Current diagnostic approaches in tumor-induced bone disease.

PURPOSE: To assess the role of the current imaging methods in the diagnosis, staging and post-therapeutic monitoring of cancer-induced bone disease. PATIENTS AND METHODS: 183 cancer patients underwent baseline whole body bone scintigraphy (WBBS) with 555- 740 MBq (99m)Tc-MDP. Computed tomography (CT) was carried out in 43 patients, and magnetic resonance imaging (MRI) in 26 patients with abnormal uptake on the bone scan in order to differentiate metastatic or degenerative skeletal lesions with similar scintigraphic appearance. Sixty-four patients with established tumor-induced bone disease were followed-up after their anticancer treatment. RESULTS: WBBS was positive for metastatic disease in 54 patients and normal skeletal scan was obtained in 28 patients. Comparative analysis of the sensitivity and specificity of WBBS in relation to CT for diagnosis of metastatic spots in the examined group of 43 patients showed: for WBBS 93.3% (28/30) and 92.8% (13/14), respectively; for CT 90% (27/30) and 100% (13/13), respectively. Sensitivity and specificity of WBBS in relation to MRI in the examined group of 26 patients showed: for WBBS 86.6% (13/15) and 77.7% (7/9), respectively/ for MRI 100% (15/15) and 88% (8/9), respectively. Scintigraphic follow-up examinations of 64 patients after appropriate therapy showed partial response (PR) in 28 cases, stable disease (SD) in 12, progressive disease (PD) in 10, pathological fractures in 11 and "flare phenomenon) in 3 cases. CONCLUSION: In most cases WBBS is suffi cient to find and locate osseous metastases. Because of the lower specificity of WBBS, patients with spots of increased mineral metabolism of unclear character and persisting pain in the spine necessitate target CT or MRI to evaluate the characteristics of the detected scintigraphic changes.

Dose tracking and radiology department management.

The purpose of this work was to review the reasonable measures that should be implemented as part of a routine practice in the process of managing CT radiation risks in a typical average radiology department. Based on 6 y of experience in the management of a general radiology department and the newly implemented supportive software for dose tracking, analysing and reporting, the approach towards radiation risk reduction is presented. Thanks to this approach, some problems have been resolved, and reasonable measures have been introduced into daily practice.

Magnetic resonance imaging and its value in the staging of cervical carcinoma - Comparison of magnetic resonance imaging and pathological images with FIGO staging system.

Cervical carcinoma is the third most common gynaecologic malignancy and is typically seen in younger women, often with serious consequences. The International Federation of Gynaecology and Obstetrics (FIGO) staging system provides worldwide epidemiologic and treatment response statistics. Magnetic resonance imaging (MRI), although not included officially in that system, plays an integral role in the evaluation of patients with cervical carcinoma. After the histological diagnosis has been made, MRI is recommended for noninvasive evaluation of tumor extent, often helping in designing optimal therapy. MRI renders excellent soft tissue contrast, allowing direct tumor visualization and assessment of tumor volume, depth of penetration, and extension to adjacent tissues. MRI obviates the use of invasive procedures such as cystoscopy and proctoscopy, especially when there is no evidence of local extension. MRI staging, when available, is invaluable for identifying important prognostic factors and optimising treatment strategies. The objective of this review is to discuss the MRI staging of the uterine cervical carcinoma, to propose a comprehensive, clinically relevant MRI examination for the assessment of uterine cervical carcinoma, and to present the correlation between MRI and pathologic imaging in comparison to the FIGO staging system.

A case of nevoid basal cell cutaneous syndrome - radiological, CT and MRI findings.

The nevoid basal cell carcinoma syndrome (NBCCS) is a rare, still well-defined autosomal dominant disorder, characterized by multiple cutaneous basal cell carcinomas, jaw keratocysts and a variety of other tumors and developmental anomalies. The nevi turn malignant with time, and thus, early diagnosis, follow-up, and treatment are imperative. This article presents a case of a 60-year-old man with classical form of NBCCS. The images from conventional radiography, CT and MRI are discussed in the context of clinical presentation of the disease, and the importance of imaging modalities in the diagnostic process is stressed.

Gastric teratoma in a 2-month-old boy.

Gastric teratoma is an extremely rare neoplasm accounting for less than 2% of all teratomas in children. Clinical manifestations usually consist in vomiting, palpable abdominal tumor and/or bleeding from the upper gastrointestinal tract. Considering its rareness and the scarce information in the literature we present a case of gastric teratoma in a 2-month-old boy with vomiting after feeding, persisting since birth. The child was referred for examination with clinical suspicion of hypertrophic pyloric stenosis. He also suffered from septic meningitis with fulminant course which caused his death 5 days after the diagnosis of teratoma was done. Imaging studies were indicative of the diagnosis.

[Experience with the elimination of a cholera focus in a psychiatric clinic and the measures for its prevention]. / Opyt likvidatsii ochaga kholery v psikhiatricheskoi klinike i mery ee profilaktiki.

The epidemic process of cholera in a mental-hospital setting is to a great extent influenced by specific factors. In view of a danger of cholera being brought into a mental in-patient facility the authors insist, based on their own experience, that in summer and autumn seasons in South regions and urban settlements with unstable, in respect of cholera, epidemic situation, not only patients with intestinal disfunction be examined for cholera but all those individuals to be managed at above facility. It is all-important for a mental hospital to have a plan at their disposal of primary antiepidemic measures to be instituted in case dangerous infections will pose too difficult a problem to deal with, with pharmacy being envisaged, provided with all the stores required.

Diagnostic imaging of intestinal malrotation in association with other inborn malformations in children and adults--case presentations and a review of the literature on the subject.

Intestinal malrotation is defined as a group of anomalies in the rotation and fixation of the small intestines and the colon during the embryological development. It can affect the duodenojejunal segment, the cecocolic segment or both. Its most common complication is the midgut volvulus. It is considered to be a childhood pathology, as it usually affects newborns and infants, but with the advent of modern imaging modalities in everyday practice, it is discovered in adults more often. This places it in the group of rare, but important causes for acute and chronic abdominal complaints in children and adults. When it is asymptomatic, it is hard to predict if and in whom complications will occur, which imposes the need to know its variants and diagnostic techniques to prove it. Extremely often the malrotation is associated with other inborn malformations and congenital cardiovascular defects. We report 6 cases of intestinal malrotation, diagnosed in the Medical Imaging Department of Tokuda Hospital Sofia between 2011 and 2014, in order to revise the condition's potential risks and to mark the role of the different imaging modalities in the diagnostic process.

[Results of the operative treatment of primary pulmonary sarcomas].

OBJECTIVE: To study and evaluate clinic, diagnostics and operative treatment of patients with primary pulmonary sarcomas (PPS). MATERIAL AND METHODS: During 24 years period, a total of 49 patients underwent surgery for PPS. There were 29 male and 20 female with a mean age of 52.6 years. Main presenting complaints were shortness of breath, cough, chest pain, weight loss and haemoptysis. Correct preoperative diagnosis was obtained in 12 (24.48%) of the patients by bronchoscopy or percutaneous core biopsy. Carcinoma was diagnosed in 14 (28.6%) of them. Almost half of the cases were operated on without histological confirmation for suspected malignancy. The histological diagnoses were fibrosarcoma (16), fibroleiomyosarcoma (10), leiomyosarcoma (6), rhabdomyosarcoma (7), hemangiopericytoma (3), epitheloid hemangioendothelioma (3), undifferentiated sarcoma (2), malignant schwannoma (1) and liposarcoma (2). Only 2 of the tumors were scored in grade 1. The rest were classified in higher grades of malignancy. The following operations were carried out: lobectomy--30 (59.2%), including 2 sleeve lobectomies; pneumonectomy--10 (20.4%), polysegmental resections--3 (6.2%) and atypical resection--1 (2%). The resections were extended to the thoracic wall, diaphragm or pericardium in 4 patients. Endoscopic laser resection was applied in 1 (2%) case. Exploratory thoracotomy was performed on 3 (6.1%) patients. There were 2 (4.1%) stage I A; 26 (53.1%) stage I B; 11 (22.4) stage II B; 5 stage III A; 4 stage III B and 1 stage IV. RESULTS: No postoperative death occurred. Postoperative empyema was observed in 2 cases (4.1%) and 1 patient (2%) was reoperated on for local recurrence 18 months after surgery. Adjuvant therapy was administered to 20 of the patients. Follow-up (range, 6 to 160 months) was available for 41 patients. The actuarial 5-year postoperative survival was 51.8% with mean survival of 40.8 months. CONCLUSION: The correct preoperative diagnosis of PPS still presents a challenge. There are no specific clinical, imaging and other signs for this tumor evaluation. Surgery with systematic lymphnode dissection is a treatment of choice with an acceptable 5-year survival rate. Only the complete resection and the low stages of the tumor significantly influence survival.

[Single-stage bilateral video-assisted thoracic surgery (VATS) in treatment of patients with primary spontaneous pneumothorax].

From January 2003 to April 2006, a total of 6 patients (mean age of 16.7 years) underwent single-stage bilateral VATS for primary spontaneous pneumothorax (PSP). All 6 patients had at least one episode of pneumothorax, requiring tube thoracostomy. Two patients had 2 previous ipsilateral episodes and 2 patients were with one episode in both sides each. One patient, operated on by VATS in another department, was with recurrence in the previously treated side. Chest CT revealed preoperatively bilateral apical bullae in 5 (83.3%) patients. Video-assisted thoracic suturing of apical bullae by Endo-Stitch was carried out in 8 pleural cavities, while in the last 2 pleural cavities apical bullae were resected using an Endo-GIA. Pleural abrasion was performed in 1 patient and the rest 5 patients had apical pleurectomy. Autologous fibrine glue was additionally applied in 3 cases for covering of suturing or resectional lines. No intraoperative complications or mortality were faced. The mean operative time was 87 minutes. No postoperative complications were observed. Mean duration of pleural drainage was 3.5 days. Postoperative hospital stay was 4.7 days. The mean follow-up was 10.3 months. One patient (the case without bullous pulmonary changes and with pleural abrasion) experienced left ipsilateral recurrence 19 months after the operation. He was reoperated on by VATS and apical pleurectomy was carried out. All patients restored their full working capacity within 1 month after the operation. They are doing well, no recurrence has been observed. In conclusion, we believe that single-stage bilateral operation by VATS is a safe procedure with excellent early and long-term results in patients with simultaneous bilateral PSP and in carefully selected young patients with ipsilateral PSP.

[99mTcDTPA-aerosol clearance in early diagnosis of pulmonary changes in patients with active systemic lupus erythematosus]. / 99mTcDTPA-aerozol kliruns v rannata diagnostika na belodrobnite izmeneniia pri patsienti s aktiven sistemen lupus eritematodes.

Nineteen patients with active SLE and a control group of 20 healthy persons were investigated. We have made to all of them 99mTcDTPA-aerosol scintigraphy and the following pulmonary functional tests--Dc CO, Dm, Vc, HRCT. Accelerated clearance of 99mTcDTPA was found in all patients with active SLE. The half-elimination time T1/2 was shortened and varied between 22.6 +/- 4.7 min for the right one. It wasn't established correlative dependence between 99mTcDTPA and the pulmonary functional tests. In 36.8% of the patients HRCT was normal, while 99mTcDTPA clearance was accelerated. This fact shows, that 99mTcDTPA-aerozsol scintigraphy is more sensitive method for early diagnosis of pulmonary changes, than the pulmonary functional tests and HRCT.

[Diagnosis and surgical treatment of pulmonary sequestration]. / Diagnostika i khirurgichno lechenie na belodrobnata sekvestratsiia.

Between Jan. 1988 and Jan. 2003 4 patients (3 male, 1 female, mean age of 20 years) were operated on for lung sequestration. Sequestration was intralobar in 3 cases and extralobar in 1 case. The abnormality was discovered by chance in 1 patient. The most frequent clinical manifestation was those of recurrent bronchopneumonia. X-ray films of the chest showed an apparently benign, posterobasal image in 80% of the cases. Arteriography was performed in 1 patient and revealed an abnormal systemic artery. Computerized tomography imaging with i.v. contrast confirmed the diagnosis in 3 patients. The intralobar type of sequestration was treated by lobectomy and polysegmental resection--S7-12, and the extralobar type--by sequestrectomy. The operative mortality and the morbidity rate were nil. The mean stay in hospital was 10 days. The long-term postoperative results are considered excellent.