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1.
Vasc Endovascular Surg ; 58(5): 540-543, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38156618

RESUMO

In this report, we describe a rare case: deep vein thrombosis due to May-Thurner syndrome with a spontaneous pelvic extraperitoneal hematoma. This unique challenge highlights balancing thrombosis treatment and bleeding risk. Endovascular treatment with delayed anticoagulation may be an alternative to surgery for stable retroperitoneal hematoma in May-Thurner syndrome patients.


Assuntos
Anticoagulantes , Hematoma , Síndrome de May-Thurner , Trombose Venosa , Humanos , Hematoma/etiologia , Hematoma/diagnóstico por imagem , Hematoma/terapia , Síndrome de May-Thurner/diagnóstico por imagem , Síndrome de May-Thurner/terapia , Síndrome de May-Thurner/complicações , Anticoagulantes/uso terapêutico , Anticoagulantes/efeitos adversos , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia , Trombose Venosa/terapia , Angiografia por Tomografia Computadorizada , Feminino , Flebografia/métodos , Procedimentos Endovasculares , Masculino , Pessoa de Meia-Idade , Espaço Retroperitoneal
2.
J Matern Fetal Neonatal Med ; 37(1): 2296360, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38146176

RESUMO

OBJECTIVE: Pelvic artery embolization (PAE) is a uterus-saving treatment for postpartum hemorrhage (PPH); however, subfertility or abnormal placentation for subsequent pregnancy has been a concern in several previous reports. This study aimed to investigate the impact of PAE on subsequent pregnancies in women with a history of PPH. METHODS: A retrospective cohort study was conducted on women transferred to the tertiary center for PPH and delivered for the next pregnancy at the same center later. The study group was divided into two groups based on PAE application to treat previous PPH. RESULTS: Of the 62 women included, 66% (41/62) had received PAE for the previous PPH, while 21 had not. Pregnancy outcomes for subsequent pregnancies were compared between the PAE and non-PAE groups. The PAE group had a higher estimated blood loss volume for the present delivery than the non-PAE group (600 vs. 300 mL, p = 0.008). The PAE group also demonstrated a higher incidence of placenta previa (4.8% vs. 24.4%, p = 0.080) and placenta accreta (0% vs. 14.6%, p = 0.082) than the non-PAE group, although the difference was not statistically significant. CONCLUSION: These findings suggest that the use of PAE to treat PPH may increase the risk of bleeding, placenta previa, and placenta accreta spectrum in subsequent pregnancies.


Assuntos
Placenta Acreta , Placenta Prévia , Hemorragia Pós-Parto , Gravidez , Feminino , Humanos , Hemorragia Pós-Parto/terapia , Hemorragia Pós-Parto/epidemiologia , Estudos Retrospectivos , Pelve , Placenta Acreta/terapia , Placenta Acreta/epidemiologia , Artérias
3.
Respir Res ; 23(1): 257, 2022 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-36127690

RESUMO

BACKGROUND: Bronchial artery embolisation (BAE) is an effective treatment option to control haemoptysis in primary lung cancer. However, no studies have investigated optimal embolisation material for BAE in lung cancer patients. Thus, this study aimed to compare the safety and efficacy of BAE performed using n-butyl-2-cyanoacrylate (NBCA) and polyvinyl alcohol (PVA) particles in primary lung cancer patients to determine which embolic material is better for patients with haemoptysis. METHODS: This retrospective study was approved by the institutional review board, and consent was waived. The rates of hemostasis, complications, procedure time, dose-area product, and haemoptysis-free survival were retrospectively compared between primary lung cancer (non-small cell [n = 111] and small cell [n = 11]) patients who underwent BAE using NBCA (n = 58) or PVA particles (n = 64) between January 2004 and December 2019. Predictors of recurrent haemoptysis were analysed using the Cox proportional hazard regression model. RESULTS: Among 122 patients (mean age, 66 ± 10 years; range 32-86 years; 103 men), more patients in the NBCA group (81.0%; 47 of 58) achieved complete hemostasis than did patients in the PVA group (53.1%; 34 of 64) (P = 0.002). No major complications were observed in either group. The procedure time (36.4 ± 21.6 vs. 56.3 ± 27.4 min, P < 0.001) was shorter, and the dose-area product (58.6 ± 64.0 vs. 233.5 ± 225.0 Gy*cm2, P < 0.001) was smaller in the NBCA group than in the PVA group. The median haemoptysis-free survival was 173.0 in the NBCA group compared with 20.0 days in the PVA group (P < 0.001). The PVA use (P < 0.001) and coagulopathy (P = 0.014) were independent predictors of shortened haemoptysis-free survival. CONCLUSION: BAE using NBCA showed significantly superior initial hemostasis with longer haemoptysis-free survival, shorter procedure time, and reduced radiation dose than BAE using PVA particles. The PVA use and coagulopathy were independent predictors of recurrent haemoptysis. TRIAL REGISTRATION: Retrospectively registered.


Assuntos
Embucrilato , Neoplasias Pulmonares , Adulto , Idoso , Idoso de 80 Anos ou mais , Artérias Brônquicas/diagnóstico por imagem , Embucrilato/efeitos adversos , Hemoptise/diagnóstico , Hemoptise/terapia , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Álcool de Polivinil/efeitos adversos , Estudos Retrospectivos
4.
Br J Radiol ; 95(1136): 20211355, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35671143

RESUMO

OBJECTIVE: To evaluate angiographic findings and outcomes of uterine artery embolization (UAE) for recurrent postpartum hemorrhage (PPH) in a subsequent pregnancy in patients with a history of prior UAE. METHODS: Between March 2004 and February 2021, UAE was performed for PPH with gelatin sponge slurry in 753 patients. Among these, 13 underwent repeat UAE for recurrent PPH after subsequent delivery. The causes of PPH, angiographic findings, hemostasis, and adverse events were evaluated. RESULTS: The causes of recurrent PPH included retained placental tissue (n = 9) and uterine atony (n = 4). On angiography, unilateral or bilateral uterine arteries were obliterated due to prior UAE in 10 patients (76.9%). The uterine collateral vessels were embolized (anterior division of the internal iliac artery [n = 10], round ligament [n = 5], and ovarian [n = 4] artery). In the remaining three patients with recanalized or patent (not embolized at prior UAE) uterine arteries, both uterine arteries were embolized. Immediate hemostasis was achieved in nine patients (69.2%). The remaining four patients (30.8%) with obliterated uterine arteries required hysterectomy. There were three mild adverse events (pelvic pain [n = 2] and fever [n = 1]). CONCLUSION: UAE with gelatin sponge slurry frequently causes permanent uterine artery obliteration. In cases of recurrent PPH occurring in subsequent pregnancy, repeat UAE may be less likely to achieve hemostasis (69.2%). ADVANCES IN KNOWLEDGE: 1. UAE with gelatin sponge slurry frequently caused permanent uterine artery obliteration.2. In recurrent PPH occurring in subsequent pregnancy, the repeat UAE may be less likely to achieve hemostasis than initial UAE.


Assuntos
Hemorragia Pós-Parto , Embolização da Artéria Uterina , Angiografia , Feminino , Gelatina , Humanos , Placenta , Hemorragia Pós-Parto/diagnóstico por imagem , Hemorragia Pós-Parto/terapia , Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Artéria Uterina/diagnóstico por imagem , Embolização da Artéria Uterina/efeitos adversos
5.
Eur J Radiol ; 102: 95-101, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29685552

RESUMO

PURPOSE: To study whether the measurement of hepatic fibrosis on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) magnetic resonance (MR) imaging using the coefficient of variation (CV) might be correlated with the presence of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). MATERIALS AND METHODS: This study included 104 patients with and without CHB, who were divided into 4 groups: control group, CHB without liver cirrhosis (LC; Group I), CHB with LC (Group II), and CHB with LC and HCC (Group III). MR images were analyzed to measure the inhomogeneity of signal intensities calculated using the CV map of the liver parenchyma. Intergroup comparisons of CV values were performed using ANOVA. The diagnostic performance of the CV map and alpha-fetoprotein (AFP) for diagnosing HCC was evaluated using the receiver operating characteristic (ROC) curve. RESULTS: On the hepatobiliary phase of Gd-EOB-DTPA-enhanced T1-weighted imaging, the mean CV values of the control group and Groups I, II, and III were 3.9 ±â€¯0.99, 3.97 ±â€¯1.09, 5.58 ±â€¯2.05, and 6.80 ±â€¯2.34, respectively (P = 0.000). On ROC analysis of the CV value for predicting HCC, the value of the area under the curve (AUC) on Gd-EOB-DTPA MR imaging was 0.788 (95% CI: 0.697-0.862). The sensitivity and specificity were 84.2% and 63.6%, respectively, at a CV cutoff value >4.75. The value of AUC determined using AFP was 0.766. CONCLUSION: The CV value for hepatic fibrosis on Gd-EOB-DTPA MR imaging may be correlated with the presence of HCC in patients with CHB, and shows comparable diagnostic performance to AFP analysis.


Assuntos
Carcinoma Hepatocelular/complicações , Meios de Contraste , Gadolínio DTPA , Hepatite B Crônica/complicações , Cirrose Hepática/diagnóstico por imagem , Neoplasias Hepáticas/complicações , Imageamento por Ressonância Magnética/métodos , Adulto , Idoso , Área Sob a Curva , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/patologia , Feminino , Hepatite B Crônica/fisiopatologia , Humanos , Fígado/diagnóstico por imagem , Fígado/patologia , Cirrose Hepática/complicações , Cirrose Hepática/patologia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade
6.
Korean J Radiol ; 18(3): 444-451, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28458596

RESUMO

OBJECTIVE: To quantitatively measure hepatic fibrosis on gadoxetic acid-enhanced magnetic resonance (MR) in chronic hepatitis B (CHB) patients and identify the correlations with aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis-4 index (FIB-4) values. MATERIALS AND METHODS: This study on gadoxetic acid-enhanced 3T MR imaging included 81 patients with CHB infection. To quantitatively measure hepatic fibrosis, MR images were analyzed with an aim to identify inhomogeneous signal intensities calculated from a coefficient of variation (CV) map in the liver parenchyma. We also carried out a comparative analysis between APRI and FIB-4 based on metaregression results. The diagnostic performance of the CV map was evaluated using a receiver-operating characteristic (ROC) curve. RESULTS: In the MR images, the mean CV values in control, groups I, II, and III based on APRI were 4.08 ± 0.92, 4.24 ± 0.80, 5.64 ± 1.11, and 5.73 ± 1.28, respectively (p < 0.001). In CHB patients grouped by FIB-4, the mean CV values of groups A, B, and C were 4.22 ± 0.95, 5.40 ± 1.19, and 5.71 ± 1.17, respectively (p < 0.001). The mean CV values correlated well with APRI (r = 0.392, p < 0.001) and FIB-4 (r = 0.294, p < 0.001). In significant fibrosis group, ROC curve analysis yielded an area under the curve of 0.875 using APRI and 0.831 using FIB-4 in HB, respectively. CONCLUSION: Gadoxetic acid-enhanced MR imaging for calculating a CV map showed moderate correlation with APRI and FIB-4 values and could be employed to quantitatively measure hepatic fibrosis in patients with CHB.


Assuntos
Aspartato Aminotransferases/análise , Plaquetas/citologia , Gadolínio DTPA/química , Hepatite B Crônica/diagnóstico , Cirrose Hepática/diagnóstico por imagem , Imageamento por Ressonância Magnética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Estudos de Casos e Controles , Feminino , Hepatite B Crônica/complicações , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/patologia , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Curva ROC , Índice de Gravidade de Doença , Adulto Jovem
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