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Sensitivity of thermophysiological models of cryoablation to the thermal and biophysical properties of tissues

Chan JY, Ooi EH

Cryobiology, 2016 12;73(3):304-315.
PMID: 27789380 DOI: 10.1016/j.cryobiol.2016.10.006

Advancement in biomedical simulation and imaging modality have catalysed the development of in silico predictive models for cryoablation. However, one of the main challenges in ensuring the accuracy of the model prediction is the use of proper thermal and biophysical properties of the patient. These properties are difficult to measure clinically and thus, represent significant uncertainty that can affect the model prediction. Motivated by this, a sensitivity analysis is carried out to identify the model parameters that have the most significant impact on the lesion size during cryoablation. The study is initially carried out using the Morris method to screen for the most dominant parameters. Once determined, analysis of variance (ANOVA) is performed to quantitatively rank the order of importance of each parameter and their interactions. Results from the sensitivity analysis revealed that blood perfusion, water transport and ice nucleation parameters are critical in predicting the lesion size, suggesting that the acquisition of these parameters should be prioritised to ensure the accuracy of the model prediction.

Matched MeSH terms: Cryosurgery*
Cryodebulking of endobronchial hamartoma via fibreoptic bronchoscopy and literature review

Ng BH, Ban Yu-Lin A, Low HJ, Faisal M

BMJ Case Rep, 2020 Aug 25;13(8).
PMID: 32843453 DOI: 10.1136/bcr-2020-235316

Endobronchial hamartoma is a rare tumour. We report a 65-year-old woman with a history of recurrent pneumonia. Bronchoscopy revealed a 1 cm endobronchial mass obstructing the left upper lobe bronchus. Histopathological examination was consistent with a pulmonary hamartoma. This lesion was successfully debulked endoscopically with the use of a flexible cryoprobe without any complications. This case highlights both the importance of investigating recurrent pneumonia and the usefulness of endoscopic recanalisation in an obstructed segmental bronchus.

Matched MeSH terms: Cryosurgery*
Fulltext Cryoballoon Ablation for the Treatment of Atrial Fibrillation in Patients With Concomitant Heart Failure and Either Reduced or Preserved Left Ventricular Ejection Fraction: Results From the Cryo AF Global Registry

Rordorf R, Scazzuso F, Chun KRJ, Khelae SK, Kueffer FJ, Braegelmann KM, et al.

J Am Heart Assoc, 2021 Dec 21;10(24):e021323.
PMID: 34889108 DOI: 10.1161/JAHA.121.021323

Background Heart failure (HF) and atrial fibrillation (AF) often coexist; yet, outcomes of ablation in patients with AF and concomitant HF are limited. This analysis assessed outcomes of cryoablation in patients with AF and HF. Methods and Results The Cryo AF Global Registry is a prospective, multicenter registry of patients with AF who were treated with cryoballoon ablation according to routine practice at 56 sites in 26 countries. Patients with baseline New York Heart Association class I to III (HF cohort) were compared with patients without HF. Freedom from atrial arrhythmia recurrence ≥30 seconds, safety, and health care utilization over 12-month follow-up were analyzed. A total of 1303 patients (318 HF) were included. Patients with HF commonly had preserved left ventricular ejection fraction (81.6%), were more often women (45.6% versus 33.6%) with persistent AF (25.8% versus 14.3%), and had a larger left atrial diameter (4.4±0.9 versus 4.0±0.7 cm). Serious procedure-related complications occurred in 4.1% of patients with HF and 2.6% of patients without HF (P=0.188). Freedom from atrial arrhythmia recurrence was not different between cohorts with either paroxysmal AF (84.2% [95% CI, 78.6-88.4] versus 86.8% [95% CI, 84.2-89.0]) or persistent AF (69.6% [95% CI, 58.1-78.5] versus 71.8% [95% CI, 63.2-78.7]) (P=0.319). After ablation, a reduction in AF-related symptoms and antiarrhythmic drug use was observed in both cohorts (HF and no-HF), and freedom from repeat ablation was not different between cohorts. Persistent AF and HF predicted a post-ablation cardiovascular rehospitalization (P=0.032 and P=0.001, respectively). Conclusions Cryoablation to treat patients with AF is similarly effective at 12 months in patients with and without HF. Registration URL: https://www.clinicaltrials.gov; Unique Identifier: NCT02752737.

Matched MeSH terms: Cryosurgery*
Fulltext Combination of 1.1 mm flexible cryoprobe with conventional guide sheath and therapeutic bronchoscope in biopsy of apical upper lobe solitary pulmonary nodule

Kho SS, Chai CS, Nyanti LE, Ismail AMB, Tie ST

BMC Pulm Med, 2020 Jun 03;20(1):158.
PMID: 32493437 DOI: 10.1186/s12890-020-01199-3

BACKGROUND: Lung cancer is frequently situated peripherally in the upper lobes of the lung. Acquiring adequate tissue from this difficult-to-reach area remains a challenge. Transbronchial cryobiopsy (TBCB) has the ability to acquire larger specimens, but the rigidity of the standard 1.9 mm and 2.4 mm cryoprobes frequently poses challenges when used with a guide sheath (GS). The novel 1.1 mm cryoprobe, being both smaller and more flexible, may address this limitation. We describe the usage of this 1.1 mm flexible cryoprobe with GS in the biopsy of solitary pulmonary nodules (SPN) in the apical segment of the upper lobe in two cases.
CASE REPORT: Both procedures were conducted with advanced airway under total intravenous anaesthesia. 2.6 mm GS was used in combination with a 2.2 mm rEBUS probe, using a therapeutic bronchoscope. Case 1 describes a SPN in the apical segment of the right upper lobe that was inconclusive by forceps biopsy due to GS displacement and inadequate biopsy depth. A steerable GS combined with the novel cryoprobe subsequently overcame this issue. Case 2 describes a SPN in the apical segment of the left upper lobe in which the standard cryoprobe failed to advance through the GS due to steep angulation. It also highlights with shorter activation time, the novel cryoprobe enable biopsied tissue to be retrieved through the GS while the bronchoscope-GS remains wedgend in the airway segment. There were no bleeding or pneumothorax complications in both cases, and histopathological examination confirmed adenocarcinoma of the lung.
CONCLUSION: The 1.1 mm flexible cryoprobe in combination with GS and therapeutic bronchoscope offers an option to acquire adequate tissue in difficult-to-reach regions in the lung such as the apical segment of upper lobes. Further prospective series to evaluate its performance and safety in SPN biopsy is highly anticipated.

Matched MeSH terms: Cryosurgery/instrumentation*
Technical tips, diagnostic yield and safety of endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy

Soo CI, Huan NC, Kho SS

Med J Malaysia, 2024 Jul;79(4):490-493.
PMID: 39086350

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is commonly used to diagnose and stage lung cancer. In clinical practice, cytology specimens from EBUS-TBNA may be low in cellularity, especially with necrotic lesions. Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy (EBUS-TBMC) has recently become the preferred method for obtaining histology biopsy. This retrospective cohort study analysed the first 30 patients who have undergone EBUS-TBMC in a tertiary centre in Malaysia. EBUS-TBMC demonstrated a high diagnostic yield and good safety profile. All the samples obtained were adequate for the detection of driver alteration by next-generation sequencing.

Matched MeSH terms: Cryosurgery/methods
Enhancing the Appearance of the "Six-Pack" Muscles Using Cryolipolysis: A Safe and Effective Method

Lim T, Ding SW, Chua CH, Moey HX

Plast Reconstr Surg, 2021 Oct 01;148(4):775-779.
PMID: 34550933 DOI: 10.1097/PRS.0000000000008320

SUMMARY: Many individuals desire a defined and athletic body with "six-pack" abdominal muscles, but even with a strict regimen of diet and exercise, this result is unattainable for many. Cryolipolysis is a noninvasive method of reducing the subcutaneous adipose tissues lying above the rectus abdominis muscles, enhancing the six-pack appearance. Eleven nonobese adults with an average body mass index of 22.5 kg/m2 were enrolled in this study. All subjects were treated with the CoolSculpting cryolipolysis system, with most of them undergoing two rounds of treatment. Improvement in appearance of the abdominal muscles was rated using the Global Aesthetic Improvement Scale, and adverse events and subjects' satisfaction scores were recorded. Treatments were well tolerated, with no reported instances of blanching, bruising, or blistering, and with only mild cases of edema, erythema, and numbness reported by some. Mean Global Aesthetic Improvement Scale rating was 1.7, corresponding to a rating of improved to much improved. Subjects were comfortable with the procedure and satisfied with the results. In conclusion, cryolipolysis is an effective and well-tolerated method for noninvasive enhancement of abdominal muscle definition.

Matched MeSH terms: Cryosurgery/adverse effects*; Cryosurgery/methods
Non-surgical options in the management of hepatocellular carcinoma

Harjit S

Med J Malaysia, 2005 Jul;60 Suppl B:108-11.
PMID: 16108189
Matched MeSH terms: Cryosurgery
Cryotherapy: A Successful Monotherapy for Earlobe Keloids

Muthanna AM, Al-Qubati YA

Malays Fam Physician, 2020;15(3):83-85.
PMID: 33329867

A keloid represents an excessive overgrowth of skin beyond the boundaries of an injury. Earlobe keloids usually follow ear piercing and can become large, sometimes producing remarkable disfigurement. Surgical excision, pressure dressing, intralesional corticosteroid injection, cryosurgery, radiation, and lasers have all been used to treat earlobe keloids. However, none has produced uniformly satisfactory results. Combinations of more than one modality have also been employed to yield successful outcomes. We describe cryotherapy as a single modality to treat seven-year-old, multiple earlobe keloids. Three cryotherapy sessions with two freezing-thawing cycles of 30-40 seconds' freezing time and two minutes' thawing time, undertaken one month apart, resulted in complete flatness of the keloids and no recurrence after 5 years. We also evaluate keloid-related and operational factors that determine the success of cryotherapy as a monotherapy for earlobe keloids.

Matched MeSH terms: Cryosurgery
Fulltext High myopia following unilateral cryocoagulation for threshold retinopathy of prematurity

Nazri Omar, Lin, Lo Yee, Rafidah Md Saleh

Malaysian Journal of Medicine and Health Sciences, 2016;12(2):49-52.
MyJurnal

Despite the proven benefit of cryotherapy in the management of
threshold retinopathy of prematurity (ROP), it was shown
leading to ocular adverse effects. A male infant was born at 28
week of gestation with a birth weight of 1200 g. Serial
examinations revealed worsening ROP in both eyes until he
reached a high risk pre-threshold ROP in his right eye and
threshold ROP in his left eye. Cryotherapy was performed for
the threshold ROP in the left eye while the right eye was
subjected to further observation. Subsequently, ROP in both
eyes regressed without cicatrisation. The patient was followedup
over 8 years and refractions showed that the treated eye
developed steadily increasing myopia while the untreated eye
remained emmetropic. This case demonstrated the detrimental
effect of cryotherapy to the treated eye leading to the progressive
myopia as the child grew.

Matched MeSH terms: Cryosurgery
Fulltext A novel technique for the management of blandin-nuhn mucocele: a case report

Kumaresan R, Karthikeyan P, Mohammed F, Thapasum Fairozekhan A

Int J Clin Pediatr Dent, 2013 Sep;6(3):201-4.
PMID: 25206223 DOI: 10.5005/jp-journals-10005-1219

Mucocele, a common benign cystic lesion of minor salivary gland and associated ducts develops following extravasation or retention of mucous material in the subepithelial tissue. Occurrence of mucocele of tongue is considered less frequent when compared to a higher incidence of mucocele in the lower lip of young patients. Different modalities of treatment, such as conventional surgical excision followed by newer techniques like cryosurgery, electrocautery have been proposed to completely remove the lesion and reduce the chances of recurrence. Herewith, we report a novel treatment technique using alginate impression material to aid in complete excision of mucocele of glands of Blandin-Nuhn. How to cite this article: Kumaresan R, Karthikeyan P, Mohammed F, Fairozekhan TA. A Novel Technique for the Management of Blandin-Nuhn Mucocele: A Case Report. Int J Clin Pediatr Dent 2013;6(3):201-204.

Matched MeSH terms: Cryosurgery
Fulltext Antifreeze Proteins and Their Practical Utilization in Industry, Medicine, and Agriculture

Eskandari A, Leow TC, Rahman MBA, Oslan SN

Biomolecules, 2020 12 09;10(12).
PMID: 33317024 DOI: 10.3390/biom10121649

Antifreeze proteins (AFPs) are specific proteins, glycopeptides, and peptides made by different organisms to allow cells to survive in sub-zero conditions. AFPs function by reducing the water's freezing point and avoiding ice crystals' growth in the frozen stage. Their capability in modifying ice growth leads to the stabilization of ice crystals within a given temperature range and the inhibition of ice recrystallization that decreases the drip loss during thawing. This review presents the potential applications of AFPs from different sources and types. AFPs can be found in diverse sources such as fish, yeast, plants, bacteria, and insects. Various sources reveal different α-helices and β-sheets structures. Recently, analysis of AFPs has been conducted through bioinformatics tools to analyze their functions within proper time. AFPs can be used widely in various aspects of application and have significant industrial functions, encompassing the enhancement of foods' freezing and liquefying properties, protection of frost plants, enhancement of ice cream's texture, cryosurgery, and cryopreservation of cells and tissues. In conclusion, these applications and physical properties of AFPs can be further explored to meet other industrial players. Designing the peptide-based AFP can also be done to subsequently improve its function.

Matched MeSH terms: Cryosurgery
A puzzling case of cardiac arrest

Hannah HB

Br J Anaesth, 1971 Oct;43(10):991-3.
PMID: 5115036
Matched MeSH terms: Cryosurgery
Transvitreal migration of a Toxocara larva resulting in a second chorioretinal granuloma

Sivaratnam D, Subrayan V, Ali NA

Jpn. J. Ophthalmol., 2008 Sep-Oct;52(5):416-417.
PMID: 18991049 DOI: 10.1007/s10384-008-0569-z
Matched MeSH terms: Cryosurgery