title: Emergency endovascular nanopharmacologic treatment in advanced gynecological cancers.
abstract: BACKGROUND
  Advanced cases of uterine carcinomas with parametrial and fornix infiltration often cause massive genital bleeding, with severe anemia, fast deterioration, and a high risk of death for patients; women with advanced uterine cancer (UC) and genital massive bleeding were treated using an endovascular therapy in local anesthesia.
  
  
  METHODS
  Ten women with advanced UC and genital massive bleeding were hospitalized for a high risk of immediate death; after blood transfusions and resuscitation therapy, the patients were submitted to an experimental nanopharmacologic endovascular therapy in local anesthesia.
  
  
  RESULTS
  On average, the total operative time for the procedure was 38.6 minutes, the intrasurgical blood loss was of 37 mL, the postoperative analgesic request for 48 hours was just for 3 patients (all dismissed in the second day after pelvic artery embolization), the hemoglobin level at dismissal was of 6.5 g/L, and the duration of hospital stay was 1.4 days. All patients well tolerated the procedure, with no linked complications; clinical check was at the 10th and 30th days after dismissal, with no further recurrent genital bleeding in the follow-up course stopped at the visit in the 60th day.
  
  
  CONCLUSIONS
  Genital bleeding in advanced UC is a serious complication because it causes deterioration of the patient's general status and has a worse prognosis. The pelvic uterine embolization according to our endovascular nanopharmacologic methods is bloodless, less traumatic, and faster than a surgical procedure. Even if it requires experience in intervention radiology, it enables the continuation of external radiotherapy without delay and can replace laparotomic or laparoscopic treatment.
authors.affiliation: Department of Gynecology and Obstetrics, Division of Experimental Endoscopic Surgery, Imaging, Minimally Invasive Therapy, and Technology, Vito Fazzi Hospital, Lecce, Italy. andreatinelli@gmail.com
authors.forename: Andrea
authors.initials: A
authors.lastname: Tinelli
authors.forename: Raffaele
authors.initials: R
authors.lastname: Prudenzano
authors.forename: Antonio
authors.initials: A
authors.lastname: Malvasi
authors.forename: Mario
authors.initials: M
authors.lastname: Santantonio
authors.forename: Vito
authors.initials: V
authors.lastname: Lorusso
mesh_terms: D018195:Adenosarcoma / Q000150:complications / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000601:surgery*; D018284:Cystadenocarcinoma, Serous / Q000150:complications / Q000601:surgery*; D004621:Embolization, Therapeutic; D004632:Emergency Medical Services; D016889:Endometrial Neoplasms / Q000150:complications / Q000601:surgery*; D057510:Endovascular Procedures; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008875:Middle Aged; D015996:Survival Rate; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000601:surgery*
chemical_list: D000700:Analgesics