January 1997 Cryosurgical Publications
A weekly updated compilation of cryosurgery related publications
Jan. 2nd, 1997
BIOSYS Database:
1. Kemeny, N.
Colorectal cancer-an undertreated disease.
Anti-Cancer Drugs, v.7, n.6, (1996): 623-629.
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.
2. Kothari, P S; Murphy, M; Howells, G L; Williams, D M.
Hemangiopericytoma: A report of two cases arising on the lip.
British Journal of Oral & Maxillofacial Surgery, v.34, n.5, (1996):
454-456.
Abstract:
Hemangiopericytoma is a rare tumour of pericytes; represents 1% of all
vasoformative tumours and 15-25% of those which occur in the head and
neck. We present two cases of hemangiopericytoma occurring on the lower
lip and report the use of cryosurgery to treat the most recent case.
Jan. 2nd, 1997
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Jan. 7th, 1997
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Jan. 7th, 1997
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1. Rodefeld MD; Gandhi SK; Huddleston CB; Turken BJ; Schuessler RB; Boineau JP;
Cox JL; Bromberg BI.
Anatomically based ablation of atrial flutter in an acute canine model of
the modified Fontan operation.
Journal of Thoracic and Cardiovascular Surgery, 1996 Oct, 112(4):898-907.
(UI: 97027592)
Abstract: BACKGROUND: Lateral tunnel total cavopulmonary connection, also
called the modified Fontan operation, uses a baffle through the right
atrium. We established, in an acute canine model, that atrial flutter after
total cavopulmonary connection revolves around a line of conduction block
imposed by the free wall lateral tunnel suture line. We hypothesized that a
line of conduction block between the free wall total cavopulmonary
connection suture line and the tricuspid anulus would interrupt atrial
flutter in this model. OBJECTIVE: Our objective was to determine whether a
cryolesion placed between the free wall total cavopulmonary connection
suture line and the tricuspid anulus would terminate atrial flutter in an
acute canine model. METHODS: Seven adult dogs underwent median sternotomy
and institution of cardiopulmonary bypass. A suture line was placed through
a right atriotomy to simulate total cavopulmonary connection lateral tunnel
construction. Form-fitting 253-point biatrial endocardial mapping
electrodes were placed via bilateral ventriculotomies. Atrial flutter was
induced by atrial burst pacing. A cryothermal lesion was then placed
between the free wall total cavopulmonary connection suture line and the
tricuspid anulus in the low lateral right atrium (i.e., CRYO 1 procedure),
and reinduction of atrial flutter was attempted. If atrial flutter was
reinduced, the cryolesion was modified superiorly to include the caudal
portion of the atriotomy (i.e., CRYO 2 procedure). Activation sequence maps
were generated for sinus rhythms before and after the cryolesions were
placed and for induced arrhythmias. RESULTS: In all seven cases, atrial
flutter was inducible after suture line placement, before placement of a
cryolesion. The reentrant circuit incorporated both caval orifices in five
of seven cases and was successfully ablated by the CRYO 1 approach in each
case. Atrial flutter was not inducible after placement of the CRYO 2 lesion
in the remaining two cases, in which breakthrough of the wave front
occurred across the lateral tunnel suture line in the intercaval region.
Activation sequence maps of sinus rhythm after placement of the cryolesions
demonstrated a conduction block at the site of the lesion. CONCLUSIONS: A
linear cryothermal lesion placed between the free wall aspect of the total
cavopulmonary connection suture line and the tricuspid anulus created a
line of conduction block that successfully ablates atrial flutter in the
canine model.
2. McKinnon JG; Temple WJ; Wiseman DA; Saliken JC.
Cryosurgery for malignant tumours of the liver [see comments].
Canadian Journal of Surgery, 1996 Oct, 39(5):401-6.
(UI: 97010957)
Abstract: OBJECTIVE: To evaluate the safety and efficacy of ultrasound-guided
cryosurgery to treat malignant tumours of the liver. DESIGN: A prospective
nonrandomized trial. The follow-up was complete and ranged from 8 to 35
months. SETTING: A university-affiliated hospital. PATIENTS: Ten patients
with secondary malignant tumours of the liver; 1 with primary hepatoma.
INTERVENTIONS: Computed portography for preoperative staging; laparotomy
and ultrasonographic examination of the liver; cryosurgical ablation of
liver tumours with or without a concomitant resection. Thirteen procedures
were performed on 11 patients. MAIN OUTCOME MEASURES: Preoperative
morbidity, disease-free and overall survival. RESULTS: Of 24 lesions
frozen, the procedure on 4 lesions was considered a technical failure
because of persistent disease. There were no perioperative deaths. One
patient had a liver abscess that resolved with percutaneous drainage. One
patient had a biliary fistula that resolved spontaneously, and one had a
transient rise in the serum creatinine level. Of 11 patients treated, 7 had
a recurrence in the liver (persistent disease in 2 and new liver metastases
in 5); 2 of these patients died. One patient died of distant disease with
no local recurrence. At the time of writing, one patient was alive with
extrahepatic disease and no local recurrence and two were free of disease.
CONCLUSIONS: Cryosurgery of the liver is a relatively safe procedure that
allows treatment of otherwise unresectable malignant disease. Proof of
long-term benefit requires further experience and follow-up.
3. Lapointe R.
To freeze or not to freeze [editorial; comment].
Canadian Journal of Surgery, 1996 Oct, 39(5):353-4.
Pub type: Comment; Editorial.
(UI: 97010945)
4. Nordin P.
[Curettage and cryosurgery of epithelial skin cancer. Good 5-year results
in the treatment of nose and ear cancer].
Lakartidningen, 1996 Sep 18, 93(38):3241-3.
Language: Swedish.
(UI: 97000625)
Abstract: In the article are presented the 5-year cure rates for 125 cases of
epithelial skin cancer of the nose (n = 98) or ear (n = 27), treated with
cryosurgery preceded by thorough curettage. As estimated with a
modification of the life-table method, the cure rate was 97.7% in the nasal
cancer subgroup, and 100% in the ear cancer subgroup.
5. Berger WK; Uhrik B.
Freeze-induced shrinkage of individual cells and cell-to-cell propagation
of intracellular ice in cell chains from salivary glands.
Experientia, 1996 Sep 15, 52(9):843-50.
(UI: 96439176)
Abstract: The formation of intracellular ice (IIF), usually a lethal event to
be avoided when cryopreserving cells, should, however, be enforced during
the cryosurgical destruction of tumour cells. IIF has been investigated so
far only in single cells in suspension. Because cells in tissues cannot be
successfully cryopreserved, in contrast to single cells in suspension, the
mechanism of IIF in tissues may depend on factors that facilitate IIF. We
studied IIF in cell strands from salivary glands, which represent a simple
form of a tissue. Their cells are connected by channels responsible for
intercellular communication. A substantial fraction of cell dehydration
during freezing occurs before cells are encapsulated by ice, and the degree
of this pre-ice-front shrinkage appears to influence IIF. In strands with
coupled cells IIF spread from one cell to adjacent cells in a sequential
manner with short delays (200-300 ms), suggesting cell-to-cell propagation
via intercellular channels. In strands pretreated with decoupling agents
(dinitrophenol, heptanol), sequential IIF was absent. Instead, formation of
ice was random, with longer and variable delays between consecutive
darkenings indicating IIF. Results suggest that the mechanism of IIF
spread, and consequently the degree of cryodamage in tissue, can be
influenced by the presence of intercellular channels (gap junctions).
6. Quinn GE; Dobson V; Hardy RJ; Tung B; Phelps DL; Palmer EA.
Visual fields measured with double-arc perimetry in eyes with threshold
retinopathy of prematurity from the cryotherapy for retinopathy of
prematurity trial. The CRYO-Retinopathy of Prematurity Cooperative Group.
Ophthalmology, 1996 Sep, 103(9):1432-7.
Pub type: Clinical Trial; Journal Article; Multicenter Study; Randomized
Controlled Trial.
(UI: 96438967)
Abstract: PURPOSE: To measure monocular visual field extent in very-low birth
weight children in whom severe (threshold) acute-phase retinopathy of
prematurity (ROP) developed in one or both eyes, and who had random
assignment of eyes to cryotherapy or no cryotherapy. A control group of
very-low birth weight children in whom ROP did not develop also was tested.
METHODS: There were 78 children in the severe ROP group from 5 of 23
centers in the randomized trial of cryotherapy for ROP (CRYO-ROP). The
comparison cohort consisted of 75 study participants in whom ROP did not
develop. All subjects had birth weights of less than 1251 g. At the 5
1/2-year study examination, visual field size was measured using double-arc
kinetic perimetry. Testers were masked to treatment status of each eye.
Four meridia were tested: superotemporal (ST), inferotemporal (IT),
inferonasal (IN), and superonasal (SN). Target size was 6 degrees. RESULTS:
When blind eyes were assigned a score of 0 degree, the no-ROP, treated, and
control eyes had an average visual field extent of 62 degrees, 35 degrees,
27 degrees at ST; 73 degrees, 42 degrees, 35 degrees at IT; 51 degrees, 30
degrees, 21 degrees IN; and 50 degrees, 26 degrees, 22 degrees at SN,
respectively. Among 25 children who had bilateral threshold ROP and
measurable fields in each eye, values for treated and control eyes were 59
versus 62 at ST, 69 versus 80 at IT, 44 versus 49 at IN, and 41 versus 48
at SN, respectively. CONCLUSIONS: Overall, visual fields in eyes that
reached threshold ROP were smaller than those of eyes that did not develop
ROP. When only pairs of sighted eyes were considered, visual fields in the
treated eyes were 6.4 degrees smaller than those of control eyes.
Therefore, it appears that a small loss of peripheral field occurs when
cryotherapy prevents the development of retinal detachment.
7. Rivoire ML; Kaemmerien P; Molina G.
Safe placement of large cryoprobes during cryosurgery of deep liver
metastases.
Journal of Surgical Oncology, 1996 Sep, 63(1):61-2.
(UI: 96439134)
8. Abramovits W; Pruiksma R; Bose S.
Ultrasound-guided thermocouple placement for cryosurgery.
Dermatologic Surgery, 1996 Sep, 22(9):771-3.
(UI: 97028511)
Abstract: BACKGROUND: Although cryosurgical methods have high cure rates,
imprecise estimates of both skin lesion depth and destructive temperature
front location result in subjective technique in skin malignancy
treatments. OBJECTIVE: We evaluated the possibility of newer ultrasound
equipment to assist in the precise placement of thermocouples in human
skin. METHODS: DermaScan C ver. 3 ultrasonographic equipment fitted with a
sharp focus probe with a frequency of 20 MHz and a scan length of 12.1 mm
was used to locate thermocouples with 27- and 30-gauge needles. RESULTS: We
successfully and reproducibly located thermocouples and thin needles, and
accurately measured their distance from the skin surface. CONCLUSION:
Ultrasound is a useful method for the accurate placement of thermocouples,
and needles as thin as 30 gauge for monitoring in cryosurgery.
9. Meijer S; Jas B; de Lange E; Derksen EJ.
[Palliative cryosurgery in rectal carcinoma].
Nederlands Tijdschrift voor Geneeskunde, 1996 Aug 31, 140(35):1766-70.
Language: Dutch.
(UI: 96399795)
Abstract: OBJECTIVE: Analysis of palliative cryosurgery in rectal cancer
patients. DESIGN: Descriptive. SETTING: Department of surgery, University
Hospital Vrije Universiteit, Amsterdam, the Netherlands. METHODS:
Ninety-three patients (age: 45-92 years) underwent palliative cryosurgery
for primary rectal cancer. They were excluded from surgical resection
because of old age, accompanying disease(s), inoperability and the presence
of hematogenous metastases. The palliative effect of cryosurgery on local
symptoms was classified as good, moderate or none. The duration of
palliation was calculated in relation to survival as a palliative index:
the number of months of (moderate or good) palliation divided by the number
of months of survival from the start of the treatment, multiplied by 100%.
RESULTS: In 58 patients (62%) there was complete relief of local symptoms
with a palliative index of 87%. In 13 patients (14%) palliation was
moderate and in 22 patients (24%) no palliation was achieved. The 50%
survival duration in the 58 patients was 37 months. Especially symptoms of
blood and/or mucous discharge could be easily alleviated. Good alleviation
of local symptoms was associated with the extent of the primary tumour
process. Palliative effect could be assessed after a few treatments.
Patients with circular rectal tumours seldom had long term palliative
effects of cryosurgery. CONCLUSION: Cryosurgery for rectal cancer is a
simple and safe treatment. It should be considered for alleviation of local
symptoms in patients with rectal cancer who are unsuitable for radical
surgery.
10. Kozluk E; Walczak F.
[Nonpharmacologic treatment of heart arrhythmia--methods].
Polski Tygodnik Lekarski, 1996 Mar, 51(10-13):163-5.
Language: Polish.
Pub type: Journal Article; Review; Review, Tutorial.
(UI: 97011975)
11. Cuthill S; Maiman M; Fruchter RG; Lopatinsky I; Cheng CC.
Complications after treatment of cervical intraepithelial neoplasia in
women infected with the human immunodeficiency virus.
Journal of Reproductive Medicine, 1995 Dec, 40(12):823-8.
(UI: 96401490)
Abstract: OBJECTIVE: To compare the frequency of complications after treatment
of cervical intraepithelial neoplasia (CIN) in human immunodeficiency virus
(HIV)-infected and -seronegative women in an ambulatory setting. STUDY
DESIGN: A retrospective record review of 15 HIV-infected and 44
HIV-negative women treated by laser therapy or cone biopsy and
retrospective interviews of 20 HIV-infected and 44 HIV-negative women
treated by cryotherapy. RESULTS: Four of 35 (11%) HIV-infected women had
excessive bleeding after laser/cone or cryotherapy as compared to one of 88
(1%) HIV-negative women (odds ratio 11.27, P = .02). After laser/cone
therapy, significantly more HIV-infected women (53%) had cervicovaginal
infections than did HIV-negative women (18%). A higher prevalence of
infection was associated with more severe immunodeficiency. CONCLUSION:
HIV-infected women are vulnerable to complications after treatment of CIN
and should be monitored closely.
12. Arfi C; Bureau B; Beauvillain C; Nguyen JM; Stalder JF; Litoux P.
[Two-stage excision of extensive cutaneous carcinoma of the face. A
retrospective study of 80 patients].
Annales de Dermatologie et de Venereologie, 1995, 122(11-12):764-8.
Language: French.
(UI: 96343028)
Abstract: INTRODUCTION: Delayed reconstruction (two-step surgery) comprised of
tumor resection and repair three or four days later, after paraffin tissue
fixation and histopathological examination, is one of the techniques used
for complete excision of spreading cutaneous carcinomas. PATIENTS AND
METHODS: In order to evaluate the efficacy and long term prognosis of
delayed reconstruction surgery, we carried out a retrospective study of 80
patients treated by this method and (Kaplan- Meier) for correlation with
the local recurrence rate: sex, age, anatomic site, histologic type and
existence of previous therapy. Long term results have been estimated. Among
the 80 patients studied, 76 patients have been followed. The sex-ratio was
0.48. Fifty-two percent of the population was more than seventy years old.
Fifty-five percent of the tumors were situated on the nose. In 32,5 p. 100
of the cases, a prior therapy (surgery, electrodessication or radiation
therapy) has been carried out. Histological analysis showed 87 p. 100 basal
cell carcinomas (of which 26 p. 100 of morpheaform basal cell carcinomas)
and 13 p. 100 squamous cell carcinomas. RESULTS: After the first operative
step, there was total excision in 69 p. 100 of thecases. In the remaining
cases, a second excision was performed with a margin of normal tissue.
Recurrences were observed (some precocious recurrences and some late
recurrences) in 18.4 p. 100 of the cases. No risk factor correlated
significantly with the recurrence rate. However, analysis of the survival
graph suggests that the squamous cell carcinomas recurred more often than
the basal cell carcinomas. CONCLUSIONS: Although extemporaneous
examinations (Mohs' technique) remains the gold standard technique in the
management of spreading cutaneous carcinomas of the face, the delayed
reconstruction (two-step surgery) is a credible alternative when compared
to the recurrence rates reported in the literature with the other
techniques (electrodessication, radiation therapy or cryosurgery).
Jan. 14th, 1997
BIOSYS Database:
1. Quigley, M R; Shih, S; Maroon, J; Elrifai, A.
MRI of intracranial cryolesions. (Meeting of the American Society for
Stereotactic and Functional Neurosurgery, Marina del Rey, California, USA,
March 8-11, 1995. )
Stereotactic and Functional Neurosurgery, v.65, n.1-4, 71.
2. Rand, R W.
Role of cryosurgery and MRI for Parkinson's disease. (Meeting of the
American Society for Stereotactic and Functional Neurosurgery, Marina del
Rey, California, USA, March 8-11, 1995. )
Stereotactic and Functional Neurosurgery, v.65, n.1-4, 18-22.
Jan. 21st, 1997
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Jan. 21st, 1997
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Jan. 28th, 1997
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1. Tai, L S; Chia, Y W.
Endoscopic Nd:YAG laser treatment of inoperable lower gastrointestinal
cancer.
Annals Academy of Medicine Singapore, v.25, n.5, (1996): 712-716.
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.
Jan. 28th, 1997
MedLine Database:
1. Corral DA; Pisters LL; von Eschenbach AC.
Treatment options for localized recurrence of prostate cancer following
radiation therapy.
Urologic Clinics of North America, 1996 Nov, 23(4):677-84.
Pub type: Journal Article; Review; Review, Tutorial.
(UI: 97104262)
Abstract: Patients with radioresistant clinically localized prostate cancer may
be treated by various means. Although androgen ablation is relatively
noninvasive, it cannot be considered a curative option. We believe that a
subset of patients with locally recurrent prostate cancer without
subclinical metastatic disease exists and would benefit from maximally
aggressive local therapy. Salvage surgery may offer long-term cancer
control, particularly when the tumor is organ-confined, but is a
technically challenging operation with a high incidence of postoperative
incontinence. Cryoablation of the prostate for postirradiation recurrence
may offer a less invasive alternative to radical surgery, but its long-term
efficacy remains to be fully determined. Each therapeutic option has its
characteristic attendant morbidity and the choice of therapy for local
recurrence should be made with informed consent after frank discussion
between physician and patient. We propose the treatment algorithm shown in
Figure 1 for the management of patients with suspected recurrence after
radiation therapy with the caveat that individual therapeutic strategies
must be patterned around individual patient needs.
2. Connolly JA; Shinohara K; Presti JC Jr; Carroll PR.
Should cryosurgery be considered a therapeutic option in localized
prostate cancer?
Urologic Clinics of North America, 1996 Nov, 23(4):623-31.
Pub type: Journal Article; Review; Review, Tutorial.
(UI: 97104258)
Abstract: Cryosurgical ablation of the prostate currently is under
investigation as a potential treatment for localized prostate cancer.
Results to date indicate that the majority of patients have negative
biopsies and a marked reduction in prostate-specific antigen levels
following cryotherapy. This treatment, however, is associated with
significant side effects, notably bladder outflow obstruction, impotence,
and incontinence, and its long-term durability is still unknown.
3. Green SN; Yarian DL; Masciulli L; Leff SR.
Office repair of retinal detachment using a Lincoff Temporary balloon
buckle.
Ophthalmology, 1996 Nov, 103(11):1804-10.
(UI: 97098333)
Abstract: PURPOSE: The purpose of the study is to report on a series of
patients with retinal detachments that were repaired in an office setting
using a temporary Lincoff balloon scleral buckle. METHODS: A retrospective
review was performed on 162 consecutive casepatients with retinal
detachment repaired in the authors' office between January 1989 and June
1995 using a temporary Lincoff balloon scleral buckle. All procedures were
performed using local anesthesia and minimal equipment. RESULTS: The retina
was attached completely with a single procedure in 88% of patients. Of the
19 retinas (12%) that failed primary surgery, all except 1 ultimately were
reattached using traditional scleral buckling in 14, combined scleral
buckling and vitrectomy in 3, and pneumatic retinopexy in 1, for a total
success rate of 99.4%. Complications were minimal. CONCLUSION: A temporary
Lincoff balloon scleral buckle can be used safely and effectively in an
office setting for retinal detachment repair. The results are comparable to
other available methods that take more time, involve greater risk, have
higher complication rates, and are more costly. This technique represents a
viable alternative, particularly in a managed care environment.
4. Montz FJ.
Impact of therapy for cervical intraepithelial neoplasia on fertility.
American Journal of Obstetrics and Gynecology, 1996 Oct, 175(4 Pt
2):1129-36.
Pub type: Journal Article; Review; Review, Tutorial.
(UI: 97040485)
Abstract: Cervical intraepithelial neoplasia is endemic in young American
women. Because the majority of these women have a strong desire to maintain
fertility, the efficacy of treatment modalities for this condition must be
weighed against potential negative effects on fertility. Except for cone
biopsy, however, the peer-reviewed literature provides little information
about the effects of such techniques on fertility. While there are no data
demonstrating that the other commonly used therapies (loop electrical
excision procedure, cryotherapy, laser vaporization, and diathermy cautery)
have a negative impact on fertility, neither has it been definitively
proved that they do not have an untoward impact on fertility. Thus further
studies are needed, and patients should be educated regarding the
limitations of available information when informed consent for treatment is
obtained.
5. Parivar F; Hricak H; Shinohara K; Kurhanewicz J; Vigneron DB; Nelson SJ;
Carroll PR.
Detection of locally recurrent prostate cancer after cryosurgery:
evaluation by transrectal ultrasound, magnetic resonance imaging, and
three-dimensional proton magnetic resonance spectroscopy.
Urology, 1996 Oct, 48(4):594-9.
Pub type: Clinical Trial; Journal Article.
(UI: 97040753)
Abstract: OBJECTIVES: To assess and compare the clinical usefulness of
transrectal ultrasound (TRUS), magnetic resonance imaging (MRI), and
three-dimensional proton magnetic resonance spectroscopic imaging (3-D
MRSI) in detecting local recurrence of carcinoma of the prostate (CaP) in
patients with detectable prostate-specific antigen (PSA) levels after
cryosurgery. METHODS: In a prospective study, 25 patients who had undergone
cryosurgery as primary treatment for CaP underwent endorectal MRI and 3-D
MRSI, followed by TRUS-guided prostate biopsy. At the time of study, 20
patients had detectable PSA; the remaining 5 patients served as controls.
All patients had random sextant and guided prostate biopsy for correlation
with imaging and MR spectroscopic findings. RESULTS: In patients with
detectable PSA, MRSI identified, location-for-location, all foci of CaP and
benign prostatic tissue that were detected by prostate biopsy. MRSI
identified more sites with CaP than did prostate biopsy, indicating a
larger volume of cancer. In 2 patients with detectable PSA and negative
prostate biopsy, MRSI identified 11 voxels with viable prostatic tissue. In
patients with undetectable PSA, both MRSI and prostate biopsy showed
necrosis. Ultrasound and MRI were very poor tools for identifying recurrent
cancer and differentiating between viable and necrotic prostate tissue.
CONCLUSIONS: 3-D MRSI is superior to TRUS and MRI in differentiating among
CaP, BPH, and necrosis when local recurrence after cryosurgery is
suspected. By providing chemical mapping of the prostate in contiguous
voxels, the addition of spectroscopy to endorectal MRI increases the
sensitivity for detection of local recurrence.
6. Cozzi PJ; Lynch WJ; Robson N; Vonthethoff L; Lumley T; Morris DL.
In vitro and in vivo assessment of urethral warming catheters for the
transperineal cryoablation of prostatic carcinoma.
British Journal of Urology, 1996 Oct, 78(4):589-95.
(UI: 97099949)
Abstract: OBJECTIVE: To evaluate the two most common urethral warming catheters
currently available for their effectiveness in preventing urethral injury
in an animal model and thus during transperineal cryosurgery for the
treatment of prostate cancer. PATIENTS, MATERIALS AND METHODS: The warming
efficiency of the variable-diameter thin latex-balloon catheter (Cook,
Australia) and the fixed-diameter PVC catheter (Candela, USA) were
evaluated in a water-bath. A sheep model was then used for subsequent
experiments to further evaluate the better catheter. The technique used for
the insertion of the Cook catheter in a series of 33 patients treated with
prostate cryosurgery is also described. RESULTS: In vitro, the Cook
catheter was more effective (P < 0.01) than the Candela catheter in
preventing localized cooling. In vivo, results in five animals showed that
the urethral epithelium was viable in all sections that had been protected
by the catheter and focally denuded or necrotic in those sections not
protected, with each animal used as its own control (P < 0.01 Fisher's
exact test). The 33 patients treated while using the Cook catheter had no
subsequent complications. CONCLUSION: The urethral warming catheter
currently in use for prostatic cryosurgery in Australia is more effective
in vitro than its competitor and is effective in preventing urethral injury
in vivo.
7. Caballero Martinez F; Plaza Nohales C; Perez Canal C; Lucena Martin MJ;
Holgado Catalan M; Olivera Canadas G.
[Cutaneous cryosurgery in family medicine: dimethyl ether-propane spray
versus liquid nitrogen].
Atencion Primaria, 1996 Sep 30, 18(5):211-6.
Language: Spanish.
(UI: 97090948)
Abstract: OBJECTIVE: To compare the efficacy, tolerance and safety of two types
of cryotherapy, performed by family physicians, for benign cutaneous
lesions: low freezing (-59 degrees C) with dimethyl either-propane
cryogenic spray (DMEP) and intense freezing (196 degrees C) with
conventional liquid nitrogen (LN). DESIGN: A randomised, multi-centered,
controlled clinical trial, with single-blind assessment. SETTING: Three
primary care teaching teams in the Community of Madrid. PATIENTS AND OTHER
PARTICIPANTS: Ten MIR from family & community medicine intervened. There
were 124 patients, who had 174 benign cutaneous lesions, suitable for
cryotherapy. There were 3 voluntary withdrawals, none because of an adverse
reaction. Interventions, in each case there was local application for a
standard time of the randomised agent. Control-group intervention, 81
cases: swab soaked in LN. Study-group intervention, 93 cases: swab
saturated with DMEP spray. Maximum of three freezings per case, at weekly
intervals. MEASUREMENTS AND MAIN RESULTS: A doctor made a blind assessment
of the results (elimination, adverse reaction, aesthetic result) 15 days
after treatment. CONCLUSIONS: No clinically relevant differences between
the efficacy, tolerance and safety of the two cryogenic agents used in
primary care were found. The low freezing of DMEP was sufficient for the
cryotherapy of benign lesions.
8. Zuro LM; Staren ED.
Cryosurgical ablation of unresectable hepatic tumors.
Aorn Journal, 1996 Aug, 64(2):231-6, 239-44; quiz 244-6, 248-50.
Pub type: Journal Article; Review; Review, Tutorial.
(UI: 97006488)
Abstract: Ultrasound-guided hepatic cryosurgery is a potential treatment option
for select patients with unresectable tumors. Intraoperative placement of
cryoprobes and monitoring of tumor freezing with ultrasonography produce
complete remission in 22% to 29% of patients with unresectable metastatic
colorectal tumors to the liver. Perioperative nurses should be
knowledgeable about cryosurgical techniques and be prepared to participate
in this innovative treatment modality to provide optimal care to surgical
patients.
9. Borkowski P; Robinson MJ; Poppiti RJ Jr; Nash SC.
Histologic findings in postcryosurgical prostatic biopsies.
Modern Pathology, 1996 Aug, 9(8):807-11.
(UI: 97025741)
Abstract: The increasing use of cryosurgical ablation of the prostate for
prostatic carcinoma necessitates that surgical pathologists be aware of the
cryosurgically induced histologic changes in the prostate. Twenty-one
patients at our institution underwent prostatic cryosurgery, and 17
subsequently had follow-up biopsies. The Gleason combined scores ascribed
to the original tumors were 4 (two patients), 5 (six patients), 6 (seven
patients), 7 (one patient), and 8 (one patient). Histologic examination
revealed residual carcinoma (four patients, with Gleason combined scores of
4, 5, 6, and 8), necrosis (all 17 patients), hyalinization (nine patients),
fibrosis (nine patients), granulomatous inflammation (three patients), foci
of calcification (eight patients), squamous metaplasia (four patients),
transitional metaplasia (two patients), hemosiderin deposition (six
patients), edema (two patients), bacterial colonization (one patient), and
hemorrhage (one patient). The grade of residual carcinoma in all four
patients was identical with the grade assigned before the cryosurgical
ablation. The stroma surrounding the residual tumor did not display any
postcryosurgical histologic changes, and we postulate that these areas were
not adequately frozen. In conclusion, prostatic cryotherapy induces a
variety of histologic changes in normal and diseased tissue.
10. Rakover Y; Rosen G.
A comparison of partial inferior turbinectomy and cryosurgery for
hypertrophic inferior turbinates.
Journal of Laryngology and Otology, 1996 Aug, 110(8):732-5.
Pub type: Clinical Trial; Journal Article.
(UI: 97023244)
Abstract: A variety of surgical procedures are performed for treatment of
hypertrophic inferior turbinates, but there is no completely effective
therapy. We evaluated subjectively and objectively 52 patients who
underwent one of two procedures: partial inferior turbinectomy (PIT) or
cryosurgery of the inferior turbinates (CS). The results of PIT showed good
functional results in 77 per cent of cases for long-term effectiveness. The
results of CS showed that effectiveness was reduced from a 62 per cent
success rate after one year to 35 per cent later, but CS was a simple
procedure which was performed on an outpatient basis with no post-operative
morbidity.
11. Schwartz RA.
Therapeutic perspectives in actinic and other keratoses.
International Journal of Dermatology, 1996 Aug, 35(8):533-8.
Pub type: Journal Article; Review; Review, Tutorial.
(UI: 97006871)
12. Berger WK; Schuder G; Feifel G.
[Temperature distribution pattern in liver tissue in freezing procedures
with new cryoprobes].
Chirurg, 1996 Aug, 67(8):833-8.
Language: German.
(UI: 96413995)
Abstract: The performance of new cryoprobes was studied by measuring the
spatial and temporal patterns of the temperature distribution in liver
tissue around one to three active cryoprobes. After 15 min of maximal
freezing a tissue region 22 mm in diameter was frozen to temperatures below
- 50 degrees C by one active cryoprobe. With three cryoprobes, using the
synergistic cooling effect, a tissue region 45 mm in diameter was cooled to
temperatures below - 50 degrees C. Optimal placement of the cryoprobes was
found to be of critical importance.
13. Konety BR; Bahnson RR.
Management of stage T1b (A2) and stage T1c adenocarcinoma of the
prostate.
Seminars in Urologic Oncology, 1996 Aug, 14(3):183-94.
Pub type: Journal Article; Review; Review, Tutorial.
(UI: 97018866)
Abstract: The management of stage T1b (A2) and T1c adenocarcinoma of the
prostate is somewhat controversial. With the widespread use of serum
prostate-specific antigen (PSA) determinations, an increasing number of
these cancers are likely to be diagnosed. Hence, it is important to
formulate a cogent management strategy for these patients, because a large
percentage of them can be expected to have clinically and pathologically
localized disease. Expectant observation with deferred treatment, radical
prostatectomy, radiation therapy (external beam or brachytherapy), and
cryosurgical ablation are all primary therapeutic options that have
individual merit. In this review, we attempt to analyze the results of the
various treatment options for these patients and evolve a practical
approach towards their management.
14. Bonnez W; Oakes D; Choi A; d'Arcy SJ; Pappas PG; Corey L; Stoler MH;
Demeter LM; Reichman RC.
Therapeutic efficacy and complications of excisional biopsy of condyloma
acuminatum.
Sexually Transmitted Diseases, 1996 Jul-Aug, 23(4):273-6.
Pub type: Journal Article; Multicenter Study.
(UI: 96432991)
Abstract: BACKGROUND AND OBJECTIVES: Among the various treatment modalities for
condyloma acuminatum, excisional cold-blade surgery appears excellent but
it has been little studied and little used, particularly for lesions not
located in the perianal area. GOALS: To examine the efficacy and
complications of scissors excision of single anogenital warts. STUDY
DESIGN: Retrospective analysis of single warts completely excised with
scissors for the purpose of biopsy before patient entry in a randomized,
placebo-controlled study of the efficacy and safety of various parenteral
interferons in combination with cryotherapy. RESULTS: Of 152 patients
entered in the main study, 85 patients were available for analysis. At 4
and 16 weeks after excision, 16 of 85 (19%) and 14 of 68 (21%) of the
excised lesions recurred. After at 6 least months of follow-up, 2 of 11
(18%) of the excision sites demonstrated some evidence of pigmentation
changes. CONCLUSIONS: Scissors excision of single anogenital warts has a
high rate of success and acceptable long-term side-effects.
15. Fong Y; Kemeny N; Paty P; Blumgart LH; Cohen AM.
Treatment of colorectal cancer: hepatic metastasis.
Seminars in Surgical Oncology, 1996 Jul-Aug, 12(4):219-52.
Pub type: Journal Article; Review; Review, Tutorial.
(UI: 96427025)
Abstract: Almost one-third of patients dying from colorectal cancer have tumor
limited to the liver. Systemic chemotherapy is the appropriate palliative
management of patients with metastases to the liver and other sites. For
many patients with isolated hepatic metastases, systemic chemotherapy is
also the most appropriate treatment. However, results with systemic
chemotherapy indicate that one-third or less of patients will respond to
such treatments, and long-term survival is rare. In this report we provide
information concerning the natural history of colorectal hepatic
metastases, followed by the expected benefits with systemic chemotherapy.
This information provides background for the regional therapeutic
strategies of surgical resection, cryosurgery, and hepatic artery
chemotherapy. We discuss the selection factors appropriate for such
treatments, morbidity and mortality, and the potential long-term benefits
of such approaches. The last section focuses on surgical considerations in
hepatic resection and hepatic artery chemotherapy.
16. Long JP.
Is there a role for cryoablation of the prostate in the management of
localized prostate carcinoma?
Hematology/Oncology Clinics of North America, 1996 Jun, 10(3):675-90.
Pub type: Journal Article; Review; Review, Tutorial.
(UI: 96369498)
Abstract: It is impossible to adequately answer the question of whether there
is a role for CSAP in the management of localized prostate carcinoma
without considering the relative advantages and limitations of using other
therapies to manage this disease (radical prostatectomy, radiation therapy,
hormonal therapy, brachytherapy, expectant observation, and so on).
Obviously, this is beyond the scope of this article. It is probably fair to
point out, however, that the management of localized prostate carcinoma in
the United States is generally quite controversial at the present time, and
that despite a considerable amount of data pertaining to these therapeutic
alternatives, it is difficult to discern a standard approach that can be
broadly applied for all men with this disease. Therefore, if an absence of
consensus on the management of localized prostate carcinoma does exist, it
seems evident that investigations into alternative therapies are justified,
and the preliminary results and efforts investigating CSAP fall well into
this paradigm. In this context, several points can be made based on the
available information. Significant numbers of patients who undergo CSAP can
sustain undetectable levels of PSA for durable periods of time (more than
24 months). Thus, on a clinical level it seems possible to ablate the
entire prostate with percutaneous CSAP, although rates of achieving this
may be lower than originally anticipated. The reasons for persistence of
carcinoma post CSAP are likely technical and related to the difficulties in
determining the effective probe placements, number of probes to be used,
number of freeze-thaw-freeze cycles to be used, and so on. Previous
radiation exposure appears to confer an increased risk of CSAP-related
morbidity, with incontinence, tissue sloughing, and rectal injury most
prominent. Among nonradiated patients, incontinence is rare, and the most
prominent postoperative concern involves BOO/tissue sloughing in a minority
of patients. The longest follow-up data available on CSAP suggests that for
patients with nonmetastatic prostate carcinoma, CSAP is associated with
persistence of carcinoma in only 25% of patients. This compares favorably
with the available biopsy data following external beam radiotherapy, in
which most reports document positive biopsy results ranging between 30% and
100%, with the majority in the 40% to 50% range. Notably, the positive
biopsy rate among patients with stage T3 disease following CSAP at 2 years
can be less than 30%, which compares very favorably with previously
reported positive biopsy result for these patients following external beam
radiation therapy, which ranged between 40% and 100%. The management of
patients with persistent carcinoma following CSAP poses fewer concerns to
physicians than for those with persistent carcinoma following radiation
therapy. Given the number of patients with prostate carcinoma who currently
undergo radiotherapy as primary management, these data indicate that CSAP
can now be considered a very viable therapeutic alternative for selected
patients. With standardizations of technique as well as improved
modifications in equipment, these preliminary CSAP results may well improve
steadily in the near future. In the absence of randomized, comparative
trials, it is difficult to draw meaningful comparisons between CSAP and
radical prostatectomy. Based on available information, CSAP appears to be
associated with a much lower incidence of stress and total incontinence
than is radical prostatectomy. The rates of impotence following CSAP are
somewhat comparable to those seen after radical prostatectomy, with wide
variation among individual series. For patients who would be ideal
candidates for radical prostatectomy (for example, less than stage T2c
disease, PSA less than 10 ng/mL, and Gleason score of 7 or less), several
authors have noted that the positive biopsy rate between 6 and 12 months is
less than 10%.
17. Watanabe H; Eguchi S; Miyamura H; Hayashi J; Aizawa Y; Wakiya Y; Igarashi
T.
Histologic findings of long-term cryolesions in a patient with
ventricular tachycardia.
Cardiovascular Surgery, 1996 Jun, 4(3):409-11.
(UI: 96377100)
Abstract: This report describes cardiac morphologic alterations in a patient
who died 14 months following cryoablation. Histologic examination of the
long-term cryolesion revealed a homogeneous fibrous scar with surrounding
sinusoid capillary proliferation. The border between the fibrosis and the
normal myocardium was sharply defined. Cryothermia is an excellent
technique for the surgical correction of arrhythmias because it provides
sharply demarcated lesions which lack arrhythmogenic potential.
18. Hanada T; Ando F; Otani S; Takechi T; Misaki T.
[Successful scartectomy and cryoablation for ventricular tachycardia
occurring late after correction of tetralogy of Fallot].
Nippon Kyobu Geka Gakkai Zasshi. Journal of the Japanese Association for
Thoracic Surgery, 1996 May, 44(5):664-7.
Language: Japanese.
Pub type: Journal Article; Review; Review of Reported Cases.
(UI: 96261156)
Abstract: A 26-year-old man had a total repair of tetralogy of Fallot at 1 year
of age, and had redo surgery for restenosis of the right ventricular
outflow tract and small residual VSD at 11 years of age. After the second
operation, AV block developed and an endocardial pacemaker system was
implanted. For the last 3 years, he had mild febrile episodes, cough,
occasional hemoptysis and paroxysmal ventricular tachycardia. Because of
his refractory tachycardia and suspected infective endocarditis, he was
admitted for further study. Blood culture revealed Peptostreptococcus,
echocardiogram showed vegetation around intravenous pacing lead, and
electrophysiological study demonstrated delayed potential on the left side
of the right ventricular outflow tract. He underwent scartectomy and
cryoablation of the focus of the tachycardia which was reconfirmed by
epicardial and endocardial mapping during the operation, which involved
removal of the endocardial lead and new outflow tract patch repair. His
postoperative course was uneventful without any antiarrhythmic drugs.
Pathological examination of the scar showed myocardial fibrosis and
replacement by fatty tissue which was different from the pathological
characters of the arrythmogenic right ventricular dysplasia.
19. Onik G.
Cryosurgery.
Critical Reviews in Oncology/Hematology, 1996 May, 23(1):1-24.
Pub type: Journal Article; Review; Review, Tutorial.
(UI: 96414020)
20. Veth RP; van Hoesel QG; Bokkerink JP; Hoogenhout J; Pruszczynski M.
The art of limb salvage in musculoskeletal oncology.
Critical Reviews in Oncology/Hematology, 1995 Nov, 21(1-3):77-103.
Pub type: Journal Article; Review; Review, Academic.
(UI: 96419740)
21. Xiang J; Xie D; Qiu J.
[Cryosurgical resection of pulmonary metastases (experience of twenty
years)].
Chung-Hua Wai Ko Tsa Chih Chinese Journal of Surgery, 1995 Oct,
33(10):639-40.
Language: Chinese.
(UI: 96331844)
Abstract: Cryosurgical resection of pulmonary metastases was performed in 112
patients from 1973 to 1993. The cumulative 1, 3, 5, 10 year survival rate
was 80.37%, 41.81%, 28.01% and 17.28%. One patient died of respiratory
failure after operation. Thirty-day mortality rate was 0.89%. The
disease-free interval (DFI) between the control of primary tumor and
appearance of metastases was significantly correlated with post-thoracotomy
survival. The multiple factor analysis also demonstrated that DFI was the
most important prognostic factor for patients after cryosurgical resection
of pulmonary metastatic lesions. The overall 5 year survival rate of
patients treated with cryosurgery in our report was higher than that of
those treated by local resection of pulmonary metastases reported by other
authors. Our results indicated that cryosurgical resection of pulmonary
metastases was effective and safe, the survival time of most patients could
be prolonged and some patients could be cured.
22. Fulton AB; Hansen RM.
Electroretinogram responses and refractive errors in patients with a
history of retinopathy prematurity.
Documenta Ophthalmologica, 1995-96, 91(2):87-100.
(UI: 96408481)
Abstract: Ametropias, particularly myopia, and mild retinal dysfunction are
found in eyes with a history of retinopathy of prematurity. The retina is
an important controller of refractive development. The aims of this study
were to find out whether altered measures of retinal function and
ametropias are associated and to consider mechanisms by which the retina
might control refractive development. Nine infants and children with a
history of stage 1, 2 or 3 retinopathy of prematurity and known courses of
refractive development were studied. Spherical equivalents at the time of
the electroretinogram ranged from +5.50 to -9.00 diopters. Rod
photoresponse characteristics were derived from the a-wave, and
postreceptoral components were also analyzed with calculation of the
sensitivity and saturated amplitude of the b-wave, the sensitivity of
oscillatory wavelet OP2, and average amplitudes of OP3 and OP4. In
hyperopic and myopic patients alike, the saturated amplitude and gain of
the rod cell response were attenuated. In all patients, b-wave sensitivity
was low, but in most there was little effect on saturated b-wave amplitude.
In patients with courses toward myopia, the amplitude of OP4, an 'OFF'
signal, is relatively more attenuated than that of OP3, an 'ON' signal. OP4
is relatively larger in patients with courses toward hyperopia. The OP
results suggest that an imbalance of 'ON' and 'OFF' activity in the retina
is associated with development of ametropias in retinopathy of prematurity.
23. Weaver ML; Atkinson D; Zemel R.
Hepatic cryosurgery in the treatment of unresectable metastases.
Surgical Oncology, 1995, 4(5):231-6.
(UI: 97002684)
Abstract: The treatment of unresectable hepatic metastases has generally been
limited to systemic or intra-arterial chemotherapy. Cryosurgery has the
advantage of potentially ablating such unresectable tumours. From November
1987 to August 1994, 140 patients underwent 155 procedures using hepatic
cryosurgery with and without resection for documented metastatic disease.
Intra-operative ultrasound was used for monitoring the freezing zone. The
tumours were frozen using liquid nitrogen cooled to -196 degrees C for 15
min. The median number of lesions treated was three. Median hospital stay
was 10 days. The operative mortality was 4%. Complications included
coagulopathy, hypothermia, myoglobinuria, pleural effusions, ATN and
infection. The median survival for all patients was 22 months. Of those
patients followed for more than 2 years, the median survival was 25 months.
Of the 65 patients that are still alive, the median follow-up is 27 months.