Transcatheter intraarterial methotrexate infusion combined with selective uterine artery embolization as a treatment option for cervical pregnancy.

PURPOSE: To assess the value of transcatheter intraarterial methotrexate infusion combined with selective uterine artery embolization (UAE) as a treatment option for cervical pregnancy. MATERIALS AND METHODS: Between January 2004 and June 2009, a prospective study was conducted in 20 consecutive patients with cervical pregnancy. The patients were treated with UAE with gelatin sponge particles (1-2 mm in size) to control active vaginal bleeding. Methotrexate was injected into the arteries before, during, and after UAE. RESULTS: Two of 20 patients (10%) had recurrent vaginal bleeding of approximately 50 mL daily after treatment; the other 18 (90%) had no significant vaginal bleeding after UAE. Fifteen cases (75%) were treated successfully by a single procedure and five (25%) required a subsequent curettage without blood transfusion. The degeneration of placenta was confirmed by light microscopy after curettage. The cervical gestational sac was eliminated at a mean of 41 days (range, 11-83 d). Increased serum beta-human chorionic gonadotrophin levels normalized by an average of 30 days (range, 7-49 d). The uterus was preserved and normal menses resumed within 2-4 months in all 20 women (100%). Of 16 women who attempted another pregnancy, eight (50%) achieved pregnancy: there were six term pregnancies with live births (38%) and two miscarriages (13%). No obvious complications related to treatment occurred, but a few mild side effects were observed in nine cases (45%). CONCLUSIONS: Based on this series of 20 patients, the conservative protocol of transcatheter intraarterial methotrexate infusion combined with UAE may be a feasible, effective, and safe option for cervical pregnancy.

Study progress of two-stage resection for primary hepatocellular carcinoma after transcatheter arterial chemoembolization / 中华肝胆外科杂志

The resection can be performed in about 20 percent of patients with primary hepatocellular carcinoma(PHC) in clinic. However, with the development of interventional treatment such as transcatheter arterial chemoembolization(TACE), better therapeutic effect has been achieved by two-stage resection such as TACE in patients with unresectable PHC. At present, surgical resection is still regarded as the first choice of PHC, and the principle of comprehensive therapeutic solutions around surgical operation has been established. The pretreatment of TACE is an important measure to improve the therapeutic effect in PHC.This paper discussed the mechanism, effect and value of TACE in pretreatment of unresectable PHC. The selection of operative opportunity, sign, and ways after TACE and the factors affecting prognosis of two-stage resection were also reviewed.