Ventral hernia after high-intensity focused ultrasound ablation for uterine fibroids treatment:A case report

BACKGROUND High-intensity focused ultrasound(HIFU) ablation is a minimally invasive approach in gynecology that is used to manage uterine fibroids.Although this procedure is safe and effective,adverse outcomes are becoming a major problem.CASE SUMMARY We present a case of ventral hernia that occurred as a rare and delayed complication of HIFU ablation for uterine fibroids treatment.The patient came to the hospital with abdominal bloating that occurred 6 mo after ultrasound-guided HIFU ablation for managing uterine fibroids.The ventral hernia,which occurred due to atrophied muscle layers following the procedure,was confirmed by imaging studies and intraoperative findings.She required a hernia repair with mesh and hysterectomy for definitive treatment of uterine fibroid.CONCLUSION High-intensity ultrasound ablation should be performed only on appropriate candidates.Patients should be educated about potential complications of the procedure and the possibility of subsequent treatment.Post-procedural long-term follow-up for detecting delayed adverse effects is important.

Ultrasound ablation of pulmonary veins for treatment of paroxysmal atrial fibrillation

Objective : to evaluate the efficacy and safety of ultrasound ablation of pulmonary veins for treatment of paroxysmal atrial fibrillation. Methods : The study population consisted of 9 patients with 5 males and 4 females enrolled consecutively who had idiopathic paroxysmal atrial fibrillation(AF) . The ultrasound balloon was positioned through a special sheath to the orifice of the target vein by a transseptal procedure. The balloon was inflated with contrast-mixed saline (contrast: saline = 1:4) whose volume was decided by the diameter of the target pulmonary vein. The ablation energy was usually set up at 35 to 40 watts with temperature controlled at 60℃ . The duration of each ablation was about 120 seconds which was repeated not over 10 times. Results: The average duration of the total procedure was 132± 68 min for our patients. The average fluoroscopy time was 33 ±17 min. With a mean follow-up of 16 ±8 months after the procedure, AF was completely eliminated in 4 patients without antiarrhythmic drugs. The episodes of atrial fibrillation were eliminated in 2 patients with low dosage of oral amiodarone (0.1, once daily) which was ineffective before the procedure. The frequency of episodes was similar to that before the procedure in 3 patients. There were no complications such as hemopericardium, air embolism and stenosis of the pulmonary veins by angiography, related to the procedure. Conclusion : Ultrasound ablation of the pulmonary veins is a new approach to treat paroxysmal atrial fibrillation. Before we determined its value, we need to do more researches with bigger sample, randomization and comparison design.

Intermittent ice-cooling to prevent skin heat injury caused by highintensity focused ultrasound therapy targeting desmoid-type fibromatosis:A case report

Introduction:Desmoid-type fibromatosis(DF)is a fibrous tumor characterized by low-grade malignant and easy invasive growth and high recurrence.High-intensity focused ultrasound(HIFU)therapy has been identified as a novel non-invasive approach for DF treatment;however,the ultrasonic energy generated by HIFU can cause skin heat injury.Case:A 31-year-old female patient with signs and symptoms of DF received treatment in our institution.The patient had undergone HIFU treatment six times from April 27,2018,to August 21,2019.After HIFU therapy for the third time,she had a third-degree skin burn showing as orange peel-like change and spent three months to promote the recovery of the skin lesions.An intermittent ice-cooling strategy was used to avoid skin damage during the fourth HIFU treatment.This patient did not have any apparent skin injury during the last three HIFU therapy and acquired satisfactory anti-tumor therapeutic effect.Conclusions:There are differences in the thermal selectivity of tumor tissues,which leads to different critical thermal injury temperature values that the tissue can tolerate.Ice-cooling can lower skin tissue temperature and reduce the thermal damage caused by HIFU treatment.

Focal ablation therapy presents promising results for selectively localized prostate cancer patients

Due to its lower risk of consequences when compared to a radical approach, focal treatment is a viable and minimally invasive option for treating specific localized prostate cancer. Although several recent good nonrandomized trials have suggested that focused therapy may be an alternative choice for some patients, additional high-quality evidence is needed before it can be made widely available as a conventional treatment. As a result, we have summarized the most recent findings from the 38th Annual European Association of Urology Congress, one of the most renowned annual conferences in the area of urology, regarding focal ablation therapy for patients with localized prostate cancer. Additionally, we also provided clinical trials in progress for researchers to better understand the current research status of this field.

Focused ultrasound induces apoptosis in pancreatic cancer cells

Background The incidence and mortality rate of pancreatic cancer have increased dramatically in China over recent decades. Focused ultrasound （FU） has been somewhat successful in treating pancreatic cancer. The purpose of this study was to investigate apoptosis in pancreatic cancer cells induced by FU. Methods Suspension of human pancreatic carcinoma cell line PaTu 8988t was radiated by FU, using five doses with different radiation parameters and patterns, including one blank control. Temperature increase of the cell suspension was monitored. Cell apoptosis and death after FU radiation was observed using fluorescence microscopy and was tested by flow cytometer at 3, 6, 12, 24, and 48 hours after ultrasound radiation. Results The maximum cell suspension temperatures following five radiation doses were 28℃, （42.20±2.17）℃, （50.80±0.84）℃, （55.80±2.17）℃, and （65.20±3.11）℃; differences between the doses were statistically significant （P 〈0.05）. The apoptosis rate peaked at 24 hours after radiation, at （0.56±0.15）%, （1.28±0.16）%, （1.84±0.29）%, （5.74±1.15）%, and （2.00±0.84）% for the five doses; differences between the doses were statistically significant （P 〈0.05）. Between doses 1--4, cell apoptosis rates increased as the Tmax increased, in dose 5, as the Tmax was above 60℃, the apoptosis rate decreased. Conclusion Sub-threshold thermal exposures of FU radiation with a continuous radiation pattern could result in higher percentage of apoptosed cells.