Secondary postpartum hemorrhage (PPH) and postabortion hemorrhage are rare complications. Retained products of conception (RPOC) is among the most common causes of both secondary PPH and postabortion hemorrhage. Other less common causes of secondary PPH are uterine vascular abnormalities such as arteriovenous malformations and pseudoaneurysms. These are usually related to a history of a procedure such as dilation and curettage or cesarean delivery. Subinvolution of the placental site is an idiopathic cause of secondary PPH; this condition may be underrecognized and therefore could have a higher incidence than currently reported. Gestational trophoblastic disease is rare but commonly presents as secondary PPH and resembles RPOC in radiologic appearance. The first-line imaging modality for secondary PPH is ultrasound, but computed tomography and magnetic resonance imaging may be used if the ultrasound findings are indeterminate. Angiography is an important tool for the definitive diagnosis of uterine vascular abnormalities. Appropriate management requires radiologists to be familiar with the multimodality imaging features of secondary PPH or postabortion hemorrhage.
Objectives: To present and characterize CT and MR imaging findings of metastases to the parotid nodes. Methods: CT (n 5 10) and MR (n 5 11) images from 14 patients with metastases to the parotid nodes were reviewed. The primary tumour sites were the ocular adnexa in five patients, facial skin in four patients, upper aerodigestive tract in four patients and thyroid gland in one patient. CT and MR images were evaluated with emphasis on the size and number of parotid tumours, their location in the parotid gland, the presence of associated clinically pathological cervical nodes or previous history of cervical node metastasis, margin characteristics and the presence of central necrosis.
Purpose: To compare the efficacy and safety of transarterial chemoembolization for the palliation of radiotherapy (RT)-failure bone metastases (BMs) with those of re-radiotherapy (Re-RT) in achieving pain relief.Materials and Methods: Fifty consecutive patients with RT-failure BMs who had undergone Re-RT (23 patients) and transarterial chemoembolization (27 patients) were retrospectively analyzed. The primary endpoint was clinical response, and the secondary endpoints were objective response and adverse events. Pain assessment was performed using the numerical rating scale, and tumor response was evaluated using the modified Response Evaluation Criteria in Solid Tumors. Pain relief was defined as lack of pain with no analgesic usage (complete pain response) or a decrease in pain score by !3 points with analgesic usage (partial pain response).Results: The pain relief rates in the Re-RT and transarterial chemoembolization groups were 57% and 92%, respectively (P ¼ .006). The median pain relief duration was 2 and 3 months in the Re-RT and transarterial chemoembolization groups, respectively (P ¼ .002). The 6-month pain-free survival rates were 30% and 51% in the Re-RT and transarterial chemoembolization groups, respectively (P ¼ .08). The median tumor reduction rates were -4% and 9% in the Re-RT and transarterial chemoembolization groups, respectively (P < .001). The objective response rates were 0% and 11% in the Re-RT and transarterial chemoembolization groups, respectively (P ¼ .29). No serious adverse events or complications were observed.Conclusions: Transarterial chemoembolization achieved a superior response rate and longer duration of palliation in symptomatic RTfailure BMs.
ABBREVIATIONSBMs ¼ bone metastases, NRS ¼ numerical rating scale, RT ¼ radiotherapy Bone metastases (BMs) are a major cause of morbidity, resulting in pain, pathological fracture, and spinal cord compression (1,2). In general, painful BMs are treated via radiotherapy (RT). Approximately 60%-90% of patients experience pain relief after RT (3,4), although 1 metaanalysis (5) has demonstrated that within the first year, pain exacerbation due to tumor regrowth can occur after RT in approximately 50% of patients, including RT responders. In patients with recurrent BMs for whom salvage surgery is not indicated, re-radiotherapy (Re-RT) is a standard second-line treatment option (6,7), with 8%-42% of the patients receiving this treatment (8,9). However, another meta-analysis on Re-RT (6) reported pain relief rates of approximately 58% for Re-RT, which are unsatisfactory.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.