Elective and emergency selective renal artery angio-graphy and embolization of angiomyolipoma: a report of two cases and review of the literature
Notice bibliographique
Résumé
Objectives : With developments in interventional radiology, selective renal artery angiography and super-selective embolization is gradually being used as an alternative treatment modality for angiomyolipoma of the kidney instead of nephrectomy or partial nephrectomy. It has been suggested that the use of steroids around the time of embolization may reduce or avoid post-embolization syndrome. Our aim is to report two cases of angiomyolipoma of kidney that were treated electively and as an emergency procedure with a review of the literature. Methods : Detailed clinical records of the two patients were obtained from their case notes, ALS records of clinic letters and discharge summaries, PACS system for records of all radiological procedures, computerized results of all laboratory tests in order to document the presentation, investigation, management and outcome of management of the patients. Literature was reviewed on embolization of angiomyolipoma of the kidney. Results : Two patients with angiomyolipoma of the kidney, (the first patient a lady with an enlarging angiomyolipoma of the right kidney and the second patient a lady who had spontaneous haemorrhage into a large angiomyolipoma of her right kidney), underwent selective right renal artery angiography and supers-selective embolization of the feeding vessels of their angiomyolipomas. The first patient was given steroid cover (Hydrocortisone and prednisolone) for two weeks in order to reduce or minimise the development of post-embolization syndrome. The second patient was not given any steroid cover. The first patient was discharged home on the first day after her embolization procedure and she did not develop any complications. The second patient who was not given any steroid cover developed post-embolization syndrome which eventually resolved after about six weeks. Literature review indicates that post-embolization syndrome is common after embolization. There is some evidence in the literature to suggest that the use of a short course of steroids around the time of embolization procedure reduces or prevents the development of post-embolization syndrome. Conclusions: Selective renal artery angiography can be used to diagnose a non-bleeding-angiomyolipoma, as well as bleeding enlarged angiomyolipoma of kidney. Super-selective renal artery embolization of a large angiomyolipoma of the kidney is a useful alternative to partial nephrectomy or full nephrectomy; it has the advantage of not requiring general anaesthesia and it is associated with less morbidity than nephrectomy or partial nephrectomy. Our limited experience and literature review would suggest that perhaps the use of steroids around the time of embolization may reduce the incidence of post-embolization syndrome.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,002 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,005 | 0,003 |
| Études des sciences et des technologies | 0,002 | 0,002 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,006 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».