M Rauch

Novel Non-invasive Treatment With High-intensity Focused Ultrasound (HIFU).

Ultrasound is not only used for diagnostic purposes but it also can be applied therapeutically so far thatxa0nowadays high-intensity focused ultrasound (HIFU) even represents a novel non-invasive treatment modality for various solid tumors. HIFU works by causing selectively deep tissue destruction of target lesions within the body without harming adjacent and overlying structures. In this article, we present an overview on both the mode of action and requirements for a HIFU treatment asxa0well as on the safety and the current status of indications and possible applications with regard to benign and malignant gynecological diseases. Based on numerous studies and original articles, HIFU proved to be an effective and low-risk treatment option particularly for uterine fibroids and adenomyosis, but it also seems to be effective for breast fibroadenomas or even for breast cancer in special cases and other rare entities.

[High-intensity focused ultrasound (HIFU) for tumor pain relief in inoperable pancreatic cancer : Evaluation with the pain sensation scale (SES)].

ZusammenfassungHintergrundZur Reduktion von Tumorschmerzen beim inoperablen Pankreaskarzinom bietet der hochintensive fokussierte Ultraschall (HIFU) in Kombination mit einer palliativen Standardtherapie eine wirksame und innovative Behandlungsoption.Ziel der Arbeit/FragestellungAuswirkung der additiven Ultraschall(US)-gesteuerten HIFU-Behandlung bei inoperablem Pankreaskarzinom auf die sensorische und affektive Schmerzempfindung anhand der Schmerzempfindungsskala (SES).Material und MethodenZwanzig Patienten mit lokal fortgeschrittenem Pankreaskarzinom und tumorassoziierter Schmerzsymptomatik wurden mittels US-gesteuertem HIFU behandelt (nxa0= 6:xa0Stadiumxa0III, nxa0= 12: Stadiumxa0IV nach UICC, nxa0= 2: Rezidiv nach Operation). Die klinische Evaluation der tumorassoziierten Schmerzsymptomatik erfolgte durch validierte Messinstrumente (SES, numerische Rating-Skala [NRS]) mit besonderem Augenmerk auf der SES mit ihrer affektiven und sensorischen Komponente.ErgebnisseNach HIFU kam es bei 15/20xa0Patienten (75u2009%) zu einer durchschnittlichen Schmerzreduktion auf der NRS-Skala von 2,87xa0Punkten und damit zu einer Linderung des Schmerzniveaus um 57,3u2009% unterhalb des initialen mittleren Ausgangswertes. Bei 4xa0Patienten ohne postinterventionelle NRS-Änderung konnte die vorherige Opioidbasismedikation beendet (nxa0= 2) oder die analgetische Medikation (nxa0= 2) reduziert werden. Darüber hinaus konnten sowohl die schmerzbedingte emotionale Belastung als auch die sensorische Schmerzempfindung signifikant reduziert werden (pxa0< 0,05 für alle Global- und Teilskalen). Bei einem Patienten wurde keine Schmerzreduktion erreicht.SchlussfolgerungDer US-gesteuerte HIFU kann zu einer effektiven Schmerzlinderung und Reduktion der affektiven und sensorischen Schmerzempfindung bei Patienten mit fortgeschrittenem Pankreaskarzinom eingesetzt werden.AbstractBackgroundHigh-intensity focused ultrasound (HIFU) in combination with palliative standard therapy is an innovative and effective treatment option for pain reduction in patients with inoperable pancreatic cancer.ObjectiveEvaluation of the effects of additive ultrasound (US)-guided HIFU treatment in inoperable pancreatic cancer on the sensory and affective pain perception using validated questionnaries.Material and methodsIn this study 20 patients with locally advanced inoperable pancreatic cancer and tumor-related pain were treated by US-guided HIFU (6xa0stagexa0III, 12xa0stagexa0IV according to UICC and 2xa0with local recurrence after surgery). Ablation was performed using the JC HIFU system (HAIFU, Chongqing, China) with an ultrasonic device for real-time imaging. Clinical assessment included evaluation of pain severity using validated questionnaires with particular attention to the pain sensation scale (SES) with its affective and sensory component and the numeric rating scale (NRS).ResultsThe average pain reduction after HIFU was 2.87 points on the NRS scale and 57.3u2009% compared to the mean baseline score (nxa0= 15, 75u2009%) in 19 of 20 treated patients. Four patients did not report pain relief, however, the previous opioid medication could be stopped (nxa0= 2) or the analgesic dosage could be reduced (nxa0= 2). No pain reduction was achieved in one patient. Furthermore, after HIFU emotional as well as sensory pain aspects were significantly reduced (before vs. 1xa0week after HIFU, pxa0< 0.05 for all pain scales).ConclusionUS-guided HIFU can be used for effective and early pain relief and reduction of emotional and sensory pain sensation in patients with locally advanced pancreatic cancer.BACKGROUNDnHigh-intensity focused ultrasound (HIFU) in combination with palliative standard therapy is an innovative and effective treatment option for pain reduction in patients with inoperable pancreatic cancer.nnnOBJECTIVEnEvaluation of the effects of additive ultrasound (US)-guided HIFU treatment in inoperable pancreatic cancer on the sensory and affective pain perception using validated questionnaries.nnnMATERIAL AND METHODSnIn this study 20 patients with locally advanced inoperable pancreatic cancer and tumor-related pain were treated by US-guided HIFU (6xa0stagexa0III, 12xa0stagexa0IV according to UICC and 2xa0with local recurrence after surgery). Ablation was performed using the JC HIFU system (HAIFU, Chongqing, China) with an ultrasonic device for real-time imaging. Clinical assessment included evaluation of pain severity using validated questionnaires with particular attention to the pain sensation scale (SES) with its affective and sensory component and the numeric rating scale (NRS).nnnRESULTSnThe average pain reduction after HIFU was 2.87 points on the NRS scale and 57.3u2009% compared to the mean baseline score (nxa0= 15, 75u2009%) in 19 of 20 treated patients. Four patients did not report pain relief, however, the previous opioid medication could be stopped (nxa0= 2) or the analgesic dosage could be reduced (nxa0= 2). No pain reduction was achieved in one patient. Furthermore, after HIFU emotional as well as sensory pain aspects were significantly reduced (before vs. 1xa0week after HIFU, pxa0< 0.05 for all pain scales).nnnCONCLUSIONnUS-guided HIFU can be used for effective and early pain relief and reduction of emotional and sensory pain sensation in patients with locally advanced pancreatic cancer.

Hochintensiver fokussierter Ultraschall (HIFU) zur Linderung tumorbedingter Schmerzen bei inoperablem Pankreaskarzinom

ZusammenfassungHintergrundZur Reduktion von Tumorschmerzen beim inoperablen Pankreaskarzinom bietet der hochintensive fokussierte Ultraschall (HIFU) in Kombination mit einer palliativen Standardtherapie eine wirksame und innovative Behandlungsoption.Ziel der Arbeit/FragestellungAuswirkung der additiven Ultraschall(US)-gesteuerten HIFU-Behandlung bei inoperablem Pankreaskarzinom auf die sensorische und affektive Schmerzempfindung anhand der Schmerzempfindungsskala (SES).Material und MethodenZwanzig Patienten mit lokal fortgeschrittenem Pankreaskarzinom und tumorassoziierter Schmerzsymptomatik wurden mittels US-gesteuertem HIFU behandelt (nxa0= 6:xa0Stadiumxa0III, nxa0= 12: Stadiumxa0IV nach UICC, nxa0= 2: Rezidiv nach Operation). Die klinische Evaluation der tumorassoziierten Schmerzsymptomatik erfolgte durch validierte Messinstrumente (SES, numerische Rating-Skala [NRS]) mit besonderem Augenmerk auf der SES mit ihrer affektiven und sensorischen Komponente.ErgebnisseNach HIFU kam es bei 15/20xa0Patienten (75u2009%) zu einer durchschnittlichen Schmerzreduktion auf der NRS-Skala von 2,87xa0Punkten und damit zu einer Linderung des Schmerzniveaus um 57,3u2009% unterhalb des initialen mittleren Ausgangswertes. Bei 4xa0Patienten ohne postinterventionelle NRS-Änderung konnte die vorherige Opioidbasismedikation beendet (nxa0= 2) oder die analgetische Medikation (nxa0= 2) reduziert werden. Darüber hinaus konnten sowohl die schmerzbedingte emotionale Belastung als auch die sensorische Schmerzempfindung signifikant reduziert werden (pxa0< 0,05 für alle Global- und Teilskalen). Bei einem Patienten wurde keine Schmerzreduktion erreicht.SchlussfolgerungDer US-gesteuerte HIFU kann zu einer effektiven Schmerzlinderung und Reduktion der affektiven und sensorischen Schmerzempfindung bei Patienten mit fortgeschrittenem Pankreaskarzinom eingesetzt werden.AbstractBackgroundHigh-intensity focused ultrasound (HIFU) in combination with palliative standard therapy is an innovative and effective treatment option for pain reduction in patients with inoperable pancreatic cancer.ObjectiveEvaluation of the effects of additive ultrasound (US)-guided HIFU treatment in inoperable pancreatic cancer on the sensory and affective pain perception using validated questionnaries.Material and methodsIn this study 20 patients with locally advanced inoperable pancreatic cancer and tumor-related pain were treated by US-guided HIFU (6xa0stagexa0III, 12xa0stagexa0IV according to UICC and 2xa0with local recurrence after surgery). Ablation was performed using the JC HIFU system (HAIFU, Chongqing, China) with an ultrasonic device for real-time imaging. Clinical assessment included evaluation of pain severity using validated questionnaires with particular attention to the pain sensation scale (SES) with its affective and sensory component and the numeric rating scale (NRS).ResultsThe average pain reduction after HIFU was 2.87 points on the NRS scale and 57.3u2009% compared to the mean baseline score (nxa0= 15, 75u2009%) in 19 of 20 treated patients. Four patients did not report pain relief, however, the previous opioid medication could be stopped (nxa0= 2) or the analgesic dosage could be reduced (nxa0= 2). No pain reduction was achieved in one patient. Furthermore, after HIFU emotional as well as sensory pain aspects were significantly reduced (before vs. 1xa0week after HIFU, pxa0< 0.05 for all pain scales).ConclusionUS-guided HIFU can be used for effective and early pain relief and reduction of emotional and sensory pain sensation in patients with locally advanced pancreatic cancer.BACKGROUNDnHigh-intensity focused ultrasound (HIFU) in combination with palliative standard therapy is an innovative and effective treatment option for pain reduction in patients with inoperable pancreatic cancer.nnnOBJECTIVEnEvaluation of the effects of additive ultrasound (US)-guided HIFU treatment in inoperable pancreatic cancer on the sensory and affective pain perception using validated questionnaries.nnnMATERIAL AND METHODSnIn this study 20 patients with locally advanced inoperable pancreatic cancer and tumor-related pain were treated by US-guided HIFU (6xa0stagexa0III, 12xa0stagexa0IV according to UICC and 2xa0with local recurrence after surgery). Ablation was performed using the JC HIFU system (HAIFU, Chongqing, China) with an ultrasonic device for real-time imaging. Clinical assessment included evaluation of pain severity using validated questionnaires with particular attention to the pain sensation scale (SES) with its affective and sensory component and the numeric rating scale (NRS).nnnRESULTSnThe average pain reduction after HIFU was 2.87 points on the NRS scale and 57.3u2009% compared to the mean baseline score (nxa0= 15, 75u2009%) in 19 of 20 treated patients. Four patients did not report pain relief, however, the previous opioid medication could be stopped (nxa0= 2) or the analgesic dosage could be reduced (nxa0= 2). No pain reduction was achieved in one patient. Furthermore, after HIFU emotional as well as sensory pain aspects were significantly reduced (before vs. 1xa0week after HIFU, pxa0< 0.05 for all pain scales).nnnCONCLUSIONnUS-guided HIFU can be used for effective and early pain relief and reduction of emotional and sensory pain sensation in patients with locally advanced pancreatic cancer.

Mesenteric Vessel Patency Following HIFU Therapy in Patients with Locally Invasive Pancreatic Cancer

PURPOSEnu2002To evaluate the effects of HIFU therapy on visceral vessel patency in patients with inoperable locally invasive pancreatic cancer.nnnMATERIALS AND METHODSnu200250 pancreatic cancer patients (26xa0men, 24 women) aged 41u200a-u200a82 years (65.0u200a±u200a10.2) underwent ultrasonography (US) and computed tomography (CT) examinations before and within one day after HIFU treatment, as well as at follow-up at six weeks, three months and six months. Evaluation and grading were performed by two experienced independent radiologists according to a classification scheme based on vessel involvement, vessel diameter, patency, and defects in flow.nnnRESULTSnu2002Before HIFU treatment, arterial vessel involvement was noted in 42 patients, venous involvement in 47, and 47 patients presented with both. Superior mesenteric artery occlusion was found in three carcinomas while nearly half of the cases (nu200a=u200a24) displayed signs of superior mesenteric vein, portal vein, or splenic vein occlusion. High-grade tumor-associated arterial narrowing was seen in ten patients. Despite vessel encasement and partially extensive propagation of collateral vessels, it was possible to safely perform HIFU treatment in all patients without complications. US and CT studies performed within one day after therapy did not show any change in vessel patency in 47 patients (94u200a%). Follow-up controls at the six-week mark revealed increased vessel narrowing and finally occlusion after six months in 11 patients due to tumor progression.nnnCONCLUSIONnu2002This study demonstrates that HIFU treatment can be safely applied to pancreatic cancers enveloping large mesenteric vessels despite vessel narrowing or extensive collateral propagation. Most patients (94u200a%) did not experience adverse effects regarding vessel patency.

Hochintensiver fokussierter Ultraschall (HIFU) zur Linderung tumorbedingter Schmerzen bei inoperablem Pankreaskarzinom@@@High-intensity focused ultrasound (HIFU) for tumor pain relief in inoperable pancreatic cancer: Evaluation anhand der Schmerzempfindungsskala (SES)@@@Evaluation with the pain sensation scale (SES)

ZusammenfassungHintergrundZur Reduktion von Tumorschmerzen beim inoperablen Pankreaskarzinom bietet der hochintensive fokussierte Ultraschall (HIFU) in Kombination mit einer palliativen Standardtherapie eine wirksame und innovative Behandlungsoption.Ziel der Arbeit/FragestellungAuswirkung der additiven Ultraschall(US)-gesteuerten HIFU-Behandlung bei inoperablem Pankreaskarzinom auf die sensorische und affektive Schmerzempfindung anhand der Schmerzempfindungsskala (SES).Material und MethodenZwanzig Patienten mit lokal fortgeschrittenem Pankreaskarzinom und tumorassoziierter Schmerzsymptomatik wurden mittels US-gesteuertem HIFU behandelt (nxa0= 6:xa0Stadiumxa0III, nxa0= 12: Stadiumxa0IV nach UICC, nxa0= 2: Rezidiv nach Operation). Die klinische Evaluation der tumorassoziierten Schmerzsymptomatik erfolgte durch validierte Messinstrumente (SES, numerische Rating-Skala [NRS]) mit besonderem Augenmerk auf der SES mit ihrer affektiven und sensorischen Komponente.ErgebnisseNach HIFU kam es bei 15/20xa0Patienten (75u2009%) zu einer durchschnittlichen Schmerzreduktion auf der NRS-Skala von 2,87xa0Punkten und damit zu einer Linderung des Schmerzniveaus um 57,3u2009% unterhalb des initialen mittleren Ausgangswertes. Bei 4xa0Patienten ohne postinterventionelle NRS-Änderung konnte die vorherige Opioidbasismedikation beendet (nxa0= 2) oder die analgetische Medikation (nxa0= 2) reduziert werden. Darüber hinaus konnten sowohl die schmerzbedingte emotionale Belastung als auch die sensorische Schmerzempfindung signifikant reduziert werden (pxa0< 0,05 für alle Global- und Teilskalen). Bei einem Patienten wurde keine Schmerzreduktion erreicht.SchlussfolgerungDer US-gesteuerte HIFU kann zu einer effektiven Schmerzlinderung und Reduktion der affektiven und sensorischen Schmerzempfindung bei Patienten mit fortgeschrittenem Pankreaskarzinom eingesetzt werden.AbstractBackgroundHigh-intensity focused ultrasound (HIFU) in combination with palliative standard therapy is an innovative and effective treatment option for pain reduction in patients with inoperable pancreatic cancer.ObjectiveEvaluation of the effects of additive ultrasound (US)-guided HIFU treatment in inoperable pancreatic cancer on the sensory and affective pain perception using validated questionnaries.Material and methodsIn this study 20 patients with locally advanced inoperable pancreatic cancer and tumor-related pain were treated by US-guided HIFU (6xa0stagexa0III, 12xa0stagexa0IV according to UICC and 2xa0with local recurrence after surgery). Ablation was performed using the JC HIFU system (HAIFU, Chongqing, China) with an ultrasonic device for real-time imaging. Clinical assessment included evaluation of pain severity using validated questionnaires with particular attention to the pain sensation scale (SES) with its affective and sensory component and the numeric rating scale (NRS).ResultsThe average pain reduction after HIFU was 2.87 points on the NRS scale and 57.3u2009% compared to the mean baseline score (nxa0= 15, 75u2009%) in 19 of 20 treated patients. Four patients did not report pain relief, however, the previous opioid medication could be stopped (nxa0= 2) or the analgesic dosage could be reduced (nxa0= 2). No pain reduction was achieved in one patient. Furthermore, after HIFU emotional as well as sensory pain aspects were significantly reduced (before vs. 1xa0week after HIFU, pxa0< 0.05 for all pain scales).ConclusionUS-guided HIFU can be used for effective and early pain relief and reduction of emotional and sensory pain sensation in patients with locally advanced pancreatic cancer.BACKGROUNDnHigh-intensity focused ultrasound (HIFU) in combination with palliative standard therapy is an innovative and effective treatment option for pain reduction in patients with inoperable pancreatic cancer.nnnOBJECTIVEnEvaluation of the effects of additive ultrasound (US)-guided HIFU treatment in inoperable pancreatic cancer on the sensory and affective pain perception using validated questionnaries.nnnMATERIAL AND METHODSnIn this study 20 patients with locally advanced inoperable pancreatic cancer and tumor-related pain were treated by US-guided HIFU (6xa0stagexa0III, 12xa0stagexa0IV according to UICC and 2xa0with local recurrence after surgery). Ablation was performed using the JC HIFU system (HAIFU, Chongqing, China) with an ultrasonic device for real-time imaging. Clinical assessment included evaluation of pain severity using validated questionnaires with particular attention to the pain sensation scale (SES) with its affective and sensory component and the numeric rating scale (NRS).nnnRESULTSnThe average pain reduction after HIFU was 2.87 points on the NRS scale and 57.3u2009% compared to the mean baseline score (nxa0= 15, 75u2009%) in 19 of 20 treated patients. Four patients did not report pain relief, however, the previous opioid medication could be stopped (nxa0= 2) or the analgesic dosage could be reduced (nxa0= 2). No pain reduction was achieved in one patient. Furthermore, after HIFU emotional as well as sensory pain aspects were significantly reduced (before vs. 1xa0week after HIFU, pxa0< 0.05 for all pain scales).nnnCONCLUSIONnUS-guided HIFU can be used for effective and early pain relief and reduction of emotional and sensory pain sensation in patients with locally advanced pancreatic cancer.

Cardiovascular Computed Tomography Findings after Pneumonectomy

RATIONALE AND OBJECTIVESnTo identify and compare cardiovascular findings on computed tomography (CT) scans after pneumonectomy (PNX) with those after lobectomy (LOBX).nnnMATERIALS AND METHODSnPre- and postoperative CT scans from 25 PNX patients were retrospectively analyzed and compared to those from 30 LOBX patients. The diameter of the main pulmonary artery (PA) and its ratio to the ascending aorta (PA/Ao) were determined. Cardiac morphometry values were ascertained by measuring maximum diameters of the right and left ventricle on axial (RVaxial, LVaxial) and four-chamber (RV4-ch, LV4-ch) views. RVaxial/LVaxial and RV4-ch/LV4-ch ratios were calculated. Vessel stumps were evaluated for thrombosis.nnnRESULTSnAfter PNX, PA (31.1u2009±u20095.8u2009mm vs 28.7u2009±u20095.4u2009mm, Pu2009=u20090.003), PA/Ao (0.97u2009±u20090.15 vs 0.86u2009±u20090.12, Pu2009=u20090.0001), and cardiac morphometry values significantly increased (RVaxial 43.6u2009±u20097.4 vs 39.4u2009±u20097.1, Pu2009=u20090.029; RV4-ch 41.1u2009±u20096.3 vs 37.6u2009±u20095.7, Pu2009=u20090.041; RVaxial/LVaxial 1.18u2009±u20090.27 vs 1.03u2009±u20090.22, Pu2009=u20090.04; RV4-ch/LV4-ch 1.17u2009±u20090.21 vs 1.02u2009±u20090.16, Pu2009=u20090.03). There were no significant differences between right and left PNX. One case of PA stump thrombosis was identified after right PNX. LOBX resulted in a significant increase in PA (30.6u2009±u20094.3 vs 28.7u2009±u20093.5, Pu2009=u20090.005) and PA/Ao (0.90u2009±u20090.09 vs 0.85u2009±u20090.10, Pu2009=u20090.017), whereas cardiac morphometry values were not significantly changed compared to baseline values. No vessel stump thrombosis was observed after LOBX. In comparison to LOBX, all ascertained values were significantly elevated after PNX.nnnCONCLUSIONSnMorphologic alterations of the cardiovascular system following PNX can be identified on CT scans. Alterations are more distinct after PNX compared to LOBX.