Cryoablation versus hybrid radiofrequency with high- and very-high-power short-duration catheter ablation for the treatment of paroxysmal atrial fibrillation.

BACKGROUND: High-power short-duration (HPSD) and very-high-power short-duration (vHPSD-90 W/4 s) radiofrequency (RF) technology has reduced the procedure time of pulmonary vein isolation (PVI) using RF without compromising the efficacy of the technique. The current study compares the novel technology of HPSD/vHPSD with cryoablation (CRYO) in terms of efficacy, safety, and procedure time in a cohort of symptomatic patients with paroxysmal atrial fibrillation (pAF). METHODS: This is a prospective, non-randomized trial. Patients with pAF received either CRYO or HPSD/vHPSD RF PVI. The primary endpoint of the study was arrhythmia recurrence in a 12 month follow-up period. Secondary endpoints included procedure time, fluoroscopy time, and safety. RESULTS: 104 patients were included (45 in HPSD/vHPSD and 59 in CRYO), with comparable characteristics between groups. The follow-up was 12.4 ± 0.5 months. There was no significant difference regarding arrhythmia recurrences during the early post-procedural period of the first 3 months (8.9% recurrences in HPSD/vHPSD versus 5.1% in CRYO-p 0.463) and in the mid-term follow-up of 12 months (17.8% recurrences in HPSD/vHPSD versus 10.2% in CRYO-p 0.385). Safety was excellent for both procedures. CRYO was a procedure of significantly shorter duration (64.64 ± 8.94 min versus 75.29 ± 18.30 min, p = 0.0001) at the expense of longer fluoroscopy time (HPSD/vHPSD 5.34 ± 1.83 versus 7.89 ± 3.70 min CRYO, p 0.001). CONCLUSIONS: HPSD/vHPSD and CRYO in pAF were comparable regarding the arrhythmia recurrence rates in a 12-month follow-up with excellent safety. The hybrid approach of HPSD/vHPSD has accelerated RF-PVI compared to conventional RF, but CRYO remains a procedure of significantly shorter duration at the expense of longer fluoroscopy time.

The role of liquid-based cytology in the investigation of colorectal lesions: a cytohistopathological correlation and evaluation of diagnostic accuracy.

BACKGROUND AND AIMS: The role of cytologic techniques is not widely accepted even if it is well documented that the cytologic investigation of colorectal tract could complement the biopsy and increase the correct diagnosis of carcinomas. This study aims to evaluate the role of Thin-Prep(R) liquid-based cytology in the investigation of colorectal lesions. MATERIALS AND METHODS: We compared the diagnostic accuracy of Thin-Prep(R) with that of biopsy in 158 patients with signs and symptoms of the lower gastrointestinal tract. Each patient underwent colonoscopy, followed by tissue biopsy and brush cytology. Brushing material was obtained and prepared according to the operating manual of Thin-Prep(R). RESULTS: The rate of unsatisfactory smears was 5% (8/158) with liquid-based technique and appeared to be slightly higher than the respective of biopsy [3.2% (5/158) (5 vs 3.2%, P = 0.18)]. Based on the final diagnosis, 89 out of 93 total malignant cases and 53 out of 53 total benign cases were correctly diagnosed with Thin-Prep(R) technique (four false negatives). Accurate diagnosis with biopsy was performed in 87 out of 93 total malignant cases and 53 out of 53 total benign cases with biopsy (six false negatives). Neither in Thin-Prep(R) technique nor in biopsy were false-positive cases observed. The sensitivities of detecting malignancy by Thin-Prep(R) and biopsy were 95.7, and 93.5%, respectively (no significant difference, P = 0.239). The sensitivity was augmented (98.9%) when the two techniques were combined, and this difference was found to be statistically significant (98.9 vs 92.9, P = 0.01, and 98.9 vs 95.7, P = 0.039). CONCLUSIONS: Liquid-based cytology appears to be an easy, highly accurate, and reliable cytologic method for the diagnostic approach of colorectal diseases and could be applied as complementary to biopsy for the improvement of the diagnosis. Moreover, could be used for DNA ploidy analysis and immmunohistochemical studies.

Clinical significance of serum levels of E-selectin, intercellular adhesion molecule-1, and vascular cell adhesion molecule-1 in gastric cancer patients.

OBJECTIVES: This study evaluated serum concentrations of soluble cell adhesion molecules in patients with gastric cancer and in healthy control subjects. Our objectives were to correlate these levels with clinicopathological features, established tumor markers, and patient survival, and to assess changes in serum levels of cell adhesion molecules after tumor surgery. METHODS: The serum concentrations of the adhesion molecules E-selectin, intercellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1) were investigated by ELISA in 57 gastric cancer patients, both before and 7 days after surgery, and in 47 healthy control subjects. RESULTS: Preoperative serum concentrations of ICAM-1 and VCAM-1 in gastric cancer patients were significantly higher when compared with those of healthy controls, whereas there were no differences regarding serum E-selectin levels. Serum levels of E-selectin, ICAM-1, and VCAM-1 correlated significantly with each other. There was a significant association between preoperative levels of all three adhesion molecules and disease stage, gastric wall invasion, lymph node involvement, and presence of distant metastases. Their concentrations decreased significantly after radical resection of the tumor, whereas they remained almost unchanged in patients with unresectable disease. Elevated preoperative serum levels of E-selectin, ICAM-1, and VCAM-1 levels were found in 24.6%, 33.3%, and 28.1% of patients, respectively. Elevated levels of all three molecules were significant prognostic factors for patient survival but not independent of disease stage. CONCLUSIONS: These findings suggest that serum concentrations of E-selectin, ICAM-1, and VCAM-1 may reflect tumor progression and metastasis, and may be clinically useful.

Clinical significance of serum and urinary c-erbB-2 levels in colorectal cancer.

In this study we measured serum and urinary c-erbB-2 levels in 63 patients with colorectal cancer and 29 healthy controls, assessing their role in cancer-specific survival and the effects of resectional surgery. Serum and urinary c-erbB-2 levels were measured by an enzyme-linked immunosorbent assay, preoperatively and 7 days following tumor resection. Preoperative serum c-erbB-2 concentrations were significantly higher in the cancer patients and correlated with disease stage and the presence of liver metastases. Urinary c-erbB-2 was detected more often in cancer patients, although levels did not differ from controls and there was no association with any clinicopathological variable. Serum c-erbB-2 levels decreased significantly in those patients resected for cure and were an independent prognostic factor for cancer-specific survival with higher preoperative concentrations correlating with worse overall survival. These findings suggest that serum assessment of c-erbB-2 concentration may be valuable in defining colorectal cancer prognosis.

Clinical significance of soluble c-erbB-2 levels in the serum and urine of patients with gastric cancer.

BACKGROUND: Both tissue c-erbB-2 expression and serum levels the shed protein have been shown to correlate with tumour stage in a range of adenocarcinomas. This study measured serum and urinary c-erbB-2 levels in patients with gastric cancer, assessing their role in cancer-specific survival and the effects of resectional surgery. PATIENTS AND METHODS: Serum and urinary c-erbB-2 concentrations were measured with commercial enzyme-linked immunosorbent assay in 41 healthy controls and in 54 gastric cancer patients. Serum and urinary c-erbB-2 levels in cancer patients were determined before and 7 days following tumour surgery. RESULTS: Preoperative serum and urinary c-erbB-2 levels in gastric cancer patients were significantly higher than those in controls although there were no significant associations between these levels and tumour pathology. Serum c-erbB-2 levels decreased significantly after radical resection of the primary tumour and were an independent prognostic factor for survival, whereas there were no changes in urinary c-erbB-2 levels after surgery or an association with patient survival. CONCLUSION: Gastric cancer patients show higher serum and urinary c-erbB-2 levels compared to healthy controls. Preoperative serum c-erbB-2 concentration decreases significantly after radical resection of the primary tumour and is an independent prognostic factor for patient survival.