Octogenarian with an untreated femoral neck fracture: upright position during the postoperative course after aortic valve replacement.

We describe a patient with a femoral neck fracture undergoing an aortic valve replacement. The study design was a case report. An 82-year-old female with an untreated right femoral neck fracture, and a severe aortic valve stenosis was admitted to a cardiac surgery department for surgical treatment of the valve disease. She underwent aortic valve replacement with a sutureless biological valve prosthesis through a partial sternotomy. At an early stage, the patient was instructed to make postural changes in the standing position. As a result, she was able to perform body movements associated with either a sitting or standing position. This case shows that appropriate early mobilization of a patient with a femoral neck fracture is feasible after aortic valve replacement, even though this does not necessarily mean that the patient needs to walk.

Five simultaneous artificial intelligence data challenges on ultrasound, CT, and MRI.

PURPOSE: The goal of this data challenge was to create a structured dynamic with the following objectives: (1) teach radiologists the new rules of General Data Protection Regulation (GDPR), while building a large multicentric prospective database of ultrasound, computed tomography (CT) and MRI patient images; (2) build a network including radiologists, researchers, start-ups, large companies, and students from engineering schools, and; (3) provide all French stakeholders working together during 5 data challenges with a secured framework, offering a realistic picture of the benefits and concerns in October 2018. MATERIALS AND METHODS: Relevant clinical questions were chosen by the Société Francaise de Radiologie. The challenge was designed to respect all French ethical and data protection constraints. Multidisciplinary teams with at least one radiologist, one engineering student, and a company and/or research lab were gathered using different networks, and clinical databases were created accordingly. RESULTS: Five challenges were launched: detection of meniscal tears on MRI, segmentation of renal cortex on CT, detection and characterization of liver lesions on ultrasound, detection of breast lesions on MRI, and characterization of thyroid cartilage lesions on CT. A total of 5,170 images within 4 months were provided for the challenge by 46 radiology services. Twenty-six multidisciplinary teams with 181 contestants worked for one month on the challenges. Three challenges, meniscal tears, renal cortex, and liver lesions, resulted in an accuracy>90%. The fourth challenge (breast) reached 82% and the lastone (thyroid) 70%. CONCLUSION: Theses five challenges were able to gather a large community of radiologists, engineers, researchers, and companies in a very short period of time. The accurate results of three of the five modalities suggest that artificial intelligence is a promising tool in these radiology modalities.

Complex repair of the thoracic aorta with the E-vita open prosthesis.

AIM: The treatment of complex aortic pathologies of the thoracic aorta remains a challenging issue in aortic surgery. The'' Frozen elephant trunk'' technique represents a recent development of the classic elephant trunk technique combining endovascular with conventional surgery. METHODS: Between January 2007 and January 2008, 24 patients were operated on for complex pathologies of the thoracic aorta using the frozen elephant trunk technique with the E-vita open prosthesis. There were 21 male (87.5%) and the mean age was 62.4+/-9.9 years. The majority of patients (N=11) presented type A chronic dissection, 6 (25%) patients had chronic aneurysm of distal aortic arch and 5 (20.8%) type B aortic dissection associated with ascending aorta/aortic arch aneurysm. There were 2 cases of acute aortic dissection (1 type A and 1 type B). Nine patients (37.5%) underwent previous cardiovascular operations. RESULTS: The overall in-hospital mortality was 4.2% (1 patient). None patient developed postoperative stroke and 1 patient suffered from spinal cord ischemia (1 paraparesis, 1 paraplegia). There were 2 cases (8.3%) of renal failure (dialysis), 2 patients (8.3%) had pulmonary complications and 2 patients (8.3%) needed rethoracotomy for bleeding. Five patients (21.7%) required extension of the descending thoracic aorta repair with endovascular treatment for persistent perfusion of dilated false lumen. CONCLUSION: The Frozen Elephant trunk technique with the new E-vita open prosthesis combines surgical and interventional technologies and it represents a feasible and efficient option in the treatment of complex aortic pathologies. However long term follow up is required.

Psoas abscess ten years after ipsilateral nephrectomy for pyonephrosis.

Pyogenic abscess of the psoas muscle is a rare disease. The Authors report a recently observed case which developed 10 years after ipsilateral nephrectomy for pyonephrosis, reviewing the pertinent literature. The culture of the pus extracted only reproduced Proteus mirabilis. The relation between psoas abscess and nephrectomy is unclear. To make diagnosis is important to consider this condition in differential diagnosis in presence of fever and flank tenderness in a nephrectomized patient.

Women's career choices in radiology in France.

PURPOSE: The purpose of this study was to determine the possible effects of gender on residents' and fellows' motivations in choosing radiology as a career in France, and on choosing a practice setting later on. MATERIAL AND METHODS: An online survey was sent to French residents and fellows in order to access their radiology practice and career aspirations, as well as the potential influence of their gender. Influence of being a woman on initial professional expectations, professional choices, and the evolution of career paths was investigated using the chi-square test. RESULTS: Responses were collected from 206 French residents and fellows. The reasons for choosing radiology residency were, at first, mostly the same for men and women such as interest in the specialty (100% of women and men), work conditions (74% of women and men), technical aspects of the specialty (63% of men and 52% of women, P=0.11) or "reasonable" workload (29% women and 21% men, P=0.19); however, 74% of women stated that maternity might influence their career choices, and were less interested in unstable positions exclusively in private practice (45% men and 33% women, P=0.05). CONCLUSION: Male and female radiologists primarily considered the same factors in choosing their specialties. However, maternity is still a source of inequality in France, including fewer opportunities for fellowship positions or academic careers. Furthermore, more women were willing to work in salaried positions to acquire a secure job, even though compensation might be lower.

Women authorship in radiology research in France: An analysis of the last three decades.

PURPOSE: The aim of this study was to evaluate the evolution of women authorship in France and to analyze the recent trends of the evolution of gender differences in French academic radiology. MATERIALS AND METHODS: A retrospective bibliometric analysis was performed by searching for articles published in Diagnostic and Interventional Imaging (Diagn Interv Imaging) and in Journal de Radiologie (J Radiol) in Pubmed over the last three decades. For each of these articles, we determined the gender of the first and last author. The specific radiological field of each article was also determined. RESULTS: The proportion of women authors has significantly increased from 12% in 1984 to 34% in 2014 (P<0.0001) for the first authors and from 11% (11/96) in 1984 to 20% (38/193) in 2014 for last authors (P =0.03). CONCLUSION: Women authorship in Diagnostic and Interventional Imaging has increased over the last years together with the proportion of women first authors. However, the fraction of women last authors is still underrepresented. More women need to become leaders in radiological research to contribute to stimulate women authorship.

Nine years experience of aortic arch repair with the aid of antegrade selective cerebral perfusion.

AIM: Antegrade selective cerebral perfusion (ASCP) is gaining widespread popularity in aortic arch surgery because it has been demonstrated to be an optimal technique of cerebral protection. This study demonstrates the clinical results of aortic arch repair with ASCP. METHODS: Between November 1996 and September 2004, 250 patients underwent thoracic aorta replacement using ASCP under moderate hypothermia. Mean patients age was 63+/-11.5 years. Presenting pathologies were chronic aneurysm in 136 patient (54.4%), type A acute aortic dissection in 80 patients (32%), post-dissection aneurysm in 30 patients (12%). Ascending aorta and hemiarch replacement was performed in 63 patients (25.2%), ascending aorta and total arch replacement in 131 patients (52.4%), total arch replacement in 33 patients (13.2%), total arch and descending aorta replacement in 10 patients (4%) and complete replacement of the thoracic aorta in 13 patients (5.2%). RESULTS: Hospital mortality was 11.6%. Multivariate analysis showed preoperative renal failure (P=0.050), cerebral perfusion time (P<0.001), pulmonary complications (P=0.009) and postoperative dialysis (P=0.030) as risk factors for hospital mortality. Permanent neurologic deficits occurred in 4 patients (1.6%) and coronary artery disease (P=0.029) was found to be the only independent risk factor. Transient neurologic deficits were noted in 18 patients (7.2%). Multivariate analysis revealed age (P=0.043), coronary artery disease (P=0.036), urgent/emergency status of the operation (P=0.016) and concomitant aortic valve replacement (P=0.001) to be independent predictors of transient neurologic dysfunction. The actuarial survival rate at 7 years was 61.7%. CONCLUSIONS: | Our results confirmed that ASCP is a safe method of brain protection allowing complex aortic repairs to be performed with good results in terms of hospital mortality and neurologic outcome. Cerebral perfusion time did not influence postoperative outcome. The use of moderate hypothermia avoided all undesirable effects of deep hypothermia.

[Pinworm infestation of the appendix]. / Ossiuriasi appendicolare: nostra esperienza.

The Authors present 2 cases of enterobiasis of appendix observed on a total of 186 appendicectomies. Enterobius infestation is an uncommon cause of acute appendicitis. Preoperative diagnosis of pinworm infestation is almost impossible without clinical suspect. Parasites may produce symptoms which resemble acute appendicitis but parasitic infection rarely causes it. It is also important considered in the differential diagnosis cases that mimic Crohn's disease.

[Multimodal imaging of ischemic heart diseases: A 2015 update]. / Imagerie multimodale des cardiopathies ischémiques : possibilités et indications en 2015.

Current realities and future possibilities of imaging in the ischemic heart diseases are very broad and constantly evolving, with the improvement of existing technologies and the introduction of new features such as dual-energy CT, strain ultrasound, multimodality fusion or perfusion MRI. Regular collaboration between prescribing clinicians, cardiologists, radiologists and nuclear radiologists is therefore essential to tailor the examination to the specific clinical question. The indications for each modality will therefore depend on its diagnostic performance, cost, acquisition and post-processing times and eventual radiation exposure. This review will detail principles and applications of current cardiac imaging examinations: echocardiography, nuclear medicine, MRI, CT and coronary angiography, emphasizing their current strengths and weaknesses in the ischemic heart diseases management.

Sacroiliac joints imaging in axial spondyloarthritis.

Imaging of the sacroiliac joints is the key point in diagnosing and classifying spondyloarthritis. Since the integration of MRI criteria to the Assessment of Spondyloarhtitis Society (ASAS) classification in 2009, the attention was focused on the presence of bone marrow edema to characterize sacroiliitis. However, returning to basics and analysing structural signs is of utmost importance to avoid overdiagnosis of spondyloarthritis.

Reoperations on the ascending aorta and aortic root. Early and late results?

AIM: We have retrospectively evaluated our results after aortic root and ascending aorta reoperations to determine risk factors of early death and late mortality. METHODS: From January 1986 to April 2002, 73 patients underwent ''reoperative'' procedures on the aortic root and the ascending aorta. The mean age was 56.1+/-13.4 years and males numbered 62 (84.9%). The most frequent indication for reoperation was degenerative aortic aneurysm (49.3%) followed by post-dissection aneurysm (11%). Aortic root replacement with composite valve graft was performed in 47 patients (64.4%) and with aortic homograft in 2 (2.7%). Nineteen patients (26%) underwent ascending aorta replacement with tubular graft, and 4 (5.5%) underwent tailoring aortoplasty of the ascending aorta. RESULTS: The 30-day mortality rate was 16.4% (12 patients). Mortality following elective operations was 8%, and that following urgent or emergency operations was 34.8% (p=0.002). Late survival of hospital survivors at 1, 5 and 10 years was 93.8%, 77.7% and 37%, respectively. In the multivariate Cox regression analysis chronic renal failure (p=0.003) and urgent or emergency operation (p=0.018) were found to be independent predictors of late mortality. CONCLUSIONS: Reoperations on the ascending aorta can be accomplished with acceptable early mortality and satisfactory long-term RESULTS: More radical treatment of the aortic pathology at the initial operation may reduce the need for further reoperations. A careful follow-up is extremely important for detecting complications of the first operation or progression of the aortic pathology before an emergency operation, predictive of poorer early and late outcome, is needed.

Seldom found acute abdomen: perforated diverticulum in the transverse colon.

The authors report a recently examined rare case of isolated perforated diverticulum of the transverse colon. At surgery, a perforated omentum-sealed diverticulum was found in the third distal wall of the transverse colon. A diverticulectomy was performed. The postoperative course was excellent.

[Postoperative lavage. Experimental study of the use of antiseptic solutions]. / Il lavaggio postoperatorio. Studio sperimentale sull'uso di soluzioni antisettiche.

The authors report their experience of surgical infections and particularly peritoneal intraoperative lavage. In a previous study they have standardized the technique. In this study they report on the lavage adding antiseptic substances in the solution. The experimental, controlled study, was carried out on Wistar rat stock, which were submitted to median laparotomy through which was injected a standard bacterial dose composed of 5 bn E. Coli. The peritoneal cavity was washed out after a few minutes with physiological solution with clorhexidine or PVPI dissolved. The main results were an increase of aderential syndrome and a less survival percent age (physiological solution = 100%, clorhexidine = 60%, iodophors = 23%). The authors concluded by pointing out that the use of antiseptic peritoneal lavage solution is a method that should be proscribed from operating rooms because it is unnecessary and detrimental to health.

[Treatment with immunomodulating drugs of patients with operated cancer. Long-term results]. / Trattamento con farmaci immunomodulatori in pazienti oncochirurgici. Risultati a distanza.

The authors produce a new course of study in order to verify the efficacy of immunomodulatory treatment in cancer-operated patients. In the General Surgical Clinic and Surgical Therapy Institute of University of Ferrara, from July '86 to June '92, 582 cancer-operated patients were treated by immunomodulatory drugs, making use of standard of absolute random. A group (100 patients) was subjected to peroperative anticontagious immunoprophylaxis; B group (482 patients) to postoperative cyclic immunomodulation; in this last group, were codified C group (166 patients) and D group (63 patients), controlled in follow-up, making use of 3 parameters: survival, clinical-oncological restage, performance status. The results obtained confirm the efficacy of the proposed immunomodulatory treatment: a reduction of incidence both early infections and late infections, an increase of survival, falls in clinical-oncological stage to less advanced levels and, above all, an improvement of performance status.

[Primary adenocarcinoma of the second portion of duodenum]. / Adenocarcinoma primitivo della II porzione duodenale.

The authors report a case of primary adenocarcinoma of the second portion of duodenum in a 56-years-old man radically managed by pancreaticoduodenectomy. They remark the rarity of this pathology, the difficulty of making diagnosis peculiar to neoplasms of the small intestine and the difficulty of treatment peculiar to tumours of duodenum. The possible therapy is surgical. Radio and chemotherapy don't significantly improve survival. Better results can be obtained only with an early diagnosis.

[Laparoscopy in iatrogenic lesions of the colon during operative endoscopy]. / La laparoscopia nelle lesioni iatrogene del colon in corso di endoscopia operativa.

Colonscopy is a standard diagnostic and therapeutic procedure that has its own morbidity. Colonic perforation is the dangerous complication of this procedure. Successful management of perforation by conservative or surgical treatment remains controversial. We report two cases, recently observed, of patients with colonic perforation occurring during therapeutic colonscopy treated with minimally invasive technique.

[Adenomyomatosis of the gallbladder. Our experience]. / L'adenomiomatosi della colecisti. Nostra esperienza.

Adenomyomatosis is a rare affection of the gallbladder and it's infrequently reported in the Literature. Having observed eighteen cases of adenomyomatosis of the gallbladder in the last five years and considering the difficulties in making an early diagnosis of gallbladder cancer, the authors suggest the importance of cholecystectomy in this pathology.

Reversal of Hartmann's procedure. Our experience.

Hartmann's procedure has progressively changed its indications in the last years; nowadays they are reduced by the increasing of anesthesiology and the introduction of stapler devices. The introduction of staplers makes reconstructive operation easier and it contributes to a sensible increasing of reversal percentage after Hartmann's procedure. Video-assisted techniques make Hartmann's procedure possible for older patients with high-risk of post-operative general complications. The authors describe the results obtained with traditional and video-assisted reversal Hartmann's procedure, comparing with data from Literature.

[The right laparoscopic adrenalectomy of an incidentaloma]. / Surrenectomia destra laparoscopica di un incidentaloma.

The authors report a case of incidental lesion of right adrenal gland in a 56-years-old patient, followed for a liver disfunction. The lesion, with cystic and hemorrhagic histological characters, was treated with laparoscopic resection. The following case report covers the diagnostic procedures, laparoscopic technique, showing the advantages, and postoperative course in surrenal lesion without local infiltration.

Intestinal occlusion secondary to Morgagni-Larrey's herniation in an adult. Case report and analysis of the literature.

Morgagni-Larrey's hernias are congenital diaphragmatic hernias, rarely observed and generally identified accidentally due to the lack of symptoms. The authors report a case of intestinal occlusion secondary to Morgagni-Larrey herniation in an adult recently observed and underline the aetiopathogenic aspects, the diagnostic tools and the clinical pattern. They suggest to consider surgical repair as a choice of treatment, also for asymptomatic patients.