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1. Nordin, P; Larko, O; Stenquist, B.
Five-year results of curettage-cryosurgery of selected large primary basal
cell carcinomas on the nose: An alternative treatment in a geographical area
underserved by Mohs' surgery.
British Journal of Dermatology, v.136, n.2, (1997): 180-183.
Abstract:
Moh's micrographic surgery (MMS) is the recommended treatment for large
basal cell carcinomas (BCCs) of the nose. This 5-year follow-up study
attempts to evaluate whether curettage-cryosurgery (CC) could be an
alternative therapy in a country where optimal resources for MMS are
lacking. All patients with a primary nasal or perinasal BCC.10 mm or
larger in diameter. were assessed at a skin tumour clinic. Sixty-one BCCs
of non-morphoeiform type were treated with CC. Most of the tumour was
removed by careful curettage with different sized curettes. The tumour
area was then frozen with liquid nitrogen in a double freeze-thaw cycle.
Fifty patients were followed for at least 5 years with only one
recurrence. The cosmetic result was good or acceptable in all patients. A
thorough curettage followed by cryosurgery could be a safe and inexpensive
alternative therapy even for large primary non-morphoeiform BCCs of the
nose.
1. Wong WS; Chinn DO; Chinn M; Chinn J; Tom WL; Tom WL.
Cryosurgery as a treatment for prostate carcinoma: results and
complications.
Cancer, 1997 Mar 1, 79(5):963-74.
(UI: 97193574)
Abstract: BACKGROUND: There has been a resurgence of interest in cryosurgical
ablation of the prostate for the treatment of carcinoma. This is due to
recent advances in cryosurgical technology, which have resulted in
relatively lower morbidity. The objective of this study was to evaluate the
effectiveness of ultrasound-guided cryosurgical ablation of prostate
carcinoma. METHODS: Eighty-three patients who had biopsy-proven prostate
carcinoma underwent cryosurgical ablation of their entire prostate gland.
The initial group of 12 patients had their procedures performed under
ultrasound guidance only. The other 71 patients had cryosurgery performed
with temperature monitoring in combination with ultrasound guidance. Twelve
patients who had positive biopsies underwent a second cryosurgical
procedure. All patients had prostate specific antigen (PSA) levels measured
at 3, 6, 12, 18, 24, and 30 months after cryosurgery. Ultrasound-guided
sextant biopsies were performed at 3-6, 12-18, and 24 months. RESULTS: The
median PSA dropped by 95%, from a preoperative value of 4.3 ng/mL to 0.2
ng/mL 30 months after cryosurgery. The authors experienced a high failure
rate (positive biopsies) of 83% for the initial group of 12 patients who
did not have temperature monitoring during the cryosurgical procedure. This
was in contrast to a success rate of 90% (negative biopsies) for the next
71 patients, who did have temperature monitoring (P < 0.05, chi-square
test). Twelve patients underwent a second cryosurgery, and the success rate
for this group was 91% (11 of 12 patients). The combined success rate for
both the first cryosurgery and the second was 94% (62 of 77 patients).
Complications included urethral sloughing, urinary incontinence, impotence,
bladder neck contracture, and bladder contracture. The majority of patients
recovered rapidly from their cryosurgical procedures and were able to
resume normal activities 3-4 weeks afterward. CONCLUSIONS: These
preliminary results demonstrate that cryosurgical ablation of the prostate
is a viable treatment option for prostate carcinoma. In the authors'
experience, ultrasound alone may not be adequate for monitoring the entire
cryosurgical procedure. The authors found that temperature monitoring
shortened their learning curve, enabled them to freeze prostate tissue more
aggressively, and may have contributed to their overall success.
2. Korpan NN.
Hepatic cryosurgery for liver metastases. Long-term follow-up.
Annals of Surgery, 1997 Feb, 225(2):193-201.
Pub type: Clinical Trial; Journal Article; Randomized Controlled Trial.
(UI: 97188753)
Abstract: OBJECTIVE: The aim of this prospective study was to evaluate the
applicability of cryogenic and conventional surgery in treating liver
metastases (LM) with respect to intraoperative tumor reduction and survival
rate. SUMMARY BACKGROUND DATA: As have been shown in animal experiments as
well as in clinical investigations, cryosurgery has been used for the
treatment of many benign and malignant conditions. For the first time, this
report summarizes a 10-year follow-up clinical experience with cryosurgery
for treatment of LM from 1983 to 1992. METHODS: One hundred twenty-three
patients with LM (87 males and 36 females, a ratio 2.4:1.0; age, 41.3 +/-
12.1 years) were stratified and entered into a long-term prospective,
randomized clinical trial for cryogenic surgery in group 1 (n = 63) and
conventional surgical techniques in group 2 (control subjects, n = 60).
Principally, a self-constructed cryogenic clamp was used for hepatic
cryoresection with preliminary freezing of the margin resection by a
cryosurgical system "Cryoelectronic-2" or "Cryoelectronic-4". Hepatic
cryoextirpation (cryoablation) and hepatic cryodestruction were performed
by means of probes of different roughly disk design from phi 5 mm to 55 mm
by volume of frozen zone of 40 cm3 to 180 cm3 for approximately 7 to 32
minutes. RESULTS: In most cases in group 1 and group 2, LM were based on
colorectal cancers (65% vs. 68%). The hepatic cryosurgical procedures in
group 1 included cryoextirpation (29 patients, 46%), cryoresection (20
patients, 32%), and cryodestruction (14 patients, 22%) solely. Clinical and
laboratory parameters showed that the curative effects were significantly
higher in group 1 than in group 2. The 3-year survival rate was in group 1
and group 2 (60% vs. 51%, respectively). The 5-year survival rate was 44%
in group 1 and 36% in group 2. Twelve patients (19%) versus 5 patients (8%)
in group 1 and group 2, respectively, survived 10 years. The disease-free
survival was in group 1 and group 2 (30% vs. 18%, respectively). During a
follow-up period, recurrence in the liver was observed in 54 patients (85%)
in group 1 and in 57 patients (95%) in control subjects. After a 10-year
follow-up period in group 1 and group 2, 9 patients (14%) versus 3 patients
(5%) remained disease free, 3 patients (4%) versus 2 patients (3%) were
surviving with disease, and 51 patients (81%) versus 55 patients (92%)
died. CONCLUSIONS: The data of this 10-year prospective, randomized
clinical trial suggest that hepatic cryosurgery is effective in the
treatment of resectable and nonresectable LM. The results show
intraoperative tumor reduction (> or = 90% < or = 97%) and extended higher
survival in these patients. The study indicated a 5-year and 10-year
survival rate of 44% and 19% after cryosurgery, respectively.
3. Silverstein JC; Staren E; Velasco J.
Thermal bile duct protection during liver cryoablation.
Journal of Surgical Oncology, 1997 Feb, 64(2):163-4.
(UI: 97199280)
4. Bishop A; Sherris J; Tsu VD; Kilbourne-Brook M.
Cervical dysplasia treatment: key issues for developing countries.
Bulletin of the Pan American Health Organization, 1996 Dec, 30(4):378-86.
(UI: 97194175)
Abstract: Many developing countries face serious obstacles that have hindered
establishment of successful cervical cancer control programs. Various
countries are now seeking to strengthen cytology services and identify
simple low-cost screening strategies; but any real gains in reducing
cervical cancer incidence and mortality will also require effective
treatment of women with preinvasive disease. Despite a trend toward
conservative outpatient approaches for treating cervical dysplasia in
industrialized countries, clinicians in many developing countries still
rely primarily on invasive inpatient methods such as cone biopsy and
hysterectomy. For women who could be treated with less invasive methods,
these procedures tend to pose unnecessary risks and entail high costs that
put them beyond the reach of many patients. Outpatient therapy, employing
methods such as cryotherapy and the loop electrosurgical excision procedure
(LEEP), combined with proper follow-up, is appropriate for dealing with
visible lesions on the ectocervix when invasive cancer and endocervical
involvement have been ruled out. Cryotherapy and LEEP hold out particular
promise for developing countries because of their effectiveness, lack of
side-effects, simplicity, and low cost. Cure rates range from 80% to 95%,
depending on the method used and the severity of the lesions. However, each
method has advantages and disadvantages that demand consideration. Various
ways of reducing the number of follow-up visits, including the two-visit
"see and treat" approach, are also available for use in areas where women's
access to health services may be limited. A recent survey by the Program
for Appropriate Technology in Health (PATH) affirmed the tendency to rely
on cone biopsy and hysterectomy. It also found that in many places all
degrees of preinvasive disease were treated, rather than only high-grade or
severe conditions; that respondents in Latin America, the Caribbean, and
Asia tended to use cryotherapy and LEEP more widely than other low-cost
methods; that LEEP was preferred over cryotherapy in Latin America; and
that colposcopes and other basic equipment needed to provide treatment were
not consistently or widely available in some settings.
5. Onik GM; Downey DB; Fenster A.
Three-dimensional sonographically monitored cryosurgery in a prostate
phantom.
Journal of Ultrasound in Medicine, 1996 Mar, 15(3):267-70.
(UI: 97078589)
6. Aylward GW.
Latest developments in treating retinal detachment.
British Journal of Hospital Medicine, 1996 Feb 7-20, 55(3):100-3.
Pub type: Journal Article; Review; Review, Tutorial.
(UI: 97064004)
Abstract: Retinal detachment is a significant cause of blindness. Until the
second quarter of this century, no successful treatment was available.
Since then, there have been many exciting developments so that nowadays the
majority of retinal detachments can be successfully repaired.
7. Sueda T; Shikata H; Orihashi K; Mitsui N; Nagata H; Matsuura Y.
A modified maze procedure performed only on the left atrium for chronic
atrial fibrillation associated with mitral valve disease: report of a
case.
Surgery Today, 1996, 26(2):135-7.
(UI: 97078362)
Abstract: We describe herein the successful treatment of a patient with chronic
atrial fibrillation (AF) associated with mitral valve stenosis and
regurgitation, achieved by performing a modified maze procedure on the left
atrium alone. The patient was a 51-year-old man who had suffered from
intractable AF for 17 years, causing multiple cerebral emboli and
palpitations. He had undergone open mitral commissurotomy and balloon
commissurotomy 15 and 7 years ago, respectively. On admission, an
echocardiogram revealed mitral valve restenosis and thrombosis in the left
atrial appendage. Prosthetic valvular replacement was performed following
isolation of all pulmonary veins with cryoablation to the posterior wall of
the left atrium and excision of the left atrial appendage. Postoperatively,
the AF disappeared and echocardiogram demonstrated a left atrial kick in
the mitral valvular inflow without any evidence of thrombosis in the left
atrium. Thus, we believe that our modified "left side only" maze procedure
is a simple and efficient method for the treatment of chronic AF with
mitral valve disease.
8. Pogrel MA.
The management of lesions of the jaws with liquid nitrogen cryotherapy.
Journal - California Dental Association, 1995 Dec, 23(12):54-7.
(UI: 97204516)
Abstract: The mandible and maxilla suffer from a number of lesions that, though
benign, have a high recurrence rate (10 percent to 80 percent) after simple
enucleation. These include the ameloblastoma, keratocyst, odontogenic
myxoma, central giant cell granuloma and ossifying fibroma. The appropriate
treatment of these lesions is controversial, eliciting accusations of both
undertreatment and overtreatment. Liquid nitrogen cryotherapy may be a
valuable treatment modality to prevent recurrences of these lesions without
causing cosmetic deformity.
9. Watanabe H; Tsukamoto Y; Saito Y; Maeda N; Kiritoshi A; Shimomura Y.
Massive proliferation of conjunctival tissue after cryotherapy for
retinopathy of prematurity [letter].
Archives of Ophthalmology, 1997 Feb, 115(2):278-9.
Pub type: Letter.
(UI: 97198215)
10. Bittencourt AL; Barral A; Costa JM.
Tegumentary leishmaniasis in childhood.
Pediatric Dermatology, 1996 Nov-Dec, 13(6):455-63.
Pub type: Journal Article; Review; Review, Tutorial.
(UI: 97140582)
Abstract: Very little has been published about tegumentary leishmaniasis in
children and there are many controversies about this disorder in the
literature. Therefore, we discuss the pathogenesis, clinical aspects, means
to diagnosis, and treatment of this endemic disease.
11. Hilton GF; Das T; Majji AB; Jalali S.
Pneumatic retinopexy: principles and practice.
Indian Journal of Ophthalmology, 1996 Sep, 44(3):131-43.
Pub type: Journal Article; Review; Review, Tutorial.
(UI: 97171821)
Abstract: Pneumatic retinopexy (PR) is an alternative to scleral buckling for
the surgical repair of selected retinal detachments. A gas bubble is
injected into the vitreous cavity, and the patient is positioned so that
the bubble closes the retinal break (s), allowing absorption of the
subretinal fluid. Cryotherapy or laser photocoagulation is applied around
the retinal break(s) to form a permanent seal. The procedure can be done in
an outpatient setting, and no incisions are required. A multicenter
randomized controlled clinical trial has demonstrated that the anatomic
success rate is comparable to scleral buckling, but the morbidity is
significantly less with PR. If the macula was detached for less than two
weeks, the visual results are significantly better with PR than with
scleral buckling. Cataract surgery was required significantly more often
following scleral buckling than following PR. Two independent reports have
shown that an attempt with PR does not disadvantage the eye; such that the
results of scleral buckling after failed PR are not significantly different
than primary scleral buckling. A comprehensive review of the world
literature on PR revealed 27 statistical series totaling 1,274 eyes. These
combined series had a single-operation success rate of 80%, and 98% were
cured with reoperations. Pneumatic retinopexy should be considered in cases
without inferior or extensive retinal breaks and without significant
proliferative vitreoretinopathy. The cost of buckling varies from 4 to 10
times that of PR.
12. Kemeny N.
Colorectal cancer--an undertreated disease.
Anti-Cancer Drugs, 1996 Aug, 7(6):623-9.
Pub type: Journal Article; Review; Review, Tutorial.
(UI: 97070503)
Abstract: Surgery is currently the first-line treatment option for primary
colorectal cancer (CRC) and resectable metastatic disease. Cytotoxic
chemotherapy is used for adjuvant treatment as well as for the treatment of
advanced disease; the combination of 5-fluorouracil (5-FU) plus leucovorin
is currently the standard chemotherapeutic regimen used in most centers. In
many countries patients with CRC do not receive chemotherapy because some
clinicians perceive that the benefits of such treatment do not compensate
for the potential negative effects on patient quality of life in terms of
toxicity and inconvenient dosage schedules. However, recent evidence
suggests that the use of cytotoxic chemotherapy can lead to an improvement
in quality of life and effective palliation in CRC. A number of new
treatment options are becoming available for the treatment of this
malignancy. These include new anticancer agents such as thymidylate
synthase inhibitors, monoclonal antibodies and topoisomerase I inhibitors,
and new treatment methods including hepatic arterial or i.p. chemotherapy,
cryosurgery and chemo-embolization. With the increased referral of patients
to oncologists and the use of a multidisciplinary team approach, these new
agents and new methods of treatment can be fully evaluated for the
treatment of CRC, and should ultimately improve the treatment and outcome
of this common disease.
13. Bonnet M; Fleury J; Guenoun S; Yaniali A; Dumas C; Hajjar C.
Cryopexy in primary rhegmatogenous retinal detachment: a risk factor for
postoperative proliferative vitreoretinopathy?
Graefes Archive for Clinical and Experimental Ophthalmology, 1996 Dec,
234(12):739-43.
(UI: 97139874)
Abstract: PURPOSE: To evaluate the role of cryopexy in the stimulation of
postoperative proliferative vitreoretinopathy (PVR) in primary
rhegmatogenous retinal detachment. MATERIALS AND METHODS: A series of 595
eyes of 554 patients with primary rhegmatogenous retinal detachment,
referred before any failed surgery, were prospectively evaluated.
Univariate and multivariate statistical analyses of the data were
conducted. RESULTS: The incidence of postoperative PVR in relation to the
methods used for retinopexy was dependent on the types and anatomy of
retinal breaks associated with retinal detachment. The incidence of
postoperative PVR was nil in retinal detachments due to atrophic holes in
lattice, oral dialyses, and macular holes, regardless of the retinopexy
methods. Postoperative PVR occurred solely in retinal detachments due to
horseshoe tears (incidence 4.42%), paravascular tears of the postequatorial
region (18.18%), and giant tears (24.6%) (P < 0.00001). The incidence of
postoperative PVR was 0.5% in eyes with horseshoe tears with mobile
posterior edges vs 9.72% in eyes with horseshoe tears with curled posterior
edges, regardless of the retinopexy methods (P < 0.00001). In retinal
detachments due to horseshoe tears with mobile posterior edges the
incidence of postoperative PVR (0.5%) was not influenced by the retinopexy
methods. In contrast, in retinal detachments due to horseshoe tears with
curled posterior edges the incidence of postoperative PVR was higher in
eyes managed with cryopexy (14.77%) than in eyes managed with laser
retinopexy (1.78%) (P < 0.02). In retinal detachments due to giant tears
the incidence of postoperative PVR was not statistically significantly
greater in eyes managed with cryopexy (33.3%) than in eyes managed with
laser retinopexy (15.6%). In tears 180 degrees and over in size, however,
the incidence of postoperative PVR was significantly higher in eyes managed
with cryopexy (9/11 eyes) than in eyes managed with laser retinopexy (5/17
eyes) (P = 0.006). CONCLUSIONS: Cryopexy is not a stimulating factor for
postoperative PVR in primary rhegmatogenous retinal detachments due to
atrophic holes in lattice, oral dialyses, macular holes, or horseshoe tears
with mobile posterior edges. In contrast, cryopexy probably is a
stimulating factor for postoperative PVR in retinal detachments due to
horseshoe tears with curled posterior edges or to retinal tears 180 degrees
and over.
14. Mastrobattista JM; Luntz M.
Ciliary body ablation: where are we and how did we get here?
Survey of Ophthalmology, 1996 Nov-Dec, 41(3):193-213.
Pub type: Journal Article; Review; Review, Academic.
(UI: 97125148)
Abstract: Management of intraocular pressure remains the cornerstone of
glaucoma treatment. Related medical and surgical practices involve
increasing aqueous outflow or decreasing aqueous production. Filtration
procedures that increase aqueous outflow are the first-line surgical
defense in glaucoma. However, some cases of glaucoma are resistant to such
treatment. In these cases, ciliary body ablation by various methods has had
substantial success. Surgical manipulation of aqueous production has been
used in glaucoma management since the turn of the century. Techniques have
progressed markedly as technology has produced more discrete therapies
designed to decrease aqueous production by destroying ciliary body
epithelium. Over the past 90 years success has been achieved with a wide
range of techniques, from surgical disinsertion of the ciliary body to
recent laser and ultrasound techniques. With the development of more
precise contact lasers and endoscopic visualization, side effects have been
reduced and clinical success rates increased.
15. Guiraudon GM; Klein GJ; van Hemel N; Guiraudon CM; de Bakker JM.
Atrial flutter: lessons from surgical interventions (musing on atrial
flutter mechanism).
Pacing and Clinical Electrophysiology, 1996 Nov, 19(11 Pt 2):1933-8.
(UI: 97100513)
Abstract: We report our experience with seven patients who underwent direct
surgical ablation of problematic common flutter. Intraoperative mapping was
obtained in four patients. Surgical techniques varied over time. A circular
incision of the right atrium was performed in the first patient. Two
patients had epicardial cryoablation of the isthmus between the inferior
vena cava and the tricuspid valve annulus. Four patients had extensive
endocardial cryoablation of the isthmus. There were no immediate
postoperative complications. One patient had atrial fibrillation 2 months
postoperatively and underwent a corridor operation 1 year later. The other
six patients are free of arrhythmias without antiarrhythmic drugs. Surgical
ablation confirmed that the common form of atrial flutter is associated
with a right atrial macroreentrant circuit. One of our intraoperative
endocardial maps suggested that variant reentrant circuits can be
associated with variant forms of flutter.
16. Ravikumar TS.
The role of cryotherapy in the management of patients with liver tumors.
Advances in Surgery, 1996, 30:281-91.
Pub type: Journal Article; Review; Review, Tutorial.
(UI: 97119517)
17. Staren ED; Sabel MS; Gianakakis LM; Wiener GA; Hart VM; Gorski M;
Dowlatshahi K; Corning BF; Haklin MF; Koukoulis G.
Cryosurgery of breast cancer.
Archives of Surgery, 1997 Jan, 132(1):28-33; discussion 34.
(UI: 97159208)
Abstract: OBJECTIVE: To determine the feasibility and efficacy of cryosurgery
of breast cancer. DESIGN: In phase 1, carcinogen-induced mammary
adenocarcinomas in 13 Sprague-Dawley rats were treated by cryosurgery and
were then examined for histopathologic change. In phase 2, transplantable
mammary adenocarcinomas in 50 DBA/IJ mice were treated by cryosurgery to
determine the effect of varying tumor temperatures, and duration and number
of freeze-thaw cycles on tumor viability. In phase 3, 2- to 3-cm
ultrasound-monitored cryolesions were formed in the breasts of 4 dogs and 4
sheep. These animals were followed up for procedure-related complications;
the histopathologic necrosis of the cryolesions were correlated with the
ultrasound images. Based on the results of these experiments,
ultrasound-guided cryosurgery of breast cancer was initiated in a human
clinical trial. RESULTS: In phase 1, a single, short-term (< 7 minutes)
freeze killed only tumors smaller than 1.5 cm in diameter, despite an
apparent decrease to -40 degrees C at the periphery of each tumor. In phase
2, varying the peripheral tumor temperature to as low as -70 degrees C,
using a single, short-term (< 7 minutes) freeze did not alter the results
from phase 1. If the ice ball fully encompassed the tumor, however,
maintaining it for at least 15 minutes achieved 100% tumor kill independent
of tumor size. In phase 3, creation of a reproducible ultrasound-monitored
cryolesion was facilitated when 2 freeze-thaw cycles were performed. No
procedure-related complications were noted. In the human trial, 2 invasive
lobular carcinomas from 1 patient were treated by cryosurgery and were
negative for persistent tumor by core needle biopsy performed 4 and 12
weeks after a well-tolerated procedure. CONCLUSIONS: In situ breast
cryosurgery has been proved to be feasible and efficacious in small and
large animal studies and has been successfully performed in 1 patient with
breast cancer. The results of this study suggest that ultrasound-guided
cryosurgery of breast cancer warrants further investigation.
18. Redlich PN; Baker EJ; McAuliffe TL; Quebbeman EJ.
Surgical management of colorectal metastases to the liver: role of
resection and cryosurgery.
Wisconsin Medical Journal, 1996 Dec, 95(12):859-63.
(UI: 97146365)
Abstract: Long-term results of 41 patients who underwent hepatic resection and
early experience with 21 patients treated by hepatic cryosurgery alone or
combined with resection for colorectal metastases are presented. Patients
treated by resection had three or fewer metastases, no perioperative
mortality, and a mean follow-up of 43.5 months. The five-year overall
survival is 34% with a median survival of 48 months. By multivariate
analysis, only transfusions correlated significantly with survival, but in
a negative manner (p = 0.05). A mean of 4.3 units were transfused per
patient, though only 25 patients actually received transfusions.
19. Tai LS; Chia YW.
Endoscopic Nd:YAG laser treatment of inoperable lower gastrointestinal
cancer.
Annals of the Academy of Medicine, Singapore, 1996 Sep, 25(5):712-6.
Pub type: Journal Article; Review; Review, Tutorial.
(UI: 97082775)
Abstract: Many patients with colorectal cancer are not amenable to curative
resection at the time of presentation. Nevertheless, palliative resection
still remains as the treatment of choice in the majority of patients. A
small group of patients that are poor candidates for surgical resection may
benefit from some non-surgical palliative procedures to relieve their
symptoms. Electrocoagulation, cryosurgery and radiotherapy are some of the
non-surgical procedure used and they are associated with high morbidity and
mortality. The use of Neodymium: Yttrium-Aluminium-Garnet (Nd:YAG) laser
photoablation to palliate patients with advanced colorectal carcinoma is
well documented. It is associated with relatively low morbidity and
perioperative mortality. It requires no anaesthesia and is the only
non-surgical procedure that can be safely carried out above the peritoneal
reflection. Nd:YAG laser had been used in some centres as a preresectional
procedure in patient presenting with high grade obstruction. It allows
proper bowel preparation followed by primary excision and anastomosis. As a
palliative procedure, most patients showed rapid improvement in obstructive
symptoms, bleeding and rectal discharge. The size of the lesion and
circumferential extent of the tumour base correlate well with the response
rate. Most patients remained asymptomatic before they succumb to the
advanced disease. In our series, good palliation of obstructive symptoms
was achieved in all obstructive cases with one laser treatment, bleeding
tumours required an average of two sessions for complete haemostasis. In
conclusion, Nd:YAG laser therapy is a safe and efficacious means for
palliation of obstructive symptoms and bleeding in advanced rectal
carcinoma.
20. Metyolkina L; Peresedov V.
Transnasal stereotactic surgery of pituitary adenomas concomitant with
acromegaly.
Stereotactic and Functional Neurosurgery, 1995, 65(1-4):184-6.
(UI: 97073642)
Abstract: Since 1960 we have performed stereotactic transsphenoidal
cryohypophysectomy in 70 patients with pituitary adenomas, 42 women and 28
men, aged 11-59 years. The dominant clinical syndrome was acromegaly in 50
patients, galactorrhea in 9, amenorrhea in 5, adiposogenital dystrophy in 4
and gigantism with mild endocrine symptomatology in 2 patients. In 67
patients the histological structure of the tumor was established by biopsy
(50 patients with eosinophil adenoma, 10 with mixed-type adenoma, 4 with
chromophobe adenoma and 3 with basophil adenoma). Somatotropic hormone,
human growth hormone, prolactin, ACTH and 17-ketosteroid levels indicated
active/inactive adenomas. In 42 cases the adenoma was only intrasellar,
which was confirmed by contrast X-ray investigations, CT scanning,
angiography and ophthalmological investigation. Transnasal stereotactic
cryohypophysectomy was performed in all 70 cases using a stereotactic
apparatus especially designed for operations on the pituitary. All patients
(except 2) tolerated the operation well. No complications occurred. Vision
deteriorated after operation in 1 patient. Thrombosis of the left middle
cerebral artery developed in another patient. All the other patients noted
improvement directly after operation - rapid diminution of signs of
acromegaly and rapid restoration of normal values in hormonal tests. Six
patients with continuing growth of the tumor underwent a second operation
1.5-6 years after the first operation. We conclude from our own clinical
experience and information from the literature that transnasal stereotactic
cryodestruction is highly effective and relatively safe in the management
of pituitary adenoma.
21. Rand RW.
Role of cryosurgery and MRI for Parkinson's disease.
Stereotactic and Functional Neurosurgery, 1995, 65(1-4):18-22.
(UI: 97073615)
Abstract: Three basic principles underlie the techniques of stereotactic
cryosurgery for Parkinson's disease: (1) high-resolution MRI of the
surgical target using thin sequential coronal, axial and sagittal views:
(2) clinical-physiological verification of localization of the surgical
target by reversible inhibition test, and (3) production of the
cryosurgical freezing lesion in a conscious, cooperative patient. The
cryosurgical lesion is created in the ventrolateral nucleus of the thalamus
for control of tremor and rigidity, or in the posterior ventral area of the
pallidum for control of rigidity and bradykinesia. An initially reversible
inhibition is produced by cooling the probe tip to -10 degrees C. This
cools the brain tissue within 3 mm of the probe to 2-15 degrees C. If
parkinsonian symptoms are suppressed, the cryoprobe tip temperature is then
lowered incrementally, resulting in a gradually enlarging lesion surrounded
by a reversible buffer zone. The final temperature is that in which
parkinsonian symptoms are abolished and/or side effects appear. After
performing and evaluating over 1,000 cryothalamotomies and
cryopallidotomies on patients for whom medical treatments had failed, the
author concludes that cryosurgical techniques are safer and produce lesions
that are better controlled for size and location than other techniques,
resulting in lasting, successful therapeutic results.
22. Cozzi PJ; Lynch WJ; Collins S; Vonthethoff L; Morris DL.
Renal cryotherapy in a sheep model; a feasibility study.
Journal of Urology, 1997 Feb, 157(2):710-2.
(UI: 97149595)
Abstract: PURPOSE: This study was designed to evaluate the safety and efficacy
of renal cryotherapy as a possible treatment of renal malignancy with
preservation of renal parenchyma. MATERIALS AND METHODS: Ten Merino sheep
were anaesthetised and the right kidney was exposed through a
retro-peritoneal approach. A 5 mm. cryotherapy probe (LCS 3000 Cryotec UK)
was inserted into the lower pole of the kidney and freezing was undertaken
to form an iceball 5 cm. in diameter. RESULTS: There was no mortality and
no complications were observed. A transient rise in creatinine was observed
post-operatively. The sheep were euthenased at 4 weeks and at necropsy
macroscopic examination revealed a contracted, fibrotic wedge shaped lesion
of 3 cm in diameter. Histological examination of the "cryolesion" revealed
a central area of coagulative necrosis and a 5 mm rim of partial necrosis
with preservation of renal tubules. CONCLUSION: We conclude that renal
cryotherapy is safe and can achieve effective renal necrosis in the sheep
model.
23. Oyasu R.
Prostate cancer [editorial; comment].
Journal of Urology, 1997 Feb, 157(2):563-4.
Pub type: Editorial.
(UI: 97149549)
24. Shuman BA; Cohen JK; Miller RJ Jr; Rooker GM; Olson PR.
Histological presence of viable prostatic glands on routine biopsy
following cryosurgical ablation of the prostate [see comments].
Journal of Urology, 1997 Feb, 157(2):552-5.
(UI: 97149546)
Abstract: PURPOSE: Cryosurgical ablation of the prostate has recently received
much attention as a therapeutic alternative for the treatment of localized
prostatic adenocarcinoma. Biopsies after treatment reveal a variety of
dysplastic changes as well as unaltered prostatic glandular epithelial
elements. Prostate specific antigen (PSA) remains undetectable in the
majority of men. However, in some PSA increases without demonstrable local
recurrence. MATERIALS AND METHODS: A total of 383 patients underwent 447
procedures between June 1990 and January 1994. Of 358 biopsies performed at
our institution, 317 (2,075 cores) were available for review. Each core was
examined for unaltered prostatic glandular epithelial elements and then
scored for the percentage of epithelial glandular involvement according to
a scale of: 0-no, 0.5-less than 10%, 1-10 to 25%, 2-25 to 50%, 3-50 to 75%
and 4-76 to 100% unaltered prostatic glandular epithelial elements.
RESULTS: Of 317 biopsies 158 (49.8%) contained no unaltered prostatic
glandular epithelial elements, while 185 (58.3%) and 206 (65%) had 1 core
containing 10% and 10 to 25%, respectively, of such elements. Of 262 cases
(82.6%) with a mean of 10% unaltered prostatic glandular epithelial
elements per core 22 (8.4%) were positive for residual carcinoma. Among 55
cases with more normal epithelium per core 24 (43.6%) were positive for
residual carcinoma. Patients with a positive biopsy had a median PSA of
2.02 ng./ml. (average gland/core score 0.54). Median PSA for men with
negative biopsies was 0.2 ng./ml. (gland/core score 0.124). CONCLUSIONS:
Cryosurgical ablation of the prostate has the ability to ablate prostatic
tissue completely, thus rendering it free of glandular elements as
determined by biopsy. Increasing PSA can indicate residual glandular
elements. Increases in unaltered prostatic glandular epithelial elements
with time are not paralleled by increased rates of local disease
recurrence. undetectable serum PSA has a low risk of residual unaltered
prostatic glandular epithelial elements and localized carcinoma. Results as
measured by unaltered prostatic glandular epithelial elements and PSA
improve with the surgical experience.
25. Harper DM.
Paracervical block diminishes cramping associated with cryosurgery.
Journal of Family Practice, 1997 Jan, 44(1):71-5.
Pub type: Clinical Trial; Journal Article.
(UI: 97163566)
Abstract: BACKGROUND: The choice of treatment method for cervical
intraepithelial neoplasia can be dictated by the lesion size, by comfort of
the operator with the technique, by the cost of the procedure, and by
patient comfort with the procedure. The purpose of this research was to
compare the usual method of cryosurgery (no anesthetic block) with a method
using a paracervical block to reduce the pain and cramping associated with
cryosurgery. METHODS: A prospective trial was designed and conducted in a
colposcopy clinic. Of the 85 women enrolled in the study, all were
immediately given 550 mg of naproxen sodium orally; 40 received no block
and 45 received a paracervical block before the cryosurgery procedure.
After the procedure, a trained interviewer elicited pain and cramping
scores using a visual analog scale. Chi-square, Fisher's exact test,
Mann-Whitney U, Wilcoxon signed-ranks test, Friedman's two-way analysis of
variance, and multivariate analysis of variance with covariates were used
to analyze the data. RESULTS: Each part of the double-freeze cryosurgical
procedure was ranked according to the participants' perceptions of pain and
cramping. The cramping after the first freeze was significantly less for
women receiving the paracervical block than for the women undergoing the
usual procedure (z = -2.44, P = .014). Including the discomfort from the
injection itself, the women who received a paracervical block perceived
less cramping overall during cryosurgery than the women with no block (z =
-2.35, P = .019). The paracervical block did not decrease the pain from
cryosurgery according to the participants' rankings of perceived pain.
CONCLUSIONS: A paracervical block is effective in reducing the cramping
from cryosurgery.
26. Zabriskie NA; Nordlund JJ; Nerad JA.
Unusual skin depigmentation following eyelid cryosurgery.
Ophthalmic Plastic and Reconstructive Surgery, 1996 Dec, 12(4):296-8.
(UI: 97099823)
Abstract: A 71-year-old African-American man was treated with cryosurgery of
the left lower lid for trichiasis. Dramatic depigmentation of the lid skin
followed, including substantial pigment loss on the untreated upper lid.
Pigmentation returned to nearly normal over a 9-year period. Depigmentation
of the skin following cryosurgery is a well-known complication. The
clinical course of the depigmentation, however, is not well demonstrated in
the literature. This case documents, with clinical photographs, the
spontaneous return to nearly normal pigmentation 9 years following the
cryosurgery. In addition, the extensive depigmentation seen in this patient
cannot be explained by cryoinjury alone. We speculate that the
depigmentation was due, in part, to segmental vitiligo initiated at the
site treated with cryosurgery.
27. DeLeo JA; Colburn RW; Nichols M; Malhotra A.
Interleukin-6-mediated hyperalgesia/allodynia and increased spinal IL-6
expression in a rat mononeuropathy model.
Journal of Interferon and Cytokine Research, 1996 Sep, 16(9):695-700.
(UI: 97041782)
Abstract: It has been suggested that neuroimmunologic mechanisms may be
involved in the development and maintenance of neuropathic pain. To further
address this concept, the immunoreactive spinal expression of the
pro-inflammatory cytokine, interleukin-6 (IL-6), was determined in the
mononeuropathy model in the rat, sciatic cryoneurolysis (SCN). This
well-established animal model expresses behaviors suggestive of neuropathic
pain in humans. Immunohistochemical localization in the spinal cord was
determined at 3, 7, 14, 21, 35, and 120 days after SCN (n = 6 per time
point). Immunoreactive IL-6 increased incrementally in the substantia
gelatinosa and motoneurons over time following SCN as compared with normal
rats. In an additional study, recombinant human IL-6 was administered
intrathecally to normal and previously SCN-lesioned rats. Intrathecal IL-6
produced touch-evoked allodynia (increased sensitivity to a nonnoxious
stimulus) in normal rats and thermal hyperalgesia (increased sensitivity to
a noxious stimulus) in previously lesioned SCN rats. These results provide
evidence that IL-6 may be involved in the cascade of events leading to the
development and maintenance of behaviors suggestive of neuropathic pain
following peripheral nerve injury.
28. Kerin JF.
New methods for transcervical cannulation of the fallopian tube.
International Journal of Gynaecology and Obstetrics, 1995 Dec, 51 Suppl
1:S29-39.
Pub type: Journal Article; Review; Review, Tutorial.
(UI: 97060192)
Abstract: Technological advances have led to major improvements in the design
and application of Fallopian tube cannulation devices using the
transcervical approach. Presently such cannulation systems are being used
to overcome infertility disorders. These transcervical access systems are
now able to displace debris that may block the tube, break down
intraluminal adhesions or place egg, sperm or embryos in the tube to
facilitate conception. Conversely, these same or modified devices could be
used to place sclerosing agents or occlusive devices within the Fallopian
tubes using similar transcervical access technology. Transcervical delivery
systems incorporating a very fine endoscopic fiber have also been developed
to visibly assess the inside lumen of the Fallopian tube using a
transcervical approach. Such a system could be used to accurately identify
specific sites in the tube for placement of such devices. The potential for
placing permanent or temporary devices in the tube and the option of
reversible sterilization may become a possibility in the future. One of the
biggest obstacles against a wide distribution of these devices,
particularly in third world countries, will be cost and the relative
technical complexity in using them. These factors will need to be addressed
more carefully in assessing the overall strategy of population control. The
pressure on governments and international agencies to place more resources
into population control may facilitate the accelerated development,
application and cost containment of these new devices and delivery systems.
29. Adam R; Akpinar E; Johann M; Kunstlinger F; Majno P; Bismuth H.
Place of cryosurgery in the treatment of malignant liver tumors.
Annals of Surgery, 1997 Jan, 225(1):39-8; discussion 48-50.
Pub type: Clinical Trial; Journal Article.
(UI: 97152187)
Abstract: OBJECTIVE: The authors evaluate the results of cryosurgery in
malignant liver tumors. SUMMARY BACKGROUND DATA: The outcome of primary or
secondary liver tumors is poor when resection can not be achieved.
Encouraging results of cryosurgery have been reported in unresectable liver
tumors, but this treatment needs further evaluation of its efficacy in
homogeneous groups of patients. METHODS: From 63 patients with malignant
liver tumors with various histology treated by cryosurgery in a 2.5-year
period, the authors evaluated the results of 34 patients with nonresectable
hepatocellular carcinoma (9 patients) or nonresectable metastases from
colorectal cancer (25 patients). Cryosurgery was used either as a single
treatment (4 hepatocellular carcinomas, 5 metastases) or in association
with liver resection (5 hepatocellular carcinomas, 20 metastases). Systemic
chemotherapy was used routinely before surgery and after surgery. RESULTS:
There was no intraoperative mortality. Mortality within 2 months was 3% and
was unrelated to the procedure. Postoperative morbidity consisted of one
sterile fluid collection and one biliary fistula (8%). At a mean follow-up
of 16 months, (range, 2-27) local recurrence rate was 0% for hepatocellular
carcinoma and 44% for metastases. Cumulative survival at 24 months was 63%
and 52%, respectively, with 6 patients (67%) and 5 patients (20%) currently
disease free. In the group of patients with metastases, survival was
related to the size of the treated tumor (p = 0.06) and the absence of
residual disease (p = 0.03). CONCLUSIONS: Cryosurgery is safe and increases
the number of patients with unresectable liver malignancies in whom surgery
can aim at eradicating the tumor. Local recurrence is observed more
frequently for metastases than for hepatocellular carcinoma. The benefit in
survival is related to the complete treatment of the tumoral disease.
30. Schwartz PE.
Cytoreductive surgery for the management of stage IV ovarian cancer
[editorial; comment].
Gynecologic Oncology, 1997 Jan, 64(1):1-3.
Pub type: Comment; Editorial.
(UI: 97151002)
31. Morris DL; Ross WB.
Australian experience of cryoablation of liver tumors: metastases.
Surgical Oncology Clinics of North America, 1996 Apr, 5(2):391-7.
Pub type: Journal Article; Review; Review, Tutorial.
(UI: 97110972)
Abstract: The authors' clinical experience of treating almost exclusively
inoperable liver malignancy in 149 patients by cryotherapy is reviewed.
There was only one 30-day death; morbidity was modest. Postoperative
carcinoembryonic antigen (CEA) changes were extremely predictive of outcome
in patients with liver metastases from colorectal cancer. For the group in
which CEA levels returned to the normal range, median survival exceeded
1000 days. In addition, the authors reported encouraging results with
cryotherapy as an adjunct to resection.
32. Zhou XD; Tang ZY; Yu YQ.
Ablative approach for primary liver cancer: Shanghai experience.
Surgical Oncology Clinics of North America, 1996 Apr, 5(2):379-90.
Pub type: Journal Article; Review; Review, Tutorial.
(UI: 97110971)
Abstract: This article summarizes the results of 2018 patients receiving
surgical treatment for pathologically proven primary liver cancer (PLC).
Special references are made to the role of cryosurgery and cytoreduction
for unresectable PLC.
33. Ravikumar TS.
Interstitial therapies for liver tumors.
Surgical Oncology Clinics of North America, 1996 Apr, 5(2):365-77.
Pub type: Journal Article; Review; Review, Tutorial.
(UI: 97110970)
Abstract: A variety of tumor-directed "interstitial" treatments based on
physical, chemical, and radiobiologic antineoplastic principles have been
investigated for the management of patients with unresectable tumors
confined to the liver. Cryosurgery, ethanol injection, and laser
photocoagulation are reviewed.
34. Starzycka M; Gorniak-Bednarz A; Ortyl E; Starzycka-Bigaj E.
[Conventional methods in retinal detachment surgery].
Klinika Oczna, 1996 Mar, 98(3):225-8.
Language: Polish.
(UI: 97155776)
Abstract: PURPOSE: To evaluate the usefulness of conventional methods in
retinal detachment (RD) surgery basing on the relationship between factors
characterizing clinical picture of the RD, the type and course of surgical
procedures and the retinal reattachment. MATERIALS AND METHODS: 252
patients (252 eyes), operated on in the last 5 years in our clinic were
enrolled in the studies. There were 120 men and 132 women, aged 9 to 83,
mean 53. In all cases scleral buckling procedures with silicone band or
sponge and cryocoagulation of the breaks were used. The relationship
between retinal reattachment and the following parameters were examined:
visual acuity, retinal degenerations, myopia, extent of the detachment,
number and kinds of breaks, macular involvement, state of vitreous, PVR,
intraocular pressure, extent of scleral buckling, subretinal fluid drainage
and intra- or post-operative complications. RESULTS: Retinal reattachment
was achieved in 82% of the eyes with one operation and additionally in 7%
after reoperation. The significant relationship was found between: visual
acuity, intraocular pressure, extent of the detachment, number of breaks,
PVR, extent of scleral buckling and retinal reattachment. CONCLUSION: PVR
is a significant cause of failure in RD surgery with conventional methods
and PVR grade C is the threshold beyond which the percentage of
reattachments decreases to about 50%. Value of other risk factors,
determining severity of RD is not certain for prognosis. Cerclage with
silicone band is a method of choice in the majority of RD with PVR grade B
and C. Our observations do not confirm the reports of severe complications
caused by cerclage, which might be connected with excessive tightening of
the band.
35. Starzycka M; Kobylarz J; Starzycka-Bigaj E.
[Use of cryotherapy in retinopathy of prematurity].
Klinika Oczna, 1996 Jan, 98(1):33-6.
Language: Polish.
(UI: 97154287)
Abstract: PURPOSE: To present our experiences in cryotherapy for ROP. MATERIAL
AND METHODS: From October 1991 to August 1995, transscleral cryotherapy was
applied in 128 eyes of 70 babies with ROP. There were 34 girls and 36 boys
with birth weight between 650 g and 1990 g and gestational age from 24 to
36 weeks. In above 90% of cases, ROP reached zone II and stage 3 with
"plus" disease. In 84% of the eyes the extent of ROP was greater than 5
clock hours. Prethreshold severity was diagnosed in 7 and threshold in 110
eyes. In 11 eyes these categories could not be seventy determined. The
chronologic age of infants at cryotherapy ranged from 8 to 22 weeks, mean
12 weeks. In all cases, cryotherapy was carried out under general
anesthesia using a technique described in CRYO-ROP study. No serious
complications during or after cryotherapy were observed. RESULTS: Favorable
structural outcome was found in 119 eyes of 70 treated infants. In 82 eyes
of 46 infants, with at least 12-month follow-up examination, also
functional outcome was evaluated, basing on the examination with the Teller
Acuity Card Procedure; the results were favorable in 57% of the eyes.
Structural and functional outcomes were in agreement in 47 of the 82 eyes
and discordant in 33. CONCLUSIONS: Our experience confirms the benefit of
cryotherapy in the treatment of active ROP. In most cases cryotherapy
should be applied in threshold ROP but in some cases especially in those
with very rapid progression it should be done earlier. Because of the
unpredictability of the natural course of ROP it is essential to use the
scheme of ophthalmological examinations proposed by CRYO-ROP Study.
1. Wong WS; Chinn DO; Chinn M; Chinn J; Tom WL; Tom WL.
Cryosurgery as a treatment for prostate carcinoma: results and
complications.
Cancer, 1997 Mar 1, 79(5):963-74.
(UI: 97193574)
Abstract: BACKGROUND: There has been a resurgence of interest in cryosurgical
ablation of the prostate for the treatment of carcinoma. This is due to
recent advances in cryosurgical technology, which have resulted in
relatively lower morbidity. The objective of this study was to evaluate the
effectiveness of ultrasound-guided cryosurgical ablation of prostate
carcinoma. METHODS: Eighty-three patients who had biopsy-proven prostate
carcinoma underwent cryosurgical ablation of their entire prostate gland.
The initial group of 12 patients had their procedures performed under
ultrasound guidance only. The other 71 patients had cryosurgery performed
with temperature monitoring in combination with ultrasound guidance. Twelve
patients who had positive biopsies underwent a second cryosurgical
procedure. All patients had prostate specific antigen (PSA) levels measured
at 3, 6, 12, 18, 24, and 30 months after cryosurgery. Ultrasound-guided
sextant biopsies were performed at 3-6, 12-18, and 24 months. RESULTS: The
median PSA dropped by 95%, from a preoperative value of 4.3 ng/mL to 0.2
ng/mL 30 months after cryosurgery. The authors experienced a high failure
rate (positive biopsies) of 83% for the initial group of 12 patients who
did not have temperature monitoring during the cryosurgical procedure. This
was in contrast to a success rate of 90% (negative biopsies) for the next
71 patients, who did have temperature monitoring (P < 0.05, chi-square
test). Twelve patients underwent a second cryosurgery, and the success rate
for this group was 91% (11 of 12 patients). The combined success rate for
both the first cryosurgery and the second was 94% (62 of 77 patients).
Complications included urethral sloughing, urinary incontinence, impotence,
bladder neck contracture, and bladder contracture. The majority of patients
recovered rapidly from their cryosurgical procedures and were able to
resume normal activities 3-4 weeks afterward. CONCLUSIONS: These
preliminary results demonstrate that cryosurgical ablation of the prostate
is a viable treatment option for prostate carcinoma. In the authors'
experience, ultrasound alone may not be adequate for monitoring the entire
cryosurgical procedure. The authors found that temperature monitoring
shortened their learning curve, enabled them to freeze prostate tissue more
aggressively, and may have contributed to their overall success.
2. Korpan NN.
Hepatic cryosurgery for liver metastases. Long-term follow-up.
Annals of Surgery, 1997 Feb, 225(2):193-201.
Pub type: Clinical Trial; Journal Article; Randomized Controlled Trial.
(UI: 97188753)
Abstract: OBJECTIVE: The aim of this prospective study was to evaluate the
applicability of cryogenic and conventional surgery in treating liver
metastases (LM) with respect to intraoperative tumor reduction and survival
rate. SUMMARY BACKGROUND DATA: As have been shown in animal experiments as
well as in clinical investigations, cryosurgery has been used for the
treatment of many benign and malignant conditions. For the first time, this
report summarizes a 10-year follow-up clinical experience with cryosurgery
for treatment of LM from 1983 to 1992. METHODS: One hundred twenty-three
patients with LM (87 males and 36 females, a ratio 2.4:1.0; age, 41.3 +/-
12.1 years) were stratified and entered into a long-term prospective,
randomized clinical trial for cryogenic surgery in group 1 (n = 63) and
conventional surgical techniques in group 2 (control subjects, n = 60).
Principally, a self-constructed cryogenic clamp was used for hepatic
cryoresection with preliminary freezing of the margin resection by a
cryosurgical system "Cryoelectronic-2" or "Cryoelectronic-4". Hepatic
cryoextirpation (cryoablation) and hepatic cryodestruction were performed
by means of probes of different roughly disk design from phi 5 mm to 55 mm
by volume of frozen zone of 40 cm3 to 180 cm3 for approximately 7 to 32
minutes. RESULTS: In most cases in group 1 and group 2, LM were based on
colorectal cancers (65% vs. 68%). The hepatic cryosurgical procedures in
group 1 included cryoextirpation (29 patients, 46%), cryoresection (20
patients, 32%), and cryodestruction (14 patients, 22%) solely. Clinical and
laboratory parameters showed that the curative effects were significantly
higher in group 1 than in group 2. The 3-year survival rate was in group 1
and group 2 (60% vs. 51%, respectively). The 5-year survival rate was 44%
in group 1 and 36% in group 2. Twelve patients (19%) versus 5 patients (8%)
in group 1 and group 2, respectively, survived 10 years. The disease-free
survival was in group 1 and group 2 (30% vs. 18%, respectively). During a
follow-up period, recurrence in the liver was observed in 54 patients (85%)
in group 1 and in 57 patients (95%) in control subjects. After a 10-year
follow-up period in group 1 and group 2, 9 patients (14%) versus 3 patients
(5%) remained disease free, 3 patients (4%) versus 2 patients (3%) were
surviving with disease, and 51 patients (81%) versus 55 patients (92%)
died. CONCLUSIONS: The data of this 10-year prospective, randomized
clinical trial suggest that hepatic cryosurgery is effective in the
treatment of resectable and nonresectable LM. The results show
intraoperative tumor reduction (> or = 90% < or = 97%) and extended higher
survival in these patients. The study indicated a 5-year and 10-year
survival rate of 44% and 19% after cryosurgery, respectively.
3. Silverstein JC; Staren E; Velasco J.
Thermal bile duct protection during liver cryoablation.
Journal of Surgical Oncology, 1997 Feb, 64(2):163-4.
(UI: 97199280)
4. Bishop A; Sherris J; Tsu VD; Kilbourne-Brook M.
Cervical dysplasia treatment: key issues for developing countries.
Bulletin of the Pan American Health Organization, 1996 Dec, 30(4):378-86.
(UI: 97194175)
Abstract: Many developing countries face serious obstacles that have hindered
establishment of successful cervical cancer control programs. Various
countries are now seeking to strengthen cytology services and identify
simple low-cost screening strategies; but any real gains in reducing
cervical cancer incidence and mortality will also require effective
treatment of women with preinvasive disease. Despite a trend toward
conservative outpatient approaches for treating cervical dysplasia in
industrialized countries, clinicians in many developing countries still
rely primarily on invasive inpatient methods such as cone biopsy and
hysterectomy. For women who could be treated with less invasive methods,
these procedures tend to pose unnecessary risks and entail high costs that
put them beyond the reach of many patients. Outpatient therapy, employing
methods such as cryotherapy and the loop electrosurgical excision procedure
(LEEP), combined with proper follow-up, is appropriate for dealing with
visible lesions on the ectocervix when invasive cancer and endocervical
involvement have been ruled out. Cryotherapy and LEEP hold out particular
promise for developing countries because of their effectiveness, lack of
side-effects, simplicity, and low cost. Cure rates range from 80% to 95%,
depending on the method used and the severity of the lesions. However, each
method has advantages and disadvantages that demand consideration. Various
ways of reducing the number of follow-up visits, including the two-visit
"see and treat" approach, are also available for use in areas where women's
access to health services may be limited. A recent survey by the Program
for Appropriate Technology in Health (PATH) affirmed the tendency to rely
on cone biopsy and hysterectomy. It also found that in many places all
degrees of preinvasive disease were treated, rather than only high-grade or
severe conditions; that respondents in Latin America, the Caribbean, and
Asia tended to use cryotherapy and LEEP more widely than other low-cost
methods; that LEEP was preferred over cryotherapy in Latin America; and
that colposcopes and other basic equipment needed to provide treatment were
not consistently or widely available in some settings.
5. Onik GM; Downey DB; Fenster A.
Three-dimensional sonographically monitored cryosurgery in a prostate
phantom.
Journal of Ultrasound in Medicine, 1996 Mar, 15(3):267-70.
(UI: 97078589)
6. Aylward GW.
Latest developments in treating retinal detachment.
British Journal of Hospital Medicine, 1996 Feb 7-20, 55(3):100-3.
Pub type: Journal Article; Review; Review, Tutorial.
(UI: 97064004)
Abstract: Retinal detachment is a significant cause of blindness. Until the
second quarter of this century, no successful treatment was available.
Since then, there have been many exciting developments so that nowadays the
majority of retinal detachments can be successfully repaired.
7. Sueda T; Shikata H; Orihashi K; Mitsui N; Nagata H; Matsuura Y.
A modified maze procedure performed only on the left atrium for chronic
atrial fibrillation associated with mitral valve disease: report of a
case.
Surgery Today, 1996, 26(2):135-7.
(UI: 97078362)
Abstract: We describe herein the successful treatment of a patient with chronic
atrial fibrillation (AF) associated with mitral valve stenosis and
regurgitation, achieved by performing a modified maze procedure on the left
atrium alone. The patient was a 51-year-old man who had suffered from
intractable AF for 17 years, causing multiple cerebral emboli and
palpitations. He had undergone open mitral commissurotomy and balloon
commissurotomy 15 and 7 years ago, respectively. On admission, an
echocardiogram revealed mitral valve restenosis and thrombosis in the left
atrial appendage. Prosthetic valvular replacement was performed following
isolation of all pulmonary veins with cryoablation to the posterior wall of
the left atrium and excision of the left atrial appendage. Postoperatively,
the AF disappeared and echocardiogram demonstrated a left atrial kick in
the mitral valvular inflow without any evidence of thrombosis in the left
atrium. Thus, we believe that our modified "left side only" maze procedure
is a simple and efficient method for the treatment of chronic AF with
mitral valve disease.
8. Pogrel MA.
The management of lesions of the jaws with liquid nitrogen cryotherapy.
Journal - California Dental Association, 1995 Dec, 23(12):54-7.
(UI: 97204516)
Abstract: The mandible and maxilla suffer from a number of lesions that, though
benign, have a high recurrence rate (10 percent to 80 percent) after simple
enucleation. These include the ameloblastoma, keratocyst, odontogenic
myxoma, central giant cell granuloma and ossifying fibroma. The appropriate
treatment of these lesions is controversial, eliciting accusations of both
undertreatment and overtreatment. Liquid nitrogen cryotherapy may be a
valuable treatment modality to prevent recurrences of these lesions without
causing cosmetic deformity.
1. Wong, W S; Chinn, D O; Chinn, M; Chinn, J; Tom, W L; Tom, W L.
Cryosurgery as a treatment for prostate carcinoma: Results and
complications.
Cancer, v.79, n.5, (1997): 963-974.
Abstract:
BACKGROUND. There has been a resurgence of interest in cryosurgical
ablation of the prostate for the treatment of carcinoma. This is due to
recent advances in cryosurgical technology, which have resulted in
relatively lower morbidity. The objective of this study was to evaluate
the effectiveness of ultrasound-guided cryosurgical ablation of prostate
carcinoma. METHODS. Eighty-three patients who had biopsy-proven prostate
carcinoma underwent cryosurgical ablation of their entire prostate gland.
The initial group of 12 patients had their procedures performed under
ultrasound guidance only. The other 71 patients had cryosurgery performed
with temperature monitoring in combination with ultrasound guidance.
Twelve patients who had positive biopsies underwent a second cryosurgical
procedure. All patients had prostate specific antigen (PSA) levels
measured at 3, 6, 12, 18, 24, and 30 months after cryosurgery.
Ultrasound-guided sextant biopsies were performed at 3-6, 12-18, and 24
months. RESULTS. The median PSA dropped by 95%, from a preoperative value
of 4.3 ng/mL to 0.2 ng/mL 30 months after cryosurgery. The authors
experienced a high failure rate (positive biopsies) of 83% for the initial
group of 12 patients who did not have temperature monitoring during the
cryosurgical procedure. This was in contrast to a success rate of 90%
(negative biopsies) for the next 71 patients, who did have temperature
monitoring (P lt 0.05, chi-square test). Twelve patients underwent a
second cryosurgery, and the success rate for this group was 91% (11 of 12
patients). The combined success rate for both the first cryosurgery and
the second was 94% (62 of 77 patients). Complications included urethral
sloughing, urinary incontinence, impotence, bladder neck contracture, and
bladder contracture. The majority of patients recovered rapidly from their
cryosurgical procedures and were able to resume normal activities 3-4
weeks afterward. CONCLUSIONS. These preliminary results demonstrate that
cryosurgical ablation of the prostate is a viable treatment option for
prostate carcinoma. In the authors' experience, ultrasound alone may not
be adequate for monitoring the entire cryosurgical procedure. The authors
found that temperature monitoring shortened their learning curve, enabled
them to freeze prostate tissue more aggressively, and may have contributed
to their overall success.
2. Bischof, J C; Smith, D; Pazhayannur, P V; Manivel, C; Hulbert, J; Roberts, K
P.
Cryosurgery of Dunning AT-1 rat prostate tumor: Thermal, biophysical, and
viability response at the cellular and tissue level.
Cryobiology, v.34, n.1, (1997): 42-69.
Abstract:
This study investigates cryodestruction of the Dunning AT-1 rat prostate
tumor at the single cell, tissue slice, and in vivo levels. The thermal
history around a 3-mm-diameter cylindrical cryosurgical probe was
predicted by solving the bioheat equation in a one-dimensional cylindrical
geometry. At various radial positions in the iceball this thermal history
was approximated by a constant cooling rate and a final, steady-state
temperature (or end-temperature). The predicted cooling rates and end
temperatures ranged from greater than or equal to 1000 degree C/min to 5
degree C/min and -196 degree C to -20 degree C, respectively. These
cooling rates and end-temperatures were then imposed on single AT-1 cells,
AT-1 tissue slices in vitro and AT-1 tumors in vivo. The single cells and
tissue slices were frozen by LN-2 immersion, copper block slam-freezing,
or controlled cooling on a cryomicroscope or a directional solidification
stage. LN-2 immersion is lethal to AT-1 cells (presumably due to
intracellular ice formation), while cooling at 5-100 degree C/min leaves
some viable cells (at end-temperatures ranging between -20 and -40 degree
C). AT-1 tumor slices show extensive intracellular ice formation due to
slam cooling, extensive dehydration at 100 degree C/min, and total
dehydration at rates less than or equal to 10 degree C/min to end
temperatures below -10 degree C. Postfreeze culture and histology of the
AT-1 tissue show that extensive intracellular ice formation is lethal,
while cellular dehydration and vascular engorgement leave viable cells (at
end-temperatures between -20 and -40 degree C). Based solely on the single
cell and in vitro tissue damage achieved by cooling rates and
end-temperatures, a sizable portion of a cryosurgically frozen tumor would
be expected to survive. However, in vivo cryosurgery performed on AT-1
tumors demonstrated that the tissue was damaged throughout the cryolesion,
even at the periphery where the thermal history would be expected to allow
single cells and tissue slices to survive in vitro. Taken together, these
results suggest that damage mechanisms other than those due to cooling
rate and end-temperature may be responsible for the increased cellular
destruction at the periphery of the iceball in vivo and that cooling rate
is less important than end-temperature in determining cryosurgical damage
in AT-1 tumors. Experiments are ongoing to determine if the time held at
an end temperature, thawing rate, vascular response, or other mechanisms
are primarily responsible for the enhanced destructive capability in vivo.
3. Lee, F T Jr; Mahvi, D M; Chosy, S G; Onik, G M; Wong, W S; Littrup, P J;
Scanlan, K A.
Hepatic cryosurgery with intraoperative US guidance.
Radiology, v.202, n.3, (1997): 624-632.
4. Kemparaja, M S V; Jayadevappa, S M.
Cryosurgical therapy for interdigital tumours in bovines.
Indian Veterinary Journal, v.73, n.11, (1996): 1187-1188.
5. Miya, K; Saji, S; Takeuchi, M; Adachi, T.
Liver regenerative and protective effects of freezing and thawing rat
hepatic tissue (FTHT) or FTHT sensitized rat serum. (Thirty-third Annual
Meeting of the Society for Cryobiology, Indianapolis, Indiana, USA,...
Cryobiology, v.33, n.6, (1996): 679-780.
6. Baust, J G; Gage, A; Ma, H; Zhang, C.
Minimally invasive cryosurgery: Technological advancements. (Thirty-third
Annual Meeting of the Society for Cryobiology, Indianapolis, Indiana, USA,
August 17-21, 1996. )
Cryobiology, v.33, n.6, (1996): 670.
1. Lee FT Jr; Mahvi DM; Chosy SG; Onik GM; Wong WS; Littrup PJ; Scanlan KA.
Hepatic cryosurgery with intraoperative US guidance.
Radiology, 1997 Mar, 202(3):624-32.
(UI: 97203433)
2. Mintz-Hittner HA; O'Malley RE; Kretzer FL.
Long-term form identification vision after early, closed,
lensectomy-vitrectomy for stage 5 retinopathy of prematurity.
Ophthalmology, 1997 Mar, 104(3):454-9.
(UI: 97226428)
Abstract: PURPOSE: Form identification vision after early, closed,
lensectomy-vitrectomy for retinopathy of prematurity (ROP) stage 5 open
funnel retinal detachment is reported from a database that included 45 eyes
of 27 infants. The focus of this report is the verbal responses at a mean
age of 7.0 years for nine nonamblyopic (preferred) eyes of nine preterm
infants with minimal developmental delay (good central nervous system
function). METHODS: All 45 eyes underwent initial cryotherapy for threshold
ROP to the avascular retina to decrease the angiogenic stimulus (mean
postconceptual age = 34.8 weeks) and subsequently underwent multiple
cryotherapy sessions to the avascular retina and shunt with scleral
buckling to decrease retinal traction (mean postconceptual age = 38.0
weeks). When tractional retinal detachment occurred with an open funnel,
each eye underwent an early, closed, lensectomy-vitrectomy (mean
postconceptual age = 45.7 weeks). The 34 eyes with a successful anatomic
result were fitted with contact lenses as soon as possible after surgery.
RESULTS: The nine nonamblyopic eyes of nine preterm infants with minimal
developmental delay had the following visual acuities using Allen figures
or Snellen test types: one eye 20/80, one eye 20/200, two eyes 20/400,
three eyes 20/800, and two eyes 20/ 1600. CONCLUSION: These nine eyes
support the thesis that form identification vision can be obtained by early
vitrectomy for ROP stage 5 open funnel retinal detachments.
3. Perry CP.
Laparoscopic treatment of genitofemoral neuralgia.
Journal of the American Association of Gynecologic Laparoscopists, 1997 Feb,
4(2):231-4.
(UI: 97210864)
Abstract: Chronic pain and tenderness in the groin, labia majora, and medial
thigh can be caused by neuropathy of the genitofemoral nerve.
Differentiation from ilioinguinal neuralgia by diagnostic blocks is crucial
to selecting proper treatment. Three women with genitofemoral neuralgia
underwent laparoscopic examination and treatment, thus avoiding laparotomy
and flank incision.
4. Zanon C; Grosso M; Zanon E; Veltri A; Alabiso O; Bazzan M; Chiappino I;
Mussa A.
Transaxillary access to perform hepatic artery infusion (HAI) for
secondary or primitive hepatic tumors.
Minerva Chirurgica, 1996 Sep, 51(9):755-8.
Pub type: Clinical Trial; Journal Article.
(UI: 97122662)
Abstract: There is a renewed interest in locoregional chemotherapy for hepatic
tumors; trials in progress are experimenting with new therapeutic protocols
with an approach combining different systems of infusion (HAI and
systematic) or with the use of HAI as adjuvant or neoadjuvant of the
surgical treatment or cryosurgical treatment of the hepatic metastases from
colo-rectal cancer. However, HAI is practicable principally with the
implantation of a catheter in the hepatic artery (port of Infusaid) by
laparotomic access. This intervention limits wide-scale use of the infusion
method, traditionally less toxic and more efficient in terms of results
than systemic treatment. Limited experience of percutaneous access for HAI
required more catheterisation with repeated puncturing of the artery and
later necessity of surgery in cases of HAI with continuous spraying.
Motivated by the first experience of certain authors from Chiba University,
we have devised a system of catheterisation of the hepatic artery with
transcutaneous access, with subcutaneous port that allows the use of HAI
without recourse to the usual intervention. Access is made through the left
axillary artery; the positioning of the catheter is in the hepatic artery
with possible embolization of the collateral or abnormal hepatic artery
that could hamper complete diffusion of the drug to the liver, or increase
to toxicity of the method. The implantation is done in day-surgery. In the
cases performed up to now there have been no complications regarding the
method and the catheters function all perfectly thanks to the collaboration
of ematologists to avoid possible thrombosis of the catheters.
5. Dasappa V; Ross WB; King J; King DW; Clingan PR; Morris DL.
Primary resection and synchronous regional hepatic chemotherapy or
cryotherapy for colorectal cancer with liver metastases.
International Journal of Colorectal Disease, 1996, 11(1):38-41.
(UI: 97078416)
Abstract: Twenty-two patients with colorectal cancer and synchronous
unresectable hepatic metastases were treated by resection the primary
tumour with concurrent insertion of an Infusaid infusaport system for
regional chemoperfusion (hepatic arterial 20, portal venous 2). Four
patients in addition had cryotherapy the liver metastases. Morbidity from
the synchronous procedures was minimal. Median survival was 10 months. Four
patients with poorly-differentiated tumours had a poor response, with a
median survival of 3.75 months.
6. Hainsworth DP; Johnson MW; Jaffe GJ.
Sustained closure of surgically repaired macular holes after retinal
detachment with submacular fluid.
American Journal of Ophthalmology, 1997 Mar, 123(3):364-9.
(UI: 97217225)
Abstract: PURPOSE: To examine the behavior of surgically repaired macular holes
when subsequent retinal detachment with submacular fluid develops and to
correlate these observations with current theories of macular hole
formation and closure. METHODS: We reviewed the medical records of four
patients who underwent successful surgical closure of macular holes and
subsequently developed rhegmatogenous retinal detachment with macular
involvement. RESULTS: No reopening of the original macular hole occurred in
any of the four patients. No focal macular attachment was seen that would
suggest firm adherence of the macular hole edges to the underlying retinal
pigment epithelium. CONCLUSIONS: When retinal detachment with submacular
fluid develops in patients with a successfully closed macular hole,
sustained closure of the macular dehiscence is typically seen. These
findings support reapproximation of the hole edges with an associated
retinal wound healing response as the mechanism of hole closure.
7. Pisters LL; von Eschenbach AC; Scott SM; Swanson DA; Dinney CP; Pettaway CA;
Babaian RJ.
The efficacy and complications of salvage cryotherapy of the prostate.
Journal of Urology, 1997 Mar, 157(3):921-5.
Pub type: Clinical Trial; Clinical Trial, Phase I; Clinical Trial, Phase
II; Journal Article.
(UI: 97188828)
Abstract: PURPOSE: A phase I/II study was done to evaluate the efficacy and
complications of salvage cryotherapy as a treatment for locally recurrent
prostate cancer following full dose radiation therapy and/or systemic
therapy. The efficacy of single and double freeze-thaw cycles was compared
using posttreatment prostate specific antigen (PSA) levels and prostate
biopsies as end points. MATERIALS AND METHODS: A total of 150 patients with
locally recurrent prostate cancer following radiation, hormonal therapy
and/or systemic chemotherapy underwent salvage cryotherapy using a single
(71 men, mean followup 17.3 months) or double (79 men, mean followup 10.0
months) freeze-thaw cycle. PSA was measured approximately every 3 months
postoperatively and sextant biopsies were repeated 6 months
postoperatively. Complications were assessed by retrospective chart review
and a mailed quality of life survey. RESULTS: Overall, 45 patients (31%)
had persistently undetectable PSA. Patients with a history of radiation
therapy only who underwent a double freeze-thaw cycle had a higher negative
biopsy rate (93 versus 71%, p < 0.02) and lower biochemical failure rate
(defined as an increase in serum PSA of 0.2 ng./ml. above the nadir value,
44 versus 65%, p < 0.03) than those who underwent a single freeze-thaw
cycle. The main complications of salvage cryotherapy were urinary
incontinence (73% of the patients), obstructive symptoms (67%), impotence
(72%) and severe perineal pain (8%). CONCLUSIONS: Salvage cryotherapy
impacts local tumor control as evident by the high frequency of negative
posttreatment biopsies. A double freeze-thaw cycle appears more effective
than a single cycle. Like salvage prostatectomy, salvage cryotherapy causes
significant morbidity.
8. Bischof JC; Merry N; Hulbert J.
Rectal protection during prostate cryosurgery: design and characterization
of an insulating probe.
Cryobiology, 1997 Feb, 34(1):80-92.
(UI: 97195352)
Abstract: This study presents the design and characterization of an insulating
probe made of silicone that could be used for enhancing the safety and
efficacy of prostate cryosurgery. The probe would be placed in
Denonvilliers' fascia between the prostate and the rectum prior to
freezing. During freezing, the iceball would be monitored by ultrasound
through the silicone, and direct temperature monitoring of the rectal and
prostatic tissue via thermocouples mounted on opposing sides of the device.
Both theoretical and experimental studies were performed to verify the
insulating and acoustic properties of the probe. The insulating effect of
the silicone will enhance cell death within the prostate while minimizing
tissue freezing injury and therefore fistula formation postfreeze in the
rectum. Experiments were also performed with the insulator placed in
gelatine which showed that the silicone material is transparent to
ultrasound. In addition the silicone was itself visible under ultrasound
imaging, a characteristic which may assist in the delivery of the device to
the surgical site. One possible scenario for reconfiguration and delivery
of the device is suggested prior to a cryosurgery. The success of this
device in insulating and monitoring temperature during freezing suggests
that it can also be useful in protecting sensitive tissues adjacent to a
surgical site when extreme heat is applied (i.e., electron or hyperthermic
surgery).
9. Bischof JC; Smith D; Pazhayannur PV; Manivel C; Hulbert J; Roberts KP.
Cryosurgery of dunning AT-1 rat prostate tumor: thermal, biophysical, and
viability response at the cellular and tissue level.
Cryobiology, 1997 Feb, 34(1):42-69.
(UI: 97195351)
Abstract: This study investigates cryodestruction of the Dunning AT-1 rat
prostate tumor at the single cell, tissue slice, and in vivo levels. The
thermal history around a 3-mm-diameter cylindrical cryosurgical probe was
predicted by solving the bioheat equation in a one-dimensional cylindrical
geometry. At various radial positions in the iceball this thermal history
was approximated by a constant cooling rate and a final, steady-state
temperature (or end-temperature). The predicted cooling rates and end
temperatures ranged from > or = 1000 degrees C/min to 5 degrees C/min and
-196 degrees C to -20 degrees C, respectively. These cooling rates and
end-temperatures were then imposed on single AT-1 cells, AT-1 tissue slices
in vitro and AT-1 tumors in vivo. The single cells and tissue slices were
frozen by LN2 immersion, copper block slam-freezing, or controlled cooling
on a cryomicroscope or a directional solidification stage. LN2 immersion is
lethal to AT-1 cells (presumably due to intracellular ice formation), while
cooling at 5-100 degrees C/min leaves some viable cells (at
end-temperatures ranging between -20 and -40 degrees C). AT-1 tumor slices
show extensive intracellular ice formation due to slam cooling, extensive
dehydration at 100 degrees C/min, and total dehydration at rates < or = 10
degrees C/min to end temperatures below -10 degrees C. Postfreeze culture
and histology of the AT-1 tissue show that extensive intracellular ice
formation is lethal, while cellular dehydration and vascular engorgement
leave viable cells (at end-temperatures between -20 and -40 degrees C).
Based solely on the single cell and in vitro tissue damage achieved by
cooling rates and end-temperatures, a sizable portion of a cryosurgically
frozen tumor would be expected to survive. However, in vivo cryosurgery
performed on AT-1 tumors demonstrated that the tissue was damaged
throughout the cryolesion, even at the periphery where the thermal history
would be expected to allow single cells and tissue slices to survive in
vitro. Taken together, these results suggest that damage mechanisms other
than those due to cooling rate and end-temperature may be responsible for
the increased cellular destruction at the periphery of the iceball in vivo
and that cooling rate is less important than end-temperature in determining
cryosurgical damage in AT-1 tumors. Experiments are ongoing to determine if
the time held at an end temperature, thawing rate, vascular response, or
other mechanisms are primarily responsible for the enhanced destructive
capability in vivo.
1. Bischof, J C; Merry, N; Hulbert, J.
Rectal protection during prostate cryosurgery: Design and characterization
of an insulating probe.
Cryobiology, v.34, n.1, (1997): 80-92.
Abstract:
This study presents the design and characterization of an insulating probe
made of silicone that could be used for enhancing the safety and efficacy
of prostate cryosurgery. The probe would be placed in Denonvilliers'
fascia between the prostate and the rectum prior to freezing. During
freezing, the iceball would be monitored by ultrasound through the
silicone, and direct temperature monitoring of the rectal and prostatic
tissue via thermocouples mounted on opposing sides of the device. Both
theoretical and experimental studies were performed to verify the
insulating and acoustic properties of the probe. The insulating effect of
the silicone will enhance cell death within the prostate while minimizing
tissue freezing injury and therefore fistula formation postfreeze in the
rectum. Experiments were also performed with the insulator placed in
gelatine which showed that the silicone material is transparent to
ultrasound. In addition the silicone was itself visible under ultrasound
imaging, a characteristic which may assist in the delivery of the device
to the surgical site. One possible scenario for reconfiguration and
delivery of the device is suggested prior to a cryosurgery. The success of
this device in insulating and monitoring temperature during freezing
suggests that it can also be useful in protecting sensitive tissues
adjacent to a surgical site when extreme heat is applied (i.e., electro-
or hyperthermic surgery).
none
none
1. Hughes PS.
Squamous cell carcinoma of the penis [letter].
Journal of the American Academy of Dermatology, 1997 Apr, 36(4):655-6.
Pub type: Letter.
(UI: 97246528)
2. Gaspar ZS; Dawber RP.
Treatment of lentigo maligna.
Australasian Journal of Dermatology, 1997 Feb, 38(1):1-6; quiz 7-8.
Pub type: Journal Article; Review; Review, Tutorial.
(UI: 97198601)
Abstract: Lentigo maligna (LM) is the in situ phase of lentigo maligna melanoma
(LMM) and, if left untreated, 30-50% of cases will progress to LMM, which
is now thought to behave as aggressively as any other melanoma. Literature
on the of treatment of LM including conventional surgery, micrographic Mohs
surgery, cryosurgery, radiotherapy, electrodesiccation and curettage.
5-fluorouracil (5-FU), azelaic acid, retinoic acid and lasers are reviewed.
It is concluded that micrographic Mohs surgery has the lowest recurrence
rates and that conventional surgery, cryosurgery and radiotherapy all have
recurrence rates in the order of 7-10%. Therefore, on the basis of the
current literature available, all three of these methods could be
recommended as primary treatment of LM. It is extremely important when
choosing one of the above treatments that the physician is adequately
trained in the appropriate technique and understands the limitation of the
method used and the need for close follow up of the patient.
3. Millikan KW; Staren ED; Doolas A.
Invasive therapy of metastatic colorectal cancer to the liver.
Surgical Clinics of North America, 1997 Feb, 77(1):27-48.
Pub type: Journal Article; Review; Review, Tutorial.
(UI: 97226448)
Abstract: Resection, when possible, is still the best hope for cure of
colorectal metastasis to the liver. Poor prognostic indicators for survival
include heavy tumor burden, the presence of extrahepatic disease,
synchronous metastasis, and the inability to perform resection with a 1-cm
margin. Questionable poor prognostic indicators include multiple metastases
(more than three), bilobar disease, and the need to transfuse patients
during resection. Preoperatively, a patient must be evaluated for the
extent of liver disease and the presence of extrahepatic disease with a CT
of the abdomen and routine studies of the chest. Intraoperatively, a
surgeon should be able to perform or obtain ultrasonography of the liver to
detect occult metastases and delineate anatomy. The surgeon should be
experienced in wedge, segmental, and lobar resection. Equipment for
cryotherapy and arterial infusion devices should be available, and staff
experienced in these modalities should be present. If all of these factors
are present, the options for the invasive treatment of colorectal
metastasis to the liver can be carried out in a manner that should provide
the most benefit at a low morbidity to this population of patients.
4. Nordin P; Larko O; Stenquist B.
Five-year results of curettage-cryosurgery of selected large primary basal
cell carcinomas on the nose: an alternative treatment in a geographical
area underserved by Mohs' surgery.
British Journal of Dermatology, 1997 Feb, 136(2):180-3.
(UI: 97221682)
Abstract: Mohs' micrographic surgery (MMS) is the recommended treatment for
large basal cell carcinomas (BCCs) of the nose. This 5-year follow-up study
attempts to evaluate whether curettage-cryosurgery (CC) could be an
alternative therapy in a country where optimal resources for MMS are
lacking. All patients with a primary nasal or perinasal BCC, 10 mm or
larger in diameter, were assessed at a skin tumour clinic. Sixty-one BCCs
of non-morphoeiform type were treated with CC. Most of the tumour was
removed by careful curettage with different sized curettes. The tumour area
was then frozen with liquid nitrogen in a double freeze-thaw cycle. Fifty
patients were followed for at least 5 years with only one recurrence. The
cosmetic result was good or acceptable in all patients. A thorough
curettage followed by cryosurgery could be a safe and inexpensive
alternative therapy even for large primary non-morphoeiform BCCs of the
nose.