Efficacy and Complications of Emergent Transcatheter Arterial Embolization for the Management of Intractable Uterine Bleeding

Objective：Transcatheter arterial embolization（TAE）, including uterine artery embolization（UAE）, is effective for the management of obstetric and gynecologic hemorrhage. Some adverse effects have been reported with TAE, such as amenorrhea, endometrial trauma, and subsequent infertility. Herein we report the efficacy and complications of emergent TAE for the management of severe intractable uterine bleeding at our institute.Methods：From 2010 to 2019, thirty-eight patients underwent emergent TAE for intractable uterine bleeding. We evaluated the efficacy and complications of TAE, including a change in menstruation, fertility, and pregnancy outcomes in perinatal patients（group A；n＝23）, and in patients with gynecologic hemorrhage（group B；n＝15）.Results：In group A, 7 cases of retained placenta, 4 cases of postpartum hemorrhage, 2 cases of placenta accrete, 2 cases of uterine artery pseudoaneurysm, 2 cases of cervical pregnancy, 1 case of cesarean scar pregnancy, and 5 cases of unexplained hemorrhage were included. The median age of the group A was 37. In group B, 4 cases of uterine artery pseudoaneurysm, 2 cases of uterine arteriovenous malformation, 3 cases of uterine fibroids, 1case of adenomyosis, and 5 cases of unexplained hemorrhage were included. The median age of the group B was 39. The first attempt at TAE successfully controlled hemorrhage in 33 of 38 patients （86.8％）without major complications, and the remaining 5 patients required an additional attempt at TAE to control hemorrhage. One patient（2.6％）had transient buttock pain and foot ischemia. Among the 33 patients who had adequate follow-up care, all patients resumed regular menstruation. The median time to resume regular menstruation after TAE was 3 months （range, 1-13 months）in group A（n＝20）and 1 month（range, 1-6 months）in group B（n＝13）. Four of patients had 6 pregnancies in total：3 full-term live births, 2 missed abortions, and 1 artificial abortion. Among the 13 patients who desired pregnancy, 3（23％）conceived spontaneously.Conclusions：This retrospective study showed that emergent TAE may be effective and safe in treating intractable uterine bleeding with a high success rate. Ovarian and endometrial function were preserved based on the relatively early return of menstruation. Further prospective investigations with large number of patients are needed to confirm the preservation of ovarian function, fertility, and pregnancy outcome in reproductive-aged women

Considering Water Quality of Urban Rivers from the Perspectives of Unpleasant Odor

Surface water degradation in urban areas is a common problem in many countries, and degradation hampers ecosystem services provided by rivers, having negative impacts on aquatic organisms and human beings. Unpleasant odor arising from impaired rivers causes annoyance to people, and the study quantitatively analyzed unpleasantness of odor in Tokyo through the application of hedonic tones of odor. Unpleasantness remained or worsened while overall dissolved oxygen (DO) concentration increased downstream. The phenomenon is considered to be caused by multiple external factors, such as combined sewer outflow, hypoxia at Tokyo Bay, and effluent from water reclamation centers (WRC). Converting descriptive odor types into numeric values helped to see changes over time and enabled to depict the relation between DO concentration and the type of odor. In Tokyo, the ratio of effluent from WRC to stream flow increased over time, and it partially contributed to odor becoming more unpleasant. Malodor is no longer a major issue since the situation improved by developing an advanced treatment facility; however, human olfactory sense detects the existence of unpleasant odor in urban rivers. The study presented the complexity of analyzing odor problems in tidal urban areas because these are caused by external factors