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1. Macaluso, J N Jr; Deutsch, J S.
Cryosurgical ablation for carcinoma of the prostate. (15th World Congress
on Endourology and Shock Wave Lithotripsy and the 13th Basic Research
Symposium, Edinburgh, Scotland, UK, August 31-September 3, 1997. )
Journal of Endourology, v.11, n.SUPPL. 1, (1997): S122.
2. Nakada, S Y; Chosy, S; Lee, F T Jr; Warner, T F.
Thermosensor-monitored renal cryosurgery in swine: Assessment of various
predictors of tissue necrosis. (15th World Congress on Endourology and Shock
Wave Lithotripsy and the 13th Basic Research Symposium, Edinburgh,...
Journal of Endourology, v.11, n.SUPPL. 1, (1997): S55.
1. Bilchik AJ; Sarantou T; Wardlaw JC; Ramming KP.
Cryosurgery causes a profound reduction in tumor markers in hepatoma and
noncolorectal hepatic metastases.
American Surgeon, 1997 Sep, 63(9):796-800.
(UI: 97435857)
Abstract: Cryosurgical ablation of hepatic metastases from colon carcinoma has
become a useful adjunct in the management of patients whose tumors are not
amenable to surgical resection. We evaluated cryoablation of hepatoma and
noncolorectal hepatic metastases by examining its effect on serum levels of
tumor markers in 20 patients with primary liver cancer (N = 5) or liver
metastases (N = 15) from breast cancer, neuroendocrine tumors, ovarian
cancer, and thyroid cancer. All patients had failed conventional therapy
and had no evidence of extrahepatic spread. After cryosurgery, 17 patients
had a significant decrease in tumor marker levels (median 77%) and a
significant improvement in symptoms. One patient died of nontumor causes,
and five patients died of recurrent disease. Median interval to death or
last follow-up was 28.3 months overall (range, 2-45 months), 17.9 months
for nonsurvivors (range, 2-44 months), and 35.2 months for survivors
(range, 26-45 months). Median survival was 32 months following curative
surgery (range, 16-45 months) and 25 months following palliative surgery
(range, 2-42 months). Cryosurgical ablation of noncolorectal hepatic
metastases and primary hepatomas produces a profound reduction in serum
levels of tumor markers. It is safe, provides excellent palliation of
symptoms, and in selected patients can be performed with curative intent.
2. Hejny C; Han DP.
Vitrectomy for macular hole after pneumatic retinopexy.
Retina, 1997, 17(4):356-7.
(UI: 97425908)
3. Dunker S; Faulborn J; Haller EM; Reich ME.
The effect of retinal cryoapplication on the vitreous.
Retina, 1997, 17(4):338-43.
(UI: 97425902)
Abstract: PURPOSE: The effect of retinal cryopexy on the vitreous was studied
morphologically in an animal model. METHODS: The retina and vitreous were
frozen with single cryolesions on one eye and 24 contiguous cryolesions on
the contralateral eye in 16 rabbits. The cryoprobe was applied to the
sclera from 3 mm to 6 mm posterior to the limbus at -60 degrees C until
ophthalmoscopically visible whitening occurred. Two animals were killed on
the first day; the third day; after 1, 2, and 4 weeks; and after 2, 3, and
6 months after surgery. The eyes were enucleated and prepared by the
celloidin embedding method. Each 200-microgram section was examined by
light microscopy. Areas of the specimens were dissected and studied by
scanning and transmission electron microscopy. RESULTS: Single cryolesions
did not have a significant generalized effect on the vitreous. Evidence of
local collagen destruction and dispersion of cells was found near the area
of cryoapplication. Contiguous cryoapplication led primarily to increased
density in the vitreous and subretinal edema. The vitreoretinal border was
invaded by mononuclear cells containing pigment granules. Thickened
collagen fibers were attached to the coagulated retina in a perpendicular
manner and traversed the whole vitreous body. After 4 weeks the increased
vitreous density slowly diminished, and preretinal capillaries surrounded
by vitreous collagen started to proliferate from the vitreoretinal
interface. After 6 months central vitreous collagen fibers looked normal.
In the area of cryoapplication, vitreoretinal membrane formation had
occurred. CONCLUSION: Single cryolesions have no significant effect of the
vitreous. Multiple cryolesions lead to neovascularization soon after the
procedure (1 month) and membrane formation later (6 months after the
procedure). This supports the concept that the extensive use of cryopexy in
human retinal surgery could contribute to the development of proliferative
vitreoretinopathy.
4. Milstein S; Dunnigan A; Tang C; Pineda E.
Right atrial appendage to right ventricle accessory atrioventricular
connection: a case report.
Pacing and Clinical Electrophysiology, 1997 Jul, 20(7):1877-80.
(UI: 97393329)
Abstract: Atrial and ventricular attachments of accessory atrioventricular
connections have classically been localized to adjacent atrial and
ventricular tissues, and this principle is responsible for the widespread
success of radiofrequency catheter ablation. We present anatomical evidence
of an unusually located accessory atrioventricular connection, which
bridged the atrioventricular ring epicardially, directly from the base of
the right atrial appendage to the right ventricle. This observation might
offer a new insight into unusual accessory atrioventricular connection
locations and may explain why some endocardial radiofrequency catheter
ablation procedures might fail.
5. Sueda T; Nagata H; Okada K; Hirai S; Morita S; Orihashi K; Matsuura Y.
Right atrial separation procedure for eliminating chronic atrial
fibrillation associated with atrial septal defect.
Pacing and Clinical Electrophysiology, 1997 Jul, 20(7):1870-3.
(UI: 97393327)
Abstract: Chronic atrial fibrillation (AF) had been documented in a patient
with atrial septal defect for 7 years. A right atrial separation procedure
was performed for ablation of chronic AF, concomitant with repair of the
atrial septal defect, and followed by atrial electrophysiological mapping.
A horizontal transectional incision extending to the borders of the atrial
septum and the tricuspid annulus was made. Cryolesions of the atrial
isthmus between the margin of the upper incision and the tricuspid valve
annulus were created at -60 degrees C for 2 minutes at a time. After the
operation, the patient had restored normal sinus rhythm during a subsequent
follow-up period of 48 months.
6. McMurrick PJ; Nelson H.
Liver-directed therapies for gastrointestinal malignancies.
Current Opinion in Oncology, 1997 Jul, 9(4):367-72.
Pub type: Journal Article; Review; Review, Tutorial.
(UI: 97395787)
Abstract: Although surgery remains the treatment of choice for hepatic
malignancy, both primary and secondary, the majority of patients presenting
with hepatic tumors are unfortunately not candidates for resection. A
number of alternative hepatic-directed therapies are assessed for their
role in the following settings: as primary treatment modalities; as
treatment adjuvants to surgical resection, including neoadjuvant therapy to
downstage tumors prior to planned resection; and as a means of palliation
when tumors are incurable. Non-surgical hepatic-directed therapies
demonstrated to prolong survival include adjuvant portal vein chemotherapy
infusion at the time of resection of primary colorectal cancer, and hepatic
artery infusion in the setting of established hepatic metastases. Several
other therapies are described but remain incompletely evaluated, including
transplantation, microwave coagulation, injection of radiolabeled
particles, chemoembolization, percutaneous ethanol injection, and
cryosurgery. Due to the rarity of these tumors, many studies present
results of heterogeneous populations of patients, making meaningful
comparison difficult. Finally, it must be said that screening asymptomatic
patients after resection of colorectal cancer with a view to application of
hepatic-directed therapy in the setting of colorectal metastases is costly.
7. al-Majali O; Routh HB; Abuloham O; Bhowmik KR; Muhsen M; Hebeheba H.
A 2-year study of liquid nitrogen therapy in cutaneous leishmaniasis.
International Journal of Dermatology, 1997 Jun, 36(6):460-2.
(UI: 97392163)
Abstract: BACKGROUND: Among the different modalities for treatment of cutaneous
leishmaniasis, liquid nitrogen is considered an effective therapy with very
mild side-effects. METHODS: A study was conducted using liquid nitrogen
topically for the treatment of cutaneous leishmaniasis in the King Hussain
Medical Centre, Amman-Jordan. Among 468 patients of cutaneous
leishmaniasis, 293 were treated with liquid nitrogen and the rest were
treated with other known treatment modalities. RESULTS: Of the patients
treated with cryo surgery liquid nitrogen, 215 of 293 permitted appropriate
follow-up; the clinical response was significant and effective. No systemic
adverse effects were noted. Mild cutaneous complications were infrequent,
and included hypopigmentation, hyperpigmentation, and scar formation.
CONCLUSIONS: From the results of this study, liquid nitrogen therapy may be
considered an effective treatment for cutaneous leishmaniasis.
1. Burton, S A; Paljug, W R; Kalnicki, S; Werts, E D.
Hypothermia-enhanced human tumor cell radiosensitivity.
Cryobiology, v.35, n.1, (1997): 70-78.
Abstract:
Ablation of neoplastic disease by freezing has found increasing utility as
a potential therapeutic modality. To assess the effect of cooling
temperatures on cellular radiation response, an established human cervical
carcinoma cell line (HTB35) was subjected to holding temperatures of 0, 5,
or 15 degree C for up to 24 h before irradiation. Survival was measured by
in vitro clonogenic assay of colonies containing at least 50 cells.
Cooling for up to 12 h did not significantly decrease survival, but after
24 h survival fell to 75% of control cultures grown at 37 degree C.
X-irradiation immediately after cooling for 24 h resulted in 1.6-fold
enhanced radiosensitivity. However, the radiosensitizing effect decayed
rapidly if the cooled cells were returned to normal growth temperature for
6 h or longer before irradiation and subculture. Both temperature and
cooling duration influenced the radiation response. With 0, 5, or 15
degree C, radiosensitivity increased after 3, 6, or 12 h, respectively,
and progressively rose with up to 24 h of cooling. By flow cytometric
analysis, no statistically significant difference was observed in the
S-phase fraction between control cells and those cooled to 0 degree C for
24 h. These data demonstrate cooling-enhanced in vitro radiation
sensitivity which is dependent upon cooling temperature, duration, and
rewarming interval before irradiation. While cell cycle redistribution
does not appear to be a factor in the increased radiosensitivity,
differences in the radiation survival curves between cooled versus
normothermic cells suggest that diminished capacity for sublethal damage
repair may be a significant influence on the changes which were observed.
2. Mack, D; Jungwirth, A; Adam, U; Kunit, G; Miller, K; Dietze, O; Frick, J.
Long-term follow-up after open perineal cryotherapy in patients with
locally confined prostate cancer.
European Urology, v.32, n.2, (1997): 129-132.
Abstract:
Objective: Appropriate therapies for locally confined adenocarcinoma of
the prostate are available - but there is as yet no gold standard of
therapy. For that reason, old therapeutic regimens are being revised. One
such regimen is cryotherapy. Methods: Between 1976 and 1989, 1,250
patients were seen with newly diagnosed prostate cancer. Sixty-six
patients of stages T-1c (n = 3), T-2a (n = 32), T-2b (n = 9), T-2c (n =
11), T-3a (n = 4), T-3b (n = 5) and T-3c (n = 2) were treated by open
perineal cryotherapy. Mean age was 68 years. Three months after surgery,
transurethral resection of the prostate and/or perineal biopsy was
performed. Results: In 66% of patients with stages T-1c-T-2b and in 87% of
patients with stages T-2c-T-3c, positive biopsies were obtained. To date,
28 patients have died between 3 and 16 years after cryotherapy, with a
mean survival of 7.2 years. The mean follow-up period of survivors (38
patients) is 8.5 years. Complications were: stress-incontinence in 10%,
impotence in 10% and temporary rectoperineal fistula in 8%. Conclusions:
Cryosurgery is an effective treatment for locally confined prostate
cancer. With improvement of the procedure, clinical outcome may also
improve.
3. Bonifaz, A; Martinez-Soto, E; Carrasco-Gerard, E; Peniche, J.
Treatment of chromoblastomycosis with itraconazole, cryosurgery, and a
combination of both.
International Journal of Dermatology, v.36, n.7, (1997): 542-547.
Abstract:
Background: Chromoblastomycosis is a subcutaneous mycosis, seen frequently
in tropical areas, and caused by dematiaceous fungi. It produces
nodulo-verrucous lesions in the arms and legs. There is no treatment of
choice for this disease and sometimes a combination of chemotherapy and
physical therapy is necessary. Methods: The study included 12 patients
diagnosed with chromoblastomycosis by means of fungal and histopathologic
tests. The patients were assigned to three treatment groups: patients with
small lesions, not greater than 15 cm-2 in area, were assigned to Group 1,
in which the treatment consisted of itraconazole 300 mg/day, or to Group
2, in which the treatment consisted of one or more sessions of open-spray
cryosurgery. Patients with large lesions were assigned to Group 3 and
started treatment with itraconazole 300 mg/day, until a maximal reduction
of lesions occurred, and then underwent one or several cryosurgery
sessions. Clinical, fungal, and laboratory tests were performed in each
group before, during, and at the completion of treatment. Results:
Positive cultures of Fonsecaea pedrosoi were obtained in 11 out of 12
patients. Two out of four patients in Groups 1 and 3 had a clinical and
fungal cure and the remaining patients experienced significant
improvement. All four patients included in Group 2 achieved a cure. No
important side-effects were seen among the patients included in any of the
two itraconazole groups, and only two out of eight patients reported
gastric discomfort. The cryosurgery group reported only normal
complications of the process, such as edema and pain; two out of eight
patients had a superimposed infection. Conclusions: The results of
itraconazole and cryosurgery were good in cases with small lesions;
antifungal therapy being more appropriate for flexion areas, The
combination of itraconazole, to reduce the size of the lesions, with
subsequent treatment of the remaining lesions with cryosurgery, represents
a new alternative in the treatment of patients with large lesions. Both
types of therapy are considered safe, with few side-effects.
(none)
1. Najimi, S; Rubinsky, B.
Non-invasive detection of thermal stress fractures in frozen biological
materials.
Cryo Letters, v.18, n.4, (1997): 209-216.
Abstract:
Thermal stress induced fractures render cryopreserved frozen tissue
unusable for transplantation and cause bleeding and medical complications
during cryosurgery. It would be beneficial to know when those internal
fractures occur prior to the medical failure of the treated tissue. To
this end, we introduce an acoustic emission technique for non-invasive and
instantaneous detection of the occurrence of internal fractures during
freezing of biological materials. The method employs a piezoelectric
element which converts the pressure waves produced by fractures into
electrical signals. The use of the technique is illustrated through a
study of one dimensional, in vitro freezing of liver. It is shown that
while fracture formation frequency and amplitude are qualitatively
proportional to the cooling rates during freezing, the fracture formation
event is stochastic and the occurrence in individual cases, unpredictable.
2. Friedman, E J; Orth, C R; Brewton, K A; Ponniah, S; Alexander, R B.
Cryosurgical ablation of the normal ventral prostate plus adjuvant does
not protect Copenhagen rats from Dunning prostatic adenocarcinoma challenge.
Journal of Urology, v.158, n.4, (1997): 1585-1588.
Abstract:
Purpose: We wished to determine if cryosurgical ablation of the normal
ventral prostate of Copenhagen rats confers protective immunity against a
subsequent challenge with Dunning R3327 MatLyLu prostatic adenocarcinoma.
In human melanoma, tumor antigens have been characterized as normal
cellular proteins. We reasoned that cryosurgical ablation of the normal
prostate along with immunostimulatory adjuvants might release prostatic
antigens to the immune system engendering an immune response and rendering
rats immune to prostatic cancer cells. Materials and Methods: On day 0,
Copenhagen rats underwent cryosurgical ablation of the normal ventral
prostate, cryosurgery and intraprostatic injection of Complete Freund's
Adjuvant (CFA), CFA injection alone, or laparotomy alone. On day 21,
animals received a subcutaneous challenge of MatLyLu tumor cells. Tumor
dimensions were recorded at regular intervals by a single blinded
investigator. Results: Animals receiving cryosurgical ablation of the
normal ventral prostate or intraprostatic CFA developed tumors more
frequently than animals receiving laparotomy alone and the effect was
statistically significant if animals received both cryosurgical ablation
of the prostate and intraprostatic CFA (3 experiments, 1 times 10-4
MatLyLu cells), total number with tumors/total number challenged:
laparotomy alone 3/17, cryosurgical ablation 7/17, cryosurgery plus CFA
10/16 (p = 0.013 versus laparotomy, Fisher's exact test), CFA alone 9/17.
Conclusions: Cryosurgical ablation of the normal rat ventral prostate and
intraprostatic CFA does not protect against and can enhance the
tumorigenicity of MatLyLu prostatic cancer cells at distant sites. This
could be occurring through specific immunologic effects or non-specific
mechanisms induced by cryorurgery and CFA.
3. Porter, M P; Ahaghotu, C A; Loening, S A; See, W A.
Disease-free and overall survival after cryosurgical monotherapy for
clinical stages B and C carcinoma of the prostate: A 20-year followup.
Journal of Urology, v.158, n.4, (1997): 1466-1469.
Abstract:
Purpose: We attempt to provide insight into the historical efficacy of
cryosurgical monotherapy for prostate carcinoma through a single
institution, retrospective, long-term followup. Materials and Methods:
From 1973 to 1977, 66 men underwent cryosurgical monotherapy for prostate
carcinoma. Patient charts were reviewed to determine age, clinical stage,
tumor grade, and progression-free, overall and cause specific survival
status. Results: Of 51 patients 47 to 81 years old (mean age 67.2) with
clinically localized carcinoma 11 had clinical stage B and 40 had stage C
disease. Tumor grade was well differentiated in 11 cases, moderately
differentiated in 26, poorly differentiated in 11 and undetermined in 3.
Recurrence was documented in 40 of the 51 men (78.4%) as local in 34 and
unspecified in 6. Following recurrence all patients were treated with
adjuvant therapy. All but 2 patients were followed until death with a mean
followup of 93.7 months. Of the 51 men 24 (47.1%) died of disease and 17
(33.3%) died of an unspecified cause. Kaplan-Meier analysis demonstrated
median overall progression-free survival of 34 months and median overall
survival of 75 months. Median progression-free survival by grade was 34
months for well differentiated, 36 for moderately differentiated and 14
for poorly differentiated disease (p = 0.0288), and 57 for stage B and 30
for stage C disease (p = 0.0377). Median overall survival by grade was 114
months for well differentiated, 80 for moderately differentiated and 82
for poorly differentiated disease (p= 0.4437), and 60 months for stage B
and 78.5 for stage C disease (p = 0.4915). Conclusions: As performed in
this series cryosurgery was poorly effective for local control of
prostatic carcinoma. Stage and grade correlated with the duration of tumor
response but not with overall survival.
4. Roberts, K P; Smith, D J; Ozturk, H; Kazem, A; Pazhayannur, P V; Hulbert, J
C; Bischof, J C.
Biochemical alterations and tissue viability in AT-1 prostate tumor tissue
after in vitro cryodestruction.
Cryo Letters, v.18, n.4, (1997): 241-250.
Abstract:
This study tested the effect of freezing with cryosurgically-achievable
freezing rates and end-point temperatures on plasma membrane integrity,
protein synthetic activity, and cell survival in cryotreated rat AT-1
prostate tumor tissue. Freezing damage to the cell membranes, as assessed
by protein leakage from the tissue, was approximately equal at all freeze
rates. Protein synthetic activity, measured by the incorporation of
radioactive methionine into secreted and total cellular protein, was lost
in all treatments except the most moderate (5 degree C/min forward arrow
-20 degree C and 10 degree C/min forward arrow -40 degree C). Loss of
chromatin from the nucleus by predominantly necrotic pathways was evident
in all tissue but the preservation of intact DNA was correlated with cell
survival at 5 degree C/min forward arrow -20 degree C and control.
Histologic examination of the tissue after in vitro cryotreatment was
consistent with extensive tissue destruction in samples cooled by LN2
immersion, at 50 degree C/min forward arrow -90 degree C or 35 degree
C/min forward arrow -75 degree C, marginal survival in samples cooled at
10 degree C/min forward arrow -40 degree C, and the highest survival in
samples cooled at 5 degree C/min forward arrow -20 degree C compared to
control. These results show that freezing results in biochemical damage
that reflects loss of cell viability, and that for the freezing rates and
endpoint temperatures tested cell damage is maximal at freeze rates
greater than 10 degree C/min to endpoint temperatures below -40 degree C.
Evidence suggests that of the freezing parameters tested, an end-point
temperature lt -40 degree C is the determining factor in tissue
destruction.
1. Gilbert JC; Rubinsky B; Wong ST; Brennan KM; Pease GR; Leung PP.
Temperature determination in the frozen region during cryosurgery of
rabbit liver using MR image analysis.
Magnetic Resonance Imaging, 1997, 15(6):657-67.
(UI: 97431768)
Abstract: Cryosurgery currently is being used clinically to treat tumors in
internal organs such as the liver and prostate. Although performed at
present under ultrasound monitoring, magnetic resonance imaging
(MRI)-guidance of these procedures not only permits monitoring of the
frozen region during cryosurgery but also makes it possible to determine
the temperature distribution in the frozen region, which is not possible
using ultrasound monitoring. A good estimate of the region of destruction
in the tissue can be obtained from correlating the temperature distribution
and the time course of the freezing with the image of the frozen region.
Unfortunately, MR pulse sequence-based temperature determination techniques
such as diffusion, relaxation time, and chemical shift cannot be used for
measuring the temperature in the frozen region because the T2 of the frozen
regions is so short that there is effectively no RF signal from the frozen
region. This paper describes a numerical technique for determining the two
dimensional temperature distribution in the frozen region during MR
image-guided cryosurgery of normal liver in rabbits. The technique involves
solving the energy equation numerically in the frozen region to determine
the temperature distribution there. The boundary conditions needed to solve
the equation are determined from MR images of the frozen tissue during
cryosurgery and from the measured temperature of the cryoprobe. The
calculated temperature in the frozen region is then correlated with the
damaged region (cryolesion) determined from post mortem histologic
evaluation.
2. Mack D; Jungwirth A; Adam U; Kunit G; Miller K; Dietze O; Frick J.
Long-term follow-up after open perineal cryotherapy in patients with
locally confined prostate cancer.
European Urology, 1997, 32(2):129-32.
(UI: 97432761)
Abstract: OBJECTIVE: Appropriate therapies for locally confined adenocarcinoma
of the prostate are available-but there is as yet no gold standard of
therapy. For that reason, old therapeutic regimens are being revised. One
such regimen is cryotherapy. METHODS: Between 1976 and 1989, 1,250 patients
were seen with newly diagnosed prostate cancer. Sixty-six patients of
stages T1c (n = 3), T2a (n = 32), T2b (n = 9), T2c (n = 11), T3a (n = 4),
T3b (n = 5) and T3c (n = 2) were treated by open perineal cryotherapy. Mean
age was 68 years. Three months after surgery, transurethral resection of
the prostate and/or perineal biopsy was performed. RESULTS: In 66% of
patients with stages T1c-T2b and in 87% of patients with stages T2c-T3c,
positive biopsies were obtained. To date, 28 patients have died between 3
and 16 years after cryotherapy, with a mean survival of 7.2 years. The mean
follow-up period of survivors (38 patients) is 8.5 years. Complications
were: stress-incontinence in 10%, impotence in 10% and temporary
rectoperineal fistula in 8%. CONCLUSIONS: Cryosurgery is an effective
treatment for locally confined prostate cancer. With improvement of the
procedure, clinical outcome may also improve.
3. Pazhayannur PV; Bischof JC.
Measurement and simulation of water transport during freezing in mammalian
liver tissue.
Journal of Biomechanical Engineering, 1997 Aug, 119(3):269-77.
(UI: 97431247)
Abstract: Optimization of cryosurgical procedures on deep tissues such as liver
requires an increased understanding of the fundamental mechanisms of ice
formation and water transport in tissues during freezing. In order to
further investigate and quantify the amount of water transport that occurs
during freezing in tissue, this study reports quantitative and dynamic
experimental data and theoretical modeling of rat liver freezing under
controlled conditions. The rat liver was frozen by one of four methods of
cooling: Method 1-ultrarapid "slam cooling" (> or = 1000 degrees C/min) for
control samples; Method 2-equilibrium freezing achieved by equilibrating
tissue at different subzero temperatures (-4, -6, -8, -10 degrees C);
Method 3-two-step freezing, which involves cooling at 5 degrees C/min. to
-4, -6, -8, -10 or -20 degrees C followed immediately by slam cooling; or
Method 4-constant and controlled freezing at rates from 5-400 degrees
C/min. on a directional cooling stage. After freezing, the tissue was
freeze substituted, embedded in resin, sectioned, stained, and imaged under
a light microscope fitted with a digitizing system. Image analysis
techniques were then used to determine the relative cellular to
extracellular volumes of the tissue. The osmotically inactive cell volume
was determined to be 0.35 by constructing a Boyle van't Hoff plot using
cellular volumes from Method 2. The dynamic volume of the rat liver cells
during cooling was obtained using cellular volumes from Method 3 (two-step
freezing at 5 degrees C/min). A nonlinear regression fit of a Krogh
cylinder model to the volumetric shrinkage data in Method 3 yielded the
biophysical parameters of water transport in rat liver tissue of: Lpg = 3.1
x 10(-13) m3/Ns (1.86 microns/min-atm) and ELp = 290 kJ/mole (69.3
kcal/mole), with chi-squared variance of 0.00124. These parameters were
then incorporated into the Krogh cylinder model and used to simulate water
transport in rat liver tissue during constant cooling at rates between
5-100 degrees C/min. Reasonable agreement between these simulations and the
constant cooling rate freezing experiments in Method 4 were obtained. The
model predicts that the water transport ceases at a relatively high subzero
temperature (-10 degrees C), such that the amount of intracellular ice
forming in the tissue cells rises from almost none (= extensive dehydration
and vascular expansion) at < or = 5 degrees C/min to over 88 percent of the
original cellular water at > or = 50 degrees C/min. The theoretical
simulations based on these experimental methods may be of use in
visualizing and predicting freezing response, and thus can assist in the
planning and implementing of cryosurgical protocols.
4. Dowlati B; Firooz A; Dowlati Y.
Granuloma faciale: successful treatment of nine cases with a combination
of cryotherapy and intralesional corticosteroid injection.
International Journal of Dermatology, 1997 Jul, 36(7):548-51.
(UI: 97413878)
Abstract: BACKGROUND: Granuloma faciale is a rare disorder characterized by
asymptomatic papules, nodules, and plaques on the face. Although the exact
pathogenesis of this disease in unclear, it is considered a variant of
leukocytoclastic vasculitis confined to the skin. Several medical and
surgical methods have been used to treat it with variable results. CASE
REPORTS: We report nine cases of granuloma faciale treated with a
combination of cryotherapy with liquid nitrogen and intralesional injection
of corticosteroids. RESULTS: The lesions cleared completely in all of the
patients without any side-effects. No recurrences have been observed.
CONCLUSIONS: Cryotherapy with liquid nitrogen, followed by intralesional
injection of corticosteroids, is a safe and effective method to treat
granuloma faciale.
5. Bonifaz A; Martinez-Soto E; Carrasco-Gerard E; Peniche J.
Treatment of chromoblastomycosis with itraconazole, cryosurgery, and a
combination of both.
International Journal of Dermatology, 1997 Jul, 36(7):542-7.
Pub type: Clinical Trial; Journal Article.
(UI: 97413877)
Abstract: BACKGROUND: Chromoblastomycosis is a subcutaneous mycosis, seen
frequently in tropical areas, and caused by dematiaceous fungi. It produces
nodulo-verrucous lesions in the arms and legs. There is no treatment of
choice for this disease and sometimes a combination of chemotherapy and
physical therapy is necessary. METHODS: The study included 12 patients
diagnosed with chromoblastomycosis by means of fungal and histopathologic
tests. The patients were assigned to three treatment groups: patients with
small lesions, not greater than 15 cm2 in area, were assigned to Group 1,
in which the treatment consisted of itraconazole 300 mg/day, or to Group 2,
in which the treatment consisted of one or more sessions of open-spray
cryosurgery. Patients with large lesions were assigned to Group 3 and
started treatment with itraconazole 300 mg/day, until a maximal reduction
of lesions occurred, and then underwent one or several cryosurgery
sessions. Clinical, fungal, and laboratory tests were performed in each
group before, during, and at the completion of treatment. RESULTS: Positive
cultures of Fonsecaea pedrosoi were obtained in 11 out of 12 patients. Two
out of four patients in Groups 1 and 3 had a clinical and fungal cure and
the remaining patients experienced significant improvement. All four
patients included in Group 2 achieved a cure. No important side-effects
were seen among the patients included in any of the two itraconazole
groups, and only two out of eight patients reported gastric discomfort. The
cryosurgery group reported only normal complications of the process, such
as edema and pain; two out of eight patients had a superimposed infection.
CONCLUSIONS: The results of itraconazole and cryosurgery were good in cases
with small lesions; antifungal therapy being more appropriate for flexion
areas. The combination of itraconazole, to reduce the size of the lesions,
with subsequent treatment of the remaining lesions with cryosurgery,
represents a new alternative in the treatment of patients with large
lesions. Both types of therapy are considered safe, with few side-effects.
6. Hodor L; Barkal K; Hatch-Fox LD.
Cryogenic denervation of the intermetatarsal space neuroma.
Journal of Foot and Ankle Surgery, 1997 Jul-Aug, 36(4):311-4.
(UI: 97443657)
Abstract: Cryoanalgesia is commonly used by pain management specialists to
alleviate painful nerve disorders of the back, face, and thoracic region.
While cryogenic denervation results in pain relief, there is little to no
incidence of neuritis or amputation-neuroma formation. The authors have
used the Neurostat unit (Westco Medical Corporation), which was designed
for cryogenic denervation of sensory and motor nerves, in the treatment of
the intermetatarsal space neuroma. The authors present an overview of
cryoanalgesic therapy, including a discussion of history, mechanism of
action, indications, and description of the apparatus. The authors submit a
case study of cryogenic denervation of the third intermetatarsal space.
7. Scudamore CH; Patterson EJ; Shapiro AM; Buczkowski AK.
Liver tumor ablation techniques.
Journal of Investigative Surgery, 1997 Jul-Aug, 10(4):157-64.
Pub type: Journal Article; Review; Review, Tutorial.
(UI: 97429683)
Abstract: Despite advances in surgical technique, patients with primary and
secondary liver tumors remain a difficult management problem, as most
tumors are unresectable at presentation. Alternative therapies, involving
the in situ destruction of liver tumors, have recently come under scrutiny
as palliative options. Percutaneous ethanol injection and cryosurgery have
been advocated, but both have associated technical difficulties and adverse
effects. Novel liver tumor ablation techniques have recently been developed
that work via the induction of localized hyperthermia. There is mounting
evidence to support a hypothesis that cancer cells are more selectively
sensitive to heat than are normal cells, due to the poor blood supply of
neoplastic tissue and the decreased vasodilatation capacity of the
neovascular bed. These ablative modalities induce a variable degree of
tumor necrosis in unresectable tumors, and therefore may provide useful
palliation. Clinical trials are needed to determine the true nature and
degree of any palliative benefit. In addition, the determinants of
treatment efficacy and the predictability of the necrotic zone must be
better understood before these techniques can be contemplated as
alternatives to liver resection for cure.
8. Rivoire M; Voiglio EJ; Kaemmerlen P; Molina G; Michot JP; Finzy J; Delay E.
[Cryosurgery of liver neoplasms].
Annales de Chirurgie, 1997, 51(1):54-9.
Language: French.
(UI: 97455594)
Abstract: Cryosurgery is the in situ destruction of tissue using subzero
temperatures. Its use for the treatment of some unresectable liver tumors
has been clearly established as a therapeutic option. Experimental studies
have demonstrated the feasibility of freezing of large liver volumes
without any major metabolic and hemorrhagic complications. Modern
cryosurgery has received substantial impetus from the development of
automated cryosurgical apparatuses using liquid nitrogen. Intraoperative
ultrasound has enhanced the process by enabling visualization of tissue
freezing and ensuring precise and optimal treatment of the tumor. Clinical
reports of cryosurgery for liver primary tumors and metastases have
confirmed the safety of the procedure. Major complications include
myoglobinuria, coagulopathy and pleural effusions. The benefit of
cryosurgery is that it broadens the number of patients that can be brought
to surgery and can potentially become disease-free.
9. [Surveillance of retinal detachment after cryoapplication and indentation].
Journal Francais D Ophtalmologie, 1997, 20(6):487-8.
Language: French.
(UI: 97441826)