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Pilot study of transperineal injection of dehydrated ethanol in the treatment of prostatic obstruction heart arrhythmia 4 year old discount bystolic 5 mg visa. Results of holmium laser resection of the prostate for benign prostatic hyperplasia hypertension with kidney disease discount bystolic 5 mg with amex. Nephroureterectomy for transitional cell carcinoma - the value of pre-operative histology arteria mesenterica superior discount 2.5 mg bystolic overnight delivery. Peripheral hypoechoic lesions of the prostate: evaluation with color and power Doppler ultrasound blood pressure medication news buy bystolic 2.5 mg low price. Is the higher prevalence of benign prostatic hyperplasia related to lower urinary tract symptoms in Korean men due to a high transition zone index. Expression of senescence-associated beta-galactosidase in enlarged prostates from men with benign prostatic hyperplasia. Prostate carcinoma risk subsequent to diagnosis of benign prostatic hyperplasia: a population-based cohort study in Sweden. Superficial transitional cell carcinoma of the ureteral orifice: higher risk of developing subsequent upper urinary tract tumors. A comparison of sonourethrography and retrograde urethrography in evaluation of anterior urethral strictures. Expression of vascular endothelial growth factor in primary superficial bladder cancer. Initiation of nonselective alpha1-antagonist therapy and occurrence of hypotension-related adverse events among men with benign prostatic hyperplasia: a retrospective cohort study. Prostate tissue and leukocyte levels of n-3 polyunsaturated fatty acids in men with benign prostate hyperplasia or prostate cancer. Microsatellite alterations in urinary sediments from patients with cystitis and bladder cancer. Risk assessment of renal cortical scarring with urinary tract infection by clinical features and ultrasonography. Double-blind randomized comparison of single-dose ciprofloxacin versus intravenous cefazolin in patients undergoing outpatient endourologic surgery. Combination of ballistic lithotripsy and transurethral prostatectomy in bladder stones with benign prostatic hyperplasia: report of 120 cases. Toxicological effects of in utero and lactational exposure of rats to a mixture of environmental contaminants detected in Canadian Arctic human populations. Change in International Prostate Symptom Score after transurethral prostatectomy in Taiwanese men with benign prostate hyperplasia: use of these changes to predict the outcome. Botulinum toxin type A improves benign prostatic hyperplasia symptoms in patients with small prostates. Sustained beneficial effects of intraprostatic botulinum toxin type A on lower urinary tract symptoms and quality of life in men with benign prostatic hyperplasia. Intraprostatic injection of botulinum toxin type-A relieves bladder outlet obstruction in human and induces prostate apoptosis in dogs. Dual effects of ouabain on the regulation of proliferation and apoptosis in human prostatic smooth muscle cells. Long-term follow-up study to evaluate the efficacy and safety of the doxazosin gastrointestinal therapeutic system in patients with benign prostatic hyperplasia with or without concomitant hypertension. Relationship between serum prostate-specific antigen and prostate volume in Korean men with benign prostatic hyperplasia: a multicentre study. Doxazosin for benign prostatic hyperplasia: an open-label, baseline- controlled study in Korean general practice. Long-term outcome of radiation-based conservation therapy for invasive bladder cancer. Transperineal sonography guided biopsy of the prostate: critical review of 1107 cases. Randomized clinical trial comparing transurethral needle ablation with transurethral resection of the prostate for the treatment of benign prostatic hyperplasia: results at 18 months. Standard versus hydrophilic catheterization in the adjuvant treatment of patients with superficial bladder cancer. Marked suppression of dihydrotestosterone in men with benign prostatic hyperplasia by dutasteride, a dual 5alpha- reductase inhibitor. Parenteral antibiotics in a palliative care unit: prospective analysis of current practice. The role of urodynamics in the diagnosis and treatment of benign prostatic hyperplasia. Drug or symptom-induced depression in men treated with alpha 1-blockers for benign prostatic hyperplasia? Validity of prostate-specific antigen as a tumour marker in men with prostate cancer managed by watchful-waiting: correlation with findings at serial endorectal magnetic resonance imaging and spectroscopic imaging. Epithelial differentiation of the lower urinary tract with recognition of the minor prostatic glands. Incidence and risk factors of bacteriuria after transurethral resection of the prostate. The effect of phytosterols on quality of life in the treatment of benign prostatic hyperplasia. Preoperative use of 3D volume rendering to demonstrate renal tumors and renal anatomy. Prevalence and correlates of prostatitis in the health professionals follow-up study cohort. Clinical significance of bacteriuria with low colony counts of Enterococcus species. Preventing diseases of the prostate in the elderly using hormones and nutriceuticals. Suprapubic prostatectomy for benign prostatic hyperplasia in rural Asia: 200 consecutive cases. Assessment of renal function in clinical practice at the bedside of burn patients. The distribution of S-100 protein in hyperplastic and neoplastic prostatic epithelium. Glycoprotein A-80 in the human prostate: immunolocalization in prostatic intraepithelial neoplasia, carcinoma, radiation failure, and after neoadjuvant hormonal therapy. Sociodemographic associations with early disease damage in patients with systemic lupus erythematosus. Adult mullerian duct or utricle cyst: clinical significance and therapeutic management of 65 cases. Transurethral hot-water balloon thermoablation for benign prostatic hyperplasia: patient tolerance and pathologic findings. Heat shock protein expression independently predicts clinical outcome in prostate cancer. Effect of heat exposure on viability and contractility of cultured prostatic stromal cells. Interstitial laser coagulation combined with minimal transurethral resection of the prostate for the treatment of benign prostatic hyperplasia. Automatic segmentation of bladder and prostate using coupled 3D deformable models. Med Image Comput Comput Assist Interv Int Conf Med Image Comput Comput Assist Interv. Volumetric density of elastic and reticular fibers in transition zone of controls and patients with benign prostatic hyperplasia. How can we best characterize the relationship between erectile dysfunction and benign prostatic hyperplasia. Evaluation of interstitial diode laser therapy for treatment of benign prostatic hyperplasia. Testosterone and prolactin regulation of metabolic genes and citrate metabolism of prostate epithelial cells. Reflux nephropathy in kidney transplants, demonstrated by dimercaptosuccinic acid scanning. Evaluation of urokinase plasminogen activator and its receptor in different grades of human prostate cancer. Palliative transurethral prostate resection for bladder outlet obstruction in patients with locally advanced prostate cancer. Amprenavir and didanosine are associated with declining kidney function among patients receiving tenofovir.

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The current literature on the standard surgical options as well as on minimally invasive procedures was similarly reviewed blood pressure chart low purchase bystolic 2.5 mg amex. Despite the rigorous methodology and detail used in these various areas blood pressure medication by class discount bystolic 2.5mg online, supporting high-quality data heart attack in sleep cheap bystolic 5 mg on-line. In these situations heart attack in women bystolic 5mg mastercard, the Panel, not surprisingly, was forced to suggest best practices based on expert opinion. We expect these concerns to grow in importance with the aging of our nation and the obesity epidemic. This will place increased demands for treatment services, and necessitate the incorporation of evidence-based medicine in treatment therein. Storage symptoms are experienced during the storage phase of the bladder and include daytime frequency and nocturia; voiding symptoms are experienced during the voiding phase. It is becoming widely accepted that the symptoms we relate in many older males may not have an etiology in prostate enlargement. Detrusor overactivity is a urodynamic observation characterized by involuntary detrusor contractions during the filling phase. The term benign prostatic hyperplasia is reserved for the histological pattern it describes. Benign prostatic enlargement is used when there is gland enlargement and is usually a presumptive diagnosis based on the size of the prostate. In addition to being responsible for the symptoms, these excluded clinical scenarios, diseases and/or conditions may affect treatment in a manner outside the purview of this Guideline. The full description of the methodology presented in Chapter 2 can be accessed at. What are the predictors of beneficial effects from © Copyright 2010 American Urological Association Education and Research, Inc. As in the previous Guideline, statements were graded using three levels with respect to the degree of flexibility in their application. A "standard" has the least flexibility as a treatment policy; a "recommendation" has significantly more flexibility; and an "option" is even more flexible. Standard: A guideline statement is a standard if: (1) the health outcomes of the alternative interventions are sufficiently well known to permit meaningful decisions and (2) there is virtual unanimity about which intervention is preferred. Recommendation: A guideline statement is a recommendation if: (1) the health outcomes of the alternative intervention are sufficiently well known to permit meaningful decisions, and (2) an appreciable but not unanimous majority agrees on which intervention is preferred. Option: A guideline statement is an option if: (1) the health outcomes of the interventions are not sufficiently well known to permit meaningful decisions, or (2) preferences are unknown or equivocal. Options can exist because of insufficient evidence or because patient preferences are divided and may/should influence choices made. Diagnostic Evaluation the Panel decided that the diagnostic section of the 2003 Guideline required updating. After review of the recommendations for diagnosis published by the 2005 International Consultation of 12 Urologic Diseases and reiterated in 2009 in an article by Abrams et al (2009), the Panel unanimously 13 agreed that the contents were valid and reflected best practices. A recommended test should be performed on every patient during the initial evaluation whereas an optional test is a test of proven value in the evaluation of select patients. In general, optional tests are performed during a detailed evaluation by a urologist. The physician can discuss with the patient treatment alternatives based on the results of the initial evaluation with no further tests being needed (See Figure 1. There should be a discussion of the benefits and risks involved with each of the recommended treatment alternatives (e. Then the choice of treatment is reached in a shared decision-making process between the physician and patient. If the patient has predominant significant nocturia and is awakened two or more times per night to void, it is recommended that the patient complete a frequency volume chart for two to three days. The frequency volume chart will show 24-hour polyuria or nocturnal polyuria when present, the first of which has been defined as greater than three liters total output over 24 hours. In practice, patients with bothersome symptoms are advised to aim for a urine output of one liter per 24 hours. Nocturnal polyuria is diagnosed when more than 33% of the 24-hour urine output occurs at night. If symptoms do not improve sufficiently, these patients can be managed similarly to those without predominant nocturia. If the patient has no polyuria and medical treatment is considered, the physician can proceed with therapy by focusing initially on modifiable factors such as concomitant drugs, regulation of fluid intake (especially in the evening), lifestyle (increasing activity) and diet (avoiding excess of alcohol and 14 highly seasoned or irritative foods). If pharmacological treatment is necessary, it is recommended that the patient be followed to assess treatment success and possible adverse events. The time from initiation of therapy to treatment assessment varies according to the pharmacological agent prescribed. If treatment is successful and the patient is satisfied, once yearly follow-up should include a repeat of the initial evaluation. The follow-up strategy will allow the physician to detect any changes © Copyright 2010 American Urological Association Education and Research, Inc. The urologist may use additional testing beyond those recommended for basic evaluation (Figure 1. The treatment options of lifestyle intervention (fluid intake alteration), behavioral modification and pharmacotherapy (anticholinergic drugs) should be discussed with the patient. It is the expert opinion of the Panel that some patients may benefit using a combination of all three modalities. Should improvement be insufficient and symptoms severe, then newer modalities of treatment such as botulinum toxin and sacral neuromodulation can be considered. The patient should be followed to assess treatment success or failure and possible adverse events according to the section on basic management above. Interventional Therapy If the patient elects interventional therapy and there is sufficient evidence of obstruction, the patient and urologist should discuss the benefits and risks of the various interventions. Transurethral resection is still the gold standard of interventional treatment but, when available, new interventional therapies could be discussed. If interventional therapy is planned without clear evidence of the presence of obstruction, the patient needs to be informed of possible higher failure rates of the procedure. Some patients with bothersome symptoms might opt for surgery, while others might opt for watchful waiting or medical therapy depending on individual views of benefits, risks and costs. The treatment choices (Table 1) are discussed in this chapter with the supporting evidence presented in Chapter 3. Symptom distress may be reduced with simple measures such as avoiding decongestants or antihistamines, decreasing fluid intake at bedtime and decreasing caffeine and alcohol intake generally. Watchful waiting patients usually are reexamined yearly, repeating the initial evaluation as previously outlined in Figure 1. Measures to reduce the risk, such as medical intervention, may be offered depending on the circumstances. Although there are slight differences in the adverse events profiles of these agents, all four appear to have equal clinical effectiveness. As stated in the 2003 Guideline, the effectiveness and efficacy of the four alpha blockers under consideration appear to be similar. Although studies directly comparing these agents are currently lacking, the available data support this * contention. Food and Drug Administration but there were no relevant published articles in the peer-reviewed literature prior to the cut-off date for the literature search. Noradrenergic sympathetic nerves have been demonstrated to effect the contraction of prostatic 15 smooth muscle. Ninety-eight percent of alpha-blockers are associated with the stromal elements of 16 the prostate and are thus thought to have the greatest influence on prostatic smooth muscle tone. For the purposes of this Guideline, the specific agents reviewed included alfuzosin, doxazosin, tamsulosin and terazosin as they theoretically act in the location that will have the greatest benefit for symptoms with the fewest side effects. Alpha-blockers produce a significant symptom improvement compared to placebo, which the average patient will appreciate as a moderate improvement from baseline. The minor differences in efficacy noted between the different alpha- blockers are not statistically (when tested) or clinically significant. The 2003 Guideline suggested that some patients treated with tamsulosin require the 0. However, during guideline development (March 2010), the Panel became aware that tamsulosin was available as a generic product which may have obviated this problem. In clinical studies, rates for specific adverse events were low and similar between treatment and placebo groups.

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The enthalpy b b is of interest because we use it in writing the First Law of Thermodynam- ics when calculating the inﬂow of thermal energy and ﬂow work to open control volumes blood pressure lowering medications discount 2.5mg bystolic with amex. The bulk enthalpy is an average enthalpy for the ﬂuid 320 Forced convection in a variety of conﬁgurations §7 pulse pressure of 96 order bystolic 2.5mg online. This deﬁnition of Tb is perfectly general and applies to either laminar or turbulent ﬂow pulse pressure 46 generic 5 mg bystolic free shipping. Of course hypertension guidelines jnc 8 purchase 2.5mg bystolic free shipping, a ﬂow must be hydrody- namically developed if it is to be thermally developed. The two ﬂows are subjected to either a uniform wall heat ﬂux or a uniform wall temperature. If we consider a small length of pipe, dx long with perimeter P, then its surface area is Pdx(e. If the ﬂow is fully developed, the boundary layers are no longer growing thicker, and we expect that h will become constant. When qw is constant, then Tw − Tb will be constant in fully developed ﬂow, so that the temperature proﬁle will retain the same shape while the temperature rises at a constant rate at all values of r. The hydrodynamic entry length for a pipe carrying ﬂuid at speeds near the transitional Reynolds number (2100) will extend beyond 100 di- ameters. Since heat transfer in pipes shorter than this is very often im- portant, we will eventually have to deal with the entry region. The velocity proﬁle for a fully developed laminar incompressible pipe ﬂow can be derived from the momentum equation for an axisymmetric ﬂow. The boundary layer equation for cylindrically symmetrical ﬂows is quite similar to that for a ﬂat surface, eqn. We can identify the lead constant (−dp/dx)R2 4µ as the maximum centerline velocity, umax. Poiseuille (pronounced Pwa-zói or, more precisely, Pwä-z´¯e) did the same thing, almost simultaneously (1840), in France. Indeed, the fact that there is only one dimensionless group in it is predictable by dimensional analysis. In this case the dimensional functional equation is merely h = fn (D,k) We exclude ∆T, because h should be independent of ∆T in forced convec- tion; µ, because the ﬂow is parallel regardless of the viscosity; and ρu2, av because there is no inﬂuence of momentum in a laminar incompressible ﬂow that never changes direction. This gives three variables, effectively in only two dimensions, W/K and m, resulting in just one dimensionless group, NuD, which must therefore be a constant. The ﬂow is fully developed at a point beyond which a constant heat ﬂux of 6000 W/m2 is imposed. As a fairly rough approximation, we evaluate properties at (74 + 20)/2 = 47◦C: k = 0. Then, noting that this greatest at the wall and setting x = L at the point where T = 74◦C, wall eqn. In the preceding example, the heat transfer coeﬃcient is actually rather large k 0. Using small scale fabrication technologies, such as have been developed in the semiconductor industry, it is possible to create channels whose characteristic diameter is in the range of 100 µm, result- ing in heat transfer coeﬃcients in the range of 104 W/m2Kfor water. If, instead, liquid sodium (k ≈ 80 W/m·K) is used as the working ﬂuid, the laminar ﬂow heat transfer coeﬃcient is on the order of 106 W/m2K— a range that is usually associated with boiling processes! Thermal behavior of the ﬂow in an isothermal pipe the dimensional analysis that showed NuD = constant for ﬂow with a uniform heat ﬂux at the wall is unchanged when the pipe wall is isother- mal. The thermal entrance region the thermal entrance region is of great importance in laminar ﬂow be- cause the thermally undeveloped region becomes extremely long for higher- Pr ﬂuids. A complete analysis of the heat transfer rate in the thermal entry re- gion becomes quite complicated. Dimensional analysis of the entry problem shows that the local value of h depends on uav, µ, ρ, D, cp, k, and x—eight variables in m, s, kg, and J K. The solution of the constant wall temperature problem, originally formulated by Graetz in 1885 [7. The ﬁgure also presents an average Nusselt number, NuD for the isothermal wall case: L L hD D 1 1 NuD ≡ = hdx = NuD dx (7. For an isothermal wall, the following curve ﬁts are available for the Nusselt number in thermally developing ﬂow [7. For ﬁxed qw, a more complicated formula reproduces the exact result for local Nusselt number to within 1%:   1/3 4 1. An electric resistance heater surrounds the last 20 cm of the pipe and supplies a constant heat ﬂux to bring the air out at T = 40◦C. The bulk temperature is speciﬁed as 40◦C, and q is obtained from this number w by a simple energy balance: 2 qw(2πRx) = ρcpuav(Tb − Tentry)πR so kg J m ◦ R 2 qw = 1. Here we see that xet is very strongly dependent on Pr and inﬂuenced rather less by ReD. Notice, too, that xet decreases with Pr in turbulent ﬂow while it increases in laminar ﬂow. The discussion that follows deals almost entirely with fully developed turbulent pipe ﬂows. However, the pipe is too short for ﬂow to be fully developed over much, if any, of its length. The rate of rise of NuD with ReD becomes very great in the transitional range, which lies between ReD = 2100 and about 5000 in this case. Above ReD 5000, the ﬂow is turbulent and it turns out 332 Forced convection in a variety of conﬁgurations §7. The Reynolds analogy and heat transfer the form of the Reynolds analogy appropriate to fully developed turbu- lent ﬂow in a pipe can be derived from eqn. We merely replace u∞ with uav and Cf (x) with a constant value of the friction coeﬃcient, Cf, for fully developed pipe ﬂow to get h Cf 2 St = = 5 (7. The frictional resistance to ﬂow in a pipe is normally expressed in terms of the Darcy-Weisbach friction factor, f [recall eqn. A number of early formulations for the Nus- selt number in turbulent pipe ﬂow were based on Reynolds analogy in the form of eqn. Actu- ally, it is quite similar to an earlier result developed by Dittus and Boelter in 1930 (see [7. However, subsequent research has provided a great many more data, and better theoretical and physical understanding of how to represent them accurately. Petukhov and his co-workers at the Moscow Insti- tute for High Temperature developed a vastly improved description of forced convection heat transfer in pipes. The effect of variable physical prop- erties is dealt with differently for liquids and gases. In both cases, the Nusselt number is ﬁrst calculated with all properties evaluated at Tb. During heat transfer to liquid metals in pipes, the same thing occurs as is illustrated in Fig. The re- gion of thermal inﬂuence extends far beyond the laminar sublayer, when Pr 1, and the temperature proﬁle is not inﬂuenced by the sublayer. Conversely, if Pr 1, the temperature proﬁle is largely shaped within the laminar sublayer. Numerous measured values of NuD for liquid metals ﬂowing in pipes with a constant wall heat ﬂux, qw, were assembled by Lubarsky and Kauf- man [7. Some of the very low data might pos- sibly result from a failure of the metals to wet the inner surface of the pipe. Another problem that besets liquid metal heat transfer measurements is the very great diﬃculty involved in keeping such liquids pure. There is a body of theory for turbulent liquid metal heat transfer that yields a prediction of the form 0. Suppose that we need to know the net heat transfer to a pipe of known length once h is known. This problem is complicated by the fact that the bulk temperature, Tb, is varying along its length. However, we need only recognize that such a section of pipe is a heat exchanger whose overall heat transfer coeﬃcient, U (between the wall and the bulk), is just h. Since Tw is uniform, the stream that it represents must have a very large capacity rate, so that Cmin/Cmax = 0. A heat exchanger for which one stream is isothermal, so that Cmin/Cmax = 0, is sometimes called a single-stream heat exchanger. An interesting feature of this evolving ﬂow pattern is the fairly continuous way in which one ﬂow transition follows another. An important reﬂection of the complexity of the ﬂow ﬁeld is the vortex-shedding frequency, fv.

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The most commonly reported adverse effect is life blood pressure chart what is high cheap bystolic 5 mg fast delivery, and according to different literature sources prehypertension ne demek best bystolic 2.5 mg, it should the occurrence of unexpected bleeding yaz arrhythmia bystolic 5 mg free shipping, which is more be used 3 to 4 times a day with a variable recommended frequent within the ﬁrst months of use arteria hepatica propria buy genuine bystolic line. History of thromboembolism promote the destruction of the endometrium with damage in or renal failure are contraindications to tranexamic acid. Endometrial A reduction of up to 50% in bleeding volume can be ablation shows good results when the uterus hysterometry expected. Several endometrial destruction techniques may be employed, all with relatively similar success, leading to Non-steroidal anti-inﬂammatory drugs signiﬁcant improvement in bleeding, and to an amenorrhea Non-steroidal anti-inﬂammatory drugs act by inhibiting rate of around 40 to 50% after 1 year. However, some require special as an adjunctive therapy for the hormonal treatment. Anti-inﬂammato- the surgical procedure is often necessary, and, therefore, the difference in cost narrows over time. The same review compared mefenamic acid with Hysterectomy naproxen, and found no difference between the two. In randomized studies comparing hys- experiencebleeding above normal (80 mL) despitetheuse of terectomy with endometrial ablation, higher satisfaction rates among women undergoing hysterectomy were found. However, the analysis of the Gonadotropin-releasing hormone analogs may be consid- high costs of the surgical treatment, the prolonged time away ered prior to surgery, in myomas, for example, particularly to from daily activities, the risk of infection, and the surgical enable the recovery of the organism and a reduction in complications results in the recommendation of this method volume. They are used when other hormonal methods are uniquely for cases in which all therapeutic alternatives have contraindicated, for a short period of time until the con- failed, and when the patient no longer wants children. It is necessary to consider (A, C, A, C) In some exceptional cases, if the patient does not the costs and frequent side effects. Treatment of Acute Abnormal Uterine Bleeding structural and non-structural causes of uterine bleeding, When the blood loss is acute and signiﬁcant, and the patient excluding gestational causes. At be prioritized, followed by the immediate start of treat- the same time, it is essential to stop the bleeding. In the ment, whether clinical or surgical, even if the bleeding literature, there are different schemes with this indication. Afterwards, an evaluation of the uterine growth of the endometrium, stimulates the contraction of cavity by imaging exams should be performed to identify the uterine arteries, and promotes platelet aggregation and the presence of organic lesions in the endometrial cavity. The only deﬁnitive treatment for for 24 hours is suggested, followed by the use of estrogen adenomyosis is hysterectomy, but the control of symp- combinedwith progestogen,or by theuseof progestogen alone toms by medical drug treatment is not rare. In cases of intramural myomas, with an increase of no estrogen availablefor intravenous use inBrazil. Thus,we use uterine bleeding, the ﬁrst therapeutic option is pharma- the other hormonal options, as explained below. If there is no response tothe clinical treatment, evidence in the literature is relatively restricted. The main therapeutic the use of multiple doses of progestogen, especially indicated options are described in ►Table 2 in cases when the use of estrogens is contraindicated. Conﬂicts of Interest Other options suggested in the literature are the use of a the authors have no conﬂicts of interest to declare. Intrauterine tamponade can also be considered, using the Foley probe with an inﬂated balloon with 3–10 mL. A systematic review may greatly aid in the control of bulky bleeding, usually used evaluating health-related quality of life, work impairment, and adjunctively and associated with other alternatives. Adding low-dose transvaginalultrasonography,sonohysterographyandhysteroscopy estrogen to the hormone-free interval: impact on bleeding pat- fortheinvestigationofabnormaluterinebleedinginpremenopausal terns in users of a 91-day extended regimen oral contraceptive. Economics of standard procedure for assessing endometrial lesions among reducing menstruation with trimonthly-cycle oral contraceptive postmenopausal women. Sao Paulo Med J 2007;125(06):338–342 therapy: comparison with standard-cycle regimens. The Obstet Gynaecol 2017;40:68–81 effects of mefenamic acid and norethisterone on measured men- 7 Di Spiezio Sardo A, Calagna G, Guida M, Perino A, Nappi C. Uterine ﬁbroid management: from the heavy menstrual bleeding: a systematic review. Efﬁcacy of micronised vaginal new presurgical classiﬁcation to evaluate the viability of hystero- progesterone versus oral dydrogestrone in the treatment scopic surgical treatment–preliminary report. J Minim Invasive of irregular dysfunctional uterine bleeding: a pilot randomised Gynecol 2005;12(04):308–311 controlled trial. Operative ofﬁce hysteroscopy oestrogen for irregular uterine bleeding associated with anovula- without anesthesia: analysis of 4863 cases performed with tion. J Obstet Gynaecol Contraception 1983;28(01):1–20 Can 2015;37(02):157–178 33 Stewart A, Cummins C, Gold L, Jordan R, Phillips W. Int J Gynaecol Obstet 2011; progestogen-releasing intrauterine systems for heavy menstrual 113(01):3–13 bleeding. Faculty of Health 2014;6:623–629 Sexual & Reproductive Healthcare Clinical Guidance. Current role of uterine artery embolization in ment of unscheduled bleeding in women using hormonal contra- the management of uterine ﬁbroids. Treatmentof vaginalbleedingirregularitiesinduced controlled trial comparing uterine ﬁbroid embolization and by progestin only contraceptives. Am J Obstet profen and tranexamic acid in the treatment of idiopathic menor- Gynecol 2016;214(01):31–44 rhagia. Acta Obstet Gynecol Scand 1988;67(07):645–648 22 American College of Obstetricians and Gynecologists. Med J Aust 2003;178(12):621–623 for heavy menstrual bleeding: a randomized controlled trial. Hormonalcontraceptionastreatmentforheavy Obstet Gynecol 2010;116(04):865–875 menstrual bleeding: a systematic review. Hysterectomy, endometrial ablation and 47 Gupta B, Mittal S, Misra R, Deka D, Dadhwal V. Levonorgestrel- Mirena for heavy menstrual bleeding: a systematic review of releasing intrauterine system vs. Clinical Am J Obstet Gynecol 1996;175(06):1432–1436, discussion trial of the uterine thermal balloon for treatment of menorrhagia. Cost-utility of levonorgestrel tives for acute uterine bleeding: a randomized controlled trial. This review emphasizes intended use, chemical composition, degradative mechanisms, and pre-clinical safety, efﬁcacy, and performance, while summarizing the key advantages and disadvantages for each degradable technology that is currently under development for transarterial embolization. This review is intended to provide an inclusive reference for clinicians that may facilitate an understanding of clinical and technical concepts related to this ﬁeld of interventional radiology. For materials scientists, this review highlights innovative devices and current evaluation methodologies. Degradable microspheres are intended to provide effective embolization on a transient basis. Ideally, after achieving their clinical outcome, they are removed from the body without interfering with the functionality of other organs. Unlike conventional permanent agents, degradable microspheres should be designed to optimize the window of therapeutic intent (e. A signiﬁcant driver for the development and utilization of degradable microspheres is that patients commonly express worries about foreign materials remaining in the body, and while this may not be a physiological problem, it is certainly an important consideration for patients, and may provide competitive marketing advantages for next generation technologies [1]. Although the safety, efﬁcacy, and performance of permanent embolic agents are well established in the clinical literature, degradable microspheres may present new safety concerns. Fortunately, when developing new biomaterials for clinical applications, researchers beneﬁt from the existence of international standards and guidance documents to help address potential risks. With respect to vascular embolization devices, speciﬁc guidance documents have been published by regulatory agencies. This document emphasizes (i) ease of deliverability (from a friction and tortuosity standpoint), (ii) acute complications, (iii) local and systemic foreign body reactions, (iv) recanalization, (v) embolization effectiveness, and (vi) device migration. Given the potential new safety risks that may arise from the use of degradable microspheres, these considerations are critical in the design and evaluation of new microsphere technologies. Further to such guidance documents, it is also instructive to consider the ideal characteristics of degradable microspheres. These innovative technologies must provide predictable and effective occlusion while also providing: 1. Tailored degradation timeframes—to provide adequate infarction to the target tissues in a variety of indications, subsequently allowing return of ﬂow (e. A variety of tightly calibrated particle size distributions—to optimize particle delivery according to target artery anatomy [3] 3. Ease of delivery through conventional microcatheters—to facilitate adoption of the novel technology into established embolization techniques 4.

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