RESUMEN
Systematic and standardized evaluation of superficial venous disease, guided by knowledge of the various clinical presentations, venous anatomy, and pathophysiology of reflux, is essential for appropriate diagnosis and optimal treatment. Duplex ultrasonography is the standard for delineating venous anatomy, detecting anatomic variants, and identifying the origin of venous insufficiency. This article reviews tools and techniques essential for physical examination and ultrasound assessment of patients with superficial venous disease.
Asunto(s)
Cuello del Útero/anomalías , Hematómetra/terapia , Dispositivos Intrauterinos , Gemelos Siameses , Enfermedades del Cuello del Útero/congénito , Vagina/anomalías , Enfermedades Vaginales/congénito , Cuello del Útero/diagnóstico por imagen , Femenino , Hematómetra/diagnóstico por imagen , Hematómetra/etiología , Humanos , Resultado del Tratamiento , Enfermedades del Cuello del Útero/diagnóstico por imagen , Vagina/diagnóstico por imagen , Enfermedades Vaginales/diagnóstico por imagen , Adulto JovenAsunto(s)
Anestésicos/administración & dosificación , Plexo Hipogástrico/efectos de los fármacos , Leiomioma/terapia , Bloqueo Nervioso/métodos , Dolor/tratamiento farmacológico , Embolización de la Arteria Uterina , Neoplasias Uterinas/terapia , Anestésicos/efectos adversos , Femenino , Fluoroscopía , Humanos , Imagen por Resonancia Magnética , Arteria Radial , Resultado del TratamientoRESUMEN
BACKGROUND: This study sought to describe the results of a single-arm multicenter clinical trial using image-guided percutaneous cryoablation for the palliation of painful metastatic tumors involving bone. METHODS: Over a 44-month period, 61 adult patients with 1 or 2 painful bone metastases with a score of 4 or more on a scale of 0 to 10 (≥4/10) worst pain in a 24-hour period who had failed or refused conventional treatment were treated with percutaneous image-guided cryoablation. Patient pain and quality of life was measured using the Brief Pain Inventory prior to treatment, 1 and 4 days after the procedure, weekly for 4 weeks, and every 2 weeks thereafter for a total of 6 months. Patient analgesic use was also recorded at these same follow-up intervals. Complications were monitored. Analysis of the primary endpoint was undertaken via paired comparison procedures. RESULTS: A total of 69 treated tumors ranged in size from 1 to 11 cm. Prior to cryoablation, the mean score for worst pain in a 24-hour period was 7.1/10 with a range of 4/10 to 10/10. At 1, 4, 8, and 24 weeks after treatment, the mean score for worst pain in a 24-hour period decreased to 5.1/10 (P < .0001), 4.0/10 (P < .0001), 3.6/10 (P < .0001), and 1.4/10 (P < .0001), respectively. One of 61 (2%) patients had a major complication with osteomyelitis at the site of ablation. CONCLUSIONS: Percutaneous cryoablation is a safe, effective, and durable method for palliation of pain due to metastatic disease involving bone.
Asunto(s)
Neoplasias Óseas/secundario , Neoplasias Óseas/cirugía , Criocirugía/métodos , Cirugía Asistida por Computador , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor/cirugía , Cuidados PaliativosRESUMEN
Over the past decade, irinotecan has become one of the first-line chemotherapeutic agents used in the treatment of metastatic colorectal cancer. Recently, irinotecan has been administered transarterially in order to perform chemoembolization in the liver. In the limited number of reports available to date using this approach, serious adverse effects have not yet been reported. In this paper, we describe the formation of an intercostal artery pseudoaneurysm after transarterial chemoembolization with irinotecan-eluting beads in a patient with spinal metastasis from colorectal cancer.