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High-grade well-differentiated neuroendocrine tumour tumours (NETs) of gastrointestinal tract are rare; they can arise in any part of the digestive system and usually present in advanced stages. Low incidence and wide heterogeneity in the biological behaviour of such lesions pose a diagnostic and therapeutic challenge. Loco-regional NETs should be resected whenever feasible, potentially with a curative intent. Management of a metastatic disease is often more complex, primarily aimed at the alleviation of symptoms, prevention of further complications, and prolongation of survival. Current literature describing the optimal treatment plan for such patients is sparse and further studies are necessary to enhance our understanding of the disease. Here we present a case of high-grade well-differentiated cecal NET with an associated carcinoid syndrome that was diagnosed following the incisional hernia repair.

Vascular calcification (VC) is linked to post-transplant cardiovascular events and hypercalcemia which may influence kidney graft function in the long term. We aimed to evaluate whether pretransplant aortic arch calcification (AoAC) can predict post-transplant cardiovascular or cerebrovascular events (CVEs), and to assess its association with post-transplant plasma calcium levels and renal function in one-year follow-up. Our single-center observational prospective study enrolled 37 kidney transplant recipients (KTR) without previous history of vascular events. Two radiologists evaluated pretransplant AoAC on chest X-ray as suggested by Ogawa et al. in 2009. Cohen’s kappa coefficient was 0.71. The mismatching results were repeatedly reviewed and resulted in consensus. Carotid-femoral (cfPWV) and carotid-radial pulse wave velocity (crPWV) was measured using applanation tonometry before and one year after transplantation. Patient clinical, biochemical data, and cardiovascular/CVE rate were monitored within 1 year. We found out that eGFR1year correlated with eGFRdischarge and calcium based on hospital discharge data (β = 0.563, p = .004 and β = 51.360, p = .026, respectively). Multivariate linear regression revealed that donor age, donor gender, and recipient eGFRdischarge (R-squared 0.65, p = .002) better predict eGFR1year than AoAC combined with recipient eGFRdischarge (R-squared 0.35, p = .006). During 1-year follow-up, four (10.81%) patients experienced cardiovascular events, which were predicted by PWV ratio (HR 7.549, p = .045), but not related to AoAC score (HR 1.044, p = .158). In conclusion, KTR without previous vascular events have quite low cardiovascular/CVE rate within 1-year follow-up. VC evaluated as AoAC on pretransplant chest X-ray together with recipient eGFRdischarge could be related to kidney function in one-year follow-up.

Background and objectives: Overdiagnosis, overtreatment, and the need for repeated procedures caused by transrectal ultrasound guided prostate biopsies and their related complications places a heavy burden on healthcare systems. This was a prospective cohort validating study to access the clinical accuracy of systematic and MRI-cognitive targeted transperineal prostate biopsies in detecting clinically significant prostate cancer after a previous negative biopsy and persistent suspicion of malignancy. The primary goal was to assess the ability of multiparametric magnetic resonance imaging (mpMRI) to detect clinically significant prostate cancer with an additional goal to assess the diagnostic value of systematic and MRI-cognitive transperineal biopsies. Materials and Methods: In total, 200 patients were enrolled who had rising serum prostate specific antigen (PSA) levels for at least 4 months after a previous negative transrectal ultrasound (TRUS) biopsy. All eligible men underwent 1.5T prostate mpMRI, reported using the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2), followed by a 20-region transperineal prostate systematic biopsy and additional targeted biopsies. Results: Systematic 20-core transperineal prostate biopsies (TPBs) were performed for 38 (19%) patients. Systemic 20-core TPB with additional cognitive targeted biopsies were performed for 162 (81%) patients. Clinically significant prostate cancer (csPC) was detected for 31 (15.5%) patients, of which 20 (64.5%) cases of csPC were detected by systematic biopsy, eight (25.8%) cases were detected by targeted biopsy, and three (9.7%) both by systematic and targeted biopsies. Conclusions: Cognitive mpMRI guided transperineal target biopsies increase the detection rate of clinically significant prostate cancer after a previously negative biopsy. However, in a repeat prostate biopsy setting, we recommend applying a cognitive targeted biopsy with the addition of a systematic biopsy.

Vascular calcification (VC) is linked to post-transplant cardiovascular events in the long term. We aimed to evaluate whether pretransplant chest X-ray based aortic arch calcification (AoAC) or pulse wave velocity measurement can better predict post- transplant cardiovascular or cerebrovascular events, and to assess the progression of calcification within 2 years. Methods: Our single-center observational longitudinal study enrolled 40 kidney transplant recipients (KTR) without previous history of vascular events (no cardiovascular, cerebrovascular events, no peripheral artery disease). Two radiologists evaluated pretransplant and postransplant (after 2 years) AoAC on chest X-ray by using two different AoAC scales: AoAC grade evaluation [1] and AoAC score as suggested by Ogawa et al. in 2009 [2]. Cohen’s kappa coefficient was 0.75. The mismatching results were repeatedly reviewed and resulted in consensus. Carotid-femoral (cfPWV) and carotid-radial pulse wave velocity (crPWV) was measured using applanation tonometry and the PWV ratio (cfPWV/rPWV) was calculated. Patient clinical, biochemical data and cardiovascular/cerebrovascular event rate were monitored within 2 years. Results: During 2-year follow-up 5 patients experienced cardiovascular events, which were predicted by PWV ratio, but not related to AoAC. In 3 patients, we observed progression of AoAC, in others – AoAC was less evident or remained unchanged in 2-years follow-up. AoAC score [2] could better describe the extent of vascular calcification in KTR. Conclusions: KTR without previous vascular events have quite low cardiovascular/ cerebrovascular event rate within 2-year follow-up, which are better predicted by pretransplant PWV ratio. AoAC postransplant regression is evident even when using simplified chest X- ray scales.