Chronic radiation proctitis, although relatively rare, can be the source of severe comorbidity in patients who had undergone prior radiotherapy for pelvic malignancy. Although current treatments for radiation proctitis include argon plasma coagulation, heater probe, bipolar neodymium/yttrium aluminum garnet (Nd: YAG) lasers, these interventions are often burdened by the frequent occurrence of rectal ulcerations and stenosis. Since radiofrequency ablation (RFA) is frequently used to ablate esophageal malignancy and pre-malignancy, we report the efficacy of RFA using through the scope system in two patients with rectal bleeding due to radiation proctitis. In both cases, the procedure was well-tolerated with hemostasis achieved after 1 or 2 sessions of RFA. Mucosal re-epithelialization was observed in areas of previous bleeding with no stenosis or ulceration observed at follow-up.
- MeSH
- chronická nemoc MeSH
- gastrointestinální krvácení etiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- proktitida * etiologie MeSH
- radiační poranění * chirurgie etiologie MeSH
- radiofrekvenční ablace škodlivé účinky metody MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
BACKGROUND: Hemolysis-related renal failure has been described after pulmonary vein isolation (PVI) with pulsed-field ablation (PFA). OBJECTIVES: This study sought to compare the potential for hemolysis during PVI with PFA vs radiofrequency ablation (RFA). METHODS: In consecutive patients, PVI was performed with PFA or RFA. Blood samples were drawn at baseline, immediately postablation, and 24 hours postablation. Using flow cytometry, the concentration of red blood cell microparticles (RBCμ) (fragments of damaged erythrocytes) in blood was assessed. Lactate dehydrogenase (LDH), haptoglobin, and indirect bilirubin were measured at baseline and 24 hours. RESULTS: Seventy patients (age: 64.7 ± 10.2 years; 47% women; 36 [51.4%] paroxysmal atrial fibrillation) were enrolled: 47 patients were in the PFA group (22 PVI-only and 36.4 ± 5.5 PFA applications; 25 PVI-plus, 67.3 ± 12.4 pulsed field energy applications), and 23 patients underwent RFA. Compared to baseline, the RBCμ concentration increased ∼12-fold postablation and returned to baseline by 24 hours in the PFA group (median: 70.8 [Q1-Q3: 51.8-102.5] vs 846.6 [Q1-Q3: 639.2-1,215.5] vs 59.3 [Q1-Q3: 42.9-86.5] RBCμ/μL, respectively; P < 0.001); this increase was greater with PVI-plus compared to PVI-only (P = 0.007). There was also a significant, albeit substantially smaller, periprocedural increase in RBCμ with RFA (77.7 [Q1-Q3: 39.2-92.0] vs 149.6 [Q1-Q3: 106.6-180.8] vs 89.0 [Q1-Q3: 61.2-123.4] RBCμ/μL, respectively; P < 0.001). At 24 hours with PFA, the concentration of LDH and indirect bilirubin increased, whereas haptoglobin decreased significantly (all P < 0.001). In contrast, with RFA, there were only smaller changes in LDH and haptoglobin concentrations (P = 0.03) and no change in bilirubin. CONCLUSIONS: PFA was associated with significant periprocedural hemolysis. With a number of 70 PFA lesions, the likelihood of significant renal injury is uncommon.
- MeSH
- fibrilace síní * chirurgie MeSH
- hemolýza * MeSH
- katetrizační ablace * škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- prospektivní studie MeSH
- radiofrekvenční ablace škodlivé účinky metody MeSH
- senioři MeSH
- venae pulmonales chirurgie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
Image-guided radiofrequency ablation (RFA) is used to treat focal tumors in the liver and other organs. Despite potential advantages over surgery, hepatic RFA can promote local and distant tumor growth by activating pro-tumorigenic growth factor and cytokines. Thus, strategies to identify and suppress pro-oncogenic effects of RFA are urgently required to further improve the therapeutic effect. Here, the proliferative effect of plasma of Hepatocellular carcinoma or colorectal carcinoma patients 90 min post-RFA was tested on HCC cell lines, demonstrating significant cellular proliferation compared to baseline plasma. Multiplex ELISA screening demonstrated increased plasma pro-tumorigenic growth factors and cytokines including the FGF protein family which uniquely and selectively activated HepG2. Primary mouse and immortalized human hepatocytes were then subjected to moderate hyperthermia in-vitro, mimicking thermal stress induced during ablation in the peri-ablational normal tissue. Resultant culture medium induced proliferation of multiple cancer cell lines. Subsequent non-biased protein array revealed that these hepatocytes subjected to moderate hyperthermia also excrete a similar wide spectrum of growth factors. Recombinant FGF-2 activated multiple cell lines. FGFR inhibitor significantly reduced liver tumor load post-RFA in MDR2-KO inflammation-induced HCC mouse model. Thus, Liver RFA can induce tumorigenesis via the FGF signaling pathway, and its inhibition suppresses HCC development.
- MeSH
- cytokiny MeSH
- fibroblastové růstové faktory MeSH
- hepatocelulární karcinom * patologie MeSH
- indukovaná hypertermie * MeSH
- karcinogeneze MeSH
- katetrizační ablace * MeSH
- lidé MeSH
- myši MeSH
- nádory jater * patologie MeSH
- radiofrekvenční ablace * škodlivé účinky MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- myši MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Research Support, N.I.H., Extramural MeSH
Introduction: Osteoid osteoma is a benign bone tumor with the classical characteristic of pain that subsides significantly with the use of nonsteroidal anti-inflammatory drugs. When conservative therapy fails, a surgical approach is then recommended. Radiofrequency ablation (RFA) has become more widely used compared to open resection due to fewer serious postoperative complications. But it is still important that the complications of RFA be recognized and addressed. Case report: We present a case of a 22-year-old man with acute pain on his left shin, accompanied by signs of localized inflammation. The clinical findings and radiology support the diagnosis of osteoid osteoma. A surgical intervention with percutaneous radiofrequency ablation was performed. However, post-operatively, the patient complains of prolonged fluid discharge from the surgical site. Following the biopsy and debridement surgery, both specimen culture and histopathology results revealed sterile inflammation with no specific process. Conclusion: RFA has become the most popular treatment of choice for osteoid osteoma, but it still comes with complications, most commonly involving subcutaneous bones such as the tibia. In conclusion, extra caution is needed when treating subcutaneously located bones with RFA.
- MeSH
- lidé MeSH
- mladý dospělý MeSH
- osteom osteoidní * komplikace terapie MeSH
- radiofrekvenční ablace škodlivé účinky MeSH
- tibie diagnostické zobrazování patologie MeSH
- zánět diagnostické zobrazování etiologie terapie MeSH
- Check Tag
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
PURPOSE: To determine whether the levels of circulating microRNAs (miRNAs) are altered in patients undergoing thermal ablation and chemoembolization and whether these changes are predictive of a clinical outcome. MATERIAL AND METHODS: This prospective study consisted of 43 patients diagnosed with hepatocellular carcinoma (n = 15) and intrahepatic colorectal cancer metastases (n = 28) treated with thermal ablation (n = 23; radiofrequency [n = 6] or microwave [n = 19]), chemoembolization using drug-eluting embolics (n = 18), or both (n = 2). Four blood samples (immediately before the intervention and 60-90 minutes, 24 hours, and 7 days after the intervention) were taken to measure the plasma concentrations of miRNAs related to hypoxia (miR-21 and miR-210), liver injury (miR-122), epithelial-mesenchymal transition (miR-200a), and apoptosis (miR-34a) using miRNA-specific TaqMan assays and quantitative real-time polymerase chain reaction. Tumor burden and treatment response at 3 months were evaluated using the modified response evaluation criteria in solid tumors. The miRNA results were compared with clinical outcomes (Mann-Whitney U test, Wilcoxon matched-pair test). RESULTS: Dynamic changes in the circulating miRNA levels were observed following both the interventions. For thermal ablation, significant increases in miR-21, miR-210, miR-122, miR-200a, and miR-34a concentrations peaked 60-90 minutes after the intervention (P < .01). However, for transarterial chemoembolization, maximum increases in the miRNA concentrations were observed at 24 hours after the intervention for miR-21, miR-210, miR-122, miR-200a, and miR-34a (P < .05). The increased concentrations of the circulating miRNAs were followed by a subsequent decline to baseline by 7 days. For the thermal ablation (but not chemoembolization) patients, elevations in the miR-210 and miR-200a levels were associated with early progressive disease at 3 months (P = .040 and P = .012, respectively). CONCLUSIONS: Increased but dynamic levels of circulating miRNAs are present following interventional oncologic procedures and may prove useful as biomarkers for the monitoring of clinical outcomes.
- MeSH
- časové faktory MeSH
- chemoembolizace * škodlivé účinky MeSH
- cirkulující mikroRNA krev MeSH
- hepatocelulární karcinom krev patologie terapie MeSH
- kolorektální nádory patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mikrovlny škodlivé účinky terapeutické užití MeSH
- nádorové biomarkery krev MeSH
- nádory jater krev patologie sekundární terapie MeSH
- prospektivní studie MeSH
- radiofrekvenční ablace * škodlivé účinky MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
The aim of this experimental study was to verify a new semi-spherical surgical tool for bipolar radiofrequency liver ablation, which can solve some of the disadvantages of the commonly used device, such as the long duration of ablation. A total of 12 pigs which were randomly divided into two groups were used. Each pig underwent resection of the two liver lobes. In group 1, pigs were treated with the commonly used device; in group 2 the newly developed semi-spherical device was used. During surgery and the post-surgical period, many categories were observed and later analyzed. The blood count and biochemistry were monitored on days 0, 14 and 30 from the operation. On day 14 since the liver resection, pigs underwent diagnostic laparoscopy to evaluate their condition focusing on the site of the liver lobe resection. On day 30 after operation, all pigs were euthanized and subjected to histopathological examination. Histopathological evaluation of thermal changes at the resection margin showed strong thermal alteration in both groups. Data between both groups were compared using median test for continuous variables and Fisher’s exact test for categorical variables. Statistical analyses were performed with IBM SPSS software version 18.0. Statistical analysis of collected data did not prove any significant (P < 0.05) differences between the commonly used device and the newly designed surgical tool.
- Klíčová slova
- RONJA,
- MeSH
- chirurgické nástroje * klasifikace MeSH
- experimenty na zvířatech MeSH
- hepatektomie metody přístrojové vybavení MeSH
- játra chirurgie patologie účinky záření MeSH
- modely u zvířat MeSH
- pooperační období MeSH
- prasata MeSH
- radiofrekvenční ablace * metody přístrojové vybavení škodlivé účinky MeSH
- výsledek terapie MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- práce podpořená grantem MeSH
- srovnávací studie MeSH
Radiofrequency ablation is a tumour destruction method, widely used in human as well veterinary medicine. Recently, it has been applied to pancreatic disorder treatment. However, little is known about healing of the pancreatic parenchyma after radiofrequency ablation as it is important for the prevention of complications and treatment strategy. The aim of this experimental in vivo study on pigs was to evaluate the pancreatic parenchyma healing dynamics after damage by radiofrequency ablation. Radiofrequency ablations of the duodenal lobe of the pancreas were performed on 8 cross-bred laboratory pigs. They were euthanized in pairs at seven, fourteen, forty and eighty days after the procedure. Histological and cytological changes of the ablated zone were evaluated after autopsy. It was proved that pancreatic necrosis after radiofrequency ablation heals by means of fibrotic scar. There was no sign of exocrine and endocrine regeneration, respectively, during 80 days after the procedure. This is the first study verifying that the healing process of an ablation zone in the pancreatic parenchyma after radiofrequency ablation is similar to healing in the liver, lung, heart and other parenchymal organs.
- Klíčová slova
- termoablace,
- MeSH
- hojení ran MeSH
- laparotomie MeSH
- nádory slinivky břišní komplikace terapie MeSH
- nekróza MeSH
- pankreas * patologie účinky záření MeSH
- pilotní projekty MeSH
- pooperační komplikace MeSH
- pooperační období MeSH
- poruchy vyvolané tepelným stresem MeSH
- prasata MeSH
- radiofrekvenční ablace * škodlivé účinky MeSH
- regenerace MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- práce podpořená grantem MeSH
- MeSH
- brachyterapie metody MeSH
- dávka záření MeSH
- klinická studie jako téma MeSH
- lidé MeSH
- nemalobuněčný karcinom plic * chirurgie diagnostické zobrazování radioterapie MeSH
- prospektivní studie MeSH
- radiochirurgie metody MeSH
- radiofrekvenční ablace škodlivé účinky statistika a číselné údaje MeSH
- radioterapie klasifikace metody MeSH
- tomografie emisní počítačová MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
