IMAGING DI FUSIONE E NUOVE TECNOLOGIE ABLATIVE IN ONCOLOGIA INTERVENTISTICA

Le terapie oncologiche interventistiche stanno entrando sempre più nella pratica clinica quali efficaci terapie alternative o complementari per molte malattie tumorali. Tali terapie, per definizione mini-invasive, sono effettuate sotto la guida delle metodiche per immagine. L’imaging di fusione consente di allineare e sovrapporre in tempo reale le immagini ottenute mediante metodiche diverse, allo scopo di sfruttare al meglio le caratteristiche di ognuna, superandone i rispettivi limiti. La prima fase del progetto ha dimostrato la fattibilità e la accuratezza della guida di procedure interventistiche mediante un sistema di fusione di immagini di tomografia computerizzata e ultrasuoni in un modello ex-vivo. Nella seconda e terza fase del progetto sono state valutate fattibilità e sicurezza di nuove procedure ablative per il trattamento di neoplasie polmonari, in un modello animale in-vivo. Nella seconda fase sono stati trattati con successo e senza complicanze 10 conigli New Zealand White, mediante agoelettrodo ad uncini per fusi. Nella terza fase è stata dimostrata la fattibilità e sicurezza della termoablazione polmonare mediante micro-onde in 10 conigli New Zealand White , paragonando i risultati con quelli ottenuti in un gruppo di 10 animali trattati con la termoablazione a radiofrequenza

Quality Improvement Guidelines for Radiofrequency Ablation of Liver Tumours

The development of image-guided percutaneous techniques for local tumour ablation has been one of the major advances in the treatment of liver malignancies. Among these methods, radiofrequency ablation (RFA) is currently established as the primary ablative modality at most institutions. RFA is accepted as the best therapeutic choice for patients with early-stage hepatocellular carcinoma (HCC) when liver transplantation or surgical resection are not suitable options [1, 2]. In addition, RFA is considered a viable alternate to surgery (1) for inoperable patients with limited hepatic metastatic disease, especially from colorectal cancer, and (2) for patients deemed ineligible for surgical resection because of extent and location of the disease or concurrent medical conditions [3]. These guidelines were written to be used in quality-improvement programs to assess RFA of HCC and liver metastases. The most important processes of care are (1) patient selection, (2) performing the procedure, and (3) monitoring the patient. The outcome measures or indicators for these processes are indications, success rates, and complication rates

Guidelines for the use of contrast-enhanced ultrasound in hepatocellular carcinoma

Abstract Surveillance of patients at risk of developing hepatocellular carcinoma (HCC) relies on ultrasound (US) examinations performed at 6-month intervals. Early detection of HCC on a cirrhotic background is a challenging issue, since the US features of the different entities in the multi-step process of hepatocarcinogenesis – such as low-grade and high-grade dysplastic nodule – do overlap. Contrast-enhanced US allows reliable detection of arterial neo-angiogenesis associated with the malignant change. Several reports have shown that the ability of contrast-enhanced US to diagnose HCC currently approaches that of optimised multidetector computed tomography (CT) or dynamic magnetic resonance (MR) imaging protocols. The use of contrast-enhanced US to characterise nodular lesions in cirrhosis has recently been recommended by the clinical practice guidelines issued by the European Federation of Societies for Ultrasound in Medicine and Biology and the American Association for the Study of Liver Diseases. Contrast-enhanced US has also been successfully used to assess response of HCC to image-guided percutaneous ablation procedures. In this article, we discuss the advantages and limitations of contrast-enhanced US with respect to the other imaging modalities in the setting of HCC

Нові тенденції розвитку термінознавства : здобутки міжнародної наукової групи Р. Теммерман

Комплексно проаналізовано здобутки міжнародної наукової групи під керівництвом Р. Теммерман: розглянуто основні положення соціокогнітивного термінознавства, питання сутності терміна, фахової мови, фахової комунікації, динаміки терміна, розуміння терміна людиною за різних умов фахового спілкування, оперування великими масивами термінологічних даних, терміноонтографії й терміноонтології, інженерії знань та галузевих онтологій.The paper comprehensively analyses the achievements of the international research group led by R. Temmerman: it examines the main thesis of sociocognitive terminology, questions of the essence of a term, professional language, professional communication, dynamics of a term, understanding of a term by person under various conditions of professional communication, handling large corpora of terminological data, terminoontography and terminoontology, knowledge engineering and specialized ontologies

Hepatic abscess caused by trans-gastric migration of a fishbone

Background Stomach or duodenal perforation due to foreign body are usually associated with the development of a walled-off abdominal mass or abscess, and are less prone to cause systemic signs of infection. Methods and Case presentation A 65-year-old man with no comorbidities was admitted for rapid onset of abdominal discomfort, fever, and chills. An abdominal computed tomography (CT) showed an 8 cm abscess in the left lobe of the liver. The lesion was aspirated under ultrasound guidance; cultures from the abscess grew Streptococcus constellatus. Chest CT scan, colonoscopy, esophagogastroduodenoscopy, and blood cultures were negative. The patient’s clinical status rapidly improved with antibiotic therapy, but a follow-up CT scan revealed the presence of a thin, 3 cm-long radiopaque object at the site of the previous abscess. A few months later, due to symptomatic cholelithiasis, the patient underwent elective laparoscopic cholecystectomy and concurrent removal of a 3 cm-long fishbone, which was embedded into the wall of the gastric antrum and the third segment of the liver, the latter which was partially resected. Results The small gastrotomy was reapproximated with a single resorbable stitch. The post-operative course was uneventful and at 6 month follow up, the patient was asymptomatic without evidence of residual abdominal pathology. Conclusions Asymptomatic perforation of the gastric wall by an ingested foreign body can occur and be subsequently complicated by a liver abscess. A contained perforation can be successfully managed conservatively

Implementing a robotic liver resection program does not always require prior laparoscopic experience

Background: Preliminary experience in laparoscopic liver surgery is usually suggested prior to implementation of a robotic liver resection program. Methods: This was a retrospective cohort analysis of patients undergoing robotic (RLR) versus laparoscopic liver resection (LLR) for hepatocellular carcinoma at a center with concomitant initiation of robotic and laparoscopic programs RESULTS: A total of 92 consecutive patients operated on between May 2014 and February 2019 were included: 40 RLR versus 52 LLR. Median age (69 vs. 67; p = 0.74), male sex (62.5% vs. 59.6%; p = 0.96), incidence of chronic liver disease (97.5% vs.98.1%; p = 0.85), median model for end-stage liver disease (MELD) score (8 vs. 9; p = 0.92), and median largest nodule size (22 vs. 24 mm) were similar between RLR and LLR. In the LLR group, there was a numerically higher incidence of nodules located in segment 4 (20.0% vs. 16.6%; p = 0.79); a numerically higher use of Pringle's maneuver (32.7% vs. 20%; p = 0.23), and a shorter duration of surgery (median of 165.5 vs. 217.5 min; p = 0.04). Incidence of complications (25% vs.32.7%; p = 0.49), blood transfusions (2.5% vs.9.6%; p = 0.21), and median length of stay (6 vs. 5; p = 0.54) were similar between RLR and LLR. The overall (OS) and recurrence-free (RFS) survival rates at 1 and 5 years were 100 and 79 and 95 and 26% for RLR versus 96.2 and 76.9 and 84.6 and 26.9% for LLR (log-rank p = 0.65 for OS and 0.72 for RFS). Conclusions: Based on our results, concurrent implementation of a robotic and laparoscopic liver resection program appears feasible and safe, and is associated with similar oncologic long-term outcomes

How to Reduce the Risk for Complications?

Interventional oncology represents a relatively new clinical discipline based upon minimally invasive therapies applicable to almost every human organ and disease. Over the last several decades, rapidly evolving research developments have introduced a newer generation of treatment devices, reagents, and image-guidance systems to expand the armamentarium of interventional oncology across a wide spectrum of disease sites, offering potential cure, control, or palliative care for many types of cancer patients. Due to the widespread use of locoregional procedures, a comprehensive review of the methodologic and technical considerations to optimize patient selection with the aim of performing a safe procedure is mandatory. This article summarizes the expert discussion and report from the Mediterranean Interventional Oncology Live Congress (MIOLive 2020) held in Rome, Italy, integrating evidence-reported literature and experience-based perceptions as a means for providing guidance on prudent ways to reduce complications. The aim of the paper is to provide an updated guiding tool not only to residents and fellows but also to colleagues approaching locoregional treatments.publishersversionpublishe

The Impact of Lifestyle Interventions in High-Risk Early Breast Cancer Patients: A Modeling Approach from a Single Institution Experience

none21noA healthy lifestyle plays a strategic role in the prevention of BC. The aim of our prospective study is to evaluate the effects of a lifestyle interventions program based on special exercise and nutrition education on weight, psycho-physical well-being, blood lipid and hormonal profile among BC patients who underwent primary surgery. From January 2014 to March 2017, a multidisciplinary group of oncologists, dieticians, physiatrists and an exercise specialist evaluated 98 adult BC female patients at baseline and at different time points. The patients had at least one of the following risk factors: BMI ≥ 25 Kg/m2, high testosterone levels, high serum insulin levels or diagnosis of MS. Statistically significant differences are shown in terms of BMI variation with the lifestyle interventions program, as well as in waist circumference and blood glucose, insulin and testosterone levels. Moreover, a statistically significant difference was reported in variations of total Hospital Anxiety and Depression Scale (HADS) score, in the anxiety HADS score and improvement in joint pain. Our results suggested that promoting a healthy lifestyle in clinical practice reduces risk factors involved in BC recurrence and ensures psycho-physical well-being.openMirco Pistelli, Valentina Natalucci, Laura Scortichini, Veronica Agostinelli, Edoardo Lenci, Sonia Crocetti, Filippo Merloni, Lucia Bastianelli, Marina Taus, Daniele Fumelli, Gloria Giulietti, Claudia Cola, Marianna Capecci, Roberta Serrani, Maria Gabriella Ceravolo, Maurizio Ricci, Albano Nicolai, Elena Barbieri, Giulia Nicolai, Zelmira Ballatore, Agnese Savini and Rossana BerardiPistelli, Mirco; Natalucci, Valentina; Scortichini, Laura; Agostinelli, Veronica; Lenci, Edoardo; Crocetti, Sonia; Merloni, Filippo; Bastianelli, Lucia; Taus, Marina; Fumelli, Daniele; Giulietti, Gloria; Cola, Claudia; Capecci, Marianna; Serrani, Roberta; Gabriella Ceravolo, Maria; Ricci, Maurizio; Nicolai, Albano; Barbieri, Elena; Nicolai, Giulia; Ballatore, Zelmira; Savini and Rossana Berardi, Agnes