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11/90. Neuropathy and malignancy: a retrospective survey.

    Peripheral neuropathy is a common condition with a variety of causes. In some cases the neuropathy is the first symptom of an underlying malignancy. The frequency of occult cancer in patients with neuropathy is of importance in planning the investigations and follow-up of these patients. This retrospective study examined the incidence of cancer-related neuropathy among patients originally diagnosed with idiopathic peripheral neuropathy. Between 1981-1995 our department discharged 187 patients with the diagnosis of idiopathic peripheral neuropathy. Their names were cross-matched with the Norwegian Cancer Registry, and the medical records of the patients with known cancer were reviewed. In 14 patients (7.5%) we found cancer as the probable cause of the peripheral neuropathy originally classified as idiopathic. In eight of the patients the neuropathic symptoms preceded the tumour. In six cancer was already diagnosed when the neuropathic symptoms developed, but in three of these the neuropathy heralded a tumour recurrence. Idiopathic progressive neuropathy should always raise the suspicion of an underlying malignancy, especially if there are atypical accompanying symptoms and signs.
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12/90. Pathologic findings in eight cases of ovarian serous borderline tumors, three with foci of serous carcinoma, that preceded death or morbidity from invasive carcinoma.

    We sought to assess the frequency of previously reported adverse histopathologic findings in ovarian serous borderline tumors (SBTs) in cases that preceded a patient's death or caused serious morbidity due to invasive carcinoma. SBTs with foci of invasive carcinoma that occupied a minority of the tumor and were associated with similar outcomes were also studied for potential additional insights. Eight cases were found over a 22-year period. Ten tumors in 5 patients were purely SBT; at initial staging, 1 patient had invasive peritoneal implants; 3 had noninvasive peritoneal implants; 1 was stage I. At last follow-up 3 of the 5 patients had died of carcinoma, 1 was alive with carcinoma, and 1 had no clinical evidence of disease 4 years after a sigmoid colectomy for invasive serous carcinoma of the bowel wall. Four tumors in 3 patients had foci of invasion that were more than microinvasive; at initial staging, all 3 patients had invasive peritoneal implants, and all died of carcinoma. All 14 of the ovarian tumors in the 8 cases had surface involvement by tumor cells, and in 8 tumors in 5 cases they were confined primarily to the ovarian surface. Foci of "micropapillary serous carcinoma" accompanied more obvious areas of infiltrative carcinoma in 2 of the 4 ovarian tumors, the peritoneal implants in 1 of the cases with purely SBTs, and a recurrence in this case and 1 other case. No morphologic finding in the 10 purely SBTs was predictive of subsequent malignant behavior. We conclude that extraovarian invasive serous carcinomas, either following or concurrent with an ovarian SBT, develop from borderline foci that may originate in the ovary, but frequently are likely to have arisen independently in the peritoneum. The carcinomas may be preceded or accompanied by noninvasive-appearing micropapillary foci in the peritoneum in some cases, but micropapillary foci in the ovarian tumors are infrequent and not a necessary antecedent.
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13/90. Flexible video cystoscope with built-in high-frequency cauterizing element for transurethral resection of bladder tumor.

    The major advantage of the flexible video cystoscope is that a digital signal can be obtained while high frequency cauterization is carried out. Cauterization while observing a digital signal picture was not possible before this new model was developed. We decided to use this new cystoscope to resect a bladder tumor and coagulate the bleeding because the patient could tolerate only local anesthesia due to severe heart disease complications. We successfully treated the patient with this technique and no complications were noted. This new flexible video cystoscope was found to be safe for resecting bladder tumor under local anesthesia.
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14/90. Percutaneous radiofrequency ablation therapy after intrathoracic saline solution infusion for liver tumor in the hepatic dome.

    Two liver tumors undetected by ultrasonography (US) because they were located in the hepatic dome were treated with radiofrequency (RF) ablation therapy after intrathoracic saline solution infusion. After administration of local anesthesia, artificial pneumothorax was produced by needle thoracentesis and a drainage catheter was inserted into the right thoracic cavity. After saline solution (450-500 mL) was injected into the thoracic cavity via the catheter, US-guided RF ablation was performed. No severe complications occurred and complete therapeutic effects were obtained. Percutaneous RF ablation therapy with intrathoracic saline solution injection seems to be a feasible alternative to other ablation therapies.
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15/90. mitral valve recurrence of a left atrial myxoma.

    recurrence of intracardiac myxoma is unusual, and heart valves are extremely rare locations for this tumor to originate, either as the primary site or the site of recurrence. We present a case of non-familial cardiac myxoma, which after successful resection of the tumor mass from the left atrium, recurred in the atrial surface of anterior leaflet of the mitral valve, along with a review of similar cases in the literature. myxoma was originally believed to recur due to inadequate resection, but recent data suggest the multicentric disease to be the reason. mitral valve myxoma mainly presents with symptoms of embolization and appears to affect women more often. It involves both leaflets with the same frequency and usually originates from the atrial side. Transesophageal echocardiography is the gold standard for non-invasive diagnosis and localization. Operative resection of the tumor along with the underlying tissue followed by suture repair of the valve and annuloplasty is recommended as the most appropriate treatment option. Long-term follow-up of patients by echocardiography is advised for early detection of any recurrence.
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16/90. Radiofrequency ablation of recurrent cholangiocarcinoma.

    Intrahepatic recurrence of cholangiocarcinoma after primary resection has traditionally been considered a contraindication to surgical management. Improvements in ablative technologies such as radiofrequency ablation (RFA) offer the surgeon additional alternatives in the management of selected intrahepatic tumors. We present a case report of a single intrahepatic recurrence of cholangiocarcinoma 12 months after primary resection of extrahepatic cholangiocarcinoma including right lobectomy for intrahepatic extension. The patient received operative treatment and RFA of the intrahepatic lesion. RFA successfully ablated the recurrent tumor, and the patient remains free of detectable disease 10 months later. A review of literature is presented. This is the first known report of the use of RFA for intrahepatic cholangiocarcinoma. In selected cases of primary or recurrent cholangiocarcinoma, RFA may increase the percentage of patients considered surgically treatable.
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17/90. Combined local hyperthermia and x-irradiation in the treatment of metastatic tumours.

    Six patients, all with evidence of metastatic or locally recurrent tumours, were selected for inclusion in a trial study of simultaneous hyperthermia and ionizing radiation therapy. Heat was applied by hot air, or microwaves, or a combination of both. When examined after treatment, 3 patients were found to be free of the lesions treated. One patient had a partial response, followed by regression of the tumour; one patient died with metastases in the lungs and one patient responded to the treatment but died from a massive pulmonary embolus. The simultaneous application of hyperthermia and ionizing radiation therapy was well tolerated. It induced disappearance of tumours in cases where conventional methods had failed, and with far greater efficiency than conventional therapeutic methods.
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18/90. portal vein thrombosis after radiofrequency ablation for recurrent hepatocellular carcinoma.

    Recurrent hepatocellular carcinoma (HCC) deserves multidisciplinary treatment in addition to surgical resection. Radiofrequency ablation (RFA) is an evolving, localized, thermal ablative treatment for unresectable hepatocellular carcinoma (HCC). Though the preliminary results of RFA in clinical studies are encouraging, its serious complications should not be underestimated. portal vein thrombosis as a result of direct blood vessel injury by RFA is rarely reported and is potentially fatal in patients with limited liver reserve due to underlying liver cirrhosis. We present a case of portal vein thrombosis as a complication of RFA treatment for recurrent HCC and illustrate its underlying possible mechanism.
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19/90. Management of pneumothorax during percutaneous radiofrequency ablation of a lung tumor: technical note.

    Percutaneous radiofrequency ablation (RFA) is a new procedure to treat lung cancer. pneumothorax (PTX) may occur intraprocedurally, especially with the large RFA probes, and complicate the completion of the treatment. The authors describe a case of PTX developing during RFA and its successful management.
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20/90. Hepatic radiofrequency ablation of metastatic ovarian granulosa cell tumors.

    Intrahepatic recurrences of a granulosa cell tumor of the ovary after primary resection has traditionally been considered a relative contraindication to surgical management. Improvements in ablative technologies such as radiofrequency ablation (RFA) offer the surgeon additional alternatives in the management of selected intrahepatic tumors. We present a case report of an intrahepatic recurrence of a metastatic ovarian granulosa cell tumor 6 months after primary resection. The patient received RFA of the intrahepatic lesions and the patient remains free of detectable disease 14 months later. A review of the literature is presented. This is the first known report of the use of RFA for intrahepatic recurrence of a metastatic ovarian granulosa cell tumor. In selected cases of metastatic ovarian granulosa cell tumors to the liver RFA may increase the percentage of patients considered surgically treatable.
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