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PubMed1998

Pelvic congestion syndrome: early clinical results after transcatheter ovarian vein embolization.

PURPOSE: This case series describes the early radiographic and clinical results of attempted transcatheter ovarian vein (OV) embolization in 11 women with symptoms that were suggestive of the pelvic congestion syndrome (PCS). METHODS: Eleven women (mean age, 33.1 years) who were multiparous were referred for lower extremity or vulvar varicosities (n = 8) or for tubo-ovarian varicosities (n = 3). After a clinical diagnosis of PCS was established, the women underwent ovarian (n = 5) or ovarian and iliac vein (n = 6) venography. Enlarged or incompetent OVs were embolized with 0.035-inch stainless steel coils or with 0.018-inch platinum microcoils and absorbable gelatin sponge. Incompetent tributaries to hypogastric veins were embolized as well (n = 1). Symptoms before embolization and after embolization were recorded with a standard questionnaire, and the post-embolization symptoms were expressed as individual and overall percent relief. RESULTS: Nine of the 11 women underwent embolization. Embolization of both OVs (n = 4), of the left OV alone (n = 4), or of a left obturator vein that communicated with vulvar varices (n = 1) was performed. Eight of the 9 women (88.9%) had more than 80% immediate relief. Overall and individual symptom relief varied from 40% to 100% at the mean 13.4-month follow-up. One woman with variant anatomy and one woman with evidence of prior left OV thrombosis were not treated. There were no major complications. Two women had a mild to moderate return of the symptoms at 6 and 22 months. CONCLUSIONS: Transcatheter embolization provides excellent initial and variable midterm relief in women with typical PCS symptoms and with OV or OV and internal iliac (hypogastric) tributary vein incompetence. This interventional technique may replace or complement the traditional surgical approaches to this rarely recognized and poorly understood disease.

Adult↗
PubMed2001

Right gastric artery embolization to prevent acute gastric mucosal lesions in patients undergoing repeat hepatic arterial infusion chemotherapy.

PURPOSE: The purpose of the study was to investigate the technical outcome and clinical effect of right gastric artery (RGA) embolization to prevent acute gastric mucosal lesions caused by influx of anticancer agents into the RGA in patients undergoing repeat hepatic arterial infusion chemotherapy (HAIC). MATERIALS AND METHODS: In 217 patients with malignant hepatic tumors, we attempted RGA embolization with use of metallic coils and/or a mixture of n-butyl cyanoacrylate (n-BCA) and iodized oil, along with the embolization of the gastroduodenal artery. After this procedure, an infusion catheter was placed radiologically and HAIC was performed. We then evaluated the technical outcome and clinical effect of RGA embolization. RESULTS: RGA embolization was technically successful in 201 of 217 patients (93%). Major complications--nausea, epigastric pain, and fever--were noted in 12%, 4%, and 2% of successful cases, respectively, and were treated conservatively. Recanalization occurred in 4% (nine of 201) of the patients. Eventually, sufficient RGA embolization was achieved in 192 patients. The incidence of acute gastric mucosal lesions confirmed endoscopically was only 3% (five of 192) in patients with sufficient RGA embolization, whereas it was 36% (nine of 25) in patients without sufficient RGA embolization, with a significant difference (P <.01). CONCLUSION: RGA embolization is a highly feasible procedure that can reduce the incidence of acute gastric mucosal lesions associated with HAIC.

Acute Disease↗
PubMed1999

Experimental evaluation of cellulose acetate NF and ethylene-vinyl alcohol copolymer for selective arterial embolization.

PURPOSE: Studies were conducted in rabbits to evaluate two new liquid polymeric compounds developed for selective arterial embolization. MATERIALS AND METHODS: The compounds consisted of cellulose acetate NF (Embolyx C) or ethylene-vinyl alcohol copolymer (Embolyx E) dissolved in anhydrous dimethyl sulfoxide (DMSO) containing 30% tantalum powder. Acute renal embolization was performed to determine an optimal method of administration and level of embolization. Kidneys were embolized with and without flow around the catheter. DMSO was also injected in the same manner. Tissue sections were examined radiographically and microscopically. Tumor embolization was performed to evaluate the efficacy of the polymers and compare their embolic effects with polyvinyl alcohol (PVA) particles and gelatin sponge (Gelfoam) powder. An embolic agent, saline, or DMSO was injected into the deep femoral artery feeding an intramuscular VX2 carcinoma. Animals were followed up for 3 weeks. RESULTS: Viscosity and administration technique affected polymer distribution and depth of penetration. Embolization with the test polymers was quicker and more easily achieved than with PVA or Gelfoam, and no recanalization occurred. Both polymers were as effective as PVA particles for tumor ablation, but DMSO caused some vascular damage. CONCLUSION: Although use of DMSO has some drawbacks, the results of this study warrant further investigation of the Embolyx polymers for tumor embolization.

Angiography↗
PubMed2001

Uterine fibroid embolization: nonsurgical treatment for symptomatic fibroids.

BACKGROUND: Earlier studies demonstrated the efficacy of uterine fibroid embolization (UFE). We seek to demonstrate the success of the procedure in a community hospital setting, and we attempt to identify patients likely not to benefit from embolization, if possible, before the procedure. STUDY DESIGN: The study followed all women treated with UFE for menorrhagia or postmenopausal bleeding at a community hospital between 1997 and 1999. Relief of symptoms, ultrasound changes, and complications were documented. Six months after the procedure, analysis was performed on ultrasound and interview data from patients who underwent UFE. A smaller number of patients has been followed for 12 months and were available for the analysis. We examined characteristics of patients and procedures performed in an attempt to identify likely failures of treatment. We calculated complication and failure rates based on the entire group of patients. RESULTS: From 183 patients who applied for UFE, 16 were excluded because ofpathologic conditions found during preembolization evaluation; 167 women had an embolization, 163 were successfully embolized bilaterally, and 4 were embolized unilaterally because of technical failure. Eighty-eight percent of the patients (147 of 167 patients) reported an improvement or stabilization of symptoms 6 months after UFE. Forty-six patients followed for 12 months experienced myoma shrinkage of 37% (a significant shrinkage over 6 months, p < 0.001), and total uterine volume decreased 52%. Analysis of shrinkage data revealed no demographic or procedure variable associated with shrinkage. Six patients underwent hysterectomy (3.5%) after embolization, one as a result of postprocedure infection. Pain in the first 24 hours postprocedure affected almost all patients. Five percent of the patients passed submucous myomata after UFE; all these patients at risk were identified at preembolization hysteroscopy. Four patients experienced premature menopause after embolization early in the study. There were three criteria for failure, of which a patient had to meet only one: hysterectomy, < 10% shrinkage ofmyoma 6 months after UFE, or worsening symptoms after UFE. No variables of age or size of the uterus could be shown to predict failure. Patients who had undergone earlier pelvic surgery were more likely to fail UFE (p = 0.012). CONCLUSIONS: Uterine fibroid embolization, an alternative treatment for myomas, offering low morbidity, can be performed in a community hospital setting. Eighty-eight percent of patients reported improvement or stabilization of symptoms. Total uterine volume decreased an average of 49% at 6 months after embolization. Shrinkage was unaffected by the size of the uterus, myoma, or patient characteristic before UFE. Longterm followup study reveals a significant continuing shrinkage of total uterine volume and myomata at 12 months. There has been no regrowth of fibroids. Earlier surgery was a factor predicting failure of UFE in our series. The risks to future fertility were small.

Embolization, Therapeutic↗
PubMed2004

Comparative incidence of venous air embolism and associated hypotension in adults and children operated for neurosurgery in the sitting position.

BACKGROUND AND OBJECTIVE: Venous air embolism is a constant threat during neurosurgery performed in the sitting position. No large prospective study has compared the incidence of venous air embolism and associated hypotension between adults and children. METHODS: Four hundred and thirty patients (334 adults, 96 children) scheduled to undergo planned posterior fossa surgery in the sitting position (between January 1989 to December 1994) were studied with end-tidal carbon dioxide monitoring. Intraoperatively, a sudden and sustained decrease in end-tidal carbon dioxide tension of >0.7 kPa was presumed to be due to venous air embolism. Management during the episode was on the established guidelines. Hypotension (decrease in systolic arterial pressure of 20% or more from the previous level) was treated with crystalloids and/or a vasopressor. RESULTS: Capnometry detected a 28% incidence rate of air embolism in adults (93/334) and a 22% incidence rate in children (21/96) (P = 0.29). In both groups, the highest incidence rate of embolism took place during muscle handling (44% of adults versus 38% of children, P = 0.8). Embolic episodes were accompanied by hypotension in 37% of adults (34/93) and in 33% of children (7/21) (P = 0.98). To restore arterial pressure to pre-embolic levels, 53% of adults (18/34) and 43% of children (3/7) were administered vasopressors (P = 0.94). There was no intraoperative mortality. The surgical procedure on one adult was abandoned because of persistent hypotension following the embolic episode. CONCLUSION: The incidence of venous air embolism and consequent hypotension is similar in adults and children.

Adult↗
PubMed1999

[The role of electron beam CT in the diagnosis of acute pulmonary embolism--presenting a new examination protocol].

PURPOSE: To evaluate electron beam tomography in the detection of acute pulmonary embolism using a new acquisition protocol. MATERIALS AND METHODS: 65 patients underwent electron beam tomography (EBT) and v./p. scintigraphy. According to the inclusion criteria 46 patients participated in the study. Contrast enhancement and detectability of pulmonary arteries were scored on a 4 step scale for image quality. The results of prospective detection of pulmonary embolism were compared for both modalities (blinded reading). "Embolism", "questionable embolism" and "no embolism" were used as categories. RESULTS: 22/46 patients (48%) showed acute pulmonary embolism. EBT and scintigraphy were discordant in 24% of patients. In EBT 1 false positive and 1 false negative case occurred, scintigraphy demonstrated 2 false negative and 3 false positive cases. 6/9 patients with questionable findings in scintigraphy were correctly classified by EBT to a category "embolism" or "no embolism" as "suspected embolism", EBT displayed a sensitivity of 96.3% and a specificity of 94.7%. Scintigraphy evidenced a sensitivity of 93.7% and a specificity of 84.4%. CONCLUSIONS: EBT shows better results than scintigraphy for the detection of acute pulmonary emboli. The evaluated new acquisition protocol for EBT seems to be well suited. High vessel contrast and thin slices allow a reliable detection of segmental and subsegmental pulmonary arteries.

Acute Disease↗
PubMed2000

Preoperative embolization of intracranial meningiomas: a 17-years single center experience.

The purpose of the present report is to review the evolution of endovascular therapy at our center as utilized for the preoperative embolization of intracranial meningiomas over a 17-years period (1982-1998). This study is based upon a consecutive series of 63 patients who underwent preoperative embolization of intracranial meningiomas. Total or subtotal angiographic devascularization of the tumor parenchyma was accomplished in 38 patients (60.3%) who had tumors with either an external carotid artery supply only (n = 30) or with contributions from the cavernous carotid artery, ophthalmic artery, vertebral artery, or pial feeders which were feasible for selective embolization (n = 8). Partial tumor embolizations were attained in the remaining 25 patients (39.7%) because 1. the remanent feeders were considered easily accessible to surgical control in the early stages of dissection, 2. the feeding branches were inaccessible for a microcatheter approach, or 3. superselective microcatheter positions allowing for safe embolization without reflux of embolic material into physiological branches were not achieved. Overall, 97 of 126 tumor feeders identified angiographically were catheterized to selective embolization (77%). Three embolization related complications occurred early in our experience (1982-1989) using techniques which no longer meet standards of treatment. In light of the remarkable evolution of endovascular techniques over the 17-years study period, however, we conclude that preoperative embolization of intracranial meningiomas can be performed safely with the endovascular tools currently available.

Adult↗
PubMed2004

[Embolization of pulmonary arteriovenous malformations with electrolytically detachable coils in patients with hereditary hemorrhagic telangiectasia].

BACKGROUND: Pulmonary arteriovenous malformations (PAVM) can be found in approximately 20 % to 35 % of patients with hereditary hemorrhagic telangiectasia (HHT). PAVM should be treated since they are a source of paradoxical embolization, potentially resulting in severe neurologic complications. The treatment of choice is the endovascular embolization with coils. PATIENTS AND METHODS: Seven patients with HHT underwent superselective embolization of PAVM detected during screening for PAVM. Four patients had a single PAVM and one patient 3, 4 and 5 PAVMs, respectively. Electrolytically detachable coils were used for embolization. In addition, coils with synthetic fibers were used during 6 embolizations for completion of embolization. RESULTS: Embolization was technically successful in all patients. Complete primary occlusion was achieved in all PAVM. No coil migration or occlusion of unaffected pulmonary arteries was observed. After embolization, one patient developed a small pleural effusion, which was treated symptomatically. CONCLUSION: As a minimally invasive procedure, superselective embolization is the treatment of choice in treating PAVM in patients with HHT. With the use of electrolytically detachable coils, the ideal coil size can be chosen and exact placement achieved without the risk of coil migration or occlusion of unaffected pulmonary arteries.

Adolescent↗
PubMed2005

[Long-term fate of left atrial thrombi and incidence of cerebral embolism under continuous anticoagulation therapy].

PURPOSE: Patients (pts.) with atrial fibrillation (AF) and atrial thrombi are known to have an increased risk for cerebral embolism. However, little is known about the clinical course of atrial thrombi and the incidence of cerebral embolism in those patients during anticoagulation therapy. The high sensitivity of MR imaging (MRI) including diffusion-weighted imaging (DWI) suggests that this technique could provide an improved estimate of cerebral embolism associated with the presence of left atrial thrombi. The aims of this prospective study were to evaluate 1) the prevalence of clinically silent and apparent cerebral embolism in pts. with newly diagnosed AF and atrial thrombi using MRI/DWI, 2) the long-term fate of atrial thrombi under continues anticoagulation therapy and 3) the incidence of cerebral embolism during a follow-up period of 12 months with continuous anticoagulation therapy. MATERIALS AND METHODS: The study group consisted of 32 pts. with 1) newly diagnosed AF and evidence of left atrial (LA) thrombi detected by TEE and 2) a new start of anticoagulation therapy [International Normalized Ratio (INR) 2.0 - 3.0]. 19 pts. with 1) newly diagnosed AF and no evidence of atrial thrombi and 2) an equivalent anticoagulation regimen served as the control group. In both groups a) MRI/DWI studies of the brain (weeks 0, 4, 8, 12, 20, 28, 36, 44, and 52), b) transesophageal echocardiographic studies (TEE) for assessment of LA-Thrombi (weeks 0 and 52) and c) clinical neurological assessments (weeks 0, 20 and 52) were performed. RESULTS: In the study group (AF and LA-Thrombi) 11 out of 32 pts. (34 %) displayed signs of acute (n = 8) or chronic (n = 3) cerebral embolism in the initial MRI studies. In 4 out of 32 pts. (13 %), MRI/DWI depicted new or additional cerebral emboli (n = 12) during the follow-up period despite continuous anticoagulation therapy. 2 (n = 2/4; 50 %) of these patients had clinically apparent neurological deficits. In the control group 1 out of 19 pts. (5 %) showed evidence of chronic cerebral embolism as assessed by MRI/DWI at the beginning of the study (week 0). No embolic cerebral lesions were detected during the 12-month follow-up. Within 12 months only 63 % (n = 20/32) of LA thrombi in the study group resolved completely under anticoagulation. CONCLUSION: 1. The incidence of clinically inapparent cerebral emboli in pts. with newly diagnosed AF and atrial thrombi is much higher than the incidence of clinically apparent emboli and has been underestimated in the past. 2. New cerebral embolism may occur even with continued effective anticoagulation therapy in 13 % of pts. 3. Only 63 % of atrial thrombi resolve completely within 12 months under anticoagulation therapy.

Aged↗
PubMed1999

[Evaluation of right heart load with spiral CT in patients with acute lung embolism].

PURPOSE: Purpose of this study was to evaluate whether spiral-CT allows judgment of right ventricular failure in patients with acute pulmonary embolism. MATERIALS AND METHODS: 61 patients underwent spiral-CT due to suspicion of acute pulmonary embolism. Patients with pulmonary embolism were divided into subpopulations according to the severity of pulmonary embolism in the CT scan. Cardiac measurements were performed on axial spiral-CT images and compared to those of patients without suspicion of pulmonary embolism or cardiac diseases. RESULTS: In 30 patients spiral-CT revealed acute pulmonary embolism. Significant differences in cardiac measurements in patients with severe and less severe pulmonary embolism were found on comparing the following dimensions: left ventricular width (p = 0.0003), left (p = 0.008) and right (p = 0.009) ventricular cross-sectional area, proportion of right to left ventricular width (p = 0.0003) and proportion of right to left ventricular cross-sectional area (p = 0.0001). The proportion of the cross-sectional areas (r = 0.65) and the proportion of the width (r = 0.60) of both ventricles correlated well with the severity of central pulmonary embolism. CONCLUSION: Besides reliable assessment of pulmonary embolism spiral-CT allows the evaluation of cardiac dimensions for judgment of right ventricular failure.

Adult↗
PubMed2001

Severe pulmonary embolism associated with air travel.

BACKGROUND: Air travel is believed to be a risk factor for pulmonary embolism, but the relation between pulmonary embolism and distance flown has not been documented. The aim of this study was to investigate whether the duration of air travel is related to the risk of pulmonary embolism. METHODS: From November 1993 to December 2000, we systematically reviewed all cases of pulmonary embolism requiring medical care on arrival at France's busiest international airport. Data on the geographic origins of all flights and the numbers of passengers were collected in order to evaluate the incidence of pulmonary embolism per 1 million passenger arrivals as a function of the distance traveled. RESULTS: A total of 135.29 million passengers from 145 countries or other areas arrived at Charles de Gaulle Airport during the period of the study, of whom 56 had confirmed pulmonary embolism. The incidence of pulmonary embolism was much higher among passengers traveling more than 5000 km (3000 mi) (1.5 cases per million, as compared with 0.01 case per million among those traveling less than 5000 km). The incidence of pulmonary embolism was 4.8 cases per million for those traveling more than 10,000 km (6000 mi). CONCLUSIONS: A greater distance traveled is a significant contributing risk factor for pulmonary embolism associated with air travel.

Aerospace Medicine↗
PubMed2002

Cost analysis of myomectomy, hysterectomy, and uterine artery embolization.

OBJECTIVE: The purpose of this study was to compare inpatient hospital costs of different treatments of uterine fibroid tumors, including myomectomy, hysterectomy, and uterine artery embolization in a teaching hospital. STUDY DESIGN: We reviewed the hospital database of 545 women with uterine fibroid tumors who were treated with abdominal myomectomy, total abdominal hysterectomy, vaginal hysterectomy, and uterine artery embolization between April 1997 and October 2001. RESULTS: Women who underwent hysterectomies and uterine artery embolization were significantly older than the women who underwent myomectomy. Uterine artery embolization was associated with the shortest hospital stay, although the hospital stay in the vaginal hysterectomy group was shorter than in the abdominal myomectomy and the total abdominal hysterectomy groups. Compared with other groups, the inpatient cost of nursing in the uterine artery embolization group was the lowest. The total inpatient cost of uterine artery embolization ($1,007.44 +/- $60.65 [Canadian dollars]) was significantly lower than the cost of total abdominal hysterectomy ($1,933.37 +/- $47.68 [Canadian dollars]), abdominal myomectomy ($1,781.73 +/- $47.16 [Canadian dollars]), and vaginal hysterectomy ($1,515.39 +/- $66.72 [Canadian dollars]; P <.001). Sixteen of the 85 patients (18.8%) were hospitalized after uterine artery embolization, mainly for abdominal pain. CONCLUSION: Compared with abdominal myomectomy, abdominal hysterectomy, and vaginal hysterectomy, uterine artery embolization is associated with a lower hospital cost and a shorter hospital stay. Hospitalization after uterine artery embolization is mainly for abdominal pain after the procedure. A better method of pain control to reduce the rate of hospitalization and its cost is needed.

Adult↗
PubMed2006

Predictive value of magnetic resonance imaging signal and contrast-enhancement characteristics on post-embolization volume reduction of uterine fibroids.

PURPOSE: To assess the magnetic resonance imaging (MRI) signal and contrast-enhancement features of uterine fibroids before and after embolization, and to determine whether or not there are pre-embolization MRI characteristics that predict the volume reduction of fibroids. MATERIAL AND METHODS: Uterine fibroid embolization (UFE) was carried out in 28 fibroids of 20 patients, all of whom were symptomatic. The patients were prospectively evaluated with T1-weighted, T2-weighted, and gadolinium-enhanced T1 MRI sequences before and 6 months after embolization. The relationship between the characteristics of MRI signal and contrast-enhancement features of fibroids before the procedure and the change in size of the lesions after treatment was investigated. RESULTS: Before embolization, the mean volume of fibroids was 123 cm3 (8-560 cm3). The decrease rate in fibroid volumes was 44.6% (range 7-70%) 6 months after embolization. Volume reduction was more prominent in fibroids that had a high signal intensity on T2-weighted images and a marked contrast enhancement on T1-weighted images (P < 0.001). However, the volume reduction was insufficient in fibroids with high signal characteristics on pre-contrast T1-weighted images (P < 0.001). CONCLUSION: MRI is an effective method for revealing size and signal changes of fibroids after embolization. MRI signal characteristics and the contrast-enhancement pattern of fibroids before embolization can predict tumor volume reduction after embolization.

Adult↗
PubMed1999

Relationship between cardiopulmonary bypass flow rate and cerebral embolization in dogs.

BACKGROUND: Cerebral embolization is a primary cause of cardiac surgical neurologic morbidity. During cardiopulmonary bypass (CPB), there are well-defined periods of embolic risk. In theory, cerebral embolization might be reduced by an increase in pump flow during these periods. The purpose of this study was to determine the CPB flow-embolization relation in a canine model. METHODS: Twenty mongrel dogs underwent CPB at 35 degrees C with alpha-stat management and a fentanyl-midazolam anesthetic. In each animal, CPB flow was adjusted to achieve a mean arterial pressure of 65-75 mmHg. During CPB, an embolic load of 1.2 x 10(5) 67 microm fluorescent microspheres was injected into the arterial inflow line. Before and after embolization, cerebral blood flow was determined using 15-microm microspheres. Tissue was taken from 12 brain regions and microspheres were recovered. The relation between pump flow and embolization/g of brain was determined. RESULTS: The mean arterial pressure at embolization was 67 +/-4 mmHg, and the range of pump flow was 0.9-3.5 l x min(-1)x m(-2). Cerebral blood flow was independent of pump flow. At lower pump flow, the percentage of that flow delivered to the brain increased. There was a strong inverse relation between pump flow and cerebral embolization (r = -0.708, P < 0.000 by Spearman rank order correlation). CONCLUSIONS: Cerebral embolization is determined by the CPB flow. At an unchanged mean arterial pressure, as pump flow is reduced, a progressively greater proportion of that flow is delivered to the brain.

Animals↗
PubMedDate not supplied

Evaluation of pulmonary embolisms using coronal reformations on 64-row multidetector-row computed tomography: Comparison with axial images.

OBJECTIVE: To evaluate coronal reformations of the chest on 64-row multidetector-row computed tomography (MDCT) for detection of pulmonary embolisms compared with axial images. METHODS: Thirty-eight consecutive patients who underwent pulmonary computed tomography angiography (CTA) on 64-row MDCT for a suspected pulmonary embolism were retrospectively studied. Contiguous 2-mm axial and coronal images were reviewed independently. A pulmonary embolism was assessed in the main, lobar, or segmental pulmonary arteries and was scored using a 5-point scale. RESULTS: A pulmonary embolism was demonstrated in 10% (4 of 38) of axial images and 16% (6 of 38) of coronal images. Interpretation was concordant in 95% to 100% of cases for a main or lobar pulmonary embolism and in 80% to 82% of cases for a segmental pulmonary embolism. Agreement of scores was almost perfect for a a main or lobar pulmonary embolism (mean weighted kappa value = 0.969) and moderate to good for a segmental pulmonary embolism (mean weighted kappa value = 0.560). CONCLUSION: Coronal reformations of the chest on 64-row MDCT were as informative as axial images for the detection of main, lobar, and segmental pulmonary embolisms.

Adult↗
PubMed1997

Preoperative embolization in the management of neck paragangliomas.

Surgery of neck paragangliomas carries inherent risks of excessive blood loss and cranial nerve injury. Preoperative embolization has been used to lessen the morbidity of surgery. We sought to characterize our experience with preoperative embolization by evaluating safety, efficacy, and surgical data. During a period of 22 years (1974 to 1996), 19 consecutive patients with 27 histopathologically confirmed neck paragangliomas were surgically treated at the Oulu University Hospital. All patients underwent preoperative arteriography and 17 patients had cervical ultrasonography (US). Eleven patients with 15 tumors were operated on without embolization and nine patients with 12 tumors were preoperatively embolized with 150- to 250-microm polyvinyl alcohol (PVA) particles. The mean blood loss during surgery in the nonembolized group was 1374 mL (range, 100 to 4500 mL) and the mean operation time was 4 hours and 48 minutes (range, 1.5 to 9 hours). In the embolized group the mean blood loss was significantly less (588 mL; range, 100 to 1800 mL; P = 0.04) and the mean operation time shorter (3 hours 24 minutes; range, 2 to 5 hours; P = 0.05). No embolic complications were recorded after the embolization. We conclude that preoperative embolization of neck paragangliomas 3 cm or greater in diameter with PVA particles is safe. Embolization to minimize operative bleeding facilitates surgery, shortens the operation time, and lessens the surgical risks.

Adolescent↗
PubMed2005

Evaluation of intra-abdominal pressures and gas embolism during laparoscopic partial nephrectomy in a porcine model.

PURPOSE: Gas embolization is a well documented complication of laparoscopic surgery. We evaluated the association of gas embolization with increased intra-abdominal pressure (IAP) in the porcine model during laparoscopic partial nephrectomy with real-time transesophageal echocardiography. MATERIALS AND METHODS: Eight domestic pigs weighing 143 to 162 pounds underwent unilateral transperitoneal laparoscopic heminephrectomy with renal artery clamping with varied IAPs. The renal vein was not clamped, allowing the exposure of venous tributaries to the pneumoperitoneum. IAP was increased in 5 mm Hg increments in 4 pigs each by 1) insufflation pressure adjustment to a maximum of 30 mm Hg and 2) intermittent application of an argon beam coagulator (ABC) to the cut kidney surface. Transesophageal echocardiography was used to monitor embolism. RESULTS: None of the 4 animals subjected to increased CO2 insufflation pressure (maximum 30 mm Hg) demonstrated gas embolization during partial nephrectomy. The ABC caused gas embolization during partial nephrectomy at an IAP of 30 to 50 mm Hg in 4 animals. The volume of embolized gas was 4 to 20 ml. None of the animals showed intraoperative hemodynamic compromise. CONCLUSIONS: Gas embolization was not seen during laparoscopic partial nephrectomy with typical insufflation pressures. The ABC can rapidly increase IAP and cause argon embolization at IAPs greater than 30 mm Hg. Prophylactic maneuvers to prevent gas embolization, such as intra-abdominal venting or renal vein clamping, should be considered when applying the ABC.

Animals↗
PubMed2006

Initial symptoms in pulmonary embolism differ from those in pneumonia: a retrospective study during seven years.

OBJECTIVE: To compare initial symptoms in pulmonary embolism with community-acquired pneumonia and relate to C-reactive protein and pulmonary infiltrates in order to improve the clinical assessment at the emergency department. METHODS: A retrospective review of patients with pulmonary embolism diagnosed in the clinic for infectious diseases (CID), (n=25), and a randomized sample of patients with pulmonary embolism diagnosed in the department of medicine (n=64), and a randomized sample of patients with community-acquired pneumonia (n=54) diagnosed in the clinic for infectious diseases. RESULTS: Initial symptoms in pulmonary embolism, dominated by dyspnoea and/or pleuritic chest pain were significantly different from those in community-acquired pneumonia, dominated by fever, chills and/or cough (P<0.001). On admission, C-reactive protein and body temperature were significantly higher and pulmonary infiltrates were more common in pneumonia compared with randomized pulmonary embolism patients. Twenty-five patients with a final diagnosis of pulmonary embolism were erroneously suspected of having lung infection, owing to increased C-reactive protein, presence of pulmonary infiltrates and/or high fever. However, they had classical symptoms of pulmonary embolism. CONCLUSIONS: Pulmonary infiltrates, high fever and a high level of C-reactive protein can deceive the physician to suspect pneumonia instead of pulmonary embolism. Classical initial symptoms ought to direct the physician in diagnosing pulmonary embolism. We emphasize a detailed patient history of initial symptoms.

Adolescent↗