Initial Experience of Uterine Fibroid Embolization Using Porous Gelatin Sponge Particles
ABSTRACT The purpose of this study was to prospectively assess the safety and effectiveness of uterine artery embolization (UAE) using porous gelatin particle (PGP; Gelpart; Asuterasu, Tokyo, Japan) for symptomatic uterine fibroids. Twenty-five consecutive premenopausal women underwent UAE with PGP. The angiographic end point of embolization was near stasis of the ascending uterine artery. Pelvic magnetic resonance imaging (MRI) was obtained before and after the procedure. Complications were assessed. The outcomes of technique, infarction rates of all fibroid tissue after UAE with contrast-enhanced MRI, change in symptoms and quality of life using serial Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaires, and additional interventions were evaluated. Bilateral UAE was successfully performed in all patients. Enhanced MRI 1 week after UAE showed that 100% infarction of all fibroid tissue was achieved in 65% (15 of 23) of patients; 90-99% infarction was achieved in 35% (8 of 23) of patients. Mean follow-up was 12 months (range 1-20). Symptom and QOL scores at baseline were 47.2 and 61.7, respectively. Both scores significantly improved to 26.3 (P<0.001) and 82.4 (P<0.001) at 4 months and to 20.4 (P<0.001) and 77.6 (P<0.001) at 1 year, respectively. No additional gynecologic interventions were performed in any patient. There were no major complications. Minor complications occurred in two patients. UAE using PGP is a safe and effective procedure and shows that outcomes after UAE, as measured with enhanced MRI and UFS-QOL questionnaires, seem comparable with those of UAE using other embolic agents. PGP is a promising embolic agent used for UAE to treat symptomatic uterine fibroids. Further comparative study between PGP and other established embolic agents is required.
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ABSTRACT: This study was designed to compare the effectiveness of systemic methotrexate (MTX) with uterine artery embolization (UAE) combined with local MTX for the treatment of cesarean scar pregnancy (CSP) with different ultrasonographic pattern, and to indicate the preferable therapy in CSP patients. The results of 21 CSP cases were reviewed. All subjects were initially administrated with systemic MTX (50 mg/m(2) body surface area). UAE combined with local MTX was added to the patients who had failed systemic MTX. The transvaginal ultrasonography data were retrospectively assessed, and two different ultrasonographic patterns were found: surface implantation and deep implantation of amniotic sac. The management and its effectiveness for patients with the two ultrasonographic patterns were studied retrospectively. Ultrasound scan and serum β-hCG were monitored during follow-up. Data were analyzed with the Student's t test. Nine patients were successfully treated with systemic MTX. The remaining 12 cases were successfully treated with additional UAE combined with local MTX. According to the classification by Vial et al. of CSP on ultrasonography, most surface implanted CSPs (8/11, 72.7%) could be successfully treated with systemic MTX, whereas most deeply implanted CSPs (9/10, 90%) had failed systemic MTX but still could be successfully treated with additional UAE combined with local MTX. All patients recovered without severe side effects. Most patients with a future desire for reproduction achieved subsequent pregnancy. For CSP patients suitable for nonsurgical treatment, UAE combined with local MTX would be the superior option compared with systemic MTX in the cases with deep implantation of amniotic sac.CardioVascular and Interventional Radiology 04/2011; 35(2):286-91. DOI:10.1007/s00270-011-0097-y · 1.97 Impact Factor
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ABSTRACT: Hyperferritinemia has been reported in adult-onset Still's disease (AOSD). This study aims to investigate clinical features of AOSD in Chinese population and diagnostic value of different hyperferritinemia cutoff points based on ROC curve. A total of 48 patients from October 2002 to February 2007 diagnosed AOSD in the department of rheumatology, the first affiliated hospital of Sun Yat-set University were enrolled. A total of 86 patients mainly complaining fever >39°C for over one week and meeting Yamaguchi criteria but confirmed as non-AOSD by other serological or pathological tests were obtained from the same department as controls. Total serum ferritin levels were determined at the time of admission. Clinical features of AOSD in Chinese population were similar to previous studies. Significantly higher levels of total serum ferritin were presented in patients with AOSD (8100.7 ± 13678.5) compared with non-AOSD controls (448.3 ± 539.4) (P < 0.01). No differences were found in serum ferritin level between different categories of non-AOSD patients (P > 0.05). High value of area under receiver operating characteristic curve (ROC curve) suggested that ferritin was very predictive in AOSD diagnosis. Three cutoff points were picked based on clinical practice and ROC curve. Ferritin level ≥2,500 µg/L appeared to be highly specific for a diagnosis of AOSD, yet the low sensitivity may falsely ruled out patients with true AOSD. Hyperferritinemia ≥750 µg/L was seldom observed in inflammatory diseases or solid tumor. Hyperferritinemia ≥1,250 µg/L could mostly rule out other autoimmune diseases and hematologic diseases. Combined Yamaguchi criteria and hyperferritinemia gave better prediction for AOSD. In conclusion, different hyperferritinemia cutoff points observed in ROC curve help to optimize diagnostic and therapeutic strategy.Rheumatology International 01/2012; 32(1):189-92. DOI:10.1007/s00296-010-1601-4 · 1.63 Impact Factor
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ABSTRACT: Abstract Purpose: To evaluate the embolic effect and degradability of gelatin microspheres (GMS) and Gelpart particles (GPS) in dogs subjected to hepatic embolization. Material and methods: We subjected 20 beagles to embolization of the hepatic artery (HA) and assessed the embolic effects of GMS measuring 500 μm in dry and 1 mm in wet state and of 1-mm GPS, porous gelatin embolic particles. We obtained celiac angiographs before and immediately after embolization and two, 14, and 28 days later; the livers were histopathologically evaluated. Reperfusion of HA was assessed by inspecting the arterial branches. We checked the liver specimens for residual GMS, injury to surrounding tissues, and inflammatory changes, and investigated embolic formation in the HA. Results: The mean amount of injected GMS and GPS was 15.5 and 14.5 mg, respectively. While none of the dogs manifested HA reperfusion two days post-embolization, there was angiographic evidence of complete reperfusion 28 days after embolization. In all dogs, histopathological study showed arterial inflammatory changes and injury of surrounding tissues irrespective of the embolization materials used. These findings were pronounced on day 28 in dogs injected with GMS. Conclusion: There was no difference in the embolic effects of GMS and GPS nor in their degradability in dogs subjected to hepatic embolization.Minimally invasive therapy & allied technologies: MITAT: official journal of the Society for Minimally Invasive Therapy 08/2012; 22(3). DOI:10.3109/13645706.2012.719909 · 1.18 Impact Factor