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1.
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
2.
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
3.
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
4.
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
5.
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
6.
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
7.
Medicine (Baltimore) ; 99(44): e22763, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126314

RESUMO

Ultrasound guided percutaneous thermal ablation has been well acknowledged in treating hepatic malignancy. Although thermal ablation is safe for the treatment, it may induce some lethal complications such as diaphragmatic injury, bile-stained pleural fistula, and bilious pleuritis.We presented 2 cancer patients in hepatic diaphragmatic dome showed diaphragmatic injury, bile-stained pleural fistula, and bilious pleuritis after microwave ablation (MVA). The symptoms were attenuated after chest drainage and anti-infection therapy. In the literature review, 17 articles published in the recent 10 years on diaphragmatic injury after MVA for treating hepatic cancer were available. Twenty-three cases were obtained, among which 2 showed bilious pleuritis after radiofrequency treatment. Most of the lesions were adjacent to the diaphragma. Among the articles reporting the localization of lesions, most of the cases showed lesions in S8, 2 in S7, 3 in S4, and 3 in S5, respectively. Surgical recovery was required for the patients with massive diaphragmatic injury. Only 2 cases underwent thorascopic surgery. After chest drainage and anti-infection, their symptoms were attenuated to some extent.Radiofrequency or MVA may induce pleural effusion, and special attention should be paid to the diaphragmatic injury induced by thermal ablation.


Assuntos
Diafragma/lesões , Neoplasias Hepáticas/radioterapia , Micro-Ondas/efeitos adversos , Pleurisia/etiologia , Lesões por Radiação/etiologia , Ablação por Radiofrequência/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Pleurais/etiologia , Fístula do Sistema Respiratório/etiologia
8.
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
9.
J Vasc Interv Radiol ; 31(10): 1587-1591, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32951970

RESUMO

Intraductal cooling via a percutaneous transhepatic biliary drainage tube holds great promise in facilitating thermal ablation of liver tumors adjacent to the central bile ducts. However, the difficulties and complications associated with puncturing nondilated bile ducts are greater than those associated with puncturing dilated bile ducts. As reported here, percutaneous transcholecystic contrast-enhanced ultrasound was performed in 7 patients to visualize the nondilated bile ducts and guide percutaneous transhepatic biliary drainage, thus facilitating the intraductal cooling-assisted thermal ablation process. The procedures were technically successful in all 7 patients, and no major complications were recorded during the follow-up period.


Assuntos
Traumatismos Abdominais/prevenção & controle , Ductos Biliares/diagnóstico por imagem , Meios de Contraste/administração & dosagem , Drenagem , Neoplasias Hepáticas/cirurgia , Fosfolipídeos/administração & dosagem , Ablação por Radiofrequência , Hexafluoreto de Enxofre/administração & dosagem , Ultrassonografia de Intervenção , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/etiologia , Idoso , Ductos Biliares/lesões , Meios de Contraste/efeitos adversos , Drenagem/efeitos adversos , Drenagem/instrumentação , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Masculino , Microbolhas , Pessoa de Meia-Idade , Fosfolipídeos/efeitos adversos , Ablação por Radiofrequência/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Hexafluoreto de Enxofre/efeitos adversos , Resultado do Tratamento , Ultrassonografia de Intervenção/efeitos adversos
10.
J Vasc Interv Radiol ; 31(10): 1636-1644.e1, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32943296

RESUMO

PURPOSE: To retrospectively investigate incidence, clinical outcome, and risk factors of iatrogenic pleural effusion in patients with hepatic tumors undergoing radiofrequency (RF) ablation using artificial ascites (AA). MATERIALS AND METHODS: Patients (N = 163) who underwent RF ablation using AA were classified into pleural effusion and non-pleural effusion groups according to the presence of pleural effusion on immediate follow-up CT and chest radiograph after RF ablation. The pleural effusion group included asymptomatic and symptomatic subgroups. The incidence and subsequent clinical outcomes of patients developing pleural effusion after RF ablation were evaluated. RESULTS: Overall, 96 patients (58.9%) developed pleural effusion, which resolved in 4.4 d ± 3.1. Hospital length of stay in the pleural effusion group was longer than the non-pleural effusion group (6.5 d ± 2.6 vs 5.7 d ± 2.8, P < .01). The pleural effusion group had longer AA infusion time (P = .01), larger infused AA volume (P < .01), and longer ablation time (P < .01) than the non-pleural effusion group. Eighteen patients (18.8%) developed symptomatic pleural effusion and had a larger infused AA volume than asymptomatic patients with pleural effusion (P < .01). Pleural effusion duration and hospital length stay were also longer in the symptomatic pleural effusion subgroup than in the asymptomatic subgroup (P < .01). Infused AA volume was the only independent prognostic factor of pleural effusion duration in multivariate analysis (P = .038). CONCLUSIONS: Pleural effusion frequently occurs after RF ablation using AA. Although generally considered negligible, pleural effusion could be a clinical problem and prolong hospitalization. Therefore, operators should be careful not to infuse too much AA when performing RF ablation.


Assuntos
Ascite , Doença Iatrogênica/epidemiologia , Neoplasias Hepáticas/cirurgia , Derrame Pleural/epidemiologia , Ablação por Radiofrequência/efeitos adversos , Idoso , Feminino , Humanos , Incidência , Infusões Parenterais , Tempo de Internação , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Derrame Pleural/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
11.
J Vasc Interv Radiol ; 31(9): 1401-1407, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32792278

RESUMO

PURPOSE: To assess the safety and feasibility of using a radiofrequency (RF) wire for portosystemic shunt creation. MATERIALS AND METHODS: Ten patients undergoing elective creation of a transjugular intrahepatic portosystemic shunt (TIPS) or a direct intrahepatic portosystemic shunt (DIPS) were prospectively enrolled. Primary outcomes were the safety and feasibility of RF wire used for the creation of TIPS and DIPS. Median age was 66.5 ± 6.1 years. Causes of liver disease included alcohol (n = 5), nonalcoholic steatohepatitis (n = 2), hepatitis C virus (n = 1), primary biliary cirrhosis (n = 1), autoimmune hepatitis (n = 1). The median score for model for end-stage liver disease was 11 ± 4.3. The Rosch-Uchida TIPS set was used with intravascular ultrasonography guidance in all cases. A 0.035-inch RF wire was used in lieu of the trocar needle through the 5-F TIPS set catheter to create a track between the hepatic vein and the portal vein. All shunts were created using stent grafts. RESULTS: Technical success rate was 100%. In 7 of 10 patients, portal vein access was achieved with a single pass. A DIPS was created in 2 patients based on anatomic favorability. Median fluoroscopy time was 13.3 ± 3.8 min, and median total procedure time was 102 ± 19 min. The wire passed through parenchyma without subjective deflection. There was 1 case of extracapsular puncture with no clinical consequence. The RF wire was too stiff to curve into the main portal vein, requiring wire exchange in all but 1 case. Mean portosystemic gradient decreased from 13.9 ± 3.3 to 5.9 ± 2.1 mm Hg. No immediate complications were encountered. Shunt patency was 100% at 30 days. CONCLUSIONS: Creation of TIPS and DIPS using an RF wire was safe and feasible, enabling creation of an intrahepatic track without subjective deflection in cirrhotic patients.


Assuntos
Cateteres , Cirrose Hepática/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática/instrumentação , Ablação por Radiofrequência/instrumentação , Idoso , Estudos de Viabilidade , Feminino , Fluoroscopia , Humanos , Cirrose Hepática/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Ablação por Radiofrequência/efeitos adversos , Radiografia Intervencionista , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia de Intervenção
12.
J Vasc Interv Radiol ; 31(8): 1201-1209, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32698956

RESUMO

PURPOSE: To describe ablation of bone, liver, lung, and soft tissue tumors from oligometastatic breast cancer and to define predictors of local progression and progression-free survival (PFS). MATERIALS AND METHODS: A total of 33 women (mean age 52 ± 12 years old; range, 28-69 years), underwent 46 thermal ablations of liver (n = 35), lung (n = 7), and bone/soft tissue (n = 4) metastases. Mean tumor diameter was 18 ± 15 mm (range, 6-50 mm). Ablations were performed to eradicate all evident sites of disease (n = 24) or to control growing sites in the setting of other stable or responding sites of disease (n = 22). Patient characteristics, ablation margins, imaging responses, and cases of PFS were assessed. Follow-up imaging was performed using contrast-enhanced computed tomography (CT), magnetic resonance (MR) imaging, or positron-emission tomography/ CT. RESULTS: Median PFS was 10 months (95% confidence interval [CI], 6.2 -14.5 months), and time to local progression was 11 months (95% CI, 5-16 months). Eight patients (24%) maintained no evidence of disease during a median follow-up period of 39 months. Ablation margin ≥5 mm was associated with no local tumor progression. Longer PFS was noted in estrogen receptor-positive patients (12 vs 4 months; P = .037) and younger patients (12 vs 4 months; P = .039) treated to eradicate all sites of disease (13 vs 5 months; P = .05). Eighteen patients (55%) developed new metastases during study follow-up. CONCLUSIONS: Thermal ablation of oligometastatic pulmonary, hepatic, bone, and soft tissue tumors can eliminate local tumor progression if margins are ≥5 mm. Longer PFS was observed in patients who were estrogen receptor-positive and patients who were younger and in whom all sites of disease were eradicated.


Assuntos
Neoplasias Ósseas/cirurgia , Neoplasias da Mama/patologia , Criocirurgia , Neoplasias Hepáticas/cirurgia , Neoplasias Pulmonares/cirurgia , Metastasectomia/métodos , Ablação por Radiofrequência , Neoplasias de Tecidos Moles/cirurgia , Adulto , Idoso , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/secundário , Neoplasias da Mama/mortalidade , Criocirurgia/efeitos adversos , Criocirurgia/mortalidade , Bases de Dados Factuais , Progressão da Doença , Estudos de Viabilidade , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/secundário , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/secundário , Margens de Excisão , Metastasectomia/efeitos adversos , Metastasectomia/mortalidade , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Ablação por Radiofrequência/efeitos adversos , Ablação por Radiofrequência/mortalidade , Estudos Retrospectivos , Fatores de Risco , Neoplasias de Tecidos Moles/diagnóstico por imagem , Neoplasias de Tecidos Moles/mortalidade , Neoplasias de Tecidos Moles/secundário , Fatores de Tempo , Carga Tumoral
14.
Am J Otolaryngol ; 41(5): 102584, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32505991

RESUMO

PURPOSE: We aimed to assess the effect of bipolar mode radiofrequency (BMRF) tonsillectomy as a model of oro-pharyngeal surgical maneuver on the integrity of the internal device in patients with cochlear implants (CIs). MATERIALS AND METHODS: This prospective case series included 15 consecutive pediatric patients with CIs (age range 4 to 8 years, mean 5.2 years) who underwent BMRF tonsillectomy. The postoperative integrity of the internal device was evaluated by comparing the electric current response tested preoperatively with that tested 2 days postoperatively. RESULTS: There were differences in the current levels in the main regions of the cochlea; (the apical, mid-turn, and basal) after comparing preoperative and postoperative values, but they were not statically significant. CONCLUSION: BMRF seems to be safe for tonsillectomy in children with CIs without negative impact on the integrity of the internal device.


Assuntos
Implantes Cocleares , Resultados Negativos , Falha de Prótese/efeitos da radiação , Ablação por Radiofrequência/efeitos adversos , Ablação por Radiofrequência/métodos , Tonsilectomia/métodos , Criança , Pré-Escolar , Impedância Elétrica , Feminino , Humanos , Masculino , Estudos Prospectivos , Falha de Prótese/etiologia , Ablação por Radiofrequência/instrumentação , Segurança , Instrumentos Cirúrgicos , Tonsilectomia/efeitos adversos
15.
Tech Vasc Interv Radiol ; 23(2): 100672, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32591188

RESUMO

Image-guided percutaneous thermal ablation is a widely acceptable local therapy for patients with colorectal liver metastases who are noneligible for surgery or present with recurrence after hepatectomy. The increasing knowledge of factors that affect oncologic outcomes has allowed selected patients with resectable small volume colorectal liver metastases to be treated by thermal ablation with curative intent. The continuous technological evolutions in imaging and image-guidance and the wide implementation of microwave ablation that overcomes most of the limitations of radiofrequency ablation have contributed to this paradigm shift. The importance of patient selection, ablation margin evaluation, and confirmation of complete tumor ablation (A0) are discussed in this article.


Assuntos
Neoplasias Colorretais/patologia , Criocirurgia , Terapia a Laser , Neoplasias Hepáticas/cirurgia , Metastasectomia , Micro-Ondas/uso terapêutico , Ablação por Radiofrequência , Cirurgia Assistida por Computador , Biópsia , Tomada de Decisão Clínica , Criocirurgia/efeitos adversos , Fluordesoxiglucose F18/administração & dosagem , Humanos , Terapia a Laser/efeitos adversos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Margens de Excisão , Metastasectomia/efeitos adversos , Micro-Ondas/efeitos adversos , Seleção de Pacientes , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Valor Preditivo dos Testes , Ablação por Radiofrequência/efeitos adversos , Compostos Radiofarmacêuticos/administração & dosagem , Cirurgia Assistida por Computador/efeitos adversos , Resultado do Tratamento , Carga Tumoral
16.
Tech Vasc Interv Radiol ; 23(2): 100673, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32591189

RESUMO

Interventional oncology and the value of thermal ablation of small tumors is increasingly recognized by the oncological community. Primary lung cancers and lung metastases have been one of the most researched applications of percutaneous ablation and as interventional oncologists gain more experience and confidence, it is becoming a more effective treatment with expanding indications. Importantly, the current literature does not demonstrate major differences in survival between ablation, sublobar resection, and stereotactic body radiation. The advantages of percutaneous ablation over other local therapies like surgery or SBRT are significantly lower morbidity, mortality, and repeatability of treatments. The focus of this essay is to highlight technical and procedural aspects of lung ablation as well as management and follow-up in a practical fashion.


Assuntos
Criocirurgia , Neoplasias Pulmonares/cirurgia , Ablação por Radiofrequência , Radiografia Intervencionista , Tomada de Decisão Clínica , Criocirurgia/efeitos adversos , Árvores de Decisões , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Seleção de Pacientes , Complicações Pós-Operatórias/terapia , Ablação por Radiofrequência/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Fatores de Risco , Resultado do Tratamento , Carga Tumoral
17.
Tech Vasc Interv Radiol ; 23(2): 100678, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32591190

RESUMO

Image-guided percutaneous thermal ablation plays an increasingly important role in the multidisciplinary management of musculoskeletal lesions. Established indications for ablation in this setting include the treatment of osteoid osteomas, palliation of painful skeletal metastases, local control of oligometastatic disease, and consolidation of bone tumors at risk for fracture. Emerging indications include the treatment of symptomatic soft tissue masses such as extra-abdominal desmoid tumors and abdominal wall endometriosis. This review will discuss considerations in patient selection and preprocedural workup, ablation technology and techniques, strategies to avoid complications, and expected outcomes of ablation in the musculoskeletal system.


Assuntos
Neoplasias Ósseas/cirurgia , Criocirurgia/tendências , Eletroporação/tendências , Micro-Ondas/uso terapêutico , Ablação por Radiofrequência/tendências , Neoplasias de Tecidos Moles/cirurgia , Cirurgia Assistida por Computador/tendências , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/patologia , Tomada de Decisão Clínica , Criocirurgia/efeitos adversos , Humanos , Micro-Ondas/efeitos adversos , Seleção de Pacientes , Complicações Pós-Operatórias/etiologia , Ablação por Radiofrequência/efeitos adversos , Fatores de Risco , Neoplasias de Tecidos Moles/diagnóstico por imagem , Neoplasias de Tecidos Moles/patologia , Cirurgia Assistida por Computador/efeitos adversos , Resultado do Tratamento
18.
Tech Vasc Interv Radiol ; 23(2): 100676, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32591192

RESUMO

Incidental adrenal masses are common and are found in 4% of the CT scans.1 While clinical history, laboratory results, and imaging characteristics are typically sufficient for diagnosis of an adrenal lesion, a biopsy is sometimes warranted. In some cases, adrenal mass ablation is subsequently indicated. This article serves as a brief but comprehensive review of preprocedural work-up and planning before an adrenal mass ablation, as well as a discussion on ablation techniques, associated challenges and solutions, and management of expected and unexpected outcomes.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Adenoma Adrenocortical/cirurgia , Carcinoma Adrenocortical/cirurgia , Criocirurgia , Micro-Ondas/uso terapêutico , Feocromocitoma/cirurgia , Ablação por Radiofrequência , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/patologia , Adenoma Adrenocortical/diagnóstico por imagem , Adenoma Adrenocortical/patologia , Carcinoma Adrenocortical/diagnóstico por imagem , Carcinoma Adrenocortical/patologia , Tomada de Decisão Clínica , Criocirurgia/efeitos adversos , Humanos , Micro-Ondas/efeitos adversos , Seleção de Pacientes , Feocromocitoma/diagnóstico por imagem , Feocromocitoma/patologia , Complicações Pós-Operatórias/etiologia , Ablação por Radiofrequência/efeitos adversos , Fatores de Risco , Resultado do Tratamento
19.
Tech Vasc Interv Radiol ; 23(2): 100677, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32591193

RESUMO

Percutaneous thermal ablation has proven to be safe and effective in the management of patients with spinal tumors. Such treatment is currently proposed following the decision of a multidisciplinary tumor board to patients with small painful benign tumors such as osteoid osteoma or osteoblastoma, as well as carefully selected patients presenting with spinal metastases. In both scenarios, in order to provide a clinically effective procedure, ablation is often tailored to the specific patients' clinical needs and features of the target tumor. In this review, we present the most common clinical contexts in which spine ablation may be proposed. We scrutinize technical aspects and challenges that may be encountered during the procedure, as well as offering insight on follow-up and expected outcomes.


Assuntos
Criocirurgia , Ablação por Radiofrequência , Neoplasias da Coluna Vertebral/cirurgia , Vertebroplastia , Tomada de Decisão Clínica , Criocirurgia/efeitos adversos , Criocirurgia/instrumentação , Humanos , Seleção de Pacientes , Complicações Pós-Operatórias/terapia , Ablação por Radiofrequência/efeitos adversos , Ablação por Radiofrequência/instrumentação , Fatores de Risco , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/patologia , Resultado do Tratamento , Vertebroplastia/efeitos adversos , Vertebroplastia/instrumentação
20.
Tech Vasc Interv Radiol ; 23(2): 100674, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32591194

RESUMO

Renal cell carcinoma is most commonly diagnosed in the sixth or seventh decade of life. Historically, surgical extirpation was the gold standard treatment option for small renal masses. However, given the comorbidities in this elderly population, not all patients are candidates for surgery. The development of minimally invasive ablative therapies has solved the surgical dilemma in this patient population. Furthermore, the 2017 American Urological Association guidelines recommends consideration of percutaneous image guided thermal ablation as a treatment option for masses smaller than 3 cm even in healthy individuals. Percutaneous image guided thermal ablation is an attractive treatment option providing excellent local tumor control, fewer complications, better preservation of the renal functions, faster recovery and shorter hospital stay. Various ablative modalities are available in clinical practice. This includes radiofrequency ablation, cryoablation, microwave ablation, irreversible electroporation, high intensity focused ultrasound, and laser ablation. In this review, we focus on the most commonly used modalities including radiofrequency ablation and cryoablation and to a lesser extent microwave ablation and irreversible electroporation.


Assuntos
Carcinoma de Células Renais/cirurgia , Criocirurgia , Eletroporação , Neoplasias Renais/cirurgia , Micro-Ondas/uso terapêutico , Ablação por Radiofrequência , Cirurgia Assistida por Computador , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/patologia , Criocirurgia/efeitos adversos , Criocirurgia/instrumentação , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/patologia , Micro-Ondas/efeitos adversos , Complicações Pós-Operatórias/terapia , Ablação por Radiofrequência/efeitos adversos , Ablação por Radiofrequência/instrumentação , Fatores de Risco , Cirurgia Assistida por Computador/efeitos adversos , Cirurgia Assistida por Computador/instrumentação , Resultado do Tratamento , Carga Tumoral
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