Psychological and behavioral disease during developmental age: the importance of the alliance with parents

The aim of the study is to analyze the clinician’s alliance with parents during the diagnostic process in relation to therapeutic compliance and clinical evolution of individuals aged 0–11 years. The sample was formed by 84 individuals aged 0 to 11 years (18 < 6 years, 66 aged 6 to 11 years; 62 males and 22 females) who came to the Neuropsychiatric Unit for Children and Adolescents for a consultation regarding psychorelational and behavioral problems. Neuropsychiatric consultation took place in five diagnostic interviews with child and parents, separately. The last session was devoted to communication of psychiatric diagnosis (according to ICD 10) and therapeutic suggestions, if any. The clinician’s relationship with parents and patients’ participation were evaluated in terms of collaboration and quality of interaction, on the basis of pre-established criteria. Data about patients’ therapeutic compliance and clinical outcome were collected during a follow-up visit eight months after the last session. Results suggest that the better the alliance between parents and clinician, the higher the therapeutic compliance and the likelihood of a positive outcome for patients. Our data suggest that good communication with parents benefits child patients, both in terms of response to the parents’ need to report their children’s worrying behavior and as a response to the discomfort expressed by children when they come in for consultation

Contrast agents for hepatic MRI

Liver specific contrast media (LSCM) can be subdivided according to different modalities of hepatic distribution: exclusive distribution to the hepatocellular compartment can be obtained using CM which accumulate within the hepatocytes after slow infusion; other CM demonstrate combined perfusion and hepatocyte-selective properties, with an initial distribution to the vascular-interstitial compartment (in an analogous manner to that of the conventional extracellular CM), thereafter, a fraction of the injected dose is taken up into the hepatocytes causing an increase in the signal intensity of the hepatic tissue. The use of the superparamagnetic effect of iron oxide particles is based on distribution in the reticuloendothelial system (RES), usually well represented in the normal parenchyma as well as in benign hepatocellular lesions, and absent in most malignant lesions. It is necessary to have an in-depth knowledge of either the biological and histological characteristics of focal liver lesions (FLL) or the enhancement mechanism of LSCM to gain significant accuracy in the differential diagnosis of FLL. Dynamic contrast-enhanced MRI is an important tool in the identification and characterization of FLL. With LSCM it is possible to differentiate benign from malignant lesions and hepatocellular lesions from non hepatocellular lesions with high accuracy. To understand the contrast behaviour after injection of LSCM it is necessary to correlate the contrast enhancement with both the biological and histological findings of FLL

Voluminous abdominal gastrointestinal stromal tumor of unknown origin manifested with bleeding in a young man: synchronous management of the emergency and oncological approach-case report

Gastrointestinal stromal tumors (GISTs) are rare tumors of the gastrointestinal tract, which cover about 1-2% of gastrointestinal neoplasms with an unadjusted incidence of around 1/100,000/year. They are also the most common non-epithelial neoplasms of the gastrointestinal tract and they are associated with a high rate of malignant transformation. They are more common in the stomach (40-60%) while a minor part repeatedly involves jejunum/ileus (25-30%), duodenum (5%), colorectal (5-15%) and esophagus (&lt;1%). There are also much rarer extragastrointestinal stromal tumor (EGIST): these tumors have immunohistochemical and molecular characteristics similar to GISTs and for this reason, they are called this way, EGIST can involve retroperitoneum, mesentery, and omentum, without affecting the gastrointestinal tract. The clinical presentation depends on the primary localization of the neoplasm, however in 18% it is asymptomatic, and it is accidentally discovered during endoscopies, radiological examinations or surgical operations performed for other reasons, especially if it is small in size. More often, they are associated with non-specific symptoms such as early satiety, nausea or vomiting. Gastrointestinal bleeding is the most dangerous complication, often necessitating emergency surgery. The purpose of this case report is to describe our experience in the management of a young patient with gastrointestinal bleeding caused by an unknown voluminous retroperitoneal GIST with metastatic progression using a combined endovascular embolization and debulking-surgery approach for emergency and imatinib therapy combined with radiofrequency for the oncological approach. GIST requires multidisciplinary management, which improves both prognosis and quality of life

Double Right Bronchial Artery Aneurysm Treated with Combined Procedures

Purpose Bronchial artery aneurysms occur rarely. We present an unusual case. Case report We present a patient with double right bronchial artery aneurysms that were treated with a combination of endovascular and surgical procedures. Conclusion This case report illustrates the treatment options for this unusual problem

A rare case of intralobar pulmonary sequestration: combined endovascular and video-assisted thoracoscopic approach

Pulmonary sequestration is a congenital malformation characterized by cystic, non-functioning embryonic lung tissue supplied by an abnormal systemic artery. It's a rare disease widely variable in clinical presentation and severity, depending mostly on the degree of lung involvement and location in the thoracic cavity. Most patients have recurrent infections and inflammatory conditions in the affected lobe. Surgical resection continues to be the gold standard of therapy and in this context anatomical resection is the procedure of choice and yields excellent long-term results. There are few studies reporting the use of combined endovascular and thoracoscopic approaches for pulmonary sequestration. We describe a case of intralobar pulmonary sequestration located in the lower lobe of the right lung, which was treated with video-assisted thoracoscopic surgery (VATS) after endovascular embolization of systemic artery arising from celiac trunk

SUBCAPSULAR HEPATIC HEMATOMA: A COMPLICATION OF HELLP SYNDROME. CONSERVATIVE MANAGEMENT AND COMPARISON WITH LITERATURE

Microangiopathic hemolytic anemia, elevated liver enzymes and low platelet count, also known as HELLP syndrome, is a rare complication of pregnancy with high maternal and fetal mortality. One of the most serious complications is a subcapsular liver hematoma. The diagnostic techniques used for diagnosis are ultrasound, CT and MRI. Hemodynamically stable patients should be treated conservatively and in cases of active bleeding with percutaneous embolization of the hepatic arteries. We present a case of a 35-year-old woman with subcapsular liver hematoma with active arterial bleeding who underwent an emergency cesarean section and was treated conservatively with artery embolization with gelatin spong

Radiologia interventistica e gravidanza: filtro cavale rimovibile nel peripartum e dato dosimetrico fetale [Interventional radiology and pregnancy: retrievable inferior vena cava filter in the peripartum and dose fetus analysis]

Una donna di 28 anni alla 26^ settimana e un giorno della sua seconda gravidanza, giungeva presso il nostro ospedale lamentando da alcuni giorni dolore e gonfiore alla gamba sinistra. Normali i segni vitali del feto. I valori di laboratorio rilevavano D-dimero di 5,37 mg/L e l’indagine ecografica dimostrava trombosi della vena femorale e della vena iliaca esterna sinistra. La paziente veniva dotata di calze elastiche compressive e iniziava terapia anticoagulante. A 33 settimane e 5 giorni è stata eseguita venografia endovascolare e posizionato un filtro rimovibile in vena cava inferiore per minimizzare il rischio di embolia polmonare prima e durante il parto. Si è deciso di optare per il posizionamento in sede sotto-renale nonostante in quel tratto la vena fosse compressa dall’utero gravido. La procedura, conclusasi senza complicanze, ha richiesto 1 minuto e 36 secondi di fluoroscopia e il feto è stato esposto a una dose di 11 mGy. Una settimana dopo è avvenuto il parto con taglio cesareo in elezione, mentre il filtro è stato recuperato tre settimane dopo il suo posizionamento, con tecnica a singolo accesso. La principale indicazione per il posizionamento del filtro cavale è il trattamento acuto di una trombosi venosa profonda prossimale e/o embolia polmonare in pazienti con controindicazione assoluta alla terapia medica anticoagulante, ad esempio durante il parto, quando l’anticoagulante deve essere interrotto. Nella nostra esperienza questa procedura si è dimostrata essere una valida opzione in gravidanza, in quanto priva di significativa morbidità materno-fetale e con una bassa dose di radiazioni al feto.A 28-year-old woman at 26 weeks and one day into her second pregnancy presented to our hospital with pain and swelling in her left leg which had started a few days before. Fetus vital signs were normal. Laboratory findings revealed D-dimer of 5.37 mg/L, and ultrasound demonstrated thrombus occluding the left femoral and external iliac vein. The patient was fitted with compression stockings and 6000 units of subcutaneous enoxaparin was initiated twice-daily. At 33 weeks and 5 days an endovascular venography was performed and a retrievable inferior vena cava filter deployed to minimize the risk of pulmonary embolism (PE) prior to and during the elective labor. Even if the inferior vena cava was compressed by the gravid uterus, an infrarenal filter was placed without complications. The procedure took 1 minute and 36 second of fluoroscopic time and exposed the fetus to a dose of 11 mGy. One week later the patient had a caesarean section and two weeks postdelivery the filter was retrieved by means of single access technique. She was discharged home and continued anticoagulation therapy with ultrasound follow-up for deep venous thrombosis. Inferior vena cava filter is mostly indicated in the acute treatment of a proximal deep venous thrombosis and/or PE in patients in whom anticoagulation therapy is contraindicated, such as during delivery, when it has to be stopped. In our experience this procedure was shown to be effective in pregnancy to prevent PE without significant fetal and maternal morbidity and with low dose exposure to the fetus

Evaluation of the Effectiveness of the Use of the Diode Laser in the Reduction of the Volume of the Edematous Gingival Tissue after Causal Therapy

Aim: The aim of this study was to evaluate and compare two different techniques for the treatment of plaque-induced gingivitis, demonstrating whether the causal therapy supported by diode laser can allow a resolution of the edema caused by gingivitis in less time compared to the single traditional causal therapy. Materials and methods: Twenty-five patients between 20 and 60 years of age with a specific diagnosis of gingivitis were evaluated at the CLID-HSR oral hygiene department. Once the clinical parameters (bleeding index, plaque index, recession, and clinical attack level) were recorded, each of them was subjected to a professional oral hygiene session and instructed in correct home hygiene procedures. Through a split-mouth protocol for each individual patient, hemi-arches were treated by simple randomization to be treated with causal therapy supported by the action of the diode laser (experimental therapy) and which with traditional causal therapy (control therapy). A first intraoral scan was performed before therapy (T0), which was repeated 20 min after rinsing with CHX. The intraoral scans were repeated at a control 7 (T1) and 14 days (T2) after the session. For each intraoral scan, a volumetric value was calculated, proportional to the edema of the gingival tissues, using special digital software. The operator who carried out the volumetric measurements on the software was not aware of the therapy implemented on each half-arch. The operator who carried out the statistical analysis was not aware of the therapy applied to each group. The collected data were statistically compared in order to detect any differences between the volumetric variations between the two therapy groups and within the therapy groups over time. After evaluating the distribution of data by means of the Kolmogorov-Smirnov statistical test, the appropriate nonparametric tests were chosen to carry out the statistical comparisons. Results: Based on the analysis of the gingival-periodontal health parameters and the volumetric value of the treated areas, no statistically significant differences were detected between the areas treated with the adjuvant action of the diode laser compared to those treated with causal therapy alone. Conclusions: With the limitations of this study, in accordance with the statistical results obtained, diode laser therapy does not allow a faster resolution of gingival edema compared to traditional therapy; the two treatment techniques for plaque-induced gingivitis, therefore, have the same efficacy

Management of iatrogenic subclavian artery rupture: two case reports

Bleeding of the branches of a subclavian artery can be a life-threatening condition. Subclavian artery bleeding can lead to tracheal obstruction, hemothorax, respiratory failure, hemorrhagic shock, and death if not diagnosed early and treated promptly. Injury to the subclavian artery occurs in multiple different manners including blunt, penetrating, or iatrogenic trauma. Here we reported two cases of injury of the branches of the right subclavian artery (RSA); one following a central venous catheterization and the other following a thoracic drainage tube placement. Herein we describe two endovascular treatment options used in the management of rupture of a subclavian artery. The proximal tract of the subclavian artery and its main branches is also considered a 'border territory' between interventional vascular radiology and interventional neuroradiology because it gives rise to branches both cervical and to the upper limbs

Risultati dell'embolizzazione arteriosa nel trattamento degli ematomi spontanei toraco-addominali

E' stata valutata la buona efficacia dell'embolizzazione arteriosa nel controllo terapeutico degli ematomi spontanei toraco addominali in 24 pazienti scoagulat