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Piriyev E, Römer T. Delayed expulsion of a large fibroid after transcervical radiofrequency ablation: A case report. Radiol Case Rep 2022; 18:779-783. [PMID: 36589487 PMCID: PMC9794886 DOI: 10.1016/j.radcr.2022.11.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
Fibroids are the most common type of benign uterine tumor, which occur up to 68.6% of women. Hypermenorrhea is the most common symptom with a general prevalence of 40%-54%, followed by dysmenorrhea and low abdominal pain. Transcervical fibroids ablation was developed as a minimally invasive, incisionless treatment of fibroids in a short time. This method is safe and effective with an excellent record of safety. We present the case of a 40-year-old woman, who attended in our fibroid excellence center. She reported severe hypermenorrhea and dysmenorrhea. Family planning was definitely completed. Using vaginal ultrasonography a FIGO 2-5 fibroid of 5 cm in diameter was detected. Different treatment options were discussed: medical treatment, laparoscopic fibroidectomy, hysterectomy, and transcervical radiofrequency ablation with Sonata System. Because of advantages of transcervical radiofrequency ablation (minimal invasive treatment without incision, effectivity of method, short surgical time) the patient decided on this method. Three months later, the patient came to the first follow up. She reported a significant improvement of hypermenorrhea. A vaginal ultrasonography was carried out. The fibroid changed its position from FIGO 2-5 to FIGO 2. The patient was very satisfied with the result. After 2 months, she attended in our department again because of severe clear vaginal discharge. She had no bleeding, no pain as well as no fever. We examined her immediately. A fibroid expulsion was detected. The fibroid was removed vaginally. There was no severe bleeding during the operation and the fibroid could be removed completely. The surgery time was 25 minutes.
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Affiliation(s)
- Elvin Piriyev
- University Witten-Herdecke, Department of Obstetrics and Gynecology, Academic Hospital Cologne Weyertal University of Cologne, Weyertal 76, 50931 Cologne, Germany
- Corresponding author.
| | - Thomas Römer
- Department of Obstetrics and Gynecology, Academic Hospital Cologne Weyertal University of Cologne, Cologne, Germany
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Römer T, Bends R, Christoffel L, Felberbaum R, Hildebrandt T, Meinhold-Heerlein I, Mueller M, Oppelt P, Renner SP, Runnebaum IB, Schiermeier S, Piriyev E, Uhl B, Toub D. The significance of transcervical ultrasound-guided radiofrequency ablation in the treatment of symptomatic fibroids: results of an expert consensus from German-speaking countries. Arch Gynecol Obstet 2022; 306:1-6. [PMID: 35316395 DOI: 10.1007/s00404-022-06516-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Uterine fibroids are one of the most common diseases in female patients, lead mainly to bleeding disorders and lower abdominal pain, and reduce the chance of having children. In recent years we have seen a trend towards more and more pharmacotherapies and minimally invasive organ-preserving treatments. One novel and innovative procedure for an organ-preserving treatment of symptomatic uterine fibroids is the transcervical ultrasound-guided radiofrequency ablation (TRFA). TRFA has been used in Germany since 2013 and later found use in other German-speaking countries as well. There have now been more than 1200 TRFA treatments performed in Germany, Austria, and Switzerland. Experts from these three countries came together for a consensus meeting to analyze the significance of the procedure in the overall concept of the treatment of symptomatic uterine fibroids.
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Affiliation(s)
- Thomas Römer
- Department of Obstetrics and Gynecology, Academic Hospital Cologne Weyertal University of Cologne, Weyertal 76, 50931, Cologne, Germany.
| | - Ralf Bends
- Department of Obstetrics and Gynecology, Academic Hospital Cologne Weyertal University of Cologne, Weyertal 76, 50931, Cologne, Germany
| | | | - Ricardo Felberbaum
- Department of Obstetrics and Gynecology, Clinic of Kempten, Academic Teaching Hospital, University of Ulm, Ulm, Germany
| | - Thomas Hildebrandt
- Department of Obstetrics and Gynecology, University Hospital Erlangen-Nuremberg, Maximilianspl. 2, 91054, Erlangen, Germany
| | - Ivo Meinhold-Heerlein
- Department of Gynecology and Obstetrics, Justus Liebig University Giessen, Giessen, Germany
| | - Michael Mueller
- University Department of Gynecology, Bern University Hospital, Bern, Switzerland
| | - Peter Oppelt
- Department for Gynecology, Obstetrics and Gynecological Endocrinology, Johannes Kepler University Linz, Linz, Austria
| | - Stefan P Renner
- Department of Obstetrics and Gynecology, Sindelfingen-Boeblingen Clinic, Boeblingen, Germany
| | - Ingo B Runnebaum
- Department of Gynecology and Reproduction Medicine, Jena University Hospital, 07747, Jena, Germany
| | - Sven Schiermeier
- Department of Obstetrics and Gynecology, University Witten-Herdecke, Marien-Hospital, Witten Marienplatz, 258452, Witten, Germany
| | - Elvin Piriyev
- Department of Obstetrics and Gynecology, Academic Hospital Cologne Weyertal University of Cologne, Weyertal 76, 50931, Cologne, Germany
- Department of Obstetrics and Gynecology, University Witten-Herdecke, Marien-Hospital, Witten Marienplatz, 258452, Witten, Germany
| | - Bernhard Uhl
- Department of Obstetrics and Gynecology, Wesel Evangelical Hospital, Wesel, Germany
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Luo X, Li Y, Shang Q, Liu H, Song L. Role of Diffusional Kurtosis Imaging in Evaluating the Efficacy of Transcatheter Arterial Chemoembolization in Patients with Liver Cancer. Cancer Biother Radiopharm 2019; 34:614-620. [PMID: 31560562 DOI: 10.1089/cbr.2019.2878] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective: To explore the role of diffusional kurtosis imaging (DKI) in evaluating the efficacy of transcatheter arterial chemoembolization (TACE) in patients with liver cancer. Materials and Methods: A total of 54 patients with primary liver cancer underwent TACE were selected as the study subjects. Magnetic resonance imaging and DKI scans were carried out before and after TACE, and the relevant parameters were analyzed. Results: Compared with those before TACE, the values of radial diffusivity (Dr), axial diffusivity (Da), and mean diffusivity (MD) of tumor tissues in the patients after TACE were significantly increased, whereas the values of axial kurtosis (Ka), fractional anisotropy of kurtosis (FAk), hepatic blood volume (HBV), hepatic blood flow (HBF), and hepatic artery perfusion (HAP) were notably decreased (p < 0.05). There were no significant changes regarding FA, radial kurtosis (Kr), mean kurtosis (MK), hepatic arterial fracture (HAF), permeability-surface area product (PS), mean transit time (MTT), and portal vein perfusion (PVP) (p > 0.05). The differences in apparent diffusion coefficients (ADCs) of different liver cancer tissues in patients under different b values after operation were statistically significant, and the ADC values of liver cancer tissues were evidently higher than those of other tumor tissues (p < 0.05). Conclusion: DKI is characterized with advantages such as fastness, simpleness, high resolution, and impregnability of the density of lipiodol. It can not only directly reflect the changes in blood perfusion at the lesion but also accurately and efficiently evaluate the remnants, necrosis, and recurrence of tumor tissues based on changes in ADC under different b values. It provides certain clinical assistance for the evaluation of the efficacy before and after TACE.
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Affiliation(s)
- Xin Luo
- Department of Radiology, Zibo Central Hospital, Zibo, China
| | - Yuhua Li
- Department of Radiology, Zibo Central Hospital, Zibo, China
| | - Qun Shang
- Department of Radiology, Zibo Central Hospital, Zibo, China
| | - Hao Liu
- Department of Radiology, Zibo Central Hospital, Zibo, China
| | - Litao Song
- Department of Radiology, Zibo Central Hospital, Zibo, China
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Kong S, Yue X, Kong S, Ren Y. Application of contrast-enhanced ultrasound and enhanced CT in diagnosis of liver cancer and evaluation of radiofrequency ablation. Oncol Lett 2018; 16:2434-2438. [PMID: 30013634 PMCID: PMC6036569 DOI: 10.3892/ol.2018.8898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 05/04/2018] [Indexed: 12/12/2022] Open
Abstract
This study investigated the application effect of contrast-enhanced ultrasound (CEUS) and enhanced CT in diagnosis of liver cancer and response evaluation of radiofrequency ablation (RFA). A total of 60 patients with liver cancer were selected in Dongying People's Hospital from April 2016 to May 2017. All patients were subjected to CEUS and enhanced CT. With pathological examination as the gold standard, diagnostic consistency of the two methods was compared. After RFA, patients were subjected to CEUS and enhanced CT to assess the efficacy, and the consistency was compared. There was no significant difference in diagnostic accuracy between CEUS and CT (p>0.05). Area under the ROC curve of CEUS was 0.896, with a sensitivity of 91.2% and a specificity of 88.7%. The area under the ROC curve for enhanced CT diagnosis was 0.907, with a sensitivity of 91.8% and a specificity of 89.7%. No significant difference in the maximal cross sectional area of lesions was found between CEUS and enhanced CT, and there was no significant difference in evaluation of therapeutic efficiency between the methods (p>0.05) before and 1 and 3 months after treatment. Bland-Altman test showed that there was a strong consistency between CEUS and enhanced CT in the measured maximum cross-sectional area of lesions at 1 and 3 months after treatment. Linear regression analysis showed that maximum section cross-sectional area measured by CEUS was significantly correlated with that detected by enhanced CT (r2=0.617). The results suggested that diagnostic efficiency of CEUS was similar to that of enhanced CT, and both showed high sensitivity and specificity. Two methods showed high consistency in evaluating the curative effect of RFA. CEUS can achieve real-time observation of focal blood flow perfusion, and was more economically affordable and convenient.
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Affiliation(s)
- Shuhong Kong
- Department of Computed Tomography, Dongying People's Hospital, Dongying, Shandong 257091, P.R. China
| | - Xuewang Yue
- Department of Computed Tomography, Dongying People's Hospital, Dongying, Shandong 257091, P.R. China
| | - Sheng Kong
- Department of Ultrasound, Laiwu Central Hospital of Xinwen Mineral Group, Laiwu, Shandong 271103, P.R. China
| | - Yujie Ren
- Department of Computed Tomography, Dongying People's Hospital, Dongying, Shandong 257091, P.R. China
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Li C, Jia L, Wang Z, Niu L, An X. Therapeutic effect of radiofrequency ablation on children with supraventricular tachycardia and the risk factors for postoperative recurrence. Exp Ther Med 2018; 15:4431-4435. [PMID: 29725383 PMCID: PMC5920273 DOI: 10.3892/etm.2018.5986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/27/2018] [Indexed: 11/17/2022] Open
Abstract
The present study investigated the therapeutic effect of radiofrequency ablation on children with supraventricular tachycardia (SVT), and explored the risk factors for postoperative recurrence. A total of 312 patients with pediatric SVT were selected in the Affiliated Children's Hospital of Xuzhou Medical University from April, 2011 to March, 2017. All the patients were subjected to radiofrequency ablation, and clinical data were retrospectively analyzed. Tilt table test was performed before and after treatment, and heart rate, systolic and diastolic blood pressure before and after treatment were compared. Plasma levels of D-dimer (D-D), platelet α-granule membrane protein (GMP-140) and thrombin-antithrombin III complex (TAT) were detected by enzyme-linked immunosorbent assay before treatment, immediately after radiofrequency oblation, and at 1, 3 and 7 days after treatment. Treatment outcomes were compared between the atrioventricular reentrant tachycardia (AVRT) and atrioventricular nodal reentrant tachycardia (AVNRT) groups. Risk factors for postoperative recurrence were analyzed. Supine position heart rate after treatment was not significantly different from that before treatment (P>0.05), while the upright position heart rate was significantly increased after treatment (P<0.05). Systolic pressures of the supine and upright positions were significantly reduced after treatment compared with the levels before (P<0.05), but no significant differences were found in diastolic blood pressure of supine and the upright position (P>0.05). No significant difference in radiofrequency ablation rate, recurrence rate and incidence of complications were found between the AVRT and AVNRT groups (P>0.05). After radiofrequency, the levels of D-D, GMP-140 and TAT ablation showed an upward trend, but decreased at day 7 to reach preoperative levels. Logistic regression analysis revealed that residual slow pathway (OR=6.718, P=0.005) and inaccurate targeting (OR=2.815, P=0.007) were independent risk factors for postoperative recurrence (P<0.05). Although radiofrequency ablation can damage the cardiac vagal nerve, resulting in an increase in the heart rate after ablation during the course of the tilt table test and changed hemagglutination state within one week after ablation, those changes returned to normal after one week. The efficacy of radiofrequency ablation in the treatment of pediatric SVT is clear, and recurrence rate is low. Residual slow pathway and inaccurate targeting were independent risk factors for postoperative recurrence.
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Affiliation(s)
- Chunli Li
- Department of Cardiovascular Medicine, The Affiliated Children's Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221006, P.R. China
| | - Libo Jia
- Department of Cardiovascular Medicine, The Affiliated Children's Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221006, P.R. China
| | - Zhenzhou Wang
- Department of Cardiovascular Medicine, The Affiliated Children's Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221006, P.R. China
| | - Ling Niu
- Department of Cardiovascular Medicine, The Affiliated Children's Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221006, P.R. China
| | - Xinjiang An
- Department of Cardiovascular Medicine, The Affiliated Children's Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221006, P.R. China
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