COVID and Lung Cancer

Purpose of Review Since the past year, the fast spread of coronavirus disease 2019 (COVID-19) has represented a global health threat, especially for cancer patients, that has required an urgent reorganization of clinical activities. Here, we will critically revise the profound impact that the pandemic has generated in lung cancer patients, as well the most significant challenges that oncologists have to face to maintain the highest possible standards in the management of lung cancer patients in the pandemic era. Recent Findings Evidences suggested a higher susceptibility and mortality of lung cancer patients due to COVID-19. The hard management of this patient population has been also due to the potential cross interference of anti-tumor drugs on SARS-Cov-2 infection and to the differential diagnosis between COVID-19 pneumonitis and drug-related pneumonitis. Summary COVID-19 pandemic has generated a profound reshaping of oncological activities and the development of recom- mendations by the oncology scientific community to prioritize anti-tumor treatments for lung cancer patients

Post mortem computed tomography of heart

Post mortem Computed tomography (CT) has been increasingly used in routine forensic practice and research. While radiological examination is generally considered to be a good complement for conventional autopsy, it was thought to have limited application in cardiovascular pathology. The aim of the present study is to show our experience of radiological analysis of the heart as single organ, as an integrative tool for research and forensic applications. The anatomo-radiologic study for forensic purpose was performed on 10 hearts sampled at autopsy (8M, 2 F, mean age 45 years old). The specimens underwent CT examinations. In 5 out of 10 of cadavers, a myocardial infarction was found at macroscopic and microscopic analysis. In these same cases, the CT examination showed the presence and the localization of calcifications, corresponding to the infarct area. In 90% of cases the presence of calcifications allowed the visualization of the coronary arteries and their branches. Basing on our experience, isolated single-organ CT could be considered a useful integrative tool in addition to traditional autopsy investigation (macroscopic sections and histology) in identifying the cause of death by recognizing the presence and degree of coronary artery pathology

Ischemic colitis following left antegrade sclerotherapy for idiopathic varicocele: the role of forensic clinical anatomy

Introduction. The Tauber procedure, i.e. antegrade sclerotherapy for varicocele, can be complicated by ischemic colitis. Its possible pathogenesis is referred to the presence of an atypical kind of portal-systemic communication, which could represent an unfrequently reported anatomic variant. Aim of this study is to solve this anatomical controversy of utmost clinical usefulness. Materials and methods. A computer-aided and hand-checked systematic review of the literature was implemented to identify relevant publications on the topic. Moreover, we reviewed the computed tomography CT-scan of a clinical case with medico-legal implications due to severe vascular complication following Tauber’s procedure. Results. Despite specific References were made on the issue in more dated hardbacks since the 19th century, only a few clinical cases reporting an ischemic colitis following the Tauber’s procedure were found in contemporary literature. By reviewing the CT-scan images of a filed lawsuit we found traces suggestive for the presence of a significant communication between the internal spermatic and the left colic vein, as part of the portal-systemic anastomoses. Conclusions. A significant anatomical finding identified in the past have been under-reported and subsequently underestimated in its clinical value. For the first time we demonstrated its pathophysiological role in a real clinical scenario, coupling the anatomical variation to the clinical complication hence stressing that its knowledge is of utmost importance to raise the scientific awareness and to prevent possible devastating complication in clinical daily practice. Progress in the medical field coupled with increased medical-legal awareness has supported the ripening of clinical anatomy and forensic clinical anatomy, whose multidisciplinary represents the best way to recover and hand down the medical knowledge at risk of being forgotten

Anatomo-radiologic study of the Suboccipital artery of Salmon

The frequency of suboccipital injections to treat cluster and chronic migraine headaches has increased in the last decade. The third segment of the vertebral artery is located in the suboccipital triangle and its main muscular branch, the suboccipital artery of Salmon (SAS), supplies blood to the suboccipital muscles and related tissues. The purpose of this study was to radiographically investigate the morphology of the SAS and its branches, and to document which muscles are supplied by this clinically-relevant blood vessel. Computed tomography angiographs of the brains of 50 subjects (25 female, 25 men) with a mean age of 70.2 years were analysed. The SAS was present in 48% of subjects. The vessel was present bilaterally in 37.1% of subjects, and had a mean (SD) luminal diameter of 1.71 (0.34) mm and mean (SD) length of 36.42 (17.1) mm. The SAS was found to have two morphologic patterns: 1) a single main trunk with collateral branches (52.6%) and 2) a short common trunk that divided into two branches (48.4%). The SAS supplied the obliquus capitis inferior, semispinalis capitis, and splenius capitis muscles. When the SAS was absent, the suboccipital muscles were supplied by a branch of the occipital artery. No anastomoses were found between the SAS and occipital artery. The suboccipital muscles are vascularised by the SAS and occipital artery. The detailed course of the SAS is important for clinicians and surgeons who perform procedures in the suboccipital region

Forensic Clinical Anatomy of Spine in Child Abuse

Forensic Clinical Anatomy of Child Abuse includes studies of Functional and/or Biomechanical Anatomy which are performed on cadavers to verify compatibility of lesions with accidental dynamics. Moreover, some kinds of damages following Child Abuse are strictly anatomical in nature and require morphological/morphometric methods of investigation for adequate assessment. Problems of differential diagnosis between anatomical structures (normal or variant) and pathological findings also frequently arise [1]. In the present work, we focused on anatomical bases of spinal lesions in two autoptical cases of abusive head trauma, with particular reference to methodological issues. Both cases presented brain subdural haemorrhage and multiple bilateral retinal haemorrhages. In both cases, the spinal cord was sampled in continuity with the dura mater and it was subjected to complete sectioning. Spinal subdural haemorrhages were found along all the spinal levels. The histopathological characteristics of these haemorrhages also permitted to reveal different chronologies of the lesions, with consequent forensic implications. Hypoxic-ischaemic damages coexisted, mainly at the level of cervical and lumbar spinal cord, together with glio-mesodermic response. On the basis of in vivo imaging suggesting cervical sub-dislocations, portions of the vertebral column were also sampled and subjected to postmortem imaging before further hystopathological sampling. In one case, postmortem imaging permitted to confirm anterolisthesis of the second vertebral body over the third one. Histopathological analysis also showed the presence of haemorrhagic infiltrations of the epidural adipose tissue at the level of the atlanto-axial joints. A consistent methodology of analysis of the spinal structures should involve integration of postmortem imaging with detailed and exhaustive histopathological study

Clinical anatomy of the caudal pancreatic arteries and their relevance in the surgery of the splenic trauma

Splenectomy is the treatment of splenic trauma but is not exempt from intra-operative and post-operative complications. Conservative approach is preferred for paediatric population and for minor trauma. The aim of the present study was to evaluate the vascularisation of the tail of the pancreas, with particular reference to the presence of anastomosis between the pancreatic and splenic vessels, through an anatomoradiologic study performed on 9 unembalmed cadavers (age range 44-77 years). To obtain vascular corrosion casts, the splenic, the gastroduodenal and the superior mesenteric arteries were injected with acrylic and radioopaque resins and computed tomography (CT) of the specimens were acquired. The caudal pancreatic arteries (mean number ± standard deviation: 3.2 ± 2.4) were observable in all the casts, originating from the splenic artery at its distal third (70%) and from its inferior branch (30%). At CT scans analysis the mean calibre of caudal pancreatic arteries was 2.1 ± 1.1 mm. Anastomosis were found with great pancreatic artery in 20%, and with hilar splenic artery in 80%. The pattern of anastomosis between the pancreas tail and the spleen could allow the surgeon to close the splenic artery at the origin and also the short gastric and the left gastroepiploic arteries, in cases of splenic trauma, favouring the hemostasis and allowing splenic preservation at a same time

Anatomical and Radiologic study about the vascular supply of the pancreas interrelated with resective surgery

Postoperative pancreatic fistula is still regarded as a major complication. Its incidence varies greatly in different reports. The aim of the present study was to evaluate possible correlation between the incidence of postoperative complications and the vascular architecture of the pancreas. Ten specimens of pancreas, duodenum and spleen were injected to obtain vascular casts of the hepatic, splenic and superior mesenteric artery (SMA). Computed tomography angiographs of the upper abdomen of 30 patients, that undergone to pancreatoduodenectomy, and of 50 subject controls (25 female, 25 men) with a mean age of 70.2 years were analysed to investigate the depiction rate and branching of the vascular supply of the pancreas main vessels. The anterior superior pancreaticoduodenal artery (ASPD) and the posterior superior pancreaticoduodenal artery (PSPD) were visible in 95% and 98.2%. The ASPD contributes to create one or two anterior arcade in 90% and 10% respectively, the PSPD contributes to create one posterior arcade in 100%. The inferior pancreaticoduodenal stem was visible in 100% with its two branches. The inferior origin of the posterior arcade i.e. inferior anterior pancreaticoduodenal artery (IAPA) emerges from SMA in 40%, from the first jejunal artery in 60%.The dorsal pancreatic artery (DPA) was visible in 45%, coming from the splenic artery in 60%, from the celiac trunk in 30%, from the common hepatic artery on 10%. The transverse artery was visible in 80% coming from the SMA in 60%, from the dorsal pancreatic artery in 30% and from the anterior arcade in 10%. Preoperative understanding of the vascular anatomy of the pancreatic head is important in order to reduce frequency of complication

Anatomic-radiologic study of the anterolateral ligament of the knee

Recent anatomic investigations of the lateral structures of the knee have identified a new ligament, called the anterolateral ligament (ALL). To date, the anterolateral ligament has not been microscopically analysed. A retrospective MRI study was carried out in 50 patients by two observers. MRI has been performed for various indications excluding trauma. 10 specimens of ALL were sampled from bodies of the Donation to Science program of the University of Padova. A thin linear structure originating at the lateral epicondyle, running obliquely downwards and forwards and inserting at the lateral aspect of the proximal tibia was observed in 18 cases (90%), with a mean length of 3.8 cm and mean thickness of 1.9 mm. The ALL was hyposignal on both T1- and T2-weighted sequences. From the microscopic point of view the ALL corresponds to a fibrous connective tissue, organised in 2-3 layers of collagen tissue (mean thickness 983+423 micron), with scarce elastic fibres, separated by a thin layer of fibroadipose tissue from the adjacent structures. The ALL appears as almost constantly depicted by MRI and shows a fibrous structure. Its layered organisation could account for its mechanical importance, as a presumed stabilizer of the medial rotation of the kne

Friar Leopoldo Mandic (1866–1942): the computed tomography of the body of a Saint

Post-mortem Computed tomography (CT) is an imaging technique for documentation and analysis of consecutive autopsy findings, including fractures and gross tissue injuries. Various post-processing techniques can provide strong forensic evidence for use in legal proceedings. On the other hand, this technique is implied also in paleopathology, in particular in mummy studies, with the aim of providing a permanent record of the mummy’s features, investigating the embalming procedure employed and analyzing the extent of the preservation in detail. For the Extraordinary Jubilee of Mercy, the mortal remains of Saint Leopoldo Mandic and Saint Pio da Pietrelcina, as examples of Mercy known by everyone, have been brought to Rome from 3 to 11 February. During the survey that preceded the preparation for transport to Rome, a whole-body CT was performed on the mummified corpse of Leopoldo Mandic, Capuchin Saint of Padova, Italy. The CT examination demonstrated the presence of arthritis at the level of the vertebral column, of the left knee and of the hand. Moreover, CT showed the preservation of skeleton, and partial preservation of the brain, ear ossicles, major arterial vessels (aorta and carotid arteries), pleurae, esophagus, heart, urinary bladder, nervous structures (plexuses and spinal nerves). Pseudo-pathologic changes, primarily postmortem skeletal dislocations were also present at the level of the hip joints. It is to emphasize the fact that San Leopoldo was not subjected before the CT to any conservative treatment, with the exception of a surface treatment with celluloid. CT demonstrated to be a non-destructive method to investigate Saint Leopoldo, in order to maintain the integrity of the body and to acquire data on his pathologies and on his preservation. CT allows not only the acquisition of sectional images but also, thanks to dedicated software, the post-processing and reconstruction of three-dimensional models, that can be used also for public displays