Magnetic Probe–Guided Excision of Nonpalpable Neck Lesions

2016 ◽  
Vol 24 (1) ◽  
pp. 42-48 ◽  
Author(s):  
Nihat Aksakal ◽  
Alper Ozturk ◽  
Firat Tutal ◽  
Selim Dogan ◽  
Orhan Agcaoglu ◽  
...  
Keyword(s):  
Neck Surgery ◽  
Scar Tissue ◽  
Magnetic Activity ◽  
Magnetic Probe ◽  
Magnetic Tracer ◽  
Nonpalpable Lesions ◽  
Pathologic Lesions ◽  
Persistent Hyperparathyroidism ◽  
Lesion Localization

Background: Reoperative neck surgery is technically more demanding because of the presence of scar tissue and distorted anatomy. We aimed to investigate the magnetic probe–guided excision of nonpalpable neck lesions in patients with previously operated neck compartments. Methods: This study included 9 patients with recurrent/persistent thyroid carcinoma, recurrent/persistent hyperparathyroidism with previously operated neck compartments. The pathologic lesions were localized by ultrasonography, and magnetic tracer (0.2 mL, iron oxide) was injected directly into the pathologic lesions. Careful dissection was carried out following the area of maximum magnetic activity until the nonpalpable lesions were identified and excised. Result: All neck lesions were removed in 9 patients. The median count from lesion was significantly higher than values from lesion bed (background activity; (9900/5 seconds vs 250/5 seconds, P < .001). During follow-up, all patients had negative ultrasonography. Conclusion: Magnetic probe–guided technique could provide access to nonpalpable lesion localization in centers without readily available access to nuclear medicine facilities.

scholarly journals Magnetically Guided Localization Using a Guiding-Marker System® and a Handheld Magnetic Probe for Nonpalpable Breast Lesions: A Multicenter Feasibility Study in Japan

Cancers ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2923
Author(s):  
Tomoko Kurita ◽  
Kanae Taruno ◽  
Seigo Nakamura ◽  
Hiroyuki Takei ◽  
Katsutoshi Enokido ◽  
...  
Keyword(s):  
Feasibility Study ◽  
Safety Margin ◽  
Target Lesion ◽  
Magnetic Probe ◽  
Resected Specimen ◽  
Breast Lesions ◽  
Marker System ◽  
Magnetic Marker ◽  
Nonpalpable Lesions ◽  
Nonpalpable Breast Lesions

Accurate pre-operative localization of nonpalpable lesions plays a pivotal role in guiding breast-conserving surgery (BCS). In this multicenter feasibility study, nonpalpable breast lesions were localized using a handheld magnetic probe (TAKUMI) and a magnetic marker (Guiding-Marker System®). The magnetic marker was preoperatively placed within the target lesion under ultrasound or stereo-guidance. Additionally, a dye was injected subcutaneously to indicate the extent of the tumor excision. Surgeons checked for the marker within the lesion using a magnetic probe. The magnetic probe could detect the guiding marker and accurately localize the target lesion intraoperatively. All patients with breast cancer underwent wide excision with a safety margin of ≥5 mm. The presence of the guiding-marker within the resected specimen was the primary outcome and the pathological margin status and re-excision rate were the secondary outcomes. Eighty-seven patients with nonpalpable lesions who underwent BCS, from January to March of 2019 and from January to July of 2020, were recruited. The magnetic marker was detected in all resected specimens. The surgical margin was positive only in 5/82 (6.1%) patients; these patients underwent re-excision. This feasibility study demonstrated that the magnetic guiding localization system is useful for the detection and excision of nonpalpable breast lesions.

Advantages and Challenges of Using Breast Biopsy Markers

2021 ◽  
Author(s):  
Taghreed I Alshafeiy ◽  
Alison Matich ◽  
Carrie M Rochman ◽  
Jennifer A Harvey
Keyword(s):  
Breast Biopsy ◽  
Percutaneous Biopsy ◽  
Standard Of Care ◽  
Benign Lesions ◽  
Accurate Identification ◽  
Biopsy Tissue ◽  
Local Practices ◽  
Frequency Of Use ◽  
Lesion Localization

Abstract Percutaneous image-guided biopsy procedures are the standard of care for histologic assessment of suspicious breast lesions. Post-biopsy tissue markers (clips) optimize patient management by allowing for assessment on follow-up imaging and precise lesion localization. Markers are used to ensure accurate correlation between imaging modalities, guide preoperative localization for malignant and high-risk lesions, and facilitate accurate identification of benign lesions at follow-up. Local practices differ widely, and there are no data detailing the exact frequency of use of clips for different breast biopsies. There are many indications for biopsy marker deployment, and some difficulties may be encountered after placement. The placement of biopsy markers has many advantages and few disadvantages, such that deployment should be routinely used after percutaneous biopsy procedures with rare exception.

scholarly journals Stand-Alone Rod Augmentation for Instrumentation Failure after Pedicle Subtraction Osteotomy: A Case Report with a 2-year Follow-up

2021 ◽  
Author(s):  
Mohammad Zarei ◽  
Mohsen Rostami ◽  
Furqan Mohammed Yaseen Khan
Keyword(s):  
Case Report ◽  
Spine Surgery ◽  
Callus Tissue ◽  
Scar Tissue ◽  
Pedicle Subtraction Osteotomy ◽  
Lumbar Pain ◽  
Sagittal Imbalance ◽  
Complex Procedure ◽  
Instrumentation Failure

Background: Revision surgery of spine can be a complex procedure and has known complications. It involves hardware revision, removal of scar/callus tissue, realignment of sagittal balance, and anterior augmentation. However, through this report, we aim to demonstrate that a stand-alone rod augmentation at the failure site without removal of scar/callus tissue and/or anterior fixation can achieve excellent results in select cases. Case Report: A 66-year-old woman underwent L2 pedicle subtraction osteotomy (PSO) + T9-iliac fixation for fixed sagittal imbalance and osteoporotic collapse of L3. One year later, she developed progressive axial lumbar pain and difficulty in mobilization. The patient was diagnosed with pseudoarthrosis and instrumentation failure and underwent revision spine surgery with stand-alone rod augmentation. She had anuneventful rehabilitation and showed complete radiographic union and excellent clinical outcome in the 2-year follow-up. Conclusion: Stand-alone rod augmentation can provide stable posterior construct to prevent future pseudoarthrosis and/or instrumentation failure after revision spine surgery in selected cases. Anterior augmentation or resection dural scar tissue or dissection through callus tissue is not always necessary.  

scholarly journals Recurrent giant cell tumour of the maxillary sinus and pterygoid process treated with denosumab

2018 ◽  
pp. bcr-2018-225095
Author(s):  
Duarte Rosa ◽  
Raquel Baptista Dias ◽  
João Cunha Salvador ◽  
Alexandra Borges
Keyword(s):  
Maxillary Sinus ◽  
Giant Cell ◽  
Giant Cell Tumour ◽  
Neck Surgery ◽  
Cell Tumour ◽  
Pterygoid Process ◽  
Bone Expansion ◽  
The Right ◽  
Denosumab Treatment

We report the case of a 74-year-old man with a giant cell tumour (GCT) of the right maxilla and pterygoid process. The patient presented to the maxillofacial and head and neck surgery clinic with an ulcerated lesion of the hard palate. Initial workup with CT revealed a mass within the right maxillary sinus and pterygoid process with associated bone expansion and erosion. Biopsy showed a GCT with mucosal ulceration. Two years after surgical resection, a follow-up CT revealed tumour recurrence involving the right pterygoid process and lateral pterygoid muscle. The patient was then proposed for therapy with denosumab. Under denosumab treatment, the lesion maintained stable dimensions and became sclerotic and heavily ossified.

scholarly journals P1437 Integrated ST segment elevation score as a new predictor of the myocardial scar extent determined with LGE-CMR at 1-month follow-up after STEMI

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Mester ◽  
T Benedek ◽  
D Opincariu ◽  
A Benedek ◽  
M Ratiu ◽  
...  
Keyword(s):  
Scar Tissue ◽  
Myocardial Scar ◽  
St Segment Elevation ◽  
Elevation Score ◽  
St Segment ◽  
Myocardial Scar Tissue ◽  
Hs Crp ◽  
Lge Cmr

Abstract Funding Acknowledgements Funded by the research grant PlaqueImage, contract number 26/01.09.2016, SMIS code 103544, by the European Union and the Government of Romania Background The inflammatory response in the acute phase of a myocardial infarction, as well as in later phases contributes to the healing process of the infarcted myocardium and the left ventricular remodeling. Restoration and improvement of LV function highly depends on the magnitude of scar formation. Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) imaging has been validated for an accurate determination of the myocardial scar size and transmurality. The recovery of ST segment elevation is a liable marker of vessel patency following PCI. Purpose The aim of the study was to validate a new integrated score of ST segment elevation score (ISSTE) as a new predictor of the myocardial scar tissue size, in relation with increased inflammatory biomarkers, with the extent of myocardial fibrosis at one month, assessed with LGE-CMR, after STEMI. Methods We included 65 patients with STEMI who underwent urgent revascularization with PCI in the first 12 hours from the onset of symptoms. The ISSTE was determined by summing the ST segment elevation in all registered ECG leads at presentation (ISSTE-1) and at 2 hours (ISSTE-2) after primary PCI. Blood samples were also collected at baseline and day-5 for determination of serum hs-CRP levels. At 1-month follow-up all patients under LGE-CMR (1.5T scanner) for evaluation of the myocardial scar extent (volume, percentage, transmurality). Results ISSTE-2 was significantly correlated with day-5 hs-CRP serum levels (r = 0.546, 95%CI: 0.030-0.832, p = 0.037), although no significant correlations were noted with baseline hs-CRP levels (r= 0.238, p = 0.407). There were no significant correlations between ISSTE-1 score and the myocardial scar percentage (r = 0.241, p = 0.11) or high transmurality volume (r = 0.194, p = 0.21), while ISSTE-2 significantly correlated with myocardial scar mass (r = 0.406, 95%CI: 0.107-0.637 p = 0.007) and high transmurality volume (r = 0.344, 95%CI: 0.0320-0.596, p = 0.0273). The restoration of the ST segment, reflected by the difference between ISSTE-1 and ISSTE -2 is correlated with the infarct size mass (r = 0.336, 95%CI: 0.0307 -0.584, p = 0.027). Conclusion The magnitude of ST segment elevation determined at 2 hours after PCI was associated with the inflammatory response at day 5 after STEMI and it may serve as a predictor for the extent of the myocardial scar tissue determined with LGE-CMR at 1 month following STEMI. The ISSTE-1 score calculated at presentation does not reflect extent of the affected myocardial tissue following PCI.

scholarly journals Computed Tomography Perfusion, Magnetic Resonance Imaging, and Histopathological Findings After Laparoscopic Renal Cryoablation: An In Vivo Pig Model

2016 ◽  
Vol 16 (4) ◽  
pp. 406-413 ◽  
Author(s):  
Tommy Kjærgaard Nielsen ◽  
Øyvind Østraat ◽  
Ole Graumann ◽  
Bodil Ginnerup Pedersen ◽  
Gratien Andersen ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Central Zone ◽  
Peripheral Zone ◽  
Scar Tissue ◽  
Resonance Imaging ◽  
Computed Tomography Perfusion ◽  
Laparoscopic Assisted

The present study investigates how computed tomography perfusion scans and magnetic resonance imaging correlates with the histopathological alterations in renal tissue after cryoablation. A total of 15 pigs were subjected to laparoscopic-assisted cryoablation on both kidneys. After intervention, each animal was randomized to a postoperative follow-up period of 1, 2, or 4 weeks, after which computed tomography perfusion and magnetic resonance imaging scans were performed. Immediately after imaging, open bilateral nephrectomy was performed allowing for histopathological examination of the cryolesions. On computed tomography perfusion and magnetic resonance imaging examinations, rim enhancement was observed in the transition zone of the cryolesion 1week after laparoscopic-assisted cryoablation. This rim enhancement was found to subside after 2 and 4 weeks of follow-up, which was consistent with the microscopic examinations revealing of fibrotic scar tissue formation in the peripheral zone of the cryolesion. On T2 magnetic resonance imaging sequences, a thin hypointense rim surrounded the cryolesion, separating it from the adjacent renal parenchyma. Microscopic examinations revealed hemorrhage and later hemosiderin located in the peripheral zone. No nodular or diffuse contrast enhancement was found in the central zone of the cryolesions at any follow-up stage on neither computed tomography perfusion nor magnetic resonance imaging. On microscopic examinations, the central zone was found to consist of coagulative necrosis 1 week after laparoscopic-assisted cryoablation, which was partially replaced by fibrotic scar tissue 4 weeks following laparoscopic-assisted cryoablation. Both computed tomography perfusion and magnetic resonance imaging found the renal collecting system to be involved at all 3 stages of follow-up, but on microscopic examination, the urothelium was found to be intact in all cases. In conclusion, cryoablation effectively destroyed renal parenchyma, leaving the urothelium intact. Both computed tomography perfusion and magnetic resonance imaging reflect the microscopic findings but with some differences, especially regarding the peripheral zone. Magnetic resonance imaging seems an attractive modality for early postoperative follow-up.

scholarly journals Spontaneous Healing in complete ACL ruptures: results at eight-year mean follow-up

2018 ◽  
Vol 6 (12_suppl5) ◽  
pp. 2325967118S0018
Author(s):  
Matias Costa-Paz ◽  
Ignacio Garcia-Mansilla ◽  
Miguel Ayerza ◽  
D. Luis Muscolo
Keyword(s):  
Cruciate Ligament ◽  
Sport Activity ◽  
Scar Tissue ◽  
Long Term Results ◽  
Return To Sports ◽  
Spontaneous Healing ◽  
Initial Evolution ◽  
Anterior Cruciate ◽  
Tissue Rupture

Objectives: The injured anterior cruciate ligament (ACL) has a limited healing capacity leading to persisting instability. Although several studies have reported spontaneous healing of torn ACLs, it is difficult to determine its healing potential and whether patients will be able to return to sports activities. In 2011, we published a series of 14 patients with spontaneous healing following a complete ACL rupture, the mean follow up was 30 months (range 25-36 months). The purpose of this study was to evaluate the long-term results of spontaneous healing in complete ACL ruptures in the same group of patients. Methods: We retrospectively reviewed a cohort of 14 patients with acute ACL injury established by physical examination and MRI (proximal third in eight patients and the midligament in six). Twelve patients were male and average age at injury was 31 years (range, 23-41 years), All patients were athletically active before the injury and suffered the lesion during a sport activity. Surgery was indicated in all patients, but it was postponed for different reasons, including related labor problems, need to travel, illnesses, planned holidays, and the patient’s personal decision not to undergo surgery. Most of the patients let the injury run its course with no bracing and unspecific rehabilitation protocol. The primary outcomes of this study were rerupture rate and time between injury and surgery. Results: Twelve patients out of 14 were reevaluated (86%), with a mean follow up of 8 years (3-14). Ten were men, with a mean age of 38 years (range, 25-51 years). Five patients had an ACL reconstruction during follow-up, with a mean time between injury and surgery of 5 years (range 3-14). Initial injury was located in the proximal third in two patients and in the midligament in three. Conclusion: Although favorable initial evolution at 30 months after a complete ACL lesion, our series show a re-rupture rate or “scar tissue” rupture of 40% at a mean follow-up of 8 years.

scholarly journals Anterior Cervical Osteophyte Resection for Treatment of Dysphagia

2020 ◽  
pp. 219256822091270
Author(s):  
Joshua M. Kolz ◽  
Mohammed A. Alvi ◽  
Atiq R. Bhatti ◽  
Marko N. Tomov ◽  
Mohamad Bydon ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Neck Surgery ◽  
High Complication Rate ◽  
Disc Space ◽  
Swallowing Function ◽  
Cervical Osteophytes ◽  
Cervical Disease ◽  
The Mean

Study Design: This was a retrospective cohort study. Objectives: When anterior cervical osteophytes become large enough, they may cause dysphagia. There is a paucity of work examining outcomes and complications of anterior cervical osteophyte resection for dysphagia. Methods: Retrospective review identified 19 patients who underwent anterior cervical osteophyte resection for a diagnosis of dysphagia. The mean age was 71 years and follow-up, 4.7 years. The most common level operated on was C3-C4 (13, 69%). Results: Following anterior cervical osteophyte resection, 79% of patients had improvement in dysphagia. Five patients underwent cervical fusion; there were no episodes of delayed or iatrogenic instability requiring fusion. Fusion patients were younger (64 vs 71 years, P = .05) and had longer operative times (315 vs 121 minutes, P = .01). Age of 75 years or less trended toward improvement in dysphagia ( P = .09; OR = 18.8; 95% CI 0.7-478.0), whereas severe dysphagia trended toward increased complications ( P = .07; OR = 11.3; 95% CI = 0.8-158.5). Body mass index, use of an exposure surgeon, diffuse idiopathic skeletal hyperostosis diagnosis, surgery at 3 or more levels, prior neck surgery, and fusion were not predictive of improvement or complication. Conclusions: Anterior cervical osteophyte resection improves swallowing function in the majority of patients with symptomatic osteophytes. Spinal fusion can be added to address stenosis and other underlying cervical disease and help prevent osteophyte recurrence, whereas intraoperative navigation can be used to ensure complete osteophyte resection without breaching the cortex or entering the disc space. Because of the relatively high complication rate, patients should undergo thorough multidisciplinary workup with swallow evaluation to confirm that anterior cervical osteophytes are the primary cause of dysphagia prior to surgery.

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