Percutaneous interstitial chemotherapy of a small hepatocellular carcinoma under ultrasound guidance

A small (less than 3 cm) inoperable hepatocellular carcinoma was treated with percutaneous interstitial chemotherapy (PIC). 5-Fluorouracil was injected by a fine needle under ultrasound guidance. After 3 months a fine needle biopsy (FNB) yielded fibronecrotic material. After 18 months another FNB yielded steatosis and dysplastic cells and the lesion showed no increase in size. PIC could be an interesting alternative treatment for small tumors unresponsive to conventional therapies.     

Secondary prevention of cryptogenic stroke in patients with patent foramen ovale: a systematic review and meta-analysis

The aim of our study is to compare patent foramen ovale (PFO) closure versus medical treatment and antiplatelet versus anticoagulant therapy in patients with cryptogenic stroke (CS) and PFO. We conducted a systematic review and meta-analysis with trial sequential analysis (TSA) of randomized trials. Primary outcomes are stroke or transient ischemic attack (TIA) and all-cause mortality. Secondary outcomes are peripheral embolism, bleeding, serious adverse events, myocardial infarction and atrial dysrhythmias. We performed an intention to treat meta-analysis with a random-effects model. We include six trials (3677 patients, mean age 47.3 years, 55.8% men). PFO closure is associated with a lower recurrence of stroke or TIA at a mean follow-up of 3.88 years compared to medical therapy [risk ratio (RR) 0.55, 95% CI 0.38–0.81; I²?=?40%]. The TSA confirms this result. No difference is found in mortality (RR 0.74, 95% CI 0.35–1.60; I²?=?0%), while PFO closure is associated with a higher incidence of atrial dysrhythmias (RR 4.55, 95% CI 2.16–9.60; I²?=?25%). The rate of the other outcomes is not different among the two groups. The comparison between anticoagulant and antiplatelet therapy shows no difference in terms of stroke recurrence, mortality and bleeding. There is conclusive evidence that PFO closure reduces the recurrence of stroke or TIA in patients younger than 60 years of age with CS. More data are warranted to assess the consequences of the increase in atrial dysrhythmias and the advantage of PFO closure over anticoagulants.     

Fine-needle aspiration biopsy of bowel lesions under ultrasound guidance: indications and results

Twenty-four patients with bowel lesions that could be imaged on a sonogram underwent ultrasound-guided fine-needle aspiration biopsy. Indications for biopsy included: poor condition of the patient precluding the use of barium studies and/or endoscopy (9 cases) or hindering technically adequate examinations (3); nonspecific radiographic images (6); inability to obtain an adequate biopsy sample during endoscopy (6). The results of biopsy were correct in the 18 cases proven by surgery or autopsy; in the remaining 6 patients, histologic results were considered conclusive, and were later confirmed by clinical, radiographic, and ultrasound follow-up. Fine-needle aspiration biopsy may be considered a simple, rapid, and accurate diagnostic procedure when an alternative approach to the study of gastrointestinal tract lesions is needed.     

Complications of Microwave Ablation for Liver Tumors: Results of a Multicenter Study

Purpose

New technologies for microwave ablation (MWA) have been conceived, designed to achieve larger areas of necrosis compared with radiofrequency ablation (RFA). The purpose of this study was to report complications by using this technique in patients with focal liver cancer.

Methods

Members of 14 Italian centers used a 2.45-GMHz generator delivering energy through a cooled miniature-choke MW antenna and a standardized protocol for follow-up. They completed a questionnaire regarding number and type of deaths, major and minor complications and side effects, and likelihood of their relationship to the procedure. Enrollment included 736 patients with 1.037 lesions: 522 had hepatocellular carcinoma with cirrhosis, 187 had metastases predominantly from colorectal cancer, and 27 had cholangiocellular carcinoma. Tumor size ranged from 0.5 to 10?cm. In 13 centers, the approach used was percutaneous, in 4 videolaparoscopic, and in 3 laparotomic.

Results

No deaths were reported. Major complications occurred in 22 cases (2.9%), and minor complications in 54 patients (7.3%). Complications of MWA do not differ from those RFA, both being based on the heat damage.

Conclusion

Results of this multicenter study confirmed those of single-center experiences, indicating that MWA is a safe procedure, with no mortality and a low rate of major complications. The low rate of complications was probably due to precautions adopted, knowing in advance possible risk conditions, on the basis of prior RFA experience.     

Normal anatomy and pathologic changes of the small bowel mesentery: US appearance

The ultrasonographic (US) appearance of the normal small bowel mesenteric leaves was evaluated in two in vitro studies and in 30 patients. Such structures had an elongated shape, echogenic surfaces, and small vessels in their center and could be recognized in 28 of the 30 patients. They did not show active movements, and at their distal end, the small bowel loops could be seen and peristalsis detected. Doppler signals were obtained from the small vascular structures in their center in three additional cases. On the basis of these anatomic findings, pathologic changes such as lymphoma, desmoid tumor, metastatic lesions, dilated vessels, and edema could be detected in 15 patients. When examining with US patients with diseases prone to involve the mesentery, careful attention should be given to this structure, since useful information about the abdominal spread of the disease can be obtained.     

West African Immigrants and New Patterns of Malaria Imported to North Eastern Italy

Background : With the settlement of increasing numbers of immigrants from tropical African countries into Italy over the last decade, the epidemiologic pattern of imported malaria underwent significant change. Italian immigrants originating from endemic areas who revisit their country of origin have exhibited an increasing incidence of malaria: the Italian Ministry of Health recorded an increase of from 14% in 1986 to 40.4% in 1991.
Methods : This retrospective study reviews the epidemiology of all malaria cases recorded from 1988 to 1991 in a regional reference center in North Eastern Italy. Epidemiologic factors, including the details of their travel experience, were examined for all cases, and the relation of immigrants to Italian-born citizens were compared.
Results : Of the 100 cases recorded during this period, 36 were diagnosed in 1988–1989 and 64 in 1990–1991. Immigrants accounted for six times more cases during the latter than during the former time period. Compared to nonimmune short-term travelers, immigrants experienced significantly milder forms of the disease and lower levels of parasitemia ( Plasmodium falciparum ) on admission. Notably, 10 cases of malaria in immigrants were not recognized at first observation on microbiology.
Conclusions : With the advent of this new risk group of immigrants that originate from endemic countries, especially those making occasional short visits to their native countries, this new epidemiologic profile of malaria imported into Italy shows the need for improvement in the areas of prophylaxis, pretravel education, and diagnostic services.