Thromboprophylaxis in varicose veins surgery: The everyday concern.

Venous thromboembolic disease (VTE) occupies an important place as a cause of morbidity and mortality in surgical patients in all specialties. Despite the existence of guidelines for thrombo prophylaxis in surgery, it is not clear due to the lack of current evidence, how to develop antithrombotic prophylaxis in varicose vein surgery and many questions arise when the surgeon is faced with a patient to be operated on. A comprehensive review of the literature was conducted to examine the evidence about the prevention of the venous thromboembolism in varicose veins surgery patients, and aims to guide the reader through questions that arise in daily practice, discussing the different scenarios presented in the literature for the choice of the most appropriate prophylaxis for each case. The lack of conclusive literature determines that risk should be individualized using available scales and other procedure-related factors, so that the type and duration of prophylaxis can be determined on a case-by-case basis.

Treatment of varicose great saphenous vein with endovenous laser alone or combined with eco-guided foam sclerotherapy: A randomized controlled trial.

Objectives: This study compares Endovenous Laser Ablation (EVLA) alone versus combined with ultrasound-guided foam sclerotherapy (UGFS) for Great Saphenous Vein (GSV) insufficiency. Methods: Sixty patients were randomly allocated to EVLA or EVLA-UGFS groups which focused on GSV occlusion rates, complications, additional treatments, and quality of life (QoL) changes. Results: Among 55 participants, the EVLA group had higher 12-month occlusion rates (92.3% vs. 75.8%, p = 0.11). Nervous injury (NI) was rarer in EVLA-UGFS (3.4% vs. 23.1%, p = 0.04). No significant difference in other complication rates (p > 0.05). QoL improved in both groups (p < 0.001). EVLA-UGFS required more subsequent procedures (24.1% vs. 7.7%, p = 0.03). Conclusions: EVLA and EVLA-UGFS effectively treat GSV insufficiency, enhancing QoL. The combined method reduces NI risk but may require more follow-up procedures.

Ablation techniques or active surveillance compared to surgical resection in patients with low-risk papillary thyroid cancer: a systematic review and meta-analysis.

BACKGROUND: The global prevalence of thyroid cancer is on the rise. About one-third of newly diagnosed thyroid cancer cases comprise low-risk papillary thyroid cancer (1.5 cm or more minor). While surgical removal remains the prevailing approach for managing low-risk papillary thyroid cancer (LPTC) in patients, other options such as active surveillance (AS), radiofrequency ablation (RFA), microwave ablation (MWA), and laser ablation (LA) are also being considered as viable alternatives. This study evaluated and compared surgical thyroid resection (TSR) versus non-surgical (NS) methods for treating patients with LPTC. METHODS: The study encompassed an analysis of comparisons between surgical thyroid resection (TSR) and alternative approaches, including active surveillance (AS), radiofrequency ablation (RFA), microwave ablation (MWA), or laser ablation (LA). The focus was on patients with biopsy-confirmed low-risk papillary thyroid cancer (LPTC) of less than 1.5 cm without preoperative indications of local or distant metastasis. The primary outcomes assessed were recurrence rates, disease-specific mortality, and quality of life (QoL). Data were collected from prominent databases, including Cochrane Database, Embase, MEDLINE, and Scopus, from inception to June 3rd, 2020. The CLARITY tool was utilized to evaluate bias risk. The analysis involved odds ratios (OR) with 95% confidence intervals (CI) for dichotomous outcomes, as well as mean differences (MD) and standardized mean differences (SMD) for continuous outcomes. The study is registered on PROSPERO under the identifier CRD42021235657. RESULTS: The study incorporated 13 retrospective cohort studies involving 4034 patients. Surgical thyroid resection (TSR), active surveillance (AS), and minimally invasive techniques like radiofrequency ablation (RFA), microwave ablation (MWA), and laser ablation (LA) were performed in varying proportions of cases. The analysis indicated that specific disease mortality rates were comparable among AS, MWA, and TSR groups. The risk of recurrence, evaluated over different follow-up periods, showed no significant differences when comparing AS, RFA, MWA, or LA against TSR. Patients undergoing AS demonstrated better physical health-related quality of life (QoL) than those undergoing TSR. However, no substantial differences were observed in the overall mental health domain of QoL when comparing AS or RFA with TSR. The risk of bias was moderate in nine studies and high in four. CONCLUSION: Low-quality evidence indicates comparable recurrence and disease-specific mortality risks among patients with LPTC who underwent ablation techniques or active surveillance (AS) compared to surgery. Nevertheless, individuals who opted for AS exhibited enhanced physical quality of life (QoL). Subsequent investigations are warranted to validate these findings.

Endovenous laser ablation vs phlebectomy of foot varicose veins.

OBJECTIVE: The aim of this study was to compare the outcomes and complications of selected patients treated with endovenous laser ablation (EVLA) or ambulatory phlebectomy for foot varicose veins. METHODS: From October 2016 to February 2022, selected patients undergoing EVLA (using 1470-nm with radial-slim or bare-tip fibers) or phlebectomy of foot varicose veins for cosmetic indications were analyzed, and the outcomes were compared. Patients were classified according to the Clinical, Etiologic, Anatomical, and Pathophysiological (CEAP) classification. Anatomic criteria provided the basis for the decision to perform EVLA or phlebectomy. Clinical and ultrasound assessments were performed on postoperative days 7, 30, and 90 for visualization of the sapheno-femoral and sapheno-popliteal junctions and the deep venous system. Disease severity was graded with the Venous Clinical Severity Score (VCSS), and quality of life was measured with the Aberdeen Varicose Vein Questionnaire (AVVQ) before and after treatment. Treatment outcomes were evaluated based on changes in VCSS and AVVQ scores. The groups were also compared for procedure-related complications. Data were statistically analyzed in SPSS v. 20.0 using the χ2, Student t test, Mann-Whitney test, Wilcoxon test, and analysis of variance. The results were presented as mean (standard deviation or median (interquartile range). RESULTS: The study included 270 feet of 171 patients. Mean patient age was 52.3 (standard deviation, 13.1) years, ranging from 21 to 84 years; 133 (77.8%) were women. Of 270 feet, 113 (41.9%) were treated with EVLA and 157 (58.1%) with phlebectomy. The median preoperative CEAP class was 2 (interquartile range, 2-3) in the phlebectomy and EVLA groups, with no statistically significant difference between the groups (P = .507). Dysesthesia was the most common complication in both groups. Only transient induration was significantly different between EVLA (7.1%) and phlebectomy (0.0%) (P = .001). The two approaches had an equal impact on quality of life and disease severity. CONCLUSIONS: Treatment complications were similar in phlebectomy and EVLA and to those previously described in the literature.

Brazilian Consensus on the Application of Thermal Ablation for Treatment of Thyroid Nodules: A Task Force Statement by the Brazilian Society of Interventional Radiology and Endovascular Surgery (SOBRICE), Brazilian Society of Head and Neck Surgery (SBCCP), and Brazilian Society of Endocrinology and Metabolism (SBEM)

ABSTRACT There is increasing interest in ultrasound-guided ablation treatments for thyroid diseases, including benign and malignant ones. Surgeons, radiologists, and endocrinologists carry out these treatments, and various organizations within these specialties have recently released multiple international consensus statements and clinical practice standards. The aim of the present consensus statement is to provide guidance, cohesion, and standardization of best practices for thermal ablation procedures of thyroid nodules. The statement includes the indications for these procedures, preprocedural evaluations, technical aspects of the procedures, posttreatment care, follow-up, complications, and training recommendations. This document was written by a panel of specialists from the Brazilian Society of Interventional Radiology and Endovascular Surgery (SOBRICE), the Brazilian Society of Head and Neck Surgery (SBCCP), and the Brazilian Society of Endocrinology and Metabolism (SBEM). The statement does not aim to provide criteria for assessing the capability of specialists to perform the procedure. Instead, it aims to promote the standardization of best practices to reduce potential adverse outcomes. Additionally, it strives to enhance the delivery of high-quality care and the widespread adoption of these technologies on a national level. The recommendations collectively serve as a guidebook for applying best practices in thyroid ablation.

Treatment of irregular astigmatism by topography-guided ablation / Tratamento do astigmatismo irregular por ablação guiada por topografia

ABSTRACT Topography-guided ablation was designed to improve corneal regularity throughout the correction of corneal high order aberrations. The present report described three cases with different indications for topography-guided ablation to correct irregular astigmatism. The patients were monitored in the immediate and late postoperative periods to evaluate long-term corneal stabilization. Surgery indications were based on the patient's complaint of poor quality of vision associated with previous radial keratotomy, corneal transplant, or keratoconus. In all three cases, the patients reported an improvement in the quality of their vision and expressed satisfaction with the procedure; however, the patient who had previously been submitted to crosslinking presented with keratoconus progression in the late postoperative period. Finally, topography-guided customized ablation appears to represent a safe and effective technique for reducing corneal irregularities.

RESUMO A ablação guiada por topografia foi projetada para melhorar a regularidade da córnea durante a correção de aberrações de alta ordem da córnea. O presente relato descreveu três casos com diferentes indicações de ablação guiada por topografia para correção de astigmatismo irregular. Os pacientes foram monitorados no pós-operatório imediato e tardio para avaliar a estabilização corneana em longo prazo. As indicações cirúrgicas basearam-se na queixa do paciente de má qualidade de visão associada a ceratotomia radial prévia, transplante de córnea ou ceratocone. Nos três casos, os pacientes relataram melhora na qualidade da visão e manifestaram satisfação com o procedimento; entretanto, o paciente que já havia sido submetido ao crosslinking apresentou progressão do ceratocone no pós-operatório tardio. Finalmente, a ablação personalizada guiada por topografia parece representar uma técnica segura e eficaz para reduzir irregularidades da córnea em córneas não ectásicas.

Chemical and morphological analysis of dentin irradiated by different high-power lasers: a systematic review.

PURPOSE: This systematic review provides an overview of the main chemical and morphological alterations generated on dentin by different high-power lasers' irradiation. METHODS: The review was registered in PROSPERO (CRD42023394164) and PRISMA guidelines were followed. The search strategy was conducted on MEDLINE (PubMed), Embase (Elsevier), and Web of Science (Clarivate) databases. The eligibility criteria were established according to the PICOS strategy, focusing on in vitro and ex vivo studies that assessed the chemical and morphological changes in dentin using five high-power lasers: Nd:YAG (1064 nm), Er:YAG (2940 nm), Er, Cr:YSGG (2780 nm), diode (980 nm), and CO2 (10,600 nm). Publication range was from 2010 to 2022. Data was summarized in tables and risk of bias was assessed by QUIN tool. RESULTS: The search resulted in 2255 matches and 57 studies composed the sample. The methods most used to assess the outcomes were scanning electron microscopy (SEM), energy-dispersive spectroscopy (EDS), and Raman. The studies presented "medium" and "low" risk of bias. The laser prevalently identified was the Er:YAG laser, associated with dentin ablation, absence of smear layer, and exposed tubules. The Nd:YAG laser generated vitreous surface and thermal damage, such as carbonization and cracks. The other lasers caused an irregular surface and no adverse thermal effects. Regarding the chemical structure, only the Er,Cr:YSGG laser caused collagen matrix reduction. The effects found were more intense with higher dosimetry. CONCLUSION: Evidence available indicates that the irradiation of dentin with high-power lasers are related to morphological outcomes favorable to adhesive restorative procedures, with minimal changes in collagen matrix and mineral content. However, those observations should be carried carefully by clinicians and more clinical trials regarding the association of high-power laser irradiation and restorative procedure longevity are needed.

Radiofrequency Endometrial Ablation with Hysteroscopic Verification: Report of Four Cases Conducted in Brazil / Ablação Endometrial por Radiofrequência e Verificaçao Histeroscópica: Relato de 4 Casos Conduzidos no Brasil

Endometrial ablation (EA) is a minimally invasive surgical procedure to reduce abnormal uterine bleeding contemplated for women who have achieved their reproductive goals. EA consists of the destruction of the endometrial layer with preservation of the uterus, although EA has lower complication rates than hysterectomy, it may be associated with metrorrhagia recurrence. One of the major causes of treatment failure is incomplete ablation of the endometrium. Thanks to techniques that have been developed in recent years, endometrial ablation can be performed on an outpatient basis, including by radiofrequency ablation. The main objective of this case series was to report four cases in which Radiofrequency Endometrial Ablation (RFEA) was used to treat abnormal uterine bleeding at a single ambulatory surgical center in Brazil. Hysteroscopic evaluation of the uterine cavity was performed immediately prior to the RFEA to diagnose possible endometrial pathologies and again at the conclusion of the procedure to assess the aspect of the newly treated endometrium. Verification of the completeness of the ablation was assessed by a third hysteroscopy 30 or 60 days after the ablation. In this case series RFEA was efficacious and safe for outpatient use. Although radiofrequency endometrial ablation can be performed without the use of the hysteroscope, we believe it is an important tool for the timely verification of the completeness of the endometrial ablation. (AU)

A ablação endometrial (AE) é um procedimento cirúrgico minimamente invasivo destinado a mulheres com prole estabelecida visando redução do sangramento uterino anormal. A AE consiste na destruição da camada endometrial com a preservação do útero, apesar da AE possuir menores índices de complicação do que a histerectomia, pode estar associada a recorrência do sangramento. Uma das causas da falha de tratamento é a ablação incompleta do endométrio. Atualmente, a ablação endometrial pode ser realizada ambulatorialmente graças às técnicas que vêm sendo desenvolvidas nos últimos anos, as quais incluem o uso de radiofrequência. O objetivo dessa série de casos é descrever 4 casos de Ablação Endometrial por Radiofrequência (AERF) para o tratamento de sangramento uterino anormal realizados em um mesmo ambulatório especializado no Brasil. Uma avaliação histeroscópica da cavidade uterina foi realizada imediatamente antes da AERF para diagnosticar possíveis patologias endometriais e imediatamente ao final do procedimento, para avaliar o aspecto do endométrio recém tratado e a necessidade de nova aplicação de radiofrequência. A integralidade da ablação foi verificada por uma terceira histeroscopia após 30 ou 60 dias depois da ablaçao. A técnica mostrou-se adequada para uso ambulatorial. Embora a ablação endometrial por radiofrequência possa ser realizada sem o uso do histeroscópio, acreditamos que seja uma ferramenta importante para a verificação oportuna da integralidade da ablação endometrial. (AU)

Effectiveness and Safety of Percutaneous Treatment in Lesions Suggestive of Thyroid Cancer (Bethesda V and VI-T1aN0M0) Compared to Surgical Treatment: Systematic Review and Meta-Analysis.

INTRODUCTION: Thyroid nodules are common entities, with 5% malignancy. Differentiated thyroid cancer represents 90% of thyroid malignancies, with papillary carcinoma being the most common. Management is generally surgical; among its complications are injury to the recurrent laryngeal and superior laryngeal nerve, causing hoarseness, postsurgical hypoparathyroidism, hypothyroidism, and pain. Other noninvasive percutaneous interventions of thermal ablation such as microwave, radiofrequency, or laser incur lower costs and could be an option for treatment. OBJECTIVE: To determine the effectiveness and safety of thermal ablation in lesions suspected of thyroid cancer (Bethesda V and VI/T1aN0M0) compared to surgical treatment. METHODS: Systematic review/meta-analysis of observational studies and clinical trials. Database search includes MEDLINE/PUBMED, Embase, Scopus, Scielo, and BVS/LILACS. Studies on patients over 18 years of age with lesions suspicious of thyroid cancer were included. RESULTS: A total of 10 studies were obtained, with 2939 patients: 1468 subjected to thermal ablation and 1471 to surgery. Regarding effectiveness, no differences were found in local recurrence [relative risk (RR) 1.17 (95% CI 0.69-1.99)] and cervical lymph node metastasis [RR 0.76 (95% CI 0.43-1.36)]. Regarding safety, infection [RR 0.29 (95% CI 0.05-1.74)], hematoma [RR 0.57 (95% CI 0.17-1.94)], and transient hoarseness [RR 0.77 (95% CI 0.39-1.51)] were evaluated, without difference. However, permanent hoarseness had significant differences in favor of thermal ablation [RR 0.29 (95% CI 0.11-0.75)]. CONCLUSIONS: Thermal ablation for the treatment of T1aN0M0 papillary thyroid carcinoma is equally effective when compared to surgical techniques and offers a better safety profile, particularly in permanent hoarseness.

Ethanol Ablation for Odontogenic myxoma: New alternative of conservative treatment

Odontogenic myxoma is a maxillofacial tumor that is benign in nature. It is characterized by a slow-growing, painless, and site-aggressive behavior. A main feature is that it is not encapsulated so it has high potential of invasiveness and penetration into peripheral tissues. Large lesions may cause extensive compromise of the region. Treatment strategy for Odontogenic Myxoma is still controversial. Radical resection with an appropriate surgical margin is recommended, but emerging evidence has suggested that a more conservative approach will result in less morbidity and adequate results. This report shows a remarkable result on a 16-year-old patient who had a Mandibular Odontogenic Myxoma treated with a conservative approach. Intra-lesional absolute alcohol irrigation was performed during a 5-month period. Considerable volume reduction of the lesion happened which allowed a minimal overall resection. No recurrence was found after a 3 year follow-up.

Use of High-Resolution Ultrasound to Guide Alcohol Neurolysis for Chronic Pain.

BACKGROUND: The diagnosis and treatment of neuropathic pain is often clinically challenging, with many patients requiring treatments beyond oral medications. To improve our percutaneous treatments, we established a clinical pathway that utilized ultrasound (US) guidance for steroid injection and alcohol ablation for patients with painful neuropathy. OBJECTIVES: To describe a collaborative neuropathy treatment pathway developed by a neurosurgeon, pain physicians, and a sonologist, describing early clinical experiences and patient-reported outcomes. STUDY DESIGN: A retrospective case series was performed. METHODS: Patients that received percutaneous alcohol ablation with US guidance for neuropathy were identified through a retrospective review of a single provider's case log. Demographics and treatment information were collected from the electronic medical record. Patients were surveyed about their symptoms and treatment efficacy. Descriptive statistics were expressed as medians and the interquartile range ([IQR]; 25th and 75th data percentiles). Differences in the median follow-up pain scores were assessed using a Wilcoxon signed-rank test. RESULTS: Thirty-five patients underwent US-guided alcohol ablation, with the average patient receiving one treatment (range: 1 to 2), having a median duration of 4.8 months until reinjection (IQR: 2.9 to 13.1). The median number of steroid injections that individuals received before US-guided alcohol ablation was 2 (IQR: 1 to 3), and the median interval between steroid injections was 3.7 months (IQR: 2.0 to 9.6). Most (20/35 [57%]) patients responded to the survey, and the median pain scores decreased by 3 units (median: -3, IQR: -6 to 0; P < 0.001) one week following the alcohol ablation. This pain reduction remained significant at one month (P < 0.001) and one year (P = 0.002) following ablation. Most (12/20 [60%]) patients reported that alcohol ablation was more effective in improving their pain than oral pain medications. LIMITATIONS: Given the small sample size, treatment efficacy for alcohol neurolysis cannot be generalized to the broader population. CONCLUSIONS: US-guided percutaneous treatments for neuropathic pain present a growing opportunity for interprofessional collaboration between neurosurgery, clinicians who treat chronic pain, and sonologists. US can provide valuable diagnostic information and guide accurate percutaneous treatments in skilled hands. Further studies are warranted to determine whether a US-guided treatment pathway can prevent unnecessary open surgical management.

Intervencionismo para el control del dolor por metástasis óseas / Interventionism for pain control due bone metastases

Objetivo: El dolor óseo por cáncer óseo o metástasis es un dolor de difícil manejo asociado a dolor incidental. Hay distintas estrategias quirúrgicas para su tratamiento, sin embargo, no todos los pacientes con metástasis óseas pueden beneficiarse de un tratamiento quirúrgico. La presente revisión bibliográfica tiene como objetivo identificar terapias intervencionales mínimamente invasivas para el control del dolor por metástasis óseas. Métodos: Revisión bibliográfica acerca de terapias intervencionales para el control del dolor por metástasis óseas utilizando la base de datos PubMed (www.pubmed.gov) y el motor de búsqueda Google (www.google.cl). Tipos de participantes: Pacientes con metástasis óseas dolorosas de cualquier tumor primario. Tipos de intervenciones: Bloqueos anestésicos, bloqueos neurolíticos, terapias ablativas, cementoplastías. Resultados: Se obtuvieron 384 resultados que incluyeron revisiones sistemáticas, revisiones bibliográficas, ensayos clínicos controlados, series de casos y reporte de casos. Todos los artículos relevantes en inglés y español se incluyeron para su análisis. Conclusión: Las metástasis óseas son un evento común en los pacientes con cáncer, y el dolor óseo es un dolor de difícil manejo asociado a dolor incidental. Se han desarrollado terapias intervencionales no invasivas o mínimamente invasivas para tratar el dolor, mejorar la calidad de vida y la funcionalidad, disminuir el consumo de fármacos, y reducir el tamaño del tumor. La gran mayoría ha demostrado ser terapias seguras y eficaces, con pocos eventos adversos y de rápida resolución, y que si son combinadas mejoran los resultados.

Objective: Bone pain from bone cancer or metastasis is a pain that is difficult to manage associated with incidental pain. There are different surgical strategies for its treatment, however, not all patients with bone metastases can benefit from a surgical treatment. This literature review aims to identify minimally invasive interventional therapies for the control of pain due to bone metastasis. Methods: Literature review of interventional therapies for the control of pain due to bone metastases was done using the PubMed database (www.pubmed.gov) and the Google search engine (www.google.cl). Types of participants: Patients with painful bone metastases from any primary tumor. Types of interventions: Anesthetic blocks, neurolytic blocks, ablative therapies, cementoplasties. Results: We obtained 384 results that included systematic reviews, literature reviews, controlled clinical trials, case series and case reports. All relevant articles in English and Spanish were included for analysis. Conclusion: Bone metastases are a common event in cancer patients, and bone pain is a difficult-to-manage pain associated with incidental pain. Non-invasive or minimally invasive interventional therapies have been developed to treat pain, improve quality of life and functionality, decrease drug use, and reduce tumor size. The vast majority therapies have been shown to be safe and effective ones, with few adverse events and rapid resolution, and that if combined they improve the outcomes.

[Hypoxemia, pleural and pericardial effusion after splanchnic neurolysis. A case report.] / Hipoxemia, derrame pleural y pericárdico en neurolisis de nervios esplácnicos. Reporte de caso

Introduction: Alcohol neurolysis of splanchnic nerves is a valuable tool for treating visceral intractable pain from the upper abdomen in cancer patients. It is a safe and effective procedure, yet not risk free. It's most common adverse effects are mild and self-limited. Materials: We present a case of a 72-year old woman suffering from pancreatic cancer with intractable pain despite opioid use. Alcohol neurolysis of splanchnic nerves was indicated after hospital admission. Results: After the procedure pain was subdued, yet hypoxemia, pleural and pericardial effusion developed. Frequent causes for these events were ruled out. The patient was discharged 24 hours after with adequate pain control. Conclusions: Hypoxemia, pleural and pericardial effusion after alcohol neurolysis of splanchnic nerves is infrequent. These findings are likely to be linked to the effect of alcohol.

Introducción: La neurolisis o alcoholización de los nervios esplácnicos es una valiosa herramienta para el tratamiento del dolor visceral del abdomen superior de origen neoplásico en pacientes con mala respuesta a tratamiento por vía oral. Es un procedimiento seguro y efectivo, aunque no exento de riesgos. Sus efectos adversos más frecuentes son leves y autolimitados. Materiales: Presentamos el caso de una mujer de 72 años con cáncer de páncreas y mal manejo del dolor pese al consumo de opioides. Se le indico neurolisis de los nervios esplácnicos bajo internación. Resultados: Post procedimiento presentó buen manejo del dolor, sin embargo evolucionó con hipoxemia, derrame pleural bilateral y pericárdico. Se descartaron causas frecuentes de estos eventos. La paciente fue dada de alta a las 24 hs con buen manejo del dolor. Conclusiones: El desarrollo de hipoxemia, derrame pleural bilateral y pericárdico posterior a la neurolisis de los nervios esplácnicos es una complicación infrecuente. Estos hallazgos probablemente se encuentren vinculados al efecto del alcohol.

Can concomitant bladder neck incision and primary valve ablation reduce early re-admission rate and secondary intervention?

ABSTRACT Objective: To assess the effect of bladder neck morphology and its incision (BNI) in patients with posterior urethral valve (PUV) on early reintervention rate. Patients and methods: Infants undergoing PUV ablation (PVA) before 24 months of age and had at least 18 months of follow-up, were categorized into three groups according to the bladder neck appearance on baseline radiological and endoscopic examination: group 1; normal bladder neck underwent PVA, group 2; high bladder neck underwent PVA plus BNI, group 3; high bladder neck underwent PVA only. Early reintervention was defined as the need for check cystoscopy because of persistent renal function deterioration, worsening hydronephrosis and/or unsatisfactory VCUG improvement during the 1st six months post primary PVA. Results: Between 2000 and 2017, a total of 114 patients underwent PVA and met the study criteria with a median follow-up of 58 (18-230) months. For group 1, 16 (22.9%) patients needed readmission. Check cystoscopy was free and no further intervention was performed in 5(7.5%) and re-ablation was performed in 11(15.7%) patients. For group 2, 3(14.3%) patients needed reintervention. Re-ablation and re-ablation plus BNI were performed in 1(4.8%) and 2(9.5%), respectively. For group 3, cystoscopy was free in 1(4.3%), re-ablation and re-ablation plus BNI were performed 2(8.7%) and 1(4.3%), respectively. There were no significant differences in the re-admission and re-intervention rates among the three study groups (p=0.65 and p=0.50, respectively). Conclusion: In morphologically high bladder neck associated PUV, concomitant BNI with PVA doesn't reduce early re-intervention rate.

Can Concomitant Bladder Neck Incision and Primary Valve Ablation Reduce Early Re-admission Rate and Secondary Intervention?

OBJECTIVE: To assess the effect of bladder neck morphology and its incision (BNI) in patients with posterior urethral valve (PUV) on early reintervention rate. PATIENTS AND METHODS: Infants undergoing PUV ablation (PVA) before 24 months of age and had at least 18 months of follow-up, were categorized into three groups according to the bladder neck appearance on baseline radiological and endoscopic examination: group 1; normal bladder neck underwent PVA, group 2; high bladder neck underwent PVA plus BNI, group 3; high bladder neck underwent PVA only. Early reintervention was defined as the need for check cystoscopy because of persistent renal function deterioration, worsening hydronephrosis and/or unsatisfactory VCUG improvement during the 1st six months post primary PVA. RESULTS: Between 2000 and 2017, a total of 114 patients underwent PVA and met the study criteria with a median follow-up of 58 (18-230) months. For group 1, 16 (22.9%) patients needed readmission. Check cystoscopy was free and no further intervention was performed in 5(7.5%) and re-ablation was performed in 11(15.7%) patients. For group 2, 3(14.3%) patients needed reintervention. Re-ablation and re-ablation plus BNI were performed in 1(4.8%) and 2(9.5%), respectively. For group 3, cystoscopy was free in 1(4.3%), re-ablation and re-ablation plus BNI were performed 2(8.7%) and 1(4.3%), respectively. There were no significant differences in the re-admission and re-intervention rates among the three study groups (p=0.65 and p=0.50, respectively). CONCLUSION: In morphologically high bladder neck associated PUV, concomitant BNI with PVA doesn't reduce early re-intervention rate.

Manejo anestésico para electroporación irreversible en el paciente pediátrico / Anesthetic management for irreversible electroporation in the pediatric patient

Resumen: Introducción: La electroporación irreversible (EIR) es una técnica conocida desde 1972; fue incorporada al ámbito oncológico en el año 2005 como técnica de ablación tumoral basada en pulsos eléctricos cortos de alto voltaje y es utilizada para introducir elementos químicos por difusión, alterar la estructura genética celular, fusionar una célula con otra (reversible) o provocarle la muerte (irreversible). Estas descargas eléctricas conllevan un riesgo asociado de arritmias cardíacas, contracciones musculares severas y convulsiones. Mantener un adecuado plano anestésico, analgesia óptima, relajación neuromuscular profunda y electrocardiograma sincronizado a los pulsos eléctricos son los objetivos principales del manejo anestésico. Objetivo: Describir las implicaciones anestésicas de la EIR en el paciente pediátrico. Material y métodos: Revisión narrativa basada en una búsqueda de artículos relacionados con la EIR en las principales bases de datos, donde la principal fuente de información son los reportes de casos y las revisiones no sistemáticas de la literatura, tanto del área de anestesiología y dolor como de ingeniería, radiología intervencionista vascular y cardiovascular, y cirugía. Resultados: Se encontraron y revisaron un total de 17 referencias bibliográficas. Conclusión: La anestesia para EIR en el paciente pediátrico debe garantizar un adecuado plano anestésico idealmente con intubación endotraqueal, analgesia óptima, relajación profunda y control de arritmias cardíacas con sincronización del electrocardiograma.

Abstract: Introduction: Irreversible electroporation (IRE) is a technique known since 1972 incorporated into the oncological field in 2005 as a tumor ablation technique based on short high-voltage electrical pulses used to introduce chemical elements by diffusion, alter the cellular genetic structure, fuse a cell with other (reversible) or cause death (irreversible). These electric shocks carry an associated risk of cardiac arrhythmias, severe muscle contractions and seizures. Maintain an adequate anesthetic plane, optimal analgesia, deep neuromuscular relaxation and an electrocardiogram synchronized to the electrical pulses are the main objectives of anesthetic management. Objective: Describe the anesthetic implications of IRE in the pediatric patient. Material and methods: Narrative review based on a search for articles related to IRE in the most important databases, where the main source of information is case reports and non-systematic reviews of the literature, both in the area of anesthesiology and pain as well as engineering, vascular and cardiovascular interventional radiology, and surgery. Results: A total of 17 bibliographic references were found and reviewed. Conclusion: The anesthesia for IRE in the pediatric patient should guarantee an adequate anesthetic plane ideally with endotracheal intubation, optimal analgesia, deep relaxation and control of cardiac arrhythmias with electrocardiogram synchronization.

Diode Green Laser in the Lid Trichiasis Treatment.

PURPOSE: To validate the standard values and evaluate the success rate in the treatment of minor and major trichiasis using thermoablation with a diode green laser. METHODS: In this interventional prospective study, individuals with minor or major trichiasis who were treated with thermoablation using diode green laser were included. The patients' mean age was 72.1 years; the majority were females (54.1%) and Caucasian (98%). The parameters of the diode laser were wavelength of 532 nm, application time of 200 ms, target size of 50 µm, interval between the shots 150 to 200 ms, and power of 600 to 750 mW. The number of shots was defined by the depth of ablation sufficient to reach the pilus hair bulb. The patients were evaluated by slit-lamp every 3 to 4 months, for up to 15 months. The treatment success rate and the association between variables were analyzed. RESULTS: The study sample was comprised of 98 patients with 135 affected lids and 337 lashes with trichiasis. Minor trichiasis (91.8%), unilateral trichiasis (67.3%), trichiasis affecting the lower eyelid (85.9%), and trichiasis resulting from blepharitis (64.3%) were the most common presentation profiles. The overall cure rate at the end of the study was 85%, with 69% being cured with a single session and 82.8% with two treatment sessions. CONCLUSION: Thermoablation using a diode green laser applying the specified parameters to treat minor and major trichiasis is effective and results in high cure rate.