Correlation of the Geriatric Assessment with Overall Survival in Older Patients with Cancer.

AIMS: Global guidelines recommend that all older patients with cancer receiving chemotherapy should undergo a geriatric assessment. However, utilisation of the geriatric assessment is often constrained by its time-intensive nature, which limits its adoption in settings with limited resources and high demand. There is a lack of evidence correlating the results of the geriatric assessment with survival from the Indian subcontinent. Therefore, the aims of the present study were to assess the impact of the geriatric assessment on survival in older Indian patients with cancer and to identify the factors associated with survival in these older patients. MATERIALS AND METHODS: This was an observational study, conducted in the geriatric oncology clinic of the Tata Memorial Hospital (Mumbai, India). Patients aged 60 years and older with cancer who underwent a geriatric assessment were enrolled. We assessed the non-oncological geriatric domains of function and falls, nutrition, comorbidities, cognition, psychology, social support and medications. Patients exhibiting impairment in two or more domains were classified as frail. RESULTS: Between June 2018 and January 2022, we enrolled 897 patients. The median age was 69 (interquartile range 65-73) years. The common malignancies were lung (40.5%), oesophagus (31.9%) and genitourinary (12.1%); 54.6% had metastatic disease. Based on the results of the geriatric assessment, 767 (85.4%) patients were frail. The estimated median overall survival in fit patients was 24.3 (95% confidence interval 18.2-not reached) months, compared with 11.2 (10.1-12.8) months in frail patients (hazard ratio 0.54; 95% confidence interval 0.41-0.72, P < 0.001). This difference in overall survival remained significant after adjusting for age, sex, primary tumour and metastatic status (hazard ratio 0.56; 95% confidence interval 0.41-0.74, P < 0.001). In the patients with a performance status of 0 or 1 (n = 454), 365 (80.4%) were frail; the median overall survival in the performance status 0-1 group was 33.0 months (95% confidence interval 24.31-not reached) in the fit group versus 14.4 months (95% confidence interval 12.25-18.73) in the frail patients (hazard ratio 0.50; 95% confidence interval 0.34-0.74, P = 0.001). In the multivariate analysis, the geriatric assessment domains that were predictive of survival were function (hazard ratio 0.68; 95% confidence interval 0.52-0.88; P = 0.003), nutrition (hazard ratio 0.64; 95% confidence interval 0.48-0.85, P = 0.002) and cognition (hazard ratio 0.67; 95% confidence interval 0.49-0.91, P = 0.011). DISCUSSION: The geriatric assessment is a powerful prognostic tool for survival among older Indian patients with cancer. The geriatric assessment is prognostic even in the cohort of patients thought to be the fittest, i.e. performance status 0 and 1. Our study re-emphasises the critical importance of the geriatric assessment in all older patients planned for cancer-directed therapy.

Comparative Study of Cytology and Histopathology of Cervical Lesion in VIA Positive Patients and Its Correlation with High Risk Human Papilloma Virus.

Cervical cancer is the second most frequent type of cancer and leading cause of mortality among women worldwide. The present study was undertaken to assess precancerous and cancerous cervical lesion by cytology as well as HPV DNA identification and their comparison with histopathology in VIA positive cases. This descriptive, cross-sectional type of observational study was carried out in the Department of Pathology, Mymensingh Medical College in collaboration with the Department of Gynecology and Obstetrics, Mymensingh Medical College Hospital and Department of Microbiology and Hygiene in Bangladesh Agriculture University for HPV DNA detection from July 2012 to June 2013. Study was carried out among 160 VIA positive patients and selected by non-random judgment sampling from the colposcopy clinic. Out of 160 cases, only 40(25.00%) were found HPV DNA positive, while the rest 120(75.00%) cases were negative. Among positive cases 77.50% were cancerous cases and 22.50% were precancerous cases. It was further revealed that in cancerous cases, 86.11% were HPV DNA positive. PCR showed low sensitivity, probably due to sampling error and inclusion of all cases (chronic cervicitis, precancerous and cancerous lesion). The statistical value of accuracy, sensitivity and specificity of Pap smear cytology, HPV DNA test and histopathology yielded some important directives. The sensitivity values of Pap smear cytology and HPV DNA were found 87.50% and 88.89% respectively. Thus Pap smear test showed almost equal sensitivity to DNA test. The accuracy of the Pap smears and HPV DNA in this study was 88.13% and 96.88% respectively. The accuracy of Pap smears is lower than HPV DNA tests. The present study show significant relationship between cytological with HPV DNA test and histopathological diagnosis. But cytology and HPV DNA testing are not suitable as a single test. In conclusion, it can be stated that combination cytology (Pap smear), histopathology and new technologies such as HPV DNA typing would ultimately be more useful.

A Retrospective Histopathological Study on Extra-pulmonary Tuberculosis in Mymensingh.

Tuberculosis is a very common disease in our country. This retrospective histopathological study was designed to assess the distribution of extra-pulmonary tuberculosis (EPTB) in various organs through examination of biopsy specimens. A total of 216 specimens were diagnosed as tubercular lesion by histopathological evaluation in the Department of pathology, Community Based Medical College and a private laboratory during the period from January 2014 to December 2014. Mean age of the case was 32 years. Majority of the cases were female (126 out of 216). Lymph nodes were the most common site of EPTB (62.96%) followed by skin and subcutaneous tissue (17.59%), intestine (11.11%), breast (2.77%), female genital tract (2.31%), male genital tract (1.38%), bone and joint (1.85%). Out of 136 cases of tubercular lymphadenitis, 96(70.58%) were cervical, 18(13.23%) were axillary, 12(3.82%) were mesenteric and 10(7.35%) were inguinal. This study reveals, in our locality, EPTB is very common in adulthood with female preponderance. Cervical lymph node is very common sites for EPTB.

[Atypical and rare cardiac revelation about Sheehan's syndrome: A report of three cases]. / Révélations cardiaques atypiques rares du syndrome de Sheehan : à propos de trois cas.

Sheehan syndrome is a potentially serious complication in the postpartum period corresponding to ischemic necrosis of the anterior pituitary related to postpartum haemorrhage. We report three original observations showing an unusual mode of revelation of this syndrome. The first observation is that of a 46-year-old patient admitted initially to resuscitation for a recovered cardiorespiratory arrest, severe hypoglycemia and profound hyponatremia. The second is that of a 45-year-old patient, admitted for recurrent cardiac tamponade after pericardial and pleural puncture and pericardial drainage; clinical survey found signs of slight panhypopituitarism. The latest case is that of a patient of 44 years, admitted to pericardial effusion average abundance revealed by dyspnea and tachypnea with hypotension. The interrogation of all patients revealed the concept of an old hemorrhagic syndrome, absence of lactation and secondary amenorrhea thereafter. Laboratory tests showed insufficient thyroid-stimulating, low cortisol, a hypogonadism hypogonadism. The pituitary magnetic resonance imaging showed an empty sella in the three cases. Patients were placed under replacement therapy with L-thyroxine and hydrocortisone with good clinical, biological and echocardiographic evolution. The three cases illustrate a rare heart atypical presentation for Sheehan's syndrome and underline the importance of early diagnosis and suitable replacement therapy of this syndrome to avoid this complication that can be life threatening.

Unenhanced whole-body MRI versus PET-CT for the detection of prostate cancer metastases after primary treatment.

OBJECTIVE: The aim of this study was to evaluate the accuracy of unenhanced whole-body MRI, including whole-body Diffusion Weighted Imaging (DWI), used as a diagnostic modality to detect  pathologic lymph nodes and skeletal metastases in patients with prostate cancer (PCa) undergoing restaging after primary treatment. PATIENTS AND METHODS: 152 male patients with biochemical recurrence after radical prostatectomy (RP) or external beam radiation therapy (EBRT) underwent MRI at a 1.5 Tesla magnet with whole spinal sagittal T2-weighted, sagittal T1-weighted, sagittal STIR images, axial T1 and T2-weighted and STIR images of the pelvis and whole-body. 18Fcholine-PET/CT exam was used as the reference standard. RESULTS: MRI protocol including whole-body combined T1-weighted+T2-weighted+STIR+DWI showed a sensitivity (Se) of 99%, a specificity (Spe) of 98%, a positive predictive value (PPV) of 98%, a negative predictive value (NPV) of 96%, an accuracy of 98% and an area under the receiver operating characteristic curve (AUC) of 0.971 for identification of bone metastatic lesion. The same protocol, displayed a Se of 98%, a Spe of 99%, a PPV of 97%, a NPV of 98%, an accuracy of 98 % and an AUC of 0.960 in the detection of pathologic lymph nodes. CONCLUSIONS: Unenhanced whole-body MRI, including whole-body-DWI, is an accurate and cost-effective diagnostic tool which is able to detect lymph node involvement and bone metastases in patients with biochemically recurrent PCa after RP or EBRT. Thanks to its lack of ionizing radiation, excellent soft tissue contrast, high spatial resolution, no need of contrast agent, high Se and Spe, it could play a role in the restaging procedure of such patients.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1000 patients with perforated appendiceal epithelial tumours.

PURPOSE: To report early and long term outcomes following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in 1000 patients with perforated appendiceal epithelial tumours, predominantly with pseudomyxoma peritonei (PMP). METHODS: Retrospective analysis of a prospective database of 1000 consecutive patients undergoing CRS and HIPEC for perforated appendiceal tumours between 1994 and 2014 in a UK National Peritoneal Malignancy unit. RESULTS: Overall 1000/1444 (69.2%) patients treated for peritoneal malignancy had appendiceal primary tumours. Of these 738/1000 (73.8%) underwent complete cytoreductive surgery (CCRS), 242 (24.2%) had maximal tumour debulking (MTD) and 20 (2%) had laparotomy and biopsies only. Treatment related 30-day mortality was 0.8% in CCRS and 1.7% in MTD group with major postoperative morbidity rates of 15.2% (CCRS) and 14.5% (MTD). Five- and 10-year overall survival was 87.4% and 70.3% in the 738 patients who had CCRS compared with 39.2% and 8.1% respectively in the MTD group. On multivariate analysis, significant predictors of reduced overall survival were male gender (p = 0.022), elevated CEA (p = 0.001), elevated CA125 (p = 0.001) and high tumour grade or adenocarcinoma (p = 0.001). CONCLUSIONS: Perforated epithelial appendiceal tumours are rare, though may be increasing in incidence and can present unexpectedly at elective or emergency abdominal surgery, often with PMP. CRS and HIPEC results in good long term outcomes in most patients.

Integrative role of vitamin D related and Interleukin-28B genes polymorphism in predicting treatment outcomes of Chronic Hepatitis C.

BACKGROUND: Improving prediction of treatment outcomes in chronic hepatitis C (CHC) genotype 4 (G4) is necessary to increase sustained viral response (SVR) rates. Vitamin D related and interferon stimulated genes are good candidates as they are recently crosstalk altering interferon response. Thus single nucleotide polymorphisms (SNPs) within some of these genes and multiple stepwise regression analysis including other independent predictors (IL28B(rs12979860), serum 25OH-vitamin D, serum alfa-fetoprotein (AFP)) were performed on a cohort of 200 Egyptian CHC patients treated with Pegylated interferon-alpha (Peg-IFN) plus ribavirin. METHODS: SNPs in cytochrome P-450 (CYP2R1)(rs10741657AG), vitamin D receptor (VDR)(rs2228570AG, rs1544410CT), oligoadenylate synthetases-like (OASL)(rs1169279CT) and adenosine deaminases acting on RNA (ADAR)(rs1127309TC) genes were analyzed by real-time PCR. RESULTS: The carrier state of A allele in VDR rs2228570 and CYP2R1 rs10741657 genes were independently associated with SVR [OR 6.453 & 3.536, p < 0.01 respectively]. Combining carriers of A allele in CYP2R1 and VDR genes with IL28B C/C genotype increased the probability of SVR from 80 % to reach 87.8 %, 93 % and 100 %. No relation was found between VDR rs1544410CT, ADAR rs1127309TC, OASL rs1169279CT polymorphisms and treatment outcome. Combining VDR rs2228570 A/A genotype with IL28B C/C genotype increased the probability of SVR from 82 % to reach 100 % and from 29 % to reach 80 % in C/T+ T/T IL28B genotype in none F4 liver disease patients. CONCLUSION: Vitamin D related (VDR rs2228570 and CYP2R1 rs10741657) and IL28B rs12979860 genes polymorphisms accurately assure SVR in naïve CHC G4 patients treated with low cost standard therapy.

Robust and automated three-dimensional segmentation of densely packed cell nuclei in different biological specimens with Lines-of-Sight decomposition.

BACKGROUND: Due to the large amount of data produced by advanced microscopy, automated image analysis is crucial in modern biology. Most applications require reliable cell nuclei segmentation. However, in many biological specimens cell nuclei are densely packed and appear to touch one another in the images. Therefore, a major difficulty of three-dimensional cell nuclei segmentation is the decomposition of cell nuclei that apparently touch each other. Current methods are highly adapted to a certain biological specimen or a specific microscope. They do not ensure similarly accurate segmentation performance, i.e. their robustness for different datasets is not guaranteed. Hence, these methods require elaborate adjustments to each dataset. RESULTS: We present an advanced three-dimensional cell nuclei segmentation algorithm that is accurate and robust. Our approach combines local adaptive pre-processing with decomposition based on Lines-of-Sight (LoS) to separate apparently touching cell nuclei into approximately convex parts. We demonstrate the superior performance of our algorithm using data from different specimens recorded with different microscopes. The three-dimensional images were recorded with confocal and light sheet-based fluorescence microscopes. The specimens are an early mouse embryo and two different cellular spheroids. We compared the segmentation accuracy of our algorithm with ground truth data for the test images and results from state-of-the-art methods. The analysis shows that our method is accurate throughout all test datasets (mean F-measure: 91%) whereas the other methods each failed for at least one dataset (F-measure≤69%). Furthermore, nuclei volume measurements are improved for LoS decomposition. The state-of-the-art methods required laborious adjustments of parameter values to achieve these results. Our LoS algorithm did not require parameter value adjustments. The accurate performance was achieved with one fixed set of parameter values. CONCLUSION: We developed a novel and fully automated three-dimensional cell nuclei segmentation method incorporating LoS decomposition. LoS are easily accessible features that ensure correct splitting of apparently touching cell nuclei independent of their shape, size or intensity. Our method showed superior performance compared to state-of-the-art methods, performing accurately for a variety of test images. Hence, our LoS approach can be readily applied to quantitative evaluation in drug testing, developmental and cell biology.

Endometrial stromal nodule - a case report.

Among the endometrial tumour endometrial stromal nodule are very rare. It is one of the form of endometrial stromal tumour. There are no definite presurgical diagnosis and diagnosis in most instances by microscopy. Hysterectomy is the treatment of choice to evaluate the tumour margin to differentiate it from stromal sarcoma. We present a case of 40 years woman, ultrasonographically diagnosed as leiomyoma and ovarian cystadenoma, underwent a total abdominal hysterectomy with one sided salpingo-oophorectomy. Microscopic examination show an endometrial stromal nodule and serous cystadenoma of the ovary. Though it is a benign tumour margin should be carefully examined to differentiate from stromal sarcoma, whose treatment and prognosis is totally different.

Nasal glioma in a six month old girl.

Congenital midline frontonasal swellings are rare condition and nasal glioma accounts for 5% of these abnormality. Nasal gliomas are benign tumours results from embryonic developmental error. Although it is a rare tumour but clinically it has some differential diagnoses. Most common are dermoid tumour, nasal glioma and nasal encephalocele. About 15-20% cases nasal glioma have a fibrous stalk that connecting to the central nervous system. Multidisciplinary approach is needed for proper diagnosis and to prevent life threatening intracranial complication. We present a case of nasal glioma in a 6 months old girl presented with a congenital swelling on the left lateral side of the nose with complaints of watering from the eye of same side.

Densitometric kneecap changes after unilateral knee arthroplasty.

PURPOSE: To assess bone density of kneecaps in subjects with femoro-tibial prosthesis before and after surgery by means of DEXA examination. SUBJECTS AND METHODS: We examined 34 patients with unilateral femoro-tibial prosthesis, 20 healthy subjects of the same age and non-carriers of knee replacement and 14 healthy young adult subjects. All the data sets were analysed by two radiologists (AS and AM). The coincidence of the results between the two specialists was evaluated by means of Cohen's Kappa index and the results were considered statistically significative if p value is < of 0.05. RESULTS: The values of patellar BMD in the group of 34 patients, were: a minimum of 0.386 g/cm(2) (K = 0.879, p = 0.0012), a maximum 1.707 g/cm(2) (K = 0.886, p = 0.0016). The comparison between the left and right knee showed the following data: minimum difference 0.034 g/cm2 (K = 0.901, p = 0.0015), maximum difference of 0.622 g/cm(2) (K = 0.908, p = 0.0017), the average was found to be of 0.277 g/cm(2) (K = 0.894, p = 0.0018). But this difference tends to decrease 6 months after surgery. In the group of healthy young adults, we obtained the following values: a minimum of 0.782 g/cm(2) (K = 0.907, p = 0.0025), maximum 1.503 g/cm(2) (K = 0.932, p = 0.0012). Between both knees, the difference was minimal 0.006 g/cm(2) (K = 0.951, p = 0.0035) and maximum 0.096 g/cm(2) (K = 0.926, p = 0.0007) with an average difference of 0.058 g/cm(2) (K = 0.954, p = 0.0026). In the group of healthy subjects of the same age and non-carriers of knee replacement the values were average higher. A maximum value of 1.134 g/cm(2) (K = 0.894, p = 0.0028) and a minimum value of 0.944 g/cm(2) (K = 0.892, p = 0.0023) were found; between both knees a minimum difference of 0.010 g/cm(2) (K = 0.918, p = 0.0047) and a maximum of 0.090 g/cm(2) (K = 0.937, p = 0.0017) were found, with an average difference of 0.052 g/cm(2) (K = 0.956, p = 0.0024). CONCLUSIONS: DEXA examination of the patellar is recommended as a supplementary study to the clinical and radiological standard exams because it is able to provide additional information to determine when to intervene surgically, on the basis of patellar bone density values.

Definitive surgical closure of enterocutaneous fistula: outcome and factors predictive of increased postoperative morbidity.

AIM: Enterocutaneous fistula (ECF) presents a complex management problem with significant mortality and morbidity. The aim of this study was to assess the outcome of patients undergoing surgical cure for ECF and to predict factors that might relate to increased postoperative morbidity. METHOD: Medical records of all patients who underwent definitive surgery for cure of an ECF within our colorectal surgery unit between 2000 and 2010 were reviewed. RESULTS: Forty-one patients (18 male) were identified, in whom 44 definitive procedures were performed. The median age was 54 (17-81) years. The median postoperative length of stay in hospital was 14 (2-213) days. Half (50%) of the ECFs occurred as a postoperative complication followed by spontaneous fistulation in Crohn's disease (36%). The interval to definitive surgery was influenced by the aetiology of the fistula. The median time to surgery after formation of postoperative fistula was 240 days (7.9 months). There was no 30-day postoperative mortality. There were two (4.5%) recurrences at 3 months. Thirty-eight (86%) patients suffered postoperative morbidity as defined by the Clavien-Dindo classification. High-grade morbidity occurred in 32% of patients. On univariate analysis, factors identified as being significantly associated with high-grade morbidity included a fistula output of > 500 ml/day (P = 0.004) in patients with postoperative ECF, malnutrition at presentation (P = 0.04) and a serum albumin value of < 30 g/l (P = 0.02) in patients with spontaneous ECF due to Crohn's disease. CONCLUSION: The majority of persistent complex ECFs can be cured surgically with low mortality and recurrence in a multidisciplinary setting. Postoperative morbidity, however, remains a significant burden.

Comparison between fine needle aspiration cytology with histopathology to validate accurate diagnosis of palpable breast lump.

A prospective study of 114 patients was conducted to assess the clinical correlation and diagnostic accuracy between FNAC and histopathology of breast lumps. Correlation was found out between clinical suspicion with FNAC and histopathological findings. The results obtained from histopathology were matched with those of FNAC and a correlation was sought based on statistical tests. Statistical analysis was performed on data and sensitivity and specificity with positive and negative predictive value were obtained. Although FNAC was performed on 114 patients presented with breast lump but histopathology available for 75 cases. Fifteen cases were found to be malignant on both FNAC and histopathology. For malignant lesion the sensitivity of the study was 96% and the specificity for malignant lesions was 100%. The positive predictive value was 100% and the negative predictive value was 95.12%. It was concluded that FNAC is a cheap, rapid, reliable and accurate test of diagnosing a palpable breast lump. It provides a good histological correlation, thus avoiding undue surgical biopsy prior to definitive surgery for malignancy.

Invasive ductal carcinoma in a young male breast.

Carcinoma arising in the male breast is a rare occurrence. The risk of male breast cancer increases with age, and the median age of diagnosis for men is 10 years later than that for females (67 to 71 years). Because of the absence of lobules in the normal male breast, lobular carcinoma cases are seen infrequently. All of the microscopic types identified in the female breast have been encountered in male but the most frequent is invasive ductal carcinoma and less frequent is invasive lobular carcinoma. We present the case of a 20 years old man presenting with a left breast lump. After left mastectomy with level 2 axillary clearance, histopathological examination revealed infiltrating ductal carcinoma. Our case represents ductal carcinoma in a proven genotypic young male patient showing no exogenous or endogenous estrogens exposure.

Surveillance of patients affected by Peutz-Jeghers syndrome: diagnostic value of MR enterography in prone and supine position.

INTRODUCTION: Peutz-Jeghers syndrome (PJS) is a familial polyposis syndrome characterized by multiple hamartomatous polyps throughout the gastrointestinal tract. The aim of our study was to retrospectively determine the diagnostic value of MR enterography (MRE), performed in supine and prone position, in the detection of small bowel polyps in PJ patients. MATERIALS AND METHODS: We retrospectively reviewed MRE examinations of 8 PJS patients who underwent MRE, pushed-double-ballon enteroscopy, laparoscopic endoscopy or surgery, within 3 months. Polietilenglicole was orally administered before the examination. True FISP and HASTE sequences were acquired in supine and prone position; 3D VIBE Gd-enhanced sequences in prone position only. RESULTS: Concordance between MRE and endoscopy was 72.6% for polyps <15 mm, 93% for polyps >15 mm. In supine and prone position concordance with endoscopy for polyps <15 mm was 63% and 66.8%, respectively. In the detection of smaller polyps the difference between supine position only and supine plus prone position was statistically significant (P < 0.027). DISCUSSION: MRE performed by combining prone and supine position was accurate in the detection of PJS polyps, with 93% concordance with enteroscopy for larger and more risky polyps. MRE offers a promising and non invasive alternative to capsule endoscopy, suggesting the possibility of an effective yearly surveillance in PJ patients.

Minor criteria for atopic dermatitis in children.

Atopic dermatitis (AD) is a common pruritic, eczematous skin disorder that runs a chronic and relapsing course. Major and minor criteria exist as guideline for arriving at a diagnosis of AD. Minor features vary with ethnicity and genetic background and can be used to aid diagnosis. A descriptive study was conducted including 210 patients of 1-12 years age who had concurrent or past history of AD according to criteria of Hanifin and Rajka. This study was conducted in the department of Dermatology of three different Hospitals of Bangladesh. Out of 33 sub-criteria of Hanifin and Rajka, 20 of which were examined encompassed tendency towards cutaneous infection, environmental factor, high IgE level, intolerance of wool, xerosis, infra-orbital fold, ichthyosis, early age of onset, itch on sweating, palmer hyperlinearity, food hypersensitivity, keratosis pilaris, pityriasis alba, facial erythema, cheilitis, hand eczema, foot eczema, intolerance of lipid solvent, scalp scaling and infra-auricular fissure. Out of 20 examined minor criteria, most common was cutaneous infection in 168(80.0%) patients followed by coursed influenced by environmental factor in 140(66.7%), high IgE level in 126(60.0%), intolerance of wool in 105(50.0%), xerosis in 92(43.8%), infra-orbital fold in 83(39.5%), ichthyosis in 72(34.3%), early age of onset in 65(31.0%), itch on sweating in 56(26.7%), palmary hyperlinearity in 52(24.8%), food hypersensitivity in 40(19.0%), keratosis pilaris in 31(14.8%), pityriasis alba in 30(14.3%), facial erythema in 25(1.9%), cheilitis in 22(10.5%), hand eczema in 19(9.0%), foot eczema in 16(7.6%), intolerance of lipid solvent in 14(6.7% ), scalp scaling in 11(5.2%) and infra-auricular fissure in 10(4.8%). These features were present singly or in combination. The result evidenced that minor criteria are many a times important for the diagnosis where major criteria are uncertain.

Magnetic resonance cholangiography: past, present and future: a review.

INTRODUCTION: Magnetic resonance cholangio-pancreatography (MRCP) is a valuable method for the evaluation of biliary and pancreatic diseases and a valuable alternative to endoscopic retrograde cholangiopancreatography (ERCP). It is noninvasive and does not require the use of contrast material or ionizing radiation. Since its introduction in 1991, this technique has significantly improved in spatial resolution, now allowing the accurate assessment of the major bilio-pancreatic diseases. STATE OF THE ART: MRCP is commonly performed with heavily T2-weighted sequences in order to highlight static fluids, as those contained in dilated pancreatic and biliary ducts. Newest MR equipments allow to perform MRCP within 10-15 minutes, due to the availability of ultra-fast sequences. Currently, MRCP is widely performed as a primary imaging modality for the assessment of obstructive jaundice and other benign or malignant bilio-pancreatic ducts abnormalities. The primary MRCP application is the evaluation of biliary obstructions due to choledocholithiasis, iatrogenic strictures, cholangiocarcinoma or pancreatic carcinoma. Other MRCP applications include the assessment of the exocrine pancreatic function, following secretin stimulation. Whenever needed, the MRCP may be completed with a conventional contrast-enhanced magnetic resonance imaging (MRI) of the upper abdomen and functional studies as well, thus providing an all-in-one mophological and functional study of the pancreas and biliary system. More recent applications include the possibility of 3D reconstructions and the use of hepato-biliary contrast agents, that provide a higher definition of the biliary tree, both in pathologic and normal conditions. The introduction of 3Tesla magnets could provide higher anatomic detail. CONCLUSIONS: In the next years the role of MRCP will further expand, due to the availability of faster sequences, 3D imaging and functional studies.

Giant lipoma of descending colon diagnosed at CT: report of a case.

Colonic lipomas are rare benign lesions, detected accidentally. These are often asymptomatic, but large lipoma may produce symptoms as abdominal pain, nausea, weight loss, diarrhea, constipation, hemorrhage, and intussusception. Colonic lipomas are more often localized in the ascending colon: literature reports less than 20 symptomatic cases situated in the descending colon. We report the case of a young man with a colonic giant lipoma diagnosed at Computed Tomography, who presented with rectum bleeding and 5-kg weight loss. The case was interesting because of the patient's young age, the tumor's location in the left side of the colon and the giant size (5.5 cm).

Correlation between faecal calprotectin and magnetic resonance imaging (MRI) in the evaluation of inflammatory pattern in Crohn's disease.

BACKGROUND: Calprotectin, a major cytosolic protein of neutrophils, is increased in inflammatory bowel disease (IBD) and may be considered a suitable marker of intestinal inflammation. Abdominal MRI is becoming more frequently used for the evaluation of IBD patients. Aim of this study was to investigate the role of MRI in IBD for the assessment of disease activity in comparison with faecal calprotectin levels. PATIENTS AND METHODS: Twenty-four consecutive hospitalized pts (12 F, 12 M, median age: 56; range: 22-77) with a proven diagnosis of CD were studied. At the time of the MRI examination, pts provided a single stool sample for calprotectin measurement. Calprotectin was measured by ELISA (Calprest(R)). Pathological values were considered more than 50 microg/g. All pts underwent MRI, performed at 1.5 T, with HASTE T2w with and without fat-saturation, FLASH T1w fat-saturated sequences pre and post iv injection of 0.1 ml/kg of Gadolinium. Presence, degree and length of wall inflammation were evaluated. The MRI degree of wall inflammation was graded with a 0-3 scoring system (0=absent 1=light 2=moderate 3=severe) by considering findings observed on T1 post Gd and T2 fat-suppressed images, as well as the degree of wall thickness. The length of extension was considered as less than 15 cm, between 15 cm and 30 cm, or more than 30 cm. Spearman's correlation coefficient was used to evaluated differences in calprotectin levels among the groups obtained by MRI findings. RESULTS: Grade 0 MRI was found in 1 pt with a faecal calprotectin measurement of 206.25 microg/g; Grade 1 MRI was found in 4 pts with a median faecal calprotectin of 100 microg/g (5-325); Grade 2 MRI was found in 10 pts with a median faecal calprotectin of 243.75 microg/g (7.5-606.25); Grade 3 MRI was found in 9 pts with a median faecal calprotectin of 1012.5 microg/g (30-1268.8). A trend of positive correlation was therefore found between MRI scores of activity and calprotectin levels (p less than 0.0001) and between MRI scores of thickening of intestinal involvement and calprotectin levels (p = 0.005). No apparent correlation was observed between faecal calprotectin concentration and length. CONCLUSIONS: Data presenting show that faecal calprotectin levels well correlate with the degree of mucosal inflammation are in agreement with previous studies. Considering the correlation obtained between calprotectin level and MRI findings, we believe that MRI is helpful in assessing and monitoring the degree of disease in Crohn's disease.