RESUMO
Uterine fibroids are the most common benign tumor in women of reproductive age and can present with symptoms including bleeding, bulk related symptoms, and infertility. Several treatment options are available for the management of uterine fibroids, including medical management, minimally invasive therapies such as uterine artery embolization and MR-guided focused ultrasound ablation, and surgical interventions ranging from laparoscopic myomectomy to open hysterectomy. Given this wide range of therapeutic interventions, it is important to understand the data supporting these interventions and to be able to apply it in different clinical settings. This document provides a summary of recent trials supporting various therapies for uterine fibroids, including recent evidence for MR-guided focused ultrasound ablation and a detailed discussion of fertility outcomes in myomectomy and uterine fibroid embolization. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Humanos , Embolização da Artéria Uterina , Ablação por Radiofrequência/normas , Leiomioma/cirurgia , LaparoscopiaRESUMO
INTRODUCTION: Liver metastases are common in patients with neuroendocrine neoplasms. The role of stereotactic ablative radiotherapy (SABR) is not well understood in this population. OBJECTIVE: The objective of this study was to evaluate the safety and efficacy of SABR in treating well-differentiated neuroendocrine liver metastases (WD-NELM). METHODS: A retrospective review of patients with WD-NELM treated with SABR was conducted between January 2015 and July 2019. Demographic, treatment, and clinical/radiographic follow-up data were abstracted. RECIST 1.1 criteria were applied to each individual target to evaluate the response to treatment. Local control (LC) and progression-free survival (PFS) were determined using the Kaplan-Meier methodology. Toxicity was reported according to the CTCAE v5.0. RESULTS: Twenty-five patients with a total of 53 liver metastases treated with SABR were identified. Most patients (68%) had midgut tumors, were grade 2 (80%), and had high-volume intrahepatic and/or extrahepatic disease (76%). The median number of liver metastases treated was 2, with a median size of 2.5 cm. The median radiation dose delivered was 50 Gy/5 fractions. The median follow-up was 14 months; 24 of the 25 patients were alive at the time of analysis. The objective response rate was 32%, with improvement or stability in 96% of lesions treated. The median time to best response was 9 months. The 1-year LC and PFS were 92 and 44%, respectively. No grade 3/4 acute or late toxicity was identified. CONCLUSIONS: Liver SABR is a safe and promising means of providing LC for WD-NELM. This treatment modality should be evaluated in selected patients in concert with strategies to manage systemic disease.
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Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/secundário , Tumores Neuroendócrinos/patologia , Ablação por Radiofrequência , Técnicas Estereotáxicas , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Ablação por Radiofrequência/efeitos adversos , Ablação por Radiofrequência/métodos , Ablação por Radiofrequência/normas , Estudos RetrospectivosRESUMO
BACKGROUND: Radiofrequency ablation is an alternative strategy for the management of benign thyroid conditions. We analyzed the proportion of patients who underwent thyroid surgery for benign conditions who would be potentially eligible for radiofrequency ablation. METHODS: We identified patients who underwent thyroid surgery from 2015 to 2019 at the study institution for Bethesda II cytopathology or toxic adenoma. Patients were considered potentially eligible for radiofrequency ablation if they had a dominant nodule >2 cm with or without compression symptoms, a dominant nodule <2 cm with compression symptoms, or a toxic adenoma. RESULTS: Of 411 patients in total, 284 (69.1%) would be eligible to consider thyroid radiofrequency ablation. In the radiofrequency ablation-eligible group, 20 (7.0%) experienced voice change after surgery, and 2 (0.7%) were dissatisfied or concerned about their scar. In the radiofrequency ablation-eligible group, 70 patients (24.6%) had malignancy diagnosed by final pathology, and 23 patients (8.1%) had cancers that were equal to or larger than 1 cm in size. CONCLUSION: Many patients who undergo surgery for benign thyroid disease could be considered for radiofrequency ablation as an alternative treatment modality. Given the rate of occult malignancy, optimal evaluation of nondominant nodules before radiofrequency ablation and long-term thyroid surveillance for patients who undergo radiofrequency ablation should be further studied.
Assuntos
Complicações Pós-Operatórias/epidemiologia , Ablação por Radiofrequência/normas , Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/cirurgia , Tireoidectomia/normas , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Guias de Prática Clínica como Assunto , Ablação por Radiofrequência/efeitos adversos , Ablação por Radiofrequência/estatística & dados numéricos , Estudos Retrospectivos , Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/patologia , Tireoidectomia/efeitos adversos , Tireoidectomia/estatística & dados numéricos , Resultado do Tratamento , Estados UnidosRESUMO
PURPOSE: To compare the outcome of paroxysmal atrial fibrillation (AF) ablation via pulmonary vein isolation using Ablation Index (AI) with strict or standard stability criteria. METHODS: We enrolled 130 consecutive naive patients affected by paroxysmal AF who underwent PVI at two high-volume centers. AI target was ≥380 at the posterior wall and ≥500 at the anterior wall. Strict versus standard stability criteria were set for Group 1 (65 patients) and Group 2 (65 patients), respectively. We compared those strategies with a historical cohort of 72 consecutive patients treated at same centers in the VISITALY study, using average force ≥10 g and strict stability criteria as target parameters. Interlesion distance target was <6 mm. Recurrence was defined as any AF, atrial tachycardia (AT) or atrial flutter (AFL) during the 12 months after ablation, excluding a 90-days blanking period. RESULTS: Procedure duration (224.05 ± 47.21 vs. 175.61 ± 51.29 min; p < .001), fluoroscopy time (11.85 ± 4.38 vs. 10.46 ± 6.49 min; p = .019) and pericardial effusion rate (9.23% vs. 0%; p = .01) were higher in Group 1 than in Group 2. Freedom from AF/AT/AFL at 12 months was not significantly different (Group 1: 86.15%; Group 2: 90.77%; p = .42). Compared to VISITALY study, there were not significant differences in terms of recurrences. CONCLUSION: A strategy of PVI using AI with standard stability criteria performed the best in terms of procedure efficiency and safety. Twelve-months arrhythmia-free survival rate was comparable with other strategies pursuing an interlesion distance target <6 mm, regardless of the use of AI.
Assuntos
Fibrilação Atrial/cirurgia , Veias Pulmonares/cirurgia , Ablação por Radiofrequência/normas , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos RetrospectivosRESUMO
Thermal ablation has been established as an alternative treatment for renal cell carcinoma (RCC) in patients who are poor candidates for surgery. However, while American and European guidelines have been established for American and European patients, respectively, no ablation guidelines for Asian patients with RCCs have been established many years after the Asian Conference on Tumor Ablation (ACTA) had been held. Given that Western guidelines are difficult to apply to Asian patients due to differences in body habitus, economic status, and insurance systems, the current review sought to establish the first version of the ACTA guidelines for treating a RCC with thermal ablation.
Assuntos
Técnicas de Ablação/normas , Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Guias de Prática Clínica como Assunto , Carcinoma de Células Renais/diagnóstico por imagem , Congressos como Assunto , Criocirurgia/normas , Humanos , Neoplasias Renais/diagnóstico por imagem , Micro-Ondas , Seleção de Pacientes , Cuidados Pré-Operatórios , Ablação por Radiofrequência/normasRESUMO
BACKGROUND: Hepatocellular carcinoma (HCC) is one of the most common type of malignant tumors in adults, and is the most common cause of death in people with cirrhosis. Both laparoscopic hepatectomy (LH) and radiofrequency ablation (RFA) are radical treatments for small HCC. However, there is no international standard for the treatment of small HCC, and it is still controversial to choose LH or RFA in treating small HCC. We try to carry out a randomized, controlled, prospective study to compare the the short-term and long-term effects and safety of LH versus RFA in the treatment of small HCC. METHODS: This study is a single-center, evaluator-blinded, randomized, controlled clinical trial (RCT). The patients will be randomly divided into RFA group and LH group in a 1:1 ratio according to a computer-generated randomization list. Postoperative complications rates, Alpha fetoprotein (AFP), hospital stay, 1, 2, 3-year overall survival (OS) rates, disease-free survival (DFS) rates and all possible adverse events will be recorded. Statistical analyses will be performed with SPSS v22.0 software. CONCLUSIONS: The study will compare the the short-term and long-term effects and safety of LH versus RFA in the treatment of small HCC. OSF REGISTRATION NUMBER: doi: 10.17605/OSF.IO/HNX2T.
Assuntos
Carcinoma Hepatocelular/cirurgia , Protocolos Clínicos , Hepatectomia/normas , Laparoscopia/normas , Ablação por Radiofrequência/normas , Adulto , China , Intervalo Livre de Doença , Feminino , Hepatectomia/métodos , Humanos , Laparoscopia/métodos , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ablação por Radiofrequência/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , alfa-Fetoproteínas/análiseRESUMO
BACKGROUND: Managing cancer pain once it is refractory to conventional treatment continues to challenge caregivers committed to serving those who are suffering from a malignancy. Although neuromodulation has a role in the treatment of cancer pain for some patients, these therapies may not be suitable for all patients. Therefore, neuroablative procedures, which were once a mainstay in treating intractable cancer pain, are again on the rise. This guideline serves as a systematic review of the literature of the outcomes following neuroablative procedures. OBJECTIVE: To establish clinical practice guidelines for the use of neuroablative procedures to treat patients with cancer pain. METHODS: A systematic review of neuroablative procedures used to treat patients with cancer pain from 1980 to April 2019 was performed using the United States National Library of Medicine PubMed database, EMBASE, and Cochrane CENTRAL. After inclusion criteria were established, full text articles that met the inclusion criteria were reviewed by 2 members of the task force and the quality of the evidence was graded. RESULTS: In total, 14 646 relevant abstracts were identified by the literature search, from which 189 met initial screening criteria. After full text review, 58 of the 189 articles were included and subdivided into 4 different clinical scenarios. These include unilateral somatic nociceptive/neuropathic body cancer pain, craniofacial cancer pain, midline subdiaphragmatic visceral cancer pain, and disseminated cancer pain. Class II and III evidence was available for these 4 clinical scenarios. Level III recommendations were developed for the use of neuroablative procedures to treat patients with cancer pain. CONCLUSION: Neuroablative procedures may be an option for treating patients with refractory cancer pain. Serious adverse events were reported in some studies, but were relatively uncommon. Improved imaging, refinements in technique and the availability of new lesioning modalities may minimize the risks of neuroablation even further.The full guidelines can be accessed at https://www.cns.org/guidelines/browse-guidelines-detail/guidelines-on-neuroablative-procedures-patients-wi.
Assuntos
Dor do Câncer/terapia , Congressos como Assunto/normas , Medicina Baseada em Evidências/normas , Neurocirurgiões/normas , Guias de Prática Clínica como Assunto/normas , Ablação por Radiofrequência/normas , Dor do Câncer/diagnóstico , Medicina Baseada em Evidências/métodos , Humanos , Dor Intratável/diagnóstico , Dor Intratável/terapia , Ablação por Radiofrequência/métodosRESUMO
BACKGROUND: The efficacy and safety of vulvovaginal restoration devices were called into question in a U.S. Food and Drug Administration statement on July 30, 2018, claiming that women are being harmed by laser and other energy-based devices. The goal of this systematic literature review was to assess existing data, determine gaps in evidence, and propose opportunities for continued investigation pertaining to laser and energy-based vaginal restoration techniques. METHODS: A review of literature using PubMed, Cochrane Library databases, Embase, MEDLINE, and the Cumulative Index to Nursing and Allied Health Literature was conducted on January 9, 2019, and articles up to this point were considered. For inclusion, studies had to be available or translated in English and relate to clinical medicine, direct patient care, and nonsurgical energy-based vulvovaginal procedures. RESULTS: The authors found five level I studies, 19 level II studies, four level III studies, and 46 level IV studies that used 15 different devices. Various degrees of improvement of symptoms were reported in all studies. Adverse events/side effects were noted in two of the 13 radiofrequency device studies, 15 of the 23 erbium:yttrium-aluminum-garnet device studies, and 17 of the 37 carbon dioxide device studies. The majority of adverse events were considered mild. CONCLUSIONS: The majority of studies resulted in mild to no adverse side effects. However, there is a large gap in level I evidence. As a result, the authors emphasize the necessity of supplemental data surrounding this subject and suggest that additional randomized sham-controlled studies be conducted to further investigate vulvovaginal restoration devices in an effort to address women's health issues.
Assuntos
Medicina Baseada em Evidências , Terapia com Luz de Baixa Intensidade/efeitos adversos , Ablação por Radiofrequência/efeitos adversos , Doenças Vaginais/terapia , Doenças da Vulva/terapia , Aprovação de Equipamentos/normas , Feminino , Humanos , Lasers de Gás/efeitos adversos , Lasers de Gás/normas , Lasers de Estado Sólido/efeitos adversos , Lasers de Estado Sólido/normas , Terapia com Luz de Baixa Intensidade/instrumentação , Terapia com Luz de Baixa Intensidade/métodos , Menopausa/fisiologia , Ablação por Radiofrequência/instrumentação , Ablação por Radiofrequência/métodos , Ablação por Radiofrequência/normas , Resultado do Tratamento , Estados Unidos , United States Food and Drug Administration/normas , Vagina/efeitos da radiação , Vulva/efeitos da radiaçãoRESUMO
OPINION STATEMENT: Malignant gliomas remain a challenging cancer to treat due to limitations in both therapeutic and efficacious options. Tumor treating fields (TTFields) have emerged as a novel, locoregional, antineoplastic treatment modality with favorable efficacy and safety being demonstrated in the most aggressive type of malignant gliomas, glioblastoma (GBM). In 2 large randomized, controlled phase 3 trials, the addition of TTFields was associated with increased overall survival when combined with adjuvant temozolomide (TMZ) chemotherapy in patients with newly diagnosed GBM (ndGBM) and comparable overall survival compared with standard chemotherapy in patients with recurrent GBM (rGBM). TTFields target cancer cells by several mechanisms of action (MoA) including suppression of proliferation, migration and invasion, disruption of DNA repair and angiogenesis, antimitotic effects, and induction of apoptosis and immunogenic cell death. Having several MoAs makes TTFields an attractive modality to combine with standard, salvage, and novel treatment regimens (e.g., radiotherapy, chemotherapy, and immunotherapy). Treatment within the field of malignant gliomas is evolving to emphasize combinatorial approaches that work synergistically to improve patient outcomes. Here, we review the current use of TTFields in GBM, discuss MOA and treatment delivery, and consider the potential for its wider adoption in other gliomas.
Assuntos
Glioma/terapia , Ablação por Radiofrequência/métodos , Algoritmos , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/terapia , Tomada de Decisão Clínica , Ensaios Clínicos como Assunto , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Gerenciamento Clínico , Análise Fatorial , Glioblastoma/diagnóstico , Glioblastoma/terapia , Glioma/diagnóstico , Glioma/etiologia , Glioma/mortalidade , Humanos , Ablação por Radiofrequência/efeitos adversos , Ablação por Radiofrequência/normas , Resultado do TratamentoRESUMO
Sarcopenia might have impact on the outcome of patients with hepatoma carcinoma (HCC). This study was to determine whether pre-sarcopenia is associated with the outcome of HCC patients undergoing radiofrequency ablation (RFA).Patients with newly diagnosed HCC undergoing RFA were enrolled. We excluded patients without pre-RFA abdominal computed tomography or with incomplete ablation. Psoas muscle area index was calculated at the mid-lumbar 3 level of computed tomography images with the manual trace method. Pre-sarcopenia was defined as psoas muscle area index less than 4.24 and 2.50âcm/m for males and females respectively. The demographics and clinical characteristics were recorded before RFA.All patients were followed regularly until death or end of 2018. A total of 136 patients, including - BCLC stage 0 (nâ=â44, 32.4%) and - stage A (nâ=â92, 67.6%), were enrolled (males/females: 78/58, age: 65.4 years) with a mean follow-up period of 3.84 years. There were 75 patients (55.1%) with HCC recurrence and 47 patients (34.6%) with mortality during follow-up. Twenty-two (16.2%) patients were diagnosed with pre-sarcopenia. Multivariate analysis showed pre-sarcopenia (HR: 2.110 (1.092-4.078); Pâ=â.026) was the only factor significantly associated with overall survival (OS); however, there were no factors associated with HCC recurrence.For patients without and with pre-sarcopenia, the 1-, 3-, and 5-year OS rates were 92.0%, 77.6%, 68.9%, and 81.8%, 54.5%, 44.1% respectively (Pâ=â.007). For early-stage HCC patients undergoing RFA, pre-sarcopenia is the prognostic factor of OS, but not of recurrence, with a worse 5-year OS rate of 44.1%.
Assuntos
Carcinoma Hepatocelular/mortalidade , Ablação por Radiofrequência/normas , Sarcopenia/complicações , Idoso , Carcinoma Hepatocelular/epidemiologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Mortalidade , Prognóstico , Músculos Psoas/anatomia & histologia , Músculos Psoas/fisiopatologia , Ablação por Radiofrequência/métodos , Ablação por Radiofrequência/estatística & dados numéricos , Sarcopenia/epidemiologia , Sarcopenia/mortalidade , Taiwan/epidemiologia , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
Venous insufficiency is a very common disease affecting about 25% of the French population (if we combine all stages of its progression). It is a complex disease and its aetiology has not yet been fully elucidated. Some of its causes are well known, such as valvular dysfunction, vein wall defect, and the suctioning effect common to all varicose veins. These factors are generally associated and together lead to dysfunction of one or more of the saphenous veins. Saphenous vein dysfunction is revealed by ultrasound scan, a reflux lasting more than 0.5 seconds indicating venous incompetence. The potential consequences of saphenous vein dysfunction over time include: symptoms (heaviness, swellings, restlessness, cramps, itching of the lower limbs), acute complications (superficial venous thrombosis, varicose bleeding), chronic complications (changes in skin texture and colour, stasis dermatitis, eczema, vein atresia, leg ulcer), and appearance of unaesthetic varicose veins. It is not possible to repair an incompetent saphenous vein. The only therapeutic options at present are ultrasound-guided foam sclerotherapy, physical removal of the vein (saphenous stripping), or its thermal ablation (by laser or radiofrequency treatment), the latter strategy having now become the gold standard as recommended by international guidelines. Recommendations concerning thermal ablation of saphenous veins were published in 2014 by the Société française de médecine vasculaire. Our society has now decided to update these recommendations, taking this opportunity to discuss unresolved issues and issues not addressed in the original guidelines. Thermal ablation of an incompetent saphenous vein consists in destroying this by means of a heating element introduced via ultrasound-guided venous puncture. The heating element comprises either a laser fibre or a radiofrequency catheter. The practitioner must provide the patient with full information about the procedure and obtain his/her consent prior to its implementation. The checklist concerning the interventional procedure issued by the HAS should be validated for each patient (see the appended document).
Assuntos
Terapia a Laser/normas , Ablação por Radiofrequência/normas , Veia Safena/cirurgia , Varizes/cirurgia , Insuficiência Venosa/cirurgia , Lista de Checagem/normas , Tomada de Decisão Clínica , Consenso , Humanos , Terapia a Laser/efeitos adversos , Ablação por Radiofrequência/efeitos adversos , Medição de Risco , Fatores de Risco , Veia Safena/diagnóstico por imagem , Índice de Gravidade de Doença , Resultado do Tratamento , Varizes/diagnóstico por imagem , Insuficiência Venosa/diagnóstico por imagemRESUMO
BACKGROUND AND AIMS: The optimal treatment strategy for recurrent hepatocellular carcinoma (HCC) remains unclear. Therefore, we aimed to compare the outcomes of repeat hepatic resection (RHR) and radiofrequency ablation (RFA) for recurrent HCC. METHOD: From December 2004 to December 2015, 138 patients who underwent RHR and 194 patients who underwent RFA were enrolled. Propensity score matching (PSM) was performed to establish 1:1 RHR-RFA group matching. Clinical outcomes were compared before and after matching. RESULTS: Before matching, the 1-, 3-, and 5-year postrecurrence survival (PRS) rates were 91.8%, 82.0%, and 72.9% for the RHR group (n = 138) and 94.4%, 75.4%, and 61.7% for the RFA group (n = 194), respectively (P = .380). After matching, the PRS rates at 1, 3, and 5 years were 90.5%, 81.5%, and 71.8% for the RHR group (n = 120) and 91.0%, 61.0%, and 41.7% for the RFA group (n = 120), respectively (P = .002). In the subgroup analysis, the PRS rates for the RHR group were better than those for the RFA group for patients who relapsed within 2 years (P = .004) or patients with primary tumor burden beyond the Milan criteria (P = .004). Multivariate analysis showed that treatment allocation was identified as an independent prognostic factor for PRS. CONCLUSION: Compared with RFA, RHR provided a survival advantage for recurrent HCC, especially for patients who relapsed within 2 years and those with primary tumor burden beyond the Milan criteria.
Assuntos
Carcinoma Hepatocelular/cirurgia , Hepatectomia/normas , Neoplasias Hepáticas/cirurgia , Ablação por Radiofrequência/normas , Carcinoma Hepatocelular/patologia , Feminino , Seguimentos , Hepatectomia/métodos , Humanos , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Ablação por Radiofrequência/métodos , Estudos Retrospectivos , Taxa de SobrevidaAssuntos
Carcinoma de Células Renais/cirurgia , Criocirurgia/normas , Neoplasias Renais/cirurgia , Micro-Ondas/uso terapêutico , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Ablação por Radiofrequência/normas , Radiografia Intervencionista/normas , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/secundário , Tomada de Decisão Clínica , Consenso , Criocirurgia/efeitos adversos , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/patologia , Micro-Ondas/efeitos adversos , Seleção de Pacientes , Ablação por Radiofrequência/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Carga TumoralAssuntos
Carcinoma de Células Renais/cirurgia , Criocirurgia/normas , Neoplasias Renais/cirurgia , Micro-Ondas/uso terapêutico , Ablação por Radiofrequência/normas , Radiografia Intervencionista/normas , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/secundário , Tomada de Decisão Clínica , Consenso , Criocirurgia/efeitos adversos , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/patologia , Micro-Ondas/efeitos adversos , Seleção de Pacientes , Ablação por Radiofrequência/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Carga TumoralRESUMO
BACKGROUND: Minimally invasive fetal surgery is commonly performed to treat twin-to-twin transfusion syndrome with selective fetoscopic laser photocoagulation and twin-reversed arterial perfusion sequence using radiofrequency ablation. Although an increasing number of centers worldwide are performing these procedures, anesthetic management varies. Both neuraxial anesthesia and monitored anesthesia care with local anesthesia are used at different institutions. We sought to determine the efficacy and outcomes of these 2 anesthetic techniques for fetal procedures at our institution. METHODS: All patients undergoing minimally invasive fetal surgery for twin-to-twin transfusion syndrome or twin-reversed arterial perfusion sequence over a 6-year time period (2011-2016) were reviewed. Patients receiving monitored anesthesia care with local anesthesia were compared with those receiving spinal anesthesia in both selective fetoscopic laser photocoagulation and radiofrequency ablation fetal procedures. The primary outcome examined between the monitored anesthesia care and spinal anesthesia groups was the difference in conversion to general anesthesia using a noninferiority design with a noninferiority margin of 5%. Secondary outcome measures included use of vasopressors, procedure times, intraoperative fluids administered, maternal complications, and unexpected fetal demise within 24 hours of surgery. RESULTS: The difference in failure rate between monitored anesthesia care and spinal was -0.5% (95% CI, -4.8% to 3.7%). Patients receiving monitored anesthesia care plus local anesthesia were significantly less likely to need vasopressors, had a shorter presurgical operating room time, and received less fluid (P < .001). Operative time did not differ significantly. CONCLUSIONS: Monitored anesthesia care plus local anesthesia is a reliable and safe anesthetic choice for minimally invasive fetal surgery. Furthermore, it decreases maternal hemodynamic instability and reduces preincision operating room time.
Assuntos
Anestesia Local/métodos , Raquianestesia/métodos , Transfusão Feto-Fetal/cirurgia , Fetoscopia/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Monitorização Intraoperatória/métodos , Adulto , Anestesia Local/normas , Raquianestesia/normas , Feminino , Transfusão Feto-Fetal/diagnóstico por imagem , Fetoscopia/normas , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/normas , Monitorização Intraoperatória/normas , Gravidez , Ablação por Radiofrequência/métodos , Ablação por Radiofrequência/normas , Estudos RetrospectivosRESUMO
Microwave ablation (MWA) for cancer treatment is frequently monitored by ultrasound (US) B-mode imaging in the clinic, which often fails due to the low intrinsic contrast between the thermal lesion and normal tissue. Deep learning, especially convolutional neural network (CNN), has shown significant improvements in medical image analysis. Here, we propose and evaluate an US imaging based on a CNN architecture for the detection and monitoring of thermal lesions induced by MWA in porcine livers. Unlike dealing with images in many visual object recognition tasks, US radiofrequency (RF) data backscattered from the ablated region were utilized to capture features related to the thermal lesion. The dataset comprised of 1640 US RF envelope data matrices and their corresponding gross-pathology images, and were utilized for training and testing. After envelope detection, US B-mode, segmentation results based on CNN (SICNN), and modified CNN (SIm-CNN) for US data were simultaneously reconstructed to reveal the suitability for monitoring of MWA. The SICNN and SIm-CNN outperformed B-mode images for the detection and monitoring of MWA-induced thermal lesions. The values of the area under the receiver operating characteristic curve were 0.8728 and 0.8948 for the SICNN and Sim-CNN, respectively, which were both higher than the value of 0.6904 for B-mode images. Ablated regions that were assessed using SIm-CNN showed a good correlation (J 0.8845, r 0.8739, and E 0.410) to gross-pathology images. This study was the first to illustrate that SIm-CNN has the potential to detect and monitor thermal lesions, and may be utilized as an alternative modality for image-guided MWA treatments.
Assuntos
Interpretação de Imagem Assistida por Computador/métodos , Redes Neurais de Computação , Lesões por Radiação/diagnóstico por imagem , Ablação por Radiofrequência/efeitos adversos , Ultrassonografia/métodos , Animais , Aprendizado Profundo , Fígado/diagnóstico por imagem , Fígado/lesões , Fígado/patologia , Fígado/cirurgia , Micro-Ondas , Lesões por Radiação/patologia , Ablação por Radiofrequência/normas , Cirurgia Assistida por Computador , SuínosRESUMO
Osteoid osteoma is frequent benign tumor, descripted initially by Bergstrand in 1930 followed by Jaffe in 1935. The painful feature of the osteoid osteoma explains the specific consideration by the medical community for this entity. The debate was focused on pathologic and imaging pattern as well as the treatment modalities. Currently, the treatment options are varied and percutaneous treatment is increasingly used. The radiofrequency is widely validated as efficient method without serious adverse and with low rate of recurrence. We hope through this this work to revue the current knowledge of the treatment of osteoid osteoma.
L'ostéome ostéoïde est une tumeur osseuse bénigne relativement fréquente initialement décrite par Bergstrand en 1930, puis comme une entité propre grâce aux recherches de Jaffe en 1935. Malgré sa bénignité, elle a concentré toute l'attention des radiologues comme des cliniciens car très symptomatique. Dès lors, l'ostéome ostéoïde a fait l'objet de nombreux débats dans la communauté scientifique en particulier concernant son étiologie, ses caractéristiques pathologiques, son bilan d'imagerie et son traitement. C'est sur cette dernière question que les avancées ont été les plus marquantes et c'est ainsi que les possibilités thérapeutiques bien décrites dans la littérature apparaissent variées. Toutefois, les résultats très favorables des traitements percutanés et en particulier de la radiofréquence, de même que le faible taux de récidives et de complications de ces traitements, ont amené de nombreux pays à les considérer comme le meilleur traitement en première intention. A travers cette revue de la littérature et de notre pratique clinique, nous souhaitons rapporter les connaissances actuelles thérapeutiques en perpétuelle progression grâce au progrès technique.
Assuntos
Neoplasias Ósseas , Osteoma Osteoide , Neoplasias Ósseas/patologia , Neoplasias Ósseas/terapia , Ablação por Cateter , Humanos , Recidiva Local de Neoplasia/prevenção & controle , Osteoma Osteoide/patologia , Osteoma Osteoide/terapia , Ablação por Radiofrequência/normasRESUMO
Only a few thyroid nodules are perceived as functional or optically disturbing. If there is a need for action, surgical intervention is the long-term standard by which thermoablative procedures (radiofrequency-, laser-, microwave ablation, high intensity focused ultrasound) must be measured against in terms of safety, effectiveness and patient satisfaction. Prior to intervention assessment of the dignity of the nodule by ultrasound-guided fine needle aspiration is essential for cold and warm nodules, as is the confirmation of an inconspicuous cervical lymph node status. The short-term treatment results of these newer interventions in terms of nodule volume reduction and symptomatic improvement are promising and the general complication rate of the procedures is low. Since functional thyroid parenchyma is preserved, maintaining normal thyroid status is the rule. The procedure is usually performed on an outpatient basis, under local anesthesia and monitoring. The subsequent convalescence is usually very short. Most studies are available on monopolar radiofrequency ablation. Several professional societies have defined indications for radiofrequency ablation (RFA), but these need to be further refined based on practical experience and literature. An acceptable long-term recurrence rate still has to be proven for practically all thermoablative methods, for monopolar RFA limited long-term data are encouraging so far. The recurrence rate as well as patient satisfaction will provide the basis for a meaningful overall cost-benefit analysis in the future.
Assuntos
Ablação por Radiofrequência/métodos , Nódulo da Glândula Tireoide/terapia , Análise Custo-Benefício , Humanos , Guias de Prática Clínica como Assunto , Ablação por Radiofrequência/efeitos adversos , Ablação por Radiofrequência/economia , Ablação por Radiofrequência/normasRESUMO
The growth of the field of fetal surgery over the last two decades driven by new indications and data from prospective randomized trials supporting prenatal intervention has resulted in techniques protocols and methodologies that have gained confidence by insuring good outcomes. Error traps are methods or techniques that usually work well in most of the cases, but which are apt to fail under certain specific circumstances. The very confidence the surgeon develops in these techniques or methodologies makes them a trap for the unwary surgeon. The purpose of this article is to discuss common error traps in fetal interventions, including ultrasound guided procedures, fetoscopic surgery, open fetal surgery and EXIT procedures. Awareness of these error traps and approaches to avoid them may enhance fetal surgical outcomes and reduce complications rates.
Assuntos
Doenças Fetais/cirurgia , Fetoscopia/normas , Fotocoagulação a Laser/normas , Erros Médicos , Ablação por Radiofrequência/normas , Procedimentos Cirúrgicos Operatórios/normas , Ultrassonografia Pré-Natal/normas , Feminino , Fetoscopia/métodos , Humanos , Fotocoagulação a Laser/métodos , Gravidez , Ablação por Radiofrequência/métodos , Procedimentos Cirúrgicos Operatórios/métodos , Ultrassonografia Pré-Natal/métodosRESUMO
INTRODUCTION: Radiofrequency ablation (RFA) of outflow tract ventricular arrhythmia (VA) that originates from the aortic cusps can be challenging. Data on long term efficacy and safety as well as optimal technique after aortic cusp ablation have not previously been reported. OBJECTIVES: This aim of the study was to determine the short- and long term outcomes after RFA of aortic cusp VA, and to evaluate aortic valve injuries according to echocardiographic screening. PATIENTS AND METHODS: This was a prospective multicenter registry (AVATAR, Aortic Cusp Ventricular Arrhythmias: Long Term Safety and Outcome from a Multicenter Prospective Ablation Registry) study. A total of 103 patients at a mean age of 56 years (34-64) from the "Electra" Registry (2005-2017) undergoing RFA of aortic cusps VA were enrolled. The following 3 ablation techniques were used: zerofluoroscopy (ZF; electroanatomical mapping [EAM] without fluoroscopy), EAM with fluoroscopy, and conventional fluoroscopy based RFA. Data on clinical history, complications after RFA, echocardiography, and 24 hour Holter monitoring were collected. The follow up was 12 months or longer. RESULTS: There were no major acute cardiac complications after RFA. In one case, a vascular access complication required surgery. The median (interquartile range [IQR]) procedure time was 75 minutes (IQR, 58-95), median follow up, 32 months (IQR, 12-70). Acute and long term procedural success rates were 93% and 86%, respectively. The long term RFA outcomes were observed in ZF technique (88%), EAM with fluoroscopy (86%), and conventional RFA (82%), without differences. During long term followup, no abnormalities were found within the aortic root. CONCLUSIONS: Ablation of VA within the aortic cusps is safe and effective in long term follow up. The ZF approach is feasible, although it requires greater expertise and more imaging modalities.