The role of endovascular therapy in acute mesenteric ischemia

Background Endovascular therapy, including aspiration thrombectomy and local thrombolytic therapy, often associated with angioplasty and stent placement, has been described in the literature. The purpose of this study was to review case series of patients with acute mesenteric ischemia treated with endovascular therapy and evaluate their outcomes. Methods An online review using PubMed was carried out to identify all English articles about this topic in the time interval from 2005 to 2016. The following variables were extracted: number of patients, cause of occlusion, symptoms, arteries involved, number of sessions of treatment, technical success, clinical success, recurrence rate, complications, mortality rate, number of patients who underwent diagnostic laparoscopy or surgical resection of ischemic bowel. Results Eighteen papers met the inclusion criteria and were included. Among the patients with arterial mesenteric ischemia treated with endovascular approach, the technical success rate was high (up to 100%) and data regarding clinical success are encouraging, even though they are few and heterogeneous. Technical success rate and clinical success of patients with acute venous mesenteric ischemia approached with endovascular treatment was 74-100% and 87.5-100% respectively. Conclusions Current advances in endovascular therapies have made these treatments feasible for mesenteric ischemia

Treatment of lung tumours with high-energy microwave ablation: a single-centre experience

The purpose of our study is to report safety, technical success, effectiveness, local progression-free survival (LPFS) and overall survival of percutaneous microwave ablation (MWA) to treat lung tumours unsuitable for surgery. Nineteen patients with thirty-one tumours (mean diameter 2.4 cm) underwent percutaneous MWA in 28 sessions. Microwave ablation was carried out using a 2450-MHz generator (Emprint/Covidien, Boulder, CO, USA). Procedures were performed under cone-beam CT (CBCT) and under fluoro-CT (one session) guidance. Safety, technical success, effectiveness, LPFS and overall survival (OS) were evaluated. Safety was defined as the frequency of major and minor complications. The efficacy was evaluated on the basis of imaging characteristics, using RECIST criteria. CT follow-up was performed at 1, 3 and 6 months and yearly. LPFS was defined as the interval between MWA treatment and evidence of local recurrence, if there was any. OS was defined as the percentage of patients who were still alive. We registered one major complication (purulent hydro-pneumothorax). Minor complications were spontaneously resolved (pneumothorax and perilesional haemorrhagic effusion). Technical success was 100%. Residual disease was registered in two cases, one of whom was retreated. Complete ablation was obtained in the remaining cases (90.3%). During available follow-up (mean 9.6 months), 9/31 tumours demonstrated local recurrence. Five tumours were retreated, and none of them presented residual disease during follow-up (LPFS 22.6%). Overall survival was 93.8%. Percutaneous high-energy MWA is a safe, effective and confident technique to treat lung tumours not suitable for surgery

Radiological Diagnosis of Pancreatic Neuroendocrine Neoplasms

Neuroendocrine tumors (NETs) pose peculiar problems for imaging techniques in relation to their functional state. In functioning NETs - in which the diagnosis is mainly based on clinical and laboratory findings - the primary imaging \u201cgoal\u201d is the localization of the hormonal hypersecretion source/sources; in nonfunctioning NETs \u2013 which appear as symptomatic masses or as incidental findings \u2013 the priority questions are represented both by the identification and correct histological typing. For all NETs \u2013 regardless of their functional state - an accurate staging is also required, as they are often malignant. The basic imaging modality is MDCT for both diagnosis and staging; although MRI is generally superior to CT for liver metastasis detection, the choice between the two methods depends on the local availability and expertise Imaging techniques have an important role also in the follow-up for both diagnosis of recurrent disease and therapy monitoring. In this respect the RECIST criteria, which were designed for general oncology, are less suited; new criteria, which take the special characteristics of NETs into account, are currently under developmen

Microwave Ablation with Percutaneous Approach for the Treatment of Pancreatic Adenocarcinoma.

Pancreatic adenocarcinoma, characterized by a late presentation and by high aggressiveness, is one of the most lethal human cancers and currently the fifth most common cause of cancer-related death in men [1]. Only 10% of the tumors are confined to the pancreas at the time of presentation, 30\u201340% are locally advanced, and 50% have distant metastases [1, 2]. Only approximately 20% of pancreatic cancers are found to be resectable at the time of presentation. Surgical resection is the only potentially curative treatment for pancreatic cancer [2]. Some palliative therapeutic modalities have been applied in treatment of unresectable locally advanced pancreatic carcinoma, such as chemotherapy and chemoradiation [3]. In a few patients, thermal ablative techniques, such as radiofrequency ablation (RFA) and microwave ablation (MWA), have been reported, especially in association with surgery [4, 5]. Date RS [6] reviewed the results of local ablative therapies for the treatment of pancreatic cancer; photodynamic therapy (PDT), high-intensity ultrasound (HIFU), cryoablation, and RFA may have role in ablation of pancreatic tumors. Wu et al. [7] reported encouraging results on the feasibility of HIFU ablation of pancreas tumor, but they excluded patients with carcinoma located in the head to avoid damage of the biliary duct. Photodynamic therapy has major disadvantages of organizational and technical difficulties in setting up the treatments and potential side effects, such as skin photosensitivity reaction [8]. Matsui et al. [9] performed laparotomy and radiofrequency heating in 20 patients with unresectable pancreatic carcinomas. They have reported an intraperitoneal abscess in one patient who died of septic shock. Potential benefits of these techniques include treatment of patients who are not surgical candidates and reduced morbidity compared with surgery. Ablation with microwave has several intrinsic advantages over RFA, including the capability to generate very high tissue temperature, less intraprocedural pain, larger coagulation zones, less sensitivity to tissue type and charring, improved performance near blood vessels, and no requirement of ground pads [10\u201312]. Recently, this technique has been proposed in different organs, such as liver, lung, and kidney [10]. However, only few cases regarding the use of MWA in pancreatic cancer have been published and they were performed under laparotomy represents the first pancreatic head cancer with the percutaneous approach treated with MWA