Pelvic Congestion Syndrome: Systematic Review of Treatment Success.

Pelvic venous insufficiency is now a well-characterized etiology of pelvic congestion syndrome (PCS). The prevalence of CPP is 15% in females aged 18 to 50 years in the United States and up to 43.4% worldwide. In addition to individual physical, emotional, and quality-of-life implications of CPP, there are profound healthcare and socioeconomic expenses with estimated annual direct and indirect costs in the United States in excess of 39 billion dollars. PCS consists of clinical symptoms with concomitant anatomic and physiologic abnormalities originating in venous insufficiency. The etiology of PCS is diverse involving both mechanical and hormonal factors contributing to venous dilatation (>5 mm) and insufficiency. Factors affecting the diagnosis of PCS include variance of causes and clinical presentations of pelvic pain and relatively low sensitivity of noninvasive diagnostic imaging and laparoscopy to identify insufficiency compared with catheter venogram. A systematic review of the literature evaluating patient outcomes following percutaneous treatment of PCS is presented.

The Radiology Resident iPad Toolbox: an educational and clinical tool for radiology residents.

Tablet computing and mobile resources are the hot topics in technology today, with that interest spilling into the medical field. To improve resident education, a fully configured iPad, referred to as the "Radiology Resident iPad Toolbox," was created and implemented at the University of Colorado. The goal was to create a portable device with comprehensive educational, clinical, and communication tools that would contain all necessary resources for an entire 4-year radiology residency. The device was distributed to a total of 34 radiology residents (8 first-year residents, 8 second-year residents, 9 third-year residents, and 9 fourth-year residents). This article describes the process used to develop and deploy the device, provides a distillation of useful applications and resources decided upon after extensive evaluation, and assesses the impact this device had on resident education. The Radiology Resident iPad Toolbox is a cost-effective, portable, educational instrument that has increased studying efficiency; improved access to study materials such as books, radiology cases, lectures, and web-based resources; and increased interactivity in educational conferences and lectures through the use of audience-response software, with questions geared toward the new ABR board format. This preconfigured tablet fully embraces the technology shift into mobile computing and represents a paradigm shift in educational strategy.

Percutaneous radiofrequency ablation of symptomatic giant hepatic cavernous hemangiomas: report of two cases and review of literature.

The presented cases detail percutaneous radiofrequency (RF) ablation of multiple giant hepatic hemangiomas in two patients who presented with right upper-quadrant pain and fullness and chose not to undergo surgical resection. Treatment of two hemangiomas per patient, 7 cm and 6 cm in one and 9 cm and 2 cm in the other, was accomplished in single ablation sessions with 12 and nine cycles, respectively. Patients had durable resolution of symptoms with reduction of lesion size by 68%-82% at a mean follow-up of 13 months. These cases, along with promising results in the current literature, support RF ablation as a safe and effective surgical alternative.

VEGF and PlGF promote adult vasculogenesis by enhancing EPC recruitment and vessel formation at the site of tumor neovascularization.

There are growing data to suggest that tissue hypoxia represents a critical force that drives adult vasculogenesis. Vascular endothelial growth factor (VEGF) expression is dramatically up-regulated by hypoxia and results in enhanced neovascularization. Although the role of VEGF in angiogenesis has been well characterized, its role in adult vasculogenesis remains poorly understood. We used two distinct murine bone marrow transplantation (BMT) models to demonstrate that increased VEGF levels at the site of tumor growth promoted vasculogenesis in vivo. This effect of VEGF was downstream of its effect to enhance either mobilization or survival of circulating endothelial progenitor cells (EPCs). Both VEGFR1 (flt1) and VEGFR2 (flk1) are expressed on culture expanded human EPCs. Previous studies suggest that the effect of VEGF on endothelial cell migration is primarily mediated via VEGFR2; however, VEGF-induced EPC migration in vitro was mediated by both receptors, suggesting that VEGF-VEGFR1 interactions in EPCs are distinct from differentiated endothelial cells. We used specific blocking antibodies to these receptors to demonstrate that VEGFR1 plays an important role in human EPC recruitment to tumors. These findings were further supported by our finding that tumor-associated placental growth factor (PlGF), a VEGFR1-specific agonist, increased tumor vasculogenesis in a murine BMT model. We further showed that both VEGF receptors were necessary for the formation of functional vessels derived from exogenously administered human ex vivo expanded EPCs. Our data suggest local VEGF and/or PlGF expression promote vasculogenesis; VEGF plays a role in EPC recruitment and subsequent formation of functional vessels.

The origin and in vivo significance of murine and human culture-expanded endothelial progenitor cells.

In adults highly purified populations of early hematopoietic progenitors or cells derived from ex vivo expanded unmobilized human peripheral blood mononuclear cells contribute to new blood vessel formation. However, the source of these culture-expanded endothelial progenitor cells (CE-EPCs) remains controversial. We demonstrate that ex vivo expansion of unmobilized human peripheral blood generated CE-EPCs with similar numbers, kinetics, and antigen expression profile as compared to plating unfractionated CD34(+)/lin(-)-enriched bone marrow mononuclear cells. Both CE-EPC populations uniformly co-expressed myeloid and endothelial markers, suggesting that peripheral blood progenitor enumeration does not correlate with the numbers of early outgrowth CE-EPCs. Using purified myeloid subpopulations obtained from mice harboring the lacZ transgene driven by an endothelial-specific promoter, we showed that the immature myeloid lineage marker CD31(+) cells generated CE-EPCs with fourfold greater frequency than mature myeloid populations. Biphenotypic cells co-expressing myeloid/endothelial antigens were not detected in circulating human or murine peripheral blood or bone marrow but were associated with murine tumors. Unlike CE-EPCs, CD14(+) leukocytes admixed within tumors did not generate vWF-positive blood vessels during a similarly defined period of tumor growth, but some leukocytes up-regulated the endothelial marker VE-cadherin. Taken together, the data suggest that the local neovascular microenvironment may facilitate vasculogenesis by promoting endothelial differentiation and that CE-EPCs may accelerate such vasculo-genesis.