[Interventional treatment of venous insufficiency]. / Prise en charge interventionnelle de l'insuffisance veineuse superficielle des membres inférieurs.

Interventional treatment of venous insufficiency has been revolutionized by endovascular techniques. Some of these techniques, and particularly thermal ablation (endovenous laser, radiofrequency) are now recommended as first-line therapy in the latest international guidelines. This is because of less post-operative pain, a shorter leave from employment and similar or lower recurrence rate. Endovenous techniques allow safer and more efficient treatment of certain particular conditions : small saphenous vein, ulcers, and recurrent varicose veins. In addition to clinical history and examination, a duplex sonography of deep and superficial veins, performed by an angiologist, is the most important exam in order to determine proper indication and best treatment strategy for each patient.

La prise en charge de l'insuffisance veineuse des membres inférieurs a été révolutionnée par l'avènement des techniques endoveineuses. En particulier, l'ablation thermique par laser endoveineux, ou radiofréquence des troncs saphéniens, a remplacé la chirurgie comme technique de référence dans les dernières guidelines publiées, notamment en raison d'une diminution des douleurs postinterventionnelles et de la durée d'incapacité de travail avec un taux de récidives identique, voire inférieur. Les techniques endoveineuses permettent, en outre, de traiter certaines indications avec un niveau d'efficacité et de sécurité accru : traitement de la petite veine saphène, ulcères et récidives de varices. Afin de déterminer l'indication et la meilleure stratégie de prise en charge, un bilan veineux par écho-Doppler par un angiologue est une étape obligatoire.

Multiple malignant tumours in the elderly.

Aging of the population and technical improvements may contribute to increase the possibility of multiple malignant tumours to be diagnosed. Over a period of 18 years, 2,749 consecutive autopsies of elderly patients were performed. In addition to macroscopic examination of every single organ, bone marrow and prostate were routinely stained and microscopically examined. One hundred and sixty-seven patients with multiple malignant tumours were found. Mean age was 81.1 years for females and 80.1 years for males. Mean interval between tumours was 2.4 years for females and 1.0 year for males. First tumours were most of the time diagnosed clinically (n = 121 vs. 46) whereas second tumours were diagnosed at autopsy (n = 121 vs. 46). Origin and metastastic sites of tumours were not different between the first and second tumour. Prostate and breast were the most frequent organs involved in males and females. Multiple malignant tumours in the elderly are not rare and the second tumour is frequently diagnosed after death despite occurring relatively soon after the diagnosis of the first tumour. Multiple malignant tumours may represent a significant clinical challenge leading to further diagnostic procedures and differentiated therapeutic approaches.

Prophylactic anti-coagulation in cancer palliative care: a prospective randomised study.

GOALS: The objective of this study was to determine utility of prophylactic anti-coagulation in cancer patients hospitalised for palliative care in a specialised centre. MATERIALS AND METHODS: Prospective 1:1 open randomised study was designed. Twenty patients aged 55 to 88 years with advanced cancer and an estimated life expectancy of less than 6 months were assigned to either receive treatment with 2,850/3,800 U (<70/>70 kg) of daily subcutaneous nadroparin or no treatment. Suspicion of venous thrombo-embolism (deep vein thrombosis and pulmonary embolism) was confirmed by echo-Doppler examination of the lower limbs and/or by spiral computed tomography scan of the lungs. Bleeding episodes were recorded. Platelet count was measured on days 7 and 14. Survival time from study entry was determined. MAIN RESULTS: One venous thrombo-embolism and one major bleeding occurred in the group receiving nadroparin, whereas two minor bleedings occurred in the control group. At 3 months, nine of ten participants had died in the control group vs five of ten in the group receiving nadroparin (P = 0.141). Five participants could be discharged home (P = 0.141). CONCLUSIONS: Decision to administer prophylactic nadroparin in hospitalised cancer patients under palliative care remains a challenge. Better mobility score at admission and the likelihood to be discharged home may be useful for practical purposes. The observation of a potential influence of prophylactic nadroparin on survival deserves further studies.