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Interventional radiology
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Diagnostic arteriography and venography are required much less frequently now than in the past, but interventional angiography is increasing in importance (Figure 90.10a and b). Arterial embolization is an effective method of controlling iatrogenic or other hemorrhage. An example is symptomatic arteriovenous or arteriocalyceal fistula following renal biopsy. These lesions may be embolized with metal coils, which are easy to use and very effective. The aim is to preserve as much renal tissue as possible.
Obstetrics: Answers
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
Once the cannulas are in place, then a further bolus of syntocinon 10 IU can be given. Ergometrine 0.5 mg can also be considered, as the effects are longer lasting than syntocinon (1). An infusion of syntocinon may be used to maintain a contraction [40 units in 500 ml 0.9% saline over 4 hours] (1). If this is unsuccessful, then prostaglandins may be considered. Carboprost [prostaglandin F2α − PGF2α, 250 μg repeated every 15 minutes to a maximum of 2 g, has been successfully used following failure of conventional treatment. Misoprostol [800 μg rectally] is also effective (2). If this fails to control the bleeding, then the genital tract and uterus should be explored to exclude trauma and retained tissue (1). If this is negative, then uterine tamponade can be performed. This can be done by packing or by the utilization of a hydrostatic balloon, such as a Rusch® balloon (1). Other options include laparotomy and surgical procedures such as arterial ligation of the uterine or internal iliac artery, the insertion of a B-lynch suture and, if all else fails, a hysterectomy (2). Some hospitals have access to interventional radiology, and in these units arterial embolization may be considered (1).
Pelvic fractures
Published in Charles M Court-Brown, Margaret M McQueen, Marc F Swiontkowski, David Ring, Susan M Friedman, Andrew D Duckworth, Musculoskeletal Trauma in the Elderly, 2016
Finally although angiography and embolization has been reported to be an effective intervention, in most of these patients the major source of blood loss is venous in origin and will not be affected by an arterial embolization. The procedure is also invariably time consuming and therefore may simply not be practical in a patient with life-threatening hypotension. Hou et al.57 in a recent study reported a high mortality rate with the use of angiography to control haemorrhage in pelvic fractures and recommended against use of this intervention as part of the acute phase of resuscitation.
Synovitis in hemophilia: preventing, detecting, and treating joint bleeds
Published in Expert Review of Hematology, 2023
According to [anonymized] and Jimenez-Yuste, in hemophilia, the appearance of hemarthrosis secondary to a spontaneous periarticular aneurysm is rare [91]. In this circumstance, angiographic embolization can be a therapeutic and coagulation factor-saving option in hemarthroses that do not respond to replacement of coagulation factor. Angiographic embolization is not a remedy for all refractory hemarthroses in hemophilia. It is essential to bear in mind that despite its efficacy, arterial embolization is an invasive procedure with a published percentage of adverse events up to 25% (16% minor, 7% serious, 2% death) [65]. In 2013, Galli et al stated that selective angiographic embolization of knee and elbow arteries was a reasonable procedure that could avert repeated hemarthroses [92]. Figure 3 shows my recommended algorithm for the current management of CHS.
An expansive aneurysmal bone cyst of the maxillary sinus in an 8 year old child: Case report and review of literature
Published in Acta Oto-Laryngologica Case Reports, 2020
Milan Urík, Ivo Šlapák, Michaela Máchalová, Jana Jančíková, Soňa Šikolová, Denisa Pavlovská, Petr Jabandžiev, Marta Ježová
Traditionally, curettage and debridement of the bone have been regarded as the mainstays of treatment. In an attempt to decrease the rate of recurrence, some authors have promoted various adjuvants for treating ABC such as use of cryotherapy [3], polymethylmethacrylate cementation [4], phenol in the bone cavity [5], use of a high-speed burr [6] or percutaneous injection of alcohol [7] or other agents has been used to treat ABCs that are difficult to approach surgically. Radiation therapy has been used for lesions determined to be nonoperable [8]. Arterial embolization has been used before surgery to decrease intraoperative blood loss and also as a stand-alone treatment for unresectable lesions [9]. However, the use of adjuvants, although producing a lower recurrence rate, is not free from complications. The most frequent complications are: cutaneous fistula, abscesses, cellulitis, osteitis, hypopigmentation, hemolysis and necrosis and of course cosmetic defect. Krishna et al. describe their special biopsy method called curopsy [10]. It is a limited percutaneous curettage that is used to obtain material for histological examination. After curopsy, patients are followed up clinically and radiographically. Only if the lesion or symptoms progress do patients undergo additional treatment, mostly with curettage without adjuvants.
Preoperative adrenal artery embolization followed by surgical excision of giant hypervascular adrenal masses: report of three cases
Published in Acta Chirurgica Belgica, 2018
Ismail Cem Sormaz, Fatih Tunca, Arzu Poyanlı, Yasemin Giles Şenyürek
Preoperative management included medical treatment with α- and β-adrenergic blockers for blood pressure control. Three weeks before surgery, the patient was started on phenoxybenzamine 10 mg per day by mouth, which was gradually titrated up to 60 mg per day. The patient was also put on β-adrenergic blocker agent (propranolol-HCL) 40 mg per day concordant with gradual increasing doses of phenoxybenzamine. Preoperative adrenal artery embolization was planned for the right-sided adrenal mass in this patient. The main aim of the arterial embolization was to reduce hypervascularity and decrease troublesome bleeding during surgery. We also thought that TAE might help to prevent severe perioperative hypertensive attacks. The day before angiography and embolization, the average blood pressure and heart rate of the patient were 123/62 mm Hg and 65 bpm, respectively. Equipment for close hemodynamic monitoring and management of possible hypertensive attacks during angiography and embolization was maintained.