Abstract:

Presented herein is a dynamic ultrasonographic study of soft tissue state in the area of a postoperative wound in 165 patients in order to determine rational policy of postoperative following up of the patient. The patients were subdivided into three groups: Group I - after an operative intervention for surgical pathology of abdominal and retroperitoneal organs; Group II - after herniotomy with combined plasty with a meshed endograft (Surgpro-mesh); Group III - after allografting of the aorta, major arteries of the lower limbs and neck. All patients after the surgical intervention were subjected to an ultrasonographic study of soft tissues of the abdominal wall, lower extremities, and neck in the B-mode in order to reveal pathological alterations, with determining the size, structure and indication of localization in relation to the surface of the skin; five cases suspected for infection of the process were subjected to duplex scanning of soft tissues around the focus revealed; detecting pathological alterations around the vessel or the graft after grafting of major vessels was followed by duplex scanning in order to determine the haemodynamic situation in the vessel or graft. The findings obtained suggest specificity of postoperative alterations characteristic of different surgical interventions, the revealing of which allows the surgeons to determine the policy of rational management of the patient, thus decreasing the risk of purulent complications in the area of the postoperative wound.

Reference

1.     Федоров В.Д., Светухин А.М. Стратегия и тактика лечения обширных гнойных ран. Избранный курс лекций по гнойной хирургии. М., Миклош. 2003; 18-30.

2.     Шляпников С.А. Хирургические инфекции мягких тканей - старая проблема в новом свете. Инфекции в хирургии. 2003; 1(1): 14 - 21.

3.     Белобородов В.Б.,Джексенбаев О.Ш.Эндотоксины грамотрицательных бактерий. Цитокины и концепция септического шока; современное состояние проблемы. Анестезия и реаниматология. М., 1991; 4:41 -43.

4.     Белобородова Н.В., Бачинская Е.Н. Иммунологические аспекты послеоперационного сепсиса. Анестезия и реаниматология. 2000; 1: 59 - 66.

5.     Измайлов С.Г., Измайлов Г.А., Тюдушкина И.В. и др. Лечение ран. - Казань: изд-во Казанского государственноготехнического университета. 2003; 137 - 144.

6.     Ерюхин И.А., Гельфанд Б.Р., Шляпников С.А. Хирургические инфекции: руководство. С-Пб.: издательский дом «Питер» (Серия «Спутник врача»), 2003; 864.

7.     Hedrick WR, Hykes L, Starchman DE. Static imaging principles and instrumentation. In: Ultrasound physics and instrumentation. St Louis (MO): Mosby. 1995; 71 -87.

8.     Евдокимова Е.Ю., Жестовская С.И. Роль ЦДК в диагностике стадий раневого процесса мягких тканей у больных с хирургической патологией Материалы краев. науч. практ. конференции, посвященной 50-летию общества рентгенологов и радиологов. Красноярск. 2000; 37 - 38.

9.     Lavoipierre AM, Kremer S. Cabrini Hospital, Melbourne The expanding role of ultrasound in medicine. Aust. Fam. Physician. 1999; 28 (11): 1121 - 7.

10.   Loyer E.M., Kaur H., David C.L., DuBrow R. et al. Importance of dynamic assessment of the soft tissues in the sonographic diagnosis of echogenic superficial abscesses. Department of Diagnostic Radiology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA. Journal ofUltrasound in Medicine. 1995; 14(9): 669 - 671.

11.   Сажин В.П., Жаболенко В.П., Авдовенко А.Л. и др. Роль сонографии в оценке течения раневого процесса у больных после эндовидеохирургического лечения постинъекционных абсцессов ягодиц. Институт хирургии им. А. В. Вишневского РАМН. Материалы конференции, посвященной 10-летию отделения ультразвуковой диагностики: Современные методы ультразвуковой диагностики заболеваний сердца, сосудов и внутренних органов. М., 4-6 октября. 2004; 126 -127.

12.   Sisley Amy С, Bonar J.P. Ultrasound in the Acute Seffing. Ultrasound for Surgeons. Second edition. Lippincott Williams & Wilkins. 2005; (1015): 179 - 191.

13.   Bureau NJ, Cardinal E, Chhem RK. Ultrasound of Soft Tissue Masses. Department de Radiologie, Hopital St-Luc, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada. Semin Musculoskelet Radiol. 1998; 2(3): 283 - 298.

14.   Chhem R.K, Kaplan P.A, Dussault R.G. Ultrasonography of the musculoskeletal system. Radiol. Clin. North Am. 1994; 32 (2): 275 - 89.

15.   Primack S.J. Musculoskeletal ultrasound. The clinician's perspective. North Suburban Rehabilitation Unit, Colorado Rehabilitation and Occupational Medicine, Aurora, USA. Radiol.Clin. North Am. 1999l; 37(4): 617-22.

16.   Newman J.S., Adler R.S., Bude R.O, Rubin J.M. Detection of soft-tissue hyperemia: value of power Doppler sonography. AJRAm. J. Roentgenol. 1994; 163 (2):385-9.

17    Breidahl W.H, Newman J.S, Taljanovic M.S, Adler R.S. Power Doppler sonography in the assessment of musculoskeletal fluid collections. AJR Am. J. Roentgenol. 1996; 166 (6): 1443 -6.

18.   Latifi H.R, Siegel M.J. Color Doppler flow imaging of pediatric soft tissue masses. J. Ultrasound Med. 1994; 13 (3): 16–— 9.

19.   Rubin J.M. Musculoskeletal power Doppler. Eur. Radiol. 1999; 9(3): 403 - 405.

20.   Волчанский А.И. Диагностика и лечение внутрибрюшных гнойно-воспалительных осложнений после операций на печени и желчных путях. Дисс. канд. мед. наук. М., 1997; 143.

21.   Жестовская С.И., Евдокимова Е.Ю. Ультразвуковая диапедевтика послеоперационных гнойных осложнений. Тезисы докладов 4-го съезда Российской ассоциации специалистов ультразвуковой диагностики в медицине. М., 2003; 87-88.

22.   Бордаков В.Н., Абрамов Н.А., Савицкий Д.С. и др. Диагностика и лечение абсцессов брюшной полости. Сб. науч. трудов IV Всеармейской международной конференции: Интенсивная терапия и профилактика хирургических инфекций: М., 23 -24 сентября, 2004; 132 -133.

23.   Чебышева Э.Н. Оценка состояния аорты и ее ветвей убольныханевризмойбрюшнойаортыпо данным ультразвукового исследования. Автореферат дисс. канд. мед. наук. М., 2005; 25.

24.   Минайчев В. Ю, Конон Т. М. Абсцесс передней брюшной стенки. Новости лучевой диагностики. М., 2000; 30 -31.

25.   Биссет Р.А., Хан А.Н. Дифференциальный диагноз при абдоминальном ультразвуковомисследовании. (Под редакцией проф. Пиманова С.И.) М., Мед. литература. 2003; 232 - 233.

26.   Евдокимова Е.Ю. Лечебно-диагностические вмешательства под контролем ультразвука у больных с послеоперационными гнойными осложнениями. Автореферат дисс. канд. мед. наук.Красноярск. 2003; 26.

27.   Hill Robert MD, Conron Richard DO, Greissinser Paul DO, Heller Michael MD. Ultrasound for the Detection of Foreign Bodies in Human Tissue. Annal of Emergency Medicine. 1997; 29(3): 178 - 179.

28.   Цветков В.О. Парапротезная инфекция. Клиника, диагностика, лечение. Дисс. докт. мед. наук. М., 2003; .96 - 104.

29.   Кунцевич Г.И. Оценка результатов хирургического лечения окклюзирующих поражений артерий. Ультразвуковая диагностика в абдоминальной и сосудистой хирургии. (Под редакцией проф. Г.И. Кунцевич). М., Кавалер Паблишерс. 1999; 191 - 195.

Abstract:

Aim: was to estimate the diagnostic value of MRI (qualitative and tumor size analysis) in the evaluation of preoperative chemotherapy in patients with soft tissue sarcomas on different stages of examination.

Material and methods: we analyzed data of 74 patients with soft tissue sarcomas. All patients underwent MRI. Patients were examined before, in the middle and at the end of the course of the preoperative chemotherapy

Results: the sensitivity (predilection of Grade III-IV pathologic response) of qualitative MRI signs in the middle of the neoadjuvant chemotherapy (after 2-3 cycles) was 73%, the specificity (predilection of Grade I-II pathologic response) was 88%; 69% and 100% for maximum tumor size evaluation, correspondingly At the end of the preoperative treatment, values of the sensitivity and specificity of qualitative MRI signs decreased to 50% and 78%, respectively, the sensitivity of maximum tumor size estimation decreased to 31%, while specificity remained the same -100%.

Conclusion: MRI with qualitative and tumor size analysis is an informative method in assessment of preoperative chemotherapy of soft tissue sarcomas.

References

1.     Fletcher C.D.M. WHO Classification of Tumors: Pathology and Genetics of Tumors of Soft Tissue and Bone. Lyon: IARC Press. 2002;312 p.

2.     Putnam J.B. Metastases from Sarcoma American Cancer Society Atlas of Clinical Oncology: Soft Tissue Sarcomas. Hamiliton-Ontario: BC Decker Inc. 2002; 266-278.

3.    Aliev M.D. Sovremennye podhody k lecheniju sarkommjagkih tkanej[Modern approaches to the treatment of soft tissue sarcomas.]. Prakticheskaja onkologija. 2004; 5(4):250- 255 [In Russ].

4.     Pisters P.W.T., Patel S.R, Varma D.G.K., et al. Preoperative chemotherapy for stage IIIB extremity soft tissue sarcoma: long term results from single institution. J. Clin.Oncol. 1997;15:3481-3487.

5.     Gortzak E., Azzarelli A., Buesa J. et al. A randomized phase II study on neo-adjuvant chemotherapy for ‘high-risk’ adult soft-tissue sarcoma. Europ. J. Cacer. 2001; 37:1096-1103.

6.     Lucas D.R., Kshirsagar M.P., Biermann J.S. et al. Histologic alterations from neoadjuvant chemotherapy in high-grade extremity soft tissue sarcoma: clinicopathological correlation. Oncologist. 2008;13( 4):451-458.

7.     WHO Handbook for reporting results of cancer treatment. WHO Publication, Geneva. 1979;48:1-45.

8.     Park J.O., Lee S.I., Song S.Y et al. Measuring response in solid tumors: comparision of RECIST and WHO response criteria. Jpn. J. Clin. Oncol. 2003; 33: 533-537.

9.     Therasse P., Arbuck S.G., Eisenhauer E.A., et al.New guidelines to evaluate the response to treatment in solid tumors (RECIST guidelines). J. Natl. Cancer Inst. 2000;92:205-216.

10.   Eisenhauer E.A., Therasse P., Bogaerts J., et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur. J. Cancer. 2009;45: 228-247.

11.   Tuma R.S. Sometimes size doesn’t matter: reevaluating RECIST and tumor response end points. J. Natl. Cancer Inst. 2006; 98: 1272-1274.

12.   Gehan E.A., Tefft M.C. Will there be resistance to the RECIST (tumor Response Criteria in Solid Tumors. J. Natl. Cancer Inst. 2000; 92: 179-181.

13.   Vanel D., Lacombe M.J., Couanet D. et al. Musculoskeletal tumors: follow-up with MR imaging after treatment with surgery and radiation therapy. Radiology. 1987; 164(1): 243-245.

14.   Siegel M.J. Magnetic resonance imaging of musculoskeletal soft tissue masses. Radiol.Clin. North. Am. 2001; 39(4):701-720.

15.   Fletcher B.D., Reddick W.E., Taylor J.S. Dynamic MR imaging of musculoskeletal neoplasm. Radiology. 1997; 200:869-872.

16.   Biondetti P.R., Ehman R.L. Soft-tissue sarcomas: use of textural patterns in skeletal muscle as a diagnostic feature in postoperative MR imaging. Radiology. 1992:183(3):845-848.

17.   Wang X., Jacobs M., Fayad L. Therapeutic Response in Musculoskeletal Soft Tissue Sarcomas: Evaluation by Magnetic Resonance Imaging. NMR Biomed. 2011;24(6):750-763.

18.   Sanchez R.B., Quinn S.F., Walling A., et al Musculoskeletal neoplasms after intraarterial chemotherapy: correlation of MR images with pathologic specimens. Radiology. 1990;174:237-240.

19.   Erlemann R., Sciuk J., Bosse A., et al. Response of osteosarcoma and Ewing sarcoma to preoperative chemotherapy: assessment with dynamic and static MR imaging and skeletal scintigraphy. Radiology. 1990; 175:791-796.

20.   Glazer H.S., Lee K.T. J., Levitt R.G. et al Radiation fibrosis: differentiation from recurrent tumor by MR imaging. Radiology. 1985;156:721-726.

21.   Glazkova T.G. Ocenka kachestva metodov diagnostiki i prognoza v medicine [Quality of assessment methods for diagnosis and prognosis in medicine.]. Vestnik ONC AMN Rossii. 1994;2:3-11 [In Russ].

22.   Eisenhauer E.A. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur. J. Cancer. 2009;45:228-247.

23.   Tuma R.S. Sometimes size doesn’t matter: reevaluating RECIST and tumor response end points J. Natl. Cancer Inst. 2006;98:1272-1274.

24.   Gehan E.A. Will there be resistance to the RECIST (tumor Response Criteria in Solid Tumors). J. Natl. Cancer Inst. 2000;92:179-181.

25.   Stacchiotti S., Collini P., Messina A. et al. High- grade soft-tissue sarcomas: tumor response assessment - pilot study to assess the correlation between radiologic and pathologic response by using RECIST and Choi criteria. Radiology. 2009;251:447-456.

26.   Carl Jaffe C. Response assistment in clinical trials: Implications for sarcoma clinical trial design. Oncologist. 2008;13(2):14-18.

27.   Choi H. Response evaluation of gastrointestinal stromal tumors. H. Choi. Oncologist. 2008;13(2):4-7.