Microwave ablation (MWA) is becoming the standard of care in treating liver lesions smaller than 3 cm benefiting from a plethora of radiofrequency ablation (RFA) data in the literature. Some of the advantages of MWA compared to RFA are as follows: Faster ablations, more reproducible and predictable heating, better thermal conductivity in different liver tissue environments, and less susceptibility to heat-sink effect. Despite its many advantages, there are still concerns regarding MWA use in high-risk locations such as near portal veins, near the bile ducts, and near the heart. Some centers have historically considered these tumor locations as a contraindication to percutaneous thermal ablation. In this review, we summarize the current data on the safety of MWA of liver tumors in challenging locations. We also discuss several technical tips with examples provided.
Hemodialysis catheters (HDCs) are an essential part of kidney replacement therapy. While these catheters are considered only the bridge to long-term vascular access such as arteriovenous fistulas and grafts, they are associated with significant morbidity and mortality and subsequent increased health care expenditures. However, despite these risks, a large proportion of end stage kidney disease population initiates dialysis using these catheters. The pathogenicity of HDCs stems from its invasive nature to the venous vasculature tree resulting in both mechanical and infectious complications. Therefore, the wide use these catheters in dialysis population and the associated complications necessitated continuous innovations in the catheter material, design, and placement techniques. This review provides an update on the catheter types, catheter tip designs, and the new technologies and innovations aimed to improve the catheter functionality and mitigate its related complications.
Primary gastric diffuse large cell lymphoma is one of the most common extranodal lymphomas of the gastrointestinal system. Diagnosing gastrointestinal lymphomas can be diffi cult, since there is no pathognomonic sign in endoscopy to distinguish it from other malignancies. In some cases biopsy can be non-diagnostic. Therefore, multiple endoscopic examinations and biopsies can be necessary. With using confocal endomicroscopy, histology of the tissue can be seen in vivo and a range of diseases can be identifi ed by using this technique. We are presenting a case, which is diagnosed as primary gastric diffuse large cell lymphoma during the evaluation of erythema nodosum etiology. We want to emphasize the role of confocal laser endomicroscopy for in vivo diagnosis of gastric lymphoma and directing the endoscopist for sampling the diseased mucosa. Confocal endomicroscopy decreases non-diagnostic rates in endoscopic biopsy and can be performed successfully in cases of gastric lymphoma. Pit patterns of gastric lymphoma, ring cell gastric carcinoma and gastric adenocarcinoma are similar. To best of our knowledge, this case is the fi fth case of confocal laser endomicroscopy aided in diagnosing gastric lymphomas (Tab. 1, Fig. 2 Extranodal lymphomas are usually detected in gastrointestinal system (40 % of cases) and in gastrointestinal system extranodal lymphomas are most commonly seen in stomach (75 % of cases) (1). Primary diffuse large B-cell lymphoma (DLBCL) and marginal zone B-cell lymphoma of the mucosa associated lymphoid tissue (MALT) are the most common types of gastric lymphomas (1). Primary gastric lymphomas can be seen as diffusely infi ltrative, ulcerative, petechial, hypertrophic or exophytic lesions; however it can be seen as normal mucosa in endoscopy (2-4). About 90 % of lymphomas can be diagnosed by performing endoscopy and biopsy. However, in some cases endoscopy and biopsy can be non-diagnostic or in some cases two or more endoscopic processes may be needed for the diagnosis (3). In submucosal lesions and lymphomas false negative biopsy rates can be 5 % or biopsy results can be nondiagnostic (5, 6). To determine the biopsy site during endoscopic examination; new endoscopic techniques have been developed, such as narrow band imaging, high defi nition endoscopy (7). Confocal endomicroscopy is a new technique that allows distinguishing between benign and malign lesions in gastrointestinal system; therefore it absolutely determines the biopsy site (8).To best of our knowledge only four cases with gastric lymphoma that were diagnosed by confocal endomicroscopy have been published. Here we present a case with primary gastric diffuse large B cell lymphoma, which have been diagnosed by confocal endomicroscopy. Case reportA 58-year-old woman was admitted to our hospital because of weakness, loss of appetite, stiff redness on her legs for two months and 30 kg weight loss in 1 year. Physical examination was normal except red nodular lesions on her legs. The lesions were considered as erythema nodosum. Lab...
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