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Lucian Lapusneanu, Marlena Radulescu and Florin Ghita

Abstract

The cases with sphenoid sinusitis associated with abducens nerve palsy are rarely cited in the literature. We present the case of a 41-year-old patient who was hospitalized for right hemicrania and ipsilateral paresis of the abducens nerve, without any other ENT previous pathology. The ENT, ophthalmologic, neurological and paraclinical evaluations (nasal endoscopy, MRI examination) have established the diagnosis of right sphenoid rhinosinusitis complicated with unilateral abducens nerve palsy. In such cases, it is important to make a differential diagnosis with tumor pathology as well as that of an infection outbreak located intracranially. In this case, the patient’s evolution was favourable after endoscopic surgical treatment of the sphenoid rhinosinusitis.

Open access

R.V. Costea, N. Zărnescu, A. Chirca, O. Rusu and S. Neagu

Abstract

Introduction. Soft tissue sarcomas (STS) are a heterogeneous group of tumors with over 80 different subtypes that account for approximately 1-2% of adult malignancies. Primary sarcomas arise from a variety of soft tissues and bone, and include fibrous connective, fat, and smooth, or striated muscle, vascular, peripheral neural and visceral tissue. With difficulties in establishing cell origin and pathogenesis, this condition lacks an effective and durable therapy with no predictive biomarkers and rapid diagnosis. Materials and methods. We reviewed the cases of 21 patients treated in our clinic for soft tissue sarcoma over a 20-year period (1999-2018). We extracted the following information from each patient’s medical record: disease status at presentation, histological diagnosis, American Joint Committee on Cancer staging, surgical procedure, oncological outcome, length of hospitalization, and follow-up information. Results. All 21 patients (14 males and 7 females, aged between 19 and 88 years) underwent surgery and total excision with safety margins was performed with histopathological confirmation stating the tumor type and subtype. Some samples required immunohistochemistry for subtype differentiation. Chondrosarcoma and myosarcoma were the most common (5 patients). 8 patients presented local recurrence and metastatic disease with 6 cases receiving adjuvant chemotherapy. Only one patient presented for the 5-year follow-up. Conclusions. STS are a rare group of tumors with poor outcome with surgical treatment being represented by total excision. We chose to present our clinic’s experience to highlight the need for post-operative therapy advancements and to raise awareness on the difficulties in managing these cases.

Open access

A.M. Bratu, I.A. Sălcianu, C. Zaharia, G. Iana and A.N. Marinescu

Abstract

Introduction. Soft tissue sarcomas (STS) are rare entities of soft tissue cancers. Their incidence is low, of only 1% of the malignant tumors. In terms of localization, most of the STS affect the extremities, and their incidence is much higher in children than in adults. Material and method. The present paper is a retrospective study that includes tumors with lower limb localizations, including the bony pelvis, over a 3-year period (2013-2016). The study group consisted of 29 patients who, following the MRI examination, were diagnosed with softtissue tumors. Of the 29 patients, 17 patients had a MRI (magnetic resonance imaging) and an anatomopathological diagnosis of leiomyosarcoma. The location of the tumor, its characteristics, and the relationship with the adjacent anatomical structures were analyzed in all cases. Results. The ages of the final group of 17 patients ranged between 28 and 84 years, with female predominance. In terms of localization, one showed a muscle tumor in the pelvis, namely left oblique muscle, other cases being located in the thigh and knee. A special importance was given to the superficial and profound location. In 5 cases, the tumor was localized in subcutaneous fatty tissue, thus superficial. In terms of the contours of the tumor, well-defined margins were present in 11 cases, and poorly defined contour in 6 cases. Regarding the size, the leiomyosarcomas in our study had dimensions between 5.2 cm and 18 cm, and their structure was inhomogeneous, with the presence of necrosis and calcifications. Necrosis was found in 14 cases, and calcifications were present in 68%, being more frequent than necrosis. Except for the necrotic areas, the contrast enhancement was intense. Conclusions. Although the diagnosis is always histopathological, the MRI plays an important role in defining a precise localization and tumor characteristics.

Open access

M. Popa, Z. Panti, M. Nica, M. Pleniceanu, B. Şerban, R. Ene and C. Cîrstoiu

Abstract

Introduction. Giant cell tumors of soft tissue (GCTs) have a relatively low incidence and their low prognosis is reserved to local relapses and distant metastases. This type of pathology usually affects adults and the elderly and it is localized in the extremities, most frequently in the thigh. Materials and methods. GCT is a relatively low aggressive tumor; approximately 85% of the patients survive at least 5 years after diagnosis. The risk factors for low prognosis are old age, metastases at the time of diagnosis, local relapse. We conducted this study in the University Emergency Hospital, Bucharest for a period of 3 years, between 01.01.2015 and 01.01.2018, which included 20 patients with ages between 22 and 83 years, of whom 9 were women and 11 were men. Results. Excision with safety margins was performed for all patients. During surgery, tissue samples from 6 different areas were sent for extemporaneous examination. After excision, the histopathological examination was performed and the diagnosis of GCT was established. Localized forms were described in 16 cases; diffuse forms were identified in 4 cases and loco-regional recurrences in 3 cases. Pre or postoperative adjuvant treatment was not applied in any of the cases. Conclusions. GCT is a rare, potentially malignant pathology, in which case evolution is unfavorable. From the clinical and imaging point of view, it is difficult to establish this diagnosis due to the large variety of pathologies it can be mistaken for, making biopsy an essential step within the diagnostic algorithm. Election treatment is represented by local excision with safety margins.

Open access

C. Berceanu, M.M. Cîrstoiu, E. Brătilă, C. Mehedinţu, S. Berceanu, N.L. Voicu and A.V. Tetileanu

Abstract

Gestational trophoblastic diseases represent a heterogeneous group of disorders that arise from trophoblastic epithelium. Choriocarcinoma is a highly anaplastic malignancy derived from trophoblastic cells. It is characterized by the secretion of human chorionic gonadotropin and early hematogenous metastasis. Metastatic choriocarcinoma in bones is very rare. Gestational trophoblastic diseases can follow normal pregnancy, ectopic pregnancy, abortions or molar pregnancy. However, the presence of bone metastases in a young woman at reproductive age requires systematic assessment for a primary lesion, for 1-2 years. This paper aims to present the bone sites where these metastases can occur, as well as the review of literature supported by a pictorial essay.

Open access

A.I. Nicula, A. Marinescu and G. Iana

Abstract

Bony metastasis is a frequent occurrence in malignancies. We present the case of a 75-year-old male patient who was investigated for a lytic lesion in the right scapula and was eventually diagnosed with metastatic renal cell carcinoma (RCC). The main indications for embolization are reducing the risk of bleeding during and after surgery of hypervascular tumors, simplifying the manipulation of tumors, palliation of pain, bleeding, fever, and hypercalcemia-like symptoms in inoperable tumors, preventing further dissemination of a tumor, and increasing the response to chemotherapy and radiotherapy. Embolization may be a therapeutic alternative to surgery in cases in which surgery is inappropriate or associated with high risk. In the case presented, CT examinations had a crucial role both in the diagnostic orientation and in the subsequent therapeutic decisions and proper monitoring under therapy.

Open access

Irén Csiszér, Silvu Albu, Cristian Mircea Neagos, Marius Navadarszki and Adriana Neagos

Abstract

OBJECTIVE. This study examines the association between the severity of obstructive sleep apnea and the pharyngeal parameters using the ultrasound of the submental region.

MATERIAL AND METHODS. For this study, data obtained from 40 patients, who had undergone investigations in the Galenus Medical Centre in order to diagnose sleep apnea, was analyzed. The following parameters were compared: the transverse diameter of the retrolingual region, the transverse diameter of the retropalatal region and the tongue base thickness. These regions were measured at different moments of respiration such as: during forced expiration, during forced inspiration and while the patients performed Müller’s Manoeuvre. The neck circumference, the body mass index of patients and the severity of sleep apnea obtained from polysomnography were analyzed.

RESULTS. The evaluation of the results revealed: severe obstructive sleep apnea in 16 patients, respectively moderate severity in 10 patients, mild apnea in 4 patients, and no obstructive sleep apnea in 10 patients. Statistically significant results (p<0.05) were found after comparing the parameters obtained in patients with severe apnea versus the parameters in patients without apnea, with mild or respectively moderate apnea.

CONCLUSION. Based on the results obtained, we consider that cervical ultrasound is useful in the diagnosis of severe obstructive apnea, identifying the pathological changes of the anatomical structures that basically cause this category of disease. Due to the fact that in our country ultrasound is a relatively inexpensive method, being also a non-irradiating, repeatable and accessible method, it should be more widely applied also in the field of otorhinolaryngology in order to view structures accessible to this type of imaging.

Open access

A.N. Marinescu, A.I. Nicula, M.A. Bratu and G. Iana

Abstract

Chondrosarcomas are malignant cartilaginous tumors, with many histological subtypes and three grades based on cellularity. They are the second most common primary malignant tumors of the bone. From the histopathologically proved clinical cases, we are reviewing the imaging semiology - size, type of calcifications, cortical breach, endosteal scalloping, permeative or moth eaten bone appearance, and revealing other differentiation elements like location, age, and pain. A special point is the frequent difficulty in distinguishing between enchondromas and low grade conventional chondrosarcomas - as the lesions are very similar both histologically and radiographically. The radiologist should point the area to aim on the biopsy - at areas that may harbor foci of high-grade tumor, such as the ones of endosteal scalloping, soft-tissue components, or diffusely enhancing areas with minimal mineralization. It is known that with cartilaginous tumors, histopathologic examination of the biopsy specimen alone does not permit an accurate classification of the tumor. We emphasized the role of imaging in positive and differential diagnosis, management, and therapy of these bone tumors.

Open access

D. Lescai

Abstract

Cats and dogs are routinely diagnosed with different forms of neoplasia. One of the simplest imaging techniques is radiography. This way one can assess neoplastic extent affecting soft and bone tissue. 493 radiographs from 235 dogs and cats have been reviewed. 372 radiographs for 94 dogs, an average of 5.2 images for every dog and 121 radiographs for 48 cats, an average of 2.5 images for each cat were done. 27 relevant or suspect radiographs were done in dogs, for a total of 14 neoplastic subjects, corresponding to 6 relevant or suspect images for a total of 3 neoplastic processes in cats. This is translated into a proportion of 7.25% relevant or suspect radiographs in dogs and 4.95% in cats. It also means that 14.89% of the dogs that require radiographic examination and 2.47% of the cats are suffering or are suspicious for neoplastic disease. 5 out of 14 (35%) dogs had relevant radiographs for bone tissue neoplasia, 1 dog (7%) for muscular neoplasia and 4 dogs (28.5%) were suspicious for digital (mixed soft tissue/ bone tissue) neoplasia. 1 out of 3 cats had relevant images for muscular neoplasia and 2 cats for maxillary/ acetabular neoplasia.