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Purpose To evaluate oncological outcomes of partial gland cryoablation (PGC) for localized prostate cancer (PCa) in a cohort of elderly patients who required an active treatment. Methods Data from 110 consecutive patients treated with PGC for localized PCa were collected. All patients underwent the same standardized follow-up with serum-PSA level and digital rectal examination. Prostate MRI and eventual re-biopsy were performed at twelve months after cryotherapy or in case of suspicion of recurrence. Biochemical recurrence was defined according to Phoenix criteria (PSA nadir + 2 ng/ml). Kaplan–Meier curves and Multivariable Cox Regression analyses were used to predict disease progression, biochemical recurrence- (BCS) and additional treatment-free survival (TFS). Results Median age was 75 years (IQR 70–79). PGC was performed in 54 (49.1%) patients with low-risk PCa, 42 (38.1%) with intermediate risk and 14 (12.8%) high risk. At a median follow-up of 36 months, we recorded a BCS and TFS of 75 and 81%, respectively. At 5 years, BCS was 68.5% and CRS 71.5%. High-risk prostate cancer was associated with lower TFS and BCS curves when compared with low-risk group (all p values p values Conclusions PGC could be a valid treatment for low- to intermediate PCa in elderly patients, when a curative approach is suitable in terms of life expectancy and quality of life.

Background: Colorectal cancer is one of the most common tumors for both men and women: in the United States, it represents the third leading cause of new cancer cases and cancer-related deaths. The prognosis is directly related to tumor infiltration in the mesorectum and lymph node metastases. In particular, it’s important to define the distance between lymphadenopathy and mesorectal fascia, as this has repercussions on surgical planning. This study aimed to evaluate the agreement among observers with different abdominal MRI expertise and intra-observer reliability in lymph nodes size and feature definition. Methods: In this retrospective study, MRI examinations were performed in 88 patients with rectal adenocarcinoma treated with primary surgery. Four observers, two senior physicians, and two junior physicians, analyzed MRI scans in two sessions 30 days apart and determined the size and morphological pattern of regional lymph nodes. Statistical analysis included the determination of Fleiss kappa (k) coefficient, Cohen's Kappa coefficient, and confidence intervals (CI). Results: The inter-observer reproducibility for MRI N-staging was good among the four physicians (kappa = 0.65; CI 0.45–0.77). Reproducibility between the two senior physicians had a kappa of 0.68 (CI 0.62–1.00), while between the two junior physicians had a kappa of 0.61 (CI 0.33–0.89). Inter-observer reproducibility was excellent for mesorectal, inferior mesenteric, and internal iliac lymph nodes (kappa values of 0.89, 0.82, and 0.80 respectively). For the other two nodal stations (superior and middle rectal lymph nodes, sacral lymph nodes), there was a good interobserver reproducibility (kappa between 0.70 and 0.77).The intra-observer reproducibility of interpretations of the MRI overall N staging progressively decreased among observer B (kappa= 0.85), observer C (kappa= 0.59), and the other two physicians. There was a significant difference in lymph nodes measurements between the first and second sessions in observer A (p ≥ 0.05). Excellent intraobserver reproducibility was found for mesorectal lymph nodes; the lowest intraobserver reproducibility values were found for presacral and lateral sacral lymph nodes.Conclusions: Although the low accuracy of MRI in assessing the involvement of metastatic lymph nodes in rectal cancer, this study demonstrates good interobserver reliability among physicians with different abdominal MRI experiences.

Simple Summary This study tested the feasibility and reliability of a novel digital microscopy technique in assessing ablation margins during partial prostate gland cryoablation. Though preliminary, findings suggest that this novel technique may increase the efficacy of focal treatments, by reducing the risk of untreated prostate cancer areas not visible to an MRI, as well as safety, by more precisely sparing uninvolved areas and surrounding structures. Abstract Partial gland cryoablation (PGC) aims at destroying prostate cancer (PCa) foci while sparing the unaffected prostate tissue and the functionally relevant structures around the prostate. Magnetic Resonance Imaging (MRI) has boosted PGC, but available evidence suggests that ablation margins may be positive due to MRI-invisible lesions. This study aimed at determining the potential role of intraoperative digital analysis of ablation margins (DAAM) by fluoresce confocal microscopy (FCM) of biopsy cores taken during prostate PGC. Ten patients with low to intermediate risk PCa scheduled for PGC were enrolled. After cryo-needles placement, 76 biopsy cores were taken from the ablation margins and stained by the urologist for FCM analysis. Digital images were sent for “real-time” pathology review. DAAM, always completed within the frame of PGC treatment (median time 25 min), pointed out PCa in 1/10 cores taken from 1 patient, thus prompting placement of another cryo-needle to treat this area. Standard HE evaluation confirmed 75 cores to be cancer-free while displayed a GG 4 PCa in 7% of the core positive at FCM. Our data point out that IDAAM is feasible and reliable, thus representing a potentially useful tool to reduce the risk of missing areas of PCa during PGC.

Introduction The aim of this article was to determine the impact of bioptic prostatic inflammation (PI) on the false positive rate of multiparametric magnetic resonance imaging (mp-MRI) in detecting clinically significant prostate ancer (csPCa). Material and methods Our prostate biopsy database was queried to identify patients who underwent mp-MRI before PB at our institution. A dedicated uropathologist prospectively assessed bioptic PI using the Irani scores. We evaluated the association between mp-MRI findings, bioptic Gleason grade (GG) and aggressiveness of PI, and PCa detection. Results In total, 366 men were included. In patients with Prostate Imaging Reporting and Data System (PIRADS) 4-5 lesions, the csPCa (GG ≥2) rate was significantly higher in those with low-grade than in those with high-grade PI (36% vs 29.7%; p = 0.002), and in those with low-aggressive than in those with high-aggressive PI (37.7% vs 30.1%; p = 0.0003). The false positive rates of PIRADS 4-5 lesions for any PCa were 34.2% and 57.8% for low- and high-grade PI, respectively (p = 0.002); similarly, they were 29.5% and 59.4% for mildly and highly-aggressive PI (p = 0.0003). Potential study limitations include its retrospective analysis and single-center study and lack of assessment of the type of PI. Conclusions Bioptic PI directly correlates with false positive rates of mp-MRI in detecting csPCa. Clinicians should be aware that PI remains the most common pitfall of mp-MRI.

Bezoars are masses formed by the concretion of stomach contents or debris within the gastrointestinal tract. Bezoars are rare and account for only 0.4–4% of all cases of gastrointestinal obstruction and mainly occur in the stomach or small intestine. Intestinal obstruction caused by colonic bezoars is extremely rare. A 39-year-old man with a transplanted kidney came to the hospital because of abdominal pain, constipation, and distension. We performed an abdominal computed tomography scan and found an ovoid intraluminal mass with a mottled gas pattern in the distal sigmoid colon. Subsequently, the patient underwent laparotomic surgery and removal of the bezoar. We report a rare case of large bowel obstruction due to colonic phytobezoar, which was confirmed intraoperatively.

Childhood ataxia with central nervous system hypomyelination (CACH) syndrome is an autosomal recessive transmitted leukodystrophy characterised by early childhood onset and acute deterioration following febrile illnesses or head trauma. We describe the case of a child with early onset of CACH syndrome. He presented with cerebellar ataxia beginning around two years of age with mild mental retardation. MRI showed diffuse white matter signal changes with thinning of the corpus callosum.

The purpose of the study was to assess the capability and the reliability of apparent diffusion coefficient (ADC) measurements in the evaluation of different benign renal abnormalities. Twenty-five healthy volunteers and 31 patients, divided into seven different groups (A-G) according to pathology, underwent diffusion-weighted magnetic resonance imaging (DW MRI) of the kidneys using 1.5-T system. DW images were obtained in the axial plane with a spin-echo echo planar imaging single-shot sequence with three b values (0, 300, and 600 s/mm²). Before acquisition of DW sequences, we performed in each patient a morphological study of the kidneys. ADC was 2.40±0.20×10⁻³ mm² s⁻¹ in volunteers. A significant difference was found between Groups A (cysts=3.39±0.51×10⁻³ mm² s⁻¹) and B (acute/chronic renal failure=1.38±0.40×10⁻³ mm² s⁻¹) and between Groups A and C (chronic pyelonephritis=1.53±0.21×10⁻³ mm² s⁻¹) (P.05). An important difference was also observed among Group D (hydronephrosis=4.82±0.35×10⁻³ mm² s⁻¹) and Groups A, B, and C (P.05), whereas no differences were found between Groups B and C (P.05). A considerable correlation between glomerular filtration rate and ADC was found (P=.04). In conclusion, significant differences were detected among different patient groups, and this suggests that ADC measurements can be useful in differentiating normal renal parenchyma from most commonly encountered nonmalignant renal lesions.

Bone bruises are focal abnormalities in subchondral bone marrow due to trabecular microfractures as a result of traumatic force. These trauma-induced lesions are better detected with magnetic resonance (MR) imaging using water-sensitive sequences. Moreover, the pattern of bone bruise is distinctive and allows us to understand the dynamics of trauma and to predict associated soft injuries. This article discusses the mechanism of traumatic injury and MR findings.

We evaluated the diagnostic accuracy of magnetic resonance enterography (MR-E) in assessing Crohn's disease (CD) activity by differentiating acute, chronic and remission stages of disease through a quantitative MR-E assessment.One hundred patients with a histological diagnosis of CD were studied with MR-E. Intestinal distension was obtained by oral administration of approximately 2 L of a polyethylene glycol solution (PEG). In all cases, the ileum and large bowel were imaged with morphological sequences (heavily T2-weighted single-shot, dual fast-field echo, balanced fast-field echo) and a postcontrast dynamic sequence (T1-weighted high-resolution isotropic volume excitation). Disease activity was assessed according to a multiparameter score (0-8) based on lesion morphology, signal intensity and contrast enhancement. MR-E findings were compared with clinical-laboratory data and disease activity indices [Crohn's Disease Activity Index (CDAI); Inflammatory Bowel Disease Questionnaire (IBDQ)]. Multiple regression analysis was performed by correlating MR-E score, CDAI and IBDQ. Frequencies were then compared using the χ (2) test.MR-E identified inactive disease in 9% of cases, chronic disease in 57% and active disease in the remaining 34%. The most frequently involved bowel segment was the terminal ileum (52%). A statistically significant correlation was found between MR-E score and CDAI (R=0.86; p0.001) and between MR-E score and IBDQ (R=-0.83; p0.001). The most suggestive parameter for disease activity was layered bowel-wall enhancement, a finding predominantly present in patients with increased CDAI (≥ 150) and/or local complications (χ (2)=7.13; p0.01).MR-E is a noninvasive and diagnostic imaging modality for CD study and follow-up. The MR-E score proposed in this study proved to be useful in assessing disease severity and monitoring response to treatment.

We evaluated with magnetic resonance imaging (MRI) the degradation and osteointegration features of a new type of bioabsorbable interference (BioRCI) screw composed of poly-L-lactic acid and hydroxyapatite (PLLA-HA) used for tibial graft fixation in anterior cruciate ligament (ACL) reconstruction. Thirty-one patients underwent arthroscopic surgery for ACL reconstruction using doubled gracilis and semitendinosus tendons fixed to the tibial tunnel with PLLA-HA (BioRCI-HA) screws. Two groups of patients were evaluated, one group 10–13 months after surgery and the other after 30–40 months. The standard knee ligament evaluation form of the International Knee Documentation Committee (IKDC) was used for clinical assessment and MRI for the radiological assessment. MRI after 10–13 months revealed findings referable to healing and integration of the bone-graft-screw system, findings that disappeared at later follow-up examinations. The BioRCI-HA screw remained constantly visible in all patients, although with changes in signal intensity over time. BioRCI-HA screws allow adequate primary stability and superior osteoconduction and biocompatibility in comparison with plain PLLA screws. The absence of ferromagnetic artefacts allows accurate MRI follow-up and adequate evaluation of ligament synovialisation, screw degradation and graft osteointegration.

The Authors report their experience with the surgical treatment of incisional hernias over the period from July 2000 to June 2004 in the Division of General Surgery of the Department of Surgical Sciences of the University of Foggia where 22 patients were operated on. Nine of them had an incisional hernia of considerable size, while in the other 13 patients the hernia was less voluminous. The authors emphasise the essential role of synthetic prostheses (polypropylene) which now replace and supersede the reabsorbable ones which have fallen into disuse due to the lack of guarantees regarding their strength over lengthy periods. An interdisciplinary approach is now mandatory for a pathology which requires the contribution of many different healthcare operatives such as cardiologists, respiratory physiopathologists, physiokinesitherapists, endocrinologists and resuscitators who all share in the work of the surgeon who represents the last link in the chain and has the technical task of resolving the basic pathology. The technique adopted for the larger incisional hernias was a Ramirez abdominoplasty, the first step of which consists in a very meticulous separation of the different structures of the abdominal wall followed by synthesis of the different anatomical layers with the application of polypropylene meshes. Our results in terms of intra- and postoperative mortality, complicating diseases and hospitalisation are compared with those reported in other studies using the Rives technique.

The aim of this study was to compare the performance of double-contrast magnetic resonance imaging (DC-MRI) with the sequential use of superparamagnetic iron oxide (SPIO) and gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA) contrast agents compared with unenhanced MRI and SPIOenhanced MRI (SPIO-MRI) in the study of the cirrhotic liver. Special attention was paid to cases in which alterations of liver uptake and distribution of the SPIO contrast medium [SPIO-liver uptake and distribution alterations (SPIO-LUDA)] could lead to diagnostic errors at SPIO-MRI. We used DC-MRI to study 67 patients suffering from hepatic cirrhosis and on a waiting list for liver transplant. The study was performed with a 1.5-Tesla device and characterised by three phases: the first phase without contrast material (unenhanced MRI), the second after the administration of ferumoxides (SPIO-MRI), and the third, a double-contrast study following the injection of a bolus of paramagnetic contrast material (DC-MRI). The sensitivity of unenhanced MRI, SPIOMRI and DC-MRI in identifying and characterising hepatic focal lesions was assessed, together with the diagnostic increment of one technique with respect to the others. The gold standard was histological confirmation in 38 cases and clinical–radiological follow-up in all cases. Liver function, kidney function, blood tests and urinalysis were performed in all patients 24–48 h before and after the MRI examination. In 14/67 cases (20.8%), SPIO-LUDA were present, which posed a limitation to the SPIO-MRI examination. Focal lesions were absent in 44 patients, and the action of the ferumoxides was reduced by the presence of SPIO-LUDA in nine cases. There were five cases of confluent fibrosis, two of decompensated cirrhosis, one of vascular thrombosis, and one of scarring in a patient who had undergone hepatic resection for hepatocellular carcinoma (HCC). In all these cases, completion of the MR examination with the DC technique clarified the MR picture, confirming the absence of focal lesions. Twenty-three patients had a total of 68 lesions, which consisted of 37 dysplastic nodules (DN), 19 HCC nodules, two relapses of HCC following chemoembolisation, two HCC associated with portal thrombosis, one cancer-cirrhosis, two angiomas and five small cysts. SPIO-LUDA were present in five patients, thus limiting the identification, characterisation or assessment of the real size of the lesions. SPIO-LUDA were the result of vascular thrombosis in one case and fibrosis in four cases. In all of these cases, DC-MRI proved useful for diagnosis. The sensitivity of unenhanced MRI, SPIO-MRI and DC-MRI for lesion detection was 57.3%, 67.6% and 75%, respectively. The results obtained in the characterisation of the lesions were 20.5%, 63.2% and 73.5% for unenhanced MRI, SPIO-MRI and DC-MRI, respectively. The diagnostic increment of SPIO-MRI over unenhanced MRI for lesion identification and characterisation was 9% and 42.7%, respectively, whereas the diagnostic increment of DC-MRI over SPIO-MRI was 7.4% and 10.3%, respectively. In our study, the combined use of two contrast agents, negative and positive, provided greater diagnostic confidence and caused no side effects in the patients.

The Authors report their personal experience with 9 patients affected by cardial cancer and 4 with medio-distal oesophageal cancer, treated at the Department of Surgical Sciences of the University of Foggia. Of the 9 patients with cardial cancers, 4 were submitted to total gastrectomy; while the other 5, who had clearly inoperable forms, were fitted with a self-expanding metal prosthesis (Ultraflex). Of the 4 cases with medio-distal oesophageal cancers, which were considered beyond any kind of surgical treatment, 2 (with stenosing forms) were fitted with the self-expanding prosthesis (Ultraflex), while the other 2 (with friable, bleeding tissue) were treated by laser therapy with all the drawbacks such treatment entails. After application of stents, dysphagia decreases and on the whole we obtain real functional success and a better quality of life. Furthermore, the percentage of acute complications such as profuse bleeding, perforation of the pharynx or migration of the prosthesis and late complications such as obstruction by food, neoplastic obstruction, or haemorrhage is marginal. Finally, the ease of application and the economic saving achieved (due to reduction in hospitalisation time and charges) confer undeniable additional advantages on the procedure.

Peripheral blood lymphocytes from a sample of 62 randomly selected donors were analysed for spontaneous and diepoxybutane (DEB)-induced chromosomal aberrations (CA). These individuals were part of a larger sample of 122 subjects whose DEB responsiveness was evaluated by means of sister chromatid exchange (SCE) analysis. Confounding factors (such as smoking, wine and coffee consumption, occupation and haematological factors) were analysed for their effect on individual DEB-responsiveness, but no statistically significant associations were observed. Interestingly, a bimodal distribution of aberrant cell frequencies was clearly detectable, showing the existence of DEB-sensitive subjects belonging to the second mode (CA frequencies > 19%). When responsiveness evaluated by means of CA induction was compared with SCE responsiveness, it was noted that all SCE-inducible subjects (> 110.9 SCEs/cell) belonged to the second mode of CA frequency distribution. On the other hand, highly CA inducible individuals did not necessarily show a higher SCE-response, although their DEB-induced SCE frequencies were above average (92 SCEs/cell). DEB-induced CA frequency correlated with baseline levels, indicating that DEB-sensitive individuals also showed higher spontaneous chromosome damage (3.6 versus DEB-resistant 2%, P < 0.05). Finally, when simple and multiple regression analyses were carried out, DEB-sensitivity appeared negatively related to haematic concentrations of proteins and uric acid (intercept 0.131 +/- 0.011, slope -0.029 +/- 0.0116, r = -0.39; P < 0.01), probably due to its antioxidant activity. This finding confirmed previous observations on the scavenger activity of plasma factors on DEB mutagenicity.

Baseline frequencies of chromosome aberrations (CAs) were assessed in three samples of healthy individuals, 60 living in a rural area (Po Delta), 134 in Pisa downtown and 116 in Cascina, a small town near Pisa, Italy. The three groups were similar for average age, sex ratio, smoking, drinking habit, and occupation. Multifactor ANOVA showed that CA frequencies increased significantly with age (p < 0.0001 excluding and including gaps), and with smoking habit (p = 0.0045 including gaps; p = 0.04 excluding gaps). Gender, drinking habit and occupation exerted no statistically significant effects. Multifactor ANOVA showed also a significant effect of the site of residence on the frequency of the CA, including gaps (p = 0.0003) and excluding gaps (p = 0.03). The CA frequency of the Pisa samples was statistically significantly higher than that of the Po Delta samples. Air pollution was considered to be a possible factor in determining the observed differences among the sites of residence, as levels of air pollutants (SO2 and TSP, total suspended articles) were more elevated in Pisa and Cascina than in the Po Delta. In addition, respiratory symptoms used as indirect indicators of air pollution at individual level were significantly more frequent in the Pisa population than in Cascina or in the Po Delta. These findings might support the hypothesis that air-pollution levels, even within E.E.C. (European Economic Community) air-quality standards, may influence baseline CA frequencies.