Safety and efficacy of superior rectal artery embolization with particles and metallic coils for the treatment of hemorrhoids (Emborrhoid technique).

PURPOSE: The purpose of this study was to comprehensively evaluate the short-term outcomes after percutaneous embolization of the superior rectal artery (SRA) with metallic coils and particles for the management of hemorrhoids. MATERIALS AND METHODS: Forty patients (15 men, 25 women) with a mean age of 35±5 years (SD) (range: 25-65 years) were prospectively enrolled. All patients had symptomatic hemorrhoids. The distribution of internal hemorrhoids was as follows: grade I (n=6, 16%); grade II (n=28, 69%) and grade III (n=6; 15%). All patients had percutaneous embolization of the SRA with metallic coils and synthetic polyvinyl alcohol particles. Follow-up evaluation included clinical examination, rectoscopy, histopathological analysis of rectal mucosa, duplex Doppler blood flow quantification, electromyography, sphincterometry of the anal sphincter and analysis of patient satisfaction. RESULTS: No immediate complications were observed and no patients had anal pain syndrome after embolization. Hemorrhoids showed a 43% size reduction after embolization (P<0.05). Taking into account the symptom resolutions such as irritation, discomfort, bloody discharge and pain, satisfaction was observed in 5/6 (83%) patients with grade III hemorrhoids and 32/34 patients (94%) with grades I-II hemorrhoids. One month after embolization, anal sphincter contractility normalized and no changes in anal electromyography were observed. Blood flow in the hemorrhoidal plexus dropped from 109±1.2ml/min/100g (SD) before treatment to 60.2±4.4ml/min/100g (SD) (P<0.05) the day after embolization and remained unchanged one month after embolization. CONCLUSION: Our study demonstrates that embolization of SRA with particle and coils does not lead to ischemia in patients with symptomatic hemorrhoids. Short-term results with regard to symptom management for hemorrhoidal disease are very encouraging and should stimulate further prospective and multicenter studies.

[Synthesis and antiviral activity of lupane triterpenoids with modified cycle E].

A reductive transformation of the peroxide products of ozonolysis of derivatives of 3beta-O-acetyl-22(17-->28)-abeo-lupa-17(28),20(29)-diene and the subsequent intramolecular ketalization led to a compound with a trioxane fragment. This is a new approach to a skeletal modification of triterpenoid cycle E. An activity of the synthesized compounds was found toward the viruses of type A influenza and herpes simplex.

[Raoultella planticola, a new strain degrading 2,4,5-trichlorophenoxyacetic acid].

A new strain that degrades the herbicide 2,4,5-trichlorophenoxyacetic acid (2,4,5-T) was isolated from soil, which was exposed to factors related to the petrochemical industry. According to its physiological, biochemical, cultural, and morphological traits, together with the sequence of the 16S rRNA gene, the strain was identified as Raoultella planticola 33-4ch. The strain could consume 2,4,5-T as a sole source of carbon and energy. The amount of 2,4,5-T in the culture medium decreased by 51% after five days of incubation. Raoultella planticola 33-4ch consumes 2,4,5-T to produce 4-chlorophenoxyacetic, phenoxyacetic, and 3-methyl-2,6-dioxo-4-hexenoic acids.

[Identification and characterization of a plasmid in strain Aeronomas hydrophila IBRB-36 4CPA carrying genes for catabolism of chlorophenoxyacetic acids]. / Identifikatsiia i kharakteristika plazmidy shtamma Aeronomas hydrophila 1BRB-36 4CPA, nesushchei geny katabolizma khlorfenoksiukusnykh kislot.

Results of studying plasmid pAH36 in strain Aeronomas hydrophila IBRB-36 4CPA are presented. Plasmid pAH36 possesses BamHI, PstI, and HindIII restriction sites and is 5.4 kb in size. The plasmid was shown to contain genes for catabolism of chlor-substituted phenoxyacetic acids.

[X-ray endovascular embolization of the superior rectal artery: New potentialities in the surgical management of chronic hemorrhoids]. / Rentgenoendovaskuliarnaia embolizatsiia verkhnei rektal'noi arterii - novyi vozmozhnosti v khirurgicheskom lechenii khronicheskogo gemorroia

Based on the concept of occurrence and development of hemorrhoids from pathologically altered groups of cavernous bodies of the anal submucosa, the author used dearterialization of hyperplastic cavernous tissue for the treatment of hemorrhoids. The treatment involves superselective catheterization and material embolization of the superior rectal artery. The characteristics of 86 remedial embolizations of the superior rectal artery and routine treatments (sclerotherapy, latex-ring ligation, cryotherapy, and surgical hemorrhoidectomy) for chronic hemorrhoids. Emphasis is placed on the advantages of embolization methods over conventional low-invasive and surgical treatment.

[X-ray guided endovascular repair of venous bed of contracted kidney from pyelonephritis in the treatment of renal hypertension and chronic renal failure]. / Rentgenoéndovaskuliarnaia rekonstruktsiia venoznogo rusla pielonefriticheski smorshchennoi pochki pri lechenii nefrogenni gipertonii i khronicheskoi pochechnoi nedostatochnosti.

For compensation for chronic ischemia of the pyelonephritically contracted kidney, the authors used X-ray endovascular venous revascularization for the first time. The surgical intervention was to stenose the subsegmental veins of the diseased kidney, resulting in recanalization of the arterial system. The outcomes of X-ray treatment were analyzed in 38 patients with chronic degree I-II renal failure and nephrogenic hypertension. In 35 (92.1%) patients of them, there was improvement in the clinical picture of the underlying disease and in the filtrating and reabsorbing function of the kidney operated on, an increase in its sizes, and a decrease in systemic blood pressure.

[Interventional radiology for chronic hemorrhoids complicated by hemorrhage]. / Interventsionnaia radiologiia khronicheskogo gemorroia, oslozhnennogo krovotecheniiem.

Based on the concept of the occurrence and development of hemorrhoids from the abnormally changed groups of cavernous bodies of the submucous membrane of the rectal transitional area, the authors used selective dearterialization of hyperplastic cavernous tissue that is simultaneously internal hemorrhoids. The essence of the new treatment is superselective X-ray endovascular catheterization of the superior hemorrhoidal artery and embolization of its distal branches which supply blood to rectal cavernous body. The outcomes of 337 Milligan-Morgan hemorrhoidectomies and 49 X-ray endovascular embolizations of the superior hemorrhoidal artery were analyzed in patients with chronic hemorrhoids complicated by hemorrhages. Emphasis is laid on the advantages of X-ray endovascular occlusion of the superior hemorrhoidal artery over conventional treatment.

[Clinical application of X-ray endovascular revascularization of pyelonephritic kidney: first experience]. / Pervyí opyt klinicheskogo primeneniia rentgenoéndovaskuliarnoí revaskuliarizatsii pielonefriticheskoí pochki.

For compensation of schronic ischemia of the pyelonephritically afflicted kidney, the authors first used peripheral venous revascularization. The surgical intervention involved X-ray endovascular stenosing of the subsegmental renal veins. Local rearrangement of venous circulation provided a better ischemic tolerance due to more complete oxygen uptake from the highly oxygenized renal venous blood. The results of peripheral venous revascularization were analyzed. There were improvements in the clinical presentation of the underlying disease, in the filtration and reabsorption of the kidney exposed to operation, and a reduction in blood pressure.

[Interventional radiology in postoperative recurrent goiter]. / Interventsionnaia radiologiia posleoperatsionnogo retsidivnogo zoba.

Roentgeno-endovascular functional thyroidectomy was used to suppress the pathological activity of the thyroid in postoperative recurrent goiter. The method consists in vascular isolation of hyperplastic stump of the thyroid by catheterization of the left and right thyroid arteries, followed by their material occlusion. For embolization, a wide spectrum of nonlysed synthetic, organic, and inorganic materials were used. The results of roentgeno-endovascular functional thyroidectomy in 14 patients with postoperative recurrent goiter are analyzed. The advantages of roentgeno-endovascular occlusion of the thyroid arteries before subtotal thyroidectomy are emphasized. A stabile clinical and hormonal remission and reduction of the thyroid in size to stage 1 were observed during three years following roentgeno-endovascular intervention.

[Interventional radiology of chronic hemorrhoids]. / Interventsionnaia radiologiia khronicheskogo gemorroia.

Basing on the concept of hemorrhoids from pathologically changed groups of cavernous bodies of submucous layer of rectal transitional zone, the author used for the first time selective dearterialization of hyperplastic cavernous bodies which were at the same time three internal hemorrhoidal nodes. The therapeutic method consisted in roentgenoendovascular catheterization of the superior hemorrhoidal artery and embolization of its distal branches delivering blood to the internal hemorrhoidal nodes. Results of roentgenoendovascular treatment of 34 patients suffering from chronic hemorrhoids are analyzed. The author emphasizes the advantages of roentgenoendovascular occlusion of the superior hemorrhoidal artery in comparison with traditional drug therapy and surgery. No recurrences were recorded over 24 months after the intervention.

[First clinical experience of radio-endovascular functional thyroidectomy in the treatment of diffuse toxic goiter]. / Pervyi opyt klinicheskogo primeneniia rentgenoéndovasculiarnoi funktsionalnoi tireoidéktomii pri lechenii diffuznogo toksicheskogo zoba.

To suppress Thyroid pathologic activity in diffuse toxic goitre the authors have for the first time resorted to roentgenoendovascular functional thyroiedctomy. This method consists in vascular isolation of the thyroid by superselective catheterization of the left and right thyroid arteries followed by their material occlusion. For embolization a wide spectrum of nonlyzed synthetic, organic, and inorganic materials were used. The operation was carried out in 32 patients with stages III-IV diffuse toxic gotre. The advantages of this technique over subtotal thyroidectomy are emphasized. A stable clinical and hormonal remission and reduction of thyroid size to first degree were observed in all the patients for more tham 1.5 years after roentgenoendovascular intervention.

[Roentgeno-endovascular surgery of hypofunctional ovaries in varicosities of the ovarian veins]. / Rentgenoéndovaskuliarnaia khirurgiia gipofunktsii iachnikov pri varikoznom rasshirenii ovarial'nykh ven.

Three degrees of ovarian varicocele in sterile women or women with menstrual disturbance were described on the basis of analysis of 62 superselective ovariophlebograms. A nonsurgical pathogenetic method for correction of ovarian hypofunction in disturbed circulation in the venous region of the pelvic organs was developed by cutting off the ovarian vein from the pathological renocaval vascular shunt with the help of roentgenovascular intervention. It is based upon transcatheter occlusion of the left ovarian vein and directly follows diagnostic phlebography. Roentgenoendovascular occlusion of the left ovarian vein was performed in 41 patients Ivanissevich's operation--in 8 patients. In 4-18 months after intervention, improved results of a clinical picture and functional diagnostic tests were observed in 46 patients. Of 19 women with passable uterine tubes 14 got pregnant.

[Clinico-roentgenologic diagnosis of chronic venous insufficiency of the ovaries]. / Kliniko-rentgenologicheskaia diagnostika khronicheskoi venoznoi nedostatochnosti iachnikov.

The paper is devoted to clinico-roentgenological correlations of venous reno-gonadal hemodynamics in 168 women of reproductive age (151 women with infertility, habitual abortion, disordered menstrual function and 17 patients without disorders of the reproductive tract). Clinico-laboratory investigation was followed by visceral and parietal phlebography for the detection of a pathological venous reflux into the ovarian pampiniform plexus. A retrograde blood flow along the internal ovarian vein with the development of venostasis and secondary pelvic varicocele was diagnosed in 67 women with disturbed reproductive function. In 17 women without disorders of reproductive function a reno-gonadal venous reflux was undetectable. Clinico-roentgenological semiotics of chronic venous ovarian insufficiency was analyzed. Infertility was shown to be the main clinical manifestation of ovarian varicocele.