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Hemorrhagic bullae after cryosurgery in a patient with hemophilia A.

BACKGROUND: A case of hemorrhagic bullae and blisters on the hand of a patient with hemophilia A after cryosurgery for verruca vulgaris is reported. OBJECTIVE: To discuss a hemorrhagic complication in a patient with hemophilia A after cutaneous cryosurgery. METHODS: This is an observatory case report. RESULTS: Even minimal cryosurgery can induce hemorrhagic bullae in patients with hemophilia A. CONCLUSION: The risks and benefits of cryosurgery should be weighed carefully in patients with bleeding disorders such as hemophilia.

Blister↗

Front-tracking image reconstruction algorithm for EIT-monitored cryosurgery using the boundary element method.

The effectiveness of cryosurgery, treatment of tumors by freezing, is highly dependent on knowledge of transient freezing extent, and therefore relies heavily on real-time imaging techniques for monitoring. Electrical impedance tomography (EIT) holds much promise for this application. In cryosurgery there is a three order of magnitude change in impedance across the freezing boundary and there is a priori knowledge of the freezing origin. Furthermore, an EIT image of the tissue can be done prior to the cryosurgery. In this study, we have developed an EIT front tracking reconstruction algorithm which takes advantage of these particular attributes of cryosurgery. The method tracks the freezing interface rather than the impedance distribution in the freezing tissue. In addition to drastically reducing the number of parameters needed to define the image, the computational complexity is further reduced by using the more appropriate boundary element method (BEM) for solution to the forward problem. The front-tracking method was found to converge rapidly and accurately to a variety of simulated phantom images.

Algorithms↗

Hepatic cryosurgery for liver metastases. Long-term follow-up.

OBJECTIVE: The aim of this prospective study was to evaluate the applicability of cryogenic and conventional surgery in treating liver metastases (LM) with respect to intraoperative tumor reduction and survival rate. SUMMARY BACKGROUND DATA: As have been shown in animal experiments as well as in clinical investigations, cryosurgery has been used for the treatment of many benign and malignant conditions. For the first time, this report summarizes a 10-year follow-up clinical experience with cryosurgery for treatment of LM from 1983 to 1992. METHODS: One hundred twenty-three patients with LM (87 males and 36 females, a ratio 2.4:1.0; age, 41.3 +/- 12.1 years) were stratified and entered into a long-term prospective, randomized clinical trial for cryogenic surgery in group 1 (n = 63) and conventional surgical techniques in group 2 (control subjects, n = 60). Principally, a self-constructed cryogenic clamp was used for hepatic cryoresection with preliminary freezing of the margin resection by a cryosurgical system "Cryoelectronic-2" or "Cryoelectronic-4". Hepatic cryoextirpation (cryoablation) and hepatic cryodestruction were performed by means of probes of different roughly disk design from phi 5 mm to 55 mm by volume of frozen zone of 40 cm3 to 180 cm3 for approximately 7 to 32 minutes. RESULTS: In most cases in group 1 and group 2, LM were based on colorectal cancers (65% vs. 68%). The hepatic cryosurgical procedures in group 1 included cryoextirpation (29 patients, 46%), cryoresection (20 patients, 32%), and cryodestruction (14 patients, 22%) solely. Clinical and laboratory parameters showed that the curative effects were significantly higher in group 1 than in group 2. The 3-year survival rate was in group 1 and group 2 (60% vs. 51%, respectively). The 5-year survival rate was 44% in group 1 and 36% in group 2. Twelve patients (19%) versus 5 patients (8%) in group 1 and group 2, respectively, survived 10 years. The disease-free survival was in group 1 and group 2 (30% vs. 18%, respectively). During a follow-up period, recurrence in the liver was observed in 54 patients (85%) in group 1 and in 57 patients (95%) in control subjects. After a 10-year follow-up period in group 1 and group 2, 9 patients (14%) versus 3 patients (5%) remained disease free, 3 patients (4%) versus 2 patients (3%) were surviving with disease, and 51 patients (81%) versus 55 patients (92%) died. CONCLUSIONS: The data of this 10-year prospective, randomized clinical trial suggest that hepatic cryosurgery is effective in the treatment of resectable and nonresectable LM. The results show intraoperative tumor reduction (> or = 90% < or = 97%) and extended higher survival in these patients. The study indicated a 5-year and 10-year survival rate of 44% and 19% after cryosurgery, respectively.

Cryosurgery↗

Unusual skin depigmentation following eyelid cryosurgery.

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.

Aged↗

Cryosurgery of the anus.

To further study the effectiveness of cryosurgery of the anus, cryolesions were produced in the rectum of pigs and healing was followed by microangiography and histologic study. In addition, cryosurgery was used on 105 patients (35 as outpatients) with anal pathologic lesions. Results demonstrated that cryosurgery is an effective method of curing most anal lesions. Since the method produced partial anesthesia, postoperative pain was decreased. The cryolesions healed rapidly and well, without major complications. The experimental work demonstrated destruction of the submucosal veins without distortion of muscles or excessive scarring. The mucosa sloughed but healed within two weeks. Cryosurgery makes office hemorrhoidectomy a reality.

Anal Canal↗

Assessment of the efficacy of cryosurgery in the treatment of granuloma faciale.

BACKGROUND: Granuloma faciale (GF) is an uncommon dermatosis of unknown pathogenesis. Multiple treatments have been proposed with varying results. We report nine cases treated successfully with cryosurgery and we review the literature. OBJECTIVES: To study the efficacy, tolerability and safety of cryosurgery techniques in the treatment of GF. METHODS: Nine immunocompetent adults with GF were treated by cryosurgery. The initiation of the therapy was preceded by a 60-day washout period in all subjects using other medication. Two different techniques were used (open-spray and contact cryo-probe). RESULTS: All patients were treated successfully. Apart from mild postinflammatory hypopigmentation in two patients that resolved within 4 months, no other adverse event was mentioned. During an average 24-month follow-up period after the integration of therapy, no recurrences were observed. CONCLUSIONS: Cryosurgery is an efficient, safe, inexpensive, easily used method for this uncommon dermatosis, which can be proposed as a treatment of first intention.

Adult↗

Cryosurgery of malignant and premalignant diseases of the skin: a simple approach.

Cryosurgical treatment of skin cancer and premalignant conditions of the skin has been in widespread use for 20 years. Data accumulated over this period suggest that if attention is paid to the treatment technique and to lesion selection, then cure rates equivalent to radiotherapy, simple surgical excision, and curettage and cautery can be achieved reliably. Moh's micrographic surgery offers a higher cure rate for skin cancer, but is not suitable for the vast majority of lesions seen in clinical practice. The decision to use cryosurgery to treat any particular lesion will therefore be influenced by a number of other considerations. Cryosurgery competes well on morbidity and cosmetic outcome and is the quickest, easiest, cheapest and most readily available of the treatment options. As such it has earned its place among the recognized treatment modalities for skin cancers as well as premalignant conditions of the skin. Cryosurgery is commonly delivered empirically without record of the dose delivered and without audit of the outcome. The aim of this review is to describe in detail one standard technique of therapy that is easily reproduced and has been audited; the timed spot freeze technique. This technique can be used, even by those inexperienced in cryosurgery, to achieve predictable success rates. Many other techniques do exist, but either have not been audited or are unnecessarily cumbersome.

Basal Cell Carcinoma↗

Percutaneous cryosurgery for renal tumours.

OBJECTIVE: To evaluate the use of percutaneous cryosurgery in the treatment of renal tumours. MATERIALS AND METHODS: A cryoprobe using liquid nitrogen was designed. The tolerance of renal cancer cells to cooling was tested. Freezing tests on two extirpated kidneys involved with hypervascular tumour were performed in water at 40 degrees C. A clinical trial of percutaneous cryosurgery was carried out in two patients with advanced renal carcinoma. RESULTS: The cooling function of the new probe was similar to that of a conventional probe. The tolerance test on renal cancer cells showed that the cooling temperature should be below -20 degrees C to render them necrotic. Freezing tests on two nephrectomized kidneys with hypervascular renal cancer suggested that embolization of the renal artery might be advisable before treatment. The clinical trial in two patients with advanced renal carcinoma showed that the whole kidney, including the tumour, became necrotic and shrunken post-operatively. The patients' Karnofsky performance scale showed a marked improvement 3 months after the operation, but their general condition gradually deteriorated. Patient 1 died 10 months and patient 2 died 5 months after the procedure. CONCLUSION: Percutaneous cryosurgery was performed successfully in two patients with hypervascular renal tumours. Cryo-immunological activity was assumed to have contributed to the temporary improvement in their condition. These results suggest that percutaneous cryosurgery might be useful as minimally invasive treatment in a limited number of patients with advanced renal carcinoma.

Aged↗

Prostate cancer: metabolic response to cryosurgery as detected with 3D H-1 MR spectroscopic imaging.

PURPOSE: To determine, in patients with prostate cancer treated with cryosurgery, whether levels of choline and citrate measured at magnetic resonance (MR) spectroscopy can help discriminate regions of residual tumor from other prostatic tissues and necrosis. MATERIALS AND METHODS: Combined MR imaging and three-dimensional proton spectroscopic imaging were performed in 25 patients (mean age, 69 years) with prostate cancer who underwent cryosurgery. Volume imaging and spectroscopic data were analytically corrected for the reception profile of the endorectal and pelvic phased-array coils. Spectral data were aligned with the MR imaging data and compared with serum prostate-specific antigen levels and biopsy results. RESULTS: Histologically confirmed necrotic tissue (432 voxels) did not demonstrate any observable choline or citrate. The (choline + creatine)/ citrate values in regions of histologically confirmed benign prostatic hyperplasia (0.61 +/- 0.21 [standard deviation], 52 voxels) and cancer (2.4 +/- 1.0, 65 voxels) after cryosurgery were not statistically significantly different from those before therapy but were statistically significantly different from the ratio in necrotic tissue and from each other. The (choline + creatine)/citrate images threshold and overlaid in color on T2-weighted images yielded an estimate of the spatial extent of prostate cancer and benign prostatic hyperplasia. CONCLUSION: Volume MR imaging with MR spectroscopic imaging provided a noninvasive assessment of the presence and location of residual cancer after unsuccessful therapy and helped identify successful cryosurgery in patients who still had an elevated prostate-specific antigen level.

Aged↗

Cryosurgery and laser surgery in the treatment of malignant and benign laryngeal processes.

Cryosurgery of the larynx is still in the stage of development. In the treatment of laryngeal papillomas cryosurgery has been quite successful. The use of cryosurgery in laryngo-hypopharyngeal carcinoma and in laryngeal stenosis is still restricted to special indications (old age, risk patients). A combination of cryosurgery and telecobalt irradiation has proven valuable in the management of tumors. After the basic physics of laser radiation are explained, the principle mechanisms of interaction between the CO2 laser on human tissue are mentioned. This is followed by the description of the different indications for laser surgery in the larynx. A chordectomy and the opening of a subglottic stenosis with the laser beam are described and documented with photographs. Finally, there is an outlook to an eventually broader spectrum of indications for laser surgery in the field of ent.

Adult↗

Freezing index in cryosurgery on the prostate gland.

Cryosurgery has been performed on 18 patients with prostatic hypertrophy, and the following conclusions are reached: The quotient obtained by dividing the estimated weight of the prostate gland by the frozen weight obtained by an equation is called the freezing index, and this index can be introduced into the evaluation of the results of cryosurgery on the prostate gland. Cryosurgery was not markedly effective in cases of freezing indices over 0.76, and the incidence of complications was high in cases of freezing indices not more than 0.5. The ideal freezing index obtained empirically was 0.6. No dysuria has recurred during past three years in the cases where cryosurgery was assessed satisfactory in effect within two to three months.

Aged↗

Effects of nasal capsaicin pretreatment and cryosurgery on sneezing reflexes, neurogenic plasma extravasation, sensory and sympathetic neurons.

Local and systemic capsaicin pretreatment as well cryosurgery induced a long-lasting loss of sensory substance P-immunoreactive nerves in the guinea-pig nasal mucosa. In addition, cryosurgery caused a loss of noradrenergic sympathetic nerves, sclerosis of blood vessels, epithelial damage and fibrosis of the mucosa. The sneezing response to local application of capsaicin--but not that to nicotine--was reduced or abolished by capsaicin pretreatment and cryosurgery, while the response to tactile stimulation was unaffected. These effects were long-lasting and still present 2 months after treatment. Local capsaicin pretreatment of the nasal mucosa had no effects on the substance P levels or the Evans Blue extravasation response to i.v. capsaicin in the ureter, indicating that this treatment has no systemic effects on other afferent SP-neurons. It is suggested that local capsaicin pretreatment is a more selective and less traumatic method than cryosurgery to induce a long-lasting desensitization of the nasal mucosa to chemical irritants in hyperreactive disorders of the nose.

Animals↗

[Research of cryosurgery in the treatment of maxillo-facial deepish hemangioma].

OBJECTIVE: To observe the effect of cryosurgery on maxillofacial deepish hemangioma, and the facial nerve recovery. METHODS: Twelve hemangioma patients were observed for the effect of cryosurgery on hemangiomaa in maxillo-facial deepish expose lesion after flapping and four rabbits were used for the observation of the recovery of the facial nerve after cryosurgery. RESULTS: The facial nerve function of rabbits recovered within six to eight weeks, the twelve hemangioma patients'-facial nerve also recovered with six to eight weeks, only one reoccured in five years. CONCLUSIONS: Cryosurgery after flapping is an effective; little-traumatic, recover-quickly and spreadingworth method for treatment of maxillo-facial deepish hemangioma.

Adult↗

Surgery for atrioventricular node reentry tachycardia. Results with surgical skeletonization of the atrioventricular node and discrete perinodal cryosurgery.

Surgical treatment options for interruption of atrioventricular node reentrant tachycardia include (1) skeletonization of the atrioventricular node by dissecting it from most of its atrial inputs and (2) discrete cryosurgery of the perinodal tissues by applying a series of sequential cryolesions to the atrial tissues immediately adjacent to the atrioventricular node. Both these techniques attempt to interrupt one of the dual atrioventricular node conduction pathways while preserving the other. This report describes 17 consecutive patients who underwent surgical treatment, 10 patients with skeletonization of the atrioventricular node and seven patients with discrete perinodal cryosurgery. There were 10 female and seven male patients and their ages ranged from 28 to 56 years (mean 38). Two of the 17 patients had Wolff-Parkinson-White syndrome and their accessory pathways were interrupted before the atrioventricular nodal reentrant tachycardia was ablated. All the procedures were performed in a normothermic beating heart while atrioventricular conduction was monitored closely. In the skeletonization technique, the right atrial septum was mobilized and the atrioventricular node exposed anterior to the tendon of the Todaro. The perinodal cryosurgical procedure was also performed through a right atriotomy and a series of sequential 3 mm cryolesions were placed around the borders of the triangle of Koch on the inferior right atrial septum. There were no operative deaths. Two patients who underwent the skeletonization operation had heart block necessitating pacemaker therapy. At postoperative electrophysiologic study, no echoes or atrioventricular nodal reentrant tachycardia were inducible in any of the 17 patients. All patients have remained free of arrhythmia recurrence and have required no antiarrhythmic therapy after a follow-up of 5 to 28 months (mean 14). In conclusion, both atrioventricular node skeletonization and perinodal cryosurgery successfully ablate atrioventricular nodal reentrant tachycardia; however, perinodal cryosurgery appears to be safer in avoiding heart block, is more easily performed, and is our procedure of choice for the management of medically refractory atrioventricular nodal reentrant tachycardia.

Adolescent↗

Argon supper-cryosurgery for patients with middle and late stage liver cancer.

OBJECTIVE: To assess the value of argon supper-cryosurgery for 42 patients with middle and late stage liver cancer. METHODS: Forty-two patients who had received argon supper-cryosurgery were analyzed retrospectively in terms of their clinical characteristics as well as the performance of argon supper-cryosurgery. RESULTS: All patients were ameliorated in symptoms shortly after the operation, including pain alleviation, psyche straightening up, alpha-fetoprotein descending or recovery. Jaundice occurred in 1 patient and intraabdominal hemorrhage in 2. The levels of aspartate transaminase and alanine transaminase in all patients were elevated 1 month after the operation, and normalized after protective therapy of the liver. No operative death was noted. CONCLUSIONS: Cold and heat reversed therapy of argon supper-cryosurgery can drastically destroy tumor tissue, especially the tumors which are too large to resect or close to the large vessels. It is applicable to increase the operative rate, decrease the operative death rate, and enlarge the therapeutic scope.

Adult↗

Cryosurgery for common skin conditions.

Cryosurgery is a highly effective treatment for a broad range of benign skin problems. With appropriate instruction and supervised experience, family physicians can master the technique quickly. Cryosurgery is best suited for use in patients with light skin and for treatment of lesions in most non-hair-bearing areas of the body. Spray methods include the timed spot freeze technique, the rotary or spiral pattern, and the paintbrush method. Benign skin lesions that are suitable for freezing include actinic keratosis, solar lentigo, seborrheic keratosis, viral wart, molluscum contagiosum, and dermatofibroma. Cryosurgery requires little time and fits easily into the physician's office schedule. Advantages of this treatment include a short preparation time, low risk of infection, and minimal wound care. In addition, cryosurgery requires no expensive supplies or injectable anesthesia, and the patient does not have to return for suture removal. Potential side effects include bleeding, blister formation, headache, hair loss, and hypopigmentation, but rarely scarring. Skin lesions often can be treated in a single session, although some require several treatments.

Cryosurgery↗

Magnetic resonance-guided percutaneous cryosurgery of breast carcinoma: technique and early clinical results.

PURPOSE: This phase I study was designed to demonstrate the feasibility, safety, efficacy and predictability of percutaneous cryosurgery, guided under magnetic resonance (MR) imaging, in the treatment of invasive breast carcinoma. PATIENTS AND METHODS: Under the guidance of near-real-time T1-weighted FSE images of a 0.5-T open-configuration MR system, percutaneous cryosurgery was performed in 25 patients with operable invasive breast carcinoma, 4 weeks prior to their scheduled mastectomy. Predictive assessments by interventional radiologists using 4 breast-imaging techniques (mammography, sonography, scintigraphy and MR) were correlated with postmastectomy results of histopathology and assessed for predictability. Local and systemic morbidity were also evaluated during the month of follow-up preceding mastectomy. RESULTS: Percutaneous cryosurgery resulted in no serious complications, either local or systemic. All tumoural tissues included in the cryogenic "iceball" were destroyed, with no viable histologic residues. Ablation was total in 13 of the 25 tumours treated. Combining periprocedural MR images with postprocedure scintimammographic findings enabled a 96% rate for predicting the cryosurgical results. CONCLUSIONS: MR-guided cryosurgery of breast carcinoma is feasible, safe and efficient, with predictable results. Major drawbacks are that the cryolesion (a palpable iceball) persists for a month or more after the procedure, undermining the reliability of the physical examination; and that breast imaging (mammography, ultrasound and MR) presents the same difficulty of interpretation as the physical exam even 1 month after the procedure. More studies are required to refine this treatment method.

Adult↗

[The results of liver cryosurgery for synchronized liver metastasis from colorectal cancer].

We examined our results of liver cryosurgery for synchronized liver metastasis from colorectal cancer. Twelve patients whose prognosis after the cryosurgery was clear were eligible. All of the patients received not only a resection of the colorectal primary lesion, but they also received a cryosurgery for liver metastases under the same laparotomy. These patients had been treated in this manner from 1981 to 1987. Ten of the 12 patients died from recurrent cancer. The range in survival time of 12 cases was from 6 months to 117 months, and the average survival length was 25.4 months. The examination of the results suggested that there were no cryosurgery induced anti-immunological response observed among the patients. The survival lengths of the patients with untreated cancer were good.

Adult↗