Our Experience with Hydrogel-Coated Trisacryl Microspheres in Uterine Artery Embolization for the Treatment of Symptomatic Uterine Fibroids and Adenomyosis: A Follow-Up of 11 Years.

Uterine artery embolization (UAE) for the treatment of symptomatic uterine fibroids and non-controllable adenomyosis symptoms is a relatively new procedure for organ-preserving therapy. These benign conditions can become symptomatic in about 30% of women between the ages of 35 and 50. The purpose of the UAE either for fibroids or adenomyosis is the elimination of blood loss, the reduction in pain, and bulky or rectal pressure symptoms. The purpose of this study is to present our experience in UAE with the use of hydrogel-coated tris acryl microspheres for the treatment of symptomatic uterine fibroids and adenomyosis.

Life Quality in Premenopausal Women after Embolization of Uterine Myomas.

Objectives: Fibroids cause significant morbidity and are the most common indication for hysterectomies worldwide, delimiting a major public health problem. Uterine artery embolization (UAE) is an alternative therapy to surgical treatment of symptomatic fibroids; it has satisfactory long-time results and is no longer considered investigational for the treatment of symptomatic fibroids. This study was undertaken to evaluate changes in fibroid specific symptom severity and health-related quality of life (HRQOL) after UAE and to optimize the assessment of safety and outcomes measures for participants who receive UAE to objective compare UAE and surgical alternatives for therapy of symptomatic fibroids. Study design: The analysis was based on questionnaires completed by 270 pre-menopausal females with a mean age of 42 years (range, 38-50 years) who underwent UAE for uterine leiomyomas and/or adenomyosis from November 2013 through December 2019. Only symptomatic women were selected whose symptoms were not improving with medication and who did not wish to have children. The primary outcome measure was a change in fibroid symptoms and HRQOL (health related quality of life) after UAE. Secondary outcomes included the decrease in uterine volume after UAE. Results: Questionnaires were completed by 270 women (100%) at a mean of 12.1 months from UAE. The median follow-up period was two years. Uterine fibroid embolization led to a shrinkage at three months for the 90% of the participants. A reduction of bleeding symptoms, pain and bulk-related symptoms was observed in 89.7%, 88.9%, and 89.5% of the patients, respectively. In the long term, there was no significant difference in parameters assessed compared with the midterm follow-up findings. A total of 6 patients (2.3%) underwent fractional curettage an average of 32.1 months after intervention due to necrotic changes in submucosal fibroids. All participants continued to be satisfied with the intervention, and 240 patients (88.9%) answered that they would recommend uterine fibroid embolization to other patients. Conclusions: Women who undergo UAE have a significant decrease in symptom severity and increase in HRQOL which is associated with high levels of satisfaction with the procedure (even when subsequent therapies are pursued).

Unsuccessful Uterine Artery Embolization Requiring Subtotal Hysterectomy: A Case Report.

INTRODUCTION: The purpose of this case report is to present the case of a 49-year-old female individual with uterine fibroids, who underwent a subtotal hysterectomy after prior unsuccessful uterine artery embolization. Uterine artery embolization is a minimally-invasive technique used as an additional option for the treatment of symptomatic fibroids. The method is a promising technique, indicated for female individuals of reproductive age wishing to preserve their uteri. CASE PRESENTATION: The patient presented symptoms of bloating and menorrhagia. Magnetic Resonance Imaging revealed uterine enlargement and elongation, with several fibroids and urinary bladder deformation caused by the enlarged uterus and the numerous fibroids compressing the uterine apex. She was referred for uterine artery embolization. In the three-year follow-up imaging, no alteration of the uterus' size was observed, while two fibroids were noted, suggesting necrosis or malignancy based on imaging findings, which led to the conduction of partial hysterectomy while leaving the cervix intact. DISCUSSION: Uterine artery embolization is regarded as a safe and successful procedure. However, in case of ineffectiveness, full or partial hysterectomy is considered as the ultimate treatment of choice. CONCLUSION: According to the available literature, uterine artery embolization is promoted to be an efficient alternative option to surgery. Patients should be offered adequate medical consultation on all the treatment options and possible complications.

Magnetic resonance imaging for early pregnancy diagnosis in the laboratory rat.

Pregnancy diagnosis and embryo counting are important end points in reproductive, developmental biology and toxicology studies. The purpose of the present study was to assess the feasibility and efficacy of magnetic resonance imaging (MRI) for early pregnancy diagnosis and embryo counting in the laboratory rat. Female Wistar rats were subjected to whole-body MRI scanning using a 1.5T MRI scanner, employing a isotropic T2-weighted 3D short-tau inversion recovery sequence from day 8 to day 12 post coitum (pc) or without prior mating, under general anaesthesia for pregnancy diagnosis and embryo counting. MRI examination was followed by laparotomy and visual inspection of the uterus to verify MRI findings. By day 8 pc, uterine bulges, characteristic of pregnancy, were depicted as oval-shaped structures of high intensity signal. By day 10 pc, embryonic vesicles were detected at the medial side of the uterine bulges. Pregnancy was diagnosed with 0% false-negative diagnosis and 100% accuracy by day 11 pc, while embryos were counted with 100% accuracy by day 12 pc. In conclusion, MRI proved to be a feasible and reliable non-invasive imaging method of early pregnancy diagnosis and embryo counting in the laboratory rat.

Gallbladder perforation. A case series and review of the literature.

INTRODUCTION: Gallbladder perforation (GBP) is an uncommon life-threatening and almost exclusive complication of cholecystitis. It is often associated with relatively high morbidity and mortality rates due to delay in diagnosis. GBP still continues to be a challenging issue for the surgeons. Most cases can only be diagnosed during surgery. The aim of this retrospective, case series was to present our clinical experience with gallbladder perforation and to provide an overview of promoting factors, clinical manifestations, diagnostic workup and management of GBP on the basis of recent literature review. PATIENTS AND METHODS: This study involved four patients with gallbladder perforation (three males and one female), who were treated in our department from May 2019 to November 2019. We made a retrospective analysis of these patients and a review of the related literature. RESULTS: According to Niemeier's classification, all patients had type II gallbladder perforation. Mean age was 70 years (range 50-85 years). They had also significant comorbidities, of which diabetes mellitus was the most common (three patients). Ultrasonography was the initial mode of investigation in these four patients. Out of the four cases, three patients underwent immediate intervention and only one patient was initially managed conservatively with intravenous antibiotics. CONCLUSIONS: Early diagnosis of gallbladder perforation and immediate intervention are of crucial importance. Clinical examination, diagnostic imaging and high index of suspicion of this severe condition would be significant in establishing an early diagnosis of the perforation. KEY WORDS: Cholecystitis, Gallbladder perforation, Niemeier.

Significance of changes in inflammatory parameters following uterine artery embolization in pre-menopausal females.

The purpose of the present study was to describe the course of changes in laboratory inflammatory markers following bilateral uterine artery embolization (UAE) as a treatment for leiomyomas and adenomyosis. The body temperature was measured and blood samples were collected to determine white blood cell (WBC) count and C-reactive protein (CRP) levels in 270 patients on the day prior to UAE and for up to 4 days post-embolization. Aside from a single case with a non-inflammatory complication, none of the other cases had any complications. Post-UAE leukocytosis with a mean maximum value of 10.8±3.5x109/l (range, 5.9-18.6x109/l) was observed one-year post-intervention. The mean leukocyte numbers were indicated to be higher on day 3 post-UAE. The CRP level was also increased post-UAE, with a mean maximum value of 7.75±3.5 mg/dl. Maximum levels were reached in 8 patients on the 2nd and in 11 patients on the 3rd post-operative day. The maximum pain score was ~5.5 and reached its lowest level at the end of the 12th week post-intervention. The present study did not consider an association between the embolic material used or uterus size with the level of treatment success. No complications were observed post-UAE; however, a significant increase in the WBC count was observed within the first 3 days, indicating mild leukocytosis.

Spontaneous rupture of a splenic artery aneurysm treated with a spleen-preserving procedure: a case report.

Splenic artery aneurysm is a rare and life-threatening condition, in case of spontaneous rupture. A rare case of such a rupture, treated successfully with an endovascular procedure, is presented. A 21-year-old man presented to the emergency department after an episode of loss of consciousness. After initial conservative treatment, he developed hemodynamic instability 12 hours later, with concurrent diffuse abdominal pain. Abdominal CT revealed a ruptured splenic artery aneurysm, which was immediately treated with coil embolization. The patient had an uneventful recovery and was discharged on the 12th day after the procedure. Although open surgery is the choice of treatment in cases of ruptured splenic artery aneurysms, endovascular embolization can also be considered a safe procedure with low complication and mortality rates.

Use of a temporary shunt to preserve the patency of a hemodialysis graft while performing ipsilateral axillo-femoral bypass.

Increased blood flow in the subclavian artery feeding a vascular access for hemodialysis can rarely induce steal phenomena in the vertebral and internal mammary artery leading to potentially life-threatening conditions. On the contrary, transient interruption of blood flow in the subclavian artery feeding a dialysis arteriovenous fistula can theoretically induce access thrombosis. Here, we describe a technical maneuver preserving continuous ipsilateral upper arm access flow when constructing a unilateral axillo-femoral polytetrafluoroethylene bypass operation for critical limb ischemia in a hemodialysis patient.

Revised Endografting for a Giant Descending Thoracic Aorta Aneurysm due to Synchronous Type III/Ib Endoleak, Causing Dysphagia.

BACKGROUND: Although surgical resection and graft replacement therapy for thoracic aortic aneurysms has advanced greatly over the last 20 years, significant perioperative morbidity and mortality still occur, particularly in patients considered high risk due to significant coexisting medical illness or previous operations performed for the treatment of intrathoracic disease. METHODS: The case described is that of a patient with a giant (13.8 cm) symptomatic descending thoracic aorta aneurysm (DTAA), previously treated endovascularly 15 years ago. The expanding aneurysm was due to undiagnosed synchronous type III/Ib endoleak resulting in chronic malnutrition and eventually dysphagia and dyspnea due to compressive symptoms of the esophagus. Besides the risk of rupture, dyspnea and dysphagia with progressive weight loss were significant indications necessitating repair. Regarding his major comorbidities, the patient was identified as high risk for open surgical repair, therefore an endovascular option was offered. Two valiant tube endografts were inserted and deployed successfully without complications. RESULTS: Postoperatively, upper gastrointestinal endoscopy imaging that was performed to the patient revealed marked persistent stenosis of the esophagus despite aneurysm pressure relief. However, at the multidisciplinary team meeting, an esophageal stenting was ruled out due to the risk of stent fracture and esophageal perforation with its devastating complications. Therefore, a conservative management was deemed appropriate for the patient taking into consideration the risks of prolonged hospitalization and malnourishment coupled with an unpredictable clinical course regarding the remission of the symptoms. Despite the slight gradual clinical improvement in the immediate postoperative period, the patient passed away at the 40th postoperative day due to hospital acquired pneumonia. CONCLUSIONS: Following endovascular repair of giant DTAA compressing the esophagus, significant symptomatic improvement should not be always expected due to the large residual thrombotic aneurysm sac. Although compression symptoms can be managed conservatively in patients deemed at high risk for esophageal perforation, postoperative course and management is of paramount importance and should be treated on an individual basis.

Ovarian reserve after fibroid embolization in premenopausal women.

OBJECTIVE: To investigate the effect of uterine artery embolization (UAE) for fibroids on ovarian pool of premenopausal women. STUDY DESIGN: Prospective case control study. MATERIAL AND METHODS: One-hundred and twenty premenopausal women, aged between 40 and 50 years, who underwent UAE for symptomatic uterine fibroids and the same number of women, aged between 40 and 50 years, with symptomatic uterine fibroids, who were not offered treatment were recruited for this study. Hormonal status and ovarian reserve were evaluated by means of anti-Müllerian hormone (AMH) and follicle stimulating hormone (FSH) pre-procedural, three months, six months and 12 months after UAE. RESULTS: No statistically significant decrease was noted in AMH values 12 months post procedure and no statistical significant alterations in AMH values between the two groups. CONCLUSIONS: Even though the study results may not be able to confirm the preservation of ovarian reserve and normal menstruation after UAE in premenopausal women, it should be considered as a friendly to normal menstruation treatment option of symptomatic fibroids.

Emergent conversion of the Ovation Stent Graft System to aortouniiliac modification via occlusion of a unilateral internal iliac artery with a stentgraft as a bailout solution.

PURPOSE: To present a case of inadvertent collapse of the contralateral limb gate caused by misorientation during the deployment of the Ovation Abdominal Stent Graft System in a narrow aortic lumen and the bailout conversion to aortouniiliac modification, using a covered stent to exclude the orifice of the internal iliac artery (IIA). TECHNIQUE DESCRIPTION: Despite the repeated efforts from the femoral and brachial site, the collapsed/occluded contralateral limb gate could not be catheterized. In order to exclude successfully the orifice of the IIA, an oversized stentgraft was placed immediately at the common-to-external iliac artery (CIA-EIA) transition followed by peripheral ligation of the latter. The procedure was completed with crossover femorofemoral bypass. CONCLUSION: Occlusion the IIA orifice with an oversized stentgraft in the CIA-EIA transition can be considered as a safe, simple, fast, and efficient bailout maneuver, followed by EIA ligation and crossover bypass.

Peripheral neuropathy electrophysiological screening in inflammatory bowel disease.

AIM: Peripheral neuropathy is often described in inflammatory bowel disease (IBD). The aim of this study was to assess the need for neurophysiological testing in IBD patients without neurological symptoms or signs to detect early subclinical neuropathy and its possible correlations with clinical and demographic characteristics. MATERIALS AND METHODS: Ninety-seven consecutive IBD patients were screened for neurological symptoms and clinical signs, and those without symptoms or signs were included. Also, patients with comorbidities associated with peripheral neuropathy or a history of neurological disease were excluded. The remaining 45 asymptomatic patients were tested electrophysiologically for peripheral nerve involvement. RESULTS: None of the examined patients showed evidence for subclinical neuropathy. CONCLUSION: IBD patients with a normal neurological clinical examination and no symptoms have no evidence for neuropathy. Therefore, proper electrophysiological testing is not considered necessary.

Currently applied cross-sectional diagnostic modalities and imaging guided interventional modalities for treatment of neuroendocrine tumors.

Technological advances in conventional cross-sectional diagnostic imaging have allowed important modalities like ultrasonography, endoscopic ultrasonography, multi-detector computed tomography, nuclear medicine single photon emission tomography, positron emission tomography and magnetic resonance imaging to exhibit an increasingly important role in the diagnosis and management of patients with neuroendocrine tumors (NET). The arterial supply of metastatic lesions provides promising treatment options through the arterial route, hence transcatheter arterial embolization has a key role in the therapeutic management of metastatic NET. The various transcatheter methods of NET treatment are discussed, including radio-embolization. Imaging-guided percutaneous interventional radiologic methods of ablation are also discussed as applicable for the effective management of primary and metastatic NET. An approach to represent the physical and technical principles on which ablative methods rely and their clinical significance has been attempted.