Over the last few years, percutaneous radiofrequency (RF) ablation has been successfully established as a viable treatment modality for small peripheral renal cell carcinoma (RCC). This technique is limited by central tumor location and tumor size. We report the interventional management of a 5.3 cm mixed RCC with central and exophytic parts by combining the RF ablation with embolization, tagging, and retrograde, as well as anterograde cooling. The potential pitfalls of complex hybrid interventions for treating RCC are discussed.
Aged ; Biopsy ; Carcinoma, Renal Cell/pathology/radiography/*surgery ; *Catheter Ablation ; Female ; Humans ; Incidental Findings ; Iodized Oil/therapeutic use ; Kidney Neoplasms/pathology/radiography/*surgery ; Tomography, X-Ray Computed ; Ultrasonography, Interventional

OBJECTIVE: To investigate the effects of hepatic radiofrequency ablation (RFA) in patients with malignant liver disease with respect to inflammation activation and stress response. MATERIALS AND METHODS: In an observational trial, we investigated the physiologic parameters of 17 patients (20 interventions) who underwent percutaneous RFA under general anesthesia after applying total intravenous anesthesia. TNFalpha, IL-6, IL-8, IL-10, adrenaline and noradrenaline, liver enzymes, lactate and creatine kinase were determined pre-interventionally after induction of anesthesia (T1), 90 minutes after initiation of RFA (T2), immediately after the conclusion of the procedure (T3), and 24 hours after the procedure (T4). RESULTS: A significant increase in body temperature (p < 0.001), and mean arterial pressure (p = 0.001) were measured intraoperatively (T2) and the day after the procedure (T4). Increased levels of IL-6 were measured at T3 and T4 (p = 0.001). IL-10 increased immediately after the procedure (T3; p = 0.007). IL-6 levels correlated well with the total energy applied (r = 0.837). Significant increases in the levels of adrenaline and noradrenaline were present at T3 and T4 (p < 0.001). The RFA-induced destruction of hepatic tissue was associated with increased levels of AST, ALT, GLDH and LDH. CONCLUSION: Percutaneous RFA of hepatic malignancies causes an inflammatory and endocrine activation, similar to the systemic inflammatory response syndrome. These effects have to be taken in account when dealing with patients susceptible to sepsis or multi-organ failure.
Adult ; Aged ; Analysis of Variance ; *Anesthesia, General ; Body Temperature ; Carcinoma, Hepatocellular/*surgery ; Catheter Ablation/*adverse effects ; Chromatography, High Pressure Liquid ; Combined Modality Therapy ; Enzyme-Linked Immunosorbent Assay ; Epinephrine/blood ; Female ; Hemodynamics ; Humans ; Interleukin-10/blood ; Interleukin-6/blood ; Liver Function Tests ; Liver Neoplasms/*surgery ; Male ; Middle Aged ; Norepinephrine/blood ; Systemic Inflammatory Response Syndrome/*etiology ; Treatment Outcome

Stenting of the central veins is well established for treating localized venous stenosis. The techniques regarding catheter preservation for central venous catheters in the superior vena cava have been described. We describe here a method for stent implantation in the superior vena cava and the left brachiocephalic vein, and principally via a single jugular venous puncture, while saving a left sided jugular central venous catheter in a patient suffering from central venous stenosis of the superior vena cava and the left brachiocephalic vein.
Brachiocephalic Veins/*pathology ; Carcinoma, Bronchogenic/complications/drug therapy ; *Catheterization, Central Venous/methods ; Catheters, Indwelling ; Constriction, Pathologic ; Endovascular Procedures/*methods ; Humans ; Lung Neoplasms/drug therapy ; Male ; Middle Aged ; Palliative Care ; *Stents ; Vena Cava, Superior/*pathology