Search Results (300)

Congenital heart disease (CHD) is the most common congenital malformation, affecting close to 9 per 1000 live births, and progressive advances in prenatal detection, surgical palliation, and perioperative care have transformed what was once an early-lethal condition into a chronic disease with a steadily expanding population of survivors reaching adolescence and adulthood [...] Full article

Background/Objectives: Young adults living with advanced cancer often experience substantial psychological and existential health challenges, while frequently being underserved by existing rehabilitative and palliative services. This mixed-methods study evaluated the effects and experiences of a nature-based intervention designed to ease the burden of distress and support coping in the context of an incurable illness. Methods: Four consecutive intervention groups participated in a six-week program consisting of one overnight nature camp and three outdoor sessions. Quantitative data on quality of life (FACT-G) were collected before and after each intervention cycle. At the session level, pre–post measures assessed distress, vitality, resilience, and perceived connectedness. Qualitative data consisted of post-intervention semi-structured group interviews. Results: Twenty-four participants completed the intervention. No significant change was observed in overall quality of life which is in line with expectations for palliative interventions for individuals with incurable illness. In contrast, session-level analyses showed consistent reductions in distress and increases in vitality, resilience, and connectedness across multiple domains. The qualitative findings indicated that the intervention provided a supportive context for emotional regulation, coping, social belonging and existential orientation. Conclusions: Together, the findings support that nature-based rehabilitative palliation may offer meaningful support for young adults living with advanced cancer. The study underscores the importance of multi-level mixed-methods evaluation for capturing the value of palliative interventions where temporality and situational benefit constitute central outcomes. Full article

Endometriosis is a chronic gynecological disease affecting approximately 10% of women of reproductive age and up to 40% of women with infertility, with a significant impact on quality of life due to pain and reproductive impairment. Its etiology remains unclear, although several mechanisms have been proposed, including retrograde menstruation and immune dysfunction. Increasing evidence highlights similarities between endometriosis and cancer, particularly regarding selected hallmarks such as sustained cell proliferation, angiogenesis, inflammation, invasion, and immune dysregulation. Notably, alterations in glucose metabolism have been identified, suggesting a metabolic reprogramming resembling the Warburg effect in cancer. This review examines clinical aspects, therapeutic challenges, and emerging evidence for Warburg-like glycolytic metabolism in endometriotic lesions, which favors aerobic glycolysis over oxidative phosphorylation to evade apoptosis and promote survival in hypoxic microenvironments. These cancer-like hallmarks—shared with malignancies—suggest repurposing glycolytic inhibitors as targeted therapies to disrupt disease progression beyond symptom palliation. However, most evidence remains preclinical, and important challenges regarding disease heterogeneity, target validation, and safety still need to be addressed. Full article

Background/Objectives: Chemotherapy-induced peripheral neuropathy (CIPN) is a common, dose-limiting complication of cancer therapy and a major contributor to chronic neuropathic pain among cancer survivors. Although traditionally managed as a treatment-related toxicity, persistent CIPN frequently persists long after chemotherapy completion and is increasingly recognized as a major survivorship and palliative care challenge. This review synthesizes current mechanistic, clinical, and translational evidence and reframes persistent CIPN as a chronic neuropathic cancer pain syndrome. Methods: A narrative review of peer-reviewed literature was conducted using PubMed/MEDLINE, Embase, and the Cochrane Library, supplemented by manual review of key references and clinical guidelines. Emphasis was placed on mechanistic investigations, clinical management, survivorship, palliative care, and emerging therapeutic strategies relevant to CIPN. Results: Current evidence suggests that persistent CIPN reflects a multifactorial chronic neuropathic pain state involving neuronal injury, mitochondrial dysfunction, oxidative stress, neuroimmune activation, and maladaptive nociceptive signaling. Existing pharmacologic therapies provide limited symptomatic benefit and largely fail to address the underlying biologic mechanisms that contribute to symptom persistence. Emerging approaches involving mitochondrial-targeted therapies, neuroimmune modulation, biomarker-guided risk stratification, and multimodal supportive care suggest the potential for earlier intervention and disease modification rather than symptom palliation alone. Conclusions: Persistent CIPN should be conceptualized as a chronic neuropathic cancer pain syndrome rather than solely as a treatment-related toxicity. Future progress will likely require mechanism-informed therapeutic development, biologic stratification, earlier intervention, and survivorship-focused multidisciplinary care to improve long-term outcomes and quality of life in patients living with persistent CIPN. Full article

Background and Objectives: Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is an emerging minimally invasive therapeutic option for pancreatic and selected extra-pancreatic lesions. However, its clinical adoption is limited by heterogeneous indications, non-standardized techniques, and variable quality of evidence. This systematic review assessed the published literature on EUS-RFA and classified available evidence according to the Oxford Centre for Evidence-Based Medicine levels of evidence. Materials and Methods: A systematic search was performed to identify peer-reviewed studies reporting clinical or translational data on EUS-RFA. Studies were grouped by indication, including pancreatic insulinoma, non-functioning pancreatic neuroendocrine neoplasms, branch-duct intraductal papillary mucinous neoplasms and other pancreatic cystic neoplasms, pancreatic ductal adenocarcinoma, pancreatic metastases, adrenal adenoma, and miscellaneous indications. Each study was categorized according to Oxford level of evidence based on study design. Results: Thirty-seven records were included in the final evidence map, comprising 36 clinical studies classifiable according to Oxford levels of evidence and one translational record not classifiable as clinical therapeutic evidence. Among the 36 clinically classifiable studies, one provided Level 1b evidence, consisting of a randomized trial evaluating EUS-guided celiac ganglion RFA for pancreatic cancer-related pain palliation, and three provided Level 2b evidence, including non-randomized comparative cohorts in pancreatic insulinoma and unresectable pancreatic ductal adenocarcinoma. Most clinically classifiable studies were Level 4 evidence (32/36), mainly uncontrolled prospective or retrospective cohorts and case series. One preclinical/translational study was not classifiable within clinical therapeutic evidence levels. Pancreatic insulinoma was the most evidence-supported tumor-ablation indication, with comparative data suggesting efficacy comparable to surgery and a more favorable safety profile. For non-functioning pancreatic neuroendocrine neoplasms, branch-duct IPMN, renal cell carcinoma pancreatic metastases, and adrenal adenomas, available data suggest feasibility and encouraging short-term outcomes but remain predominantly non-comparative. In pancreatic ductal adenocarcinoma, EUS-RFA remains investigational as an adjunct to systemic therapy. Conclusions: EUS-RFA is a promising therapeutic platform, but evidence remains highly indication-dependent and dominated by low-level observational studies. Standardized protocols, indication-specific outcomes, prospective registries, and comparative trials are needed. Full article

Background/Objectives: A fully covered self-expandable metal stent (FCSEMS) with a central waist and long retrieval string has recently been introduced for benign biliary strictures; however, its role in malignant biliary obstruction (MBO) remains unclear. This prospective, multicenter study evaluated the feasibility of palliation for unresectable distal MBO. Methods: Between April 2022 and March 2023, patients with extrahepatic MBO were enrolled across six tertiary referral centers. The FCSEMS was a silicone-covered, cross-wired nitinol stent with an anti-migration central waist 2 mm narrower than both ends, three radiopaque markers, and a 10 cm retrieval string. Stent-related outcomes and adverse events were analyzed. Results: Both technical and clinical success rates were 100% (46/46). The median stent patency and survival times were 251 and 360 days, respectively. Stent dysfunction occurred in 18 patients (39.1%), including 10 with migration and 8 with occlusion. Stent migration was observed exclusively in the transpapillary stenting group and showed no significant association with stricture length, stent-bending angle, or the ratio of stent lengths above and below the maximal bending point. All the occluded stents were successfully removed. Early non-recurrent biliary obstruction (RBO) adverse events occurred in five patients (three with pancreatitis, one with bleeding, one with cholecystitis), whereas late non-RBO events were reported in three patients (two with cholecystitis, one with cholangitis). Conclusions: An FCSEMS with a central waist and retrieval string is feasible for the palliation of unresectable distal MBO. Optimization of the mechanical properties is warranted to minimize migration. Full article

Primary liver malignancies, including hepatocellular carcinoma, intrahepatic cholangiocarcinoma, and combined hepatocellular cholangiocarcinoma, remain major causes of cancer-related morbidity and mortality worldwide. Although systemic therapies have advanced substantially, intrahepatic tumor progression, liver failure, and portal hypertension continue to drive adverse outcomes in many patients. Interventional radiology plays a central and expanding role in the multidisciplinary management of these tumors by providing image-guided locoregional therapies for local tumor control, downstaging, bridging transplantation or resection, palliation, and potential survival benefit. This narrative review summarizes current evidence and technical considerations for major locoregional approaches, including radiofrequency ablation, microwave ablation, cryoablation, transarterial chemoembolization, transarterial radioembolization, endobiliary therapies, stereotactic body radiation therapy, irreversible electroporation, histotripsy, high-intensity focused ultrasound, hepatic arterial infusion, and brachytherapy. Interventional radiology also contributes to preoperative liver optimization through portal vein embolization, liver venous deprivation, lobar radioembolization to induce contralateral hypertrophy, and, in some patients, portal decompression before hepatic resection. For hepatocellular carcinoma, ablation and transarterial therapies are integrated into stage-based treatment algorithms and may provide curative-intent treatment in some patients. In intrahepatic cholangiocarcinoma, locoregional therapies provide meaningful disease control and may prolong survival, particularly when combined with systemic therapy. In combined hepatocellular cholangiocarcinoma, treatment remains individualized because of limited prospective data and heterogeneous tumor biology. Beyond cytoreduction, locoregional therapies can modulate the tumor immune microenvironment through immunogenic cell death, antigen release, cytokine signaling, and vascular remodeling, providing a rationale for combination strategies with immune checkpoint inhibitors, anti-angiogenic agents, and targeted therapies. As treatment paradigms evolve, the future of interventional radiology in primary liver cancer will depend on appropriate patient selection, optimized dosimetry and technique, integration with molecular and immunologic biomarkers, and coordinated multidisciplinary care. Full article

Background: Although most patients with univentricular physiology undergo staged palliation during childhood, a small subset reaches adolescence or adulthood without complete cavopulmonary connection. The role of late total cavopulmonary connection (TCPC) in these patients remains poorly defined. This review summarizes the available evidence regarding TCPC surgery in adolescents and adults and discusses contemporary patient selection. Methods: A structured narrative review of PubMed/MEDLINE was conducted from database inception to December 2024. Studies reporting primary Fontan or TCPC completion in adolescents and adults were included, whereas studies exclusively addressing Fontan conversion were excluded. The review was conducted according to SANRA recommendations. Results: Sixteen studies reporting outcomes after late TCPC completion were identified. Most adult candidates presented with cyanosis, reduced functional capacity, previous palliation, and dominant left ventricular morphology. Surgical techniques evolved from atriopulmonary connections to lateral tunnel and extracardiac conduit TCPC. Early postoperative mortality ranged from 0% to 20%, with low cardiac output syndrome representing the leading cause of death. Reported survival at 5, 10, and 15 years ranged from 76 to 95%, 71–81%, and 66–79%, respectively. Preserved ventricular function, low pulmonary vascular resistance, and absence of significant atrioventricular valve regurgitation were consistently associated with better outcomes. Conclusions: Late TCPC surgery in carefully selected adults is feasible and may improve oxygenation and functional status. Contemporary decision-making should integrate anatomical, hemodynamic, functional, rhythm, and end-organ assessment while considering alternative strategies such as transplantation or conservative management. Full article

Background: In congenital heart disease patients with single-ventricle physiology, accurate anatomical and hemodynamic evaluation prior to the Fontan completion procedure is critical for surgical planning and long-term outcomes. Although conventional catheter angiography (CCA) remains the reference standard for hemodynamic evaluation, cardiac computed tomography angiography (CTA) has emerged as an increasingly valuable tool for anatomical assessment in the preoperative evaluation of Fontan candidates. Objective: To compare the anatomical and hemodynamic information provided by CTA and CCA before Fontan completion and to evaluate their complementary roles in the preoperative assessment of pediatric patients with single-ventricle physiology. Methods: This single-center, retrospective study included 32 patients with single-ventricular physiology who underwent staged palliation and Fontan completion. All patients underwent TTE and CCA. Twenty-three patients also underwent cardiac CTA with three-dimensional reconstruction. Anatomical and hemodynamic findings obtained from CTA and CCA were compared, with particular focus on extracardiac anatomy, collateral vessels, and findings relevant to surgical planning. Results: Cardiac CTA showed concordant detection of clinically significant anatomical findings identified by CCA, while providing a more comprehensive assessment of extracardiac anatomy. While CCA remained superior for hemodynamic assessment, CTA provided more comprehensive evaluation of extracardiac anatomy. In this cohort, catheterization findings did not alter the planned surgical strategy (0%, 95% CI 0–10.9%). Conclusions: CTA may provide valuable anatomical information for preoperative assessment and surgical planning; however, larger prospective multicenter studies are required before less invasive pre-Fontan evaluation strategies can be considered. Full article

Background/Objectives: Adults with single-ventricle physiology (SVP) represent a growing population with complex cardiovascular conditions and an increasing need for noncardiac surgical and interventional procedures. However, perioperative outcomes in this group remain poorly characterized. This study aimed to provide a descriptive characteristic of perioperative management, complications and mortality in adults with SVP undergoing noncardiac surgical and interventional procedures. Methods: We conducted a retrospective cohort study including all adult patients (≥18 years) with SVP who underwent noncardiac surgical and interventional procedures requiring anesthesia or sedation at a tertiary university hospital between 1 January 1995 and 30 November 2023. Demographic data, comorbidities, type of procedure and anesthetic technique were collected. Complications were defined as intraoperative or postoperative adverse events requiring intervention or associated with hemodynamic, respiratory, or cardiovascular instability. Primary outcomes were perioperative complications and all-cause mortality at 24 h, 30 days, and one year, with mortality reported at the patient level. Results: A total of 114 procedures were performed in 67 patients (mean age 32.3 ± 10.8 years). Most procedures were elective (78.9%) and minimally invasive, frequently performed under sedation, with or without local anesthesia (67.5%). Common comorbidities included arrhythmias (46.3%), liver disease (49.3%), and heart failure (17.9%). The overall complication rate was 6.1% (2.6% intraoperative, 3.5% postoperative). Mortality was 1.5% in 24 h, 2.9% in 30 days and 5.9% at one year. Most clinically relevant adverse events occurred in patients with earlier-stage palliation, advanced functional limitation or multiple comorbidities. Conclusions: Perioperative outcomes in adults with SVP undergoing noncardiac surgical and interventional procedures were acceptable when procedures were elective and managed in specialized settings. Risk remains heterogeneous and appears to be influenced by physiological status and stage of palliation. Full article

Background/Objectives: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with Lumen-Apposing Metal Stent (LAMS) is an established option for high-surgical-risk patients, with high technical and clinical success. Indications include acute cholecystitis and palliation of jaundice in malignant distal biliary obstruction (MDBO). Both trans-gastric and trans-duodenal approaches are used, but the optimal route remains debated. The aim of the study was to compare trans-gastric and trans-duodenal access in terms of technical success, adverse events, readmissions, and reinterventions. Methods: We implemented a single-centre retrospective study of consecutive EUS-GBD procedures with LAMS at a tertiary endoscopy unit (January 2020–January 2026). Demographic, clinical, and procedural data were analyzed using appropriate statistical tests. Results: Seventy patients were included (51.4% male; mean age 77 ± 12 years). Indications were acute cholecystitis (64.3%) and MDBO (35.7%). Trans-gastric access was used in 48.5% of cases. A Hot-Axios LAMS was deployed in 77.2% of cases, mostly >10 mm. Technical success was achieved in 98.5% of cases. Naso-cystic drainage (NCD) was used through the LAMS in 47.1% of patients, while a double pig-tail plastic stent was used in 7.2% of patients. Adverse events were rare (1.4% misdeployment). LAMS obstruction occurred in 10% of patients, with reintervention required in 12.8% of patients. No differences were found between access routes in indication, technical success, LAMS type/size, or adjunctive drainage. However, trans-gastric access was associated with a higher reintervention rate (p = 0.01). Conclusions: EUS-GBD is a safe and effective procedure. While both approaches are comparable in most outcomes, the trans-gastric route may carry a higher risk of reintervention and should be avoided when alternative access is feasible. Full article

Background and Objective: Heart failure (HF) is a major cause of morbidity in adults with congenital heart disease (ACHD), who may also have limited access to transplant. Intermittent levosimendan administration has shown benefit in advanced HF due to acquired heart disease, but currently, there are no data on ACHD. We aimed to evaluate the effects of this treatment in ACHD patients with advanced heart failure, focusing on both clinical status and objective outcome measures. Materials and Methods: We conducted a single-center retrospective analysis of ACHD patients aged >18 years with advanced HF who received ≥ three intermittent levosimendan infusions (either 12.5 mg once monthly or 6.25 mg every two weeks over a 6 h infusion) between March 2020 and January 2025 at a tertiary ACHD center. Clinical outcomes during follow-up were compared with those in the year preceding treatment. Primary endpoints included safety and HF-related adverse events, particularly HF hospitalizations. Secondary endpoints included changes in New York Heart Association (NYHA) class, nt-pro-B-natriuretic peptide (nt-proBNP) values, and ventricular systolic function assessed by echocardiography. Results: Twelve patients (median age 44.6 years, 25% female) were included, with heterogeneous congenital diagnoses and advanced HF. Five patients had a systemic right ventricle (sRV) and one had a single ventricle with previous Fontan palliation. During a median follow-up of 1.3 years, intermittent levosimendan was well-tolerated, with no treatment-limiting adverse events. Two patients (16%) required hospitalization for HF during follow-up compared with 8 (66%) in the year preceding treatment. The incidence of HF hospitalizations decreased from 0.83 to 0.20 events per person-year during follow-up (p = 0.03), although findings should be interpreted cautiously given the small sample size and retrospective design. NYHA functional class improved significantly (p = 0.005). While no significant changes were observed in NT-proBNP or left ventricular ejection fraction, patients with a systemic right ventricle (sRV) showed an increase in right ventricular fractional area change (27 ± 7.4% to 30.6 ± 7%, p = 0.02); however, this observation should be regarded as exploratory given the limited sample size. Two deaths occurred, consistent with the severity of the underlying disease and not directly attributable to levosimendan and the Fontan patient received a successful heart and liver transplant. Conclusions: In a small, real-world cohort of ACHD and advanced HF, intermittent levosimendan administration was safe and associated with improved symptoms, reduced HF hospitalizations, and signals of enhanced systemic right ventricular function. These hypothesis-generating findings may help inform future multicenter studies in ACHD patients with advanced HF, suggesting a potential role for intermittent levosimendan in selected patients, while highlighting the need for prospective, adequately powered studies to confirm its efficacy and better define optimal patient selection. Full article

This prospective case series evaluated the short-term outcomes following percutaneous cementoplasty as the sole palliative treatment for appendicular osteosarcoma in 10 dogs. Synthetic self-hardening calcium phosphate bone substitute was injected into the osseous defect under fluoroscopic guidance after curettage of the bone tumor. Clinician assessment included a numerical rating score for lameness, offloading, and ease of lifting the contralateral limb as well as the 4A-VET postoperative pain scale. Owner assessment was obtained using three descriptive questionnaires, the Helsinki Chronic Pain Index (HCPI), the Canine Brief Pain Inventory (CBPI) and the Canine Symptom Assessment Scale (CSAS). Measures were recorded preoperatively and at 2, 4, 8, and 12 weeks following surgery. Early improvement in the 4A-Vet score was noted at the 2-, 4-, 8-, and 12-week time points for all major pain and function metrics. Similarly, the CBPI pain severity and interference scores demonstrated early postoperative improvement during the 2- and 4-week time points with partial attenuation by 8 and 12 weeks. Panting, difficulty sleeping, whining/moaning, and lack of appetite were significantly reduced when assessed via the CSAS. Cementoplasty as a monotherapy, affording early pain relief and improved structural integrity, supports its role as a palliative limb-preserving option for dogs unable to undergo amputation. Full article

Endobiliary photodynamic therapy (PDT) in cholangiocarcinoma (CCA) is used mainly for local palliation of malignant biliary obstruction, particularly in extrahepatic and perihilar disease. This Review synthesizes the clinical evidence on endobiliary PDT while using drainage, infection control, stent strategy, light delivery, and systemic-therapy context as an interpretive framework rather than as practice recommendations. This narrative review was informed by targeted searching of PubMed/MEDLINE, Embase, and Web of Science from database inception through to 31 December 2025, supplemented by reference-list screening. We prioritized prospective studies, comparative cohorts, systematic reviews, and relevant guidance documents. Across the literature, the clearest support for PDT concerns selected local biliary palliation, including decompression, stent patency or delayed dysfunction, and symptom relief. Survival signals remain inconsistent: early positive studies contrast with the negative PHOTOSTENT-02 randomized trial and are highly confounded by drainage adequacy, infection control, retreatment strategy, and systemic-therapy access. We therefore interpret PDT as a context-dependent local biliary strategy rather than an established survival-prolonging treatment, and we highlight the clinical variables that make published outcome signals more or less interpretable. Full article

Background/Objectives: Pain is one of the most disabling symptoms in patients with unresectable pancreatic ductal adenocarcinoma (PDAC), having a major impact on quality of life, functional status, and tolerance to oncologic treatment. Percutaneous computed tomography (CT)-guided cryoablation may provide tumor-directed pain palliation in selected patients. This study aimed to evaluate the safety and palliative clinical benefit of percutaneous CT-guided cryoablation in patients with painful unresectable PDAC. Methods: This retrospective single-center pilot case series included 11 consecutive patients with painful unresectable PDAC treated with percutaneous CT-guided cryoablation between January 2022 and May 2024. Primary endpoints were change in visual analogue scale (VAS) score and reduction in analgesic requirement. Secondary endpoints included technical success, adverse events, supportive clinical outcomes, imaging evolution, progression status, and survival. Results: Technical success was achieved in all procedures (11/11, 100%). No major procedure-related complications occurred; minor adverse events were observed in 3/11 patients (27.3%). Mean VAS score decreased from 6.72 ± 1.56 at baseline to 3.45 ± 1.44 at 1 month, 2.54 ± 1.29 at 3 months, 2.27 ± 1.43 at 6 months, and 1.60 ± 1.07 at 12 months. At 1 month, all patients showed a reduction of at least 3 VAS points. A reduction in analgesic requirement was documented in all patients during early follow-up, with complete opioid discontinuation in 5/11 patients (45.5%). At 1-month CT, residual enhancement was present in 9/11 patients (81.8%), although with an estimated 50–80% reduction in enhancing tumor burden. Observed survival proportions at 6 and 12 months were 90.9% and 72.7%, respectively. Conclusions: Percutaneous CT-guided cryoablation appears to be a feasible palliative option for selected patients with painful unresectable PDAC, with meaningful pain relief, opioid sparing, acceptable short-term safety, and exploratory imaging evidence of local cytoreductive effect. Further prospective studies are warranted. Full article