Transarterial chemoembolization (TACE) is commonly used as a bridge therapy for patients awaiting liver transplantation (LT) and for downstaging patients initially not meeting the Milan criteria. The ...primary aim of this study was to analyze whether a difference exists between selective/superselective and lobar TACE in determining tumor necrosis by a pathological analysis of the whole lesion at the time of LT. The secondary aim was to investigate the relationship between the tumor size and the capacity of TACE to induce necrosis. Data were extracted from a prospective database of 67 consecutive patients who underwent LT for hepatocellular carcinoma and cirrhosis from 2003 to 2009 and were treated exclusively with TACE as a bridging (n = 53) or downstaging therapy (n = 14). We identified 122 nodules; 53.3% were treated with selective/superselective TACE. The mean histological necrosis level was 64.7%; complete tumor necrosis was obtained in 42.6% of the nodules. In comparison with lobar TACE, selective/superselective TACE led to significantly higher mean levels of necrosis (75.1% versus 52.8%, P = 0.002) and a higher rate of complete necrosis (53.8% versus 29.8%, P = 0.013). A significant direct relationship was observed between the tumor diameter and the mean tumor necrosis level (59.6% for lesions < 2 cm, 68.4% for lesions of 2.1‐3 cm, and 76.2% for lesions > 3 cm). Histological necrosis was maximal for tumors > 3 cm: 91.8% after selective/superselective TACE and 66.5% after lobar procedures. Independent predictors of complete tumor necrosis were selective/superselective TACE (P = 0.049) and the treatment of single nodules (P = 0.008). Repeat sessions were more frequently needed for nodules treated with lobar TACE (31.6% versus 59.3%, P = 0.049). Conclusion: Selective/superselective TACE was more successful than lobar procedures in achieving complete histological necrosis, and TACE was more effective in 3‐ to 5‐cm tumors than in smaller ones. (Hepatology 2011;)
Atlantoaxial rotatory subluxation/fixation (AARS/F) is a rare cause of torticollis in children. The aim of our study is to investigate all possible clinical and radiological prognostic factors in ...children with AARS/F. We retrospectively reviewed all cervical spine CT scans of children with AARS/F treated in our Hospital over the last 15 years. AARS/F was classified according to Fielding and Hawkins classification and C1-C2 rotation-degree was calculated. Moreover, two orthopedic surgeons reviewed all clinical reports of these children. All patients were conservatively treated (cervical traction/neck collar). An early recovery was considered in patients with complete clinical/radiological healing at 3 months follow-up, while a late recovery was considered in patients with disease persistence or relapse at 3 months follow-up or earlier. Fifty-five patients with diagnosis of AARS/F were included in the study (mean age = 8.5 years old – 25F, 30M). In 9/55 subjects (16.4%), a late recovery was observed. The presence of a concomitant infection or inflammation in the head and neck region (Grisel’s syndrome) was significantly associated with a late recovery (
p
< .001). Also, the type of AARS/F (
p
= .019), according to the Fielding and Hawkins classification, and C1-C2 rotation-degree (
p
= .027) were significantly correlated with the recovery time.
Conclusion
: In patients with AARS/F, the presence of a concomitant infection/inflammation in the head and neck region is the most important prognostic factor and it is associated with a late recovery. The Fielding and Hawkins classification and C1-C2 rotation-degree well correlate with patients’ recovery time.
What is Known:
• Atlantoaxial rotatory subluxation/fixation (AARS/F) is a rare cause of torticollis in children and CT is the most useful imaging tool for diagnosis and classification of AARS/F.
• Conservative treatments are effective in the majority of pediatric patients with AARS/F.
What is New:
• The presence of a concomitant infection/inflammation in the head and neck region associated with AARS/F (Grisel’s syndrome) is the most important prognostic factor and it is associated with a late recovery.
• C1-C2 rotation-degrees, as well as Fielding and Hawkins classification system, well correlate with patients’ recovery time.
Osteopetrosis (from the Greek “osteo”: bone; “petrosis”: stone) is a clinically and genetically heterogeneous group of rare diseases of the skeleton, sharing the same main characteristic of an ...abnormally increased bone density. Dense bones in radiological studies are considered the hallmark of these diseases, and the reason for the common term used: “Marble bone disease”. Interestingly, a radiologist, Dr. Albers-Schonberg, described this disease for the first time in Germany in 1904. Indeed, radiology has a key role in the clinical diagnosis of osteopetrosis and is fundamental in assessing the disease severity and complications, as well as in follow-up controls and the evaluation of the response to treatment. Osteopetrosis includes a broad spectrum of genetic mutations with very different clinical symptoms, age onset, and prognosis (from mild to severe). This diversity translates into different imaging patterns related to specific mutations, and different disease severity. The main recognized types of osteopetrosis are the infantile malignant forms with autosomal recessive transmission (ARO—including the rarer X-linked recessive form); the intermediate autosomal recessive form (IAO); and the autosomal dominant ones ADO, type I, and type II, the latter being called ‘Albers-Schonberg’ disease. Imaging features may change among those distinct types with different patterns, severities, skeletal segment involvement, and speeds of progression. There are several classical and well-recognized radiological features related to osteopetrosis: increased bone density (all types with different degrees of severity assuming a ‘Marble Bone Appearance’ especially in the ARO type), different metaphyseal alterations/enlargement including the so-called ‘Erlenmeyer flask deformity’ (particularly of femoral bones, more frequent in ADO type 2, and less frequent in ARO and IAO), ‘bone in bone’ appearance (more frequent in ADO type 2, less frequent in ARO and IAO), and ‘rugger-jersey spine’ appearance (typical of ADO type 2). After conducting an overview of the epidemiological and clinical characteristic of the disease, this review article aims at summarizing the main radiological features found in different forms of osteopetrosis together with their inheritance pattern.
•Mineralization is present in 61.9% of extraskeletal osteosarcomas, mostly gross and amorphous.•A thin ‘rim-like’ peripheral enhancement is seen in 17/40 (42.5%) of extraskeletal osteosarcomas.•At ...univariable analysis, mineralization of extraskeletal osteosarcoma is associated with poorer overall survival.•Heterogeneity on T2-weighted images and hemorrhagic signal are independent variables associated with poorer overall survival in patients with extraskeletal osteosarcoma.
The purpose of this study was to analyze the imaging features of extraskeletal osteosarcomas (ESOS) on computed tomography (CT) and magnetic resonance imaging (MRI) and to investigate their associations with overall survival (OS) using uni- and multivariable survival analyses.
This two-center retrospective study included all consecutive adult patients between 2008 and 2021 with histopathologically-proven ESOS who underwent pre-treatment CT and/or MRI. Clinical and histological characteristics, ESOS presentation on CT and MRI, treatment and outcomes were reported. Survival analyses were performed using Kaplan-Meier analysis and Cox regressions. Associations between imaging features and OS were searched using uni- and multivariable analyses.
Fifty-four patients were included (30/54 56% men, median age: 67.5 years). Twenty-four died of ESOS (median OS: 18 months). ESOS were mostly deep-seated (46/54, 85%) in the lower limb (27/54, 50%) with a median size of 95 mm (interquartile range: 64, 142; range: 21–289 mm). Mineralization was seen on 26/42 (62%) patients, mainly gross-amorphous (18/26; 69%). ESOS were generally highly heterogeneous on T2-weighted images (38/48; 79%) and contrast-enhanced (CE) T1-weighted images (29/40; 72%), with necrosis (39/40; 97%), well-defined or focally infiltrative margins (39/47; 83%), with moderate peritumoral edema (39/47; 83%) and rim-like peripheral enhancement (17/40; 42%). Size, location, mineralization on CT, signal intensity heterogeneity on T1-, T2- and CE-T1-weighted images and hemorragic signal on MRI were associated with poorer OS (range of log-rank P = 0.0069–0.0485). At multivariable analysis, hemorragic signal and signal intensity heterogeneity on T2-weighted images remained predictive for poorer OS (hazard ratio HR = 2.68, P = 0.0299; HR = 9.85, P = 0.0262, respectively)
ESOS typically presents as mineralized heterogeneous and necrotic soft tissue tumor with a possible rim-like enhancement and limited peritumoral abnormalities. MRI may help estimate outcome of patients with ESOS.
There are several cases of unilateral spontaneous tennis leg which occurred due to namaz praying.1 Bilateral, spontaneous rupture of the quadriceps tendon or Achilles tendon has been described in ...patients with renal disease, rheumatoid arthritis and osteogenesis imperfecta; and in case of medication use such as steroids, antibiotics (fluoroquinolone) and statins.2 3 The injury mechanism in tennis leg is that of a sudden push off when initiating a sprint, with forced dorsiflexion of the ankle while the knee remains in full extension. The medial head is injured most often, however a haematoma between the medial gastrocnemius and soleus muscles without muscle rupture can occur.4 As for our patient, we hypothesised a cascade of injury, involving conditions such as pre-existent poor gastrocnemius-soleus flexibility, low-flexibility shoes (high heels) and muscle fatigue/medial gastrocnemius stress secondary to walking in forced plantar flexion for 4 hours. Learning points Deep-vein thrombosis and tennis leg (medial head of gastrocnemius muscle tear) may cause similar symptoms of pain and calf tightness, and these entities often co-occur.
The sellar spine is a rare congenital malformation due to the persistence of a notochord rest within the fetal sella turcica. We describe a unique case of a sellar spine vertically oriented ...displacing the pituitary stalk upwards and forwards. The MRI findings are briefly discussed.
Within the field of research on the promotion of teachers' social and emotional competence, the present paper illustrates preliminary evidence of the efficacy of a new training program named "ME4YOU" ...aimed at supporting teachers' self-reflexive competences to deal with the emotional and relational dimensions of teaching, with constant and continuous attention towards underlining the close connection between the way teachers perform as professionals at work and the way they function as individuals in their personal life. A total of 109 teachers from kindergarten to primary school took part in the experimental group, while 67 teachers constituted the control group; the two groups were compared using a pre-test/post-test approach with regard to some self-reported variables related to professional and personal aspects. Teachers in the experimental group exhibited increased levels of professional self-efficacy and self-efficacy as emotional socializers toward students' emotions; moreover-although with a more limited impact-they reported benefits with regard to their personal life (i.e., reduced denial of own emotions and improved authenticity). The findings are discussed highlighting that health promotion among teachers is both of value in itself and an investment that can generate health in the whole school system.
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