Neuro-Oncology Multidisciplinary Tumor Board: The Point of View of the Neuroradiologist

Background: The multi-disciplinary tumor board (MTB) is essential to quality cancer care and currently recommended to offer the best personalized clinical approach, but little has been published regarding MTBs in neuro-oncology (nMTBs). The aim of the present paper is to describe our nMTB, to evaluate its impact on clinical management decisions, and to assess the role of neuroradiologists. Methods: The retrospective evaluation of the cases discussed at our nMTB from March 2017 to March 2020. From the electronic records, we extracted epidemiological, clinical and other specific data of nMTB. From the radiological records, we calculated data relating to the number, time for revision, and other specifications of MRI re-evaluation. Statistical analysis was performed. Results: a total of 447 discussions were analyzed, representing 342 patients. The requests for case evaluations came from radiation oncologists (58.8%) and neurosurgeons (40.5%), and were mainly addressed to the neuroradiologist (73.8%). The most frequent questions were about the treatment's changes (64.4%). The change in patient treatment was reported in 40.5% of cases, 76.8% of these were based on the neuroradiologic assessment. A total of 1514 MRI examinations were re-evaluated, employing approximately 67 h overall. The median of the MRI exams reviewed per patient was 3 (min-max 1-12). Conclusions: Our study supported that the multidisciplinary approach to patient care can be particularly effective in managing brain tumors. A review by an expert neuroradiologist impacts patient management in the context of nMTBs, but has costs in terms of the time and effort spent preparing for it

Urinary Excretion of Kidney Aquaporins as Possible Diagnostic Biomarker of Diabetic Nephropathy

Diabetic nephropathy (DN) is a microangiopathic complication of diabetes mellitus (DM) affecting one-third of diabetic patients. The large variability in the clinical presentation of renal involvement in patients with DM makes kidney biopsy a prerequisite for a correct diagnosis. However, renal biopsy is an invasive procedure associated with risk of major complications. Numerous studies aimed to identify a noninvasive biomarker of DN but, so far, none of these is considered to be sufficiently specific and sensitive. Water channel aquaporins (AQPs), expressed at the plasma membrane of epithelial tubular cells, are often dysregulated during DN. In this work, we analyzed the urine excretion of AQP5 and AQP2 (uAQP5 and uAQP2), via exosomes, in 35 diabetic patients: 12 normoalbuminuric with normal renal function (DM), 11 with proteinuric nondiabetic nephropathy (NDN), and 12 with histological diagnosis and classification of DN. ELISA and WB analysis independently showed that uAQP5 was significantly increased in DN patients. Interestingly, linear regression analysis showed a positive correlation between uAQP5 and the histological class of DN. The same analysis, focusing on uAQP2, showed comparable results. Taken together, these data suggest a possible use of AQP5 and AQP2 as novel noninvasive biomarkers to help in classifying the clinical stage of DN

L'amministrazione di sostegno. Inquadramento, disciplina ed effetti

Com’è noto, l’amministrazione di sostegno è stata introdotta, in Italia, da una legge del 2004 , che ha inserito, nel codice civile, gli artt. 404-413 e ne ha modificato alcune norme in tema di interdizione e inabilitazione. L’art. 1 della l. 6/2004, con norma non inserita nel codice civile, manifesta espressamente la propria finalità «di tutelare, con la minore limitazione possibile della capacità di agire, le persone prive in tutto o in parte di autonomia nell’espletamento delle funzioni della vita quotidiana, mediante interventi di sostegno temporaneo o permanente». con la normativa in esame, vi è stato un «passaggio dallo status della persona inabile al regime degli atti da essa compiuti»; e, ancora, che va distinta l’incapacità generale (ma non più assoluta), tipica dell’interdizione, dalla capacità relativa ovvero generale, sia pure con specifiche limitazioni, che contraddistingue invece l’amministrazione di sostegno. E’ proprio questo tratto fortemente caratteristico a porre l’a.d.s. in costante relazione con tutti i settori dell’ordinamento: tradizionalmente, all’interdetto era ed è precluso il compimento di tutti o di quasi tutti gli atti demandati al tutore. Il beneficiario di a.d.s. rimane capace per tutti gli atti non vietati dal giudice e, talvolta, l’amministratore sembrerebbe assumere il ruolo del (mero) nuncius: dunque, non restando il beneficiario escluso dall’attività giuridica, la disciplina dell’a.d.s. va coordinata con le norme dettate in tema di contratti, di impresa anche familiare, di società, di successioni e di donazioni. Si pensi, poi, ad ambiti particolarmente delicati, talvolta di recente emersione, quali le scelte in materia di trattamenti sanitari ed i diritti personalissimi. Proprio in ragione del continuo mutamento della società e dell’ordinamento, amministratore, beneficiario, giudice tutelare ed interpreti si trovano a ricercare soluzioni a questioni sollevata da un quadro normativo assai complesso. Le nuove norme, non solo quelle in tema di a.d.s., impongono inoltre di verificare se sia superata, o meno, l’impostazione del codice civile e, più in generale dell’ordinamento, che consentiva solo in casi assolutamente eccezionali il compimento di atti personalissimi al rappresentante legale. Può sembrare ovvio che gli atti personalissimi siano di competenza esclusiva del titolare del diritto: tuttavia, numerose sentenze sembrano porre fortemente in discussione tale principio

Tecniche e metodiche in neuroradiologia

PER AFFRONTARE LA TRATTAZIONE DEGLI ASPETTI TECNICI DELLE PRINCIPALI METODICHE DI IMAGING DIAGNOSTICO DEL SISTAMA NERVOSO CENTRALE (SNC) E' NECESSARIA UNA PREMESSA

Capacità e incapacità

Il volume prende in esame le più rilevanti questioni interpretative, che registrano tuttora discordanze di opinioni, relative alla capacità giuridica, di agire, nonché di intendere e di volere. Particolare attenzione è dedicata all’incidenza delle più o meno recenti novelle a protezione degli incapaci di agire sull’obiettivo, perseguìto dal legislatore, della valorizzazione della personalità, della dignità e dell’autodeterminazione di ciascun individuo, nella prospettiva di un ripensamento delle distinzioni, operate dalla dottrina prevalente, tra capacità giuridica e capacità di agire, e, con riguardo al minore, tra sfera personale e sfera patrimoniale

Urinary Excretion of Kidney Aquaporins as Possible Diagnostic Biomarker of Diabetic Nephropathy

Diabetic nephropathy (DN) is a microangiopathic complication of diabetes mellitus (DM) affecting one-third of diabetic patients. The large variability in the clinical presentation of renal involvement in patients with DM makes kidney biopsy a prerequisite for a correct diagnosis. However, renal biopsy is an invasive procedure associated with risk of major complications. Numerous studies aimed to identify a noninvasive biomarker of DN but, so far, none of these is considered to be sufficiently specific and sensitive. Water channel aquaporins (AQPs), expressed at the plasma membrane of epithelial tubular cells, are often dysregulated during DN. In this work, we analyzed the urine excretion of AQP5 and AQP2 (uAQP5 and uAQP2), via exosomes, in 35 diabetic patients: 12 normoalbuminuric with normal renal function (DM), 11 with proteinuric nondiabetic nephropathy (NDN), and 12 with histological diagnosis and classification of DN. ELISA and WB analysis independently showed that uAQP5 was significantly increased in DN patients. Interestingly, linear regression analysis showed a positive correlation between uAQP5 and the histological class of DN. The same analysis, focusing on uAQP2, showed comparable results. Taken together, these data suggest a possible use of AQP5 and AQP2 as novel noninvasive biomarkers to help in classifying the clinical stage of DN

Clinical Reasoning: A Young Man With Subacute Onset of Spastic Paraparesis

: Leukodystrophies are a group of rare neurodegenerative disorders, usually presenting in infancy with a variable combination of cognitive, motor, and coordination impairment. Adult-onset cases are even more rare, often representing a diagnostic challenge even for experienced neurologists. Here, we present a case of a 44-year-old man with subacute and rapidly progressive spastic paraplegia, whose brain MRI revealed white matter abnormalities compatible with a diagnosis of leukodystrophy. We discuss how to apply a simplified diagnostic algorithm to distinguish acquired leukoencephalopathies from leukodystrophies and how to delve into the maze of genetic testing for white matter diseases. In our patient, we reached the diagnosis of a treatable disorder, whose early recognition is essential to prevent severe neurologic deterioration

Neurofibromatosis Type 1 Associated with Vertebrobasilar Dolichoectasia and Pontine Ischemic Stroke

Neurofibromatosis type 1 (NF1) is a heterogeneous, common, neurocutaneous disorder presenting different complications during a life span, including cerebrovascular dysplasia. To our knowledge this is the first reported case of NF1 associated with vertebrobasilar dolichoectasia and pontine ischemic stroke. We describe a 57-year-old man with NF1 who presented an acute onset right-sided facial palsy and hemiplegia, dysarthria, and gait imbalance. Magnetic resonance imaging showed an acute left paramedian pontine infarct and a hypoplastic right vertebral artery. Brain Computed Tomography Angiography revealed the occurrence of vertebrobasilar dolichoectasia. Co-occurrence of VBD and NF1 might not be merely casual and it may significantly heighten the mortality rate in this multisystem disorder. We suggest a possible role of VBD in the genesis of our patient's clinical-radiological features and prompt the early detection of asymptomatic arteriopathy in individuals with NF1 in order to ameliorate patients' quality of life and life expectanc