Background Transcatheter arterial embolization (TAE) is not common for hemorrhagic complications after gynecologic hysterectomy. Purpose To evaluate the effectiveness and safety of TAE for hemorrhage after hysterectomy for gynecologic diseases. Material and Methods This is a retrospective, multicenter study, which investigated 11 patients (median age = 45 years) who underwent TAE for hemorrhage after gynecologic hysterectomy between 2004 and 2020. Results The median interval between surgery and angiography was one day (range = 0–82 days). Hemodynamic instability and massive transfusion were present in 6 (54.5%) and 4 (36.4%) patients, respectively. CT scans (n = 7) showed contrast extravasation (n = 5), pseudoaneurysm (n = 1), or both (n = 1). On angiography, the bleeding arteries were the anterior division branches of the internal iliac artery (IIA) (n = 6), posterior division branch (lateral sacral artery, n = 1), and inferior epigastric artery (n = 1) in eight patients with active bleeding. In the remaining three patients, angiographic staining without active bleeding foci was observed at the vaginal stump, and the feeders for staining were all anterior division branches of the IIA. Technical and clinical success rates were 100% and 90.9% (10/11), respectively. In one patient, active bleeding focus was successfully embolized on angiography, but surgical hemostasis was performed for suspected bleeding on exploratory laparotomy. Postembolization syndrome occurred in one patient. Conclusions TAE is effective and safe for hemorrhage after hysterectomy for gynecologic diseases. Angiographic findings are primarily active bleeding, but angiographic staining is not uncommon. A bleeding focus is possible in any branch of the IIA, as well as the arteries supplying the abdominal wall.
Multicast in wireless LANs (Local Area Networks) is very useful for transmitting multimedia traffic from a sender to a group of receivers. The IEEE 802.11 WLAN MAC (Medium Access Control) layer does not support reliable multicast since, for multicast transmissions, it has no control packets such as the RTS, CTS, and ACK, which are used for unicast transmissions. Several protocols have been proposed to provide reliable multicast transmissions. However, they are not efficient for IEEE 802.11 WLANs due to the large number of packet transmissions and the excessive control overhead caused by the use of a large number of control packets in the error recovery process. In this paper, we propose a simple and effective scheme. The proposed scheme combines FEC (Forward Error Correction) and ARQ (Automatic Repeat reQuest) to reduce a large number of packet transmissions and to provide data reliability in the IEEE 802.11 WLANs multicast environment. It then uses busy tones to improve efficiency by reducing the excessive control overhead. Performance evaluation is conducted using both numerical analysis and simulation. The results show that the proposed scheme has good performance in terms of normalized throughput and average delay.
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