Catastrophic antiphospholipid syndrome and pulmonary embolism in a 3-year-old child

International Nuclear Information System (INIS)

Olivier, Carine; Blondiaux, Eleonore; Dacher, Jean-Nicolas; Blanc, Thierry; Borg, Jeanne-Yvonne

2006-01-01

We report a rare example of catastrophic antiphospholipid syndrome (CAPS) in a young child. A 3-year-old girl with no previous medical history presented with extensive and recurrent thromboses. The diagnosis of CAPS was based on the occurrence of cardiopulmonary embolism in the child with a high titre of autoantibodies directed against phospholipids and beta-2-glycoprotein 1. In spite of a relatively rapid diagnosis and multiple treatments, the outcome was unfavourable. Multimodality imaging, including both ultrasonography and spiral CT, allowed close follow-up of the thromboses. (orig.)

Catastrophic antiphospholipid syndrome and pulmonary embolism in a 3-year-old child

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Olivier, Carine; Blondiaux, Eleonore; Dacher, Jean-Nicolas [University Hospital of Rouen, Department of Radiology, Rouen (France); Blanc, Thierry [University Hospital of Rouen, Department of Neonatal Medicine, Rouen (France); Borg, Jeanne-Yvonne [University Hospital of Rouen, Haematology Laboratory, Rouen (France)

2006-08-15

We report a rare example of catastrophic antiphospholipid syndrome (CAPS) in a young child. A 3-year-old girl with no previous medical history presented with extensive and recurrent thromboses. The diagnosis of CAPS was based on the occurrence of cardiopulmonary embolism in the child with a high titre of autoantibodies directed against phospholipids and beta-2-glycoprotein 1. In spite of a relatively rapid diagnosis and multiple treatments, the outcome was unfavourable. Multimodality imaging, including both ultrasonography and spiral CT, allowed close follow-up of the thromboses. (orig.)

Embolization of Incompetent Pelvic Veins for the Treatment of Recurrent Varicose Veins in Lower Limbs and Pelvic Congestion Syndrome

International Nuclear Information System (INIS)

Meneses, Luis; Fava, Mario; Diaz, Pía; Andía, Marcelo; Tejos, Cristian; Irarrazabal, Pablo; Uribe, Sergio

2013-01-01

We present our experience with embolization of incompetent pelvic veins (IPV) in women with recurrence of varicose veins (VV) in lower limbs, as well as symptoms of pelvic congestion syndrome (PCS), after first surgery. In addition, we evaluated the effects of embolization in decreasing the symptoms of VV before surgery as well as its effects on PCS symptoms. We included 10 women who had consulted a vascular surgeon because of recurrent VV in lower limbs after surgery. All of these patients were included in the study because they also had symptoms of PCS, probably due to IPV. In patients who had confirmed IPV, we performed embolization before a second surgery. VV and PCS were assessed before and at 3 months after embolization (before the second surgery) using a venous clinical severity score (VCSS) and a visual analog pain scale (VAS), respectively. Patients were controlled between 3 and 6 months after embolization. Paired Student t test analysis was used for comparing data before and after embolization. Fifteen vein segments in 10 women were suitable for embolization. There was a significant (p < 0.001) decrease of VCSS after embolization, and recurrence of VV was not detected within a period of 6 months. There was also significant (p < 0.01) relief of chronic pelvic pain related to PCS evaluated using VAS at 3 months after embolization. Embolization decreases the risk of VV recurrence after surgery and also improves PCS symptoms in women with VV in lower limbs and IPV.

Embolization of Incompetent Pelvic Veins for the Treatment of Recurrent Varicose Veins in Lower Limbs and Pelvic Congestion Syndrome

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Meneses, Luis, E-mail: lmeneseq@gmail.com; Fava, Mario; Diaz, Pia; Andia, Marcelo [Pontificia Universidad Catolica de Chile, Radiology Department and Biomedical Imaging Center (Chile); Tejos, Cristian; Irarrazabal, Pablo [Pontificia Universidad Catolica de Chile, Biomedical Imaging Center (Chile); Uribe, Sergio, E-mail: suribe@med.puc.cl [Pontificia Universidad Catolica de Chile, Radiology Department and Biomedical Imaging Center (Chile)

2013-02-15

We present our experience with embolization of incompetent pelvic veins (IPV) in women with recurrence of varicose veins (VV) in lower limbs, as well as symptoms of pelvic congestion syndrome (PCS), after first surgery. In addition, we evaluated the effects of embolization in decreasing the symptoms of VV before surgery as well as its effects on PCS symptoms. We included 10 women who had consulted a vascular surgeon because of recurrent VV in lower limbs after surgery. All of these patients were included in the study because they also had symptoms of PCS, probably due to IPV. In patients who had confirmed IPV, we performed embolization before a second surgery. VV and PCS were assessed before and at 3 months after embolization (before the second surgery) using a venous clinical severity score (VCSS) and a visual analog pain scale (VAS), respectively. Patients were controlled between 3 and 6 months after embolization. Paired Student t test analysis was used for comparing data before and after embolization. Fifteen vein segments in 10 women were suitable for embolization. There was a significant (p < 0.001) decrease of VCSS after embolization, and recurrence of VV was not detected within a period of 6 months. There was also significant (p < 0.01) relief of chronic pelvic pain related to PCS evaluated using VAS at 3 months after embolization. Embolization decreases the risk of VV recurrence after surgery and also improves PCS symptoms in women with VV in lower limbs and IPV.

Embolization of Life-Threatening Arterial Rupture in Patients with Vascular Ehlers–Danlos Syndrome

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Okada, Takuya, E-mail: okabone@gmail.com [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Interventional Radiology Department (France); Frank, Michael, E-mail: michael.frank@egp.aphp.fr [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Rare Vascular Diseases Reference Center (France); Pellerin, Olivier, E-mail: olivier@pellerin.as; Primio, Massimiliano Di, E-mail: massimiliano.di.primio@gmail.com; Angelopoulos, Georgios, E-mail: giorginos78@msn.com [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Interventional Radiology Department (France); Boughenou, Marie-Fazia, E-mail: marie-fazia.boughenou@egp.aphp.fr [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Anesthesia and Surgical Intensive Care Unit (France); Pagny, Jean-Yves, E-mail: jean-yves.pagny@egp.aphp.fr [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Interventional Radiology Department (France); Messas, Emmanuel, E-mail: emmanuel.messas@egp.aphp.fr [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Rare Vascular Diseases Reference Center (France); Sapoval, Marc, E-mail: marc.sapoval2@egp.aphp.fr [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Interventional Radiology Department (France)

2013-05-09

PurposeTo evaluate the safety and efficacy of transarterial embolization of life-threatening arterial rupture in patients with vascular Ehlers–Danlos syndrome (vEDS) in a single tertiary referral center.MethodsWe retrospectively analyzed transarterial embolization for vEDS performed at our institution from 2000 to 2012. The indication of embolization was spontaneous arterial rupture or pseudoaneurysm with acute bleeding. All interventions used a percutaneous approach through a 5F or less introducer sheath. Embolic agents were microcoils and glue in 3 procedures, glue alone in 2, and microcoils alone in 2.ResultsFive consecutive vEDS patients were treated by 7 embolization procedures (4 women, mean age 29.8 years). All procedures were successfully performed. Two patients required a second procedure for newly arterial lesions at a different site from the first procedure. Four of the five patients were still alive after a mean follow-up of 19.4 (range 1–74.7) months. One patient died of multiple organ failure 2 days after procedure. Minor procedural complications were observed in 3 procedures (43 %), all directly managed during the same session. Remote arterial lesions occurred after 3 procedures (43 %); one underwent a second embolization, and the other 2 were observed conservatively. Puncture site complication was observed in only one procedure (14 %).ConclusionEmbolization for vEDS is a safe and effective method to manage life-threatening arterial rupture.

Embolization of Life-Threatening Arterial Rupture in Patients with Vascular Ehlers–Danlos Syndrome

International Nuclear Information System (INIS)

Okada, Takuya; Frank, Michael; Pellerin, Olivier; Primio, Massimiliano Di; Angelopoulos, Georgios; Boughenou, Marie-Fazia; Pagny, Jean-Yves; Messas, Emmanuel; Sapoval, Marc

2014-01-01

PurposeTo evaluate the safety and efficacy of transarterial embolization of life-threatening arterial rupture in patients with vascular Ehlers–Danlos syndrome (vEDS) in a single tertiary referral center.MethodsWe retrospectively analyzed transarterial embolization for vEDS performed at our institution from 2000 to 2012. The indication of embolization was spontaneous arterial rupture or pseudoaneurysm with acute bleeding. All interventions used a percutaneous approach through a 5F or less introducer sheath. Embolic agents were microcoils and glue in 3 procedures, glue alone in 2, and microcoils alone in 2.ResultsFive consecutive vEDS patients were treated by 7 embolization procedures (4 women, mean age 29.8 years). All procedures were successfully performed. Two patients required a second procedure for newly arterial lesions at a different site from the first procedure. Four of the five patients were still alive after a mean follow-up of 19.4 (range 1–74.7) months. One patient died of multiple organ failure 2 days after procedure. Minor procedural complications were observed in 3 procedures (43 %), all directly managed during the same session. Remote arterial lesions occurred after 3 procedures (43 %); one underwent a second embolization, and the other 2 were observed conservatively. Puncture site complication was observed in only one procedure (14 %).ConclusionEmbolization for vEDS is a safe and effective method to manage life-threatening arterial rupture

Embolization of the Systemic Arterial Supply via a Detachable Silicon Balloon in a Child with Scimitar Syndrome

International Nuclear Information System (INIS)

Sahin, Sinan; Celebi, Ahmet; Yalcin, Yalim; Saritas, Mustafa; Bilal, Mehmet S.; Celik, Levent

2005-01-01

Scimitar syndrome is a rare congenital disorder. It is characterized by partial or total abnormal venous drainage of the right lung into the inferior vena cava, which is often associated with anomalous systemic arterial supply to the right lung, congenital cardiac anomalies, hypoplasia of the right lung and bronchial anomalies. Symptoms depend on the degree of the shunt and severity of the associated anomalies, which determine the treatment. We present a 6-year-old boy who was diagnosed as having the adult form of scimitar syndrome during evaluation for recurrent pulmonary infections, and underwent embolization with a detachable silicon balloon of the anomalous systemic arterial supply from the abdominal aorta to the right lower lung lobe. Successful elective surgery was performed 6 months later, in which right pulmonary veins were directed to the left atrium using a Gore-Tex patch by creating an intra-atrial tunnel. The patient has been symptom-free period during 6 months of follow-up, which supports the idea that recurrent pulmonary infections can be eliminated by embolization of the anomalous arterial supply

Pulmonary fat embolism: a case report

International Nuclear Information System (INIS)

Douvlou, E.; Vakhnina-Vassila, O.; Vlahou, I.; Petrocheilou, G.; Markantonatos, D.; Petinelli, A.; Stathopoulou, S.; Kokkinis, C.

2012-01-01

Full text: Introduction: Fat embolism is a clinical syndrome that usually occurs from the first to third day after a bone fracture or/and an orthopaedic surgery. The target organs are the lungs and more rarely the brain and the skin. Objectives and tasks: The aim of this presentation is to discuss the imaging diagnostic criteria of lung fat embolism in CT on the occasion of a case. Material and methods: A 30-years-old male patient was admitted to the Orthopaedic Department after a motorbike accident. A fracture of the head of his right femur was diagnosed and the patient underwent a surgery 3 days later. During the first postoperative day, the patient presented severe dyspnoea, tachycardia, a significant fall of PO 2 (59 mmHg) and a parallel increase in d-Dimmers (7.8 mg/l). The patient was then referred for a chest CT scan. Results: Contrast enhanced CT excluded the presence of thrombus in the pulmonary arteries and raised the diagnosis of lung fat embolism (septal thickening with a nodular pattern and diffuse ground-glass opacities along with the presence of small quantity of bilateral pleural effusions). Conclusion: Chest CT prior and the use of intravenous contrast media after is the most reliable diagnostic method to confirm or exclude pulmonary fat embolism syndrome

Renal Artery Embolization of Perirenal Hematoma in Hemorrhagic Fever with Renal Syndrome: A Case Report

International Nuclear Information System (INIS)

Choi, Hee Seok; Lee, Yong Seok; Lim, Ji Hyon; Kim, Kyung Soo; Yoon, Yup; Hwang, Jae Cheol

2007-01-01

Hemorrhagic fever with renal syndrome (HFRS) is an acute viral disease characterized by fever, hemorrhage and renal failure. Among the various hemorrhagic complications of HFRS, spontaneous rupture of the kidney and perirenal hematoma are very rare findings. We report here on a case of HFRS complicated by massive perirenal hematoma, and this was treated with transcatheter arterial embolization. Hemorrhagic fever with renal syndrome (HFRS) is an acute infectious disease caused by hantavirus. HFRS is clinically characterized by fever, renal failure and hemorrhage in organs such as lung, kidney, spleen and the pituitary gland. Renal medullary hemorrhage is a well-known complication in the kidney, but spontaneous rupture of the kidney and perirenal hematoma in HFRS is rare, and patients showing continuous bleeding and massive perirenal hematoma have often been surgically treated. We report here on a case of HFRS complicated by massive perirenal hematoma, and the patient was treated with transcatheter arterial embolization. In summary, spontaneous rupture of the kidney and perirenal hematoma is a rare complication of HFRS. We report here on a case of HFRS that caused massive perirenal hematoma, and this was treated with superselective renal artery embolization

Renal Artery Embolization of Perirenal Hematoma in Hemorrhagic Fever with Renal Syndrome: A Case Report

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Choi, Hee Seok; Lee, Yong Seok; Lim, Ji Hyon; Kim, Kyung Soo; Yoon, Yup [Dongguk University College of Medicine, Goyang (Korea, Republic of); Hwang, Jae Cheol [Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (Korea, Republic of)

2007-08-15

Hemorrhagic fever with renal syndrome (HFRS) is an acute viral disease characterized by fever, hemorrhage and renal failure. Among the various hemorrhagic complications of HFRS, spontaneous rupture of the kidney and perirenal hematoma are very rare findings. We report here on a case of HFRS complicated by massive perirenal hematoma, and this was treated with transcatheter arterial embolization. Hemorrhagic fever with renal syndrome (HFRS) is an acute infectious disease caused by hantavirus. HFRS is clinically characterized by fever, renal failure and hemorrhage in organs such as lung, kidney, spleen and the pituitary gland. Renal medullary hemorrhage is a well-known complication in the kidney, but spontaneous rupture of the kidney and perirenal hematoma in HFRS is rare, and patients showing continuous bleeding and massive perirenal hematoma have often been surgically treated. We report here on a case of HFRS complicated by massive perirenal hematoma, and the patient was treated with transcatheter arterial embolization. In summary, spontaneous rupture of the kidney and perirenal hematoma is a rare complication of HFRS. We report here on a case of HFRS that caused massive perirenal hematoma, and this was treated with superselective renal artery embolization.

Transcatheter ovarian vein embolization for pelvic congestion syndrome: short-term outcome

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Park, Ji Seon; Oh, Joo Hyeong; Yoon, Yup; Huh, Joo Yup [College of Medicine, Kyunghee Univ., Seoul (Korea, Republic of); Jeong, Yu Mee [College of Medicine, Dongguk Univ., Seoul (Korea, Republic of)

2002-04-01

To evaluate the short-term therapeutic effectiveness of ovarian vein embolization using coils for pelvic congestion syndrome (PCS), a common cause of chronic pelvic pain, and to determine patient satisfaction. Forty-four multiparous women aged 26-73 (mean, 39.9) years in whom chronic pelvic pain due to unknown causes had lasted for more than six months, and whose gynecologic findings and laboratory data suggested PCS, underwent transabdominal or transvaginal ultrasonography and selective ovarian venography. PSC was finally diagnosed in 21 of th 44, who underwent 22 ovarian vein embolizations (in one case, bilaterally). The simple pain rating system was used at admission, with a 'minimal' or 'moderate' grade representing discomfort in daily life, and 'severe; indicating the need for medication. Indications for coil embolization included dilatation of the ovarian vein to a diameter of more than 6 mm, reflux involving an incompetent valve, congestion of the pelvic venous plexus (involving the stasis of contrast media), and /or opacification of the ipsilateral internal iliac vein (or contralateral filling). Embolizations were undertaken using coils of optimal size and number, and the mean follow-up period was 217 (31-267) days. By means of a telephone questionnaire, the outcome was classified as a cure, pain reduction, or 'no change, or aggravation', and on the basis of whether or not they would opt for the same treatment, or recommend embolization to others, patient satisfaction was graded as 'substantial', 'moderate', or 'absent'. Venous occlusion was confirmed at postembolization venography in all 22 cases. Clinical treatment led to symptomatic relief in 76.2% of patients a cure in 33.3%(7/21), pain reduction in 42.9%(9/21) and no imchage, or aggravation, in 23.8%(5/21). Eighteen patients (85.5%) were very (9/21, 42.9%) or moderately (9/21, 42.9%) satisfied with coil embolization. In two, the coil

Transcatheter ovarian vein embolization for pelvic congestion syndrome: short-term outcome

International Nuclear Information System (INIS)

Park, Ji Seon; Oh, Joo Hyeong; Yoon, Yup; Huh, Joo Yup; Jeong, Yu Mee

2002-01-01

To evaluate the short-term therapeutic effectiveness of ovarian vein embolization using coils for pelvic congestion syndrome (PCS), a common cause of chronic pelvic pain, and to determine patient satisfaction. Forty-four multiparous women aged 26-73 (mean, 39.9) years in whom chronic pelvic pain due to unknown causes had lasted for more than six months, and whose gynecologic findings and laboratory data suggested PCS, underwent transabdominal or transvaginal ultrasonography and selective ovarian venography. PSC was finally diagnosed in 21 of th 44, who underwent 22 ovarian vein embolizations (in one case, bilaterally). The simple pain rating system was used at admission, with a 'minimal' or 'moderate' grade representing discomfort in daily life, and 'severe; indicating the need for medication. Indications for coil embolization included dilatation of the ovarian vein to a diameter of more than 6 mm, reflux involving an incompetent valve, congestion of the pelvic venous plexus (involving the stasis of contrast media), and /or opacification of the ipsilateral internal iliac vein (or contralateral filling). Embolizations were undertaken using coils of optimal size and number, and the mean follow-up period was 217 (31-267) days. By means of a telephone questionnaire, the outcome was classified as a cure, pain reduction, or 'no change, or aggravation', and on the basis of whether or not they would opt for the same treatment, or recommend embolization to others, patient satisfaction was graded as 'substantial', 'moderate', or 'absent'. Venous occlusion was confirmed at postembolization venography in all 22 cases. Clinical treatment led to symptomatic relief in 76.2% of patients a cure in 33.3%(7/21), pain reduction in 42.9%(9/21) and no imchage, or aggravation, in 23.8%(5/21). Eighteen patients (85.5%) were very (9/21, 42.9%) or moderately (9/21, 42.9%) satisfied with coil embolization. In two, the coil migrated, and was successfully retrieved using a snare loop. In this

[Thoracic aortic dissection revealed by systemic cholesterol embolism].

Science.gov (United States)

Braem, L; Paule, P; Héno, P; Morand, J J; Mafart, B; La Folie, T; Varlet, P; Mioulet, D; Fourcade, L

2006-10-01

Systemic cholesterol embolism is a rare complication of atherosclerosis, and has various presentations. Arterial catheterisms are a common cause. However, the association with an aortic dissection has been exceptionally reported. We report the observation of a 70 year-old man, with coronary artery disease, hypertension, diabetes and dyslipidemia. Six months before hospitalization, a coronary angioplasty was performed due to recurrent angina. The association of purpuric lesions on the feet, with acute renal failure confirmed cholesterol embolism syndrome. Transoesophageal echocardiography showed a dissection of the descending thoracic aorta associated with complex atheroma. The evolution was marked by the pulpar necrosis of a toe and by a worsening of the renal failure, requiring definitive hemodialysis. Further echographic control highlighted the rupture of the intimal veil of the dissection. Cholesterol embolism syndrome may reveal an aortic dissection in patients without thoracic symptoms. In such cases, transoesophageal echocardiography is a useful and non-invasive examination.

Cerebral fat embolism after bilateral total knee replacement arthroplasty -A case report-

OpenAIRE

Chang, Ri-Na; Kim, Jong-Hak; Lee, Heeseung; Baik, Hee-Jung; Chung, Rack Kyung; Kim, Chi Hyo; Hwang, Tae-Hu

2010-01-01

Fat embolism syndrome is a rare and potentially lethal complication most commonly seen in long bone fractures and intramedullary manipulation. The clinical triad of fat embolism syndrome consists of mental confusion, respiratory distress, and petechiae. This study reports a case of cerebral fat embolism syndrome following elective bilateral total knee replacement. After an uneventful anesthesia and initial recovery, the patient developed neurologic symptoms nine hours postoperatively.

Blue toe syndrome treated with sympathectomy in a patient with acute renal failure caused by cholesterol embolization

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Min-Gang Kim

2013-12-01

Full Text Available Blue toe syndrome is the most frequent manifestation of tissue ischemia caused by cholesterol embolization (CE, which can lead to amputation of affected lower extremities, if severe. However, any effective treatment is lacking. We experienced a case of spontaneously presenting blue toe syndrome and concomitant acute renal failure in a patient with multiple atherosclerotic risk factors. CE was confirmed by renal biopsy. Despite medical treatment including prostaglandin therapy and narcotics, the toe lesion progressed to gangrene with worsening ischemic pain. Therefore, we performed lumbar sympathectomy, which provided dramatic pain relief as well as an adequate blood flow to the ischemic lower extremities, resulting in healing of the gangrenous lesion and avoiding toe amputation. This is the first reported case of a patient with intractable ischemic toe syndrome caused by CE that was treated successfully by sympathectomy. Our observations suggest that sympathectomy may be beneficial in some patients with CE-associated blue toe syndrome.

Renal aneurysm and arteriovenous fistula; Management with transcatheter embolization

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Savastano, S.; Feltrin, G.P.; Miotto, D.; Chiesura-Corona, M. (Padua Univ. (Italy). Ist. di Radiologia Padua Univ. (Italy). Ist. di Fisioterapia)

1990-01-01

Embolization was performed in six patients with renal artery aneurysms (n=2) and arteriovenous fistulas (AVF) (n=5). The aneurysms were observed in one patient with fibromuscular dysplasia and in another with Ehlers-Danlos syndrome. All the AVFs were intraparenchymal and secondary to iatrogenic trauma. Elective embolization was performed in five patients with good clinical results at follow-up between 1 and 9 years. Because of rupture of the aneurysm emergency embolization was attempted without success in the patient with Ehlers-Danlos syndrome, and nephrectomy was carried out. A postembolization syndrome complicated three procedures in which Gelfoam and polyvinyl alcohol were used; in two of these cases unexpected reflux of the particulate material occurred, resulting in limited undesired ablation of the ipsilateral renal parenchyma. Embolization is the most reliable and effective treatment for intrarenal vascular abnormalities since it minimizes the parenchymal damage. (orig.).

A rare presentation of Klippel-Trenaunay syndrome

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Tanweer Karim

2014-01-01

Full Text Available The Klippel-Trenaunay syndrome (KTS is a congenital disorder characterized by capillary malformation, varicosities and bony and soft tissue hypertrophy. This disease has several morbidities like bleeding, deep venous thrombosis, embolic complications and in some cases enlargement of limb that may require amputation. Vascular malformations are segmented and never cross midline. However, we came across a case, a 45-year-old male, who presented with varicosity of veins and deformity of left lower limb besides cavernous hemangiomas (port-wine stains scattered all over his face, chest, back, gluteal region, groin and legs since birth. Multiple paravertebral soft tissue masses and bladder hypertrophy were also noted due to involving neurofibromatosis. Simultaneous occurrence of KTS and neurofibromatosis is rarely seen in clinical practice.

Verapamil-induced breakdown of the blood-brain barrier presenting as a transient right middle cerebral artery syndrome.

Science.gov (United States)

Pace, Jonathan; Nelson, Jeffrey; Ray, Abhishek; Hu, Yin

2017-12-01

A middle-aged patient presented for elective embolization of an incidentally found right internal carotid aneurysm. An angiogram was performed, during which the left internal carotid artery was visualized to evaluate a second, small aneurysm. During the embolization of the right internal carotid artery aneurysm, a catheter-induced vasospasm was identified that prompted treatment with intra-arterial verapamil. The procedure was uncomplicated; a postoperative rotational flat-panel computed tomography scan was performed on the angiography table that demonstrated right hemisphere contrast staining. The patient developed a right middle cerebral artery (MCA) syndrome after extubation with repeat cerebral angiography negative for occlusion and magnetic resonance imaging negative for stroke. The patient was observed for 48 hours, during which time the patient had slowly improved. At a six-week follow up visit, the patient had fully recovered. We present an interesting case of a verapamil-induced breakdown of the blood-brain barrier and self-limited right MCA syndrome.

Partial splenic embolization combined with vincristine infusion for the treatment of refractory idiopathic thrombocytopenic purpura and Evans syndrome: observation of its long-term efficacy

International Nuclear Information System (INIS)

Chen Shibing

2011-01-01

Objective: To observe the long-term efficacy of partial spleen embolization combined with vincristine infusion in treating refractory idiopathic thrombocytopenic purpura (ITP) and Evans syndrome. Methods: During the period of 2000-2007, partial spleen embolization together with vincristine infusion was carried out in 30 patients with refractory idiopathic thrombocytopenic purpura (n=24) or Evans syndrome (n=6). Vincristine infusion (2 mg) via splenic artery was performed before partial spleen embolization procedure. The long-term effectiveness was observed and analyzed. Results: One week after the treatment, the platelet count was increased from preoperative (10.23±8.28) × 10 9 /L to (140.28±85.45) × 10 9 /L in patients with ITP, while the platelet count was increased from preoperative (12±8) × 10 9 /L to (210±60) × 10 9 /L in patients with Evans syndrome. Meanwhile, the hemoglobin level showed an increase in different degrees, from preoperative (63.00±13.62) g/L to postoperative (123.00±13.14) g/L. The therapeutic effectiveness was 100%. During the follow-up time lasting for 3-5 years, recurrence was seen in 11 patients (36.7%) and the overall efficacy rate was 63.3%. Conclusion: For the treatment of refractory idiopathic thrombocytopenic purpura and Evans syndrome, partial spleen embolization combined with vincristine infusion carries reliable long-term efficacy. (author)

Brain fat embolism

International Nuclear Information System (INIS)

Sugiura, Yoshihiro; Kawamura, Yasutaka; Suzuki, Hisato; Yanagimoto, Masahiro; Goto, Yukio

1994-01-01

Recently CT and MR imaging have demonstrated that cerebral edema is present in cases of fat embolism syndrome. To simulate this we have made a model of brain-fat embolism in rats under MR imaging. In 20 rats, we did intravenous injection of heparinized blood, 1.5 ml·kg -1 taken from femoral bone marrow cavity. Twenty four hours after the injection, we examined the MR images (1.5 tesla, spin-echo method) of brains and histologic findings of brains and lungs were obtained. In 5 of 20 rats, high signal intensity on T2-weighted images and low signal intensity on T1-weighted images were observed in the area of the unilateral cerebral cortex or hippocampus. These findings showed edema of the brains. They disappeared, however, one week later. Histologic examinations showed massive micro-fat emboli in capillaries of the deep cerebral cortex and substantia nigra, but no edematous findings of the brain were revealed in HE staining. In pulmonary arteries, we also found large fat emboli. We conclude that our model is a useful one for the study of brain fat embolism. (author)

The Role of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs in the Management of the Post-Embolization Symptoms after Uterine Artery Embolization

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Tiago Bilhim

2010-05-01

Full Text Available Uterine artery embolization (UAE is usually a very painful procedure. Although pain after the procedure can occur as a single symptom, it usually is associated with other symptoms such as nausea, vomiting, pelvic pain, general malaise, fever and leukocytosis that characterize the post-embolization syndrome. Management of the post-embolization symptoms and of pain in particular, is paramount if UAE is to be performed as an outpatient procedure. Different protocols have used analgesic and/or anti-inflammatory agents to control these symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs are frequently used in association with analgesic drugs to control post-embolization symptoms. In our institution the patients start oral medication with NSAIDs the day before the procedure and continue it during and after UAE. We also mix NSAIDs with the embolizing particles. This enables a reduction in the inflammation present in the uterine fibroids and helps controlling the pain. The purpose of this paper is to review the importance of NSAIDs in the management of the post-embolization symptoms. We describe the protocol that we use in our institution that enables us to perform the procedure on an outpatient basis with same day discharge and good control of the post-embolization symptoms with oral NSAIDs and analgesics.

Fat embolism after fractures in Duchenne muscular dystrophy: an underdiagnosed complication? A systematic review

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Feder D

2017-10-01

Full Text Available David Feder,1 Miriam Eva Koch,1 Beniamino Palmieri,2 Fernando Luiz Affonso Fonseca,1 Alzira Alves de Siqueira Carvalho3 1Pharmacology Department, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil; 2Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, Modena, Italy; 3Neuroscience Department, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil Abstract: Duchenne muscular dystrophy is the most frequent lethal genetic disease. Several clinical trials have established both the beneficial effect of steroids in Duchenne muscular dystrophy and the well-known risk of side effects associated with their daily use. For many years it has been known that steroids associated with ambulation loss lead to obesity and also damage the bone structure resulting in the bone density reduction and increased incidence of bone fractures and fat embolism syndrome, an underdiagnosed complication after fractures. Fat embolism syndrome is characterized by consciousness disturbance, respiratory failure and skin rashes. The use of steroids in Duchenne muscular dystrophy may result in vertebral fractures, even without previous trauma. Approximately 25% of patients with Duchenne muscular dystrophy have a long bone fracture, and 1% to 22% of fractures have a chance to develop fat embolism syndrome. As the patients with Duchenne muscular dystrophy have progressive cardiac and respiratory muscle dysfunction, the fat embolism may be unnoticed clinically and may result in increased risk of death and major complications. Different treatments and prevention measures of fat embolism have been proposed; however, so far, there is no efficient therapy. The prevention, early diagnosis and adequate symptomatic treatment are of paramount importance. The fat embolism syndrome should always be considered in patients with Duchenne muscular dystrophy presenting with fractures, or an unexplained and

Postoperative hypoxemia due to fat embolism

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Tarun Bhalla

2011-01-01

Full Text Available Although the reported incidence of fat embolism syndrome (FES is low (approximately 1%, it is likely that microscopic fat emboli are showered during manipulation of long bone fractures. Even though there continues to be debate regarding the etiology and proposed mechanism responsible for FES, significant systemic manifestations may occur. Treatment is generally symptomatic based on the clinical presentations. We report a 10-year-old girl who developed hypoxemia following treatment of a displaced Salter-Harris type II fracture of the distal tibia. The subsequent evaluation and hospital course pointed to fat embolism as the most likely etiology for the hypoxemia. We discuss the etiology for FES, review the proposed pathophysiological mechanisms responsible for its clinical manifestations, present currently accepted diagnostic criteria, and discuss its treatment.

Cerebral Fat Embolism in a Trauma Patient with Captured Imaging of Echogenic Emboli in the Inferior Vena Cava

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Nancy N. Wang

2016-12-01

Full Text Available The authors present a case of fat embolism syndrome after traumatic long-bone fracture in a patient with rapid neurologic deterioration and multiple cerebral embolic events. Diagnostic workup revealed the neuroradiologic findings classically described with cerebral fat emboli. The authors present hallmark ultrasound imaging of echogenic material actively traveling through the inferior vena cava.

A Case of Acute Budd-Chiari Syndrome Complicating Primary Antiphospholipid Syndrome Presenting as Acute Abdomen and Responding to Tight Anticoagulant Therapy

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Naofumi Chinen

2016-01-01

Full Text Available A 34-year-old woman with primary antiphospholipid syndrome was admitted to the Gastroenterology Department of our hospital with fever, acute abdomen, watery diarrhea, and extremely high levels of inflammatory parameters. She had a history of left lower limb deep vein thrombosis and pulmonary embolism and was taking warfarin potassium. Acute gastroenteritis was suspected and an antibiotic was administered, but symptoms progressed. Abdominal ultrasonography showed occlusion of the left hepatic vein and the middle hepatic vein and her D-dimer level was high. Accordingly, Budd-Chiari syndrome was diagnosed and high-dose intravenous infusion of heparin was initiated. Her abdominal symptoms improved and the levels of inflammatory parameters and D-dimer decreased rapidly. It is known that antiphospholipid syndrome can be complicated by Budd-Chiari syndrome that usually occurs as subacute or chronic onset, but acute onset is rare. It is difficult to diagnose acute Budd-Chiari syndrome complicating antiphospholipid syndrome and this complication generally has a poor outcome. However, the present case can get early diagnosis and successful treatment with tight anticoagulant therapy.

Fatal Peritoneal Bleeding Following Embolization of a Carotid-Cavernous Fistula in Ehlers-Danlos Syndrome Type IV

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Usinskiene, Jurgita; Mazighi, Mikael; Bisdorff, Annouk; Houdart, Emmanuel

2006-01-01

We report the case of a 25-year-old woman treated for a spontaneous carotid-cavernous fistula in a context of Ehlers-Danlos syndrome type IV. Embolization with a transvenous approach was achieved without complications; however, the patient died 72 hr later of massive intraperitoneal bleeding. At autopsy, no lesion of the digestive arteries was identified. Possible causes of this bleeding are discussed

Brain CT and MRI findings in fat embolism syndrome

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Suzuki, Shin; Hayashi, Takaki; Ri, Kyoshichi

1996-01-01

To elucidate brain CT and MRI findings in fat embolism syndrome (FES), we retrospectively analyzed images from 5 patients with FES during the acute and subacute stages. Brain CT examinations demonstrated brain edema in 2 patients and transient spotty low density lesions in 2 patients. Three patients showed no abnormalities. Brain MRI, however, showed brain abnormalities in all patients during the acute stages. These were revealed as spotty high signal intensity lesions on T2WI, and some showed low intensity on T1WI. These spotty lesions were considered to reflect edematous fluid occurring as a result of the unique pathophysiological condition of FES. While the spotty high signal intensity lesions on T2WI were distributed in the cerebrum, cerebellum, brain stem, thalamus, basal ganglia, internal capsule and corpus callosum, cerebral and cerebellar spotty lesions were characteristically located along the boundary zones of the major vascular territories. This characteristic location might be induced by a hypoxic brain condition in FES because the numerous fat globules present in this condition can block entire brain capillaries. This characteristic signal location on T2WI is a useful indicator for differentiating FES from the primary intra-axial brain injury in patients with multifocal trauma. (author)

Dissecting Vertebral Artery Aneurysm Presenting Regrowth After Stent-Assisted Coil Embolization in Acute Stage.

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Hijikata, Takamichi; Baba, Eiichi; Shirokane, Kazutaka; Tsuchiya, Atsushi; Nomura, Motohiro

2018-06-01

For a case of dissecting vertebral artery aneurysm (DVAA) in a dominant vertebral artery (VA) or posterior inferior cerebellar artery (PICA)-involving lesion, stent-assisted coil embolization (SACE) is an effective technique to preserve blood flow of the VA. A 41-year-old man presented with subarachnoid hemorrhage. Angiography demonstrated DVAA on the left VA just distal to the PICA, and the right VA was thinner than the left. For this case, SACE was performed to preserve the left VA and PICA. On the 10th day, angiography showed recurrence of the dissection. The dissected portion had thickened and extended to both distal and proximal sides involving the PICA origin and proximal portion to the PICA. A second endovascular embolization was performed and the recurrent dissecting aneurysm was embolized including the main VA cavity. In cases of DVAA, there is a possibility of recurrence after SACE, if a dissecting cavity remains unembolized. Therefore, total embolization is necessary under close observation from multiple angles, including the down-the-barrel view.

Mucous plug syndrome. A pulmonary embolism mimic

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Bray, S.T.; Johnstone, W.H.; Dee, P.M.; Pope, T.L. Jr.; Teates, C.D.; Tegtmeyer, C.J.

1984-01-01

Reported are ten instances of major bronchial obstruction by mucous plugs in eight patients during which the clinical features resembled pulmonary embolism. Perfusion lung studies showed significantly diminished perfusion of the involved portions of the lungs. The chest radiographs generally did not, however, reflect the severity of the airway obstruction and in some instances were completely normal. The ventilation studies indicated the extent and severity of the obstruction and matched with the perfusion scans. Pulmonary arteriograms were performed in three patients and gave direct evidence of focally diminished lung perfusion without embolism. The physiologic mechanisms underlying the condition are discussed

Transcatheter Arterial Embolization for Upper Gastrointestinal Nonvariceal Hemorrhage: Is Empiric Embolization Warranted?

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Arrayeh, Elnasif; Fidelman, Nicholas, E-mail: nicholas.fidelman@ucsf.edu; Gordon, Roy L.; LaBerge, Jeanne M.; Kerlan, Robert K. [University of California San Francisco, Department of Radiology (United States); Klimov, Alexander; Bloom, Allan I. [Hadassah Hospital, Department of Radiology (Israel)

2012-12-15

Purpose: To determine whether transcatheter arterial embolization performed in the setting of active gastric or duodenal nonvariceal hemorrhage is efficacious when the bleeding source cannot be identified angiographically. Methods: Records of 115 adult patients who underwent visceral angiography for endoscopically documented gastric (50 patients) or duodenal (65 patients) nonvariceal hemorrhage were retrospectively reviewed. Patients were subdivided into three groups according to whether angiographic evidence of arterial hemorrhage was present and whether embolization was performed (group 1 = no abnormality, no embolization; group 2 = no abnormality, embolization performed [empiric embolization]; and group 3 = abnormality present, embolization performed). Thirty-day rates and duration of primary hemostasis and survival were compared.ResultsFor patients with gastric sources of hemorrhage, the rate of primary hemostasis at 30 days after embolization was greater when embolization was performed in the setting of a documented angiographic abnormality than when empiric embolization was performed (67% vs. 42%). The rate of primary hemostasis at 30 days after angiography was greater for patients with duodenal bleeding who either underwent empiric embolization (60%) or embolization in the setting of angiographically documented arterial hemorrhage (58%) compared with patients who only underwent diagnostic angiogram (33%). Patients with duodenal hemorrhage who underwent embolization were less likely to require additional invasive procedures to control rebleeding (p = 0.006). Conclusion: Empiric arterial embolization may be advantageous in patients with a duodenal source of hemorrhage but not in patients with gastric hemorrhage.

ANCA-Negative Churg-Strauss Syndrome Presenting as Acute Multiple Cerebral Infarcts: A Case Report.

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Psychogios, Klearchos; Evmorfiadis, Ilias; Dragomanovits, Spyros; Stavridis, Athanasios; Takis, Konstantinos; Kaklamanis, Loukas; Stathis, Pantelis

2017-03-01

Eosinophilic granulomatosis with polyangiitis (EGPA, previously named Churg-Strauss syndrome) is a form of necrotizing vasculitis occurring in patients with asthma and eosinophilia. Ischemic stroke is a relatively rare complication of the disease. We report a case of a 63-year-old woman with multiple embolic infarcts, hypereosinophilia (for >7 years), and skin rash. Elevated cardiac enzymes and cardiac magnetic resonance imaging were consistent with endomyocarditis. The simultaneous presence of history of asthma, sinusitis, hypereosinophilia, and vasculitis led to the diagnosis of EGPA. This case contributes to the recent debate of the 2 possible presentations of the disease according to the ANCA (antineutrophil cytoplasmic antibodies) status. We furthermore underscore the need for careful differential diagnosis of the "ANCA negative" cases with persistent hypereosinophilia from the idiopathic hypereosinophilic syndrome. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Splenic Infarct and Pulmonary Embolism as a Rare Manifestation of Cytomegalovirus Infection

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Prashanth Rawla

2017-01-01

Full Text Available Cytomegalovirus (CMV is a type of herpes infection that has a characteristic feature of maintaining lifelong latency within the host cell. CMV manifestations can cover a broad spectrum from fever to as severe as pancytopenia, hepatitis, retinitis, meningoencephalitis, Guillain-Barre syndrome, pneumonia, and thrombosis. Multiple case reports of thrombosis associated with CMV have been reported. Deep vein thrombosis or pulmonary embolism is more common in immunocompetent patients while splenic infarct is more common in immunocompromised patients. However, here we report a female patient on low-dose methotrexate for rheumatoid arthritis who presented with both pulmonary embolism and splenic infarct.

Intimal sarcoma of the pulmonary artery presenting as pulmonary embolism

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Plata, María Camila; Rey, Diana Lucía; Villaquirán, Claudio; Rosselli, Diego

2017-01-01

SUMMARY Pulmonary artery sarcomas are extremely rare; due to their insidious growth, diagnosis occurs late and prognosis is poor. We present the case of a 33-year-old woman with a history of dyspnea, chest pain and syncope. An obstructing mass on the right ventricle, main pulmonary artery and right branch were interpreted as a possible pulmonary embolism. RESUMEN Los sarcomas de la arteria pulmonar son extremadamente raros; debido a su crecimiento lento y silencioso, el diagnóstico suele s...

Two different embolic agents in the treatment of uterine arterial embolization for symptomatic fibroids

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Shi Hongjian; Huang Youhua; Xu Qiang; Shen Tao; Chen Jing; Wu Xiaosong; Jiang Lei; Dong Weihua

2008-01-01

Objective: To compare the efficacy and safety of dextran microspheres and polyvinyl alcohol particles in the uterine arterial embolization (UAE)for symptomatic uterine leiomyomata. Methods: Forty women (mean aged 38.5 years, ranged 28-44 years)with symptomatic myomas were randomly divided into two groups with 20 patients in each, PVA (polyvinyl alcohol particles, 355-500 μm)was used as embolic agents in group A and dextran microspheres(Sephadex G-50, 100-300 μm)in group B. The mean diameter of fibroids was 6.5 cm (range, 3-12 cm)with symptoms of menorrahgia, bulk-related symptoms, dysmenorrhea and infertility. Analgesics, anti-infection and rehydration treatments were used after the procedure. The hospital stay, post-embolization syndromes, follow-up materials were reviewed and compared. Results: The hospital stay and the post embolization pain showed no obvious difference between the two groups, simultaneously with no serious complications. The average follow-up duration was 9 months (range, 6-24 months). The average volumes of uterus and fibroid in group A and B decreased gradually during follow-up: 53.4%, 55% and 48.6%, 40.9%, respectively. Conclusion: Dextran microspheres is as the same effective and safe as PVA particles for UAE, but rather cheaper than latter. Further prospective study is warranted. (authors)

Treatment of symptomatic pelvic varices by ovarian vein embolization

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Capasso, Patrizio; Simons, Christine; Trotteur, Genevieve; Dondelinger, Robert F.; Henroteaux, Denis; Gaspard, Ulysse

1997-01-01

Purpose. Pelvic congestion syndrome is a common cause of chronic pelvic pain in women and its association with venous congestion has been described in the literature. We evaluated the potential benefits of lumboovarian vein embolization in the treatment of lower abdominal pain in patients presenting with pelvic varicosities. Methods. Nineteen patients were treated. There were 13 unilateral embolizations, 6 initial bilateral treatments and 5 treated recurrences (a total of 30 procedures). All embolizations were performed with either enbucrilate and/or macrocoils, and there was an average clinical and Doppler duplex follow-up of 15.4 months. Results. The initial technical success rate was 96.7%. There were no immediate or long-term complications. Variable symptomatic relief was observed in 73.7% of cases with complete responses in 57.9%. All 8 patients who had partial or no pain relief complained of dyspareunia. The direct relationship between varices and chronic pelvic pain was difficult to ascertain in a significant number of clinical failures. Conclusion. Transcatheter embolization of lumboovarian varices is a safe technique offering symptomatic relief of pelvic pain in the majority of cases. The presence of dyspareunia seemed to be a poor prognostic factor, indicating that other causes of pelvic pain may coexist with pelvic varicosities

Evaluation of Effectiveness of Embolization in Pelvic Congestion Syndrome with the New Vascular Occlusion Device (ArtVentive EOS™): Preliminary Results

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Pyra, Krzysztof; Woźniak, Sławomir; Drelich-Zbroja, Anna; Wolski, Andrzej; Jargiełło, Tomasz

2016-01-01

PurposeThis study aimed to collect confirmatory data in support of the safety and efficiency of the ArtVentive EOS™ for the treatment of the pelvic congestion syndrome (PCS). This study was based on the OCCLUDE 1 Study Protocol approved by the Local Ethics Committee.Materials and MethodsA prospective study carried out in June and July 2014 included 12 women aged 21–48 years (mean 31 years) scheduled for PCS embolization using the ArtVentive EOS™. The inclusion criteria were clinical symptoms of PCS documented by transvaginal Doppler ultrasound and pelvic MRI. The pelvic pain was assessed by VAS score from 0 to 10 (0 represents lack of pain and 10 unbearable pain). A decrease in pelvic pain intensity based on the VAS was considered a clinical success.ResultsSuccessful embolization procedures with ArtVentive EOS™ were performed in 11 out of 12 patients. Nine patients underwent unilateral embolization of the left ovarian vein, and two had bilateral embolization of the ovarian veins. Complete ovarian vein occlusion confirmed by post deployment venography was achieved in all 11 patients. Procedures lasted from 19 to 45 min (average 28 min). Pain intensity decrease was observed in all 11 patients—a decrease of 5.6 points—from 7.3 pre-procedure to 1.6 post-embolization (standard deviation: 0.67). In one case, the left ovarian vein was injured by guide wire manipulation with contrast extravasation—not clinically significant.ConclusionsThe use of ArtVentive EOS™ for occlusion of the ovarian veins in PCS patients is safe and effective.

Evaluation of Effectiveness of Embolization in Pelvic Congestion Syndrome with the New Vascular Occlusion Device (ArtVentive EOS™): Preliminary Results

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Pyra, Krzysztof, E-mail: k.pyra@poczta.fm [Medical University of Lublin, Department of Interventional Radiology and Neuroradiology (Poland); Woźniak, Sławomir, E-mail: slavwo7572@gmail.com [Medical University of Lublin, III Gynecology Clinic (Poland); Drelich-Zbroja, Anna, E-mail: zbroanna@interia.pl; Wolski, Andrzej, E-mail: andrzej.s.wolski@gmail.com; Jargiełło, Tomasz, E-mail: tojarg@interia.pl [Medical University of Lublin, Department of Interventional Radiology and Neuroradiology (Poland)

2016-08-15

PurposeThis study aimed to collect confirmatory data in support of the safety and efficiency of the ArtVentive EOS™ for the treatment of the pelvic congestion syndrome (PCS). This study was based on the OCCLUDE 1 Study Protocol approved by the Local Ethics Committee.Materials and MethodsA prospective study carried out in June and July 2014 included 12 women aged 21–48 years (mean 31 years) scheduled for PCS embolization using the ArtVentive EOS™. The inclusion criteria were clinical symptoms of PCS documented by transvaginal Doppler ultrasound and pelvic MRI. The pelvic pain was assessed by VAS score from 0 to 10 (0 represents lack of pain and 10 unbearable pain). A decrease in pelvic pain intensity based on the VAS was considered a clinical success.ResultsSuccessful embolization procedures with ArtVentive EOS™ were performed in 11 out of 12 patients. Nine patients underwent unilateral embolization of the left ovarian vein, and two had bilateral embolization of the ovarian veins. Complete ovarian vein occlusion confirmed by post deployment venography was achieved in all 11 patients. Procedures lasted from 19 to 45 min (average 28 min). Pain intensity decrease was observed in all 11 patients—a decrease of 5.6 points—from 7.3 pre-procedure to 1.6 post-embolization (standard deviation: 0.67). In one case, the left ovarian vein was injured by guide wire manipulation with contrast extravasation—not clinically significant.ConclusionsThe use of ArtVentive EOS™ for occlusion of the ovarian veins in PCS patients is safe and effective.

Embolization as an Alternative Treatment of Insulinoma in a Patient with Multiple Endocrine Neoplasia Type 1 Syndrome

International Nuclear Information System (INIS)

Peppa, Melpomeni; Brountzos, Elias; Economopoulos, Nicolaos; Boutati, Eleni; Pikounis, Vasilios; Patapis, Paul; Economopoulos, Theofanis; Raptis, Sotirios A.; Hadjidakis, Dimitrios

2009-01-01

Insulinoma is a rare neuroendocrine tumor, most commonly originating from the pancreas, which is either sporadic or familial as a component of multiple endocrine neoplasia type 1 syndrome (MEN1). It is characterized by increased insulin secretion leading to hypoglycemia. Surgical removal is considered the treatment of choice, with limited side effects and relatively low morbidity and mortality, both being improved by the laparoscopic procedure. We present the case of a 30-year-old patient with MEN1 and recurrent insulinoma with severe hypoglycemic episodes who could not be surgically treated due to the adherence of the tumor to large blood vessels and to prior multiple surgical operations. He was treated by repeated embolization using spherical polyvinyl alcohol particles, resulting in shrinkage of the tumor, improvement of the frequency and severity of the hypoglycemic episodes, and better quality of life.

Fat embolism syndrome in femoral shaft fractures: does the initial treatment make a difference?

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Janio Jose Alves Bezerra Silva

Full Text Available ABSTRACT Objective: To identify the risk factors correlated with the initial treatment performed. Methods: This is a retrospective study involving a total of 272 patients diagnosed with femoral shaft fractures. Of the patients, 14% were kept at rest until the surgical treatment, 52% underwent external fixation, 10% received immediate definitive treatment, and 23% remained in skeletal traction (23% until definitive treatment., Results: There were six cases of fat embolism syndrome (FES, which showed that , polytrauma is the main risk factor for its development and that initial therapy was not important. Conclusion: Polytrauma patients have a greater chance of developing FES and there was no influence from the initial treatment.

Paradoxical cerebral air embolism

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Lopez-Negrete, L.; Garcia-Lozano, J.; Sanchez, J. L.; Sala, J.

2000-01-01

We present a fatal case of intracranial air embolism produced by the passage of intravenous air to the arteries owing to the existence of a patent foremen ovale associated with pulmonary hypertension, which permitted a right-left shunt (paradoxical embolism). The pathophysiological mechanisms of pneumcephalus and paradoxical embolism are discussed and the pertinent literature is reviewed. (Author) 6 refs

Predicting in-hospital death during acute presentation with pulmonary embolism to facilitate early discharge and outpatient management.

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Jerrett K Lau

Full Text Available Pulmonary embolism continues to be a significant cause of death. The aim was to derive and validate a risk prediction model for in-hospital death after acute pulmonary embolism to identify low risk patients suitable for outpatient management.A confirmed acute pulmonary embolism database of 1,426 consecutive patients admitted to a tertiary-center (2000-2012 was analyzed, with odd and even years as derivation and validation cohorts respectively. Risk stratification for in-hospital death was performed using multivariable logistic-regression modelling. Models were compared using receiver-operating characteristic-curve and decision curve analyses.In-hospital mortality was 3.6% in the derivation cohort (n = 693. Adding day-1 sodium and bicarbonate to simplified Pulmonary Embolism Severity Index (sPESI significantly increased the C-statistic for predicting in-hospital death (0.71 to 0.86, P = 0.001. The validation cohort yielded similar results (n = 733, C-statistic 0.85. The new model was associated with a net reclassification improvement of 0.613, and an integrated discrimination improvement of 0.067. The new model also increased the C-statistic for predicting 30-day mortality compared to sPESI alone (0.74 to 0.83, P = 0.002. Decision curve analysis demonstrated superior clinical benefit with the use of the new model to guide admission for pulmonary embolism, resulting in 43 fewer admissions per 100 presentations based on a risk threshold for admission of 2%.A risk model incorporating sodium, bicarbonate, and the sPESI provides accurate risk prediction of acute in-hospital mortality after pulmonary embolism. Our novel model identifies patients with pulmonary embolism who are at low risk and who may be suitable for outpatient management.

Delayed Diagnosis in an Elderly Schizophrenic Patient with Catatonic State and Pulmonary Embolism

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Hsueh-Chin Hu

2013-09-01

Full Text Available Catatonia is a syndrome with any two of five core features: stupor/motoric immobility/catalepsy/waxy flexibility, excitement, negativism/mutism, posturing, and echolalia/echopraxia. We describe a case of delayed diagnosis of pulmonary embolism with an atypical presentation in an elderly schizophrenia male patient, which led to a life-threatening brain infarction. A 75-year-old male was hospitalized in a psychiatric ward because of stupor, poor intake and mutism under a diagnosis of recurrent catatonia. His inability to express his suffering, dehydration, exacerbation of chronic obstructive pulmonary disease, and upper gastrointestinal bleeding, however, made an accurate diagnosis difficult. Finally, the high D-dimer level and further chest computed tomography confirmed pulmonary embolism in the trunk of the bilateral main pulmonary arteries. The brain computed tomography also confirmed brain infarcts. He was transferred to the cardiac intensive care unit and was eventually rescued from near death due to pulmonary embolism and brain infarction. A careful differential diagnosis for pulmonary embolism-induced delirium and catatonic state is important in the treatment of patients with a previous diagnosis of catatonic schizophrenia.

Atypical presentations of Wolframs syndrome

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S Saran

2012-01-01

Full Text Available Background: Wolfram syndrome is a rare hereditary or sporadic neurodegenerative disorder also known as DIDMOAD. The classically described presentation is of insulin-dependent diabetes, followed by optic atrophy, central diabetes insipidus, and sensory neural deafness. Also included are less well-described presentations of Wolframs syndrome. We here present three cases of atypical presentation of this syndrome. Case 1: A 15-year-old boy with insulin-dependent diabetes was presented for evaluation of depressive symptoms associated with suicidal tendency. Neuropsychiatric manifestations are described with Wolframs syndrome, and wolframin gene, in recessive inheritance, is associated with psychiatric illnesses without other manifestations of Wolframs syndrome. Case 2: A 17-year-old diabetic boy on insulin with good control of blood sugar presented for evaluation of delayed puberty. Central hypogonadism and other anterior pituitary hormone dysfunctions are the less publicized hormone dysfunctions in Wolframs syndrome. Case 3: A 23-year-old female who was on insulin for diabetes for the past 14 years, got admitted for evaluation of sudden loss of vision. This patient had developed a vitreous hemorrhage and, on evaluation, was found to have optic atrophy, sensory neural hearing loss, and diabetes insipidus, and presented differently from the gradual loss of vision described in Wolframs syndrome. Conclusion: Wolframs syndrome being a multisystem degenerative disorder can have myriad other manifestations than the classically described features. Neuropsychiatric manifestations, depression with suicidal risk, central hypogonadism, and secondary adrenal insufficiency are among the less well-described manifestations of this syndrome.

Radiologic diagnosis of pulmonary embolism

International Nuclear Information System (INIS)

Fink, C.; Ley, S.; Kauczor, H.U.

2004-01-01

Pulmonary embolism is a frequent and potentially life-threatening complication of venous thromboembolism. Despite numerous modern diagnostic methods, the diagnosis of pulmonary embolism remains problematic, especially in view of the nonspecific clinical presentation. In this educational review, current diagnostic methods and their role in the diagnostic workup of pulmonary embolism will be discussed. In addition, practical guidelines are given for the diagnostic cascade contingent on the clinical probability for pulmonary embolism. (orig.) [de

Severe fat embolism in perioperative abdominal liposuction and fat grafting.

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de Lima E Souza, Rodrigo; Apgaua, Bruno Tavares; Milhomens, João Daniel; Albuquerque, Francisco Tadeu Motta; Carneiro, Luiz Antônio; Mendes, Márcio Henrique; Garcia, Tiago Carvalho; Paiva, Clerisson; Ladeia, Felipe; Jeunon, Deiler Célio

2016-01-01

Fat embolism syndrome may occur in patients suffering from multiple trauma (long bone fractures) or plastic surgery (liposuction), compromising the circulatory, respiratory and/or central nervous systems. This report shows the evolution of severe fat embolism syndrome after liposuction and fat grafting. SSS, 42 years old, ASA 1, no risk factors for thrombosis, candidate for abdominal liposuction and breast implant prosthesis. Subjected to balanced general anesthesia with basic monitoring and controlled ventilation. After 45min of procedure, there was a sudden and gradual decrease of capnometry, severe hypoxemia and hypotension. The patient was immediately monitored for MAP and central catheter, treated with vasopressors, inotropes, and crystalloid infusion, stabilizing her condition. Arterial blood sample showed pH=7.21; PCO2=51mmHg; PO2=52mmHg; BE=-8; HCO3=18mEqL(-1), and lactate=6.0mmolL(-1). Transthoracic echocardiogram showed PASP=55mmHg, hypocontractile VD and LVEF=60%. Diagnosis of pulmonary embolism. After 24h of intensive treatment, the patient developed anisocoria and coma (Glasgow coma scale=3). A brain CT was performed which showed severe cerebral hemispheric ischemia with signs of fat emboli in right middle cerebral artery; transesophageal echocardiography showed a patent foramen ovale. Finally, after 72h of evolution, the patient progressed to brain death. Fat embolism syndrome usually occurs in young people. Treatment is based mainly on the infusion of fluids and vasoactive drugs, mechanical ventilation, and triggering factor correction (early fixation of fractures or suspension of liposuction). The multiorgânico involvement indicates a worse prognosis. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

Palliative percutaneous kidney embolization with enbucrilate in patients with renal cell carcinoma: safety and symptom control.

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Serafin, Zbigniew; Karolkiewicz, Maciej; Strześniewski, Piotr; Lasek, Władysław; Bryczkowski, Michał; Wolski, Zbigniew

2007-05-01

Primarily palliative renal embolization is a relatively rare procedure which is indicated in patients with unresectable kidney malignancies and in patients in poor general condition. The aim of this paper was to evaluate the role of primarily palliative transarterial renal embolization for the treatment of inoperable patients with renal cell carcinoma, assessing the indications, safety, and efficacy of this procedure. Seventy-three patients scheduled for palliative embolization between 1998 and 2005 were retrospectively analyzed regarding their medical history, the procedure report, and data from the early postoperative period. Sixty-six of the 73 patients presented with renal cell carcinoma stage IV. The most common indication for embolization was hematuria (34%), followed by flank pain (32%), prophylaxis in stage IV (25%), lack of consent for surgery (7%), and poor general condition (3%). Embolizations were performed under local anesthesia with a mixture of enbucrilate and iodinated oil, with the use of additional embolizing materials in two cases. The procedure eliminated hematuria in 100% of cases and removed the loin pain completely in 72%. Migration of the embolizing material was observed in 10% of cases, and in 4% it resulted in symptomatic occlusion of the lower extremity distal arteries. Postembolic syndrome was noted in 92% of the patients Percutaneous palliative embolization with enbucrilate is a safe and effective method of treating patients with unresectable renal cell carcinoma. The potential effect of the embolization on cancer progression and improvement of survival in these patients still requires prospective investigation.

FAT LUNG EMBOLISM AS A PRECIPITATING FINAL CAUSE OF DEATH IN POLVTRAUMATIZED PATIENTS

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Slobodan Savic

2001-07-01

Full Text Available Two studies analyzing the autopsy material of the Institute for ForensicMedicine in Belgrade have been done. The first study (group A was a prospectivehistological one and it comprised the examined in which lung fat embolism was notrecorded as a cause of death in the autopsy protocol conclusion but was confirmed bythe microscopic examination in all the cases. Ali these poly traumatized patients hadan injury that could be an outcome of fat embolism. The second group (group B wasa retrospective autopsy one and it analyzed autopsy protocols and čaše histories ofthepatients who died of the fat embolism syndrome (FES that was the only or competingcause of death. The autopsy records and the čaše histories of ali the patients wereanalyzed; the groups were compared with respect to gender and age, way of gettinginjured, an injury severity score (ISS and the period of living after the injury. Ali theobtained data were processed by corresponding statistic methods. The data analysisled to the conclusion that in the poly traumatized patients the fat lung embolism couldbe a precipitating and flam cause of death either as a singular or as a competitive onecombined with some other. It is obvious that the fat embolism of the lungs and thesystem fat embolism could be accepted as a consequence of every more serious injuryof the fat depots in the organism while a possible later development of the fatembolism syndrome would represent a complication of the injury.

Partial splenic embolization in a child with Gaucher disease, massive splenomegaly and severe thrombocytopenia

International Nuclear Information System (INIS)

Pena, Andres H.; Clevac, Egor; Marie Cahill, Anne; Kaplan, Paige; Ganesh, Jaya

2009-01-01

A 13-month-old boy with Gaucher disease presented with severe thrombocytopenia, anemia and massive splenomegaly. In addition he had significant respiratory compromise caused by abdominal compartment syndrome, requiring mechanical ventilation. Because of the degree of respiratory compromise and his existing bone marrow suppression, splenic artery embolization was chosen as an alternative to splenectomy. Splenic artery embolization was performed using 355-500-μm polyvinyl alcohol particles, with 70% ablation achieved. Within 24 h of the procedure the platelet count had risen to greater than 70,000/mm 3 and to more than 170,000/mm 3 on postoperative day 4. At the 8-month follow-up the splenic size had decreased from 18 cm to 8 cm, with a platelet count of 578,000/mm 3 . Partial splenic embolization provides a minimally invasive alternative to splenectomy in patients with Gaucher disease with massive splenomegaly and bone marrow suppression. (orig.)

Correlation between the time elapsed after liposuction and the risk of fat embolism: An animal model

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Kwang-Ryeol Lim

2018-01-01

Full Text Available Background Liposuction has become one of the most frequently performed procedures in the field of aesthetic surgery. Fat embolism syndrome after liposuction can easily be overlooked or underestimated; however, occasionally, fulminating fat embolism syndrome can develop and lead to a critical situation within 2–3 days after lipoplasty. Changes over time in the amount of circulating fat particles and the histology of major organs have not yet been studied. Methods This study was conducted using 18 male Sprague-Dawley rats aged 12 weeks and weighing 500–628 g (average, 562 g. Fifteen rats were used as the experimental group and 3 as the control group. Under general anesthesia, tumescent-technique liposuction was performed at the lateral flank areas and abdomen for 1 hour. Blood, lung, and brain tissue specimens were obtained at 1 hour, 1 day, and 2 days after the liposuction procedure. Results The average number of fat particles in the blood samples was 25,960/dL at 1 hour, 111,100/dL at 24 hours, and 21,780/dL at 48 hours. The differences between study groups were statistically significant. Both intravascular and extravascular fat particles with inflammation were seen in all 15 rats, as were inflammatory cell infiltration, hemorrhage, and consolidation with shrinkage of the lung alveoli. Conclusions These results imply that there is a strong possibility of fat embolism syndrome after liposuction in real clinical practice, and the first 24–48 hours after the operation were found to be the most important period for preventing pulmonary embolism and progression to fulminating fat embolism syndrome.

Nonfunctioning Renal Allograft Embolization as an Alternative to Graft Nephrectomy: Report on Seven Years' Experience

International Nuclear Information System (INIS)

Atar, Eli; Belenky, Alexander; Neuman-Levin, Margalit; Yussim, A.; Bar-Nathan, Nathan; Bachar, Gil N.

2003-01-01

Purpose: Graft nephrectomy is the treatment of choice in patients with graft intolerance syndrome, but it is associated with high morbidity and mortality rates. Renal vascular embolization has been suggested as a possible alternative. The aim of this study was to evaluate the efficacy and safety of arterial embolization of these nonfunctioning transplanted kidneys. Methods: Twenty-six transplanted kidneys in 25 patients with irreversible renal graft rejection and graft intolerance who underwent arterial embolization at our center from August 1994 to April 2001 we reanalyzed for procedural success and long-term outcome. Embolization was performed with absolute alcohol or with polyvinyl alcohol (Ivalon) and coils. Results: Twenty-four of the 26 (92%) procedures were technically successful, but in one patient only partial occlusion of one of two renal arteries was achieved, and in another the renal artery was already completely occluded. There were two major complications: emphysematous pyelonephritis necessitating nephrectomy and groin abscess that was drained. Follow-up ranged from 8 to 84 months. Clinical success was achieved in 24 of the 26 procedures(92%), and only in one patient did embolization fail to relieve the symptoms, and nephrectomy was performed 3 months later. Conclusion: Renal vascular embolization is a simple, safe and effective technique for the treatment of nonfunctioning renal allografts associated with graft intolerance syndrome. We suggest that it be considered the treatment of choice

Síndrome da angústia respiratória do adulto por embolia gordurosa no período pós-operatório de lipoaspiração e lipoenxertia Adult respiratory distress syndrome due to fat embolism in the postoperative period following liposuction and fat grafting

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André Nathan Costa

2008-08-01

Full Text Available A embolia gordurosa é definida como a ocorrência de bloqueio mecânico da luz vascular por gotículas circulantes de gordura. Acomete principalmente o pulmão, podendo afetar também o sistema nervoso central, a retina e a pele. A síndrome da embolia gordurosa é uma disfunção desses órgãos causada pelos êmbolos gordurosos. As causas mais comuns de embolia gordurosa e síndrome da embolia gordurosa são as fraturas de ossos longos, mas há relatos de sua ocorrência após procedimentos estéticos. O diagnóstico é clínico, e o tratamento ainda se restringe a medidas de suporte. Apresentamos o caso de uma paciente que evoluiu com síndrome da angústia respiratória do adulto por embolia gordurosa no período pós-operatório de lipoaspiração e lipoenxertia e respondeu bem às manobras de recrutamento alveolar e à ventilação mecânica protetora.Apresentamos também uma análise epidemiológica e fisiopatológica da síndrome da embolia gordurosa após procedimentos estéticos.Fat embolism is defined as mechanical blockage of the vascular lumen by circulating fat globules. Although it primarily affects the lungs, it can also affect the central nervous system, retina, and skin. Fat embolism syndrome is a dysfunction of these organs caused by fat emboli. The most common causes of fat embolism and fat embolism syndrome are long bone fractures, although there are reports of its occurrence after cosmetic procedures. The diagnosis is made clinically, and treatment is still restricted to support measures. We report the case of a female patient who developed adult respiratory distress syndrome due to fat embolism in the postoperative period following liposuction and fat grafting. In this case, the patient responded well to alveolar recruitment maneuvers and protective mechanical ventilation. In addition, we present an epidemiological and pathophysiological analysis of fat embolism syndrome after cosmetic procedures.

Xylem resistance to embolism: presenting a simple diagnostic test for the open vessel artefact.

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Torres-Ruiz, José M; Cochard, Hervé; Choat, Brendan; Jansen, Steven; López, Rosana; Tomášková, Ivana; Padilla-Díaz, Carmen M; Badel, Eric; Burlett, Regis; King, Andrew; Lenoir, Nicolas; Martin-StPaul, Nicolas K; Delzon, Sylvain

2017-07-01

Xylem vulnerability to embolism represents an essential trait for the evaluation of the impact of hydraulics in plant function and ecology. The standard centrifuge technique is widely used for the construction of vulnerability curves, although its accuracy when applied to species with long vessels remains under debate. We developed a simple diagnostic test to determine whether the open-vessel artefact influences centrifuge estimates of embolism resistance. Xylem samples from three species with differing vessel lengths were exposed to less negative xylem pressures via centrifugation than the minimum pressure the sample had previously experienced. Additional calibration was obtained from non-invasive measurement of embolism on intact olive plants by X-ray microtomography. Results showed artefactual decreases in hydraulic conductance (k) for samples with open vessels when exposed to a less negative xylem pressure than the minimum pressure they had previously experienced. X-Ray microtomography indicated that most of the embolism formation in olive occurs at xylem pressures below -4.0 MPa, reaching 50% loss of hydraulic conductivity at -5.3 MPa. The artefactual reductions in k induced by centrifugation underestimate embolism resistance data of species with long vessels. A simple test is suggested to avoid this open vessel artefact and to ensure the reliability of this technique in future studies. © 2017 The Authors. New Phytologist © 2017 New Phytologist Trust.

Unusual presentation of Klinefelter syndrome

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Das, Chanchal; Sahana, Pranab Kumar; Sengupta, Nilanjan; Roy, Mukut; Dasgupta, Ranen

2013-01-01

Introduction: Klinefelter syndrome usually presents in the puberty and adulthood with its characteristic features. We report a boy who had Klinefelter syndrome with hypospadias and hydrocele. Case Note: Six and half year old boy had complaints of genitourinary problem in the form of hypospadias, small phallus and hydrocele. Karyotyping showed 47,XXY. Conclusion: This case illustrates that Klinefelter syndrome was presented in the infancy with hypospadias and hydrocele which are very uncommon presentation of the disease PMID:24910838

Partial splenic embolization in a child with Gaucher disease, massive splenomegaly and severe thrombocytopenia

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Pena, Andres H.; Clevac, Egor; Marie Cahill, Anne [Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Kaplan, Paige; Ganesh, Jaya [Children' s Hospital of Philadelphia, Division of Metabolic Diseases, Philadelphia, PA (United States)

2009-09-15

A 13-month-old boy with Gaucher disease presented with severe thrombocytopenia, anemia and massive splenomegaly. In addition he had significant respiratory compromise caused by abdominal compartment syndrome, requiring mechanical ventilation. Because of the degree of respiratory compromise and his existing bone marrow suppression, splenic artery embolization was chosen as an alternative to splenectomy. Splenic artery embolization was performed using 355-500-{mu}m polyvinyl alcohol particles, with 70% ablation achieved. Within 24 h of the procedure the platelet count had risen to greater than 70,000/mm{sup 3} and to more than 170,000/mm{sup 3} on postoperative day 4. At the 8-month follow-up the splenic size had decreased from 18 cm to 8 cm, with a platelet count of 578,000/mm{sup 3}. Partial splenic embolization provides a minimally invasive alternative to splenectomy in patients with Gaucher disease with massive splenomegaly and bone marrow suppression. (orig.)

Metabolic syndrome presenting as abdominal pain

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Mohammed Y Al-Dossary

2017-01-01

Full Text Available Metabolic syndrome represents a sum of risk factors that lead to the occurrence of cardiovascular and cerebrovascular events. The early detection of metabolic syndrome is extremely important in adults who are at risk. Although the physiopathological mechanisms of the metabolic syndrome are not yet clear, insulin resistance plays a key role that could explain the development of type 2 diabetes mellitus in untreated metabolic syndrome patients. Here, we present the case of a 26-year-old male who was diagnosed with metabolic syndrome and severe hypertriglyceridemia after presenting with abdominal pain. Although hypertriglyceridemia and hyperglycemia are the most common predictors of metabolic syndrome, clinicians need to be vigilant for unexpected presentations in patients at risk for metabolic syndrome. This case sheds light on the importance of early detection.

Cerebral fat embolism: Use of MR spectroscopy for accurate diagnosis

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Laxmi Kokatnur

2015-01-01

Full Text Available Cerebral fat embolism (CFE is an uncommon but serious complication following orthopedic procedures. It usually presents with altered mental status, and can be a part of fat embolism syndrome (FES if associated with cutaneous and respiratory manifestations. Because of the presence of other common factors affecting the mental status, particularly in the postoperative period, the diagnosis of CFE can be challenging. Magnetic resonance imaging (MRI of brain typically shows multiple lesions distributed predominantly in the subcortical region, which appear as hyperintense lesions on T2 and diffusion weighted images. Although the location offers a clue, the MRI findings are not specific for CFE. Watershed infarcts, hypoxic encephalopathy, disseminated infections, demyelinating disorders, diffuse axonal injury can also show similar changes on MRI of brain. The presence of fat in these hyperintense lesions, identified by MR spectroscopy as raised lipid peaks will help in accurate diagnosis of CFE. Normal brain tissue or conditions producing similar MRI changes will not show any lipid peak on MR spectroscopy. We present a case of CFE initially misdiagnosed as brain stem stroke based on clinical presentation and cranial computed tomography (CT scan, and later, MR spectroscopy elucidated the accurate diagnosis.

Impact of delay in clinical presentation on the diagnostic management and prognosis of patients with suspected pulmonary embolism

NARCIS (Netherlands)

Den Exter, Paul L.; Van Es, Josien; Erkens, Petra M.G.; Van Roosmalen, Mark J.G.; Van Den Hoven, Pim; Hovens, Marcel M.C.; Kamphuisen, Pieter W.; Klok, Frederikus A.; Huisman, Menno V.

2013-01-01

Rationale: The nonspecific clinical presentation of pulmonary embolism (PE) frequently leads to delay in its diagnosis. Objectives: This study aimed to assess the impact of delay in presentation on the diagnostic management and clinical outcome of patients with suspected PE. Methods: In 4,044

Impact of delay in clinical presentation on the diagnostic management and prognosis of patients with suspected pulmonary embolism

NARCIS (Netherlands)

Den Exter, P. L.; Van Es, J.; Erkens, P. G. M.; Roosmalen, M.; Hoven, P.; Hovens, M.; Kamphuisen, P. W.; Klok, F. A.; Huisman, M.

Background: The non-specific clinical presentation of pulmonary embolism (PE) frequently leads to delay in its diagnosis. Aims: To assess the impact of delay in presentation on the diagnostic management and clinical outcome of patients with suspected PE. Methods: For this post-hoc analysis, we used

Gas embolism: pathophysiology and treatment

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van Hulst, Robert A.; Klein, Jan; Lachmann, Burkhard

2003-01-01

Based on a literature search, an overview is presented of the pathophysiology of venous and arterial gas embolism in the experimental and clinical environment, as well as the relevance and aims of diagnostics and treatment of gas embolism. The review starts with a few historical observations and

Superselective embolization with microcoil in acute gastronitestinal hemorrhage

International Nuclear Information System (INIS)

Ko, Eun Hye; Kim, Jae Kyu; Jang, Nam Kyu

2000-01-01

To evaluate the efficacy and safety of superselective arterial embolization using the microcoil in acute gastrointerstinal hemorrhage. We evaluated 11 of 42 patients who had undergone diagnostic angiography and transcatheter arterial embolization due to acute gastrointestinal hemorrhage and subsequently underwent superselective arterial embolization using the microcoil. Nine were males and two were females, and their age ranged from 33 to 70 (mean, 51) years. The etiologies were bleeding ulcer (n=3D5), pseudoaneurysm from pancreatitis (n=3D3), and postoperative bleeding (n=3D3). The symptoms were melena, hematemesis, and hematochzia, and the critical signs were cecreased hemoglobin and worsening of vital signs. All patients underwent superselective embolization using the microcatheter and microcoil. Bleeding occurred in the gastroduodenal artery (n=3D5), inferior pancreaticoduodenal artery (n=3D2), left gastric artery (n=3D2), right hepatic artery (n=3D1), and ileal branch of the superior mesenteric artery (n=3D1). All cases were treated succesfully, without complications. In one case in which there was bleeding in the right hepatic artery, reembolization with a microcoil was needed because of persistent melena. During follow up, three patients died from complications arising underlying diseases, namely disseminated intravascular coagulopathy, chronic renal failure, and adult resiratory distress syndrome. (author)=20

Isolated transient aphasia at emergency presentation is associated with a high rate of cardioembolic embolism.

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Wasserman, Jason K; Perry, Jeffrey J; Dowlatshahi, Dar; Stotts, Grant; Sivilotti, Marco L A; Worster, Andrew; Emond, Marcel; Sutherland, Jane; Stiell, Ian G; Sharma, Mukul

2015-11-01

A cardiac source is often implicated in strokes where the deficit includes aphasia. However, less is known about the etiology of isolated aphasia during transient ischemic attack (TIA). Our objective was to determine whether patients with isolated aphasia are likely to have a cardioembolic etiology for their TIA. We prospectively studied a cohort of TIA patients in eight tertiary-care emergency departments. Patients with isolated aphasia were identified by the treating physician at the time of emergency department presentation. Patients with dysarthria (i.e., a phonation disturbance) were not included. Potential cardiac sources for embolism were defined as atrial fibrillation on history, electrocardiogram, Holter monitor, atrial fibrillation on echocardiography, or thrombus on echocardiography. Of the 2,360 TIA patients identified, 1,155 had neurological deficits at the time of the emergency physician assessment and were included in this analysis, and 41 had isolated aphasia as their only neurological deficit. Patients with isolated aphasia were older (73.9±10.0 v. 67.2±14.5 years; p=0.003), more likely to have a history of heart failure (9.8% v. 2.6%; p=0.027), and were twice as likely to have any cardiac source of embolism (22.0% v. 10.6%; p=0.037). Isolated aphasia is associated with a high rate of cardioembolic sources of embolism after TIA. Emergency patients with isolated aphasia diagnosed with a TIA warrant a rapid and thorough assessment for a cardioembolic source.

Comparison of post-embolization syndrome in the treatment of patients with unresectable hepatocellular carcinoma: Trans-catheter arterial chemo-embolization versus Yttrium-90 glass microspheres

International Nuclear Information System (INIS)

Goin, J.E.; Roberts, C.A.; Dancey, J.E.; Sickles, C.J.; Leung, D.A.; Soulen, M.C.

2004-01-01

Post-embolization syndrome (PES) occurs in most patients who undergo trans-catheter arterial chemoembolization (TACE) for treatment of unresectable hepatocellular carcinoma (HCC). Intra-hepatic arterial administration of TheraSphere, yttrium-90 glass microspheres, is an alternative treatment for unresectable HCC that does not require embolization of major vessels and may have a more favorable toxicity profile than TACE. This paper compares the incidence of PES after TACE vs. TheraSphere treatment in unresectable HCC patients. Data for 29 TACE-treated and 34 TheraSphere-treated patients were evaluated for PES. PES toxicities (i.e., nausea, vomiting, fever in the absence of infection, and abdominal pain) were scored according to Southwest Oncology Group (SWOG) toxicity criteria. PES was defined as a total score for the four toxicities of 2 or greater. Survival was defined from the date of treatment to the date of death. TACE patients underwent one to seven treatment procedures; TheraSphere patients underwent one to two treatment procedures. The incidence of PES was 3.8-times (95% confidence interval 1.6-16.3) higher after TACE [20/29(69%)] than after TheraSphere [6/34 (18%)] treatment; this difference was statistically significant (p=.003). Median survival was similar for TheraSphere (N=20; 378 days, CI 209-719) and TACE (N=29; 343 days, CI 217-511) patients. It was concluded that treatment of unresectable HCC with TheraSphere results in a much lower incidence of PES compared to TACE. Since TheraSphere is a pure beta emitter; it can potentially be administered safely on an outpatient basis, and appears to be at least as efficacious as TACE on survival with fewer treatments per patient. (author)

Carbon Dioxide Embolism during Laparoscopic Surgery

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Park, Eun Young; Kwon, Ja-Young

2012-01-01

Clinically significant carbon dioxide embolism is a rare but potentially fatal complication of anesthesia administered during laparoscopic surgery. Its most common cause is inadvertent injection of carbon dioxide into a large vein, artery or solid organ. This error usually occurs during or shortly after insufflation of carbon dioxide into the body cavity, but may result from direct intravascular insufflation of carbon dioxide during surgery. Clinical presentation of carbon dioxide embolism ranges from asymptomatic to neurologic injury, cardiovascular collapse or even death, which is dependent on the rate and volume of carbon dioxide entrapment and the patient's condition. We reviewed extensive literature regarding carbon dioxide embolism in detail and set out to describe the complication from background to treatment. We hope that the present work will improve our understanding of carbon dioxide embolism during laparoscopic surgery. PMID:22476987

Clinical application of partial splenic embolization with PVA particles for hypersplenism in cirrhosis

International Nuclear Information System (INIS)

Zhu Kangshun; Shan Hong; Li Zhengran; Meng Xiaochun; Shen Xinying; Huang Mingsheng; Jiang Zaibo; Guan Shouhai

2004-01-01

Objective: To evaluate the efficacy and complications of partial splenic embolization (PSE) using polyvinyl alcohol (PVA) particles as embolic material for hypersplenism in cirrhosis. Methods: 50 patients with hypersplenism and cirrhosis were treated with PSE and followed up for 1 years. According to the difference of the embolic material in PSE, 41 patients were divided into 2 groups. Group A: 22 patients with gelfoam cubes as the embolic material of PSE. Group B: 19 patients with PVA as the embolic material of PSE. The follow-up indices included peripheral blood cells counts (white blood cell (WBC), platelet (PLT) and red blood cell (RBC)) and the complications associated with PSE. Results: In group A and group B, WBC and PLT counts kept significantly higher in number than pre-embolization from 2 weeks to 1 years after PSE (P 0.05). RBC counts did not show significant changes after PSE within 1 year follow-up (P>0.05). The most frequent side-effects were abdominal pain and fever. The degree and duration of abdominal pain were higher and longer in group B than those in group A, but the occurrence rate of fever was lower in group B. The occurrence rate of severe complications showed no significant differences for both groups. The increase of embolization degree may aggravate post-embolization side-effects and raise the incidence of complications. Conclusions: PVA may be used as the embolic material of PSE with embolization degree ranging from 50% to 70% which may alleviate hypersplenism in patients with cirrhosis, relieve post-embolization syndrome and decrease the incidence of severe complications

An Unusual Aneurysm of the Main Pulmonary Artery Presenting as Acute Coronary Syndrome

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Kholeif, Mona A.; El Tahir, Mohamed; Kholeif, Yasser A.; El Watidy, Ahmed

2006-01-01

A 70-year old man presented with retrosternal chest pain. His electrocardiogram showed nonspecific T wave changes. Cardiac-specific troponin I (cTnI) was elevated. His condition was managed as acute coronary syndrome, following which he had two minor episodes of hemoptysis. A CT pulmonary angiogram showed no evidence of pulmonary embolism, but a large mass lesion was seen in the mediastinum. Echocardiography and cardiac MRI demonstrated a large solid mass, arising from the right ventricular outflow tract and causing compression of the main pulmonary artery (MPA). The differential diagnosis included pericardial and myocardial tumors and clotted aneurysm of the MPA. At surgery, a clotted aneurysmal sac was identified originating from the MPA and the defect was healed. Aneurysms of the MPA are rare. They most commonly present with dyspnea and chest pain. Compression of surrounding structures produces protean manifestations. A high index of suspicion coupled with imaging modalities establishes the diagnosis. Blunt trauma to the chest, at the time of an accident 4 years previously, may explain this aneurysm. The patient's presentation with chest pain was probably due to compression and/or stretching of surrounding structures. Coronary artery compression simulating acute coronary syndrome has been documented in the literature. The rise in cTnI may have been due to right ventricular strain, as a result of right ventricular outflow obstruction by the aneurysm. This has not been reported previously in the literature. The saccular morphology and narrow neck of the aneurysm predisposed to stagnation leading to clotting of the lumen and healing of the tear, which caused the diagnostic difficulty

Comparison of four embolic materials for portal vein embolization: experimental study in pigs

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Baere, Thierry de [Institut de Cancerologie Gustave Roussy, Department of Interventional Radiology, Villejuif (France); Denys, Alban [Centre Hospitalier Universitaire Vaudois, Department of Radiology and Interventional Radiology, Lausanne (Switzerland); Paradis, Valerie [Hopital Beaujon-Inserm U773, Department of Anatomie Pathologique, Clichy (France)

2009-06-15

Different embolic materials for portal vein embolization (PVE) were evaluated. Twenty pigs received left and median PVE. Hydrophilic phosphorylcholine, N-butyl cyanoacrylate, hydrophilic gel, and polyvinyl alcohol (PVA) particles measuring either 50-150 {mu}m or 700-900 {mu}m were used in five pigs each. Portography and portal vein pressure measurement were performed before, immediately after PVE, and before being euthanized at day 7. Tissue wedges from embolized, and non-embolized liver were obtained for pathology. After complete embolization, recanalization occurred at 7 days in one gel and one 700-900 PVA embolization. Post-PVE increase in portal pressure was found in all groups (p = 0.01). The area of the hepatic lobules in non-embolized liver was larger than in the embolized liver in all groups (p = 0.001). The ratios of the areas between non-embolized/embolized livers were 1.65, 2.19, 1.57, and 1.32 for gel, NBCA, 50-150 PVA and 700-900 PVA, respectively; the ratios of fibrosis between the embolized and non-embolized livers were 1.37, 3.01, 3.49, and 2.11 for gel, NBCA, 50-150 PVA and 700-900 PVA, respectively. Hepatic lobules in non-embolized liver were significantly larger with NBCA than in other groups (p = 0.01). Fibrosis in embolized liver was significantly higher for NBCA and 50-150 PVA (p = 0.002). The most severe changes in embolized and non-embolized liver were induced by 50-150 PVA and NCBA PVE. (orig.)

Clinical presentation and in-hospital death in acute pulmonary embolism: does cancer matter?

Science.gov (United States)

Casazza, Franco; Becattini, Cecilia; Rulli, Eliana; Pacchetti, Ilaria; Floriani, Irene; Biancardi, Marco; Scardovi, Angela Beatrice; Enea, Iolanda; Bongarzoni, Amedeo; Pignataro, Luigi; Agnelli, Giancarlo

2016-09-01

Cancer is one of the most common risk factors for acute pulmonary embolism (PE), but only few studies report on the short-term outcome of patients with PE and a history of cancer. The aim of the study was to assess whether a cancer diagnosis affects the clinical presentation and short-term outcome in patients hospitalized for PE who were included in the Italian Pulmonary Embolism Registry. All-cause and PE-related in-hospital deaths were also analyzed. Out of 1702 patients, 451 (26.5 %) of patients had a diagnosis of cancer: cancer was known at presentation in 365, or diagnosed during the hospital stay for PE in 86 (19 % of cancer patients). Patients with and without cancer were similar concerning clinical status at presentation. Patients with cancer less commonly received thrombolytic therapy, and more often had an inferior vena cava filter inserted. Major or intracranial bleeding was not different between groups. In-hospital all-cause death occurred in 8.4 and 5.9 % of patients with and without cancer, respectively. At multivariate analysis, cancer (OR 2.24, 95 % CI 1.27-3.98; P = 0.006) was an independent predictor of in-hospital death. Clinical instability, PE recurrence, age ≥75 years, recent bed rest ≥3 days, but not cancer, were independent predictors of in-hospital death due to PE. Cancer seems a weaker predictor of all-cause in-hospital death compared to other factors; the mere presence of cancer, without other risk factors, leads to a probability of early death of 2 %. In patients with acute PE, cancer increases the probability of in-hospital all-cause death, but does not seem to affect the clinical presentation or the risk of in-hospital PE-related death.

Transcatheter Embolization of Pseudoaneurysms Complicating Pancreatitis

International Nuclear Information System (INIS)

Golzarian, Jafar; Nicaise, Nicole; Deviere, Jacques; Ghysels, Marc; Wery, Didier; Dussaussois, Luc; Gansbeke, Daniel van; Struyven, Julien

1997-01-01

Purpose: To evaluate the therapeutic role of angiography in patients with pseudoaneurysms complicating pancreatitis. Methods: Thirteen symptomatic pseudoaneurysms were treated in nine patients with pancreatitis. Eight patients had chronic pancreatitis and pseudocyst and one had acute pancreatitis. Clinical presentation included gastrointestinal bleeding in seven patients and epigastric pain without bleeding in two. All patients underwent transcatheter embolization. Results: Transcatheter embolization resulted in symptomatic resolution in all patients. Rebleeding occurred in two patients, 18 and 28 days after embolization respectively, and was successfully treated by repeated emnbolization. One patient with severe pancreatitis died from sepsis 28 days after embolization. Follow-up was then available for eight patients with no relapse of bleeding after a mean follow-up of 32 months (range 9-48 months). Conclusion: Transcatheter embolization is safe and effective in the management of pseudoaneurysms complicating pancreatitis

Transcatheter Splenic Artery Occlusion for Treatment of Splenic Artery Steal Syndrome After Orthotopic Liver Transplantation

International Nuclear Information System (INIS)

Uflacker, Renan; Selby, J. Bayne; Chavin, Kenneth; Rogers, Jeffrey; Baliga, Prabhakar

2002-01-01

Purpose: To review some aspects of the problem of splenic artery steal syndrome as cause of ischemia in transplanted livers and treatment by selective splenic artery occlusion. Materials and Methods: Eleven liver transplant patients from a group of 350 patients, nine men and two women,ranging in age from 40 years to 61 years (mean 52 years), presented with biochemical evidences of liver ischemia and failure, ranging from one to 60 days following orthotopic liver transplantation. Diagnosis of splenic artery steal syndrome was suspected by elevated enzymes, Doppler ultrasound and confirmed by celiac angiogram. Patients with confirmed hepatic artery thrombosis before angiography were excluded from the study. Embolization with Gianturco coils was performed. Results: All patients were treated by splenic artery embolization with Gianturco coils. The 11 patients improved clinically within 24 hours of the procedure with significant change in the biochemical and clinical parameters. Followup ranged from one month to two years. One of the 11 patient initially improved, but developed hepatic artery thrombosis within 24 hours of the embolic treatment,requiring surgical repair. Conclusion: Splenicartery steal syndrome following liver transplantation surgery can be diagnosed by celiac angiography, and effectively treated by splenic artery embolization with coils. Embolization is one of the treatments available, it is minimally invasive, and leads to immediate clinical improvement. Hepatic artery thrombosis is a possible complication of the procedure

Waardenburg syndrome presenting with constipation since birth.

Science.gov (United States)

Gupta, R; Sharma, S B; Mathur, P; Agrawal, L D

2014-12-01

Shah-Waardenburg syndrome is Waardenburg syndrome associated with Hirschsprung's disease. A 10-day-old full-term male neonate of Waardenburg syndrome presented with constipation since birth along with features of small bowel obstruction. Exploratory laparotomy revealed distended proximal jejunal and ileal loops along with microcolon; an ileostomy was performed. Postoperatively patient developed sepsis and died. Histopathology confirmed total colonic aganglionosis. Suspect familial Shah-Waardenburg syndrome in a neonate of Waardenburg syndrome presenting with constipation since birth or intestinal obstruction.

Analysis of acute ischemic stroke presenting classic lacunar syndrome. A study by diffusion-weighted MRI

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Terai, Satoshi; Ota, Kazuki; Tamaki, Kinya [Hakujyuji Hospital, Fukuoka (Japan)

2002-03-01

We retrospectively assessed the pathophysiological features of acute ischemic stroke presenting ''classic'' lacunar syndrome by using diffusion-weighted imaging (DWI). Subjects were 16 patients who were admitted to our hospital within 24 hours of stroke onset and underwent DWI examination on admission. These were divided into three categorical groups; pure motor hemiplegia (PMH) in 8, sensorimotor stroke (SMS) in 7, and dysarthria-clumsy hand syndrome (DCHS) in 1. The fresh responsible lesions were identified by DWI in the perforating territory in 7 patients with PMH and 7 with SMS. Four (one had two possible response lesions; pons and corona radiata) and five patients in the respective groups were diagnosed as lacunar infarction on admission (the largest dimension of the lesion measuring smaller than 15 mm). On the contralateral side to the neurological symptoms, DWI revealed high intensities in cortex, subcortical white matter, and anterior and posterior border zones in the remaining one patient with PMH and in the precentral arterial region in one with DCHS. They were diagnosed as atherothrombotic infarction resulting from the occlusion of the internal carotid artery and cerebral embolism due to atrial fibrillation, respectively. Three patients with PMH showed progressive deterioration after admission and follow-up DWI study in an acute stage revealed enlargement of heir ischemic lesions. The present study suggests that DWI is a useful imaging technique for diagnosis of clinical categories and observation for pathophsiological alteration in the acute ischemic stroke patients with ''classic'' lacunar syndrome. Our results also indicate a necessity to be aware that various types of fresh ischemic lesions other than a single lacune might possibly be developing in cases with this syndrome. (author)

Chest computed tomography of a patient revealing severe hypoxia due to amniotic fluid embolism: a case report

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Inui Daisuke

2010-02-01

Full Text Available Abstract Introduction Amniotic fluid embolism is one of the most severe complications in the peripartum period. Because its onset is abrupt and fulminant, it is unlikely that there will be time to examine the condition using thoracic computed tomography (CT. We report a case of life-threatening amniotic fluid embolism, where chest CT in the acute phase was obtained. Case presentation A 22-year-old Asian Japanese primiparous woman was suspected of having an amniotic fluid embolism. After a Cesarean section for cephalopelvic disproportion, her respiratory condition deteriorated. Her chest CT images were examined. CT findings revealed diffuse homogeneous ground-glass shadow in her bilateral peripheral lung fields. She was therefore transferred to our hospital. On admission to our hospital's intensive care unit, she was found to have severe hypoxemia, with SpO2 of 50% with a reservoir mask of 15 L/min oxygen. She was intubated with the support of noninvasive positive pressure ventilation. She was successfully extubated on the sixth day, and discharged from the hospital on the twentieth day. Conclusion This is the first case report describing amniotic fluid embolism in which CT revealed an acute respiratory distress syndrome-like shadow.

Technique and methods in uterine leiomyoma embolization

International Nuclear Information System (INIS)

Helmberger, T.K.; Jakobs, T.F.; Reiser, M.F.

2003-01-01

Uterine leiomyomas are the most common benign tumors of the female urogenital tract. Beside the classic surgical treatment options the minimal-invasive embolization therapy of the leiomyomas increasingly gains importance world-wide. Technique, complications, and results of uterine leiomyoma embolization will be presented. After careful evaluation of indications for embolization the procedure is mostly performed under conscious sedation. A single-sided femoral access route together with cross-over technique generally allows for a flow-directed embolization via both uterine arteries. After embolizing the vessels supplying the tumor, the uterine arteries should be still patent. The success rate of embolization of uterine leiomyomas ranges between 85 and 100%, whereas a reduction in size of the tumors in 42 to 83% and a relief of symptoms in up to 96% can be achieved. The total complication rate is about 10% with mainly ''minor complications''. Worldwide only three deaths following embolization of uterine leiomyomas were reported. The high technical and clinical success rate together with a low complication rate make the embolization of uterine leiomyomas a minimally-invasive alternative to the classic treatment. As long term results are not available indication to embolization of uterine leiomyomas must be carefully established in consensus with gynecologists. (orig.) [de

Paraneoplastic Cushing Syndrome Due To Wilm's Tumor.

Science.gov (United States)

Faizan, Mahwish; Manzoor, Jaida; Saleem, Muhammad; Anwar, Saadia; Mehmood, Qaiser; Hameed, Ambreen; Ali, Agha Shabbir

2017-05-01

Paraneoplastic syndromes are rare disorders that are triggered by an altered immune system response to neoplasm. Paraneoplastic syndromes may be the first or the most prominent manifestations of cancer. Wilm's tumor is the most frequent pediatric renal malignancy and usually presents with abdominal mass. Unusual presentations like acquired von Willebrand disease, sudden death due to pulmonary embolism and Cushing syndrome have been described in the literature. Cushing syndrome, as the presenting symptom of a malignant renal tumor in children, is a very rare entity. Few case reports are available in the literature exploring the option of preoperative chemotherapy as well as upfront nephrectomy. We report a rare case of paraneoplastic Cushing syndrome due to a Wilm's tumor. Based on gradual decrease of postoperative weight, blood pressure, serum adrenocorticotropic hormone, and plasma cortisol levels, along with histological confirmation of Wilm's tumor, paraneoplastic Cushing syndrome due to Wilm's tumor was confirmed.

Paraneoplastic cushing syndrome due to wilm's tumor

International Nuclear Information System (INIS)

Faizan, M.; Anwar, S.; Hameed, A.; Manzoor, J.; Saleem, M.; Mehmood, Q.; Ali, A. S.

2017-01-01

Paraneoplastic syndromes are rare disorders that are triggered by an altered immune system response to neoplasm. Paraneoplastic syndromes may be the first or the most prominent manifestations of cancer. Wilm's tumor is the most frequent pediatric renal malignancy and usually presents with abdominal mass. Unusual presentations like acquired von Willebrand disease, sudden death due to pulmonary embolism and Cushing syndrome have been described in the literature. Cushing syndrome, as the presenting symptom of a malignant renal tumor in children, is a very rare entity. Few case reports are available in the literature exploring the option of preoperative chemotherapy as well as upfront nephrectomy. We report a rare case of paraneoplastic Cushing syndrome due to a Wilm's tumor. Based on gradual decrease of postoperative weight, blood pressure, serum adrenocorticotropic hormone, and plasma cortisol levels, alongwith histological confirmation of Wilm's tumor, paraneoplastic Cushing syndrome due to Wilm's tumor was confirmed. (author)

Giant liver hemangioma resected by trisectorectomy after efficient volume reduction by transcatheter arterial embolization: a case report

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Akamatsu Nobuhisa

2010-08-01

Full Text Available Abstract Introduction Liver hemangiomas are the most common benign liver tumors, usually small in size and requiring no treatment. Giant hemangiomas complicated with consumptive coagulopathy (Kasabach-Merritt syndrome or causing severe incapacitating symptoms, however, are generally considered an absolute indication for surgical resection. Here, we present the case of a giant hemangioma, which was, to the best of our knowledge, one of the largest ever reported. Case presentation A 38-year-old Asian man was referred to our hospital with complaints of severe abdominal distension and pancytopenia. Examinations at the first visit revealed a right liver hemangioma occupying the abdominal cavity, protruding into the right diaphragm up to the right thoracic cavity and extending down to the pelvic cavity, with a maximum diameter of 43 cm, complicated with "asymptomatic" Kasabach-Merritt syndrome. Based on the tumor size and the anatomic relationship between the tumor and hepatic vena cava, primary resection seemed difficult and dangerous, leading us to first perform transcatheter arterial embolization to reduce the tumor volume and to ensure the safety of future resection. The tumor volume was significantly decreased by two successive transcatheter arterial embolizations, and a conventional right trisectorectomy was then performed without difficulty to resect the tumor. Conclusions To date, there have been several reports of aggressive surgical treatments, including extra-corporeal hepatic resection and liver transplantation, for huge hemangiomas like the present case, but because of its benign nature, every effort should be made to avoid life-threatening surgical stress for patients. Our experience demonstrates that a pre-operative arterial embolization may effectively enable the resection of large hemangiomas.

Symptomatology, Clinical Presentation and Basic Work up in Patients with Suspected Pulmonary Embolism

DEFF Research Database (Denmark)

Madsen, Poul Henning; Hess, Søren

2017-01-01

Basic knowledge of pulmonary embolism is relevant to most practicing physicians. Many medical specialties care for patients with increased risk of pulmonary embolism, why recognition of relevant symptoms, a thorough medical history, assessment of the clinical condition of the patient and possibly......-ray and biochemical analyses are appropriate. In addition, lung ultrasound and echocardiography are indicated in many of these patients. The information available from the medical history, clinical assessment and basic investigation form the basis on which the decision about further diagnostic imaging and intensity...... of treatment and monitoring can be made. These decisions can be guided by clinical scoring systems like the Wells score, revised Geneva score and the PESI....

Fibrocartilaginous embolic myelopathy: demographics, clinical presentation, and functional outcomes.

Science.gov (United States)

Moore, Brittany J; Batterson, Anna M; Luetmer, Marianne T; Reeves, Ronald K

2018-05-25

Retrospective cohort study. To describe the demographics, clinical presentation, and functional outcomes of fibrocartilaginous embolic myelopathy (FCEM). Academic inpatient rehabilitation unit in the midwestern United States. We retrospectively searched our database to identify patients admitted between January 1, 1995 and March 31, 2016, with a high probability of FCEM. Demographic, clinical, and functional outcome measures, including Functional Independence Measure (FIM) information was obtained by chart review. We identified 31 patients with findings suggestive of FCEM (52% male), which was 2% of the nontraumatic spinal cord injury population admitted to inpatient rehabilitation. The age distribution was bimodal, with peaks in the second and sixth-to-seventh decades. The most common clinical presentation was acute pain and rapid progression of neurologic deficits consistent with a vascular myelopathy. Only three patients (10%) had FCEM documented as a diagnostic possibility. Most patients had paraplegia and neurologically incomplete injuries and were discharged to home. Nearly half of the patients required no assistive device for bladder management at discharge, but most were discharged with medications for bowel management. Median FIM walking locomotion score for all patients was 5, but most patients were discharged using a wheelchair for primary mobility. Median motor FIM subscale score was 36 at admission and 69 at discharge, with a median motor efficiency of 1.41. FCEM may be underdiagnosed and should be considered in those with the appropriate clinical presentation, because their functional outcomes may be more favorable than those with other causes of spinal cord infarction.

Metabolic syndrome pathophysiology and clinical presentation.

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Handelsman, Yehuda

2009-01-01

Metabolic syndrome is a relatively new definition, designed to help the health care practitioner to easily identify people at risk for the development of cardiovascular disease and diabetes. With the obesity epidemic, we are witnessing an epidemic of multiple-risk patients. Insulin resistance is the perceived pathophysiology of metabolic syndrome and defines its clinical presentation. Hypertension, dyslipedemia, polycystic ovarian syndrome, fatty liver disease, pre-diabetes, sleep and breathing disorder, certain cancers, and cognitive impairment are many of the presentations of the syndrome; patients with any of these conditions are at a high risk of developing cardiovascular disease and diabetes. The metabolic syndrome helps identify people at risk to allow early intervention for prevention. Lifestyle modification is the most important part of the management of people with the syndrome. Lately medications--though none approved by the U.S. Food and Drug Administration (FDA)--have been recommended by major medical societies when lifestyle modification is not enough or when it fails.

Pulmonary embolism in the elderly: a review on clinical, instrumental and laboratory presentation

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Luca Masotti

2008-06-01

Full Text Available Luca Masotti1,8, Patrick Ray2, Marc Righini3, Gregoire Le Gal4, Fabio Antonelli5, Giancarlo Landini1, Roberto Cappelli6, Domenico Prisco7, Paola Rottoli81Internal Medicine, Cecina Hospital, Cecina, Italy; 2Department of Emergency Medicine, Centre Hospitalo-Universitaire Pitié-Salpêtrière, Université Pierre et Marie Curie-Paris 6, Paris, France; 3Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland; 4Department of Internal Medicine and Chest Diseases, Brest University Hospital, Brest, France; 5Clinical Chemistry, Cecina Hospital, Cecina, Italy; 6Department of Internal, Cardiovascular and Geriatric Medicine, University of Siena, Siena, Italy; 7Department of Critical Care Medicine, Thrombosis Centre, Careggi Hospital, Florence, Italy; 8Departiment of Clinical Medicine and Immunological Sciences, Division of Respiratory Diseases, University of Siena, Siena, ItalyObjective: Diagnosis of pulmonary embolism (PE remains difficult and is often missed in the elderly due to nonspecific and atypical presentation. Diagnostic algorithms able to rule out PE and validated in young adult patients may have reduced applicability in elderly patients, which increases the number of diagnostic tools use and costs. The aim of the present study was to analyze the reported clinical presentation of PE in patients aged 65 and more.Materials and Methods: Prospective and retrospective English language studies dealing with the clinical, instrumental and laboratory aspects of PE in patients more than 65 and published after January 1987 and indexed in MEDLINE using keywords as pulmonary embolism, elderly, old, venous thromboembolism (VTE in the title, abstract or text, were reviewed.Results: Dyspnea (range 59%–91.5%, tachypnea (46%–74%, tachycardia (29%–76%, and chest pain (26%–57% represented the most common clinical symptoms and signs. Bed rest was the most frequent risk factor for VTE (15%–67%; deep vein

Ovarian Artery: Angiographic Appearance, Embolization and Relevance to Uterine Fibroid Embolization

International Nuclear Information System (INIS)

Pelage, J.P.; Walker, W.J.; Le Dref, O.; Rymer, R.

2003-01-01

Purpose: To describe the angiographic appearance of the ovarian artery and its main variations that may be relevant to uterine fibroid embolization. Methods: The flush aortograms of 294 women who had been treated by uterine artery embolization for fibroids were reviewed. Significant arterial supply to the fibroid, and the origin and diameter of identified ovarian arteries were recorded. In patients with additional embolization of the ovarian artery, the follow-up evaluation also included hormonal levels and Doppler imaging of the ovaries. Results: A total of 75 ovarian arteries were identified in 59 women (bilaterally in 16 women and unilaterally in 43 women). All ovarian arteries originated from the aorta below the level of the renal arteries with a characteristic tortuous course. Fifteen women had at least one enlarged ovarian artery supplying the fibroids. Fourteen women (14/15, 93%) presented at least one of the following factors: prior pelvic surgery, tubo-ovarian pathology or large fundal fibroids. Conclusion: We advocate the use of flush aortography in women with prior tubo-ovarian pathology or surgery or in cases of large fundal fibroids. In the case of an ovarian artery supply to the fibroids, superselective catheterization and embolization of the ovarian artery should be considered

Preoperative trans-arterial embolization for spinal tumor: embolization techniques and results

International Nuclear Information System (INIS)

Shi Haibin; Xu Daizhe

2000-01-01

Objective: To analyze the technique and to evaluate the safety and value of preoperative trans-arterial embolization of hypervascular spinal tumors. Methods: Eighteen patients with hypervascular spinal tumors underwent trans-arterial embolization before surgery. They arose intradural in six patients and extradural in 12. Thirty-one arteries were embolized with polyvinyl alcohol (PVA) particles (150-500 μm), of which 18 with additional pieces of gelatin sponge for proximal pedicular embolization. The criteria for judging the effectiveness of embolization were the completeness of tumor removal and estimated blood loss during surgery. Results: Tumor embolization with total occlusion was obtained in eight patients, second to total in seven, subtotal in one, and partial in two. There were no symptomatic complications associated with embolization. Tumors were totally removed in 17 patients and nearly totally removed in one. The average estimated blood loss during surgery was 1100 ml (range, 200-6000 ml) for all 18 patients, and 1540 ml in patients with extradural tumors. Conclusions: Preoperative embolization of hypervascular spinal tumors is safe and effective. It can make complete resection of a tumor possible and can make an unresectable tumor resectable. Superselection or flow control is necessary to achieve effective devascularization and avoid complications

Analysis of complications in thyroid arterial embolization for hyperthyroidism caused by Graves' disease

International Nuclear Information System (INIS)

Gao Bulang; Zhao Wei; Huang Jianqiang; Xiang Shutian; Li Liyuan; Li Minghua

2006-01-01

Objective: To investigate complications and causes of thyroid arterial embolization for hyperthyroidism caused by Graves' disease. Methods: Twenty-eight patients with hyperthyroidism caused by Graves' disease had been treated through transcathter arterial embolization with mid-term follow up. The thyroid angiography, interventional treatment, complications and causes were investigated. Results Followed up for over one year (12-24 months), mid-term rate of efficiency was 78.6% with recurrent rate of one year being 14.2%. Two patients (7.1%) had brain infarction with one partially recovered after proper therapy and the other died due to subsequent hyperthyroidism crisis. One case had temporary hypothyroidism, and another hypoparathyroidism but no permanent hypothyroidism or hypoparathyroidism occurred. One patient suffered relatively severe post-embolization syndrome. All the other complications disappeared after proper treatment. Followed up for more than a year, no other complications occurred. Conclusion: Misembolization due to regurgitation of embolized agent is one of the most important factors leading to complications of arterial embolization for Graves' disease. In order to reduce complications and improve therapeutic efficacy, it is essential to superselectively catheterize the thyroid, avoid dangerous anastomose, prevent regurgitation misembolization and strictly operate under fluoroscopy. (authors)

The serpentine mitral valve and cerebral embolism

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Ker James

2011-02-01

Full Text Available Abstract Valvular strands, well-delineated filiform masses, attached to cardiac valve edges are associated with cerebral embolism and stroke. Strokes, caused by emboli from valvular strands, tend to occur among younger persons. In this case report a valvular strand, giving a peculiar serpentine appearance to the mitral valve is described. This mitral valvular strand was the only explanation for an episode of cerebral embolism, presenting with a transient right sided hemiparesis. It is proposed that a randomized study involving combined treatment with aspirin and clopidogrel is warranted in young patients with valvular strands, presenting with a first episode of cerebral embolism.

Unusual Presentation of Recurrent Pyogenic Bilateral Psoas Abscess Causing Bilateral Pulmonary Embolism by Iliac Vein Compression

OpenAIRE

Ijaz, Mohsin; Sakam, Sailaja; Ashraf, Umair; Marquez, Jose Gomez

2015-01-01

Patient: Male, 47 Final Diagnosis: Bilateral psoas abscess • acute lower extremity deep vein thrombosis • bilateral pulmonary embolism Symptoms: Progressive left leg swelling • productive cough with whitish sputum • right flank pain Medication: Antibiotics and anticoagulation Clinical Procedure: CT-guided percutaneous drain placement Specialty: Internal Medicine/Critical Care Objective: Unusual presentation Background: Psoas abscesses are a known cause of back pain, but they have not been rep...

CT findings of cerebral fat embolism

International Nuclear Information System (INIS)

Mashiyama, Shoji; Kawakami, Kiyoshi; Ohtsuki, Taisuke; Ishibashi, Takao.

1986-01-01

A case of cerebral fat embolism following multiple bone fractures is presented. A 27-year-old patient was admitted to our clinic 50 minutes after a traffic accident. He was somnolent on admission, but his consciousness level was gradually raised and respiratory symptoms (dyspnea, bloody sputum) appeared with petechiae of his conjunctiva and chest. We diagnosed cerebral fat embolism. On CT scan we found multiple high-density areas, which gradually turned into multiple low-density areas. Subsequent cerebral atrophy and subdural effusion developed one month after the injury. This patient showed a typical clinical course and CT findings of cerebral fat embolism. (author)

Uterine Necrosis after Uterine Artery Embolization for Symptomatic Fibroids

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Steve Kyende Mutiso

2018-01-01

Full Text Available Introduction. Uterine artery embolization (UAE is a minimally invasive intervention that is used in the treatment of fibroids. UAE can lead to complications including postembolization syndrome, postprocedure pain, infection, endometrial atrophy leading to secondary amenorrhea, and uterine necrosis. Uterine necrosis after UAE is very rare and hence poses a clinical dilemma for any clinician in its identification and management. We document a case of uterine necrosis after UAE and conduct a literature review on its causation, clinical features, and management principles. Case. A patient presented one month after UAE with abdominal pain and abdominal vaginal discharge. Her work-up revealed features of possible uterine necrosis with sepsis and she was scheduled for a laparotomy and a subtotal hysterectomy was performed. She was subsequently managed with broad spectrum antibiotic and recovered well. Conclusion. Uterine necrosis after UAE is a rare occurrence and we hope the documentation of this case will add to the body of knowledge around it. Theories that explain its occurrence include the use of small particles at embolization, the use of Contour-SE a spherical poly-vinyl alcohol, and lack of collateral supply to the uterus. Its symptoms may be nonspecific but unremitting abdominal pain is invariably present. Finally although conservative management may be successful at times, surgical management with hysterectomy will be required in some cases. The prognosis is good after diagnosis and surgical management.

[Economy-class syndrome or Immobile Traveler's syndrome?].

Science.gov (United States)

Gispert, Pilar; Drobnic, M Estrella; Vidal, Rafael

2006-07-01

Economy class syndrome describes the situation of patients who suffer pulmonary embolism following prolonged immobility in a long distance flight. The objective of the present study was to analyze whether there is a risk of pulmonary thromboembolism after a long overland journey. The study consecutively enrolled 100 patients diagnosed with pulmonary thromboembolism. Nine of them had previously undertaken a long journey (>5 h), 6 of which had been over land. Consequently, we think that the preventative measures recommended for airline passengers should be extended to users of other means of transport.

Catheter Embolization

Science.gov (United States)

... or treatment. top of page What are the benefits vs. risks? Benefits Embolization is a highly effective way of controlling ... risk of infection after embolization, even if an antibiotic has been given. However, the physician takes ample ...

Efficacy analysis of thyroidal arterial embolization in treating hyperthyroidism with different embolizing materials

International Nuclear Information System (INIS)

Yang Jijin; Ling Ling; Tian Jianming; Ye Hua; Zhang Huojun; Bi Yongmin; Zou Dajing; Chen Wei

2003-01-01

Objective: To study the efficacy of thyroidal arterial embolization in treating hyperthyroidism by using different embolizing materials and the relationship between recurrence rate and the numbers of embolized arteries. Methods: 56 cases with hyperthyroidism were divided into group A (25 cases) and group B (31 cases). Patients of group A had their thyroidal arteries embolized with gelfoam particles and stainless coils after arterial infusion of a total dosage of 24 mg of bleomycin. Patients of group B had their thyroidal arteries occluded with polyvinyl alcohol (PVA) particles. The effectiveness and general complications of arterial embolization for these two groups were compared and the relationship between recurrence rate of hyperthyroidism after treatment and numbers of embolized thyroidal arteries was studied. Results: It showed effectiveness in all patients within 2-3 months. The follow-up records showed, the recurrence rate of hyperthyroidism was 28% and 16.1% for group A and group B respectively but without statistical difference. The recurrence rates were 46.7% for those patients with 2 thyroid-arteries embolized and 12.2% for those with 3-4 arteries embolized, showing significant difference (χ 2 =7.751, P < 0.01). General complications for group A were much more than those for group B. Conclusions: Thyroidal arterial embolization is minimally invasive and highly effective in treating hyperthyroidism. With better results obtained by more than three thyroid-arteries be embolized, PVA particles are easy to be used and perhaps more effective in occluding thyroidal arteries

Primary antiphospholipid syndrome presenting with homonymous quadrantanopsia.

Science.gov (United States)

Yang, Hee Kyung; Moon, Ki Won; Ji, Min Jung; Han, Sang Beom; Hwang, Jeong-Min

2018-06-01

To report a case of primary antiphospholipid syndrome presenting with isolated homonymous superior quadrantanopsia. A 50-year-old Korean man presented with subjective visual disturbance for 1 month. Visual field testing showed a right homonymous superior quadrantanopsia. Brain magnetic resonance imaging (MRI) revealed an old infarct in his left occipital lobe and multiple lesions in other areas of the brain. Laboratory tests showed a marked increase in serum anti-β2 glycoprotein I antibody, which remained elevated after 12 weeks. He was diagnosed with primary antiphospholipid syndrome and started anticoagulation therapy. This is the first case report of primary antiphospholipid syndrome presenting with isolated homonymous quadrantanopsia. Antiphospholipid syndrome should be considered as a differential diagnosis in patients with homonymous visual field defects accompanying multiple cerebral infarcts.

Antiphospholipid syndrome: A case study

International Nuclear Information System (INIS)

Davies, T.

1998-01-01

Full text: A forty-two-year-old male presented to the Royal Adelaide Hospital with symptoms of increasing shortness of breath, swelling in both ankles, petechial rash and blood in his sputum. Initial investigations showed cardiomegaly, right ventricular hypertrophy, patchy lung infiltrates, a platelet count of 1500 and a clotting time of 60 seconds. A V/Q scan indicated a high probability of pulmonary embolism. Further investigations showed that the patient was positive for lupus anticoagulant and cardiolipin antibodies. A diagnosis of primary antiphospholipid syndrome was made. The patient''s high risk of strokes and hemorrhaging prompted investigation by a 99 mTc-HMPAO brain scan. Further V/Q scans were performed to follow up the initial finding of multiple pulmonary embolism and a R-L shunt study was performed to investigate a left subclavian murmur. The patient was admitted for four weeks and began treatment which included cyclaphosphamide, corticosteroids and plasmaphoresis and was discharged when stable. Over the next six months he was re admitted three times for relapse of antiphospholipid syndrome. On his fourth admission he collapsed and died five hours after admission. Cause of death was due to cardiac arrhythmia secondary to severe right ventricular hypertrophy and dilation. The effects of antiphospholipid syndrome was believed to be responsible for this outcome

Antiphospholipid syndrome: A case study

Energy Technology Data Exchange (ETDEWEB)

Davies, T. [Royal Adelaide Hospital, Adelaide, SA (Australia). Department of Nuclear Medicine

1998-03-01

Full text: A forty-two-year-old male presented to the Royal Adelaide Hospital with symptoms of increasing shortness of breath, swelling in both ankles, petechial rash and blood in his sputum. Initial investigations showed cardiomegaly, right ventricular hypertrophy, patchy lung infiltrates, a platelet count of 1500 and a clotting time of 60 seconds. A V/Q scan indicated a high probability of pulmonary embolism. Further investigations showed that the patient was positive for lupus anticoagulant and cardiolipin antibodies. A diagnosis of primary antiphospholipid syndrome was made. The patient``s high risk of strokes and hemorrhaging prompted investigation by a {sup 99}mTc-HMPAO brain scan. Further V/Q scans were performed to follow up the initial finding of multiple pulmonary embolism and a R-L shunt study was performed to investigate a left subclavian murmur. The patient was admitted for four weeks and began treatment which included cyclaphosphamide, corticosteroids and plasmaphoresis and was discharged when stable. Over the next six months he was re admitted three times for relapse of antiphospholipid syndrome. On his fourth admission he collapsed and died five hours after admission. Cause of death was due to cardiac arrhythmia secondary to severe right ventricular hypertrophy and dilation. The effects of antiphospholipid syndrome was believed to be responsible for this outcome.

Transcatheter arterial embolization with trisacryl gelatin microspheres (Embosphere®) leads to life-threatening tumor lysis syndrome in a rectal carcinoid patient with hepatic metastases

International Nuclear Information System (INIS)

Lo, Yuan-Hao; Tsai, Ming-Tsun; Kuo, Chen-Yu; Liu, Wen-Sheng; Lee, Rheun-Chuan; Yeh, Yi-Chen; Li, Chung-Pin; Chen, Jinn-Yang; Chao, Yee

2012-01-01

The incidence of gastrointestinal carcinoids appears to be increasing, and the rectum is the third most common location. Transcatheter arterial embolization (TAE) with trisacryl gelatin microspheres (Embosphere ® ) has been reported as an effective method for hepatic metastases of rectal carcinoids. Complications are uncommon and usually of minor consequence. We report an unusual case of a 34-year-old man with tumor lysis syndrome following TAE with Embosphere ® in a patient with multiple hepatic metastases of a rectal carcinoid. Early detection and effective treatment are essential for this rare but potentially catastrophic complication

Conns' syndrome - atypical presentations

International Nuclear Information System (INIS)

Kumar, K V S Hari; Modi, K D; Jha, Sangeeta; Jha, Ratan

2009-01-01

Primary hyperaldosteronism (Conns' syndrome) commonly presents with a combination of clinical features of hypokalemia and hypertension. Atypical presentations like normotension, normokalemia and neurological ailments are described in few cases. We encountered two such cases, the first presenting with acute neurological complaint and second case having insignificant hypertension. Both the patients had a characteristic biochemical and imaging profile consistent with primary hyperaldosteronism and responded to surgical resection of adrenal adenoma. (author)

Superselective transarterial embolization for the management of acute gastrointestinal bleeding

International Nuclear Information System (INIS)

Lee, In Kyoung; Kim, Young Min; Kim, Jeong; Shin, Sang Soo; Yoon Woong; Kim, Jae Kyu; Park, Jin Gyoon; Cho, Chol Kyoon; Kang, Heoung Keun

2006-01-01

We wanted to evaluate the safety and effectiveness of superselective transarterial embolization for the management of gastrointestinal bleeding. We evaluated 97 of 115 patients who had undergone diagnostic angiography and transarterial embolization for gastrointestinal bleeding from February 2001 to July 2004, and they subsequently underwent superselective transarterial embolization. Their ages ranged from 17 to 88 years (mean age: 58.5 years), and 73 were men and 24 were women. The etiologies were a postoperative condition (n=31), ulcer (n=23), Mallory-Weiss syndrome (n=3), trauma (n=3), pseudoaneurysm from pancreatitis (n=3), diverticula (n=2), inflammatory bowel disease (n=2), tumor (n=2), Behcet's disease (n=2), hemobilia (n=1), and unknown origin (n=25). The regions of bleeding were the esophagus (n=3), stomach and duodenum (n=41), small bowel (n=38) and colon (n=15). All the patients underwent superselective transarterial embolization using microcoils, gelfoam or a combination of microcoils and gelfoam. Technical success was defined as devascularization of targeted vascular lesion or the disappearance of extravasation of the contrast media, as noted on the angiography after embolization. Clinical success was defined as the disappearance of clinical symptoms and the reestablishment of normal cardiovascular hemodynamics after transarterial embolization without any operation or endoscopic management. The technical success rate was 100%. The primary clinical success rate was 67% (65 of 97 patients). Of the 32 primary failures, fourteen patients underwent repeat embolization; of these, clinical success was achieved in all the patients and so the secondary clinical success rate was 81% (79 of 97 patients). Of the 18 patients with primary failures, five patients underwent operation, one patient underwent endoscopic management and the others died during the observation period due to disseminated coagulopathy or complications of their underlying diseases. During the

Superselective transarterial embolization for the management of acute gastrointestinal bleeding

Energy Technology Data Exchange (ETDEWEB)

Lee, In Kyoung; Kim, Young Min; Kim, Jeong; Shin, Sang Soo; Yoon Woong; Kim, Jae Kyu; Park, Jin Gyoon [Chonnam National University Hospital, Gwangju (Korea, Republic of); Cho, Chol Kyoon; Kang, Heoung Keun [Chonnam National University Hwasun Hospital, Hwasun (Korea, Republic of)

2006-03-15

We wanted to evaluate the safety and effectiveness of superselective transarterial embolization for the management of gastrointestinal bleeding. We evaluated 97 of 115 patients who had undergone diagnostic angiography and transarterial embolization for gastrointestinal bleeding from February 2001 to July 2004, and they subsequently underwent superselective transarterial embolization. Their ages ranged from 17 to 88 years (mean age: 58.5 years), and 73 were men and 24 were women. The etiologies were a postoperative condition (n=31), ulcer (n=23), Mallory-Weiss syndrome (n=3), trauma (n=3), pseudoaneurysm from pancreatitis (n=3), diverticula (n=2), inflammatory bowel disease (n=2), tumor (n=2), Behcet's disease (n=2), hemobilia (n=1), and unknown origin (n=25). The regions of bleeding were the esophagus (n=3), stomach and duodenum (n=41), small bowel (n=38) and colon (n=15). All the patients underwent superselective transarterial embolization using microcoils, gelfoam or a combination of microcoils and gelfoam. Technical success was defined as devascularization of targeted vascular lesion or the disappearance of extravasation of the contrast media, as noted on the angiography after embolization. Clinical success was defined as the disappearance of clinical symptoms and the reestablishment of normal cardiovascular hemodynamics after transarterial embolization without any operation or endoscopic management. The technical success rate was 100%. The primary clinical success rate was 67% (65 of 97 patients). Of the 32 primary failures, fourteen patients underwent repeat embolization; of these, clinical success was achieved in all the patients and so the secondary clinical success rate was 81% (79 of 97 patients). Of the 18 patients with primary failures, five patients underwent operation, one patient underwent endoscopic management and the others died during the observation period due to disseminated coagulopathy or complications of their underlying diseases. During

Permanent Cortical Blindness After Bronchial Artery Embolization

Energy Technology Data Exchange (ETDEWEB)

Doorn, Colette S. van, E-mail: cvandoorn@gmail.com; De Boo, Diederick W., E-mail: d.w.deboo@amc.uva.nl [Academic Medical Centre, Department of Radiology (Netherlands); Weersink, Els J. M., E-mail: e.j.m.weersink@amc.uva.nl [Academic Medical Centre, Department of Pulmonology (Netherlands); Delden, Otto M. van, E-mail: o.m.vandelden@amc.uva.nl; Reekers, Jim A., E-mail: j.a.reekers@amc.uva.nl; Lienden, Krijn P. van, E-mail: k.p.vanlienden@amc.uva.nl [Academic Medical Centre, Department of Radiology (Netherlands)

2013-12-15

A 35-year-old female with a known medical history of cystic fibrosis was admitted to our institution for massive hemoptysis. CTA depicted a hypertrophied bronchial artery to the right upper lobe and showed signs of recent bleeding at that location. Bronchial artery embolization (BAE) was performed with gelfoam slurry, because pronounced shunting to the pulmonary artery was present. Immediately after BAE, the patient developed bilateral cortical blindness. Control angiography showed an initially not opacified anastomosis between the embolized bronchial artery and the right subclavian artery, near to the origin of the right vertebral artery. Cessation of outflow in the bronchial circulation reversed the flow through the anastomosis and allowed for spill of embolization material into the posterior circulation. Unfortunately the cortical blindness presented was permanent.

Successful treatment of direct carotid-cavernous fistula in a patient with Ehlers-Danlos syndrome type IV without arterial puncture: the transvenous triple-overlay embolization (TAILOREd) technique.

Science.gov (United States)

Huynh, Thien J; Morton, Ryan P; Levitt, Michael R; Ghodke, Basavaraj V; Wink, Onno; Hallam, Danial K

2017-08-18

We report successful transvenous treatment of direct carotid-cavernous fistula in a patient with Ehlers-Danlos syndrome type IV using a novel triple-overlay embolization (TAILOREd) technique without the need for arterial puncture, which is known to be highly risky in this patient group. The TAILOREd technique allowed for successful treatment using preoperative MR angiography as a three-dimensional overlay roadmap combined with cone beam CT and live fluoroscopy, precluding the need for an arterial puncture. 2017 BMJ Publishing Group Ltd.

[Forensic analysis of death caused by fat embolism: A study of 20 autopsy cases].

Science.gov (United States)

Zhou, Lan; Mu, Jiao; Dong, Hong-Mei; Zhang, Ji

2013-12-01

To analyze the general and forensic pathological characteristics of death due to fat embolism syndrome (FES) and to provide reference data for forensic identification. Twenty autopsy cases due to FES were selected from the forensic center of a medical college from 1999 to 2012. The general and forensic pathological characteristics such as the ways and types of injuries, clinical manifestation and the pathological changes were summarized. Fat embolism mainly occurred after long bone fracture or a large area of soft tissue injury with the majority of cases being fat embolism of lung and occasional cases being combined embolisms of lung and brain as well. The onset of symptoms appeared shortly after the injury or surgery. Lipid droplets could be observed within small pulmonary vessels and verified by special staining. There are particular characteristics in death due to FES in concern with types of injuries, onset of symptoms and pathological findings. In order to find out the direct evidence of FES, special staining (oil red O staining) can be used in the forensic identification.

Sudden death in a case of catatonia due to pulmonary embolism

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Archana Javadekar

2014-01-01

Full Text Available Catatonic syndrome carries relatively high mortality. One of the causes of death is pulmonary embolism. Prolonged immobility, dehydration, use of low-potency antipsychotic drugs, and electroconvulsive therapy (ECT increase the risk of venous thromboembolism. Evaluating the risk of catatonic patients is of paramount importance. Prevention of venous thromboembolism by reducing the risk factors and relieving catatonic symptoms early is essential.

Right Gastric Artery Embolization Prior to Treatment with Yttrium-90 Microspheres

International Nuclear Information System (INIS)

Cosin, Octavio; Bilbao, Jose Ignacio; Alvarez, Sergio; Luis, Esther de; Alonso, Alberto; Martinez-Cuesta, Antonio

2007-01-01

Purpose. Intra-arterial infusion of yttrium-90 microspheres is a form of radiation treatment for unresectable hepatic neoplasms. Misdeposition of particles in the gastroduodenal area such as the right gastric artery (RGA) may occur with serious consequences. We present a series of patients who underwent a detailed vascular study followed by RGA embolization. Special emphasis is placed on anatomic variations and technical considerations .Methods. In a 1 year period, 27 patients were treated. Initial vascular evaluation was performed, with careful attention to anatomic variants or extrahepatic arterial supply, especially to the gastroduodenal area. Embolization of such arteries was planned if needed. RGA embolization was performed antegradely from the hepatic artery or retrogradely via the left gastric artery (LGA). Postprocedural follow-up included clinical interview and gastroscopy if necessary. Results. RGA embolization was performed in 9 patients presenting with primary (n = 3) or metastatic liver tumors (n 6). Six patients underwent antegrade RGA embolization and 3 had embolization done retrogradely via the LGA. Retrograde access was chosen for anatomic reasons. None of the patients complained of gastroduodenal symptoms. Conclusion. RGA embolization can help minimize the gastroduodenal deposition of radioactive particles. RGA embolization should routinely be carried out. The procedure can be performed, with similar technical success, by both anterograde and retrograde approaches

Systemic Multiple Aneurysms Caused by Vascular Ehlers-Danlos Syndrome.

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Gui, Xinyu; Li, Fangda; Wu, Lingeer; Zheng, Yuehong

2016-07-01

Systemic multiple aneurysms are rare and usually associated with collagen tissue disease, such as Ehlers-Danlos syndrome (EDS) or Marfan syndrome. In the present case, we describe a 39-year-old male patient with systemic multiple aneurysms and acute intraperitoneal hemorrhage who was clinically diagnosed with vascular EDS. Coil embolization of the distal segment of the common hepatic artery was performed, which resolved the patient's symptoms. With this case presentation, we aim to increase the awareness of vascular EDS among clinicians and emphasize the extreme fragility of the arteries in patients with vascular EDS. © The Author(s) 2016.

Paradoxical embolization via a patent foramen ovale following acute pulmonary embolism

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Thomas, D.V.; Bynevelt, V.; Price, R.

2005-01-01

The foramen ovale is usually obliterated following establishment of the adult circulation but remains patent in 25% of individuals. This potential communication between the venous and arterial circulations can allow thromboembolic material to bypass the lungs and enter the systemic circulation. We report two cases of paradoxical embolization through a patent foramen ovale following acute large pulmonary embolism (PE) and discuss the factors that predispose to paradoxical embolization following PE Copyright (2005) Blackwell Publishing Asia Pty Ltd

Thrombolysis for acute lower limb arterial embolism in patients with recent cerebral embolism

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Si Tongguo; Guo Zhi

2008-01-01

Objective: To assess the feasibility and efficacy of catheter-directed thrombolysis with recombinant tissue plasminogen activator (rt-PA)for acute limb embolism in patients with recent cerebral embolism. Methods: Eight patients with atrial fibrillation history happened to suffer acute limb embolism after recent cerebral embolism. The affected arteries included 2 left common iliac arteries, 4 femoral arteries (3 left, 1 right), 2 right popliteal arteries. Catheter-directed thrombolysis with rt-PA was applied with bolus administration plus continuous perfusion. Percutaneous transluminal angioplasty with balloon dilatation was applied in 3 patients, and one stent placement in one patient. Results: The mean duration of continuous perfusion was 3.6 hours and the mean dose of rt-PA administered was 23.6 mg (range, 20-28 mg)with complete recanalization rate of 100%. Clinical complete relief rate was 7/8 with one patient suffering from rest pain due to distal occlusion of anterior/posterior tibial artery. The complications included hematoma at puncture site (6/8), bleeding around the vascular sheath (2/8)and hematuria (1/8). NO intracerebral hemorrhage was found on CT scans after the thrombolysis. During follow up of 3-6 months, no recurrent embolism or thrombosis occurred in the limbs except one patient with recurrent cerebral embolism and died. Conclusions: Catheter-directed thrombolysis with rt-PA is probably to be a safe and effective method for acute limb embolism in patients with recent cerebral embolism and atrial fibrillation history. (authors)

Radioembolization: Is Prophylactic Embolization of Hepaticoenteric Arteries Necessary? A Systematic Review

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Borggreve, Alicia S., E-mail: alicia.borggreve@gmail.com; Landman, Anadeijda J. E. M. C., E-mail: ajemclandman@gmail.com; Vissers, Coco M. J., E-mail: coco.vissers@hotmail.com; De Jong, Charlotte D., E-mail: charlotte-dejong@live.nl; Lam, Marnix G. E. H., E-mail: m.lam@umcutrecht.nl [University Medical Center Utrecht, Division of Radiology and Nuclear Medicine (Netherlands); Monninkhof, Evelyn M., E-mail: e.monninkhof@umcutrecht.nl [University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care (Netherlands); Prince, Jip F., E-mail: jipfprince@gmail.com [University Medical Center Utrecht, Division of Radiology and Nuclear Medicine (Netherlands)

2016-05-15

PurposeTo study the effectiveness of prophylactic embolization of hepaticoenteric arteries to prevent gastrointestinal complications during radioembolization.MethodsA PubMed, Embase and Cochrane literature search was performed. We included studies assessing both a group of patients with and without embolization.ResultsOur search revealed 1401 articles of which title and abstract were screened. Finally, eight studies were included investigating 1237 patients. Of these patients, 456 received embolization of one or more arteries. No difference was seen in the incidence of gastrointestinal complications in patients with prophylactic embolization of the gastroduodenal artery (GDA), right gastric artery (RGA), cystic artery (CA) or hepatic falciform artery (HFA) compared to patients without embolization. Few complications were reported when microspheres were injected distal to the origin of these arteries or when reversed flow of the GDA was present. A high risk of confounding by indication was present because of the non-randomized nature of the included studies.ConclusionIt is advisable to restrict embolization to those hepaticoenteric arteries that originate distally or close to the injection site of microspheres. There is no conclusive evidence that embolization of hepaticoenteric arteries influences the risk of complications.

Radioembolization: Is Prophylactic Embolization of Hepaticoenteric Arteries Necessary? A Systematic Review

International Nuclear Information System (INIS)

Borggreve, Alicia S.; Landman, Anadeijda J. E. M. C.; Vissers, Coco M. J.; De Jong, Charlotte D.; Lam, Marnix G. E. H.; Monninkhof, Evelyn M.; Prince, Jip F.

2016-01-01

PurposeTo study the effectiveness of prophylactic embolization of hepaticoenteric arteries to prevent gastrointestinal complications during radioembolization.MethodsA PubMed, Embase and Cochrane literature search was performed. We included studies assessing both a group of patients with and without embolization.ResultsOur search revealed 1401 articles of which title and abstract were screened. Finally, eight studies were included investigating 1237 patients. Of these patients, 456 received embolization of one or more arteries. No difference was seen in the incidence of gastrointestinal complications in patients with prophylactic embolization of the gastroduodenal artery (GDA), right gastric artery (RGA), cystic artery (CA) or hepatic falciform artery (HFA) compared to patients without embolization. Few complications were reported when microspheres were injected distal to the origin of these arteries or when reversed flow of the GDA was present. A high risk of confounding by indication was present because of the non-randomized nature of the included studies.ConclusionIt is advisable to restrict embolization to those hepaticoenteric arteries that originate distally or close to the injection site of microspheres. There is no conclusive evidence that embolization of hepaticoenteric arteries influences the risk of complications.

Anterior mediastinal paraganglioma: A case for preoperative embolization

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Shakir Murtaza

2012-07-01

Full Text Available Abstract Background Paraganglioma is a rare but highly vascular tumor of the anterior mediastinum. Surgical resection is a challenge owing to the close proximity to vital structures including the heart, trachea and great vessels. Preoperative embolization has been reported once to facilitate surgical treatment. Case presentation We report a case of anterior mediastinal paraganglioma that was embolized preoperatively, and was resected without the need for cardiopulmonary bypass and without major bleeding complications. Conclusion We make a case to further the role of preoperative embolization in the treatment of mediastinal paragangliomas.

Evaluation of preoperative embolization of meningioma

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Park, Sung Tae; Suh, Dae Chul; Lee, Ho Kyu; Choi, Choong Gon; Lee, Myung Jun; Ji, Eun Kyung; Shin, Byung Suck; Kim, Chang Jin; Kim, Jong Uk; Whang, C. Jin

1998-01-01

To evaluate the efficacy and safety of preoperative embolization of intrancranial meningioma.Materials and Methods : We retrospectively reviewed intrancranial meningioma patients (n=37) who underwent preoperative embolization. They were categorized into two groups, skull base lesions (n=22) and non-skull base lesions (n=15), according to tumor location. In addition, embolization results were classified by comparison between pre- and post-embolization angiography as complete (residual tumor staining 10 or 30%). In each group, estimated blood loss (EBL) was estimated by amount of intraoperative transfusion with pre- and post-operative hemoglobin level. Tumor resectability was evaluated by follow-up computed tomography. New symptoms occurring within 24 hours of embolization were considered to be those associated with embolization ; symptoms improved by conservative treatment were regarded as mild, while those resulting in new deficits were considered severe. Results : In the group with skull base lesions (n=22), complete embolization with the criteria of residual tumor staining of less than 30% was performed in 14 patients(EBL=1770ml;complete surgical removal in nine patients and incomplete removal four). Incomplete embolization was performed in eight patients (EBL=3210ml; complete and incomplete removal each in four patients). In the group with non-skull base lesions, complete embolization with the criteria of residual tumor staining of less than 10% was performed in five patients (EBL=970ml) and incomplete embolization in ten (EBL=2260ml). Complete tumor removal was possible in this group regardless of the completeness of preoperative tumor embolization. In a case of intraventricular meningioma (3%), intratumoral hemorrhage occurred on the day following embolization. Other mild post-embolization complications occurred in three cases (8%). Conclusion : Preoperative embolization can be an effective and safe procedure for meningioma and may reduce intraoperative blood

Churg–Strauss Syndrome Presenting with Endobronchial Masses

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Veli Çetinsu

2015-12-01

Full Text Available Churg–Strauss syndrome is a condition with unknown etiology and asthma, allergic rhinitis, eosinophilic infiltration of blood and tissues, and transient infiltration of the lungs. It occurs mostly in the 3rd–4th decades of life with an incidence of 2.4/1000000. Presentation frequently involves nodular lung infiltrations, infiltrations with cavity, ground-glass appearance, and alveolar opacity. However, endobronchial mass is an unexpected presentation. In the current case report, we present a 45-year-old male patient who was receiving asthma therapy for 5 years. In the last follow-up visit, we identified a mass in the right hilum on X-ray radiography and performed fiberoptic bronchoscopy. Pathologic examination of biopsy material verified the diagnosis of Churg–Strauss syndrome. Bronchial mass is an unexpected presentation of Churg–Strauss syndrome and pathologic examination is essential to distinguish it from pulmonary malignancies

Treatment of Rectal Hemorrhage by Coil Embolization

International Nuclear Information System (INIS)

Dobson, Craig Charles; Nicholson, Anthony A.

1998-01-01

Four patients, aged 54-84 years, presenting with life-threatening rectal bleeding from the superior hemorrhoidal artery, underwent percutaneous fibered platinum coil embolization via coaxial catheters. Pre-procedure sigmoidoscopy had failed to identify the source of hemorrhage, because the rectum was filled with fresh blood. Embolization was technically and clinically successful in all four patients. Subsequent sigmoidoscopy confirmed the diagnoses in three patients as a solitary rectal ulcer, iatrogenic traumatic ulceration following manual evacuation, and a rectal Dieulafoy's lesion. The other case was angiographically seen to be due to a rectal angiodysplasia. Embolization is an effective procedure in life-threatening superior hemorrhoidal arterial bleeding when endoscopic treatment fails, and should be preferred to rectosigmoid resection

Patent Foramen Ovale: Is Stroke Due to Paradoxical Embolism?

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Ranoux, D.; Cohen, A.; Cabanes, L.; Amarenco, P.; Bousser, M. G.; Mas, J. L.

1993-01-01

Background and Purpose: A patent foramen ovale has been reported to be significantly more frequent in young stroke patients than in matched control subjects, and paradoxical embolism has been suggested as the main mechanism of stroke in-this situation. The present study was designed to test this hypothesis. Methods: Sixty-eight consecutive patients under 55 years of age presenting with an ischemic stroke had an extensive workup, including transesophageal echocardiography with contrast. We compared the prevalence of criteria for the diagnosis of paradoxical embolism in patients with and without a patent foramen ovale. Results: A patent foramen ovale was found in 32 patients (47%). A Valsalva-provoking activity was present at stroke onset in six patients with a patent foramen ovale and in eight patients with no patent foramen ovale (X(sup 2)=0.1, nonsignificant). Clinical/radiological features suggestive of an embolic mechanism were not more frequent in patients with a patent foramen ovale. Clinical evidence of deep vein thrombosis was present in one patient with a patent foramen ovale and in none of the others. No occult venous thrombosis was found in a subgroup of patients with a patent foramen ovale and no definite cause for stroke who underwent venography (n=13). Conclusions. Our results do not support the hypothesis that paradoxical embolism is the primary mechanism of stroke in patients with a patent foramen ovale. (Stroke 1993;24:31-34) KEY WORDS e cerebral ischemia e embolism foramen ovale, patent

Bardet-Biedl syndrome presenting with steroid sensitive nephrotic syndrome

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K K Singh

2015-01-01

Full Text Available Bardet-Biedl syndrome (BBS is a rare autosomal recessive disorder characterized by postaxial polydactyly, retinitis pigmentosa, central obesity, mental retardation, hypogonadism, and renal involvement. Renal involvement in various forms has been seen in BBS. Cases with nephrotic range proteinuria not responding to steroid have been described in this syndrome. Here we report a case of BBS who presented with nephrotic range proteinuria. The biopsy findings were suggestive of minimal change disease. The child responded well to steroid therapy and remains in remission.

Septic Pulmonary Embolism Requiring Critical Care: Clinicoradiological Spectrum, Causative Pathogens and Outcomes

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Chou, Deng-Wei; Wu, Shu-Ling; Chung, Kuo-Mou; Han, Shu-Chen; Cheung, Bruno Man-Hon

2016-01-01

OBJECTIVES: Septic pulmonary embolism is an uncommon but life-threatening disorder. However, data on patients with septic pulmonary embolism who require critical care have not been well reported. This study elucidated the clinicoradiological spectrum, causative pathogens and outcomes of septic pulmonary embolism in patients requiring critical care. METHODS: The electronic medical records of 20 patients with septic pulmonary embolism who required intensive care unit admission between January 2005 and December 2013 were reviewed. RESULTS: Multiple organ dysfunction syndrome developed in 85% of the patients, and acute respiratory failure was the most common organ failure (75%). The most common computed tomographic findings included a feeding vessel sign (90%), peripheral nodules without cavities (80%) or with cavities (65%), and peripheral wedge-shaped opacities (75%). The most common primary source of infection was liver abscess (40%), followed by pneumonia (25%). The two most frequent causative pathogens were Klebsiella pneumoniae (50%) and Staphylococcus aureus (35%). Compared with survivors, nonsurvivors had significantly higher serum creatinine, arterial partial pressure of carbon dioxide, and Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores, and they were significantly more likely to have acute kidney injury, disseminated intravascular coagulation and lung abscesses. The in-hospital mortality rate was 30%. Pneumonia was the most common cause of death, followed by liver abscess. CONCLUSIONS: Patients with septic pulmonary embolism who require critical care, especially those with pneumonia and liver abscess, are associated with high mortality. Early diagnosis, appropriate antibiotic therapy, surgical intervention and respiratory support are essential. PMID:27759843

Septic Pulmonary Embolism Requiring Critical Care: Clinicoradiological Spectrum, Causative Pathogens and Outcomes

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Deng-Wei Chou

Full Text Available OBJECTIVES: Septic pulmonary embolism is an uncommon but life-threatening disorder. However, data on patients with septic pulmonary embolism who require critical care have not been well reported. This study elucidated the clinicoradiological spectrum, causative pathogens and outcomes of septic pulmonary embolism in patients requiring critical care. METHODS: The electronic medical records of 20 patients with septic pulmonary embolism who required intensive care unit admission between January 2005 and December 2013 were reviewed. RESULTS: Multiple organ dysfunction syndrome developed in 85% of the patients, and acute respiratory failure was the most common organ failure (75%. The most common computed tomographic findings included a feeding vessel sign (90%, peripheral nodules without cavities (80% or with cavities (65%, and peripheral wedge-shaped opacities (75%. The most common primary source of infection was liver abscess (40%, followed by pneumonia (25%. The two most frequent causative pathogens were Klebsiella pneumoniae (50% and Staphylococcus aureus (35%. Compared with survivors, nonsurvivors had significantly higher serum creatinine, arterial partial pressure of carbon dioxide, and Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores, and they were significantly more likely to have acute kidney injury, disseminated intravascular coagulation and lung abscesses. The in-hospital mortality rate was 30%. Pneumonia was the most common cause of death, followed by liver abscess. CONCLUSIONS: Patients with septic pulmonary embolism who require critical care, especially those with pneumonia and liver abscess, are associated with high mortality. Early diagnosis, appropriate antibiotic therapy, surgical intervention and respiratory support are essential.

Renal Artery Embolization - A First Line Treatment Option For End-Stage Hydronephrosis

International Nuclear Information System (INIS)

Mitra, Kakali; Prabhudesai, Vikramaditya; James, R. Lester; Jones, Robert W. A.; French, Michael E.; Cowling, Mark; West, David J.

2004-01-01

Conventionally poorly functioning hydronephrotic kidneys have been removed if they are symptomatic. In our unit, patients are offered renal artery embolization as an alternative treatment option. Patients and Methods: Fifteen patients (11 male, 4 female) with a mean age of 32.9 yr (20-51 yrs) have undergone renal artery embolization for symptomatic hydronephrosis with poor function. Mean follow-up was 64.13 weeks (range 14-200). All patients had loin pain and hydronephrosis. Twelve patients had primary pelvi-ureteric junction obstruction (PUJO). Two patients had poorly functioning hydronephrotic kidneys secondary to chronic calculous obstruction. One patient had chronic pain in an obstructed but reasonably functioning kidney following a previous pyeloplasty for PUJO which demanded intervention. Mean split function on renography was 11% (range 0-46%). Selective renal artery embolization was carried out under antibiotic cover using a 7 Fr balloon occlusion catheter and absolute alcohol, steel coils, and polyvinyl alcohol particles.Results: Nine patients developed post-embolization syndrome of self-limiting pain and pyrexia with no evidence of sepsis. One patient required readmission with this condition. One patient developed a hematoma at the puncture site. Mean hospital stay was 2.3 days. Fourteen patients are happy with the result and are completely pain free. One patient has minor discomfort but is delighted with the result. Nine patients have had follow-up ultrasound confirming resolution of the hydronephrosis. Conclusion: Renal artery embolization is an effective, safe, well-tolerated minimally invasive treatment option in end-stage hydronephrosis and we routinely offer it as an alternative to nephrectomy

A novel method for the angiographic estimation of the percentage of spleen volume embolized during partial splenic embolization

International Nuclear Information System (INIS)

Ou, Ming-Ching; Chuang, Ming-Tsung; Lin, Xi-Zhang; Tsai, Hong-Ming; Chen, Shu-Yuan; Liu, Yi-Sheng

2013-01-01

Purpose: To evaluate the efficacy of estimating the volume of spleen embolized in partial splenic embolization (PSE) by measuring the diameters of the splenic artery and its branches. Materials and methods: A total of 43 liver cirrhosis patients (mean age, 62.19 ± 9.65 years) with thrombocytopenia were included. Among these, 24 patients underwent a follow-up CT scan which showed a correlation between angiographic estimation and measured embolized splenic volume. Estimated splenic embolization volume was calculated by a method based on diameters of the splenic artery and its branches. The diameters of each of the splenic arteries and branches were measured via 2D angiographic images. Embolization was performed with gelatin sponges. Patients underwent follow-up with serial measurement of blood counts and liver function tests. The actual volume of embolized spleen was determined by computed tomography (CT) measuring the volumes of embolized and non-embolized spleen two months after PSE. Results: PSE was performed without immediate major complications. The mean WBC count significantly increased from 3.81 ± 1.69 × 10 3 /mm 3 before PSE to 8.56 ± 3.14 × 10 3 /mm 3 at 1 week after PSE (P < 0.001). Mean platelet count significantly increased from 62.00 ± 22.62 × 10 3 /mm 3 before PSE to 95.40 ± 46.29 × 10 3 /mm 3 1 week after PSE (P < 0.001). The measured embolization ratio was positively correlated with estimated embolization ratio (Spearman's rho [ρ] = 0.687, P < 0.001). The mean difference between the actual embolization ratio and the estimated embolization ratio was 16.16 ± 8.96%. Conclusions: The method provides a simple method to quantitatively estimate embolized splenic volume with a correlation of measured embolization ratio to estimated embolization ratio of Spearman's ρ = 0.687

Hemolysis, hemorrhage, headache, and hidden abortion: imaging findings in antiphospholipid syndrome

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Mahnken, A.H.; Brandenburg, V.M.; Haage, P.; Guenther, R.W. [Dept. of Diagnostic Radiology, Univ. Hospital, Univ. of Technology, Aachen (Germany); Frank, R.D. [Dept. of Nephrology and Immunology, Univ. of Technology, Aachen (Germany)

2003-12-01

Antiphospholipid antibodies are associated with arterial and venous thromboses, recurrent pregnancy loss, and organ infarction. Any vascular region can be affected. We present a 20-year-old woman suffering from secondary antiphospholipid syndrome with a unique combination of multifocal venous thromboses, pulmonary embolism, spontaneous abortion, and splenic infarction. Diversity of clinical symptoms and diagnostic imaging modalities are discussed with emphasis on cross-sectional imaging. The syndrome should be suspected in patients with thromboses and organ infarctions of otherwise undetermined etiology. (orig.)

Hemolysis, hemorrhage, headache, and hidden abortion: imaging findings in antiphospholipid syndrome

International Nuclear Information System (INIS)

Mahnken, A.H.; Brandenburg, V.M.; Haage, P.; Guenther, R.W.; Frank, R.D.

2003-01-01

Antiphospholipid antibodies are associated with arterial and venous thromboses, recurrent pregnancy loss, and organ infarction. Any vascular region can be affected. We present a 20-year-old woman suffering from secondary antiphospholipid syndrome with a unique combination of multifocal venous thromboses, pulmonary embolism, spontaneous abortion, and splenic infarction. Diversity of clinical symptoms and diagnostic imaging modalities are discussed with emphasis on cross-sectional imaging. The syndrome should be suspected in patients with thromboses and organ infarctions of otherwise undetermined etiology. (orig.)

Oral Rehabilitation for Amniotic Band Syndrome: An Unusual Presentation.

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Hotwani, Kavita; Sharma, Krishna

2015-01-01

Amniotic band syndrome (ABS) is a congenital disorder caused by entrapment of fetal parts in fibrous amniotic bands while in utero. The syndrome is underdiagnosed and its presentation is variable. The syndrome has been well described in the pediatric, orthopedic and obstetric literature; however, despite the discernable craniomaxillofacial involvement, ABS has not been reported in the dental literature very often. The present report describes a case of a patient with ABS and concomitant dental findings. How to cite this article: Hotwani K, Sharma K. Oral Rehabilitation for Amniotic Band Syndrome: An Unusual Presentation. Int J Clin Pediatr Dent 2015;8(1):55-57.

Cerebral fat embolism

International Nuclear Information System (INIS)

Sakamoto, Toshihisa; Sawada, Yusuke; Yukioka, Tetsuo; Nishide, Kazuyuki; Yoshioka, Toshiharu

1982-01-01

A case of cerebral fat embolism is reported. A 18-year-old patient with multiple bone fractures was in semiconma immediately after an injury. Brain CT showed no brain swelling or intracranial hematoma. Hypoxemia and alcoholemia were noted on admission, which returned to normal without improvement of consciousness level. In addition, respiratory symptoms with positive radiographic changes, tachycardia, pyrexia, sudden drop in hemoglobin level, and sudden thrombocytopenia developed. These symptoms were compatible with Gurd's criteria of systemic fat embolism. Eight days after injury, multiple low density areas appeared on CT and disappeared within the subsequent two weeks, and subdural effusion with cerebral atrophy developed. These CT findings were not considered due to cerebral trauma. Diagnosis of cerebral fat embolism was made. The subdural effusion was drained. Neurologic and pulmonary recoveries took place slowly and one month following the injury the patient became alert and exhibited fully coordinated limb movement. The CT scans of the present case well corresponded with hitherto reported pathological findings. Petechiae in the white matter must have developed on the day of injury, which could not be detected by CT examination. It is suggested that some petechial regions fused to purpuras and then gradually resolved when they were detected as multiple low density areas on CT. CT in the purpuras phase would have shown these lesions as high density areas. These lesions must have healed with formation of tiny scars and blood pigment which were demonstrated as the disappearance of multiple low density areas by CT examination. Cerebral atrophy and subsequent subdural effusion developed as a result of demyelination. The patient took the typical clinical course of cerebral fat embolism and serial CT scans served for its assessment. (author)

Coil Migration after Transarterial Coil Embolization of a Splenic Artery Pseudoaneurysm

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Bezawit D. Tekola

2013-11-01

Full Text Available A 48-year-old man with a history of splenic artery pseudoaneurysm requiring transarterial embolization 3 months earlier presented to the emergency department with abdominal pain and fever. Computed tomography showed evidence of embolization coil fragments within the gastrointestinal tract. Upper endoscopy showed a large gastric ulcer with numerous embolization coils extruding into the gastric lumen. The patient underwent partial gastrectomy, distal pancreatectomy and resection of the splenic artery pseudoaneurysm. This case illustrates a rare delayed complication of transarterial embolization of a splenic artery pseudoaneurysm.

Lemierre syndrome: two cases and a review.

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Syed, Mohammed Iqbal; Baring, David; Addidle, Michael; Murray, Craig; Adams, Calum

2007-09-01

Lemierre syndrome is usually caused by an acute oropharyngeal infection in previously healthy young adults, resulting in thrombophlebitis of the internal jugular vein, leading to metastatic septic embolization and bacteraemia. The usual organism is Fusobacterium necrophorum. Lemierre syndrome, not so long ago labeled as the "forgotten disease," is on the rise. Today with increasing antibiotic-resistant organisms, and decreasing awareness of the syndrome, subsequent re-emergence of this "forgotten disease" is becoming more common in clinical settings. Lemierre syndrome has significant morbidity. Cranial nerve complications associated with the condition have been increasingly diagnosed in the last few years. Looking back at literature on Lemierre syndrome, there have been review articles in medical and microbiology journals but rarely in otolaryngology journals. By presenting our cases we demonstrate the diverse presentations and severity of the illness. A review of the literature and a case report on two cases seen in our institution in the last year are presented. Each of these had varied presentations and neurologic complications-one developed 9th to 12th cranial nerve palsies and Horner syndrome, which have not been described in previous literature, and the other developed polyneuropathy and a frontal lobe infarct among other multisystem complications. Diagnosis of Lemierre syndrome is not always straightforward as clinical features are variable and blood cultures are often negative. Awareness of the syndrome and a high degree of suspicion are needed.

Metachronous Bilateral Posterior Tibial Artery Aneurysms in Ehlers-Danlos Syndrome Type IV

International Nuclear Information System (INIS)

Hagspiel, Klaus D.; Bonatti, Hugo; Sabri, Saher; Arslan, Bulent; Harthun, Nancy L.

2011-01-01

Ehlers-Danlos syndrome type IV is a life-threatening genetic connective tissue disorder. We report a 24-year-old woman with EDS-IV who presented with metachronous bilateral aneurysms/pseudoaneurysms of the posterior tibial arteries 15 months apart. Both were treated successfully with transarterial coil embolization from a distal posterior tibial approach.

Amniotic fluid embolism

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Kiranpreet Kaur

2016-01-01

Full Text Available Amniotic fluid embolism (AFE is one of the catastrophic complications of pregnancy in which amniotic fluid, fetal cells, hair, or other debris enters into the maternal pulmonary circulation, causing cardiovascular collapse. Etiology largely remains unknown, but may occur in healthy women during labour, during cesarean section, after abnormal vaginal delivery, or during the second trimester of pregnancy. It may also occur up to 48 hours post-delivery. It can also occur during abortion, after abdominal trauma, and during amnio-infusion. The pathophysiology of AFE is not completely understood. Possible historical cause is that any breach of the barrier between maternal blood and amniotic fluid forces the entry of amniotic fluid into the systemic circulation and results in a physical obstruction of the pulmonary circulation. The presenting signs and symptoms of AFE involve many organ systems. Clinical signs and symptoms are acute dyspnea, cough, hypotension, cyanosis, fetal bradycardia, encephalopathy, acute pulmonary hypertension, coagulopathy etc. Besides basic investigations lung scan, serum tryptase levels, serum levels of C3 and C4 complements, zinc coproporphyrin, serum sialyl Tn etc are helpful in establishing the diagnosis. Treatment is mainly supportive, but exchange transfusion, extracorporeal membrane oxygenation, and uterine artery embolization have been tried from time to time. The maternal prognosis after amniotic fluid embolism is very poor though infant survival rate is around 70%.

Bartter syndrome: presentation in an extremely premature neonate.

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Flores, F X; Ojeda, F J; Calhoun, D A

2013-08-01

Reports of Bartter syndrome in premature neonates are rare. We describe the presentation and clinical course of a neonate born at 25.6 weeks estimated gestational age with polyuria, hyponatremia, hypokalemia and hypercalciuria ,who was diagnosed with neonatal Bartter syndrome. The evaluation, diagnosis and management of neonatal Bartter syndrome in this premature neonate are discussed.

Rarity of isolated pulmonary embolism and acute aortic syndrome occurring outside of the field of view of dedicated coronary CT angiography

International Nuclear Information System (INIS)

Lee, Hwa Yeon; Song, In Sup; Yoo, Seung Min; Rho, Ji Young; Moon, Jae Youn; Kim, In Jai; Lim, Sang Wook; Sung, Jung Hoon; Cha, Dong Hun; White, Charles S.

2011-01-01

Background Although triple rule-out CT angiography (TRO) to simultaneously evaluate acute coronary syndrome (ACS), pulmonary embolism (PE), and acute aortic syndrome (AAS) is increasingly used in many institutions, TRO is inevitably associated with increased radiation exposure due to extended z-axis coverage compared with dedicated coronary CT angiography (DCTA). Purpose To determine the frequency of exclusion of findings of AAS, PE, and significant incidental non-cardiac pathology that may be the cause of acute chest pain when using a restricted DCTA field of view (FOV). Material and Methods We retrospectively reviewed CT images and charts of 103 patients with acute PE and 50 patients with AAS. Either non-ECG gated dedicated pulmonary or aortic CT angiography was performed using 16- or 64-slice multidetector CT (MDCT). We analyzed the incidence of isolated PE, AAS, or significant non-cardiac pathology outside of DCTA FOV (i.e. from tracheal carina to the base of heart). Results There were two cases of isolated PE (2/103, 1.9%) excluded from the FOV of DCTA. One case of PE was isolated to the subsegmental pulmonary artery in the posterior segment of the right upper lobe. In the second case, pulmonary embolism in the left main pulmonary artery was located out of the FOV of DCTA because the left main pulmonary artery was retracted upwardly by fibrotic scar in the left upper lobe due to prior tuberculosis. There was no case of AAS and significant non-cardiac pathology excluded from the FOV of DCTA. AAS (n = 50) consisted of penetrating atherosclerotic ulcer (n = 7), intramural hematoma (n = 5) and aortic dissection (n = 38). Conclusion As isolated PE, AAS, and significant non-cardiac pathology outside of the DCTA FOV rarely occur, DCTA may replace TRO in the evaluation of patients with non-specific acute chest pain and a low pre-test probability of PE or aortic dissection

Rarity of isolated pulmonary embolism and acute aortic syndrome occurring outside of the field of view of dedicated coronary CT angiography

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Lee, Hwa Yeon; Song, In Sup (Dept. of Diagnostic Radiology Chung-Ang Univ. College of Medicine, Seoul (Korea, Republic of)); Yoo, Seung Min; Rho, Ji Young (Dept. of Diagnostic Radiology CHA Medical Univ. Hospital, Bundang (Korea, Republic of)), email: smyoo68@hanmail.net; Moon, Jae Youn; Kim, In Jai; Lim, Sang Wook; Sung, Jung Hoon; Cha, Dong Hun (Dept. of Cardiology CHA Medical Univ. Hospital, Bundang (Korea, Republic of)); White, Charles S. (Dept. of Diagnostic Radiology Univ. of Maryland, Baltimore (United States))

2011-05-15

Background Although triple rule-out CT angiography (TRO) to simultaneously evaluate acute coronary syndrome (ACS), pulmonary embolism (PE), and acute aortic syndrome (AAS) is increasingly used in many institutions, TRO is inevitably associated with increased radiation exposure due to extended z-axis coverage compared with dedicated coronary CT angiography (DCTA). Purpose To determine the frequency of exclusion of findings of AAS, PE, and significant incidental non-cardiac pathology that may be the cause of acute chest pain when using a restricted DCTA field of view (FOV). Material and Methods We retrospectively reviewed CT images and charts of 103 patients with acute PE and 50 patients with AAS. Either non-ECG gated dedicated pulmonary or aortic CT angiography was performed using 16- or 64-slice multidetector CT (MDCT). We analyzed the incidence of isolated PE, AAS, or significant non-cardiac pathology outside of DCTA FOV (i.e. from tracheal carina to the base of heart). Results There were two cases of isolated PE (2/103, 1.9%) excluded from the FOV of DCTA. One case of PE was isolated to the subsegmental pulmonary artery in the posterior segment of the right upper lobe. In the second case, pulmonary embolism in the left main pulmonary artery was located out of the FOV of DCTA because the left main pulmonary artery was retracted upwardly by fibrotic scar in the left upper lobe due to prior tuberculosis. There was no case of AAS and significant non-cardiac pathology excluded from the FOV of DCTA. AAS (n = 50) consisted of penetrating atherosclerotic ulcer (n = 7), intramural hematoma (n = 5) and aortic dissection (n = 38). Conclusion As isolated PE, AAS, and significant non-cardiac pathology outside of the DCTA FOV rarely occur, DCTA may replace TRO in the evaluation of patients with non-specific acute chest pain and a low pre-test probability of PE or aortic dissection

Embolization of iatrogenic uterine pseudoaneurysm

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Luca Boi

2017-05-01

Full Text Available Uterine artery pseudoaneurysms (UAPs are rare vascular lesions that may be life threatening if not diagnosed and properly treated. The clinical presentation of UAPs includes a spectrum of symptoms that are often associated with other and more frequent gynecologic/obstetric pathologies, both with and without vaginal bleeding, and may span from postpartum hemorrhage to the absence of symptoms. We report cases of two patients with UAP, both of whom were diagnosed with ultrasonography and contrast-enhanced computed tomography and successfully treated with transcatheter embolization. The first patient presented delayed hypovolemic shock following surgery for endometriosis, whereas the second patient suffered from postpartum hemorrhage after cesarean section. Diagnosis of UAPs relies on noninvasive imaging; transcatheter arterial embolization is an effective treatment to control bleeding in both hemodynamically stable and unstable patients.

A novel method for the angiographic estimation of the percentage of spleen volume embolized during partial splenic embolization

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Ou, Ming-Ching; Chuang, Ming-Tsung [Department of Diagnostic Radiology, National Cheng-Kung University Hospital, No. 138 Sheng Li Road, Tainan 704, Taiwan, ROC (China); Lin, Xi-Zhang [Department of Internal Medicine, National Cheng-Kung University Hospital, No. 138 Sheng Li Road, Tainan 704, Taiwan, ROC (China); Tsai, Hong-Ming; Chen, Shu-Yuan [Department of Diagnostic Radiology, National Cheng-Kung University Hospital, No. 138 Sheng Li Road, Tainan 704, Taiwan, ROC (China); Liu, Yi-Sheng, E-mail: taicheng100704@yahoo.com.tw [Department of Diagnostic Radiology, National Cheng-Kung University Hospital, No. 138 Sheng Li Road, Tainan 704, Taiwan, ROC (China)

2013-08-15

Purpose: To evaluate the efficacy of estimating the volume of spleen embolized in partial splenic embolization (PSE) by measuring the diameters of the splenic artery and its branches. Materials and methods: A total of 43 liver cirrhosis patients (mean age, 62.19 ± 9.65 years) with thrombocytopenia were included. Among these, 24 patients underwent a follow-up CT scan which showed a correlation between angiographic estimation and measured embolized splenic volume. Estimated splenic embolization volume was calculated by a method based on diameters of the splenic artery and its branches. The diameters of each of the splenic arteries and branches were measured via 2D angiographic images. Embolization was performed with gelatin sponges. Patients underwent follow-up with serial measurement of blood counts and liver function tests. The actual volume of embolized spleen was determined by computed tomography (CT) measuring the volumes of embolized and non-embolized spleen two months after PSE. Results: PSE was performed without immediate major complications. The mean WBC count significantly increased from 3.81 ± 1.69 × 10{sup 3}/mm{sup 3} before PSE to 8.56 ± 3.14 × 10{sup 3}/mm{sup 3} at 1 week after PSE (P < 0.001). Mean platelet count significantly increased from 62.00 ± 22.62 × 10{sup 3}/mm{sup 3} before PSE to 95.40 ± 46.29 × 10{sup 3}/mm{sup 3} 1 week after PSE (P < 0.001). The measured embolization ratio was positively correlated with estimated embolization ratio (Spearman's rho [ρ] = 0.687, P < 0.001). The mean difference between the actual embolization ratio and the estimated embolization ratio was 16.16 ± 8.96%. Conclusions: The method provides a simple method to quantitatively estimate embolized splenic volume with a correlation of measured embolization ratio to estimated embolization ratio of Spearman's ρ = 0.687.

Ovarian protection by selective coil embolization of a uteroovarian anastomosis before uterine fibroid embolization: a report of two cases

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Yang, Seung Boo; Im, Han Hyeok [Soonchunhyang University, Gumi (Korea, Republic of); Chang, Yun Woo; Goo, Dong Erk [Soonchunhyang University Hospital, Gumi (Korea, Republic of)

2006-09-15

Premature menopause can be developed as a result of undesired nontarget ovary embolization during the performance of uterine fibroid embolization. The etiology of varian failure after uterine fibroid embolization is not yet clearly defined, but one of the leading possibilities is nontarget embolization of the varies. We report here on two cases in which superselective coil embolization of distal uterine artery collateral pathways to the ovary was performed during uterine fibroid embolization.

An Abdominal Presentation of Churg-Strauss Syndrome

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Rees, J. R. E.; Burgess, P.

2010-01-01

Churg-Strauss syndrome is a small and medium vessel vasculitis that is also known as allergic granulomatous angiitis. It most commonly presents with an asthma like symptoms. It was first described in Mount Siani Hospital, New York in 1951 by Jacob Churg and Lotte Stauss and was recognised after the study of a series of 13 patients who had asthma, eosinophilia, granulomatous inflammation necrotising systemic vasculitis and necrotising glomerulonephritis. We describe a case of Churg-Strauss syndrome presenting with abdominal pain and later during the hospital admission a mono-neuritis multiplex syndrome affecting the lower limbs. The patient presented in such an atypical fashion with abdominal signs and symptoms that they required laparotomy and the diagnosis was made after histological examination of tissue taken at the time of surgery. Treatment with immunosuppression and aggressive rehabilitation achieved a progressive recovery which continued on discharge from hospital. PMID:20814555

Spontaneous Carotid-Cavernous Fistula in the Type IV Ehlers-Danlos Syndrome.

Science.gov (United States)

Kim, Jeong Gyun; Cho, Won-Sang; Kang, Hyun-Seung; Kim, Jeong Eun

2014-02-01

Ehlers-Danlos syndrome (EDS) is a rare inherited connective disease. Among several subgroups, type IV EDS is frequently associated with spontaneous catastrophic bleeding from a vascular fragility. We report on a case of carotid-cavernous fistula (CCF) in a patient with type IV EDS. A 46-year-old female presented with an ophthalmoplegia and chemosis in the right eye. Subsequently, seizure and cerebral infarction with micro-bleeds occurred. CCF was completely occluded with transvenous coil embolization without complications. Thereafter, the patient was completely recovered. Transvenous coil embolization can be a good treatment of choice for spontaneous CCF with type IV EDS. However, every caution should be kept during invasive procedure.

Turner′s syndrome presenting as metabolic bone disease

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Sadishkumar Kamalanathan

2012-01-01

Full Text Available Turner′s syndrome is a genetic disorder with a complete or partial absence of one X chromosome with characteristic phenotypic features. The prevalence of renal anomalies in turner syndrome is 30-40%. However, the renal function is usually normal. We report a case of Turner′s syndrome presenting with chronic kidney disease and renal osteodystrophy.

Bringing SASI back: Single session selective arterial secretin injection and transarterial embolization of intrahepatic pancreatic neuroendocrine metastasis in a MEN-1 patient

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Jawad S. Hussain, MD, MS

2018-04-01

Full Text Available SASI (selective arterial secretin injection is a form of ASVS (arterial stimulation and venous sampling used to localize pancreatic gastrinomas. This report aims to review the protocol for SASI and demonstrate its utility in localizing functional and nonfunctional gastrinomas. Even if a patient has a pancreatic mass and a laboratory profile fitting a specific endocrine syndrome, these may or may not be associated as has been previously demonstrated with adrenal vein sampling. We present a case where a patient underwent simultaneous SASI and bland embolization of a hepatic metastasis to facilitate partial pancreatectomy for Zollinger-Ellison syndrome. Keywords: SASI, ASVS, Gastrinoma, Sampling

Embolism of high energy firearm projectile

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Jaime Álvarez Soler

2016-12-01

Full Text Available The embolism of a projectile is very rare and out of the normal context, so the cor-oner in front of a wound projectile firearm must make a very judicious and careful analysis to recover the projectile and/or its fragments. This case presents evidence how modern military high-velocity weapons have a high kinetic energy which is transferred to body tissues, so including their fragments and parts of the projectile can cause serious injury and embolism, requiring a great effort scientific and in-terdisciplinary to give technical support to justice.

Embolization of spinal arteriovenous malformations

International Nuclear Information System (INIS)

Son, Mi Young; Kim, Sun Yong; Park, Bok Hwan

1990-01-01

Recently, therapeutic embolization has been advocated as the treatment of choice for spinal AVM(arteriovenous malformations). The authors review our experience with two cases of spinal AVM treated by embolization using coaxial Tracker-18 microcatheter with Latvian. The patients included a 10 year old male with glomus type and a 14 year old female with juvenile type spinal AVM revealed recanalization 5 month later. Embolization provides curative or temporary treatment for spinal AVM. After embolic occlusion, delayed reassessment with arteriography is indicated, particularly if symptoms persist or recur

C-arm CT for planning and guidance of extrahepatic embolizations

International Nuclear Information System (INIS)

Wacker, F.K.; Meissner, O.A.; Meyer, B.C.

2009-01-01

Interventional radiological vascular embolizations are complex procedures that require exact imaging of the target region to facilitate safe and effective treatment. The purpose of this paper is to present the technique and feasibility of flat detector C-arm computed tomography (C-arm CT) for control and guidance of extrahepatic abdominal embolization procedures. C-arm CT images can provide important information on both vascular and cross-sectional anatomy of the target region, help in determining therapy endpoints and provide follow-up during and immediately after the abdominal interventions.The cases presented demonstrate that C-arm CT images are beneficial for abdominal embolization procedures and facilitate precise treatment. (orig.) [de

Liver Regeneration After Portal Vein Embolization Using Absorbable and Permanent Embolization Materials in a Rabbit Model

NARCIS (Netherlands)

van den Esschert, Jacomina W.; van Lienden, Krijn P.; Alles, Lindy K.; van Wijk, Albert C.; Heger, Michal; Roelofs, Joris J.; van Gulik, Thomas M.

2012-01-01

Objective: To compare the safety and hypertrophy response after portal vein embolization (PVE) using 2 absorbable and 3 permanent embolization materials. Background: Portal vein embolization is used to increase future remnant liver volume preoperatively. Application of temporary, absorbable

An Abdominal Presentation of Churg-Strauss Syndrome

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J. R. E. Rees

2010-01-01

inflammation necrotising systemic vasculitis and necrotising glomerulonephritis. We describe a case of Churg-Strauss syndrome presenting with abdominal pain and later during the hospital admission a mono-neuritis multiplex syndrome affecting the lower limbs. The patient presented in such an atypical fashion with abdominal signs and symptoms that they required laparotomy and the diagnosis was made after histological examination of tissue taken at the time of surgery. Treatment with immunosuppression and aggressive rehabilitation achieved a progressive recovery which continued on discharge from hospital.

Atypical presentation of HELLP syndrome: clinical case report

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Juan Manuel Tobar Parra

2017-12-01

Full Text Available Objective: To describe a case of HELLP syndrome with atypical presentation form. Background: HELLP syndrome is a complication of preeclampsia, characterized by: haemolysis, elevation of liver enzymes and thrombocytopenia; Can present atypical, without hypertension or proteinuria, 10-20% of the cases. Case report: 38 year old female patient, with a pregnancy of 38.5 weeks of gestation, treated at the Hospital Universitario San José de Popayán (Colombia. Atypical HELLP syndrome is diagnosed in a pregnant woman with thrombocytopenia, impaired liver enzymes, but no evidence of proteinuria or hypertension. Gestation is terminated by cesarean section and magnesium sulfate is given for 24 hours, with adequate post-surgical evolution, clinical improvement of the symptomatology presented, normalization of liver enzymes and platelet elevation. Conclusion: Knowledge of this syndrome, although of rare occurrence, allows a fast action, an effective diagnosis and treatment, to avoid morbidity and greater maternal fetal mortality.

Paradoxical embolism: Experiences from a single center

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Hong-Liang Zhang

2017-06-01

Full Text Available Objective: To present our treatment experiences and the follow-up data of patients with paradoxical embolism (PDE. Methods: The clinical characteristics, management, and follow-up data of all included patients who were diagnosed with PDE at Fuwai Hospital from January 1994 to October 2015 were recorded. Results: Twelve patients were included; all had a pulmonary embolism, and 8 had deep venous thrombosis. The artery embolisms involved the cerebral artery (7 patients, renal artery (2 patients, mesentery artery (2 patients, popliteal artery (1 patient, descending aorta thrombus (1 patient, and thrombus-straddled patent foramen ovale (PFO (1 patient. PFO was found in 3 cases. One patient underwent thrombectomy and PFO closure; Six patients received thrombolysis; and 3 patients were implanted with a vena cava filter. Long-term anticoagulation with warfarin was recommended for each patient. One patient died from ventricular fibrillation despite cardiopulmonary resuscitation. Eleven patients were discharged with improvements. No late mortality occurred in 8 patients with a complete follow-up of 10.6–17.7 years. One had a recurrent deep venous thrombosis. No patient had a recurrent pulmonary or arterial embolism. Two patients changed their treatment from warfarin to aspirin; others remained on warfarin. Only 1 case had an occasional gum bleeding. Conclusions: PDE treatment including thrombolysis, anticoagulation, and embolectomy should be individualized. We recommend long-term anticoagulation therapy to prevent the recurrence of PDE, especially to those with an intracardiac communication or persistent risk factors for re-thrombosis. Keywords: Paradoxical embolism, Pulmonary embolism, Deep venous thrombosis, Patent foramen ovale

Recent progress in the clinical application of partial splenic embolization

International Nuclear Information System (INIS)

Zhou Yaojun; Liu Changjiang; Wang Yaojun

2012-01-01

Partial splenic embolization (PSE) is a non-surgical procedure used to treat hypersplenism in various clinical settings and thus to avoid the disadvantages of splenectomy. PSE can be employed for the treatment of a variety of diseases including hypersplenism, thrombocytopenia, portal hypertension, splenic arterial aneurysms, etc. PSE can effectively relieve the splenic artery steal syndrome which occurred after liver transplantation, and therefore significantly improve the blood perfusion of the recipient liver. Besides, PSE can also be adopted to reduce the bleeding risk in patients with esophageal and gastric varices caused by portal hypertension. PSE is beneficial to the improvement of peripheral hematologic parameters, which helps the patients successfully undergo the high-dose chemotherapy or interferon therapy. In addition, PSE possesses potential curative effect for thrombocytopenia related diseases such as chronic idiopathic thrombocytopenic purpura. This paper aims to make a comprehensive review of the recent progress in the clinical application of partial splenic embolization. (authors)

Pinch-off syndrome: case report and review of the literature = Síndrome de pinzamiento costoclavicular: reporte de un caso y revisión de la literatura

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Vega Peña, Neil Valentín

2013-04-01

Full Text Available Pinch-off syndrome is a rare complication of central venous catheter insertion through the subclavian approach. It is secondary to external compression of the catheter in the costoclavicular angle, which can lead to obstruction, rupture and embolization of its distal fragment. It is usually associated with premonitory radiological and clinical signs. Due to the severe complications of this syndrome, a proper prophylaxis should be done from the moment of insertion until the end of treatment. We present the case of a patient undergoing chemotherapy for adenocarcinoma of the colon, who developed pinch-off syndrome, with rupture and embolization of the distal fragment of the catheter to the right pulmonary artery. Treatment was successful by means of catheterization through the femoral vein.

Embolization Therapy for Traumatic Splenic Lacerations

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Dasgupta, Niloy; Matsumoto, Alan H., E-mail: ahm4d@virginia.edu; Arslan, Bulent; Turba, Ulku C.; Sabri, Saher; Angle, John F. [University of Virginia Health System, Division of Vascular and Interventional Radiology, Department of Radiology (United States)

2012-08-15

Purpose: This study was designed to evaluate the clinical success, complications, and transfusion requirements based on the location of and agents used for splenic artery embolization in patients with splenic trauma. Methods: A retrospective study was performed of patients with splenic trauma who underwent angiography and embolization from September 2000 to January 2010 at a level I trauma center. Electronic medical records were reviewed for demographics, imaging data, technical aspects of the procedure, and clinical outcomes. Results: Fifty patients were identified (34 men and 16 women), with an average age of 48 (range, 16-80) years. Extravasation was seen on initial angiography in 27 (54%) and was absent in 23 (46%). All 27 patients with extravasation were embolized, and 18 of 23 (78.2%) without extravasation were embolized empirically. Primary clinical success was similar (>75%) across all embolization locations, embolic agents, and grades of laceration treated. Of 45 patients treated, 9 patients (20%) were embolized in the main splenic artery, 34 (75.6%) in the splenic hilum, and 2 (4.4%) were embolized in both locations. Partial splenic infarctions developed in 47.3% treated in the splenic hilum compared with 12.5% treated in the main splenic artery. There were four (8.9%) mortalities: two occurred in patients with multiple critical injuries and two from nonbleeding etiologies. Conclusions: Embolization of traumatic splenic artery injuries is safe and effective, regardless of the location of treatment. Embolization in splenic hilar branches may have a higher incidence of infarction. The grade of laceration and agents used for embolotherapy did not impact the outcomes.

Embolization Therapy for Traumatic Splenic Lacerations

International Nuclear Information System (INIS)

Dasgupta, Niloy; Matsumoto, Alan H.; Arslan, Bulent; Turba, Ulku C.; Sabri, Saher; Angle, John F.

2012-01-01

Purpose: This study was designed to evaluate the clinical success, complications, and transfusion requirements based on the location of and agents used for splenic artery embolization in patients with splenic trauma. Methods: A retrospective study was performed of patients with splenic trauma who underwent angiography and embolization from September 2000 to January 2010 at a level I trauma center. Electronic medical records were reviewed for demographics, imaging data, technical aspects of the procedure, and clinical outcomes. Results: Fifty patients were identified (34 men and 16 women), with an average age of 48 (range, 16–80) years. Extravasation was seen on initial angiography in 27 (54%) and was absent in 23 (46%). All 27 patients with extravasation were embolized, and 18 of 23 (78.2%) without extravasation were embolized empirically. Primary clinical success was similar (>75%) across all embolization locations, embolic agents, and grades of laceration treated. Of 45 patients treated, 9 patients (20%) were embolized in the main splenic artery, 34 (75.6%) in the splenic hilum, and 2 (4.4%) were embolized in both locations. Partial splenic infarctions developed in 47.3% treated in the splenic hilum compared with 12.5% treated in the main splenic artery. There were four (8.9%) mortalities: two occurred in patients with multiple critical injuries and two from nonbleeding etiologies. Conclusions: Embolization of traumatic splenic artery injuries is safe and effective, regardless of the location of treatment. Embolization in splenic hilar branches may have a higher incidence of infarction. The grade of laceration and agents used for embolotherapy did not impact the outcomes.

Rheumatic fever associated with antiphospholipid syndrome: systematic review.

Science.gov (United States)

da Silva, Felipe; de Carvalho, Jozélio

2014-01-01

To evaluate the clinical associations between rheumatic fever and antiphospholipid syndrome and the impact of coexistence of these two diseases in an individual. Systematic review in electronics databases, regarding the period from 1983 to 2012. The keywords: "Rheumatic Fever," "Antiphospholipid Syndrome," and "Antiphospholipid Antibody Syndrome" are used. were identified 11 cases described in the literature about the association of rheumatic fever and antiphospholipid syndrome. Clinical presentation of rheumatic fever was characterized by the predominance of carditis (11/11) and chorea (7/11). Regarding the manifestations of APS, the stroke was observed in 7/11 (63.6%), with one of them having probable embolic origin. The present study brings the information that the association between APS and RF is quite rare, however, is of great clinical importance. Doctors who deal with the RF should include in their differential diagnosis the APS, especially in the presence of stroke in patients with RF and whose echocardiogram does not show intracavitary thrombi.

NEPHROTIC SYNDROME: PAST, PRESENT AND FUTURE

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M. S. Ignatova

2017-01-01

Full Text Available This literature review is focused to change our ideas about the etiology, pathogenesis and treatment tactics of the nephrotic syndrome  in recent decades. The change in the treatment outcomes of the primary nephrotic syndrome in connection with the emergence of new  therapy technologies, is shown. Features of the course, examination and therapy of congenital and infantile nephrotic syndrome and  the possibility of the debut of a nephrotic syndrome associated with various gene mutations and at an older age are presented. Principal differences in diagnostic and therapeutic approaches are accentuated depending on the cause of the development of the disease.  Modern syndromological and pathogenetic methods of therapy of primary nephrotic syndrome are presented, and the immediate opportunities for the introduction of new treatment technologies based on the use of monoclonal antibodies, are shown.

Coil embolization of an enlarging fusiform myxomatous cerebral aneurysm

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Frances Lazarow, MD

2018-04-01

Full Text Available Myxomatous cerebral aneurysms are rare sequelae of cardiac atrial myxoma. These aneurysms are generally fusiform, multiple, and distal. Pathogenesis and evolution of these aneurysms is still debated. There are currently no guidelines on the management of aneurysms secondary to atrial myxoma. We present a case of a 52-year-old man with multiple fusiform aneurysms 3 years after resection of a left atrial myxoma. One of these aneurysms was followed with cerebral angiography and showed substantial interval enlargement. This aneurysm was subsequently embolized. All aneurysms were stable 6 months post-embolization. Keywords: Myxomatous aneurysm, Fusiform, Coil embolization

An experimental study on combined transcatheter hepatic arterial embolization and retrograde hepatic venous embolization

International Nuclear Information System (INIS)

Wang Maoqiang; Zhang Jinshan; Xing Zhanhai

1997-01-01

The experimental study is aimed at achieving the effect of hepatic tumor and tumor-bearing lobar or segmental resection by using combined transcatheter hepatic arterial embolization and retrograde hepatic venous embolization (THAE-RHVE) in experimental study. THAE-RHVE was carried out in 8 mongrel dogs. Hepatic arterial embolization was performed by injecting lipiodol followed by gelatin sponge particles, following complete occlusion of the hepatic vein with balloon catheter. Retrograde hepatic venous embolization (RHVE) was then performed by injecting a mixture of absolute ethanol and meglumini diatrizoatis (MD) via the inflated balloon catheter. Ethanol and MD were combined with a ratio of 1:1. RHVE alone was performed in 4 dogs as control. The animals were followed up for 1∼8 weeks with liver function test, CT, gross and microscopic examinations. There was no technical failure or procedural complications. Transient elevation of AST and ALT levels was seen immediately in both groups after the procedure. Follow-up CT after 3 weeks showed dense lipiodol accumulation in the embolized lobe or segment and the corresponding portal branches in the THAE-RHVE animals. At 1 week after THAE-RHVE, complete coagulation necrosis was seen at histologic examination in the embolized lobe. The hepatic vein and portal branches of the embolized area had thickened walls and were filled with thrombus. At 2 weeks, granulomatous tissue and inflammatory cell infiltration surrounding the necrotic area could be seen. At 4∼8 weeks, marked atrophy of the embolized lobe was found, and the necrotic area was progressively reducing in size and being replaced by fibrosis. In the control group, incomplete segmental coagulated necrosis was seen and the necrosis area wa smaller than that of THAE-REVE. Hepatic lobectomy or segmentectomy can be achieved with THAE-RHVE. This new method is safe and easy, and may be useful in the treatment of HCC

Embolization of Spontaneous Hemarthrosis Post Total Knee Replacement

International Nuclear Information System (INIS)

Given, M. F.; Smith, P.; Lyon, S. M.; Robertson, D.; Thomson, K. R.

2008-01-01

Spontaneous nonhemophiliac hemarthrosis is an unusual entity, which has been little described. We present three cases of spontaneous recurrent hemarthrosis post total knee replacement (TKR) and successful management with embolization. Three male patients were referred to our service for angiography and treatment of recurrent hemarthrosis post TKR. In all three patients antegrade ipsilateral common femoral artery punctures and selective angiography of the geniculate branches were performed with a microcatheter. Abnormal vasculature was noted in all cases. Subsequent embolization was performed with Contour (Boston Scientific, Target Vascular, Cork, Ireland) embolization particles (150-250 and 250-355 μm) in two patients and microcoils in the third (TornadoR; Cook Inc., Bloomington, IN, USA). Technical success was 100%. One patient had a recurrence of symptoms requiring a repeat procedure 6 months later. No complications were encountered. Selective angiography and particle embolization is an effective technique for management of this unusual but problematic postoperative sequelae.

Superselective transcatheter renal arterial embolization for acute renal bleeding in patients with renal insufficiency: its clinical efficacy and safety

International Nuclear Information System (INIS)

Hu Tingyang; Zhou Bing; Yu Wenqiang; Luo Zuyan; Mao Yingmin; Chen Fanghong; Li Bo; Yuan Jianhua

2010-01-01

Objective: To discuss the clinical efficacy and complications of super selective renal arterial embolization in treating acute renal arterial bleeding in patients with renal insufficiency, and to evaluate the influence of the treatment on the renal function. Methods: During the period of January 2000 December 2009, super selective renal arterial embolization was performed in our institution for acute renal bleeding in 13 patients with renal insufficiency. The complete clinical and imaging materials of all patients were properly collected. The clinical effectiveness, the renal function, the extent of embolization and the complications were observed and the relationship between each other was analyzed. Results: The embolization procedure was successfully completed in all patients with a technical success rate of 100%. The mean embolized territory was 22% of a single kidney. Three days after the procedure, the hemoglobin level, hematocrit, blood pressure and heart rate were considerably improved in all patients. Compared to the corresponding preoperative data, all the differences were statistically significant (P 0.05), while the blood urea nitrogen was markedly decreased (P=0.011). Post embolization syndrome occurred in 5 patients and progressive aggravation of the renal function was observed in one patient, who had to receive hemodialysis finally. The embolized territory in patients occurring complications was larger than that in patients without occurring complications (U=1.500, P=0.006). Conclusion: Super selective renal arterial embolization is an effective and safe treatment for acute renal arterial bleeding in patients with renal insufficiency, the therapy will not significantly worsen the renal function. Appropriate and reasonable extent of embolization, as small as possible, is the key point for reducing the complications. (authors)

Transcatheter arterial embolization for hepatoma; I. Short-term evaluation

Energy Technology Data Exchange (ETDEWEB)

Seo, Heung Suk; Koh, Byung Hee; Cho, On Koo; Hahm, Chang Kok; Rhee, Jong Chul; Lee, Min Ho; Kee, Choon Suhk [Hanyang University College of Medicine, Seoul (Korea, Republic of)

1985-12-15

Anticancer effect and complications were evaluated after transcatheter arterial embolization (TAE) in 12 patients with hepatocellular carcinoma until 2 weeks and 4 weeks after TAE, respectively. The results were as follows; 1. Serum alpha-fetoprotein value decreased in 7 out of 9 patients with high value prior to TAE. 2. Loss of enhancement and better definition on enhanced computed tomography (CT) were seen in the tumors in all caes, and low density areas in 9/10.Gas bubbles were seen in low-density areas in 4/10 and high density areas caused by lipiodol in 6/10. 3. Post-embolization syndrome was developed in most patients but improved clinically within a week after TAE. 4. On laboratory examination, impairment of liver function was developed in most patients but improved within 4 weeks after TAE. 5. Complications on CT included splenic infarction and thickening of wall of the gallbladder, which didn't require specific treatment. The authors conclude that TAE for hepatocellular carcinoma reveals apparent anticancer effect on short-term evaluation, and resultant complications are transient and improved by conservative treatment.

Transcatheter arterial embolization for hepatoma; I. Short-term evaluation

International Nuclear Information System (INIS)

Seo, Heung Suk; Koh, Byung Hee; Cho, On Koo; Hahm, Chang Kok; Rhee, Jong Chul; Lee, Min Ho; Kee, Choon Suhk

1985-01-01

Anticancer effect and complications were evaluated after transcatheter arterial embolization (TAE) in 12 patients with hepatocellular carcinoma until 2 weeks and 4 weeks after TAE, respectively. The results were as follows; 1. Serum alpha-fetoprotein value decreased in 7 out of 9 patients with high value prior to TAE. 2. Loss of enhancement and better definition on enhanced computed tomography (CT) were seen in the tumors in all caes, and low density areas in 9/10.Gas bubbles were seen in low-density areas in 4/10 and high density areas caused by lipiodol in 6/10. 3. Post-embolization syndrome was developed in most patients but improved clinically within a week after TAE. 4. On laboratory examination, impairment of liver function was developed in most patients but improved within 4 weeks after TAE. 5. Complications on CT included splenic infarction and thickening of wall of the gallbladder, which didn't require specific treatment. The authors conclude that TAE for hepatocellular carcinoma reveals apparent anticancer effect on short-term evaluation, and resultant complications are transient and improved by conservative treatment

Greater saphenous vein anomaly and aneurysm with subsequent pulmonary embolism

OpenAIRE

Ma, Truong; Kornbau, Craig

2017-01-01

Abstract Venous aneurysms often present as painful masses. They can present either in the deep or superficial venous system. Deep venous system aneurysms have a greater risk of thromboembolism. Though rare, there have been case reports of superficial aneurysms and thrombus causing significant morbidity such as pulmonary embolism. We present a case of an anomalous greater saphenous vein connection with an aneurysm and thrombus resulting in a pulmonary embolism. This is the only reported case o...

Fatal pulmonary embolism following splenectomy in a patient with Evan's syndrome: case report and review of the literature.

Science.gov (United States)

Monga, Varun; Maliske, Seth M; Perepu, Usha

2017-01-01

Evans syndrome (ES) is a rare disease characterized by simultaneous or sequential development of autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP) with or without immune neutropenia. Splenectomy is one of the treatment options for disease refractory to medical therapy. Venous thromboembolism (VTE) following splenectomy for hematological diseases has an incidence of 10%. Here we describe a case report of a young patient hospitalized with severe hemolytic anemia with Hgb 4.8 g/dl. He developed thrombocytopenia with platelet nadir of 52,000/mm 3 , thus formally diagnosed with ES. He failed standard medical therapy. He underwent splenectomy and had a fatal outcome. Autopsy confirmed the cause of death as pulmonary embolism (PE). This case report and review of the literature highlight important aspects of the association between VTE, splenectomy, and hemolytic syndromes including the presence of thrombocytopenia. The burden of the disease is reviewed as well as various pathophysiologic mechanisms contributing to thromboembolic events in these patients and current perioperative prophylactic anticoagulation strategies. Despite an advancing body of literature increasing awareness of VTE following splenectomy, morbidity and mortality remains high. Identifying high risk individuals for thromboembolic complications from splenectomy remains a challenge. There are no consensus guidelines for proper perioperative and post-operative anti-coagulation. We encourage future research to determine which factors might be playing a role in increasing the risk for VTE in real time with hope of forming a consensus to guide management.

Value of the ventilation/perfusion scan in acute pulmonary embolism: Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED)

International Nuclear Information System (INIS)

Anon.

1990-01-01

To determine the sensitivities and specificities of ventilation/perfusion lung scans for acute pulmonary embolism, a random sample of 933 of 1,493 patients was studied prospectively. Nine hundred thirty-one underwent scintigraphy and 755 underwent pulmonary angiography; 251 (33%) of 755 demonstrated pulmonary embolism. Almost all patients with pulmonary embolism had abnormal scans of high, intermediate, or low probability, but so did most without pulmonary embolism. Of 116 patients with high-probability scans and definitive angiograms, 102 (88%) had pulmonary embolism, but only a minority with pulmonary embolism had high-probability scans. Of 322 with intermediate-probability scans and definitive angiograms, 105 (33%) had pulmonary embolism. Follow-up and angiography together suggest pulmonary embolism occurred among 12% of patients with low-probability scans. Clinical assessment combined with the ventilation/perfusion scan established the diagnosis or exclusion of pulmonary embolism only for a minority of patients--those with clear and concordant clinical and ventilation/perfusion scan findings

Selective arterial embolization in the management of symptomatic renal angiomyolipomas

Energy Technology Data Exchange (ETDEWEB)

Mourikis, Dimitrios; Chatziioannou, Achilles; Antoniou, Aristidis; Kehagias, Dimitrios; Gikas, Dimitrios; Vlahos, Lambros

1999-12-01

Current management of renal angiomyolipomas (AMLs) include observation, transcatheter embolization and partial or total nephrectomy. Patients symptoms and size of the lesion are the determinants for the choice of the treatment. In general symptomatic or greater than 8 cm masses require intervention. A retrospective study of five patients presented with symptomatic lesions and treated with selective transcatheter embolization, over a 3 year period was performed in our hospital. A total of eight embolizations were performed, all on an emergency basis due to retroperitoneal bleeding or significant hematuria. Surgical intervention was necessary in one case, due to massive rebleeding on the fourth post-procedural day. Two patients rebled within 6 months and 2 years respectively, and were managed successfully with additional embolization. The remaining two patients are still asymptomatic 26 and 18 months after the successful initial result. Experience with this procedure is reported on with emphasis to the clinical outcome. It is believed that selective arterial embolization should be the standard initial therapy for symptomatic renal AMLs.

Selective arterial embolization in the management of symptomatic renal angiomyolipomas

International Nuclear Information System (INIS)

Mourikis, Dimitrios; Chatziioannou, Achilles; Antoniou, Aristidis; Kehagias, Dimitrios; Gikas, Dimitrios; Vlahos, Lambros

1999-01-01

Current management of renal angiomyolipomas (AMLs) include observation, transcatheter embolization and partial or total nephrectomy. Patients symptoms and size of the lesion are the determinants for the choice of the treatment. In general symptomatic or greater than 8 cm masses require intervention. A retrospective study of five patients presented with symptomatic lesions and treated with selective transcatheter embolization, over a 3 year period was performed in our hospital. A total of eight embolizations were performed, all on an emergency basis due to retroperitoneal bleeding or significant hematuria. Surgical intervention was necessary in one case, due to massive rebleeding on the fourth post-procedural day. Two patients rebled within 6 months and 2 years respectively, and were managed successfully with additional embolization. The remaining two patients are still asymptomatic 26 and 18 months after the successful initial result. Experience with this procedure is reported on with emphasis to the clinical outcome. It is believed that selective arterial embolization should be the standard initial therapy for symptomatic renal AMLs

Preoperative embolization of facial angiomas

International Nuclear Information System (INIS)

Causmano, F.; Bruschi, G.; De Donatis, M.; Piazza, P.; Bassi, P.

1988-01-01

Preoperative embolization was performed on 27 patients with facial angiomas supplied by the external carotid branches. Sixteen were males and 11 females; 13 of these angiomas were high-flow arterio-venous (A-V), 14 were low-flow capillary malformations. Fourteen patients underwent surgical removal after preoperative embolization; in this group embolization was carried out with Spongel in 3 cases and with Lyodura in 11 cases. In 12 of these patients the last angiographic examination was performed 3-6 years later: angiography evidenced no recurrence in 8 cases (67%), while in 3 cases (25%) there was capillary residual angioma of negligible size. Treatment was unsuccessful in one patient only, due to the large recurrent A-V angioma. Thirteen patients underwent embolization only, which was carried out with Lyodura in 10 cases, and with Ivalon in 3 cases. On 12 of these patients the last angiographic study was performed 2-14 months later: there was recurrent A-V angioma in 5 patients (42%), who underwent a subsequent embolization; angiography evidenced no recurrence in the other 7 patients (58%). In both series, the best results were obtained in the patients with low-flow capillary angiomas. Embolization and subsequent surgical removal are the treatment of choice for facial angiomas; embolization alone is useful in the management of surgically inacessible vascular malformations, and it can be the only treatment in patients with small low-flow angiomas when distal occlusion of the feeding vessel with Lyodura or Ivalon particles is performed

Spontaneous Carotid-Cavernous Fistula in the Type IV Ehlers-Danlos Syndrome

Science.gov (United States)

Kim, Jeong Gyun; Cho, Won-Sang; Kim, Jeong Eun

2014-01-01

Ehlers-Danlos syndrome (EDS) is a rare inherited connective disease. Among several subgroups, type IV EDS is frequently associated with spontaneous catastrophic bleeding from a vascular fragility. We report on a case of carotid-cavernous fistula (CCF) in a patient with type IV EDS. A 46-year-old female presented with an ophthalmoplegia and chemosis in the right eye. Subsequently, seizure and cerebral infarction with micro-bleeds occurred. CCF was completely occluded with transvenous coil embolization without complications. Thereafter, the patient was completely recovered. Transvenous coil embolization can be a good treatment of choice for spontaneous CCF with type IV EDS. However, every caution should be kept during invasive procedure. PMID:24653803

Tentorial artery embolization in tentorial dural arteriovenous fistulas

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Rooij, Willem Jan van; Sluzewski, Menno [St. Elisabeth Ziekenhuis, Department of Radiology, Tilburg (Netherlands); Beute, Guus N [St. Elisabeth Ziekenhuis, Department of Neurosurgery, Tilburg (Netherlands)

2006-10-15

The tentorial artery is often involved in arterial supply to tentorial dural fistulas. The hypertrophied tentorial artery is accessible to embolization, either with glue or with particles. Six patients are presented with tentorial dural fistulas, mainly supplied by the tentorial artery. Two patients presented with intracranial hemorrhage, two with pulsatile tinnitus and one with progressive tetraparesis, and in one patient the tentorial dural fistula was an incidental finding. Different endovascular techniques were used to embolize the tentorial artery in the process of endovascular occlusion of the fistulas. All six tentorial dural fistulas were completely occluded by endovascular techniques, confirmed at follow-up angiography. There were no complications. When direct catheterization of the tentorial artery was possible, glue injection with temporary balloon occlusion of the internal carotid artery at the level of the tentorial artery origin was effective and safe. Different endovascular techniques may be successfully applied to embolize the tentorial artery in the treatment of tentorial dural fistulas. (orig.)

Tentorial artery embolization in tentorial dural arteriovenous fistulas

International Nuclear Information System (INIS)

Rooij, Willem Jan van; Sluzewski, Menno; Beute, Guus N.

2006-01-01

The tentorial artery is often involved in arterial supply to tentorial dural fistulas. The hypertrophied tentorial artery is accessible to embolization, either with glue or with particles. Six patients are presented with tentorial dural fistulas, mainly supplied by the tentorial artery. Two patients presented with intracranial hemorrhage, two with pulsatile tinnitus and one with progressive tetraparesis, and in one patient the tentorial dural fistula was an incidental finding. Different endovascular techniques were used to embolize the tentorial artery in the process of endovascular occlusion of the fistulas. All six tentorial dural fistulas were completely occluded by endovascular techniques, confirmed at follow-up angiography. There were no complications. When direct catheterization of the tentorial artery was possible, glue injection with temporary balloon occlusion of the internal carotid artery at the level of the tentorial artery origin was effective and safe. Different endovascular techniques may be successfully applied to embolize the tentorial artery in the treatment of tentorial dural fistulas. (orig.)

Nephrotic syndrome: a rare cause of acute coronary syndrome in a child

International Nuclear Information System (INIS)

Khan, J.A.; Shamsi, F.

2012-01-01

Patients with nephrotic syndrome are at risk of developing thrombosis in both veins and arteries. Various manifestations in different organs have been reported. Thrombi in heart seen, associated with multi organ thrombosis have been reported on autopsy earlier, but only once in a living patient with nephrotic syndrome. Here, we report a 13 years old boy with steroid-resistant nephrotic syndrome, who developed an asymptomatic but potentially hazardous large intracardiac thrombus. The child developed nephrotic syndrome at the age of 9 years and had multiple recurrences. At the age of 13 years, he developed myocardial infarction (MI) due to embolism from a large intracardiac thrombus. Later on, he was treated with heparin and warfarin anticoagulation. (author)

Management of thromboembolism-in-transit with pulmonary embolism

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V S Ellensen

2017-10-01

Full Text Available We present a rare complication of deep venous thrombosis with pulmonary embolism that threatened the patient with systemic embolization. A 36-year-old female was referred to the hospital after five days of progressive shortness of breath and chest pain. Preceding onset of symptoms, she had undergone surgery leading to reduced physical activity and had just returned from vacation by a long flight. Investigations with transthoracic and transesophageal echocardiography revealed a thromboembolism-in-transit across a patent foramen ovale. Thoracic CT showed submassive bilateral pulmonary embolism. Hemodynamic parameters were stable. The patient was treated surgically with extraction of the thrombus, closure of the foramen ovale and removal of the bilateral pulmonary emboli. She was discharged after an uneventful hospital stay.

Case Report of a Left Atrial Myxoma Associated with Carney%u2019s Syndrome

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Anil Ozen

2016-05-01

Full Text Available Primary cardiac neoplasms are very rare as compared to metastatic tumors. 70% to 80% of them are benign myxomas. Complications of myxomas include cyst and microabscess formation, embolization, syncope and sudden death. Rarely, cardiac myxomas are associated with primary nodular adrenal cortical disease, mammary fibroadenomas, testicular tumors or pitiutary adenomas with gigantism or acromegaly known as Carney%u2019s syndrome. We present a patient with a left atrial myxoma who underwent reoperation associated with Carney%u2019s syndrome.

Uterine arterial embolization to treat uterine leiomyoma

International Nuclear Information System (INIS)

Wang Huali; Han Lu; Wang Feng

2002-01-01

Objective: To assess the clinical effects of uterine arterial embolization on uterine leiomyoma. Methods: The authors treated 21 patients with uterine leiomyoma by Seldinger's uterine arterial embolization. The 4.0 F Cobra catheter was laced into the double uterine arteries with Polyvinyl Alcohol Foam (PVA) particles as the embolization. At 3 and 6 months postoperatively, the authors investigated the effects of the embolization. Results: After uterine arterial embolization, the volume of uterine leiomyoma decreased and menorrhagia was under controlled. The symptoms of anemia and oppression were relieved. The physiologic functions of ovary and uterus were preserved completely. Conclusions: Uterine arterial embolization is an effective and less invasive way to treat uterine leiomyoma

Crouzon’s Syndrome with Life-Threatening Ear Bleed: Ruptured Jugular Vein Diverticulum Treated by Endovascular Embolization

International Nuclear Information System (INIS)

Mondel, Prabath Kumar; Anand, Sunanda; Limaye, Uday S.

2015-01-01

Crouzon’s syndrome is the commonest variety of syndromic craniosynostosis. Life-threatening ear bleed due to ruptured jugular venous diverticulum in Crouzon’s syndrome has not been described previously. In patients with syndromic craniosynostosis, definitive repair of jugular diverticulum by open surgery is fraught with high risk of bleeding, poor functional outcomes, and even death. A 24-year-old woman with Crouzon’s syndrome presented with conductive hearing loss and recurrent episodes of torrential bleeding from her left ear. On computed tomography, a defect in the roof of jugular fossa containing jugular venous diverticulum immediately inferior to the bony external auditory canal was seen. The clinical presentation, imaging features, and endovascular management of Crouzon’s syndrome due to a ruptured jugular venous diverticulum is described

Crouzon’s Syndrome with Life-Threatening Ear Bleed: Ruptured Jugular Vein Diverticulum Treated by Endovascular Embolization

Energy Technology Data Exchange (ETDEWEB)

Mondel, Prabath Kumar, E-mail: prabathmondel@gmail.com; Anand, Sunanda, E-mail: sunandaanand@gmail.com; Limaye, Uday S., E-mail: uslkem@gmail.com [Lilavati Hospital and Research Centre, Department of Interventional Neuroradiology (India)

2015-08-15

Crouzon’s syndrome is the commonest variety of syndromic craniosynostosis. Life-threatening ear bleed due to ruptured jugular venous diverticulum in Crouzon’s syndrome has not been described previously. In patients with syndromic craniosynostosis, definitive repair of jugular diverticulum by open surgery is fraught with high risk of bleeding, poor functional outcomes, and even death. A 24-year-old woman with Crouzon’s syndrome presented with conductive hearing loss and recurrent episodes of torrential bleeding from her left ear. On computed tomography, a defect in the roof of jugular fossa containing jugular venous diverticulum immediately inferior to the bony external auditory canal was seen. The clinical presentation, imaging features, and endovascular management of Crouzon’s syndrome due to a ruptured jugular venous diverticulum is described.

Surgical Management of Juvenile Nasopharyngeal Angiofibroma Without Angiographic Embolization

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Raja Ahmad

2008-10-01

Full Text Available Juvenile nasopharyngeal angiofibroma (JNA is a rare benign neoplasm that occurs almost exclusively in the nasopharynx of adolescent males. Surgery remains the primary treatment of choice. JNA has always presented a management challenge to surgeons because of its vascular nature, site of occurrence, and local tissue destruction. The surgical approaches are either standard open method which include external or intraoral incisions, or the recent advanced approach, i.e. via using the endonasal endoscope. It is widely accepted that the use of preoperative angiographic embolization reduces the occurrence of intraoperative bleeding and facilitates tumour removal. However, angiographic embolization is not available at all centres. The purpose of this article is to present our experience with five patients diagnosed with JNA who were resected without embolization, using various surgical approaches. Two tumours were removed via endonasal endoscopic surgery. None of the tumours were embolized prior to surgery. We highlight the preoperative evaluation of tumour extent, using both computed tomography (CT and magnetic resonance angiography, and the importance of temporary clamping of the external carotid artery intraoperatively. Our results suggest that the latter procedure is a safe and effective means of facilitating surgery and reducing intraoperative bleeding.

Percutaneous Direct Puncture Embolization with N-butyl-cyanoacrylate for High-flow Priapism

Energy Technology Data Exchange (ETDEWEB)

Tokue, Hiroyuki, E-mail: tokue@s2.dion.ne.jp; Shibuya, Kei [Gunma University Hospital, Department of Diagnostic and Interventional Radiology (Japan); Ueno, Hiroyuki [Isesaki Municipal Hospital, Department of Radiology (Japan); Tokue, Azusa; Tsushima, Yoshito [Gunma University Hospital, Department of Diagnostic and Interventional Radiology (Japan)

2016-09-15

There are many treatment options in high-flow priapism. Those mentioned most often are watchful waiting, Doppler-guided compression, endovascular highly selective embolization, and surgery. We present a case of high-flow priapism in a 57-year-old man treated by percutaneous direct puncture embolization of a post-traumatic left cavernosal arteriovenous fistula using N-butyl-cyanoacrylate. Erectile function was preserved during a 12-month follow-up. No patients with percutaneous direct puncture embolization for high-flow priapism have been reported previously. Percutaneous direct puncture embolization is a potentially useful and safe method for management of high-flow priapism.

Massive hemoptysis in a patient with pulmonary embolism, a real therapeutic conundrum

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Yiolanda Herodotou

2017-01-01

Full Text Available Massive Hemoptysis and pulmonary embolism are two very severe and potentially fatal pulmonary emergencies requiring completely different treatments. We present the case of a 45-year old male transmitted to our Hospital for massive hemoptysis who at the same time was found to suffer from pulmonary embolism. Hemoptysis was treated with bronchial artery embolization which resulted in cessation of haemorrhage and allowed the administration of anticoagulant therapy a few days later. This case report gives an answer on how to manage a real therapeutic conundrum which is the coexistence of a massive hemoptysis and a concomitant pulmonary embolism.

Microcatheter Embolization of Intractable Idiopathic Epistaxis

International Nuclear Information System (INIS)

Leppaenen, Martti; Seppaenen, Seppo; Laranne, Jussi; Kuoppala, Katriina

1999-01-01

Purpose: To assess the efficacy and safety of microcatheter embolization in the treatment of intractable idiopathic epistaxis. Methods: Thirty-seven patients underwent microcatheter embolization in 1991-1998. We evaluated retrospectively the technical and clinical outcome, the number of complications, the duration of embolization in each case, and the number of blood transfusions needed. All embolizations were done with biplane digital subtraction angiography (DSA) equipment. The procedure was carried out under local anesthesia using transfemoral catheterization, except in one case where the translumbar route was used. Tracker 18 or 10 microcatheters were advanced as far as possible to the distal branches of the sphenopalatine artery. Polyvinyl alcohol (PVA) particles were used for embolization in most cases, while platinum coils or a combination of these two materials were occasionally used. The primary outcome was always assessed immediately by angiography. Follow-up data were obtained from patient records, by interviewing patients on the telephone or by postal questionnaires when necessary. The mean follow-up time was 21 months. Results: The embolization was technically successful in all 37 cases. A curative outcome was achieved in 33 cases (89%). The mean duration of the procedure was 110 min. Four patients (8%) had mild transient complications, but no severe or persistent complications were encountered. Twenty-three patients needed a blood transfusion. Slight rebleeding occurred in three patients during the follow-up; all responded to conservative treatment. One patient suffered two episodes of rebleeding within 2 months after primary embolization. Re-embolizations successfully stopped the bleeding. Conclusion: Embolization is the primary invasive modality for treating intractable idiopathic epistaxis. It proved both safe and effective over a relatively long follow-up

Percutaneous Mechanical Thrombectomy Treatment of Acute Superior Mesenteric Artery Embolism

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Z. Zhang

Full Text Available : Objective/Background: This report presents a superior mesenteric artery (SMA embolism managed by percutaneous mechanical thrombectomy (PMT. Methods: A 61 year old woman diagnosed with SMA embolism was admitted. Emboli were found in the middle and distal segments of the SMA on abdominal computed tomography angiography. Under local anaesthesia, a 6 F Rotarex system was used to remove the emboli via left brachial artery access. Emboli were successfully removed and patency was restored to the SMA and its branches. Results: Post-operatively, the patient's symptoms were significantly relieved. No post-operative complications were observed and no discomfort was documented during follow-up. Conclusion: Endovascular treatment of SMA embolism using PMT is a feasible and alternative option. Keywords: Acute mesenteric ischaemia, Embolism, Endovascular treatment, Percutaneous mechanical thrombectomy, Superior mesenteric artery

Prostatic Artery Embolization as an Alternative to Indwelling Bladder Catheterization to Manage Benign Prostatic Hyperplasia in Poor Surgical Candidates

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Rampoldi, Antonio; Barbosa, Fabiane, E-mail: fabiane001@hotmail.com [Ospedale Niguarda Ca’ Granda, Department of Interventional Radiology (Italy); Secco, Silvia [Ospedale Niguarda Ca’ Granda, Department of Urology (Italy); Migliorisi, Carmelo [Ospedale Niguarda Ca’ Granda, Department of Interventional Radiology (Italy); Galfano, Antonio; Prestini, Giovanni [Ospedale Niguarda Ca’ Granda, Department of Urology (Italy); Harward, Sardis Honoria [Dartmouth-Hitchcock Medical Center, The Dartmouth Institute for Health Policy and Clinical Practice (United States); Trapani, Dario Di [Ospedale Niguarda Ca’ Granda, Department of Urology (Italy); Brambillasca, Pietro Maria; Ruggero, Vercelli; Solcia, Marco [Ospedale Niguarda Ca’ Granda, Department of Interventional Radiology (Italy); Carnevale, Francisco Cesar [University of Sao Paulo Medical School, Department of Interventional Radiology (Brazil); Bocciardi, Aldo Massimo [Ospedale Niguarda Ca’ Granda, Department of Urology (Italy)

2017-04-15

PurposeTo prospectively assess discontinuation of indwelling bladder catheterization (IBC) and relief of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) following prostate artery embolization (PAE) in poor surgical candidates.MethodsPatients ineligible for surgical intervention were offered PAE after at least 1 month of IBC for management of urinary retention secondary to BPH; exclusion criteria for PAE included eligibility for surgery, active bladder cancer or known prostate cancer. Embolization technical and clinical success were defined as bilateral prostate embolization and removal of IBC, respectively. Patients were followed for at least 6 months and evaluated for International Prostate Symptom Score, quality of life, prostate size and uroflowmetric parameters.ResultsA total of 43 patients were enrolled; bilateral embolization was performed in 33 (76.7%), unilateral embolization was performed in 8 (18.6%), and two patients could not be embolized due to tortuous and atherosclerotic pelvic vasculature (4.7%). Among the patients who were embolized, mean prostate size decreased from 75.6 ± 33.2 to 63.0 ± 23.2 g (sign rank p = 0.0001, mean reduction of 19.6 ± 17.3%), and IBC removal was achieved in 33 patients (80.5%). Clavien II complications were reported in nine patients (21.9%) and included urinary tract infection (three patients, 7.3%) and recurrent acute urinary retention (six patients, 14.6%). Nine patients (22.0%) experienced post-embolization syndrome.ConclusionsPAE is a safe and feasible for the relief of LUTS and IBC in highly comorbid patients without surgical treatment options.

Prostatic Artery Embolization as an Alternative to Indwelling Bladder Catheterization to Manage Benign Prostatic Hyperplasia in Poor Surgical Candidates

International Nuclear Information System (INIS)

Rampoldi, Antonio; Barbosa, Fabiane; Secco, Silvia; Migliorisi, Carmelo; Galfano, Antonio; Prestini, Giovanni; Harward, Sardis Honoria; Trapani, Dario Di; Brambillasca, Pietro Maria; Ruggero, Vercelli; Solcia, Marco; Carnevale, Francisco Cesar; Bocciardi, Aldo Massimo

2017-01-01

PurposeTo prospectively assess discontinuation of indwelling bladder catheterization (IBC) and relief of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) following prostate artery embolization (PAE) in poor surgical candidates.MethodsPatients ineligible for surgical intervention were offered PAE after at least 1 month of IBC for management of urinary retention secondary to BPH; exclusion criteria for PAE included eligibility for surgery, active bladder cancer or known prostate cancer. Embolization technical and clinical success were defined as bilateral prostate embolization and removal of IBC, respectively. Patients were followed for at least 6 months and evaluated for International Prostate Symptom Score, quality of life, prostate size and uroflowmetric parameters.ResultsA total of 43 patients were enrolled; bilateral embolization was performed in 33 (76.7%), unilateral embolization was performed in 8 (18.6%), and two patients could not be embolized due to tortuous and atherosclerotic pelvic vasculature (4.7%). Among the patients who were embolized, mean prostate size decreased from 75.6 ± 33.2 to 63.0 ± 23.2 g (sign rank p = 0.0001, mean reduction of 19.6 ± 17.3%), and IBC removal was achieved in 33 patients (80.5%). Clavien II complications were reported in nine patients (21.9%) and included urinary tract infection (three patients, 7.3%) and recurrent acute urinary retention (six patients, 14.6%). Nine patients (22.0%) experienced post-embolization syndrome.ConclusionsPAE is a safe and feasible for the relief of LUTS and IBC in highly comorbid patients without surgical treatment options.

Multiple systemic embolism in infective endocarditis underlying in Barlow's disease.

Science.gov (United States)

Yu, Ziqing; Fan, Bing; Wu, Hongyi; Wang, Xiangfei; Li, Chenguang; Xu, Rende; Su, Yangang; Ge, Junbo

2016-08-11

Systemic embolism, especially septic embolism, is a severe complication of infective endocarditis (IE). However, concurrent embolism to the brain, coronary arteries, and spleen is very rare. Because of the risk of hemorrhage or visceral rupture, anticoagulants are recommended only if an indication is present, e.g. prosthetic valve. Antiplatelet therapy in IE is controversial, but theoretically, this therapy has the potential to prevent and treat thrombosis and embolism in IE. Unfortunately, clinical trial results have been inconclusive. We describe a previously healthy 50-year-old man who presented with dysarthria secondary to bacterial endocarditis with multiple cerebral, coronary, splenic, and peripheral emboli; antibiotic therapy contributed to the multiple emboli. Emergency splenectomy was performed, with subsequent mitral valve repair. Pathological examination confirmed mucoid degeneration and mitral valve prolapse (Barlow's disease) as the underlying etiology of the endocardial lesion. Continuous antibiotics were prescribed, postoperatively. Transthoracic echocardiography at 1.5, 3, and 6 months after the onset of his illness showed no severe regurgitation, and there was no respiratory distress, fever, or lethargy during follow-up. Although antibiotic use in IE carries a risk of septic embolism, these drugs have bactericidal and antithrombotic benefits. It is important to consider that negative blood culture and symptom resolution do not confirm complete elimination of bacteria. However, vegetation size and Staphylococcus aureus infection accurately predict embolization. It is also important to consider that bacteria can be segregated from the microbicide when embedded in platelets and fibrin. Therefore, antimicrobial therapy with concurrent antiplatelet therapy should be considered carefully.

A Case of Paraneoplastic Cushing Syndrome Presenting as Hyperglycemic Hyperosmolar Nonketotic Syndrome

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Christina E. Brzezniak

2017-04-01

Full Text Available Carcinoid tumors are neuroendocrine tumors that mainly arise in the gastrointestinal tract, lungs, and bronchi. Bronchopulmonary carcinoids have been associated with Cushing syndrome, which results from ectopic adrenocorticotrophic hormone (ACTH secretion. We report the case of a 65-year-old man, a colonel in the US Air Force, with metastatic bronchopulmonary carcinoid tumors treated on a clinical trial who was hospitalized for complaints of increasing thirst, polydipsia, polyuria, weakness, and visual changes. Decompensated hyperglycemia suggested a diagnosis of hyperglycemic hyperosmolar nonketotic syndrome (HHNS. Additional findings, which included hypokalemia, hypernatremia, hypertension, metabolic alkalosis, moon facies, and striae, raised a red flag for an ectopic ACTH syndrome. Elevated ACTH levels confirmed Cushing syndrome. Treatment with a fluid replacement and insulin drip resulted in immediate symptomatic improvement. Cushing syndrome should be considered in carcinoid patients with physical stigmata such as moon facies and striae. HHNS may be the presenting clinical feature in patients with impaired glucose metabolism.

Retrieval of Embolized Amplatzer Patent Foramen Ovale Occlusion Device: Issues Related to Late Recognition

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Allan J. Davies

2017-01-01

Full Text Available Embolization of a percutaneous patent foramen ovale (PFO closure device is a rare but serious complication. While early, periprocedural device embolization can normally be managed with snare and percutaneous retrieval, late embolization requires a different management strategy due to inability of the device to deform to allow passage into a large caliber sheath. We present a case of asymptomatic device embolization recognized six months following implantation and discuss the challenges encountered in successfully retrieving the device.

Transcatheter Embolization in the Management of Epistaxis

Science.gov (United States)

Dubel, Gregory J.; Ahn, Sun Ho; Soares, Gregory M.

2013-01-01

A majority of the population will experience epistaxis at some time in their life. Most cases will be from an anterior source and can be treated with pressure, anterior nasal packing, or cautery. Intractable epistaxis is generally posterior in origin and may require endoscopic cautery, posterior packing, surgical ligation, or embolization. Embolization has been used to treat epistaxis for more than 30 years and success can be achieved in approximately 90% of patients, with major complications occurring in approximately 2%. These excellent results require thorough knowledge of the regional anatomy, familiarity with the equipment and various agents used to achieve this type of embolization, as well as attention to detail and meticulous technique. There remains debate on several aspects of embolization, including the agent of choice, preferred size of the embolic, and the number of vessels to embolize. Advances in endoscopic surgery have evolved to the point that similar success rates for embolization and modern surgical techniques in treating epistaxis may be expected. This detailed review of pertinent vascular anatomy, embolization technique, and surgical alternatives should allow practitioners to formulate treatment algorithms that result in optimal outcomes at their institutions. PMID:24436547

Embolization of AV intra-hepatic fistulas

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Mallarini, G; Saitta, S; Cariati, M; Nicorelli, M; de Caro, G

1982-05-01

The use of therapeutic embolization in a case of hepatic AV fistula with portal flow inversion and portal hypertension is described. Indications, technique and an illustrative case followed up for one year after the intervention are presented.

Transcatheter arterial embolization as therapy of renal angiomyolipomas: The evolution in 15 years of experience

International Nuclear Information System (INIS)

Chatziioannou, A.; Gargas, D.; Malagari, K.; Kornezos, I.; Ioannidis, I.; Primetis, E.; Moschouris, H.; Gouliamos, A.; Mourikis, D.

2012-01-01

Objective: This study aims at presenting the evolution of the embolization technique in treating renal angiomyolipomas (AMLs) either diagnosed in patients with acute bleeding or discovered accidentally. Methods: Ten patients with renal AMLs have been through thirteen selective transcatheter arterial embolizations for 15 years. Two patients had tuberous sclerosis complex (TSC) with bilateral tumors and were embolized twice. Four embolic materials were employed: PVA particles, Gianturco coils, microspheres and microcoils. Catheterization was achieved by means of 5F Cobra 2 catheters and coaxial microcatheter systems. Results: On an emergency basis, embolization was a first-line treatment. In one case, surgery was necessary; in two patients, a second embolization was performed. When treatment was preventive, a single embolization proved to be sufficient, as well. There was no significant deterioration of the serum creatinine levels in the post-embolization period. Conclusion: Selective arterial embolization is a rather safe and effective technique to treat AMLs both urgently and preventively. Different embolic materials can be employed. Microspheres and microcatheters stand for new promising materials

Absolute Ethanol Embolization of Arteriovenous Malformations in the Periorbital Region

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Su, Li-xin, E-mail: sulixin1975@126.com [Shanghai Jiao Tong University School of Medicine, Department of Oral and Maxillofacial & Head and Neck Oncology, Ninth People’s Hospital (China); Jia, Ren-Bing, E-mail: jrb19760517@hotmail.com [Shanghai Jiao Tong University School of Medicine, Department of Ophthalmology, Ninth People’s Hospital (China); Wang, De-Ming, E-mail: wdmdeming@hotmail.com; Lv, Ming-Ming, E-mail: lvmingming001@163.com; Fan, Xin-dong, E-mail: fanxindong@aliyun.com [Shanghai Jiao Tong University School of Medicine, Department of Radiology, Ninth People’s Hospital (China)

2015-06-15

ObjectiveArteriovenous malformations (AVMs) involving the periorbital region are technically challenging clinical entities to manage. The purpose of the present study was to present our initial experience of ethanol embolization in a series of 16 patients with auricular AVMs and assess the outcomes of this treatment.MethodsTranscatheter arterial embolization and/or direct percutaneous puncture embolization were performed in the 16 patients. Pure or diluted ethanol was manually injected. The follow-up evaluations included physical examination and angiography at 1- to 6-month intervals.ResultsDuring the 28 ethanol embolization sessions, the amount of ethanol used ranged from 2 to 65 mL. The obliteration of ulceration, hemorrhage, pain, infection, pulsation, and bruit in most of the patients was obtained. The reduction of redness, swelling, and warmth was achieved in all the 16 patients, with down-staging of the Schobinger status for each patient. AVMs were devascularized 100 % in 3 patients, 76–99 % in 7 patients, and 50–75 % in 6 patients, according to the angiographic findings. The most common complications were necrosis and reversible blister. No permanent visual abnormality was found in any of the cases.ConclusionEthanol embolization is efficacious and safe in the treatment of AVMs in the periorbital region and has the potential to be accepted as the primary mode of therapy in the management of these lesions.

Treatment of unresectable primary and metastatic liver cancer with yttrium-90 microspheres (TheraSphere): assessment of hepatic arterial embolization.

Science.gov (United States)

Sato, Kent; Lewandowski, Robert J; Bui, James T; Omary, Reed; Hunter, Russell D; Kulik, Laura; Mulcahy, Mary; Liu, David; Chrisman, Howard; Resnick, Scott; Nemcek, Albert A; Vogelzang, Robert; Salem, Riad

2006-01-01

In Canada and Europe, yttrium-90 microspheres (TheraSphere); MDS Nordion, Ottawa, Canada) are a primary treatment option for primary and secondary hepatic malignancies. We present data from 30 patients with hepatocellular carcinoma (HCC) and metastatic liver disease treated with TheraSphere from a single academic institution to evaluate the angiographically evident embolization that follows treatment. Seven interventional radiologists from one treatment center compared pretreatment and posttreatment angiograms. The reviewers were blinded to the timing of the studies. The incidence of postembolization syndrome (PES) was determined as well as objective tumor response rates by the World Health Organization (WHO), Response Evaluation Criteria in Solid Tumors (RECIST), and European Association for the Study of the Liver (EASL) criteria. There were 420 independent angiographic observations that were assessed using the chi-squared statistic. The pretreatment and posttreatment angiograms could not be correctly identified on average more than 43% of the time (p = 0.0004). The postprocedure arterial patency rate was 100%. The objective tumor response rates for all patients were 24%, 31%, and 72% for WHO, RECIST, and EASL criteria, respectively. All of the patients tolerated the procedure without complications and were treated on an outpatient basis, and four patients had evidence of PES. This treatment method does not result in macroscopic embolization of the hepatic arteries, thereby maintaining hepatic tissue perfusion. These data support the principle that the favorable response rates reported with TheraSphere are likely due to radiation and microscopic embolization rather than flow-related macroscopic embolization and ischemia.

Management of Severe Hemoptysis from Pulmonary Aspergilloma Using Endovascular Embolization

International Nuclear Information System (INIS)

Corr, Peter

2006-01-01

Purpose. To determine the effectiveness of endovascular embolization as a temporizing measure in the management of severe hemoptysis caused by intracavitary pulmonary aspergilloma. Methods. Patients presenting with hemoptysis, estimated to be more than 300 ml in the preceding 24 hr, in whom a radiological diagnosis of pulmonary aspergilloma was made on chest radiographs and/or computed tomography of the chest were subjected to bronchial and systemic arteriography and embolization using triacryl microspheres. Results. Twelve patients with upper lobe intracavitary aspergillomas were managed with embolization. In 11 patients hemoptysis stopped within 24 hr and with no recurrence over the next 4 weeks. In 1 patient hemoptysis persisted and an upper lobe lobectomy was performed. Conclusion. Embolization of bronchial and systemic arteries is an effective method for treating acute severe hemoptysis from intracavitary aspergillomas, allowing the patient time to recover for definitive surgical management

Clinical application of arterial embolization for the treatment of uterine leiomyoma

International Nuclear Information System (INIS)

Wu Wei; Cheng Zhigang; Liu Yongsheng; Xia Huihuan; Luo Fuying; Peng Fang

2003-01-01

Objective: To explore the curative effects, side effects and complications of arterial embolization for the treatment of uterine leiomyoma. Methods: Bilateral uterine arterial embolization with silk particles of 350-500 μm was performed in 16 cases of uterine leiomyomas with uterine hemorrhage as the main complaint. Results: 15 patients underwent technically successful embolization. No serious complications occurred. The patients were followed up for 3-12 months. Menses returned to regular cycle. In the patients with anemia, the hemoglobin concentration rose up to normal level. The sizes of uterine leiomyoma decreased by 52% after 6 months of the treatment. Conclusions: Uterine arterial embolization is an effective and less invasive therapy with no serious complications for patients with uterine leiomyoma, especially for presentation of the uterus

Outcome of acute nonvariceal gastrointestinal haemorrhage after nontherapeutic arteriography compared with embolization

International Nuclear Information System (INIS)

Defreyne, Luc; Vanlangenhove, Peter; Decruyenaere, Johan; Van Maele, Georges; De Vos, Martine; Troisi, Roberto; Pattyn, Piet

2003-01-01

In acute nonvariceal gastrointestinal (GI) bleeding, immediate arteriographic haemostasis is presently assumed to be a therapeutic advantage. This study assesses whether the risk of a delayed haemostasis, caused by arteriographic findings precluding embolization, might influence patient outcome. We performed a 5.5-year retrospective database search to find all patients referred for arteriography to arrest acute nonvariceal GI bleeding with embolization. The embolized and nonembolized patients were compared for differences in baseline characteristics and bleeding parameters. In both groups the outcome of all endoscopic or surgical interventions after catheterization was included in the follow-up. Clinical success (at 30 days, after all therapy) and in-hospital mortality in the embolized and nonembolized group were compared. We retrieved 63 nonembolized bleedings in 58 patients and 49 embolized bleedings in 49 patients. In the nonembolized group, transfusion need and haemodynamic instability were significantly less severe. Forty-two of 63 (66%) nonembolized bleedings persisted requiring haemostasis by surgery (n=23), endoscopy (n=13) or supportive transfusions. Thirteen of 49 (27%) embolized bleedings recurred and were managed by surgery (n=7), endoscopy (n=3) or transfusion. Overall clinical success rate was 88.9% (56 of 63) in the nonembolized and 87.8% (43 of 49) in the embolized group. Mortality rate was 17.2% (10 of 58) in the nonembolized vs 30.6% (15 of 49) in the embolized patients (P=0.115). Whether or not arteriographic findings afforded the opportunity to embolize, outcome of acute nonvariceal GI bleeding did not differ significantly; however, patients undergoing embolization were more critically bleeding and ill. (orig.)

Economy class syndrome: still a recurrent complication of long journeys.

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Feltracco, Paolo; Barbieri, Stefania; Bertamini, Francesca; Michieletto, Elisa; Ori, Carlo

2007-04-01

Economy class syndrome is a rare but still unavoidable complication of long haul flights, particularly in patients who carry various intrinsic risk factors. The tendency to affect even asymptomatic young people and the greater risk to fragment and propagate to the pulmonary circulation are the main characteristics of deep vein thrombosis of long-flight travelers. We report the clinical history of eight patients admitted to intensive care unit for confirmed or highly suspected economy class syndrome. Seven of them developed the syndrome within 72 h from a long return flight, one suffered from pulmonary embolism after a 12-h car trip. Two out of eight patients died, one because of extremely severe hemodynamic impairment, the other as a consequence of multiple organ failure caused by a concomitant myocardial infarction. Deep vein thrombosis and pulmonary embolism represent one of the main medical problems of air travel and cause almost 20% of deaths in people with no medical history. Although economy class syndrome occurs mostly in elderly, even the healthy young population can be affected and, in fact, three out of eight patients of our series were under 50 years of age. All our patients but one carried a well recognized risk factor for deep vein thrombosis. Clinical symptoms of deep vein thrombosis can sometimes be aspecific and confusing, so that a certain proportion of post-travel deep vein thrombosis, evolving favorably and not giving rise to pulmonary embolism, might effectively remain undiagnosed. Economy class syndrome is still quite difficult to deal with and controversial in terms of preventive strategies.

Fanconi syndrome and severe polyuria: an uncommon clinicobiological presentation of a Gitelman syndrome.

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Bouchireb, Karim; Boyer, Olivia; Mansour-Hendili, Lamisse; Garnier, Arnaud; Heidet, Laurence; Niaudet, Patrick; Salomon, Remi; Poussou, Rosa Vargas

2014-08-11

Gitelman syndrome is an autosomal recessive tubulopathy characterized by hypokalemia, hypomagnesemia, metabolic alkalosis and hypocalciuria. The majority of patients do not present with symptoms until late childhood or adulthood, and the symptoms are generally mild. We report here the first case of Gitelman syndrome presenting with the biological features of Fanconi syndrome and an early polyuria since the neonatal period. We discuss in this article the atypical electrolytes losses found in our patient, as well as the possible mechanisms of severe polyuria. A 6-year-old Caucasian girl was admitted via the Emergency department for vomiting, and initial laboratory investigations found hyponatremia, hypokalemia, metabolic acidosis with normal anion gap, hypophosphatemia, and hypouricemia. Urinalysis revealed Na, K, Ph and uric acid losses. Thus, the initial biological profile was in favor of a proximal tubular defect. However, etiological investigations were inconclusive and the patient was discharged with potassium chloride and phosphorus supplementation. Three weeks later, further laboratory analysis indicated persistent hypokalemia, a metabolic alkalosis, hypomagnesemia, and hypocalciuria. We therefore sequenced the SLC12A3 gene and found a compound heterozygosity for 2 known missense mutations. Gitelman syndrome can have varying and sometimes atypical presentations, and should be suspected in case of hypokalemic tubular disorders that do not belong to any obvious syndromic entity. In this case, the proximal tubular dysfunction could be secondary to the severe hypokalemia. This report emphasizes the need for clinicians to repeat laboratory tests in undiagnosed tubular disorders, especially not during decompensation episodes.

Transcatheter arterial embolization for upper gastrointestinal tract bleeding.

Science.gov (United States)

Širvinskas, Audrius; Smolskas, Edgaras; Mikelis, Kipras; Brimienė, Vilma; Brimas, Gintautas

2017-12-01

Transcatheter arterial embolization is a possible treatment for patients with recurrent bleeding from the upper gastrointestinal tract after failed endoscopic management and is also an alternative to surgical treatment. To analyze the outcomes of transcatheter arterial embolization and identify the clinical and technical factors that influenced the rates of morbidity and mortality. A retrospective analysis was carried out, based on the data of 36 patients who underwent transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding in 2013 to 2015 in our center. An analysis was performed between early rebleeding rates, mortality and the following factors: patient sex, age, number of units of packed red blood cells and packed plasma administered to the patients, length of hospital stay, therapeutic or prophylactic embolization. The technical success rate of the embolization procedure was 100%. There were 15 (41.70%) therapeutic embolizations and 21 (58.3%) prophylactic embolizations. There was a 77.8% clinical success rate. Following embolization, 10 (27.80%) patients had repeated bleeding and 9 (25.0%) patients died. Significant associations were found between rebleeding and prophylactic embolization (OR = 10.53; p = 0.04) and between mortality and prophylactic embolization (OR = 10.53; p = 0.04) and units of packed red blood cells (OR = 1.25; p < 0.01). In our experience, transcatheter arterial embolization is a safe treatment method for acute nonvariceal upper gastrointestinal bleeding and a possible alternative to surgery for high-risk patients.

METABOLIC DISORDERS AND PULMONARY EMBOLISM

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O. Ya. Vasiltseva

2015-01-01

Full Text Available The purpose of the study. To examine the contribution of diabetes and obesity in the development of pulmonary embolism on the based data of the Register of new hospital of pulmonary embolism (PE in hospitals inTomsk(2003–2012. Material and Methods. The medical history and records of autopsies of patients treated in hospitals in the city ofTomsk, 2003–2012, and anatomopathological and/or instrumental examination revealed pulmonary embolism have been subjected to studies. We used the classification of diabetes mellitus proposed by the WHO in1999 inour work, because the register including data (2003–2012. The degree of obesity was assessed according to WHO classification (1997. Statistical analysis of the results was carried out with the help of software for computer Statistica for Windows, version 8.0. The Shapiro–Wilk and Kolmogorov–Smirnov tests was used to determine the nature of the distribution of the data. The ho mogeneity of the population variance was assessed using Fisher's exact test andLeuventest. The Mann– Whitney test was used when comparing two independent samples to determine the significance of differences. The analysis was conducted by means of qualitative characteristics contingency tables using Pearson χ 2 . The odds ratio was calculated to assess the association between a specific outcome and the risk. Data are presented as M ± SD factor. The significance level of p for all procedures used by the statistical analysis was taken to be 0.05. It was considered statistically significant level of p < 0.05. The results of the study. In intermediate urbanized city ofWestern Siberia,Tomsk, established register of hospital pulmonary embolism (2003–2012. The register included 751patients whose in vivo and / or postmortem revealed pulmonary embolism (PE. The data histories and autopsy reports was analyze. The type 2diabetes was diagnosed in 205 patients. The type 2 diabetes moderate had 29%. Diabetes severe suffer 82

A case of piriformis syndrome presenting as radiculopathy

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Rammurthy Kulkarni

2015-01-01

Full Text Available Piriformis syndrome has always remained as a diagnostic dilemma because of its varied presentation. Piriformis syndrome is myofascial dysfunction syndrome which causes pain not only because of trigger points within the muscle but also due to peripheral neuritis of the sciatic nerve. The sciatic neuritis is due to compression of the nerve as it passes through the greater sciatic foramen. The symptoms of sciatic nerve entrapment caused by the piriformis syndrome can be easily mistaken for radiculopathy as the nerve entrapment causes pain which radiates down below the knee and can go up to the foot. Electromyography (EMG and nerve conduction velocity (NCV studies can help differentiating these two conditions and can eliminate the need for the magnetic resonance imaging (MRI. In this paper, we have reported a case of piriformis syndrome which mimicked S 1 radiculopathy, where diagnosis was confirmed by diagnostic piriformis injection.

Unusual presentation of uncommon disease: anorexia nervosa presenting as wernicke-korsakoff syndrome-a case report from southeast Asia.

Science.gov (United States)

Mushtaq, Raheel; Shoib, Sheikh; Shah, Tabindah; Bhat, Mudasir; Singh, Randhir; Mushtaq, Sahil

2014-01-01

Anorexia nervosa presenting as Wernicke-Korsakoff syndrome is rare. The causes of Wernicke-Korsakoff syndrome are multiple like alcohol abuse, thyrotoxicosis, haemodialysis, severe malnutrition because of gastric carcinoma and pyloric obstruction, hyperemesis gravidarum, and prolonged parenteral feeding. We report a case of anorexia nervosa, who presented with Wernicke's encephalopathy and progressed to Korsakoff's syndrome. Knowledge, awareness, and early intervention of anorexia nervosa by mental health professionals can prevent development of Wernicke-Korsakoff syndrome.

Interventional embolization for refractory hyperthyroidism

International Nuclear Information System (INIS)

Jiang Guomin; Zhang Yunping; Chen Yaxian; Zhao Jinwei; Yang Weihuai; Chen Jinluo

2001-01-01

Objective: To evaluate the clinical effects of the thyroid artery embolization for refractory hyperthyroidism. Methods: Super selective catheterization and interventional embolization of thyroid superior and inferior arteries were performed with PVA microspheres and Gelfoam particles. Changes of function and size of thyroid were investigated after embolization. Results: The procedures were succeeded in all 21 patients. Followed up by 3-12 months, serum level of thyroid hormones dropped significantly (median FT 3 from 17.1 pmol/L to 7.44 pmol/L, median FT 4 from 51.1 pmol/L to 23.3 pmol/L, P< 0.01). The size of thyroid glands decreased remarkably. Symptoms of hyperthyroidism were controlled in 4 patients and were effectively controlled through low dose antithyroid medication in 17 patients. No serious complications occurred. Conclusions: Thyroid artery embolization is a new safe and effective method for refractory hyperthyroidism

Selective embolization in the treatment of intractable epistaxis

DEFF Research Database (Denmark)

Andersen, Pia Juul; Kjeldsen, Anette Drøhse; Nepper-Rasmussen, Jørgen

2005-01-01

: This was a retrospective review. Post-treatment effects and complications were evaluated by means of a questionnaire and a telephone interview. Owing to the different treatment strategies used, the results were evaluated for 2 groups of patients: Group A, 9 patients with HHT; and Group B, 13 patients with causes...... the bleeding may present difficulties. Several methods are used to control posterior epistaxis, one of the latest treatment strategies being selective embolization of the nasal arteries. The aim of this study was to describe the effect of selective embolization in 22 patients treated with a total of 30...... procedures at the ENT Department of Odense University Hospital between January 1995 and March 2004. To our knowledge this is the first Nordic work in which selective embolization has been used as a treatment strategy for patients with hereditary hemorrhagic telangiectasia (HHT). MATERIAL AND METHODS...

One patient with Sjogren’s syndrome presenting schizophrenia-like symptoms

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Lin CE

2016-03-01

Full Text Available Ching-En Lin1,2 1Department of Psychiatry, Taipei Tzu-Chi Hospital, Buddhist Medical Foundation, Taiwan, Republic of China; 2School of Medicine, Tzu-Chi University, Hualien, Taiwan, Republic of China Abstract: Comorbid depression in patients with Sjogren’s syndrome has been reported frequently, while comorbid psychosis in subjects with Sjogren’s syndrome has rarely been reported. Here we report a patient with Sjogren’s syndrome who presented with schizophrenia-like symptoms such as persecutory delusions and auditory hallucinations in contrast to her previous psychiatric presentations, which only included depression and anxiety. Keywords: mental illness, psychosis, Sjogren’s syndrome, schizophrenia

Presenting A Case with Tubulointerstitial Nephritis and Uveitis (TINU- Syndrome

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E Fotouhi Ardakani

2008-10-01

Full Text Available Concurrence of interstitial nephritis and uveitis named tubulointestitioal nephritis and uveitis syndrome (TINU are unusual and uncommon presentations of interstitial nephritis. This syndrome is considered after ruling out other differential diagnoses. A-38-year old man presented with acute renal failure and uveitis. The histologic findings of renal biopsy showed acute tubulointestitioal nephritis. The patient had no clinical and paraclinical manifestations of other etiologies of interstitial nephritis and uveitis such as Wegener's granulomatosis , Sjogren's syndrome or sarcoidosis. The diagnosis of TINU-Syndrome was therefore considered. The patient was treated by oral and ophthalmic prednisolone and had a good response to treatment.

Transcatheter Coil Embolization of Splenic Artery Aneurysm

International Nuclear Information System (INIS)

Yamamoto, Satoshi; Hirota, Shozo; Maeda, Hiroaki; Achiwa, Sachiko; Arai, Keisuke; Kobayashi, Kaoru; Nakao, Norio

2008-01-01

The purpose of this study was to evaluate clinical results and technical problems of transcatheter coil embolization for splenic artery aneurysm. Subjects were 16 patients (8 men, 8 women; age range, 40-80 years) who underwent transcatheter embolization for splenic artery aneurysm (14 true aneurysms, 2 false aneurysms) at one of our hospitals during the period January 1997 through July 2005. Two aneurysms (12.5%) were diagnosed at the time of rupture. Multiple splenic aneurysms were found in seven patients. Aneurysms were classified by site as proximal (or strictly ostial) (n = 3), middle (n = 3), or hilar (n = 10). The indication for transcatheter arterial embolization was a false or true aneurysm 20 mm in diameter. Embolic materials were fibered coils and interlocking detachable coils. Embolization was performed by the isolation technique, the packing technique, or both. Technically, all aneurysms were devascularized without severe complications. Embolized aneurysms were 6-40 mm in diameter (mean, 25 mm). Overall, the primary technical success rate was 88% (14 of 16 patients). In the remaining 2 patients (12.5%), partial recanalization occurred, and re-embolization was performed. The secondary technical success rate was 100%. Seven (44%) of the 16 study patients suffered partial splenic infarction. Intrasplenic branching originating from the aneurysm was observed in five patients. We conclude that transcatheter coil embolization should be the initial treatment of choice for splenic artery aneurysm

Treatment of Unresectable Primary and Metastatic Liver Cancer with Yttrium-90 Microspheres (TheraSphere (registered) ): Assessment of Hepatic Arterial Embolization

International Nuclear Information System (INIS)

Sato, Kent; Lewandowski, Robert J.; Bui, James T.; Omary, Reed; Hunter, Russell D.; Kulik, Laura; Mulcahy, Mary; Liu, David; Chrisman, Howard; Resnick, Scott; Nemcek, Albert A.; Vogelzang, Robert; Salem, Riad

2006-01-01

In Canada and Europe, yttrium-90 microspheres (TheraSphere); MDS Nordion, Ottawa, Canada) are a primary treatment option for primary and secondary hepatic malignancies. We present data from 30 patients with hepatocellular carcinoma (HCC) and metastatic liver disease treated with TheraSphere from a single academic institution to evaluate the angiographically evident embolization that follows treatment. Seven interventional radiologists from one treatment center compared pretreatment and posttreatment angiograms. The reviewers were blinded to the timing of the studies. The incidence of postembolization syndrome (PES) was determined as well as objective tumor response rates by the World Health Organization (WHO), Response Evaluation Criteria in Solid Tumors (RECIST), and European Association for the Study of the Liver (EASL) criteria. There were 420 independent angiographic observations that were assessed using the chi-squared statistic. The pretreatment and posttreatment angiograms could not be correctly identified on average more than 43% of the time (p = 0.0004). The postprocedure arterial patency rate was 100%. The objective tumor response rates for all patients were 24%, 31%, and 72% for WHO, RECIST, and EASL criteria, respectively. All of the patients tolerated the procedure without complications and were treated on an outpatient basis, and four patients had evidence of PES. This treatment method does not result in macroscopic embolization of the hepatic arteries, thereby maintaining hepatic tissue perfusion. These data support the principle that the favorable response rates reported with TheraSphere are likely due to radiation and microscopic embolization rather than flow-related macroscopic embolization and ischemia

Transcatheter embolization therapy of the gastrointestinal hemorrhage

International Nuclear Information System (INIS)

Sim, Jae In; Park, Auh Whan; Ryeom, Hun Kyu; Kim, Yong Joo

1994-01-01

To evaluate the effectiveness of transcatheter embolization for the treatment of massive gastrointestinal arterial bleeding. The study was based on retrospective analysis of twelve cases(8 men, 4 woman) including two patients with hemobilia in which transcatheter embolization was attempted for the control of massive gastrointestinal bleeding from March 1987 to October 1993. Clinical diagnoses of these patients were peptic ulcer(5), pseudoaneurysm formation(3) following percutaneous transhepatic biliary drainage or traffic accident, stomach cancer(1), typhoid fever(1), duodenal leiomyoma(1) and Osler-Weber-Rendu disease (1). Embolized vessels are as follows: gastroduodenal artery(6), left gastric artery(2), ileocolic artery(2), and hepatic artery(2). Embolization was effective in immediate control of bleeding in all patients. Although five of the six patients who had undergone embolization of the gastroduodenal artery developed rebleeding within 24 hour, only 2 required surgery and none showed serious complication. Embolization therapy is safe and effective initial treatment of choice for life-threatening massive gastrointestinal bleeding

Transcatheter embolization therapy of the gastrointestinal hemorrhage

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Sim, Jae In; Park, Auh Whan; Ryeom, Hun Kyu; Kim, Yong Joo [Kyungpook National University Hospital, Daegu (Korea, Republic of)

1994-05-15

To evaluate the effectiveness of transcatheter embolization for the treatment of massive gastrointestinal arterial bleeding. The study was based on retrospective analysis of twelve cases(8 men, 4 woman) including two patients with hemobilia in which transcatheter embolization was attempted for the control of massive gastrointestinal bleeding from March 1987 to October 1993. Clinical diagnoses of these patients were peptic ulcer(5), pseudoaneurysm formation(3) following percutaneous transhepatic biliary drainage or traffic accident, stomach cancer(1), typhoid fever(1), duodenal leiomyoma(1) and Osler-Weber-Rendu disease (1). Embolized vessels are as follows: gastroduodenal artery(6), left gastric artery(2), ileocolic artery(2), and hepatic artery(2). Embolization was effective in immediate control of bleeding in all patients. Although five of the six patients who had undergone embolization of the gastroduodenal artery developed rebleeding within 24 hour, only 2 required surgery and none showed serious complication. Embolization therapy is safe and effective initial treatment of choice for life-threatening massive gastrointestinal bleeding.

Thrombolytic therapy in pulmonary embolism.

LENUS (Irish Health Repository)

Nagi, D

2010-01-01

Massive pulmonary embolism carries a high mortality. Potential treatment includes anticoagulation, thrombolytic therapy and embolectomy. We report a case of deep vein thrombosis leading to progressive massive pulmonary embolism despite appropriate anticoagulation, where thrombolysis with IVC filter placement resulted in a successful outcome.

Bartter syndrome presenting as poor weight gain and abdominal mass in an infant.

Science.gov (United States)

Heffernan, Annie; Steffensen, Thora S; Gilbert-Barness, Enid; Perlman, Sharon

2008-01-01

Bartter syndrome, a group of disorders that encompasses multiple genetic defects with similar clinical presentation, has been divided into six different genotypes, according to different genetic defects, and into three main clinical variants (or phenotypes). Classic laboratory findings in all variants include hypochloremia, hypokalemia, and metabolic alkalosis with excessive excretion of chloride and potassium. Classic Bartter syndrome, neonatal Bartter syndrome, and Gitelman syndrome are the three main clinical variants. Classic Bartter syndrome and neonatal Bartter syndrome have defects in genes that affect transport channels in the ascending loop of Henle, where as in Gitleman syndrome the defect occurs in the transport channels of the distal convoluted tubule. Classic Bartter syndrome and neonatal Bartter syndrome have similar presenting symptoms, potential outcomes, and treatment, but different ages at presentation. Gitelman syndrome, a more benign condition than the other clinical variants, has the classic hallmark finding of hypomagnesemia and low to normal excretion of calcium. This differentiates it from the classic and neonatal variants of the disease. With early diagnosis and proper treatment, Bartter syndrome has a good prognosis. But failure to identify it can lead to tubulointerstitial nephritis and renal failure. We present a case of a 6-month-old boy with Bartter syndrome who presented with poor weight gain and an abdominal mass.

Atypical Presentation of Sjögren-Larsson Syndrome

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D. Papathemeli

2017-01-01

Full Text Available Sjögren-Larsson syndrome is a rare neurocutaneous disorder characterized by ichthyosis, spastic diplegia or tetraplegia, and intellectual disability. Herein, we describe a case of a Greek patient with ichthyosis and spasticity of the legs but with normal intelligence (IQ 95. This syndrome should be suspected when a child presents with ichthyosis and spastic diplegia or tetraplegia, even if intelligence is normal.

Embolization of carotid artery branch in intractable epistaxis

International Nuclear Information System (INIS)

Kordecki, K.; Janica, J.; Lewszuk, A.; Lebkowska, U.; Ustymowicz, A.

2008-01-01

Long-term intractable epistaxis results in a series of complications including demise. Unprofessional therapy may account for severe topical and systemic complications. The authors assessed the efficacy and safety of embolization treatment of intractable epistaxis with the use of available embolizing materials. Embolization was performed in 58 patients (39 males aged 24-48 and 19 females aged 26-44) admitted to the ENT Department, Medical University of Bialystok in years 2000 -2005. 65 embolization procedures, including reembolizations, were performed. In 41 procedures (63%) a sponge was used, in 14 (21.6%) PVA, in 10 (15.4%) PVA and coils. In 9 patients, bleeding of a lesser intensity recurred within early hours following the procedure - 84.5% embolization success. On longer follow-up, embolization success was assessed to be 100%. Embolization with the use of proper embolisation materials is an efficient method of arresting spontaneous and posttraumatic epistaxis and may be a safe treatment procedure when performed by experienced medical personnel. (author)

Renal Angiomyolipoma: Mid- to Long-Term Results Following Embolization with Onyx

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Thulasidasan, Narayanan, E-mail: narayanant@doctors.net.uk; Sriskandakumar, Srividhiya; Ilyas, Shahzad; Sabharwal, Tarun [Guy’s & St Thomas’ NHS Foundation Trust, Department of Interventional Radiology (United Kingdom)

2016-12-15

PurposePercutaneous transcatheter embolization is currently the preferred treatment for ruptured or enlarging renal angiomyolipoma (AML), although the optimum choice of embolic material has not yet been established. We present mid- to long-term outcomes following embolization of AMLs with Onyx.Materials and MethodsTen AMLs in seven patients (including two with tuberous sclerosis) were embolized with Onyx. Patients were followed-up clinically, with tumour size and renal function measured pre- and post-procedure.ResultsMean pre-treatment AML size was 63.4 mm (range 42–100). Mean clinical follow-up was 431.4 days (range 153–986) and imaging follow-up 284.2 days (range 30–741). There was no haemorrhage from treated lesions within the follow-up period. Of patients who had cross-sectional imaging pre- and post-procedure, mean decrease in AML size of 22 mm was seen after Onyx embolization (p = 0.0058, 95 % CI 9.13–34.87). No significant difference between serum creatinine was seen pre- and post-procedure (p = 0.54, 95 % CI 8.63–4.85).ConclusionsOnyx embolization of renal AMLs is effective in the medium to long term, with theoretical benefits in safety and durability of result.

Status epilepticus as the only presentation of the neonatal Bartter syndrome.

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Patra, Soumya; Konar, Mithun C; Basu, Rajarshi; Khaowas, Ajoy K; Dutta, Soumyadeep; Sarkar, Debanjali

2012-03-01

Bartter syndrome is a rare hereditary (autosomal recessive) salt-losing tubulopathy characterized by hypokalemia, hypochloremia, metabolic alkalosis, and normal blood pressure with hyperreninemia, The underlying renal abnormality results in excessive urinary losses of sodium, chloride, and potassium. We report a case of a four-month-old infant with neonatal Bartter syndrome, who presented only with status epilepticus. To the best of our present knowledge, there is no reported case of Bartter syndrome who presented with status epilepticus.

Cerebrovascular Accident Secondary to Paradoxical Embolism Following Arteriovenous Graft Thrombectomy

OpenAIRE

Santos, Jolina Pamela; Hamadeh, Zaher; Ansari, Naheed

2012-01-01

Thrombectomy is a common procedure performed to declot thrombosed dialysis arteriovenous fistula (AVF) or arteriovenous graft (AVG). Complications associated with access thrombectomy like pulmonary embolism have been reported, but paradoxical embolism is extremely rare. We report a case of a 74-year-old black man with past medical history significant for end-stage renal disease (ESRD), atrial fibrillation on anticoagulation with warfarin, who presented to our hospital with lethargy, aphasia, ...

Burning mouth syndrome: Present perspective

OpenAIRE

Ramesh Parajuli

2015-01-01

Introduction: Burning mouth syndrome is characterized by chronic oral pain or burning sensation affecting the oral mucosa in the absence of obvious visible mucosal lesions. Patient presenting with the burning mouth sensation or pain is frequently encountered in clinical practice which poses a challenge to the treating clinician. Its exact etiology remains unknown which probably has multifactorial origin. It often affects middle or old age women and it may be accompanied by xerostomia and alte...

EEC syndrome sans clefting: Variable clinical presentations in a family

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Thakkar Sejal

2007-01-01

Full Text Available Ectrodactyly, ectodermal dysplasia and cleft palate/lip syndrome (EEC is a rare autosomal dominant syndrome with varied presentation and is actually a multiple congenital anomaly syndrome leading to intra- and interfamilial differences in severity because of its variable expression and reduced penetrance. The cardinal features include ectrodactyly, sparse, wiry, hypopigmented hair, peg-shaped teeth with defective enamel and cleft palate/lip. A family comprising father, daughter and son presented to us with split hand-split foot deformity (ectrodactyly, epiphora, hair changes and deafness with variable involvement in each family member.

Status epilepticus as the only presentation of the neonatal Bartter syndrome

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Soumya Patra

2012-01-01

Full Text Available Bartter syndrome is a rare hereditary (autosomal recessive salt-losing tubulopathy characterized by hypokalemia, hypochloremia, metabolic alkalosis, and normal blood pressure with hyperreninemia, The underlying renal abnormality results in excessive urinary losses of sodium, chloride, and potassium. We report a case of a four-month-old infant with neonatal Bartter syndrome, who presented only with status epilepticus. To the best of our present knowledge, there is no reported case of Bartter syndrome who presented with status epilepticus.

Uterine fibroid embolization

International Nuclear Information System (INIS)

Totev, M.

2013-01-01

Full text: Introduction: Today, after numerous lengthy randomized trials embolization of uterine fibroids has become a standard treatment. Percutaneous embolization of myomas is a micro - invasive surgery, which can be regarded as an alternative to traditional surgery. Although these data 2/3 of the patients were not informed about this treatment option. What you will learn: The uterine embolization is minimal invasive non-surgical procedure. It is an alternative treatment to surgery. Under local anesthesia in the femoral artery puncture reaches the internal iliac artery and uterine arteries. Reached selectively by the catheter and chemicals, which causes clogging, are injected into them. In the vessels that feed fibroids occur a process like an attack, the feeding stops, it starts to shrink and it is replaced by fibrous tissue. The blood vessels of the healthy tissue are different in size and have a plurality of collateral connections as opposed to those of the myoma and thus the blood supply to the normal tissue of the uterus is not distorted. Discussion: Nowadays there are more well- calibrated materials for embolization and those with a particle size of about 700µ are proven as the most successful. The procedure is well tolerated, but after a pain occurs, which has to be covered with anesthetics. Usually pain and metrorrhagia disappear immediately. The fibroids themselves shrink to varying degrees. Hospital stay was significantly shorter than that after surgery, and remained fertile power. Complications are few and rare require further treatment. Multiple nodes are problematic and it is difficult to detect the primary one. A three and six months tracking by MRI is desirable. Conclusion: Embolization of uterine myoma is an established method of treatment primarily on clinical symptoms resulting therefrom. In all patients rapidly disappear metrorrhagia symptoms and morbidity, the volume of the assembly decrease, which together with shorter hospital stays and

Nelson′s syndrome presenting as bilateral oculomotor palsy

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Abhay Gundgurthi

2013-01-01

Full Text Available Nelson′s syndrome refers to a clinical spectrum arising from progressive enlargement of pituitary adenoma and elevated adrenocorticotrophic hormone after total bilateral adrenalectomy for Cushing′s disease comprising of hyperpigmentation, visual field defects which can be life threatening. We report here a 50-year male presenting with rapid onset of Nelson′s syndrome with an unusual finding of bilateral oculomotor palsy mistakenly treated as ocular myasthenia.

Silent Aortic Dissection Presenting as Transient Locked-In Syndrome

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Nadour, Wadih; Goldwasser, Brian; Biederman, Robert W.; Taffe, Kevin

2008-01-01

Acute aortic dissection is a medical emergency. Without prompt recognition and treatment, the mortality rate is high. An atypical presentation makes timely diagnosis difficult, especially if the patient is experiencing no characteristic pain. Many patients with aortic dissection are reported to have presented with various neurologic manifestations, but none with only a presentation of transient locked-in syndrome. Herein, we report a case of completely painless aortic dissection in a woman who presented with a transient episode of anarthria, quadriplegia, and preserved consciousness. On physical examination, she had a 40-point difference in blood pressure between her left and right arms, and a loud diastolic murmur. The diagnosis of acute aortic dissection was reached via a combination of radiography, computed tomography, echocardiography, and a high index of clinical suspicion. The patient underwent emergency surgery and ultimately experienced a successful outcome. To our knowledge, this is the 1st report of aortic dissection that presented solely as locked-in syndrome. We suggest that silent aortic dissection be added to the differential diagnosis for transient locked-in syndrome. PMID:18941610

Successful Treatment of Free-Floating Right Ventricular Thrombus with Acute Pulmonary Embolism

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Sanjay Singhal

2015-01-01

Full Text Available Acute pulmonary embolism with floating right intra-ventricular thrombus is a rare phenomena associated with poor prognosis. Here, we are presenting a case of 35-year-young male with no co-morbid illness diagnosed to have right ventricular thrombus with bilateral pulmonary embolism, which was managed successfully with thrombolytic therapy.

Fatal rebleeding following coil embolization of cerebral aneurysms: the role of long-term systemic anticoagulation

International Nuclear Information System (INIS)

Sinson, G.; Bagley, L.J.; Hurst, R.W.; Flamm, E.S.

2001-01-01

Embolization of cerebral aneurysms has become a common technique. Its impact on subsequent medical management of the patient is not well known. We report two patients who presented in a poor neurological grade after subarachnoid hemorrhage from posterior communicating artery aneurysms. Both were treated by coil embolization and both developed subclavian vein thrombosis, requiring systemic anticoagulation, initiated 11 and 21 days after embolization, respectively. Both developed a large, fatal intracranial hemorrhage adjacent to the embolized aneurysm in the fourth week of anticoagulation. Systemic anticoagulation of patients who have had a ruptured aneurysm treated by coil embolization may carry a significant risk of rebleeding. Alternate management strategies should be considered in these patients. (orig.)

Fatal rebleeding following coil embolization of cerebral aneurysms: the role of long-term systemic anticoagulation

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Sinson, G. [Dept. of Neurosurgery, University of Pennsylvania School of Medicine, Philadelphia, PA (United States); Bagley, L.J.; Hurst, R.W. [Dept. of Radiology-Neuroradiology, University of Pennsylvania School of Medicine, Philadelphia, PA (United States); Flamm, E.S. [Hyman-Newman Institute for Neurology and Neurosurgery, New York, NY (United States)

2001-05-01

Embolization of cerebral aneurysms has become a common technique. Its impact on subsequent medical management of the patient is not well known. We report two patients who presented in a poor neurological grade after subarachnoid hemorrhage from posterior communicating artery aneurysms. Both were treated by coil embolization and both developed subclavian vein thrombosis, requiring systemic anticoagulation, initiated 11 and 21 days after embolization, respectively. Both developed a large, fatal intracranial hemorrhage adjacent to the embolized aneurysm in the fourth week of anticoagulation. Systemic anticoagulation of patients who have had a ruptured aneurysm treated by coil embolization may carry a significant risk of rebleeding. Alternate management strategies should be considered in these patients. (orig.)

CT analysis of intratumoral gas formation after hepatic tumor embolization

International Nuclear Information System (INIS)

Kim, Hyun Sook; Ahn, In Oak; Kim, Hyung Jin; Lee, Goo; Chung, Sung Hoon

1994-01-01

To evaluate the prevalence and the patterns of sterile gas shown at computed tomography(CT) after transarterial embolization(TAE) for primary hepatic tumor. Among 102 patients who performed TAE for hepatoma, thirty-four in whom follow-up CT was underwent constituted the basis of our study. At CT, we evaluated the patterns and locations of intratumoral gas. We also reviewed the clinical data to exclude an infectious origin of intratumoral gas. Of 34 patients, intratumoral gas was detected in 11 patients(32%), in all of whom Gelfoam was used as an embolic material. The initial tumor size measured at pre-TAE CT was larger in patients with intratumoral gas than in patients without it(p < 0.005). No specific patterns or locations of intratumoral gas were noted on CT scans. No patients had clinical signs and symptoms that suggested infection. Intratumoral gas formation without clinical evidence of infection is not an infrequent finding after TAE for hepatoma, especially when Gelfoam is used and when the tumor is larger in size. This finding may be a part of postinfarction syndrome and should not be misinterpreted as an postprocedural abscess formation

Radio-embolization for hepatocellular carcinoma

International Nuclear Information System (INIS)

Raoul, J.L.; Edeline, J.; Pracht, M.; Boucher, E.; Rolland, Y.; Garin, E.

2011-01-01

Hepatocellular carcinoma is now a major public health concern. In intermediate stages (one third of hepatocellular carcinoma patients), chemo-embolization is the standard of care despite a poor tolerance and a moderate efficacy. Moreover, despite recent improvements, this technique seems in a dead end. Radio-embolization could be an excellent tool for such patients. Currently 131 I-Lipiodol, 188 Re-Lipiodol, 90 Y-glass or resin microspheres are available. More recent and promising data come from microspheres, but phase II and III studies are needed before drawing any conclusion. In the future, the combination of radio-embolization with systemic chemotherapy or targeted agents (particularly anti-angiogenic drugs) seems very promising. (authors)

QUALITY OF LIFE IN PATIENTS AFTER MASSIVE PULMONARY EMBOLISM

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Dragan Kovačić

2004-04-01

could not identify the patients with deminished aerobic capacity.Conclusions. Aerobic capacity, emotional and physical quality of life is decreased one year after massive pulmonary embolism in patients treated with thrombolysis. A linear correlation between decrease in aerobic capacity and total pulmonary resistance after 12 hours of treatment was present.

Mesenteric Air Embolism Following Enteroscopic Small Bowel Tattooing Procedure

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Natalie Chen

2012-01-01

Full Text Available Double balloon enteroscopy (DBE is a revolutionary procedure in which the entire small bowel can be visualized endoscopically. DBE has the advantage of both diagnostic and therapeutic capabilities in the setting of small bowel neoplasms and vascular malformations. We present a unique case of a 76-year-old female who underwent small bowel DBE tattoo marking of a distal small bowel tumor complicated by development of severe abdominal pain postprocedure secondary to bowel air embolism into the mesenteric veins. Mesenteric air can be seen after other endoscopic procedures such as biopsy, mucosal clip placement and polypectomy, or following a colonoscopy. Mesenteric air embolism following small bowel tattooing procedure has not been previously reported in the literature. Mesenteric air when present may be attributed to mesenteric ischemia and can subject the patient to unnecessary surgical intervention if misdiagnosed. Thus, this report holds significance for the radiologist as computed tomography (CT findings of mesenteric air embolism must be evaluated in the context of appropriate clinical history before treatment decisions are made.

The diagnosis and treatment of paradoxical embolism: a systematic review

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Atooshe Rohani

2016-11-01

Full Text Available One in five adults has patent foramen ovale (PFO, which is typically without symptoms. Because of the low pressure in both atria and the anatomical position of the septum secundum, there is no left-to-right shunting and little right-to-left shunting in the general condition; however, when the right atrial pressure increases, this slit-like flap separates and allows right-to-left shunting. According to the Johnson criteria, simultaneous occurrences of arterial emboli, such as those caused by cerebrovascular accident or pulmonary embolism, demonstrate the presence of paradoxical embolism through a PFO. When a patient presents with multivascular arterial embolism, the clinician should perform a contrast transthoracic echo, a transesophageal (TEE, a real-time three-dimensional TEE, and even an intracardiac echocardiography (ICE in order to differentiate between PFO, flat atrial septal defect (ASD and hybrid defects. The randomized trials that have assessed therapeutic interventions for paradoxical embolism have not produced any clear guidelines as to how best to treat this condition. The classic treatment is surgical embolectomy with exploration of the right chambers and the pulmonary arteries under full cardiopulmonary bypass. Patients with a history of ≥1 paradoxical embolism may be indicated for device PFO closure.

The establishment of animal model of acute massive pulmonary embolism

International Nuclear Information System (INIS)

Lu Junliang; Yang Ning; Yang Jianping; Ma Junshan; Zhao Shijun

2008-01-01

Objective: To find a way of establishing the model of acute massive pulmonary embolism in dog. Methods: Seven dogs were selected with self-clots made outside the body transferring through a 10 F guiding catheter into the central branch of pulmonary artery via the femoral vein approach on one side and then under pressure monitor of pulmonary artery until the very branch of pulmonary artery was occluded. Blood gas and pulmonary arterial pressure were tested before and after the embolization, Pulmonary artery pressure was continuously monitored together with the examinations of angiography. The bilateral lung specimens were resected for histological examination 12 hours in average after the embolization for comparative study. Results: One animal died of cardiogenic shock after clots injection; the other one presented with tachycardia and premature ventricular beat causing partial recanalization 12 h later. The others were occluded successfully in central branch of pulmonary artery and the pulmonary arterial pressure reached above 50 mmHg after occlusion. Pathologic examination showed the formation of red and mix thrombi within the vascular lumens. Conclusions: This method for making acute massive pulmonary embolism animal model was reliable, feasible and reproducible, and could provide an animal model of acute massive pulmonary embolism for other correlative experiments. (authors)

Fatal air embolism during cardiopulmonary bypass : analysis of an incident and prevention measures

NARCIS (Netherlands)

van der Zee, Michiel P.; Koene, Bart M.; Mariani, Massimo A.

Air embolism is a life-threatening complication during cardiopulmonary bypass. We present a case of a patient who suffered an air embolism during coronary bypass surgery, despite standard safety features and procedures. The patient died 3 days after surgery due to massive cerebral oedema. This case

MELAS syndrome presenting as an acute surgical abdomen.

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Dindyal, S; Mistry, K; Angamuthu, N; Smith, G; Hilton, D; Arumugam, P; Mathew, J

2014-01-01

MELAS (mitochondrial cytopathy, encephalomyopathy, lactic acidosis and stroke-like episodes) is a syndrome in which signs and symptoms of gastrointestinal disease are uncommon if not rare. We describe the case of a young woman who presented as an acute surgical emergency, diagnosed as toxic megacolon necessitating an emergency total colectomy. MELAS syndrome was suspected postoperatively owing to persistent lactic acidosis and neurological symptoms. The diagnosis was later confirmed with histological and genetic studies. This case highlights the difficulties in diagnosing MELAS because of its unpredictable presentation and clinical course. We therefore recommend a high index of suspicion in cases of an acute surgical abdomen with additional neurological features or raised lactate.

Meige's Syndrome: Rare Neurological Disorder Presenting as Conversion Disorder.

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Debadatta, Mohapatra; Mishra, Ajay K

2013-07-01

Meige's syndrome is a rare neurological syndrome characterized by oromandibular dystonia and blepharospasm. Its pathophysiology is not clearly determined. A 35-year-old female presented to psychiatric department with blepharospasm and oromandibular dystonia with clinical provisional diagnosis of psychiatric disorder (Conversion Disorder). After thorough physical examination including detailed neurological exam and psychiatric evaluation no formal medical or psychiatric diagnosis could be made. The other differential diagnoses of extra pyramidal symptom, tardive dyskinesia, conversion disorder, anxiety disorder were ruled out by formal diagnostic criteria. Consequently with suspicion of Meige's syndrome she was referred to the department of Neurology and the diagnosis was confirmed. Hence, Meige's syndrome could be misdiagnosed as a psychiatric disorder such as conversion disorder or anxiety disorder because clinical features of Meige's syndrome are highly variable and affected by psychological factors and also can be inhibited voluntarily to some extent.

Combined embolization and gamma knife radiosurgery for cerebral arteriovenous malformations

International Nuclear Information System (INIS)

Guo, W.Y.; Wikholm, G.; Karlsson, B.; Lindquist, C.; Svendsen, P.; Ericson, K.

1993-01-01

In a study of 46 patients with cerebral arteriovenous malformations (AVMs) the value of combining embolization and gamma knife radiosurgery was assessed. In 35 patients with large grade III to V AVMs (Spetzler-Martin system) staged combined treatment was planned. In 11 patients, radiosurgery complemented embolization for a residual AVM. The number of embolization sessions ranged from 1 to 7 (median 2). Twenty-six patients needed multiple embolization sessions. In 28 patients the grade of AVMs decreased as a result of embolization. In 16 patients collateral feeding vessels developed after embolization which made delineation of the residual nidus difficult. The time lag between the last embolization and radiosurgery ranged from 1 to 24 months (median 4). Nineteen of 35 large grade III to V AVMs were possible to treat by radiosurgery following embolization. In the 46 patients complications occurred in 9 from embolization and in 2 from radiosurgery. Two patients had transient and 9 had permanent neurologic deficits. It is concluded that embolization facilitates radiosurgery for some large AVMs and therefore this combined treatment has a role in the management of AVMs. (orig.)

Marfan's syndrome presenting with abdominal aortic aneurysm: A ...

African Journals Online (AJOL)

We present the case of a 16-year old student with Marfan's syndrome and abdominal aortic aneurysm who presented with a diagnostic conundrum. He presented with a three months history of progressive painful left upper abdominal mass and back pain. It became severe in the last two weeks before presentation and was ...

Simultaneous transcatheter closure of intralobar pulmonary sequestration and patent ductus arteriosus in a patient with infantile Scimitar syndrome.

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Aslan, Eyüp; Tanıdır, İbrahim Cansaran; Saygı, Murat; Onan, Sertaç Hanedan; Güzeltaş, Alper

2015-03-01

Scimitar syndrome is a rare disease associated with a right lung sequestration vascularised by arteries arising from the abdominal aorta and abnormal venous drainage into the inferior vena cava. The infantile form is generally presented with severe heart failure, pulmonary hypertension and respiratory distress. It may be associated with various intracardiac defects, including atrial septal defects, ventricular septal defects, patent ductus arteriosus or more complicated structural congenital heart defects. Here, we present a 2-month-old girl with Scimitar syndrome whose pulmonary arterial pressure decreased after transcatheter patent ductus arteriosus closure and embolization of the anomalous systemic arterial supply.

Acute pulmonary embolism in helical computed tomography

International Nuclear Information System (INIS)

Paslawski, M.

2005-01-01

Pulmonary embolism is a common condition in which diagnostic and therapeutic delays contribute to substantial morbidity and mortality. Clinical diagnosis is difficult because the signs and symptoms re unspecific, and a differential diagnosis is extensive, including pneumonia or bronchitis, asthma, myocardial infraction, pulmonary edema, anxiety, dissection of the aorta, pericardial tamponade, lung cancer, primary pulmonary hypertension, rib fracture, and pneumothorax. The purpose of the study was to present the use of CT in diagnosing acute pulmonary embolism. A group of 23 patients with clinically suspected pulmonary embolism underwent CT examination with a helical CT scanner (Somatom Emotion, Siemens) before and after administration of 150 ml of Ultravist. Pulmonary embolism was found in the CT examinations of 13 patients. In two of these it was a central filling defect. Amputation of the artery was found in one. Parietal filling defect in three patients formed an acute angle with the vessel walls. Saddle emboli appearing as filling defects in the contrast column that hung over vessel bifurcations was found in two patients. In five patients,emboli were found in small segmental arteries. CT provides information not only on the pulmonary arteries, but also on the lung parenchyma, hila, mediastinum, and the heart. Alternative findings may be identified by CT chest examination, stablishing alternative diagnoses, including pulmonary disorders (such as pneumonia or fibrosis), pleural abnormalities, and cardiovascular disease (such as aortic dissection or pericardial tamponade). Another advantage of the CT is its widespread availability.(author)

Mortality and Embolic Potential of Cardiac Tumors

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Dias, Ricardo Ribeiro, E-mail: ricardo.dias@incor.usp.br; Fernandes, Fábio; Ramires, Félix José Alvarez; Mady, Charles; Albuquerque, Cícero Piva; Jatene, Fábio Biscegli [Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP (Brazil)

2014-07-15

Cardiac tumors are rare, mostly benign with high embolic potential. To correlate the histological type of cardiac masses with their embolic potential, implantation site and long term follow up in patients undergoing surgery. Between January 1986 and December 2011, we retrospectively analyzed 185 consecutive patients who underwent excision of intracardiac mass (119 females, mean age 48±20 years). In 145 patients, the left atrium was the origin site. 72% were asymptomatic and prior embolization was often observed (19.8%). The diagnosis was established by echocardiography, magnetic resonance and histological examination. Most tumors were located in the left side of the heart. Myxoma was the most common (72.6%), followed by fibromas (6.9%), thrombi (6.4%) and sarcomas (6.4%). Ranging from 0.6cm to 15cm (mean 4.6 ± 2.5cm) 37 (19.8%) patients had prior embolization, stroke 10.2%, coronary 4.8%, peripheral 4.3% 5.4% of hospital death, with a predominance of malignant tumors (40% p < 0.0001). The histological type was a predictor of mortality (rhabdomyomas and sarcomas p = 0.002) and embolic event (sarcoma, lipoma and fibroelastoma p = 0.006), but not recurrence. Tumor size, atrial fibrillation, cavity and valve impairment were not associated with the embolic event. During follow-up (mean 80±63 months), there were 2 deaths (1.1%) and two recurrences 1 and 11 years after the operation, to the same cavity. Most tumors were located in the left side of the heart. The histological type was predictor of death and preoperative embolic event, while the implantation site carries no relation with mortality or to embolic event.

Thyroid artery embolization with microspheres for hyperthyroidism

International Nuclear Information System (INIS)

Du Yahui; Zhong Chenfu; Chen Weijun; Zhang Ying; Luo Jun; Li Xiaoguang; Cao Junjie; Gan Changli; Cao Junjie; Gan Changli

2006-01-01

Objective: To evaluate the method and efficacy of thyroid artery embolization as a new therapy for hyperthyroidism. Methods: Thirteen patients with hyperthyroidism underwent selective thyroid artery embolization. Totally 25 thyroid arteries were embolized with microspheres. The indications for this therapy were as followings: 1) To give hyperthyroid patients having an alternative for surgical and 131 I treatment, and 2) To provide a new method for those clinically being difficult to get control with medicine. Results: Serum level of thyroid hormones dropped significantly[T3 from 2.84-9.0 ng/ml to 0.8-2.2 ng/ml, T4 from 162.9-277.2 ng/ml to 50-126 ng/ml] and symptoms of hyperthyroidism were under control in 12 patients within 1 month after the embolization. One patient remained no change 1 month later and refused to be embolized again. The symptoms of twelve patients were effectively controlled through low dose antithyroid medication for more than 6 months follow up with no serious complications. Conclusion: Thyroid artery embolization with microspheres is an effective alternative for surgical and 131 I treatment of hyperthyroidism. (authors)

Fat embolism syndrome in long bone trauma following vehicular accidents: Experience from a tertiary care hospital in north India

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Parvaiz A Koul

2013-01-01

Full Text Available Background: Fat embolism syndrome (FES is a clinical problem arising mainly due to fractures particularly of long bones and pelvis. Not much literature is available about FES from the Indian subcontinent. Materials and Methods: Thirty-five patients referred/admitted prospectively over a 3-year period for suspected FES to a north Indian tertiary care center and satisfying the clinical criteria proposed by Gurd and Wilson, and Schonfeld were included in the study. Clinical features, risk factors, complications, response to treatment and any sequelae were recorded. Results: The patients (all male presented with acute onset breathlessness, 36-120 hours following major bone trauma due to vehicular accidents. Associated features included features of cerebral dysfunction ( n = 24, 69%, petechial rash (14%, tachycardia (94% and fever (46%. Hypoxemia was demonstrable in 80% cases, thrombocytopenia in 91%, anemia in 94% and hypoalbuminemia in 59%. Bilateral alveolar infiltrates were seen on chest radiography in 28 patients and there was evidence of bilateral ground glass appearance in 5 patients on CT. Eleven patients required ventilatory assistance whereas others were treated with supportive management. Three patients expired due to associated sepsis and respiratory failure, whereas others recovered with a mean hospital stay of 9 days. No long term sequelae were observed. Conclusion: FES remains a clinical challenge and is a diagnosis of exclusion based only on clinical grounds because of the absence of any specific laboratory test. A high index of suspicion is required for diagnosis and initiating supportive management in patients with traumatic fractures, especially in those having undergone an invasive orthopedic procedure.

Prognostic factors in bronchial arterial embolization for hemoptysis

International Nuclear Information System (INIS)

Kim, Eui Jong; Yoon, Yup; Oh, Joo Hyeong; Lim, Joo Won; Sung, Dong Wook

1994-01-01

To find the rebleeding factors in bronchial arterial embolization for treatment of hemoptysis, a retrospective study was performed. Medical records, angiographic findings and embolic materials of 35 patients who had undertaken arterial embolization for control of hemoptysis were reviewed. The period of follow-up for rebleeding was from 3 to 32 months after arterial embolization. We investigated the angiographic findings of extravasation, neovascularity, intervascular shunt, aneurysm and periarterial diffusion. Neovascularity was classified as mild(numerable neovascularity) and severe(innumerable). Rebleeding occurred in 15(43%) among 35 cases. Only two of 11 cases with no past episode of hemoptysis showed recurrence, while 9 of 15 cases who had more than three episodes did. Severe neovascularity were seen in 11 of 15 recurred cases, but seven of 20 non- recurred cases showed severe neovascularity. More than three angiographic findings representing hemoptysis were seen on 11(73%) among recurred 15 cases and seven(35%) among non- recurred 20 cases. The lesion was supplied by more than two different arteries on 8(54%) of the recurred cases, but only three(15%) of the non- recurred cases. Six of seven cases persistent neovascularity after arterial embolization were recurred. The history of repeated hemoptysis, severe neovascularity, variable angiographic findings, and post-embolization persistency of neovascularity were the factors related with the rebleeding after arterial embolization for hemoptysis. Careful and active arterial embolization are required on these conditions

Prognostic factors in bronchial arterial embolization for hemoptysis

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Kim, Eui Jong; Yoon, Yup; Oh, Joo Hyeong; Lim, Joo Won; Sung, Dong Wook [Kyung Hee University Hospital, Seoul (Korea, Republic of)

1994-07-15

To find the rebleeding factors in bronchial arterial embolization for treatment of hemoptysis, a retrospective study was performed. Medical records, angiographic findings and embolic materials of 35 patients who had undertaken arterial embolization for control of hemoptysis were reviewed. The period of follow-up for rebleeding was from 3 to 32 months after arterial embolization. We investigated the angiographic findings of extravasation, neovascularity, intervascular shunt, aneurysm and periarterial diffusion. Neovascularity was classified as mild(numerable neovascularity) and severe(innumerable). Rebleeding occurred in 15(43%) among 35 cases. Only two of 11 cases with no past episode of hemoptysis showed recurrence, while 9 of 15 cases who had more than three episodes did. Severe neovascularity were seen in 11 of 15 recurred cases, but seven of 20 non- recurred cases showed severe neovascularity. More than three angiographic findings representing hemoptysis were seen on 11(73%) among recurred 15 cases and seven(35%) among non- recurred 20 cases. The lesion was supplied by more than two different arteries on 8(54%) of the recurred cases, but only three(15%) of the non- recurred cases. Six of seven cases persistent neovascularity after arterial embolization were recurred. The history of repeated hemoptysis, severe neovascularity, variable angiographic findings, and post-embolization persistency of neovascularity were the factors related with the rebleeding after arterial embolization for hemoptysis. Careful and active arterial embolization are required on these conditions.

Transcatheter embolization of pseudoaneurysms complicating acute severe pancreatitis

International Nuclear Information System (INIS)

Wu Hanping; Liang Huimin; Zheng Chuansheng; Feng Gansheng

2005-01-01

Objective: To evaluate the therapeutic roles of transcatheter embolization in patients with pseudoaneurysms complicating acute severe pancreatitis. Methods: Seven patients who suffered from pseudoaneurysms complicating acute severe pancreatitis received abdominal angiography and were treated with transcatheter embolization. The angiographic findings, complications related to the procedure and post- embolization, and rebleeding were observed. Results: The pseudoaneurysms developed at the splenic artery (n=5), right gastroepiploic artery (n=1), and left gastric artery (n=1), respectively. Findings of active bleeding were observed in 3 patients. Six of them were embolized with coils, and the bleedings were stopped immediately. Rebleeding occurred 14-60 days after the embolization in 3 patients, and in one of them, another pseudo aneurysm was observed in repeated angiography and was successfully treated by repeated embolization. No causes of bleeding were found in repeated angiography in the other 2 patients, who died from severe hemorrhage. One pseudo aneurysm was embolized with gelfoam granule. The gastrointestinal bleeding was not controlled and the patient died 3 days later. Procedure related complications occurred in 2 patients. One was celiac trunk rupture during angiography, the other was intima dissecting in splenic artery. Severe post procedure complications occurred in none of the patients. Conclusion: Transcatheter embolization is safe and relatively effective in the management of pseudoaneurysms complicating acute severe pancreatitis. (authors)

Preoperative embolization of gigantic meningioma

International Nuclear Information System (INIS)

Wang Hongsheng; Chen Huaqun; Dong Congsong; Li Wenhui; Dai Zhenyu; Chen Guozhi

2006-01-01

Objective: To evaluate the clinical efficacy of preoperative embolization in treatment of patients with gigantic meningioma. Methods: Fourteen cases of gigantic meningioma diameter from 6 to 11 cm were measured by CT and MRI scan. DSA manifested that they are vascularizd meningioma and showed the mainly feeding arteries. We used getation sponge to superselectively embilized the feeding arteries. All tumors were performed surgical excision 3-7 days after the embolization. Results: DSA showed the blood supplies in the tumors in 9 cases were completely blocked, and that in 5 cases were dramatically eliminated. All patients were operated 3-7 days after the embolization. During the operations the bleeding were dramatically decreased and the operation time was shortened compared with those in unembolized cases. It helps us remove the tumors easy and quickly from the attachments. No complication occurred during and after the operations. Conclusion: Preoperative embolization of gigantic meningioma is a useful and relatively safe method in helping surgicaly and completely excised of tumor with significant reduction of blood loss and operation time. (authors)

Embolic Brain Infarcts: A Rare Fatal Complication of Preoperative Embolization of a Massive Solitary Fibrous Tumor of the Pleura

Energy Technology Data Exchange (ETDEWEB)

Patel, Shreyas R., E-mail: Shrey000@gmail.com; Vachhani, Prasann; Moeslein, Fred [University of Maryland Medical Center, Department of Diagnostic Radiology and Nuclear Medicine (United States)

2017-02-15

Solitary fibrous tumor of the pleura (SFTP) is a rare intrathoracic neoplasm, often giant in size and highly vascular, which can make surgical resection very challenging. Preoperative percutaneous embolization before surgical removal can significantly reduce the risk of uncontrollable intraoperative hemorrhage. However, a rare potential life threatening complication could result from embolization of SFTP and must be taken into consideration. This report describes a 69-year-old female with a large right thoracic SFTP, who underwent preoperative angiography and embolization and developed diffuse embolic brain infarcts immediately after the administration of polyvinyl alcohol particles.

Ethanol embolization of auricular arteriovenous malformations

International Nuclear Information System (INIS)

Fan Xindong; Zheng Lianzhou; Yi Hongying; Su Lixin; Zheng Jiawei

2009-01-01

Objective: To present the authors' initial experience of treating auricular arteriovenous malformations(AVMs) with ethanol embolization and to assess the clinical effectiveness of this therapeutic method. Methods: Twenty-two patients with AVMs were enrolled in this study. Through local puncturing or super-selective catheterization the absolute ethanol,or diluted alcohol (based on the pattern of the AVMs), was manually injected into the abnormal vascular plexus of the auricular lesion. The clinical results were estimated with physical examination or angiography at intervals of 3-4 month, and telephone questionnaire was made at monthly intervals for all patients. Results: Thirty-eight ethanol embolization procedures were performed, the amount of ethanol used during the procedure ranged from 4 ml to 65 ml. After the treatment the clinical symptoms were improved, which were manifested as healing of the ulceration, stop of bleeding, disappearing or alleviation of tinnitus. Angiographic examination showed that the abnormal vascular lesion was completely vanished in 9 cases, decreased by 50%-75% in 8 cases and decreased less than 50% in remaining 5 cases. The common complications included irreversible local necrosis and vesiculation. Conclusion: For the treatment of auricular AVMs ethanol embolization is an effective and safe method,which might become the therapy of first choice. (authors)

Ethanol embolization of auricular arteriovenous malformations

Energy Technology Data Exchange (ETDEWEB)

Xindong, Fan; Lianzhou, Zheng [Department of Interventional Radiology, the Ninth People' s Hospital, School of Medicine, Shanghai Jiaotong Univ., Shanghai (China); Hongying, Yi; Lixin, Su; Jiawei, Zheng

2009-11-15

Objective: To present the authors' initial experience of treating auricular arteriovenous malformations(AVMs) with ethanol embolization and to assess the clinical effectiveness of this therapeutic method. Methods: Twenty-two patients with AVMs were enrolled in this study. Through local puncturing or super-selective catheterization the absolute ethanol,or diluted alcohol (based on the pattern of the AVMs), was manually injected into the abnormal vascular plexus of the auricular lesion. The clinical results were estimated with physical examination or angiography at intervals of 3-4 month, and telephone questionnaire was made at monthly intervals for all patients. Results: Thirty-eight ethanol embolization procedures were performed, the amount of ethanol used during the procedure ranged from 4 ml to 65 ml. After the treatment the clinical symptoms were improved, which were manifested as healing of the ulceration, stop of bleeding, disappearing or alleviation of tinnitus. Angiographic examination showed that the abnormal vascular lesion was completely vanished in 9 cases, decreased by 50%-75% in 8 cases and decreased less than 50% in remaining 5 cases. The common complications included irreversible local necrosis and vesiculation. Conclusion: For the treatment of auricular AVMs ethanol embolization is an effective and safe method,which might become the therapy of first choice. (authors)

Stereotactic Radiosurgery with Neoadjuvant Embolization of Larger Arteriovenous Malformations: An Institutional Experience

Directory of Open Access Journals (Sweden)

Richard Dalyai

2014-01-01

Full Text Available Objective. This study investigates the safety and efficacy of a multimodality approach combining staged endovascular embolizations with subsequent SRS for the management of larger AVMs. Methods. Ninety-five patients with larger AVMs were treated with staged endovascular embolization followed by SRS between 1996 and 2011. Results. The median volume of AVM in this series was 28 cm3 and 47 patients (48% were Spetzler-Martin grade IV or V. Twenty-seven patients initially presented with hemorrhage. Sixty-one patients underwent multiple embolizations while a single SRS session was performed in 64 patients. The median follow-up after SRS session was 32 months (range 9–136 months. Overall procedural complications occurred in 14 patients. There were 13 minor neurologic complications and 1 major complication (due to embolization while four patients had posttreatment hemorrhage. Thirty-eight patients (40% were cured radiographically. The postradiosurgery actuarial rate of obliteration was 45% at 5 years, 56% at 7 years, and 63% at 10 years. In multivariate analysis, larger AVM size, deep venous drainage, and the increasing number of embolization/SRS sessions were negative predictors of obliteration. The number of embolizations correlated positively with the number of stereotactic radiosurgeries (P<0.005. Conclusions. Multimodality endovascular and radiosurgical approach is an efficacious treatment strategy for large AVM.

Pulmonary Embolism

Science.gov (United States)

... increase the risk for PE, such as: Being bedridden or unable to move around much Having surgery ... of pulmonary embolism (PE) include unexplained shortness of breath, problems breathing, chest pain, coughing , or coughing up ...

Presentation and clinical course of Wolfram (DIDMOAD) syndrome from North India.

Science.gov (United States)

Ganie, M A; Laway, B A; Nisar, S; Wani, M M; Khurana, M L; Ahmad, F; Ahmed, S; Gupta, P; Ali, I; Shabir, I; Shadan, A; Ahmed, A; Tufail, S

2011-11-01

Wolfram syndrome, also known as DIDMOAD, is a relatively rare inherited neurodegenerative disorder, first evident in childhood as an association of juvenile-onset diabetes mellitus and optic atrophy, followed by diabetes insipidus and deafness. The aim of the study was to examine the clinical profile of patients with DIDMOAD syndrome presenting to a tertiary care hospital in north India. Clinical presentation of juvenile-onset diabetes mellitus fulfilling the diagnosis of Wolfram syndrome was studied using a prepared standardized form. Subjects with juvenile-onset non-autoimmune diabetes mellitus attending the diabetic clinic at a tertiary care centre in north India were followed for 10 years and a diagnosis of fully developed Wolfram syndrome was confirmed in seven individuals. The series consisted of five male and two female patients with a mean age of 17.5 ±7.34 years. Two subjects had consanguinity and none had any other family member affected. Optic atrophy was present in all, sensorineural hearing loss in 4/7, central diabetes insipidus in 4/7 and nephrogenic diabetes insipidus in 2/7 subjects. The new associations found were: spastic myoclonus, short stature with pancreatic malabsorption, nephrogenic diabetes insipidus, cyanotic heart disease and choledocholithiasis with cholangitis. Genetic analysis revealed mutation in exon 8 of the WFS1 gene in all the cases studied. The present clinical series of Wolfram syndrome reveals a varied clinical presentation of the syndrome and some new associations. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.

Rheumatic Fever Associated with Antiphospholipid Syndrome: Systematic Review

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Felipe da Silva

2014-01-01

Full Text Available Objective. To evaluate the clinical associations between rheumatic fever and antiphospholipid syndrome and the impact of coexistence of these two diseases in an individual. Methods. Systematic review in electronics databases, regarding the period from 1983 to 2012. The keywords: “Rheumatic Fever,” “Antiphospholipid Syndrome,” and “Antiphospholipid Antibody Syndrome” are used. Results. were identified 11 cases described in the literature about the association of rheumatic fever and antiphospholipid syndrome. Clinical presentation of rheumatic fever was characterized by the predominance of carditis (11/11 and chorea (7/11. Regarding the manifestations of APS, the stroke was observed in 7/11 (63.6%, with one of them having probable embolic origin. Conclusion. The present study brings the information that the association between APS and RF is quite rare, however, is of great clinical importance. Doctors who deal with the RF should include in their differential diagnosis the APS, especially in the presence of stroke in patients with RF and whose echocardiogram does not show intracavitary thrombi.

Prophylactic Residual Aneurysmal Sac Embolization with Expandable Hydrogel Embolic Devices for Endoleak Prevention: Preliminary Study in Dogs

International Nuclear Information System (INIS)

Hiraki, Takao; Pavcnik, Dusan; Uchida, Barry T.; Timmermans, Hans A.; Yin Qiang; Wu Renghong; Niyyati, Mahtab; Keller, Frederick S.; Roesch, Josef

2005-01-01

Objective. To explore the feasibility and efficacy of residual aneurysmal sac (RAS) embolization with the expandable hydrogel embolic device (EHED) in prevention of endoleaks in a surgically created and endoluminally treated abdominal aortic aneurysm (AAA). Methods. In eight dogs, an AAA was created by means of side-to-side anastomosis between the infrarenal abdominal aorta and inferior vena cava (IVC) with ligation of the IVC above and below the anastomotic end, followed by deployment of an endograft with holes. The RAS was then embolized with the EHED. One animal was killed immediately after RAS embolization and one animal died 12 hr after the procedure. Follow-up aortograms were obtained in six animals after 1 day (1 animal), 2 weeks and 6 months (1 animal), and 8 weeks (4 animals). Results. Four animals had no endoleaks on the follow-up aortograms. The remaining two animals with incomplete RAS embolization had moderate type III endoleaks. Type I or II endoleaks were not seen in any animals. Complications included RAS wall penetration by the devices with platinum wires in two animals (nos. 1 and 2), device migration into an aortic circulation through the endograft holes in two animals (nos. 2 and 3) or through distal interstices between the aortic wall and endograft in one animal (no. 8), aortic occlusion in three animals (nos. 3, 7, and 8), and RAS rupture in one animal (no. 7). Histologic examination showed expanded hydrogels occupying the RAS with associated mature or immature organized thrombus, fibrinous thrombus, or degenerate blood cells. Conclusion. RAS embolization was feasible with the EHED, although additional modifications to the device are required to avoid complications. Angiographic and histologic results suggested that RAS embolization with the EHED may help in the prevention of endoleaks

Neurofibromatosis Type 1: Transcatheter Arterial Embolization for Ruptured Occipital Arterial Aneurysms

International Nuclear Information System (INIS)

Kanematsu, Masayuki; Kato, Hiroki; Kondo, Hiroshi; Goshima, Satoshi; Tsuge, Yusuke; Kojima, Toshiaki; Watanabe, Haruo

2011-01-01

Two cases of ruptured aneurysms in the posterior cervical regions associated with type-1 neurofibromatosis treated by transcatheter embolization are reported. Patients presented with acute onset of swelling and pain in the affected areas. Emergently performed contrast-enhanced CT demonstrated aneurysms and large hematomas widespread in the posterior cervical regions. Angiography revealed aneurysms and extravasations of the occipital artery. Patients were successfully treated by percutaneous transcatheter arterial microcoil embolization. Transcatheter arterial embolization therapy was found to be an effective method for treating aneurysmal rupture in the posterior cervical regions occurring in association with type-1 neurofibromatosis. A literature review revealed that rupture of an occipital arterial aneurysm, in the setting of neurofibromatosis type 1, has not been reported previously.

Pulmonary embolism: spiral CT evaluation; Embolie pulmonaire: apport de la tomodensitometrie helicoidale

Energy Technology Data Exchange (ETDEWEB)

Senac, J.P.; Vernhet, H.; Bousquet, C.; Giron, J.; Pieuchot, P.; Durand, G.; Benezet, O.; Aubas, P. [Centre Hospitalier Universitaire, 34 - Montpellier (France)

1995-06-01

Purpose: Spiral computed tomography was compared retrospectively with digital substraction pulmonary angiography (PA) in 45 patients suspected of having acute or chronic pulmonary embolism. Materials and method : 45 patients in whom the presence of acute or chronic pulmonary embolism was suspected underwent examination by spiral CT and PA. Diagnosis of pulmonary embolism was based on the direct visualization of intraluminal clots. The study of the agreement between the two methods was based on the Kappa test. In 35 cases, pulmonary emboli were proved. Acute pulmonary emboli were present in 28 cases and chronic in 7 cases. Results: Spiral computed tomography represents an excellent way to detect acute pulmonary embolism. In the chronic form, spiral CT is better than PA to detect intraluminal clots. However, Spiral CT can fail to detect small emboli in the peripheral arterial bed. In the 10 patients without pulmonary embolism, the spiral CT proved diagnosis pulmonary oedema (n=3), lymphangi-carcinoma (n=4), pleural effusion (n=3). Conclusion: This study suggest that the spiral CT examination is accurate for diagnosis of pulmonary embolism specifically in case of suspected important embolism. The advantages of spiral CT are multiple (non invasive, wide diagnosis spectrum). However, may be a limitation to is use is insufficient distal thrombi detection. This eventuality (5 to 10% in the Pioped study) justify the practice of pulmonary angiography. Spiral CT improvements should reduce this insufficiency in the next future. (Authors). 16 refs., 4 figs., 3 tabs.

Differences in clinical features and computed tomographic findings between embolic and non-embolic acute ischemic stroke. A quantitative differential diagnosis

International Nuclear Information System (INIS)

Takano, Kentaro; Yamaguchi, Takenori; Minematsu, Kazuo; Sawada, Tohru; Omae, Teruo

1998-01-01

A diagnosis based on the presumed mechanism of stroke onset is useful for management strategies in acute ischemic stroke. Ninety-two patients with embolic (cardiac or artery-to-artery) and 107 with non-embolic (thrombotic or hemodynamic) stroke were diagnosed on strict cerebral angiographic criteria alone. To clearly discriminate between these two groups, the neurological and computed tomographic (CT) findings were then compared. Rapidity of onset, vomiting, urinary incontinence, level of consciousness, cervical bruit, anisocoria, tongue deviation, sensory disturbance, and CT findings (location of hypodense area, findings of brain edema and hemorrhagic transformation) were discriminatory factors between the two groups (p<0.01). According to these 11 items, we prepared a numerical table for quantitative differential diagnosis. A diagnostic accuracy of 98.9% for embolic and 87.9% for non-embolic stroke in internal verification, and 90.0% and 82.9%, respectively, in external verification was observed. The differences in clinical features and CT findings between embolic and non-embolic stroke may reflect the pathophysiological mechanisms of the occlusive process of cerebral artery as well as the extent and severity of ischemia. (author)

Differences in clinical features and computed tomographic findings between embolic and non-embolic acute ischemic stroke. A quantitative differential diagnosis

Energy Technology Data Exchange (ETDEWEB)

Takano, Kentaro; Yamaguchi, Takenori; Minematsu, Kazuo; Sawada, Tohru; Omae, Teruo [National Cardiovascular Center, Suita, Osaka (Japan)

1998-02-01

A diagnosis based on the presumed mechanism of stroke onset is useful for management strategies in acute ischemic stroke. Ninety-two patients with embolic (cardiac or artery-to-artery) and 107 with non-embolic (thrombotic or hemodynamic) stroke were diagnosed on strict cerebral angiographic criteria alone. To clearly discriminate between these two groups, the neurological and computed tomographic (CT) findings were then compared. Rapidity of onset, vomiting, urinary incontinence, level of consciousness, cervical bruit, anisocoria, tongue deviation, sensory disturbance, and CT findings (location of hypodense area, findings of brain edema and hemorrhagic transformation) were discriminatory factors between the two groups (p<0.01). According to these 11 items, we prepared a numerical table for quantitative differential diagnosis. A diagnostic accuracy of 98.9% for embolic and 87.9% for non-embolic stroke in internal verification, and 90.0% and 82.9%, respectively, in external verification was observed. The differences in clinical features and CT findings between embolic and non-embolic stroke may reflect the pathophysiological mechanisms of the occlusive process of cerebral artery as well as the extent and severity of ischemia. (author)

Colonic ischemic necrosis following therapeutic embolization

International Nuclear Information System (INIS)

Shenoy, S.S.; Satchidanand, S.; Wesp, E.H.; State Univ. of New York, Buffalo

1981-01-01

Transcatheter embolization of the middle colic artery for diverticular bleeding was followed by ischemic necrosis in the transverse colon at the site of previous anastomosis and stricture formation. This is a potential complication of intra-arterial embolization for colonic bleeding. (orig.)

Colonic ischemic necrosis following therapeutic embolization

Energy Technology Data Exchange (ETDEWEB)

Shenoy, S S; Satchidanand, S; Wesp, E H

1981-07-15

Transcatheter embolization of the middle colic artery for diverticular bleeding was followed by ischemic necrosis in the transverse colon at the site of previous anastomosis and stricture formation. This is a potential complication of intra-arterial embolization for colonic bleeding.

Systemic Air Embolism After CT-guided Lung Biopsy

Science.gov (United States)

2017-11-27

Patients Who Underwent Percutaneous Lung Biopsy Under CT Guidance; Patients Who Presented Systemic Air Embolism After Percutaneous Lung Biopsy Under CT Guidance Depicted at the Time of the Procedure on a Whole Thoracic CT

Pancoast syndrome: A rare presentation of non-Hodgkin′s lymphoma

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Anirban Sarkar

2013-01-01

Full Text Available Pancoast syndrome is a common presentation of bronchogenic carcinoma, but other malignancies are rarely cited as its cause. Pancoast syndrome due to non-Hodgkin′s lymphoma is rarely described in the literature. Here, we report a case of Pancoast syndrome due to non-Hodgkin′s lymphoma to increase the awareness of the clinicians regarding essentiality of tissue diagnosis of Pancoast tumor before starting the treatment.

A case of late-onset allgrove syndrome presenting with predominant autonomic dysfunction

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Debmalya Sanyal

2013-01-01

Full Text Available Allgrove Syndrome or triple A syndrome is a rare familial multisystem disorder characterized by achalasia, alacrima and adrenal insufficiency. The objective was to describe a case of 4A syndrome where autonomic dysfunction was the presenting feature. A 22-year-old male presented with erectile dysfunction and loss of spontaneous morning erections for six months. He was having nocturnal diarrhea and recurrent postural dizziness for three months. He was found to have hyperpigmentation at pressure points, postural hypotension and other features of autonomic dysfunction. Laboratory investigations and imaging studies revealed hypoadrenalism, achalasia, alacrima and peripheral neuropathy. Autonomic neuropathy-related features persisted even after correction of hypoadrenalism. Based on clinical features and investigation he was diagnosed as a case of 4A syndrome presenting with autonomic dysfunction. Allgrove or 4A syndrome should be considered as a rare differential diagnosis of someone presenting with features of autonomic neuropathy.

A Case of Myopathy, Encephalopathy, Lactic Acidosis and Stroke-Like Episodes (MELAS) Syndrome with Intracardiac Thrombus [corrected].

Science.gov (United States)

Joo, Jung-Chul; Seol, Myung Do; Yoon, Jin Won; Lee, Young Soo; Kim, Dong-Keun; Choi, Yong Hoon; Ahn, Hyo Seong; Cho, Wook Hyun

2013-03-01

Myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS) is a multisystem clinical syndrome manifested by mitochondrial myopathy, encephalopathy, lactic acidosis and recurrent stroke-like episodes. A 27-year-old female with MELAS syndrome presented with cerebral infarction. Echocardiography revealed a thrombus attached to the apex of the hypertrophied left ventricle, with decreased systolic function. The embolism of the intracardiac thrombus might have been the cause of stroke. There should be more consideration given to the increased possibility of intracardiac thrombus formation when a MELAS patient with cardiac involvement is encountered.

Transcatheter embolization of renal neoplasms. A comparison of the merits of the radio-active infarct implant versus total embolization with inert material

International Nuclear Information System (INIS)

Lang, E.K.; Pisco, J.M.

1980-01-01

Transcatheter embolization with radio-active infarct particles and inert embolic material has been proposed for adjuvant therapy in the management of renal cell carcinoma. Transcatheter embolization with inert embolic material has been advocated in preparation for surgical resection of renal tumours. Embolization with radio-active infarct particles is undertaken to deliver a tumouricidal dose to the primary neoplasm. The resultant interstitial implant offers the advantage of a high dose to the primary tumour, choice of time of delivery of the radiant energy by selection of a radio-isotope with appropriate half-life, and limitation of the integral dose to the patient by selection of appropriate physical characteristics of the radio-isotope utilized. Transcatheter embolization with radio-active infarct particles is advocated either as definitive therapy for clearly inoperable neoplasms, or in hope to make an initially inoperable neoplasm operable. (Auth.)

Identification of patients with low-risk pulmonary embolism suitable for outpatient treatment using the pulmonary embolism severity index (PESI).

LENUS (Irish Health Repository)

McCabe, A

2013-06-01

There is increasing evidence that outpatient treatment of patients with low-risk stable pulmonary embolism (PE) is safe, effective and potentially reduces costs. It is not clear how many patients presenting to an Irish Emergency Department (ED) are potentially suitable for outpatient management.

Antiphospholipid Antibody Syndrome Presenting with Hemichorea

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Yezenash Ayalew

2012-01-01

Full Text Available A 25-year-old Bangladeshi lady presented to neurology with a three-month history of involuntary movements of her right arm, associated with loss of power. There was progression to the right leg, and she subsequently developed episodes of slurred speech and blurred vision. At the time of presentation, she was 12 weeks pregnant and the symptoms were reported to have started at conception. Past medical history was unremarkable apart from one first trimester miscarriage and there was no significant family history suggestive of a hereditary neurological condition. MRI of the head revealed no abnormalities but serology showed positive antinuclear antibodies (ANAs at a titre of 1/400. Further investigations revealed strongly positive anticardiolipin antibodies (>120 and positive lupus anticoagulant antibodies. The patient had a second miscarriage at 19 weeks gestation strengthening the possibility that the chorea was related to antiphospholipid antibody syndrome and she was started on a reducing dose of Prednisolone 40 mg daily and aspirin 300 mg daily. Six months later, she had complete resolution of neurological symptoms. There are several reports of chorea as a feature of antiphospholipid syndrome, but no clear consensus on underlying pathophysiology.

A temible complication of ischemic stroke: pulmonary embolism

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Linda Iurato

2015-12-01

Pulmonary embolism is a major contributor to in-hospital death after stroke. Although the rate of clinically overt pulmonary embolism after stroke has been estimated to be less than 1%, pulmonary emboli account for up to 50% of early deaths after stroke. In daily practice, the clinical burden of pulmonary embolism in patient with stroke is, however, underestimated since the clinical symptoms of stroke may obscure the recognition of this complication. The aim of this article is to describe the clinical and therapeutic aspects of pulmonary embolism as complication after stroke.

Paradoxical embolism: computed tomography demonstration

International Nuclear Information System (INIS)

Kaye, J.; Hayward, M.

2001-01-01

Paradoxical emboli are rare and often presumptively diagnosed. A case of paradoxical embolism, in which both the arterial and venous emboli were documented on CT, is described. While paradoxical emboli are not infrequently diagnosed clinically on a presumptive basis, it is rare to document them with imaging such as CT which, in the present case, confirmed the diagnosis. Copyright (2001) Blackwell Science Pty Ltd

Intrapartum diagnostic of Roberts syndrome - case presentation.

Science.gov (United States)

Socolov, Răzvan Vladimir; Andreescu, Nicoleta Ioana; Haliciu, Ana Maria; Gorduza, Eusebiu Vlad; Dumitrache, Florentin; Balan, Raluca Anca; Puiu, Maria; Dobrescu, Mihaela Amelia; Socolov, Demetra Gabriela

2015-01-01

Roberts syndrome is a rare disease, with multiple limb and skeletal abnormalities (called "pseudothalidomide disease"). There are only around 150 cases described in literature. We present a case of Roberts syndrome, diagnosed in moment of delivery, after a pregnancy without prenatal follow-up. The stillborn baby was naturally delivered by a 17-year-old primiparous woman at 38 weeks of amenorrhea. The pregnancy was not followed due to socioeconomic and family situation, and no prenatal ultrasound was performed. The male baby has 2650 g and presented several morphological abnormalities and tight double umbilical abdominal loop. The macroscopic evaluation showed: dolichocephaly, hypoplastic inferior maxilla with micrognathia, antimongoloid palpebral slant, pterygium colli, abnormal and lower implanted ears, superior limbs phocomelia, syndactyly at lower left limb and tetradactyly in all limbs, bilateral cryptorchidism, pancreatic aplasia. Roberts syndrome is a rare genetic disease with recessive autosomal transmission generated by mutations in ESCO2 gene, located on chromosome 8. The disease should be easy to diagnose by antenatal ultrasound examination, but in our case, the lack of prenatal follow-up determined the diagnostic at term. We believe consider this case is an argument towards introducing ultrasound-screening compulsory to all pregnancies. To identify a possible genetic mutation, further investigations of the parents are in progress, but classically the disease has a recessive autosomal transmission.

Preoperative cellulose porous beads for therapeutic embolization of meningioma: provocation test and technical considerations

International Nuclear Information System (INIS)

Kai, Yutaka; Morioka, Motohiro; Yano, Shigetoshi; Nakamura, Hideo; Makino, Keishi; Mizuno, Takamasa; Takeshima, Hideo; Kuratsu, Jun-ichi; Hamada, Jun-ichiro

2007-01-01

Cellulose porous beads (CPBs) are exceptionally uniform in size and nonabsorbable and they provide highly effective tumor devascularization. The risk of cranial nerve palsy must not be overlooked when embolization with CPBs is considered in meningioma patients. We attempted to identify patients at risk of cranial nerve palsy after meningioma embolization. Prior to preoperative superselective embolization with 200 μm diameter CPBs, 141 patients with meningioma underwent provocation test with lidocaine and amytal. They were divided into two groups on the basis of whether they were or were not considered eligible for embolization. We evaluated the differences between the two groups with respect to tumor anatomy, angiographic findings, and clinical presentation and recorded complications associated with the embolization of the meningioma. Of the 141 patients, 128 underwent CPB embolization (group 2); 13 were not embolized because their provocation test results were positive (group 1, n = 11) or because they showed vasospasm (n = 2). Group 1 patients had meningioma in the cavernous sinus or petroclival region. Characteristically, the feeders were of middle meningeal artery origin and exhibited a posteromedial course toward the petrous apex or cavernous sinus. In group 2 patients the middle meningeal artery was the feeder, but it lacked branches coursing posteromedially. Three of these patients experienced complications which included intratumoral hemorrhage (n 2) and post-embolization hearing disturbance (n = 1). Patients with meningioma whose tumor-feeding arteries run posteromedially toward the petrous apex or cavernous sinus are at increased risk of post-embolization cranial nerve palsy. Appropriate protocols, including lidocaine and amytal provocation tests, may reduce the risk of complications after CPB embolization of the external carotid territory in this group of patients. (orig.)

Preoperative cellulose porous beads for therapeutic embolization of meningioma: provocation test and technical considerations

Energy Technology Data Exchange (ETDEWEB)

Kai, Yutaka; Morioka, Motohiro; Yano, Shigetoshi; Nakamura, Hideo; Makino, Keishi; Mizuno, Takamasa; Takeshima, Hideo; Kuratsu, Jun-ichi [Kumamoto University, Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto (Japan); Hamada, Jun-ichiro [Kanazawa University, Department of Neurosurgery, Graduate School of Medical Sciences, Kanazawa (Japan)

2007-05-15

Cellulose porous beads (CPBs) are exceptionally uniform in size and nonabsorbable and they provide highly effective tumor devascularization. The risk of cranial nerve palsy must not be overlooked when embolization with CPBs is considered in meningioma patients. We attempted to identify patients at risk of cranial nerve palsy after meningioma embolization. Prior to preoperative superselective embolization with 200 {mu}m diameter CPBs, 141 patients with meningioma underwent provocation test with lidocaine and amytal. They were divided into two groups on the basis of whether they were or were not considered eligible for embolization. We evaluated the differences between the two groups with respect to tumor anatomy, angiographic findings, and clinical presentation and recorded complications associated with the embolization of the meningioma. Of the 141 patients, 128 underwent CPB embolization (group 2); 13 were not embolized because their provocation test results were positive (group 1, n = 11) or because they showed vasospasm (n = 2). Group 1 patients had meningioma in the cavernous sinus or petroclival region. Characteristically, the feeders were of middle meningeal artery origin and exhibited a posteromedial course toward the petrous apex or cavernous sinus. In group 2 patients the middle meningeal artery was the feeder, but it lacked branches coursing posteromedially. Three of these patients experienced complications which included intratumoral hemorrhage (n = 2) and post-embolization hearing disturbance (n = 1). Patients with meningioma whose tumor-feeding arteries run posteromedially toward the petrous apex or cavernous sinus are at increased risk of post-embolization cranial nerve palsy. Appropriate protocols, including lidocaine and amytal provocation tests, may reduce the risk of complications after CPB embolization of the external carotid territory in this group of patients. (orig.)

Treatment of acute renal artery embolism

International Nuclear Information System (INIS)

Fava, C.; Grosso, M.; Malara, D.; Barile, C.

1987-01-01

The possible ways of treating renal artery embolisms are reviewed with an examination of their advantages and defects. Surgical treatment has a fairly high mortality rate but quickly cures any type of vascular occlusion and will cures any type of vascular occlusion and will cure any concomitant problems such as arterial stenosis. Medical treatement with anticoagulant or mortality rate and is effective even on narrow blood vessels but the response varies according to the type of thromboembolic damage and the way the drugs are administred. Recently developed forms of radiological treatment are also examined. A personal technique successfully applied to an embolism in a patient with only one functioning kidney is described. It consists of a two-stepmechanical and pharmacological attack. First the occluded artery was opened by means of a balloon catheter that was pushedbeyond the embolism and withdrawn into the aorta after inflation of the balloon. Thrombolytic drugs (Urokinase) were then infused through the catheter into the bed of the renal artery in order to cure the secondary thrombosis found, as is generally the case, downstream of the embolism. The technique appears ideal for the treatment of patients with embolisms and total involvement of the renal parenchyma, especially when their general condition makes surgery inadvisable

[Selective embolization to treat obstetric hemorrhage].

Science.gov (United States)

Ferrer Puchol, M D; Lanciego, C; Esteban, E; Ciampi, J J; Edo, M A; Ferragud, S

2014-01-01

To describe cases of obstetric hemorrhage that have called for selective intra-arterial embolization and the different embolization techniques used. To assess the clinical outcomes and postprocedural fertility. We studied 27 women with obstetric hemorrhage. In 24 patients, embolization was performed by catheterizing both uterine arteries and in 2 patients only one uterine artery was catheterized (pseudoaneurysm). The materials used for embolization consisted of Spongostan in 17/27, particles in 9/27, and coils in 1/27. Clinical follow-up included an analysis of early and late complications and of postprocedural fertility. Hemorrhage was classified as primary (25/27) or secondary (2/27). The cause of bleeding was vaginal delivery (20), cesarean sections (5), abortion (1), and cervical ectopic pregnancy (1). The initial technical success rate was 100% and the clinical success rate was 92.6% (25 of the 27 patients). Bleeding ceased and the outcome was satisfactory in 25 patients. During clinical follow-up ranging from one to seven years, 23 patients had normal menstruation and 6 patients completed 7 full-term pregnancies. Intra-arterial embolization for obstetric hemorrhage leads to good outcomes and few complications and it preserves fertility. Copyright © 2011 SERAM. Published by Elsevier Espana. All rights reserved.

Preoperative embolization of hypervascular head and neck tumours

International Nuclear Information System (INIS)

Gupta, A. K.; Purkayastha, S.; Bodhey, N. K.; Kapilamoorthy, T. R.; Kesavadas, C.

2007-01-01

Full text: The embolization of vascular tumours of the head and neck has become an important adjunct to the surgical treatment of these tumours. A vascular tumour in the head and neck region in a surgically treatable patient may be a candidate for embolization. Palliative embolization may be the sole treatment for high risk patients. Reducing intraoperative bleeding may shorten surgery time thus decreasing morbidity and mortality. The purpose of this study is to assess the efficacy of embolization as an adjunct to surgery or as a curative measure in the management of hypervascular head and neck tumours. We retrospectively reviewed the records of 46 consecutive patients 27 men and 16 women; mean age, 37.8 years) with 48 hypervascular head and neck tumours that had undergone preoperative transarterial, direct puncture or combined mode of embolization. Diagnosis of tumours was made on the basis of findings of imaging studies. The 46 patients underwent embolization either through transarterial route, by direct puncture technique or both direct puncture and arterial route. The devascularization reached 90-95% with the use of NBCA. The amount of devascularization reached by transarterial particle embolization is a little lesser. One patient (carotid body tumour) developed mild unilateral seventh, ninth and 10th cranial nerve palsy after transarterial embolization, transient hemiparesis was seen in another patient (nasopharyngeal angiofibroma). Both patients improved completely with steroids and had no deficit on follow up. One patient developed delayed glue migration into the middle cerebral artery territory 6 h after the procedure with no reported increase in size of the lesion in the following 5 years. Preoperative embolization of hypervascular tumour of head and neck region appears to be safe and improves the chance of complete removal during surgery with minimal blood loss

Recurrent thrombo-embolic episodes: the association of cholangiocarcinoma with antiphospholipid syndrome

Science.gov (United States)

Samadian, S; Estcourt, L

1999-01-01

Antiphospholipid syndrome is a disorder of recurrent vascular thrombosis, pregnancy loss and thrombocytopenia associated with persistently elevated levels of antiphospholipid antibodies. It was first described in a group of patients with systemic lupus erythematosus but has since been associated with a wide range of conditions, including other autoimmune disorders and malignancy. It can also occur in isolation, the so-called primary antiphospholipid syndrome. We describe an elderly woman with the antiphospholipid syndrome thought to be associated with a cholangiocarcinoma.


Keywords: antiphospholipid syndrome; cholangiocarcinoma; deep vein thrombosis PMID:10396590

Isolated Pulmonary Infective Endocarditis with Septic Pulmonary Embolism Complicating a Right Ventricular Outflow Tract Obstruction: Scarce and Devious Presentation

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Abdelrahmen Abdelbar

2013-01-01

Full Text Available We present a case of a fifty-three-year-old male who presented with severe sepsis. He had been treated as a pneumonia patient for five months before the admission. Investigations revealed isolated pulmonary valve endocarditis and septic pulmonary embolism in addition to undiagnosed right ventricular outflow tract (RVOT obstruction. The patient underwent surgery for the relief of RVOT obstruction by substantial muscle resection of the RVOT, pulmonary artery embolectomy, pulmonary valve replacement, and reconstruction of RVOT and main pulmonary artery with two separate bovine pericardial patches. He was discharged from our hospital after 6 weeks of intravenous antibiotics. He recovered well on follow-up 16 weeks after discharge. A high-suspicion index is needed to diagnose right-side heart endocarditis. Blood cultures and transesophageal echocardiogram are the key diagnostic tools.

Fatal air embolism in hospital confirmed by autopsy and postmortem computed tomography.

Science.gov (United States)

Edler, Carolin; Klein, Anke; Püschel, Klaus; Schröder, Ann Sophie

2018-06-01

Vascular air embolism is caused by penetration of air into veins or arteries through a surgical wound or other connection between the external and internal aspects of the body. Vascular air embolism has various causes, and iatrogenic air embolisms are the most frequently described. We report a case of fatal air embolism in an 83-year-old woman who was admitted to hospital. At the time of the incident, she was alone in her ward receiving an intravenous infusion of antibiotics via a peripheral line in her right forearm. She was also inhaling air through a mask, which was connected via a tubing system to a compressed air connection in the wall behind her bed. Autopsy and postmortem computed tomography (PMCT) findings are presented. The case illustrates the high diagnostic value of PMCT, which is an effective procedure for detecting the presence of air or gas.

Prostate embolization: A new acting field of interventional radiology

International Nuclear Information System (INIS)

Kisilevzky, N.; García Mónaco, R.; Peralta, O.; Rabelino, M.; Rosales Arroba, R.; Rodriguez, P.; Ocantos, J.; Martínez, P.F.; Damia, O.

2014-01-01

Purposes: To present the initial experience with prostatic embolization as an alternative treatment for benign prostatic hyperplasia (BPH) from a technical perspective to establish the contribution provided by diagnostic imaging. Materials and methods: Sixteen patients with lower urinary tract symptoms due to benign prostatic hyperplasia underwent prostatic embolization. All patients were evaluated with specific questionnaires to determine the severity of symptoms, impact on quality of life and erectile function, ultrasound and MRI of the pelvis, urinary flowmetry and PSA before and 30 days after the procedure. Results: Embolization was successful in all patients; in 10 cases the procedure was performed bilaterally and in six, only one side was embolized. The average time for completion of the procedure was 82 minutes and the average fluoroscopy time was 38.5 minutes. All procedures were performed on an outpatient basis with an average hospital stay of 6.4 hours. The mean contrast medium used was 175 ml. At 30 days there was a mean reduction on prostate volume of 21%. Clinical improvement was characterized by a mean 8-point improvement on IPSS, 2 points on QOL and 4 points on IIEF. The uroflowmetry improved 39% and PSA dropped 26%. No major complications that implied unscheduled hospitalization or performing additional surgical procedures were seen. Minor adverse events were verified in 9 patients. Conclusion: The initial results of prostatic embolization as an alternative treatment for BPH indicate that it is a safe and effective procedure to be consolidated as a new field of action of interventional radiology. (authors) [es

Transcatheter embolization for treatment of acute lower gastrointestinal bleeding

International Nuclear Information System (INIS)

Uflacker, R.

1987-01-01

Treatment of lower gastrointestinal bleeding was attempted in 13 patients by selective embolization of branches of the mesenteric arteries with Gelfoam. Bleeding was adequately controlled in 11 patients with active bleeding during the examination. One patient improved after embolization but bleeding recurred within 24 hours and in another patient the catheterization was unsuccessful. Five patients with diverticular hemorrhage were embolized in the right colic artery four times, and once in the middle colic artery. Three patients had embolization of the ileocolic artery because of hemorrhage from cecal angiodysplasia, post appendectomy, and leukemia infiltration. Three patients had the superior hemorrhoidal artery embolized because of bleeding from unspecific proctitis, infiltration of the rectum from a carcinoma of the bladder, and transendoscopic polypectomy. One patient was septic and bled from jejunal ulcers. Ischemic changes with infarction of the large bowel developed in two patients and were treated by partial semi-elective colectomy, three and four days after embolization. Four other patients developed pain and fever after embolization. Transcatheter embolization of branches of mesenteric arteries in an effective way to control acute lower gastrointestinal bleeding, but still has a significant rate of complications that must be seriously weighed against the advantages of operation. (orig.)

Posterior reversible encephalopathy syndrome mimicking a left middle cerebral artery stroke.

Science.gov (United States)

Terranova, Santo; Kumar, Jai Dev; Libman, Richard B

2012-01-01

Certain Acute Clinical presentations are highly suggestive of stroke caused by specific mechanisms. One example of this would be the sudden onset of aphasia without hemiparesis often reflecting cerebral embolism, frequently from a cardiac source. Posterior reversible encephalopathy syndrome (PRES) describes a usually reversible neurologic syndrome with a variety of presenting symptoms from headache, altered mental status, seizures, vomiting, diminished spontaneity and speech, abnormalities of visual perception and visual loss. We report a patient presenting with elevated blood pressure, CT characteristics of PRES but a highly circumscribed neurologic syndrome (Wernicke's Aphasia without hemiparesis) suggestive of a cardioembolic stroke affecting the left MCA territory. That is, PRES mimicked a focal stroke syndrome. The importance of recognizing this possibility is that his deficits resolved with blood pressure control, while other treatments, such as intensifying his anticoagulation would have been inappropriate. In addition, allowing his blood pressure to remain elevated as is often done in the setting of an acute stroke might have perpetuated the underlying pathophysiology of PRES leading to a worse clinical outcome. For this reason PRES needs to be recognized quickly and treated appropriately.

Guillain-Barre Syndrome Presenting as Acute Abdomen

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Faruk incecik

2015-09-01

Full Text Available Guillain-Barr and eacute; syndrome (GBS is the most common cause of acute flaccid paralysis in childhood. Symmetric weakness, headache, respiratory symptom, neuropathic pain, muscle pain, paresthesia, and facial palsy were the most common clinical presentations. We report 13-year-old boy with GBS who presented with acute abdominal pain. This is the first report, to our knowledge, first presented of acute abdomen of a pediatric patient with GBS. [Cukurova Med J 2015; 40(3.000: 601-603

Ovarian Artery Embolization in Patients With Collateral Supply to Symptomatic Uterine Leiomyomata

International Nuclear Information System (INIS)

Scheurig-Muenkler, C.; Poellinger, A.; Wagner, M.; Hamm, B.; Kroencke, T. J.

2011-01-01

Purpose: To evaluate the safety and outcome of ovarian artery embolization (OAE) in patients with collateral supply to symptomatic uterine leiomyomata. Materials and Methods: Thirteen patients with relevant leiomyoma perfusion by way of enlarged ovarian arteries underwent additional OAE during the same (N = 10) or a second procedure (N = 3). Uterine artery embolization (UAE) was performed bilaterally in 10 and unilaterally in 2 patients with a single artery. One patient had no typical uterine arteries but bilaterally enlarged ovarian arteries, prompting bilateral OAE. OAE was accomplished with coil embolization in one and particle embolization in 12 patients. Symptoms before therapy and clinical outcome were assessed using a standardized questionnaire. Contrast-enhanced magnetic resonance (MR) imaging after embolization was available in 11 of 13 patients and was used to determine the percentage of fibroid infarction. Results: UAE and OAE were technically successful in all patients. One patient experienced prolonged irritation at the puncture site. Median clinical follow-up time was 16 months (range 4–37). Ten of 13 patients showed improvement or complete resolution of clinical symptoms. One patient reported only slight improvement of her symptoms. These women presented with regular menses. Two patients (15%), 47 and 48 years, both with unilateral OAE, reported permanent amenorrhea directly after embolization. Their symptoms completely resolved. Seven patients showed complete and 4 showed >90% fibroid infarction after embolization therapy. Conclusions: OAE is technically safe and effective in patients with ovarian artery collateral supply to symptomatic uterine leiomyomata. The risk of permanent amenorrhea observed in this study is similar to the reported incidence after UAE.

Early Onset Marfan Syndrome: Atypical Clinical Presentation of Two Cases

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Ozyurt Abdullah

2015-06-01

Full Text Available Early onset Marfan Syndrome (eoMFS is a rare, severe form of Marfan Syndrome (MFS. The disease has a poor prognosis and most patients present with resistance to heart failure treatment during the newborn period. This report presents two cases of eoMFS with similar clinical features diagnosed in the newborn period and who died at an early age due to the complications related to the involvement of the cardiovascular system.

Transarterial embolization in head and neck lesions

International Nuclear Information System (INIS)

Chang, Kee Hyun; Han, Man Chung

1985-01-01

The transarterial embolization procedures have been performed in a total of 38 patients with head and neck lesions, including 5 carotid-cavernous fistulas, 1 internal carotid aneurysm, 10 meningiomas, 16 nasopharyngeal angiofibromas, 1 post-traumatic epistaxis and 5 other vascular tumors, over the 18 months-period. Six cases of C-C fistula and ICA aneurysm were treated with the detachable balloon catheter technique. The meningiomas, angiofibromas and all other lesions were embolized with superselection of the branches of the external carotid artery such as the internal maxillary, the middle meningeal, the ascending pharyngeal the facial or other branches, using Berenstein superselective catheters or conventional angiographic catheters. The PVA (polyvinyl alcohol foam) and/or Gelfoam particles were used as embolic materials in these cases. Most of the lesions were successfully embolized with minor transient complications such as pain, headache, vomiting, fever and etc. But in 4 cases occurred the serious complications; one cerebral hemorrhage, two cerebral infarctions, and one acute laryngeal edema. The selection of the embolic materials and the catheters, and the complications are briefly discussed

Transcatheter arterial embolization for traumatic bleeding control

International Nuclear Information System (INIS)

Ryu, Choon Wook; Lee, Sang Kwon; Suh, Kyung Jin; Kim, Tae Heon; Kim, Yong Joo; Kang, Duck Sik

1989-01-01

Angiography is essential for the detection of bleeding vessels in traumatic vascular injury. Immediately after the diagnosis, transcatheter embolization can be performed for the control of bleeding effectively and easily with proper use of embolic materials. Transcatheter embolization is believed to be the treatment of choice when emergency control is needed, where surgical approach is difficult and in those who are poor candidate for surgery. We have tried bleeding control in 18 cases of trauma over recent 4 years. The results were as follows; 1. Causes of bleeding(cases): Blunt or penetrating trauma (10), latrogenic trauma (8), (Postoperative (5), Needle biopsy (2), Percutaneous hepatic procedure (1)) 2. Embolized vessels: Renal artery branches (8), Hepatic artery branches (2), Arteries supplying chest wall (2), External carotid artery branches (3), Internal carotid artery (1), Circumflex humeral artery (1), Internal iliac artery branches (1). 3. Embolic agents: Gelfoam cubes (16), Stainless steel coils (3), Detachable latex balloon (1). 4. Successful bleeding control was achieved in 17 cases and reduction of the amount of bleeding in one case without significant complications

Transarterial embolization in head and neck lesions

Energy Technology Data Exchange (ETDEWEB)

Chang, Kee Hyun; Han, Man Chung [College of Medicine, Seoul National University, Seoul (Korea, Republic of)

1985-06-15

The transarterial embolization procedures have been performed in a total of 38 patients with head and neck lesions, including 5 carotid-cavernous fistulas, 1 internal carotid aneurysm, 10 meningiomas, 16 nasopharyngeal angiofibromas, 1 post-traumatic epistaxis and 5 other vascular tumors, over the 18 months-period. Six cases of C-C fistula and ICA aneurysm were treated with the detachable balloon catheter technique. The meningiomas, angiofibromas and all other lesions were embolized with superselection of the branches of the external carotid artery such as the internal maxillary, the middle meningeal, the ascending pharyngeal the facial or other branches, using Berenstein superselective catheters or conventional angiographic catheters. The PVA (polyvinyl alcohol foam) and/or Gelfoam particles were used as embolic materials in these cases. Most of the lesions were successfully embolized with minor transient complications such as pain, headache, vomiting, fever and etc. But in 4 cases occurred the serious complications; one cerebral hemorrhage, two cerebral infarctions, and one acute laryngeal edema. The selection of the embolic materials and the catheters, and the complications are briefly discussed.

A Guyon's canal ganglion presenting as occupational overuse syndrome: A case report.

LENUS (Irish Health Repository)

Chan, Jeffrey C Y

2008-01-01

Occupational overuse syndrome (OOS) can present as Guyon\\'s canal syndrome in computer keyboard users. We report a case of Guyon\\'s canal syndrome caused by a ganglion in a computer user that was misdiagnosed as OOS.

Superior Thyroid Artery Lesion After US-Guided Chemical Parathyroidectomy: Angiographic Diagnosis and Treatment by Embolization

International Nuclear Information System (INIS)

Perona, Franco; Barile, Antonio; Oliveri, Michele; Quadri, Piergiorgio; Ferro, Carlo

1999-01-01

A 71-year-old woman presented with a life-threatening thyroid hemorrhage after US-guided chemical parathyroidectomy. The diagnosis was made by angiography followed by immediate embolization of a pseudoaneurysm of the left superior thyroid artery. Embolization controlled the hemorrhage, obviating the need for surgery. The patient made a full recovery with no evidence of further hemorrhage. Pseudoaneurysm of the superior thyroid artery is a rare cause of hemorrhage and percutaneous embolization is an effective method of treatment

Acute Embolic Myocardial Infarction in a Patient with Paroxysmal Atrial Fibrillation Receiving Direct-current Cardioversion

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Tung-Chao Lin

2009-03-01

Full Text Available Coronary embolism with acute myocardial infarction (MI following direct-current (DC cardioversion of atrial fibrillation (AF has rarely been reported. We present the case of a 34-year-old female with severe aortic regurgitation and highly symptomatic paroxysmal AF. Acute embolic MI occurred 4 days after DC cardioversion of AF, although there was no left atrial thrombus detected before this procedure. Insufficient anticoagulation therapy during the post-cardioversion period was the cause, leading to embolic MI.

Percutaneous artherial embolization in the treatment of liver trauma

International Nuclear Information System (INIS)

Flores, G.S.; Uflacker, R.

1989-01-01

Percutaneous arterial embolization in the treatment of liver trauma. Liver trauma requires emergency therapy. Because it is highly vascular and because of its location, the hemostasis is difficult to achieve. The main causes of death associated to liver trauma are due to prolonged hipovolemia. The current forms of surgical treatment of liver wounds are associated with a high morbidity rate. In some hepatic injuries, hemorrage is so massive that operative control of bleeding is necessary, bu t in most cases, particularly in blunt trauma, an angiographic approach with diagnosis and embolotherapy is preferable. Six patients with blunt or perforating hepatic trauma were managed with percutaneous arterial embolization. Hemostasis was achieved immediately in all of them withoyt recurrence. Surgical intervention with additional trauma was thus avoided, decreasing the morbidity rate. The percutaneous arterial embolization presents an efficient alternative in the management of hemorrage due to liver trauma, being particularly useful in the poor risk patient. (author) [pt

Traversing boundaries: thrombus in transit with paradoxical embolism

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Varun Miriyala

2016-09-01

Full Text Available A 72-year-old male is diagnosed with paradoxical embolus after he presented with concurrent deep vein thrombosis, stroke, and multiple arterial emboli in the presence of a patent foramen ovale (PFO. Paradoxical embolus requires the passage of a thrombus from the venous into the arterial circulation through a right-to-left shunt leading to systemic embolism. But, despite the high incidence of PFO (27.3% across all age groups by autopsy, paradoxical embolism (PDE is uncommon, representing <2% of all arterial emboli. We present a case report where a thrombus has been directly observed passing through the PFO during an echocardiogram study; thus, clearly delineating the true cause of multiple thromboemboli and stoke in our patient. Subsequent Transesophageal Echocardiography (TEE also interestingly showed the thrombus in transit in the aorta and pulmonary artery.

Severe Psychomotor Delay in a Severe Presentation of Cat-Eye Syndrome

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Guillaume Jedraszak

2015-01-01

Full Text Available Cat-eye syndrome is a rare genetic syndrome of chromosomal origin. Individuals with cat-eye syndrome are characterized by the presence of preauricular pits and/or tags, anal atresia, and iris coloboma. Many reported cases also presented with variable congenital anomalies and intellectual disability. Most patients diagnosed with CES carry a small supernumerary bisatellited marker chromosome, resulting in partial tetrasomy of 22p-22q11.21. There are two types of small supernumerary marker chromosome, depending on the breakpoint site. In a very small proportion of cases, other cytogenetic anomalies are reportedly associated with the cat-eye syndrome phenotype. Here, we report a patient with cat-eye syndrome caused by a type 1 small supernumerary marker chromosome. The phenotype was atypical and included a severe developmental delay. The use of array comparative genomic hybridization ruled out the involvement of another chromosomal imbalance in the neurological phenotype. In the literature, only a few patients with cat-eye syndrome present with a severe developmental delay, and all of the latter carried an atypical partial trisomy 22 or an uncharacterized small supernumerary marker chromosome. Hence, this is the first report of a severe neurological phenotype in cat-eye syndrome with a typical type 1 small supernumerary marker chromosome. Our observation clearly complicates prognostic assessment, particularly when cat-eye syndrome is diagnosed prenatally.

Thoracic vasculitis presenting as surgical problems.

LENUS (Irish Health Repository)

Jansen, Michael

2010-01-01

We present four patients with vasculitis manifesting with unusual clinical or pathological features, generating surgical problems. Two cases presented with pulmonary hypertension, with investigations and radiological evidence prompting clinical suspicion of pulmonary thrombo-embolic disease. First case, with an antecedant history of Wegener\\'s granulomatosis (WG), demonstrated following "embolectomy", WG involving the large pulmonary elastic arteries. The second case of inoperable "pulmonary thrombo-embolic disease" was subsequently found at limited post mortem to have giant cell arteritis, which affected widespread small peripheral pulmonary arterial vessels. The other two cases were of aortitis occurring in the background of immune-mediated disease, which had been treated with aggressive immunosuppression regimens. The first of these was a case of Cogan\\'s syndrome complicated by descending aortitis, a rarely reported phenomenon, with co-existent acute endocarditis of the aortic valve leaflets. Most cases of endocarditis in this context occur secondary to and in continuity with ascending aortitis. That this case, and a case of ascending aortitis occurring in the context of relapsing polychondritis occurred in the face of aggressive immunosuppression with an apparent clinical response, underscores the need to not accept a clinical picture at face value. This has implications for clinical management, particularly in the follow-up of surgical prosthetic devices such as grafts which may be used in these cases. All four cases emphasise the continued importance of histology and the post-mortem examination in elucidating previously undetected or unsuspected disease.

Presentation of Depression in Autism and Asperger Syndrome: A Review

Science.gov (United States)

Stewart, Mary E.; Barnard, Louise; Pearson, Joanne; Hasan, Reem; O'Brien, Gregory

2006-01-01

Depression is common in autism and Asperger syndrome, but despite this, there has been little research into this issue. This review considers the current literature on the prevalence, presentation, treatment and assessment of depression in autism and Asperger syndrome. There are diagnostic difficulties when considering depression in autism and…

The relationship between tumor markers and pulmonary embolism in lung cancer.

Science.gov (United States)

Xiong, Wei; Zhao, Yunfeng; Xu, Mei; Guo, Jian; Pudasaini, Bigyan; Wu, Xueling; Liu, Jinming

2017-06-20

Tumor markers (TMs) and D-Dimer are both hallmarks of severity and prognosis of lung cancer. Tumor markers could be related to pulmonary embolism (PE) in lung cancer. The number of abnormal tumor markers of lung cancer patients with pulmonary embolism (3.9 ± 1.1vs1.6 ± 0.6,P 0.005) was more than that in patients without pulmonary embolism. TMs panel (P trend tumor markers, TMs panel (OR5.98, P Tumor markers were compared between lung cancer patients complicated with pulmonary embolism and those without pulmonary embolism Then the correlation between each tumor marker as well as panel of combined TMs and D-Dimer as well as pulmonary embolism were analyzed for patients with pulmonary embolism. There is a relationship between tumor markers and pulmonary embolism in patients with lung cancer. The panel of combined tumor markers is a valuable diagnostic marker for pulmonary embolism in lung cancer.

Onyx embolization as a first line treatment for intracranial dural arteriovenous fistulas with cortical venous reflux

International Nuclear Information System (INIS)

Panagiotopoulos, V.; Forsting, M.; Wanke, I.; Moeller-Hartmann, W.; Asgari, S.; Sandalcioglu, I.E.

2009-01-01

Our purpose was to present our experience regarding embolization of intracranial dural arteriovenous fistulas (DAVFs) with cortical venous reflux using Onyx, a non-adhesive liquid embolic agent. From January 2006 to December 2007, 16 patients (12 men and 4 women) with a mean age of 61 years (range 42 - 78) with an intracranial DAVF with cortical venous reflux underwent at least one transarterial embolization using Onyx. According to the Cognard classification, 2 lesions were grade V, 5 were grade IV, 6 were grade III, 2 were grade IIa+b, and 1 was grade IIb. The clinical presentation included 5 hemorrhagic deficits, 10 non-hemorrhagic manifestations, and 1 patient was asymptomatic. Twenty-four embolization sessions were performed in 16 patients with an average of 3 arterial feeders (range 1 - 9) embolized per DAVF. Immediately after embolization, complete occlusion was achieved in 9 / 16 (56 %) patients after the first session. Further postembolization surgical treatment was performed in 3 patients. Partial reperfusion occurred in 1 patient at the time of mean follow-up of 3.7 months (range 0 - 12). Treatment has been completed for 11 / 16 patients with angiographic cure in 10 / 11 (91 %). An infratentorial bleeding complication related to embolization occurred in one patient with temporary worsening of the patient's gait disturbance. At the time of mean clinical follow-up of 4.5 months (range 0 - 12), no procedure-related permanent morbidity was added to our cohort. According to our experience, embolization of intracranial DAVFs with cortical venous drainage using Onyx is feasible with promising results, indicating stability at the time of mid-term follow-up. In very complex DAVFs additional embolization material might be necessary, and in some cases surgery is warranted. (orig.)

The clinical course of patients with suspected pulmonary embolism

NARCIS (Netherlands)

van Beek, E. J.; Kuijer, P. M.; Büller, H. R.; Brandjes, D. P.; Bossuyt, P. M.; ten Cate, J. W.

1997-01-01

BACKGROUND: The outcome of patients with suspected pulmonary embolism is known to a limited extent only. OBJECTIVE: To address this limited knowledge in a cohort in whom pulmonary embolism was proved or ruled out. METHODS: Consecutive patients with clinically suspected pulmonary embolism underwent

Control of haematuria with superselective embolization

Energy Technology Data Exchange (ETDEWEB)

Vlahos, L.; Gouliamos, A.; Kalovidouris, A.; Colias, S.; Papacharalambous, X.; Papavasiliou, C. (Athens Univ. (Greece). Dept. of Radiology)

1991-02-01

Fifteen patients with severe haematuria due to causes other than malignant disease were seen between 1981 and 1989. Arteriography was done in an attempt to treat these patients with superselective embolization. In 7 patients, the cause of bleeding was due to injuries of iatrogenic origin and of the remaining 8, 2 had been in a car accident, 2 had knife stabwounds, 3 angiomatous malformations and 1 tuberous sclerosis. Twelve of the 15 patients were treated successfully with superselective embolization with steel coils. We consider angiography followed by superselective embolization to be the method of choice for the diagnosis and treatment of haematuria due to renal injury or other benign conditions. (orig.).

Primary Antiphospholipid Syndrome: Unusual Presentation in a ...

African Journals Online (AJOL)

A 72 year old man with a history of TIAs and stroke with unexplained moderately raised ESR presented a year later with rapid deterioration of vision in his left eye because of central retinal vein occlusion. Primary antiphospholipid syndrome is found in patients with history of arterial or venous thromboembolism, ...

Transcatheter Arterial Embolization with n-Butyl Cyanoacrylate for the Treatment of Acquired Uterine Vascular Malformations

Energy Technology Data Exchange (ETDEWEB)

Picel, Andrew C., E-mail: apicel@ucsd.edu [University of California, San Diego, Department of Radiology (United States); Koo, Sonya J. [University of Texas Southwestern Medical Center, Department of Radiology (United States); Roberts, Anne C. [University of California, San Diego, Department of Radiology (United States)

2016-08-15

PurposeThe purpose of the study was to evaluate the technique and outcomes of transcatheter arterial embolization (TAE) with n-butyl cyanoacrylate (NBCA) for the treatment of acquired uterine arteriovenous malformations (AVMs).Materials and methodsA retrospective review identified five women treated for suspected acquired uterine AVMs with TAE at our institution. Four women (80 %) presented with heavy or intermittent vaginal bleeding after obstetric manipulation. One woman (20 %) was treated for an incidental AVM discovered on ultrasound after an uncomplicated cesarean section. Three women underwent one embolization procedure and two women required two procedures. Embolization material included NBCA in six procedures (80 %) and gelatin sponge in one procedure (20 %).ResultsEmbolization resulted in angiographic stasis of flow in all seven procedures. Four women (80 %) presented with vaginal bleeding which was improved after treatment. One woman returned 24 days after unilateral embolization with recurrent bleeding, which resolved after retreatment. One woman underwent two treatments for an asymptomatic lesion identified on ultrasound. There were no major complications. Three women (60 %) experienced mild postembolization pelvic pain that was controlled with non-steroidal anti-inflammatory drugs. Three women (60 %) had pregnancies and deliveries after embolization.ConclusionsTAE is a safe alternative to surgical therapy for acquired uterine AVMs with the potential to maintain fertility. Experience from this case series suggests that NBCA provides predictable and effective occlusion.

Transcatheter Arterial Embolization with n-Butyl Cyanoacrylate for the Treatment of Acquired Uterine Vascular Malformations

International Nuclear Information System (INIS)

Picel, Andrew C.; Koo, Sonya J.; Roberts, Anne C.

2016-01-01

PurposeThe purpose of the study was to evaluate the technique and outcomes of transcatheter arterial embolization (TAE) with n-butyl cyanoacrylate (NBCA) for the treatment of acquired uterine arteriovenous malformations (AVMs).Materials and methodsA retrospective review identified five women treated for suspected acquired uterine AVMs with TAE at our institution. Four women (80 %) presented with heavy or intermittent vaginal bleeding after obstetric manipulation. One woman (20 %) was treated for an incidental AVM discovered on ultrasound after an uncomplicated cesarean section. Three women underwent one embolization procedure and two women required two procedures. Embolization material included NBCA in six procedures (80 %) and gelatin sponge in one procedure (20 %).ResultsEmbolization resulted in angiographic stasis of flow in all seven procedures. Four women (80 %) presented with vaginal bleeding which was improved after treatment. One woman returned 24 days after unilateral embolization with recurrent bleeding, which resolved after retreatment. One woman underwent two treatments for an asymptomatic lesion identified on ultrasound. There were no major complications. Three women (60 %) experienced mild postembolization pelvic pain that was controlled with non-steroidal anti-inflammatory drugs. Three women (60 %) had pregnancies and deliveries after embolization.ConclusionsTAE is a safe alternative to surgical therapy for acquired uterine AVMs with the potential to maintain fertility. Experience from this case series suggests that NBCA provides predictable and effective occlusion.

Potentialities of embolization of life threatening hemorrhages

International Nuclear Information System (INIS)

Moskvichev, V.G.

1985-01-01

The author analysed experience in the embolization of the abdominal vessels in 79 patients with diseases and lesions of the peritoneal cavity and retroperitoneal space accompanied by life threatening hemorrhage. In 51 cases embolization was used as an independent method of hemorrhage arrest and in 28 cases for patients' preoperative preparation. A hemostatic sponge combined with a superselective administration of 150-200 ml of aminocaproic acid was used as an emboilizing material. Complications attributed to embolization were noted in 5 patients: pancreatitis, subdiaphragmatic abscess, paranephritis, ischemia of the gluteal soft tissues, sciatic neuritis. An analysis has shown that urgent embolization of the abdominal vessels in diseases and lesions of the organs of the peritoneal cavity and retroperitoneal space accompanied by massive hemorrhage, can be used as an independent method for hemorrhage arrest

Primary Sjogren's syndrome presenting as Acute Flaccid Quadriplegia:

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Singhvi, J.P.; Ganguli, Anirban; Kaur, Bramhjyot

2010-01-01

Primary Sjogren's Syndrome presenting as quadriplegia and respiratory involvement due to renal tubular acidosis causing hypokalemia is rare and the significance of managing such case with potassium citrate instead of potassium chloride is highlighted.

Spontaneous delayed migration/shortening of the pipeline embolization device: report of 5 cases.

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Chalouhi, N; Tjoumakaris, S I; Gonzalez, L F; Hasan, D; Pema, P J; Gould, G; Rosenwasser, R H; Jabbour, P M

2013-12-01

Five patients were found to have spontaneous delayed migration/shortening of their Pipeline Embolization Devices on follow-up angiography. The device migrated proximally in 4 patients and distally in 1 patient. One patient had a subarachnoid hemorrhage and died as a result of migration of the Pipeline Embolization Device, and another patient presented with complete MCA occlusion and was left severely disabled. Mismatch in arterial diameter between inflow and outflow vessels was a constant finding. Migration of the Pipeline Embolization Device was managed conservatively, with additional placement of the device, or with parent vessel occlusion. Obtaining complete expansion of the embolization device by using a longer device, increasing vessel coverage, using adjunctive aneurysm coiling, and avoiding dragging and stretching of the device are important preventive measures. Neurointerventionalists should be aware of this potentially fatal complication and take all necessary preventive measures.

Unusual presentation of adult Marfan syndrome as a complex diaphragmatic hiatus hernia.

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Thakur, Shruti; Jhobta, Anupam; Sharma, Brij; Chauhan, Arun; Thakur, Charu S

2017-07-01

Marfan syndrome is multisystem connective tissue disorder that primarily involves the skeletal, cardiovascular, and ocular systems. The gastrointestinal complications in Marfan syndrome are rare, with only a few case reports described in the literature. We present a 25-year-old woman who presented with acute abdominal pain for 1 day. The imaging features revealed complex diaphragmatic hiatus hernia with organoaxial gastric volvulus. This is a unique case report about an adult patient with Marfan syndrome who presented with symptomatic paraesophageal hernia and organoaxial gastric volvulus. Copyright © 2014. Published by Elsevier Taiwan.

Unusual presentation of adult Marfan syndrome as a complex diaphragmatic hiatus hernia

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Shruti Thakur

2017-07-01

Full Text Available Marfan syndrome is multisystem connective tissue disorder that primarily involves the skeletal, cardiovascular, and ocular systems. The gastrointestinal complications in Marfan syndrome are rare, with only a few case reports described in the literature. We present a 25-year-old woman who presented with acute abdominal pain for 1 day. The imaging features revealed complex diaphragmatic hiatus hernia with organoaxial gastric volvulus. This is a unique case report about an adult patient with Marfan syndrome who presented with symptomatic paraesophageal hernia and organoaxial gastric volvulus.

Hydralazine-induced anti-neutrophil cytoplasmic antibody-positive renal vasculitis presenting with a vasculitic syndrome, acute nephritis and a puzzling skin rash: a case report

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Keasberry Justin

2013-01-01

Full Text Available Abstract Introduction Anti-neutrophil cytoplasmic antibody-associated vasculitis has been associated with many drugs and it is a relatively rare side effect of the antihypertensive drug hydralazine. The diagnosis and management of patients who have anti-neutrophil cytoplasmic antibody-associated vasculitis may be challenging because of its relative infrequency, variability of clinical expression and changing nomenclature. The spectrum of anti-neutrophil cytoplasmic antibody-associated vasculitis is wide and can be fatal. This case documents a 62-year-old woman who presented with hydralazine-induced anti-neutrophil cytoplasmic antibody-positive renal vasculitis with a puzzling cutaneous rash. Case presentation We report a rare case of hydralazine-induced anti-neutrophil cytoplasmic antibody-associated vasculitis in a 62-year-old Caucasian woman who presented with a vasculitic syndrome with a sore throat, mouth ulcers and otalgia after several months of constitutional symptoms. She then proceeded to develop a rash over her right lower limb. Clinically, the rash had features to suggest Sweet’s syndrome, but also had some appearances consistent with embolic phenomena and did not have the appearance of palpable purpure usually associated with cutaneous vasculitis. Differential diagnoses were hydralazine-associated Sweet’s syndrome, streptococcal-induced cutaneous eruption or an unrelated contact dermatitis. A midstream urine sample detected glomerular blood cells in the setting of anti-neutrophil cytoplasmic antibody-positive renal vasculitis and Streptococcus pyogenes bacteremia. A renal biopsy revealed a pauci-immune, focally necrotizing glomerulonephritis with small crescents. Her skin biopsy revealed a heavy neutrophil infiltrate involving the full thickness of the dermis with no evidence of a leucocytoclastic vasculitis, but was non-specific. She was initially commenced on intravenous lincomycin for her bloodstream infection and subsequently

Strut fracture and disc embolization of a Björk-Shiley mitral valve prosthesis: localization of embolized disc by computerized axial tomography.

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Larrieu, A J; Puglia, E; Allen, P

1982-08-01

The case of a patient who survived strut fracture and embolization of a Björk-Shiley mitral prosthetic disc is presented. Prompt surgical treatment was directly responsible for survival. In addition, computerized axial tomography of the abdomen aided in localizing and retrieving the embolized disc, which was lodged at the origin of the superior mesenteric artery. A review of similar case reports from the literature supports our conclusions that the development of acute heart failure and absent or muffled prosthetic heart sounds in a patient with a Björk-Shiley prosthetic heart valve inserted prior to 1978 should raise the possibility of valve dysfunction and lead to early reoperation.

Acquire uterine vascular malformation: Clinical outcome of transarterial embolization

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Kang, Chae Hoon [Dept. of Radiology, Gangneung Asan Hospital, Gangneung (Korea, Republic of); Yang, Seung Boo; Goo, Dong Erk; Kim, Yong Jae; Lee, Jae Myung; Lee, Woong Hee [Dept. of Radiology, Soonchunhyang University Gumi Hospital, Gumi (Korea, Republic of)

2017-02-15

To evaluate clinical outcomes of transarterial embolization of bilateral uterine arteries (UAE) in patients with acquired uterine vascular malformation (UVM). This retrospective study was performed on the medical records of all 19 patients who underwent transarterial embolization of bilateral UAE for the treatment of symptomatic UVMs from January 2003 to June 2011. Embolization was performed via the unilateral femoral artery approach with a catheter and angiographic techniques. Clinical success was defined as definitive resolution of abnormal vaginal bleeding. Post-procedural complications included all adverse events related to the embolization procedure. A total of 20 procedures were performed in 19 patients. One patient required repeat embolization because of incomplete embolization related to prominent high flow malformation. Clinically, in all patients, bleeding was controlled immediately after embolization. No complications occurred in all patients during the follow up period. In all patients who underwent successful UAE, menstrual cycles were normally restored within 1-2 months. Normal pregnancy with term delivery was observed in two of the 19 cases. Transarterial bilateral UAE is a safe and effective treatment in patients with vaginal bleeding caused by acquired UVM, and it allows the possibility of future pregnancy.

Acquire uterine vascular malformation: Clinical outcome of transarterial embolization

International Nuclear Information System (INIS)

Kang, Chae Hoon; Yang, Seung Boo; Goo, Dong Erk; Kim, Yong Jae; Lee, Jae Myung; Lee, Woong Hee

2017-01-01

To evaluate clinical outcomes of transarterial embolization of bilateral uterine arteries (UAE) in patients with acquired uterine vascular malformation (UVM). This retrospective study was performed on the medical records of all 19 patients who underwent transarterial embolization of bilateral UAE for the treatment of symptomatic UVMs from January 2003 to June 2011. Embolization was performed via the unilateral femoral artery approach with a catheter and angiographic techniques. Clinical success was defined as definitive resolution of abnormal vaginal bleeding. Post-procedural complications included all adverse events related to the embolization procedure. A total of 20 procedures were performed in 19 patients. One patient required repeat embolization because of incomplete embolization related to prominent high flow malformation. Clinically, in all patients, bleeding was controlled immediately after embolization. No complications occurred in all patients during the follow up period. In all patients who underwent successful UAE, menstrual cycles were normally restored within 1-2 months. Normal pregnancy with term delivery was observed in two of the 19 cases. Transarterial bilateral UAE is a safe and effective treatment in patients with vaginal bleeding caused by acquired UVM, and it allows the possibility of future pregnancy

Rett syndrome: EEG presentation.

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Robertson, R; Langill, L; Wong, P K; Ho, H H

1988-11-01

Rett syndrome, a degenerative neurological disorder of girls, has a classical presentation and typical EEG findings. The electroencephalograms (EEGs) of 7 girls whose records have been followed from the onset of symptoms to the age of 5 or more are presented. These findings are tabulated with the Clinical Staging System of Hagberg and Witt-Engerström (1986). The records show a progressive deterioration in background rhythms in waking and sleep. The abnormalities of the background activity may only become evident at 4-5 years of age or during stage 2--the Rapid Destructive Stage. The marked contrast between waking and sleep background may not occur until stage 3--the Pseudostationary Stage. In essence EEG changes appear to lag behind clinical symptomatology by 1-3 years. An unexpected, but frequent, abnormality was central spikes seen in 5 of 7 girls. They appeared to be age related and could be evoked by tactile stimulation in 2 patients. We hypothesize that the prominent 'hand washing' mannerism may be self-stimulating and related to the appearance of central spike discharges.

Prevention and treatment of complications for thyroid-arterial embolization

International Nuclear Information System (INIS)

Yang Jijin; Yuan Min; Tian Jianming; Chen Wei; Yang Chaoai; Hao Qiang; Zou Dajing; Wang Yongchun

2003-01-01

Objective: To investigate the complications of thyroid-arterial embolization and their prevention and treatment. Methods: 61 cases of thyroid disorders received the therapy of thyroid-arterial embolization were retrospectively studied. The complications of arterial embolization during or after the procedure were analyzed. How to prevent and deal with these complications were discussed. Results: Sensitivity to contrast media occurred in 1 case and surgical arterial injury in 2. After embolization thyroid storm occurred in 1 patient and all other complications including headache (23 cases), toothache (11 cases), neckache (13 cases), hoarseness (37 cases) were caused by non-target arterial embolization with the most serious one of cerebral infarction (1 case) and another eyelid ptosis (1 case). The cerebral infarct one was treated with some vasodilating drugs and anti-coagulant, all others were given anti-symptomatics or no special treatment. Conclusions: Proper treatment should be ready during thyroid arterial embolization and given in time with occurrence of complications

Polymyositis-like syndrome caused by hypothyroidism, presenting as camptocormia.

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Kim, Ji Min; Song, Eun Joo; Seo, Jae Seok; Nam, Eon Jeong; Kang, Young Mo

2009-01-01

Polymyositis-like syndrome characterized by proximal muscle weakness and elevation of muscle enzymes may be a presenting manifestation of hypothyroidism. Camptocormia, which can be caused by myopathy of the paraspinal muscles, is an involuntary truncal flexion of the thoracolumbar spine while standing or walking. Among various neuromuscular disorders, hypothyroidism has not been reported in the literature as a cause of camptocormia. This is the first report of polymyositis-like syndrome with camptocormia caused by hypothyroidism.

Adult presentation of Bartter syndrome type IV with erythrocytosis.

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Heilberg, Ita Pfeferman; Tótoli, Cláudia; Calado, Joaquim Tomaz

2015-01-01

Bartter syndrome comprises a group of rare autosomal-recessive salt-losing disorders with distinct phenotypes, but one unifying pathophysiology consisting of severe reductions of sodium reabsorption caused by mutations in five genes expressed in the thick ascending limb of Henle, coupled with increased urinary excretion of potassium and hydrogen, which leads to hypokalemic alkalosis. Bartter syndrome type IV, caused by loss-of-function mutations in barttin, a subunit of chloride channel CLC-Kb expressed in the kidney and inner ear, usually occurs in the antenatal-neonatal period. We report an unusual case of late onset presentation of Bartter syndrome IV and mild phenotype in a 20 years-old man who had hypokalemia, deafness, secondary hyperparathyroidism and erythrocytosis.

Severe pulmonary oedema following therapeutic embolization with Onyx for cerebral arteriovenous malformation

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Murugesan, C.; Saravanan, Sundararaj; Rajkumar, John; Prasad, Jagadish; Banakal, Sanjay; Muralidhar, Kanchi [Narayana Hrudayalaya Institute of Medical Sciences, Bangalore (India)

2008-05-15

Acute respiratory distress syndrome (ARDS) is characterized by sudden onset of respiratory distress, infiltrates on radiographs consistent with pulmonary oedema, hypoxaemia and increased work in breathing. Infiltrates on radiographs are bilateral, but may be patchy or diffuse and fluffy or dense. It is associated with absence of left heart failure and a PaO{sub 2}/FiO{sub 2} ratio of {<=}200. Ethylene vinyl alcohol copolymer dissolved in dimethyl sulfoxide (DMSO), which was approved by the US FDA in July 2005, is used as an embolic agent for cerebral arteriovenous malformation (AVM). It is a biocompatible liquid polymer that precipitates and solidifies on contact with blood, thus forming a soft and spongy embolus. We report a case of ARDS following therapeutic embolization with ethylene vinyl alcohol copolymer for cerebral AVM under general anaesthesia. Experienced perioperative physicians adopted standard anaesthetic technique and monitoring for this procedure. Acute respiratory distress and hypoxaemia developed in the patient following extubation of the trachea. Infiltrates seen on postprocedural chest radiographs were consistent with pulmonary oedema. DMSO, the solvent for the ethylene vinyl alcohol copolymer, is excreted via the lungs after administration and we postulate that DMSO was the possible cause of ARDS in this patient. Monitoring of haemodynamic parameters (invasive blood pressure, electrocardiography) and ventilatory parameters (ETCO{sub 2}, SpO{sub 2}, airway pressure monitoring) are important in the recognition of this possible event. One should be vigilant and anticipate this complication following therapeutic embolization with ethylene vinyl alcohol polymer for the treatment of cerebral AVM. (orig.)

Distal Embolic Protection for Renal Arterial Interventions

International Nuclear Information System (INIS)

Dubel, Gregory J.; Murphy, Timothy P.

2008-01-01

Distal or embolic protection has intuitive appeal for its potential to prevent embolization of materials generated during interventional procedures. Distal protection devices (DPDs) have been most widely used in the coronary and carotid vascular beds, where they have demonstrated the ability to trap embolic materials and, in some cases, to reduce complications. Given the frequency of chronic kidney disease in patients with renal artery stenosis undergoing stent placement, it is reasonable to propose that these devices may play an important role in limiting distal embolization in the renal vasculature. Careful review of the literature reveals that atheroembolization does occur during renal arterial interventions, although it often goes undetected. Early experience with DPDs in the renal arteries in patients with suitable anatomy suggests retrieval of embolic materials in approximately 71% of cases and renal functional improvement/stabilization in 98% of cases. The combination of platelet inhibition and a DPD may provide even greater benefit. Given the critical importance of renal functional preservation, it follows that everything that can be done to prevent atheroembolism should be undertaken including the use of DPDs when anatomically feasible. The data available at this time support a beneficial role for these devices

Uterine artery embolization to treat uterine fibroids

International Nuclear Information System (INIS)

Machan, L.; Martin, M.

2001-01-01

The first reported application of uterine artery embolization, in 1979, was to treat life-threatening hemorrhage after a failed hysterectomy. Since then, uterine artery embolization has been used very successfully to control acute or delayed post-partum hemorrhage, post-surgical hemorrhage and hemorrhage from ectopic pregnancy, to treat uterine arteriovenous malformations and as prophylaxis before high-risk surgery, such as cesarean delivery in women with placenta previa. In contrast to these proven but underutilized applications, uterine embolization for fibroids has, in a short time, achieved significant notice in the lay press and is being widely offered. Ravina and colleagues, first reported uterine fibroid shrinkage after embolization for the treatment of acute bleeding. Since then, his group has performed over 100 procedures with up to a 6-year follow-up. The cumulative clinical success rate for the treatment of abnormal uterine bleeding due to fibroids is reported to be approximately 85% and for treatment of pain or pressure symptoms, about 75%. Six-month follow-up sonography reveals an average reduction of fibroid size of approximately 40%. However, to date, no studies have compared patients who undergo embolization with a nontreatment cohort or with surgical intervention. (author)

Uterine artery embolization to treat uterine fibroids

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Machan, L.; Martin, M. [Univ. of British Columbia Hospital, Dept. of Radiology, Vancouver, BC (Canada)

2001-06-01

The first reported application of uterine artery embolization, in 1979, was to treat life-threatening hemorrhage after a failed hysterectomy. Since then, uterine artery embolization has been used very successfully to control acute or delayed post-partum hemorrhage, post-surgical hemorrhage and hemorrhage from ectopic pregnancy, to treat uterine arteriovenous malformations and as prophylaxis before high-risk surgery, such as cesarean delivery in women with placenta previa. In contrast to these proven but underutilized applications, uterine embolization for fibroids has, in a short time, achieved significant notice in the lay press and is being widely offered. Ravina and colleagues, first reported uterine fibroid shrinkage after embolization for the treatment of acute bleeding. Since then, his group has performed over 100 procedures with up to a 6-year follow-up. The cumulative clinical success rate for the treatment of abnormal uterine bleeding due to fibroids is reported to be approximately 85% and for treatment of pain or pressure symptoms, about 75%. Six-month follow-up sonography reveals an average reduction of fibroid size of approximately 40%. However, to date, no studies have compared patients who undergo embolization with a nontreatment cohort or with surgical intervention. (author)

Heart disease in patients with pulmonary embolism.

Science.gov (United States)

Pesavento, Raffaele; Piovella, Chiara; Prandoni, Paolo

2010-09-01

Several heart diseases are promoters of left-side cardiac thrombosis and could lead to arterial embolism. The same mechanism may be responsible for right-side cardiac thrombosis and therefore be a direct source of pulmonary embolism. Yasuoka et al. showed a higher incidence of perfusion defects in lung scan in patients with spontaneous echocontrast in the right atrium than in those without it (40% and 7% respectively; P=0.006). We recently assessed the prevalence of heart diseases in 11.236 consecutive patients older than 60 years discharged from Venetian hospitals with a diagnosis of pulmonary embolism. We observed a higher prevalence of all-cause heart diseases (odds ratio 1.26; 95% confidence interval, 1.13-1.40) in patients with a diagnosis of pulmonary embolism alone (secondary or unprovoked) compared with those discharged with a diagnosis of pulmonary embolism associated with deep vein thrombosis, generating the hypothesis that some specific heart diseases in older patients could themselves be a possible source of pulmonary emboli. Further prospective studies are required to confirm these findings, which have the potential to open new horizons for the interpretation and management of venous thromboembolic disease.

Follow-up of cerebral aneurysm embolization with hydrogel embolic system: Systematic review and meta-analysis.

Science.gov (United States)

Serafin, Zbigniew; Di Leo, Giovanni; Pałys, Alicja; Nowaczewska, Magdalena; Beuth, Wojciech; Sardanelli, Francesco

2015-10-01

Hydrogel embolic system (HES) for endovascular treatment of cerebral aneurysms was developed to reduce the risk of aneurysm recurrence and the rate of retreatment. The aim of this systematic review was to verify the efficacy of HES, also in comparison to bare platinum coils (BPC). A systematic literature search was performed by two independent reviewers for articles published until January 31st, 2013 on the follow-up recurrence rate of intracranial aneurysm embolization with hydrogel-coated coils. Thirteen articles on the use of HES for embolization of cerebral aneurysms were included in this study, for a total of 1683 embolized aneurysms. Significant heterogeneity was found regarding patient populations, methods of aneurysm coiling, follow-up schedules, and recurrence definitions. The pooled rate of initial complete aneurysm occlusion was 55% (95%CI, 38-70%); 59% (95%CI, 43-74%) in the subgroup of aneurysms treated with the use of HES. The pooled total recurrence rate was 19% (95%CI, 15-24%); 17% (95%CI, 14-22%) in the HES-treated subgroup. The pooled major recurrence rate was 12% (95%CI, 8-18%); 11% (95%CI, 7-16%) in the HES-treated subgroup. Comparing both types of coils, the pooled odds ratio for total recurrence was 0.63 (95%CI, 0.45-0.88; p=0.008) in favor of HES. Embolization of cerebral aneurysms using HES seems to result in a lower rate of recurrence than that obtained using BPC, which is in line with the only randomized controlled trial. High-quality prospective studies are needed to define specific indications for the use of hydrogel-coated coils. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Short bowel syndrome presenting with re-feeding syndrome in a Han Chinese patient: a case report

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Xie Ying

2012-05-01

Full Text Available Abstract Introduction Re-feeding syndrome is common in patients with long-term starvation. To the best of our knowledge this case is the first to report a patient with short bowel syndrome developing re-feeding syndrome 12 years after the bowel resection. Case presentation A 33-year-old Chinese Han man underwent small bowel resection leaving only 40 cm of bowel, without an ileocecal valve, 12 years previously. At that time he was weaned from total parenteral nutrition and had a normal diet. He later developed features of severe malnutrition, and when parenteral nutrition was given, he developed re-feeding syndrome. Conclusion Although re-feeding syndrome is a common complication in patients with any kind of nutritional support, and known to us for many years, high risk patients still need more attention and monitoring. Re-feeding syndrome in this case was not only a macronutrients deficiency but also a micronutrient deficient, and prompt supplement therapy and organ function support proved to be successful.

Fatal central venous air embolism: a rare complication of esophageal dilation by rendezvous.

Science.gov (United States)

Zald, Philip B; Andersen, Peter E

2011-03-01

Esophageal dilation by rendezvous is a useful technique for the treatment of complicated esophageal strictures. We present a case of a 74-year-old man with chronic dysphagia caused by a complete cervical esophageal stricture that developed after external beam radiotherapy for treatment of papillary thyroid carcinoma. During attempted dilation using the rendezvous technique, the patient suffered a fatal pulmonary air embolism. The technique of esophageal dilation by rendezvous, complications, and risk factors for development of venous air embolism are discussed. To the best of our knowledge, this is the first report in the literature of fatal venous air embolism after dilation by rendezvous. Copyright © 2009 Wiley Periodicals, Inc.

Control of haematuria with superselective embolization

International Nuclear Information System (INIS)

Vlahos, L.; Gouliamos, A.; Kalovidouris, A.; Colias, S.; Papacharalambous, X.; Papavasiliou, C.

1991-01-01

Fifteen patients with severe haematuria due to causes other than malignant disease were seen between 1981 and 1989. Arteriography was done in an attempt to treat these patients with superselective embolization. In 7 patients, the cause of bleeding was due to injuries of iatrogenic origin and of the remaining 8, 2 had been in a car accident, 2 had knife stabwounds, 3 angiomatous malformations and 1 tuberous sclerosis. Twelve of the 15 patients were treated successfully with superselective embolization with steel coils. We consider angiography followed by superselective embolization to be the method of choice for the diagnosis and treatment of haematuria due to renal injury or other benign conditions. (orig.) [de

Devascularization of Head and Neck Paragangliomas by Direct Percutaneous Embolization

International Nuclear Information System (INIS)

Ozyer, Umut; Harman, Ali; Yildirim, Erkan; Aytekin, Cuneyt; Akay, Tankut Hakki; Boyvat, Fatih

2010-01-01

Preoperative transarterial embolization of head and neck paragangliomas using particulate agents has proven beneficial for decreasing intraoperative blood loss. However, the procedure is often incomplete owing to extensive vascular structure and arteriovenous shunts. We report our experience with embolization of these lesions by means of direct puncture and intratumoral injection of n-butyl cyanoacrylate (NBCA) or Onyx. Ten patients aged 32-82 years who were referred for preoperative embolization of seven carotid body tumors and three jugular paragangliomas were retrospectively analyzed. Intratumoral injections were primarily performed in four cases with multiple small-caliber arterial feeders and adjunctive to transarterial embolization in six cases with incomplete devascularization. Punctures were performed under ultrasound and injections were performed under roadmap fluoroscopic guidance. Detailed angiographies were performed before and after embolization procedures. Control angiograms showed complete or near-complete devascularization in all tumors. Three tumors with multiple small-caliber arterial feeders were treated with primary NBCA injections. One tumor necessitated transarterial embolization after primary injection of Onyx. Six tumors showed regional vascularization from the vasa vasorum or small-caliber branches of the external carotid artery following the transarterial approach. These regions were embolized with NBCA injections. No technical or clinical complications related to embolization procedures occurred. All except one of the tumors were surgically removed following embolization. In conclusion, preoperative devascularization with percutaneous direct injection of NBCA or Onyx is feasible, safe, and effective in head and neck paragangliomas with multiple small-caliber arterial feeders and in cases of incomplete devascularization following transarterial embolization.

Transarterial Embolization With Cyanoacrylate for Severe Arterioportal Shunt Complicated by Hepatocellular Carcinoma

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Shi Haibin, E-mail: shihb@vip.sina.com; Yang Zhengqiang; Liu Sheng; Zhou Weizhong; Zhou Chungao; Zhao Linbo; Xia Jinguo; Li Linsun [First Affiliated Hospital of Nanjing Medical University, Department of Radiology (China)

2013-04-15

To evaluate the efficacy and safety of cyanoacrylate glue embolization in the treatment of severe arterioportal shunt (APS) presenting with hepatofugal portal venous flow in hepatocellular carcinoma (HCC) patients. Between July 2000 and January 2010, 27 HCC patients with severe APS presenting with hepatofugal portal venous flow underwent transarterial angiography and treatment. Among them, four patients were excluded from the study. Twelve patients underwent transarterial chemoperfusion and embolization of APS with cyanoacrylate glue between January 2006 and January 2010 (Emb group), and the other 11 patients undergoing only transarterial chemoperfusion without embolization of APS between July 2000 and December 2005 served as a control group (non-Emb group). The change of APS, survival rates, and procedure related complications were analyzed. In the Emb group, APS was improved in all of the 12 patients after initial glue embolization; long-term APS improvement with hepatopetal portal flow was achieved in 80 % (8 of 10) patients who underwent follow-up angiography. Survival rates in the Emb group were 67 % at 6 months, 33 % at 1 year, and 8 % at 2 years, whereas those in the non-Emb group were 0 % at 6 months (P < 0.05). Median survival time in the Emb group was 275 days, which was longer than that of 107 days in the non-Emb group (P = 0.001). There were no major complications in both groups. The preliminary experience suggests that glue embolization may be an effective and safe therapy in the management of severe APS accompanied by HCC and also improve patient survival.

Uterine Artery Anatomy Relevant to Uterine Leiomyomata Embolization

International Nuclear Information System (INIS)

Gomez-Jorge, Jackeline; Keyoung, Andrew; Levy, Elliot B.; Spies, James B.

2003-01-01

To categorize the anatomic variants of uterine arteries, and determine the incidence of menopausal symptoms where the tubo-ovarian branches were seen prior to embolization. Between July 1997 and June 2000, 257 (n = 257) uterine fibroid embolizations were performed at our institution. Arteriograms were retrospectively evaluated. Uterine arteries were classified into groups: type I (the uterine artery as first branch of the inferior gluteal artery), type II (the uterine artery as second or third branch of the inferior gluteal artery), type III (the uterine artery, the inferior gluteal and the superior gluteal arteries arising as a trifurcation), type IV (the uterine artery as first branch of the hypogastric artery), inconclusive, or not studied. Tubo-ovarian branches were recorded if visualized prior to and/or after embolization. Menopausal symptoms were recorded (n = 175 at 3 months, n = 139 at 6 months, n = 98 at 1 year, n = 22 at 2 years) using written questionnaires. Five hundred and fourteen uterine arteries (n = 514) were evaluated. There were 38% classifiable types, 23% inconclusive, and 39% not studied. Classification was as follows: type I, 45%; type II, 6%; type III, 43%; type IV, 6%. Among 256 patients, tubo-ovarian arteries were seen in 36 prior to embolization, but not afterwards. In this group, 25 patients reported transient menopausal symptoms (hot flashes, amenorrhea). Five patients did not report any menopausal symptoms. Six patients did not answer the questionnaires. Type I is the most common type of anatomy, followed by type III. The tubo-ovarian arteries may be visualized prior to and/or after embolization. The embolization was monitored to avoid embolization of the tubo-ovarian branches. Menopausal symptoms were transient all patients when the tubo-ovarian branches were seen prior to embolization

First multimodal embolization particles visible on x-ray/computed tomography and magnetic resonance imaging.

Science.gov (United States)

Bartling, Soenke H; Budjan, Johannes; Aviv, Hagit; Haneder, Stefan; Kraenzlin, Bettina; Michaely, Henrik; Margel, Shlomo; Diehl, Steffen; Semmler, Wolfhard; Gretz, Norbert; Schönberg, Stefan O; Sadick, Maliha

2011-03-01

Embolization therapy is gaining importance in the treatment of malignant lesions, and even more in benign lesions. Current embolization materials are not visible in imaging modalities. However, it is assumed that directly visible embolization material may provide several advantages over current embolization agents, ranging from particle shunt and reflux prevention to improved therapy control and follow-up assessment. X-ray- as well as magnetic resonance imaging (MRI)-visible embolization materials have been demonstrated in experiments. In this study, we present an embolization material with the property of being visible in more than one imaging modality, namely MRI and x-ray/computed tomography (CT). Characterization and testing of the substance in animal models was performed. To reduce the chance of adverse reactions and to facilitate clinical approval, materials have been applied that are similar to those that are approved and being used on a routine basis in diagnostic imaging. Therefore, x-ray-visible Iodine was combined with MRI-visible Iron (Fe3O4) in a macroparticle (diameter, 40-200 μm). Its core, consisting of a copolymerized monomer MAOETIB (2-methacryloyloxyethyl [2,3,5-triiodobenzoate]), was coated with ultra-small paramagnetic iron oxide nanoparticles (150 nm). After in vitro testing, including signal to noise measurements in CT and MRI (n = 5), its ability to embolize tissue was tested in an established tumor embolization model in rabbits (n = 6). Digital subtraction angiography (DSA) (Integris, Philips), CT (Definition, Siemens Healthcare Section, Forchheim, Germany), and MRI (3 Tesla Magnetom Tim Trio MRI, Siemens Healthcare Section, Forchheim, Germany) were performed before, during, and after embolization. Imaging signal changes that could be attributed to embolization particles were assessed by visual inspection and rated on an ordinal scale by 3 radiologists, from 1 to 3. Histologic analysis of organs was performed. Particles provided a

Pulmonary embolism and cor pulmonale in a cat

International Nuclear Information System (INIS)

Sottiaux, J.; Franck, M.

1999-01-01

A 14-year-old male neutered cat experienced pulmonary embolism 15 days following surgical debridement of a recurrent dorsolumbar abscess. Clinical signs were dominated by respiratory distress. Pulmonary embolism was suggested from the lateral thoracic radiograph by the presence of an abruptly attenuated lobar artery and a contiguous oligaemic area in the caudal lung lobe. Pulmonary hypertension was demonstrated on Doppler echocardiography by right pulmonary artery dilation and tricuspid regurgitation raising the pulmonary arterial pressure to 56 mmHg. Chronic pulmonary hypertension, assumed from right ventricular wall hypertrophy, and hypokinesia, indicating chronic cor pulmonale, was suggestive of chronic rather than acute pulmonary embolism. Postmortem histological evidence of pulmonary arteriolar occlusion confirmed the diagnosis of pulmonary embolism

Embolization of cranial dural arteriovenous fistulae with ONYX: Indications, techniques, and outcomes

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Saraf Rashmi

2010-01-01

Full Text Available Objectives: The purpose of this study was to establish the role of the liquid embolic agent, ONYX, in the treatment of cranial dural arteriovenous fistulae (DAVFs and to redefine the indications, techniques and outcomes of treatment with ONYX. Materials and Methods: This is a retrospective study of 25 DAVF patients who underwent endovascular treatment with ONYX between February 2006 and July 2008. All patients of DAVF presenting in this period were treated with ONYX. Results: Anatomic cure (i.e., complete angiographic closure of the fistula was achieved in a single session and through a single arterial pedicle injection in 21 out of 25 patients (cure rate of 84%. Out of four patients with residual fistulae, one achieved cure that was evident on a control angiogram obtained at 3 months while three had no vascular access for further embolization and so were referred for radiosurgery. There was only one recurrence seen in angiograms obtained at the end of one year and this patient was re-embolized successfully with ONYX. Complications were seen in two patients. Conclusion: ONYX embolization of DAVFs has revolutionized the endovascular treatment of DAVFs, achieving high cure rates in a single session with minimal complications. Transarterial ONYX embolization should be the first option for all locations, except cavernous DAVFs.

Facial Palsy Following Embolization of a Juvenile Nasopharyngeal Angiofibroma.

Science.gov (United States)

Tawfik, Kareem O; Harmon, Jeffrey J; Walters, Zoe; Samy, Ravi; de Alarcon, Alessandro; Stevens, Shawn M; Abruzzo, Todd

2018-05-01

To describe a case of the rare complication of facial palsy following preoperative embolization of a juvenile nasopharyngeal angiofibroma (JNA). To illustrate the vascular supply to the facial nerve and as a result, highlight the etiology of the facial nerve palsy. The angiography and magnetic resonance (MR) imaging of a case of facial palsy following preoperative embolization of a JNA is reviewed. A 13-year-old male developed left-sided facial palsy following preoperative embolization of a left-sided JNA. Evaluation of MR imaging studies and retrospective review of the angiographic data suggested errant embolization of particles into the petrosquamosal branch of the middle meningeal artery (MMA), a branch of the internal maxillary artery (IMA), through collateral vasculature. The petrosquamosal branch of the MMA is the predominant blood supply to the facial nerve in the facial canal. The facial palsy resolved since complete infarction of the nerve was likely prevented by collateral blood supply from the stylomastoid artery. Facial palsy is a potential complication of embolization of the IMA, a branch of the external carotid artery (ECA). This is secondary to ischemia of the facial nerve due to embolization of its vascular supply. Clinicians should be aware of this potential complication and counsel patients accordingly prior to embolization for JNA.

Bronchial Artery Embolization for Massive Hemoptysis: a Retrospective Study

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Ali Fani

2013-05-01

Full Text Available   Introduction: To assess the efficacy and safety of bronchial artery embolization in the treatment of massive hemoptysis.   Materials and Methods: A retrospective study on 46 patients (26 males and 20 females who were referred to the Razavi Hospital from April 2009 to May 2012 with massive hemoptysis and had bronchial artery embolization procedures. General characteristics of the patients including age, gender, etiology, and thorax computed tomograms, findings of bronchial angiographic, results of the embolization, complications related to bronchial artery embolization and clinical outcome during follow-up were reviewed. Results: The etiology included previous pulmonary tuberculosis in 20 cases, previous tuberculosis with bronchiectasis in 16 cases, bronchiectasis in 6 cases, and active pulmonary tuberculosis in one case. No identifiable causes could be detected in three patients. Moreover, massive hemoptysis was successfully and immediately controlled following the embolization procedure in all patients. One patient developed recurrent hemoptysis during one month following the procedure and was treated by re-embolization. No major procedure–related complication such as bronchial infarction was identified However none of the patientsexperienced neurological complications. Conclusion: Bronchial artery embolization is a safe and effective means of controlling massive hemoptysis and should be regarded as the first-line treatment for this condition.

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

Science.gov (United States)

Zakharchenko, A; Kaitoukov, Y; Vinnik, Y; Tradi, F; Sapoval, M; Sielezneff, I; Galkin, E; Vidal, V

2016-11-01

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. 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. No immediate complications were observed and no patients had anal pain syndrome after embolization. Hemorrhoids showed a 43% size reduction after embolization (Phemorrhoids 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) (Phemorrhoids. Short-term results with regard to symptom management for hemorrhoidal disease are very encouraging and should stimulate further prospective and multicenter studies. Copyright © 2016 Editions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

[Embolic stroke by thrombotic non bacterial endocarditis in an Antiphospholipid Syndrome patient].

Science.gov (United States)

Graña, D; Ponce, C; Goñi, M; Danza, A

2016-01-01

The antiphospholipid syndrome (APS) is an acquired thrombophilia, considered a systemic autoimmune disorder. We report a patient with APS who presented multiple cerebral infarcts (stroke) as a complication of a thrombotic non bacterial endocarditis. We review the literature focused on the physiological mechanism that produce this disease and its complications. Clinical features and their prognostic value and the different therapeutic options were also studied.

Thyroid artery embolization for hyperthyroidism

International Nuclear Information System (INIS)

Li Jingyu; Zhang Xinguo; Xu Liyang; Liu Ming; Zhang Yongtian; Jin Weiya

2001-01-01

Objective: To evaluate the method and result of thyroid artery embolization as a new therapy for hyperthyroidism. Methods: Twenty-two patients with hyperthyroidism underwent selective thyroid artery embolization. Totally 52 thyroid arteries were embolized with microspheres. The indications to this therapy were following: hyperthyroid patients having indications to surgical and 131 I therapy, clinically being difficult to complete the preparation for subtotal thyroidectomy and having high risk for surgical process because of their huge thyroid gland. Results: Serum level of thyroid hormones dropped significantly [median T3 from 8.8 nmol/L (4.3-43.0 nmol/L) to 4.0 nmol/L (1.1-9.2 nmol/L), median T4 from 206.4 nmol/L (77.4-748.2 nmol/L) to 144.5 nmol/L (25.8-279.9 nmol/L), P 131 I treatment of hyperthyroidism. A long term follow-up study is still needed

Myocardial Infarction as a Complication of Bronchial Artery Embolization

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Labbé, Hugo, E-mail: hugo.labbe.1@ulaval.ca [Université Laval, Department of Medicine (Canada); Bordeleau, Simon [Université Laval, Department of Emergency Medicine (Canada); Drouin, Christine [Université Laval, Department of Anesthesiology and Critical Care Medicine (Canada); Archambault, Patrick [Université Laval, Department of Emergency Medicine (Canada)

2017-03-15

Bronchial artery embolization is now a common treatment for massive pulmonary hemoptysis if flexible bronchoscopy at the bedside failed to control the bleeding. Complications of this technique range from benign chest pain to devastating neurological impairments. We report the case of a 41-year-old man who developed an ST elevation myocardial infarction during bronchial artery embolization, presumably because of coronary embolism by injected particles. In this patient who had no previously known coronary artery disease, we retrospectively found a communication between the left bronchial artery and the circumflex coronary artery. This fistula was not visible on the initial angiographic view and likely opened because of the hemodynamic changes resulting from the embolization. This case advocates for careful search for bronchial-to-coronary arterial fistulas and the need for repeated angiographic views during embolization procedures.

Cerebral gas embolism due to upper gastrointestinal endoscopy

NARCIS (Netherlands)

ter Laan, Mark; Totte, Erik; van Hulst, Rob A.; van der Linde, Klaas; van der Kamp, Wim; Pierie, Jean-Pierre E.

Cerebral gas embolism as a result of upper gastrointestinal endoscopy is a rare complication and bares a high morbidity. A patient is presented who underwent an upper endoscopy for evaluation of a gastric-mediastinal fistula after subtotal oesophagectomy and gastric tube reconstruction because of

Cerebral gas embolism due to upper gastrointestinal endoscopy

NARCIS (Netherlands)

ter Laan, Mark; Totte, Erik; van Hulst, Rob A.; van der Linde, Klaas; van der Kamp, Wim; Pierie, Jean-Pierre E.

2009-01-01

Cerebral gas embolism as a result of upper gastrointestinal endoscopy is a rare complication and bares a high morbidity. A patient is presented who underwent an upper endoscopy for evaluation of a gastric-mediastinal fistula after subtotal oesophagectomy and gastric tube reconstruction because of

Video-assisted open supraclavicular sympathectomy following air embolism.

Science.gov (United States)

Shpolyanski, G; Hashmonai, M; Rudin, M; Abaya, N; Kaplan, U; Kopelman, D

2012-01-01

Air embolism is a relatively rare complication of thoracoscopic surgery. Open supraclavicular sympathectomy was indicated to overcome the risk of re-embolization. A novel video-assisted technique was performed. conclusions: The previously prevalent open supraclavicular sympathectomy is a good choice for avoiding air embolism. Laparoscopic instrumentation and technology can be used to improve open procedures, especially when exposure and visibility are limited. Sometimes we should remember to use the experience of our teachers.

Mechanisms underlying gas exchange alterations in an experimental model of pulmonary embolism

Directory of Open Access Journals (Sweden)

J.H.T. Ferreira

2006-09-01

Full Text Available The aim of the present study was to determine the ventilation/perfusion ratio that contributes to hypoxemia in pulmonary embolism by analyzing blood gases and volumetric capnography in a model of experimental acute pulmonary embolism. Pulmonary embolization with autologous blood clots was induced in seven pigs weighing 24.00 ± 0.6 kg, anesthetized and mechanically ventilated. Significant changes occurred from baseline to 20 min after embolization, such as reduction in oxygen partial pressures in arterial blood (from 87.71 ± 8.64 to 39.14 ± 6.77 mmHg and alveolar air (from 92.97 ± 2.14 to 63.91 ± 8.27 mmHg. The effective alveolar ventilation exhibited a significant reduction (from 199.62 ± 42.01 to 84.34 ± 44.13 consistent with the fall in alveolar gas volume that effectively participated in gas exchange. The relation between the alveolar ventilation that effectively participated in gas exchange and cardiac output (V Aeff/Q ratio also presented a significant reduction after embolization (from 0.96 ± 0.34 to 0.33 ± 0.17 fraction. The carbon dioxide partial pressure increased significantly in arterial blood (from 37.51 ± 1.71 to 60.76 ± 6.62 mmHg, but decreased significantly in exhaled air at the end of the respiratory cycle (from 35.57 ± 1.22 to 23.15 ± 8.24 mmHg. Exhaled air at the end of the respiratory cycle returned to baseline values 40 min after embolism. The arterial to alveolar carbon dioxide gradient increased significantly (from 1.94 ± 1.36 to 37.61 ± 12.79 mmHg, as also did the calculated alveolar (from 56.38 ± 22.47 to 178.09 ± 37.46 mL and physiological (from 0.37 ± 0.05 to 0.75 ± 0.10 fraction dead spaces. Based on our data, we conclude that the severe arterial hypoxemia observed in this experimental model may be attributed to the reduction of the V Aeff/Q ratio. We were also able to demonstrate that V Aeff/Q progressively improves after embolization, a fact attributed to the alveolar ventilation redistribution

Arterial Embolization in the Management of Mesenteric Bleeding Secondary to Blunt Abdominal Trauma

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Ghelfi, Julien, E-mail: JGhelfi@chu-grenoble.fr; Frandon, Julien, E-mail: JFrandon2@chu-grenoble.fr [CHU de Grenoble, Clinique Universitaire de Radiologie et Imagerie Médicale (France); Barbois, Sandrine, E-mail: SBarbois@chu-grenoble.fr [CHU de Grenoble, Clinique Universitaire de Chirurgie Digestive et d’Urgences (France); Vendrell, Anne, E-mail: AVendrell@chu-grenoble.fr; Rodiere, Mathieu, E-mail: MRodiere@chu-grenoble.fr; Sengel, Christian, E-mail: CSengel@chu-grenoble.fr; Bricault, Ivan, E-mail: IBricault@chu-grenoble.fr [CHU de Grenoble, Clinique Universitaire de Radiologie et Imagerie Médicale (France); Arvieux, Catherine, E-mail: CArvieux@chu-grenoble.fr [CHU de Grenoble, Clinique Universitaire de Chirurgie Digestive et d’Urgences (France); Ferretti, Gilbert, E-mail: GFerretti@chu-grenoble.fr; Thony, Frédéric, E-mail: FThony@chu-grenoble.fr [CHU de Grenoble, Clinique Universitaire de Radiologie et Imagerie Médicale (France)

2016-05-15

IntroductionMesenteric bleeding is a rare but potentially life-threatening complication of blunt abdominal trauma. It can induce active hemorrhage and a compressive hematoma leading to bowel ischemia. Emergency laparotomy remains the gold standard treatment. We aimed to study the effectiveness and complications of embolization in patients with post-traumatic mesenteric bleeding.Materials and MethodsThe medical records of 7 consecutive patients with active mesenteric bleeding treated by embolization in a level-one trauma center from 2007 to 2014 were retrospectively reviewed. All patients presented with active mesenteric bleeding on CT scans without major signs of intestinal ischemia. We focused on technical success, clinical success, and the complications of embolization.ResultsSix endovascular procedures were successful in controlling hemorrhage but 1 patient had surgery to stop associated arterial and venous bleeding. One patient suffered from bowel ischemia, a major complication of embolization, which was confirmed by surgery. No acute renal failure was noted after angiography. For 1 patient we performed combined management as the endovascular approach allowed an easier surgical exploration.ConclusionIn mesenteric trauma with active bleeding, embolization is a valuable alternative to surgery and should be considered, taking into account the risk of bowel ischemia.

Hepatic Artery Angiography and Embolization for Hemobilia Following Laparoscopic Cholecystectomy

International Nuclear Information System (INIS)

Nicholson, Tony; Travis, Simon; Ettles, Duncan; Dyet, John; Sedman, Peter; Wedgewood, Kevin; Royston, Christopher

1999-01-01

Purpose: The effectiveness of angiography and embolization in diagnosis and treatment were assessed in a cohort of patients presenting with upper gastrointestinal hemorrhage secondary to hepatic artery pseudoaneurysm following laparoscopic cholecystectomy. Methods: Over a 6-year period 1513 laparoscopic cholecystectomies were carried out in our region. Nine of these patients (0.6%) developed significant upper gastrointestinal bleeding, 5-43 days after surgery. All underwent emergency celiac and selective right hepatic artery angiography. All were treated by coil embolization of the right hepatic artery proximal and distal to the bleeding point. Results: Pseudoaneurysms of the hepatic artery adjacent to cholecystectomy clips were demonstrated in all nine patients at selective right hepatic angiography. In three patients celiac axis angiography alone failed to demonstrate the pseudoaneurysm. Embolization controlled hemorrhage in all patients with no further bleeding and no further intervention. One patient developed a candidal liver abscess in the post-procedure period. All patients are alive and well at follow-up. Conclusion: Selective right hepatic angiography is vital in the diagnosis of upper gastrointestinal hemorrhage following laparoscopic cholecystectomy. Embolization offers the advantage of minimally invasive treatment in unstable patients, does not disrupt recent biliary reconstruction, allows distal as well as proximal control of the hepatic artery, and is an effective treatment for this potentially life-threatening complication

Rendu-Osler-Weber syndrome presenting with pulmonary arteriovenous fistula

International Nuclear Information System (INIS)

Halefoglu, A.M.

2005-01-01

A pulmonary arteriovenous fistula is an abnormal connection between pulmonary arteries and veins. Patients with Rendu-Osler-Weber syndrome may present with this vascular malformation, which is a typical finding of the disease. Approximately 5-15% of Rendu-Osler-Weber syndrome patients have pulmonary arteriovenous malformations (AVM) and there is usually a family history of AVM in these patients. The malformations are usually located in the lower lobes. In this paper, I describe a 49-year-old male patient with dyspnoea, cough, haemoptysis and epistaxis. Physical examination showed nasal telangiectasias, cyanosis of the lips and nails, and a systolic bruit over the left lung. Chest X-ray revealed a 5-cm mass in the left lower lobe and after magnetic resonance examination, together with 3-D magnetic resonance angiography, it was demonstrated to be a pulmonary arteriovenous fistula. The history of a niece with a similar history of suspected pulmonary arteriovenous fistula led me to consider the possibility of Rendu-Osler-Weber syndrome presenting with a pulmonary arteriovenous fistula. Copyright (2005) Blackwell Science Pty Ltd

Turner Syndrome in Girls Presenting with Coarctation of the Aorta.

Science.gov (United States)

Eckhauser, Aaron; South, Sarah T; Meyers, Lindsay; Bleyl, Steven B; Botto, Lorenzo D

2015-11-01

To evaluate the frequency of Turner syndrome in a population-based, statewide cohort of girls with coarctation of the aorta. The Utah Birth Defects Network was used to ascertain a cohort of girls between 1997 and 2011 with coarctation of the aorta. Livebirths with isolated coarctation of the aorta or transverse arch hypoplasia were included and patients with complex congenital heart disease not usually seen in Turner syndrome were excluded. Of 244 girls with coarctation of the aorta, 77 patients were excluded, leaving a cohort of 167 girls; 86 patients (51%) had chromosomal studies and 21 (12.6%) were diagnosed with Turner syndrome. All patients were diagnosed within the first 4 months of life and 5 (24%) were diagnosed prenatally. Fifteen patients (71%) had Turner syndrome-related findings in addition to coarctation of the aorta. Girls with mosaicism were less likely to have Turner syndrome-associated findings (3/6 mosaic girls compared with 12/17 girls with non-mosaic 45,X). Twelve girls (57%) diagnosed with Turner syndrome also had a bicommissural aortic valve. At least 12.6% of girls born with coarctation of the aorta have karyotype-confirmed Turner syndrome. Such a high frequency, combined with the clinical benefits of an early diagnosis, supports genetic screening for Turner syndrome in girls presenting with coarctation of the aorta. Copyright © 2015 Elsevier Inc. All rights reserved.

Embolization with Gamma Knife Radiosurgery of Giant Intracranial Arteriovenous Malformations.

Science.gov (United States)

Chun, Dong Hyun; Kim, Moo Seong; Kim, Sung Tae; Paeng, Sung Hwa; Jeong, Hae Woong; Lee, Won Hee

2016-01-01

Giant arteriovenous malformations (i.e., those greater than 6 cm maximum diameter or volume > 33 cc) are difficult to treat and often carry higher treatment morbidity and mortality rates. In our study, we reviewed the angiographic results and clinical outcomes for 11 patients with giant arteriovenous malformations who were treated between 1994 and 2012. The patients selected included 9 males (82%) and 2 females (18%). Their presenting symptoms were hemorrhage (n=2; 18%), seizure (n=7; 64%), and headache (n=2; 12%). Nine patients were Spetzler-Martin Grade III, 2 were Spetzler-Martin Grade IV. The mean arteriovenous malformation volume was 41 cc (33-52 cc). The mean age of the patients was 45.1 years (24-57 years) and the mean radiation dose delivered to the margin of the nidus was 14.2 Gy. Ten patients received pre-Gamma Knife radiosurgery embolization and Gamma Knife radiosurgery, 1 patient received pre-Gamma Knife radiosurgery embolization and Gamma Knife radiosurgery twice and the interval between Gamma Knife radiosurgeries was 3 months. The complete obliteration rate following Gamma Knife radiosurgery was 36%, subtotal obliteration ( > 70% decreased size of nidus) was 36%, and partial obliteration was 28%. One patient experienced a small hemorrhage after embolization. Combined embolization and Gamma Knife radiosurgery showed successful obliteration of the arteriovenous malformation nidus. The use of embolization to initially reduce nidus size followed by Gamma Knife radiosurgery improves the treatment results. Repeated Gamma Knife radiosurgery should be a treatment option when there is a small nidus remnant.

Apoptotic study in Graves disease treated with thyroid arterial embolization

International Nuclear Information System (INIS)

Zhao Wei; Gao Bulang; Yi Genfa

2009-01-01

The objective of this study was to investigate apoptosis in the thyroid of Graves disease (GD) induced by thyroid arterial embolization. Forty one patients with clinically and laboratorily ascertained GD were treated with thyroid arterial embolization and followed up for 3-54 months following embolization. Prior to embolization and at 1, 3, 6, 12 and 36 months following embolization, thyroid autoimmune antibodies were tested respectively, including thyroid stimulating antibody (TSAb), thyroglobulin antibody (TGAb) and thyroid microsomal antibody (TMAb). Thyroid biopsy was performed under the guidance of computed tomography for immunohistochemistry examination using semi-quantity analysis. The positive staining of Fas and FasL was mostly in the cytoplasma and cell membrane, the positive expression of Bax was mainly in the cytoplasma, and no positive expression of P53 was detected in the thyroid cells before embolization. After arterial embolziation, the positive cell number and staining degree of these genes were both greater than before embolization. The treatment method of thyroid arterial embolization can effectively enhance the positive expression of pro-apoptotic genes of Fas, FasL, Bax, Bcl-2 and P53 in GD thyroid, thus promoting apoptosis of GD thyroid and helping restore the thyroid size and function to normal conditions. (author)

Can catheter-directed thrombolysis be applied to acute lower extremity artery embolism after recent cerebral embolism from atrial fibrillation?

International Nuclear Information System (INIS)

Si, T.-G.; Guo, Z.; Hao, X.-S.

2008-01-01

Purpose: To assess the feasibility and efficacy of catheter-directed thrombolysis with recombinant tissue plasminogen activator (rt-PA) for acute limb embolism in patients with recent cerebral embolism due to atrial fibrillation. Materials and methods: Eight patients (six men, two women; mean age 63.5 years) with acute embolic occlusion of two left common iliac arteries, four femoral arteries (three left; one right), and two right popliteal arteries were treated. All patients had a history of recent cerebral embolism (mean 6 days, range 5-15 days) and all had a history of atrial fibrillation (duration 5-10 years). Catheter-directed thrombolysis started a few hours (mean 6.2 h; range 3-10 h) after the onset of arterial embolism. Two 5 mg boluses of rt-PA were injected into the proximal clot through a 5 F end-hole catheter and, subsequently, two additional boluses of 5 mg rt-PA were injected into the emboli. In patients with residual emboli, infusion with rt-PA (1 mg/h) was continued. Percutaneous transluminal angioplasty was performed in three patients, and a stent was deployed in one patient. Results: Technical success was achieved in all patients. Clinical success rate was 87.5% (7/8). The one clinical failure was secondary to chronic occlusion of outflow runoff vessels. The mean duration of continuous rt-PA infusion was 3.6 h, the mean total dose of rt-PA administered was 23.6 mg (range 20-28 mg). There was no significant change in stroke scale scores during thrombolysis and no intracerebral haemorrhage was found at computed tomography (CT) after thrombolysis. Minor complications included haematomata at puncture sites (6/8), bleeding around the vascular sheath (2/8), and haematuria (1/8). During the follow-up period of 3-6 months, one patient suffered from recurrent cerebral embolism and died. Conclusions: Catheter-directed thrombolysis with rt-PA is an option for acute lower extremity arterial embolism in patients with recent cerebral embolism and a history of

Can catheter-directed thrombolysis be applied to acute lower extremity artery embolism after recent cerebral embolism from atrial fibrillation?

Energy Technology Data Exchange (ETDEWEB)

Si, T.-G. [Department of interventional treatment, Tianjin medical university cancer Hospital and Institution, Tianjin (China); Guo, Z. [Department of interventional treatment, Tianjin medical university cancer Hospital and Institution, Tianjin (China)], E-mail: dr.guozhi@yahoo.com.cn; Hao, X.-S. [Department of interventional treatment, Tianjin medical university cancer Hospital and Institution, Tianjin (China)

2008-10-15

Purpose: To assess the feasibility and efficacy of catheter-directed thrombolysis with recombinant tissue plasminogen activator (rt-PA) for acute limb embolism in patients with recent cerebral embolism due to atrial fibrillation. Materials and methods: Eight patients (six men, two women; mean age 63.5 years) with acute embolic occlusion of two left common iliac arteries, four femoral arteries (three left; one right), and two right popliteal arteries were treated. All patients had a history of recent cerebral embolism (mean 6 days, range 5-15 days) and all had a history of atrial fibrillation (duration 5-10 years). Catheter-directed thrombolysis started a few hours (mean 6.2 h; range 3-10 h) after the onset of arterial embolism. Two 5 mg boluses of rt-PA were injected into the proximal clot through a 5 F end-hole catheter and, subsequently, two additional boluses of 5 mg rt-PA were injected into the emboli. In patients with residual emboli, infusion with rt-PA (1 mg/h) was continued. Percutaneous transluminal angioplasty was performed in three patients, and a stent was deployed in one patient. Results: Technical success was achieved in all patients. Clinical success rate was 87.5% (7/8). The one clinical failure was secondary to chronic occlusion of outflow runoff vessels. The mean duration of continuous rt-PA infusion was 3.6 h, the mean total dose of rt-PA administered was 23.6 mg (range 20-28 mg). There was no significant change in stroke scale scores during thrombolysis and no intracerebral haemorrhage was found at computed tomography (CT) after thrombolysis. Minor complications included haematomata at puncture sites (6/8), bleeding around the vascular sheath (2/8), and haematuria (1/8). During the follow-up period of 3-6 months, one patient suffered from recurrent cerebral embolism and died. Conclusions: Catheter-directed thrombolysis with rt-PA is an option for acute lower extremity arterial embolism in patients with recent cerebral embolism and a history of

Animal models of cerebral arterial gas embolism

NARCIS (Netherlands)

Weenink, Robert P.; Hollmann, Markus W.; van Hulst, Robert A.

2012-01-01

Cerebral arterial gas embolism is a dreaded complication of diving and invasive medical procedures. Many different animal models have been used in research on cerebral arterial gas embolism. This review provides an overview of the most important characteristics of these animal models. The properties

Cogan's syndrome: present and future directions.

LENUS (Irish Health Repository)

Murphy, Grainne

2009-08-01

Cogan\\'s syndrome, typified by the combination of interstitial keratitis and immune-mediated sensorineural hearing loss, is a rare condition, and commonly associated with a diagnostic delay. Using a standard search protocol, we review the literature to date, focusing on a number of key areas pertaining to diagnosis, presentation and treatment. Using a case illustration of atypical disease which led to fulminant aortic regurgitation, we highlight the need for continued and collaborative research in order to identify negative prognostic factors and thus tailor therapeutic regimens. Atypical Cogan\\'s syndrome is more commonly associated with systemic manifestations than typical disease, and may be refractory to immunosuppressive treatment. We discuss the application of laboratory (e.g antibodies targeting inner ear antigens) and radiological (PET-CT) aids to disease confirmation and detection of sub-clinical vascular inflammation. As illustrated by the included case description, some patients remain refractory to intense immunosuppression and delineation of adverse prognostic factors which may direct treatment, perhaps including the use of PET-CT, will contribute in the future to improving patient outcomes.

The selective external carotid arterial embolization treatment of uncontrollable epistaxis

International Nuclear Information System (INIS)

Yao Qunli; Liu Yizhi; Ni Caifang

2004-01-01

Objective: To evaluate the selective external carotid arterial embolization of uncontrollable epistaxis. Methods: 27 procedures of super-selective external carotid arterial embolization were performed with absorbable gelfoam by using Seldinger's method in 26 cases with uncontrollable epistaxis. Results: 27 procedures of super-selective intra-arterial embolization of uncontrollable epistaxis were all successful without any serious complication. Conclusions: Selective external carotid arterial embolization is safe, effective and successful in the treatment of severe epistaxis. (authors)

Inferior phrenic artery embolization in the treatment of hepatic neoplasms

International Nuclear Information System (INIS)

Duprat, G.; Charnsangavej, C.; Wallace, S.; Carrasco, C.H.

1988-01-01

Twenty-nine inferior phrenic artery embolizations were performed in 20 patients with primary or metastatic hepatic neoplasms. All patients had interruption of their hepatic arteries by previous infusion of chemotherapy, hepatic arterial embolization or surgical ligation. In one patient, bilateral pleural effusions developed following embolization of the inferior phrenic artery. No other severe complications occurred. Inferior phrenic artery embolization is a safe procedure and permits the continuation of transcatheter treatment of hepatic neoplasms. (orig.)

Inferior phrenic artery embolization in the treatment of hepatic neoplasms

Energy Technology Data Exchange (ETDEWEB)

Duprat, G.; Charnsangavej, C.; Wallace, S.; Carrasco, C.H.

Twenty-nine inferior phrenic artery embolizations were performed in 20 patients with primary or metastatic hepatic neoplasms. All patients had interruption of their hepatic arteries by previous infusion of chemotherapy, hepatic arterial embolization or surgical ligation. In one patient, bilateral pleural effusions developed following embolization of the inferior phrenic artery. No other severe complications occurred. Inferior phrenic artery embolization is a safe procedure and permits the continuation of transcatheter treatment of hepatic neoplasms.

Partial thyroid arterial embolization for the treatment of hyperthyroidism

International Nuclear Information System (INIS)

Brzozowski, Krzysztof; Piasecki, Piotr; Zięcina, Piotr; Frankowska, Emilia; Jaroszuk, Andrzej; Kamiński, Grzegorz; Bogusławska-Walecka, Romana

2012-01-01

Background: Hyperactive thyroid gland in patients that are unable to tolerate or accept standard therapy is a common clinical problem. Aim of the study was to evaluate effectiveness of partial thyroid arterial embolization in patients with hyperthyroidism. Material/methods: From May 2004 to November 2005 partial thyroid gland embolization was performed in 15 patients. Mean thyroid gland volume was 162 ml. Embolization of one to three thyriod arteries was performed with the mixture of Histoacryl and Lipiodol. Selective angiography was performed after embolization to ensure that the targeted arteries were completely occluded. Follow-up study covered 12 patients. Results: The embolization procedure was well tolerated by all patients. Three days after embolization fT3 and fT4 levels were higher than before the procedure. Further laboratory tests showed quick reversal to near-normal or normal levels of thyroid hormones. 12 weeks follow-up showed: normal serum levels of fT3, fT4 and TSH in 9 of 12 patients (75%), hyperthyroidism in 3 of 12 patients (25%), goiter volume reduction of approximately 32% of its original volume (from 13 to 76.3%), mean thyroid gland volume of 94 ml. One year after embolization 7 of 12 patients required thyreostatic drugs. At two and four years follow-up thyreostatics doses were significantly lower and thyroid tissue was fibrotic. Conclusions: Based on our results the treatment of the thyroid gland goiters using arterial thyroid gland partial embolization may be offered as an effective alternative for patients who will not or cannot accept standard therapy.

Metastatic neuroendocrine tumor with initial presentation of orbital apex syndrome

Directory of Open Access Journals (Sweden)

Yen-Yu Huang

2017-03-01

Full Text Available The possible etiologies of orbital apex syndrome range from inflammatory, infectious, neoplastic, iatrogenic/traumatic, to vascular processes. In patients without obvious infection or systemic cancer history, judicious use of corticosteroids is a reasonable strategy. We describe a 64-year-old man who presented with orbital apex syndrome and had progressed to total visual loss in three days after admission. Radiological imaging and pathological studies were consistent with a neuroendocrine tumor with multiple metastases. We recommend that a biopsy-proven specimen is warranted in patient with orbital apex syndrome even without a cancer history.

Arterial embolization for the treatment of hemoptysis

International Nuclear Information System (INIS)

Wang Yaoheng; Xiao Enhua

2009-01-01

Hemoptysis is a life-threatening clinical emergency. Many diseases can cause hemoptysis and the blood vessels supplying the bleeding site are complicated and varied. Using endovascular embolization to treat hemoptysis has many advantages. It is safe to apply this technique in a great variety of indications with less contraindications. Besides,this technique is minimally-invasive and takes hemostatic effect immediately with less complications. Therefore, endovascular embolization has become the therapy of first choice for hemoptysis. This paper aims to make a comprehensive review in the respects of embolic materials, technical points, short-term and long-term effectiveness and related complications, etc.. (authors)

Uterine artery embolization for adenomyosis without fibroids

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Kim, M.D. E-mail: mdkim@cha.ac.kr; Won, J.W.; Lee, D.Y.; Ahn, C.-S

2004-06-01

AIM: To evaluate the potential usefulness of transcatheter uterine artery embolization as a treatment for symptomatic adenomyosis in patients without uterine fibroids. MATERIALS AND METHODS: Uterine artery embolization using polyvinyl alcohol particles sized 250-710 mm was performed in 43 patients (mean; 40.3 years, range; 31-52 years) with dysmenorrhoea, menorrhagia, or bulk-related symptoms (pelvic heaviness, urinary frequency) due to adenomyosis without fibroids. All patients underwent pre-procedural and 3.5 months (range 1-8 months) follow-up magnetic resonance imaging (MRI) with contrast enhancement. Clinical symptoms were also assessed at the time of MRI before and after embolization. RESULTS: Significant improvement of dysmenorrhoea (95.2%) and menorrhagia (95.0%) was reported in most patients. Contrast-enhanced MRI revealed non-enhancing areas suggesting coagulation necrosis of adenomyosis in 31 patients (72.1%), decreased size without necrosis in 11 patients (25.6%), and no change in one patient (2.3%). The mean volume reduction of the uteri after uterine artery embolization was 32.5% (from 321.7{+-}142.9 to 216.7{+-}130.1 cm{sup 3}). CONCLUSION: Transcatheter uterine artery embolization is an effective therapy for the treatment of symptomatic pure adenomyosis, and may be a valuable alternative to hysterectomy.

Uterine artery embolization for adenomyosis without fibroids

International Nuclear Information System (INIS)

Kim, M.D.; Won, J.W.; Lee, D.Y.; Ahn, C.-S.

2004-01-01

AIM: To evaluate the potential usefulness of transcatheter uterine artery embolization as a treatment for symptomatic adenomyosis in patients without uterine fibroids. MATERIALS AND METHODS: Uterine artery embolization using polyvinyl alcohol particles sized 250-710 mm was performed in 43 patients (mean; 40.3 years, range; 31-52 years) with dysmenorrhoea, menorrhagia, or bulk-related symptoms (pelvic heaviness, urinary frequency) due to adenomyosis without fibroids. All patients underwent pre-procedural and 3.5 months (range 1-8 months) follow-up magnetic resonance imaging (MRI) with contrast enhancement. Clinical symptoms were also assessed at the time of MRI before and after embolization. RESULTS: Significant improvement of dysmenorrhoea (95.2%) and menorrhagia (95.0%) was reported in most patients. Contrast-enhanced MRI revealed non-enhancing areas suggesting coagulation necrosis of adenomyosis in 31 patients (72.1%), decreased size without necrosis in 11 patients (25.6%), and no change in one patient (2.3%). The mean volume reduction of the uteri after uterine artery embolization was 32.5% (from 321.7±142.9 to 216.7±130.1 cm 3 ). CONCLUSION: Transcatheter uterine artery embolization is an effective therapy for the treatment of symptomatic pure adenomyosis, and may be a valuable alternative to hysterectomy

[Severe pulmonary embolism revealed by status epilepticus].

Science.gov (United States)

Allou, N; Coolen-Allou, N; Delmas, B; Cordier, C; Allyn, J

2016-12-01

High-risk pulmonary embolism (PE) is associated with high mortality rate (>50%). In some cases, diagnosis of PE remains a challenge with atypical presentations like in this case report with a PE revealed by status epilepticus. We report the case of a 40-year-old man without prior disease, hospitalized in ICU for status epilepticus. All paraclinical examinations at admission did not show any significant abnormalities (laboratory tests, cardiologic and neurological investigations). On day 1, he presented a sudden circulatory collapse and echocardiography showed right intra-auricular thrombus. He was treated by thrombolysis and arteriovenous extracorporeal membrane oxygenation. After stabilization, computed tomography showed severe bilateral PE. He developed multi-organ failure and died 4days after admission. Pulmonary embolism revealed by status epilepticus has rarely been reported and is associated with poor prognosis. Physicians should be aware and think of the possibility of PE in patients with status epilepticus without any history or risk factors of seizure and normal neurological investigations. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Systemic embolism produced by subcutaneous injections of liquid silicone for esthetic purposes

International Nuclear Information System (INIS)

Falconi, Guillermo

2003-01-01

Even though its use is not recommended, liquid silicone is a substance that has been used illegally for esthetic purposes for a long time. A case report is presented in which a young woman was injected subcutaneously, by an uncertified practitioner, industrial fluid silicone and subsequently developed a case of systemic embolism with pulmonary, skin and ocular complications. This article explains the physiopathology and the different manifestations of systemic embolism produced by fluid silicone. TAC was used. (The author)

Uterine artery embolization angiography and fertility related aspects

Directory of Open Access Journals (Sweden)

Irina A. Horhoianu

2016-05-01

Full Text Available Purpose. Uterine artery embolization is a minimally invasive technique. It applies the principle of targeted anatomical structure devascularisation with utility in fibroid conservative therapy, including for future fertility preserving status. The objective of our paper represents a description and evaluation of angiography utility as a predictive method for fertility maintenance. Material and Methods. The angiography and ultrasound aspects obtained from a prospective study in which selected patients have undergone uterine artery embolization for fertility preservation are detailed. Results. The following angiography aspects have been detected: left- right shunt and utero-ovarian collaterals; these have been compared with the ultrasound aspects related to the fibroid evolution form a volumetric and Doppler ultrasound point of view. The angiographical description predicts the impact on post embolization fibroid evolution and upon fertility. An analysis is made in order to assess the way in which angiography can contribute to fertility alteration. Conclusions. The angiography aspects during embolization and the following ultrasound aspects can represent predictive factors as to fertility evolution after uterine artery embolization.

DSA diagnosis and embolization therapy of gastrointestinal hemorrhage

International Nuclear Information System (INIS)

Zhou Ruming; Qiu Shuibo; Liu Minhua; Yang Huijun; Zhuang Shaoyu

2006-01-01

Objective: To evaluate the effect of digital subtraction angiography and transcatheter embolization for gastrointestinal hemorrhage. Methods: Twenty patients with gastrointestinal hemorrhage received celiac arteries, superior mesenteric arteries and inferior mesenteric arteries angiography. Superselective angiography were performed when the arteries were suspicious by clinic or angiogrraphy. Ten patients with definite diagnosis and manifestation of hemorrhagic arteries by angiography were embolized after superselective catheterization with gelfoam particles, gelfoam particles and coils, polyvinyl alcohol particles. Results: The positive signs were observed in 13 cases. The DSA features including contrast medium accumulation in the gastrointestinal tract outside vascular, aneurysm, tumorous vascularization and staining, artery affect and local vasospasm. The bleedings were stopped immediately in 8 patients. No rebleeding and intestinal ischaemia or necrosis were observed in 30 days. One patient died in the second day after embolization from multiple organ failure. Rebleeding occurred 3 days after embolization in another patient, and was recovered after surgical operation. Conclusion: DSA is more effective for the diagnosis of gastrointestinal vascular malformation and tumors complicating acute bleeding. Transcatheter embolization is effective and safe to control the hemorrhage. (authors)

[Feasibility and efficiency of embolization of spinal dural arteriovenous fistula].

Science.gov (United States)

Zhang, Hong-qi; Liu, Jiang; Wang, Jian-sheng; Zhi, Xing-long; Zhang, Peng; Bian, Li-song; He, Chuan; Ye, Ming; Wang, Zhi-chao; Li, Meng; Ling, Feng

2013-03-01

To evaluate the feasibility and efficiency of embolization of spinal dural arteriovenous fistula (SDAVF). From December 2010 to May 2012, there were 104 cases of SDAVF were treated, and 26 cases were selected to be treated with embolization. The inclusion criteria was as follows: (1) No anterior or posterior spinal artery originated from the fistula segment; (2) The segmental artery can be catheterized with guiding or micro catheter; (3) High flow in fistula; (4) Patient's situation was not suitable for surgery or general anesthesia. Among 26 cases, there were 22 male and 4 female patients, the average age was 55.9 years (ranged from 34 to 81 years). The locations of SDAVF were 10 cases in thoracic, 9 in lumbar and 7 in sacral segment. The main symptoms were progressive numbness and weakness in both lower extremities, most cases accompanied with difficulties in urination and defecation. The average history was 17.1 months (from 1 to 156 months). ONYX-18 liquid embolic agent or Glubran-2 surgical glue were used as embolic material. The patients not cured with embolization were treated with surgery in the following 1 - 2 weeks. Follow-up evaluation was done with MRI after 3 months and DSA after 6 months, besides physical examination. Fifteen from 26 cases achieved immediate angiographic cure results: 14 in 20 cases which embolized with ONYX-18; only 1 in 6 cases with Glubran-2. Three in 10 cases of thoracic SDAVF and 12 in 16 cases of lumbar/sacral SDAVF were cured with embolization. Partially embolized cases were treated with surgical obliteration of drainage veins within 2 weeks. Cured patients experienced immediate improvement after embolization and kept getting better in the follow-up. All the patients had MRI follow-up after 3 months and DSA follow-up after 6 months. In 6 month's follow-up, MRI showed the edema and flow void signal in the spinal cord disappeared. DSA showed no fistula recurrence or remnant. There was no deterioration case in all of the embolized

MDCT angiography and transcatheter embolization in management ...

African Journals Online (AJOL)

Hassan Abdelsalam

2015-12-18

Dec 18, 2015 ... 14 patients did not have a MDCT and proceeded straight to angiography;. 6 of them showed active bleeding on angiography. Conclusion: MDCT is an excellent technique before angiography and embolization in cases with acute gastrointestinal bleeding. Transcatheter embolization is an effective tool for ...

Unusual presentation of prune belly syndrome: a case report.

Science.gov (United States)

Demisse, Abayneh Girma; Berhanu, Ashenafi; Tadesse, Temesgen

2017-12-04

Prune belly syndrome is a rare congenital malformation of unknown etiology, with the following triad of findings: abdominal muscle wall weakness, undescended testes, and urinary tract abnormalities. In most cases, detection of prune belly syndrome occurs during neonatal or infancy period. In this case report, we describe a 12-year-old boy from Ethiopia with the triad of findings of prune belly syndrome along with skeletal malformations. We are unaware of any previous report of prune belly syndrome in Ethiopia. A 12-year-old Amhara boy from the Northwest Gondar Amhara regional state presented to our referral hospital with a complaint of swelling over his left flank for the past 3 months. Maternal pregnancy course and medical history were noncontributory, and he had an attended birth at a health center. He has seven siblings, none of whom had similar symptoms. On examination he had a distended abdomen, asymmetric with bulging left flank, visible horizontal line, upward umbilical slit, and absent rectus abdominis muscles. His abdomen was soft with a tender cystic, bimanually palpable mass on the left flank measuring 13 × 11 cm. Both testes were undescended and he also has developmental dysplasia of the hips. An abdominal ultrasound revealed a large cystic mass in his left kidney area with echo debris and a hip X-ray showed bilateral developmental dysplasia of the hip. Intraoperative findings were cystic left kidney, both testes were intraperitoneal, tortuous left renal vein, enlarged bladder reaching above umbilicus, and left megaureter. bilateral orchidectomy and left nephrectomy were done. He was given intravenously administered antibiotics for treatment of pyelonephritis and discharged home with an appointment for follow up and possible abdominoplasty. In the current report delayed presentation contributed to testicular atrophy and decision for orchidectomy. Furthermore, he will be at potential risk for sex hormone abnormality. Therefore, diagnosis of prune

Clinical presentation of Attenuated Psychosis Syndrome in children and adolescents: Is there an age effect?

Science.gov (United States)

Ribolsi, Michele; Lin, Ashleigh; Wardenaar, Klaas J; Pontillo, Maria; Mazzone, Luigi; Vicari, Stefano; Armando, Marco

2017-06-01

There is limited research on clinical features related to age of presentation of the Attenuated Psychosis Syndrome in children and adolescents (CAD). Based on findings in CAD with psychosis, we hypothesized that an older age at presentation of Attenuated Psychosis Syndrome would be associated with less severe symptoms and better psychosocial functioning than presentation in childhood or younger adolescence. Ninety-four CAD (age 9-18) meeting Attenuated Psychosis Syndrome criteria participated in the study. The sample was divided and compared according to the age of presentation of Attenuated Psychosis Syndrome (9-14 vs 15-18 years). The predictive value of age of Attenuated Psychosis Syndrome presentation was investigated using receiver operating characteristic (ROC)-curve calculations. The two Attenuated Psychosis Syndrome groups were homogeneous in terms of gender distribution, IQ scores and comorbid diagnoses. Older Attenuated Psychosis Syndrome patients showed better functioning and lower depressive scores. ROC curves revealed that severity of functional impairment was best predicted using an age of presentation cut-off of 14.9 years for social functioning and 15.9 years for role functioning. This study partially confirmed our hypothesis; older age at presentation of Attenuated Psychosis Syndrome was associated with less functional impairment, but age was not associated with psychotic symptoms. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Emergent endovascular embolization of iatrogenic renal vascular injuries

International Nuclear Information System (INIS)

Liu Fengyong; Wang Maoqiang; Duan Feng; Wang Zhijun; Wang Zhongpu

2007-01-01

Objective: To evaluate the efficacy and safety of the interventional techniques for emergent treatment of iatrogenic renal injuries. Methods: Nine patients with iatrogenic renal vascular injuries were treated with superselective renal arterial embolization. The causes of renal injury included post-renal biopsy in 5 patients, endovascular interventional procedure-related in 2, post-renal surgery in 1, and post-percutaneous nephrostomy in 1 patient. The patients presented clinically with hemodynamical unstability with blood loss shock in 7 patients, severe flank pain in 7, and hematuria in 8 patients. Perirenal hematoma was confirmed in 8 patients by CT and ultrasonography. The embolization materials used were microcoils in 7 and standard stainless steel coils in 2 patients, associated with polyvinyl alcohol particles (PVA) in 5, and gelfoam particles in 2 cases. Results: Renal angiogram revealed intra-renal arteriovenous fistula in 6 cases, intrarenal pseudoaneurysm in 2 cases, and the contrast media extravasation in 1 patient. The technical success of the arterial embolization was achieved in all 9 cases within a single session. All angiographies documented complete obliteration of the abnormal vessels together with all major intrarenal arterial branches maintaining patent. Seven patients with hemodynamically compromise experienced immediate relief of their blood loss related symptoms, and another 7 with severe flank pain got relief progressively.. Hematuria ceased in 8 patients within 2-14 days after the embolization and impairment of renal function occurred after the procedure in 5 cases, including transient aggravation (n=3 )and developed new renal dysfunction (n=2). Two of these patients required hemodialysis. Perirenal hematoma were gradually absorbed on ultrasonography during 2-4 months after the procedures. Follow-up time ranged from 6-78 months (mean, 38 months), 4 patients died of other primary diseases of renal and multi-organ failures. Five patients are

Bardet-biedl syndrome presenting with end stage renal failure

International Nuclear Information System (INIS)

Ansari, R.M.; Junejo, A. M.

2006-01-01

A young male presented in the Nephro-Urology Department with advanced renal failure, blindness in early childhood, polydactaly,obesity, decreased mentation and hypogonadism. With these phenotypical features and renal ultrasonographic findings, he was diagnosed as a case of Bardet-Biedl syndrome. Only one younger sister of patient had similar features. Renal impairment is frequent and an important cause of death. End stage renal disease (ESRD) is rarely seen in younger patient of Bardet-Biedl syndrome. However, ESRD in early age is associated with substantially reduced survival. (author)

The selective angiographic diagnosis and endovascular embolization treatment of severe epistaxis

International Nuclear Information System (INIS)

Zhang Xiquan; Lu Yonghong; Sun Jinghua; Guo Deqiang; Li Yuzhen; Wei Aihua

2002-01-01

Objective: To evaluate selective angiographic diagnosis and embolization of severe epistaxis in 57 cases. Methods: 41 cases with spontaneous haemorrhage, 11 cases with traumatic haemorrhage, 3 cases with haemorrhage of nasopharyngeal fibroangioma, and 2 case with haemorrhage of nasopharyngeal carcinoma were included in the study. Selective angiographic diagnosis and embolization of epistaxis were performed with absorbable gelatin sponge or balloon or spring coil by using Seldinger's method. Results: 59 procedure of angiographic diagnosis and embolization were performed in 57 cases. Both maxillaris internal artery embolization was performed in 6 cases. After embolization, satisfactory results were achieved immediately in 55 cases. After 6 months to 2 years' follow-up, no haemorrhage recurred. In 4 cases with traumatic haemorrhage in the face, simple maxillaris internal artery embolization was performed in 2 cases. Conclusion: Selective angiographic diagnosis and embolization are safe, effective, and successful method of choices in the treatment of severe epistaxis

Percutaneous N-Butyl cyanoacrylate embolization of a pancreatic pseudoaneurysm after failed attempts of transcatheter embolization

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Kim, Ri Hyeon; Yoo, Roh Eul; Kim, Hyo Cheol [Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Seoul (Korea, Republic of)

2014-10-15

One common complication after major pancreatic surgery is bleeding. Herein we describe a case of pancreatic pseudoaneurysm which developed after pylorous preserving pancreaticoduodenectomy for common bile duct cancer. Three attempts of transcatheter embolization failed since feeders to the pseudoaneurysm had unfavorable anatomy. Direct percutaneous N-butyl cyanoacrylate injection was performed under fluoroscopy-guidance and the pseudoaneurysm was successfully treated. Percutaneous fluoroscopy-guided direct N-butyl cyanoacrylate injection may be a useful alternative when selective transcatheter embolization fails or is technically challenging.

A unique case of Shwachman-Diamond syndrome presenting with congenital hypopituitarism.

Science.gov (United States)

Jivani, Nurin; Torrado-Jule, Carmen; Vaiselbuh, Sarah; Romanos-Sirakis, Eleny

2016-11-01

Shwachman-Diamond syndrome (SDS) is an autosomal recessive bone marrow failure syndrome typically characterized by neutropenia and pancreatic dysfunction, although phenotypic presentations vary, and the endocrine phenotype is not well-described. We report a unique case of a patient with SDS who initially presented with hypoglycemia and micropenis in the newborn period and was diagnosed with congenital hypopituitarism. We are not aware of any other cases of SDS documented with this combination of complex endocrinopathies.

Pathophysiology of spontaneous venous gas embolism

Science.gov (United States)

Lambertsen, C. J.; Albertine, K. H.; Pisarello, J. B.; Flores, N. D.

1991-01-01

The use of controllable degrees and durations of continuous isobaric counterdiffusion venous gas embolism to investigate effects of venous gas embolism upon blood, cardiovascular, and respiratory gas exchange function, as well as pathological effects upon the lung and its microcirculation is discussed. Use of N2O/He counterdiffusion permitted performance of the pathophysiologic and pulmonary microstructural effects at one ATA without hyperbaric or hypobaric exposures.

Carefully calibrated microsphere embolization of tumors and AVMs

International Nuclear Information System (INIS)

Laurent, A.; Wassef, M.; Beaujeux, R.; Hodes, J.E.; Gobin, P.Y.; Schenker, C.; Bouchez, B.; Brette, M.D.; Aymard, A.; Cophignon, J.; Merland, J.J.

1990-01-01

This paper evaluates the efficacy of a new type of uniformly calibrated microsphere for embolization of various pathologies. Fourteen tumors (five intracranial, eight extracranial, one spine), and seven facial arteriovenous malformations (AVMs) (nose, lip, and scalp) were embolized preoperatively. Angiographic, surgical devascularization, and histologic findings were correlated with the spheres' size. In the second part of the study, spinal cord (n = 22) and intracerbral (n = 14) AVM, Weber-Osler-Rendu disease (n = 2), and epistaxis (n = 1) embolization was angiographically evaluated

Successful treatment of massive pulmonary embolism with prolonged catheter-directed thrombolysis.

LENUS (Irish Health Repository)

Kelly, Peter

2012-02-03

This is a case report of a young woman who presented with an extensive pulmonary embolism and echocardiographic evidence of right ventricular dysfunction. Although hemodynamically stable, the patient\\'s clinical condition failed to improve with standard heparin anticoagulation. Successful local catheter-directed thrombolysis was performed over an extended period of 48 h with regular monitoring of response to therapy by computed tomography-pulmonary angiography and echocardiography. To our knowledge, treatment of a pulmonary embolism by catheter-directed thrombolytic infusion over an extended period of 48 h has not previously been described.

Preoperative embolization for juvenile nasopharyngeal angiofibroma. Usefulness of IADSA and problems of external carotid ligation

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Saitoh, Ryuichi; Nakagawa, Nobuo; Kohrogi, Yukinori; Izunaga, Hiroshi; Bussaka, Hiromasa; Miyawaki, Masayuki; Takahashi, Mutsumasa; Ikawa, Tsutomu; Ishikawa, Takashi (Kumamoto Univ. (Japan). School of Medicine)

1984-10-01

Three male cases of juvenile nasopharyngeal angiofibroma are presented. Satisfactory results were obtained by performing preoperative embolization combined with intraarterial digital subtraction angiography (IADSA) in two of them. The other case had undergone external carotid ligation. Usefulness of IADSA in performing preoperative embolization for this disease and problems of external carotid ligation are discussed.

Transcatheter Arterial Embolization for Primary Postpartum Hemorrhage: Predictive Factors of Need for Embolic Material Conversion of Gelatin Sponge Particles to N-Butyl Cyanoacrylate

Energy Technology Data Exchange (ETDEWEB)

Tanahashi, Yukichi; Goshima, Satoshi, E-mail: gossy@par.odn.ne.jp [Gifu University Hospital, Department of Radiology (Japan); Kondo, Hiroshi [Teikyo University School of Medicine, Department of Radiology (Japan); Ando, Tomohiro; Noda, Yoshifumi; Kawada, Hiroshi; Kawai, Nobuyuki [Gifu University Hospital, Department of Radiology (Japan); Kotoku, Junichi [Teikyo University School of Medicine, Department of Radiological Technology, Faculty of Medical Technology (Japan); Furui, Shigeru [Teikyo University School of Medicine, Department of Radiology (Japan); Matsuo, Masayuki [Gifu University Hospital, Department of Radiology (Japan)

2017-02-15

PurposeTo identify predictive factors for embolic material conversion to N-butyl cyanoacrylate (NBCA) for the treatment of primary postpartum hemorrhage (PPH) after failed transcatheter arterial embolization (TAE) using gelatin sponge (GS).Materials and MethodsInstitutional review board approval was obtained. We retrospectively studied 62 consecutive women with primary PPH who underwent TAE between January 2006 and March 2015. Five of them were excluded for the following: cardiopulmonary arrest at arrival (n = 1), uterine inversion (n = 1), and hysterectomy after TAE (n = 3). Remaining 57 women (age range, 21–43 years; mean, 32.6 years) comprised study population. TAE was initially performed using GS in all cases and then converted to NBCA after two embolizations using GS with persistent hemodynamic instability or vaginal bleeding. The patients’ background, uterine height, vital signs, laboratory tests, disseminated intravascular coagulation score, and details of procedure were reviewed. Univariate and multivariate analyses were performed to determine factors related to embolic material conversion.ResultsTechnical success rate was 100%. Fourteen patients (25%) needed embolic material conversion to NBCA. Univariate analysis showed that uterine height, systolic blood pressure (sBP), and hemoglobin level were significantly related to embolic material conversion to NBCA (P = 0.029, 0.030, and 0.042). Logistic regression analysis showed that uterine height (odds ratio, 1.37; P = 0.025) and sBP (odds ratio, 0.96; P = 0.003) were associated with embolic material conversion to NBCA.ConclusionUterine height and sBP can be predictive factors for embolic material conversion to NBCA for the treatment of PPH.Level of EvidenceLevel 4, Case Control Study.

Transcatheter Arterial Embolization for Primary Postpartum Hemorrhage: Predictive Factors of Need for Embolic Material Conversion of Gelatin Sponge Particles to N-Butyl Cyanoacrylate

International Nuclear Information System (INIS)

Tanahashi, Yukichi; Goshima, Satoshi; Kondo, Hiroshi; Ando, Tomohiro; Noda, Yoshifumi; Kawada, Hiroshi; Kawai, Nobuyuki; Kotoku, Junichi; Furui, Shigeru; Matsuo, Masayuki

2017-01-01

PurposeTo identify predictive factors for embolic material conversion to N-butyl cyanoacrylate (NBCA) for the treatment of primary postpartum hemorrhage (PPH) after failed transcatheter arterial embolization (TAE) using gelatin sponge (GS).Materials and MethodsInstitutional review board approval was obtained. We retrospectively studied 62 consecutive women with primary PPH who underwent TAE between January 2006 and March 2015. Five of them were excluded for the following: cardiopulmonary arrest at arrival (n = 1), uterine inversion (n = 1), and hysterectomy after TAE (n = 3). Remaining 57 women (age range, 21–43 years; mean, 32.6 years) comprised study population. TAE was initially performed using GS in all cases and then converted to NBCA after two embolizations using GS with persistent hemodynamic instability or vaginal bleeding. The patients’ background, uterine height, vital signs, laboratory tests, disseminated intravascular coagulation score, and details of procedure were reviewed. Univariate and multivariate analyses were performed to determine factors related to embolic material conversion.ResultsTechnical success rate was 100%. Fourteen patients (25%) needed embolic material conversion to NBCA. Univariate analysis showed that uterine height, systolic blood pressure (sBP), and hemoglobin level were significantly related to embolic material conversion to NBCA (P = 0.029, 0.030, and 0.042). Logistic regression analysis showed that uterine height (odds ratio, 1.37; P = 0.025) and sBP (odds ratio, 0.96; P = 0.003) were associated with embolic material conversion to NBCA.ConclusionUterine height and sBP can be predictive factors for embolic material conversion to NBCA for the treatment of PPH.Level of EvidenceLevel 4, Case Control Study

Evaluation of a liquid embolization agent (Onyx) for transcatheter embolization for renal vascular lesions

Energy Technology Data Exchange (ETDEWEB)

Rennert, Janine; Herold, T.; Schreyer, A.G.; Jung, E.M.; Mueller-Wille, R.; Zorger, N. [Inst. fuer Roentgendiagnostik, Klinikum der Univ. Regensburg (Germany); Banas, B.; Feuerbach, S. [Medizinische Klinik, Nephrologie, Univ. Regensburg (Germany); Lenhart, M. [Klinik fuer Diagnostische und Interventionelle Radiologie, Sozialstiftung Bamberg (Germany)

2009-10-15

Purpose: to evaluate the therapeutic outcome after endovascular treatment of renal vascular lesions using the liquid embolization agent, Onyx. Materials and methods: between 2004 and 2008 nine patients with renal vascular lesions were treated with transcatheter arterial embolization using Onyx. The renal vascular lesions consisted of 4 AV-fistulas, a pseudoaneurysm, bleeding from a single subsegmental artery, diffuse parenchymal bleeding after trauma, septic embolizations and multiple aneurysms in endocarditis. All patients underwent selective angiography of the renal artery. A dimethyl sulfoxide (DMSO)-compatible microcatheter was used and Onyx was injected. The technical and clinical success rate, examination time and procedure-related complications were documented. Results: the overall technical and clinical success rate was 100%. One patient had to be treated twice due to recurrent bleeding after an accidental puncture with a drainage catheter. No loss of viable renal tissue occurred in 4 cases. In 4 patients mild to moderate parenchyma loss was noted. In one patient having diffuse renal bleeding, occlusion of the main renal artery was performed. No procedure-related complications were noted. The mean examination time was 16.17 min when treating with Onyx alone and 60 min when using a combination of Onyx and coils. Within an average follow-up period of 21 months, no recurrent renal bleeding or recurrent AV-fistulas occurred. Conclusion: Onyx is an effective embolization agent for the treatment of renal vascular lesions. It allows controlled and quick application with low complication rates and a short examination time as a standalone agent or in combination with coils. (orig.)

Aortic embolization of an Edwards SAPIEN prosthesis due to sigmoid left ventricular hypertrophy: Case report.

Science.gov (United States)

Yuksel, Isa Öner; Koklu, Erkan; Arslan, Sakir; Cagirci, Goksel; Kucukseymen, Selcuk

2016-06-01

Transcatheter aortic valve implantation (TAVI) is considered an alternative therapy in high-risk patients with severe aortic stenosis. Although a minimally invasive procedure, it is not free from complications, one of which is valve embolization at the time of TAVI. We present a case of embolization of a balloon-expandable aortic valve due to sigmoid left ventricular hypertrophy and managed with a second valve without surgery. The embolized valve was repositioned in the aortic arch between the left common carotid artery and the brachiocephalic trunk. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

Churg-Strauss syndrome presenting with conjunctival and eyelid masses: a case report.

Science.gov (United States)

Ameli, F; Phang, K S; Masir, N

2011-12-01

Churg-Strauss syndrome, a small and medium vessel vasculitis, was first described by Churg and Strauss in 1951. It is characterised by the presence of asthma, prominent tissue and blood eosinophilia, systemic vasculitis, and pulmonary and systemic necrotising allergic granulomas. Involvement of the skin, heart and gastrointestinal tract is well documented, but ocular presentation is unusual. We describe a 40-year-old lady who presented with recurrent upper eyelid swelling due to conjunctival lesions. Although she has chronic asthma, Churg-Strauss syndrome was never suspected. The diagnosis of Churg-Strauss syndrome was only made following histological examination of the conjunctival lesions.

Cement pulmonary embolism after vertebroplasty.

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Sifuentes Giraldo, Walter Alberto; Lamúa Riazuelo, José Ramón; Gallego Rivera, José Ignacio; Vázquez Díaz, Mónica

2013-01-01

In recent years, the use of vertebral cementing techniques for vertebroplasty and kyphoplasty has spread for the treatment of pain associated with osteoporotic vertebral compression fractures. This is also associated with the increased incidence of complications related with these procedures, the most frequent being originated by leakage of cementation material. Cement can escape into the vertebral venous system and reach the pulmonary circulation through the azygous system and cava vein, producing a cement embolism. This is a frequent complication, occurring in up to 26% of patients undergoing vertebroplasty but, since most patients have no clinical or hemodynamical repercussion, this event usually goes unnoticed. However, some serious, and even fatal cases, have been reported. We report the case of a 74-year-old male patient who underwent vertebroplasty for persistent pain associated with osteoporotic L3 vertebral fracture and who developed a cement leak into the cava vein and right pulmonary artery during the procedure. Although he developed a pulmonary cement embolism, the patient remained asymptomatic and did not present complications during follow-up. Copyright © 2012 Elsevier España, S.L. All rights reserved.

Pulmonary Cement Embolism following Percutaneous Vertebroplasty

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Ümran Toru

2014-01-01

Full Text Available Percutaneous vertebroplasty is a minimal invasive procedure that is applied for the treatment of osteoporotic vertebral fractures. During vertebroplasty, the leakage of bone cement outside the vertebral body leads to pulmonary cement embolism, which is a serious complication of this procedure. Here we report a 48-year-old man who was admitted to our hospital with dyspnea after percutaneous vertebroplasty and diagnosed as pulmonary cement embolism.

Neuroleptic malignant syndrome following catatonia: Vigilance is the price of antipsychotic prescription

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Thomas J Reilly

2017-03-01

Full Text Available Objectives: To describe a case of neuroleptic malignant syndrome following antipsychotic treatment of catatonia, highlighting the potentially serious complications of this rare adverse drug reaction. Methods: We present a case report of a patient who developed this syndrome with various sequelae. Results: The patient developed neuroleptic after being treated with lorazepam and olanzapine for catatonia. He subsequently developed the complications of rhabdomyolysis, acute kidney injury, pulmonary embolism, urinary retention and ileus. He received high-dose lorazepam, anticoagulation and intravenous fluids. Antipsychotic medication in the form of haloperidol was reinstated with no adverse effect, and he went on to make a full recovery. Conclusions: This case illustrates the potential life-threatening complications of neuroleptic malignant syndrome and the need for a low index of clinical suspicion. It also highlights the lack of evidence for treatment of catatonia, including the use of antipsychotics.

Cerebral Venous Thrombosis and Pulmonary Embolism with Prothrombin G20210A Gene Mutation

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Dagli, Canan Eren; Koksal, Nurhan; Guler, Selma; Gelen, Mehmet Emin; Atilla, Nurhan; Tuncel, Deniz

2010-01-01

A 25-year-old man presented with symptoms of syncope, cough, headache and hemoptysis. Cranial MR and venography showed thrombus formation in the right transverse sinus and superior sagittal sinus. Computed tomographic pulmonary angiography (CTPA) showed an embolic thrombus in the right pulmonary truncus and lung abscess. The patient was young, and there were no signs of lower extremity deep venous thrombosis or other major risk factors for pulmonary embolism (PE) including cardiac anomaly. Th...

Experimental study of vascular embolization with homemade second-level Copper coil

International Nuclear Information System (INIS)

Jiang Hua; Wang Jiaping; Li Yingchun; Tong Yuyun; Yang Qing; Yan Dong; Ding Lili; Yuan Shuguang

2013-01-01

Objective: To evaluate the embolic effect of homemade copper coil in rabbits. Methods: Seventeen New Zealand Big Ear Rabbit was included in this study. After conventional anesthesia, one common carotid artery or subclavian artery was embolized with second-level copper coated platinum microcoils (experimental group) through a 3F catheter, and the other common carotid artery or subclavian artery was embolized with second-level platinum micro-coils (control group) as control. Angiography was processed to observe the extent of vascular occlusion 10 min, 30 min, 3 d, 1 w, 2 w, 4 w, 6 w, and 12 w after embolization respectively. The rabbits were sacrificed to observe thrombosis and pathological change of the embolic artery 3 days, 1 w, 2 w, 4 w, 6 w and 12 w after the embolization. Vascular occlusion and thrombosis were compared between experimental group and the control group by using the exact probability method and rank sum test for statistical analysis. Results: Embolization experiment was successfully implemented in 15 of 17 rabbits. Twenty-one second-level copper coated platinum micro-coils were used in the experimental group, while 19 second-level platinum micro-coils were used in the control group. Ten min and 30 min after embolization, angiography showed that vascular embolization effect was not significantly different between the two groups. The vascular embolization effect of the experiment group was superior to control group 3 d, 1, 2, 4, 6 and 12 w after embolization (P < 0.05). Pathological examination showed that there were a lot of blood clots around the copper coil and in the proximal and distal arterial lumen. Only a small amount of blood clots was found around the platinum coil in the control group. For every time point of observation, thrombosis was more severe in the experiment group than that in the control group (P < 0.05). Conclusion: Second-level copper coated coil can be released with 4F catheter to embolize the vessel, showing good physical

Concomitant coronary and pulmonary embolism associated with patent foramen ovale: A case report.

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Chen, Zhongxiu; Li, Chen; Li, Yajiao; Tang, Hong; Rao, Li; Wang, Mian

2017-12-01

The differential diagnosis of acute chest pain is very important, and can sometimes be challenging. Related diseases share a number of risk factors, and occasionally, 1 condition causes another disease to develop. We described a 59-year-old man who presented to emergency department complaining of chest pain. He was suffered acute myocardial infarction (MI) and pulmonary embolism (PE) simultaneously. Dual antiplatelet therapy, statin, and low molecular weight heparin were administrated during his stay. The searches for cancers, autoimmune diseases, and hematologic diseases were unremarkable, ruling out a hypercoagulable state. Subsequent ultrasound scan revealed a thrombus in a vein of the lower left extremity. Thus, paradoxical embolism was highly suspected. Paradoxical embolism is a rare cause of acute MI, which may have occurred in our patient. This was evidenced by a previously unrecognized patent foramen ovale (PFO) with a right-to-left atrial shunt detected using contrast transesophageal echocardiography. Acute MI complicated with PE is not common in the clinical setting. The fatal condition is difficult to diagnose because of the similar symptoms and confusing causes. Paradoxical embolism can cause this phenomenon, and physicians should be highly vigilant in the search for a PFO in cases of paradoxical embolism. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

Embolization of renal arteries before transplantation in patients with polycystic kidney disease: a single institution long-term experience

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Petitpierre, F.; Cornelis, F.; Lasserre, A.S.; Tricaud, E.; Le Bras, Y.; Grenier, N. [Pellegrin Hospital, Department of Radiology, Bordeaux (France); Couzi, L.; Merville, P. [Pellegrin Hospital, Department of Nephrology, Bordeaux (France); Combe, C.; Ferriere, J.M. [Pellegrin Hospital, Department of Urology, Bordeaux (France)

2015-11-15

We aimed to retrospectively assess the long-term safety and efficacy of embolization of renal arteries (ERA) in patients with polycystic kidney disease (PKD) before renal transplantation. Between January 2008 and November 2013, 82 ERA procedures were performed on 76 kidneys in 73 patients (mean age 53 years, range: 34-72). All patients had terminal-stage PKD and were under dialysis and on the renal transplant waiting list with a temporary contraindication due to excessive renal volume. ERA was considered successful in 89.5 % (68/76) of embolized kidneys, meaning that the temporary contraindication for transplantation could be withdrawn for 65 patients (on average 5.6 months, range: 2.8-24.3, after ERA). Mean volume reduction was 40 (range: 2-69) at 3 months and 59 % (35-86) thereafter (both p < 0.001). Post-embolization syndrome occurred after 15 of 82 procedures (18.3 %). The severe complication rate was 4.9 %. Forty-three (67.7 %) transplantations were successfully conducted after ERA, with a mean follow-up of 26.2 months (range: 1.8-59.5), and the estimated 5-year graft survival rate was 95.3 % [95 % CI: 82.7-98.8]. ERA is a safe and effective alternative to nephrectomy before renal transplantation in patients with PKD. (orig.)

Embolization of renal arteries before transplantation in patients with polycystic kidney disease: a single institution long-term experience

International Nuclear Information System (INIS)

Petitpierre, F.; Cornelis, F.; Lasserre, A.S.; Tricaud, E.; Le Bras, Y.; Grenier, N.; Couzi, L.; Merville, P.; Combe, C.; Ferriere, J.M.

2015-01-01

We aimed to retrospectively assess the long-term safety and efficacy of embolization of renal arteries (ERA) in patients with polycystic kidney disease (PKD) before renal transplantation. Between January 2008 and November 2013, 82 ERA procedures were performed on 76 kidneys in 73 patients (mean age 53 years, range: 34-72). All patients had terminal-stage PKD and were under dialysis and on the renal transplant waiting list with a temporary contraindication due to excessive renal volume. ERA was considered successful in 89.5 % (68/76) of embolized kidneys, meaning that the temporary contraindication for transplantation could be withdrawn for 65 patients (on average 5.6 months, range: 2.8-24.3, after ERA). Mean volume reduction was 40 (range: 2-69) at 3 months and 59 % (35-86) thereafter (both p < 0.001). Post-embolization syndrome occurred after 15 of 82 procedures (18.3 %). The severe complication rate was 4.9 %. Forty-three (67.7 %) transplantations were successfully conducted after ERA, with a mean follow-up of 26.2 months (range: 1.8-59.5), and the estimated 5-year graft survival rate was 95.3 % [95 % CI: 82.7-98.8]. ERA is a safe and effective alternative to nephrectomy before renal transplantation in patients with PKD. (orig.)

Technique and methods in uterine leiomyoma embolization; Technik und Methodik der Uterusmyomembolisation

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Helmberger, T.K.; Jakobs, T.F.; Reiser, M.F. [Institut fuer Klinische Radiologie, Klinikum der Universitaet Muenchen-Grosshadern (Germany)

2003-08-01

Uterine leiomyomas are the most common benign tumors of the female urogenital tract. Beside the classic surgical treatment options the minimal-invasive embolization therapy of the leiomyomas increasingly gains importance world-wide. Technique, complications, and results of uterine leiomyoma embolization will be presented. After careful evaluation of indications for embolization the procedure is mostly performed under conscious sedation. A single-sided femoral access route together with cross-over technique generally allows for a flow-directed embolization via both uterine arteries. After embolizing the vessels supplying the tumor, the uterine arteries should be still patent. The success rate of embolization of uterine leiomyomas ranges between 85 and 100%, whereas a reduction in size of the tumors in 42 to 83% and a relief of symptoms in up to 96% can be achieved. The total complication rate is about 10% with mainly ''minor complications''. Worldwide only three deaths following embolization of uterine leiomyomas were reported. The high technical and clinical success rate together with a low complication rate make the embolization of uterine leiomyomas a minimally-invasive alternative to the classic treatment. As long term results are not available indication to embolization of uterine leiomyomas must be carefully established in consensus with gynecologists. (orig.) [German] Uterusmyome sind die haeufigsten benignen Tumoren des weiblichen Genitaltrakts. Neben den klassischen operativ-gynaekologischen Behandlungsverfahren gewinnt die minimal-invasive Uterusmyomembolisation (UME) weltweit an Bedeutung. Technik, Komplikationen und Ergebnisse der UME werden vorgestellt. Die Indikation zur UME muss sehr sorgfaeltig und kritisch gestellt werden. Die Intervention kann meist unter Analgosedierung vorgenommen werden. Die Embolisation kann in der Regel ueber einen einseitigen femoralen Zugang erfolgen. In beide Aa. uterinae wird das Embolisat

A proposed angioarchitecture grading system related to embolization of brain arteriovenous malformations

International Nuclear Information System (INIS)

Fang Bing; Wang Yirong; Li Tielin; Duan Chuanzhi

2007-01-01

Objective: To analyze the risk of embolization of brain AVMs, study the angioarchitectural factors affecting the difference of embolization level, and to establish the angioarchitecture grading system for embolization of brain AVMs. Methods: The clinical data, angioarchitectural features, embolism complication and embolism level were retrospectively analyzed. Multivariate statistical analysis was performed to determine if any of the variables was predictive of a poor outcome of embolization (death or permanent neurological deficit), and if any of the variables was predictive of the percentage obliteration achieved by embolization. Based on the above results, we established the angioarchitecture grading system. Results: Endovascular procedures for embolization were performed 324 times in 189 patients during an 11-year period. Embolization was performed using N-butyl cyanoacrylate. In those patients, 3 (1.6%) died and 5(2.6%) had a permanent neurological deficit as a result of the embolization. The AVMs were given a score from 0 to 5 based on the size, number of the first grade feeding artery, and number of the second grade feeding artery. The assigned scores were as follows: nidus size (AVF=0, <30 mm=1, ≥30 mm=2), number of the first grade feeding artery (1=0, 2-3=1, ≥4=2)and number of the second grade feeding artery(≤3=0, ≥4=1). Angiographic results based on percentage obliteration were grouped into four categories: complete, 80%-99%, 50%-79%, and 0%-50%. In the AVMs with angioarchitecture scores 0-1, 24(77.4% )of 31 were fully embolised, with scores of 4-5, none of the 101 were fully embolised, 82(81.2%)were below 50% embolization percentage. The correlation between the angioarchitecture grading system and the embolization percentage was strong (κ= 0.736, P<0.05). Conclusions: The angioarchitecture grading system predicts the embolization percentage perfectly. The lower the scores, the higher the possibility of fully embolization is; the higher the scores

Improving the results of transarterial embolization of type 2 endoleaks with the embolic polymer Onyx.

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Wojtaszek, Mikolaj; Wnuk, Emilia; Maciag, Rafal; Solonynko, Bohdan; Korzeniowski, Krzysztof; Lamparski, Krzysztof; Rowinski, Olgierd

2016-01-01

Type 2 endoleaks (T2E) occur in 10 to 20% of patients after endovascular abdominal aortic aneurysm repair (EVAR) and remain a significant clinical issue. To evaluate the efficacy and clinical outcomes of transarterial treatment of persistent type II endoleaks after EVAR using the liquid embolic Onyx. From February 2012 to August 2015 transarterial T2E embolization was attempted in 22 patients (21 men, median age: 73, range: 62-88 years). Indications for treatment included an increase in the diameter of the aneurysm sac above 5 mm and a persistent endoleak observed for more than 6 months. Mean time from EVAR to endoleak treatment was 43 months (range: 2-125 months). Primary technical success was achieved in 17 (77.3%) patients and secondary technical success in 81.8%, with 0% in-hospital mortality. The mean procedure time was 95 ±48 min, with an average fluoroscopy time of 54 ±25 min. The mean amount of Onyx used was 7.5 ±6.6 ml. Clinical success was seen in 17/21 patients with follow-up imaging (80.9%). Mean follow-up time was 17 months (range: 3-38 months). Onyx has been shown to effectively stabilize previous aneurysm growth as a result of the T2E in the majority of our patients. Transarterial embolization of T2E can be significantly improved as compared to previously reported results by using liquid embolic polymers such as Onyx.

Transcatheter arterial embolization for congenital renal arteriovenous malformation

International Nuclear Information System (INIS)

Zhou Jun; Hu Tingyang; Yuan Jianhua; Yu Wenqiang

2008-01-01

Objective: To evaluate the effectiveness of transcatheter arterial embolization for congenital renal arteriovenous malformation. Methods: Seven cases of congenital renal arteriovenous malformation causing gross hematuria were retrospectively studied. All of 7 cases were demonstrated by means of angiography and then the catheter was placed superselectively into the involved arterial end of the malformation undertaking embolization with gelfoam, dehydrated ethanol, coils, etc. Results: All the malformations of the 7 cases were successfully embolized with stoppage of gross hematuria within 24 hours. No serious complications occurred except lumbago, fever, gastrointestinal reaction for one week. There was no recurrence of haematuria and the renal function was also normal in all cases during the follow-up for 36 to 98 months. Conclusions: Transcatheter renal arterial angiography and embolization are the important and effective management for the diagnosis and treatment of congenital renal arteriovenous malformation. (authors)

Electrocardiographic findings in Emergency Department patients with pulmonary embolism.

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Richman, Peter B; Loutfi, Hassan; Lester, Steven J; Cambell, Patricia; Matthews, Jessica; Friese, Jeremy; Wood, Joseph; Kasper, David; Chen, Frederick; Mandell, Mark

2004-08-01

To assess the pre-study, null hypothesis that there is no difference in the electrocardiogram (EKG) findings for Emergency Department (ED) patients who rule in vs. rule out for suspected pulmonary embolism, a retrospective review of a cohort of patients with pulmonary embolism and their controls was conducted in an academic, suburban ED. Patients who were evaluated in the ED during a one-year study period for symptoms suggestive of pulmonary embolism were eligible for inclusion. All patients with pulmonary embolism and sex- and age-matched controls comprised the final study groups. Two board-certified cardiologists reviewed each patient's EKG. There were 350 eligible patients identified; 49 patients with pulmonary embolism and 49 controls were entered into the study. The most common rhythm observed in both groups was normal sinus rhythm (67.3% cases vs. 68.6 % controls; p = 1.0). Abnormalities believed to be associated with pulmonary embolism occurred with similar frequency in both case and control groups (sinus tachycardia [18.8 % vs. 11.8%, respectively; p = 0.40]), incomplete right bundle branch block (4.2% vs. 0.0%, respectively; p = 0.24), complete right bundle branch block (4.2% vs. 6.0, respectively; p = 1.0), S1Q3T3 pattern (2.1 vs. 0.0, respectively; p = 0.49), S1Q3 pattern (0.0 vs. 0.0), and extreme right axis (0.0 vs. 0.0). New EKG changes were identified more frequently for patients with pulmonary embolism (33.3% vs. 12.5% controls; p = 0.03), but specific findings were rarely different between cases and controls. In our cohort of ED patients, we did not identify EKG features that are likely to help distinguish patients with pulmonary embolism from those who rule out for the disease.

Central retinal and posterior ciliary artery occlusion after particle embolization of the external carotid artery system.

Science.gov (United States)

Mames, R N; Snady-McCoy, L; Guy, J

1991-04-01

A 15-year-old boy underwent neuroradiologic embolization of the left internal maxillary artery with polyvinyl alcohol to stop traumatic epistaxis after failure of surgical clipping and nasal packing. Selective catheterization of the external carotid artery before embolization showed a faint choroidal blush. Although the procedure provided hemostasis, embolization to the central retinal artery and ciliary arteries resulted in loss of vision. The route of the emboli to the eye was via the anastomotic network of the lacrimal artery supplied by the external carotid artery system. Neuroradiologic embolization of the external carotid artery is an effective mode of therapy for dural-cavernous fistulas when fed by the external carotid artery system. Because the blood flow to the brain and eye is predominantly supplied by the internal carotid artery, embolization of the external carotid artery is considered relatively safe. The authors document the importance of recognition of the choroidal blush during selective external carotid artery angiography as a sign of collateral blood flow to the eye. Physicians and patients need to be aware of the risk of blindness as a complication of external carotid artery embolization when this sign is present.

Cauda equina syndrome as the initial presenting clinical feature of medulloblastoma: a case report

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Al-Otaibi Faisal

2012-05-01

Full Text Available Abstract Introduction Medulloblastoma is one of the most common pediatric brain malignancies. The usual presenting clinical features are related to posterior fossa syndrome or/and hydrocephalus. Cauda equina syndrome is a very rare presentation for this disease. Case presentation We describe the case of a three-year-old boy with cauda equina syndrome as the initial presenting clinical feature for medulloblastoma. He was initially diagnosed as having a spinal tumor by magnetic resonance imaging scan. Subsequently, a cranial magnetic resonance imaging scan revealed a posterior fossa tumor with features of dissemination. He had substantial improvement after treatment. This case report is complemented by a literature review related to this unusual presentation. Conclusions Medulloblastoma primarily presenting with cauda equina syndrome is very rare. However, spinal drop metastasis should be considered in the pediatric age group to avoid suboptimal management.

Embolization techniques in severe obstetrical and nonmalignant vaginal hemorrhage

International Nuclear Information System (INIS)

Sniderman, K.W.; Shewchun, J.; Colapinto, R.F.; Odurny, A.; Rosenthal, D.

1988-01-01

Fifteen of 16 patients with vaginal hemorrhage following vaginal delivery (n=2), cesarian section (n=2), vaginal hysterectomy (n=1), abdominal hysterctomy (n=10), or vaginal trachelectomy (n=1) were treated with transcatheter embolotherapy when conservative methods failed. Pelvic and/or hypogastric arteriography showed a bleeding point in 15 patients. Unilateral hypogastric embolization stopped the bleeding in 12 and was unsuccessful in one; recurrent bleeding in four patients was managed with contralateral embolization. Bilateral synchronous embolizations were performed in one patient. One of two patients with continued bleeding following hypogastric artery ligation was treated with collateral artery embolization. No serious complications occurred. In this patient population, the authors recommend therapeutic embolotherapy as the treatment of choice

Embolization with the Amplatzer Vascular Plug in TIPS Patients

International Nuclear Information System (INIS)

Pattynama, Peter M. T.; Wils, Alexandra; Linden, Edwin van der; Dijk, Lukas C. van

2007-01-01

Vessel embolization can be a valuable adjunct procedure in transjugular intrahepatic portosystemic shunt (TIPS). During the creation of a TIPS, embolization of portal vein collaterals supplying esophageal varices may lower the risk of secondary rebleeding. And after creation of a TIPS, closure of the TIPS itself may be indicated if the resulting hepatic encephalopathy severely impairs mental functioning. The Amplatzer Vascular Plug (AVP; AGA Medical, Golden Valley, MN) is well suited for embolization of large-diameter vessels and has been employed in a variety of vascular lesions including congenital arteriovenous shunts. Here we describe the use of the AVP in the context of TIPS to embolize portal vein collaterals (n = 8) or to occlude the TIPS (n = 2)

A RETROSPECTIVE STUDY ON CLINICAL PRESENTATION OF STEROID SENSITIVE NEPHROTIC SYNDROME

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Sosamma M. M

2016-09-01

Full Text Available BACKGROUND Nephrotic syndrome is a disease affecting the renal system. Most paediatricians will invariably encounter children with nephrotic syndrome in their clinic. The disease is characterised by the presence of oedema, persistent heavy proteinuria, hypoproteinaemia and hypercholesterolaemia. The disease is influenced by factors like age, geography, race and also has certain genetic influence related to HLA (DR7, B12, B8. In children, minimal change nephrotic syndrome is the most common variant of primary nephrotic syndrome. It accounts to more than eighty per cent of the cases seen children under seven years whereas it has a chance of fifty per cent in the age group of seven to sixteen years. Males are affected two times higher compared to females. The parents usually bring the child to the hospital with signs of oedema. Usually, the child recovers with treatment, but in some cases, there can be relapse. MATERIALS AND METHODS  The study was conducted in the Department of Paediatrics, Travancore Medical College, Kollam.  The study was done from January 2015 to January 2016.  Sixty cases were identified and were chosen for the study. INCLUSION CRITERIA 1. Steroid sensitive cases of nephrotic syndrome. 2. Age less than twelve years. 3. Admitted cases. EXCLUSION CRITERIA 1. Steroid-resistant and steroid-dependent cases. 2. Age more than twelve years. 3. Outpatient cases. RESULTS Out of the sixty cases studied, forty one cases belonged to male sex and nineteen cases belonged to female sex. Based on the age group, maximum number of cases belonged to age group four to eight years, which amounted to thirty four cases followed by age group eight to twelve years, which amounted to eighteen cases. Age group zero to four years had the least number of cases, which amounted to eight in number. Based on clinical signs and symptoms, fifty five cases presented with oedema either periorbital, scrotal or pedal oedema. Ten cases presented with fever

Impact of delay in clinical presentation on the diagnostic management and prognosis of patients with suspected pulmonary embolism.

Science.gov (United States)

den Exter, Paul L; van Es, Josien; Erkens, Petra M G; van Roosmalen, Mark J G; van den Hoven, Pim; Hovens, Marcel M C; Kamphuisen, Pieter W; Klok, Frederikus A; Huisman, Menno V

2013-06-15

The nonspecific clinical presentation of pulmonary embolism (PE) frequently leads to delay in its diagnosis. This study aimed to assess the impact of delay in presentation on the diagnostic management and clinical outcome of patients with suspected PE. In 4,044 consecutive patients with suspected PE, patients presenting more than 7 days from the onset of symptoms were contrasted with those presenting within 7 days as regards the safety of excluding PE on the basis of a clinical decision rule combined with D-dimer testing. Patients were followed for 3 months to assess the rates of recurrent venous thromboembolism and mortality. A delayed presentation (presentation >7 d) was present in 754 (18.6%) of the patients. The failure rate of an unlikely clinical probability and normal D-dimer test was 0.5% (95% confidence interval [CI], 0.01-2.7) for patients with and 0.5% (95% CI, 0.2-1.2) for those without diagnostic delay. D-dimer testing yielded a sensitivity of 99% (95% CI, 96-99%) and 98% (95% CI, 97-99%) in these groups, respectively. Patients with PE with diagnostic delay more frequently had centrally located PE (41% vs. 26%; P presentation. PE can be safely excluded based on a clinical decision rule and D-dimer testing in patients with a delayed clinical presentation. A delayed presentation for patients who survived acute PE was associated with a more central PE location, although this did not affect the clinical outcome at 3 months.

Nuclear medicine diagnosis of pulmonary embolism

Energy Technology Data Exchange (ETDEWEB)

Goebel, S; Magdsick, G; Stroetges, M W [Essen Univ. (Gesamthochschule) (Germany, F.R.). Abt. fuer Nuklearmedizin

1978-11-01

Pulmonary embolism is an emergency situation. The earlier therapy begins, the more effective it will be. This, however, asks for immediate diagnosis. At present the most effective method of diagnosing and localizing pulmonary embolism is perfusion scintiscan of the lung. It should be completed by chest radiography to exclude peripheral infiltration and/or central lung cancer. Generally, these two procedures ensure optimal diagnosis. In case of additional disease of the pleura, mediastinum and lung parenchyma, further measures may be necessary: especially in chronic obstructive lung disease ventilation perfusion ratio and outwash of xenon might be helpful. Scintiscan of the lung is suited for early diagnosis as well as for follow-up examinations. Only if thrombectomy is planned, pulmonary angiography should be preferred. Scintiscan of the lung with marked particle suspensions ensures a minimum of complications. There is only one incident in 10 000 examinations. According to Quinn (1964) and Felix (1971) pulmonary scintiscan might be harmful in patients with right heart failure. We made no such observation in 4000 cases.

Treatment of High-Flow Vascular Malformations by Venous Embolization Aided by Flow Occlusion Techniques

International Nuclear Information System (INIS)

Jackson, James E.; Mansfield, Averil O.; Allison, David J.

1996-01-01

Purpose: Transvenous embolization techniques may be helpful as alternatives to the arterial route when treating high-flow vascular malformations. We present our experience using these techniques in four patients. Methods: In one patient the venous portion of the arteriovenous malformation (AVM) was punctured directly; in the other three patients it was catheterized via a retrograde venous approach. Flow occlusion techniques were utilized in all patients during embolization, which was performed with absolute alcohol or N-butyl-2-cyanoacrylate.Results: Excellent clinical and angiographic results were obtained, with obliteration of arteriovenous shunting in all patients. There were no complications.Conclusion: The embolization of certain AVMs using a venous approach is a safe and effective treatment

Place of Arterial Embolization in Severe Blunt Hepatic Trauma: A Multidisciplinary Approach

International Nuclear Information System (INIS)

Monnin, Valerie; Sengel, Christian; Thony, Frederic; Bricault, Ivan; Voirin, David; Letoublon, Christian; Broux, Christophe; Ferretti, Gilbert

2008-01-01

This study evaluates the efficacy of arterial embolization (AE) for blunt hepatic traumas (BHT) as part of a combined management strategy based on the hemodynamic status of patients and CT findings. From 2000 to 2005, 84 patients were admitted to our hospital for BHT. Of these, 14 patients who had high-grade injuries (grade III [n = 2], grade IV [n = 9], grade V [n = 3]) underwent AE because of arterial bleeding and were included in the study. They were classified into three groups according to their hemodynamic status: (1) unresponsive shock, (2) shock improved with resuscitation, and (3) hemodynamic stability. Four patients (group 1) underwent, first, laparotomy with packing and, then, AE for persistent bleeding. Ten patients who were hemodynamically stable (group 1) or even unstable (group 2) underwent AE first, based on CT findings. AE was successful in all cases. The mortality rate was 7% (1/14). Only two angiography-related complications (gallbladder infarction) were reported. Liver-related complications (abdominal compartment syndrome and biliary complications) were frequent and often required secondary interventions. Our multidisciplinary approach for the management of BHT gives a main role to embolization, even for hemodynamically unstable patients. In this strategy AE is very efficient and has a low complication rate.

Pulmonary Embolism in 2017: How We Got Here and Where Are We Going?

Science.gov (United States)

Merli, Geno J

2017-09-01

In the 1970s, both the Urokinase Pulmonary Embolism and Urokinase-Streptokinase Pulmonary Embolism trials began the quest to develop thrombolytic therapy for the treatment of acute massive and submassive pulmonary embolism (PE). The goals of these studies were the immediate reduction in clot burden, restoration of hemodynamic stability, and improved survival. Major bleeding became the major barrier for clinicians to employ these therapies. From 1980s to the present time, a number of studies using recombinant tissue-type plasminogen activator for achieving these same above outcomes were completed but major bleeding continued to remain an adoption barrier. Finally, the concept of bringing the thrombolytic agent into the clot has entered the quest for the Holy Grail in the treatment of PE. This article will review all the major trials using peripheral thrombolysis and provide insight into the need for a team approach to pulmonary care (Pulmonary Embolism Response Team), standardization of pulmonary classification, and the need for trials designed for both short- and long-term outcomes using thrombolysis for selected PE populations. Copyright © 2017. Published by Elsevier Inc.

Cerebrovascular Accident Secondary to Paradoxical Embolism Following Arteriovenous Graft Thrombectomy

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Jolina Pamela Santos

2012-01-01

Full Text Available Thrombectomy is a common procedure performed to declot thrombosed dialysis arteriovenous fistula (AVF or arteriovenous graft (AVG. Complications associated with access thrombectomy like pulmonary embolism have been reported, but paradoxical embolism is extremely rare. We report a case of a 74-year-old black man with past medical history significant for end-stage renal disease (ESRD, atrial fibrillation on anticoagulation with warfarin, who presented to our hospital with lethargy, aphasia, and right-sided hemiparesis following thrombectomy of a clotted AVG. Computed tomography (CT scan of brain showed a hypodensity within the left posterior parietal lobe. INR was 2.0 on admission. Echocardiogram revealed a normal sized left atrium with no intracardiac thrombus, and bubble study showed the presence of right-to-left shunting. These findings suggest that the stroke occurred as a result of an embolus originating from the AVG. Paradoxical cerebral embolism is uncommon but can occur after thrombectomy of clotted vascular access in ESRD patients. Clinicians and patients should be aware of this serious and potentially fatal complication of vascular access procedure.

Cerebrovascular accident secondary to paradoxical embolism following arteriovenous graft thrombectomy.

Science.gov (United States)

Santos, Jolina Pamela; Hamadeh, Zaher; Ansari, Naheed

2012-01-01

Thrombectomy is a common procedure performed to declot thrombosed dialysis arteriovenous fistula (AVF) or arteriovenous graft (AVG). Complications associated with access thrombectomy like pulmonary embolism have been reported, but paradoxical embolism is extremely rare. We report a case of a 74-year-old black man with past medical history significant for end-stage renal disease (ESRD), atrial fibrillation on anticoagulation with warfarin, who presented to our hospital with lethargy, aphasia, and right-sided hemiparesis following thrombectomy of a clotted AVG. Computed tomography (CT) scan of brain showed a hypodensity within the left posterior parietal lobe. INR was 2.0 on admission. Echocardiogram revealed a normal sized left atrium with no intracardiac thrombus, and bubble study showed the presence of right-to-left shunting. These findings suggest that the stroke occurred as a result of an embolus originating from the AVG. Paradoxical cerebral embolism is uncommon but can occur after thrombectomy of clotted vascular access in ESRD patients. Clinicians and patients should be aware of this serious and potentially fatal complication of vascular access procedure.

Bronchial artery embolization in the treatment of massive hemoptysis

International Nuclear Information System (INIS)

Zubairi, Ali Bin Sarwar; Zubairi, M.A.; Irfan, M.; Tanveer-ul-Haq; Fatima, K.; Azeemuddin, M.

2007-01-01

Objective was to evaluate the efficacy of bronchial arteriography and bronchial artery embolization (BAE) in the management of massive hemoptysis in a developing Asian country. A retrospective review was carried out from March 2000 to March 2005 to evaluate the demographics, clinical presentation, radiographic studies, bronchoscopy results, and complications of bronchial arteriography and BAE at a tertiary care hospital in Pakistan. Fourteen patients (9males, 5 females) with a mean age of 49 years underwent bronchial arteriography and BAE for massive hemoptysis. Hemoptysis was caused by bronchiectasis (10 patients), active pulmonary tuberculosis (3 patients), and lung malignancy (one patient). A CT scan of the chest was carried out in 11 patients, which revealed bronchiectasis (8 patients), cavity with infiltrates (3 patients), and mass lesion (one patient). Bronchoscopy was performed in all patients. Bleeding lobe or segment was identified in 12 patients. Bronchial arteriography revealed hypervascularity (13 patients), bronchial artery hypertrophy (5 patients), hypervascularity with shunting (one patient), dense soft tissue staining (7 patients), extravasation of contrast (one patient) pseudoaneurysm (one patient). Bronchial artery embolization was carried out in all patients. Rebleeding occurred within 24 hours in 2 patients who underwent surgery and within one week another 2 patients who were managed with repeat BAE. The complication of embolization occurred in one patient (transverse myelitis). Thirteen patients improved and were discharged home. One patient with terminal lung carcinoma died due to cardiogenic shock secondary to acute myocardial infarction. Bronchial artery embolization is an effective method for management of massive hemoptysis in developing countries and has a low complication rate. (author)

Multiple Autoimmune Syndromes Associated with Psoriasis: A Rare Clinical Presentation

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Sadia Masood

2014-03-01

Full Text Available Autoimmune diseases are known to have association with each other but it is very rare to see multiple autoimmune diseases in one patient. The combination of at least three autoimmune diseases in the same patient is referred to as multiple autoimmune syndrome. The case we are reporting features multiple autoimmune syndrome with five different conditions. The patient had type 1 diabetes mellitus, autoimmune hemolytic anemia, systemic lupus erythematosus, vitiligo, and psoriasis. Psoriasis has rarely been reported previously under the spectrum of autoimmune syndrome. Although the relationship of autoimmune conditions with each other has been explored in the past, this case adds yet another dimension to the unique evolution of autoimmune pathologies. The patient presented with a combination of five autoimmune diseases, which makes it consistent type three multiple autoimmune syndromes with the addition of psoriasis. The current case is unique in this aspect that the combination of these five autoimmune disorders has never been reported in the past.

Prevention and management of the complications during embolizing intracranial aneurysm with GDC

International Nuclear Information System (INIS)

Zhong Ming; Tan Xianxi; Wang Junlu; Hu Wenhao; Fan Lianghao

2002-01-01

Objective: To sum up the experience of embolization of intracranial aneurysm with Guglielmi detachable coil (GDC) and to discuss how to prevent and manage the complications during the endovascular treatment. Methods: 108 patients with intracranial aneurysm were embolized with GDC. 24 accident out of 20 patients during embolization were reviewed. Results: Among the 24 accidents, there were 10 aneurysm rupture, 5 over- embolization 5 coils end protruding to parent artery, and 4 thrombosis. Once the aneurysm ruptures, neutralizing heparin and continuing embolization was administered. Among 10 cases of aneurysm ruptures, 4 were death, 1 was severe deformity, 1 was mild deformity. Thrombolysis, heparinisation and raising blood pressure were used to control over-embolization, coil protrusion, and thrombosis. Among 5 cases of over-embolization, 1 died, 4 recovered. Among 5 cases of coils end protruding, 1 was severe deformity, 1 was mild deformity. Among 4 cases of embolization, 1 died, 1 was led sensory aphasics. The accidents resulted in 5 deaths (4.6%), 4 permanent neurological deficits (3.7%). Conclusion: The correct management of the complications during the treatment, the better understanding of the aneurysm and its parent artery angio-anatomy and the improved skill of embolizing technique are helpful to reduce the accidents and increase the cure rate

Thrombolytic and anticoagulation treatment in a rat embolic stroke model

DEFF Research Database (Denmark)

Rasmussen, Rune Skovgaard; Overgaard, K; Meden, P

2003-01-01

OBJECTIVES: The effects of pentasaccharide (PENTA), given alone or combined with thrombolysis using recombinant tissue plasminogen activator (rt-PA), on infarct size and clinical outcome were evaluated in a rat embolic stroke model. MATERIALS AND METHODS: Ninety-two rats were embolized unilateral...... alone or combined with rt-PA did not significantly increase mortality or tendency for hemorrhage.......OBJECTIVES: The effects of pentasaccharide (PENTA), given alone or combined with thrombolysis using recombinant tissue plasminogen activator (rt-PA), on infarct size and clinical outcome were evaluated in a rat embolic stroke model. MATERIALS AND METHODS: Ninety-two rats were embolized unilaterally...

Predictors of response to radio-embolization (TheraSphere®) treatment of neuroendocrine liver metastasis.

Science.gov (United States)

Shaheen, Mohammed; Hassanain, Mazen; Aljiffry, Murad; Cabrera, Tatiana; Chaudhury, Prosanto; Simoneau, Eve; Kongkaewpaisarn, Nuttawut; Salman, Ayat; Rivera, Juan; Jamal, Mohammad; Lisbona, Robert; Khankan, Azzam; Valenti, David; Metrakos, Peter

2012-01-01

Neuroendocrine tumours (NET) frequently metastasize to the liver. NET liver metastasis has been shown to respond to Yttrium-90 microspheres therapy. The aims of the present study were to define factors that predict the response to radio-embolization in patients with NET liver metastases. From January 2006 until March 2009, all patients with NET liver metastasis that received radio-embolization using TheraSphere® (glass microspheres) were reviewed. The response was determined by a change in the percentage of necrosis (ΔN%) after the first radio-embolization based on the modified RECIST criteria (mRECIST) criteria. The following confounding variables were measured: age, gender, size of the lesions, liver involvement, World Health Organization (WHO) classification, the presence of extra-hepatic metastasis, octereotide treatment and previous operative [surgery and (RFA)] and non-operative treatments (chemo-embolization and bland-embolization). In all, 25 patients were identified, with a median follow-up of 21.7 months. The median age was 64.6 years, 28% had extra-hepatic metastasis and 56% were WHO stage 2. Post-treatment, the mean ΔN% was 48.4%. Previous surgical therapy was a significant predictor of the response with a response rate of 66.7 ΔN% vs. 31.5 ΔN% (P= 0.02). Bilateral liver disease, a high percentage of liver involvement and large metastatic lesions were inversely related to the degree of tumour response although did not reach statistical significance. Radio-embolization increased the necrosis of NET liver metastasis mainly in patients with less bulky disease. This may imply that surgical therapy before radio-embolization would increase the response rates. © 2011 International Hepato-Pancreato-Biliary Association.

Nitinol Embolic Protection Filters: Design Investigation by Finite Element Analysis

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Conti, Michele; de Beule, Matthieu; Mortier, Peter; van Loo, Denis; Verdonck, Pascal; Vermassen, Frank; Segers, Patrick; Auricchio, Ferdinando; Verhegghe, Benedict

2009-08-01

The widespread acceptance of carotid artery stenting (CAS) to treat carotid artery stenosis and its effectiveness compared with surgical counterpart, carotid endarterectomy (CEA), is still a matter of debate. Transient or permanent neurological deficits may develop in patients undergoing CAS due to distal embolization or hemodynamic changes. Design, development, and usage of embolic protection devices (EPDs), such as embolic protection filters, appear to have a significant impact on the success of CAS. Unfortunately, some drawbacks, such as filtering failure, inability to cross tortuous high-grade stenoses, malpositioning and vessel injury, still remain and require design improvement. Currently, many different designs of such devices are available on the rapidly growing dedicated market. In spite of such a growing commercial interest, there is a significant need for design tools as well as for careful engineering investigations and design analyses of such nitinol devices. The present study aims to investigate the embolic protection filter design by finite element analysis. We first developed a parametrical computer-aided design model of an embolic filter based on micro-CT scans of the Angioguard™ XP (Cordis Endovascular, FL) EPD by means of the open source pyFormex software. Subsequently, we used the finite element method to simulate the deployment of the nitinol filter as it exits the delivery sheath. Comparison of the simulations with micro-CT images of the real device exiting the catheter showed excellent correspondence with our simulations. Finally, we evaluated circumferential basket-vessel wall apposition of a 4 mm size filter in a straight vessel of different sizes and shape. We conclude that the proposed methodology offers a useful tool to evaluate and to compare current or new designs of EPDs. Further simulations will investigate vessel wall apposition in a realistic tortuous anatomy.

Retrograde Transvenous Ethanol Embolization of High-flow Peripheral Arteriovenous Malformations

International Nuclear Information System (INIS)

Linden, Edwin van der; Baalen, Jary M. van; Pattynama, Peter M. T.

2012-01-01

Purpose: To report the clinical efficiency and complications in patients treated with retrograde transvenous ethanol embolization of high-flow peripheral arteriovenous malformations (AVMs). Retrograde transvenous ethanol embolization of high-flow AVMs is a technique that can be used to treat AVMs with a dominant outflow vein whenever conventional interventional procedures have proved insufficient. Methods: This is a retrospective study of the clinical effectiveness and complications of retrograde embolization in five patients who had previously undergone multiple arterial embolization procedures without clinical success. Results: Clinical outcomes were good in all patients but were achieved at the cost of serious, although transient, complications in three patients. Conclusion: Retrograde transvenous ethanol embolization is a highly effective therapy for high-flow AVMs. However, because of the high complication rate, it should be reserved as a last resort, to be used after conventional treatment options have failed.

Chronic recurrent hemoptysis: effectiveness of bronchial artery embolization in 25 patients

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Lee, Jong Ik; Shim, Hyung Jin; Wang, Chi Hyung; Hyun, Yu; Kim, Yang Soo; Kim, Young Goo; Kim, Kun Sang [Chungang University College of Medicine, Seoul (Korea, Republic of)

1994-09-15

Bronchial artery embolization has been effective in the treatment of massive hemoptysis. The purpose of this study was to report the effectiveness of bronchial artery embolization in patients with chronic recurrent hemoptysis intractable to medical treatment. This study included 25 patients who were admitted for treatment of chronic recurrent hemoptysis with bronchial artery embolization. Chronic recurrent hemoptysis was defined as condition in tractable to medical treatment persistently and occurring over two times per two months The target vessels for embolization were selected in consideration of the results of aortography as well as the finding of chest radiography and bronchoscopy. After selective arteriography for embolization by using 5-French Simmons catheter, embolic agents(mainly polyvinyl alcohol(PVA) and additionally gelfoam and coils) were released through the catheter. The results of the embolization were assessed with review of medical records. The cases of the hemoptysis were pulmonary tuberculosis(n=12.48%), bronchiectasis(n=6.24%), aspergilloma(n=3.12%), chronic obstructive pulmonary disease(n=2.8%), chronic bronchitis(n=1.4%) and lung abscess(n=1.4%). Selective embolization was carried out in 49 sites(42 in bronchial artery and 7 in nonbronchial systemic collaterals). Early success rate within 2 months was 96%. After long-term follow up study (6-30 months, average 15 months), complete remission was 72%, partial remission 12% and recurrence 12% respectively. During and after embolization, major complications such as spinal cord injury or bronchial wall necrosis was not found. Minor complications were chest pain, shoulder pain and chilling sense, which were relieved spontaneously within a few days. High success rate and relatively low recurrence with no significant complication were achieved with bronchial artery embolization in the patients complaining of chronic recurrent hemoptysis.

Mounier-Kuhn syndrome: radiological findings and clinical presentation

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Bastos, Andrea de Lima [Hospital Julia Kubitschek-FHEMIG, Belo Horizonte, MG (Brazil). Unidade de Diagnostico por Imagem; Brito, Isabela Lage Alves, E-mail: andblima@yahoo.com.b [Hospital Julia Kubitschek-FHEMIG, Belo Horizonte, MG (Brazil). Dept. de Pneumologia

2011-05-15

Mounier-Kuhn syndrome is a rare disease clinically characterized by recurrent respiratory infections. The present report describes a case of this disease with analysis of chest radiography and high resolution computed tomography showing increased caliber of the trachea, main bronchi and central bronchiectasis. Such changes, in association with clinical data, suggest the diagnosis. (author)

Applicability of liquid radiopaque polyurethane for transcatheter embolization

International Nuclear Information System (INIS)

Novak, D.; Wieners, H.; Rueckner, R.

1983-01-01

Polyurethane Bayer was tested as an occlusive agent for experimental embolization in postmortem and postnephrectomy kidneys which served as a tumor model. Coaxial and balloon catheters were used for the embolization. To make polyurethane radiopaque, the material was labeled with different water-soluble, oily and solid contrast agents. Best results were achieved with oily contrast materials, e.g., Pantopaque. We found that polyurethane can easily be injected during a predetermined working time of 8-10 min. The embolization results in a complete, permanent, and homogeneous occlusion of the proximal arterial branches and small peripheral vessels. (orig.)

Leiomyosarcoma of the Uterus with Intravascular Tumor Extension and Pulmonary Tumor Embolism

International Nuclear Information System (INIS)

McDonald, Douglas K.; Kalva, Sanjeeva P.; Fan, C.-M.; Vasilyev, Aleksandr

2007-01-01

We report the case of a 48-year-old woman presenting with recurrent uterine leiomyosarcoma (LMS) associated with right iliac vein and inferior vena cava (IVC) invasion and left lower lobe pulmonary tumor embolus. Because the prognosis and treatment differ from that of thrombotic pulmonary emboli, the differentiating imaging characteristics of intravascular tumor embolism are reviewed. To our knowledge, only two other cases of intravenous uterine leiomyosarcomatosis have been described in the existing literature, and this is the first reported case of the entity with associated intravascular tumor embolism

Transarterial embolization for hematuria caused by renal arteriovenous malformations or fistulae

International Nuclear Information System (INIS)

Meng Xiaoxi; Liu Shiyuan; Dong Weihua; Dong Sheng; Jia Ningyang; Xiao Xiangsheng

2008-01-01

Objective: To evaluate the efficacy and safety of transarterial embolization for hematuria caused by renal arteriovenous malformation or fistulae. Methods: Seven patients with gross hematuria caused by renal arterial abnormalities were retrospectively reviewed, of which three had congenital renal arteriovenous malformations and the other four had non-neoplastic acquired renal arteriovenous fistulae. All patients were confirmed by renal arterial angiography and undergone embolization with various embolic materials. Results: Embolization was successfully carried out in all cases. Gross hematuria disappeared one to seven days after the procedure. No severe complications were encountered. No recurrence occurred within 12 to 36 months of follow-up. Conclusions: Transarterial embolization is safe and effective for hematuria caused by renal arteriovenous malformations or fistulae. (authors)

Embolic Protection using the WIRION Embolic Protection System with JetStream Atherectomy in a Patient with Superficial Femoral Artery Chronic total Occlusion.

Science.gov (United States)

Shammas, Nicolas W

2017-06-01

Distal embolization is a common occurrence with peripheral arterial interventions and is more frequent with the use of atherectomy devices. We report the first case of JetStream atherectomy (Boston Scientific, Maple Grove, MN) with the use of the novel WIRION embolic protection system filter. The procedure was performed successfully with no distal embolizations beyond the filter and with no complications in the delivery or retrieval of the filter. The pros and cons of the off label use of this filter with JetStream atherectomy are discussed.

New thermoreversible liquid embolic agent for embolotherapy: technical report

International Nuclear Information System (INIS)

Takao, Hiroyuki; Murayama, Yuichi; Ebara, Masaki; Ishibashi, Toshihiro; Saguchi, Takayuki; Irie, Koreaki; Abe, Toshiaki; Yoshioka, Hiroshi; Mori, Yuichi; Vinuela, Fernando

2009-01-01

To evaluate potential feasibility of new liquid embolic agent, thermoreversible gelation polymer (TGP), for embolotherapy. TGP is a liquid polymer that was originally developed as a cell culture medium for tissue engineering. TGP becomes liquid at temperatures lower than the sol-gel transition temperature (TT) and becomes a gel at temperatures higher than the TT. The TT can be adjusted from 10 C to 40 C, allowing gelation at body temperature without solvent. The renal arteries in six swine were embolized with TGP. Angiographic evaluations were obtained 0, 3 h, and 14 days after embolization. The animals were sacrificed at day 14 after angiogram. All renal arteries were successfully embolized with TGP using cooling catheter. No acute and chronic clinical complication was observed. Follow-up angiogram demonstrated complete or near complete occlusion of renal arteries. No untoward inflammatory response was observed in acute and chronic specimen. This embolic material has potential feasibility to be used in the treatment of cerebral arteriovenous malformations, aneurysms, or hyper vascular tumors. (orig.)

Posttranscatheter embolization computed tomography in hepatocellular carcinoma

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Yasumori, K; Tamura, S; Hasuo, K; Kudo, S; Uchino, A; Nishitani, H; Onitsuka, H; Kawanami, T; Kawahira, K; Ono, M

1984-12-01

The postcontrast CT scans and angiography of 26 lesions in 23 patients with hepatomas who underwent transcatheter arterial embolization therapy were reviewed. Newly developed low density and high density areas and gas were noted on CT scans of the tumors after embolization in 100, 8 and 58% of the lesions, respectively. The CT findings of residual tumors correlated well with those of follow-up angiography. When discrete smooth round low density zones were observed on CT, there was no residual neovascularity on follow-up arteriography. When there were nodular or thick septum-like structures in low density lesions, arteriography revealed residual tumor vascularity in the lesions. CT proved useful not only in evaluating the effects of embolization, but also in providing important information about residual tumors.

Síndrome de embolia gordurosa: relato de caso associado à lipoaspiração Fat embolism syndrome: report of a case associated to liposuction

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Jõao Carlos Folador

1999-04-01

Full Text Available Mulher, 40 anos, 72 horas após lipossucção apresentou dispnéia súbita, febre, taquipnéia e taquicardia. Radiografia torácica e eco-doppler de membros inferiores eram normais, mas hipoperfusão pulmonar à cintilografia sugeriu tromboembolismo pulmonar. Após três dias de heparinização, observou-se hipóxia, anemia e confusão mental. Diagnosticou-se síndrome de embolia gordurosa, suspendeu-se heparinização e iniciou-se pulsoterapia com corticóide, seguida de melhora clínica e alta hospitalar.A forty year old woman, 72 hours after liposuction, complained of sudden dyspnea, fever and tachycardia. Thoracic radiography and duplex-scan of deep veins were normal. Pulmonary scintigraphy suggested thromboembolism. The patient had hypoxia, anemia and mental confusion after three days of systemic heparin. Once fat embolism syndrome was suspected, heparin infusion was stopped and corticosteroid therapy was started. After that, the patient was much better and discharged from hospital.

Intermittent Brugada Syndrome Presenting with Syncope in an Adult Female

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Patricia Chavez

2014-01-01

Full Text Available Background. Brugada syndrome accounts for 4–12% of all sudden deaths worldwide and at least 20% of sudden deaths in patients with structurally normal hearts. Case Report. A 48-year-old female presented to the emergency department after two witnessed syncopal episodes. While awaiting discharge had a third collapse followed by cardiac arrest with shockable rhythm. Initial electrocardiogram showed wide QRS complex with left axis deviation, ST-segment elevation of 2 mm followed by a negative T wave with no isoelectric separation, suggestive of spontaneous intermittent Brugada type 1 pattern. Cardiac magnetic resonance imaging demonstrated neither structural heart disease nor abnormal myocardium. After placement of an implantable cardioverter defibrillator the patient was discharged. Why should an emergency physician be aware of this? Brugada syndrome is an infrequently encountered clinical entity which may have a fatal outcome. This syndrome primarily presents with syncope. It should be considered as a component of differential diagnosis in patients with family history of syncope and sudden cardiac death.

Persistent or recurrent varicocoele after failed varicocoelectomy: Outcome in patients treated using percutaneous transcatheter embolization

International Nuclear Information System (INIS)

Kim, J.; Shin, J.H.; Yoon, H.K.; Ko, G.Y.; Gwon, D.I.; Kim, E.Y.; Sung, K.B.

2012-01-01

Aim: To determine the efficacy of percutaneous transcatheter embolization in the management of patients with spermatic varicocoeles persisting or recurring after surgery. Materials and methods: Over a period of 10 years, 28 patients (age range 13–55 years) were referred for percutaneous transcatheter embolization of postsurgical, recurrent varicocoeles. Medical documents were retrospectively reviewed to evaluate past surgical history, subjective symptoms, and results of scrotal examination, ultrasound, and semen parameters. Pre-embolization venograms were analysed to assess the anatomy of the testicular vein. The technical and clinical outcomes of embolization were then determined. Results: The 28 patients included in the study had undergone laparoscopic varicocoelectomy (39.3%), high retroperitoneal ligation (25%), or inguinal ligation (25%). Subjective symptoms were scrotal pain (60.7%) and a palpable scrotal mass (50%) exclusively on the left side. Venograms revealed abnormalities of the left testicular vein in all cases. Embolization was technically successful in all but two cases, thus yielding an occlusion rate of 93%; a single case of suspected thrombophlebitis was the only complication. After excluding two, technically unsuccessful cases and one patient who was lost to follow-up, 25 patients underwent scrotal examination after embolization, which revealed complete resolution in 20 cases (80%), partial improvement in four cases (16%), and no improvement in a single case (4%). Among the follow-up group of patients, of the 12 who initially presented with scrotal pain, six (50%) were symptom-free and four (33.3%) had partial improvement. Conclusion: Percutaneous transcatheter embolization of the testicular vein is technically feasible and effective for managing postsurgical recurrent varicocoeles.

Persistent or recurrent varicocoele after failed varicocoelectomy: Outcome in patients treated using percutaneous transcatheter embolization

Energy Technology Data Exchange (ETDEWEB)

Kim, J. [Department of Radiology, Hanyang University, College of Medicine, Hanyang University Guri Hospital, Gyeonggi-do (Korea, Republic of); Shin, J.H., E-mail: jhshin@amc.seoul.kr [Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul (Korea, Republic of); Yoon, H.K.; Ko, G.Y.; Gwon, D.I.; Kim, E.Y.; Sung, K.B. [Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul (Korea, Republic of)

2012-04-15

Aim: To determine the efficacy of percutaneous transcatheter embolization in the management of patients with spermatic varicocoeles persisting or recurring after surgery. Materials and methods: Over a period of 10 years, 28 patients (age range 13-55 years) were referred for percutaneous transcatheter embolization of postsurgical, recurrent varicocoeles. Medical documents were retrospectively reviewed to evaluate past surgical history, subjective symptoms, and results of scrotal examination, ultrasound, and semen parameters. Pre-embolization venograms were analysed to assess the anatomy of the testicular vein. The technical and clinical outcomes of embolization were then determined. Results: The 28 patients included in the study had undergone laparoscopic varicocoelectomy (39.3%), high retroperitoneal ligation (25%), or inguinal ligation (25%). Subjective symptoms were scrotal pain (60.7%) and a palpable scrotal mass (50%) exclusively on the left side. Venograms revealed abnormalities of the left testicular vein in all cases. Embolization was technically successful in all but two cases, thus yielding an occlusion rate of 93%; a single case of suspected thrombophlebitis was the only complication. After excluding two, technically unsuccessful cases and one patient who was lost to follow-up, 25 patients underwent scrotal examination after embolization, which revealed complete resolution in 20 cases (80%), partial improvement in four cases (16%), and no improvement in a single case (4%). Among the follow-up group of patients, of the 12 who initially presented with scrotal pain, six (50%) were symptom-free and four (33.3%) had partial improvement. Conclusion: Percutaneous transcatheter embolization of the testicular vein is technically feasible and effective for managing postsurgical recurrent varicocoeles.

A unique association of Noonan syndrome and 47,XYY syndrome in a male presenting with failure to thrive.

Science.gov (United States)

Bellfield, Edward J; Shad, Zohra

2017-09-01

We describe a 24-month-old male patient who presented to our Genetics-Endocrinology Clinic with a history of failure to thrive, short stature and cryptorchidism. Soon after birth he was diagnosed with 47,XYY syndrome, but due unusual facial features had further diagnostic workup which revealed Noonan syndrome (NS) as well. This report illustrates significant phenotypic-cytogenetic variability within the clinical presentation of NS and 47,XYY syndrome, as well as the need to investigate patients for other genetic defects when phenotype does not correlate with genotype. Furthermore, in this case, the cellular pathways attenuating growth via PTPN11 mutation appear to supersede the SHOX overdosage-an observation that can lead to further research in genetic mechanisms of growth physiology.

The role of lung imaging in pulmonary embolism

Science.gov (United States)

Mishkin, Fred S.; Johnson, Philip M.

1973-01-01

The advantages of lung scanning in suspected pulmonary embolism are its diagnostic sensitivity, simplicity and safety. The ability to delineate regional pulmonary ischaemia, to quantitate its extent and to follow its response to therapy provides valuable clinical data available by no other simple means. The negative scan effectively excludes pulmonary embolism but, although certain of its features favour the diagnosis of embolism, the positive scan inherently lacks specificity and requires angiographic confirmation when embolectomy, caval plication or infusion of a thrombolytic agent are contemplated. The addition of simple ventilation imaging techniques with radioxenon overcomes this limitation by providing accurate analog estimation or digital quantitation of regional ventilation: perfusion (V/Q) ratios fundamental to understanding the pathophysiologic consequences of embolism and other diseases of the lung. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5Fig. 6Fig. 7p495-bFig. 8Fig. 9Fig. 10Fig. 11Fig. 12Fig. 13 PMID:4602128

Investigation on the clinical practice of transcatheter embolization for acute gastrointestinal hemorrhage

International Nuclear Information System (INIS)

Gao Bin; Xu Shengde; Cheng Bing; Peng Qiong; Hong Ci; Xu Guozhong; Wang Tao

2002-01-01

Objective: To study the tactics, methods and relevant factors of transcatheter embolization for acute gastrointestinal hemorrhage. Methods: Fifteen patients with acute gastrointestinal hemorrhage were embolized by one of the methods of Polyvinyl Alcohol (PVA), gelfoam or metal coils. Four of the fifteen patients were upper gastrointestinal hemorrhage, the other cases were lower gastrointestinal hemorrhage which were embolized using coaxial microcatheter. Results: Fourteen of the fifteen patients were treated successfully by these methods. There were total 17 times of embolization for 16 parts, the success rate reached 94. 1%. The other one revealed an infarction of intestine after the embolization and was cured by resection. One of the fifteen patients appeared a recurrent hemorrhage 3 months later, and confirmed to be a hemangiolymphangioma. Two patients with malignant tumor were operated upon selectively. The other patient of intestinal hemorrhage was embolized successfully by using a metal coil after shock. Leiomyoma complicated with large area of bleeding was finally proven by operation. Conclusions: Transcatheter embolization for acute massive gastrointestinal hemorrhage is safe and efficient under different choice of methods. The key of success is the right selection of embolized target artery and dosage of emboli

A Case of Acinetobacter Septic Pulmonary Embolism in an Infant

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Poonam Wade

2016-01-01

Full Text Available Case Characteristics. An 11-month-old girl presented with fever and breathlessness for 5 days. Patient had respiratory distress with bilateral coarse crepitations. Chest radiograph revealed diffuse infiltrations in the right lung with thick walled cavities in mid and lower zone. Computed tomography showed multiple cystic spaces and emboli. Blood culture grew Acinetobacter species. Intervention. Patient was treated with Meropenem and Vancomycin. Outcome. Complete clinical and radiological recovery was seen in child. Message. Blood cultures and CT of the chest are invaluable in the evaluation of a patient with suspected septic pulmonary embolism. With early diagnosis and appropriate antimicrobial therapy, complete recovery can be expected in patients with septic pulmonary embolism.

Juvenile nasopharyngeal angiofibroma with skull base invasion : intratumoral direct puncture embolization

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Shin, Hye Young; Kim, Sun Yong; Suh, Jung Ho; Park, Kee Hyun [Ajou Univ., Suwon (Korea, Republic of). Coll. of Medicine

1998-04-01

The purpose of this study is to demonstrate the utility and efficacy of percutaneous direct glue embolization for juvenile nasopharyngeal angiofibromas with skull base invasion. In nine cases of juvenile nasopharyngeal angiofibromas with invasion of the skull base, embolization under general anethesia was performed. Using an 18G spinal needle, direct puncture were made via the transnasal or mandibular sciatic notch. A glue-lipiodol mixture (1:1 -1:3) was injected slowly for 15 to 30 seconds under fluoroscopic control; the number of post-embolization angiography and the distribution of embolic materials was assessed on CT within 1-3 days. The mass was surgically removed 3 to 7 days after embolization. Direct glue embolization of juvenile angiofibroma with skull base invasion appears to be a simple and safe procedure. The technique could be used for other hypervascular lesions in the base of the skull or parapharyngeal space. (author). 19 refs., 1 tab., 2 figs.

Juvenile nasopharyngeal angiofibroma with skull base invasion : intratumoral direct puncture embolization