Costanza Bruno

Comparison of CT Features of Aspergillus and Bacterial Pneumonia in Severely Neutropenic Patients

Purpose To establish whether a relationship exists between computed tomography features of lung opacities in severely neutropenic patients and their Aspergillus or bacterial etiology. Methods Computed tomography scans of 124 patients with lung opacities larger than 5 mm occurring during severe (neutrophils <500/mm3) and prolonged (>7 d) neutropenia—induced by bone marrow transplantation and/or high-dose chemotherapy for hematologic malignancies—were reviewed. Invasive pulmonary aspergillosis or bacterial pneumonia were assessed by means of bronchoalveolar lavage, bronchial washing, trans-bronchial biopsy or (for bacteria only) blood cultures. Pulmonary opacities were classified as nodules or as consolidations. The presence of a perinodular ground-glass halo, the similarity of consolidations to a pulmonary infarction and the presence of cavitation (crescent-shaped or not) were recorded. Results Invasive pulmonary aspergillosis was diagnosed in 68 patients; bacterial pneumonia in 56. Nodules (85) were more common than consolidations (39); their distribution among the patients with aspergillosis (52 nodules and 16 consolidations) and those with bacterial pneumonia (33 nodules and 23 consolidations) was even. Out of the 19 nodules surrounded by a halo 17 were due to aspergillosis. Nine consolidations (3 due to aspergillosis) were infarctionlike shaped. Cavitation appeared during 22/68 aspergillosis and 31/56 bacterial pneumonias; an air-crescent in 6 patients with aspergillosis and in 24 with bacterial pneumonia. Conclusions Although rare enough, the perinodular halo is highly specific for invasive aspergillosis. The nodular pattern of lung opacities, their similarity to a pulmonary infarction, the occurrence of cavitation and the air-crescent are not related to aspergillosis.

Renal function and volume of infants born with a very low birth‐weight: a preliminary cross‐sectional study

Aim:  The aim of our study was to compare the function and volumes of kidneys of very low birth‐weight (VLBW) and of extremely low birth‐weight (ELBW) infants at pre‐school ages.

Hidden high-grade vesicoureteral reflux is the main risk factor for chronic renal damage in children under the age of two years with first urinary tract infection.

Abstract Objective. The aim of the present prospective trial was to investigate, in a cohort of young children with first urinary tract infection (UTI) and negative prenatal history, the role of imaging in screening babies at risk of renal deterioration. Material and methods. Children who had experienced the first febrile UTI at or under the age of 2 years were enrolled. They had had normal foetal routine ultrasound. All the children underwent renal ultrasound after admission; those with sonographic signs of obstruction were excluded. Voiding cystoureterogram (VCUG) and 99mTc-dimercaptosuccinic acid (DMSA) scintigraphy were performed approximately 1 month and 6 months after the UTI, respectively. Finally, 65 babies (47.7% males, 38.6 ± 1.3 weeks of gestational age) were prospectively followed up. Results. In 15.4% and 29.2% of cases, the renal pelvis was ≤7 and >7 mm in diameter, respectively. Vesicoureteral reflux (VUR) was detected in 55.4% of the children and renal scarring in 18.5%. Stepwise binary logistic regression analysis showed that the severity of VUR correlated significantly with renal scarring, excluding all the other variables from the model. In this cohort of babies, the severity of VUR seriously enhanced the risk of renal damage (odds ratio = 6.658, p = 0.004). Conclusion. Follow-up renal scintigraphy 6 months after a UTI can predict severe VUR in very young children showing renal scarring, detecting only those who are at risk of loss of kidney function and who would require further assessment. After the first episode of UTI, the practice of performing VCUG in babies with normal DMSA scintigraphy is of doubtful value.

Agenesis of the corpus callosum in fetuses with mild ventriculomegaly: role of MR imaging.

PurposeWe evaluated the role of magnetic resonance (MR) imaging in the diagnosis of corpus callosum agenesis — isolated or associated with other anomalies — in fetuses with mild cerebral ventriculomegaly, as depicted at prenatal sonography.Material and methodsBetween January 2005 and March 2007, 33 fetuses with a mean gestational age of 28.9 weeks (range 17–37) and mild ventriculomegaly diagnosed at prenatal sonography were included in this prospective study. All fetuses underwent MR imaging according to the following protocol: half-Fourier T2-weighted images along the three orthogonal plane according to the longitudinal axis of the mother, and subsequently three orthogonal planes were acquired according to the fetal brain. Quantitative image analysis included the size of the transverse diameter of the lateral ventricles, in the axial plane, and the thickness of the adjacent cerebral cortex. Qualitative image analysis included morphology of the lateral ventricles (normal, parallel pattern colpocephaly), signal intensity changes of the fetal brain, interruption of the germinative matrix, agenesis of the corpus callosum (complete/partial) and associated malformations. Postnatal physical examination and diagnostic imaging, as well as surgery, were the standard of diagnosis.ResultsMean axial diameter of the lateral ventricle was 11.6 mm (range 10–15 mm), and mean thickness of the adjacent cerebral cortex was 2.1 mm (range 1.8–3 mm); 23/33 fetuses (70%) showed normal morphology of the lateral ventricles, and 8/33 (24%) showed abnormal morphology (parallel pattern, colpocephaly). The entire corpus callosum was visualised in 20/33 fetuses (60%). In 8/33 fetuses (25%), partial agenesis was diagnosed, whereas in 5/33 (15%), there was hypogenesis. In 6/13 fetuses (46%), isolated corpus callosum agenesis was detected, and two cases of hypogenesis of the corpus callosum were misinterpreted — overestimated in one case and underestimated in another.ConclusionsMR imaging may prove to be a useful second-line imaging modality in the prenatal diagnosis of corpus callosum agenesis in fetuses with mild ventriculomegaly.RiassuntoObiettivoL’obiettivo di questo lavoro è la valutazione della risonanza magnetica (RM) fetale nella diagnosi di agenesia del corpo calloso, isolata o associata ad altre anomalie, in presenza di riscontro ecografico di ventricolomegalia cerebrale lieve.Materiali e metodiTra gennaio 2005 e marzo 2007, 33 feti con età gestazionale media di 28,9 settimane (range 17–37) e ventricolomegalia lieve all’ecografia, sono stati inclusi in questo studio prospettico. Sono state eseguite immagini T2-dipendenti half-Fourier lungo i tre piani ortogonali all’asse longitudinale materno e all’encefalo fetale. L’analisi quantitativa ha compreso la misura del diametro trasversale ventricolare sul piano assiale e lo spessore della corteccia cerebrale adiacente. L’analisi qualitativa ha compreso: morfologia dei ventricoli laterali, alterazioni dell’intensità di segnale, focali o diffuse, del tessuto nervoso encefalico, soluzioni di continuo della matrice germinativa, agenesia del corpo calloso (completa/parziale) e malformazioni associate. L’esame obiettivo neonatologico, la diagnostica per immagini e la chirurgia post-natale hanno costituito il gold standard di riferimento.RisultatiIl diametro trasversale medio ventricolare è stato di 11,6 mm (range 10–15 mm) con spessore corticale adiacente di 2,1 mm (range 1,8–3 mm). Ventitre/33 (70%) feti hanno dimostrato morfologia ventricolare normale; 8/33 (24%) anomala (corna frontali parallele, colpocefalia). Il corpo calloso è stato completamente visualizzato in 20/33 (60%) feti; in 8/33 (25%) feti vi era agenesia totale mentre in 5/33 (15%) un’ipogenesia. Sei feti su 13 (46%) mostravano agenesie isolate. Due ipogenesie erano state misinterpretate: in un caso sovrastimata e nell’altro sottostimata.ConclusioniLa RM può rappresentare una metodica di secondo livello nell’identificazione pre-natale delle forme di agenesia del corpo calloso associata a ventricolomegalia lieve.

Renal Elasticity Quantification by Acoustic Radiation Force Impulse Applied to the Evaluation of Kidney Diseases: A Review

For centuries, clinicians have used palpation to evaluate abdominal organs. After exploring almost all the different methods of interaction between x-rays, ultrasound, and magnetic fields on tissues, recent interest has focused on the evaluation of their mechanical properties. Acoustic radiation force impulse (ARFI) is a recent, established ultrasound-based diagnostic technique that allows physicians to obtain a measure of the elastic properties of an organ. Shear wave velocity, obtained by the ARFI technique, depends on the elasticity of tissues. To date, there are studies on the ARFI technique applied to normal kidneys, chronic kidney diseases, and kidney transplants. Mechanical properties of the kidney, such as stiffness and deformity, depend on various conditions that alter its histology, in particular the amount of fibrosis in the renal parenchyma; urinary pressure and renal blood perfusion may be other important contributing factors. Unfortunately, the ARFI technique applied to native renal pathologies is still limited, and not all studies are comparable because they used different methods. Therefore, the results reported in recent literature encourage further improvement of this method and the drawing up of standardized guidelines of investigation.

ARFI: from basic principles to clinical applications in diffuse chronic disease—a review

The many factors influencing the shear wave velocity (SWV) measured with Acoustic Radiation Force Impulse (ARFI) are examined in order to define the most correct examination technique. In particular, attention is given to the information achieved by experimental models, such as phantoms and animal studies. This review targets the clinical applications of ARFI in the evaluation of chronic diffuse disease, especially of liver and kidneys. The contribution of ARFI to the clinical workout of these patients and some possible perspectives are described.Teaching Points• Stiffness significantly varies among normal and abnormal biological tissues.• In clinical applications physical, geometrical, anatomical and physiological factors influence the SWV.• Elastographic techniques can quantify fibrosis, which is directly related to stiffness.• ARFI can be useful in chronic diffuse disease of liver and kidney.

Congenital fibrosarcoma of the bowel: Sonographic description of a rare case of neonatal intestinal obstruction

A case of localization in the bowel of congenital fibrosarcoma (a rare soft‐tissue tumor usually occurring in the extremities) causing intestinal obstruction in a newborn girl is described. A focal thickening of the ileal wall with features mimicking intussusception was identified at sonography; the final diagnosis was achieved by means of molecular analysis after surgical removal of the mass.

Transumbilical laparoscopic treatment of Congenital Infantile Fibrosarcoma of the Ileum.

Congenital-Infantile Fibrosarcoma (CIF) is a malignant mesenchymal tumor representing 10-20% of soft-tissue tumors. Complete surgical resection is generally the treatment of choice. The most recurrent cytogenetic abnormality was identified as the traslocation t(12;15)(p13:q25), which bears the fusion of Tel gene EVT6 with TrkC gene. This study describes a case of infantile fibrosarcoma of the ileum in a female newborn examined for intestinal occlusion and its laparoscopic treatment.

The Role of Sonoelastography in the Evaluation of Testes With Varicocele

OBJECTIVE To evaluate the role of elastosonography in the evaluation of testicular elasticity as a predictive sign of testicular damage in patients with varicocele. MATERIALS AND METHODS Between December 2010 and December 2014, we evaluated patients with varicocele by sonoelastography (SE) of the testes. We created 3 groups: group A included patients with untreated varicocele; group B, patients treated with the same technique; and group C, healthy age-matched patients without varicocele. All patients underwent SE for the evaluation of testicular stiffness and results were graded from 1 to 3 following the color scale grading. RESULTS During the study period, 36 boys (9-16 years old) with untreated varicocele, 47 treated patients, and 24 age-matched healthy subjects underwent control visit for varicocele and SE. All right testes of all groups were scored as 1, whereas testes with varicocele were stiffer than normal; all hypotrophies were scored as 3, whereas not all testes that were scored 3 were associated with testicular hypotrophy. There was a significant and statistical recovery rate of the testicular volume and the sonoelastographic score after surgery. CONCLUSION Testes with varicocele are significantly stiffer than normal ones. All testes with testicular hypotrophy had grade 3 sonoelastographic scores, but not all patients with a grade 3 score have testicular hypotrophy or continuous spermatic vein reflux. Our results show that sonoelasography can play a significant role in the evaluation of testicular elasticity as a predictive sign of testicular damage.

Chronic graft versus host disease is associated with erectile dysfunction in allogeneic hematopoietic stem cell transplant patients: a single-center experience

Angelo Andreini , Nicola Zampieri , Claudio Costantini, Giovanni Malerba, Costanza Bruno, Gianluca Salvagno, Giuseppe Francia, Michele Gottardi, Michela Rimondini, Isacco Ferrarini, Giuseppe Lippi, Achille Ambrosetti, Fabio Benedetti and Cristina Tecchio Department of Medicine, Section of Hematology and Bone Marrow Transplant Unit, University of Verona, Verona, Italy; Department of Surgery, Pediatrics and Gynecology, Section of Pediatric Surgery, University of Verona, Verona, Italy; Department of Neuroscience, Biomedicine and Movement Science, Section of Biology and Genetics, University of Verona, Verona, Italy; Department of Diagnostics and Public Health, Section of Radiology, University of Verona, Verona, Italy; Department of Neuroscience, Biomedicine and Movement Science, Section of Clinical Biochemistry, University of Verona, Verona, Italy; Department of Medicine, Section of Endocrinology, University of Verona, Verona, Italy; Hematology Unit, Ospedale C a Foncello, Treviso, Italy; Department of Neuroscience, Biomedicine and Movement Science, Section of Clinical Psychology, University of Verona, Verona, Italy