ABSTRACT High-resolution three-dimensional endovaginal ultrasonography (EVUS) provides a detailed... more ABSTRACT High-resolution three-dimensional endovaginal ultrasonography (EVUS) provides a detailed evaluation of the pelvic floor muscles and the levator ani complex, the lower urinary tract, and the anorectal region in planes that cannot be determined by conventional two-dimensional EVUS. Multiplanar reconstruction and rendering techniques allow the investigator to correctly recognize and measure specific anatomic elements of the pelvic floor and to understand their true spatial relationships (anterior, lateral, and posterior compartments). This modality is relatively easy to perform and is time efficient, correlates well with other imaging modalities, and delivers relevant information in patients with pelvic floor disorders. KeywordsAnal sphincters-Endovaginal ultrasonography-Levator ani-Levator hiatus-Pelvic floor-Perineal muscles-Pubovisceral muscle-Three-dimensional ultrasonography-Urethral complex-Urogenital hiatus
When writing can change your life, when writing can enrich you by offering much money, why don... more When writing can change your life, when writing can enrich you by offering much money, why don't you try it? Are you still very confused of where getting the ideas? Do you still have no idea with what you are going to write? Now, you will need reading. A good writer is a good reader at once. You can define how you write depending on what books to read. This pelvic floor disorders imaging and multidisciplinary approach to management can help you to solve the problem. It can be one of the right sources to develop your writing skill.
BACKGROUND Mixed adeno-neuroendocrine carcinomas (MANEC) are a subgroup of mixed neuroendocrine n... more BACKGROUND Mixed adeno-neuroendocrine carcinomas (MANEC) are a subgroup of mixed neuroendocrine non-neuroendocrine neoplasms (MiNEN) described as mixed neoplasms containing dual neuroendocrine and non-neuroendocrine components. The aim of this study was to appraise the prevalence of MANEC in the lower gastrointestinal (GI) tract and provide reliable estimates of survival. METHOD A systematic review was undertaken in accordance with PRISMA guidelines using PubMed, Embase, Cochrane Library of Systematic Review, Web of Science, and Scopus databases, and a Bayesian hierarchical survival pooled analysis was performed. RESULTS Of 182 unique records identified, 71 studies reporting on 752 patients met the inclusion criteria. Mean age was 64.2 ± 13.6, with a male-to-female ratio of 1.25. Overall, 60.3% of MANEC were located in the appendix, 29.3% in the colon, and 10.4% in the anorectum. More than a quarter (29%) of patients had stage IV disease at diagnosis, with higher prevalence in appendiceal than colonic and anorectal primaries. More than 80% had a high-grade (G3) endocrine component. Of the 152 patients followed up for a median of 20 months (interquartile range limits, 16.5-32), median overall survival was 12.3 months (95% credible interval [95%CrI], 11.3-13.7), with a 1.12 [95%CrI, 0.67-1.83] age-adjusted hazard ratio between metastatic and non-metastatic MANEC. Stage IV disease at diagnosis was more prognostically unfavorable in cases of colonic compared to anorectal origin. CONCLUSION MANEC is a clinically aggressive pathological entity. The results of this study provide new insights for the understanding of tumor location within the lower GI tract and its prognosis in terms of overall survival.
Colon cancer is the third most common cancer in man and woman in the developed world. Laparoscopi... more Colon cancer is the third most common cancer in man and woman in the developed world. Laparoscopic right colectomy is the standard of care for right colon cancer. Since the first report on laparoscopic approach in 1991, the surgical technique has been improved and currently all procedure is performed intracorporeally. The ileo-colic anastomosis can be performed either intracorporeal and extracorporeal: the differences in clinical outcome, complications rate, hospital stay and quality of life between that two techniques are not still clear and a large number of studies has been published about that. According to most recent meta-analysis, intracorporeal anastomosis have showed better outcome in anastomotic leakage rate, surgical site infection rate, development of incisional hernia, postoperative pain and recovery of gastrointestinal function.
The presence of endometriosis in the anal canal and perianal tissues is rare and difficult to sus... more The presence of endometriosis in the anal canal and perianal tissues is rare and difficult to suspect at clinical examination. We report our experience with preoperative ultrasound evaluation of four cases of anal endometriosis. Four patients were evaluated by transperineal and high-resolution three-dimensional endoanal ultrasonography. In 3 of 4 women, the lesions involved old episiotomy scars. Anal endometriosis appeared as hypoechoic cystic lesions with areas of microcalcification, not well delimited and highly vascularized. The lesions either involved the anal sphincter (n = 2, one within the rectovaginal septum) or were localized superficially in the ischiorectal space (n = 2). Surgery and pathologic exam confirmed the ultrasonographic findings. Ultrasonographic findings of anal endometriosis are characteristics and may allow accurate preoperative staging of the disease.
Anal fistula (AF) is a common referral to colorectal surgeons. Management remains challenging and... more Anal fistula (AF) is a common referral to colorectal surgeons. Management remains challenging and sometimes controversial. Magnetic resonance imaging (MRI) is commonly performed in initial workup for AF. However, reports often lack key information for guiding treatment strategies. It has been shown that with structured radiology reports, there is less missing information. We present a structured MRI template report including 8 key descriptors of anal fistulas, whose effectiveness and acceptability are being assessed in a cross-sectional study (NCT04541238).
Background The optimal treatment of anastomotic leak after rectal cancer resection is unclear. Th... more Background The optimal treatment of anastomotic leak after rectal cancer resection is unclear. This worldwide cohort study aimed to provide an overview of four treatment strategies applied. Methods Patients from 216 centres and 45 countries with anastomotic leak after rectal cancer resection between 2014 and 2018 were included. Treatment was categorized as salvage surgery, faecal diversion with passive or active (vacuum) drainage, and no primary/secondary faecal diversion. The primary outcome was 1-year stoma-free survival. In addition, passive and active drainage were compared using propensity score matching (2 : 1). Results Of 2470 evaluable patients, 388 (16.0 per cent) underwent salvage surgery, 1524 (62.0 per cent) passive drainage, 278 (11.0 per cent) active drainage, and 280 (11.0 per cent) had no faecal diversion. One-year stoma-free survival rates were 13.7, 48.3, 48.2, and 65.4 per cent respectively. Propensity score matching resulted in 556 patients with passive and 278 w...
ABSTRACT In this chapter the diagnostic potential of evaluating structural and functional interac... more ABSTRACT In this chapter the diagnostic potential of evaluating structural and functional interactions of female pelvic floor structures using novel image-processing techniques is presented. Technical innovations include three-dimensional volume render mode, maximum intensity projection, manual segmentation and sculpting, fusion imaging, PixelFlux, framing, color vector mapping, and motion tracking. When introduced into routine clinical practice, these new modalities will improve the management of pelvic floor dysfunctions. KeywordsFraming-Fusion imaging-Maximum intensity projection-Motion tracking-PixelFlux-Render mode-Sculpting-Three-dimensional ultrasonography
Ultrasound scanning plays an important role in evaluating the extent of benign and malignant anor... more Ultrasound scanning plays an important role in evaluating the extent of benign and malignant anorectal and pelvic diseases. This chapter discusses this important method for evaluating rare anorectal and pelvic neoplasias, one which allows for the quantification of the exact circumferential and longitudinal extension of the lesion into the rectal wall or adjacent tissue and the relation between the lesion and the sphincter muscles. This is the most important aspect to consider when planning surgical resection with or without sphincter-saving. In addition, the three-dimensional scanning mode is safer, making it possible to review the images posteriorly, in real time, as required by some lesions.
ABSTRACT High-resolution three-dimensional endovaginal ultrasonography (EVUS) provides a detailed... more ABSTRACT High-resolution three-dimensional endovaginal ultrasonography (EVUS) provides a detailed evaluation of the pelvic floor muscles and the levator ani complex, the lower urinary tract, and the anorectal region in planes that cannot be determined by conventional two-dimensional EVUS. Multiplanar reconstruction and rendering techniques allow the investigator to correctly recognize and measure specific anatomic elements of the pelvic floor and to understand their true spatial relationships (anterior, lateral, and posterior compartments). This modality is relatively easy to perform and is time efficient, correlates well with other imaging modalities, and delivers relevant information in patients with pelvic floor disorders. KeywordsAnal sphincters-Endovaginal ultrasonography-Levator ani-Levator hiatus-Pelvic floor-Perineal muscles-Pubovisceral muscle-Three-dimensional ultrasonography-Urethral complex-Urogenital hiatus
When writing can change your life, when writing can enrich you by offering much money, why don... more When writing can change your life, when writing can enrich you by offering much money, why don't you try it? Are you still very confused of where getting the ideas? Do you still have no idea with what you are going to write? Now, you will need reading. A good writer is a good reader at once. You can define how you write depending on what books to read. This pelvic floor disorders imaging and multidisciplinary approach to management can help you to solve the problem. It can be one of the right sources to develop your writing skill.
BACKGROUND Mixed adeno-neuroendocrine carcinomas (MANEC) are a subgroup of mixed neuroendocrine n... more BACKGROUND Mixed adeno-neuroendocrine carcinomas (MANEC) are a subgroup of mixed neuroendocrine non-neuroendocrine neoplasms (MiNEN) described as mixed neoplasms containing dual neuroendocrine and non-neuroendocrine components. The aim of this study was to appraise the prevalence of MANEC in the lower gastrointestinal (GI) tract and provide reliable estimates of survival. METHOD A systematic review was undertaken in accordance with PRISMA guidelines using PubMed, Embase, Cochrane Library of Systematic Review, Web of Science, and Scopus databases, and a Bayesian hierarchical survival pooled analysis was performed. RESULTS Of 182 unique records identified, 71 studies reporting on 752 patients met the inclusion criteria. Mean age was 64.2 ± 13.6, with a male-to-female ratio of 1.25. Overall, 60.3% of MANEC were located in the appendix, 29.3% in the colon, and 10.4% in the anorectum. More than a quarter (29%) of patients had stage IV disease at diagnosis, with higher prevalence in appendiceal than colonic and anorectal primaries. More than 80% had a high-grade (G3) endocrine component. Of the 152 patients followed up for a median of 20 months (interquartile range limits, 16.5-32), median overall survival was 12.3 months (95% credible interval [95%CrI], 11.3-13.7), with a 1.12 [95%CrI, 0.67-1.83] age-adjusted hazard ratio between metastatic and non-metastatic MANEC. Stage IV disease at diagnosis was more prognostically unfavorable in cases of colonic compared to anorectal origin. CONCLUSION MANEC is a clinically aggressive pathological entity. The results of this study provide new insights for the understanding of tumor location within the lower GI tract and its prognosis in terms of overall survival.
Colon cancer is the third most common cancer in man and woman in the developed world. Laparoscopi... more Colon cancer is the third most common cancer in man and woman in the developed world. Laparoscopic right colectomy is the standard of care for right colon cancer. Since the first report on laparoscopic approach in 1991, the surgical technique has been improved and currently all procedure is performed intracorporeally. The ileo-colic anastomosis can be performed either intracorporeal and extracorporeal: the differences in clinical outcome, complications rate, hospital stay and quality of life between that two techniques are not still clear and a large number of studies has been published about that. According to most recent meta-analysis, intracorporeal anastomosis have showed better outcome in anastomotic leakage rate, surgical site infection rate, development of incisional hernia, postoperative pain and recovery of gastrointestinal function.
The presence of endometriosis in the anal canal and perianal tissues is rare and difficult to sus... more The presence of endometriosis in the anal canal and perianal tissues is rare and difficult to suspect at clinical examination. We report our experience with preoperative ultrasound evaluation of four cases of anal endometriosis. Four patients were evaluated by transperineal and high-resolution three-dimensional endoanal ultrasonography. In 3 of 4 women, the lesions involved old episiotomy scars. Anal endometriosis appeared as hypoechoic cystic lesions with areas of microcalcification, not well delimited and highly vascularized. The lesions either involved the anal sphincter (n = 2, one within the rectovaginal septum) or were localized superficially in the ischiorectal space (n = 2). Surgery and pathologic exam confirmed the ultrasonographic findings. Ultrasonographic findings of anal endometriosis are characteristics and may allow accurate preoperative staging of the disease.
Anal fistula (AF) is a common referral to colorectal surgeons. Management remains challenging and... more Anal fistula (AF) is a common referral to colorectal surgeons. Management remains challenging and sometimes controversial. Magnetic resonance imaging (MRI) is commonly performed in initial workup for AF. However, reports often lack key information for guiding treatment strategies. It has been shown that with structured radiology reports, there is less missing information. We present a structured MRI template report including 8 key descriptors of anal fistulas, whose effectiveness and acceptability are being assessed in a cross-sectional study (NCT04541238).
Background The optimal treatment of anastomotic leak after rectal cancer resection is unclear. Th... more Background The optimal treatment of anastomotic leak after rectal cancer resection is unclear. This worldwide cohort study aimed to provide an overview of four treatment strategies applied. Methods Patients from 216 centres and 45 countries with anastomotic leak after rectal cancer resection between 2014 and 2018 were included. Treatment was categorized as salvage surgery, faecal diversion with passive or active (vacuum) drainage, and no primary/secondary faecal diversion. The primary outcome was 1-year stoma-free survival. In addition, passive and active drainage were compared using propensity score matching (2 : 1). Results Of 2470 evaluable patients, 388 (16.0 per cent) underwent salvage surgery, 1524 (62.0 per cent) passive drainage, 278 (11.0 per cent) active drainage, and 280 (11.0 per cent) had no faecal diversion. One-year stoma-free survival rates were 13.7, 48.3, 48.2, and 65.4 per cent respectively. Propensity score matching resulted in 556 patients with passive and 278 w...
ABSTRACT In this chapter the diagnostic potential of evaluating structural and functional interac... more ABSTRACT In this chapter the diagnostic potential of evaluating structural and functional interactions of female pelvic floor structures using novel image-processing techniques is presented. Technical innovations include three-dimensional volume render mode, maximum intensity projection, manual segmentation and sculpting, fusion imaging, PixelFlux, framing, color vector mapping, and motion tracking. When introduced into routine clinical practice, these new modalities will improve the management of pelvic floor dysfunctions. KeywordsFraming-Fusion imaging-Maximum intensity projection-Motion tracking-PixelFlux-Render mode-Sculpting-Three-dimensional ultrasonography
Ultrasound scanning plays an important role in evaluating the extent of benign and malignant anor... more Ultrasound scanning plays an important role in evaluating the extent of benign and malignant anorectal and pelvic diseases. This chapter discusses this important method for evaluating rare anorectal and pelvic neoplasias, one which allows for the quantification of the exact circumferential and longitudinal extension of the lesion into the rectal wall or adjacent tissue and the relation between the lesion and the sphincter muscles. This is the most important aspect to consider when planning surgical resection with or without sphincter-saving. In addition, the three-dimensional scanning mode is safer, making it possible to review the images posteriorly, in real time, as required by some lesions.
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