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    Keywords: CANCER ; CELLS ; tumor ; SYSTEM ; ASSOCIATION ; metastases ; RADIOFREQUENCY ABLATION ; lung neoplasms ; HISTOLOGY ; Local thermal therapy ; PULMONARY TUMORS
    Abstract: Objective: Radiofrequency ablation (RFA) has obtained increasing attention as an interventional approach for the local treatment of primary and secondary lung neoplasms. The local effect of the procedure is usually controlled by radiologic means. The objectives of this 'ablate and resect' study were to investigate the efficacy of bipolar and multipolar RFA by histologic evaluation and to compare the two techniques. Methods: In a total of 32 subjects with histologically proven non-small-cell lung cancer or pulmonary metastases from an extrathoracic primary tumor, bipolar, or multipolar RFA was performed during open thoracotomy. Curative resection (lobectomy or wedge resection including mediastinal lymph node dissection) was performed subsequently. The extent of cell death and early histologic findings following RFA were determined by histology and immunohistochemistry (nicotinamide adenine dinucleotide (NADH) and monoclonal anti-mitochondrial antibodies MAB 1273). Results: Intra-operative bipolar and multipolar RFA is a safe procedure, and there was no bleeding or thermal damage of the lung tissue. Routine histologic staining could not identify tumor cell death. However, immunohistochemistry was able to verify cell death in the ablated tumor tissue. Complete tumor cell necrosis was determined in 12 tumors (37.5%); and scattered vital tumor tissue was detected in 16 tumors (50%). Incomplete ablation with a ratio of 〉20% vital tumor tissue was found in four tumors (12.5%), particularly surrounding vascular structures within the tumor tissue or in marginal zones of the tumor tissue. The local efficacy of bipolar and multipolar RFA was comparable, and incomplete ablations were found only in adenocarcinoma. Conclusions: Bipolar and multipolar RFA in an open thoracotomy setting is a technically feasible and safe procedure. Early immunohistochemical findings after RFA showed complete tumor cell necrosis in 38% of cases. The high rate of viable tumor cells remaining after ablation casts doubt on RFA as a curative concept. This approach should be reserved for palliative indications. Patients fulfilling the criteria for curative resection should not be denied surgery.
    Type of Publication: Journal article published
    PubMed ID: 20961771
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    Keywords: Germany ; GENERATION ; SYSTEM ; TOOL ; VOLUME ; DISEASE ; SURGERY ; PATIENT ; PARAMETERS ; Jun ; MANAGEMENT ; monitoring ; cardiac surgery ; ejection fraction ; pulmonary artery catheter ; right ventricle ; thermodilution ; transesophageal 3D echocardiography ; TRANSESOPHAGEAL ECHOCARDIOGRAPHY
    Abstract: Objective: Right ventricular function is an important aspect of global cardiac performance which affects patients' outcome after cardiac surgery. Due to its geometrical complexity, the assessment of right ventricular function is still a very difficult task. Aim of this study was to investigate the value of a new technique for intraoperative assessment of right ventricle based on transesophageal 3D-echocardiography, and to compare it to volumetric thermodilution by using a new generation of fast response thermistor pulmonary artery catheters. Methods: Twenty-five patients with coronary artery disease underwent 68 intraoperative measurements by 3D-echocardiography and thermodilution simultaneously. Following parameters were analysed: right ventricular end-diastolic volume (RVEDV), end-systolic volume (RVESV) and ejection fraction (RVEF). Pulmonary, systemic and central venous pressures were simultaneously recorded. Segmentation of right ventricular volumes were obtained by the 'Coons-Patches' technique, which was implemented into the EchoAnalyzer (R), a multitask system developed at our institution for three-dimensional functional and structural measurements. Results: Right ventricular volumes obtained by 3D-echocardiography did not show significant correlations to those obtained by thermodilution. Volumetric thermodilution systematically overestimates right ventricular volumes. Significant correlations were found between RVEF measured by 3D-echocardiography and those obtained by thermodilution (r=0.93; y=0.2+0.80x; SEE=0.03; P 〈 0.01). Bland-Altmann analysis showed that thermodilution systematically underestimates RVEF. The bias for measuring RVEF was +15.6% with a precision of +/- 4.3%. The patients were divided into two groups according to left ventricular function. The group of patients with impaired function showed significantly tower right ventricular ejection fraction (44.1 +/- 4.6 vs. 55.1 +/- 3.9%; P 〈 0.01). Conclusions: Three-dimensional echocardiography provides a useful non-invasive tool for intraoperative and serial assessment of right ventricular function. This new technique, which overcomes the limitations of previous methods, may offer key insights into management and outcome of patients with severe impairment of cardiac function. (c) 2005 Elsevier B.V. All rights reserved
    Type of Publication: Journal article published
    PubMed ID: 15896606
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    Keywords: Germany ; CLASSIFICATION ; VOLUME ; DISEASE ; PATIENT ; COMPLEX ; COMPLEXES ; DYNAMICS ; MR ; LESIONS ; REPAIR ; REGIONS ; QUANTITATIVE ASSESSMENT ; SURGICAL-TREATMENT ; cardiac surgery ; function ; CARDIOMYOPATHY ; 3-DIMENSIONAL COLOR DOPPLER ; annuloptasty ; coronary artery disease ; ischemic mitral regurgitation ; OVINE MODEL ; REPLACEMENT ; transesophageal 3D-echocardiography ; VALVE RECONSTRUCTION
    Abstract: Objective: Recent studies in animals showed that regional annulus distortion is a major determinant of ischemic mitral regurgitation (IMR) and accordingly suggested new surgical approaches with asymmetrical annuloplasty rings. As accurate measurement of annulus in patients is still a challenge, we performed this study to analyze the changes in three-dimensional annular geometry in patients with IMR compared to primary valvular lesions. Methods: We studied 110 patients divided into three groups: (1) 30 with coronary artery disease without IMR, (2) 38 with chronic IMR, and (3) 42 with MR due to primary valvular lesions. Longitudinal and septal-lateral annulus diameters; global diastolic and systolic annular area and its percentual shortening, diastolic and systolic areas of six regions corresponding to the segmental Carpentier classification were measured by 3D-echocardiography. The degree of MR was assessed by three-dimensional color Doppler. Global and regional left ventricular geometry were assessed by sphericity index and by measuring anterior and posterior tethering of papillary muscles. Results: Patients with significant IMR (group 2) showed larger longitudinal (52.7 +/- 3.9 mm vs 41.8 +/- 2.9 mm; p 〈 0.01) and antero-lateral (31.8 +/- 3.5 mm vs 26.7 +/- 2.8 mm; p 〈 0.01) annular diameters than the patients with MR due to primary valvular lesions (group 3). Diastolic (997.8 +/- 64.9 mm(2) vs 700.7 +/- 46.8 mm(2); p 〈 0.01) and systolic (894.9 +/- 57.3 mm(2) vs 547.3 +/- 35.0 mm(2); p 〈 0.01) annular areas were larger in group 2 than in group 3. Annular area change was significantly lower in the group with ischemic mitral. regurgitation than in the group with primary valvular lesions (10.3 +/- 1.1% vs 21.9 +/- 1.6%; p 〈 0.01). Regional annular areas of the six sectors were homogeneously larger in group 2 than in group 3. The sector P3 did not show larger area than the other ones. The degree of MR, as assessed by the volumes of regurgitant jets, was higher in the group with primary valvular lesions than in the patients with IMR (32.6 +/- 13.4 cm(3) vs 23.1 +/- 11.1 cm(3); p 〈 0.01). Conclusions: This study showed that annular enlargement in patients with IMR affects the different annular regions to the same extent. An ideal surgical repair of IMR should be individually tailored after quantitative assessment measurement of geometry and function of each single component of the mitral. valve complex. (c) 2005 Elsevier B.V. All. rights reserved
    Type of Publication: Journal article published
    PubMed ID: 16439153
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