ObjectivesPercutaneous cervical cordotomy (PCC) is an interventional ablative procedure in the armamentarium for cancer pain treatment, but there is limited evidence to support its use. This study aimed to assess the effectiveness and safety of PCC.MethodsAnalysis was undertaken of the first national (UK) prospective data repository of adult patients with cancer undergoing PCC for pain treatment. The relationship between pain and other outcomes before and after PCC was examined using appropriate statistical methods.ResultsData on 159 patients’ PCCs (performed from 1 January 2012 to 6 June 2017 in three centres) were assessed: median (IQR) age was 66 (58–71) years, 47 (30%) were female. Mesothelioma was the most common primary malignancy (57%). The median (IQR) time from cancer diagnosis to PCC assessment was 13.3 (6.2–23.2) months; PCC to follow-up was 9 (8–25) days; and survival after PCC was 1.3 (0.6–2.8) months. The mean (SD) for ‘average pain’ using a numerical rating scale was 6 (2) before PCC and 2 (2) at follow-up, and for ‘worst pain’ 9 (1) and 3 (3), respectively. The median (IQR) reduction in strong opioid dose at follow-up was 50% (34–50). With the exception of ‘activity’, all health-related quality of life scores (5-level version of EuroQol-5 Dimension) either improved or were stable after PCC. Six patients (4%) had PCC-related adverse events.ConclusionsPCC is an effective treatment for cancer pain; however, findings in this study suggest PCC referrals tended to be late in patients’ disease trajectories. Further study into earlier treatment and seeking international consensus on PCC outcomes will further enhance opportunities to improve patient care.
SUMMARY
A case of intra‐uterine rupture of a neurogenic bladder in a female child with spina bifida is reported, together with the unusual histological appearances of detrusor‐muscle atrophy at the site of rupture. The literature on ruptured bladder in the neonatal period is reviewed.
RÉSUMÉ
Rupture congénilale d'une vessie neurologique: un cas
L'article rapporte un cas de rupture intra‐utérine d'une vessie neurologique chez une fille avec spina bifida; un aspect inhabituel histologique de I'atrophie du détrusor à l'endroit de la rupture fut aussi noté. Une revue de la littérature est faite sur les ruptures de vessie à la période néo‐natale.
ZUSAMMENFASSUNG
Congenitale Ruptur einer neurogenen Blase: ein Fallbericht
Es wird der Fall einer intra‐uterinen Ruptur einer neurogenen Blase bei einem weiblichen Kind mit Spina bifída dargestellt, bei dem der ungewöhnliche histologische Befund einer Atrophie des M. detrusor im Bereich der Ruptur erhoben wurde. Es wird eine Literaturübersicht über die Blasenruptur in der Neonatal‐periode gegeben.
RESUMEN
Ruptur a congénita de una vejiga neurogena: aportación de un caso
Se aporta un caso de ruptura intrauterina de una vejiga neurógena en un lactante hembra con espina bífida, juntamente con el aspecto histológico inusual de una atrofia del músculo detrusor en el lugar de la ruptura. Se revisa la literatura de la ruptura de vejiga en periodo neonatal.
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