1,720,985 research outputs found
Evolution of incidental branch-duct intraductal papillary mucinous neoplasms of the pancreas: A study with magnetic resonance imaging cholangiopancreatography
Full text linkAIM: To investigate the type and timing of evolution of incidentally found branch-duct intraductal papillary mucinous neoplasms (bd-IPMN) of the pancreas addressed to magnetic resonance imaging cholangiopancreatography (MRCP) follow-up. METHODS: We retrospectively evaluated 72 patients who underwent, over the period 2006-2016, a total of 318 MRCPs (mean 4.4) to follow-up incidental, presumed bd-IPMN without signs of malignancy, found or confirmed at a baseline MRCP examination. Median follow-up time was 48.5 mo (range 13-95 mo). MRCPs were acquired on 1.5T and/or 3.0T systems using 2D and/ or 3D technique. Image analysis assessed the rates of occurrence over the follow-up of the following outcomes: (1) imaging evolution, defined as any change in cysts number and/or size and/or appearance; and (2) alert findings, defined as worrisome features and/or high risk stigmata (e.g., thick septa, parietal thickening, mural nodules and involvement of the main pancreatic duct). Time to outcomes was described with the Kaplan-Meir approach. Cox regression model was used to investigate clinical or initial MRCP findings predicting cysts changes. RESULTS: We found a total of 343 cysts (per-patient mean 5.1) with average size of 8.5 mm (range 5-25 mm). Imaging evolution was observed in 32/72 patients (44.4%; 95%CI: 32-9-56.6), involving 47/343 cysts (13.7%). There was a main trend towards small ( 0.01). CONCLUSION: Changes in MRCP appearance of incidental bd-IPNM were frequent over the follow-up (44.4%), with relatively rare (8.3%) occurrence of non-malignant alert findings that prompted further diagnostic steps. Changes occurred at a wide interval of time and were unpredictable, suggesting that imaging followup should be not discontinued, though MRCPs might be considerably delayed without a significant risk of missing malignancy
Multimodality approach to a big defect of the abdominal wall
No full textAim. Abdominal wound dehiscence is common, usually resulting from laparotomies associated with contamination and necrosis. Dehiscences are managed by controlling the infection and local wound toilet, until local conditions at the site allow for wound closure. When this is not feasible, healing is by secondary intention. The objective of our study was to find a simple and reproducible method for abdominal wall reconstruction after trauma. Methods. This paper describes our experience in four cases of post-trauma reconstruction of complex abdominal wall defects by means of skin expansion associated with the use of a prosthetic mesh to repair the fascial defects. Results. In the cases described, we found a method for restoring abdominal wall integrity, with the use of skin expansion and a mesh for fascial closure. Tissue expansion has the advantage of ensuring a well vascularised and innervated autologous tissue reconstruction. Conclusion. This method was simple and had good clinical, functional and aesthetic results, achieving reconstructions with a long term stability and patients' satisfaction
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