Correlation between the grade of tumoral invasion and pain relief in patients with celiac ganglia block.
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Abdominal Neoplasms↗
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Abdominal aortic aneurysms. Unusual clinical manifestations.
Misleading symptoms were responsible for failure to make the diagnosis of symptomatic abdominal aortic aneurysm in 15 patients. The presenting complaints appeared to be specific for other diseases, such as genitourinary disease, diverticulitis, intra-abdominal neoplasm and functional large intestinal disorders. A correct diagnosis was ultimately made in 12 patients and aneurysmectomy was performed. In three patients, who died of ruptured aneurysm, the diagnosis was not made until postmortem examination. An awareness of the atypical symptoms of aneurysms, careful physical examination and appropriate x-ray studies will lead to the diagnosis of symptomatic aortic aneurysms. Early resection will result in a lower mortality rate.
Aged↗
Pseudomyxoma peritonei. Long-term patient survival with an aggressive regional approach.
OBJECTIVE: The aims of this study were to analyze the natural history of patients with pseudomyxoma peritonei (PMP), evaluate clinical and pathologic variables as prognostic indicators, and review the authors' experience with different treatments. SUMMARY BACKGROUND DATA: PMP is an unusual form of intra-abdominal neoplasm that presents with large amounts of extracellular mucin. Diffuse peritoneal spread occurs in most patients with PMP, and distant metastasis is infrequent. Debulking surgery, radiation therapy (radioisotope and external beam), and chemotherapy (both intraperitoneal and systemic) have all been advocated for optional patient management, but the variability of patients studied, the small patient numbers, and the prolonged course of this disease make the evaluation of results difficult. METHODS: Fifty-six patients were treated for PMP at the Mayo Clinic between 1957 and 1983. The data were collected retrospectively. Univariate (log-rank test) and multivariate (Cox regression model) analyses were performed for disease recurrence and patient survival. RESULTS: Most patients with PMP had carcinomas of the appendix (52%) or ovary (34%). All gross tumor could be removed only in the 34% of patients with limited disease. Although tumor progression occurred in 76% of patients, the 1-, 5-, and 10-year survival rates were 98%, 53%, and 32%, respectively. Adverse predictors of patient survival included weight loss (p = 0.001), abdominal distention (p = 0.004), use of systemic chemotherapy (p = 0.005), diffuse disease (p = 0.038), and invasion of other organs (p = 0.04). Intraperitoneal chemotherapy (p = 0.009) and radioisotopes (p = 0.0043) both were effective in prolonging the recurrence time of symptomatic PMP. CONCLUSIONS: Although PMP is an indolent disease, aggressive surgical debulking followed by intraperitoneal radioisotopes and/or chemotherapy should be considered because of the diffuse peritoneal involvement.
Adolescent↗
Reduction of abdominal wall blood flow by clamping or carbon dioxide insufflation increases tumor growth in the abdominal wall: an experimental study in rats.
BACKGROUND: We have previously demonstrated that there is a reduction of blood flow in the abdominal wall in rats insufflated with air concomitant with an increase in tumor growth. The present study was designed to examine whether a reduction of blood flow achieved by clamping or insufflation with carbon dioxide (CO(2)) would increase tumor growth in the abdominal wall. METHODS: In the first part of the experiments, laser Doppler blood flow of both rectus muscles was measured in 16 Wistar Fu rats. The left rectus muscle was clamped to reduce blood flow, and 5 x 10(4) adenocarcinoma cells were injected into both rectus muscles. Clamping was maintained for 45 min. In the second part, 22 rats had 5 x 10(4) adenocarcinoma cells injected into the rectus muscle and blood flow was measured. The experimental group (n = 11) was insufflated with CO(2) at 10 mmHg for 45 min; the control group (n = 11) was not insufflated. After 9 days, tumor weight and volume were analyzed. RESULTS: Clamping caused a 69% reduction of blood flow (p < 0.001), whereas no reduction was registered on the nonclamped side. Tumor weight (p = 0.028) and volume (p = 0.030) were increased on the clamped side. The insufflation of CO(2) caused a 71% reduction of blood flow, whereas no reduction was registered in the control group. Tumor weight (p = 0.006) and volume (p = 0.006) were increased in the insufflated group. CONCLUSION: Clamping, as well as CO(2) insufflation, causes a significant reduction of blood flow in the abdominal wall, which seems to increase tumor growth at the same site.
Abdominal Neoplasms↗
[Differential sonographic diagnosis of retroperitoneal tumors].
Presentation of the sonographic findings of 170 retroperitoneal masses: primary and metastatic neoplasms, abdominal aortic aneurysms, hematomas and abszesses. A typical diagnostically reliable sonographic pattern was seen only in retroperitoneal hematomas in the area of the psoas and in aortic aneurysms, provided the aorta itself could be visualized. In all the other masses the ultrasound pattern did not provide reliable clues as to their histology; ultrasound, however, proved to be highly successful in demonstrating the presence and location of the lesion.
Abscess↗
Calcifying fibrous pseudotumor: a rare benign tumor detected on bone scintigraphy.
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Abdominal Neoplasms↗
Biphasic synovial sarcoma of the abdominal wall.
Synovial sarcoma arising in the abdominal wall is a rare tumor. We report a case of a 38-year-old man who complained of abdominal pain. Physical examination revealed a firm mobile mass, 25 cm in diameter, in the left lower abdominal wall. The tumor was first thought to be a sarcoma arising from the omentum or mesentery. During surgery, a large tumor was found attached to the inner surface of the abdominal wall and compressing the gastrointestinal tract. On microscopic examination the tumor corresponded to a biphasic synovial sarcoma immunoreactive for cytokeratins (AE1/AE3, 7 and 19), epithelial membrane antigen and carcinoembryonic antigen in the epithelial tumor cells, for E-cadherin especially in their glandular structure, vimentin, CD99, and CD56 in the spindle cell component and for bcl-2 protein. The tumor recurred at the same site, and clinical course progressed to death 3 months after the initial diagnosis.
12E7 Antigen↗
[Abdominal and pelvic segmented T1-weighted echo-planar imaging and MRI. Comparison with T1-TSE and T2-UTSE sequences].
PURPOSE: To assess, quantitatively and qualitatively, the diagnostic value of a segmented EPI T1W sequence compared to T1W and T2W TSE sequences. MATERIAL AND METHODS: A prospective analysis of abdominal and pelvic MRI examinations of 70 patients (44 women, 26 men, mean age of 61 years), was performed on a 0.5 T supraconductive magnet with 15 mT/m gradients. The sequences were randomized and compared in a blinded fashion by 3 independent reviewers: TSE T1W (TR/TE = 500/12 ms, NSA = 6, turbo factor 5, 3:49 min), EPI T1W (TR/TE = 500/30 ms, NSA = 6, EPI factor = 7, 2:13 min) and UTSE T2W (TR/TE = 1600-2500/100, NSA = 6, turbo factor = 31, 2:20 min). RESULTS: Quantitatively, no significant difference was found between T1W sequences for signal to noise ratio. The EPI T1W sequence had lower signal but stronger enhancement after gadolinium injection. Qualitatively, EPI T1W had significantly less flow artefacts (p < 0.001, wilcoxon test), and more chemical shift artifact (p < 0.01). For lesion detection, differences were not statistically significant between T1W sequences or between paired T1W and T2W sequences (sensitivity and specificity 84 and 86% for TSE T1W 76 and 86% for EPI T1W, 78 and 79% for UTSE T2W, 90 and 65% for TSE T1W-UTSE T2W, 88 and 65% for EPI T1W-UTSE T2W). Kappa concordance test (0.686) and Mac Nemar symmetry test (3.55) were high between T1W sequences. CONCLUSION: The segmented EPI T1W sequence used had equivalent results compared to the TSE T1W sequence, it allows a 40% reduction in acquisition time and this without difference in the diagnostic performances of the reviewers.
Abdomen↗
Combined neurolytic block of celiac, inferior mesenteric, and superior hypogastric plexuses for incapacitating abdominal and/or pelvic cancer pain.
Thirty-five patients with extensive abdominal or pelvic cancer who suffered uncontrolled, diffuse, extensive, and incapacitating pain were treated with a combination of neurolytic celiac plexus block (CPB), inferior mesenteric plexus block (IMPB), and superior hypogastric plexus block (SHGPB). The combination of neurolytic CPB, IMPB, and SHGPB was performed with alcohol, mainly using a transintervetebral disc approach. The combination neurolysis produced effective immediate pain relief in all the patients (visual analog scale (VAS), reduced from 8.8 +/- 0.2 to 0). This pain relief persisted during the first 3 months (VAS, 2.3 +/- 0.5) or until death. Morphine consumption was significantly decreased for the first 1 month (from 96 +/- 29 mg to 31 +/- 10 mg per day) after the neurolysis and thereafter continued to be lower than before the surgery, though not significantly so. No serious complications were observed to have been caused by the neurolytic procedure on the three sympathetic plexuses. Our preliminary clinical results suggest that the combination of neurolytic CPB, IMPB, and SHGPB improves the quality of life of patients who have incapacitating cancer pain, by reducing both the intensity of the pain and their opioid consumption, without serious complications. This combination procedure may provide a new therapeutic option for pain relief in patients with advanced cancer.
Abdominal Neoplasms↗
Diagnostic yield and management benefit of laparoscopy: a prospective audit.
A prospective audit of the diagnostic yield and management benefit of laparoscopy was undertaken in 220 consecutive patients. The procedure was performed electively in 180 patients and as an emergency in 40. The indications for laparoscopy in the elective group were suspected hepatic disease, staging of intra-abdominal malignancy, diagnostic problems, and chronic abdominal pain. Emergency laparoscopy was performed in patients admitted with acute abdominal pain. Diagnostic benefit varied with the indication for the procedure: liver disease 71%, tumour staging 87%, uncertain diagnosis 74%, acute abdominal pain 100%, and chronic abdominal pain 41%. Clinical management was significantly influenced by laparoscopy in 15 of 21 (71%) patients with liver disease, 10 of 30 (33%) with intra-abdominal malignancy, 5 of 19 (26%) with uncertain diagnosis, 32 of 40 (80%) with acute abdominal pain, and 15 of 110 (23%) patients with chronic abdominal pain. A wrong assessment of the nature or stage of the disease was made by laparoscopy in 3 of 220 (1.0%). There was no morbidity or mortality attributed to laparoscopy in the study.
Abdomen, Acute↗
Long-term results of celiac Ganglia block: correlation of grade of tumoral invasion and pain relief.
OBJECTIVE: We evaluated the long-term results and response rates of celiac ganglia block to the level of tumor invasion of the celiac region. SUBJECTS AND METHODS. Forty-one patients each with an inoperable intraabdominal carcinoma who were referred to our department for celiac ganglia block were included in this study. Tumor invasion of the celiac ganglia region was graded on a four-point scale according to CT features (grade I = no invasion, grade II = invasion < 50%, grade III = invasion > 50%, and grade IV = complete invasion). Subjective pain levels (0 = no pain, 10 = worst pain) were obtained from the patients, and objective criteria (change in daily analgesic doses) were noted before the procedure and during the follow-up to determine effectiveness of the celiac ganglia block. RESULTS: Celiac ganglia block was successfully performed in all 41 patients (100%). In 39 (95%) of 41 patients, pain decreased significantly after the procedure, and the pain level did not change in the remaining two patients. Major complications were not encountered in any of the patients. Minor complications were observed in 35 patients (85%). Mean pain intensity and mean daily analgesic consumption significantly decreased after the procedure in all four groups. The amount of pain decrease for these two parameters was inversely related to degree of invasion. Responses of the patients were obtained at the end of the first week after the procedure and remained unchanged during long-term follow-up. CONCLUSION: Percutaneous celiac ganglia block, particularly when performed in earlier stages of ganglia invasion, is an effective, easy, and safe procedure with successful long-term results.
Abdominal Neoplasms↗
Intraperitoneal delivery of hrR3 and ganciclovir prolongs survival in mice with disseminated pancreatic cancer.
UNLABELLED: BACKGROUND AND OBJECTIVES; Intraperitoneal dissemination of pancreatic cancer is associated with a poor prognosis. Surgical resection does not prolong survival. Here we describe a novel approach to this difficult clinical problem consisting of intraperitoneal delivery of the herpes simplex virus (HSV) vector (hrR3) to mice with peritoneal dissemination of the pancreatic cancer cells. METHODS: The human pancreatic cancer cell line (SW1990) was implanted into the abdominal cavity of nude mice. Fifteen days later, the abdominal neoplasm was treated by intraperitoneal injection of the replication-conditional HSV vector (hrR3). The mutant lacks the ribonucleotide reductase gene, but contains an intact HSV-tk gene. Beginning 5 days after vector injection, mice were treated with a 14-day course of ganciclovir. RESULTS: Long-term survival (150 days) was seen in 70% of mice receiving hrR3 and ganciclovir, 40% of mice receiving hrR3 alone, and 0% of untreated mice. No vector-related mortality was observed. X-Gal tissue staining revealed blue-stained cells only in tumor nodules, not in normal organs. CONCLUSIONS: Intraperitoneal delivery of hrR3 and ganciclovir improves survival in this murine model of peritoneal dissemination of pancreatic cancer. The ability of hrR3 to replicate only in rapidly dividing cells makes this virus an attractive vector for gene therapy of cancer.
Animals↗
Operability and early outcome in 100 consecutive laparotomies for peritoneal malignancy.
BACKGROUND: Peritoneal malignancy is common at the terminal stages of many intra-abdominal neoplasms. In selected patients a novel approach of complete macroscopic tumour removal by extensive surgical cytoreduction, combined with intraperitoneal chemotherapy, provides a possibility of cure. Initial experience with 100 consecutive laparotomies is reported. METHODS: Between 1994 and 2002, 218 patients with peritoneal malignancy were referred to a specialized unit. One hundred underwent laparotomy, of whom 85 had a primary appendiceal tumour. Treatment aims were complete macroscopic tumour excision combined with intraoperative intraperitoneal chemotherapy. RESULTS: Sixty-five patients had complete macroscopic tumour excision, 28 palliative major cytoreduction and seven were inoperable. The overall mortality rate was 8 per cent. The most common complications were pulmonary (25 per cent) and wound (14 per cent) infection. At a median follow-up of 30 (range 3-113) months, 44 of 51 patients with primary appendiceal tumours who had complete macroscopic cytoreduction were alive and 36 were disease free. CONCLUSION: Cytoreduction combined with intraperitoneal chemotherapy is an emerging technique with promising results in selected patients with peritoneal malignancy.
Adult↗
Somatostatinoma: a case report and review of the literature.
Somatostatinomas are rare endocrine tumors that were first described in 1977. In addition to the present case report, there have been 31 cases reported in the literature. We have reviewed the literature to integrate the symptoms, physical findings, diagnostic tests, treatment, and length of survival of these patients. Although the symptoms that occurred in the majority of cases were those that are seen in most patients with intra-abdominal neoplasms, symptoms relating to the presence of excess circulating somatostatin--diabetes, maldigestion, and cholelithiasis--were frequently seen. Physical findings and the results of diagnostic tests were usually nonspecific. The majority of the patients underwent radical surgical procedures (Whipple procedure or pancreatic resection). The pancreas was the most frequent site of involvement (21/31 cases), but primaries in the duodenum, ampulla of Vater, cystic duct, and jejunum have been described as well. Metastases were most frequently seen in the liver and lymph nodes. Chemotherapeutic agents were administered to 10 patients, usually as adjuvant therapy, and appear to be useful in treating recurrent and metastatic disease. The one-year survival of these patients is 48%, which is better than that for patients with carcinoma of the pancreas or biliary tree. Therefore, it is important that the diagnosis of somatostinoma be made so that the patient may be treated accordingly and followed by serial somatostatin levels for evidence of metastasis or recurrent disease.
Adenoma, Islet Cell↗
Two- and three-dimensional Doppler ultrasound analysis of abdominal wall clear cell carcinoma.
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Abdominal Neoplasms↗
The value of CT in genetic counseling in tuberous sclerosis.
The families of two patients with known tuberous sclerosis were electively evaluated by computed tomography. The CT positive (and negative) examination proved to be valuable for the genetic counseling of family members without overt clinical manifestations of tuberous sclerosis. Two patients had evidence of smaller enhancing lesions (minimal demonstrable mass without hydrocephalus) following intravenous contrast enhancement. We, therefore, suggest the use of contrast enhanced scans in addition to the plain scans to identify what may represent occult neoplasms. Abdominal CT scans can prove useful in identifying the frequently associated renal hamartomas.
Adolescent↗
The value of hyoscine butylbromide in abdominal MR imaging with and without oral magnetic particles.
PURPOSE: The purpose of this article was to assess the impact of intravenous (IV) anticholinergic hyoscine butylbromide in abdominal magnetic resonance (MR) imaging with oral magnetic particles (OMP) [ABDOS-CAN, Ferristene (USAN), Nycomed Imaging AS, Oslo, Norway]. MATERIALS AND METHODS: In 31 patients with abdominal tumors, T1-weighted spin-echo (SE) images (SE 600/ 15; 1.5 T) were obtained without and with IV hyoscine butylbromide (20 mg) before and after administration of 800 ml of OMP. Two blinded readers assessed motion artifacts, bowel-wall visualization, and lesion delineation on the four sets of T1-weighted images. The two-tailed Wilcoxon paired sample test was used for statistical analysis (p < .05). RESULTS: Hyoscine butylbromide reduced motion artifacts and improved bowel-wall visualization on precontrast and OMP-enhanced images at a statistically significant level (p = 0.0006-0.037). The lowest degree of artifacts was recorded on OMP images with hyoscine butylbromide. OMP with hyoscine butylbromide significantly improved lesion delineation compared to studies without antiperistaltic drug before (p = 0.019) and after OMP administration (p = 0.01). CONCLUSIONS: The authors conclude that the use of IV hyoscine butylbromide is recommended for OMP-enhanced abdominal MR imaging with T1-weighted SE pulse sequences at 1.5 T.
Abdominal Neoplasms↗
Laparoscopic resection of an abdominal wall desmoid using a modified suture traction technique: the "marionette trick".
Desmoids are rare mesenchimal tumors that may originate also inside the abdomen or in the abdominal wall. These tumors are biologically characterized by a tendency to local growth, and only rarely are they able to develop distant metastases. Surgical excision usually is the best treatment with a chance of a cure. In the few reports on intraabdominal or abdominal wall desmoids, open surgery always was performed. The first case of successful laparoscopic resection of a symptomatic anterior wall desmoid tumor with intraabdominal growth is reported. During the procedure, it was difficult to mobilize and grasp the mass using the common laparoscopic instruments, but with the help of the "marionette trick," modified suture traction technique, the tumor could be removed easily using only three trocars. With four traction sutures minimizing the wall trauma, the trick made it possible to mobilize the mass in at least, seven directions, according to the principles of physical forces and vectors. This simple trick can be helpful for other common laparoscopic procedures, avoiding the insertion of sometimes ineffective instruments through more traumatic trocars.
Abdominal Neoplasms↗