MR-guided HIFU treatment of symptomatic uterine fibroids using novel feedback-regulated volumetric ablation: effectiveness and clinical practice.

PURPOSE: To evaluate a novel feedback-regulated volumetric sonication method in MR-guided HIFU treatment of symptomatic uterine fibroids. MATERIALS AND METHODS: 27 fibroids with an average volume of 124.9 ± 139.8 cc in 18 women with symptomatic uterine fibroids were ablated using the new HIFU system Sonalleve (1.5 T MR system Achieva, Philips). 21 myomas in 13 women were reevaluated 6 months later. Standard (treatment) cells (TC) and feedback-regulated (feedback) cells (FC) with a diameter of 4, 8, 12, and 16 mm were used and compared concerning sonication success, diameter of induced necrosis, and maximum achieved temperature. The non-perfused volume ratio (NPV related to myoma volume) was quantified. The fibroid volume was measured before, 1 month, and 6 months after therapy. Symptoms were quantified using a specific questionnaire (UFS-QoL). RESULTS: In total, 205 TC and 227 FC were applied. The NPV ratio was 23 ± 15 % (2 - 55). The TC were slightly smaller than intended (-3.9 ± 52 %; range, -100 - 81), while the FC were 20.1 ± 25.3 % bigger (p = 0.02). Feedback mechanism is less diversifying in diameter (p < 0.001). Overall, the FC correlate well with the planned treatment diameter (r = 0.79), other than the TC (r = 0.38). Six months after therapy, the fibroid volume was reduced by 45 ± 21 % (5 - 100) (p = 0.001). The symptoms decreased significantly (p = 0.001). No serious adverse events were recorded. CONCLUSION: Use of volumetric sonication leads to homogenous heating and sufficient necrosis. It is a safe and effective therapy for treating symptomatic uterine fibroids. Successful sonication of feedback cells leads to more contiguous necrosis in diameter and a less diversifying temperature. KEY POINTS: ▶ MR-guided HIFU ablation of symptomatic uterine fibroids is a valuable treatment option. ▶ By non-invasive HIFU fibroid volumes can be reduced and symptoms improved. ▶ The novel feedback-regulated treatment cells offer advantages over standard treatment cells.

MR-guided HIFU treatment of symptomatic uterine fibroids using novel feedback-regulated volumetric ablation: effectiveness and clinical practice.

PURPOSE: To evaluate a novel feedback-regulated volumetric sonication method in MRguided HIFU treatment of symptomatic uterine fibroids. MATERIALS AND METHODS: 27 fibroids with an average volume of 124.9 ± 139.8 cc in 18 women with symptomatic uterine fibroids were ablated using the new HIFU system Sonalleve (1.5 TMR system Achieva, Philips). 21 myomas in 13 women were reevaluated 6 months later. Standard (treatment) cells (TC) and feedback-regulated (feedback) cells (FC) with a diameter of 4, 8, 12, and 16 mm were used and compared concerning sonication success, diameter of induced necrosis, and maximum achieved temperature. The non-perfused volume ratio (NPV related to myoma volume) was quantified. The fibroid volume was measured before, 1 month, and 6 months after therapy. Symptoms were quantified using a specific questionnaire (UFS-QoL). RESULTS: In total, 205 TC and 227 FC were applied. The NPV ratio was 23 ± 15 % (2 ­ 55). The TC were slightly smaller than intended (-3.9 ± 52 %; range, -100 ­ 81), while the FC were 20.1 ± 25.3 % bigger (p = 0.02). Feedback mechanism is less diversifying in diameter (p < 0.001). Overall, the FC correlate well with the planned treatment diameter (r = 0.79), other than the TC (r = 0.38). Six months after therapy, the fibroid volume was reduced by 45 ± 21 % (5 ­ 100) (p = 0.001). The symptoms decreased significantly (p = 0.001). No serious adverse events were recorded. CONCLUSION: Use of volumetric sonication leads to homogenous heating and sufficient necrosis. It is a safe and effective therapy for treating symptomatic uterine fibroids. Successful sonication of feedback cells leads to more contiguous necrosis in diameter

Angiogenesis and healing with non-shrinking, fast degradeable PLGA/CaP scaffolds in critical-sized defects in the rabbit femur with or without osteogenically induced mesenchymal stem cells.

Cost effective and safely to apply tissue engineered constructs of big volume bone transplants for the reconstruction of critical sized defects (CSD) are still not available. Key problems with synthetic scaffold materials are shrinkage and fast degradation of the scaffolds, a lack of blood supply and nutrition in the central scaffold volume and the absent or the scarce development of bone tissue along the scaffold to bridge the bone defect. The use of composite scaffolds made of biopolymers like polylactidglycolid acid (PLGA) coated and loaded with calcium phosphates (CaP) revealed promising therapeutical options for the regeneration of critical sized bone defects. In this study interconnectively macroporous PLGA scaffolds loaded with microporous and coated with nanoporous calcium phosphates were either seeded in fixed bed bioreactors with allogenic osteogenically induced mesenchymal stem cells and implanted or implanted unseeded into critical sized femoral bone defects. As CSD a 12 mm long segment of the chinchilla femur was excised where the proximal and distal parts of the femur were fixed and stabilized by the use of an eight-hole linear reconstruction plate and secured with three bicortical screws (2.7 mm diameter) on every side of the osteotomy. Aim of the study was if we could find a way to load and coat PLGA scaffolds with CaP so that shrinkage of scaffolds could be avoided, which would favour angiogenesis, blood supply and nutrition in the construct and thus avoid central necroses regularly observed so far in transplants not vascularized and which would be inhabited by cells of he bone lineage forming new bone and healing the defect. Four weeks, at least, a notable shrinkage of the scaffolds was avoided and scaffolds were practically not degraded. Both scaffolds, loaded and loaded and coated, revealed blood vessels in all parts of the implants after 4 weeks. Only in scaffolds seeded with allogenic mesenchymal stem cells the development of bridging bone constructs between proximal and distal edges of the femur was observed after four weeks without further supplementation of growth factors. In case of the implantation of non-seeded scaffolds no obvious scaffold bound bone development could be shown.

[Effect of cataract technique and duration of surgery on fibrin reaction after IOL implantation]. / Einfluss von Katarakttechnik und Operationsdauer auf die Fibrinreaktion nach IOL-Implantation.

BACKGROUND: Having changed our cataract operation technique from ECCE to phacoemulsification (PE) we had the impression of less fibrinous membranes postoperatively. METHOD: To ascertain whether our impression was correct, we examined the last 2056 IOL implanted cataract patients retrospectively. RESULTS: In the 2056 cataract cases we found 152 fibrinous reactions (7.4%). We observed after ECCE (n = 586) a 12.8% rate of fibrinous membranes, after phacoemulsification (PE) with sutured 6.5-mm corneoscleral incision (n = 546) 7.0%, and after PE with clear corneal self-sealing 4.1-mm incision (n = 924) only 3.9%. In 56% of these patients we found diabetes, in 13% former uveitis with posterior synechiae, in 11% glaucoma with rigid pupil, and in 10% pseudoexfoliation syndrome. In those cases with no diabetic retinopathy but known diabetes (n = 198), we found a 27% rate of fibrin reactions following ECCE (12 mm), 12% following PE (6.5 mm) and 8% following PE (4.1 mm). In non-proliferative diabetic retinopathy (n = 80) a 32% rate of fibrinous changes was observed after ECCE, 18% after PE (6.5 mm), and 9% after PE (4.1 mm). In cases of uncomplicated ECCE (n = 341) the rate of fibrinous reactions amounted to 22.4% following prolonged procedures (> 50 min) by residents, while it was as low as 9.5% following operations of short duration (< 30 min) by experienced surgeons. Intraocular injection of tPA (25 micrograms) was the most effective treatment. CONCLUSION: The self-sealing corneal small incision cataract technique guarantees a short duration of the surgical procedure and the last fibrinous reactions.

Serious occurrences in the natural history of advanced climatic keratopathy.

BACKGROUND: Climatic or chronic actinic keratopathy is an important corneal degeneration occurring after prolonged climatic exposure. The advanced stages of disease are confined generally to tropical or arid localities (including the Arctic) with high levels of sunlight. After many years of disease evolution, the advent of stage 3 keratopathy often presages a rapid downhill course. The instability of advanced climatic keratopathy has received little attention. METHODS: Eighteen patients with advanced climatic keratopathy are described from the Transvaal region in South Africa and from Saudi Arabia. Patients with rapid disease progression, spontaneous sterile ulceration, and secondary microbial keratitis are described. RESULTS: The rapid progression characteristic of stage 3 climatic keratopathy is illustrated. Severe, focal, sterile ulceration of the devitalized corneal degeneration may be common. Secondary infection may occur, leading to rapid dissolution of the climatic keratopathy material. Corneal perforation may ensue. The occurrence of yellow or brown fragments of the climatic keratopathy within or adjacent to the corneal inflammatory infiltrate indicates the predisposing cause of the infection, as usually also with examination of the opposite eye. CONCLUSIONS: These observations emphasize the inherent instability of advanced climatic keratopathy, which frequently takes a relentless downhill course. In rural populations of the developing world, climatic keratopathy is an important cause of blindness. Disease pathogenesis, treatment, and prevention deserve greater study.

Lacrimal testing. Age as a factor in Jones testing.

PURPOSE: A modified Jones test is used to assess whether lacrimal transit time varies with age. METHODS: The right eyes of 101 control subjects and 18 patients suspected of having lacrimal system abnormalities were tested with one drop of 2% sodium fluorescein solution. A cotton applicator was placed in the nose next to the inferior turbinate and participants were asked to lean forward. Dye passage was assessed every 3 minutes for 24 minutes. RESULTS: The results were assessed by age. In control subjects, there seemed to be a natural break in the distribution of the data at the age of 45 to 50 years. In control subjects younger than 45 years of age, 10/11 (91%) passed dye in 6 minutes or less (median = 3 minutes), whereas in those 45 years of age and older, 79/90 (84%) passed dye in 12 minutes or less (median = 6 minutes). The results were statistically significant (P = 0.0091). In contrast, patients with symptoms of epiphora due to a nasolacrimal duct obstruction had lacrimal transit times in excess of the above limits. CONCLUSION: This study confirms that the lacrimal transit time slows with age. The modification of the Jones test presented here requires a cutoff of 6 minutes in patients younger than 45 years of age and 12 minutes in patients 45 years of age and older.