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1.
J Cardiothorac Surg ; 15(1): 291, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008467

RESUMO

BACKGROUND: Concomitant bipolar radiofrequency ablation and valve replacement in the elderly remains controversial. In the current study, we aimed to compare the outcomes of concomitant valve replacement and bipolar radiofrequency ablation with valve replacement alone in elderly patients with atrial fibrillation (AF). METHODS: This was a retrospective study of patients aged ≥70 years who underwent valve replacement with or without bipolar radiofrequency ablation in a single-centre between January 2006 and March 2015. The early postoperative results and long-term clinical outcomes were compared after propensity score matching. RESULTS: A total of 34 pairs of patients (73.94 ± 2.64 years old; 34 in the AF with ablation group and 34 in the AF without ablation group) were enrolled in the propensity score matching analysis. There were no significant differences between the two matched groups in terms of surgical mortality (5.88% vs. 2.94%, P = 0.555) and major postoperative morbidity. Kaplan-Meier analysis revealed a significantly better overall survival in the AF with ablation group compared to the AF without ablation group (P = 0.009). Cumulative incidence curves showed a lower incidence of cardiovascular death in the AF with ablation group (P = 0.025, Gray's test). Patients in the AF with ablation group had a reduced incidence of stroke compared to patients in the AF with ablation group (P = 0.009, Gray's test). The freedom from AF after 5 years was 58.0% in the AF with ablation group and 3.0% in the AF without ablation group. CONCLUSIONS: The addition of bipolar radiofrequency ablation is a safe and feasible procedure, even in patients aged ≥70 years, with a better long-term survival and a reduced incidence of stroke compared to valve replacement alone. These findings suggest that bipolar radiofrequency ablation should always be considered as a concomitant procedure for elderly patients with AF who require cardiac surgery. However, a large-scale, prospective, multi-centre, randomized study should be performed in the future to fully validate our findings.


Assuntos
Ablação por Cateter , Doenças das Valvas Cardíacas/cirurgia , Idoso , Fibrilação Atrial/cirurgia , Procedimentos Cirúrgicos Cardíacos , Ablação por Cateter/métodos , Cateteres , Feminino , Humanos , Incidência , Masculino , Período Pós-Operatório , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento
2.
Medicine (Baltimore) ; 99(40): e22640, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019488

RESUMO

INTRODUCTION: Danon disease is a rare X-linked dominant genetic disorder caused by defects in the lysosome-associated membrane protein 2 (LAMP2) gene. Unless treated, cardiogenic death is the main cause of mortality. This case report describes a 19-year-old man who was diagnosed with Danon disease and survived for 3 years from symptom onset to death. The mutation in his LAMP2 gene (p.Gly221Ilefs*19) had not been previously reported. PATIENT CONCERNS: A 19-year-old man patient was hospitalized for intermittent palpitations. He had no family history of cardiomyopathy, arrhythmia, or sudden cardiac death, but his sister had died of cirrhosis at age 12 years, but the exact cause of cirrhosis was unknown. DIAGNOSIS: Exome sequencing and Sanger sequencing identified a novel missense mutation (p.Gly221Ilefs*19) in the LAMP2 gene of the proband. This mutation was also detected in his mother, confirming the diagnosis of Danon disease. INTERVENTIONS: The patient experienced various types of arrhythmia throughout the clinical process, including Wolff-Parkinson-White syndrome, non-sustained atrial tachycardia, atrial flutter, and third-degree atrioventricular block. He was therefore treated with cardiac ablation procedures and cardiac resynchronization therapy. OUTCOMES: The period from the onset of symptoms to the onset of heart failure was 2 years. The patient died of cardiogenic death during the third year, at age 22 years. LESSONS: Danon disease is a rare disease that is difficult to recognize because of its hidden early manifestations. Early identification of its clinical symptoms can lead to early diagnosis and treatment.


Assuntos
Doença de Depósito de Glicogênio Tipo IIb/genética , Doença de Depósito de Glicogênio Tipo IIb/terapia , Proteína 2 de Membrana Associada ao Lisossomo/genética , Arritmias Cardíacas/etiologia , Terapia de Ressincronização Cardíaca/métodos , Ablação por Cateter/métodos , Evolução Fatal , Doença de Depósito de Glicogênio Tipo IIb/complicações , Doença de Depósito de Glicogênio Tipo IIb/diagnóstico , Insuficiência Cardíaca/etiologia , Humanos , Masculino , Mutação de Sentido Incorreto/genética , Sequenciamento Completo do Exoma/métodos , Síndrome de Wolff-Parkinson-White/genética , Síndrome de Wolff-Parkinson-White/terapia , Adulto Jovem
3.
Medicine (Baltimore) ; 99(36): e22086, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899085

RESUMO

RATIONALE: Dextrocardia is a rare congenital heart disease, while the persistent left superior vena cava (PLSVC) is an uncommon congenital vascular malformation. It is extremely rare for a person to have dextrocardia and PLSVC. A case with a combination of dextrocardia, PLSVC, and atrioventricular nodal reentrant tachycardia has not been reported. PATIENT CONCERNS: A 51-year-old woman was admitted to the hospital with palpitations. The physical examination revealed a heart rate of patient increased significantly, and that apex beating was found in the right fifth intercostal space approximately 0.5 cm from the midclavicular line. DIAGNOSIS: We used different techniques, including electrocardiography, esophagus heart electrophysiology, chest radiograph, and cardiac color Doppler echocardiography to reveal the presence of the combination of dextrocardia, PLSVC, and supraventricular tachycardia. INTERVENTIONS: We terminated tachycardia by esophageal pacing and cured patients with radiofrequency catheter ablation (RFCA). OUTCOMES: The complex structural anomalies presented great technical challenges for interventional treatments. After consulting the literature, thorough examination and understanding of the structural anatomy and anomalies of the vena cava and cardiac chambers, we successfully treated this patient by RFCA. After half a year of follow-up, the patient did not have palpitations, and no arrhythmia was seen on the electrocardiography. LESSONS: Physicians need to be aware that the key to the success of RFCA, in this case, is to clarify the complexity of the morphological and anatomical structures of dextrocardia accompanying PLSVC and to consult and understand the experience of access vessels reported in relevant cases before the operation.


Assuntos
Ablação por Cateter/métodos , Dextrocardia/complicações , Taquicardia por Reentrada no Nó Atrioventricular/complicações , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Veia Cava Superior/anormalidades , Feminino , Frequência Cardíaca , Humanos , Pessoa de Meia-Idade
4.
Circ J ; 84(10): 1679-1685, 2020 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-32908073

RESUMO

The health crisis due to coronavirus disease 2019 (COVID-19) has shocked the world, with more than 1 million infections and casualties. COVID-19 can present from mild illness to multi-organ involvement, but especially acute respiratory distress syndrome. Cardiac injury and arrhythmias, including atrial fibrillation (AF), are not uncommon in COVID-19. COVID-19 is highly contagious, and therapy against the virus remains premature and largely unknown, which makes the management of AF patients during the pandemic particularly challenging. We describe a possible pathophysiological link between COVID-19 and AF, and therapeutic considerations for AF patients during this pandemic.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Antiarrítmicos/uso terapêutico , Anticoagulantes/uso terapêutico , Antivirais/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Fibrilação Atrial/fisiopatologia , Ablação por Cateter/métodos , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/virologia , Citocinas/sangue , Interações Medicamentosas , Humanos , Pandemias , Peptidil Dipeptidase A/metabolismo , Pneumonia Viral/fisiopatologia , Pneumonia Viral/virologia , Risco
5.
Medicine (Baltimore) ; 99(31): e21482, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756175

RESUMO

RATIONALE: In absence of conduction over the accessory pathway (AP) during the electrophysiological study, mapping and ablation is impossible. Various techniques can be used to activate absent conduction. In this presentation we describe the first case of latent AP ablation performed under continuous infusion of adenosine. PATIENT CONCERNS: A 65-year-old man, presented to emergency department with atrial fibrillation and antegrade conduction through a left lateral AP. He had palpitations and lightheadedness that occurred every 2 to 3 weeks. DIAGNOSIS: The electrophysiological study confirmed a latent left-side AP. INTERVENTIONS: Catheter ablation could not be performed because of absent conduction through AP. Therefore, a continuous infusion of adenosine was used to activate AP. Ablation was performed at the left lateral mitral ring. OUTCOMES: After catheter ablation and a new adenosine bolus there was no conduction through AP. LESSONS: In case of a latent AP when ablation is difficult to perform because of absent conduction at the time of electrophysiological study, adenosine can be used in doses of 1.5 mg/kg over 5 minutes continuous infusion.


Assuntos
Feixe Acessório Atrioventricular/cirurgia , Adenosina/administração & dosagem , Antiarrítmicos/administração & dosagem , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Feixe Acessório Atrioventricular/complicações , Idoso , Fibrilação Atrial/complicações , Humanos , Infusões Intra-Arteriais , Masculino
6.
Radiol Clin North Am ; 58(5): 981-993, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32792128

RESUMO

Based on Surveillance, Epidemiology, and End Results studies, most renal cancers are low grade and slow growing. Long-term, single-center studies show excellent outcomes for T1a renal cell carcinoma (RCC), comparable to partial nephrectomy without affecting renal function and with much lower rates of complications. However, there are no multicenter randomized controlled trials of multiple ablative modalities or comparison with partial nephrectomy, and most studies are single-arm observational studies with short-term and intermediate follow-up. For treatment of stage T1a RCC, percutaneous TA is an effective alternative to surgery with preservation of renal function, low risk, and comparable overall and disease-specific survival.


Assuntos
Carcinoma de Células Renais/cirurgia , Ablação por Cateter/métodos , Neoplasias Renais/cirurgia , Diagnóstico por Imagem/métodos , Humanos , Rim/diagnóstico por imagem , Rim/cirurgia , Neoplasias Renais/diagnóstico por imagem , Resultado do Tratamento
7.
Am J Cardiol ; 128: 12-15, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32650904

RESUMO

Although atrial fibrillation (AF) is strongly associated with stroke, previous studies have shown suboptimal use of anticoagulation (AC). In particular, there is a lack of data on the long-term use of AC after AF catheter ablation. We followed up patients 1 to 5 years out from catheter ablation at the Johns Hopkins Hospital (JHH) to assess their long-term use of AC. We sent a survey to patients from the JHH AF database who underwent an AF catheter ablation between 01/01/2014 and 03/31/2018. Patients were asked whether they were still on AC, if they thought the ablation was successful in controlling AF symptoms and whether they had follow-up rhythm monitoring. Replies were compared with risk scores and demographic data from the electronic medical record. We sent the survey to 628 patients in the database meeting our inclusion criteria, and we received 289 responses. The average age of patients was 67 ± 10 with a median CHA2DS2-VASc of 2 and a median follow-up of 3.6 years. Overall, 81.6% of patients with a CHA2DS2-VASc >2 reported taking AC. Use of AC was positively correlated with a higher CHA2DS2-VASc score (p = 0.012) and older age (p = 0.028), but negatively correlated with a successful ablation (p = 0.040). The most common reason (50.0%) for not being on AC was that doctors were recommending stopping it after a successful ablation. In general, higher risk patients (older, higher CHA2DS2-VASC score) were more likely to remain on AC. However, patients who self-reported a successful ablation were less likely to remain on AC. There may be many patients who can tolerate AC, but are recommended to stop due to a successful ablation. It is still debated how successful AF ablation affects stroke risk. In conclusion, there is considerable variation in the long-term management of AC after an ablation, but for the present, it seems prudent to continue AC based on stroke risk scores until more definite data are available.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/terapia , Ablação por Cateter/métodos , Desprescrições , Acidente Vascular Cerebral/prevenção & controle , Idoso , Fibrilação Atrial/complicações , Feminino , Humanos , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Acidente Vascular Cerebral/etiologia
8.
Medicine (Baltimore) ; 99(26): e20795, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590762

RESUMO

To explore different posttreatment changes between multimode tumor ablation therapy (MTAT) and radiofrequency ablation (RFA) using intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and diffusion kurtosis imaging (DKI) in patients with hepatic malignancies.Eighty - seven patients with one hundred and twenty eight hepatic lesions receiving MTAT or RFA underwent IVIM-DWI and DKI before and after treatment. The mean value of apparent diffusion coefficient (ADC), IVIM-DWI parameters, including true diffusion coefficient (D), pseudo-diffusion coefficient (DP), perfusion fraction (f), and DKI parameters including diffusion coefficient (DK), apparent diffusional kurtosis (K) were retrospectively compared prior to and following treatment as well as between treatment groups. The degree of parameters change after ablation was compared between 2 treatment modalities.The mean value of ADC, D, and DK increased while f, and K decreased significantly in MTAT group. In RFA group, just ADC and K showed significantly change following treatment. The ADC and D value were higher in MTAT group than in RFA group 1 month after treatment. While f was lower in MTAT group after treatment compared with RFA group. The ADC, D and DK increased (21.89 ±â€Š24.95% versus 8.76 ±â€Š19.72%, P = .04 for ADC, 33.78 ±â€Š54.01% versus 7.91 ±â€Š25.16%, P = .03 for D, 25.91 ±â€Š36.28% versus 1.75 ±â€Š46.42%, P = .01 for DK) while f declined (-32.62 ±â€Š41.48% versus 6.51 ±â€Š44.16%, P < .001) more in MTAT group.The MTAT induced different posttreatment changes on water molecule diffusion and microvasculature related functional MR parameters compared to RFA in patients with liver tumors.


Assuntos
Ablação por Cateter , Imagem de Difusão por Ressonância Magnética/métodos , Neoplasias Hepáticas , Imagem por Ressonância Magnética/métodos , Microvasos/diagnóstico por imagem , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Feminino , Humanos , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Ablação por Radiofrequência/métodos
9.
Medicine (Baltimore) ; 99(23): e20321, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32501978

RESUMO

BACKGROUND: In recent years, there has been considerable uncertainty about the optimal treatment option for very early hepatocellular carcinoma (HCC) with tumor size less than 2 cm. Therefore, we performed a systematic review and meta-analysis to evaluate the outcomes of the different treatments. METHODS: This study was designed in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA). PubMed, EMBASE, and Cochrane library were searched for calculating the survival rates, and the "time to event" method was used to compare the outcomes of liver resection (LR) and radiofrequency ablation (RFA). All studies focusing on the treatment of solitary HCC up to 2 cm by different techniques were included in our analysis. The Hazard ratios (HR) and 95% confidence intervals (CI) derived from multivariate and univariate analysis were utilized to assess the treatment risks. RESULTS: We included 32 studies in our systematic review. The median 5-year overall survival (OS) and recurrence-free survival rate (RFS) for LR were 73% and 47%, respectively, and those for RFA were 73% and 43%, respectively. RFA was found to be associated with increased risk of mortality and recurrence compared to LR (HR = 1.61, 95% CI: 1.35-1.92, P < .0001 for OS and HR = 1.75, 95% CI: 1.56-1.96, P < .0001 for RFS). CONCLUSION: Our meta-analysis demonstrated that LR is superior to RFA in the treatment of solitary HCC up to 2 cm, with reduction in mortality and recurrence risk and improved long-term outcome.


Assuntos
Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/cirurgia , Ablação por Cateter/métodos , Hepatectomia/métodos , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Carcinoma Hepatocelular/mortalidade , Ablação por Cateter/efeitos adversos , Hepatectomia/efeitos adversos , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/mortalidade , Recidiva Local de Neoplasia , Modelos de Riscos Proporcionais , Taxa de Sobrevida , Carga Tumoral
10.
Medicine (Baltimore) ; 99(21): e19970, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481260

RESUMO

INTRODUCTION: The RF ablation of ventricular tachycardia (VT) or atrial flutter (AFl) can be unsuccessful due to lack of lesion transmurality. Bipolar ablation (BA) is more successful than unipolar ablation (UA). The purpose of our study was to investigate the long-term effect of BA ablation in patients after failed UA. METHODS: Patients with septal VT (5) or AFL (2) after 2 to 5 unsuccessful UA were prospectively analysed after BA. All patients presented with heart failure or had ICD interventions. RESULTS: BA was successful in 5 patients (1 failure each in the AFL and VT group). The follow-up duration was 10 to 26 months. In AFL group, BA was successful in 1 patient, unidirectional cavotricuspid block in was achieved in the other patient. All patients were asymptomatic for 12 months, but 1 had atrial fibrillation and the other had AFL reablation 19 months after BA. In VT group, all patients had several forms of septal VT. BA was successful in 4 patients. In 2 patients with high septal VT BA resulted in complete atrioventricular block. During follow-up, 1 patient had VT recurrence 26 months after BA and died after an unsuccessful reablation. Three patients had VT recurrences of different morphologies, which required reablation (UA in 2 and alcohol septal ablation in the other patient). CONCLUSION: BA was successful in patients with AFL and septal VT resistant to standard ablation. Relapses of clinical arrhythmia are rare; however, long-term follow-up is complicated by recurrences of different arrhythmias related to complex arrhythmogenic substrate.


Assuntos
Ablação por Cateter/métodos , Taquicardia Ventricular/cirurgia , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recidiva , Irrigação Terapêutica , Fatores de Tempo , Resultado do Tratamento
11.
Circ Arrhythm Electrophysiol ; 13(7): e008999, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32530306

RESUMO

Coronavirus disease 2019 (COVID-19) has presented substantial challenges to patient care and impacted healthcare delivery, including cardiac electrophysiology practice throughout the globe. Based upon the undetermined course and regional variability of the pandemic, there is uncertainty as to how and when to resume and deliver electrophysiology services for patients with arrhythmia. This joint document from representatives of the Heart Rhythm Society, American Heart Association, and American College of Cardiology seeks to provide guidance for clinicians and institutions reestablishing safe electrophysiological care. To achieve this aim, we address regional and local COVID-19 disease status, the role of viral screening and serological testing, return-to-work considerations for exposed or infected health care workers, risk stratification and management strategies based on COVID-19 disease burden, institutional preparedness for resumption of elective procedures, patient preparation and communication, prioritization of procedures, and development of outpatient and periprocedural care pathways.


Assuntos
Arritmias Cardíacas/cirurgia , Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Controle de Infecções/organização & administração , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , American Heart Association , Arritmias Cardíacas/diagnóstico por imagem , Arritmias Cardíacas/epidemiologia , Eletrofisiologia Cardíaca , Técnicas de Imagem Cardíaca , Ablação por Cateter/métodos , Ablação por Cateter/estatística & dados numéricos , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Sociedades Médicas , Estados Unidos
12.
Cancer Radiother ; 24(5): 374-378, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32527694

RESUMO

Therapeutic advances in oncology have led to longer survival in many forms of cancer, including those complicated by bone metastases. When a bone metastasis is painful or when there is a risk of fracture, interventional radiology procedures can be carried out for pain control and/or stabilisation. All of these techniques can be performed under local anaesthesia. Cementoplasty and vertebroplasty are stabilisation procedures consisting in the percutaneous injection of acrylic cement into a lytic bone lesion. The effect on pain can be explained by the consolidation of weakened, fractured or pre-fractured bone, but also to a lesser extent by the toxic, chemical and thermal effect of the cement. Tumour ablation techniques include alcoholisation or thermal ablation (by heat with radiofrequency and microwave or cold by cryoablation). Percutaneous thermal ablation of bone tumours is most often performed as a palliative measure resulting in a significant and lasting reduction in symptoms. Radiofrequency ablation consists in placing needles through which an electrical current passes. Microwave ablation acts by causing very high frequency vibrations of water molecules. Cryoablation releases argon gas at the tip of the needle, forming an "ice ball" effectively destroying tumour cells. Any of these techniques can be combined to radiation therapy, performed before or after radiation. Finally, tumour embolisation can have a goal of pain control, or preparation of surgery to reduce the risk of peroperative haemorrhage.


Assuntos
Neoplasias Ósseas/secundário , Neoplasias Ósseas/terapia , Dor do Câncer/terapia , Fraturas Espontâneas/terapia , Radiologia Intervencionista/métodos , Anestesia Local , Cimentos para Ossos/uso terapêutico , Ablação por Cateter/métodos , Cementoplastia/métodos , Criocirurgia/métodos , Embolização Terapêutica/métodos , Etanol/administração & dosagem , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/prevenção & controle , Hemorragia/prevenção & controle , Humanos , Micro-Ondas/uso terapêutico , Bloqueio Nervoso/métodos , Cuidados Paliativos/métodos , Ablação por Radiofrequência/métodos , Solventes/administração & dosagem , Vertebroplastia/métodos
13.
J Cancer Res Ther ; 16(2): 292-300, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32474516

RESUMO

Objective: To compare the overall survival (OS), disease-free survival (DFS) and liver-cancer-specific survival (LCSS) of elderly (≥65 years) and younger patients (< 65 years) with early-stage hepatocellular carcinoma (HCC) using ultrasound-guided percutaneous microwave ablation (US-PMMA). Materials and Methods: From January 2002 to December 2017, 510 elderly and 1053 younger patients were diagnosed with early-stage HCC according to the Milan criteria. All of these patients were treatment-naïve to US-PMMA. Baseline characteristics were collected to identify any risk factors to determine the survival outcomes. OS, DFS, and LCSS probabilities were calculated with the Kaplan-Meier method and compared using the Log-rank test. Results: Complete ablation was achieved in all patients. Elderly patients were more likely to be, hepatitis C virus infection, comorbidities, cirrhosis, larger tumors, poor liver functional reservation, more ablation points, longer ablation time, longer hospital stays, and higher hospitalization costs (P < 0.05). Over the follow-up period (12-156 months), no significant differences were detected in OS, DFS, and LCSS between the two groups ( P = 0.092, 0.318, and 0.183). r-GT, ALB and ablation session were significant factors for OS, r-GT and ALB for LCSS, and cirrhosis, tumor number, AFP and ablation points for RFS in the multivariate analysis, respectively. No treatment-related deaths occurred in the two groups. Any complications were treated as appropriate. Conclusions: Although advanced age and comorbidities are intrinsic factors in elderly HCC patients, similar survival outcomes were obtained in elderly and younger HCC patients treated by US-PMWA, despite elderly patients having more comorbidities.


Assuntos
Carcinoma Hepatocelular/cirurgia , Ablação por Cateter/métodos , Neoplasias Hepáticas/cirurgia , Micro-Ondas/uso terapêutico , Cirurgia Assistida por Computador/métodos , Ultrassonografia/métodos , Fatores Etários , Idoso , Carcinoma Hepatocelular/patologia , Feminino , Seguimentos , Humanos , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
14.
J Cancer Res Ther ; 16(2): 327-334, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32474520

RESUMO

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors. Currently, the main effective treatment options for HCC include resection, liver transplantation, various percutaneous modalities (such as transarterial chemoembolization [TACE] and thermal ablation), and tyrosine kinase inhibitors (TKIs). Herein, we have proposed a novel therapy which consists of TACE, ablation, tyrosine kinase inhibitors, and immunotherapy (TATI) for patients with advanced HCC). We reported the therapeutic effects of TATI in four patients with advanced HCC. All patients underwent TACE treatment at the beginning of disease diagnosis. During follow-up, all patients were treated with microwave ablation because of a residual tumor or recurrence. For tumor control, apatinib, a TKI, was administered after ablation. If the tumor was resistant to the TKI, we continued to apatinib therapy in combination with immunotherapy (camrelizumab). All the four patients had better survival benefits and no serious adverse effects.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Hepatocelular/terapia , Ablação por Cateter/métodos , Quimioembolização Terapêutica/métodos , Neoplasias Hepáticas/terapia , Micro-Ondas/uso terapêutico , Recidiva Local de Neoplasia/terapia , Idoso , Anticorpos Monoclonais Humanizados/administração & dosagem , Carcinoma Hepatocelular/imunologia , Carcinoma Hepatocelular/patologia , Humanos , Hipertermia Induzida/métodos , Fatores Imunológicos , Neoplasias Hepáticas/imunologia , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/imunologia , Recidiva Local de Neoplasia/patologia , Piridinas/administração & dosagem , Resultado do Tratamento
15.
J Cancer Res Ther ; 16(2): 356-364, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32474524

RESUMO

Objective: This study aimed to classify hepatocellular carcinomas (HCCs) according to their diameter using statistic technology and evaluate the prognosis of the classified groups after the combined use of transarterial chemoembolization (TACE) and radiofrequency ablation (RFA). Materials and Methods: Electronic medical records of 128 consecutive patients who underwent TACE-RFA as the initial treatment for HCC from January 2010 to April 2018 were retrospectively analyzed. TACE was initially performed with subsequent RFA performed after 3-7 days. The decision tree model was used to classify overall survival (OS), progression-free survival (PFS), local recurrence rate (LRR), and treatment complications in HCC. Results: The tumors were divided into three groups of sizes ≤2.9 cm, 2.9-4.8 cm, and >4.8 cm. The group of tumors >4.8 cm showed inferior OS, PFS, and LRR than the other two groups (P < 0.05) on long-term follow-up but not in thefirst 6 months (P > 0.05). The groups of tumors ≤2.9 cm and 2.9-4.8 cm showed no statistically significant difference in OS, PFS, and LRR (P > 0.05). Conclusions: The cutoff points of 2.9 and 4.8 cm were achieved using the objective decision tree model rather than the artificial division of 3 and 5 cm. The prognosis was not significantly different between the groups of tumors ≤2.9 cm and 2.9-4.8 cm, and the prognosis of the two groups was better than the group of tumors >4.8 cm in the long-term follow-up but not in thefirst 6 months.


Assuntos
Carcinoma Hepatocelular/classificação , Carcinoma Hepatocelular/patologia , Ablação por Cateter/mortalidade , Quimioembolização Terapêutica/mortalidade , Carga Tumoral/efeitos dos fármacos , Carcinoma Hepatocelular/terapia , Ablação por Cateter/métodos , Quimioembolização Terapêutica/métodos , Terapia Combinada , Feminino , Seguimentos , Humanos , Neoplasias Hepáticas/classificação , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/terapia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
16.
J Cancer Res Ther ; 16(2): 365-371, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32474525

RESUMO

Aim: This study aims to assess the use of contrast-enhanced ultrasonography (CEUS) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in the evaluation of percutaneous microwave ablation (PMWA) of localized adenomyosis. Materials and Methods: Sixty-six patients with single-onset adenomyosis who underwent PMWA at the Liaocheng Tumor Hospital of Shandong Province from January 2013 to February 2019 were enrolled. Venous CEUS and DCE-MRI examinations were performed before and 1-2 days after the surgery. The ablation rates calculated by CEUS and DCE-MRI were compared and analyzed for accuracy. Results: After microwave ablation (MWA), CEUS showed that the volume and ablation rate of the ablated zone were 52.03 ± 28.39 cm3 and 90.90% ±6.61%, respectively. By DCE-MRI, the ablation volume and ablation rate of adenomyosis were 52.20 ± 28.65 cm3 and 90.88% ±6.32%, respectively. Dysmenorrhea was significantly relieved within 3 months of the operation, and nonmenstrual hemoglobin levels were significantly improved at 3 and 6 months after the operation (P < 0.05). All 66 cases of adenomyosis were treated using PMWA. Postoperatively, 17 patients reported a change in vaginal fluid; however, no special treatment was required as this disappeared 2-11 days after surgery. Conclusions: CEUS can accurately evaluate the ablation rate of localized adenomyosis treated with MWA, which is consistent with DCE-MRI. It is convenient and easy to perform ablation of adenomyomas, with incomplete ablation and angiography, and is a method worthy of clinical promotion.


Assuntos
Adenomiose/patologia , Adenomiose/cirurgia , Ablação por Cateter/métodos , Imagem por Ressonância Magnética/métodos , Micro-Ondas/uso terapêutico , Ultrassonografia/métodos , Adenomiose/diagnóstico por imagem , Adulto , Meios de Contraste/metabolismo , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
17.
Ann R Coll Surg Engl ; 102(7): 525-531, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32538106

RESUMO

INTRODUCTION: Flush ligation at the saphenofemoral junction and stripping of the great saphenous vein is being increasingly replaced by endovenous methods such as radiofrequency or endovenous laser ablation for the treatment of varicose veins. These modalities are expensive and not widely available. A minimally invasive ultrasound-guided surgery with non-flush ligation and stripping under local anaesthesia is a cost-effective alternative with similar postoperative outcomes. MATERIALS AND METHODS: A total of 62 limbs (58 patients) with saphenofemoral junction incompetence underwent clinical evaluation including the CEAP clinical score, the venous clinical severity score, the venous disability score and venous doppler. Patients were randomly assigned to either group A (radiofrequency ablation) or group B (ultrasound-guided non-flush ligation and stripping of the great saphenous vein) for procedures under tumescent anaesthesia and ultrasound guidance. Patients were followed-up on days 7, 30 and 90 to assess primary (obliteration rates) and secondary (venous clinical severity score and venous disability score) outcomes. RESULTS: Both the groups showed 100% obliteration of the great saphenous vein at day 90. The venous clinical severity and venous disability scores significantly improved from day 0 to day 90 in both groups (p = 0.0001). There were no major complications. Group A showed significantly lower minor complications (p = 0.001). None required conversation to general anaesthesia. CONCLUSIONS: The ultrasound-guided non-flush ligation and stripping of the great saphenous vein are as efficacious as radio frequency ablation, with similar obliteration rates, improvement in disability scores and complication profile at a lower cost. It has the potential for wider availability in the community as most surgeons are conversant with the surgical procedure.


Assuntos
Ablação por Cateter/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Veia Safena/cirurgia , Cirurgia Assistida por Computador/métodos , Ultrassonografia Doppler Dupla/métodos , Varizes/cirurgia , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Ligadura/métodos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
18.
Br J Radiol ; 93(1114): 20200266, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32520586

RESUMO

Osteoid osteoma is a painful benign bone tumour of children and young adults with characteristic clinico-radiological features depending upon the location of the lesion. Intraoperative visualisation of the nidus is difficult and therefore curative surgery is often associated with excessive bone removal, significant perioperative morbidity and potential need of bone grafting procedures. With advancement in cross-sectional imaging and radiofrequency ablation (RFA) technology, CT-guided RFA has emerged as the treatment of choice for the osteoid osteoma. This procedure involves accurate cannulation of the nidus and subsequent thermocoagulation-induced necrosis.Multidisciplinary management approach is the standard of care for patients with osteoid osteoma. Appropriate patient selection, identification of imaging pitfalls, pre-anaesthetic evaluation and a protocol-based interventional approach are the cornerstone for a favourable outcome. Comprehensive patient preparation with proper patient position and insulation is important to prevent complications. Use of spinal needle-guided placement of introducer needle, namely, "rail-road technique" is associated with fewer needle trajectory modifications, reduced radiation dose and patient morbidity and less intervention time. Certain other procedural modifications are employed in special situations, for example, intra-articular osteoid osteoma and osteoid osteoma of the subcutaneous bone in order to reduce complications. Treatment follow-up generally includes radiographic assessment and evaluation of pain score. Dynamic contrast-enhanced MRI has been recently found useful for demonstrating post-RFA healing.


Assuntos
Neoplasias Ósseas/cirurgia , Ablação por Cateter/métodos , Osteoma Osteoide/cirurgia , Cirurgia Assistida por Computador , Tomografia Computadorizada por Raios X , Humanos , Ondas de Rádio
19.
Am Heart J ; 224: 182-191, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32416333

RESUMO

Atrial fibrillation is the most common sustained arrhythmia affecting over 33 million people worldwide. Approximately 70% of AF patients have non-paroxysmal AF. As AF progresses from paroxysmal to non-paroxysmal forms, the prevalence of comorbidities increases. The efficacy of catheter ablation for persistent and long standing persistent (LSP) AF is <40%, often requiring multiple ablation procedures with greater cost and potentially more complications. There is an unmet need to effectively treat such patients. METHODS: CONVERGE is an investigational device exempt, prospective, multi-center, open label 2:1 randomized controlled pivotal study to evaluate the overall success of the Convergent hybrid procedure compared to endocardial catheter ablation for the treatment of symptomatic persistent AF refractory or intolerant to at least one Class I and /or III anti-arrhythmic drug (AAD). A total of 153 subjects at 27 centers are treated in the study. The CONVERGE study is differentiated from other studies currently being conducted on the persistent AF population, because a) there is no time restriction on the duration of diagnosed AF in the patients being studied and b) the trial allows patients with left atrial sizes up to 6 centimeters. The ongoing trials are limited to either 6 months, 12 months or 3-years of continuous AF making CONVERGE the only ablation trial thus far to include a substantial portion of patients with longstanding persistent AF. The convergent procedure involves combination of minimally invasive pericardioscopic epicardial ablation with endocardial left atrial ablation. The primary endpoint is freedom from AF/AFL/AF absent class I/III AAD, except for a previously failed class I/ III AAD with no increase in dosage following 3-months through 12-months. The primary safety endpoint is the incidence of major adverse events from the procedure through 30-days post procedure. CONCLUSION: CONVERGE AF compares the overall success of the Convergent hybrid procedure to endocardial catheter ablation for the treatment of persistent and longstanding persistent AF. By providing objective comparative data, the study aims to provide guidance on the treatment of such patients.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Endocárdio/cirurgia , Sistema de Condução Cardíaco/cirurgia , Pericárdio/cirurgia , Fibrilação Atrial/fisiopatologia , Eletrocardiografia Ambulatorial , Feminino , Seguimentos , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
20.
Cancer Imaging ; 20(1): 37, 2020 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-32460898

RESUMO

BACKGROUND: Combination therapy using hepatic resection (HR) and intra-operative thermal ablation is a treatment approach for patients with technically unresectable liver malignancies. The aim of this study was to investigate safety, survival and local recurrence rates for patients with technically unresectable liver tumors undergoing HR and separate percutaneous MR-guided thermoablation procedure as an alternative approach. METHODS: Data from all patients with primary or secondary hepatic malignancies treated at a single institution between 2004 and 2018 with combined HR and MR-guided percutaneous thermoablation was collected and retrospectively analyzed. Complications, procedure related information and patient characteristics were collected from institutional records. Overall survival and disease-free survival were estimated using the Kaplan-Meier method. RESULTS: A total of 31 patients (age: 62.8 ± 9.1 years; 10 female) with hepatocellular carcinoma (HCC; n = 7) or hepatic metastases (n = 24) were treated for 98 hepatic tumors. Fifty-six tumors (mean diameter 28.7 ± 23.0 mm) were resected. Forty-two tumors (15.1 ± 7.6 mm) were treated with MR-guided percutaneous ablation with a technical success rate of 100%. Local recurrence at the ablation site occurred in 7 cases (22.6%); none of these was an isolated local recurrence. Six of 17 patients (35.3%) treated for colorectal liver metastases developed local recurrence. Five patients developed recurrence at the resection site (16.1%). Non-local hepatic recurrence was observed in 18 cases (58.1%) and extrahepatic recurrence in 11 cases (35.5%) during follow-up (43.1 ± 26.4 months). Ten patients (32.3%) developed complications after HR requiring pharmacological or interventional treatment. No complication requiring therapy was observed after ablation. Median survival time was 44.0 ± 7.5 months with 1-,3-, 5-year overall survival rates of 93.5, 68.7 and 31.9%, respectively. The 1-, 3- and 5-year disease-free survival rates were 38.7, 19.4 and 9.7%, respectively. CONCLUSION: The combination of HR and MR-guided thermoablation is a safe and effective approach in the treatment of technically unresectable hepatic tumors and can achieve long-term survival.


Assuntos
Carcinoma Hepatocelular/terapia , Ablação por Cateter/métodos , Neoplasias Hepáticas/terapia , Imagem por Ressonância Magnética/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/diagnóstico por imagem , Ablação por Cateter/efeitos adversos , Intervalo Livre de Doença , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade
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