predictive value of thrombocytopenia for bleeding or liver decompensation following percutaneous radiofrequency ablation therapy of hepatocellular carcinoma in patients with liver cirrhosis

To assess if thrombocytopenia has a predictive value for bleeding and/or liver decompensation following percutaneous radiofrequency ablation [RFA] therapy of hepatocellular carcinoma [HCC] in patients with liver cirrhosis. 64 consecutive patients with cirrhosis complicated by hepatocellular carcinoma, and associated with mild thrombocytopenia ranged from 37 to 99 x 10[9] platelets/L, and had undergone percutaneous RFA for treatment 86 hccs, were retrospectively studied. Nine possible factors were analyzed for their ability to predict bleeding or liver decompensation using the Cox proportional hazards regression model; Age, sex, Child-Pugh class, etiology of cirrhosis, platelet count, prothrombin activity, number of tumors, maximum size of the tumor, and type of electrode. It was shown that platelet threshold of 37 x 10[9]/L and the other variables were not significant risk factors of bleeding. Statistical [univariante and multivariente] analysis revealed that liver decompensation was clearly linked to prothrombin activity [p = 0,010 and p = 0.006, respectively] and < 63% of prothrombin activity was found to be a significant threshold for the occurrence of liver decompensation [p = 0.003] confirmed by Cox model [p = 0.05] Mild thrombocytopenia > 37 x 109/L is not an independent risk factor of bleeding or liver decompensation after RFA therapy of HCC in patient with cirrhosis. However, in such situation a significant higher risk of liver decompensation followed the procedure was found in cases of prothrombin activity < 63%.Radiofrequency ablation, hepatocellular carcinoma, thrombocytopenia, prothrombin activity, liver cirrhosis RFA= radiofrequency ablation, HCC = hepatocellular carcinoma, US = ultrasonography, CT = computed tomography

Percutaneous image-guided radiofrequency ablation of painful bone metastases

To determine the value of radiofrequency ablation [RFA] in alleviating pain in patients with refractory pain secondary to bone metastases. Over 11 months, [from January 2006 to November 2006] 14 patients with painful osteolytic metastases were treated with image-guided radiofrequency ablation. The inclusion criteria were pain score >/= 4 [scale of 0-10] over a 24-hour period not responding to standard treatment such as radiation or opioid analgesics, or patients unfit for radiotherapy. Primary pain assessment and follow- were according to the Brief Pain Inventory-Short Form, Worst pain intensity was the primary end point with a 2-units drop considered clinically significant. Follow-up was scheduled one day post procedure, then weekly for one month and thereafter every other week, up to six months. Analgesics used were also recorded at these follow-up intervals. Follow-up contrast enhanced CT was performed one week after the procedure. Complications were monitored. The procedure was technically successful in all patients. Initial pain relief was achieved in 100% of patients [14 of 14]. There was a significant decrease in the VAS [visual analogue scale] score from 7 +/- 2.4 to 1.2 +/- 1.8 Analgesic reduction was achieved in 92.9% [13 out of 14 patients]. The tumor necrosis ratio ranged from 40% to 100% [mean, 67.1% +/- 5.9]. No serious complications were observed. There was transient local pain in most cases. Adverse events were seen in 2 patients, including a second degree skin burn at the grounding pad site in one patient and transient bowel and bladder incontinence following treatment of metastases involving the sacrum in the second patients. RFA is effective and safe for palliation of pain in cases of osteolytic metastases. It provides significant pain relief for patients who have failed standard treatment

Radiofrecuencia en tumores hepáticos: nuestra experiencia y revisión de la bibliografía / Radiofrequency ablation in liver tumors

Antecedentes: la termoablación por radiofrecuencia (RFA) es uno de los métodos miniinvasivos más recientes y prometedores para la destrucción local de tumores hepáticos no resecables. Su utilización en tumores primarios y secundarios ha sido demostrada en numerosos trabajos científicos. Objetivo: el objetivo de este estudio es analizar las diferentes indicaciones, abordajes, complicaciones, y conocer de esta forma sus resultados y valor terapéutico. Lugar de aplicación: Istituto Nazionale per lo Studio e la Cura dei Tumori. Via Venezian, 1.20133 Milano, Italia. Diseño: trabajo de revisión bibliográfico. Material y Método: existen diferentes equipos técnicos, formas de abordaje y de control post-ablación. Resultados: la respuesta completa al tratamiento varía entre un 50 y 100 por ciento. La morbilidad del método es inferior al 10 por ciento, con una mortalidad aproximada al 1 por ciento. La recidiva local post-RFA varía entre 5 y 60 por ciento. Conclusión: actualmente es considerada una técnica segura y efectiva para la ablación de tumores hepáticos en pacientes no candidatos a cirugía

Surgical Radiofrequency MAZE III Ablation for Treatment of Atrial Fibrillation During Open Heart Surgery

Atrial fibrillation is a common arrhythmia in patients with rheumatic mitral and other valve diseases who are c and idates for valve repair surgeries. Conversion of rhythm to sinus has positive effects on quality of life and lower use of medications. The aim of this clinical study was to evaluate the effectiveness of the radiofrequency ablation Maze III procedure in the treatment of atrial fibrillation associated with rheumatic heart valve disease We applied a modified Cox III Maze procedure using radiofrequency ablation in the treatment of atrial fibrillation associated with rheumatic heart valve disease and evaluated the outcome of 20 patients of atrial fibrillation associated rheumatic valve disease who underwent radiofrequency ablation Maze III procedure plus heart valve surgery. Demographic, echocardiographic, Electrocardiographic and Doppler study data were calculated before surgery, six month and one year after surgery.No perioperative deaths occurred in the study group. Duration of additional time for doing radiofrequency ablation was about 22 minutes. Freedom from atrial fibrillation was 85% and 75% at six months and one year follow-up respectively.The addition of the radiofrequency ablation Maze procedure to heart valve surgery is safe and effective in the treatment of atrial fibrillation associated with rheumatic heart valve disease

Pediatric Radiofrequency Catheter Ablation: Results of Initial 100 Consecutive Cases Including Congenital Heart Anomalies

Radiofrequency catheter ablation (RFCA) has recently become a management option for pediatric tachycardia. We reviewed the records of a total of 100 patients (aged 10 months to 19 yr) who had undergone RFCA, from March 2000 to June 2004. Types of arrhythmia (age, acute success rate) were as follows: atrioventricular reentrant tachycardia (AVRT, 9.0+/-3.7 yr, 66/67), atrioventricular nodal reentrant tachycardia (AVNRT, 13+/-2.5 yr, 16/16), ectopic atrial tachycardia (6.4+/-3.3 yr, 5/5), junctional ectopic tachycardia (10 month, 1/1), ventricular tachycardia (12+/-4.9 yr, 6/6), postsurgical intraatrial reentrant tachycardia (15.6+/-4.1 yr, 2/3), twin node tachycardia (4 yr, 0/1), and His bundle ablation (9 yr, 1/1). The age of AVNRT was older than that of AVRT (p=0.002). Associated cardiac disease was detected in 17 patients, including 6 univentricular patients, and 3 Ebstein's anomaly patients. RFCA for multiple accessory pathways required longer fluoroscopic times than did the single accessory pathway (53.9+/-4.8 vs. 36.2+/-24.1 min; p=0.03), and was associated with a higher recurrence rate (3/9 vs. 3/53; p=0.03). Regardless of the presence or absence of cardiac diseases, the overall acute success rate was 97% without major complications, the recurrence rate was 8.2%, and the final success rate was 97%. This experience confirmed the efficacy and safety of RFCA in the management of tachycardia in children.

Evaluation of subthreshold stimulation the predicting the site of successful radiofrequency ablation in supra-ventmcular tachycardia

This study is aimed to determine the incidence of terminating the supra-ventricular tachycardia [SVT, [AVNRT and AVRT]] by Subthreshold stimulation [STS] and to evaluate the ultrarapid STS in predicting the site of successful radiofrequency ablation in these arrhythmias. Thirty patients were selected during routine EPS; for this study; fifteen have had AVNRT and fifteen have had AVRT, [patients with other arrhythnhias were excluded]. All patients were well prepared for EPS and subjected to the following: Pacing protocol: in all cases pacing of the RV was followed to avoid early atrial stimulation that would potentially throw the patients into AF 1- Ventricular stimulation protocol: to initiate orthodromic tachycardia and localization the site; and to detect the site of earliest retrograde atrial activation. 2- Atrial stimulation protocol: to initiate antidromic wide QRS tachycardia and discover presence or absence of AH jump suggesting dual AVNodal pathway. Subthreshold stimulation [STS] method. Once patient developed AVNRT or AVRT we put ablation catheter near to expect site of ablation either slow pathway in case of AVNRT or accessory pathway in case of AVRT. We started pacing from ablation catheter aiming to terminate the re-entry circuit by STS and not to capture the whole myocardium. STS by threshold ranging between 2-5 mA and cycle length [CL] shorter than that of tachycardia by 50 msec., then decreasing CL every step by 50 msec., until reach CL 200 msec., for aduration of 3-5 sec. continuous pacing each step. If AVNRT or AVRT was terminated in certain site we started ablation in this site and if AVNRT lead to slow Junctional rhythm or AVRT terminated tachycardia with or without VA dissociation this would be considered. a positive result. If AVNRT or AVRT was not terminated in certain site we started ablation in this site and if slow functional rhythm in AVNRT or termination of AVRT with or without AV dissociation in AVRT this would be considered negative result. If AVNRT or AVRT did not terminated by STS as well as by ablation we tried STS and ablation in another site and so on. We achieved [53%] positive results in cases of AVRT and negative results in [47%] of cases; while in AVRT the positive results was [66%] of cases and the negative results was [34%] of cases. STS-guided mapping is a novel tool for the detection of target sites of slow pathway [SP] and accessory pathway [AP] ablation in patients with reproducible inducible and sustained AVNRT and AVRT. This technique helps to reduce the number of RFC pulses required for SF and AP ablation without an increase of fluoroscopy time or procedure duration

Litiasis intrahepática: aporte de los tratamientos percutáneos / Intrahepatic primitive lithiasis

Se presenta una serie de 82 casos de litiasis intrahepática primitiva. Esta alta cantidad rara en Occidente, se explica por tratarse en su mayoría de pacientes que han quedado con litiasis remanente y enviados para su extracción percutánea. Desde de 1964 hasta la actualidad (5.000 casos). Se analiza la etiopatogenia dando importancia capital a las estenosis prelitiásicas, presentes en el 80 por ciento, que se consiguieron dilatar en todos los casos y no recidivaron. De las 82, 16 fueron difusas, 52 del conducto hepático izquierdo y 14 del derecho. En casi todos la cirugía fue complementada con el tratamiento instrumental. Se hizo tratamiento percutáneo en 79 casos, 73 se realizaron por la vía transfistular y 6 por vía TPH. Se obtuvo un éxito global del 94 por ciento. Las complicaciones fueron del 17 por ciento y la mortalidad del 2,4 por ciento. No se realizó ninguna hepatectomía

Inserción de catéteres percutáneos en vena subclavia por abordaje supraclavicular en pacientes pediátricos gravemente enfermos / Supraclavicular insertion on percutaneous catheters in the subclavian vein in critcally ill child

Introducción. En la actualidad el manejo del paciente en estado crítico se ve facilitado al contar con un catéter venoso central por considerarse como un arma para su tratamiento integral. Las vías utilizadas tradicionalmente para su colocación por punción percutánea son: la vena yugular interna, la femoral y la subclavia (VSc) por aboradaje infraclavicular. Se presenta una serie en la cual se colocó catetér venoso central por punción percutánea en VSc por vía supraclavicular. Material y métodos. En dos años se intentó la colocación percutánea de 53 catéteres subclavios por abordaje supraclavicular en 48 pacientes pediátricos en estado crítico cuando había fracasado la colocación por otra vía. Resultados. Se colocaron exitosamente 50 catéteres (94 por ciento) en pacientes pediátricos con edad promedio de 3.7 años, peso mínimo de 1.9 kg y máxima de 60 kg. La principal indicación fue la vigilancia hemodinámica y la técnica más utilizada fue la descrita por Seldinger. Unicamente la colocación falló en 3 intentos. La única complicación mayor fue neumotórax en 4 pacientes, sin consecuencias. Conclusiones. La colocación de catéter venoso central subclavio por abordaje supraclavicular tiene un alto porcenjate de éxito en paciente pediátricos, convirtiéndose en una excelente opción; sin embargo, no se considera que sea una vía de primera elección en la colocación de catéteres venosos centrales. Se sugiere como una buena alternativa cuando se ha fracasado por otras vías

Resultados tardios da fulguraçäo da junçäo atrioventricular em pacientes com taquicardias supraventriculares utilizando choques de alta energia / Long Term Follow -up After Direct Current Catheter Ablation (High Energy) of the Atrioventricular Junction in Patients with Supraventricular Tachycardias

Purpose - To evaluate the long term efficacy and safety at long term after atrioventricular junction fulguration (complete AV block induction, using high energy shocks, to control drug-resistant supraventricular tachyarrythmias. Methods - Twenty-eigth patients, 17 (60,7%) men, with mean age 48,1 years, were submitted to one up to six ablation sessions with high energy shocks. The total delivered energy per patient was 1304 ± 868 J. Each shock ranged from 100 to 400J. Results - After 12 months, at least, 60,6% of patients were in complete atrioventricular block; three (10,8%) were assymptomatics without complete AV block, and infive (17,8%) the ablation was unsuccessful. Conclusion - AV junction ablation with high energy shocks is safe and efficient in long term follow-up

Objetivo - Avaliar a eficácia a longo prazo da fulguração da junção AV (indução de BAVT), utilizando choques de alta energia, para controle de arritmias supraventriculares refratárias a drogas. Métodos - Vinte e oito pacientes, 17 (60,7%) do sexo masculino, com média etária de 48,1 anos, foram submetidos a uma até seis sessões de fulquração da junção AV, com choques de alta energia. Cada paciente recebeu em média de um a dez choques. A energia total aplicada por paciente variou de 100 a 3200 J (1304 ± 868 J); cada choque foi de 100 a 400J. Resultados - No mínimo após 12 meses, 60,6% dos pacientes permaneceram em BAVT; 3 (10,8%) pacientes apresentam-se assintomáticos, com alterações na condução AV, sem apresentar BAVT. Em 5 (17,8%) pacientes o procedimento foi ineficaz. Conclusão - A fulguração da junção AV (indução de BA VT) com choques de alta energia é procedimento seguro e eficaz a longo prazo