No abstract

pontaneous soft-tissue hematoma (SSTH) is a frequent condition due to the growing use of anticoagulation and antiplatelet therapy and predominantly affects older patients (1-4). The occurrence of SSTH in older patients on anticoagulant therapy may require hospitalization and transfusion and may ultimately lead to death (2). Predisposing factors of SSTH include underlying coagulopathies, arterial hypertension, and previous abdominal surgery (5).SSTH occurs in a muscle group, mainly in the rectus sheath and iliopsoas muscle (6). In most patients, SSTH can be managed conservatively (5-7). Clinical management includes correction of coagulation parameters, resuscitation with fluids, blood transfusions, and supportive care (8). While most SSTHs remain confined within the fascia of the muscle, some are more extensive and can become life-threatening in the presence of preexisting comorbidities (6,9).Percutaneous transarterial embolization (PTAE) is effective in the management of life-threatening bleedings from various causes (10-14). Regarding SSTH, the role of PTAE has received less attention in the literature with only small, retrospective series (5,6,8,(15)(16)(17). To date, the indication for PTAE and the predictors of mortality have not been well identified using a large study (8,(15)(16)(17)(18).The purpose of this study was to evaluate the safety and efficacy of PTAE for the treatment of SSTH in a large multicenter cohort and to identify variables that may be used as predictors of short-term outcome. Materials and MethodsThis retrospective multicenter study received local ethics and institutional review board committee approval from all institutions. According to the design of this retrospective study, the institutional review boards waived the requirement to obtain written informed consent. PatientsWe retrospectively analyzed the files of all consecutive patients with SSTH treated with PTAE between January

RSL is safe and accurate, and has comparable surgical endpoints to WL. Because RSL offers flexible scheduling and facilitated oncoplasty, RSL may replace WL for resection of nonpalpable single breast lesions.

When there is obstruction of the left ventricular outflow tract, there are several surgical approaches to the repair of discordant ventriculo-arterial connections in the setting of concordant atrioventricular connections. Choosing the optimal technique demands not only knowledge of the different surgical procedures, but also the understanding of the particular anatomic features present in a specific patient. These requisites are then essential to plan the operation, to foresee some difficult situations, and to avoid post-operative complications. In this review, we assess all these surgical and anatomic aspects, focussing on their relative importance in clinical assessment.

Objective To determine whether the addition of ethanol to water for irrigation during transurethral resection of the prostate (TURP) and monitoring breath ethanol could be used to detect irrigant absorption and to limit free plasma haemoglobin in cases of absorption. Patients and methods One hundred patients (46 in Pitea Ê, Sweden and 54 in Uong bi, Vietnam) underwent surgery for benign prostatic hyperplasia (BPH) under an intermittent irrigation technique using water containing 2% ethanol. An expired breath alcohol meter was used to monitor ethanol in the patients' breath every 5 min. Blood samples taken after TURP were assessed for free haemoglobin in 99 patients, and other markers of haemolysis were also evaluated in the Swedish group. Results Thirty-two patients had detectable ethanol in their breath. There was a close correlation between the maximum ethanol reading during surgery and the level of free plasma haemoglobin after TURP (r=0.90, P<0.001). There was no correlation between the duration of TURP and the free haemoglobin level. Conclusion Monitoring breath ethanol during TURP assesses absorption and so can help to keep control of haemolysis. It is suggested that the value on the alcohol meter should not be allowed to exceed 0.15 (corresponding to a blood ethanol level of 0.15½), which should maintain the free plasma haemoglobin level at <1.0 g/L after TURP. Restricting the operative duration per se is not a reliable safety measure.