Search

The purpose of this bicentric case series was to report the safety, efficacy, and clinical outcome of transcatheter embolization in pulmonary artery pseudoaneurysms (PAPAs). Between January 2016 and June 2021, eight patients with PAPA were subjected to transcatheter embolization. The total number of patients was eight, of which five were female, with a mean age of 62 ± 14 years (average ± standard deviation). Etiology was traumatic in 2/8 cases and iatrogenic in 6/8 cases (after positioning a Swan-Ganz catheter in 5/6 cases and a temporary pacemaker in the latter case). In a single case, the PAPA was incidentally discovered during a routine X-ray, in the remaining 7 cases, the procedure was performed in emergency settings. PAPA embolization was performed using detachable coils alone in 3 cases; coils and glue in 1 case; coils, glue, and vascular plug in 1 case; coils and non-adhesive liquid embolic agents (Onyx and Squid respectively) in 2 cases; and non-adhesive liquid embolic agent alone (Onyx) in 1 case. No peri-procedural or post-procedural complications were recorded. Both the technical and clinical success rates were 100.0%. In conclusion, endovascular embolization is a technically feasible and safe therapeutic option for patients with PAPAs.

Background: This study is focused on Internal Iliac Artery (IIA) embolization in patients undergoing Endovascular Aneurysm Repair (EVAR). Our aims were: to establish the feasibility of the procedure; to assess the presence of endoleak (EL) and increase in the size of the sac at follow-up; to define the need for reintervention; and to evaluate mortality rate. Methods: In this retrospective single-center study, EVAR-treated patients with an embolization of IIA were chosen. Coils and vascular plug were used as embolizing agents. Results: A total of 49 participants were enrolled in the study (48 men and one woman) with a median age of 76 ± 12 years. Patients had no early EL in 87.75% of cases, 8.16% had type 1a EL, 2.04% type 1b EL, and 2.04% type 2 EL, with a comprehensive technical success of 95.91%. In the follow-up, at 1 month 72.22% remained without EL, at 6 months 70.97%, and at 1 year 81.48%. In the same period, the trend of type 1 EL was 5.56% (1 month), 3.23% (6 months), and 0% (1 year). For EL type 2: 22.22% at 1 month, 25.81% at 6 months, and 16.7% at 1 year. The overall mortality was 35.58% and the re-intervention rate was 16.33%. Conclusions: IIA embolization is a feasible and safe procedure. The presence of EL is not superior to EVAR procedures that do not involve embolization.

Objective: To report the safety and efficacy of trans-arterial embolization (TAE) for upper gastrointestinal bleeding (UGIB) and lower gastrointestinal bleeding (LGIB) due to different etiologies in 91 patients for ten years. Methods: A retrospective analysis of GIB treated between January 2010 and December 2020 was performed. TAE was performed using different embolic agents (coils, particles, glue, gelatin sponge, and EVOH-based agents). Technical success, secondary technical success, clinical success, and complications were evaluated. Results: Technical success was achieved in 74/91 (81.32%) patients. Seventeen patients (18.68%) required re-intervention. Secondary technical success was achieved in all cases (100.0%). Clinical success was achieved in 81/91 patients (89.01%). No major complications were recorded, overall, minor complications occurred in 20/91 patients. Conclusions: TAE is a technically feasible and safe therapeutic option for patients with GIB from a known or blind anatomic source where endoscopic therapy has failed or is deemed unfeasible.

Purpose: To present a selected series of extensively occlusive thrombosis of arteriovenous graft treated with the Penumbra’s Indigo System. Materials and Methods: Ten patients with acute (within 72 h) extensively occlusive thrombosis of arteriovenous graft (mean extension = 30.1 (range = 15–45) cm) were treated at our institution with the Indigo System. Of the 10 cases, thrombosis was extended to venous outflow in 7 cases and to both arterial inflow and venous outflow in 3 cases. Results: Both anatomic and clinical success were achieved in 8 of the 10 procedures (80.0%). In the 2 cases of technical failure, the patients underwent surgical thrombectomy with the finding of arteriovenous graft exhaustion, which was then replaced. The 6-month primary patency, primary-assisted patency, and secondary patency rates were 37.5% (3/8), 50.0% (4/8), and 62.5% (5/8). We reported 2 complications (one minor and one major adverse event). Conclusion: Percutaneous mechanical thrombectomy aspiration with Indigo System is a relatively safe and effective procedure and can be used even in extensively thrombosed arteriovenous graft.

Visceral artery aneurysms (VAAs) are rare, usually asymptomatic and incidentally discovered during a routine radiological examination. Shared guidelines suggest their treatment in the following conditions: VAAs with diameter larger than 2 cm, or 3 times exceeding the target artery; VAAs with a progressive growth of at least 0.5 cm per year; symptomatic or ruptured VAAs. Endovascular treatment, less burdened by morbidity and mortality than surgery, is generally the preferred option. Selection of the best strategy depends on the visceral artery involved, aneurysm characteristics, the clinical scenario and the operator’s experience. Tortuosity of VAAs almost always makes embolization the only technically feasible option. The present narrative review reports state of the art and new perspectives on the main endovascular and other interventional options in the treatment of VAAs. Embolization techniques and materials, use of covered and flow-diverting stents and percutaneous approaches are accurately analyzed based on the current literature. Visceral artery-related considerations and targeted approaches are also provided and discussed.

Intermittent incubation in birds is currently interpreted as the result of trade-offs between the needs of the embryo and those of the parents. However, the low nest attendance in some species is still puzzling. We studied the Crab Plover (Dromas ardeola), a tropical burrow nesting shorebird with very low incubation constancy (less than 55%) due to frequent recesses from incubation (on average 5 recesses/h), mostly spent in the colony area without any apparent function. We aimed to test whether such unusual incubation rhythm can be partly explained by the need to scan for approaching predators. Data collected at Dahret Island (Eritrea) between 2006 and 2014 support the antipredatory function of the incubation rhythm: (1) many recesses on the colony surface were so short (50% less than 37 s in the hotter periods) that a thermoregulatory function can be dismissed; (2) adults on the colony surface responded to approaching predators with alarm calls that drove most incubating Crab Plovers to run out of the burrows and to escape in flocks; (3) sound intensity sharply decreased inside burrows, which explains the delayed escape observed for 9% of the incubating birds; (4) the delayed exit when predators were still in the colony area rules out their permanence inside burrows as an alternative antipredatory strategy; (5) after the visit of a predator, adults restarted incubation with very short in-bouts (2 min on average) apparently in order to scan frequently for approaching predators. We discuss how burrow nesting, alarm calls, and the antipredatory reactions of adults (escape into or out of the burrows, flock flight, mobbing) and chicks (escape into burrows) might have favoured colonial breeding in Crab Plovers.

Balloon sphincteroplasty is a well-known procedure for the treatment of biliary stones. Scoring balloons are characterized by rigid tangential elements that provide focal force, achieving a greater pressure than normal balloons. We report the first (to our knowledge) use of a scoring balloon to perform sphincteroplasty in 4 cases of elderly people presenting with symptomatic choledocholithiasis. In all cases we achieved complete common bile duct clearing with good symptom relief. No procedural complications were observed.

The aim of the study was to establish if a novel tablet ultrasound (US) may replace a high-end US machine during routine interventional radiology activities. Thirty consecutive patients were evaluated by two operators comparing the performance of the new US tablet system (VISIQ, Philips Healthcare) against a high-end US system (iU22, Philips Healthcare) using a curved probe (C5-2). A structured questionnaire was used to rank on a 4-point scale the ability of each system to locate a target as detected by previous examinations and visualize needles and path during an interventional procedure. Necessity for conversion from the tablet US to the high-end US system was registered; body mass index (BMI) was annotated for each patient. Agreement between the operators was found for every patient. Mean patient BMI was 25 (range 17–34). Image quality of the tablet US was considered insufficient in 1 case to visualize the target and in another case to visualize the needle. Mean target image quality was superior with the high-end US system, while needle visibility scored higher with the tablet US. Conversion to the high-end system was registered in 40 % of cases: in most cases (66.6 %) the decision was due to the absence of a dedicated needle guide for the tablet US. The novel tablet US was found to provide sufficient image quality for the majority of routine interventional procedures. Dedicated accessories and additional experience with this new generation US device may be needed to replace bulky high-end US systems.

We report our experience regarding use of Fluency stent graft (Bard, Murray Hill, NJ, USA) for the treatment of peripheral aneurysms, pseudoaneurysms, arteriovenous fistulae, dissections and arterial ruptures, lacerations or perforations. This two-center study included 59 patients (40 M, 19 F) with a mean age of 64.37 years (range 20–91 years). In total 61 lesions were treated, so subdivided: 10 true aneurysms, 26 pseudoaneurysms, 5 iatrogenic arteriovenous fistulae, 20 arterial ruptures, lacerations or perforations. Immediate technical success was obtained in 60 of 61 lesions (98.3 %); in 1 case (pseudoaneurysm of hepatic artery) additional embolization of the gastroduodenal artery with microcoils was needed. Follow-up was available for 57 patients and 59 lesions; mean period was 23.52 months (range 1–60 months). At 1-year primary patency was 89.47 %, whereas secondary patency was 96.4 %. Endovascular application of Fluency stent graft seems to offer an effective, and durable less invasive alternative to standard surgical techniques for the treatment of peripheral aneurysms, pseudoaneurysms, iatrogenic arteriovenous fistulae and arterial ruptures, or penetrating injuries.

Purpose: To evaluate the variations in aortic diameters and long-term results in patients who underwent thoracic endovascular aortic repair (TEVAR) for acute blunt traumatic thoracic aortic injuries (BTTAIs). Materials and Methods: We retrospectively evaluated 23 patients with a mean age of 39 years (range: 17-74 years) who underwent TEVAR for BTTAI between October 2000 and November 2014. All of the patients underwent computed tomography angiography (CTA) before hospital discharge as a baseline imaging for the subsequent follow-up examinations. The technical success, overall survival, and complications were evaluated. Furthermore, the aortic diameters outside of the stent-graft (1 cm proximal and 1 cm distal to the stent-graft) and the aortic diameters within the stent-graft (2 cm distal to the proximal end and 2 cm proximal to the distal end) were assessed. The diameters at baseline on CTA were compared with those of the latest available follow-up examination. Results: Technical success was 100% with a mean follow-up of 65.4 months (range: 12-171 months). No death was registered, and 2 (8.7%) of 23 endograft-related complications (1 stent-graft distal infolding and 1 endoleak 2 and 4 months after the procedure, respectively) were observed. An increase in aortic diameter either proximal or distal to the stent-graft (mean value 0.7 and 0.5 mm, respectively) or within the stent-graft (mean value of 0.5 mm for both proximal and distal diameters) was registered (mean follow-up at 65.4 months, range: 12-171 months). Conclusion: Aortic dilatation following TEVAR for BTTAI is minimal during long-term follow-up. Endovascular treatment represents a durable and safe option in acute BTTAIs.

Being trapped is a potentially stressful experience, especially for breeding birds, so capture should be limited to target individuals and be as least harmful as possible. We describe here a modified leg-noose trap that we developed for the burrow nesting Crab-plover (Dromas ardeola). Similar to other commonly used devices, it consists of monofilament fishing line nooses secured to a heavy metal base. We modified this traditional device by positioning the nooses perpendicular to the bird movement and by adding shock-absorbing elastic bands. This last addition proved effective in protecting the captured bird's legs from superficial wounds and abrasions; it did not affect capture success relative to a version of the same trap lacking these improvements. Such improvements could be applied to similar noose traps employed for other birds in order to reduce discomfort and avoid injury.

The timing of breeding in birds is a life-history trait that generally depends on food availability, but other factors may play a role, particularly in tropical areas where food availability is less seasonal than in temperate or polar areas. We studied the factors affecting the breeding season of the Crab Plover Dromas ardeola, a burrownesting colonial shorebird endemic to the north-western Indian Ocean. A reduced risk of burrow flooding, high temperatures suitable for exploiting solar incubation, a reduced interference by Palaearctic shorebirds during foraging, a reduced risk of predation by Palaearctic raptors and a high food abundance are all associated with the summer breeding season of the Crab Plover in our study area in Eritrea. In addition, we collected remotely recorded data associated with these advantageous environmental factors around breeding colonies in nine well-separated areas. Only average annual chlorophyll a concentration, a proxy of marine productivity, was significantly correlated wit...

The Danakil Depression in northeastern Africa represents one of the harshest arid environments on Earth, yet two genera of fishes, Danakilia (Cichlidae) and Aphanius (Cyprinodontidae), share its sparse aquatic habitats. The evolutionary history of these fishes is investigated here in the context of genetic, geological and paleoenvironmental information. We collected samples from seven sites and assessed phylogeographic relationships using concatenated COI and cytb mtDNA genes. Danakilia morphospecies show low differentiation at mitochondrial markers, but variation is partitioned between a northern cluster containing D. dinicolai plus three undescribed riverine populations, and a southern cluster including two creek populations of D. franchettii separated by the hypersaline waters of Lake Afrera. Aphanius displayed four genetically distinct clades (A. stiassnyae in Lake Afrera; one distributed across the entire area; one in Lake Abaeded; and one in the Shukoray River), but without clear large-scale geographic structure. However, Danakil Aphanius are clearly differentiated from A. dispar sensu stricto from the Sinai Peninsula. Geological evidence suggests that after the Late Pleistocene closure of the Danakil-Red Sea connection, increased post-glacial groundwater availability caused the formation of a brackish paleo-lake flooding the entire region below the -50 m contour. Fish populations previously isolated in coastal oases during glaciation were able to mix in the paleo-lake. Subsequently, in a more arid phase starting ∼7300 BP, paleo-lake regression isolated fishes in separate drainages, triggering their still ongoing diversification.

To determine the accuracy of MDCT in the evaluation of blunt surgically relevant bowel and/or mesenteric injuries (BMIs) using single specific CT signs together with specific pairs of nonspecific signs. Fifty-four patients examined with MDCT were divided into two groups: a ‘surgical’ group of 20 patients—which underwent surgery for blunt BMIs—and a control group of 34 ‘nonsurgical’ trauma patients. Two radiologists with different experience performed a double-blind retrospective evaluation of the images, classifying the patients in the two groups by using only single specific signs; then, the images were reviewed in consensus with a third radiologist and sensitivity and specificity were calculated. Subsequently, the frequency of every single sign and of every possible combination of nonspecific signs in the two groups was registered, to find combinations present only in the surgical group; sensitivity and specificity were calculated by using even those specific combinations. At the first consensual evaluation, sensitivity and specificity were 75 and 100%, respectively. Two combinations of nonspecific signs (focal wall thickening + extraluminal air; focal wall thickening + seat belt sign) were found only in surgical patients that did not present any single specific sign: Sensitivity calculated adding those two combinations was 95%, without a decrease in specificity. MDCT is an accurate technique in the evaluation of blunt surgically relevant BMIs. The single specific CT signs were sufficient for the diagnosis in only 75% of the cases; adding the two specific combinations allowed an increase in sensitivity of 20%.

To affirm technical success, clinical success and safety of fluoroscopically guided transurethral replacement of double-J (DJ) ureteral stents. From January 2005 to December 2015, in a follow-up period ranging from 9 to 73 months, we replaced 6167 DJ ureteral stents in 3221 procedures in 1168 patients. All the procedures were performed in the angiography suite under fluoroscopic control. Technical success was achieved in 97.5% of the procedures. In eighty procedures, cystoscopic approach was necessary; time from previous procedure and side were significantly associated with technical success. Clinical success was reached in 95.7% of the procedures and was significantly lower in urological and gynaecological tumours (when compared to fibrosis and other causes) and in bilateral stents. No major complications were reported. In 90 cases, self-limiting transient minor haematuria occurred and in 160 procedures urinary tract infection responding to antibiotics were registered. Overall procedure time was 27 min. Mean fluoroscopic time was 6 min and 45 s. Mean radiation dose of the procedure was 38.40 Gy cm2. In patients that need routine replacement of DJ ureteral stent, transurethral fluoroscopically guided method may be the first choice; only in few cases of technical failure, cystoscopy may be considered.

We used GPS data-loggers, video-recordings and dummy eggs to assess whether foraging needs may force the low incubation attentiveness (

The gazelles of Dahlak Kebir are the only population of Nanger soemmerringii Cretzschmar, 1828 living on an island. Little is known on the biology of these animals, except that they are evidently smaller than their conspecifics living on the continent. We took advantage of a recently acquired collection of crania, probably the largest available study sample of the Dahlak Kebir population worldwide, to explore the phenotypic variation of this island endemism. To this aim, we employed state of the art geometric morphometrics techniques and multivariate statistics to compare the insular population with samples of two out of three subspecies of N. soemmerringii from continental Africa. We found that not only is the size of the animal remarkably smaller in Dahlak Kebir gazelles, but their cranial shape is also highly distinctive, and this might be only partly explained by allometry. We also showed that phenotypic variance might have been reduced in the island population, likely as a consequence of genetic bottlenecks. This unique population is part of a species vulnerable to extinction. Our results suggest that the Dahlak Kebir Island gazelles might represent a significant component of its variation and potential for adaptive change and evolution. More information, including molecular data, and an accurate assessment of its taxonomic relevance and conservation status, is urgently needed. © 2014 The Linnean Society of London, Biological Journal of the Linnean Society, 2014, 111, 603–620.

The present study describes the breeding biology of Crab Plovers (Dromas ardeola), a little-known shorebird species nesting on Nakhilu and Omol-Karam Islands located in the Nakhilu Marine National Park in the northern Persian Gulf, Iran. This study occurred during the breeding seasons of 2009–2011. Colonies had between 500–1,500 nests and were located on sand banks 1–3 m higher than the surrounding ground in non-overlapping areas. Burrow digging began in mid-April, and single nests were built in 2.82 ± 0.1 days (Range = 2–4 days, n = 45) in a period of 10.5 ± 0.76 days (Range = 8–13 days, n = 6), although a spread of digging and laying of 87.50 ± 2.96 days (Range = 82–94 days, n = 4) was recorded primarily due to renesting after human damage to the burrows. Range in nest densities was 0.14–0.26 nest per m2. The clutch size was 1.01 ± 0.005 (Range = 1-2, n = 421). Egg size (n = 47) was 64.05 × 44.04 mm with an average incubation period of 33 days (Range = 31–35, n = 21). Hatching success was 63–81%, with failures primarily due to egg collecting by local fishermen and tourists. An estimated of 7 weeks passed between hatching and fledging. Fledglings had almost fully developed wings (83% of adult wing length) and feathers, but very low weight (about 55% of adult weight) and smaller bill length (only 60% of adult bill length). A stronger control of visitors and local fishermen would benefit the breeding population of Crab Plovers on the islands.

This study was done to evaluate the feasibility, effectiveness and safety of microwave (MW) ablation of lung tumours.Twenty-four patients underwent percutaneous MW ablation of 26 intraparenchymal pulmonary masses. All patients were judged to be inoperable on the basis of tumour stage, comorbidities, advanced age and/or refusal to undergo surgery. Ablation was performed using a microwave generator (Evident Microwave Ablation System, Covidien Ltd., Dublin). Lesions with a diameter ≤ 3 cm were treated with a single antenna, lesions with a diameter3 cm were treated by positioning two or more antennae, simultaneously. All patients underwent computed tomography (CT) follow-up with and without contrast administration at 1, 3 and 6 months and then yearly in combination with complete blood and metabolic tests.Technical success was 100 %. No major complications were recorded. Asymptomatic grade-1 pneumothorax was recorded in 9 patients (37.5 %). One case of asymptomatic pleural effusion and one of haemoptysis, not requiring transfusion, were observed. No patients were diagnosed with a post-ablation syndrome. Complete necrosis was observed in 16 of 26 lesions (61.6 %). Partial necrosis was obtained in 30.8 % (8/26 lesions); in one case (3.8 %) a progression of the disease was recorded and in another case (3.8 %) a stability was observed.Our preliminary experience may be considered in accordance with literature dates, in terms of efficacy and safety.

Determining the sex of Crab Plovers (Dromas ardeola) based on morphology has, hitherto, proven difficult. Here, six morphological traits (head-bill length, bill length, bill depth, wing chord, tarsus length and weight) of 39 molecularly or behaviorally sexed breeding Crab Plovers were compared in order to find a reliable morphometric way to determine their sex. Males were significantly larger than females in all traits, except tarsus length, and especially in traits related to head and bill size, where males were 6.8 to 11.4% larger than females. Discriminant Function Analysis correctly classified 97.4% of birds using only bill depth and bill length, providing an efficient tool for sexing Crab Plovers in the hand.

Aims On the basis of the current knowledge, cardiac resynchronization therapy (CRT) cannot be recommended as a first-line treatment for patients with severely symptomatic permanent atrial fibrillation undergoing atrioventricular (AV) junction ablation. We examined whether CRT was superior to conventional right ventricular (RV) pacing in reducing heart failure (HF) events. Methods and results In this prospective, multi-centre study, we randomly assigned 186 patients, in whom AV junction ablation and CRT device implantation had been successfully performed, to receive optimized echo-guided CRT (97 patients) or RV apical pacing (89 patients). The data were analysed according to the intention-to-treat principle. During a median follow-up of 20 months (interquartile range 11–24), the primary composite endpoint of death from HF, hospitalization due to HF, or worsening HF occurred in 11 (11%) patients in the CRT group and 23 (26%) patients in the RV group [CRT vs. RV group: sub-hazard ratio (SHR) 0.37 ( 95% CI 0.18–0.73), P = 0.005]. In the CRT group, compared with the RV group, fewer patients had worsening HF [SHR 0.27 (95% CI 0.12–0.58), P = 0.001] and hospitalizations for HF [SHR 0.20 (95% CI 0.06–0.72), P = 0.013]. Total mortality was similar in both groups [hazard ratio (HR) 1.57 (95% CI 0.58–4.27), P = 0.372]. The beneficial effects of CRT were consistent in patients who had ejection fraction ≤35%, New York Heart Association Class ≥III and QRS width ≥120 and in those who did not. At multi-variable Cox regression, only CRT mode remained an independent predictor of absence of clinical failure during the follow-up [HR = 0.23 (95% CI 0.08–0.66), P = 0.007]. Conclusions In patients undergoing ‘Ablate and Pace’ therapy for severely symptomatic permanent atrial fibrillation, CRT is superior to RV apical pacing in reducing the clinical manifestations of HF. (ClinicalTrials.gov number: [NCT00111527][1]) [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00111527&atom=%2Fehj%2F32%2F19%2F2420.atom

The Crab Plover (Dromas ardeola) is a little-known shorebird that breeds colonially in self-dug burrows on islands in the north-western Indian Ocean. To test whether the “nest site limitation” hypothesis could satisfactorily explain the high nest density in this species, 21 colonies were studied in Eritrea from 2002 to 2009. The hypothesis was falsified by the following observations: across the study period, nesting colonies were relocated on the same sandbanks every year and most occupied no more than 4% of the area suitable for excavating burrows; colony size and area suitable for burrowing were not correlated; nest density and colony size were not significantly correlated; the area occupied by nests increased steadily throughout the nest-building period; nests were closely-spaced throughout the building phase rather than being scattered throughout the area eventually used for digging. These results indicate that the Crab Plover is not site-limited but a truly colonial species.

This study was designed to evaluate the utility of dual phase cone beam computed tomography (DP-CBCT) and automatic vessel detection (AVD) software to guide transarterial embolization (TAE) of angiographically challenging arterial bleedings in emergency settings. Twenty patients with an arterial bleeding at computed tomography angiography and an inconclusive identification of the bleeding vessel at the initial 2D angiographic series were included. Accuracy of DP-CBCT and AVD software were defined as the ability to detect the bleeding site and the culprit arterial bleeder, respectively. Technical success was defined as the correct positioning of the microcatheter using AVD software. Clinical success was defined as the successful embolization. Total volume of iodinated contrast medium and overall procedure time were registered. The bleeding site was not detected by initial angiogram in 20 % of cases, while impossibility to identify the bleeding vessel was the reason for inclusion in the remaining cases. The bleeding site was detected by DP-CBCT in 19 of 20 (95 %) patients; in one case CBCT-CT fusion was required. AVD software identified the culprit arterial branch in 18 of 20 (90 %) cases. In two cases, vessel tracking required manual marking of the candidate arterial bleeder. Technical success was 95 %. Successful embolization was achieved in all patients. Mean contrast volume injected for each patient was 77.5 ml, and mean overall procedural time was 50 min. C-arm CBCT and AVD software during TAE of angiographically challenging arterial bleedings is feasible and may facilitate successful embolization. Staff training in CBCT imaging and software manipulation is necessary.

To compare the diagnostic performance of cone-beam CT (CBCT)-guided and CT fluoroscopy (fluoro-CT)-guided technique for transthoracic needle biopsy (TNB) of lung nodules. The hospital records of 319 consecutive patients undergoing 324 TNBs of lung nodules in a single radiology unit in 2009–2013 were retrospectively evaluated. The newly introduced CBCT technology was used to biopsy 123 nodules; 201 nodules were biopsied by conventional fluoro-CT-guided technique. We assessed the performance of the two biopsy systems for diagnosis of malignancy and the radiation exposure. Nodules biopsied by CBCT-guided and by fluoro-CT-guided technique had similar characteristics: size, 20 ± 6.5 mm (mean ± standard deviation) vs. 20 ± 6.8 mm (p = 0.845); depth from pleura, 15 ± 15 mm vs. 15 ± 16 mm (p = 0.595); malignant, 60 % vs. 66 % (p = 0.378). After a learning period, the newly introduced CBCT-guided biopsy system and the conventional fluoro-CT-guided system showed similar sensitivity (95 % and 92 %), specificity (100 % and 100 %), accuracy for diagnosis of malignancy (96 % and 94 %), and delivered non-significantly different median effective doses [11.1 mSv (95 % CI 8.9–16.0) vs. 14.5 mSv (95 % CI 9.5–18.1); p = 0.330]. The CBCT-guided and fluoro-CT-guided systems for lung nodule biopsy are similar in terms of diagnostic performance and effective dose, and may be alternatively used to optimize the available technological resources. • CBCT-guided and fluoro-CT-guided lung nodule biopsy provided high and similar diagnostic accuracy. • Effective dose from CBCT-guided and fluoro-CT-guided lung nodule biopsy was similar. • To optimize resources, CBCT-guided lung nodule biopsy may be an alternative to fluoro-CT-guided.

To evaluate the usefulness and safety of percutaneous transluminal forceps biopsy in patients suspected of having a malignant biliary obstruction.Forty consecutive patients (21 men and 19 women; mean age, 71.9 years) underwent forceps biopsy through percutaneous transhepatic biliary access performed to drain bile. Lesions involved the common bile duct (n 8), common hepatic duct (n 18), hilum (n 6), ampullary segment of the common bile duct (n 8) and were biopsied with 7-F biopsy forceps. Final diagnosis was confirmed with pathologic findings at surgery, or clinical and radiologic follow-up.Twenty-one of 40 biopsies resulted in correct diagnosis of malignancy. Thirteen biopsy diagnosis were proved to be true-negative. There were six false-negative and no false-positive diagnoses. Sensitivity, specificity and accuracy in aspecific biliary obstructions were 85%, 100% and 88,7% respectively. Sensitivity of biopsy in malignancies was higher than in benign obstructions (100% vs 68,4%, CI = 95%). Sensitivity was lower in the hilum tract and in the common bile duct than in other sites (CI = 95%). No major complications related to biopsy procedures occurred.Percutaneous transluminal forceps biopsy is a safe procedure, easy to perform through a transhepatic biliary drainage tract, providing high accuracy in the diagnosis of malignant biliary obstructions.

Image-guided thyroid nodule ablation is a relatively new technique for the management of thyroid disease. Notably, if there has been the correct patient selection and if they are performed in high volume centers and via a standardized technique, image-guided thyroid nodule ablation seems to be safe and effective and it can be used to treat thyroid goiters. However, there is still paucity of level 1 evidences and recommendation comparing ablation to surgical or to other non-surgical treatment modalities. Herein, some technical notes for the thyroid nodule ablation to achieve the critical view of safety are presented. Moreover, an additional remark and appraisal from a surgical point of view is described.

We describe an unknown mode of solar-assisted egg development in the crab plover Dromas ardeola, a shorebird that breeds in self-excavated burrows. The insulating properties of the nest burrow and the intense solar radiation allowed egg development at near-optimal temperature (35.2°C±0.2) and humidity (60.2%±4.4), allowing a very low incubation attendance by the parent birds (28.3% of time, with recesses lasting up to 58 h). Crab plovers did not abandon completely parental incubation, possibly because of the need to turn their egg, and because the slight warming provided by parents (0.8°C) may improve hatching. This is the first case of solar assisted incubation in a species unrelated to the Megapodiidae, the only birds known to develop their eggs without contact incubation.

Lower gastrointestinal bleeding (LGIB) is associated with high morbidity and mortality. Embolization is currently proposed as the first step in the treatment of acute, life-threatening LGIB, when endoscopic approach is not possible or is unsuccessful. Like most procedures performed in emergency setting, time represents a significant factor influencing outcome. Modern tools permit identifying and reaching the bleeding site faster than two-dimensional angiography. Non-selective cone-beam CT arteriography can identify a damaged vessel. Moreover, sophisticated software able to detect the vessel may facilitate direct placement of a microcatheter into the culprit vessel without the need for sequential angiography. A further important aspect is the use of an appropriate technique of embolization and a safe and effective embolic agent. Current evidence shows the use of detachable coils (with or without a triaxial system) and liquid embolics has proven advantages compared with other embolic agents. The present article analyses these modern tools, making embolization of acute LGIB safer and more effective.

A new species of cichlid fish is described from a small, endorheic lake (Lake Abaeded), situated some 30 m below sea level in the Danakil Depression of Eritrea (East Africa). Danakilia dinicolai is readily distinguished from its congener, D. franchettii, on the basis of body proportions and in the possession of markedly longer pectoral fins at all sizes. Additionally, oral dentition is more robust than that of its congener, and the lower pharyngeal jaw is markedly hypertrophied and covered with considerably finer and more densely implanted teeth on the posterior field of the jaw.

To evaluate safety, feasibility, technical success, and clinical success of direct percutaneous sac injection (DPSI) for the treatment of type II endoleaks (T2EL) using anatomical landmarks on cone beam computed tomography (CBCT) and fusion imaging (FI). Eight patients with T2EL were treated with DPSI using CBCT as imaging guidance. Anatomical landmarks on unenhanced CBCT were used for referencing T2EL location in the first five patients, while FI between unenhanced CBCT and pre-procedural computed tomography angiography (CTA) was used in the remaining three patients. Embolization was performed with thrombin, glue, and ethylene–vinyl alcohol copolymer. Technical and clinical success, iodinated contrast utilization, procedural time, fluoroscopy time, and mean radiation dose were registered. DPSI was technically successful in all patients: the needle was correctly positioned at the first attempt in six patients, while in two of the first five patients the needle was repositioned once. Neither minor nor major complications were registered. Average procedural time was 45 min and the average administered iodinated contrast was 13 ml. Mean radiation dose of the procedure was 60.43 Gy cm2 and mean fluoroscopy time was 18 min. Clinical success was achieved in all patients (mean follow-up of 36 months): no sign of T2EL was reported in seven patients until last CT follow-up, while it persisted in one patient with stability of sac diameter. DPSI using unenhanced CBCT and FI is feasible and provides the interventional radiologist with an accurate and safe alternative to endovascular treatment with limited iodinated contrast utilization.