Percutaneous interventions in the presacral space: CT-guided precoccygeal approach--early experience.

A computed tomography (CT)-guided, precoccygeal approach was used for interventions in the presacral space in four patients (three biopsies, one abscess drainage). Localization comprised palpation of the coccyx and measurement of the distance from the coccyx to the lesion on a prone CT scan. This approach provided an easy, straight vector to all points in the presacral space and involved no radiation exposure to the physician.

A novel second line chemotherapy treatment of recurrent thymoma.

Thymoma is an uncommon malignancy which is initially treated with surgery. Combined modality treatment with radiation and chemotherapy is utilized in cases of unresectable or metastatic disease. In patients with relapse, a number of different chemotherapeutic regimens have been used with varying success. The case of a male with recurrent thymoma treated with carboplatin and paclitaxel is presented and the literature reviewed. The patient responded to this novel regimen with improvement in clinical symptoms and reduction in tumor mass. This novel regimen has shown activity as second line therapy and merits further investigation as a first line treatment for patients with invasive and or metastatic thymoma.

Improved success of antegrade ureteral catheterization via the lower pole calix using a Chuang reverse curve catheter: technical note.

Although antegrade ureteral catheterization is best approached from a middle or upper middle calix for the most favorable force vector, it is occasionally necessary to use a lower pole caliceal approach. A catheter technique is described for completing antegrade ureteral catheterization via the lower pole calix when conventional catheter-guidewire combinations fail.

Arterial embolization in the management of abdominal and retroperitoneal hemorrhage.

In the field of gynecologic oncology, surgical intervention has been the traditional management of postoperative abdominal hemorrhage. Recently, arterial embolization has been reported to effectively control vaginal hemorrhage associated with gynecologic malignancy, obstetrical trauma, and hysterectomy. This study reports the use of arteriographic embolization in the management of six cases of postoperative abdominal and retroperitoneal arterial hemorrhage. Analysis of these cases provides valuable information which enhances the safety and efficacy of this procedure. Results suggest that arterial embolization, by an experienced arteriographer, should be considered early in the postoperative management of abdominal hemorrhage in gynecology and gynecologic oncology.

Ruptured hepatic artery aneurysms in a patient with systemic lupus erythematosus: case report.

Spontaneous hemorrhage caused by ruptured left hepatic artery branch aneurysms occurred in a 49-year-old man with systemic lupus erythematosus. Following evaluation by computerized tomography and angiography, transcatheter embolization of the left hepatic artery resulted in hemostasis. The various etiologies of hepatic artery aneurysms are discussed. This case demonstrates that systemic lupus erythematosus must be considered in the differential diagnosis of hepatic artery aneurysms and spontaneous hepatic hemorrhage.

Percutaneous transhepatic balloon dilatation of benign biliary strictures.

Between February 1981 and June 1984, 15 patients with benign biliary strictures were treated with percutaneous transhepatic balloon dilatation. Three of these patients had received liver transplants. The treatment began with a course of balloon dilatation therapy, after which a stent catheter was left across the stricture. Six weeks later, after duct patency had been shown by cholangiography, the stent catheter was removed from all but two patients, both of whom had intrahepatic sclerosing cholangitis. After this procedure, six patients (40%), including two liver-transplant patients, were stricture-free after one treatment for periods ranging from 27 to 56 months, and were considered to be treatment successes. Nine patients (60%) suffered stricture recurrences. In eight of these patients, the stricture was heralded by symptoms of either cholangitis or jaundice; in one patient, who was on permanent catheter drainage, the stricture was discovered only on follow-up cholangiography. All successfully treated patients had only one stricture, while all patients with more than one stricture suffered recurrences. Our data also suggest a greater responsiveness for anastomotic strictures than for non-anastomotic strictures. Of the patients with recurrences, five had symptom-free intervals of 23 months or more (up to 31 months). The fact that strictures recurred after such long periods of time underscores the importance of long-term follow-up. In view of the number of patients helped, the favorable experience with post-liver-transplantation strictures, and the lack of any major complications in our series, percutaneous biliary balloon dilatation offers a viable alternative to surgical management of benign biliary strictures.