The purpose of this study was to assess the efficacy and safety of percutaneous radiofrequency (RF) ablation therapy combined with cementoplasty under computed tomography and fluoroscopic guidance for painful bone metastases. Seventeen adult patients with 23 painful bone metastases underwent RF ablation therapy combined with cementoplasty during a 2-year period. The mean tumor size was 52 x 40 x 59 mm. Initial pain relief, reduction of analgesics, duration of pain relief, recurrence rate of pain, survival rate, and complications were analyzed. The technical success rate was 100%. Initial pain relief was achieved in 100% of patients (n=17). The mean VAS scores dropped from 63 to 24 (p<0.001) (n=8). Analgesic reduction was achieved in 41% (7 out of 17 patients). The mean duration of pain relief was 7.3 months (median: 6 months). Pain recurred in three patients (17.6%) from 2 weeks to 3 months. Eight patients died and 8 patients are still alive (a patient was lost to follow-up). The one-year survival rate was 40% (observation period: 1--30 months). No major complications occurred, but one patient treated with this combined therapy broke his right femur 2 days later. There was transient local pain in most cases, and a hematoma in the psoas muscle (n=1) and a hematoma at the puncture site (n=1) occurred as minor complications. Percutaneous RF ablation therapy combined with cementoplasty for painful bone metastases is effective and safe, in particular, for bulky tumors extending to extraosseous regions. A comparison with cementoplasty or RF ablation alone and their long-term efficacies is needed.

The chemotherapy described in this report is beneficial in terms of survival for HCC patients with PVTT for whom transcatheter arterial embolization or surgical treatment is contraindicated.

In conclusion, our findings suggest that endovascular therapy is an effective, safe, and repeatable treatment for oral hemorrhage caused by malignant head and neck tumors.

this patient was placed in the supine position. The right femoral artery was exposed and inserted with a delivery system. A handmade stent-graft composed of a modified Gianturco stainless steel Z-stent and thin-walled Dacron material was introduced into a delivery sheath catheter with a 20F diameter. An angiographic catheter was put into the thoracic aorta via a guidewire from the right brachial artery. The sheath catheter was inserted through the right femoral artery and deployed with the guidance of transesophageal echocardiography and fluoroscopy. Before deployment of the stent-graft, the mean arterial pressure was lowered to 70 mm Hg with the aid of an occlusion balloon in the superior and the inferior caval veins to avoid graft migration. A second aortogram revealed a small endoleak immediately after the deployment. The postoperative course was uneventful. A small leakage from the stent-graft shown on CT 2 weeks after the intervention disappeared in the next 6 weeks (Figure 2). CommentRight-sided aortic arch is an uncommon congenital anomaly with an incidence of 0.1%. 2 Thoracic aortic aneurysm associated with right-sided aortic arch is also a rare disorder, only 4 cases of surgical treatment of this disorder having been reported. 3 Three anatomic findings of right-sided aortic arch make surgical treatment difficult: (1) the pattern of the aortic arch vessels, (2) the location of the descending aorta, and (3) the relation between the esophagus and the aortic arch. Caus and associates 4 performed bilateral thoracotomy because the esophagus was located in front of the aortic arch and the ascending and descending aortas were in different pleural spaces. In our patient, the right internal thoracic artery, which was anastomosed to the left anterior descending artery, was positioned over the heart. Thus, either secondary median sternotomy or bilateral thoracotomy seemed to be complicated and difficult.Endovascular stent-graft repair has become a viable therapeutic alternative in the treatment of patients with thoracic aortic aneurysm.This technique is less invasive than standard techniques and brings acceptable morbidity and mortality rates. 1 The presence of a curve and branch vessels in the aortic arch makes it difficult to apply this method to aortic arch diseases. There are considered to be 3 major prerequisites for such repairs: sufficient size of the arteries providing access, limited tortuosity of the distal aortic arch, and proximal neck morphology. Specifically, suitability entails relatively straight portions of the aorta and the absence of important side branches.In the present patient, the distal part of the aortic arch was relatively straight, the 3 cervical branches had arisen from the ascending aorta, and the left subclavian artery was totally occluded. These anatomic features made the landing zone between the right subclavian artery and the aneurysm long enough to develop a stent-graft.

PVP did not increase the incidence of new compression fractures compared with conservative treatment, but half of the new fractures at the adjacent vertebral bodies occurred sooner.