2.Radiofrequency ablation versus partial nephrectomy for the treatment of clinical stage 1 renal masses: a systematic review and meta-analysis.
Shangqian WANG ; Chao QIN ; Zhihang PENG ; Qiang CAO ; Pu LI ; Pengfei SHAO ; Xiaobing JU ; Xiaoxin MENG ; Qiang LU ; Jie LI ; Meilin WANG ; Zhengdong ZHANG ; Min GU ; Wei ZHANG ; Changjun YIN
Chinese Medical Journal 2014;127(13):2497-2503
BACKGROUNDOver the past two decades, the clinical presentation of renal masses has evolved, where the rising incidence of small renal masses (SRMs) and concomitant minimal invasive treatments have led to noteworthy changes in paradigm of kidney cancer. This study was to perform a proportional meta-analysis of observational studies on perioperative complications and oncological outcomes of partial nephrectomy (PN) and radiofrequency ablation (RFA).
METHODSThe US National Library of Medicine's life science database (Medline) and the Web of Science were exhaustly searched before August 1, 2013. Clinical stage 1 SRMs that were treated with PN or RFA were included, and perioperative complications and oncological outcomes of a total of 9 565 patients were analyzed.
RESULTSPatients who underwent RFA were significantly older (P < 0.001). In the subanalysis of stage T1 tumors, the major complication rate of PN was greater than that of RFA (laparoscopic partial nephrectomy (LPN)/robotic partial nephrectomy (RPN): 7.2%, open partial nephrectomy (OPN): 7.9%, RFA: 3.1%, both P < 0.001). Minor complications occurred more frequently after RFA (RFA: 13.8%, LPN/RPN: 7.5%, OPN: 9.5%, both P < 0.001). By multivariate analysis, the relative risks for minor complications of RFA, compared with LPN and OPN, were 1.7-fold and 1.5-fold greater (both P < 0.01), respectively. Patients treated with RFA had a greater local progression rate than those treated by PN (RFA: 4.6%, LPN/RPN: 1.2%, OPN: 1.9%, both P < 0.001). By multivariate analysis, the local tumor progression for RFA versus LPN/RPN and OPN were 4.5-fold and 3.1-fold greater, respectively (both P < 0.001).
CONCLUSIONSThe current data illustrate that both PN and RFA are viable strategies for the treatment of SRMs. Compared with PN, RFA showed a greater risk of local tumor progression but a lower major complication rate, which is considered better for poor candidates. PN is with no doubt the golden treatment for SRMs, and LPN has been widely accepted as the first option for nephron-sparing surgery by experienced urologists. RFA may be the best option for select patients with significant comorbidity.
Catheter Ablation ; adverse effects ; methods ; Humans ; Kidney Neoplasms ; surgery ; therapy ; Nephrectomy ; adverse effects ; methods
4.Right phrenic injury after radiofrequency catheter ablation of atrial tachycardia at crista terminalis.
Yu-He JIA ; Fang-Zheng WANG ; Dong-Sheng GAO ; Jian-Min CHU ; Jie-Ling PU ; Xiao-Qing REN ; Wei HUA ; Shu ZHANG
Chinese Medical Journal 2011;124(10):1588-1589
A 62-year-old woman with frequent occurrence of symptomatic atrial tachycardia with a foci located at the root of the upper crista terminalis was found to have right diaphragm paresis after receiving a total of 8 radiofrequency energy deliveries (40-60 W, 50-60ºC) and a total duration of 540 seconds of ablation therapy (7Fr 8 mm deflectable ablation catheter). The right diaphragm paresis remained resolved up to 14 months after the procedure as confirmed by repeated chest X-rays.
Catheter Ablation
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adverse effects
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Diaphragm
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injuries
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Female
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Humans
;
Middle Aged
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Tachycardia, Supraventricular
;
therapy
8.Autotransfusion in the management of cardiac tamponade occurring during catheter ablation of atrial fibrillation.
Ling-Yun GAO ; Ri-Bo TANG ; Jian-Zeng DONG ; Xing-Peng LIU ; De-Yong LONG ; Rong-Hui YU ; Chen-Xi JIANG ; Gang CHEN ; Cai-Hua SANG ; Xin-Yong ZHANG ; Man NING ; Chang-Sheng MA
Chinese Medical Journal 2010;123(7):961-963
Atrial Fibrillation
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surgery
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Cardiac Tamponade
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etiology
;
surgery
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Catheter Ablation
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adverse effects
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Female
;
Humans
;
Male
;
Middle Aged
10.Transient ST-segment elevation after transseptal puncture for atrial fibrillation ablation in two cases.
Yan-li CHENG ; Jian-zeng DONG ; Xing-peng LIU ; De-yong LONG ; Dong-ping FANG ; Rong-hui YU ; Ri-bo TANG ; Chang-sheng MA
Chinese Medical Journal 2012;125(5):941-944
The present report demonstrates two cases of transient inferior ST-segment elevation accompanied by profound hypotension and bradycardia immediately after transseptal puncture for catheter ablation of atrial fibrillation. This rare complication of transseptal puncture was resolved quickly within several minutes. The most likely mechanism of this phenomenon is coronary vasospasm, although coronary embolism can not be ruled out completely. This complication is characterized as follows: (1) The right coronary artery might be the most likely involved vessel and therefore myocardial ischemia usually occurs in the inferior wall of left ventricular; (2) Reflex hypotension and bradycardia by the Bezold-Jarisch reflex secondary to inferior ischemia often occur at the same time. Though it appears to be a transient and completely reversible phenomenon, there are still potential life-threatening risks because of myocardial ischemia and profound haemodynamic instability. Clinical cardiologists should be aware of this rare complication and properly deal with it.
Aged
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Atrial Fibrillation
;
therapy
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Catheter Ablation
;
adverse effects
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Heart Septum
;
injuries
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Humans
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Male
;
Middle Aged
;
Punctures