The role of sentinel lymph node biopsy in early-stage cervical cancer: A systematic review.

Pelvic lymphadenectomy procedure is included as part of the standard protocol of radical hysterectomy for women with early-stage cervical cancer (Stage IA to IB1). However, an important sequel to lymphadenectomy procedure is the possible occurrence of lymphedema in the lower abdomen and lower extremities. Previous researches also find that women with lymphedema experience many emotional impacts, including depression, anxiety, and adjustment problems. Only approximately 10% of women with clinical stage IB cervical carcinoma were involved with metastatic disease. If we could better define the relevant lymphatic nodes that must be removed, it is then possible to limit routinely performed lymphadenectomy for regional nodal metastasis in the pelvis, and hence reduce the need for extended surgical staging (para-aortic lymphadenectomy). We systematically reviewed a body of literature and updated available information concerning the current progress on the application of sentinel lymph node biopsy in women with early-stage cervical cancer. All detection methods (preoperative injection of radiocolloid tracer, intraoperative injection of blue dye, or a combination of both techniques) demonstrated reasonable sensitivity (with a few exceptions), high specificity, low false-negative rate and high negative predictive value. The review of the literature in this paper should convince the readers that sentinel lymph node biopsy has the potential to improve the quality of life and the possibility to maintain relapse-free survival for women with cervical cancer. The proper identification of negative sentinel lymph node allows individualized therapy and may preclude the need of lymphadenectomy procedure in most of these women.

Preoperative embolization of carotid body tumor by direct percutaneous intratumoral injection of N-butyl cyanoacrylate glue assisted with balloon protection technique.

Substantial intraoperative bleeding during surgical removal of carotid body tumor may be a major problem in the management of these highly vascularized tumors. Traditional preoperative embolization via a transarterial access has proved effective but is often limited by complex vascular anatomy and small feeding vessels that is difficult to catheterize. We report two cases of carotid body tumor treated with direct puncture and intratumoral injection of N-butyl cyanoacrylate glue (NBCA) assisted with balloon protection technique for preoperative devascularization. The result was impressive and minimal bleeding loss during surgery was observed.

Bilateral developing reexpansion pulmonary edema treated with extracorporeal membrane oxygenation.

A right-side spontaneous pneumohemothorax developed in a 16-year-old boy who was transferred from a local medical department to our emergency department 12 hours later. After an emergency operation to remove the blood clot, right-side reexpansion pulmonary edema developed, with about 3100 mL of foamy and bloody fluid drainage from the right-side endotracheal tube. The patient was sent to the intensive care unit with differential lung ventilation, but developed left-side pulmonary edema resulting in worsening oxygen saturation. Further extracorporeal membrane oxygenation support was used. The patient recovered gradually, and the endobronchial tube was removed 5 days later.

Angioplasty as the first-line therapeutic option for venous hypertension with outlet obstruction of dural sinus.

We describe a nonconventional endovascular approach to the treatment of pseudotumor cerebri with venous outlet stricture or obstruction. In three patients presenting with acute visual loss, angiograms showed sinus occlusion and stasis of contrast material, with an increased pressure gradient in the venous system. We used venous sinus angioplasty as the first therapeutic option. This treatment was effective, and symptoms and signs of all three patients subsided quickly. In our initial and limited experience, sinus balloon angioplasty appeared to be a good first-line treatment for patients with pseudotumor cerebri, sinus outlet obstruction and acute vision loss. We prefer to use sinus stent placement as a second-line option when initial attempts are unsuccessful, especially in pediatric and young-adult patients, as illustrated in our cases.

Diffusion magnetic resonance imaging as an evaluation of the response of brain metastases treated by stereotactic radiosurgery.

BACKGROUND: Loss of tumor cell results in a relative increase in extracellular space that may lead to alteration of ADC. Our purpose was to see if the ADC could be used, rather than methods depending on changes in tumor size, to predict treatment success after treatment of brain metastases with SRS. METHODS: In a prospective study, the ADCs of 21 patients with 32 solid or solid-dominated brain metastases were taken before and 1 week, 1 month, and at 3-month intervals after SRS. Mean ADC values at the various time intervals were compared with each other to see whether or not the ADC might be used as an early indicator of treatment success or failure. RESULTS: The mean pretreatment value of the ADC in the metastatic tumors was 1.05 +/- 0.12 x 10(-3) mm2/s (mean +/- SD). This value for the tumors rose significantly (P = .009) 7 days after SRS and continued to rise with time. Magnetic resonance imaging showed that 91% of these tumors had been controlled by the SRS. The ADC values in cystic/necrotic tumor tissue (2.13 +/- 0.18 x 10(-3) mm2/s) were significantly (P < .001) higher than those in noncentral necrotic tumor tissue (1.61 +/- 0.14 x 10(-3) mm2/s). CONCLUSIONS: The ADC values might eventually be useful to evaluate treatment success-and in some patients, detected even at early time points-and to distinguish radiation-induced central necrosis from tumor regrowth in cases where other imagery is not definitive.

Gastrointestinal stromal tumors: computed tomographic features and prediction of malignant risk from computed tomographic imaging.

BACKGROUND: Gastrointestinal stromal tumors (GISTs) are specific, generally Kit (CD117)-positive, mesenchymal tumors of the gastrointestinal tract encompassing a majority of tumors previously considered gastrointestinal smooth muscle tumors. Our aim was to characterize the computed tomographic findings and predict malignant risk from computed tomography for the evaluation of GISTs. METHODS: The computed tomographic images of 39 patients with pathologically and immunohistochemically proven GISTs were reviewed by 2 radiologists, and the final interpretations were reached by consensus. Images were assessed for the size, contour, growth pattern, boundary, degree of enhancement, and necrosis of the tumors. The presence of calcification within the lesions, abdominal lymphadenopathy, ascites, and bowel obstruction were also recorded. Categorical variables were compared using Fishers exact test. Univariate and multivariate logistic regression analyses were used for selection of significant predictors of high-risk malignancy. In addition, the relationships between computed tomographic features and tumor size were assessed by means of nonparametric univariate analysis with the MannWhitney U test and KruskalWallis test. RESULTS: Both old age and larger tumor size (>or= 5 cm) were statistically significant in the univariate logistic analysis for high-risk malignant tumors (p < 0.25). However, in multivariate logistic regression, only larger tumor size (>or= 5 cm) was found to have final statistical significance for high-risk malignant GISTs (p < 0.05). In addition, more exophytic growth pattern (p < 0.01), more lobulated appearance (p < 0.01), good enhancement (p < 0.05),and more necrosis (p < 0.01) of masses were more often observed in larger GISTs than small ones on computed tomography. CONCLUSION: Larger tumor size (>or= 5 cm) was found to have a predictive value with respect to high-risk malignant GISTs.

Goldenhar syndrome (oculoauriculovertebral dysplasia): report of one case.

Goldenhar syndrome, also known as oculoauriculovertebral dysplasia, is an uncommon condition, characterized by a combination of anomalies: epibulbar dermoids or lipodermoids, preauricular appendices, malformation of the ears, hemifacial microsomia, vertebral anomalies, and others. The etiology of this disease has remained unclear; factors including chromosomal abnormalities, maternal diabetes mellitus or drug use, and influence of environment during pregnancy have been proposed. Here, we describe a case of Goldenhar syndrome in a 1-day-old female newborn, who presented with right external ear atresia, left preauricular appendices, cleft-like extension of the right oral angle, mandibular hypoplasia and relatively small hands. The literature on Goldenhar syndrome is briefly reviewed.

Unilateral subcortical calcification: a manifestation of dural arteriovenous fistula.

We describe the imaging findings in a dural arteriovenous fistula (AVF) with unilateral subcortical calcification. A 50-year-old woman patient suffered from hypertension and chronic headache. Recently, marked headache and a changed consciousness level were noted. The imaging studies demonstrated left subcortical calcification and cerebral sulcus effacement. MR imaging and angiography revealed multiple abnormal tortuous vessels, mainly from left external carotid artery with left-sided transverse sinus occlusion. The final diagnosis was type II a + b dural AVF (classification of Djindjian and Merland), and the patient underwent endovascular embolization and radiosurgery.

Nasopharyngeal carcinoma spreading along the eustachian tube: the imaging appearance.

Nasopharyngeal cancer (NPC) is one of the most common cancers in Taiwan. It can spread anteriorly, laterally, posteriorly, superiorly and inferiorly. Skull base invasion is the common presentation, in up to one-third of cases. We report a rare spreading pathway of NPC, via the eustachian tube. A 44-year-old male suffered from NPC and got radiotherapy about 2 years ago. He suffered from middle ear effusion and facial nerve palsy on the right side recently. The computed tomography and magnetic resonance image could clearly depict the infiltrating tumor over the mastoid region and tympanic cavity on the right side, spreading along the eustachian tube. It could result in eustachian tube dysfunction and middle ear effusion. The nature of the right facial palsy was most likely due to tumor infiltration.

Intraspinal extradural ganglion cyst of the cervical spine.

Intraspinal ganglion cyst is an uncommon lesion, which occurs most frequently in the lower lumbar region; occurrence in the cervical region is extremely rare. We report a case of ganglion cyst in the cervical region and describe its clinical pathological and radiological findings. A 59-year-old man presented with sudden lower limbs weakness and numbness below the nipple level. Magnetic resonance imaging revealed an intraspinal extradural lobulated cystic lesion at the level of C6-7 in contact with the left facet joint and posterior erosion of the spinal process at C7. The spinal cord was severely compressed by this lesion which was hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging and short T1 inversion recovery. The cyst wall was strongly enhanced after contrast injection. Intraoperatively, the mass was found to arise from the capsule of the C6-7 facet joint. The excised cyst contained jelly-like fluid. The patient's neurologic symptoms had fully recovered 20 days after the operation. The histopathologic analysis was consistent with ganglion cyst. Ganglion cyst of the cervical region is extremely rare, but must be considered in the differential diagnosis of intraspinal extradural compressive syndromes.

Angiographic embolization for emergent and prophylactic management of obstetric hemorrhage: a four-year experience.

BACKGROUND: To retrospectively evaluate the efficacy and safety of emergent and prophylactic arterial embolization for obstetric hemorrhage within the past 4 years. METHODS: We retrospectively collected 21 obstetric patients with treatment of selective arterial embolization between 1999 and 2002. Two groups of patients were identified. The first group consisted of 15 patients who experienced postpartum hemorrhage and underwent emergent embolization. The second group was made up of 6 patients who underwent prophylactic embolization with risk factors of severe obstetric bleeding. They had abnormal placentation antepartum diagnosed and accepted termination of pregnancy followed by hysterectomy. RESULTS: In the first group, 12 of 15 cases had a favorable outcome treated by single embolization session. One patient expired 4 days after embolization due to severe disseminated intravascular coagulopathy and multiple organ failure. One retained placenta with recurrent bleeding was controlled by repeated selective arterial embolization. One uterine subinvolution with persistent mild bleeding and genital tract infection was improved by conservative treatment. Further surgical procedure was not necessary for all cases. One woman delivered her next baby 13 months after embolization. In the second group, all women had abnormal placentation with histopathological confirmation, including 1 accreta, 3 increta, and 2 percreta. No immediate complication was noted after embolization. The estimated blood loss during operation ranged from 300 to 3000 mL (mean, 1770 mL). CONCLUSIONS: Our study indicates that selective arterial embolization should be the early management for intractable postpartum hemorrhage after conservative treatment fails and before more invasive surgical intervention is considered. Our experience also confirms the effectiveness and safety of prophylactic selective arterial embolization for anticipated high morbidity or mortality of obstetric surgery.