Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 8 de 8
Filter
Add more filters










Database
Publication year range
1.
Neurol Sci ; 45(1): 203-211, 2024 Jan.
Article in English | MEDLINE | ID: mdl-37507617

ABSTRACT

AIM: To describe different referral strategies for acute ischemic stroke (AIS) patients in a Hub-Spoke emergency stroke network with their incidence, time metrics and related outcomes. METHODS: Referral paradigms were defined as follows: primary transfer to the comprehensive stroke center (CSC) from a remote region, called mothership (MS); secondary transfer to the CSC from a primary stroke center where intravenous thrombolysis was available, called drip and ship (DS); secondary transfer to the CSC from a community hospital where no reperfusion therapy was available, called ship and drip (SD); primary transfer to the CSC from its catchment area, called direct CSC (dCSC). RESULTS: Among 517 anterior circulation AIS patients treated with mechanical thrombectomy between 2015 and 2020, 16.6% of them were SD, in addition to the well-known referral paradigms of MS (21.8%) and DS (18.1%). This rate grew to 30% when only patients whose place of onset was outside the CSC catchment area were considered. In the SD group, onset to CSC and onset to groin were significantly longer (178±80 min vs. 102±60 min, p<0.001, and 277±77 min vs. 211±61 min, p<0.001, respectively), and the risk of any intracranial hemorrhage (ICH) was significantly higher (OR: 2.514; 95%CI: 1.18-5.35, p=0.017) compared to MS. CONCLUSION: In this hub-spoke stroke network, a high proportion of SD paradigm was found, which was associated with longer times to treatment and higher rates of any ICH. A closer cooperation between hospital stroke physicians, national health system staff, and paramedics is warranted to identify the most appropriate referral strategy for each patient.


Subject(s)
Brain Ischemia , Ischemic Stroke , Stroke , Humans , Ischemic Stroke/etiology , Brain Ischemia/therapy , Brain Ischemia/drug therapy , Thrombolytic Therapy , Patient Transfer , Treatment Outcome , Stroke/diagnosis , Stroke/epidemiology , Stroke/therapy , Intracranial Hemorrhages/etiology , Referral and Consultation , Thrombectomy/adverse effects , Retrospective Studies
2.
Eur Rev Med Pharmacol Sci ; 25(3): 1680-1683, 2021 Feb.
Article in English | MEDLINE | ID: mdl-33629338

ABSTRACT

OBJECTIVE: Although pulmonary involvement represents the primary and most characteristic presentation of Sars-Cov-2 infection, due to its innate tropism for endothelium, it is also associated with systemic pro-coagulative changes and thromboses. This paper describes a COVID-19 atypical presentation with massive thrombotic occlusion of the splenoportal-mesenteric axis and the splenic artery in the absence of clinical or radiological manifestation of pulmonary involvement. PATIENTS AND METHODS: Female patient, with no history of disease, trauma or fever in the last 30 days, was admitted to ER for persistent left subcostal pain. Laboratory exams, including inflammation, coagulation markers and Sars-CoV-2 serology, were requested. Whole-body CT with contrast media injection was performed. RESULTS: Laboratory exams showed elevated reactive C-protein, bilirubin, γ-GT and D-dimer. Whole-body CT showed: splenic artery occlusion, thrombosis of splenic, mesenteric and portal veins with portal intra-hepatic branches ectasia, juxta-hilar portal cavernomatosis of probable acute onset (absence of signs of chronic hepatopathy and of varices), a hypodense area in the spleen indicating ischemic parenchymal suffering. The patient resulted positive for Sars-CoV-2 IgG, thus in the absence of typical clinics or pulmonary parenchymal abnormality at chest CT. CONCLUSIONS: A case of acute venous thrombosis and arterial occlusion as primary manifestations of COVID-19.


Subject(s)
COVID-19/diagnostic imaging , Mesenteric Vascular Occlusion/diagnostic imaging , Mesenteric Veins/diagnostic imaging , SARS-CoV-2 , Spleen/blood supply , Splenic Artery/diagnostic imaging , Thrombosis/diagnostic imaging , Aged , COVID-19/blood , COVID-19/complications , Diagnosis, Differential , Female , Humans , Immunoglobulin G/blood , Immunoglobulin M/blood , Mesenteric Vascular Occlusion/blood , Mesenteric Vascular Occlusion/etiology , Spleen/diagnostic imaging , Thrombosis/blood , Thrombosis/etiology , Tomography, X-Ray Computed
3.
Eur Rev Med Pharmacol Sci ; 24(19): 10045-10050, 2020 10.
Article in English | MEDLINE | ID: mdl-33090412

ABSTRACT

OBJECTIVE: Crohn's Disease (CD) has been associated with non-Hodgkin lymphoma. Follicular Lymphoma (FL) limited to the liver is extremely rare, accounting for 1% to 4.4% of all Primary Hepatic Lymphoma (PHL). CASE PRESENTATION: In 2018, an 85-years old male patient with post-operative recurrence of ileal CD referred rare episodes of fever and mild diffuse abdominal pain. Since cholecystectomy in 2001, clinical history was characterized by recurrent episodes of cholangitis and common bile duct stones. In 2018, ultrasonography and MRI showed a solid focal hepatic lesion (FHL)(4.5 cm x 2.5 cm) in the IV hepatic segment. The radiographic aspect of the lesion was unusual. Initially, focal nodular hyperplasia was suspected. Clinical history of cholangitis and radiological findings subsequently suggested a diagnosis of Hepatic Abscess (HA). A progressive enlargement of the FHL (7.3 cm x 5.8 cm) despite antibiotic treatments, led to perform a liver biopsy. Histological and immunophenotypical analysis of the FHL (7.5 cm x 5.4 cm) enabled a final diagnosis of FL. The "in situ" hybridization for Epstein-Barr virus (EBER) was negative. No additional lesions related to FL were initially detected, thus suggesting a very rare case of PHL in an old patient with CD never treated with thiopurines. CONCLUSIONS: This case report highlights the need to consider a rare diagnosis of FL of the liver in patients showing a challenging focal hepatic lesion of unknown origin.


Subject(s)
Crohn Disease/diagnosis , Liver Neoplasms/diagnosis , Lymphoma, Follicular/diagnosis , Aged, 80 and over , Humans , Male
5.
Eur Radiol ; 26(3): 664-73, 2016 Mar.
Article in English | MEDLINE | ID: mdl-26024849

ABSTRACT

OBJECTIVES: To identify frequent MRI features of parathyroid adenomas (PTAs) in patients with primary hyperparathyroidism (PHPT) using a fast protocol with a 3 T magnet. METHODS: Thirty-eight patients with PHPT underwent a 3 T-MR. All patients had positive US and Tc-99 sestamibi, for a total number of 46 PTAs. T2-weighted IDEAL-FSE and T1 IDEAL-sequences, before and after contrast, were performed. Five features of PTAs were recognised: hyperintensity, homogeneous or "marbled" appearance and elongated morphology on T2-sequences; cleavage plane from thyroid gland on T2-outphase; rapid enhancement in post-contrast T1. Image quality for T2-weighted IDEAL FSE and usefulness for IDEAL post-contrast T1-weighted and T2-outphase sequences were also graded. RESULTS: PTAs were hyperintense in T2-sequences in 44/46 (95.7%), "marbled" in 30/46 (65.2%) and elongated in 38/46 (82.6%) patients. Cleavage plane was observed in 36/46 (78.3%), and rapid enhancement in 20/46 (43.5%) patients. T2-sequences showed both excellent fat suppression and image quality (average scores of 3.2 and 3.1). T2-outphase images demonstrated to be quite useful (score 2.8), whereas, post-contrast T1 images showed a lower degree of utility (score 2.4). CONCLUSIONS: A fast protocol with 3.0-T MRI, recognising most common features of PTAs, may be used as a second-line method in the preoperative detection of PTAs. KEY POINTS: 3 T MRI protocol based on T2-weighted IDEAL FSE sequences was used. T2-hyperintensity and elongated morphology are common features of PTAs. 3 T MRI could be used in the preoperative detection of PTAs.


Subject(s)
Adenoma/diagnosis , Hyperparathyroidism, Primary/complications , Magnetic Resonance Imaging/methods , Parathyroid Neoplasms/diagnosis , Adenoma/diagnostic imaging , Adenoma/pathology , Adult , Aged , Aged, 80 and over , Contrast Media , Female , Follow-Up Studies , Humans , Image Enhancement/methods , Magnetic Resonance Imaging/statistics & numerical data , Male , Middle Aged , Minimally Invasive Surgical Procedures , Multimodal Imaging/methods , Neck/surgery , Parathyroid Neoplasms/diagnostic imaging , Parathyroid Neoplasms/pathology , Prospective Studies , Radiopharmaceuticals , Technetium Tc 99m Sestamibi , Ultrasonography , Young Adult
6.
BJR Case Rep ; 1(3): 20150110, 2015.
Article in English | MEDLINE | ID: mdl-30363609

ABSTRACT

Aggressive angiomyxoma (AA) is a rare mesenchymal tumour which mainly arises in the soft tissue of the pelvis and perineum in women of reproductive age. AA usually shows an aggressive behaviour, with a high rate of incomplete surgical excision and post-surgical recurrence. Most cases of AA exhibit oestrogen and/or progesterone receptors; in these cases, maintenance of a hypo-oestrogenic state can be helpful in the medical management of this tumour. We describe a case of spontaneous reduction in size of an AA during a 6-month period of hormonal replacement therapy withdrawal, assessed by MRI using a 3T magnet.

7.
Clin Ter ; 163(5): 377-81, 2012.
Article in English | MEDLINE | ID: mdl-23099964

ABSTRACT

OBJECTIVES: Ultrasonography and surgery have now become the elective diagnostic and therapeutic tools for neck lymph node (LN) metastases from differentiated thyroid carcinoma (DTC), reserving radioiodine therapy (RAI) for surgery failures. Aim of the present retrospective study was to evaluate results of RAI in cases of LN metastases displaying (131)I uptake over a long-term observation period and its possible role today. MATERIALS AND METHODS: From a series of 1276 patients who had undergone surgery for DTC, 130 cases were selected showing (131)I uptaking LN metastases, detected during follow-up scans and who were then submitted to surgery and/or RAI. Patients were divided into groups according both to extent of surgery, with/without lymphectomy, and to following treatment and outcome. RESULTS: The initial surgical approach does not seem to significantly influence the outcome. (131)I therapy alone, sometimes at low doses, can be very effective in the management of LN metastases detected at Whole Body Scan, but multiple doses are often needed. The age at diagnosis is confirmed as a negative prognostic factor. CONCLUSIONS: Considered radioprotection questions, RAI may solve (131)I uptaking LN metastases, above all if < 10 mm. For larger LN metastases and in the case of failure of RAI surgical excision is mandatory, while a subsequent therapeutic dose of (131)I could be useful to reveal incomplete excision.


Subject(s)
Iodine Radioisotopes/therapeutic use , Thyroid Neoplasms/pathology , Thyroid Neoplasms/radiotherapy , Adolescent , Adult , Aged , Child , Female , Humans , Lymphatic Metastasis , Male , Middle Aged , Neck , Retrospective Studies , Young Adult
8.
Radiol Med ; 117(8): 1374-85, 2012 Dec.
Article in English, Italian | MEDLINE | ID: mdl-22744340

ABSTRACT

PURPOSE: This study was done to evaluate the diagnostic accuracy of dual-energy X-ray absorptiometry (DXA) compared with conventional radiography for identifying vertebral fractures. MATERIALS AND METHODS: A total of 930 postmenopausal women underwent conventional radiography and DXA imaging of the spine. The images were evaluated by two expert skeletal radiologists using the semiquantitative (SQ) method for conventional radiography and the morphometric vertebral fracture assessment (VFA) for DXA. RESULTS: The SQ method for radiography (SQ-Rx) analysed 99.1% of vertebrae, identifying 442 vertebral fractures; VFA analysed 97.5% vertebrae, detecting 420 vertebral fractures. Agreement between SQ-Rx and VFA reached 98.76%, and the κ-score was 0.96 [95% confidence interval (CI), 0.95-0.98]. Assessing the grading of vertebral fractures, agreement reached 97.5% and the κ-score was 0.841 (95% CI, 0.821-0.891). Considering SQ-Rx method as "gold standard", VFA had a sensitivity of 97.85 % and a specificity of 99.81%. The negative (NPV) and positive (PPV) predictive value for VFA were 99.83 % and 98.15%, respectively. Fractures were identified in 251 (27 %) and 242 (26 %) of patients on SQ-Rx and VFA, respectively. On a per-patient basis, the agreement between the two methods was 97% and the κ-score was 0.95 (95% CI, 0.920-0.968). The diagnostic parameters for VFA were 97.23% sensitivity, 98.86% specificity, 97.60% PPV and 98.84% NPV. CONCLUSIONS: This study demonstrated that VFA with DXA may reach a high level of accuracy for diagnosing vertebral fractures, suggesting that VFA should be introduced in the screening of individuals with a risk of osteoporosis and in the follow-up of osteoporotic patients receiving treatment.


Subject(s)
Absorptiometry, Photon , Osteoporotic Fractures/diagnostic imaging , Spinal Fractures/diagnostic imaging , Aged , Aged, 80 and over , Bone Density , Female , Humans , Lumbar Vertebrae/diagnostic imaging , Middle Aged , Observer Variation , Osteoporosis, Postmenopausal/complications , Sensitivity and Specificity , Thoracic Vertebrae/diagnostic imaging
SELECTION OF CITATIONS
SEARCH DETAIL
...