Presacral neurolytic block for relief of pain from pelvic cancer: description and use of a CT-guided lateral approach.

A CT guided lateral approach for neurolysis of the presacral plexus is described for treatment of pelvic pain due to advanced cancer. The technique was evaluated in two patients with unrelieved pelvic and perineal pain. Other neurolytic techniques used to treat pelvic pain due to advanced cancer are reviewed with a discussion of benefits and potential side effects of this technique.

Coeliac plexus block using computed tomography guidance.

Coeliac plexus blocks have been used successfully in the treatment of abdominal pain in advanced cancer and in benign chronic abdominal pain. However, concern remains about occasional potentially serious complications. One possible way to reduce the risks of this procedure may be to improve imaging during the procedure. We report a series of 38 coeliac plexus blocks carried out under computer tomographic (CT) guidance, mostly using the anterior approach. The technique is described. Effectiveness and side-effect rates were similar to other reported series. There were no major complications. Analysis of contrast spread would indicate that anterior preaortic or bilateral contrast spread is necessary to obtain pain relief. Our experience would indicate that routine CT guidance can be a simple aid to coeliac plexus block, and can be achieved easily in a district general hospital. Improved imaging allows accurate needle placement, while avoiding vital structures such as the aorta and pleura. Accurate placement may also allow the use of reduced volumes of neurolytic drugs.

Posture, blood velocity in common femoral vein, and prophylaxis of venous thromboembolism.

Might leg elevation and avoidance of poor postures provide better prophylaxis against venous thromboembolism than heparin or mechanical methods? 12 supine subjects tilted in 3 degrees increments from 6 degrees leg-down to 12 degrees leg-up showed linear increase in mean peak blood velocity and reduction in calibre in the common femoral vein (colour-duplex ultrasound). Between horizontal and 6 degrees leg-up, velocity was increased by 17% and diameter reduced by 14%. A ranking of mean peak velocities in six postures (sitting; standing; trunk raised 35 degrees to legs which were first horizontal and then tilted up 6 degrees; supine, first horizontal then 6 degrees leg-up) showed significant increases in velocity between consecutive positions.

Ultrasound in the diagnosis and management of spinal and sacral tumours.

Spinal and sacral tumours present not only a challenge in their initial diagnosis but also in their subsequent progress. Imaging of these tumours usually requires intrathecal contrast medium but where an acoustic window is present ultrasound may be used. The ability and clinical value of ultrasound has been assessed in 13 examinations on 10 patients. Although there was no clinical advantage in three and only equivocal advantage in one, ultrasound provided unequivocal benefit in five examinations and was synergistic in four. The technique is simple, quick and well tolerated.

Aerosol lung scintigraphy in the detection of bronchiectasis.

Twenty patients were studied to assess the value of aerosol ventilation scintigraphy, using 99Tcm diethylene triamine penta-acetic acid (DTPA) as a screening test for bronchiectasis. All patients had previously undergone bronchography for suspected bronchiectasis. Nine had cylindrical bronchiectasis and 11 had no demonstrable abnormality. Only two of the 20 patients had features suggestive of bronchiectasis on their chest radiographs. Segmental defects in ventilation were demonstrated by scintigraphy in five of the nine patients with bronchiectasis (56%). Regional ventilation appeared normal in 26 of the 27 lungs which were bronchographically normal (96%). Whilst the sensitivity of aerosol ventilation scintigraphy in detecting bronchiectasis is low (56%), it compares favourably with that of the chest radiograph (22%) in this group of patients with mild disease and non-specific symptoms. Thus, in some, it may obviate the need for bronchography.

Dense renal papillae: a quantitative study using computed tomography.

The attenuation of the renal papillae has been compared with that of the cortex/outer medulla (COM) in 100 consecutive patients undergoing abdominal computed tomography (CT). In most patients (73%) there were areas within the papillae measuring more than 5 Hounsfield units (HU) higher than the COM. In 11% of the patients this increase in papillary attenuation was even more marked (15 or more HU). Increased papillary attenuation was most marked in patients with newly diagnosed widespread malignancy; it was also common in thin patients and in those who were in-patients. The region of the papilla has been shown to have a slightly higher CT attenuation than the rest of the renal parenchyma and such density seems especially noticeable in sick patients.