Modern technologies of diagnosis and combined surgical treatment in liver tumors

Modern technologies used at St. Petersburg Central Research Institute of Roentgenology and Radiotherapy of Russia's Ministry of Health in the diagnosis and treatment of malignant and benign liver cancers are surveyed in the paper. Apart from routine examinations, like ultrasound scanning, computer tomography, MRT, angiography, the below new technologies were widely used: multi-stratum spiral computer tomography, special MRT techniques and positron-emission tomography. The new methods enabled us to diagnose the tumor and its extension, to choose an optimal intervention technique, to make an objective assessment of the results and to correct the treatment strategy. Preoperative embolization of the portal-vein branches in the damaged hepatic lobe and postoperative adjuvant local chemotherapy of the hepatic artery and portal vein belong to the new combined surgical treatment scheme. The method of combined arterial-portal chemoembolization, used in unresectable malignant hepatic pathologies, extends the survival of patients by 3-5 times. Ferromagnetic embolization presupposes the administration of ferromagnetic, through the arterial bed or direct puncture, into the tumor with a subsequent SHF-current treatment which brings about a selective tumor hyperthermia without heating the normal hepatic parenchyma. Arterial embolization combined with local injection sclerotherapy in hemangiomas of the liver provides for a complete regeneration of benign tumors and can be regarded as a low-trauma alternative to liver resection. The use of new methods of diagnosis and treatment expands the possibilities of surgical care for patients with hepatic neoplasms and essentially improves the treatment results.     

Clinical aspects, diagnosis and surgical treatment of developmental anomalies of the cervical spine

The examination of 20 patients with abnormal cervical spine has identified Klippel-Feil disease in 12 of them, isolated vertebral synostoses of the cervical spine in 8. In 2 patients with Klippel-Feil anomaly neurovascular syndrome was reported which resulted from compression of the neurovascular bundle by extra cervical ribs. Indications to surgical treatment in Klippel-Feil disease are specified. The authors performed operations to correct the cosmetic defect and relieve compression of the neurovascular bundle in neurovascular syndrome.     

23-year experience on diagnosis and surgical treatment of benign and malignant cardiac tumors

Introduction

Although myxoma is the most frequent cardiac tumor, other conditions should be taken into consideration in the differential diagnosis. Transthoracic echocardiography (TTE), followed by transesophageal echocardiography (TEE) remain the principal methods for cardiac tumor screening and visualizing. The aim of the study was to compare the diagnostics, surgical treatment and prognosis of malignant and benign cardiac tumors.

Material and methods

From 1986 to 2009 there were 121 patients with cardiac tumors operated on in the Cardiac Surgery Clinic of the Medical University in Lodz. Patients were referred to surgery mainly on the basis of the TTE and TEE image. In 4 cases valvular prosthesis implantation or valve repair were carried out. Patients remained under long-term observation in the Cardiac Surgery Outpatient Clinic.

Results

Myxoma was diagnosed in 114 cases. Malignancies were discovered in 7 cases. The left atrium was the most frequent localization. The echocardiographic image differed significantly in benign and malignant tumors. The postoperative period was complicated by embolic events or myocardial infarctions. Only malignant tumors were associated with mortality due to cardiovascular events. The survival for malignant tumors was significantly shorter.

Conclusions

Short and long-term results of operative treatment are very good for benign tumors in contrast to cardiac malignancies. The TTE and TEE image can be very significant in the final diagnosis.