Kenneth D. Murphy

Uterine artery embolization: the role in obstetrics and gynecology.

OBJECTIVE Evaluation of the studies for the use of uterine artery embolization in various conditions in both obstetrics and gynecology. DESIGN Literature review. RESULTS Uterine artery embolization was successful in controlling postpartum hemorrhage in 94.9% of the cases. It was effective in controlling the bleeding in 96% of cases with uterine arteriovenous malformations and in 100% of the cases with abdominal and cervical pregnancies. Recently, it has been introduced as a line of treatment for uterine fibroids. It controlled bleeding in 82-92% of cases, and lead to 20-64% reduction in size of fibroids. CONCLUSIONS Uterine artery embolization is of significant value in treating certain hemorrhagic conditions in obstetrics and gynecology including postpartum hemorrhage, ectopic pregnancy, and arteriovenous malformations. Its use in treatment of uterine fibroids is new and needs more collaborative studies by gynecologists and intervention radiologists to evaluate issues related to necrosis of the tumor, sepsis, and the long-term effect on size and recurrence rate.

Iliac Artery Stent Placement with the Palmaz Stent: Follow-up Study

PURPOSE The long-term efficacy of iliac artery stent placement with the Palmaz stent was evaluated for treatment of limb ischemia. PATIENTS AND METHODS Iliac stent implantation for limb ischemia was performed on 108 limbs in 83 patients. Eighty patients (96.4%) were followed up clinically from 1 to 70 months (mean, 25.8 months), and 30 patients (37.5%) were followed up with angiography from 1 to 48 months (mean, 10.4 months). Patients were classified into six categories by using an ischemic ranking profile. Clinical success was defined as a minimum one-category improvement from preprocedure ranking. RESULTS The clinical success rate was 98.9% immediately after the procedure and 86.2% at 48 months. Long-term success was statistically more common in patients with higher preprocedure and lower postprocedure ischemic ranking, and in patients without diabetes. Arteriography demonstrated a primary patency rate of 87.5% at latest follow-up, with five occlusions (12.5%) and only two (5.0%) restenoses. Average stenosis was 17.8% at 6 months and 24.7% at 2 years. Stent restenosis was statistically more common with a higher postprocedure pressure gradient. The complication rate was 9.7%, and 30-day mortality was 1.2%. CONCLUSION Long-term clinical and angiographic follow-up demonstrates iliac artery stent placement with the Palmaz stent is safe and efficacious for treatment of limb ischemia.

Use of Stents Covered with Polytetrafluoroethylene in Experimental Abdominal Aortic Aneurysm

PURPOSE To establish the effectiveness of covered stents in the treatment of aortic aneurysms, to investigate the histopathologic healing patterns of the device, and to determine the long-term endurance and integrity of modified polytetrafluoroethylene (PTFE). MATERIALS AND METHODS Experimental aneurysms were created in dogs by enlarging the aortic lumen with a patch of abdominal fascia. After 5 months, eight animals underwent an endoluminal bypass. The bypass device consisted of a 6-cm-long stent covered with thin PTFE. After surgery, the animals were killed at 3, 6, and 12 months in groups of three, three, and two, respectively. Specimens were processed for luminal surface studies and cross-sectional histologic study. Explanted PTFE material was analyzed for its physical characteristics and performance and was compared with retained control samples. RESULTS Before the animals were killed, aortography showed patent bypass conduits in all animals, although two of eight had leaks into the aneurysmal sac. Endothelialized neointima largely covered the luminal surface of the PTFE stent. The percentage of prosthetic surface covered by tissue did not change from 3 months to 1 year. Physical testing of the explanted PTFE material showed no structural deterioration and no change in the internodal distance. Thickness and axial tensile strength varied 12% and 17% from controls, respectively. CONCLUSION Thin-walled PTFE seems to have physicochemical characteristics that make this material adequate for endovascular use. Though limited, this study supports the establishment of preliminary clinical evaluation of metallic stents combined with PTFE for the treatment of abdominal aortic aneurysm.

Conjoined gastric and mediastinal benign cystic teratomas case report of a rare occurrence and review of literature

Teratomas are embryonal neoplasms which arise from totipotential cells and contain elements from all three germ layers (ectoderm, mesoderm, and the endoderm). Simultaneous occurrence of mediastinal and gastric teratomas in infants has not been reported, although gastric teratomas extending into the mediastinum have been reported twice in literature. We report here a case in which a gastric cystic teratoma was connected to its mediastinal counterpart with a pedicle. The pertinent literature is reviewed.