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Acoustic radiation force impulse (ARFI) is a new software-based technique that evaluates liver stiffness during B-mode ultrasonography. The purpose of this study was to evaluate the accuracy of ARFI in distinguishing patients with chronic autoimmune liver disease from healthy subjects.We enrolled 9 adult patients (8 women, 1 man; age 48.1 ± 12.8 years) with chronic autoimmune disease (primary biliary cirrhosis (PBC, n = 3), autoimmune hepatitis (AIH, n = 2), primary sclerosing cholangitis (PSC, n = 1) and overlap syndromes, (n = 3) who underwent a liver biopsy and 11 healthy volunteers (age 34.7 ± 10.4 years; 7 women, 4 men). Liver stiffness was evaluated and expressed as the shear wave velocity (SWV) in m/sec. We used a US scanner Siemens-Acuson S2000, evaluating the right liver lobe and the left liver lobe.THE SWV WAS SIGNIFICANTLY HIGHER IN CASES (RIGHT LOBE: 1.51 ± 0.44; left lobe: 1.57 ± 0.40) than in controls (right lobe: 1.08 ± 0.10; left lobe: 1.12 ± 0.13) (right lobe: P = 0.002; left lobe: P = 0.013). We found no significant correlation between right and left lobe SWVs in cases (P = 0.779) or controls (P = 0.385). The SWV cut-off that best distinguished cases from controls was 1.25 m/sec (accuracy: AUC=0.885; sensitivity: 70.6%; specificity: 95.5%).ARFI elastography is a noninvasive ultrasonographic technique that can differentiate healthy subjects from patients with fibrotic stages of chronic liver disease.L'elastografia ARFI è una tecnologia integrata all'ultrasonografia convenzionale B-mode in grado di determinare la rigidità tissutale. L'obiettivo di questo studio è stato valutare se l'elastografia ARFI sia in grado di differenziare pazienti affetti da patologie epatiche croniche autoimmuni e soggetti normali.Sono stati arruolati 9 pazienti affetti da epatopatia cronica autoimmune sottoposti a biopsia epatica (età 48.1 ± 12.8 anni; femmine/maschi: 8/1; 3 PBC, 2 AIH, 1 PSC e 3 overlap) e 11 volontari sani (età 34.7 ± 10.4 anni; F/M: 7/4). La rigidità epatica è stata valutata mediante l'elastografia ARFI ed espressa come “shear wave velocity” (SWV) in m/sec. È stato utilizzato un ecografo Siemens-Acuson S2000 valutando entrambi i lobi epatici. Le misurazioni sono state eseguite a respiro bloccato, ad una profondità compresa tra 2 e 5 cm.La SWV è risultata significativamente più elevata nei casi (Dx: 1.51 ± 0.44; Sn: 1.57 ± 0.40) rispetto ai controlli (Dx: 1.08 ± 0.10; Sn: 1.12 ± 0.13) (Dx:L'elastografia ARFI è una metodica ultrasonografica utile nel differenziare soggetti sani da pazienti affetti da epatopatia cronica in evoluzione fibrotica.

BACKGROUND: Bladder cancer is the fourth most frequently diagnosed cancer among males and the eleventh among females. At present, radical cystectomy is considered the standard therapy in patients with muscle invasive disease or in some cases of high-grade superficial cancer. TNM classification includes as independent predictors of disease-specific survival the grade, the pathological stage and the presence of lymph node involvement, whilst the prognostic value of lymphovascular invasion (LVI) still remains controversial. The aim of the study was to assess the prognostic role of LVI at final pathology. PATIENTS AND METHODS: From June 1995 to January 2007, 340 consecutive patients underwent radical cystectomy. Surgical specimens were examined according to our pathological protocol. Patients with a non-transitional cell carcinoma or submitted to a salvage procedure or neoadjuvant/adjuvant chemo-radiotherapy were excluded. The follow-up consisted of abdominal ultrasound every 3 months, blood sampling every six months and both computerized tomography and urethroscopy yearly. RESULTS: The median patient age was 69 years. Of the 265 patients, 218 were males and 47 females. LVI was present in 77 pathological specimens (29.1%). LVI was not significantly associated with age (p=0.908) or sex (p=0.382), but was significantly associated with high pathological grade (p=0.028) and stage (p

Introduction. Health-related quality of life is becoming a major issue in the evaluation of any therapeutic intervention in patients with chronic or hard to cure diseases. Aims. To assess the quality of life in patients with chronic pancreatitis, the majority of whom have had the disease for a long time, and to evaluate which factors linked to the disease are able to influence the quality of life. Subjects and methods. A total of 190 consecutive patients (157 males, 33 females; mean age 58.6 ± 12.7 years, range 18–92 years) with proven chronic pancreatitis were enrolled. The SF-36 questionnaire was used for assessing the health-related quality of life. Results. The z -scores of the eight domains of the patients with chronic pancreatitis were significantly negative indicating an overall impairment of the quality of life when compared to the Italian normative sample. Pancreatic pain was the unique clinical variable able to significantly impair all eight domains of the SF-36, while Wirsung dilation and diabetes were negatively related to some physical and mental domains. The body mass index was the unique variable positively related with some SF-36 domains. Conclusions. Pain may be considered the most important factor affecting the quality of life of chronic pancreatitis patients; moreover, alimentary and metabolic factors deserve more attention in improving the quality of life of these subjects.

The aim of this study was to test the usefulness of the Clavien-Dindo classification after pancreatic resection. In 183 patients who underwent pancreatic resections, complications were classified according to Clavien-Dindo classification and each grade was evaluated regarding the length of the postoperative stay and was compared to the most important complications. Sixty-four (35.0%) patients had no complications; out of the 119 (65.0%) patients with complications, grade I, was 9.3%; grade II, 35.5%; grade III, 9.3%; grade IV, 7.7% and grade V, 3.3%. The postoperative pancreatic fistula rate was 29.1%, postpancreatectomy hemorrhage, 35% and delayed gastric emptying, 11.5%. There was a progressive increase in the length of hospitalization from patients with no complications to those having grade IV (P < 0.001). Postoperative pancreatic fistula, postpancreatectomy hemorrhage and delayed gastric empty rates significantly increased from Clavien-Dindo grade I to grade IV; only postoperative pancreatic fistula and postpancreatectomy hemorrhage severity significantly increased from grade I to grade IV (both P < 0.001). The Clavien-Dindo classification is an objective, simple, and reliable way of reporting all complications following pancreatic resections and it allows to recognize appropriately all the most important complications after pancreatic resection, and the severity of postoperative pancreatic fistula and postpancreatectomy hemorrhage.

OBJECTIVES: Completion rates, pain, and difficulties during the exam are still problems in colonoscopy. New methods of lubrication, rarely considered a matter of study, may help in this respect. Our aim was to compare an oil-assisted technique with a modified warm water method applied during colonoscopy. METHODS: A prospective, randomized, and controlled study was planned in which three groups of patients were submitted to colonoscopy: a standard lubricating method (water-soluble jelly: group A, 170 patients) was adopted in a control group, whereas the standard method plus injection into the colon of corn seed oil (group B, 170 patients) or warm water (group C, 170 patients) were employed in the other groups. The main variables evaluated were: the success rate for total intubation, the time required to reach the cecum and the time needed to examine the colon at withdrawal, and the level of pain and degree of difficulty associated with the examination. RESULTS: Successful intubation to the cecum was significantly more frequent (P < 0.01 and P < 0.001, respectively) in the oil group (group B, 155/166) and in the warm water group (group C, 156/163) than in the control group (group A, 138/164), and less time was needed (P < 0.001); no significant difference was found between group B and C. Furthermore, no significant differences were found with regard to time for examination at withdrawal among the three groups. Level of pain and degree of difficulty during colonoscopy were significantly lower in the oil (P < 0.001) and in the warm water (P < 0.001) groups than in the control group, but no significant difference was found between group B and C. Neither side effects were observed for patients nor damage to the instrument. CONCLUSIONS: Warm water and oil-assisted colonoscopy could be simple, safe, and inexpensive methods for easier and less painful examinations.