Research progress on the treatment of gingival pigmentation / 口腔疾病防治

@#Gingival pigmentation is a nonplaque gum disease. Patients are often afraid to communicate with others because of gum color problems, which affect the social and mental health of patients. The commonly used treatment methods for gingival pigmentation include scalpel excision, gingival grinding, laser therapy, cryosurgery and electrosurgery. In this paper, the progress of gingival pigmentation treatment was reviewed in terms of bleeding, pain, tissue healing and recoloring. The results showed that the clinical effect of laser treatment was better. Among them, the semiconductor laser had more advantages in reducing bleeding, pain and the restaining rate, while the Er:Cr:YSSG/Er:YAG laser performed better for promoting tissue healing. Clinicians can choose the best kind of laser to use according to the actual situation. For patients with thin gingival biotypes, floating gingival transplantation or substitute materials can be selected to restore the gingival morphology. With the in-depth study of melanin regulation mechanisms, various drugs, such as ascorbic acid, natural peptides, synthetic peptides and derivatives, may be the main research direction for the treatment of gingival pigmentation in the future.

Crioterapia en pacientes geriátricos con estomatitis subprótesis

Introducción: En la actualidad se emplean nuevas alternativas no invasivas para la remoción de diversos procesos inflamatorios del epitelio mucoso bucal, siendo la crioterapia una técnica fisioterapéutica basada en la aplicación del frío intenso con nitrógeno líquido para producir en la piel o mucosas del organismo una congelación y destrucción local de células y tejidos afectados de forma controlada. Objetivo: Evaluar los efectos terapéuticos de la criocirugía en pacientes geriátricos portadores de estomatitis subprótesis. Métodos: Se efectuó un estudio descriptivo y transversal de 50 pacientes adultos mayores, de ambos sexos, diagnosticados con estomatitis subprótesis y asistidos en la consulta estomatológica del Policlínico de Especialidades referente al Hospital Clinicoquirúrgico Universitario Saturnino Lora Torres de la provincia Santiago de Cuba, en el periodo comprendido desde marzo de 2022 hasta igual mes de 2023. Resultados: Se evidenció que las congelaciones entre 20 y 30 segundos y los deshielos entre 91 y 120 segundos fueron los más eficaces en la destrucción de la mucosa palatina dañada, logrando la regeneración tisular en un tiempo mínimo con la indicación de uno a tres ciclos de enfriamientos rápidos y deshielos lentos en una sesión terapéutica. La ausencia de síntomas fue lo más relevante en la evolución postquirúrgica. Conclusiones: La crioterapia demostró ser un método eficaz e inocuo para regenerar los tejidos lesionados al realizar congelaciones rápidas con deshielos lentos. Este método crioquirúrgico, fácil de aplicar y atraumático, logró una óptima reparación y reepitelización de los tejidos bucales dañados con excelentes respuestas terapéuticas, evitando complicaciones postquirúrgicas como la infección y el sangramiento local.

Introduction: At present, new non-invasive alternatives are used for the removal of various inflammatory processes of the oral mucous epithelium; being cryotherapy a physiotherapeutic technique based on the application of intense cold with liquid nitrogen to produce freezing on the skin or mucous membranes of the organism and local destruction of affected cells and tissues in controlled manner. Objective: To evaluate the therapeutic effects of cryotherapy in geriatric patients with sub-prosthesis stomatitis. Methods: A descriptive and cross-sectional study of 50 older adult patients, of both sexes, clinically diagnosed with subprosthesis stomatitis and assisted in the dentistry consultation of the Specialties Polyclinic referring to the Saturnino Lora Torres University Clinical Surgical Hospital in the city of Santiago de Cuba, in the period from March 2022 to the same month of 2023. Results: It was evidenced that freezing between 20 and 30 seconds and thawing between 91 and 120 seconds were the most effective in the destruction of the damaged palatal mucosa, achieving tissue regeneration in a minimum time with the performance of 1 to 3 cycles of rapid cooling and slow thawing in a therapeutic session. The absence of symptoms was the most relevant in the post-surgical evolution. Conclusions: Cryotherapy proved to be an effective and innocuous method to regenerate injured tissues when fast freezing with slow thawing. This cryosurgical method, easy to apply and atraumatic, achieved optimal repair and re-epithelization of damaged oral tissues with excellent therapeutic responses, avoiding post-surgical complications such as infection and local bleeding.

Tratamento bem-sucedido da cromoblastomicose pela associação entre criocirurgia e itraconazol em dose baixa / Successful treatment of chromoblastomycosis by the combination of cryosurgery with low-dose itraconazole

Cromoblastomicose é uma infecção granulomatosa crônica causada por fungos dematiáceos, com apresentações clínicas variadas, que podem representar um desafio terapêutico. Neste relato, apresentamos um caso de cromoblastomicose em forma localizada, de longa evolução, em paciente idoso, resistente a terapêuticas medicamentosas prévias, tratado com sucesso pela associação entre um método físico e tratamento farmacológico sistêmico, o que permitiu o uso de dose reduzida do medicamento.

Chromoblastomycosis is a chronic granulomatous infection caused by dematiaceous fungi with varied clinical presentations, which may represent a therapeutic challenge. In this report, we present a case of chromoblastomycosis in a localized form, with a long evolution, in an elderly patient, resistant to previous drug therapies, successfully treated by the association of a physical method with systemic pharmacological treatment, which allowed the use of a reduced dose of the drug

Comparative Evaluation of Clinical Efficacy of Diode LASER and Cryosurgery for Gingival Pigmentation: A Split-Mouth Randomized Clinical Study

ABSTRACT Objective: To compare and evaluate the clinical efficacy of diode laser and cryosurgery for treating melanin pigmentation of gingiva. Material and Methods: A total of twenty-five subjects with physiological gingival pigmentation on the facial aspect of both maxillary and mandibular anterior arches (50 sites), both male and female, with an average age ranging from 18-35 years, participated in the study. The sites were randomly divided into Group I: depigmentation by Laser and Group II: depigmentation by Cryosurgery. The following parameters were assessed for the evaluation of treatment results: Melanin Oral Pigmentation Index (PI), Visual Analogue Scale (VAS) for pain evaluation and Healing index (HI). The data collected was statistically evaluated. Results: On intergroup comparison, there was no statistical difference in the score from baseline (p>0.05); however, a statistically significant difference was seen at the end of 1 year (p<0.05). Moreover, 57-60% of arches showed recurrence of pigmentation in the laser group whereas; only 12.7-17% recurrence was seen in the cryosurgery group at the end of the first year. Conclusion: Treatment of gingival hyperpigmentation with laser and cryosurgery shows a marked improvement of gingival pigmentation in both groups, but the cryosurgery depigmentation sites showed more sustainability.

Impacto Terapêutico da Associação do Uso de Imiquimode e Criocirurgia no Tratamento de Verrugas Subungueais e Periungueais: Relato de Caso / Therapeutic Impact of the Association of Imiquimod Use and Cryosurgery in the Treatment of Subungual and Periungual Warts: Case Report

Introdução: Habitualmente, as verrugas virais são causadas pelo papilomavírus humano (HPV) e, embora tenham tendência à resolu- ção espontânea, quando crônicas, conferem resistência terapêutica. Objetivo: Divulgar um caso de sucesso terapêutico da associação do uso de imiquimode e criocirurgia para verrugas virais periungueais e subungueais. Relato do caso: O relato é de um homem de 56 anos, com cinco anos de evolução de verrugas subungueais e periungueais distribuídas na maioria dos dedos das mãos. Anteriormente, foi tratado com antifúngicos pelo resultado micológico, sem sucesso. Foi submetido à biópsia subungueal, cujo anatomopatológico confirmou verruga plana. Foi proposto o tratamento combinado de imiquimode creme 5% e criocirurgia. Evoluiu com resolução completa das lesões virais. Conclusão: Os autores demonstram a importância dos achados anatomopatológicos no diagnóstico de verrugas virais recalcitrantes, bem como é ressaltada a eficácia da associação do uso de imiquimode e criocirurgia.

Introduction: Viral warts are usually caused by the human papillomavirus (HPV), and although they tend to resolve spontaneously, when chronic, they confer therapeutic resistance. Aim: To report a case of therapeutic success of imiquimod and cryosurgery combination for periungual and subungual viral warts. Case Report: The report is of a 56-year-old man with five years of evolution of subungual and periungual warts distributed on most fingers of the hands. Previously, he received treatment with antifungal drugs due to the mycological result, but it was unsuccessful. He underwent a subungual biopsy, whose pathology confirmed the flat wart. A combined treatment of imiquimod cream 5% and cryosurgery was proposed. The patient evolved with complete resolution of the viral lesions. Conclusion: The authors demonstrate the importance of pathological findings in the diagnosis of recalcitrant viral warts, as well as the efficacy of the association of imiquimod and cryosurgery.

Sporotrichosis refractory to conventional treatment: therapeutic success with potassium iodide

Abstract Sporotrichosis is a subcutaneous mycosis caused by dimorphic fungi of the genus Sporothrix. The authors report a case of fixed cutaneous sporotrichosis with therapeutic failure after 18 months of itraconazole and terbinafine associated with cryosurgery. The patient was cured after the introduction of saturated potassium iodide solution. Sporothrix brasiliensis was the identified species, presenting a susceptibility profile to itraconazole and terbinafine. This fact suggests that therapeutic failure is probably related to the host-fungus interaction rather than drug resistance. It is possible that the immunomodulatory action of the saturated potassium iodide solution may have played an important role in curing this patient.

Criocirurgia com nitrogênio líquido versus ácido tricloroacético no tratamento de verruga peniana por papilomavírus humano (HPV): um ensaio clínico randomizado / Cryosurgery with liquid nitrogen versus trichloroacetic acid in the treatment of human papillomavirus (HPV) penile wart: a randomized controlled trial

Introdução: verrugas anogenitais são a infecção sexualmente transmissível prevalente (0,5%) entre atendimentos dermatológicos. Dentre as estratégias de tratamento, destacam-se a crioterapia com nitrogênio líquido (NL) e causoterapia com ácido tricloroacético (ATA). Objetivo: avaliar a eficácia do NL versus ATA no tratamento de verrugas penianas em pacientes de instituição pública brasileira. Métodos: ensaio clínico aberto, paralelo e randomizado. Em cada visita, as verrugas foram contadas e submetidas à crioterapia (10s) ou à causoterapia (ATA 80%), após randomização. A principal variável dependente foi a contagem de lesões antes e após quatro semanas de tratamento. Foram analisados: eliminação completa, idade, imunossupressão, tabagismo, topografia e escolaridade. Resultados: foram avaliados 142 tratamentos em 52 participantes. Houve predominância de adultos jovens, menor escolaridade, e a principal topografia afetada foi a haste. A redução percentual média por sessão foi 48% para o NL e 26% para o ATA (p=0,11). Clearance completo foi atingido por 42 (81%) participantes, sendo que 39 (75%; IC95%: 64-85%) atingiram o clearance em até três sessões. A idade associou-se à pior taxa de resposta terapêutica (ß=-0,09; p<0,01). Conclusões: NL e ATA mostraram-se eficazes na terapêutica das verrugas penianas, sem diferença entre os tratamentos. A idade foi associada à pior resposta terapêutica.

Background: Anogenital warts are the most prevalent sexually transmitted infection (0.5%) among dermatological consultations. Cryotherapy with liquid nitrogen (LN) and therapy with trichloroacetic acid (TCA) are remarkable among the treatment strategies. Objective: To evaluate the effectiveness of LN versus TCA in to treat penile warts in patients from a Brazilian public institution. Methods: Open, parallel, randomized clinical trial. Following randomization, the warts were counted and submitted to cryotherapy (10s) or case therapy (TCA 80%) in each visit. The primary dependent variable was the lesion count before and after four weeks of treatment. We assessed the following variables: complete clearance, age, immunosuppression, smoking, topography, and education. Results: 142 treatments were evaluated in 52 participants. There was a predominance of young adults, and the main topography affected was the penis shaft. The mean reduction rate per session was 48% for LN and 26% for TCA (p=0.11). 42 (81%) participants achieved complete clearance, with 39 (75%; 95% CI: 64-85%) reaching clearance in up to three sessions. Age was associated with a worse therapeutic response rate (ß =-0.09; p<0.01). Conclusions: LN and TCA proved to be effective to treat penile warts, without difference between treatments. Age was associated with a worse therapeutic response

Translational Approach for Percutaneous Interventions for the Treatment of Cardiac Arrhythmias

Abstract New translational concepts on cellular and tissue substrate of cardiac arrhythmias have been responsible for the development of non-pharmacological interventions, with important achievements compared to the conventional approach with antiarrhythmic drugs. In addition, the increasing knowledge of anatomical and electrophysiological studies, sophisticated mapping methods, special catheters, and controlled clinical trials have favored the progression of ablation of tachyarrhythmias, particularly of ventricular tachyarrhythmias and atrial fibrillation.

Células-tronco mesenquimais de origem adiposa na fase de proliferação do processo de cicatrização de queimaduras frias / Adipose-derived stem cells in the proliferation phase of the healing process in cold burns

A criocirurgia tem sido utilizada no tratamento de diferentes enfermidades de sistemas e órgãos. Contudo, são relatados efeitos adversos, como cicatrização lenta, cicatrizes extensas, disfunção estética e funcional. As lesões que ocorrem naturalmente pela exposição ao frio extremo, comumente, resultam em gangrena. O presente trabalho teve como objetivo avaliar a influência das células-tronco mesenquimais de origem adiposa (ADSCs) na fase de proliferação da cicatrização de feridas cutâneas. Por meio da aplicação do nitrogênio líquido pela técnica do spray aberto, realizou-se a indução de uma ferida, de aproximadamente 15mm de diâmetro, na região dorsal de cada rato. A ferida recebeu o tratamento de acordo com o grupo ao qual pertencia: 1) aplicação das ADSCs no 15º dia (grupo tratado); 2) aplicação da solução cloreto de sódio 0,9% no 15º dia (grupo sham); 3) nenhuma intervenção até o momento da eutanásia (grupo controle). O grupo tratado com as ADSCs apresentou as maiores taxas de contração média das feridas e obteve diferença estatisticamente significativa em relação ao grupo sham quanto à neovascularização. A terapia com as ADSCs proporcionou uma relevante evolução clínica das feridas, podendo ser constatada ao final do período de avaliação por cicatrizes mais estreitas e compridas.(AU)

Cryosurgery has been used to treat different diseases of systems and organs, although adverse effects have been reported such as delayed wound healing, large scars, esthetical deformation and functional impairment. Injuries caused naturally by the exposure to extreme cold weather conditions mostly result in gangrene. This study aims to evaluate the influence of adipose-derived stem cells (ADSCs) in the proliferation phase on cutaneous wound healing. Through the application of liquid nitrogen by the spraying technique, a 15 millimeter diameter lesion was produced in the dorsal region of each rat. The wound received treatment according to the group it belonged: 1) ADSCs application on the 15th day (treated group); 2) application of 0.9% sodium chloride solution on the 15th day (sham group); 3) no intervention until euthanasia (control group). The group treated with ADSCs showed the highest wound average contraction rate; this group got a significant statistical difference in relation to the sham group when it refers to neovascularization. The ADSCs therapy provides an important clinical evolution of wounds. This was verified at the end of the evaluation period through narrower and longer scars.(AU)

Criocirurgia intralesional em lesões vasculares benignas: boa opção para angioma rubi e hamartomas sobre mancha vinho do Porto / Intralesional cryosurgery in benign vascular lesions: a good option for cherry angioma and hamartomas over port-wine stain

A criocirurgia é uma técnica de vasto conhecimento e uso entre dermatologistas. A aplicação intralesional já é utilizada no tratamento de queloides e tem como vantagem restringir a zona de ação das baixas temperaturas do nitrogênio líquido. O uso da criocirurgia de contato em lesões vasculares é relatado, mas não há publicações sobre a técnica intralesional nesses tipos de lesões. Aqui, relatamos dois casos: 1- Hamartomas sobre mancha vinho do Porto em um paciente de 61 anos; e 2 - Angioma rubi em um paciente de 70 anos, ambos tratados de forma satisfatória e segura com criocirurgia intralesional.

Cryosurgery is a technique widely known and used among dermatologists. Intralesional application is already used to treat keloids and has the advantage of restricting the zone of action of low temperatures of liquid nitrogen. The use of contact cryosurgery in vascular lesions is well reported in the literature, but there are no intralesional technique publications on these types of lesions. Here, we report two cases, one of port-wine stain hamartomas in a 61-year-old patient and another of a cherry angioma in a 70-year-old patient, safely and satisfactorily treated with intralesional cryosurgery

Comparison of the effect of traditional hysteroscopy and HEOS system hysteroscopy in the treatment of refractory intrauterine residual / 中国基层医药

Objective@#To compare the clinical effects of conventional hysteroscopy and HEOS hysteroscopy in the treatment of refractory intrauterine residuals.@*Methods@#From January 2017 to February 2019, 60 patients with refractory intrauterine pregnancy residuals admitted to the Integrated Traditional Chinese and Western Medicine Hospital of Wenzhou were randomly selected.The patients were divided into traditional endoscopy group and HEOS system endoscope group according to the different operation method, with 30 cases in each group.The operation time, intraoperative blood loss, hospitalization cost, postoperative uterine adhesion rate, postoperative menstrual recovery time, postoperative recovery rate of endometrium at the first, second and third month after operation were compared between the two groups.@*Results@#The operation time of the conventional laparoscopic group was (24.38±3.16)min, which was longer than that of the HEOS system hysteroscopy group[(18.71±3.32)min](t=1.336, P=0.027). The intraoperative blood loss of the conventional laparoscopic group was (18.41±4.35)mL, which was higher than that of the HEOS system hysteroscopy group[(12.81±3.84)mL](t=1.853, P=0.031). The hospitalization cost of the conventional laparoscopic group was (7 461.87±344.92)CNY, which was more than that of the HEOS system hysteroscopy group[(6 743.19±298.52)CNY](t=0.037, P=0.040). In addition, the uterine adhesion rate in the traditional hysteroscopic group was 20.00%(6/30), which was higher than that in the HEOS system hysteroscopy group[6.67%(2/30)](χ2=2.308, P=0.029), and the postoperative menstrual recovery time in the traditional hysteroscopic group was (31.46±4.12)d, which was longer than that in the HEOS system hysteroscopy group[(26.18±3.72)d](t=1.730, P=0.026). At the first, second and third month after operation, the good endometrial recovery rates in the traditional laparoscopic group were 20.00%(6/30), 43.33%(13/30), 63.33%(19/30), respectively, which were lower than those in the HEOS system hysteroscopy group[46.67%(14/30), 70.00%(21/30), 93.33%(28/30)](χ2=4.800, 4.344, 7.954, P=0.028, 0.037, 0.005).@*Conclusion@#HEOS system endoscope in the treatment of refractory intrauterine residual has good effect and is worthy of promoting.

Comparison of the effect of traditional hysteroscopy and HEOS system hysteroscopy in the treatment of refractory intrauterine residual / 中国基层医药

Objective To compare the clinical effects of conventional hysteroscopy and HEOS hysteroscopy in the treatment of refractory intrauterine residuals.Methods From January 2017 to February 2019,60 patients with refractory intrauterine pregnancy residuals admitted to the Integrated Traditional Chinese and Western MedicineHospital of Wenzhou were randomly selected .The patients were divided into traditional endoscopy group and HEOS system endoscope group according to the different operation method ,with 30 cases in each group.The operation time, intraoperative blood loss , hospitalization cost , postoperative uterine adhesion rate , postoperative menstrual recovery time,postoperative recovery rate of endometrium at the first ,second and third month after operation were compared between the two groups.Results The operation time of the conventional laparoscopic group was (24.38 ±3.16)min, which was longer than that of the HEOS system hysteroscopy group [(18.71 ±3.32)min](t=1.336,P=0.027). The intraoperative blood loss of the conventional laparoscopic group was (18.41 ±4.35) mL,which was higher than that of the HEOS system hysteroscopy group[(12.81 ±3.84)mL](t=1.853,P=0.031).The hospitalization cost of the conventional laparoscopic group was (7461.87 ±344.92) CNY,which was more than that of the HEOS system hysteroscopy group[(6743.19 ±298.52)CNY](t=0.037,P=0.040).In addition,the uterine adhesion rate in the traditional hysteroscopic group was 20.00％( 6/30 ) , which was higher than that in the HEOS system hysteroscopy group[6.67％(2/30)] (χ2 =2.308,P=0.029),and the postoperative menstrual recovery time in the traditional hysteroscopic group was ( 31.46 ±4.12 ) d, which was longer than that in the HEOS system hysteroscopy group [(26.18 ±3.72)d](t=1.730,P=0.026).At the first,second and third month after operation ,the good endometrial recovery rates in the traditional laparoscopic group were 20.00％(6/30),43.33％(13/30),63.33％(19/30), respectively,which were lower than those in the HEOS system hysteroscopy group [46.67％(14/30),70.00％(21/30),93.33％(28/30)](χ2 =4.800,4.344,7.954,P =0.028,0.037,0.005).Conclusion HEOS system endoscope in the treatment of refractory intrauterine residual has good effect and is worthy of promoting .

The factors affecting rhythm control for cryoablation of atrial fibrillation in mitral valve surgery

Abstract Objective: To evaluate the factors impacting on the conversion to sinus rhythm and on the postoperative rhythm findings in the six-month follow-up period of a mitral valve surgery combined with cryoablation Cox-Maze III procedure, in patients with atrial fibrillation. Methods: In this study, we evaluated 80 patients who underwent structural valve disease surgery in combination with cryoablation. Indications for the surgical procedures were determined in the patients according to the presence of rheumatic or non-rheumatic structural disorders in the mitral valve as evaluated by echocardiography. Cox-Maze III procedure and left atrial appendix closure were applied. Results: The results of receiver operating characteristics analysis indicated that the rate of conversion to the sinus rhythm was significantly higher in patients with left atrial diameters ≥ 45.5 mm and with ejection fraction (EF) ≥ 48.5%. However, the statistical differences disappeared in the sixth month. Thromboembolic (TE) events were seen only in three patients in the early period and no more TE events occurred in the six-month follow-up period. Conclusion: The EF and the preoperative left atrial diameter were determined to be the factors impacting on the conversion to sinus rhythm in patients who underwent mitral valve surgery in combination with cryoablation. Mitral valve surgery in combination with ablation for atrial fibrillation does not affect mortality and morbidity in the experienced health centers; however, it remains controversial whether it will provide additional health benefits to the patients compared to those who underwent only mitral valve surgery.

18F-FDG PET/CT performed immediately after percutaneous ablation to evaluate outcomes of the procedure: preliminary results / 18F-FDG PET/CT realizada imediatamente após ablação percutânea para avaliar os desfechos do procedimento: resultados preliminares

Abstract Objective: To determine whether 18F-fluorodeoxyglucose positron emission tomography/computed tomography performed immediately after percutaneous ablation (iPA18F-FDG PET/CT) is useful in evaluating the outcomes of the procedure. Materials and Methods: This was a retrospective study of 20 patients (13 males, 7 females; mean age, 65.8 ± 12.1 years) submitted to percutaneous ablation of metastases. All of the lesions treated had shown focal uptake on a 18F-FDG PET/CT scan obtained at baseline. The primary tumors were mainly colorectal cancer (in 45%) or lung cancer (in 40%). iPA18F-FDG PET/CT was performed to identify any residual viable tumor cells. The treatment was considered a success (no viable tumor cells present) if no uptake of 18F-FDG was noted on the iPA18F-FDG PET/CT scan. Results: Twenty-six lesions were submitted to percutaneous ablation with either cryoablation (n = 7) or radiofrequency ablation (n = 19). The mean lesion diameter was 2.52 ± 1.49 cm. For the detection of viable tumor cells, iPA18F-FDG PET/CT had a sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 66.7%, 95%, 88.5%, 80%, and 90.5%, respectively. There was a significant correlation between the iPA18F-FDG PET/CT findings and the results of the follow-up studies (kappa = 0.66; p < 0.01). Conclusion: iPA18F-FDG PET/CT studies appear to constitute a useful means of evaluating the outcomes of percutaneous ablation. By detecting residual viable tumor cells, this strategy might allow early re-intervention, thus reducing morbidity. Studies involving larger numbers of patients are needed in order to confirm our findings.

Resumo Objetivo: Demonstrar se a tomografia por emissão de pósitrons acoplada a tomografia computadorizada usando-se fluorodesoxiglicose marcada com flúor-18 realizada imediatamente após ablação percutânea (iAP18F-FDG PET/CT) pode ser útil na avaliação do resultado desse tratamento. Materiais e Métodos: Foram avaliados, retrospectivamente, 20 pacientes (13 homens e 7 mulheres; média de idade: 65,8 ± 12,1 anos) submetidos a ablação percutânea de metástases apresentando captação de 18F-FDG no exame de PET/CT. Os tumores primários foram, principalmente, câncer colorretal (45%) ou câncer de pulmão (40%). A iAP18F-FDG PET/CT foi realizada para avaliar tumor residual viável. O tratamento foi considerado sucesso (sem lesão viável) se nenhuma captação de 18F-FDG fosse observada na iAP18F-FDG PET/CT. Resultados: Vinte e seis lesões foram submetidas a ablação percutânea por meio de crioablação (n = 7) ou radiofrequência (n = 19). O tamanho médio das lesões era de 2,52 ± 1,49 cm. A iAP18F-FDG PET/CT detectou tumor viável com sensibilidade, especificidade, acurácia, valor preditivo positivo e valor preditivo negativo de 66,7%, 95%, 88,5%, 80% e 90,5%, respectivamente. Houve correlação significativa entre os achados da iAP18F-FDG PET/CT e os resultados do seguimento clínico dos pacientes (kappa = 0,66; p < 0,01). Conclusão: A iAP18F-FDG PET/CT é capaz de avaliar o resultado da ablação percutânea e poderá permitir reintervenção precoce de lesões residuais viáveis, reduzindo a morbidade. Um número maior de pacientes é necessário para confirmar esses achados.

Criobiópsia na prática dermatológica / Cryobiopsy in dermatological practice

biópsia de pele é ferramenta propedêutica importante e indispensável para o médico dermatologista. O método convencional de biópsia, com a utilização de anestésicos locais, campos estéreis, instrumental cirúrgico (punch, bisturi, pinças, tesoura) e fios de sutura, exige equipe, tempo e considerável investimento financeiro. A criobiópsia é método simples, que, por meio do criocautério, faz a extração de fragmentos de pele de boa qualidade para análise histopatológica, o que a torna excelente alternativa às biópsias convencionais.

Skin biopsy is an important introductory tool and also essential for the dermatologist. The conventional biopsy method, with the use of local anesthetics, sterile fields, surgical instruments (punch, scalpel, forceps, scissors) and suture material demand staff, time and considerable financial investment. Criobiopsy is a simple method, where by using the cryocautery an extraction of good quality skin fragments is made for histopathologic analysis, making it an excellent alternative to the conventional biopsies.

Effect of radiofrequency ablation of low temperature plasma knife in the treatment of 32 cases of early glottal carcinoma / 中国基层医药

Objective@#To investigate the effect and recurrence rate of radiofrequency ablation of low temperature plasma knife in the treatment of patients with early glottal carcinoma.@*Methods@#A total of 64 cases of early glottic carcinoma in the People's Hospital of Shanxi Province from February 2012 to January 2016 were divided into observation group and control group according to the different treatment schemes, with 32 cases in each group.The observation group was treated with radiofrequency ablation of low temperature plasma knife, and the control group was performed with routine larynx cleft surgery.The surgical related indicators and postoperative complications of the two groups were recorded.The phonetic changes (amplitude perturbation, fundamental frequency perturbation and harmonic noise ratio) before and 6 months after operation of two groups were compared.After 2 years of follow-up, the recovery of vocal mucosa in the two groups after 1 year of operation and the recurrence rate of 6 months, 1 year and 2 years after operation of the two groups were statistically recorded.@*Results@#The intraoperative blood loss in the observation group was less than that in the control group(P<0.05), and the operative time and hospital stay observation time in the observation group were shorter than those in the control group(all P<0.05). The incidence rate of postoperative complications in the observation group [9.38% (3/32)] was lower than that in the control group[31.25%(10/32)], and the smoothness rate of the vocal cords at 1 year after operation in the observation group [90.63% (29/32)] was higher than that in the control group[62.50%(20/32)], the difference were statistically significant(χ2=4.730, 7.053, all P<0.05). There were no statistically significant differences in amplitude perturbation, fundamental frequency perturbation and harmonic noise ratio between the two groups(all P>0.05). After operation, the amplitude perturbation and the fundamental frequency perturbation in the observation group were lower than those of the control group, and the harmonic noise ratio was higher than that of the control group, the difference were statistically significant (t=18.618, 4.258, 2.579, all P<0.05). In the observation group, the recurrence rates at 6 months, 1 year and 2 years after operation were lower than those in the control group(χ2=4.598, 6.335, 4.730, all P<0.05).@*Conclusion@#Radiofrequency ablation of low temperature plasma knife in the treatment of patients with early glottal carcinoma can significantly reduce the intraoperative blood loss, shorten the operation time and observation time of postoperative hospital stay, and significantly reduce the incidence of postoperative complications and recurrence rate.It can also improve the patients' voice, and promote the recovery of vocal cord mucosal smooth.Besides, it has remarkable effect, and it has important significance in clinical treatment.

Effect of radiofrequency ablation of low temperature plasma knife in the treatment of 32 cases of early glottal carcinoma / 中国基层医药

Objective To investigate the effect and recurrence rate of radiofrequency ablation of low temperature plasma knife in the treatment of patients with early glottal carcinoma.Methods A total of 64 cases of early glottic carcinoma in the People＇s Hospital of Shanxi Province from February 2012 to January 2016 were divided into observation group and control group according to the different treatment schemes ,with 32 cases in each group.The observation group was treated with radiofrequency ablation of low temperature plasma knife ,and the control group was performed with routine larynx cleft surgery.The surgical related indicators and postoperative complications of the two groups were recorded.The phonetic changes (amplitude perturbation,fundamental frequency perturbation and harmonic noise ratio ) before and 6 months after operation of two groups were compared.After 2 years of follow －up,the recovery of vocal mucosa in the two groups after 1 year of operation and the recurrence rate of 6 months,1 year and 2 years after operation of the two groups were statistically recorded.Results The intraoperative blood loss in the observation group was less than that in the control group (P＜0.05),and the operative time and hospital stay observation time in the observation group were shorter than those in the control group ( all P＜0.05).The incidence rate of postoperative complications in the observation group [9.38%(3／32)] was lower than that in the control group [31.25%(10／32)],and the smoothness rate of the vocal cords at 1 year after operation in the observation group [90.63%(29／32)] was higher than that in the control group [62.50%(20／32)],the difference were statistically significant (χ2 ＝4.730,7.053,all P＜0.05).There were no statistically significant differences in amplitude perturbation ,fundamental frequency perturbation and harmonic noise ratio between the two groups (all P＞0.05).After operation,the amplitude perturbation and the fundamental frequency perturbation in the observation group were lower than those of the control group,and the harmonic noise ratio was higher than that of the control group , the difference were statistically significant (t＝18.618,4.258,2.579,all P＜0.05).In the observation group,the recurrence rates at 6 months, 1 year and 2 years after operation were lower than those in the control group ( χ2 ＝4.598,6.335,4.730,all P＜0.05).Conclusion Radiofrequency ablation of low temperature plasma knife in the treatment of patients with early glottal carcinoma can significantly reduce the intraoperative blood loss ,shorten the operation time and observation time of postoperative hospital stay ,and significantly reduce the incidence of postoperative complications and recurrence rate.It can also improve the patients＇voice,and promote the recovery of vocal cord mucosal smooth.Besides,it has remarkable effect,and it has important significance in clinical treatment.

Research progress of cryoablation in the treatment of lung cancer / 国际肿瘤学杂志

Clinical studies have confirmed that cryoablation is a safe and effective treatment for lung cancer. Cryoablation has been clinically used in the treatment of various types of lung cancer,and has achieved good therapeutic effects. Some of the complications of cryoablation can be alleviated after symptomatic treat-ment. However,cryoablation still needs further research and exploration in clinical applications.

Which method to use for surgical ablation of atrial fibrillation performed concomitantly with mitral valve surgery: radiofrequency ablation versus cryoablation

Abstract Objective: The effects of energy source on the maintenance of sinus rhythm and the contribution of demographic characteristics to the case selection in patients submitted to ablation performed concurrently with mitral valve surgery were analyzed. Methods: Cryothermal (n=42; 43.8%) and radiofrequency (n=54; 56.3%) energy were employed in 96 patients submitted to mitral valve replacement and Cox maze IV procedure. Patients were called for control visits between 15 days and 12 months after discharge. The causal relationship between recurrence of atrial fibrillation and factors such as left atrial diameter, C-reactive protein, hypertension, left ventricular ejection fraction, chronic obstructive pulmonary disease, and body mass index was determined. Results: Maintenance rates of the sinus rhythm with radiofrequency and cryoablation were 97.6% and 96.3%, respectively, in the first postoperative month, whereas at the 12th postoperative month were 88.1% and 83.3%. No significant difference was found between groups in relation to the energy source. Sensitivity and specificity for left atrial diameter with a cut-off value of 50.5 mm were 85.7% and 70.7%, respectively. Sensitivity and specificity for C-reactive protein with a cut-off value of 12 mg/dL on the 15th postoperative day were 83.3% and 88.9%, respectively. The effect of body mass index on atrial fibrillation recurrence was 3.2 times. Sensitivity and specificity for left ventricular ejection fraction 37% cut-off value were 96.3% and 11.4%, respectively. Atrial fibrillation in hypertensive cases was 5.3 times more. In patients with chronic obstructive pulmonary disease, recurrence of atrial fibrillation was 40%. The causal relation between recurrence of atrial fibrillation and the studied factors was established. Conclusion: Demographic characteristics have a significant impact on ablation efficiency, while the type of energy source does not.

Mid-Term Results of Surgical Treatment of Atrial Fibrillation in Valvular Heart Disease Assesed by Speckle Tracking Echocardiography / Resultados em Médio Prazo do Tratamento da Fibrilação Atrial na Doença Valvular Cardíaca Avaliados por Ecocardiografia com Speckle Tracking

Abstract Background: Atrial fibrillation frequently affects patients with valvular heart disease. Ablation of atrial fibrillation during valvular surgery is an alternative for restoring sinus rhythm. Objectives: This study aimed to evaluate mid-term results of successful atrial fibrillation surgical ablation during valvular heart disease surgery, to explore left atrium post-ablation mechanics and to identify predictors of recurrence. Methods: Fifty-three consecutive candidates were included. Eligibility criteria for ablation included persistent atrial fibrillation <10 years and left atrium diameter < 6.0 cm. Three months after surgery, echocardiogram, 24-hour Holter monitoring and electrocardiograms were performed in all candidates who maintained sinus rhythm (44 patients). Echo-study included left atrial deformation parameters (strain and strain rate), using 2-dimensional speckle-tracking echocardiography. Simultaneously, 30 healthy individuals (controls) were analyzed with the same protocol for left atrial performance. Significance was considered with a P value of < 0.05. Results: After a mean follow up of 17 ± 2 months, 13 new post-operative cases of recurrent atrial fibrillation were identified. A total of 1,245 left atrial segments were analysed. Left atrium was severely dilated in the post-surgery group and, mechanical properties of left atrium did not recover after surgery when compared with normal values. Left atrial volume (≥ 64 mL/m2) was the only independent predictor of atrial fibrillation recurrence (p = 0.03). Conclusions: Left atrial volume was larger in patients with atrial fibrillation recurrence and emerges as the main predictor of recurrences, thereby improving the selection of candidates for this therapy; however, no differences were found regarding myocardial deformation parameters. Despite electrical maintenance of sinus rhythm, left atrium mechanics did not recover after atrial fibrillation ablation performed during valvular heart disease surgery.

Resumo Fundamento: A fibrilação atrial frequentemente afeta pacientes com doenças das valvas cardíacas. A ablação da fibrilação atrial durante a cirurgia das válvulas é uma alternativa para restaurar o ritmo sinusal. Objetivos: Este estudo teve como objetivos avaliar resultados em médio prazo da ablação cirúrgica bem sucedida da FA durante cirurgia para doença valvar, para explorar a mecânica do AE após a ablação e identificar preditores de recorrência. Métodos: Foram incluídos 53 candidatos consecutivos. Os critérios de elegibilidade para ablação foram fibrilação atrial persistente <10 anos e diâmetro do átrio esquerdo < 6 cm. Três meses após a cirurgia, foram realizados ecocardiografia, Holter por 24 horas, e eletrocardiografias em todos os candidatos que mantiveram o ritmo sinusal (44 pacientes). O estudo eco incluiu parâmetros de deformação ao átrio esquerdo (strain e taxa de strain) usando ecocardiografia bidimensional com speckle tracking. Simultaneamente, 30 indivíduos sadios (controles) foram analisados com o mesmo protocolo para o desempenho do átrio esquerdo. Um valor de P < 0,05 foi considerado significativo. Resultados: Após um período médio de acompanhamento de 17 ± 2 meses, 13 novos casos de fibrilação atrial no pós-operatório foram identificados. Um total de 1245 segmentos do átrio esquerdo foi analisado. O grupo pós-cirúrgico apresentou dilatação grave do átrio esquerdo, e as propriedades mecânicas do átrio esquerdo não se recuperaram após a cirurgia quando comparadas com valores normais. O volume do átrio esquerdo (≥ 64 mL/m2) foi o único preditor independente de recorrência de fibrilação atrial (p = 0,03). Conclusões: O volume do átrio esquerdo foi maior nos pacientes com fibrilação atrial recorrente, e desponta como o principal preditor de recorrência, melhorando, assim, a seleção de candidatos para essa terapia. No entanto, não foram encontradas diferenças em relação aos parâmetros de deformação do miocárdio. Apesar da manutenção elétrica do ritmo sinusal, a função mecânica do átrio esquerdo não se recuperou após a ablação da fibrilação atrial realizada durante a cirurgia para doença da valva cardíaca.