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Predictors of Uterine Rupture and Recurrence after Myomectomy
Published in Rooma Sinha, Arnold P. Advincula, Kurian Joseph, FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
Vascular occlusion. With regard to optimal hemostatic technique in LM, the role of temporary bilateral uterine artery occlusion alone or in combination with utero-ovarian vessel occlusion compared with no vascular occlusion was assessed in 200 patients undergoing an LM. No difference in recurrence rates was found at 30-month follow-up. Furthermore, no statistical difference was noted in anti-Müllerian hormone between the groups preoperatively or at 3, 6, and 12 months postoperatively [44]. A better hemostasis during the myomectomy may allow a more efficient eradication of smaller residual ULs. However, there is currently no convincing biological rationale for reduction in recurrence rate associated with uterine artery occlusion at the index surgery. Sanders et al. analyzed 25 studies involving 2871 patients on uterine artery occlusion at the time of myomectomy and reported to have found a significantly reduced fibroid recurrence rate [45]. However, these results should be interpreted with caution as fibroid recurrence was evaluated as a secondary outcome whereas only a small number of the included studies reported data on recurrence rates and the follow-up time was relatively short. It is noteworthy that there are no data on long-term reproductive implications.
Thumbprinting Sign
Published in Michael E. Mulligan, Classic Radiologic Signs, 2020
Thumbprinting as a sign of submucosal hemorrhage or edema in colonic vascular occlusion was reported in two articles by Scott Boley and colleagues1 and Solomon Schwartz and co-workers2, in 1963. The first article described the barium enema findings in five patients seen at the Jewish Hospital of Brooklyn and Downstate Medical Center (Figure 1). ‘The roentgenologic finding of importance is pseudotumor formation or ‘thumbprinting’. This appears to be caused by submucosal hemorrhage or by pericolic fat inflammation or both.’1 The second article detailed the course of the radiographic changes in one of the original five patients. They confirmed their impressions of the radiographic findings by conducting animal experiments. ‘Pathologic examination, when marginal indentation or ‘thumbprinting’ was present, revealed two possible explanations: (1) submucosal hemorrhage and (2) inflammatory areas in pericolic fat.’1 Recognizing these ‘pseudotumors’ as a sign of vascular disease is important. The vascular occlusion may only be temporary and the patient’s symptoms may resolve without surgical intervention.
Fibrinolytic Defects in the Cutaneous Vasculitis Atrophie Blanche
Published in Pia Glas-Greenwalt, Fibrinolysis in Disease Molecular and Hemovascular Aspects of Fibrinolysis, 2019
Michael G. Hitchcock, Salvatore V. Pizzo
In humans or animal models, circulating levels of t-PA are extremely low because of its rapid hepatic clearance.13 As a result, measurements of plasma t-PA do not correlate very well with various known disorders of fibrinolysis. In order to assess the role of t-PA in thromboembolic disease, it is necessary to stimulate release of t-PA from storage sites in the vessel wall. This can be done by administration of various drugs such as vasopressin, or by the expedient of vascular occlusion. The simplest technique developed for vascular occlusion is the use of an inflated blood pressure cuff. In order to use this approach, it is necessary to standardize both the pressure employed and the length of occlusion.
The role of neoadjuvant conventional transarterial chemoembolization with radiofrequency ablation in the treatment of recurrent hepatocellular carcinoma after initial hepatectomy with microvascular invasion
Published in International Journal of Hyperthermia, 2022
Zhenwei Peng, Xiaoxue Wu, Jiaping Li, Hui Pang, Yaojun Zhang, Manxia Lin, Zaiguo Wang, Han Xiao, Bin Li, Minshan Chen, Shiting Feng, Ming Kuang, Shuling Chen
cTACE was performed by two experienced radiologists with over 10 years of experience in interventional therapy at each center [24–26]. At the beginning of cTACE, visceral angiography via a superior mesenteric artery or common hepatic artery was conducted to evaluate arterial blood supply of the liver and to confirm patency of the portal vein by combining the pre-operational CECT images. Then, a microcatheter was inserted into the segmental or subsegmental tumor-feeding arteries. cTACE was performed using an emulsion of mixtures of lipiodol (3–5mL) and chemotherapeutic agents according to the practice of each center such as epirubicin, cisplatin or oxaliplatin. Subsequently, embolization was finally performed with absorbable gelatin sponge particles (1–2 mm in diameter) until the blood flow was static for more than 10 successive heartbeats. After embolization, angiography was performed to confirm the extent of vascular occlusion and to assess blood flow in other arterial vessels.
Acute Chest Syndrome in Sickle Cell Disease: Clinical Presentation and Outcomes. The Experience of a Single Thalassemia and Sickle Cell Unit in a University Hospital
Published in Hemoglobin, 2021
Sophia Delicou, Konstantina Aggeli, Konstantinos Magganas, Dimitrios Patsourakos, Aikaterini Xydaki, John Koskinas
Recurring ACS episodes can contribute to the development of interstitial lung disease known as chronic lung sickle disease. For prophylactic therapy both HU [26] and chronic transfusion treatment decrease the risk of severe acute vaso-occlusive episodes and ACS. It is worth noting that 56.2% of patients were receiving chronic HU treatment, which did not prevent the development of ACS. Complex vascular occlusion mechanisms appear to be resistant to HU, although the link between dosage and patient compliance cannot be ignored. A significant number of patients had relapsed in less than 1 year with ACS, which is more common in infancy due to frequent respiratory infections. We assume that the recurrence of acute thoracic syndrome in our own patients is related to the fact that they were all smokers with poor medical compliance.
Retinal findings in glomerulonephritis
Published in Clinical and Experimental Optometry, 2022
Heather G Mack, Deborah J Colville, Phillip Harraka, Judith Anne Savige, Alessandro Invernizzi, Samantha Fraser-Bell
Reported retinal vascular changes include central retinal artery occlusion,80–82 central and branch retinal vein occlusion80,82–85 and retinal vasculitis.73,86–88 In some cases, vascular occlusion is reported in the absence of vasculitis. One proposed mechanism for this is central retinal vein compression by extracapillary granulomatous lesions.85 Limited histopathology studies demonstrate immunoglobulin deposition in retinal and choroidal vessels.89–91 Reported treatments include eculizumab,80,92 which blocks C5 activation; and plasma infusion,84 which provides fresh coagulation factors, immunoglobulins and complement molecules.