Can DW-MRI, with its ADC values, be a reliable predictor of biopsy outcome in patients with suspected prostate cancer?

PURPOSE: To relate the multiparametric magnetic resonance imaging (mp-MRI) of patients with suspect peripheral prostate cancer (PCa) to the results of the subsequent biopsy: in particular to explore whether DWI and ADC can predict the biopsy outcome and to investigate the relation between ADC and Gleason score (GS). MATERIALS AND METHODS: 175 consecutive patients who underwent 1.5 T mp-MRI followed by prostate biopsy were retrospectively analyzed by two independent radiologists. ADC values were measured in the peripheral suspect lesion areas (ADCSL) and in the contralateral zones (ADCNSL) obtaining ADCnorm = ADCSL/ADCNSL. Results on T2W images, DWI, ADC values, and perfusion studies were matched to their corresponding biopsy. RESULTS: Negative DWI and T2W had 100% negative predictive value (NPV). When DWI was positive, ADCSL > 0.90 × 10 > 0.90 × 10(-3) mm(2)/s (ADCnorm > 0.60) identified by the ROC curve (AUC = 0.80) corresponded to NPV = 85%. In positive biopsies, ADCSL and ADCnorm decreased significantly from GS = 6 to GS ≥ 8 with Spearman coefficient ρ = -0.40 and ROC curve AUC = 0.72. CONCLUSION: mp-MRI allows a reliable prediction of a negative biopsy through the values of DWI, T2W, and ADC. In positive biopsies, there is a moderate correlation between ADC and the various GS levels.

Further evidence against the implication of active cytomegalovirus infection in vascular atherosclerotic diseases.

The possible contribution of cytomegalovirus (CMV) to pathogenetic events associated with atherosclerotic lesion establishment and progression is still controversial. We evaluated the possibility that active ongoing CMV infection could be correlated to evolution of unstable atheromatous lesion, by analyzing patients suffering from unstable angina (n=61), acute myocardial infarction (n=43), stable angina (n=26) and peripheral arteriopathy (n=22) as compared to healthy subjects (n=30). Particularly, we assessed: past exposure to CMV by evaluating anti-CMV IgG antibodies; ongoing CMV infection by evaluating anti-CMV IgM antibodies and circulating interleukin (IL)-8 in serum; and CMV DNAemia in peripheral blood mononuclear cells (PBMC). Mean IgG values were significantly increased in patients from all groups, as compared to healthy subjects. CMV-specific IgM, as well as CMV DNAemia, were undetectable in both controls and patients. Circulating IL-8, significantly elevated in a group of individuals experiencing active CMV infection, was not significantly higher in cardiovascular disease patients, as compared to control subjects. These findings confirm previous evidence from the increased exposure to CMV infection in patients with atheromatous lesions. However, they provide further evidence against a direct implication of active systemic CMV infection in the pathogenesis of cardiovascular diseases, particularly those involving plaque instability.

Ischemic colitis with chronic stenotic evolution.

The authors describes a case of ischemic chronic stenosis of colon after aneurysmectomy. They consider eziopatogenesis, clinical aspects and differential diagnosis with other causes of large bowel stenosis. They illustrate on therapeutic sequence after examination of recent literature.

[Endoscopic surgery of chronic venous insufficiency (CVI)]. / La chirurgia endoscopica nell'insufficienza venosa cronica (IVC): risultati preliminari.

The endoscopic technique in chronic venous insufficiency is simple and almost complication free. Our preliminary results due to a good postoperative course and to a quick return to social activity induce the Authors to indicate this type of procedure as the best treatment in chronic venous insufficiency.

[Abdominal vascular and colonic pathology: the timing of combined treatment]. / Patologia vascolare addominale e colica: timing del trattamento combinato.

The authors report their experience with the combined treatment of concomitant vascular and colic pathology. After a wide review of the literature, the different surgical approaches to reduce the risks of mortality, morbidity and bacterial contamination of the vascular prosthesis are discussed.

[Abdominal vascular and biliary pathology: timing of the combined treatment]. / Patologia vascolare addominale e biliare: timing del trattamento combinato.

The Authors, after an accurate review of the Literature, report their experience in the combined management of aorto-iliac and biliary lesions. Surgical priorities are well specified in order to reduce the possibility of bacterial contamination of the vascular prosthesis.

[The Trabucco tension-free hernioplasty: our experience and technical considerations]. / L'ernioplastica "tension free" secondo Trabucco: nostra esperienza e considerazioni tecniche.

The Authors report their experience in the management of 30 patients undergone tension free hernioplasty according to Trabucco for inguinal hernia. Results and some modifications of the original technique are discussed.

[Peroperative endoscopic papillotomy in a patient with an abdominal aortic aneurysm and biliary calculi]. / Papillotomia endoscopica peroperatoria in paziente con aneurisma dell'aorta addominale e calcolosi biliare.

The authors report a case of abdominal aortic aneurysm associated with biliary tract lithiasis. The need to simultaneously treat both diseases is stressed. A technique which involves endoscopy during open surgery in order to prevent contamination is illustrated. The technique used together with other manoeuvres is part of a methodology aiming to broaden indications to the treatment of abdominal diseases associated with vascular diseases, limiting at the same time the risks of prosthetic infection.

[Infection of the vascular prosthesis. The diagnostic, preventive and treatment protocols: preliminary results]. / L'infezione di protesi vascolare. Protocollo diagnostico, di prevenzione e di trattamento: risultati preliminari.

A number of strategies for the management of vascular graft infections are described in literature. Nevertheless, this serious compliance is still burdened with high rates of morbidity and mortality. At the present the principal efforts are therefore directed towards prevention and early diagnosis. In this view, the authors propose their protocol of study, on the basis of the encouraging results till now obtained.

[Posttraumatic pseudoaneurysms of the anterior tibial artery: a review of the literature and a clinical case report]. / Pseudoaneurismi post-traumatici dell'arteria tibiale anteriore: revisione della letteratura e presentazione di un caso clinico.

The authors after a review of the literature report a case of anterior tibial artery false aneurysm in a seventeen year old male, due to traumatic sprained ankle during a basketball match. Surgical techniques used in repairing the lesion as well as microsurgical technique for the direct suture of the artery, which allowed to resolve the problem, are discussed.

[Juvenile vascular pathology due to homocystinuria. A clinical case report]. / Patologia vascolare giovanile da omocistinuria. Presentazione di un caso clinico.

The authors report a case of juvenile vasculopathy in a homocystinuria patient. They point out that thromboembolism may be the only symptomatic expression of this genetically determined metabolic disease. Diagnostic approach and surgical therapy of the vascular lesions as well as medical therapy to prevent further complications are analysed. The opportunity to perform clinical tests for the diagnosis of homocystinuria in all those young patients presenting vascular lesions without other risk factors is finally stressed.

Fasciola hepatica: host responders and nonresponders to parasite glutathione S-transferase.

Fasciola hepatica glutathione S-transferase (FhGST) was isolated from adult worms by glutathione agarose affinity chromatography. SDS-PAGE shows three proteins of M(r) ranging from 29-27.8 kDa. Western immunoblot analyses using SDS-PAGE separated adult worm extracts and probed with a rabbit anti-FhGST antiserum reveal two bands in the same M(r) range. Mice and rabbits immunized with purified FhGST develop copious amounts of anti-FhGST antibodies. Moreover, antisera to F. hepatica adult worms and excretion-secretion products also react with FhGST. Cross-reactivity with schistosomes is evidenced in the reactivity with FhGST of anti-Schistosoma mansoni adult worm antisera and, to a lesser extent, antisera to S. mansoni-soluble egg antigens. The time of appearance of anti-FhGST antibodies in different species of animals infected with F. hepatica was determined. Sheep and a New Zealand white rabbit developed anti-FhGST antibodies detectable by ELISA as early as 2 weeks postexposure with F. hepatica. However, neither mice nor calves infected with F. hepatica developed antibodies to FhGST through the 5-10 weeks of infection tested. But mice infected with S. mansoni developed anti-FhGST cross-reacting antibodies by 6 weeks of infection. Calves immunized with a Fasciola/Schistosoma cross-reactive, cross-protective antigen complex in which a 12,000-kDa protein (Fh12) has been shown to contain immunoprophylactic activity, also developed antibodies to FhGST. Since FhGST is a novel potential vaccine, its protection-inducing capability in a multivalent vaccine combined with Fh12 clearly warrants study. In summary, it appears that hosts with fascioliasis are either responders to FhGST (rabbits, sheep) or nonresponders (mice, cattle), offering interesting models for studying the immune response.

[Problems related to resuscitation in studies with contrast media]. / Problematiche di interesse rianimatorio nelle indagini contrastografiche.

This study has the purpose of describing indications and legal implications related to the intravascular use of contrast media (ICM) in order to provide useful guidelines to the intensivist, often involved in the treatment of adverse reactions. The structure of modern contrast media (CM), is a benzenic ring carrying steadily three iodine ions. Adverse reactions due to the use of ICM, are local or systemic ranging from skin rashes or flushes (urticaria et al.), to cardiovascular, respiratory and neurologic symptoms. The prevention of these reactions is mandatory in patients reporting a history of allergy or atopia disease. From a legal point of view, the contraindication to procedures involving i.v. use of CM are not clearly pointed out therefore several concerns have been expressed. The intensivist is not required to physically attend the procedure, in agreement with the circular #64 edited in 1979; on the other hand his prompt intervention should be granted if necessary. Furthermore every therapeutic supply suitable for any resuscitational intervention should be available in the area where the test is performed. In conclusion we would like to stress the financial and ethic implications related to the choice of ICM (ionic versus non-ionic). The use of non-ionic CM offers several advantages: among them the better tolerance for the patient and the lower incidence of adverse reactions. However non-ionic CM have a cost ten-fold higher and both groups of drugs have same incidence of fatal reactions, therefore the use of non-ionic ICM is recommended for high risk patients.

[Revascularization of distal arteries of the leg: critical considerations on more than 2000 cases reported in the literature]. / Le rivascolarizzazioni delle arterie distali della gamba: considerazioni critiche su oltre 2000 casi raccolti in letteratura.

The Authors review the results of more than 2000 cases of lower extremity revascularization, treated from 1969 to 1991 and reported in the literature. They evaluate indications, contraindications and results at 12 and 24 months from operation performed with saphenous vein "in situ" and reversed. Finally they stress the greater reliability of by-passes performed with "in situ" saphenous vein graft.

[Formation of calculi on a double J catheter]. / Formazione di calcoli su catetere a doppio J.

A case of lithiasis due to indwelling double J ureteral stent is described. Pathogenesis and possibilities of prevention are discussed.

[Adjuvant chemotherapy in carcinoma of the bladder: current results and prospects]. / La chemioterapia adiuvante nel carcinoma della vescica: risultati attuali e prospettive.

Adjuvant chemotherapy is one of the latest and more promising modality of cancer treatment within the multidisciplinary approach to neoplasms. This paper illustrates the biological rationale as well as preliminary evaluation of its effectiveness for bladder carcinoma.