Ultrasound-Guided Interstitial Laser Photocoagulation of an Autonomous Thyroid Nodule: The Introduction of a Novel Alternative

Thyroid ◽  
2003 ◽  
Vol 13 (9) ◽  
pp. 885-888 ◽  
Author(s):  
Helle Døssing ◽  
Finn Noe Bennedbaek ◽  
Laszlo Hegedüs
2015 ◽  
Vol 40 (2) ◽  
pp. 156-160 ◽  
Author(s):  
Alan M. Coleman ◽  
Arnold C. Merrow ◽  
Timothy M. Crombleholme ◽  
Ronald Jaekle ◽  
Foong-Yen Lim

While bronchopulmonary sequestration typically has a benign course, this congenital lung malformation has a high mortality rate when associated with untreated in utero tension hydrothorax and hydrops. Hydrops related to bronchopulmonary sequestration is believed to result from torsion of the mass with compromise of the associated blood supply. The impaired venous return of the mass then leads to tension hydrothorax with compression of the heart and mediastinal vessels, impairing global venous return. To our knowledge, this scenario has only been described prenatally by ultrasound. We present the imaging findings of a dichorionic, diamniotic twin gestation with one fetus developing tension hydrothorax and hydrops from presumed intermittent torsion of a bronchopulmonary sequestration. This diagnosis was only able to be confirmed by MRI prior to the use of ultrasound-guided interstitial laser photocoagulation for the treatment of this anomaly.


2005 ◽  
Vol 152 (3) ◽  
pp. 341-345 ◽  
Author(s):  
Helle Døssing ◽  
Finn Noe Bennedbæk ◽  
Laszlo Hegedüs

Aim: To evaluate the efficacy of ultrasound (US)-guided interstitial laser photocoagulation (ILP) on thyroid function, nodule size and patient satisfaction in benign solitary solid cold thyroid nodules by comparing one ILP session with no treatment in a prospective randomised study. Materials and methods: Thirty euthyroid outpatients with a benign solitary solid and a scintigraphically cold thyroid nodule causing local discomfort were assigned to one session of ILP (n = 15) or observation (n = 15) and followed for 6 months. Thyroid nodule volume and total thyroid volume were assessed by US and thyroid function was determined by routine assays before and during follow-up. Pressure and cosmetic complaints before and at 6 months were evaluated on a visual analogue scale. ILP was performed under US guidance and with an output power of 2.5–3.5 W. Results: In the ILP group, the nodule volume decreased from 8.2 ml (6.1; 11.9) (median; quartiles) to 4.8 ml (3.0; 6.6) after 6 months (P = 0.001). The overall median reduction was 44% (37; 52), which correlated with a significant decrease in pressure symptoms as well as cosmetic complaints. In the control group, a non-significant increase in median nodule volume of 7% (0; 34) after 6 months was seen. No major side-effects were seen in the ILP group. There was no correlation between thermal energy deposition and nodule volume reduction. Thyroid function was unaltered throughout. Conclusion: US-guided ILP, given as a single treatment, resulted in a satisfactory clinical response in the majority of patients with a benign solitary solid cold thyroid nodule, and may become a clinically relevant alternative to surgery in selected patients.


2011 ◽  
Vol 165 (1) ◽  
pp. 123-128 ◽  
Author(s):  
Helle Døssing ◽  
Finn Noe Bennedbæk ◽  
Laszlo Hegedüs

AimTo evaluate the long-term efficacy of interstitial laser photocoagulation (ILP) in solitary benign thyroid nodules.Design and methodsA total of 78 euthyroid outpatients (45 participating in randomized trials) with a benign solitary solid and scintigraphically cold thyroid nodule causing local discomfort were assigned to ILP. ILP (using one laser fiber) was performed under continuous ultrasound (US) guidance and with an output power of 1.5–3.5 W. Thyroid nodule volume was assessed by US and thyroid function determined by routine assays, before and during follow-up. Pressure symptoms and cosmetic complaints were evaluated on a visual analogue scale (0–10 cm). Of the total patients, six had thyroid surgery 6 months after ILP and three were lost to follow-up. The median follow-up for the remaining 69 patients was 67 months (range 12–114).ResultsThe overall median nodule volume decreased from 8.2 ml (range 2.0–25.9) to 4.1 ml (range 0.6–33.0; P<0.001) at the final evaluation, corresponding to a median reduction of 51% (range: −194 to 95%). This correlated with a significant decrease in pressure as well as cosmetic complaints. After 12--96 months (median 38 months) of ILP, 21 patients (29%) had thyroid surgery because of an unsatisfactory result. All had benign histology. Thyroid function was unaltered throughout and side effects were restricted to mild local pain.ConclusionUS-guided ILP results in a satisfactory long-term clinical response in the majority of patients with a benign solitary solid cold thyroid nodule. Further large-scale studies should aim at optimizing selection criteria for ILP, preferably in randomized studies.


1999 ◽  
Author(s):  
William M. Whelan ◽  
Douglas R. Wyman

Abstract Interstitial laser photocoagulation (ELP) was performed ex vivo in lean bovine muscle by delivering 1.5 W of continuous-wave 1064 nm Nd:YAG laser energy from a 400 μm core plane-cut optical fiber. The strategy for determining the char temperature involved measuring temperatures where thermal gradients were reduced, and extracting times at which temperature-time profiles displayed interesting nonlinear changes. These times were used to guide a finite difference thermal model, calculating transient temperatures based on two physical descriptions of tissue charring. Modifications in the optical and thermophysical properties due to tissue coagulation (T ≥ 60 °C) and vaporization of tissue water (T ≥ 100°C), respectively, were considered. By placing measured charring dimensions, 2.0 ± 0.3 mm, on calculated temperature-distance profiles, a tissue charring temperature of 414 ± 92°C was estimated.


1994 ◽  
Vol 2 (3) ◽  
pp. 299-302 ◽  
Author(s):  
M. Clemence ◽  
H. R. S. Roberts ◽  
M. Paley ◽  
G. Buonaccorsi ◽  
M. A. Hall-Craggs ◽  
...  

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