Risk prediction of intraoperative pain in percutaneous microwave ablation of lung tumors under CT guidance.

OBJECTIVES: To evaluate the effect of intraoperative pain in microwave ablation of lung tumors (MWALT) on local efficacy and establish the pain risk prediction model. METHODS: It was a retrospectively study. Consecutive patients with MWALT from September 2017 to December 2020 were divided into mild and severe pain groups. Local efficacy was evaluated by comparing technical success, technical effectiveness, and local progression-free survival (LPFS) in two groups. All cases were randomly allocated into training and validation cohorts at a ratio of 7:3. A nomogram model was established using predictors identified by logistics regression in training dataset. The calibration curves, C-statistic, and decision curve analysis (DCA) were used to evaluate the accuracy, ability, and clinical value of the nomogram. RESULTS: A total of 263 patients (mild pain group: n = 126; severe pain group: n = 137) were included in the study. Technical success rate and technical effectiveness rate were 100% and 99.2% in the mild pain group and 98.5% and 97.8% in the severe pain group. LPFS rates at 12 and 24 months were 97.6% and 87.6% in the mild pain group and 91.9% and 79.3% in the severe pain group (p = 0.034; HR: 1.90). The nomogram was established based on three predictors: depth of nodule, puncture depth, and multi-antenna. The prediction ability and accuracy were verified by C-statistic and calibration curve. DCA curve suggested the proposed prediction model was clinically useful. CONCLUSIONS: Severe intraoperative pain in MWALT reduced the local efficacy. An established prediction model could accurately predict severe pain and assist physicians in choosing a suitable anesthesia type. CLINICAL RELEVANCE STATEMENT: This study firstly provides a prediction model for the risk of severe intraoperative pain in MWALT. Physicians can choose a suitable anesthesia type based on pain risk, in order to improve patients' tolerance as well as local efficacy of MWALT. KEY POINTS: • The severe intraoperative pain in MWALT reduced the local efficacy. • Predictors of severe intraoperative pain in MWALT were the depth of nodule, puncture depth, and multi-antenna. • The prediction model established in this study can accurately predict the risk of severe pain in MWALT and assist physicians in choosing a suitable anesthesia type.

Preoperative computed tomographic-guided percutaneous coil localization of pulmonary nodules: 184 Cases in Single-center.

OBJECTIVES: The aim of this study was to evaluate the feasibility, accuracy, and safety of computed tomographic (CT)-guided coil localization before video-assisted thoracoscopic surgery. METHODS: One hundred and eighty-four consecutive patients with 200 pulmonary nodules who underwent CT-guided percutaneous coil localization before thoracoscopic surgery were retrospectively analyzed in this study. Success rate for localization, complication rates, CT findings, and pathological results of the lesions, as well as the data related to surgery were all recorded and analyzed. RESULTS: All 184 patients with 200 lesions completed localization and resection. The success rate of the coil localization on lesion baseline was 99.0% (198/200) and 98.9% (182/184) on patient baseline. The number of wedge resection, segmental resection, and lobectomy were 179 (89.5%), 19 (9.5%), and 2 (1.0%), respectively. The malignancy rates in a lesion-based analysis were 83.5% (91.1% in ground-glass nodules, 91.4% in part-solid nodules, and 37.9% in solid nodules). No serious complications occurred in all localization procedures. CONCLUSION: Preoperative CT-guided percutaneous coil localization is a safe and effective method to facilitate high success rates for both wedge and segmental resection for peripheral pulmonary nodules.

[Efficacy of endolymphatic sac-mastoid shunt surgery for intractable Meniere's disease].

OBJECTIVE: To investigate the effect and mechanism of endolymphatic sac-mastoid shunt surgery for intractable Meniere's disease of different stages according to hearing level. METHODS: Data from 240 patients diagnosed with unilateral MD strictly meeting the criteria issued by Chinese Academy of Otolaryngology-Head and Neck Surgery Committee (2006) from January 1983 to January 2012 were analyzed in this study. Endolymphatic sac-mastoid shunt surgery was performed in affected ear for each patient. The evaluation of therapy followed the guidelines issued by Chinese Academy of Otolaryngology Head and Neck Surgery Committe. Vertigo control and auditory function were measured in two-year's follow-up. RESULTS: According to the preoperative staging of hearing, among these 240 patients, there were 12 cases in stage I (with an average hearing threshold < 25 dB), 130 cases in stage II (with an average hearing threshold of 25-40 dB), 85 in stage III (41-70 dB) and 13 cases in stage IV(with an average hearing threshold > 70 dB). Overall control rate of vertigo was 77.9% (187/240) in two-year's follow-up, with total control 49.2% (118/240) and substantial control 28.7% (69/240). The hearing was improved in 25.0% (60/240) of cases, no change in 59.2% (142/240) of cases, and worse in 15.8% (38/240) of cases. According to different stages, vertigo control rate was 83.3% (10/12) in stage I, 82.3% (107/130) in stage II, 75.3% (64/85) in stage III and 46.2% (6/13) in stage IV. Vertigo control rate of stage IV patients was significantly lower than that of stage II and III patients (χ(2) = 9.318 and 4.692, P < 0.05), while vertigo control rate of stage I, II, III patients had no significant difference with each other (P > 0.05). CONCLUSION: Endolymphatic sac-mastoid shunt operation is an effective method in the treatment of intractable Meniere's disease, but the effect was poor in stage IV patients.

[Visualization of endolymphatic hydrops in 3D-FLAIR MRI after intratympanic Gd-DTPA administration in Meniere's disease patients].

OBJECTIVE: To study the feasibility of endolymphatic visualization and the diagnosis of Meniere's disease by applying intratympanic gadolinium administration through the tympanic membrance and three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging (3D-FLAIR MRI). To study the relationship between the endolymphatic hydrops visualized by MRI and audio-vestibular functional tests, such as pure tone audiometry (PTA), electrocochleography (EcoG), caloric test and vestibular evoked myogenic potential (VEMP). METHODS: With a three Tesla magnetic resonance imaging (MRI) unit, 3D-FLAIR imaging was performed 24 hours after intratympanic gadolinium through the tympanic membrance in 32 patients with clinically diagnosed unilateral Meniere's Disease. We visualized the enhanced imaging of perilymphatic space in bilateral cochlea, vestibular and (or) canal, scoring scala tympani and scala vestibule of bilateral cochlear basal turn respectively and measuring the developing area of bilateral vestibule and the signal intensity ratio (SIR) between the vestibule and the brain stem subjectively. PTA, EcoG, caloric test and VEMP were performed. The relationship between the endolymphatic hydrops visualized by MRI and audio-vestibular functional tests were studied. RESULTS: The gadolinium appeared in almost all parts of the perilymph in cochlea, vestibular and (or) canals in all 32 patients' inner ears, so the endolymphatic space was clearly shown on 3D-FLAIR imaging. The scala vestibuli score value between the affected side and the healthy side were statistically significant (Z = 4.309, P < 0.05) . The developing vestibular area between the affected side and the healthy side [(6.04 ± 2.89) mm(2), (8.28 ± 3.04)mm(2)] were statistically significant (t = 3.322, P < 0.05) . Abnormal vestibular evoked myogenic potentials were significantly correlated with the developing vestibular area of the affected side (F = 11.96, P < 0.05) . Abnormal electrocochleography were significantly correlated with scala vestibuli score value of cochlear basal turn in the affected side (Z = 3.17, P < 0.05) . No significant correlation was found between the scala vestibuli score value or the developing vestibular area and caloric test or PTA findings. CONCLUSIONS: 3D-FLAIR MRI with intratympanic gadolinium injection through the tympanic membrance can discriminate the border between the perilymph and the endolymph and show endolymphatic hydrops. This method may provide radiographic reference for the diagnosis of Meniere's disease. The results of VEMP and electrocochleography might have appropriate correlation with degree of vestibular and cochlear hydrops.