Adjacent Organs Research Articles

Computed tomography of suppurative and neoplastic diseases involving the canine omenta and omental bursa.

The greater and lesser omenta are fused peritoneal folds that largely delimit the omental bursa (lesser peritoneal cavity). The omental bursa is a potential space within the abdominal cavity that communicates with the greater peritoneal cavity via the omental (epiploic) foramen: it is subdivided into the omental vestibule, caudal omental recess, and splenic recess. Aims of this retrospective case series study were to describe the frequencies of CT findings of dogs with confirmed inflammatory or neoplastic disease of the omenta, omental bursa, or both. The sample included seven adult, medium-to-large breed dogs. All had fluid in the greater peritoneal cavity and 5/7 (71%) dogs also had fluid in the omental bursa. Primary suppurative inflammatory disease was present in three dogs, each dog had a large abscess with central gas in either the omental vestibule (two dogs) or caudal omental recess (one dog). Both abscesses in the omental vestibule arose from the papillary process of the caudate liver lobe and were surgically removed without complication. Neoplasia was present in four dogs and either arose from omentum (hemangiosarcoma, carcinoma) or infiltrated the omentum from an adjacent organ (splenic leiomyosarcoma, gastric adenocarcinoma). Neoplasms created mass-like tumors, infiltrative tumors, or both and had variable distribution (focal, multifocal, or locally extensive). All dogs with neoplasia were euthanized. CT signs of inflammatory and neoplastic disease overlapped, but the presence of gas might prioritize abscessation. CT signs helped decide feasibility of surgery based on extent of local invasion, especially involvement of structures passing through the porta hepatis.

Intraoperative Ultrasound in Colorectal Liver Metastases

Intraoperative ultrasound (IOUS) is a diagnostic technique that allows obtaining additional information about the number and localization of colorectal cancer (CRC) metastases in the liver (especially with their intraparenchymal location), determining their relationship with the arteries and veins of the liver, navigating for puncture biopsy and / or performing minimally invasive treatment of lesions, and adjusting the amount of resection intervention on the liver during surgery. When performing minimally invasive medical procedures, IOUS application helps to avoid injuries to blood vessels, bile ducts and adjacent organs, and also allows evaluating the effectiveness of treatment and identifying potential complications. An important component of IOUS is the support of surgical procedures with a staged assessment of the liver hemodynamics, providing an immediate correction of the surgical situation. Thus, IOUS is a safe, inexpensive and highly informative diagnostic option, which should be a mandatory diagnostic step in the surgical treatment of CRC liver metastases.Based on literature data and personal experience, the authors present indications, technical aspects and features of application of various IOUS options and modalities in the surgical treatment of CRC liver metastases.

Clinical and Pathological Features of Primary Orbital Liposarcoma in Chinese Patients

Purpose Liposarcomas are rare in the orbit. We analyzed a series of primary liposarcomas to determine the features unique to the orbit. Methods Records from 10 Chinese patients treated for primary orbital liposarcoma at Beijing Tongren Hospital, Capital Medical University, between September 2009 and September 2020 were reviewed. Results This cohort included four men and six women with age of onset ranging from 18 to 80 years. The pathology was myxoid liposarcoma in five patients, dedifferentiated liposarcoma in two patients, well-differentiated liposarcoma and pleomorphic liposarcoma in one patient each, and dedifferentiated liposarcoma and well-differentiated liposarcoma co-existing in one case. Magnetic resonance imaging (MRI) revealed a well-defined, irregular, or lobulated mass in the orbit, which contained components that were suppressible in the fat-suppression sequence, as well as components that were enhanced by gadolinium enhancement. Nine patients relapsed after surgery, with a mean recurrence of 2.44, and one patient was lost to follow-up. The interval between treatment and first recurrence ranged from 4 months to 16 years; 55.6% of patients with orbital liposarcoma relapsed within one year. Three patients underwent local excision alone, four patients underwent excision combined with radiotherapy, and three patients underwent exenteration. Half of the patients were misdiagnosed in the pathologic diagnosis after their first or multiple surgeries. No distant metastasis, death from tumors, or invasion of adjacent organs was observed after 21–150 months of follow-up. Conclusion Orbital liposarcoma is easily misdiagnosed and prone to recurrence; however, MRI findings may help identify orbital liposarcoma prior to surgery. The optimal treatment choice remains to be discussed.

Dynamic contrast-enhanced CT and clinical features of sarcomatoid hepatocellular carcinoma

PurposeTo investigate the dynamic contrast-enhanced computed tomography (CECT) features and clinical characteristics of sarcomatoid hepatocellular carcinoma (S-HCC).MethodsWe retrospectively reviewed the CECT data and clinical findings of 13 patients (11 male and 2 female, with an average age of 58.6 ± 11.2 years) with pathologically proven S-HCC, including 9 patients with surgical resection and 4 patients with biopsy examination. All patients underwent CECT scans. Two radiologists reviewed and evaluated general features, CECT features and extratumoral features of each lesions based on a consensus.ResultsAmong the thirteen tumors, a mean size of 66.7 mm was observed, ranging in diameter from 30 to 146 mm. Seven of thirteen patients had hepatitis B virus (HBV) infection and an elevation of alpha-fetoprotein (AFP) level. Most of cases located in the right lobe of liver (84.6%, 11/13). Nine of thirteen tumors showed lobulated or wavy contours and infiltrative morphology, while eight tumors presented with unclear margin. The tumor textures were mainly heterogeneous for ischemia or necrosis, with solid components dominantly in all cases. Eight of thirteen tumors exhibited “slow-in and and slow-out” dynamic enhancement pattern in CECT, with a enhancement peak in the portal venous phase. Portal vein or hepatic thrombus, adjacent organs invasion and lymph node metastasis were observed in two patients, respectively. Four of thirteen lesions occurred intrahepatic metastasis and hepatic surface retraction respectively.ConclusionS-HCC gengerally seen in elderly male with HBV infection and elevated AFP level. The CT manifestations including: large diameter, frequently hepatic right lobe involvement, lobular or wavy contours, ill-defined margins, infiltrative morphology, obvious heterogeneity and dynamic enhancement pattern of “slow-in and and slow-out” , contributed to the diagnosis of S-HCC. These tumors usually occurred hepatic surface retraction and intrahepatic metastasis.

Case Report on Misplaced and Malpositioned Fragmented IUCD

IUCD is one of the preferred forms of contraception that is reliable and cost effective. Nonetheless, IUCDs are not risk free and several complications have been reported, including unintended expulsion, misplacement and uterine perforation. Uterine perforation with an IUCD is uncommon, but it may have serious consequences including intra-abdominal bleeding, bowel or bladder perforation, fistula formation, especially when IUCD migrates to pelvic peritoneal spaces invading the adjacent organs. It is rare for IUCD to break during removal and fragments lodged in uterine cavity. We present a case of retained fragment of IUCD which was diagnosed after 3 years of its so called ‘removal’. The case report emphasizes the need to train doctors not only to insert IUCD but also to educate the women about potential risks and benefits and self-examination of IUCD thread for its correct placement.

A rare cause of acute abdomen in childhood: coexistence of mesenteric cystic lymphangioma and acute appendicitis

Abdominal cystic lymphangiomas are benign congenital anomalies of the mesenteric and retroperitoneal lymphatics, which are not common in the literature. Diagnosis is usually made by physical examination, ultrasonography, and computed tomography. If a significant portion of adjacent organs is not to be sacrificed, complete surgical removal of the mass is the therapeutic option for symptomatic abdominal cystic lymphangiomas. In this study, a patient with mesenteric cystic lymphangioma who underwent surgical treatment is presented. A result of the radiological examinations performed on a 17-year-old female patient who applied for intermittent abdominal pain and a mass in the abdomen as a result of the well-defined, septated mesenteric cystic lymphangioma and acute appendicitis were detected. The patient underwent a diagnostic laparoscopic procedure and then an open surgical treatment, and excision and resection anastomosis were performed on the mass surrounding the jejunum approximately 100 cm distal to the ligament of Treitz. The patient did not have any postoperative problems and was discharged with recovery on the 5th day after surgery. Mesenteric cystic lymphangiomas should be kept in mind in patients with intermittent abdominal pain and abdominal mass, and surgical treatment should be applied in selected cases, as it may rarely cause serious complications.

A CFD-FFT approach to hemoacoustics that enables degree of stenosis prediction from stethoscopic signals

In this paper, we identify a new (acoustic) frequency-stenosis relation whose frequencies lie within the recommended auscultation threshold of stethoscopy (< 120 Hz). We show that this relation can be used to extend the application of phonoangiography (quantifying the degree of stenosis from bruits) to widely accessible stethoscopes. The relation is successfully identified from an analysis restricted to the acoustic signature of the von Karman vortex street, which we automatically single out by means of a metric we propose that is based on an area-weighted average of the Q-criterion for the post-stenotic region. Specifically, we perform CFD simulations on internal flow geometries that represent stenotic blood vessels of different severities. We then extract their emitted acoustic signals using the Ffowcs Williams-Hawkings equation, which we subtract from a clean signal (stenosis free) at the same heart rate. Next, we transform this differential signal to the frequency domain and carefully classify its acoustic signatures per six (stenosis-)invariant flow phases of a cardiac cycle that are newly identified in this paper. We then automatically restrict our acoustic analysis to the sounds emitted by the von Karman vortex street (phase 4) by means of our Q-criterion-based metric. Our analysis of its acoustic signature reveals a strong linear relationship between the degree of stenosis and its dominant frequency, which differs considerably from the break frequency and the heart rate (known dominant frequencies in the literature). Applying our new relation to available stethoscopic data, we find that its predictions are consistent with clinical assessment. Our finding of this linear correlation is also unlike prevalent scaling laws in the literature, which feature a small exponent (i.e., low stenosis percentage sensitivity over much of the clinical range). They hence can only distinguish mild, moderate, and severe cases. Conversely, our linear law can identify variations in the degree of stenosis sensitively and accurately for the full clinical range, thus significantly improving the utility of the relevant scaling laws... Future research will investigate incorporating the vibroacoustic role of adjacent organs to expand the clinical applicability of our findings. Extending our approach to more complex 3D stenotic morphologies and including the vibroacoustic role of surrounding organs will be explored in future research to advance the clinical reach of our findings.

Survival analysis and prognostic factors of retroperitoneal liposarcoma curative surgery in a single centre. Analysis of adjacent organ invasion between imaging and definitive histopathology

IntroductionRetroperitoneal liposarcoma (RPL) is a rare primary mesenchymal tumour that develops in retroperitoneal adipose tissue. Unlike the majority of published series, this homogeneous cohort focuses on RPL. The main purpose of this study is to evaluate the overall and recurrence-free survival of RPLs who underwent excision surgery and the prognostic factors involved. Patients and methodsA total of 82 patients from a single centre, who underwent curative surgery for histologically confirmed retroperitoneal liposarcoma between 2008 and 2020, were analysed in the study. Compartmental surgical excision was advised as per the guidelines. The primary endpoints were 5 years of overall survival and recurrence-free survival. Predictable tumour invasion of adjacent organs, based on a pre-operative CT scan, was also investigated to test the correlation between pre-operative imaging and pathological data. ResultsMedian follow-up was 61.6 months. Five year overall survival was 71.9% [95% CI: 59.8; 80.9] and 5 year recurrence-free survival was 49% [95% CI: 36.4; 60.5]. Following multivariable analysis, the factors influencing overall survival were tumour rupture and onset of severe complications (Dindo-Clavien grade ≥3). Factors influencing recurrence-free survival were neoadjuvant radiotherapy and tumour rupture.A significant correlation (p < 0.05) was found between predicted invasion based on a CT scan of the colon, spleen, adrenal gland, posterior abdominal wall and diaphragm, and pathological invasion. ConclusionsCurative compartmental surgery remains the gold standard treatment for RPL. This study, highlights the fact that the quality of the surgical excision is a crucial factor in patient prognosis.

Myoepithelial Carcinoma of Sinonasal Cavity: Peculiar Diagnosis, Conventional Treatment

Myoepithelial carcinoma is a morphologically diverse tumor which either arises de novo or from the malignant transformation of its benign counterpart i.e. myoepithelioma. These are relatively lesser known entities and are rarely found in head and neck region. Although rare, their first presentation is usually a painless growing mass as seen in our case presentation as well and are infamous for lymph node recurrence and distant metastasis. Due to their clinical presentation and varied morphology these become tedious to diagnose and pose difficulty for a surgeon when presented at a later date due to their effect on the adjacent vital structures. We report a case of myoepithelial carcinoma in head and neck region arising from the nasal cavity, it’s mass effect on the adjacent vital organs and the diagnosis and treatment plan to render the patient free of this tumor, preservation of the vision and keeping the recurrence of the tumor at bay.

Laparoscopic correction of combined forms of genital prolapse

BACKGROUND: The significance of pelvic organ prolapse is determined by the absence of a downward trend in its frequency and severity and by the steadily high number of recurrences in every third woman who underwent surgery. According to most authors, surgical correction is the primary treatment for genital prolapse. Therefore, the search for an effective and safe surgical treatment of this pathology is important. Currently, various minimally invasive surgical interventions have been performed via laparoscopic access, which reduces the risk of tissue or adjacent organ damage, possible intraoperative bleeding, and potential complications.&#x0D; AIM: This study aimed to assess the efficiency and safety of laparoscopic techniques for the correction of genital prolapse.&#x0D; MATERIALS AND METHODS: The study included 12 patients with pelvic organ prolapse quantification system grades IIIV who underwent surgical correction using a combined laparoscopic approach. The inclusion criterion was the presence of prolapse, including recurrent forms. At the outpatient stage, the patients medical history was collected, and complaints, and degree of pelvic organ prolapse were assessed. Genital prolapse was diagnosed based on medical history, clinical data, and additional methods of examination.&#x0D; RESULTS: With this surgical intervention technique, intraoperative bleeding was avoided, the number of possible postoperative complications was reduced, and disease recurrence was prevented. The criteria for assessing the surgical intervention included improvement of the pelvic floor anatomy, elimination of symptoms, patients satisfaction with treatment results and quality of life, and reduced risk of recurrence of complications. Mesh-associated complications were excluded by avoiding contact of the synthetic implanted material with the vaginal mucosa.&#x0D; CONCLUSIONS: Through laparoscopic access, the length of hospital stay was reduced, and compared with abdominal access, a better cosmetic effect was achieved. A comprehensive system considering the assessment of the anatomical outcome, functional status of the pelvic floor, and patients quality of life may become the most objective tool to evaluate the success of surgical treatment of genital prolapse.

Preoperative neoadjuvant chemoradiotherapy provides borderline resectable thoracic esophageal cancer with equivalent treatment results as clinically T3 thoracic esophageal cancer.

Because the optimal treatment strategy for borderline resectable (cT3br) thoracic esophageal cancer patients remains unclear, it is of great interest whether preoperative neoadjuvant therapy for cT3br could achieve results comparable to those seen with resectable T3 cancer (cT3r). We speculated that preoperative neoadjuvant chemoradiotherapy (NACRT) would be particularly effective in cT3br thoracic esophageal cancer patients and compared to cT3br and cT3r. Of 186 cT3 thoracic esophageal cancer patients treated with intended NACRT, 162 received radical esophagectomy. More than 97% were squamous cell carcinomas. Patients were partitioned into two groups according to whether invasion of adjacent organs was suspected (cT3br and cT3r). Treatment outcomes and survival were analyzed. Sixty-eight patients (36.6%) were classified as cT3br and 118 (63.4%) as cT3r. The cT3br group had significantly more tumors in the upper and middle mediastinum (p < 0.0001) and more cases with cM1 (lymph node) (p = 0.0104) than the cT3r group. In addition, the cT3br patients receiving esophagectomy exhibited a significantly lower pathological complete response rate than the cT3r patients (p = 0.0374). However, the R0 resection rate did not differ between the cT3br and cT3r patients (p = 0.0978), and the two groups treated with intended NACRT had similar 5-year overall (OS) and disease-specific survival (DSS) (p = 0.3831 and p = 0.9020). In addition, the incidence and patterns of recurrence did not differ between the cT3br and cT3r patients receiving esophagectomy (p = 0.8109 and p = 0.3128). Preoperative neoadjuvant chemoradiotherapy appears to be a promising treatment for patients with borderline resectable thoracic esophageal squamous cell carcinoma.

Using the concept of preperitoneal membrane anatomy in total extraperitoneal prosthesis: a preliminary report.

Total extraperitoneal prosthesis (TEP) is one of the most commonly used laparoscopic inguinal hernia repair procedures. This work aims to report the application of membrane anatomy to TEP and its value in intraoperative space expansion. The clinical data of 105 patients, from January 2018 to May 2020, with inguinal hernia who were treated with TEP (58 patients in the General Department of the Second Hospital of Sanming City, Fujian Province, and 47 patients in the General Department of the Zhongshan Hospital Affiliated to Xiamen University) were retrospectively analyzed. All surgeries were successfully completed under the guidance of the concept of preperitoneal membrane anatomy. The operation time was 27.5 ± 9.0 min, blood loss was 5.2 ± 0.8 ml, and the peritoneum was damaged in six cases. The postoperative hospital stay was 1.5 ± 0.6 days, and five cases of postoperative seroma occurred, all self-absorbed. During the follow-up period of 7-59 months, there was no case of chronic pain and recurrence. The membrane anatomy at the correct level is the premise of a bloodless operation to expand the space while protecting adjacent tissues and organs to avoid complications.

Low incidence of occult colorectal carcinoma in a cohort of 150 consecutive patients with diverticular strictures

BackgroundThe symptoms of stricturing diverticulitis can overlap with those of colorectal cancer. Additionally, the stricture itself may mask a “hidden” colorectal cancer. We aimed to describe the demographics, operative details and outcomes, including occult colorectal cancer, in a cohort of consecutive resections for presumed diverticular strictures. MethodsIn this single-center, retrospective cohort study, all patients undergoing resection for a presumed diverticular stricture between January 2010 and December 2015 were included. Preoperative imaging and colonoscopies were individually reviewed. Only patients with radiographically, endoscopically and/or intraoperatively benign-appearing strictures were included. ResultsOne hundred fifty patients (72.7% female, mean age = 70.4 ± 11.8 years, 62.7% elective) were included. Only 34 (22.7%) had a complete preoperative colonoscopy. In 95 (63.6% of cohort) patients, the stricture was non-traversable colonoscopically. Overall, 47 (31.3%) patients did not have complete preoperative imaging or a colonoscopy.In total, 53.3% were open procedures and 62% had non-diverted primary anastomosis. Eleven (14.7%) underwent resection of adjacent organs (5 appendixes/5 right colons/7 fallopian tubes ± ovaries/3 small bowel resections/2 partial cystectomies/1 spleen). The median length of stay was 7 (5, 12.5) days. Only 2 cancers (1.3% of patients) involving the stricture (1 invasive moderately differentiated sigmoid adenocarcinoma/1 lymphoma) were found. Three additional cancers were found in organs involved in the inflammatory process (20% of concomitantly resected organs, 1 ovarian carcinoma/1 leukemia in a lymph node/1 appendiceal tumor). ConclusionDespite approximately one-third of the cohort not having undergone successful preoperative colonoscopy or imaging, the rate of neoplasia involving diverticular strictures was only 1.3%. A relatively high cancer rate was found in concomitantly resected organs involved in the stricturing process.

DASS Good: Explainable Data Mining of Spatial Cohort Data.

Developing applicable clinical machine learning models is a difficult task when the data includes spatial information, for example, radiation dose distributions across adjacent organs at risk. We describe the co-design of a modeling system, DASS, to support the hybrid human-machine development and validation of predictive models for estimating long-term toxicities related to radiotherapy doses in head and neck cancer patients. Developed in collaboration with domain experts in oncology and data mining, DASS incorporates human-in-the-loop visual steering, spatial data, and explainable AI to augment domain knowledge with automatic data mining. We demonstrate DASS with the development of two practical clinical stratification models and report feedback from domain experts. Finally, we describe the design lessons learned from this collaborative experience.

The pre-thyroidectomy surgeon's checklist. Recommendations of the AFC&gt;E (Association francophone de chirurgie endocrinienne), with the SFE (Société française d’endocrinologie) and the SFMN (Société française de médecine nucléaire)

During the patient interview, signs of compression or invasion are sought out: dyspnea, dysphagia, dysphonia. The circumstances of discovery of the thyroid pathology are indicated. The surgeon must be closely acquainted with the EU-TIRADS and Bethesda classifications so as to be able to evaluate and explain to the patient the risk of malignancy. He must also be able to interpret a cervical ultrasound in view of proposing a procedure adapted to the pathology. Cervicothoracic CT-scan (or MRI) must be prescribed in the event of suspected plunging nodule or clinical/echography signs: non-palpable lower pole of the thyroid behind the clavicle, dyspnea, dysphagia, collateral circulation. The surgeon goes on to investigate possible relationships with adjacent organs, to evaluate extension toward the aortic arch and the positions (anterior, posterior or mixed) of the goiter, the objective being to determine the most adapted approach: classical cervicotomy, manubriotomy or sternotomy. Even in the event of a tumoral pathology, PET-FDG is not one of the imagery exams carried out systematically. Only in case of TSH<0.5μU/mL should thyroid scintigraphy be proposed. Prior to any thyroid surgery, serum TSH levels, calcitoninemia and calcemia must be measured.

A pilot curriculum to transition from 2D to 3D image-guided brachytherapy: A preliminary needs assessment.

11039 Background: Gynecologic cancers are one of the leading causes of death globally with a disproportionate burden of disease found in low to middle income countries (LMIC). Brachytherapy is often a necessary component in treatment management as it can deliver a high dose of radiation to the tumor while employing a steep dose fall off that spares the adjacent organs at risk. With 3D image guided brachytherapy (3D-IGBT), treatment planning utilizes volumetric images with the target volume and organs at risk contoured, reducing toxicity and improving outcomes when compared to 2D planar imaging. Despite this advantage, only a limited number of LMIC centers perform 3D-IGBT. Transitioning to 3D-IGBT requires considerable planning, resources, and training. The development of a multidisciplinary, computer-based training program to facilitate the transition to 3D-IGBT was identified as a priority of multiple Radiation Oncology departments in Nigeria. The aim of this preliminary needs assessment was to identify the necessary resources and anticipated barriers to development of a pilot training curriculum for the transition to 3D-IGBT. Methods: An anonymous, 16-question online survey was distributed to clinicians, physicists, radiation therapists, and staff within a Radiation Oncology department of a teaching hospital in Lagos, Nigeria. Results: In January 2023, 53 respondents completed the survey. Of the respondents, 36.5% were female and 63.5% were male. The average age was 37.5 (SD = 7.8). Clinical experience ranged from &lt; 5 years (52.6%), 6-10 years (9.4%), to &gt; 10 years (30.2%). Respondents included radiation therapists (28.8%), clinicians (27%), nurses (23.1%), and physicists (15.4%). Multiple barriers to implementation of 3D-IGBT were identified including lack of training (79.2%) or experience (58.5%), lack of financial investment (50.9%), and anticipated repair/replacement of equipment (41.5%). A majority of respondents identified staff training/education (66%) as critical to delivering 3D-IGBT. When asked about the curriculum components needed, most respondents believed that it should include plan review (96.2%), contour review (94.3%), and peer review of clinical cases (92.5%). Conclusions: Various areas of potential need were identified through this preliminary needs assessment, most notably, staff training. These findings suggest that there is an unmet need to further develop and implement a structured didactic and skills-based curriculum to transition from 2D to 3D-IGBT at these institutions. Identified focus areas including contour, peer, and plan review will help guide the refinement of this curriculum. These findings are an important first step in delivery of safe and efficacious 3D-IGBT in an LMIC.

Surgery for locally advanced gastric cancer in the era of neoadjuvant therapies: something new?

Locally advanced gastric cancer (LAGC) represents a therapeutic challenge, particularly as it often involves adjacent organs. The necessity of neoadjuvant treatments for LAGC patients is still controversial. The aim of this study was to analyze the factors affecting prognosis and survival in patients with LAGC with particular regard to the effect of neoadjuvant therapies. Between January 2005 and December 2018, the medical records of 113 patients with LAGC who underwent curative resection were retrospectively reviewed. Patient characteristics, related complications, long-term survival, and prognostic factors were analyzed at uni- and multivariate analyses. Postoperative mortality and morbidity rates of patients undergoing neo-adjuvant therapies were 2.3% and 43.2%, respectively. Whereas in patients undergoing upfront surgery were 4.6% and 26.1%, respectively. R0 resection was achieved 79.5% and in 73.9% of patients undergoing neoadjuvant therapy and upfront surgery, respectively (P<0.001). Multivariate analysis revealed that neoadjuvant therapy, completeness of resection (R0), number of lymph nodes retrieved, N status and the adoption of hyperthermic intraperitoneal chemotherapy were independent prognostic factors associated with longer survival. Five-year overall survival for NAC group and upfront surgery group was 46% and 32%, respectively (P=0.04). Five-year disease-free survival for NAC group and upfront surgery group was 38% and 25%, respectively (P=0.02). Patients with LAGC undergoing surgery plus neoadjuvant therapy had a better OS and DFS with respect to patients treated with surgery alone.

Clinical Outcomes of Intensity-modulated Carbon-ion Radiotherapy for Bone and Soft Tissue Tumors.

Carbon-ion radiotherapy (CIRT) for bone and soft tissue tumors (BSTs) has been reported to have favorable clinical outcomes. Intensity-modulated CIRT (IMCT) techniques have been developed to further reduce dose delivery to adjacent organs compared to conventional CIRT. We retrospectively analyzed the clinical results of IMCT for BSTs and investigated treatment efficacy and toxicity. This study included 9 consecutive BSTs patients who underwent IMCT at the Kanagawa Cancer Center from January 2016 to April 2021. IMCT was administered at a dose of 60.8-70.4 Gy (relative biological effect) in 16 fractions. The time to event was calculated from the initiation of IMCT. Toxicities were evaluated using the Common Terminology Criteria for Adverse Events version 5.0. The median age was 49 (range=16-71) years. The median observation period was 57.6 (range=7.0-77.8) months. There were 7 and 2 cases for IMCT because of proximity to the spinal cord and intestinal tract, respectively. There was one death during the observation period, which occurred 7.0 months after the initiation of treatment. Clinical recurrence occurred in 3 patients at 1.3, 17.8, and 22.4 months after the initiation of treatment, respectively. Acute toxicity of Grade 2 or higher was seen in 2 patients with Grade 2 pharyngeal mucositis. Late toxicities of Grade 2 or higher included 1 case each of Grade 2 neuralgia and peripheral neuropathy, as well as 1 case of Grade 3 fracture. IMCT for BSTs showed good local therapeutic efficacy and tolerable toxicity in patients with bone and soft tissue tumors.

Logistics of safe and stress-free epicardial access in the electrophysiology lab: creative percutaneous subxiphoid pericardiostomy

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Professor Nanthakumar is a recipient of the mid-career investigator award from the Heart &amp; Stroke Foundation of Ontario. Introduction Dry epicardial access (EA) into the virtual pericardial space carries a 6-25% risk of collateral damage to important adjacent structures including the right ventricle and the coronary and internal thoracic arteries.1 This renders conventional dry EA a potentially daunting and stressful undertaking. Separation of the parietal and visceral pericardial layers by CO2 insufflation has been described and may mitigate some risk , however even in experienced tertiary centres, injury to superior epigastric arteries, liver, stomach, and transverse colon, has been reported. Furthermore, insufflating the pericardial space may cause unwanted haemodynamic changes . There is thus the need for an approach that separates the pericardial layers and avoids injury to right ventricle and coronary arteries while also avoiding abdominal and thoracic structures by direct visualisation. Purpose We describe the logistics of a creative technique that combines percutaneous EA with a minimally-invasive subxiphoid pericardiostomy that can be done with a surgeon in the electrophysiology (EP) lab for the initial 20 minutes of the procedure. Methods We performed the procedure with a surgeon in 4 patients in a single tertiary centre. The procedure was done in the EP lab under general anaesthesia with standard surgical asepsis and IV cefazolin administered pre-operatively. The subxiphoid area is infiltrated with local anaesthesia. Following a limited 5cm midline incision, the linea alba is dissected exposing the preperitoneal fat but the peritoneal space is not entered. The lower sternum is retracted anteriorly to expose the diaphragm and cardiophrenic fat pad. The diaphragm is progressively sutured to the skin to bring the pericardium into view. A 0-silk suture is then used to tent the pericardium at which point an incision is made in the pericardium to create the window. The steerable sheath and pericardial drain are inserted in the standard over-the-wire percutaneous technique through separate adjacent punctures with direct pathway visualisation through the window. Following this, the surgical incision is closed, allowing the surgeon to leave, and mapping to ensue. Results The time from skin incision to pericardial drain insertion was 18±5 minutes. None of our patients had acute or delayed bleeding or adjacent organ injury peri-procedurally. The pericardial drain was removed within 12-24 hours. One patient had mild pericarditis that resolved after a short course of non-steroidal anti-inflammatory agents. The subxiphoid wound healed well in all patients. Conclusions Percutaneous EA with easy entry into the pericardial space under direct visualisation and realtime monitoring via a pericardiostomy can be readily attained with surgical collaboration. We propose this as an alternative approach to EA, particularly in situations in which the percutaneous access will be challenging (e.g. obesity, or in presence of adhesions).

Patología tumoral esofágica: claves diagnósticas mediante neumo-tomografía computarizada (Neumo-TC)

ObjectiveTo review and describe the most characteristic radiological findings of the most frequent esophageal tumor lesions, with emphasis on the esophago-gastric distention technique pneumo-computed tomography performed in our institution. To know the main advantage of this distension technique. ConclusionMalignant tumor lesions (predominantly squamous cell carcinoma in the mid esophagus and adenocarcinoma in the distal esophagus) present as asymmetric wall thickening, mucosal irregularity, or mass extending into adjacent organs with lymph node involvement. Benign tumors (mainly leiomyoma being the most frequent and others such as lipoma) present as endoluminal growth, with defined borders and homogeneous attenuation. Post-contrast enhancement is scarce or moderate. The technique of computed tomography pneumotomography technique achieves an additional distension of the esophageal lumen in all cases. It allows delimiting the superior and inferior borders of the lesions, helping the surgeon to define the therapeutic strategy.