ABSTRACT
A 52-year-old woman had giant adenomyosis uteri treated by pseudo-menopause therapy. However, she did not take oral anticoagulant for deep vein thrombosis prevention because of metrorrhagia. She developed pulmonary thromboembolism, and was refered to our department. She complained mild dyspnea but free from leg edema. Enhanced computed tomography (CT) showed massive thrombi in the central pulmonary artery trunk. Therefore, she underwent emergency thrombectomy. Three days later, uterine artery embolization( UAE) was performed to control metrorrhagia worsened by anticoagulation therapy. However, UAE caused significant swelling of the uterus, and bi-lateral external iliac veins were more compressed. Two months later, total hysterectomy was performed to prevent recurrence of pulmonary thromboembolism( PTE). Clinical course thereafter was satisfactory.
Subject(s)
Adenomyosis , Metrorrhagia , Female , Humans , Middle Aged , Adenomyosis/complications , Adenomyosis/surgery , Thrombectomy , Acute Disease , UterusABSTRACT
This study clarifies the predicted subcutaneous shoulder depth and investigates the safety of the conventional (three-finger breadth method) and new (axillary method) intramuscular injection methods. The anatomical features of 245 volunteers who received the COVID-19 vaccination via the conventional method were investigated at the injection site (T point) and the hypothetical injection site using the new method (A point) via ultrasonography. The body mass index (BMI) and subcutaneous thickness at the T point (men: r = 0.75; women: r = 0.45) and the A point (men: r = 0.81; women: r = 0.55) were positively correlated. The upper arm circumference and subcutaneous thickness at the T point (r = 0.51) and the A point (r = 0.58) were correlated in women. Formulas to predict subcutaneous thickness using BMI and upper arm circumference were established: predicted subcutaneous thickness at the A point = 0.62 × BMI - 7.7 mm (R2 = 0.66) in men and 0.658 × BMI - 5.5 mm (R2 = 0.31) in women. This study demonstrates safe intramuscular injection sites and their depth.
ABSTRACT
We have presented the case of a 76-year-old patient with a type V thoracoabdominal aortic aneurysm treated by retrograde in situ branched stent grafting to the superior mesenteric artery (SMA). Via a 9-cm, median laparotomy, a percutaneous transhepatic gallbladder drainage needle was inserted from the distal part of the first jejunal artery to the origin of the SMA. After stent graft placement into the aorta, the graft was retrogradely punctured using the percutaneous transhepatic gallbladder drainage needle. The SMA ischemic time was 6 minutes. The puncture site was dilated, and a small, covered stent was deployed. Postoperative computed tomography scanning showed no endoleak with sac regression.
ABSTRACT
PURPOSE: To demonstrate the efficacy of a combination of Amplatzer vascular plug (AVP2) and Endologix AFX for a visceral entry closure. CASE REPORT: A 70-year-old woman with treated chronic type B aortic dissection was seen to have sac enlargement. An isolated residual tear was observed at the origin of the celiac artery. A 12 mm AVP2 was successfully deployed for the entry closure. Angiography after the plug deployment still demonstrated residual flow to the false lumen. Hence, an Endologix AFX VELA proximal endograft was deployed, covering the AVP membrane and leaving no endoleak. CONCLUSION: Deployment of a vascular plug with Endologix AFX lining was efficacious for securing complete closure of an entry tear at the origin of the celiac artery in our patient. CLINICAL IMPACT: Vascular plugs are reported to be effective for closing small entries, although their effectiveness is limited when the entry site is not located on the flat intima, or in a high-flow situation. In the presented case, an isolated entry tear at the origin of the celiac artery was successfully closed with a vascular plug following Endologix AFX stent-graft lining of the true lumen.
