Tadeusz Krwawicz, MD: The inventor of cryosurgery in ophthalmology.

Tadeusz Krwawicz (1910-1988) pioneered the use of cryosurgery in, as ophthalmology. The idea arose in 1959 while experimenting because on lyophilization to store corneas and lenses for transplantation it was difficult to remove the lens without damage the capsule was usually torn. Subsequent experiments on rabbits revealed that touching the lens with a wire cooled to 203°K (-70°C) resulted in firm attachment of the lens capsule and subcapsular masses. A cryoextractor was developed and employed for clinical use in cataract extraction, likewise in intumescent cataracts and lens subluxation. Cataract surgery utilizing cryoextraction led to substantial progress to ophthalmology by reducing the number of complications, particularly capsule rupture, and resulted in achieving better outcome compared to other methods. This surgery soon and for almost 20 years became a routine method used all around the world in cataract removal. Simultaneously, Krwawicz developed techniques for corneal refractive surgery-partial lamellar removal of the corneal stroma and temporary interlaminar introduction of a plastic disk in order to change the corneal curvature. Krwawicz presented other ophthalmic interests-his research concerned immunology, histology, histochemistry, biochemistry of ocular tissue, and mainly corneal and experimental surgery with a particular focus on the pathology of the cornea.

Technological aspects of delivering cryotherapy for prostate cancer.

Since the era of prostate specific antigen (PSA) testing, there has been a stage and grade migration seen with prostate cancer along with a reduction in mortality. Subsequently, concerns have been raised about the over treatment of patients following the diagnosis of localized prostate cancers. Cryotherapy, in which extremely low temperatures induce cell death via multiple mechanisms, has seen a drastic improvement in its technology since the 1800s. Such advances have improved oncological outcomes while reducing complication rates. Furthermore, technological advances have allowed the development of focal cryotherapy which aims to reduce morbidity associated with more radical whole-gland therapies. There is growing evidence that focal cryotherapy provides good oncological and morbidity rates when compared with traditional radical/whole-gland therapies.

Advances in clinical application of cryoablation therapy for hepatocellular carcinoma and metastatic liver tumor.

Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. Although surgical resection and liver transplantation are the curative treatments, many of HCC patients do not qualify for these curative therapies at the presentation. Thus, ablation therapies are currently important modalities in HCC treatment. Among currently available ablation therapies, cryoablation (ie, cryotherapy) is a novel local therapeutic modality. However, cryoablation has not been widely used as one of ablation therapies for HCC, because of historical concerns about risk of bleeding when cryotherapy is delivered by early generation of the argon-helium device. Nevertheless, with technological advances and increased clinical experience in the past decade, clinical application of cryoablation for HCC management has significantly increased. Accumulating data have demonstrated that cryoablation is highly effective in local tumor control with well-acceptable safety profile, and the overall survival is comparable with that of radiofrequency ablation in patients with tumors <5 cm. Compared with radiofrequency ablation and other thermal-based modalities, cryoablation has several advantages, such as the ability to produce larger and precise zones of ablation. This article systemically reviews the advances in clinical application of cryoablation therapy for HCC, including the related mechanisms and technology, clinical indications, efficacy and safety profiles, and future research directions.

[Cryoablation in urology].

Modern science opens up new potentials for the effective treatment of complex diseases using minimally invasive techniques. One of the obvious achievements of recent years is cryoablation - technology of local freezing of tissues, allowing to create a precision zone of tumor cell death in renal cancer and prostate cancer. The literature review presents historical information, highlighting the main stages in the development of cryosurgery since the XIX century. The analysis of domestic and foreign literature has shown that in urological practice cryoablation has been widely used. Based on the literature data, indications, contraindications and complications of cryoablation in renal cancer and prostate cancer, as well as long-term results of treatment are discussed. Cryoablation has been used actively abroad; in the Russia, method is developing, but without a doubt, will be actively introduced in medical practice.

Percutaneous renal cryoablation: current status.

Over the last 13 years, renal cryoablation has emerged as a promising technique for the treatment of solid renal tumors. The improvement in imaging modalities such as ultrasound, computed tomography and MRI, as well as the introduction of thinner probes, has led to the spread of the minimally invasive percutaneous approach. We review the historical background of percutaneous renal cryoablation (PRC), present its basic principles, mention the contemporary clinical data and outcomes of this technique and suggest future directions for its wider application in renal tumors. Early results have demonstrated that it may offer an alternative for the treatment of small renal masses with the advantages of minimal complications, spared renal function, decreased overall costs and equivalent oncologic efficacy. Long-term results are required in order to apply this minimally invasive technique to a broader spectrum of patients.

Cold as a therapeutic agent.

The use of cold as a therapeutic agent has a long and colorful history. The Edwin Smith Papyrus, the most ancient medical text known, dated 3500 B.C., made numerous references to the use of cold as therapy. Baron de Larrey, a French army surgeon during Napoleon's Russian campaign, packed the limbs in ice prior to amputations to render the procedures painless. In the early twentieth century, a neurosurgeon, Temple Fay, pioneered "human refrigeration" as a treatment for malignancies and head injuries. In 1961, Irving Cooper developed the first closed cryoprobe system and ushered in the modern era of cryogenic surgery with his imperturbable convictions. Fay's early work fell victim to the disruptive sequel of the World War II. The Nazis confiscated his data (presented before the Third International Cancer Congress in 1939) forwarded to Belgium for publication and brutally applied his refrigeration techniques experimentally without any benefit of anesthesia in the concentration camps, especially Dachau. Hypothermia became associated in the public mind with the atrocities exposed at the war trials in Nürnberg. After lying dormant for decades, the interest was rekindled in the late 80s when mild hypothermia was shown to confer dramatic neuroprotection in a number of experimental models of brain injury. With several large multi-center clinical studies currently under way, hypothermia is receiving unprecedented attention from the medical and scientific communities.

Cryosurgery.

Cryosurgery is a surgical technique that employs freezing to destroy undesirable tissue. Developed first in the middle of the nineteenth century it has recently incorporated new imaging technologies and is a fast growing minimally invasive surgical technique. A historical review of the field of cryosurgery is presented, showing how technological advances have affected the development of the field. This is followed by a more in-depth survey of two important topics in cryosurgery: (a) the biochemical and biophysical mechanisms of tissue destruction during cryosurgery and (b) monitoring and imaging techniques for cryosurgery.

Irving S. Cooper (1922-1985): a pioneer in functional neurosurgery.

Irving S. Cooper (1922-1985), the son of a salesman, worked his way through high school, college, and medical school to become one of the pioneers in functional neurosurgery. He developed several novel techniques for the surgical management of Parkinson's disease and other crippling movement disorders. A keen interest in the physiology of movement disorders was kindled by his doctoral research and continued during his neurosurgical training. He began to apply this knowledge to surgical practice in 1952 when he began his faculty career as Assistant Professor of Surgery at New York University. At the time, surgical treatment of parkinsonian tremor focused on various techniques used to interrupt the pyramidal tract. During a subtemporal approach for a cerebral pedunculotomy, he inadvertently injured and, subsequently, was forced to occlude the anterior choroidal artery. Much to Cooper's surprise, following emergence from anesthesia the patient's tremor and rigidity were abolished without any residual hemiparesis. This serendipitous observation, together with Meyer's earlier work on the role of the basal ganglia in motor control, helped focus surgical efforts on targets within the basal ganglia and, subsequently, within the thalamus to alleviate the movement disorders associated with Parkinson's disease. While at New York University, Cooper developed chemopallidectomy and, later at St. Barnabas Hospital in the Bronx (1954-1977), he used cryothalamectomy as a surgical technique for primary control of tremor in patients with Parkinson's disease. Cooper authored many original papers on surgical techniques and several textbooks on the lives of patients afflicted with Parkinson's disease and other crippling movement disorders. Although considered controversial, this fascinating and complex neurosurgeon made significant contributions to this field.

History of direct vision internal urethrotomy.

Throughout medical history, the treatment of urethral strictures ranged from catheterization, the insertion of bougies, and the application of caustics to different methods of dilation, blind internal urethrotomy, and open surgery. The rise of endoscopy in the 19th century added the possibility of direct vision internal urethrotomy to this therapeutic spectrum. The development of this endourologic method is recapitulated from the first report in 1865 to the gold standard of cold knife urethrotomy in 1971 and later modifications (eg, advanced laser techniques).

History of cryosurgery.

The use of freezing temperatures for the therapeutic destruction of tissue began in England in 1845-51 when James Arnott described the use of iced salt solutions (about-20 degrees C) to freeze advanced cancers in accessible sites, producing reduction in tumor size and amelioration of pain. Improved freezing techniques were possible early in the 1990s when solidified carbon dioxide came into use and later when liquid nitrogen and nitrous oxide became available. Nevertheless, cryotherapy was a minor technique, used only for the accessible lesions of skin and mucosa. With the development of modern cryosurgical apparatus by Cooper in 1961, a resurgence of interest in cryosurgery was initiated and techniques for diverse clinical conditions, including visceral cancer, evolved, After the initial widespread clinical trials matured in the 1970s, some applications of the technique fell into disuse while others became standard treatment. Late in the 1980s, further improvements in apparatus and imaging techniques have permitted increased clinical use in neoplastic disease, including visceral cancer.

[Thirty years of cryo-ophthalmology. Work dedicated to the memory of Dr. Tadeusz Krwawicz]. / Trzydziesci lat rozwoju kriooftalmologii. Praca poswiecona pamieci prof. dr hab. Tadeusza Krwawicza.

It is 30 years since Krwawicz presented a new method of cataract surgery at low temperature. This operation was not only widely accepted, but also showed the possibilities of the use of low temperature in medicine. It soon became apparent that such methods might be helpful in treating a number of eye diseases. This was beginning of a new branch of ophthalmology, cryoophthalmology. The paper presents its development, its position in ophthalmology and the latest achievements. After the 30 years, cryoophthalmology has preserved its importance and its constant evolution; it remains the subject of investigations of many research centres.

Criocirugía / Cryosurgery

Se analiza la criocirugía como un método físico destinado a la destrucción selectiva de tejidos. Se realiza una breve reseña de la historia desde Hipócrates hasta la fecha, pasando por James Arnott, Temple Fay, Irving Cooper, Setrag Zacarian, Andrew Gade, Douglas Torre, etc., colegas que entre otros contribuyeron con sus investigaciones para dar el soporte científico de la moderna Criocirugía. Se expone el mecanismo de acción con sus diferentes fases y finalmente se brinda una detallada lista de indicaciones y contraindicaciones en el área dermatológica. Se destaca la importancia del Programa de Educación Continua para su práctica

Criocirugía / Cryosurgery

Se analiza la criocirugía como un método físico destinado a la destrucción selectiva de tejidos. Se realiza una breve reseña de la historia desde Hipócrates hasta la fecha, pasando por James Arnott, Temple Fay, Irving Cooper, Setrag Zacarian, Andrew Gade, Douglas Torre, etc., colegas que entre otros contribuyeron con sus investigaciones para dar el soporte científico de la moderna Criocirugía. Se expone el mecanismo de acción con sus diferentes fases y finalmente se brinda una detallada lista de indicaciones y contraindicaciones en el área dermatológica. Se destaca la importancia del Programa de Educación Continua para su práctica