Gonzalez-Cantu, Cynthia Minerva;Moreno-Pena, Pablo Juan;Salazar-Lara, Mayela Guadalupe;Garcia, Pablo Patricio Flores;Montes-Tapia, Fernando Felix;Cervantes-Kardasch, Victor Hugo;Castro-Govea, Yanko
Archives of Plastic Surgery
/
v.48
no.5
/
pp.518-523
/
2021
Epignathus is a rare congenital orofacial teratoma that arises from the sphenoid region of the palate or the pharynx. It occurs in approximately 1:35,000 to 1:200,000 live births representing 2% to 9% of all teratomas. We present the case of a newborn of 39.4 weeks of gestation with a tumor that occupied the entire oral cavity. The patient was delivered by cesarean section. Oral resection was managed by pediatric surgery. Plastic surgery used virtual 3-dimensional models to establish the extension, and depth of the tumor. Bloc resection and reconstruction of the epignathus were performed. The mass was diagnosed as a mature teratoma associated with cleft lip and palate, nasoethmoidal meningocele that conditions hypertelorism, and a pseudomacrostoma. Tridimensional technology was applied to plan the surgical intervention. It contributed to a better understanding of the relationships between the tumor and the adjacent structures. This optimized the surgical approach and outcome.
Kwak, In-Suk;Kang, Han Gyu;Son, Jeong-Whan;Lee, Jae Sung;Hong, Seong Jong
Journal of Biomedical Engineering Research
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v.37
no.1
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pp.7-14
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2016
Radiopharmaceutical agents for positron emission tomography (PET), such as $^{18}F$-FDG and $^{68}Ga$, have been used not only for whole-body PET imaging but also for intraoperative radionuclide-guided surgery due to their quantitative and sensitive imaging characteristics. Current intraoperative probes detect gamma or beta particles, but not both of them. Gamma probes have low sensitivities since a collimator has to be used to reduce backgrounds. Positron probes have a high tumor-to-background ratio, but they have a 1-2 mm depth limitation from the body surface. Most of current intraoperative probes produce only audible sounds proportional to count rates without providing tumor images. This research aims to detect both positrons and annihilation photons from $^{18}F$ using plastic scintillators and a GAGG scintillation crystal attached to silicon photomultiplier (SiPM). The depth-of-interaction (DOI) along the plastic scintillator can be used to obtain the 2-D images of tumors near the body surface. The front and rear part of the intraoperative probe consists of $4{\times}1$ plastic scintillators ($2.9{\times}2.0{\times}12.0mm^3$) for positron detection and a Ce:GAGG scintillation crystal ($12.0{\times}12.0{\times}9.0mm^3$) for annihilation photon detection, respectively. The DOI resolution of $4.4{\pm}1.6mm$ along the plastic scintillator was obtained by using the 3M enhanced specular reflector (ESR) with rectangular holes between the plastic scintillators, which showed the feasibility of a 2-D image pixel size of $2.9{\times}4.4mm^2$ (X-direction ${\times}$ Y-direction).
The Journal of the Korean bone and joint tumor society
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v.10
no.2
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pp.71-78
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2004
Purpose: The purpose of this study is to investigate the characteristic of recurred giant cell tumor after bony curettage and cementation, and to review a way to prevent the recurrence. Materials and Methods : Thirty seven cases were analyzed, which were pathologically diagnosed giant cell tumor after diagnostic biopsy or surgical excision, followed by curative curettage, burring and cementation. Location, character, and time interval to recurrence were reviewed. Results: Thirteen out of thirty seven analyzed cases(35%) showed recurrence after primary curettage and cementation. The mean interval to recurrence was sixteen months(5 months to 43 months). Most of recurrence happened within the first two years except two cases. Among the recurred cases, eleven showed recurrence in the vicinity of window area. Two cases recurred in the depth of bone marrow, where cementation was made. The advantage of curettage and cementation is the immediate stability of the operation site, early rehabilitation, and early detection of recurrence. Furthermore, cementation is beneficial in that the cement-producing heat can eradicate the residual tumor burden. In this study, 85% of cases with insufficient curettage (for example, in cases where too small surgical window was made, or where there were anatomical difficulty in approaching the target tumor burden) showed recurrence. Conclusion: Bony curettage, burring and cementation is widely used as the primary curative modality for giant cell tumor. A few other modalities such as chemical cautery using phenol and $H_2O_2$; cryotherapy; and anhydroalcohol have also been introduced, but the benefit of these are still questionable. For some cases that relatively small surgical window was made due to anatomically complicated structures (such as ligament insertion or origin site) over the target tumor burden, unsatisfactory curettage and burring was made. This study showed high chance of recurrence after unsatisfactory curettage, and 85% of recurrence developed in the vicinity of the small window area. Most of the recurrence occurred within the first two years. It is concluded that sufficient window opening, extensive curettage and eradicative burring are key factors to prevent recurrence. Also, it should be reminded that careful and close observation should be made for at least the first two years after initial treatment for early detection of recurrence.
Background: Heparanase is believed to be involved in gastric carcinogenesis. However, the clinicopathologic features of gastric cancer with high heparanase expression remain unclear. Aim : The purpose of this study was to comprehensively and quantitatively summarize available evidence for the use of heparanase mRNA and protein expression to evaluate the clinicopathological associations in gastric cancer in Asian patients by meta-analysis. Materials and Methods: Relevant articles listed in MEDLINE, CNKI and the Cochrane Library databases up to MARCH 2015 were searched by use of several keywords in electronic databases. A meta-analysis was performed to clarify the impact of heparanase mRNA and protein on clinicopathological parameters in gastric cancer. Combined ORs with 95%CIs were calculated by Revman 5.0, and publication bias testing was performed by stata12.0. Results: A total of 27 studies which included 3,891 gastric cancer patients were combined in the final analysis. When stratifying the studies by the pathological variables of heparanase mRNA expression, the depth of invasion (633 patients) (OR=4.96; 95% CI=2.38-1.37; P<0.0001), lymph node metastasis (639 patients) (OR=6.22; 95%CI=2.70-14.34, P<0.0001), and lymph node metastasis (383 patients) (OR=6.85; 95% CI=2.04-23.04; P=0.002) were all significant. When stratifying the studies by the pathological variables of heparanase protein expression, this was the case for depth of invasion (1250 patients) (OR=2.76; 95% CI=1.52-5.03; P=0.0009), lymph node metastasis (1178 patients) (OR=4.79 ; 95% CI=3.37-6.80, P<0.00001), tumor size (727 patients) (OR=2.06 ; 95% CI=1.31-3.23; P=0.002) (OR=2.61; 95% CI=2.09-3.27; P=0.000), and TNM stage (1233 patients) (OR=6.85; 95% CI=2.04-23.04; P=0.002). Egger's tests suggested publication bias for depth of invasion, lymph node metastasis, lymph node metastasis and tumor size of heparanase mRNA and protein expression. Conclusions: This meta-analysis suggests that higher heparanase expression in gastric cancer is associated with clinicopathologic features of depth of invasion, lymph node metastasis and TNM stage at mRNA and protein levels, and of tumor size only at the protein level. Egger's tests suggested publication bias for these clinicopathologic features of heparanase mRNA and protein expression, and which may be caused by shortage of relevant studies. As a result, although abundant reports showed heparanase may be associated with clinicopathologic features in gastric cancer, this meta-analysis indicates that more strict studies were needed to evaluate its clinicopathologic significance.
This study aimed to assess of beam-matching accuracy for an 8 MV beam between the same model linear accelerators(Linac) commissioned over two years. Two models were got the customer acceptance procedure(CAP) criteria. For commissioning data for beam-matched linacs, the percentage depth doses(PDDs), beam profiles, output factors, multi-leaf collimator(MLC) leaf transmission factors, and the dosimetric leaf gap(DLG) were compared. In addition, the accuracy of beam matching was verified at phantom and patient levels. At phantom level, the point doses specified in TG-53 and TG-119 were compared to evaluate the accuracy of beam modelling. At patient level, the dose volume histogram(DVH) parameters and the delivery accuracy are evaluated on volumetric modulated arc therapy(VMAT) plan for 40 patients that included 20 lung and 20 brain cases. Ionization depth curve and dose profiles obtained in CAP showed a good level for beam matching between both Linacs. The variations in commissioning beam data, such as PDDs, beam profiles, output factors, TF, and DLG were all less than 1%. For the treatment plans of brain tumor and lung cancer, the average and maximum differences in evaluated DVH parameters for the planning target volume(PTV) and the organs at risk(OARs) were within 0.30% and 1.30%. Furthermore, all gamma passing rates for both beam-matched Linacs were higher than 98% for the 2%/2 mm criteria and 99% for the 2%/3 mm criteria. The overall variations in the beam data, as well as tests at phantom and patient levels remains all within the tolerance (1% difference) of clinical acceptability between beam-matched Linacs. Thus, we found an excellent dosimetric agreement to 8 MV beam characteristics for the same model Linacs.
Purpose : In order to understand in vivo radiation damage modifying of bFGF on jejunal mucosa, bone marrow and the effect of bFGF on the growth of transplanted mouse sarcoma 180 tumor in mice. Materials and Methods : Mice were treated with $6\;{\mu}g$ of bFGF at 24 hours and 4 hours before exposing to 600 cGy, 800 cGy and 1,000 cGy total body irradiation (TBI), and then exposed to 3,000 cGy local radiation therapy on the tumor bearing thigh. Survival and tumor growth curve were plotted in radiation alone group and combined group of bFGF and irradiation (RT). Histologic examination was performed in another experimental group. Experimental groups consisted of normal control, tumor control, RT (radiation therapy) alone, $6\;{\mu}g$ bFGF alone, combined group of $3\;{\mu}g$ bFGF and irradiation (RT), combined group of $6\;{\mu}g$ bFGF and irradiation (RT). Histologic examination was peformed with H-E staining in marrow, jejunal mucosa, lung and sarcoma 180 bearing tumor. Radiation induced apoptosis was determined in each group with the DNA terminal transferase nick-end labeling method ($ApopTag^{\circledR}$ S7100-kit, Intergen Co.) Results : The results were as follows 1) $6\;{\mu}g$ bFGF given before TBI significantly improved the survival of lethally irradiated mice. bFGF would protect against lethal bone marrow syndrome. 2) $6\;{\mu}g$ bFGF treated group showed a significant higher crypt depth and microvilli length than RT alone group (p<0.05). 3) The bone marrow of bFGF treated group showed less hypocellularity than radiation alone group on day 7 and 14 after TBI (p<0.05), and this protective effect was more evident in $6\;{\mu}g$ bFGF treated group than that of $3\;{\mu}g$ bFGF treated group. 4) bFGF protected against early radiation induced apoptosis in intestinal crypt cell but might have had no antiapoptotic effect in bone marrow stem cell and pulmonary endothelial cells. 5) There was no significant differences in tumor growth rate between tumor control and bFGF alone groups (p>0.05). 6) There were no significant differences in histopathologic findings of lung and mouse sarcoma 180 tumor between radiation alone group and bFGF treated group. Conclusions : Our results suggest that bFGF protects small bowel and bone marrow from acute radiation damage without promoting the inoculated tumor growth in C3H mice. Improved recovery of early responding normal tissue and reduced number of radiation induced apoptosis may be possible mechanism of radioprotective effect of bFGF.
Purpose: To evaluate the role of surgical clips and scars in determining electron boost field for early stage breast cancer undergoing conserving surgery and postoperative radiotherapy and to provide an optimal method in drawing the boost field. Materials and Methods: Twenty patients who had $4{\sim}7$ surgical clips in the excision cavity were selected for this study. The depth informations were obtained to determine electron energy by measuring the distance from the skin to chest wall (SCD) and to the clip implanted in the most posterior area of tumor bed. Three different electron fields were outlined on a simulation film. The radiological tumor bed was determined by connecting all the clips implanted during surgery Clinical field (CF) was drawn by adding 3 cm margin around surgical scar. Surgical field (SF) was drawn by adding 2 cm margin around surgical clips and an Ideal field (IF) was outlined by adding 2 cm margin around both scar and clips. These fields were digitized into our planning system to measure the area of each separate field. The areas of the three different electron boost fields were compared. Finally, surgical clips were contoured on axial CT images and dose volume histogram was plotted to investigate 3-dimensional coverage of the clips. Results : The average depth difference between SCD and the maximal clip location was $0.7{\pm}0.55cm$. Greater difference of 5 mm or more was seen in 12 patients. The average shift between the borders of scar and clips were 1.7 1.2, 1.2, and 0.9 cm in superior, inferior, medial, and lateral directions, respectively. The area of the CF was larger than SF and IF in 6y20 patients. In 15/20 patients, the area difference between SF and if was less than 5%. One to three clips were seen outside the CF in 15/20 patients. In addition, dosimetrically inadequate coverage of clips (less than 80% of prescribed dose) were observed in 17/20 patients when CF was used as the boost field. Conclusion: The electron field determined from clinical scar underestimates the tumor bed in superior-inferior direction significantly and thereby underdosing the tissue at risk. The electron field obtained from surgical clips alone dose not cover the entire scar properly As a consequence, our technique, which combines the surgical clips and clinical scars in determining electron boost field, was proved to be effective in minimizing the geographical miss as well as normal tissue complications.
Radiation-induced fibrosarcoma tumors were grown on the flanks of C3H mice. The mice were divided intro two groups. One group was injected with Photofrin II, intravenously (2.5mg/kg body weights). The other group received no Photofrin E Mice from both groups were irradiated for approximately 15 minutes at 100,300, or $500{\;}mW/\textrm{cm}^2$ with the argon (488nm/514.5 nm), dye(628nm) and gold vapor (pulsed 628 nm) laser light. A photosensitizer behaved as an added absorber. Under our experimental conditions, the presence of Photofrin II increased surface temperature by at least 40% and the temperature rise due to $300{\;}mW/\textrm{cm}^2$ irradiation exceeded values for hyperthermia. Lights and temperature distributions with depth were estimated by a computer model. The model demonstrated the influence of wavelength on the thermal process and proved to be a valuable tool to investigate internal temperature rise.
Direct volume rendering (DVR) is an important 3D visualization method for medical images as it depicts the full volumetric data. However, because DVR renders the whole volume, regions of interests (ROIs) such as a tumor that are embedded within the volume maybe occluded from view. Thus, conventional 2D cross-sectional views are still widely used, while the advantages of the DVR are often neglected. In this study, we propose a new visualization algorithm where we augment the 2D slice of interest (SOI) from an image volume with volumetric information derived from the DVR of the same volume. Our occlusion-based DVR augmentation for SOI (ODAS) uses the occlusion information derived from the voxels in front of the SOI to calculate a depth parameter that controls the amount of DVR visibility which is used to provide 3D spatial cues while not impairing the visibility of the SOI. We outline the capabilities of our ODAS and through a variety of computer tomography (CT) medical image examples, compare it to a conventional fusion of the SOI and the clipped DVR.
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