[Women with pelvic complaints and atypical varicose veins, varicose veins of the vulva and insufficiency of the pelvic veins; treatment with embolisation]. / Vrouwen met onderbuikklachten en met atypische varices, vulvavarices en insufficiënte bekkenvenen; behandeling door embolisatie.

In three women, aged 34, 52 and 30 years, respectively, who suffered from chronic pelvic symptoms such as a heavy feeling and abdominal pain, atypical varicose veins were observed on the medial side of the upper thighs together with varicose veins of the vulva; these are indicators of insufficiency of the pelvic veins. The symptoms were reduced following embolisation of the insufficient pelvic veins. These symptoms are also known as the pelvic congestive syndrome. The exact correlation between insufficiency of the pelvic veins and the complaints mentioned above has not yet been determined, but it seems that in most patients the symptoms diminish or disappear following embolisation of the insufficient pelvic veins. When patients complain of chronic pelvic pain of unknown aetiology, one should look for atypical varices and vulval varices and consider pelvic-vein insufficiency as a possible cause.

Palliative cryosurgery for rectal carcinoma.

Cryosurgery is one of the palliative treatment options to decrease local symptoms due to rectal carcinoma. A total of 106 patients (aged 45-92 years) underwent palliative cryosurgery for primary rectal cancer. Inclusion criteria were prohibitive surgical risk, unresectability, distant metastases, patient refusal of surgical intervention, and old age. The palliative effect of cryosurgery on local symptoms was classified as good, moderate, or none. The duration of palliation was calculated in relation to survival as a palliative index: the number of months of (moderate or good) palliation divided by the number of months of survival from the start of the treatment, multiplied by 100. In 66 patients (62%) there was complete relief of local symptoms, with a palliative index of 88%. In 17 patients (16%) palliation was moderate, and in 23 patients (22%) no palliation was achieved. The 50% survival duration in the 66 patients was 33 months. Especially symptoms of blood and/or mucous discharge were easily alleviated. Good alleviation of local symptoms was associated with the extent of the primary tumor process. Palliative effect was be assessed after a few treatments. Patients with circular rectal tumors seldom had long-term palliative effects of cryosurgery. Our findings show that Cryosurgery is a simple and safe treatment for rectal cancer. It should be considered for alleviation of local symptoms in patients with rectal cancer who are unsuitable for radical surgery.