U-Net Modelling-Based Imaging MAP Score for Tl Stage Nephrectomy: An Exploratory Study

We evaluate the stability of the clinical application of the MAP scoring system based on anatomical features of renal tumour images, explore the relevance of this scoring system to the choice of surgical procedure for patients with limited renal tumours, and investigate the effectiveness of automated segmentation and reconstruction 3D models of renal tumour images based on U-net for interpretative cognitive navigation during laparoscopy Tl stage radical renal tumour cancer surgery. A total of 5 000 kidney tumour images containing manual annotations were applied to the training set, and a stable and efficient full CNN algorithm model oriented to clinical needs was constructed to regionalism and multistructure and to finely automate segmentation of kidney tumour images, output modelling information in STL format, and apply a tablet computer to intraoperatively display the Tl stage kidney tumour model for cognitive navigation. Based on a training sample of MR images from 201 patients with stage Tl renal tumour cancer, an adaptation of the classical U-net allows individual segmentation of important structures such as renal tumours and 3D visualisation to visualise the structural relationships and the extent of tumour invasion at key surgical sites. The preoperative CT and clinical data of 225 patients with limited renal tumours treated surgically at our hospital from August 2011 to August 2012 were retrospectively analysed by three imaging physicians using the MAP scoring system for the total score and the variables R (maximum diameter), E (exogenous/endogenous), N (distance from the renal sinus), A (ventral/dorsal), L (relationship along the longitudinal axis of the kidney), and h (whether in contact with the renal hilum). The score for each variable (contact with the renal hilum) was statistically compared with each other for the three observers. Patients were divided into three groups according to the total score—low, medium, and high—and according to the surgical procedure—radical and partial resection. The correlation between the total score and the score of each variable and the choice of surgical procedure was analysed. The agreement rate of the total score and the score of each variable for all three observers was over 90% ( P ≤ 0.001). The map scoring system based on the anatomical features of renal tumour imaging was well stabilized, and the scores were significantly correlated with the surgical approach.

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NCOG-31. GIANT PITUITARY ADENOMA (GPA) SCORE: A NOVEL SCORING SYSTEM TO PREDICT POSTOPERATIVE OUTCOMES OF GIANT PITUITARY ADENOMAS

Neuro-Oncology ◽

10.1093/neuonc/noab196.621 ◽

2021 ◽

Vol 23 (Supplement_6) ◽

pp. vi158-vi158

Author(s):

Syed Ather Enam ◽

Fauzan Alam Hashmi ◽

Sanam Mir Ghazi ◽

Ahsan Ali Khan ◽

Muhammad Bilal Tariq ◽

...

Keyword(s):

Pituitary Adenoma ◽

Linear Regression ◽

Pituitary Adenomas ◽

Scoring System ◽

Tumor Resection ◽

Maximum Diameter ◽

Giant Pituitary Adenoma ◽

Giant Pituitary Adenomas ◽

The Mean ◽

Suprasellar Extension

Abstract BACKGROUND Giant pituitary adenomas (GPA) are uncommon and highly variable in morphology and extension. There is no scoring system that considers all the dimensions of adenoma invasion. We developed a new Giant Pituitary Adenoma score and report our surgical experience and evaluate outcomes after resection of these tumors in accordance with the preoperative score. METHODS We developed a novel scoring system for classifying giant pituitary adenomas, and 11-year data of GPA surgery at our center was collected retrospectively, based on this scoring system. GPA Score considered tumor’s parasellar extension, encasement of cavernous internal carotid artery (ICA), suprasellar extension > 2 cm, suprasellar extension > 4cm and retrosellar extension. Maximum possible score was 9. The scoring system was applied to 53 patients of GPA who underwent surgical resection between January 1, 2006, and December 2017. The Lundin-Pederson (ABC/2) method was used to calculate the tumor volume both pre- and post-resection and linear regression was used to assess the relationship between extent of tumor resection and GPA score. RESULTS The median age of the study population was 42.08 ± 16.49 years. The mean maximum diameter of the pituitary adenomas was 5.0 cm (range 4.0 cm-8.5cm) while the mean volume of the adenomas was 27.3 cm3 (range 10 cm3-149 cm3). There were 3 cases of score 2, 5 cases of score 3, 13 cases of score 4, 20 cases of score 5, 9 cases of score 6 and 3 cases of score 7. The range of tumor volumes of tumors for scores from 2-7 was 17.3 cm3 to 65.8 cm3 and GPA score was correlated with the percent residual tumor using linear regression that was statistically significant (p= 0.001). CONCLUSION GPA Score is a reliable scoring system to predict the extent and subsequent difficulty in tumor resection in GPA.

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Combining contrast-enhanced ultrasound, CT perfusion and 99mTc-Sestamibi SPECT/CT to guide diagnosis in a case of solid renal tumour

BJR|case reports ◽

10.1259/bjrcr.20200115 ◽

2020 ◽

pp. 20200115

Author(s):

Georgios Kalarakis ◽

Katharina Brehmer ◽

Anders Svensson ◽

Rimma Axelsson ◽

Torkel B Brismar ◽

...

Keyword(s):

Ct Perfusion ◽

Added Value ◽

Renal Tumour ◽

Contrast Enhanced Ultrasound ◽

Renal Lesions ◽

Ultrasound Contrast ◽

Contrast Enhanced ◽

Renal Tumours ◽

Examination Techniques ◽

99Mtc Sestamibi

Definitive, pre-operative differentiation of solid renal lesions by ultrasound, contrast-enhanced multiphasic CT or MRI examinations is often not possible. An increasing amount of literature indicates the added value of 99mTc-Sestamibi SPECT/CT, CT perfusion and contrast-enhanced ultrasound in the pre-operative characterisation of solid renal tumours. This case report presents the diagnostic approach of a solid renal tumour that turned out to be a hybrid oncocytic chromophobe tumour in a patient with Stage 3 renal failure by combining the three aforementioned modern examination techniques.

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Renal tumour invasion depth and diameter are the two most accurate anatomical features regarding the choice of radical vs partial nephrectomy

European Urology Supplements ◽

10.1016/s1569-9056(16)15017-1 ◽

2016 ◽

Vol 15 (5) ◽

pp. e1186-e1187

Author(s):

S. Tornberg ◽

T. Kilpeläinen ◽

P. Järvinen ◽

H. Visapää ◽

R. Järvinen ◽

...

Keyword(s):

Partial Nephrectomy ◽

Renal Tumour ◽

Tumour Invasion ◽

Invasion Depth ◽

Anatomical Features

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Proposal for a new classification of the renal artery in the bovine kidney

Veterinární Medicína ◽

10.17221/130/2017-vetmed ◽

2018 ◽

Vol 63 (No. 2) ◽

pp. 63-72 ◽

Cited By ~ 2

Author(s):

J. Szymanski ◽

L. Olewnik ◽

G. Wysiadecki ◽

A. Przygocka ◽

M. Polguj ◽

...

Keyword(s):

Renal Artery ◽

Mammalian Species ◽

Type I ◽

Renal Sinus ◽

Adult Cattle ◽

Segmental Artery ◽

Renal Hilum ◽

Hilar Region ◽

Segmental Arteries

Proper vascularisation is necessary for the correct functioning of all organs. The kidneys of various mammalian species have been examined in order to understand the functioning of this organ. This article presents the first classification of the renal artery division in the kidneys of adult cattle. We collected and analysed specimens of arteries from bovine kidneys with the aim of improving our understanding of their morphology and functioning. The study was conducted on 50 kidneys, 25 right ones and 25 left ones, taken from cattle of both sexes. The examined kidneys were dissected and corrosion casts were made. Division of the renal artery into between two and four primary segmental arteries takes place just before entering the renal hilum. Cranial primary segmental arteries number from one to two (most frequently one), whereas the hilar and caudal ones always occur singly. The mentioned vessels are then divided into between one and four secondary segmental arteries running within the renal sinus. The hilar region (mid-zone) of the kidney exhibits the most variation in terms of vascularisation. The vascularisation of the caudal pole exhibits the lowest degree of variation. Taking into consideration the range of vascularisation of the organ by the particular divisions of the renal artery, three renal branching pattern types were distinguished: type I (84.1% of cases; this type consists of Ia, Ib, Ic and Ic subtypes) – two branches – the renal artery is divided into cranial and caudal primary segmental arteries; type II (11.36% of cases; with IIa and IIb subtypes) – three branches – the renal artery is divided into the cranial, hilar and caudal primary segmental arteries; type III (4.54% of cases) – four branches – the renal artery is divided into two cranial, one hilar and one caudal primary segmental artery. The division of the renal artery takes place along the long axis of the organ. Bovine kidneys are characterised by asymmetry, which may influence the length and diameter of the main arteries. The caudal primary segmental artery has the biggest mean length and mean diameter. The division of the renal artery occurs just before it enters the renal hilum or in the renal sinus.

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Clinicopathological Features, Management and Outcome of Paediatric Solid Renal Tumours in Southeast Nigeria: The Need for Protocol and Multidisciplinary Collaboration

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/46506.14775 ◽

2021 ◽

Author(s):

Okechukwu Hyginus Ekwunife ◽

Jideofor Okechukwu Ugwu ◽

Victor Ifeanyichukwu Modekwe ◽

Chijioke Elias Ezeudu ◽

Thomas Obiajulu Ulasi ◽

...

Keyword(s):

Left Kidney ◽

Treatment Protocol ◽

University Teaching ◽

Renal Tumour ◽

Duration Of Symptoms ◽

Multidisciplinary Collaboration ◽

Retrospective Audit ◽

Abdominal Masses ◽

Renal Tumours ◽

The Mean

Introduction: Renal malignancies are common in children and they constitute 6-7% of all childhood tumours and nephroblastoma is the most common solid renal tumour in children. Currently, standardised institutional protocols in management of renal tumours in children are the norm. Large scale collaborative studies have started emerging, yet not much has been documented on the clinical presentation, pathology and outcome of solid renal tumours particularly in Africa. Aim: To review the presentations, pathology and the management-outcome of solid renal tumour in the centre in the absence of a coordinated protocol and multi-disciplinary collaboration. Materials and Methods: This was a nine and a half year longitudinal retrospective audit study of consecutive patients with solid renal tumours managed in a single tertiary centre: Nnamdi Azikiwe University Teaching Hospital Nnewi South-east Nigeria. It took place from January 2009-June 2018. Relevant data on demography, clinical features, management and outcome were extracted from records. Results were analysed using Statistical Package for Social Sciences (SPSS) version 22. Categorical data were tested for independence using Chi-square test and significant p-value set at <0.05. Results: Twenty two paediatric cases (15 males and 7 females) were included in the study. The mean age at presentation was 50.10±4.8 months. There were 15 males and 7 females. The mean duration of symptoms was 5.5 months; 21 (95%) presented with abdominal masses while 6 (27.3%) had gross haematuria and 13 (59%) were emaciated. Tumours involved left kidney in 15 (68%). Histological reports were available in 9 cases with nephroblastoma being the most common 6 (27.3%). The Commonest stage was stage 3, 10 (45%) and commonest procedure was nephroureterectomy, 11 (50%). Neo-adjuvant and adjuvant therapies were inconsistent. Conclusion: Late presentation, discordant treatment protocol, noncompletion of treatment and poor collaboration, were found to contribute largely to poor outcome of solid renal tumours in children in our setting. It is strongly believed that adoption of standard protocol and a multidisciplinary collaboration in management will improve records keeping and outcome.

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Renal Arteries Embolization in Unresectable Clear Cell Renal Carcinoma: First Time Experience at Haji Adam Malik Hospital

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2018.282 ◽

2018 ◽

Vol 6 (8) ◽

pp. 1454-1457

Author(s):

Noor Riza Perdana ◽

Elvita Rahmi Dulay ◽

Fauriski Febrian Prapiska

Keyword(s):

Renal Carcinoma ◽

Clear Cell ◽

Histopathological Examination ◽

Signs And Symptoms ◽

Tumour Volume ◽

Renal Tumour ◽

Clear Cell Renal Carcinoma ◽

Cell Renal Carcinoma ◽

Renal Hilum ◽

Eortc Qlq

OBJECTIVE: To report a case of renal arterial embolisation (RAE) in unresectable renal tumour before nephrectomy.CASE REPORT: On presentation, the clinical features of this patient, including medical history, signs and symptoms, imaging examinations were recorded. After diagnosis and initial treatment, the result and histopathological examination were performed and discussed. We performed RAE in the unresectable renal tumour in the 28-year-old male that was complaining a palpable pain right flank mass and intermittent hematuria that had been observed five months earlier. A month after RAE, the tumour shrinks and become resectable. The parameter used was tumour volume, propulsion and component, with subjective value VAS, hematuria symptom and Quality Of Life Score EORTC-QLQ C30. The next step we performed nephrectomy with histopathology results in Clear Cell Renal Carcinoma (CCRC).CONCLUSION: RAE is an effective therapeutic and adjuvant tool because it facilitates the dissection of unresectable large renal tumours and tumours with extensive involvement around the renal hilum; it leading to lower overall morbidity. However, the lack of randomised prospective studies is the primary reason that RAE is not used often before surgery.

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Use of radiotherapy for seminoma patients with low-volume infradiaphragmatic nodal disease.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.6_suppl.335 ◽

2013 ◽

Vol 31 (6_suppl) ◽

pp. 335-335 ◽

Cited By ~ 3

Author(s):

Swetha Sridharan ◽

Peter W. M. Chung ◽

Michael A. Jewett ◽

Eshetu Atenafu ◽

Philippe Bedard ◽

...

Keyword(s):

Background Radiation ◽

Patient Choice ◽

Maximum Diameter ◽

Nodal Disease ◽

Testicular Seminoma ◽

First Line Therapy ◽

Standard Management ◽

Renal Hilum ◽

Low Volume ◽

Grade 3

335 Background: Radiation therapy (RT) is established as standard management in testicular seminoma patients with low volume (< 5cm in maximum diameter) retroperitoneal lymphadenopathy. Increasingly multi-agent chemotherapy (CT) is being recommended as first line therapy with its attendant toxicity. To further examine this issue, we reviewed the outcomes for such patients managed at our institution. Methods: After ethics board approval, data on 106 patients identified from a prospectively maintained institutional database with low volume retroperitoneal disease (<5cm) were retrospectively reviewed. All patients were treated between 1995-2010 and had either relapsed Stage I disease on surveillance (59 pts) or Stage IIA/B at diagnosis (47 pts). Fifty eight patients had nodal disease of <2cm (57 treated with RT, 1 with CT), and 48 had disease 2-5cm (30 treated with RT, 18 with CT). Median age was 37 years (range 24-83). The preferred treatment policy was to use RT when possible (25 Gy in 20 fractions to para-aortic and pelvis with 10 Gy boost to gross disease). Reasons for using chemotherapy included multiple enlarged nodes with largest node at least 3cm (n=11), disease proximity to renal hilum (n=4), inflammatory bowel disease (n=3) and patient choice (n=1). Seventeen-patients received EP (4 cycles) chemotherapy and 2 received BEP (3 cycles). Results: With a median follow-up of 73 months, there were no disease or treatment related deaths. The 5-year overall and relapse-free survival was 100% and 91%. Of 58 patients with LN size ≤ 2 cm, 5 relapsed, all initially treated with RT. Of 48 patients with LN size 2-5cm, 4 relapsed (3/30 treated with RT, 1/18 treated with CT). Acute toxicity (CTCAE v4 >grade 1) was not observed in any patient treated with RT. In patients treated with CT, 7 developed G3/4 neutropenia, 2–grade 3 anemia, 2–grade 3 diarrhea, and 1 patient grade 3 weight loss. All relapsed patients were successfully salvaged by CT. Conclusions: A policy of routine use of RT in patients with low-volume nodal disease gives excellent results with >75% of patients avoiding CT and only 6% of patients receiving both RT and CT. Retroperitoneal RT should be strongly considered as the treatment of choice in these patients.

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Renal hypothermia during partial nephrectomy for patients with renal tumours: a randomised controlled clinical trial protocol

BMJ Open ◽

10.1136/bmjopen-2018-025662 ◽

2019 ◽

Vol 9 (1) ◽

pp. e025662

Author(s):

Rodney H Breau ◽

Ilias Cagiannos ◽

Greg Knoll ◽

Christopher Morash ◽

Sonya Cnossen ◽

...

Keyword(s):

Renal Function ◽

Glomerular Filtration ◽

Partial Nephrectomy ◽

Controlled Trial ◽

Controlled Clinical Trial ◽

Open Partial Nephrectomy ◽

Spot Urine ◽

Renal Tumours ◽

Renal Hilum ◽

Renal Hypothermia

IntroductionPartial nephrectomy is a standard of care for non-metastatic renal tumours when technically feasible. Despite the increased use of partial nephrectomy, intraoperative techniques that lead to optimal renal function after surgery have not been rigorously studied. Clamping of the renal hilum to prevent bleeding during resection causes temporary renal ischaemia. The internal temperature of the kidney may be lowered after the renal hilum is clamped (renal hypothermia) in an attempt to mitigate the effects of ischaemia. Our objective is to determine if renal hypothermia during open partial nephrectomy results in improved postoperative renal function at 12 months following surgery as compared with warm ischaemia (no renal hypothermia).Methods and analysesThis is a multicentre, randomised, single-blinded controlled trial comparing renal hypothermia versus no hypothermia during open partial nephrectomy. Due to the nature of the intervention, complete blinding of the surgical team is not possible; however, surgeons will be blinded until the time of hilar clamping. Glomerular filtration will be based on plasma clearance of a radionucleotide, and differential renal function will be based on renal scintigraphy. The primary outcome is overall renal function at 12 months measured by the glomerular filtration rate (GFR). Secondary outcomes include change in GFR, GFR of the affected kidney, change in GFR of the affected kidney, serum creatinine, haemoglobin, spot urine albumin to creatinine ratio, quality of life and postoperative complications. Data will be collected at baseline, immediately postoperatively and at 3, 6, 9 and 12 months postoperatively.Ethics and disseminationEthics approval was obtained for all participating study sites. Results of the trial will be submitted for publication in a peer-reviewed journal.Trial registration numberNCT01529658; Pre-results.

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Repair of chronic Achilles tendon rupture using Bosworth’s technique

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1177/2210491720972713 ◽

2020 ◽

pp. 221049172097271

Author(s):

Dhruba Narayan Borah ◽

Siddhartha Rai ◽

Herman Conrad Frank ◽

Anshuman Dutta

Keyword(s):

Achilles Tendon ◽

Functional Outcome ◽

Scoring System ◽

Surgical Procedure ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Surgical Techniques ◽

Distal Stump ◽

Zone Ii

Background: A large number of ruptures of the Achilles tendon occurs in the watershed hypovascular region (zone II) of the tendon which is approximately 2–6 cm proximal to the insertion of tendon at calcaneum. Chronic Achilles tendon rupture in the watershed area makes end to end repair of tendon less feasible and the neglected distal stump is often inapt for repair. A number of surgical techniques have been described for repair of chronic Achilles tendon in zone II. Our study was conducted with the objective of determining the efficacy and functional outcome of Bosworth’s technique that involves gastrocnemius-soleus turndown of proximal Achilles tendon. Materials and Methods: The study was conducted in a total of five patients with chronic tear of Achilles tendon and the Bosworth technique was used for repair in all the patients. All the patients were followed up for a period of 1 year and the functional outcome was assessed by scoring system devised by Leppilahti et al. Results: four out of the five patients showed excellent functional at the end of 1 year follow up. A good functional outcome was seen in one of the patients. All the patients were able to resume work 6 months postoperatively. Conclusion: The Bosworth’s technique is an excellent surgical procedure for repair of chronic Achilles tendon rupture in the watershed zone of the tendon.

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The Influence of Wall Stress on AAA Growth and Biomarkers

ASME 2010 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2010-19227 ◽

2010 ◽

Author(s):

Lambert Speelman ◽

Femke A. Hellenthal ◽

E. Marielle H. Bosboom ◽

Jaap Buth ◽

Marcel Breeuwer ◽

...

Keyword(s):

Growth Rate ◽

Surgical Procedure ◽

Surgical Repair ◽

Wall Stress ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Maximum Diameter ◽

Long Period ◽

Abdominal Aortic ◽

Risk Of Rupture

In the decision for surgical repair of abdominal aortic aneurysms (AAAs), the risk of rupture is weighed carefully against the risk of the surgical procedure. The risk of rupture is estimated based on the maximum diameter and the growth rate of the AAA. Previous studies indicate that AAA growth rate increases with the diameter of the AAA [1, 2]. However, this growth rate is not the same for each AAA, as some AAA’s remain stable over a long period of time, while others show a fast growth or grow discontinuously.

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