With a recent randomized prospective trial revealing that thermal ablative therapy as local tumor control improved overall survival (OS) in patients with unresectable colorectal cancer liver metastases (CRLM), thermal...With a recent randomized prospective trial revealing that thermal ablative therapy as local tumor control improved overall survival (OS) in patients with unresectable colorectal cancer liver metastases (CRLM), thermal ablation continues to remain as an important treatment option in this patient population. Our aim of this article is to review the current role of the ablative therapy in the management of CRLM patients. Main indications for thermal ablation include (Ⅰ) unresectable liver lesions;(Ⅱ) in combination with hepatectomy;(Ⅲ) in patients with significant medical comorbidities or poor performance status (PS);(Ⅳ) a small (<3 cm) solitary lesion, which would otherwise necessitate a major liver resection;and (Ⅴ) patient preference. There are several approaches and modalities for ablative therapy, including open, percutaneous, and laparoscopic approaches, as well as radiofrequency ablation (RFA) and microwave ablation (MWA). Each approach and ablation modality have its own pros and cons. Percutaneous and laparoscopic approaches are preferred due to minimally invasive nature, yet laparoscopic approach has more benefits from thorough intraoperative ultrasound (US) exam as well as complete peritoneal staging with laparoscopy. Similarly, whereas high local tumor failure rate has been a major concern with RFA, MWA or microwave thermosphere ablation (MTA) have demonstrated significantly improved local tumor control due to homogenous tissue heating, ability to reach higher tissue temperatures, and less susceptible to the "heat-sink" effect. Although liver resection is the standard of care for CRLM, there have been some retrospective studies demonstrating similar oncological outcome between ablative therapy and surgical resection in very selected populations with small (<3 cm) solitary CRLM. Lastly, ablative therapy and liver resection should not be mutually exclusive, especially in the management of bilobar liver metastases. Concomitant ablative therapy with hepatectomy may spare the patients from having two展开更多
Objective The aim of the study was to evaluate the long-term efficacy and safety of percutaneous microwave ablation(MWA) for small hepatic cancers adjacent to large vessels and to investigate the treatment strategies....Objective The aim of the study was to evaluate the long-term efficacy and safety of percutaneous microwave ablation(MWA) for small hepatic cancers adjacent to large vessels and to investigate the treatment strategies.Methods From March 2009 to July 2015,a total of 86 patients with 94 tumors underwent ultrasound(US)-guided percutaneous MWA,with pathologically proven or clinically diagnosed liver cancers measuring ≤ 3 cm in diameter and located ≤ 10 mm from a major vessel(n = 94).Regular follow-up after MWA was performed to assess treatment efficacy and perioperative complications.Results The complete ablation rate at 1 month after MWA was 93.3%(84/90).The 6-,9-,12-,24-,36-,48-,60-,72-,and 84-month local recurrence rates were 2.4%,2.4%,3.7%,6.6%,8.4%,8.4%,8.4%,8.4%,and 8.4%,respectively.There were no major complications.The perioperative special complication rate was 5.32%(5/94),including 3 cases of moderate liver function damage and 2 cases of limited sub-capsular hematoma.Conclusion Percutaneous MWA for small hepatic cancers adjacent to large vessels is feasible,effective,and safe with an acceptable rate of complications.The key point is to strictly follow operative indications and adopt proper treatment strategies.展开更多
The aim was to prospectively evaluate the efficacy and safety of splenic microwave ablation (MWA) combined with transcatheter hepatic arterial chemoembolization (TACE) in treatment of hepatocellular carcinoma (HCC) as...The aim was to prospectively evaluate the efficacy and safety of splenic microwave ablation (MWA) combined with transcatheter hepatic arterial chemoembolization (TACE) in treatment of hepatocellular carcinoma (HCC) associated with hypersplenism. Five patients suffering from primary HCC associated with hypersplenism caused by cirrhosis were received MWA combined with TACE. Follow-up examinations included calculation of peripheral blood cells (leukocytes, platelets and red blood cells) and treatment-associated complications. After treatment, leukocyte and platelet counts were significantly higher (P < 0.05) than prior-treatment. Right upper quadrant pain occurred in 3 patients, fever occurred in 4 patients, and mild nausea & vomiting occurred in 3 patients. Complications such as pleural effusion, ascites, bacterial peritonitis, and variceal bleeding did not occur after treatment. So, MWA combined with TACE is effective and safe for the patients with HCC associated with hypersplenism caused by cirrhosis.展开更多
Migraine is a common neurological disorder, prevalent in almost all over the world population and being considered as the 13th major medical disorder among other major disorders across the globe, generally characteriz...Migraine is a common neurological disorder, prevalent in almost all over the world population and being considered as the 13th major medical disorder among other major disorders across the globe, generally characterized with unilateral or bilateral headache, nausea and vomiting. In developing world, countries like Pakistan, most of the patients are not well aware of migraine headaches, as usually taken for simple headache due to no proper awareness. Usually it is not a contagious condition and most of the time it is recoded as episodic in nature. To assess the migraine, its frequency, symptoms, usual triggers and patients’ perceptions, the present study was conducted. For this purpose a prospective study was carried out based on properly designed questionnaire. The data were collected from 7 educational institutes, including students of Islamia College Peshawar, University of Peshawar, Khyber Medical College, Engineering University Peshawar, Fatima Jinnah College Peshawar, Commerce College Peshawar and Agriculture University Peshawar. Part of data was also collected from patients visiting Khyber Teaching Hospital Peshawar for their headache problems. A total of 270 questionnaires were filled up. About 81 (30.00%) headache cases were recorded, fulfilling the International criteria of Headache. Out of 81 recorded cases, 31 (38.3%) patients were of migraine with aura and 50 (61.7%) were of migraine without aura condition. The prevalence of migraine in the study population was found to be 30.00%. The frequency of female migraine patients was higher i.e. 31 (34.1%) than the male sufferers 50 (27.9%). The present study clearly showed that the higher frequency (65.0%) of migraine exists in the age group of above 30 years age. The most prevalent trigger was found to be tension, which was in parallel followed by the lack of sleep or oversleeping. A family history for migraine was found in migraine patients. Usually the condition was found to limit the routine activities of patients. The present study recorded that most 展开更多
文摘With a recent randomized prospective trial revealing that thermal ablative therapy as local tumor control improved overall survival (OS) in patients with unresectable colorectal cancer liver metastases (CRLM), thermal ablation continues to remain as an important treatment option in this patient population. Our aim of this article is to review the current role of the ablative therapy in the management of CRLM patients. Main indications for thermal ablation include (Ⅰ) unresectable liver lesions;(Ⅱ) in combination with hepatectomy;(Ⅲ) in patients with significant medical comorbidities or poor performance status (PS);(Ⅳ) a small (<3 cm) solitary lesion, which would otherwise necessitate a major liver resection;and (Ⅴ) patient preference. There are several approaches and modalities for ablative therapy, including open, percutaneous, and laparoscopic approaches, as well as radiofrequency ablation (RFA) and microwave ablation (MWA). Each approach and ablation modality have its own pros and cons. Percutaneous and laparoscopic approaches are preferred due to minimally invasive nature, yet laparoscopic approach has more benefits from thorough intraoperative ultrasound (US) exam as well as complete peritoneal staging with laparoscopy. Similarly, whereas high local tumor failure rate has been a major concern with RFA, MWA or microwave thermosphere ablation (MTA) have demonstrated significantly improved local tumor control due to homogenous tissue heating, ability to reach higher tissue temperatures, and less susceptible to the "heat-sink" effect. Although liver resection is the standard of care for CRLM, there have been some retrospective studies demonstrating similar oncological outcome between ablative therapy and surgical resection in very selected populations with small (<3 cm) solitary CRLM. Lastly, ablative therapy and liver resection should not be mutually exclusive, especially in the management of bilobar liver metastases. Concomitant ablative therapy with hepatectomy may spare the patients from having two
文摘Objective The aim of the study was to evaluate the long-term efficacy and safety of percutaneous microwave ablation(MWA) for small hepatic cancers adjacent to large vessels and to investigate the treatment strategies.Methods From March 2009 to July 2015,a total of 86 patients with 94 tumors underwent ultrasound(US)-guided percutaneous MWA,with pathologically proven or clinically diagnosed liver cancers measuring ≤ 3 cm in diameter and located ≤ 10 mm from a major vessel(n = 94).Regular follow-up after MWA was performed to assess treatment efficacy and perioperative complications.Results The complete ablation rate at 1 month after MWA was 93.3%(84/90).The 6-,9-,12-,24-,36-,48-,60-,72-,and 84-month local recurrence rates were 2.4%,2.4%,3.7%,6.6%,8.4%,8.4%,8.4%,8.4%,and 8.4%,respectively.There were no major complications.The perioperative special complication rate was 5.32%(5/94),including 3 cases of moderate liver function damage and 2 cases of limited sub-capsular hematoma.Conclusion Percutaneous MWA for small hepatic cancers adjacent to large vessels is feasible,effective,and safe with an acceptable rate of complications.The key point is to strictly follow operative indications and adopt proper treatment strategies.
文摘The aim was to prospectively evaluate the efficacy and safety of splenic microwave ablation (MWA) combined with transcatheter hepatic arterial chemoembolization (TACE) in treatment of hepatocellular carcinoma (HCC) associated with hypersplenism. Five patients suffering from primary HCC associated with hypersplenism caused by cirrhosis were received MWA combined with TACE. Follow-up examinations included calculation of peripheral blood cells (leukocytes, platelets and red blood cells) and treatment-associated complications. After treatment, leukocyte and platelet counts were significantly higher (P < 0.05) than prior-treatment. Right upper quadrant pain occurred in 3 patients, fever occurred in 4 patients, and mild nausea & vomiting occurred in 3 patients. Complications such as pleural effusion, ascites, bacterial peritonitis, and variceal bleeding did not occur after treatment. So, MWA combined with TACE is effective and safe for the patients with HCC associated with hypersplenism caused by cirrhosis.
文摘Migraine is a common neurological disorder, prevalent in almost all over the world population and being considered as the 13th major medical disorder among other major disorders across the globe, generally characterized with unilateral or bilateral headache, nausea and vomiting. In developing world, countries like Pakistan, most of the patients are not well aware of migraine headaches, as usually taken for simple headache due to no proper awareness. Usually it is not a contagious condition and most of the time it is recoded as episodic in nature. To assess the migraine, its frequency, symptoms, usual triggers and patients’ perceptions, the present study was conducted. For this purpose a prospective study was carried out based on properly designed questionnaire. The data were collected from 7 educational institutes, including students of Islamia College Peshawar, University of Peshawar, Khyber Medical College, Engineering University Peshawar, Fatima Jinnah College Peshawar, Commerce College Peshawar and Agriculture University Peshawar. Part of data was also collected from patients visiting Khyber Teaching Hospital Peshawar for their headache problems. A total of 270 questionnaires were filled up. About 81 (30.00%) headache cases were recorded, fulfilling the International criteria of Headache. Out of 81 recorded cases, 31 (38.3%) patients were of migraine with aura and 50 (61.7%) were of migraine without aura condition. The prevalence of migraine in the study population was found to be 30.00%. The frequency of female migraine patients was higher i.e. 31 (34.1%) than the male sufferers 50 (27.9%). The present study clearly showed that the higher frequency (65.0%) of migraine exists in the age group of above 30 years age. The most prevalent trigger was found to be tension, which was in parallel followed by the lack of sleep or oversleeping. A family history for migraine was found in migraine patients. Usually the condition was found to limit the routine activities of patients. The present study recorded that most
