Symptomatic pelvic venous insufficiency: a review of the current controversies in pathophysiology, diagnosis, and management.

Symptomatic pelvic venous insufficiency (PVI) is defined as chronic pelvic pain resulting from dilated pelvic veins. It is a controversial area, with ongoing debate surrounding the underlying aetiology of pain, as well as how best to investigate and manage these patients. Multiple distinct underlying pathophysiological processes have been implicated and can broadly be classified as primary venous reflux, normally involving the ovarian veins, and secondary venous obstruction, which may involve either the ovarian or internal iliac veins. Multiple terms have been used to describe this spectrum of conditions including pelvic congestion, May-Thurner and nutcracker syndromes; however, this terminology is imprecise and fails to define the underlying pathological process. A recent consensus classification of pelvic venous disorders aims to improve this nomenclature to aid clinical communication, decision-making, and future research. This is important as the treatment options differ according to the underlying cause. Imaging plays an essential role in the diagnostic process, both to define the underlying pathophysiology and to help plan treatments. Minimally invasive radiologically guided embolisation and/or venous stenting now form the mainstay of management with good reported outcomes. The present article discusses the proposed pathophysiology and aetiology of pain in PVI, reviews the role of imaging in the diagnosis, and considers the role of catheter-directed treatments.

A bump in the night: a 15-year retrospective analysis of urgent inpatient and emergency CT reporting out of hours in a tertiary referral centre.

AIM: To assess the impact on specialty trainee (ST) experience of out-of-hours (OOH) working, focusing on what might be improved with both patient safety and staff wellbeing in mind. MATERIALS AND METHODS: The number of acute computed tomography (CT) examinations reported OOH over the last 15 years (2007-2021) at Oxford University Hospitals NHS Foundation Trust was analysed. Qualitative data from the radiology STs participating in the acute OOH rotas were obtained using questionnaires during winter months in 2019 and 2021, before and after the introduction of an OOH CT outsourcing service in 2020. RESULTS: Overnight acute CT has increased over 10-fold over the last decade to almost 50 CT examinations in 2021, and similar increases were observed during evening and weekend shifts. The option to outsource acute CT on an ad hoc basis was introduced in 2020 to manage the increase in demand. This resulted in a statistically significant improvement in the STs' level of reported satisfaction for OOH shifts (p<0.018), despite significantly increased perception of how busy the shifts were (p<0.035). CONCLUSION: OOH acute CT reporting at Oxford NHS Foundation Trust has increased dramatically over the previous 15 years. Working patterns and resources have changed incrementally to absorb this increase in demand, most recently with the option for outsourcing at times of peak demand. The trend for increasing OOH CT demand has considerable implications for future resource planning.

Musculoskeletal Embolotherapy.

Painful articular musculoskeletal (MSK) conditions are common, debilitating and sometimes difficult to treat. Transcatheter embolisation may offer an alternative way to manage the pain associated with these conditions, but the field is still in its infancy. To date, the most commonly studied indication is knee osteoarthritis, but the technique has been trailed in multiple other tissue beds, including for adhesive capsulitis and tendinopathies. Whilst early results appear promising, the existing studies are mostly open-labelled and non-randomised; there is a need for high-quality evidence to robustly assess the procedures efficacy. In this review, we set out to evaluate the current evidence underlying the pathophysiology and mechanism of action of embolisation; discuss the technical aspects of the procedure including embolic selection, and appraise the published clinical outcomes and adverse effects. Finally, we discuss the future directions and research priorities in this rapidly developing field.

[Isolation, sequencing and ultrastructure of HTLV-I and HTLV-II retroviruses. Presence of the HTLV-II subtype b among Spanish intravenous drug addicts]. / Aislamiento, secuenciación y ultraestructura de los retrovirus HTLV-I y HTLV-II. Presencia del HTLV-II subtipo b entre adictos a drogas por vía parenteral españoles.

BACKGROUND: Six cases of HTLV-I/II infection were selected for isolation and characterization of these retrovirus. METHODS: Detection of anti-HTLV antibodies was carried out by enzyme immunoassay (EIA), immunofluorescence (IFI), and Western blot (WB). Analysis of proviral DNA was performed by PCR. Viral culture and partial sequencing of the pol and pX genes were carried out. Electron microscopy morphologically characterized the viral particles. RESULTS: Serologic study demonstrated four cases of HTLV-II, one of HTLV-I, and one non-typeable HTLV infections. This last case was confirmed as positive for HTLV-II by PCR. Five new HTLV-II and one HTLV-I infected cell lines have been established by co-culture. Electron microscopy allowed morphologic characterization of the viral particles found in the infected cells. The sequence of the five strains of HTLV-II was identical demonstrating a divergence of 0.49% in the pX region and of 4.5% in the pol region compared with the HTLV-II Mo prototype. Comparison of these sequences with those corresponding to different strains of HTLV-II isolates from American Indians (subtypes b) suggest that these Spanish strains are more closely related with the subtype b than with the subtype a (HTLV-II Mo). Genetic variability study did not reveal any change in the sequence of these stains suggesting that the variability of these retroviruses in very infrequent in the regions studied. The analysis of the pol region of the HTLV-I strain demonstrated a divergence of 3.4% with respect to the sequence of the ATK-1 prototype (Japan) and of 1.7% of the strain HS-35 (Caribbean) showing a greater relation with the Caribbean strains than with those from Japan. CONCLUSIONS: The presence of HTLV-II subtype has been confirmed among intravenous drug addicts in Spain. Isolation and characterization of the HTLV-I strain demonstrated that this also circulating around Spain despite its South American origin.