RESUMEN
PURPOSE: CT-guided MWA is a safe and effective tool that should be utilized in the treatment of small renal masses (SRMs). We aim to clarify the utility of CT-guided MWA by examining patient outcomes such as recurrence, treatment success, changes in renal function, and complications. METHODS: A retrospective review of consecutive patients with SRMs who underwent same day renal mass biopsy (RMB) and CT-guided MWA between 2015 and 2022 was performed. Treatment safety was assessed by 30-day complications according to the Clavien-Dindo system and change in eGFR >30 days post-procedure. Treatment efficacy was defined by local recurrence and incomplete treatment rates and calculated using the Kaplan-Meier method. RESULTS: A total of 108 renal masses were found in 104 patients. The overall complication rate was 7.4% (8/108), of which 4 were major complications (3.7%). For those with renal function available >30 days post ablation, the median eGFR was 47.2 (IQR: 36.0, 57), compared to 52.3 (IQR: 43.7, 61.5) pre-ablation, p<0.0001. 5-year local recurrence free survival was 86%. Among those with biopsy proven malignancy (n= 66), there were five local recurrences (7.54%) occurring at a median of 25.1 months (IQR 19.9, 36.2) and one case (1.5%) of incomplete treatment. CONCLUSIONS: As the medical field continues to evolve towards less invasive interventions, MWA offers a valuable tool in the management of renal masses. With low major complication and recurrence rates, our findings support the utility of CT-guided MWA as a tool for treatment of SRMs.
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Técnicas de Ablación , Carcinoma de Células Renales , Ablación por Catéter , Neoplasias Renales , Humanos , Neoplasias Renales/patología , Carcinoma de Células Renales/patología , Microondas/uso terapéutico , Resultado del Tratamiento , Técnicas de Ablación/efectos adversos , Técnicas de Ablación/métodos , Estudios Retrospectivos , Ablación por Catéter/métodosRESUMEN
INTRODUÇÃO: As técnicas de ablação são usadas para destruir tumores pequenos (até 4 cm), sem removê-los com cirurgia ou para diminuir seu tamanho possibilitando a cirurgia. A ablação por radiofrequência já é utilizada no SUS para tratamento do carcinoma hepático primário localizado, em estágios I e II. PERGUNTA DE PESQUISA: Para adultos com diagnóstico de câncer de cólon e reto com metástase hepática irressecável ou ressecável com alto risco cirúrgico, o tratamento com ablação térmica (por radiofrequência ou por micro-ondas) é eficaz, efetivo, seguro, custoefetivo e viável economicamente quando comparado ao tratamento com quimioterapia? EVIDÊNCIAS CIENTÍFICAS: Identificaram-se, por busca estruturada, duas revisões sistemáticas e dois estudos primários (duas publicações de um ECR de fase 2, de 2002 a 2007, e um estudo observacional retrospectivo). Não foi identificada evidência para ablação por micro-ondas que atendesse aos critérios de elegibilidade deste PTC. No estudo observa
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Humanos , Neoplasias del Recto/tratamiento farmacológico , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Neoplasias del Colon/tratamiento farmacológico , Medición de Riesgo/métodos , Técnicas de Ablación/métodos , Neoplasias Hepáticas/secundario , Sistema Único de Salud , Brasil , Eficacia , Análisis Costo-Beneficio/economíaRESUMEN
Resumen: El síncope mediado neuralmente es un trastorno causado por un reflejo autónomo anormalmente amplificado que involucra componentes tanto simpáticos como parasimpáticos. Es la causa más frecuente de síncope en personas jóvenes y su tratamiento sigue siendo un desafío, ya que no se ha demostrado que alguna terapia farmacológica prevenga por completo su recurrencia. En los últimos años ha surgido una técnica denominada cardioneuroablación, que consiste en la ablación por radiofrecuencia de los plexos ganglionares (PG) parasimpáticos, con buenos resultados a corto y largo plazo en la prevención de síncope recurrente, según los diferentes grupos de investigación. Presentamos el primer caso en Chile de un hombre joven con síncopes mediados neuralmente recurrentes que fue tratado con esta técnica en el Hospital Regional de Concepción.
Abstract: Cardioneuroablation is a novel method that can be used to treat reflex syncope. Although the experience with this technique is relatively limited it provides a more physiological way to treat this condition. The first case in Chile is herein reported along with a discussion of the subject.
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Humanos , Masculino , Adulto , Técnicas de Ablación/métodos , Ablación por Radiofrecuencia/métodos , Atropina/farmacología , Síncope Vasovagal/diagnóstico , Electrocardiografía/instrumentaciónRESUMEN
PURPOSE: To review the current evidence regarding protocols and outcomes of image-guided focal therapy (FT) for prostate cancer (PCa). METHODS: A literature search of the latest published studies assessing primary FT for PCa was carried out in Medline and Cochrane library databases followed by a critical review. FT modalities, follow-up strategies, and oncological and toxicity outcomes were summarized and discussed in this review. RESULTS: Twenty-four studies with six different sources of energy met the inclusion criteria. A heterogeneity of patient selection, energy sources, treatment templates, and definitions of failure was found among the studies. While a third of patients may be found to have additional cancer burden over 3-5 years following FT, most patients will remain free of a radical procedure. The vast majority of patients maintain urinary continence and good erectile function after FT. Acute urinary retention is the most common complication, whilst severe complications remain rare. CONCLUSION: An increasing number of prospective studies with longer follow-up have been recently published. Acceptable cancer control and low treatment toxicity after FT have been consistently reported. Follow-up imaging and routine biopsy must be encouraged post-FT. While there is no reliable PSA threshold to predict failure after FT, reporting post-FT positive biopsies and retreatment rates appear to be standard when assessing treatment efficacy.
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Técnicas de Ablación/métodos , Tratamientos Conservadores del Órgano/métodos , Neoplasias de la Próstata/cirugía , Humanos , MasculinoRESUMEN
RESUMEN La incidencia de enfermedades oncológicas se incrementa cada día. Las terapias ablativas tumorales percutáneas guiadas por imagen constituyen una alternativa de tratamiento para pacientes sin criterio de resección quirúrgica. El objetivo del estudio es argumentar la necesidad del uso de las terapias ablativas tumorales percutáneas en Cuba mediante la revisión de su estado actual en el mundo. Se realizó una revisión bibliográfica descriptiva, en bases de datos Google Escolar, MEDLINE (Pubmed) y SciELO. Se seleccionaron 31 artículos, que fueron útiles para actualizar la información. Con la ablación tumoral percutánea se intentó erradicar completamente todas las células malignas viables dentro del tumor. La ablación química, la térmica y otras no térmicas, son las más usadas. Este tratamiento ha demostrado ser efectivo y seguro. Debido su elevado costo, no ha sido posible su introducción en el país(AU)
ABSTRACT The incidence of oncological diseases increases every day. Image-guided percutaneous tumor ablative therapies are treatment alternatives for patients not eligible based on surgical resection criteria. The objective of the study is support the need for the use of percutaneous tumor ablative therapies in Cuba, by reviewing its current state in the world. A descriptive bibliographic review was carried out using the databases Google Scholar, MEDLINE (Pubmed) and SciELO, from which 31 articles were selected, useful to update the information. Percutaneous tumor ablation was performed in view of completely eradicating all viable malignant cells within the tumor. Chemical, thermal and other non-thermal ablations are the most used. This treatment has proven effective and safe. Due to its high cost, its introduction in the country has not been possible(AU)
Asunto(s)
Humanos , Literatura de Revisión como Asunto , Técnicas de Ablación/métodos , Neoplasias/epidemiología , Epidemiología Descriptiva , Bases de Datos BibliográficasRESUMEN
INTRODUCCIÓN: El presente dictamen expone la evaluación de la eficacia y seguridad de tirotropina recombinante (rhTSH) en pacientes adultos posoperados de cáncer de tiroides diferenciado (CTD), sin contraindicación de suspensión del reemplazo hormonal con hormona tiroidea exógena (THW) y que requieren terapia radioablativa (RAI). El cáncer de tiroides es la neoplasia endocrina más frecuente. Entre 2012 y 2016, la incidencia de cáncer de tiroides en Estados Unidos fue de 15.8/100 000 habitantes. En oposición a la alta incidencia, la mortalidad en el mismo periodo de tiempo se estimó en 0.5/100 000 hombres y mujeres. El año 2017, se diagnosticaron 637 nuevos casos de cáncer de tiroides en el Instituto Nacional de Enfermedades Neoplásicas de Perú. Estudios poblacionales sugieren que entre el 70 % y 90 % de los casos corresponderían al sobrediagnóstico1 de lesiones asintomáticas detectadas durante exámenes de rutina. El tratamiento de los pacientes con cáncer de tiroides diferenciado (CTD) se basa en tres actividades: la resección quirúrgica del tumor, la terapia radioablativa con yodo (RAI) y la terapia de reemplazo hormonal con hormona tiroidea exógena. Para realizar la RAI, el tejido tiroideo remanente debe absorber el yodo radioactivo (I 131). La absorción y retención del I131 se consigue aumentando el nivel de hormona estimulante de la tiroides (TSH, por sus siglas en inglés). La terapia de reemplazo hormonal suprime la TSH; por lo tanto, la forma más sencilla de estimular la producción de TSH es suspender la terapia de reemplazo hormonal. Sin embargo, la suspensión de la terapia de reemplazo hormonal (THW, por sus siglas en inglés) también induce hipotiroidismo clínico secundario debido a la falta de hormona tiroidea. Actualmente, en EsSalud, los pacientes con CTD que requieren RAI del tejido tiroideo remanente son preparados mediante THW, excepto para los pacientes que tienen contraindicación de THW. De acuerdo con lo señalado en el Dictamen Preliminar de Evaluación de Tecnología Sanitaria N° 053-SDEPFYOTS-DETS- IETSI-2019 del IETSI, la tirotropina recombinante humana (rhTSH, por sus siglas en inglés) puede utilizarse en pacientes con contraindicación de THW, así el paciente puede acceder a la RAI sin el riesgo que conlleva la THW. La TSH recombinante humana (rhTSH, por sus siglas en inglés) es una forma recombinante de la TSH humana desarrollada para elevar los niveles de TSH antes del escaneo con I131 de la realización de la prueba de tiroglobulina y antes del procedimiento de RAI. El uso de rhTSH estimula la captación de yodo por la tiroides, de este modo la radiación del I131 usado en la RAI elimina las células neoplásicas que no fueron extraídas durante la cirugía. Adicionalmente, con rhTSH no hay necesidad de la THW, por lo tanto, se evita el hipotiroidismo secundario a THW. METODOLOGÍA: Se llevó a cabo una búsqueda sistemática de la literatura con respecto a la eficacia y seguridad de rhTSH en el tratamiento de pacientes adultos posoperados de CTD, que requieren RAI y no tienen contraindicación de THW. Se realizó tanto una búsqueda sistemática como una búsqueda manual en las páginas web de grupos dedicados a la investigación y educación en salud que elaboran guías de práctica clínica (GPC) y evaluaciones de tecnologías sanitarias (ETS). RESULTADOS: En la presente sinopsis se describe la evidencia disponible según el tipo de publicación, siguiendo lo indicado en los criterios de elegibilidad. CONCLUSIONES: El presente dictamen preliminar tuvo como objetivo evaluar la evidencia disponible la eficacia y seguridad de rhTSH en términos de: sobrevida global, calidad de vida e incidencia de eventos adversos, en comparación con placebo, para el tratamiento de pacientes adultos posoperados de CTD sin contraindicación de THW, y que requieren RAI. Tras la búsqueda sistemática de literatura, se incluyeron tres GPC (Pacini et al. 2012; Haugen et al. 2016; Pacini et al. 2016), dos ETS (Deminco, Alemán, y Pérez-Galán 2011; CCATES 2016) y una RS con MA (Xu et al. 2015) como evidencia para responder la pregunta PICO de interés del presente dictamen preliminar. Con respecto a lo expuesto previamente, el equipo técnico del IETSI valoró los siguientes aspectos: i) El CTD es una enfermedad infrecuente y de buen pronóstico, y, ii) La evidencia disponible sugiere que rhTSH y THW tienen resultados similares en eficacia y calidad de vida en pacientes con CTD que son preparados para la RAI. Por todo lo expuesto, el IETSI no aprueba el uso de rhTSH como parte del tratamiento de pacientes adultos posoperados de cáncer de tiroides diferenciado que requieren terapia radioablativa y no tienen contraindicación de suspensión del reemplazo hormonal con hormona tiroidea exógena.
Asunto(s)
Humanos , Neoplasias de la Tiroides/tratamiento farmacológico , Tirotropina/uso terapéutico , Técnicas de Ablación/métodos , Eficacia , Análisis Costo-BeneficioRESUMEN
BACKGROUNDS AND AIMS: New mucosal resective and ablative endoscopic procedures based on gastric cardiac remodeling to prevent reflux have appeared. We aimed to evaluate the feasibility of a new ablative technique named antireflux ablation therapy (ARAT) for control of GERD in patients without hiatal hernia. METHODS: Patients with proton pump inhibitor (PPI)-refractory GERD without hiatal hernia underwent ARAT between January 2016 and October 2019. Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQL), upper endoscopy, 24-hour pH monitoring, and PPI use were documented at 3, 6, 12, 24, and 36 months after ARAT. RESULTS: One hundred eight patients were included (61 men [56.5%]; median age, 36.5 years; range, 18-78 years). ARAT was performed on all patients. At the 36-month evaluation, 84 patients had completed the protocol. Median ARAT time was 35.5 minutes (range, 22-51 minutes), and median circumference ablation was 300° (range, 270°-320°). No major adverse events occurred, and 14 of 108 patients (12.9%) presented with stenosis that was responsive to balloon dilation (<5 sessions). At the 3-month evaluation, the acid exposure time (AET), DeMeester score, and GERD-HRQL score had decreased from 18.8% to 2.8% (P = .001), 42.5 to 9.1 (P = .001), and 36.5 to 10 (P = .02), respectively, and these values were maintained up to 36 months. Success (AET <4%) was achieved in 89% and 72.2% at 3 and 36 months, respectively. Related factors at 36 months were as follows: pre-ARAT Hill type II (odds ratio [OR], 3.212; 95% confidence interval [CI], 1.431-5.951; P = .033), post-ARAT 3-month Hill type I (OR, 4.101; 95% CI, 1.812-9.121; P = .042), and AET <4% at 3 months (OR, 5.512; 95% CI, 1.451-7.621; P = .021). CONCLUSIONS: ARAT is a feasible, safe, and effective therapy for early and mid-term treatment of GERD in patients without a sliding hiatal hernia. However, longer follow-up evaluations and randomized comparative studies are needed to clarify its real role. (Clinical trial registration number: NCT03548298.).
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Técnicas de Ablación , Fundoplicación , Reflujo Gastroesofágico , Hernia Hiatal , Técnicas de Ablación/métodos , Adolescente , Adulto , Anciano , Endoscopía Gastrointestinal , Monitorización del pH Esofágico , Estudios de Factibilidad , Femenino , Reflujo Gastroesofágico/tratamiento farmacológico , Reflujo Gastroesofágico/cirugía , Hernia Hiatal/tratamiento farmacológico , Hernia Hiatal/cirugía , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Inhibidores de la Bomba de Protones/uso terapéutico , Calidad de Vida , Resultado del Tratamiento , Adulto JovenRESUMEN
Background: The spinal cord's central pattern generators (CPGs) have been explained by the symmetrical half-center hypothesis, the bursts generator, computational models, and more recently by connectome circuits. Asymmetrical models, at odds with the half-center paradigm, are composed of extensor and flexor CPG modules. Other models include not only flexor and extensor motoneurons but also motoneuron pools controlling biarticular muscles. It is unknown whether a preferred model can explain some particularities that fictive scratching (FS) in the cat presents. The first aim of this study was to investigate FS patterns considering the aiming and the rhythmic periods, and second, to examine the effects of serotonin (5HT) on and segmental inputs to FS. Methods: The experiments were carried out first in brain cortex-ablated cats (BCAC), then spinalized (SC), and for the midcollicular (MCC) preparation. Subjects were immobilized and the peripheral nerves were used to elicit the Monosynaptic reflex (MR), to modify the scratching patterns and for electroneurogram recordings. Results: In BCAC, FS was produced by pinna stimulation and, in some cases, by serotonin. The scratching aiming phase (AP) initiates with the activation of either flexor or extensor motoneurons. Serotonin application during the AP produced simultaneous extensor and flexor bursts. Furthermore, WAY 100635 (5HT1A antagonist) produced a brief burst in the tibialis anterior (TA) nerve, followed by a reduction in its electroneurogram (ENG), while the soleus ENG remained silent. In SC, rhythmic phase (RP) activity was recorded in the soleus motoneurons. Serotonin or WAY produced FS bouts. The electrical stimulation of Ia afferent fibers produced heteronymous MRes waxing and waning during the scratch cycle. In MCC, FS began with flexor activity. Electrical stimulation of either deep peroneus (DP) or superficial peroneus (SP) nerves increased the duration of the TA electroneurogram. Medial gastrocnemius (MG) stretching or MG nerve electrical stimulation produced a reduction in the TA electroneurogram and an initial MG extensor burst. MRes waxed and waned during the scratch cycle. Conclusion: Descending pathways and segmental afferent fibers, as well as 5-HT and WAY, can change the FS pattern. To our understanding, the half-center hypothesis is the most suitable for explaining the AP in MCC.
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Técnicas de Ablación , Corteza Cerebral/fisiología , Estado de Descerebración/fisiopatología , Nervios Periféricos/fisiología , Reflejo Monosináptico/fisiología , Médula Espinal/fisiología , Técnicas de Ablación/métodos , Animales , Encéfalo/efectos de los fármacos , Encéfalo/fisiología , Encéfalo/cirugía , Gatos , Corteza Cerebral/efectos de los fármacos , Corteza Cerebral/cirugía , Estimulación Eléctrica/métodos , Neuronas Motoras/efectos de los fármacos , Neuronas Motoras/fisiología , Nervios Periféricos/efectos de los fármacos , Reflejo Monosináptico/efectos de los fármacos , Serotonina/administración & dosificación , Antagonistas de la Serotonina/administración & dosificación , Médula Espinal/efectos de los fármacos , Médula Espinal/cirugía , Colículos Superiores/efectos de los fármacos , Colículos Superiores/fisiología , Colículos Superiores/cirugíaRESUMEN
Introducción: El cáncer diferenciado de tiroides (CDT), es actualmente la neoplasia endocrina más frecuente. Su tratamiento estándar es la resolución quirúrgica, asociado a ablación con radioyodo (RI) según la clasificación propuesta por la American Thyroid Association (ATA). Las indicaciones y dosis de este último, han ido variando en los últimos años según avanzan las investigaciones en este ámbito. Objetivo: En el siguiente estudio se compararon las dosis de RI utilizadas previo y posterior a la implementación de las últimas guías de la ATA. Materiales y métodos: Estudio retrospectivo observacional de 70 pacientes con diagnóstico de CDT del Hospital Clínico de la Universidad de Chile entre 2012 y 2017. Se agruparon los pacientes en dos cohortes, los operados entre los años 2012-2015 y los 2016-2017 clasificándolos según riesgo ATA, TNM y riesgo de recurrencia. Se consignaron las dosis de RI utilizadas y se compararon entre las cohortes. Análisis estadístico: Mann Whithney. Resultados: Al comparar la dosis de RI entre ambas cohortes, según TNM y riesgo ATA, se obtuvo los siguientes resultados: los pacientes T1b de la cohorte 2012-2015 presentaron dosis de RI significativamente mayores que los de la cohorte 2016-2017; también se evidenció que en pacientes N0 hubo una diferencia estadísticamente significativa, mostrando una tendencia a disminuir la dosis de RI; además, en los pacientes de la cohorte 2012-2015 con riesgo ATA intermedio, se obtuvo que las dosis de RI fueron significativamente mayores que las utilizadas en la cohorte 2016-2017. Conclusión: Se concluye que las variaciones de las dosis de RI utilizadas en pacientes con CDT en un hospital universitario van acorde a las recomendaciones internacionales actuales, particularmente la publicación de la guía ATA 2015, aplicándose radioablación con menor dosis de RI. Dado este cambio, se ha evidenciado igualdad de efectos con dosis menores de RI y consecuentemente menos efectos adversos.
Introduction: Differentiated thyroid cancer (CDT) is currently the most frequent endocrine neoplasia. Its standard of care is surgical treatment, associated with radioiodine ablation (IR) according to the classification proposed by the American Thyroid Association (ATA). The indications and doses of the latter have changed in recent years as research in this area advances. Objective: In the following study, the doses of IR used before and after the implementation of the latest ATA guidelines were compared. Materials and methods: Retrospective observational study of 70 patients with a diagnosis of CDT from the Clinical Hospital of the University of Chile between 2012 and 2017. Patients were grouped into two cohorts, those surgically intervened between the years 2012-2015 and 2016-2017, classifying them according to ATA risk, TNM and recurrence risk. The IR doses used were reported and compared between the cohorts. Statistical analysis: Mann Whithney. Results: When comparing the IR dose between both cohorts, according to TNM and ATA risk, the following results were obtained: T1b patients in the 2012-2015 cohort had significantly higher IR doses than those in the 2016-2017 cohort; It was also evidenced that N0 patients showed a statistically significant tendency to decrease the IR dose; In addition, the 2012-2015 cohort with intermediate ATA risk, revealed IR doses significantly higher than those used in the 2016-2017 cohort. Conclusion: It is concluded that the variations in IR doses, used in patients with CDT in a university hospital, are in accordance with current international recommendations, particularly the publication of the ATA 2015 guidelines, applying radioablation with a lower dose of IR. Given this change, equality of effects has been evidenced with lower doses of IR and consequently fewer adverse effects.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Dosis de Radiación , Radioterapia/normas , Neoplasias de la Tiroides/radioterapia , Endocrinología/normas , Radioisótopos de Yodo/administración & dosificación , Tiroidectomía/métodos , Neoplasias de la Tiroides/cirugía , Estudios Retrospectivos , Estudios de Cohortes , Guías de Práctica Clínica como Asunto , Medición de Riesgo , Radioterapia Adyuvante , Endocrinología/métodos , Técnicas de Ablación/métodos , Radioisótopos de Yodo/efectos adversosRESUMEN
Eighty percent of hepatocarcinomas are inoperable at the moment of diagnosis. Liver transplantation is the treatment of choice in these cases, but local therapies are another alternative. Among these, Image-Guided BrachyAblation is a safe choice. We report a 76-year-old male with a hepatocarcinoma, who was considered inoperable due to the high surgical risk of the patient. A local treatment with Image-Guided BrachyAblation was decided. A brachytherapy needle was placed in the tumor under computed tomography guidance and a 15 Gy single dose was delivered from an Iridium-192 source. The patient had no immediate complications and at one month of follow up he continued without incidents.
Asunto(s)
Técnicas de Ablación/métodos , Braquiterapia/métodos , Carcinoma Hepatocelular/radioterapia , Neoplasias Hepáticas/radioterapia , Radioterapia Guiada por Imagen/métodos , Anciano , Carcinoma Hepatocelular/diagnóstico por imagen , Humanos , Radioisótopos de Iridio , Neoplasias Hepáticas/diagnóstico por imagen , Masculino , Dosis de Radiación , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Eighty percent of hepatocarcinomas are inoperable at the moment of diagnosis. Liver transplantation is the treatment of choice in these cases, but local therapies are another alternative. Among these, Image-Guided BrachyAblation is a safe choice. We report a 76-year-old male with a hepatocarcinoma, who was considered inoperable due to the high surgical risk of the patient. A local treatment with Image-Guided BrachyAblation was decided. A brachytherapy needle was placed in the tumor under computed tomography guidance and a 15 Gy single dose was delivered from an Iridium-192 source. The patient had no immediate complications and at one month of follow up he continued without incidents.
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Humanos , Masculino , Anciano , Braquiterapia/métodos , Carcinoma Hepatocelular/radioterapia , Técnicas de Ablación/métodos , Radioterapia Guiada por Imagen/métodos , Neoplasias Hepáticas/radioterapia , Dosis de Radiación , Radioisótopos de Iridio , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Carcinoma Hepatocelular/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico por imagenAsunto(s)
Vigilancia de la Población , Neoplasias de la Próstata/epidemiología , Espera Vigilante/métodos , Técnicas de Ablación/métodos , Biopsia/métodos , Progresión de la Enfermedad , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Antígeno Prostático Específico , Prostatectomía/métodos , Neoplasias de la Próstata/diagnóstico por imagen , Neoplasias de la Próstata/patología , RiesgoAsunto(s)
Vigilancia de la Población , Neoplasias de la Próstata/epidemiología , Espera Vigilante/métodos , Técnicas de Ablación/métodos , Biopsia/métodos , Estudios de Seguimiento , Humanos , Masculino , Próstata/patología , Próstata/cirugía , Antígeno Prostático Específico , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/patologíaAsunto(s)
Humanos , Masculino , Neoplasias de la Próstata/epidemiología , Vigilancia de la Población , Espera Vigilante/métodos , Prostatectomía/métodos , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/patología , Biopsia/métodos , Imagen por Resonancia Magnética/métodos , Riesgo , Antígeno Prostático Específico , Progresión de la Enfermedad , Técnicas de Ablación/métodosRESUMEN
OBJECTIVE: To evaluate efficacy of using 2D and 3D contrast enhanced ultrasound (CEUS) for surveillance of RCC recurrence in patients post-ablation and identify imaging hallmarks of recurrence. METHODS: 53 patients >8 months post ablation of RCC provided informed consent for this IRB approved study. Patients received 2D and 3D CEUS examinations with Optison (GE Healthcare). Three radiologists of varying CEUS experience described enhancement characteristics, made a diagnosis of recurrence/no-recurrence, and quantified their diagnostic confidence levels. RESULTS: Cases of RCC recurrence showed full ablation cavity enhancement with equal arrival times and intensity compared to the renal cortex. Lack of recurrence was characterized as a complete lack of enhancement within the cavity, or delayed enhancement stemming from the periphery of the ablation cavity. Sensitivity for detecting RCC recurrence was 100% for all readers and specificity was 90%-94%. Reader agreement ranged from 88% to 96%. No significant improvements were achieved with the addition of 3D CEUS, and its inclusion resulted in decreased reader confidence. CONCLUSION: Contrast-enhanced ultrasound successfully identified all cases of RCC recurrence in this study. Importantly, some patients with complete response to treatment developed delayed enhancement at the periphery of the ablation cavity over time, corresponding to fat necrosis, scarring or granulation tissue within the ablation cavity.
Asunto(s)
Albúminas/farmacología , Carcinoma de Células Renales , Fluorocarburos/farmacología , Aumento de la Imagen/métodos , Neoplasias Renales , Riñón/diagnóstico por imagen , Recurrencia Local de Neoplasia/diagnóstico , Ultrasonografía/métodos , Técnicas de Ablación/efectos adversos , Técnicas de Ablación/métodos , Anciano , Carcinoma de Células Renales/patología , Carcinoma de Células Renales/cirugía , Medios de Contraste/farmacología , Femenino , Humanos , Neoplasias Renales/patología , Neoplasias Renales/cirugía , Masculino , Persona de Mediana Edad , Reproducibilidad de los ResultadosRESUMEN
PURPOSE OF REVIEW: An abnormal heightened carotid body (CB) chemoreflex, which produces autonomic dysfunction and sympathetic overactivation, is the common hallmark of obstructive sleep apnea (OSA), resistant hypertension, systolic heart failure (HF), and cardiometabolic diseases. Accordingly, it has been proposed that the elimination of the CB chemosensory input to the brainstem may reduce the autonomic and cardiorespiratory alterations in sympathetic-associated diseases in humans. RECENT FINDINGS: A growing body of evidence obtained in preclinical animal models support that an enhanced CB discharge produces sympathetic hyperactivity, baroreflex sensitivity and heart rate variability impairment, breathing instability, hypertension, and insulin resistance. The elimination CB chemosensory input reduces the sympathetic hyperactivity, the elevated arterial blood pressure in OSA and hypertensive models, abolishes breathing instability and improves animal survival in HF models, and restores insulin tolerance in metabolic models. These results highlight the role played by the enhanced CB drive in the progression of sympathetic-related diseases and support the proposal that the surgical ablation of the CB is useful to restore the autonomic balance and normal cardiorespiratory function in humans. Accordingly, the CB ablation has been used in pilot human studies as a therapeutic treatment for resistant hypertension and HF-induced sympathetic hyperactivity. In this review, I will discuss the supporting evidence for a crucial contribution of the CB in the central autonomic dysfunction and the pros and cons of the CB ablation as a therapy to revert autonomic overactivation. The CB ablation could be a useful method to reverse the enhanced chemoreflex in HF and severe hypertension, but caution is required before extensive use of bilateral CB ablation, which abolished ventilatory responses to hypoxia and may impair baroreceptor function.
Asunto(s)
Técnicas de Ablación/métodos , Enfermedades del Sistema Nervioso Autónomo/cirugía , Cuerpo Carotídeo/cirugía , Animales , Sistema Nervioso Autónomo/fisiopatología , Enfermedades del Sistema Nervioso Autónomo/fisiopatología , Cuerpo Carotídeo/fisiopatología , Humanos , Hipertensión/fisiopatología , Hipertensión/terapia , Hipoxia/fisiopatología , Modelos Animales , Proyectos Piloto , Reflejo/fisiologíaRESUMEN
Contexto: Faz-se importante o conhecimento técnico dos ajustes de potência e de densidade de energia linear endovenosa (linear endovenous energy density, LEED) adequados para atingir o objetivo final da termoablação endovenosa (endovenous laser ablation, EVLA). Objetivos: Avaliar a influência de diferentes LEEDs em termos de patência e presença de refluxo, bem como determinar a evolução clínica. Métodos: Foram incluídas 60 veias safenas magnas (VSM). Os pacientes foram randomizados em dois grupos: EVLA com baixa potência (7 W e LEED de 20-40 J/cm) e com alta potência (15 W e LEED de 80-100 J/cm). O acompanhamento com eco-Doppler e escore de severidade clínica venoso (VCSS) foi realizado nos intervalos de 3-5 dias, 30 dias, 180 dias e 1 ano após o procedimento. Resultados: Dezoito pacientes (29 membros) tratados com 7W de potência e 13 pacientes (23 membros) com 15 W completaram o estudo. Não houve diferença significativa considerando idade, tempo de cirurgia e o uso de analgésicos, lateralidade, gênero e presença de comorbidades. O LEED médio foi de 33,54 J/cm no grupo de 7 W e de 88,66 J/cm no de 15 W. Ambos apresentaram melhora no VCSS, redução significativa dos diâmetros da JSF e ausência de diferença significativa quanto ao aumento do comprimento do coto da VSM e de refluxo após o tratamento. Conclusões: A utilização de maior densidade de energia mostrou-se mais efetiva em relação à estabilização do comprimento do coto da VSM e do refluxo em 6 meses. Fazem-se necessários estudos com um período de acompanhamento maior para fundamentar essa hipótese
Background: It is important to acquire technical knowledge about the power and linear endovenous energy density (LEED) settings needed to achieve the ultimate goal of endovenous laser ablation (EVLA). Objectives: To evaluate the influence of different LEEDs in terms of patency and presence of reflux and to determine clinical outcomes. Methods: Sixty great saphenous veins (GSVs) were included. Patients were randomized into 2 groups, low-power EVLA (7 W and LEED of 20-40 J/cm) and high-power EVLA (15 W and LEED of 80-100 J/cm). Patients were followed-up with duplex ultrasound and calculation of venous clinical severity score (VCSS) at 3-5 days, 30 days, 180 days, and 1 year after the procedure. Results: 18 patients (29 limbs) treated with 7 W of laser power and 13 patients (23 limbs) treated with 15 W of laser power completed the study. There was no significant difference regarding age, operating time, use of analgesics, laterality, sex, or presence of comorbidities. Mean LEED was 33.54 J/cm in the 7-W group and 88.66 J/cm in the 15-W group. Both groups exhibited improvements in VCSS and significant reductions in SFJ diameters, and there were no significant difference in increase of length of the GSV stump or rates of reflux after treatment. Conclusions: The higher energy density setting was more effective for stabilizing the length of the GSV stump and was associated with a lower incidence of reflux at 6 months. Further studies with a longer follow-up period are required to substantiate this hypothesis
Asunto(s)
Humanos , Masculino , Femenino , Técnicas de Ablación/métodos , Terapia por Láser/métodos , Resultado del Tratamiento , Várices/terapia , Ecocardiografía Doppler/métodos , Vena Femoral , Extremidad Inferior , Estudios Prospectivos , Interpretación Estadística de Datos , Ultrasonido/métodos , Insuficiencia Venosa/complicacionesRESUMEN
INTRODUCTION:: Left atrial ganglionated plexi ablation is an adjuvant technique used to increase the success rate of surgical ablation of atrial fibrillation. Ganglionated plexi ablation requires previous detection. We aimed to assess determinants of successful ganglionated plexi detection and to correlate range of ganglionated plexi ablation with risk of early atrial fibrillation recurrence. METHODS:: The study involved 34 consecutive patients referred for surgical coronary revascularization with concomitant atrial fibrillation ablation. Ganglionated plexi detection was done by inducing vagal reflexes in the area of the pulmonary veins and left atrial fat pads. RESULTS:: Detection of GP was successful in 85% of the patients. There was no difference in preoperative characteristics nor in atrial fibrillation type between patients in whom ganglionated plexi detection was successful and others. The number of detected ganglionated plexi correlated significantly only with preoperative resting heart rate. Significant negative correlation was found in patients with preoperative heart rate>75 beat/min in terms of total number of detected ganglionated plexi (P=0.04). Average number of detected ganglionated plexi was significantly higher in patients with in-hospital atrial fibrillation recurrence requiring electrical cardioversion (3.8±3) in comparison to rest of the study population (2±1.3; P=0.02). In patients in whom 4 or more ganglionated plexi were detected, significantly increased risk of in-hospital atrial fibrillation recurrence was observed (OR 15; 95% CI 1.5-164; P=0.003). CONCLUSION:: Left atrial ganglionated plexi detection was unsuccessful in a considerable percentage of patients. Preoperative heart rate significantly influenced positive ganglionated plexi detection and number of ablated ganglia. Higher number of detected ganglionated plexi was related with early recurrence of atrial fibrillation.