Tissue Volume Reduction Research Articles

Cervical nucleoplasty as an effective treatment method of cervical degenerative disc disease

Cervical nucleoplasty as an effective treatment method of cervical degenerative disc disease

Efficacy Study of Nasal Irrigation after Radiofrequency Tissue Volume Reduction for Inferior Turbinate Hypertrophy: An Equivalence Randomized Controlled Trial

To determine the benefits of nasal irrigation after radiofrequency tissue volume reduction (RFTVR) for inferior turbinate hypertrophy (ITH) in terms of nasal obstructive symptoms, endoscopic nasal findings, and acoustic rhinometry. An equivalence randomized controlled trial was performed at the Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand. Seventy-nine subjects with ITH planned for RFTVR were enrolled consecutively. The intervention was randomized into two groups: with and without nasal saline irrigation. Primary outcome was visual analog scale (VAS; 0-10) of postoperative nasal obstructive symptoms. Rhinorrhea, pain, nasal itching and sneezing, foul odor, bleeding, crusting and discharge, and patient satisfaction were self-assessed by the patients. Findings from endoscopic nasal examination and acoustic rhinometry (total nasal volume and cross-sectional area 2 [CSA2]) were performed before and after the intervention by blinded assessors. The study revealed no difference of nasal obstruction and other symptoms between the saline group and the control group on the 1st postoperative week, except nasal itching and sneezing. The saline group had itching and sneezing symptoms lower than the control group on the 5th-7th postoperative day. All patients had minimal or no postoperative nasal bleeding. There were also no differences of satisfaction and acoustic rhinometry findings between both groups. The nasal irrigation with normal saline had no additional benefits after RFTVR for ITH in terms of nasal obstructive symptoms, endoscopic nasal findings, and acoustic rhinometry except nasal itching and sneezing symptoms.

Reduction in synovial tissue volume following intra-articular steroid injection in knee osteoarthritis

Reduction in synovial tissue volume following intra-articular steroid injection in knee osteoarthritis

Long-Term Efficacy of Radiofrequency Treatment of Turbinate Hypertrophy: A Patient Based Point of View

Nasal turbinate hypertrophy is a major cause of nasal airway obstruction that affects up to 20% of the European general population. This study aims to determine the efficacy of radiofrequency treatment as perceived by patients during a 2-years period. From 2007 to 2009, an observational study was conducted on 36 patients who consecutively underwent temperature-controlled radiofrequency tissue volume reduction. A questionnaire was administered to each patient in order to collect demographic data, lifestyle habits, health status and visual analogue scale (VAS) score of perceived symptoms. Mean VAS scores of nasal obstruction, headache, rhinorrhoea and anosmia after treatment were significantly lower than that at baseline. Urban residence and allergic rhinitis were significantly associated with lower mean improvement (2.9 vs. 5.6; P=0.04 and 2.3 vs. 5.3; P=0.01, respectively). A non significant association with scarce nasal obstruction improvement was present in older aged patients, in patients other than students and in active and passive smokers. Our data enrich the general knowledge on radiofrequency treatment of turbinate hypertrophy identifying the rate of long-term efficacy of radiofrequency treatment as perceived by patients and focusing on several risk factors involved in patient prognosis after treatment.

Long-term clinical results of radiofrequency tissue volume reduction for inferior turbinate hypertrophy

To investigate the long-term clinical results of radiofrequency tissue volume reduction for symptomatic inferior turbinate hypertrophy. Patients who were unresponsive to medical treatment (n = 197) received turbinate reduction using radiofrequency energy. Subjective symptoms were assessed using a 10 cm visual analogue scale, and all patients underwent acoustic rhinometry before the procedure and six, 24, 48 and 60 months afterwards. Of the 197 treated patients, 148 completed the protocol. No significant peri-operative complications were observed. Thirty-two patients required follow-up treatment. Significant improvements were seen in nasal obstruction and discharge scores and in acoustic rhinometry values, at six, 24, 48 and 60 months post-operatively, compared with pre-operative values (p < 0.001 and p < 0.05, respectively). Radiofrequency tissue volume reduction is an effective procedure for inferior turbinate hypertrophy. The clinical benefit of this procedure persisted 60 months after the procedure.

Radiofrequency tissue volume reduction for treatment of auricle keloids

Keloids are often refractive to treatment, and recurrences occur quite frequently. Radiofrequency tissue volume reduction (RFTVR) is a surgical technology that induces extensive fibrosis at the target tissues. We applied RFTVR in 14 patients (19 auricles, 5 patients treated bilaterally; 9 female, 5 male; range, 10-66 years) with keloids of the auricle. Keloids were located at the earlobe in 4 patients (5 auricles), helix in 9 patients (12 auricles), and at both earlobe and helix in 1 patient (2 auricles). In 6 patients (8 auricles) RFTVR was the sole treatment modality applied, and in 7 patients (10 auricles) intralesional steroid injection was also performed. Patients underwent one to seven sessions of RFTVR. Patients were followed up between 2 and 92 months postoperatively (median, 24.5 months). Good cosmetic results were achieved in 10 of 14 patients (13 auricles). Three patients (5 auricles) were refractive to treatment, and 1 patient (1 auricle) showed progressive disease despite treatment. Radiofrequency tissue volume reduction may be considered as a new, minimally invasive treatment option for keloids of the auricle.

Surgery of the turbinates and "empty nose" syndrome.

Surgical therapy of the inferior and/or middle turbinate is indicated when conservative treatment options have failed. The desired goal is a reduction of the soft tissue volume of the turbinates regarding the individual anatomic findings, whilst simultaneously conserving as much mucosa as possible. As the turbinates serve as a functional entity within the nose, they ensure climatisation, humidification and cleaning of the inhaled air. Thus free nasal breathing means a decent quality of life, as well.Regarding the multitude of different surgical techniques, we confirm that no ideal standard technique for turbinate reduction has been developed so far. Moreover, there is a lack of prospective and comparable long-term studies, which makes it difficult to recommend evidence-based surgical techniques. However, the anterior turbinoplasty seems to fulfil the preconditions of limited tissue reduction and mucosa-preservation, and therefore it is the method of choice today.Radical resection of the turbinates may lead to severe functional disturbances developing a secondary atrophic rhinitis. The “empty nose” syndrome is a specific entity within the secondary atrophic rhinitis where intranasal changes in airflow result in disturbed climatisation and also interfere with pulmonary function. Results deriving from an actual in vivo study of climatisation and airflow in “empty nose” patients are presented.

A new method to deliver supraclavicular radiation in breast radiotherapy for lung sparing

Due to the angulation of the breast board used for tangential breast irradiation, additional normal lung tissues are included in the supraclavicular field. This work investigates a method to reduce the lung volume and dose delivered during supraclavicular irradiation for breast cancer. Ten patients included for this retrospective study received chest wall and supraclavicular irradiation following radical surgery or breast‐conserving surgery. Three‐dimensional conformal radiation therapy plans were generated using the CMS XiO treatment planning system. The clinical target volume (CTV) of the supraclavicular irradiation is defined as the subcutaneous tissues from 0.5 cm under the anterior skin surface to a 3 cm depth. Only the ipsilateral lung is defined as the organ at risk. In the new method, the couch is rotated 90° and the supraclavicular field is tilted to maintain a normal incident angle to the breast board rather than the couch surface to spare more normal lung tissues. The absolute volume of the ipsilateral lung irradiated, and the volumes of lung tissues receiving 5 Gy and 20 Gy (V5 and V20) are analyzed. The new method can reduce the lung volume irradiated by the supraclavicular field significantly. For the ten patients investigated, only 5.3% of the ipsilateral lung is irradiated with the new method, while 14.9% of the ipsilateral lung is irradiated using the conventional method. Compared with the conventional method, the new method reduces V5 by 53.6% and V20 by 59.0%. Our new method does not alter the patient positioning for breast treatment but rotates the couch to deliver a tilted supraclavicular field to maintain adequate CTV coverage and spare more normal lung tissues. The results of this study demonstrated that our new method is effective, and that the reduction of normal lung tissue volume in the field is significant.PACS number: 87.55.D‐

Long-term Antipsychotic Treatment and Brain Volumes

Progressive brain volume changes in schizophrenia are thought to be due principally to the disease. However, recent animal studies indicate that antipsychotics, the mainstay of treatment for schizophrenia patients, may also contribute to brain tissue volume decrement. Because antipsychotics are prescribed for long periods for schizophrenia patients and have increasingly widespread use in other psychiatric disorders, it is imperative to determine their long-term effects on the human brain. To evaluate relative contributions of 4 potential predictors (illness duration, antipsychotic treatment, illness severity, and substance abuse) of brain volume change. Predictors of brain volume changes were assessed prospectively based on multiple informants. Data from the Iowa Longitudinal Study. Two hundred eleven patients with schizophrenia who underwent repeated neuroimaging beginning soon after illness onset, yielding a total of 674 high-resolution magnetic resonance scans. On average, each patient had 3 scans (≥2 and as many as 5) over 7.2 years (up to 14 years). Brain volumes. During longitudinal follow-up, antipsychotic treatment reflected national prescribing practices in 1991 through 2009. Longer follow-up correlated with smaller brain tissue volumes and larger cerebrospinal fluid volumes. Greater intensity of antipsychotic treatment was associated with indicators of generalized and specific brain tissue reduction after controlling for effects of the other 3 predictors. More antipsychotic treatment was associated with smaller gray matter volumes. Progressive decrement in white matter volume was most evident among patients who received more antipsychotic treatment. Illness severity had relatively modest correlations with tissue volume reduction, and alcohol/illicit drug misuse had no significant associations when effects of the other variables were adjusted. Viewed together with data from animal studies, our study suggests that antipsychotics have a subtle but measurable influence on brain tissue loss over time, suggesting the importance of careful risk-benefit review of dosage and duration of treatment as well as their off-label use.

A common neonatal image phenotype predicts adverse neurodevelopmental outcome in children born preterm

Diffuse white matter injury is common in preterm infants and is a candidate substrate for later cognitive impairment. This injury pattern is associated with morphological changes in deep grey nuclei, the localization of which is uncertain. We test the hypotheses that diffuse white matter injury is associated with discrete focal tissue loss, and that this image phenotype is associated with impairment at 2 years. We acquired magnetic resonance images from 80 preterm infants at term equivalent (mean gestational age 29 + 6 weeks) and 20 control infants (mean GA 39 + 2 weeks). Diffuse white matter injury was defined by abnormal apparent diffusion coefficient values in one or more white matter region (frontal, central or posterior white matter at the level of the centrum semiovale), and morphological difference between groups was calculated from 3D images using deformation based morphometry. Neurodevelopmental assessments were obtained from preterm infants at a mean chronological age of 27.5 months, and from controls at a mean age of 31.1 months. We identified a common image phenotype in 66 of 80 preterm infants at term equivalent comprising: diffuse white matter injury; and tissue volume reduction in the dorsomedial nucleus of the thalamus, the globus pallidus, periventricular white matter, the corona radiata and within the central region of the centrum semiovale ( t = 4.42 p < 0.001 false discovery rate corrected). The abnormal image phenotype is associated with reduced median developmental quotient (DQ) at 2 years (DQ = 92) compared with control infants (DQ = 112), p < 0.001. These findings indicate that specific neural systems are susceptible to maldevelopment after preterm birth, and suggest that neonatal image phenotype may serve as a useful biomarker for studying mechanisms of injury and the effect of putative therapeutic interventions.

Laser-Assisted Liposculpture Improves Male Gynecomastia Outcomes with Minimal Scarring

Background: Currently, 36% to 40% of men have gynecomastia. Most cases involve excessive subareolar glandular development, an enlarged subareolar region, and adipose cells. When obesity is present, gynecomastia is complicated by the intertwining of glandular breast tissue with enlarged adipose cells. Although direct excision has been the standard technique for fat removal, it is often accompanied by periareolar scars, skin laxity, and other adverse events. Laser-assisted liposculpture removes adipose and glandular tissue in gynecomastia with postsurgical contraction of the skin. The purpose of this article is to evaluate the use of laser-assisted liposculpture for removing glandular and adipose tissue in gynecomastia. Materials/Participants/Methods: Forty men (aged 30 to 35 years) with gynecomastia underwent treatment in both breasts with laser-assisted liposculpture. Most participants were overweight but in good overall health. Using Klein's double-strength solution as a local anesthetic, breast tissue was treated using a 4-mm Blugerman disruptor for 3–5 minutes on each side until the tissue became morsalized. Laser-assisted lipolysis was then used on the subareolar bud and remaining fatty and fibrous breast tissue to create tissue coagulation and skin contraction. Energy levels of 1000 J per pass were used, and total energy applied to each breast ranged from 3000 to 5000 J. After treatment, components of the destroyed adipocytes were removed by negative pressure (350–450 mm Hg) through a 3-mm cannula. The small incisions did not require sutures. Patients were examined for symmetry between the treated breasts. Diluted triamcinolone (0.1 mL Kenalog 40 mg/0.9 mL sterile water) was injected beneath the areolar complex to reduce swelling. Patient satisfaction with skin tightening, chest contour, skin smoothness, and reduction of areolar size was graded on a scale of 0 to 10. Results: Postsurgical photographs showed reductions in breast tissue volume and more masculine-appearing chests. Patient expectations for outcome were met; satisfaction was generally 8 or higher. Discussion: Two earlier studies and the present study show that use of laser-guided lipolysis results in cellular lysis and collagen neoformation. Laser-assisted lipolysis and traditional liposculpture have similar risks and complications: increased asymmetry, waviness, pitting, and cobble-stoning or sagging in breasts. Patients may also develop hematomas, seromas, nerve damage, hypertrophic scars, infection/sepsis, bleeding, persistent edema, and allergic reaction. Conclusion: The SmartLipo and SlimLipo laser-assisted liposculpture systems can be used on most anatomic regions. Both offer reduced treatment time, smoother skin and less contour deformities, improved healing, less bruising, and reduced pain compared with traditional lipolysis.

High-Intensity Focused Ultrasound Effectively Reduces Adipose Tissue

Liposonix is considered to be a nonsurgical treatment for body contouring that uses high-intensity focused ultrasound (HIFU) to disrupt adipocytes percutaneously. We wanted to find out about its efficacy, effectiveness, and so forth. The technique delivers energy across the skin surface at a relatively low intensity, but brings this energy to a sharp focus in the subcutaneous fat. At the skin surface, the intensity of the ultrasound energy is low enough so that no damage occurs. The focusing of the ultrasound beam at specific depths beneath the epidermis, combined with proprietary application techniques, results in adipose tissue disruption. Once adipocytes have been disrupted, chemotactic signals activate the body's inflammatory response mechanisms. Macrophage cells are attracted to the area to engulf and transport the lipids and cell debris. This results in an overall reduction in local adipose tissue volume. Our clinical and histologic studies will show exactly what happens under the skin. We did a series of studies on gross pathology and histology, and we tried to correlate these with the clinical results. The histologies show clearly that adipocytes are disrupted by HIFU. The pathologies show the lesions, but they are always at a safe distance from dermis or the epidermis. The correlation between focal depth, energy levels, and clinical results is evident. The average circumference reduction after treatment of the abdomen and waist is 4-5 cm. Liposonix turns out to be a safe and effective technique for nonsurgical body sculpting by reduction of fat deposits.

First-Choice Treatment in Mild to Moderate Obstructive Sleep Apnea

To compare the efficacy of single-stage, multilevel, temperature-controlled radiofrequency tissue volume reduction (TCRFTVR) for the soft palate and base of the tongue with that of nasal continuous positive airway pressure (CPAP) in primary treatment of mild to moderate obstructive sleep apnea. A prospective nonrandomized clinical study. Tertiary care referral center. Data from 47 patients with mild to moderate obstructive sleep apnea treated between January 1, 2003, and October 31, 2006, were reviewed. Twenty-six patients underwent TCRFTVR and 21 underwent nasal CPAP as a primary treatment modality. Baseline and 12-month posttreatment measurements using the Epworth Sleepiness Scale and polysomnography were compared. The baseline characteristics of the groups were not significantly different. Both methods showed meaningful results for the Epworth Sleepiness Scale and polysomnography variables 12 months after treatment compared with baseline measurements. The results were not significantly different in the posttreatment intergroup comparisons. Treatment success rates were 52.4% for nasal CPAP and 53.8% for TCRFTVR (P = .92). Similar comparison results with nasal CPAP in objective and subjective variables make single-stage, multilevel TCRFTVR a good alternative in primary treatment of mild to moderate obstructive sleep apnea.

Ridge alterations following tooth extraction with and without flap elevation: an experimental study in the dog

Different approaches were advocated to preserve or improve the dimension and contour of the ridge following tooth extraction. In some of studies, socket 'flapless extraction' apparently had a successful outcome. The objective of the present experiment was to compare hard tissue healing following tooth extraction with or without the prior elevation of mucosal full-thickness flaps. Five mongrel dogs were used. The two second mandibular premolars ((2)P(2)) were hemi-sected. The mesial roots were retained. By random selection the distal root in one side was removed after the elevation of full-thickness flaps while on the contralateral side, root extraction was performed in a flapless procedure. The soft tissue wound was closed with interrupted sutures. After 6 months of healing, the dogs were euthanized and biopsies were sampled. From each experimental site, four ground sections - two from the mesial root and two from the healed socket - were prepared, stained and examined in the microscope. The data showed that the removal of a single tooth (root) during healing caused a marked change in the edentulous ridge. In the apical and middle portions of the socket site minor dimensional alterations occurred while in the coronal portion of the ridge the reduction of the hard tissue volume was substantial. Similar amounts of hard tissue loss occurred during healing irrespective of the procedure used to remove the tooth was, i.e. flapless or following flap elevation. Tooth loss (extraction) resulted in marked alterations of the ridge. The size of the alveolar process was reduced. The procedure used for tooth extraction - flapless or following flap elevation - apparently did not influence the more long-term outcome of healing.

Contractile function is preserved in unloaded hearts despite atrophic remodeling

Recent studies have shown that mechanically unloading a failing heart may induce reverse remodeling and functional improvement. However, these benefits may be balanced by an unloading-related remodeling including myocardial atrophy that might lead to decrease in function. Using a model of heterotopic heart transplantation, we aimed to characterize the myocardial changes induced by long-term unloading. Macroscopic as well as cellular and functional changes were followed in normal hearts unloaded for a 3-month period. Microscopic parameters were evaluated with stereologic methodology. Myocardial contractile function was quantified with a Langendorff isolated, perfused heart technique. Atrophy was macroscopically obvious and accompanied by a 67% reduction of the myocyte volume and a 43% reduction of the interstitial tissue volume, thus accounting for a shift of the myocyte/connective tissue ratio in favor of noncontractile tissue. The absolute number of cardiomyocyte nuclei decreased from 64.7 +/- 5.1 x 10(7) in controls to 22.6 +/- 3.7 x 10(7) (30 days) and 21.6 +/- 3.1 x 10(7) (90 days) after unloading (P < .05). The numeric nucleic density in the unloaded myocardium, as well as the mean cardiomyocyte volume per cardiomyocyte nucleus, remained constant throughout the 90 days of observation. Functional data indicated an increase in ventricular stiffness, although contractile function was preserved, as confirmed by unaltered maximal developed pressure and increased contractility (maximum rate of left ventricular pressure development) and relaxation (minimum rate of left ventricular pressure development). Atrophic remodeling involves both the myocyte and interstitial tissue compartment. These data suggest that although there is decreased myocardial volume and increased stiffness, contractile capacity is preserved in the long-term unloaded heart.

Mucosal changes in chronic hypertrophic rhinitis after surgical turbinate reduction

Chronic nasal obstruction owed to chronic hypertrophic rhinitis is one of the most common problems encountered in rhinology. Various forms of conservative therapy have been used, but these are often ineffective and surgical reduction techniques have been successfully applied. However, the issue of postoperative histological changes in the nasal mucosa has not been adequately addressed. The aim of the present study was to comparatively evaluate the effect of the methods of submucosal monopolar diathermy, radiofrequency coblation and ultrasounds on the nasal mucosa. Sixty patients with chronic hypertrophic rhinitis of nonallergic etiology underwent different surgical methods of turbinate reduction, divided into two groups: (1) 30 patients underwent tissue volume reduction of the inferior nasal turbinates using ultrasound procedure on the left side and monopolar diathermy on the right; (2) 30 patients underwent radiofrequency coblation technique on the left side and ultrasound reduction on the right. We studied 20 preoperative specimens of the inferior turbinate mucosa taken randomly from both groups of patients, 5 from each side of each group. Normal nasal mucosal specimens taken from ten healthy persons were used as controls. Specimens of the inferior turbinate were taken after 1, 3, and 6 months after surgery, from the same patients. All specimens were examined by electron microscopy. Preoperative observation revealed degeneration of epithelial cells, loss of cilia, disruption of intercellular connections, edema, nasal mucus overproduction and inflammatory infiltration in chorium. Postoperative observations revealed decrease of intercellular edema, reduction of mucus, overproduction of collagen and degeneration of the epithelium to flattened stratified. Only specimens after use of ultrasounds showed islands with normally organized epithelium of columnar ciliated cells. It may be concluded that epithelial changes owed to chronic hypertrophic rhinitis do not significantly improve postoperatively after turbinate tissue volume reduction. Only in several cases operated with ultrasounds, regeneration of epithelium occurs, resulting to anatomical and functional restoration of the nasal physiology.

Sutter®bipolar radiofrequency volumetric tissue reduction of palate for snoring and mild obstructive sleep apnoea: is one treatment adequate?

To evaluate the efficacy of bipolar radiofrequency volumetric tissue reduction, using Sutter technology, in the treatment of snoring and mild obstructive sleep apnoea. Prospective, non-randomised trial. Fifty-two patients with simple snoring and mild obstructive sleep apnoea underwent bipolar radiofrequency palate reduction under local anaesthesia. All patients were Friedman stage II and III, with tonsil sizes graded as zero, one or two, a mean body mass index of 22.6, and a mean age of 36.2 years. Seventy-seven per cent of patients reported improvement in their snoring; patients' mean snoring level (assessed by visual analogue scale) improved from 8.9 to 3.4 (p < 0.05). Eighty-three per cent of patients reported an improvement in their Epworth sleepiness scale score, from a mean of 14.6 to 9.5. Seven out of the 17 patients (41.2 per cent) met the surgical success criteria (i.e. at least a 50 per cent reduction of the pre-procedure apnoea-hypopnoea index, and a post-procedure apnoea-hypopnoea index of below 15). Patients' mean apnoea-hypopnoea index improved from 13.6 to 9.8, and their mean lowest oxygen saturation improved from 88.3 to 92.5 per cent. Eighty-two per cent of patients reported an improvement in their quality of life as a result of the procedure. One session of Sutter bipolar radiofrequency tissue volume reduction represents a viable method of treating snoring and mild obstructive sleep apnoea, with good results.

WE-D-351-08: Integrated Subvolume Boosting Technique to Reduce Normal Tissue Irradiation During SBRT Treatment Planning Using Helical Tomotherapy

Purpose: To characterize the reduction in normal tissue volume irradiated in a SBRT treatment plan by delivering an inhomogeneous dose to the PTV—via integrated subvolumes prescribed to increasing doses above prescription dose—instead of a homogeneous dose using helical tomotherapy. Method and Materials: Three patients were retrospectively planned using helical tomotherapy with two treatment plans: (1) homogenous plan delivering a uniform prescription dose to the PTV and (2) inhomogeneous plan delivering a non‐uniform dose to the PTV. Subvolumes were created by volumetrically contracting the PTV by 4mm resulting in three subvolumes within the PTV (PTVi, PTVii, and PTViii). Dose prescriptions to the various targets were as follows: Homogenous: PTV: 95% of volume to receive 60.0Gy; Inhomogeneous: PTViii: 20% of volume to receive 80.0Gy, PTVii: 50% of volume to receive 75.0Gy, PTVi: 50% of volume to receive 70.0Gy, PTV: 95% of volume to receive 60.0Gy. The homogenous and inhomogeneous plans were compared on the basis of normal tissue volume reductions to various dose levels assuming identical target coverage of the PTV. Results: A significant reduction in the volume of normal tissue irradiated to high doses was achieved for all patients. Average reduction of V90%, V80%, V50%, and V20% were 18, 15, 9, and 7%, respectively. It was noted that as the dose level decreases, the percent volume reduction between the homogeneous and inhomogeneous plans decreases. Conclusion: The study served to quantify the volumetric reduction of normal tissue irradiated during lungSBRT treatments with helical tomotherapy when delivering non‐uniform doses to the PTV as compared to uniform doses. Our results indicate that an inhomogeneous dose distribution generated by the creation of integrated subvolumes prescribed to higher doses within the PTV significantly reduces the volume of normal tissue irradiated, especially at higher doses (>50% of prescription dose).

Transmural Changes in Myocardial Tissue Volume During the Cardiac Cycle: Implications for Microvascular Flow Patterns with Ventricular Pacing

The transmural gradient in average myocardial blood flow is well known. However, few techniques have the temporal and transmural resolution to examine tissue volume and by implication vascular volume changes during the cardiac cycle during normal activation and with epicardial ventricular pacing. We studied the time course of transmural tissue volume change (TVC) in the anterior left ventricular wall of normal canine heart (n=14) using implanted markers and 125 Hz cineradiography. TVC was calculated from marker locations (as a relative fraction, 1.00=no change), and capillary volume was an assumed fraction of the compressible tissue. Capillary diameter (CD) was estimated from capillary volume and length changes (from myofiber strain). During normal activation there was a significant transmural gradient in TVC 72ms (Early) after QRS (.99±.04 (SD) epi, .95±.05 endo), and at end systole (ES) (.97±.06 epi, .89±.08 endo). This corresponded to an Early gradient in CD: 5.6±.6 (μm, epi) to 4.9±1.0 (endo), and a gradient at ES: 5.1±.8 (epi) to 4.2±1.4 (endo). During ventricular pacing the Early TVC gradients reversed: .97±.02 (epi) and .99±.05 (endo), with reduced gradients at ES. Early CDs were 5.3±.4 (epi) and 5.3±.6 (endo). Thus, there is a transmural gradient of reduction in tissue volume and CD during systole, which changes with ventricular pacing. Changes in transmural blood flow may trigger local tissue remodeling associated with areas of early ventricular activation. Supported by HL43617 and HL32583.

Comparison of radiofrequency tissue volume reduction and submucosal resection with microdebrider in inferior turbinate hypertrophy

To compare the efficacy of submucosal temperature-controlled radiofrequency tissue volume reduction (TCRFTVR) and resection with microdebrider (SMRM) in chronic inferior turbinate hypertrophy. Prospective, randomized, and single-blinded clinical trial. The study group consisted of 30 symptomatic patients who underwent simultaneous TCRFTVR and SMRM for consecutive sides. Visual analogue scale (VAS) and acoustic rhinometry (ARM) were made preoperatively and at 12th week and 6th month postoperatively; saccharine transport time (STT) and ciliary beat frequency (CBF) were performed at 12th week and 6th month postoperatively. The rate of the need for the revision operation was determined between 6 and 12 months period postoperatively. Significant improvement was achieved in VAS scores and ARM measurements after both procedures, whereas both parameters did not differ significantly between two procedures postoperatively. STT and CBF showed no significant post-treatment variation in comparison of the intergroup measurements. The rates of the need for revision operation were not significantly different. Identical results in objective and subjective parameters were observed for both techniques.