Passive acoustic mapping significantly outperformed the conventional hyperecho technique as an ultrasound-based HIFU monitoring method, as both a detector of lesion occurrence and a method of mapping the position of ablated tissue.

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ObjectivesDoes phaco–ECP reduce intraocular pressure? Is phaco–ECP safe?DesignRetrospective case note review of all patients undergoing phaco–ECP between June 2008 and June 2009. All glaucoma subtypes were included.SettingSingle District General Hospital Ophthalmology Department within the UK.Participants58 participants case notes reviewed. Mean age 79.0 years (SD ±9.8).InterventionsAll patients received combined cataract surgery and endoscopic cyclophotocoagulation.Outcome measuresFollow-up was 1 day, 1 week, 1, 3, 6, 12, 18 and 24 months for intraocular pressure (IOP) measurement. Number of medications, visual acuity and presence of complications were also assessed.ResultsOf the 58 cases performed, 56 case notes (97%) were available for analysis. Mean age 79.0 years (SD ±9.8). Mean pre-procedural IOP was 21.54 mm Hg (95% CI 19.86 to 23.22, n=56). Mean IOP was 14.43 mm Hg (95% CI 13.65 to 15.21, n=53) at 18 months and 14.44 mm Hg (95% CI 13.63 to 15.25, n=41) at 24 months. The mean drop from baseline to 18 and 24 months was 7.1 mm Hg. Statistically significant decrease in IOP was demonstrated at all time points (p<0.001). Mean medication usage was 1.97 agents (95% CI 1.69 to 2.25) at baseline, 1.96 agents (95% CI 1.70 to 2.22) at 18 months and 2.07 agents (95% CI 1.76 to 2.38) at 24 months. No statistically significant change throughout.ConclusionsThis study confirms the safety of phaco–ECP. In this case series, the IOP-lowering effect was significant at all time points; however, the effect of cataract surgery alone was not controlled. A randomised controlled trial is required to draw efficacy conclusions. The authors proposed endoscopic cyclophotocoagulation's main role is to optimise control of low-risk glaucoma of low-risk patients at the time of cataract surgery. However, the authors do not propose that phaco–ECP is a substitute for filtration surgery in high-risk eyes or when low target pressures (<14 mm Hg) are indicated.

Objectives: To assess the safety and feasibility of high-intensity focused ultrasound (HIFU) ablation of liver tumours and to determine whether post-operative MRI correlates with intra-operative imaging. Methods: 31 patients were recruited into two ethically approved clinical trials (median age 64; mean BMI 26 kg m 22). Patients with liver tumours (primary or metastatic) underwent a single HIFU treatment monitored using intra-operative Bmode ultrasound. Follow-up consisted of radiology and histology (surgical trial) or radiology alone (radiology trial). Radiological follow-up was digital subtraction contrast-enhanced MRI. Results: Treatment according to protocol was possible in 30 of 31 patients. One treatment was abandoned because of equipment failure. Transient pain and superficial skin burns were seen in 81% (25/31) and 39% (12/31) of patients, respectively. One moderate skin burn occurred. One patient died prior to radiological follow-up. Radiological evidence of ablation was seen in 93% (27/29) of patients. Ablation accuracy was good in 89% (24/27) of patients. In three patients the zone of ablation lay #2 mm outside the tumour. The median cross-sectional area (CSA) of the zone of ablation was 5.0 and 5.1 cm 2 using intra-operative and post-operative imaging, respectively. The mean MRI:B-mode CSA ratio was 1.57 [95% confidence interval (CI)50.57-2.71]. There was positive correlation between MRI and B-mode CSA (Spearman's r50.48; 95% CI 0.11-0.73; p50.011) and the slope of linear regression was significantly non-zero (1.23; 95% CI50.68-1.77; p,0.0001). Conclusions: HIFU ablation of liver tumours is safe and feasible. HIFU treatment is accurate, and intra-operative assessment of treatment provides an accurate measure of the zone of ablation and correlates well with MRI follow-up. Colorectal cancer is one of the leading causes of mortality in Europe and the USA [1]. Of those diagnosed with colorectal cancer, 20-30% will have metastases in the liver at the time of diagnosis, and overall 50% will develop liver metastases during the course of their disease [2,3]. Despite this, at post-mortem, approximately one-quarter of patients are found to have metastases confined to the liver, and so the possibility of cure in such patients is available if these metastases can be treated effectively. Hepatic resection is feasible in only 10-25%, and although it is associated with an operative mortality of up to 5%, it can achieve 5-year survival rates in the region of 40% [4]. The favoured current alternative to surgery is combination chemotherapy, but this is associated with an objective response rate of just 20-50%, and relatively short median overall survival of approximately 12 months [5]. As a result there have been considerable efforts to provide minimally invasive alternatives to surgery for these patients. These alternatives include transarterial chemo-embolisation (TACE), direct percutaneous ethanol injection (PEI), and energy-based ablative techniques such as radiofrequency ablation (RFA), cryoablation, microwave th...

Study Type – Therapy (case series)
Level of Evidence 4 OBJECTIVE To determine whether primary extracorporeal high‐intensity focused ultrasound (HIFU) is safe, feasible and effective for managing small renal tumours. PATIENTS AND METHODS Although surgery currently remains the standard treatment for localized renal cell carcinoma (RCC), the increasing incidence of small renal cancers has led to a shift towards nephron‐sparing surgery, with associated morbidity in 20–25% of cases, and minimally invasive ablative therapies present an alternative management. HIFU results in ‘trackless’ homogenous tissue ablation and when administered via an extracorporeal device, is entirely noninvasive. The study comprised 17 patients (mean tumour size 2.5 cm) with radiologically suspicious renal tumours who underwent extracorporeal HIFU using the Model‐JC System (Chongqing HAIFUTM, China), under general anaesthesia with one overnight hospital stay. Real‐time diagnostic ultrasonography was used for targeting and monitoring. Patients were followed with a clinical review and gadolinium‐enhanced magnetic resonance imaging at 12 days and every 6 months for a mean of 36 months. The outcomes measures were patient morbidity and oncological efficacy of HIFU treatment. RESULTS Of the 17 patients, 15 were treated according to protocol; two procedures were abandoned due to intervening bowel. There were no major complications related to HIFU. Radiological evidence of ablation was apparent at 12 days in seven of the 15 patients. Before the 6‐month follow‐up one patient had surgery due to persisting central enhancement. Fourteen patients were evaluated at the 6‐month follow‐up; eight tumours had involuted (mean 12% decrease in tumour area). Four patients had irregular enhancement on imaging and had alternative therapies. Ten patients remain on follow‐up at a mean (range) of 36 (14–55) months after HIFU (mean 30% decrease in tumour area). There was central loss of enhancement in all. CONCLUSIONS Renal HIFU achieves stable lesions in two‐thirds of patients, with minimal morbidity, and might be appropriate in selected cases. Further trials with accurate histological follow‐up are essential to fully evaluate this novel technique.

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This qualitative study explores older adults', caregivers', and nurses' perceptions regarding adult day care (ADC). The study took place in two small towns and one small city in the northern interior region of British Columbia, Canada, with the intent to develop ADC programs that reflect the needs of older persons and their caregivers. The 32 participants contributed their perceptions in focus groups and individual interviews. The interviews, in this descriptive/exploratory study, were audiotaped, transcribed verbatim, and analyzed using inductive, qualitative techniques. The participants acknowledged ADC services as essential to the health and well-being of older adults and their caregivers. The major themes that emerged were need for respite; aging in place; ADC programming; program characteristics; staff knowledge, skills, and attitudes; and northern perspectives. The study participants identified a number of possible reasons for underuse of ADC programming in the north. This study provides information that can facilitate the grounding of ADC policy within the clients' perspectives and a northern context. The participants' thoughts also highlight areas of policy that have broad applicability to the provision of services to the elderly in any setting.