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            "title": "Factors contributing to cavitation after CT-guided percutaneous radiofrequency ablation for lung tumors",
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                    "firstName": "Tomohisa",
                    "lastName": "Okuma"
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                    "lastName": "Oyama"
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                    "lastName": "Inoue"
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                    "firstName": "Yuichi",
                    "lastName": "Inoue"
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            "title": "Early enlarging cavitation after percutaneous radiofrequency ablation of lung tumors: Incidence, risk factors and outcome",
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                    "creatorType": "author",
                    "firstName": "Koji",
                    "lastName": "Tomita"
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                {
                    "creatorType": "author",
                    "firstName": "Toshihiro",
                    "lastName": "Iguchi"
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                {
                    "creatorType": "author",
                    "firstName": "Yusuke",
                    "lastName": "Matsui"
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                    "firstName": "Mayu",
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                    "creatorType": "author",
                    "firstName": "Jun",
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            "abstractNote": "PURPOSE: The purpose of this study was to retrospectively determine the incidence of early enlarging cavitation after percutaneous radiofrequency ablation (RFA) of lung tumor and identify risk factors associated with their occurrence.\nPATIENTS AND METHODS: A total of 245 patients (140 men, 105 women; mean age, 62.7 ± 11.8 [SD] years; age range: 31-87 years) with 605 lung tumors who were treated using 401 RFA sessions from April 2010 to March 2020 were included. Of which, 31 patients with 38 early enlarging cavitation and control group (151 patients with 228 tumors) were analyzed. Early enlarging cavitation was defined as cavities with an enlarged size (>3 cm) occurring on ablated lesions within seven days after RFA. Incidence of cavitation, risk and post-procedural factors of occurrence, major adverse events (AEs) that occurred in RFA sessions with cavitation, and course of cavitation were evaluated. AEs were classified using the CIRSE classification system for complications.\nRESULTS: Thirty-eight cavities (6.3%, 38/605 tumors) in 31 patients occurred in an average of 3.1 ± 1.7 days (range, 1-7 days) after 32 RFA sessions. Distance from pleura ≥ 20 mm, contact with vessel ≥ 3 mm, multitined expandable electrode ≥ 3 cm, and bronchus ≥ 2 mm encompassed in the ablation zone were independent risk factors of occurrence. Fever ≥ 38.5 °C, white blood cell count ≥ 10,000/μl one day after RFA, and steroid therapy were independent post-procedural factors of occurrence. Twenty-four Grade 3 and two Grade 6 AEs occurred. Twenty-nine cavities disappeared within a mean duration of 111.9 ± 64.9 (SD) days (range: 44-274 days) and four remained with a mean follow-up of 279.2 ± 174 (SD) days; five patients were lost to follow-up.\nCONCLUSIONS: Early enlarging cavitation occurs in 6.3% of lung tumors treated with RFA and are associated with 26 major AEs in 32 sessions. Aforementioned procedural factors and post-procedural inflammation were significant risk factors of occurrence.",
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            "abstractNote": "Interventional oncology procedures such as thermal ablation are becoming widely used for many tumours in the liver, kidney and lung. Thermal ablation refers to the focal destruction of tissue by generating cytotoxic temperatures in the treatment zone. Hydrodissection - separating tissues with fluids - protects healthy tissues adjacent to the ablation treatment zone to improve procedural safety, and facilitate more aggressive power application or applicator placement. However, fluids such as normal saline and 5% dextrose in water (D5W) can migrate into the peritoneum, reducing their protective efficacy. As an alternative, a thermo-gelable poloxamer 407 (P407) solution has been recently developed to facilitate hydrodissection procedures. We hypothesise that the P407 gel material does not provide convective heat dissipation from the ablation site, and therefore may alter the heat transfer dynamics compared to liquid materials during hydrodissection-assisted thermal ablation. The purpose of this study was to investigate the heat dissipation mechanics within D5W, liquid P407 and gel P407 hydrodissection barriers. Overall it was shown that the gel P407 dissipated heat primarily through conduction, whereas the liquid P407 and D5W dissipated heat through convection. Furthermore, the rate of temperature change within the gel P407 was greater than liquid P407 and D5W. Testing to evaluate the in vivo efficacy of the fluids with different modes of heat dissipation seems warranted for further study.",
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                    "lastName": "Moon"
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            "volume": "198",
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            "title": "Thermal epiphysiodesis performed with radio frequency in a porcine model",
            "creators": [
                {
                    "creatorType": "author",
                    "firstName": "Juan M.",
                    "lastName": "Shiguetomi-Medina"
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                {
                    "creatorType": "author",
                    "firstName": "Ole",
                    "lastName": "Rahbek"
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                {
                    "creatorType": "author",
                    "firstName": "Ahmed Abdul-Hussein",
                    "lastName": "Abood"
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                    "creatorType": "author",
                    "firstName": "Hans",
                    "lastName": "Stødkilde-Jørgensen"
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            "abstractNote": "BACKGROUND AND PURPOSE: Current techniques for epiphysiodesis involve opening of cortical windows; use of staples, screws, and tension devices; and fusion with curettes or drills. Complications may have serious consequences. There is a need for a more reliable, precise, and less traumatic procedure that overcomes the known complications from existing techniques. We analyzed a new epiphysiodesis technique using radio-frequency ablation (RFA) in a porcine model.\nMETHODS: Six 35-kg and two 25-kg immature pigs were used. 1 hind leg of each animal was randomly selected and the proximal tibia growth plate was ablated laterally and medially. The contralateral leg was used as a control. MR images were obtained immediately after the ablation and 12 weeks later for 6 animals, and 24 weeks later for the other 2 animals. CT was done for the 2 animals that were followed for 24 weeks for proof of bone bridges.\nRESULTS: Both tibias were equal in length initially. At the 12-week follow-up, there was an average leg length discrepancy of 3.9 mm (95% CI: 3.0-4.8), and at 24 weeks the difference was 8.4 mm and 7.5 mm. No damage to the adjacent tissue was found. Bone bridges and physeal closure were found after 24 weeks. The pigs showed no discomfort after the intervention.\nINTERPRETATION: We found RFA to be feasible for epiphysiodesis in a pig model. The method is minimally invasive and recovery may be quick compared to conventional methods. We recommend that the method should be tested in larger-scale safety studies before clinical application.",
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            "title": "Percutaneous radiofrequency epiphysiodesis in a rabbit model: a pilot study",
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                    "firstName": "Roger F.",
                    "lastName": "Widmann"
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                    "firstName": "Terry D.",
                    "lastName": "Amaral"
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                    "firstName": "Cemil",
                    "lastName": "Yildiz"
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                    "firstName": "Xu",
                    "lastName": "Yang"
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            "abstractNote": "BACKGROUND: Techniques for epiphysiodesis have evolved from open surgical techniques requiring direct observation of the physis to percutaneous techniques performed with fluoroscopy.\nQUESTIONS/PURPOSES: Our purposes were to (1) describe a new minimally invasive surgical technique used to achieve epiphysiodesis using radiofrequency ablation, (2) document the effect of radiofrequency ablation on tibia length at 2, 6, and 12 weeks after ablation in a skeletally immature rabbit model, and (3) assess the effects of radiofrequency ablation on the histologic appearance of the proximal tibia physis and proximal tibia articular cartilage.\nMATERIALS AND METHODS: We performed epiphysiodesis of the rabbit proximal tibia on 15 skeletally immature male New Zealand White rabbits using a 22-gauge radiofrequency probe. The probe was positioned percutaneously and heated to 90 degrees C for 4 minutes on the medial and lateral (1/2) of the physis. The opposite tibia was used as a control. Five animals were sacrificed at 2, 6, or 12 weeks postoperatively. Tibia length was compared using Faxitron(R) radiographs and electronic calipers. Histology of the growth plate was assessed with light microscopy.\nRESULTS: We observed differences in tibia length between 4.16 mm and 11.59 mm (average 7.86 mm) at 12 weeks. The proximal tibia physis closed radiographically and histologically in all animals by 12 weeks. Histologic analysis showed no evidence of articular cartilage injury.\nCONCLUSIONS: This technique was reproducible and resulted in bone fusion of the rabbit proximal tibial growth plate. The use of radiofrequency ablation as described in this report may be used as an alternative to other surgical epiphysiodesis techniques.\nCLINICAL RELEVANCE: This technique may be useful for epiphysiodesis of small tubular bones of the hands and feet in humans.",
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            "title": "Radiofrequency application to the growth plate in the rabbit: a new potential approach to epiphysiodesis",
            "creators": [
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                    "creatorType": "author",
                    "firstName": "Ismat",
                    "lastName": "Ghanem"
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                {
                    "creatorType": "author",
                    "firstName": "Samer",
                    "lastName": "El Hage"
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                    "creatorType": "author",
                    "firstName": "Michel",
                    "lastName": "Diab"
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                {
                    "creatorType": "author",
                    "firstName": "Elie",
                    "lastName": "Saliba"
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                {
                    "creatorType": "author",
                    "firstName": "Aline",
                    "lastName": "Khazzaka"
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                    "creatorType": "author",
                    "firstName": "Georges",
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                    "firstName": "Fernand",
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            "abstractNote": "BACKGROUND: Radiofrequency energy is being used more and more frequently in orthopaedics, mainly in the treatment of bone tumors. We postulated that radiofrequency ablation may produce growth plate lesions similar to those observed in the bone and conducted this study to see whether radiofrequency may be used as a technique for producing epiphysiodesis.\nMETHODS: We randomized 60 8-week-old female New Zealand white rabbits into 3 groups. Group A was destined for a total epiphysiodesis at 60 degrees C, group B was destined for a total epiphysiodesis at 90 degrees C, and group C for a lateral hemiepiphysiodesis at 90 degrees C. Radiofrequency energy was delivered in 1 minute in all 3 groups. Using fluoroscopic imaging, radiofrequency was applied percutaneously to the left proximal tibial physis whereas the right growth plate received a sham procedure. A bicortical pin was used to evaluate the longitudinal growth rate at every monthly radiologic control, beginning 8 weeks after the procedure. Comparisons between the right and left side and between groups A and B were achieved using a paired t test. A histopathologic study was conducted in parallel to the radiographic study.\nRESULTS: In a radiograph at the 8-week point, pin migration was 4.74 mm on the left side compared with 9.72 mm on the right (P<0.0001), in group A. In group B, pin migration on the left was 1.37 mm compared with 5.49 mm on the right (P<0.0001). In group C, mean angular deviation was 11.6 degrees on the left compared with 1.9 degrees on the right (P=0.0001). These differences were maintained until the end of growth. Pathology specimens revealed cellular anarchy, loss of columnar stratification, and height of the physis on the left side, which occurred earlier and were more pronounced in group B than in group A. In group C, these changes involved only the lateral half of the left physis whereas its medial counterpart remained normal. There was no evidence of articular cartilage damage.\nCONCLUSIONS: This experimental study shows that radiofrequency can efficiently and rapidly achieve epiphysiodesis. It is one of many methods that can be used for this purpose. The development of new electrodes suitable for use on human growth plates and the elaboration of specific utilization protocols may lead to its use in children. Its simplicity and precision may lead to a quick and efficient growth arrest with little pain and postoperative disability in addition to reduced costs.\nCLINICAL RELEVANCE: Radiofrequency has proved to be effective in producing growth arrest in rabbits with no complications. Technical improvements and adaptations may allow its use for pediatric limb inequalities or angular deformities in the near future.",
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