Point shear wave elastography and vibration controlled transient elastography for estimating liver fibrosis in a cohort of liver transplant patients.

OBJECTIVE: Liver transplant (LT) patients need regular follow-up both by ultrasonography and elastography. Shear wave elastography is now available in high-end ultrasound systems that, however, may yield different values for any given liver, reflecting technological differences. The aim of this study was to establish whether the point shear wave elastography QElaXto® (QEpSWE), available on Esaote (Genoa, Italy) systems, is comparable to the standard Fibroscan® (vibration-controlled transient elastography, VCTE) in the real-life setting of liver transplant (LT) patients. PATIENTS AND METHODS: We prospectively examined with QEpSWE 196 consecutive LT patients referred for VCTE and ultrasound examination. The agreement between QEpSWE and VCTE was assessed with Lin concordance correlation coefficient (CCC) and Bland-Altman analysis. The performance of QEpSWE was assessed with the ROC curves using the VCTE cut-offs of 7 and 12 kPa for F2-F3 and F4, respectively. RESULTS: The two methods showed 100% of successful and reliable liver stiffness measurements (LSM), similar median LSM in the whole group and in the two subgroups F2-F3 and F4 of fibrosis, with a disagreement in categorization of liver fibrosis in only 2% of cases, and never more than 1 stage of fibrosis. Further, they presented the same degree of higher LSMs in clinically unstable LT patients and an excellent overall agreement (CCC=0.91, accuracy=0.95, precision=0.96), even if agreement was less satisfactory in the range of severe fibrosis. The optimal cutoffs of QEpSWE were 6.7 and 11.6 kPa for F2-F3 and F4, respectively. CONCLUSIONS: The values of VCTE and QEpSWE showed a very high correlation in the staging of liver fibrosis. QEpSWE seems a promising method for staging liver fibrosis in LT patients.

Non-hormonal treatment of hot flushes in breast cancer survivors: gabapentin vs. vitamin E.

OBJECTIVES: To assess the efficacy and the tolerability of gabapentin 900 mg/day compared to vitamin E for the control of vasomotor symptoms in 115 women with breast cancer. The secondary objective was to evaluate the effect of the treatments on the quality of sleep and other aspects of the quality of life. METHODS: A hot flush diary was completed daily; sleep quality and other menopausal symptoms were assessed with the Pittsburgh Sleep Quality Index (PSQI), the Menopause Rating Scale (MRS) and the SF-36 Health Survey. RESULTS: The prescribed treatment with gabapentin was never started by 28.3% of the patients and was interrupted by 28% for side-effects (dizziness and somnolence). Among the women allocated to vitamin E, 16.36% never started therapy and 34.78% dropped out because of inefficacy. Hot flush frequency and score decreased by 57.05% and 66.87%, respectively (p < 0.05) in the gabapentin group. The effect of vitamin E was fairly small: hot flush frequency and score were reduced by 10.02% and 7.28%, respectively (p > 0.05). Gabapentin was also particularly effective in improving the quality of sleep (PSQI score reduction: 21.33%, p < 0.05). CONCLUSION: Gabapentin appears to be effective for the treatment of hot flushes with a favorable effect on quality of sleep. Vitamin E has only marginal effect on vasomotor symptoms.

[Intraperitoneal hemorrhage from rupture of an aneurysm of splenic artery: case report and literature review]. / Emoperitoneo da fissurazione di aneurisma dell'arteria splenica: case report e revisione della letteratura.

Splenic artery aneurysm presented with rupture is an unusual and potentially deadly reason of intraperitoneal hemorrhage. There are a lot of pathogenetic hypothesis; timing according to disease severity and surgical choices aren't definitely codified authors present one patient with hemoperitoneum for ruptured splenic artery aneurysm affected by chronic lymphatic leukaemia too and review international literature; they underline pathogenesis, symptoms, preoperative investigations and therapy. Degeneration of the media, atherosclerotic changes and high blood flow due to pregnancy and portal hypertension could be the main pathogenetic factors. Ultrasonography is the first investigation we have to practice if we suspect hemoperitoneum. We can practice computed tomography and angiography too if cardiovascular condition are good. Rupture showing acute abdominal pain and cardiovascular collapse suggest strongly urgent operation. The choice of operation is determined by location of the aneurysm. When located in the distal third of the splenic artery, the aneurysm is resected with spleen; alternatively, when it is located in prossimal third we can perform conservative operation.

Cyclic voiding cystourethrography in the diagnosis of occult vesicoureteric reflux.

Cyclic voiding cystourethrography (CVC) enhances the detection of vesicoureteric reflux (VUR). We investigated whether more-severe VUR may be overlooked, and whether older children are at risk of having their VUR missed with the conventional single-cycle study. Three hundred and seventy patients, 168 boys and 202 girls aged 1 month to 16 years, consecutively admitted over 1 year for suspicion of VUR, underwent two complete cycles of filling and voiding CVC. One hundred and four subjects, 33 boys and 71 girls, were older than 3 years (mean age 5.7 years, range 3.2-16 years). Sixty-six refluxing ureters from 51 patients were identified in the first cycle and 61 refluxing ureters from 45 patients were identified only with the second cycle. Four instances of grade IV VUR in 4 patients and three of grade V VUR in 3 patients were overlooked completely in the first cycle. Seven episodes of VUR < or = grade III from 5 patients diagnosed in the first cycle were upgraded to > or = grade IV at the second cycle. The presence of VUR was identified only in the second cycle in 35 of 74 subjects aged < or = 3 years and in 10 of 22 aged > 3 years (not significant). Of the 10 children aged > 3 years, 2, who had diagnosis only at the second cycle, had > or = grade IV VUR. More-severe VUR may be overlooked or down-graded in a single-cycle study. Two-cycle CVC is also useful in children older than 3 years.

[Role of fine needle biopsy guided with computerized tomography in peripheral lung nodules with a diameter lower than 2 centimeters]. / Ruolo della biopsia con ago sottile guidata con tomografia computerizzata nei noduli polmonari periferici con diametro inferiore a due centimetri.

We investigated the role of CT in guiding fine-needle biopsy (FNB) in small (< 2 cm phi) lung lesions, reviewing 2109 CT-guided biopsies of peripheral lung nodules performed 1983 to 1993. "Peripheral" refers to non intrabronchial lesions, independent of the nodule position in the chest. Two hundred lesions < 2 cm phi were selected, 52 of them with complete clinical and surgical follow-up. This group was compared with 195 lung lesions > 2 cm phi for CT-guided FNB sensitivity, specificity and diagnostic accuracy. Cytologic specimens were positive for malignancy in 40/52 cases (76.9%) and negative in 12 (23.1%). Clinical-surgical follow-up confirmed all the positive cytologic findings (40 cases), while 2 of the extant 12 cases were false negatives (95.20% sensitivity, 100% specificity and 96.15% diagnostic accuracy). 158 of 195 nodules > 2 cm phi and with clinical-surgical follow-up (81.3%) were positive for malignancy and 34 were negative (17.43%) (98.75% sensitivity, 97.14% specificity and 98.46% diagnostic accuracy). Pneumothorax occurred in 33 patients (16.5%) with nodules < 2 cm phi as a complication of biopsy. Hemoptysis occurred in 15 patients (7.5%). In the whole group of lung lesions, the complications were pneumothorax in 80 patients (4.1%), hemoptysis in 199 (10.4%) and hypotensive vagal crises in 92 patients (4.8%). We conclude that CT is the best guidance for FNB also in small lung nodules, providing high sensitivity and specificity and low complication rates. Finally, the result of this procedure depends on the operator's skills.

Middle mediastinum lesions: preliminary experience with CT-guided fine-needle aspiration biopsy with a suprasternal approach.

The technical feasibility and safety of a suprasternal approach in the computed tomography (CT)-guided biopsy of lesions in the middle mediastinum was studied in 30 patients. Patients were positioned on their back with their head hyperextended. Biopsies were performed with local anesthesia and 22-gauge needles. Adequate biopsy material for diagnosis was obtained in 25 (83%) of 30 patients. A single biopsy specimen was sufficient in 14 patients, but as many as three biopsy specimens were necessary in 16 patients. Nineteen (63%) patients had various histotypes of lung cancer. In 24 (89%) of 27 adequate specimens, findings at fine-needle aspiration biopsy were consistent with findings at pathologic examination. No major complications were observed. CT-guided biopsy of middle mediastinum lesions was safe and successful with a suprasternal approach.

Lactobacillus casei endocarditis in an intravenous heroin drug addict: a case report.

A 24-year-old HIV negative unemployed intravenous heroin addict with teeth in poor condition was admitted to hospital with left hemiparesis; CT scan of the brain revealed a hypodense area in the right parietal region. He was apyrexial with marked leukocytosis and raised ESR, had an aortic diastolic murmur and an echocardiogram showed marked aortic insufficiency with possible small vegetations on the anterior leaflet of the mitral valve. Lactobacillus Casei was isolated from repeated blood cultures. Therapy with penicillin G together with netilmicin for 6 weeks led to improvement of his clinical status and an echocardiogram on discharge showed clear improvement. Regression of the cerebral lesions was also demonstrated on CT scan. We conclude that lactobacillus species should be sought in all haemoculture negative endocarditis in the presence of tooth disease.