Endoscopic submucosal dissection for superficial premalignant and malignant epithelial neoplasms of the digestive tract: a real-life experience in Italy.

OBJECTIVE: Endoscopic submucosal dissection (ESD) is a technique for en bloc resection of neoplastic lesions of the digestive tract. Endoscopic submucosal dissection was developed in Asia, and data from Western countries are scarce. Our study aimed to assess the efficacy and safety of ESD for resection of superficial premalignant and malignant epithelial neoplasms in a tertiary center in Italy. PATIENTS AND METHODS: All patients with gastrointestinal lesions who underwent ESD between January 2013 and December 2018 in our center were retrospectively evaluated. Technical success, en bloc, R0, curative resection, and complication rates were assessed. RESULTS: A total of 107 lesions (stomach, no.=41; rectum, no.=32; colon, no.=28; esophagus, no.=5; duodenum, no.=1) were resected by ESD in 93 patients. Endoscopic submucosal dissection was technically successful in 99.1% (106/107) of lesions. Among the 90 superficial premalignant and malignant epithelial neoplasms, en bloc, and R0 resection rates were 97.8% (no.=88) and 75.6% (no.=68), respectively. Major complications occurred in 9.3% (10/107) of cases: 4 (3.7%) were perforations and 6 (5.6%) were major bleedings. All complications, but two which needed surgery, were managed endoscopically. CONCLUSIONS: Our study shows that ESD is a feasible, effective, and safe technique in a Western country.

7T mMR in the assessment of acute arterial mesenteric ischemia in a rat model.

To validate a rat model of acute arterial mesenteric ischemia correlating MRI patterns with macro and microscopic changes in the small bowel. Thirty Sprague-Dawley rats were assigned to two experimental groups (Group I and Group II) of fifteen rats each. Group I underwent surgical procedure of superior mesenteric artery (SMA) ligation, followed by macroscopic observation. In Group II, a loop was tied loosely around the SMA without occluding the vessel. Three days after surgery, the loop was tied by external tips to completely occlude the artery. 7T microMR (7Tesla microMR) was performed before and 8 hours after SMA occlusion. At predetermined time-points the histopathological examinations were performed in both of groups. Macroscopic monitoring revealed thinning of mesenteric vessels, hypotonic reflex ileus and chromatic change of some loops. 7T microMR sequences evidenced loop dilation with gas-fluid mixed stasis, intraperitoneal free fluid and bowel wall hyperintensity. There were no significant differences in the histological analysis between the two groups. The gap of three days from surgery, adopted in the Group 2, allowed to avoid signs of peritoneal and mesenteric irritation which could bias imaging patterns. MR succeeded to identify the signs of arterial mesenteric ischemia.

Ankle impingement: a review of multimodality imaging approach.

Ankle impingement is defined as entrapment of an anatomic structure that leads to pain and decreased range of motion of the ankle and can be classified as either soft tissue or osseous (Bassett et al. in J Bone Joint Surg Am 72:55-59, 1990). The impingement syndromes of the ankle are a group of painful disorders that limit full range of movement. Symptoms are due to compression of soft-tissues or osseous structures during particular movements (Ogilvie-Harris et al. in Arthroscopy 13:564-574, 1997). Osseous impingement can result from spur formation along the anterior margin of the distal tibia and talus or as a result of a prominent posterolateral talar process, the os trigonum. Soft-tissue impingement usually results from scarring and fibrosis associated with synovial, capsular, or ligamentous injury. Soft-tissue impingement most often occurs in the anterolateral gutter, the medial ankle, or in the region of the syndesmosis (Van den Bekerom and Raven in Knee Surg Sports Traumatol Arthrosc 15:465-471, 2007). The main impingement syndromes are anterolateral, anterior, anteromedial, posterior, and posteromedial impingement. These conditions arise from initial ankle injuries, which, in the subacute or chronic situation, lead to development of abnormal osseous and soft-tissue thickening within the ankle joint. The relative contributions of the osseous and soft-tissue abnormalities are variable, but whatever component is dominant there is physical impingement and painful limitation of ankle movement. Conventional radiography is usually the first imaging technique performer and allows assessment of any potential bone abnormality, particularly in anterior and posterior impingement. Computed tomography (CT) and isotope bone scanning have been largely superseded by magnetic resonance (MR) imaging. MR imaging can demonstrate osseous and soft-tissue edema in anterior or posterior impingement. MR imaging is the most useful imaging modality in evaluating suspected soft-tissue impingement or in excluding other ankle pathology such as an osteochondral lesion of the talus. MR imaging can reveal evidence of previous ligamentous injury and also can demonstrate thickened synovium, fibrosis, or adjacent reactive soft-tissue edema. Studies of conventional MR imaging have produced conflicting sensitivities and specificities in assessment of anterolateral impingement. CT and MR arthrographic techniques allow the most accurate assessment of the capsular recesses, albeit with important limitations in diagnosis of clinical impingement syndromes. In the majority of cases, ankle impingement is treated with conservative measures, with surgical debridement via arthroscopy or an open procedure reserved for patients who have refractory symptoms. In this article, we describe the clinical and potential imaging features, for the four main impingement syndromes of the ankle: anterolateral, anterior, anteromedial, posterior, and posteromedial impingement.

Magnetic resonance imaging in brachial plexus injury.

Brachial plexus injury represents the most severe nerve injury of the extremities. While obstetric brachial plexus injury has showed a reduction in the number of cases due to the improvements in obstetric care, brachial plexus injury in the adult is an increasingly common clinical problem. The therapeutic measures depend on the pathologic condition and the location of the injury: Preganglionic avulsions are usually not amenable to surgical repair; function of some denervated muscles can be restored with nerve transfers from intercostals or accessory nerves and contralateral C7 transfer. Postganglionic avulsions are repaired with excision of the damaged segment and nerve autograft between nerve ends or followed up conservatively. Magnetic resonance imaging is the modality of choice for depicting the anatomy and pathology of the brachial plexus: It demonstrates the location of the nerve damage (crucial for optimal treatment planning), depicts the nerve continuity (with or without neuroma formation), or may show a completely disrupted/avulsed nerve, thereby aiding in nerve-injury grading for preoperative planning. Computed tomography myelography has the advantage of a higher spatial resolution in demonstration of nerve roots compared with MR myelography; however, it is invasive and shows some difficulties in the depiction of some pseudomeningoceles with little or no communication with the dural sac.

Technical note: patient-specific quality assurance methods for TomoDirect(TM) whole breast treatment delivery.

PURPOSE: To investigate the feasibility of implementing a novel approach for patient-specific QA of TomoDirect(TM) whole breast treatment. METHODS: The most currently used TomoTherapy DQA method, consisting in the verification of the 2D dose distribution in a coronal or sagittal plane of the Cheese Phantom by means of gafchromic films, was compared with an alternative approach based on the use of two commercially available diode arrays, MapCHECK2(TM) and ArcCHECK(TM). The TomoDirect(TM) plans of twenty patients with a primary unilateral breast cancer were applied to a CT scan of the Cheese Phantom and a MVCT dataset of the diode arrays. Then measurements of 2D dose distribution were performed and compared with the calculated ones using the gamma analysis method with different sets of DTA and DD criteria (3%-3 mm, 3%-2 mm). The sensitivity of the diode arrays to detect delivery and setup errors was also investigated. RESULTS: The measured dose distributions showed excellent agreement with the TPS calculations for each detector, with averaged fractions of passed Γ values greater than 95%. The percentage of points satisfying the constraint Γ < 1 was significantly higher for MapCHECK2(TM) than for ArcCHECK(TM) and gafchromic films using both the 3%-3 mm and 3%-2 mm gamma criteria. Both the diode arrays show a good sensitivity to delivery and setup errors using a 3%-2 mm gamma criteria. CONCLUSIONS: MapCHECK2™ and ArcCHECK(TM) may fulfill the demands of an adequate system for TomoDirect(TM) patient-specific QA.

Low prevalence of Listeria monocytogenes in foods from Italy.

Listeria monocytogenes is an important foodborne pathogen that causes gastrointestinal disorders, and, especially in immunocompromised people, serious extraintestinal diseases, such as septicemia and meningitis, as well as abortion in pregnant women. Many foods, from both plant and animal origin, have been involved in listeriosis outbreaks. This article reports the results of a 12-year survey (1993 through 2004) on the presence of L. monocytogenes in several kinds of food marketed in Italy. Of 5,788 analyzed samples, 121 (2.1%) were contaminated with L. monocytogenes. The highest prevalence was found in smoked salmon (10.6%) and in poultry meat samples (8.5%) and the lowest in red meat (0.3%). L. monocytogenes was not found in 154 samples of fresh seafood products. Fifty-two isolates were also serotyped by the agglutination method. The most common serotypes detected in the 52 strains tested were 1/2a (36.5%), followed by 1/2c (32.8%), 1/2b (13.5%), 4b (11.5%), 3a (3.8%), and 3b (1.9%). The results of the present study showed low levels of L. monocytogenes in the analyzed samples. A total of 61.5% of the 52 L. monocytogenes strains analyzed belonged to serotypes 1/2a, 1/2b, and 4b, namely the serovars that are most commonly involved in extraintestinal human listeriosis outbreaks. In the ready-to-eat samples, these three serotypes were 40.0% (1/2a), 17.1% (1/2b), and 14.3% (4b). This finding highlights the need to implement strict hygienic measures during the production, distribution, and sale of foods to reduce the risk of foodborne listeriosis in humans to an acceptable level.

[The importance of using computed tomographic scanning in breast irradiation after conservative treatment]. / L'importanza dell'utilizzazione delle scansioni con Tomografia Computerizzata nell'irradiazione della mammella dopo trattamento conservativo.

Conservative surgery followed by radiotherapy is the current treatment of choice for primary breast cancer: indeed, this protocol ensures local control, relatively good cosmetic results and NED survival values similar to those of more invasive surgery. Radiotherapy requires the optimization of the irradiation technique to minimize the dose to the organs at risk. To this purpose, 30 patients submitted to quadrantectomy for breast carcinoma and then to radiotherapy on the residual breast were examined, January through December, 1994, at the Radiotherapy Service of the Ivrea Hospital, to investigate if CT can help optimize treatment planning, sparing as much of the pulmonary tissue underlying the residual breast as possible. Our series of patients was then compared with a literature series whose treatment had been planned only on the mapping of body outline. Some interesting considerations follow from our results: 1) With CT, larger fields can be used than those used with the body outline, so that the planned target volume can be more closely approached; 2) Larger fields can be used because the critical organ included in the irradiation field is more correctly and precisely defined; 3) The comparison with the literature shows that in the past the fields were larger, because the target volume and the critical organ were more difficult to define. The use of larger fields means a higher dose to the lung and thus maybe a higher risk of radiation pneumonia.