The analysis of the clinical case in the stepped treatment of multiple choledocholithiasis and locally advanced kidney cancer

This article is devoted to the analysis of the clinical case which includes the clinical manifestations and treatment of multiple choledocholithiasis and locally advanced kidney cancer. A staged surgery was performed. Retrograde papillosphincterotomy with cholechocholitholite extraction was done at the first stage. The second stage includes laparotomy, removal of the tumor of the right kidney / adrenal gland as a single block, cholecystectomy after preliminary angiography and embolization of the vessels feeding the tumor. The presented successful observation demonstrates one of the modern approaches in the treatment of patients with comorbid pathology.

Method of diagnosis and treatment of profusional bleeding from stenosing postbulbar ulcers of the duodenum

The aim. To evaluate the effectiveness of X-ray interventions in arosive bleeding in patients with complicated duodenal ulcer. Materials and methods. X-ray endovascular interventions were used in 8 patients who developed arosive bleeding as a complication of duodenal ulcer. All patients with signs of gastrointestinal bleeding were examined according to clinical protocols. Hemodynamically stable patients underwent X-ray endovascular interventions. Results and discussion. In the near future, bleeding stopped in all 8 (100 %, OR–0.04 [0.005–0.29], p=0.03) patients. On day 2, two patients who underwent embolization of their own hepatic artery had a recurrence of bleeding (0.56 [0.065–4.76], p=0.29). Repeated angiography and embolization attempts were ineffective, and both patients died. In patients who underwent gastroduodenal and pancreatouodenal artery embolization, bleeding did not resume. Thus, we obtained good results as 6 out of 8 patients recovered (75 %), despite the severity of their condition and a disappointing prognosis (OR–9.0 [1.0–46.7], p <0.05). Conclusions. Adherence to the tactics mentioned above in the treatment of bleeding in duodenal ulcer was highly effective, especially in superselective embolization with the detection of bleeding gel. If the presence of arosive bleeding is confirmed, emergency surgical treatment with suturing of the damaged vessel is shown in hemodynamically unstable patients, and endovascular intervention is possible in hemodynamically stable patients. Further studies are needed to determine the criteria for a high risk of arosive bleeding developing in patients with complicated duodenal ulcer as well as to prevent its occurrence through the use of X-ray endovascular interventions.

Role of Transarterial Angiography with Embolization in Deciding Surgical Approach to Juvenile Nasopharyngeal Angiofibroma: A Step-Ladder Approach

Objectives This study was aimed to understand the usefulness of transarterial angiography and embolization in management of juvenile nasopharyngeal angiofibroma (JNA) and to apply the information obtained to stage the disease, select appropriate surgical approach, predict intraoperative bleeding, and prognosticate the disease. Design This study represents a retrospective review of the patients of JNA with major focus on transarterial angiography and embolization findings and its clinical and surgical implications. Setting The study conducted at a tertiary-care super-specialty referral center. Participants Forty-two patients who had undergone transarterial angiography and embolization followed by surgery over the period of 5 years from July 2015 till February 2019 were participated in this study. Main Outcome Measures Tumor vascular pattern based on transarterial angiography, staging of the disease based on extent and vascular supply, surgical approach selected, and prognosticating the disease were determined from this study. Conclusion Transarterial angiography with embolization becomes a prudent preoperative investigation for management of JNA. It provides a complete three-dimensional map of the tumor with stage-specific vascular pattern, reduces vascularity of the tumor, and predicts the sites from where bleeding can occur intra operatively. Thus, it helps in choosing the appropriate surgical approach aiding in complete tumor removal with minimal bleeding.

Minimally invasive treatment in the victim with spleen injury

The article describes the clinical experience of treatment of the victim using minimally invasive methods such as angiography and embolization. The applied treatment tactics made it possible to preserve the damaged parenchymal organ of the abdominal cavity and avoid performing other more traumatic surgical interventions (laparoscopy, laparotomy).