Format
Sort by
Items per page

Send to

Choose Destination

Search results

Items: 1 to 20 of 25

1.
Pol J Radiol. 2018 Dec 30;83:e519-e523. doi: 10.5114/pjr.2018.81441. eCollection 2018.

Corona mortis variant of the obturator artery: a systematic study of 300 hemipelvises by means of computed tomography angiography.

Author information

1
Azienda Ospedaliera Universitaria Integrata Verona (AOUI), Verona, Italy.

Abstract

Purpose:

The purpose of the present study is to systematically assess the prevalence and characteristics of the corona mortis (CM) variant of the obturator artery by means of computerised tomography angiography (CTA).

Material and methods:

A total of 150 consecutive patients (112 males, average age 73 years) referred to CTA for lower limb arterial evaluation were included in this retrospective study. Patient demographics, anastomosis incidence, artery diameter, distance from the symphysis pubis, Kellgren-Lawrence score, and pelvic size were evaluated.

Results:

In this study 40.6% of patients presented at least one competent CM arterial anastomosis. In the 300 evaluated arteries, 90 arterial anastomoses were found (30%), 40 on the right side (average diameter 1.63 mm) and 50 on the left side (1.78 mm). In 32 cases there was only one anastomosis, while in 29 cases the CM was bilateral. No anastomoses were detected in 89 patients. Mean distance from the symphysis was 50 mm. No relevant association with hip osteoarthrosis was found for CM. Mean pelvic size was 213 mm.

Conclusions:

The evidence from this study suggests that CM is a common variant that needs to be acknowledged before pelvic intervention.

KEYWORDS:

computerised tomography angiography; corona mortis; variant anatomy

Conflict of interest statement

The authors report no conflict of interest.

2.
J Ultrason. 2018;18(75):359-364. doi: 10.15557/JoU.2018.0053.

Iodinated contrast-induced sialadenitis: a review of the literature and sonographic findings in a clinical case.

Author information

1
Department of Radiology, University Hospital of Verona, Polo Chirurgico "Confortini" , Verona , Italy.

Abstract

Swelling of the salivary glands, also known as iodide or iodine mumps, is a rare adverse reaction to administration of iodine, a component steadily present in current contrast media and in a variety of medications. We report and compare with published literature the clinical and sonographic findings in a case of iodide mumps that developed after the intravenous administration of iodine-based contrast media for a contrast-enhanced computed tomography scan. The exact pathogenesis is unknown to date: based on sonographic appearance, we support the hypothesis of an acute inflammatory condition elicited by iodine accumulation in the salivary glands. The emergency care practitioner needs to be confident with the clinical symptoms as well as the sonographic findings and therapeutic options to successfully manage this condition.

3.
J Obstet Gynaecol Res. 2018 Feb;44(2):292-297. doi: 10.1111/jog.13523. Epub 2017 Nov 2.

Defining probabilities of bowel resection in deep endometriosis of the rectum: Prediction with preoperative magnetic resonance imaging.

Author information

1
Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
2
Department of Radiology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.

Abstract

AIM:

Deep endometriosis of the rectum is a highly challenging disease, and a surgical approach is often needed to restore anatomy and function. Two kinds of surgeries may be performed: radical with segmental bowel resection or conservative without resection. Most patients undergo magnetic resonance imaging (MRI) before surgery, but there is currently no method to predict if conservative surgery is feasible or whether bowel resection is required. The aim of this study was to create an algorithm that could predict bowel resection using MRI images, that was easy to apply and could be useful in a clinical setting, in order to adequately discuss informed consent with the patient and plan the an appropriate and efficient surgical session.

METHODS:

We collected medical records from 2010 to 2016 and reviewed the MRI results of 52 patients to detect any parameters that could predict bowel resection. Parameters that were reproducible and with a significant correlation to radical surgery were investigated by statistical regression and combined in an algorithm to give the best prediction of resection.

RESULTS:

The calculation of two parameters in MRI, impact angle and lesion size, and their use in a mathematical algorithm permit us to predict bowel resection with a positive predictive value of 87% and a negative predictive value of 83%.

CONCLUSIONS:

MRI could be of value in predicting the need for bowel resection in deep endometriosis of the rectum. Further research is required to assess the possibility of a wider application of this algorithm outside our single-center study.

KEYWORDS:

conservative surgery; deep infiltrating endometriosis; laparoscopic bowel resection; magnetic resonance imaging

PMID:
29094417
DOI:
10.1111/jog.13523
[Indexed for MEDLINE]
Icon for Wiley
4.
Pol J Radiol. 2017 May 1;82:244-247. doi: 10.12659/PJR.899825. eCollection 2017.

Endovascular Repair of an Unusually Complex Anastomotic Pseudoaneurysm of an Aorto-Bisiliac Graft.

Author information

1
Department of Radiology - Interventional Radiology Unit, University Hospital of Verona, Polo Chirurgico "P. Confortini", Verona, Italy.
2
Department of Vascular Surgery, University Hospital of Verona, Polo Chirurgico "P. Confortini", Verona, Italy.

Abstract

BACKGROUND:

Anastomotic pseudoaneurysm is an underestimated complication of aorto-iliac grafts.

CASE REPORT:

This case report describes an unusual presentation of a pseudoaneurysm with a particularly complex anatomy involving both the left iliac branches, which hindered the interpretation of diagnostic studies and therapeutic management in a patient with multiple comorbidities.

CONCLUSIONS:

The manuscript describes a successful management of such a complication by means of an elective endovascular approach.

KEYWORDS:

Aneurysm, False; Aortic Aneurysm, Abdominal; Endovascular Procedures

Conflict of interest statement

Conflicts of interest All the authors declare that they have no conflict of interest.

5.
Pol J Radiol. 2016 Nov 10;81:532-535. eCollection 2016.

Successful Treatment of Resistant Hypertension by Means of Chronic Renal Artery Occlusion Revascularization in a Fragile Patient.

Author information

1
Department of Radiology, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy.
2
Department of Radiology, Fondazione Poliambulanza Brescia, Brescia, Italy.

Abstract

BACKGROUND:

Renal artery stenosis is a common cause of secondary hypertension refractory to medical therapy. Percutaneous angioplasty along with metallic stent placement has been described as an effective treatment for revascularization of the renal artery.

CASE REPORT:

A 54-year-old woman affected by paranoid schizophrenia with a history of hypertension and chronic renal failure due to renal artery occlusion was treated by endovascular recanalization and stent placement that resulted in improvement of renal function and control of hypertension. Laboratory studies 4 months after the revascularization revealed blood creatinine decrease gradually from 8.57 mg/dL to 3 mg/dL.

CONCLUSIONS:

Revascularization with stenting has proven to be a safe and effective procedure in the treatment of total renal artery occlusion which also led to a significant relief at a psychological level.

KEYWORDS:

Endovascular Procedures; Hypertension, Renovascular; Mentally Disabled Persons; Renal Artery Obstruction; Stents

6.
World J Radiol. 2016 Aug 28;8(8):729-34. doi: 10.4329/wjr.v8.i8.729.

Enhanced characterization of solid solitary pulmonary nodules with Bayesian analysis-based computer-aided diagnosis.

Author information

1
Simone Perandini, Gian Alberto Soardi, Massimiliano Motton, Raffaele Augelli, Chiara Dallaserra, Gino Puntel, Arianna Rossi, Giuseppe Sala, Manuel Signorini, Laura Spezia, Federico Zamboni, Stefania Montemezzi, Department of Radiology, Azienda Ospedaliera Universitaria Integrata di Verona, 37100 Verona, Italy.

Abstract

The aim of this study was to prospectively assess the accuracy gain of Bayesian analysis-based computer-aided diagnosis (CAD) vs human judgment alone in characterizing solitary pulmonary nodules (SPNs) at computed tomography (CT). The study included 100 randomly selected SPNs with a definitive diagnosis. Nodule features at first and follow-up CT scans as well as clinical data were evaluated individually on a 1 to 5 points risk chart by 7 radiologists, firstly blinded then aware of Bayesian Inference Malignancy Calculator (BIMC) model predictions. Raters' predictions were evaluated by means of receiver operating characteristic (ROC) curve analysis and decision analysis. Overall ROC area under the curve was 0.758 before and 0.803 after the disclosure of CAD predictions (P = 0.003). A net gain in diagnostic accuracy was found in 6 out of 7 readers. Mean risk class of benign nodules dropped from 2.48 to 2.29, while mean risk class of malignancies rose from 3.66 to 3.92. Awareness of CAD predictions also determined a significant drop on mean indeterminate SPNs (15 vs 23.86 SPNs) and raised the mean number of correct and confident diagnoses (mean 39.57 vs 25.71 SPNs). This study provides evidence supporting the integration of the Bayesian analysis-based BIMC model in SPN characterization.

KEYWORDS:

Bayesian prediction; Computer-aided diagnosis; Lung neoplasms; Multidetector computed tomography; Solitary pulmonary nodule

Publication type

Publication type

7.
Eur Radiol. 2017 May;27(5):2042-2046. doi: 10.1007/s00330-016-4580-3. Epub 2016 Sep 15.

Multicenter external validation of two malignancy risk prediction models in patients undergoing 18F-FDG-PET for solitary pulmonary nodule evaluation.

Author information

1
UOC Radiologia, Ospedale Maggiore di Borgo Trento, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale Stefani 1, Verona, 37124, Italy. mail@simoneperandini.com.
2
UOC Radiologia, Ospedale Maggiore di Borgo Trento, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale Stefani 1, Verona, 37124, Italy.
3
Dipartimento di Scienze Radiologiche, Università Cattolica del Sacro Cuore, Roma, Italy.
4
UO Chirurgia Toracica, Ospedale Humanitas Gavazzeni, Bergamo, Italy.
5
UO Radiologia, Ospedale Humanitas Gavazzeni, Bergamo, Italy.
6
UO Pneumologia, Ospedale dell'Angelo di Mestre, Venezia, Italy.
7
UO Radiologia, Ospedale dell'Angelo di Mestre, Venezia, Italy.

Abstract

OBJECTIVES:

To achieve multicentre external validation of the Herder and Bayesian Inference Malignancy Calculator (BIMC) models.

METHODS:

Two hundred and fifty-nine solitary pulmonary nodules (SPNs) collected from four major hospitals which underwent 18-FDG-PET characterization were included in this multicentre retrospective study. The Herder model was tested on all available lesions (group A). A subgroup of 180 SPNs (group B) was used to provide unbiased comparison between the Herder and BIMC models. Receiver operating characteristic (ROC) area under the curve (AUC) analysis was performed to assess diagnostic accuracy. Decision analysis was performed by adopting the risk threshold stated in British Thoracic Society (BTS) guidelines.

RESULTS:

Unbiased comparison performed In Group B showed a ROC AUC for the Herder model of 0.807 (95 % CI 0.742-0.862) and for the BIMC model of 0.822 (95 % CI 0.758-0.875).

CONCLUSIONS:

Both the Herder and the BIMC models were proven to accurately predict the risk of malignancy when tested on a large multicentre external case series. The BIMC model seems advantageous on the basis of a more favourable decision analysis.

KEY POINTS:

• The Herder model showed a ROC AUC of 0.807 on 180 SPNs. • The BIMC model showed a ROC AUC of 0.822 on 180 SPNs. • Decision analysis is more favourable to the BIMC model.

KEYWORDS:

18 F-fluorodeoxyglucose positron emission tomography; Computed tomography; Decision analysis; Lung cancer; Solid pulmonary nodule

PMID:
27631108
DOI:
10.1007/s00330-016-4580-3
[Indexed for MEDLINE]
Icon for Springer
8.
Eur Radiol. 2017 May;27(5):1929-1933. doi: 10.1007/s00330-016-4538-5. Epub 2016 Aug 23.

Multicentre external validation of the BIMC model for solid solitary pulmonary nodule malignancy prediction.

Author information

1
UOC Radiologia, Ospedale Maggiore di Borgo Trento, AOUI Verona, Verona, Italy.
2
UOC Radiologia, Ospedale Maggiore di Borgo Trento, AOUI Verona, Verona, Italy. mail@simoneperandini.com.
3
Dipartimento di Scienze Radiologiche, Università Cattolica del Sacro Cuore, Roma, Italy.
4
UO Chirurgia Toracica, Ospedale Humanitas Gavazzeni, Bergamo, Italy.
5
UO Radiologia, Ospedale Humanitas Gavazzeni, Bergamo, Italy.
6
UO Pneumologia, Ospedale dell'Angelo di Mestre (VE), Mestre, Italy.
7
UO Radiologia, Ospedale dell'Angelo di Mestre (VE), Mestre, Italy.

Abstract

OBJECTIVES:

To provide multicentre external validation of the Bayesian Inference Malignancy Calculator (BIMC) model by assessing diagnostic accuracy in a cohort of solitary pulmonary nodules (SPNs) collected in a clinic-based setting. To assess model impact on SPN decision analysis and to compare findings with those obtained via the Mayo Clinic model.

METHODS:

Clinical and imaging data were retrospectively collected from 200 patients from three centres. Accuracy was assessed by means of receiver-operating characteristic (ROC) areas under the curve (AUCs). Decision analysis was performed by adopting both the American College of Chest Physicians (ACCP) and the British Thoracic Society (BTS) risk thresholds.

RESULTS:

ROC analysis showed an AUC of 0.880 (95 % CI, 0.832-0.928) for the BIMC model and of 0.604 (95 % CI, 0.524-0.683) for the Mayo Clinic model. Difference was 0.276 (95 % CI, 0.190-0.363, P < 0.0001). Decision analysis showed a slightly reduced number of false-negative and false-positive results when using ACCP risk thresholds.

CONCLUSIONS:

The BIMC model proved to be an accurate tool when characterising SPNs. In a clinical setting it can distinguish malignancies from benign nodules with minimal errors by adopting current ACCP or BTS risk thresholds and guiding lesion-tailored diagnostic and interventional procedures during the work-up.

KEY POINTS:

• The BIMC model can accurately discriminate malignancies in the clinical setting • The BIMC model showed ROC AUC of 0.880 in this multicentre study • The BIMC model compares favourably with the Mayo Clinic model.

KEYWORDS:

Computed tomography; Decision analysis; Lung cancer; Solid pulmonary nodule

PMID:
27553937
DOI:
10.1007/s00330-016-4538-5
[Indexed for MEDLINE]
Icon for Springer
9.
Pol J Radiol. 2016 Apr 5;81:146-51. doi: 10.12659/PJR.895417. eCollection 2016.

Distribution of Solid Solitary Pulmonary Nodules within the Lungs on Computed Tomography: A Review of 208 Consecutive Lesions of Biopsy-Proven Nature.

Author information

1
Department of Radiology, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy.

Abstract

BACKGROUND:

The solitary pulmonary nodule (SPN) is a common radiologic abnormality on chest x-rays or computed tomography (CT) scans of the lungs. The differential diagnosis of SPNs is particularly wide as it includes a multitude of benign as well as malignant entities. Nodule location within the lungs has been proposed as a predictive feature in the literature. This study aims at illustrating the distribution within the lungs of a large current series of consecutive SPNs according to their histological subtype, which was definitely proved at core biopsy.

MATERIAL/METHODS:

Two hundred-eight SPNs referred to our center for characterization were reviewed in this single-centre retrospective study. Histological subtypes were defined following the IASLC/ATS/ERS and WHO (2004) histological classification.

RESULTS:

This study provides evidence with respect to the prevalence of adenocarcinomas and other non-neuroendocrine primary lung cancer types in the right upper lobe. It also provides new evidence with respect to the prevalence of carcinoid tumors in the middle and right lower lobe, with a tendency to occur in the central lung parenchyma.

CONCLUSIONS:

This work updates existing knowledge of solid SPNs location within the lungs by providing a current picture of SPN distribution according to their nature.

KEYWORDS:

Carcinoid Tumor; Multidetector Computed Tomography; Solitary Pulmonary Nodule

10.
Pol J Radiol. 2016 Feb 11;81:46-50. doi: 10.12659/PJR.895307. eCollection 2016.

CT Imaging Features in the Characterization of Non-Growing Solid Pulmonary Nodules in Non-Smokers.

Author information

1
Department of Radiology, Azienda Ospedaliera Universitaria Integrata (AOUI) Verona, Verona, Italy.

Abstract

BACKGROUND:

A disappearing or persistent solid pulmonary nodule is a neglected clinical entity that still poses serious interpretative issues to date. Traditional knowledge deriving from previous reports suggests particular features, such as smooth edges or regular shape, to be significantly associated with benignity. A large number of benign nodules are reported among smokers in lung cancer screening programmes. The aim of this single-center retrospective study was to correlate specific imaging features to verify if traditional knowledge as well as more recent acquisitions regarding benign SPNs can be considered reliable in a current case series of nodules collected in a non-smoker cohort of patients.

MATERIAL/METHODS:

Fifty-three solid SPNs proven as non-growing during follow-up imaging were analyzed with regard to their imaging features at thin-section CT, their predicted malignancy risk according to three major risk assessment models, minimum density analysis and contrast enhanced-CT in the relative subgroups of nodules which underwent such tests.

RESULTS:

Eleven nodules disappeared during follow-up, 29 showed volume loss and 16 had a VDT of 1121 days or higher. There were 48 nodules located peripherally (85.71%). Evaluation of the enhancement after contrast media (n=29) showed mean enhancement ±SD of 25.72±35.03 HU, median of 18 HU, ranging from 0 to 190 HU. Minimum density assessment (n=30) showed mean minimum HU ±SD of -28.27±47.86 HU, median of -25 HU, ranging from -144 to 68 HU. Mean malignancy risk ±SD was 15.05±26.69% for the BIMC model, 17.22±19.00% for the Mayo Clinic model and 19.07±33.16% for the Gurney's model.

CONCLUSIONS:

Our analysis suggests caution in using traditional knowledge when dealing with current small solid peripheral indeterminate SPNs and highlights how quantitative growth at follow-up should be the cornerstone of characterization.

KEYWORDS:

Lung Neoplasms; Multidetector Computed Tomography; Solitary Pulmonary Nodule

11.
Eur Radiol. 2016 Sep;26(9):3071-6. doi: 10.1007/s00330-015-4138-9. Epub 2015 Dec 8.

Solid pulmonary nodule risk assessment and decision analysis: comparison of four prediction models in 285 cases.

Author information

1
Department of Radiology, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale Stefani 1, Verona, Italy, 37124. mail@simoneperandini.com.
2
Department of Radiology, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale Stefani 1, Verona, Italy, 37124.

Abstract

OBJECTIVES:

The aim of this study was to compare classification results from four major risk prediction models in a wide population of incidentally detected solitary pulmonary nodules (SPNs) which were selected to crossmatch inclusion criteria for the selected models.

METHODS:

A total of 285 solitary pulmonary nodules with a definitive diagnosis were evaluated by means of four major risk assessment models developed from non-screening populations, namely the Mayo, Gurney, PKUPH and BIMC models. Accuracy was evaluated by receiver operating characteristic (ROC) area under the curve (AUC) analysis. Each model's fitness to provide reliable help in decision analysis was primarily assessed by adopting a surgical threshold of 65 % and an observation threshold of 5 % as suggested by ACCP guidelines.

RESULTS:

ROC AUC values, false positives, false negatives and indeterminate nodules were respectively 0.775, 3, 8, 227 (Mayo); 0.794, 41, 6, 125 (Gurney); 0.889, 42, 0, 144 (PKUPH); 0.898, 16, 0, 118 (BIMC).

CONCLUSIONS:

Resultant data suggests that the BIMC model may be of greater help than Mayo, Gurney and PKUPH models in preoperative SPN characterization when using ACCP risk thresholds because of overall better accuracy and smaller numbers of indeterminate nodules and false positive results.

KEY POINTS:

• The BIMC and PKUPH models offer better characterization than older prediction models • Both the PKUPH and BIMC models completely avoided false negative results • The Mayo model suffers from a large number of indeterminate results.

KEYWORDS:

CT; Computer aided diagnosis; Decision analysis; Lung cancer; Solitary pulmonary nodule

PMID:
26645862
DOI:
10.1007/s00330-015-4138-9
[Indexed for MEDLINE]
Icon for Springer
12.
Ann Vasc Surg. 2016 Jan;30:307.e15-9. doi: 10.1016/j.avsg.2015.07.025. Epub 2015 Oct 28.

Thoracic Aortic Pseudoaneurysm after Esophageal Perforation and Mediastinitis Caused by Accidental Ingestion of a Mutton Bone: A Case Report on Staged Endoscopic and Endovascular Treatments.

Author information

1
Department of Vascular and Endovascular Surgery, University Hospital of Verona, Verona, Italy.
2
Department of Upper Gastrointestinal Surgery, University Hospital of Verona, Verona, Italy.
3
Department of Radiology, University Hospital of Verona, Verona, Italy.
4
Department of Vascular and Endovascular Surgery, University Hospital of Verona, Verona, Italy. Electronic address: gianfranco.veraldi@ospedaleuniverona.it.

Abstract

BACKGROUND:

Esophageal perforation involving the thoracic aorta is a rare but potentially life-threatening event. Esophageal wall dehiscence, aortoesophageal fistula, mycotic aneurysms, or mediastinitis may complicate this challenging condition, and a multidisciplinary approach is mandatory. Aggressive endoscopic and medical therapy followed by thoracic endovascular aneurysm repair (TEVAR) may be a valuable approach to reduce the mortality rate of this catastrophic event.

CASE REPORT:

A 79-year-old man presented at the emergency department with a 2-day history of worsening dysphagia and fever, suddenly appeared after consuming mutton meat. Esophagogastroduodenoscopy and computed tomography (CT) scan at admission showed a bone fragment penetrating the esophagus very close to the thoracic aorta, associated with signs of mild mediastinitis. After endoscopic removal of the bone, an esophageal fistula occurred. A conservative approach by means of endoscopic clipping of the esophageal perforation, nasojejunal tube for enteral nutrition and broad spectrum antibiotic therapy was preferred at this stage. Control chest X-ray with oral water-soluble contrast (Gastrografin) and repeat CT at 10- and 20-day follow-up showed a complete resolution of the esophageal fistula and mediastinitis. On the other hand, an increase of the aortic pseudoaneurysm was noted. This was treated by means of TEVAR. Subsequent clinical evolution was uneventful, and the patient was discharged in optimal clinical conditions with a 4-week course of home antibiotic therapy. The 6-month follow-up was uneventful.

CONCLUSIONS:

Foreign body esophageal perforation causing mediastinitis and aortic pseudoaneurysm is a very rare and challenging situation that requires a strict follow-up and an intensive multidisciplinary approach. A staged approach, first by endoscopy followed by endovascular treatment, may be safe and effective in selected patients.

PMID:
26520422
DOI:
10.1016/j.avsg.2015.07.025
[Indexed for MEDLINE]
Icon for Elsevier Science
13.
Lung Cancer. 2015 Oct;90(1):118-9. doi: 10.1016/j.lungcan.2015.05.015. Epub 2015 Jun 4.

Critique of Al-Ameri et al. (2015) - Risk of malignancy in pulmonary nodules: A validation study of four prediction models.

Author information

1
Department of Radiology, AOUI Verona, Pzle Stefani 1, 37100 Verona, Italy. Electronic address: simone.perandini@ospedaleuniverona.it.
2
Department of Radiology, AOUI Verona, Pzle Stefani 1, 37100 Verona, Italy. Electronic address: gianalberto.soardi@ospedaleuniverona.it.
3
Department of Radiology, AOUI Verona, Pzle Stefani 1, 37100 Verona, Italy. Electronic address: massimiliano.motton@ospedaleuniverona.it.
4
Department of Radiology, AOUI Verona, Pzle Stefani 1, 37100 Verona, Italy. Electronic address: stefania.montemezzi@ospedaleuniverona.it.
PMID:
26070614
DOI:
10.1016/j.lungcan.2015.05.015
[Indexed for MEDLINE]
Icon for Elsevier Science
14.
Ann Vasc Surg. 2015 Aug;29(6):1090-6. doi: 10.1016/j.avsg.2015.02.007. Epub 2015 May 19.

Treatment of popliteal artery aneurysms by means of cryopreserved homograft.

Author information

1
Department of Vascular and Endovascular Surgery, Azienda Ospedaliera Universitaria Integrata di Verona, Polo Chirurgico "P. Confortini", Verona, Italy.
2
Unit of Interventional Radiology, Azienda Ospedaliera Universitaria Integrata di Verona, Polo Chirurgico "P. Confortini", Verona, Italy.
3
Department of Vascular and Endovascular Surgery, Azienda Ospedaliera Universitaria Integrata di Verona, Polo Chirurgico "P. Confortini", Verona, Italy. Electronic address: gianfranco.veraldi@ospedaleuniverona.it.

Abstract

BACKGROUND:

Autologous saphenous vein is considered the gold standard conduit in the femoral-popliteal revascularization for popliteal artery aneurysms (PAAs). In several cases, it may be absent or unsuitable for length or diameter and so it may be considered unfit for a conduit. In such patients, a synthetic graft or the endovascular correction can be useful, but results are controversial. In this retrospective case series, we have analyzed the safety and efficacy of the cryopreserved homograft (CHg) as a conduit in the PAA revascularization.

METHODS:

In the period between January 2005 and December 2013, 54 PAAs have been treated with an arterial CHg. Indications to surgery were asymptomatic aneurysm with >25-mm diameter in 30 cases (55.6%), ischemic symptoms in 20 (37%), and compressive symptoms in 4 (7.4%). An urgent treatment was performed in 8 cases (14.8%) for severe ischemic symptoms. All cases have been operated by the same vascular team: a posterior surgical approach was preferred whenever possible (33 cases, 61.1%). All patients received a clinical and radiologic follow-up, and all data were collected in a specific database. A >10-mm diameter increase of the conduit was considered significant for an aneurysmatic degeneration.

RESULTS:

The primary outcomes were complications and reoperation rate, limb salvage, and primary and secondary patency. Secondary outcome was the incidence of aneurysmatic degeneration of the CHg. Mean diameter of the homografts was 6.3 mm (range, 4-8 mm). In the 30-day postoperative period, 7 PAAs (13%) developed a complication: 3 wound infections, 3 graft thrombosis, and 1 anastomotic bleeding. Six cases needed a reoperation: 2 surgical revascularizations, 2 wound debridement, and 1 anastomotic hemostasis; 1 major amputation was necessary for graft failure after the revascularization. Mean follow-up was 34.8 months (range, 1-96). Five cases (9.3%) developed a graft complication with 4 reoperations necessary (7.4%): 2 grafts required a percutaneous transluminal angioplasty for a perigraft stenosis and 2 underwent a femorodistal bypass in CHg for severe ischemic symptoms after CHg occlusion. Another one CHg occlusion was treated conservatively because it was clinically asymptomatic. Primary patency was 96.3%, 93.9%, and 88.3% at 12, 36, and 60 months, respectively; secondary patency was 98.1% at 12, 36, and 60 months. Freedom from amputation resulted in 98.1%. No aneurysmatic degeneration was observed. Univariate and multivariate analysis showed urgent surgery to be independent risk factors for complications, reoperations, and CHg occlusion (P < 0.05).

CONCLUSIONS:

In this retrospective study, the use of CHg showed to be safe and effective in the surgery of PAAs, either in the short or in the long-term follow-up. Urgent surgery can be considered predictive of graft failure. In our experience, CHg can be considered a good alternative conduit to the autologous saphenous vein.

PMID:
26001618
DOI:
10.1016/j.avsg.2015.02.007
[Indexed for MEDLINE]
Icon for Elsevier Science
15.
Eur Radiol. 2015 Jan;25(1):155-62. doi: 10.1007/s00330-014-3396-2. Epub 2014 Sep 3.

Assessing probability of malignancy in solid solitary pulmonary nodules with a new Bayesian calculator: improving diagnostic accuracy by means of expanded and updated features.

Author information

1
Department of Radiology, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale Stefani 1, 37124, Verona, Italy.

Abstract

OBJECTIVES:

A crucial point in the work-up of a solitary pulmonary nodule (SPN) is to accurately characterise the lesion on the basis of imaging and clinical data available. We introduce a new Bayesian calculator as a tool to assess and grade SPN risk of malignancy.

METHODS:

A set of 343 consecutive biopsy or interval proven SPNs was used to develop a calculator to predict SPN probability of malignancy. The model was validated on the study population in a "round-robin" fashion and compared with results obtained from current models described in literature.

RESULTS:

In our case series, receiver operating characteristic (ROC) analysis showed an area under the curve (AUC) of 0.893 for the proposed model and 0.795 for its best competitor, which was the Gurney calculator. Using observational thresholds of 5% and 10% our model returned fewer false-negative results, while showing constant superiority in avoiding false-positive results for each surgical threshold tested. The main downside of the proposed calculator was a slightly higher proportion of indeterminate SPNs.

CONCLUSIONS:

We believe the proposed model to be an important update of current Bayesian analysis of SPNs, and to allow for better discrimination between malignancies and benign entities on the basis of clinical and imaging data.

KEY POINTS:

• Bayesian analysis can help characterise solitary pulmonary nodules • Volume doubling time (VDT) is a good predictor of malignancy • A VDT of between 25 and 400 days is highly suggestive of malignancy • Nodule size, enhancement, morphology and VDT are the best predictors of malignancy.

PMID:
25182626
DOI:
10.1007/s00330-014-3396-2
[Indexed for MEDLINE]
Icon for Springer
16.
J Surg Oncol. 2014 Dec;110(7):883-7. doi: 10.1002/jso.23730. Epub 2014 Aug 2.

Limited value of logistic regression analysis in solid solitary pulmonary nodules characterization: a single-center experience on 288 consecutive cases.

Author information

1
Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale Stefani 1, Verona, Italy.

Abstract

BACKGROUND AND OBJECTIVES:

Preoperative characterization of the solitary pulmonary nodule is a delicate task faced by surgeons, radiologists, and clinicians. Mathematical models have been developed to overcome subjectivity. The Mayo Clinic model was suggested in the latest ACCP evidence-based clinical practice guidelines for the preoperative risk assessment of solitary pulmonary nodule malignancy. The aim of the study is to assess the validity of the Mayo Clinic model in a current continuous case series of biopsy-proven nodules.

METHODS:

The Mayo Clinic model was applied to estimate probability of malignancy in 288 consecutive cases in this single-center retrospective study.

RESULTS:

ROC curve analysis returned an AUC of 0.767, while analysis performed on 158 malignant nodules showed a mean predicted risk value of 38.15%. In our clinical setting, using a risk observational threshold set at 5% and a risk surgical threshold set at 60%, there would have been 4 cases of unnecessary surgery (false positives) at the cost of 13 cases of cancer progression (false negatives), while 68.75% of all nodules would have received non-decisional values.

CONCLUSIONS:

Surgeons should be aware that current data shows how the Mayo Clinic model is of little use in preoperative nodule characterization.

KEYWORDS:

lung cancer; preoperative risk assessment; solitary pulmonary nodule

PMID:
25088475
DOI:
10.1002/jso.23730
[Indexed for MEDLINE]
Icon for Wiley
17.
Int J Cardiol. 2014 May 15;173(3):e56-7. doi: 10.1016/j.ijcard.2014.03.096. Epub 2014 Mar 20.

Asymptomatic severe aortic coarctation at old age.

Author information

1
Division of Cardiology, Department of Medicine, University of Verona, Italy.
2
Institute of Radiology, Department of Imaging, AOUI, Verona, Italy.
3
Division of Cardiology, Department of Medicine, University of Verona, Italy. Electronic address: flavio.ribichini@univr.it.

KEYWORDS:

Aortic coarctation; Aortic disease

PMID:
24704404
DOI:
10.1016/j.ijcard.2014.03.096
[Indexed for MEDLINE]
Icon for Elsevier Science
18.
Orthopedics. 2012 Apr;35(4):e566-9. doi: 10.3928/01477447-20120327-35.

Deep external pudendal artery injury after percutaneous adductor tenotomy during THA in ankylosing spondylitis.

Author information

1
Department of Orthopaedic Surgery and Traumatology, Azienda Ospedaliera Universitaria Integrata, Policlinico GB Rossi, Verona, Italy. andrea.sandri@ospedaleuniverona.it

Abstract

Arterial injuries following total hip arthroplasty (THA) are uncommon and are usually related to revision THA. Deep external pudendal artery injury and delayed bleeding due to percutaneous adductor tenotomy during THA has not been reported.A 62-year-old man with bilateral hip osteoarthritis and ankylosing spondylitis was treated with right cementless THA. Persistent severely limited hip abduction after prosthetic implantation required a percutaneous adductor tenotomy, which was performed bilaterally. No clinical signs of bleeding existed postoperatively. On postoperative day 3, the patient had a hypotensive attack, his right anteromedial thigh at the tenotomy site was distended, and the hemoglobin was 5.9 g/dL. Computed tomography angiography of the iliac and femoral vessels showed a right hematoma medial to the common femoral artery, with active contrast extravasation. Volumetric data reconstruction revealed active bleeding from the right external pudendal artery into an inguinal collection. Angiography was performed by the standard Seldinger technique via the contralateral femoral artery. A guiding catheter was placed as near to the lesion as possible. A microcatheter system and microguidewire were used for superselective catheterization, and 2 embolization coils were used to control the bleeding. The patient remained hemodynamically stable and was discharged 12 days later. Two-year follow-up was uneventful.The deep external pudendal artery may be injured during percutaneous adductor tenotomy, especially in patients with fragile arterial walls, and life-threatening complications may occur. Angiography and embolization are the best treatment options.

PMID:
22495861
DOI:
10.3928/01477447-20120327-35
[Indexed for MEDLINE]
Icon for SLACK Incorporated.
19.
Radiol Med. 2012 Mar;117(2):282-92. doi: 10.1007/s11547-011-0774-6. Epub 2012 Jan 7.

Quantitative MRCP assessment of pancreatic exocrine reserve and its correlation with faecal elastase-1 in patients with chronic pancreatitis.

Author information

1
Istituto di Radiologia, Università di Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro, 37134, Verona, Italy. rmanfredi@univr.it

Abstract

PURPOSE:

This retrospective study was done to correlate a quantitative assessment of the pancreatic exocrine reserve by dynamic secretin magnetic resonance cholangiopancreatography (MRCPQ) with the faecal elastase-1 (FE-1) test in patients with chronic pancreatitis.

MATERIALS AND METHODS:

Thirty-five patients with a clinical diagnosis of chronic (CP) or acute recurrent (ARP) pancreatitis were enrolled. FE-1 was indicative of the pancreatic exocrine reserve. Subsequently, the patient population was subdivided into two groups according to a clinical threshold value of 200 μg/g. All patients underwent MRCP examination during secretin administration. Duodenal filling volume was calculated on T2-weigthed rapid acquisition with relaxation enhancement (RARE) MRCP images obtained 10 min after secretin injection. Duodenal filling volumes were compared with FE-1 values. Scatter plots, Pearson correlation coefficient and the Mann-Whitney U test were performed.

RESULTS:

Thirty-five paired MRCPQ-FE1 data sets were analysed. MRCPQ was significantly different (p=0.007) between patients with impaired and preserved pancreatic function; median and interquartile range (IQR) were 150.7 ml (137.3-205.5 ml; n=9) and 332.4 ml (190.6-506.9 ml; n=26). Both Pearson correlation coefficient (p<0.001) and the Mann-Whitney U test (p=0.007) were significant.

CONCLUSIONS:

MRCPQ significantly correlates with FE-1 values. It is possible to discriminate impaired and preserved pancreatic exocrine function using MRCPQ.

PMID:
22231574
DOI:
10.1007/s11547-011-0774-6
[Indexed for MEDLINE]
Icon for Springer
20.
J Surg Oncol. 2012 Mar 15;105(4):387-92. doi: 10.1002/jso.22117. Epub 2011 Oct 24.

Perioperative and long-term results of laparoscopic spleen-preserving distal pancreatectomy with or without splenic vessels conservation: a retrospective analysis.

Author information

1
Department of Surgery, University of Verona, Verona, Italy. giovanni.butturini@ospedaleuniverona.it

Abstract

BACKGROUND AND OBJECTIVES:

Laparoscopic spleen-preserving distal pancreatectomy can be performed with or without splenic vessels conservation. The formation of perigastric varices is the main long-term complication and represents the area of major concern among surgeons. Aim of this paper was to evaluate the outcomes of patients who underwent spleen-preserving distal pancreatectomy (with or without splenic vessels conservation) at our institution.

METHODS:

Retrospective search of an electronic database from 1999 through 2007. Standard statistical methods were used.

RESULTS:

43 individuals were analyzed. Postoperative morbidity was 56%. Patients managed by splenic vessels conservation were 36; in the remaining seven splenic vessels resection was performed. Pathologic details and the rate postoperative complications were not different between the two groups. Two splenectomies were necessary for postoperative splenic infarction (one in each group). 28 patients accepted the follow-up protocol. At 12 months, the rate of perigastric varices was 60.0% after splenic vessels resection and 21.7% after splenic vessels conservation (P = 0.123). No gastrointestinal bleeding occurred at a median follow-up of 69 months (37-139).

CONCLUSION:

Laparoscopic spleen-preserving distal pancreatectomy is feasible. A moderate risk of postoperative splenic infarction has to be taken into account, and the formation of perigastric varices may be interpreted as a paraphysiologic phenomenon, especially after splenic vessels resection.

PMID:
22025322
DOI:
10.1002/jso.22117
[Indexed for MEDLINE]
Icon for Wiley

Supplemental Content

Loading ...
Support Center