Prostatic artery embolization via inferior epigastric collateral in chronic total occlusion of the anterior division of the left internal iliac artery.

Prostatic artery embolization (PAE) is one of the new treatment therapies for lower urinary tract symptoms in male patients with benign prostatic hyperplasia. PAE is considered a minimally invasive option besides other famous traditional therapies such as transurethral resection of the prostate (TURP) and open surgery. Additionally, PAE has a specific advantage in managing the elderly group and underlying health conditions like anticoagulation. In this article, we presented the case of an 83-year-old male patient who has chronic urinary retention due to benign prostatic hyperplasia, left coronary artery stent placement, and long-term anticoagulation. The preinterventional computed tomography angiography showed chronic total occlusion of the anterior division of the left internal iliac artery. Bilateral PAE was performed successfully, and his urinary symptoms were significantly improved. Computed tomography allows for the accurate detection of prostatic anatomy and facilitates planning prostatic artery embolization.

Successful treatment of thoracic duct injury from blunt trauma.

Chylothorax is a rare condition after blunt trauma. We present a 32-year-olds man with a thoracic duct injury resulting in the right chylothorax after a motor vehicle collision. After the failure of conservative management, the patient underwent lymphangiography and successfully embolized the thoracic duct. This report emphasizes the importance of identifying thoracic duct injury in setting blunt trauma and management of this injury.

Solitary cardiac cysticercosis.

Cardiac cysticercosis is rare in clinical practice and is usually accidentally identified during cardiac surgery or autopsies. Although mostly asymptomatic, cardiac cysticercosis could present with severe clinical conditions such as myocarditis, acute myocardial infarction, and arrhythmia. We present a 51-year-old female patient who accidentally discovered a solitary mass in the myocardium. The cardiac magnetic resonance imaging revealed a nonenhanced cyst in the interventricular septum protruding into the right ventricular chamber. Because of cardiac tamponade presenting during a right ventricular endomyocardial biopsy, an emergency open-heart surgery was performed to suture the ventricular wall perforation and remove the tumor. The histopathologic report demonstrated typical cysticercosis. Cardiac cysticercosis is an uncommon lesion and may present with atypical clinical and laboratory features. Therefore, this diagnosis should be considered single or multiple cardiac cystic lesions.

The role of computed tomography in arterial injury evaluation in solid organ trauma.

BACKGROUND: Abdominal solid organ trauma accounts for 86.9% of all blunt abdominal trauma cases, among which 5%-25% of cases are associated with arterial injuries. Aim: In this study, we aimed to determine the characteristics and diagnostic functions of computed tomography (CT) scans during the diagnosis of arterial injuries, including active extravasation, pseudoaneurysm, and arteriovenous fistula associated with solid organ trauma compared with digital subtraction angiography (DSA). METHODS: From July 2019 to March 2020, a retrospective study was performed on 44 patients who presented with clinical manifestations of blunt abdominal injury and CT diagnosis of arterial injuries due to solid organ trauma, including active extravasation, pseudoaneurysm, and arteriovenous fistula, and later underwent DSA at Vietduc Hospital, in Hanoi, Vietnam. The features of arterial lesions on CT scan was described. Value of CT scan for the diagnosis of arterial injuries was analyzed compared to the DSA findings. RESULTS: There were 53 arterial lesions observed on CT scan including 15 active extravasations, 34 pseudoaneurysms, and 4 arteriovenous fistulas while 51 arterial lesions were observed on DSA including 15 active extravasations, 30 pseudoaneurysms, and 6 arteriovenous fistulas. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of active extravasation, pseudoaneurysm, and arteriovenous fistula on CT scan were 93.3%, 97.7%, 93.3%, 97.7% and 96.6% ; 90%, 75%, 79.4%, 87.5% and 82.8%; and 66.7%, 100%, 100%, 96.3% and 96.6%, respectively. CONCLUSIONS: Our study showed that CT scans had high sensitivity and specificity for the diagnosis of active extravasation; however, CT scans demonstrated low specificity for detecting pseudoaneurysm and low sensitivity for the diagnosis of arteriovenous fistula.

The Efficacy of Transanal Total Mesorectal Excision: a Preliminary Vietnamese Report.

INTRODUCTION: The e physical anatomical characteristics of Vietnamese people are similar to those of other East Asian populations, with a deep and narrow pelvis but an average body mass index (BMI) among patients at the advanced stage of rectal cancer. AIM: This study aimed to prospectively evaluate the short-term outcomes of transanal total mesorectal excision (TaTME) for rectal cancer treatment in a Vietnamese population. METHODS: A total of 64 patients who underwent TaTME were included in this study. The pelvic anatomical parameters, BMI, operative morbidities, macroscopic qualities of the mesorectal specimens, circumferential resection margins, and anal sphincter functional data were collected. The method popularized by Quirke and Kirwan's classification were used to assess to quality of the mesorectal specimens and the sphincter function, respectively. Statistical analysis was performed using SPSS 20.0. RESULTS: The mean age and BMI of the patients were 66.4 years and 20.5 kg/m2, respectively. Most patients had narrow pelvises, with mean transverse pelvic outlet diameters of 10.12 ±1.85 cm, for males, and 10.43 ± 1.32 cm, for females, and pelvic depths of 12.36 ±2.03 cm, for males, and 11.73 ±1.12 cm, for females. The mean tumor size was 5.17 ±1.62 cm. Among the mesorectal specimens, 82.8% were complete and 14.1% were nearly complete. Disease-free survival and overall survival rates were 98.2% and 100%, respectively. Sphincter functions at 12 months post-operation were rated as 30.8% Kirwan I, 42.3% Kirwan II, and 26.9% Kirwan III. CONCLUSION: TaTME surgery represents a safe and suitable option among Vietnamese patients with narrow and deep pelvises and advanced rectal tumors in the middle third and lower third of the rectum.