Abstract only
e13069
Background: Cancer is the second leading cause of death globally, and was responsible for ~9.6 million deaths in 2018. Importantly, between 30–50% of cancers can be prevented by ...avoiding risk factors and implementing existing evidence-based prevention strategies. Methods: We present the results of 15758 adults who came to our clinic between 2006 and 2018. Patients were counseled on reducing risk factors and screened for early detection of 11 of the most common cancer types. Patients were examined by specialists in internal medicine, surgery, plastic surgery, OBGYN, urology, oncology, oral surgery, gastroenterology, and others. Women underwent vaginal US, pap smear, mammography (40yr) and US/MRI of the breast with a clinical indication. Men underwent PSA/free PSA ( > 40yr). LDCT for moderate smokers. Colonoscopy was recommended to all subjects ( > 40yr). Results: A total of 7900 (50.1%) men and 7857 women (49.9%) mean age 46.9±11.3 years were screened. A total of 418 (2.7%) malignant lesions were detected in patients who had been screened, 245 (1.6%) of which were detected through our screening: skin 66 (0.4%), prostate 30 (0.2%), thyroid 28 (0.2%), breast 28 (0.2%), colorectal 19 (0.1%), urinary 13 (0.08%), lung 11 (0.07%), cervical 11 (0.07%), other/unknown 9 (0.06%), hematologic 8 (0.05%), ovarian 5 (0.03%), uterine 5 (0.03%), pancreas 3 (0.02%), testicular 3 (0.02%), oropharyngeal 2 (0.01%), hepatobiliary 2 (0.01%), stomach 1 (0.01%), larynx 1 (0.01%). A total of 17 (0.1%) malignant lesions were missed: breast 3 (0.02%), colorectal 3 (0.02%), skin 2 (0.01%), thyroid 2 (0.01%), hematologic 2 (0.01%), pancreas 2 (0.01%), kidney 1 (0.01%), lung 1 (0.01%), brain 1 (0.01%). A total of 147 (0.9%) malignant lesions developed > 1year after a visit. Only forty-nine of the cancer patients (12.5%) died after 18.9±17.8 months at a mean age of 66.5±12.2 years. Significantly, better than the expected cancer mortality in general. First-degree family member with cancer (HR = 1.46) and advanced age (HR = 21.8) was associated with increased cancer risk (P < 0.05). Conclusions: One stop shop cancer screening, in the setting of a multidisciplinary outpatient clinic is feasible, can detect cancer at an early stage, and can significantly improve survival.
Worldwide, colorectal cancer is the third most frequent cancer occurring in both sexes. Screening programs for early detection enable detection of tumors at an earlier stage and have been shown to ...reduce death rate. Currently, colonoscopy is the investigation of choice for colorectal cancer screening and for investigation of patients with suspected colorectal cancer. However, colonoscopy remains an invasive technique requiring anesthesia, with a risk of perforation and bleeding. In addition, even experienced colonoscopists may be unable to complete the colonoscopy due to multiple reasons such as severe diverticulosis, stricture, obstructing mass, or fixation of colonic loops. CT colonography, also known as virtual colonoscopy, is a relatively new technique that is becoming increasingly popular. The technical aspects, indications, advantages and diagnostic performance of this technique are briefly reviewed.
Iatrogenic Injury to the Spleen—CT Appearance Galperin-Aizenberg, Maya, MD; Blachar, Arye, MD; Gayer, Gabriela, MD
Seminars in ultrasound, CT, and MRI,
02/2007, Letnik:
28, Številka:
1
Journal Article
Recenzirano
Splenic injury is a well-known but rare complication of various abdominal surgical and invasive procedures, and even of cardiac surgery. The true incidence of iatrogenic splenic trauma is, however, ...difficult to assess and is probably underestimated. Overt injuries diagnosed during surgery are usually immediately treated by splenectomy without imaging. This review focuses on missed splenic injuries that are diagnosed on imaging following surgery or an invasive procedure.
Reduction or elimination of catharsis with fecal tagging enhances the tolerability of CT colonography (CTC) and may increase compliance with colorectal cancer (CRC) screening recommendations. We ...systematically reviewed studies that prospectively evaluated performance and patient satisfaction with decreased-purgation CTC and with optical colonoscopy.
The nine studies reviewed showed moderate-to-good performance for decreased-purgation CTC; however, data are limited, and study design and data presentation are inconsistent. Further study of decreased-purgation CTC and standardization of terminology are needed.
Background
The use of the deep inferior epigastric artery perforator (DIEP) flap has gained popularity as a technique for autologous breast reconstruction. This surgery entails finely dissecting the ...perforators of the deep inferior epigastric artery passing through the rectus abdominis muscle, while deciding which of the perforators will best supply the flap. Computed tomography angiography (CTA) has emerged as the imaging modality of choice for preoperative evaluation. This study evaluates the accuracy of CTA in identifying perforator anatomy and flap volume calculation, as well as its impact on the patient’s outcome.
Methods
A prospective study was conducted. Thirty-two consecutive patients that underwent CT angiography prior to unilateral DIEP flap reconstruction surgery were included in the study. The control group was composed of 32 patients, who were operated on by the same surgical team, using the same surgical technique, prior to the initiation of the CTA study. The imaging provided by CTA was correlated with actual intra-operative findings. Operative time, the duration of hospital stay, and postoperative complications were assessed. The volume of the flap as calculated by CT was compared to the flap’s actual weight after harvest.
Results
CTA identified 285 perforators; of these, 278 were found intra-operatively. There was no statistically significant difference between the data provided by the CT and intra-operative findings. The use of CTA was associated with decreased operating time (unilateral, 424 versus 546 min,
p
< 0.0001) and significantly decreased hospitalization (unilateral, 7.6 versus 11.6 days,
p
= 0.0002). There was good correlation between the volume of the flap as calculated by CT and the flap’s measured weight after harvest (1117 cm
3
versus 1181 g,
r
= 0.774).
Conclusions
CTA is an accurate tool in planning and calculating flap volume of DIEP flap and is associated with improved outcomes.
Level of Evidence: Level III, diagnostic study.
To review the clinical and radiologic features of internal hernia and to derive useful radiographic and CT criteria to assist in diagnosis.
Retrospective review of medical records revealed 17 ...patients with surgically proved internal hernia (three paraduodenal, 14 transmesenteric) who had 15 computed tomographic (CT) scans and three small-bowel follow-through (SBFT) images.
CT signs common to all types of internal hernia included evidence of small-bowel obstruction; clustering of small bowel; stretched, displaced, crowded, and engorged mesenteric vessels; and displacement of other bowel segments, especially the transverse colon and fourth portion of the duodenum. Left-sided paraduodenal hernias demonstrated a sac-like mass of small-bowel loops interposed between the stomach and pancreatic tail and a posterior mass effect on the stomach. All three paraduodenal hernias were diagnosed confidently at retrospective review of CT and SBFT findings. Transmesenteric hernias demonstrated clustered small-bowel loops adjacent to the abdominal wall without overlying omental fat and central displacement of colon and were frequently complicated by small-bowel volvulus (five of 14) and bowel ischemia (six of 14). CT demonstrated signs of volvulus in four of six patients with ischemia. CT findings considered definitive or suggestive of internal hernia were demonstrated in 15 patients.
Internal hernia is an important and underdiagnosed condition. Transmesenteric hernia is most common in our experience and is usually related to prior abdominal surgery, especially with creation of a Roux-en-Y anastomosis. CT may allow confident diagnosis in most patients.
Abstract only
1549
Background: Cancer is the leading cause of mortality worldwide. Prevention and early detection are pivotal tools for reducing cancer burden. Methods: We describe the 10 year ...experience (2006-2016) of an integrated cancer prevention center that provides screening for prevention and early detection of 11 most common cancer types. Healthy individuals (20-80 yr) were included. Extensive clinical and epidemiological data was obtained. DNA was extracted from all participants and genotyped for APC I1307K and E1317Q. Patients were examined by specialists in internal medicine, surgery, plastic surgery, OBGYN, urology, oncology, oral surgery, gastroenterology, and others. Women underwent vaginal US and pap smear and (40yr) mammography and US/MRI with a clinical indication. PSA and free PSA for Men ( > 40yr). LDCT for heavy smokers. Colonoscopy was recommended to all subjects ( > 40yr). Results: A total of 6258 (49%) men and 6461 (51%) women mean age 47.0±11.5 year were screened. New malignant lesions were detected in 389 (1.75%) of screeners. The most common cancers were of skin (74, 0.6%), prostate (62, 0.5%), thyroid (51, 0.4%), breast (36, 0.3%), colorectal (22, 0.2%), ovarian (19, 0.1%), uterus (14, 0.1%), testis (12, 0.09%) urinary (9, 0.07%) and lung (10, 0.08%). In 28 patients (0.22%) more than one cancer was detected. Twenty eight of the cancer patients (7.2%) died after 32.4±28.1 months at a mean age of 69.4±14.2 years. Significantly, better than the expected cancer mortality. The APC I1307K and E1317Q variants were detected in 572 (4.8%) and 182 (1.5%) subjects respectively. First degree family member with cancer (OR = 2.02), I1307K carrier ship (OR = 1.53), female gender (OR = 1.23) and advanced age (OR = 1.06) were all associated with statistically significant (P < 0.05) increased cancer risk. Advanced age and first degree family history were also associated with detection of more than one cancer types. Conclusions: One stop shop screening, in the setting of a multidisciplinary outpatient clinic, is feasible and can prevent and detect cancer at an early stage. It significantly improve morbidity and mortality. Impressively the APC I1307K carries an overall increase cancer risk.
Objective To describe the post-percutaneous nephrolithotomy (PNL) non–contrast-enhanced computed tomography (NCCT) findings and assessed their clinical significance. NCCT evaluates stone clearance ...after PNL and also reveals procedure-related changes. Methods One hundred consecutive patients who underwent PNL were evaluated by NCCT one day post-procedure. Two radiologists analyzed the type and severity of the NCCT findings, which were then statistically analyzed in relation to the patient's clinical course. Results The patients' mean age was 54 years (range 18–82) and the mean maximal stone diameter was 37 mm (range 15–70). The median operative time was 110 minutes for an immediate stone-free rate of 83%, changing to 94% ( P = .073) after a second-look PNL in 11 patients. The post-PNL NCCT findings were hydronephrosis (70%), atelectasis (54%), ipsilateral pleural effusion (52%), paracolic gutter fluid (44%), perinephric hematoma (40%), perinephric fluid (32%), ureteronephrosis (31%), renal swelling (23%), contralateral pleural effusion (22%), residual fragments (RFs) (17%), subcapsular hematoma (10%), and flank hematoma (6%). Univariate analysis revealed a significant association with clinical variables for all NCCT findings except for atelectasis, ureteronephrosis, contralateral pleural effusion, RFs, and flank hematoma. In multivariate analysis, only perinephric fluid ( P = .007) and ipsilateral pleural effusion ( P = .034) were associated with longer hospitalization, and perinephric fluid with longer recovery ( P = .004). The complication rate was 12%, but none were linked with the radiological findings. Conclusion This work describes the post-PNL NCCT findings and their clinical significance. Perinephric fluid and ipsilateral pleural effusion were found to independently predict longer hospitalization and recovery time.
