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1.
Medicine (Baltimore) ; 100(8): e24896, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33663121

RESUMO

INTRODUCTION: Hemodynamically-instable ventricular arrhythmias (VAs) are rare in patients with pulmonary hypertension (PH). To the best of our knowledge, only 1 case has been reported so far. Moreover, the pathogenesis of this kind of arrhythmia remains obscured and its treatment is challenging. Here we report another case and presented the substrate for VAs initiation and therapeutic effect of radiofrequency ablation. PATIENT CONCERNS: This is a 57-year-old man who presented paroxysmal palpitation associated with presyncope at rest. Surface electrocardiogram (ECG) revealed frequent ventricular premature contractions and non-sustained ventricular tachycardia when symptoms occurred. He also had a history of severe PH which was secondary to atrial septal defect and partial anomalous pulmonary venous drainage and suffered from obvious dyspnea when climbing stairs World Health Organization Class III (WHO Class III). DIAGNOSIS: Hemodynamically-instable VAs associated with severe PH. INTERVENTION: Echocardiography revealed enlargement of right ventricle (right ventricle [RV]: 43 mm). Electrophysiological examination showed the origin of VAs is next to a small low-voltage zone of RV. Radiofrequency delivery at the origin successfully terminated VAs without occurrence of complication. OUTCOME: The patient was free from arrhythmias and got an improvement of exercise tolerance, just with mild dyspnea when climbing stairs World Health Organization Class II (WHO class II), during six-month follow up. LESSONS: This case suggests the low-voltage zone of remodeled RV, which may be secondary to increased pulmonary artery pressure, serves as the substrate for VAs initiation in patient with PH. Radiofrequency ablation can successfully terminate VAs and the termination of VAs can significantly improve the patient's impaired exercise tolerance.


Assuntos
Hipertensão Pulmonar/complicações , Ablação por Radiofrequência/métodos , Complexos Ventriculares Prematuros/complicações , Ecocardiografia , Técnicas Eletrofisiológicas Cardíacas/métodos , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Hipertensão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Complexos Ventriculares Prematuros/fisiopatologia , Complexos Ventriculares Prematuros/terapia , Remodelação Ventricular
2.
Sensors (Basel) ; 21(4)2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33669692

RESUMO

Cardiac radiofrequency ablation (RFA) has received substantial attention for the treatment of multiple arrhythmias. In this scenario, there is an ever-growing demand for monitoring the temperature trend inside the tissue as it may allow an accurate control of the treatment effects, with a consequent improvement of the clinical outcomes. There are many methods for monitoring temperature in tissues undergoing RFA, which can be divided into invasive and non-invasive. This paper aims to provide an overview of the currently available techniques for temperature detection in this clinical scenario. Firstly, we describe the heat generation during RFA, then we report the principle of work of the most popular thermometric techniques and their features. Finally, we introduce their main applications in the field of cardiac RFA to explore the applicability in clinical settings of each method.


Assuntos
Ablação por Cateter , Miocárdio , Ablação por Radiofrequência , Termometria , Temperatura
3.
Zhonghua Zhong Liu Za Zhi ; 43(2): 188-193, 2021 Feb 23.
Artigo em Chinês | MEDLINE | ID: mdl-33601483

RESUMO

Objective: To explore the effective mode of ultrasound-guided radiofrequency ablation for the treatment of hepatocellular carcinoma (HCC). Methods: The morphological changes of human liver cancer cells HepG2 and human permanent liver cells LO2 after high temperature treatment were observed. The cell counting kit 8 (CCK-8) array was used to detect cell proliferation ability. The HepG2 cells (ΔHepG2 cells) and LO2 cells (ΔLO2 cells) those were still alive after treatment with 47℃ were collected and subjected to secondary high temperature treatment, and their proliferation ability was tested by the CCK-8 array. The ablation was performed at different locations of the ex-vivo porcine liver. The consistency of the vaporization area of the ultrasound image with that of the actual ablation was compared, the temperature of each area in the ultrasonic image was observed. Results: After incubated water was heated to 50℃, with the extension of the culture time, the number of adherent cells of HepG2 and LO2 cells became less and less, and gradually lost their normal cell morphology. After 50℃ and above, all of the proliferation rates of HepG2 cells, LO2 cells, ΔHepG2 cells and ΔLO2 cells were decreased. Compared with the 37℃ group, the differences were statistically significant (P<0.05), and the cells were irreversible damaged. There was no significant difference between the transverse diameters of the sonographic vaporization zones and the actual ablation zones (P>0.05). Nine minutes was considered to be an effective ablation time point since the temperatures in the hyperechoic areas were all above 53℃. Conclusion: The HCC cells within the vaporization zone observed by ultrasound can be damaged irreversibly when they were effectively ablated for over 9 minutes at 105℃ and 200 W.


Assuntos
Carcinoma Hepatocelular , Ablação por Cateter , Neoplasias Hepáticas , Animais , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/cirurgia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Ablação por Radiofrequência , Suínos , Ultrassonografia de Intervenção
4.
Medicine (Baltimore) ; 100(7): e24585, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607788

RESUMO

OBJECTIVE: This study aimed to evaluate and compare the long-term therapeutic efficacy of radiofrequency ablation (RFA) versus that of surgical resection in small hepatocellular carcinoma (HCC). METHODS: Relevant articles in English from PubMed, EMBASE, and the Cochrane Library were retrieved. Pooled hazard ratios (HRs) were calculated to assess the prognostic value of RFA compared with that of surgical resection. RESULTS: A total of 19 studies involving 15,071 patients were included. The combined HRs (95% confidence interval [CI]) of RFA for recurrence/relapse-free survival (RFS) and overall survival (OS) were 1.55 (95% CI = 1.29-1.86, I2 = 72.5%) and 1.61 (95% CI = 1.29-2.01, I2 = 60.4%), respectively, compared with surgical resection. In subgroup analyses according to study design, both RFS and OS of the prospective subgroups showed statistical significance, and no statistical heterogeneity existed between studies. CONCLUSION: Our clinical data suggest that surgical resection offers better long-term oncologic outcomes than RFA.


Assuntos
Carcinoma Hepatocelular/cirurgia , Hepatectomia , Neoplasias Hepáticas/cirurgia , Ablação por Radiofrequência , Carcinoma Hepatocelular/patologia , Humanos , Neoplasias Hepáticas/patologia
5.
Medicine (Baltimore) ; 100(1): e23678, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429736

RESUMO

BACKGROUND: Hepatocellular carcinoma (HCC) is one of the most common type of malignant tumors in adults, and is the most common cause of death in people with cirrhosis. Both laparoscopic hepatectomy (LH) and radiofrequency ablation (RFA) are radical treatments for small HCC. However, there is no international standard for the treatment of small HCC, and it is still controversial to choose LH or RFA in treating small HCC. We try to carry out a randomized, controlled, prospective study to compare the the short-term and long-term effects and safety of LH versus RFA in the treatment of small HCC. METHODS: This study is a single-center, evaluator-blinded, randomized, controlled clinical trial (RCT). The patients will be randomly divided into RFA group and LH group in a 1:1 ratio according to a computer-generated randomization list. Postoperative complications rates, Alpha fetoprotein (AFP), hospital stay, 1, 2, 3-year overall survival (OS) rates, disease-free survival (DFS) rates and all possible adverse events will be recorded. Statistical analyses will be performed with SPSS v22.0 software. CONCLUSIONS: The study will compare the the short-term and long-term effects and safety of LH versus RFA in the treatment of small HCC. OSF REGISTRATION NUMBER: doi: 10.17605/OSF.IO/HNX2T.


Assuntos
Carcinoma Hepatocelular/cirurgia , Protocolos Clínicos , Hepatectomia/normas , Laparoscopia/normas , Ablação por Radiofrequência/normas , Adulto , China , Intervalo Livre de Doença , Feminino , Hepatectomia/métodos , Humanos , Laparoscopia/métodos , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ablação por Radiofrequência/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , alfa-Fetoproteínas/análise
6.
J Urol ; 205(4): 1090-1099, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33315505

RESUMO

PURPOSE: We determined the early efficacy of bipolar radiofrequency ablation with a coil design for focal ablation of clinically significant localized prostate cancer visible at multiparametric magnetic resonance imaging. MATERIALS AND METHODS: A prospective IDEAL phase 2 development study (Focal Prostate Radiofrequency Ablation, NCT02294903) recruited treatment-naïve patients with a single focus of significant localized prostate cancer (Gleason 7 or 4 mm or more of Gleason 6) concordant with a lesion visible on multiparametric magnetic resonance imaging. Intervention was a focal ablation with a bipolar radiofrequency system (Encage™) encompassing the lesion and a predefined margin using nonrigid magnetic resonance imaging-ultrasound fusion. Primary outcome was the proportion of men with absence of significant localized disease on biopsy at 6 months. Trial followup consisted of serum prostate specific antigen, multiparametric magnetic resonance imaging at 1 week, and 6 and 12 months post-ablation. Validated patient reported outcome measures for urinary, erectile and bowel functions, and adverse events monitoring system were used. Analyses were done on a per-protocol basis. RESULTS: Of 21 patients recruited 20 received the intervention. Baseline characteristics were median age 66 years (IQR 63-69) and preoperative median prostate specific antigen 7.9 ng/ml (5.3-9.6). A total of 18 patients (90%) had Gleason 7 disease with median maximum cancer 7 mm (IQR 5-10), for a median of 2.8 cc multiparametric magnetic resonance imaging lesions (IQR 1.4-4.8). Targeted biopsy of the treated area (median number of cores 6, IQR 5-8) showed absence of significant localized prostate cancer in 16/20 men (80%), concordant with multiparametric magnetic resonance imaging. There was a low profile of side effects at patient reported outcome measures analysis and there were no serious adverse events. CONCLUSIONS: Focal therapy of significant localized prostate cancer associated with a magnetic resonance imaging lesion using bipolar radiofrequency showed early efficacy to ablate cancer with low rates of genitourinary and rectal side effects.


Assuntos
Imageamento por Ressonância Magnética Multiparamétrica , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/cirurgia , Ablação por Radiofrequência/instrumentação , Idoso , Biomarcadores Tumorais/sangue , Biópsia , Desenho de Equipamento , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Estudos Prospectivos , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/patologia
7.
J Vasc Interv Radiol ; 32(1): 33-38, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33308948

RESUMO

PURPOSE: To determine effect of body mass index (BMI) on safety and cancer-related outcomes of thermal ablation for renal cell carcinoma (RRC). MATERIALS AND METHODS: This retrospective study evaluated 427 patients (287 men and 140 women; mean [SD] age, 72 [12] y) who were treated with thermal ablation for RCC between October 2006 and December 2017. Patients were stratified by BMI into 3 categories: normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), and obese (≥ 30 kg/m2). Of 427 patients, 71 (16%) were normal weight, 157 (37%) were overweight, and 199 (47%) were obese. Complication rates, local recurrence, and residual disease were compared in the 3 cohorts. RESULTS: No differences in technical success between normal-weight, overweight, and obese patients were identified (P = .72). Primary technique efficacy rates for normal-weight, overweight, and obese patients were 91%, 94%, and 93% (P = .71). There was no significant difference in RCC specific-free survival, disease-free survival, and metastasis-free survival between obese, overweight, and normal-weight groups (P = .72, P = .43, P = .99). Complication rates between the 3 cohorts were similar (normal weight 4%, overweight 2%, obese 3%; P = .71). CONCLUSIONS: CT-guided renal ablation is safe, feasible, and effective regardless of BMI.


Assuntos
Índice de Massa Corporal , Carcinoma de Células Renais/cirurgia , Criocirurgia , Neoplasias Renais/cirurgia , Micro-Ondas/uso terapêutico , Obesidade/diagnóstico , Ablação por Radiofrequência , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/mortalidade , Carcinoma de Células Renais/secundário , Criocirurgia/efeitos adversos , Criocirurgia/mortalidade , Progressão da Doença , Intervalo Livre de Doença , Feminino , Humanos , Neoplasias Renais/mortalidade , Neoplasias Renais/patologia , Masculino , Micro-Ondas/efeitos adversos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Obesidade/mortalidade , Segurança do Paciente , Ablação por Radiofrequência/efeitos adversos , Ablação por Radiofrequência/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
8.
Acad Radiol ; 28(1): 68-76, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32111469

RESUMO

RATIONALE AND OBJECTIVES: Although computed tomography (CT) guided radiofrequency ablation (RFA) is accepted as the gold standard treatment for osteoid osteoma (OO) in extremities, most researchers have omitted OO in critical sites. We aimed to evaluate the efficacy and safety of CT-guided RFA in the management of OO in atypical sites. MATERIALS AND METHODS: A prospective interventional study conducted on 34 patients (12 women and 22 men; mean age, 22.3 ± 3.5 years; range, 12-48 years) with OO in atypical sites. All patients were treated with CT-guided RFA. All procedures were performed under general anesthesia using a single straight, rigid RF electrode for 6 minutes at 90°C. All patients were followed up; technical and clinical successes of treatment were evaluated. The severity of pain was assessed on a visual analogue scale (VAS). RESULTS: CT-guided RFA was performed in all patients with 100% technical success and 100% primary clinical success. All patients had complete pain relief and returned to their quality of life without further analgesics within 1 month after the procedure. All procedures were successfully completed without any major complications. The mean preprocedure VAS score dropped to zero by the end of the first week with a highly statistically significant difference (p < 0.001). CONCLUSION: CT-guided RFA is a safe and effective procedure in the management of OO in atypical sites with 100% primary success rate, 0% long-term recurrence rate, and very low complication rate.


Assuntos
Neoplasias Ósseas , Ablação por Cateter , Osteoma Osteoide , Adolescente , Adulto , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/cirurgia , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoma Osteoide/diagnóstico por imagem , Osteoma Osteoide/cirurgia , Estudos Prospectivos , Qualidade de Vida , Ablação por Radiofrequência , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
9.
Tech Vasc Interv Radiol ; 23(4): 100699, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33308579

RESUMO

This article provides a step-by-step guide for minimally invasive percutaneous image-guided thermal ablation for treatment of vertebral metastases. Such interventions have proved safe and effective in management of selected patients with spinal metastases primarily to achieve pain palliation and local tumor control. Particular attention to patient selection guidelines, details of procedure techniques, thermal protection, adequacy of treatment, recognition and management of potential complications, and post-ablation imaging are essential for improved patient outcomes.


Assuntos
Dor nas Costas/cirurgia , Criocirurgia , Metastasectomia , Micro-Ondas/uso terapêutico , Manejo da Dor , Ablação por Radiofrequência , Radiografia Intervencionista , Neoplasias da Coluna Vertebral/cirurgia , Dor nas Costas/diagnóstico , Criocirurgia/efeitos adversos , Humanos , Metastasectomia/efeitos adversos , Micro-Ondas/efeitos adversos , Manejo da Dor/efeitos adversos , Complicações Pós-Operatórias/terapia , Ablação por Radiofrequência/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/secundário , Resultado do Tratamento
10.
Tech Vasc Interv Radiol ; 23(4): 100706, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33308582

RESUMO

Knee osteoarthritis, a chronic degenerative condition, can be a debilitating and limiting process with affected patients presenting with symptoms such as pain, restrictive range of motion, and swelling. This condition commonly afflicts millions of people with a higher incidence among the elderly that results from chronic mechanical repetitive loading. The treatment of pain generating conditions such as arthritis in large joints is complex requiring interventions of varying focuses such as weight loss, anti-inflammatory medications, corticosteroid, hyaluronic and viscosupplementation injections, and prescription opioids. A gap in the treatment options of this ailment currently exists between short term pain solutions and surgical approaches such as total knee arthroplasty that may offer longer pain relief. Cooled radiofrequency ablation is an emerging technique that offers a minimally invasive alternative for treating knee pain with a clinical relevance in patients who are not surgical candidates due to coexistent medical comorbidities or those who are undesiring of surgery. This procedure uses radiofrequency ablation that blocks genicular nerves from transmitting knee pain signals to the brain. Further research will allow the application of this technique to treat other sensory nerves in large joints such as the hip and shoulder.


Assuntos
Artralgia/cirurgia , Denervação , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Manejo da Dor , Ablação por Radiofrequência , Radiografia Intervencionista , Artralgia/diagnóstico por imagem , Artralgia/fisiopatologia , Denervação/efeitos adversos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/fisiopatologia , Manejo da Dor/efeitos adversos , Complicações Pós-Operatórias/etiologia , Ablação por Radiofrequência/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Fatores de Risco , Resultado do Tratamento
11.
Tech Vasc Interv Radiol ; 23(4): 100700, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33308584

RESUMO

Degenerative lumbar spine disorder (DLSD) is a ubiquitously occurring event that may be induced or accelerated by multiple factors such as from overuse, trauma, genetic predisposition, nutrition deficiency, and others. While our understanding of this degenerative disorder is limited, in terms of prevention, the symptoms from DLSD can be significant and may lead to the reduction in the patient's quality of life and loss of work time. In the Global Burden of Disease Study, low back pain was ranked the highest of 291 different conditions, due to the number of years lost to disability, amounting to 83 million disability-adjusted life years lost in 2010. DLSD contains conditions involving disc degeneration, lumbar spinal stenosis, and spondylolisthesis, including symptoms ranging from low back pain to lower extremity radicular pain and weakness. In this issue, we will be discussing treatments for patients suffering with chronic low back pain from endplate disruption, utilizing basivertebral nerve radiofrequency ablation, also known as the INTRACEPT procedure. This issue will also cover minimally invasive lumbar decompression from lumbar spinal stenosis, due to contributory ligamentum flavum hypertrophy, utilizing the percutaneous image-guided lumbar decompression technique known as the MILD procedure.


Assuntos
Dor Crônica/cirurgia , Descompressão Cirúrgica , Dor Lombar/cirurgia , Vértebras Lombares/cirurgia , Manejo da Dor , Ablação por Radiofrequência , Radiografia Intervencionista , Doenças da Coluna Vertebral/cirurgia , Dor Crônica/diagnóstico , Dor Crônica/fisiopatologia , Descompressão Cirúrgica/efeitos adversos , Humanos , Dor Lombar/diagnóstico , Dor Lombar/fisiopatologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Manejo da Dor/efeitos adversos , Ablação por Radiofrequência/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/fisiopatologia , Resultado do Tratamento
12.
Medicine (Baltimore) ; 99(52): e23924, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350797

RESUMO

ABSTRACT: To investigate whether MRI features could preoperatively predict local tumor progression (LTP) in patients with hepatocellular carcinoma (HCC) treated with radiofrequency ablation (RFA) as the first-line treatment and improve a novel predictive model through developing a nomogram including various conventional MRI parameters. 105 patients with HCCs who had received RFA were enrolled. All patients had undergone conventional MRI before RFA. Uni- and multivariable analyses for LTP were assessing using a Cox proportional hazards model. The developed MRI-based nomogram was further designed based on multivariable logistic analysis in our study and the usefulness of the developed model was validated according to calibration curves and the C-index. Rim enhancement (hazard ratio: 2.689, P = .044) and the apparent diffusion coefficient (ADC) values (hazard ratio: 0.055, P = .038) were statistically significant independent predictors of LTP after RFA at multivariable analysis. The performance of the nomogram incorporating two MRI parameters (with a C-index of 0.782) was improved compared with that based on rim enhancement and ADC alone (with C-index values of 0.630 and 0.728, respectively). The calibration curve of the MRI-based nomogram showed good conformance between evaluation and observation at 0.5, 1, and 1.5 years after RFA. The preliminary predictive model based on MRI findings including rim enhancement and ADC value could be used preoperatively to estimate the risk of LTP of HCC after RFA as the first-line treatment.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Fígado/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Recidiva Local de Neoplasia/diagnóstico , Nomogramas , Ablação por Radiofrequência , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/cirurgia , Feminino , Humanos , Fígado/patologia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Prognóstico , Ablação por Radiofrequência/efeitos adversos , Ablação por Radiofrequência/métodos , Reprodutibilidade dos Testes
15.
J Vasc Interv Radiol ; 31(11): 1874-1885, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33129433

RESUMO

PURPOSE: To assess the feasibility of inducing vascular occlusion by application of radiofrequency (RF) energy via conductive endovascular wires or baskets. MATERIALS AND METHODS: A retrievable nitinol basket and stainless steel guidewire with a platinum tip were evaluated as conductors for endovascular application of RF energy. Tissue-mimicking thermochromic gel phantoms that change color with heating were cast with 2-, 5-, and 7-mm-diameter lumens and filled with 37 oC saline. After ablation, the phantoms were sectioned, and the thermal footprints were evaluated. Six castrated male domestic swine underwent endovascular ablation using the basket in iliac arteries and guidewires in renal arteries. Post-procedural angiography was performed, and postmortem arterial segments were resected for histopathologic analysis. RESULTS: In the phantom, the depth of thermal change in the 5- and 7-mm lumens averaged 6.3 and 6.0 mm along the basket, respectively, and in the 2- and 5-mm lumens, the depth of thermal change averaged 1.9 and 0.5 mm along the wire, respectively. In the swine, RF energy delivery led to angiographic occlusion at 12 of 13 sites. Thermal injury and occlusion were similar at the proximal, middle, and distal basket treatment zone, whereas injury and occlusion decreased from the proximal to the distal end of the 5-cm wire treatment zone. CONCLUSIONS: Endovascular delivery of RF energy via a conductive basket in medium-sized arteries or a guidewire in small arteries led to acute angiographic and histologic occlusion. The potential to induce stasis might be useful in settings where rapid occlusion is desirable.


Assuntos
Procedimentos Endovasculares/instrumentação , Artéria Ilíaca/cirurgia , Ablação por Radiofrequência/instrumentação , Artéria Renal/cirurgia , Ligas , Animais , Condutividade Elétrica , Desenho de Equipamento , Estudos de Viabilidade , Temperatura Alta , Artéria Ilíaca/patologia , Masculino , Teste de Materiais , Modelos Animais , Orquiectomia , Platina , Artéria Renal/patologia , Aço Inoxidável , Sus scrofa
16.
J Vasc Interv Radiol ; 31(11): 1745-1752, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33129427

RESUMO

PURPOSE: To evaluate the effectiveness of radiofrequency (RF) ablation as measured by change in worst pain score from baseline to 3 mo after RF ablation for the palliative treatment of painful bone metastases. MATERIALS AND METHODS: One hundred patients (mean age, 64.6 y) underwent RF ablation for metastatic bone disease and were followed up to 6 mo. Subjects' pain and quality of life were measured before RF ablation and postoperatively by using the Brief Pain Index and European Quality of Life questionnaires. Opioid agent use and device-, procedure-, and/or therapy-related adverse events (AEs) were collected. RESULTS: Eighty-seven patients were treated for tumors involving the thoracolumbar spine and 13 for tumors located in the pelvis and/or sacrum. All ablations were technically successful, and 97% were followed by cementoplasty. Mean worst pain score decreased from 8.2 ± 1.7 at baseline to 3.5 ± 3.2 at 6 mo (n = 22; P < 0.0001 for all visits). Subjects experienced significant improvement for all visits in average pain (P < .0001), pain interference (P < .0001), and quality of life (P < .003). Four AEs were reported, of which 2 resulted in hospitalization for pneumonia and respiratory failure. All 30 deaths reported during the study were attributed to the underlying malignancy and not related to the study procedure. CONCLUSIONS: Results from this study show rapid (within 3 d) and statistically significant pain improvement with sustained long-term relief through 6 mo in patients treated with RF ablation for metastatic bone disease.


Assuntos
Neoplasias Ósseas/cirurgia , Dor/prevenção & controle , Cuidados Paliativos , Ablação por Radiofrequência , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/complicações , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/secundário , Cementoplastia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico , Dor/etiologia , Dor/mortalidade , Medição da Dor , Estudos Prospectivos , Qualidade de Vida , Ablação por Radiofrequência/efeitos adversos , Ablação por Radiofrequência/mortalidade , Fatores de Tempo , Resultado do Tratamento
17.
J Vasc Interv Radiol ; 31(11): 1753-1762, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33012648

RESUMO

A systematic review and meta-analysis of pain response after radiofrequency (RF) ablation over time for osseous metastases was conducted in 2019. Analysis used a random-effects model with GOSH plots and meta-regression. Fourteen studies comprising 426 patients, most with recalcitrant pain, were identified. Median pain reduction after RF ablation was 67% over median follow-up of 24 weeks (R2 = -.66, 95% confidence interval -0.76 to -0.55, I2 = 71.24%, fail-safe N = 875) with 44% pain reduction within 1 week. A low-heterogeneity subgroup was identified with median pain reduction after RF ablation of 70% over 12 weeks (R2 = -.75, 95% confidence interval -0.80 to -0.70, I2 = 2.66%, fail-safe N = 910). Addition of cementoplasty after RF ablation did not significantly affect pain scores. Primary tumor type and tumor size did not significantly affect pain scores. A particular, positive association between pain after RF ablation and axial tumors was identified, implying possible increased palliative effects for RF ablation on axial over appendicular lesions. RF ablation is a useful palliative therapy for osseous metastases, particularly in patients with recalcitrant pain.


Assuntos
Neoplasias Ósseas/cirurgia , Aprendizado de Máquina , Dor/prevenção & controle , Cuidados Paliativos , Ablação por Radiofrequência , Adulto , Idoso , Neoplasias Ósseas/complicações , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/secundário , Cementoplastia , Análise por Conglomerados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico , Dor/etiologia , Dor/mortalidade , Medição da Dor , Qualidade de Vida , Ablação por Radiofrequência/efeitos adversos , Ablação por Radiofrequência/mortalidade , Fatores de Tempo , Resultado do Tratamento
19.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5263-5266, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019171

RESUMO

Thermal ablation techniques are increasingly used for the treatment of symptomatic uterine fibroids. Thermal protection of myometrial tissue adjacent to the fibroid from ablation is critical to maximally preserve the uterus. This study presents a bench top experimental setup, using ex vivo bovine muscle as a surrogate tissue, for evaluating collateral thermal damage in tissues during fibroid ablation. The study reports on the effect of applicator insertion angles (67.5° and 90°) into a mock fibroid on the efficacy of treatment. 6 experiments were performed (3 for each insertion angle) with 30 W applied power at 2.45 GHz. The heating duration was restricted to the time at which a thermal dose of 10 cumulative equivalent minutes at 43 °C (10 CEM 43) was accrued at the boundary of the mock fibroid. Results showed that the volume of ablation inside the mock fibroid dropped considerably from 66% to 17% when the applicator insertion angle was changed from 90º to 67.5º, suggesting that insertion angle plays an important role during microwave ablation of fibroid. The proposed setup provides a method for validating computational models for accurate and safe delivery of ablation to target tissues in fibroid treatment.


Assuntos
Leiomioma , Miométrio , Animais , Bovinos , Feminino , Leiomioma/cirurgia , Micro-Ondas , Miométrio/cirurgia , Ablação por Radiofrequência , Útero
20.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5267-5271, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019172

RESUMO

Microwave-induced thermoacoustic (TA) imaging is a potential alternative to conventional real-time imaging methods for monitoring microwave ablation (MWA). In this study, we develop a multi-physics model for the generation and propagation of microwave-induced TA signals during pulsed MWA. Our model couples electromagnetics, heat transfer, and acoustics physics. We compare simulation and experimental results for a pulsed MWA system wherein a coaxial MWA antenna is used to heat water. The simulated and experimentally measured TA signals for this configuration are in good qualitative agreement. This multi-physics modeling tool is valuable for understanding the fundamentals of TA signal generation and propagation from within an evolving ablation zone.


Assuntos
Micro-Ondas , Ablação por Radiofrequência , Fenômenos Eletromagnéticos , Frequência Cardíaca , Reprodução
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