PubMed · 8817080
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G Onik. 1996. Cryosurgery.. https://doi.org/10.1016/1040-8428(96)00189-8
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The use of freezing temperatures for the therapeutic destruction of tissue began in England in 1845-51 when James Arnott described the use of iced salt solutions (about-20 degrees C) to freeze advanced cancers in accessible sites, producing reduction in tumor size and amelioration of pain. Improved freezing techniques were possible early in the 1990s when solidified carbon dioxide came into use and later when liquid nitrogen and nitrous oxide became available. Nevertheless, cryotherapy was a minor technique, used only for the accessible lesions of skin and mucosa. With the development of modern cryosurgical apparatus by Cooper in 1961, a resurgence of interest in cryosurgery was initiated and techniques for diverse clinical conditions, including visceral cancer, evolved, After the initial widespread clinical trials matured in the 1970s, some applications of the technique fell into disuse while others became standard treatment. Late in the 1980s, further improvements in apparatus and imaging techniques have permitted increased clinical use in neoplastic disease, including visceral cancer.
Cryosurgery is a technique that is widely used in the treatment of cutaneous tumors. However, there are still features of healing in cryosurgery wounds that are incompletely understood and necessitate further study. In the present paper, we describe two in vitro models that were developed to study the initial stages of development of the cryolesion: reconstituted human skin and organ-cultured human skin. Cryolesions were generated in both models by applying a 2-mm-diameter cryoprobe at -196 degrees C for 35 s. Histological features were analyzed at days 0, 3, 5, and 14 following cryotreatment and showed epidermal detachment and keratinocyte necrosis very close to the findings reported in vivo. Results were similar in the two models. Gross alteration of the dermal architecture was noticed beneath the cryolesion, particularly in the reconstituted skin model. Cell proliferation was investigated at days 0, 3, and 5 by [3H]thymidine incorporation and Ki-67 antigen immunolabeling. In the case of organ-cultured skin, a significant increase in keratinocyte and fibroblast proliferation was observed at day 3, compared to the controls. At day 5, a return to the basic level was noticed. This was not observed in the reconstituted skin model at either day 3 or day 5. These data led us to propose that organ-cultured skin may be a useful model for evaluating the response of human skin to freezing; reconstituted skin was not adequate for this purpose.
In our comparative study, 40 infants ranging in age from 1 week to six months, were treated for their hemangiomas. Cryosurgery was performed on 20 hemangiomas whereas the others were treated with flash lamp-pumped pulsed dye laser (FPDL). In 72% of initial macular, flat-topped, superficial hemangiomas a predominant (> 75%) or complete regression could be achieved. In 68% of cutaneous-exophytic lesions, both therapeutical modalities showed a sufficient regression (> 50%) or marked growth inhibition after two sessions with further improvement after additional treatment. Cutaneous hemangiomas and the cutaneous part of combined hemangiomas responded well to both therapies whereas subcutaneous hemangiomas were predominantly influenced by cryotherapy. Our data emphasise the efficiency of early treatment of childhood hemangiomas. Since FPDL therapy is easy to perform, less time-consuming and reduces post-therapeutic exsudation, this treatment is preferable in initial macular, flat-topped and superficial lesions while cryotherapy is considered to be superior in lesions with marked elevated and/or subcutaneous parts.