Roberto Stramare - Academia.edu (original) (raw)
Papers by Roberto Stramare
European Journal of Surgical Oncology
BACKGROUND AND PURPOSE Locoregional recurrence after resection of primary retroperitoneal sarcoma... more BACKGROUND AND PURPOSE Locoregional recurrence after resection of primary retroperitoneal sarcoma (RPS) is a challenging therapeutic issue. The objective of this study was to identify clinicopathological factors predictive of overall survival (OS) and disease specific survival (DSS) after reoperation for recurrent RPS. PATIENTS AND METHODS We retrospectively collected data from the medical records of 800 patients who underwent resection for sarcoma at our Institution, from 1983 to 2015. Among these patients, 120 were treated for retroperitoneal sarcoma and 55 had a locoregional recurrence (LR). Four of them did not undergo surgery and thus were excluded from this study leaving 51 cases available for data analysis. Univariate and multivariate survival analyses were performed to identify prognostic factors. RESULTS Median overall survival was 33 months. The 1-year, 3-year and 5-year OS rates were 75.5%, 47.1% and 31.6% respectively. Multivariate Cox regression analysis suggested that extension of surgery (P = 0.026), surgical margin status (P = 0.015) and histological grade of recurrent tumor (P = 0.047) were independent prognostic factors for OS. Median DSS was 48 months. The 1-year, 3-year and 5-year DSS rates were 79.2%, 53.1% and 40.9%, respectively. At multivariate analysis, predictors of DSS were extension of surgery (P = 0.004), margin status (P = 0.011), histological grade of recurrent tumor (P = 0.008), and disease free interval (DFI) (P = 0.020). As regards histological subtype of recurrent RPS, at univariate analysis, well-differentiated liposarcoma (WDLS) was associated with better OS and DSS (P = 0.052 and P = 0.016 respectively) compared to dedifferentiated liposarcoma (DDLS). CONCLUSIONS According to our findings, surgery is more beneficial in patients with low-grade sarcoma, WDLS and long DFI. The achievement of clear resection margins, rather than performing a multivisceral resection, appears to be a key factor to improve OS and DSS.
Journal of Clinical Medicine
At the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) outbreak in I... more At the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) outbreak in Italy, the cluster of Vò Euganeo was managed by the University Hospital of Padova. The Department of Diagnostic Imaging (DDI) conceived an organizational approach based on three different pathways for low-risk, high-risk, and confirmed Coronavirus Disease 19 (COVID-19) patients to accomplish three main targets: guarantee a safe pathway for non-COVID-19 patients, ensure health personnel safety, and maintain an efficient workload. Thus, an additional pathway was created with the aid of a trailer-mounted Computed Tomography (CT) scanner devoted to positive patients. We evaluated the performance of our approach from February 21 through April 12 in terms of workload (e.g., number of CT examinations) and safety (COVID-19-positive healthcare workers). There was an average of 72.2 and 17.8 COVID-19 patients per day in wards and the Intensive Care Unit (ICU), respectively. A total of 176 high-risk...
Radiology and Oncology, 2022
Background Pediatric soft tissue sarcomas are rare tumors with rhabdomyosarcoma being the most fr... more Background Pediatric soft tissue sarcomas are rare tumors with rhabdomyosarcoma being the most frequent histotype. Diagnostic imaging plays a significant role in the evaluation of this type of tumors. Thus, aim of this study was to assess the prognostic and diagnostic value of radiomic features extracted from axial T2w images of the primary lesion in children with soft tissue sarcomas examined by PET/MR for staging. Methods Using an open source software, each lesion was segmented and 33 radiomic features then extracted. Factor and logistic regression analyses were applied to select highly correlating features and evaluate their prognostic role, respectively. Differences in radiomic, demographics, metabolic, and laboratory variables according to tumor grade and histotype were investigated by the Students’ and Chi-square tests. In case of differences the diagnostic value of the variable/s was assessed by receiver operating curves. Results Eighteen children (11 female; mean age 7.8 ± 4...
Annals of Nuclear Medicine, 2021
To compare the accuracy of contrast-enhanced MRI using established dimensional and morphological ... more To compare the accuracy of contrast-enhanced MRI using established dimensional and morphological criteria versus integrated [18F]FDG PET/MRI in identifying regional lymph node metastases in patients with newly diagnosed head and neck squamous cell carcinoma (HNSCC). For this purpose, we compare MRI and PET/MRI using the histopathological findings in dissected lymph nodes as the gold standard. We retrospectively reviewed 26 patients with histologically proven HNSCC who underwent gadolinium-enhanced [18F]FDG PET/MRI as part of their staging. All neck lymph nodes were classified on MRI using dimensional and/or morphological criteria. Then, they were jointly assessed by a nuclear medicine physician and a radiologist using integrated [18F]PET/MR images. ROC curves were obtained to compare the techniques. Lymph node histopathology was considered as the reference standard. Out of 865 lymph nodes, 35 were malignant at histopathology (3 with micro-metastases). Sensitivity and specificity were 48.6% and 99.5% for MRI using dimensional criteria; 60.0% and 99.6% for MRI using morphological criteria; 60.0% and 99.4% for MRI using both; and 74.3% and 97.6% for PET using MR as anatomic localization. The area under the ROC curve was higher for PET and MRI localization (0.859) than for MRI using dimensional (0.740; p < 0.05), or morphological (0.798; p < 0.05), or both criteria (0.797; p < 0.05). PET/MR using a PET SUVmax cutoff of 5.7 combined with MRI using dimensional and/or morphological criteria reached high values for accuracy (98.2%), NPV (98.2%), and PPV (95.2%). Compared with traditional contrast-enhanced MRI or PET alone, integrated PET/MRI could improve diagnostic accuracy in detecting metastatic lymph nodes in patients with HNSCC.
Journal of Ultrasound, 2020
Contrast-enhanced ultrasonography (CEUS) is increasingly being performed in Italy and Europe, par... more Contrast-enhanced ultrasonography (CEUS) is increasingly being performed in Italy and Europe, particularly in the field of hepato-gastroenterology. Initially, it was mainly carried out to characterize focal hepatic lesions, but, since then, numerous studies have demonstrated its efficacy in the differential diagnosis of focal pancreatic pathologies (D’Onofrio et al. in Expert Rev Med Devices 7(2):257–273, 2010; Vidili et al. in J Ultrasound 22(1):41–51, 2019). The purpose of this paper is to provide Italian Medical Doctors with recommendations and thereby practical guidelines on the management of these patients. The present paper reports the final conclusions reached by the SIUMB guideline commission. This paper addresses particularly percutaneous ultrasound (US) examination (transabdominal US) and is drawn up specifically for publication.
Acta Oto-Laryngologica, 2019
Background: Deep neck infections (DNIs) are often clinically challenging, and may be life-threate... more Background: Deep neck infections (DNIs) are often clinically challenging, and may be life-threatening. Objective: The present retrospective study aimed to identify panels of clinical, laboratory, radiological, and microbiological parameters that could identify patients with DNIs at higher risk of complications or long-term hospitalization. Materials and methods: The investigation concerned 301 consecutive patients with DNIs treated at our institution between 2000 and 2014. Results: The discriminatory power of a combination of two variables (unknown origin of the infection and the need for surgical treatment) in terms of deep neck infection complications occurrence featured an AUC (ROC) of 0.6701. The power of a panel of four variables (age, leukocyte count, need for surgical treatment, days elapsing from hospitalization to surgical procedure) to identify DNIs necessitating long-term hospitalization featured an AUC (ROC) of 0.7929. Conclusion: Using the scale proposed by Hosmer and Lemeshow, the four-variable panel showed an amply acceptable, nearly excellent discriminatory power for long-term hospitalization. Significance: Although this panel achieved promising results for prognostic purposes, other parameters potentially capable of predicting the outcome of DNIs and orienting treatment decisions need to be investigated.
CardioVascular and Interventional Radiology, 2020
The aim of this study was to evaluate the safety and the effectiveness of polydioxanone-made biod... more The aim of this study was to evaluate the safety and the effectiveness of polydioxanone-made biodegradable biliary stent placement for the treatment of posttransplant benign, refractory biliary anastomotic strictures. Materials and Methods This was a retrospective observational study on all adult liver transplant recipients who developed a clinically significant anastomotic stricture between January 2014 and June 2017. Percutaneous transhepatic cholangioplasty with balloon dilation was performed as therapeutic approach in selected patients after multidisciplinary evaluation. Refractory strictures (defined as stricture persistence after two interventional procedures) were managed with placement of polydioxanone-made biodegradable biliary stent (SX-Ella biliary stent, Czech Republic). Patency of the common bile duct was calculated using Kaplan-Meier analysis. Results Eighteen adult liver transplant recipients who developed a refractory biliary anastomotic stricture [males/ females 13/5, median (IQR) 58.2 (9.3) years] underwent biodegradable biliary stent placement after 10.4 (32) months from liver transplantation. All procedures except one were uneventful. After a median (IQR) follow-up time of 27.2 (22) months, complete resolution of anastomotic stricture was achieved in 72% of patients, with significant improvement on liver enzymes. Conclusions Polydioxanone-made biodegradable biliary stent might be a safe and effective therapeutic option for the difficult-to-treat benign biliary anastomotic stricture after liver transplantation. Keywords Liver transplantation Á Anastomosis Á Stent Á Biliary stricture Á Percutaneous transhepatic cholangioplasty Á Polydioxanone Abbreviations AS Anastomotic stricture BBS Biodegradable biliary stent ERCP Endoscopic retrograde cholangiopancreatography LT Liver transplantation MRCP Magnetic resonance cholangiopancreatography PDX Polydioxanone PTC Percutaneous transhepatic cholangioplasty Michele Battistel and Marco Senzolo equally contributed to the study and should be considered as co-first authors.
European Radiology, 2020
Objectives Juvenile localized scleroderma (JLS) is a rare chronic autoimmune disease which can al... more Objectives Juvenile localized scleroderma (JLS) is a rare chronic autoimmune disease which can also affect bones and muscles. Nevertheless, muscle loss was not previously investigated in patients with JLS. Thus, the aim of this study was to retrospectively evaluate deep involvement and assess and quantify sarcopenia in JLS patients using magnetic resonance imaging (MRI). Methods Fourteen children with JLS (nine females, mean age ± SD, 7.1 ± 3.6 years) referring to our tertiary center from January 2012 to January 2018 who underwent at least one MRI examination including axial T1-weighted and short tau inversion recovery images were included. Two readers assessed in consensus superficial and deep involvement. Muscle edema, muscle fatty infiltration, and sarcopenia were independently scored (absent, moderate, or severe) and the Cohen's kappa coefficient computed. Skin perimeter, subcutaneous area, muscle area, and muscle volume were independently measured using the contralateral unaffected extremity as reference (paired Student's t test, p < 0.05). The intraclass correlation coefficient (ICC) was used to investigate the reliability of the measurements. Results All patients showed superficial involvement with subcutaneous fat atrophy being the most common finding (13 patients). Bone marrow edema occurred in five patients. Muscle edema affected ten children (moderate in seven, severe in three; k = 0.89), muscle fatty replacement occurred in one case (severe; k = 1.00), and sarcopenia was detected in eight patients (severe in two; k = 0.78). All quantitative parameters were lower on the affected side than on the unaffected contralateral limb (p < 0.05, each) and all measurements showed a high reliability (ICC > 0.750, each). Conclusion Patients with JLS can be affected by sarcopenia and quantitative analyses allow a robust characterization of such finding. Key Points • Deep involvement in juvenile localized scleroderma is frequently characterized by sarcopenia. • In juvenile localized scleroderma, muscle edema and sarcopenia are mostly moderate while fatty infiltration, even if rare, can be severe. • Sarcopenia can be reliably quantified in children with juvenile localized scleroderma using MRI.
Scientific Reports, 2020
Standard electrochemotherapy (ECT) is effective in many tumour types but is confined to the treat... more Standard electrochemotherapy (ECT) is effective in many tumour types but is confined to the treatment of small superficial lesions. Variable electrode-geometry ECT (VEG-ECT) may overcome these limitations by using long freely-placeable electrodes. Patients with bulky or deep-seated soft-tissue malignancies not amenable to resection participated in a single-arm phase-2 study (ISRCTN.11667954) and received a single course of VEG-ECT with intravenous bleomycin (15,000 IU/m2) and concomitant electric pulses applied through an adjustable electrode array. The primary outcome was radiologic complete response rate (CRR) per RECIST; secondary endpoints included feasibility, metabolic response, toxicity (CTCAE), local progression-free survival (LPFS) and patient perception (EQ-5D). During 2009–2014, we enrolled 30 patients with trunk/limb sarcomas, melanoma, Merkel-cell carcinoma, and colorectal/lung cancer. Median tumour size was 4.7 cm. Electrode probes were placed under US/TC guidance (28 ...
In Vivo, 2019
Paediatric invasive fungal infections have significantly increased over the past few decades, in ... more Paediatric invasive fungal infections have significantly increased over the past few decades, in particular among the immunocompromised population. Candida and Aspergillus spp. are still the most commonly isolated organisms. Image-based assessment of fungal infections can indeed be challenging especially in oncological patients where the differential diagnosis relative to other infections and neoplastic lesions cannot be often obvious. Therefore, the knowledge of the main radiological features associated with fungal infections is crucial to achieve an early correct diagnosis and address the most appropriate therapeutic approach. Thus, our aim was to review the main radiological features of paediatric fungal infections with particular focus on positron emission tomography/magnetic resonance imaging (PET/MRI), referring to the experience of our tertiary level hospital.
American Journal of Gastroenterology, 2019
Journal of Cancer Research and Oncobiology, 2018
Background: Leiomyomas are benign mesenchymal neoplasms which rarely occur in the urinary bladder... more Background: Leiomyomas are benign mesenchymal neoplasms which rarely occur in the urinary bladder, accounting for just 0.43% of all bladder tumours. Due to the paucity of data, very little is known about diagnosis, treatment and follow-up. Thus, despite their nonmalignant nature, they may be considered a true therapeutic challenge. Objective: Conservative management is paramount when assessing and managing benign neoplasms. It is the responsibility of the surgeon to tailor the most appropriate surgery for each patient, finding the best balance between oncologic and functional outcomes and future quality of life. Case report: We present a case report of a patient who was incidentally diagnosed with a large, asymptomatic intramural leiomyoma of the urinary bladder. Following abdominal imaging, biopsy specimens were obtained through cystoscopy, and a transurethral resection of the bladder (TURB) was eventually performed. Imaging findings including Ultrasonography (US), triple-phase Computed Tomography Urography (CTU) and Magnetic Resonance Urography (MRU) are reported, and the most representative images are shown. The patient has been successfully managed with staged TURB and then close outpatient follow-up, and she is currently recurrence-free 8 years after the last endoscopic treatment. Conclusion: Despite the benign nature of leiomyomas, the surgical options for these tumours range from TURB to radical cystectomy. Here, we underline how a conservative approach may be successful regardless of the size and site of the lesion, thus preserving the bladder and the patient's quality of life without affecting the oncologic outcomes.
Neurology, Jan 23, 2018
To identify and characterize patients with calsequestrin 1 ()-related myopathy. Patients selected... more To identify and characterize patients with calsequestrin 1 ()-related myopathy. Patients selected according to histopathologic features underwent genetic screening. mutated patients were clinically evaluated and underwent muscle MRI. Vacuole morphology and vacuolated fiber type were characterized. Twenty-two -mutated patients (12 families) were identified, 21 sharing the previously described founder mutation (p.Asp244Gly) and 1 with the p.Gly103Asp mutation. Patients usually presented in the sixth decade with exercise intolerance and myalgias and later developed mild to moderate, slowly progressive proximal weakness with quadriceps atrophy and scapular winging. Muscle MRI (n = 11) showed a recurrent fibrofatty substitution pattern. Three patients presented subclinical cardiac abnormalities. Muscle histopathology in patients with p.Asp244Gly showed vacuoles in type II fibers appearing empty in hematoxylin-eosin, Gomori, and nicotinamide adenine dinucleotide (NADH) tetrazolium reducta...
European Journal of Surgical Oncology
BACKGROUND AND PURPOSE Locoregional recurrence after resection of primary retroperitoneal sarcoma... more BACKGROUND AND PURPOSE Locoregional recurrence after resection of primary retroperitoneal sarcoma (RPS) is a challenging therapeutic issue. The objective of this study was to identify clinicopathological factors predictive of overall survival (OS) and disease specific survival (DSS) after reoperation for recurrent RPS. PATIENTS AND METHODS We retrospectively collected data from the medical records of 800 patients who underwent resection for sarcoma at our Institution, from 1983 to 2015. Among these patients, 120 were treated for retroperitoneal sarcoma and 55 had a locoregional recurrence (LR). Four of them did not undergo surgery and thus were excluded from this study leaving 51 cases available for data analysis. Univariate and multivariate survival analyses were performed to identify prognostic factors. RESULTS Median overall survival was 33 months. The 1-year, 3-year and 5-year OS rates were 75.5%, 47.1% and 31.6% respectively. Multivariate Cox regression analysis suggested that extension of surgery (P = 0.026), surgical margin status (P = 0.015) and histological grade of recurrent tumor (P = 0.047) were independent prognostic factors for OS. Median DSS was 48 months. The 1-year, 3-year and 5-year DSS rates were 79.2%, 53.1% and 40.9%, respectively. At multivariate analysis, predictors of DSS were extension of surgery (P = 0.004), margin status (P = 0.011), histological grade of recurrent tumor (P = 0.008), and disease free interval (DFI) (P = 0.020). As regards histological subtype of recurrent RPS, at univariate analysis, well-differentiated liposarcoma (WDLS) was associated with better OS and DSS (P = 0.052 and P = 0.016 respectively) compared to dedifferentiated liposarcoma (DDLS). CONCLUSIONS According to our findings, surgery is more beneficial in patients with low-grade sarcoma, WDLS and long DFI. The achievement of clear resection margins, rather than performing a multivisceral resection, appears to be a key factor to improve OS and DSS.
Journal of Clinical Medicine
At the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) outbreak in I... more At the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) outbreak in Italy, the cluster of Vò Euganeo was managed by the University Hospital of Padova. The Department of Diagnostic Imaging (DDI) conceived an organizational approach based on three different pathways for low-risk, high-risk, and confirmed Coronavirus Disease 19 (COVID-19) patients to accomplish three main targets: guarantee a safe pathway for non-COVID-19 patients, ensure health personnel safety, and maintain an efficient workload. Thus, an additional pathway was created with the aid of a trailer-mounted Computed Tomography (CT) scanner devoted to positive patients. We evaluated the performance of our approach from February 21 through April 12 in terms of workload (e.g., number of CT examinations) and safety (COVID-19-positive healthcare workers). There was an average of 72.2 and 17.8 COVID-19 patients per day in wards and the Intensive Care Unit (ICU), respectively. A total of 176 high-risk...
Radiology and Oncology, 2022
Background Pediatric soft tissue sarcomas are rare tumors with rhabdomyosarcoma being the most fr... more Background Pediatric soft tissue sarcomas are rare tumors with rhabdomyosarcoma being the most frequent histotype. Diagnostic imaging plays a significant role in the evaluation of this type of tumors. Thus, aim of this study was to assess the prognostic and diagnostic value of radiomic features extracted from axial T2w images of the primary lesion in children with soft tissue sarcomas examined by PET/MR for staging. Methods Using an open source software, each lesion was segmented and 33 radiomic features then extracted. Factor and logistic regression analyses were applied to select highly correlating features and evaluate their prognostic role, respectively. Differences in radiomic, demographics, metabolic, and laboratory variables according to tumor grade and histotype were investigated by the Students’ and Chi-square tests. In case of differences the diagnostic value of the variable/s was assessed by receiver operating curves. Results Eighteen children (11 female; mean age 7.8 ± 4...
Annals of Nuclear Medicine, 2021
To compare the accuracy of contrast-enhanced MRI using established dimensional and morphological ... more To compare the accuracy of contrast-enhanced MRI using established dimensional and morphological criteria versus integrated [18F]FDG PET/MRI in identifying regional lymph node metastases in patients with newly diagnosed head and neck squamous cell carcinoma (HNSCC). For this purpose, we compare MRI and PET/MRI using the histopathological findings in dissected lymph nodes as the gold standard. We retrospectively reviewed 26 patients with histologically proven HNSCC who underwent gadolinium-enhanced [18F]FDG PET/MRI as part of their staging. All neck lymph nodes were classified on MRI using dimensional and/or morphological criteria. Then, they were jointly assessed by a nuclear medicine physician and a radiologist using integrated [18F]PET/MR images. ROC curves were obtained to compare the techniques. Lymph node histopathology was considered as the reference standard. Out of 865 lymph nodes, 35 were malignant at histopathology (3 with micro-metastases). Sensitivity and specificity were 48.6% and 99.5% for MRI using dimensional criteria; 60.0% and 99.6% for MRI using morphological criteria; 60.0% and 99.4% for MRI using both; and 74.3% and 97.6% for PET using MR as anatomic localization. The area under the ROC curve was higher for PET and MRI localization (0.859) than for MRI using dimensional (0.740; p < 0.05), or morphological (0.798; p < 0.05), or both criteria (0.797; p < 0.05). PET/MR using a PET SUVmax cutoff of 5.7 combined with MRI using dimensional and/or morphological criteria reached high values for accuracy (98.2%), NPV (98.2%), and PPV (95.2%). Compared with traditional contrast-enhanced MRI or PET alone, integrated PET/MRI could improve diagnostic accuracy in detecting metastatic lymph nodes in patients with HNSCC.
Journal of Ultrasound, 2020
Contrast-enhanced ultrasonography (CEUS) is increasingly being performed in Italy and Europe, par... more Contrast-enhanced ultrasonography (CEUS) is increasingly being performed in Italy and Europe, particularly in the field of hepato-gastroenterology. Initially, it was mainly carried out to characterize focal hepatic lesions, but, since then, numerous studies have demonstrated its efficacy in the differential diagnosis of focal pancreatic pathologies (D’Onofrio et al. in Expert Rev Med Devices 7(2):257–273, 2010; Vidili et al. in J Ultrasound 22(1):41–51, 2019). The purpose of this paper is to provide Italian Medical Doctors with recommendations and thereby practical guidelines on the management of these patients. The present paper reports the final conclusions reached by the SIUMB guideline commission. This paper addresses particularly percutaneous ultrasound (US) examination (transabdominal US) and is drawn up specifically for publication.
Acta Oto-Laryngologica, 2019
Background: Deep neck infections (DNIs) are often clinically challenging, and may be life-threate... more Background: Deep neck infections (DNIs) are often clinically challenging, and may be life-threatening. Objective: The present retrospective study aimed to identify panels of clinical, laboratory, radiological, and microbiological parameters that could identify patients with DNIs at higher risk of complications or long-term hospitalization. Materials and methods: The investigation concerned 301 consecutive patients with DNIs treated at our institution between 2000 and 2014. Results: The discriminatory power of a combination of two variables (unknown origin of the infection and the need for surgical treatment) in terms of deep neck infection complications occurrence featured an AUC (ROC) of 0.6701. The power of a panel of four variables (age, leukocyte count, need for surgical treatment, days elapsing from hospitalization to surgical procedure) to identify DNIs necessitating long-term hospitalization featured an AUC (ROC) of 0.7929. Conclusion: Using the scale proposed by Hosmer and Lemeshow, the four-variable panel showed an amply acceptable, nearly excellent discriminatory power for long-term hospitalization. Significance: Although this panel achieved promising results for prognostic purposes, other parameters potentially capable of predicting the outcome of DNIs and orienting treatment decisions need to be investigated.
CardioVascular and Interventional Radiology, 2020
The aim of this study was to evaluate the safety and the effectiveness of polydioxanone-made biod... more The aim of this study was to evaluate the safety and the effectiveness of polydioxanone-made biodegradable biliary stent placement for the treatment of posttransplant benign, refractory biliary anastomotic strictures. Materials and Methods This was a retrospective observational study on all adult liver transplant recipients who developed a clinically significant anastomotic stricture between January 2014 and June 2017. Percutaneous transhepatic cholangioplasty with balloon dilation was performed as therapeutic approach in selected patients after multidisciplinary evaluation. Refractory strictures (defined as stricture persistence after two interventional procedures) were managed with placement of polydioxanone-made biodegradable biliary stent (SX-Ella biliary stent, Czech Republic). Patency of the common bile duct was calculated using Kaplan-Meier analysis. Results Eighteen adult liver transplant recipients who developed a refractory biliary anastomotic stricture [males/ females 13/5, median (IQR) 58.2 (9.3) years] underwent biodegradable biliary stent placement after 10.4 (32) months from liver transplantation. All procedures except one were uneventful. After a median (IQR) follow-up time of 27.2 (22) months, complete resolution of anastomotic stricture was achieved in 72% of patients, with significant improvement on liver enzymes. Conclusions Polydioxanone-made biodegradable biliary stent might be a safe and effective therapeutic option for the difficult-to-treat benign biliary anastomotic stricture after liver transplantation. Keywords Liver transplantation Á Anastomosis Á Stent Á Biliary stricture Á Percutaneous transhepatic cholangioplasty Á Polydioxanone Abbreviations AS Anastomotic stricture BBS Biodegradable biliary stent ERCP Endoscopic retrograde cholangiopancreatography LT Liver transplantation MRCP Magnetic resonance cholangiopancreatography PDX Polydioxanone PTC Percutaneous transhepatic cholangioplasty Michele Battistel and Marco Senzolo equally contributed to the study and should be considered as co-first authors.
European Radiology, 2020
Objectives Juvenile localized scleroderma (JLS) is a rare chronic autoimmune disease which can al... more Objectives Juvenile localized scleroderma (JLS) is a rare chronic autoimmune disease which can also affect bones and muscles. Nevertheless, muscle loss was not previously investigated in patients with JLS. Thus, the aim of this study was to retrospectively evaluate deep involvement and assess and quantify sarcopenia in JLS patients using magnetic resonance imaging (MRI). Methods Fourteen children with JLS (nine females, mean age ± SD, 7.1 ± 3.6 years) referring to our tertiary center from January 2012 to January 2018 who underwent at least one MRI examination including axial T1-weighted and short tau inversion recovery images were included. Two readers assessed in consensus superficial and deep involvement. Muscle edema, muscle fatty infiltration, and sarcopenia were independently scored (absent, moderate, or severe) and the Cohen's kappa coefficient computed. Skin perimeter, subcutaneous area, muscle area, and muscle volume were independently measured using the contralateral unaffected extremity as reference (paired Student's t test, p < 0.05). The intraclass correlation coefficient (ICC) was used to investigate the reliability of the measurements. Results All patients showed superficial involvement with subcutaneous fat atrophy being the most common finding (13 patients). Bone marrow edema occurred in five patients. Muscle edema affected ten children (moderate in seven, severe in three; k = 0.89), muscle fatty replacement occurred in one case (severe; k = 1.00), and sarcopenia was detected in eight patients (severe in two; k = 0.78). All quantitative parameters were lower on the affected side than on the unaffected contralateral limb (p < 0.05, each) and all measurements showed a high reliability (ICC > 0.750, each). Conclusion Patients with JLS can be affected by sarcopenia and quantitative analyses allow a robust characterization of such finding. Key Points • Deep involvement in juvenile localized scleroderma is frequently characterized by sarcopenia. • In juvenile localized scleroderma, muscle edema and sarcopenia are mostly moderate while fatty infiltration, even if rare, can be severe. • Sarcopenia can be reliably quantified in children with juvenile localized scleroderma using MRI.
Scientific Reports, 2020
Standard electrochemotherapy (ECT) is effective in many tumour types but is confined to the treat... more Standard electrochemotherapy (ECT) is effective in many tumour types but is confined to the treatment of small superficial lesions. Variable electrode-geometry ECT (VEG-ECT) may overcome these limitations by using long freely-placeable electrodes. Patients with bulky or deep-seated soft-tissue malignancies not amenable to resection participated in a single-arm phase-2 study (ISRCTN.11667954) and received a single course of VEG-ECT with intravenous bleomycin (15,000 IU/m2) and concomitant electric pulses applied through an adjustable electrode array. The primary outcome was radiologic complete response rate (CRR) per RECIST; secondary endpoints included feasibility, metabolic response, toxicity (CTCAE), local progression-free survival (LPFS) and patient perception (EQ-5D). During 2009–2014, we enrolled 30 patients with trunk/limb sarcomas, melanoma, Merkel-cell carcinoma, and colorectal/lung cancer. Median tumour size was 4.7 cm. Electrode probes were placed under US/TC guidance (28 ...
In Vivo, 2019
Paediatric invasive fungal infections have significantly increased over the past few decades, in ... more Paediatric invasive fungal infections have significantly increased over the past few decades, in particular among the immunocompromised population. Candida and Aspergillus spp. are still the most commonly isolated organisms. Image-based assessment of fungal infections can indeed be challenging especially in oncological patients where the differential diagnosis relative to other infections and neoplastic lesions cannot be often obvious. Therefore, the knowledge of the main radiological features associated with fungal infections is crucial to achieve an early correct diagnosis and address the most appropriate therapeutic approach. Thus, our aim was to review the main radiological features of paediatric fungal infections with particular focus on positron emission tomography/magnetic resonance imaging (PET/MRI), referring to the experience of our tertiary level hospital.
American Journal of Gastroenterology, 2019
Journal of Cancer Research and Oncobiology, 2018
Background: Leiomyomas are benign mesenchymal neoplasms which rarely occur in the urinary bladder... more Background: Leiomyomas are benign mesenchymal neoplasms which rarely occur in the urinary bladder, accounting for just 0.43% of all bladder tumours. Due to the paucity of data, very little is known about diagnosis, treatment and follow-up. Thus, despite their nonmalignant nature, they may be considered a true therapeutic challenge. Objective: Conservative management is paramount when assessing and managing benign neoplasms. It is the responsibility of the surgeon to tailor the most appropriate surgery for each patient, finding the best balance between oncologic and functional outcomes and future quality of life. Case report: We present a case report of a patient who was incidentally diagnosed with a large, asymptomatic intramural leiomyoma of the urinary bladder. Following abdominal imaging, biopsy specimens were obtained through cystoscopy, and a transurethral resection of the bladder (TURB) was eventually performed. Imaging findings including Ultrasonography (US), triple-phase Computed Tomography Urography (CTU) and Magnetic Resonance Urography (MRU) are reported, and the most representative images are shown. The patient has been successfully managed with staged TURB and then close outpatient follow-up, and she is currently recurrence-free 8 years after the last endoscopic treatment. Conclusion: Despite the benign nature of leiomyomas, the surgical options for these tumours range from TURB to radical cystectomy. Here, we underline how a conservative approach may be successful regardless of the size and site of the lesion, thus preserving the bladder and the patient's quality of life without affecting the oncologic outcomes.
Neurology, Jan 23, 2018
To identify and characterize patients with calsequestrin 1 ()-related myopathy. Patients selected... more To identify and characterize patients with calsequestrin 1 ()-related myopathy. Patients selected according to histopathologic features underwent genetic screening. mutated patients were clinically evaluated and underwent muscle MRI. Vacuole morphology and vacuolated fiber type were characterized. Twenty-two -mutated patients (12 families) were identified, 21 sharing the previously described founder mutation (p.Asp244Gly) and 1 with the p.Gly103Asp mutation. Patients usually presented in the sixth decade with exercise intolerance and myalgias and later developed mild to moderate, slowly progressive proximal weakness with quadriceps atrophy and scapular winging. Muscle MRI (n = 11) showed a recurrent fibrofatty substitution pattern. Three patients presented subclinical cardiac abnormalities. Muscle histopathology in patients with p.Asp244Gly showed vacuoles in type II fibers appearing empty in hematoxylin-eosin, Gomori, and nicotinamide adenine dinucleotide (NADH) tetrazolium reducta...