The Role of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) in the Management of the Post-Embolization Symptoms after Uterine Artery Embolization

Uterine artery embolization (UAE) is usually a very painful procedure. Although pain after the procedure can occur as a single symptom, it usually is associated with other symptoms such as nausea, vomiting, pelvic pain, general malaise, fever and leukocytosis that characterize the post-embolization syndrome. Management of the post-embolization symptoms and of pain in particular, is paramount if UAE is to be performed as an outpatient procedure. Different protocols have used analgesic and/or anti-inflammatory agents to control these symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used in association with analgesic drugs to control post-embolization symptoms. In our institution the patients start oral medication with NSAIDs the day before the procedure and continue it during and after UAE. We also mix NSAIDs with the embolizing particles. This enables a reduction in the inflammation present in the uterine fibroids and helps controlling the pain. The purpose of this paper is to review the importance of NSAIDs in the management of the post-embolization symptoms. We describe the protocol that we use in our institution that enables us to perform the procedure on an outpatient basis with same day discharge and good control of the post-embolization symptoms with oral NSAIDs and analgesics.publishersversionpublishe

MR and ablation for cancer and prostatic artery embolization for benign prostatic hyperplasia

© 2019 The Authors. Published by the British Institute of Radiology.Multiparametric MRI (mpMRI) has proven to be an essential tool for diagnosis, post-treatment follow-up, aggressiveness assessment, and active surveillance of prostate cancer. Currently, this imaging technique is part of the daily practice in many oncological centres. This manuscript aims to review the use of mpMRI in the set of prostatic diseases, either malignant or benign: mpMRI to detect and stage prostate cancer is discussed, as well as its use for active surveillance. Image-guided ablation techniques for prostate cancer are also reviewed. The need to establish minimum acceptable technical parameters for prostate mpMRI, standardize reports, uniform terminology for describing imaging findings, and develop assessment categories that differentiate levels of suspicion for clinically significant prostate cancer led to the development of the Prostate Imaging Reporting and Data System that is reviewed. Special focus will also be given on the most up-to-date evidence of prostatic artery embolization (PAE) for symptomatic benign prostatic hyperplasia (BPH). Management of patients with BPH, technical aspects of PAE, expected outcomes and level of evidence are reviewed with the most recent literature. PAE is a challenging technique that requires dedicated anatomical knowledge and comprehensive embolization skills. PAE has been shown to be an effective minimally-invasive treatment option for symptomatic BPH patients, that can be viewed between medical therapy and surgery. PAE may be a good option for symptomatic BPH patients that do not want to be operated and can obviate the need for prostatic surgery in up to 80% of treated patients.publishersversionpublishe

Portal vein embolization, biembolization, and liver venous deprivation

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Se fosse hoje, o Eduardo seria Radiologista de Intervenção?

This perhaps audacious title will probably be as provocative as: "If it were today, would Eduardo be a member of Benfica Club"? We speak, of course, of Prof. Dr. Eduardo Barroso, Director of the Surgery Area of ​​the University Hospital Center of Central Lisbon (CHULC), who retired last month. He is a nationally and internationally renowned surgeon, with proven experience, being a reference in the field of hepatic-bile-pancreatic surgery and transplantation. He has chaired the Portuguese Society of General Surgery and the European Surgical Association, elected by his peers. He would hardly give up his professional passion for ours, but when we admire someone we try to project into the person all the qualities or virtues that stand out as the most positive.Este título, talvez audaz, provavelmente será tão provocador como: “se fosse hoje, o Eduardo seria Benfiquista”? Falamos, claro, do Prof. Doutor Eduardo Barroso, Director da Área de Cirurgia do Centro Hospitalar Universitário de Lisboa Central (CHULC), que se reformou no mês passado. Cirurgião reconhecido nacional e internacionalmente, com provas dadas, sendo uma referência na área da cirurgia hépato-bílio-pancreática e da transplantação, tendo presidido à Sociedade Portuguesa de Cirurgia Geral e à European Surgical Association, eleito pelos seus pares. Dificilmente largaria a sua paixão profissional pela nossa, mas quando admiramos alguém tentamos projectar na pessoa todas as qualidades ou virtudes que destacamos como mais positivas

Embolização Percutânea da Artéria Epigástrica Superior no contexto de Hematoma dos Músculos Rectos do Abdómen: a Propósito de dois Casos Clínicos.

Os hematomas dos músculos rectos abdominais são uma complicação frequente em doentes anticoagulados. Apesar da maioria ser tratada de forma conservadora, podem por vezes evoluir de forma potencialmente fatal. O embolização percutânea transarterial surge como uma alternativa terapêutica eficaz nesses casos. Contudo, na sua maioria, estão descritos na literatura hematomas com origem na artéria epigástrica inferior. Com estes dois casos clínicos, a par da revisão da literatura, os autores pretendem alertar para a necessidade de estudar o território epigástrico superior em doentes com hematomas com extensão ao 1/3 superior da parede abdominal anterior ou sem resolução após embolização do território da artéria epigástrica inferior

Renal arteriovenous malformation managed with embolization – case report and review of literature

Vascular malformations of the kidney are pathologic processes that involve renal veins and arteries and include arteriovenous malformations (AVMs) and arteriovenous fistulas (AVFs). These lesions may present with a wide range of signs and symptoms that vary from hypertension, hematuria to renal masses. The presence of arterio-venous shunting characterizes AVMs and AVFs. We report the case of a congenital renal AVM in a woman who presented with hematuria and was successfully treated with endovascular embolization in an emergency setting. The lesion was selectively catheterized with a microcatheter and embolization was performed by injection of a mixture containing n- butyl 2-cyanoacrylate (NBCA) and lipiodol. Diagnostic imaging modalities and the technique of embolization are discussed

Idiopathic Splenic Artery Pseudoaneurysm Successfully Treated with Embolization

Splenic artery pseudoaneurysms are rare and typically resultant from pancreatitis, spleen trauma, and iatrogenic complications. Unlike trueaneurysms, pseudoaneurysms are usually symptomatic and more prone to rupture. We report the case of an asymptomatic, idiopathic splenic artery pseudoaneurysm in a 84-year-old woman that underwent an abdominal computed tomography (CT) examination after the inaugural diagnosis of diabetes mellitus. No prior history of pancreatitis, trauma or abdominal surgery was documented. Attending to the unpredictable risk of rupture, splenic artery embolization was performed with no immediate complications. One month after the procedure, a follow-up Doppler ultrasound found no flow inside the pseudoaneurysm

Sciatic Nerve High Division: Two Different Anatomical Variants

Introduction: Sciatic nerve variations are relatively common. These variations are often very significant in several fields of Medicine. The purpose of this paper is to present two such variants and discuss their clinical implications. Material and Methods: Three Caucasian cadavers with no prior history of lower limb trauma or surgery were dissected and found to present anatomical variants of the sciatic nerve. Results: In all cases the sciatic nerve divided above the popliteal fossa. In two cases (cadavers 1 and 2) it divided on both sides in the inferior portion of the gluteal region in its two terminal branches: the common fibular and the tibial nerves. In another case (cadaver 3) the sciatic nerve was found to divide inside the pelvis just before coursing the greater sciatic notch. The common fibular nerve exited the pelvis above the pyriformis muscle and then passed along its posterior aspect, while the tibial nerve coursed deep to the pyriformis muscle. Discussion: According to the literature, the anatomical variant described in cadaver 3 is considered relatively rare. This variant can predispose to nerve entrapment and thus to the pyriformis syndrome, sciatica and coccygodynia. The high division of the sciatic nerve, as presented in cadavers 1 and 2, can make popliteal nerve blocks partially ineffective. Conclusion: The anatomical variants associated with a high division of the sciatic nerve, must always be born in mind, as they are relatively prevalent, and have important clinical implications, namely in Anesthesiology, Neurology, Sports Medicine and Surgery.publishersversionpublishe

Retrospective Study of Transjugular Intrahepatic Portosystemic Shunt Placement for Cirrhotic Portal Hypertension

Background and Aims: Transjugular intrahepatic portosystemic shunt (TIPS) is used for decompressing clinically significant portal hypertension. The aims of this study were to evaluate clinical outcomes and adverse events associated with this procedure. Methods: Retrospective single-center study including 78 patients submitted to TIPS placement between January 2015 and November 2018. Follow-up data were missing in 27 patients, and finally 51 patients were included in the study sample. Data collected from individual registries included demographics, comorbidities, laboratory results, complications, and clinical results according to the indication. Results: Averagepre-TIPS portosystemic pressure gradient decreased from 18.1 ± 5 to 6 ± 3 mm Hg after TIPS placement. Indications for TIPS were refractory ascites (63%, n = 49), recurrent or uncontrolled variceal bleeding (36%, n = 28), and Budd-Chiari syndrome (1.3%, n = 1). TIPS-related adverse events occurred in 29/51 (56.8%) patients, with hepatic encephalopathy (HE) in 21 (41%) patients, sepsis in 3, liver failure in 2, hemolytic anemia in 1, acute pulmonary edema in 1, and capsular perforation in 1 patient. Mean follow-up was 15.7 ± 15 months. First-month mortality was 11.7% (n = 6) (sepsis, n = 3; acute liver failure, n = 2; and recurrence of variceal bleeding, n = 1) and was significantly higher for patients with Child-Pugh >9 points (p = 0.01), model of end-stage liver disease (MELD) scores >19 (p = 0.02), and for patients with a history of HE before the procedure (p = 0.001). Older age (p = 0.006) and higher levels of creatinine (p = 0.008) were significantly higher in patients developing HE after TIPS. Ascites persisted in 21.2% (7/33 patients) and was more frequent in patients with lower baseline albumin levels (p = 0.003). Recurrent variceal bleeding occurred in 22% (n = 4/18 patients) and was more frequent in patients with lower baseline hemoglobin levels (p = 0.03). Conclusion: TIPS is effective in up to 80% of patients presenting with variceal bleeding or refractory ascites. Careful patient selection based on age and HE history may reduce adverse events after TIPS.publishersversionpublishe