Incidental Diagnosis of a Rare Case of Corkscrew Aorta.

The corkscrew aorta is a variant of the normal anatomical course of the aorta. This rare condition is characterized by a marked tortuosity of the aorta. In our experience it concerns the tract of subrenal aorta, that is an unusual condition, since there are no other cases in the literature. It is characterized by the presence of at least two kinking, and a coiling interposed among them. It is diagnosed by Angio-CT and its response is incidental, being from an asymptomatic clinical point of view.

Chagas disease knocks on our door: a cross-sectional study among Latin American immigrants in Milan, Italy.

OBJECTIVES: We aimed to assess the prevalence and risk factors for Chagas disease (CD) in Latin American immigrants and to evaluate the accuracy of diagnostic tests. Moreover, we offered to all positive subjects a complete free-of-charge clinical/instrumental evaluation as well as benznidazole treatment in order to stage the disease and verify drug tolerability. METHODS: A cross-sectional survey of CD among Latin Americans living in Milan and its metropolitan area was conducted between July 2013 and July 2014. Blood samples were tested for serologic evidence of CD together with a questionnaire covering demographic and clinical-epidemiological information. RESULTS: Forty-eight (9.6%) of the 501 tested subjects were conclusively diagnosed as having CD. The highest prevalence of CD was among those from Bolivia (43/169, 25.4%) and El Salvador (4/68, 5.9%). Older age (adjusted odds ratio (aOR)] 1.05, p =0.004), a Bolivian origin (aOR 8.80; p =0.003), being born in the department of Santa Cruz (aOR 3.72, p =0.047), having lived in mud houses (aOR 2.68; p =0.019), and having an affected relative (aOR 12.77, p =0.001) were independently associated with CD. The ARCHITECT Chagas test showed the highest sensitivity (100%) and specificity (99.8%). Twenty-nine of the subjects with CD (60.4%) underwent disease staging, 10 of whom (35.7%) showed cardiac and/or digestive involvement. Benznidazole treatment was associated with high frequency of adverse reactions (19/27, 70.4%) and permanent discontinuation (8/27, 29.6%). CONCLUSIONS: CD is highly prevalent among Bolivians and Salvadorans living in Milan. Regions with a large Latin American immigrant population should implement programmes of active detection and treatment.

Emerging resistant bacteria strains in bloodstream infections of acute leukaemia patients: results of a prospective study by the Rete Ematologica Lombarda (Rel).

Multiresistant bacterial infections are a potentially life-threatening condition in acute leukaemia (AL) patients. We aimed to better define the very recent epidemiology and outcome of bloodstream infections (BSIs) in a real-life setting. We prospectively collected all consecutive febrile/infectious episodes occurring in AL patients admitted to 9 haematology units. In 293 AL patients, 433 BSIs were diagnosed. Gram-positive (GP) bacteria were isolated in 44.8 % BSI and Gram-negative (GN) in 38.3 %, while polymicrobial aetiology- or fungi-related events were identified in 15.7 and 1.1 % of the cases, respectively. GP was observed more frequently in patients not in complete remission (p = 0.04), while GN during consolidation cycles (p = 0.003). Extended spectrum ß-lactamase-producing strains accounted for 23.2 % of enterobacteria. They were associated with previous antibiotic exposure, including fluoroquinolones prophylaxis (p = 0.01). Carbapenem-resistant (CR) strains occurred in 9 % of enterobacteria. Among Pseudomonas aeruginosa strains, 21.6 % were multiresistant. Overall 30-day mortality was 8.5 %. CR GN and multiresistant P. aeruginosa BSIs were independent predictors of death (p = 0.002), as well as relapsed/resistant AL (18.3 %; p = 0.0002) and the presence of pulmonary infiltrates (26.6 %; p < 0.001). Although GP still predominate over GN BSI, the percentage of antibiotic resistant GN strains is considerable in AL patients and it is associated with poor prognosis.

Ultra-low-dose CT for left atrium and pulmonary veins imaging using new model-based iterative reconstruction algorithm.

AIMS: To evaluate the feasibility of ultra-low-dose CT for left atrium and pulmonary veins using new model-based iterative reconstruction (MBIR) algorithm. METHODS AND RESULTS: Two hundred patients scheduled for catheter ablation were randomized into two groups: Group 1 (100 patients, Multidetector row CT (MDCT) with MBIR, no ECG triggering, tube voltage and tube current of 100 kV and 60 mA, respectively) and Group 2 [100 patients, MDCT with adaptive statistical iterative reconstruction algorithm (ASIR), no ECG triggering, and kV and mA tailored on patient BMI]. Image quality, CT attenuation, image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) of left atrium (LA) and pulmonary veins, and effective dose (ED) were evaluated for each exam and compared between two groups.No significant differences between groups in terms of population characteristics, cardiovascular risk factors, anatomical features, prevalence of persistent atrial fibrillation and image quality score. Statistically significant differences were found between Group 1 and Group 2 in mean attenuation, SNR, and CNR of LA. Significantly, lower values of noise were found in Group 1 versus Group 2. Group 1 showed a significantly lower mean ED in comparison with Group 2 (0.41 ± 0.04 versus 4.17 ± 2.7 mSv). CONCLUSION: The CT for LA and pulmonary veins imaging using MBIR is feasible and allows examinations with very low-radiation exposure without loss of image quality.

Percutaneous cholecystostomy as the sole treatment in critically ill and elderly patients.

PURPOSE: This study was done to investigate the effectiveness and clinical outcome of percutaneous cholecystostomy (PC) of treating acute cholecystitis in critical ill and elderly patients. MATERIALS AND METHODS: In the last 3 years, PC was performed on 30 elderly and critically ill patients (17 men, 13 women; mean age 78.6, range 57-97 years) with acute cholecystitis and comorbid diseases. RESULTS: Technical success was 30/30 (100%). Clinical effectiveness was 30/30 (100%), with statistically significant reductions in while blood cell (WBC) count, C-reactive protein (CRP) and fever. Mean WBC upon admission (19.87×10(3)±1.61×10(3) /µl), axillary temperature (38.2±0.11 °C), and CRP (248.7±4.76 mg/l) values were significantly decreased in the 72 h following PC [12.9×10(3) ± 1.05×10(3)/µl (p≤0.0001), 37 ± 0.04 °C (p≤0.0001), 113.5 ± 3 mg/l (p≤0.0001), respectively]. Clinical and ultrasonographic (US) signs of acute cholecystitis decreased in all patients. There were no major complications or procedure-related deaths, and the morbidity rate was low (3/30; 10%). CONCLUSIONS: PC appears to be a fast, easy and effective treatment for the acute phase of cholecystitis in elderly and critically ill patients. Procedure-related morbidity and mortality rates are very low compared with surgery. Conservative treatment for patients who are not eligible for surgery is acceptable.

Ultrasound-guided thermal radiofrequency ablation (RFA) as an adjunct to systemic chemotherapy for breast cancer liver metastases.

PURPOSE: The aim of this study was to evaluate the effectiveness of radiofrequency thermal ablation (RFA) of liver metastases from breast cancer and its impact on survival. MATERIALS AND METHODS: Thirteen female patients (age range 36-82 years; median 54.5 years) underwent RFA for the treatment of 21 liver metastases from breast cancer. The procedures were performed under ultrasound (US) guidance using an RF 2000 or RF 3000 generator system and Le Veen monopolar needle electrodes. Follow-up was carried out by computed tomography (CT) after 1, 3, 6 and 12 months. RESULTS: Technical success was 100%. No major or minor complications occurred at the end of the procedure. In our series, 7/21 lesions in 7/13 patients increased in size at 7, 18, 19 and 38 months. This resulted in a mean disease-free interval of 16.6 months. Mean overall survival after RFA was 10.9 months. CONCLUSIONS: RFA appears to be a useful adjunct to systemic chemotherapy and/or hormone therapy in the locoregional treatment of hepatic metastases from breast cancer. RFA may also be a less invasive alternative to surgery in the locoregional treatment of liver metastases from breast cancer.

Percutaneous imaging-guided ablation therapies in the treatment of symptomatic bone metastases: preliminary experience.

PURPOSE: The treatment of pain in bone metastases is currently multidisciplinary. Among the various therapies, local radiotherapy is the gold standard for pain palliation from single metastasis, even though the maximum benefit is obtained between 12 and 20 weeks from initiation. In carefully selected patients, several ablation therapies achieve this objective in 4 weeks. The purpose of this study was to assess the technical success, effectiveness and possible complications of percutaneous ablation therapies in patients with symptomatic bone metastases. MATERIALS AND METHODS: From November 2003 to May 2008, ten ablation treatments were performed in ten patients with acute pain from metastatic bone lesions. Patient selection and choice of the most appropriate ablation treatment was made based on lesion characteristics. Three patients were treated with radiofrequency, one with plasma-mediated radiofrequency, two with plasma-mediated radiofrequency and cementoplasty, three with radiofrequency and cementoplasty and one with microwave. RESULTS: Assessments were based not only on imaging but also on the visual analogue scale (VAS) score for determining pain and on changes in morphine-equivalent doses. In both cases, 3-month follow-up showed a statistically significant reduction of pain. In no case did local complications occur either during or after treatment. Only one patient treated with radiofrequency (1/9, 11%) developed low-grade fever and general malaise during the 6 days following the procedure, compatible with a post-radiofrequency syndrome, which was treated with acetaminophen (paracetamol) only and resolved on day 7. CONCLUSIONS: Percutaneous ablation therapies represent a safe and valuable alternative for treating localised pain from single bone metastasis, providing rapid (4-week) relief of symptoms and a significant reduction in morphine doses. This contributes to improving the quality of life of patients with metastatic disease.

[Diagnostic value of out-patient lymph node biopsy]. / La biopsia linfonodale in regime ambulatoriale nella diagnostica delle linfoadenopatie.

Authors review their outpatient lymph node biopsies in order to verify safety and diagnostic accuracy. They didn't observe any complication and in every case, the procedure provided the correct diagnosis. Lymph node biopsy is the procedure of choice to study the pharmacologic therapy non responsive lymph node pathology that is not surely defined by fine needle aspiration, as almost always in lymphomas.

Imaging-guided percutaneous radiofrequency ablation of adrenal metastases: preliminary results at a single institution with a single device.

The aim of this study was to show the feasibility, safety, imaging appearance, and short-term efficacy of image-guided percutaneous radiofrequency ablation (RFA) of adrenal metastases (AM). Seven imaging-guided percutaneous RFA treatments were performed in six patients (two men and four women; mean age, 67.2 years; range, 55-74 years) with six AM who were referred to our institution from 2003 to 2006. One patient was treated twice for recurrence after first treatment. The average diameter of the treated AM was 29 mm (range, 15-40 mm). In all patients, the diagnosis was obtained with CT current protocols in use at our institution and confirmed by pathology with an image-guided biopsy. No major complications occurred. In one patient shortly after initiation of the procedure, severe hypertension was noted; another patient developed post-RFA syndrome. In five of six lesions, there was no residual enhancement of the treated tumor. In one patient CT examination showed areas of residual enhancement of the tumor after treatment. Our preliminary results suggest that imaging-guided percutaneous RFA is effective for local control of AM, without major complications and with a low morbidity rate related to the procedure. Long-term follow-up will need to be performed and appropriate patient selection criteria will need to be determined in future randomized trials.

[Shoulder instability and pain. Computerized arthro-tomography assessment]. / Spalla instabile e dolorosa. Valutazione con artro-tomografia computerizzata.

The growing interest in shoulder joint imaging comes from the ever-increasing demand for such an examination in orthopedics. Since more complete and detailed imaging of bone, capsuloligamentous and musculotendinous compartments is always needed, CT arthrography has necessarily become a widely used method. In this study, 282 patients were investigated with CT arthrography. Seventy per cent of them had anatomical instability, 17.3% had functional instability and the extant 12.7% had shoulder pain. In traumatic instability, the most often injured structures were the glenoid labra (91%) and the capsule (82%). Lesions in the two structures were nearly always associated. Moreover, high incidence (65.8%) of Hill-Sachs lesions of the humeral head was observed. In atraumatic instability, abnormal anteversion of the scapular glenoid was always detected. In the patients with shoulder pain, the most common causes were the impingement syndrome (30.5%), superior labrum lesions (16.7%), adhesive capsulitis (16.7%) and synovial osteochondromatosis (13.7%). With CT arthrography, labial abnormalities (detachments, tears, amputations, eversions and degeneration) can be identified, as well as capsular lesions (insertional detachment and laxity), rotator cuff conditions (bursitis, tendinitis and partial/complete tears), biceps tendon abnormalities and glenoid rim and humeral head fractures. Moreover, CT arthrography is minimally invasive and well tolerated. It exhibits 97.7% specificity, 91% sensitivity and 96% accuracy. Furthermore, it has been proven to be extremely useful in treatment and surgical planning.