1
|
Saito R, Amemiya H, Hosomura N, Kawaida H, Shoda K, Furuya S, Akaike H, Kawaguchi Y, Inoue S, Kono H, Ichikawa D. Intended preoperative trans-arterial embolization for large hepatocellular carcinoma: a retrospective cohort study. World J Surg Oncol 2022; 20:90. [PMID: 35317819 PMCID: PMC8939167 DOI: 10.1186/s12957-022-02563-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Received: 09/13/2021] [Accepted: 03/11/2022] [Indexed: 12/11/2022] Open
Abstract
Background Generally, a large tumor size of hepatocellular carcinoma (HCC) is associated with poor visibility and uncertainty in the surgical field which results in increased surgical difficulty as well as unfavorable postoperative outcomes. We performed intended preoperative trans-arterial embolization (TAE) in patients with a large HCC. In this study, we investigated the oncological significance of intended preoperative TAE for a large HCC, using a comparison between patients with and without TAE, and detailed analyses for pre- and post-TAE status. Methods A total of 411 patients who underwent hepatectomy for primary HCC at the University of Yamanashi Hospital between January 2007 and December 2018 were included in this study. The patients were divided into two groups: patients with larger HCCs (≥50 mm, n=51) and those with smaller HCC (<50 mm, n=360) according to the size of their HCCs. Comparison of clinicopathological features between these groups and clinical outcomes between the TAE and non-TAE groups were compared. In addition, a detailed analysis of each case in the TAE group was conducted, comparing clinicopathological factors between pre- and post-TAE status. Results The clinical unfavorable short- and long-term outcomes of patients with large HCCs (≥50 mm) were revealed compared to those with small HCCs (<50 mm). The prognostic analyses showed that a large tumor size and increased tumor markers, multiple tumor numbers, and others were adverse prognostic factors, and vascular invasions and residual tumors were included in the multivariate analysis. Further detailed analyses revealed that the average rates of change in tumor size and tumor shrinkage after TAE were − 48.6±35.6 mm and − 30.7±17.0%, respectively. Pathological high necrotic changes in the tumor, after multiple-times TAE aiming to a better effect, were related to a better prognosis in patients with large HCC. Poor prognostic factors became less common in patients who underwent intended preoperative TAE, and these patients had better prognoses. Conclusions The large tumor size of HCC is associated with unfavorable outcomes; the intended preoperative TAE for large HCC patients performed multiple times aiming to affect the tumor as much as possible might improve their prognoses.
Collapse
Affiliation(s)
- Ryo Saito
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 4093898, Japan
| | - Hidetake Amemiya
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 4093898, Japan
| | - Naohiro Hosomura
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 4093898, Japan
| | - Hiromichi Kawaida
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 4093898, Japan
| | - Katsutoshi Shoda
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 4093898, Japan
| | - Shinji Furuya
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 4093898, Japan
| | - Hidenori Akaike
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 4093898, Japan
| | - Yoshihiko Kawaguchi
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 4093898, Japan
| | - Shingo Inoue
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 4093898, Japan
| | - Hiroshi Kono
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 4093898, Japan
| | - Daisuke Ichikawa
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 4093898, Japan.
| |
Collapse
|
2
|
Hindsø L, Riis RGC, Hölmich P, Petersen MM, Nielsen MB, Lönn L, Taudorf M. Current Status of Trans-Arterial Embolization in Pain Management of Musculoskeletal Inflammatory Conditions - An Evidence-Based Review. Cardiovasc Intervent Radiol 2021; 44:1699-1708. [PMID: 34476578 DOI: 10.1007/s00270-021-02948-5] [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: 06/16/2021] [Accepted: 08/10/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To summarize the literature on trans-arterial embolization in inflammatory musculoskeletal conditions, focusing on efficacy and safety. MATERIALS AND METHODS PRISMA guidelines were followed. A systematic literature search revealed 19 studies, with a total of 394 participants, eligible for inclusion. RESULTS The included studies consisted of case reports/series and non-randomized interventional studies, with knee osteoarthritis and adhesive capsulitis of the shoulder as the most frequent conditions. In all studies except one, pain was reduced up to four years after treatment. All adverse events were transient. Due to high heterogeneity, meta-analysis was not possible. CONCLUSION The included early studies showed encouraging results regarding efficacy and safety. However, randomized, placebo-controlled trials are warranted.
Collapse
Affiliation(s)
- Louise Hindsø
- Department of Radiology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. .,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark.
| | | | - Per Hölmich
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark.,Department of Orthopedic Surgery, Amager-Hvidovre Hospital, Kettegård Alle 30, 2650, Hvidovre, Denmark
| | - Michael Mørk Petersen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark.,Department of Orthopedic Surgery, Rigshospitalet, Inge Lehmanns Vej 6, 2100, Copenhagen, Denmark
| | - Michael Bachmann Nielsen
- Department of Radiology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - Lars Lönn
- Department of Radiology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - Mikkel Taudorf
- Department of Radiology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| |
Collapse
|
3
|
Furuta T, Nakagawa I, Park H, Nakase K, Yokoyama S, Kotsugoi M, Takeshima Y, Nakase H. Thoracolumbar intraosseous spinal epidural arteriovenous fistulas after vertebral compression fracture: A case report and literature review. Surg Neurol Int 2021; 12:270. [PMID: 34221601 PMCID: PMC8247718 DOI: 10.25259/sni_349_2021] [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] [Received: 04/09/2021] [Accepted: 04/30/2021] [Indexed: 11/27/2022] Open
Abstract
Background: The pathophysiology of spinal epidural arteriovenous fistulas (SEAVFs) with perimedullary venous drainage remains to be elucidated. This report describes a case of intraosseous SEAVF in a patient with a history of a thoracolumbar vertebral fracture at the same level 10 years before presenting with progressive myelopathy secondary to retrograde venous reflux into the perimedullary vein. Case Description: A 71-year-old man presenting with progressive paraparesis was diagnosed with a SEAVF involving a previous Th12 and L1 vertebral compression fracture on which feeders from multiple segmental arteries converged. The interesting feature of this case was that the fistula was located in the fractured vertebral body. The fistula was totally obliterated by transarterial embolization of the segmental arteries followed by symptom improvement. Conclusion: We presented a rare case of an intraosseous SEAVF secondary to a thoracolumbar compression fracture with perimedullary venous reflux causing progressive myelopathy. The fistula was located in the fractured vertebral body.
Collapse
Affiliation(s)
- Takanori Furuta
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - HunSoo Park
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Kenta Nakase
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Shohei Yokoyama
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Masashi Kotsugoi
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | | | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| |
Collapse
|
4
|
Faiella E, Santucci D, Bernetti C, Schena E, Pacella G, Zobel BB, Grasso RF. Combined trans-arterial embolisation and microwave ablation for the treatment of large unresectable hepatic metastases (>3 cm in maximal diameter). Int J Hyperthermia 2021; 37:1395-1403. [PMID: 33342310 DOI: 10.1080/02656736.2020.1849823] [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: 10/22/2022] Open
Abstract
PURPOSE To assess the safety and efficacy of a two-step single-session procedure, combining transarterial embolization (TAE) and percutaneous microwave ablation (MWA), in the treatment of > 3 cm unresectable liver metastases. We also compared the final volume obtained by the two techniques (VE-T) and the expected ablation volume of the stand-alone MWA (VT). METHODS From January 2015 to December 2017, 22 consecutive patients, with a total of 24 unresectable hepatic metastases >3 cm in diameter underwent a two-step single-session combined treatment of TAE and MWA. Follow-up computed tomography scans were performed at 1-, 3-, 6-, 12, and 24 months post-procedure. VE-T as final ablation volume induced by the combined treatment (TAE-MWA), VN as initial nodule volume, VT as expected ablation volume of MWA treatment alone were evaluated and compared. RESULTS Tumor dimensions ranged from 32 to 73 mm. Technical success was achieved in all treated tumors with no local tumor recurrence. Final ablation volumes ranged from 50 to 450 cm3 and the short-axis diameter of the ablation zone ranged from 12 to 48 mm. The mean ΔV increment in the final ablation volume with respect to the stand-alone MWA was 196% (ranging from 25 cm3 - 210 cm3) (p < 0.05). The VE-T mean was four times the VN mean, while the VT mean was about twice the VN mean. No recurrence and only one case of post-embolization bleeding were observed. CONCLUSIONS This study demonstrated the safety and efficacy of a combined two-step single-session TAE-MWA treatment of unresectable hepatic metastases > 3 cm in diameter.
Collapse
Affiliation(s)
- Eliodoro Faiella
- Department of Radiology, Campus Bio-Medico University, Rome, Italy
| | | | | | - Emiliano Schena
- Center for Integrated Research, University Campus Bio-Medico di Roma, Rome, Italy
| | | | | | | |
Collapse
|
5
|
de Freitas RK, Monsignore LM, Castro-Afonso LHD, Nakiri GS, Elias-Junior J, Muglia VF, Scarpelini S, Abud DG. Transarterial embolization with n-butyl cyanoacrylate for the treatment of active abdominopelvic bleeding in the polytraumatized patient. CVIR Endovasc 2021; 4:39. [PMID: 33956262 PMCID: PMC8102658 DOI: 10.1186/s42155-021-00222-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Received: 11/28/2020] [Accepted: 03/22/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE An increasing number of polytraumatized patient presenting with active abdominal pelvic bleeding (APB) have been treated by endovascular selective embolization. However, reports on evaluate the efficacy, safety and complications caused by this technique have been limited. The aim of this study was to assess the safety and efficacy of embolization of APB using N-butyl cyanoacrylate glue (NBCA). MATERIALS AND METHODS Single center retrospective study, that included consecutive 47 patients presenting with traumatic APB treated by embolization with NBCA between January 2013 and June 2019. The efficacy endpoint was defined as the absence of contrast extravasation immediately after procedure and clinical stabilization in the following 24 h after procedure. Clinical stabilization was defined as no rebleeding after embolization or the need for a surgical approach until the patient is discharged. Safety endpoint were any technical or clinical complications related to the embolization procedure. RESULTS The mean age of patients was 38.6 years (3-81), with a predominance of males (87.2%). The major causal factor of APB being involvement in a car accident, accounting for 68% of cases. Of the 47 cases, 29.8% presented pelvic trauma and the remaining (70.2%) presented abdominal trauma. The efficacy rate was 100%, while no complications related to the procedure were observed. The mortality rate was 14.8% (7/47) due to neurologic decompensation and other clinical causes. CONCLUSION Endovascular embolization of traumatic abdominopelvic bleedings appear to be a highly safe and effective treatment, while avoiding emergent exploratory open surgeries.
Collapse
Affiliation(s)
- Rafael Kiyuze de Freitas
- Division of Interventional Radiology, Department of Radiology, Hematology and Oncology, Medical School of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP 14048-090 Brazil
| | - Lucas Moretti Monsignore
- Division of Interventional Radiology, Department of Radiology, Hematology and Oncology, Medical School of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP 14048-090 Brazil
| | - Luis Henrique de Castro-Afonso
- Division of Interventional Radiology, Department of Radiology, Hematology and Oncology, Medical School of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP 14048-090 Brazil
| | - Guilherme Seizem Nakiri
- Division of Interventional Radiology, Department of Radiology, Hematology and Oncology, Medical School of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP 14048-090 Brazil
| | - Jorge Elias-Junior
- Division of Abdominal Radiology, Department of Radiology, Hematology and Oncology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Valdair Francisco Muglia
- Division of Abdominal Radiology, Department of Radiology, Hematology and Oncology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Sandro Scarpelini
- Division of Emergency Surgery, Department of surgery and anatomy, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Daniel Giansante Abud
- Division of Interventional Radiology, Department of Radiology, Hematology and Oncology, Medical School of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP 14048-090 Brazil
| |
Collapse
|
6
|
Jin Z, Xiang YW, Liao QS, Yang XX, Wu HC, Tuo BG, Xie R. Massive gastric bleeding - perforation of pancreatic pseudocyst into the stomach: A case report and review of literature. World J Clin Cases 2021; 9:389-395. [PMID: 33521106 PMCID: PMC7812897 DOI: 10.12998/wjcc.v9.i2.389] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/11/2020] [Accepted: 11/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pancreatic pseudocyst may cause serious gastrointestinal complications including necrosis, infection, and perforation of the gastrointestinal tract wall, but massive gastric bleeding is very rare.
CASE We report a rare case of a 49-year-old man with life-threatening gastric bleeding from a pseudoaneurysm of the splenic artery perforating the stomach induced by pancreatic pseudocyst. During hospitalization, gastroscopy revealed a bare blood vessel in an ulcer-like depression of the greater gastric curvature, and computed tomography scan confirmed a pancreatic pseudocyst invading part of the spleen and gastric wall of the greater curvature. Arteriography showed that the bare blood vessel originated from a pseudoaneurysm of the splenic artery. The bleeding was controlled by the trans-arterial embolization, the patient’s recovery was rapid and uneventful.
CONCLUSION Massive gastrointestinal bleeding could be a rare complication of pancreatic pseudo aneurysm.
Collapse
Affiliation(s)
- Zhe Jin
- Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Yi-Wei Xiang
- Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Qiu-Shi Liao
- Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Xiao-Xu Yang
- Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Hui-Chao Wu
- Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Bi-Guang Tuo
- Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Rui Xie
- Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| |
Collapse
|
7
|
Liu CH, Kuo SM, Gao HW, Hsu YJ. A rat toxicological study of intra-arterial injection of Tirapazamine, a hypoxia-activating Cancer therapeutic agent, followed by hepatic artery ligation. Invest New Drugs 2021; 39:747-55. [PMID: 33428079 DOI: 10.1007/s10637-020-01057-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/20/2020] [Indexed: 11/27/2022]
Abstract
Background Tirapazamine's (TPZ) tolerability after an intra-arterial (IA) injection remains unclear. We investigated TPZ's safety and tolerability in rats by first injecting into the left hepatic artery and then performing a hepatic artery ligation, which recapitulates the transarterial embolization used clinically. Research design and methods: Forty-six rats in five groups were respectively injected with 0, 0.25, 0.50, 1.0, or more than 1.5 mL IA of TPZ (0.7 mg/mL) into the left hepatic artery and then subjected to hepatic artery ligation under laparotomy. Blood samples were collected four times daily up to day 15 after which the rats were euthanized and necropsied. The toxicity profile of IA injection of TPZ followed by hepatic artery ligation was then assessed. Results No significant changes to the rats' body weight and serum total bilirubin were observed. Serum alanine aminotransferase (ALT) levels increased slightly but remained below 100 U/L one day after treatment for most rats. Three rats in Groups 3 and 4 exhibited an over two-fold transient elevation of ALT. All ALT recovered to the baseline at day 14. Liver tissues were collected on day 15 using H&E staining. One rat in Group 3 showed ischemic coagulative necrosis in its liver tissue. Other sporadic pathological changes not related to TPZ doses were observed in Groups 2, 3, 4, and 5. Conclusion TPZ by IA injection followed by embolization is tolerated up to 7 mg/kg. This finding supports the strategy of administering an IA injection of TPZ followed by trans-arterial embolization to the liver.
Collapse
|
8
|
Choi C, Lim H, Kim MJ, Lee BY, Kim SY, Soh JS, Kang HS, Moon SH, Kim JH. Relationship between angiography timing and angiographic visualization of extravasation in patients with acute non-variceal gastrointestinal bleeding. BMC Gastroenterol 2020; 20:426. [PMID: 33317472 PMCID: PMC7737270 DOI: 10.1186/s12876-020-01570-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 12/04/2020] [Indexed: 12/17/2022] Open
Abstract
Background Angiographic embolization is now considered the first-line therapy for acute gastrointestinal (GI) bleeding refractory to endoscopic therapy. The success of angiographic embolization depends on the detection of the bleeding site. This study aimed to identify the clinical and procedural predictors for the angiographic visualization of extravasation, including angiography timing, as well as analyze the outcomes of angiographic embolization according to the angiographic visualization of extravasation. Methods The clinical and procedural data of 138 consecutive patients (mean age, 66.5 years; 65.9% men) who underwent angiography with or without embolization for acute non-variceal GI bleeding between February 2008 and July 2018 were retrospectively analyzed. Results Of the 138 patients, 58 (42%) had active extravasation on initial angiography and 113 (81.9%) underwent embolization. The angiographic visualization of extravasation was significantly higher in patients with diabetes (p = 0.036), a low platelet count (p = 0.048), high maximum heart rate (p = 0.002) and AIMS65 score (p = 0.026), upper GI bleeding (p = 0.025), and short time-to-angiography (p = 0.031). The angiographic embolization was successful in all angiograms, with angiographic visualization of extravasation (100%). The clinical success of patients without angiographic visualization of extravasation (83.9%) was significantly higher than that of patients with angiographic visualization of extravasation (65.5%) (p = 0.004). In multivariate analysis, the time-to-angiography (odds ratio 0.373 [95% CI 0.154–0.903], p = 0.029) was the only significant predictor associated with the angiographic visualization of extravasation. The cutoff value of time-to-angiography was 5.0 h, with a sensitivity and specificity of 79.3% and 47.5%, respectively (p = 0.012). Conclusions Angiography timing is an important factor that is associated with the angiographic visualization of extravasation in patients with acute GI bleeding. Angiography should be performed early in the course of bleeding in critically ill patients.
Collapse
Affiliation(s)
- Chungjo Choi
- Department of Internal Medicine, University of Hallym College of Medicine, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170-gil, Dongan-gu, Anyang, 431-796, Republic of Korea
| | - Hyun Lim
- Department of Internal Medicine, University of Hallym College of Medicine, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170-gil, Dongan-gu, Anyang, 431-796, Republic of Korea.
| | - Min-Jeong Kim
- Department of Radiology, University of Hallym College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Bo Young Lee
- Department of Internal Medicine, University of Hallym College of Medicine, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170-gil, Dongan-gu, Anyang, 431-796, Republic of Korea
| | - Sung-Yeun Kim
- Department of Internal Medicine, University of Hallym College of Medicine, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170-gil, Dongan-gu, Anyang, 431-796, Republic of Korea
| | - Jae Seung Soh
- Department of Internal Medicine, University of Hallym College of Medicine, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170-gil, Dongan-gu, Anyang, 431-796, Republic of Korea
| | - Ho Suk Kang
- Department of Internal Medicine, University of Hallym College of Medicine, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170-gil, Dongan-gu, Anyang, 431-796, Republic of Korea
| | - Sung Hoon Moon
- Department of Internal Medicine, University of Hallym College of Medicine, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170-gil, Dongan-gu, Anyang, 431-796, Republic of Korea
| | - Jong Hyeok Kim
- Department of Internal Medicine, University of Hallym College of Medicine, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170-gil, Dongan-gu, Anyang, 431-796, Republic of Korea
| |
Collapse
|
9
|
Ueda T, Murata S, Saito H, Miki I, Yasui D, Sugihara F, Shimizu W, Kumita SI. Balloon-assisted Transcatheter arterial embolization using N-butyl cyanoacrylate for iatrogenic arterial bleeding by groin puncture: a new technology. CVIR Endovasc 2020; 3:42. [PMID: 32830301 PMCID: PMC7443418 DOI: 10.1186/s42155-020-00132-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/18/2020] [Indexed: 12/02/2022] Open
Abstract
Background Balloon-assisted transcatheter arterial embolization (TAE) using n-butyl cyanoacrylate (NBCA) and lipiodol (Lp) mixture is a new endovascular treatment technique for iatrogenic arterial bleeding by groin puncture. It is less invasive compared to surgical repair, and NBCA migration into the circulation can be prevented by temporary balloon occlusion of the parent artery without ultrasound-guidance. This study aimed to report on the technical aspects and evaluate the efficacy and safety of fluoroscopically guided balloon-assisted transcatheter arterial embolization using NBCA for iatrogenic arterial bleeding by groin puncture. Materials and methods The study included five patients (mean age 54.6 years; 3 male and 2 female) with iatrogenic arterial bleeding by groin puncture. We performed transcatheter arterial embolization using NBCA while occluding the responsible artery with a balloon catheter during the embolization to prevent NBCA migration. Two sheaths were inserted into the common femoral artery. A microcatheter was advanced into the pseudoaneurysm or extravasation via the contralateral sheath. A balloon catheter was advanced into the responsible artery until the balloon portion covered the leakage site via another sheath. After balloon inflation, the NBCA and Lip mixture was slowly injected until the pseudoaneurysm, or the extravasation was filled without touching the balloon. The microcatheter was removed immediately after the filling. We assessed technical success, overall success, and complications. Results The injured arteries were the external iliac artery (n = 1), the common femoral artery (n = 2), and the proximal portion of the superficial femoral artery (n = 2). NBCA was injected once in four cases and twice in one case where complete hemostasis could not be achieved with one injection. The technical and overall success rate was 100% with no complications, including distal embolization of NBCA. Conclusions Balloon-assisted TAE using NBCA is a feasible, effective, and safe treatment for iatrogenic arterial bleeding by groin puncture. It may also be applicable in other arterial bleeding situations where the potential risk of distal embolization can be decreased by applying the balloon-assisted technique.
Collapse
Affiliation(s)
- Tatsuo Ueda
- Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
| | - Satoru Murata
- Center for Interventional Radiology, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara-City, Chiba, 299-0011, Japan
| | - Hidemasa Saito
- Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Izumi Miki
- Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Daisuke Yasui
- Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Fumie Sugihara
- Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Shin-Ichiro Kumita
- Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| |
Collapse
|
10
|
Micallef S, Cortis K, Magri C. Hepatic Necrosis after Trans-Arterial Embolization of Metastatic Neuroendocrine Tumour. Eur J Case Rep Intern Med 2020; 7:001530. [PMID: 32399442 PMCID: PMC7213831 DOI: 10.12890/2020_001530] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/03/2020] [Indexed: 11/21/2022] Open
Abstract
Liver metastases from neuroendocrine tumours (NETs) are usually seen on cross-sectional imaging at presentation. In such cases, curative surgical resection is usually not possible given that most patients have bilobar disease. Various locoregional approaches are now widely available that enable local control of disease and management of systemic symptoms. These include trans-arterial embolization (TAE), trans-arterial chemoembolization (TACE), selective internal radiotherapy and thermal ablation. We describe a rare case of hepatic necrosis after TAE in a 61-year-old woman with a metastatic NET. Cross-sectional imaging showed extensive necrosis affecting segments VII and VIII of the liver. This occurred secondary to thrombosis in the portal vein branches to these segments, confirmed on a Doppler ultrasound scan. The mechanism of portal vein thrombosis after TAE could be due to the presence of occult arterioportal anastomoses. These allow transit of the embolizing agents into the portal vein branches supplying the treated segments and subsequent thrombosis.
Collapse
Affiliation(s)
- Sarah Micallef
- Department of Medicine, Mater Dei Hospital, Msida, Malta
| | - Kelvin Cortis
- Department of Radiology, Mater Dei Hospital, Msida, Malta
| | - Claude Magri
- Department of Oncology, Sir Anthony Mamo Oncology Centre, Msida, Malta
| |
Collapse
|
11
|
Choi CJ, Lim H, Kim DS, Jeong YS, Park SY, Kim JE. Massive Duodenal Bleeding after the Migration of Endovascular Coils into the Small Bowel. Clin Endosc 2019; 52:612-615. [PMID: 31104455 PMCID: PMC6900307 DOI: 10.5946/ce.2019.020] [Citation(s) in RCA: 5] [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: 12/28/2018] [Accepted: 02/17/2019] [Indexed: 11/29/2022] Open
Abstract
Among gastrointestinal emergencies, acute upper gastrointestinal bleeding remains a challenging clinical problem owing to significant patient morbidity and costs involved in management. Endoscopic hemostatic therapy is the mainstay of treatment and decreases the incidence of re-bleeding, the need for surgery, morbidity, and mortality. However, in 8%–15% of patients with upper gastrointestinal bleeding, endoscopic hemostatic therapy does not successfully control bleeding. Trans-arterial coil embolization is an effective alternative treatment for endoscopic hemostatic failure; however, this procedure can induce adverse outcomes, such as non-target vessel occlusion, vessel dissection and perforation, and coil migration. Coil migration is rare but causes severe complications, such as re-bleeding and bowel ischemia. However, in most cases, coil migration is local and involves spontaneous healing without serious complications. Here, we report the case of a patient who underwent trans-arterial coil embolization of the gastroduodenal artery with the purpose of controlling massive duodenal bleeding, resulting in a fatal outcome caused by coil migration.
Collapse
Affiliation(s)
- Chung-Jo Choi
- Department of Internal Medicine, University of Hallym College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Hyun Lim
- Department of Internal Medicine, University of Hallym College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Dong-Suk Kim
- Department of Internal Medicine, University of Hallym College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Yong-Seol Jeong
- Department of Internal Medicine, University of Hallym College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sang-Young Park
- Department of Internal Medicine, University of Hallym College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jeong-Eun Kim
- Department of Radiology, University of Hallym College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| |
Collapse
|
12
|
Kemal Harzif A, Rei OG, Haloho A, Silvia M, Pratama G, Og Rei, MRepSc, Purwosunu Y, Og Mfm, Ph D, Wibawa A, Og Mfm, Sidipratomo P, Rad Ir, Ph D, Pandelaki J, Rad Ir, Ph D. Trans-arterial embolization of acquired uterine arteriovenous malformation after Cesarean section: A case series. Int J Reprod Biomed 2019; 17. [PMID: 31435591 PMCID: PMC6693317 DOI: 10.18502/ijrm.v17i2.3991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Received: 09/07/2017] [Revised: 03/11/2018] [Accepted: 04/26/2018] [Indexed: 11/24/2022] Open
Abstract
Background Acquired uterine arteriovenous malformation (AVM) is a rare condition due to traumatic episodes in cesarean section. The patient can suffer from life-threatening hemorrhage or recurrent vaginal bleeding. Establishing this diagnosis is difficult, often misdiagnosed due to lack of information and number of cases. Trans-Arterial Embolization (TAE) procedure is rarely performed in our center. All of the cases were found with history of massive bleeding and diagnosed lately after recurrent bleeding history. Even though promising, one of our cases failed to be managed with TAE. It is important to diagnose early symptoms of AVM in order to prevent the life threatening event. Case presentation In these case series, four cases of AVMs after cesarean procedures will be reviewed. One could be diagnosed in less than a month but the other three took several months. The symptom of vaginal bleeding might occur a few weeks after the procedure is done, and most patients need transfusion and hospitalization. Three out of four patients were initially sent to the hospital in order to recover from shock condition, and one patient was sent for a diagnostic procedure. AVMs diagnostic was established with ultrasound with or without angiography. Three of our cases were succeeded by performing TAE procedure without further severe vaginal bleeding. One case failed to be treated with embolization and had to proceed with hysterectomy. Conclusion AVM should be considered early-on in patient with abnormal uterine bleeding and history of cesarean section. Embolization is still the first-choice treatment of AVMs, otherwise definitive treatment is hysterectomy in a patient without fertility need, or impossible to perform TAE.
Collapse
Affiliation(s)
- Achmad Kemal Harzif
- Division of Immuno-Endocrinology and Fertility, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia
| | - O G Rei
- Division of Immuno-Endocrinology and Fertility, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Indonesian Reproductive Medicine Research and Training Center, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Department of Radiology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia
| | - Agrifa Haloho
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia
| | - Melisa Silvia
- Indonesian Reproductive Medicine Research and Training Center, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia
| | - Gita Pratama
- Division of Immuno-Endocrinology and Fertility, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia
| | - Og Rei
- Division of Immuno-Endocrinology and Fertility, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Indonesian Reproductive Medicine Research and Training Center, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Department of Radiology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia
| | - MRepSc
- Division of Immuno-Endocrinology and Fertility, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Indonesian Reproductive Medicine Research and Training Center, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Department of Radiology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia
| | - Yuditiya Purwosunu
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia
| | - Og Mfm
- Division of Immuno-Endocrinology and Fertility, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Indonesian Reproductive Medicine Research and Training Center, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Department of Radiology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia
| | - Ph D
- Division of Immuno-Endocrinology and Fertility, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Indonesian Reproductive Medicine Research and Training Center, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Department of Radiology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia
| | - Aria Wibawa
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia
| | - Og Mfm
- Division of Immuno-Endocrinology and Fertility, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Indonesian Reproductive Medicine Research and Training Center, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Department of Radiology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia
| | - Prijo Sidipratomo
- Department of Radiology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia
| | - Rad Ir
- Division of Immuno-Endocrinology and Fertility, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Indonesian Reproductive Medicine Research and Training Center, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Department of Radiology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia
| | - Ph D
- Division of Immuno-Endocrinology and Fertility, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Indonesian Reproductive Medicine Research and Training Center, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Department of Radiology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia
| | - Jacub Pandelaki
- Department of Radiology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia
| | - Rad Ir
- Division of Immuno-Endocrinology and Fertility, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Indonesian Reproductive Medicine Research and Training Center, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Department of Radiology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia
| | - Ph D
- Division of Immuno-Endocrinology and Fertility, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Indonesian Reproductive Medicine Research and Training Center, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.,Department of Radiology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia
| |
Collapse
|
13
|
Li CC, Li CZ, Liu CY, Gao HW, Wu ST, Cha TL, Sun GH, Yu DS, Tsao CW. Dedifferentiated liposarcoma of the left kidney: A rare case report. Urol Case Rep 2018; 21:24-26. [PMID: 30140614 PMCID: PMC6104588 DOI: 10.1016/j.eucr.2018.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 07/16/2018] [Indexed: 11/26/2022] Open
Affiliation(s)
- Chiao-Ching Li
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Chiao-Zhu Li
- Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.,Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chin-Yu Liu
- Department of Nutritional Science, Fu Jen Catholic University, New Taipei, Taiwan
| | - Hong-Wei Gao
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Sheng-Tang Wu
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tai-Lung Cha
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Guang-Huan Sun
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Dah-Shyong Yu
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Wei Tsao
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| |
Collapse
|
14
|
Tung CC, Yu JF, Lan SJ. Predictability of successful trans-arterial embolization in pelvic fracture bleeding based on patient initial presentation. Am J Emerg Med 2017; 36:1363-1366. [PMID: 29366659 DOI: 10.1016/j.ajem.2017.12.044] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 11/12/2017] [Accepted: 12/19/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Pelvic fracture bleeding generally leads to hemorrhagic shock. Trans-arterial embolization (TAE) is regarded as the most useful treatment; however, the initial presentation of the patient can impact the effectiveness of TAE for pelvic fracture bleeding. The aim of this retrospective study is to explore whether the patient data at the initial presentation can predict the success of TAE for pelvic fracture bleeding. METHODS Twenty-seven charts were retrospectively reviewed. TAE failure was defined as any patient who eventually received an exigent laparotomy or who died due to uncontrolled bleeding after TAE. For patients who received TAE, we analyzed factors recorded at the initial presentation, including age, gender, systolic blood pressure, heart rate, respiratory rate, body temperature, Glasgow coma scale (GCS) score, injury severity score (ISS) and associated injuries, using Pearson's correlation and independent t-tests. The odds ratio was used to determine the cut-off values for the patient presentation findings related to successful TAE and thus was used to assess congruity. RESULTS Successful TAE was not correlated with age or gender. The hierarchical order of statistically significant associations between successful TAE and initial presentation data was as follows: the patient's body temperature, associated injury, respiratory rate, systolic blood pressure, GCS score, and ISS. The odds ratios for all statistically significant initial presentation factors were within a 95% confidence interval. CONCLUSION The findings upon initial presentation of a patient with pelvic fracture bleeding that were related to the predictability of successful TAE include the following: hypothermia prevention with maintenance of the body temperature above 36°C, associated injuries limited to two organ systems, maintenance of the respiratory rate at approximately twenty-two breaths per minute, a sustained systolic blood pressure of approximately 90mmHg, maintenance of a heart rate of approximately one hundred beats per minute, a minor head injury with a GCS score greater than thirteen and a moderate ISS of less than twenty.
Collapse
Affiliation(s)
- Cheng-Cheng Tung
- Trauma Center, Department of Surgery, Yuan Rung Hospital, Changhua 510, Taiwan; Department of Healthcare Administration, Asia University, Taichung 413, Taiwan; General Education Center, Chienkuo Technology University, Changhua 500, Taiwan.
| | - Jei-Feng Yu
- Trauma Center, Department of Surgery, Yuan Rung Hospital, Changhua 510, Taiwan; General Education Center, Chienkuo Technology University, Changhua 500, Taiwan
| | - Shou-Jen Lan
- Department of Healthcare Administration, Asia University, Taichung 413, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 404, Taiwan.
| |
Collapse
|
15
|
Matsuda Y, Sakamoto K, Nishino E, Kataoka N, Yamaguchi T, Tomita M, Kazi A, Shinozaki M, Makimoto S. Pancreatectomy and splenectomy for a splenic aneurysm associated with segmental arterial mediolysis. World J Gastrointest Surg 2015; 7:78-81. [PMID: 26015853 PMCID: PMC4438451 DOI: 10.4240/wjgs.v7.i5.78] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 02/23/2015] [Accepted: 03/18/2015] [Indexed: 02/06/2023] Open
Abstract
Segmental arterial mediolysis (SAM) is characterized by intra-abdominal, retroperitoneal bleeding or bowel ischemia, and the etiology is unknown. A 44-year-old man complaining of abdominal pain was admitted to our hospital. He had been admitted for a left renal infarction three days earlier and had a past medical history of cerebral aneurysm with spontaneous remission. The ruptured site of the splenic arterial aneurysm was clear via a celiac angiography, and we treated it using trans-arterial embolization. Unfortunately, the aneurysm reruptured after two weeks, and we successfully treated it with distal pancreatomy and splenectomy. We recommended a close follow-up and prompt radiological or surgical intervention because SAM can enlarge rapidly and rupture.
Collapse
|