A giant retroperitoneal hemangiosarcoma in a young boy: CT findings

Retroperitoneal hemangiosarcoma (RH) is an uncommon neoplasm that derives from the vascular endothelium; due to its biological behavior, it should be distinguished from other retroperitoneal tumors. We report a case of a 40-year-old man with diagnosis of retroperitoneal mass, that was suspected to be malignant. The specimen was histopathologically proved to be a hemangiosarcoma. The patient was suffering from left upper quadrants prolonged abdominal pain, and had made a contrast-enhanced abdominal Computed Tomography (CT) that had shown the voluminous abdominal mass

A Case Report of a Giant Adrenal Angiomyolipoma at Computed Tomography

Angiomyolipoma of the adrenal gland is an extremely uncommon tumor detected incidentally in studies for other pathologies. We present the case of a 55-year-old female patient with a giant incidental right adrenal angiomyolipoma, detected by Computed Tomography (CT), performed for abdominal pain

COVID-19 Severity in Multiple Sclerosis: Putting Data Into Context

Background and objectives: It is unclear how multiple sclerosis (MS) affects the severity of COVID-19. The aim of this study is to compare COVID-19-related outcomes collected in an Italian cohort of patients with MS with the outcomes expected in the age- and sex-matched Italian population. Methods: Hospitalization, intensive care unit (ICU) admission, and death after COVID-19 diagnosis of 1,362 patients with MS were compared with the age- and sex-matched Italian population in a retrospective observational case-cohort study with population-based control. The observed vs the expected events were compared in the whole MS cohort and in different subgroups (higher risk: Expanded Disability Status Scale [EDSS] score > 3 or at least 1 comorbidity, lower risk: EDSS score ≤ 3 and no comorbidities) by the χ2 test, and the risk excess was quantified by risk ratios (RRs). Results: The risk of severe events was about twice the risk in the age- and sex-matched Italian population: RR = 2.12 for hospitalization (p < 0.001), RR = 2.19 for ICU admission (p < 0.001), and RR = 2.43 for death (p < 0.001). The excess of risk was confined to the higher-risk group (n = 553). In lower-risk patients (n = 809), the rate of events was close to that of the Italian age- and sex-matched population (RR = 1.12 for hospitalization, RR = 1.52 for ICU admission, and RR = 1.19 for death). In the lower-risk group, an increased hospitalization risk was detected in patients on anti-CD20 (RR = 3.03, p = 0.005), whereas a decrease was detected in patients on interferon (0 observed vs 4 expected events, p = 0.04). Discussion: Overall, the MS cohort had a risk of severe events that is twice the risk than the age- and sex-matched Italian population. This excess of risk is mainly explained by the EDSS score and comorbidities, whereas a residual increase of hospitalization risk was observed in patients on anti-CD20 therapies and a decrease in people on interferon

DMTs and Covid-19 severity in MS: a pooled analysis from Italy and France

We evaluated the effect of DMTs on Covid-19 severity in patients with MS, with a pooled-analysis of two large cohorts from Italy and France. The association of baseline characteristics and DMTs with Covid-19 severity was assessed by multivariate ordinal-logistic models and pooled by a fixed-effect meta-analysis. 1066 patients with MS from Italy and 721 from France were included. In the multivariate model, anti-CD20 therapies were significantly associated (OR = 2.05, 95%CI = 1.39–3.02, p < 0.001) with Covid-19 severity, whereas interferon indicated a decreased risk (OR = 0.42, 95%CI = 0.18–0.99, p = 0.047). This pooled-analysis confirms an increased risk of severe Covid-19 in patients on anti-CD20 therapies and supports the protective role of interferon

A suggestive case report of acute mesenteric venous thrombosis diagnosed at Computed Tomography Angiography

Acute mesenteric venous thrombosis (MVT) is a rare but potentially fatal condition with superior mesenteric vein being the most common site of thrombosis development. It is more common in patients with underlying disorders which cause disruptions to Virchow's Triad of hypercoagulability, stasis and endothelial injury. The disease is often associated with intestinal ischemia in its acute form, further complicating its management. We present a case of acute superior mesenteric venous thrombosis, in a 65 years old man with initial features of intestinal infarction, diagnosed at Computed Tomography Angiography (CTA) scan. However, the patient was stable, with a nonperitonitic abdomen, and was subsequently managed with conservative measures

A fuzzy-enhanced deep learning approach for early detection of Covid-19 pneumonia from portable chest X-ray images

The Covid-19 pandemic is the defining global health crisis of our time. Chest X-Rays (CXR) have been an important imaging modality for assisting in the diagnosis and management of hospitalised Covid-19 patients. However, their interpretation is time intensive for radiologists. Accurate computer aided systems can facilitate early diagnosis of Covid-19 and effective triaging. In this paper, we propose a fuzzy logic based deep learning (DL) approach to differentiate between CXR images of patients with Covid-19 pneumonia and with interstitial pneumonias not related to Covid-19. The developed model here, referred to as CovNNet, is used to extract some relevant features from CXR images, combined with fuzzy images generated by a fuzzy edge detection algorithm. Experimental results show that using a combination of CXR and fuzzy features, within a deep learning approach by developing a deep network inputed to a Multilayer Perceptron (MLP), results in a higher classification performance (accuracy rate up to 81%), compared to benchmark deep learning approaches. The approach has been validated through additional datasets which are continously generated due to the spread of the virus and would help triage patients in acute settings. A permutation analysis is carried out, and a simple occlusion methodology for explaining decisions is also proposed. The proposed pipeline can be easily embedded into present clinical decision support systems

First therapy choice in newly diagnosed Multiple Sclerosis patients: A multicenter Italian study

Background: The approval of an increasing number of disease modifying drugs for the treatment of Multiple Sclerosis (MS) creates new challenges for patients and clinicians on the first treatment choice. The main aim of this study was to assess factors impacting first therapy choice in a large Italian MS cohort. Methods: Newly diagnosed relapsing -remitting (RR) MS patients (2010-2018) followed in 24 Italian MS centres were included in the study. We evaluated the association of baseline demographics, clinical and MRI char- acteristics to the first treatment choice by logistic regression models applied to pre -de fined binary alternatives

SARS-CoV-2 serology after COVID-19 in multiple sclerosis: An international cohort study

Background: The MuSC-19 project is an Italian cohort study open to international partners that collects data on multiple sclerosis (MS) patients with COVID-19. During the second wave of the pandemic, serological tests became routinely available. Objective: To evaluate the seroprevalence of anti-SARS-CoV-2 antibodies according to the use of disease-modifying therapy (DMT) in a subset of patients included in the MuSC-19 data set who had undergone a serological test. Methods: We evaluated the association between positive serological test results and time elapsed since infection onset, age, sex, Expanded Disability Status Scale score, comorbidities and DMT exposure using a multivariable logistic model. Results: Data were collected from 423 patients (345 from Italy, 61 from Turkey and 17 from Brazil) with a serological test performed during follow-up. Overall, 325 out of 423 tested patients (76.8%) had a positive serological test. At multivariate analysis, therapy with anti-CD20 was significantly associated with a reduced probability of developing antibodies after COVID-19 (odds ratio (OR) = 0.20, p = 0.002). Conclusion: Patients with MS maintain the capacity to develop humoral immune response against SARS-COV-2, although to a lesser extent when treated with anti-CD20 drugs. Overall, our results are reassuring with respect to the possibility to achieve sufficient immunization with vaccination