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Szkodziak F, Wozniak S, Szkodziak PR, Pyra K, Paszkowski T. Noninvasive diagnostic imaging of pelvic venous disorders. Ultraschall Med 2024. [PMID: 38325406 DOI: 10.1055/a-2263-7193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
It is estimated that chronic pelvic pain (CPP) may affect up to 24% of women. Unfortunately, very often, despite extensive diagnostics, the cause of CPP remains unknown. The pathophysiology of CPP could be explained to a large extent by the occurrence of pelvic venous disorders (PVD). Although pelvic venography is still considered the gold standard for the diagnosis of PVD, noninvasive diagnostic imaging techniques seem to be instrumental in the initial identification of patients with PVD. This literature review aimed to analyze and evaluate the usefulness of noninvasive diagnostic imaging techniques like transvaginal ultrasonography, transabdominal ultrasonography, magnetic resonance, and computed tomography in the diagnosis and identification of patients with PVD. Forty-one articles published between 1984 and 2023 were included in this literature review. Based on this literature review, we conclude that the clinical application of noninvasive diagnostic techniques in the diagnosis of PVD seems to be very promising. Future studies investigating the role of noninvasive diagnostic imaging techniques in the diagnosis of PVD are required.
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Affiliation(s)
- Filip Szkodziak
- 3rd Chair and Department of Gynaecology, Medical University of Lublin, Lublin, Poland
| | - Slawomir Wozniak
- 3rd Chair and Department of Gynaecology, Medical University of Lublin, Lublin, Poland
| | | | - Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Tomasz Paszkowski
- 3rd Chair and Department of Gynaecology, Medical University of Lublin, Lublin, Poland
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Szmygin M, Pyra K, Bèrczi V, Woźniak S, Światłowski Ł, Paszkowski T. Endovascular Treatment of Pelvic Venous Congestion Syndrome in Nulliparous Patients-Preliminary Results of 10 Years of Experience. Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03731-y. [PMID: 38691123 DOI: 10.1007/s00270-024-03731-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/09/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE The aim of this article is to present our experience with minimally-invasive treatment for nulliparous patients with pelvic venous congestion syndrome (PVCS) with special attention to anatomical considerations, procedural and clinical outcome. MATERIALS AND METHODS In this retrospective, monocentric study, 21 patients with PVCS treated from January 2014 to June 2023 were included. The preprocedural imaging evaluation of PVCS was based on color Doppler ultrasound, contrast-enhanced CT and/or MRI. In all cases insufficient ovarian veins and/or internal iliac branches were occluded with coils and sclerosant. Procedural and clinical outcomes were measured 30 and 90 days after the procedure. RESULTS Average duration of pelvic pain was 44.8 ± 54.2 months (from 6 to 200) with the mean VAS-recorded pain intensity of 8.5 ± 1.1 (range from 7 to 10 where 0 was "no pain" and 10 "worst pain possible"). Most common symptoms included dysmenorrhea, dyspareunia and dysuria. Complete embolization was observed in in all cases. Targeted vessels included left ovarian vein (13/21, 62%), both ovarian veins (7/21, 33%) and left pudendal with left ovarian (1/21, 5%). Residual PVCS was noted in 1 patient. Mean VAS at 90-days after the procedure was 2.4 ± 1.4 (range from 0 to 6, p < 0.001). Nineteen patients (90%) were satisfied with the clinical outcome (13 "very satisfied", 6 "satisfied") and reported improvement in quality of life. Two patients (9.5%) reported to be "neutral" as the VAS reduction was less than 50%. CONCLUSION Our study confirms that endovascular coil embolization is safe and effective in treatment of nulliparous patients with PVCS that provides very high rate of clinical success and overall satisfaction.
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Affiliation(s)
- Maciej Szmygin
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Jaczewskiego 8 Str., 20-954, Lublin, Poland.
- Department of Human Anatomy, Medical University of Lublin, Lublin, Poland.
| | - Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Jaczewskiego 8 Str., 20-954, Lublin, Poland
| | - Viktor Bèrczi
- Department of Radiology, Medical Imaging Clinic, Semmelweis University Budapest, Budapest, Hungary
| | - Sławomir Woźniak
- Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Łukasz Światłowski
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Jaczewskiego 8 Str., 20-954, Lublin, Poland
| | - Tomasz Paszkowski
- Department of Gynecology, Medical University of Lublin, Lublin, Poland
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Luchowski P, Szmygin M, Barton E, Prus K, Szmygin H, Pyra K, Ficek R, Rejdak K. Poor Prestroke Glycemic Control Increases the Rate of Symptomatic Intracranial Hemorrhage after Mechanical Thrombectomy. J Clin Med 2024; 13:1227. [PMID: 38592044 PMCID: PMC10932016 DOI: 10.3390/jcm13051227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: Diabetes is a well-established risk factor for acute ischemic stroke (AIS). This study evaluated the impact of prestroke glycemic control in diabetic patients on their 3-month clinical outcome after mechanical thrombectomy (MT). (2) Methods: AIS patients with a premorbid modified Rankin scale (mRS) score of 0-2 who were admitted within 6 h after stroke onset and treated with MT between January 2020 and August 2023 were retrospectively analyzed. The study evaluated the effect of prestroke glycemic control on the stroke severity, reperfusion rate, symptomatic intracranial hemorrhage (sICH) and favorable clinical outcome (modified Rankin scale score 0-2) at 3 months after endovascular treatment. (3) Results: A total of 364 patients were analyzed, with 275 cases of non-diabetes (ND), 66 of well-controlled diabetes (WCD) and 23 of poorly controlled diabetes (PCD). There was no significant difference in the baseline neurological deficit expressed according to the National Institutes of Health Stroke Scale among the three groups. The time from stroke onset to groin puncture was similar in the ND, WCD and PCD groups (median 215 min, 194.5 min and 222.5 min, respectively). There was no significant difference in the favorable 3-month clinical outcomes among these three groups (35.2% of ND patients, 42.4% of WCD patients and 39.1% of PCD patients) or full recovery (12.4% of ND patients, 11.0% of WCD patients and 17.4% of PCD patients). The rate of sICH was significantly higher in the PCD group as compared to the ND and WDP groups (21.7% of PCD patients versus 7.6% of ND patients, p = 0.038, and 6.0% of WCD patients, p = 0.046), but the 3-month mortality did not differ between the three groups (21.8% of ND group, 19.7% of WCD group and 26.1% of PCD group). (4) Conclusions: This study shows that poor prestroke glycemic control in AIS diabetic patients does not change the chance of a good clinical functional outcome after endovascular treatment. However, the increased risk of hemorrhagic complications in this group of patients should be considered.
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Affiliation(s)
- Piotr Luchowski
- Department of Neurology and Neurological Nursing, Medical University of Lublin, 20-954 Lublin, Poland;
| | - Maciej Szmygin
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, 20-954 Lublin, Poland; (M.S.); (K.P.)
| | - Elzbieta Barton
- Department of Neurology and Neurological Nursing, Medical University of Lublin, 20-954 Lublin, Poland;
| | - Katarzyna Prus
- Department of Neurology, Medical University of Lublin, 20-954 Lublin, Poland; (K.P.); (R.F.); (K.R.)
| | - Hanna Szmygin
- Department of Endocrinology, Center of Oncology of the Lublin Region St. Jana z Dukli, 20-090 Lublin, Poland;
| | - Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, 20-954 Lublin, Poland; (M.S.); (K.P.)
| | - Remigiusz Ficek
- Department of Neurology, Medical University of Lublin, 20-954 Lublin, Poland; (K.P.); (R.F.); (K.R.)
| | - Konrad Rejdak
- Department of Neurology, Medical University of Lublin, 20-954 Lublin, Poland; (K.P.); (R.F.); (K.R.)
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Szmygin M, Moqbil S, Mierzynski R, Leszczynska-Gorzelak B, Pyra K. Misleading diagnosis in a pregnant patient - ruptured metastatic choriocarcinoma mimicking liver hemangiomas treated with emergency embolization. Ginekol Pol 2024:VM/OJS/J/96875. [PMID: 38334343 DOI: 10.5603/gpl.96875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/13/2023] [Indexed: 02/10/2024] Open
Affiliation(s)
- Maciej Szmygin
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Poland.
| | - Sara Moqbil
- Medical University of Lublin, Students Association at the Department of Interventional Radiology and Neuroradiologu, Poland
| | | | | | - Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Poland
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Szmygin M, Giurazza F, Marini PD, Jargiełło T, Pyra K. Pelvic AVM Embolization: A Tricky Affair-Multicenter Retrospective Experience. J Endovasc Ther 2024:15266028231221977. [PMID: 38178592 DOI: 10.1177/15266028231221977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
PURPOSE Pelvic arteriovenous malformations (pAVMs) are congenital or acquired vascular anomalies, presenting with hematuria, menometrorrhagia, pelvic pain, and varices; they can be life-threatening in case of rupture. Surgical therapies have been proposed but endovascular embolization has been recognized as the primary modality. The aim of this article was to report a retrospective multicenter experience concerning embolization of pelvic AVMs and provide literature overview. MATERIALS AND METHODS We describe 18 patients (14 female and 4 male) diagnosed with pAVM and treated with minimally invasive methods. The pre-procedural imaging evaluation was based on transpelvic and/or transvaginal color Doppler ultrasound, contrast-enhanced computed tomography, and/or magnetic resonance. In 3 cases, the malformation was congenital and in other 15, acquired. Most common symptoms were menometrorrhagia, hematuria, pelvic pain and pressure, and heaviness in the lower abdominal region. In 10 cases (56%), only 1 procedure was required. Eight patients underwent multistage treatment. RESULTS Complete occlusion of the lesion in post-procedural angiography was observed in 12 patients (67%). No major periprocedural complications were observed. In 14 cases (78%), both satisfactory embolization and significant clinical improvement was achieved in long-term follow-up. Sixteen patients (88%) were at least satisfied with the clinical outcome. One patient reported subsequent successful pregnancy 5 years after the treatment. CONCLUSION Hemodynamics of pAVM are variable and thorough understanding of the vessel anatomy is crucial in planning and choosing proper treatment. Both transarterial and percutaneous direct puncture embolization strategies appear safe, technically feasible, and clinically effective. CLINICAL IMPACT In this manuscript, we discuss the role of interventional radiology methods in the treatment of pelvic arteriovenous malformations along with its advantages, limitations and possible complications. In addition to this, we review the current literature and confront our findings with those made by other authors. We believe that modern endovascular methods offer safe and reliable alternative for traditional surgical therapy and should be therefore considered during multidisciplinary treatment of these patients.
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Affiliation(s)
- Maciej Szmygin
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Francesco Giurazza
- Department of Interventional Radiology, Cardarelli Hospital, Naples, Italy
| | - Pierre De Marini
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Tomasz Jargiełło
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
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Czeczelewski M, Mikos E, Moqbil S, Szmygin M, Szmygin H, Pyra K. Concentration of Inflammatory Markers in Plasma of Varicose Ovarian Veins in Women With Pelvic Venous Disorders: A Pilot Study. Eur J Vasc Endovasc Surg 2023; 66:597-598. [PMID: 37336357 DOI: 10.1016/j.ejvs.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 05/16/2023] [Accepted: 06/14/2023] [Indexed: 06/21/2023]
Affiliation(s)
- Marcin Czeczelewski
- Students' Scientific Society at the Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland.
| | - Eryk Mikos
- Students' Scientific Society at the Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Sara Moqbil
- Students' Scientific Society at the Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Maciej Szmygin
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Hanna Szmygin
- Department of Endocrinology, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
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Pyra K, Moqbil S, Czeczelewski M, Mikos E, Mitura P, Szmygin H. Bland embolization hits the target: endovascular method for treating liver neuroendocrine tumor metastases. Pol Arch Intern Med 2023; 133:16521. [PMID: 37389452 DOI: 10.20452/pamw.16521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Affiliation(s)
- Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland.
| | - Sara Moqbil
- Student Scientific Society at the Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Marcin Czeczelewski
- Department of Urology and Urological Oncology, Medical University of Lublin, Lublin, Poland
| | - Eryk Mikos
- Student Scientific Society at the Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Przemysław Mitura
- Department of Urology and Urological Oncology, Medical University of Lublin, Lublin, Poland
| | - Hanna Szmygin
- Department of Endocrinology, Diabetology and Metabolic Diseases, Medical University of Lublin, Lublin, Poland
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Czeczelewski M, Czajkowski W, Szmygin M, Moqbil S, Mikos E, Pyra K. Unexpected malignancy: resection of a large thoracic solitary fibrous tumor of the pleura with preoperative arterial embolization. Pol Arch Intern Med 2023; 133:16519. [PMID: 37387611 DOI: 10.20452/pamw.16519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Affiliation(s)
- Marcin Czeczelewski
- Student Scientific Society, Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland.
| | | | - Maciej Szmygin
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Sara Moqbil
- Student Scientific Society, Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Eryk Mikos
- Student Scientific Society, Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
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Szmygin M, Polski P, Mikos E, Moqbil S, Alzubedi A, Pyra K. Lack of biopsy: a lesson to learn. Pol Arch Intern Med 2023; 133. [PMID: 36734921 DOI: 10.20452/pamw.16419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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10
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Szmygin M, Góralczyk W, Wach D, Jargiełło T, Pyra K. Byrd sheaths for complex inferior vena cava filter retrieval: Results of a preliminary study. Kardiol Pol 2023; 81:388-390. [PMID: 36772951 DOI: 10.33963/kp.a2023.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 01/15/2023] [Indexed: 05/03/2023]
Affiliation(s)
- Maciej Szmygin
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland.
| | - Wanesa Góralczyk
- Students' Scientific Society at the Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Damian Wach
- Students' Scientific Society at the Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Tomasz Jargiełło
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
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Pyra K, Szmygin M, Mikos E, Czeczelewski M, Moqbil S, Celiński R, Jargiełło T. Uncommon complication of a common procedure. Kardiol Pol 2023; 81:410-411. [PMID: 36800483 DOI: 10.33963/kp.a2023.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 02/11/2023] [Indexed: 05/03/2023]
Affiliation(s)
- Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Maciej Szmygin
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Eryk Mikos
- Students' Scientific Society at the Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland.
| | - Marcin Czeczelewski
- Students' Scientific Society at the Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Sara Moqbil
- Students' Scientific Society at the Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Rafał Celiński
- Department of Cardiology, Independent Public Provincial Specialist Hospital in Chelm, Chełm, Poland
| | - Tomasz Jargiełło
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
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Pyra K, Szmygin M, Szmygin H, Woźniak S, Jargiełło T. Unilateral Uterine Artery Embolization as a Treatment for Patients with Symptomatic Fibroids-Experience in a Case Series. Medicina (B Aires) 2022; 58:medicina58121732. [PMID: 36556934 PMCID: PMC9783256 DOI: 10.3390/medicina58121732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022] Open
Abstract
Background and Objectives: Uterine artery embolization (UAE) has become an accepted and widely performed therapy for patients with symptomatic (reporting at least two of the following symptoms: severe or prolonged menstrual bleeding, abdominal pain, tension in abdomen, problems with urination, constipation or anemia) uterine fibroids. Although in the majority of cases, bilateral occlusion is required to obtain a successful clinical outcome, there are patients in whom treatment of only one uterine artery could be attempted. There are several reasons for unilateral UAE: hemodynamic conditions, technical difficulties, anatomical variants and unilateral dominancy of blood supply to the fibroid. Our aim is to present our 10-year experience with unilateral UAE and evaluate the radiological and clinical outcomes. Materials and Methods: Records of 369 patients with fibroids who underwent UAE from 2010 to 2021 were analyzed. We identified 26 patients treated with unilateral uterine artery embolization and analyzed the data of these patients. All patients attended medical consultation, were assessed using a five-grade symptom scale and underwent MRI examination. Clinical response was evaluated at least 6 months after the procedure and was categorized to one of the following groups: complete improvement, partial improvement, no change and a worsening in symptoms. Results: Twenty-two patients (85%) reported at least partial improvement 6 months following the procedure. One patient required secondary embolization due to recanalization. The secondary procedure was successful, and complete improvement was achieved. One patient did not observe any clinical improvement, and in two cases, symptom recurrence was observed. All three patients were referred for surgical treatment. No major complications were noted. Overall, the success rate was 88%. Conclusions: The results of our study support the statement that elective unilateral embolization is an appropriate treatment in patients with a dominant uterine artery.
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Affiliation(s)
- Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Jaczewskiego 8 Str., 20-090 Lublin, Poland
| | - Maciej Szmygin
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Jaczewskiego 8 Str., 20-090 Lublin, Poland
- Correspondence: ; Tel.: +48-509-679-033
| | - Hanna Szmygin
- Department of Endocrinology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Sławomir Woźniak
- 3rd Department of Gynecology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Tomasz Jargiełło
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Jaczewskiego 8 Str., 20-090 Lublin, Poland
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13
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Pyra K, Szmygin M, Dymara-Konopka W, Pietras G, Dziduch P, Grzechnik M, Jargiello T, Leszczynska-Gorzelak B. Maternal and perinatal outcomes in placenta accreta spectrum disorders with prophylactic internal iliac artery balloon catheterization and embolization. Ginekol Pol 2022; 93:980-986. [PMID: 35315022 DOI: 10.5603/gp.a2021.0221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/12/2021] [Accepted: 11/20/2021] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To summarize our five-year experience with managing patients diagnosed with wide range of PAS disorder and treated with prophylactic internal iliac balloon implantation prior to cesarean section and to assess maternal and fetal outcomes. MATERIAL AND METHODS Retrospective cohort study. RESULTS A total of 30 patients were included in the study. Hysterectomy was performed in 10 cases - partial hysterectomy in six and total hysterectomy in four. Median estimated blood loss was 1.18 L. In two cases technical complications were noted. In one case bilateral internal iliac artery thrombosis requiring urgent surgical intervention occurred. A total of 30 live infants were delivered. Mean birth weight was 2435 g and mean Apgar score at 1', 5' and 10' minutes was 6.8, 8 and 8.7 respectively. After average 30 days of hospitalization all infants and their mothers were discharged in good clinical condition. CONCLUSIONS Placenta accreta spectrum remains a challenge for obstetricians and gynecologists and despite interdisciplinary approach is associated with numerous complications with life-threatening postpartum hemorrhage being the most serious one. Prophylactic placement of iliac balloons is a minimally invasive and safe endovascular technique which allows rapid and effective control of postpartum bleeding in patients with PAS, with low complication rate for both mother and the child.
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Affiliation(s)
- Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Poland
| | - Maciej Szmygin
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Poland.
| | | | - Grzegorz Pietras
- Department of Obstetrics and Perinatology, Medical University of Lublin, Poland
| | - Piotr Dziduch
- Department of Obstetrics and Perinatology, Medical University of Lublin, Poland
| | - Marek Grzechnik
- Department of Obstetrics and Perinatology, Medical University of Lublin, Poland
| | - Tomasz Jargiello
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Poland
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Pyra K, Szmygin M, Szmygin H, Jargiello T, Rechberger T, Wozniak S. Uretero-vaginal fistulas - clinical presentation, treatment and literature overview. Ginekol Pol 2022; 93:501-505. [PMID: 35315024 DOI: 10.5603/gp.a2021.0240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/28/2021] [Indexed: 11/25/2022] Open
Abstract
A uretero-vaginal fistula (UVF) describes an abnormal connection between the ureter and vagina causing urinary incontinence, frequent infection, and discomfort. Although UVF might be diagnosed after vaginal delivery, infertility treatment or pelvic radiation therapy, gynecological operations, especially total abdominal hysterectomy, remain the leading cause of ureteral injury and formation of UVF. Traditional ureteroneocystostomy was usually the treatment of choice in patients with UVF. Nevertheless, it is now frequently replaced by less invasive endoscopic and percutaneous procedures which are also highly effective and feasible. That is why, ureteral stenting became the first-line treatment in uncomplicated UVF. The aim of this review is to present clinical presentation of UVF and to assess the current state of knowledge about the diagnosis and management of uretero-vaginal fistula with special interest on minimally-invasive methods.
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Affiliation(s)
- Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Poland
| | - Maciej Szmygin
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Poland.
| | - Hanna Szmygin
- Department of Endocrinology, Medical University, Lublin, Poland
| | - Tomasz Jargiello
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Poland
| | - Tomasz Rechberger
- 2nd Department of Gynecology, Medical University of Lublin, Poland, Poland
| | - Slawomir Wozniak
- 3rd Chair and Department of Gynecology, Medical University in Lublin, Poland
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Szmygin M, Sojka M, Tarkowski P, Pyra K, Luchowski P, Wojczal J, Ficek R, Drelich-Zbroja A, Jargiełło T. Predictors of favorable outcome after endovascular thrombectomy for acute ischemic stroke due to large vessel occlusion in young patients. Acta Radiol 2021; 63:1689-1694. [PMID: 34766505 DOI: 10.1177/02841851211056476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mechanical thrombectomy (MT) became a standard of care for patients with acute ischemic stroke (AIS) with its efficacy demonstrated by meta-analysis and randomized studies. Although ischemic stroke is associated more with older patients, it may also have devastating neurological effects on young patients. PURPOSE To present our experience with stroke patients aged <50 years treated with endovascular means and to evaluate clinical and procedural factors associated with outcome and mortality. MATERIAL AND METHODS This study was conducted on 34 young stroke patients treated with MT. Clinical features including baseline results, radiological imaging, procedural details, and outcome results were documented and evaluated. Recanalization was assessed according to the TICI score. The clinical condition was evaluated after three months using mRS. Mortality rate was calculated. RESULTS The rate of successful recanalization (TICI ≥2c) was 79% (27/34). Symptomatic intracranial hemorrhage (sICH) was observed in 5 (15%) patients. After 90 days, the mortality rate was 12%. Favorable clinical outcome (mRs 0-2) was regained in 65% of the patients whereas satisfactory clinical outcome was seen in 85%. Poor clinical outcome (mRs >2) was observed in 9 (23.7%) patients. CONCLUSION In conclusion, the results of this study demonstrate that MT for AIS in young patients is feasible and provides an excellent rate of arterial recanalization and high rate of favorable outcomes. Statistical analysis showed that shorter time from onset to arrival and reperfusion, successful recanalization and absence of hemorrhagic transformation are the predictors of favorable clinical outcome and overall survival rate.
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Affiliation(s)
- Maciej Szmygin
- Medical University of Lublin, Department of Interventional Radiology and Neuroradiology, Lublin, Lubelskie, Poland
| | - Michał Sojka
- Medical University of Lublin, Department of Interventional Radiology and Neuroradiology, Lublin, Lubelskie, Poland
| | - Piotr Tarkowski
- Medical University of Lublin, Department of Radiology and Nuclear Medicine, Lublin, Lubelskie, Poland
| | - Krzysztof Pyra
- Medical University of Lublin, Department of Interventional Radiology and Neuroradiology, Lublin, Lubelskie, Poland
| | - Piotr Luchowski
- Medical University of Lublin, Department of Neurology, Lublin, Lubelskie, Poland
| | - Joanna Wojczal
- Medical University of Lublin, Department of Neurology, Lublin, Lubelskie, Poland
| | - Remigiusz Ficek
- Medical University of Lublin, Department of Neurology, Lublin, Lubelskie, Poland
| | - Anna Drelich-Zbroja
- Medical University of Lublin, Department of Interventional Radiology and Neuroradiology, Lublin, Lubelskie, Poland
| | - Tomasz Jargiełło
- Medical University of Lublin, Department of Interventional Radiology and Neuroradiology, Lublin, Lubelskie, Poland
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Szmygin M, Sojka M, Pyra K, Tarkowski P, Luchowski P, Wojczal J, Drelich-Zbroja A, Jargiełło T. Mechanical thrombectomy for acute ischemic stroke in the posterior circulation: assessment of efficacy and outcome and identification of prognostic factors. Acta Radiol 2021; 62:1374-1380. [PMID: 33016085 DOI: 10.1177/0284185120962735] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Mechanical thrombectomy (MT) is well-established in the treatment of acute ischemic anterior circulation stroke. However, there is no evidence from randomized trials or meta-analyses that MT is safe and effective in the treatment of patients with acute ischemic posterior circulation stroke (PCS). PURPOSE To evaluate the clinical and procedural factors associated with recanalization and outcome of patients with PCS treated with MT. MATERIAL AND METHODS Forty-three patients with PCS (median age 73 years) who underwent treatment with MT were included. Data including demographics, baseline stroke severity, radiological imaging, procedure and post-procedure complications were documented. Clinical outcome was evaluated using the modified Rankin Scale (mRS). The patients were classified into two groups based on clinical outcome (favorable vs. unfavorable mRS after 90 days). RESULTS Median baseline National Institute of Health Stroke Scale (NIHSS) was 17. Twenty patients were eligible for intravenous thrombolysis and received recombinant tissue plasminogen activator before MT. Successful recanalization was observed in 88.4% of patients. After 90 days, favorable outcome (defined as mRS 0-2) was achieved in 26 patients; six patients had an unfavorable outcome (mRs >2). Final mortality rate was 25.5%. Baseline NIHSS, onset to reperfusion time, procedure duration, and successful recanalization had a statistically significant association with outcome. Failed recanalization and occurrence of intracranial hemorrhage were found to be associated with a higher mortality rate. CONCLUSION MT is feasible and effective method in treatment of PCS. Baseline NIHSS and onset to reperfusion time were found to be independent predictive factors of clinical outcome.
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Affiliation(s)
- Maciej Szmygin
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Michał Sojka
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Piotr Tarkowski
- Department of Diagnostic Radiology and Nuclear Medicine, Medical University of Lublin, Lublin, Poland
| | - Piotr Luchowski
- Department of Neurology, Medical University of Lublin, Lublin, Poland
| | - Joanna Wojczal
- Department of Neurology, Medical University of Lublin, Lublin, Poland
| | - Anna Drelich-Zbroja
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Tomasz Jargiełło
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
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Pyra K, Szmygin M, Wozniak S, Jargiello T, Paszkowski T. Recurrent cesarean scar pregnancy treated successfully with uterine artery chemoembolization. Ginekol Pol 2021; 92:394-395. [PMID: 33844267 DOI: 10.5603/gp.a2021.0048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Poland
| | - Maciej Szmygin
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Poland.
| | | | - Tomasz Jargiello
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Poland
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Szmygin M, Bielewicz J, Pyra K, Szczepańska-Szerej A, Rejdak K. A rare neurological manifestation of a malnourished alcohol-dependent acute pancreatitis patient with Marchiafava-Bignami disease. Gastroenterol Rep (Oxf) 2021; 9:179-181. [PMID: 34026226 PMCID: PMC8128018 DOI: 10.1093/gastro/goaa062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Maciej Szmygin
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Joanna Bielewicz
- Department of Neurology, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | | | - Konrad Rejdak
- Department of Neurology, Medical University of Lublin, Lublin, Poland
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Pyra K, Zbroja M, Cyranka W, Kuczyńska M, Sojka M, Jargiełło T. Pelvic congestion syndrome: a still underdiagnosed cause of chronic pain in premenopausal women. Pol Arch Intern Med 2021; 131:187-189. [PMID: 33567800 DOI: 10.20452/pamw.15801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Monika Zbroja
- Students’ Scientific Society at the Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Weronika Cyranka
- Students’ Scientific Society at the Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Maryla Kuczyńska
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland.
| | - Michał Sojka
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Tomasz Jargiełło
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
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Sojka M, Szmygin M, Pyra K, Tarkowski P, Luchowski P, Wojczal J, Drelich-Zbroja A, Jargiełło T. Predictors of outcome after mechanical thrombectomy for acute ischemic stroke in patients aged ≥90 years. Clin Neurol Neurosurg 2020; 200:106354. [PMID: 33172718 DOI: 10.1016/j.clineuro.2020.106354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/19/2020] [Accepted: 10/29/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mechanical thrombectomy (MT) has established its role as a first-line treatment of acute ischemic stroke due to large vessel occlusions (LVO). However, patients older than 85 or even 80 years of age are commonly excluded from large randomized controlled stroke studies as this group was found to be associated with significantly poorer clinical outcome and increased mortality compared to younger patients. The aim of this study was to evaluate clinical and procedural factors associated with clinical outcome and mortality among nonagenarians with acute ischemic stroke treated with mechanical thrombectomy. MATERIALS AND METHODS This retrospective, single-center study was conducted on 38 patients with LVO treated with MT. Clinical features including baseline results, radiological imaging, procedural details and outcome results were documented and evaluated. Recanalization was assessed according to the TICI score. The clinical condition was evaluated on admission (NIHSS) and after 3 months (mRS). RESULTS The rate of successful recanalization (TICI ≥2b) was 84.2 % (32/38). Symptomatic intracranial hemorrhage (sICH) was observed in 3 (7.9 %) patients. After 90 days, the mortality rate was 47.4 %. Favorable clinical outcome (mRs 0-2) was regained in 28.9 % of the patients (11/38). Poor clinical outcome (mRs<2) was observed in 9 patients (23.7 %). CONCLUSION Very elderly patients with LVO should not be excluded from MT even if prognosis for good clinical outcome in this age group remains low and the procedure is more challenging. Long-term outcome is predicted by stroke severity (baseline NIHSS and occluded vessel) and hospital arrival time.
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Affiliation(s)
- Michał Sojka
- Medical University of Lublin, Department of Interventional Radiology and Neuroradiology, Poland
| | - Maciej Szmygin
- Medical University of Lublin, Department of Interventional Radiology and Neuroradiology, Poland.
| | - Krzysztof Pyra
- Medical University of Lublin, Department of Interventional Radiology and Neuroradiology, Poland
| | - Piotr Tarkowski
- Medical University of Lublin, Department of Radiology and Nuclear Medicine, Poland
| | - Piotr Luchowski
- Medical University of Lublin, Department of Neurology, Poland
| | - Joanna Wojczal
- Medical University of Lublin, Department of Neurology, Poland
| | - Anna Drelich-Zbroja
- Medical University of Lublin, Department of Interventional Radiology and Neuroradiology, Poland
| | - Tomasz Jargiełło
- Medical University of Lublin, Department of Interventional Radiology and Neuroradiology, Poland
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Kuczyńska M, Nowakowski Ł, Zbroja M, Cyranka W, Szmygin M, Pyra K. Third gender - the clinical image of Morris syndrome. Endokrynol Pol 2020; 71:581-582. [PMID: 33125696 DOI: 10.5603/ep.a2020.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/05/2020] [Accepted: 09/06/2020] [Indexed: 11/25/2022]
Abstract
Not required for Clinical Vignette.
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Affiliation(s)
- Maryla Kuczyńska
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland.
| | - Łukasz Nowakowski
- 2nd Department of Gynaecology, Medical University of Lublin, Lublin, Poland
| | - Monika Zbroja
- Students' Scientific Society at the Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Weronika Cyranka
- Students' Scientific Society at the Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Maciej Szmygin
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
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Pyra K, Szmygin M, Sojka M, Drelich-Zbroja A, Jargiełło T. Endovascular treatment of visceral artery aneurysms and pseudoaneurysms - evaluation of efficacy and safety based on long-term results. Pol Przegl Chir 2020; 92:23-28. [PMID: 32312922 DOI: 10.5604/01.3001.0013.5895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND With estimated prevalence of 1% of the general population, visceral artery aneurysms are not a frequent pathology, however, their rupture is a life-threatening occurrence with mortality rate ranging from 10% to 25%, up to 75% in case of pregnant women. Therefore, the identification and treatment of visceral artery aneurysms is of great importance in the prevention of early rupture. PURPOSE To assess the effectiveness and safety of treatment of visceral artery aneurysms with various endovascular methods focusing on technical aspects, complications and long-term clinical outcome. MATERIALS AND METHODS 60 patients with visceral artery aneurysms were treated percutaneously. Various techniques were used: coiling (23), covered stents (15), thrombin (7), and other mixed techniques. Aneurysm characteristics, size and localization, procedural data, peri-procedural complications, technical success, 90- and 180-day clinical success and follow-up period (aneurysm exclusion, patency of the artery and complications) were prospectively analyzed. RESULTS The procedure was performed in 57 of 60 patients. In 56 of 57 patients aneurysms ware effectively excluded. The success rate was 93.3% (56 of 60 enrolled patients). Technical success after the intervention was 82.4%, after second 98.2%. Embolization with covered stents was characterized by the highest efficiency. Serious complications occurred in 1.8% of cases. CONCLUSIONS The minimally invasive endovascular treatment of visceral artery aneurysms is characterized by high efficacy and safety. Good treatment results depend on proper assessment of the aneurysm's morphology as well as on selection of the appropriate vascular approach and endovascular technique.
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Affiliation(s)
- Krzysztof Pyra
- Zakład Radiologii Zabiegowej i Neuroradiologii, Uniwersytet Medyczny w Lublinie
| | - Maciej Szmygin
- Zakład Radiologii Zabiegowej i Neuroradiologii, Uniwersytet Medyczny w Lublinie
| | - Michał Sojka
- Zakład Radiologii Zabiegowej i Neuroradiologii, Uniwersytet Medyczny w Lublinie
| | - Anna Drelich-Zbroja
- Zakład Radiologii Zabiegowej i Neuroradiologii, Uniwersytet Medyczny w Lublinie
| | - Tomasz Jargiełło
- Zakład Radiologii Zabiegowej i Neuroradiologii, Uniwersytet Medyczny w Lublinie
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Pyra K, Szmygin M, Dymara-Konopka W, Zych A, Sojka M, Jargiełło T, Leszczyńska-Gorzelak B. The pregnancy rate of infertile patients with proximal tubal obstruction 12 months following selective salpingography and tubal catheterization. Eur J Obstet Gynecol Reprod Biol 2020; 254:164-169. [PMID: 32979628 DOI: 10.1016/j.ejogrb.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/01/2020] [Accepted: 08/21/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the efficacy of selective salpingography (SSG) with additional tubal catheterization (TC) among infertile patients diagnosed with PTO and analysis of reproductive outcome. STUDY DESIGN Retrospective cohort study. RESULTS Of a total of 399 tubes with confirmed proximal tubal occlusion, 383 successfully restored their patency resulting in 96 % technical success rate. Thirty-five percent of oviducts that had their patency restored was treated with SSG and 65% required additional TC. Reproductive outcomes at minimum 12 months following the treatment were collected by a telephone survey. 21/221 women were lost to follow up. Out of remaining 200 patients with at least one patent tube, 80 patients conceived which resulted in 40 % overall pregnancy rate. CONCLUSION Selective salpingography and tubal canalization offer patient-friendly, minimally invasive and cost-effective alternatives to tubal microsurgery and IVF-ET in women with tubal occlusion with very high technical success rate and promising clinical results which depend also on the complexity of couple infertility. Specific indications and limitations make a careful assessment of fallopian tubes and comprehensive evaluation of partners' reproductive situation prior to therapy an absolute requirement.
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Affiliation(s)
- Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Jaczewskiego 8 Str., 20-954, Lublin, Poland.
| | - Maciej Szmygin
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Jaczewskiego 8 Str., 20-954, Lublin, Poland.
| | - Weronika Dymara-Konopka
- Department of Obstetrics and Perinatology, Medical University of Lublin, Jaczewskiego 8 Str., 20-954, Lublin, Poland.
| | - Anna Zych
- Student's Scientific Association at the Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, Jaczewskiego 8 Str., 20-954, Lublin, Poland.
| | - Michał Sojka
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Jaczewskiego 8 Str., 20-954, Lublin, Poland.
| | - Tomasz Jargiełło
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Jaczewskiego 8 Str., 20-954, Lublin, Poland.
| | - Bożena Leszczyńska-Gorzelak
- Department of Obstetrics and Perinatology, Medical University of Lublin, Jaczewskiego 8 Str., 20-954, Lublin, Poland.
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Szkodziak P, Pyra K, Szkodziak F, Krzyżanowski J, Czuczwar P, Woźniak S, Jargiełło T, Paszkowski T. The Lublin Protocol of the Uterine Arteries Embolization in the Treatment of Symptomatic Uterine Fibroids. J Vis Exp 2020. [PMID: 33016950 DOI: 10.3791/61530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Uterine fibroids are benign tumors originating from smooth muscle tissue, constituting uterine muscle stroma. Uterine fibroids are the most common benign tumors found in women. In 20%-50% of women, fibroids are asymptomatic and do not require any treatment. The main symptoms of uterine fibroids are profuse menstrual bleeding, abnormal uterine bleeding, and pressure symptoms. Pressure symptoms can cause pelvic pain syndrome, urination disorders, and constipation. The treatment methods that are currently used include surgical treatment, pharmacological therapy, and minimally invasive procedures. The most commonly applied minimally invasive method is the embolization of uterine arteries. This procedure is currently a widely accepted method of treatment for symptomatic uterine fibroids and has been recognized as such by the National Institute for Health and Clinical Excellence in the guidelines for heavy menstrual bleeding. This is a complicated procedure and requires close cooperation between gynecologists and interventional radiologists. We present a protocol applicable to uterine artery embolization in the treatment of symptomatic uterine fibroids. The protocol is divided into five section. The first two section are intended for gynecologists and interventional radiologists, explaining how to qualify and prepare a patient for embolization in a step-by-step manner. Section three, which is directed at interventional radiologists, explains how embolization should be done. Section four is directed at gynecologists or hospital ward doctors who look after the patients after embolization. This section of the protocol offers a method for treating post-embolization pain using the Patient Controlled Analgesia (PCA) pump. Section five completes the procedure with an assessment of the effects and late complications of uterine artery embolization. All five section create a uniform protocol directed at clinicians, experts, and researchers new to the field.
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Affiliation(s)
- Piotr Szkodziak
- 3rd Chair and Department of Gynecology, Medical University of Lublin;
| | - Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin
| | - Filip Szkodziak
- 3rd Chair and Department of Gynecology, Medical University of Lublin
| | | | - Piotr Czuczwar
- 3rd Chair and Department of Gynecology, Medical University of Lublin
| | - Sławomir Woźniak
- 3rd Chair and Department of Gynecology, Medical University of Lublin
| | - Tomasz Jargiełło
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin
| | - Tomasz Paszkowski
- 3rd Chair and Department of Gynecology, Medical University of Lublin
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Szmygin M, Bielewicz J, Pyra K. Trigeminal Neuralgia as a Sole Symptom of Large Tumor of the Skull Base. Headache 2020; 60:1814-1816. [PMID: 32740924 DOI: 10.1111/head.13924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/13/2020] [Accepted: 07/10/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Maciej Szmygin
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Joanna Bielewicz
- Department of Neurology, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
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Sojka M, Szmygin M, Pyra K, Tarkowski P, Luchowski P, Wojczal J, Drelich-Zbroja A, Jargiełło T. Effectiveness and safety of ICA stenting in conjunction with mechanical thrombectomy (antegrade approach) in acute ischaemic stroke patients due to tandem occlusion. Neurol Neurochir Pol 2020; 54:426-433. [PMID: 32700307 DOI: 10.5603/pjnns.a2020.0055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/10/2020] [Accepted: 06/21/2020] [Indexed: 11/25/2022]
Abstract
AIM OF STUDY We investigated the effectiveness and safety of an antegrade approach consisting of emergency ICA stenting in conjunction with mechanical thrombectomy (MT) in a one-stage procedure as a treatment for Tandem Occlusion (TO). CLINICAL RATIONALE FOR STUDY We here describe our experience in the treatment of TO with an antegrade approach with long-term results. We also discuss the advantages and drawbacks of this treatment modality with special attention to possible haemorrhagic complications that can be encountered in patients with ischaemic stroke who receive antiplatelet treatment. We believe that our study adds to the limited number of reports on this topic. MATERIALS AND METHODS We selected 34 patients diagnosed with acute ischaemic stroke due to ICA and ipsilateral intracranial occlusion treated with ICA stenting in conjunction with MT. We analysed the short- and long-term results as well as investigating complications with special regard to haemorrhagic transformation associated with the need for antiplatelet treatment after stent implantation in patients after acute ischaemic stroke treatment. RESULTS A favourable angiographic outcome was defined as mTICI 2b-3. This was achieved in 33/34 patients (97%). On average, NIHSS at 24 hours after the procedure was 8.5 ± 7, which indicates a significant clinical improvement. Four cases of symptomatic ICH were observed (11.8%). One re-occlusion in stent was noted. At three-month follow-up, mRS scores were 0 in 11 (34.3%), 1 in 5 (16%), 2 in 1 (3%), 3 in 3 (9.3%), 4 in 3 (9.3%), and 5 in 2 (6%) patients. Seven patients did not survive (22%). Overall, a favourable outcome (mRS 0-2) was achieved in 17/34 patients (50%). The final mortality rate was 26.5% (9/34 patients). CONCLUSIONS AND CLINICAL IMPLICATIONS We conclude that an antegrade approach is a feasible and effective method for treating acute TO stroke, giving the patient the chance to regain his or her full independence in everyday life, with low overall complication and final mortality rates.
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Affiliation(s)
- Michał Sojka
- Medical University of Lublin, Department of Interventional Radiology and Neuroradiology, 20-954 Lublin, Poland
| | - Maciej Szmygin
- Medical University of Lublin, Department of Interventional Radiology and Neuroradiology, 20-954 Lublin, Poland.
| | - Krzysztof Pyra
- Medical University of Lublin, Department of Interventional Radiology and Neuroradiology, 20-954 Lublin, Poland
| | - Piotr Tarkowski
- Medical University of Lublin Department of Radiology, Jaczewskiego 8, 20-954 Lublin, Poland
| | - Piotr Luchowski
- Department of Neurology, Medical University of Lublin, Lublin, Poland
| | - Joanna Wojczal
- Department of Neurology, Medical University of Lublin, Lublin, Poland
| | - Anna Drelich-Zbroja
- Medical University of Lublin, Department of Interventional Radiology and Neuroradiology, 20-954 Lublin, Poland
| | - Tomasz Jargiełło
- Medical University of Lublin, Department of Interventional Radiology and Neuroradiology, 20-954 Lublin, Poland
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Kuczyńska M, Światłowski Ł, Sojka M, Pyra K, Drelich-Zbroja A, Jargiełło T. Abdominal angina: underrecognized cause of alarming symptoms. Pol Arch Intern Med 2020; 130:898-900. [DOI: 10.20452/pamw.15485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Sojka M, Sobstyl J, Drelich-Zbroja A, Pyra K, Kuczyńska M, Jargiełło T. Innominate arteriovenous fistula following laser lead extraction: endovascular treatment of a potentially fatal complication. Pol Arch Intern Med 2019; 129:716-718. [PMID: 31316044 DOI: 10.20452/pamw.14897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Michał Sojka
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Jan Sobstyl
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland.
| | - Anna Drelich-Zbroja
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Maryla Kuczyńska
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Tomasz Jargiełło
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
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Drelich-Zbroja A, Sojka M, Kuczyńska M, Światłowski Ł, Kuklik E, Sobstyl J, Pyra K, Wolski A, Czekajska-Chehab E, Pech M, Powerski M, Jargiełło T. Diagnostic imaging in patients after endovascular aortic aneurysm repair with special focus on ultrasound contrast agents. Pol Arch Intern Med 2018; 129:80-87. [PMID: 30600308 DOI: 10.20452/pamw.4409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Endovascular treatment of abdominal aortic aneurysms (AAAs) constitutes an alternative to the classic surgical approach. The procedure may be associated with specific complications, including persistent flow within the aneurysm sac, otherwise known as endoleak. OBJECTIVES The aim of the study was to assess the utility of ultrasound contrast agents in the diagnosis of endoleaks after endovascular AAA repair. PATIENTS AND METHODS A total of 198 patients with AAA underwent endovascular treatment. Follow‑up examinations were performed at 6 and 12 months after the procedure, including pre- and postcontrast ultrasound, followed by computed tomography angiography (CTA) as a reference. Each ultrasound examination consisted of B‑flow, color, and power Doppler evaluation before and after contrast injection, supplemented by a contrast‑enhanced ultrasound (CEUS) scan. RESULTS At 6 months, endoleaks were diagnosed in 16 and 22 patients during pre- and postcontrast ultrasound, respectively. CEUS confirmed the presence of 22 previously diagnosed and 4 new (type II) endoleaks. At 12 months, endoleaks were detected in 7 and 13 patients by means of pre- and postcontrast ultrasound, respectively. CEUS confirmed the presence of endoleaks in 17 patients. None of the endoleaks diagnosed solely with CEUS at 6 and 12 months were detected by CTA. CONCLUSIONS Contrast agents substantially increase the sensitivity of ultrasound in the diagnosis of endoleaks, particularly type II. CEUS proved to have the highest sensitivity for the diagnosis of endoleaks by revealing pathologies undetected by other modalities, including CTA. CEUS may substitute CTA in surveillance of patients after stent graft deployment.
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Affiliation(s)
- Anna Drelich-Zbroja
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Michał Sojka
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Maryla Kuczyńska
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Łukasz Światłowski
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Ewa Kuklik
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Jan Sobstyl
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Andrzej Wolski
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | | | - Maciej Pech
- Department of Radiology and Nuclear Medicine, Otto von Guericke University, Magdeburg, Germany
| | - Maciej Powerski
- Department of Radiology and Nuclear Medicine, Otto von Guericke University, Magdeburg, Germany
| | - Tomasz Jargiełło
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
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Jargiełło T, Sobstyl J, Kasztelan-Szcerbinska B, Sojka M, Pyra K. Endovascular treatment of the superior mesenteric arteriovenous fistula complicated by gastrointestinal bleeding. Turk J Gastroenterol 2018; 30:652-654. [PMID: 30460904 DOI: 10.5152/tjg.2018.17744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Tomasz Jargiełło
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Jan Sobstyl
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | | | - Michal Sojka
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
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Kuklik E, Pyra K, Światłowski Ł, Kuczyńska M, Sobstyl J, Drelich-Zbroja A, Jargiełło T, Tsitskari M, Szczerbo-Trojanowska M. Embolization of iatrogenic renal arteriovenous fistula - a case report. J Ultrason 2018; 18:170-173. [PMID: 30335925 PMCID: PMC6440502 DOI: 10.15557/jou.2018.0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2018] [Indexed: 11/22/2022] Open
Abstract
Renal artery pseudoaneurysms and arteriovenous fistulae most often occur as an iatrogenic complication. The article discusses a case of a patient diagnosed with an arteriovenous fistula and a pseudoaneurysm. A 64-year-old woman was admitted to the hospital due to nonspecific pain in the lumbar region. Imaging showed a typical picture of clear cell renal carcinoma. The patient was qualified for surgical treatment. After tumor resection, the patient developed microhematuria. Arteriovenous fistula and renal pseudoaneurysm were diagnosed using Doppler and computed tomography scans. The patient was qualified for arteriography with simultaneous embolization of the lesion. A follow-up evaluation confirmed the exclusion of aneurysm and fistula. Treatment outcomes were monitored using Doppler ultrasound. Doppler ultrasonography is the first method of choice in detecting and monitoring renal artery irregularities. Safety, non-invasiveness and easy access to this tool make it play a key role in the diagnosis of renal artery fistulas and pseudoaneurysms.
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Affiliation(s)
- Ewa Kuklik
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Łukasz Światłowski
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Maryla Kuczyńska
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Jan Sobstyl
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Anna Drelich-Zbroja
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Tomasz Jargiełło
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Maria Tsitskari
- Department of Vascular and Interventional Radiology, Apollonio Hospital, Nicosia, Cyprus
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Kuczyńska M, Piasek E, Światłowski Ł, Kuklik E, Sobstyl J, Drelich-Zbroja A, Słomka T, Pyra K, Furmaga O, Szczerbo-Trojanowska M. Sonographic assessment of the prevalence and evolution of fluid collections as a complication of kidney transplantation. J Ultrason 2018; 18:126-132. [PMID: 30335921 PMCID: PMC6440513 DOI: 10.15557/jou.2018.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2018] [Indexed: 11/22/2022] Open
Abstract
AIM OF THE STUDY The aim of this study is to assess the prevalence and evolution of perirenal fluid collections in a group of 488 patients who have undergone kidney transplantation. MATERIAL AND METHODS Sonographic documentation of 488 deceased-donor kidney recipients was evaluated for the prevalence of perirenal fluid collections and their evolution in time, depending on selected demographic features of the patients, time of detection, initial dimensions and precise position of the collection relative to the kidney and the location of the transplanted organ in the right or left iliac fossa. The collected data were used for statistical analysis to determine the strength of the potential relationships. RESULTS In 146 out of 488 subjects perirenal fluid collections were found. In 1/3 of the patients more than one fluid collection was diagnosed. Over 40% of fluid collections were detected within 10 days from the date of the first scan and 24.11% were detected within 10-20 days from the date of the first scan. The majority of fluid collections were located near the lower pole of the kidney. Perihilar collections were the least common. Collections encapsulating the kidney and subcutaneous collections were the largest in size on average. A statistically significant difference between the size of collections located on the surface and the size of those located near the upper pole of the transplanted kidney was demonstrated. However, no correlation was proven to exist between the persistence of the fluid collection and its position relative to the transplanted kidney and its initial size. CONCLUSIONS The correct evaluation of a fluid collection's dynamics of development and nature requires periodic follow-up of the recipient, preferably in a single clinical center. Ultrasonography is an inexpensive, non-invasive and repeatable method for the determination of the presence of fluid collections. However, the decision whether treatment is necessary requires the sonographic image to be compared with the laboratory signs of inflammation and biochemical analysis of the contents of fluid collections.
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Affiliation(s)
- Maryla Kuczyńska
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Ewa Piasek
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Łukasz Światłowski
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Ewa Kuklik
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Jan Sobstyl
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Anna Drelich-Zbroja
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Tomasz Słomka
- Department of Information Technology and Medical Statistics, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Olga Furmaga
- Department of Radiology, 424 General Military Hospital, Thessaloniki, Greece
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Abstract
Cesarean sections account for approximately 20% of all deliveries worldwide. In Poland, the percentage of women delivering by cesarean section amounts to over 43%. According to studies, the prevalence of cesarean scar defects ranges from 24-70%. Due to the overall cesarean section rate, this is a medical problem affecting a large population of women. In such cases, ultrasonographic evaluation of a cesarean scar reveals a hypoechoic space filled with postmenstrual blood, representing a myometrial tear at the wound site. Such an ultrasound appearance is referred to as a niche, and it forms after a cesarean section at the site of the hysterotomy of the anterior uterine wall, most commonly within the uterine isthmus. Currently, the exact cause of niche formation remains unexplained, yet the risk factors for its development are universally acknowledged. They include the site of hysterotomy, multiple previous cesarean section deliveries, suturing technique and maternal diabetes or smoking. Ultrasound evaluation of the cesarean section scar is an important element of obstetric and gynecologic practice, especially in the case of further pregnancies. It facilitates an early diagnosis of a cesarean scar ectopic pregnancy, and the prediction of the risk for perinatal dehiscence in the case of a vaginal birth after a cesarean section.
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Affiliation(s)
- Andrzej Woźniak
- 3rd Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Pyra
- Surgical Radiology and Neuroradiology Unit, Medical University of Lublin, Lublin, Poland
| | - Hugo Rio Tinto
- Radiology Department, Champalimaud Foundation, Lisbon, Portugal
| | - Sławomir Woźniak
- 3rd Department of Gynecology, Medical University of Lublin, Lublin, Poland
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Światłowski Ł, Pyra K, Kuczyńska M, Kuklik E, Sobstyl J, Sojka M, Drelich-Zbroja A, Pech M, Powerski M, Jargiełło T. Selecting patients for embolization of varicoceles based on ultrasonography. J Ultrason 2018; 18:90-95. [PMID: 30335916 PMCID: PMC6440507 DOI: 10.15557/jou.2018.0013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2018] [Indexed: 11/22/2022] Open
Abstract
Aim: The aim of the study was to assess patient selection for embolization of varicoceles based on ultrasonography. An additional objective of the work was to evaluate the results of endovascular treatment. Material and methods: From January 2015 till August 2017, 53 patients with varicoceles diagnosed in an ultrasound examination underwent endovascular treatment in the Department of Interventional Radiology and Neuroradiology in Lublin, Poland. Each ultrasound examination was performed using the Logiq 7 GE Medical System with a linear probe at 6–12 MHz using the B-mode and Doppler functions. The study was performed in both the supine and standing position of the patient. The morphological structures of the scrotum and the width of the pampiniform venous plexus were assessed. Based on clinical signs and symptoms as well as ultrasound findings, the patients were selected for endovascular treatment. This procedure involved the implantation of coils in the distal and proximal parts of the testicular vein and administration of a sclerosing agent between the coils. Results: Varicoceles were confirmed in all patients during a color Doppler scan. Diagnostic venography confirmed venous stasis or retrograde flow in the testicular vein and widened vessels of the pampiniform venous plexus over 2 mm in diameter in all patients undergoing endovascular treatment. The diagnostic efficacy of ultrasound was 100%. The technical success of the procedure was 89%. One patient had a recurrence of varicose veins (2.2%). There were no complications in any of the patients. Conclusions: Ultrasound is the preferred method in the diagnosis of varicoceles and selection for their treatment. Testicular vein embolization is a minimally invasive procedure characterized by high efficacy and safety.
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Affiliation(s)
- Łukasz Światłowski
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Maryla Kuczyńska
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Ewa Kuklik
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Jan Sobstyl
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Michał Sojka
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Anna Drelich-Zbroja
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, Otto von Guericke University, Magdeburg, Germany
| | - Maciej Powerski
- Department of Radiology and Nuclear Medicine, Otto von Guericke University, Magdeburg, Germany
| | - Tomasz Jargiełło
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
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Szkodziak P, Czuczwar P, Pyra K, Szkodziak F, Paszkowski T, Tinto HR, Woźniak S. Ascites Index - an attempt to objectify the assessment of ascites. J Ultrason 2018; 18:140-147. [PMID: 30335923 PMCID: PMC6440512 DOI: 10.15557/jou.2018.0020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2018] [Indexed: 12/15/2022] Open
Abstract
Introduction: Ascites is observed in cancer patients as well as in other non-neoplastic processes. In some patients, it may cause severe symptoms that can become directly life-threatening. The assessment of the degree of ascites seems useful in the determination of treatment effects as well as in the monitoring of fluid accumulation and early planning of decompression procedures. Aim: Determination of the clinical usefulness of a quantitative method of determining the degree of ascites, so-called Ascites Index. Material and methods: The Ascites Index is an ultrasonographic way of assessing the grade of ascites. The examination result is an index which is analogous to the amniotic fluid index determined in pregnant patients. The Ascites Index was determined in patients with ascites in the course of stage III–IV ovarian carcinoma (7 patients) and ovarian hyperstimulation syndrome (12 patients). Results: The patients with ovarian hyperstimulation syndrome required decompressive paracentesis at the median Ascites Index above 290 mm (range: 216–386 mm). In the patients with ovarian carcinoma, the median value of the Ascites Index at which paracentesis was required was 310 mm (range: 273–389 mm). To avoid complications associated with excessive protein loss, 2000 mL of fluid was evacuated at a single occasion. Following the procedure, the median value of the Ascites Index was 129 mm (range: 121–145 mm) in the patients with ovarian hyperstimulation syndrome and 146 cm (119–220 mm) in cancer patients. Conclusions: The proposed index is simple and rapid to determine. It makes evaluation of the degree of ascites considerably easier. Moreover, it only minimally burdens patients and enables assessment of the effect of decompression or treatment. It seems that this method might be useful also in the assessment of ascites caused by other factors, but this requires further clinical studies.
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Affiliation(s)
- Piotr Szkodziak
- 3rd Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Piotr Czuczwar
- 3rd Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Filip Szkodziak
- Student Study Group at the 3rd Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Tomasz Paszkowski
- 3rd Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Hugo Rio Tinto
- Radiology Department, Champalimaud Foundation, Lisbon, Portugal
| | - Sławomir Woźniak
- 3rd Department of Gynecology, Medical University of Lublin, Lublin, Poland
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Czuczwar P, Wozniak S, Szkodziak P, Kudla MJ, Pyra K, Paszkowski T. Elastography Improves the Diagnostic Accuracy of Sonography in Differentiating Endometrial Polyps and Submucosal Fibroids. J Ultrasound Med 2016; 35:2389-2395. [PMID: 27629761 DOI: 10.7863/ultra.15.12017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/18/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To assess whether strain elastography may be used to visualize the different stiffness of endometrial polyps and submucosal fibroids. METHODS We conducted a prospective monocentric single-operator study on diagnostic accuracy. Patients who qualified for hysteroscopy because of suspected endometrial polyps and submucosal fibroids were included. Before the procedure, all patients underwent routine sonographic and power Doppler examinations. Additionally, the stiffness of intrauterine lesions was assessed by strain elastography. The enhancement was adjusted to visualize hard myometrium and soft endometrium around the intrauterine lesion. Due to their histologic structure, we assumed that on strain elastography, endometrial polyps should appear as soft lesions, whereas submucosal fibroids should appear as hard lesions. Sonographic, power Doppler, and elastographic findings were verified by pathologic examinations after hysteroscopies. The diagnostic accuracy of sonography, power Doppler imaging, and strain elastography was compared by the McNemar test. RESULTS Forty-seven patients were included and underwent hysteroscopy. In 29 cases, endometrial polyps were found, and in 18, submucosal fibroids were found. The diagnostic accuracy rates for B-mode sonography, power Doppler imaging, and strain elastography in distinguishing endometrial polyps and submucosal fibroids were 70.2%, 65.9%, and 89.4%, respectively. The proportion of correct findings was significantly higher for strain elastography than for B-mode sonography (P = .0265) and power Doppler imaging (P = .0153). CONCLUSIONS Strain elastography complements sonography in differentiating intrauterine lesions. Strain elastography may be used to visualize the different stiffness of endometrial polyps and submucosal fibroids.
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Affiliation(s)
- Piotr Czuczwar
- Third Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Slawomir Wozniak
- Third Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Piotr Szkodziak
- Third Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Marek J Kudla
- Department of Obstetrics and Gynecology, Medical University of Silesia, Katowice, Poland
| | - Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Tomasz Paszkowski
- Third Department of Gynecology, Medical University of Lublin, Lublin, Poland
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Pyra K, Woźniak S, Drelich-Zbroja A, Wolski A, Jargiełło T. Evaluation of Effectiveness of Embolization in Pelvic Congestion Syndrome with the New Vascular Occlusion Device (ArtVentive EOS™): Preliminary Results. Cardiovasc Intervent Radiol 2016; 39:1122-7. [PMID: 27250353 PMCID: PMC4923086 DOI: 10.1007/s00270-016-1380-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 05/08/2016] [Indexed: 02/05/2023]
Abstract
Purpose This study aimed to collect confirmatory data in support of the safety and efficiency of the ArtVentive EOS™ for the treatment of the pelvic congestion syndrome (PCS). This study was based on the OCCLUDE 1 Study Protocol approved by the Local Ethics Committee. Materials and Methods A prospective study carried out in June and July 2014 included 12 women aged 21–48 years (mean 31 years) scheduled for PCS embolization using the ArtVentive EOS™. The inclusion criteria were clinical symptoms of PCS documented by transvaginal Doppler ultrasound and pelvic MRI. The pelvic pain was assessed by VAS score from 0 to 10 (0 represents lack of pain and 10 unbearable pain). A decrease in pelvic pain intensity based on the VAS was considered a clinical success. Results Successful embolization procedures with ArtVentive EOS™ were performed in 11 out of 12 patients. Nine patients underwent unilateral embolization of the left ovarian vein, and two had bilateral embolization of the ovarian veins. Complete ovarian vein occlusion confirmed by post deployment venography was achieved in all 11 patients. Procedures lasted from 19 to 45 min (average 28 min). Pain intensity decrease was observed in all 11 patients—a decrease of 5.6 points—from 7.3 pre-procedure to 1.6 post-embolization (standard deviation: 0.67). In one case, the left ovarian vein was injured by guide wire manipulation with contrast extravasation—not clinically significant. Conclusions The use of ArtVentive EOS™ for occlusion of the ovarian veins in PCS patients is safe and effective.
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Affiliation(s)
- Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Jaczewskiego 8 Street, 20-954, Lublin, Poland.
| | - Sławomir Woźniak
- III Gynecology Clinic, Medical University of Lublin, Jaczewskiego 8 Street, 20-954, Lublin, Poland
| | - Anna Drelich-Zbroja
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Jaczewskiego 8 Street, 20-954, Lublin, Poland
| | - Andrzej Wolski
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Jaczewskiego 8 Street, 20-954, Lublin, Poland
| | - Tomasz Jargiełło
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Jaczewskiego 8 Street, 20-954, Lublin, Poland
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Pyra K, Woźniak S, Roman T, Czuczwar P, Trojanowska A, Jargiełło T, Paszkowski T. Evaluation of effectiveness of endovascular embolisation for the treatment of pelvic congestion syndrome – preliminary study. Ginekol Pol 2015; 86:346-51. [DOI: 10.17772/gp/2420] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Jargiello T, Drelich-Zbroja A, Falkowski A, Sojka M, Pyra K, Szczerbo-Trojanowska M. Endovascular transcatheter embolization of recurrent postsurgical varicocele: anatomic reasons for surgical failure. Acta Radiol 2015; 56:63-9. [PMID: 24413222 DOI: 10.1177/0284185113519624] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Formation or pre-existence of collateral gonadal veins in varicocele patients has been reported as the main cause of surgical treatment failure. PURPOSE To describe venographic findings in patients with postsurgical recurrent varicoceles and to assess the efficacy of the following minimally invasive endovascular treatment. MATERIAL AND METHODS Thirty-three men with failed surgical treatment of left-sided varicocele were examined between 2006 and 2013, using retrograde venography to assess the anatomy of varicocele draining veins before the attempted transcatheter embolization. Anatomic variants of gonadal veins were categorized according to the classification modified for the purpose of the present study. 3% polidocanol was used as an embolic agent together with pushable fibered coils. RESULTS In 31 (93%) out of 33 patients venography demonstrated incompetence of the gonadal vein or veins draining varicoceles after failed surgical treatment. The most frequent venographic finding was gonadal vein duplication - 66% of cases (39% in its mid-portion). Technical success of embolization was achieved in all 31 patients. No major complications were observed. CONCLUSION Retrograde varicocele embolization may be superior to surgery because of its ability to detect gonadal vein variants. In our study group, transcatheter embolization with 3% polidocanol and fibered coils allowed successful, minimally invasive treatment of postsurgical varicoceles.
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Affiliation(s)
- Tomasz Jargiello
- Department of Interventional Radiology, Medical University of Lublin, Lublin, Poland
| | - Anna Drelich-Zbroja
- Department of Interventional Radiology, Medical University of Lublin, Lublin, Poland
| | - Aleksander Falkowski
- Department of Interventional Radiology, Medical University of Lublin, Lublin, Poland
| | - Michal Sojka
- Department of Interventional Radiology, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Pyra
- Department of Interventional Radiology, Medical University of Lublin, Lublin, Poland
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Woźniak S, Kłudka-Sternik M, Czuczwar P, Szkodziak P, Paszkowski T, Sczerbo-Trojanowska M, Pyra K. Uterine artery embolization using gelatin sponge particles performed due to massive vaginal bleeding caused by ectopic pregnancy within a cesarean scar: a case study. Ginekol Pol 2013; 84:966-9. [DOI: 10.17772/gp/1668] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Pyra K, Woźniak S, Szkodziak P, Paszkowski T, Sojk M, Szczerbo-Trojanowska M. [Uterine artery embolisation in massive vaginal bleeding in ectopic pregnancy--case report]. Przegl Lek 2012; 69:399-401. [PMID: 23276048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Implantation of the ovum within the scar after cesarean section is the rarest form of ectopic pregnancy. We present the case of 32-year-old patient with vaginal bleeding in 10th week of pregnancy. Missed abortion was diagnosed. Previous pregnancy was terminated by caesarean section. During hospitalization spontaneous abortion had place. The patient was qualified to curettage after which massive vaginal bleeding occurred. Ectopic pregnancy in the scar after cesarean section was diagnosed. Because of the patients age and desire to preserve fertility, embolization of the uterine artery was performed. Gelatine sponge, unstable embolic material was used. The procedure successfully stopped the bleeding. Six months after embolization patient feels well and menstruates regularly. Embolization could be a lifesaving procedure, moreover it could be an alternative for surgical treatment in young patients, who wants to save their fertility.
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Affiliation(s)
- Krzysztof Pyra
- Zakład Radiologii Zabiegowej i Neuroradiologii, Uniwersytet Medyczny w Lublinie.
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Jarzabek M, Trojanowski P, Szajner M, Pyra K, Sojka M, Szczerbo-Trojanowska M. [Epistaxis in Rendu-Osler-Weber disease treated with selective embolization--case report]. Przegl Lek 2012; 69:317-319. [PMID: 23276024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Hereditary hemorrhagic telangiectasia (HHT), known as well as Osler-Weber-Rendu syndrome (ORW disease) is autosomal dominant inheritance disease with the worldwide prevalence of 1 case per 5000-10000 population. The pathophysiology of the disease consists of disorders in the growth and migration of endothelial cells, which leads to telangiectasias and arterio-venous malformations (AVM) development. Vascular abnormalities can form in various organs. The most frequent locations are nose and mouth mucous membranes, as well as the rest of GI tract, skin, lungs, urinary system and central nervous system. The most common symptom is reccurent epistaxis (80-90% of patients). Advanced stage disease can result in extensive bleeding with dicrease in hemoglobin levels. Unfortunately, the only available treatment options for Osler-Weber-Rendu syndrom fight the symptoms, not the essential cause, and because of the rarity of the disease there are no guidelines for effective therapy. We are presenting a case of a patient suffering from recurrent episodes of nose bleeding due to hereditary hemorrhagic telangiectasia, who was successfully treated using low-invasive, intravascular arterial embolisation in interventional radiology department.
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Affiliation(s)
- Magdalena Jarzabek
- Zakład Radiologii Zabiegowej i Neuroradiologii, Uniwersytet Medyczny w Lublinie.
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Szajner M, Pyra K, Poluha P, Przyszlak M, Sojka M, Szczerbo-Trojanowska M. [Endovascular treatment of vein of galen malformation with coils and onyx--case report]. Przegl Lek 2012; 69:307-310. [PMID: 23276021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Vein of galen malformation (VOGM) is a very rare disease which affects blood vessels of the brain. In general population the incidence is estimated at 1%. Treatment of choice is transluminal embolization. We present the case of five-month-old child with low degree heart failure, hydrocephalus and significantly delayed psychomotor development. MR examination reveals a vein of Galen malformations, wall type (type I according to Yasargil) 6 cm in diameter, with venous drainage to the sinus rectus. The enlarged vein filled with thrombus. It causes brain stem compression. Angiography shows one feeder leading to the VOGM, from right posterior brain artery. Lesion was treated with two embolic materials: 5 coils and 2 ml of ONYX. Angiography confirmed total exclusion of the fistula and the circulation in the vein of Galen. One of the most important elements of treatment is to perform a proper diagnosis and evaluation of lesions morphology. With proper technique, high skills and proper equipment, intravascular embolization of vein of Galen malformation is an effective treatment.
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Affiliation(s)
- Maciej Szajner
- Zakład Radiologii Zabiegowej i Neuroradiologii, Uniwersytet Medyczny w Lublinie.
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Jarzabek M, Jargiełło T, Pyra K, Budzyńska A, Przyszlak M, Szczerbo-Trojanowska M. [Chemoembolization (DEM-TACE) in hepatocellularcarcinoma. Report of a case and review of treatment standards in advanced stage disease]. Przegl Lek 2012; 69:386-389. [PMID: 23276044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Despite, new diagnostic and treatment techniques, the wide majority of patients are still diagnosed too late and only from 5% to 10% of patients are qualified for tumour surgical resection. Up to date, treatment for advanced, inoperable liver tumors includes systemic chemotherapy, sorafenib therapy and selective, local arterial injection of chemotherapeutic drug into tumour vessels with simultaneous vessel closure - transarterial chemoembolisation (TACE). Beceause of recent development of palliative treatment techniques, the treatment guidelines are changed, especially in advanced stage disease with HCC. Unfortunately, too low percentage of patients is qualified for this type of treatment. We present a case of a patient suffering from advenced stage hepatocellular cancer treated with palliative chemoembolisation using microspheres. In whom, after treatment, regression of the tumor was observed and patient was referred to radical surgery.
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Affiliation(s)
- Magdalena Jarzabek
- Zakład Radiologii Zabiegowej i Neuroradiologii, Uniwersytet Medyczny w Lublinie.
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