1/19. Pelvic arterial embolization for control of obstetric hemorrhage: a five-year experience.OBJECTIVE: Obstetric hemorrhage is a significant cause of maternal morbidity and death. postpartum hemorrhage that cannot be controlled by local measures has traditionally been managed by bilateral uterine artery or hypogastric artery ligation. These techniques have a high failure rate, often resulting in hysterectomy. In contrast, endovascular embolization techniques have a success rate of >90%. An additional benefit of the latter procedure is that fertility is maintained. We report our experience at Stanford University Medical Center in which this technique was used in 6 cases within the past 5 years. STUDY DESIGN: Six women between the ages of 18 and 41 years underwent placement of arterial catheters for emergency (n = 3) or prophylactic (n = 3) control of postpartum bleeding. Specific diagnoses included cervical pregnancy (n = 1), uterine atony (n = 3), and placenta previa and accreta (n = 2). RESULTS: Control of severe or anticipated postpartum hemorrhage was obtained with transcatheter embolization in 4 patients. A fifth patient had balloon occlusion of the uterine artery performed prophylactically, but embolization was not necessary. In a sixth case, bleeding could not be controlled in time, and hysterectomy was performed. The only complication observed with this technique was postpartum fever in 1 patient, which was treated with antibiotics and resolved within 7 days. CONCLUSIONS: uterine artery embolization is a superior first-line alternative to surgery for control of obstetric hemorrhage. Use of transcatheter occlusion balloons before embolization allows timely control of bleeding and permits complete embolization of the uterine arteries and hemostasis. Given the improved ultrasonography techniques, diagnosis of some potential high-risk conditions for postpartum hemorrhage, such as placenta previa or accreta, can be made prenatally. The patient can then be prepared with prophylactic placement of arterial catheters, and rapid occlusion of these vessels can be achieved if necessary.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/19. Transient myocardial ischemia may occur following subendometrial vasopressin infiltration.A case of transient myocardial ischemia following subendometrial vasopressin infiltration in intractable intra-operative postpartum bleeding due to placenta accreta is described. In our experience, the rate of this side effect is one in 14 patients (rate of 7.1%). We believe that the benefits of the treatment outweigh the risks, since the uterus was saved in all 14 patients. Nevertheless, this case emphasises that extreme precaution is needed with subendometrial vasopressin infiltration. It should be emphasised that the needle must not be within a blood vessel because intravascular injection of vasopressin solution can precipitate acute arterial hypertension, bradycardia and even death. We suggest that local vasopressin infiltration into the placental site is indicated in cases of intractable bleeding at cesarean section after other conventional obstetric and pharmacological maneuvers have failed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/19. Retained products of conception masquerading as acquired arteriovenous malformation.This case documents a seldom-described event of retained products of conception masquerading as an acquired arteriovenous malformation (AVM) of the uterus. The patient presented with sudden onset of heavy vaginal bleeding 6 weeks after artificial abortion. ultrasonography and magnetic resonance imaging revealed a diffuse intramural lesion predominantly consisting of prominent vessels, which raised suspicion of an AVM. hysterectomy revealed retained products of placenta that were necrotic and encroached into thin myometrium.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/19. Percutaneous transcatheter embolization for control of life-threatening pelvic hemorrhage from gestational trophoblastic disease.Pelvic hemorrhage from gestational trophoblastic disease remains a common and vexing problem. Traditional surgical therapy, including hysterectomy and hypogastric artery ligation, may be technically difficult as well as hazardous to debilitated patients. In contrast, percutaneous transcatheter embolization specifically occludes the vessels that directly contribute to bleeding. Other potential advantages include avoidance of general anesthesia and major surgery, a rapid recovery period, and preservation of fertility. Various embolic materials allow one to tailor the duration of occlusion to the underlying disorder. Reported complications are rare and generally involve aberrant emboli or inadequate collateral circulation leading to ischemic injury. We believe that transcatheter embolization should be considered an alternative to operative intervention for control of pelvic hemorrhage from gestational trophoblastic disease.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/19. Acute abdomen as first symptom of acute leukemia.CASE REPORT: The authors presented a rare case of acute abdomen syndrome caused by the rupture of the corpus rubrum as the first symptom in a 35-years-old woman with the acute lymphatic leukemia. During the laparotomy is notice diffuse bleeding from under skin blood vessels and muscles. The blood was electrocoagulated and was sewn with catgut sutures. The right ruptured corpus rubrum was found from which fresh blood was leaking. The right ovary was carefully resected and sutured, and each ligature was bleeding. At the beginning of the surgery laboratory analysis results arrived which showed a high leukocytosis (28.0 x 10(9)/l) with sever thrombocytopenia (10 x 10(9)/l) and afibrinogenemia (0.1 g/l) with anemia (1.9 x 10(12)/l erythrocyte, haematocrit 0.24), which indicated leukemia with disseminated intravascular coagulopathy (antithrombin iii levels 0.9 g/l, D-dimers 1989 micro g/l). RESULT. A year later she died with the picture of severe disseminated intravascular coagulopathy, agranulocytosis and septic condition with multiorganic failure.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/19. Laparoscopic uterine artery dissection in an undiagnosed endometrial stromal sarcoma. Case report.We present a case of a 24-year-old woman, gravida 0, with menometrorrhagia and pelvic pain. A uterine hemorrhagic fibroid was diagnosed after ultrasound and magnetic resonance imaging (MRI). The endometrial biopsy was negative for malignancy. Laparoscopic sentinel lymph node sampling, lavage, and myometrial biopsy with negative results were performed before dissection of the uterine vessels. The final diagnosis of endometrial stromal sarcoma was made by myomectomy and hysterectomy one year later. This case should demonstrate the difficulty of making the right diagnosis of sarcoma before laparoscopic dissection of uterine vessels in patients with symptomatic fibroids.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
7/19. Arteriovenous malformation of the uterus--a cause of massive operative bleeding.arteriovenous malformations of the uterus are extremely rare and they occur either in congenital or acquired forms. The most common clinical presentation is abnormal uterine bleeding, which may be aggravated by therapeutic curettage. Because of their rare incidence and clinical importance in management of patients, we report a case of arteriovenous malformation causing serious bleeding during a hysterectomy for uterine leiomyoma. The patient was a 47-year-old multiparous woman who had a history of chronic vaginal bleeding for one year. Numerous anomalous blood vessels draining into the right and left uterine arteries were found on the anterior wall of the uterus and parametrium.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/19. Multiple hepatocellular tumours in a patient treated with oral contraceptives.A case of multiple hepatic tumours in a patient treated for four years with high doses of oral contraceptives is described. Solitary hepatocellular lesions associated with conventional doses of oral contraceptives have been reported previously in twenty nine cases. Haemorrhage has been a common mode of presentation and is attributed to the marked vascularity of the lesions, an appearance referred to as peliosis hepatis. Radiographic studies show this term to be inappropriate as the vessels are of arterial origin. Another finding not previously reported is the presence of diffuse hyperplasia in the non-tumourous parts of the liver.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/19. Non-resolution of pelvic sonographic abnormality after chemotherapy for persistent trophoblastic disease--a word of caution.A case of persistent trophoblastic disease (PTD) is presented in whom pelvic sonography demonstrated persistent uterine abnormality and dilated adnexal vessels after cessation of chemotherapy. hysterectomy was performed on account of subsequent uterine bleeding. A viable tumour was not demonstrated in the hysterectomy specimen. In the absence of haemorrhagic complications persistent sonographic abnormality should not necessarily indicate hysterectomy, especially when hCG levels are normal.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/19. Arteriographic management of uterine arteriovenous fistula.A 21-year-old woman had an arteriovenous fistula of the uterus diagnosed by arteriography after several episodes of profuse uterine bleeding. Arteriographic embolization of the uterine vessels was performed twice with the resumption of normal menses after the second procedure. 15-Methyl-prostaglandin F2 alpha was used effectively for short-term control of hemorrhage.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
| | Next -> |