Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.645
Filtrar
1.
J Surg Res ; 246: 260-268, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31610354

RESUMO

BACKGROUND: Irreversible electroporation (IRE) is a relatively new ablation technique utilized as focal therapy to target areas of significant tumor burden to ablate tumors in situ or improve margins of resection. Its application has largely been reported in the pancreas, liver, kidney, and prostate. Because locoregional therapy is becoming more common, IRE may be a reasonable alternative in additional situations if shown to be safe and efficacious. We have utilized IRE intraoperatively in highly selected patients for adjunctive treatment of primary and metastatic tumors at the time of surgical resection to achieve local control where an R1 resection is clinically felt to be likely. We hypothesize that IRE is a safe and effective adjuvant therapy. Our primary objective was to evaluate the safety of IRE with regard to the effects of other structures within the ablated zone. A secondary objective was to estimate local control rates of locally advanced tumors when IRE was used as an adjunct for margin enhancement. METHODS: This is a retrospective chart review of a prospective database at a single tertiary institution. The study included patients receiving IRE from November 2013 through May 2016 at the time of resection of tumor resection for margin enhancement. Primary tumors included liver, pancreatic, retroperitoneal, extremity, and pelvic tumors. Patients undergoing treatment for palliation or in situ ablation were excluded. RESULTS: Forty patients received IRE for margin enhancement. Median follow-up was 14 mo. Three patients (7.5%) had a local recurrence, and 12 (30%) had a distant recurrence. Adverse events possibly related to IRE are described. CONCLUSIONS: Our institution demonstrated a low local recurrence rate of only 7.5% in patients treated with intraoperative IRE for margin enhancement. This may be a useful adjunct at the time of surgical resection to help achieve local control in difficult areas where an R1 resection is likely. This topic will require further investigation with prospective trials and longer follow-up.


Assuntos
Técnicas de Ablação/efeitos adversos , Eletroporação , Recidiva Local de Neoplasia/epidemiologia , Neoplasias/cirurgia , Complicações Pós-Operatórias/epidemiologia , Técnicas de Ablação/métodos , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Seguimentos , Humanos , Cuidados Intraoperatórios/efeitos adversos , Cuidados Intraoperatórios/métodos , Margens de Excisão , Recidiva Local de Neoplasia/prevenção & controle , Neoplasias/patologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Estudos Retrospectivos
2.
World Neurosurg ; 133: 248-252, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31629148

RESUMO

BACKGROUND: Persistent idiopathic facial pain is characterized by persistent facial or oral pain in the absence of a neurologic deficit. This underexplored pain may be conducted by various nerves, including cranial nerves and upper cervical spinal roots, and its etiology is unclear. CASE DESCRIPTION: A patient presented with persistent idiopathic facial pain associated with occipital muscle stiffness after an improper neck massage. The patient achieved almost complete pain relief by coblation of right upper cervical nerves (C1 and C2 spinal roots) followed by continuous cervical epidural analgesia for a period of 3 weeks. The analgesic effect was stable during the 3-month follow-up period. CONCLUSIONS: Persistent idiopathic facial pain may be cervicogenic, and treatments focusing on cervical spinal roots may provide satisfactory pain control in patients with cervical abnormalities.


Assuntos
Técnicas de Ablação/métodos , Dor Facial/cirurgia , Raízes Nervosas Espinhais/cirurgia , Adulto , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Dor Facial/diagnóstico por imagem , Humanos , Masculino , Raízes Nervosas Espinhais/diagnóstico por imagem , Resultado do Tratamento
4.
Parasitol Int ; 74: 101921, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31026594

RESUMO

Cystic echinococcosis (CE) is a global public health problem associated with a high overall disease burden. Multiple organ systems are involved in approximately 20% of cases, and treatment is challenging and rarely reported. In this study, we described microwave ablation (MWA) combining surgery for the treatment of a multiorgan CE patient. The patient underwent percutaneous MWA for a hepatic CE3b lesion and exploratory resection of the pelvic cavity lesions. The hepatic lesion was effectively treated by MWA, and invasiveness was reduced by avoiding hepatectomy. The patient had a favorable prognosis at a 20-month's follow-up. More studies are needed to evaluate its usefulness in CE treatment.


Assuntos
Técnicas de Ablação , Equinococose/cirurgia , Equinococose/terapia , Fígado/efeitos da radiação , Micro-Ondas/uso terapêutico , Adulto , Equinococose/diagnóstico , Feminino , Humanos , Fígado/parasitologia , Fígado/patologia , Resultado do Tratamento
6.
Rev Med Chil ; 147(6): 808-812, 2019 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-31859836

RESUMO

Eighty percent of hepatocarcinomas are inoperable at the moment of diagnosis. Liver transplantation is the treatment of choice in these cases, but local therapies are another alternative. Among these, Image-Guided BrachyAblation is a safe choice. We report a 76-year-old male with a hepatocarcinoma, who was considered inoperable due to the high surgical risk of the patient. A local treatment with Image-Guided BrachyAblation was decided. A brachytherapy needle was placed in the tumor under computed tomography guidance and a 15 Gy single dose was delivered from an Iridium-192 source. The patient had no immediate complications and at one month of follow up he continued without incidents.


Assuntos
Técnicas de Ablação/métodos , Braquiterapia/métodos , Carcinoma Hepatocelular/radioterapia , Neoplasias Hepáticas/radioterapia , Radioterapia Guiada por Imagem/métodos , Idoso , Carcinoma Hepatocelular/diagnóstico por imagem , Humanos , Radioisótopos de Irídio , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Doses de Radiação , Tomografia Computadorizada por Raios X , Resultado do Tratamento
7.
J Cardiothorac Surg ; 14(1): 188, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31694695

RESUMO

BACKGROUND: The aim of this study is to report the long-term efficacy and safety of thoracoscopic epicardial left atrial ablation (TELA) in patients with paroxysmal atrial fibrillation (AF). METHODS: This was a retrospective review of medical records. We included all patients diagnosed with paroxysmal AF who underwent TELA at our institution between 04/2011 and 06/2017. TELA included pulmonary vein isolation, LA dome lesions and LA appendage exclusion. All (n = 55) patients received an implantable loop recorder (ILR), 30 days post-operatively. Antiarrhythmic and anticoagulation therapy were discontinued at 90 and 180 days postoperatively, respectively, if patients were free of AF recurrence. Failure was defined as ≥two minutes of continuous AF, or atrial tachycardia. RESULTS: Fifty-five patients (78% males, mean age = 61.6 years) qualified for the study. The average duration in AF was 3.64 +/- 3.4 years, mean CHA2DS2-VASc Score was 2.0 +/- 1.6. The procedure was attempted in 57 patients and completed successfully in 55 (96.5%). Two patients experienced a minor pulmonary vein bleed that was managed conservatively. Post procedure, one patient experienced pulmonary edema, another experienced a pneumothorax requiring a chest tube and another experienced acute respiratory distress syndrome resulting in longer hospitalization. Otherwise, there were no major procedural complications. Success rates were 89.1% (n = 49/55), 85.5% (n = 47/55) and 76.9% (n = 40/52) at 6, 12 and 24 months, respectively. In the multivariate cox-proportional hazard model, survival at the mean of covariates was 86 and 74% at 12 and 24 months, respectively. CONCLUSION: In this single center experience, TELA was a safe and efficacious procedure for patients with paroxysmal AF.


Assuntos
Técnicas de Ablação/métodos , Fibrilação Atrial/cirurgia , Átrios do Coração/cirurgia , Toracoscopia/métodos , Adulto , Idoso , Fibrilação Atrial/diagnóstico por imagem , Feminino , Seguimentos , Átrios do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
8.
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
9.
Cardiol Rev ; 27(6): 308-313, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31584472

RESUMO

The management of ventricular arrhythmias (VA) has evolved over time to an advanced discipline, incorporating many technologies in the diagnosis and treatment of the myriad types of VA. The first application of imaging is in the assessment for structural heart disease, as this has the greatest impact on prognosis. Advanced imaging has its greatest utility in the planning and execution of ablation for VA. The following review outlines the application of different imaging modalities, such as ultrasonography, magnetic resonance imaging, computed tomography, and positron emission tomography, for the treatment of VA.


Assuntos
Técnicas de Ablação/métodos , Arritmias Cardíacas/diagnóstico por imagem , Arritmias Cardíacas/cirurgia , Gerenciamento Clínico , Humanos , Imagem por Ressonância Magnética , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Ultrassonografia
10.
JAMA ; 322(14): 1343, 2019 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-31593251
11.
Niger J Clin Pract ; 22(10): 1408-1411, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31607731

RESUMO

Objective: To study the clinical effect of ultrasound-guided microwave ablation on primary hepatic carcinoma. Method: The subjects comprised 94 patients with primary hepatic carcinoma who were admitted to our hospital between August 2014 and November 2016. They were divided into two groups in accordance with a random-number table. The control (n = 47) and study (n = 47) groups received conventional surgical excision and ultrasound-guided microwave ablation, respectively. The operation duration, clinical effect, complication occurrence rates, and hepatic functions of the two groups were compared. Results: The control group exhibited longer duration of operation and length of stay but significantly lower quantities of intraoperative bleeding and blood transfusion (P < 0.05) than the study group. The study group demonstrated significantly higher (P < 0.05) effective rate of treatment but significantly lower (P < 0.05) occurrence rate of complications than the control group. The study group exhibited significantly higher (P < 0.05) albumin and total bilirubin levels but significantly lower alanine aminotransferase and aspartate transaminase levels than the control group. No difference was observed in prothrombin time between the two groups (P > 0.05). Conclusion: Ultrasound-guided microwave ablation treatment offers the advantages of minor injury and low complication occurrence rates. Moreover, it is associated with faster postoperative recovery and improved hepatic function. Thus, it is worthy as a clinical option and must be promoted and applied.


Assuntos
Técnicas de Ablação , Carcinoma Hepatocelular/cirurgia , Laparotomia/métodos , Neoplasias Hepáticas/cirurgia , Micro-Ondas/uso terapêutico , Ablação por Radiofrequência/métodos , Adulto , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Carcinoma Hepatocelular/patologia , Feminino , Humanos , Tempo de Internação , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
12.
Arch Esp Urol ; 72(8): 786-793, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31579037

RESUMO

INTRODUCTION: Bothersome lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) are increasingly common amongst ageing men leading to poor quality of life. Surgical treatment options targeted at the obstructing prostate are often required to relief the bladder outlet obstruction, following failure or discontinuation of medical therapies. Transurethral resection of the prostate (TURP) has been the mainstay and gold standard for benign prostate surgery for last few decades. Currently with technological advancements, numerous minimally invasive surgical therapies have been employed to provide effective symptom relief while minimalizing morbidities and preserving sexual function. Prostatic hydroablation (Aquablation) is a new technique which involves high velocity water jets used in non-thermal ablation of the obstructing prostatic tissue robotically delivered by a transurethral cystoscopic handpiece and guided by real time transrectal ultrasound imaging. Recent trials have shown that aquablation is safe and effective in the treatment of symptomatic BPH while maintaining sexual preservation. METHOD: Aquablation using the Aquabeam system (PROCEPT BioRobotics, Redwood Shores, CA, USA) combines the precision of autonomous robotic execution in delivering high velocity waterjets via a cystoscopic handpiece with accurate anatomical prostatic mapping using real time transrectal ultrasound imaging. The initial part of the surgery involves careful treatment planning tailored to the prostatic anatomy with preservation of important landmarks nearby, then, high velocity waterjet streams are delivered to ablate the obstructing prostatic tissue without use of any heat. Following the ablation and removal of handpiece, a routine cystoscopic bladder washout is performed and haemostasis achieved with balloon tamponade from a 3 way catheter placed under tension empolying a custom designed catheter tensioning device. RESULTS: Initial studies involving a few case series and a phase II trial demonstrated the safety and effectiveness of aquablation in treatment of symptomatic BPH. Subsequently, a large multicentre international prospective randomised blinded clinical trial (WATER) was conducted to assess the efficacy of aquablation versus TURP. Results from this pivotal trial showed non-inferior symptom relief compared to transurethral prostate resection but with a lower risk of sexual dysfunction. WATER II study was then conducted to assess the safety and feasibility from a multicentre prospective study of aquablation in the treatment of symptomatic large-volume BPH. The results from this study showed that aquablation is feasible and safe in treating men with men with large prostates (80-150 mL). CONCLUSION: The current landscape of BPH surgical treatment should be individualized with a shared decision- making process based on prostatic anatomy and clinical parameters combined with patient's preferences to select the ideal treatment option for each patient. Aquablation is one such option that involves a robotically delivered hydroablation technique based on individualised real time ultrasonic prostatic mapping that can offer safe and effective treatment for symptomatic BPH while minimising sexual dysfunction. Larger trials with longer follow up data will be required to further validate the long term effectiveness of aquablation.


Assuntos
Técnicas de Ablação , Hiperplasia Prostática , Procedimentos Cirúrgicos Robóticos , Ressecção Transuretral da Próstata , Técnicas de Ablação/métodos , Humanos , Masculino , Estudos Prospectivos , Hiperplasia Prostática/terapia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Ultrassonografia , Água
13.
Heart rhythm ; 16(10): 1552-1553, Oct., 2019.
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1022668
14.
Investig Clin Urol ; 60(5): 351-358, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31501797

RESUMO

Purpose: Transurethral needle ablation (TUNA) is a minimally invasive procedure for the treatment of symptomatic benign prostatic hyperplasia (BPH). Compared to transurethral resection of the prostate (TURP), office-based TUNA is an attractive alternative as it is minimally invasive and avoids general anaesthesia. The aim of this study is to evaluate the efficacy of single session office-based TUNA. Materials and Methods: Data of 121 patients who had undergone TUNA was retrieved from June 2008 to March 2017. Patients were followed-up with visits at 1, 3, 6, and 12-months with the International Prostate Symptom Score (IPSS), quality of life (QoL) scoring and uroflowmetry. Results: Patients were 39 to 85 years old. The prostate volumes were 20.00 to 96.90 mL with a median of 26.95 mL. The median IPSS score pre-TUNA was 19, median QOL score pre-TUNA was 4 and median maximum urinary flow (Qmax) pre-TUNA was 10.3 mL/s. There is 65% improvement of IPSS post-TUNA (p<0.001). There is 75% improvement of QOL post-TUNA QOL (p<0.001). There is 35% improvement of Qmax post-TUNA Qmax (p<0.001). The mean relapse-free survival for TUNA is 6.123 years. The 1st, 3rd, and 5th year relapse-free survival rate were 91.7%, 76.6% and 63.7% respectively. Conclusions: Our study is the first to investigate the use of a single-setting office-based TUNA requiring minimal sedation in the Asian community. Complication rates were low in our series, with no associated mortality. When applied to selected patients, TUNA is an effective and reasonably safe alternative for the treatment of symptomatic BPH.


Assuntos
Técnicas de Ablação/instrumentação , Agulhas , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Ambulatórios , Humanos , Masculino , Pessoa de Meia-Idade , Hiperplasia Prostática/diagnóstico , Estudos Retrospectivos , Resultado do Tratamento
15.
J Pediatr Orthop ; 39(9): 479-486, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31503237

RESUMO

BACKGROUND: Although physeal fractures and physeal bars can result in significant clinical consequences to growth and development of the injured physis, little orthopaedic research has focused upon this topic. Our objective was to extend a previously developed rat model to examine the immunohistochemical features following surgical application of techniques disrupting the physis. METHODS: Physes were surgically disrupted using fracture (control), epiphyseal scrape (ES), or epiphyseal drill (ED). After 1, 3, 6, 10, or 21 days, animals were euthanized, sites processed for histology and immunohistochemical localization of vascular endothelial growth factor (VEGF), Factor VIII, Sox-9, PTHrP (parathyroid hormone-related protein) and PTHrP-R (parathyroid hormone-related protein receptor) in resting, proliferative, and hypertrophic physeal zones. Incidence of physeal bars, vertical septa and islands within the metaphysis was quantified. Semiquantitative analysis of immunohistochemistry was performed. RESULTS: Physeal bars, vertical septa, and displaced cartilage islands were present each of the surgical treatments. Fisher's exact test showed a statistically significant increase in the presence of physeal bars (P=0.002) and vertical septa (P=0.012) in the ED group at 10 and 21 days. Analysis of VEGF showed significant differences among the surgical treatments involving the resting zone, and the proliferative zone for days 1, 6, and 21 (P≤0.02) with greater mean scores present in the fracture (control) group, followed by the ED group; the lowest scores were present in the ES group. PTHrP-R immunolocalization showed significant differences among treatments in the hypertrophic zone at days 6 and 21 (P=0.022 and 0.044, respectively). CONCLUSIONS: On the basis of the type of surgical treatment, results show significant differences in the presence of VEGF (reflecting the vascular bed) in the resting and proliferating zones at days 1, 6, and 21. VEGF localization was less abundant in the ED group (which had more physeal bars), suggesting that lack of vascular ingrowth plays a role in physeal bar formation. CLINICAL RELEVANCE: Basic science data presented here provide insight into the importance of the various regions of the physis and its repair and continued growth after physeal fracture. We suggest that a better understanding of the cellular basis of physeal arrest following physeal fracture may have future relevance for the development of treatments to prevent or correct arrest.


Assuntos
Lâmina de Crescimento/metabolismo , Fraturas Salter-Harris/metabolismo , Técnicas de Ablação , Animais , Epífises/lesões , Epífises/metabolismo , Fator VIII/metabolismo , Lâmina de Crescimento/cirurgia , Imuno-Histoquímica , Proteína Relacionada ao Hormônio Paratireóideo/metabolismo , Ratos , Receptor Tipo 1 de Hormônio Paratireóideo/metabolismo , Fatores de Transcrição SOX9/metabolismo , Fraturas Salter-Harris/cirurgia , Fator A de Crescimento do Endotélio Vascular/metabolismo
16.
Clin Hemorheol Microcirc ; 73(1): 73-83, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31561352

RESUMO

AIM: Evaluation of the post-interventional success following ablative techniques (radiofrequency and microwave) using a new color coded perfusion quantification software with CEUS in patients with primary and secondary liver malignancies. MATERIAL AND METHODS: 75 patients (60 males, 15 females, age 24-84 years, mean 62.7 years) with 128 malignant liver lesions were included in this study. Between 01/2013 and 06/2018, the therapeutic interventional procedure in 88 lesions was MWA, in 40 lesions RFA. All patients underwent CEUS using a convex multifrequency probe (1-6 MHz) following application of 1-2.4 ml sulphur hexaflouride microbubbles, before and within 24 hours following RFA and MWA to detect residual tumor tissue. Postprocessing of the stored DICOM loops from 15 sec up to 1 min using a perfusion quantification software regarding peak enhancement (pE), time to peak (TTP), mean transit time (MTT), rise time (Ri) and Wash-in area under the curve (WiAUC) in the center of the lesion, the border area and periphery was performed. RESULTS: In patients treated with RFA, pE differences between center of the lesion vs. surrounding liver were found to be statistically extremely significant (p < 0.001), differences between center of the lesion and margin were also statistically significant (p < 0.01). mTT, TTP, WiAuC and Ri showed no significant difference between center, margin or surrounding liver.In patients treated with MWA, statistically significant differences (p < 0.05) were found for pE, Ri and mTT regarding the differences between center of lesion and surrounding tissue. WiAuC and TTP showed no significant differences between center, margin or surrounding liver. CONCLUSION: CEUS with perfusion imaging is a valuable supporting tool for post-interventional success control following RFA and MWA of primary and secondary liver maligancies. Focus should be placed upon pE following MWA and pE, Ri and mTT following RFA.


Assuntos
Técnicas de Ablação/métodos , Meios de Contraste/uso terapêutico , Neoplasias Hepáticas/diagnóstico por imagem , Ablação por Radiofrequência/métodos , Ultrassonografia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Perfusão/métodos , Adulto Jovem
17.
Technol Cancer Res Treat ; 18: 1533033819876899, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31533537

RESUMO

Irreversible electroporation causes cell death through low frequency, high voltage electrical pulses and is increasingly used to treat non-resectable cancers. A recent systematic review revealed that tissue damage through irreversible electroporation is time-dependent, but the impact of time on the ablation zone size remains unknown. Irreversible electroporation ablations were performed hourly during 24 consecutive hours in the peripheral liver of 2 anaesthetized domestic pigs using clinical treatment settings. Immediately after the 24th ablation, the livers were harvested and examined for tissue response in time based on macroscopic and microscopic pathology. The impact of time on these outcomes was assessed with Spearman rank correlation test. Ablation zones were sharply demarcated as early as 1 hour after treatment. During 24 hours, the ablation zones showed a significant increase in diameter (rs = 0.493, P = .014) and total surface (rs = 0.499, P = .013), whereas the impact of time on the homogeneous ablated area was not significant (rs = 0.172, P = .421). Therefore, the increase in size could mainly be attributed to an increase in the transition zone. Microscopically, the ablation zones showed progression in cell death and inflammation. This study assessed the dynamics of irreversible electroporation on the porcine liver during 24 consecutive hours and found that the pathological response (ie, cell death/inflammation), and ablation size continue to develop for at least 24 hours. Consequently, future studies on irreversible electroporation should prolong their observation period.


Assuntos
Técnicas de Ablação , Eletroporação/métodos , Fígado , Animais , Biópsia , Imuno-Histoquímica , Modelos Animais , Pilotos , Suínos
18.
Eur J Radiol ; 119: 108650, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31525680

RESUMO

PURPOSE: To evaluate a strategy that used thermal-ablation of vertebral metastases (VM) to prevent vertebral related events (VRE) in patients with differentiated thyroid cancer (DTC). METHODS: This single center study retrospectively reviewed records and post-operative imaging of all DTC patients treated with thermal-ablation for asymptomatic VMs. Rate of local tumor control at first post-operative imaging, 12 and 24 months after thermal-ablation and rate of VREs at 12 and 24 months among the treated VMs were reported. New VMs that occurred during the follow-up and were not considered for additional thermal-ablation were moniroted and VREs were reported. RESULTS: Thermal-ablation was used to achieve local control of 41 VMs in 28 patients. Median post-treatment follow-up was 22 months [range: 12-80] and the mean delay for first post-operative imaging was 2 months [range: 0.6-7.5]. Local control at first post-operative imaging, 12 and 24 months was achieved in 87.8%, 82.9% and 75.6%, respectively. Among the treated VMs the rates of VRE was 7.3% at 2 years, significantly lower if local control was achieved at first post-operative imaging than if it was not (0% vs 30%, p = 0.011, OR = 0.184 [95%CI = 0.094-0.360]). After thermal-ablation procedures, 19 news VMs occurred in 11 patients (39.2%) with a median interval of 8 months [range 1-26] and remained untreated. Among these untreated VMs, the rate of VREs at 2 years was significantly higher compared to the treated VMs: (36.8% vs. 7.3%, p = 0.008, OR = 0.135, [95%CI = 0.030-0.607]). CONCLUSION: local tumor control of VMs using thermal-ablation decreases the risk of VREs in DTC patients.


Assuntos
Técnicas de Ablação/métodos , Hipertermia Induzida/métodos , Neoplasias da Coluna Vertebral/cirurgia , Neoplasias da Glândula Tireoide/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/cirurgia , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sacro/cirurgia , Neoplasias da Coluna Vertebral/prevenção & controle , Neoplasias da Coluna Vertebral/secundário , Cirurgia Assistida por Computador/métodos , Vértebras Torácicas/cirurgia , Resultado do Tratamento
19.
Int J Hyperthermia ; 36(1): 980-985, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31544547

RESUMO

Objective: This study aimed to evaluate the risk factors of biloma formation and secondary infection after thermal ablation for malignant hepatic tumors. Patients and methods: A total of 58 patients with 68 bilomas after thermal ablation were recruited as the complication group, and 61 patients with 72 lesions without major complications were selected randomly as the control group. The potential risk factors for biloma formation were analyzed with the chi-square test and multivariate logistic regression analysis. To determine the optimum management method for biloma, patients with secondary infection were included for the subgroup analysis of risk factors. Results: A history of transcatheter arterial chemoembolization (TACE) treatment (odds ratio [OR]: 3.606, 95% confidence interval [CI]: 1.165-11.156, p = .026) and tumor location (OR: 37.734, 95% CI: 13.058-109.034, p = .000) were independent predictors of biloma formation. Among the 58 patients with biloma, 49 (84.5%) showed no symptoms (i.e., the asymptomatic group), while the remaining 9 (15.5%) developed symptoms related to secondary infections (i.e., the symptomatic group). There were significant differences in the history of biliary manipulation (p = .031) between the symptomatic and asymptomatic groups. Conclusion: A history of TACE treatment and the distance from the biliary tract were independent predictors of biloma formation after thermal ablation. Therefore, protecting the bile duct (i.e., cooling of the bile duct and combing thermal ablation with chemical ablation) should be considered for high-risk patients. Moreover, active monitoring and management should be performed for patients with bilomas who underwent biliary surgery before.


Assuntos
Técnicas de Ablação/efeitos adversos , Ductos Biliares/patologia , Carcinoma Hepatocelular/complicações , Hipertermia Induzida/efeitos adversos , Neoplasias Hepáticas/complicações , Técnicas de Ablação/métodos , Carcinoma Hepatocelular/radioterapia , Feminino , Humanos , Hipertermia Induzida/métodos , Neoplasias Hepáticas/radioterapia , Masculino , Pessoa de Meia-Idade , Fatores de Risco
20.
Electromagn Biol Med ; 38(4): 249-261, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31554439

RESUMO

Microwave ablation is used to treat lung tumors by releasing microwave magnetic field to produce high temperature of more than 60 ℃ in the tumor tissues, thus causing tissue coagulation, dehydration and necrosis to achieve the purpose of treatment. However, the lack of appropriate power and time parameters for microwave ablation in clinical treatment of lung tumors leads to poor ablation or excessive ablation. In this paper, a two-dimensional simulation model of microwave antenna and ideal lung was established to realize the simulation of microwave ablation process. Meanwhile, microwave ablation experiments were carried out in ex-vivo porcine lung under different power and time. The temperature distribution was obtained by thermocouples and compared with the simulation calculation. Set 60℃ as boundary of the ablation area and the ablation time was 360 s. The length of the ablation area parallel to the antenna direction is longitudinal, and the length perpendicular to the antenna direction is transverse. From the simulation results, with the increase of ablation power (20 W to 60 W), the transverse diameter of ablation area increased from 32.5 mm to 55.6 mm, and the longitudinal diameter increased from 47.8 mm to 69.1 mm. From the results of ex-vivo experiments, with the increase of ablation power (30 W to 50 W), the transverse diameter of ablation area increased from 29.5 mm to 48.9 mm, the longitudinal diameter increased from 41.1 mm to 66.3 mm, and the maximum slot temperature increased from 75.6 ℃ to 106.7 ℃. The results of numerical simulation are slightly larger than those of ex-vivo experiments under the same parameters. When the average diameter of lung tumors is less than 40 mm, 30 W and 40 W ablation power can be selected. The ablation time is limited to 360 s. 50 W ablation power can be used to ablate the lesion quickly in a shorter time to achieve the same purpose. Although there are differences between ex-vivo and in vivo, the validity of the lung model and the influence of ablation parameters in the simulation are verified in this paper. The ablation area under different parameters was obtained, which served as a reference data for clinical practice. A basic study was made to consider the complex lung model and the changes of parameters with temperature in the future.


Assuntos
Técnicas de Ablação , Pulmão/efeitos da radiação , Micro-Ondas/uso terapêutico , Animais , Estudos de Viabilidade , Análise de Elementos Finitos , Modelos Biológicos , Suínos , Temperatura Ambiente
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA