Transarterial Embolization for Active Gastrointestinal Bleeding: Predictors of Early Mortality and Early Rebleeding.

Background: The aim of this study was to determine predictive factors of early mortality and early rebleeding (≤30 days) following transarterial embolization (TAE) for treatment of acute gastrointestinal bleeding. Methods: All consecutive patients admitted for acute gastrointestinal bleeding to the interventional radiology department in a tertiary center between January 2012 and January 2022 were included. Exclusion criteria were patients: (1) aged < 18-year-old, (2) referred to the operation room without TAE, (3) treated for hemobilia, (4) with mesenteric hematoma, (5) lost to follow-up within 30 days after the procedure. We evaluated pre and per-procedure clinical data, biological data, outcomes, and complications. Results: Sixty-eight patients were included: 55 (80.9%) experienced upper gastrointestinal bleeding and 13 (19.1%) lower gastrointestinal bleeding. Median age was 69 (61−74) years. There were 49 (72%) males. Median hemoglobin was 7.25 (6.1−8.3) g/dL. There were 30 (50%) ulcers. Coils were used in 46 (67.6%) procedures. Early mortality was 15 (22.1%) and early rebleeding was 17 (25%). In multivariate analysis, hyperlactatemia (≥2 mmol/L) were predictive of early mortality (≤30 days). A high number of red blood cells units was associated with early rebleeding. Conclusion: This study identified some predictive factors of 30-day mortality and early rebleeding following TAE. This will assist in patient selection and may help improve the management of gastrointestinal bleeding.

Transarterial Embolization for Spontaneous Soft-Tissue Hematomas: Predictive Factors for Early Death.

INTRODUCTION: The aim of this retrospective monocentric study was to assess the safety and efficacy of spontaneous soft-tissue hematoma transarterial embolization (TAE) and to evaluate predictive factors for early mortality (≤30 days) after TAE for spontaneous soft-tissue hematoma (SSTH). MATERIALS AND METHODS: Between January 2010 and March 2022, all patients referred to our hospital for spontaneous soft-tissue hematoma and treated by emergency TAE were reviewed. Inclusion criteria were patients: ≥18-year-old, with active bleeding shown on preoperative multidetector row computed tomography, with spontaneous soft-tissue hematoma, and treated by TAE. Exclusion criteria were patients with soft-tissue hematomas of traumatic, iatrogenic, or tumoral origin. Clinical, biological, and imaging records were reviewed. Imaging data included delimitation of hematoma volume and presence of fluid level. Univariate and multivariate analyses were performed to check for associations with early mortality. RESULTS: Fifty-six patients were included. Median age was 75.5 [9-83] ([Q1-Q3] years and 23 (41.1%) were males. Fifty-one patients (91.1%) received antiplatelet agent and/or anticoagulant therapy. All 56 patients had active bleeding shown on a preoperative CT scan. Thirty-seven (66.0%) hematomas involved the retroperitoneum. Median hemoglobin level was 7.6 [4.4-8.2] g/dL. Gelatine sponge was used in 32/56 (57.1%) procedures. Clinical success was obtained in 48/56 (85.7%) patients and early mortality occurred in 15/56 (26.8%) patients. In univariate and multivariate analysis, retroperitoneal location and volume of hematoma were associated with early mortality. CONCLUSION: Retroperitoneal location and volume of hematoma seem to be risk factors for early death in the context of TAE for spontaneous soft-tissue hematoma. Larger multicenter studies are necessary to identify others predictive factors for early mortality and to anticipate which patients may benefit from an interventional strategy with TAE.

Topographical analysis of stimulus-related and response-related electrical scalp activity and interhemispheric dynamics in normal humans.

It is believed that reaction time estimates of interhemispheric relay (IHR) time or accuracy cost reflect motor relay and that visual evoked response potential (ERP) estimates reflect visual relay. If this is so, then response-related ERP estimates of IHR might be expected to correlate more with reaction time (RT) estimates of IHR than visual ERPs do, and the former ought to interact with the latter. A simple reaction time experiment (Poffenberger paradigm) was carried out with an 18-electrode montage on 10 normal subjects to investigate visual and motor interhemispheric relay effects and their interrelation. Three components in stimulus-synchronized and three other components in response-synchronized averaged signals were analyzed. Latencies and amplitudes of these components were studied as a function of the visual field stimulated and the hand required to respond. Effects interpretable as interhemispheric relay effects were observed in stimulus-related as well as response-related components. Few interhemispheric relay effect estimates in stimulus-related and response-related electrical scalp potentials were related to behavioral estimates of interhemispheric relay effects (derived from reaction times and omission errors). The spatiotemporal distributions of the electrical interhemispheric relay effects differed in stimulus and response-related components and they were statistically unrelated. We conclude that sensory interhemispheric relay may be picked up with stimulus-synchronized ERPs whereas motor interhemispheric relay effects may be measurable with response-related ERPs in normal humans. However, this proposal ought to be tested with callosotomized subjects.