Applications of new radiological scores: the Node-rads in colon cancer staging.

PURPOSE: The study focuses on the evaluation of the new Node Reporting and Data System 1.0 (Node-rads) scoring accuracy in the assessment of metastatic lymph nodes (LN) in patients with colon carcinoma. MATERIAL AND METHODS: From April 2021 to May 2022, retrospective chart reviews were performed on 67 preoperative CT (Computed Tomography) of patients undergoing excisional surgery for colon cancer at the Polyclinic of Bari, Italy. Primary endpoints were to assess lymph node size and configuration to express the likelihood of a metastatic site adopting the Node-rads score system, whose categories of risk are defined from 1 (very low) to 5 (very high). The nodal postsurgical histological evaluation was the gold standard. The relationship between Node-rads score, LN size, configuration criteria (texture, border and shape) and the presence of histological metastases was statistically evaluated. RESULTS: All surgical specimens examined had correlation with Node-rads score. They were significantly more likely to present nodes micrometastasis those patients with (a) spherical LN shape (82.8%), (b) with lymph node necrosis (100%), (c) irregular borders (87%) and (d) the LN short axis more than 10 mm (61.9%). CONCLUSIONS: Our experience highlights how the Node-rads system proposes an intuitive and effective definition of criteria to standardize the lymph node radiological reports in colon cancer disease. Further studies are needed to streamline the classification of the nodal and peripheral LN in all the oncological imaging.

Diagnostic difficulties of antero-superior mediastinal masses with cardiac infiltration. Endovascular bioptic alternative approach.

The diagnosis of mediastinal masses is challenging due to the variety of possiblepathologies , and its definitive diagnosis is mainly confirmed by histological evaluation. Sometimes some lesions may have a greater intravascular rather than mediastinal development and the collection of a biopsy sample becomes even more complex. In these cases endovascular catheter biopsy is helpful in the collection of the necessary biological material, having to adapt to the type of surface and consistency of the mass to be analyzed. Endovascular catheter biopsy was performed with a biliary forceps to sample a mediastinal mass with greater endovascular and cardiac development, with a hard and difficult to sample surface. The histological result was diagnosed with non-hodgkins lymphoma.

Abdominal compartment syndrome: a situation thet needs to be better known.

Abdominal compartment syndrome was initially described as a cascade of physiopathological events triggered by the increase in intra-abdominal pressure induced by a surgical procedure for aneurysm of the abdominal aorta. In practice, it is a complication that can arise after various procedures; it has a multi-organ impact and can lead to exitus. We retrospectively analyzed a total of 9 patients with abdominal compartment syndrome. In 5 cases onset of the syndrome was due to a secondary complication of a vascular procedure (3 mesenteric, 2 renal). The clinical data characterizing the disease included abdominal distension and reduced diuresis. In all cases the finding of increased necrosis scores (LDH, CPK) was evident, while the appearance of leukocytosis occurred only in 4 (44%). The basic treatment was surgical decompression. In one case we obtained an excellent result with medical treatment alone, consisting in steroids and PGE1; these were useful in all cases in which an inflammatory bowel component played a role. Our experience encourages us to stress the importance of early assessment of abdominal hypertension in patients with a potential risk of abdominal compartment syndrome. In this phase, appropriate medical and supportive treatment could limit the surgical indications or at any rate favour the healing process after surgical decompression, the basic treatment indicated for this syndrome.

[Reoperation on the femoral arterial bifurcation: technical notes and surgical strategy]. / I reinterventi sulla biforcazione arteriosa femorale. Note di tecnica e di strategia chirurgica.

Femoral bifurcation reoperation is a stern test for skilfull surgeons, owing to the presence of thick scar tissue from the previous operations, especially when prosthetic grafts are used. In cases of aorto-femoral graft thrombosis, if thrombectomy of the entire graft is possible, one could isolate the anastomotic tract with all the afferent vessels and construct a new anastomosis downstream in tissue which allows a better run-off. Often in our experience we executed a by-pass, with a vein or short tract of new graft, from the previous prosthetic branch to a distal part of the deep femoral artery. In this way the reoperation is faster and safer, limiting dangerous dissection times. In infected inguinal pseudo-aneurysms we prefer an axillo-femoral by-pass, with isolation of the deep femoral artery by lateral incision, outside the infected field. In the non-infected ones, the reconstruction involves the use of a new small-sized graft between the previous structures. In cases of femoro-femoral occlusion we think it is better, first of all, to evaluate the possibility of an orthotopic graft from the aorta or iliac artery.

[Arterial embolism of venous origin: a clinical entity to keep always in mind]. / L'embolia arteriosa di origine venosa: entità clinica da tenere sempre presente.

In patients with unexplained arterial embolism or unexplained cerebral vascular accidents, a diagnosis of paradoxical embolism should be taken into consideration. It consists in the passage of an embolus, originating in the venous system or the right side of the heart, via an abnormal right to left channel, into the systemic circulation. In the majority of cases the abnormal communication is a patent foramen ovale; its incidence varies from 6% to 29% in unselected autopsies. The diagnosis of paradoxical embolism requires the presence of four Johnson's criteria. Nowadays the diagnostic procedures have been simplified by introducing non-invasive techniques based on ultrasound evaluation. The treatment of paradoxical embolism must be individualized and consists above all in the use of anticoagulants. Here we report a case of right leg paradoxical embolism in a young woman who had been operated on three months earlier for breast cancer. After ilio-femoro-popliteal thromboembolectomy, Doppler of the lower limb veins was performed. The presence of iliac venous thrombosis led to a suspicion of paradoxical embolism, which was then confirmed by the demonstration of a patent foramen ovale. The diagnosis of paradoxical embolism is important because the condition is associated with significant morbidity and mortality rates.