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S C Goodwin

Publications and source records attributed to S C Goodwin.

14 recordsLinked to original sources
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↗
PubMed1998

Uterine artery embolization for the treatment of uterine fibroids.

The first reported cases of uterine artery embolization in obstetric and gynaecological practice were carried out in the late 1970s. Recently, bilateral uterine artery embolization was used as a primary treatment for fibroids. Meticulous preoperative assessment is essential. The technique of uterine artery embolization involves the catheterization of both uterine arteries and the installation of tiny micro particles of polyvinyl alcohol. Following the procedure, post-procedural pain occurs within the first 24 h and most patients are advised to rest for 1 week. In the UCLA and RSCH series, three infective complications occurred leading to hysterectomy and some patients developed amenorrhoea. Average shrinkage of fibroids in the UCLA, RSCH and French series were 40%, 64% and 70%, respectively, with most patients losing their symptoms and being satisfied with the procedure. Meticulous pre-operative assessment is essential. At UCLA, 140 patients, and at RSCH, 96 patients have been embolized. To date in the UK, US and French series, fibroid growth has been arrested and new fibroids have not formed. However, long-term follow-up on a larger number of cases will be required before the role of uterine artery embolization in the gynaecologic therapeutic armamentarium can be fully defined.

Arteries↗
PubMed1997

Uterine artery embolization: an underused method of controlling pelvic hemorrhage.

Transcatheter arterial embolization has recently emerged as a highly effective percutaneous technique for controlling acute and chronic genital bleeding in a wide variety of obstetric and gynecologic disorders. Benefits for the patient and health care system have included low complication rates, avoidance of surgical risks, fertility preservation, and shorter hospitalizations. In this article the current indications for pelvic embolotherapy, types of embolotherapy, technical considerations, immediate success rates, causes of failure, complications, and outcome expectations are discussed. Our comprehensive literature review and clinical experience suggest that embolization should be used before surgical treatment of nonmalignant pelvic bleeding in many clinical settings, including postpartum, postcesarean, and postoperative bleeding. It is our strong belief that this form of therapy is underused, and the primary purpose of this article is to emphasize its developing role as a highly effective, relatively noninvasive method of treating genital bleeding.

Arteries↗
PubMedDate not supplied

Dialysis access graft thrombolysis: randomized study of pulse-spray versus continuous urokinase infusion.

PURPOSE: To compare pulse-spray to continuous-infusion thrombolysis with high-dose urokinase in thrombosed dialysis access grafts. METHODS: A prospective randomized controlled trial was performed. From August 1992 to September 1993, 30 thrombosed polytetrafluoroethylene (PTFE) grafts in 24 patients were included, 15 grafts in each group. The success of thrombolysis, mean time to thrombolysis, mean urokinase dose, and 60-day patency rate were evaluated. RESULTS: In the pulse-spray group, the mean time to thrombolysis was 72 min with a mean urokinase dose of 560,000 U. The 60-day patency rate was 71%. In the continuous-infusion group, the mean infusion time to thrombolysis was 55 min with a mean dose of 479,000 U. The 60-day patency rate was 73%. CONCLUSION: No statistically significant difference was found between the two techniques in the mean time to thrombolysis, the mean urokinase dose used, or the 60-day patency rate.

Arm↗
PubMedDate not supplied

Prevention of significant hemobilia during placement of transhepatic biliary drainage catheters: technique modification and initial results.

PURPOSE: The authors evaluated a technique for the prevention of significant hemobilia during placement of transhepatic biliary drainage catheters (TBDCs). PATIENTS AND METHODS: Twenty patients with strictures were randomized to two groups. In the control group, the biliary tree was accessed with an Accustick system and a TBDC was placed routinely. In the experimental group, following initial access, a rotating hemostatic valve was attached and the outer sheath was pulled back over the wire while contrast material was injected. If a major vascular structure was encountered, the tract was not used for TBDC placement. However, the outer sheath was re-advanced and used to opacify the ducts. This facilitated separate access. Once access was achieved without traversing a major vascular structure, a TBDC was placed, and the Accustick system was removed. If a portal vein or hepatic vein branch was traversed, no additional maneuvers were performed. However, if a branch of the hepatic artery had been traversed, the tract and biliary-arterial fistula were embolized with gelatin sponge pledgets. Both groups were evaluated for hemobilia for 6 weeks. RESULTS: In the control group, there were three cases of significant hemobilia; two were mild, one was severe. In the experimental group, the tract communicated with a major vascular structure in three patients. In these patients, a second access was used for TBDC placement. None of the patients in the experimental group experienced significant hemobilia. CONCLUSION: Visualization prevents the usage of tracts that communicate with large vascular structures. Initial results indicate that this reduces the frequency of significant hemobilia when TBDCs are placed.

Adolescent↗
PubMedDate not supplied

A porcine model of chronic peripheral arterial occlusion.

PURPOSE: To create a simple and reproducible model of chromic thrombosis for the evaluation of thrombolytic agents and devices. MATERIALS AND METHODS: A stenosis was created in the superficial femoral artery of domestic swine, and autologous blood clot was deposited above the stenosis. Follow-up last for up to 3 months. Degree of clot organization was determined at histologic examination. Two thrombolytic agents, urokinase and collagenase, were used to test this model. RESULTS: There was a 27% delayed recanalization rate with this model. At histologic examination, early thrombus organization was seen at the vessel periphery after 10 days. One-month-old thrombus was substantial but variable in amount. Three-month-old thrombus was completely organized. Neither urokinase nor collagenase proved effective against chronic clot in the doses and time course of this study. CONCLUSION: This simple method yields a chronic porcine clot in a reliable number of domestic swine in 1 month.

Animals↗
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↗
PubMedDate not supplied

Prevention of hemobilia during percutaneous biliary drainage: long-term follow-up.

PURPOSE: The authors evaluated a technique for the prevention of hemobilia when placing transhepatic biliary drainage catheters (THBDCs). MATERIALS AND METHODS: Initially, 20 patients were randomized into two groups. In the control group, a THBDC was placed after blind needle passage without contrast material opacification of the needle tract. In the experimental group, the tract was studied and then abandoned if a major vascular structure was encountered. Once a tract was found that did not traverse a major vascular structure, a THBDC was placed. An additional 35 patients undergoing 40 procedures were studied with use of the technique as outlined for the original experimental group. The original experimental group patients and the additional 35 patients were followed for up to 3 years. RESULTS: There were three cases of hemobilia in the initial control group. None of the patients in the initial experimental group experienced hemobilia. In the additional 35 patients, there were three cases of bloody drainage from the THBDC; however, the etiology of hemobilia was not secondary to transgression of a vascular structure. CONCLUSION: Visualization of the tract prevents the usage of tracts that communicate with large vascular structures. This technique reduces the incidence of hemobilia when placing THBDCs.

Adolescent↗
PubMedDate not supplied

Technique for reduction of bile peritonitis after T-tube removal in liver transplant patients.

PURPOSE: The purpose of this work was to evaluate the incidence of bile peritonitis following T-tube removal in liver transplant patients as a function of the method of T-tube removal. Removal at the bedside was compared to removal in the interventional radiology department with subsequent placement of a temporary drainage catheter. MATERIALS AND METHODS: From June 1987 through July 1993, 1,105 patients underwent orthotopic liver transplantation at the UCLA Medical Center. Three hundred patients were randomly selected from this group and their charts were reviewed. Two hundred sixty-three patients who had choledocho-choledochostomies over a T tube, and adequate documentation of the method of T-tube removal and subsequent clinical course were included in the study. Forty-one patients had their drainage catheter removed at the bedside, and 222 patients had their T-tube removed over a wire in the interventional radiology department with subsequent placement of a temporary drainage catheter. RESULTS: Among all patients included in this study, 10.3% had bile peritonitis. Of the patients who had their T-tube removed at the bedside, 19.5% had bile peritonitis, whereas only 8.6% of the patients who had their T-tube removed in the interventional radiology department had bile peritonitis. This result is statistically significant (P < .05). CONCLUSION: Placing a temporary drain at the time of T-tube removal in the interventional radiology department results in a significant reduction in the incidence of bile peritonitis in liver transplant patients. The procedure is relatively simple, quickly mastered, and well tolerated by patients.

Adolescent↗