Sphincter saving resection after preoperative chemoradiation for T3 carcinoma of the lower rectum

Surgical treatment has evolved over the past ten years particularly for cancer involving the mid and lower third of the rectum. carcinomas of the lower third of the rectum are usually treated by abdominoperineal resection especially for T3 lesions. Few data are available evaluating Concomitant chemotherapy with preoperative radiotherapy for increasing sphincter saving resection [SSR] in low rectal cancer The purpose of this study was to evaluate the possibility of SSR for T3 cancers of the lower third of the rectum and subsequently the complication oncologic and functional results of preoperative chemoradiation followed sphincter saving procedure is assessed and determined. Twelve patients with T3 rectal carcinoma were treated by preoperative radiation with concomitant chemotherapy were included in the study. All patients had invasive adenocarcinoma of the rectum and underwent staging before treatment by endorectal ultrasonography All patients underwent conservative surgey after chemoradiation for low rectal cancer tumors located at a mean of 5 cm from the anal verge. Transanal intersphincteric resection was done in 7 patients. A colonic J-pouch was done in 2 patients. All patients had a defunctioning loop ileastomy. There were no deaths related to preoperative chemoradiation or surgery. Morbidity occurred in 33.3% of patients was complicated by a pelvic abscess that responded to conservative treatment. The other complications local recurrence at the anastomosis site at 13 months and was treated by salvage APR After preoperative chemoradiation all the tumors appeared as an ulcerative scar without any vegetative component. The mean tumor size in fresh specimens was 3.6 cm range [l-9]. The mean distal margin, assessed in fresh specimens without traction, was 23 +/- 8 mm [range 10-40]. The mean radial margin assessed microscopically was 8 +/- 4 mm [range 1-20]. Both distal and radial margins were negative [> 2 mm] in 11 [91.6%] patients; they were positive [

CT and MR imaging of cerebral tuberous sclerosis

Tuberous sclerosis is heredofamilial neurocutaneous syndrome, or phakomatosis, with multisystem involvement including the brain. The four major intracranial manifestarions [of TS are cortical tubers, white matter abnormalities, subependymal nodules, and subependymal giant cell astrocytoma. Eighteen patients with a clinical diagnosis of Tuberous sclerosis were examined by MR imaging. Their ages ranged from 3 months to 20 years. In 18 [100%] patients, MR examinations showed subependymal nodules, multiple peripheral gyral lesions consistent with cortical tubers were demonstrated in 14 [77%] patients. Subependymal nodules were best visualized on spin-echo images obtained with short repetition times [TR], although hypointesity within the nodules consistent with calcification was present in 15 patients and was most evident on long TR spin-echo images. Cortical tubers were more frequently demonstrated on long TR spin-echo images. White matter lesions were detected in 8 [44%] patients and subependymal giant cell astrocytoma in 4 [22%] patients. Computed tomographic scans were obtained for comparison in 15 patients. Intracranial calcification was more accurately diagnosed with CT. However, MR imaging was more sensitive than CT in detecting cortical tubers. Therefore MR may be better for screening family members and others in whom tuberous sclerosis is a possibility