS Forty such patients (PAE for PPH/PA) were retrospectively reviewed. Medical records were reviewed regarding the delivery and PAE procedure. Follow-up gynaecological outcomes after PAE were obtained by telephone interviews. RESULTS Technical success was achieved in all women (100 %). The initial clinical success rate was 82.5 % (33/40). Three patients with PA underwent hysterectomy after PAE failed to stop the bleeding within 24 h after the embolisation. The other three patients underwent re-embolisation (two patients underwent re-embolisation on the next day and one patient had undergone re-embolisation 6 h after the first embolisation), and bleeding had stopped eventually. The clinical success rate was 92.5 %. There were four cases of immediate complications, such as, pelvic pain, nausea and urticaria. There were three late minor complications, temporary menopause, but no late major complications. After the procedure, 35 patients resumed normal menstruation, including two uncomplicated pregnancies. One patient expired owing to disseminated intravascular coagulopathy and intracerebral haemorrhage, despite successful embolisation. CONCLUSION PAE can be performed safely and effectively for patients with PPH and PA and can preserve the uterus in many patients.
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Abstract
Evaluation and management of acute abdominal pain in special populations can be challenging for the emergency physician. This article focuses on two specific populations: patients with altered immunologic function and postprocedural patients. Recognition of life-threatening abdominal diseases may be delayed in immunosuppressed patients because of the atypical presentations of these conditions. In postprocedural patients, evaluation of acute abdominal symptoms requires an understanding of the complications of procedures often performed by others. The unique characteristics of abdominal pain in these two populations and, more specifically, which diseases to consider and how to use appropriate testing to detect life-threatening conditions, are discussed.
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Affiliation(s)
- Esther H Chen
- Department of Emergency Medicine, University of San Francisco, San Francisco General Hospital, San Francisco, CA 94110, USA.
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Chen EH, Nemeth A. Complications of percutaneous procedures. Am J Emerg Med 2010; 29:802-10. [PMID: 20674222 DOI: 10.1016/j.ajem.2010.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Revised: 05/06/2010] [Accepted: 05/15/2010] [Indexed: 12/11/2022] Open
Abstract
Minimally invasive percutaneous procedures are increasingly being performed by both interventional radiologists and noninterventionalists. Patients with postprocedural issues will likely present to the emergency department for evaluation and treatment. This review focuses on the evaluation and management of the complications of common percutaneous procedures.
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Affiliation(s)
- Esther H Chen
- San Francisco General Hospital, University of California, San Francisco, CA 94110, USA.
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Schwaner SL, Haug SB, Matsumoto AH. Overview of Embolotherapy: Agents, Indications, Applications, and Nursing Management. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.cpen.2010.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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