Hsiao-Ping Chou

Percutaneous cryoablation for inoperable malignant lung tumors: midterm results.

OBJECTIVE To retrospectively analyze the efficacy and short- to mid-term survival rate of cryoablation for malignant lung tumors. METHODS Percutaneous CT-guided cryoablation for 45 malignant lung tumors in 26 patients during 41 sessions from 2009 to 2013 were performed. Follow up CT-scan were used to determine local tumor progression. Survival rate, local tumor control rate and associated risk factors were analyzed. RESULTS The immediate during and short-term complications with CTCAE grade 2 or upper include pneumothorax (15%), pleural effusion (20%), pulmonary hemorrhage (24%), pneumonitis (15%), hemothorax (15%), hemoptysis (10%), pain (20%), bronchopleural fistula (n=1), and empyema (n=2). Life-threatening bleeding or hemodynamic instability was not observed. There was no procedural-related mortality. Overall survival rate of 1, 2, 3 years are 96%, 88%, 88%. For curative intent, local tumor control (LTC) rate of 1, 2, 3 years are 75%, 72%, 72%. CONCLUSION Cryoablation for malignant lung tumors is effective and feasible in local control of tumor growth, with good short- to mid-term survival rate, as an alternative option for inoperable patients.

Outcome comparison between thoracic endovascular and open repair for type B aortic dissection: A population-based longitudinal study

Background Management of diseases of the descending thoracic aorta is trending from open surgery toward thoracic endovascular aortic repair (TEVAR), because TEVAR is reportedly associated with less perioperative mortality. However, comparisons between TEVAR and open surgery, adjusting for patient comorbidities, have not been well studied. In this nationwide population‐based study, we compared the outcomes between TEVAR and open surgery in type B aortic dissection. Methods From 2003 to 2009, data on patients with type B aortic dissection who underwent either open surgery or TEVAR were obtained from the National Health Insurance Research Database. Survival, length of stay, and complications were compared between TEVAR and open repair. To minimize possible bias, we performed an additional analysis after matching patients by age, sex, and propensity score. Results A total of 1661 patients were identified, of whom 1542 underwent open repair and 119 TEVAR. Patients in the TEVAR group were older (63.0 ± 15.4 years vs. 58.1 ± 13.1 years; p = 0.001), included more males, and had more preoperative comorbidities. Thirty‐day mortality in the TEVAR group was significantly lower than that in the open repair group (4.2% vs. 17.8%; p < 0.001). The midterm survival rates in the unmatched cohort between the open surgery and TEVAR groups at 1 year, 2 years, 3 years, and 4 years were 76%, 73%, 71%, and 68% vs. 92%, 86%, 82%, and 79%, respectively. The length of stay in the TEVAR group was shorter than that in the open repair group (p = 0.001). The TEVAR group had less respiratory failure (p = 0.022) and fewer wound complications than the open repair group (p = 0.008). The matched cohort showed similar results. Conclusion TEVAR for type B aortic dissection repair has less perioperative mortality, a shorter length of hospitalization, a higher midterm survival rate, less postoperative respiratory failure, and fewer wound complications than open surgery.

Image-guided lung tumor ablation: Principle, technique, and current status

&NA; Image‐guided tumor ablation for lung malignancies has emerged as a treatment modality for medically inoperable patients. Overall, image‐guided lung tumor ablation is a minimally invasive procedure that has an acceptable safety profile and less impact on lung function. This is important for patients with poor pulmonary and/or cardiac functions or with multiple comorbidities, which prevent them from undergoing surgery, chemotherapy, and radiation therapy. Herein, we review the principle, techniques, clinical application, and patient outcomes of image‐guided lung tumor ablation.

Evolutionary magnetic resonance appearance of renal cell carcinoma after percutaneous cryoablation

Objective: To determine the evolutionary MRI appearance of renal cell carcinoma (RCC) following cryoablation. Methods: For this institution review board-approved study, we recruited patients with biopsy-proven RCC and treated them with percutaneous cryoablation between November 2009 and October 2014. Two radiologists retrospectively reviewed the pre-procedural and follow-up MRI. The findings included tumour sizes, signal intensities on T1 weighted imaging (T1WI), T2 weighted imaging (T2WI), diffusion-weighted imaging, apparent diffusion coefficient (ADC) map and contrast enhancement patterns. The ADC values of the tumours before and after treatment were measured. Results: A total of 26 patients were enrolled. The ablated tumours exhibited predominantly high signals on T1WI at 1–9-month follow-up (47.1% strong hyperintense at 3 months) and subsequently returned to being isointense. In T2WI, the signals of the ablated tumours were highly variable during the first 3 months and became strikingly hypointense after 6 months (58.3% strong hypointense at 6 months). Diffusion restriction was prominent during the first 3 months (lowest ADC: 0.62 ± 0.29 × 10−3 mm2 s−1 at 1 month). Contrast enhancement persisted up to 6 months after the procedure. The residual enhancement gradually increased in the dynamic scan and was most prominent in the delay phase. Conclusion: The MRI of the cryoablated renal tumour follows a typical evolutionary pattern. Advances in knowledge: Familiarity of practitioners with the normal post-cryoablation change of RCC on MRI can enable the early detection and prevention of tumour recurrence.

Percutaneous computed tomography-guided cryoablation for renal tumor: Experience in 30 cases

Background Percutaneous cryoablation is a minimally invasive alternative for surgical resection of a renal tumor. We report our experience with applying computed tomography‐guided cryoablation in renal tumors, focusing on the technique, safety, and treatment response. Methods We retrospectively reviewed the medical records of patients who received cryoablation from October 2009 to August 2013 for renal tumor diagnosed by imaging studies performed at Taipei Veterans General Hospital, Taipei, Taiwan. Patient comorbidities and tumor morphology, technical success rate, tumor control rate, renal function change, and complications were recorded. Results A total of 30 patients (32 tumors) were treated, comprising 30 renal cell carcinomas and two angiomyolipomas. The mean age of the patients was 73.7 years (range, 34–89 years). The patients were referred for percutaneous cryoablation arising from old age, medical comorbidities, or preexisting malignancy. The mean follow‐up period was 15.2 months (range, from 32 days to 47.4 months). According to the Clavien–Dindo classification, surgical complications included one Grade III, four Grade II, and two Grade I complications. The mean decrease in hemoglobin was 0.77 g/dL (range, from +1.1 g/dL to −3 g/dL). The mean hospital stay after cryoablation was 2.2 days (range, 1–10 days). Incomplete ablation was noted in two patients and local tumor recurrence in two patients. One of them received repeated cryoablation and achieved successful local control. Of the 22 renal cell carcinoma patients with follow‐up period > 6 months, 19 patients achieved successful local tumor control (86.4%). The percentage change of glomerular filtration rate before and 3–6 months after the procedure was +1.9%, which was statistically nonsignificant (p = 0.94). Conclusion Computed tomography‐guided percutaneous cryoablation is a safe and effective technique for treating renal tumors with excellent renal function preservation.

Lung involvement in primary Sjögren's syndrome: Correlation between high-resolution computed tomography score and mortality.

Background: Lung involvement is one of the major systemic manifestations of primary Sjögrens syndrome (pSS). This study aims to demonstrate the correlation between high‐resolution computed tomography (HRCT), pulmonary function test (PFT) results, and outcome in these patients. Methods: Forty‐four pSS patients were enrolled and their PFT results and HRCT findings/scores were retrospectively investigated. Results: All patients had reduced carbon monoxide‐diffusing capacity (DLCO; <75% of the predicted value); <60% of the predicted value of peak expiratory flow (PEF), of forced vital capacity (FVC), and of forced expiratory volume in the 1st second (FEV1) were noted in 15 (34.1%) patients, 13 (29.5%) patients, and 12 (27.3%) patients, respectively. HRCT scores had a negative correlation with DLCO (r = −0.376, p = 0.012), but not with other PFT results. Twelve patients (27.3%) expired during a mean follow‐up of 3.7 years; 11 (91.7%) patients died of respiratory failure in the lung‐involved patients, of which three were present with pneumonia. The expired patients had lower predicted values of FEV1 (63.1 ± 19.4% vs. 79.0 ± 22.7%, p = 0.017), FVC (58.7 ± 20.4% vs. 77.1 ± 17.5%, p = 0.005), and PEF (54.3 ± 20.5% vs. 72.0 ± 24.8%, p = 0.035), and higher HRCT scores (9.2 ± 5.7 vs. 5.2 ± 3.5, p = 0.033) than those patients who survived. Patients with FEV1, FVC, PEF < 60% of the predicted value, or high HRCT score (13–18) presented shorter median overall survival (p = 0.005, p < 0.001, p = 0.021, p < 0.001, respectively). Multivariate analysis adjusted for PFT results showed that HRCT ≥13 was an independent risk factor for mortality (p = 0.007). Conclusion: The clinical outcome of pSS patients with lung involvement in Taiwan is not very favorable. Although HRCT score was poorly correlated with PFT, high HRCT score was significantly associated with higher mortality.

Outcome of mammography screening in Taiwan.

Breast cancer is the most common malignancy occurring in women worldwide. An increasing number of investigators are focusing on the prevention, diagnosis, treatment, and posttreatment care of patients with breast cancer to improve their longevity and quality of life. In addition to the genetic studies contributing to advances in breast cancer prevention and the progress of molecular biochemistry that has facilitated the selection of systemic treatment, substantial efforts in recent decades have led to the development of many effective diagnostic modalities, especially in the early detection of breast cancer. A randomized trial using mammography-based screening for the prevention of breast cancer was conducted in the 1960s and was believed to be associated with a reduction in mortality. The first nationwide population-based screening program started in Finland in 1987. This program grouped patients aged between 50 years and 59 years into cohorts born in odd and even years and obtained the ratio of the detection rate among those women invited to mammographic screening with the rate among those women not invited. This ratio was 1:6. It was further observed that the prevalence of breast cancer detected was 0.4%. Since then, a growing number of studies have reported benefits of reduced mortality from early detection with screening mammograms ranging from 21% to 32%. In these studies, the age of the invited group had a greater range, including populations of women aged 45e50 years and 69e74 years. However, considerable discussion and debate has challenged the long-term benefits of screening mammograms in reducing mortality and, moreover, the extent to which routine screening mammograms could foster overdiagnosis and the unnecessary examination of patients. The incidence of breast cancer in Taiwan has increased rapidly and it has become the most frequently diagnosed cancer in women based on a report by the Health Promotion Administration in the Ministry of Health and Welfare. In 2011, the incidence rate was 64.3 per 100,000 after adjustment for age (the median age was 53 years). The mortality rate is 15.99/ 100,000, which represents 8.7% of all cancer deaths, with a total of 10,056 patients diagnosed with invasive cancer (the 4 highest percentage of all cancer deaths; the median age is 57 years). A total of 1852 women died from breast cancer. Among these patients, the highest incidence of breast cancer was in the group aged 40e49 years and 2157 women aged <45 years 20.6 % were diagnosed with breast cancer. In the

Dynamic computed tomography of angioedema of the small bowel induced by iodinated contrast medium: prompted by coughing-related motion artifact

Small bowel angioedema is a rare adverse effect of iodinated contrast medium. Here, we report the first case of contrast medium-induced small bowel angioedema with concurrent respiratory tract symptoms. A patient with colon cancer underwent CT scanning for preoperative staging. After injection of the contrast medium, a persistent cough developed and CT images showed that the small bowel wall was abnormally thickened. It returned to normal by the follow-up. The persistent coughing that developed right after the CT and small bowel wall thickening on the contrast-enhanced CT suggested the diagnosis of small bowel angioedema induced by the contrast medium.

Progressive Enlarging Symptomatic Mediastinal Mullerian Cyst in a Female Patient with High Estradiol Level

Mullerian cyst is a very rare disease. We reported the case of a 48-year-old woman with a gynecologic abnormality and high estradiol having a progressively enlarging posterior mediastinal cystic mass that caused intermittent chest tightness. The computed tomography and magnetic resonance imaging showed a well-defined cystic mass with homogenous fluid content located in right paravertebral area. The mass was surgically removed and was proven to be Mullerian cyst pathologically.