Uterine arteriovenous malformations (AVM) are a rare entity, presenting in women of reproductive age. The presentation may vary with bleeding being the chief presenting symptom. Though traditionally hysterectomy has been a definitive form of treatment, trans-catheter embolization is being considered as a good treatment option. We present three cases with uterine AVM who presented with heavy bleeding per vaginam. Three patients of reproductive age group (29-33 years) presented with heavy bleeding per vaginam from January 2017- May 2017. Two had previous miscarriages for which curettage was done and one had undergone a Caesarean section previously. Diagnosis of uterine AVM was made by ultrasound-grey scale, colour Doppler, followed by MRI. All patients underwent trans-catheter angiogram followed by selective embolization of the AVM with n-BCA (n- Butyl Cyanoacrylate) and polyvinyl alcohol (PVA) particles. Successful embolization was done in all of our patients with technical success rate of 100%. On follow-up, all patients are currently asymptomatic. Trans-catheter arterial embolization of uterine AVM is a simple and effective treatment alternative with less morbidity associated with anaesthesia and surgery in turn reducing hospital stay. It has to be considered in patients who need to preserve their fertility.
Background: The incidence of oropharyngeal carcinoma has been on the rise in recent decades. About 30% of patients who undergo definitive chemoradiation as the initial treatment present with residual/recurrent disease. In such a situation, surgical salvage either in the form of traditional open surgery or transoral robotic surgery (TORS) remains a viable treatment option. However, the extensive vascular supply of the posterior tongue and tonsillar bed increases the risk of perioperative bleeding, which is a key concern. The article describes the technique of selective pre-operative embolization to reduce the risk of perioperative bleeding and enumerate its advantages in providing a bloodless field during surgery. Methods: Prospective study of 5 patients with recurrent or residual midline BOT tumours who underwent TORS after selective lingual artery embolization at our centre. Results and Conclusions: None of the patients had any major perioperative bleeding or post procedural complications. All the patients after TORS had their tongue vascularity preserved with adequate recovery of tongue functions. Selective embolization of the feeder vessels provides a favorable bloodless surgical field without affecting the vascular integrity of the remnant tongue. This added advantage helps restoring the normal oral phase of swallowing.
Purpose This article presents our experience regarding survival benefits in inoperable intermediate stage hepatocellular carcinoma (HCC) and advanced stage HCC treated with 131I-lipiodol.
Materials and Methods This is a retrospective study of intermediate stage HCC (Barcelona Clinic Liver Cancer [BCLC] stage B) not responding to prior treatment and/or advanced stage HCC (BCLC stage C) treated with 131I-lipiodol. 131I-lipiodol was injected into the hepatic artery through transfemoral route. Postprocedure, the patient was isolated for 5 to 7 days. All patients underwent tumor response evaluation after 4 weeks. Survival of patients was calculated up to either death or conclusion of the study.
Results A total of 55 patients (52 males [94.5%], 3 females [5.4%]) were given intra-arterial 131I-lipiodol therapy. The median overall survival after transarterial radioembolization (TARE) was 172 ± 47 days (95% confidence limit, 79–264 days). The overall survival at 3, 6, 9, and 12 months was 69, 47, 32, and 29%, respectively. A multivariate Cox regression analysis showed the presence of treatment prior to TARE to most significantly influence survival (B = 2.161, p ≤ 0.001). This was followed by size of the lesion which was second in line (B = 0.536, p = 0.034). Among 45 patients, 14 patients (31.1%) showed a partial response, 11 patients (24.4%) showed stable disease, and 20 patients (44.4%) showed progressive diseases.
Conclusion TARE with 131I-lipiodol can be a safe and effective palliative treatment in advanced stage HCC and in patients with poor response to prior treatments like transarterial chemoembolization.
Objectives: To investigate the possibility of DWI as an imaging bio marker and evaluate its role in prediction and monitoring of chemoradiotherapy response in cervical carcinoma. Methods: 30 carcinoma cervix patients undergoing radiation for Carcinoma Cervix were examined with routine pelvic MRI and DWI before chemoradiation, following EBRT and on completion of brachytherapy. Based on the response on conventional MRI patients were categorized into complete, good and partial response groups. Analysis of variance (ANOVA) and Student t test (two tailed, independent) were used to compare the ADC, size and volume parameters between response groups and therapeutic times. Patients with greater post EBRT tumor ADC changes and greater size and volume responses responded better to therapy. The pretreatment tumor ADC values, post EBRT ADC changes were found to be correlating well with the final outcome. However ADC mapping was less useful in predicting the extension and staging of carcinoma. Conclusion: DWI and its quantitative parameter, ADC has a potential role in the prediction, assessment and monitoring of cervical cancer treatment response to chemo radiation therapy.
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