Computer aided preoperative evaluation of the residual liver volume using computed tomography images.

Major hepatectomy causes a risk of postoperative liver dysfunction, failure, and infections like surgical site infection. Preoperative assessment of the liver volume and function of the remnant liver is a mandatory prerequisite before performing such surgery. The aim of this work is to develop and test a software application for evaluation of the residual function of the liver prior to the intervention of the surgeons. For this purpose, a technique for evaluation of liver volume from computed tomography (CT) images has been developed. Furthermore, the methodology algorithms were implemented and incorporated within a software tool with three basic functionalities: volume determination based on segmentation of liver from CT images, virtual tumour resection and estimation of the residual liver function and 3D visualisation. Forty-one sets of abdominal CT images consisting of different number of tomographic slice images were used to test and evaluate the proposed approach. Volumes that were obtained after manual tracing by two surgeon experts showed a relative difference of 3.5 %. The suggested methodology was encapsulated within an application with user-friendly interface that allows surgeons interactively to perform virtual tumour resection, to evaluate the relative residual liver and render the final result. Thereby, it is a tool in the surgeons' hands that significantly facilitates their duties, saves time, and allows them to objectively evaluate the situation and take the right decisions. At the same time, the tool appears to be appropriate educational instrument for virtual training of young surgeon specialists.

Virilizing adrenal oncocytoma in a 9-year-old girl: rare neoplasm with an intriguing postoperative course.

Adrenal oncocytoma is an extremely rare neoplasm, which is mostly non-functional. Only five cases of childhood adrenal oncocytoma have been described so far, all of which were hormonally active. Currently, guidelines for management and follow-up are not available. We report a 9-year-old girl with benign adrenal oncocytoma, presenting with severe short-term virilization. After diagnostic work-up the patient underwent laparoscopic unilateral adrenalectomy. For the first 2 weeks following surgery she suffered marked mood swings, irritability and fatigue. There were no other clinical and/or laboratory abnormalities except the rapid drop-down of androgen levels to normal values. Follow-up showed no signs of recurrence and in the absence of signs of adrenal insufficiency, we speculate that, the rapid drop of androgen levels after removal of the tumor might be the reason for the deteriorated psychoemotional condition of our patient.

The role of 3-D endorectal ultrasound in rectal cancer: our experience.

In the last 20 years, endorectal ultrasound (ERUS) has been one of the main diagnostic methods for locoregional staging of rectal cancer. ERUS is accurate modality for evaluating local invasion of rectal carcinoma into the rectal wall layers (T category). Adding the three-dimensional modality (3-D) increases the capabilities of this diagnostic tool in rectal cancer patients. We review the literature and report our experience in preoperative 3-D ERUS in rectal cancer staging. In the group of 71 patients, the staging of preoperative 3-D endorectal ultrasonography was compared with the postoperative morphologic examination. Three-dimensional ERUS preoperative staging was confirmed with morphologic evaluation in 66 out of 71 cases (92.9%). The detection sensitivities of rectal cancer with 3-D ERUS were as follows: T1, 92.8%; T2, 93.1%; T3, 91.6%; and T4, 100.0%; with specificity values of T1, 98.2%; T2, 95.4%; T3, 97.8%; and T4, 98.5%. Three-dimensional ERUS correctly categorized patients with T1, 97.1%; T2, 94.3%; T3, 95.7%; and T4, 98.5%. The percentage of total overstaged cases was 2.75% and that of understaged cases was 6.87%. The metastatic status of the lymph nodes was determined with a sensitivity of 79.1% (19 of 24), specificity of 91.4% (43 of 47), and diagnostic accuracy of 87.3% (62 of 71). In our experience, 3-D ERUS has the potential to become the diagnostic modality of choice for the preoperative staging of rectal cancer.