420 research outputs found
"Author Meets Critics: Predrag Cicovacki, Author of Gandhi's Footprints, Meets Critics Sanjay Lal and Carlo Filice"
No full textTwo critics respond to Predrag Cicovacki’s book, Gandi’s Footprints. Cicovacki opens the discussion by presenting his motivations for exploring a paradox, that Gandhi’s work is widely revered but not widely emulated. Cicovacki explores a resolution to the paradox by suggesting how Gandhi’s promising visions may be followed without being imitated, especially Gandhi’s insight that we must seek spiritual grounding for life in a materialistic world. Critic Sanjay Lal affirms Cicovacki’s insight but suggests that precisely because Gandhi’s aspirations for spiritual life were profoundly transformative we should take care not to dilute them into our conventional wisdoms. Critic Carlo Filice asks how Gandhi’s commitment to unified reality could be more clearly articulated once a distinction is drawn between spirit and matter, also how Gandhi’s nonviolence could manage to embrace important exceptions. In reply to critics, Cicovacki proposes an approach to Gandhi informed by the insights of Tagore
Radiofrequency ablation of liver tumors: the role of microbubble ultrasound contrast agents
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Radiofrequency ablation of liver tumors: the role of microbubble ultrasound contrast agents.
Author(s): Meloni, Maria Franca; Livraghi, Tito; Filice, Carlo; Lazzaroni, Sergio; Calliada, Fabrizio; Perretti, Leonardo
Source: Ultrasound quarterly Volume: 22 Issue: 1 Pages: 41-7 Published: 2006-Mar
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Abstract: Radiofrequency ablation (RFA) is currently indicated for the treatment of primary and metastatic hepatic malignancies. Real-time ultrasound (US) is generally used during the procedure to guide electrode placement, but for evaluating the results of treatment, contrast-enhanced computed tomography and magnetic resonance imaging have traditionally been considered more effective. This view has changed, however, with the recent development of contrast-enhanced ultrasound (CEUS) (eg, using sulfur hexafluoride microbubbles), which can provide valuable information on the effects of RFA more rapidly and economically than computed tomography or magnetic resonance imaging without exposing the patient to ionizing radiation. In our center, CEUS is performed in patients with liver tumors before and immediately after RFA, in selected cases during the procedure as well, and in the follow-up. Between January 2003 and June 2005, we performed CEUS on 350 patients scheduled for RFA of primary or metastatic liver tumors. In 14 (13.4%) of the 96 patients whose disease was metastatic, CEUS revealed lesions that had been missed on the conventional US examination. In most of these cases, the result was a more complete treatment performed under CEUS guidance. In the remaining 2 (14%) of 14, the results of the examination allowed us to avoid subjecting the patient to useless treatment. In our experience, the use of CEUS also improved the management and follow-up of patients undergoing interstitial therapy
Radiofrequency thermal ablation of echinococcal liver cysts
No full textPercutaneous treatment of cystic echinococcosis of the liver is increasingly being employed. However, puncture of multivesiculated cysts may be difficult and Gharbi type IV cysts are generally thought unsuitable both for medical and percutaneous treatment. Small daughter cysts may easily recur after treatment with albendazole, and they may be difficult to reach with a needle. Two groups have reported their successful experience in percutaneous treatment of type IV cysts with large-bore catheters.4, 5 Although ground-breaking, this method is still rather complex. We present an alternative simpler percutaneous method for these cysts, based on thermal ablation of the germinal layer.
We used a radiofrequency ablation device (LeVeen Needle Electrode, RadioTherapeutics, Mountain View, CA), currently used for percutaneous treatment of solid neoplasms of the liver. The technique uses an insulated 14-gauge outer needle that houses ten solid retractable curved electrodes. When deployed, the electrodes assume the configuration of an umbrella 3·5 cm in diameter.
Two men, aged 66 and 75 years, respectively, were selected and gave informed consent for this procedure. One had a 10 cm cyst in the right liver, and the other a 10 cm right-liver cyst and 12 cm middle-liver cyst. The two men had been treated with albendazole for at least 2 years, with incomplete solidification of their cysts and permanence of small, peripheral daughter cysts.
In the presence of an anaesthesiologist, a LeVeen needle was inserted through a 15-gauge coaxial needle under ultrasonographic guidance in the cyst, by a transhepatic approach. The needle was attached to a 100 W generator operated at 480 kHz. Daughters cysts were reached and broken by deploying the electrodes; then energy was applied for 8 min at each location. The procedure was completed without complications.
No scolices were seen on microscopic examination and no residual germinal membrane was found at pathological and electron microscopy examination of the material aspirated after radiofrequency.
Ultrasound-guided radiofrequency of complex cysts is feasible, safe, and simpler than treatment with large-bore catheters. No dilators, hypertonic saline and contrast-medium injection, fluoroscopy, or catheters for external drainage are needed with this technique. If proven effective at longterm follow-up, it may extend the indications of percutaneous treatment to complex echinococcal cysts, carrying further the challenge to surgery
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