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The aim of the study is to evaluate the diagnostic performance of apparent diffusion coefficient (ADC) and apparent kurtosis coefficient (Kapp) for the characterization of prostate lesions on 1.5T MRI. This retrospective study included 34 patients with at least one lesion with PI-RADS score≥ 3. Performances of ADC and Kapp were evaluated using the Mann-Whitney U test and receiver operating characteristics curve (AUROC). Lesions with Gleason score≥6 had significantly lower Kapp compared to benign lesions (p=0.025). The ADC-ratio was the only significantly different parameter between GS≥7 and GS=6 lesions (p=0.039). Kapp showed the largest AUROC for the diagnosis of GS≥6 prostate cancers (AUROC: 0.741, p=0.025), while the largest AUROC for the diagnosis of GS≥7 prostate cancers was achieved by the ADC-ratio (AUROC: 0.709, p=0.039). While Kapp demonstrated no significant benefit in characterization of prostate cancers compared to ADC, it could be helpful to distinguish benign lesions from prostate cancers.

Purpose: Aim of this study was to evaluate a fully automated deep learning network named Efficient Neural Network (ENet) for segmentation of prostate gland with median lobe enlargement compared to manual segmentation. Materials and Methods: One-hundred-three patients with median lobe enlargement on prostate MRI were retrospectively included. Ellipsoid formula, manual segmentation and automatic segmentation were used for prostate volume estimation using T2 weighted MRI images. ENet was used for automatic segmentation; it is a deep learning network developed for fast inference and high accuracy in augmented reality and automotive scenarios. Student t-test was performed to compare prostate volumes obtained with ellipsoid formula, manual segmentation, and automated segmentation. To provide an evaluation of the similarity or difference to manual segmentation, sensitivity, positive predictive value (PPV), dice similarity coefficient (DSC), volume overlap error (VOE), and volumetric difference (VD) were calculated. Results: Differences between prostate volume obtained from ellipsoid formula versus manual segmentation and versus automatic segmentation were statistically significant (P < 0.049318 and P < 0.034305, respectively), while no statistical difference was found between volume obtained from manual versus automatic segmentation (P = 0.438045). The performance of ENet versus manual segmentations was good providing a sensitivity of 93.51%, a PPV of 87.93%, a DSC of 90.38%, a VOE of 17.32% and a VD of 6.85%. Conclusion: The presence of median lobe enlargement may lead to MRI volume overestimation when using the ellipsoid formula so that a segmentation method is recommended. ENet volume estimation showed great accuracy in evaluation of prostate volume similar to that of manual segmentation.

Ingestion of caustic substances, whether accidental or for the purpose of suicide, can cause severe lesions of the lips, oral cavity, pharynx, upper gastrointestinal system, and upper airways. In particular, caustic agents could be responsible for severe esophageal injuries resulting in short- and long-term complications. Because of these important clinical implications, timely diagnosis and appropriate management are crucial. In the evaluation of esophageal injuries, thoraco-abdominal computed tomography (CT) is preferable to endoscopy as it avoids the risk of esophageal perforation and allows the evaluation of esophageal injuries as well as of the surrounding tissue. In this review, we report CT findings of esophageal injuries and possible related thoracic complications caused by caustic ingestion.

Behçet’s disease is a chronic and multisystemic inflammatory vascular disease of unknown etiology, affecting vessels of all kinds and sizes. The involvement of the vascular system is observed in approximately 5-30% of patients. The most frequent vascular manifestations are venous thrombosis followed by arterial aneurysms and arterial thrombosis. The identification of vascular involvement is very important for prognosis, indeed the rupture of an arterial aneurysm represents the leading cause of sudden death in patients with Behçet’s disease. Computed tomography (CT) plays a crucial role in the identification and in the follow-up of vascular involvement. In this paper, we report the case of a 42-year-old woman with Behçet’s disease, admitted to our emergency department for hemoptysis, showing pulmonary and visceral artery aneurysms identified at CT examination. A particular “string of beads” appearance of pulmonary arteries is described. We report, also, follow-up CT examination after medical therapy showing pulmonary artery aneurysms reduction and visceral artery aneurysms stability.

BACKGROUND: To evaluate if normal and pathological prostate tissue can be distinguished by using apparent diffusion coefficient (ADC) values on magnetic resonance imaging (MRI) and to understand if it is possible to differentiate among pathological prostate tissues using ADC values.METHODS:Our population consisted in 81 patients (mean age 65.4 years) in which 84 suspicious areas were identified. Regions of interest were placed over suspicious areas, detected on MRI, and over areas with normal appearance, and ADC values were recorded. Statistical differences between ADC values of suspicious and normal areas were evaluated. Histopathological diagnosis, obtained from targeted biopsy using MRI-US fusion biopsies in 39 patients and from prostatectomy in 42 patients, were correlated to ADC values.RESULTS: Histopathological diagnosis revealed 58 cases of prostate cancer (PCa), 19 patients with indolent PCa (Gleason Score ≤6) and 39 patients with clinically significant PCa (Gleason Score ≥7), 16 of high-grade prostatic intraepithelial neoplasia (HG-PIN) and 10 of atypical small acinar proliferation (ASAP). Significant statistical differences between mean ADC values of normal prostate tissue versus PCa (P

Congenital pulmonary airway malformations (CPAMs) are a heterogeneous group of congenital, non-hereditary lesions of the lung, cystic and non-cystic type with clear developmental anomalies and evident malformative changes, which derive from the excessive proliferation of the tubular bronchial structures. We described two rare cases of type IV CPAM detected in adult patients with different clinical presentation: one of these cases was symptomatic, complaining of cough and hemoptysis. Conversely, the other case was reported as incidental findings in patient with abdominal pain without respiratory symptoms. Chest computed tomography (CT) scan was performed showing voluminous cystic formations with fibrotic septa within the lesions in both patients. The patient with hemoptysis was subjected to video assisted thoracoscopic lobectomy, while the other one was hospitalized to perform biopsy, which confirmed the diagnosis of CPAM. All patients were advised to follow-up. The incidence of type IV CPAM in adult patients is probably underestimated; the knowledge of the CT features of CPAM is crucial for a correct diagnosis and an appropriate management of asymptomatic patients, which may be conservative.

The role of opioids for moderate pain (so-called "weak" opioids) in the second step of the World Health Organization's analgesic ladder has been investigated in a prospective randomized study. Sixteen patients were administered dextropropoxyphene (DPP) in a dosage ranging from 120 mg to 240 mg daily (group 1), and 16 patients were administered the lowest doses (20 mg daily) of commercially available controlled-release morphine (group 2). Equianalgesic doses of oral morphine, pain relief, and symptoms during the first 10 days of therapy and during the last 4 weeks before death were assessed. Three of 16 patients maintained DPP until death, whereas three patients in group 2 were switched to DPP due to the occurrence of intolerable side effects. Intensity and frequency of nausea and vomiting, drowsiness, and dry mouth were higher in group 2 than in group 1 during the initial treatment. These results stress the role of "weak" opioids during the induction of opioid therapy in opioid-naive cancer patients.

A survey of Italian physicians was conducted to assess knowledge, attitudes, and beliefs on cancer pain. Physicians attending a refresher course on cancer pain and symptom relief were given a questionnaire composed of 28 questions before starting the lectures. The physicians represented the different centers treating cancer pain, or were going to deal with cancer pain, and were from all the provinces of Sicily, a southern region of Italy. Insufficient knowledge and education of the physicians regarding the management of cancer pain was evidenced. Limited experience may be the principal reason. Most participants had difficulties in prescribing opioids (23%). Analgesics were frequently administered intramuscularly (46%), although the oral route was suggested by 86% of the physicians as the route of choice for opioids. Opioids were used in more than 75% of the patients by only 33% of the physicians. Opioid treatment was considered effective in more than 75% of the patients by only 63% of the physicians. An arbitrary maximum dose of opioids was reported by 35% of the respondents. Opioid spinal administration was mainly considered the most effective route, the first-choice route to start opioid therapy by 4% of the physicians, and the alternative route to the oral one in 29% of cases. Nausea and vomiting, and tolerance were considered the principal problem during opioid therapy. Antidepressants were the most common adjuvants associated with opioid therapy, and laxatives and antiemetics were frequently used to limit the side effects. Incident pain was rarely reported as a challenging pain syndrome. Examples of cancer pain syndromes were mainly reported correctly, although some definitions were disputable. Inadequate knowledge about cancer pain management limits appropriate treatment. Greater efforts should be made to improve medical education.

Analgesic response, incidental pain and pain mechanism were evaluated in order to predict the chances of pain relief in advanced cancer patients. In an observation period of about 2 months, 130 patients were followed at home until death using only a pharmacological approach to control pain according to the WHO ladders. Ninety-eight patients were considered. Pain relief was considered good if less than moderate. Pain was assessed during the course of examinations (2–3 a week) by independent observers. If other techniques were needed the result was considered negative. The patients were tested with an NSAID (Diclofenac) and assigned to group 1 if the pain became slight in 3 days. If the response was negative, a 4-day trial with opioids was started. If the pain was slight the patient was included in group 3, otherwise in group 5. Every patient belonging to these groups but with incidentical pain was included in groups 2, 4 and 6, respectively. For each group a subdivision was made according to the pain characteristics. There was a progressive worsening in pain relief in groups 4, 5 and 6, suggesting a good correlation between response to the drugs and future chances of pain control in a period of 2 months. This study demonstrates that incidental pain reduces the possibility of pain control (50%) with the exclusive administration of analgesics in patients with a mean life expectation of about 2 months. This negative influence is counterbalanced by the possible individual response to analgesics administered sequentially during a 1-week period (85.8% good pain relief with NSAID, 74% with opioids). Influence of the mechanism of the pain type was not evident. This simple method of cancer pain prognosis can be used at home and makes selection of patients in the least favorable groups to be sent to specialized centers possible.

Symptom relief is the major goal of palliative care. Its assessment is essential and several methods have been described. To evaluate immediately the clinical situation, a circular diagram for a visual representation of the physical symptoms is proposed. Particular patterns derived from the given data emerge from the diagrams. Certain critical situations often observed in palliative care, especially in the last weeks of life, show specific patterns that are easily distinguished. Effective treatments may change the appearance of different pictures.

Sixty consecutive lung cancer patients referred to a palliative care service were followed until death to obtain specific information about the prevalence, characteristics and localization of pain. To determine the course of treatment, an Opioid Escalation Index and Effective Analgesic Score were calculated. The prevalence of pain was almost 90%. Chest and lumbar pain were the most common sites with a clear correlation between site and metastases for the chest. Somatic incident pain did not achieve good pain relief while patients with neuropathic pain did not show any particular disadvantage compared to those exhibiting somatic or visceral pain. Mean Opioid Escalation Index and percentage of pain control observed in lung cancer patients were similar to those recorded in the general cancer population.

Home care is greatly expanding because of the savings it offers by avoiding unnecessary hospitalization and also because patients benefit from being in their own home environments. Since 1988, Societa Assistenza Malato Oncologico Terminale (SAMOT) has organized a pain relief and home palliative care unit for terminal cancer patients. Objectives, difficulties, protocols, and achievements of 4 years of experience were examined, and the findings of the various years were compared. Our results suggest that considerable progress has been made in home palliative care. There are still social and cultural difficulties to overcome, however.

The hydroxyl radical scavengers thiourea, ethanol, and dimethyl sulfoxide significantly reduced the killing of Escherichia coli elicited by low concentrations of H2O2 (resulting in mode 1 killing) when treatments with the oxidant and the scavengers were performed in a complete growth medium (K medium) but not in M9 salts. In addition, thiourea efficiently prevented the toxic response to high concentrations of H2O2 (resulting in mode 2 killing) under both exposure conditions. Sod A cells, which do not respond with a bimodal pattern of toxicity when challenged with increasing concentrations of H2O2, were markedly protected by thiourea against the lethal action of various levels of the oxidant (which in the wild-type strain result in either mode 1 or mode 2 killing) under conditions of treatments in both K medium and M9 salts. In some experiments, wild-type cells were challenged with a low concentration of H2O2 (in the absence or presence of hydroxyl radical scavengers) and then postincubated in fresh K medium for various time intervals. It was found that scavengers were able to inhibit the filamentous response generated by exposure to the oxidant in K medium. Both the length and the number of filaments were markedly reduced. Treatment in M9 salts resulted in a limited number of very short filaments, and this response was slightly reduced by the scavengers.