[Intraoperative neoplastic implantation on the cicatrix].
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A 76-year-old male patient complained of frequent urination. Computed tomographic and magnetic resonance imaging scans revealed a heterogeneous mass involving his bladder, prostate and Sigmoid colon. He was diagnosed with an invasive urachal tumor and surgery was performed due to severe tumor adhesion to adjacent organs. Partial resection of the tumor was performed with partial cystectomy and sigmoidectomy. A post-operative pathological diagnosis revealed the tumor was a desmoid abdominal wall tumor. The desmoid abdominal wall tumor was not easily differentiated preoperatively from an urachal tumor.
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OBJECTIVE: In Japan, the incidence of both colorectal carcinoma and vascular disease is increasing. We screened preoperative patients with abdominal aortic aneurysm (AAA) or peripheral artery disease (PAD) for colorectal cancer. DESIGN OF STUDY: This study was retrospective and cross-sectional. MATERIALS: The subjects were 492 patients admitted for elective surgery of AAA or PAD. METHODS: The patients underwent immunochemical faecal occult blood tests (FOBT) before operation, and those with positive results underwent investigations for colorectal neoplasm. We compared the results with that of screening programmes performed on the general population. RESULTS: Of the 408 patients that underwent FOBT, 104 (25.5%) were positive. After colonoscopy, six (1.5%) had colorectal carcinoma and 16 (3.9%) had advanced adenoma. These values were several folds higher than that for the general population in Japan. CONCLUSIONS: Patients with AAA or PAD carry a high risk for colorectal neoplasm.
Thoracoabdominal tumors of childhood include a pathologically diverse spectrum of neoplasms. Improved survival for many of these once lethal malignancies reflects current multimodality approaches to treatment based on the combined experience of specific tumor study groups. The choice of surgery, chemotherapy, and/or radiation depend on accurate clinical and radiologic staging based on determination of tumor extent and the feasibility of surgical resection. Advanced cross-sectional and scintigraphic imaging techniques have enhanced the accuracy of radiologic assessment and staging. Established pathologic patterns of local extension and more distant dissemination, as well as the relative sensitivity and specificity of applicable imaging modalities determine radiologic approaches to radiologic staging of specific neoplasms.
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Three cases of abdominal and chest wall defects after radical excision of soft tissue sarcomas reconstructed with dura mater are presented. Based on intraoperative findings and early results it is suggested that dura mater (Lyodura) is of great value for the repair of full-thickness integument defects.
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From 1982 through 1989, 94 patients at the University of Louisville with ovarian neoplasm had abdominal instillation of 15 mCi chromic 32P as part of their management. The timing of the 32P was immediately postoperative in 55 patients and delayed greater than 24 hr in 39 patients. This is an analysis of factors contributing to gastrointestinal (GI) complications. GI complications were graded according to RTOG guidelines. There was a total of 11 GI complications grade 3 or worse for an overall incidence of 12%. Factors analyzed include timing of 32P delivery, age, stage, number of previous surgeries, use of Hyskon at surgery, addition of external beam radiation, and subsequent use of chemotherapy. There were significantly fewer complications when 32P was given on the same day as surgery than when 32P administration was delayed more than 12 hr following surgery (4% vs 21%), P = 0.007. This difference held significance when adjusted for the number of previous surgeries, use of Hyskon, external beam radiation, and stage. None of the other factors had a significant effect on complication rate. There have been no incidences of contamination even though 32P instillation in the immediate post-operative period had increased risk of contamination due to wound leakage or reoperation. In our experience, the delivery of 32P in the immediate postoperative period resulted in a significant reduction in abdominal complications.
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BACKGROUND AND OBJECTIVES: The management of unexpected intra-abdominal malignancy, discovered at laparotomy for elective treatment of an abdominal aortic aneurysm (AAA), is controversial. It is still unclear whether both conditions should be treated simultaneously or a staged approach is to be preferred. To contribute in improving treatment guidelines, we retrospectively reviewed the records of patients undergoing laparotomy for elective AAA repair. METHODS: From January 1994 to March 2003, 253 patients underwent elective, trans-peritoneal repair of an AAA. In four patients (1.6%), an associated, unexpected neoplasm was detected at abdominal exploration, consisting of one renal, one gastric, one ileal carcinoid, and one ascending colon tumor. All of them were treated at the same operation, after aortic repair and careful isolation of the prosthetic graft. RESULTS: The whole series' operative mortality was 3.6%. None of the patients simultaneously treated for AAA and tumor resection died in the postoperative period. No graft-related infections were observed. Simultaneous treatment of AAA and tumor did not prolong significantly the mean length of stay in the hospital, compared to standard treatment of AAA alone. CONCLUSIONS: Except for malignancies of organs requiring major surgical resections, simultaneous AAA repair and resection of an associated, unexpected abdominal neoplasm can be safely performed, in most of the patients, sparing the need for a second procedure. Endovascular grafting of the AAA can be a valuable tool in simplifying simultaneous treatment, or in staging the procedures with a very short delay.
B-mode ultrasonography was performed in 246 patients with suspected abdominal masses over a seven-year period. In 105 (40 percent), the accuracy of ultrasonic diagnosis was evaluated surgically. Sonography was proven correct in 60 (57 percent) patients who had undergone operation. Among 141 patients who had not undergone operation and whose diagnoses were established by other means, ultrasonography agreed with the clinical diagnosis in 69 (31 percent). Ultrasound accuracy, as confirmed by operation, was highest for splenic masses (100 percent) and for aortic aneurysm (88 percent). Liver masses were correctly identified in 56 percent of patients and gallbladder lesions in 38 percent. While only a 48 percent accuracy was obtained in diagnosing pancreatic disease, 64 percent of all pseudocysts were localized. Ultrasonography correlated positively with operative findings in 56 percent of renal masses. Intraperitoneal abscess was accurately diagnosed in 61 percent of patients but retroperitoneal adenopathy in only 33 percent. Abdominal ultrasonography, while accurately diagnosing splenic and aortic masses, failed to identify approximately half of other mass lesions. Improved techniques hold promise of improving this diagnostic accuracy.