Minimal Invasive Treatment Research Articles

Transperineal Laser Ablation Treatment for Lower Urinary Tract Symptoms Due to Benign Prostatic Obstruction: Protocol for a Prospective In Vivo Pilot Study.

BackgroundStandard surgical treatments for lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO) use a transurethral approach. Drawbacks are the need for general or spinal anesthesia and complications such as hematuria, strictures, and cloth retention. Therefore, a minimal invasive technique under local anesthesia is desired to improve patient safety. Recently, SoracteLite transperineal laser ablation (TPLA) has been introduced as a novel minimal invasive treatment for BPO. The system used is unique because 4 laser sources are independently available. This 1064-nm diode laser induces coagulative necrosis. Moreover, TPLA is unique because it has a transperineal approach and can be performed under local anesthesia in an outpatient setting.ObjectiveThe primary objective of this study is to determine the safety and feasibility of TPLA treatment for men, who are fit for standard surgery, with LUTS due to BPO. The secondary objectives are to determine functional outcomes by flowmetry and patient-reported outcome measures (PROMs), side effects, and tissue changes observed on imaging.MethodsThis study is a prospective, single center, interventional pilot study IDEAL framework stage 2a and will include 20 patients. Eligible patients are men ≥40 years of age, with a prostate volume of 30 to 120 cc, have urodynamically proven bladder outlet obstruction, and have a peak urinary flow of 5 to 15 mL per second. All patients will undergo TPLA of their prostate under local anesthesia by using the EchoLaser system. Depending on the prostate volume, 2 to 4 laser fibers will be placed bilaterally into the prostate. Patient follow-up consists of uroflowmetry, PROMs, and imaging by using contrast-enhanced ultrasound. Total follow-up is 12 months following treatment.ResultsPresently, recruitment of patients is ongoing. Publication of first results is expected by early 2020.ConclusionsTPLA offers the potential to be a novel minimal invasive technique for treatment of LUTS due to BPO in men fit for standard desobstruction. This study will evaluate the safety and feasibility of TPLA and report on functional outcomes and tissue changes observed on imaging following TPLA treatment.International Registered Report Identifier (IRRID)DERR1-10.2196/15687

The role of neutrophil-to-lymphocyte ratio in predicting overall survival in patients undergoing laser interstitial thermal therapy for glioblastoma

Laser interstitial thermal therapy (LITT) offers a minimally-invasive treatment option for glioblastomas (GBM) which are relatively small or in eloquent areas. While laser ablation for malignant gliomas has been shown to be safe and effective, the role of the subsequent immune response in not well established. In this study we aim to analyze the prognostic potential of edema volume and acute inflammation, quantified as neutrophil-to-lymphocyte ratio (NLR), in predicting overall survival. Twenty-one patients were identified with new or recurrent GBMs that were candidates for LITT. Laser ablation was performed using standard solid tumor protocol for treatment volume, intensity and duration. Edema volume was quantified using MRI imaging, while retrospective chart review was performed to calculate NLR and survival. In patients treated with LITT for GBM, peri-tumoral vasogenic edema volumes did not significantly change post-operatively, p > 0.200, while NLR significantly increased, p = 0.0002. The degree of NLR increase correlated with longer overall survivals, and ROC analysis demonstrated an area under the curve of 0.827, p = 0.0112. A delta-NLR cutoff of 7.0 results in positive and negative predictive values of 78% and 75%, respectively, in predicting overall survival >1 year. Patients with with delta-NLR > 7.0 lived significantly longer that those with delta-NLR < 7.0, median survival 440 days compared to 239 days, p = 0.0297. We demonstrate preliminary data that monitoring the inflammatory response after LITT in GBM patients offers a potential prognostic measurement to assist in predicting treatment efficacy and overall survival.

The role of microwave ablation as an alternative or adjunct to resection of neuroendocrine liver metastases

Background: Surgical resection of neuroendocrine tumor liver metastases (NETLM) has been proven to improve survival, but the benefit of microwave ablation (MWA) as a minimally invasive, tissue-sparing alternative to curative surgery or debulking procedure has yet to be assessed. We present our center’s experience with MWA and/or surgery for NETLM in terms of safety and recurrence rates. Methods: Retrospective study including all patients treated with MWA and/or resection for NETLM between 2000 and 2017. Follow-up consisted in 3-monthly imaging according to the recommendation of the interdisciplinary conference. Results: A total of 47 patients, median age 60 years (27-76), were included in this analysis, receiving 68 interventions. Patients underwent between 1 and 4 interventions, including 34 liver resections (6 laparoscopic, 28 open), 20 MWAs (12 percutaneous, 8 open), and 14 combined procedures (3 laparoscopic, 11 open). A total of 130 individual lesions were treated with MWA, representing 4 lesions per session (1-30). While no complications occurred after MWA, after open resection 9 patients needed drainage for 8 biliomas and 1 abscess (IIIa) and 1 patient was transplanted for liver failure (IVb). The majority of patients (33/47, 70.2%) received curative procedures, 14 patients (29.8%) debulking procedures. Two patients (4.3%) had a local recurrence at the ablation site, both combined with disease progression in the liver. One patient (2.1%) had a recurrence at the resection site and underwent successful re-resection. Liver-only disease progression occurred in 17% of patients and overall progression in 47%, after median 7 months (range 0-43). Mean survival was not significantly different between the debulking and curative group (38.9 (SD 20.1) and 50.8 (SD 38.8) months respectively, p=0.2288). Conclusion: MWA might be a safe alternative or addition to resection for NETLM with low complication and local recurrence rates, allowing a liver-sparing minimal invasive treatment of this often recurring chronic disease.

Periradicular Cystic Enucleation and PRF Grafting Following Apicoectomy in Trichotillomania Patient- A Case Report

Diagnosis and treatment planning of untreated traumatised anterior teeth specially in children with psychiatric disorders or special health care needs is a challenge to paediatric dentist, that too in non-pharmacological means is a difficult task. Most of the time when these patients report with such complaint, it is already too late. This could be due to unintentional reasons like lack of parent awareness or patient’s response at the time of insult. All these factors bypass the time of conservative and minimal invasive treatment approaches. Ultimately, delayed treatment of trauma to anterior region exposes pulp and infection progress to periradicular region with cystic changes. Here, in this case report, the non-pharmacological management of periradicular cyst enucleation, followed by apicoectomy and Platelet Rich Fibrin (PRF) grafting was done in a 15-year-old female patient with obsessive compulsive disorder i.e., Trichotillomania (TTM) under local anaesthesia. Symptoms and intraoral swelling was resolved postoperatively in follow-up visits.

Laparoscopic and Robotic Management of Ureteral Stricture in Adults.

The aim of this review was to provide an update on the status of minimal invasive treatment of ureteral stricture either with a laparoscopic or robotic surgery. Eligible studies, published until November 2019 were retrieved through Medline, Cochrane and Pubmed databases. Predetermined inclusion and exclusion criteria were used as selection method for data synthesis and acquisition. The study was performed in accordance with the PRISMA statement. A total of 19 retrospective studies met the inclusion criteria. All of them demonstrated the safety, feasibility and success of both laparoscopic and robotic ureteral reconstruction. Individual case series or cumulative comparison analysis of the available studies showed at least equivalent success rates and a trend favoring laparoscopic and robotic groups in terms of estimated blood loss and length of hospital stay to the detriment of longer operative times and possibly higher cost. Current evidence suggests the effectiveness, safety and increasing incorporation of minimally invasive techniques for complex stricture repair and reconstruction.

”Geometry-based cannulation technique” for cannulation of great saphenous vein during radiofrequency ablation of varicose veins at a university hospital of Nepal

Background: Radiofrequency ablation is an established minimal invasive treatment modality of varicose veins. This technique involves accessing the great saphenous vein (GSV) through which radiofrequency ablation catheter is inserted. Some established puncture techniques like in-plane and out-plane techniques are also not devoid of limitations. Aims and Objectives: To know the applicability of “Geometry based cannulation technique” in terms of mean cannulation attempts and percentage of successful cannulation. Materials and Methods: We are doing “Geometry based cannulation technique” for the cannulation of GSV. For cannulation 18G needle of length 3 cm attached with 10 ml syringe (cannulating needle) partly filled with normal saline is used. Doppler ultrasonography is done with Siemen's Acuson P300 machine with linear probe of frequency 7.5–12 MHz. The depth from the skin to the upper part of vein is measured in cm and is termed as distance “A.” The tip of the cannulating needle is positioned on the middle of the probe and gently pressed down the skin to form the shadow in the Doppler. The needle is readjusted such that the shadow corresponds to the GSV. Then, the needle is moved distally to A distance. Then the needle is made rotated 45° and skin is punctured to the length (distance B) calculated from the Pythagoras theorem as square root of 2A2. Then the angle is decreased to about 30° and further 2–3 mm advancement of the cannulating needle is done such that it lies inside the target GSV. Results: From 459 cannulations in the time frame of August 2013–December 2018, we found that mean cannulation attempts were 1.4 (standard deviation 0.72, 1–3 attempts). In 429 GSVs (95.5%), there were successful cannulations, whereas in 20 GSVs (4.5%), there was failure in cannulation. The cannulation of GSV has higher success if the diameter of GSV is more than 5 mm and the depth is less than 10mm. Conclusion: “Geometry based cannulation technique” for cannulation of GSV is a novel technique and can be used with high success.

Stereotactic radiofrequency ablation of a variety of liver masses in children

Background and aims Surgical resection is currently the cornerstone of liver tumor treatment in children. In adults radiofrequency ablation (RFA) is an established minimally invasive treatment option for small focal liver tumors. Multiprobe stereotactic RFA (SRFA) with intraoperative image fusion to confirm ablation margins allows treatment for large lesions. We describe our experience with SRFA in children with liver masses. Methods SRFA was performed in 10 patients with a median age of 14 years (range 0.5–17.0 years) suffering from liver adenoma (n = 3), hepatocellular carcinoma (n = 1), hepatoblastoma (n = 2), myofibroblastic tumor (n = 1), hepatic metastases of extrahepatic tumors (n = 2) and infiltrative hepatic cysts associated with alveolar echinococcosis (n = 1). Overall, 15 lesions with a mean lesion size of 2.6 cm (range 0.7–9.5 cm) were treated in 11 sessions. Results The technical success rate was 100%, as was the survival rate. No transient adverse effects higher than grade II (Clavien and Dindo) were encountered after interventions. The median hospital stay was 5 d (range 2–33 d). In two patients who subsequently underwent transplant hepatectomy complete ablation was histologically confirmed. Follow-up imaging studies (median 55 months, range 18–129 months) revealed no local or distant recurrence of disease in any patient. Conclusions SRFA is an effective minimal-invasive treatment option in pediatric patients with liver tumors of different etiologies.

Diagnostic and interventional management of infective spine diseases.

Spondylodiscitis (SD) is one of the main causes of back pain. Although the low mortality, high morbidity is related to spondilodiscitys, leading spine instability, chronic pain or neurological deficit. Diagnostic imaging plays a primary role in diagnosing spondylodiscitis. However different accuracy is highlighted by different diagnostic tool, depending also on timing of disease which represents a cardinal element for the phenotypic manifestation of the disease, beyond spatial resolution and tissue characterization proper of specific modality imaging. Conventional Radiology (CR), Computed Tomography (CT) and MRI (Magnetic Resonance Imaging) all have proven to be of primary importance in the approach to spondylodiscitis, although magnetic resonance imaging has demonstrated the greatest advantage in identifying the disease from its earliest stages, demonstrating high sensitivity and specificity (92% and 96%, respectively). This review focus on the role of different imaging modality in the approach to the spondylodiscitis, also addressing the role of interventional radiology that is pivotal not only for a diagnosis of certainty through biopsy, but also for a minimally-invasive treatment of paravertebral abscesses spondylodiscitis-related. (www.actabiomedica.it)

Primary obstructive megaureter: a domain of conservative treatment

The term "megaureter" is an entirely descriptive designation for a number of different entities. It is crucial to distinguish between primary and secondary forms of megaureter and between obstructive and/or refluxive forms. In the majority of cases, there is a primary obstruction in the terminal ureterovesical segment. The treatment of primary obstructive megaureter has changed fundamentally over the last 3 decades. Whereas ureteral reimplantation was the treatment of choice in the past, conservative treatment is now preferred in 85 to 90 % of patients. With the advent of endoscopic balloon dilatation, a modern, minimally-invasive treatment option has become an alternative to ureteral reimplantation in selected patients. However, due to the possibility of postoperative VUR (vesicoureteral reflux), it is necessary to emphasize that this option should not weaken the generally strict indication for surgical treatment of primary obstructive megaureter.

Treatment of bone loss in proximal femurs of postmenopausal osteoporotic women with AGN1 local osteo-enhancement procedure (LOEP) increases hip bone mineral density and hip strength: a long-term prospective cohort study

SummaryThis first-in-human study of AGN1 LOEP demonstrated that this minimally-invasive treatment durably increased aBMD in femurs of osteoporotic postmenopausal women. AGN1 resorption was coupled with new bone formation by 12 weeks and that new bone was maintained for at least 5–7 years resulting in substantially increased FEA-estimated femoral strength.IntroductionThis first-in-human study evaluated feasibility, safety, and in vivo response to treating proximal femurs of postmenopausal osteoporotic women with a minimally-invasive local osteo-enhancement procedure (LOEP) to inject a resorbable triphasic osteoconductive implant material (AGN1).MethodsThis prospective cohort study enrolled 12 postmenopausal osteoporotic (femoral neck T-score ≤ − 2.5) women aged 56 to 89 years. AGN1 LOEP was performed on left femurs; right femurs were untreated controls. Subjects were followed-up for 5–7 years. Outcomes included adverse events, proximal femur areal bone mineral density (aBMD), AGN1 resorption, and replacement with bone by X-ray and CT, and finite element analysis (FEA) estimated hip strength.ResultsBaseline treated and control femoral neck aBMD was equivalent. Treated femoral neck aBMD increased by 68 ± 22%, 59 ± 24%, and 58 ± 27% over control at 12 and 24 weeks and 5–7 years, respectively (p < 0.001, all time points). Using conservative assumptions, FEA-estimated femoral strength increased by 41%, 37%, and 22% at 12 and 24 weeks and 5–7 years, respectively (p < 0.01, all time points). Qualitative analysis of X-ray and CT scans demonstrated that AGN1 resorption and replacement with bone was nearly complete by 24 weeks. By 5–7 years, AGN1 appeared to be fully resorbed and replaced with bone integrated with surrounding trabecular and cortical bone. No procedure- or device-related serious adverse events (SAEs) occurred.ConclusionsTreating femurs of postmenopausal osteoporotic women with AGN1 LOEP results in a rapid, durable increase in aBMD and femoral strength. These results support the use and further clinical study of this approach in osteoporotic patients at high risk of hip fracture.

Floating Thoracic and Abdominal Aortic Thrombus: Endovascular Solutions to Unexpected Findings. A Minimal Invasive Treatment With a High Primary Success

Floating Thoracic and Abdominal Aortic Thrombus: Endovascular Solutions to Unexpected Findings. A Minimal Invasive Treatment With a High Primary Success

Postoperative discomfort and pain in the management of hemorrhoidal disease: laser hemorrhoidoplasty, a minimal invasive treatment of symptomatic hemorrhoids.

Hemorrhoidal disease (HD) treatment still remains controversial. In fact, despite many surgical progresses, postoperative pain, and discomfort remain the major weaknesses. Laser hemorrhoidoplasty (LHP) is a minimal invasive procedure for HD treatment determining the shrinkage of the hemorrhoidal piles by diode laser. The aim of the current study is to analyze the feasibility and efficacy of LHP in patients with II-III degrees hemorrhoids. Consecutive patients with II-III degree hemorrhoids were enrolled in the study and underwent an LHP treatment using a 1470-nm diode laser. Operative time, postoperative pain and complications, resolution of symptoms, and length of return to daily activity were prospectively evaluated. Recurrence of prolapsed hemorrhoid or symptoms at a minimum follow-up of 6months was evaluated. Fifty patients (28 males and 22 females) were enrolled in the study. No significant intraoperative complications occurred. Postoperative pain score (at 12, 18, and 24h postoperatively), evaluated through visual analogue scale, was extremely low (mean value 2). No postoperative spontaneous bleeding occurred. The 100% of our population came back to daily activity 2 days after surgery. At a mean follow-up period of 8.6months, we reported a recurrence rate of 0%. LHP demonstrated a large efficacy in selected patients. The greatest strength points were low postoperative pain, the presence of slightly significant peri-anal wounds, no special anal hygienic measures and low surgical time. Thus, resulting in a negligible postoperative discomfort, LHP could be considered a painless and minimal invasive technique in the treatment of HD.

Cyberknife Radiosurgery for Trigeminal Neuralgia.

IntroductionImage-guided robotic radiosurgery is an emerging minimally-invasive treatment option for trigeminal neuralgia (TN). Our group has treated 560 cases up to date, and report here the clinical outcomes of 387 treatments with three years follow-up. This study represents the largest single-center experience on CyberKnife radiosurgery for the treatment of TN so far reported.MethodsCyberKnife radiosurgery treatment was offered to patients with drug-resistant TN, after the failure of other treatments or refusal of invasive procedures. A second treatment was offered to patients with a poor response after the first treatment or with recurrent pain. Treatment protocol required the non-isocentric delivery of 60 Gy prescribed to the 80% isodose to a 6 mm retrogasserian segment of the affected trigeminal nerve. Retreatments typically received 45 Gy, again prescribed to the 80% isodose. The final plan was developed accordingly to individual anatomy and dose distribution over the trigeminal nerve, gasserian ganglion, and brainstem. Clinical outcomes such as pain control and hypoesthesia/numbness have been evaluated after 6, 12, 24, and 36 months. ResultsOur group has treated 527 patients with Cyberknife radiosurgery at Centro Diagnostico Italiano (CDI), Milan, Italy, during the last decade. A minimum follow-up of six months was available on 496 patients. These patients received 560 treatments: 435 patients (87.7%) had a single treatment, 60 patients (12.1%) had two treatments, and one patient (0.2%) had five treatments (two on the right side, three on the left side). Twenty four patients had multiple sclerosis (4.8%). Four hundred and forty-three patients (84%) received the treatment without previous procedures, while 84 patients (16%) underwent radiosurgery after the failure of other treatments. A neurovascular conflict was identified in 59% of the patients. Three hundred and forty-three patients (receiving a total of 387 treatments) had a minimum of 36 months follow up. Pain relief rate at 6, 12, 18, 24, 30 and 36 months was respectively 92, 87, 87, 82, 78 and 76%. Forty-four patients out of 343 (12.8%) required a second treatment during the observed period. At 36 months post-treatment, 21 patients (6,1%) reported the presence of bothering facial hypoesthesia. Eighteen patients out of 21 (85.7%) developed this complication after a repeated treatment. ConclusionsFrameless image-guided robotic radiosurgery in experienced hands is a safe and effective procedure for the treatment of TN, providing excellent pain control rates in the absence of major neurological complications. Repeated treatments due to recurrent pain are associated with restored pain control but at the price of a higher rate of sensory complications.

Pregnancy and symptomatic relief following ultrasound-guided transvaginal radiofrequency ablation in patients with adenomyosis.

To report the reproductive results and symptomatic relief of patients with adenomyosis who attempted to conceive after ultrasound-guided radiofrequency ablation (RFA). Of 182 consecutive patients with adenomyosis who had undergone RFA, only 81 patients were eligible for this study. Pregnancy outcomes, postoperative complications, preoperative and postoperative pictorial blood loss assessment chart scores, and pain scores were evaluated. Of these 81 patients, 74 were infertile and seven were single at the time of RFA. The mean age at the time of operation was 35.8 years. The mean duration from the time of RFA to conception was 18.9 months (range, 2-72 months). Fifty-nine patients tried natural conception, while 22 patients attempted conception with assisted reproductive techniques. Twenty-nine (35.8%) patients achieved 39 pregnancies. Except for the 23 patients who did not actively try to conceive and who inevitably or arbitrarily discontinued pregnancy attempts, the pregnancy success rate reached 50%. Twenty-two (84.6%) of the 29 patients delivered 24 (66.7%) live babies (nine vaginal deliveries and 15 cesarean sections). Twelve (33.3%) pregnancies ended in spontaneous abortions. No uterine ruptures occurred. Paired sample t-tests revealed that preoperative pictorial blood loss assessment chart and pain scores were significantly (P < 0.05) different from the postoperative scores at 1-, 3- and 6-months. RFA could be considered a minimally-invasive treatment option for patients with adenomyosis who desire to maintain fertility and alleviate symptoms.

Stereotactic radiofrequency ablation of primary liver tumors in the caudate lobe

BackgroundThe encasement of the caudate lobe by a vascular ring of large vessels may apart from the technical difficulties in needle placement increase the probability of local recurrence after thermal ablation due to cooling effects. This single-center retrospective study evaluates the results after multiprobe stereotactic radiofrequency ablation (SRFA) of hepatocellular carcinoma (HCC) in the caudate lobe. MethodsTwenty patients underwent 24 multiple-probe SRFA sessions for the treatment of 24 HCCs in the caudate lobe. Eight of twenty patients had initially solitary tumors, the remaining 12 patients suffered from multifocal disease. ResultsThe median tumor size was 1.5 cm (range: 1–8 cm). After a mean follow-up of 21 months one local recurrence in the caudate lobe was observed resulting in a local recurrence rate of 4.2% (1/24). The overall survival rates at 1, 3, and 5 years from the date of the first SRFA were 95%, 59%, and 44%, respectively, with a median overall survival of 51.3 months. The disease-free survival after SRFA was 48%, 24% and 24%, at 1, 3 and 5 years, respectively. One patient suffering from Child C liver cirrhosis died due to septic shock 26 days after SRFA and one postinterventional complication required minimal invasive interventional treatment. ConclusionMultiprobe SRFA for HCC in the caudate lobe appears to be safe and feasible. The overall outcome is at least comparable to that of surgical resection, with low perioperative mortality and only minimal morbidity.

Therapeutic and diagnostic efficacy of root block procedure in lumbosacral radiculopathy: A study of 75 cases

Background: Back pain and leg pain are one of the most common symptoms in day to day orthopaedic clinical practice. Also, there is rise in incidence of discogenic back ache because of changed lifestyle, abnormal posture of sitting and lying, continuous sitting in vehicles, and inadequate physical activities. Selective nerve root blockings having the diagnostic and therapeutic use, which is popular and possess certain advantages in avoiding uncertain potential of surgical complications. Aim: To evaluate diagnostic and therapeutic efficacy of selective nerve root block procedure. To study relief in terms of pain alleviation, decrease in disability and straight leg raising (SLR) restriction. Materials and Method: It is a Prospective study of 75 patients of sciatic radiculopathy between the ages of 20 and 60 years are assessed under study that satisfied the inclusion criteria, received selective nerve blocks. Patients were assessed for pain relief and disability reduction.Results: Total of 75 patients were included in study with 55 males and 20 females with male to female ratio of approx 2:1. The VAS and ODI scores were evaluated in the patients received the nerve block. There was significant immediate improvement in the VAS score and reduction in ODI score at 1st week, 1 month and 6 month of follow-up period in patients. Conclusion: SNRB is a important and most effective less expensive and minimal invasive treatment modality to provide relief to patients with pain and long lasting therapeutic benefits. This allows the patients to resume the physical activity or work.

Randomized controlled trials reflected clinical practice when comparing the course of low back pain symptoms in similar populations

ObjectiveThis study compares participants in randomized controlled trials (RCTs) (the Minimal Invasive Treatment [MinT] trials) to participants in a related observational study with regard to their low back pain (LBP) symptom course. Study Design and SettingEligible patients were diagnosed with chronic LBP originating from the facet joints (N = 615) or sacroiliac (SI) joints (N = 533) and were treated with radiofrequency denervation and an exercise program. Randomized patients were compared to patients in the related observational study who fulfilled all RCT eligibility criteria (observational group 1) and to patients who did not fulfill at least one of the RCT eligibility criteria (observational group 2). Outcomes were pain intensity, treatment success, and functional status over a 3-month period. Longitudinal mixed-model analyses and linear regression models were applied to analyze the differences in outcomes between the RCT and observational study groups. ResultsNo differences in symptom course were found between patients in the RCTs and patients in observational group 1. Patients with facet joint pain in observational group 2 had overall less treatment success (odds ratios [OR], 0.67; 95% confidence interval [CI], 0.50–0.90), and less improvement in physical functioning (mean difference [MD], 5.82; 95% CI, 2.54–9.11) compared to the RCT patients. Patients with SI joint pain in observational group 2 had higher pain scores (MD, 0.40; 95% CI, 0.09–0.72), less treatment success (OR, 0.72; 95% CI, 0.54–0.96), and less improvement in physical functioning (MD, 7.16; 95% CI, 3.84–10.47) compared to the RCT patients. ConclusionThis supports the generalizability of results from the MinT RCTs as this study suggests that these RCTs reflect clinical practice when comparing similar populations. To what extent this holds true for all RCTs in LBP should be further explored.

Particularities and Efficacy of Extracorporeal Shock Wave Lithotripsy in Children

Background: Extracorporeal shock wave lithotripsy (ESWL) was first introduced in paediatric population in 1986. Given the more frequent recurrence in children, compared to adults, urinary stones treatments should require minimal invasive treatment methods. In this study, we aimed to evaluate the profile of the young patient with lithiasis who can benefit from ESWL, analysing the experience of 2 clinical departments. Materials and Methods: We have retrospectively reviewed the medical records of 54 children who underwent ESWL for urolithiasis. ESWL success rate was defined as stone-free status or the presence of clinically insignificant residual fragments. Data were analysed using the STATA 14.2. Results: In our study, the incidence of renal-ureteral calculi is significantly higher in girls (68.5%), compared to boys (31.5%). In total, 83.3% of patients showed a favourable outcome after treatment and the remaining 16.7% showed minimal complications. The presence of complications and remaining calculi was correlated to children age. The overall stone free rate was 88.9%. For calculus of 8.5 mm, only one ESWL session is recommended. Conclusions: The high percentage of cases with favourable outcome indicate that ESWL treatment is effective, considering the minimal cost, minimal invasiveness, repeatability and no need for general anaesthesia.

Endoscopic repair of anastomotic leakage after low anterior resection for rectal cancer: A systematic review.

Anastomotic leakage (AL) after low anterior resection for rectal cancer is a severe complication. Except for re-operation, several endoscopic options have been proposed for the minimal invasive treatment of AL, including the endoluminal vacuum devices, tissue sealants and Over-The-Scope-Clip (OTSC) technique. The aim of the present review is to evaluate the effect of alternative treatment options for AL repair, by means of endoscopy. A bibliographic search was performed in the international literature. Ten case reports and series were finally included, reporting 75 cases of endoscopic repair of AL. A descriptive statistical analysis and a systematic review were performed. The patients' mean age was 65.84 ± 9.92 years (95% CI: 61.70-68.76), the male-to-female ratio being 1.5:1. The mean diameter of the cavity was 5.17 ± 3.32 cm (95% CI: 4.03-6.31). The mean time until the diagnosis was 44.15 ± 105.91 days (95% CI: 13.39-74.90). Vacuum-assisted closure therapy was the most common technique (52%), followed by fibrin glue (25.3%) and OTSC (22.7%). As supplementary therapy, OTSC was applied in 8.3%, vacuum-assisted closure in 25%, endoclips in 4.2%, while fibrin glue was the most frequently used (62.5%). Endoscopic management of AL after low anterior resection is considered as an alternative to surgical treatment with promising results.

Early recurrence detected in hepatocellular carcinoma patients after transcatheter arterial chemoembolization treatment with plasma cell-free DNA.

Hepatocellular carcinoma (HCC) is one of the most lethal malignancies worldwide with poor prognosis due to the high incidence of recurrence. For patients with advanced HCC, transcatheter arterial chemoembolization (TACE) is the preferred treatment option owing to the minimal invasive clinical treatment with optimum therapeutic outcomes. But, there is a paucity of studies on early detection of residual cancer and relapse that result in the bottleneck of long-term effects after TACE therapy. Using next-generation sequencing platform targeting a panel of 622 cancer-associated genes, we prospectively evaluated the predictive significance of plasma cell-free DNA (cfDNA) to detect minimal residual disease in plasma cfDNA in comparison with DNA obtained from tumor tissue and blood cells of three eligible cases with HCC following TACE therapy. The results indicated that the mutational spectrum from plasma cfDNA was consistent with tumor-derived DNA and potentially suggested disease progression. Next, we determined if the dynamic variation of plasma cfDNA could indicate treatment response, the findings suggested that the mutation burden of plasma cfDNA could reveal relapse before alterations in conventional computed tomography imaging and serum α-fetoprotein values. The mutation burden in plasma cfDNA may serve as a novel prognostic biomarker by providing early evidence of residual disease and identifying high risk of recurrence in patients with HCC following TACE therapy.