Maria Marsico

Therapeutic usability of two different fiducial gold markers for robotic stereotactic radiosurgery of liver malignancies: A pilot study

AIM To assess how the application of different types of markers affects the tracking accuracy of CyberKnifes. METHODS Fifteen patients were recruited and subjected to the ultrasound-guided placement of markers. Two different type of needles 25 gauge (G) and 17 G containing two different fiducial marker, gold notched flexible anchor wire 0.28 mm × 10 mm (25 G needle) and gold cylindrical grain 1 mm × 4 mm (17 G), were used. Seven days after the procedure, a CyberKnife planning computed tomography (CT) for the simulation of radiation treatment was performed on all patients. A binary CT score was assigned to the fiducial markers visualization. Also, the CT number was calculated for each fiducial and the values compared with a specific threshold. RESULTS For each patient from 1 to 5, intra-hepatic markers were placed (one in 2 patients, three in 8 patients, four in 3 patients, and five in 2 patients). A total of 48 needles were used (thirty-two 17 G and sixteen 25 G) and 48 gold markers were placed (32 Grain shaped markers and 16 Gold Anchor). The result showed that the CT visualization of the grain markers was better than the anchor markers (P = 5 × 10(-9)). Furthermore, the grain markers were shown to present minor late complications (P = 3 × 10(-6)), and the best CT threshold number (P = 0.0005). CONCLUSION The study revealed that the Gold Anchor fiducial marker is correlated with a greater number of late minor complications and low visualization by the CT.

Metabolomic analysis with 1H-NMR for non-invasive diagnosis of hepatic fibrosis degree in patients with chronic hepatitis C

BACKGROUND The assessment of fibrosis degree in liver diseases is based on several non-invasive techniques, but none has been accurate. AIM This study employed proton nuclear magnetic resonance spectroscopy to identify metabolic profiles in serum and urine, specific for different fibrosis degree in chronic hepatitis C patients. METHOD 71 plasma, 73 serum, and 578 urine samples were collected. All samples were analyzed using 1H-NMR spectroscopy technique and three different NMR spectra were acquired for each serum/plasma sample. The data analyses were performed by partial least square regression, principal component analysis, and Monte Carlo cross-validation in a supervised methodology. RESULTS The cross-validation test correctly assigned each sample to its specific donor with 98.44% accuracy for urine samples and 65% for serum/plasma samples. Advanced fibrosis and cirrhosis were recognized with 71% sensitivity for CPMG plasma spectra and 69% specificity for NOESY serum spectra. Accuracy for NOESY serum spectra was 68%. Noesy spectra recognized advanced fibrosis and cirrhosis with 71% sensitivity, 30% specificity, and 50% accuracy in urine samples. CONCLUSION Metabolomic analysis of urine spectra using 1H-NMR spectroscopy can recognize a specific individual profile in all patients with chronic hepatitis C. However, this method cannot yet differentiate with sufficient accuracy, patients with advanced fibrosis from patients with milder disease.

Small bowel lymphangioma: A rare case of intestinal bleeding

A 28-year-old male with history of melena and anaemia went o Emergency Unit for weakness: laboratory tests revealed severe naemia with haemoglobin of 4 g/dL. Thereafter endoscopic invesigation revealed a bleeding circumferential ulcerated lesion of he third duodenal segment (Fig. 1A). An abdominal computerized omography scan showed an inhomogeneous mass involving a tract f jejunum with intestinal lumen stenosis (Fig. 1B). Histopathoogical examination demonstrated numerous dilated lymphatic essels in the mucous corium with histiocytes compatible with ymphangiectasia (Fig. 2A(H&E staining) and B(D2-40 staining) – 0× magnification). Considering the radiological findings and the multiple gasrointestinal bleeding episodes, the patient underwent surgicalry esection of third and fourth duodenal segments and a small tract f jejunum. Histological examination confirmed an intestinal lymhangioma.

Percutaneous ultrasound-guided bowel biopsy of a pseudokidney mass

A 35-year-old man was admitted to our department for weight loss, long-lasting constipation, and abdominal pain. Abdominal ultrasound (US) examination revealed a segmental wall thickening of the sigmoid colon with an ultrasound aspect of a pseudokidney lesion (70 mm in diameter) (Figure 1). The concerned bowel tract had no cleavage from the bladder. Furthermore, a thickening of the pericolic fat was detected. Computed tomography (CT) confirmed the presence of a homogeneously dense lesion of the sigmoid colon tightly connected to the bladder and suspicious for malignancy. Colonoscopy was performed and stopped at the distal sigmoid colon because of the presence of a non-ulcerated stricture. Therefore, a percutaneous US-guided bowel biopsy of the pseudokidney lesion was performed using a 21-G needle without bleeding or other complications. Turk J Gastroenterol 2017; 28: 60-2

Computed tomography or contrast‐enhanced ultrasonography for follow‐up of liver metastases after Cyberknife therapy?: A prospective pilot study

Contrast‐enhanced ultrasonography (CEUS) allows the study of vascularization of secondary liver lesions. The Cyberknife (Accuray, Inc, Sunnyvale, CA) is a therapeutic method that allows a tumor target to be subjected to a high radiant dose gradient. This prospective pilot study aimed to demonstrate the concordance of CEUS versus contrast‐enhanced computed tomography (CECT) in determining the stability or disease progression of secondary liver lesions after treatment with the Cyberknife.

Main-duct intraductal papillary mucinous neoplasm of the pancreas: a case report

Three distinct entities among non-inflammatory cystic lesions of the pancreas have been defined: intraductal papillary mucinous neoplasm (IPMN), serous cystic neoplasm (SCN) and mucinous cystic neoplasm (MCN). IPMN is characterized by intraductal papillary growth and thick mucus secretion: its incidence has dramatically increased since its initial description. These lesions probably can progress towards invasive carcinoma. IPMNs are symptomatic in most cases: the typical presentation is a recurrent acute pancreatitis, without evident cause, of low or moderate severity. The diagnosis is usually based upon the imaging (CT/cholangio-MRI) demonstrating a pancreatic cystic mass, involving a dilated main duct, eventually associated to some filling defects, or a normal Wirsung duct communicating with the cyst lesion. Surgical treatment is generally indicated for main duct IPMN and branch duct IPMN with suspected malignancy (tumour size ≥ 30 mm, mural nodules, dilated main pancreatic duct, or positive cytology) or prominent symptoms. Herein we present a case of IPMN of the main duct which occurred with abdominal and back pain associated with weight loss. After the diagnosis, she successfully underwent surgery and is now in a follow-up program.