Surgical treatment of the perihilar cholangiocarcinoma with portal vein invasion

Background. Perichilar cholangiocarcinoma is a rare type of malignant neoplasm and is 3-7 cases per 100,000 population. Surgical method is the only radical method of treatment, allowing to improve long-term survival results. One of the important and characteristic features of perihilar cholangiocarcinoma is tumor invasion to the area of the portal vein bifurcation, which occurs in 30–45% of cases. Portal vein invasion is the one of the main causes of perihilar cholangiocarcinoma irresectability. However, innovative surgical technologies allow resection of the liver with resection and reconstruction of the portal vein with acceptable mortality. The aim. The aim of our study was to asses results of surgical treatment of perihilar cholangiocarcinoma with (Group 1) and without (Group 2) portal vein invasion. Materials and methods. From 2003 to January 2023 in the Department of Surgery and Liver Transplantation of the Ukrainian National Institute of Surgery and Transplantation, 208 patients with perihilar cholangiocarcinoma underwent major extended liver resections. We compared 93 (46%) patients who received extended liver resection with portal vein resection (Group 1) with 115 (54%) patients who underwent liver resections without vascular reconstructions (Group 2). The average Ca 19–9 in the group 1 was 288 (8 – 1000) U/ml, in the group 2 –262 (10 – 612) U/ml. The level of total bilirubin in patients of the group 1 was 312 (43 – 621) mcmol/l, in the group 2 – 267 (10 – 612) mcmol/l. In view of this, in the preoperative period, 190 (91,3%) patients underwent decompression of the bile ducts, using percutaneous transhepatic cholangiostomy (PTBD) or retrograde endobiliary stenting. For patients with small remnant liver volume less than 40 %, in 80(38,5%) cases we did preoperative PVE of a resected part of the liver. In 9 cases we made simultaneous PVE and PTBD. When choosing the volume of surgical intervention, we proceeded from the tumor type of Bismuth-Corlette classification, invasion into the portal vessels and the depth of the liver lesion. The portal vein reconstruction was in all cases performed in an “end-to-end”. In all cases we made extended lymphadenectomy. Results. All complications were classified according to the Dindo-Clavien classification. Postoperative mortality in the main group was 11.5%. The overall 1, 3, 5-year survival in the group 1 was 96%, 68,3%, 57,4%, respectively. 1, 3, 5-year survival rate in the comparison group 2 was 98,4%, 76,7%, 47,3%, respectively. Conclusions. Aggressive tactics of surgical treatment of perihilar cholangiocarcinoma provides maximum radicality, allows to increase resectability in case of tumor invasion of the portal vein with acceptable mortality and long-term survival

Imaging findings after meniscal repair with degradable polyurethane scaffold: preliminary results.

Purpose / Introduction: To date, there are no satisfactory solutions to the meniscal originated knee pain post meniscal tear repair. In this study a newly developed polyurethane material that has the intended properties of reducing pain and inducing tissue growth in a damaged meniscus is tested. Materials and Methods: All patients will be imaged using conventional and dynamic MR imaging techniques at 1 week and 3, 12 and 24 months after surgery. The influx of gadolinium contrast in a tissue during the first three minutes after injection gives a measure of the vascularisation, capillary permeability, perfusion and composition of the interstitial fluid. It can be measured using dynamic MRI and is represented as a Time Intensity Curve (TIC). This curve permits an evaluation of the healing process after surgery. Discussion / Conclusion: Thus far 11 patients have received meniscal implants. Eight medial and three lateral menisci were operated. All implants covered the posterior horn with 3 reaching halfway into the meniscal body and one extending into the anterior horn. The average length of the scaffold meniscus measured on MR imaging was 45mm. In the first week after surgery, the capsule and suture area display fast and intense enhancement typical for post-operative inflammation and the formation of early scar-tissue. There is no enhancement in the base or the tip of the scaffold meniscus. After three months the speed and intensity of enhancement in the capsule and suture area between the remnants of the native meniscus and the scaffold have decreased indicating maturation of scar-tissue. However, the base of the scaffold meniscus now shows enhancement. This can only be explained by proliferation of blood vessels from the capsule and theresidual meniscus wall into the scaffold meniscus. The tip of the matrix shows limited enhancement in some patients after three months. On anatomical MR images, the signal intensity (SI) of the implanted scaffold is close to that of water on both T1- and T2-weighted spin echo and turbo spin echo sequences in the first week. After three months the SI decreases but is still clearly higher than that of the native meniscus. The implants in the posterior horn all had a normal position and no loosening of the sutures or tears of the scaffold were found. After three months, one of the patients had slight expulsion of body of the scaffold meniscus but this is a common finding in transplanted menisci

Three-dimensional reconstruction of intracoronary ultrasound images. Rationale, approaches, problems, and directions

Although intracoronary ultrasonography allows detailed tomographic imaging of the arterial wall, it fails to provide data on the structural architecture and longitudinal extent of arterial disease. This information is essential for decision making during therapeutic interventions. Three-dimensional reconstruction techniques offer visualization of the complex longitudinal architecture of atherosclerotic plaques in composite display. Progress in computer hardware and software technology have shortened the reconstruction process and reduced operator interaction considerably, generating three-dimensional images with delineation of mural anatomy and pathology. The indications for intravascular ultrasonography will grow as the technique offers the uni

Surgical intervention is not required for all patients with subclavian vein thrombosis

AbstractPurpose: The role of thoracic outlet decompression in the treatment of primary axillary-subclavian vein thrombosis remains controversial. The timing and indications for surgery are not well defined, and thoracic outlet procedures may be associated with infrequent, but significant, morbidity. We examined the outcomes of patients treated with or without surgery after the results of initial thrombolytic therapy and a short period of outpatient anticoagulation. Methods: Patients suspected of having a primary deep venous thrombosis underwent an urgent color-flow venous duplex ultrasound scan, followed by a venogram and catheter-directed thrombolysis. They were then converted from heparin to outpatient warfarin. Patients who remained asymptomatic received anticoagulants for 3 months. Patients who, at 4 weeks, had persistent symptoms of venous hypertension and positional obstruction of the subclavian vein, venous collaterals, or both demonstrated by means of venogram underwent thoracic outlet decompression and postoperative anticoagulation for 1 month. Results: Twenty-two patients were treated between June 1996 and June 1999. Of the 18 patients who received catheter-directed thrombolysis, complete patency was achieved in eight patients (44%), and partial patency was achieved in the remaining 10 patients (56%). Nine of 22 patients (41%) did not require surgery, and the remaining 13 patients underwent thoracic outlet decompression through a supraclavicular approach with scalenectomy, first-rib resection, and venolysis. Recurrent thrombosis developed in only one patient during the immediate period of anticoagulation. Eleven of 13 patients (85%) treated with surgery and eight of nine patients (89%) treated without surgery sustained durable relief of their symptoms and a return to their baseline level of physical activity. All patients who underwent surgery maintained their venous patency on follow-up duplex scanning imaging. Conclusion: Not all patients with primary axillary-subclavian vein thrombosis require surgical intervention. A period of observation while patients are receiving oral anticoagulation for at least 1 month allows the selection of patients who will do well with nonoperative therapy. Patients with persistent symptoms and venous obstruction should be offered thoracic outlet decompression. Chronic anticoagulation is not required in these patients. (J Vasc Surg 2000;32:57-67.

Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES-AAST guidelines

Duodeno-pancreatic and extrahepatic biliary tree injuries are rare in both adult and pediatric trauma patients, and due to their anatomical location, associated injuries are very common. Mortality is primarily related to associated injuries, but morbidity remains high even in isolated injuries. Optimal management of duodeno-bilio-pancreatic injuries is dictated primarily by hemodynamic stability, clinical presentation, and grade of injury. Endoscopic and percutaneous interventions have increased the ability to non-operatively manage these injuries. Late diagnosis and treatment are both associated to increased morbidity and mortality. Sequelae of late presentations of pancreatic injury and complications of severe pancreatic trauma are also increasingly addressed endoscopically and with interventional radiology procedures. However, for moderate and severe extrahepatic biliary and severe duodeno-pancreatic injuries, immediate operative intervention is preferred as associated injuries are frequent and commonly present with hemodynamic instability or peritonitis. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) duodenal, pancreatic, and extrahepatic biliary tree trauma management guidelines

Aetiology and Imaging Findings in Traumatic Spine Injury among Patients Attending Muhimbili Orthopedics Institute in Dar es Salaam

Background: The main objective of the study was to determine etiology and imaging features of traumatic spine injury in spine injured patients attending Muhimbili orthopedics institute Methods: The study was a hospital based cross-sectional and consecutively included 87 with traumatic Spine Injury. Data was collected through a structured questionnaire. Statistical package for social science (SPSS 20) was used for data analysis. Results: Eight seven (87) patients with traumatic spine injury were studied. The age range was 4 to 81 years, with a mean age of 33 years. Males were more affected than females. Young individuals aged 16-30 years were the most affected. The commonest cause of spine trauma was motor traffic crashes. The commonest vertebral spine injury seen was compression wedge fracture (35.6%), followed by dislocation (18.4%). The most frequent spine level involved was lumbar spine (37.9%). Paraplegia (33.3%) and quadriplegia (10.3%) were the common clinical presentations. Fifty six percent of patients had associated injuries Conclusion: Traumatic spine injury is common at our settings. Young individuals below 30 years of age are most affected and the most common cause is motor traffic accident (MTA). The use of Computed Tomography (CT) in this study helped to identify several types of injuries especially injury to vertebral bodies and their effect unto neuro structures. MRI helped to identify patients with spinal cord injury which was not evident on CT.Key words: Spine trauma, vertebral fracture, Computed Tomograph

Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES-AAST guidelines

Duodeno-pancreatic and extrahepatic biliary tree injuries are rare in both adult and pediatric trauma patients, and due to their anatomical location, associated injuries are very common. Mortality is primarily related to associated injuries, but morbidity remains high even in isolated injuries. Optimal management of duodeno-bilio-pancreatic injuries is dictated primarily by hemodynamic stability, clinical presentation, and grade of injury. Endoscopic and percutaneous interventions have increased the ability to non-operatively manage these injuries. Late diagnosis and treatment are both associated to increased morbidity and mortality. Sequelae of late presentations of pancreatic injury and complications of severe pancreatic trauma are also increasingly addressed endoscopically and with interventional radiology procedures. However, for moderate and severe extrahepatic biliary and severe duodeno-pancreatic injuries, immediate operative intervention is preferred as associated injuries are frequent and commonly present with hemodynamic instability or peritonitis. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) duodenal, pancreatic, and extrahepatic biliary tree trauma management guidelines

Métodos de reconstrucción en dominio temporal para tomografía por transmisión de ultrasonidos

Tesis inédita de la Universidad Complutense de Madrid, Facultad de Ciencias Físicas, Departamento de Física Atómica, Molecular y Nuclear, leída el 06-06-2017Breast cancer (BC) is the leading cause of cancer-related death for women in Europe, and the second one after lung cancer in the US [World Cancer Report, 2008]. Early detection is very important for the survival rate of BC, because the smaller the local extension of the neoplasia, the better the output of the surgical treatments employed. Besides, early detection increases the possibility of preserving the breast and decreases the probability of needing more invasive treatments [Secretaría de Salud, 2007, Alteri et al., 2011]. Mammography is currently the standard procedure employed for breast screening programs around the world. Nevertheless, its efficiency has been questioned lately because: (i) it generates many abnormal findings not related to cancer, (ii) it requires irradiating the patient and (iii) it has low specificity with dense breasts [Santen and Mansel, 2005]. Consequently, complementary techniques to mammography are being proposed to improve the detection and characterization of BC. Among these techniques, is the Ultrasound Computed Tomography (USCT), in reflection mode (which provides qualitative maps with the concentration of scatterers in the tissue), and transmission mode (which provides quantitative maps of the sound speed (SS) and the acoustic attenuation (AA) of the tissues). The images provided by the transmission modality have been proposed for BC detection as they can improve the detectability of malignancies in the breast [Mast, 2000, Duric et al., 2009]...El cáncer de mama (CM) es el cáncer más mortal entre las mujeres europeas, y el segundo más común en Estados Unidos [World Cancer Report, 2008]. La detección temprana es un factor que condiciona en gran medida la tasa de supervivencia a esta enfermedad, ya que a menor tamaño de la neoplasia detectada, mejores resultados pueden esperarse para los tratamientos quirúrgicos que se realicen. Además, la detección temprana aumenta la posibilidad de conservar la mama después de la cirugía y disminuye la necesidad de emplear otros tratamientos más invasivos[Secretaría de Salud, 2007, Alteri et al., 2011]. La mamografía es actualmente el procedimiento estándar que se emplea para el cribado del CM. Sin embargo, en los últimas años su eficiencia está siendo muy cuestionada por varios factores: (i) alta tasa de falsos positivos, (ii) requiere la irradiación del paciente y (iii) baja especificidad en mamas densas 2. Debido a lo anterior, para mejorar la detección y caracterización del CM se han propuesto varias técnicas complementarias. Entre ellas está la tomografía ultrasónica (TU), que es una técnica en desarrollo que presenta dos modalidades principales: la reflexión (proporciona mapas cualitativos de la concentración de dispersores en el tejido) y la transmisión (proporciona mapas cuantitativos de la velocidad y atenuación del sonido en el tejido). Los mapas del modo transmisión han sido propuestos como una eficiente alternativa, libre de radiación, para la detección del CM, ya que proporcionan alto contraste y especificidad [Mast, 2000, Duric et al., 2009]...Depto. de Estructura de la Materia, Física Térmica y ElectrónicaFac. de Ciencias FísicasTRUEunpu