Challenging Issues in Hepatic Adenoma

Hepatic adenoma is known as a benign lesion encountered mainly in female patients and classically linked to the administration of oral contraceptives. In the last decade, the risk factors for its occurrence have changed and so did the sex ratio. The histopathological classification of hepatic adenomas was found to be related with certain genetic mutations that determine the risk for malignancy. The diagnosis of hepatic tumor is correlated with clinical and imaging data in an effort not only to rule out other tumors but also to distinguish the subtype of adenoma, which is very important for the management of the patient. The ultimate diagnosis is established by pathologists by routine histopathological and specific immunohistochemical staining. There are two major issues that pathologists need to recognize: the presence of β-catenin gene mutation and/or malignant degeneration. The best imaging examination is considered to be MRI. However, along with MRI, ultrasound and computer tomography have proved themselves to be effective not only in evaluating the number, size, localization, and complications of hepatic adenomas, but also in identifying their subtype. A detailed presentation of characteristics of all groups of hepatic adenoma is provided. The means of management of hepatic adenomas are documented and decisional algorithm is explained, based on certain criteria

3D APPLICATIONS IN DISASTER MITIGATION AND MANAGEMENT: CORE RESULTS OF DITAC PROJECT

According to statistical data, natural disasters as well as the number of people affected by them are occurring with increasing frequency compared to the past. This situation is also seen in Europe Union; So, Strengthening the EU capacity to respond to Disasters is very important. This paper represents the baseline results of the FP-7 founded DITAC project, which aims to develop a holistic and highly structured curriculum for responders and strategic crisis managers. Up-to-date geospatial information is required in order to create an effective disaster response plan. Common sources for geospatial information such as Google Earth, GIS databases, and aerial surveys are frequently outdated, or insufficient. This limits the effectiveness of disaster planning. Disaster Management has become an issue of growing importance. Planning for and managing large scale emergencies is complex. The number of both victims and relief workers is large and the time pressure is extreme. Emergency response and triage systems with 2D user interfaces are currently under development and evaluation. Disasters present a number of spatially related problems and an overwhelming quantity of information. 3D user interfaces are well suited for intuitively solving basic emergency response tasks. Such tasks include commanding rescue agents and prioritizing the disaster victims according to the severity of their medical condition. Further, 3D UIs hold significant potential for improving the coordination of rescuers as well as their awareness of relief workers from other organizations. This paper describes the outline of a module in a Disaster Management Course related to 3D Applications in Disaster Mitigation and Management. By doing this, the paper describes the gaps in existing systems and solutions. Satellite imageries and digital elevation data of Turkey are investigated for detecting sites prone to natural hazards. Digital image processing methods used to enhance satellite data and to produce morphometric maps in order to contribute to the detection of causal factors related to landslides, local site conditions influencing and/or experiencing earthquake damage intensity or those of tsunami and storm surge hazard sites at the coasts

Parametric exploration of the liver by magnetic resonance methods

MRI, as a completely noninvasive technique, can provide quantitative assessment of perfusion, diffusion, viscoelasticity and metabolism, yielding diverse information about liver function. Furthermore, pathological accumulations of iron and lipids can be quantified. Perfusion MRI with various contrast agents is commonly used for the detection and characterization of focal liver disease and the quantification of blood flow parameters. An extended new application is the evaluation of the therapeutic effect of antiangiogenic drugs on liver tumours. Novel, but already widespread, is a histologically validated relaxometry method using five gradient echo sequences for quantifying liver iron content elevation, a measure of inflammation, liver disease and cancer. Because of the high perfusion fraction in the liver, the apparent diffusion coefficients strongly depend on the gradient factors used in diffusion-weighted MRI. While complicating analysis, this offers the opportunity to study perfusion without contrast injection. Another novel method, MR elastography, has already been established as the only technique able to stage fibrosis or diagnose mild disease. Liver fat content is accurately determined with multivoxel MR spectroscopy (MRS) or by faster MRI methods that are, despite their widespread use, prone to systematic error. Focal liver disease characterisation will be of great benefit once multivoxel methods with fat suppression are implemented in proton MRS, in particular on high-field MR systems providing gains in signal-to-noise ratio and spectral resolution

Juvenile Nasopharyngeal Angiofibroma

Introduction: Nasopharyngeal Angiofibroma (NAF), occurring mostly in young men, is histological a benign tumor with aggressive clinical behavior that includes repeated epistaxis and intractable nasal obstruction.Methods: This paper reviews our experience regarding clinical features and the treatment of NAF in E.N.T. Department-Timisoara. 37 patients with diagnosis of NAF from 1984-2009 were included, and their clinical presentations, imaging studies (C.T. and M.R.I.), treatments and outcomes were retrospectively analyzed. The duration of symptoms in the current study was 8-9 months. The current treatment modality was in all cases surgery. The patients underwent combined transpalatal or retropalatal and lateral rhinotomy approach.Results: In present series there were 4 recurrences due to failure in complete removing of the tumor. They were all reoperated by lateral rhinotomy approach and they are now free of disease. The follow up period was at least 12 month for all patients, even in cases of recurrences.Conclusions: Contemporary radiographic methods (C.T., M.R.I.) improve the evaluation of the patients, and provide essential information for the surgeon regarding the approach to use. Complete surgical excision may be impossible and may carry significant morbidity and potential mortality