March 1997 Cryosurgical Publications
A weekly updated compilation of cryosurgery related publications
| Mar. 4th | Mar. 11th | Mar. 18th | Mar. 25th |
| BIOSYS |  | | | |
| MEDLINE | | | | |
BIOSYS Database:
1. Shuman, B A; Cohen, J K; Miller, R J Jr; Rooker, G M; Olson, P R.
Histological presence of viable prostatic glands on routine biopsy
following cryosurgical ablation of the prostate.
Journal of Urology, v.157, n.2, (1997): 552-555.
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.
2. Patel, B G; Parsons, C L; Bidair, M; Schmidt, J D.
Cryoablation for carcinoma of the prostate.
Journal of Surgical Oncology, v.63, n.4, (1996): 256-264.
Abstract:
Percutaneous transperineal cryoablation of the prostate is now available
in the armamentarium for treatment of prostate cancer. Technical advances
in real-time transrectal imaging of the prostate and improvements in
cryosurgical equipment have brought this modality into the limelight of
available prostate cancer management. Cryosurgery can be offered to many
patients with prostate cancer. However, the main indications for its use
include primary treatment for localized disease, salvage therapy after
failure of traditional methods, and relief of local symptoms. A historical
background, description of the technique, and clinical experience at
several medical centers including the University of California San Diego,
Allegheny General Hospital, University of Texas M.D. Anderson Cancer
Center, and Crittenton Hospital, are presented.
3. Guzman, M H.
A technique for reconstruction of pharyngostomas with a sternomastoid
myocutaneous flap.
Prensa Medica Argentina, v.83, n.9, (1996): 858-860.
Language: Spanish.
Abstract:
Cryosurgery is the therapeutic application of extremely low temperatures,
"in vivo" to tissues for their destruction, and radiofrequency is the use
of radiofrequency electron-wave to perform any type of skin surgery.
Knowledge of the advantages derived from each of these methods for the
study and treatment of skin lesions has led to the combination of both
techniques. Thus obtaining optimum results and minimum collateral effects
and sequelae. An initial experiment including 100 procedures on 60
patients for the treatment of skin lesions, is hereby presented.
MedLine Database:
1. 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.
2. 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)
3. 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.
4. 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.
5. 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.
6. 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.
7. 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.
BIOSYS Database:
1. BOOK
Daly, J M.
Metastatic cancer to the liver.
DeVita, V. T. Jr., S. Hellman and S. A. Rosenberg (Ed.). Cancer:
Principles and practice of oncology, 5th edition. lxiv3125p.
Lippincott-Raven Publishers: Philadelphia, Pennsylvania, USA. ISBN
0-397-51573-1. 1997. p. 2551-2570.
2. BOOK
Malawer, M M.
Sarcomas of bone.
DeVita, V. T. Jr., S. Hellman and S. A. Rosenberg (Ed.). Cancer:
Principles and practice of oncology, 5th edition. lxiv3125p.
Lippincott-Raven Publishers: Philadelphia, Pennsylvania, USA. ISBN
0-397-51573-1. 1997. p. 1789-1852.
3. Chin, J L; Downey, D; Fenster, A; Onik, G.
Cryosurgery for prostate cancer with three-dimensional ultrasound
guidance. (14th World Congress of Endourology and Shock Wave Lithotripsy and
the 12th Basic Research Symposium, Melbourne, Australia, November...
Journal of Endourology, v.10, n.SUPPL. 1, (1996): S94.
4. Ozkeceli, R.
The effect of cryosurgical procedure on humoral immunity in the benign
prostate hyperplasia. (14th World Congress of Endourology and Shock Wave
Lithotripsy and the 12th Basic Research Symposium, Melbourne,...
Journal of Endourology, v.10, n.SUPPL. 1, (1996): S87.
5. Nakada, S Y; Lee, F T Jr; Warner, T; Chosy, S G; Moon, T D.
Laparoscopic cryosurgery of the kidney in the porcine model: An acute
feasibility study. (14th World Congress of Endourology and Shock Wave
Lithotripsy and the 12th Basic Research Symposium, Melbourne,...
Journal of Endourology, v.10, n.SUPPL. 1, (1996): S65.
MedLine Database:
1. 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.
2. Oyasu R.
Prostate cancer [editorial; comment].
Journal of Urology, 1997 Feb, 157(2):563-4.
Pub type: Editorial.
(UI: 97149549)
3. 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.
4. 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.
5. 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.
6. 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.
7. 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.
BIOSYS Database:
MedLine Database:
1. 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.
2. 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.
3. 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.
4. 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)
5. 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.
6. 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.
7. 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.
8. 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.
9. 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.
BIOSYS Database:
MedLine Database:
1. 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)
2. 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.
3. 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.
4. 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.