PRELIMINARY FINDINGS OF A POTENZIATED PIEZOSURGERGICAL DEVICE AT THE RABBIT SKULL

The number of available ultrasonic osteotomes has remarkably increased. In vitro and in vivo studies have revealed differences between conventional osteotomes, such as rotating or sawing devices, and ultrasound-supported osteotomes (Piezosurgery®) regarding the micromorphology and roughness values of osteotomized bone surfaces. Objective: the present study compares the micro-morphologies and roughness values of osteotomized bone surfaces after the application of rotating and sawing devices, Piezosurgery Medical® and Piezosurgery Medical New Generation Powerful Handpiece. Methods: Fresh, standard-sized bony samples were taken from a rabbit skull using the following osteotomes: rotating and sawing devices, Piezosurgery Medical® and a Piezosurgery Medical New Generation Powerful Handpiece. The required duration of time for each osteotomy was recorded. Micromorphologies and roughness values to characterize the bone surfaces following the different osteotomy methods were described. The prepared surfaces were examined via light microscopy, environmental surface electron microscopy (ESEM), transmission electron microscopy (TEM), confocal laser scanning microscopy (CLSM) and atomic force microscopy. The selective cutting of mineralized tissues while preserving adjacent soft tissue (dura mater and nervous tissue) was studied. Bone necrosis of the osteotomy sites and the vitality of the osteocytes near the sectional plane were investigated, as well as the proportion of apoptosis or cell degeneration. Results and Conclusions: The potential positive effects on bone healing and reossification associated with different devices were evaluated and the comparative analysis among the different devices used was performed, in order to determine the best osteotomes to be employed during cranio-facial surgery

Predictive Factors of Biological Behaviour in Pituitary Adenoma

Background: Predicting biological behavior of pituitary adenomas is a complex but highly desirable issue for both scientific and practical porpoises. Recently, a clinico-pathological grading based on histopathological and neuroradiological features has been proposed, stratifying the risk of progression/recurrence in 5 classes. Aim of our study is to perform an independent external validation of this score and identify other potential predictor of aggressive behaviour. Results: Five hundred sixty-six patients with pituitary adenomas were included in this study (253 FSH/LH, 147 GH, 85 PRL, 72 ACTH and 9 TSH tumors). In 437 cases, pituitary adenomas were non-invasive, with low (grade 1a: 378 cases) or high (grade 1b: 59 cases) proliferative activity. In 129 cases, tumors were invasive, with low (grade 2a: 87 cases) or high (grade 2b: 42 cases) proliferative activity. During the follow-up (mean: 5.8 years), 60 patients developed disease recurrence or progression, with a total of 130 patients with pituitary disease at last follow-up. Univariate analysis demonstrated a significantly higher risk of disease persistence and recurrence/progression in patients with PRL, ACTH and FSH/LH tumors as compared to those with somatotroph tumors, and in those with high proliferative activity (grade 1b and 2b) or >1 cm diameter. Multivariate analysis confirmed that tumor type and grade are independent predictors of disease free-survival and progression free-survival. Tumor grading resulted the first parameter emerging in the decision tree analyses with CHAID growing process to stratify patients according to the risk of recurrence/progression. Conclusions: Our data confirmed the validity of Trouillas’ score, being tumor type and grade independent predictors of disease evolution. Therefore, we recommend to always consider both features, together with tumor histological subtype, in the clinical setting to early identify patients at higher risk of an aggressive behaviour

3rd National Conference of Neuro-Oncology (NCNO 2013) with International Participation: 16th - 20th April 2013

ABSTRACT

Characterization of alar ligament on 3.0T MRI: a cross-sectional study in IIUM Medical Centre, Kuantan

INTRODUCTION: The main purpose of the study is to compare the normal anatomy of alar ligament on MRI between male and female. The specific objectives are to assess the prevalence of alar ligament visualized on MRI, to describe its characteristics in term of its course, shape and signal homogeneity and to find differences in alar ligament signal intensity between male and female. This study also aims to determine the association between the heights of respondents with alar ligament signal intensity and dimensions. MATERIALS & METHODS: 50 healthy volunteers were studied on 3.0T MR scanner Siemens Magnetom Spectra using 2-mm proton density, T2 and fat-suppression sequences. Alar ligament is depicted in 3 planes and the visualization and variability of the ligament courses, shapes and signal intensity characteristics were determined. The alar ligament dimensions were also measured. RESULTS: Alar ligament was best depicted in coronal plane, followed by sagittal and axial planes. The orientations were laterally ascending in most of the subjects (60%), predominantly oval in shaped (54%) and 67% showed inhomogenous signal. No significant difference of alar ligament signal intensity between male and female respondents. No significant association was found between the heights of the respondents with alar ligament signal intensity and dimensions. CONCLUSION: Employing a 3.0T MR scanner, the alar ligament is best portrayed on coronal plane, followed by sagittal and axial planes. However, tremendous variability of alar ligament as depicted in our data shows that caution needs to be exercised when evaluating alar ligament, especially during circumstances of injury

Primary Cardiac Tumors in The Veneto Region of Italy: epidemiology and surgical pathology study in a 12-years interval

Background: Primary cardiac tumors represent a rare entity in cardiac surgery but have the potential to cause significant morbidity if not treated in an appropriate and timely manner. The aim of the study was to investigate the incidence, histopathology and survival characteristics of patients who underwent surgical resection in Veneto Region in the time interval 2005-2016. Material and Methods: A Regional Registry of primary cardiac tumors was created from data of 6 Cardiac Surgery Institutions of Veneto Region (Mestre, Treviso, Mirano, Padova, Vicenza and Verona), gathering retrospectively all consecutive patients who underwent surgical resection in time interval 2005- 2016 (12 years). Data included histopathology reports. The tumors have been classifield and incidence estimated. A subgroup of this cohort ( Mestre, Mirano, Treviso) was evaluated in term of clinical outcomes, follow-up and surgical success, defined as disease-free survival. Results: The study population included 279 patients, average age of 59.8±16.8 years (<1 year to 83 years), female gender in 55.6% (155 women). The incidence of primary cardiac tumors in Veneto Region was constant every years (0.47%) and the distribution per age showing a peak of incidence in people 60–70 years of age (n=75, 26.88%). 254 patients (91%) were affected by benign primary cardiac tumors and 25 (9%) patients by malignant cardiac tumors. Among the benign cardiac tumours group, the majority (70.08%) were myxomas, followed by papillary fibroelastomas (18.90%), lipomas (3.15%), hemangioma (2.76%), rhabdomyomas (0.79%), leiomyoma (0.79%) and fibroma (0.39%). In the malignant group the most prevalent histotype was angiosarcoma (n=8, 32%), followed by lymphoma (n=6, 24%), leiomyosarcoma (n=3, 12%) and undifferentiated sarcoma (n=6, 24%). Cardiac myxoma is the most frequent primary cardiac tumor in our surgical series and his location was mostly in the left atrium (n=162, 91%), followed by the right atrium (n=16, 9%). The location of the second most frequent primary cardiac tumor (papillary fibroelastoma) was the valvular endocardium in 41 patients: aortic valve (n=23, 47.9%), mitral valve (n=13, 27.1%), tricuspid valve (n=6, 12.5%), and pulmonary valve (n=1, 2.1); and the mural endocardium in 7 patients (left ventricular cavity and right atrial cavity). Subgroup of general population was analyzed by processing clinical, surgical and follow-up data. Seventy-nine consecutive patients, 41 female (51.9%) and 38 male (48.1%), were referred for surgical resection of a cardiac mass at three Cardiac Surgery Institutions of the Veneto Region (Mestre, Treviso, Mirano). The median age was 63.3±15.2 years. All tumors were detected by transthoracic and transesophageal echocardiography. The incidence of benign neoplasms was much higher than malignant masses; of the benign tumors, 77.2% (n=61 patients) were myxomas. Of the malignant tumors, synovial sarcoma was the most common cardiac tumor (n=2 patients, 2.5%). The clinical pre-operative presentation was: dyspnea with NYHA Class II-III in 36.7% patients, chest pain in 29.1% and embolic complications in 8.8% of which 6.7% cerebral ischemic events. The location of the tumors was: 54.7% in the left atrium, 8.9% in the right atrium, 5.1% in the ventricles, 10.1% on the valves. Eleven patients underwent a mini-invasive surgical approach. Early (30 day) mortality was 1.2% (n=1), due to septic shock and multiorgan failure. Late mortality was 10.1% (n=8). One malignant tumor (angiosarcoma) and one benign tumor (myxoma) recurred during follow-up requiring re-intervention. Conclusions: Epidemiological data of primary cardiac tumours are still based on post-mortem studies. The incidence and prevalence of cardiac neoplasms, in general, have shown little change over time. Surgical pathology started with the advent of cardiac imaging and open heart surgery when cardiac neoplasms were diagnosed during life. The purpose of Veneto Registry is to discuss the actual prevalence and pathology of primary cardiac tumours. Histology with immunohistochemistry of any cardiac mass is mandatory for diagnosis, therapy and prognosis. The surgical results suggest that complete surgical resection of primary benign cardiac tumors is associated with very-good long-term survival and recurrence is rare. Immediate surgical treatment was indicated because of the high risk of embolization or of sudden cardiac death

Case series of breast fillers and how things may go wrong: radiology point of view

INTRODUCTION: Breast augmentation is a procedure opted by women to overcome sagging breast due to breastfeeding or aging as well as small breast size. Recent years have shown the emergence of a variety of injectable materials on market as breast fillers. These injectable breast fillers have swiftly gained popularity among women, considering the minimal invasiveness of the procedure, nullifying the need for terrifying surgery. Little do they know that the procedure may pose detrimental complications, while visualization of breast parenchyma infiltrated by these fillers is also deemed substandard; posing diagnostic challenges. We present a case series of three patients with prior history of hyaluronic acid and collagen breast injections. REPORT: The first patient is a 37-year-old lady who presented to casualty with worsening shortness of breath, non-productive cough, central chest pain; associated with fever and chills for 2-weeks duration. The second patient is a 34-year-old lady who complained of cough, fever and haemoptysis; associated with shortness of breath for 1-week duration. CT in these cases revealed non thrombotic wedge-shaped peripheral air-space densities. The third patient is a 37‐year‐old female with right breast pain, swelling and redness for 2- weeks duration. Previous collagen breast injection performed 1 year ago had impeded sonographic visualization of the breast parenchyma. MRI breasts showed multiple non- enhancing round and oval shaped lesions exhibiting fat intensity. CONCLUSION: Radiologists should be familiar with the potential risks and hazards as well as limitations of imaging posed by breast fillers such that MRI is required as problem-solving tool

Volume 28, issue 2

The mission of CJS is to contribute to the effective continuing medical education of Canadian surgical specialists, using innovative techniques when feasible, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research. Visit the journal website at http://canjsurg.ca/ for more.https://ir.lib.uwo.ca/cjs/1202/thumbnail.jp

Track 2: Catheter interventions from fetus to adult

Catheter interventions from fetus to adult