Control of massive retroperitoneal bleeding associated with pelvic fractures by angiographic embolization.

Continuous retroperitoneal bleeding may be an immediate life-threatening complication of pelvic fractures. While surgical control of the bleeding vessels has been advocated in these cases, today angiographic embolization of the branches of the internal iliac arteries is proving to be the treatment of choice. This is a relatively simple, safe, prompt and effective method of controlling the hemorrhage. It avoids the disadvantages of surgery, general anesthesia, loss of the tamponade effect of the retroperitoneum when opened, and the not uncommon difficulty of identifying and ligating the bleeding vessels. Two cases in which massive retroperitoneal bleeding associated with pelvic fractures was controlled by angiographic embolization are described, illustrating the importance of early angiography.

Conservative management of suspected prolactin secreting pituitary adenoma during pregnancy.

Seventeen women with prolactin levels of 100 ng/ml and above suspected of harboring prolactin-secreting pituitary adenoma, from the basis of this study. Ten patients had radiological signs of an adenoma while in 7 the radiological criteria for such a diagnosis were not fulfilled. Ovulation and pregnancy were induced with bromocriptine in all 17 patients. They were carefully observed during pregnancy and following delivery. All gave birth to full-term babies after uneventful pregnancies, except for one patient who experienced intrauterine fetal death at 31 wk of gestation. It is our policy that women with suspected intrasellar prolactin-secreting pituitary adenoma be allowed to conceive and give birth without previous surgical intervention. The patient should be closely followed during pregnancy for clinical symptoms of enlargement of the tumor, including periodic visual field examinations. In cases of neurologic or ophthalmologic complications, surgery or bromocriptine administration without interruption of pregnancy is advocated, or if lung maturity is achieved, delivery should be induced.

Vascular changes in traumatic amenorrhea and hypomenorrhea.

Pelvic angiography was performed in 12 cases of amenorrhea and hypomenorrhea which developed following curettage of abortion and in the puerperium. Six cases of similar age and obstetric history with normal menstrual cycles served as control. Pelvic angiography revealed widespread vascular occlusion of myometrial arteries, in seven of the twelve cases. These findings account for the small amount of endometrium removed on diagnostic curettage in these cases as well as the greatly reduced menstrual loss. The poor obstetric history of the cases studied may well be due to this excessive vascular damage.

PIP: In 12 women with amenorrhea or hypomenorrhea which developed following curettage for abortion or in the puerperium, 10 had hypomenorrhea and 2 had amenorrhea; there were 6 control cases. Pelvic angiography was done during the proliferative phase of cycles prior to Day 10. The uterine vascular bed was studied by the Seldinger retrograde femoral technique using 2 methods. In each case, a total volume of 30 ml of 80% sodium iothalamate (Angio-Conray) was used. Over 50% of the cases of hypomenorrhea showed significantly reduced vascularity in the endometrium. The poor obstetric history of these patients, with frequent early spontaneous abortions, may be due to the extensive vascular damage to the endometrium with fibrosis. Also these changes may account for the small amount of endometrium removed at diagnostic curettage as well as the greatly reduced menstrual loss. Radiographic findings are illustrated.