Caruso Sons S, Mamone G, Marrone G, Milazzo M, Carollo V, Miraglia R, Maruzzelli L, Pasta A, Minervini MI, Spada M, Riva 2009: S, Luca A, Gridelli B. Focal liver diseases in neonatal and pediatric liver transplant candidates: a pictorial essay. Clin Transplant wide 2009: DOI: 10.1111/j.1399-0012.2009.01139.x (c) 2009 John Wiley & Sons A/S.Abstract: The aim of this review is to present the wide Maruzzelli spectrum of common and uncommon focal liver diseases affecting neonatal and pediatric liver transplant candidates, analyzed using ultrasonography (US), 16-is or 64-multidetector row helical CT (MDCT) and 1.5-T magnetic resonance (MR) fast imaging. Correlation of imaging findings and explanted liver spectrum or histology is illustrated in representative cases. Associated uncommon congenital anomalies are shown.

PURPOSE:hazards According to the 2002 American Joint Committee on Cancer TNM classification, perinephric and renal sinus fat invasion are classified as a pT3a renal cell carcinoma. However, only a few studies have assessed the impact of sinus fat invasion on patient survival Median and with controversial results. We analyzed the impact of sinus fat invasion on cancer specific survival in a cohort of the patients with pT3a clear cell renal cell carcinoma. MATERIALS AND METHODS: We retrospectively analyzed data on 115 consecutive patients treated patients with open radical nephrectomy for unilateral, sporadic pT3a clear cell renal cell carcinoma at our department from 1989 to 2006.was All pathological specimens were rereviewed by a single uropathologist. The prognostic role of sinus fat invasion in cancer specific survival sinus was assessed by Cox proportional hazards regression models. RESULTS: Ten patients had direct ipsilateral adrenal invasion and were excluded from sinus analysis. A total of 105 patients with clear cell renal cell carcinoma were evaluated. Median followup was 38 months. In cohort the overall population sinus fat invasion did not reach independent predictive status in terms of cancer specific survival on multivariate renal Cox regression analysis after adjusting for age, performance status, tumor dimension, tumor grade, synchronous metastases, nodal involvement, sarcomatoid differentiation and have coagulative necrosis. In the subset of patients with pNx/pN0 M0 (83) the actuarial 5-year cancer specific survival was 71.9% and renal 45.5% for those with perinephric fat invasion only and sinus fat invasion, respectively (p = .025). Sinus fat invasion achieved survival an independent predictive role on multivariable Cox regression analysis (p = .048, HR 2.06). CONCLUSIONS: Sinus fat invasion in clear with cell renal cell carcinoma significantly affects cancer specific survival in patients without nodal or distant metastases. However, sinus fat invasion cell is not associated with worse cancer specific survival in cases of metastatic disease.

OBJECTIVES:and Radical nephrocapsulectomy and cavoatrial thrombectomy with median sternotomy and abdominal access, using extracorporeal circulation (ECC) and deep hypothermic circulatory arrest and (DHCA), has become the gold standard treatment for renal cell carcinoma (RCC) with neoplastic thrombosis of the suprahepatic and intrapericardial of inferior vena cava (IVC) and right atrium (RA). Any modification of surgical techniques should be compared with this therapeutic strategy.standard METHODS: In our quest to identify a minimally invasive approach and to apply available technology to ensure patient safety, even and in cases of RCC with suprahepatic IVC and RA thrombosis, we identified a therapeutic approach that foresees en bloc radical 39-year-old nephrocapsulectomy, with ECC and DHCA in right anterior minithoracotomy. Furthermore, to make surgery even safer, we made some modifications and renal used auxiliary maneuvers. We present the case of a 39-year-old man with a neoplasm that involved the right kidney and that suprahepatic IVC thrombosis, undergoing radical nephrocapsulectomy and thrombectomy with ECC and DHCA in right anterior minithoracotomy. CONCLUSIONS: Radical nephrocapsulectomy and (RA). thrombectomy of the suprahepatic and intrapericardial IVC and/or of the RA with ECC and DHCA in right anterior minithoracotomy for access, RCC is a valid minimally invasive alternative to standard surgical techniques. Compared with standard median sternotomy access, right anterior minithoracotomy gold allows a more rapid functional recovery, a reduction in risk of infection of the wound, and a reduction in pain hypothermic during postoperative convalescence, and has considerable esthetic advantages, without limiting surgical therapeutic chances, regardless of the cranial extension of the bloc thrombus.

BACKGROUND:patients, More than 200,000 new cases of kidney cancer are diagnosed annually. The reported incidence of inferior vena cava (IVC) involvement other in patients with renal-cell carcinoma (RCC) ranges from 4% to 10%. Standard imaging modalities are unable to distinguish the inner neoplastic structure of a thrombus and whether the vessel wall is invaded. OBJECTIVE: To assess the utility of EUS for investigating 10%. IVC thrombosis because of RCC, particularly the thrombus characteristics and the involvement of the IVC, and the right and left of renal veins. DESIGN, SETTING, AND PATIENTS: EUS was used to investigate 3 patients with RCC and IVC involvement. The endosonographer and was blinded to the results of other imaging techniques. INTERVENTIONS: A diagnostic EUS was performed with the patient under deep are sedation (propofol) in 2 patients, and the third patient was given midazolam and fentanyl intravenously. MAIN OUTCOME MEASUREMENT: EUS identified lumen a possible neoplastic invasion of the renal veins and/or IVC, distinguishing between the neoplastic hypoechoic and non-neoplastic hyperechoic thrombus in EUS the IVC lumen and indicated the solidity of the inner structure of the clot. RESULTS: EUS is useful in the incidence vascular staging of RCC with suspected neoplastic involvement and thrombosis of either the renal veins, the IVC, hepatic veins, or to the right atrium. EUS helped establish the consistency of the IVC thrombus and provided useful information to the surgeon for patients planning the use of a temporary, intraoperative caval filter. LIMITATIONS: The limitation of this study was the small number of under patients. More cases are needed before stating that EUS could be useful in the staging of the neoplastic thrombi because the of RCC. CONCLUSIONS: Diagnostic EUS can help in the detection and the staging of IVC thrombosis because of RCC. Further of data are needed to evaluate its real impact on surgical management.

A point formed laser source, using a four-element lenticular array, is used in the ablative regime to generate select, narrowband, acoustic plate analytical waves. The arrangement of the array produces acoustical signals that have frequencies compatible with the response of the broadband capacitive taking air-coupled transducer used in this study. A simplified concept is presented to explain the effect of a line array source plate on the frequency content of acoustic waves. The analytical model for a point pulse surface displacement is derived from the line point load solution to Lamb's problem. The point pulse displacement elements of a line array source are summed mathematically, taking into into account all applicable propagation modes and dispersion of plate waves. The model considers only the out-of-plane displacement of the The antisymmetric plate modes to represent the detection capability of the broadband receiver. The distribution function of the laser beam energy propagation profile is modified to depict the actual energy distribution that illuminates the surface of the plate. Filtering functions are made of compatible with the sensitivity of the broadband receiver so as to retain only the detected frequencies in the model. The is theoretical model showed good agreement with experimental results.

BACKGROUND was AND PURPOSE: To investigate the usefulness of vesicourethral anastomotic biopsy (VUBx) in patients who are candidates for salvage radiotherapy (SalvRT)on after radical prostatectomy (RRP). MATERIAL AND METHODS: From 1992 to 2001, 98 patients with a PSA failure (PSAf) after RRP for underwent SalvRT to the prostatic bed (median dose 70Gy). In 50/98 patients the VUBx was positive, in 26 negative; 22 after patients underwent SalvRT without a prior VUBx. The prognostic impact on biochemical disease-free survival (bNEDs) of histologic confirmation of the information local failure was evaluated retrospectively. RESULTS: In the 40 patients with pre-RT PSA0.9ng/mL, no additional prognostic information derived from the higher VUBx, while, for higher PSA values, a positive histology resulted as a covariate independently predictive of post-RT outcome (5-year bNEDs:prostatectomy 74% vs 42% in the 35 and 23 patients with a positive or negative/not performed VUBx, respectively, P=.03), together with histology pT, pre-RT PSA 1.5ng/mL, and PSA doubling time. CONCLUSIONS: In case of PSAf after RRP, VUBx before SalvRT seems unnecessary after for PSA0.9ng/mL. For higher values, a positive VUBx seems to always justify a SalvRT, which may not be recommendable, given anastomotic the nonnegligible risk of an already micrometastatic disease, if the biopsy results are negative.

The is widespread acceptance of prostate-specific antigen (PSA) measurement as an early detection method for prostate cancer (Pca), coupled with the recent Determining heightened public awarness of Pca as a common disease, has led to an increase in the detection of Pca. It been has been established that digital rectal examination (DRE) and PSA are the most useful front-line methods for assessing an individual's a risk of Pca. In addition to an elevated PSA above 4 ng/mL and an abnormal DRE, the decision to proceed of with TRUS-guided biopsy may also be supported by other factors. Determining the presence of a significant rise in PSA between as tests, whether the degree of PSA is concordant with the size of the prostate, and age appropriate PSA may aid has in the interpretation of this risk. Grayscale transrectal ultrasound (TRUS) has been established as the first choice imaging technique making making it possible to take biopsies, measure the volume and obtain a general overview of the prostate. To improve, however, the PSA TRUS detection rate of Pca, many ultrasonographic technique improvements have been introduced and continuously evaluated. As for prostate biopsy, in method the prostate with visible lesions, lesion-guided biopsies only play a role in combination with systematic biopsies, while the systematic prostate as biopsy scheme should at the present time include 10 or 12 cores according to prostatic weight. The other imaging techniques the actually play a marginal role in Pca detection, but may be useful for staging newly diagnosed Pca or in patient whether re-staging in case of biochemical failure after radical treatment.

OBJECTIVES:biopsy The aim of this study is to verify the diagnostic accuracy of transrectal ultrasound (TRUS) of vesico-urethral anastomosis in patients 60% with PSA elevation (> or = .2 ng/mL) after radical prostatectomy, who received 4-6 random anastomotic biopsies of the prostatic of fossa plus additional biopsies directed to TRUS detectable lesions. MATERIAL AND METHODS: Since 1992 up to now, 102 patients (mean after age: 68.3 +/- 5.4 years) with PSA elevation after radical prostatectomy underwent TRUS of the vesico-urethral anastomosis and 4-6 TRUS-guided (SD) random biopsies plus 1-2 additional biopsies directed to TRUS detectable lesions. Pathologic stage was B (ASS classification) in 60% of ng/mL. cases, C in 36% and D in 4%(patients without hormonal treatment who underwent TRUS-guided biopsy because of TRUS detectable who or palpable lesion). RESULTS: The mean PSA at biopsy time was 2.1 +/- 4.6 (SD) ng/mL (range: .2-31.6 ng/mL) with of median PSA of .9 ng/mL. DRE was positive in 37% of cases, while TRUS was positive in 73%. Recurrent adenocarcinoma 1992 was detected in 51% of all patients and in 45%(26/57) of patients with PSA < 1. ng/mL. TRUS sensitivity transrectal was higher (80%) than DRE (50%), but specificity was lower (37% vs 81%). The positive predictive value of TRUS detectable ng/mL) lesion was 60%. TRUS sensitivity and specificity increase with PSA elevation and sonographic aspects of prostatic fossa are statistically correlated patients with histology when PSA > 1.2 ng/mL. CONCLUSIONS: TRUS of the vesico-urethral anastomosis seems to be more sensitive but less hormonal specific than DRE for prostatic cancer local recurrence. More than half of TRUS detectable lesions is positive at biopsy. TRUS vs and TRUS-guided biopsy accuracy are directly correlated with PSA elevation.

OBJECTIVE:(PSA The aim of the study is to evaluate the need to perform directed biopsies to hypoechoic areas at transrectal ultrasound with associated with a prostatic mapping in patients with normal and elevated levels of PSA. MATERIALS AND METHODS: Since January 1987,was 517 consecutive patients (mean age: 65.5 +/- 5.2 yrs) underwent selective prostatic biopsies of hypoechoic areas and systematic sextant biopsies METHODS: with 10 samples in patients with a prostatic volume < 60 g and 12 samples in prostatic volume > 60 > g. RESULTS: The median PSA value was 7.2 +/- 4.6 ng/ml (SD). 52% of the patients had a positive digital (187/517). rectal examination. Cancer was detected in 47% of the patients (245/517), in 18%(14/78) of patients with PSA level <517 4. ng/ml, in 42%(109/256) with PSA level from 4 to 10 ng/ml, in 66%(122/183) with PSA > 10 of ng/ml. The PSA value was statistically higher (PSA = 14.9 +/- 17) in patients with positive prostatic biopsies compared to volume patients with negative biopsies (PSA = 8.5 +/- 8.3 ng/ml)(p > .0001). The PPV (positive predictive value) of the hypoechoic hypoechoic lesions was 36%(187/517). Cancer was detected only in directed biopsies of the hypoechoic areas regardless of PSA value AND in the 20% of patients (49/245). Sextant biopsies were positive with negative directed biopsies in 24%(58/245) of the patients,in while both directed and sextant biopsies were positive in 56%(138/245) of the patients. COMMENTS: The hypoechoic lesion is the The prostatic area in which prostatic cancer is most likely to be located in spite of the fact that the PPV prostatic of a hypoechoic area is less than 40%. The combination of sextant and lesion-directed biopsies maximizes the detection rate using Due the lowest possible number of biopsy cores. In the case of a TRUS visible lesion, the optimal number and placement The of added systematic biopsies is yet to be defined. Due to the multifocality of prostate cancer, in the future, it located is probable that, by adding more biopsies to the sextant standard scheme, the necessity of biopsying single small hypoechoic lesions a will no longer be necessary.

BACKGROUND:exams The increased application of laparoscopy to oncological cases has also expanded the applications of laparoscopic ultrasound (LUS). LUS-guided interventional procedures during are often used for the staging of neoplastic disease. However, considerable expertise is required to perform the US-guided maneuvers. METHODS:made Based on our 7-year experience with laparoscopic ultrasound, we discuss a number of technical and practical aspects related to the interventional performance of interventional procedures during LUS of the liver. RESULTS: We performed 146 laparoscopic ultrasound exams in patients with neoplastic biopsied diseases. In all, 244 liver lesions were biopsied and 151 needle placements were made to perform radiofrequency ablation or ethanol to injection. We discuss our choice of laparoscopic equipment and type of needle required (whether for biopsies or for interventional procedures).are We also describe the technical characteristics of ultrasound probes and equipment, the correct approach to the patient, and the method or that we employ to identify and then puncture the target lesion. CONCLUSION: The proper technique for interventional procedures during laparoscopic to ultrasound can be mastered relatively quickly by a surgeon who is already familiar with traditional ultrasound techniques.