Herida abierta y fistulización cutánea tras ablación por microondas de hepatocarcinoma

Varón de 64 años con antecedentes de cirrosis VHB Child A MELD 9 en tratamiento con entecavir oral 0,5 mg/día. Diagnosticado de hepatocarcinoma de 2 cm en segmento 6 tratado con radiofrecuencia en abril de 2016 con respuesta completa hasta junio de 2021, cuando se detecta aumento del tamaño del componente sólido de la lesión tratada (28 x 20 mm de diámetro) con realce precoz tras la administración de contraste paramagnético, sugestivo de recidiva tumoral local. La ablación por microondas es un tratamiento térmico percutáneo que crea un campo electromagnético alrededor de un electrodo monopolar, lo que induce un calentamiento homogéneo y necrosis tisular coagulativa. Permite tratar varias lesiones simultáneamente y en menor tiempo que la ablación por radiofrecuencia con baja morbimortalidad. La incidencia de eventos adversos oscila entre el 2,6% y el 7,5%. Las complicaciones más frecuentes son el sangrado y el hematoma. La fistulización del trayecto de ablación es una complicación infrecuente, con mayor riesgo de aparecer en lesiones hepáticas subcapsulares o periféricas, como fue el caso de nuestro paciente. (AU)

Open wound and cutaneous fistulization after microwave ablation of hepatocarcinoma.

A 64-year-old male with a history of HBV Child A MELD 9 cirrhosis on treatment with oral entecavir 0.5 mg/day. Diagnosed with 2 cm hepatocarcinoma in segment 6 treated by radiofrequency in April 2016 with complete response until June 2021, when an increase in the size of the solid component of the treated lesion (28 x 20 mm in diameter) was detected with early enhancement after the administration of paramagnetic contrast, suggestive of local tumor recurrence. Microwave ablation is a percutaneous thermal treatment that creates an electromagnetic field around a monopolar electrode, inducing homogeneous heating and coagulative tissue necrosis. It allows treating several lesions simultaneously and in less time than radiofrequency ablation with low morbidity and mortality. The incidence of adverse events ranges between 2.6% and 7.5%. The most frequent complications are bleeding and hematoma. Ablation tract fistulization is an infrequent complication, with a higher risk of appearing in subcapsular or peripheral hepatic lesions, as was the case in our patient.

The feasibility and acceptability of a web-based physical activity for the heart (PATH) intervention designed to reduce the risk of heart disease among inactive African Americans: Protocol for a pilot randomized controlled trial.

BACKGROUND: Many studies have used the internet to promote physical activity (PA) in several settings, including the home environment, but few have been tailored for African Americans (AAs). To address this research gap, we conducted focus groups with AAs to inform the development of a web-based intervention, Physical Activity for The Heart (PATH), that leverages openly accessible platforms, such as YouTube, to promote PA in any setting. PURPOSE: To describe the rationale and design of a pilot randomized clinical trial (RCT), that examines the feasibility and acceptability of the PATH intervention among 30 AA adults aged 40--70 years without history of cardiovascular disease. METHODS: A 12-week, single-site, wait-listed RCT with subjects randomized 1:1 to either: 1) treatment group - participants receive the PATH intervention, including the online portal and twice a month phone calls from a PA coach, or 2) attention control group - participants receive a self-help PA handout and twice a month general health newsletter. All participants self-monitor step count using actigraphy. The primary outcomes of this 12-week, pilot RCT are recruitment, retention, and adherence to self-monitoring (Actigraph wear time) and the intervention protocol (PATH utilization). The secondary outcomes include changes in PA (step count, moderate-to-vigorous PA, exercise self-efficacy), and cardiometabolic risk (HbA1C, HDL, LDL, total cholesterol, type 2 diabetes risk score, percent body fat, weight, and waist circumference) from baseline to 12 weeks. CONCLUSIONS: This study will provide PATH intervention feasibility and acceptability data among inactive AA adults and will inform a future, full-scale RCT testing efficacy.