Sarcopenia is a progressive, generalized skeletal muscle disorder characterized by reduction of muscle mass and strength. It is associated with increased adverse outcomes including falls, fractures, physical disability, and mortality, particularly, in elderly patients. Nowadays, sarcopenia has become a specific imaging biomarker able to predict clinical outcomes of patients. Muscle fibre reduction has shown to be an unfavourable pre-operative predictive factor in patients with cancer, and is associated with worse clinical outcomes in terms of postoperative complications, morbidity, mortality, and lower tolerance of chemoradiation therapy. Several imaging modalities, including dual-energy X-ray absorptiometry, CT, MRI, and US can be used to estimate muscle mass and quality to reach the diagnosis of sarcopenia. This article reviews the clinical implications of sarcopenia, how this condition can be assessed through different imaging modalities, and future perspectives of imaging of sarcopenia.
The objective of our study is to describe the sonographic findings of an extremely rare pathology. We therefore present two case reports of prenatal diagnosis of fetus-in-fetu (FIF) with a review of the literature. FIF is a benign disorder, unlike the teratoma with which often enter into the differential diagnosis, localized in most cases in the retroperitoneal space. Prenatal diagnosis is based mainly on ultrasound and radiological characteristics. The treatment of choice is surgical excision. The importance of prenatal diagnosis of fetus-in-fetu and the effect on subsequent management are described.
Objective: Epithelial ovarian cancer (EOC) is the most lethal gynecological malignancy, crucial prognostic factors are no gross residual disease and centralization of cases. To evaluate the centralization of EOC patients, we report the results of a survey that shows the daily management of EOC patients in Italy. Methods: A 49-items electronic unblinded survey assessing demographics, practice characteristics, current opinions and approach to managing advanced EOC at first diagnosis was sent both to general gynecologists (GG) and gynecologic oncologists (GO). Differences in frequency distribution of answers between gynecologists with different expertise were evaluated using Fisher exact test. Multivariable analyses were performed applying generalized linear models. Results: 84/192 (44%) GG and 108/192 (56%) GO from all Italian regions answered to our survey. GOs declared to perform fertility sparing surgery in early EOC more frequently than GG (p=0.002). GOs can perform a frozen section and have both a gynecopathologist and a dedicated general surgeon. 89% of GOs consider as “optimal debulking” no gross residual disease and 81% achieve this at upfront cytoreduction in more than 40% of patients. Use of neoadjuvant chemotherapy decreases in higher volume centers (p<0.001) while it is lower in the group of GOs than in the GGs group (p<0.001). Conclusions: EOC patients are still treated by GGs. GOs perform more upfront surgery and achieve optimal debulking in a greater percentage of patients than GGs. In Italy an adequate centralization of cases has not yet been achieved, and this may have detrimental effects on the quality of treatment.
Purpose The purpose of this study was to compare the efectiveness of a lexion spacer in the clinical and radiological outcomes of patients who underwent total knee arthroplasty (TKA) and to compare these patients to a group of patients subjected to the same type of surgery but without the use of a lexion spacer. It was hypothesized that patients who underwent TKA using a lexion spacer would have better clinical and radiological outcomes than those without a lexion spacer in both short-and medium-term follow-ups. Methods A consecutive series of patients undergoing TKA were included, yielding 20 patients in the study group. The control group was identiied from the consultant database of the senior author, yielding 21 patients who underwent the same operation. All 41 patients received a Vanguard Knee System (Zimmer-Biomet, Warsaw, Indiana, USA). Cases were deined as those patients who had undergone TKA using a lexion spacer device for gap balancing; controls were deined as patients who had undergone TKA without the support of a lexion spacer device. Patients were clinically and radiographically evaluated at two consecutive follow-ups: T 1 -13.1 ± 1.3 months and T 2 -108 ± 6 months. Clinical evaluation was performed using the Knee Society Scoring System and the Western Ontario, McMaster Universities Osteoarthritis Index score. Radiographic evaluation included the femoral angle (α), the tibial angle (β), the sagittal femoral (γ) angle and the tibial slope (δ). Furthermore, the lateral patellofemoral angle (LPFA) and the Caton-Deschamps index were evaluated. ResultsNo statistically signiicant clinical diferences were found between the two groups at T 1 and T 2 ; moreover, the clinical outcomes of the two groups were stable between the two follow-ups, with no signiicant improvement or worsening. Radiographic evaluation showed no diference in the two groups between T 1 and T 2 ; the only signiicant radiographic diference between the two groups concerned the LPFA (both at 30° and 60°) at each follow-up, which was signiicantly greater in cases than in controls (p = 0.001). Conclusions The current study demonstrates that the use of a lexion spacer signiicantly improves radiographic patellofemoral tracking, although no signiicant clinical diferences were found between the two groups. Level of evidence Case-control study, level III.
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