Peritoneal malignancy: anatomy, pathophysiology and an update on modern day imaging

With increasing subspecialized experience in radical cytoreductive surgery and intra abdominal chemotherapy for peritoneal malignancy, outcomes have improved significantly in selected patients. The surgery and the treatment regimens are radical and therefore correct patient selection is critical. The radiologist plays a central role in this process by estimating, as precisely as possible, the pre-treatment disease burden. Because of the nature of the disease process, accurate staging is not an easy task. Tumour deposits may be very small and in locations where they are very difficult to detect. It must be acknowledged that no form of modern day imaging has the capability of detecting the smallest peritoneal nodules which may only be visible to direct inspection or histopathological evaluation. Nonetheless, it behoves the radiologist to be as exact and precise as possible in the reporting of this disease process. This is both to select patients who are likely to benefit from radical treatment, and just as importantly, to identify patients who are unlikely to achieve adequate cytoreductive outcomes. In this review, we outline the patterns of spread of disease and the anatomic basis for this, as well as the essential aspects of reporting abdominal studies in this patient group. We provide an evidence-based update on the relative strengths and limitations of our available multimodality imaging techniques namely CT, MRI and PET/CT.

The Transformation of the Balloon Shape in Percutaneous Balloon Compression for Trigeminal Neuralgia

Background: The pear shape of an inflated balloon is thought to be a gold standard of a successful percutaneous balloon compression (PBC). However, neither how the balloon shape changes nor why it changes in that way (the anatomic basis) has not yet been fully described. Methods: Radiographs from over 150 percutaneous balloon compression (PBC) cases were thoroughly evaluated. We proposed a model of changing balloon shape in Meckel's cave (MC) and 70 cases were followed up over 2 years, in which therapeutic effect was measured.Results: We found that the balloon changed stereotypically in MC. The model that we proposed is consistent with the description of the structures of MC and its surroundings in the literature. The distinct pear (pear in MC) brought about a far better surgical result than other shapes (p < 0.01).Conclusion: Our study showed how and why the balloon shape changed during PBC surgery. The model provides favorable guidance for PBC surgery.

Cleft Lip

Many techniques exist at present for surgical repair of primary cleft lip. Since the introduction of Millard, most of the techniques are based on Millard’s Rotation advancement principle. However, every cleft surgeon aims to modify his/her technique to achieve optimum symmetry and function of the nose and lip. In this chapter, we have presented the principles of lip repair followed at our centre based on the very principles of Millard. We have also discussed embryology and anatomy from a surgical pint of view so as to understand the anatomic basis if cleft surgery.

Comparisons of Ocular Anatomic Differences of Lens-Subluxated Eye with or without Acute Angle Closure: A Retrospective Study

Purpose. To compare ocular anatomy differences of lens subluxation between eyes with or without acute angle closure (AAC). Methods. This is a retrospective and case-control study. Sixty cases with mild lens subluxation were recruited. Among them, 30 eyes with acute angle closure were assigned to the AAC group and 30 eyes without AAC were assigned to the non-AAC group. The anterior segment was quantitatively evaluated by ultrasound biomicroscopy (UBM). The axial length (AL) was measured with IOL Master. All patients underwent lens extraction surgery and were followed up for six months. Results. The history of blunt trauma accounted for 22 (73.3%) cases in the AAC group and 21 (70%) cases in the non-AAC group. Fifteen (50%) patients in the AAC group had iridotomy history, and high intraocular pressure recurred. The UBM analysis showed that the average central chamber depth of the affected eyes in the AAC group was 1.82 mm, which was significantly shallower than that in the fellow eyes (2.58 mm, P<0.05) or both eyes in the non-AAC group.Both eyes in the AAC group presented a shorter AL and shallower anterior chamber than the eyes in the non-AAC group. Conclusions. An asymmetrical anterior chamber between bilateral eyes is an important feature in lens subluxation-induced AAC. The crowded anterior chamber and shorter AL might be the anatomic basis for the eye with lens subluxation-induced AAC.

A new anatomic zone division within the human cervical spinal canal

Background: Anatomic details are important for identifying the origin and anatomic basis of symptoms in patients with cervical spondylosis. However, very little quantitative data has been reported. In an effort to provide an anatomic basis for the examination of cervical spondylosis mechanisms, we characterized the morphologic features of cervical spinal nerve rootlets and defined different zones of the human cervical spinal canal.Methods: In 10 cadaveric cervical cords from C2 to T1, we defined three zones bilaterally from the midline (zones I-III) and two zones from cranial to caudal (zones P and IP) on the coronal plane within the cervical spinal canal. We measured each anatomic zone, including 1) horizontal widths of zones I, II and III; 2) the length of the cervical spinal segment at the ventral rootlets (LV); 3) the pedicle height (zone P) and interpedicle height (zone IP); and 4) the distance between the superior margin of the pedicle and the exit of the uppermost ventral nerve rootlet (PN). Results: The horizontal widths of zone I tended to decrease gradually from C4 to C8 (p=0.98). The width of zone II at C4 was significantly less than that at other levels (p=0.008). The width of zone III increased from C4 to C8 and was significantly greater at C7 and C8 than at C4, C5, and C6 (p=0.032). Pedical and interpedical heights were not significantly different at different levels (p=0.365 and 0.240, respectively). LV values at C4 and C8 were smaller than those at C5, C6, and C7 (p=0.001). At C4, the uppermost ventral rootlet was at approximately the same height as the C3 pedicle, whereas at C8, the uppermost ventral rootlet was at the same level as the inferior part of the C6 pedicle. Ventral intradural intersegmental connections were found in three of 20 (15%) intersegments (two specimens).Conclusions: These anatomic zones may be useful for diagnosing cervical spondylosis and guiding anterior decompression surgery.