外鼻皮肤癌的冷冻治疗临床观察

外鼻皮肤癌好发于老年人,多为基底细胞癌和鳞状细胞癌,其特点为原发性、恶性程度低、发展较慢且易于发现,目前的治疗多以外科治疗为主,但修复根治性切除后所造成的鼻部缺损,常需要皮瓣的修复重建鼻部外形,损伤较大,老年人不易耐受,我科自2005年应用自制冷冻器实施液氮冷冻治疗此病,不需要皮瓣修复,减少了患者的创伤,取得了良好的治疗效果。

Magnetic resonance imaging-guided percutaneous cryoablation of hepatocellular carcinoma in special regions

BACKGROUND: Local cryoablation guided by CT or ultrasound has been widely applied in the treatment of hepatocellular carcinoma. However, it is still difficult to apply this technique in certain regions such as the diaphragm dome, the first hepatic hilum, and regions adjacent to the gallbladder. This study aimed to evaluate the safety and efficacy of using magnetic resonance imaging (MRI)-guided percutaneous cryoablation as well as the effect of using an open MRI system in guiding and monitoring the treatment of hepatocellular carcinoma in these regions. METHODS: Cryoablation, guided by an open 0.35T MRI scanner and with the assistance of an MRI-compatible optical navigation system, was performed on 32 patients with hepatocellular carcinoma at the diaphragm dome, the first hepatic hilum, and regions adjacent to the gallbladder. Each patient had one or two tumors. The total number of tumors treated was 36. The tumor diameters ranged from 2.5 to 10.0 cm (mean 4.7±1.8 cm). The cryosurgical system was MRI-compatible and equipped with cryoprobes 1.47 mm in outside diameter. Under the guidance of MRI in combination with the optical navigation system, the cryoprobes were introduced percutaneously into a tumor at the planned targeting points while critical organs or tissues were avoided. Each cryoablation procedure included two freezing-thawing cycles, and MRI images were acquired dynamically to monitor the ablation of the tumor from time to time during the operation. In order to investigate the therapeutic effects of a cryoablation procedure, AFP measurements and liver- enhanced MRI or CT-enhanced scans were performed at regular times.RESULTS: MRI and optical navigation system-guided cryoablation procedures were successfully performed on all 32 patients (36 tumor sites) and no serious complications occurred. The follow-up period ranged from 5 to 12 months. The 6- and 12-month overall survival rates were 96.8% and 90.6%, respectively. According to the diagnosis of liver- enhanced MRI scans, 10 patients (31.3%) had complete ablation, 18 (56.3%) partial ablation (>80%), 3 (9.4%) stable disease (>50% ablation), and 1 (3.1%) progressive disease (a new tumor site in the liver). The overall efficacy was 87.5%. CONCLUSIONS: MR-guided percutaneous cryoablation using optical navigation is a safe and effective minimally invasive procedure for the treatment of hepatocellular carcinoma at certain special regions, which is difficult to treat with other imaging guidance approaches. With its unique and superb imaging functions, MRI plays an important role in the display, guidance, and monitoring of the cryoablation procedure in treating hepatocellular carcinoma at these special regions. Equipped with an MRI-compatible optical navigation system, MRI-guided therapy makes the cryoablation procedure more precise and safe.

Percutaneous cryoablation after chemoembolization of liver carcinoma: report of 34 cases

OBJECTIVE: To assess the indications, efficacy and clinical significance of percutaneous cryoablationfor liver carcinoma after transcatheter liver artery chemoembolization (TACE).METHODS: Thirty-four patients with histologically or clinically confirmed primary or metastaticcarcinomas were treated with TACE. One week to 1 month later, they were treated percutaneously underultrasound guidance using cryosurgical system in the period of July 2001 -June 2002. All patients werefollowed up to determine serum tumor marker, CT scans, MRI images or ultrasound images.RESULTS: This therapy was performed in 34 patients including 32 patients with Child A liver reserve, 2patients with Child B and no patient with Child C. There were 28 patients with primary liver cancer and6 patients with metastatic liver cancer. During the follow-up period (3 to 15 months), 41.1% patientswere recognized clinically cured because the serum tumor markers became normal, or CT scans and MRIimages revealed that the lesion became completely necrotic. 44.1% patients were recognized effectivelytreated.CONCLUSIONS: Percutaneous cryoablation combined with TACE is a choice of treatment for livercarcinoma. It is minimally invasive, safe and effective for those patients with liver cancer unsuitable forsurgery.

CT assessment of liver hemodynamics in patients with hepatocellular carcinoma after argon-helium cryoablation

BACKGROUND:Assessment of tumor response after argonhelium cryoablation is critical in guiding future therapy for unresectable hepatocellular carcinoma.This study aimed to evaluate liver hemodynamics in hepatocellular carcinoma after argon-helium cryoablation with computed tomography perfusion.METHODS:The control group comprised 40 volunteers without liver disease.The experimental group was composed of 15 patients with hepatocellular carcinoma treated with argon-helium cryoablation.Computed tomography perfusion parameters were measured:hepatic blood flow,hepatic blood volume,mean transit time,permeability of capillary vessel surface,hepatic arterial fraction,hepatic arterial perfusion,and hepatic portal perfusion.RESULTS:After treatment,in the tumor foci,permeability of capillary vessel surface was higher,and hepatic blood flow,hepatic blood volume,hepatic arterial fraction,and hepatic arterial perfusion values were lower(P<0.05).In the liver parenchyma surrounding the tumor,hepatic arterial perfusion was significantly lower(P<0.05);however,there was no significant difference in hepatic blood flow,hepatic blood volume,mean transit time,permeability of capillary vessel surface,hepatic arterial fraction,or hepatic portal perfusion(P>0.05).CONCLUSION:Computed tomography perfusion can evaluate tumor response after argon-helium cryoablation.

Serial therapies oriented by surgery for large primary liver carcinoma

Objective: To discuss the methods and effects of serialtherapies oriented by surgery in the treatment of pri-mary large liver cancers.Methods: From January 1993 to June 1999, 191 pa-tients with large liver carcinoma were treated surgi-cally. The size of tumors varied from 5.2 to 19.7 cm(mean 9.4 cm). Several types of liver resectionswere made in 121 patients and as a supplement, cry-osurgery was carried out for the remaining 70 pa-tients. Importable drug delivery system was institu-ted intraoperatively. Transcatheter arterial chemo-embolization (THP 30-60 mg, E-ADM 20-40 mg,CDDP 40-80 mg, MMC 10-20 mg, iodin oil 5-30ml), percutaneous ethanol injection, bioimmunother-apy and traditional Chinese medicine were used pre-and post-operatively. CT angiography and CT dur-ing arterial portography were used to find satellitenodules. Early stage recurrences were predicted byAFPmRNA in peripheral blood. Child-Pugh’s classi-fication plus branch chain amino acid/aromatic ami-no acid ratio (BCAA/AAA) was adopted in evalua-ting pre-operative liver functions.Results: Marked results were observed after serialtreatments oriented by surgery. The 1-, 3- and 5-year survival rates in resection group were 75.8 %,45.6% and 30.4%. respectively. The 1- and 3-yearsurvival rates in cryosurgery group were 63.2 % and37.0 %. The operative mortality was 1.57 %. Recur-rence rates were 69.2 % in AFPmRNA positive groupand 33.3% in AFPmRNA negative group (P【0.05). The BCAA/AAA ratio was lower than 1.5 intwo patients who died of hepatic failure after resec-tion.Conclusions: Serial treatments with surgery as thechief modality gives satisfactory results in patientswith large primary liver carcinoma. This regimenshould be regarded as a main strategy to deal withlarge liver carcinoma. AFPmRNA in the peripheralblood, signifying a recurrence, may become a newclinical parameter. The BCAA/AAA ratio plusChild-Pugh’s classification is able to evaluate moreaccurately liver function reserve before surgery.

Treatment of Non Melanoma Skin Cancers: An Intra-Comparison Study of CuradermBEC5 and Various Established Modalities

Dermatologists, surgeons, oncologists and radiotherapists usually jointly manage skin cancers. The strengths and limitations of the established procedures are known. A new naturally derived topical cream, CuradermBEC5, for the treatment of non melanoma skin cancers has previously been described. In this communication, intra-comparison treatments of skin cancer between CuradermBEC5 therapy and the established treatments, surgery, radiation therapy, laser therapy, photodynamic therapy, imiquimod cream and cryosurgery are presented. Non melanoma skin cancer cases that had previously been treated unsuccessfully with the established procedures were subsequently treated successfully with CuradermBEC5. These observations are interesting because the identical lesions were treated by various modalities. In addition to the superior efficacious outcome of CuradermBEC5 therapy versus the established treatments, the cosmetic end results with CuradermBEC5 treatment are remarkable.

Effects of deep low temperature on secondary branches enclosed in Glisson 's system of pig hepatic lobes

Hepatic cryosurgery, a safe and effective approach for an unresectable hepatoma, has been extensively applied in clinical setting. But whether direct deep freezing to the tumor involving special location, i. e. , Glisson’s system of certain hepatic lobe could cause the impairment of the duct system or post impairment effect remains a mystery. Consequently, the aim of the study was to investigate the effect of freezing on the secondary branches enclosed in the Glisson’s system of certain hepatic lobes. METHODS:Twenty pigs were divided into 2 groups randomly. The treated group:the area of secondary branches of the Glisson’s system in the left lateral lobe was frozen by a cryoprobe at deep low temperature for 3 minutes, with the blockage of blood flow from the porta hepatis. The control group:only the blockage of the porta hepatis was performed for 3 minutes. Serologic examinations, color Doppler examination and pathological observation were used for evaluation of this procedure postoperatively. RESULTS:The frozen hepatic parenchyma, the wall of the frozen secondary bile duct and portal vein showed necrosis. However, the frozen hepatic artery ramification did not show any obvious changes postoperatively. Eight weeks after cryosurgery, the lumen of the hepatic artery and portal vein maintained unobstructed. Meanwhile, atrophy and fibroplasia occurred in the related hepatic lobe. All the animals recovered well. CONCLUSIONS:Animals could tolerate the direct deepfreezing of the area of secondary branches enclosed in the Glisson’s system. The therapeutic effect could be attained by the necrosis of the frozen hepatic parenchyma.

Cryotherapy in Ophthalmology

Cryogens have been used to freeze living tissue for the purpose of treating benign and malignant lesions. Within the last century, ophthalmologists have found cryotherapy to be useful in treating a variety of ocular pathologies. Here, we review the history of cryotherapy, its introduction to the field of ophthalmology, its proposed mechanism of action, and its current applications in treating surface and intraocular eye disease.

Recent advances in the management of hemorrhoids

Hemorrhoids are considered one of the most common anorectal diseases with a prevalence of 4.4% up to 36.4% of the general population, and a peak incidence between 45 and 65 years. Hemorrhoidal disease presents with a prolapsed lump, painless bleeding, discomfort, discharge, hygiene problems, soiling, and pruritus. Sliding anal canal lining theory is the most accepted theory as a cause of hemorrhoidal disease; however, it is also associated with hyper-vascularity, and, recently, with several enzymes or mediators involved in the disintegration of the tissues supporting the anal cushions, such as matrix metalloproteinase. A comprehensive search in published English-language literature till 2013 involving hemorrhoids was performed to construct this review article, which discusses advances in the management of hemorrhoids. This includes conservative treatment(life style modification, oral medications, and topical treatment), office procedures(rubber band ligation, injection sclerotherapy, infrared and radiofrequency coagulation, bipolar diathermy and direct-current electrotherapy, cryosurgery, and laser therapy), as well as surgical procedures including diathermy hemorrhoidectomy, Liga Sure hemorrhoidectomy, Harmonic scalpel hemorrhoidectomy, hemorrhoidal artery ligation, stapled hemorrhoidopexy(SH), and double SH. Results, merits and demerits of the different modalities of treatment of hemorrhoids are presented, in addition to the cost of the recent innovations.

Successful Treatment of Adult Pleomorphic Rhabdomyosarcoma in the Posterior Left Femur: A Case Report

Introduction: Rhabdomyosarcoma (RMS) is the most common childhood soft tissue sarcoma, but it represents only a small portion of soft tissue sarcoma in adult population. There is a treatment protocol based on Intergroup Rhabdomyosarcoma Study (IRS) that provides satisfactory results in treating RMS in children, but there is only limited evidence regarding the outcome and prognosis in extrapolating the IRS protocol to treat RMS in adults. We report a case of adult pleomorphic RMS treated with multidisciplinary approach and the results we have obtained. Case presentation: A 48-year-old woman was admitted in February 2011 due to a painful mass on her left thigh. Diagnosis of pleomorphic rhabdomyosarcoma was made by histopathology and immunohistochemistry. After multimodal treatment that includes Trans-Arterial Chemotherapy Infusion, Cryosurgery, and wide excision surgery, our patient remains disease-free as of the latest annual follow up examination on June 2017. Conclusions: The pleomorphic type of Rhabdomyosarcoma is very rare in adults and is often associated with a poor prognosis. In our case, a multidisciplinary approach with multimodal treatment provides excellent result, even after a routine follow up spanning through six years.

Effect of hyperthermia in combination with cryotherapy on sarcoma 180 in mice

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Evaluation of Characteristics of Phase Change Heat Transfer in Ultrafine Cryoprobe

To reduce the invasiveness of cryosurgery, a miniaturized cryoprobe is necessary. The authors have developed an ultrafine cryoprobe for realizing low-invasive cryosurgery by local freezing. The objectives of this study are to estimate the heat transfer coefficient and investigate the characteristics of the phase change heat transfer in the ultrafine cryoprobe. This cryoprobe has a double-tube structure consisting of two stainless steel microtubes. The outer diameter of the cryoprobe was 550 μm. The alternative Freon HFC-23, which has a boiling point of ?82?C at 0.1 MPa, was used as a refrigerant. To evaluate the characteristics of boiling flow in the cryoprobe, the heat transfer coefficient was estimated. The derived heat transfer coefficient was higher than that obtained from the conventional correlation. Additionally, a bubble expansion model was introduced to evaluate the heat transfer mode of the phase change flow in the ultrafine cryoprobe. This model can estimate the liquid film thickness during the expansion of a single bubble in a microchannel. The experimentally measured wall superheat was much lower than that obtained from the model. Therefore, this result also implied that the heat transfer mode in the ultrafine cryoprobe should be nucleate boiling.

VAB and MRI Following Percutaneous Ultra-Sound Guided Cryoablation for Primary Early-Stage Breast Cancer: A Pilot Study in Japan

Objective: This study aimed to evaluate the feasibility, safety, and cosmetic outcomes of percutaneous cryoablation (PCA) of breast intraductal carcinoma (IDC) lesions, as well as post-cryoablation magnetic resonance imaging (MRI) as a follow-up tool for detection of residual malignancies and local recurrences. Methods: Eight female patients underwent percutaneous ultrasound-guided cryoablation of breast IDC tumors under local anesthesia without subsequent resection. All patients received radiation- and endocrine therapies (RT, ET). The patients were followed using vacuum-assisted biopsy (VAB), mammography (MG), magnetic resonance imaging (MRI), and Moiré Topography for cosmetic outcomes. VAB was performed 6 months following cryoablation treatment for cases 1 and 2 (after starting radiation- and endocrine-therapies) or one month after PCA (cases 3, 4, 5, 6 and 7), prior to RT and ET. One patient declined VAB. Results: Mean age of the patients was 61.9 years, SD 7.7, ages range 53 - 72 years. Mean tumor size was 10.3 mm, SD 2.74, ranged 6.8 - 14.5 mm, median follow-up time was 28 months (range 13 - 34 months). No residual or recurrent malignancies were detected. One minor adverse event was observed: A skin redness in the ablated area;MRI at one-month post-cryotherapy showed various degrees of thermal burns in all patients in the pectoralis major muscle, which were not symptomatic and were resolved by 6 months following PCA. Decrease of fat necrosis areas in the vicinity of ablated ex-tumor was traced with MRI (mean size 54.9 mm, mean decrease after 2 years was 58%) and validated with VAB. Conclusions: Percutaneous cryoablation of early-stage low-risk breast cancer tumors smaller than 15 mm potentially presents a potential substitute for lumpectomy, offering encouraging short- to mid-term oncology results with good cosmesis outcomes. Patients would be able to benefit from local anesthesia in an outpatient setting and a shorter recovery period.

Cryogenic Thermophysical Studies for Clinical Medicine

Cryogenic technology has been widely used in clinical medicine and in pharmaceutics, so thermophysical studies are extremely important to solve problems during freezing and thawing. This paper reports some recent research in clinical medicine, including cryo injury, cryosurgery, and cryopreservation of some important cells and tissues. Microscopic images of the freezing process with a cryomicroscope system show that the dendritic ice growth is affected by the solution concentration, the cooling rate, and the number of embryos. An enthalpy method is used for the freeze thaw analysis of the cryosurgery with a program developed to predict the temperature profile and the interface motion, which compares well with experimental results. A very rapid cooling technique is developed by quenching the samples into subcooled liquid nitrogen for vitrification of cells and tissues. An analytical method developed to prevent the fracture of arteries during freezing has been verified by the electronic microscopic investigation.