Biomedical subjects
Publications and source records attributed to Y Ben-Menachem.
Use of therapeutic arterial embolization (TAE) in the traumatized patient can achieve rapid control of hemorrhage and obviate the need for immediate surgery on poor-risk patients or in high-risk areas of the body. The techniques of embolization, its risks, and complications are discussed in light of the authors' experience, and a review of recent literature is presented.
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A patient developed benign nodular hyperplasia of the liver after long-term, high-dose estrogen therapy. A 10.5-cm benign liver nodule appeared after three years of high-dose estrogen therapy and was resected. Fourteen months later, while still receiving estrogen, a 4.5-cm nodule and multiple small nodules were seen on angiography. Four months after estrogen was discontinued, the larger liver nodule disappeared and the smaller ones decreased.
In older patients with glucose-6-phosphatase deficiency adenomatous nodules develop within the liver parenchyma. Investigation of eight such patients, age 3 to 28 years, using radioisotopic scans, has demonstrated areas of depressed isotope uptake in the liver in all except the one preteenaged child. Three patients were further studied with hepatic angiograms and liver biopsy specimens. A diffuse nodularity, more widespread than apparent on isotopic scans, was demonstrated on angiograms. Although initial histologic study in each case showed adenomatous tissue without evidence of neoplasm, the development of hepatocellular carcinoma in one of our patients and in others from the literature suggests that the nodules may be premalignant.
Five patients with pelvic fractures were studied arteriographically and all were found to have injury to one or both superior gluteal arteries, in addition to other injuries. In three of the five patients no adjacent bony damage was seen on plain pelvic roentgenograms. A possible explanation for this finding is given in terms of anatomic relationships within the pelvis. The importance of early arteriography in the diagnosis management of blunt pelvic trauma is emphasized.
An hour before nephrectomy 10 patients with hypernephroma and 2 with pyonephrosis underwent occlusion of the renal arteries with gelfoam via selective catheterization, using the Seldinger percutaneous technique. This technique facilitated the operation by collapsing the renal and perirenal veins, decreased blood loss and prevented the dissemination of tumor cells or septic emboli from organ manipulation.
Selective transcatheter arterial embolization was performed in 7 cancer patients with gastrointestinal or uterine bleeding. Most were bleeding from neoplastic tissue and were refractory to conservative management. Complete and permanent cessation of bleeding was obtained in 5 patients, including 3 with gastric bleeding, 1 with colonic bleeding, and in 1 with uterine bleeding. Successful arterial embolization allowed further treatment of the underlying disease which was particularly critical as these patients were poor surgical candidates. No significant or prolonged side effects were noted.
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