Serum Levels of Surfactant Proteins in Patients with Combined Pulmonary Fibrosis and Emphysema (CPFE)

Introduction Emphysema and idiopathic pulmonary fibrosis (IPF) present either per se or coexist in combined pulmonary fibrosis and emphysema (CPFE). Serum surfactant proteins (SPs) A, B, C and D levels may reflect lung damage. We evaluated serum SP levels in healthy controls, emphysema, IPF, and CPFE patients and their associations to disease severity and survival. Methods 122 consecutive patients (31 emphysema, 62 IPF, and 29 CPFE) and 25 healthy controls underwent PFTs, ABG-measurements, 6MWT and chest HRCT. Serum levels of SPs were measured. Patients were followed-up for 1-year. Results SP-A and SP-D levels differed between groups (p = 0.006 and p= 26 ng/mL) presented a weak association with reduced survival (p = 0.05). Conclusion In conclusion, serum SP-A and SP-D levels were higher where fibrosis exists or coexists and related to disease severity, suggesting that serum SPs relate to alveolar damage in fibrotic lungs and may reflect either local overproduction or overleakage. The weak association between high levels of SP-B and survival needs further validation in clinical trials

Transarterial chemotherapy and embolization as adjuvant and alternative therapeutic methods for hepatic neoplasms

Introduction: HCC is the third most common cause of tumor-related death among males and the sixth among females. Surgical resection and liver transplantation are the most effective treatments for early or very early HCC according to the BCLC staging-system. However, many patients are presented with unrespectable HCC in the so-called intermediate stage according to BCLC (BCLC-stage B) where trans-arterial chemoembolization (TACE) is recommended as the standard care. Trans-arterial chemoembolization is associated with better survival in BCLC-stage B patients with hepatocellular carcinoma and Child-Pugh A whereas in Child-Pugh B there is no definite evidence of benefit. Furthermore, several uncertainties have been raised in every day clinical practice regarding factors affecting TACE modality like tumor burden, selection criteria, chemotherapeutic regimens and use or disuse of lipiodol, use and type of embolizing agents and frequency of TACE courses.Objectives: To assess the safety and efficacy of TACE during routine clinical practice in patients with inoperable HCC and to evaluate survival and factors affecting survival. Patients and Methods: Seventy one patients were enrolled for this study (mean follow-up 24.6 months). TACE was performed with intra-arterial injection of 100 mg cisplatin, 50 mg doxorubicin and 10 ml lipiodol as well as embolic materials. CT-scans and blood-biochemical tests were obtained prior and post-TACE. Kaplan–Meier method and Cox proportional- hazard models were used to evaluate survival and factors affecting survival. Results: Survival at 1-year, 2-years, 3-years and 5-years was 73.2%, 45.4%, 33.2% and 14.9% respectively. Procedure-related mortality was 1.4%. Multivariate analysis showed lesion diameter, Child-Pugh classification, alcohol abuse, tumor response and a-fetoprotein levels prior TACE as independent prognostic factors of survival. Furthermore, patients diagnosed during surveillance had significantly better survival rates compared to those diagnosed after development of symptoms.Conclusions: TACE is safe and efficient for unrespectable HCC. Alcohol abuse, tumor burden, response criteria, Child-Pugh and a-fetoprotein levels prior to the session were identified as independent predictors of survival whereas, adherence to surveillance programs resulted in significantly better survival in these patients.Εισαγωγή: Το ηπατοκυτταρικό καρκίνωμα (ΗΚΚ) αποτελεί την τρίτη συχνότερη αιτία θανάτου σχετιζόμενη με νεοεξεργασίες στους άντρες και την έκτη συχνότερη στις γυναίκες. Σε ασθενείς με πολύ πρώιμο ή πρώιμο ΗΚΚ σύμφωνα με το σύστημα σταδιοποίησης BCLC, η χειρουργική εκτομή και η μεταμόσχευση αποτελούν τις πιο αποτελεσματικές θεραπείες. Ωστόσο, πολλοί ασθενείς παρουσιάζονται με ανεγχείρητο όγκο, στο λεγόμενο ενδιάμεσο στάδιο κατά BCLC (στάδιο BCLC B), όπου ο διακαθετηριακός χημειοεμβολισμός προτείνεται ως θεραπεία εκλογής. Η μέθοδος σχετίζεται με βελτίωση της επιβίωσης σε ασθενείς σταδίου BCLC B με κίρρωση σταδίου Α κατά Child-Pugh, ενώ δεν υπάρχει σαφής απόδειξη του οφέλους σε ασθενείς σταδίου Β κατά Child-Pugh. Επιπρόσθετα, έχουν ανακύψει πολλές αβεβαιότητες στην καθημερινή κλινική πράξη όσον αφορά στους παράγοντες που επηρεάζουν τη μέθοδο του χημειοεμβολισμού όπως το φορτίο του όγκου, τα κριτήρια επιλογής των ασθενών, τα χημειοθεραπευτικά φάρμακα, τη χρήση ή όχι της λιπιοδόλης, τη χρήση και το είδος των εμβολικών παραγόντων και τη συχνότητα των συνεδριών.Σκοπός: Η εκτίμηση της ασφάλειας και της αποτελεσματικότητας του διακαθετηριακού χημειοεμβολισμού στην κλινική πράξη σε ασθενείς με ανεγχείρητο ΗΚΚ και η ανάλυση της επιβίωσης και των δυνητικών παραγόντων που την επηρεάζουν. Υλικό και μέθοδος: Στη μελέτη συμπεριλήφθησαν 71 ασθενείς με μέση διάρκεια παρακολούθησης 24.6 μήνες. Ο διακαθετηριακός χημειοεμβολισμός πραγματοποιήθηκε με τη χορήγηση 100 mg σισπλατίνης, 50 mg δοξορουβικίνης και 10 ml λιπιοδόλης καθώς και εμβολικών παραγόντων. Προ και μετά τη συνεδρία πραγματοποιήθηκαν Υπολογιστική Τομογραφία ήπατος και αιματολογικός-βιοχημικός έλεγχος. Η μέθοδος Kaplan-Meier και τα μοντέλα αναλογικού κινδύνου Cox (Cox proportional-hazard models) χρησιμοποιήθηκαν για την απεικόνιση της αθροιστικής πιθανότητας επιβίωσης και την εύρεση των παραγόντων που σχετίζονται με την επιβίωση.Αποτελέσματα: Η πιθανότητα επιβίωσης στο 1, 2, 3 και 5 έτη υπολογίστηκε στο 73.2%, 45.4%, 33.2% και 14.9% αντίστοιχα. Η θνησιμότητα σχετιζόμενη με τη διαδικασία βρέθηκε 1.4%. Η πολυπαραγοντική ανάλυση έδειξε ότι η διάμετρος του όγκου, το στάδιο της κίρρωσης κατά Child-Pugh, η κατάχρηση αλκοόλ ως αίτιο της κίρρωσης, η ανταπόκριση στη θεραπεία και τα προ-επεμβατικά επίπεδα της α-φετοπρωτεϊνης αποτελούν ανεξάρτητους παράγοντες επιβίωσης. Επιπρόσθετα, οι ασθενείς που διαγνώστηκαν με ΗΚΚ στα πλαίσια του προσυμπτωματικού ελέγχου είχαν σημαντικά καλύτερη επιβίωση συγκριτικά με αυτούς που διαγνώστηκαν στα πλαίσια διερεύνησης λόγω παρουσίας συμπτωμάτων.Συμπεράσματα: Ο διακαθετηριακός χημειοεμβολισμός αποτελεί μια ασφαλή και αποτελεσματική μέθοδο για τη θεραπεία του ανεγχείρητου ΗΚΚ. Η διάμετρος του όγκου, το στάδιο της κίρρωσης κατά Child-Pugh, η κατάχρηση αλκοόλ ως αίτιο της κίρρωσης, η ανταπόκριση στη θεραπεία και τα προ-επεμβατικά επίπεδα της α-φετοπρωτεϊνης αποτελούν ανεξάρτητους παράγοντες επιβίωσης, ενώ η συμμόρφωση στα προγράμματα στα προγράμματα προσυμπτωματικού ελέγχου σχετίζεται με σημαντική βελτίωση της επιβίωσης των ασθενών

Percutaneous, Imaging-Guided Biopsy of Bone Metastases

Approximately 70% of cancer patients will eventually develop bone metastases. Spine, due to the abundance of red marrow in the vertebral bodies and the communication of deep thoracic-pelvic veins with valve-less vertebral venous plexuses, is the most common site of osseous metastatic disease. Open biopsies run the risk of destabilizing an already diseased spinal or peripheral skeleton segment. Percutaneous biopsies obviate such issues and provide immediate confirmation of correct needle location in the area of interest. Indications for percutaneous bone biopsy include lesion characterization, optimal treatment and tumor recurrence identification, as well as tumor response and recurrence rate prediction. Predicting recurrence in curative cases could help in treatment stratification, identification, and validation of new targets. The overall accuracy of percutaneous biopsy is 90–95%; higher positive recovery rates govern biopsy of osteolytic lesions. The rate of complications for percutaneous biopsy approaches is <5%. The purpose of this review is to provide information about performing bone biopsy and what to expect from it as well as choosing the appropriate imaging guidance. Additionally, factors governing the appropriate needle trajectory that would likely give the greatest diagnostic yield and choice of the most appropriate biopsy system and type of anesthesia will be addressed

Solitary round pulmonary lesions in the pediatric population: a pictorial review

The purpose of this current pictorial review is to define the solitary round pulmonary lesion (SRPL), to familiarize with its prevalence in the pediatric population, and, moreover, to educate radiologists on its vast differential diagnosis and imaging manifestations. Furthermore, by highlighting valuable clues, it intends to assist radiologists efficiently partake in its diagnosis, work-up, and follow-up in order to narrow down the differential diagnosis by working alongside the clinician and combining clinical information, lab results, and radiological findings

Percutaneous Microwave Ablation of Liver Lesions: Differences on the Sphericity Index of the Ablation Zone between Cirrhotic and Healthy Liver Parenchyma

To compare different parameters of the sphericity index of the ablation zone following microwave ablation (MWA) on cirrhotic- and healthy-liver parenchyma in a series of patients treated with the same MWA system. Institutional database research identified 46 patients (77 lesions) who underwent MWA. “Cirrhotic liver group” (CLG) included 35 hepatocellular carcinoma lesions; “healthy liver group” (HLG) included 42 metastatic lesions. The long axis (LAD), short axis 1 (SAD-1) and 2 (SAD-2), the mean SAD-1 and SAD-2 (mSAD) diameter (in mm) and the mean sphericity (mSPH) index of the ablation zones were evaluated for each treated lesion in both groups from baseline to follow-up. A mixed model analysis of variance reported significant main effect of group on SAD-1 (p = 0.023), SAD-2 (p = 0.010) and mSAD (p = 0.010), with HLG showing lower values compared to CLG. No differences were detected on the LAD (pFDR = 0.089; d = 0.45), and mSPH (pFDR = 0.148, d = 0.40) between the two groups. However, a significant main effect of time was found on LAD (p < 0.001), SAD-1 (p < 0.001), SAD-2 (p < 0.001) and mSAD (p < 0.001), with decreased values in all indices at follow-up compared to baseline. A significant group by time interaction was observed on mSPH (p = 0.044); HLG had significantly lower mSPH at follow-up where CLG did not show any significant change. Our findings indicate that although in cirrhotic liver short axis diameter of the MWA zone seems to be significantly longer, this has no effect on the sphericity index which showed no significant difference between cirrhotic vs. healthy liver lesions. On the contrary, on one month follow-up ablation zones tend to become significant more ellipsoid in healthy whilst remains stable in cirrhotic liver

Percutaneous Navigation under Local Anesthesia for Computed Tomography-Guided Microwave Ablation of Malignant Liver Lesions Located in the Hepatic Dome

Background and Objectives: The aim of the present study was to report the safety and efficacy of percutaneous navigation under local anesthesia for computed tomography-guided microwave ablation of malignant liver lesions located in the hepatic dome. Patients with primary and secondary malignant liver lesions located in the hepatic dome who underwent percutaneous computed tomography-guided microwave ablation using a computer-assisted navigation system under local anesthesia were prospectively evaluated. The primary objective was technical success. Materials and Methods: The sample consisted of 10 participants (16 lesions) with a mean age of 60.60 years (SD = 9.25 years) and a mean size of 20.37 ± 7.29 cm, and the mean follow-up time was 3.4 months (SD = 1.41) months. Results: Primary technical success was 93.75%. Tumor remnant was noticed at one month follow-up in a single metastatic lesion, which was re-treated with an ablation session, and no tumor remnant was depicted in the subsequent imaging follow-up (secondary technical success 100%). Grade I self-limited complications (according to the CIRSE classification system) included small pleural effusion (n = 1) and minor bleeding post antenna removal (n = 1) requiring nothing but observation. Conclusions: the findings of the present study indicate that percutaneous navigation under local anesthesia is a safe and efficacious approach for computed tomography-guided microwave ablation of malignant liver lesions located in the hepatic dome. Large randomized controlled studies are warranted to observe treatment effectiveness and compare the results with those of other options

Percutaneous Microwave Ablation of Liver Lesions: Differences on the Sphericity Index of the Ablation Zone between Cirrhotic and Healthy Liver Parenchyma

To compare different parameters of the sphericity index of the ablation zone following microwave ablation (MWA) on cirrhotic- and healthy-liver parenchyma in a series of patients treated with the same MWA system. Institutional database research identified 46 patients (77 lesions) who underwent MWA. “Cirrhotic liver group” (CLG) included 35 hepatocellular carcinoma lesions; “healthy liver group” (HLG) included 42 metastatic lesions. The long axis (LAD), short axis 1 (SAD-1) and 2 (SAD-2), the mean SAD-1 and SAD-2 (mSAD) diameter (in mm) and the mean sphericity (mSPH) index of the ablation zones were evaluated for each treated lesion in both groups from baseline to follow-up. A mixed model analysis of variance reported significant main effect of group on SAD-1 (p = 0.023), SAD-2 (p = 0.010) and mSAD (p = 0.010), with HLG showing lower values compared to CLG. No differences were detected on the LAD (p(FDR) = 0.089; d = 0.45), and mSPH (p(FDR) = 0.148, d = 0.40) between the two groups. However, a significant main effect of time was found on LAD (p < 0.001), SAD-1 (p < 0.001), SAD-2 (p < 0.001) and mSAD (p < 0.001), with decreased values in all indices at follow-up compared to baseline. A significant group by time interaction was observed on mSPH (p = 0.044); HLG had significantly lower mSPH at follow-up where CLG did not show any significant change. Our findings indicate that although in cirrhotic liver short axis diameter of the MWA zone seems to be significantly longer, this has no effect on the sphericity index which showed no significant difference between cirrhotic vs. healthy liver lesions. On the contrary, on one month follow-up ablation zones tend to become significant more ellipsoid in healthy whilst remains stable in cirrhotic liver

High-Resolution Computed Tomography Examinations for Chronic Suppurative Lung Disease in Early Childhood: Radiation Exposure and Image Quality Evaluations With Iterative Reconstruction Algorithm Use

Purpose: High radiosensitivity of children undergoing repetitive computed tomography examinations necessitates the use of iterative reconstruction algorithms in order to achieve a significant radiation dose reduction. The goal of this study is to compare the iDose iterative reconstruction algorithm with filtered backprojection in terms of radiation exposure and image quality in 33 chest high-resolution computed tomography examinations performed in young children with chronic bronchitis. Methods: Fourteen patients were scanned using the filtered backprojection protocol while 19 patients using the iDose protocol and reduced milliampere-seconds, both on a 64-detector row computed tomography scanner. The iDose group images were reconstructed with different iDose levels (2, 4, and 6). Radiation exposure,quantities were estimated, while subjective and objective image qualities were evaluated. Unpaired t tests were used for data statistical analysis. Results: The iDose application allowed significant effective dose reduction (about 80%). Subjective image quality evaluation showed satisfactory results even with iDose level 2, whereas it approached excellent image with iDose level 6. Subjective image noise was comparable between the 2 groups with the use of iDose level 4, while objective noise was comparable between filtered backprojection and iterative reconstruction level 6 images. Conclusions: The iDose algorithm use in pediatric chest high-resolution computed tomography reduces radiation exposure without compromising image quality. Further evaluation with iterative reconstruction algorithms is needed in order to establish high-resolution computed tomography as the gold standard low-dose method for children suffering from chronic lung diseases