Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 692
Filtrar
1.
Z Gastroenterol ; 58(3): 241-244, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-32198738

RESUMO

Treatment of adenoma of the major duodenal papilla is often a challenge for the endoscopist. We report about two patients with papillary adenoma who had residual adenoma in the center of the ductus hepatocholedochus papillary region after endoscopic papillectomy. Due to missing possibility of further endoscopic resection we carried out endobiliary radiofrequency ablation instead of surgical treatment. In follow-up examination, there where no macroscopic or histological relapse, therefore endobiliary radiofrequency ablation needs to be discussed as an alternative to surgical therapy option.


Assuntos
Adenoma/cirurgia , Ampola Hepatopancreática/cirurgia , Neoplasias do Ducto Colédoco/cirurgia , Adenoma/patologia , Ampola Hepatopancreática/patologia , Neoplasias do Ducto Colédoco/patologia , Endoscopia Gastrointestinal , Humanos , Recidiva Local de Neoplasia , Ablação por Radiofrequência , Resultado do Tratamento
2.
Medicine (Baltimore) ; 99(11): e19398, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176065

RESUMO

Electrocardiographic (ECG) criteria identifying right- and left-sided outflow tract origins have been established. The purpose of this study was to define the criteria for premature ventricular contractions (PVCs) originating from the right coronary cusp (RCC) adequately.We analyzed ECG and electrophysiologic study data from patients who underwent successful ablation of PVCs originating from the RCC and right ventricular outflow tract (RVOT). Eighteen RCC and 28 septal RVOT PVCs were studied. Among these 18 successful RCC PVCs, a predominantly positive QRS in lead I in 18/18 (100%), longer V1-2 R-wave duration (81.4 ±â€Š31.1 vs 44.8 ±â€Š7.0 ms, P = .02), V1-2 R wave duration index (RWDI) (51.3 ±â€Š22.0 vs 31.2 ±â€Š7.5%, P = .06) were observed compared to those with posteroseptal RVOT. Local ventricular activation time preceding QRS onset was significantly earlier (-38 ±â€Š12 ms) at the successful RCC ablation site compared to the failed ablation site of the septal RVOT (-22 ±â€Š8 ms), even without good pace mapping at the RVOT (P < .001). The receiver operating characteristic curve showed that a pre-QRS time of ≥-31 ms predicted successful RCC ablation with 67% sensitivity and 94% specificity. A predominantly positive QRS in lead I, longer R-wave duration and RWDI in lead V1 or V2 with a local ventricular activation preceding QRS onset by an average of -31 ms suggests an effective RCC ablation site.


Assuntos
Eletrocardiografia , Ablação por Radiofrequência , Complexos Ventriculares Prematuros/fisiopatologia , Complexos Ventriculares Prematuros/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade
3.
J Laryngol Otol ; 134(3): 222-227, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32066510

RESUMO

OBJECTIVE: This study compared the efficacy of microwave ablation and silver nitrate cautery as treatments for idiopathic recurrent anterior epistaxis in adults. METHODS: A case series with chart review was conducted. Adults with recurrent anterior epistaxis intra-operatively treated via microwave ablation or silver nitrate chemical cautery of the anterior nasal septum were enrolled. The primary outcomes were the proportion of patients in each group for whom bleeding ceased within 24 hours of treatment, and the time to successful haemostasis. The secondary outcomes were re-bleeding rates at 1 and 12 weeks and 6 months, and complications. RESULTS: The haemostasis success rate within 24 hours' treatment of convex lesions was significantly higher in the microwave ablation group than in the cautery-only group. Of patients with convex lesions, the recurrence rate to six months was significantly higher in the cautery group than in the microwave ablation group, but this was not the case for those with flat lesions. CONCLUSION: Microwave ablation afforded rapid and simple haemostasis for adults with recurrent anterior epistaxis in an out-patient setting. Microwave ablation had significant advantages compared to silver nitrate cautery when used to treat epistaxis in patients with convex lesions.


Assuntos
Cauterização/métodos , Epistaxe/cirurgia , Hemostasia Cirúrgica/métodos , Micro-Ondas/uso terapêutico , Ablação por Radiofrequência/métodos , Adulto , Feminino , Humanos , Masculino , Septo Nasal/cirurgia , Nitrato de Prata/administração & dosagem , Resultado do Tratamento
4.
World Neurosurg ; 133: 178-184, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31606502

RESUMO

BACKGROUND: Radiofrequency ablation (RFA) focally destroys abnormal or dysfunctional tissue using thermal energy generated from alternating current. The utilization of RFA has gained popularity as a minimally invasive procedure for the treatment of skeletal metastases with a particular focus on palliative pain treatments to the spine, pelvis, long bones, sternum, and glenoid. More recently, single-session procedures that combine RFA with vertebral augmentation techniques have allowed treatment to areas of pain associated with pathologic fractures secondary to metastatic disease. Although many studies have been done to investigate the safety and efficacy of RFA, there have been no reported cases to date in which the use of RFA for the treatment of spinal metastases has led to any major permanent neurological injury. CASE DESCRIPTION: This report describes a case of a 61-year-old woman who underwent RFA and kyphoplasty for spinal metastases and noted the immediate onset of lower extremity paralysis after the procedure. To the best of our knowledge, this is the first documented case of permanent lower extremity paralysis in the medical literature after radiofrequency thermal ablation of spine metastases. CONCLUSIONS: Postoperative magnetic resonance imaging and physical examination suggest RFA-induced thermal injury as the most likely mechanism of paralysis. In this report, a review of previous in vivo models used in studying the efficacy and safety of spine RFA is conducted. Additionally, the literature has been reviewed for any neurological events reported with the use of RFA in the treatment of patients with vertebral pathology.


Assuntos
Cifoplastia/efeitos adversos , Paraplegia/etiologia , Ablação por Radiofrequência/efeitos adversos , Neoplasias da Coluna Vertebral/cirurgia , Feminino , Humanos , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/cirurgia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Paraplegia/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/secundário
5.
Urology ; 135: 88-94, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31585198

RESUMO

OBJECTIVE: To compare perioperative and oncologic outcomes for patients with clinical T1b renal cell carcinoma following treatment with microwave ablation (MW), partial nephrectomy (PN), or radical nephrectomy (RN). METHODS: Comprehensive clinical and pathologic data were collected for nonmetastatic renal cell carcinoma patients with cT1b tumors following MW, PN, or RN from 2000 to 2018. Local recurrence-free, metastasis-free, cancer-specific and overall survival were estimated using Kaplan-Meier method. Prognostic factors for complications and survival were determined using logistic regression and Cox hazard models, respectively. RESULTS: A total of 325 patients (40 MW, 74 PN, and 211 RN) were identified. Patients treated with MW were older with higher Charlson comorbidity indices compared to surgical patients. Median length of hospitalization was shorter for MW compared to surgical patients (1 day vs 4 days, P <.0001). Post-treatment estimated glomerular filtration rate decreased by median 4.5% for MW compared to 3.2% for PN (P = .58) and 29% for RN (P <.001). Median follow-up was 34, 35, and 49 months following MW, PN, and RN, respectively. Estimated 5-year local recurrence-free survival was 94.5% for MW vs 97.9% for PN (P = .34) and 99.2% for RN (P = .02). Two patients recurred after MW and underwent repeat ablation without subsequent recurrence. No difference in 5-year metastasis-free survival or cancer-specific survival was found among MW, PN, or RN. Four (10%) MW patients had high-grade complication. Only prior abdominal surgery predicted high-grade complication (OR 6.29, P = .017). CONCLUSION: Microwave ablation is a feasible alternative to surgery in select comorbid patients with clinical T1b renal cell carcinoma.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Recidiva Local de Neoplasia/cirurgia , Nefrectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Ablação por Radiofrequência/efeitos adversos , Idoso , Carcinoma de Células Renais/mortalidade , Intervalo Livre de Doença , Estudos de Viabilidade , Feminino , Seguimentos , Taxa de Filtração Glomerular , Humanos , Estimativa de Kaplan-Meier , Neoplasias Renais/mortalidade , Masculino , Micro-Ondas/uso terapêutico , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/prevenção & controle , Estadiamento de Neoplasias , Nefrectomia/métodos , Complicações Pós-Operatórias/etiologia , Ablação por Radiofrequência/métodos , Reoperação/estatística & dados numéricos
6.
Dis Mon ; 66(1): 100850, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30808502

RESUMO

Barrett's esophagus (BE) is characterized by a change in the mucosal lining of the distal esophagus whereby the squamous epithelium of the esophagus is replaced by the metaplastic columnar epithelium. It is a pre-malignant lesion associated with esophageal adenocarcinoma. Patients with gastroesophageal reflux disease who have additional risk factors (Caucasian race, male gender, age > 50 years, tobacco use, and central obesity) should undergo an esophagogastroduodenoscopy to screen for Barrett's esophagus. Patients with Barrett's esophagus should undergo endoscopic surveillance every 3-5 years if no dysplasia is found. Patients with Barrett's esophagus who are found to have dysplasia should be treated endoscopically. We present a comprehensive review of the pathophysiology, diagnosis, surveillance and management of Barrett's esophagus.


Assuntos
Esôfago de Barrett/diagnóstico , Esôfago de Barrett/terapia , Adenocarcinoma/etiologia , Adenocarcinoma/terapia , Crioterapia , Progressão da Doença , Neoplasias Esofágicas/etiologia , Neoplasias Esofágicas/terapia , Esofagoscopia , Humanos , Obesidade/complicações , Fotoquimioterapia , Inibidores da Bomba de Prótons/uso terapêutico , Ablação por Radiofrequência , Fatores de Risco , Fumar/efeitos adversos , Conduta Expectante
7.
Br J Radiol ; 93(1105): 20190719, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31670571

RESUMO

OBJECTIVE: To compare therapeutic outcomes between hepatic resection (HR) and radiofrequency ablation (RFA) for small hepatic masses diagnosed as hepatocellular carcinoma (HCC) on pre-treatment imaging study. METHODS: Our institutional review board approved this retrospective study, and informed consent was waived. Patients with a single (≤3 cm) mass diagnosed as HCC on pre-treatment imaging study between January 2008 and December 2009 who underwent HR (n = 145) or RFA (n = 178) were included. Recurrence-free survival (RFS) and overall survival (OS) were assessed. In the HR group, the false-positive rate for imaging diagnosis was calculated. For the RFA group, the local tumor progression rate was calculated. RESULTS: RFS rates at 5 years were 59.3% for the HR group and 32.2% for the RFA group. OS rates at 5 years were 85.4% for the HR group and 76.8% for the RFA group. In the RFA group, cumulative local tumor progression rates were 8.3 and 20.2% at 1 and 3 years. Treatment modality was not an independent prognostic factor for either RFS or OS on multivariate analysis. The false-positive rate for HCC diagnosis based on imaging criteria was 4.8% in the HR group. CONCLUSION: The imaging criteria for diagnosis of HCC have a high positive predictive value. Multivariate analysis showed that RFS and OS rates were not significantly different between HR and RFA for small hepatic masses diagnosed as HCC on pre-treatment imaging. ADVANCES IN KNOWLEDGE: Treatment modality (hepatic resection vs RFA) was not an independent prognostic factor for both RFS and OS for small masses (≤3 cm) diagnosed as hepatocellular carcinoma on pre-treatment imaging.


Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/cirurgia , Hepatectomia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Ablação por Radiofrequência , Biomarcadores Tumorais/sangue , Meios de Contraste , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
8.
Ann Vasc Surg ; 62: 45-50.e2, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31201974

RESUMO

BACKGROUND: The rates of thromboembolic complications such as deep vein thrombosis (DVT) after venous ablation procedures for symptomatic superficial venous insufficiency are controversial. We sought to describe the risk factors for and incidence of DVT after radiofrequency ablation (RFA) and laser ablation (LA). METHODS: We queried the Truven Health Marketscan Database from 2007-16 for patients who underwent RFA or LA and had a follow-up duplex ultrasound within 30 days of the ablation procedure. The primary outcome was DVT at 7 and 30 days identified by International Classification of Diseases-9 and International Classification of Diseases-10 codes. Multivariable regression was used to evaluate the patient and procedural variables associated with a DVT at 30 days, expressed as odds ratios (ORs) with a 95% confidence interval (95% CI). Patients and procedures with a previous DVT diagnosis were excluded. RESULTS: A total of 256,999 patients underwent 433,286 ablation procedures: 192,195 (44.4%) RFA and 241,091 LA. Of these, 8,203 (1.9%) had a newly diagnosed DVT within 7 days and 13,347 (3.1%) within 30 days of the procedure. The incidence of DVT decreased over the study period. LA (2.8%) demonstrated a lower incidence of DVT at 30 days compared with RFA (3.4%), P < 0.001. On multivariable regression, LA (OR, 0.82; 95% CI 0.80-0.85) was again associated with a decreased risk for 30-day DVT, as was female gender (OR, 0.74; 95% CI, 0.71-0.77), and sclerotherapy performed on the same day (OR, 0.91; 95% CI, 0.85-0.98). A diagnosis of peripheral artery disease (OR, 1.23; 95% CI, 1.16-1.31) and concomitant stab phlebectomy (OR, 1.43; 95% CI, 1.37-1.49) was associated with an increased risk of DVT within 30 days. CONCLUSIONS: The incidence of newly diagnosed DVT within 30 days of an ablation procedure was 3.2%. The risk for DVT decreased in recent years, and LA was associated with an 18% decreased risk compared with RFA.


Assuntos
Terapia a Laser/efeitos adversos , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/cirurgia , Ablação por Radiofrequência/efeitos adversos , Trombose Venosa/etiologia , Adulto , Bases de Dados Factuais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/epidemiologia , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia , Trombose Venosa/diagnóstico por imagem
9.
Ann Vasc Surg ; 62: 263-267, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31394220

RESUMO

BACKGROUND: Endovenous thermal ablation has become the procedure of choice in the treatment of superficial venous reflux disease. The current armamentarium of devices and techniques aimed at the elimination of saphenous reflux offers surgeons and interventionalists a variety of treatment options; however, there is a lack of data comparing the safety of these products. The most concerning complication after endovenous thermal ablation is endothermal heat-induced thrombosis (EHIT) due to the risk of progression to deep venous thrombosis. This study aimed to compare the incidence rate of EHIT between radiofrequency ablation (RFA) and endovenous laser therapy (EVLT). METHODS: This was a single-center, office-based, retrospective study over the course of 5 years, in which 3,218 consecutive patients underwent 10,029 endovenous saphenous ablations. The patient cohort was 66.2% female, with an average age of 61.9 years. At the time of each individual intervention, 24, 212, 3,620, 4,806, 200, and 1,167 patients had Clinical-Etiology-Anatomy-Pathophysiology disease 1, 2, 3, 4, 5, and 6, respectively. RESULTS: There was a total of 3,983 EVLT and 6,091 RFA procedures. The most common vessel treated was the great saphenous vein, 63.6% of the time, followed by the small saphenous vein (25.6%), accessory saphenous vein (6.1%), and perforator vein (4.6%). There were 186 cases of EHIT, with 137 (73.6%) identified as type 1 as per the Kabnick classification. Endovenous ablation performed via RFA resulted in significantly more cases of EHIT than of EVLT (109 vs. 77; P = 0.034; odds ratio = 1.52), which was confirmed by a multivariate analysis. CONCLUSIONS: In the largest single-center study of endovenous saphenous ablations to date, RFA was shown to pose a significantly higher risk of EHIT than of EVLT.


Assuntos
Terapia a Laser/efeitos adversos , Ablação por Radiofrequência/efeitos adversos , Veia Safena/cirurgia , Insuficiência Venosa/cirurgia , Trombose Venosa/epidemiologia , Humanos , Incidência , New York/epidemiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Veia Safena/diagnóstico por imagem , Fatores de Tempo , Resultado do Tratamento , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/epidemiologia , Trombose Venosa/diagnóstico por imagem
10.
Urologiia ; (5): 124-125, 2019 Dec.
Artigo em Russo | MEDLINE | ID: mdl-31808646

RESUMO

Diphallia is an uncommon deformity, with glans duplication being its rarest form. We discuss here a case of a 6-year-old boy who presented due to excess prepuce malformation that, on examination, revealed a "penile nodule" that proved to be glans duplication. Our patient had only one urethra present and no congenital anomalies. Surgical uneventful penile reconstruction involving radiofrequency ablation (RFA) resolved the issue.


Assuntos
Pênis/cirurgia , Ablação por Radiofrequência , Procedimentos Cirúrgicos Reconstrutivos/métodos , Criança , Humanos , Masculino , Pênis/anormalidades , Resultado do Tratamento , Uretra
11.
Cancer Imaging ; 19(1): 87, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31849340

RESUMO

OBJECTIVE: The present study aimed to evaluate the short-term clinical performance and safety of percutaneous microwave ablation (MWA) techniques for the treatment of bone tumors. METHODS: This single-institution retrospective study investigated 47 cases of bone tumors treated by MWA from June 2015 to June 2018. The study included 26 patients (55.3%) with benign bone tumors and 21 patients (44.7%) with malignant bone tumors. The tumors were located in the spine or sacrum (15, 31.9%), the upper extremities (6, 12.8%), the lower extremities (17, 36.2%) and the pelvis (9, 19.1%). Outcomes regarding clinical efficacy, including pain relief, quality of life, and intervention-related complications, were evaluated before and after MWA using the visual analog scale (VAS) and the 36-item Short-Form Health Survey (SF-36) scoring system. RESULTS: Of the 47 patients included in this study, all of them completed follow-up examinations, with a mean follow-up duration of 4.8 ± 1.6 months (range, 2-9 months). Significantly improved VAS and SF-36 scores were recorded after the initial treatment (P<0.001), suggesting that almost 100% of patients experienced pain relief and an improved quality of life following surgery. No major intervention-related complications (e.g., serious neurovascular injury or infection) occurred during or after the treatment. We recorded only three minor posttreatment complications (6.4%, 3/47), which were related to thermal injury that caused myofasciitis and affected wound healing. CONCLUSION: In our study, the short-term efficacy of MWA was considerably favorable, with a relatively low rate of complications. Our results also showed that MWA was effective for pain relief and improved patients' quality of life, making it a feasible treatment alternative for bone tumors.


Assuntos
Neoplasias Ósseas/terapia , Micro-Ondas/uso terapêutico , Ablação por Radiofrequência/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Resultado do Tratamento
12.
Medicine (Baltimore) ; 98(45): e17832, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702638

RESUMO

INTRODUCTION: The prognosis for recurrent intrahepatic cholangiocarcinoma with bone metastasis remains dismal and its treatment poses a challenge for oncologists. To date, only 2 cases were reported in which pembrolizumab, an agent against programmed cell death protein-1 (PD-1), combined with chemotherapy led to a complete response. The safety and efficacy of nivolumab-based immunotherapy combined with lenvatinibin intrahepatic cholangiocarcinoma is unknown. PATIENT CONCERNS: A 40-year-old female was identified as having a lesion of 7.0 cm in diameter in the right lobe of the liver. In addition, calculi in the main and left hepatic bile ducts as well as the gallbladder were found. DIAGNOSIS: Based on the results of imaging studies and tumor biomarker level, the patient was initially diagnosed as having intrahepatic cholangiocellular carcinoma and cholelithiasis, after which surgery was performed. The pathological examination confirmed that the tumor was cholangiocarcinoma. Adjuvant chemotherapy was administered after surgery. However, the patient developed recurrent lesions at the 5th month after surgery, and the cholangiocarcinoma expanded to the right thoracic vertebral pedicle (T7-8) at the 6th month. INTERVENTIONS: The patient underwent percutaneous microwave ablation after recurrence in the liver was identified. After that, the patient received nivolumab plus lenvatinib. OUTCOMES: The lesions in the liver decreased in size and disappeared after treatment with nivolumab plus lenvatinib. Additionally, the metastases in the right thoracic vertebral pedicle were stable after 9 months of therapy. LESSONS: Immunotherapy has revolutionized the treatment of non-small-cell lung cancer, melanoma, and advanced renal cell carcinoma. In this case, the patient achieved an excellent radiological and symptomatic response after receiving nivolumab plus lenvatinib combination therapy. Patients suffering from cholangiocarcinoma with dMMR status and a high tumor mutation burden (TMB) may have a consistent eutherapeutic effect with anti-PD-1-directed treatment.


Assuntos
Neoplasias dos Ductos Biliares/tratamento farmacológico , Ductos Biliares Intra-Hepáticos/patologia , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/secundário , Colangiocarcinoma/tratamento farmacológico , Adulto , Anticorpos Monoclonais Humanizados/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos/cirurgia , Colangiocarcinoma/cirurgia , Feminino , Humanos , Recidiva Local de Neoplasia , Compostos de Fenilureia/uso terapêutico , Quinolinas/uso terapêutico , Ablação por Radiofrequência , Análise de Sobrevida , Resultado do Tratamento
13.
Presse Med ; 48(10): 1146-1155, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31676219

RESUMO

Percutaneous tumor ablation has faced a major growth in recent years with progressive expansion of clinical indications and subsequent adoption by national and international guidelines. Such techniques have become popular due to their minimally invasive profile and precise image-guided targeting resulting into a significant decrease of the procedure-related morbidity. Traditionally, malignant, and to lesser extent benign tumors, have been treated with these new techniques in several different organs including liver, kidney, lung and bone. More recently, other anatomic districts/organs including thyroid, breast, uterus and soft tissues have also been treated. Nevertheless, in order to optimize clinical results, precise knowledge of physical principles underlying these new techniques is of paramount importance, since technical adjustments may be provided according to specific tissue features (e.g. vascularization, density, etc.) and clinical indications of the procedure. Therefore, the goal of this review article is to present all the available ablation techniques with particular regard to their underlying physical principles and most common clinical indications.


Assuntos
Técnicas de Ablação/métodos , Neoplasias/cirurgia , Neoplasias Ósseas/cirurgia , Criocirurgia , Eletroporação , Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Humanos , Hipertermia Induzida/métodos , Neoplasias Renais/cirurgia , Terapia a Laser , Neoplasias Hepáticas/cirurgia , Neoplasias Pulmonares/cirurgia , Micro-Ondas/uso terapêutico , Neoplasias Musculares/cirurgia , Ablação por Radiofrequência
14.
Zhonghua Nei Ke Za Zhi ; 58(12): 883-888, 2019 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-31775450

RESUMO

Objective: To study the correlation between left atrial sphericity (LASP) and thromboembolic events (TE) in patients with atrial fibrillation (AF). Methods: This study was conducted in patients with AF underwent radiofrequency ablation in the Department of Cardiology of First Affiliated Hospital of Zhengzhou University from January 2011 to October 2018. The AF patients with TE (study group, n=157) and the AF patients without TE (control group, n=157) were matched for age and gender. The differences of LASP and other related indexes between the two groups were compared, and the correlation between LASP and TE was analyzed by conditional logistic regression. The receiver operating characteristic (ROC) curve was drawn to analyze the diagnostic value of LASP for TE. Results: (1) The LASP in the study group was significantly higher than that in the control group [ (87.5±7.1) % vs. (82.8±6.1) %, P=0.001]. (2) Conditional logistic regression analyses showed that LASP (OR=1.10, 95%CI 1.05-1.16, P=0.001), left atrial volume index (OR=1.01, 95%CI 1.00-1.02, P=0.016) and CHA(2)D-VASc score (OR=1.77, 95%CI 1.30-2.41, P=0.001) were independently and positively correlated with TE. (3) The ROC curve analysis showed that the area under the curve (AUC) of left atrial sphericity (AUC=0.712, 95%CI 0.656-0.768, P=0.001) was larger than the AUC of either left atrial volume index (AUC=0.650, 95%CI 0.589-0.710, P=0.001) or CHA(2)D-VASc score (AUC=0.612, 95%CI 0.550-0.674, P=0.001). (4) CHA(2)D-VASc-LASP(2) score was positively correlated with TE (OR=1.95, 95%CI 1.55-2.42, P=0.001). Conclusion: LASP is independently and positively correlated with TE in patients with AF.


Assuntos
Apêndice Atrial/diagnóstico por imagem , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/terapia , Angiografia Coronária/métodos , Ablação por Radiofrequência , Acidente Vascular Cerebral/etiologia , Tromboembolia/etiologia , Apêndice Atrial/fisiopatologia , Fibrilação Atrial/complicações , Fibrilação Atrial/fisiopatologia , Átrios do Coração , Humanos , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Tromboembolia/sangue , Tromboembolia/diagnóstico
16.
Zhonghua Fu Chan Ke Za Zhi ; 54(11): 730-735, 2019 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-31752454

RESUMO

Objective: To investigate the safety and effectiveness of radiofrequency ablation (RFA) for selective fetal reduction in complex multiple pregnancies and analyze factors affecting perinatal outcomes. Methods: This was a retrospective case series of 156 patients undergoing selective fetal reduction by RFA in Provincial Hospital Affiliated to Shandong University from July 22th, 2011 to September 12th, 2018. They were divided into five groups according to surgical indications, including 46 cases in the monochorionic twins discordant for fetal anomalies group, 42 cases in the multiple pregnancies for reducing fetal numbers group, 40 cases in the twin to twin transfusion syndrome (TTTS) group, 24 cases in the selective intrauterine growth restriction (sIUGR) group and 4 cases in the twin reversed arterial perfusion sequence (TRAPS) group. According to the gestational age at surgery, patients were divided into two groups: the gestational age at surgery <20 weeks group (75 cases) and the gestational age at surgery≥20 weeks group (81 cases). According to the cycles of RFA required for surgery, patients were divided into two groups: one cycle group (124 cases) and ≥2 cycles group (32 cases). Basic information of patients, surgical process, postoperative complications and pregnancy outcomes were recorded. The growth and development of survival newborns were also followed up. Factors affecting perinatal outcomes were analyzed. Results: (1) The median gestational age at procedure of 156 patients was 20 weeks (14(+5)- 29(+1) weeks). The median cycles of RFA was 1 cycle (1-3 cycles), of which one cycle accounted for 79.5% (124/156). (2) Eleven (7.1%, 11/156) patients experienced intrauterine fetal death, 27 (17.3%, 27/156) patients miscarried, and the overall survival rate was 75.6% (118/156). Premature birth rate before 34 weeks was 19.5% (23/118). There were 129 neonates. The median gestational age at delivery was 37(+3) weeks (28(+2)- 41(+1) weeks) with a mean birth weight of (2 657±700) g. (3) Analysis of pregnancy outcomes based on surgical indications found that, the gestational age at delivery [38 weeks (30(+1)-41(+1) weeks), 36(+4) weeks (29- 39 weeks), 36(+4) weeks (28(+2)-39(+5) weeks), 38 weeks (31-39(+6) weeks), 38(+3) weeks (30(+4)-38(+4) weeks)] and neonatal birth weight [(2 820±671), (2 435±416), (2 497±843), (2 998±718), (2 517±1 087) g] were significantly different among fetal anomalies group, reducing fetal numbers group, TTTS group, sIUGR group and TRAPS group, respectively (all P<0.05). There were no significant differences in the pregnancy outcomes between gestational age at surgery <20 weeks group and gestational age at surgery ≥20 weeks group, or between one cycle group and ≥2 cycles group, respectively (all P>0.05). Conclusions: RFA is a safe and effective procedure in treating complex monochorionic multiple pregnancies. Surgical indications would affect the gestational age at delivery and neonatal outcomes.


Assuntos
Ablação por Cateter/métodos , Parto Obstétrico/métodos , Transfusão Feto-Fetal/cirurgia , Redução de Gravidez Multifetal/métodos , Gravidez de Gêmeos , Ablação por Radiofrequência/métodos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Gêmeos Monozigóticos
17.
Zhonghua Fu Chan Ke Za Zhi ; 54(11): 736-740, 2019 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-31752455

RESUMO

Objective: To assess the effectiveness of radiofrequency ablation (RFA) in the treatment of multiple pregnancies. Methods: In this retrospective study, 84 cases (total 174 fetuses) of complex monochorionic pregnancies treated with RFA for selective fetal reduction were analyzed. All cases were managed in the Guangdong Women and Children Hospital from January 2015 to January 2018. Indications for offering RFA, details of the procedure and pregnancy outcomes were collected and analyzed. Results: (1)The rate of miscarriage and fetal intrauterine death was 21% (18/84), termination of pregnancy because of fetal malformation or oligohydramnion occurred in 10% (8/84) of cases. Total live birth rate was 69% (58/84) and the gestation age at delivery was (35.0±3.0) weeks. (2) The live birth rate of twin reversed arterial perfusion sequence (TRAPS) was the lowest (6/11), followed by twin to twin transfusion syndrome (TTTS; 66%, 27/41), structural or genetic abnormalities of one fetus in monochorionic twin pregnancy (10/14), triplet pregnancy reduction (4/6) and selective intrauterine growth restriction (sIUGR) (11/12). (3) The live birth rate was 67% (20/30) in stage Ⅲ of TTTS and 7/11 in the stage Ⅳ of TTTS (P>0.05). The average gestational age was (33.6±3.0) weeks in stage Ⅲ of TTTS compared with (36.5±2.4) weeks in the stage Ⅳof TTTS (P<0.05). Conclusions: RFA appears to be a reliable option for selective fetal reduction in monochorionic multiple pregnancies. The indication of RFA is an influencing factor on its pregnancy outcomes. Type Ⅱand type Ⅲ sIUGR may choose this technique as a priority. Compared with stage Ⅲ of TTTS, the live birth rate and the gestation age at delivery in stage Ⅳ of TTTS, there are no significant differences.


Assuntos
Transfusão Feto-Fetal/cirurgia , Nascimento Vivo/epidemiologia , Resultado da Gravidez/epidemiologia , Redução de Gravidez Multifetal/métodos , Gravidez de Gêmeos , Ablação por Radiofrequência/métodos , Criança , China/epidemiologia , Feminino , Idade Gestacional , Humanos , Gravidez , Prognóstico , Estudos Retrospectivos , Gêmeos Monozigóticos
19.
BMC Cancer ; 19(1): 983, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640620

RESUMO

BACKGROUND: To determine the safety and efficacy of transarterial chemoembolization (TACE) combined with radiofrequency ablation (hereafter, TACE-RFA) in treating Barcelona Clinic Liver Cancer (BCLC) Stage A or B (hereafter, BCLC A/B) hepatocellular carcinoma (HCC) patients, and to explore the range of tumor sizes suitable for combination therapy. METHODS: This retrospective study assessed the consecutive medical records of HCC patients with BCLC A/B who received TACE-RFA or TACE from September 2009 to September 2018. Progression-free survival (PFS), overall survival (OS), therapeutic response, and complications were compared between the two groups. RESULTS: Among 2447 patients who received TACE-RFA or TACE, 399 eligible patients were enrolled in our study, including 128 patients in the TACE-RFA group and 271 patients in the TACE group. Compared with the TACE group, the PFS and OS rates of 1,3,5,8 years in the TACE-RFA group were significantly better, with higher objective tumor regression rate and better disease control rate. RFA treatment did not increase the risk of death in patients with HCC, and both liver subcapsular hematoma and bile duct injury were improved by symptomatic treatment. Serum α-fetoprotein level and treatment method were important independent prognostic factors for OS, whereas albumin, hepatitis B and treatment method were important independent prognostic factors for PFS. Subgroup analysis showed that patients in the TACE-RFA group always showed better OS and PFS. CONCLUSIONS: TACE-RFA had an advantage over TACE alone in prolonging PFS and improving OS in HCC patients with BCLC A/B, and can benefit patients regardless of tumor size.


Assuntos
Carcinoma Hepatocelular/cirurgia , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Neoplasias Hepáticas/cirurgia , Neoplasias Hepáticas/terapia , Ablação por Radiofrequência/métodos , Carga Tumoral , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/patologia , Quimioembolização Terapêutica/efeitos adversos , Terapia Combinada , Feminino , Seguimentos , Humanos , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Intervalo Livre de Progressão , Ablação por Radiofrequência/efeitos adversos , Estudos Retrospectivos , Espanha , Adulto Jovem
20.
Indian J Cancer ; 56(4): 350-353, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31607706

RESUMO

Osteoid osteoma of foot and ankle account for ten percent of benign bone tumors and commonly involve the talus and metatarsals. Its occurrence in calcaneus is extremely rare and can mimic ankle instability, subtalar arthritis, osteochondritis or plantar fasciitis leading to delay in diagnosis. We present the case of a 17 year old boy with periarticular osteoid osteoma in the calcaneum, who presented following an ankle sprain. He was successfully treated with CT guided percutaneous radiofrequency ablation and we feel that it is a safe, precise and effective treatment option for even periarticular osteoid osteoma in the foot and ankle region.


Assuntos
Traumatismos do Tornozelo/diagnóstico , Neoplasias Ósseas/diagnóstico , Calcâneo/patologia , Osteoma Osteoide/diagnóstico , Ablação por Radiofrequência/métodos , Articulação Talocalcânea/patologia , Adolescente , Diagnóstico Diferencial , Erros de Diagnóstico , Humanos , Masculino , Tomografia Computadorizada por Raios X
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA