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1.
Medicine (Baltimore) ; 98(41): e17333, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593082

RESUMO

Patients with structural heart disease (SHD) are more difficult to ablate than those with a structurally healthy heart. The reason may be technical problems. We compared periprocedural data in unselected patients (including SHD group) recruited for zero-fluoroscopy catheter ablation (ZF-CA) of supraventricular arrhythmias (SVTs).Consecutive adult patients with atrioventricular nodal reentry tachycardia (AVNRT), accessory pathways (AP), atrial flutter (AFL), and atrial tachycardia (AT) were recruited. A 3-dimensional electroanatomical mapping system (Ensite Velocity, NavX, St Jude Medical, Lake Bluff, Illinois) was used to create electroanatomical maps and navigate catheters. Fluoroscopy was used on the decision of the first operator after 5 minutes of unresolved problems.Of the 1280 patients ablated with the intention to be treated with ZF approach, 174 (13.6%) patients with SHD (age: 58.2 ±â€Š13.6; AVNRT: 23.9%; AP: 8.5%; AFL: 61.4%; and AT: 6.2%) were recruited. These patients were compared with the 1106 patients with nonstructural heart disease (NSHD) (age: 51.4 ±â€Š16.4; AVNRT: 58.0%; AP: 17.6%; AFL: 20.7%; and AT: 3.7% P ≤ .001). Procedural time (49.9 ±â€Š24.6 vs 49.1 ±â€Š23.9 minutes, P = .55) and number of applications were similar between groups (P = 0.08). The rate of conversion from ZF-CA to fluoroscopy was slightly higher in SHD as compared to NSHD (13.2% vs 7.8%, P = .02) while the total time of fluoroscopy and radiation doses were comparable in the group of SHD and NSHD (P = .55; P = .48).ZF-CA is feasible and safe in majority of patients with SHD and should be incorporated into a standard approach for SHD; however, the procedure requires sufficient experience.


Assuntos
Arritmias Cardíacas/cirurgia , Ablação por Cateter/métodos , Fluoroscopia/métodos , Cardiopatias Congênitas/cirurgia , Taquicardia Supraventricular/cirurgia , Adulto , Idoso , Arritmias Cardíacas/congênito , Estudos de Viabilidade , Feminino , Cardiopatias Congênitas/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Taquicardia Supraventricular/congênito , Resultado do Tratamento
2.
Br J Radiol ; 92(1103): 20190183, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31509441

RESUMO

OBJECTIVE: To evaluate the effectiveness of contrast-enhanced ultrasound (CEUS) in detecting incomplete ablation and local recurrence of renal tumors after percutaneous radiofrequency ablation (RFA). METHODS: 31 patients were included for RFA treatment and underwent CEUS examination after RFA, ablation zone and contrast distribution in the ablation area were observed, CEUS images were compared with enhanced CT/MRI images to determine the residual tumors and local recurrence of renal tumors. RESULTS: The average maximum diameters of the tumor and the ablation zone after the first RFA were 32.3 ± 14.7 mm and 35.9 ± 12.2 mm, respectively. A higher rate of complete tumor ablation was achieved if the ablation zone was larger than the primary tumor (p = 0.026). Within 1 month after RFA, contrast-enhanced CT/MRI examinations demonstrated incomplete ablation in 9 of 31 patients (29.0%), while CEUS revealed incomplete ablation in 8 of 31 patients (25.8%). The sensitivity, specificity, positive predictive value and negative predictive value of CEUS in evaluating complete ablation of renal tumors were 88.9%, 100%, 100%, 95.7%, respectively. During the follow-up period, local recurrence was reported in 2 (7.4%) of the 27 patients with complete tumor ablation. Tumor recurrence signs in the two patients were identified by both CEUS and contrast-enhanced CT/MRI. Therefore, both the sensitivity and specificity of CEUS for the evaluation of tumor recurrence were 100%. CONCLUSION: After percutaneous RFA of renal tumors, the effectiveness of CEUS in the follow-up assessment of residual and recurrent tumors is basically the same as that of contrast-enhanced CT/MRI. ADVANCES IN KNOWLEDGE: In this study, we evaluated the effectiveness of CEUS in the follow-up assessment of residual and recurrent tumors after RFA is basically the same as that of contrast-enhanced CT/MRI. Combining multiple follow-up methods may improve the detection rate of residual or recurrent tumors.


Assuntos
Ablação por Cateter/métodos , Neoplasias Renais/cirurgia , Adulto , Idoso , Meios de Contraste , Feminino , Humanos , Biópsia Guiada por Imagem/métodos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/patologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/patologia , Cuidados Pós-Operatórios/métodos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Carga Tumoral , Ultrassonografia
3.
Braz J Med Biol Res ; 52(9): e8446, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31482999

RESUMO

Left atrial diameter (LAD) has been considered an independent risk factor for atrial fibrillation (AF) relapse after pulmonary vein isolation (PVI). However, whether LAD or other factors are more predictive of late recurrence in patients with paroxysmal AF remains unclear. We aimed to evaluate the value of pulmonary vein (PV) parameters for predicting AF relapse 1 year after patients underwent cryoablation for paroxysmal AF. Ninety-seven patients with paroxysmal AF who underwent PVI successfully were included. PV parameters were measured through computed tomography scans prior to PVI. A total of 28 patients had recurrence of AF at one-year follow-up. The impact of several variables on recurrence was evaluated in multivariate analyses. LAD and the time from first diagnosis of AF to ablation maintained its significance in predicting the relapse of AF after relevant adjustments in multivariate analysis. When major diameter of right inferior pulmonary vein (RIPV) (net reclassification improvement (NRI) 0.179, CI=0.031-0.326, P<0.05) and cross-sectional area (CSA) of RIPV (NRI: 0.122, CI=0.004-0.240, P<0.05) entered the AF risk model separately, the added predictive capacity was large. The accuracy of the two parameters in predicting recurrence of AF were not inferior (AUC: 0.665 and 0.659, respectively) to echocardiographic LAD (AUC: 0.663). The inclusion of either RIPV major diameter or CSA of RIPV in the model increased the C-index (0.766 and 0.758, respectively). We concluded that major diameter of RIPV had predictive capacity similar to or even better than that of LAD for predicting AF relapse after cryoablation PVI.


Assuntos
Fibrilação Atrial/etiologia , Átrios do Coração/anatomia & histologia , Veias Pulmonares/anatomia & histologia , Idoso , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Criocirurgia/métodos , Feminino , Átrios do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Veias Pulmonares/diagnóstico por imagem , Recidiva , Fatores de Risco , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , Resultado do Tratamento
4.
Braz J Cardiovasc Surg ; 34(4): 495-498, 2019 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-31454207

RESUMO

Management of symptomatic atrial tachycardia (AT) during pregnancy seems challenging, especially those originating from left atrial appendage (LAA), which easily tend to be incessant and mediate cardiomyopathy. It's contradictory between therapy and pregnancy. In this study, we report a case of a woman who presented with persistent AT, which lead to heart failure, during early pregnancy. She underwent successful catheter ablation using CartoSound and electroanatomic mapping without fluoroscopy. An electrophysiology (EP) study confirmed a focal LAA tachycardia. Soon after, left ventricular function of her heart normalized, and the patient successfully delivered a healthy child.


Assuntos
Apêndice Atrial/cirurgia , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Complicações Cardiovasculares na Gravidez/cirurgia , Adulto , Apêndice Atrial/diagnóstico por imagem , Fibrilação Atrial/diagnóstico por imagem , Eletrocardiografia , Eletrofisiologia , Feminino , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem
5.
Presse Med ; 48(7-8 Pt 2): e245-e250, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31445698

RESUMO

Embolization and percutaneous ablations became well-established therapeutic options for hepatocellular carcinomas (HCC). All are performed under minimally invasive conditions using imaging guidance. Selection of a technique over another follows guidelines but also patient's status and availability of the techniques. The aim of this review is to present these techniques performed in routine to treat HCC and to report the outcomes.


Assuntos
Carcinoma Hepatocelular/cirurgia , Ablação por Cateter/métodos , Neoplasias Hepáticas/cirurgia , Cirurgia Assistida por Computador/métodos , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/patologia , Ablação por Cateter/efeitos adversos , Ablação por Cateter/estatística & dados numéricos , Terapia Combinada , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/métodos , Humanos , Fígado/irrigação sanguínea , Fígado/patologia , Fígado/cirurgia , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/patologia , Radioterapia Guiada por Imagem/efeitos adversos , Radioterapia Guiada por Imagem/métodos , Cirurgia Assistida por Computador/efeitos adversos , Cirurgia Assistida por Computador/estatística & dados numéricos , Resultado do Tratamento
6.
Presse Med ; 48(7-8 Pt 2): e233-e243, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31445699

RESUMO

The rise in incidentally discovered small renal neoplasms has focused attention on nephron-sparing treatment strategies including partial nephrectomy and percutaneous ablation as well as active surveillance. As all treatment modality, renal ablation has matured technically. Radiofrequency ablation, microwave ablation or cryoablation are now performed in many institutions under imaging guidance. The long-term results allow them to be now recommended as a therapeutic option whatever the patients' condition if complete ablation can reliably be achieved.


Assuntos
Carcinoma de Células Renais/cirurgia , Ablação por Cateter , Neoplasias Renais/cirurgia , Nefrectomia , Cirurgia Assistida por Computador , Carcinoma de Células Renais/epidemiologia , Carcinoma de Células Renais/patologia , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Intervalo Livre de Doença , Humanos , Neoplasias Renais/epidemiologia , Neoplasias Renais/patologia , Nefrectomia/efeitos adversos , Nefrectomia/métodos , Seleção de Pacientes , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Cirurgia Assistida por Computador/efeitos adversos , Cirurgia Assistida por Computador/métodos , Fatores de Tempo , Resultado do Tratamento
7.
Presse Med ; 48(7-8 Pt 2): e219-e231, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31447333

RESUMO

Image-guided ablation is performed by percutaneously introducing ablation probes to deliver energy into a tumor to destroy it in a controlled and localized fashion. Ablation modalities can be broadly classified as thermal or non-thermal based on the mechanism of tumor destruction and are performed using different types of image guidance for planning, delivering and follow-up of the treatment. Ablation is performed in a minimally invasive fashion, providing greater residual organ preservation with minimal morbidity to the patient. Image-guided ablation is being used in the clinic for the treatment of primary and metastatic tumors, and this article reviews state of the art for the treatment of malignancies in the liver, lung, kidney and musculoskeletal tissue.


Assuntos
Ablação por Cateter/métodos , Neoplasias/cirurgia , Cirurgia Assistida por Computador/métodos , Ablação por Cateter/efeitos adversos , Tecido Conjuntivo/patologia , Tecido Conjuntivo/cirurgia , Humanos , Rim/patologia , Rim/cirurgia , Fígado/patologia , Fígado/cirurgia , Pulmão/patologia , Pulmão/cirurgia , Sistema Musculoesquelético/patologia , Sistema Musculoesquelético/cirurgia , Neoplasias/diagnóstico , Neoplasias/patologia , Especificidade de Órgãos , Complicações Pós-Operatórias/etiologia , Cirurgia Assistida por Computador/efeitos adversos , Resultado do Tratamento
8.
Presse Med ; 48(7-8 Pt 2): e251-e256, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31447338

RESUMO

Cancer patients quite commonly will report different types of pain associated with the disease substrate. Systemic analgesia and radiotherapy provide only partial pain relief in the majority of these patients. Interventional Oncology techniques for pain management and mobility improvement in cancer patients include percutaneous techniques such as neurolysis, ablation and augmentation (both in the spine and peripheral skeleton) as well as trans-arterial embolization. Percutaneous neurolysis acts indirectly providing regional anesthesia whilst the rest of the aforementioned techniques act directly upon the tumor either by inhibiting local growth or by providing stability and skeletal augmentation. Whenever possible, techniques such as ablation and trans-arterial embolization apart from pure palliation may add to the principle of local tumor control. The aim of this review is to provide details concerning the Interventional Oncology techniques used for cancer pain management and to address the necessity for a tailored-based approach applying different techniques or combinations of them in different cases and locations.


Assuntos
Dor do Câncer/terapia , Oncologia/métodos , Neoplasias/terapia , Manejo da Dor/métodos , Cuidados Paliativos/métodos , Anestesia por Condução , Osso e Ossos/cirurgia , Ablação por Cateter/métodos , Embolização Terapêutica/métodos , Humanos , Oncologia/tendências , Neoplasias/complicações , Bloqueio Nervoso/métodos , Cuidados Paliativos/tendências , Coluna Vertebral/patologia , Coluna Vertebral/cirurgia , Vertebroplastia/métodos
9.
Int Heart J ; 60(5): 1192-1195, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31447464

RESUMO

Here we report two young patients with atrial fibrillation/atrial flutter complicated with cardiogenic cerebral embolism. Electrophysiological study revealed a large area of low-voltage zone or area of electric silence in both sides of the atrium during restoration of sinus rhythm, and the echocardiogram showed loss of mechanical function of the atrium. The electrical-mechanical dysfunction of the atrium was considered to be the cause of embolic event in this type of patient who was "very low" stroke risk atrial fibrillation or atrial flutter. The idiopathic, fibrotic atrial cardiomyopathy may be underlying in these patients.


Assuntos
Fibrilação Atrial/complicações , Flutter Atrial/complicações , Ablação por Cateter/métodos , Eletrocardiografia/métodos , Acidente Vascular Cerebral/etiologia , Adulto , Fatores Etários , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Flutter Atrial/diagnóstico , Flutter Atrial/cirurgia , Mapeamento Potencial de Superfície Corporal/métodos , China , Feminino , Seguimentos , Humanos , Masculino , Doenças Raras , Medição de Risco , Amostragem , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia
10.
Med Clin North Am ; 103(5): 835-846, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378329

RESUMO

Atrial fibrillation (AF) is the most common arrhythmia and its management may be organized into risk stratification and/or treatment of heart failure, stroke prevention, and symptom control. At the core of symptom control, treatment is tailored to either allow AF continue with controlled heart rates, so-called rate control, versus restoring and maintaining sinus rhythm or rhythm control. Rate control strategies mainly use rate-modulating medications, whereas rhythm control treatment includes therapy aimed at restoring sinus rhythm, including pharmacologic and direct current cardioversion, as well as maintenance of sinus rhythm, including antiarrhythmic medications and ablation therapy.


Assuntos
Antiarrítmicos/administração & dosagem , Fibrilação Atrial/terapia , Ablação por Radiofrequência/métodos , Antiarrítmicos/uso terapêutico , Ablação por Cateter/métodos , Ensaios Clínicos como Assunto , Gerenciamento Clínico , Humanos , Medição de Risco
11.
Med Clin North Am ; 103(5): 863-879, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378331

RESUMO

The term paroxysmal supraventricular tachycardia encompasses a heterogeneous group of arrhythmias with different electrophysiologic characteristics. Knowledge of the mechanism of each supraventricular tachycardia is important in determining management in the office, at the bedside, and in the electrophysiology laboratory. Paroxysmal supraventricular tachycardias have an abrupt onset and offset, typically initiating and terminating with premature atrial ectopic beats. In the acute setting, both vagal maneuvers and pharmacologic therapy can be effective in arrhythmia termination. Catheter ablation has revolutionized therapy for many supraventricular tachycardias, and newer techniques have significantly improved ablation efficacy and decreased periprocedural complications and procedure times.


Assuntos
Antiarrítmicos/administração & dosagem , Ablação por Cateter/métodos , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/terapia , Eletrocardiografia , Humanos , Taquicardia Supraventricular/fisiopatologia , Resultado do Tratamento
12.
Medicine (Baltimore) ; 98(32): e16642, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393361

RESUMO

RATIONALE: Tachycardia-induced cardiomyopathy (TIC) is defined as systolic and/or diastolic dysfunction of the left ventricle resulting from prolonged elevated heart rates, completely reversible upon control of the arrhythmia. Atrioventricular reentrant tachycardia (AVRT) is one of the most frequent causes of TIC. In its incessant form, it is unlikely to be controlled by pharmacological treatment, catheter ablation being the principal therapeutic option. The coexistence of left bundle branch block (LBBB) in patients with AVRT may cause difficulties in the early diagnosis and management of tachycardia because of the wide complex morphology, making it harder to localize the accessory pathway (AP). PATIENT CONCERNS: A 60-year-old woman, presented incessant episodes of palpitations and shortness of breath due to a LBBB tachycardia leading to hemodynamic instability. DIAGNOSIS: The patient had a wide QRS tachycardia, with LBBB morphology and a heart rate of 160/minute. Echocardiography showed global hypokinesia with 25% left ventricular ejection fraction (LVEF). Considering the patient's clinical picture, TIC was suspected. INTERVENTIONS: The electrophysiological study revealed a left lateral accessory pathway. Catheter ablation was successfully performed at the level of the lateral mitral ring. OUTCOMES: One week after the ablation the patient had no signs of heart failure and the LVEF normalized to 55%. During 6-months follow-up the patient presented no more episodes of tachycardia or heart failure and the LVEF remained normal. LESSONS: AVRT is rarely associated with intrinsic LBBB, being a potential cause of TIC. In these patients, it is unlikely to control the arrhythmia pharmacologically, catheter ablation being the best therapeutic option. The variation of QRS complex duration between LBBB pattern in SR and AVRT could be useful for early diagnosis of an ipsilateral AP on surface ECG.


Assuntos
Bloqueio de Ramo/cirurgia , Ablação por Cateter/métodos , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Bloqueio de Ramo/complicações , Bloqueio de Ramo/diagnóstico , Cardiomiopatias/diagnóstico , Cardiomiopatias/etiologia , Ecocardiografia , Eletrocardiografia , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Volume Sistólico , Taquicardia por Reentrada no Nó Atrioventricular/complicações
13.
Radiol Med ; 124(10): 1043-1048, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31270723

RESUMO

AIM: Evaluating clinical and technical factors affecting thermal ablation of B-Mode/CEUS inconspicuous HCC nodules, relying only on fusion imaging (FI) performed under conscious sedation and using previously acquired CT or MR. MATERIALS AND METHODS: Among 367 HCC nodules treated in the study period, data of 37 B-mode/CEUS undetectable HCC nodules treated with FI-guided ablation were extracted from our prospectively collected institutional database. Analyzed variables included patients' sex, age, cirrhosis etiology, Child-Pugh status, size of the lesion, liver segment, subcapsular or central liver site, type of imaging used for fusion (MR/CT), and the presence of surrounding anatomical landmarks (SAL) < 3 cm from the index lesion. RESULTS: The primary efficacy was 59.4% (22/37 nodules); nine lesions (24.3%) were partially ablated (PA), six lesions (16.7%) were mistargeted (MA). Eight nodules were retreated with a CA obtained in all cases (100% CA, secondary efficacy in 30/37-81.1%). LTP was observed in 2/30 cases (6.7%). Two minor complications were registered (Clavien-Dindo, Grade1, CIRSE Classification Grade 2). SAL were related to a better ablation outcome (37.5% vs 84.6% p = 0.01). No differences were observed between CA group and PA-MA group in terms of lesion size (15.4 mm vs 14.9 mm p = 0.63), liver segment (p = 0.58), subcapsular or central liver site (8/22 36% vs 4/15 26.7% p = 0.84), and imaging (MR vs CT, p = 0.72). CONCLUSION: Even in the presence of potentially critical conditions (completely B-Mode/CEUS inconspicuous nodules, spontaneous breathing, and previously acquired CT or MRI), FI-only guidance is safe and allows having good primary, secondary efficacy and LTP rates. The outcome of the procedure is heavily affected by the presence of SAL.


Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/cirurgia , Ablação por Cateter/métodos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Imagem Multimodal , Ultrassonografia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Pontos de Referência Anatômicos , Carcinoma Hepatocelular/patologia , Sedação Consciente , Meios de Contraste , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Neoplasias Hepáticas/patologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fosfolipídeos , Estudos Prospectivos , Hexafluoreto de Enxofre , Tomografia Computadorizada por Raios X , Resultado do Tratamento
14.
Artigo em Português | LILACS | ID: biblio-1023043

RESUMO

Os maiores avanços no tratamento das arritmias cardíacas, que geraram propostas de mudança e/ou incorporação de novas tecnologias de tratamento medicamentoso ou intervencionista, referem-se à fibrilação atrial, arritmia sustentada mais frequente na prática clínica, razão pela qual demos maior ênfase a essa análise. Os últimos estudos que têm proporcionado revisões, atualizações e perspectivas das principais diretrizes mundiais são os que envolvem as comparações dos esquemas de combinações de anticoagulação e antiagregação plaquetária em pacientes com fibrilação atrial no contexto da doença arterial coronariana com intervenção planejada ou imediata, bem como os que envolvem a estratégia de ablação por cateteres com opção no início do tratamento da fibrilação atrial nos pacientes com insuficiência cardíaca com fração de ejeção reduzida


The greatest advances in the treatment of cardiac arrhythmias, which have led to proposals of change and/or the incorporation of new drug or intervention treatment technologies, relate to atrial fibrillation, the most common sustained arrhythmia in medical practice, which is why we have placed more emphasis on it in this analysis. The latest studies to have revised, updated, and offered new perspectives on the principal global guidelines are those that involve comparisons of regimens that combine anticoagulation and antiaggregation of platelets in patients with atrial fibrillation within the context of coronary artery disease with planned or immediate intervention, as well of those that involve a catheter ablation strategy as an option at the beginning of treatment for atrial fibrillation in patients with heart failure with reduced ejection fraction


Assuntos
Humanos , Masculino , Feminino , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/terapia , Fibrilação Atrial , Varfarina/uso terapêutico , Doença da Artéria Coronariana , Stents , Aspirina/uso terapêutico , Guias como Assunto/normas , Ablação por Cateter/métodos , Hemorragia , Anticoagulantes
15.
Medicine (Baltimore) ; 98(29): e16438, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335698

RESUMO

In many types of surgery, obesity may influence patient selection, prognosis, and/or management. Quantifying the accuracy of the coding of obesity and other prognostic factors is important for the design and interpretation of studies of surgical outcomes based on administrative healthcare data. This study assessed the validity of obesity diagnoses recorded in insurance claims data in selected surgical populations.This was a retrospective, observational study. Deidentified electronic health record (EHR) and linked administrative claims data were obtained for US patients age ≥20 years who underwent a qualifying surgical procedure (bariatric surgery, total knee arthroplasty [TKA], cardiac ablation, or hernia repair) in 2014Q1-2017Q1 (first = index). Patients' body mass index (BMI) as coded in the claims data (error-prone measure) during the index procedure or 180d pre-index was compared with their measured BMI as recorded in the EHR (criterion standard) to estimate the sensitivity and positive predictive value (PPV) of obesity diagnosis codes.Among patients who underwent bariatric surgery (N = 1422), TKA (N = 8670), cardiac ablation (N = 167), or hernia repair (N = 5450), obesity was present in 98%, 63%, 52%, and 54%, respectively, based on measured BMI. PPVs of obesity diagnosis codes were high: 99.3%, 96.0%, 92.8%, and 94.1% in bariatric surgery, TKA, cardiac ablation, and hernia repair, respectively. The sensitivity of obesity diagnoses was: 99.8%, 46.2%, 41.3%, and 42.3% in bariatric surgery, TKA, cardiac ablation, and hernia repair, respectively. Among false-positive patients diagnosed as obese but with measured BMI <30, the proportion with a BMI ≥28 was 40.0%, 67.6%, 60.7%, and 65.8% for bariatric surgery, TKA, cardiac ablation, and hernia repair, respectively.Our data indicate that obesity is highly prevalent in many surgical populations, obesity diagnosis codes have high PPVs, but also obesity is generally undercoded in claims data. Quantifying the validity of diagnosis codes for obesity and other important prognostic factors is important for the design and interpretation of studies of surgical outcomes based on administrative data. Further research is needed to determine the extent to which undercoding of BMI and obesity can be addressed through the use of proxies that may be better documented in claims data.


Assuntos
Artroplastia do Joelho , Cirurgia Bariátrica , Ablação por Cateter , Codificação Clínica , Herniorrafia , Obesidade/diagnóstico , Adulto , Idoso , Artroplastia do Joelho/métodos , Artroplastia do Joelho/estatística & dados numéricos , Cirurgia Bariátrica/métodos , Cirurgia Bariátrica/estatística & dados numéricos , Índice de Massa Corporal , Ablação por Cateter/métodos , Ablação por Cateter/estatística & dados numéricos , Codificação Clínica/métodos , Codificação Clínica/normas , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Herniorrafia/métodos , Herniorrafia/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Avaliação de Resultados (Cuidados de Saúde)/estatística & dados numéricos , Seleção de Pacientes , Prevalência , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Estados Unidos/epidemiologia
16.
J Cancer Res Clin Oncol ; 145(9): 2199-2209, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31309302

RESUMO

PURPOSE: Radiofrequency (RF) ablation therapy is of great interest in cancer therapy as it is non-ionizing radiation and can effectively penetrate into the tissue. However, the current RF ablation technique is invasive that requires RF probe insertion into the tissue and generates a non-specific heating. Recently, RF-responsive nanomaterials such as gold nanoparticles (AuNPs) and iron oxide nanoparticles (IONPs) have led to tremendous progress in this area. They have been found to be able to absorb the RF field and induce a localized heating within the target, thereby affording a non-invasive and tumor-specific RF ablation strategy. In the present study, for the first time, we used a hybrid core-shell nanostructure comprising IONPs as the core and AuNPs as the shell (IO@Au) for targeted RF ablation therapy. Due to the magnetic core, the nanohybrid can be directed toward the tumor through a magnet. Moreover, IONPs enable the nanohybrid to be used as a magnetic resonance imaging (MRI) contrast agent. RESULTS: In vitro cytotoxicity experiment showed that the combination of IO@Au and 13.56-MHz RF field significantly reduced the viability of cancer cells. Next, during an in vivo experiment, we demonstrated that magnetically targeting of IO@Au to the tumor and subsequent RF exposure dramatically suppressed the tumor growth. CONCLUSION: Therefore, the integration of targeting, imaging, and therapeutic performances into IO@Au nanohybrid could afford the promise to improve the effectiveness of RF ablation therapy.


Assuntos
Ablação por Cateter/métodos , Compostos Férricos/química , Ouro/química , Hipertermia Induzida/métodos , Nanopartículas de Magnetita/uso terapêutico , Neoplasias/cirurgia , Ablação por Radiofrequência/métodos , Animais , Compostos Férricos/uso terapêutico , Ouro/uso terapêutico , Imagem por Ressonância Magnética/métodos , Nanopartículas de Magnetita/química , Masculino , Nanopartículas Metálicas/química , Nanopartículas Metálicas/uso terapêutico , Camundongos , Camundongos Endogâmicos BALB C , Terapia de Alvo Molecular/métodos , Nanocompostos/química , Nanocompostos/uso terapêutico , Nanoconchas/química , Nanoconchas/uso terapêutico , Neoplasias/patologia , Células Tumorais Cultivadas
17.
Pediatr Cardiol ; 40(6): 1144-1150, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31152184

RESUMO

Congenital right atrial appendage aneurysm (RAAA) is an extremely rare malformation that can coexist with atrial tachyarrhythmia. There is no consensus on treatment for this condition. This research aimed to investigate the clinical characteristics and efficacy of surgical resection to treat atrial tachyarrhythmia originating from RAAA in children. Four RAAA children diagnosed with atrial tachyarrhythmia at the age of 1-5.25 years weighing 8.3-17.1 kg were discussed in this retrospective study. Patients underwent various treatments, included electrocardiogram (ECG) and echocardiography, antiarrhythmic medication therapy, radiofrequency catheter ablation (RFCA), surgical resection of RAAA and pathological examinations. The results from these treatments along with clinical features of patients were analyzed. The incidence of RAAA in patients with atrial tachycardia originating from the right or left atrial appendages (RAA or LAA) was 7.3% (4/55). The prevalence of RAAA in the RAA was 12.5% (4/32). Atrial tachyarrhythmia was identified both prenatally (26 and 36 weeks of gestational age) and postnatally (1 and 4 months after birth), with two patients per group, respectively. The RAAAs condition in two patients with atrial tachycardia (AT), concomitant atrial flutter (AF) and atrial fibrillation (Af) was identified using echocardiogram. Although, RAAA in two patients with mono AT was unidentified in echocardiogram and failed to be identified in the procedure of RFCA, RAAA was confirmed during surgical resection of the RAA. Multiple pre-surgical antiarrhythmic medications combined therapy used to treat all four patients showed either no effect at all or was only partially effective. The original atrial tachyarrhythmia was successfully abolished after RAAA surgical resection in four patients. AT originating from new foci was established in two patients post-surgically. The conditions of these two patients were successfully reverted and normal sinus rhythm maintained in the application of antiarrhythmic medications. These results confirmed the efficacy of RAAA surgical resection. The pathology study showed cystic dilation in parts of the atrial cavity, fibrosis of the cyst wall, generalized fibrosis of atrial myocardium with myocardium atrophy and cystic dilation. RAAA is prone to misdiagnosis by echocardiogram. Atrial tachyarrhythmia in patients with RAAA is usually resistant to antiarrhythmic medication therapy and RFCA. Surgical resection of RAAA is a safe and effective option that is minimally invasive.


Assuntos
Apêndice Atrial/cirurgia , Aneurisma Cardíaco/cirurgia , Taquicardia/cirurgia , Antiarrítmicos/uso terapêutico , Apêndice Atrial/anormalidades , Ablação por Cateter/métodos , Pré-Escolar , Ecocardiografia , Feminino , Aneurisma Cardíaco/complicações , Aneurisma Cardíaco/epidemiologia , Humanos , Incidência , Lactente , Masculino , Estudos Retrospectivos , Taquicardia/complicações , Taquicardia/diagnóstico , Taquicardia/tratamento farmacológico , Resultado do Tratamento
18.
Surg Clin North Am ; 99(3): 543-553, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31047041

RESUMO

Gastrointestinal stromal tumors (GISTs) arise anywhere along the gastrointestinal tract, most commonly as a result of c-kit or PDGFRA proto-oncogene mutations. Surgical resection is an important component of treatment. However, molecular profiling of GISTs has provided many insights into adjuvant and neoadjuvant therapy options. Imatinib, the most frequently studied medical therapy, has been shown in numerous studies to provide benefit to patients in both the neoadjuvant and adjuvant setting. Interval imaging is an important component of the treatment of GISTs and national surveillance recommendations should be followed.


Assuntos
Neoplasias Esofágicas/cirurgia , Tumores do Estroma Gastrointestinal/cirurgia , Neoplasias Gástricas/cirurgia , Assistência ao Convalescente/métodos , Antineoplásicos/uso terapêutico , Ablação por Cateter/métodos , Quimioembolização Terapêutica/métodos , Terapia Combinada/métodos , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/patologia , Tumores do Estroma Gastrointestinal/tratamento farmacológico , Tumores do Estroma Gastrointestinal/patologia , Perfilação da Expressão Gênica/métodos , Humanos , Mesilato de Imatinib/uso terapêutico , Laparoscopia/métodos , Metástase Neoplásica , Prognóstico , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/patologia , Tomografia Computadorizada por Raios X
19.
Anticancer Res ; 39(5): 2501-2508, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31092445

RESUMO

BACKGROUND/AIM: High-dose-rate interstitial brachytherapy (iBT) has been shown to provide high tumor control rates in the treatment of primary or secondary malignancies at various sites. The objective of this study was to evaluate the efficacy and safety of image-guided iBT in patients with metastatic renal cell carcinoma (mRCC). MATERIALS AND METHODS: A total of 14 patients with a cumulative number of 54 unresectable RCC liver metastases after treatment with computed tomography (CT)- or open magnetic resonance imaging (MRI)-guided iBT using an iridium-192 source (single fraction irradiation) were included in this retrospective study. RESULTS: Local tumor control rate was 92.6% during a median follow-up of 10.2 months (range=2.4-73.6 months). Median progression-free survival after iBT was 3.4 months (range=1.0-27.8 months). Median overall survival was 51.2 months (range=10.2-81.5 months). No severe adverse events (grade 3 or more) were recorded. CONCLUSION: Image-guided iBT is a safe and feasible treatment in patients with mRCC.


Assuntos
Braquiterapia/métodos , Carcinoma de Células Renais/radioterapia , Fígado/efeitos da radiação , Radioterapia Guiada por Imagem/métodos , Adulto , Idoso , Braquiterapia/efeitos adversos , Carcinoma de Células Renais/patologia , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Feminino , Humanos , Fígado/patologia , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Intervalo Livre de Progressão , Radioterapia Guiada por Imagem/efeitos adversos
20.
Int Heart J ; 60(3): 761-767, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31105149

RESUMO

A 70-year-old woman was admitted for treatment of supraventricular tachycardia. Ventriculoatrial conduction was revealed through programmed ventricular stimulation; the coronary sinus ostium (CSos) was the earliest atrial activation site. The fast-slow forms of atrioventricular nodal reentrant tachycardia (AVNRT) were induced by ventricular extra-stimuli. During tachycardia, the earliest atrial activation site was located at the bottom of CSos. Radiofrequency (RF) energy application to this site resulted in the delay of local electrical potential, prolongation of tachycardia cycle length, and a shift of the earliest retrograde activation site to the roof of CSos. Subsequent ablation induced a similar shift to the inferior tricuspid annulus and to the right posterior septum. Finally, RF energy application to the right posterior septum resulted in the termination of tachycardia, which was not induced afterward. Multiple shifts in the earliest retrograde atrial activation site along the tricuspid annulus after each slow pathway ablation suggested that annular tissue plays a substantial role as a substrate for AVNRT.


Assuntos
Nó Atrioventricular/fisiopatologia , Ablação por Cateter/métodos , Taquicardia por Reentrada no Nó Atrioventricular/diagnóstico , Taquicardia por Reentrada no Nó Atrioventricular/terapia , Idoso , Eletrofisiologia Cardíaca/instrumentação , Eletrocardiografia/métodos , Feminino , Humanos , Taquicardia por Reentrada no Nó Atrioventricular/fisiopatologia , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/fisiopatologia , Taquicardia Supraventricular/terapia , Resultado do Tratamento
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