Rosario Francesco Grasso

Herlyn-werner-wunderlich syndrome: MRI findings, radiological guide (two cases and literature review), and differential diagnosis

BackgroundHerlyn-Werner-Wunderlich (HWW) syndrome is a very rare congenital anomaly of the urogenital tract involving Müllerian ducts and Wolffian structures, and it is characterized by the triad of didelphys uterus, obstructed hemivagina and ipsilateral renal agenesis. It generally occurs at puberty and exhibits non-specific and variable symptoms with acute or pelvic pain shortly following menarche, causing a delay in the diagnosis. Moreover, the diagnosis is complicated by the infrequency of this syndrome, because Müllerian duct anomalies (MDA) are infrequently encountered in a routine clinical setting.Cases presentationtwo cases of HWW syndrome in adolescents and a differential diagnosis for one case of a different MDA, and the impact of magnetic resonance (MR) imaging technology to achieve the correct diagnosis.ConclusionsMR imaging is a very suitable diagnostic tool in order to perform the correct diagnosis of HWW syndrome.

Stature estimation from scapular measurements by CT scan evaluation in an Italian population

This study evaluated the correlation between scapula size and stature and developed standard equations in order to estimate stature by CT scan evaluation. A total of 200 healthy Italian subjects (100 men and 100 women, mean age 64.2±12.8years) underwent thoracic CT scan evaluation during pulmonary screening in our department; we measured the stature of each patient with standard anthropometric instruments and then analyzed images to calculate the longitudinal scapular length (LSL) and the transverse scapular length (TSL). The correlation between stature and each parameter measured was analyzed by dividing the population into two groups, males and females, and was examined by simple regression analysis using Pearsons correlation coefficient (r). Each anthropometric variable showed a significant difference between males and females (p value <0.001). The correlation coefficients (r-values) were LSL=0.74 and TSL=0.51 in males and LSL=0.70 and TSL=0.48 in females. In both sexes the r-values showed a significant correlation between stature and LSL. Our study demonstrates that scapulae can be used for stature estimation; in our sample LSL was found to have a better correlation with stature then TSL. hm=4.247*LSL+93.74 and hf=4.031*LSL+92.38 are the formulae that provide the most accurate stature assessment in males and females respectively.

Diffusion-weighted magnetic resonance imaging in patients selected for radical cystectomy: detection rate of pelvic lymph node metastases.

Study Type – Diagnostic (exploratory cohort)

EUS-guided Nd:YAG laser ablation of a hepatocellular carcinoma in the caudate lobe

Vascular liverinjuries and portobiliary fistulas related to biliary proceduresappear to be a more recognized complication of percutane-ous biliary drainage rather than ERCP. However, this casereport illustrates that if the apparent biliary anatomy looksunusual, particularly if radiographic contrast material washesout from the biliary tree, then entry into the portal vein haslikely occurred, a diagnosis of portobiliary fistula should beconsidered, and stent placement should take place only withcaution. As in this case, if a stent has been placed previously,then further stenting may be needed to occlude the fistula. Inthe occurrence of a portobiliary fistula, biliary stenting viaeither ERCP or percutaneous transhepatic cholangiographyoffers an opportunity to prevent significant hemorrhage andpotential portal sepsis.

Radial Basis Function and Multilayer Perceptron neural networks for sea water optically active parameter estimation in case II waters: a comparison

This paper deals with the problem of retrieving optically active parameters of the water from multispectral remotely sensed data. We analyse the neural networks approach applied to the estimation of chlorophyll concentration in coastal waters (Case II Waters) and discuss the use of two types of networks: the Radial Basis Function neural network and Multilayer Perceptron. We present a brief summary concerning their architectures and training methods. For proving the concept we analyse the procedures and the performances on a simulated data set reproducing the data acquired from the MERIS (Medium Resolution Imaging Spectrometer), the multispectral sensor on board the ENVISAT satellite. The multispectral subsurface reflectance data have been generated by means of a three component ocean colour direct model and statistically reproduce the case II waters. The neural networks performances have been analysed in terms of MSE (Mean Square Error), correlation coefficient and relative error. We provide a detailed discussion and comparison of the two types of networks and the obtained results confirm the effectiveness of the neural approach in such an application.

Bone metastases in breast cancer: higher prevalence of osteosclerotic lesions

PurposeIt is well known that bone metastases from breast cancer usually show osteolytic changes. We retrospectively analysed the computed tomography (CT) appearance of bone metastases to quantify the distribution of lytic, mixed and sclerotic changes in a series of patients presenting with neoplastic bone involvement from breast cancer.Materials and methodsBetween 1996 and 2005, 468 women with a diagnosis of breast cancer were referred to our department for staging or follow-up CT examinations. Staging CT examinations detected systemic metastases in 142/468 patients, 60 of which had bone involvement. Patients with a second primary tumour or bone metabolic disorders were excluded from this retrospective analysis.ResultsIn patients with bone metastases, CT identified 18 with osteolytic lesions (30%), 32 with osteosclerotic lesions (53.3%) and ten with mixed lesions (16.7%). Analysis of the cases observed for the first time during the 1996–2000 period showed osteolytic lesions in 53.6% (15/28), osteosclerotic lesions in 32.1% (9/28) and mixed lesions in 14.3% (4/28). Results were 9.4% (3/32), 71.9% (23/32) and 18.7% (6/32), respectively, for the same groups in the 2001–2005 period. Histological analysis of all cases included 81.9% of infiltrative ductal carcinoma, 11.2% of infiltrative lobular carcinoma, 3.7% of ductal lobular mixed carcinoma and 3% of medullar carcinoma. We found no statistically significant correlation between histological type of breast cancer and radiological appearance of bone metastasis. A significant difference between patients treated with or without zoledronic acid was observed, with a higher prevalence of osteosclerotic lesions in the former group of patients (p<0.05).ConclusionsWe observed an increasing prevalence of osteosclerotic bone metastasis when comparing the 1996–2000 period with the 2001–2005 period. The significance of these distribution changes is not clear. However, we found a significant correlation of osteosclerotic lesions with zoledronic acid treatment. The advent of third generation bisphosphonates may have changed the CT appearance of bone metastasis from breast cancer.RiassuntoObiettivoÈ ormai accertato che le metastasi ossee da carcinoma della mammella spesso si presentano come lesioni osteolitiche. Abbiamo analizzato retrospettivamente le immagini TC di metastasi ossee al fine di quantificare la distribuzione delle lesioni litiche, miste o addensanti in una serie di pazienti che presentavano localizzazione ossea metastatica da carcinoma della mammella.Materiali e metodiTra il 1996 e il 2005, 468 pazienti con carcinoma della mammella sono stati sottoposti presso il nostro dipartimento ad una TC di stadiazione o per follow-up. La TC di stadiazione ha rilevato la presenza di metastasi sistemiche in 42/468 pazienti, 60 delle quali presentavano coinvolgimento del tessuto osseo. Pazienti con secondo tumore primitivo o pazienti con disordini metabolici ossei sono stati esclusi dallo studio.RisultatiIn pazienti con metastasi ossee, la TC ha rilevato 18 pazienti con lesioni osteolitiche (30%), 32 con lesioni osteoaddensanti (53,3%) e 10 (16,7%) con lesioni miste. L’analisi dei casi osservati per la prima volta nel periodo compreso tra il 1996 e 2000, ha mostrato lesioni osteolitiche nel 53,6% dei casi (15/28), lesioni osteoaddensanti nel 32,1% dei casi (9/28) e miste nel 14,3% dei casi (4/28) mentre i risultati erano rispettivamente del 9,4% (3/32), 71,9% (23/32) e 18,7% (6/32) per gli stessi gruppi nel periodo compreso tra il 2001 e 2005. L’analisi istologica di tutti i casi evidenziava la presenza di carcinoma duttale infiltrante nel 81,9% dei casi, di carcinoma lobulare infiltrante nel 11,2% dei casi, di carcinoma duttale lobulare misto nel 3,7% dei casi e nel 3% dei casi di carcinoma midollare. Non abbiamo rilevato una correlazione statisticamente significativa tra il tipo istologico di carcinoma della mammella e l’aspetto radiologico delle metastasi ossee. È stata osservata una differenza significativa tra i pazienti trattati con o senza acido zoledronico, con una maggiore prevalenza di lesioni osteoaddensanti nel gruppo di pazienti trattati (p<0,05).ConclusioniAbbiamo osservato un aumento della prevalenza delle metastasi ossee osteoaddensanti nel periodo compreso tra il 2001–2005 rispetto a quello compreso tra il 1996–2000. Il significato del cambiamento di tale distribuzione non è ancora chiaro. Tuttavia abbiamo rilevato una correlazione significativa tra le lesioni osteoaddensanti e il trattamento con acido zoledronico. L’avvento dei bifosfonati di terza generazione può aver cambiato l’aspetto TC delle metastasi ossee da carcinoma della mammella.

Temperature monitoring during microwave ablation in ex vivo porcine livers

OBJECTIVE The aim of the present study was to assess the temperature map and its reproducibility while applying two different MWA systems (915 MHz vs 2.45 GHz) in ex vivo porcine livers. MATERIALS AND METHODS Fifteen fresh pig livers were treated using the two antennae at three different settings: treatment time of 10 min and power of 45 W for both systems; 4 min and 100 W for the 2.45 GHz system. Trends of temperature were recorded during all procedures by means of fiber optic-based probes located at five fixed distances from the antenna, ranging between 10 mm and 30 mm. Each trial was repeated twice to assess the reproducibility of temperature distribution. RESULTS Temperature as function of distance from the antenna can be modeled by a decreasing exponential trend. At the same settings, temperature obtained with the 2.45 GHz system was higher than that obtained with the 915 MHz thus resulting into a wider area of ablation (diameter 17 mm vs 15 mm). Both systems showed good reproducibility in terms of temperature distribution (root mean squared difference for both systems ranged between 2.8 °C and 3.4 °C). CONCLUSIONS When both MWA systems are applied, a decreasing exponential model can predict the temperature map. The 2.45 GHz antenna causes higher temperatures as compared to the 915 MHz thus, resulting into larger areas of ablation. Both systems showed good reproducibility although better results were achieved with the 2.45 GHz antenna.

Superficial Temporal Artery Pseudoaneurysm: A Conservative Approach in a Critically Ill Patient

A 71-year-old man affected by cardio- and cerebrovascular disease experienced an accidental fall and trauma to the fronto-temporal area of the head. A few weeks later a growing mass appeared on his scalp. A diagnosis of superficial temporal artery pseudoaneurysm was made following CT and color Doppler ultrasound. His clinical condition favoured a conservative approach by ultrasound-guided compression and subsequent surgical resection. A conservative approach should be considered the treatment of choice in critically ill patients affected by superficial temporal artery pseudoaneurysm.

Percutaneous Image-Guided Cryoablation of Breast Cancer: A Systematic Review.

A systematic review of the clinical safety and efficacy of percutaneous breast cancer cryoablation was performed. Of 202 papers screened, seven matched the inclusion criteria. Cryoablation was mainly performed under ultrasound guidance, and on average two cryoprobes were used. Complete local tumor control was noted in 73% of patients (mean follow-up, 8 mo). No major complications were noted. The cosmetic outcome was satisfactory. Breast cancer cryoablation is safe, although local tumor control is suboptimal. The best results are achieved with small (<15 mm) ductal tumors treated by application of multiple cryoprobes.

Deep Vein Thrombosis, Inferior Vena Cava Interruption and Multiple Thrombophilic Gene Mutations

Interruption or hypoplasia of the inferior vena cava, with associated azygos continuation, is an uncommon congenital vascular malformation (Ellis et al, Comput Radiol 1986;10:15-22). Although this anomaly causes venous stasis, few patients present with history of deep vein thrombosis (DVT). The exact role of coexisting thrombophilic gene mutations, also heterozygotic, is far from being completely understood. However, in these cases, because of a probable additive effect, treatment of complications and careful prophylaxis for recurrent DVT are recommended lifelong. The authors report a case of inferior vena cava interruption with azygos continuation in a 30-year-old woman who presented with a history of recurrent lower limb DVT. In addition, heterozygosis for the H1299R polymorphism of the factor V gene (Factor V HR2), for the C677T polymorphism of the methylenetetrahydrofolate reductase gene (MTHFR C677T) and for the 4G/5G polymorphism of the plasminogen activator inhibitor-1 gene (PAI-1 4G/5G) was found in DNA analyses.