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Beltrame V, Gruppo M, Pastorelli D, Pedrazzoli S, Merigliano S, Sperti C. Outcome of pancreaticoduodenectomy in octogenarians: Single institution's experience and review of the literature. J Visc Surg 2015; 152:279-84. [PMID: 26117303 DOI: 10.1016/j.jviscsurg.2015.06.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Pancreatic and perampullary neoplasms in patients aged 80 or older trouble the surgeons because of the risk of surgical treatment. We have reviewed our experience and literature's reports of pancreaticoduodenectomy in octogenarians, evaluating early results and long-term survival in pancreatic cancer group. METHODS Three hundred eighty-five patients who underwent pancreaticoduodenectomy for neoplasms from 1998 to 2011 were included in the study, and were divided in two groups: group 1, patients younger than 80 years of age, and group 2, patients 80 years of age and older. Operative morbidity, mortality, disease-free and long-term survival were analysed. English literature was systematically searched for pancreatic resection's outcome in octogenarians. RESULTS There were 385 pancreaticoduodenectomies: 362 patients were in group 1 and 23 patients in group 2. There was no significant difference regarding gender, and pathologic findings between the two groups. Complications' rate (40 vs. 43%), mortality rate (4% vs. 0%), and overall median survival for pancreatic cancer patients were not statistically different in the two groups (median 21 vs. 19 months). Literature's review showed 14 reports of pancreatic resection in octogenarians. Most of the studies (particularly in centres with high-volume pancreatic surgery) showed that outcome after pancreatectomy was not different in octogenarians or in younger patients. CONCLUSION Pancreaticoduodenectomy is an acceptable option for elderly patients. Age alone should not be considered a contraindication to major pancreatic resection, but a careful preoperative evaluation and an accurate postoperative management are mandatory.
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Affiliation(s)
- V Beltrame
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, via Giustiniani 2, 35128 Padua, Italy
| | - M Gruppo
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, via Giustiniani 2, 35128 Padua, Italy
| | - D Pastorelli
- Department of Oncology, Veneto Institute of Oncology, IOV, via Gattamelata 64, 35128 Padua, Italy
| | - S Pedrazzoli
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, via Giustiniani 2, 35128 Padua, Italy
| | - S Merigliano
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, via Giustiniani 2, 35128 Padua, Italy
| | - C Sperti
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, via Giustiniani 2, 35128 Padua, Italy.
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Beltrame V, Gruppo M, Merigliano S, Bissoli S, Pasquali C, Sperti C. Preoperative 18-FDG PET predicts survival in resectable pancreatic cancer. Eur J Surg Oncol 2015. [DOI: 10.1016/j.ejso.2014.10.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Raffeiner B, Grisan E, Bernardi L, Botsios C, Ometto F, Coran A, Beltrame V, Ciprian L, Punzi L, Stramare R. AB0953 A Comparison of Region-Based and Pixel-Based CEUS Kinetics Parameters in the Differentiation of Rheumatoid Arthritis and Simil-Rheumatoid Psoriatic Arthritis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Raffeiner B, Grisan E, Bernardi L, Botsios C, Ometto F, Coran A, Beltrame V, Ciprian L, Stramare R, Punzi L. SAT0175 Dynamic Automated Synovial Imaging (DASI) for Differentiating between Rheumatoid Arthritis and Simil-Rheumatoid Psoriatic Arthritis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rubaltelli L, Beltrame V, Scagliori E, Bezzon E, Frigo AC, Rastrelli M, Stramare R. Potential use of contrast-enhanced ultrasound (CEUS) in the detection of metastatic superficial lymph nodes in melanoma patients. Ultraschall Med 2014; 35:67-71. [PMID: 23860858 DOI: 10.1055/s-0033-1335857] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE Malignant melanoma represents a significant and growing public health burden worldwide. Ultrasonography is the most useful diagnostic modality for regional lymph nodal staging. Because any focal areas of cortical lobulation or thickening-swelling should also be considered as a sign of metastases, we are going to report the usefulness of contrast-enhanced ultrasonography (CEUS) in the differential diagnosis of benign or malignant lymph nodes in patients with malignant melanoma based on blood stream patterns and investigate the diagnostic capability. PATIENTS AND METHODS After the excision of cutaneous melanoma with positive excision margins but with negative sentinel lymph node, 540 patients underwent US of superficial lymph nodes. The inclusion criteria for CEUS consisted of both major signs (absence of the echogenic hilus, round shape, and peripheral capsular vascularity) and minor ones (the presence of focal cortical thickening). The diagnostic capability was evaluated by comparing the cytological findings with the enhancement pattern on CEUS. RESULTS US in combination with CEUS correctly classified 534/540 patients. CEUS applied to lymph nodes with focal cortical thickening on grayscale US confirmed great sensitivity (0.98) and specificity (0.99) but above all, it showed a markedly improved accuracy of 0.99. The likelihood ratios confirmed the good performance of the methods used. CONCLUSION CEUS increases the diagnostic accuracy of US in the differential diagnosis of benign and malignant LNs but it also allows us, when possible, to avoid unnecessary invasive operations such as LN FNAC. Moreover, CEUS may guide FNAC in the case of focal cortical thickening on the basis of hypoperfusion, with a reduction in the number of false negatives and much earlier detection of nodal metastatic foci.
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Affiliation(s)
- L Rubaltelli
- Department of Medicine, Radiology, University of Padova
| | - V Beltrame
- Department of Medicine, Radiology, University of Padova
| | - E Scagliori
- Department of Radiology, Venetian Oncology Institute (IOV), IRCCS, Padova
| | - E Bezzon
- Department of Radiology, Venetian Oncology Institute (IOV), IRCCS, Padova
| | - A C Frigo
- Department of Environmental Medicine and Public Health, University of Padova
| | - M Rastrelli
- Melanoma and Sarcoma Unit, Veneto Institute of Oncology (IOV), IRCCS, Padova
| | - R Stramare
- Department of Medicine, Radiology, University of Padova
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Raffeiner B, Stramare R, Ciprian L, Bernardi L, Botsios C, Beltrame V, Coran A, Scagliori E, Punzi L, Grisan E. FRI0478 Dynamic automated synovial imaging (DASI) For differentiating between rheumatoid arthritis and other forms of arthritis: automated versus manual interpretation in contrast-enhanced ultrasound. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-eular.1605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Raffeiner B, Coran A, Bernardi L, Botsios C, Grisan E, Beltrame V, Faccinetto A, Costantini G, Stramare R, Punzi L. FRI0477 Validity of contrast-enhanced ultrasound (CEUS) in the detection of synovial inflammation in rheumatoid arthritis compared to power doppler in contrast-enhanced mri controlled pilot study. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Stramare R, Gazzola M, Coran A, Sommavilla M, Beltrame V, Gerardi M, Scattolin G, Faccinetto A, Rastrelli M, Grisan E, Montesco MC, Rossi CR, Rubaltelli L. Contrast-enhanced ultrasound findings in soft-tissue lesions: preliminary results. J Ultrasound 2013; 16:21-7. [PMID: 24046796 DOI: 10.1007/s40477-013-0005-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Accepted: 12/08/2012] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES There is currently no widely available, minimally invasive first-level examination that allows physicians to identify soft-tissue lesions that are likely to be malignant. The aim of this pilot study was to explore the potential suitability of dynamic contrast-enhanced ultrasound (DCE-US) for this purpose. MATERIALS AND METHODS 23 patients were referred to the Veneto Oncological Institute for work-up of superficial soft-tissue lesions. Fourteen lesions were examined with CEUS and enhancement kinetics was analyzed. Subsequently, all lesions were surgically removed and subjected to histological analysis. RESULTS The 14 lesions included in the study were histologically classified as malignant (n = 7) or benign (n = 7, including 3 schwannomas). A statistically significant difference between benign and malignant lesions was found in terms of mean times to peak enhancement intensity (p = 0.03) but not mean filling times (FT). When schwannomas were analyzed as a separate group, their mean FT was found to be significantly different from that of the other benign lesions (p = 0.001) and from that of the group comprising other benign lesions as well as malignant lesions (p < 0.005). CONCLUSIONS CEUS with analysis of contrast-enhancement kinetics is a relatively low-cost, minimally invasive imaging technique, which appears to be a potentially effective first-level method for identifying suspicious soft-tissue masses.
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Affiliation(s)
- R Stramare
- Department of Medicine, Radiology Section, University of Padua, Padua, Italy ; Dipartimento di Medicina, Radiologia, Università di Padova, Via Giustiniani 2, 35128 Padua, Italy
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Dalla Bona E, Moletta L, Beltrame V, Liessi F, Sperti C. Leiomyosarcoma of the pancreas: A paradigm of multimodality treatment. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.07.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Beltrame V, Tona F, della Bona E, Pasquali C, Sperti C. Pancreatectomy for pancreatic cancer is safe and feasible in octogenarians. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.07.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Beltrame V, Tona F, della Bona E, Pasquali C, Sperti C. Multimodal management of recurrent pancreatic cancer: Myth or reality? Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.07.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Cozzolino P, Stramare R, Udilano A, Castoro M, Scagliori E, Beltrame V, Rubaltelli L. Quality control of ultrasound transducers: analysis of evaluation parameters and results of a survey of 116 transducers in a single hospital. Radiol Med 2010; 115:668-77. [PMID: 20177978 DOI: 10.1007/s11547-010-0533-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Accepted: 07/21/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study was to develop a quality control programme for ultrasound equipment and assess equipment performance at a single hospital. MATERIALS AND METHODS We tested 116 transducers by means of a phantom; ultrasound quality control tests were done on parameters from B-mode images, and each parameter was rated according to a three-point score as good, sufficient or poor. RESULTS Surface transducers showed worse performance in terms of image uniformity, with 7/55 (13%) transducers rated poor, and depth of penetration, with 24/55 (44%) transducers, rated sufficient or poor. The 3.5-MHz transducers showed worse performance in lateral resolution, with 18/48 (38%) rated poor, and particularly in focusing, with 40/48 (83%) classified as poor. In addition, the 3.5-MHz transducers proved less accurate in vertical distance accuracy than in horizontal distance, with 31/48 (64%) considered sufficient. No significant geometric distortions of masses were identified, although 4/116 (3%) transducers failed to visualise two masses. CONCLUSIONS The first goal of an ultrasound quality control programme is to establish specific parameters to evaluate equipment performance and, should results be below recommended action levels, implement corrective measures.
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Affiliation(s)
- P Cozzolino
- Dipartimento di Scienze Medico Diagnostiche e Terapie Speciali, Università degli Studi di Padova, Via Giustiniani 2, Padova, Italy
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Stramare R, Beltrame V, Dal Borgo R, Gallimberti L, Frigo AC, Pegoraro E, Angelini C, Rubaltelli L, Feltrin GP. MRI in the assessment of muscular pathology: a comparison between limb-girdle muscular dystrophies, hyaline body myopathies and myotonic dystrophies. Radiol Med 2010; 115:585-99. [PMID: 20177980 DOI: 10.1007/s11547-010-0531-2] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Accepted: 09/09/2009] [Indexed: 11/24/2022]
Abstract
PURPOSE The continuous discovery of new subtypes of neuromuscular disorders demands more accurate imaging analyses. We set out to establish the specific patterns of muscular involution using magnetic resonance imaging (MRI). MATERIALS AND METHODS A systematic clinical evaluation based on the Medical Research Council scale and MRI was completed in ten patients with calpainopathy [limb-girdle muscular dystrophy (LGMD)-2A], 16 with dysferlinopathy (LGMD-2B), ten with hyaline body myopathy (HBM), six with myotonic dystrophy (MD) types 1 and 5 with MD type 2. Severity of fibroadipose degeneration was specifically staged using T1-weighted sequences. Turbo inversion recovery magnitude (TIRM) sequences were used to assess oedema-like changes. RESULTS T1 scans showed recurrent patterns of fibroadipose replacement, whereas TIRM images revealed differences in oedema-like changes between the various diseases. In LGMD, the posterior compartments are more vulnerable to degeneration. In HBM, fatty muscle degeneration and oedema are allocated to muscles of the posterior compartments of the leg. In MD, fatty muscle degeneration and oedematous changes are allocated to muscles of the anterior thigh and posterior lower leg. CONCLUSIONS Imaging examination suggests a characteristic pattern of muscle involvement. MRI represents an important diagnostic technique useful in differential diagnosis, thanks to the distinctive patterns observed in the distribution of muscular changes between the different muscular diseases.
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Affiliation(s)
- R Stramare
- Department of Medical Diagnostic Sciences and Special Therapies, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
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Rubaltelli L, Stramare R, Tregnaghi A, Scagliori E, Cecchelero E, Mannucci M, Gallinaro E, Beltrame V. The role of sonoelastography in the differential diagnosis of neck nodules. J Ultrasound 2009; 12:93-100. [PMID: 23396686 DOI: 10.1016/j.jus.2009.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Sonoelastography is an imaging technique that provides information on tissue elasticity. Its use as a diagnostic procedure is based on the premise that pathological processes like cancer alter the physical characteristics of the involved tissue. Ultrasonographic studies of the neck can reveal the nonpalpable thyroid nodules, but the nature of these lesions generally has to be established on the basis of FNAB findings. In our hands, sonoelastography displayed a diagnostic accuracy of 86.2% in identifying thyroid nodule malignancy, with positive and negative predictive values (PPV and NPV) of 64% and 94.5%, respectively. In the study of cervical lymph nodes, the results were less impressive (sensitivity 75%, specificity 80%, accuracy 77%, PPV 80%, NPV 70%), but the information obtained with this technique can in our opinion be a useful adjunct to sonographic findings. Indeed, in 5 lymph nodes with sonographic features consistent with malignancy, sonoelastography revealed diffuse elasticity that was indicative of benign disease, which was confirmed by pathological studies. Other nodular lesions of the neck can also be evaluated with sonoelastography, including enlarged parotid glands, but the data in the literature are too limited to allow hypotheses on the role of this imaging modality in this field. Sonoelastography is rapid and simple to perform, and it appears to be a potentially useful tool for the differential diagnosis of neck nodules. This is particularly true of thyroid nodules. Our experience with these lesions indicates that diffuse elasticity is strongly correlated with benign disease. If this finding is confirmed in larger studies, sonoelastography might be used to identify thyroid nodules that do not require immediate biopsy.
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Affiliation(s)
- L Rubaltelli
- Department of Medical-Diagnostic Sciences and Special Therapy, University of Padua, Padua, Italy
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