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Purpose: Endophytic renal cancer treatment is a challenge. Due to difficulties in endophytic tumor visualization during surgical extirpation, image-guided percutaneous cryoablation (PCA) is an attractive alternative. The minimally invasive nature of PCA makes it favorable for comorbid patients as well as patients in which surgery is contraindicated. Oncological outcomes and complications after PCA of endophytic biopsy-proven renal cell carcinoma (RCC) were reviewed in this study. Materials and Methods: Patients were included after a multidisciplinary team conference from January 2015 to November 2021. Inclusion criteria were endophytic biopsy-proven T1 RCC treated with PCA with one year of follow-up. Complications were reported according to the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) classification system and the Clavien-Dindo classification (CDC) system. Major complications were defined as a grade ≥ 3 according to the CDC. Results: Fifty-six patients were included with a total of 56 endophytic tumors treated during 61 PCA sessions. The median RENAL nephrometry score was 9 (IQR 2), and the mean tumor size was 25.7 mm (SD ± 8.9 mm). Mean hospitalization time was 0.39 (SD ± 1.1) days. At a mean follow-up of 996 days (SD ± 559), 86% of tumors were recurrence free after one PCA. No patients progressed to metastatic disease. According to the CIRSE classification, 10.7% (n = 6) had grade 3 complications, and 5.4% (n = 3) had CDC major complications. Conclusion: This study demonstrates that PCA of endophytic biopsy-proven T1 RCC is safe with few major complications and excellent local tumor control rates at almost three-year mean follow-up. Level of Evidence 3: Retrospective cohort study. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to investigate renal function after robot-assisted partial nephrectomy (RAPN) and percutaneous cryoablation (PCA) in clinical stage T1 (cT1) renal cell carcinoma (RCC) and evaluate the relationship between baseline renal function and renal functional outcome. Material and Methods: Patients with cT1 RCC treated with RAPN or PCA were prospectively enrolled between June 2019 and January 2021. Renal function was evaluated using estimated glomerular filtration rate, Tc-99m diethylenetriamine-pentaacetate plasma clearance, Tc-99m mercaptoacetyltriglycine renography, and renal volume at baseline and 6 months after treatment. Results: Fifty-six patients were included (18 RAPN, 38 PCA). PCA patients had a significantly higher age (68.5 years; P = 0.019) and Charlson comorbidity index (3.0; P = 0.007). Tumor characteristics did not differ significantly between RAPN and PCA. Total renal volume decreased significantly after PCA (-18.2 cm³; P = 0.001). Baseline chronic disease stage IIIb-IV leads to a greater reduction in renal volume (-31.8 cm³; P = 0.003) but not other renal function measures. Renal function declined significantly after either treatment without significant differences between RAPN and PCA. Conclusion: This study found a small, similar decrease in renal function 6 months after RAPN or PCA, despite significant differences in baseline patient characteristics. Reduced renal function at baseline did not lead to a worse renal functional outcome. [ABSTRACT FROM AUTHOR]

Background: Percutaneous cryoablation (PCA) of renal tumors is a well-established alternative to partial nephrectomy, but the effects on renal function after the procedure are not well-documented. The purpose of this study was to evaluate renal function after computed tomography–guided PCA. Materials and Methods: A retrospective cohort study including 259 patients treated with PCA at Odense University Hospital, Denmark from January 1, 2015 to December 31, 2019. Both patients with malignant (96%) and benign tumors (4%) were included. Mean age of patients was 66.5 years (standard deviation [SD] = 10.9, range: 27–91) and 174 (67%) patients were men. Baseline estimated glomerular filtration rate (eGFR) was recorded at baseline and 12 months after cryoablation. Results: Mean tumor size was 27.5 mm (SD = 10.0) distributed in seven different histopathological types, mainly clear cell renal-cell carcinoma (RCC) (64%) and papillary RCC (22%). Mean eGFR at baseline was 73.7 mL/min/1.73 m2 (SD = 23.2) with a follow-up mean eGFR of 69.7 (SD = 23.7) (p < 0.0001). At baseline before intervention 190 patients (73%) had eGFR matching chronic kidney disease (CKD) groups 1 and 2 (normal to mild CKD), 64 patients (24%) matching CKD group 3 (average CKD), and 1% in groups 4 and 5. At 12-month follow-up, 171 patients (66%) had eGFR matching CKD groups 1 and 2, 77 patients (30%) matching CKD group 3 and 11 patients (4%) matching CKD groups 4 and 5. In patients with skewed renography who had PCA in the kidney with better excretion, eGFR at baseline was 64.7 and 61.2 at follow-up (p = 0.703). Conclusions: This study showed minimal decline in renal function 12 months after PCA, even for patients with reduced renal function. PCA is therefore considered a safe and relevant intervention. [ABSTRACT FROM AUTHOR]

Background: Cryoablation is a promising minimally invasive, nephron-sparing treatment of small renal carcinoma (RCC) in co-morbid patients. Purpose: To assess the safety, efficacy, and cancer-specific outcomes of computed tomography (CT)-guided cryoablation of stage T1 (RCC). Material and Methods: A retrospective evaluation of 122 consecutive patients with 128 tumors treated with cryoablation during 2016–2017. All patients had biopsy-verified T1 RCC. Results: Median age was 69 years (IQR=59–76); 69% were male. Median tumor size was 26 mm (± 20–33); 9% were stage T1b. Mean follow-up time was 36.3±12.0 months. In total, 14 (11%) procedures led to complications, of which 4 (3%) were intraoperative, 5 (4%) appeared ≤30 days and 5 (4%) >30 days after treatment. Major complications arose after 4 (3%) procedures. Statistically significant associations were found between major complications and stage T1b (P = 0.039), RENAL score (P = 0.010), and number of needles used in cryoablation (P = 0.004). Residual tumor was detected after 4 (3%) procedures and 5 (4%) tumors had local tumor progression. Of 122 patients, 3 (2%) advanced to metastatic disease. Significant statistical associations were found between local tumor progression and T1b stage tumors and number of needles used in cryoablation (P = 0.05 and P = 0.004, respectively). For patients with T1a tumors, the one- and three-year disease-free survival was 98% and 95%, respectively, and for T1b 100% after one year and 75% after three years. Conclusions: This study showed that cryoablation is a safe and effective treatment of stage T1 RCC and suggests that in selecting candidates for cryoablation of RCC, the tumor characteristics are more critical than patients' baseline health status. [ABSTRACT FROM AUTHOR]

Background: Despite the fact that nephron-sparing treatment is considered preferable from a surgical perspective patients' quality of life (QoL) following different types of nephron-sparing treatments remains unclear. Purpose: To investigate the quality of life and complications after nephron-sparing treatment of renal cell carcinomas of stage T1. Materials and methods: A systematic search of six databases was carried out. We included studies that reported the quality of life and complications in patients aged 18 years or older following nephron-sparing treatment of renal cell carcinoma stage T1. The quality assessment was performed using the Critical Appraisal Skills Programme (CASP) checklist for cohort studies and the CASP Randomized Controlled Trial Checklist. Data were analyzed using a narrative approach. Results: Eight studies were included, six of which investigated QoL after partial nephrectomy and two after ablation therapies. Seven studies reported complications. Three studies reported higher QoL scores after partial nephrectomy compared to radical nephrectomy. Two studies showed that QoL increased or returned to baseline levels up to 12 months following partial nephrectomy. One study reported a gradual increase in QoL after radiofrequency ablation, and one study reported that all patients recovered to baseline QoL following cryoablation. Across studies, we found a complication rate up to 20% after partial nephrectomy and up to 12.5% after ablation therapy. Conclusions: The results of this systematic review suggest that nephron-sparing treatment appears to be superior or comparable to other treatment alternatives with regard to QoL outcomes. Additionally, based on the studies included in this review, partial nephrectomy appears to have a higher complication rate compared with ablation therapies. Systematic review registration: PROSPERO CRD42020155594 [ABSTRACT FROM AUTHOR]

Background: Distal radius fracture characterization and treatment are mainly based on radiographic measurements but with contradictory findings on the correlation of those measurements to clinical outcome. Before applying radiographic measurement to the treatment decision and before correlating the measurements to clinical outcome, an accuracy of measurements must be established. Purpose: To summarize existing evidence on accuracy of the radiographic measurements of: (i) dorsal/volar tilt of the distal radius; (ii) radial shortening; (iii) ulnar variance; (iv) radial inclination; and (v) articular step-off of the distal radius. We conducted a systematic critical review of the literature. Material and Methods: MEDLINE, EMBASE, and the Cochrane Library database were searched. The Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines were followed. Quality of included studies was assessed using a tailored version of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Results: A total of 5908 publications were screened and five studies met the inclusion criteria. Four studies assessed accuracy of articular step-off but with contradictory outcomes. Radiographic measurements of step-off were accurate in two studies and inaccurate in one study. In the last step-off study, some of their measurements varied significantly but accuracy was not reported. The radiographic measurements of ulnar variance were significantly underestimated when compared to the true variance. We were not able to include studies that assessed accuracy of radial shortening, radial inclination, or dorsal/volar tilt against a reference standard. Conclusion: Currently, evidence is not available to support accuracy of the radiographic measurements commonly used to characterize distal radius fractures. [ABSTRACT FROM AUTHOR]

Background: Ultrasonography of the testis is a well-established diagnostic tool in detection of testicular microlithiasis (TML). Operator-dependent diagnostic variation related to skill, knowledge, and operator consistency are factors that influence detection of TML. Purpose: To determine inter- and intraobserver agreement for detection of TML using ultrasonography for a group of physicians with no or limited experience compared to a group of experience senior radiologists. Material and Methods: Between May and September 2014 a total of six observers evaluated 34 patients scrotal ultrasonography recorded from September to December 2013. The observers were blinded to patient history and previous ultrasonography. Three of the observers had no or limited experience with detection of TML, and three of the observers had more than 15 years of experience. Each observer reviewed all the scrotal ultrasonography recordings twice with a time interval of 3 months. Results: The inter-observer agreement showed substantial agreement and up to almost perfect agreement (κ = 0.86). Both the experienced and less experienced observers had a higher agreement in detecting and grading TML in their second reading. Conclusion: The ultrasonography grading system of TML in this study showed to be reproducible, with an inter- and intraobserver agreement ranging between substantial agreement and up to almost perfect agreement with many years of experience not necessarily being essential. [ABSTRACT FROM AUTHOR]

An aberrant systemic artery originating from the abdominal aorta supplying a pulmonary sequestration is a rare congenital malformation. This causes a left-to-left shunt. Symptoms include recurrent pneumonias, hemoptysis, and, in the long term, heart failure. Aneurysm of the aberrant vessel is rarely seen. Traditionally, treatment of pulmonary sequestrations includes ligation of the feeding vessel and lobectomy. A new promising treatment is an endovascular approach. Only a few cases describe endovascular treatment of pulmonary sequestration. This is the first published case of a giant aneurysmal branch from the abdominal aorta to the normal basal segments of the lung, successfully occluded with an Amplatzer Vascular Plug II (AVP II, St.Jude Medical, MN, USA) alone. [ABSTRACT FROM AUTHOR]