Liquefaction and Rupture of Angiomyolipoma after Embolization.
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ABSTRACT:
SUBMITTER: Uzzo RN
PROVIDER: S-EPMC7710590 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Arteriovenous shunting associated with angiomyolipoma is an unusual entity, which carries important implications to embolization approach. We present a distinctive case involving a 41-year-old woman who presented with retroperitoneal hemorrhage relating to renal angiomyolipoma. During angiography for urgent embolization, a complex vascular supply with arteriovenous shunting was encountered. Superselective embolization using alcohol or small particles is the standard approach to definitive treatment of symptomatic angiomyolipoma; however; their use is precluded in the setting of arteriovenous shunt hemodynamics. In this case, a 2-step approach was employed by which the initial hemorrhage was treated with proximal embolization using large gelatin foam and metallic coils. This resulted in decreased flow through the arteriovenous shunt, allowing the use high viscosity ethylene vinyl alcohol copolymer dissolved in dimethyl sulfoxide for definitive treatment.
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Project description:BackgroundA diverse clinical course after the spontaneous rupture of hepatocellular carcinoma (HCC) renders nonstandardized treatment protocols.PurposeTo evaluate clinical course and role of transcatheter arterial embolization (TAE) in patients with rupture of HCC.Materials and methodsThis retrospective study included 127 patients who were treated for ruptured HCC at single institution between 2005 and 2014. After multidisciplinary discussion, patients underwent medical management, TAE, emergency surgery or staged surgery. Patients were retrospectively divided into two groups based on the intent of treatment: curative and palliative. The rebleeding rate and 1-month and overall survival (OS) were compared between two groups. The incidence and survival of patients with intraperitoneal drop metastasis (IPDM) were also analyzed.ResultsThe overall rebleeding rate in patients who underwent TAE was 3.1% (3/96). One-month mortality rate was 6.3% (8/127). The rebleeding and 1-month mortality rates were not significantly different between two groups. OS was significantly higher in the curative treatment group (median: 12.0 vs 2.2 months, p<0.001). Among 96 patients who initially received TAE, ten patients underwent staged operation (10.4%). The median OS for medical management, TAE, emergency surgery and staged surgery was 2.8, 8.7, 19.1 and 71.1 months, respectively. Of all patients, 15.2% developed IPDM mostly within 1 year and their survival was poorer than that of patients without IPDM (median: 6.3 vs. 15.1 months, p<0.001).ConclusionTAE provided effective immediate hemostasis with a low rebleeding rate and may serve as a bridge to elective surgery. IPDM frequently occurred within 1 year and manifested poor survival; thus, close surveillance should be considered for patients with spontaneous rupture of HCC.
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Project description:Cholesterol crystal embolic (CCE) syndrome is often a clinically challenging condition that has a poor prognostic implication. It is a result of plaque rupture with release of cholesterol crystals into the circulation that embolize into various tissue organs. Plaque rupture seems to be triggered by an expanding necrotic core during cholesterol crystallization forming sharp tipped crystals that perforate and tear the fibrous cap. Embolizing cholesterol crystals then initiate both local and systemic inflammation that eventually lead to vascular fibrosis and obstruction causing symptoms that can mimic other vasculitic conditions. In fact, animal studies have demonstrated that cholesterol crystals can trigger an inflammatory response via NLRP3 inflammasome similar to that seen with gout. The diagnosis of CCE syndrome often requires a high suspicion of the condition. Serum inflammation biomarkers including elevated sedimentation rate, abnormal renal function tests and eosinophilia are useful but non-specific. Common target organ involvement includes the skin, kidney, and brain. Various testing including fundoscopic eye examination and other non-invasive procedures such as trans-esophageal echocardiography and magnetic resonance imaging may be helpful in identifying the embolic source. Treatment includes aspirin and clopidogrel, high dose statin and possibly steroids. In rare cases, mechanical intervention using covered stents may help isolate the ruptured plaque. Anticoagulation with warfarin is not recommended and might even be harmful. Overall, CCE syndrome is usually a harbinger of extensive and unstable atherosclerotic disease that is often associated with acute cardiovascular events.
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Project description:Loosely packed sand that is saturated with water can liquefy during an earthquake, potentially causing significant damage. Once the shaking is over, the excess pore water pressures that developed during the earthquake gradually dissipate, while the surface of the soil settles, in a process called post-liquefaction reconsolidation. When examining reconsolidation, the soil is typically divided in liquefied and solidified parts, which are modelled separately. The aim of this paper is to show that this fragmentation is not necessary. By assuming that the hydraulic conductivity and the one-dimensional stiffness of liquefied sand have real, positive values, the equation of consolidation can be numerically solved throughout a reconsolidating layer. Predictions made in this manner show good agreement with geotechnical centrifuge experiments. It is shown that the variation of one-dimensional stiffness with effective stress and void ratio is the most crucial parameter in accurately capturing reconsolidation.
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Project description:Microfluidic-based portable devices for stool analysis are important for detecting established biomarkers for gastrointestinal disorders and understanding the relationship between gut microbiota imbalances and various health conditions, ranging from digestive disorders to neurodegenerative diseases. However, the challenge of processing stool samples in microfluidic devices hinders the development of a standalone platform. Here, we present the first microfluidic chip that can liquefy stool samples via acoustic streaming. With an acoustic transducer actively generating strong micro-vortex streaming, stool samples and buffers in microchannel can be homogenized at a flow rate up to 30 ?L min-1. After homogenization, an array of 100 ?m wide micropillars can further purify stool samples by filtering out large debris. A favorable biocompatibility was also demonstrated for our acoustofluidic-based stool liquefaction chip by examining bacteria morphology and viability. Moreover, stool samples with different consistencies were liquefied. Our acoustofluidic chip offers a miniaturized, robust, and biocompatible solution for stool sample preparation in a microfluidic environment and can be potentially integrated with stool analysis units for designing portable stool diagnostics platforms.
| S-EPMC6626638 | biostudies-literature
Project description:We performed spatial transcriptomics on one IS-dominant tumor and on SLS-dominant tumor. Our goal was to determin different immune infiltration in these two subtypes.
2022-08-09 | GSE210755 | GEO
Project description:Angiomyolipoma is a benign neoplasm of the kidney, and is the most common renal tumour associated with haemorrhage. Risk of bleeding increases with the size of the angiomyolipoma. We report a case of spontaneous bleeding from an upper polar renal angiomyolipoma mimicking a spontaneous adrenal bleed from a pheochromocytoma.
| S-EPMC6796711 | biostudies-literature
Project description:BackgroundTo evaluate the efficacy and safety of everolimus, a mTOR inhibitor, on invasive malignant renal epithelioid angiomyolipoma (EAML).Materials and methodsFrom Oct 2014 to May 2019, we collected data from seven patients with a definite (clinical and pathological) diagnosis of EAML received everolimus in our hospital. Targeted sequence capture array technique with next-generation of high throughput sequencing (NGS) were performed to detect mutations of TSC1/2 genes. All patients had received surgery and everolimus. The clinical efficacy and safety of the therapy were evaluated.ResultsMutations of TSC1 and TSC2 were detected in two and three patients though targeted sequence capture array technique with NGS, respectively. Among seven patients, three had missense mutations, one had nonsense mutation, and one had the large fragment deletion mutation. Five patients accompanied with tuberous sclerosis complex (TSC) were identified. All patients were administered 10mg everolimus once daily, the treatment duration lasted for 3 to 28 months. The objective response was assessed 3 months later, five partial response, two stable disease (SD), the mean greatest tumor diameter of all patients decreased from 9.6 to 5.2cm. Six patients stayed SD and one patient died during follow up. Patients accompanying with TSC had better responses to everolimus compared with non-TSC.ConclusionThe mTOR inhibitor can be an effective treatment for patients with invasive malignant renal EAML. Patients with TSC may benefit more from the therapy.
| S-EPMC7870865 | biostudies-literature
Project description: Not available
| S-EPMC5737944 | biostudies-literature