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Very-high-flow injection rate for upper abdominal CT angiography.

BACKGROUND: The purpose of this study was to compare a very-high-flow injection-rate method (group A) and a conventional injection-rate method (group B) for visualization of upper abdominal arteries by multidetector helical computed tomography (MDHCT). METHODS: The subjects were 240 patients suspected to have abdominal lesions. They were randomly assigned to group A (120 patients) and group B (120 patients). In group A, the bilateral medial cubital veins were punctured, and contrast medium was infused at a rate of 8.6-9.6 ml/s. In group B, the unilateral medial cubital vein was punctured, and contrast medium was infused at a rate of 2.0-3.0 ml/s. The quality of vascular visualization was graded as poor, good, or excellent by three radiologists. RESULTS: All visualizations of the celiac trunk (CE) and superior mesenteric artery (SMA) were graded as excellent in both group A and group B. Visualization grades of the subsegmental branches of the hepatic artery (HA), right gastric artery (RGA), cystic artery, dorsal pancreatic artery (DPA), and superior pancreaticoduodenal artery (SPDA) were good or excellent, in 75% (paging method)/53.3% (three-dimensional method), 85%/30%, 77.7%/18.3%, 76.7%/28.3%, and 88.3%/42.5%, respectively, in group A, and 33.3%/11.7%, 46.7%/3.4%, 41.6%/5%, 55%/4.2%, and 72.5%/14.2%, respectively, in group B. The appearance rate of intrahepatic portal branches was 28.3% in group A and 66.7% in group B in the arterial dominant phase. CONCLUSION: Group A showed better visualization results than Group B in upper abdominal arteries according to MDHCT.

Abdomen↗

Intraabdominal haemangiopericytoma associated with uncontrolled diabetes mellitus.

Haemangiopericytoma (HPC) is a rare tumour with a predilection for the central nervous system. Though previously thought to originate from the meninges and ventricular walls, HPC's are currently accepted as distinct mesenchymal neoplasms unrelated to meningiomas. Haemangiopericytomas have been previously reported to be associated with the production of insulin like growth factor II (IGF-II) and hypoglycaemia. A case of a 61-year-old poorly controlled diabetic lady with a rare presentation of an abdominal haemangiopericytoma is discussed. A laparoscopic assisted resection of the massive lobulated tumour arising from the parietal peritoneum with dense attachment to the diaphragm and the liver was performed with an uncomplicated postoperative recovery. Control of the patient's diabetes improved dramatically following surgery and the rare association of hyperglycaemia and HPC, which has not been previously described, is elaborated upon in this report.

Abdominal Neoplasms↗

Hemihypertrophy.

Hemihypertrophy refers to asymmetry of the body to a greater degree than can be attributed to normal variation. Most causes can be diagnosed from history and physical examination. Hemihypertrophy is cosmetically unsightly and the psychological impact can be quite prolonged. This article reviews the causes and differential diagnosis of hemihypertrophy and offers an approach to the management of this condition. Children with isolated hemihypertrophy are at increased risk for neoplasms. Periodic abdominal ultrasound examination and physical examination during infancy and childhood are recommended for early tumour detection.

Congenital Abnormalities↗

Primary umbilical adenocarcinoma. A case report and review of literature.

A case of primary adenocarcinoma of the umbilicus is reported along with a review of the literature and discussion of possible origins of glandular tissue within this area. Multiple connections are present within the umbilicus (vascular, lymphatic, and embryologic) that may give this area access to metastatic lesions. The primary tumors may originate within the usual umbilical tissue (skin and soft tissue). Glands that are not normally present in the region of the umbilicus rarely develop malignant neoplasms. As postulated, glandular tissue may arise either as metaplasia from squamous epithelium or from glandular embryologic rests including omphalomesenteric duct remnants and urachal remnants.

Abdominal Neoplasms↗

Acute megakaryoblastic leukemia simulating carcinoma.

Acute megakaryoblastic leukemia has emerged as an important subset of early childhood leukemia. It often presents a diagnostic dilemma because of its many morphologic manifestations and propensity to mimic metastatic carcinoma. An abdominal mass was identified by sonographic and computed tomographic scans in a 10-month-old girl, who had anemia and thrombocytopenia. An open biopsy of the 3-cm, peripancreatic mass showed cohesive nests and sheets of tumor cells with focal spindling and desmoplasia. Although the diagnosis of acute megakaryoblastic leukemia was established from a bone marrow aspirate using immunocytochemical techniques and karyotype analysis, a coexistent abdominal epithelial malignant neoplasm could not be excluded entirely by light microscopic examination alone. The megakaryoblastic nature of the abdominal tumor was established by immunocytochemical stains for glycoprotein IIIa on paraffin-embedded tissue.

Abdominal Neoplasms↗

Radiologic imaging of AIDS.

The acquired immunodeficiency syndrome (AIDS) is an increasingly important disease that has become a social phenomenon. Although our therapeutic options for treating AIDS patients are limited at present, radiologic investigation is often of crucial importance in determining the extent and stage of opportunistic infections and neoplasms. This manuscript deals in depth with the manifestations of AIDS in the chest, abdomen, and central nervous system. It emphasizes the importance of cross-sectional imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound as well as guided fine needle aspiration biopsy. The first chapter is a brief overview of the general management of AIDS patients in the radiology department. It seeks to emphasize a careful caring approach to patients with this disease. It also emphasizes the importance of educating all radiology personnel to an awareness of how precautions can be taken to avoid the spread of AIDS while dealing with patients in a professional, courteous manner.

AIDS-Related Complex↗

Spontaneous fibrosarcoma in a thymus-transplanted nude mouse.

A fibrosarcoma was observed in a 6-month-old nude mouse that had a neonatal thymus transplant and had been kept since birth under nearly pathogen-free conditions. This was the first tumor found in more than 1,000 nude mice maintained in a colony in which mammary carcinomas were observed among the female heterozygous breeders. This finding confirmed the fact that malignant neoplasms are rare in an animal model that lacks T-cell-mediated immunologic capability and apparently contradicted the postulates of the immunosurveillance theory.

Abdominal Neoplasms↗

[Application of computerized tomoscintigraphy in the detection of tumors using cobalt-57-marked bleomycin].

57Co-bleomycin scanning dates from the early 1970s, when the first results were presented by Renault et al. Since then there have been numerous publications concerning the high sensitivity of this type of study in the detection of pulmonary or cerebral neoplasms. In the region below the diaphragm, however, sensitivity was poor due to hyperactivity of the kidney, liver and bladder. To eliminate this problem the authors have used single photon emission computerized tomography (SPECT), and their department is currently investigating the sensitivity of this technique for the detection of neoplasms. Two typical cases are described which illustrate the value of this method in the detection of cancer.

Abdominal Neoplasms↗

High-dose tamoxifen and sulindac as first-line treatment for desmoid tumors.

BACKGROUND: Desmoid tumors are mesenchymal nonmetastasizing neoplasms. Although rare in the general population, they are a common extracolonic manifestation of familial adenomatous polyposis (FAP). Because of high tumor recurrence rates, surgery has been less than satisfactory in the treatment of desmoid tumors. In the current study, high doses of tamoxifen in combination with sulindac were used to treat severe desmoid tumors to avoid surgery. METHODS: Since 1992, 25 patients at Heinrich Heine University (Dusseldorf, Germany) were treated with a combination of tamoxifen and sulindac. In the current study, 17 patients with FAP-associated and 8 patients with sporadic desmoid tumors received 120 mg of tamoxifen and 300 mg of sulindac daily. Every 6 months, the protracted course of desmoid growth was measured by computed tomography and/or magnetic resonance imaging scans. Tumor responses were characterized as progressive disease, stable disease (SD), partial regression (PR), and complete regression (CR). RESULTS: Of the group of patients who received tamoxifen and sulindac as a primary treatment, all three patients with sporadic desmoid tumors demonstrated cessation of growth, and 10 of the 13 patients with FAP-associated tumors achieved either a PR or CR. In the sporadic desmoid tumor group, eight of nine patients developed tumor recurrences after undergoing surgery at other institutions. Of these, two patients had SD and two patients had a PR to CR. CONCLUSIONS: The patients with desmoid tumors who were managed conservatively with high-dose tamoxifen and sulindac had the best outcome. Desmoid tumor recurrence after surgery was high and in the FAP-associated tumor group, therapy with tamoxifen and sulindac was found to be less successful. Based on this experience, the authors recommended high-dose tamoxifen and sulindac as the primary treatment for patients with FAP-associated desmoid tumors. However, to our knowledge, the best approach after surgical intervention for patients with sporadic desmoid tumors remains to be determined.

Abdominal Neoplasms↗

Gastric squamous cell carcinoma in three horses.

Gastric squamous cell carcinoma was diagnosed in three horses. Clinical signs observed in all cases were weight loss, anorexia and lethargy. Respiratory signs were prominent in one case. All three horses had depressed albumin and elevated globulin and fibrinogen concentrations. Two horses were mildly anaemic. Inflammatory exudates were present in peritoneal cavities in all cases, and cytological evaluation provided a positive diagnosis of squamous cell carcinoma in two cases. Pleural fluid samples taken from two cases were also classified as inflammatory exudates, but no neoplastic cells were detected on initial examination. In all cases the neoplasms had arisen from the oesophageal region of the stomach, and had metastised throughout the abdomen. Two cases had metastatic lesions within the pleural cavity.

Abdominal Neoplasms↗

Solitary intraocular lymphoma as an initial presentation of widespread disease.

A patient presented with a large peripapillary choroidal mass as the initial manifestation of widespread, poorly differentiated, large cell lymphoma. The choroidal tumor had clinical and ultrasonographic characteristics of a uveal malignant melanoma. A systemic evaluation and fine-needle aspiration biopsy specimens of the abdomen and choroid established the diagnosis of a lymphoma. On rare occasion, other neoplasms can simulate the diagnostic pattern of uveal melanoma, and fine-needle aspiration biopsy can be crucial in establishing the correct diagnosis.

Abdominal Neoplasms↗

Lipoblastoma in infancy and childhood.

Lipoblastoma is a rare benign neoplasm of fetal-embryonal fat tissue with a 14% tendency to recur. It occurs almost exclusively in infants and children. To my knowledge, less than 100 cases, including children and adults, have been reported in the English literature. Two retroperitoneal and one case of mesenteric lipoblastoma, all presenting as a large palpable abdominal mass, are described. Our patients, aged 12 years, 7 months, and 11 months, were treated by total surgical excision of the tumors. They are alive and well 5, 4, and 3 years postoperative, respectively, with no evidence of recurrence and no indication for any adjunctive therapy. Pathologic evaluation was decisive for the best treatment and prognosis.

Abdominal Neoplasms↗

Cutaneous metastasis from squamous cell carcinoma of the cervix.

Metastasis to the skin occurs rarely, regardless of the nature of the primary systemic neoplasm. Although carcinoma of the cervix is the fourth most common malignancy in women, cutaneous involvement originating from cervical cancer is particularly unusual, even in the terminal stages of disease. Only 22 cases, including this one, are clearly documented in the literature. The main sites of the cutaneous metastases in these cases were the abdominal wall or lower extremity. However, we describe a 41-year-old woman with cervical cancer who developed metastatic nodules on the upper back. The skin of the back is an uncommon location for metastasis from any malignant tumor, and when it occurs in women, it is generally associated with carcinoma of the breast or malignant melanoma. To the best of our knowledge, this is the first reported case of cervical carcinoma metastasis to this unlikely cutaneous site.

Abdominal Neoplasms↗

[Oral contrast media for magnetic resonance tomography of the abdomen. III. Initial patient research with gadolinium-DTPA].

32 patients with abdominal tumours or inflammatory abdominal diseases were examined by MRI (0.5 T) prior to and after oral administration of gadolinium-DTPA (Gd-DTPA). T1- and T2-weighted sequences were employed. 10 ml/kg body weight of a Gd-DTPA formulation were administered (1.0 mmol/l, 15 g mannitol/l). Gd-DTPA provided markedly hyperintensive opacification of the gastrointestinal tract. In 19 of 32 studies Gd-DTPA-enhanced scans showed improved delineation of abdominal pathologies. In most cases Gd-DTPA-enhanced T1-weighted multislice gradient echo images provided the most useful diagnostic result. Meteorism and diarrhea were recorded in 13 patients.

Abdomen↗

MR imaging of lymphomas: impact on therapy.

Seventy-six patients with either Hodgkin disease or non-Hodgkin lymphoma underwent magnetic resonance (MR) imaging as part of their evaluation. In this report the unique and common MR findings of these neoplasms are reviewed in each of the major anatomic sites. Further, the impact of these findings on therapy decisions and follow-up is emphasized.

Abdominal Neoplasms↗

Survival after palliative surgery for advanced intraabdominal cancer.

The clinical course of 300 patients with known intraabdominal neoplasm requiring surgical exploration was analyzed. The most common primary tumor sites were the gastrointestinal tract (60 per cent), female reproductive organs (17 per cent), and urinary tract (6 per cent). Gastrointestinal and extrahepatic biliary obstruction, gastrointestinal bleeding, and peritonitis were the most common indications for surgery. The overall operative mortality was 26 per cent, and the mean survival time was 6.6 months. Small bowel fistulas, intraabdominal abscesses, and cardiopulmonary and renal failure were the leading causes of death. Palliative procedures in patients less than sixty years old with single site of obstruction or with tumor of gastrointestinal origin were associated with a low operative mortality and prolonged survival. On the other hand, surgical intervention in patients more than seventy years old undergoing chemotherapy, with multiple sites of obstruction, peritonitis, or primary tumor originating outside the gastrointestinal tract, was associated with high operative mortality and seldom benefited from palliative intervention. Surgical intervention to relieve a distressing symptom in a patient with advanced neoplasm is a well established procedure, but the risks and benefits of such intervention should be carefully weighed against the expected mortality and the quality of survival.

Abdominal Neoplasms↗

Brushing cytology in biliary tract obstruction.

During a period of eight years (1980 to 1987), cytologic samples were obtained by brushing and reverse screw devices from 54 patients undergoing transhepatic cholangiography for evaluation of obstructive jaundice. Eight patients were excluded from this study, seven for inadequate follow-up and one because of unsatisfactory cytologic material. Of the remaining cases, 32 were cytologically diagnosed as adenocarcinomas; all but one patient proved to have malignant disease by histologic examination and/or through clinical follow-up. These included 21 pancreatic carcinomas, 6 bile duct carcinomas, 1 ampullary carcinoma, 1 gallbladder carcinoma and 2 metastatic carcinomas. In one case, the diagnosis of malignancy was found to be in error upon review of the cytologic smears. Of 14 patients with negative cytologic diagnoses, 7 were found to have malignant neoplasms and 7 had benign diseases. These findings indicate that, while a positive cytologic diagnosis is a reliable indicator of a malignant biliary obstruction, a negative result does not exclude malignancy.

Abdominal Neoplasms↗