scholarly journals Review of the efficacy and safety of cryoablation for the treatment of small renal masses

2013 ◽  
Vol 7 (1-2) ◽  
pp. 38 ◽  
Author(s):  
Anil Kapoor ◽  
Naji J. Touma ◽  
Regina El Dib
Keyword(s):  
Treatment Algorithm ◽  
Case Series ◽  
Cancer Control ◽  
Standard Of Care ◽  
Cochrane Library ◽  
Success Rates ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Perinephric Hematoma ◽  
Ablative Techniques

Purpose: Small renal masses are increasingly being discovered incidentally on imaging for another reason. The standard of care of these masses involves excision by open or laparoscopic techniques. Recently, ablative techniques, such as radiofrequency ablation (RFA) and cryoablation, have taken a more prominent role in the treatment algorithm of these masses. We evaluate the effectiveness and safety of cryoablation to treat renal tumours.Methods: A review of the literature was conducted. There was no language restriction. Studies were obtained from the following sources: the Cochrane Library, PUBMED, EMBASE and LILACS.Results: There was no clinical trial identified in the literature. Thus, we described the results from 23 case series and retrospective studies with a reasonable sample size (number of reported patients in each study ≥30), with a total of 2104 analyzed tumours from 2038 patients. There was wide variability in the outcomes reported, but success rates were generally good. Follow-up was generally short, but some series reported outcomes at 5 years. The most common complications reported were hemorrhage (some of the patients requiring transfusion), perinephric hematoma and urine leaks.Conclusion: Cryoablation presents a feasible treatment for patients with small renal masses. Only short-term data are available and, assuch, meaningful conclusions regarding long-term cancer control cannot be made. More rigorous studies are needed.

scholarly journals Review of the efficacy and safety of radiofrequency ablation for the treatment of small renal masses

2013 ◽  
Vol 3 (2) ◽  
pp. 143 ◽  
Author(s):  
Regina El Dib ◽  
Naji J. Touma ◽  
Anil Kapoor
Keyword(s):  
Clinical Trials ◽  
Radiofrequency Ablation ◽  
Tumour Size ◽  
Treatment Algorithm ◽  
Case Series ◽  
Cancer Control ◽  
Cochrane Library ◽  
Efficacy And Safety ◽  
Small Renal Masses ◽  
Renal Masses

Background: Small renal masses are increasingly being discoveredincidentally on imaging performed for another reason. Thestandard of care for these masses involves excision by open orlaparoscopic techniques. Recently, ablative techniques such asradiofrequency ablation (RFA) and cryoablation have taken a moreprominent role in the treatment algorithm for these masses. Wesought to evaluate the efficacy and safety of radiofrequency ablationin the treatment of renal tumours.Methods: We conducted a review of the literature. There was nolanguage restriction. We obtained studies from the followingsources: the Cochrane Library, PubMed, EMBASE, LILACS andCurrent Controlled Trials.Results: We identified no clinical trials in the literature. Thus wedescribed the results from case series and retrospective studieswith a reasonable sample size (number of reported patients in eachstudy > 65). Most patients undergoing RFA had T1a disease witha mean tumour size of about 3 cm. Radiofrequency ablation wasusually performed percutaneously with image guidance. Reportedfollow-up was short and ranged from 1 to 30 months. Most seriesused radiographic response as a surrogate for cancer control. Therates of local recurrence of the tumour were as high as 13.0%(average 8.5%) and were slightly higher than those associated withcryoablation and partial nephrectomy. Complications includedhemorrhage, ureteral strictures and loss of a renal unit.Conclusion: Our review demonstrates that RFA is a suitable andpromising therapy in patients with small renal tumours who areconsidered to be poor candidates for more involved surgery.However, clinical trials with long-term data are needed to establishthe oncological efficacy.Contexte : De petites masses rénales sont de plus en plus souventdécouvertes de façon fortuite lors d’épreuves d’imagerie commandéespour une autre raison. Les soins standard pour ces massesincluent une excision par chirurgie ouverte ou par laparoscopie.Dernièrement, des techniques comme l’ablation par radiofréquence(ARF) et la cryoablation ont pris plus d’importance dans l’algorithmede traitement. Nous examinons l’efficacité et l’innocuité del’ablation par radiofréquence dans le traitement des tumeurs rénales.Méthodologie : Une revue de la littérature a été effectuée, sansrestriction de langue. Des articles ont été obtenus des sources suivantes: la Bibliothèque Cochrane, PUBMED, EMBASE, LILACS etCurrent Controlled Trials.Résultats : Comme aucun essai clinique n’a pu être cerné dans cesbases de données, nous décrivons les résultats d’études de cas etd’analyses rétrospectives avec populations de taille raisonnable(nombre de patients pour chaque étude > 65). La vaste majoritédes patients ayant subi une ARF présentaient une tumeur T1a detaille moyenne d’environ 3 cm. L’ARF était habituellement effectuéepar voie percutanée et guidée par imagerie. Le suivi était court,allant de 1 à 30 mois. La plupart des études sérielles avaient recoursà la réponse radiographique comme paramètre de substitutionde la maîtrise du cancer. Les taux de récidive locale de la tumeuratteignaient 13.0 % (moyenne 8.5%), et étaient en général légèrementplus élevés que les taux notés avec la cryoablation et lanéphrectomie partielle. Les complications signalées étaient les suivantes: hémorragie, sténose urétérale et perte d’une unité rénale.Conclusion : Le présent article montre que l’ARF est une techniqueconvenable et prometteuse chez les patients porteurs depetites tumeurs rénales considérés comme de mauvais candidatspour une intervention plus lourde. Cependant, il est impératifd’effectuer des essais cliniques à long terme afin d’établir dans unavenir rapproché l’efficacité oncologique de cette technique.

scholarly journals CURRENT THERAPEUTIC OPTIONS FOR CORONAVIRUS DISEASE-2019 – A PHARMACOLOGICAL REVIEW

2020 ◽  
pp. 42-50
Author(s):  
SASMI MB ◽  
MARIA JOSE ◽  
PRAVEENLAL KUTTICHIRA
Keyword(s):  
Case Reports ◽  
Treatment Options ◽  
Case Series ◽  
Standard Of Care ◽  
Therapeutic Options ◽  
Cochrane Library ◽  
Global Public Health ◽  
Medical Subject Headings ◽  
Published Evidence

Objectives: Coronavirus pandemic is currently a global public health emergency. With expanding knowledge of the virus and the disease, new therapeutic targets are emerging widely. There is limited evidence about the use of different treatment options in coronavirus disease-2019 (COVID-19). This review aims to summarize the available evidence regarding therapeutic options in treating coronavirus infection. Methods: We searched PubMed, Google Scholar, and Cochrane library using pre-specified Medical Subject Headings terms about the role of therapeutic options in COVID-19 patients. Results: The majority of the published evidence is either case reports or small observational studies. Antimalarial like hydroxychloroquine reported equivocal results with five studies got positive results and five without any added benefit compared with standard of care. Lopinavir/ ritonavir monotherapy does not show any significant role except in combination with other antiviral drugs but encouraging results are emerging with remdesivir. Studies with favipiravir are inconclusive with some exhibit benefit and others not. Limited case series have shown that tocilizumab and convalescent plasma to be useful as adjuvant therapy in critically ill patients. Conclusion: There is currently no strong evidence for the efficacy of different therapeutic agents in the treatment of COVID-19. More data from ongoing and future trials will add more insight into the role of various drugs.

scholarly journals Identifying the use and barriers to the adoption of renal tumour biopsy in the management of small renal masses

2018 ◽  
Vol 12 (8) ◽  
Author(s):  
Patrick O. Richard ◽  
Lisa Martin ◽  
Luke T. Lavallée ◽  
Philippe D. Violette ◽  
Maria Komisarenko ◽  
...  
Keyword(s):  
False Negative ◽  
Standard Of Care ◽  
Fellowship Training ◽  
Renal Tumour ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Translation Strategy ◽  
Urological Oncology ◽  
Chi Squared ◽  
Tumour Biopsy

Introduction: Renal tumour biopsies (RTBs) can provide the histology of small renal masses (SRMs) prior to treatment decisionmaking. However, many urologists are reluctant to use RTB as a standard of care. This study characterizes the current use of RTB in the management of SRMs and identifies barriers to a more widespread adoption.Methods: A web-based survey was sent to members of the Canadian and Quebec Urological Associations who had registered email address (n=767) in June 2016. The survey examined physicians’ practice patterns, RTB use, and potential barriers to RTB. Chi-squared tests were used to assess for differences between respondents.Results: The response rate was 29% (n=223), of which 188 respondents were eligible. A minority of respondents (12%) perform RTB in >75% of cases, while 53% never perform or perform RTB in <25% of cases. Respondents with urological oncology fellowship training were more likely to request a biopsy than their colleagues without such training. The most frequent management-related reason for not using routine RTB was a belief that biopsy won’t alter management, while the most frequent pathology-related reason was the risk of obtaining a false-negative or a non-diagnostic biopsy.Conclusions: Adoption of RTBs remains low in Canada. Concerns about the accuracy of RTB and its ability to change clinical practice are the largest barriers to adoption. A knowledge translation strategy is needed to address these concerns. Future studies are also required in order to define where RTB is most valuable and how to best to implement it.

scholarly journals A Mini-Review on Ceftaroline in Bacteremia Patients with Methicillin-Resistant Staphylococcus aureus (MRSA) Infections

Antibiotics ◽  
2019 ◽  
Vol 8 (1) ◽  
pp. 30 ◽  
Author(s):  
Nicole Lounsbury ◽  
Mary Reeber ◽  
Georges Mina ◽  
Christiane Chbib
Keyword(s):  
Staphylococcus Aureus ◽  
Clinical Trials ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Clinical Success ◽  
Case Reports ◽  
Case Series ◽  
Cochrane Library ◽  
Success Rates ◽  
Ceftaroline Fosamil ◽  
Methicillin Resistant

Objective: The objective of this review is to describe the outcomes of patients treated with ceftaroline in the non-Food and Drug Administration (FDA) approved indication of methicillin-resistant Staphylococcus aureus (MRSA) infections in both pediatric and adult populations. Data sources: A systematic overview was conducted by searching PubMed, Medline, and The Cochrane Library up to January 2019. Study selection and data extraction: All English-language clinical trials and case reports related to the efficacy of ceftaroline in new, not-yet-approved FDA indications in MRSA infections in pediatric or adult populations. Data synthesis: In the case of MRSA bacteremia (MRSAB) infections, three different randomized studies in pediatric patients showed effectiveness of ceftaroline. When used in the case of adult populations with MRSA bacteremia, a small trial of 16 patients showed 50% clinical success in patients with acute bacterial skin and skin structure infections versus 63% clinical success in patients with community-acquired bacterial pneumonia. Another case series of six refractory case reports showed 50% clinical success of ceftaroline in patients with MRSA. Conclusions: Although there are few case reports and limited data to date, ceftaroline fosamil should continue to be studied as an alternative therapy in MRSA infections in both pediatric and adult populations. Clinical success rates of ceftaroline were, in most cases, considered high when treating patients with MRSA infection. More clinical trials need to be studied. In the specific case of MRSA bacteremia, the treatment options remain few and ceftaroline should be extensively studied for the salvage treatment of MRSAB.

scholarly journals Endogenous Endophthalmitis: A Review of Case Series Published between 2011 and 2020

2020 ◽  
Vol 2020 ◽  
pp. 1-13
Author(s):  
Ciprian Danielescu ◽  
Nicoleta Anton ◽  
Horia Tudor Stanca ◽  
Mihnea Munteanu
Keyword(s):  
Fungal Infections ◽  
Diagnostic Yield ◽  
Significant Risk ◽  
Case Series ◽  
Pyogenic Liver Abscess ◽  
Significant Risk Factor ◽  
Cochrane Library ◽  
Endogenous Endophthalmitis ◽  
Success Rates ◽  
Endogenous Fungal Endophthalmitis

This is a literature review of 31 case series of endogenous endophthalmitis (EE) published in the last ten years, identified from a literature search of several databases (PubMed, EMBASE, and the Cochrane Library). While diabetes mellitus and malignancies remain the most frequently associated medical conditions, intravenous drug use is a significant risk factor (especially in the last years, in studies from Western countries). Ophthalmologic screening is recommended for candidaemia, but not in patients with sepsis of other aetiologies (however, the physician treating patients with sepsis must be well aware of EE). The most frequent Gram-positive microorganisms that cause EE are Staphylococcus and Streptococcus; the most frequent Gram-negative organism is Pseudomonas, and yeasts, probably Candida, usually cause fungal infections. In all-cause EE, prognostic factors of better visual outcomes are initial VA better than counting fingers, performing a pars plana vitrectomy (PPV), performing an intravitreal injection within the first 24 hours after clinical diagnosis, and the presence of a focal type of EE. In endogenous fungal endophthalmitis, more than 1/4 of patients have bilateral involvement. Blood samples have a low rate of positivity. Yeasts remain the most prevalent cause. Many authors report using azoles and echinocandins for systemic therapy (and voriconazole for intravitreal injections). Although PPV was performed in small proportions of eyes, the anatomical success rate is quite high. Klebsiella pneumoniae is an important cause of EE in Southeast Asia (and probably an emergent etiology in other regions), which is frequently associated with diabetes. There is a robust association with pyogenic liver abscess (PLA) (but in up to half of the cases, the diagnosis of EE precedes that of PLA). Blood cultures have a high diagnostic yield, while vitreous samples have a low yield. K. pneumoniae may carry antibiotic resistance. Anatomical and functional success rates are small, but they may be improved with PPV.

Delay in Nephrectomy and Cancer Control Outcomes in Elderly Patients with Small Renal Masses

2014 ◽  
Vol 92 (4) ◽  
pp. 455-461 ◽  
Author(s):  
Andreas Becker ◽  
Florian Roghmann ◽  
Praful Ravi ◽  
Zhe Tian ◽  
Luis Alexander Kluth ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Cancer Control ◽  
Small Renal Masses ◽  
Renal Masses

Needle tract seeding after percutaneous cryoablation of small renal masses; a case series and literature review

2020 ◽  
Vol 54 (2) ◽  
pp. 122-127
Author(s):  
Michele Rizzo ◽  
Paolo Cabas ◽  
Nicola Pavan ◽  
Paolo Umari ◽  
Enrica Verzotti ◽  
...  
Keyword(s):  
Literature Review ◽  
Case Series ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Percutaneous Cryoablation ◽  
Needle Tract ◽  
Needle Tract Seeding

scholarly journals Cryoablation for Small Renal Masses

2008 ◽  
Vol 2008 ◽  
pp. 1-10 ◽  
Author(s):  
J. L. Dominguez-Escrig ◽  
K. Sahadevan ◽  
P. Johnson
Keyword(s):  
Minimally Invasive ◽  
Partial Nephrectomy ◽  
Imaging Techniques ◽  
Rapid Development ◽  
High Intensity Focused Ultrasound ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Invasive Approach ◽  
Open Partial Nephrectomy ◽  
Ablative Techniques

Advances in imaging techniques (CT and MRI) and widespread use of imaging especially ultrasound scanning have resulted in a dramatic increase in the detection of small renal masses. While open partial nephrectomy is still the reference standard for the management of these small renal masses, its associated morbidity has encouraged clinicians to exploit the advancements in minimally invasive ablative techniques. The last decade has seen the rapid development of laparoscopic partial nephrectomy and novel ablative techniques such as, radiofrequency ablation (RFA), high-intensity focused ultrasound (HIFU), and cryoablation (CA). In particular, CA for small renal masses has gained popularity as it combines nephron-sparing surgery with a minimally invasive approach. Studies with up to 5-year followup have shown an overall and cancer-specific 5-year survival of 82% and 100%, respectively. This manuscript will focus on the principles and clinical applications of cryoablation of small renal masses, with detailed review of relevant literature.

scholarly journals The Past, Present, and Future in Management of Small Renal Masses

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Sarah C. Ha ◽  
Haley A. Zlomke ◽  
Nicholas Cost ◽  
Shandra Wilson
Keyword(s):  
Renal Mass ◽  
Treatment Modalities ◽  
Small Renal Mass ◽  
Consensus Guidelines ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Cross Sectional ◽  
The Past ◽  
Cross Sectional Imaging ◽  
Ablative Techniques

Management of small renal masses (SRMs) is currently evolving due to the increased incidence given the ubiquity of cross-sectional imaging. Diagnosing a mass in the early stages theoretically allows for high rates of cure but simultaneously risks overtreatment. New consensus guidelines and treatment modalities are changing frequently. The multitude of information currently available shall be summarized in this review. This summary will detail the historic surgical treatment of renal cell carcinoma with current innovations, the feasibility and utility of biopsy, the efficacy of ablative techniques, active surveillance, and use of biomarkers. We evaluate how technology may be used in approaching the small renal mass in order to decrease morbidity, while keeping rates of overtreatment to a minimum.

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