Purpose The purpose of this study is to assess the effects upon lethal ice (< −30°C) proportions in different heat load phantoms while varying the size and number of cryoprobes at 2 cm spacing. Materials and Methods Thermocouples at 0.5, 1.0 and 1.5 cm intervals from 1.7 or 2.4 mm diameter cryoprobes were held by jigs accommodating 1–4 cryoprobes. Agar phantoms (N=24) used 3 sets of baseline temperatures at approximately 6°C, 24°C and 39°C. Temperatures during 15 minutes freeze cycles were correlated with actual thermocouple locations seen within the ice by computed tomography (CT). Diameters and surface areas of the −30°C lethal isotherm were assessed over time as percentages of the overall iceball. Results The high heat load, 39°C, phantom experiments showed the greatest impact upon percentage lethal zones for all probe configurations. Single, double, triple and quadruple probe arrangements of 2.4mm cryoprobes at 15 minutes had average lethal ice diameters of 1.2, 3.3, 4.1 and 4.9 cm, comprising 13 %, 46 %, 51 % and 56 % surface areas of lethal ice, respectively. Surface areas and diameters of lethal ice made by 1.7mm cryoprobes were 71%and 84% of the 2.4 mm cryoprobes, respectively. Lethal ice resides <1 cm behind the leading edge for nearly all probe configurations and heat loads. Conclusion Single cryoprobes have very low percentages of lethal ice. Multiple cryoprobes overcome both the high heat load of body temperature phantoms and help compensate for lower freeze capacity of thinner cryoprobes.
PURPOSE To assess the feasibility of percutaneous multiprobe breast cryoablation (BC) for diverse presentations of cancers that remained in situ after BC. MATERIALS AND METHODS After breast magnetic resonance (MR) imaging and thorough consultation, patients underwent BC after giving informed consent. This study was approved by the institutional review board. In 12 BC sessions, 22 breast cancer foci (stages I–IV) were treated in 11 patients who refused surgery by using multiple 2.4-mm cryoprobes. Five patients had recurrent disease and six had new diagnoses. With use of only local anesthesia, six patients were treated with ultrasonographic (US) guidance and five were treated with both computed tomographic (CT) and US guidance. Saline injections and warming bags were used to protect the skin. Procedure success was defined as 1 cm visible ice beyond all tumor margins. MR imaging and/or clinical follow-up were available for up to 72 months after BC. RESULTS US produced sufficient ice visualization for small tumors, whereas CT helped confirm overall ice extent. The mean pretreatment breast tumor diameter was 1.7 cm ± 1.2 (range, 0.5–5.8 cm), and an average of 3.1 cryoprobes produced 100% procedural success with mean ice diameters of 5.1 cm ± 2.2 (range, 2.0–10.0 cm). No significant complications, retraction, or scarring were noted. Biopsies at the margins of the cryoablation site immediately after BC and at follow-up were all negative. No local recurrences have been noted at an average imaging follow-up of 18 months. CONCLUSIONS In conjunction with thorough pre- and postablation MR imaging, CT/US-guided multiprobe BC safely achieved 1 cm visible ice beyond tumor margins with minimal discomfort, good cosmesis, and no short-term local tumor recurrences.
Cisplatin was the first platinum compound to be introduced as a chemotherapeutic agent with antineoplastic activity against a wide variety of solid tumors. Renal impairment with a decline in glomerular filtration has been the classical nephrotoxicity of cisplatin. Renal salt wasting syndrome is yet another, though it is not common. Previous studies were identified by searching the Pubmed database using the following keywords: cisplatin, cisplatin nephrotoxicity, renal salt wasting, and salt loosing nephropathy. Renal salt wasting syndrome has been described in 17 case reports since 1984. It is a rare side effect of cisplatin that manifests with polyuria, hypovolemia, and hyponatremia, and, because of similarities in clinical settings and laboratory values, it is frequently misdiagnosed as a syndrome of inappropriate antidiuretic hormone. Other causes of polyuria and hyponatremia should be excluded. Treatment aims at restoring the lost water and salt. Substituting cisplatin with carboplatin depends on individual clinical settings. Prognosis is excellent, as recovery was the rule in all the reported cases.
whole-brain radiation and highly active antiretroviral therapy (haart). CASE DESCRIPTIONA 43-year-old man presented to our hospital with headaches and right facial twitching for few days, associated with nausea and dizziness. His past medical history was significant for infection with hiv diagnosed 10 years earlier. Because of financial circumstances, the patient had stopped his haart 10 months earlier.On physical examination, the patient was alert and oriented. His vital signs were normal. He had a mild word-finding deficit, right facial droop, right pronator drift, and mild right arm hyperreflexia. The rest of the physical examination was normal.Laboratory work up showed a white blood cell count of 3400/mL, a CD4 count of 78/mL (normal: 493-1666/mL), an hiv viral load above 500,000/mL, positive Toxoplasma immunoglobulin G antibodies, negative serum cryptococcal antigen, and a nonreactive rapid plasma reagin test.Magnetic resonance imaging (mri) of the brain showed a large mass in the left frontoparietal region, with small non-enhancing lesions in the brain (Figure 1). A presumptive diagnosis of cerebral toxoplasmosis was made, for which the patient was treated with pyrimethamine, sulfadiazine, and leucovorin, with phenytoin for seizure prophylaxis. To avoid possible complications of anemia and immune reconstitution syndrome, haart was planned to be restarted 2 weeks later.The patient improved symptomatically and was discharged home. A follow-up brain mri 10 days later demonstrated no significant changes.One month later, the man came to our emergency department with a history of progressively increasing partial focal seizures that had started after he had stopped his medications 2 weeks earlier because of financial concerns. Brain mr i showed a slight increase of the old left frontoparietal lesion ABSTRACTAccording to the published data, most primary central nervous system lymphomas (pcnsls) are B-cell lymphomas; primary T-cell lymphomas are rare. In a search of the medline database, we found only 6 cases of primary T-cell pcnsl. Here, we present the case of a 43-year-old man with aids, not on highly active antiretroviral therapy, who presented with focal neurologic symptoms and was found on magnetic resonance imaging to have multiple brain lesions. A biopsy showed T-cell lymphoma, and the patient was subsequently treated with whole-brain radiation, to marked clinical response. Reported cases from the literature of primary T-cell pcnsl in aids patients are summarized in this review.
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