Six novel minimally invasive therapies for benign prostatic hyperplasia / 浙江大学学报·医学版

Benign prostatic hyperplasia (BPH) is the most common cause of lower urinary tract symptoms in men. When drug treatment is ineffective or conventional surgery is not suitable, novel minimally invasive therapies can be considered. These include prostatic urethral lift, prostatic artery embolisation, water vapor thermal therapy, Aquablation-image guided robotic waterjet ablation, temporary implantable nitinol device and prostatic stents. These novel therapies can be performed in outpatient setting under local anesthesia, with shorter operative and recovery times, and better protection of ejaculatory function and erectile function. General conditions of the patient and advantages and disadvantages of the each of these therapies should be fully considered to make individualized plans.

Embolización de la arteria renal: serie de casos y revisión de la literatura / Renal artery embolization: case series and literature review

Resumen Introducción: La embolización de arteria renal (EAR) es un procedimiento percutáneo que ocluye la arteria renal, con la consecuente isquemia del territorio vascular. Sus indicaciones más comunes son la hematuria y el manejo paliativo en cáncer renal metastásico. A pesar del desarrollo técnico y de la experiencia progresiva, los estudios incluyen un número reducido de pacientes y en nuestro país se revisan casos aislados. Objetivo: Describir la experiencia en el Servicio de Salud Valparaíso San Antonio y revisar la literatura existente. Materiales y Método: Realizamos un estudio descriptivo de los pacientes sometidos a EAR por anemia severa secundaria a hematuria, durante los años 2012 a 2020. Posteriormente, realizamos una revisión de la literatura en PubMed, hasta abril de 2020. Resultados: Incluimos 9 pacientes, 6 (66,7%) hombres y 3 (33,3%) mujeres. La mediana de edad fue de 69 años (RIC = 18). La principal causa de la hematuria fue cáncer renal avanzado (7 pacientes). No hubo complicaciones, y se logró éxito clínico en todos los pacientes. Nuestra búsqueda de literatura arrojó 571 referencias y 24 cumplieron con nuestros criterios de elegibilidad. La edad de los pacientes y las causas subyacentes de hematuria fueron variadas. La menor tasa de éxito clínico fue de 65%, sin embargo, 15 estudios (62,5%) reportaron un éxito igual o mayor al 90%. Seis estudios reportaron más de un 10% de pacientes con alguna complicación. Conclusión: Nuestros resultados y la evidencia revisada muestran que la EAR parece ser segura y eficaz en el manejo de anemia severa secundaria a hematuria.

Introduction: Renal artery embolization (RAE) is a percutaneous procedure that occludes the renal artery, with consequent ischemia of the vascular territory. The most common indications include hematuria and palliation for metastatic renal cancer. Despite technical development and progressive experience, studies include a small number of patients and few cases have been published in our country. Aim: To share our experience at Valparaíso-San Antonio Health Service and to review the existing literature. Materials and Method: We performed a retrospective descriptive review of medical records of patients with severe anemia due to hematuria managed with RAE, between 2012 and 2020. Subsequently, we conducted a literature search in PubMed, from inception until April 2020. Results: We included 9 patients. There were 6 (66.7%) males and 3 (33.3%) females with a median age of 69 years (IQR = 18). Main cause of hematuria was advanced kidney cancer (7 patients). There were no complications and clinical success was achieved in all patients. Our literature search yielded 571 references, 24 met our eligibility criteria. The age of patients and the underlying causes of hematuria were varied. The lowest clinical success rate was 65%, however, 15 studies (62.5%) reported a success equal to or greater than 90%. Six studies reported more than 10% of patients with complications. Conclusión: Our results and the studies reviewed show that RAE appears to be safe and effective in the management of patients with severe anemia due to hematuria.

Contrast-Induced Acute Kidney Injury after Coil Embolization for Aneurysmal Subarachnoid Hemorrhage

PURPOSE: Contrast-induced acute kidney injury (CI-AKI) is associated with poor outcomes after percutaneous coronary intervention. However, CI-AKI has rarely been evaluated within the neurovascular field. The aim of this study was to investigate the incidence and clinical implication of CI-AKI after coil embolization in patients with an aneurysmal subarachnoid hemorrhage (aSAH). MATERIALS AND METHODS: Between January 2005 and March 2016, 192 patients who underwent coil embolization were enrolled in this study. CI-AKI was defined as an increase from baseline serum creatinine concentration of >25% or >0.5 mg/dL within 72 hours after coil embolization. A poor clinical outcome was defined as a score of ≥3 on the modified Rankin Scale at one-year post-treatment. RESULTS: A total of 16 patients (8.3%) died as a result of medical problems within one year. CI-AKI was identified in 14 patients (7.3%). Prominent risk factors for one-year mortality included CI-AKI [odds ratio (OR): 16.856; 95% confidence interval (CI): 3.437–82.664] and an initial Glasgow Coma Scale (GCS) score ≤8 (OR: 5.565; 95% CI: 1.703–18.184). A poor clinical outcome was associated with old age (≥65 years) (OR: 7.921; 95% CI: 2.977–21.076), CI-AKI (OR: 11.281; 95% CI: 2.138–59.525), an initial GCS score ≤8 (OR 31.02; 95% CI, 10.669–90.187), and a ruptured aneurysm (p=0.016, OR: 4.278) in posterior circulation. CONCLUSION: CI-AKI seems to be an independent predictor of the overall outcomes of aSAH after endovascular treatment.

Intraventricular hemorrhage after dural fistula embolization / Hemorragia intraventricular após embolização de fístula dural

Abstract Background and objectives: Dural arteriovenous fistulas are anomalous shunts between dural arterial and venous channels whose nidus is located between the dural leaflets. For those circumstances when invasive treatment is mandatory, endovascular techniques have grown to become the mainstay of practice, choice attributable to their reported safety and effectiveness. We describe the unique and rare case of a dural arteriovenous fistula treated by transarterial embolization and complicated by an intraventricular hemorrhage. We aim to emphasize some central aspects of the perioperative management of these patients in order to help improving the future approach of similar cases. Case report: A 59-year-old woman with a previously diagnosed Cognard Type IV dural arteriovenous fistula presented for transarterial embolization, performed outside the operating room, under total intravenous anesthesia. The procedure underwent without complications and the intraoperative angiography revealed complete obliteration of the fistula. In the early postoperative period, the patient presented with clinical signs of raised intracranial pressure attributable to a later diagnosed intraventricular hemorrhage, which conditioned placement of a ventricular drain, admission to an intensive care unit, cerebral vasospasm and a prolonged hospital stay. Throughout the perioperative period, there were no changes in the cerebral brain oximetry. The patient was discharged without neurological sequelae. Conclusion: Intraventricular hemorrhage may be a serious complication after the endovascular treatment of dural arteriovenous fistula. A close postoperative surveillance and monitoring allow an early diagnosis and treatment which increases the odds for an improved outcome.

Resumo Justificativa e objetivos: Fístulas arteriovenosas durais (FAVD) são comunicações anômalas entre os canais venosos e arteriais da dura-máter cujo centro está localizado entre os folhetos da dura-máter. Para as circunstâncias nas quais o tratamento invasivo é obrigatório, as técnicas endovasculares se tornaram os pilares da prática, escolha atribuível a relatos de sua segurança e eficácia. Descrevemos o caso único e raro de uma FAVD tratada por embolização transarterial (ETA) e complicada por uma hemorragia intraventricular (HIV). Nosso objetivo foi destacar alguns aspectos centrais do manejo perioperatório desses pacientes para ajudar a melhorar uma futura abordagem de casos semelhantes. Relato de caso: Paciente do sexo feminino, 59 anos, com diagnóstico prévio de FAVD tipo IV (Cognard), apresentou-se para ETA, realizada fora da sala de cirurgia soBanestesia venosa total. O procedimento transcorreu sem complicações, e a angiografia intraoperatória revelou obliteração completa da fístula. No período pós-operatório imediato, a paciente apresentou sinais clínicos de aumento da pressão intracraniana (PIC) atribuíveis a uma HIV posteriormente diagnosticada, o que condicionou a colocação de um dreno ventricular, internação em Unidade de Terapia Intensiva (UTI), vasoespasmo cerebral e internação hospitalar prolongada. Durante todo o período perioperatório, não houve alterações na oximetria cerebral. A paciente recebeu alta sem sequelas neurológicas. Conclusão: HIV pode ser uma complicação grave após o tratamento endovascular de FAVD. A observação e o monitoramento cuidadosos no pós-operatório permitem o diagnóstico precoce e o tratamento que aumenta as chances de um resultado melhor.

Complications of Portal Vein Embolization: Evaluation on Cross-Sectional Imaging

Portal vein embolization (PVE) is known as an effective and safe preoperative procedure that increases the future liver remnant (FLR) in patients with insufficient FLR. However, some possible major complications can lead to non-resectability or delayed elective surgery that results in increased morbidity and mortality. Although the majority of these complications are rare, knowledge of the radiologic findings of post-procedural complications facilitate an accurate diagnosis and ensure prompt management. We accordingly reviewed the CT findings of the complications of PVE.

Evaluation of Arterial Impairment after Experimental Gelatin Sponge Embolization in a Rabbit Renal Model

OBJECTIVE: Arterial stenosis is a major obstacle for subsequent interventional procedures. We hypothesized that the stenosis is caused by gelatin sponge embolization and performed an experimental study in a rabbit renal model. MATERIALS AND METHODS: A total of 24 rabbits were embolized with porcine gelatin sponge particles injected into the renal arteries. Four rabbits were sacrificed on 1 day, 4 days, 1 week, 2 weeks, 3 weeks, and 4 weeks after embolization. Microscopic evaluations were performed on hematoxylin-eosin and smooth muscle actin immunohistochemical stained sections. RESULTS: Gelatin sponge particles were mainly observed in the segmental and interlobar arteries. Transmural inflammation of the embolized arterial wall and mild thickening of the media were observed 1 week after embolization. Resorption of the gelatin sponge and organization of thrombus accompanied by foreign body reactions, were observed from 2 to 4 weeks after embolization. Microscopic images of the 3 weeks group showed vessel lumens filled mostly with organized thrombi, resulting in severe stenosis. Additionally, vessels showed a thickened intima that contained migrating smooth muscle cells and accompanying interruption of the internal elastic lamina. The migrating smooth muscle cells were distributed around the recanalized arterial lumen. CONCLUSION: Gelatin sponge embolization may induce arterial stenosis by causing organized thrombus and intimal hyperplasia, which consists of migrating smooth muscle cells and intimal collagen deposits.

A anatomia e o ensino de anatomia no Brasil: a escola boveriana / Anatomy and the teaching of anatomy in Brazil: the Boverian school

A história da anatomia humana, de sua pesquisa e seu ensino no Brasil é tema pouco explorado academicamente. Observa-se a quase inexistência de uma visão mais abrangente do percurso da anatomia contextualizada pelas contingências nacionais, o que gera insegurança entre os pesquisadores que buscam aprofundar-se nessa temática, majorada pelo fato de que muitos dos dados disponíveis nem sempre se apresentam suficientemente apurados. Este texto visa retraçar o desenvolvimento da disciplina anatômica – de sua pesquisa e seu ensino no contexto paulista e nacional –, em muito sintetizada pela ação da autoproclamada escola boveriana de anatomia, fundada pelo médico italiano Alfonso Bovero, por ocasião da criação da Faculdade de Medicina da Universidade de São Paulo.

There is little scholarly research on the history, teaching and research of human anatomy in Brazil. A broader vision of the progress of anatomy under different circumstances in the country is virtually non-existent, leaving researchers keen to study the subject insecure. This is compounded by the fact that the data available are not always reliable. This text retraces the development of the discipline of anatomy and its research and education in Brazil in general and São Paulo state in particular, which can largely be reduced to the action of the self-proclaimed Boverian school of anatomy, founded by Italian physician Alfonso Bovero at the same time as the Medical Faculty of the University of São Paulo.

Embolization of splenic artery aneurysm associated with gastrointestinal bleeding: case report / Embolização de aneurisma de artéria esplênica associado à hemorragia digestiva: relato de caso

The splenic artery is the visceral vessel that is most often affected by aneurysmal disease. Occasionally, gastrointestinal bleeding may signify that the aneurysm is in communication with the digestive tract. We report on the case of a 64-year-old multiparous patient with intermittent digestive bleeding caused by a splenic artery aneurysm who was successfully treated with endovascular embolization.

A artéria esplênica é o vaso visceral mais acometido pela doença aneurismática. Ocasionalmente, um sangramento gastrointestinal pode refletir uma comunicação entre o aneurisma de artéria esplênica e o trato digestivo. Relatamos o caso de uma paciente de 64 anos com hemorragia digestiva intermitente devida a aneurisma de artéria esplênica, a qual foi submetida ao tratamento endovascular por embolização com sucesso.

Outcome and immediate complications of device occlusion of different types of patent ductus arteriosus with range of devices

The aim of our study was to report the outcome and immediate complications of PDA device closure, comparing ducts according to Krichenko classification. Quasi experimental study. Pediatric Cardiology Department of Armed Forces Institute of Cardiology / National institute of Heart Diseases [AFIC/NIHD] from 1[st] May 2012 to 30[th] Nov 2013. Total 368 consecutive cases, were included with intention of transcatheter closure of patent ductus arteriosus [PDA]. Detailed echocardiography was done before procedure. Aortogram determined duct size, length, narrowest diameter and morphology. Device attempted only after duct was considered suitable. The mean narrowest duct diameter was 4.5 +/- 2.4 mm. Out of 368 cases, five cases were considered unsuitable for device closure after aortogram. In two cases, device embolized after deployment and in one case procedure abandoned due to technical reasons. There was no cardiac perforation, tamponade or death in our study population. The success according to Krichenko duct types was 100% for type A, 100% for type B, 87.5% for type C, 100% for type D and 100% for type E. PDA device closure is a safe and effective therapeutic option in vast majority of cases. Type C tubular type ducts are more difficult to negotiate with high complication rates