Old versus New – Tumor Ablation versus Tumor Nanoablation with Particular Emphasis on Liver Tumors

Loco-regional treatments play a key role in the management of hepatocellular carcinoma (HCC). Image-guided tumor ablation is recommended in patients with early-stage HCC when surgical options are precluded. Radiofrequency ablation is currently established as the standard method for local tumor treatment. Despite major advances in tumor ablation techniques the disease recurs in a high proportion of cases. A major limitation in its overall effectiveness is due to the difficulties of heating large tumors. Small regions of viable tumor may still remain even after apparently good tumor ablation by perfusion-mediated tissue cooling, preventing the whole tumor reaching a sufficient temperature for coagulation and necrosis. Moreover simple heating techniques have trouble discriminating between tumors and surrounding healthy tissues leading to many side effects. In order to overcome these major limitations numerous groups are investigating the use of energy-absorbing agents localized within tumor tissues to facilitate localized heating. A personal answer based on the review of the literature will be offered to the following questions: NIR photothermal therapy, RFA with nanoparticles, or magnetic fluid hyperthermia for the long term management of HCC? How should we deliver nanoparticles: systemically or directly intratumoral? Ablation versus mild hyperthermia: Pros and Cons in the majority of cases, hyperthermia is applied in one of two ways: a) high temperature for short time periods commonly referred to as ablation, or b) lower temperatures for long time periods, often called mild hyperthermia. The former is used to kill cells directly with heat and consequently can be used to thermally ablate tumor. The second method is just above physiological temperature, and these temperatures are more often used to trigger release from thermosensitive drug carriers. Both approaches can be combined with heat-sensitive drug targeting. There are many ways to induce nanoparticle mediated thermal therapy in solid tumors including absorption of infrared light, radiofrequency ablation and magnetically induced heating. These approaches have demonstrated high efficacy in preclinical models of HCC and are already tested in human clinical trials

EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part III - Abdominal Treatment Procedures (Short Version)

Publisher Copyright: © Georg Thieme Verlag KG Stuttgart · New York ·.The third part of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Guidelines on Interventional Ultrasound assesses the evidence for ultrasound-guided and assisted interventions in abdominal treatment procedures. Recommendations for clinical practice are presented covering indications, contraindications, safety and efficacy of the broad variety of these techniques. In particular, drainage of abscesses and fluid collections, interventional tumor ablation techniques, interventional treatment of symptomatic cysts and echinococcosis, percutaneous transhepatic cholangiography and drainage, percutaneous gastrostomy, urinary bladder drainage, and nephrostomy are addressed (short version; a long version is published online).publishersversionPeer reviewe

EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part III - Abdominal Treatment Procedures (Long Version)

Publisher Copyright: © Georg Thieme Verlag KG Stuttgart. New York .The third part of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Guidelines on Interventional Ultrasound (INVUS) assesses the evidence for ultrasound-guided and assisted interventions in abdominal treatment procedures. Recommendations for clinical practice are presented covering indications, contraindications, and safe and effective performance of the broad variety of these techniques. In particular, drainage of abscesses and fluid collections, interventional tumor ablation techniques, interventional treatment of symptomatic cysts and echinococcosis, percutaneous transhepatic cholangiography and drainage, percutaneous gastrostomy, urinary bladder drainage, and nephrostomy are addressed (long version).publishersversionPeer reviewe

Ultrasonography and color Doppler in juvenile idiopathic arthritis: diagnosis and follow-up of ultrasound-guided steroid injection in the wrist region. A descriptive interventional study

<p>Abstract</p> <p>Background</p> <p>The wrist region is one of the most complex joints of the human body. It is prone to deformity and functional impairment in juvenile idiopathic arthritis (JIA), and is difficult to examine clinically. The aim of this study was to evaluate the role of ultrasonography (US) with Doppler in diagnosis of synovitis, guidance of steroid injections, and follow-up examinations of the wrist in JIA.</p> <p>Methods</p> <p>In 11 patients (median age 12.5 years, range 2-16), 15 wrists with clinically active arthritis were assessed clinically by US and color Doppler (Logiq 9, GE, 16-4 MHz linear transducer) prior to and 1 and 4 weeks after US-guided steroid injection.</p> <p>Results</p> <p>US detected synovitis in the radio-carpal joints, the midcarpal joints, and the tendon sheaths in 87%, 53% and 33% of the wrists, respectively. Multiple compartments were involved in 67%. US-guidance allowed accurate placement of steroid in all 21 injected compartments, with a low rate of subcutaneous atrophy. Synovial hypertrophy was normalized in 86% of the wrists, hyperemia in 91%, and clinically active arthritis in 80%.</p> <p>Conclusions</p> <p>US enabled detection of synovial inflammation in compartments that are difficult to evaluate clinically and exact guidance of injections, and it was valuable for follow-up examinations. Normalization of synovitis was achieved in most cases, which supports the notion that US is an important tool in management of wrist involvement in JIA.</p

EFSUMB Recommendations for Gastrointestinal Ultrasound Part 3: Endorectal, Endoanal and Perineal Ultrasound

This article represents part 3 of the EFSUMB Recommendations and Guidelines for Gastrointestinal Ultrasound (GIUS). It provides an overview of the examination techniques recommended by experts in the field of endorectal/endoanal ultrasound (ERUS/EAUS), as well as perineal ultrasound (PNUS). The most important indications are rectal tumors and inflammatory diseases like fistula and abscesses in patients with or without inflammatory bowel disease (IBD). PNUS sometimes is more flexible and convenient compared to ERUS. However, the technique of ERUS is quite well established, especially for the staging of rectal cancer. EAUS also gained ground in the evaluation of perianal diseases like fistulas, abscesses and incontinence. For the staging of perirectal tumors, the use of PNUS in addition to conventional ERUS could be recommended. For the staging of anal carcinomas, PNUS can be a good option because of the higher resolution. Both ERUS and PNUS are considered excellent guidance methods for invasive interventions, such as the drainage of fluids or targeted biopsy of tissue lesions. For abscess detection and evaluation, contrast-enhanced ultrasound (CEUS) also helps in therapy planning

American College of Rheumatology Provisional Criteria for Clinically Relevant Improvement in Children and Adolescents With Childhood-Onset Systemic Lupus Erythematosus

10.1002/acr.23834ARTHRITIS CARE & RESEARCH715579-59