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1.
Medicine (Baltimore) ; 100(14): e25370, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33832121

RESUMO

RATIONALE: Dual atrioventricular node non-reentrant tachycardia (DAVNNRT) is a rare arrhythmia. We present a case of inappropriate implantable cardioverter defibrillator (ICD) therapy caused by DAVNNRT. DAVNNRT is easily misdiagnosed as atrial fibrillation and is often identified as ventricular tachycardia (VT) by the supraventricular tachycardia-ventricular tachycardia (SVT-VT) discriminator of the ICD. PATIENT CONCERNS: A 73-year-old man with ischemic heart disease (IHD) presented with palpitations accompanied by dyspnea and syncope. Frequent multifocal premature ventricular beats and non-sustained ventricular tachycardia were observed on ambulatory electrocardiography. The left ventricular ejection fraction decreased to 32%. DIAGNOSIS: He was diagnosed with IHD, heart failure with reduced ejection fraction (HFrEF), and VT. INTERVENTIONS: : Initially, the patient received a single-chamber ICD implantation for secondary prevention of sudden death. He then suffered from inappropriate anti-tachycardia pacing (ATP)/shock therapy many times after the procedure. DAVNNRT was confirmed in an electrophysiology study (EPS), and radiofrequency ablation of the slow pathway successfully terminated this tachycardia. OUTCOMES: No episode of inappropriate ICD therapy or tachycardia occurred during the follow-up. LESSONS: In conclusion, it is essential to have a full understanding of DAVNNRT and eliminate slow pathways for patients with DAVNNRT and be prepared to implant an ICD.


Assuntos
Desfibriladores Implantáveis/estatística & dados numéricos , Insuficiência Cardíaca/diagnóstico , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/terapia , Idoso , Eletrofisiologia Cardíaca/métodos , Desfibriladores Implantáveis/efeitos adversos , Erros de Diagnóstico , Eletrocardiografia Ambulatorial/métodos , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Isquemia Miocárdica/complicações , Ablação por Radiofrequência/métodos , Volume Sistólico/fisiologia , Taquicardia Supraventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Resultado do Tratamento , Função Ventricular Esquerda/fisiologia
2.
Medicine (Baltimore) ; 100(16): e25569, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33879714

RESUMO

BACKGROUND: Studies comparing data between the high-power short-duration radiofrequency (HPSR) and low power longer duration therapy were limited and inconsistent. Therefore, we conduct a high-quality systematic review and meta-analysis to assess the efficacy and safety of HPSR on outcomes for patients with atrial fibrillation (AF). METHODS: The online literature is searched using the following combination of medical subject heading terms: "high-power" OR "high power" AND "radiofrequency" AND "atrial fibrillation." MEDLINE (PubMed), EMBASE (OVID), Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science (ISI database) will be searched without any language restrictions. All clinical trials to assess the efficacy and safety of HPSR in the treatment of atrial fibrillation will be considered eligible for analysis. The present study will be performed by Review Manager Software (RevMan Version 5.3, The Cochrane Collaboration, Copenhagen, Denmark). Ethical approval and patient consent are not required because this study is a literature-based study. RESULTS: This study expects to provide credible and scientific evidence for the efficacy and safety of HPSR on outcomes for patients with AF. REGISTRATION NUMBER: 10.17605/OSF.IO/WAEBN.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Radiofrequência/métodos , Ensaios Clínicos como Assunto , Humanos , Metanálise como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento
3.
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
4.
Br J Radiol ; 94(1121): 20200445, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33756082

RESUMO

OBJECTIVES: To retrospectively evaluate feasibility and safety of CT-guided percutaneous radiofrequency ablation (RFA) of metastatic lymph nodes (LN) in terms of achieving local tumor control. METHODS: Institutional database research identified 16 patients with 24 metastatic LNs who underwent percutaneous CT-guided radiofrequency ablation. Mean patient age was 66.6 ± 15.70 years (range 40-87) and male/female ratio was 8/8. Contrast-enhanced CT or MRI was used for post-ablation follow-up. Patient and tumor characteristics and RFA technique were evaluated. Technical and clinical success on per tumor and per patient basis as well as complication rates were recorded. RESULTS: Mean size of the treated nodes was 1.78 ± 0.83 cm. The mean number of tumors per patient was 1.5 ± 0.63. The mean procedure time was 56.29 ± 24.27 min including local anesthesia, electrode(s) placement, ablation and post-procedural CT evaluation. Median length of hospital stay was 1.13 ± 0.34 days. On a per lesion basis, the overall complete response post-ablation according to the mRECIST criteria applied was 75% (18/24) of evaluable tumors. Repeat treatment of an index tumor was performed on two patients (three lesions) with complete response achieved in 87.5% (21/24) of evaluable tumors following a second RFA. On a per patient basis, disease progression was noted in 10/16 patients at a mean of 13.9 ± 6.03 months post the ablation procedure. CONCLUSION: CT-guided percutaneous RFA for oligometastatic LNs is a safe and feasible therapy. ADVANCES IN KNOWLEDGE: With this percutaneous therapeutic option, metastatic LNs can be eradicated with a very low complication rate.


Assuntos
Excisão de Linfonodo/métodos , Ablação por Radiofrequência/métodos , Radiografia Intervencionista/métodos , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Progressão da Doença , Estudos de Viabilidade , Feminino , Humanos , Tempo de Internação , Linfonodos/patologia , Metástase Linfática/terapia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Ablação por Radiofrequência/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/efeitos adversos
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.
Am J Otolaryngol ; 42(1): 102778, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33137675

RESUMO

OBJECTIVES: The aim of this study was to compare radiofrequency ablation (RFA), diode laser, and microdebrider-assisted inferior turbinoplasty (MAIT) in the treatment of chronic nasal obstruction in a one-year follow-up, and to pay special attention to the effect of the procedures on the contractility capacity of the inferior turbinates. METHODS: The patients filled a Visual Analogue Scale (VAS) questionnaire regarding nasal symptoms pre- and postoperatively. Saccharin transit time (STT) evaluation and acoustic rhinometry were also performed. A total of 77 patients attended the one-year control visit and had technically reliable acoustic rhinometry results. RESULTS: All the examined techniques decreased the VAS score for the severity of nasal obstruction statistically significantly. There was no deterioration found in the symptoms of crusting, nasal discharge, and sneezing, nor in mucociliary function in any of the groups. All the three techniques increased the non-decongested total V2-5 cm values and decreased the decongested total V2-5 cm values statistically significantly. The V2-5 cm change (%) values decreased statistically significantly in the RFA, diode laser, and the MAIT groups following the operations, the mean changes being -57 percentage points (pp), -53 pp, and -73 pp respectively. CONCLUSION: All three techniques decreased the severity of nasal obstruction significantly in the one-year follow-up. Although submucosal fibrosis seemed to increase, all the techniques increased the anterior nasal cavity volume significantly. Inferior turbinate contractility decreased to the normal level from the preoperative congested state following the surgery with every examined technique.


Assuntos
Desbridamento/métodos , Lasers Semicondutores , Obstrução Nasal/cirurgia , Procedimentos Cirúrgicos Nasais/métodos , Ablação por Radiofrequência/métodos , Microcirurgia Endoscópica Transanal/métodos , Conchas Nasais/cirurgia , Adulto , Doença Crônica , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Resultado do Tratamento , Conchas Nasais/fisiopatologia
7.
Neurosurgery ; 88(3): 437-442, 2021 02 16.
Artigo em Inglês | MEDLINE | ID: mdl-33355345

RESUMO

BACKGROUND: Managing cancer pain once it is refractory to conventional treatment continues to challenge caregivers committed to serving those who are suffering from a malignancy. Although neuromodulation has a role in the treatment of cancer pain for some patients, these therapies may not be suitable for all patients. Therefore, neuroablative procedures, which were once a mainstay in treating intractable cancer pain, are again on the rise. This guideline serves as a systematic review of the literature of the outcomes following neuroablative procedures. OBJECTIVE: To establish clinical practice guidelines for the use of neuroablative procedures to treat patients with cancer pain. METHODS: A systematic review of neuroablative procedures used to treat patients with cancer pain from 1980 to April 2019 was performed using the United States National Library of Medicine PubMed database, EMBASE, and Cochrane CENTRAL. After inclusion criteria were established, full text articles that met the inclusion criteria were reviewed by 2 members of the task force and the quality of the evidence was graded. RESULTS: In total, 14 646 relevant abstracts were identified by the literature search, from which 189 met initial screening criteria. After full text review, 58 of the 189 articles were included and subdivided into 4 different clinical scenarios. These include unilateral somatic nociceptive/neuropathic body cancer pain, craniofacial cancer pain, midline subdiaphragmatic visceral cancer pain, and disseminated cancer pain. Class II and III evidence was available for these 4 clinical scenarios. Level III recommendations were developed for the use of neuroablative procedures to treat patients with cancer pain. CONCLUSION: Neuroablative procedures may be an option for treating patients with refractory cancer pain. Serious adverse events were reported in some studies, but were relatively uncommon. Improved imaging, refinements in technique and the availability of new lesioning modalities may minimize the risks of neuroablation even further.The full guidelines can be accessed at https://www.cns.org/guidelines/browse-guidelines-detail/guidelines-on-neuroablative-procedures-patients-wi.


Assuntos
Dor do Câncer/terapia , Congressos como Assunto/normas , Medicina Baseada em Evidências/normas , Neurocirurgiões/normas , Guias de Prática Clínica como Assunto/normas , Ablação por Radiofrequência/normas , Dor do Câncer/diagnóstico , Medicina Baseada em Evidências/métodos , Humanos , Dor Intratável/diagnóstico , Dor Intratável/terapia , Ablação por Radiofrequência/métodos
8.
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
9.
Medicine (Baltimore) ; 99(43): e22703, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120763

RESUMO

BACKGROUND: Several randomized control trials (RCTs) were conducted to compare microwave ablation (MWA) and radiofrequency ablation (RFA) in the treatment of hepatocellular carcinoma (HCC) over the years. The purpose of this study was to compare the efficacy of RFA and MWA for early stage HCC. METHODS: Studies were systematically searched on Emabse, Ovid Medline, PubMed, and Cochrane Library until March 20, 2020. Continuous variables and dichotomous variables were compared using weighted mean difference (WMD) and odds ratio (OR), respectively. For the comparison of overall survival (OS) and disease-free survival (DFS), the hazard ratio (HR) and 95% confidence interval (CI) were extracted from univariate analysis or survival plots. RESULTS: A total of 26 studies (5 RCTs and 21 cohorts) with 4396 patients (2393 patients in RFA and 2003 patients in MWA) were included in our study. Of these patients, 47% received treatment under general anesthesia in the MWA group and 84% in the RFA group (OR = 0.529, P < .001). The median ablation time was reduced in the MWA group (12 minutes) compared with RFA group (29 minutes) (WMD = -15.674, P < .001). In total, 17.6% patients exhibited progression during follow-up in the MWA group compared with 19.5% in the RFA group (OR = 0.877, P = .225). No statistically significant differences were observed between MWA and RFA groups in terms of OS and DFS (HR = 0.891 and 1.014, P = .222 and .852, respectively). CONCLUSIONS: MWA exhibited similar therapeutic effects as RFA in the treatment of early stage HCC. Given the shorter ablation time, MWA can be performed under local anesthesia.


Assuntos
Carcinoma Hepatocelular/cirurgia , Neoplasias Hepáticas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/patologia , Progressão da Doença , Feminino , Humanos , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Masculino , Micro-Ondas/uso terapêutico , Pessoa de Meia-Idade , Ablação por Radiofrequência/métodos , Resultado do Tratamento
10.
Zhonghua Wai Ke Za Zhi ; 58(10): 770-775, 2020 Oct 01.
Artigo em Chinês | MEDLINE | ID: mdl-32993264

RESUMO

Objective: To examine the safety and effectiveness of ultrasound-guided percutaneous radiofrequency ablation in the treatment of liver malignant tumor under subcardiac. Methods: The clinical data of 26 patients (31 tumors) with subcardiac liver malignant tumors who underwent ultrasound-guided percutaneous radiofrequency ablation from January 2017 to October 2019 at the Affiliated Tumor Hospital of Zhengzhou University were retrospectively analyzed. There were 21 males and 5 females. The age was 55 years old (range: 40 to 77 years old) .There were 14 cases of primary liver cancer and 12 cases of metastatic liver cancer. The maximum diameter of tumor was (2.3±1.0) cm (range: 1.0 to 4.2 cm) .According to the maximum diameter of the tumor, 1∶1 match was made between 27 non-subcardiac patients admitted at the same time and a total of 36 liver malignant tumors. subcardiac tumor is defined as tumor ≤1 cm from pericardium in sagittal or coronal imaging. The ablation effect and complications were recorded, and the one-time complete ablation rate, main technical efficiency and complications were evaluated. The preoperative baseline characteristics, ablation effect and complications of the two groups of patients were collected and counted. Single factor analysis and Logistic regression analysis were used to analyze the independent risk factors that affect the ablation effect of ultrasound-guided percutaneous radiofrequency ablation for liver malignant tumors under subcardiac. Results: The one-time complete ablation rate of tumor after radiofrequency ablation was 80.8% (21/26) in the subcardiac group and 92.6% (25/27) in the non-subcardiac group. There was no significant difference between the two groups (P>0.05) . No evidence of local tumor progression was found in the follow-up evaluation of the two groups one month after radiofrequency ablation, and the main technical effective rate was 100%.Ablation-related complications occurred in 2 patients in the subcardiac group. Multivariate analysis both showed that the distance between tumor margin and pericardium ≤5 mm was an independent risk factor affecting radiofrequency ablation (OR=0.020, 95%CI: 0.001 to 0.454, P=0.014) . Conclusions: Ultrasound-guided percutaneous radiofrequency ablation can safely and effectively treat liver malignant tumor under subcardiac. When there is a tumor near the patient's heart (the distance between the edge of the tumor and pericardium is ≤5 mm) , special attention should be paid to formulate a detailed and reasonable ablation plan to minimize tumor residue.


Assuntos
Neoplasias Hepáticas , Ablação por Radiofrequência , Adulto , Idoso , Feminino , Humanos , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Ablação por Radiofrequência/métodos , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia de Intervenção
11.
Medicine (Baltimore) ; 99(39): e22256, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991422

RESUMO

BACKGROUND: Striae distensae (SD) are common and aesthetically undesirable dermal lesions. The aim of this study is to comprehensively evaluate the effectiveness of different therapies in treating striae distensae using network meta-analysis. METHODS: A systematic search of electronic databases up to December 1, 2019 was conducted. Randomized controlled trails (RCTs) examining the effectiveness of different methods in treating striae distensae were included. The primary outcomes are clinical effective rate and patient's satisfaction degree. Risk of bias was assessed by the Cochrane risk of bias tool. Network meta-analysis was based on Bayesian framework. RESULTS: Fourteen trails that met the criteria with 651 subjects were included. The results of the network meta-analysis show that topical tretinoin combined bipolar radiofrequency showed the highest probability of being the best method to improve the clinical effectiveness and patient satisfaction rate of treating SD (84.5% and 95.7% respectively), closely followed by bipolar radiofrequency (75.3% and 84.3% respectively). Among laser treatment, CO2 fractional laser is superior to other lasers in the clinical effectiveness and patient satisfaction (72.0% and 58.1% respectively). Statistics showed the topical tretinoin was the worst-performing option in improving the clinical effectiveness and patient satisfaction rate of SD treatment (5.4% and 5.1% respectively). CONCLUSION: Based on the results of network meta-analysis, we recommend treating striae distensae with bipolar radio frequency combined topical tretinoin. The commonly used CO2 fractional laser can be considered as alternative treatment candidate. Additional large-scale RCTs are necessary to obtain more precise estimates of their relative efficacy.


Assuntos
Ceratolíticos/administração & dosagem , Lasers de Gás/uso terapêutico , Ablação por Radiofrequência/métodos , Estrias de Distensão/terapia , Tretinoína/administração & dosagem , Administração Tópica , Adolescente , Adulto , Feminino , Humanos , Masculino , Satisfação do Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto Jovem
12.
Br J Radiol ; 93(1115): 20200465, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-32783618

RESUMO

Management of musculoskeletal (MSK) tumours has traditionally been delivered by surgeons and medical oncologists. However, in recent years, image-guided interventional oncology (IO) has significantly impacted the clinical management of MSK tumours. With the rapid evolution of relevant technologies and the expanding range of clinical indications, it is likely that the impact of IO will significantly grow and further evolve in the near future.In this narrative review, we describe well-established and new interventional technologies that are currently integrating into the IO armamentarium available to radiologists to treat MSK tumours and illustrate new emerging IO indications for treatment.


Assuntos
Neoplasias Ósseas/terapia , Oncologia/tendências , Neoplasias Musculares/terapia , Antineoplásicos/administração & dosagem , Dor do Câncer/terapia , Terapia Combinada/métodos , Criocirurgia/métodos , Eletroporação/métodos , Potenciais Evocados , Feminino , Fluoroscopia/métodos , Previsões , Fraturas Ósseas/terapia , Ablação por Ultrassom Focalizado de Alta Intensidade , Humanos , Doença Iatrogênica/prevenção & controle , Lipossomos/administração & dosagem , Imagem por Ressonância Magnética Intervencionista/métodos , Masculino , Micro-Ondas/uso terapêutico , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/prevenção & controle , Ablação por Radiofrequência/métodos , Terapia por Radiofrequência/métodos , Radiologia Intervencionista/métodos , Radiologia Intervencionista/tendências , Neoplasias da Coluna Vertebral/terapia , Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia de Intervenção/métodos
14.
Br J Radiol ; 93(1113): 20200112, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32706978

RESUMO

Interventional oncology (IO) has proven to be highly efficient in the local therapy of numerous malignant tumors in addition to surgery, chemotherapy, and radiotherapy. Due to the advent of immune-oncology with the possibility of tumor control at the molecular and cellular levels, a system change is currently emerging. This will significantly rule oncology in the coming decades. Therefore, one cannot think about IO in the 21st century without considering immunology. For IO, this means paying much more attention to the immunomodulatory effects of the interventional techniques, which have so far been neglected, and to explore the synergistic possibilities with immuno-oncology. It can be expected that the combined use of IO and immuno-oncology will help to overcome the limitations of the latter, such as limited local effects and a high rate of side-effects. To do this, however, sectoral boundaries must be removed and interdisciplinary research efforts must be strengthened. In case of success, IO will face an exciting future.


Assuntos
Imunoterapia/tendências , Oncologia/tendências , Neoplasias/terapia , Vacinas Anticâncer/uso terapêutico , Quimioembolização Terapêutica/métodos , Quimioembolização Terapêutica/tendências , História do Século XXI , Humanos , Imunização Passiva/métodos , Imunomodulação , Imunoterapia/métodos , Imunoterapia Ativa/métodos , Neoplasias/imunologia , Radioterapia (Especialidade)/tendências , Ablação por Radiofrequência/métodos , Ablação por Radiofrequência/tendências , Radioisótopos de Ítrio/uso terapêutico
15.
PLoS One ; 15(6): e0234461, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32544209

RESUMO

Cardiac catheterization procedure is the gold standard to diagnose and treat cardiovascular disease. However, radiation safety and cancer risk remain major concerns. This study aimed to real-time dynamic radiation dose measurement to estimate lifetime attributable risk (LAR) of cancer incidence and mortality in operators. Coronary angiography (CA) with percutaneous coronary intervention (PCI), CA, and others (radiofrequency ablation, pacemaker and defibrillator implantation) procedures with different beam directions, were undertaken on x-ray angiography system. A real-time electronic personal dosimeter (EPD) system was used to measure the radiation dose of staff during all procedures. We followed the Biological Effects of Ionizing Radiation (BEIR) VII report to estimate the LAR of all cancer incidence and mortality. Primary operators received radiation dose in CA with PCI, CA, and others procedures were 59.33 ± 95.03 µSv, 39.81 ± 103.85 µSv, and 21.92 ± 37.04 µSv, respectively. As to the assistant operators were 30.03 ± 55.67 µSv, 14.67 ± 14.88 µSv, and 4 µSv, respectively. LAR of all cancer incidences for staffs aged from 18 to 65 are varied from 0.40% for males to 1.50% for females. LAR of all cancer mortality for staffs aged from 18 to 65 are varied from 0.22% for males to 0.83% for females. Our study provided an easy, real-time and dynamic radiation dose measurement to estimate LAR of cancer for staff during the cardiac catheterization procedures. The LAR for all cancer incidence is about twice that for cancer mortality. Although the radiation doses of staff are lower during each procedure, the increased years of service leads to greater radiation risk to the staff.


Assuntos
Cateterismo Cardíaco/efeitos adversos , Neoplasias Induzidas por Radiação/epidemiologia , Exposição Ocupacional/efeitos adversos , Doses de Radiação , Exposição à Radiação/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Adolescente , Adulto , Idoso , Feminino , Pessoal de Saúde , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/métodos , Monitoramento de Radiação , Ablação por Radiofrequência/métodos , Fatores de Risco , Adulto Jovem
16.
Jt Dis Relat Surg ; 31(2): 255-259, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584722

RESUMO

OBJECTIVES: This study aims to present the importance of a multidisciplinary approach to radiofrequency ablation (RFA) treatment in osteoid osteoma (OO) patients by a team of experts in their field in preventing recurrence and complications. PATIENTS AND METHODS: For this retrospective study, a team of two orthopedists, two interventional radiologists, and one anesthesiologist was established in January 2013 to manage the diagnosis, follow-up, and treatment process of patients with OO at Bakirköy Dr. Sadi Konuk Training and Research Hospital. A total of 27 patients (15 males, 12 females; mean age 22.9 years; range, 9 to 54 years) were treated by this team between February 2013 and September 2016. The anatomic localization included iliac crest in four patients, the femur in 12 patients, fibula in two patients, humerus in three patients, radius in one patient, tibia in three patients, talus in one patient, and metacarpal in one patient. The procedures were carried out by the same interventional radiologists, same orthopedic surgeons, and same anesthesiologist in the computed tomography (CT) unit under aseptic conditions. After appropriate anesthesia for the localization of OO, the patient was positioned on the CT bed and the localization of the lesion was confirmed with a CT scan mapping. Then, a bone penetration cannula was advanced and bone cortex was penetrated with a charged motor and Kirschner (K)-wire. When the cannula reached the nidus, it was replaced with RFA probe. Ablation of the nidus was performed for five minutes at 90°C. RESULTS: The mean follow-up period was 46 months (range, 25 to 66 months). Patients were evaluated with visual analog scale (VAS) scores preoperatively and at postoperative 15th day, sixth month, and first year. In the last evaluation of the study data, the patients were called by telephone and questioned whether there were any changes in their final status. The mean preoperative VAS score was 7.2. The mean postoperative VAS scores of the 15th day, sixth month, and first year were 1.3, 0.6, and 0, respectively. In the last follow-up, the OO-related pain completely disappeared and none of the patients had any recurrence. There was a significant difference between preoperative and postoperative 15th day and sixth month VAS score measurements. CONCLUSION: Radiofrequency ablation treatment of OOs is a minimally invasive, safe, low-cost, and efficient method. We believe that with experienced teams and appropriate planning, RFA will take part in practice as the standard treatment of OO.


Assuntos
Neoplasias Ósseas , Recidiva Local de Neoplasia/prevenção & controle , Osteoma Osteoide , Equipe de Assistência ao Paciente , Adulto , Neoplasias Ósseas/patologia , Neoplasias Ósseas/terapia , Feminino , Seguimentos , Humanos , Masculino , Osteoma Osteoide/patologia , Osteoma Osteoide/terapia , Ablação por Radiofrequência/métodos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
17.
Int J Hyperthermia ; 37(1): 549-563, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32484019

RESUMO

Purpose: Thermal intervention is a potent sensitizer of cells to chemo- and radiotherapy in cancer treatment. Glioblastoma multiforme (GBM) is a potential clinical target, given the cancer's aggressive nature and resistance to current treatment options. The annular phased array (APA) technique employing electromagnetic waves in the radiofrequency (RF) range allows for localized temperature increase in deep seated target volumes (TVs). Reports on clinical applications of the APA technique in the brain are still missing. Ultrahigh field magnetic resonance (MR) employs higher frequencies than conventional MR and has potential to provide focal temperature manipulation, high resolution imaging and noninvasive temperature monitoring using an integrated RF applicator (ThermalMR). This work examines the applicability of RF applicator concepts for ThermalMR of brain tumors at 297 MHz (7.0 Tesla).Methods: Electromagnetic field (EMF) simulations are performed for clinically realistic data based on GBM patients. Two algorithms are used for specific RF energy absorption rate based thermal intervention planning for small and large TVs in the brain, aiming at maximum RF power deposition or RF power uniformity in the TV for 10 RF applicator designs.Results: For both TVs , the power optimization outperformed the uniformity optimization. The best results for the small TV are obtained for the 16 element interleaved RF applicator using an elliptical antenna arrangement with water bolus. The two row elliptical RF applicator yielded the best result for the large TV.Discussion: This work investigates the capacity of ThermalMR to achieve targeted thermal interventions in model systems resembling human brain tissue and brain tumors.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/terapia , Glioblastoma/diagnóstico por imagem , Glioblastoma/terapia , Imagem por Ressonância Magnética/métodos , Ablação por Radiofrequência/métodos , Humanos
19.
Medicine (Baltimore) ; 99(26): e20795, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590762

RESUMO

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


Assuntos
Ablação por Cateter , Imagem de Difusão por Ressonância Magnética/métodos , Neoplasias Hepáticas , Imagem por Ressonância Magnética/métodos , Microvasos/diagnóstico por imagem , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Feminino , Humanos , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Ablação por Radiofrequência/métodos
20.
PLoS One ; 15(6): e0233219, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32542034

RESUMO

Microwave Ablation (MWA) is one of the most recent developments in the field of thermal therapy. This approach is an effective method for thermal tumor ablation by increasing the temperature above the normal physiological threshold to kill cancer cells with minimum side effects to surrounding organs due to rapid heat dispersive tissues. In the present study, the effects of the shape and size of the tumor on MWA are investigated. To obtain the temperature gradient, coupled bio-heat and electromagnetic equations are solved using a three-dimensional finite element method (FEM). To extract cellular response at different temperatures and times, the three-state mathematical model was employed to achieve the ablation zone size. Results show that treatment of larger tumors is more difficult than that of smaller ones. By doubling the diameter of the tumor, the percentage of dead cancer cells is reduced by 20%. For a spherical tumor smaller than 2 cm, applying 50 W input power compared to 25 W has no significant effects on treatment efficiency and only increases the risk of damage to adjacent tissues. However, for tumors larger than 2 cm, it can increase the ablation zone up to 21%. In the spherical and oblate tumors, the mean percentage of dead cells at 6 GHz is nearly 30% higher than that at 2.45GHz, but for prolate tumors, treatment efficacy is reduced by 10% at a higher frequency. Moreover, the distance between two slots in the coaxial double slot antenna is modified based on the best treatment of prolate tumors. The findings of this study can be used to choose the optimum frequency and the best antenna design according to the shape and size of the tumor.


Assuntos
Técnicas de Ablação/métodos , Micro-Ondas/uso terapêutico , Neoplasias/terapia , Biologia Computacional/métodos , Simulação por Computador , Fenômenos Eletromagnéticos , Desenho de Equipamento , Análise de Elementos Finitos , Humanos , Modelos Teóricos , Ablação por Radiofrequência/métodos , Temperatura
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