Safety and Clinical Outcomes of Two-Session Catheter-Directed Sclerotherapy Using Ethanol for Endometrioma.

PURPOSE: To evaluate the safety and clinical outcome of two-session catheter-directed sclerotherapy (CDS) with 99% ethanol in patients with endometrioma. MATERIALS AND METHODS: This prospective study was approved by the institutional review board with written informed consent obtained from all participants and was registered on clinicaltrial.gov. Consecutive patients with ovarian endometrioma between June 2020 and March 2023 were prospectively evaluated for two sessions of CDS. After successful transvaginal ultrasound-guided puncture of the endometrioma, the biopsy needle was exchanged for a 7- or 8.5-F catheter for aspiration and ethanol injection. The catheter was retained in situ for a second session the next day. Endometrioma volume was measured on ultrasound before and 1, 3, and 6 months after CDS, and volume reduction ratio (VRR) was calculated. Serum anti-Müllerian hormone (AMH) was measured before and 6 months after CDS to assess ovarian reserve. RESULTS: Thirty-one endometriomas in 22 patients (mean age, 31.0 years; range, 19-44 years) were treated; 28 endometriomas were successfully treated with two-session CDS, while one session was incomplete in three endometriomas in three patients due to contrast medium leakage or pain. Minor procedure-related complications developed in four patients and resolved spontaneously before discharge on the same day of the second session. No recurrence was identified during follow-up. At the 6-month follow-up, the mean endometrioma diameter decreased from 5.5 ± 1.7 to 1.4 ± 0.9 cm (P < 0.001), and the serum AMH level was lowered without statistical significance (1.37 ± 0.96 ng/mL vs. 1.18 ± 0.92 ng/mL; P = 0.170). VRRs at 1, 3, and 6 months after CDS were 84.3 ± 13.7%, 94.3 ± 5.8%, and 96.4 ± 4.7%, respectively. CONCLUSION: Two-session CDS with 99% ethanol is safe, feasible, and effective for treating endometrioma with the ovarian function well preserved.

Uterine artery embolization combined with percutaneous microwave ablation for the treatment of prolapsed uterine submucosal leiomyoma: A case report.

BACKGROUND: Vaginal myomectomy is the most common form of radical treatment for prolapsed submucosal leiomyoma and is typically performed under general anesthesia. However, an alternative treatment approach is needed for patients who cannot tolerate general anesthesia. We describe a case with such a patient who was successfully treated via a minimally invasive method under local anesthesia. CASE SUMMARY: A 46-year-old female suffered from abnormal uterine bleeding, severe anemia, and a reduced quality of life attributed to a massive prolapsed submucosal leiomyoma. She could not tolerate general anesthesia due to a congenital thoracic malformation and cardiopulmonary insufficiency. A new individualized combined treatment, consisting uterine artery embolization (UAE), percutaneous microwave ablation (PMWA) of the pedicle and the endometrium, and transvaginal removal of the leiomyoma by twisting, was performed. The lesion was completely removed successfully under local anesthesia without any major complications. The postoperative follow-up showed complete symptom relief and a significant improvement in the quality of life. CONCLUSION: UAE combined with PMWA can be performed under local anesthesia and is a promising alternative treatment for patients who cannot tolerate general anesthesia.

[Long-term outcome of interventional therapy for malignant biliary obstruction: a retrospective analysis of 109 cases].

OBJECTIVE: To evaluate the long-term outcome and its relative influenced factors of interventional therapy in dealing malignant biliary obstruction (MBO). METHOD: 109 MBO patients, 54 males and 55 females, aged (71 +/- 12), underwent interventional therapy: 55 patients received percutaneous transhepatic cholangiography and drainage (PTCD), and 54 underwent bile duct stent implantation. One week later, total bilirubin (TB), direct bilirubin (DB), and alanine transaminase (ALT) were examined, and Child-Pugh scoring was conducted.38 of the patient underwent transcatheter arterial chemo-embolization (TACE). RESULTS: One week after drainage the levels of ALT, TB, and DB of the patients undergoing PTCD and stent implantation all decreased in comparison with those before the treatment, the levels of the stent implantation group being significantly lower than those of the PTCD group (P = 0.019, 0.002, and 0.002 respectively), but there was no significant difference in Child-Pugh scale between these 2 group (P = 0.396). One week after TACE the levels of TB, DB, and Child-Pugh scale of the TACE group were all significantly lower than those of the patients without TACE (P = 0.000, 0.002, and 0.002 respectively), however, there was no significant difference in ALT level between these 2 groups (P = 0.834). The cumulative mean survival time was 26.45 weeks [standard error (SE) 4.07], and the mean survival time of the PTCD group was 28.19 weeks (SE, 6.54), not significantly different from that of the stenting groups were [21.38 weeks (SE, 2.51), P = 0.713]. The mean survival time of the TACE group was 43.71 weeks (SE, 8.32), significantly longer than that of the patients without TACE [14.38 weeks (SE, 2.66), P = 0.000]. CONCLUSION: Stenting is more effective than PTCD on relieving jaundice when the decreasing extent of bilirubin level is concerned. TACE therapy following PTCD and stent implantation will significantly contribute to the survival time of MBO patients.

[Cryosurgical ablation for 23 cases of prostate cancer guided by rectal ultrasound].

OBJECTIVE: To detect the short-term clinical and side effects of cryosurgical ablation for prostate cancer. METHODS: The ENDOCAm cryosurgical system with 2 mm Cryo-probes was used to treat the prostate cancer guided by rectal ultrasonic. 1. Completeness of freeze; 2. Complications; 3. The changes of PSA and PSMA before and after operation were observed respectively. RESULTS: 1. The completeness of freeze rate and non-completeness of freeze rate were 34.8% (8/23) and 65.2% (15/23) showed by MRI 3 weeks later after operation; the biopsy results showed that tumor positive rates in completeness of freeze group and non-completeness of freeze group were 0 and 20% (3/15) respectively after 6 months. 2. The incontinence rate was 13%, and all recovered during 1 month; and the erectile dysfunction rate post-operation was 56.2% (9/16). 3. The levels of PSA before and after cryosurgical ablation were (32.98 +/- 35. 50) microg/L, (11.65 +/- 26. 51) microg/L respectively (P < 0.05). PSMA increased significantly after the cryosurgical ablation. CONCLUSION: The short-term curative effects of cryosurgical ablation, which guided by rectal ultrasound for prostate cancer is satisfied with low complication rate and minor vulnus.

[A randomized trial of docetaxol plus cisplatin versus gemzar plus cisplatin in treating advanced non-small cell lung cancer].

BACKGROUND & OBJECTIVE: Treating advanced non-small cell lung cancer (NSCLC) is difficult. The response rate (RR) of NSCLC patients to traditional chemotherapy regimen is about 40%. Now the RR has been improved with application of new drugs, such as taxol, docetaxal, and gemzar. This randomized trial was designed to determine treatment efficacies of docetaxol plus cisplatin and gemzar plus cisplatin on advanced NSCLC, and observe their cytotoxicities. METHODS: A total of 43 advanced NSCLC patients were randomized into 2 groups, 22 in TP group (docetaxol plus cisplatin) and 21 in GP group (gemzar plus cisplatin), and received relevant treatments. The RR, time to progression (TTP), mean survival time (MST), and 1- and 2-year survival rates of the patients were analyzed. RESULTS: The RR was 45.4% in TP group with 1 case of complete remission (CR) and 9 cases of partial remission (PR), and 42.9% in GP group with 9 cases of PR. The TTP was 4.6 months in TP group, and 4.7 months in GP group; the MST was 10.6 months in TP group [95% confidence interval (CI), 9.3-11.3 months], and 11.3 months in GP group (95% CI, 6.8-14.8 months). The 1- and 2-year survival rates were 38.1% and 15.3% in TP group, and 34.1% and 11.2% in GP group. The differences of RR and survival rate between the 2 groups were not significant (P=0.71, P=0.89). The major cytotoxicity of TP was leukopeniaû the major cytotoxicities of GP group were fatigue and thrombocytopenia. All adverse reactions were tolerable. CONCLUSION: TP and GP regimens may enhance the remission rate of NSCLC patients with tolerable adverse reaction, and improve the short-term survival rate, but the differences in treatment efficacies of TP and GP groups are not significant.