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Journal of Medical Radiation Sciences Mar 2018Radiotherapy outcomes are influenced by treatment delivery geometric accuracy and organ-at-risk dose. The location of abdominal structures such as the liver, kidneys and...
INTRODUCTION
Radiotherapy outcomes are influenced by treatment delivery geometric accuracy and organ-at-risk dose. The location of abdominal structures such as the liver, kidneys and tumour volumes can be strongly influenced by respiratory motion. This increases geometric uncertainty and dose to organs-at-risk. One common method of minimising respiratory motion is abdominal compression (AC).
METHODS
Fifteen patients being treated for radiotherapy to upper abdominal tumours were analysed. Each patient underwent 2 four-dimensional computerised tomography (4D-CT) scans, one with and one without AC with a pneumatic compression belt. Liver and kidney positions were measured on the 4DCT scans at the peak inspiratory and expiratory respiratory phases. The patient received radiation therapy treatment planned on the CT data set with the technique (compression or no compression) that provided the least respiratory motion.
RESULTS
There was no statistically significant motion difference over the sample population with AC for the kidneys or liver. Of the 14 evaluable patients, 4, 6 and 6 saw reduction in superior-inferior motion for left kidney, right kidney and liver respectively. The remainder either had negligible (<2 mm) or increase in motion with AC. For anterior-posterior motion, 2, 2 and 1 saw a reduction for left-kidney, right-kidney and liver respectively.
CONCLUSION
AC through the use of a pneumatic compression belt was found to result in inconsistent reduction in kidney and liver respiratory motion. It is recommended that the effect of AC is evaluated on a per-patient basis.
Topics: Abdomen; Abdominal Neoplasms; Compression Bandages; Four-Dimensional Computed Tomography; Humans; Radiotherapy; Respiration; Retrospective Studies
PubMed: 29205937
DOI: 10.1002/jmrs.254 -
Cancer Reports (Hoboken, N.J.) Nov 2022Large and rapidly growing abdominal tumors may result in fatal outcomes in newborns. In some cases, a rapidly worsening clinical condition requires surgical...
BACKGROUND
Large and rapidly growing abdominal tumors may result in fatal outcomes in newborns. In some cases, a rapidly worsening clinical condition requires surgical decision-making despite the absence of a precise histological diagnosis. In these situations, there is neither a guide nor consensus.
CASE
We highlight our experience with five patients with large abdominal tumors and assess the available literature for the best possible management of a rare condition.
CONCLUSION
In these cases, laparostomy should be considered as a life-saving procedure. If the liver is involved and coagulopathy is present, prognosis is often compromised.
Topics: Humans; Infant, Newborn; Abdominal Neoplasms; Prognosis; Decision Making
PubMed: 36195561
DOI: 10.1002/cnr2.1726 -
Journal of Cancer Research and... 2019The aim of the study is to evaluate the effectiveness of ultrasound (US)-guided interventional treatments in local tumor control (LTC) for thoracoabdominal wall seeding...
OBJECTIVE
The aim of the study is to evaluate the effectiveness of ultrasound (US)-guided interventional treatments in local tumor control (LTC) for thoracoabdominal wall seeding tumor (TAWST) from hepatocellular carcinoma (HCC), and explore the survival outcomes of the patients underwent surgical resection (SR) and microwave ablation (MWA) for intrahepatic tumor.
MATERIALS AND METHODS
A total of 40 patients with 47 TAWST from HCC were recruited from April 2007 to May 2018. LTC was evaluated by contrast-enchanced image. Long-time survival outcomes were compared. Overall survival (OS), disease-free survival (DFS), and local seeding progress-free survival (LSPFS) were analyzed.
RESULTS
One-year LTC rate was 65.2% in all patients; 72%, 0%, 50%, and 0% in the patients who underwent MWA, high-intensity focused US, iodine-125 (I) brachytherapy and MWA combined with I brachytherapy, respectively. The 3-year OS, DFS rates and LSPFS rates were 51.8% and 28.6%, 12.0% and 23.8%, and 10.0% and 10.0% after MWA and SR, respectively. Univariate analysis results showed that age (P = 0.049), Karnofsky performance scale (KPS) (P = 0.002), and chemoradiation (P = 0.032); and multivariate analysis results showed that age (P = 0.045) and KPS (P = 0.010) might be predictors for LCT. While univariate analysis results showed that KPS (P = 0.032), intrahepatic tumor size (P = 0.006), chemoradiation (P = 0.003), preoperative alpha-fetoprotein level (P = 0.007), metastasis (P = 0.049), and albumin-bilirubin grade (P = 0.002), and multivariate analysis results showed that comorbidities (P = 0.004), KPS (P = 0.007), and metastasis (P = 0.009) might be predictors for OS. The pain degree of patients was improved obviously after treatments.
CONCLUSIONS
US-guided interventional treatments were an effective option in LTC for TAWST from HCC, and MWA could achieve comparable long-time survival outcomes with SR for HCC patients with TAWST.
Topics: Abdominal Neoplasms; Ablation Techniques; Adult; Aged; Carcinoma, Hepatocellular; Female; Humans; Image Processing, Computer-Assisted; Iodine Radioisotopes; Liver Neoplasms; Male; Microwaves; Middle Aged; Neoplasm Grading; Neoplasm Seeding; Neoplasm Staging; Surgery, Computer-Assisted; Survival Analysis; Tomography, X-Ray Computed; Treatment Outcome; Tumor Burden; Ultrasonography
PubMed: 30964119
DOI: 10.4103/jcrt.JCRT_784_18 -
PloS One 2017Preclinical CT-guided radiotherapy platforms are increasingly used but the CT images are characterized by poor soft tissue contrast. The aim of this study was to develop...
INTRODUCTION
Preclinical CT-guided radiotherapy platforms are increasingly used but the CT images are characterized by poor soft tissue contrast. The aim of this study was to develop a robust and accurate method of MRI-guided radiotherapy (MR-IGRT) delivery to abdominal targets in the mouse.
METHODS
A multimodality cradle was developed for providing subject immobilisation and its performance was evaluated. Whilst CT was still used for dose calculations, target identification was based on MRI. Each step of the radiotherapy planning procedure was validated initially in vitro using BANG gel dosimeters. Subsequently, MR-IGRT of normal adrenal glands with a size-matched collimated beam was performed. Additionally, the SK-N-SH neuroblastoma xenograft model and the transgenic KPC model of pancreatic ductal adenocarcinoma were used to demonstrate the applicability of our methods for the accurate delivery of radiation to CT-invisible abdominal tumours.
RESULTS
The BANG gel phantoms demonstrated a targeting efficiency error of 0.56 ± 0.18 mm. The in vivo stability tests of body motion during MR-IGRT and the associated cradle transfer showed that the residual body movements are within this MR-IGRT targeting error. Accurate MR-IGRT of the normal adrenal glands with a size-matched collimated beam was confirmed by γH2AX staining. Regression in tumour volume was observed almost immediately post MR-IGRT in the neuroblastoma model, further demonstrating accuracy of x-ray delivery. Finally, MR-IGRT in the KPC model facilitated precise contouring and comparison of different treatment plans and radiotherapy dose distributions not only to the intra-abdominal tumour but also to the organs at risk.
CONCLUSION
This is, to our knowledge, the first study to demonstrate preclinical MR-IGRT in intra-abdominal organs. The proposed MR-IGRT method presents a state-of-the-art solution to enabling robust, accurate and efficient targeting of extracranial organs in the mouse and can operate with a sufficiently high throughput to allow fractionated treatments to be given.
Topics: Abdomen; Abdominal Neoplasms; Adrenal Glands; Animals; Cell Line, Tumor; Humans; Magnetic Resonance Imaging; Mice, Inbred BALB C; Mice, Inbred CBA; Mice, Inbred NOD; Mice, Nude; Mice, Transgenic; Motion; Multimodal Imaging; Neoplasm Transplantation; Phantoms, Imaging; Radiometry; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Radiotherapy, Image-Guided; Tomography, X-Ray Computed; Tumor Burden
PubMed: 28453537
DOI: 10.1371/journal.pone.0176693 -
World Journal of Gastroenterology May 2007To analyze the local and systemic complications of high intensity focused ultrasound (HIFU) for patients with recurrent and metastatic abdominal tumors. (Clinical Trial)
Clinical Trial
AIM
To analyze the local and systemic complications of high intensity focused ultrasound (HIFU) for patients with recurrent and metastatic abdominal tumors.
METHODS
From Aug 2001 to Aug 2004, 17 patients with recurrent and metastatic abdominal tumors were enrolled in this study. Real-time sonography was taken, and vital signs, liver and kidney function, skin burns, local reactions, and systemic effects were observed and recorded before, during, and after HIFU. CT and MRI were also taken before and after HIFU.
RESULTS
All 17 patients had skin burns and pain in the treatment region; the next common complication was neurapraxia of the stomach and intestines to variable degrees. The other local and systemic complications were relatively rare. Severe complications were present in two patients; one developed a superior mesenteric artery infarction resulting in necrosis of the entire small intestines, and the other one suffered from a perforation in terminal ileum due to HIFU treatment.
CONCLUSION
Although HIFU is a one of noninvasive treatments for the recurrent and metastatic abdominal tumors, there are still some common and severe complications which need serious consideration.
Topics: Abdominal Neoplasms; Adult; Aged; Female; Gastrointestinal Tract; Humans; Hypesthesia; Intestinal Perforation; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Pain; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonic Therapy
PubMed: 17569147
DOI: 10.3748/wjg.v13.i19.2747 -
Medicine Apr 2018Extra-adrenal myelolipoma in the presacral area often raises a concern for liposarcoma because they have similar radiologic features.
RATIONALE
Extra-adrenal myelolipoma in the presacral area often raises a concern for liposarcoma because they have similar radiologic features.
PATIENT CONCERNS
A 70-year-old woman with multiple abdominal surgeries in the past presented with persistent lower abdominal pain and anemia. A presacral mass, found on a pelvic magnetic resonance image (MRI), was suspicious of liposarcoma, as it is the most common fat containing mass in the presacral area. It is often difficult to make a diagnosis of myelolipoma just based on the radiological studies, which necessitates a histopathologic examination of the resected mass for a definitive diagnosis.
DIAGNOSES
Myelolipoma is an encapsulated, benign tumor containing mature adipocytes and hematologic cells. Most of the patients with myelolipoma remain asymptomatic but continued growth of tumor without local invasion can lead to compression of nearby structures, causing persistent pain.
INTERVENTIONS
Asymptomatic patients do not require intervention but surgical resection is indicated for persistent pain or hemorrhage inside the tumor. Our patient had 2 indications for surgery - persistent pain as well as a provisional diagnosis of liposarcoma. After the surgical resection, pelvic pain was resolved, and a diagnosis of myelolipoma was made based on histopathologic examination.
OUTCOMES
Patient was reassured that it was myelolipoma, a benign tumor, not requiring subsequent surveillance for recurrence.
LESSONS
Despite advancement in imaging techniques, and knowledge of the radiological features of myelolipoma, it still remains as a challenge for clinicians to make the distinction between liposarcoma and myelolipoma only based on diagnostic radiology. Although myelolipoma is a benign tumor, if patient suffers from persistent pain due to local mass effect, surgical resection is required.
Topics: Abdominal Neoplasms; Aged; Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging; Myelolipoma; Neoplasm Staging; Pelvic Pain; Prognosis; Sacrum
PubMed: 29642172
DOI: 10.1097/MD.0000000000010337 -
Annals of the Royal College of Surgeons... Nov 2021Management of malignant small bowel obstruction (mSBO) is challenging. The decision to perform an operation evaluates the perceived chance of success against a patient's...
INTRODUCTION
Management of malignant small bowel obstruction (mSBO) is challenging. The decision to perform an operation evaluates the perceived chance of success against a patient's fitness for operation. The aim of this study was to characterise the mSBO patient population in a tertiary UK centre and assess the patient's treatment pathway including use and effects of palliative surgery, total parenteral nutrition (TPN), Gastrografin and dexamethasone as well as preoperative stratification.
METHODS
Patients were included if they had mSBO confirmed on computed tomography imaging due to a primary or metastatic neoplasm. Data were collected on pathway and management, and Cox proportional hazard methods were utilised to observe effects on survival.
RESULTS
Ninety-four patients were included, with 104 inpatient episodes. Mean age was 67.4 (SD 13.7), with 57 (60.6%) females. Most (89.4%) had only one admission for mSBO. Eighty-four (89.4%) patients died over the ten-year period, 18 (17.3%) within 30 days of admission. Fifty patients (53.1%) underwent operative management: 70% bypass, 24% stoma formation and 6% open-close laparotomies. Log rank testing of survival probability analysis was significant (= 0.00018), with 50% survival probability at 107.32 days for operative management and 47.87 days for non-operative.
DISCUSSION AND CONCLUSION
Operative management forms part of the treatment pathway for a significant proportion of patients with mSBO, offering a survival benefit, though quality of survival is not known. Case selection is good, with few open-close laparotomies. Trials of non-operative interventions such as Gastrografin and dexamethasone are not utilised fully.
Topics: Abdominal Neoplasms; Aged; Female; Humans; Intestinal Obstruction; Male; Parenteral Nutrition, Total; Proportional Hazards Models; Retrospective Studies; Survival Analysis
PubMed: 34436951
DOI: 10.1308/rcsann.2021.0044 -
Journal of Medical Case Reports Nov 2018Uterine fibroids are the commonest benign gynecological tumors. Laparoscopic myomectomy is becoming increasingly popular as one of the surgical treatment options for... (Review)
Review
BACKGROUND
Uterine fibroids are the commonest benign gynecological tumors. Laparoscopic myomectomy is becoming increasingly popular as one of the surgical treatment options for symptomatic cases. Large tissues such as leiomyomas or even the uterus need to be morcellated in order to be retrieved from the abdominal cavity. Some of the morcellated fragments or small fibroids may be accidentally left in the abdominal cavity during the retrieval process. These may subsequently become implanted in the abdominal cavity, develop blood supply from the surrounding structures, and grow to form parasitic myomas with varied clinical presentation, depending on the location and size.
CASE PRESENTATION
A 47-year-old African woman presented to our hospital 6 years after laparoscopic myomectomy with a lower abdominal mass. Her work-up revealed an anterior abdominal wall mass consistent with uterine leiomyoma. She was scheduled for excision of the mass, which was subsequently histologically confirmed to be a uterine fibroid.
CONCLUSIONS
Parasitic leiomyomas are a rare late complication of power morcellation following laparoscopic myomectomy or hysterectomy. Most patients present with an abdominal/pelvic mass and may need surgical excision to relieve the symptoms. Care should be taken during power morcellation to prevent excessive fragmentation of the tissues, some of which may become implanted and persist to form parasitic myomas. Moreover, effort should be made to retrieve all myoma fragments by carefully checking the abdominal cavity. Whenever possible, the morcellation should be done in a containment bag.
Topics: Abdominal Neoplasms; Abdominal Pain; Female; Humans; Hysterectomy; Leiomyoma; Middle Aged; Morcellation; Peritoneal Cavity; Treatment Outcome; Uterine Myomectomy
PubMed: 30428912
DOI: 10.1186/s13256-018-1873-y -
The American Journal of Case Reports Jul 2019BACKGROUND Desmoid tumors are fibrous neoplasms that originate from the musculoaponeurotic structures in the body. Abdominal wall desmoid tumors are rare, but they can...
BACKGROUND Desmoid tumors are fibrous neoplasms that originate from the musculoaponeurotic structures in the body. Abdominal wall desmoid tumors are rare, but they can be locally aggressive, with high incidence of recurrence. These tumors are more common in young, fertile women. They frequently occur during or after pregnancy. CASE REPORT We present the case of a 63-year-old post-menopausal woman with a desmoid tumor of the anterior abdominal wall. She had no relevant family history. During abdominoplasty, an incidental mass was excised and biopsied, and was identified as a desmoid tumor with free margins. One year later, the patient presented with vague abdominal discomfort and feeling of heaviness. An incision was made through the previous abdominoplasty scar to maintain the aesthetic outcome. A large mass, arising from the abdominal wall and extending intra-abdominally, was excised and was determined to be a recurrent desmoid tumor. CONCLUSIONS Recurrent anterior abdominal wall desmoid tumors in post-menopausal women are rare and locally aggressive, with a high risk of recurrence. During abdominal wall repair in abdominoplasty, desmoid tumor filaments might seed deep intra-abdominally. Therefore, it is necessary to take adequate safe margins before abdominal wall repair. Post-operatively, surgeons should keep a high index of suspicion for tumor recurrence.
Topics: Abdominal Neoplasms; Abdominal Wall; Abdominoplasty; Female; Fibromatosis, Aggressive; Humans; Middle Aged; Neoplasm Recurrence, Local
PubMed: 31270310
DOI: 10.12659/AJCR.916227 -
RoFo : Fortschritte Auf Dem Gebiete Der... Jan 2016A highly striated contrast pattern of the kidneys occasionally appears in abdominal MRI examinations of children following the administration of gadolinium. As this...
PURPOSE
A highly striated contrast pattern of the kidneys occasionally appears in abdominal MRI examinations of children following the administration of gadolinium. As this phenomenon is well known but has not yet been explicitly described in literature, we investigated how frequently and in which clinical context this occurred.
MATERIAL AND METHODS
855 abdominal MRI examinations with contrast media of 362 children between 2006 and 2014 were analysed retrospectively.
RESULTS
A striated renal parenchyma was found in a total of nine children and eleven examinations (1.3 % of examinations) and did only occur at a field strength of 3 Tesla. Of these children, seven had previously had tumors and chemotherapy. In two children there was no evidence of a previously serious condition with medications or a kidney disease. All of them had a normal renal function.
CONCLUSION
A noticeably striated nephrogram in the later phase of an MRI examination following administration of gadolinium may appear as an incidental finding in examinations at 3 Tesla without pathological relevance.
KEY POINTS
• striated nephrograms may appear at a field strength of 3 Tesla. • incidental finding without pathological relevance.
Topics: Abdominal Neoplasms; Adolescent; Child; Child, Preschool; Female; Gadolinium; Humans; Image Enhancement; Incidental Findings; Infant; Kidney; Magnetic Resonance Imaging; Male; Retrospective Studies; Risk Factors
PubMed: 26566269
DOI: 10.1055/s-0041-106539