Surgical management of varicose veins: a comparative analysis between radiofrequency ablation and open surgery with venous stripping

Background: Varicose veins are a common condition affecting the lower limbs. Apart from having cosmetic problem, if not treated in time it can have some serious complications and are difficult to treat. Multiple modes of surgical management exist for the disease.Methods: This is a prospective clinical study, done over a period of 5-years, between February 2015 to February 2020. Patients were divided into 2 groups: group I (n=103) included those who underwent open surgical to treatment with venous stripping. Group II (n=104) included those who subjected to Radiofrequency ablation (RFA). Groups were selected with comparable physical parameters. Various parameters like bleeding, hematoma, blood requirement, postoperative inflammation, pain, numbness, mobilization, date of discharge and resuming duties were compared. All patients were followed up for 1y ear.Results: Majority of our patients belongs to age group 20-40 years with mean age of 35year in both groups. Male has dominance over female with male to female ratio 4:1. We noticed significant complication in group I than group II, such as bleeding (20:1), hematoma (5:0), inflammation (60:1) and blood requirement (1:0). In group II, we noticed early mobilization of patient (1day v/s 3 days), discharge from hospital (1day v/s 5 days) and resuming duties (5 days v/s 2 weeks).Conclusion: RFA keeps an edge over open surgical treatment with venous stripping.

Purely Endovenous Polytherapy for Varicose Veins - How Good is It?

Introduction: Varicose veins are common disorder causingleg pain, blue veins and ulcer in humans. Varicose veinsproduce symptoms due to junctional incompetence, perforatorincompetence or both. In a unique combination of treatmentmodality we have used RFA for large vein ie GSV and SSV, glueembolization for incompetent perforator and sclerotherapyfor superficial varicosity. In our mind Combination of thesetherapies have synergistic action and better short term andlong term outcome and our aim is to find the same.Material and methods: Study was done in department ofradiology Geetanjali Medical College and Hospital,Udaipurfrom january 2019 to july 2019. Patients with varicose veinswho underwent combination polytherapy in interventionalradiology subdivision of were included in the study. Closurefast RFA system with 7cm ablation zone catheter fromMedtronic was used in all cases.Results: In our study of 27 patients all had leg pain and visiblevericocity as presenting symptoms 15 patients had pain withvenous edema and 12 patients had active ulcers. On followup at 1 month 11 patient had ulcer healing mean duration was2 weeks 1 patient had to undergo skin grafting. At 6 monthsfollow up 2 patients had residual symptomatic varicosity andsegmental recanalization of GSV. The long term obliterationrate was 92.59%. 5 patients had mild leg pain on prolongedstanding. Complications were bruising of overlying skin in5 patients but none had ulceration. Thrombophlebitis in 1patient and transient paraesthesia in 3 patients however nonehad permanent deficits. We did not record any DVT.Conclusion: For treatment of varicose veins especially inthe presence of venous stasis ulcers, treatment with triplecombination therapy is associated with faster ulcer healingand lower recurrence rate of ulcer as well as varicocities.

A Comparative Study between Radio Frequency Ablation and Laser Therapy in the Treatment and Management of Varicose Veins

Various studies have recorded the comparison of use of both surgical techniques endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) in the treatment of varicose veins. However, it is still not clear that which technique out of these two methods is more effective and useful for the treatment of varicose veins is more effective. Therefore the present study was designed to compare the effectiveness of EVLA and RFA in the treatment of varicose veins. Methods: Hundred patients, with symptomatic great saphenous vein deficiency in both lower extremities were enrolled in this study. Patients’ ages ranged between 29 and 64. Two groups were made group 1 ELVA consisting of fifty patients and group II RFA consisting of fifty patients. A 12 W diode laser source with a wavelength of 1470 nm and radial fiber were used for EVLA. Radiofrequency Ablation Procedure was applied to the saphenous vein in the form of 25 W every 0.5 cm from the distal aspect of the saphenofemoral junction. Results: Pain score (inter-operative) was 1.7 ± 0.8 for ELVA group while 1.8 ± 0.9 for RFA group which was insignificant (p>0.05). Further, there was a significant lesser postoperative pain score in ELVA group (1.2 ± 0.6/ d) compare to RFA group (1.4 ± 0.8/ d) with p <0.05. There was an insignificant difference between the post-operative analgesic requirement of both groups (800 ± 150 mg/d vs 900 ± 200 mg/d, p>0.05). In addition a significantly less time duration to start post-operative activity was recorded in ELVA group (22 ± 4.5 hrs) in comparison of RFA group (28 ± 5.2 hrs) with p value <0.05. Conclusion: Finding of the present study showed that success rate of both techniques in the treatment of varicose veins was almost similar. However, there was significantly better patients’ satisfaction along with lesser post-operative complications in EVLA group compare to RFA group. Therefore, we conclude that ELVA method EVLA at a wavelength of 1470 nm and using radial fibre is superior to RFA technique.

Comparison of Chronologic Change in the Size and Contrast-Enhancement of Ablation Zones on CT Images after Irreversible Electroporation and Radiofrequency Ablation

OBJECTIVE: To compare short-, mid-, and long-term follow-up ablation zone volume alterations as well as imaging features on contrast-enhanced computed tomography (CT) after irreversible electroporation (IRE) of primary and secondary liver tumors with findings subsequent to radiofrequency ablation (RFA). MATERIALS AND METHODS: Volume assessment of 39 ablation zones (19 RFA, 20 IRE) after intervention was performed at four time intervals (day 0 [t1; n = 39], day 1–7 [t2; n = 25], day 8–55 [t3; n = 28], after day 55 [t4; n = 23]) on dual-phase CT. Analysis of peripheral rim enhancement was conducted. Lesion's volume decrease relative to the volume at t1 was calculated and statistically analyzed with respect to patient's sex, age, ablation modality (IRE/RFA), and history of platinum-based chemotherapy (PCT). RESULTS: No influence of patient's sex or age on ablation volume was detected. The decrease in ablation zones' volume was significantly larger (p < 0.05 for all time intervals) after IRE (arterial phase, 7.5%; venous phase, 9.7% of initial volume) compared to RFA (arterial phase, 39.6%; venous phase, 45.3% of initial volume). After RFA, significantly smaller decreases in the ablation volumes, in general, were detected in patients treated with PCT in their history (p = 0.004), which was not detected after IRE (p = 0.288). In the arterial phase, peripheral rim enhancement was frequently detected after both IRE and RFA. In the venous phase, rim-enhancement was depicted significantly more often following IRE at t1 and t2 (pt1 = 0.003, pt2 < 0.001). CONCLUSION: As per our analysis, ablation zone volume decreased significantly in a more rapid and more profound manner after IRE. Lesion's remodeling after RFA but not IRE seems to be influenced by PCT, possibly due to the type of cell death induced by the different ablation modalities.

Efficacy of radiofrequency ablation in treatment of complicated pyogenic liver abscess / 中华肝胆外科杂志

Objective To evaluate the efficacy of radiofrequency ablation (RFA) in treatment of complicated pyogenic liver abscess (PLA).Methods A retrospective analysis was conducted on 20 patients with complicated PLA treated from August 2010 to January 2018 in the West Campus of Beijing Chao-yang Hospital which is Affiliated to the Capital Medical University and Rizhao Central Hospital of Shandong Province.These patients were treated with RFA based treatment modalities using CT-guided or laparoscopy combined with Ultrasound-guided RFA.The successful rate,efficacious rate and safety of RFA were respectively analyzed.Routine follow-up was carried out after treatment.Results The successful rate of RFA was 100％.The median operation time was 45 minutes.All the 20 patients were cured by one session of RFA.The multilocular lesion in one patient was converted to a unilocular lesion after one session of RFA.The patient was then cured by percutaneous hepatic abscess drainage.No serious complications were observed.Conclusions RFA was safe and efficacious.It should be considered as an alternative treatment for patients with complicated PLA who were not responsive to,or not applicable to antibiotics treatment and radiological intervention.

Evaluation of the stability of sandblasted, large-grit, acid-etched implants with tapered straight body design

PURPOSE: Implant surface modification and implant design are the principle targets for achieving successful primary stability. The aim of this study was to measure implant stability quotient (ISQ) values of sandblasted, large-grit, acid-etched (SLA) implants with tapered straight body design during the healing period, and to determine the various factors affecting implant stability. MATERIALS AND METHODS: To measure implant stability, resonance frequency analysis (RFA) was performed in 26 patients (13 women and 13 men) with 44 SLA implants with tapered straight body design. Implant stability (ISQ values) was evaluated at baseline and healing abutment connection (12 weeks), and the correlations between RFA and insertion torque (IT), bone quality, and jawbone were determined. RESULTS: The mean ISQ value of the implants was 69.4 ± 10.2 at the time of implant placement (baseline) and 81.4 ± 6.9 at the time of healing abutment connection (P 0.05). CONCLUSION: ISQ values of SLA implants with tapered straight body design were high at baseline and healing abutment connection. It was concluded that SLA implants with tapered straight body design show improved primary and secondary stability, and that immediate or early loading may be applicable.

Subperiosteal Osteoid Osteoma of the Knee: Case Report

Osteoid osteoma, a frequent lesions of bone, is usually intraosseous but occasionally subperiosteal. We describe the case of a 19-year-old male with knee pain caused by subperiosteal osteoid osteoma. Radiologic evaluation was performed with radiographic, computed tomography (CT), ultrasonographic (US) and magnetic resonance imaging (MRI). But the preoperative diagnosis of osteoid osteoma was delayed because of unusual imaging findings and atypical symptom. After excisional biopsy, histological examination confirmed the diagnosis of osteoid osteoma. The lesion was treated successfully with CT-guided radiofrequency ablation.

Assessment of Implant Stability: Methods and Recent Advances.

Achieving primary stability is of greatest importance, at the time of implant placement. A rigid fixation of implant within the host bone, in absence of micromotion is the most critical factor for successful osseointegration. Over the years, several authors have reported various methods in literature to monitor implant stability, which include, tapping the abutment with a metallic instrument, histomorphometry test, removal torque test, cutting torque test, radiography, periotest, and resonance frequency analysis. Resonance frequency analysis (RFA) offers a clinical, objective way to measure stability and presumed osseointegration of implants. The review focuses on different methods used to assess implant stability and recent advances in this field.

Nursing Experience on Ultrasonic Guidance Radiofrequency Ablation Treating Lung Cancer / 浙江中医药大学学报

[Objective] To discuss the nursing to the common complications in perioperational period of lung cancer treated with ultrasonic guidance transdermal radiofrequency ablation(RFA). [Method] 12 cases of peripheral lung cancer treated with ultrasonic guidance transdermal RFA, took active mental nursing, closely cooperated in operation, strictly observed the disease condition after operation, had good nursing of perioperational period, and were strengthened on observation of complications and prevention. [Result] 12 cases had smooth operation, part of them had pain at puncture spot, fever, little aerothorax and hydrops, with blood in sputum at cough, and were relieved timely with active observation and clinical nursing, without other severe complications, final y they were discharged from hospital upon recovery, without death in perioperational period. [Conclusion] The ultrasonic guidance RFA is a safe and effective method to treat peripheral lung cancer with little invasion; the nursing point is to closely observe disease condition before and after operation, and do wel general nursing.

Risk factors for 302 hepatic malignancies cases with residual tumor after ultrasound-guided radiofrequency ablation treatment / 中国癌症杂志

Background and purpose: Radiofrequency ablation (RFA) is one of the effective treatment methods for primary liver cancer and metastatic liver cancer. The purpose of this study was to investigate the risk factors of residual tumor after RFA for hepatic malignancies. Methods:A total number of 302 hepatic malignancies cases with 691 tumors after ultrasound-guided RFA from Jan. 2010 to Mar. 2013 were retrospectively analyzed. Single factor and multi-factor Logistic regression model were used to analyze the risk factors of residual tumor after RFA. Results:Complete ablation cases were 90.07%(272/302) for patients and 91.46%(632/691) for tumors, and the ablation residual rate was 8.54%. Ablation residual rates for tumor ≤3 cm, 3-5 cm and >5 cm in diameter were 6.30%, 9.57% and 28.57%, for tumor close to the intrahepatic vascular and gallbladder were 17.14%and 18.52%, for with and without combination with other local treatments were 7.02%and 13.41%, respectively. Multivariate analysis showed that tumor size>5 cm (P=0.044), proximity to large vessel (P=0.039) and without combination with other local treatments (P=0.001) were independent risk factors for ablation residual. Multivariate analysis showed that tumor near the intrahepatic vascular (P=0.014), single needle RFA (P=0.047) and without combination with other local treatments (P=0.023) were independent ablation residua risk factors for tumors between 3-5 cm in maximum diameter. Conclusion:Ultrasound-guided RFA can achieve satisfactory ablation effect. Tumor close to the intrahepatic vascular, tumor diameter>5 cm and without combination with other local treatment act as the independent risk factors for ablation residual. For tumors between 3-5 cm in diameter, in addition to close to intrahepatic blood vessels and without combination with other local treatment, single needle RFA is also another independent risk factor for ablation residual, and double-needle or multi-needle treatment can improve the ablation efifciency and reduce residual rate.

Hypertensive crisis during percutaneous radiofrequency ablation of a metastatic adrenal tumor under general anesthesia: A case report

Radiofrequency ablation (RFA) has been used as an alternative method of surgical treatment to treat neoplasms of variable body organs. In considerable proportion of RFA cases, anesthesiologists are asked to conduct general anesthesia. RFA has been known to be a safe and effective treatment, however injury to adjacent normal tissue during RFA develops serious complications. In particular, unintended injury to normal adrenal tissue of adrenal tumors can cause severe complications such as hypertensive crisis due to excessive secretion of catecholamine. However, serious complications of primary or metastatic adrenal tumors have been rarely reported due to RFA. We report a case of hypertensive crisis with associated tachycardia and ventricular arrhythmia during RFA of hepatocellular carcinoma metastatic to the adrenal gland.

CT-guided radiofrequency ablation of VX2 lung tumors in rabbits / 中国癌症杂志

10.3969/j.issn.1007-3969.2013.05.005

Hemorrhagic Cardiac Tamponade: Rare Complication of Radiofrequency Ablation of Hepatocellular Carcinoma

Local treatment for hepatocellular carcinoma (HCC) has been widely used in clinical practice due to its minimal invasiveness and high rate of cure. Percutaneous radiofrequency ablation (RFA) is widely used because its treatment effectiveness. However, some serious complications can arise from percutaneous RFA. We present here a rare case of hemorrhagic cardiac tamponade secondary to an anterior cardiac vein (right marginal vein) injury during RFA for treatment of HCC.

The influence of implant diameter, length and design changes on implant stability quotient (ISQ) value in artificial bone / 대한치과보철학회지

PURPOSE: The purpose of this study is to ascertain the stability of the implant by comparing the effects of the change of implant diameter, length and design on implant stability quotient. MATERIALS AND METHODS: To remove the variable due to the difference of bone quality, the uniform density (0.48 g/cm3) Polyuretane foam blocks (Sawbones(R), Pacific Research Laboratories Inc, Vashon, Washington) were used. Implants (Implantium(R), Dentium, Seoul, Korea) were placed with varying diameters (phi3.8, phi4.3 and phi4.8) and length (8 mm, 10 mm and 12 mm), to assess the effect on implant stability index (ISQ). Also the influence of the design of the submerged and the non-submerged (SimplelineII(R), Dentium, Seoul, Korea) on ISQ was evaluated. To exclude the influence of insertion torque, a total of 60 implants (n = 10) were placed with same torque to 35 N. Using Osstell(TM) mentor (Integration Diagnostic AB, Sweden) ISQ values were recorded after measuring the resonant frequency, one-way ANOVA and Tukey HSD test results were analyzed. (alpha=0.05). RESULTS: 1. The change of the diameter of the implant did not affect the ISQ (P>.05), but the increase of implant length increased the ISQ(P<.001). 2. The change in implant design were correlated with the ISQ, and the ISQ of submerged design was significantly higher than that of the non-submerged design(P<.05). CONCLUSION: In order to increase implant stability, the longer implant is better to be selected, and on the same length of implant, submerged design is thought to be able to get a higher ISQ than the non-submerged.

Radiofrequency Ablation for Benign Thyroid Nodules Performed by Surgeon / 대한내분비외과학회지

PURPOSE: The ability to apply radiofrequency ablation (RFA) has provided for a greater diversity of approaches for treatment of benign thyroid nodules. This study evaluated the efficacy and safety of RFA performed by a surgeon. METHODS: From January 2009 to November 2010, a total of 47 benign thyroid nodules were treated with RFA performed by one surgeon. Nodular patterns were divided into mainly cystic, mixed, and mainly solid (soft solid, hard solid) nodules, and ultrasonography was performed for assessment of the volume-reduction radio (VRR) of each nodule. Follow-up ultrasonography was performed three to 19 months after ablation. And complication was observed. One session of RFA was performed. RESULTS: The median volume before ablation was 7.8 cm³ (range 1.3~43.2 cm³). After ablation, the median volume was 0.9 cm³ (range 0.0-21.6 cm³) and VRR was 81.5±17.3%. RFA in mainly cystic nodules resulted in significant decreases in VRR (93.7±5.0%, P=0.009). It was the largest among the nodular types. VRR was 81.4±13.1% in mixed nodules, 77.2±19.2% in mainly solid nodules, 85.9±11.0% in soft solid nodules, and 54.2±17.3% in hard solid nodules 95.7% of nodules (45 nodules) showed more than 50% reduction, while the two remaining nodules, which were hard solid nodules, showed less than 50% reduction. Complications included pain, voice change, nausea, and transient voice change. CONCLUSION: Results of this study demonstrated the safety and effectiveness of RFA performed by a surgeon for reducing nodule volume.

Structurally conserved C-RFa revealed prolactin releasing activity in vitro and gene expression changes in pituitary of seasonally acclimatized carp

Here we show the cloning and characterization of a novel homolog of prepro C-RFa cDNA from Cyprinus carpió. The deduced preprohormone precursor of 115 amino acids leads to a mature bioactive peptide of 20 amino acids with identical sequence to other teleost C-RFa. Modeling of the mature C-RFa peptide highlighted significant similarity to homologous human PrRP20, specifically the conserved amphipathic system defined by the C-terminal alpha-helix. Clearly, the synthetic C-RFa peptide stimulated prolactin release from primary cultured fish pituitary cells. For the first time, significant variation was shown in C-RFa mRNA and protein levels in the hypothalamus and pituitary between summer- and winter-acclimatized carp. Furthermore, C-RFa protein distribution in carp central nervous tissue was visualized by immunodetection in fibers and cells in hypothalamus, olfactory tract, cerebellum and pituitary stalk. In conclusion, we demonstrated the structure conservation of C-RFa in teleosts and mammals and immunopositive cells and fibers for C-RFa in brain areas. Finally, the increase of C-RFa expression suggests the participation of this hypothalamic factor in the mechanism of modulation in PRL expression in carp.

Resonance frequency analysis.

Initial stability at the placement and development of osseointegration are two major issues for implant survival. Implant stability is a mechanical phenomenon which is related to the local bone quality and quantity, type of implant, and placement technique used. The application of a simple, clinically applicable, non-invasive test to assess implant stability and osseointegration is considered highly desirable. Resonance frequency analysis (RFA) is one of such techniques which is most frequently used now days. The aim of this paper was to review and analyze critically the current available literature in the field of RFA, and to also discuss based on scientific evidence, the prognostic value of RFA to detect implants at risk of failure. A search was made using the PubMed database to find all the literature published on "Resonance frequency analysis for implant stability" till date. Articles discussed in vivo or in vitro studies comparing RFA with other methods of implant stability measurement and articles discussing its reliability were thoroughly reviewed and discussed. A limited number of clinical reports were found. Various studies have demonstrated the feasibility and predictability of the technique. However, most of these articles are based on retrospective data or uncontrolled cases. Randomized, prospective, parallel-armed longitudinal human trials are based on short-term results and long-term follow up are still scarce in this field. Nonetheless, from available literature, it may be concluded that RFA technique evaluates implant stability as a function of stiffness of the implant bone interface and is influenced by factors such as bone type, exposed implant height above the alveolar crest. Resonance frequency analysis could serve as a non-invasive diagnostic tool for detecting the implant stability of dental implants during the healing stages and in subsequent routine follow up care after treatment. Future studies, preferably randomized, prospective longitudinal studies are certainly needed to establish threshold ranges for implant stability and for implants at risk for losing stability for different implant system.

Management of Pulmonary Metastasis / 대한내과학회지

The lung is a common site for metastasis of malignant tumors from other organs. The metastatic cascade is a complex process that involves a series of events. Tumors can spread to the lung through hematogenous or lymphangitic routes. In the absence of extrathoracic metastasis, complete resection is associated with increased survival, regardless of histology. With appropriate patient selection, life expectancy is often improved with pulmonary metastasectomy. Stereotactic body radiation therapy (SBRT) and radiofrequency ablation (RFA) are 2 approaches that have been increasingly reported for pulmonary tumors. Although these new therapies have yet to match the long-term success rates of surgical therapy, the techniques demonstrate good results in treating high-risk surgical candidates with metastatic lesions to the lungs that would otherwise be considered with resection. This review will focus on the role of local therapy in oligometastasis that arise in the lung.

COMPARISON OF RESONANCE FREQUENCY ANALYSIS BETWEEN VARIOUS SURFACE PROPERTIES

A comparative study on the accuracy of the devices for measuring the implant stability

STATEMENT OF PROBLEM: How the ISQ values measured by Osstell(TM) and Osstell(TM) Mentor are related, and whether the ISQ values acquired from the two machines changes in accordance with changes in implant stability are not yet fully understood. PURPOSE: The aim of this study was to find out correlation between the ISQ values acquired from Osstell(TM) and Osstell(TM) Mentor, and to evaluate the clinical effectiveness and accuracy of two devices. MATERIAL AND METHODS: Sixty two implants were inserted into 47 patients, and their ISQ values were measured using Osstell(TM) and Osstell(TM) Mentor. In the first stage surgery, the ISQ values of forty four implants inserted into thirty five patients were measured. In the second stage surgery, the values of fifty implants inserted into thirty seven patients were measured. The values were analyzed to determine the difference between the mean ISQ values of Osstell(TM) and Osstell(TM) Mentor. In addition, the correlation between implants used in the first and second stage of surgery with regard to their types and areas of insertion were analyzed. The difference between the ISQ values of 32 implants in each patient during the first and second stage was analyzed. The statistical assessment was carried out using SPSS V. 12.0 for Win. (SPSS Inc., Chicago, USA). The Pearson correlation coefficient was used to examine the correlation between Osstell(TM) and Osstell(TM) Mentor in the first and second stages of surgery, whereas the difference between their ISQ values was evaluated using a paired t-test. RESULTS: In the first stage, the mean ISQ value for Osstell(TM) and Osstell(TM) Mentor was 70.84 and 75.09, respectively, showing a significant difference (P < .01). In the second stage, the mean ISQ value of Osstell(TM) and Osstell(TM) Mentor was 71.76 and 75.94, respectively, also showing a significant difference (P < .01). The difference between the ISQ values in patients in the first and the second stages was significant with both instruments. CONCLUSION: The significant difference in the values obtained using the Osstell(TM) and Osstell(TM) Mentor between the first and second stages of implant surgery indicates that these values can be a convenient and precise way for evaluating the implant stability in clinical practice.