Cold endoscopic mucosal resection versus cold snare polypectomy for colorectal lesions: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Cold resection of colorectal lesions is widely performed because of its safety and effectiveness; however, it remains uncertain whether adding submucosal injection could improve the efficacy and safety. We aimed to compare cold endoscopic mucosal resection (C-EMR) versus cold snare polypectomy (CSP) for colorectal lesions. METHODS: We performed a systematic review of randomized controlled trials (RCTs) identified from PubMed, Cochrane Library, and Embase. The primary outcome was complete resection. Secondary outcomes were procedure time, en bloc resection, and adverse events (AEs). Prespecified subgroup analyses based on the size and morphology of the polyps were performed. The random-effects model was used to calculate the pooled risk ratio (RR) and mean difference, with corresponding 95%CIs, for dichotomous and continuous variables, respectively. Heterogeneity was assessed using the Cochran Q test and I 2 statistics. RESULTS: 7 RCTs were included, comprising 1556 patients, with 2287 polyps analyzed. C-EMR and CSP had similar risk ratios for complete resection (RR 1.02, 95%CI 0.98-1.07), en bloc resection (RR 1.08, 95%CI 0.82-1.41), and AEs (RR 0.74, 95%CI 0.41-1.32). C-EMR had a longer procedure time (mean difference 42.1 seconds, 95%CI 14.5-69.7 seconds). In stratified subgroup analyses, the risk was not statistically different between C-EMR and CSP for complete resection in polyps<10 mm or ≥10 mm, or for complete resection, en bloc resection, and AEs in the two groups among nonpedunculated polyps. CONCLUSIONS: The findings of this meta-analysis suggest that C-EMR has similar efficacy and safety to CSP, but significantly increases the procedure time. PROSPERO: CRD42023439605.

Innovation of the protocol for the application of cryolipolysis: Effects and mechanisms of action.

BACKGROUND: In recent years, aesthetic procedures aiming at body remodeling and have grown exponentially. Cryolipolysis (CLL) has stood out as a noninvasive resource that acts directly on the subcutaneous adipose tissue promoting a significant reduction of adipose tissue through of cooling that could lead to the crystallization cytoplasmic lipids, loss of cellular integrity, apoptosis/necrosis of adipocytes, and local inflammation, producing selective loss of adipose tissue. Thus, the objective of the present study was to evaluate the effects of a specific technique of CLL application on the inflammatory reactions of the target tissue in different post-application times. METHODS: This is a randomized, blind clinical study that evaluated the tissue sample of six patients after 45, 60, and 90 days of an innovative protocol for the application of CLL, with samples collected through abdominoplasty surgeries. The samples were evaluated by immunohistochemical analyses of several markers. RESULTS: A significantly greater increase in fibroblasts was observed at 45 days and greater phagocytic action at 60 days. Regarding the apoptosis process, the expression of caspase 3 and cleaved caspase 3 markers varied at different times, with cleaved caspase 3 being higher at 45 and 90 days after CLL application. CONCLUSION: The protocol of the CLL presented in this study was able to induce inflammatory responses in addition to confirming the selective apoptotic action at the different times studied.

State of the art on cryo-laser cryo-sclerotherapy in lower limb venous aesthetic treatment.

Here we describe a combination of neodymium:yttrium-aluminium-garnet 1064-nm laser emission and injection of 75% dextrose solution to treat lower limb reticular veins. The strategy is known as cryo-laser cryo-sclerotherapy. Preliminary outcomes are reported, showing ecchymosis in up to 30% of cases and intravenous thrombus in 14%. A satisfactory vessel elimination is found in 86% of cases. No improvement or worsening was reported in 14% of patients. The paper provides technical details with the aim of promoting homogeneity in future data collection, so fostering publication of long-term effectiveness and related comparative evaluation with sclerotherapy and laser treatment alone.

Noninvasive submental fat reduction using colder cryolipolysis.

BACKGROUND: Cryolipolysis has shown to significantly reduce localized subcutaneous fat, including submental fat. Temperatures below -11°C have not been used to treat the submental region. OBJECTIVE: The purpose of this study was to evaluate safety and efficacy of Cryolipolysis for noninvasive reduction of submental fat using lower temperatures and reduced treatment time. METHODS: A small volume applicator was used to treat 15 subjects, using a noninvasive tissue cooling device (CoolSculpting System, ZELTIQ Aesthetics, Pleasanton, CA, USA) during 45 and 30 minutes at -12 and -15°C, respectively, to induce reduction of submental fat. Two treatments with an interval of 10 weeks were performed. Adverse events were monitored to assess safety. Treated area was evaluated using digital photography, and caliper measurements prior treatment, 10 weeks after first treatment and 12 weeks after second treatment. All patients were also evaluated before and after 12-week postlast treatment by Magnetic Resonance Imaging (MRI). RESULTS: The mean (SD) reduction measured by skin fold caliper was 33% (3.2 mm [1.7 mm]), (95% CI, 0.2297-0.4236; P=.05), and by MRI, mean (SD) reduction was 1.78 mm (1.157 mm). Independent blinded panel was able to correctly identify 60% of before and after photographs; 12 of 15 subjects (80%) were satisfied or very satisfied with the treatment. Side effects were mild and resolved completely within 10 weeks, except for one hyperpigmentation, which resolved spontaneously within 6 months after last treatment. CONCLUSION: Cryolipolysis with colder temperature and reduced treatment time continues to be effective and is safe for noninvasive reduction of the submental fat.

Comparative efficacy and safety of contact force-sensing catheter and second-generation cryoballoon ablation for atrial fibrillation: a meta-analysis.

This meta-analysis compared the efficacy and safety of the contact force (CF)-sensing catheter and second-generation cryoballoon (CB) ablation for treating atrial fibrillation (AF). Six controlled clinical trials comparing ablation for AF using a CF-sensing catheter or second-generation CB were identified from PubMed, EMBASE, Cochrane Library, Wanfang Data, and China National Knowledge Infrastructure. The procedure duration was significantly lower in the CB group compared with that in the CF group [mean difference (MD)=29.4; 95%CI=17.84-40.96; P=0.01], whereas there was no difference between the groups for fluoroscopy duration (MD=0.59; 95%CI=-4.48-5.66; P=0.82). Moreover, there was no difference in the incidence of non-lethal complications (embolic event, tamponade, femoral/subclavian hematoma, arteriovenous fistula, pulmonary vein stenosis, phrenic nerve palsy, and esophageal injury) between the CB and the CF groups (8.38 vs 5.35%; RR=0.66; 95%CI=0.37-1.17; P=0.15). Transient phrenic nerve palsy occurred in 17 of 326 patients (5.2%) of the CB group vs none in the CF group (RR=0.12; 95%CI=0.03-0.43; P=0.001). A comparable proportion of patients in CF and CB groups suffered from AF recurrence during the 12-month follow-up after a single ablation procedure [risk ratio (RR)=1.03; 95%CI=0.78-1.35; P=0.84]. AF ablation using CF-sensing catheters and second-generation CB showed comparable fluoroscopy duration and efficacy (during a 12-month follow-up), with shorter procedure duration and different complications in the CB group.

Criocirurgía: efectos y complicaciones después del tratamiento / Cryosurgery: effects and post treatment complications / Criocirurgia: efeitos e complicações pós-tratamento

Criocirugía, a menudo referido como criocirugía o crioablación, es una técnica quirúrgica que emplea sustancias a temperaturas criogénicas para destruir tejidos y células no deseadas, especialmente neoplásicas. La muerte celular se produce debido a los efectos a corto y largo plazo de la congelación y descongelación. En todos los métodos de tratamiento quirúrgico la complicación es inherente al procedimiento, y la criocirugía no es una excepción. Este estúdio tiene como objetivo presentar las reacciones y complicaciones post-tratamiento derivados de la aplicación de la criocirugía como tratamiento curativo, adyuvante o paliativo en perros y gatos. Muchoscambios se producen en el tejido tratado por criocirugía, lo que lleva a la destrucción de las lesiones de la piel, y la respuesta del tejido varía de acuerdo com la intensidad y la profundidad de la lesión criogénica. Algunas señales, que pueden ser interpretadas como "efectos secundarios" de la criocirugía, se consideran normales y esperados, ya que representan la progresión del proceso fisiológico de congelación del tejido. Algunos efectos inmediatos observados son dolor, hemorragia, insuflación por gas y edema; Los efectos a corto plazo son: formación de ampollas, infección, granuloma piógeno, y reacciones sistémicas como fiebre; Los efectos a largo plazo son: hiperplasia seudoepiteliomatosa, hiperpigmentación, leucodermia [...]

Cryosurgery, as known as cryotherapy or cryoablation, is a surgical technique that use substances in cryogenic temperatures to destroy undesirable tissue and cells, mainly neoplastic. Cellular death occurs due to short and long term freezing and thawing effect. In all methods of surgical treatment, complications are inherent to procedure, and cryosurgery is no exception. This paper aims to show post-treatment reaction and complications of cryosurgery application as curative, adjuvant or palliative treatment in dogs and cats. Many changes occur on cryosurgical treated tissue, that leads to destruction of cutaneous lesion, and tissue response vary according to intensity and depth of cryogenic injury. Some signs, that may be interpreted as side effects of cryosurgery are expected and considered normal due to progression of freezing physiologic process. Some immediate effects are: pain, bleeding, inflation by gas and edema; short-term effects are: blistering formation, infection, pyogenic granuloma, and systemic reaction as fever; long-term effects are: pseudo-epiteliomatous hyperplasia, hyperpigmentation, leucodermia, nerve damage, coat changes, natural orifices stenosis due to scar retraction and cutaneous necrosis. Post-treatment effects depend of freezing technique, disease process, lesion size and individual response of the patient. Despite the side effects and complications [...]

A criocirurgia, muitas vezes referida como crioterapia ou crioablação, é uma técnica cirúrgica que emprega substâncias em temperaturas criogênicas para destruir tecidos ou células indesejáveis, principalmente neoplásicas. A morte celular ocorre devido aos efeitos do congelamento e descongelamento, a curto e longo prazo. Em todos os métodos de tratamento cirúrgico a complicação é inerente ao procedimento e a criocirurgia não é exceção. O presente trabalho tem como objetivo apresentar as reações e complicações pós-tratamento decorrentes da aplicação da criocirurgia como tratamento curativo, adjuvante ou paliativo em cães e gatos. Muitas mudanças ocorrem no tecido tratado criocirurgicamente, que levam à destruição da lesão cutânea, e a resposta tecidual varia de acordo com a intensidade e profundidade da injúria criogênica. Alguns sinais, que podem ser interpretados como efeitos colaterais da criocirurgia, são esperados e considerados normais porque representam a progressão do processo fisiológico do congelamento do tecido. Alguns efeitos imediatos observados são: dor, hemorragia, insuflação pelo gás e edema; efeitos a curto prazo: formação de bolhas, infecção, granuloma piogênico, e reações sistêmicas, como febre; efeitos a longo prazo: hiperplasia pseudoepiteliomatosa, hiperpigmentação, leucodermia, danos a nervos, alteração nos pelos, estenose de orifícios naturais devido a [...]

Criocirurgía: efectos y complicaciones después del tratamiento / Cryosurgery: effects and post treatment complications / Criocirurgia: efeitos e complicações pós-tratamento

Criocirugía, a menudo referido como criocirugía o crioablación, es una técnica quirúrgica que emplea sustancias a temperaturas criogénicas para destruir tejidos y células no deseadas, especialmente neoplásicas. La muerte celular se produce debido a los efectos a corto y largo plazo de la congelación y descongelación. En todos los métodos de tratamiento quirúrgico la complicación es inherente al procedimiento, y la criocirugía no es una excepción. Este estúdio tiene como objetivo presentar las reacciones y complicaciones post-tratamiento derivados de la aplicación de la criocirugía como tratamiento curativo, adyuvante o paliativo en perros y gatos. Muchoscambios se producen en el tejido tratado por criocirugía, lo que lleva a la destrucción de las lesiones de la piel, y la respuesta del tejido varía de acuerdo com la intensidad y la profundidad de la lesión criogénica. Algunas señales, que pueden ser interpretadas como "efectos secundarios" de la criocirugía, se consideran normales y esperados, ya que representan la progresión del proceso fisiológico de congelación del tejido. Algunos efectos inmediatos observados son dolor, hemorragia, insuflación por gas y edema; Los efectos a corto plazo son: formación de ampollas, infección, granuloma piógeno, y reacciones sistémicas como fiebre; Los efectos a largo plazo son: hiperplasia seudoepiteliomatosa, hiperpigmentación, leucodermia [...](AU)

Cryosurgery, as known as cryotherapy or cryoablation, is a surgical technique that use substances in cryogenic temperatures to destroy undesirable tissue and cells, mainly neoplastic. Cellular death occurs due to short and long term freezing and thawing effect. In all methods of surgical treatment, complications are inherent to procedure, and cryosurgery is no exception. This paper aims to show post-treatment reaction and complications of cryosurgery application as curative, adjuvant or palliative treatment in dogs and cats. Many changes occur on cryosurgical treated tissue, that leads to destruction of cutaneous lesion, and tissue response vary according to intensity and depth of cryogenic injury. Some signs, that may be interpreted as side effects of cryosurgery are expected and considered normal due to progression of freezing physiologic process. Some immediate effects are: pain, bleeding, inflation by gas and edema; short-term effects are: blistering formation, infection, pyogenic granuloma, and systemic reaction as fever; long-term effects are: pseudo-epiteliomatous hyperplasia, hyperpigmentation, leucodermia, nerve damage, coat changes, natural orifices stenosis due to scar retraction and cutaneous necrosis. Post-treatment effects depend of freezing technique, disease process, lesion size and individual response of the patient. Despite the side effects and complications [...](AU)

A criocirurgia, muitas vezes referida como crioterapia ou crioablação, é uma técnica cirúrgica que emprega substâncias em temperaturas criogênicas para destruir tecidos ou células indesejáveis, principalmente neoplásicas. A morte celular ocorre devido aos efeitos do congelamento e descongelamento, a curto e longo prazo. Em todos os métodos de tratamento cirúrgico a complicação é inerente ao procedimento e a criocirurgia não é exceção. O presente trabalho tem como objetivo apresentar as reações e complicações pós-tratamento decorrentes da aplicação da criocirurgia como tratamento curativo, adjuvante ou paliativo em cães e gatos. Muitas mudanças ocorrem no tecido tratado criocirurgicamente, que levam à destruição da lesão cutânea, e a resposta tecidual varia de acordo com a intensidade e profundidade da injúria criogênica. Alguns sinais, que podem ser interpretados como efeitos colaterais da criocirurgia, são esperados e considerados normais porque representam a progressão do processo fisiológico do congelamento do tecido. Alguns efeitos imediatos observados são: dor, hemorragia, insuflação pelo gás e edema; efeitos a curto prazo: formação de bolhas, infecção, granuloma piogênico, e reações sistêmicas, como febre; efeitos a longo prazo: hiperplasia pseudoepiteliomatosa, hiperpigmentação, leucodermia, danos a nervos, alteração nos pelos, estenose de orifícios naturais devido a [...](AU)

Comparative efficacy and safety of contact force-sensing catheter and second-generation cryoballoon ablation for atrial fibrillation: a meta-analysis

This meta-analysis compared the efficacy and safety of the contact force (CF)-sensing catheter and second-generation cryoballoon (CB) ablation for treating atrial fibrillation (AF). Six controlled clinical trials comparing ablation for AF using a CF-sensing catheter or second-generation CB were identified from PubMed, EMBASE, Cochrane Library, Wanfang Data, and China National Knowledge Infrastructure. The procedure duration was significantly lower in the CB group compared with that in the CF group [mean difference (MD)=29.4; 95%CI=17.84-40.96; P=0.01], whereas there was no difference between the groups for fluoroscopy duration (MD=0.59; 95%CI=-4.48-5.66; P=0.82). Moreover, there was no difference in the incidence of non-lethal complications (embolic event, tamponade, femoral/subclavian hematoma, arteriovenous fistula, pulmonary vein stenosis, phrenic nerve palsy, and esophageal injury) between the CB and the CF groups (8.38 vs 5.35%; RR=0.66; 95%CI=0.37-1.17; P=0.15). Transient phrenic nerve palsy occurred in 17 of 326 patients (5.2%) of the CB group vs none in the CF group (RR=0.12; 95%CI=0.03-0.43; P=0.001). A comparable proportion of patients in CF and CB groups suffered from AF recurrence during the 12-month follow-up after a single ablation procedure [risk ratio (RR)=1.03; 95%CI=0.78-1.35; P=0.84]. AF ablation using CF-sensing catheters and second-generation CB showed comparable fluoroscopy duration and efficacy (during a 12-month follow-up), with shorter procedure duration and different complications in the CB group.

Utilization and perioperative complications of laparoscopic cryoablation vs. robotic partial nephrectomy for localized renal tumors.

OBJECTIVE: To compare the utilization, perioperative complications and predictors of LCA versus RPN in the treatment of localized renal tumors. METHODS: From the Nationwide Inpatient Sample we identified patients undergoing RPN or LCA for the treatment of localized renal tumors from October 2008 through 2010. Patient and hospital-specific factors which predict postoperative complications and use of LCA were investigated. RESULTS: 14,275 patients with localized renal tumors were identified: 70.3% had RPN and 29.7% had LCA. LCA was more common in older patient and at hospitals without robotic consoles. No difference was identified in perioperative complications (0.2% vs. 0.2%), transfusion (5.1% vs. 6.2%), length of stay (2.9 vs. 3.0 days) or median cost ($41,753 vs. $44,618) between the groups, LCA vs. RPN. On multivariate analysis sicker patients were more likely to have LCA (OR 1.34, p=0.048) and sicker patients had greater postoperative complications (OR 3.30, p<0.001); LCA did not predict more complications (OR 1.63, p=0.138) and LCA was performed at hospitals without RCs (OR 0.02, p<0.001). Limitations include observational study design, inability to assess disease severity, operative time, or body mass index, which may affect patient selection and outcomes. CONCLUSIONS: More patients had RPN vs. LCA; surgical technique was not predictive of postoperative complications. As technology develops to treat localized renal tumors, it will be important to continue to track outcomes and costs for procedures including RPN and LCA.

Utilization and perioperative complications of laparoscopic cryoablation vs. robotic partial nephrectomy for localized renal tumors

To compare the utilization, perioperative complications and predictors of LCA versus RPN in the treatment of localized renal tumors.

Acute and Long-Term Outcomes of Catheter Ablation of Atrial Fibrillation Using the Second-Generation Cryoballoon versus Open-Irrigated Radiofrequency: A Multicenter Experience.

INTRODUCTION: There are limited comparative data on catheter ablation of atrial fibrillation (CAAF) using the second-generation cryoballoon (CB-2) versus point-by-point radiofrequency (RF). This study examines the acute/long-term CAAF outcomes using these 2 strategies. METHODS AND RESULTS: In this multicenter, retrospective, nonrandomized analysis, procedural and clinical outcomes of 1,196 patients (76% with paroxysmal AF) undergoing CAAF using CB-2 (n = 773) and open-irrigated, non-force sensing RF (n = 423) were evaluated. Pulmonary vein isolation was achieved in 98% with CB-2 and 99% with RF (P = 0.168). CB-2 was associated with shorter ablation time (40 ± 14 min vs. 66 ± 26 min; P < 0.001) and procedure time (145 ± 49 minutes vs. 188 ± 42 minutes; P < 0.001), but greater fluoroscopic utilization (29 ± 13 minutes vs. 23 ± 14 minutes; P < 0.001). While transient (7.6% vs. 0%; P < 0.001) and persistent (1.2% vs. 0%; P = 0.026) phrenic nerve palsy occurred exclusively with CB-2, other adverse event rates were similar between CB-2 (1.6%) and RF (2.6%); P = 0.207. However, freedom from AF/atrial flutter/tachycardia at 12 months following a single procedure without antiarrhythmic therapy was greater with CB-2 (76.6%) versus RF (60.4%); P < 0.001. While this difference was evident in patients with paroxysmal AF (P < 0.001), it did not reach significance in those with persistent AF (P = 0.089). Additionally, CB-2 was associated with reduced long-term need for antiarrhythmic therapy (16.7% vs. 22.0%; P = 0.024) and repeat ablations (14.6% vs. 24.1%; P < 0.001). CONCLUSION: In this multicenter, retrospective, nonrandomized study, CAAF using CB-2 coupled with RF as occasionally required was associated with greater freedom from atrial arrhythmias at 12 months following a single procedure without antiarrhythmic therapy when compared to open-irrigated, non-force sensing RF, alone.

Initial brazilian experience in the treatment of localized prostate cancer using a new generation cryotechnology: feasibility study.

INTRODUCTION: The objective of our study is to present the first Brazilian cryoablation experience in the treatment of low and intermediate risk localized prostate cancer using 3rd generation cryoablation and real-time biplanar transrectal ultrasonography. MATERIALS AND METHODS: Ten Brazilian patients underwent primary cryoablation for localized prostate cancer between October 2010 and June 2011. All patients consented for whole gland primary cryotherapy. The procedures were performed by 3rd generation cryoablation with the Cryocare System ® (Endocare, Irvine, California). Preoperative data collection included patient demographics along with prostate gland size, Gleason score, serum prostate specific antigen, and erectile function status. Operative and post--operative assessment involved estimated blood loss, operative time, complications, serum PSA level, erectile function status, urinary incontinence, biochemical disease free survival (BDFS), and follow-up time. RESULTS: All patients in the study successfully underwent whole gland cryoablation. The mean of: age, prostate size, PSA level, and Gleason score, was 66.2 years old; 40.7 g; 7.8 ng/mL; and 6 respectively. All patients were classified as low or moderate D' Amico risk (5 low and 5 moderate). Erectile dysfunction was present in 50% of patients. The estimated blood loss was minimal, operative time was 46.1 minutes. All patients that developed erectile dysfunction post-treatment responded to oral or intracavernosal medications with early penile rehabilitation. All patients maintained urinary continence by the end of a 10 months evaluation period and none had biochemical relapse within the mean follow-up of 13 months (7-15 months). CONCLUSION: Our initial experience shows that cryoablation is a minimally invasive option for the treatment of localized prostate cancer. Short term data seems to be promising but longer follow-up is necessary to verify oncological and functional results.

Initial Brazilian experience in the treatment of localized prostate cancer using a new generation cryotechnology: feasibility study

INTRODUCTION: The objective of our study is to present the first Brazilian cryoablation experience in the treatment of low and intermediate risk localized prostate cancer using 3rd generation cryoablation and real-time biplanar transrectal ultrasonography. MATERIALS AND METHODS: Ten Brazilian patients underwent primary cryoablation for localized prostate cancer between October 2010 and June 2011. All patients consented for whole gland primary cryotherapy. The procedures were performed by 3rd generation cryoablation with the Cryocare System® (Endocare, Irvine, California). Preoperative data collection included patient demographics along with prostate gland size, Gleason score, serum prostate specific antigen, and erectile function status. Operative and post-operative assessment involved estimated blood loss, operative time, complications, serum PSA level, erectile function status, urinary incontinence, biochemical disease free survival (BDFS), and follow-up time. RESULTS: All patients in the study successfully underwent whole gland cryoablation. The mean of: age, prostate size, PSA level, and Gleason score, was 66.2 years old; 40.7g; 7.8ng/mL; and 6 respectively. All patients were classified as low or moderate D'Amico risk (5 low and 5 moderate). Erectile dysfunction was present in 50% of patients. The estimated blood loss was minimal, operative time was 46.1 minutes. All patients that developed erectile dysfunction post-treatment responded to oral or intracavernosal medications with early penile rehabilitation. All patients maintained urinary continence by the end of a 10 months evaluation period and none had biochemical relapse within the mean follow-up of 13 months (7-15 months). CONCLUSION: Our initial experience shows that cryoablation is a minimally invasive option for the treatment of localized prostate cancer. Short term data seems to be promising but longer follow-up is necessary to verify oncological and functional results.

Histomorphometric assessment of bone necrosis produced by two cryosurgery protocols using liquid nitrogen: an experimental study on rat femurs

OBJECTIVE: The aim of this study was to evaluate the effects of liquid nitrogen cryosurgery on the femoral diaphysis of rats. MATERIAL AND METHODS: The femoral diaphyses of 42 Wistar rats were exposed to three local and sequential applications of liquid nitrogen for 1 or 2 min, intercalated with periods of 5 min of passive thawing. The animals were sacrificed after 1, 2, 4 and 12 weeks and the specimens obtained were processed and analyzed histomorphometrically. RESULTS: The depth and extent of peak bone necrosis were 124.509 µm and 2087.094 µm for the 1-min protocol, respectively, and 436.424 µm and 12046.426 µm for the 2-min protocol. Peak necrosis was observed in the second experimental week with both cryotherapy protocols. CONCLUSIONS: The present results indicate that the 2-min protocol produced more marked bone necrosis than the 1-min protocol. Although our results cannot be entirely extrapolated to clinical practice, they contribute to the understanding of the behavior of bone tissue submitted to different cycles of liquid nitrogen freezing and may serve as a basis for new studies.

Pain evaluation in the cryosurgery of actinic keratoses.

BACKGROUND: Background: Actinic keratosis is a frequently-encountered premalignant lesion occurring in areas exposed to sunlight in fair-skinned elderly or middle-aged people. Cryosurgery with liquid nitrogen is the most common method for treating the lesions. OBJECTIVES: The primary objective of this study was to measure the intensity of pain during cryosurgery by using the Visual Analog Scale (VAS). We also sought to identify the pain level deemed appropriate by the patient, to assess the proportion of patients who considered it necessary to reduce the pain and, finally, to gauge whether or not additional analgesia was required. METHODS: Cross-sectional study with patients referred for cryosurgical treatment of actinic keratoses to the Sanitary Dermatology Outpatient Clinic. We applied a questionnaire to 112 patients [48 men (42.8%) and 64 women (57.2%)] after their treatment for actinic keratoses, asking them to assess the intensity of pain experienced during surgery and the pain that they considered to be bearable or appropriate for the procedure. RESULTS: The mean referred pain during surgery was 32.85 mm on the Visual Analog Scale, while the mean pain deemed appropriate by the patients was 23.01 mm. The difference between the two means was statistically significant (p <0.05). 30.4% of the patients reported in the direct and objective questionnaire that they needed the pain to be reduced. CONCLUSIONS: Although the level of pain considered to be appropriate by the patients was statistically lower than the referred pain, it did not reach the level at which it would be judged necessary to provide additional analgesia in this type of intervention.

Avaliação da dor em criocirurgia de ceratoses actínicas / Pain evaluation in the cryosurgery of actinic keratoses

FUNDAMENTOS: a ceratose actínica é lesão pré-maligna frequente, que ocorre em áreas expostas à luz solar, em pessoas idosas ou adultas de meia-idade e pele clara. A criocirurgia com nitrogênio líquido é a modalidade mais comum para o tratamento de ceratoses actínicas. OBJETIVOS: o objetivo primário deste estudo foi medir a intensidade da dor durante a criocirurgia, por meio da Escala Visual Análoga. Também buscou-se identificar o nível de dor considerado adequado pelo paciente, avaliar a proporção de pacientes que consideram necessária a diminuição da dor sentida e verificar a necessidade ou não de analgesia suplementar. MÉTODOS: Estudo transversal com pacientes encaminhados para terapêutica criocirúrgica de ceratoses actínicas no Ambulatório de Dermatologia Sanitária. Foram avaliados 112 pacientes, após tratamento de ceratoses actínicas, aplicando-se um questionário com perguntas sobre a intensidade da dor sentida durante o procedimento cirúrgico, assim como a dor considerada confortável ou adequada ao procedimento. RESULTADOS: participaram 48 homens (42,8 por cento) e 64 mulheres (57,2 por cento). A média da dor referida durante o procedimento cirúrgico, medida em milímetros na Escala Visual Análoga, foi de 32,85 mm; a média da dor considerada adequada pelos pacientes foi de 23,01 mm. A diferença entre as duas médias foi estatisticamente significativa (p<0,05). Em questionário objetivo e direto, a percentagem de pacientes que referiu ser necessária a diminuição da dor foi 30,4 por cento. CONCLUSÕES: embora a dor considerada adequada seja menor estatisticamente do que a sentida, não alcança níveis suficientes para que seja atribuída a necessidade de método de analgesia suplementar neste tipo de intervenção.

BACKGROUND: Background: Actinic keratosis is a frequently-encountered premalignant lesion occurring in areas exposed to sunlight in fair-skinned elderly or middle-aged people. Cryosurgery with liquid nitrogen is the most common method for treating the lesions. OBJECTIVES: The primary objective of this study was to measure the intensity of pain during cryosurgery by using the Visual Analog Scale (VAS). We also sought to identify the pain level deemed appropriate by the patient, to assess the proportion of patients who considered it necessary to reduce the pain and, finally, to gauge whether or not additional analgesia was required. METHODS: Cross-sectional study with patients referred for cryosurgical treatment of actinic keratoses to the Sanitary Dermatology Outpatient Clinic. We applied a questionnaire to 112 patients [48 men (42.8 percent) and 64 women (57.2 percent)] after their treatment for actinic keratoses, asking them to assess the intensity of pain experienced during surgery and the pain that they considered to be bearable or appropriate for the procedure. RESULTS: The mean referred pain during surgery was 32.85 mm on the Visual Analog Scale, while the mean pain deemed appropriate by the patients was 23.01 mm. The difference between the two means was statistically significant (p <0.05). 30.4 percent of the patients reported in the direct and objective questionnaire that they needed the pain to be reduced. CONCLUSIONS: Although the level of pain considered to be appropriate by the patients was statistically lower than the referred pain, it did not reach the level at which it would be judged necessary to provide additional analgesia in this type of intervention.

660 AsGaAl laser to alleviate pain caused by cryosurgical treatment of oral leukoplakia: a preliminary study.

OBJECTIVE: To investigate the ability of low-level laser therapy (LLLT) to alleviate pain caused by the cryosurgical treatment of oral leukoplakia (OL). METHODS: Ten patients with OL were submitted to cryosurgical treatment (Non-LLLT group) and eight were submitted to cryosurgical treatment associated with LLLT (LLLT group). Laser irradiation of patients within the LLLT group was performed using a 50 mW 660 nm continuous wave Gallium Aluminum Arsenide (GaAlAs) laser with a spot size at the tissue surface of 0.0286 cm(2) (irradiance = 1.75 W/cm(2)). Three points within an area of 1 cm(2) around the cryosurgical site were irradiated in contact mode for 28 s per point (1.4 J at 49 J/cm(2) per point). Irradiation was carried out immediately following cryosurgical treatment and at 48 and 72 h post-cryosurgical treatment. A numerical rating scale was used to assess the pain. The relationship between the treated groups and pain was assessed using the Mann-Whitney test. RESULTS: Treated OL sites appeared to be clinically normal and with no evidence of recurrence during the average 9-month follow-up period. It could be observed that the LLLT group reported less pain than did the non-LLLT group. CONCLUSION: LLLT is an important strategy used to reduce post-surgical pain caused by cryosurgical treatment of OL.

Histomorphometric assessment of bone necrosis produced by two cryosurgery protocols using liquid nitrogen: an experimental study on rat femurs.

OBJECTIVE: The aim of this study was to evaluate the effects of liquid nitrogen cryosurgery on the femoral diaphysis of rats. MATERIAL AND METHODS: The femoral diaphyses of 42 Wistar rats were exposed to three local and sequential applications of liquid nitrogen for 1 or 2 min, intercalated with periods of 5 min of passive thawing. The animals were sacrificed after 1, 2, 4 and 12 weeks and the specimens obtained were processed and analyzed histomorphometrically. RESULTS: The depth and extent of peak bone necrosis were 124.509 µm and 2087.094 µm for the 1-min protocol, respectively, and 436.424 µm and 12046.426 µm for the 2-min protocol. Peak necrosis was observed in the second experimental week with both cryotherapy protocols. CONCLUSIONS: The present results indicate that the 2-min protocol produced more marked bone necrosis than the 1-min protocol. Although our results cannot be entirely extrapolated to clinical practice, they contribute to the understanding of the behavior of bone tissue submitted to different cycles of liquid nitrogen freezing and may serve as a basis for new studies.