Colorectal cancer is the third most frequently reported malignancy and also the third leading cancer-related cause of death worldwide. Lymph node evaluation, both preoperatively and postoperatively, represents an important aspect of the diagnosis and therapeutic strategy in colorectal cancer, such that an accurate preoperative staging is required for a correct therapeutic strategy. Treatment of rectal cancer with positive lymph nodes, a very important predictive prognostic parameter, is currently based on neoadjuvant chemoradiotherapy followed by total/ surgical mesorectal excision and adjuvant regimen. Preoperative evaluation of the lymph node status in rectal cancer is based on endoscopic ultrasound and magnetic resonance imaging, but their accuracy, specificity, and sensitivity still require improvement. Postoperative evaluation also presents points of debate, especially related to the role of sentinel lymph node mapping and their final implication, represented by detection of micrometastases and isolated tumor cells. The pathologic interpretation of tumor deposits represents other points in discussion. From a surgical perspective, extended lateral lymph node dissection vs. abstinence and (neo)adjuvant therapeutic approach represent another unresolved issue. This review presents the major controversies existing today in the treatment and pathologic interpretation of the lymph nodes in rectal cancer, the role/ indication and value of the lateral pelvic lymph node dissection, and the postoperative interpretation of the value of the micrometastatic disease and tumor deposits.
The majority of studies concerning Helicobacter pylori ( H. pylori ) are oriented towards the implication of infection with H. pylori in processes that end in the formation of neoplasia, without assessing the impact of the bacterium in triggering acute gastroduodenal hemorrhagic episodes. The present study includes 166 patients with upper digestive hemorrhage, admitted to the ATI Clinic, the Gastroenterology Clinic or to the Surgery II Clinic of the County Emergency Clinical Hospital in Craiova, Romania between 2017 and 2019. All patients were monitored for evolution and received treatment according to current guidelines, and hemorrhagic lesions were biopsied. In the study group, 56.8% of the patients with upper gastrointestinal bleeding (UGIB) were positive for H. pylori and 43.2% were negative. In patients less than 50 years of age, non-steroidal anti-inflammatory drug (NSAID) use and H. pylori infection had a cumulative effect in causing bleeding lesions, but in patients older than 50 years of age, the use of NSAIDs was replaced by therapies with oral antiplatelet or anticoagulant agents. The need for hemostasis surgery was more common in patients who exhibited H. pylori -positive UGIB compared to H. pylori -negative (16 vs. 9.7%). In patients with H. pylori -positive hemorrhagic lesions, gastric resection was frequently required to obtain hemostasis. Persistence of H. pylori infection in patients with a history of gastric resection (4.1%) still predisposes to a hemorrhagic or neoplastic complication.
Objectives:The aim of this study is to introduce an automatic algorithm that identifies abdominal aorta and estimates its diameter and aorta intima media thickness (aIMT) from videos recorded during routine third trimester ultrasonographic fetal biometry Methods: aIMT was measured in singleton pregnant women during routine third trimester ultrasonography. In each frame, the algorithm locates and segments the region corresponding to aorta by means of an active contour driven by two different external forces: a static vector field convolution force and a dynamic pressure force. Then, in each frame, the mean diameter of the vessel is computed, to reconstruct the cardiac cycle: in fact, we expect the diameter to have a sinusoidal trend, according to the heart rate. From the obtained sinusoid, we identified the frames corresponding to the end diastole and to the end systole. Finally, in these frames was assessed the aIMT. The correlation between end-diastole and end-systole aIMT automatic and manual measures is 0.90 and 0.84 respectively. Results: The mean aorta diameter (blue line) and the mean aIMT (red line) estimated in 78 subsequent frames are shown: for visual purpose the values of aIMT are scaled to be superimposed to aorta diameter. The videos were acquired with a frame rate of 25 frames per second, thus three seconds of acquisition are shown. The estimated heart rate in coherent with physiological fetal heart rate. The correlation between end-diastole and end-systole aIMT automatic and manual measures was 0.90 and 0.84 respectively. Conclusions:The high values of correlation between manual and automatic results suggest that the proposed algorithm provides a reliable technique to faster the measure of important structures during ultrasonographic fetal biometry, such as aorta diameter and aIMT. Besides, being fully automatic, it allows avoiding the problems of intra-and inter-operator variability, typical of any manually performed measure. P17: FETAL NEUROSONOGRAPHY AND CNS ANOMALIES CASE REPORTS P17.01 Fetal epidural hematoma following ''non primary'' Cytomegalovirus infection: a case report Fetal Medicine Unit, Department of Obstetrics, St George's Hospital, London, United KingdomHuman Cytomegalovirus (CMV) is a common cause of intrauterine infection, and occurs in 0.2-2.2% of all live births in western countries. A 30 years old pregnant woman gravida 1 at 20 weeks of gestation was referred because of suspected fetal hydrocephalus at screening second trimester ultrasound scan. A detailed scan revealed an intracranial hyper-echoic space-occupying lesion overlying the left temporo-parietal lobes. The anterior horns of the ventricles appeared prominent, although the transverse size of the right lateral atria was within normal range (9.28 mm) with mild midline shift. Cavum septum pellucidi and third ventricle were compressed. The fourth ventricle appeared dilated. Hyper-echoic bowel was revealed at ultrasound scan. Fetal MRI was performed and sequences were acquired confirming the US suspect of epidural hemorrha...
Vulvar cancer is a malignant disease having a low frequency and with well-established surgical and oncological treatments based on the stage of the disease. The most important therapeutic problem encountered is represented by cases of perineal local regional recurrence, which are common in patients with large primary tumors and can occur even if the margins of the resection had no tumoral invasion. We present a case study of a 64-year-old patient diagnosed one year ago with squamous vulvar carcinoma (G3) for which a vulvectomy was performed after neoadjuvant radiotherapy. The patient later developed local recurrence with invasion of the anal sphincter, creating a delicate problem regarding a surgical approach. The size and the extent of the recurrent tumor required a complex surgical intervention using a mixed surgical team of general surgeons and plastic surgeons. Surgical intervention with a large excision of the recurrent cancer along with amputation of the inferior rectum via perineal route, and creation of a left iliac anus was performed. The perineal defect was covered via a musculocutaneous flap using the gracilis muscle. The immediate post-operative evolution was favorable.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.