We evaluated factors affecting long-term survival after transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) complicating cirrhosis. One hundred eighty-two patients with Child's class A or B cirrhosis and an HCC, not amenable to surgery or percutaneous ethanol injection, underwent 346 TACEs (mean 1.9) with epirubicin, iodized oil, and gelatin sponge. Many prognostic factors were subjected to univariate analysis and thereafter, when significant, to the Cox's hazard proportional model. Finally, the significant indices in the Cox's model were used to estimate the accuracy of the probability of death with computation of the area under the receiving operative characteristic (ROC) curve. The cumulative survival rates at 1, 2, 3, and 5 years were 0.83, 0.52, 0.40, and 0.16, respectively. According to Cox's model, the factors associated with significantly worse survival were the presence of ascites (p = 0.0027), elevated bilirubin levels (p = 0.0163), elevated alpha-fetoprotein (alphaFP) values (p = 0.0067), a tumor greater than 5 cm in diameter (p = 0.0001), and the absence of a tumor capsule-like rim (p = 0.0278). According to these parameters, the accuracy of the probability of death estimated with ROC analysis was 0.63. Minor and major complications occurred in 82 patients (45%) and caused death in 2 patients. Long-term prognosis after TACE for HCCs in patients with Child's class A or B cirrhosis depends on the presence of ascites, the bilirubin level, the alphaFP value, the diameter of the tumor, and the presence of a tumor capsule-like rim. However, when considered altogether, these variables are poor predictors to evaluate survival, and other factors should be investigated to identify subjects more responsive to TACE. Complications occur in a high percentage of patients, but they do not affect long-term prognosis.

A 53-year-old male was admitted to our Emergency Department affected by a contemporary high-flow priapism and induration on the dorsal penile surface, in consequence of a prior transrectal prostate biopsy performed 2 weeks earlier on the basis of a suspicion of prostate cancer. We describe a penile Mondor's disease (penile superficial dorsal vein thrombosis) of uncertain pathogenesis involving the penile superficial vein, and employing a careful diagnostic pathway by using magnetic resonance angiography (MRA). In the literature many reports described pulsedand color-Doppler ultrasonography classical findings about penile Mondor's disease. For the first time we report the pathognomonic features of penile Mondor's disease on MRA, which may be considered a useful and comprehensive tool to deepen the analysis only in the case of a complex clinical picture such as the one presented. CASE REPORTA 53-YEAR-OLD MALE was admitted to our Emergency Department affected by a high-flow priapism and the contemporary onset of an induration on the dorsal penile surface. He had an unremarkable previous medical history with the exception of a prior transrectal prostate biopsy performed 2 weeks earlier by another medical center on the basis of a suspicion of prostate cancer. The histologic examination reported the presence of benign prostatic hyperplasia.The patient complained only of mild discomfort and persistent erection, and physical examination revealed a palpable cord-like induration on the dorsal surface of the penis, which could be perceived to the penile base.The induration corresponded to the penile superficial dorsal vein, and appeared poorly compressible. A complete hemocoagulative screening was normal, and a penile pulsed-and color-Doppler ultrasonography (US) confirmed the presence of echogenic content within the dorsal vein, in the absence of any flow signals, hence confirming the presence of a penile Mondor's disease (1) with a coexistent diagnosis of a high flow priapism sustained by a bulbourethral arteriovenous fistula.Our primary treatment for high-flow priapism was a conservative approach, with daily cold packs as described by Ficarra et al (2). After 3 days we noted a gradual resolution of the priapism, but persistence of the asymptomatic induration due to Mondor's disease. Two days later the patient underwent a pelviperineal magnetic resonance angiography (MRA) to better investigate the real extension of penile superficial dorsal vein thrombosis, clinically broadening further the pubic symphysis. All MRI scans were performed using a 1.0 T unit equipped with a phased-array surface coil (Magnetom Harmony, Siemens AG Medical Solutions, Munich, Germany). The free-breathing scans of maximum 22 seconds covering the whole abdominal and pelviperineal region were done in all orthogonal planes (axial, coronal, and sagittal) upon images acquisition by the localizer to place the slices in the right position: 1) by a turbo-spin echo (TSE) 2D T2-weighted sequence in the three planes with TR 3640 -5430 msec, TE 89 msec, a f...

The aim of this study was to evaluate the sensitivity and accuracy of computed tomography (CT) scanning, 75Se-selenomethyl-norcholesterol scintigraphy (SNS) and magnetic resonance imaging (MRI) in patients with Cushing's syndrome (CS) undergoing adrenalectomy. A series of 67 patients with CS due to benign adrenal disease was reviewed. There were 11 (16.4%) men and 56 (83.6%) women, with an overall median age of 44 years (range 19-69 years). Prior to surgery all patients underwent both CT and SNS, and 58 (86.6%) underwent adrenal MRI. Thirty-five (52.2%) of the patients (group A) had histologically confirmed unilateral adrenal involvement (33 patients with a solitary adrenocortical adenoma, and two with unilateral nodular cortical hyperplasia), while 32 (47.8%) of the patients (group B) had CS caused by bilateral adrenal involvement, including two patients with multinodular adrenal hyperplasia. The sensitivity, specificity and accuracy of adrenal imaging in group A were 97.1%, 100% and 98.5% for SNS, 94.3%, 68.7% (P<0.05, chi2 test) and 82.1% for CT scan, and 92.3%, 60.0% (P<0.05) and 64.3% (P<0.05) for MRI, respectively. In group B the sensitivity, specificity and accuracy were 100%, 97.2% and 98.5% for SNS, 64.5% (P<0.05), 97.2% and 82.1% for CT scan, and 60.0% (P<0.05), 92.3% and 35.7% (P<0.05) for MRI, respectively. In conclusion, SNS represents the most sensitive and specific adrenal imaging study and should be used in all patients with confirmed biochemical diagnosis of CS undergoing adrenalectomy. The sensitivity and specificity of CT scan and MRI are similar, but the latter shows a lower accuracy, especially in patients with bilateral adrenal involvement.

No abstract