Adequate rectal preparation reduces hospital admission for urosepsis after transrectal ultrasound - guided prostate biopsy

ABSTRACT Objectives: Previous studies have compared infectious outcomes on the basis of whether rectal preparation was performed; however, they failed to evaluate the quality of each rectal preparation, which may have led to confounding results. This study aimed to compare hospitalizations for urosepsis within 1 month after transrectal ultrasound-guided prostate biopsy between patients with adequate and traditional rectal preparations. Materials and Methods: Between January 2011 and December 2016, a total of 510 patients who underwent transrectal ultrasound - guided prostate biopsy at our institutions and were orally administered prophylactic antibiotics (levofloxacin) were included. Two rectal preparations were performed: (1) adequate rectal preparation confirmed by digital rectal examination and transrectal ultrasound (Group A, n = 310) and (2) traditional rectal preparation (Group B, n = 200). All patient characteristics were recorded. A logistic regression model was used to assess the effects of the two different rectal preparations on urosepsis, adjusted by patient characteristics. Results: There were a total of three and nine hospitalizations for urosepsis in Groups A and B, respectively. Differences in the demographic data between the two groups were insignificant. Logistic regression showed that adequate rectal preparation before biopsy significantly decreased the risk for urosepsis after biopsy (adjusted odds ratio: 0.2; 95% confidence interval: 0.05 - 0.78; P = 0.021). Conclusions: Adequate rectal preparation could significantly reduce hospitalizations for urosepsis within 1 month after transrectal ultrasound-guided prostate biopsy. The quality of rectal preparation should be evaluated before biopsy. If adequate rectal preparation is not achieved, postponing the biopsy and adjusting the rectal preparation regimen are suggested.

Prostate cancer volume estimations based on transrectal ultrasonography-guided biopsy in order to predict clinically significant prostate cancer

Tumor diameter is a reliable parameter to estimate tumor volume in solid organ cancers; its use in prostate cancer is controversial since it exhibits a more irregular pattern of growth. This study aimed to examine the association between the tumor volume estimations based on transrectal ultrasound (TRUS) guided biopsy results and the tumor volume measured on the pathological specimen.

Clinical study of PEI combined with HIFU for treating unresectable middle and advanced stages of primary liver cancer / 重庆医学

Objective To investigate whether the percutaneous ethanol injection (PEI)under sedation and analgesia can in-crease the energy deposition and curative efficiency of the high intensity focused ultrsound(HIFU)in treating unresectable middle and advanced stages of primary liver cancer.Methods Thirty-six cases of clinically diagnosed unresectable middle and advanced sta-ges of primary liver cancer were randomly divided into the PEI+ HIFU group(combination group,n = 23)and the simple HIFU group (HIFU group,n=13);10mL of the mixture of 99.7% ethanol and iodized oil (9:1)was given by intratumoral injection at 30 min before ablation in the PEI+HIFU group,while 0.9% physiological saline 10mL was replaced in the simple HIFU group.The ablation energy efficiency factor(EEF)and irradiation time were compared between the two groups.Results The ablation EEF in the PEI+HIFU group and the simple HIFU group were (13.82+4.26)J/mm3 and (25.63+6.31)J/mm3 respectively,the PEI+HIFU group was significantly lower than the simple HIFU group (P <0.05);the irradiation time were (1 468.28+253.21)s and (2 352.56+463.34)s respectively;which in the PEI+ HIFU group was significantly shortened (P <0.05).Conclusion PEI can enhance the HIFU ablation energy deposition and improve the efficiency of HIFU for treating unresectable primary liver cancer.

Preliminary study on the relationship between the blood supply of rabbit liver VX2 tumor models and the HIFU / 中国医师杂志

Objectives To explore the effects of the blood supply extent on the temperature of target site of tumor and volume of coagulation necrosis (V),and to provide experimental evidence for further precise control of dosage of high intensity focused ultrasound (HIFU) and improve the efficiency of HIFU in the treatment.Methods Twenty-four rabbit liver VX2 tumor models were established and were divided into four groups:10 d group,15 d group,20 d group,no blood supply group (rabbits were put to death in the 10 d after the models were established).The same irradiation parameters of HIFU were used to irradiate the hepatic tumor tissue of every group,the real-time temperature of target site of tumor were measured,the software from temperature controller was used to plot the time-temperature curve (TTC),V was measured after HIFU.Residual tumor tissue was resected for pathological observation and microvascular density (MVD) determination.Results (1) Histopathological analysis showed that the extent of a tumor's blood supply followed the order 10 d group ＞ 15 d group ＞ 20 d group (P ＜ 0.01).(2)Tmax,T1,k1:betweengroups had no statistical difference among 10 d group,15 d group,20 d group (P ＞0.05),T T1,and k1 between three groups with no blood supply group had statistical difference (P ＜ 0.05).(3) k2:10 d group ＞ 15d group ＞ 20d group ＞ no blood supply group;T2:10d group ＜ 15d group ＜ 20d group ＜ no blood supply group;(4)V:10 d group ＜ 15 d group ＜ 20 d group ＜ no blood supply group.Conclusions The extent of a tumor's blood supply had a significant effect on the temperature-decrease phase but not on the temperature-increase phase during HIFU treatment.The more abundant blood supply of the tumor was,the faster heat abstraction after HIFU was;and the easier the tissue return to normal temperature,the smaller the volume of coagulation necrosis tissue were.

Dosimetry and efficacy of high intensity focused ultrasound in the treatment of pancreatic cancer / 中华肝胆外科杂志

Objective To study the efficacy and the safe dosage of high intensity focused ultrasound (HIFU) ablation in pancreatic cancer.Methods From November 2010 to May 2013,21 patients with advanced pancreatic cancer were treated by HIFU at the First Affiliated Hospital of Zhengzhou University.These patients who were randomly divided into two groups (10 and 11 patients respectively),were given a low-power (100～249 W) treatment and a high power (250 ～350 W) treatment.These two groups of 21 patients received a total of 25 times of HIFU treatment (3 patients received twice of low-power treatment,while 1 patient received twice of high-power treatment).The two groups were compared by analyzing the treatment parameters (average power,total treatment time,treatment total energy,treatment volume,etc.) and volume of tumour response as shown on postoperative imaging (CT or MRI) examinations.Also,the complications,degree of pain relief and survival were compared.The energy efficiency factor (EEF) and the ablation ratio were calculated.A preliminary study was conducted on the relationship of the ultrasound dose and the ablation effect of HIFU treatment for pancreatic cancer.Results (1) The EEF of the high-power group (≥250 W) and the low-power group (＜ 250 W) were (10.39 ± 5.71) J/mm3 and (21.62 ± 9.81) J/mm3,the former group was significantly lower than the latter group (P ＜0.05) ; the ablation ratio of the high-power group was higher than the low-power group,(91.52 ± 4.18)％ versus (51.59 ± 7.66)％ respectively,the difference was statistically significant (P ＜ 0.001).(2) The efficiency factor and the ablation volume for the HIFU treatment showed a linear trend,and both were negatively correlated (Pearson correlation coefficient r =-0.485,P ＜ 0.05).(3) There was no serious complication after the HIFU treatment.In the low-power group,six of ten patients were alleviated of his pain (60％) ; the CA19-9 decreased in four of ten patients after HIFU treatment (40％).In the high-power group,nine of eleven patients were significantly relieved of pain after treatment (82％),the CA19-9 decreased in five of nine patients after HIFU treatment (56％).(4) On Kaplan-Meier survival analysis,HIFU treatment of patients with pancreatic cancer,the median survival was 8 months and 9 months in the low-power group and high power group,respectively (Log-rank test x2 =0.05,P =0.944).Conclusion During HIFU treatment of patients with pancreatic cancer,if the ultrasound power was between 250 W and 350 W,there was a higher proportion of tumor ablation,but with no serious complications.Thus,this dose was safe.

Pain related and overall morbidity with TRUS guided prostate biopsy a prospective study

Objective To assess analgesia requirement after trans-rectal ultrasound guided prostate biopsy(TRUSBx) for appropriate counselling. Materials and Methods Prospectively, successive patients undergoing TRUSBx between July 2009 and November 2011 were given questionnaires prior to procedure. Standard 12-core TRUSBx under peri-prostatic block (10 mL of 1% lidocaine) and antibiotic prophylaxis (oral ciprofloxacin, intravenous gentamicin and metronidazole suppository) were performed. Pain perception was assessed using a Visual Analogue Score (VAS). Results Mean (range) age of the 405 patients was 67.3 years (48-88). Mean VAS during the procedure was 2.93 and 2.20 on reaching home. Mean maximum VAS for the cohort on day 1 and day 2 were 1.27 and 0.7 respectively. 140 (35%) were independent with some or minimal discomfort. 14 patients required assistance for some of their basic daily needs. 9 patients (2.2%) were hospitalised due to sepsis. 131 patients (32.4%) required additional oral analgesia following TRUSBx on days 0, 1 and 2. These patients were generally younger with a mean age for this group of 63.6 years (46-88). The difference in the mean age between those self-medicating and not was not statistically significant (p > 0.005). This group had mean VAS during the procedure of 4 and when patients reached home was 3.5. Mean maximum VAS on day 1 and 2 was 2.1 and 1.3 respectively. 11 patients required assistance from another adult. Conclusion A third of patients required self-medicated analgesia post-procedure. Age alone cannot be used as a criterion to identify patients who will subsequently require analgesia post-procedure, but a higher VAS during the procedure may be indicative. These patients must be counselled appropriately. .

The application of ultrasound visualization in instantly evaluation and supplement therapeutics in the treatment of uterine fibroids and adenomyosis with HIFU / 重庆医学

Objective To investigate the application of ultrasound visualization in instantly evaluation and supplement therapeu-tics in the treatment of uterine fibroids and adenomyosis with high intensity focused ultrasound (HIFU ) .Methods 57 patients with 67 uterine fibroids and 31 patients with 41 adenomyosis were treated with JC-200 HIFU treatment system and monitored the blood flow change in the lesion with B-ultrasound .Evaluated the curative effect with ablation ratio and ablation ratio after supplement therapeutics .Results The average ablation ratio of 57 uterine fibroids was(84 .6 ± 16 .1)% and the increased to(87 .0 ± 10 .7)% af-ter supplement therapeutics to 9 lesions with blood flow in the border of all .The changes were no significance(P>0 .05) .The aver-age ablation ratio of 31 adenomyosis was(62 ± 22 .7)% and increased to(74 ± 14 .7)% after supplement therapeutics to 11 lesions with blood flow in the border of all .The changes were statically significance(P<0 .05) .Conclusion Ultrasound visualization could be used to evaluate the area and extent of ablation with HIFU therapy ,it can clear lesions remaining parts and guiding the supple-ment therapeutics to improve the ablation ratio .Ultrasound visualization provided an evidence of therapeutics in the early period .

Localized scleroderma: assessment of the therapeutic response to phototherapy / Esclerodermia cutânea: avaliação da resposta terapêutica à fototerapia

BACKGROUND: Scleroderma is a chronic autoimmune disease characterized by progressive connective tissue sclerosis and microcirculatory changes. Localized scleroderma is considered a limited disease. However, in some cases atrophic and deforming lesions may be observed that hinder the normal development. Literature reports indicate phototherapy as a therapeutic modality with favorable response in cutaneous forms of scleroderma. OBJECTIVES: This study had the purpose of assessing the phototherapy treatment for localized scleroderma. METHODS: Patients with localized scleroderma were selected for phototherapy treatment. They were classified according to the type of localized scleroderma and evolutive stage of the lesions. Clinical examination and skin ultrasound were used to demonstrate the results thus obtained. RESULTS: Some clinical improvement was observed after an average of 10 phototherapeutic sessions. All skin lesions were softer at clinical palpation with scores reduction upon pre and post treatment comparison. The ultrasound showed that most of the assessed lesions presented a decrease in dermal thickness, and only five maintained their previous measure. Treatment response was similar regardless of the type of phototherapeutic treatment employed. CONCLUSIONS: The proposed treatment was effective for all lesions, regardless of the phototherapeutic modality employed. The improvement was observed in all treated skin lesions and confirmed by clinical evaluation and skin ultrasound.

FUNDAMENTOS: A esclerodermia é uma doença autoimune caracterizada pela esclerose progressiva do tecido conjuntivo e alterações da microcirculação. A forma cutânea é considerada uma doença autolimitada. No entanto, em alguns casos, ocorrem lesões atróficas, deformantes, que dificultam o desenvolvimento normal. Relatos da literatura apontam a fototerapia como uma modalidade terapêutica com resposta favorável nas formas cutâneas da esclerodermia. OBJETIVOS: Este trabalho teve como objetivo avaliar o tratamento da esclerodermia cutânea com fototerapia. MÉTODOS: Foram selecionados pacientes com diagnóstico de esclerodermia cutânea para o tratamento com fototerapia, os quais foram classificados de acordo com o tipo clínico e o estágio evolutivo das lesões. Utilizou-se o exame clínico e a ultrassonografia da pele como metodologia para demonstrar os resultados obtidos com o tratamento proposto. RESULTADOS: Foi observado o início da melhora clínica das lesões com média de 10 sessões de fototerapia. A palpação clínica mostrou amolecimento em todas as lesões estudadas, com redução nos escores de avaliação estabelecidos. No exame de ultrassom, a maioria das lesões avaliadas mostrou diminuição da espessura da derme, e apenas cinco mantiveram sua medida. Não se observou diferença na resposta ao tratamento de acordo com o tipo de fototerapia instituída. CONCLUSÕES: O tratamento proposto foi efetivo em todas as lesões, independentemente do tipo de fototerapia realizada. A melhora foi observada em todas as lesões tratadas e comprovada pela avaliação clínica e pelo exame de ultrassom da pele.

High-frequency ultrasound guided paracentesis for the treatment of perianal and perirectal abscess / 中国介入影像与治疗学

Objective To explore the method and therapeutic effect of high-frequency ultrasound guided paracentesis for the treatment of perirectal abscess.Methods Thirty-three patients with perirectal abscess were treated under the guidance of high-frequency ultrasound.Results All 33 patients were treated successfully,the curative rate was 100%.Six patients were treated 3 times,6 patients were treated twice and 21 patients were treated once.Conclusion High-frequency ultrasound guided paracentesis for the treatment of perirectal abscess has the superiorities of little distress,rapid therapeutic effect without complications,worthy Of further clinical application.

Avaliação de morfologia e histologia endometrial de mulheres após a menopausa / Assessment of endometrial morphology and histology in postmenopausal women

OBJETIVO: Avaliar ambulatorialmente a morfologia e histologia endometrial de mulheres sem sangramento genital após a menopausa. MÉTODOS: Em estudo descritivo foram selecionadas 52 mulheres, após a menopausa, entre 50 e 60 anos, sem terapia hormonal nos últimos seis meses. Todas foram submetidas a exame ultrassonográfico, histeroscópico e biópsias endometriais. RESULTADOS: Das 52 mulheres selecionadas 32 (61,5 por cento) apresentaram ultrassonografia normal, cavidade uterina normal com endométrio atrófico à histeroscopia, confirmada pela biópsia endometrial. Vinte (38,4 por cento) apresentaram achados histeroscópicos ou histológicos anormais, sendo que apenas cinco destas mostraram endométrio com espessura superior a cinco milímetros ao ultrassom. CONCLUSÃO: A histeroscopia diagnóstica associada à biópsia aspirativa (Pipelle) pode evidenciar alterações não observadas ao ultrassom transvaginal.

OBJECTIVE: Evaluate in outpatients , the endometrial morphology and histology of non- bleeding postmenopausal women. METHODS: We conducted a descriptive study where 52 menopausal women were selected, between 50 and 60 years of age, who had not used hormone replacement therapy in the last six months and did not present any kind of vaginal bleeding after menopause. These women underwent ultrasound examination, hysteroscopy and biopsy, and then endometrial findings were analyzed. RESULTS: Of the 52 women selected, thirty two (61,5 percent) had normal ultrasound, normal uterine cavity with atrophic endometrium, hysteroscopy, confirmed by endometrial biopsy. Twenty (38,4 percent) had hysteroscopuc and histologic alterations and only five women showed by ultrasound an endometrial thickness of more than five millimeters. CONCLUSION: Diagnostic Hysteroscopy associated with aspiration biopsy (Pipelle) performed in the day care facility can reveal endometrial alterations that cannot be diagnosed by transvaginal ultrasound.

Evaluate the effectiveness of the treatment of high risk benign prostatic hyperplasia with transrectal high-intensity focused ultrasound by urodynamic test / 中国医师进修杂志

Objective To evaluate the effectiveness of the treatment of high risk benign prostatic hyperplasia (BPH) with transrectal high-intensity focused ultrasound (TR-HIFU) by urodynamic test. Methods One hundred and thirty patients with BPH, most of who suffering with diabetes mellitus,cardio-cerebrovascular disease, respiratory disease. All patients were given the operation with Sonablate-500 high-intensity focused ultrasound (HIFU). International prostate symptom score (IPSS), quality of life (QOL), maximum urinary flow rate (Qmax), post void residual urine volume (PVR), pressure-flow tests (A-G) were employed for the evaluation of curatives effect on preoperation, 30th and 90th day after the treatment. Results The duration of the TR-HIFU prostate ablation treatment was 15-85 rain. One hundred and seven patients after treatment were followed up for 3 months. Compared the effect before treatment with that after treatment, IPSS improved from (27.0 ±11.5) scores to (8.5±1.4) scores, Qmax increased from (5.7±2.3) ml/s to (14.1±4.2) ml/s, PVR decreased from (118.5±78.0) ml to (30.0±15.0) mI,A-G parameters reduced from 62.4±19.3 to 25.6±13.0 and urine volume (VV) increased from (85.8 + 42.0) ml to (194.0±52.0) ml. The parameters all altered obviously (P < 0.05). Conclusions TR-HIFU appears highly attractive as a new optional, safe and efficacious and minimally invasive treatment for the high risk BPH. Main post-operative urodynamie parameters are more obviously improved than those of the preoperation.

Clinical study of HIFU combined with transcatheter arterial chemoembolization in treatment of 56cases of primary liver cancer / 肿瘤研究与临床

Objective To explore the clinical effect of high intensity focused ultrasound(HIFU)combined with transcatheter arterial chemoembolization(TACE)in the treatment of primary liver cancer.Methods A total of 106 patients with primary liver cancer were divided into two groups:50 cases were treated with TACE,and the other 56 were treated with combination of HIFU and TACE.The changes of AFP levels and the size of tumors after three months treatment were analyzed and compared with each other.The survival rates for one,two and three years were calculated with Kaplan-Meier method and compared between the two groups.Results In the two groups,AFP decreased significantly after treatment,but the combined group was superior to the other in AFP decrease.In the combined group,the 1-,2-and 3-year survival rates were higher than those in the TACE group with 82.3%,60.8%and 39.2% vs 68.0%,42.6%and 21.0%respectively(P＜0.01).No serious complications were seen,such as burn of skin,bleeding,gastrointestinal perforation. Conclusion The use of HIFU combined with TACE in the treatment of patients with primary liver cancers is feasible and safe.The combined group is superior to simple TACE for the management of primary liver cancers,and the former is more effective in decreasing AFP level and improving survival rates.

High intensity focused ultrasound is treatment of 14 hepatic metastases from colorectal cancer / 肿瘤研究与临床

Objective To evaluate the clinical safety and efficacy of HIFU treatment of hepatic metastases from colorectal cancer.Methods 20 tumor lesions in 14 patients with hepatic metastases from colonectal cancer were treated with HIFU therapy.The vital signs,main organs'functions,examination of MRI and complications were observed.Results Vital signs of all the 14 patients were stable.The function of liver and kidney were normal and life quality were improved with elevation of Karnofsky in 5 patients.On MRI examination,the MRI signals of treating area of 20 tumor lesion in 14 patients decreased remarkably with disappearance of blood supply and a thin layer of edematous intensified zone was detected on the margin of lesion.6 patients were found to have cord-like burning scar on skin.Conclusion HIFU treatment is safe and effective in treatment of hepatic metastases from colorectal cancer.