Verification Study of in Silico Computed Intracardiac Blood Flow With 4D Flow MRI.

OBJECTIVE: Major challenges for clinical applications of in silico medicine are limitations in time and computational resources. Computational approaches should therefore be tailored to specific applications with relatively low complexity and must be verified and validated against clinical gold standards. METHODS: This study performed computational fluid dynamics simulations of left ventricular hemodynamics of different complexity based on shape reconstruction from steady state gradient echo magnetic resonance imaging (MRI) data. Computed flow results of a rigid wall model (RWM) and a prescribed motion fluid-structure interaction (PM-FSI) model were compared against phase-contrast MRI measurements for three healthy subjects. RESULTS: Extracted boundary conditions from the steady state MRI sequences as well as computed metrics, such as flow rate, valve velocities, and kinetic energy show good agreement with in vivo flow measurements. Regional flow analysis reveals larger differences. CONCLUSION: Basic flow structures are well captured with RWM and PM-FSI. For the computation of further biomarkers like washout or flow efficiency, usage of PM-FSI is required. Regarding boundary-near flow, more accurate anatomical models are inevitable. SIGNIFICANCE: These results delineate areas of application of both methods and lay a foundation for larger validation studies and sensitivity analysis for healthy and diseased cases, being an essential step upon clinical translations.

[Renal liposarcoma clinical and pathological aspects. Case report and literature review]. / Liposarcoma renale aspetti clinici ed anatomo-patologici. Case report e revisione della letteratura.

Sarcomas of the retroperitoneum represent 0.2% of tumors and 15% of soft tissue sarcomas. Retro-peritoneal differentiated liposarcoma must be distinguished from the connective neoplasm of kidney. The main features of these tumors are: the rapid growth, infiltration of surrounding tissue, the tendency to local relapse and very fast metastasis (60-80%). Authors report a clinical case of a patient 61 old years with occasional reflected ultrasound is performed for lumbar pain a retro peritoneal mass. CT described a retro peritoneal mass that raised medially and displaced the left kidney. The patient was subjected to removal of the mass now to his kidney capsule, which was nevertheless preserved.The histological examination showed a picture of well-differentiated liposarcoma with areas of high-grade sarcoma with malignant morphology fibrohistiocytoma-like aspects and fibromyxomatosis. The well-differentiated liposarcoma has biological behavior similar to other sarcomas with high degree of adults with high local recurrence and distant metastases in 15-20% with overall mortality at 5 years about 30%. The most significant prognostic factor is the location of the cancer and the extent and degree of differentiation did not impact on the clinical prognosis is conditioned by the difficulty of obtaining a radical surgery in spite linfoadenectomia a retro peritoneal accurate.

Cystic struma ovarii: a report of three cases.

Three cases of cystic struma ovarii in women aged 16, 20 and 40 are described. All patients had an asymptomatic ovarian mass at ultrasound scan. The tumours, all of which were unilateral and confined to the ovary, ranged from 7 to 10 cm in the greatest dimension. Two lesions were unilocular, the third multilocular, and all were filled with green fluid. Microscopic examination showed cysts with fibrous wall lined by non-specific-appearing epithelial cells. In the wall of the cysts, there was a small number of thyroid follicles. In one case, an association with a cystic mature teratoma was seen. The paucity of thyroid follicles and the non-specific appearance of the epithelial cells required a careful sampling and immunohistochemical staining for thyroglobulin to establish an exact diagnosis. The postoperative period was uneventful and thyroid function remained normal. In conclusion, cystic struma is probably often underdiagnosed and should be considered when evaluating cystic ovarian tumours whose features are not obviously those of another tumour type. A careful search for thyroid follicles should be undertaken. In problematic cases immunohistochemical staining for thyroglobulin may be required.

[Three cases of renal cell carcinoma with sarcomatoid differentiation]. / Tre casi di carcinoma renale con differenziazione sarcomatoide.

Renal cell carcinoma with sarcomatoid differentiation has an incidence of 4-6%. It occurs more frequently with clinical advanced presentation in relation to the greater biological aggressiveness. This variant was also found both in transplanted kidneys and in patients with von Hippel-Lindau syndrome. The authors present three cases of cancer all clinically evolving to rapidly progressive conditions. The pathologic staging was, respectively: Case 1 pT4 N0 M0 G4 case, Case 2 P G4 T3a N2 M0, Case 3 pT3a N0 M1 G4. The clinical responses related to protocols with VEGF drugs that seem to have better clinical response compared to immunotherapy are still being studied. From the pathologic point of view it is necessary, for all renal cell cancers, to search and identify the sarcomatoid components that, although poorly represented, give a negative prognosis.

[A case of chronic schistosomiasis four years after infestation]. / Caso di schistosomiasi cronica a quattro anni dalla infestazione.

Authors present a case of bilharziosis incidentally diagnosed in a patient undergoing TURB for suspected bladder cancer. The patient, who in 2005 had gone to Malaysia, had been suffering from recurrent hemorrhagic cystitis since 2007, which were treated with antibiotic therapy. In November 2009 he presented to our observation for persistent hematuria, underwent ultrasound examination, fibroscopy and TURB diagnostics for suspicious lesions. The histopathology diagnosis found granulomatous lesions with typical parasites eggs due to schistosomiasis eggs. As a consequence of that, the patient underwent medical therapy. The pathologist's role becomes nullifying not only for the diagnosis of parasitic infections but also for the exclusion or evidence of urothelial squamous neoplasia. The low incidence of this rare parasitic disease in European tourists and the presence of immigrants in our country require to spread the knowledge of these parasites and the most simple tests for early detection.

Diagnostic value of micro-histology in endometrial brushing.

INTRODUCTION: The efficacy of direct endometrial sampling by brushing in the collection of adequate and representative material is evaluated. METHODS: From January 1 2008 to October 31 2009, 195 women (age 29-82, mean 56, 113 postmenopausal), underwent endometrial brushing with Endoflower. All samplings were performed in an outpatient setting. 137 patients had abnormal uterine bleeding (70 postmenopausal), 25 had asymptomatic endometrial thickening (> 4 mm), 6 had atypical endometrial cells on pap-smear, 9 patients needed preoperative controls for uterine prolapse, 11 were treated with tamoxifen and 7 had other problems. The samples were fixed in a solution containing alcohol, water, EDTA and KCO3, and centrifuged. The supernatant was filtered and the pellet embedded in paraffin. RESULTS: All patients reported that the technique was painless. Three cases suffered from shock. In 29 cases (15%), the sampling procedure was difficult due to cervical stenosis. A cellular sample large enough to prepare a cell-block was obtained in all cases. In 27 cases (14%), the sample was non-diagnostic. Cases were categorized as non-pathologic (negative) or pathologic (atypical and carcinoma). The correlation between cyto-histology on samples obtained with brushing and histology on biopsy or surgical specimen was possible in 46 cases (24%), with a diagnostic concordance of 93%. The rate of inadequate biopsies was 27% (8/30). 13 of 15 malignant neoplasias (2 carcinosarcomas, 13 endometrioid adenocarcinomas) were correctly diagnosed in samples collected with Endoflower. The sensitivity was 87% and specificity was 96%, with a positive predictive value of 92% and a negative predictive value of 90%. CONCLUSIONS: Endometrial direct sampling with the Endoflower device in an outpatient setting is well tolerated and well accepted by the gynaecologist. This sampling procedure allows preparation of cell-blocks. Endometrial cyto-histology is less expensive and invasive than other procedures and it could therefore be used in association with transvaginal sonography, even in institutions where liquid-based cytology is not in use.

[Multilocular cystic renal cell carcinoma: our experience].

Multilocular cystic renal cell carcinoma is now recognized as an independent pattern by WHO; it is a rare malignancy with a predominantly cystic growth, characterized by very low oncologic evolution and then susceptible to conservative treatment. In the kidney cystic masses of different origin may arise, i.e. due to malformation, acquired disease or tumor. Renal neoplastic lesions may have a cystic or pseudocystic component. There are also four types of neoplasm with a predominantly cystic growth, including the multilocular cystic carcinoma, which are macroscopically very similar and impossible to differentiate through diagnostic pre-operative images. The Authors present four cases of multilocular cystic renal cell carcinoma diagnosed in the 2000-2007 period, with special reference to diagnostic difficulties and to pre- and intra-operative features of the neoplasm. In conclusion, the extemporaneous histological preoperative diagnosis of multilocular cystic renal cell carcinoma is not possible because it requires extensive sampling; furthermore, the final histological diagnosis sometimes needs particular immunohistochemical procedures to be confirmed.

[Serous cystadenocarcinoma of the ovary with simultaneous breast metastases. Description of a case]. / Cistoadenocarcinoma sieroso dell'ovaio con simultanea metastasi mammaria. Descrizione di un caso.

Metastasis to the breast from extramammary malignancies are rare especially from ovarian carcinoma. We report a case of a 72-year-old woman with a mass in the right ovary and a lump in the left breast together with axillary lymph node enlargement. Both the ovarian and mammary neoplasms were found to be papillary carcinoma with similar immunohistochemical pattern (anti-CA-125: positive; anti-GCDFP-15: negative); some of the axillary lymph nodes showed metastasis with papillary features. On the basis of clinical, morphological and immunohistochemical data we proposed the diagnosis of papillary cystoadenocarcinoma of the ovary with simultaneous metastasis to the breast and axillary lymph nodes.

[Description of a case of squamous cell carcinoma of the renal pelvis]. / Descrizione di un caso di carcinoma squamocellulare della pelvi renale.

A case of squamous cell carcinoma of renal pelvis is reported. A 73-year-old Caucasian male complained of macrohematuria. The echography and Computer Tomography scan of the abdomen and pelvis revealed a large tumor mass in the right kidney associated with lymphadenopathy. A nephrectomy of the right kidney and lymphadenectomy were performed. The isotologic examination revealed a squamous carcinoma of the renal pelvis involving the renal parenchyma and extending to the perirenal fat. The regional lymph nodes were also involved. Neoplastic invasion of inferior vena cava was found. Squamous carcinoma in situ and squamous metaplasia were noted in the urothelium adjacent to the tumor. Three months later an echography revealed a local recurrence of the disease. The patient underwent adjuvant chemotherapy. The aggressive course of the disease is in agreement with the poor prognosis of squamous carcinomas of the renal pelvis as previously reported in the literature.

[Treatment of infection of the lower respiratory tract. Experience with a new quinolinone: pefloxacin]. / Il trattamento delle infezioni delle basse vie respiratorie. Esperienza con un recente chinolonico: la pefloxacina.

Twenty-nine patients (16 females and 13 males, aged 48 to 81 years) with lower respiratory tract infections have been treated with pefloxacin 400 mg, orally and/or intravenously, every 12 hours for 3 to 13 days. No other antibacterial agent was associated. Two patients dropped out because of gastralgia and vomiting and one because of pruritus. Success was obtained in 23 (88%) out of the 26 patients who completed the study. A patient with pleural empyema was treated successfully by washing the pleural cavity with a dextrose solution of pefloxacin. In addition to the drop-outs, 4 patients complained of gastralgia which disappeared spontaneously in 2 of them or after switching from oral to parenteral administration in the other 2. No adverse interaction was observed between pefloxacin and other drugs taken concomitantly, in particular theophylline, corticosteroids, and beta 2-adrenoceptor stimulants. Hematological tests including blood-cell count did not reveal any adverse modification.