Resource utilization and direct costs of pediatric HIV in Italy.

This multicenter, prospective, observational study assessed the global economic impact of HIV care in a large cohort of HIV-infected children and adolescents in Italy. Three pediatric departments of reference participated on a voluntary basis. Centers were asked to enroll all their children during the period April 2010-March 2011. At enrollment, a pediatrician completed a questionnaire for each patient, including the type of service at access (outpatient consultation or day hospital), laboratory tests, instrumental examinations, specialists' consultations, antiretroviral therapy and opportunistic illness prophylaxis. Eligible patients had a confirmed diagnosis of HIV infection caused by direct vertical maternal-fetal transmission, their age ranging from 0 to 24 years. Since patients routinely have quarterly check-ups in all three centers, we adopted a three-month time horizon. Health-care services were priced using outpatient and inpatient tariffs. Drug costs were calculated by multiplying the daily dose by the public price for each active ingredient. A total of 142 patients were enrolled. More than half the patients were female and the mean age was 14 years, with no significant differences by center. There were substantial differences in health-care management among the three centers, particularly as regards the type of access. One center enrolled the majority of its patients in day-hospital and prescribed a large number of clinical tests, while children accessed another center almost exclusively through outpatient consultation. Drug therapy was the main cost component and was very similar in all three centers. The day-hospital was the second highest cost component, much higher than outpatient consultation (including examinations), leading to significant differences between total costs per center. These findings suggest that a recommendation to the Italian National Health Service would be to use more outpatient consultation for patients' access in order to increase their efficiency in treating pediatric HIV infection.

Unusual complications of endovascular repair of the thoracic aorta: MDCT findings.

With the development of minimally invasive surgical techniques, endovascular stent-graft placement has become an accepted and widely used alternative to the traditional surgical repair of aortic disease and is gaining acceptance as the treatment of choice. Many studies show that endovascular stent-graft therapy is safe and effective, although complications related to this treatment are also recognised. Although the incidence of major complication is low, neurological sequelae remain the major concern of endovascular repair. With growing experience, however, the spectrum of mid- and long-term complications has broadened to include potentially disastrous events, other than paraplegia or stroke, that require diligent surveillance. Three-dimensional data sets acquired quickly by multidetector computed tomography (MDCT) allow multiplanar reformations and 3D viewing, as well as quantitative assessment of vessel lumens, walls and surroundings. Although a large portion of radiologists will not be involved in the actual endograft deployment, many will be involved in the interpretation of postprocedural surveillance studies. Accordingly, the goal of this report is to summarise our experience with the presentation, diagnostic approach, management and outcomes of these unusual, but potentially catastrophic, postendovascular aortic repair complications to highlight their significance and increase familiarity with them among the imaging community. Increasing awareness of these complications may facilitate rapid diagnosis and/or triage and treatment.

MDCT in diagnosing acute aortic syndromes: reviewing common and less common CT findings.

Nontraumatic acute thoracic aortic syndromes (AAS) describe a spectrum of life-threatening aortic pathologies with significant implications on diagnosis, therapy and management. In this context, multidetector computed tomography (MDCT) is the gold standard due to its intrinsic diagnostic value; its performance approaches 100% sensitivity and specificity, and it is accepted as a first-line modality for suspected acute aortic disease. MDCT allows early recognition and characterisation of acute aortic syndromes as well as the presence of any associated complications - findings that are essential for optimising treatment and improving clinical outcomes. Although classic CT findings have long been known, other unusual signs are continually reported in the medical literature. We reviewed the classic and less common CT findings, correlating them with pathophysiology, timing and management options, to achieve a definite and timely diagnostic and therapeutic definition.

H1N1 pneumonia: our experience in 50 patients with a severe clinical course of novel swine-origin influenza A (H1N1) virus (S-OIV).

PURPOSE: The authors reviewed chest radiographs (CXR) and thin-section computed tomography (CT) findings of pulmonary complications in a selected population of 50 consecutive patients with severe novel swine-origin influenza A (H1N1) virus (S-OIV) pneumonia who were seen at the Subintensive Respiratory Unit (UTSIR) and at the Intensive Care Unit (ICU) at Monaldi Hospital, Naples, Italy. MATERIALS AND METHODS: CXR and CT findings of 50 patients who fulfilled the World Health Organisation (WHO) criteria for S-OIV infection were reviewed by four radiologists. The final study group of 50 patients was divided into two subgroups on the basis of clinical course: group 1 consisted of 42 patients requiring noninvasive mechanical ventilation and admitted to the UTSIR; group 2 consisted of eight patients who required ICU admission and extracorporeal membrane oxygenation or advanced mechanical ventilation from October 2009 to December 2009. All patients underwent CXR and thin-section multidetector CT (MDCT) scan; the initial and follow-up radiographs and CT scans were evaluated for the presentation and follow-up pattern (consolidation, ground-glass opacities, nodules, reticulation), distribution and extent of abnormality. RESULTS: All patients had radiological signs of pulmonary involvement. Ground-glass opacity and consolidation, which was mainly peripheral, was the most frequent finding. In three patients, we report for the first time in viral pneumonia the reversed halo sign. Lesion extent was related to aggressiveness of the illness. More often, both lungs were involved (82%). Thoracic comorbidity was present in 18% of patients; 22% of patients was obese, and in this group, the clinical course was more aggressive than in the others with the same lesion extent at imaging. Furthermore, superinfection led to worsening of the clinical conditions. CONCLUSIONS: The most common CXR and CT findings in patients with S-OIV infection were unilateral or bilateral ground-glass opacities with or without associated focal or multifocal areas of consolidation. On MDCT, ground-glass opacities and areas of consolidation had a predominant peribronchovascular and subpleural distribution, resembling organising pneumonia; they progressed to bilateral extensive airspace disease in severely ill patients.

Adult-onset pulmonary involvement in Niemann-Pick disease type B.

Niemann-Pick disease type B is caused by a deficiency in acid sphingomyelinase activity; among the six variants of Niemann-Pick disease known to date, it is the most frequently associated with lung involvement, a major cause of morbidity and mortality in this subtype in patients of all ages. Nevertheless, the vast majority of reports in the literature concern infantile forms, while less reported is, for several reasons, the onset in adults being consequently still poorly understood and characterized its clinical, radiographic and functional manifestations. We report a case of a 37 years-old female patient affected by subtype B since she was an infant, operated for aortic valve replacement two years before and came to our attention for the onset of a worsening exertional dyspnoea which proved, through a series of functional tests and radiological exams, to be a consequence of the diffuse lung involvement by the metabolic disorder; we performed a review on this topic through a Medline search of all the available "adult-onset" case reports published since the first description in 1964, also considering the possible association between NPDB and, more generally lysosomal storage disorders, and the valvular disease, already suggested by several Authors in previous works.

Primary pleural haemangioendothelioma in an Italian female patient: a case report and review of the literature.

Primary epithelioid haemangioendothelioma (EHE) of the pleura is a rare vascular tumour that occurs mainly in men. Pleural effusion and thickening are the most common clinical presentations. A 58 year old female, nonsmoking patient presented to us with dry cough, dyspnoea and left chest pain for several weeks (no asbestos exposure). Standard chest X-ray and contrast enhanced multislice computed tomography revealed a large-size lobulated mass originating from the pleura which was diagnosed as primary pleural haemangioendothelioma (PHE) by histology and immunohistochemistry (reactivity for vimentin, CD31, CD34, Factor VIII and ulex europeaus). No metastases were detected. The patient refused treatment and died three months later due to the onset of acute and progressive respiratory failure. Despite the lack of high-grade malignancy, primary PHE displays a poor prognosis while curative therapies are actually not available. To our knowledge, this is the first case of primary PHE in a female patient occurring in Italy and the third one to have been reported in English literature. Difficulties in diagnosis and treatment management are discussed below.

HRCT in detection of pulmonary infections from nontuberculous mycobacteria: personal experience.

PURPOSE: The authors sought to assess the role of high-resolution computed tomography (HRCT) in the detection and follow-up of nontuberculous mycobacteria (NTM) pulmonary infection in immunocompetent patients and to identify the most common radiological patterns for diagnosis. MATERIALS AND METHODS: Plain chest radiographs and HRCT scans of 42 consecutive patients with NTM pulmonary infection (M/F 26/16; mean age 57, range 41-83) were retrospectively reviewed. Ten of these patients were followed up for 18 months after diagnosis. Small nodules (<10 mm), nodules 10- to 30-mm in diameter, lobar/segmental consolidation, cavitations, bronchiectasis and tree-in-bud pattern were analysed. RESULTS: Small nodules were more frequent than nodules 10- to 30-mm in diameter, and segmental consolidation was more frequent than lobar. Cavitations, tree-in-bud and bronchiectasis were more frequently located in the upper lobes. Four of the followed-up patients had cavitation of preexisting nodules, and five had progression of bronchiectasis. CONCLUSIONS: HRCT allows accurate detection and followup of the most frequent presentation patterns: diffuse small nodules, bronchiectasis, upper lobe segmental consolidation and cavitations. The appearance of new bronchiectasis and progression of old disease are due to pulmonary infection.

Nuclear-matter modification of decay widths in the phi-->e+e- and phi-->K+K- channels.

The invariant mass spectra of phi-->K+K- are measured in 12 GeV p+A reactions in order to search for the in-medium modification of phi mesons. The observed K+K- spectra are well reproduced by the relativistic Breit-Wigner function with a combinatorial background shape in three betagamma regions between 1.0 and 3.5. The nuclear mass number dependence of the yields of the K+K- decay channel is compared to the simultaneously measured e+e- decay channel for carbon and copper targets. We parameterize the production yields as sigma(A)=sigma0Aalpha and obtain alphaphi-->K+K- -alphaphi-->e+e- to be 0.14+/-0.12. Limits are obtained for the partial decay widths of the phi mesons in nuclear matter.

Evidence for in-medium modification of the phi meson at normal nuclear density.

Invariant mass spectra of e(+) e(-) pairs have been measured in 12 GeV p + A reactions to detect possible in-medium modification of vector mesons. Copper and carbon targets are used to study the nuclear-size dependence of e(+) e(-) invariant mass distributions. A significant excess on the low-mass side of the phi meson peak is observed in the low betagamma(= beta/square root(1-beta(2))) region of phi mesons (betagamma < 1.25) with copper targets. However, in the high betagamma region (betagamma > 1.25), spectral shapes of phi mesons are well described by the Breit-Wigner shape when experimental effects are considered. Thus, in addition to our earlier publications on rho/omega modification, this study has experimentally verified vector meson mass modification at normal nuclear density.

Experimental signature of medium modifications for rho and omega mesons in the 12 GeV p+A reactions.

The invariant mass spectra of e+e- pairs produced in 12 GeV proton-induced nuclear reactions are measured at the KEK Proton Synchrotron. On the low-mass side of the meson peak, a significant enhancement over the known hadronic sources has been observed. The mass spectra, including the excess, are well reproduced by a model that takes into account the density dependence of the vector meson mass modification, as theoretically predicted.

A factor of inducing IgE from a filarial parasite is an agonist of human CD40.

Immune responses to parasitic helminth are usually characterized by quite mysterious phenomena: dominance of Th2-like immunity and antigen-nonspecific IgE secretion. We previously purified a factor from Dirofilaria immitis that induces antigen-nonspecific IgE in rats and named it DiAg. In the presence of IL-4, DiAg induces mouse B cells to secrete IgE, which is antigen-nonspecific polyclonal antibody. We investigated the biochemical characteristics of DiAg as a factor of inducing IgE in this study. Recombinant DiAg (rDiAg) with interleukin (IL)-4 induced IgE synthesis in highly purified human normal B cells in vitro cell culture systems. The addition of recombinant human soluble CD40 IgG fusion protein (rsCD40-Ig) inhibited induction of IgE synthesis by rDiAg with IL-4. Monocyte cells were stimulated with rDiAg and recombinant human soluble CD40L (rsCD40L); IL-12 and TNF-alpha were induced. The addition of rsCD40-Ig to THP-1 cells activated with rDiAg and rsCD40L inhibited the production of IL-12. rDiAg bound to the monocyte cell membrane fraction and recombinant human soluble CD40; this binding of rDiAg was competitively inhibited by addition of rsCD40L. Moreover, in CD40-deficient mice, IgE production and MLN-B cell proliferation by rDiAg were completely absent. Based on these results, we concluded that DiAg is an agonist of CD40.