Maria Rosa Biagini

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

BACKGROUNDnThe assessment of fibrosis degree in liver diseases is based on several non-invasive techniques, but none has been accurate.nnnAIMnThis 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.nnnMETHODn71 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.nnnRESULTSnThe 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.nnnCONCLUSIONnMetabolomic 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.

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

Percutaneous ultrasound-guided fiducial marker placement for liver cancer robotic stereotactic radio-surgery treatment: A comparative analysis of three types of markers and needles

BACKGROUND AND STUDY AIMSnPercutaneous placement of fiducial markers is required to perform stereotactic body radiation therapy (SBRT) for liver neoplastic lesions. This prospective trial was designed to evaluate the feasibility and safety of percutaneous ultrasound-guided placement of three different types of markers in patients with liver cancer referred for SBRT.nnnPATIENTS AND METHODSnFifty patients underwent percutaneous ultrasound-guided implantation of a fiducial marker in the liver. Three sizes of needles were used: 25 gauge (G), 22G, and 17G. The 25G and 22G needles contained gold anchor markers of 0.28×10mm and 0.4xa0×10mm size, respectively. In contrast, the 17G needle contained a gold grain marker of 1×4mm. Each patient received 1-6 markers, depending on lesion size and numbers. Technical feasibility and the occurrence of adverse events were registered. Computed tomography scans were acquired prior to SBRT to evaluate the location, visibility, or complications related to the markers.nnnRESULTSnA total of 163 needles were used to deliver 163 markers in 50 patients. No major complications occurred. Minor complication occurrence rate was 12%. The total complication occurrence for all type of markers was 8.5%. No complications were observed with the use of the gold anchor marker of 0.4xa0×10mm size. Variance analysis of the three markers showed a significant difference in the frequency of complications amongst the three markers (p<0.01).nnnCONCLUSIONnPercutaneous ultrasound-guided placement of fiducial markers for SBRT of liver neoplastic lesions is safe and feasible. In our series, the 22G needle showed some advantage in terms of handling and safety when compared with the 25G and 17G needles. In addition, the gold anchor marker of 0.4xa0×10mm size displayed a lower percentage of displacement.

Factors Predictive of Improved Abdominal Ultrasound Visualization after Oral Administration of Simethicone

Ultrasonography is a non-invasive, accurate and low-cost technique used to study the upper abdomen, but it has reduced reliability in the study of the pancreas and retroperitoneum. Simethicone is a well-known emulsifying agent that has been used to improve ultrasonographic visualization. The aim of this study was to identify anthropometric parameters that are able to predict a good response to simethicone in improving ultrasonographic visualization of abdominal structures. One hundred twenty-seven patients were recruited. After basal examination, their anthropometric parameters were collected. Patients with an incomplete upper abdominal examination because of gastrointestinal gas have greater body mass index, waist circumference and abdominal wall thickness. In our study, the best anthropometric parameter for identifying patients with poor visualization at abdominal ultrasound examination is waist circumference. Using a cutoff of 84xa0cm, we can identify patients with poor visibility at abdominal ultrasound examination (group B) with a sensitivity of 90%.

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.