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1.
Am Heart J ; 222: 64-72, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32018203

RESUMO

BACKGROUND: Radiofrequency current (RFC) catheter ablation for patients with paroxysmal atrial fibrillation (AF) has been shown to be safe and effective in first-line therapy. Recent data demonstrates that RFC ablation provides better clinical outcomes compared to antiarrhythmic drug (AAD) in the treatment of early AF disease. Furthermore, studies comparing RFC and cryoballoon have established comparable efficacy and safety of pulmonary vein isolation (PVI) for patients with symptomatic paroxysmal AF. OBJECTIVES: The Cryo-FIRST trial was designed to compare AAD treatment against cryoballoon PVI as a first-line therapy in treatment naïve patients with AF. Efficacy and safety will be compared between the two cohorts and amongst subgroups. METHODS: The primary hypothesis is that cryoablation is superior to AAD therapy. To test this hypothesis, patients will be randomized in a 1:1 design. Using a 90-day blanking period, primary efficacy endpoint failure is defined as (at least) one episode of atrial arrhythmia with a duration >30 sec (documented by 7-day Holter or 12-lead ECG). Secondary endpoints (Quality-of-Life, rehospitalization, arrhythmia recurrence rate, healthcare utilization, and left atrial function) and adverse events will also be evaluated. Study enrollment will include 218 patients in up to 16 centers. CONCLUSIONS: This study will be a multi-national randomized controlled trial comparing cryoablation against AAD as a first-line treatment in patients with paroxysmal AF. The results may help guide the selection of patients for early AF disease therapy via cryoballoon ablation.


Assuntos
Técnicas de Ablação/métodos , Antiarrítmicos/uso terapêutico , Fibrilação Atrial/terapia , Criocirurgia/métodos , Eletrocardiografia , Sistema de Condução Cardíaco/fisiopatologia , Fibrilação Atrial/fisiopatologia , Função do Átrio Direito/fisiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Veias Pulmonares/cirurgia , Qualidade de Vida , Recidiva , Método Simples-Cego , Resultado do Tratamento
2.
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
3.
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
5.
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
6.
PLoS One ; 14(12): e0226764, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31869376

RESUMO

Parallel to establishment of diagnostic surveillance protocols for detection of prostatic diseases, novel treatment strategies should be developed. The aim of the present study is to evaluate the feasibility and possible side effects of transrectal, MRI-targeted intraprostatic steam application in dogs as an established large animal translational model for prostatic diseases in humans. Twelve healthy experimental, intact, male beagle dogs without evidence of prostatic pathology were recruited. An initial MRI examination was performed, and MRI-targeted steam was applied intraprostatically immediately thereafter. Serum levels of C-reactive protein (CRP), clinical and ultrasonographic examinations were performed periodically following the procedure to assess treatment effect. Four weeks after treatment, all dogs underwent follow-up MRI examinations and three needle-core biopsies were obtained from each prostatic lobe. Descriptive statistics were performed. MRI-guided intraprostatic steam application was successfully performed in the study population. The first day after steam application, 7/12 dogs had minimal signs of discomfort (grade 1/24 evaluated with the short-form Glasgow Composite Measure Pain Scale) and no dogs showed any sign of discomfort by day 6. CRP elevations were detected in 9/12 dogs during the first week post steam application. Mild to moderate T2 hyperintense intraparenchymal lesions were identified during follow-up MRI in 11/12 dogs four weeks post procedure. Ten of these lesions enhanced mild to moderately after contrast administration. Coagulative necrosis or associated chronic inflammatory response was detected in 80.6% (58/72) of the samples obtained. MRI-targeted intraprostatic steam application is a feasible technique and displays minimal side effects in healthy dogs as translational model for human prostatic diseases. This opens the possibility of minimally invasive novel treatment strategies for intraprostatic lesions.


Assuntos
Técnicas de Ablação/métodos , Imagem por Ressonância Magnética/métodos , Próstata/cirurgia , Doenças Prostáticas/cirurgia , Animais , Cães , Estudos de Viabilidade , Masculino , Próstata/diagnóstico por imagem , Doenças Prostáticas/diagnóstico por imagem , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/cirurgia , Vapor/análise
7.
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
8.
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
9.
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
10.
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
11.
Curr Urol Rep ; 20(10): 63, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31478109

RESUMO

PURPOSE OF REVIEW: Although still considered experimental, focal irreversible electroporation (IRE) as a primary treatment for prostate cancer (PCa) is considered one of the most promising ablative technologies for focal therapy. This review provides a description of the principle of IRE for the treatment of PCa, combined with an overview of the recent research. RECENT FINDINGS: It has been almost a decade since the first human studies of focal IRE for PCa were trying to demonstrate its feasibility and safety, and recently new data are emerging regarding the functional and oncological outcomes. It was shown that the expected ablation efficacy of IRE is dependent on increased safety margins of > 9 mm and an uninterrupted IRE procedure, but these findings need further investigation in larger cohorts and randomized control trials (RCT). Recent data from larger cohorts with a longer follow-up of up to 12 months prove that focal IRE as primary treatment for localized PCa is indeed safe, has effective short-term oncological control in selected patients, and it has good functional outcomes by retaining urinary function and causing only mild erectile dysfunction.


Assuntos
Técnicas de Ablação/métodos , Eletroporação/métodos , Neoplasias da Próstata/terapia , Disfunção Erétil/etiologia , Humanos , Masculino , Margens de Excisão , Neoplasias da Próstata/patologia , Recuperação de Função Fisiológica
12.
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
13.
Cardiovasc Intervent Radiol ; 42(12): 1771-1776, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31489473

RESUMO

INTRODUCTION: To assess the performance of pre-ablation computed tomography texture features of adrenal metastases to predict post-treatment local progression and survival in patients who underwent ablation using machine learning as a prediction tool. MATERIALS AND METHODS: This is a pilot retrospective study of patients with adrenal metastases undergoing ablation. Clinical variables were collected. Thirty-two texture features were extracted from manually segmented adrenal tumors. A univariate cox proportional hazard model was used for prediction of local progression and survival. A linear support vector machine (SVM) learning technique was applied to the texture features and clinical variables, with leave-one-out cross-validation. Receiver operating characteristic analysis and the area under the curve (AUC) were used to assess performance between using clinical variables only versus clinical variables and texture features. RESULTS: Twenty-one patients (61% male, age 64.1 ± 10.3 years) were included. Mean time to local progression was 29.8 months. Five texture features exhibited association with progression (p < 0.05). The SVM model based on clinical variables alone resulted in an AUC of 0.52, whereas the SVM model that included texture features resulted in an AUC 0.93 (p = 0.01). Mean overall survival was 35 months. Fourteen texture features were associated with survival in the univariate model (p < 0.05). While the trained SVM model based on clinical variables resulted in an AUC of 0.68, the SVM model that included texture features resulted in an AUC of 0.93 (p = 0.024). DISCUSSION: Pre-ablation texture analysis and machine learning improve local tumor progression and survival prediction in patients with adrenal metastases who undergo ablation.


Assuntos
Técnicas de Ablação/métodos , Neoplasias das Glândulas Suprarrenais/cirurgia , Aprendizado de Máquina , Tomografia Computadorizada por Raios X/métodos , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Prognóstico , Modelos de Riscos Proporcionais , Curva ROC , Estudos Retrospectivos , Máquina de Vetores de Suporte , Análise de Sobrevida , Resultado do Tratamento
14.
Med Ultrason ; 21(3): 217-224, 2019 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-31476199

RESUMO

AIM: Percutaneous radiofrequency (RFA) and microwave ablation (MWA) are currently the best treatment options forpatients with liver metastases (LM) who cannot undergo a liver resection procedure. Presently, few studies have evaluated theefficacy of tumor ablation in beginner's hands but none at all in hepatic metastasis. Our aim was to report the initial experiencewith ultrasound as a tool to guide tumor ablation in a low volume center with no experience in tumor ablation. MATERIAL AND METHODS: We conducted a retrospective cohort study, on a series of 61 patients who had undergone percutaneous US-guided ablations for 82 LM between 2010 and 2015. Long term outcome predictors were assessed using univariate and multivariate analysis. RESULTS: Complete ablation was achieved in 86.9% of cases (53/61). All MWA sessions (20/20) attained ablation margins >5mm, compared to 79% (49/62) for RFA sessions (p=0.031). Ablation time was significantly shorter for MWA, with a median duration of 10 minutes (range: 6-12) vs. 14 minutes (range: 10-19.5, p=0.003). There was no statistically significant difference in local tumor progression (LTP)-free survival rates between MWA and RFA (p=0.154). On univariate analysis, significant predictors for local recurrence were multiple metastases (p=0.013) and ablation margins <5 mm (p<.001), both retaining significance on multivariate analysis. Significant predictors for distant recurrence on both univariate and multivariate analysis were multiple metastases (p<0.001) and non-colorectal cancer metastases (p<0.05). CONCLUSION: A larger than 5 mm ablation size is critical for local tumor control. We favor the use of MWA due to its ability to achieve ablation in significantlyshorter times with less incomplete ablations.


Assuntos
Técnicas de Ablação/métodos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Ultrassonografia de Intervenção/métodos , Ablação por Cateter/métodos , Estudos de Coortes , Feminino , Humanos , Fígado/diagnóstico por imagem , Fígado/cirurgia , Neoplasias Hepáticas/secundário , Masculino , Micro-Ondas , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
15.
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
16.
World J Gastroenterol ; 25(32): 4614-4628, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31528090

RESUMO

Liver cancers are the second most frequent cause of global cancer-related mortality of which 90% are attributable to hepatocellular carcinoma (HCC). Despite the advent of screening programmes for patients with known risk factors, a substantial number of patients are ineligible for curative surgery at presentation with limited outcomes achievable with systemic chemotherapy/external radiotherapy. This has led to the advent of numerous minimally invasive options including but not limited to trans-arterial chemoembolization, radiofrequency/microwave ablation and more recently selective internal radiation therapy many of which are often the first-line treatment for select stages of HCC or serve as a conduit to liver transplant. The authors aim to provide a comprehensive overview of these various image guided minimally invasive therapies with a brief focus on the technical aspects accompanied by a critical analysis of the literature to assess the most up-to-date evidence from comparative systematic reviews and meta-analyses finishing with an assessment of novel combination regimens and future directions of travel.


Assuntos
Carcinoma Hepatocelular/terapia , Gastroenterologia/métodos , Neoplasias Hepáticas/terapia , Oncologia/métodos , Técnicas de Ablação/métodos , Técnicas de Ablação/tendências , Antineoplásicos/administração & dosagem , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/patologia , Quimioembolização Terapêutica/métodos , Quimioembolização Terapêutica/tendências , Terapia Combinada/métodos , Terapia Combinada/tendências , Gastroenterologia/tendências , Humanos , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Oncologia/tendências , Metanálise como Assunto , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Estadiamento de Neoplasias , Intervalo Livre de Progressão , Radiografia Intervencionista/métodos , Radiografia Intervencionista/tendências , Revisões Sistemáticas como Assunto
17.
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
18.
Rev Port Cardiol ; 38(7): 473-480, 2019 07.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31495717

RESUMO

INTRODUCTION: In obstructive hypertrophic cardiomyopathy (HCM), alcohol septal ablation (ASA) can lead to gradient reduction and symptom improvement. We aimed to assess the efficacy and safety of ASA in a long-term outcome study. METHODS: We analyzed patients who underwent ASA over a seven-year period in a tertiary center. The primary echocardiographic endpoint was >50% reduction in left ventricular outflow tract (LVOT) gradient within a year of the procedure. The primary clinical endpoints were improvement in functional capacity and a combined endpoint of cardiac death and rehospitalization for cardiac cause. The follow-up period was 4.17±2.13 years. RESULTS: A total of 80 patients, mean age 63.9±12.3 years, 30.0% male, were analyzed. Baseline LVOT gradient was 96.3±34.6 mmHg and interventricular septal thickness was 21.6±3.1 mm. Minor complications were observed in 6.3% and major complications in 2.5%, and 8.8% received a permanent pacemaker. The primary echocardiographic endpoint was achieved by 85.7%. At three-month follow-up, LVOT gradient was 25.8±26.0 mmHg in the successful procedure group, compared to 69.2±35.6 mmHg in the other patients (p=0.001). At six months, LVOT gradient was 27.1±27.4 vs. 58.2±16.6 mmHg (p=0.024). Among 74 patients in NYHA class III/IV before the procedure, 57 (77%) improved to NHYA class I/II. The combined primary clinical endpoint (cardiac death and rehospitalization for cardiac cause) was observed in 27.5% (n=22). In the unsuccessful group, the combined endpoint was observed in 54.5%, compared to only 22.7% in the successful group. Only two patients died of cardiac causes. CONCLUSION: ASA is a safe procedure with a high success rate. Patients who achieved significant reductions in LVOT gradient suffered less cardiac death and rehospitalization for cardiac cause.


Assuntos
Técnicas de Ablação/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Cardiomiopatia Hipertrófica/cirurgia , Etanol/farmacologia , Obstrução do Fluxo Ventricular Externo/cirurgia , Septo Interventricular/cirurgia , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/diagnóstico , Ecocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/diagnóstico , Obstrução do Fluxo Ventricular Externo/etiologia , Septo Interventricular/diagnóstico por imagem
19.
World J Gastroenterol ; 25(28): 3704-3721, 2019 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-31391767

RESUMO

Hepatocellular carcinoma (HCC) is the most common liver malignancy worldwide and a major cause of cancer-related mortality for which liver resection is an important curative-intent treatment option. However, many patients present with advanced disease and with underlying chronic liver disease and/or cirrhosis, limiting the proportion of patients who are surgical candidates. In addition, the development of recurrent or de novo cancers following surgical resection is common. These issues have led investigators to evaluate the benefit of neoadjuvant and adjuvant treatment strategies aimed at improving resectability rates and decreasing recurrence rates. While high-level evidence to guide treatment decision making is lacking, recent advances in locoregional and systemic therapies, including antiviral treatment and immunotherapy, raise the prospect of novel approaches that may improve the outcomes of patients with HCC. In this review, we evaluate the evidence for various neoadjuvant and adjuvant therapies and discuss opportunities for future clinical and translational research.


Assuntos
Carcinoma Hepatocelular/terapia , Hepatectomia , Neoplasias Hepáticas/terapia , Terapia Neoadjuvante/métodos , Recidiva Local de Neoplasia/terapia , Técnicas de Ablação/métodos , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Antivirais/uso terapêutico , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/virologia , Quimioembolização Terapêutica/métodos , Quimioterapia Adjuvante/métodos , Humanos , Fígado/patologia , Fígado/cirurgia , Fígado/virologia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/virologia , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Radiocirurgia/métodos , Resultado do Tratamento , Radioisótopos de Ítrio/administração & dosagem
20.
Cardiovasc Intervent Radiol ; 42(12): 1718-1725, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31367773

RESUMO

INTRODUCTION: Renal ablation is a recognized treatment modality for small renal masses. Cone-beam CT (CBCT) has been recently used in interventional oncology as a promising new guidance device, but this technology still needs to be validated for renal ablations. We aimed to assess the technical success of CBCT applications in renal ablative treatments. MATERIALS AND METHODS: Between March 2016 and June 2018, 14 patients (mean age 69, range 54-83, 7F, 7M) underwent 21 renal ablations for histologically proven renal cell carcinoma (RCC). All treatments were performed with ultrasound (US) and CBCT guidance under general anesthesia in a dedicated angiography room setting. CBCT was mainly used to assess needle placement and to exclude complications at the end of the procedure. In two small lesions (< 1 cm), pre-acquired CBCT was co-registered with real-time US to obtain a US-CBCT fusion image guidance for tumor ablation. RESULTS: Whether used alone or in combination with other imaging modalities, CBCT was proven to be technically successful in all 21 procedures to guide or assist tumor ablation. A primary technical efficacy of thermal ablation was achieved in 19/21 ablations (90.1%) at 1 month. Mean procedure duration was 100.2 min (range 160-64). Mean length of hospital stay was 2 days (range 1-10 days). All patients are still under active surveillance for a mean follow-up of 14.5 months (range 4-26 months). CONCLUSIONS: CBCT for renal ablation guidance is a viable tool. Larger series are needed to compare it to MDCT.


Assuntos
Técnicas de Ablação/métodos , Carcinoma de Células Renais/cirurgia , Tomografia Computadorizada de Feixe Cônico/métodos , Neoplasias Renais/cirurgia , Radiografia Intervencionista/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Rim/diagnóstico por imagem , Rim/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia de Intervenção
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