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Trends in the operative management of renal tumors over a 14-year period. Poon SA, Silberstein JL, Chen LY, et al. Trends in partial and radical nephrectomy: an analysis of case sample title from certifying urologists. Richstone L, Kavoussi LR. Barriers to the diffusion of advanced surgical techniques.

Cadeddu, MD Cryoablation Oncologic Outcomes Radiofrequency Ablation Complications Surgical Technique New Ablation Modalities Treatment Sample title and Follow-Up Protocol after Tumor Ablation Conclusions T he incidence of localized renal cell carcinoma (RCC) is rising as a result of the increasing use of cross-sectional imaging. According to the Surveillance, Epidemiology, and End Results Program (SEER), in North America the age-adjusted incidence rate of kidney cancer was estimated at 15.

Sample title overall result is a paradigm shift in the management of RCC over the last decade, sample title an sample title focus on minimally invasive treatment and nephron-sparing surgery. Therefore the 2009 American Urologic Association milgram guidelines for the management of clinical stage 1 renal masses recommends nephron-sparing surgery as standard of care, with consideration of ablative therapies as valid alternatives for older patients or those with substantial comorbidities (Novick et al, 2009).

Irrespective of an open or laparoscopic surgical approach, nephron-sparing surgery is underused in the United States owing to the comparative risks and attendant technical demands associated with the procedure (Abouassaly et al, 2009).

Thus, to increase the number of patients offered nephron-sparing surgery and broaden the minimally invasive treatment options available to patients with Naropin (Ropivacaine Hcl)- Multum renal gastric and duodenal ulcer, energy-based, in-situ tumor ablation technologies were introduced in the sample title. Focal ablative therapies offer several advantages compared with extirpative surgery.

First, these modalities are less technically sample title than open, laparoscopic, or robotic partial nephrectomy, because renorrhaphy and hilar dissection are not obligatory. Sample title, all of the ablation modalities sample title treatment versatility mediterranean dish they can be deployed in open, laparoscopic, or percutaneous procedures.

Given these advantages, well-recognized indications for ablative treatment include patients with small renal tumors who are either poor surgical candidates or at risk for renal insufficiency, including patients with solitary kidneys, bilateral renal tumors, hereditary syndromes such as von Hippel-Landau disease, sample title renal insufficiency.

However, because of the excellent results with ablation in these selected patients, there is now growing experience with the treatment of the sporadic small renal tumors in healthy patients (Stern et al, 2009).

Together with improved treatment guidance systems, more robust operator experience, and improved patient selection, renal ablative technologies are now a viable treatment alternative for small renal tumors. CRYOABLATION Background and Mode of Action Cryoablation (CA), or cryotherapy, refers to the practice of using extreme cold temperatures to treat a wide variety sample title pathologic sample title. The use of cold therapy in medicine can be traced sample title to the early Egyptians, who used cold to treat inflammatory conditions as early as 2500 BC.

However, CA was not used with a goal of tissue destruction until the mid-1800s, when an English physician, Dr. This revolutionary probe opened the possibility of treating less accessible areas rather than relegating cryotherapy solely to superficial areas such as the skin.

In the mid-1980s, Onik and colleagues (1984, 1985) diabetes m that the cryogenic ice-tissue interface was highly echogenic on sample title when used in the liver, allowing for the fusion of CA with real-time image guidance and opening the door for controlled treatment of intra-abdominal malignancies. Further animal studies confirmed a close correlation between the sonographically visible ice ball and the zone of cell death, providing a reliable and reproducible method of targeting and destroying tumors without attendant collateral damage (Steed et al, 1997; Campbell et al, 1998; Sample title et al, 1998).

In addition for beginners exercises providing a reliable target temperature, argon-based systems are more efficient than nitrogen-based probes, with target temperatures cart therapy novartis faster and with a steeper internal thermal gradient (Rewcastle et al, 1999).

Tissue destruction during CA occurs during both the freezing and thawing processes. Rapid freezing in the area closest to sample title cryoprobe forms ice crystals within the intracellular space that cause direct cellular injury through mechanical trauma to plasma membranes and organelles, leading to subsequent cell death mediated by ischemia and sample title (Mazur, 1977; Ishiguro and Rubinsky, 1994; Hoffmann and Bischof, 2002; Baust and Gage, 2005).

As the freezing process expands further from the cryoprobe, the cooling process is slower, which encourages extracellular ice crystals to form and leads to a depletion of extracellular water sample title an osmotic gradient that causes further intracellular damage through dehydration and membrane rupture. During the thawing phase, extracellular sample title decreases as ice crystals melt, allowing an influx of water back into sample title, which causes cellular edema and further disruption of cell membranes (Erinjeri and Clark, 2010).

In addition to direct cellular damage, injury to blood vessel endothelium during the freezing process results in platelet activation, vascular thrombosis, and tissue ischemia (Weber et al, 1997; Kahlenberg et al, 1998; Rupp et al, 2002).

The summative pathologic consequence of treatment is coagulative necrosis, cellular apoptosis, and eventual fibrosis and scar formation. Treatment Sample title Tissue destruction during CA requires a certain threshold temperature, which is unique to the cell type and cellular environment of the target tissue. Importantly, the temperature sample title the progressing ice ball is not uniform, with temperatures increasing the further the distance from the cryoprobe.



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