Percutaneous Radiofrequency Ablation of Pulmonary Metastases from Colorectal Carcinoma: Prognostic Determinants for Survival

Background Preliminary results have shown that percutaneous radiofrequency ablation (RFA) may play a useful role in patients with inoperable lung tumors. This series evaluated the prognostic features for survival in nonsurgical candidates who underwent percutaneous RFA of pulmonary metastases from colorectal carcinoma.Methods Fifty-five patients not suitable for surgery underwent percutaneous RFA for colorectal pulmonary metastases. All clinical and treatment-related data were collected prospectively. The primary end point of the study was overall survival, defined from the time of RFA intervention. Univariate and multivariate analyses were performed to identify statistically significant prognostic parameters for overall survival.Results The overall median survival was 33 months (range, 4–40 months), with actuarial 1-, 2-, and 3-year survival of 85%, 64%, and 46%, respectively. Univariate analysis demonstrated that largest size of lung metastasis (P < .001), location of lung metastases (P = .032), and repeat percutaneous RFA for pulmonary recurrence (P = .024) were statistically significant for overall survival. Multivariate analysis demonstrated that largest size of lung metastasis >3 cm was independently associated with a reduced overall survival (P = .003).Conclusions Percutaneous lung RFA may play a useful role in nonsurgical candidates with colorectal pulmonary metastases. However, the survival benefit of this interventional procedure for patients with a pulmonary metastasis >3 cm was limited.     

Effect on Pregnancy on Gallstone Formation

An ultrasound study was carried out to determine the incidence of gallstone formation during pregnancy. One hundred and thirty seven pregnant women attending antenatal clinics were studied; 70 women were primigravidas and 67 were 1 para or more. An ultrasound of the gallbladder was carried out at 20 weeks or less of gestation and a repeat of ultrasound examination was performed soon after delivery. Five women had gallstones diagnosed before pregnancy; 1 of these was a primigravida, the other 4 were para 1 or more. None of the women developed gallstones during pregnancy. This finding suggests that pregnancy is unlikely to be an important factor in gallstone formation.     

Breast MRI: Early experience with a 3-D fat-suppressed Gradient Echo Sequence in the evaluation of breast lesions

The early clinical experience with a 3-Dimensional Fourier Transform Gradient Echo sequence with fat suppression in the evaluation of breast masses is reported. Ten female patients with breast malignancies were pre-operatively evaluated with this sequence and the results compared with the pathological specimens. The scanning protocol included a noncontrast sequence followed by an immediate post-contrast sequence (completed 4.5 min after intravenous contrast injection) and a delayed sequence. Images were assessed for maximum lesion and parenchymal enhancement, lesion size and additional enhancing abnormalities. In six patients, malignant masses enhanced maximally on the immediate post-contrast sequence with parenchyma enhancing maximally on delayed images. In three cases, there was preferential enhancement of malignant lesions over normal parenchyma but to a similar degree on both post-contrast sequences. In one case, both the lesion and parenchyma enhanced maximally on the delayed sequence. Magnetic resonance assessed lesion size accurately and also detected satellite malignancies in one case. However, lesion grade, associated in situ carcinoma and lymphovascular invasion did not impact on lesion enhancement. In this small series, a contrast-enhanced, fat-suppressed 3-D Gradient Echo Sequence detected breast carcinoma with high sensitivity. The technique holds promise but further evaluation is required.     

Fetal Renal Vein Thrombosis

Two cases of fetal renal vein thrombosis, diagnosed via maternal ultrasound scan are presented. One was associated with severe placental dysfunction and demonstrated haematuria and renal failure which resolved on day 10. The other followed an antepartum haemorrhage and resolved before the baby was born. The ultrasound showed, as transient findings, unilateral renal enlargement, thrombus protruding into the inferior vena cava, and mild fetal ascites. We suggest that fetal renal vein thrombosis may be more common than previously suspected, and warrants close monitoring of fetal well-being. Delivery should be considered if there is other evidence of fetal compromise, if the amount of peritoneal fluid suggests substantial haemorrhage, or if there is propagating thrombus in the inferior vena cava.     

Ureteric Injury at Burch Colposuspension 4 Case Reports and Literature Review

Summary: The Burch colposuspension operation is an accepted and effective technique for the correction of genuine stress incontinence. It is, however, associated with a number of well-recognized complications. Ureteric injury at the time of colposuspension is a potentially severe, if uncommon, complication of this procedure with legal ramifications for the surgeon as well as health risks for the patient. To date, only 19 cases have been described in the literature. This paper highlights 4 cases of this injury occurring amongst the patients of 1 urogynaecologist (2) and gives an incidence for its occurrence as well as discussing the aetiology and management of this complication.     

Endoluminal repair of internal carotid artery aneurysm: A feasible but hazardous procedure

Purpose: The aim of this study was to report the repair of an aneurysm of the internal carotid artery using the endoluminal method. Methods: A 70-year-old male patient noted a swelling in the right side of his neck 22 years after endarterectomy of the right internal carotid artery. Duplex ultrasound confirmed the clinical diagnosis of aneurysm of the internal carotid artery. Further investigation included contrast-enhanced computed tomographic (CT) scanning and carotid angiography performed via a retrograde femoral approach. The aneurysm contained thrombus and was 3 cm in diameter and in length. It extended superiorly from a point 0.5 cm above the carotid bifurcation to a point estimated to be 2 cm from the base of the skull. Repair of the aneurysm was undertaken using the endoluminal method. A self-expanding endograft 8 mm in diameter and 4 cm in length was introduced through a 12F sheath in the common carotid artery. An on-table completion angiogram of the right-sided extracranial carotid arteries and the intracranial internal carotid artery and branches was obtained. Results: The completion angiogram and postoperative CT scan confirmed exclusion of the aneurysm sac from the circulation. The patient awoke from anesthesia with complete paralysis of the left arm. Recovery of movement commenced 1 hour later. A brain CT scan demonstrated the event to be an embolic stroke. Strength had returned by 7 days. Function of the arm was good 1 month after operation, but coordination for fine movements was lacking. At the 6-month follow-up, good arm function was maintained. A duplex ultrasound scan demonstrated not only continued exclusion of the aneurysm sac but occlusion of the endograft, also. Conclusions: Endoluminal repair of aneurysms of the internal carotid artery is feasible but carries the risk of major morbidity as a result of peripheral embolization and early occlusion of the endograft. (J Vasc Surg 1997;26:1055-60.)     

Splenic Artery Aneurysm in Pregnancy

EDITORIAL COMMENT: We accepted this rather detailed case report for publication because of the special relationship of rupture of splenic artery aneurysms with pregnancy. It is wise for obstetricians to know that this condition is an important uncommon cause of abdominal pain and collapse during pregnancy, labour or the puerperium.
Summary: Rupture of a splenic artery aneurysm during pregnancy or delivery is a rare event. Only 99 cases have been reported. There is significant risk to mother and fetus. This paper describes a splenic artery aneurysm rupture with a concomitant unruptured hepatic artery aneurysm and coincidental partial placental abruption with fetal death at 22 weeks' gestation. Splenectomy was performed to achieve haemostasis. Nonsurgical treatment by embolization of the hepatic artery aneurysm was performed after a routine postoperative computed tomogram (CT) and angiogram revealed the lesion. CT screening of high-risk patients and ultrasound/pulsed Doppler screening of pregnant women with unexplained abdominal pain might be an important precaution in the avoidance of obstetric catastrophies.