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1.
Rev. cuba. oftalmol ; 34(3): e1066, 2021. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1352033

ABSTRACT

Se realizó una búsqueda sobre carcinoma basal de párpado, con el objetivo de describir el contexto actual del tratamiento quirúrgico, no quirúrgico y reconstructivo. Con el fin de eliminar el tumor con las menores secuelas funcionales y estéticas posibles, son aceptadas muchas opciones de tratamiento en el manejo actual de esta patología, que incluyen: tratamientos tópicos (imiquimod, interferones, vismodegib, sonidegib), procedimientos mínimamente invasivos (terapia fotodinámica), modalidades ablativas (curetaje, electrocauterización, criocirugía) y procedimientos altamente especializados (resección quirúrgica convencional, radioterapia o cirugía de Mohs). El tratamiento previo, el subtipo histológico, el sitio y el tamaño de la lesión deben considerarse en la planificación quirúrgica, porque se ha demostrado que afectan las tasas de curación. A partir de estos elementos, se desarrolló un algoritmo para el tratamiento del carcinoma basocelular que podría ayudar a elegir la técnica quirúrgica y los márgenes de seguridad, especialmente en lugares donde la cirugía micrográfica no está ampliamente disponible(AU)


A bibliographic search was conducted about basal eyelid carcinoma with the purpose of describing the current context of surgical, non-surgical and reconstructive treatment. Current management of this condition includes many treatment options aimed at removing the tumor with the least possible functional and esthetic sequels. Among them are the following: topical medication (imiquimod, interferons, vismodegib, sonidegib), minimally invasive procedures (photodynamic therapy), ablative therapy (curettage, electrocauterization, cryosurgery) and highly specialized procedures (conventional surgical resection, radiotherapy or Mohs surgery). Surgical planning should consider the previous treatment, the histological subtype, and the site and size of the lesion. These factors have been shown to affect cure rates. Based on these elements, an algorithm was developed for the treatment of basal cell carcinoma which may be useful in selecting the surgical technique and safety margins, particularly in settings where micrographic surgery is not widely available(AU)


Subject(s)
Humans , Carcinoma, Basal Cell/radiotherapy , Mohs Surgery/methods , Cryosurgery/methods , Eyelids/injuries , Review Literature as Topic , Imiquimod/therapeutic use
2.
Arch. cardiol. Méx ; 90(1): 69-76, Jan.-Mar. 2020. tab
Article in English | LILACS | ID: biblio-1131008

ABSTRACT

Abstract Atrial fibrillation (AF) is a frequent arrhythmia; its prevalence is near 2% in the general population; in Mexico, more than one-half million people are affected. AF needs to be considered as a public health problem. Because AF is an independent risk factor associated with mortality, due to embolic events, heart failure, or sudden death; early diagnosis is of utmost importance. In unstable patients with a recent onset of AF, electrical cardioversion should be practiced. In stable patients, once thromboembolic measures have been taken, it is necessary to assess whether it is reasonable to administer an antiarrhythmic drug to restore sinus rhythm or performed electrical cardioversion. For recidivating cases of paroxysmal and persistent presentation, the most effective strategy is performed pulmonary vein isolation with either radiofrequency or cryoballoon energy. Permanent AF is that in which recovery of sinus rhythm is not possible, the distinguishing feature of this phase is the uncontrollable variability of the ventricular frequency and could be treated pharmacologically with atrioventricular (AV) nodal blockers or with a VVIR pacemaker plus AV nodal ablation. The presence of AF has long been associated with the development of cerebral and systemic (pulmonary, limb, coronary, renal, and visceral) embolism. The prevention of embolisms in “valvular” AF should perform with Vitamin K antagonists (VKA). For patients with AF not associated with mitral stenosis or a mechanical valve prosthesis, a choice can be made between anticoagulant drugs, VKA, or direct oral anticoagulants. Antiplatelet agents have the weakest effect in preventing embolism.


Resumen La fibrilación auricular (FA) es una arritmia frecuente; su prevalencia es cercana al 2% en la población general, en México se ven afectados más de medio millón de personas por eso debe considerarse como un problema de salud pública. Debido a que la FA es un factor de riesgo independiente asociado a mortalidad, por eventos embólicos, insuficiencia cardíaca o muerte súbita, la identificación y diagnóstico temprano es de suma importancia. En el inicio reciente de FA en pacientes inestables, se debe practicar la cardioversión eléctrica. En pacientes estables, una vez que se han tomado medidas tromboembólicas, es necesario evaluar si es razonable administrar un medicamento antiarrítmico para restaurar el ritmo sinusal o realizar una cardioversión eléctrica. Para los casos que recidivan, ya sea paroxística o persistente, la estrategia más efectiva es realizar el aislamiento de la venas pulmonares con radiofrecuencia o crioablación con balón. La FA permanente es aquella en la que no es posible la recuperación del ritmo sinusal, la característica distintiva de esta fase de la FA es la variabilidad incontrolable de la frecuencia ventricular. Puede tratarse farmacológicamente con bloqueadores nodales AV o con un marcapasos VVIR mas ablación del nodo AV. La presencia de FA se ha asociado durante mucho tiempo con el desarrollo de embolia cerebral y sistémica (pulmonar, de extremidades, coronaria, renal y visceral). La prevención de embolias en la FA “valvular” debe realizarse con antagonistas de la vitamina K (AVK). Para los pacientes con FA no asociados con estenosis mitral o una prótesis valvular mecánica, se puede elegir entre medicamentos anticoagulantes, AVK o anticoagulantes orales directos (DOAC). Los agentes antiplaquetarios tienen el efecto más débil para prevenir la embolia.


Subject(s)
Humans , Atrial Fibrillation/therapy , Thromboembolism/prevention & control , Anticoagulants/administration & dosage , Atrial Fibrillation/complications , Atrial Fibrillation/epidemiology , Thromboembolism/etiology , Electric Countershock/methods , Risk Factors , Cryosurgery/methods , Fibrinolytic Agents/administration & dosage , Radiofrequency Ablation/methods , Mexico/epidemiology , Anti-Arrhythmia Agents/administration & dosage
3.
Rev. bras. cir. cardiovasc ; 34(5): 525-534, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1042053

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Atrial Fibrillation/surgery , Atrial Fibrillation/physiopathology , Heart Valve Prosthesis Implantation/methods , Cryosurgery/methods , Heart Rate/physiology , Mitral Valve/surgery , Postoperative Period , Reference Values , Atrial Fibrillation/prevention & control , Time Factors , Retrospective Studies , Risk Factors , Sensitivity and Specificity , Treatment Outcome , Electrocardiography , Preoperative Period , Heart Atria/surgery , Mitral Valve/physiopathology
4.
Rev. chil. cardiol ; 38(2): 113-118, ago. 2019. graf, ilus
Article in Spanish | LILACS | ID: biblio-1042604

ABSTRACT

Abstract An 18-year-old woman with recurrent tachycardia was shown to have orthodromic supraventricular tachycardia through an antero-septal occult pathway near the His. Cryoablation was selected to avoid A-V block. The accesory pathway was finally interrupted after 360 sec of cryoablation. No recurrence was documented after a 12 month follow-up


Subject(s)
Humans , Female , Adolescent , Tachycardia, Supraventricular/surgery , Cryosurgery/methods , Electrocardiography , Arrhythmias, Cardiac , Tachycardia, Supraventricular/physiopathology , Electrophysiologic Techniques, Cardiac
5.
Med. infant ; 26(2): 142-146, Junio 2019.
Article in Spanish | LILACS | ID: biblio-1016341

ABSTRACT

El tratamiento de los trastornos del ritmo cardíaco ha sufrido recientemente una verdadera revolución. El empleo de avanzadas terapéuticas por catéter para tratar una gran variedad de arritmias, utilizando diferentes fuentes de energía, han permitido evolucionar de un tratamiento antiguamente basado casi con exclusividad en el empleo de fármacos antiarrítmicos, como terapia aguda y/o preventiva, a uno actualmente curativo, con el consiguiente avance que estos últimos métodos conllevan para la calidad de vida de nuestros pacientes y sus familias. La tendencia ha continuado con el empleo de navegadores 3 D que ya no requieren el empleo de radiación ionizante para efectuar estos procedimientos y permiten una mayor exactitud para mejorar los excelentes resultados alcanzados. El desarrollo de dispositivos eléctricos como los marcapasos, sumado a la aparición de otros más avanzados como defibriladores y resincronizadores cardíacos también ha contribuido a mejorar la expectativa de vida de muchos niños con cardiopatías diversas. La mejora evidenciada con el empleo de registradores de eventos implantables y el seguimiento mediante monitoreo a distancia de los diferentes dispositivos eléctricos han demostrado mejorar los resultados obtenidos con dichos métodos a largo plazo. Sin duda con la ayuda de la genética en un futuro cercano será posible hacer tratamientos cada vez más específicos para ayudar en casos de arritmias graves hereditarias o causadas por mutaciones en los canales iónicos de las células cardíacas. Si bien existen aún controversias respecto de algunos ítems muy puntuales los mismos se irán aclarando con las experiencias colaborativas en marcha en diferentes centros médicos especializados (AU)


Recently, treatment of heart rhythm disorders has revolutionized. The use of advanced catheter-based therapies to treat a wide spectrum of arrhythmias, using different energy sources, has led the treatment to evolve from an almost exclusively antiarrhythmic drug-based treatment, such as acute and/or preventive therapy, to a currently curative one, with the consequent advance that these latter methods add to the quality of life of our patients and their families. The trend has continued with the use of 3D navigators that no longer require the use of ionizing radiation to perform these procedures and allow greater accuracy to improve the excellent results achieved. The development of electrical devices, such as pacemakers, coupled with the emergence of more advanced devices, such as defibrillators and cardiac resynchronizers, has also been useful to improve the life expectancy of many children with different types of heart disease. The advances evidenced by the use of implantable event loggers and remote monitoring of different electrical devices have shown to improve the long-term results obtained with such methods. Undoubtedly, with the help of genetics in the near future it will be possible to develop increasingly specific therapies to treat patients with severe hereditary arrhythmias or those caused by mutations in the ion channels of the heart cells. Although controversy still exists regarding some very specific issues, these will be clarified with the collaborative experience underway at different specialized medical centers


Subject(s)
Humans , Pacemaker, Artificial , Arrhythmias, Cardiac/surgery , Arrhythmias, Cardiac/therapy , Defibrillators , Cardiac Electrophysiology/trends , Cardiac Resynchronization Therapy , Cryosurgery/methods , /methods
6.
Braz. j. med. biol. res ; 52(9): e8446, 2019. tab, graf
Article in English | LILACS | ID: biblio-1019563

ABSTRACT

Left atrial diameter (LAD) has been considered an independent risk factor for atrial fibrillation (AF) relapse after pulmonary vein isolation (PVI). However, whether LAD or other factors are more predictive of late recurrence in patients with paroxysmal AF remains unclear. We aimed to evaluate the value of pulmonary vein (PV) parameters for predicting AF relapse 1 year after patients underwent cryoablation for paroxysmal AF. Ninety-seven patients with paroxysmal AF who underwent PVI successfully were included. PV parameters were measured through computed tomography scans prior to PVI. A total of 28 patients had recurrence of AF at one-year follow-up. The impact of several variables on recurrence was evaluated in multivariate analyses. LAD and the time from first diagnosis of AF to ablation maintained its significance in predicting the relapse of AF after relevant adjustments in multivariate analysis. When major diameter of right inferior pulmonary vein (RIPV) (net reclassification improvement (NRI) 0.179, CI=0.031-0.326, P<0.05) and cross-sectional area (CSA) of RIPV (NRI: 0.122, CI=0.004-0.240, P<0.05) entered the AF risk model separately, the added predictive capacity was large. The accuracy of the two parameters in predicting recurrence of AF were not inferior (AUC: 0.665 and 0.659, respectively) to echocardiographic LAD (AUC: 0.663). The inclusion of either RIPV major diameter or CSA of RIPV in the model increased the C-index (0.766 and 0.758, respectively). We concluded that major diameter of RIPV had predictive capacity similar to or even better than that of LAD for predicting AF relapse after cryoablation PVI.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Pulmonary Veins/anatomy & histology , Atrial Fibrillation/etiology , Heart Atria/anatomy & histology , Pulmonary Veins/diagnostic imaging , Recurrence , Atrial Fibrillation/surgery , Tomography, X-Ray Computed , Prospective Studies , Risk Factors , Sensitivity and Specificity , Treatment Outcome , Catheter Ablation/methods , Cryosurgery/methods , Heart Atria/diagnostic imaging
7.
Rev. bras. cir. cardiovasc ; 33(6): 542-552, Nov.-Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-977484

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Middle Aged , Atrial Fibrillation/surgery , Catheter Ablation/methods , Heart Valve Prosthesis Implantation/methods , Cryosurgery/methods , Radiofrequency Ablation/methods , Mitral Valve/surgery , Postoperative Period , Case-Control Studies , Polymerase Chain Reaction , Retrospective Studies , Risk Factors , Electrocardiography , Cardiac Surgical Procedures , Heart Valve Diseases/surgery
8.
Arq. bras. cardiol ; 110(5): 440-448, May 2018. tab, graf
Article in English | LILACS | ID: biblio-950162

ABSTRACT

Abstract Background: The influence of pulmonary vein (PV) anatomy on cryo kinetics during cryoballoon (CB) ablation is unclear. Objective: To investigate the relationship between PV anatomy and cryo kinetics during CB ablation for atrial fibrillation (AF). Methods: Sixty consecutive patients were enrolled. PV anatomy, including ostial diameters (long, short and corrected), ratio between short and long diameters, ostium shape (round, oval, triangular, and narrow), and drainage pattern (typical, with common trunk, common antrum, ostial branch and supernumerary PV) were evaluated on multi-detector computed tomography (MDCT) images pre-procedure. Cryo kinetics parameters [balloon freeze time from 0 to -30ºC (BFT), balloon nadir temperature (BNT) and balloon warming time from -30 to +15ºC (BWT)] were recorded during procedure. All p values are two-sided, with values of p < 0.05 considered to be statistically significant. Results: 606 times of freezing cycle were accomplished. Moderate negative correlation was documented between BNT and corrected PV diameter (r = -0.51, p < 0.001) when using 23-mm CBs, and mild negative correlation (r = - 0.32, p = 0.001) was found when using 28-mm CBs. Multivariate logistic regression analysis revealed that PV corrected ostial diameter (OR, 1.4; p = 0.004) predicted a BNT < -51ºC when using 23-mm CBs, while PV ostium oval shape (OR, 0.3; p = 0.033) and PV locations (left inferior PV: OR, 0.04; p = 0.005; right superior PV: OR, 4.3; p = 0.025) predicted BNT < -51ºC when using 28-mm CBs. Conclusions: MDCT can provide PV anatomy accurate evaluation prior CB ablation. PV anatomy is associated with cryo kinetics during ablation.


Resumo Fundamentos: A influência da anatomia da veia pulmonar (VP) na criocinética durante a ablação por criobalão (CB) não está clara. Objetivo: Investigar a relação entre a anatomia da VP e a criocinética durante a ablação com CB para fibrilação atrial (FA). Métodos: sessenta pacientes consecutivos foram matriculados. Foram avaliados em imagens de tomografia computadorizada multidetectora (TCMD) pré-procedimento a anatomia da VP, incluindo diâmetros dos óstios (longo, curto e corrigido), relação entre diâmetros curtos e longos, forma do óstio (redondo, oval, triangular e estreito) e padrão de drenagem (típico, com tronco comum, antro comum, ramo ostial e VP supranumerária). Os parâmetros criocinéticos [tempo de congelamento de balão de 0 a -30ºC (TCB), temperatura do nadir do balão (TNB) e tempo de aquecimento do balão de -30 a + 15ºC (TAB)] foram registrados durante o procedimento. Todos os valores de p são bicaudais, com valores de p < 0,05 considerados estatisticamente significativos. Resultados: o ciclo de congelamento foi realizado 606 vezes. Correlação negativa moderada foi documentada entre o TNB e o diâmetro VP corrigido (r = - 0,51, p < 0,001) ao usar CBs de 23 mm e correlação negativa leve (r = - 0,32, p = 0,001) foi encontrada ao usar 28- mm CBs. A análise de regressão logística multivariada revelou que o diâmetro corrigido do óstio da VP (OR, 1,4; p = 0,004) previu um TNB < -51ºC ao usar CB de 23 mm, enquanto a forma oval do óstio VP (OR, 0,3; p = 0,033) e as localizações da VP (VP inferior: OR, 0,04; p = 0,005; VP superior direito: OR, 4,3; p = 0,025) previram TNB < -51ºC ao usar CBs de 28 mm. Conclusões: A TCMD pode fornecer uma avaliação precisa da anatomia da VP antes da ablação por CB. A anatomia da VP está associada à criocinética durante a ablação.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Pulmonary Veins/anatomy & histology , Atrial Fibrillation/surgery , Catheter Ablation/methods , Cryosurgery/methods , Pulmonary Veins/physiopathology , Pulmonary Veins/diagnostic imaging , Atrial Fibrillation/diagnostic imaging , Kinetics , Tomography, X-Ray Computed , Prospective Studies , Treatment Outcome , Imaging, Three-Dimensional
9.
Arq. bras. cardiol ; 110(4): 312-320, Apr. 2018. tab, graf
Article in English | LILACS | ID: biblio-888058

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Atrial Fibrillation/surgery , Atrial Fibrillation/diagnostic imaging , Cryosurgery/methods , Heart Valve Diseases/surgery , Heart Valve Diseases/diagnostic imaging , Recurrence , Atrial Fibrillation/physiopathology , Time Factors , Echocardiography/methods , Prospective Studies , Reproducibility of Results , Risk Factors , Follow-Up Studies , Atrial Function, Left/physiology , Treatment Outcome , Statistics, Nonparametric , Electrocardiography , Heart Atria/surgery , Heart Atria/physiopathology , Heart Atria/diagnostic imaging , Heart Rate/physiology , Heart Valve Diseases/physiopathology
10.
Braz. j. med. biol. res ; 50(9): e6409, 2017. graf
Article in English | LILACS | ID: biblio-888992

ABSTRACT

This meta-analysis compared the efficacy and safety of the contact force (CF)-sensing catheter and second-generation cryoballoon (CB) ablation for treating atrial fibrillation (AF). Six controlled clinical trials comparing ablation for AF using a CF-sensing catheter or second-generation CB were identified from PubMed, EMBASE, Cochrane Library, Wanfang Data, and China National Knowledge Infrastructure. The procedure duration was significantly lower in the CB group compared with that in the CF group [mean difference (MD)=29.4; 95%CI=17.84-40.96; P=0.01], whereas there was no difference between the groups for fluoroscopy duration (MD=0.59; 95%CI=-4.48-5.66; P=0.82). Moreover, there was no difference in the incidence of non-lethal complications (embolic event, tamponade, femoral/subclavian hematoma, arteriovenous fistula, pulmonary vein stenosis, phrenic nerve palsy, and esophageal injury) between the CB and the CF groups (8.38 vs 5.35%; RR=0.66; 95%CI=0.37-1.17; P=0.15). Transient phrenic nerve palsy occurred in 17 of 326 patients (5.2%) of the CB group vs none in the CF group (RR=0.12; 95%CI=0.03-0.43; P=0.001). A comparable proportion of patients in CF and CB groups suffered from AF recurrence during the 12-month follow-up after a single ablation procedure [risk ratio (RR)=1.03; 95%CI=0.78-1.35; P=0.84]. AF ablation using CF-sensing catheters and second-generation CB showed comparable fluoroscopy duration and efficacy (during a 12-month follow-up), with shorter procedure duration and different complications in the CB group.


Subject(s)
Humans , Atrial Fibrillation/surgery , Catheter Ablation/methods , Cryosurgery/methods , Catheter Ablation/adverse effects , Controlled Clinical Trials as Topic , Cryosurgery/adverse effects , Catheters
11.
Arch. cardiol. Méx ; 86(2): 123-129, abr.-jun. 2016. tab, graf
Article in Spanish | LILACS | ID: biblio-838361

ABSTRACT

Resumen Los resultados a largo plazo del procedimiento de maze con criotermia en pacientes con fibrilación auricular durante procedimientos quirúrgicos concomitantes son todavía inciertos. Método Entre 2006 y 2011, 150 pacientes consecutivos con fibrilación auricular persistente y cardiopatía asociada fueron sometidos a cirugía de ablación mediante criotermia asociada a cirugía concomitante. El procedimiento de Cox-Maze biauricular fue realizado en 67 pacientes y ablación aislada de la aurícula izquierda en 83 pacientes. Los resultados a tres años en estos grupos fueron comparados mediante seguimiento clínico, electrocardiográfico y mediante Holter 24 horas y ecocardiografía con medición de la onda A transmitral al mes, a los 6 y 12 meses y después anualmente. Resultados Los pacientes sometidos a ablación Cox-Maze presentaron una libertad de fibrilación auricular del 97, 94, 89, 80 y 54% a 1, 6, 12, 24 y 36 meses respectivamente. En el seguimiento de los 12 meses estas diferencias resultaron significativas (p < 0.05). Como factor de riesgo de recurrencia de fibrilación auricular se identificó la ablación aislada de la aurícula izquierda. Conclusiones La ablación mediante criotermia tiene un elevado porcentaje de éxitos a dos años; la recurrencia se incrementa a partir de entonces independientemente de la técnica realizada. Para el tratamiento de la fibrilación auricular persistente asociada a otra patología quirúrgica cardiaca se debe realizar un tratamiento intensivo mediante ablación biauricular.


Abstract The long-term results of cryomaze in patients with longstanding persistent atrial fibrillation during concomitant surgical procedures are still uncertain. Methods Between 2006 and 2011, 150 consecutive patients with associated long-lasting permanent atrial fibrillation and associated heart disease underwent heart surgery were treated by biatrial Cox-Maze (63 patients) or by isolated endocardial or epicardial left atrial cryoablation (83 patients) concomitantly. The results at 3 years in these groups were compared with clinical monitoring, electrocardiography, 24-hour Holter, and echocardiography with measurement of the transmitral A wave at 1, 6 and 12 months and annually thereafter in all patients. Results Patients undergoing Cox-Maze IV ablation presented rates of freedom from atrial fibrillation of 97, 94, 89, 80 and 54% at 1, 6, 12, 24 and 36 months, respectively. In the 12-month follow-up, these differences were significant (p < .05). The independent risk factors of atrial fibrillation recurrence was isolated ablation of left atrium. Conclusions Atrial fibrillation by cryothermia ablation had a high success rate before 2 years postoperatively. Recurrence of atrial fibrillation increased thereafter regardless of the technique used, although it was more intense and developed earlier in cases of monoatrial ablation. For the treatment of other long-lasting permanent atrial fibrillation cardiac surgery-associated pathology, an aggressive biatrial treatment with Cox maze ablation should be performed.


Subject(s)
Humans , Male , Female , Aged , Atrial Fibrillation/surgery , Cryosurgery/methods , Heart Atria/surgery , Recurrence , Time Factors , Prospective Studies , Cardiac Surgical Procedures/methods
12.
Int. braz. j. urol ; 41(3): 473-485, May-June 2015. tab
Article in English | LILACS | ID: lil-755858

ABSTRACT

ABSTRACTObjective:

To compare the utilization, perioperative complications and predictors of LCA versus RPN in the treatment of localized renal tumors.

Methods:

From the Nationwide Inpatient Sample we identified patients undergoing RPN or LCA for the treatment of localized renal tumors from October 2008 through 2010. Patient and hospital-specific factors which predict postoperative complications and use of LCA were investigated.

Results:

14,275 patients with localized renal tumors were identified: 70.3% had RPN and 29.7% had LCA. LCA was more common in older patient and at hospitals without robotic consoles. No difference was identified in perioperative complications (0.2% vs. 0.2%), transfusion (5.1% vs. 6.2%), length of stay (2.9 vs. 3.0 days) or median cost ($41,753 vs. $44,618) between the groups, LCA vs. RPN. On multivariate analysis sicker patients were more likely to have LCA (OR 1.34, p=0.048) and sicker patients had greater postoperative complications (OR 3.30, p<0.001); LCA did not predict more complications (OR 1.63, p=0.138) and LCA was performed at hospitals without RCs (OR 0.02, p<0.001). Limitations include observational study design, inability to assess disease severity, operative time, or body mass index, which may affect patient selection and outcomes.

Conclusions:

More patients had RPN vs. LCA; surgical technique was not predictive of postoperative complications. As technology develops to treat localized renal tumors, it will be important to continue to track outcomes and costs for procedures including RPN and LCA.

.


Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Cryosurgery/methods , Intraoperative Complications , Kidney Neoplasms/surgery , Laparoscopy/methods , Nephrectomy/methods , Robotic Surgical Procedures/methods , Age Factors , Cryosurgery/adverse effects , Hospital Mortality , Kidney Neoplasms/mortality , Kidney Neoplasms/pathology , Operative Time , Reference Values , Reproducibility of Results , Risk Factors , Robotic Surgical Procedures/adverse effects , Sex Factors , Treatment Outcome
14.
Article in English | IMSEAR | ID: sea-159374

ABSTRACT

Cryosurgery is a therapeutical approach that uses freezing to obtain a tissue inflammatory or destructive response. It has been successfully used for both cutaneous and oral conditions. The characteristics of oral mucosa like humidity and smoothness makes it an ideal site for this approach. Oral submucous fibrosis is a potentially malignant disorder of the oral mucosa, with areca nut chewing being the primary causative agent. Leukoplakia is a potentially malignant lesion associated with excessive consumption of alcohol and tobacco. Although there are no specific treatment modalities to prevent recurrence, abandoning habits can decrease the chance of recurrence, as well as the transfiguration into malignant tumors of these disorders. However, with the advent of cryosurgery, oral surgeons are provided with a new modality for treating oral potentially malignant disorders. This case report highlights the pioneering effect of nitrous oxide cryosurgery in treating two cases of oral submucous fibrosis with leukoplakia and oral leukoplakia respectively showing promising results during follow-up.


Subject(s)
Adult , Aged, 80 and over , Cryosurgery/methods , Cryosurgery/therapeutic use , Leukoplakia, Oral/diagnosis , Leukoplakia, Oral/surgery , Leukoplakia, Oral/therapy , Male , Oral Submucous Fibrosis/classification , Oral Submucous Fibrosis/diagnosis , Oral Submucous Fibrosis/surgery , Oral Submucous Fibrosis/therapy
15.
Article in English | WPRIM | ID: wpr-65417

ABSTRACT

PURPOSE: To report the long-term follow-up results after cyclocryotherapy, applied to the 3-o'clock and 9-o'clock positions in blind refractory glaucoma patients. METHODS: We retrospectively reviewed the charts of 19 blind patients, and a total of 20 eyes with refractory glaucoma who were treated with cyclocryotherapy. Cyclocryotherapy treatments were performed using a retinal cryoprobe. The temperature of each cyclocryotherapy spot was -80degrees C and each spot was maintained in place for 60 seconds. Six cyclocryotherapy spots were placed in each quadrant, including the 3-o'clock and 9-o'clock positions. RESULTS: The mean baseline pretreatment intraocular pressure (IOP) in all eyes was 50.9 ± 12.5 mmHg, which significantly decreased to a mean IOP at last follow-up of 14.1 ± 7.1 mmHg (p < 0.001). The mean number of antiglaucoma medications that patients were still taking at last follow-up was 0.3 ± 0.6. Devastating post-procedure phthisis occurred in only one eye. CONCLUSIONS: Cyclocryotherapy, performed at each quadrant and at the 3-o'clock and 9-o'clock position, is an effective way to lower IOP and, thus, is a reasonable treatment option for refractory glaucoma patients who experience with ocular pain and headaches.


Subject(s)
Adult , Aged , Aged, 80 and over , Blindness/etiology , Cryosurgery/methods , Female , Follow-Up Studies , Glaucoma/complications , Humans , Intraocular Pressure/physiology , Male , Middle Aged , Retrospective Studies , Time Factors , Treatment Outcome , Visual Acuity
16.
Article in English | WPRIM | ID: wpr-83658

ABSTRACT

Treatments for pure ground-glass nodules (GGNs) include limited resection; however, surgery is not always possible in patients with limited pulmonary functional reserve. In such patients, cryoablation may be a suitable alternative to treat a pure GGN. Here, we report our initial experience with cryoablation of a pure GGN that remained after repeated surgical resection in a patient with multiple GGNs. A 5-mm-sized pure GGN in the left lower lobe was cryoablated successfully without recurrence at the 6-month follow-up.


Subject(s)
Cryosurgery/methods , Female , Humans , Lung Neoplasms/diagnostic imaging , Middle Aged , Multiple Pulmonary Nodules/diagnostic imaging , Neoplasm Recurrence, Local/diagnostic imaging , Tomography, X-Ray Computed
17.
Dermatol. peru ; 24(2): 89-91, abr.-jun. 2014. ilus
Article in Spanish | LIPECS, LILACS, LIPECS | ID: lil-765230
18.
An. bras. dermatol ; 89(3): 410-413, May-Jun/2014. graf
Article in English | LILACS | ID: lil-711598

ABSTRACT

BACKGROUND: Cryosurgery is an efficient therapeutic technique used to treat benign and malignant cutaneous diseases. The primary active mechanism of cryosurgery is related to vascular effects on treated tissue. After a cryosurgical procedure, exuberant granulation tissue is formed at the injection site, probably as a result of angiogenic stimulation of the cryogen and inflammatory response, particularly in endothelial cells. OBJECTIVE: To evaluate the angiogenic effects of freezing, as part of the phenomenon of healing rat skin subjected to previous injury. METHODS: Two incisions were made in each of the twenty rats, which were divided randomly into two groups of ten. After 3 days, cryosurgery with liquid nitrogen was performed in one of incisions. The rats' samples were then collected, cut and stained to conduct histopathological examination, to assess the local angiogenesis in differing moments and situations. RESULTS: It was possible to demonstrate that cryosurgery, in spite of promoting cell death and accentuated local inflammation soon after its application, induces quicker cell proliferation in the affected tissue and maintenance of this rate in a second phase, than in tissue healing without this procedure. CONCLUSIONS: These findings, together with the knowledge that there is a direct relationship between mononuclear cells and neovascularization (the development of a rich system of new vessels in injury caused by cold), suggest that cryosurgery possesses angiogenic stimulus, even though complete healing takes longer to occur. The significance level for statistical tests was 5% (p<0,05). .


Subject(s)
Animals , Male , Rats , Cryosurgery/methods , Dermatologic Surgical Procedures/methods , Neovascularization, Physiologic/physiology , Nitrogen/therapeutic use , Cell Count , Random Allocation , Rats, Inbred Lew , Reproducibility of Results , Time Factors , Wound Healing/physiology
19.
Rev. Soc. Bras. Clín. Méd ; 12(1)jan.-mar. 2014. ilus
Article in Portuguese | LILACS | ID: lil-707354

ABSTRACT

A cromomicose é uma micose profunda, crônica, com acometimento da pele e do subcutâneo. O fungo é encontrado na natureza nas plantas e no solo, sendo introduzido no organismo através de traumas ou ferimentos. A localização das lesões é, principalmente, nos membros inferiores, podendo também comprometer outras regiões. Os trabalhadores rurais são mais frequentemente acometidos por falta de proteção e exposição contínua. O objetivo deste relato foi apresentar um caso de cromomicose de evolução crônica, fazendo diagnóstico diferencial com outras doenças que causam a síndrome verrucosa (leishmaniose, esporotricose e tuberculose) e realizando breve revisão da literatura. Paciente do gênero masculino, 83 anos, branco, trabalhador rural, procurou Ambulatório de Dermatologia apresentando lesão vegetante, verrucosa, de base eritematosa, com distribuição linear, localizada no membro superior direito com evolução de 9 anos. As características da lesão sugeririam como hipóteses diagnósticas doenças que causam a síndrome verrucosa LECT (iniciais de leishmaniose, esporotricose, cromomicose e tuberculose). Para confirmação diagnóstica, foi realizada biópsia da lesão e exame histopatológico, que revelou presença de células arredondadas de cor castanho escuro em processo de reprodução binária, confirmando o diagnóstico de cromomicose. O paciente foi submetido ao tratamento com itraconazol e crioterapia combinados. A cromomicose possui diagnósticos diferencias em decorrência das características clínicas da lesão,sendo fundamentais, para sua confirmação diagnóstica, exames específicos.


Chromomycosis is a deep and chronic mycosis that affects the skin and the subcutaneous tissues. The fungus is found in nature, in plants and soil, being introduced into the body through trauma or injury. Lesions occur mainly on the lower limbs, but can also involve other regions. Rural workers are more frequently affected due to lack of protection and continuous exposure. The objective of this report was to present a case of chronic chromomycosis evolution, making differential diagnosis with other diseases that cause warty syndrome (leishmaniasis, sporotrichosis and tuberculosis) and performing a brief literature review. Male patient, 83 years old, white, farm laborer, sought the Dermatology Department presenting vegetative, verrucous lesion, with erythematous base, linear distribution, located on the right upper limb, with a 9-year progression. Lesion characteristics would suggest as diagnostic hypotheses diseases that cause warty syndrome LECT (acronym in Portuguese from leishmaniasis, sporotrichosis, chromomycosis and tuberculosis). For diagnostic confirmation, a biopsy and an histopathological examination were performed and revealed the presence of round, dark brown cells in binary reproduction process, confirming the diagnosis of chromomycosis. The patient was treated with itraconazole and cryotherapy combination. Chromomycosis has differential diagnosis due to the clinical characteristics of the lesion; therefore specific tests are fundamental to confirm the diagnosis.


Subject(s)
Humans , Male , Female , Aged, 80 and over , Cryosurgery/methods , Chromoblastomycosis/diagnosis , Chromoblastomycosis/therapy , Agricultural Workers' Diseases/diagnosis , Agricultural Workers' Diseases/therapy , Itraconazole/therapeutic use , Combined Modality Therapy
20.
Korean Journal of Urology ; : 834-840, 2014.
Article in English | WPRIM | ID: wpr-187586

ABSTRACT

PURPOSE: To evaluate tumor-specific immunity and define the mechanisms involved in the cryoimmunologic response, we compared the tumor control efficacy and immunologic responses of cryoablation with those of surgical excision in a tumor rechallenge model. MATERIALS AND METHODS: Sixty BALB/c mice with RENCA tumors that were generated in the left flank area underwent cryoablation or radical excision. The mice successfully treated were rechallenged with RENCA or an undifferentiated colon carcinoma cell line, CT26, in the contralateral right flank area. The recurrence rate after tumor rechallenge in each group was then observed. To assess the immunologic response of each treatment modality, fluorescent-activated cell sorting (FACS) analysis and a cytotoxicity assay using 51Cr release were performed. RESULTS: After reinoculation of the RENCA cells, the rate of tumor growth was significantly higher in the surgical excision group than in the cryoablation group (94.4% vs. 11.1%, p=0.001). In the cryoablation group, the tumor growth rate was significantly increased after rechallenge of CT26 cells compared with RENCA (94.1% vs. 11.1%, p=0.001). The cryoablation group showed an elevated CD3, CD4, CD8 T, and natural killer cell count in the FACS analysis and also showed significantly increased cytotoxicity in the 51Cr release assay compared with the excision group. CONCLUSIONS: These results showed that cryoablation, compared to surgical resection, was more effective in preventing tumor growth after rechallenge with RENCA cells and that this response was tumor-specific, because the CT26 cells did not have the same effect.


Subject(s)
Animals , CD4-Positive T-Lymphocytes/immunology , CD8-Positive T-Lymphocytes/immunology , Carcinoma, Renal Cell/immunology , Cell Death , Cryosurgery/methods , Cytotoxicity, Immunologic , Disease Models, Animal , Kidney Neoplasms/immunology , Lymphocyte Count , Lymphocytes, Tumor-Infiltrating/immunology , Mice, Inbred BALB C , Neoplasm Recurrence, Local/immunology , Neoplasm Transplantation
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