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The aim of the present study was to evaluate the impact of the aortic bifurcation (AB) morphological characteristics, analyzed on computed tomography angiography (CTA), on outcomes of patients with abdominal aortic aneurysms (AAAs), treated by endovascular aneurysm repair (EVAR) in a single-center experience. A retrospective analysis was conducted using a prospectively collected database. Morphological features considered as potentially impacting outcomes were maximum AB diameter (ABmax), minimum diameter (ABmin), mean diameter (ABaverage), AB area (ABarea), and AB calcification (ABcalcification) and thrombosis (ABthrombosis). Outcome measures were perioperative, 30-day, and midterm AAA-related reinterventions and all-cause mortalities. Investigators reviewed 306 preoperative CTA scans. Maximum aortic diameter was 51.4 ± 12.4 mm (range 40–110), and mean ABmax was 24.2 ± 8.8 mm (range 10–60), ABmin 17.0 ± 5.4 mm (range 4–40), ABaverage 20.6 ± 6.5 mm (range 9–47.5), and ABarea 35.2 ± 24.2 mm2 (range 6–176). ABcalcification ≥ 50% was present in 63 patients (20.6%), and ABthrombosis ≥ 50% in 102 patients (33.3%). Technical success was obtained in all cases, without perioperative reintervention or death. At 30-day follow-up, the reintervention rate was 3.3%, and mortality rate was 1.3%. At a mean follow-up period of 35 ± 28.6 (range, 1–72) months, reintervention and mortality rates were 6.5 and 4.9%, respectively. None of the analyzed thresholds were predictive of adverse outcomes. At multivariate analysis, association of a narrowed AB with severe calcification of the distal aorta showed a significant differences in terms of reinterventions (p = 0.009). Our limited experience seems to reveal that a cutoff of ≤ 20 mm for AB diameter, as in current guidelines, is ineffective in predicting outcomes after EVAR.

We reported the case of a 38-year-old patient who in 2017 presented to our institution after post-traumatic complete ankylosis of the elbow. He complained of stiffness and pain, and the radiographs revealed complete fusion of the humeroulnar joint. The Mayo Elbow Performance Score (MEPS) on admission was 31, and the elbow was fused at 90° flexed position. The patient underwent semiconstrained total elbow arthroplasty with Bryan-Morrey approach; after a 2.1 years follow-up, active arc of movement was 120°. The MEPS was excellent with a 100 points score, the patient was able to complete all activities of daily living. We did not report any complications. Total elbow arthroplasty has shown to be a good therapeutic option that make it possible to restore adequate functional range of motion and relieve pain in young patients with post-traumatic stiffness/arthritis of the elbow.

Introduction Erectile dysfunction is a highly prevalent condition. Existing guidelines provide recommendations for diagnosis and treatment, but they are often disregarded in clinical practice in favor of a “patient-tailored” approach. Objectives We planned a Delphi consensus method to bridge the gap between evidence-based medicine and the real-life approach in daily practice. Materials and Methods The Advisory Board prepared 15 statements on debated topics in andrology, each including 4–6 items designed as a 5-point Likert scale. After a validation phase, the questionnaire was sent by e-mail to a panel of experts for a first round of voting; members of the panel were later invited to a second round of voting, preceded by discussion of the “hot topics” identified in the first round. Results The first round of the Delphi consensus involved 101 experts; 71 (70%) also took part in the second round of voting. The Advisory Board deemed 22 items to be worthy of debate, and these underwent the second round of voting. “Real-life” results from the survey proved quite different from evidence-based recommendations. Conclusion Although guidelines suggest the best approach for a “standard” patient, real-life settings require flexibility. Diagnostic and therapeutic approaches should be tailored to the patients’ needs. Phosphodiesterase type 5 inhibitors are recognized as the first-line therapy in both settings, including the newly introduced sildenafil orodispersible film. Indications from the panel might help close the gap between recommendations from guidelines and real-life practice in relation to the diagnosis and treatment of erectile dysfunction.

Acute limb ischemia (ALI) is a pathological condition resulting from a sudden blood interruption (or, at least, from an important reduction in flow) limiting tissues’ survival. ALI is always a serious event requiring immediate diagnosis and treatment, also considering the high associated amputation risk. The most frequent causes of acute limb ischemia are embolism, thrombosis, and trauma. Clinical findings are grouped together in a series mnemonic note as “6P of Pratt”: pain, pallor, pulselessness, poikilothermia, paresthesia, and paralysis. Those in concert with duplex ultrasound assume a primary and crucial role in diagnostic and preoperative evaluation of ALI patients. Treatment for ALI largely depends on the clinical presentation according to Rutherford’s classification. When indication for surgery is posed, several open, endovascular, and hybrid procedures are developed to restore blood flow in acute patients.

Purpose: Hypogastric artery (HA) revascularization during endovascular aneurysm repair (EVAR) is still open to debate. Moreover, exclusion-related complication rates reported in literature are not negligible. The aim of this study is to present and analyze the outcomes in patients undergoing EVAR with exclusion of 1 or both HAs at our academic center. Methods: We retrospectively reviewed our results in patients submitted to EVAR and needing HA exclusion, in terms of perioperative (30-day) and follow-up rates of intestinal and spinal cord ischemia, buttock claudication, buttock skin necrosis, and sexual dysfunction. Results: From January 2008 to December 2014, a total of 527 patients underwent elective standard infrarenal EVAR; among those 104 (19.7%) had iliac involvement needing HA exclusion. In 73 patients with unilateral iliac involvement (70.1%, group UH), many single HAs were excluded. Thirty-one patients (29.9%) had bilateral iliac involvement (group BH), of which 16 (51.6%) had 1 HA excluded with revascularization of the contralateral one (group BHR); in the remaining 15 patients (48.4%) both HAs were excluded (group BHE). No 30-day or follow-up aneurysm-related mortality, intestinal, or spinal cord ischemia were recorded. At 30 days, skin necrosis was observed in 2 patients. Buttock claudication and sexual dysfunction rates were significantly greater in group BHE than in group BHR ( P < .05). At a mean 18.6 months follow-up (range: 4-47), buttock claudication and sexual dysfunction rates in group BHE were persistently higher than that in groups UH and BHR ( P < .05); HA coil embolization was significantly associated with buttock claudication and sexual dysfunction ( P < .05). Conclusions: Whenever anatomically feasible, at least 1 HA should be salvaged in case of bilateral involvement. In case of unilateral HA exclusion, the rate of complications is not negligible. Coil embolization is related to a higher complication rate.

The aim of the present study was to evaluate the reciprocal relationships between motor impairment, dopaminergic dysfunction, and cerebral metabolism (rCMRglc) in de novo Parkinson's disease (PD) patients.Twenty-six de novo untreated PD patients were scanned with (123)I-FP-CIT SPECT and (18)F-FDG PET. The dopaminergic impairment was measured with putaminal (123)I-FP-CIT binding potential (BP), estimated with two different techniques: an iterative reconstruction algorithm (BP(OSEM)) and the least-squares (LS) method (BP(LS)). Statistical parametric mapping (SPM) multiple regression analyses were performed to determine the specific brain regions in which UPDRS III scores and putaminal BP values correlated with rCMRglc.The SPM results showed a negative correlation between UPDRS III and rCMRglc in premotor cortex, and a positive correlation between BP(OSEM) and rCMRglc in premotor and dorsolateral prefrontal cortex, not surviving at multiple comparison correction. Instead, there was a positive significant correlation between putaminal BP(LS) and rCMRglc in premotor, dorsolateral prefrontal, anterior prefrontal, and orbitofrontal cortex (p0.05, corrected for multiple comparison).Putaminal BP(LS) is an efficient parameter for exploring the correlations between PD severity and rCMRglc cortical changes. The correlation between dopaminergic degeneration and rCMRglc in several prefrontal regions likely represents the cortical functional correlate of the dysfunction in the motor basal ganglia-cortical circuit in PD. This finding suggests focusing on the metabolic course of these areas to follow PD progression and to analyze treatment effects.

In this study we evaluated a further refinement of the background subtraction technique and the introduction of correction factors for the influences produced by kidney depth and surface dimensions on the system counting efficiency

Multihole collimators are the most important piece of instrumentation in determining the tradeoff between spatial resolution and noise in nuclear medicine images. Recently, we found that the collimator-to-detector gap greatly influences the hole-pattern artifacts. In addition, we also showed that specific values of the gap exist which minimize the artifacts: here we call this phenomenon "penumbral masking" (PM). In this paper, we study the matter in greater detail and we take PM into account in the problematic context of designing high-energy collimators by, basically, substituting the conventional hole-array pattern constraint with a mathematical expression of the PM effect. With this approach we found that a solution to the problem of maximizing sensitivity for a given spatial resolution always exists while, without the PM concept, in the case of lead (Pb), a solution exists below 300 KeV, a suboptimal solution can be found within the 300-320 KeV range and no solution at all exists beyond 320 KeV. Thus, one is able to minimize the hole-pattern artifacts while designing high -energy collimators even if a somewhat lower sensitivity has to be accepted: for example, with lead, at 511 KeV, sensitivity is reduced by 20% compared to what it would be without the introduction of PM. When high energies are involved, even with our approach the weight constraint is a major problem, but this does not affect the capability of reducing the hole-pattern artifacts. However, even when the theoretical solution may not be feasible, this approach clarifies the design of high-energy collimators.

To report a case of pararenal aortic aneurysm (PAAA) with narrowed iliac arteries treated by the chimney technique combined with the INCRAFT® AAA stent graft system. A 75-year-old man was diagnosed with a 55-mm PAAA. Patient was judged unfit for open repair and for standard endovascular aneurysm repair (EVAR) due to its clinical and anatomical requirements. Custom-made fenestrated device (FEVAR) was excluded due to the presence of narrowed and heavily calcified iliac axes. Consequently, patient underwent auspicious endovascular aneurysm repair with the INCRAFT System and chimney grafts in the superior mesenteric artery and both renal arteries. At 12 months' follow-up, patient was in good clinical condition, with preserved renal function. Computed tomographic angiography revealed inceptive shrinkage of the aneurysm with patency of aortic and visceral grafts even in the presence of a low-flow type Ia endoleak. Chimney grafts (CGs) combined with the low-profile INCRAFT System seem to be feasible for treating PAAA, in high-risk patients unfit for standard EVAR or FEVAR devices.

Biological treatments represent a novel approach to counteract cancer cachexia. Monoclonal antibodies targeting cytokines and molecules responsible for muscle wasting, with an anti-inflammatory effect, however, still have several limitations and need further clinical investigation. New research in this field will contribute to the better understanding of the multifactorial pathogenesis of cancer cachexia, while favoring the consolidation of multimodal preventive and therapeutic strategies encompassing nutritional and pharmacological treatments. New pharmacological therapies and conventional nutritional treatments will soon integrate in the ‘parallel pathway’, aimed at early recognition, prevention and treatment of the metabolic and nutritional derangements occurring in cancer. This will likely produce improvement in quality of life, tolerance to treatments and survival.

Metastatic involvement of the extrahepatic digestive system is rare. We here report the case of a 62-year-old woman who presented with a bowel obstruction related to a metastasis of breast cancer occurring 12 years after a mastectomy for lobular carcinoma. No other distant metastases were detected except for two nodules of 20 and 5 mm on the right chest wall. Biopsy of the larger nodule showed a lobular carcinoma. The patient underwent a right hemicolectomy and then received chemotherapy combined with letrozole, resulting in a partial response. The literature revealed only a few cases of breast cancer metastatic to the colon. Patients with known breast cancer, particularly of the lobular histological type, who present with specific or less specific abdominal symptoms or signs such a microcytic anemia, should be endoscopically explored in order to detect possible metastases of the primary breast tumor.

In the last decades, diagnosing medical images has heavily relied on digital imaging. As a consequence, huge amounts of data produced by modern medical instruments need to be processed, organized, and visualized in a suitable response time. Many efforts have been devoted to the development of digital Picture Archiving and Communications Systems (PACS) which archive and distribute image information across a hospital and provide Web access to avoid the expensive deployment of a large number of such systems. On the other hand, this approach does not solve problems related to the increasing demand of high performance computing and storage facilities, which cannot be placed within a hospital. In this work we describe MedIGrid, an application that enables nuclear doctors to transparently use high performance computers and storage systems for the PET/SPECT (Positron Emission Tomography/Single Photon Emission Computed Tomography) image processing, management, visualization and analysis. MedIGrid is the result of the joint efforts of a group of researchers committed to the development of a distributed application to test and deploy new reconstruction methods in clinical environments. The outcomes of this work include a set of platform independent software tools to read medical images, control the execution of computing intensive tomographic algorithms, and explore the reconstructed tomographic volumes. In the paper we describe how the collaboration among different research groups has contributed to the integration of the application into a single framework. The results of our work are discussed.

BACKGROUND Histologic grade of differentiation is a strong prognostic factor for prostate carcinoma. However, most tumors fall in the intermediate group. Nuclear and nucleolar morphometry and analysis of the argyrophilic nucleolar organizer regions (AgNORs) were performed to improve prognosis, especially for patients with intermediate histologic grade tumors. METHODS Core needle biopsies from 65 patients with primary prostate carcinoma at diagnosis were studied. Patients received only hormone therapy. Formalin fixed and paraffin embedded sections were stained with the method of Ploton. The mean AgNOR count was calculated in 100 tumor cells for each case. Nuclear and nucleolar areas from 100 cells were measured with an automated image analyzer. One-way analysis of variance and uni- and multivariate survival analyses were used for statistical evaluation. RESULTS In the whole series, World Health Organization (WHO) tumor grade, nuclear and nucleolar areas, and AgNOR counts were correlated with survival time. By multivariate analysis, only AgNOR counts retained independent prognostic significance. In WHO Grade 2 carcinoma, the 5-year survival rate for patients with AgNOR/cell ≤ 7.84 was 77%, but was only 12% for those with higher counts (P < 0.0001). These survival rates were similar to those obtained when patients with WHO Grade 1 carcinoma and Grade 2 carcinoma plus low AgNOR counts were compared with patients with Grade 3 carcinoma and Grade 2 carcinoma plus high AgNOR counts. In Gleason intermediate Grade 6 and 7 carcinomas, the 5-year survival rate for patients with AgNOR/cell ≤ 7.84 was 71%, but was only 7% for those having higher counts (P = 0.0001). CONCLUSIONS Nuclear and nucleolar areas, as well as AgNOR counts, supplement histologic grading in the prognostic assessment of prostate carcinoma in patients receiving only hormone therapy. AgNOR count also is a prognostic factor for patients with intermediate grade tumors. The combination of histologic grade and proliferative activity allows the stratification of patients into low and high risk groups. Cancer 1997; 79:1956-63. © 1997 American Cancer Society.

This study aimed to identify risk factors for squamous intraepithelial lesions (SIL) in women with known HIV status and to explore the association between SIL, HPV subtype, and HIV-induced immunosuppression. The study population consisted of women with known HIV serological status who were attending a network of 16 clinical centres in Italy. Detailed behavioural data, clinical and laboratory parameters, and samples for diagnosis of SIL by Papanicolau smear and HPV infection using a polymerase chain reaction (PCR) were obtained from each study participant. The strength of the association between SIL and possible risk factors was assessed calculating crude and adjusted odds ratios derived from univariate analysis and multivariate models. We enrolled 236 women, of whom 135 (57.2%) were HIV-infected. SIL was diagnosed in 57 women (24.1%); of these, 48 (35.6%) were HIV-infected and 9 (8.9%) were HIV-negative. HPV-DNA was detected in 41 (72%) women with SIL and in 45 (25%) women without SIL. HPV-DNA was more often detected among HIV-infected women than among HIV-negative women (40% vs. 32%), but the difference was not statistically significant. Women infected with high-risk types or with low-risk-uncharacterised types of HPV both had a higher risk of SIL compared with HPV-negative women (respectively, AOR: 17.53 and AOR: 2.89). HIV-infected women with severe or moderate immunosuppression were more likely to have SIL than HIV-negative women (respectively, AOR: 7.29 and AOR: 3.09) also independently from HPV infection. Women reporting use of a contraceptive pill had a 2.5 times higher risk of SIL compared with those who never used hormonal contraceptives. The results confirm that high-risk HPV types are strongly associated with SIL, and that HIV infection may strengthen the effect of HPV at cervical level. The use of oral contraceptives may slightly increase the risk of SIL in women with at-risk behaviour for HIV infection.

The prognostic significance of the argyrophilic nucleolar organizer regions (AgNORs) in tumour pathology is still a matter of debate. A prospective study was performed in a series of renal cell carcinomas to clarify the prognostic value of AgNOR counting. Sections from 21 renal cell carcinomas were stained in 1990 with the method of Ploton. Black dots within the nucleus from 200 tumour cells were counted: the mean AgNOR count for the whole series was 6.13, the median 5.94 and the SD 1.78. Patients were then followed up for at least 6 years or to death: at the time of the survival analysis (June 1996), 13 patients were alive without evidence of recurrence or metastasis, 6 had died of the disease and 2 of myocardial infarction. All the patients with 5.94 AgNORs per cell or fewer were alive at 6-year follow-up, while only 60% of patients with more than 5.94 AgNORs per cell survived (p=0.01). In the multivariate analysis, only AgNOR count (p=0.015) retained an independent prognostic significance. With the limitation due to the small number of cases, this prospective study clearly indicates that AgNOR count has a significant prognostic role, at least in renal cell carcinoma.

High intensity focused ultrasound is a minimally invasive treatment option for prostate cancer. Data from the literature show promising early oncological outcomes and a favorable side effect profile. This study is a preliminary report of the Italian experience (Perugia and Turin) of patients treated with the Sonablate(R)500 high intensity focused ultrasound device.Between 2004 and 2007, 163 consecutive men with T1-T3 N0M0 prostate cancer underwent high intensity focused ultrasound with the Sonablate 500. Followup included prostate specific antigen tests at 1 month and then every 3 months after treatment, and a random prostate biopsy at 6 months. Failure was defined according to prostate specific antigen nadir, positive findings on followup biopsy and biochemical failure according to Phoenix criteria.Median patient age was 72 years old, median baseline prostate specific antigen was 7.3 ng/ml, and disease stage was T1 in 44.1%, T2 in 42.5% and T3a in 13.4% of patients. Median followup was 23.8 months. After high intensity focused ultrasound treatment prostate specific antigen decreased to a median nadir of 0.15 ng/ml. Median prostate specific antigen at 3 and 6 months was 0.30 and 0.54 ng/ml, respectively. At 6 months the negative biopsy rate was 66.1%. There was no biochemical evidence of disease in 71.9% overall. On multivariate analysis prostate specific antigen nadir became the only independent predictor of no biochemical evidence of disease and positive biopsy at a cutoff of 0.40 ng/ml.A favorable outcome of high intensity focused ultrasound is associated with lower baseline prostate specific antigen, lower prostate specific antigen nadir, lower Gleason score and lower tumor stage. As with any novel technology long-term data will be required before this technique gains widespread clinical acceptance.

OBJECTIVE To investigate metabolic disturbances, possibly leading to stone disease, in the Camey II technique for creating a urinary reservoir from an intestinal segment. PATIENTS, SUBJECTS AND METHODS Thirty patients with a Camey II ileal neobladder and 26 controls had metabolic investigations of blood samples, and 24-h and fasting urine samples, to assess renal function, the risk of stone formation, and bone turnover. The state of saturation with calcium oxalate, uric acid and brushite were calculated using a computer program. RESULTS The patients had lower renal clearances than the controls (P

Technetium 99md,l-cyclobutylpropylene amine oxime (99mTc-CBPAO) has been developed as a brain-imaging agent for single photon emission tomography (SPET).99mTc-CBPAO can be prepared using a simple labelling procedure suitable for routine clinical use. It has a high in vitro stability, as has been demonstrated by high-pressure liquid chromatography (HPLC) analysis. This shows that 3 h after labelling, less than 5% of the primary lipophilic complex which is capable of crossing the blood-brain barrier (BBB) converts to a secondary hydrophilic complex. Brain uptake (% dose/g wet tissue) of99mTc-CBPAO, determined at 5 and 30 min after injection in two groups of six adult male Sprague-Dawley rats, was found to be 0.74±0.06 and 0.73±0.13 (mean ± SD), respectively. These values are not significantly different from those obtained repeating the experiment with99mTc-labelled hexamethylpropylene amine oxime (99mTc-HMPAO) (0.72±0.15 at 5 min and 0.88 ± 0.24 at 30 min after injection). Since the rat brain uptake of99mTc-CBPAO remained unchanged for a period of time suitable for tomographic study, the comparison of the two tracers was extended to two groups of ten patients. The latter were affected by neurological and psychiatric disorders and were studied with SPET. Human brain uptake (% dose/cc cortical grey matter) of99mTc-CBPAO and99mTc-HMPAO were 3.04±0.57 and 4.22±0.46 (mean × 10−3 ± SD × 10−3), respectively, with a 32% significant difference. In two other groups of five patients, the first transit time-activity curves of the two tracers were compared. From the analysis of these curves we suggest that99mTc-CBPAO has a higher binding effect on blood components and/or a higher degradation rate in blood than that of99mTc-HMPAO. This may account for the reduced human brain uptake. In conclusion, SPET images of99mTc-CBPAO reflect blood perfusion, and they have a good diagnostic quality. The main advantage of99mTc-CBPAO is its in vitro stability; however,99mTc-HMPAO is a superior imaging agent.

All patients (n 1⁄4 1177) Wound (0-3) 1.1 (0.9-1.3) 1.7 (1.3-2.3) 1.2 (1.0-1.4) Ischemia (1-3) 1.5 (1.2-1.8) 3.5 (2.0-6.5) 1.2 (0.9-1.4) Infection (0 3) 1.2 (1.0 1.3) 1.7 (1.3-2.1) 1.2 (0.9-1.4) Composite (2-9) 1.2 (1.1-1.2) 1.8 (1.5-2.0) 1.2 (1.0-1.3) Mean (0-3) 1.4 (1.2-1.6) 4.5 (3.1-6.5) 1.2 (1.0-1.5) Clinical stage (1-4) 1.1 (0.9-1.3) 2.2 (1.6-3.1) 1.1(0.9-1.2) Bypass only (n 1⁄4 592) Wound (0-3) 1.3 (1.1-1.5) 1.6 (1.2-2.3) 1.3 (1.0-1.6) Laura Capoccia, Maria Antonietta Panico, DaniloMenna, Pasqualino Sirignano, Wassim Mansour, Nunzio Montelione, Chiara Pranteda, Martina Formiconi, Francesco Speziale. “Sapienza” University of Rome, Vascular and Endovascular Surgery Division, Department of Surgery “Paride Stefanini”, Policlinico Umberto I, “Sapienza” University of Rome, Roma, Italy; Maria Antonietta Panico, Vascular and Endovascular Surgery Division, Rome, Italy; Danilo Menna, Vascula and Endovascular Surgery Division, Rome, Italy; Policlinico Umberto I, Rome, Italy

Several reconstructive surgical techniques have been developed for correction of penile curvature in Peyronie's disease. In some cases plaque excision and grafting with various autologous tissues or synthetic material are performed. Autologous dermal graft is the most commonly used. Today a cadaveric dermal allograft as fully decellularized dermal matrix is available (AlloDerm). This clinical study evaluated the capacity of AlloDerm allograft dermal matrix to function as a permanent dermal transplant and potentially enhance the quality of grafts applied to penile albuginea defect after plaque excision in five patients with Peyronie's disease. Biopsy specimens were obtained from 2 patients at 4 months to test revascularization and adherence of the graft.

Recently we applied the direct reconstruction of region-of-interest (ROI) to three-projection data sets acquired in fast mode with a three-headed SPECT system. In this study, we evaluated whether the fast sampling of the time-activity curves (TACs) in regions of specific (striata) and non-specific (cerebellum) binding could allow for quantitative estimation of the binding potential (BP) in human /sup 123/I-FPCIT dopamine receptor studies. Numerical simulations and phantom studies showed that this TACs-based method estimates regional concentrations better than using the ROI contents taken on expectation maximization (EM) reconstructed images. Moreover, it allows for an estimation of the statistical uncertainty. In the phantom study, the TACs-based method reproduced the real target-to-background ratio within about 10%; the ratio evaluated on EM images underestimated the real value of about 45%. Indeed, partial volume effect (PVE) correction is naturally embedded in the method. The approach was also applied in a patient DATSCAN study. The TACs were used to describe the evolution of the specific-to-nonspecific ratio (R) in time. The R values retrieved on EM images were about a 40% of the estimates obtained on TACs. The higher accuracy of TACs in measuring receptor density should allow for better clinical performance of receptor SPECT in Parkinson's disease. The drawback of the method resides in a higher sensibility to region segmentation errors with respect to the conventional procedure.

Purpose: We evaluated the adaptability and the efficacy of a cyanoacrylic glue for the conservative treatment of urinary fistulas of different etiologies using an endoscopic, percutaneous or endovaginal approach.Materials and Methods: From May 1998 to July 2004, 13 patients with long lasting iatrogenic and/or inflammatory urinary fistulas were treated conservatively with endoscopic, percutaneous or endovaginal application of 1 to 3 cc of cyanoacrylic glue.Results: The complication rate in this cohort of 13 patients was low. Occlusion therapy failed in 2 genitourinary fistulas which were wider (diameter greater than 1 cm) and short. In the remaining 11 cases urinary fistulas were successfully sealed and at a median followup of 35 months no relapses were observed.Conclusions: Cyanoacrylic glue is suitable for endoscopic, percutaneous and endovaginal use. This occlusion therapy represents a safe and minimally invasive approach that might be offered as a first line option for the treatment of urinary ...

Recently, we developed a technique for the accurate determination of time-activity curves (TACs) based on the direct reconstruction of region-of-interest (ROD contents from a series of three-projections data sets acquired with a three-headed SPECT system. This technique allows to reach a very fast sampling of the TACs and has been applied in renal studies for the determination of the blood pool input function and of the renal TACs (sampling interval: 0.67 sec). A simple data analysis method has been developed for the estimation of the renal clearance values directly from the comparison of these curves. The approach is in principle analogous to the conventional one of fitting the tracer kinetic model to the TACs generated from the ROIs segmented on a temporal series of images, but, the new fast sampling procedure is not affected by the problems of inconsistency of data and unbiased estimates can be retrieved. The method has been compared with the Direct Least Squares Estimation (DLSE) one and it has shown many advantages both under the computational and the theoretical aspects. The number of equations is strongly reduced and iterative estimation can be avoided; the number of unknowns is reduced too, since the method does not require the description, often not realistic at all, of the tracer behavior in regions different from kidneys and blood. The method has been compared to the DLSE one by means of simulations and showed, in general, better performances

We present here a direct least-squares estimation (DLSE) method for the determination of renal kinetic parameters from sequences of very fast acquisitions performed with a three-headed single photon emission computed tomography (SPECT) system. A simple linear model for the behavior of the radiopharmaceutical, as well as a spatial model for its spatial distribution are defined. The model enables one to estimate the kinetic parameters directly from the projections, once the plasma concentration function is known. A new technique for the accurate reconstruction of time-radioactivity curves based on the direct reconstruction of the region-of-interest contents from a series of data from three-projections is presented. The technique is used to determine the plasma concentration function with a sub-second time resolution. The spatially-variant geometrical response is also included in the model to compensate for the spatial resolution of the SPECT system. Results obtained from simulations are presented. Basic spatial and time features of the simulations are derived from a patient study. Noise and segmentation errors are also simulated. The DLSE method is compared with the conventional one of deriving kinetic parameters from the time series of reconstructed images. The standard deviation of results given by DLSE is less than 2%, whereas with the conventional method it is between 5% and 6%. Within the limit of statistical fluctuations, DLSE results are unbiased whereas those of the conventional method are overestimated by 24%.

We present here a new method for the determination of renal kinetic parameters from time-activity curves (TACs) obtained in dynamic tomographic Nuclear Medicine studies. The method allows to achieve subsecond sampling rates when using three-headed Single Photon Emission Computed Tomography (SPECT) systems.

BACKGROUND Recurrence of transitional cell carcinoma of the bladder cannot be predicted accurately by traditional criteria alone. This study examined the value of cell proliferative activity, morphometry, and expression of p53, c-erbB-2, and bcl-2 oncogenes in predicting recurrence of superficial papillary urothelial neoplasms of low malignant potential (LMP) and Grade 1 (G1) papillary carcinomas of the bladder. METHODS Sixty-two patients (mean age, 62 years) with newly diagnosed superficial pTa bladder tumors (19 LMP, and 43 G1) were analyzed retrospectively. All patients underwent transurethral resection (TUR). Median follow-up was 69 months. Serial sections from formalin-fixed, paraffin-embedded material at initial TUR were stained with monoclonal antibodies (MoAbs) DO7, CB11, and bcl-2-124. Cell proliferation was assessed by MIB-1 MoAb, the quantity of argyrophilic nucleolar organizer region-associated proteins (AgNORs), and mitotic count. RESULTS Of the 62 patients, 42 (67.7%) had one or more recurrences. Recurrence rates were higher in MIB-1 (P < 0.0001) and p53 immunopositive cases (P = 0.02), when the mitotic count was greater than 5 (P = 0.004), and in G1 carcinomas (P = 0.04). In univariate analysis, the disease-free period was shorter for MIB-1 (P < 0.0001) and p53 immunopositive (P = 0.0001) cases, for cases with high AgNOR quantity (P = 0.04), mitotic count greater than 5 (P = 0.01), and in G1 carcinomas (P = 0.002). In multivariate analysis, only MIB-1 immunoreactivity retained independent prognostic significance. CONCLUSIONS Despite the small cohort, the results confirm the prognostic value of cell proliferation and p53 expression in patients with bladder neoplasms. The results also indicate that MIB-1 immunopositivity is the most significant predictor of recurrence and disease-free survival in superficial LMP and G1 papillary bladder carcinomas. Cancer 2002;95:784–90. © 2002 American Cancer Society. DOI 10.1002/cncr.10733

We investigated the expression of oncogenes p53, c-erbB-2, and bcl-2 and cell proliferative activity in 62 newly diagnosed superficial pTa papillary bladder tumors. Based on the 1998 World Health Organization/International Society of Urological Pathology (WHO/ISUP) and 1999 WHO classifications, 19 were urothelial neoplasias of low malignant potential (LMP) and 43 low-grade (grade 1) papillary carcinomas. All the patients underwent transurethral resection and were followed up to 97 months; 42 had recurrences. Initial biopsies were tested for p53, c-erbB-2, and bcl-2 proteins using DO7, CB11, and bcl-2 124 monoclonal antibodies. Cell proliferation was assessed by MIB-1 mAb and mitotic count. LMP had significantly lower MIB-1 (p = 0.002) and p53 immunopositivity (p = 0.03), mitotic count (p = 0.006), and recurrence rates (p = 0.04) than did grade 1 cases, whereas no difference was observed for c-erbB-2 and bcl-2 expression. The median disease-free survival for LMP was 76 months but only 15 months for grade 1 cases (p = 0.002). Although the cohort is small, the results indicate that the distinction between LMP and low-grade (grade 1) papillary urothelial neoplasias, as proposed by the 1998 WHO/ISUP and 1999 WHO classifications, reflects different biologic activity and clinical behavior; however, a long-term follow-up is advisable also for patients with LMP.

Background: The study was aimed at comparing the diagnostic accuracy of the quantitative bladder tumor antigen (BTA) TRAK™ immunoassay with exfoliative urine cytology in the detection of primary and recurrent bladder cancer. Methods: The analysis was carried out on 194 high risk patients undergoing a diagnostic cystoscopy, 279 patients with previous history of transitional cell carcinoma awaiting a follow-up cystoscopy, and 45 healthy controls. Urine cytology was performed by a skilled cytopathologist on three consecutive samples. Results: BTA TRAK values resulted significantly higher in tumor positive cases than in absence of bladder tumor for both groups of patients. Non neoplastic urothelial diseases as well as the absence of mucosal abnormalities were associated with a marked increase in BTA TRAK levels with respect to the control group. Overall sensitivity and specificity was 63 and 63% for BTA TRAK (cut-off 34 U/ml), and 68.3 and 73.4% for urine cytology, respectively. The diagnostic advantage of urine cytology was maintained when patients were stratified by tumor grade. Conclusions: The clinical performance of the BTA TRAK in the detection of primary or recurrent bladder cancer is acceptable and reproducible as shown by similar results with previous reports, although urine cytology performed on three samples showed the highest sensitivity and specificity.

Purpose: Both BTA TRAK and NMP22 urine concentrations have shown a sensitivity superior to urine cytology in the detection of bladder cancer. We compared these tumor markers with urine cytology performed on 3 consecutive samples and evaluated by an expert cytopathologist. Patients and Methods: The investigations were conducted on 94 patients undergoing a diagnostic cystoscopy for a high suspicion of bladder cancer (group 1) and on 102 patients with previous history of transitional cell carcinoma awaiting a follow-up cystoscopy (group 2). Biopsy specimens were obtained also from tumor negative patients. Immunoassays for BTA TRAK and NMP22 were carried out according to standard methods. The choice of the cut-off was based on the ground of sensitivity and specificity curves intersection. Urine cytology results were expressed as positive, negative and ‘dubious’. Results: Overall sensitivity was 56% for NMP22 (cut-off 11 U/ml) and 57% for BTA TRAK (cut-off 60 U/ml). When dubious results were considered as positive cases, urine cytology achieved a sensitivity of 73.3%. Assuming dubious cases as negative results, urine cytology sensitivity resulted 59.3%. When the 2 groups of patients were evaluated separately with different cut-off, there was no significant gain in sensitivity for BTA TRAK and NMP22 over urine cytology. Conclusions: Urine cytology performed on 3 samples showed the highest sensitivity and specificity. The diagnostic advantage of urine cytology over BTA TRAK and NMP22 was maintained when patients were stratified by tumor grade.

Damage to nonmotor dopamine (DA)-mediated frontostriatal circuits has been proposed as the main pathophysiological basis of cognitive dysfunction in Parkinson's disease (PD). In the present study, 18 early nondemented drug naive PD patients were investigated, by dual-tracer N-ω-fluoropropyl-2β-carbomethoxy-3β-4-[123I]iodophenyl-nortropane ([123I]FP-CIT) single-photon emission computed tomography (SPECT)/[18F] fluoro-deoxyglucose (FDG) positron emission tomography (PET) imaging, to test whether an early and not yet treatment-modulated relation exists between cognitive functions, caudate nucleus (CN) DA impairment and brain metabolism (CMRglc) in associative frontostriatal circuits. Verbal fluency performance correlated with DA impairment in CN, and with CMRglc in dorsolateral prefrontal cortex (DLPFC) and anterior cingulate cortex (ACC). Further, CMRglc in orbitofrontal cortex, DLPFC, and ACC was shown to be early modulated by the level of DA impairment in CN. The present study demonstrates in vivo the early functional disruption of nonmotor frontostriatal circuits in PD. The effect of CN DA impairment on DLPFC and ACC metabolism is proposed as a possible early pathophysiological and functional substrate for executive dysfunction in PD.

A brain phantom is described that is characterized by a high anatomical definition and by the possibility of varying the internal contrast with the use of a single radioactive solution. The experimental work was done with a single-photon emission computerized tomographic (SPET) rotating camera. The phantom was used to study the contrast recovery of both the filtered back-projection and an iterative reconstruction algorithm. Moreover, it was also used to find a cross-calibration factor between activity concentrations in the SPET slices and an external reference.

A method of estimating the 131I-hippuran clearance of each kidney during renal sequential scintigraphy is presented. The clearance rates were obtained from the elaboration of the renal histograms and of a blood curve recorded on the precordium, directly compared with the injected dose. A function simulating the progressive deformation of the radioactive bolus as kidney perfusion is impaired was introduced into the computation. The method was tested on 23 patients who underwent simultaneous determination of the clearance rate with the Sapirstein method, the results being corrected to 1.73 m2 of body surface area. The correlation coefficient r between the obtained data (the sum of the clearance rates of the two sides) and the results of the Sapirstein method was 0.89.

The present study analyses the case histories of urinary stone colics recorded at the hospital “Val di Sieve” (Florence) during the period 1962–1971 by comparing the weather conditions of the 353 days during which the cases occurred, with the weather conditions of a sample of “normal” reference days.

The diagnostic efficacy of 99mTc-citrate brain scintigraphy was assessed in 22 patients with proven brain lesions. All patients were given 99mTc-DTPA and then 2 days later, 99mTc-citrate. Our results show a superior diagnostic efficacy of the 99mTc-DTPA test in detecting brain lesions both of vascular and neoplastic type, especially when the lesions have a poor blood supply.