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R Perrella

Publications and source records attributed to R Perrella.

11 recordsLinked to original sources
PubMed2002

Outcomes following unilateral uterine artery embolisation.

Uterine artery embolisation has been described as successful only when both arteries are embolised. However, results in patients with one congenitally absent or previously ligated artery are unknown. Women suffering from symptomatic uterine myomata were treated at a university teaching hospital, a community hospital and an outpatient surgery centre. Retrospective review of patient response to embolisation was assessed by chart review and questionnaire. Uterine and dominant fibroid size response was assessed by comparing pre- and post-embolisation ultrasound examinations. This study analysed three patient groups within the general population: those who underwent unilateral embolisation because of technical failure, those who ultimately underwent bilateral embolisation after initial technical failure and those who underwent unilateral embolisation because of an absent uterine artery. 12 patients underwent unilateral embolisation, 4 of whom underwent this procedure because of an absent uterine artery. Three of these four patients had a congenitally absent uterine artery arising from the internal iliac artery and all three experienced successful outcomes. The fourth patient had a previously ligated internal iliac artery and her symptoms worsened after the procedure. Eight patients had unilateral embolisation due to technical failure. Five of these patients underwent a subsequent procedure during which the contralateral uterine artery was embolised. Four of these five patients had successful outcomes and one was lost to follow-up. Another of the eight patients suffered an arterial injury leading to technical failure, and was lost to follow-up. Of the two remaining patients with unilateral technical failure, only one had a successful outcome. This study concluded that patients who undergo unilateral embolisation for technical reasons should be offered a second embolisation procedure shortly after the initial procedure. Patients with a congenitally absent uterine artery may respond with similar success to those who underwent bilateral embolisation. In contrast, the patient with a previously ligated internal iliac artery failed. The numbers in this study are too small for statistical analysis and subsequent studies should be performed to confirm these findings.

Angiography↗
PubMed2001

Pregnancy following uterine fibroid embolization.

OBJECTIVE: This paper seeks to evaluate the ability to deliver term pregnancies following uterine fibroid embolization, and to identify impediments to pregnancy in the embolization procedure. STUDY DESIGN: Four physicians performed embolization procedures at various facilities. Patients were asked if fertility was an issue prior to embolization. We measured follicle-stimulating hormone levels before and after embolization. Clinical follow-up, six months following embolization was obtained by interview. Patients were questioned regarding attempts to conceive, menstrual history, and subsequent pregnancy. MAIN OUTCOME MEASURES: Complications were calculated upon the entire patient population, whether or not fertility was identified as a goal. Fertility risks from embolization were identified. We measured radiation exposure in a random consecutive group of 50 women undergoing embolization. All patients who conceived were asked the details of the pregnancy. RESULTS: Four hundred women underwent uterine fibroid embolization between 1996 and 1999. One hundred and thirty nine patients stated a desire for fertility after embolization. Of these, 52 were <40 years old. Seventeen pregnancies have been reported in 14 women. Five spontaneous abortions were observed. Ten women have had normal term deliveries and two women are currently pregnant. No perfusion problems, either during the pregnancy or labor, were reported. The average radiation dosage calculated for 50 women undergoing embolization was 14 rads. Four women under 45 years old suffered premature menopause (10/1000). Two women underwent hysterectomy as a complication of embolization (5/1000). CONCLUSION: The risks of infertility following embolization, premature menopause, and hysterectomy are small, as is the radiation exposure during embolization. These risks compare favorably with those associated with myomectomy. Fertility rates appear similar to patients undergoing myomectomy. No problems, either during pregnancy or delivery, have been observed after embolization. The course of pregnancy and delivery was normal after embolization with no maternal or fetal complications reported. These findings confirm results from other centers. Desire for future pregnancy is not a contraindication to fibroid embolization.

Abortion, Spontaneous↗
PubMed2001

Uterine fibroid embolization: nonsurgical treatment for symptomatic fibroids.

BACKGROUND: Earlier studies demonstrated the efficacy of uterine fibroid embolization (UFE). We seek to demonstrate the success of the procedure in a community hospital setting, and we attempt to identify patients likely not to benefit from embolization, if possible, before the procedure. STUDY DESIGN: The study followed all women treated with UFE for menorrhagia or postmenopausal bleeding at a community hospital between 1997 and 1999. Relief of symptoms, ultrasound changes, and complications were documented. Six months after the procedure, analysis was performed on ultrasound and interview data from patients who underwent UFE. A smaller number of patients has been followed for 12 months and were available for the analysis. We examined characteristics of patients and procedures performed in an attempt to identify likely failures of treatment. We calculated complication and failure rates based on the entire group of patients. RESULTS: From 183 patients who applied for UFE, 16 were excluded because ofpathologic conditions found during preembolization evaluation; 167 women had an embolization, 163 were successfully embolized bilaterally, and 4 were embolized unilaterally because of technical failure. Eighty-eight percent of the patients (147 of 167 patients) reported an improvement or stabilization of symptoms 6 months after UFE. Forty-six patients followed for 12 months experienced myoma shrinkage of 37% (a significant shrinkage over 6 months, p < 0.001), and total uterine volume decreased 52%. Analysis of shrinkage data revealed no demographic or procedure variable associated with shrinkage. Six patients underwent hysterectomy (3.5%) after embolization, one as a result of postprocedure infection. Pain in the first 24 hours postprocedure affected almost all patients. Five percent of the patients passed submucous myomata after UFE; all these patients at risk were identified at preembolization hysteroscopy. Four patients experienced premature menopause after embolization early in the study. There were three criteria for failure, of which a patient had to meet only one: hysterectomy, < 10% shrinkage ofmyoma 6 months after UFE, or worsening symptoms after UFE. No variables of age or size of the uterus could be shown to predict failure. Patients who had undergone earlier pelvic surgery were more likely to fail UFE (p = 0.012). CONCLUSIONS: Uterine fibroid embolization, an alternative treatment for myomas, offering low morbidity, can be performed in a community hospital setting. Eighty-eight percent of patients reported improvement or stabilization of symptoms. Total uterine volume decreased an average of 49% at 6 months after embolization. Shrinkage was unaffected by the size of the uterus, myoma, or patient characteristic before UFE. Longterm followup study reveals a significant continuing shrinkage of total uterine volume and myomata at 12 months. There has been no regrowth of fibroids. Earlier surgery was a factor predicting failure of UFE in our series. The risks to future fertility were small.

Embolization, Therapeutic↗
PubMed1999

Uterine artery embolization for the treatment of uterine leiomyomata midterm results.

INTRODUCTION: The authors review their midterm experience with uterine artery embolization for the treatment of uterine fibroids. MATERIALS AND METHODS: Sixty patients were referred for permanent polyvinyl alcohol (PVA) foam particle uterine artery embolization during an 18-month period. Detailed clinical follow-up and ultrasound follow-up were obtained. RESULTS: Bleeding was a presenting symptom in 56 patients and pain was a presenting symptom in 47 patients. All patients underwent a technically successful embolization. One of the patients underwent unilateral embolization. Fifty-nine patients underwent bilateral embolization. Of all patients undergoing bilateral embolization, at last follow-up (mean, 16.3 months), 81% had their uterus and had moderate or better improvement in their symptoms. Ninety-two percent of these patients also had reductions in uterine and dominant fibroid volumes. Overall, the mean uterine and dominant fibroid volume reduction were 42.8% and 48.8%, respectively (mean follow-up, 10.2 months). One infectious complication that necessitated hysterectomy occurred. CONCLUSION: Uterine artery embolization for the treatment of uterine fibroids is a minimally invasive technique with low complication rates and very good clinical efficacy.

Adult↗
PubMed1989

Budd-Chiari syndrome: the results of duplex and color Doppler imaging.

This study was designed to evaluate duplex and color-flow Doppler imaging as potential noninvasive methods of diagnosing patients with Budd-Chiari syndrome and following them after surgery. Five patients with confirmed hepatic venoocclusive disease were imaged. All five underwent duplex Doppler examinations; three were also evaluated with color-flow Doppler. The hepatic vasculature was examined in all five patients; decompressive mesoatrial shunts were present and were evaluated in four of the five patients. Color-flow Doppler precisely defined intrahepatic, portal, and inferior vena caval circulatory dynamics. Correlation with angiography was excellent. In the two patients in whom hepatic vasculature was evaluated with duplex Doppler alone, the results were less impressive. Intrahepatic flow abnormalities were identified, but the sites of occlusion were not determined convincingly. Signals transmitted from the heart and the inability to visualize the hepatic veins made duplex Doppler evaluation problematic. Duplex Doppler was able to define patency and the direction of flow in the portal vein and inferior vena cava. Our results suggest that color-flow Doppler is an excellent technique for the initial evaluation of patients suspected of having Budd-Chiari syndrome. In the evaluation of decompressive mesoatrial shunts, color-flow Doppler produced dramatic images. However, both duplex and color-flow Doppler were highly accurate in determining the patency of decompressive shunts. Either duplex or color-flow Doppler may be used as the primary imaging procedure to determine shunt patency.

Adult↗
PubMed1988

Second-trimester sonographic diagnosis of Down syndrome: role of femur-length shortening and nuchal-fold thickening.

Relative shortening of femur length and nuchal-fold thickening were evaluated as sonographic signs for the prenatal detection of Down syndrome. The sonograms of 28 fetuses identified by amniocentesis as having trisomy 21 were reviewed. The sonograms of 128 fetuses with a normal karyotype were evaluated as a control group. The finding of either an actual-to-expected femur-length ratio of 0.91 or less or a nuchal-fold measurement of 6 mm or more detected Down syndrome with a sensitivity of 42% and a specificity of 88%. The positive predictive value for Down syndrome detection when using femur-length shortening alone was greater than that when using the combination of femur-length shortening and nuchal-fold thickness. We conclude that femur-length shortening may be potentially useful for the detection of Down syndrome, whereas nuchal-fold thickening has a limited role.

Down Syndrome↗
PubMed1988

Infant cranial sonography.

Sonography is well recognized as an excellent method of imaging the infant brain. A detailed discussion of the sonography of the preterm patient forms the first portion of this article. The numerous other clinical situations in which sonography can be used either alone or in conjunction with CT follow.

Brain↗
PubMed1988

Cerebrovascular ultrasound imaging.

Advancements in technology have brought noninvasive diagnosis of cerebrovascular disease to a high level of accuracy in a relatively short period of time. Conventional duplex sonography allows precise vessel localization and Doppler quantification. The further refinement of color flow imaging promises to simplify the examination and add considerable confidence to the diagnosis. Regardless of the technology used, ultrasound evaluation of the carotid arteries remains a difficult examination to perform, and excellent results are only possible with meticulous technique. The astute sonographer or sonologist will use all aspects of available ultrasound technology to the fullest. Careful evaluation of a seemingly overwhelming array of parameters will result in an impressive degree of diagnostic accuracy.

Carotid Artery, Internal↗
PubMedDate not supplied

Preliminary experience with uterine artery embolization for uterine fibroids.

PURPOSE: To evaluate the potential usefulness of transcatheter uterine artery embolization as a treatment for fibroid-related vaginal bleeding and pelvic pain refractory to hormonal therapy and myomectomy. MATERIALS AND METHODS: Eleven patients (aged 27-55 years; mean, 44.2 years; none desiring future pregnancy) with refractory vaginal bleeding and/or chronic pelvic pain related to uterine leiomyomata underwent uterine artery embolization with use of polyvinyl alcohol (PVA) particles. Clinical improvement was assessed by detailed questionnaire at 2-9 months (mean, 5.8 months) after the procedure. Sonographic measurements of the uterus and dominant masses were obtained before and at 2 months after the procedure. RESULTS: All 11 patients underwent technically successful embolization. Eight of nine women who completed the follow-up questionnaire reported noticeable symptomatic improvement, including three women with complete resolution of symptoms. One woman (the only patient undergoing unilateral embolization) exhibited no clinical response. Another patient developed endometritis and pyometra 3 weeks after the procedure, necessitating hysterectomy. Large reductions in uterine volume (average, 40%) and dominant fibroid size (average, 60%-65%) were sonographically demonstrated. CONCLUSION: Uterine artery embolization represents a promising new method of treating fibroid-related menorrhagia and pelvic pain. Further investigation will be required to assess clinical response and durability, identify appropriate candidates, and define the optimal angiographic technique and PVA particle size.

Adult↗