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OBJECTIVE: To determine whether small, incidentally detected testicular lesions can be safely followed up, by assessing growth rate and volume threshold for benign vs. malignant lesions. METHODS: This retrospective observational study includes a consecutive series of 130 testicular incidentalomas < 1 cm and with negative tumour markers identified from October 2001 to November 2022, which were initially followed up with ultrasound. A total of 39 cases proceeded to surgery during the study period, either due to lesion growth (n = 28) or patient preference/recommendation by the referring urologist (n = 11). For the lesions that were growing, specific growth rate (SGR) and doubling time (DT) were calculated assuming an exponential growth pattern. In addition, the velocity of increase of the average diameter (∆Dav) and of the maximum diameter (∆Dmax) were calculated. RESULTS: Of the 130 nodules that were initially followed up, six disappeared, eight were reduced in size, eighty-eight were stable, and twenty-eight increased in size. For operated nodules all 18 malignant tumours, 8/9 benign tumours, and 2/12 surgically proved non-neoplastic lesions were growing. The best cut-off values of the growth indicators to differentiate between malignant and non-malignant histology were 3.47 × 10-3%volume/day, ≤ 179 days, > 10 × 10-3 mm/day, and > 5 × 10-3 mm/day for SGR, DT, ∆Dmax, ∆Dav, respectively. CONCLUSIONS: Malignant and non-malignant small incidentalomas can be effectively differentiated based on growing parameters, even though overlap exists. An increase of the maximum diameter of about 1 mm and 2 mm in three months and in six months, respectively, suggests malignancy. CLINICAL RELEVANCE STATEMENT: Growing parameters allow an educated assessment of benign and malignant small testicular incidentalomas. Non-aggressive management is justified and safe when follow-up includes self-examination and tumour marker assessment to reduce the risk of interval tumour growth. KEY POINTS: Small, non-palpable and asymptomatic testicular nodules < 1 cm are unexpectedly discovered during scrotal ultrasound. Growth indicators estimate the potential malignancy, even though overlap with non-malignant lesions exists. Non-growing incidentalomas can be safely followed up.
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Zinner's syndrome is a rare congenital malformation characterized by the association of unilateral renal agenesis with ipsilateral seminal vesicle cyst and ejaculatory duct obstruction. Most patients are asymptomatic until the third or fourth decade of life when the syndrome is associated with dysuria, perineal pain, infertility, and painful ejaculation. In this report, we present the common imaging findings of this rare developmental anomaly involving the mesonephric duct in a 48-year-old male patient experiencing pelvic pain, recurrent dysuria, and pollakiuria.
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Enfermedades de los Genitales Masculinos , Riñón , Masculino , Humanos , Persona de Mediana Edad , Riñón/diagnóstico por imagen , Riñón/anomalías , Disuria , Vesículas Seminales/diagnóstico por imagen , Vesículas Seminales/anomalías , Conductos Mesonéfricos/diagnóstico por imagen , Conductos Mesonéfricos/anomalías , SíndromeRESUMEN
Many countries are facing an aging population. As people live longer, surgeons face the prospect of operating on increasingly older patients. Traditional teaching is that with older age, these patients face an increased risk of mortality and morbidity, even to a level deemed too prohibitive for surgery. However, this is not always true. An active 90-year-old patient can be much fitter than an overweight, sedentary 65-year-old patient with comorbidities. Recent literature shows that frailty-an age-related cumulative decline in multiple physiological systems, is therefore a better predictor of mortality and morbidity than chronological age alone. Despite recognition of frailty as an important tool in identifying vulnerable surgical patients, many surgeons still shun objective tools. The aim of this position paper was to perform a review of the existing literature and to provide recommendations on emergency laparotomy and in frail patients. This position paper was reviewed by an international expert panel composed of 37 experts who were asked to critically revise the manuscript and position statements. The position paper was conducted according to the WSES methodology. We shall present the derived statements upon which a consensus was reached, specifying the quality of the supporting evidence and suggesting future research directions.
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Fragilidad , Humanos , Anciano , Anciano de 80 o más Años , Laparotomía , Anciano Frágil , Consenso , ComorbilidadRESUMEN
Heterojunction photodetector based on reduced graphene oxide (rGO) has been realized using a spin coating technique. The electrical and optical characterization of bare GO and thermally reduced GO thin films deposited on glass substrate has been carried out. Ultraviolet-visible-infrared transmittance measurements of the GO and rGO thin films revealed broad absorption range, while the absorbance analysis evaluates rGO band gap of about 2.8 eV. The effect of GO reduction process on the photoresponse capability is reported. The current-voltage characteristics and the responsivity of rGO/n-Si based device have been investigated using laser diode wavelengths from UV up to IR spectral range. An energy band diagram of the heterojunction has been proposed to explain the current versus voltage characteristics. The device demonstrates a photoresponse at a broad spectral range with a maximum responsivity and detectivity of 0.20 A/W and 7 × 1010 cmHz/W, respectively. Notably, the obtained results indicate that the rGO based device can be useful for broadband radiation detection compatible with silicon device technology.
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BACKGROUND: Since the COVID-19 pandemic has occurred, nations showed their unpreparedness to deal with a mass casualty incident of this proportion and severity, which resulted in a tremendous number of deaths even among healthcare workers. The World Society of Emergency Surgery conceived this position paper with the purpose of providing evidence-based recommendations for the management of emergency surgical patients under COVID-19 pandemic for the safety of the patient and healthcare workers. METHOD: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) through the MEDLINE (PubMed), Embase and SCOPUS databases. Synthesis of evidence, statements and recommendations were developed in accordance with the GRADE methodology. RESULTS: Given the limitation of the evidence, the current document represents an effort to join selected high-quality articles and experts' opinion. CONCLUSIONS: The aim of this position paper is to provide an exhaustive guidelines to perform emergency surgery in a safe and protected environment for surgical patients and for healthcare workers under COVID-19 and to offer the best management of COVID-19 patients needing for an emergency surgical treatment. We recommend screening for COVID-19 infection at the emergency department all acute surgical patients who are waiting for hospital admission and urgent surgery. The screening work-up provides a RT-PCR nasopharyngeal swab test and a baseline (non-contrast) chest CT or a chest X-ray or a lungs US, depending on skills and availability. If the COVID-19 screening is not completed we recommend keeping the patient in isolation until RT-PCR swab test result is not available, and to manage him/she such as an overt COVID patient. The management of COVID-19 surgical patients is multidisciplinary. If an immediate surgical procedure is mandatory, whether laparoscopic or via open approach, we recommend doing every effort to protect the operating room staff for the safety of the patient.
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COVID-19/prevención & control , Control de Infecciones/normas , Atención Perioperativa/normas , Procedimientos Quirúrgicos Operativos/normas , COVID-19/diagnóstico , COVID-19/epidemiología , COVID-19/transmisión , Prueba de COVID-19/métodos , Prueba de COVID-19/normas , Urgencias Médicas , Salud Global , Humanos , Control de Infecciones/instrumentación , Control de Infecciones/métodos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Laparoscopía/métodos , Laparoscopía/normas , Pandemias , Atención Perioperativa/métodos , Equipo de Protección Personal , Procedimientos Quirúrgicos Operativos/métodosRESUMEN
Acute scrotum is characterized by intense acute scrotal pain, which may be associated with other symptoms and signs such as abdominal pain, inflammation, and fever. Many pathologic conditions can present in this way, most which involve the scrotal contents. Nonscrotal conditions, however, can rarely present clinically only as acute scrotum: among them, renal colic, aneurysm rupture or other causes of retroperitoneal hemorrhage, primary abdominal or pelvic tumors and metastases, pancreatitis, pelvic inflammation, and muscle injuries. The pathophysiologic characteristics of the clinical presentation, clues for diagnosis, and imaging features of a series of nonscrotal lesions presenting clinically with acute scrotal pain are herein reported and illustrated. In patients presenting with acute scrotal symptoms and normal scrotal ultrasound findings, nonscrotal causes of acute scrotal pain should be considered in the differential diagnosis. Therefore, an ultrasound investigation of the abdomen, groin, and thighs is indicated.
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Enfermedades de los Genitales Masculinos , Escroto , Enfermedad Aguda , Diagnóstico Diferencial , Enfermedades de los Genitales Masculinos/diagnóstico por imagen , Hemorragia , Humanos , Masculino , Escroto/diagnóstico por imagen , UltrasonografíaRESUMEN
The magneto-mechanical behaviour of structural steel specimens stressed up to the plastic deformation stage was investigated using a 2nd order gradiometer based on Giant Magneto Resistive (GMR) sensors. The correlation between the gradient of the magnetization and the dislocation density before the crack initiation inside the test material was reported. The capability of the GMR scanning sensor to detect the residual magnetization due to the tensile stress with a non-invasive technique was demonstrated.
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In the present article, we present the experimental results concerning the fine-tuning and optimization of superconducting quantum interference device (SQUID) parameters by thermal annealing. This treatment allows for the modification of the parameters in order to meet a specific application or to adjust the device parameters to prevent the increase of magnetic field noise and work instability conditions due to a different critical current with respect to the design value. In particular, we report the sensor critical current, the voltage-flux (V-Φ) characteristics and the spectral density of the magnetic field of SQUID magnetometers for different annealing temperatures. The measurements demonstrate that it is possible to achieve a fine control of the most important device parameters. In particular, we show that thermal annealing allows for the reduction of SQUID noise by more than a factor of 5 and makes the device working operations very stable. These results are very useful in view of quantum technology applications related to superconducting quantum computing where the correct functioning of the quantum bit depends on the fine control of the superconducting quantum device parameters and selectable annealing is possible by using a suitable laser as a thermal source.
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OBJECTIVE: To investigate the role of strain elastography using calculated strain ratio and visual elastography score in differentiating nonneoplastic, benign, and malignant neoplastic intratesticular lesions. MATERIALS AND METHODS: The study was approved by the hospital review board as a retrospective review of 86 patients examined with gray scale, color Doppler ultrasonography and strain elastography (visual elastography score and strain ratio). Sensitivity, specificity, and positive and negative likelihood ratio of color Doppler and stain elastography were documented. Receiver operator characteristic curves assessed the diagnostic accuracy of strain elastography to discriminate nonneoplastic, benign, and malignant neoplasms. Histology or follow-up ultrasonography determined lesion character. RESULTS: Thirty-one of 86 (36.0%) intratesticular malignant neoplasms, 17 of 86 (19.8%) benign neoplasms, and 38 of 86 (44.2%) nonneoplastic lesions were confirmed with histology (n = 52) or follow-up sonography (n = 34); 89.5% of intratesticular lesions were heterogeneous or hypoechoic on gray scale, with no difference between benign and malignant. Sensitivity, specificity, positive and negative likelihood ratio for nonneoplasm versus neoplasm were documented: color Doppler: 68.8%, 97.4%, 26.5, 0.32; visual elastography score: 81.3%, 57.9%, 1.93, 0.32; strain ratio: 68.8%, 81.6%, 3.73, 0.38. Neoplastic lesions showed a higher strain ratio than nonneoplastic lesions (P < .001), with strong correlation between median strain ratio and visual elastography score (Spearman's coefficient, 0.693; P < .001). Strain ratio is a significantly better assessment than visual elastography score for malignant lesions (P = .025). Logistic regression analysis revealed significant associations between size (P = .001), hypervascularity (P < .001), and malignancy. CONCLUSION: Higher strain ratio and visual elastography score are associated with neoplastic lesions and offer an alternative to assess tissue characteristics but do not improve the diagnostic accuracy when compared with the color Doppler pattern.
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Diagnóstico por Imagen de Elasticidad/métodos , Enfermedades Testiculares/diagnóstico por imagen , Ultrasonografía Doppler en Color/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sensibilidad y Especificidad , Neoplasias Testiculares/diagnóstico por imagen , Testículo/diagnóstico por imagen , Adulto JovenRESUMEN
á : Obstruction and perforation due to colorectal cancer represent challenging matters in terms of diagnosis, life-saving strategies, obstruction resolution and oncologic challenge. The aims of the current paper are to update the previous WSES guidelines for the management of large bowel perforation and obstructive left colon carcinoma (OLCC) and to develop new guidelines on obstructive right colon carcinoma (ORCC). Methods: The literature was extensively queried for focused publication until December 2017. Precise analysis and grading of the literature has been performed by a working group formed by a pool of experts: the statements and literature review were presented, discussed and voted at the Consensus Conference of the 4th Congress of the World Society of Emergency Surgery (WSES) held in Campinas in May 2017. Results: CT scan is the best imaging technique to evaluate large bowel obstruction and perforation. For OLCC, self-expandable metallic stent (SEMS), when available, offers interesting advantages as compared to emergency surgery; however, the positioning of SEMS for surgically treatable causes carries some long-term oncologic disadvantages, which are still under analysis. In the context of emergency surgery, resection and primary anastomosis (RPA) is preferable to Hartmann's procedure, whenever the characteristics of the patient and the surgeon are permissive. Right-sided loop colostomy is preferable in rectal cancer, when preoperative therapies are predicted.With regards to the treatment of ORCC, right colectomy represents the procedure of choice; alternatives, such as internal bypass and loop ileostomy, are of limited value.Clinical scenarios in the case of perforation might be dramatic, especially in case of free faecal peritonitis. The importance of an appropriate balance between life-saving surgical procedures and respect of oncologic caveats must be stressed. In selected cases, a damage control approach may be required.Medical treatments including appropriate fluid resuscitation, early antibiotic treatment and management of co-existing medical conditions according to international guidelines must be delivered to all patients at presentation. Conclusions: The current guidelines offer an extensive overview of available evidence and a qualitative consensus regarding management of large bowel obstruction and perforation due to colorectal cancer.
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Neoplasias Colorrectales/terapia , Guías como Asunto/normas , Obstrucción Intestinal/terapia , Perforación Intestinal/terapia , Colectomía/métodos , Colostomía/métodos , Humanos , Obstrucción Intestinal/diagnóstico , Perforación Intestinal/diagnóstico , Stents Metálicos Autoexpandibles , Tomografía Computarizada por Rayos X/métodosRESUMEN
On cross-sectional imaging studies performed for other indications, incidental discovery of renal lesions is not uncommon. In daily use, grey-scale ultrasonography (US) and conventional Doppler modes are often the modality of choice for the initial assessment. While simple cysts are fully characterized with US, other lesions require further characterization, which is traditionally obtained by multiphase imaging, such as contrast-enhanced CT and MRI. Contrast-enhanced ultrasound (CEUS) has become a powerful additional tool for imaging renal lesions. With its lack of nephrotoxicity, the absence of ionizing radiation, and the ability to evaluate the enhancement pattern of renal lesions quickly and in real- time, CEUS has unique advantages over traditional modes. Established applications are differentiation between solid tumours, pseudolesions, and complex cysts; characterization of complex cysts with different malignant potential, and evaluation of tumor ablation. Microbubble contrast agents are safe. Adverse reactions are rare. This article provides an overview of the current clinical applications of CEUS in characterizing renal masses, discussing advantages and limitations. The aim is to provide the framework for sonologists to make informed decisions regarding this emerging imaging test in appropriate circumstances.
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Medios de Contraste , Enfermedades Renales Quísticas/diagnóstico por imagen , Neoplasias Renales/diagnóstico por imagen , Microburbujas , Ablación por Catéter , Femenino , Humanos , Hallazgos Incidentales , Riñón/diagnóstico por imagen , Enfermedades Renales Quísticas/patología , Enfermedades Renales Quísticas/cirugía , Neoplasias Renales/patología , Neoplasias Renales/cirugía , Imagen por Resonancia Magnética , Masculino , Seguridad del Paciente , Ultrasonografía/métodosRESUMEN
Desmoid-type fibromatosis (DF), also known as aggressive fibromatosis, is a locally aggressive benign fibroblastic neoplasm that can infiltrate or recur but cannot metastasize. It is rare, with an estimated annual incidence of two to four new cases per million people. Most DFs occur sporadically, but it may also be associated with the hereditary syndrome familial adenomatous polyposis. Treatment is necessary when the disease is symptomatic, especially in case of compression of critical structures. When possible, surgical resection is the treatment of choice; however, recurrence is common. Due to the high rate of recurrence, imaging plays an important role not only in diagnosis, but also in the management of DF. Although there are a number of studies describing CT and MRI findings of DF, there is no description of contrast-enhanced ultrasound findings.
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Neoplasias Abdominales/diagnóstico por imagen , Fibromatosis Abdominal/diagnóstico por imagen , Fibromatosis Agresiva/diagnóstico por imagen , Ultrasonografía , Neoplasias Abdominales/patología , Anciano , Medios de Contraste , Diagnóstico Diferencial , Femenino , Fibromatosis Abdominal/patología , Fibromatosis Abdominal/cirugía , Fibromatosis Agresiva/patología , Fibromatosis Agresiva/cirugía , Humanos , Imagen por Resonancia Magnética , Microburbujas , Tomografía Computarizada por Rayos XRESUMEN
The origin of eumelanin optical properties remains a formidable conundrum preventing a detailed understanding of the complex photo-protective role of these widespread natural pigments and the rational design of innovative bioinspired materials for optoelectronic applications. Here we report the unusual kinetic and thickness-dependent evolution of the optical properties of black eumelanin polymers generated by spontaneous aerial polymerization of 5,6-dihydroxyindole (DHI) thin films (0.1-1 µm), consistent with peculiar solid state reorganization mechanisms governing broadband absorption. The complete reversal of eumelanin UV-visible transmittance spectrum curvature on passing from 0.2 to 0.5 µm thick films, the marked increase in visible extinction coefficients with increasing film thickness and the higher UV extinction coefficients in slowly vs. rapidly generated polymers concur to support distinct dynamic regimes of solid-state molecular reorganization at the nanoscale level and to do affect the development of broadband visible absorption. Solid state control of molecular reorganization disclosed herein may delineate new rational strategies for tuning optical properties in eumelanin thin films for optoelectronic applications.
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In this work we present a novel route to produce a graphene-based film on a polymer substrate. A transparent graphite colloidal suspension was applied to a slat of poly(methyl methacrylate) (PMMA). The good adhesion to the PMMA surface, combined with the shear stress, allows a uniform and continuous spreading of the graphite nanocrystals, resulting in a very uniform graphene multilayer coating on the substrate surface. The fabrication process is simple and yields thin coatings characterized by high optical transparency and large electrical piezoresitivity. Such properties envisage potential applications of this polymer-supported coating for use in strain sensing. The electrical and mechanical properties of these PMMA/graphene coatings were characterized by bending tests. The electrical transport was investigated as a function of the applied stress. The structural and strain properties of the polymer composite material were studied under stress by infrared thermography and micro-Raman spectroscopy.
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Códigos de Ética/historia , Ética Médica/historia , Juramento Hipocrático , Antigua Grecia , Historia Antigua , Humanos , ItaliaRESUMEN
Pooled data from 16 radiology centers were retrospectively analyzed to seek patients with pathologically proven testicular lymphoma and grayscale and color Doppler images available for review. Forty-three cases were found: 36 (84%) primary and 7 (16%) secondary testicular lymphoma. With unilateral primary lymphoma, involvement was unifocal (n = 10), multifocal (n = 11), or diffuse (n = 11). Synchronous bilateral involvement occurred in 6 patients. Color Doppler sonography showed normal testicular vessels within the tumor in 31 of 43 lymphomas (72%). Testicular lymphoma infiltrates through the tubules, preserving the normal vascular architecture of the testis. Depiction of normal testicular vessels crossing the lesion is a useful adjunctive diagnostic criterion.
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Linfoma/diagnóstico por imagen , Neoplasias Testiculares/diagnóstico por imagen , Ultrasonografía Doppler en Color , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
Computed tomography (CT) still represents the preferred imaging method in the assessment of patients presenting with multiple trauma. Nevertheless, in patients with low-energy abdominal trauma, the use of CT is debated because of the possible unnecessary radiation exposure. Accordingly, conventional ultrasound (US) imaging has been increasingly employed as the initial imaging modality in the workup of minor traumatic emergency conditions. Focused assessment with sonography for trauma is widely used to detect free intra-abdominal fluid, but its role is controversial, because the absence of free fluid does not exclude the presence of injuries to abdominal organ. Injection of an ultrasound contrast agent (UCA) may give the radiologist relevant additional information to that obtained with conventional US. Thus, in trauma patients, following early assessment with conventional US imaging, a contrast-enhanced US (CEUS) can provide a more reliable evaluation of solid organ injuries and related vascular complications, including active bleeding, pseudoaneurysms, and artero-venous fistulas. CEUS cannot replace abdominal CT, but it represents a noninvasive and repeatable imaging tool capable of providing a reliable assessment of trauma severity and expedite the patient's treatment.
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Traumatismos Abdominales/diagnóstico por imagen , Medios de Contraste , Ultrasonografía/métodos , Heridas no Penetrantes/diagnóstico por imagen , Medicina de Emergencia , Humanos , Tomografía Computarizada por Rayos XRESUMEN
Grey-scale ultrasound has an important diagnostic role in nephrology. The absence of ionizing radiations and nephrotoxicity, rapidity of execution, excellent repeatability, the possibility to perform the test at the patient's bed and the low cost represent important advantages of this technique. Paired with real-time sonography and colour-power-Doppler contrast-enhanced ultrasound (CEUS) reduces the diagnostic gap with computed tomography (CT) and magnetic resonance (MR) and represents a major step in the evolution of clinical ultrasound. Although there are several situations in which contrast-enhanced CT and MR are indicated (i.e. evaluation of cystic or ischemic lesions, traumatisms and ablative therapies of the native and transplanted kidney), the use of CT contrast media presents a high risk of contrast-induced nephropathy (i.e. in elderly people, subjects with comorbidities and those with renal dysfunction), while gadolinium-based RM contrast agents are contraindicated for the risk of nephrogenic systemic fibrosis (i.e. in patients with severe renal dysfunction). In these situations, CEUS may be a viable alternative, however, as any technique associated with the infusion of pharmacological substances, the potential advantages and risks of CEUS should be critically evaluated. In this regard, the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) has published the guidelines for the use of CEUS for the kidney imaging and the International Contrast Ultrasound Society (ICUS) has been recently founded. The aim of this review is to offer an updated overview of the potential applications of CEUS in nephrology, reporting some indications and possible risks associated to its use.
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Medios de Contraste , Enfermedades Renales/diagnóstico por imagen , Nefrología/métodos , Humanos , UltrasonografíaRESUMEN
OBJECTIVE: Chest auscultation and chest x-ray commonly are used to detect postoperative abnormalities and complications in patients admitted to intensive care after cardiac surgery. The aim of the study was to evaluate whether chest ultrasound represents an effective alternative to bedside chest x-ray to identify early postoperative abnormalities. DESIGN: Diagnostic accuracy of chest auscultation and chest ultrasound were compared in identifying individual abnormalities detected by chest x-ray, considered the reference method. SETTING: Cardiac surgery intensive care unit. PARTICIPANTS: One hundred fifty-one consecutive adult patients undergoing cardiac surgery. INTERVENTIONS: All patients included were studied by chest auscultation, ultrasound, and x-ray upon admission to intensive care after cardiac surgery. MEASUREMENTS AND MAIN RESULTS: Six lung pathologic changes and endotracheal tube malposition were found. There was a highly significant correlation between abnormalities detected by chest ultrasound and x-ray (k = 0.90), but a poor correlation between chest auscultation and x-ray abnormalities (k = 0.15). CONCLUSIONS: Chest auscultation may help identify endotracheal tube misplacement and tension pneumothorax but it may miss most major abnormalities. Chest ultrasound represents a valid alternative to chest x-ray to detect most postoperative abnormalities and misplacements.