Percutaneous radiofrequency ablation of small renal cell carcinoma: technique, complications, and outcomes.

Imaging-guided radiofrequency ablation (RFA) is an option for treatment in patients with early-stage small renal cell carcinomas (RCCs). RFA has been introduced to treat focal renal tumors, particularly incidental lesions <3 cm in elderly patients and those with comorbid conditions. Other uses have included treatment in patients with von Hippel-Lindau syndrome and other diseases that predispose patients to multiple renal carcinomas, where renal parenchymal preservation is desired. It appears that this technique has a low complication rate, preserves renal function, is well tolerated by the patients, and, in a high percentage of patients, can eradicate small renal tumors. Techniques, patient selection, complications, and results are discussed.

Percutaneous imaging-guided radiofrequency ablation of small renal cell carcinoma: techniques and outcomes of 24 treatment sessions in 18 consecutive patients.

PURPOSE: To evaluate the early clinical experience associated with percutaneous imaging-guided radiofrequency ablation (RFA) in patients with renal cell carcinoma (RCC). METHODS: Eighteen consecutive patients with RCC were treated with percutaneous RFA sessions (24 sessions for 19 solitary RCC in 18 patients: 15 patients underwent a single RFA session, 3 had 2 sessions and one 3 sessions). Treatment indications were localized, solid renal mass <4.5 cm, comorbidities precluding surgery, high operation risk, and refusal to perform surgery. During 23 sessions, RFA was performed using computed tomography (CT) guidance and in one session it was guided by ultrasonography. The average patient age was 76.8±7.6 years (range 64-89), and the average renal mass size 3.3 ±0.7 cm (range 2.0-4.5). Follow-up imaging was performed at 3- and 6-month intervals and yearly thereafter. Successful treatment was defined as lack of enhancement of the treated region on follow-up CT studies. RESULTS: RFA was technically successful in all patients. After the last imaging control, 17 of the 19 tumors were completely necrotic according to the imaging criteria (the secondary clinical success rate was 89.5%). Thirteen tumors were not visible on the first follow-up imaging control (the primary clinical success rate was 68.4% - 13 of 19). In 4 of the 6 patients residual tumors were successfully re-ablated, while in 2 patients repeated RFAs were not performed at the time of writing this report. Five patients (20.8%) developed treatmentrelated complications, including mild pain, large perirenal abscess, mild perirenal hematoma and transient elevation of the white blood cell count. The mean follow-up period was 25.3±16.8 months (range 1-51). CONCLUSION: RFA is effective and safe treatment option of exophytic RCC <5 cm in diameter in patients not suitable for surgery due to serious concomitant diseases or advanced age.

Arterial embolization of uterine fibroids.

PURPOSE: the aim of this study was to analyze outcomes in a series of patients with symptomatic uterine fibroids who had undergone endovascular arterial embolization. METHODS: analysis included 36 patients with uterine fibroids and average age of 38.5 years, with bilateral endovascular embolization of fibroid-feeding arteries. Solitary uterine fibroids were present in 20 (56%) patients, and multiple in 16 (44%) patients. The patients were followed up to one year after embolization. RESULTS: in the subgroup of patients with solitary uterine fibroids, 6 months after the embolization, the volume of uterine fibroids was reduced to 50% in 16 patients, and to 38% in 4 patients. After one year, the volume of uterine fibroids was reduced to 50% in all 36 patients. In the subgroup of patients with multiple uterine fibroids, 6 months after the embolization, the volume of uterine fibroids was reduced to 50% in 10 patients, and to 36% in 6 patients. After one year, the volume of uterine fibroids was reduced to 50% in 14 patients, while in 2 patients the reduction of the volume remained 36%. After one year, all patients became symptomless. CONCLUSION: the results of this case series show high efficacy of endovascular embolization of uterine fibroids: with a minimally invasive treatment, the volume of uterine fibroids is halved and symptoms disappear, obviating the need for a surgical intervention.

[Transcatether chemoembolization in the treatment of hepatocellular carcinoma].

UNLABELLED: The authors describe their own experience with chemoembolization as a palliation in the treatment of non resectable hepatocellular carcinoma. MATERIAL/METHODS: During period of 64 months procedure was performed in 41 patients with non resectable hepatocellular carcinoma. The combination of Lipiodol and chemotherapeutic agents were applied in a. hepatica propria and its branches via transfemorally placed catheter. Stages of neoplasms were defined by Okuda method. RESULTS: The majority of tumors (30) were classified as Grade I. Liver cirrhosis was present in 36 patients, and abnormal levels of alpha-fetoprotein were found in 68% of cases. Each of twenty nine patients had more than one chemoembolization therapy, therefore, a total of 85 treatments were carried out. CT scanning perfomed one month following the procedure revealed more than 75% of Lipiodol retention in 42% of cases, and over 90% of neoplasm necrosis was recorded in 90% of cases, while all treated patients manifested lower levels of alpha-fetoprotein. All patients survived during three and six months, respectively, while the survival rate was 68% after 18 months. No letal outcome was reported during procedure, and morbidity in relation to total number of interventions was 19%. CONCLUSION: Achieved effects of this relatively safe procedure in our series do not differ significantly from those in the literature.

[Intra-arterial embolisation of uterine fibroma].

UNLABELLED: Uterine fibroid are benign tumors that consist most of the tumor occurrences in pelvic cavity of women. Possible courses of treatment include: medicament treatment, surgical and new intra-arterial embolisation method. The aim of the paper is to present achieved results in intra-arterial embolisation treatment of Uterine fibroid. MATERIAL AND METHODS: A prospective study was performed in the period from October 2007 until October 2008. It included 36 women with symptomatic uterine fibroid. They were treated by intra-arterial embolisation. All patients had control MRI examinations after treatment. Embolisation was performed by "cross-over" technique, using bilateral punction of femoral arteries, a selective catheterization a. uterine, and application of 750-900m Bead Blocks. RESULTS: Average age of patients was 38.5 years. The most of fibroids had intramural localization (39%). solitary fibroids were seen in 56% of patients, multiple in 44%. Gynecological hemorrhage was the leading symptom with 34 patients (94%). One year after receiving intra-arterial embolisation treatment, fibroid regression of 50% was registered in all patients. There were no serious complications noted in our study, with the exception of postembolisation syndrome which occurred in 11 (30%) patients in a relatively mild form. CONCLUSION: Intra-arterial embolisation of uterine fibroma is a method that in large percent of patients removes symptoms of uterine fibroma presence, prevents its growth, and safely helps women enter menopause when activity of hormone dependant tumor ceases.

Enhancement of electromagnetically induced absorption with elliptically polarized light--laser intensity dependent coherence effect.

Using the (2)S(1/2)F(g) = 2 --> (2)P(3/2)F(e) = 3 transition in (87)Rb vapor at room temperature, we study effect of the laser light polarization on the electromagnetically induced absorption (EIA). This work extends the recent study of the behavior of the EIA as a function of the laser ellipticity (Brazhnikov et. al., JETP Lett. 83, 64, 2006). We have shown that such behavior strongly depends on the laser power. For the low laser power EIA amplitude has maximum for linearly polarized light, while for high laser power elliptically polarized light of ellipticity 15-20 degrees generates maximum of the EIA amplitude. EIA width varies slowly with the laser ellipticity at lower laser power, and much stronger at higher laser power. Through our theoretical model we attributed observed results to combined effect of the laser ellipticity and power on the population of ground state Zeeman sublevels.

On non-vanishing amplitude of Hanle electromagnetically induced absorption in Rb.

Amplitude and linewidts of the Hanle EIA, obtained from transmission of the laser locked to closed F(g) ? F(e) = F(g) +1 transitions in (85)Rb and(87)Rb, have maximum values at few mW/cm2. Amplitude of the EIA reaches steady value different from zero for higher laser intensities, even for laser intensities of 40 mW/cm(2). Theoretical model of EIA, for the same atomic system as in the experiment, show that the laser intensity, at which maximum of amplitudes and widths occur, depends on the laser detuning. For smaller laser detuning of a few tens of MHz, EIA has a maximum and then vanishes at higher laser intensities. For larger laser detuning of the order of hundreds MHz (but still in the range of Doppler broadening) amplitude of the EIA has very broad maximum and remains above zero for intensities above 40 mW/cm(2). Such theoretical results indicate that Hanle absorption peak remains in the experimental results, regardless of the laser intensities, due to Doppler effect.

Childhood onset of obesity: does an obese child become an obese adult?

The aim of this study was to highlight the influence of age of obesity onset on anthropometric parameters in obese adults. We examined 1,451 obese adults with childhood or adolescent onset of obesity, divided into three subgroups in regard to age of onset of obesity: group A--onset before 4 years, group B--onset between 5 and 11 years, and group C--onset between 12 and 19 years. Significantly higher values for body mass index (BMI) and waist circumference (WC) were found in groups with earlier obesity onset, but not for body fat percent (%BF) and waist to hip ratio (WHR). Age of obesity onset may have a significant influence in the persistence of obesity and adverse consequences in adult life. Treatment of obesity and other risk factors for cardiovascular diseases should be initiated as early as possible.

[Immune complexes in diabetes mellitus]. / Imunski kompleksi u dijabetesu melitusu.

Research in recent years has documented more exactly the genetic and immunopathogenetic basis of insulin-dependent diabetes mellitus. Also, in some genetically susceptible subjects, a triggering event activates both cellular and humoral immunity, with diminishing of b cellular mass. Early intervention to prevent diabetes development as well as to prevent microvascular complications is identification of individuals in whom autoimmunity has been activated. One of the non-specific tests is a screening test for the detection of circulating immune complexes /CIC/ by precipitating tests using polyethylene glycol it was performed in series of healthy, insulin-dependent and non-insulin dependent diabetic subjects. Highly increased precitability was seen in a great percentage of pathological sera. In spite of the non-specific method for immune complexes detection, positive results obtained by PEG method generally presumed that diabetes represent immune complex disease.

Evaluation of 242 consecutive parotidectomies performed for benign and malignant disease.

Between 1987 and 1992, one surgeon performed 242 parotidectomies in 229 patients. Among 97 patients with benign disease, pleomorphic adenoma (46) and sialo-adenitis (28) predominated, while metastatic melanoma (22) and squamous cell carcinoma (21) were the most common diagnoses among 132 patients with malignancy. The extent of parotidectomies were: 114 'appropriate' resections, 77 complete superficial parotidectomies, 35 near-total conservative and 14 radical total resections. The facial nerve was sacrificed in 19 operations and reconstructed in four. One hundred and five patients had a concomitant neck dissection and 45 patients had adjuvant radiotherapy. Postoperative facial nerve function was normal in 90% of patients with localized tumours and 55% of patients overall. Patients with sialo-adenitis or deep lobe tumours and those having a neck dissection were at greatest risk of facial weakness despite nerve preservation. At a median follow up of 34 months, 13 patients had developed tumour recurrence and attempts at salvage surgery have generally been disappointing.