RESUMEN
BACKGROUND: Augmented Reality (AR) is a technology that can allow a surgeon to see subsurface structures. This works by overlaying information from another modality, such as MRI and fusing it in real time with the endoscopic images. AR has never been developed for a very mobile organ like the uterus and has never been performed for gynecology. Myomas are not always easy to localize in laparoscopic surgery when they do not significantly change the surface of the uterus, or are at multiple locations. OBJECTIVE: To study the accuracy of myoma localization using a new AR system compared to MRI-only localization. METHODS: Ten residents were asked to localize six myomas (on a uterine model into a laparoscopic box) when either using AR or in conditions that simulate a standard method (only the MRI was available). Myomas were randomly divided in two groups: the control group (MRI only, AR not activated) and the AR group (AR activated). Software was used to automatically measure the distance between the point of contact on the uterine surface and the myoma. We compared these distances to the true shortest distance to obtain accuracy measures. The time taken to perform the task was measured, and an assessment of the complexity was performed. RESULTS: The mean accuracy in the control group was 16.80 mm [0.1-52.2] versus 0.64 mm [0.01-4.71] with AR. In the control group, the mean time to perform the task was 18.68 [6.4-47.1] s compared to 19.6 [3.9-77.5] s with AR. The mean score of difficulty (evaluated for each myoma) was 2.36 [1-4] versus 0.87 [0-4], respectively, for the control and the AR group. DISCUSSION: We developed an AR system for a very mobile organ. This is the first user study to quantitatively evaluate an AR system for improving a surgical task. In our model, AR improves localization accuracy.
Asunto(s)
Laparoscopía/métodos , Leiomioma/cirugía , Modelos Anatómicos , Cirugía Asistida por Computador/métodos , Miomectomía Uterina/métodos , Neoplasias Uterinas/cirugía , Femenino , Procedimientos Quirúrgicos Ginecológicos/métodos , Ginecología/educación , Humanos , Internado y Residencia , Leiomioma/diagnóstico por imagen , Imagen por Resonancia Magnética , Programas Informáticos , Interfaz Usuario-Computador , Neoplasias Uterinas/diagnóstico por imagenRESUMEN
BACKGROUND: The purpose of this study is to report prolonged survival in patients with metastatic pancreatic ductal adenocarcinoma (PDAC) managed by chemotherapy and surgery. METHODS: Between January 2009 and August 2013, 284 patients with metastatic PDAC were managed in our oncologic department. Among them, three (1%) with a single metastasis (liver in two cases and interaorticaval in one case) underwent one- or two-stage surgical resection of the metastasis and the main tumor. Perioperative data were recorded retrospectively, including disease-free and overall survival. RESULTS: The three patients had chemotherapy (FOLFOX or FOLFIRINOX regimen) with objective response or stable disease prior to surgery. Median time between chemotherapy and surgery was 9 (8 to 15) months. Resection consisted in pancreaticoduodenectomy in the three cases. None of the patients had grade III/IV postoperative complications, and median hospital stay was 12 (12 to 22) days. All the patients had postoperative chemotherapy. Only one patient experienced recurrence 11 months after surgery and died after 32.5 months. The two other patients were alive with no recurrence 26.3 and 24.7 months after initial treatment. CONCLUSION: Radical resection of PDAC with single distant metastases can offer prolonged survival with low morbidity after accurate selection by neoadjuvant chemotherapy.
Asunto(s)
Carcinoma Ductal Pancreático/cirugía , Neoplasias Hepáticas/cirugía , Neoplasias Pulmonares/cirugía , Pancreatectomía , Neoplasias Pancreáticas/cirugía , Neoplasias Peritoneales/cirugía , Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma Ductal Pancreático/tratamiento farmacológico , Carcinoma Ductal Pancreático/mortalidad , Carcinoma Ductal Pancreático/patología , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/secundario , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/secundario , Metástasis Linfática , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Recurrencia Local de Neoplasia/tratamiento farmacológico , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/cirugía , Estadificación de Neoplasias , Neoplasias Pancreáticas/tratamiento farmacológico , Neoplasias Pancreáticas/mortalidad , Neoplasias Pancreáticas/patología , Neoplasias Peritoneales/tratamiento farmacológico , Neoplasias Peritoneales/mortalidad , Neoplasias Peritoneales/secundario , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia , Neoplasias PancreáticasRESUMEN
Abdominal wall endometriosis is unusual and mostly occurs in scars following Cesarean section. Although malignant transformation is rare, it must be recognized in order to benefit from radical resection. We report a very rare case of mixed endometrioid and serous carcinoma developing in a Cesarean section endometriosis scar and the way we managed it using surgery and chemotherapy. 18-FDG PET-CT imaging was performed to correctly stage the disease.
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Neoplasias Abdominales/diagnóstico , Pared Abdominal/patología , Cistadenocarcinoma Seroso/diagnóstico , Neoplasias Endometriales/diagnóstico , Endometriosis/diagnóstico , Imagen por Resonancia Magnética , Neoplasias Abdominales/patología , Neoplasias Abdominales/cirugía , Cesárea , Cicatriz/patología , Cicatriz/cirugía , Cistadenocarcinoma Seroso/patología , Cistadenocarcinoma Seroso/cirugía , Diagnóstico Diferencial , Neoplasias Endometriales/patología , Neoplasias Endometriales/cirugía , Endometriosis/patología , Endometriosis/cirugía , Femenino , Humanos , Laparoscopía , Persona de Mediana Edad , Mallas QuirúrgicasRESUMEN
Hepatic necrosis after ethanol ablation for hepatocellular carcinoma (HCC), although rare, is well known and described, particularly in patients with chronic liver disease. The present report describes a rare case of massive hepatic necrosis with partial gastric, splenic, and pancreatic infarctions after local treatment of liver HCC with ethanol ablation and discusses the reasons for this complication. With the increasing use of percutaneous techniques to treat liver tumors, it is imperative for the interventional radiologist to be aware of the potential vascular complications of these techniques. An appreciation of vascular anatomy via multidetector computed tomography (CT) and/or magnetic resonance (MR) angiography is important when planning image-guided interventions.
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Carcinoma Hepatocelular/terapia , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Etanol/efectos adversos , Infarto/inducido químicamente , Neoplasias Hepáticas/terapia , Páncreas/irrigación sanguínea , Bazo/irrigación sanguínea , Estómago/irrigación sanguínea , Anciano , Antineoplásicos/administración & dosificación , Antineoplásicos/efectos adversos , Carcinoma Hepatocelular/irrigación sanguínea , Carcinoma Hepatocelular/diagnóstico por imagen , Enfermedad Hepática Inducida por Sustancias y Drogas/diagnóstico por imagen , Enfermedad Hepática Inducida por Sustancias y Drogas/terapia , Etanol/administración & dosificación , Humanos , Infarto/diagnóstico por imagen , Infarto/terapia , Inyecciones Intralesiones , Neoplasias Hepáticas/irrigación sanguínea , Neoplasias Hepáticas/diagnóstico por imagen , Masculino , Necrosis , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Percutaneous stenting of the superior vena cava (SVC) is usually recommended as a palliative procedure for malignant SVC obstruction with low reported morbidity. Complications are uncommon and usually of minor consequence. We report two unusual cases of cardiac tamponade following SVC stenting in patients with malignant SVC syndrome. Echocardiography allows rapid diagnosis and guides pericardial drainage in the interventional radiology suite.
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Taponamiento Cardíaco/diagnóstico por imagen , Taponamiento Cardíaco/etiología , Neoplasias Pulmonares/complicaciones , Complicaciones Posoperatorias/diagnóstico por imagen , Stents/efectos adversos , Síndrome de la Vena Cava Superior/cirugía , Vena Cava Superior/diagnóstico por imagen , Adenocarcinoma/complicaciones , Anciano , Carcinoma Broncogénico/complicaciones , Carcinoma de Células Escamosas/complicaciones , Taponamiento Cardíaco/terapia , Drenaje/métodos , Resultado Fatal , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Síndrome de la Vena Cava Superior/complicaciones , Ultrasonografía , Vena Cava Superior/cirugíaRESUMEN
Epithelioid hemangioendothelioma of the liver is a very rare vascular tumour in children with intermediate malignant potential. We present a case in which the typical imaging appearances of coalescent peripheral hepatic masses with capsular retraction contributed to the diagnosis. A positron emission tomography-CT (PET-CT) procedure was performed in staging the disease with a strong suspicion of coeliac nodal involvement confirmed after laparotomy and histological analysis. Our case is unique because of the rarity of the disease, the young age of the child, and proven nodal metastases at initial diagnosis. The use of PET-CT allows better staging at initial diagnosis and thus better management with improved follow-up in these patients.
Asunto(s)
Hemangioendotelioma Epitelioide/diagnóstico , Hemangioendotelioma Epitelioide/secundario , Neoplasias Hepáticas/diagnóstico , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X , Abdomen/diagnóstico por imagen , Niño , Humanos , Metástasis Linfática , Masculino , Radiografía Abdominal , Técnica de SustracciónRESUMEN
Mucinous cystic adenoma (MCA) of the pancreas is a rare benign cystic tumor with ovarian-like stroma and lack of communication with the pancreatic ductal system. The ovarian tissue is incorporated from the left gonad within the dorsal pancreas during embryogenesis. Consequently, congenital dorsal agenesis of the pancreas (DAP) cannot be associated with MCA. We report the case of a giant MCA associated with atrophy of the dorsal pancreas mimicking complete DAP. Pancreato-magnetic resonance imaging failed to identify the dorsal pancreas but the absence of diabetes mellitus and compression of the splenic vein with major tributaries rectified the diagnosis of secondary atrophy of the distal pancreas. Unusual proximal location of the cyst in the pancreas may have induced chronic obstruction of both the dorsal pancreatic duct and the splenic vein, with secondary atrophy of the distal pancreas.
RESUMEN
Hepatic capsular retraction is an imaging feature that deserves the attention of the radiologist. Hepatic capsular retraction is associated with a number of hepatic lesions, benign or malignant, treated or untreated. The purpose of this pictorial review is to discuss the most common benign and malignant hepatic lesions associated with this feature with an emphasis on magnetic resonance imaging (MRI).
RESUMEN
Right portal vein ligation (PVL) is a safe and widespread procedure to induce controlateral liver hypertrophy for the treatment of bilobar colorectal liver metastases. We report a case of a 60-year-old man treated by both right PVL and ligation of the glissonian branches of segment 4 for colorectal liver metastases surrounding the right and median hepatic veins. After surgery, the patient developed massive hepatic necrosis with secondary pulmonary and renal insufficiency requiring transfer to the intensive care unit. This so-called toxic liver syndrome finally regressed after hemofiltration and positive oxygen therapy. Diagnosis of acute congestion of the ligated lobe was suspected. The mechanism suspected was an increase in arterial inflow secondary to portal vein ligation concomitant with a decrease in venous outflow due to liver metastases encircling the right and median hepatic vein. This is the first documented case of toxic liver syndrome in a non-cirrhotic patient with favorable issue, and a rare complication of PVL.
Asunto(s)
Neoplasias Colorrectales/patología , Hepatopatías/etiología , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/cirugía , Vena Porta/cirugía , Procedimientos Quirúrgicos Vasculares/efectos adversos , Biopsia , Hemofiltración , Humanos , Ligadura , Hepatopatías/patología , Hepatopatías/terapia , Neoplasias Hepáticas/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Tomografía Computarizada Multidetector , Necrosis , Terapia por Inhalación de Oxígeno , Vena Porta/diagnóstico por imagen , Insuficiencia Renal/etiología , Insuficiencia Respiratoria/etiología , Síndrome , Resultado del TratamientoRESUMEN
Peribiliary cysts are common in patients with chronic liver disease. Ambiguous imaging features and association with cirrhosis-induced hyperbilirubinemia may lead to misdiagnose an obstructive jaundice. Magnetic resonance cholangiopancreatography (MRCP) may be a useful sequence by showing small cystic structures with a specific periportal distribution on both sides of the portal veins, which do not communicate with the biliary ducts. These abnormalities may be recognized in order to avoid unnecessary endoscopic retrograde cholangiography.