scholarly journals Effectiveness of Bilateral Inferior Petrosal Sinuses Sampling in Tumor Lateralization: Intraoperative Findings and Postoperative Results

2017 ◽  
Vol 78 (06) ◽  
pp. 506-511 ◽  
Author(s):  
Oscar Feo-Lee ◽  
Manuel Giraldo-Grueso ◽  
Juan Puentes ◽  
Pablo Harker
Keyword(s):  
Prediction Accuracy ◽  
Resonance Imaging ◽  
Postoperative Results ◽  
Inferior Petrosal Sinus Sampling ◽  
Number Of Patients ◽  
Remission Rates ◽  
Macroscopic Lesion ◽  
Biochemical Remission ◽  
Magnetic Resonance Imaging Mri ◽  
Abnormal Tissue

Object Diagnosis and treatment of Cushing's disease (CD) is a demanding endeavor. We evaluated the effectiveness of inferior petrosal sinus sampling (IPSS) in preoperative tumor lateralization and surgical outcomes. Methods Fifty-two consecutive patients with CD and normal magnetic resonance imaging (MRI) were enrolled between 2009 and 2015. Selective catheterization of petrosal sinuses for IPSS was performed. All patients underwent microsurgical dissection, and if a lesion was found, underwent lesion resection. Demographic, biochemical, and intraoperative findings were prospectively collected and reviewed 6 and 12 months postoperatively. Results Forty-five patients (86.4%) had clear lateralization while seven patients had bilateral elevation. Twenty-two patients (42%) were found to have a macroscopic lesion, defined as an abnormal tissue during microsurgical dissection, which was thus resected. No patient had a lesion larger than 4 mm. Eighty-one percent of patients had the lesion where IPSS had been predicted. Hemi-hypophysectomy was performed on twenty-eight patients based on IPSS findings, since no lesion was found. Eighty-six percent of patients with lesion resection had biochemical remission by 12 months. Biochemical remission was documented in 78 and 71% of patients who underwent hemi-hypophysectomy by 6 and 12 months, respectively. Conclusion With careful microsurgical dissection, a macroscopic lesion could be found in a significant number of patients with normal MRI. When no lesion was found, we recommend performing a hemi-hypophysectomy based on IPSS findings, since prediction accuracy was high and remission rates were significant.

scholarly journals A quick guide to safety and compatibility of passive implants and devices in an MR environment

2004 ◽  
Vol 8 (2) ◽  
pp. 6 ◽  
Author(s):  
D.J. Kotze ◽  
C. De Vries
Keyword(s):  
Resonance Imaging ◽  
Electrical Currents ◽  
Additional Risk ◽  
Metal Implants ◽  
Passive Devices ◽  
Number Of Patients ◽  
Magnetic Resonance Imaging Mri ◽  
Mr Safe ◽  
Intended Use

An increasing number of patients with metal implants are being referred for magnetic resonance imaging (MRI) investigations. Implants and devices may be divided into two groups, namely active and passive. This article will focus on passive devices. A device is MR-safe when it is used in the MR environment, but presents no additional risk to the patient or other individuals, although the quality of diagnostic information may be affected. MR procedures may be contraindicated due to various interactions between the MR environment and medical devices, which include torque, translational force, heating, induced electrical currents, magnetic field interactions, artefacts, and misrepresentation. Therefore, before deciding whether any object is MRsafe/ compatible, the intended use and the possible retaining mechanisms must be considered.

scholarly journals Is it necessary to remove intrapapillary ducts in therapeutic mammary adenectomies for breast cancer?

Mastology ◽  
2020 ◽  
Vol 30 (Suppl 1) ◽  
Author(s):  
Rebeca Neves Heinzen ◽  
Alfredo Carlos Simões Dornellas de Barros ◽  
Filomena Marino Carvalho ◽  
Cristiane da Costa Brandeia Abrahao Nimir ◽  
Alfredo Luiz Jacomo
Keyword(s):  
Breast Cancer ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Glandular Tissue ◽  
Resonance Imaging ◽  
Areola Complex ◽  
Number Of Patients ◽  
Magnetic Resonance Imaging Mri

Introduction: The nipple-areola complex (NAC) has glandular tissue in intrapapillary ducts (IPDs). When the NAC is preserved during mammary adenectomies (MA) for the treatment of breast cancer (BC), this glandular tissue, which is a potential focus of tumor residues, remains. Objective: To estimate the frequency of neoplastic development in IPDs among BC patients treated with MA. Method: After the MA and with evidence of free retroareolar margin through intraoperative examination, the nipple was inverted, and its central portion, where mammary ducts are located, removed. A pointed-tip scalpel was used, preserving a tissue rim of 1.0 to 2.0 mm. The analysis involved 219 cases submitted to this type of surgery in the Clínica Professor Alfredo Barros. In all patients, the distance tumor-NAC was ≥2.0 cm, according to magnetic resonance imaging (MRI). The intrapapillary tissue removed was sent for microscopic examination of sections embedded in paraffin. Results: We found 4 cases of ductal carcinoma in situ (none infiltrating) in IPDs (1.19%). Considering only the 217 cases with free retroareolar margin in the definitive examination, the number of patients with ductal carcinoma in situ in IPDs decreased to 2 (0.9%). Conclusion: IPDs are rarely involved in selected cases of MA (distance tumor-NAC≥2.0 cm on MRI and free retroareolar margin). Ideally, they should be removed, especially when the intent is avoiding radiotherapy.

Incidentally detected acromegaly: single-center study of surgically treated patients over 22 years

2020 ◽  
pp. jim-2020-001605
Author(s):  
Erica Alexandra Giraldi ◽  
Emir Veledar ◽  
Nelson M Oyesiku ◽  
Adriana G Ioachimescu
Keyword(s):  
Multimodality Treatment ◽  
Mass Effect ◽  
Tumor Diameter ◽  
Cavernous Sinus Invasion ◽  
Improved Outcomes ◽  
Number Of Patients ◽  
Single Center Study ◽  
Remission Rates ◽  
Biochemical Remission

Acromegaly is a rare disease associated with comorbidities that are common in the general population. Most patients undergo screening for classic phenotypical (CP) or mass effect manifestations. By retrospective review of pituitary tumor surgeries performed between 1994 and 2016 (1836), we identified patients with acromegaly (112). Main presentations were: CP (43%), mass effect (26%), incidentally detected (ID) tumors (17%), and other (14%). We compared the ID and CP groups regarding prevalence, clinical, biochemical, radiological and histopathological characteristics, and postoperative outcomes. The prevalence of ID among all surgeries increased after 2011 from 0.6% to 1.9% (p=0.01), while prevalence of CP remained stable (2.8% and 2.33%, p=0.65). Almost half of ID (47.4%) presented with otolaryngological manifestations. The ID and CP groups were similar regarding age, gender, comorbidities (hypertension, diabetes, hypopituitarism), tumor diameter and cavernous sinus invasion. Median insulin-like growth factor (IGF-1) and growth hormone (GH) levels were lower in the ID than CP (p<0.05 and p=0.07). Patients younger than 40 had smaller tumors in the ID than CP, while the opposite was true for older patients. The 3-month biochemical remission rates were similar (68% ID and 58% CP). A similar number of patients had normal IGF-1 at last follow-up (89.5% ID and 81.25% CP) after surgery alone and multimodality treatment. In conclusion, an increased number of patients with GH-secreting adenomas were ID in recent years. Education of physicians other than endocrinologists regarding presentation and comorbidity clustering may lead to an earlier diagnosis of acromegaly and improved outcomes.

scholarly journals Syndrome "empty" Turkish saddle

1999 ◽  
Vol 45 (3) ◽  
pp. 42-47
Author(s):  
M. B. Babarina
Keyword(s):  
Magnetic Resonance Imaging ◽  
Pituitary Adenoma ◽  
Sellar Region ◽  
Combined Exposure ◽  
Resonance Imaging ◽  
Non Invasive ◽  
Number Of Patients ◽  
Invasive Method ◽  
Magnetic Resonance Imaging Mri ◽  
Methods Of Treatment

The syndrome of the "empty" Turkish saddle (PTS) is one of the poorly studied problems of neuroendocrinology. The urgency of this problem has increased at the present time with the widespread use in the diagnosis of the non-invasive method of magnetic resonance imaging (MRI), as well as with the increase in the number of patients exposed to radiation, surgical, combined exposure due to pituitary adenoma. The term "PTS syndrome" should be understood as the prolapse of the suprasellar tank into the cavity of the Turkish saddle with the pituitary gland spreading along the bottom and walls of the Turkish saddle, accompanied by endocrine, neurological and visual impairment. There are primary (idiopathic) and secondary PTS, which occurs after radiation, surgical and combined methods of treatment of diseases of the chiasm-sellar region. This review will focus mainly on primary PTS syndrome.

scholarly journals Hepatoid Adenocarcinoma of the Urachus

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Daniel Fernando Gallego ◽  
Carlos Muñoz ◽  
Carlos Andrés Jimenez ◽  
Edwin Carrascal
Keyword(s):  
Magnetic Resonance Imaging ◽  
Poor Prognosis ◽  
Rare Condition ◽  
Hepatoid Adenocarcinoma ◽  
Resonance Imaging ◽  
Pelvic Magnetic Resonance Imaging ◽  
Multiple Organs ◽  
Remission Rates ◽  
Atypical Cells ◽  
Magnetic Resonance Imaging Mri

Hepatoid adenocarcinoma of the urachus is a rare condition. We present the case of a 51-year-old female who developed abdominal pain and hematuria. Pelvic magnetic resonance imaging (MRI) reported an urachal mass with invasion to the bladder that was resected by partial cystectomy. On light microscopy the tumor resembled liver architecture, with polygonal atypical cells in nest formation and trabecular structures. Immunochemistry was positive for alfa-fetoprotein (AFP) and serum AFP was elevated. Hepatoid adenocarcinomas have been reported in multiple organs, being most commonly found in the stomach and the ovaries. Bladder compromise has been rarely described in the literature, and it has been associated with poor prognosis, low remission rates, and early metastasis.

scholarly journals Clinically significant prostate cancer (csPCa) detection with various prostate sampling schemes based on different csPCa definitions

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fei Wang ◽  
Tong Chen ◽  
Meng Wang ◽  
Hanbing Chen ◽  
Caishan Wang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Resonance Imaging ◽  
Concomitant Increase ◽  
First Line ◽  
Detection Rates ◽  
Sampling Schemes ◽  
Number Of Patients ◽  
Clinically Significant ◽  
Magnetic Resonance Imaging Mri ◽  
Biopsy Method

Abstract Background Combining targeted biopsy (TB) with systematic biopsy (SB) is currently recommended as the first-line biopsy method by the European Association of Urology (EAU) guidelines in patients diagnosed with prostate cancer (PCa) with an abnormal magnetic resonance imaging (MRI). The combined SB and TB indeed detected an additional number of patients with clinically significant prostate cancer (csPCa); however, it did so at the expense of a concomitant increase in biopsy cores. Our study aimed to evaluate if ipsilateral SB (ipsi-SB) + TB or contralateral SB (contra-SB) + TB could achieve almost equal csPCa detection rates as SB + TB using fewer cores based on a different csPCa definition. Methods Patients with at least one positive prostate lesion were prospectively diagnosed by MRI. The combination of TB and SB was conducted in all patients. We compared the csPCa detection rates of the following four hypothetical biopsy sampling schemes with those of SB + TB: SB, TB, ipsi-SB + TB, and contra-SB + TB. Results The study enrolled 279 men. The median core of SB, TB, ipsi-SB + TB, and contra-SB + TB was 10, 2, 7 and 7, respectively (P < 0.001). ipsi-SB + TB detected significantly more patients with csPCa than contra-SB + TB based on the EAU guidelines (P = 0.042). They were almost equal on the basis of the Epstein criteria (P = 1.000). Compared with SB + TB, each remaining method detected significantly fewer patients with csPCa regardless of the definition (P < 0.001) except ipsi-SB + TB on the grounds of D1 (P = 0.066). Ten additional subjects were identified with a higher Gleason score (GS) on contra-SB + TB, and only one was considered as significantly upgraded (GS = 6 on ipsi-SB + TB to a GS of 8 on contra-SB + TB). Conclusions Ipsi-SB + TB could acquire an almost equivalent csPCa detection value to SB + TB using significantly fewer cores when csPCa was defined according to the EAU guidelines. Given that there was only one significantly upgrading patient on contra-SB, our results suggested that contra-SB could be avoided.

Polyregional and hemispheric syndromes: a study of these uncommon first attacks in a CIS cohort

2007 ◽  
Vol 13 (6) ◽  
pp. 731-736 ◽  
Author(s):  
R. Pelayo ◽  
M. Tintoré ◽  
A. Rovira ◽  
J. Rio ◽  
C. Nos ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Clinical Symptoms ◽  
Brain Mri ◽  
Resonance Imaging ◽  
Number Of Patients ◽  
Cns Demyelination ◽  
Magnetic Resonance Imaging Mri ◽  
Definition Of

Clinically isolated syndromes (CIS) classically refer to optic neuritis (ON), brainstem or spinal cord syndromes. Less common first episodes suggestive of central nervous system (CNS) demyelination, such as hemispheric or clinically polyregional syndromes, have been only slightly studied. The aim of this study was to describe these CIS topographies in our cohort of patient with a CIS. We evaluated 320 patients with a CIS, and classified the topographies of the attacks according to clinical symptoms only into CIS of the optic nerve (123), brainstem (78), spinal cord (89), hemispheric (6), polyregional (12) or undetermined (12) topographies. Patients underwent brain MRI within three months of their first attack, and again 12 months later. Conversion to multiple sclerosis (MS), determined either clinically or by magnetic resonance imaging (MRI), was evaluated according to topography. Hemispheric and polyregional syndromes were closer to brainstem or spinal cord syndromes than ON in clinical and MRI conversion terms, although a statistical analysis was not performed because of the small number of patients. There are differences between several studies in the definition, and, therefore, the prevalence of these so-called atypical CIS. Consensus on the denomination and definition of these syndromes must be reached. Multiple Sclerosis 2007; 13: 731-736. http://msj.sagepub.com

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