¿Supuración crónica o pseudoquiste infectado? Una complicación de la eventroplastia con malla / Chronic suppuration or infected pseudocyst? A complication of incisional hernia repair with mesh

RESUMEN Las infecciones crónicas posteriores a reparaciones de la pared abdominal pueden presentarse como colecciones que involucran a la malla y suelen obligar a su extracción, mientras que los pseudoquistes son colecciones estériles con una gruesa pared fibrótica que debe ser extirpada para lograr la curación. Presentamos una paciente de 75 años con antecedente de eventroplastia, que consultó por un tumor abdominal de 6 meses de evolución, con características imagenológicas de pseudoquiste parietal. Durante la operación se encontró una malla preperitoneal no integrada a los tejidos y rodeada de "biofilm" y líquido turbio. La prótesis se retiró fácilmente y la aponeurosis, muy engrosada, se cerró borde a borde. El posoperatorio transcurrió sin incidentes y el cultivo desarrolló estafilococo aureus sensible a trimetoprima-sufametoxazol. Seis meses después, la evolución fue favorable y sin signos de recidiva.

ABSTRACT Chronic infections after abdominal wall repairs may present as collections involving the mesh which usually require removing the mesh, while pseudocysts are sterile collections with a thick fibrotic wall that must be removed to achieve healing. We report the case of a 75-year-old female patient with a history incisional hernia repair who sought medical advice due to an abdominal tumor which appeared 6 months before consultation with imaging tests suggestive of an abdominal wall pseudocyst. Surgery revealed a preperitoneal mesh without tissue integration surrounded by biofilm and cloudy fluid. The mesh was easily removed and the edges of the thick aponeurosis were sutured. The postoperative period evolved uneventful and the fluid culture was positive for staphylococcus aureus sensitive to trimethoprim-sufamethoxazole. Six months later the patient evolved with favorable outcome without recurrence.

Progress in Precision Medicine of Radiomics in Abdominal Tumors Practice / 中国医疗器械杂志

With the advent of the era of artificial intelligence, as an emerging technology, radiomics can extract a large amount of quantitative information describing the physiological condition and phenotypic characteristics of tumors with high throughput from the massive data of CT, MRI and other imaging tomography, and analyze these high-dimensional imaging omics features containing disease pathophysiological information can be used to accurately determine tumor differentiation, staging, and predict tumor behavior, which has broad application prospects. This article aims to introduce the technical principles of radiomics and its abdominal tumor application status, and to prospect its application prospects in pediatric abdominal neuroblastoma.

Do the radiological criteria with the use of risk factors impact the forecasting of abdominal neuroblastic tumor resection in children? / Critérios radiológicos impactam a previsão de ressecabilidade em neuroblastomas abdominais na criança com o uso de fatores de risco?

ABSTRACT Background: The treatment of neuroblastoma is dependent on exquisite staging; is performed postoperatively and is dependent on the surgeon's expertise. The use of risk factors through imaging on diagnosis appears as predictive of resectability, complications and homogeneity in staging. Aim: To evaluate the traditional resectability criteria with the risk factors for resectability, through the radiological images, in two moments: on diagnosis and in pre-surgical phase. Were analyzed the resectability, surgical complications and relapse rate. Methods: Retrospective study of 27 children with abdominal and pelvic neuroblastoma stage 3 and 4, with tomography and/or resonance on the diagnosis and pre-surgical, identifying the presence of risk factors. Results: The mean age of the children was 2.5 years at diagnosis, where 55.6% were older than 18 months, 51.9% were girls and 66.7% were in stage 4. There was concordance on resectability of the tumor by both methods (INSS and IDRFs) at both moments of the evaluation, at diagnosis (p=0.007) and post-chemotherapy (p=0.019); In this way, all resectable patients by IDRFs in the post-chemotherapy had complete resection, and the unresectable ones, 87.5% incomplete. There was remission in 77.8%, 18.5% relapsed and 33.3% died. Conclusions: Resectability was similar in both methods at both pre-surgical and preoperative chemotherapy; preoperative chemotherapy increased resectability and decreased number of risk factors, where the presence of at least one IDRF was associated with incomplete resections and surgical complications; relapses were irrelevant.

RESUMO Racional: O tratamento do neuroblastoma é dependente de estadiamento primoroso, realizado no pós-cirúrgico e dependente da expertise do cirurgião. O uso de fatores de risco através da imagem ao diagnóstico surge como preditivo de ressecabilidade, complicações e homogeneidade no estadiamento. Objetivos: Avaliar o critério de ressecabilidade tradicional com os fatores de risco para ressecabilidade, através das imagens radiológicas, em dois momentos no diagnóstico e no pré-cirúrgico analisando a ressecabilidade, complicações cirúrgicas e índice de recidiva. Métodos: Estudo retrospectivo em 27 crianças com neuroblastoma estádios 3 e 4 em abdome e pelve, e com tomografia e/ou ressonância no diagnóstico e pré-cirúrgico, identificando-se a presença de fatores de risco. Resultados: A idade média das crianças foi de 2,5 anos ao diagnóstico, onde 55,6% estavam acima dos 18 meses, 51,9% eram meninas e 66,7% tinham estádio 4. Houve concordância da ressecabilidade do tumor pelos dois métodos avaliados (INSS e IDRFs) e em ambos os momentos da avaliação, ao diagnóstico (p=0,007) e pós-quimioterapia (p=0,019). Desta forma todos pacientes ressecáveis por IDRFs no pós-quimioterapia tiveram ressecção completa; já nos irressecáveis, 87,5% tiveram ressecção incompleta. Houve remissão em 77,8%, 18,5% recaíram e 33,3% morreram. Conclusões: Aressecabilidade foi semelhante em ambos os métodos tanto no diagnóstico como no pré-cirúrgico. A quimioterapia pré-operatória aumentou a ressecabilidade e diminuição do número de fatores de risco, onde a presença de ao menos um IDRF associou-se às ressecções incompletas e complicações cirúrgicas. As recidivas foram irrelevantes.

Mesotelioma multiquístico benigno: primer caso reportado en Bolivia / Benign multicystic mesothelioma: first reported case in Bolivia

Hasta 2 013 sólo 130 casos de quistes mesentéricos habían sido descritos en el mundo, por lo que constituye un hallazgo bastante raro de diagnóstico difícil, por la sintomatología poco específica, sin hallazgos imagenológicos patognomónicos, que en todos los casos requiere un abordaje quirúrgico y estudio histopatológico. Presentamos el primer caso descrito en la literatura boliviana, de mesotelioma multiquístico peritoneal benigno en una paciente de sexo femenino, con cuadro de 3 meses de evolución, caracterizado por dolor y aumento de volumen en hipogastrio, asociado a dificultad para miccionar, con evidencia imagenológica de masa pélvica de origen vesical u ovárico, realizándose laparotomía exploradora y estudio histopatológico para determinar diagnóstico, presentó evolución favorable y fue dada de alta con sonda foley. Actualmente realiza controles regulares por ginecología oncológica y oncología clínica.

Until 2 013 only 130 cases of mesenteric cysts have been described in the world, which is a rare find with difficulties to diagnose by uns-pecific symptoms, without pathognomonic imaging findings, which in all cases require surgical approach and histopathological study. We report the first case described in Bolivian literature of bening peritoneal multicystic mesothelioma benign in a female patient with Table 3 months of evolution, characterized by pain and increased volume in lower abdomen, difficulty in urination associated with radiographical evidence bladder pelvic mass or ovarian origin, performing laparotomy and histopathological study to determine diagnosis the patients presented a favorable evolution and she was discharged with foley catheter. Currently she has regular controls by gynecologic oncology and clinical oncology.

Spontaneous Regression of a Cystic Tumor in a Postpartum Woman; Is It A Cystic Lymphangioma?

Spontaneous regression of intra-abdominal cystic tumors in adults is unusual. Here, we present the case of an apparently spontaneous regression of a large intra-abdominal cystic mass found in the postpartum period of an 18-year-old woman. The regression was demonstrated using serial computed tomography (CT) examinations over a two-year period.

Spontaneous Regression of a Cystic Tumor in a Postpartum Woman; Is It A Cystic Lymphangioma?

Spontaneous regression of intra-abdominal cystic tumors in adults is unusual. Here, we present the case of an apparently spontaneous regression of a large intra-abdominal cystic mass found in the postpartum period of an 18-year-old woman. The regression was demonstrated using serial computed tomography (CT) examinations over a two-year period.

FDG Uptake in PET by Bladder Hernia Simulating Inguinal Metastasis

A 70-year-old man with past history of hemicolectomy due to colon cancer underwent a follow-up abdominal/pelvic CT scan. CT revealed a right adrenal metastasis and then he underwent FDG-PET/CT study to search for other possible tumor recurrence. In PET images, other than right adrenal gland, there was an unexpected intense FDG uptake at right inguinal region and at first, it was considered to be an inguinal metastasis. However, correlation of PET images to concurrent CT data revealed it to be a bladder herniation. This case provides an example that analysis of PET images without corresponding CT images can lead to an insufficient interpretation or false positive diagnosis. Hence, radiologists should be aware of the importance of a combined analysis of PET and CT data in the interpretation of integrated PET/CT and rare but intriguing conditions, such as bladder herniation, during the evaluation of PET scans in colon cancer patients.

Value of ultrasound guided needle biopsy of abdominal masses

Forty one cases [22 males and 19 females] with abdominal and pelviabdominal masses were subjected to ultrasound guided needle biopsy in Kasr El-Aini Hospital Radiodiagnostic Department. The biopsies were taken from different organs, liver [9 cases], ovaries [6 cases], kidneys [5 cases], small and large intestine [5 cases], pancreas [3 cases], lymph nodes [2 cases], stomach [2 cases], suprarenal gland [2 cases], and spleen [1 case]. Six biopsies were obtained from masses belonging to no sonographically recognized organ of origin. The biopsy results diagnosed 23 lesions as being malignant [true positive], 13 lesions as benign [true negative], and 5 lesions as [false negative], [benign by us, malignant after surgery], no false positive results were reported. The overall accuracy in this study was 87.8%. The results were confirmed either surgically, by endoscopy, autopsy biopsy of other lesions in the patient or by follow-up using other imaging modalities. No significant complications occurred only minor ones in the form of vaso-vagal attacks in two patients. From this work we concluded that ultrasound guided needle biopsy should be the method of choice for biopsy guidance in the abdomen as it is quick, cheep and less hazardous as there is no ionizing radiation or contrast media used

Sonographic evaluation of neonatal abdominal masses

This study included 35 neonates referred to the ultrasound unit at the New Children Hospital of Cairo University, for abdominal sonography. They were divided into two groups.The first group included 22 cases presenting with clinically palpable abdominal mass [es]. They proved by sonography to have renal pathology in 12 cases, hepatic pathology in 7 cases and splenomegaly in 3 cases. The second group contained 13 cases with no clinically palpable mass but suspected of having an intraabdominal pathology for variable reasons as multiple congenital anomalies, persistent unexplained jaundice, abdominal distension etc... Sonography diagnosed renal malformations in 2 cases, suprarenal hematoma in 4 cases, ascites in 3 cases, obstructive uropathy in 2 cases, congenital nephrosis in one case and liver malformation in the last one. Both groups were subjected to proper history with systemic and abdominal examination. Confirmatory laboratory tests, other imaging techniques and postoperative pathologic examination were selected according to each case. Our results emphasize the importance of abdominal sonography in identifying the anatomical origin and pathological nature of clinically detectable abdominal masses. It also proved very helpful in detecting significant abdominal pathology in the absence of clinically palpable masses