Superior Abdomen Research Articles

Microwave System: A Novel Treatment for Localized Adiposity Reduction in a Latin American Population.

The microwave body remodeling system is indicated for people who want to improve their physical appearance as it can penetrate deep tissues, causing thermic stress on adipocytes to produce adipolysis while in superficial tissues, it dissolves fibrous tracts and stimulates new collagen. The aim of this study was to assess the localized adiposity reduction in Latin American patients using a microwave system. A total of 35 patients with a mean age of 47.5 (±9.0) years received body remodeling treatment, using the microwave system between the years 2019-2022 in a Bogota, Colombia reference center. Data descriptive analysis was made as well as single-factor repeated measures ANOVA to show pre- and post-treatment difference, and mixed ANOVA for body mass index (BMI) subgroup analysis was performed. In all patients examined, statistical significant differences were found in pre- and post-treatment skinfold test for each body area: superior abdomen (F(1,27) = 63.13; p=0.001), iliac crest (F(1, 23) = 114.33; p < 0.001), posterior waist (F(1, 20) = 27.36; p < 0.001), trochanter (F(1, 17) = 26.94; p < 0.001), among others. According to the study's findings, this microwave system is an innovative and effective technique for body remodeling and cellulite and localized fat reduction.

The fundamental role of the exploration of the upper abdomen in ovarian cancer surgery

Purpose: Several studies have shown the benefit of cytoreductive surgery in advanced disease, that is why the residual tumor has prognostic value. Our primary objective was to determine the frequency of involvement of the upper abdomen, defined as the extension of the disease above the transverse colon (diaphragm, spleen, gallbladder, stomach, hepatic parenchyma, hepatic capsule, minor omentum, hepatic ilium, pancreas). Our secondary objective was to analyze the possibilities of complete cytoreduction in these patients, their complications and results. Materials and methods: We retrospectively include patients undergoing primary and secondary cytoreduction due to ovarian carcinoma between January 2008 and December 2012, in the gynecology department of the German Hospital. Results: One hundred and thirty nine patients with ovarian carcinoma were analyzed. An average age of 60 years (28-90). 91 of them with attempted primary cytoreduction and 48 secondary cytoreduction. In the group of primary cytoreductions we excluded 17 patients that were stages I and II, 20 (22%) of the 74 stages III-IV had upper abdomen involvement, 17 stages III and 3 stages IV. Those stage IV patients were only limited to hepatic intraparenchymal involvement. Of the 48 secondary cytoreductions, 21 (43%) presented upper abdominal involvement. Including both groups we have 30% of upper abdomen compromise. Complete or optimal cytoreduction was achieved in 56% of them. Conclusion: The exploration of the superior abdomen in ovarian cancer surgery is key, and the approach of this patients by a team of properly trained gynecologists is mandatory if we want to obtain better complete cytoreduction rates.

Excision of Stage IV Endometriosis Extending to the Diaphragm Following Removal of Seven Liters of Peritoneal Fluid

<h3>Study Objective</h3> Educate on procedures for endometriosis removal. <h3>Design</h3> Educational surgical video. <h3>Setting</h3> Patient placed in dorsal lithotomy position, with robot docked initially for excision of lesions in superior abdomen, followed by undocking and repositioning of robot for approach of inferior abdominal cavity and pelvis. <h3>Patients or Participants</h3> Single patient selected following referral from outside hospital system. <h3>Interventions</h3> Robotic-assisted excision of endometriosis throughout abdominal cavity, with complete resection of visible lesions. <h3>Measurements and Main Results</h3> Biopsies of pericardium, right diaphragm, falciform ligament, hepatic lesion, rectum, bladder, right and left pelvic sidewall, and right and left upper abdominal wall positive for endometriosis. <h3>Conclusion</h3> Complete excision of endometriosis has been shown to potentially eradicate disease and should be attempted. Atypical endometriosis can be found throughout the abdominal cavity, which requires proficiency in both anatomy and surgical technique outside of the pelvis.

Autologous islanded breast enhancement by reversed abdominoplasty (AIBERA) flap

We present a surgical technique of recuperating tissue from the upper abdominal wall, based on the superior epigastric artery perforators, thereby providing tissue for autologous augmentation of the breasts in combination with reversed abdominoplasty in patients after massive weight loss. A 20-year-old woman was seen in the outpatient clinic with a large residual skin laxity of the superior abdomen following circular abdominoplasty after weight loss of 55 kg. She was dissatisfied with the appearance of her breasts and superior abdomen. Bilaterally, pedicled SEAP flaps were harvested from the epigastric region. In addition, a reversed abdominoplasty was performed. The flaps were secured in a retroglandular pocket superiorly to the anterior chest wall in order to augment the breasts. The islanded pedicled SEAP flap in combination with reversed abdominoplasty is a useful and safe technique for autologous breast augmentation following massive weight loss. In addition, the potential risk of implant-related complications is eliminated as implants are replaced by autologous tissue. Level of evidence: Level V, therapeutic study.

Primitive neuroectodermal tumors: a clinical and radiological analysis of six cases.

Primitive neuroectodermal tumor (PNET) is extremely rare and highly aggressive with poor prognosis. Few studies concerning PNET's the imaging features have been published. Six cases of PNET, all confirmed by pathology and immunohistochemical (IHC) examinations, were treated during January 2012 to December 2016. These cases' clinical course and imaging findings were retrospectively analyzed. Among six PNET cases, one located in left superior abdomen, one case at posterior abdominal wall, one case in right orbit, one case in left frontal temporal lobe, one case in pelvic cavity, and one case located in left supraclavicular fossa. The tumor's density was uniform for small tumor and heterogeneous for large tumors on CT images, while the size of tumors differed during presentation depending on the location of the tumor. Marked enhancement was visualized after injection of contrast media. The demarcation between the lesion and adjacent tissues or organs tended to be unclear. On magnetic resonance imaging (MRI) images, the mass mainly showed heterogeneously long T1 and long T2 signal intensity, mixed high signal intensity on fluid-attenuated inversion recovery (FLAIR) image. In two cases maximum intensity projection image reconstruction demonstrates tortuous blood vessels within the tumor on enhanced CT images. Five cases were treated by surgical resection with two cases received adjuvant radiotherapy and three cases received adjuvant chemotherapy. Six patients were followed up with a mean period of 34.5 months (ranging from 6 to 55 months). Five patients survived and one died. Among the five patients undergoing surgeries, one patient presented pelvic and abdominal recurrence/metastasis 2 months after abdominal PNET resection. One patient had a recurrent lesion in the right orbit involving the right ethmoid sinus 6 months after right orbital PNET resection. One patient's pelvic tumor recurred 7 months after PNET operation, and this patient died after 1 year and 10 months of follow-up. During the follow-up period, the remaining three cases did not show obvious recurrence and/or metastasis. Overall, the imaging appearances of PNET lack characteristics. PNETs generally do not have clear boundary, or partially so, with its adjacent organs or tissues suggesting their invasive nature. Upon further validation, maximum intensity projection image reconstruction demonstrates tortuous blood vessels within the tumor on enhanced CT images may be valuable information for the diagnosis of PNET.

Thoracoabdominal breathing motion pattern and coordination of professional ballet dancers

Ballet training includes exercises of high and moderate intensities, which require breathing control for a good performance. This study describes the thoracoabdominal motion of professional dancers and compares the breathing patterns between professional dancers and non-dancers. Participants of this study were four male and four female (30.33 ± 4.64 years) professional dancers and four male and four female (22.75 ± 1.49 years) non-dancers. The participants executed two breathing manoeuvres while sitting motionless: quiet breathing (QB) and vital capacity (VC). The 3D coordinates of 32 retro-reflective markers positioned on the trunk were used to calculate the volume of the superior thorax, inferior thorax and abdomen. Principal component analysis was applied in the volume variation of each trunk compartment to search for dominant independent variables in a breathing motion pattern. The correlation coefficient was calculated to verify the coordination between the compartments during the breathing manoeuvres. A predominance of the superior thorax or abdomen movement was found in both groups. The professional ballet dancers have an efficient breathing pattern and maintain the same breathing pattern in QB and VC manoeuvres. On the other hand, the non-dancers group showed relevant changes of the breathing pattern to respond to a greater breathing effort, like in VC.

Consensus and controversies of surgical approach selection in the treatment for thoracic esophageal cancers

Esophageal cancer is one of the most prevalent carcinoma with an incidence ranking at the fifth and the mortality at the fourth among all the carcinomas in China. Up to now, surgery-based multi-modality treatment is still the most effective treatment for esophageal carcinoma. The surgical approaches for esophageal cancer include left and right thoracic approaches. Esophagectomy through left thoracotomy is the earliest approach applied for esophageal cancer in China, and now is still used frequently for esophageal cancer in northern China. However, left thoracic approach is insufficient in the lymph node dissection for superior mediastinum and abdomen, especially for the tracheoesophageal groove and para-recurrent laryngeal nerve nodes. On the contrary, right thoracic approach can achieve complete thoracic and abdominal field(two-field) lymph node dissection, especially the tracheoesophageal groove and para-recurrent laryngeal nerve nodes, which may eventually improve the survival of the patients with esophageal cancer. This article summarizes the results of lymph node dissection and prognosis based on published literatures through left thoracic approach versus through right thoracic approach for esophageal cancer, comments on recent controversies and consensus: for resectable thoracic esophageal carcinoma, resection of thoracic esophageal carcinoma with 2-field or 3-field lymph node dissection through right thoracic approach should be recommended as the major treatment mode, but this consensus was made based on retrospective studies, and the evidence is only level III(, therefore, prospective randomized studies with larger sample size are warranted. The selection of surgical approach for the lower thoracic esophageal cancer patients without upper mediastinal lymph node enlargement is also the direction of future clinical trials.

Thoracoabdominal mobility is improved in subjects with tetraplegia after one year of wheelchair rugby training

Summary Objective The purpose of this study was to analyse the effect of one year of wheelchair rugby training on thoracoabdominal mobility and its association with lung volume in adults with tetraplegia. Equipment and methods Participants (10 male adults with chronic spinal cord injury at cervical level) underwent to regular training in wheelchair rugby. At the beginning and after one year of training, lung volume and tridimensional mobility of four-chest wall compartments (superior and inferior thorax, superior and inferior abdomen) were obtained by spirometric testing and kinematic analysis, respectively. Results Seven athletes completed the study. During quiet breathing, significant improvements and linear relationships were observed for the tidal volume (16.9%), superior thorax (61.3%) and inferior thorax mobility (83.7%). During maximal breathing, significant improvements were found for the vital capacity (24.8%) and superior thorax mobility (31.5%). Besides that, there was also a significant linear relationship between the vital capacity volumes and mobility in the superior and inferior thorax and superior abdomen. These findings could support the practice of wheelchair rugby to reduce respiratory dysfunction in tetraplegics.

When the chest is clueless, look downstairs

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Acute deep vein thrombosis (DVT) of the lower limbs in a 32-year-old man with chronic hypoplasia of the inferior vena cava (HIVC) without risk factors

The anomalies of the inferior vena cava (IVC) have an incidence between 0.2 and 1 % in the general population [1]. The normal average diameter of the IVC is 17.5 mm (up to 25 mm maximum) and the spectrum of anatomical abnormalities of the IVC (e.g., absence or interruption of the vessel or variation in diameter) can be responsible for serious hemodynamic effects to the venous circulation of the lower limbs (i.e., venous stasis), and be a risk factor for the development of deep vein thrombosis (DVT). The association between hypoplasia of the IVC (HIVC) and DVT has been previously reported, even though the association of absence of the IVC and DVT is more frequently recorded [2]. Hypoplasia of the inferior vena cava should be taken into account when an unexplained DVT occurs in young patients, as DVT can occur in up to 5 % of young adults with IVC anomalies [3]. A 32-year-old man was referred to our Unit of Internal Medicine because of acute and intense back pain. History was unrevealing for risk factors related to venous disease, but the man had remained immobilised 3–4 days because of the intense pain. After admission, he underwent full (abdominal and pelvic) ultrasound examination, which revealed bilateral proximal (iliac–femoral veins) DVT (Fig. 1a, b; see Fig. 1c for comparison) and severe dilatation of the superficial venous circle of the lower limbs. Laboratory investigations for thrombophilic defects (including factor V Leiden, prothrombin G20210A, mutations A1298C and C8677T, proteins C and S and antithrombin III) were all negative. A computed tomography (CT scan) study of the superior abdomen showed hypoplasia of inferior vena cava (diameter 11 9 5 mm) along with bilateral thrombosis of the iliac and hypogastric veins; the right iliac vein was dilated and the paralumbar veins were hypertrophic; dilatation of the right hypogastric venous circle was present (Fig. 2a; see Fig. 2b for comparison). Treatment with subcutaneous low molecular weight heparin was initiated, and shortly followed by oral anticoagulant therapy (INR range 3.0) with application of stocking bandage compression to the lower limbs. Currently, the man is still under follow-up at our unit: his general condition is good with no further recorded episodes of thrombosis; he is still taking oral anticoagulant therapy. Anomalies of the IVC are a rare finding in clinical practice, but should be suspected when an unexplained DVT presents in a young adult, particularly in the absence of risk factors such as inherited thrombophilia. The main findings in patients with DVT and HICV are summarised in Table 1. Notably, dilatation of the ascending lumbar veins, paravertebral venous plexus, azygous and hemiazygous veins are typical imaging findings of these patients. The hemodynamic data on venous return from the lower part of the body are crucial for differentiating acute and chronic anomalies of the IVC. Although ultrasonography is useful to demonstrate anomalies of the IVC, by revealing the lack of continuity of the IVC segment and the presence of collateral veins in the abdomen or in the retroperitoneal region, the gold standard of imaging is a CT scan (Fig. 2) or magnetic resonance imaging studies, which are more sensitive and specific in showing the anomalies of the IVC, and to explain the & Salvatore Santo Signorelli ssignore@unict.it

Splenosis Mimicking Relapse of a Neuroendocrine Tumor at Gallium-68-DOTATOC PET/CT.

A 48-year-old female patient underwent splenopancreasectomy for a 4-cm pancreatic neuroendocrine tumor (pNET), grade G2, located in the pancreatic tail. One year after surgery, the patient presented an increased serum level of the tumor marker chromogranin A (value: 160 U/l). Therefore, she underwent somatostatin receptor PET/CT using gallium-68-DOTATOC for restaging. This imaging method showed a focal area of increased radiopharmaceutical uptake corresponding to a 2.5-cm nodule located in the left superior abdomen near a clip from the previous surgery, suggesting a possible relapse of pNET (Fig. 1). Based on this PET/CT finding, the patient underwent ultrasonography-guided core biopsy of this nodule. Histology did not reveal findings suggestive of pNET but identified spleen tissue most likely caused by splenosis accidentally seeded at the previous operation. It is likely that the increased serum level of the tumor marker chromogranin A was due to the chronic proton-pump inhibitors use. Fig. 1 A 48-year-old female patient previously treated with splenopancreasectomy for a 4-cm pNET, grade G2, located in the pancreatic tail underwent somatostatin receptor PET/CT for restaging because of an increase in the chromogranin A serum levels (value: ... Somatostatin receptor PET/CT is an accurate imaging method for staging and restaging pNET, presenting high sensitivity and specificity in this setting [1–7]. Nevertheless, possible sources of false-negative and -positive findings with this method should be taken into account [1]. Inflammatory lesions represent the most frequent causes of false-positive findings for pNET at somatostatin receptor imaging because inflammatory cells may overexpress somatostatin receptors on their cell surface [8, 9]. In our case, we showed that splenosis may represent a possible cause of false-positive findings for pNET relapse due to the physiological uptake of somatostatin analogs by the spleen tissue [10, 11].

Prenatal Ultrasound Screening of Congenital Heart Disease in the General Population

Congenital heart diseases (CHDs) carry a high prevalence rate in the general population (0.8%-1%). Most fetal CHDs occur in patients without any risk factors. The prenatal recognition of CHD has major impacts on the pregnancy and its outcome. The aforementioned data justify prenatal ultrasound (US) screening of CHD in the general low-risk population. As demonstrated in the literature, the application of an extended basic US cardiac examination improves the detection of CHD, in particular the conotruncal anomalies. The stepwise method suggested for fetal heart US screening during the mid-second trimester sonogram is based on 4 routine axial views of heart and great vessels: (1) a transverse view of the superior abdomen, (2) a 4-chamber view, (3) a 3-vessel view, and (4) a transverse view of the aortic arch. This protocol can be obtained rapidly because these scans are easy to perform. Despite the fact that the sequential segmental approach universally used in the postnatal diagnosis of CHD is not specifically addressed here, the detected anomalies can be categorized according to these views, and a short differential diagnosis proposed. Abnormal cardiac and/or vascular landmarks shown on these key scans should lead to a referral in the fetal cardiac center for a more precise evaluation, as well as for counseling.

Primary Aldosteronism in a Patient Who Exhibited Heart Failure

Primary aldosteronism (PA) is a common cause of secondary hypertension due to unilateral adrenocortical adenoma (APA) or idiopathic hyperplasia. There is increased awareness of the possible cardiac sequelae of aldosterone excess, including cardiac hypertrophy, fibrosis, and vascular endothelium injury. A 54-year-old woman was referred for rest and nighttime worsening dyspnea and palpitations. One year earlier she was admitted to another hospital with the same symptoms and discharged with a diagnosis of idiopathic dilated cardiomiopathy. At admission, physical examination revealed a body mass index of 21 kg ⁄m and blood pressure (BP) of 210 ⁄105 mm Hg. Chest auscultation revealed mild expiratory wheezes and rales in both lower lobes. Electrocardiography showed signs of left ventricular (LV) overloading and hypertrophy. Laboratory analysis showed severe hypokalemia (1.8 mEq ⁄L; normal range 3.5–5 mEq ⁄L) and metabolic alkalosis (pH 7.51; partial pressure of carbon dioxide 41 mm Hg; partial pressure of oxygen 86 mm Hg; HCO 3 32.6 mmol ⁄L; excess bases 10 mmol ⁄L) (Table I). Chest radiography revealed an enlarged cardiac silhouette, congested pulmonary hilum, and bilateral pleural effusion (Figure 1A). Echocardiography showed an increase in LV end-diastolic diameter (58 mm) and left atrial volume (46 mm) and a signficant decrease in global LV performance (ejection fraction [EF] 30%) (Table II). The 24hour ambulatory BP monitoring (ABPM) revealed severe systo-diastolic hypertension without physiological nocturnal fall (nondipper pattern). Subsequent investigation showed suppressed plasma renin activity (PRA) (0.08 ng ⁄mL ⁄h; normal range 0.2–2.7 ng ⁄mL ⁄h), high plasma aldosterone (PAC 16.17 ng ⁄dL; normal range 7.5–15 ng ⁄dL), and PAC ⁄ PRA ratio (202.17 ng ⁄dL: ng ⁄ml ⁄h; normal value<30 ng ⁄dL: ng ⁄mL ⁄h). Because of suspicion of PA, we performed a captopril test. After 60 minutes of captopril 50 mg, the PAC ⁄PRA ratio was still elevated (529.93 ng ⁄dL: ng ⁄mL ⁄h). Magnetic resonance imaging of the superior abdomen demonstrated a 20-mm nodule in the left adrenal gland (Figure 2). The patient underwent laparoscopy adrenalectomy, and histopathology revealed an APA. Subsequently, her BP was normalized at 140 ⁄90 mm Hg with amlodipine, ramipril, and serum potassium. After 6 months of follow-up, BP was 110 ⁄80 mm Hg, with normal serum potassium. Chest radiography showed resolution of congestive heart pulmonary imaging with a decreased cardiac silhouette (Figure 1B). Repeat echocardiography demonstrated a significant improvement in LV hypertrophy and EF (50%). Recently, the Primary Aldosteronism Prevalence in Italy Study (PAPY) reported a PA prevalence of 11.2% in patients with new-onset hypertension. The potential comorbidity and prevention of excessive cardiovascular events and organ damage led to development of accurate strategies for diagnosis of PA. PA patients display an unfavorable cardiovascular profile, suggesting a role of aldosterone beyond its well-known hypertensive effects. TABLE I. Laboratory Data and Blood Gas Analysis

Splenic autotransplantation in a patient with human immunodeficiency virus infection: a case report

IntroductionSplenectomy is performed mostly because of traumatic events that cause rupture of the spleen. Postsplenectomy, a patient has a higher risk of developing sepsis. Autotransplantation of splenic tissue decreases the risk of opportunistic infection and sepsis, but its role in patients with human immunodeficiency virus is debated because the spleen is a replication site, especially during the asymptomatic phase of this infection. We present a case of a patient with human immunodeficiency virus infection who was admitted to our hospital for a traumatic rupture of the spleen and underwent spleen autotransplantation.Case presentationA 36-year-old Caucasian man was admitted to the shock trauma center of our hospital after a car accident. Anamnesis showed that the patient had been human immunodeficiency virus-positive for 13 years. A computed tomography scan showed abundant fluid collection in his superior and inferior abdomen caused by splenic rupture, with no other associated intra-abdominal lesions. During surgery, the spleen appeared severely damaged. A splenectomy was performed, and 35 g of splenic tissue was autotransplanted in a pouch created in the omentum. No complications occurred after surgery, and our patient was discharged from our hospital nine days after the operation. One year later, computed tomography and scintigraphy showed that the transplanted tissue was functioning well.ConclusionsAutotransplantation of splenic tissue decreases the risk of opportunistic infection and sepsis, and it might also be useful in patients with human immunodeficiency virus. Other studies need to be done to validate this hypothesis.

ColeCIstItIs aGUda asoCIada a Ascaris lumbricoides

An unusual case attended at Ciego’s provincial Hospital “Antonio Luaces”, Cuba, is described. A male patient, 44 years old, complaining of severe pain of colic type, at epigastrium, with irradiation to both flanks and to the back, accompanied with fever and vomits. On physical examination he presented: slight icteric mucosa, fever (38oC), tachycardia (90 bpm), slightly distended abdomen, normal abdominal sounds, and reaction of defence on the superior abdomen whose percussion was painful. Abdominal ultrasonography showed cholecystitis and an image of Ascaris lumbricoides inside the gallbladder. The patient underwent surgery with cholecystectomy when the presence of the parasite was confirmed inside the gallbladder.

Analysis of the rule of lymph node metastasis and evaluation of the consistence of preoperative computed tomographic findings and postoperative pathologic diagnosis for thoracic esophageal carcinoma

Objective To analyze the rule of lymph node metastasis, compare the preoperative computed tomographic findings with pathological diagnosis in thoracic esophageal carcinoma and to evaluate the clinical value. Methods Six hundred and eighteen patients with esophageal carcinoma after radical resection were enrolled. All patients did not receive any preoperative radiotherapy or chemotherapy, having complete information of postoperative pathological reports. CT scanning were applied to all patients in our hospital. The CT image were transmitted to the three-dimensional treatment planning system via the network at digital format and be reconstructed. In which system the sensitivity, specificity and accuracy rates in diagnosis of lymph node metastasis of the preoperative CT image were observed, measured and recorded. x2 test or Fisdher's statistical methods was adopted for comparing the concord rate of preoperative CT scanning with postoperative pathological diagnosis. Results Lymph nodes metastasis were defected in 242 of the 618 treated patients(39.2%), The rate of lymph node metastasis present in lower neck, upper-mediastinum,middle-mediastinum, lower-mediastinum, and superior abdomen regions in upper-thoracic esophageal carcinoma were 3.2% ,20.8% ,6.4% ,2.4% and 8.0%, in middle-thoracic esophageal carcinoma 1.5%,7.8% ,22.0% ,3.5% and 22.8%, and in lower-thoracic esophageal carcinoma 0% ,2.0% ,21.4% ,6.1% and 32.7%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value,younden index and accuracy rates of diagnosis of lymph node metastasis with preoperative CT scan were 58.3%, 70.7%, 56.2%, 72.5%, 29.0% and 65.9%, respectively. The concordance rate of 0, 1, 2 and ≥ 3 lymph node metastasis by preoperative CT scanning with postoperative pathological diagnosis were 72.4%, 32.2% , 58.3% and 73.1%, respectively in whole group(x2 = 82. 61, P = 0.000). The concordance rate of no lymph node metastasis by CT scan comparing with that by postoperative pathological diagnosis was higher than that of the 1 lymph node metastasis in upper-thoracic esophageal carcinoma 3 lymph node metastasis were 71.1%, 30.1%, 55.6% and 77.8%, respectively(x2 =55.14,P =0.000.Conclusions Preoperative CT image can accurately predict the distribution patterns of the lymph node metastasis in esophageal carcinoma. The concordance rate was the highest in diagnosis of 0 and ≥3 lymph node metastasis, the lowest in diagnosis of one lymph node metastasis. These findings are valuable for definition of the target range of radiotherapy after radical resection of esophageal carcinoma. Key words: Esophageal neoplasms, lymph node metastasis; Tomography, X-ray computed; Pathology

Bilateral superior epigastric pedicle perforator flaps for total chest wall coverage

The superior epigastric artery (SEA), a terminal branch of the internal mammary artery, is analogous to the deep inferior epigastric artery (DIEA) in that it supplies a large number of perforators that are clustered together. This allows tissue from the superior abdomen to be used as a pedicled flap for reconstruction. A reliable and well-perfused pedicled flap can be based on this cluster of perforators, hence the term 'pedicle cluster perforator flap'. We present a case of a patient with recurrent angiosarcoma, who required total anterior chest wall reconstruction. This was achieved using bilateral pedicled SEA perforator flaps for complete coverage. To our knowledge, this is the first documented case of bilateral pedicled perforator flap reconstruction for complete chest wall reconstruction.

An unusual presentation of thoracic para-aortic hematoma due to blunt trauma

An 11-yr-old boy was admitted to the hospital with gradually aggravating acute abdominal pain along with nausea, vomiting and constipation for 5 days. The pain started after blunt trauma on the superior abdomen. He had normal laboratory tests and abdominal examination, but his chest radiograph showed infiltration in the right lung and an abnormal mass on the left diaphragm. Further investigation like computed tomography (CT) and magnetic resonance MR angiography, revealed an abnormal para-aortic mass located a mass located para-aortic above posterior to the left diaphragm with a well-defined margin. The abnormal mass was finally confirmed to be a hematoma with exploratory thoracotomy. The rarity of this kind of presentation is discussed for making an early and correct diagnosis.

TH‐C‐350‐07: Impacts of Dose Distribution Variations in Proton Therapy According to Gastro‐Intestinal Tract Air Filling and Breathing

Purpose: For upper abdominal cancers, the simulation CT represents a snapshot of the possible air distribution and radiological thickness of a patient, both of which impact proton dose distribution. The purpose of this dosimetric study is to analyze the effect of gastro‐intestinal tract air filling and breathing on the dose delivered to a superior abdomen target using passive scattering proton therapy. Method and Materials: We used free‐breathing CT (FBCT) and 4D‐CT data sets showing the same 3‐cm pancreatic tumor. Air distribution was reasonable. We reproduced a situation where proton beam parameters would be calculated on a normal breathing patient with gas (no air override: O−FBCT), and we analyzed the dosimetric impacts if air was replaced by stools (air override: O+FBCT) during treatments and vice‐versa. Target coverage for 50.4 CGE in 28 fractions and dose to critical structures were evaluated for different air‐filling and breathing‐phase scenarios. Four‐field plans including 3 incidences going through some gas were compared to 2‐posterior‐field plans. Results: For the 4‐field plans, beam parameter calculations from the O+FBCT resulted in adequate target coverage when the same beam parameters were applied to the O−FBCT. The converse situation resulted in the need for an additional 1‐cm SOBP width to achieve adequate coverage for the antero‐posterior and right‐lateral beams. The 4‐field plans provided insufficient distal target coverage to account for planning uncertainties in the expiration phase, a problem avoided with the 2‐field plan. Conclusion: Our choice of planning margins on O+FBCT for upper abdominal cancer proton therapy is safe for target coverage, even if air filling variations occur during treatments. Planning on an O−FBCT, using a passive scattering technique, results in less conformal plans. The use of posterior incidences for upper abdominal cancers prevents uncertainties, especially in specific clinical situations like ileus or breathing disorders.

Técnica para obtenção do aparelho geniturinário e dosagem do PSA (Prostate Specific Antigen) no hamster sírio, Mesocricetus auratus

Objetivo: Expor a técnica utilizada na colheita de sangue para dosagem do PSA ( Prostate Specific Antigen ) e retirada do aparelho geniturinário no hamster sírio, Mesocricetus auratus, e correlacionar os achados do PSA com as alterações histológicas dos anexos sexuais desse roedor. Métodos: Foram usados no experimento trinta (n= 30) Hamsters: dez (n=10) animais considerados jovens com idade média no momento da morte de 47,5 dias e vinte (n=20) animais considerados adultos com idade superior à um ano. Após serem anestesiados com cloridrato de quetamina e diazepam, foi colhido diretamente da veia cava, em nível de abdome superior, cerca de 1,5mL a 2,0mL de sangue para dosagem do PSA totalpelo método ELISA, com antígeno humano. Morriam após colheita do sangue. Constatado a morte do animal, fazia-se a laparotomia retirando-se em monobloco todo aparelho geniturinário para estudo histológico dos anexos sexuais. Correlacionou-se o PSA com as alterações histológicas encontradas. Resultados: Os animais após serem anestesiados com cloridrato de quetamina e diazepam intraperitonealmente, obteve-se um excelente plano anestésico, que possibilitou colher via trans-dérmica da veia cava inferior em abdome superior sangue para dosagem do PSA. O animal morria após colheita do sangue. Fazia-se a laparotomia, com retirada em monobloco do aparelho geniturinário para estudo histológico e comparação das alterações encontradas nos anexos sexuais com o PSA dosado. Entre os Hamsters Jovens a média do PSA encontrado foi de 0,252ng/mL. Desvio Padrão (DP) = 0,36. Entre os Hamsters adultos esta média foi de 0,325 ng/mL, DP= 0,12 . Quando comparou-se as médias do PSA entre os dois grupos de jovens e adultos obteve-se p= 0,0427. Dentre os Hamsters jovens, três apresentaram PSA não detectado. A análise histológica mostrou que, entre os animais jovens, não foi identificada qualquer alteração das estruturas microscópicas da próstata, vesículas seminais e testículos. Observou-se nos Hamsters adultos (n=20), setenta por cento de alterações nos anexos sexuais a saber: um caso (5%) de processo supurativo das vesículas seminais, um caso (5%) de processo inflamatório isolado das vesículas seminais, um caso (5%) de Processo inflamatório das vesículas seminais, HBP e prostatite concomitante e um caso (5%) de infarto testicular e prostatite. Onze animais (55%), dos Hamsters adultos, apresentaram HBP (Hiperplasia Benigna da Próstata). Conclusão: A técnica cirúrgica descrita mostrou-se eficiente para a obtenção dos orgãos e estruturas do aparelho geniturinário, estudo histológico desses orgãos e dosagem do PSA no Hamster Sírio, Mesocricetus auratus.