Maria Pomoni

Percutaneous radiofrequency ablation of renal cell carcinomas in patients with solitary kidney: 6 years experience

OBJECTIVE In this study we attempt to present our clinical experience in RFA under CT-guidance, in patients with renal cell carcinoma in a solitary kidney. MATERIAL AND METHOD Between October 2000 and June 2005, 18 patients with solitary kidney and renal cell carcinoma underwent percutaneous CT-guided radiofrequency ablation in our institution. Tumors diameter ranged from 1 to 7 cm and there was no evidence of spread beyond the kidney. The RFA-system used was with expandable needle electrode (7 or 9 arrays). Technical success, recurrence and survival rate and complications were accessed. Patients were available for clinical and laboratory evaluation at a mean follow-up time of 31.2 months (range: 12-72 months). RESULTS In all cases the electrode was successfully placed at the lesion. The 18 tumors were treated with totally 24 RFA sessions. In small (1-3 cm) exophytic tumors technical success was 85.7%. Residual disease was totally seen in 6/18 tumors which required a 2nd RFA session. The recurrence rate was 11.1% but no recurrence was noticed in tumors less than 3 cm in diameter. No major complications were observed. Serum creatinine values were normal in 17/18 patients till the 3rd-month follow-up. Survival ranged from 12 to 72 months. CONCLUSION RFA is an acceptable alternative for patients with small RCCs in a solitary kidney, which are not ideal candidates for surgical resection as their renal function must be preserved. They have an immediate solution to their clinical problem, under a minimally invasive therapy with no serious complications.

Aorto-enteric fistula: CT findings

The objective of this pictorial essay is to present the different CT findings encountered in patients with aorto-enteric fistulas (AEFs). An AEF is a rare and sometimes disastrous occurrence, responsible for intermittent or massive gastrointestinal hemorrhage and hematemesis. CT provides fast and effective evaluation in hemodynamically stable patients suspected of having an AEF.

Percutaneous radiofrequency thermal ablation in the management of lung tumors: presentation of clinical experience on a series of 35 patients.

PURPOSE To present our results in a series of 35 patients with malignant pulmonary lesions, who underwent radiofrequency thermal ablation (RFA) during a period of 18 months. MATERIALS AND METHODS In our institution, 55 RFA sessions under computed tomography (CT) guidance were performed on 48 pulmonary malignant lesions (23 inoperable primary and 25 metastatic) in 35 patients. RESULTS Total necrosis was noted in 19 primary (82.6%) and in 19 metastatic lesions (76%). In four primary (17.4%) and in six metastatic lesions (14%), partial necrosis was achieved, and a second RFA session was performed. The 6-month spiral CT follow-up demonstrated recurrence in seven lesions (14.5%) (four primary and three metastatic), which were treated with an additional RFA session. Two of the patients who underwent the procedure died of disseminated disease after one year, accounting for a 1-year survival rate of 94.2%. Mean survival was 14.48 +/- 3.3 months. CONCLUSION RFA is an effective method for treating unresectable lung carcinoma and lung metastases.

Percutaneous CT-Guided Core Needle Biopsy Versus Fine Needle Aspiration in Diagnosing Pneumonia and Mimics of Pneumonia

The purpose of this study was to determine the diagnostic value of percutaneous core needle biopsy (CNB) relative to fine needle aspiration (FNA) in patients with pneumonia and pneumonia mimics. In this prospective study we present our experience with 48 thoracic FNAs and CNBs carried out on 48 patients with pneumonia and pneumonia mimics. Samples were obtained from all patients using both CNB (with an automated 18-G core biopsy needle and a gun) and FNA (with a 22-G needle). A specific diagnosis was made in 10/48 cases (20.83%) by FNA and in 42/48 (87.5%) by CNB. The main complications encountered were pneumothorax (n = 4) and hemoptysis (n = 2), yielding a total complication rate of 12.5%. We concluded that CNB using an automated biopsy gun results in a higher diagnostic accuracy for pneumonia and pneumonia mimic biopsies than FNA. Complications should be considered and proper patient observation should follow the procedure.

Post embolization syndrome in doxorubicin eluting chemoembolization with DC bead.

BACKGROUND/AIMS The investigation of post embolization syndrome (PES) in patients with hepatocellular carcinoma (HCC) after treatment with doxorubicin loaded DC Bead (DEB-DOX). METHODOLOGY The study included 237 patients treated with sequential DEB-TACE performed at set time intervals every two months until 3 sessions/6 month f-u. Patients were ECOG 0-1, Child-Stage-A (n=116, 48.9%) and B (n=121, 51%). Embolizations were as selective as possible with DC Bead of 100-300µm in diameter followed by 300-500µm loaded with doxorubicin at 37.5mg/mL of hydrated bead (max:150mg). RESULTS PES regardless of severity was observed in up to 86.5%. However grade 2 PES ranged between 25% and 42.19% across treatments. Temperatures above 38°C were seen in 22.7% to 38.3% across treatments. No statistically significant increase of PES was seen in beads of 100-300µm in diameter; incidence of fever and pain presented correlation with the extent of embolization (p=0.0001-0.006 across treatments). Baseline tumor diameter was associated with incidence of fever (p=0.0001-0.001). Duration of fever correlated with the extent of embolization (p=0.008). PES was not associated with elevation of liver enzymes and was correlated with degree of necrosis (p<0.001). CONCLUSIONS PES after DEB-DOX represents tumor response to treatment and does not represent collateral healthy liver damage.

Infected False Aneurysms of the Limbs Secondary to Chronic Intravenous Drug Abuse: Analysis of Perioperative Considerations and Operative Outcomes

PurposeTo discuss the perioperative considerations and operative outcomes of 26 intravenous (i.v.) drug abusers who presented with infected false aneurysms of the limbs.MethodsThe subjects were 20 men and 6 women with pseudoaneurysms (mean age 34 years, range 19–53 years). The femoral and brachial arteries were most commonly involved. All patients, except for those with active bleeding, underwent digital subtraction angiography or Doppler ultrasonography, or both. Treatment consisted of excision and ligation of the aneurysm and local debridement, followed by revascularization with a vein graft or vein patch angioplasty.ResultsThe presenting symptoms and signs included a pulsatile mass (69%), ischemic pain (23%), active bleeding (38.5%), signs of inflammation (61.5%), and positive blood culture (31%). Bleeding complications developed in two patients, who underwent subsequent extra-anatomic bypass. One of these patients had hip disarticulation and eventually died. None of the remaining patients had claudication or required an amputation. The mean follow-up period was 24 months (range: 3–50 months). Only five (19.2%) patients received drug rehabilitation, whereas the remaining patients admitted to continued drug abuse after discharge from hospital.ConclusionsLimb salvage with immediate revascularization is safe and achieves functionality; therefore, its use is justified. Recidivism and continued abuse is the usual consequence after discharge from hospital, making recovery difficult.

Percutaneous treatment of true splenic cysts: report of two cases

We report two cases of successful percutaneous therapy of epithelial splenic cysts. A 19-year-old woman and a 48-year-old man underwent drainage of their epithelial cysts with subsequent instillation of alcohol into the cavities under computed tomographic guidance.

Radiofrequency ablation of liver metastases from cancer of unknown primary site

PURPOSE This retrospective study was performed to review the efficacy of local radiofrequency ablation (RFA) in all the management of liver cancer of unknown primary site (CUP), and to identify possible prognostic features and complications that affect the efficacy of this treatment on survival. MATERIALS AND METHODS From April 2003 to December 2007, 22 patients (15 men, 7 women) with a total of 36 liver metastasis of CUP and poor response to prior systemic chemotherapy were treated with computed tomography-guided RFA. The median age of patients was 66 years. All patients (22/22) had 1-, 3-, and 6- month follow-up and 8/22 of them had a 12-month followup. RESULTS The overall median survival of all 22 patients was 10.9 months. Survival was better in patients with lesions 3 cm or smaller. No severe complications, including local seeding, were occured. CONCLUSION Our study revealed that RFA appears to be an effective, safe and relatively simple alternative procedure for the local ablation of these lesions. These results are more encouraging for lesions 3 cm or smaller, all of which were successfully treated, as proved by the imaging criteria and the statistical analysis. Further prospective trials are needed to determine whether RFA should be proposed for standard protocols.

Long term recurrence analysis post drug eluting bead (deb) chemoembolization for hepatocellular carcinoma (hcc).

UNLABELLED BACKROUND-AIMS: To determine long term outcomes, regarding recurrence and survival, in patients with HCC that achieved complete response after initial treatment with drug eluting beads (DEB) using DC Bead loaded with doxorubicin (DEB-DOX). METHODOLOGY Forty-five patients with HCC, not suitable for curative treatments that exhibited complete response (EASL criteria) to initial DEB-DOX treatment were retrospectively analyzed after a median follow up period of 63 months. Child-Pugh class was A/B (62.2/37.8%) and mean lesion diameter 5.36 ± 1.1 cm. Lesion morphology was one dominant ≤5cm (53.3%), one dominant >5cm (31.1%) and multifocal (15.6%). RESULTS At 5 years, overall survival was 62.2% and recurrence-free survival 8.9%. All deaths that occurred were related to tumor progression (31.1%) or complications of underlying liver disease (28.9%). Median time of initial recurrence from baseline treatment was 18 months (range 8-52). When recurrence occurred, a mean time interval between additional DEB-DOX procedures less than 9 months was correlated to a poorer prognosis (p=0.025). Multivariate analysis identified Child-Pugh class at baseline (p=0.048), combined therapy of recurrences with local ablation (p=0.03) and number of DEB-DOX procedures (p=0.037) as significant prognostic factors of 5-year survival. Lesion morphology displayed significance for recurrence-free survival (p=0.014). Child-Pugh class at baseline, additional local ablation, pattern of initial recurrence and initial sum of recurrent tumor diameters all displayed statistical significance for post-recurrence survival (median 40 months), with the first two variables maintaining statistical significance in multivariate analysis (p=0.015 and p=0.014 respectively). CONCLUSION Initial complete response to DEB-DOX ensures a favorable prognosis. However, management of recurrent tumors, which occur frequently mostly as new lesions, and preservation of underlying liver function appear to play a key role in prolonging survival.

Image-Guided Radiofrequency Ablation of a Pancreatic Tumor with a New Triple Spiral-Shaped Electrode

Image-guided, minimally invasive treatment modalities have become an area of considerable interest and research during the last few years for the treatment of primary and secondary liver tumors. We report our experience with an unresectable pancreatic tumor, treated with application of radiofrequency ablation under CT guidance that even though a complication occurred during the procedure, had excellent results on follow-up CT scans.