Objective: Retrospective evaluation of pelvic arterial embolization for the treatment of severe post-partum hemorrhage. Methods: Data were collected, from our departmental clinical records, on all patients with life-t...Objective: Retrospective evaluation of pelvic arterial embolization for the treatment of severe post-partum hemorrhage. Methods: Data were collected, from our departmental clinical records, on all patients with life-threatening post-partum hemorrhage managed with arterial embolization between January 2001 and December 2003. Results: During the period analyzed, there were 29,119 deliveries in our institution. Of these, 27 patients underwent pelvic arterial embolization to control severe hemorrhaging despite conservative management. Of the 27 patients, 22(81.5%) had a vaginal delivery and 5 had a caesarean section. The major indication for embolization was uterine atony(15 women). Disseminated intravascular coagulation developed in 20 cases(74.1%). There were eight cases(29.6%) who underwent hysterectomy, seven of them pre-emboliza-tion. The most frequent vessel embolized was the uterine artery(13 cases; 38.3%). One patient(3.7%) presented complications related to the procedure. The success rate was 96.3%. Conclusion: Pelvic arterial embolization is a good therapeutic choice for severe post-partum hemorrhage refractory to conservative treatment measures.展开更多
Background: Endoscopic removal of malfunctioning self-expandable metallic biliary stents (SEMS) is difficult and not well described. The aim of this study is to review the indications, the techniques, and the results ...Background: Endoscopic removal of malfunctioning self-expandable metallic biliary stents (SEMS) is difficult and not well described. The aim of this study is to review the indications, the techniques, and the results of SEMS removal in a cohort of patients with malfunctioning stents. Methods: All patients who underw ent an attempt at endoscopic removal of biliary SEMS over a 5-year period were retrospectively identified. The main indications for SEMSremovalwere the followi ng: distal migration of the stent or impaction to the duodenum, impaction into t he bile-duct wall, tissue ingrowth, and inappropriate length of the stent causi ng occlusion of intrahepatic ducts. SEMS were removed by using foreign-body for ceps or polypectomy snares. Results: Endoscopic removal of 39 SEMS (13 uncovered and 26 covered) was attempted in 29 patients (17 men; mean age, 66 years). SEMS extraction was attempted after a mean of 7.5 months (8.75 months standard devia tion) post-SEMS insertion. Removal was successful in 20 patients (68.9%) and i n 29 SEMS (74.3%). Covered SEMS were effectively removed more frequently than u ncovered ones: 24 of 26 (92.3%) and 5 of 13 (38.4%), respectively (p < 0.05). No major complications were recorded. Multivariate analysis showed that the time interval between insertion and removal, SEMS length, stent-mesh design (zigzag vs. interlaced), and indication for removal were no t predictive of success at stent removal. Conclusions: Endoscopic removal of bil iary SEMS is feasible and safe in more than 70%of cases. Because only 38%of un covered SEMS were removable, the presence of a stent covering is the only factor predictive of successful stent extraction. The presence of diffuse and severe i ngrowth was the main feature limiting SEMS removal.展开更多
Background: While the role of EUS in the evaluation of pancreaticobiliary (PB) disorders in adults is well established, its utility in children remains unproven. This pros-pective study evaluates the feasibility, the ...Background: While the role of EUS in the evaluation of pancreaticobiliary (PB) disorders in adults is well established, its utility in children remains unproven. This pros-pective study evaluates the feasibility, the safety, and the impact of EUS in the evaluation of PB disorders in children. Methods: All children (< 18 years)referred for ERCP for evaluation of suspected PB disorders who underwent EUS before scheduled ERCP. The main outcome measure was to evaluate the impact of EUS in the evaluation of PB disorders in children. EUS was considered to have a significant impact if a new diagnosis was established or if the findings altered subsequent management. Results: Fourteen patients (mean age 13 years; range 5- 17 years) underwent 15 EUS procedures over a 3-year period. Main indications were the following: acute or recurrent pancreatitis (6 patients), suspected biliary obstruction (5), and abdominal pain suggestive of PB origin (3). EUS diagnosed chronic pancreatitis (3 patients), idiopathic fibrosing pancreatitis (2), carcinoid tumor (1), pancreatic pse-udocyst (1), pancreas divisum (1), choledocholithiasis (1), duodenal duplication cyst (1), and normal (4). Dia-gnosis of idiopathic fibrosing pancreatitis and carcinoid tumor was established by EUS-guided FNA. The procedure was successful in all patients, and no complications were encountered. EUS had an impact on patient management in 93% of cases: established new diagnosis (10), precluded need for ERCP (9), and provided additional information that facilitated focused endotherapy (4). A limitation was the small number of enrolled patients and absence of long-term clinical follow-up. Conclusions: EUS and EUS-guided FNA are feasible, safe, and have significant impact that alters subsequent management in the majority of children with PB disorders. Further studies and dissemination of information is required to facilitate its increased application in children.展开更多
文摘Objective: Retrospective evaluation of pelvic arterial embolization for the treatment of severe post-partum hemorrhage. Methods: Data were collected, from our departmental clinical records, on all patients with life-threatening post-partum hemorrhage managed with arterial embolization between January 2001 and December 2003. Results: During the period analyzed, there were 29,119 deliveries in our institution. Of these, 27 patients underwent pelvic arterial embolization to control severe hemorrhaging despite conservative management. Of the 27 patients, 22(81.5%) had a vaginal delivery and 5 had a caesarean section. The major indication for embolization was uterine atony(15 women). Disseminated intravascular coagulation developed in 20 cases(74.1%). There were eight cases(29.6%) who underwent hysterectomy, seven of them pre-emboliza-tion. The most frequent vessel embolized was the uterine artery(13 cases; 38.3%). One patient(3.7%) presented complications related to the procedure. The success rate was 96.3%. Conclusion: Pelvic arterial embolization is a good therapeutic choice for severe post-partum hemorrhage refractory to conservative treatment measures.
文摘Background: Endoscopic removal of malfunctioning self-expandable metallic biliary stents (SEMS) is difficult and not well described. The aim of this study is to review the indications, the techniques, and the results of SEMS removal in a cohort of patients with malfunctioning stents. Methods: All patients who underw ent an attempt at endoscopic removal of biliary SEMS over a 5-year period were retrospectively identified. The main indications for SEMSremovalwere the followi ng: distal migration of the stent or impaction to the duodenum, impaction into t he bile-duct wall, tissue ingrowth, and inappropriate length of the stent causi ng occlusion of intrahepatic ducts. SEMS were removed by using foreign-body for ceps or polypectomy snares. Results: Endoscopic removal of 39 SEMS (13 uncovered and 26 covered) was attempted in 29 patients (17 men; mean age, 66 years). SEMS extraction was attempted after a mean of 7.5 months (8.75 months standard devia tion) post-SEMS insertion. Removal was successful in 20 patients (68.9%) and i n 29 SEMS (74.3%). Covered SEMS were effectively removed more frequently than u ncovered ones: 24 of 26 (92.3%) and 5 of 13 (38.4%), respectively (p < 0.05). No major complications were recorded. Multivariate analysis showed that the time interval between insertion and removal, SEMS length, stent-mesh design (zigzag vs. interlaced), and indication for removal were no t predictive of success at stent removal. Conclusions: Endoscopic removal of bil iary SEMS is feasible and safe in more than 70%of cases. Because only 38%of un covered SEMS were removable, the presence of a stent covering is the only factor predictive of successful stent extraction. The presence of diffuse and severe i ngrowth was the main feature limiting SEMS removal.
文摘Background: While the role of EUS in the evaluation of pancreaticobiliary (PB) disorders in adults is well established, its utility in children remains unproven. This pros-pective study evaluates the feasibility, the safety, and the impact of EUS in the evaluation of PB disorders in children. Methods: All children (< 18 years)referred for ERCP for evaluation of suspected PB disorders who underwent EUS before scheduled ERCP. The main outcome measure was to evaluate the impact of EUS in the evaluation of PB disorders in children. EUS was considered to have a significant impact if a new diagnosis was established or if the findings altered subsequent management. Results: Fourteen patients (mean age 13 years; range 5- 17 years) underwent 15 EUS procedures over a 3-year period. Main indications were the following: acute or recurrent pancreatitis (6 patients), suspected biliary obstruction (5), and abdominal pain suggestive of PB origin (3). EUS diagnosed chronic pancreatitis (3 patients), idiopathic fibrosing pancreatitis (2), carcinoid tumor (1), pancreatic pse-udocyst (1), pancreas divisum (1), choledocholithiasis (1), duodenal duplication cyst (1), and normal (4). Dia-gnosis of idiopathic fibrosing pancreatitis and carcinoid tumor was established by EUS-guided FNA. The procedure was successful in all patients, and no complications were encountered. EUS had an impact on patient management in 93% of cases: established new diagnosis (10), precluded need for ERCP (9), and provided additional information that facilitated focused endotherapy (4). A limitation was the small number of enrolled patients and absence of long-term clinical follow-up. Conclusions: EUS and EUS-guided FNA are feasible, safe, and have significant impact that alters subsequent management in the majority of children with PB disorders. Further studies and dissemination of information is required to facilitate its increased application in children.
