Perfusion CT can predict tumoral grading of pancreatic adenocarcinoma.

OBJECTIVES: To describe perfusion CT features of locally advanced pancreatic ductal adenocarcinoma and to evaluate correlation with tumor grading. METHODS: Thirty-two patients with locally advanced pancreatic adenocarcinoma were included in this study. Lesions were evaluated by P-CT and biopsy after patient's informed consent. P-CT parameters have been assessed on a large single and on 6 small intratumoral ROIs. Values obtained have been compared and related to the tumor grading using Mann-Whitney U test. Sensibility, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy in predicting tumor grading have been calculated for cut-off values chosen by using ROC curves. RESULTS: Out of 32 lesions, 12 were classified as low grade and 20 as high grade. A statistically significant difference between high and low grade neoplasms were demonstrated for PEI and BV parameters. PEI and BV cut-off values were respectively 17.8 HU and 14.8 ml/100g. PEI identified high grade neoplasms with a 65% sensitivity, 92% specificity, 93% PPV, 61% NPV and 75% accuracy. BV identified high grade neoplasms with a 80% sensitivity, 75% specificity, 84% PPV, 69% NPV, 78% accuracy. Considering both PEI and BV, P-CT identified high grade lesions with a 60% sensitivity, 100% specificity, 100% PPV, 60% NPV and 75% accuracy. CONCLUSIONS: PEI and BV perfusion CT parameters proved their efficiency in identifying high grade pancreatic adenocarcinoma.

[Various features of neonatal outcome in assisted fertilization pregnancies]. / Alcuni aspetti dell'outcome neonatale delle gravidanze da fecondazione medico-assistita.

Assisted pregnancies have been often considered as high risk pregnancies because of several factors as increased maternal age, primary sterility, pharmacological treatments, embryos and gametes manipulation in the first weeks of life. Many studies showed high rates of perinatal morbidity (especially low birth weight and prematurity), and an increase of maternal morbidity and mortality. The present study was designed to analyse correlation between morbidity and twinning rate, and to show the distribution of birth weight in a population of neonates after assisted reproductive techniques (ART). We studied 352 newborns (168 singletons, 126 twins, 42 triplets, 16 quadruplets) from assisted pregnancies; morbidity was 7.1% in singletons, 11.9% in twins, 21.4% in triplets, raising to 56.3% in quadruplets. Our experience suggests that multiple gestations after ART seem to have an increased incidence of neonatal complications.

[Congenital malformations and asymmetric crying facies]. / Malformazioni congenite e asimmetria della bocca nel pianto.

Asymmetric crying face (ACF) means a congenital anomaly caused by either agenesis or hypoplasia of the depressor anguli oris muscle. This defect is on only one corner of the mouth since the birth, affects lower lip, and is particularly evident when the newborn is crying. Lesions at different levels of seventh nerve can cause similar and confounding weakness of the facial expressions. But, in case of ACF, forehead wrinkling, eye closure, nasolabial fold depth, and tearing are normal and symmetric functions. ACF can be either as single plain aesthetic defect or as early only index of several congenital malformations, especially of heart and genitourinary tract. Our study recognized 80 ACF cases in 11,643 newborn's population during a 34 consecutive month period: 34 on right side and 46 on left side of the mouth. ACF population presented a higher malformative risk than general population (on average 4.73% versus 3.3% of our base-line). Congenital anomalies were found more frequently associated with left ACF (3 versus 1, for a general rate of 6.52% versus 2.94%), on the same body side when anomaly was affecting pair organs. Those 3 congenital malformations were on genitourinary tract, 2 of which detected by ultrasonography. We did not find any congenital cardiac defects. According to opinion of numerous other researchers, we think ACF is not to be considered a simple aesthetic anomaly: therefore, in front of all ACF cases, a thorough search for associated anomalies should be performed.