Hepatocellular adenoma: An unsolved diagnostic enigma

Hepatocellular adenoma (HCA) is a rare benign liver tumour associated with the use of oral contraceptives or other steroid medications which occurs predominantly in young and middle-aged women. Unlike other benign liver tumours, an HCA may be complicated by bleeding and malignant transformation. HCAs have been divided into four subtypes based on molecular and pathological features: hepatocyte nuclear factor 1\u3b1-mutated HCA, inflammatory HCA, \u3b2-catenin-mutated HCA, and unclassified HCA. \u3b2-catenin-mutated HCA has the highest risk of haemorrhage or malignant transformation. In the latest upgrade of the guidelines regarding the management of benign liver tumours published in 2016 by the European Association for the Study of the Liver, magnetic resonance imaging (MRI) was recognized to be superior to all other imaging modalities in detecting HCAs and in being able to subtype HCAs up to 80%, with positive identification of 1\u3b1-mutated HCA or inflammatory HCA achievable with > 90% specificity. This review analyzed the imaging features of HCA using MRI with hepato-specific contrast agents, focusing on the limitations in the HCA characterization

Bilateral osteoma of the internal auditory canal: Case report and literature review

Osteomas of the external auditory canal tend to be rather common; those of the internal auditory canal (IAC) are much rarer, though, with less than twenty cases reported in literature up to this very day. Bilateral IAC osteomas, as in this case, are extremely unusual.These benign bone tumors grow very slowly and this implies that the patient is very often asymptomatic. The diagnosis is generally made relatively late and it is, in many cases, absolutely incidental, with Computed Thomography (CT) scans of the temporal bones performed for other reasons. The manuscript describe the case of a patient complaining with progressive bilateral hearing impairment, worsening in the course of many years; we would like to point out the benefits brought by CT in the diagnosis and therapeutic choice, which is, still today, not yet subject to unanimous consensus. (C) 2014 The College of Radiographers. Published by Elsevier Ltd. All rights reserved

Analysis of size and shape differences between ancient and present-day Italian crania using metrics and geometric morphometrics based on multislice computed tomography

The Museum of Human Anatomy in Naples houses a collection of ancient Graeco-Roman crania. The aim of this study was to use multislice computed tomography (MSCT) to evaluate and objectively quantify potential differences in cranial dimensions and shapes between ancient Graeco-Roman crania (n = 36) and modern-day southern Italian crania (n = 35) and then to characterize the cranial changes occurring over more than 2000 years, known as secular change. The authors used traditional metric criteria and morphometric geometry to compare shape differences between the sets of crania. Statistically significant differences in size between the ancient and modern crania included shorter facial length, narrower external palate, smaller minimum cranial breadth, shorter right and left mastoid processes, and wider maximum occipital and nasal breadth. The shape changes from the ancient to modern crania included a global coronal enlargement of the face and cranial diameters, with more anterior projection of the face at the anterior nasal spine, but also posterior projection at the glabella and the nasion. It is not possible to determine whether these differences result exclusively from secular changes in the cranium or from other factors, including a mix of secular change and other unknown factors. To the best of our knowledge, this is the first MSCT-based study to compare ancient Graeco-Roman and modern-day southern Italian crania and to characterize shape and size differences

The beneficial effects of TAVI in mitral insufficiency.

Background Although everolimus potentially improves long-term heart transplantation (HTx) outcomes, its early postoperative safety profile had raised concerns and needs optimization. Methods This 6-month, open-label, multicenter randomized trial was designed to compare the cumulative incidence of a primary composite safety endpoint comprising wound healing delays, pericardial effusion, pleural effusion needing drainage, and renal insufficiency events (estimated glomerular filtration rate ≤30/mL/min per 1.73 m2) in de novo HTx recipients receiving immediate everolimus (EVR-I) (≤144 hours post-HTx) or delayed everolimus (EVR-D) (4-6 weeks post-HTx with mycophenolate mofetil as a bridge) with reduced-dose cyclosporine A. Cumulative incidence of biopsy-proven rejection ≥ 2R, rejection with hemodynamic compromise, graft loss, or death was the secondary composite efficacy endpoint. Results Overall, 181 patients were randomized to the EVR-I (n = 89) or EVR-D (n = 92) arms. Incidence of primary safety endpoint was higher for EVR-I than EVR-D arm (44.9% vs 32.6%; P = 0.191), mainly driven by a higher rate of pericardial effusion (33.7% vs 19.6%; P = 0.04); wound healing delays, acute renal insufficiency events, and pleural effusion occurred at similar frequencies in the study arms. Efficacy failure was not significantly different in EVR-I arm versus EVR-D arm (37.1% vs 28.3%; P = 0.191). Three patients in the EVR-I arm and 1 in the EVR-D arm died. Incidence of clinically significant adverse events leading to discontinuation was higher in EVR-I arm versus EVR-D arm (P = 0.02). Conclusions Compared with immediate initiation, delayed everolimus initiation appeared to provide a clinically relevant early safety benefit in de novo HTx recipients, without compromising efficacy. © 2017 The Author(s). Published by Wolters Kluwer Health, Inc

Variations of endonasal anatomy: relevance for the endoscopic endonasal transsphenoidal approach

Contains fulltext : 87525.pdf (publisher's version ) (Closed access)BACKGROUND: The endoscopic endonasal transsphenoidal approach (EETA) to the pituitary is performed by ear, nose, and throat (ENT) surgeons in collaboration with neurosurgeons but also by neurosurgeons alone even though neurosurgeons have not been trained in rhinological surgery. PURPOSE: To register the frequency of endonasal anatomical variations and to evaluate whether these variations hinder the progress of EETA and require extra rhinological surgical skills. METHODS: A prospective cohort study of 185 consecutive patients receiving an EETA through a binostril approach was performed. All anatomical endonasal variations were noted and the relevance for the progress of surgery evaluated. RESULTS: In 48% of patients, anatomical variations were recognized, the majority of which were spinae septi and septum deviations. In 5% of patients, the planned binostril approach had to be converted into a mononostril approach; whereas in 18% of patients with an anatomical variation, a correction had to be performed. There was no difference between the ENT surgeon and the neurosurgeon performing the approach. Complications related to the endonasal phase of the surgery occurred in 3.8%. Fluoroscopy or electromagnetic navigation has been used during 6.5% of the surgeries. CONCLUSION: Although endonasal anatomical variations are frequent, they do not pose a relevant obstacle for EETA.1 juni 201