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1. Vellet, A D; Saliken, J; Donnelly, B; Raber, E; Malaughlin, R F; Wiseman, D;
Ali-Ridha, N H.
Prostatic cryosurgery: Use of MR imaging in evaluation of success and
technical modifications.
Radiology, v.203, n.3, (1997): 653-659.
Abstract:
PURPOSE: To evaluate the usefulness of contrast material-enhanced magnetic
resonance (MR) imaging in objective assessment of prostatic cryosurgery
and the role of MR imaging in the modification of prostatic cryosurgical
technique. MATERIALS AND METHODS: Thirty-eight consecutive patients with
localized (T1-3, N0, M0) prostatic adenocarcinoma treated with prostatic
cryosurgery underwent MR imaging without contrast enhancement before
cryosurgery and unenhanced and gadolinium-enhanced MR imaging within 1-3
weeks after cryosurgery. The first 20 patients also underwent MR imaging
at 3 months after cryosurgery. MR imaging findings were correlated with
those from transrectal ultrasound-directed prostatic staging biopsy.
RESULTS: Cryonecrotic prostate was identified as avascular regions
characterized by absolute signal void on contrast-enhanced images. With
progressive modification of cryosurgical technique, complete cryoablation
of the prostate was achieved in the latter nine of the 38 patients. When
cryoablation was considered complete according to MR imaging criteria,
findings invariably correlated with those at biopsy, with no residual
prostate tissue or tumor. CONCLUSION: Gadolinium-enhanced MR imaging of
the prostate after cryosurgery provides a highly accurate means of
monitoring success. Objective MR imaging findings allow modifications to
the technology and technique, resulting in optimal therapeutic results
with prostatic cryosurgery.
1. Pauleikhoff D; Engineer B; Wessing A.
[Cryocoagulation in therapy of proliferative diabetic retinopathy].
Klinische Monatsblatter fur Augenheilkunde, 1997 Mar, 210(3):147-52.
Language: German.
(UI: 97278271)
Abstract: BACKGROUND: The importance and indication of panretinal
photocoagulation in proliferative diabetic retinopathy is well established.
In contrast the indication of cryotherapy in this disease is more
controversial especially in regard of new indications for early vitrectomy.
The present study was performed to characterize the clinical possibilities
and limitations of cryotherapy in complicated proliferative diabetic
retinopathy. PATIENTS AND METHODS: In 231 patients with proliferative
diabetic retinopathy and vitreous hemorrhage limiting further
photocoagulation the visual outcome and diabetic retinal changes were
observed before and after cyrotherapy (15-20 effects) of the
ophthalmoscopically visible peripheral retina. RESULTS: After cryotherapy
regression of active proliferations could be seen in 70% of the patients.
Resorption of vitreous hemorrhages could be found in 80% of the patients.
This was associated with improvement in visual acuity in 50-60% of the
patients. Loss of vision was caused due to tractional detachment in 20% of
the patients and due to further vitreous hemorrhages in 10% of the
patients. Comparison of retinal changes between patients with worsened
visual acuity and patients with increase in visual acuity demonstrated the
preoperative fibrotic status of disc neovascularisation as the most
important prognostic factor. The development of central tractional
detachment was significantly higher in patients with preoperatively partly
regressed disc neovascularisation. CONCLUSIONS: Cryotherapy of the
peripheral retina in proliferative diabetic retinopathy with vitreous
hemorrhages is therefore only indicated after ophthalmoscopical or
echographical exclusion of peripapillary fibrosis and retinal traction and
with sufficient visibility of the peripheral retina for the application.
2. Vellet AD; Saliken J; Donnelly B; Raber E; McLaughlin RF; Wiseman D;
Ali-Ridha NH.
Prostatic cryosurgery: use of MR imaging in evaluation of success and
technical modifications.
Radiology, 1997 Jun, 203(3):653-9.
(UI: 97313080)
Abstract: PURPOSE: To evaluate the usefulness of contrast material-enhanced
magnetic resonance (MR) imaging in objective assessment of prostatic
cryosurgery and the role of MR imaging in the modification of prostatic
cryosurgical technique. MATERIALS AND METHODS: Thirty-eight consecutive
patients with localized (T1-3, N0, M0) prostatic adenocarcinoma treated
with prostatic cryosurgery underwent MR imaging without contrast
enhancement before cryosurgery and unenhanced and gadolinium-enhanced MR
imaging within 1-3 weeks after cryosurgery. The first 20 patients also
underwent MR imaging at 3 months after cryosurgery. MR imaging findings
were correlated with those from transrectal ultrasound-directed prostatic
staging biopsy. RESULTS: Cryonecrotic prostate was identified as avascular
regions characterized by absolute signal void on contrast-enhanced images.
With progressive modification of cryosurgical technique, complete
cryoablation of the prostate was achieved in the latter nine of the 38
patients. When cryoablation was considered complete according to MR imaging
criteria, findings invariably correlated with those at biopsy, with no
residual prostate tissue or tumor. CONCLUSION: Gadolinium-enhanced MR
imaging of the prostate after cryosurgery provides a highly accurate means
of monitoring success. Objective MR imaging findings allow modifications to
the technology and technique, resulting in optimal therapeutic results with
prostatic cryosurgery.
3. Lee F; Bahn DK; McHugh TA; Kumar AA; Badalament RA.
Cryosurgery of prostate cancer. Use of adjuvant hormonal therapy and
temperature monitoring--A one year follow-up.
Anticancer Research, 1997 May-Jun, 17(3A):1511-5.
(UI: 97322698)
Abstract: OBJECTIVE: To determine the clinical outcomes at one year of Stages
T2-T3 prostate cancer by cryosurgery utilizing pretreatment with total
androgen ablation therapy and temperature monitoring to control the
freezing process. Study Group To date, 347 patients have had 356
cryosurgical procedures, 280 have reached one year post treatment. Of these
131 had re-evaluation with prostatic biopsy and serum PSA. METHODS:
Transrectal ultrasound (TRUS) measurement of tumor size and biopsy of
extraprostatic space was used to stage patients into two main groups:
confined (66.6%) versus nonconfined (19.3%). Radiation failures (14.1%)
formed a separate group. Failure rates for the 131 men include all cancer
diagnosed during the one year period following cryosurgery. RESULTS: The
one year failure rate for the study group was 19.8% (26/131). For stages
T2a, T2h C, T3 and radiation failures, the rates of positive biopsies were
13.9%, 12.9%, 33.3% and 35%, respectively. For those with local control of
cancer (negative biopsy), 80% had prostate specific antigen (PSA) levels of
< 0.5 ng/ml. The statistical variables for persistent cancer with prostate
specific antigen > 0.5 ng/ml were: sensitivity of 66.7%, PPV of 16.7%, NPV
of 98% and specificity of 83.7%. A statistically significant difference
exist between stages T2 vs T3 and radiation failures (p = < 0.5). Major
complications of rectal fistula and total incontinence for previously
non-treated cancer versus radiation failures were 0.33% and 8.7%
respectively, a 26 times greater risk. CONCLUSION: Results of cryosurgery
for all stages of prostate cancer at one year are encouraging, being 80%
free of disease (biopsy and prostate specific antigen). The morbidity of
the previously non-treated cancers from this procedure for us was minimal
with high patient acceptance. For radiation failures a local control rate
of 65% was achieved. However, early in our experience significant morbidity
did occur and our enthusiasm for attempted salvage was initially tempered.
4. Sivkova N; Katsarov K; Kreissig I; Chilova-Atanassova B.
Our experience in minimized surgery for retinal detachment: first results.
Folia Medica, 1997, 39(1):44-7.
(UI: 97286644)
Abstract: This study included the first 35 patients with retinal detachment
that underwent cryopexy and scleral segmental buckling by silicone sponge
with nondrainage and without serclage after Lincoff. Precise localization
of the retinal lesions and proper circumferential cryopexy was achieved
intraoperatively under the guidance of indirect ophthalmoscope provided
with +20/+30d biaspherical lens (Volk, USA). Mean age of the patients was
42 +/- 11 years. A single hole/break was visualized in 20%, two
holes/breaks in 26%, and more than two holes/breaks in 40% of the patients;
disinsertion of the retina of one quadrant was present in 14%. The duration
of the disease was less than 3 months in 66% and more than 3 months in 34%
of the patients. On the first postoperative day anatomical reattachment of
the retina was achieved in 86% of the patients and in 14% of the resorption
was delayed until day 7. Postoperative haemophthalmus, vitreitis, ischaemia
of the anterior ocular segment, or elevated intraocular pressure were found
in none of the patients. All patients were discharged with reattached
retinas. Visual acuity was more than 0.5 in 60% and from 0.1 to 0.5 in 40%
of the patients. At the last postoperative examination the visual acuity
was 1.0 in 40%, 0.5-0.9 in 40% and 0.1-0.4 in 20% of the eyes. The retina
was reattached in all patients. The method of minimized surgery for retinal
detachment yields good anatomical and functional results. It helps to avoid
the postoperative complications of conventional scleroplastic surgery with
serclage and drainage.
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1. Steed J; Saliken JC; Donnelly BJ; Ali-Ridha NH.
Correlation between thermosensor temperature and transrectal
ultrasonography during prostate cryoablation.
Canadian Association of Radiologists Journal, 1997 Jun, 48(3):186-90.
Pub type: Clinical Trial; Clinical Trial, Phase II; Journal Article.
(UI: 97336671)
Abstract: OBJECTIVE: To determine if the adequacy of freezing in the
neurovascular bundle region of the prostate during prostate cryotherapy can
be monitored by transrectal ultrasonography (TRUS). PATIENTS AND METHODS:
The study group consisted of 11 patients undergoing TRUS-guided prostate
cryotherapy. The actual temperature in the gland was monitored with
thermosensors placed in each prostatic neurovascular bundle. The 2
cryo-operators, working together and blinded to the actual temperature,
used sonographic observations to estimate the temperature at the
neurovascular bundles every 2 minutes until they believed that the gland
was adequately frozen. The congruity between the estimated and measured
temperatures was analyzed to determine if the operators could accurately
monitor the progress of cryoablation by ultrasonography. RESULTS: There
were a total of 85 data points for which the operators thought tumoricidal
cryo-injury had been achieved at the neurovascular bundles (temperature -20
degrees C or below). For these points the measured temperature was on
average 6.0 degrees C warmer than the estimated temperature (standard
deviation, 22). For operator estimates of -20 degrees C or below, the
measured temperature was -20 degrees C or below for 37 (44%) data points,
between -19 degrees C and 0 degree C for 32 (38%) and greater than 0 degree
C for 16 (19%). CONCLUSIONS: The operators were not able to accurately
predict subzero temperatures at the neurovascular bundle region by TRUS
evaluation. Moreover, the bias and magnitude of the error were significant
and might lead to inadequate freezing of the prostate during attempted
cryoablation.
1. Wren SM; Coburn MM; Tan M; Daniels JR; Yassa N; Carpenter CL; Stain SC.
Is cryosurgical ablation appropriate for treating hepatocellular cancer?
Archives of Surgery, 1997 Jun, 132(6):599-603; discussion 603-4.
(UI: 97341524)
Abstract: OBJECTIVE: To examine the feasibility and efficacy of cryosurgical
ablation as treatment for patients with cirrhosis with unresectable
hepatocellular carcinoma. DESIGN: Retrospective case series. SETTING: A
tertiary public hospital and a cancer center. PATIENTS: Twelve patients
with cirrhosis with hepatocellular carcinoma (stage II, 2; stage III, 1;
stage IVA, 7; stage IVB, 2). INTERVENTIONS: Cryosurgical ablation of all
identifiable tumors. Nine patients treated with curative intent were
included in the survival analysis, and 3 were treated for palliation. Five
patients were treated with preoperative intra-arterial chemoembolization.
MAIN OUTCOME MEASURES: Perioperative complications and the effects of tumor
stage and chemoembolization were examined. Patient survival and
disease-free interval were calculated by life-table analysis. RESULTS: No
perioperative deaths occurred and 1 patient had 2 postoperative
complications: pneumonia and biloma. The mean survival has been 19 months
after cryosurgical ablation and 29 months after diagnosis. Three of the 9
patients treated with curative intent died with recurrence at a mean of 17
months after cryosurgical ablation. Four patients are alive with recurrence
at a mean of 19 months after cryosurgical ablation and 38 months after
diagnosis. Two patients with stage II disease have no evidence of
recurrence 10 and 32 months after cryosurgical ablation. CONCLUSIONS:
Cryosurgical ablation is feasible and safe for treatment of hepatocellular
carcinoma in patients with cirrhosis. The technique is primarily palliative
but may provide a possibility of cure in patients with lower-stage disease.
2. Moriche M; Revilla R.
Repair of rhegmatogenous retinal detachments [letter].
Ophthalmology, 1997 Jun, 104(6):897-8.
Pub type: Letter.
(UI: 97329962)
3. Baust J; Gage AA; Ma H; Zhang CM.
Minimally invasive cryosurgery--technological advances.
Cryobiology, 1997 Jun, 34(4):373-84.
(UI: 97344375)
Abstract: The technological advances which have caused renewed interest in
cryosurgery are the development of intraoperative ultrasound to monitor the
therapeutic process and the development of new cryosurgical equipment
designed to use supercooled liquid nitrogen. The thin, highly efficient
probes, available in several sizes, can be placed in diseased sites via
endoscopy or percutaneously in minimally invasive procedures. The manner of
use is to place the probe in the desired location in the diseased tissue
with ultrasound guidance. If required by the size or location of the tumor,
as many as five probes can be inserted and cooled to -195 degrees C
simultaneously. The process of freezing is monitored by ultrasound which
displays a hypoechoic (dark) image when the tissue if frozen. Rapid
freezing, slow thawing, and repetition of the freeze/thaw cycle are
standard features of technique. Clinical applications which have become
common in the past 4 years include the treatment of prostatic cancer and
liver tumors. The cases selected for cryosurgery are generally those for
which no conventional treatment is possible. However, especially in
prostatic cancer, the operative morbidity is so low and the results of
therapy are sufficiently good in the short term to merit consideration of
use in earlier stages of the disease. Diverse tumors in other sites, such
as the brain, bronchus, bone, pancreas, kidney, and uterus, have also been
treated in small numbers by cryosurgery. Judging from this experience,
further expansion in the use of cryosurgical techniques seems certain.
4. Tandan VR; Harmantas A; Gallinger S.
Long-term survival after hepatic cryosurgery versus surgical resection for
metastatic colorectal carcinoma: a critical review of the literature.
Canadian Journal of Surgery, 1997 Jun, 40(3):175-81.
Pub type: Journal Article; Review; Review, Tutorial.
(UI: 97338216)
Abstract: OBJECTIVE: To critically assess the evidence for long-term survival
after hepatic resection and hepatic cryosurgery for metastatic colorectal
cancer. The purpose of this review is to determine if a randomized
controlled trial comparing these two treatment modalities is justified.
DATA SOURCES: A review of the medical literature from 1973 to 1995 using
the MEDLINE and CANCERLIT databases. References were also retrieved from
the bibliographies of identified articles and from experts in the field of
hepatobiliary and pancreatic surgery. STUDY SELECTION: One hundred and
seventy-eight studies were reviewed. Studies presenting original data on
the results of hepatic resection or cryotherapy for colorectal liver
metastases were selected. Studies were excluded if they did not present
survival data longer than 2 years. Studies pertaining to resection for
fewer than 60 patients with colorectal metastases to the liver were
excluded. DATA EXTRACTION: Data forms were designed before studies were
examined in detail. All studies that met the inclusion and exclusion
criteria were reviewed and the identified data extracted and tabulated.
DATA SYNTHESIS: No controlled studies were identified, only case series.
Four reports on hepatic cryosurgery and 9 on hepatic resection met the
study criteria. The cryosurgery studies were methodologically poor; the
resection studies were larger and more methodologically sound. The median
follow-up for cryosurgery ranged from 12 to 28.8 months, that for resection
21 to 69 months. There is clear evidence that hepatic cryosurgery has a
role in the management of selected patients with colorectal metastases to
the liver. However, valid conclusions cannot be made about the 5-year
survival rate. The results of the studies on hepatic resection in patients
with colorectal metastases to the liver have greater validity and
consistency, with 5-year survival rates of 20% to 40%. CONCLUSIONS:
Although hepatic cryosurgery offers some unequivocal and other potential
advantages over surgical resection for colorectal metastases to the liver,
the published data do not support its use in patients with resectable
disease outside a clinical trial, and do not yet justify a randomized
trial. A study that collects prospective data on 2 groups of patients
(resectable v. unresectable) who differ only in the anatomic location of
their metastases within the liver is needed.
5. Riley DK; Babinchak TJ; Zemel R; Weaver ML; Rotheram EB.
Infectious complications of hepatic cryosurgery.
Clinical Infectious Diseases, 1997 May, 24(5):1001-3.
(UI: 97287684)
Abstract: Hepatic cryosurgery is a novel procedure for patients with metastatic
liver disease. To date, no reviews of the infectious complications of this
procedure have been published. One hundred and fifty patients underwent 158
hepatic cryosurgical procedures at Allegheny General Hospital (Pittsburgh)
from November 1987 through July 1995. Gastrointestinal malignancies
accounted for 93% of the underlying diagnoses. The following 12 infections
were directly related to the cryosurgical procedure: hepatic abscess (six),
intraperitoneal abscess (three), ascending cholangitis (two), and an
intrahepatic device (Infusaid; Strato/Infusoid, Norwood, MA) infection
(one). Enterococcus was the most commonly isolated organism. Seven of the
12 infections were polymicrobial. The patients who developed infections had
longer hospital stays (26 days vs. 13 days) and had more days of fever (6.5
days vs. 2.3 days). than those who did not develop infections. If
perioperative manipulation of the biliary tree is avoided, the infection
rate in patients who undergo hepatic cryosurgery may be decreased even
further. Overall, cryoablation of the liver is not related to an increased
risk of infection.
6. Etienne G; Constantin JM; Hevia M.
Cryo-stripping: an alternative to perforate-invaginate stripping [letter].
Annals of Vascular Surgery, 1997 May, 11(3):325-8.
Pub type: Letter.
(UI: 97285356)
7. The risk of explosions when handling liquid nitrogen in Delasco glass-bottle
thermos-type Cryo-Tainers.
Health Devices, 1997 Apr, 26(4):177-9.
(UI: 97280067)