Underwent Laser Ablation Research Articles

Analysis of DNA from brain tissue on stereo-EEG electrodes reveals mosaic epilepsy-related variants.

Somatic mosaic variants contribute to focal epilepsy, but genetic analysis has been limited to patients with drug-resistant epilepsy (DRE) who undergo surgical resection, as the variants are mainly brain-limited. Stereoelectroencephalography (sEEG) has become part of the evaluation for many patients with focal DRE, and sEEG electrodes provide a potential source of small amounts of brain-derived DNA. We aimed to identify, validate, and assess the distribution of potentially clinically relevant mosaic variants in DNA extracted from trace brain tissue on individual sEEG electrodes. We enrolled a prospective cohort of eleven pediatric patients with DRE who had sEEG electrodes implanted for invasive monitoring, one of whom was previously reported. We extracted unamplified DNA from the trace brain tissue on each sEEG electrode and also performed whole-genome amplification for each sample. We extracted DNA from resected brain tissue and blood/saliva samples where available. We performed deep panel and exome sequencing on a subset of samples from each case and analysis for potentially clinically relevant candidate germline and mosaic variants. We validated candidate mosaic variants using amplicon sequencing and assessed the variant allele fraction (VAF) in amplified and unamplified electrode-derived DNA and across electrodes. We extracted DNA from >150 individual electrodes from 11 individuals and obtained higher concentrations of whole-genome amplified vs unamplified DNA. Immunohistochemistry confirmed the presence of neurons in the brain tissue on electrodes. Deep sequencing and analysis demonstrated similar depth of coverage between amplified and unamplified samples but significantly more called mosaic variants in amplified samples. In addition to the mosaic PIK3CA variant detected in a previously reported case from our group, we identified and validated four potentially clinically relevant mosaic variants in electrode-derived DNA in three patients who underwent laser ablation and did not have resected brain tissue samples available. The variants were detected in both amplified and unamplified electrode-derived DNA, with higher VAFs observed in DNA from electrodes in closest proximity to the electrical seizure focus in some cases. This study demonstrates that mosaic variants can be identified and validated from DNA extracted from trace brain tissue on individual sEEG electrodes in patients with drug-resistant focal epilepsy and in both amplified and unamplified electrode-derived DNA samples. Our findings support a relationship between the extent of regional genetic abnormality and electrophysiology, and suggest that with further optimization, this minimally invasive diagnostic approach holds promise for advancing precision medicine for patients with DRE as part of the surgical evaluation.

Prognostic outcome of cervical laser ablation using a holmium yttrium-aluminum-garnet (Ho:YAG) laser for the treatment of cervical intraepithelial neoplasia: A single-center retrospective study

ObjectiveAlthough cervical conization is considered a standard treatment for cervical intraepithelial neoplasia (CIN) 2/3, laser ablation can compensate for the disadvantages of the former. CO2, semiconductor, and holmium yttrium-aluminum-garnet (Ho:YAG) lasers are applied in ablation, but no previous studies have shown the effectiveness of any of these techniques. Here, we retrospectively analyzed the application of the Ho:YAG laser in our hospital to verify its efficacy, and discussed the methods for optimal recurrence detection. MethodsWe evaluated the recurrence rates of the pathological condition in patients who underwent laser ablation with a Ho:YAG laser for CIN2/3 at our institution from June 2012 to November 2021. We defined the recurrence as histologically confirmed CIN2 or more advanced stage. Age, preoperative diagnosis, human papillomavirus (HPV) genotype, and postoperative high-risk HPV status were recorded to establish their association with recurrence rates. ResultsWe performed surgery in 607 patients and the 2-year recurrence rate after interventions was 5.6%. Five patients were diagnosed with invasive cancer at the time of recurrence. Older age significantly correlated with higher risk of recurrence, but preoperative CIN grade and preoperative HPV 16/18 status did not significantly affect it. The postoperative high-risk HPV test was 100% sensitive for detecting recurrence. ConclusionsLaser ablation with the Ho:YAG laser yields promising results. Together with postinterventional management, high-risk HPV test after laser ablation should be conducted after diagnostic conization.This study received the approval from the Ethics Committee of the NHO Tokyo Medical Center (Ethics Committee approval number: R22-067).

Successful Management of Metastatic Lymph Nodes in the Chest by Laser Ablation via Endoscopic Ultrasound: A Case Report

Isolated spread of metastatic breast carcinoma to mediastinal lymph nodes is not an uncommon phenomenon. The prognosis worsens with the advent of any metastases in the chest. Conventional treatment mandates chemotherapy or radiotherapy as a control measures. Laser treatment has helped many patients with inaccessible or inoperable tumours, as it works on devascularisation and can benefit both benign and malignant tumours. This is a case report of a patient who did not respond to Trastuzumab and T-DM1 (Trastuzumab with Emtansine). She developed mediastinal lymph nodes during treatment with TDM1. Additionally, she had a documented change in hormonal status from Human Epidermal growth factor Receptor-2 (HER2) positive to negative. She underwent laser ablation of mediastinal lymph nodes around the trachea. A Positron Emission Tomography (PET) scan after six months showed a total resolution of the lymph nodes with no significant uptake in the chest or any other part of the body. Laser ablation of mediastinal lymph nodes is a very skillful and demanding procedure that can be attempted in refractory and isolated cases where chemotherapy and radiation have failed. Further studies are needed to assess the long-term results of this new procedure.

Approach, complications, and outcomes for 37 consecutive pediatric patients undergoing laser ablation for medically refractory epilepsy at Stanford Children's Health.

The objective of this study was to better understand the safety and efficacy of laser interstitial thermal therapy (LITT) for children with medically refractory epilepsy. Thirty-seven consecutive pediatric epilepsy patients at a single pediatric center who underwent LITT ablation of epileptogenic foci between May 2017 and December 2021 were retrospectively reviewed. Patient demographics, medication use, seizure frequency, prior surgical interventions, procedural details, and pre- and postoperative seizure history were analyzed. Thirty-seven pediatric patients (24 male, 13 female) with severe medically refractory epilepsy were included; all underwent stereo-electroencephalography (SEEG) prior to LITT. The SEEG electrode placement was based on the preoperative workup and tailored to each patient by the epileptologist and neurosurgeons working together to identify the epileptic network and hopefully quiet borders. Seizure onset was at a mean age of 2.70 ± 2.82 years (range 0.25-12 years), and the mean age at the time of LITT was 9.46 ± 5.08 years (range 2.41-17.86 years). Epilepsy was lesional in 23 patients (18 tuberous sclerosis, 4 focal cortical dysplasia, 1 gliosis) and nonlesional in 14. Eighteen patients had prior surgical interventions including open resections (n = 13: 11 single and 2 multiple), LITT (n = 4), or both (n = 1). LITT targeted a region adjacent to the previous target in 5 cases. The median number of lasers placed during the procedure was 3 (range 1-5). Complications occurred in 14 (37.8%) cases, only 3 (8.11%) of which resulted in a permanent deficit: 1 venous hemorrhage requiring evacuation following laser ablation, 1 aseptic meningitis, 2 immediate postoperative seizures, and 10 neurological deficits (7 transient and 3 permanent). Postoperatively, 22 (59.5%) patients were seizure free at the last follow-up (median follow-up 18.35 months, range 7.40-48.76 months), and the median modified Engel class was I (Engel class I in 22 patients, Engel class II in 2, Engel class III in 2, and Engel class IV in 11). Patients having tried a greater number of antiseizure medications before LITT were less likely to achieve seizure improvement (p = 0.046) or freedom (p = 0.017). Seizure improvement following LITT was associated with a shorter duration of epilepsy prior to LITT (p = 0.044), although postoperative seizure freedom was not associated with a shorter epilepsy duration (p = 0.667). Caregivers reported postoperative neurocognitive improvement in 17 (45.9%) patients. In this large single-institution cohort of pediatric patients with medically refractory seizures due to various etiologies, LITT was a relatively safe and effective surgical approach for seizure reduction and seizure freedom at 1 year of follow-up.

Third-trimester fetoscopic ablation therapy for types II and III vasa previa

Vasa previa is an obstetrical condition in which fetal vessels located near the cervix traverse the fetal membranes unprotected by underlying placenta. Type I vasa previa arises directly from a velamentous cord root, whereas types II and III arise from an accessory lobe or a distal lobe of the same placenta, respectively. Fetoscopic laser ablation for types II and III vasa previa is a novel therapeutic option with benefits that include surgical resolution of the vasa previa, avoidance of prolonged hospitalization, and opportunity for a term vaginal delivery. The potential risks of fetoscopy can be mitigated by delaying laser surgery until a gestational age of 31 to 33 weeks, immediately before anticipated hospitalized surveillance. This study aimed to assess feasibility and outcomes of types II and III vasa previa patients treated via fetoscopic laser ablation in the third trimester. This is a retrospective study of singleton pregnancies with types II and III vasa previa treated with fetoscopic laser ablation at a gestational age ≥31 weeks at a single center between 2006 and 2022. Pregnancy and newborn outcomes were assessed. Continuous variables are expressed as mean±standard deviation. Of 84 patients referred for vasa previa, 57 did not undergo laser ablation: 19 either had no or resolved vasa previa, 25 had type I vasa previa (laser-contraindicated), and 13 had type II or III vasa previa but declined laser treatment. Of the remaining 27 patients who underwent laser ablation, 7 were excluded (laser performed at <31 weeks and/or twins), leaving 20 study patients. The mean gestational age at fetoscopic laser ablation was 32.0±0.6 weeks, and total operative time was 62.1±19.6 minutes. There were no perioperative complications. All patients had successful occlusion of the vasa previa vessels (1 required a second procedure). All patients were subsequently managed as outpatients. The mean gestational age at delivery was 37.2±1.8 weeks, the mean birthweight was 2795±465 g, and 70% delivered vaginally. Neonatal intensive care unit admission occurred in 3 cases: 1 for respiratory distress syndrome and 2 for hyperbilirubinemia requiring phototherapy. There were no cases of neonatal transfusion, intraventricular hemorrhage, sepsis, patent ductus arteriosus, or death. Laser ablation for types II and III vasa previa at 31 to 33 gestational weeks was technically achievable and resulted in favorable outcomes.

Clinical analysis of 175 cases of vaginal intraepithelial neoplasia

ObjectiveTo evaluate the risk factors related to vaginal intraepithelial neoplasia (VaIN) severity. Study DesignThis retrospective study included patients with histologically confirmed VaIN diagnosed at Hubei Provincial Maternal and Child Health Hospital, China, between January 2017 and October 2021. The primary outcomes were persistence, remission, progression, and recurrence. Multiple ordinal logistic regression analysis was used to analyze the risk factors of VaIN severity. ResultsA total of 175 patients were included, 135 (77.1%) with VaIN 1, 19 (10.9%) with VaIN 2, and 21 (12%) with VaIN 3. Patients with VaIN 3 were older than those with VaIN1 2 (P < 0.001). The ratio of patients with concomitant cervical lesions increased with VaIN grade (23.7%, 47.4%, and 47.6% for VaIN 1, 2, and 3, respectively). The proportion of patients with intraepithelial neoplasia (CIN) 3 increased with the VaIN grade (3.1%, 44.5%, and 80% for VaIN 1, 2, and 3, respectively, respectively; all P < 0.001). In patients with VaIN 1, 19.4% had regression (spontaneous regression in 90.5%) and 80.6% underwent laser ablation (regression in 93.1%). In patients with VaIN 2 and 3, 3.1% showed no regression, 53.1% underwent laser ablation (regression in 76.4%), and 73.8% underwent excision (regression in 78.7%). Age (OR = 1.05, 95 %CI: 1.01–1.10, P = 0.010) and concomitant cervical lesion (OR = 6.99, 95 %CI: 2.31–21.12, P = 0.001) were independent risk factors for the severity of VaIN. ConclusionAge and cervical lesions might be the risk factors for VaIN severity.

A Comparison of Laser and Fistulotomy Techniques in the Treatment of Fistula-in-Ano.

Background Anal fistulas are a common complication of perianal abscesses.The treatment of anal fistulas is challenging, with persistent and high recurrence rates. The aim of this study was to evaluate the efficacy and cost-effectiveness of laser ablation compared to fistulotomy in the treatment of anal fistulas. Materials and methods The patients were examined for external and internal openings of the fistula, its number, length, type, relationship with the sphincters, and any previous history of abscess or proctological surgery. The surgical procedures, complications, incontinence, recurrence, and recovery time were evaluated and compared between the two groups. The laser ablation group received an intermittent laser application at a wavelength of 1470 nmand 10 watts for three seconds, while the fistulotomy group underwent cutting of the fistula tract with electrocautery while keeping a stylet in place. Results A total of 253 patients were included in this retrospective study, with 149 patients undergoing fistulotomy and 104 patients undergoing laser ablation. The patients were evaluated based on the type, number, and location of internal and external openings, and the length of the fistula tract according to the Parks classification. The mean follow-up period was 9.0±4.3 months. The results showed that the laser group had a shorter time to return to work and less postoperative pain compared to the fistulotomy group. However, the recurrence rate was higher in the laser group. The recurrence rate was also found to be higher in patients with low transsphincteric fistulas and in patients with diabetes mellitus. Conclusion Our study findings indicate that while laser ablation may be associated with less pain and quicker recovery time, it may also have a higher recurrence rate compared to fistulotomy.We believe that laser ablation is a valuable option for surgeons to consider early on in the treatment process, especially in cases where fistulotomy is not suitable.

An effective and considerable treatment of pilonidal sinus disease by laser ablation

The treatment of sacrococcygeal pilonidal disease (SPD) is still challenging. Although many non-surgical and surgical methods exist, no consensus has been reached on the best treatment. This study aimed to evaluate the efficacy of laser ablation using 1470‐nm radial diode laser fiber in treating SPD. We retrospectively studied the data of our 48 patients who operated on this technique between March 2019 and July 2022. All patients were treated with laser ablation using 1470‐nm radial diode laser fiber. The healing rate and recurrence rate, demographic and surgical data, postoperative pain, complications (wound infection, wound bleeding), the time of returning to regular work and life, and the time of wound healing were recorded. Postoperative pain was measured based on the visual analog scale (VAS) score. Postoperative follow-up was performed in the outpatient clinic every 1 week for 1 month. Among the 48 patients, 41 males and 7 females, with a mean age of 27.7 years (range 14–42), the healing rate was 100%, and the average healing time was 28.3 ± 5.5 days. Mean operative time was 15.5 ± 3.3 min. The recurrence rate was 2.1%. One patient relapsed 3 months after the operation. The patient underwent laser ablation again, and the sinus tract was closed. The median visual analog scale (VAS) score on the day of operation was 0(0,2). The median VAS score on the first, third, seventh, and fourteenth day after operation was 0(0,2), 0(0,1), 0(0,1), and 0(0,0), respectively. There was no wound infection or bleeding after the operation. The mean time to normal work/life was 7.1 ± 3.2 days. Almost all the patients felt very satisfied with the operation. Laser ablation using 1470‐nm radial diode laser fiber is effective in SPD treatment. It is associated with minor wounds and mild postoperative pain. It is a simple, safe, and minimally invasive technique and its clinical application for acute and chronic SPD in the absence of abscess is promising.

Long-Term Visual Prognosis of Patients Following Lens-Sparing Vitrectomy for Stage 4A Retinopathy of Prematurity.

This study evaluated the long-term visual outcomes of patients in whom at least one eye underwent successful lens-sparing vitrectomy (LSV) for stage 4A retinopathy of prematurity (ROP). A retrospective chart review was conducted using the data of 61 eyes of 42 patients with a minimum 4-year follow-up after successful LSV, with or without anti-vascular endothelial growth factor (VEGF) therapy, and whose best-corrected visual acuity (BCVA) was measurable using Landolt rings at the final visit. The mean age at the final follow-up was 10.1 ± 3.3 years. Before LSV, all eyes underwent laser ablation therapy. Twenty eyes (32.8%) with high vascular activity received anti-VEGF therapy before LSV. The mean decimal BCVA at the final follow-up was 0.23 ± 0.26 (range: hand motion to 1.2). Twenty-three eyes (54.1%) had a decimal BCVA of ≥0.4. Among 49 phakic eyes at the final examination, the mean refractive error was -10.1 ± 5.0 D, with 37 eyes (75.5%) having high myopia (>-6.0 D). No significant differences were observed in terms of decimal BCVA and refractive errors between eyes with and without anti-VEGF therapy. Approximately half of the patients had a decimal BCVA of ≥0.4, despite myopic refraction after successful LSV for stage 4A ROP. LSV for stage 4A ROP seemed to be associated with good visual function, despite myopic refraction.

Treatment of the fistula tract with laser ablation in high anal fistula

&lt;b&gt;Aim and introduction:&lt;/b&gt; Considering the recurrence and fecal incontinence rates in high anal fistulas, surgical treatment of anal fistulas is a challenging process, although many treatments have been defined today. The aim of our study is to evaluate the long-term results of laser ablation of the fistula tract in high anal fistulas.&lt;br /&gt; &lt;b&gt;Material and methods: &lt;/b&gt;The files of patients who underwent laser ablation of the fistula tract due to high anal fistula between June 2020 and January 2022 were evaluated retrospectively. Moreover, their postoperative complications, preoperative and postoperative Cleveland fecal incontinence scores (CCFFSI score), postoperative first day and first-week visual analog scale (VAS) scores, follow-up times, and recurrence rates were analyzed.&lt;br /&gt; &lt;b&gt;Results:&lt;/b&gt; 26 patients were included in the study. The mean follow-up period was 39.88±14.34 weeks, and the postoperative first and 7th day VAS scores were 4.61±1.41 and 0.8±1.02, respectively. Preoperative and postoperative CCFI scores were calculated as 1.8±1.41, 1.65±1.32, respectively. Recurrence was observed in 7 patients postoperatively. Postoperative anal abscess developed in 1 patient.&lt;br /&gt; &lt;b&gt;Conclusion: &lt;/b&gt;Although laser ablation of the fistula tract can be safely performed as a technique that does not affect incontinence, recurrence rates should also be considered. Furthermore, more extensive randomized prospective studies on this technique should be performed.&lt;b&gt; &lt;/b&gt;

ANALYSIS OF VARIOUS INTERVENTIONS IN THE MANAGEMENT OF INFANTILE HEMANGIOMAS

Introduction: Infantile hemangiomas are the most common benign vascular tumors of infancy. The prevalence is around 3-10%. The various risk factors include female gender, prematurity, low birth weight, multiple pregnancies, advanced maternal age and in vitro fertilization. IH most commonly affect the head and neck region. This study aims to give an insight and highlight the evidence-based approach in the management of IH. To assess the occurrence, plan Aim: of management and the interventions in the management of hemangiomas occurring in children. This study used a retrospective observational m Method: ethod to assess and evaluate the various interventions employed in the management of infantile hemangiomas between July 2021 and February 2022. A total of 50 patients were Result: included in the study, 30 were females and 20 males. 15 lesions were surgically treated, 5 underwent laser ablation and remaining 30 were treated with beta blockers and corticosteroids. The primary outcome measures were clearance, a subjective measure of improvement, and adverse events. Secondary outcomes were other measures of resolution; aesthetic appearance; and requirement for surgical correction. The Outcome: treatment of IH depends on the following factors: Type of hemangioma, stage of the lesion, location and extent, number and distribution of the lesion, associated systemic involvement, presence or absence of ulceration and psychosocial distress of the parents or child. In general, any function threatening (ocular, ear, nasal tip, lip, large disguring facial lesion and genitalia involvement) or life-threatening hemangioma, need intervention. The remaining cases need only active non-intervention, like education about the natural course, treatment options and anticipatory guidance. Systemic corticosteroids are used for complicated hemangiomas, followed by non-selective beta-blockers, such as oral propranolol and topical timolol can be used for uncomplicated localized lesions.

Placental Characteristics in Fetuses with Fetal Growth Restriction Undergoing Laser Ablation for Twin-to-Twin Transfusion Syndrome

To investigate the placental characteristics (vascular anastomoses and placental share) in a cohort of consecutive monochorionic (MC) twins complicated with selective fetal growth restriction (sFGR) coexistent with twin-to-twin transfusion syndrome (TTTS) underwent fetoscopic laser surgery (FLS).

Analysis of a two-year independent screening effort for retinopathy of prematurity in rural Egypt

BackgroundThe third epidemic of retinopathy of prematurity (ROP) has majorly involved middle income countries in which tailored screening and local guidelines require development. The data regarding ROP prevalence and cutoff numbers for screening in Egypt are lacking.MethodsRetrospective analysis of an independent screening effort spanning 2 years (February 2019 to February 2021) and involving 32 neonatal care units within Sharkia governorate, Egypt. Infants of gestational age (GA) ≤ 34 weeks and/or birth weight (BW) ≤ 2000 g were included, as well as those with unstable clinical course. Two eyecare centers located in Sharkia and Cairo governorates served as referral centers for any required interventions.ResultsOf the 276 screened infants, 133 (48.2%) had some form of ROP that was bilateral in 127 (95.5%) of them. Aggressive posterior ROP (AP-ROP) was detected in both eyes of 24 infants (8.7%). The median (IQR) GA of infants with ROP was 32 (30–34) weeks, and the median (IQR) BW was 1600 (1350–2000) g. Sixty-three infants (47.4%) required treatment. Of the total 84 eyes that primarily were treated, 73 (86.9%) received intravitreal ranibizumab, 8 (9.5%) underwent laser ablation therapy, and 3 eyes (3.6%) underwent surgery. Recurrence rate was 16.7% (14 eyes). Final outcome was favorable in 83 eyes (98.8%). Applying the American Academy criteria would have led to the missing of 36.8% of infants with ROP and 28.6% of those requiring treatment in our sample.ConclusionThe incidence of both ROP and AP-ROP in the Egyptian rural setting appears to be in the high end of global reported rates. Prevention measures should urgently be planned and implemented.

Polyetheretherketone and titanium surface treatments to modify roughness and wettability – Improvement of bioactivity and antibacterial properties

• PEEK and titanium both sustain cell adhesion, proliferation and differentiation. • Air-plasma treatment increases PEEK and titanium surface wettability. • Surface properties affect cell behavior depending on material nature. • Micropatterned titanium surface induce dental pulp stem cell differentiation. Among the materials available for implant production, titanium is the most used while polyetheretherketone (PEEK) is emerging thanks to its stability and to the mechanical properties similar to the ones of the bone tissue. Material surface properties like roughness and wettability play a paramount role in cell adhesion, cell proliferation, osteointegration and implant stability. Moreover, the bacterial adhesion to the biomaterial and the biofilm formation depend on surface smoothness and hydrophobicity. In this work, two different treatments, sandblasting and air plasma, were used to increase respectively roughness and wettability of two materials: titanium and PEEK. Their effects were analyzed with profilometry and contact angle measurements. The biological properties of the material surfaces were also investigated in terms of cell adhesion and proliferation of NIH-3T3 cells, MG63 cells and human Dental Pulp Stem Cells. Moreover, the ability of Staphylococcus aureus to adhere and form a viable biofilm on the samples was evaluated. The biological properties of both treatments and both materials were compared with samples of Synthegra® titanium, which underwent laser ablation to obtain a porous micropatterning, characterized by a smooth surface to discourage bacterial adhesion. All cell types used were able to adhere and proliferate on samples of the tested materials. Cell adhesion was higher on sandblasted PEEK samples for both MG63 and NIH-3T3 cell lines, on the contrary, the highest proliferation rate was observed on sandblasted titanium and was only slightly dependent on wettability; hDPSCs were able to proliferate similarly on sandblasted samples of both tested materials. The highest osteoblast differentiation was observed on laser micropatterned titanium samples, but similar effects, even if limited, were also observed on both sandblasted materials and air plasma treated titanium. The lowest bacterial adhesion and biofilm formation was observed on micropatterned titanium samples whereas, the highest biofilm formation was detected on sandblasted PEEK samples, and in particular on samples not treated with air-plasma, which displayed the highest hydrophobicity. The results of this work showed that all the tested materials were able to sustain osteoblast adhesion and promote cell proliferation; moreover, this work highlights the feasible PEEK treatments which allow to obtain surface properties similar to those of titanium. The results here reported, clearly show that cell behavior depends on a complex combination of surface properties like wettability and roughness and material nature, and while a rough surface is optimal for cell adhesion, a smooth and less hydrophilic surface is the best choice to limit bacterial adhesion and biofilm formation.

Abstract No. 230 Percutaneous ablation for the treatment of osteoid osteomas: a systematic review and meta-analysis

To evaluate the safety and efficacy of percutaneous ablative therapy for the treatment of osteoid osteomas. PubMed database, Web of Science, and SCOPUS were searched from their inception until November 2019 for articles describing osteoid osteoma. Inclusion criteria were as follows: studies reporting > 5 patients, and pre- and post-procedure pain assessment recorded with Visual Analog Scale (VAS). Demographic data, procedural details, technical success rates, pre- and post-procedure VAS scores, and procedural complications were recorded. A random-effects meta-analyses of the VAS pain score pre-procedurally, at 24-48 hours, at 3-6 months, and at 12 months were calculated. For radiofrequency ablation, VAS scores for pain at pre-procedure, 24-48 hours, and 3-6 months yielded cumulative pain scores of 7.64 ± 0.175 (1023 patients), 0.78 ± 0.186 (1009 patients), and 0.02 ± 0.0196 (1009 patients), respectively. For cryoablation, VAS scores for pain at pre-procedure, 24-48 hours, and 3-6 months yielded cumulative pain scores of 8.46 ± 0.549 (75 patients), 0.975 ± 0.66 (75 patients), and 0.112 ± 0.08 (75 patients), respectively. For laser ablation, VAS scores for pain at pre-procedure and 24-48 hours yielded cumulative pain scores of 4.94 ± 1.42 (59 patients), and 0.506 ± 0.268 (276 patients), respectively. Though the mean follow-up time for patients undergoing laser ablation was 49.15 ± 25.25 months, VAS scores were not reported 3-6 months post-procedure. For microwave ablation, VAS scores for pain at pre-procedure, 24-48 hours, and 3-6 months yielded cumulative pain scores of 6.14 ± 1.07 (7 patients), 1.636 ± 1.215 (44 patients), and 0 ± 0.0 (24 patients), respectively. All ablation methods resulted in a significant immediate and lasting pain reduction (P< 0.001). Overall recurrence of bone pain at the same site occurred in 4.07% of all patients an average of 11 months post-procedure. Percutaneous ablative therapies are safe and result in significant and lasting pain reduction as demonstrated through Visual Analog Scale pain scores.Tabled 1VAS PreprocedureVAS 24-48 Hours PostprocedureVAS 3-6 Months PostprocedureRadiofrequency ablation7.64 ± 0.175 (n = 1023)0.78 ± 0.186 (n = 1009)0.02 ± 0.0196 (n = 1009)Laser ablation4.94 ± 1.42 (n = 59)0.506 ± 0.268 (n = 276)-Cryoablation8.46 ± 0.549 (n = 75)0.975 ± 0.66 (n = 75)0.112 ± 0.08 (n = 75)Microwave ablation6.14 ± 1.07 (n = 7)1.636 ± 1.215 (n = 44)0 ± 0.0 (n = 24) Open table in a new tab

Predicting fetal and neonatal demise after fetoscopy for twin-twin transfusion syndrome using recursive partitioning.

Donor demise after laser surgery for twin-twin transfusion syndrome (TTTS) is well-characterized, but recipient demise is not, nor is neonatal death. This study aims to characterize factors associated with recipient death, donor death, and dual twin death after laser, both before and after birth. This is a prospective cohort study of monochorionic twin pairs who underwent laser ablation for TTTS. Risk factors for fetal and neonatal death of both twins were identified using univariable analysis and recursive partitioning, a novel statistical method to quantify contributions of each factor to outcomes. In 413 twin pairs, death of both twins occurred in 9.2% (38/413), donor death in 12.1% (50/413), and recipient death in 2.4% (10/413). Recursive partitioning showed that gestational age at delivery predicts dual twin death (below 23.7 weeks, likely [p<0.001], above 28.3weeks, unlikely [p=0.004]). Abnormal umbilical artery Doppler and weight discordance predict donor demise (p<0.001 and p=0.033, respectively). Cervical length under 16mm predicts neonatal death of both twins (p<0.001). Parents can gain individualized information about the survival of each fetus based on variables available from preoperative and delivery variables. Short cervix and premature delivery cause significant mortality in TTTS.

Ultrasound-Guided Femoral Nerve Block for Pain Management in Endovenous Laser Ablation for Varicose Vein

Background: Chronic venous insufficiency and its associated complications are a common condition affecting 15%–20% of the general population. Endovenous laser ablation (EVLA) is an effective day care treatment procedure. Tumescent anesthesia is given during EVLA to for pain relief and to prevent thermal damage to surrounding soft tissue by the laser energy. Regional nerve blocks can be given to reduce the pain of tumescent anesthesia and EVLA procedure. This study was aimed to evaluate pain score in varicose vein patients undergoing laser ablation with or without femoral nerve block. Materials and Methods: A total of 60 patients having only great saphenous vein disease were enrolled and divided into two Groups A and B using random number table. Group A was given tumescent anesthesia before laser EVLA procedure. Group B patients were given ultrasound guided femoral nerve block before tumescent anesthesia and laser ablation. Pain score was recorded intraoperatively, immediate and delated postoperative period (0, 1, and 3 h) on the Visual Analog Score. Data were analyzed using the standard statistical analysis tools. Results: Intraoperative and postoperative pain was significantly lower in Group B patients as compared to Group A (P

Role of laser ablation in recalcitrant instent restenosis post iliofemoral venous stenting.

Instent restenosis (ISR) represents the most common reason for recurrent symptoms requiring reintervention in patients who have undergone venous stenting for chronic iliofemoral venous obstruction. Treatment of ISR requires stent angioplasty typically using angioplasty balloons equal to or larger than the rated diameter of the stent. At times this does not yield the required result, and in these patients, utilization of a laser catheter supported by an angled sheath is helpful to ablate the ISR or make it more amenable to repeat balloon angioplasty. The authors report their experience with this technique for 18 patients with recurrent symptoms impacting quality of life as a result of recalcitrant ISR in this retrospective review of contemporaneously entered electronic medical record data. 12 (67%) limbs underwent laser ablation only, while 6 (33%) limbs underwent additional angioplasty post laser ablation. Post intervention for ISR, at 12 months, the venous clinical severity score improved from 5 to 3.5 (P = .0005) and the VAS pain score went from 7 to 5 (P = .0005). At 10 months, primary patency was 87% and primary assisted patency was 100%. There were no stent occlusions. Laser ablation of recalcitrant instent restenosis in patients presenting with recurrent chronic iliac venous obstruction post iliofemoral venous stenting is a safe and effective option. Corroboration from larger studies is warranted.

Experience with Intravitreal Ranibizumab as an Adjunct to Ablation Therapy in Eyes with Exudative Coats' Disease.

BackgroundCoats’ disease is a rare entity with retinal vascular telangiectasia that can progress to exudative retinal detachment, neovascular glaucoma, and a blind painful eye requiring enucleation. Despite recent therapeutic advances decreasing the need for enucleation, no consensus exists about the optimum management of exudative Coats’ disease. The use of intravitreal anti-vascular endothelial growth factor agents as an adjunct to ablation therapy has been shown to achieve favorable outcomes, but some reports suggest an increased incidence of vitreoretinal (VR) fibrosis and tractional retinal detachment (TRD).MethodsWe retrospectively reviewed records of patients presenting with exudative Coats’ disease (stages 2 and 3) from April 2016 till November 2020. Extracted data included clinical and radiological assessment, stage (Shields’ classification), interventions, and follow-up.ResultsSixteen eyes were included in the final analysis, of which 4 (25%) were stage 2 and 12 (75%) were stage 3. All eyes underwent intravitreal ranibizumab injection combined with ablation therapy, 14 (87.5%) underwent cryotherapy, 4 (25%) underwent laser ablation, 3 (18.75%) underwent external subretinal fluid drainage, and 3 (18.75%) underwent buckle or vitrectomy surgery. After a median follow-up of 16 months, 11 eyes (68.75%) had complete resolution, 4 (25%) had incomplete resolution, and only one (6.25%) progressed but did not require enucleation. Three eyes (18.75%) developed VR fibrosis, but none progressed to TRD.ConclusionCombining intravitreal ranibizumab injection with ablation therapy is effective in managing exudative Coats’ disease. External drainage should be preserved for when ablation therapy is not feasible. Future prospective trials with pre-defined outcomes are required.

Twin-twin transfusion syndrome - a University Hospital experience with intrauterine treatment.

twin-to-twin transfusion syndrome (TTTS), defined by combination of polyhydramnios-oligohydramnios, is the most prevalent (5%-35%) of the abnormalities due to placental vascular anastomoses and the most lethal (80%-100% mortality) if untreated. Fetoscopic laser ablation of abnormal vasculature using the Solomon technique is the gold standard approach. It consists of interrupting the intertwin blood flow. to present our initial experience at the Fetal Surgery Service of the Hospital de Clinicas of the Federal University of Parana (HC-UFPR) and to compare our results with those reported in the literature. we conducted a retrospective analysis of pregnancies who had undergone laser ablation, assessing data on Quintero's staging, gestational age at diagnosis and at the time of the procedure, placental position, immediate post-procedure survival, and survival after the neonatal period. We then compared these data with the most recent data available in the literature. we analyzed ten TTTS cases. The diagnosis was performed before the 26th week of pregnancy (median 20.8 weeks) and treatment occurred in a median of 9.5 days later. The distribution by the Quintero's staging was of three cases in stage II, five in stage III, and two in stage IV. In 50% of the gestations, at least one of the fetuses survived through the neonatal period. the treatment of TTTS in the HC-UFPR had a positive impact in the survival of the affected fetuses, although the results were worse than the ones reported in the literature, probably due to the delay in referencing the patients to our service, leading to a prolonged interval between diagnosis and treatment.