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ObjectiveTo investigate the efficacy and safety of cryoablation combined with Camrelizumab monoclonal antibody in the treatment of hepatocellular carcinoma （HCC）. MethodsA total of 103 HCC patients who were admitted to our hospital from June 2020 to June 2023 were enrolled and randomly divided into combined treatment group with 53 patients and control group with 50 patients. The patients in the control group received percutaneous argon-helium cryoablation， and those in the combined treatment group received percutaneous argon-helium cryoablation combined with Camrelizumab monoclonal antibody. The two groups were compared in terms of short-term response， changes in T lymphocyte subsets after treatment， changes in liver function and alpha-fetoprotein （AFP） after treatment， and progression-free survival and overall survival during follow-up. The t-test was used for comparison of normally distributed continuous data between groups， and the chi-square test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to plot survival curves， and the log-rank test was used for comparison of survival time between the two groups. ResultsThe combined treatment group had significantly higher overall response rate and disease control rate than the control group （χ2=4.156 and 4.348， P=0.042 and 0.037）. After treatment， the combined treatment group had significant increases in the percentages of CD3+ and CD4+ T lymphocytes and CD4+/CD8+ ratio （P<0.05） and a significant reduction in the percentage of CD8+ T lymphocytes （P<0.05）， while the control group had no significant changes in T lymphocyte subsets after treatment （P>0.05）， and compared with the control group after treatment， the combined treatment group had significantly higher percentages of CD3+ and CD4+ T lymphocytes and CD4+/CD8+ ratio （all P<0.05） and a significantly lower percentage of CD8+ T lymphocytes （P<0.05）. After treatment， both groups had significant reductions in the levels of alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， and AFP （all P<0.05） and a significant increase in the level of albumin （Alb） （P>0.05）， and compared with the control group after treatment， the combined treatment group had significantly lower levels of ALT， AST， and AFP （all P<0.05） and a significantly higher level of Alb （P<0.05）. There were no significant differences in the incidence rates of grade Ⅲ—Ⅳ （moderate to severe） adverse reactions between the two groups （P>0.05）. Compared with the control group， the combined treatment group had significantly better median progression-free survival （21.32 months vs 15.31 months， χ2=4.689， P=0.030） and median overall survival （28.36 months vs 20.75 months， χ2=5.030， P=0.025）. ConclusionArgon-helium cryoablation combined with Camrelizumab monoclonal antibody can effectively improve short-term response， enhance immune function， and prolong survival time， with a favorable safety profile.
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ObjectiveTo investigate whether anti-PD-1 monoclonal antibody can improve the efficacy and safety of cryoablation combined with lenvatinib in the treatment of unresectable hepatocellular carcinoma （HCC）. MethodsA retrospective analysis was performed for 232 patients with unresectable HCC who were treated at The Fifth Medical Center of Chinese PLA General Hospital from January 2018 to December 2022， among whom 128 received cryoablation combined with lenvatinib （double combination） and 104 received cryoablation combined with lenvatinib and anti-PD-1 monoclonal antibody （triple combination）. Propensity score matching was performed at a ratio of 1∶1， and finally there were 86 patients in each group. The two groups were evaluated in terms of objective response rate （ORR）， disease control rate （DCR）， overall survival （OS）， progression-free survival （PFS）， and adverse events （AEs）. The independent-samples t test was used for comparison of normally distributed continuous data between two groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups； the chi-square test was used for comparison of categorical data between two groups. Survival curves were plotted， and the Kaplan-Meier method was used to calculate the survival rate of patients in both groups， while the log-rank test was used for comparison between the two groups. The Cox regression model was used to calculate hazard ratio （HR） and 95% confidence interval （CI） and perform the univariate and multivariate analyses of influencing factors for prognosis. ResultsThe median follow-up time was 28 months， and there were 33 deaths （38.0%） in the triple combination group and 40 deaths （46.0%） in the double combination group. Compared with the double combination group， the triple combination group had significantly higher ORR （35.6% vs 14.5%， P=0.008） and DCR （86.1% vs 64.1%， P=0.003）. OS and PFS in the triple combination group were significantly higher than those in the double combination group （P=0.045 and 0.026）. The univariate and multivariate Cox proportional-hazards regression model analyses showed that treatment regimen （HR=0.60， P=0.038） and alpha-fetoprotein level （HR=2.37， P=0.001） were independent risk factors for OS， and treatment regimen （HR=0.65， P=0.025）， diabetes mellitus （HR=1.94， P=0.005）， whether or not to have received local treatment （HR=0.63， P=0.014）， and distant metastasis （HR=0.58， P=0.009） were independent risk factors for PFS. There was no significant difference in the incidence rate of AEs between the two groups （P>0.05）. ConclusionFor patients with unresectable HCC， the triple combination of cryoablation， lenvatinib， and anti-PD-1 monoclonal antibody significantly improves the treatment outcome and survival of patients compared with the double combination of cryoablation and lenvatinib， without increasing AEs， which provides a clinical basis for optimizing the treatment regimen for unresectable HCC.
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Resumo Fundamento A ablação da taquicardia por reentrada nodal atrioventricular (TRNAV) com crioablação é uma alternativa à ablação por radiofrequência (RF) em pacientes devido ao baixo risco de bloqueio atrioventricular total. Um aumento nas recorrências precoces e tardias após a crioablação é relatado como uma desvantagem importante. Objetivos Neste estudo, objetivamos comparar o sucesso do procedimento agudo e as taxas de recorrência em longo prazo de pacientes com TRNAV submetidos a métodos. Métodos Foram incluídos no estudo 73 pacientes com TRNAV: 32 com crioablação e 41 com ablação por RF. Não houve diferença estatisticamente significativa entre o sucesso agudo do procedimento nos métodos. O procedimento de ablação foi realizado por operador com experiência em arritmologia. A escolha entre RF ou crioablação foi feita no laboratório de eletrofisiologia com base no material já disponível durante o procedimento. Após o procedimento, os pacientes foram avaliados a cada 3 meses durante 2 anos em controle policlínico. O nível de significância adotado na análise estatística foi de 5%. Resultados Os dois grupos de pacientes foram homogêneos. O tempo de fluoroscopia (p<0,001) foi menor, mas os tempos his-átrio (p=0,004) e his-ventricular (p=0,015) foram maiores no grupo crioablação. Não houve diferença significativa em termos de sucesso agudo do procedimento, salto pós-procedimento sem eco único e presença de eco e salto. Conclusões A crioablação requer menos tempo de fluoroscopia e é uma alternativa segura e não inferior à ablação por RF em pacientes com TRNAV. O risco de bloqueio AV é um problema significativo com o uso de energia de RF, tornando-o menos adequado para uso em pacientes jovens e fisicamente ativos.
Abstract Background The ablation of atrioventricular nodal reentrant tachycardia (AVNRT) with cryoablation is an alternative to radiofrequency (RF) ablation in patients due to the low risk of total atrioventricular block. An increase in early-late recurrences after cryoablation is reported as an important disadvantage. Objectives In this study, we aimed to compare the acute procedural success and the long-term recurrence rates of patients, with AVNRT who underwent methods. Methods 73 patients with AVNRT were included in the study: 32 with cryoablation and 41 with RF ablation. There was no statistically significant difference between acute procedural success in methods. The ablation procedure was performed by an operator experienced in arrhythmology. The choice of RF or cryoablation was made in the electrophysiology laboratory based on the material already available during the procedure. After the procedure, the patients were evaluated every 3 months for 2 years in polyclinic control. The significance level adopted in the statistical analysis was 5%. Results The 2 groups of patients were homogeneous. The fluoroscopy time (p<0.001) was shorter, but atrium-his (p=0.004) and his-ventricular (p=0.015) times were longer in the cryoablation group. There was no significant difference, in terms of acute procedural success, post-procedure jump without a single echo, and presence of echo and jump. Conclusions Cryoablation requires less fluoroscopy time and is a safe non-inferior alternative to RF ablation in patients with AVNRT. The risk of AV block is a significant problem with the use of RF energy, making it less suitable for use in young and physically active patients.
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ABSTRACT Postoperative pain after cardiac surgery plays an important role in the patient's recovery process. In particular, pain at the chest tube site can negatively affect the comfort and recovery of these patients. Effective pain control minimizes the risk of many complications. Oral and intravenous analgesics, epidural anesthesia, paravertebral block, and intercostal nerve blockade are used in chest tube pain control. We routinely use the surgical cryoablation method in the presence of atrial fibrillation in the preoperative period of cardiac surgery in our clinic. Here we aimed to describe our method of using the cryoablation catheter for intercostal nerve blockade.
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@#Gingival pigmentation is a nonplaque gum disease. Patients are often afraid to communicate with others because of gum color problems, which affect the social and mental health of patients. The commonly used treatment methods for gingival pigmentation include scalpel excision, gingival grinding, laser therapy, cryosurgery and electrosurgery. In this paper, the progress of gingival pigmentation treatment was reviewed in terms of bleeding, pain, tissue healing and recoloring. The results showed that the clinical effect of laser treatment was better. Among them, the semiconductor laser had more advantages in reducing bleeding, pain and the restaining rate, while the Er:Cr:YSSG/Er:YAG laser performed better for promoting tissue healing. Clinicians can choose the best kind of laser to use according to the actual situation. For patients with thin gingival biotypes, floating gingival transplantation or substitute materials can be selected to restore the gingival morphology. With the in-depth study of melanin regulation mechanisms, various drugs, such as ascorbic acid, natural peptides, synthetic peptides and derivatives, may be the main research direction for the treatment of gingival pigmentation in the future.
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Objective To observe the feasibility of low tube voltage scanning technology in CT-guided cryoablation therapy of liver cancer.Methods Twenty-one patients who underwent routine CT(tube voltage 120 kV)-guided cryoablation of liver cancer(group A)were retrospectively enrolled,while low tube voltage(100 kV)CT-guided cryoablation of liver cancer was prospectively performed in 23 patients(group B).CT scanning were performed before and after ablation with automatic tube current mode(50-450 mA),and adaptive statistical iterative reconstruction(ASIR)algorithm was used for image reconstruction(reconstruction percentages of 40%)of both groups.The subjective scores and objective evaluations of CT image quality before and after treatment were compared between groups,so as the treatment effect and patient's radiation dose(volume CT dose index[CTDIvol]).Results No significant difference of subjective scores,objective evaluations of CT image quality nor treatment effect was detected between groups(all P＞0.05).Before and after treatment,CTDIvol of patients in group A was significantly higher than that in group B(btoh P＜0.001).Conclusion Low tube voltage scanning technology could be used for CT-guided cryoablation of liver cancer,which might ensure image quality without affecting evaluation on cryoablation effect and reduce radiation dose combined with ASIR algorithm.
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Cromoblastomicose é uma infecção granulomatosa crônica causada por fungos dematiáceos, com apresentações clínicas variadas, que podem representar um desafio terapêutico. Neste relato, apresentamos um caso de cromoblastomicose em forma localizada, de longa evolução, em paciente idoso, resistente a terapêuticas medicamentosas prévias, tratado com sucesso pela associação entre um método físico e tratamento farmacológico sistêmico, o que permitiu o uso de dose reduzida do medicamento.
Chromoblastomycosis is a chronic granulomatous infection caused by dematiaceous fungi with varied clinical presentations, which may represent a therapeutic challenge. In this report, we present a case of chromoblastomycosis in a localized form, with a long evolution, in an elderly patient, resistant to previous drug therapies, successfully treated by the association of a physical method with systemic pharmacological treatment, which allowed the use of a reduced dose of the drug
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ABSTRACT Objective: To compare and evaluate the clinical efficacy of diode laser and cryosurgery for treating melanin pigmentation of gingiva. Material and Methods: A total of twenty-five subjects with physiological gingival pigmentation on the facial aspect of both maxillary and mandibular anterior arches (50 sites), both male and female, with an average age ranging from 18-35 years, participated in the study. The sites were randomly divided into Group I: depigmentation by Laser and Group II: depigmentation by Cryosurgery. The following parameters were assessed for the evaluation of treatment results: Melanin Oral Pigmentation Index (PI), Visual Analogue Scale (VAS) for pain evaluation and Healing index (HI). The data collected was statistically evaluated. Results: On intergroup comparison, there was no statistical difference in the score from baseline (p>0.05); however, a statistically significant difference was seen at the end of 1 year (p<0.05). Moreover, 57-60% of arches showed recurrence of pigmentation in the laser group whereas; only 12.7-17% recurrence was seen in the cryosurgery group at the end of the first year. Conclusion: Treatment of gingival hyperpigmentation with laser and cryosurgery shows a marked improvement of gingival pigmentation in both groups, but the cryosurgery depigmentation sites showed more sustainability.
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Humans , Male , Female , Adolescent , Adult , Hyperpigmentation/surgery , Laser Therapy/methods , Gingival Diseases , Melanins , Visual Analog Scaleالملخص
Introducción: En la actualidad se emplean nuevas alternativas no invasivas para la remoción de diversos procesos inflamatorios del epitelio mucoso bucal, siendo la crioterapia una técnica fisioterapéutica basada en la aplicación del frío intenso con nitrógeno líquido para producir en la piel o mucosas del organismo una congelación y destrucción local de células y tejidos afectados de forma controlada. Objetivo: Evaluar los efectos terapéuticos de la criocirugía en pacientes geriátricos portadores de estomatitis subprótesis. Métodos: Se efectuó un estudio descriptivo y transversal de 50 pacientes adultos mayores, de ambos sexos, diagnosticados con estomatitis subprótesis y asistidos en la consulta estomatológica del Policlínico de Especialidades referente al Hospital Clinicoquirúrgico Universitario Saturnino Lora Torres de la provincia Santiago de Cuba, en el periodo comprendido desde marzo de 2022 hasta igual mes de 2023. Resultados: Se evidenció que las congelaciones entre 20 y 30 segundos y los deshielos entre 91 y 120 segundos fueron los más eficaces en la destrucción de la mucosa palatina dañada, logrando la regeneración tisular en un tiempo mínimo con la indicación de uno a tres ciclos de enfriamientos rápidos y deshielos lentos en una sesión terapéutica. La ausencia de síntomas fue lo más relevante en la evolución postquirúrgica. Conclusiones: La crioterapia demostró ser un método eficaz e inocuo para regenerar los tejidos lesionados al realizar congelaciones rápidas con deshielos lentos. Este método crioquirúrgico, fácil de aplicar y atraumático, logró una óptima reparación y reepitelización de los tejidos bucales dañados con excelentes respuestas terapéuticas, evitando complicaciones postquirúrgicas como la infección y el sangramiento local.
Introduction: At present, new non-invasive alternatives are used for the removal of various inflammatory processes of the oral mucous epithelium; being cryotherapy a physiotherapeutic technique based on the application of intense cold with liquid nitrogen to produce freezing on the skin or mucous membranes of the organism and local destruction of affected cells and tissues in controlled manner. Objective: To evaluate the therapeutic effects of cryotherapy in geriatric patients with sub-prosthesis stomatitis. Methods: A descriptive and cross-sectional study of 50 older adult patients, of both sexes, clinically diagnosed with subprosthesis stomatitis and assisted in the dentistry consultation of the Specialties Polyclinic referring to the Saturnino Lora Torres University Clinical Surgical Hospital in the city of Santiago de Cuba, in the period from March 2022 to the same month of 2023. Results: It was evidenced that freezing between 20 and 30 seconds and thawing between 91 and 120 seconds were the most effective in the destruction of the damaged palatal mucosa, achieving tissue regeneration in a minimum time with the performance of 1 to 3 cycles of rapid cooling and slow thawing in a therapeutic session. The absence of symptoms was the most relevant in the post-surgical evolution. Conclusions: Cryotherapy proved to be an effective and innocuous method to regenerate injured tissues when fast freezing with slow thawing. This cryosurgical method, easy to apply and atraumatic, achieved optimal repair and re-epithelization of damaged oral tissues with excellent therapeutic responses, avoiding post-surgical complications such as infection and local bleeding.
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Introdução: Habitualmente, as verrugas virais são causadas pelo papilomavírus humano (HPV) e, embora tenham tendência à resolu- ção espontânea, quando crônicas, conferem resistência terapêutica. Objetivo: Divulgar um caso de sucesso terapêutico da associação do uso de imiquimode e criocirurgia para verrugas virais periungueais e subungueais. Relato do caso: O relato é de um homem de 56 anos, com cinco anos de evolução de verrugas subungueais e periungueais distribuídas na maioria dos dedos das mãos. Anteriormente, foi tratado com antifúngicos pelo resultado micológico, sem sucesso. Foi submetido à biópsia subungueal, cujo anatomopatológico confirmou verruga plana. Foi proposto o tratamento combinado de imiquimode creme 5% e criocirurgia. Evoluiu com resolução completa das lesões virais. Conclusão: Os autores demonstram a importância dos achados anatomopatológicos no diagnóstico de verrugas virais recalcitrantes, bem como é ressaltada a eficácia da associação do uso de imiquimode e criocirurgia.
Introduction: Viral warts are usually caused by the human papillomavirus (HPV), and although they tend to resolve spontaneously, when chronic, they confer therapeutic resistance. Aim: To report a case of therapeutic success of imiquimod and cryosurgery combination for periungual and subungual viral warts. Case Report: The report is of a 56-year-old man with five years of evolution of subungual and periungual warts distributed on most fingers of the hands. Previously, he received treatment with antifungal drugs due to the mycological result, but it was unsuccessful. He underwent a subungual biopsy, whose pathology confirmed the flat wart. A combined treatment of imiquimod cream 5% and cryosurgery was proposed. The patient evolved with complete resolution of the viral lesions. Conclusion: The authors demonstrate the importance of pathological findings in the diagnosis of recalcitrant viral warts, as well as the efficacy of the association of imiquimod and cryosurgery.
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Imiquimodالملخص
Abstract Sporotrichosis is a subcutaneous mycosis caused by dimorphic fungi of the genus Sporothrix. The authors report a case of fixed cutaneous sporotrichosis with therapeutic failure after 18 months of itraconazole and terbinafine associated with cryosurgery. The patient was cured after the introduction of saturated potassium iodide solution. Sporothrix brasiliensis was the identified species, presenting a susceptibility profile to itraconazole and terbinafine. This fact suggests that therapeutic failure is probably related to the host-fungus interaction rather than drug resistance. It is possible that the immunomodulatory action of the saturated potassium iodide solution may have played an important role in curing this patient.
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Sporotrichosis/drug therapy , Sporothrix , Potassium Iodide/therapeutic use , Itraconazole , Antifungal Agents/therapeutic useالملخص
Introdução: verrugas anogenitais são a infecção sexualmente transmissível prevalente (0,5%) entre atendimentos dermatológicos. Dentre as estratégias de tratamento, destacam-se a crioterapia com nitrogênio líquido (NL) e causoterapia com ácido tricloroacético (ATA). Objetivo: avaliar a eficácia do NL versus ATA no tratamento de verrugas penianas em pacientes de instituição pública brasileira. Métodos: ensaio clínico aberto, paralelo e randomizado. Em cada visita, as verrugas foram contadas e submetidas à crioterapia (10s) ou à causoterapia (ATA 80%), após randomização. A principal variável dependente foi a contagem de lesões antes e após quatro semanas de tratamento. Foram analisados: eliminação completa, idade, imunossupressão, tabagismo, topografia e escolaridade. Resultados: foram avaliados 142 tratamentos em 52 participantes. Houve predominância de adultos jovens, menor escolaridade, e a principal topografia afetada foi a haste. A redução percentual média por sessão foi 48% para o NL e 26% para o ATA (p=0,11). Clearance completo foi atingido por 42 (81%) participantes, sendo que 39 (75%; IC95%: 64-85%) atingiram o clearance em até três sessões. A idade associou-se à pior taxa de resposta terapêutica (ß=-0,09; p<0,01). Conclusões: NL e ATA mostraram-se eficazes na terapêutica das verrugas penianas, sem diferença entre os tratamentos. A idade foi associada à pior resposta terapêutica.
Background: Anogenital warts are the most prevalent sexually transmitted infection (0.5%) among dermatological consultations. Cryotherapy with liquid nitrogen (LN) and therapy with trichloroacetic acid (TCA) are remarkable among the treatment strategies. Objective: To evaluate the effectiveness of LN versus TCA in to treat penile warts in patients from a Brazilian public institution. Methods: Open, parallel, randomized clinical trial. Following randomization, the warts were counted and submitted to cryotherapy (10s) or case therapy (TCA 80%) in each visit. The primary dependent variable was the lesion count before and after four weeks of treatment. We assessed the following variables: complete clearance, age, immunosuppression, smoking, topography, and education. Results: 142 treatments were evaluated in 52 participants. There was a predominance of young adults, and the main topography affected was the penis shaft. The mean reduction rate per session was 48% for LN and 26% for TCA (p=0.11). 42 (81%) participants achieved complete clearance, with 39 (75%; 95% CI: 64-85%) reaching clearance in up to three sessions. Age was associated with a worse therapeutic response rate (ß =-0.09; p<0.01). Conclusions: LN and TCA proved to be effective to treat penile warts, without difference between treatments. Age was associated with a worse therapeutic response
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Abstract New translational concepts on cellular and tissue substrate of cardiac arrhythmias have been responsible for the development of non-pharmacological interventions, with important achievements compared to the conventional approach with antiarrhythmic drugs. In addition, the increasing knowledge of anatomical and electrophysiological studies, sophisticated mapping methods, special catheters, and controlled clinical trials have favored the progression of ablation of tachyarrhythmias, particularly of ventricular tachyarrhythmias and atrial fibrillation.
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Arrhythmias, Cardiac/physiopathology , Translational Research, Biomedical/methods , Percutaneous Coronary Intervention/methods , Arrhythmias, Cardiac/surgery , Arrhythmias, Cardiac/drug therapy , Catheter Ablation , Anti-Arrhythmia Agentsالملخص
A criocirurgia tem sido utilizada no tratamento de diferentes enfermidades de sistemas e órgãos. Contudo, são relatados efeitos adversos, como cicatrização lenta, cicatrizes extensas, disfunção estética e funcional. As lesões que ocorrem naturalmente pela exposição ao frio extremo, comumente, resultam em gangrena. O presente trabalho teve como objetivo avaliar a influência das células-tronco mesenquimais de origem adiposa (ADSCs) na fase de proliferação da cicatrização de feridas cutâneas. Por meio da aplicação do nitrogênio líquido pela técnica do spray aberto, realizou-se a indução de uma ferida, de aproximadamente 15mm de diâmetro, na região dorsal de cada rato. A ferida recebeu o tratamento de acordo com o grupo ao qual pertencia: 1) aplicação das ADSCs no 15º dia (grupo tratado); 2) aplicação da solução cloreto de sódio 0,9% no 15º dia (grupo sham); 3) nenhuma intervenção até o momento da eutanásia (grupo controle). O grupo tratado com as ADSCs apresentou as maiores taxas de contração média das feridas e obteve diferença estatisticamente significativa em relação ao grupo sham quanto à neovascularização. A terapia com as ADSCs proporcionou uma relevante evolução clínica das feridas, podendo ser constatada ao final do período de avaliação por cicatrizes mais estreitas e compridas.(AU)
Cryosurgery has been used to treat different diseases of systems and organs, although adverse effects have been reported such as delayed wound healing, large scars, esthetical deformation and functional impairment. Injuries caused naturally by the exposure to extreme cold weather conditions mostly result in gangrene. This study aims to evaluate the influence of adipose-derived stem cells (ADSCs) in the proliferation phase on cutaneous wound healing. Through the application of liquid nitrogen by the spraying technique, a 15 millimeter diameter lesion was produced in the dorsal region of each rat. The wound received treatment according to the group it belonged: 1) ADSCs application on the 15th day (treated group); 2) application of 0.9% sodium chloride solution on the 15th day (sham group); 3) no intervention until euthanasia (control group). The group treated with ADSCs showed the highest wound average contraction rate; this group got a significant statistical difference in relation to the sham group when it refers to neovascularization. The ADSCs therapy provides an important clinical evolution of wounds. This was verified at the end of the evaluation period through narrower and longer scars.(AU)
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Animals , Rats , Wound Healing/physiology , Burns/veterinary , Cryosurgery/veterinary , Mesenchymal Stem Cells , Wounds and Injuries/therapy , Rats, Wistar , Cooling Agents , Cold-Shock Responseالملخص
A criocirurgia é uma técnica de vasto conhecimento e uso entre dermatologistas. A aplicação intralesional já é utilizada no tratamento de queloides e tem como vantagem restringir a zona de ação das baixas temperaturas do nitrogênio líquido. O uso da criocirurgia de contato em lesões vasculares é relatado, mas não há publicações sobre a técnica intralesional nesses tipos de lesões. Aqui, relatamos dois casos: 1- Hamartomas sobre mancha vinho do Porto em um paciente de 61 anos; e 2 - Angioma rubi em um paciente de 70 anos, ambos tratados de forma satisfatória e segura com criocirurgia intralesional.
Cryosurgery is a technique widely known and used among dermatologists. Intralesional application is already used to treat keloids and has the advantage of restricting the zone of action of low temperatures of liquid nitrogen. The use of contact cryosurgery in vascular lesions is well reported in the literature, but there are no intralesional technique publications on these types of lesions. Here, we report two cases, one of port-wine stain hamartomas in a 61-year-old patient and another of a cherry angioma in a 70-year-old patient, safely and satisfactorily treated with intralesional cryosurgery
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Objective@#To compare the clinical effects of conventional hysteroscopy and HEOS hysteroscopy in the treatment of refractory intrauterine residuals.@*Methods@#From January 2017 to February 2019, 60 patients with refractory intrauterine pregnancy residuals admitted to the Integrated Traditional Chinese and Western Medicine Hospital of Wenzhou were randomly selected.The patients were divided into traditional endoscopy group and HEOS system endoscope group according to the different operation method, with 30 cases in each group.The operation time, intraoperative blood loss, hospitalization cost, postoperative uterine adhesion rate, postoperative menstrual recovery time, postoperative recovery rate of endometrium at the first, second and third month after operation were compared between the two groups.@*Results@#The operation time of the conventional laparoscopic group was (24.38±3.16)min, which was longer than that of the HEOS system hysteroscopy group[(18.71±3.32)min](t=1.336, P=0.027). The intraoperative blood loss of the conventional laparoscopic group was (18.41±4.35)mL, which was higher than that of the HEOS system hysteroscopy group[(12.81±3.84)mL](t=1.853, P=0.031). The hospitalization cost of the conventional laparoscopic group was (7 461.87±344.92)CNY, which was more than that of the HEOS system hysteroscopy group[(6 743.19±298.52)CNY](t=0.037, P=0.040). In addition, the uterine adhesion rate in the traditional hysteroscopic group was 20.00%(6/30), which was higher than that in the HEOS system hysteroscopy group[6.67%(2/30)](χ2=2.308, P=0.029), and the postoperative menstrual recovery time in the traditional hysteroscopic group was (31.46±4.12)d, which was longer than that in the HEOS system hysteroscopy group[(26.18±3.72)d](t=1.730, P=0.026). At the first, second and third month after operation, the good endometrial recovery rates in the traditional laparoscopic group were 20.00%(6/30), 43.33%(13/30), 63.33%(19/30), respectively, which were lower than those in the HEOS system hysteroscopy group[46.67%(14/30), 70.00%(21/30), 93.33%(28/30)](χ2=4.800, 4.344, 7.954, P=0.028, 0.037, 0.005).@*Conclusion@#HEOS system endoscope in the treatment of refractory intrauterine residual has good effect and is worthy of promoting.
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Objective To compare the clinical effects of conventional hysteroscopy and HEOS hysteroscopy in the treatment of refractory intrauterine residuals.Methods From January 2017 to February 2019,60 patients with refractory intrauterine pregnancy residuals admitted to the Integrated Traditional Chinese and Western MedicineHospital of Wenzhou were randomly selected .The patients were divided into traditional endoscopy group and HEOS system endoscope group according to the different operation method ,with 30 cases in each group.The operation time, intraoperative blood loss , hospitalization cost , postoperative uterine adhesion rate , postoperative menstrual recovery time,postoperative recovery rate of endometrium at the first ,second and third month after operation were compared between the two groups.Results The operation time of the conventional laparoscopic group was (24.38 ±3.16)min, which was longer than that of the HEOS system hysteroscopy group [(18.71 ±3.32)min](t=1.336,P=0.027). The intraoperative blood loss of the conventional laparoscopic group was (18.41 ±4.35) mL,which was higher than that of the HEOS system hysteroscopy group[(12.81 ±3.84)mL](t=1.853,P=0.031).The hospitalization cost of the conventional laparoscopic group was (7461.87 ±344.92) CNY,which was more than that of the HEOS system hysteroscopy group[(6743.19 ±298.52)CNY](t=0.037,P=0.040).In addition,the uterine adhesion rate in the traditional hysteroscopic group was 20.00％( 6/30 ) , which was higher than that in the HEOS system hysteroscopy group[6.67％(2/30)] (χ2 =2.308,P=0.029),and the postoperative menstrual recovery time in the traditional hysteroscopic group was ( 31.46 ±4.12 ) d, which was longer than that in the HEOS system hysteroscopy group [(26.18 ±3.72)d](t=1.730,P=0.026).At the first,second and third month after operation ,the good endometrial recovery rates in the traditional laparoscopic group were 20.00％(6/30),43.33％(13/30),63.33％(19/30), respectively,which were lower than those in the HEOS system hysteroscopy group [46.67％(14/30),70.00％(21/30),93.33％(28/30)](χ2 =4.800,4.344,7.954,P =0.028,0.037,0.005).Conclusion HEOS system endoscope in the treatment of refractory intrauterine residual has good effect and is worthy of promoting .
الملخص
Abstract Objective: To evaluate the factors impacting on the conversion to sinus rhythm and on the postoperative rhythm findings in the six-month follow-up period of a mitral valve surgery combined with cryoablation Cox-Maze III procedure, in patients with atrial fibrillation. Methods: In this study, we evaluated 80 patients who underwent structural valve disease surgery in combination with cryoablation. Indications for the surgical procedures were determined in the patients according to the presence of rheumatic or non-rheumatic structural disorders in the mitral valve as evaluated by echocardiography. Cox-Maze III procedure and left atrial appendix closure were applied. Results: The results of receiver operating characteristics analysis indicated that the rate of conversion to the sinus rhythm was significantly higher in patients with left atrial diameters ≥ 45.5 mm and with ejection fraction (EF) ≥ 48.5%. However, the statistical differences disappeared in the sixth month. Thromboembolic (TE) events were seen only in three patients in the early period and no more TE events occurred in the six-month follow-up period. Conclusion: The EF and the preoperative left atrial diameter were determined to be the factors impacting on the conversion to sinus rhythm in patients who underwent mitral valve surgery in combination with cryoablation. Mitral valve surgery in combination with ablation for atrial fibrillation does not affect mortality and morbidity in the experienced health centers; however, it remains controversial whether it will provide additional health benefits to the patients compared to those who underwent only mitral valve surgery.
الموضوعات
Humans , Male , Female , Adult , Middle Aged , Atrial Fibrillation/surgery , Atrial Fibrillation/physiopathology , Heart Valve Prosthesis Implantation/methods , Cryosurgery/methods , Heart Rate/physiology , Mitral Valve/surgery , Postoperative Period , Reference Values , Atrial Fibrillation/prevention & control , Time Factors , Retrospective Studies , Risk Factors , Sensitivity and Specificity , Treatment Outcome , Electrocardiography , Preoperative Period , Heart Atria/surgery , Mitral Valve/physiopathologyالملخص
Abstract Objective: To determine whether 18F-fluorodeoxyglucose positron emission tomography/computed tomography performed immediately after percutaneous ablation (iPA18F-FDG PET/CT) is useful in evaluating the outcomes of the procedure. Materials and Methods: This was a retrospective study of 20 patients (13 males, 7 females; mean age, 65.8 ± 12.1 years) submitted to percutaneous ablation of metastases. All of the lesions treated had shown focal uptake on a 18F-FDG PET/CT scan obtained at baseline. The primary tumors were mainly colorectal cancer (in 45%) or lung cancer (in 40%). iPA18F-FDG PET/CT was performed to identify any residual viable tumor cells. The treatment was considered a success (no viable tumor cells present) if no uptake of 18F-FDG was noted on the iPA18F-FDG PET/CT scan. Results: Twenty-six lesions were submitted to percutaneous ablation with either cryoablation (n = 7) or radiofrequency ablation (n = 19). The mean lesion diameter was 2.52 ± 1.49 cm. For the detection of viable tumor cells, iPA18F-FDG PET/CT had a sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 66.7%, 95%, 88.5%, 80%, and 90.5%, respectively. There was a significant correlation between the iPA18F-FDG PET/CT findings and the results of the follow-up studies (kappa = 0.66; p < 0.01). Conclusion: iPA18F-FDG PET/CT studies appear to constitute a useful means of evaluating the outcomes of percutaneous ablation. By detecting residual viable tumor cells, this strategy might allow early re-intervention, thus reducing morbidity. Studies involving larger numbers of patients are needed in order to confirm our findings.
Resumo Objetivo: Demonstrar se a tomografia por emissão de pósitrons acoplada a tomografia computadorizada usando-se fluorodesoxiglicose marcada com flúor-18 realizada imediatamente após ablação percutânea (iAP18F-FDG PET/CT) pode ser útil na avaliação do resultado desse tratamento. Materiais e Métodos: Foram avaliados, retrospectivamente, 20 pacientes (13 homens e 7 mulheres; média de idade: 65,8 ± 12,1 anos) submetidos a ablação percutânea de metástases apresentando captação de 18F-FDG no exame de PET/CT. Os tumores primários foram, principalmente, câncer colorretal (45%) ou câncer de pulmão (40%). A iAP18F-FDG PET/CT foi realizada para avaliar tumor residual viável. O tratamento foi considerado sucesso (sem lesão viável) se nenhuma captação de 18F-FDG fosse observada na iAP18F-FDG PET/CT. Resultados: Vinte e seis lesões foram submetidas a ablação percutânea por meio de crioablação (n = 7) ou radiofrequência (n = 19). O tamanho médio das lesões era de 2,52 ± 1,49 cm. A iAP18F-FDG PET/CT detectou tumor viável com sensibilidade, especificidade, acurácia, valor preditivo positivo e valor preditivo negativo de 66,7%, 95%, 88,5%, 80% e 90,5%, respectivamente. Houve correlação significativa entre os achados da iAP18F-FDG PET/CT e os resultados do seguimento clínico dos pacientes (kappa = 0,66; p < 0,01). Conclusão: A iAP18F-FDG PET/CT é capaz de avaliar o resultado da ablação percutânea e poderá permitir reintervenção precoce de lesões residuais viáveis, reduzindo a morbidade. Um número maior de pacientes é necessário para confirmar esses achados.
الملخص
biópsia de pele é ferramenta propedêutica importante e indispensável para o médico dermatologista. O método convencional de biópsia, com a utilização de anestésicos locais, campos estéreis, instrumental cirúrgico (punch, bisturi, pinças, tesoura) e fios de sutura, exige equipe, tempo e considerável investimento financeiro. A criobiópsia é método simples, que, por meio do criocautério, faz a extração de fragmentos de pele de boa qualidade para análise histopatológica, o que a torna excelente alternativa às biópsias convencionais.
Skin biopsy is an important introductory tool and also essential for the dermatologist. The conventional biopsy method, with the use of local anesthetics, sterile fields, surgical instruments (punch, scalpel, forceps, scissors) and suture material demand staff, time and considerable financial investment. Criobiopsy is a simple method, where by using the cryocautery an extraction of good quality skin fragments is made for histopathologic analysis, making it an excellent alternative to the conventional biopsies.