P02-216 The contributes of cerebellum in higher cognitive and social behaviour in childhood

Many studies have confirmed the role of the cerebellum in the organization of superior brain functions in adults. Congenital cerebellar alterations are frequently observed in children with neurological diseases. These anatomical alterations are associated with neuropsychological or developmental disorders that often give rise to pictures of mental insufficiency of varying severity with behavioural changes even leading to autism.Aim:To evaluate of cerebellum role in cognitive and social organization also during development.We report 25 children with different kinds of acquired cerebellar lesions (12 with hemispheric astrocytoma, 12 with vermis medulloblastoma, and 1 with hemispheric stroke) who showed different clinical patterns according to the lesion localization. All subject were studied by neurological examination and MRI. Neuropsychological assessment included:•observation of spontaneous behaviour;•Recording of spontaneous language;•Intelligence evaluation (WISC-test);•Language evaluation;•Memory evaluation;•Assessment of frontal lobe functions (categorical memory, sequential memory, language fluency, design fluency, flexibility of reasoning and problem solving).Lesion in the vermis, mainly in the lower lobuli, caused different degrees of behavioural disturbances ranging from irritability to psychosis; lesions in the right hemisphere impaired language processing and symbolic sequencing, categorical memory and executive functions; lesions in the left hemisphere impaired speech prosody, visual sequential memory and design fluency.These data confirm that the connections from the cerebellum to the associative cortical areas are operative very early and that the cerebellum has an essential role in cognitive and social organization also during development

MR imaging in locally advanced rectal cancer: quantitative evaluation of the full response to neoadjuvant therapy

To assess the diagnostic performance of DW Imaging (DWI) for the discrimination of complete responder (CR) from the non-complete responder (n-CR) in patients with locally advanced rectal cancer (LARC) undergoing chemotherapy and radiation (CRT)

Safety and efficacy of the Yukon Choice Flex sirolimus-eluting coronary stent in an all-comers population cohort

Aims: The use of biodegradable-polymer drug-eluting stents has been shown to provide favorable results when compared with durable polymer drug-eluting stents and long-term follow up data have recently shown significant reductions in terms of very late stent thrombosis. Aim of the present study was to assess the safety and efficacy profile of a novel biodegradable polymer DES, the Yukon Choice Flex sirolimus-eluting stent. Methods: We report here the one-year clinical outcomes associated with the use of the Yukon Choice Flex sirolimus-eluting stent in an all-comers patient population. The present stent represents a further refinement of the stent platform tested in the ISAR TEST 3 and 4 randomized clinical trials. A total of 778 consecutive patients undergoing implantation of this stent were enrolled in the present observational study and prospectively followed for one year. Results: The use of the Yukon Choice Flex stent in a patient population with complex coronary lesion morphology was associated with optimal immediate angiographic results. At one year follow up the rates of death, myocardial infarction, definite stent thrombosis and ischemia-driven target lesion revascularization were respectively 2.4%, 1.9%, 0.3% and 11.3%. Conclusions: The use of the sirolimus-eluting biodegradable polymer Yukon Choice Flex stent in an all-comers population of patients with complex coronary artery disease is associated with a favorable safety and efficacy profile up to one year follow up

A very rare complication of an abdominal aortic aneurysm: primary aortoduodenal fistula without gastrointestinal bleeding

Abstract An abdominal aortic aneurism (AAA) is an enlargement of the lower part of the aorta that extends through the abdominal area.The diameter of the aneurismatic vessel is represented by 3 cm or more in either anterior – posterior, or transverse planes. The developpement of Abdominal aortic aneurysm (AAA) is a complex, multifactorial process involving destructive remodeling of aortic wall connective tissue. Four interrelated factors involved in this process include: (1) chronic inflammation associated with neovascularization and increased proinflammatory cytokine production, (2) increased and dysregulated production of matrix-degrading proteinases, (3) destruction of structural matrix proteins, and (4) decreased medial smooth muscle cell (SMC) presence, resulting in impaired connective tissue repair. This understanding has developed from a characterization of human AAA tissue, as well as the use of different animal models that replicate human disease. The mortality of ruptured AAA is set between 40 – 70% in patients that manage to arrive alive in the emergency room, and that of 90% in overall patients confirmed with rAAA in the autopsy results. A ruptured abdominal aortic aneurysm (rAAA) represents a disruption of a dilated aortic wall that leads to blood outside the aortic wall

Magnetic resonance imaging in locally advanced rectal cancer: Quantitative evaluation of the complete response to neoadjuvant therapy

Purpose: To assess the diagnostic performance of diffusion-weighted imaging (DWI) for the discrimination of complete responder (CR) from the non-complete responder (n-CR) in patients with locally advanced rectal cancer (LARC) undergoing chemotherapy and radiation (CRT). Material and methods: Between December 2009 and January 2014, 32 patients (33 lesions: one patient had two synchronous lesions) were enrolled in this retrospective study. All patients underwent a pre-and post-CRT conventional MRI study completed with DWI. For both data sets (T2-weighted and DWI), the pre-and post-CRT tumour volume (V T2 ; V DWI ) and the tumour volume reduction ratio ( 06V%) were determined as well as pre-and post-CRT apparent diffusion coefficient (ADC) and ADC change ( 06ADC%). Histopathological findings were the standard of reference. Receiver operating characteristic (ROC) curves were generated to compare performance of T2-weighted and DWI volumetry, as well as ADC. Results: The area under the ROC curve (AUC) revealed a good accuracy of pre-and post-CRT values of V T2 (0.86; 0.91) and V DWI (0.82; 1.00) as well as those of \u394V T2 % (0.84) and \u394V DWI % (1.00) for the CR assessment, with no statistical difference. The AUC of pre-and post-CRT ADC (0.53; 0.54) and that of \u394ADC% (0.58) were significantly lower. Conclusions: Both post-CRT V DWI and \u394V DWI % (AUC = 1) are very accurate for the assessment of the CR, in spite of no significant differences in comparison to the conventional post-CRT V T2 (AUC = 0.91) and \u394V T2 % (AUC = 0.84). On the contrary, both ADC and \u394ADC% values are not reliable

Ethylene-vinyl alcohol polymer trans-arterial embolization in emergency peripheral active bleeding : initial experience

AIM: The aim of this paper was to evaluate the efficacy, safety, and clinical outcomes of superselective embolization using ethylene-vinyl alcohol copolymer (Onyx Liquid Embolic System; ev3 Neurovascular, Irvine, CA, USA) as the primary treatment in active peripheral emergency arterial bleeding. METHODS: Between January 2014 and June 2014, all patients with active peripheral arterial bleeding who were treated by embolization were retrospectively analyzed. We selected 15 (age 37-91 year old) patients embolized with Onyx, chosen as embolic agent in an intention-to-treat fashion. Multidetector computed tomography was performed in all patients. RESULTS: Active bleeding was detected in all cases. Digital subtraction angiography confirmed CT findings in all cases. The causes of bleeding were traumatic in 8 patients, angiodysplasia in 1 patient, duodenal ulcer in 1, chronic pancreatitis in 1 and unknown in 4 patients. Nine patients were under anticoagulant or antiplatelet therapy. Embolization was possible in all patients. The technical success rate was 100%. The immediate bleeding control rate was 100%. No rebleeding at 30 days occurred (0%). There were no major complications, or deaths attributable to the treatment. No patient needed surgery or new embolization during a mean follow-up period of 5.1 months (range, 4.5-6 months). CONCLUSION: Control of massive active peripheral emergency arterial bleeding using superselective embolization with Onyx is feasible and safe