Comparison of microcoils and polyvinyl alcohol particles in selective microcatheter angioembolization of non variceal acute gastrointestinal hemorrhage

To compare the efficacy of polyvinyl alcohol [PVA] particles with microcoils in angiembolisation of non variceal acute gastrointestinal haemorrhage. This is a retrospective cross-sectional study of patients who underwent transcatheter angioembolization from January, 1995 to December, 2013 at Aga Khan University Hospital, Karachi. Patients were divided into two groups on basis of use of either microcoils or PVA particles and compared in terms of technical success, clinical success, re-bleeding and ischemic complication rates. Chi [chi[2]] square and Fisher's exact tests were applied and a P-value of less than 0.05 was considered statistically significant. Fifty seven patients underwent angioembolization. Microcoil and PVA particles embolization was performed in 63% [36/57] and 35% [20/57] cases respectively. Technical success was achieved in all cases [100%]. Clinical success rate was higher in microcoils group [92%] than PVA particles group [75%] with statistically significant P value [p=0.048]. Ischemic complication was seen in one case [3%] in the microcoil group, while no such complications were seen in the PVA particles group. In angioembolization of non variceal acute gastrointestinal haemorrhage microcoils are better than Polyvinyl alcohol particles with higher clinical success and lower re-bleed rates

Abdominal tuberculosis with massive jejunal haemorrhage

Jejunum is a rare site of involvement in intestinal tuberculosis [TB] and massive lower gastrointestinal haemorrhage is an even rare reported condition. The authors report a 15-year-old female student, who presented with fever, anaemia, hypoalbunemia and developed massive lower gastrointestinal haemorrhage during hospital stay. The diagnosis of abdominal TB was established on tissue biopsy; tissue culture was positive for Mycobacterium TB. Optimal outcome was achieved with aggressive resuscitation, repeated mesenteric angio-embolization and anti-tuberculosis chemotherapy

unsuspected bleeding Meckel's diverticulum in an adult detected on mesenteric angiography

Meckel's diverticulum is usually asymptomatic and found in almost 2% of the population. Haemorrhage from Meckels diverticulum is common in children but rare in adults. Here we report a case of 20 years old male with recurrent gastrointestinal bleeding. Meckel's diverticulum was diagnosed due to abnormal vascularity on mesenteric angiography and embolization was performed. Diagnosis was correlated with other radiological imaging and later elective resection was performed. This case is reported to emphasize the potential role of mesenteric angiography in the detection and management of bleeding Meckel's diverticulum and correlation with other radiological imaging

Outcome of radiologically placed tunneled haemodialysis catheters

To study the outcome of radiologically placed double lumen tunneled haemodialysis catheters for the management of renal failure. Case series. Interventional Suite of Radiology Department at the Aga Khan University Hospital, Karachi, from April 2010 to June 2011. All consecutive patients who were referred to the department of radiology by the nephrologists for double lumen tunneled haemodialysis catheter [Permacath] placement during the study period were included. Patients with septicemia, those for whom follow-up was not available, those coming for catheter exchange or who died due to a noncatheter related condition were excluded. A radio-opaque, soft silicone double lumen catheter was inserted through a subcutaneous tunnel created over the anterior chest wall. The catheter tip was placed in the right atrium via the internal jugular vein. Ultrasound guidance was used for initial venous puncture. The rest of the procedure was carried out under fluoroscopic guidance. Technical success, catheter related bacteremia rates, adequacy of dialysis, patency, and adverse events were analyzed. Overall 88 tunneled haemodialysis catheters were placed in 87 patients. Patients were followed-up for duration of 1 - 307 days with mean follow-up period of 4 months. Immediate technical success was 100%. The procedural complication rate was 5.6% [5 catheters]. Eight patients died during the study period, seven from causes unrelated to the procedure. One patient died due to septicemia secondary to catheter related infection. Of the remaining 69 patients, 50 [72.4%] predominantly had uneventful course during the study period. Twelve patients developed infection [17.3%]; two were successfully treated conservatively while in 10 patients catheter had to be removed. Seven catheters [10.1%] failed due to mechanical problems. In 3 patients the internal jugular veins got partially thrombosed. One catheter was accidentally damaged in the ward and had to be removed. Radiological guided tunneled haemodialysis catheter placements are a safe and reasonable means of providing temporary vascular access for haemodialysis patients.

Idiopathic adult ileoileal and ileocolic intussusception in situs inversus totalis: a rare coincidence

Situs inversus totalis is a rare autosomal recessive congenital anomaly that is characterized by mirror image anatomy of the abdominal and thoracic organs. We report a case of a 28-year-old male with situs inversus totalis, who developed an idiopathic ileoileal and ileocolic intussusception, which was diagnosed on computed tomography scan. Patient underwent successfully ileal resection and side-to-side functional anastomosis of ileum 12 cms from ileocecal junction. Postoperative course was uneventful. To the best of our knowledge, this is the first case of idiopathic adult intussusception with situs inversus totalis in the literature

Uterine artery embolization for the treatment of uterine fibroids: Initial experience

To evaluate the initial results of uterine artery embolization for the treatment of symptomatic uterine fibroids in our local population. Medical records and radiological images of all patients undergoing uterine artery embolization [UAE] in Aga Khan University Hospital [AKUH] between January 2003 and December 2009 were retrospectively analyzed. Fourteen patients [Age range: 19-50 years] with sonographic diagnosis of uterine fibroids associated with menorrhagia and/or pelvic pain underwent uterine artery embolization with use of polyvinyl alcohol [PVA] particles. Single femoral access technique was used in all patients. Clinical improvement was assessed by detailed questionnaire for symptomatic improvement and follow up ultrasounds. All 14 patients underwent technically successful embolization. Five patients were lost to follow up and were not included in the final analysis. Out of remaining 9 patients, eight patients had initially presented with menorrhagia with pelvic pain while one patient had presented with menorrhagia alone. On follow up after one year menorrhagia was significantly reduced in 7 out of 9 patients [77%]. Pelvic pain was improved in 7 out of 8 patients [89%]. Majority of patients experienced post procedure pain of various intensities which was treated conservatively. One patient developed scanty periods, a known complication of this procedure. No other procedure related significant complications were seen. Uterine fibroid embolization represents a promising method of treating fibroid-related menorrhagia and pelvic pain. Further studies with larger patient population will be required for definitive results

Haemobilia: a rare cause of gastrointestinal bleeding

Iatrogenic injury to hepatic duct leading to pseudoaneurysm and haemobilia can occur following laparoscopic cholecystectomy. We report a case of a 60 years old man presenting with haematemesis found to have pseudoaneurysm of accessory hepatic artery 4 months after laparoscopic cholecystectomy. Diagnosis was made by computed tomography [CT] scan followed by celiac and mesenteric artery angiogram. The bleeding was successfully treated with coil embolization

Open pyeloplasty in adult patients with primary PUJ obstruction - experience at urology department, Nishtar hospital, Multan

To assess the clinical presentation of primary PUJ obstruction and outcome of pyeloplasty in adult patients. The study was carried out at the Department of Urology, Nishtar Hospital, Multan from June 2006 to June 2007. A total of 25 adult patients were included in the study. All patients were evaluated in terms of clinical presentation, physical examination and investigations. Different techniques of open pyeloplasty were performed in these patients. Out of 25 patients, 16 were male and 9 were females [male to female ratio was 1.8: 1]. Age of patients ranged between 13 to 45 years. All patients underwent some form of open pyeloplasty. Thirteen patients [52%] had Culp Deweerd spiral flap pyeloplasty, 10 [40%] had Anderson Hynes pyeloplasty while 2 [8%] had Foley Y-V pyeloplasty. Minor complications like superficial wound infection [4 patients, UTI [4 patients] and minor anastomotic leakage [1 patients] was seen in early postoperative period. Twenty three [92%] patients had good symptomatic relief, improvement in overall GFR and drainage across PUJ on DTPA seen at 3 months, 6 months and one year follow up. PUJ obstruction is the most common congenital abnormality of ureter, less invasive procedures are available for treatment of PUJ obstruction, but the pyeloplasty is the most effective in relief of obstruction and can be performed safely

Cerebral venous system anatomy

Cerebral venous system can be divided into a superficial and a deep system. The superficial system comprises of sagittal sinuses and cortical veins and these drain superficial surfaces of both cerebral hemispheres. The deep system comprises of lateral sinus, straight sinus and sigmoid sinus along with draining deeper cortical veins. Both these systems mostly drain themselves into internal jugular veins. The veins draining the brain do not follow the same course as the arteries that supply it. Generally, venous blood drains to the nearest venous sinus, except in the case of that draining from the deepest structures, which drain to deep veins. These drain, in turn, to the venous sinuses. The superficial cerebral veins can be subdivided into three groups. These are interlinked with anastomotic veins of Trolard and Labbe. However, the superficial cerebral veins are very variable. They drain to the nearest dural sinus. Thus the superolateral surface of the hemisphere drains to the superior sagittal sinus while the posteroinferior aspect drains to the transverse sinus. The veins of the posterior fossa are variable in course and angiographic diagnosis of their occlusion is extremely difficult. Blood from the deep white matter of the cerebral hemisphere and from the basal ganglia is drained by internal cerebral and basal veins, which join to form the great vein of Galen that drains into the straight sinus. With the exception of wide variations of basal vein, the deep system is rather constant compared to the superficial venous system. Hence their thrombosis is easy to recognize

Median survival time of patients after transcatheter chemo embolization for hepatocellular carcinoma

To determine the effect on survival after transarterial chemoembolization [TACE] in patients with unresectable hepatocellular carcinoma [HCC]. Longitudinal cohort study. Radiology Department, The Aga Khan University Hospital, Stadium Road, Karachi, from December 1997 to September 2005. Patients undergoing TACE procedure for HCC were prospectively followed. Fortythree patients were enrolled from December 1997 to March 2003 in the study and subjected to chemoembolization therapy. Eight out of 43 patients were excluded from the study, who lost to follow-up. All the patients were followed till their death. Median and mean survival were calculated. The median survival of these 35 patients was 410 days [13.6 months], with 95% confidence interval [236 days lower bound and 536 days upper bound]. Mean survival time was 603 days [20.1 months] with 95% confidence interval [394 days lower bound and 812 days upper bound]. There was significant difference in mean survival time [in days] by Child's Pugh class [c2 = 12.384; df=2, pvalue= 0.002]. The study showed that TACE is an effective palliative treatment. TACE increases the median survival time

Discuss the effects of surgical ligation and percutaneous embolization of testicular varicocele on improvements in fertility parameters

Varicocele is term used to define as abnormal dilatation of testicular vein and or its collaterals with retrograde venous blood flow. It is treated by two techniques surgical ligation and percutaneous emblization. It is claimed in various international journal that varicocele is a leading cause of male infertility and shows significant improvement in fertility parameters and pregnancy rate after treatment of varicocele either by varicocelectomy or gondal vein embolization but we have disproved this claim in our study. A retrospective study with few prospective cases. It is retrospective study with few prospective cases. We have selected all those infertile male patients who under gone varicocele treatment. We obtained hormonal assay, seminal assay as pre-treatment baseline values as well as post-treatment values at 1,2,3 and 6 months intervals. Couples were also followed for pregnancy for up to 5 years. Total cases selected were pre-treatment and post-treatment. Results were analyzed and compared with those published in national and international journals. No significant improvement was observed in fertility parameters and pregnancy rate. This signifies that varicocele is not significant and leading cause of infertility in males. Treatment of varicocele either by surgical ligation or percutaneous embolization did not showed any significant improvement in fertility parameters and pregnancy rate. This signifies that varicocele is not significant and leading cause of infertility in males

Transcatheter embolization of acute non-variceal gastrointestinal hemorrhage

To determine the efficacy and safety of transcatheter embolization of nonvariceal gastrointestinal hemorrhage. Descriptive analytical study. Radiology Department. The Aga Khan University Hospital, Karachi, Pakistan, from October 1999 to August 2004. The study included 27 patients who underwent angiography for suspected gastrointestinal hemorrhage. The presumptive diagnosis was based on the findings of endoscopy in 08 patients, scintigraphy in 05 patients and on clinical findings only in 14 patients. Nine patients had gastroduodenal hemorrhage, 04 patients had hemobilia and 14 patients had lower gastrointestinal bleeding. Five patients had comorbidities. One patient had uremia, 2 had hepatitis C, 1 had cirrhosis and 1 had coagulopathy. Technical success, clinical success, complications and patient survival were assessed. Nine patients had upper gastrointestinal hemorrhage, 4 patients had hemobilia and 14 patients had lower gastrointestinal bleeding. Etiology of bleeding was known in 15 patients and unknown in 12 patients. Clinical success was achieved in 23 [85.18%] of 27 patients. Two patients had early rebleeding. One of these was managed surgically and recovered. The other had severe coagulopathy and was unfit for surgery. Two patients had bowel infarction, one of these was managed surgically and recovered and the other died of complication of procedure. One patient had small splenic infarcts and was managed conservatively. Overall 85.18% success was achieved for the embolization procedure. Two of 27 patients died. One patient died because of recurrence of bleeding and other died because of infarction of right hemi-colon which occurred as complication of embolization. Transcatheter embolization is effective and safe in patients with nonvariceal gastrointestinal hemorrhage

Unenhanced helical CT scan for ureterolithiasis

The study was carried out from November 2002 to January 2004 and included patients who presented with flank pain at the Aga Khan University Hospital. One hundred and twenty patients were excluded from the study that were less than 15 years of age, pregnant or had history of trauma and infection. A total of 80 out of these 200 patients were included in this study that had a CT diagnosis of ureteric calculus after a UEHCT. In all those 80 patients with diagnosis of ureteric calculus on CT scan was confirmed later on either IVU, stone passage in the urine, ESWL [extracorporeal shock wave lithotripsy] or on the ureteroscopic removal of calculus. The images were interpreted for site, size and location of ureteric calculus, hydronephrosis, hydroureter, perinephric stranding, periureteral stranding, nephromegaly and incidental findings. The age range was 15-69 years, with a mean age of 37.5 years. Out of 80 patients, 32 [40%] patients presented with right sided flank pain and 48 [60%] of the patients had left sided flank pain. In 12 [15%] patients, calculi were present in the proximal ureter, in 24 [30%] in the mid ureter and in 44 [55%] in distal ureter. Most of the stones were between 3-5 mm size range [47%]; 20% stones were less than 3 mm in size and 32.5% of stones were more than 5 mm in size. Most common secondary sign was perinephric stranding seen in 48 patients [60%]. The second most common secondary sign was periureteral stranding seen in 44 [55%] patients. In 30 of the patients [37.5%] hydronephrosis was observed. In 18 [22.5%] hydroureter was present. Nephromegaly was observed in 2.3% of the patients. In 2 of 120 patients in which CT was negative, ureteric calculus was present on IVU which was carried out 3 days after UEHCT. In 2 of 120 patients in which CT was negative for ureteric calculus, ureteric calculus was present on IVU which was carried out 3 days after UEHCT. The sensitivity, specificity, positive and negative predictive values of unenhanced helical CT scan for detection of ureteric calculi was 97.5%, 98.3%, 97.5% and 98.3% respectively

Transjugular liver biopsy

Transjugular liver biopsy [TJLB] was performed in six patients in whom percutaneous liver biopsy was contraindicated because of coagulation disorder and / or ascites. An adequate biopsy allowing histological diagnosis was obtained in all six patients [100%]. Major complications were none. TJLB is a valuable diagnostic technique when percutaneous liver biopsy is considered unsafe