Underwent Laser Ablation Research Articles

SURG-19. EVALUATION OF SERUM NEURON SPECIFIC ENOLASE, INTERFERON-ALPHA, AND INTERFERON-GAMMA IN RESPONSE TO LASER ABLATION OF HIGH GRADE GLIOMAS

Abstract BACKGROUND The blood-brain barrier (BBB) is a formidable obstacle in the treatment of gliomas. It has been speculated that the BBB may be temporarily disrupted in laser ablation, a relatively new treatment used for newly diagnosed and recurrent high grade gliomas (HGG). BBB disruption can be measured non-invasively through serum neuron specific enolase (NSE) levels. In addition to disrupting the BBB, laser ablation could trigger an immune response in brain that has yet to be studied. Interferon-alpha (IFN-α) and interferon-gamma (IFN-ɣ) are cytokines used as serum markers for an immune response. OBJECTIVE To measure NSE and IFN-α and IFN-ɣ as serum markers for BBB disruption and brain immune response activation, respectively, in patients undergoing laser ablation for recurrent high grade gliomas. METHODS Sixteen patients with recurrent HGG underwent laser ablation from 2/2017 to 12/2019. All 16 patients had gross total ablation of the contrast enhancing mass. Serum levels of NSE, IFN-α, IFN-ɣ were measured pre-operatively and at 24 hours, 2 weeks, and 8-16 weeks post-operatively, depending on adjuvant treatment received post-operatively. RESULTS Levels of NSE consistently increased 24 hours post-operatively (2.28±0.37 ng/ml) compared to pre-operative levels (1.62±0.29 ng/ml), p=0.032. Afterwards, NSE decreased and reached baseline by 2 weeks postoperatively (2 weeks- 1.67±0.29 ng/ml, 8 weeks- 1.85±0.91 ng/ml, 12 weeks- 0.81±0.33 ng/ml, 16 weeks- 1.23±0.93 ng/ml). Compared to their pre-operative levels, IFN-α and IFN-ɣ (85.46±35.29 and 1.62±0.47 pg/ml, respectively) did not display a significant difference in their serum levels (p=0.26-0.72 and 0.14-0.60, respectively, for IFN-α and IFN-ɣ) at any post-operative measurement time. Conclusions: Elevated NSE levels following laser ablation in HGG indicate a temporary disruption of the BBB that persists for approximately 2 weeks without eliciting an accompanying immune reaction in brain. Correlation studies with DCE-MRI are on-going.

LASER ABLATION OF NON-MUSCLE INVASIVE BLADDER TUMORS; ANY ADVANTAGE OVER STANDARD RESECTION PROSPECTIVE COMPARATIVE STUDY

Background: The choice of treatment modality in patients with Non muscle invasive bladder cancer (NMIBC) is one of the most discussed issues in urology.One of major problems in management of NMIBC in high recurrence and progression rates. In recent years, the laser has increasing role in different urological fields.Aim of the Work: Evaluation of the value of adding LASER ablation of the tumor bed after resection of the non-muscle invasive transitional cell carcinoma of the urinary bladder.Patients and Methods: 136 patients with non-muscle invasive bladder cancer randomly divided into two groups: Group 1 underwent Laser ablation of tumor bed after resection (Laser group)(n=68), and Group 2 underwent conventional transurethral resection of bladder tumor (TURBT group) (n=68). Operation time, irrigation time, Catheterization time, postoperative hospital stay, Postoperative clot retention or any postoperative complications, and results after each follow up cystoscopy were collected and compared.Results: after one year follow up for all patients we found that patients who underwent laser ablation after resection has less recurrence or progression rates than patients of the other group which was significant statistically. Also they had less postoperative hospital stay and early catheter removal.Conclusion: laser found that it can decrease the recurrence and progression rates in NMIBC after 1 year follow up, it also found to improve postoperative hematuria and decrease postoperative catheterization time and postoperative hospital stay when compared to conventional TURBT.

Bladder pain syndrome/interstitial cystitis in contemporary UK practice: Outcomes of phenotype-directed management.

Problem bladder pain syndrome/interstitial cystitis (BPS/IC) is a heterogeneous disorder with variation in management worldwide. Phenotyping aims to personalize therapy and optimize outcomes. The most well-described phenotype is Hunner lesion disease (HLD). The prevalence of HLD and outcome of phenotype-directed management in the UK is not well-studied. We describe the management of a contemporary cohort of patients with BPS/IC in the UK. Retrospective analysis of all patients with BPS/IC from January 2015-November 2018. Outcomes of patients who underwent laser ablation to Hunner lesions were collected using the Global Response Assessment tool. One hundred and sixty-three patients (mean age of 43 years [20-85]) were included. 78% were female and patients had experienced symptoms for an average 6 years (1-30) prior to specialist assessment. Eighty-three percent of patients had pelvic imaging (44% ultrasound, 42% magnetic resonance imaging and 14% computed tomography), and a relevant abnormality was found in five (4%). Twenty-two patients (14%) had HLD (International Society for the Study of BPS [ESSIC] 3), with a mean bladder capacity of 373 mL (175-650 mL); 77% were ESSIC C on histopathology. All patients with HLD underwent laser ablation, with 55% experiencing a moderate/marked improvement in symptoms, with a mean duration of effect of 10 months (3-36); 27% of patients had a repeat treatment. The presence of HLD in patients with BPS/IC is not uncommon. Pelvic imaging rarely identifies any cause for pain and so cystoscopy under anesthesia is essential for accurate phenotyping. Phenotype-directed management with holmium laser ablation to Hunner lesions has good short-term efficacy in improving pain, but re-intervention is often required.

Experience of surgical treatment of leukoplakia of the urinary bladder in women with chronic cystitis

28 women with leukoplakia of the bladder, clinically manifested by dysuria and pain in the bladder were observed. All patients have a history of chronic urinary tract infection. At the time of inclusion in the study there were no signs of exacerbation of cystitis. All patients underwent laser ablation of the altered bladder mucosa. Control examinations were performed 1, 3, and 6 months after surgery. Positive dynamics of clinical indicators was noted after surgery in all patients. Tolerance to laser ablation was satisfactory, there were no postoperative complications. A complete recovery of urothelium in the operation area was achieved after 6 months according to control cystoscopy. The results of the study showed high efficiency and safety of laser ablation of the altered bladder mucosa in patients with leukoplakia.

Fetoscopic Laser Ablation Therapy for Type II Vasa Previa

Background: In type II vasa previa, fetoscopic laser ablation has the potential to avoid prolonged hospitalization, elective prematurity, and cesarean delivery associated with traditional conservative management. Objective: To assess the feasibility and to report perinatal outcomes of type II vasa previa patients treated via fetoscopic laser ablation. Study Design: This is a retrospective descriptive study of all women with vasa previa treated with laser at our center between 2006 and 2019. After 2010, laser ablation of vasa previa was only offered after 31 gestational weeks. Continuous variables are expressed as means ± SD. Results: 33 patients were evaluated for laser ablation of suspected vasa previa. Fifteen were not candidates (7 had type I vasa previa and 8 had no vasa previa), and the 18 remaining had type II vasa previa. Ten (56%) elected to undergo in utero laser ablation of the vasa previa vessel(s), which was successful in all patients. The mean gestational age (GA) at the time of the procedure was 28.8 ± 5.4 weeks, and the total operative time was 48.1 ± 21.3 min; there were no perioperative complications. The number of vessels lasered were distributed as follows: 1 (2 cases), 2 (5 cases), and 3 (3 cases). All patients except for 1 were subsequently managed as outpatients. The mean GA at delivery was 35.5 ± 3.2 weeks, and vaginal delivery occurred in 5 cases. The 5 patients with singletons who underwent laser ablation for primary diagnosis of type II vasa previa after the protocol change in 2010 had the following outcomes: mean GA of surgery was 32.5 ± 0.8 weeks, mean GA at delivery was 38.1 ± 1.4 weeks, vaginal delivery occurred in all cases, mean birth weight was 2,965 ± 596 g, and none were admitted to the neonatal intensive care unit. Conclusion: This cohort represents the largest number of vasa previa cases treated via in utero laser reported to date. Laser occlusion of type II vasa previa was technically achievable in all cases and resulted in favorable outcomes.

Fiber Optic Sensors-Based Thermal Analysis of Perfusion-Mediated Tissue Cooling in Liver Undergoing Laser Ablation.

The current challenge in the field of thermo-ablative treatments of tumors is to achieve a balance between complete destruction of malignant cells and safeguarding of the surrounding healthy tissue. Blood perfusion plays a key role for thermal ablation success, especially in the case of highly vascularized organs like liver. This work aims at monitoring the temperature within perfused swine liver undergoing laser ablation (LA). Temperature was measured through seven arrays of Fiber Bragg Grating sensors (FBGs) around the laser applicator. To mimic reality, blood perfusion within the ex-vivo liver was simulated using artificial vessels. The influence of blood perfusion on LA was carried out by comparing the temperature profiles in two different spatial configurations of vessels and fibers. The proposed setup permitted to accurately measure the heat propagation in real-time with a temperature resolution of 0.1°C and to observe a relevant tissue cooling near to the vessel up to 65%.

Spatially resolved thermometry during laser ablation in tissues: Distributed and quasi-distributed fiber optic-based sensing

Abstract This work assesses quasi-distributed Fiber Bragg Gratings (FBGs) and Rayleigh scattering-based distributed sensing for accurate and millimeter resolved thermometry in media undergoing laser ablation. Mono-, two- and three-dimensional temperature measurements were performed with a network of 1 mm-long FBGs in 10-25-40-FBGs-arrays and distributed-sensing fiber with gauge lengths (GL) of 5.2 and 1.3 mm. Results confirm that the lower the spatial resolution of the sensors, the highest the root mean square error (RMSE) and temperature underestimation with respect to reference sensors (25-FBGs array). Compared to 1 mm-long FBGs, distributed sensing with 5.2 mm GL provided RMSE >7 °C and underestimation >16 °C in agar-gel phantom. Signal-to-noise ratio over time and temperature standard deviation over temperature show better performances of FBGs over distributed sensors. Indeed, any improvement of spatial resolution for distributed sensors determines an increase of noise in the signal. The three-dimensional measurement performed with 420 FBGs with 1 mm-sensing length demonstrated the spatial and thermal gradient occurring in the pancreas undergoing LA, reaching 28 °C over 5 mm. Millimeter-resolved FBGs proved to be effective for accurate thermometry in laser irradiated tissues, and potentially usable in clinical applications.

Evaluation of healing of varicose ulcers after endovenous laser ablation of great saphenous vein

Background: Varicose veins are permanently swollen, tortuous and elongated while standing due to back flow of blood caused by incompetent valve closure which result in venous congestion .they are of two types primary and secondary varicosities .The main symptoms are tingling, itching, pain, fatigue, a heavy feeling in the legs especially if one has to stand for a long time. Ulcers and thrombophlebitis are possible complications. The aim of this study is to assess the outcome of laser ablation of great saphenous vein on healing of varicose ulcers.Methods: A prospective study conducted at Suez Canal University Hospitals and Nasser Institute Hospital in Cairo on 20 patients complaining varicose ulcers due to incompetent saphenous femoral junction.Results: All patients had improvement in Abrdeen Varicose vein questionnaire after endovenous laser ablation (EVLA) during the first, second and third follow up visits when compared with preoperative scores. The Aberdeen Varicose vein questionnaire ranged from 8 to 18 before the procedure, with a mean of 12.11, ranged from 3 to 11 at the first follow up visit with a mean of 7.07, ranged from 2 to 10 at the second follow up visit with a mean of 4.89 and ranged from 2 to 10 at the third follow up visit with a mean of 3.85, p value is less than 0.001 compared to the pre-operative data. During the assessment of the patients of our study after 6 months of continuous follow up, we found that the healing rate of the patients who underwent laser ablation of great saphenous vein were (91.67) (p=0.769).Conclusions: EVLA of great saphenous vein leads to better wound healing rates in treating patients with varicose ulcers.

Clinical outcomes of vaginectomy and laser ablation for the treatment of post-hysterectomy women with vaginal high-grade squamous intraepithelial lesions: A retrospective study

ObjectiveTo evaluate the clinical outcomes of vaginectomy and laser ablation for the treatment of vaginal high-grade squamous intraepithelial lesion (HSIL) patients who underwent previous hysterectomy for cervical HSIL or cancer. Study DesignThe clinicopathologic data and follow-up information of 167 post-hysterectomy vaginal HSIL patients who underwent laser ablation or vaginectomy were retrospectively reviewed from 2010 to 2018 at the Obstetrics and Gynecology Hospital of Fudan University. ResultsOf the 167 vaginal HSIL patients enrolled, 74 patients underwent vaginectomy, and 93 patients underwent laser ablation. At a median follow-up of 15 months, 13 (7.8 %) patients experienced progression to vaginal cancer, and 22 (13.2 %) patients had persistent/recurrent disease. Upon multivariate analysis, laser ablation (OR: 5.16, p = 0.02), cytology indicating HSIL (OR: 25.45, p = 0.00), and a shorter interval between previous hysterectomy and vaginal HSIL diagnosis (< 24 vs ≥ 24 months, OR: 0.10, p = 0.02) were associated with disease persistence/recurrence. In post-hysterectomy for cervical HSIL patients, the vaginectomy group had a significantly higher recurrence-free survival rate (RFS, 94.5 % vs 69.0 %, p = 0.00) and a similar progression-free survival rate (PFS, 96.4 % vs 91.4 %, p = 0.17) compared with the laser ablation group. Among post-hysterectomy for cervical cancer patients, RFS (89.5 % vs 65.7 %, p = 0.04) and PFS (100.0 % vs 82.9 %, p = 0.05) were both higher in the vaginectomy group than in the laser ablation group. ConclusionCompared with laser ablation, vaginectomy resulted in better clinical outcomes among vaginal HSIL patients who had undergone previous hysterectomy for cervical neoplasia.

Clinical course and surgical treatment of paraurethral cysts in women

The results of surgical treatment of 59 women (average age 31.9 1.3 years) who underwent laser ablation of paraurethral cysts using the Lakhta-Milon laser apparatus (Russia) (diode laser with a wavelength of 0.97 m) are presented. The postoperative period in all patients proceeded without serious complications. The average hospital stay was 1.7 1.5 days. 4 weeks after surgery, all 59 patients noted improvement such as lack of dysuria, only 10 (16.9%) had minor discharge from the genital tract. 6 weeks after surgery all 59 operated patients had wound epithelization. Conclusion: The treatment of paraurethral cysts should be surgical and as radical as possible. The operation of choice is laser ablation of paraurethral formations.

Twelve-Month Volume Reduction Ratio Predicts Regrowth and Time to Regrowth in Thyroid Nodules Submitted to Laser Ablation: A 5-Year Follow-Up Retrospective Study.

ObjectiveLaser ablation is a therapeutic modality used to reduce the volume of large benign thyroid nodules. Unsatisfactory reduction and regrowth are observed in some treated nodules. The aim of the study was to evaluate the long-term outcomes of laser treatment for solid nodules during a 5-year follow-up period, the regrowth rate, and the predictive risk factors of nodule regrowth.Materials and MethodsWe retrospectively evaluated patients with benign, solid, cold thyroid nodules who underwent laser ablation and were followed-up for 5 years. According to the selection criteria, 104 patients were included (median baseline nodule volume, 12.5 mL [25.0–75.0%, 8–18 mL]; median energy delivered, 481.5 J/mL [25.0–75.0%, 370–620 J/mL]). Nodule volume, thyroid function test results, and ultrasound were evaluated at baseline and then annually after the procedure.ResultsOf 104 patients, 31 patients (29.8%) had a 12-month volume reduction ratio (VRR) < 50.0% and 39 (37.5%) experienced nodule regrowth. Of these 39 patients, 17 (43.6%) underwent surgery and 14 (35.9%) underwent a second laser treatment. The rate of nodule regrowth was inversely related to the 12-month VRR, i.e., the lower the 12-month VRR, the higher the risk of regrowth (p < 0.001). The mean time for nodule regrowth was 33.5 ± 16.6 months. The 12-month VRR was directly related to time to regrowth, i.e., the lower the 12-month VRR, the shorter the time to regrowth (p < 0.001; R2 = 0.3516). Non-spongiform composition increased the risk of regrowth with an odds ratio of 4.3 (95% confidence interval [CI] 1.8–10.2; p < 0.001); 12-month VRR < 50.0% increased the risk of regrowth with an odds ratio of 11.7 (95% CI 4.2–32.2; p < 0.001).ConclusionThe VRR of thyroid nodules subjected to similar amounts of laser energy varies widely and depends on the nodule composition; non-spongiform nodules are reduced to a lesser extent and regrow more frequently than spongiform nodules. A 12-month VRR < 50.0% is a predictive risk factor for regrowth and correlates with the time to regrowth.

SURG-07. STEREOTACTIC LASER ABLATION AS A THERAPEUTIC OPTION FOR RECURRENT GLIOBLASTOMA: A LARGE SINGLE INSTITUTIONAL EXPERIENCE

Abstract INTRODUCTION The prognosis of patients diagnosed with recurrent glioblastoma remains dismal, and therapeutic options are limited. The median survival is only 3 to 5 months. Stereotactic laser ablation is a minimally invasive neurosurgical technique used as an ablative treatment. We report outcomes of a large single institutional patient database of recurrent glioblastoma treated with laser ablation. METHODS Patients with recurrent glioblastoma, previously treated with biopsy or surgical resection plus standard radiation/temozolomide (and any other additional therapies), who underwent laser ablation with the NeuroBlate system at The Cleveland Clinic were retrospectively reviewed from 2011 through 2017. Primary endpoints were progression free survival (PFS) and overall survival (OS). RESULTS Between 2011 and 2017, 31 patients with recurrent glioblastoma were treated with laser ablation out of more than 250 laser ablation cases for brain tumors. This population included 17 males and 14 females. Age at the time of diagnosis ranged from 27 to 77. 84% underwent surgical resection as the initial treatment. 65% were treated with laser ablation after the first recurrence of previously treated glioblastoma. The average number of postoperative hospital days was 2.8, and most patients went home. 54% remained neurologically stable without new postoperative deficits, and 52% had no reported change in Karnofsky Performance Scale from before to after laser ablation. Median PFS was 5 months, and median OS was 13 months. CONCLUSIONS Laser ablation has been used to treat various intracranial lesions at The Cleveland Clinic, particularly recurrent glioblastoma. This treatment modality can be utilized at any point of recurrence in patients with appropriate clinical and radiographic characteristics. In addition, the minimally invasive nature and relatively short hospital stay in comparison to surgical tumor resection make laser ablation favorable. Laser ablation is becoming a valuable tool in a multidisciplinary approach to treat recurrent glioblastoma.

Five-Year Outcomes of a Randomized Trial of Treatments for Varicose Veins

BackgroundEndovenous laser ablation and ultrasound-guided foam sclerotherapy are recommended alternatives to surgery for the treatment of primary varicose veins, but their long-term comparative effectiveness remains uncertain.MethodsIn a randomized, controlled trial involving 798 participants with primary varicose veins at 11 centers in the United Kingdom, we compared the outcomes of laser ablation, foam sclerotherapy, and surgery. Primary outcomes at 5 years were disease-specific quality of life and generic quality of life, as well as cost-effectiveness based on models of expected costs and quality-adjusted life-years (QALYs) gained that used data on participants’ treatment costs and scores on the EuroQol EQ-5D questionnaire.ResultsQuality-of-life questionnaires were completed by 595 (75%) of the 798 trial participants. After adjustment for baseline scores and other covariates, scores on the Aberdeen Varicose Vein Questionnaire (on which scores range from 0 to 100, with lower scores indicating a better quality of life) were lower among patients who underwent laser ablation or surgery than among those who underwent foam sclerotherapy (effect size [adjusted differences between groups] for laser ablation vs. foam sclerotherapy, −2.86; 95% confidence interval [CI], −4.49 to −1.22; P<0.001; and for surgery vs. foam sclerotherapy, −2.60; 95% CI, −3.99 to −1.22; P<0.001). Generic quality-of-life measures did not differ among treatment groups. At a threshold willingness-to-pay ratio of £20,000 ($28,433 in U.S. dollars) per QALY, 77.2% of the cost-effectiveness model iterations favored laser ablation. In a two-way comparison between foam sclerotherapy and surgery, 54.5% of the model iterations favored surgery.ConclusionsIn a randomized trial of treatments for varicose veins, disease-specific quality of life 5 years after treatment was better after laser ablation or surgery than after foam sclerotherapy. The majority of the probabilistic cost-effectiveness model iterations favored laser ablation at a willingness-to-pay ratio of £20,000 ($28,433) per QALY. (Funded by the National Institute for Health Research; CLASS Current Controlled Trials number, ISRCTN51995477.)

420: Differences in impedance to blood flow in the umbilical arteries determine infant survival in TTTS

Unequal placental sharing is associated with inter-twin size discordance, twin-to-twin transfusion syndrome (TTTS) and reduced infant survival in monochorionic twin pregnancies. This study explores if inter-twin differences in impedance to blood flow (IDIBF) in the umbilical arteries influences infant survival in TTTS. All women who underwent laser ablation of placental anastomoses for the management of TTTS between January 2012 and May 2018 at a single institution were included. Laser surgery was performed in all cases with Quintero stages II or greater and in women with Quintero stage I with either symptomatic polyhydramnios, cervix shortening or preterm labor. IDIBF in the umbilical arteries was estimated by substracting the pulsatility index (PI) of the umbilical artery of the donor twin from that of the recipient twin, prior to surgery. Outcomes included dual infant survival or survival of at least one fetus at delivery and at 30 days of age. Logistic regression analyses were perfomed to determine the relationship of IDIBF in the umbilical arteries with the study outcomes, while controling for gestational age (GA) at surgery, GA at delivery, Quintero stage, cervical length prior to surgery, inter-twin size discordance ≥25% and/or EFW<10 percentile for GA, advanced maternal age (≥35 years old), maternal obesity (BMI>35), and number of placental anastomoses. A total of 230 consecutive TTTS cases met study the inclusion criteria. TTTS Quintero stages I, II, III and IV were present in 10%, 31.3%, 50.9% and 7.8% of all cases, respectively. Inter-twin size discordance ≥25% and/or EFW<10 percentile for gestational age was present in 72.4% of cases. Two live births or at least one live birth was present in 68.3% and 88.3% of cases, respectively. Two infants or al least one infant was alive by 30 days in 70.8% and 96.4% of cases, respectively. 27% (n=62) were lost to follow-up by 30 days or have not reached this age yet. Logistic regression analysis demonstrated that IDIBF in the umbilical arteries is an independent factor for the survival of one (p=0.004) or both infants (p<0.001) at birth as well as for the survival of both infants at 30 days of age (p=0.01). In contrast, neither Quintero staging nor inter-twin size discordance were associated with these outcomes (see Table). Differences in impedance to blood flow in the umbilical arteries may influence infant survival in TTTS cases following laser ablation of placental anastomoses.

Treatment of condyloma acuminatum using the combination of laser ablation and ALA-PDT.

Human papilloma virus (HPV) infection and condyloma acuminatum (CA) in the genital area often exist in extensive and multi-point fashion. Laser ablation combined with topical photodynamic therapy (PDT) is a feasible approach for genital CA but its effectiveness and limitations need to be evaluated. This single-arm prospective study consisted of 100 newly diagnosed CA cases of both sexes. All patients underwent laser ablation and then three times aminolaevulinic acid-based photodynamic therapy (ALA-PDT). The outcomes were evaluated and analyzed 3 months after the treatment. A total of 98 patients completed the study. Except for 6 patients (4 males and 2 females) showed some residual lesions other 92 patients (93.8%) showed complete cure. However, there were 18 patients (10 males and 8 females) showed new lesions near the treated areas. Although the HPV types of 18 patients before and after treatment were not completely consistent, 94.4% percent of patients (17/18) had the same HPV type as the primary lesion, which suggested that these late-onset CA might have latent infection or subclinical infection in the early stage of the disease but the length of the incubation period was longer. Combination approach is effective in treating genital CA and preventing CA recurrence. But its limitations need to be recognized as the late-onset CA might occur near the treated area. The treatment plan needs to be optimized for multiple genital CA lesions.

Quality of life and outcomes in patients with a large toxic adenoma undergoing laser ablation plus radioiodine vs lobectomy

Purpose: Patients with toxic adenomas (TAs) that are too large to undergo radioactive iodine (RAI) treatment aimed at resolving hyperthyroidism and/or relieving mechanical pressure symptoms are referred to surgery. This prospective study aimed to assess the outcomes of combining laser ablation (LA) plus RAI vs lobectomy to treat large TAs in terms of clinical efficacy and the health-related quality of life (HRQoL).Patients and methods: Patients with TAs of volumes greater than 20 mL and a calculated therapeutic activity exceeding 600 Mbq were randomly assigned to undergo LA + RAI (Group A) or lobectomy (Group B). The HRQoL was assessed using 12-item Short Form Health Survey questionnaire before and 6 months after treatment.Results: Twenty-seven patients entered the study. After completing treatment, patients in Group A showed a TA reduction by a mean of 68% compared to baseline. Two of 14 patients (14.3%) in Group A and 2 of 13 (15.4%) in Group B became subclinically hypothyroid, whereas the remaining patients were euthyroid. HRQoL significantly improved in both groups after treatment.Conclusions: For patients with large TAs, a combination of LA and RAI is a feasible alternative to surgery. Similar to surgery, LA + RAI resolves the mechanical discomfort induced by nodule pressure and effectively treats the hyperthyroidism. This procedure also avoids the potential complications associated with surgery while guaranteeing a similar HRQoL benefit.

Postprocedural LGE‐CMR comparison of laser and radiofrequency ablation lesions after pulmonary vein isolation

The purpose of this study was to compare the anatomical characteristics of scar formation achieved by visual-guided laser balloon (Laser) and radiofrequency (RF) pulmonary vein isolation (PVI), using late-gadolinium-enhanced cardiac magnetic resonance imaging (LGE-CMR). We included 17 patients with paroxysmal or early persistent drug resistant AF who underwent Laser ablation; 2 were excluded due to procedure-related complications. The sample was matched with a historical group of 15 patients who underwent PVI using RF. LGE-CMR sequences were acquired before and 3 months post-PVI. Ablation gaps were defined as pulmonary vein (PV) perimeter sections showing no gadolinium enhancement. The number of ablation gaps was lower in Laser versus RF ablations (median 7vs. 14, P=0.015). Complete anatomical PVI (circumferential scar around PV, without gaps) was more frequently achieved with Laser than with RF (39%vs. 19% of PVs, P=0.025). Fewer gaps were present at the superior and anterior left PV and posterior right PV antral regions in the Laser group, compared to RF. Scar extension into the PVs was similar in both groups, although RF produced more extensive ablation scar toward the LA body. AF recurrences at 1 year were similar in both groups (Laser 36%vs. RF 27%, P=1.00). Compared to RF, Laser ablation achieved more complete anatomical PVI, with less LA scar extension. However, AF recurrence appears to be similar after Laser compared to RF ablation. Further studies are needed to assess whether the anatomical advantages of Laser ablation translate into clinical benefit in patients with AF.

Laser Ablation Facilitates Closure of Chronic Enterocutaneous Fistulae

This report describes the use of laser ablation for treatment of chronic enterocutaneous fistulae (ECFs) after failure of conservative therapy. Three patients underwent laser ablation for treatment of 8 ECFs. Mean duration of fistula patency was 28 months with mean fistula output of 134 mL/day. The initial technical success was 100% with no major or minor complications. Three ECFs required repeat treatment. At mean follow-up of 53 days, 7 of the fistulae were occluded. One fistula showed a markedly reduced output of 10 mL/day.

Laser ablation as monotherapy for penile squamous cell carcinoma: A multi-center cohort analysis

IntroductionAlthough the trend towards penile sparing therapy is increasing for penile squamous cell carcinoma, outcomes for laser ablation therapy have not been widely reported. We assessed the clinical outcomes of penile cancer patients treated with only laser ablation. Materials and methodsA retrospective review was performed on 161 patients across 5 multi-center tertiary referral centers from 1985 to 2015. All patients underwent penile sparing surgery with only laser ablation for squamous cell carcinoma of the penis. Laser ablation was performed with neodymium-doped yttrium aluminum garnet or carbon dioxide. Overall and recurrence-free survival was calculated using the Kaplan-Meier method and compared with the log rank test. ResultsA total of 161 patients underwent laser ablation for penile cancer. The median age was 62 (IQR: 52–71) years and median follow-up was 57.7 (IQR: 28–90) months. The majority of patients were pTa/Tis (59, 37%) or pT1a (62, 39%). Only 19 (12%) had a poorly differentiated grade. The 5-year recurrence-free survival was 46%. When stratified by stage, the 5-year local recurrence-free survival was pTa/Tis: 50%; pT1a: 41%; pT1b: 38%; and pT2: 52%. The inguinal/pelvic nodal recurrence was pTa/Tis: 2%; pT1a: 5%; pT1b: 18%; and pT2: 22%. There were no differences among stages with respect to recurrence-free survival (P = 0.98) or overall survival (P = 0.20). ConclusionLaser ablation therapy is safe for appropriately selected patients with penile squamous cell carcinoma. Due to the increased risk of nodal recurrence, laser ablation coupled with diagnostic nodal staging is indicated for patients with pT1b or higher.

Treatment resistance in potentially malignant disorders-'Nature' or 'Nurture'…?

Contemporary potentially malignant disorder management is based upon provisional histological diagnosis followed by interventional surgery to excise or ablate 'high-risk' mucosal lesions. Although the majority of patients achieve disease-free status post-treatment, others develop further or persistent disease unresponsive to intervention. A detailed, retrospective clinico-pathological review of treatment resistant potentially malignant lesions, from a 590 patient cohort treated by CO2 laser surgery and followed for a mean of 7.3 years, was undertaken. Clinical outcome was determined at study census date (31 December 2014). A total of 87 patients (15%) exhibited PMD disease resistant to treatment: 34 (6%) became disease free following further treatment, whilst 53 (9%) had persistent disease despite intervention. Disease-free patients were younger, changed lesion appearance from erythroleukoplakia to leukoplakia (P = .004), developed further lesions at new sites, demonstrated reduction in dysplasia severity with time and required multiple treatments to achieve disease-free status (P = .0005). In contrast, persistent disease patients were older, male, often presented with proliferative verrucous leukoplakia (PVL) on gingival and alveolar sites, displayed less severe dysplasia initially and underwent laser ablation rather than excision (P = .027). Despite clinico-pathological profiling of treatment resistant patients, the precise inter-relationship between the inherent nature of potentially malignant disease and the external influence of treatment intervention remains obscure.