Embolization of the uterine artery in the treatment of uterine myoma

STUDY OBJECTIVE: To evaluate the prevalence of different anatomic factors in women with recurrent spontaneous abortion (RSA). DESIGN: Retrospective analysis over 9 years (Canadian Task Force classification II-2). SETTING: University hospital-affiliated endoscopic unit. PATIENTS: Three hundred forty-four consecutive patients with RSA and 922 controls referred for abnormal uterine bleeding. INTERVENTION: Diagnostic hysteroscopy. MEASUREMENTS AND MAIN RESULTS: Major and minor uterine mullerian abnormalities (septate, unicornuate uteri) were found significantly more often in women with RSA than in controls (32% vs 6%, p <0.001). The frequency of acquired uterine anomalies (submucous myomas, polyps) was significantly higher in controls (32% vs 9%, p <0.001). No significant differences were observed between groups in frequency of adhesions (4% vs 2%). CONCLUSION: Major mullerian uterine abnormalities are associated with RSA, and minor uterine anomalies may be correlated with an increased risk of recurrent miscarriage. PMID: 11509781 [PubMed - indexed for MEDLINE] 46. Radiol Med. 2001 Mar;101(3):157-64. [Embolization of the uterine artery in the treatment of uterine myoma]. [Article in Italian] Simonetti G, Romanini C, Pocek M, Piccione E, Guazzaroni M, Zupi E, Gandini R, Gabriele A, Vaquero E. Istituto di Radiologia-Tor Vergata, Università degli Studi Tor Vergata, Roma. PURPOSE: To propose uterine myoma embolization as an alternative to myomectomy or hysterectomy in the treatment of symptomatic myomas; to evaluate the efficacy of the procedure in terms of clinical outcome, adopting all procedural and technical precautions to ensure minimal X-ray exposure and preserve reproductive potential. MATERIAL AND METHODS: Between April 1998 and February 2000, 26 patients, age range 32-54 years (mean 41 years), underwent uterine arterial embolization for menorrhagia, pelvic pain, and sensation of mass and pressure. Inclusion criteria were: single myomas, intramural localization and rich vascolarization of the lesion. Dose to patient was obtained by placing a thermoluminescent dosimeter (Harshaw, Solon, Ohio) both placed in posterior fornix of the vagina and on the skin at the beam entrance site. The procedure was performed under peridural anesthesia; polyvinil alcohol particles 355-500 mu (Contour) (Target Therapeutics, Boston Scientific Corporation, Fremont CA, USA) were employed as embolic agent. The uterine arteries were incannulated with a 5F (Glidecath, Terumo, Europe NV, Belgium) and successively 3F coaxial microcatheter (Target, Boston Scientific Corporation, Fremont CA, USA); the embolic material was injected as distally as possible. Color Power Doppler Ultrasound follow-up before and after i.v. contrast media administration (Levovist SHU 508 A, Shering, Berlin, Germany) was carried out at 15 days, at 1, at 3, at 6 months, and at 1 year from embolization. Pre-procedural evaluation and follow-up at 1 year was performed by MRI using T1 and T2 weighted images before and after Gadolinium (GdDTPA Shering, Berlin, Germany) administration. RESULTS: The technical success of the interventional procedure was 100% (26/26 cases). The mean fluoroscopy time was 20 minutes, and the mean number of angiographic exposures was 10. The mean estimated ovarian dose was 18.75 cGy and the mean adsorbed skin dose was 126.71 cGy. The imaging follow-up showed a 55% reduction of myoma volume at 6 months and a 75% reduction at 1 year. All patients reported a marked decrease in symptoms. No major complications were observed. The appearance of pelvic pain in the 24-48 hours after the procedure required sedation by analgesic pump; transitorial amenorrhea was observed in 3 patients. As for term complications, 2 patients have eliminated necrotic material through the vagina four weeks after procedure. The patients reported great satisfaction with the procedure. DISCUSSION: Many treatment options are currently available for symptomatic uterine myomas. One is surgical myomectomy which is associated with increased blood loss, pain and post operative morbidity and requires an additional surgical procedure for fibroma recurrence in 20-25% of patients. Another alternative treatment is hormonal therapy, which drammatically improves symptoms and reduces fibroid size although leiomyomas regrow to their original size within a few months of discontinuing treatment. Uterine embolization is a relatively new treatment for uterine fibroids that can be considered as an alternative to surgical and medical procedures. The radiation exposure adsorbed by the patient is reduced by using pulsed fluoroscopy and taking all the precautionary measures required to minimize the dose. CONCLUSIONS: The technical success, the patient' satisfation, the short hospitalization time and preservation of fertility confer to uterine artery embolization the role of a new alternative therapy for the treatment of symptomatic uterine myoma

Levovist in the breast nodular lesions = Le levovist dans les lesions nodulaires du sein

Our aim was to evaluate the effectiveness of Levovist SHU 508 A (Shering, Germany) in the characterization of breast lesions. From June 1996 to May 1997 we studied 29 solid lesions in 29 patients (28 women and one man) between the age of 17 and 83 years. The 29 solid lesions included of 20 carcinomas (15 DCI ductal invasive carcinoma, 4 DCIS ductal carcinoma in situ, 1 LCIS lobular carcinoma in situ) 6 fibroadenomas, 1 postsurgical lesion and 2 apparently benign lesions at mammography, suspected after contrast agent injection, with histologically proven malignancy. We used parameters suitable for the study of low flow. A single bolus of contrast, at a concentration of 300 mg/ml, was administrated at a rate of 1-2 ml/sec. Morphological parameters, considered, before the administration of the Levovist were signal intensity and number of vascular poles. After contrast we assessed the previous parameters and the following: the presence and modification of vessels, not seen at the previous ultrasound exam, the increased in the number of vessels the initial modification, the duration of enhancement, and the presence of vessels within and external to the lesion. Considering the signal intensity after contrast there was no improvement in 17 % of cases, mild increases in 7 % and marked improvement in 76 % of cases. We have obtained an increase in the number of vessels in 10 % of cases. The type of enhancement characteristic of carcinoma (rapid increase, marked intensity) and fibroadenoma (slow increase with a lower intensity) were observed. This study demonstrated that Levovist can be useful in the following cases: differential diagnosis of benign from malignant lesions, differentiation between recurrence and post-surgical fibrosis, staging and follow-up of patients treated with chemotherapy

Computerized tomography assessment of bone damage following injury of the anterior cruciate ligament [Valutazione con Tomografia Computerizzata del danno osseo conseguente a lesione del legamento crociato anteriore.]

An ACL tear causes an anterior subluxation of the tibial bone which rotates with its fulcrum on the medial collateral ligament; consequently, the lateral femoral condyle impacts on the external tibial plateau. The presence of a subcortical lesion of the spongiform bone in the posterior external tibial plateau is an indirect sign of an ACL tear. On MR images, traumatic changes are depicted as changes in bone marrow signals. To assess the diagnostic capabilities of CT in demonstrating the bone lesion subsequent to ACL trauma, 23 patients with positive MR exams of the knee were submitted to CT. Fifteen patients had complete ACL tears, 8 had partial tears and 20 exhibited an occult fracture of the posterior portion of the external tibial plateau. This study pointed out a significant correlation between ACL tears and changes in the spongiform structure of the posterolateral tibial plateau. Such changes are depicted not only by MRI but also by CT: the latter method is also a valuable tool to study these conditions long after the traumatic event. No more than 5 slices, 1-1.5 mm thick, acquired at the tibial plateau allowed the trabecular structure and its abnormal changes to be studied without markedly lengthening examination time

Embolization of the uterine artery in the treatment of uterine myoma [Embolizzazione delle arterie uterine nel trattamento dei miomi dell'utero.]

PURPOSE: To propose uterine myoma embolization as an alternative to myomectomy or hysterectomy in the treatment of symptomatic myomas; to evaluate the efficacy of the procedure in terms of clinical outcome, adopting all procedural and technical precautions to ensure minimal X-ray exposure and preserve reproductive potential. MATERIAL AND METHODS: Between April 1998 and February 2000, 26 patients, age range 32-54 years (mean 41 years), underwent uterine arterial embolization for menorrhagia, pelvic pain, and sensation of mass and pressure. Inclusion criteria were: single myomas, intramural localization and rich vascolarization of the lesion. Dose to patient was obtained by placing a thermoluminescent dosimeter (Harshaw, Solon, Ohio) both placed in posterior fornix of the vagina and on the skin at the beam entrance site. The procedure was performed under peridural anesthesia; polyvinil alcohol particles 355-500 mu (Contour) (Target Therapeutics, Boston Scientific Corporation, Fremont CA, USA) were employed as embolic agent. The uterine arteries were incannulated with a 5F (Glidecath, Terumo, Europe NV, Belgium) and successively 3F coaxial microcatheter (Target, Boston Scientific Corporation, Fremont CA, USA); the embolic material was injected as distally as possible. Color Power Doppler Ultrasound follow-up before and after i.v. contrast media administration (Levovist SHU 508 A, Shering, Berlin, Germany) was carried out at 15 days, at 1, at 3, at 6 months, and at 1 year from embolization. Pre-procedural evaluation and follow-up at 1 year was performed by MRI using T1 and T2 weighted images before and after Gadolinium (GdDTPA Shering, Berlin, Germany) administration. RESULTS: The technical success of the interventional procedure was 100% (26/26 cases). The mean fluoroscopy time was 20 minutes, and the mean number of angiographic exposures was 10. The mean estimated ovarian dose was 18.75 cGy and the mean adsorbed skin dose was 126.71 cGy. The imaging follow-up showed a 55% reduction of myoma volume at 6 months and a 75% reduction at 1 year. All patients reported a marked decrease in symptoms. No major complications were observed. The appearance of pelvic pain in the 24-48 hours after the procedure required sedation by analgesic pump; transitorial amenorrhea was observed in 3 patients. As for term complications, 2 patients have eliminated necrotic material through the vagina four weeks after procedure. The patients reported great satisfaction with the procedure. DISCUSSION: Many treatment options are currently available for symptomatic uterine myomas. One is surgical myomectomy which is associated with increased blood loss, pain and post operative morbidity and requires an additional surgical procedure for fibroma recurrence in 20-25% of patients. Another alternative treatment is hormonal therapy, which drammatically improves symptoms and reduces fibroid size although leiomyomas regrow to their original size within a few months of discontinuing treatment. Uterine embolization is a relatively new treatment for uterine fibroids that can be considered as an alternative to surgical and medical procedures. The radiation exposure adsorbed by the patient is reduced by using pulsed fluoroscopy and taking all the precautionary measures required to minimize the dose. CONCLUSIONS: The technical success, the patient' satisfation, the short hospitalization time and preservation of fertility confer to uterine artery embolization the role of a new alternative therapy for the treatment of symptomatic uterine myomas