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Biomedical subjects

Debra A Gervais

Publications and source records attributed to Debra A Gervais.

At least 19 recordsLinked to original sources
PubMed2006

Residual and recurrent disease following renal energy ablative therapy: a multi-institutional study.

PURPOSE: In this study we detail the incidence and pattern of residual and recurrent disease after radio frequency ablation or cryoablation of a renal mass and, using this information, determine reasonable minimum recommendations for when to perform surveillance imaging during year 1 after treatment. To our knowledge no evidence based guidelines exist for determining how or when followup abdominal imaging should be performed after renal energy ablative therapy. MATERIALS AND METHODS: We reviewed treatment and followup information of patients who underwent radio frequency ablation or cryoablation for a renal mass at 7 institutions. Postoperative monitoring was performed using a variety of surveillance schedules. RESULTS: Of 616 patients 63 were found to have residual or recurrent disease after primary radio frequency ablation (13.4%) or cryoablation (3.9%) for a median of 8.7% in 7 institutions. Most incomplete treatments (70%) were detected within the first 3 months. After salvage ablative therapy was rendered, therapy failed in only 4.2%. At a mean followup of 2 years patients with residual or recurrent disease had an overall survival rate of 82.5% and a 2-year metastasis-free survival rate of 97.4% for those with localized, unilateral renal tumors. CONCLUSIONS: In most cases initial treatment failure was detected within the first 3 months after treatment. Our findings support a minimum of 3 to 4 imaging studies in year 1 after ablative therapy, and at months 1, 3, 6 (optional) and 12.

Catheter Ablation↗
PubMed2006

Imaging-guided catheter drainage of abdominal collections with fistulous pancreaticobiliary communication.

OBJECTIVE: Our aim was to study the success of percutaneous imaging-guided catheter drainage of abdominal collections with documented fistulous pancreaticobiliary communication. MATERIALS AND METHODS: Fifty-seven patients (age range, 23-88 years) with abdominal collections who underwent imaging-guided catheter drainage were included in this retrospective study. These collections showed communication with either the pancreatic duct (n = 15) or the biliary duct (n = 42) on imaging. The imaging guidance included CT (n = 40), sonography (n = 17), and fluoroscopy (n = 4), either alone or in combination. The success of catheter drainage was described as resolution of the collection on follow-up imaging and clinical improvement. Other treatments directed toward management of leaks or collections were also recorded. RESULTS: The success rates of catheter drainage for abdominal collections with biliary and pancreatic ductal communication were 93% (39/42) and 67% (10/15), respectively. The difference was statistically significant (p = 0.01). The three complications seen in this study were pneumothorax in one patient, bowel perforation in one, and death in one. The drainage catheter was upsized in five patients and an additional catheter was needed in nine patients. CONCLUSION: Imaging-guided catheter drainage is a clinically useful option for drainage of abdominal collections that have pancreaticobiliary communications. The success rate is significantly better for collections with biliary communication than for those with pancreatic communication.

Adult↗
PubMed2006

Percutaneous radiofrequency ablation of ovarian cancer metastasis to the liver: indications, outcomes, and role in patient management.

OBJECTIVE: Stages III and IV ovarian cancer are treated with a combination of chemotherapy and resection, in some cases including second and third surgical procedures, to achieve cytoreduction. Percutaneous radiofrequency ablation has proved effective in local control of hepatic tumors. We report early experience with percutaneous radiofrequency ablation in the management of isolated foci of metastatic ovarian cancer and assess the efficacy of the technique in achieving and maintaining local control by percutaneous cytoreduction. CONCLUSION: Percutaneous radiofrequency ablation is effective in achieving local control in selected patients with metastasis from ovarian cancer. In patients with limited macroscopic disease, cytoreduction can be achieved without surgery.

Adult↗
PubMed2005

Percutaneous radiofrequency ablation of renal cell carcinoma.

Conventional curative therapy for renal cell carcinoma has been open nephrectomy. However, several less invasive and/or nephron-sparing procedures have been developed as alternatives in selected patients. The newest of these therapeutic modalities involves percutaneous image-guided ablation with straight or expandable needle applicators that deposit energy. Radiofrequency ablation is the modality for which there is the largest reported experience with percutaneous application, and involves the use of electrical current to generate frictional heating of tissue. Animal studies confirm the ability of radiofrequency ablation to cause regions of necrosis within normal kidney and in VX2 tumors. Clinically, radiofrequency ablation of small renal cell carcinoma is increasingly being performed in selected patients who are not ideal surgical candidates. Results are excellent for small exophytic tumors, but successful treatment is less likely as tumor size increases or the location becomes more central. Complete treatment of most tumors requires one or more overlapping ablations with the needle electrodes positioned so as to cause necrosis in the entire volume of tumor. The number of overlapping ablations and the position of the needle electrodes vary based on tumor size and geometry. For very large tumors, pre-ablation catheter embolization may enhance the results of ablation by decreasing blood flow and perfusion mediated cooling. Following ablation, imaging with CT or MR is performed to assess the result and to diagnose any residual tumor so that it can be treated. Because the tumor remains in situ, imaging follow-up continues indefinitely. The complication rate of radiofrequency ablation is favorable when compared to surgical techniques. Long-term survival data are not yet available.

Animals↗
PubMed2005

Long-term followup of patients with renal cell carcinoma treated with radio frequency ablation with curative intent.

PURPOSE: We defined the role of radio frequency ablation in the treatment of renal cell carcinoma. MATERIALS AND METHODS: A total of 16 patients with biopsy proven renal cell carcinoma were treated with radio frequency ablation in an outpatient setting and followed for a minimum of 4 years. RESULTS: Of the 16 patients 5 died before 4 years of followup of unrelated causes. All except 1 tumor was successfully treated. All patients with exophytic tumors were successfully treated. CONCLUSIONS: Radio frequency ablation of exophytic renal cell carcinomas less than 5 cm in diameter is effective in eradicating the tumor and comparable to surgical extirpation at 4 years.

Adult↗
PubMed2005

CT and fluoroscopically guided percutaneous embolization treatment of a pseudoaneurysm associated with pancreatitis.

A novel approach to embolization treatment with a cyanoacrylate solution for a bleeding pseudoaneurysm associated with pancreatitis is described in the setting of a critically ill patient. Computed tomography and a C-arm fluoroscopic unit were used to guide percutaneous placement of a needle and injection of the embolic material. This technique represents an alternative form of embolization when traditional angiographic techniques are not possible.

Aneurysm, False↗
PubMed2005

Radiofrequency ablation of a central renal tumor: protection of the collecting system with a retrograde cold dextrose pyeloperfusion technique.

Renal radiofrequency (RF) ablation therapy is a safe and effective therapy for small renal cell carcinoma. Although the risk of complications is low, the potential for ureteral or calyceal injury does increase in the case of a centrally located lesion. A retrograde cold dextrose pyeloperfusion technique was designed to protect the collecting system in a patient who underwent percutaneous RF ablation of a central tumor of the left kidney.

Carcinoma, Renal Cell↗
PubMed2005

Image-guided percutaneous radiofrequency ablation and incidence of post-radiofrequency ablation syndrome: prospective survey.

PURPOSE: To evaluate prospectively the incidence of post-radiofrequency (RF) ablation syndrome and determine its impact on the quality of life in the 10 days after percutaneous RF ablation. MATERIALS AND METHODS: This study was approved by the institutional review board and was HIPAA compliant. Informed consent was obtained for this survey in all patients by the interventional nurse coordinators. Thirty-six patients (20 men, 16 women; mean age, 69.3 years; range, 40-88 years) underwent RF ablation for 26 liver tumors and 17 renal tumors. Twenty control patients (11 men, nine women; mean age, 60.8 years; range, 35-76 years) underwent biopsy of focal liver lesions or renal lesions. With a standardized questionnaire, a telephone survey was conducted on days 1, 3, 5, and 10 after RF ablation or biopsy. The symptoms and interference with lifestyle were documented prospectively with a numeric intensity scale by using grades 0-10. Statistical analysis with Fisher exact test and analysis of variance was performed. RESULTS: After RF ablation, 15 (42%) patients developed low-grade fever (P < .001), 29 (81%) had flulike symptoms (P < .001), and four were asymptomatic. Symptoms peaked on day 3 and mainly resolved by day 10. Twelve (33%) patients had complete post-RF ablation syndrome: fever and flulike symptoms (P = .005). Flulike symptoms were more prolonged when they were accompanied with fever, peaked on day 5, and resolved more quickly for patients with renal lesions than they did for patients with liver lesions. Four patients had persistent fever caused by pneumonia (n = 2), pleural effusion and atelectasis (n = 1), or liver abscess (n = 1). No control patients developed both fever and flulike symptoms. Post-RF ablation patients with symptoms experienced significantly greater pain and interference with general and work activities, which peaked on day 1, than did control patients (P = .01 [pain], P < .001 [general and work activities]). CONCLUSION: Complete post-RF ablation syndrome occurs in approximately one-third of patients but is self-limiting within 10 days after the procedure. Persistent or late-onset fever may indicate concurrent infection elsewhere or possible abscess formation. SUPPLEMENTAL MATERIAL: radiology.rsnajnls.org/cgi/content/full/237/3/1097/DC1

Adult↗
PubMed2005

Percutaneous cholecystostomy catheter removal and incidence of clinically significant bile leaks: a clinical approach to catheter management.

OBJECTIVE: We sought to determine the incidence of bile leaks upon removal of small-bore percutaneous cholecystostomy catheters and to evaluate clinical and imaging guidelines to ensure safe catheter removal. MATERIALS AND METHODS: A retrospective evaluation of all gallbladder drainages performed over a 5-year period revealed 163 patients (range, 7-98 years) who underwent percutaneous cholecystostomy catheter placement. Medical records and imaging studies were reviewed to assess the events at catheter removal (e.g., inadvertent removal, controlled removal with cholangiography without tract imaging, or controlled removal with cholangiography with tract imaging) and the incidence of major and minor bile leaks. RESULTS: The events at catheter removal were assessed in 66 patients. Group 1 was 45 patients whose catheters were removed after a minimum of approximately 3 weeks with a cholangiogram that established cystic and common duct patency and no imaging of the tract. Catheters were not removed until the patient recovered from acute illnesses that contributed to acalculous cholecystitis. Group 2 was 11 patients managed similarly to group 1 except that tract imaging was performed at catheter removal. Group 3 was 10 patients whose tubes came out inadvertently without cholangiogram or tract imaging. Two major (group 2 and group 3) and two minor (group 2) bile leaks occurred. No bile leaks occurred in group 1 (p = 0.006). CONCLUSION: Major bile leaks occurred in 3% of patients, and minor leaks occurred with equal frequency. Tract imaging may not be necessary in patients with small-bore gallbladder catheters who have recovered from critical illness, show patent cystic and common ducts, and have had catheters for 3-6 weeks.

Adolescent↗
PubMed2005

Radiofrequency ablation of renal cell carcinoma: part 1, Indications, results, and role in patient management over a 6-year period and ablation of 100 tumors.

OBJECTIVE: The objectives of our article are to review our experience with radiofrequency ablation of renal cell carcinoma and to assess size and location as predictors of the ability to achieve complete necrosis by imaging criteria. MATERIALS AND METHODS: Over a 6-year period, 100 renal tumors in 85 patients underwent radiofrequency ablation at a single institution. The absence of enhancement on CT or MRI after radiofrequency ablation was interpreted as complete coagulation necrosis. Results were analyzed by tumor size and location using multivariate analysis. A p value of 0.05 or less was considered significant. RESULTS: All 52 small (3 cm) and all 68 exophytic tumors underwent complete necrosis regardless of size, although many large tumors (> 3 cm) required a second ablation session. Using multivariate analysis, we found that both small size (p < 0.0001) and noncentral location (p = 0.0049) proved to be independent predictors of complete necrosis after a single ablation session. Location was a significant predictor (p = 0.015) of complete necrosis after any number of sessions, whereas size showed a strong trend (p = 0.059) toward predicting success after any number of sessions. Complications were either self-limited or readily treated and included hemorrhage (major, n = 2; minor, n = 3), inflammatory track mass (n = 1), transient lumbar plexus pain (n = 2), ureteral injury (n = 2), and skin burns (n = 1). CONCLUSION: Radiofrequency ablation is a promising minimally invasive therapy for renal cell carcinoma in patients who are not good operative candidates. Small size and noncentral location are favorable tumor characteristics, although large tumors can sometimes be successfully treated with multiple ablation sessions.

Aged↗
PubMed2005

Radiofrequency ablation of renal cell carcinoma: part 2, Lessons learned with ablation of 100 tumors.

OBJECTIVE: The objective of our study was to review radiofrequency ablation of 100 renal tumors and lessons learned with respect to electrode approach, effects on collecting system, bowel proximity, and patterns of residual disease. MATERIALS AND METHODS: Over 6 years, 100 renal tumors in 85 patients underwent radiofrequency ablation. Images were reviewed to determine the following: effect of initial electrode approach at and parallel to the tumor-kidney interface; effect of collecting system proximity to the tumor and to the zone of ablation; bowel proximity to the tumor and strategies to protect bowel; patterns of residual disease; and approaches at subsequent sessions. RESULTS: The initial placement of the electrode at and parallel to the tumor-kidney interface did not result in significantly fewer overlapping ablations (p = 0.91) or a lower rate of residual disease (p = 0.86). Direct contiguity of tumor or zone of ablation to the collecting system did not increase the complication rate. However, obscuration of calyces by a central tumor was a significant predictor of collecting system hemorrhage necessitating treatment (p < 0.001) seen in three of nine tumors obscuring calyces. Clinically significant urine leaks were rare (1/100) and related to downstream obstruction. There were no bowel complications despite the fact that 27 of the tumors were within 1 cm of bowel. Protective strategies progressed from reliance on electrode positioning to hydrodissection. Residual patterns were predominantly nodules or crescents, and straight electrodes were commonly used to approach residual disease. CONCLUSION: Initial electrode position at and parallel to the tumor-kidney interface does not result in less difficult or more successful ablations. Contiguity of tumor or zone of ablation to the collecting system does not increase the risk of complications, but obscuration of calyces does. Bowel complications are rare, and protection with hydrodissection is becoming more common. Residual tumor presents as nodules or crescents of persistent enhancement.

Aged↗
PubMed2005

Percutaneous ablation of kidney tumors in nonsurgical candidates.

Although resection currently remains the standard of care for renal carcinoma, the search for less invasive treatments has led to alternative surgical approaches. Even less invasive, and appropriate for many groups of patients, is percutaneous radiofrequency ablation, which induces tumor necrosis via lethal hyperthermia. Multiple series of renal tumors treated with percutaneous ablation in vivo and left in situ have been published; these series reveal that for small renal tumors, radiofrequency ablation results in complete necrosis at imaging in 79% to 100% of cases. Because current results come from tumors left in situ with short postablation follow-up, long-term results are necessary to compare outcomes to surgical standards. Complication rates are lower than those following partial nephrectomy. Future reports will shed light on the long-term outcomes of percutaneous ablation and the relative advantages and disadvantages of various technologies for thermal ablation.

Carcinoma, Renal Cell↗
PubMed2004

Acute pancreatitis: the role of imaging and interventional radiology.

Acute pancreatitis can manifest as a benign condition with minimal abdominal pain and hyperamylasemia or can have a fulminant course, which can be life-threatening usually due to the development of infected pancreatic necrosis, and multisystem organ failure. Fortunately, 70-80% of patients with acute pancreatitis have a benign self-limiting course (figs. 1, 2, 4). The initial 24-48 hours after the initial diagnosis is usually the period that determines the subsequent course, and for many of the 20-30% of patients who subsequently have a fulminant course, this becomes apparent within this time frame. With reference to long-term outcome following acute pancreatitis, most cases recover without long-term sequelae with only a minority of cases progressing to chronic pancreatitis. In the initial management of acute pancreatitis, assessment of metabolic disturbances and systemic organ dysfunction is critical. However, the advent and continued refinement of cross-sectional imaging modalities over the past two decades has led to a prominent role for diagnostic imaging in assessing acute pancreatitis. Furthermore, these cross-sectional imaging modalities have enabled the development of diagnostic and therapeutic interventional techniques in the hands of radiologists. In this article we review the diagnostic features of acute pancreatitis, the clinical staging systems, complications and the role of imaging. The role of interventional radiology techniques in the management of acute pancreatitis will be discussed as well as potential complications associated with these treatments.

Acute Disease↗
PubMed2004

Recurrent abdominal and pelvic abscesses: incidence, results of repeated percutaneous drainage, and underlying causes in 956 drainages.

OBJECTIVE: We undertook this study to determine the incidence and results of repeated (secondary) percutaneous abscess drainage performed on recurrent abscesses after successful initial (primary) percutaneous abscess drainage. MATERIALS AND METHODS: Imaging studies from patients who underwent multiple drainages were reviewed to define a cohort of patients who underwent secondary percutaneous abscess drainage after successful initial percutaneous abscess drainage of the same abscess. Medical records of these patients were then reviewed to assess the results of secondary percutaneous abscess drainage. RESULTS: Forty-five abscesses in 43 patients required secondary percutaneous abscess drainage. Twenty-four of the 43 patients avoided surgery. Secondary percutaneous abscess drainage was successful in evacuating the abscess cavity in 39 (91%) of 43 patients. Duration of drainage and time until recurrence were not significant predictors for avoiding surgery. Mean duration of secondary percutaneous abscess drainage was significantly longer than mean duration of primary percutaneous abscess drainage, but duration of secondary percutaneous abscess drainage (25 vs 14 days, respectively; p = 0.007) did not differ significantly between patients who ultimately required surgery and those who did not (17 vs 11 days, respectively; p = 0.10). Time to recurrence ranged from 2 days to 1 year (mean, 51 days). CONCLUSION: After successful primary percutaneous abscess drainage, secondary percutaneous abscess drainage of recurrent abscesses succeeded in evacuating the abscess cavity in most patients, and surgery was avoided by slightly more than half. Patients with postoperative abscesses were significantly more likely to avoid surgery (p = 0.008), whereas patients with pancreatic abscesses were significantly more likely to require it (p = 0.03).

Abdominal Abscess↗
PubMed2004

Enteric feeding with gastric decompression: management with separate gastric accesses.

OBJECTIVE: Our purpose is to describe our experience with combined enteral feeding and gastric decompression or drainage in debilitated patients with persistent gastroesophageal reflux using two separate catheters. CONCLUSION: The placement of two percutaneous catheters through separate skin sites is a feasible and successful approach to providing enteral feeding and gastric decompression or drainage in debilitated patients with persistent gastroesophageal reflux and aspiration pneumonia.

Adolescent↗