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Purpose: To evaluate the significance of the hypertrophy concept in patients requiring extended liver resections for colorectal metastasis in the time of computer assisted surgery. Methods: Retrospective analysis of patient collective undergoing major liver surgery. 2D CT, 3D CAS with Fraunhofer MeVis Sofware. Portal vein embolisation (PVE) with the Amplazer Plug, portal vein ligation (PVL) as 1. Stage operative procedure. Results: 2D CT data identified 29 patients out of 319 (2002-2009) to be at risk for liver failure after resection. After 3D CAS analysis and virtual operation planning, only 7/29 were at true risk and were submitted to portal vein occlusion (PVO). Another 5 patients were submitted to the hypertrophy concept for intraoperative finding of insufficient parenchyma quality. In total, 12 patients underwent PVO (6 PVE/6 PVL). 9/12 patients went to stage 2 and were successfully operated. There was no difference in future remnant liver volume (FRLV) gain or waiting time to step 2 between the groups, though survival was better in the PVE group. Conclusion: PVO is an effective approach if the patient's future remnant liver (FRL) is too small on 2D CT volumetry. 3D CAS has great impact on the analysis of FRL capacity and in augmenting resectability - in our experience only patients with insufficient FRLV on the virtual resection plan have to take the risk of PVO to maintain the chance of liver resection. [ABSTRACT FROM AUTHOR]

Abdominal pain is a frequent cause of consultation to doctors' offices and emergency rooms. The most common differential diagnoses can be confirmed with readily available, cost-effective, and low-risk diagnostic tools such as laboratory tests, ultrasound, or gastroscopy. Additional diagnostic tests are required to exclude rare causes such as small, solid, or hematological malignancies, metabolic disorders, or polyneuropathies of varying origin. In the following, we present the case of a patient with severe epigastric pain due to neuroborreliosis, and recapitulate the diagnostic steps for clarifying abdominal pain using this example.

Clinical Issue: Biliary diseases require fast and rational use of diagnostic tests by both gastroenterologists and radiologists., Standard Treatment: Standard diagnostic workup includes transabdominal ultrasound, endoscopic retrograde cholangiography (ERC), endoscopic ultrasound, direct cholangioscopy, magnetic resonance cholangiopancreatography (MRI/MRCP), and computed tomography (CT)., Treatment Innovations: Modular cholangioscopy is a novel diagnostic method., Diagnostic Work-Up: The goal of diagnostic examinations is the determination of the location of obstructions and differentiation of benign from malignant lesions., Achievements: Transabdominal ultrasound is risk-free and can show the gallbladder in great detail providing high diagnostic accuracy in most conditions. Endoscopic ultrasound, ERC and/or cholangioscopy are powerful tools to investigate the large bile ducts but are associated with inherent procedural risks., Practical Recommendations: Gall bladder diseases can often be diagnosed with transabdominal ultrasound alone. Bile duct disease often requires the use of endoscopic ultrasound, ERC and/or cholangioscopy.

Introduction: The presence of liver cirrhosis goes along with a higher chance for the need of liver resection. As established laboratory parameters often underestimate the degree of cirrhosis this is associated with an increased risk for postoperative liver failure due to the preoperatively impaired liver function. Known liver function tests are unlikely to be performed in daily use because of high cost or expenditure of time. Liver maximum function capacity test (LiMAx) provides a novel tool for measurement of liver function and references for the safety of liver resection., Presentation of Case: A 63-year old patient presented at our hospital with a large, solitary liver metastasis from hypopharyngeal cancer in segments VII/VIII with infiltration of the diaphragm. Liver resection was unsuccessful in a peripheral hospital 10 months before due to considerable macroscopic liver cirrhosis (CHILD B). Upon presentation conventional laboratory parameters revealed sufficient liver function. LiMAx was performed and showed regular liver function (354μg/kg/h; at norm >315μg/kg/h). Consequently, atypical liver resection (R0) was performed resulting in a postoperative LiMAx value of 281μg/h/kg (>150μg/kg/h). The patient was discharged from hospital 37days after surgery without any signs of postoperative liver failure., Conclusion: The LiMAx-test enables determination of liver function at a so far unavailable level (metabolism via cytochrome P450 1A2) and hence might provide crucial additional diagnostic information to allow for safe liver resection even in cirrhotic patients., (Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Unlabelled: The aim of this article is to review the significance of percutaneous thermal ablation in the treatment of bone tumors. We describe available ablation techniques as well as advantages and disadvantages in specific settings. In detail, radiofrequency ablation (RFA), microwave ablation (MWA), laser ablation, high intensity focused ultrasound (HIFU) and cryoablation are presented. In the second part of this review curative and palliative indications for the treatment of benign and malignant bone tumors are discussed. This includes especially RFA, laser or cryoablation for the treatment of osteoid osteoma, as well as the palliative treatment of painful bone metastases, for example, by means of MWA or MR-guided HIFU., Key Points: • The various thermoablative techniques demonstrate specific advantages and disadvantages.• Radiofrequency ablation is the evidence-based method of choice for treating osteoid osteoma.• Laser ablation is primarily suited for the treatment of small lesions of the hands and feet.• The intrinsically analgesic effect of cryoablation is advantageous when treating painful lesions.• Palliative treatment of painful bone metastases can for example be performed using MWA or MR-guided HIFU, by itself or combined with cementoplasty. Citation Format: • Ringe KI, Panzica M, von Falck C. Thermoablation of Bone Tumors. Fortschr Röntgenstr 2016; 188: 539 - 550., (© Georg Thieme Verlag KG Stuttgart · New York.)

The multi-kinase inhibitor sorafenib still remains the only approved agent for advanced HCC. Its benefits typically involve disease stabilisation, whereas an induction of response is rare. We report a series of five cases with extraordinary response to sorafenib. For two patients complete response to sorafenib was reported with a recurrence-free survival of 51 and 21 months. In another HCC patient pretreated with transarterial chemoembolisation (TACE) sorafenib treatment resulted in a complete response with no evidence of disease 18 months after first diagnosis. In patient 4 with unresectable HCC and sorafenib therapy secondary resectability and subsequent liver transplantation was achieved. Patient 5 had stabilised disease for 48 months after TACE and sorafenib treatment. Sorafenib may be very potent in individual patients. Excellent interdisciplinary strategies are required to achieve best results. There is an urgent need of predictive biomarkers to identify HCC patients that will benefit the most.

We present the case of a 22 year old man who developed a permanent penile erection after a blunt perineal trauma. Conservative treatment in terms of cooling, compression and puncture of the cavernosal corpora with blood aspiration failed to resolve the priapism. Angiography confirmed the diagnosis of high-flow priapism caused by an arteriovenous fistula. Interventional coil embolization of the fistula was effective meaning that complete detumescence was achieved and erectile function was preserved.