ABSTRACT
Objective:To investigate the related factors affecting intraoperative blood loss in patients with spinal tumors undergoing preoperative selective arterial embolization.Methods:The clinical data of 90 patients with spinal tumors who underwent preoperative selective arterial embolization in the Affiliated Hospital of Jining Medical College and the Second Affiliated Hospital of Shanxi Medical University from January 2017 to December 2020 were retrospectively analyzed. The influencing factors of intraoperative bleeding were analyzed by using multiple linear regression.Results:There were statistically significant differences in intraoperative blood loss of spinal tumor patients undergoing preoperative selective arterial embolization with different blood supply abundance and the number of tumors involving vertebral body (all P < 0.05). There were no significant differences in age, gender, body mass index, interval after embolization, operation time, pathological type, tumor site, embolization degree, the number of embolized vessels, preoperative Frankel grade among different groups (all P > 0.05). Multiple linear regression analysis showed that the number of tumors involving vertebral body and tumor blood supply abundance were factors affecting intraoperative blood loss, and vertebra number and tumor blood supply were positively correlated with intraoperative blood loss (all P < 0.05). Conclusion:For patients with spinal tumors undergoing preoperative selective arterial embolization, the number of tumors involving vertebral body and the abundance of the tumor blood supply are factors affecting the amount of intraoperative bleeding.
ABSTRACT
Background: There are no standardized treatments for giant cell tumors of the bone (GCTB) in rare locations such as the spine and pelvis or for those that are inoperable and recurrent, let alone for multicentric GCTB. This study reports a novel case of multicentric GCTB treated with a promising antiangiogenic drug, apatinib, a small-molecule tyrosine kinase inhibitor. The efficacy of apatinib in the treatment of GCTB has not been reported previously. Patients and Methods: A 27-year-old female presented with two giant cell tumors of the spine and sacrum–ilium diagnosed on December 15, 2016. Surgery and selective arterial embolization (SAE) were not reasonable options for this patient, and denosumab was unavailable; therefore, the antiangiogenic drug apatinib and the osteoclast inhibitor zoledronic acid were administered. Apatinib was initially administered at a dose of 850 mg daily, which was decreased to 425 mg daily after 7 months, and then increased again to 635 mg after 11 months. The patient was prescribed a maintenance dose of 500 mg daily after 16 months. The patient reported side effects of Grades I–III nausea, vomiting, and Grades II–III hand–foot syndrome. The patient underwent SAE at 26 months, and at that time, she was switched to denosumab instead of zoledronic acid. Results: The patient showed noticeable symptomatic improvement and visibly reduced tumor size after the first month of treatment. Computed tomography in the 4th month identified a partial response based on the RECIST criteria. The patient has achieved an objective reduction in tumor size at 32 months. Conclusions: Comprehensive treatment including apatinib represents a potential new treatment strategy for inoperable GCTB, with tolerable side effects. However, further clinical trials are now necessary to confirm an effective dose and determine the efficacy and safety of apatinib in the treatment of GCTB
ABSTRACT
Resumen La tuberculosis pulmonar es una infección frecuente en nuestro medio. Generalmente se presenta con síntomas sistémicos como tos, expectoración, fiebre y diaforesis. En algunos casos puede presentarse con hemoptisis cuyo espectro va desde leve hasta masiva. Una vez iniciado el tratamiento, los síntomas de sangrado generalmente resuelven. Presentamos el caso de un paciente masculino de 38 años, con hemoptisis secundaria a una tuberculosis pulmonar, el cual a pesar del inicio del tratamiento, continuó con sangrado activo, por lo que fue llevado a embolización arterial selectiva como alternativa terapéutica con resolución del sangrado. (Acta Med Colom 2018; 43: 45-48).
Abstract Pulmonary tuberculosis is a frequent infection in our environment. It usually presents with systemic symptoms such as cough, expectoration, fever and diaphoresis. In some cases it can present with hemoptysis whose spectrum ranges from mild to massive. Once the treatment is started, the symptoms of bleeding usually resolve. The case of a 38-year-old male patient with hemoptysis secondary to pulmonary tuberculosis is presented. Despite the initiation of treatment, he continued with active bleeding, which led to selective arterial embolization as a therapeutic alternative with resolution of bleeding. (Acta Med Colom 2018; 43: 45-48).
Subject(s)
Humans , Male , Adult , Tuberculosis, Pulmonary , Signs and Symptoms , Grief , Cough , Fever , HemoptysisABSTRACT
Los angiomiolipomas renales son formaciones renales que se presentan de forma aislada o asociadas con otras patologías como esclerosis tuberosa o enfermedad de Von Hippel Lindau. Los angiomiolipomas renales se pueden presentar clínicamente con un shock hipovolémico por lesión de uno de sus vasos o con dolor abdominal por efecto masa debido a su tamaño. La resolución de los angiomiolipomas puede ser de manera programada o de urgencia, siendo las vías elegidas la nefrectomía parcial o la embolización arterial selectiva, dependiendo siempre de los recursos que se tengan y la experiencia del equipo quirúrgico.
Renal angiomyolipomas are kidney formations presented in isolation or associated with other diseases such as tuberous sclerosis or Von Hippel Lindau disease. Renal angiomyolipoma may present clinically with hypovolemic shock due to injury of one of its vessels or with abdominal pain due to mass effect because of its size. Angiomyolipomas can be resolved on scheduled basis or emergency, where the chosen ways are partial nephrectomy or selective arterial embolization, always depending on the resources you count on and the experience of the surgical team.
Subject(s)
Female , Humans , Young Adult , Kidney/surgery , Tuberous Sclerosis/complications , Tuberous Sclerosis/surgery , Angiomyolipoma/diagnosis , Angiomyolipoma/surgery , Urogenital Abnormalities/surgery , Organ Sparing Treatments , Emergencies , Sex Distribution , Hypovolemia , SepsisABSTRACT
A 39-yr-old female patient, diagnosed with tuberous sclerosis 10 years ago, presented for selective arterial embolization under general anesthesia. The symptoms of the patient were lower abdominal pain and gross hematuria. Renal arteriography showed multiple bilateral renal angiomyolipomas and ruptured aneurysms in right kidney. She had also pulmonary lymphangiomyomatosis, hepatic angiomyolipomas, and multiple subependymal nodules without mass effect in brain. We report the anesthetic management of this case with tuberous sclerosis for selective arterial embolization under general anesthesia.
Subject(s)
Female , Humans , Abdominal Pain , Anesthesia , Anesthesia, General , Aneurysm, Ruptured , Angiography , Angiomyolipoma , Brain , Hematuria , Kidney , Lymphangioleiomyomatosis , Tuberous SclerosisABSTRACT
Laparoscopic cholecystectomy has recently been accepted as a procedure of choice for treating cholelithiasis. Its complication rates were known to be comparable to classical cholecystectomy. Hemobilia is very rare after cholecystectomy but is one of the lethal complications that may occur weeks to months after the operation. Therefore, it is important to keep in mind that hemobilia due to communications between cystic duct and cystic artery or right hepatic artery pseudoaneurysms, can occur in the patients who have history of laparoscopic cholecystectomy when they have upper gastro-intestinal bleeding. Selective hepatic arteriography can be an important diagnostic and therapeutic modality having high success rate (81-96%). We report a case of hemobilia caused by cystic artery pseudoaneurysm following laparoscopic cholecystectomy which was undergone 1 month before admission, and will discuss the mechanism and the treatment of the pseudoaneurysm associated with hemobilia.
Subject(s)
Humans , Aneurysm, False , Angiography , Arteries , Cholecystectomy , Cholecystectomy, Laparoscopic , Cholelithiasis , Cystic Duct , Hemobilia , Hemorrhage , Hepatic ArteryABSTRACT
Selective arterial embolization can reduce the size and pressure whtihin the nidus of the arteriovenous malformations(AVMS) and diminish the number of feeding pedicles, making subsequent surgical excision technically easier and safer, especially in those AVM patients whose lesions are judged to be inoperable or respectable with major risk. Authors have successfully and repeatedly performed selective arterial embolizations with polyvinyl alcoholfoam(PVA foam) and isobutyl-2-cyanoacrylate(IBCA) to a large AVM at the left basal ganglia, thalamus and lateral ventricles, and a large cortical AVM near right motor strip.