Effectiveness of cryotherapy treatment for cervical intraepithelial neoplasia.

OBJECTIVE: To assess the effectiveness of cryotherapy treatment delivered by general practitioners in primary care settings, as part of a screen-and-treat approach for cervical cancer prevention. METHOD: Women aged between 25 and 49 years residing in San Martin, Peru, who were positive on visual inspection screening were treated, if eligible, with cryotherapy following biopsy. At 12 months post cryotherapy treatment the participants were evaluated for treatment effectiveness and examined by visual inspection and Papanicolaou test and, if positive, referred to a gynecologist for colposcopy and biopsy. RESULTS: Cryotherapy treatment was performed for 1398 women; of these, 531 (38%) had a histology result of cervical intraepithelial neoplasia (CIN). Cryotherapy effectively cured CIN in 418 (88%) women, including 49 (70%) women with a baseline diagnosis of CIN 3. CONCLUSION: Cryotherapy is an effective treatment for cervical precancerous lesions; it can easily be administered by general practitioners in primary care settings following visual inspection screening.     

醋酸白试验在液氮冷冻治疗儿童尖锐湿疣中的应用

目的探讨醋酸白试验在冷冻尖锐湿疣中的价值。方法将40例尖锐湿疣患者随机分为对照组和试验组,试验组冷冻前行醋酸白试验,而对照组则不做醋酸白试验。结果试验组痊愈率为87·5%(17/20),复发率为15(3/20),对照组痊愈率为55%(11/20),复发率为45%(9/20)。两组痊愈效率,复发率的差异有显著性意义(χ2=4·29,P<0·05)。结论尖锐湿疣冷冻治疗前行醋酸白试验可提高治愈率,降低复发率,且简单、方便,可作为尖锐湿疣冷冻治疗前的常规处理方法。     

冷凝治疗早产儿视网膜病变初步报告

目的探讨冷冻治疗阈值或阈值前期(1型)早产儿视网膜病变(retinopathy of pre-maturity,ROP)的治疗效果。方法对筛查过程中发现的25例(50只眼)阈值或阈值前期(1型)ROP进行冷凝手术。全麻后在间接检眼镜直视下冷凝周边视网膜无血管区,术后局部应用皮质类固醇和睫状肌麻痹剂2周。病变继续发展者补充冷凝手术,或进行间接检眼镜直视下光凝治疗,发生视网膜脱离或有玻璃体积血者进行玻璃体手术治疗。结果第一次手术后21例(42只眼)病变控制;4例(8只眼)病变仍继续发展,其中2例(4只眼)第2次冷凝手术后病变控制,最后冷凝治疗成功率为92%。1例(2只眼)第2次冷凝手术后1只眼玻璃体积血,3个月后对侧眼发生视网膜脱离,进行了玻璃体视网膜手术病变控制;另外1例(2只眼)一次冷凝治疗后病变继续发展,遂进行激光治疗、玻璃体手术,最后病变控制。结论冷凝是阻止阈值或阈值前期(1型)ROP发展的有效方法,术后玻璃体出血是冷凝的主要并发症之一。冷凝治疗长期疗效有待进一步随访。     

Phonosurgery: A review of current methodologies

Cold-steel has served as the gold standard modality of phonosurgery for most of its history. Surgical laser technology has revolutionized this field with its wide use of applications. Additional modalities have also been introduced such as coagulative lasers, photodynamic therapy, and cryotherapy. This review will compare the surgical modalities of cold steel, surgical lasers, phototherapy and cryotherapy. The mechanism of action, tissue effects and typical uses will be addressed for each modality.     

冷凝联合810激光治疗新生血管性青光眼

目的 探讨冷凝联合810激光治疗新生血管性青光眼的方法和效果。方法 对12例中11例严重的新生血管性青光眼患者实行分段性治疗，先行赤道部巩膜外冷凝，7天后再行睫状体810激光光凝。另1例直接行810激光光凝，术后前房积血、渗出、反应重。结果 所有病例术中及术后无严重并发症，一次治疗眼压控制10例，占83.33%，2例接受二次治疗。术后眼压控制且视力提高者占75％。讨论 赤道部巩膜外冷凝联合810激光睫状体光凝是一种治疗新生血管性青光眼的有效方法。     

A systematic review of randomised controlled trials of radiotherapy for localised prostate cancer

BackgroundProstate cancer is the second most frequently diagnosed cancer and the sixth leading cause of cancer death in males. A systematic review of randomised controlled trials (RCTs) of radiotherapy and other non-pharmacological management options for localised prostate cancer was undertaken.MethodsA search of thirteen databases was carried out until March 2014. RCTs comparing radiotherapy (brachytherapy (BT) or external beam radiotherapy (EBRT)) to other management options i.e. radical prostatectomy (RP), active surveillance, watchful waiting, high intensity focused ultrasound (HIFU), or cryotherapy; each alone or in combination, e.g. with adjuvant hormone therapy (HT), were included.Methods followed guidance by the Centre for Reviews and Dissemination and the Cochrane Collaboration. Indirect comparisons were calculated using the Bucher method.ResultsThirty-six randomised controlled trials (RCTs, 134 references) were included. EBRT, BT and RP were found to be effective in the management of localised prostate cancer. While higher doses of EBRT seem to be related to favourable survival-related outcomes they might, depending on technique, involve more adverse events, e.g. gastrointestinal and genitourinary toxicity. Combining EBRT with hormone therapy shows a statistically significant advantage regarding overall survival when compared to EBRT alone (Relative risk 1.21, 95% confidence interval 1.12–1.30). Aside from mixed findings regarding urinary function, BT and radical prostatectomy were comparable in terms of quality of life and biochemical progression-free survival while favouring BT regarding patient satisfaction and sexual function.There might be advantages of EBRT (with/without HT) compared to cryoablation (with/without HT). No studies on HIFU were identified.ConclusionsBased on this systematic review, there is no strong evidence to support one therapy over another as EBRT, BT and RP can all be considered as effective monotherapies for localised disease with EBRT also effective for post-operative management. All treatments have unique adverse events profiles. Further large, robust RCTs which report treatment-specific and treatment combination-specific outcomes in defined prostate cancer risk groups following established reporting standards are needed. These will strengthen the evidence base for newer technologies, help reinforce current consensus guidelines and establish greater standardisation across practices.     

A systematic review and meta-analysis of the effect of whole body cryotherapy on mental health problems

ObjectiveTo give an overview of the nature and methodological quality of studies on whole body cryotherapy (WBC) as add-on intervention for mental health problems.MethodsA meta-analysis according to PRISMA guidelines was conducted (Prospero registration: CRD42020167443). Databases MEDLINE, PsycINFO and the Cochrane Library were searched. Risk of bias was scored according to the Cochrane ROBINS-I-tool to which an extra bias-dimension of allegiance bias was added. Within and between Hedges’ g pooled effect sizes were calculated for the main aspect of mental health measured. Treatment efficacy was examined using a random effects model. Heterogeneity was examined through identification of visual outliers and by I² statistics.ResultsOut of 196 articles coming up from the search, ten studies met all inclusion criteria, six of which were (randomized) controlled trials. Together these studies report on a total of 294 participants receiving WBC. The within-group pooled effect size for mental health problems is large (Hedges’ g = 1.63, CI: 1.05-2.21), with high heterogeneity (I² = 93%). Subgroup analyses on depressive symptoms and quality of life (QOL) showed a diminution of heterogeneity to moderate. Effect sizes for depressive symptoms are very large (Hedges’ g = 2.95, CI: 2.44-3.45) and for QOL medium (Hedges’ g = 0.70, CI: 0.15-1.24). The between-group pooled effect size is medium (Hedges’ g = 0.76, CI: 0.17-1.36).ConclusionsResults indicate preliminary evidence for WBC as efficacious add-on intervention for mental health problems, especially depressive symptoms. Further research in the form of RCTs with larger numbers of participants is needed.     

Management of Barrett's esophagus with dysplasia refractory to radiofrequency ablation

Radiofrequency ablation(RFA) is very effective for eradication of flat Barrett's mucosa in dysplastic Barrett's esophagus after endoscopic resection of raised lesions. However, in a minority of the time, RFA may be ineffective at eradication of the Barrett's mucosa. Achieving complete eradication of intestinal metaplasia can be challenging in these patients. This review article focuses on the management of patients with dysplastic Barrett's esophagus refractory to RFA therapy. Management strategies discussed in this review include optimizing the RFA procedure, optimizing acid suppression(with medical, endoscopic, and surgical management), cryotherapy, hybrid argon plasma coagulation, and EndoRotor resection.     

Cryoablation for prostate cancer: an overview about background,procedure and nurses' responsibilities

Cryoablation was introduced in clinical practice for the treatment of skin lesions more than 100 years ago. Treatment to other areas of the body followed including the liver, lungs, bones, corneas and nerves, with applications extended to use in analgesia. The potential of using cryoablation for treatment of the prostate has been recognized as a therapeutic option for more than half a century. However, early results were unsatisfactory due to poor oncological outcome and the high morbidity of the procedure. Cryotherapy has evolved dramatically during the last decades with an improvement in technique, resulting in a significant reduction of complication rates and improved outcome for patients. Although it is regarded as a minimally invasive therapy, there are several nursing aspects that have to be observed pre‐ intra‐ and postoperatively which are essential to ensure that the patient's recovery is effected and that all benefits of a minimally invasive therapy are achieved.