Spontaneous hepatic haemangioma rupture and hemoperitoneum: a double problem with a single stage interventional radiology solution

Hepatic haemangioma is a congenital vascular malformation, considered the most common benign mesenchymal hepatic tumour. Spontaneous or traumatic rupture is the most severe complication. In case of rupture, surgical resection and enucleation, as a single therapy or after trans-arterial embolization are considered the treatments of choice. We report a case of spontaneous rupture of a hepatic haemangioma with massive hemoperitoneum successfully treated by percutaneous hepatic trans-arterial embolization and pelvic drainage alone

REAL-TIME ELASTOGRAPHY IN THE ASSESSMENT OF LIVER FIBROSIS: A REVIEW OF QUALITATIVE AND SEMI-QUANTITATIVE METHODS FOR ELASTOGRAM ANALYSIS

Despite its invasiveness, liver biopsy is still considered the gold standard for the assessment of hepatic fibrosis. Non-invasive ultrasound-based techniques are increasingly employed to assess parenchymal stiffness and the progression of chronic diffuse liver diseases. Real-time elastography is a rapidly evolving technique that can reveal the elastic properties of tissues. This review examines qualitative and semi-quantitative methods developed for analysis of real-time liver elastograms, to estimate parenchymal stiffness and, indirectly, the stage of fibrosis. Qualitative analysis is the most immediate approach for elastogram analysis, but this method increases intra- and inter-observervariability,whichisseenasamajorlimitationofreal-timeelastography.Semi-quantitativemethods include analysis of the histogram derived from color-coded maps, as well as calculation of the elastic ratio and fibrosis index. (E-mail: [email protected]) 2014 World Federation for Ultrasound in Medicine & Biology

Case Report: A Peculiar Case of Inflammatory Colitis After SARS-CoV-2 Infection

open14noWe report a case of inflammatory colitis after SARS-CoV-2 infection in a patient with no additional co-morbidity who died within three weeks of hospitalization. As it is becoming increasingly clear that SARS-CoV-2 infection can cause immunological alterations, we investigated the expression of the inhibitory checkpoint PD-1 and its ligand PD-L1 to explore the potential role of this axis in the break of self-tolerance. The presence of the SARS-CoV-2 virus in colon tissue was demonstrated by qRT-PCR and immunohistochemical localization of the nucleocapsid protein. Expression of lymphocyte markers, PD-1, and PD-L1 in colon tissue was investigated by IHC. SARSCoV- 2-immunoreactive cells were detected both in the ulcerated and non-ulcerated mucosal areas. Compared to healthy tissue, where PD-1 is weakly expressed and PD-L1 is absent, PD-1 and PD-L1 expression appears in the inflamed mucosal tissue, as expected, but was mainly confined to non-ulcerative areas. At the same time, these markers were virtually undetectable in areas of mucosal ulceration. Our data show an alteration of the PD-1/PD-L1 axis and suggest a link between SARS-CoV-2 infection and an aberrant autoinflammatory response due to concomitant breakdown of the PD-1/ PD-L1 interaction leading to early death of the patient.openRutigliani, Mariangela; Bozzo, Matteo; Barberis, Andrea; Greppi, Marco; Anelli, Emanuela; Castellaro, Luca; Bonsignore, Alessandro; Azzinnaro, Antonio; Pesce, Silvia; Filauro, Marco; Rollandi, Gian Andrea; Castagnola, Patrizio; Candiani, Simona; Marcenaro, EmanuelaRutigliani, Mariangela; Bozzo, Matteo; Barberis, Andrea; Greppi, Marco; Anelli, Emanuela; Castellaro, Luca; Bonsignore, Alessandro; Azzinnaro, Antonio; Pesce, Silvia; Filauro, Marco; Rollandi, Gian Andrea; Castagnola, Patrizio; Candiani, Simona; Marcenaro, Emanuel

Development of a smart post-hospitalization facility for older people by using domotics, robotics, and automated tele-monitoring

Recent studies showed that about the 8% of beds are occupied by patients who experience a delayed hospital discharge (DHD). This is attributed to a delay in the arrangement of home-care assistance or in admission to long-term care facilities. Recently a lot of technologies have been developed to improve caring and monitoring of older people. The aim of this study is to design, implement and test a prototype of a technology based post-hospitalization facility for older people at risk of DHD by using domotics, robotics and wearable sensors for tele-monitoring. A sensorised posthospitalization facility has been built inside the hospital. Thirty-five healthy volunteers aged from 20 to 82 years were recruited. Clinical and functional assessment, i.e. motility index (MI), and human-robot interaction satisfaction were measured. A significant correlation was observed between automatic MI and the Gait Speed, the time sit-to-stand, and the Timed Up and Go test. Domotics, robotics and technology-based telemonitoring may represent a new way to assess patient’s autonomy and functional and clinical conditions in an ecological way, reproducing as much as possible a real life at home

MDCT enteroclysis urography with split-bolus technique provides information on ureteral involvement in patients with suspected bowel endometriosis

The objective of our study was to evaluate the accuracy of MDCT enteroclysis with a split-bolus technique in detecting ureteral compression caused by endometriosis in women with suspected bowel endometriosis

Bowel endometriosis: CT-enteroclysis.

Although several radiological techniques have been used for the diagnosis of bowel endometriosis, no gold standard is currently established. We used multislice computerized tomography (CT) combined with the distention of the colon by rectal enteroclysis (MSCTe) for the diagnosis of bowel endometriosis. Following bowel preparation, pharmacological hypotonicity, retrograde colonic distention by water enteroclysis, and intravenous injection of iodinated contrast medium, a single volumetric acquisition of the abdomen is performed. MSCTe findings suggestive of bowel endometriosis are the presence of solid nodules with positive enhancement, contiguous or penetrating the colonic wall. When endometriotic lesions are detected, the degree of infiltration of the intestinal wall can be estimated; however, the depth infiltrated by nodules reaching the submucosa may be underestimated. MSCTe is well tolerated by the patients. The strength of MSCT consists in the high spatial resolution; volumetric data acquired by using thin slices provide isotropic voxels and multiplanar reconstructions have a quality comparable with that of the original axial scans. The potential of MSCTe for the diagnosis of bowel endometriosis relies on the fact that the serosal, muscular, and mucosal layers of the bowel wall can be evaluated

A multidisciplinary approach to short bowel syndrome.

Short bowel syndrome is a complex clinical picture, characterized by signs and symptoms of malabsorption and subsequent malnutrition, which often occurs after extensive bowel resections. Short bowel syndrome's treatment must begin together with the planning of the first surgery, especially for disease that may need multiple interventions. Patients with short bowel should be individually managed because they all are different in diagnosis, length of the remaining bowel and in psychosocial characteristics. For all these reasons, a multidisciplinary approach between the various specialists is therefore needed. KEY Words: Crohn's disease, Extensive surgery, Malabsorption, Malnutrition, Short bowel syndrome

Data-Driven Continuous Assessment of Frailty in Older People

The process of aging affects an individual’s potential in several dimensions, encompassing the physical, cognitive, psychological, economic, and social domains. The assessment of frailty in elderly patients is key to estimate their overall well-being and to predict mortality risk. In the clinical practice, frailty is usually estimated through medical tests and questionnaires performed sporadically. Continuous automatic assessment may help physicians in evaluating frailty by complementing their assessments with quantitative and non sporadic measurements. In this paper, we present the state-of-the-art in frailty evaluation, we summarize recent research achievements that could lead to an improved assessment, and we illustrate a case study we are conducting in our institution. Finally, based on our experience and results, we comment on the open challenges of automatic assessment of frailty