Arterial balloon occlusion of the internal iliac arteries for treatment of life-threatening massive postpartum haemorrhage: a series of 15 consecutive cases.

OBJECTIVE: To evaluate arterial balloon occlusion of the internal iliac arteries for treatment of life-threatening massive postpartum haemorrhage. STUDY DESIGN: Retrospective cohort study at a tertiary referral perinatal centre in a teaching hospital in the Netherlands. All patients who delivered in our hospital between January 1998 and January 2008 were included in the study. A retrospective analysis of all cases of postpartum haemorrhage was performed. All 15 consecutive cases of massive postpartum haemorrhage were selected from an electronic database. The patients with massive postpartum haemorrhage (blood loss>5000 ml) and the patients with postpartum haemorrhage treated with arterial balloon occlusion of internal iliac arteries were analyzed. RESULTS: In the study period 1246 (7%) of all 17,308 deliveries were complicated by postpartum haemorrhage. 15 (0.1%) patients suffered from massive postpartum haemorrhage. They were all treated with balloon occlusion of the internal iliac arteries. Hysterectomy was performed in 4 patients. All patients survived without any complications. CONCLUSION: Arterial balloon occlusion of the internal iliac arteries is a safe and in most cases effective procedure for treatment of massive life-threatening postpartum haemorrhage.

[A patient with vague inguinal complaints due to a leiomyosarcoma of the inferior caval vein]. / Een patiënt met vage liesklachten door een leiomyosarcoom van de v. cava inferior.

A 64-year-old male presented with progressive right-sided inguinal pain radiating to the right flank and lower back. He had noticed an infrequent altered sensibility on frontal parts of his right upper leg. Physical examination demonstrated the presence of a process in the lower abdomen. Computer tomography showed a retroperitoneal tumor with a 10 cm diameter that probably originated from the inferior caval vein (ICV). During an explorative laparotomy a tumor that was compressing the right N. genitofemoralis was radically removed together with the right kidney and the ventral wall of the ICV. The histological diagnosis was a radically removed leiomyosarcoma. Based on the clinical picture, diagnostic imaging and pathologic examination the diagnosis leiomyosarcoma ofthe ICV was confirmed. A leiomyosarcoma of the ICV is a rare tumor with atypical symptomatology and a slow growth rate often leading to a late diagnosis. Surgery is the only effective treatment. The prognosis is moderate.

[Sore throat and a swollen neck: Lemierre's syndrome until proven otherwise]. / Keelpijn en een gezwollen hals: syndroom van Lemierre totdat het tegendeel is bewezen.

Physicians seldom prescribe antibiotics to patients presenting with a combination of sore throat and feelings of malaise. However, this restrictive regimen may have a downside. Two patients, men aged 23 and 19 years, respectively, with pharyngitis developed a life-threatening syndrome following a Fusobacterium throat infection. They suffered from Lemierre's syndrome, referred to in recent literature as the 'forgotten disease'. The second patient recovered uneventfully after prompt intravenous antibiotic treatment. The first, however, succumbed following overwhelming multiple organ failure. A classical case of Lemierre's syndrome is characterised by bacterial embolisation from a clogged internal jugular vein following a sore throat. Spread of organisms may lead to sepsis and organ failure. The main pathogen is Fusobacterium necrophorum. Early recognition is essential, since prompt antibiotic treatment is usually effective. This syndrome should be suspected until proven otherwise in any patient with signs of pharyngitis, a painful swollen neck and pulmonary symptoms.

MRI for diagnosing aortic valve stenosis: a comparison study of MRI and ultrasound.

BACKGROUND: In cases when Doppler ultrasound examinations are not reliable for determining the severity of aortic valve stenosis, patients undergo a catheterisation. Cardiac magnetic resonance imaging (MRI) is a promising tool for the determination of this disease. AIM: We investigated the value of MRI as a substitute for catheterisation in such circumstances, by comparing MRI measurements with Doppler ultrasound measurements. METHODS: Five volunteers and ten patients entered this study, which was approved by the Institutional Ethics Committee. A 1.0T MRI scanner was used for cardiac MRI. On the same day, a Doppler ultrasound examination was performed. The maximum velocity and the orifice area of the aortic valve (called orifice) were compared. RESULTS: A good correlation was observed between the maximum velocity measured with MRI and that measured with ultrasound (r2=0.95) and between the orifice determined by MRI and by ultrasound (r2=0.94); however, the orifice determined by MRI is consistently larger than the orifice determined by ultrasound. CONCLUSION: MRI measurements of velocity and orifice of the aortic valve correlate well with Doppler ultrasound measurement. MRI is a useful diagnostic tool and can be a good substitute for catheterisation, in particular because it allows simultaneous acquisition of anatomical and functional information.