RESUMEN
La electroporación irreversible o IRE (irreversible electroporation) es una técnica de ablación tumoral no térmica basada en la aplicación de pulsos eléctricos de alto voltaje entre pares de agujas insertadas alrededor de un tumor. La corriente generada favorece la creación de nanoporos en la membrana plasmática, desencadenando la apoptosis. Por ello, la IRE puede utilizarse de manera segura en localizaciones cercanas a estructuras vasculares delicadas, contraindicadas para el resto de técnicas termoablativas. Actualmente la IRE se emplea con éxito para la ablación de tumores en páncreas, riñón e hígado y, de manera muy extendida, como opción terapéutica focal para el cáncer de próstata. La necesidad de un manejo anestésico específico y la colocación precisa y en paralelo de múltiples agujas implican un alto nivel de complejidad, siendo necesaria una gran experiencia del equipo intervencionista. No obstante, se trata de una técnica muy prometedora con una gran capacidad inmunológica sistémica que puede provocar un efecto a distancia del tumor tratado (efecto abscopal).(AU)
Irreversible electroporation (IRE) is a non-thermal tumor ablation technique. High-voltage electrical pulses are applied between pairs of electrodes inserted around and/or inside a tumor. The generated electric current induces the creation of nanopores in the cell membrane, triggering apoptosis. As a result, IRE can be safely used in areas near delicate vascular structures where other thermal ablation methods are contraindicated. Currently, IRE has demonstrated to be a successful ablation technique for pancreatic, renal, and liver tumors and is widely used as a focal therapeutic option for prostate cancer. The need for specific anesthetic management and accurate parallel placement of multiple electrodes entails a high level of complexity and great expertise from the interventional team is required. Nevertheless, IRE is a very promising technique with a remarkable systemic immunological capability and may impact on distant metastases (abscopal effect).(AU)
Asunto(s)
Humanos , Masculino , Femenino , Electroporación/métodos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Renales/diagnóstico por imagen , Neoplasias Pancreáticas/diagnóstico por imagen , Inmunoterapia , Radiología Intervencionista , Radiología , Diagnóstico por Imagen , Oncología Médica , Técnicas de Ablación , Anestesia/métodosRESUMEN
Irreversible Electroporation (IRE) is a non-thermal tumor ablation technique. High-voltage electrical pulses are applied between pairs of electrodes inserted around and/or inside a tumor. The generated electric current induces the creation of nanopores in the cell membrane, triggering apoptosis. As a result, IRE can be safely used in areas near delicate vascular structures where other thermal ablation methods are contraindicated. Currently, IRE has demonstrated to be a successful ablation technique for pancreatic, renal, and liver tumors and is widely used as a focal therapeutic option for prostate cancer. The need for specific anesthetic management and accurate parallel placement of multiple electrodes entails a high level of complexity and great expertise from the interventional team is required. Nevertheless, IRE is a very promising technique with a remarkable systemic immunological capability and may impact on distant metastases (abscopal effect).
Asunto(s)
Técnicas de Ablación , Neoplasias Hepáticas , Neoplasias de la Próstata , Masculino , Humanos , Técnicas de Ablación/métodos , Electroporación/métodos , PáncreasRESUMEN
Percutaneous irreversible electroporation (IRE) is a novel tumour ablation method. The application of short and high-voltage electrical pulses to the target lesion induces alterations in cell membrane permeability, finally causing tumour cell death. The extremely high-voltage that is needed in this technique requires the surveillance and management of an experienced anaesthesiologist, as it involves a significant risk of complications, such as cardiac arrhythmias or seizures. The case is presented of a 66 year-old patient diagnosed with a renal adenocarcinoma, and who received without intention-to-cure IRE under general anaesthesia. This case represents the first time this type of technique is used in Spain.
Asunto(s)
Electroporación , Neoplasias Renales , Técnicas de Ablación , Anciano , Anestésicos , Humanos , Neoplasias Renales/cirugía , EspañaAsunto(s)
Humanos , Femenino , Persona de Mediana Edad , Enfermedad Iatrogénica , Perforación del Esófago/diagnóstico , Perforación del Esófago/cirugía , Anastomosis Quirúrgica , Fluconazol/uso terapéutico , Ganciclovir/uso terapéutico , Combinación Amoxicilina-Clavulanato de Potasio/uso terapéutico , /métodos , Enfisema/complicacionesRESUMEN
The clinical manifestations of Langerhans cell histiocytosis in the central nervous system include not only the classical involvement of the hypothalamus-hypophyseal axis, but also of other anatomic locations, with the corresponding variability of symptoms. We report here two patients with meningeal lesions. In both patients, the onset of the disease was systemic, and neurological symptoms developed some years later. Imaging studies, particularly magnetic resonance, are very sensitive tools for the diagnosis and follow-up of these lesions. The natural history of this disease is still poorly understood. In this paper we related the clinical manifestations to the morphological changes observed in imaging studies.