经翼点眶内入路显微手术切除球后肿瘤临床分析

目的探讨经翼点眶内入路显微手术切除球后肿瘤的方法和疗效。方法对4例球后肿瘤患者在全麻下经翼点眶内入路手术治疗,观察手术疗效,并根据病理指导治疗。结果4例均肿瘤全切,其中转移瘤1例,神经鞘瘤1例,脑膜瘤1例,眶内脓肿1例。视力2例恢复正常,1例好转,1例未恢复。结论经翼点眶内入路是切除球后肿瘤的有效入路。     

Ethmoid sinus disease: CT evaluation in 400 cases. Part III. Craniofacial resection

Of 400 patients with ethmoid sinus disease, 18 had undergone craniofacial resection. This operation is an aggressive surgical procedure directed at total en bloc extirpation of tumors that extend through the floor of the anterior cranial fossa. Recent advances in surgical technique have made it the procedure of choice for sinonasal tumors that extend through the cribriform plate, fovea ethmoidalis, and orbital roof. Specifically, this operation has had excellent results in patients with esthesioneuroblastomas. Radiologists must be aware of the possible pitfalls in interpreting the postoperative computed tomographic scans and the findings that suggest tumor recurrence.     

The role of imaging for the surgeon in primary malignant bone tumors of the chest wall

Primary malignant chest wall tumors are rare. The most frequent primary malignant tumor of the chest wall is chondrosarcoma, less common are primary bone tumors belonging to the Ewing Family Bone Tumors (EFBT), or even rarer are osteosarcomas. They represent a challenging clinical entities for surgeons as the treatment of choice for these neoplasms is surgical resection, excluding EFBT which are normally treated by a multidisciplinary approach.     

Late orbital metastasis from colon cancer complicated by multiple tumors in the breast,lung, liver,and spine

A 69-year-old woman sustained progressive proptosis for 2 months. The patient had undergone surgery for resection of colon cancer 10 years prior, which was considered to have been completely cured 5 years prior. She was also aware of a hard mass in her left breast, but it had been left untreated. Furthermore, she experienced back pain for a month. Blood examination revealed an elevated level of serum carcinoembryonic antigen, at 17.4 ng/mL (< 5). Computed tomography (CT) revealed a tumor occupying the superolateral part of the right orbit, with intratumoral calcifications and destructive changes in the lateral orbital wall. On magnetic resonance imaging, it appeared as a heterogeneously enhancing, extraconal tumor, 44 mm × 31 mm in maximal dimension, extending into the middle fossa and the adjacent subcutaneous region. Fluorodeoxyglucose positron emission tomography/CT revealed abnormal accumulation in the left breast, T12 vertebra, liver, and lung, in addition to the orbital tumor. The patient underwent total tumor resection through a lateral orbitotomy. Histological examination of the tumor was highly suggestive of a metastatic colon cancer. Late metastasis should be assumed as a differential diagnosis that can be determined only through histological verification.     

Radiofrequenzablation – ist eine Technik am Ende?

According to current scientific investigations radiofrequency ablation (RFA) as a local ablative tumor therapy for unresectable liver malignancies is currently accepted as the best therapeutic choice. The results of randomized trials justify RFA for small hepatocellular carcinomas (HCC) and RFA is considered to be a viable alternative to resection for inoperable patients with limited hepatic metastatic disease, especially from colorectal cancer (CRC LM). However, surgical resection still remains the gold standard for resectable CRC LM. The intraprocedural image guidance modality of choice is computed tomography (CT) alongside CT fluoroscopy. Contrast-enhanced ultrasound (CEUS) and magnetic resonance imaging (MRI) are used for preprocedural lesion detection and differentiation as well as for follow-up and can be used to perform RFA procedures as well. This article highlights new developments in RFA.     

CO2激光显微手术全切除侧脑室内脑膜瘤（附3例报告）

为探讨侧脑室内脑膜瘤的手术方法，用激光显微手术全切除３例侧脑室内脑膜瘤。侧脑室内脑膜瘤手术入路的选择应以肿瘤位置、形状、大小以及肿瘤血循环丰富与否为准；尽力避开功能区，以既能切除肿瘤又能减少术后并发症为主要原则。提出了用不同功率激光的手术程序和手术方法。激光显微手术可在较小的术野下精细准确地切割、汽化肿瘤，明显提高手术疗效，是目前理想的手术方法之一。     

Estadificación mediante tomografía computarizada del carcinoma de páncreas

Pancreatic carcinoma is becoming more common in our environment; the mortality rate for this tumor has barely changed over the last 20 years.Early diagnosis and accurate staging are crucial to ensure an appropriate therapeutic approach, which should aim to improve survival in patients in whom complete resection is possible and to minimize surgical morbidity and mortality in those with a high risk of residual disease after the intervention.Various imaging techniques are used for tumor staging: multidetector computed tomography (CT), magnetic resonance imaging, positron emission tomography (PET)-CT, endoscopic ultrasound, and diagnostic laparoscopy. Currently, multidetector CT is the technique of choice for the study of pancreatic tumors; thus, this article aims to review the state of the art in staging adenocarcinoma of the pancreas, focusing mainly on the applications and limitations of this technique.     

Indikationen zur chirurgischen Therapie benigner Pankreastumoren

Benign pancreatic tumors should undergo surgical resection when they are symptomatic or - in the case of incidental discovery - bear malignant potential. This is the case for the majority of benign pancreatic tumors, especially for intraductal papillary mucinous neoplasms or mucinous cystic adenomas. In addition, resection is indicated for all tumors where preoperative diagnostic fails to provide an exact classification.Several different operative techniques are available. The treatment of choice depends on the localization of the tumor, its size and on whether there is evidence of malignant transformation. Partial duodenopancreatectomy is the oncological treatment of choice for tumors of the pancreatic head whereas for tumors of the pancreatic tail a left-sided pancreatectomy is appropriate. Middle pancreatectomy or duodenum-preserving resection of the pancreatic head is not a radical oncologic procedure. They should only be performed in cases of tumors without malignant potential.     

Dosimetric aspects of radiolabeled antibodies for tumor therapy

Radioimmunotherapy (RIT) is rapidly attracting interest as a potential new weapon in the arsenal for cancer therapy. This article concentrates on some of the dosimetric aspects affecting the potential success of RIT, and examines factors which influence the choice of a radiolabel for RIT. No radionuclide is likely to give an optimum tumor/nontumor insult for all tumor types; therefore, the concept of matching the source to tumor morphology is introduced. Lists of candidate radionuclides are given, classified according to the type of decay, range, and energy of the emission. The article examines how the choice of radionuclide for radiolabeling the antibody affects the local energy deposition in the tumor. Both the effect of tumor size on the energy absorbed fraction and the problem of antibody binding heterogeneity are discussed. The approach to RIT is to relate the choice of radionuclide to the physical properties of the tumor.     

Combined therapies including interventional radiology

Interventional tumor therapies are a therapeutic option that is increasingly applied in the treatment of malignant diseases. Thermoablation of primary and secondary liver tumors is the most widely used of them, and owing to the promising results it has given, it is becoming an increasingly well-accepted treatment procedure. These interventional radiological tumor therapies must be evaluated in comparison with standard therapies, and particularly in comparison with surgical resection, radiotherapy, and systemic chemotherapy. This comparative approach to the evaluation of different therapies is reflected in the current literature. Besides this approach, interdisciplinary combination of therapies is a promising approach to the optimization of oncological therapy strategies. Local thermoablation in association with systemic or local chemotherapy, and surgical resection in association with thermoablation are interdisciplinary therapy concepts that expand the range of therapeutic options available. Against this backdrop, studies to evaluate interventional tumor therapies as part of interdisciplinary combination therapies are necessary.     

Interventionelle Kombinationstherapien

Interventional tumor therapies are a therapeutic option that is increasingly applied in the treatment of malignant diseases. Thermoablation of primary and secondary liver tumors is the most widely used of them, and owing to the promising results it has given, it is becoming an increasingly well-accepted treatment procedure. These interventional radiological tumor therapies must be evaluated in comparison with standard therapies, and particularly in comparison with surgical resection, radiotherapy, and systemic chemotherapy. This comparative approach to the evaluation of different therapies is reflected in the current literature. Besides this approach, interdisciplinary combination of therapies is a promising approach to the optimization of oncological therapy strategies. Local thermoablation in association with systemic or local chemotherapy, and surgical resection in association with thermoablation are interdisciplinary therapy concepts that expand the range of therapeutic options available. Against this backdrop, studies to evaluate interventional tumor therapies as part of interdisciplinary combination therapies are necessary.     

High dose rate treatment of a maxillary sarcomatoid carcinoma: a case report.

A 37-year old Native American woman presented with a rare sarcomatoid carcinoma of the left maxilla. She underwent extensive resection, but developed an orbital cavity recurrence. This was treated with external beam radiation therapy. The boost posed dosimetric difficulties due to the anatomic peculiarities of the treatment area. Extensive treatment planning for a high dose rate Iridium 192 source helped overcome these problems. Control of the tumor was achieved in the site of recurrence.     

Metastasen des kolorektalen Karzinoms

Metastases of colorectal cancer represent an interdisciplinary therapeutic challenge. Evidence-based guidelines are supportive of treatment decisions in specific situations with the objective to improve the therapeutic outcome for patients. Interventional tumor therapies are increasingly applied therapeutic options in the treatment of colorectal metastases. The current literature indicates that thermoablation of colorectal liver metastasis can lead to an improved survival in selected patients. However, recommendation of thermoablation as a part of guidelines for the therapy of colorectal metastases is restricted due to a shortcoming of randomized controlled trials. Therefore, interventional tumor therapies have to be evaluated in comparison with standard therapies, particularly with regard to surgical resection and chemotherapy. Moreover, the interdisciplinary combination of tumor ablation, surgical resection, and chemotherapy is a promising approach for the optimization of oncological therapy strategies in the treatment of colorectal metastases.     

Recurrent desmoid tumor arising from latissimus dorsi flap: A case report

Fibromatosis or desmoid tumor in the breast is a very rare benign soft tissue tumor. We report a case of recurrent desmoid tumor arising from latissimus dorsi flap after lumpectomy for breast carcinoma. To our knowledge, this is the first case of desmoid tumor arising from the latissimus dorsi flap. Despite its benignity, desmoid tumor is often locally aggressive, therefore timely diagnosis and proper management are very important. Imaging and pathological diagnosis as well as treatment management are discussed. High clinical suspicion and multidisciplinary approach are essential for prompt diagnosis and management. Wide surgical resection is required, but there is no consensus regarding treatment due to limited data.     

Management of thyroid eye disease

Thyroid eye disease (TED) is the most frequent extrathyroidal manifestation of Graves' disease. In most instances it is mild and non-progressive, but in 3%-5% of cases it is severe. Non-severe TED requires only supportive measures, such as eye ointments, sunglasses and prisms. By contrast, severe TED requires aggressive treatment, either medical (high-dose glucocorticoids, orbital radiotherapy) or surgical (orbital decompression). The choice of treatment relies on the assessment of both TED severity and activity. Removal of controllable risk factors, especially cigarette smoking, is important to improve the course and the therapeutic outcome. A coordinated approach to the treatment of hyperthyroidism and TED is also required. Novel promising treatments, to be verified in large series of patients, include somatostatin analogues and cytokine antagonists.     

胸腔镜-内镜并用和腹腔镜-内镜并用进行2例食管肌瘤切除手术

背景平滑肌瘤是常见的食管良性肿瘤,术前若能排除恶性的可能,则可通过胸腔镜或腹腔镜进行最小侵入性的手术治疗。方法此处报道2例手术,均借助内镜接近术位,一例通过胸腔镜切除了一个食管中部的肿瘤,另一例通过腹腔镜切除了一个食管末端的肿瘤。通过这种胸腔镜与内镜并用和腹腔镜与内镜并用的方法,切除手术较简单,也避免了在身体上做切口。结论推荐采用最小侵入性手术疗法切除良性的食管黏膜下肿瘤。位于食管中部和下部三分之一段的肿瘤可以很容易地被切除。推荐在手术中并用内镜控制以避免损伤黏膜。     

Contrast optimization of fluid-attenuated inversion-recovery (FLAIR) MR imaging in patients with high CSF blood or protein content.

After surgical resection of a brain tumor or infection of the cerebrospinal fluid (CSF), elevated levels of blood by-products or protein contaminations are seen in the patient's CSF spaces. In fast fluid-attenuated inversion-recovery (FLAIR) imaging CSF signal is nulled by an appropriate choice of the inversion recovery time TI to improve the contrast between tissue structures adjacent to CSF-filled volumes. With contaminated CSF, however, the longitudinal relaxation time T(1) may change significantly, which results in an incomplete suppression in the FLAIR images, if standard inversion times are used. In this work, a fast single-voxel T(1) measurement pulse sequence with integrated T(1) calculation that allows determination the optimal TI value in 15 sec is presented. The method was tested in five patients after surgical resection of a brain tumor, where FLAIR MRI with and without contrast agent was performed to identify remaining tumor fragments at the margin of the resection cavity.     

Radiofrequency ablation of liver cancer

The development of image-guided percutaneous techniques for local tumor ablation has been one of the major advances in the treatment of liver malignancies. Over the past two decades, several methods for chemical or thermal tumor destruction have been clinically tested. Among these methods, radiofrequency (RF) ablation is currently established as the primary ablative modality at most institutions. RF ablation is accepted as the best therapeutic choice for patients with early stage hepatocellular carcinoma (HCC) when liver transplantation or surgical resection is not suitable options. In addition, RF ablation is emerging as a viable alternative to surgery for inoperable patients with limited hepatic metastatic disease, especially from colorectal cancer. Several series have shown that RF ablation can result in complete tumor eradication in properly selected candidates, and have provided indirect evidence that the treatment improves survival. In this article, we review technique, indications, and clinical results of percutaneous RF ablation in the treatment of HCC and colorectal hepatic metastases.     

CT and MR imaging of the pediatric orbit.

Orbital abnormalities encountered in the pediatric population differ substantially from those found in adult patients. Retinoblastoma, the most serious intraocular tumor, is often difficult to diagnose, but use of computed tomography (CT) (which reveals the characteristic focal calcification) and magnetic resonance (MR) imaging allows this tumor to be differentiated from pseudogliomas, such as Coats disease, and retrolental fibroplasia. CT and MR imaging help in the differentiation of orbital cellulitis from preseptal, lacrimal, and eyelid infectious processes and of orbital pseudotumor from Graves disease. In cases of orbital trauma, CT is excellent for detecting orbital fractures and metallic foreign bodies; MR imaging is better for depicting ocular and optic nerve injuries. Both modalities allow the differentiation of rhabdomyosarcoma from dermoid, cavernous hemangioma, and lymphangioma and provide helpful information for the diagnosis of many other tumors. Since CT and MR imaging have widely expanded the capabilities of orbital imaging, it is more important than ever before for radiologists to understand pediatric orbital disease.     

Radiology for detecting brain tumor recurrences.

Angiography, 99Tcm-pertechnetate scintigraphy and encephalography are compared in their efficacy in the detection of tumor recurrences in 45 patients following brain tumor resection. No single method is always preferable and the best way of detecting a particular tumor recurrence is based on the location and nature of the primary tumor. Scintigraphy is the method of choice for performing routine postoperative follow-up. In cerebral hemisphere tumors angiography may be replaced by brain scanning which is a lesser procedure for the patient and does not necessitate hospitalisation. Encephalography is the examination favoured for detecting recurrences near the base of the skull. Angiography is the best method for demonstrating recurrences near the surface in the region of craniotomy and is essential before reoperation.