High-risk HPV-positive and -negative high-grade cervical dysplasia: Analysis of 5-year outcomes

OBJECTIVE

To evaluate the outcomes of high-risk (HR) HPV-positive and -negative women affected by high-grade cervical dysplasia.

METHODS

This is a retrospective multi-institutional study. Medical records of consecutive patients with high-grade cervical dysplasia undergoing conization between 2010 and 2014 were retrieved. All patients included had at least 5 years of follow-up. A propensity-score matching was adopted in order to reduce the presence of confounding factors between groups. Kaplan-Meir and Cox hazard models were used to estimate 5-year outcomes.

RESULTS

Overall, data of 2966 women, affected by high-grade cervical dysplasia were reviewed. The study population included 1478 (85%) and 260 (15%) women affected by HR-HPV-positive and HR-HPV-negative high-grade cervical dysplasia. The prevalence of CIN2 and CIN3 among the HR-HPV-positive and -negative cohort was similar (p = 0.315). Patients with HR-HPV-positive high-grade cervical dysplasia were at higher risk of 5-year recurrence (after primary conization) that HR-HPV-negative patients (p < 0.001, log-rank test). Via multivariate analysis, HR-HPV-negative women were at low risk of recurrence (HR: 1.69 (95%CI: 1.05, 4.80); p = 0.018, Cox Hazard model). A propensity-score matched comparison was carried out in order to reduce biases that are related to the retrospective study design. In comparison to HR-HPV-negative patients, thosewith HR-HPV-positive CIN3 was associate with a 8-fold increase in the risk of recurrence (p < 0.001, log-rank test).

CONCLUSIONS

HR-HPV-negative high-grade cervical dysplasia is not uncommon, accounting for 15% of our study population. Those patients experience more favorable outcomes than patients with documented HR-HPV infection(s). Further prospective studies are needed to corroborate our data.

Sentinel node mapping vs. sentinel node mapping plus back-up lymphadenectomy in high-risk endometrial cancer patients: Results from a multi-institutional study

OBJECTIVE

Sentinel node mapping (SLN) has replaced lymphadenectomy for staging surgery in apparent early-stage low and intermediate risk endometrial cancer (EC). Only limited data about the adoption of SNM in high risk EC is still available. Here, we evaluate the outcomes of high-risk EC undergoing SNM (with or without back-up lymphadenectomy).

METHODS

This is a multi-institutional international retrospective study, evaluating data of high-risk (FIGO grade 3 endometrioid EC with myometrial invasion >50% and non-endometrioid histology) EC patients undergoing SNM followed by back-up lymphadenectomy and SNM alone.

RESULTS

Chart of consecutive 196 patients were evaluated. The study population included 83 and 113 patients with endometrioid and non-endometrioid EC, respectively. SNM alone and SNM followed by back-up lymphadenectomy were performed in 50 and 146 patients, respectively. Among patients having SNM alone, 14 (28%) were diagnosed with nodal disease. In the group of patients undergoing SNM plus back-up lymphadenectomy 34 (23.2%) were diagnosed with nodal disease via SNM. Back-up lymphadenectomy identified 2 (1%) additional patients with nodal disease (in the para-aortic area). Back-up lymphadenectomy allowed to remove adjunctive positive nodes in 16 (11%) patients. After the adoption of propensity-matched algorithm, we observed that patients undergoing SNM plus back-up lymphadenectomy experienced similar disease-free survival (p = 0.416, log-rank test) and overall survival (p = 0.940, log-rank test) than patients undergoing SLN alone.

CONCLUSIONS

Although the small sample size, and the retrospective study design this study highlighted that type of nodal assessment did not impact survival outcomes in high-risk EC. Theoretically, back-up lymphadenectomy would be useful in improving the removal of positive nodes, but its therapeutic value remains controversial. Further prospective evidence is needed.

Transmission of SARS-CoV-2 in Surgical Smoke during Laparoscopy: A Prospective, Proof-of-concept Study

STUDY OBJECTIVE

There are growing concerns regarding the potential risk of coronavirus disease transmission during surgery and in particular during minimally invasive procedures owing to the aerosolization of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) particles. However, no study has demonstrated this hypothesis. Here, we aimed to investigate the presence of SARS-CoV-2 in surgical smoke.

DESIGN

A prospective pilot study.

SETTING

A tertiary cancer center in northern Italy.

PATIENTS

Overall, 17 patients underwent laparoscopic procedures for the management of suspected or documented gynecologic malignancies. The median age was 57 years (range 26-77). The surgical indications included endometrial cancer (n = 11), borderline ovarian tumor (n = 3), early-stage ovarian cancer (n = 1), stage IA cervical cancer after diagnostic conization (n = 1), and an ovarian cyst that turned out to be benign at final histologic examination (n = 1).

INTERVENTIONS

We evaluated all consecutive women scheduled to have laparoscopic procedures for suspected or documented gynecologic cancers. The patients underwent planned laparoscopic surgery. At the end of the laparoscopic procedures (after extubation), we performed reverse transcription-polymerase chain reaction (RT-PCR) tests for the detection of SARS-CoV-2 from both the endotracheal tube and the filter applied on the trocar valve.

MEASUREMENTS AND MAIN RESULTS

In 1 patient, both swab tests (endotracheal tube and trocar valve filter) showed amplification of the N gene on RT-PCR analysis. This case was considered to be a presumptive positive case. In another case, the RT-PCR analysis showed an amplification curve for the N gene only in the swab test performed on the filter. No ORF1ab amplification was detected.

CONCLUSION

Our study suggested the proof of principle that SARS-CoV-2 might be transmitted through surgical smoke and aerosolized native fluid from the abdominal cavity.

Spotlight on the role of human papillomavirus vaccines

In high income setting, the massive implementation of screening programs has reduced the incidence of cervical cancer, dramatically. However, cervical cancer still remains a major health concern, being one of the most common cause of death for cancer among women. The adoption of primary prevention through vaccination against HPV aims to reduce the prevalence of HPV-related lesions and cervical cancer. Accumulating data highlighted the cost-effectiveness of introducing HPV vaccination for adolescent and young adults. In the present review, we critically evaluated the role of vaccination against HPV, focusing much more on the role of vaccination in specific cluster of subjects (eg, post-treatment and older adults). Additionally, we evaluated the available evidence on the role of vaccination in HIV-positive subjects and in women receiving solid organs transplantation. We observed that although vaccination might be considered effective in those cluster of subjects; further evidence is needed to assess the cost-effectiveness of vaccination in these settings.

The impact of HPV-specific infection in women diagnosed with atypical glandular cells: Results from the HPV-AGC study

OBJECTIVE

To evaluate the impact of various HPV types on the risk of developing lesions of the uterus (either uterine cervix and endometrium) in women diagnosed with "atypical glandular cells" (AGC) at Pap smear.

METHODS

This is a multi-institutional retrospective study. Data of women diagnosed with AGC were retrospectively reviewed. All patients included had data about HPV DNA testing and 1-year clinical follow-up.

RESULTS

Overall, chart of 480 patients were evaluated. After the exclusion of 286 patients, data of 194 patients were available for the analysis. Mean age was 43.9 (±6.0) years. HPV infection was documented in 136 women (70.1 %). Among HPV positive patients the risk of having/developing a lesion was 33.8 % (n = 46). Lesions included low- (L-SIL) and high- (H-SIL) squamous intraepithelial lesions, in situ adenocarcinoma of the uterine cervix, invasive cancer of the uterine cervix, endometrial hyperplasia and endometrial cancer in 16 (11.7 %), 18 (13.2 %), 6 (4.4 %), 3 (2.2 %), 2 (1.5 %) and 1 (1%), respectively. Among HPV negative patients the risk of having/developing a lesion was 15.5 %. They included l-SIL, H-SIL, in situ adenocarcinoma, endometrial hyperplasia and endometrial cancer in 1 (1.7 %), 1 (1.7 %), 1 (1.7 %), 3 (5.1 %) and 3 (5.1 %), respectively. Patients diagnosed with HPV16 were at higher risk of having/developing cervical lesions in comparison to patients with other HPV infections (p < 0.01). In comparison to other HPV types, the presence of HPV 18, 31, 33, and 45 did not increase the risk of developing a lesion over the time (p > 0.2). HPV positive patients were at higher risk of being diagnosed with a cervical lesion within 6 months from detection of AGC.

CONCLUSIONS

Patients diagnosed with AGC are at risk to have / developing cervical and uterine lesions. Further prospective evidence is needed.

Recurrence rate after loop electrosurgical excision procedure (LEEP) and laser Conization: A 5-year follow-up study

OBJECTIVE

Conization aims to remove pre-neoplastic lesions of the uterine cervix. Several techniques for conization have been compared, but evidence regarding the most effective therapeutic option is scant. Here, we aimed to compare the recurrence rate following laser conization and loop electrosurgical excision procedure (LEEP) in patients with high-grade cervical dysplasia (HSIL/CIN2+).

METHODS

This is a retrospective multi-institutional study. Medical records of consecutive patients with HSIL/CIN2+ undergoing conization between 2010 and 2014 were retrieved. A propensity-score matching (PSM) was applied in order to reduce allocation bias. The risk of developing recurrence was estimated using Kaplan-Meir and Cox hazard models.

RESULTS

Overall, 2966 patients had conization over the study period, including 567 (20%) and 2399 (80%) patients having laser conization and LEEP, respectively. Looking at predictors of recurrence, diagnosis of CIN3 (HR:3.80 (95%CI:2.01,7.21); p < 0.001) and HPV persistence (HR:1.81 (95%CI:1.11,2.96); p < 0.001) correlated with an increased risk of recurrence. After applying a PSM we selected 500 patients undergoing laser conization and 1000 undergoing LEEP. Patients undergoing LEEP were at higher risk of having positive surgical margins in comparison to patients undergoing laser conization (11.2% vs. 4.2%). The risk of having persistence of HPV was similar between the two groups (15.0% vs. 11.6%;p = 0.256). Five-year recurrence rate was 8.1% and 4% after LEEP and laser conization, respectively (p = 0.023). HPV persistence was the only factor associated with [5-]year recurrence after both laser conization (p = 0.003) and LEEP (p = 0.001).

CONCLUSIONS

HPV persistence is the only factor associated with an increased risk of recurrence after either laser conization or LEEP. Owing to the lack of data regarding obstetrical outcomes, we are not able to assess the best therapeutic option for women with cervical dysplasia.

The role of sentinel lymph node mapping in lower genital tract melanoma

INTRODUCTION

Vulvar and vaginal melanomas are rare cancers of the female genital tract and account for 1% to 3% of all melanomas diagnosed in women. Due to the rarity of the disease, few data are available on the clinical and pathologic features of these cancers. Furthermore, treatment options are generally based on extrapolations of the information available for the more common cutaneous counterparts. Surgery represents the mainstay of treatment for lower genital tract melanoma. Moreover, the role of sentinel lymph node (SLN) assessment is controversial because no prospective data are available.

EVIDENCE ACQUISITION

Data were collected from Medline, Embase, Web of Sciences and Scopus databases. On July 10, 2020, we used the search comprising the terms "vulvar melanoma," "genital melanoma" and "vulvovaginal melanoma" including only studies in which SLN biopsy was performed.

EVIDENCE SYNTHESIS

Ten retrospective studies have been found. No randomized trials have been reported. The studies included 132 patients while only 63 (47%) undergone SLN. 99mTC with or without blue dye followed by ultrastaging was highly accurate and is currently the gold standard. Mean detection rate was 98.3%. No clear evidence supported the execution of back lymphadenectomy (after SLN mapping), in fact, extrapolating data from cutaneous melanomas of other sites, completion of lymphadenectomy does not confer a melanoma-specific survival advantage.

CONCLUSIONS

Although the small amount of available data, sentinel lymph node procedure is feasible and capable of identifying patients who have occult lymph node metastases. However, the potential role of the sentinel lymph node procedure as an alternative method of lymph node staging in patients with vulvar or vaginal melanoma needs further investigation.

Immunotherapy for platinum-resistant ovarian cancer

Ovarian cancer is characterized by a high mortality on incidence ratio. Although the majority of patients achieve complete response after primary treatment, approximately 65-80% of patients recur with the first 5 years. Platinum-free interval is one of the main prognostic factors. Patients recurring with 6 months within the end of platinum-based chemotherapy are characterized by poor prognosis. To date no effective treatment modality are identified for those patients. The mainstay of treatment for platinum-resistant ovarian cancer is single agent chemotherapy. Other treatment modalities have tested in this setting with discouraging results. Growing evidence suggested that immunotherapy would improve outcomes of patients with various types of solid tumors including melanoma, non-small cell lung cancer as well as uterine malignancies. Here, we reviewed current evidence on the adoption of immunotherapy in platinum-resistant ovarian cancer. To date no mature evidence supports the routine adoption of immunotherapy in ovarian cancer patients. Further strategies have to be explored.

Management of patients with ovarian cancer in the COVID-19 era

At the beginning of 2020, coronavirus disease 2019 (COVID‐19) spreads worldwide. Patients with ovarian cancer should be considered at high‐risk of developing severe morbidity related to COVID‐19. Most of them are diagnosed in advanced stages of disease, and they are fragile. Here, we evaluated the major impact of COVID‐19 on patients with ovarian cancer, discussing the effect of the outbreak on medical and surgical treatment.

Gynecologic oncology at the time of COVID-19 outbreak

The World Health Organization (WHO) classified the novel coronavirus (i.e., coronavirus disease 2019 [COVID-19]) as a global public health emergency. COVID-19 threatens to curtail patient access to evidence-based treatment. Medicine is changing, basically due to the limited available resources. In the field of gynecologic oncology, we have to re-design our treatments' paradigm. During COVID-19 pandemic outbreak, the highest priority is to achieve the maximum benefit from less demanding procedures. Extensive procedures should be avoided, in order to reduce hospitalization and postoperative events that might increase the in-hospital spread of the virus. There are ongoing concerns on the use of laparoscopic procedures, related to the possible contamination of the staff working in the operation room. Other minimally invasive techniques, including, vaginal surgery as well as robotic-assisted and isobaric procedures would be preferred over laparoscopy. A fair allocation of resources is paramount adequate treatments.

Influence of Biliopancreatic Diversion on Pregnancy Outcomes in Comparison to Other Bariatric Surgery Procedures

BACKGROUND

Pregnancy after bariatric surgery (BS) has an increased risk for small-for-gestational-age infants (SGA), shorter length of gestation, and probably perinatal mortality. The aim of this study was to investigate if biliopancreatic diversion could impair pregnancy outcomes in comparison to other bariatric surgery procedures.

METHODS

We conducted a cohort retrospective single-center study in 65 women before and after BS. Thirty-one pregnancies occurred before BS, while 109 after BS, amongst which n = 51 after biliopancreatic diversion (BPD) and n = 58 after non-malabsorptive procedures.

RESULTS

The pregnancy outcomes after BS in comparison with those before BS resulted less affected by diabetes, hypertensive disorders, macrosomia, and large-for-gestational-age (LGA), but more complicated by preterm births (14.5 versus 4.0%) and low birth weight (LBW) infants (28.9 versus 0%). Moreover, mean birth weight resulted lower after BS than before BS (p < 0.001). In pregnancies after BPD in comparison to those before BS, the LBW rate (42.5%) resulted a drastic increase (p < 0.001), and mean birth weight (p < 0.001) and mean birth weight centile (p < 0.001) were lower after BPD. When pregnancy outcomes after BPD were compared with those after non-malabsorptive procedures, the rate of congenital anomalies, preterm births, LBW, and SGA resulted an increase (p = 0.002, 0.008, 0.032, and < 0.001, respectively).

CONCLUSIONS

BPD drastically reduced diabetes, hypertensive disorders, macrosomia, and LGA; however, it was associated with the poorest pregnancy outcomes in comparison to those observed after other BS procedures. On the basis of the present study, we recommend a cautious multidisciplinary selection of severely obese patients for BPD during the fertile age.

The role of Echo Colour/Power Doppler and magnetic resonance in expansive parotid lesions

The purpose of this research was to evaluate the role of Echo Colour/Power Doppler and Magnetic Resonance Imaging (MRI) in the diagnosis of expansive parotid lesions, and to establish criteria for differential diagnosis between benign and malignant forms. Forty nine patients (23 males and 26 females), aging from 30 to 85 years, with an expansive pathology of parotid gland were enrolled in our study from February 1999 through August 2004. Each patient was carefully assessed employing both ultrasonography integrated with Color/Power Doppler and MRI. Eventually, all patients received echo-guided needle-biopsy and surgical excision of the parotid lesion. Preliminary ultrasound assessed site, size, echoic appearance and margins of the lesion. In order to assess blood supply by means of Colour/Power Doppler, we divided the patients in four groups. Our MRI diagnostic criteria included site, size, intensity of signal, behaviour of the lesion after i.v. contrast, relationship with facial nerve and retromandibular vein, detection of margins and proximity to adjacent structures. On the basis of our results, the Authors concluded that both Echo Colour/Power Doppler and MRI play a very important role in the diagnosis and surgical planning of parotid gland lesions.

[Magnetic resonance of the knee: possibility and current indications]

MRI is a multiparametric, multiplanar, non-invasive largely employed tool for assessing osseous, ligamentous and tendineous injuries, inflammatory and degenerative changes of the knee. Although its wider availability and the lack of ionizing radiations MRI should be used only if clinically useful in patient management, in a appropriate diagnostic iter including plain film and/or ultrasound examination. The aim of our work is to review possibilities, limits and current indications for MRI assessment of diseases of the knee.

Extraskeletal myxoid chondrosarcoma of the thoracic wall

The authors report the CT features of a very rare case of Extraskeletal Myxoid Chondrosarcoma of the thoracic wall, one of a few malignant primary bone tumors which rarely originate from soft tissues.

[Esthesioneuroblastoma. Description of a case investigated with CT and MR]

Esthesioneuroblastoma, also known as olfactory neuroblastoma, is a rare neuroendocrine tumor originating from the olfactory epithelium of the upper nasal cavity and representing < 3% of all tumors of the nasal cavities. This malignant tumor is characterized by a slow growth and local recurrencies and has a more favorable prognosis as compared with other more frequent forms of neuroblastomas originating from the suprarenal medulla and the sympathetic nervous system. Affected patients usually present with a history of progressive nasal obstruction, rhinorrhea, and severe epistaxis--sign of the conspicuous vascularity of this type of tumor. The combined use of CT and MR techniques allows the diagnostic suspicion of esthesioneuroblastoma and is of vital importance in the accurate staging of the disease and in the treatment planning.

[Computed tomography evaluation of metastasis of cutaneous melanoma]

PURPOSE

To assess the value of Computed Tomography (CT) in the diagnosis and in morphologic characterization of metastatic melanoma.

MATERIALS AND METHODS

The data of total body CT of 124 consecutive patients with melanoma having a Breslow index 1 mm or a positive sentinel lymph node have been retrospectively reviewed.

RESULTS

The CT scan showed loco-regional and/or distant metastases in 36 patients (39%). Ten of these (28%) had metastases only to lymph nodes, whereas 26 patients (72%) had multiple metastases. Nodal, pulmonary, brain, subcutaneous, hepatic, adrenal, bone, gastrointestinal, breast and abdominal wall metastases were detected in 80.6%, 47.2%, 25%, 25%, 16.7%, 13.9%, 11.1%, 5.6%, 5.6% and 2.8% of the patients respectively. All the patients with metastases also had a positive sentinel lymph nodes and/or symptoms of metastatic disease.

CONCLUSIONS

CT fails to reveal any characteristic feature of metastatic melanoma, but it is of value in the diagnosis of loco-regional and distant metastases in III stage disease.

Relationship of rheumatoid factor isotype levels with joint lesions detected by magnetic resonance imaging in early rheumatoid arthritis

OBJECTIVE

To evaluate the relationship between rheumatoid factor isotypes and articular damage detected by magnetic resonance imaging and plain radiography in early rheumatoid arthritis.

METHODS

20 consecutive patients with early active rheumatoid arthritis underwent determinations of serum IgM, IgA, and IgG rheumatoid factors by enzyme-linked immunosorbent assay (ELISA). Plain radiographs of the hands and wrists were obtained, and the wrist, metacarpophalangeal joints, and proximal interphalangeal (PIP) joints on the more severely affected side were investigated by magnetic resonance imaging before and after gadolinium-DTPA injection.

RESULTS

IgM, IgA, and IgG rheumatoid factors were found in 13 (65%), 13 (65%), and 15 (75%) of patients, respectively. Sera from five patients (25%) contained no detectable rheumatoid factor isotypes. Correlations were found among the levels of the three rheumatoid factor isotypes. Levels of IgA, IgG, and IgM rheumatoid factor were significantly higher in patients with than without erosions on magnetic resonance imaging scans. No such difference was found when patients with and without erosions on plain radiographs were compared. Magnetic resonance imaging detected soft tissue lesions more frequently than plain radiography. Magnetic resonance imaging was also more likely than plain radiography to show bone erosions and bone cysts, but this difference was not statistically significant.

CONCLUSIONS

Quantitative rheumatoid factor isotype assays and magnetic resonance imaging evaluation of erosions of the hand and wrist may be useful for investigating patients with early rheumatoid arthritis.

[The solitary pulmonary nodule: the preliminary results in differential diagnosis by high-resolution computed tomography with a contrast medium]

INTRODUCTION

High-resolution computed tomography (HRCT) with iodinated contrast material has been used by many authors to study solitary pulmonary nodules (SPNs). The degree of enhancement was correlated with the nodule malignancy.

MATERIAL AND METHODS

Forty adult patients were examined, before and after contrast agent administration, with incremental dynamic CT. We selected 22 patients with SPNs (3-30 mm phi, except one with 40 mm phi). The CT numbers of the inner nodule were calculated before and 1, 2 and 3 minutes after the i.v. administration of a weight-related dose (1.5 mL/kg/min) of nonionic iodinated contrast agent. A dose of 100 mL contrast agent was used in the first 6 patients. The difference in CT numbers between unenhanced images and the images with maximum enhancement (max. attenuation) was also calculated.

RESULTS

Histologic diagnoses included 4 tuberculomas, 3 hamartomas and 15 malignant tumors (9 adenocarcinomas, 5 squamous cell carcinomas and 1 non-Hodgkin lymphoma). The CT numbers (in Hounsfield units, HU) of malignant nodules ranged 12-31 HU (mean: 21.5 HU) before contrast agent administration; the "long-standing" tuberculomas ranged 11-22 HU (mean: 16.5 HU) and the hamartomas had a mean density of 10.5 HU. We excluded for the study two "fresh" tuberculomas, one of which was surrounded by a low-attenuation infiltrate (the halo sign). We selected a threshold value of 20 HU on enhanced CT images to distinguish malignant (> or = 20 HU) from benign (< or = 20 HU) nodules. All lung cancers had complete enhancement (mean density: 35.5 HU). With 20 HU as the threshold value for a positive test, sensitivity was 100%, specificity 85.7%, positive predictive value 93.8% and negative predictive value 100%; test bias was 1.067.

CONCLUSION

Positron emission tomography (PET) with 2-[fluorine-18] fluoro-2-deoxy-D glucose is reported to be as accurate as enhanced HRCT, but it does not provide accurate morphological information, is not widely available and it is quite expensive: therefore, in our opinion, CT should be preferred. After examining over 100 patients, we may use our results in the decision analysis comparing surgical risk with cancer risk.

[Technical principles of solid tridimensional modeling with computerized tomography for the study of maxillofacial diseases]

3DCT allows the solid modeling of body structures from contiguous slices. The 3D images are free to rotate on the x, y, and z axes. It is possible to evidentiate structures with various densities by means of threshold operators, which allow a 3D model of both soft tissues and bones to be obtained. Shading operations allow image quality to be improved by varying the elementary units to surface units ratio. Implemented 3D rendering reduces the spatial edges by means of anti-aliasing functions. The 3D images allow the study of the complexity of maxillofacial bony structures, and they are especially useful in both surgical planning and in postoperative follow-up. We studied 58 patients with maxillofacial diseases (34 traumatic, 14 malformations, 4 dysplastic, and 6 neoplastic). In most cases (96.5%), we obtained high-quality images, which allowed both the site and the extension of the lesions to be evaluated, together with their relationships to adjacent structures. In 65% of traumatic cases, the 4 basic views thoroughly demonstrated lesion spread, while in the extant 35% of cases cutting operations and rotatory translations were necessary. In all malformation cases a clear visualization of somatic asymmetries was obtained. In both dysplastic and neoplastic cases, the best lesion evidence was obtained in superficial lesions with cortical bone involvement. This technique was always easy and quick to perform, with no need for supplemental dose exposure to the patient.

Sternoclavicular joint disease in psoriatic arthritis

The radiological and tomographic aspects of the sternoclavicular joint were examined in 10 patients with psoriatic arthritis to evaluate better how this joint was affected using different radiological techniques. Imaging of the sternoclavicular joint showed that computed tomography provides a better visualisation of erosions, subchondral cysts, and sclerosis than standard radiography and conventional linear tomography.

Progress of brown tumors in patients with chronic renal insufficiency undergoing dialysis

In a group of 73 patients, affected by chronic renal insufficiency, whose skeleton was periodically checked, three cases of brown tumors were found. These cases demonstrated a variety of locations that were involved, especially the pelvis, ribs and mandible. During therapeutic treatment the brown tumors presented a different behavior; while some lesions tended toward complete sclerosis, others increased in size and in both instances new lesions appeared. Parathyroidectomy, carried out in two patients, determined a definitive sclerosis of these lesions. Brown tumors also correlate with high PTH levels and with lesions from osteitis fibrosa.

[Neoplasms of the base of the tongue. Evaluation with magnetic resonance]

The authors investigated MR capabilities in evaluating the neoplasms of the base of tongue. Thirty patients were examined. The images were obtained--at INI, Grottaferrata, Rome--using a 1.5 T superconductive Gyroscan unit by Philips. On T2-weighted images, the neoplasms were always hyperintense; in 10 patients edema could be distinguished from neoplasm. On T1-weighted scans the tumor exhibited the same signal intensity as the tongue muscle in 4 patients, while in the extant 26 cases it was hypointense. This pattern proved to be aspecific and could not be correlated with a specific histology. In 3 clinically symptomatic patients, MR imaging diagnosed the invasion of the internal pterigoid muscle. MR capabilities in identifying swollen lymph nodes was also evaluated on the basis of the signal intensities of the latter, as well as on their size. The authors' conclusion is that MR imaging is to be considered the method of choice in the staging of tumors at the base of tongue thanks to its high contrast resolution and multiplanar capabilities.

[Radiologic changes in the pelvis of patients with chronic renal insufficiency undergoing periodic dialysis]

Bone alterations in the patients undergoing periodic dialysis represent a frequent and invalidating complication and cause the pattern called uremic osteodystrophy. In this study we have examined 173 pelvic X-rays of 73 patients affected with chronic renal insufficiency and undergoing periodic dialysis. The results indicate the presence of all the lesions characterizing uremic osteodystrophy. Arterial calcifications and osteoporosis are the most frequent patterns; with various incidence, osteomalacia, osteitis fibrosa, osteosclerosis and brown tumors are associated. In this group of patients, who were followed for many years, a non-univocal behavior was observed: next to patterns of progressive aggravation, such as vascular calcifications, phases of stabilization/improvement were observed, e.g., in case of brown tumors and osteitis fibrosa.

[NMR of phakomatoses]

23 patients affected by phakomatoses were studied with NMR, including tuberous sclerosis (11 cases), Sturge-Weber's disease and Von Recklinghausen's neurofibromatosis (6 cases). SE sequence was used performing T1-WIs with TR = 350-750 ms and TE = 20-30 ms and T2-WIs with TR = 1500-2100 ms and TE = 50-100 ms. Tuberous sclerosis was characterized in each case by the presence of hiperintense areas in T2-WIOs, associated in 9 cases to subependimal microcalcifications. Sturge-Weber-disease showed: cerebral or lobar emiatrophia, abnormal vascularization and cortical calcifications. Cerebral neurofibromatosis was characterized by extra-assial tumors, associated in 4 cases to gliomas of the optical pathways. The AA. conclude that NMR is the choice examination in the evaluation of phakomatoses.

The response of ventral horn neurons to ricin. An experimental abiotrophy model

The morphological alterations of anterior horn neurons of the spinal cord of rabbits produced by the administration of ricin conveyed via retrograde axonal flow are described. The differences with the primary response after axonal transection and the similarity with degenerative abiotrophic systemic lesions are discussed.

[A case of radial nerve paralysis caused by lipoma. Role of C.A.T. in diagnosis and clinical aspects]

It is described a case of compression of the deep branch of radial nerve caused by a lipoma, in which the use of C.T. was very important from a diagnostic point of view. It is described the use of C.T. in the evaluation of musculoskeletal neoplasms.