Magnetic resonance/ultrasound fusion targeted biopsy of the prostate can be improved by adding systematic biopsy.

AIM: Magnetic resonance/ ultrasound fusion targeted biopsy (Tbs) is widely used for diagnosing prostate cancer (PCa). The aim of our study was to compare the cancer detection rate (CDR) and the clinically significant prostate cancer detection rate (csPCa) of the magnetic resonance/ultrasound fusion targeted biopsy with those of the standard systematic biopsy (Sbs) and of the combination of both techniques. MATERIAL AND METHODS: A total of 182 patients underwent magnetic resonance/ultrasound fusion Tbs on the prostate for PCa suspicion based on multiparametric magnetic resonance imaging (mMRI) detection of lesions with PI-RADSv2 score ≥3. A total of 78 patients had prior negative biopsies. Tb was performed by taking 2-4 cores from each suspected lesion, followed by Sb with 12 cores. We evaluated the overall detection rate of PCa and clinically significant prostate cancer, defined as any PCa with Gleason score ≥3+4. RESULTS: Median prostate specific antigen (PSA) level pre-biopsy was 7.4 ng/ml and median free-PSA/PSA ratio was 10.2%. Patient median age was 62 years old. PIRADSv2 score was 3 in 54 cases, 4 in 96 cases and 5 in 32 cases. PI-RADS-dependent detection rate of Tbs for scores 3, 4 and 5 was 25.9%, 65.6% and 84.4%, respectively, with csPCa detection rates of 24.1%, 54.2%, and 71.9%. Overall detection rate was 57.1% for Tbs, which increased to 60.4% by adding Sbs results. Detection rate for clinically significant prostate cancer (csPCa) was 48.4% and increased to 51.1% by adding Sbs. Overall detection rate for repeated biopsy was 50% and 68.3% for biopsy in naïve patients. Sbs detection rate was 55.5%, 8 patients having a negative biopsy on Tbs. CONCLUSIONS: When Tbs is considered due to a PI-RADS ≥3 lesion on mMRI, combined Tbs + Sbs increases the overall CDR and csPCa detection rates.

Predictive factors for pseudocysts and peripancreatic collections in acute pancreatitis.

BACKGROUND: Acute pancreatitis (AP) is a proteiform disease which may lead to various complications. Pancreatic pseudocysts and fluid collections are among the most frequent of them. The aim of our study was to find predictive factors of their occurrence. METHODS: We carried out a retrospective cohort study comprising one year patients admitted to our department with AP. Fisher's exact and U Mann Whitney tests were used for correlations, with a probability of error < 5% (p<0.05). RESULTS: We included 62 patients with a mean age of 49 years; 77.4% were males. AP etiology was due to alcohol (58.1%), biliary disorders (22.6%), hyper-triglycerides (8.1%) and post-ERCP (3.2%). Pancreatic cancer was revealed in (6.5%) patients. From the whole group 2 patients (3.2%) died. There were 22 patients with pseudocysts (35.5%) and 13 patients with acute fluid collections (21%). Multiple pseudocysts were present in 12 cases (54.5%), mean diameter was 39.5 mm. Pancreatic head localization was most frequent (63.6%). Alcoholic etiology was associated with acute pseudocysts formation (p=0.007) as well as lower values of alkaline phosphatase (96 U/L versus 286 U/L, p = 0.016). The area under the receiver operating characteristics curve demonstrated values of alkaline phosphatase < 2 x upper normal values were predicting pseudocyst occurrence with > 90% specificity. Presence of ascites predicted formation of acute fluid collections, (p < 0.001). CONCLUSIONS: Alcoholic etiology and low values of serum alkaline phosphatase seem to predict pseudocysts formation in acute pancreatitis, while ascites forecast acute fluid collections occurrence.

The contribution of non-invasive imaging modalities to the diagnosis of left ventricular pseudoaneurysm.

BACKGROUND: Left ventricular pseudoaneurysm (LVPA) is a rare entity characterized by a tendency to spontaneous rupture due to its morphology, a lack of myocardial fibers and fibrous tissue delineating the cavity. An early diagnosis is essential in order to guide appropriate therapy. PURPOSE: To determine the diagnostic accuracy of different imaging techniques, treatment results, and prognosis of patients (pts) with LVPA. METHODS: We evaluated the incidence of LVPA during a five-year period. The initial clinical presentation, the etiology of LVPA, time between symptom onset and diagnosis, and use of various non-invasive techniques were studied. Mean follow-up was 15 months. RESULTS: Of 19113 pts admitted to our Institute in a five-year period, LVPA was diagnosed in 11 pts (0.05%) (mean age 51 +/- 3.9 years, 8 men). The diagnosis of LVPA was confirmed by surgery in 4 pts, and by pathology in 2 pts. LVPA was an incidental finding in one asymptomatic pt, it was diagnosed in 6 pts presenting with an acute myocardial infarction (AMI) and in 4 pts presenting with LV failure. The main etiology was coronary artery disease (CAD) (9 pts), with the remaining 2 cases being post-traumatic (thoracic stab wound, surgery). LVPA location was postero-inferior in 6 patients, infero-lateral in 3 patients, and anterior in 2 patients. ECG, X-ray and TTE were performed in all cases. 6 pts had a radionuclide angiography (RNA), 3 pts had a computed tomography (CT) scan and 2 pts had a magnetic resonance imaging (MRI) study. Two-dimensional transthoracic echocardiography (TTE) provided information regarding LVPA dimensions and LV-LVPA flow. Four pts were operated (one died). Of the seven non-operated pts., 5 died. CONCLUSIONS: The clinical presentation was variable and non-specific. The most frequent cause of LVPA was MI and the most frequent location was inferior. Echocardiography offered the most reliable information when compared to ventriculography. Because clinical examination, ECG, X-ray data are non-specific for the diagnosis of LVPA, an adequate TTE study performed with a high clinical index of suspicion (especially in pts with inferior MI or thoracic trauma) could facilitate the early diagnosis of LVPA and could be relevant to outcome.

Implementation of preventive mental health services for children of physically ill parents: experiences in seven European countries and health care systems.

OBJECTIVE: Parental physical disease is a family issue, but families' minor children are seldom considered. The current study analyzed experiences with implementation of counseling for families with physically ill parents and minor children during a European multisite pilot project. METHOD: Implementation protocols of seven European partner centers collaborating in a joint research project were analyzed by Mayring's qualitative content analysis. Both an inductive approach and a deductive approach were chosen. Satisfaction of families and therapists was considered based on information from three partner centers. RESULTS: Satisfaction with counseling was rather high. Mentioned problems referred to aspects related to liaison partners, family-related aspects and physicians' concerns. Recommendations related to contacting families, liaising with other professions, implementing counseling together with a research project, and training. Results are integrated in the current dissemination literature. CONCLUSION: Successful implementation was mostly determined by aspects of interdisciplinary cooperation and communication, perceived relative advantage and organizational premises. With regard to this kind of innovative child-centered family mental health services, top-down and bottom-up implementation strategies should be combined, and strategies of maintenance and sustainability should be considered from the very beginning.

A normal FEV1/VC ratio does not exclude airway obstruction.

BACKGROUND: A decreased forced expiratory volume in 1 s/vital capacity (FEV(1)/VC) ratio is the hallmark of the definition of airway obstruction. We recently suggested that a lung function pattern, we called small airways syndrome (SAOS), has a normal FEV(1)/VC and total lung capacity (TLC) and reflects obstruction of small airways. OBJECTIVES: To substantiate our hypothesis we measured and compared lung function tests including maximal expiratory flow rates (MEFR), sensitive indicators of airway obstruction, in SAOS subjects and in matched controls. METHODS: We selected 12 subjects with the pattern of SAOS, but without chronic lung or heart disease (average age: 40.7 +/- 7.8 years) and 36 age-matched subjects with normal lung function (42.8 +/- 6.3 years). We measured static and dynamic lung volumes, MEFR and lung diffusing capacity (DL(CO)). RESULTS: SAOS subjects were heavier smokers (p < 0.05) and body mass index was less than in control subjects (p < 0.01). Both FEV(1)/VC ratio and TLC were comparable in the two groups. However, FEV(1), VC, DL(CO), and MEFR were lower and residual volume (RV) and RV/TLC ratio were higher (p < 0.05) in the SAOS group than in the control one. Furthermore, the MEFR curve of the SAOS group was displaced to the left without any change in slope, suggesting premature airway closure. CONCLUSION: Our results suggest that a normal FEV(1)/VC ratio does not exclude airway obstruction. A decrease of FEV(1), provided TLC is normal, reflects small airway obstruction.