Celiac Plexus Blockade and Neurolysis: Fluoroscopy

Image-guided celiac plexus neurolysis can provide substantial and long-lasting pain relief in patients suffering from malignant pain from upper abdominal viscera. When performed by experienced hands, celiac plexus neurolysis also appears to be a relatively safe procedure with a limited side effect profile. Multiple imaging modalities are available for this procedure, though no single approach has systematically been proven superior in terms of efficacy or side effect profile. Each imaging guidance modality has advantages and disadvantages. Given the ability to visualize soft-tissue structures, CT guidance is recommended over fluoroscopy when intentionally transgressing into the retroperitoneum for celiac plexus neurolysis. It is also recommended in those patients with complicated anatomy, where anatomic distortion may complicate successful celiac blockade. However, in the patient without significant tumor burden involving the celiac axis and/or pancreatic body/tail, the fluoroscopy-guided retrocrural approach has been demonstrated to be efficacious, and complications are exceedingly rare.

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The Effectiveness of Alcohol Versus Phenol Based Splanchnic Nerve Neurolysis for the Treatment of Intra-Abdominal Cancer Pain

January 2018 - Pain Physician ◽

10.36076/ppj/2019.19.281 ◽

2016 ◽

Vol 4;19 (4;5) ◽

pp. 281-292 ◽

Cited By ~ 13

Author(s):

Dhanalakshmi Koyyalagunta

Keyword(s):

Abdominal Pain ◽

Cancer Pain ◽

Visceral Pain ◽

Splanchnic Nerve ◽

Well Being ◽

Pain Reduction ◽

Celiac Plexus ◽

Safe Procedure ◽

Abdominal Organ ◽

Upper Abdominal

Pancreatic and other upper abdominal organ malignancies can produce intense visceral pain syndromes that are frequently treated with splanchnic nerve neurolysis (SNN) or celiac plexus neurolysis (CPN). Although commonly performed with either alcohol or phenol, there is scant literature on the comparative effectiveness, duration of benefit, and complication profile comparing the 2 agents. This study presents a retrospective chart review of 93 patients who underwent SNN for cancer-related abdominal pain in order to describe patient characteristics, examine comparative efficacy, duration of benefit, and incidence of complications with alcohol vs. those of phenol. Consistent with previous studies, SNN reduced reported pain scores while not significantly reducing opioid consumption. No difference in pain outcomes was found comparing alcohol versus phenol based neurolytic techniques. Celiac axis tumor infiltration and pre-procedural local radiation therapy did not change the effectiveness of the procedure. Our data demonstrated that 44.57% of patients had ≥ 30% pain reduction while 43.54% did not have pain reduction. Interestingly, the procedure produced significant improvements in anxiety, depression, difficulty thinking clearly, and feeling of well-being. In addition, no difference in complications was seen between the agents either. SNN was an effective and relatively safe procedure for the treatment of pain associated with pancreatic and other upper abdominal organ malignancies in our sample of patients. Choice of neurolytic agent can appropriately be left to the clinical judgment and local availability of the treating physician. The change in ancillary symptoms has a theoretical basis that supports a biopsychosocial model of pain since changes in one target area (pain) impact other related ones (depression and anxiety). Key words: Celiac plexus, splanchnic nerves, neurolysis, nerve block, alcohol, ethanol, phenol, pain, cancer pain, abdominal pain, visceral pain, symptom assessment

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Patient preferences based on treatment effectiveness and side effect profile for maintenance therapy for Crohn's disease (CD) following a medically induced remission

Gastroenterology ◽

10.1016/s0016-5085(01)81339-1 ◽

2001 ◽

Vol 120 (5) ◽

pp. A270-A270

Author(s):

E KENNEDY ◽

D MUKRAJ ◽

T TO ◽

A DETSKY ◽

H LLEWELLYNTHOMAS ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Maintenance Therapy ◽

Patient Preferences ◽

Side Effect ◽

Treatment Effectiveness ◽

Side Effect Profile

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Valproic Acid:

Revista Neurociências ◽

10.34024/rnc.2008.v16.8650 ◽

1999 ◽

Vol 16 (2) ◽

pp. 130-136 ◽

Cited By ~ 3

Author(s):

Sayonara Beatriz Ranciaro Fagundes

Keyword(s):

Health Care ◽

Valproic Acid ◽

Antiepileptic Drug ◽

Detailed Analysis ◽

Side Effect ◽

Side Effect Profile ◽

Care Givers

Clinical pharmacologists, neurologists, and all health care givers must consider the efficacy, safety, and side effect profile of a given antiepileptic drug when determining which drug is best for a given patient.The purpose of this study was to investigate valproic acid with a detailed analysis of the different reports.

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Structural and Functional Imaging in Glioma Management

Neurosurgery ◽

10.1093/neuros/nyaa360 ◽

2020 ◽

Author(s):

Bledi C Brahimaj ◽

Ryan B Kochanski ◽

John J Pearce ◽

Melike Guryildirim ◽

Carter S Gerard ◽

...

Keyword(s):

Diffusion Tensor ◽

Imaging Modalities ◽

Hemispheric Dominance ◽

Tumor Control ◽

Histopathological Diagnosis ◽

Glioma Surgery ◽

Multiple Modalities ◽

Advantages And Disadvantages ◽

Multiple Imaging

Abstract The goal of glioma surgery is maximal safe resection in order to provide optimal tumor control and survival benefit to the patient. There are multiple imaging modalities beyond traditional contrast-enhanced magnetic resonance imaging (MRI) that have been incorporated into the preoperative workup of patients presenting with gliomas. The aim of these imaging modalities is to identify cortical and subcortical areas of eloquence, and their relationship to the lesion. In this article, multiple modalities are described with an emphasis on the underlying technology, clinical utilization, advantages, and disadvantages of each. functional MRI and its role in identifying hemispheric dominance and areas of language and motor are discussed. The nuances of magnetoencephalography and transcranial magnetic stimulation in localization of eloquent cortex are examined, as well as the role of diffusion tensor imaging in defining normal white matter tracts in glioma surgery. Lastly, we highlight the role of stimulated Raman spectroscopy in intraoperative histopathological diagnosis of tissue to guide tumor resection. Tumors may shift the normal arrangement of functional anatomy in the brain; thus, utilization of multiple modalities may be helpful in operative planning and patient counseling for successful surgery.

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Long-term efficacy and safety of imiquimod 5% and fluorouracil 1% creams in medical monotherapy of complex eyelid basal cell carcinomas

European Journal of Ophthalmology ◽

10.1177/11206721211035614 ◽

2021 ◽

pp. 112067212110356

Author(s):

Manpreet Singh ◽

Aditi Mehta Grewal ◽

Himanshi Singh ◽

Manjula Sharma ◽

Manpreet Kaur ◽

...

Keyword(s):

Basal Cell ◽

Side Effect ◽

The Elderly ◽

Fixed Dose ◽

Side Effect Profile ◽

Efficacy And Safety ◽

Term Efficacy ◽

Basal Cell Carcinomas ◽

Double Blinded

Purpose: To study the long-term efficacy and safety of local application of imiquimod 5% and fluorouracil 1% creams in complex eyelid basal cell carcinomas (BCCs). Methods: A retrospective, non-comparative study in biopsy-proven, complex (involving canthi or >50% of eyelid length) eyelid BCC patients who were medically unfit for surgical procedures. All patients were medically treated with either of the creams using fixed-dose regimens for a minimum of 3 months. All received oral vitamin C 500 mg QID for 3 months as an adjunct for collagen healing. A minimum of “post-treatment” follow-up of 12 months was observed. Results: Of total 30 patients, imiquimod 5% and fluorouracil 1% were used in 16 and 14 patients, respectively. The mean age of our patients was 70.5 years. The co-morbidities included – severe coronary artery disease using blood-thinners ( n = 19), poorly controlled diabetes ( n = 12), poorly controlled hypertension ( n = 6), on nebulization ( n = 3), and tuberculosis with pulmonary fibrosis ( n = 2). Complete clinical tumor resolution was noted in 10 and 8 patients over 12 and 16.5 weeks, respectively, in imiquimod and fluorouracil groups. Periocular skin erythema, chemical conjunctivitis, and skin depigmentation were seen in all the patients of imiquimod group. On the other hand, the local side-effect profile in fluorouracil patients was limited. Conclusion: The medical treatment of complex eyelid BCC is a useful alternative to surgery in the elderly with significant co-morbidities. It provides a promising long-term relief with a tolerable side-effect profile. A prospective, randomized, double-blinded trial would provide stronger evidence for the efficacy of these drugs.

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Design of Novel Photosensitizers and Controlled Singlet Oxygen Generation for Photodynamic Therapy

New Journal of Chemistry ◽

10.1039/d1nj02656a ◽

2021 ◽

Author(s):

Esra Tanrıverdi Eçik ◽

Onur BULUT ◽

Hasan Hüseyin Kazan ◽

Elif Şenkuytu ◽

Bunyemin Cosut

Keyword(s):

Photodynamic Therapy ◽

Cancer Treatment ◽

Singlet Oxygen ◽

Side Effect ◽

Side Effect Profile ◽

High Ability ◽

Lower Side ◽

Oxygen Generation ◽

Singlet Oxygen Generation ◽

Promising Strategy

Photodynamic therapy (PDT) is a promising strategy in cancer treatment with its relatively lower side effect profile. Undoubtedly, the key component of PDT is the photosensitizers with a high ability...

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