Meigs syndrome is a rare disease defined by the coexistence of benign ovarian neoplasm, ascites a... more Meigs syndrome is a rare disease defined by the coexistence of benign ovarian neoplasm, ascites and hydrothorax, which mainly affects women over the age of 30. This clinical condition refers only to cases in which the ovarian neoformation is a fibroid, a thecoma, a granulosa cell tumor or a Brenner tumor with disappearance of symptoms and effusions after removal of the neoplasm. Meigs syndrome is most frequently characterized by the presence of an ovarian fibroid, which in childhood is very rare and not commonly associated with the disease. In this article we report the case of an 11- year-old girl who came to our observation for a high fever for five days accompanied by cough and abdominal pain; imaging methods revealed bilateral hydrothorax, ascites, and a voluminous expansive right ovarian formation. On histological examination, the mass showed a cellular fibroid and the diagnosis of Meigs syndrome was made. Furthermore, we present a review of the literature aimed at detecting the state of knowledge on this disease in pediatric age, giving particular emphasis to the condition for which, in the presence of pleural effusion and ascites, an ovarian neoformation is not necessarily malignant. KEY WORDS: CT, Meigs syndrome, Pediatric, Pelvic mass, Ultrasounds.
Chronic inflammatory bowel diseases (IBD) are chronic disorders of the gastrointestinal tract, wi... more Chronic inflammatory bowel diseases (IBD) are chronic disorders of the gastrointestinal tract, with an increasing incidence in pediatric populations. Ultrasound of the intestinal wall represents the first-line imaging technique in children since it is a noninvasive method, is free of ionizing radiation, and is inexpensive. Furthermore, the absence of intestinal wall thickening has a good negative predictive value for IBD, which is greater for Crohn's disease than for ulcerative colitis. Ultrasound is used for the diagnosis of disease, for the differential diagnosis in IBD, in the follow-up of known IBD, in the definition of the site and extent of the disease, for the diagnosis of intestinal complications, for the evaluation of disease activity, in the definition of prognostic parameters, and in the postoperative follow-up.
Biomedical Journal of Scientific and Technical Research, Aug 16, 2019
Assisted ventilation in preterm infants treated for respiratory distress syndrome (RDS) may cause... more Assisted ventilation in preterm infants treated for respiratory distress syndrome (RDS) may cause typically neonatal pneumomediastinum. [1] It is often anterior or anterolateral to the heart and is caused by the escape of air from the broken alveoli through the perivascular sheaths which, moving towards the hilum, finally reaches the anterior mediastinum [2]. The cause is the development of a pressure difference between the alveoli and the perivascular and peribronchial spaces with alveolar break and diffusion of air to the hilus and into the mediastinum that generate airway stretching with lung damage (volutrauma) [3,4]. The aim of this paper is to analyze these unusual patterns through an approach by multidetector CT (MDCT). We report three cases of loculated/ pseudo cystic para cardiac collections anterior and posterior to the hearth mimicking congenital and non-congenital conditions. Methods Three newborns with respiratory distress and atypical chest X ray signs have been submitted to chest CT. CT studies were performed on one of the following scanners: A secondgeneration dual source CT system (Siemens Somatom Definition Flash, Siemens Erlangen, Germany), with two x-ray tubes and two detectors settled at an angular offset of 95°. A Somaton Sensation 64 (Siemens Medical Solutions, Erlangen, Germany). In both the systems we used a tube current modulation (CARE Dose) with kVp: 70-80 and ref. mAs: 70. Images were reconstructed with a slice thickness of 1 mm. Kernel/Algorithm: B30, B60. With the dual source, Sinogram-Affirmed Iterative Reconstruction (SAFIRE) filter, strength of 1, was employed. None of the children required sedation for CT examinations. We did not inject contrast media because it was considered superfluous. The cases reported for the differential diagnosis studied by CT were performed with the same systems. Cross sectional imaging by MRI was obtained by a 1.5 T MRI scanner
Biomedical Journal of Scientific & Technical Research, Sep 22, 2017
A 2-year-old Caucasian female patient, referred to our Department, presented on physical examinat... more A 2-year-old Caucasian female patient, referred to our Department, presented on physical examination a symmetrical duplication of the 5th finger in both hands and feet. (Figure 1) Bone structures could be also palpated and observed at X-ray exam (Figures 1 & 2). Clinical family history was negative for malformation disease or teratogenic drugs taken during pregnancy. Furthermore the child was not suffering from other associated malformations or organ dysfunction, the genetic examinations showed a normal karyo type and the absence of known mutations. She had no other anomalies and growth and development were normal. Radiographic examination showed six sets of phalanges with five metacarpals Figure 1; the last finger did not have an associated metacarpal in both hands but on the left the proximal phalanx of the last finger appears fused with the fifth metacarpal instead on the right hand the sixth finger is attached by a skin bridge only. The long bones of the arms were normal. According to Stelling and Turek classification, the right hand can be classificated as Type I, the left one as Type II [1].
In infants and children, the spleen is involved in many pathological processes, whether those pro... more In infants and children, the spleen is involved in many pathological processes, whether those processes are isolated or related to systemic diseases. Pathology of the pediatric spleen includes congenital anomalies, splenomegaly, trauma, focal lesions, infarction, and tumors. Ultrasonography (US) is a widely available, fast, noninvasive imaging technique to assess the size, shape, and position of the spleen, as well as to define splenic echotexture. US is capable of screening for splenic disorders without the risk of ionizing radiation; it is the initial imaging examination performed to evaluate suspected splenic pathology, providing clinicians with helpful decisional support. US plays an important role in the detection of even very small amounts of hemoperitoneum, a herald of significant abdominal organ injury, in pediatric blunt abdominal trauma. Moreover, contrastenhanced US may allow early detection of splenic injuries, ideally minimizing children's risk from radiation exposure. This pictorial essay illustrates the normal ultrasound appearance of the pediatric spleen and the sonographic findings which may guide clinicians to a correct diagnosis of pathologic conditions.
The effects of a chronic treatment with octreotide were evaluated in 19 patients affected with fu... more The effects of a chronic treatment with octreotide were evaluated in 19 patients affected with functionless pituitary adenomas. Octreotide caused a significant decrease of GH and IGF-I levels in all the patients and no significant change in thyroid, adrenal and gonadal function. In contrast, during the therapy, the glucose response to an oral glucose tolerance test considerably increased and was delayed, while the insulin response decreased and was delayed. Serum alpha-subunit (alpha-SU) was above normal in 10 of 16 patients in which this evaluation was performed: octreotide caused a significant decrease (p < 0.01) of alpha-SU levels in 6 of these 10 patients. Octreotide did not induce any significant change in visual fields except in 1 patient, who had a great improvement of visual perimetry and a decrease of alpha-SU levels but unmodified CT scan features. In our series of patients, octreotide was ineffective in reducing tumor mass. The efficacy of octreotide might rely on the presence of somatostatin receptors on adenoma-cell membranes. Therefore patients with functionless adenomas to be treated with octreotide might be identified with pituitary scintiscan using the recently available labeled 111In-octreotide.
Subjects: Twenty vertically HIV-infected children, 6-16 years of age, with stable viral load cont... more Subjects: Twenty vertically HIV-infected children, 6-16 years of age, with stable viral load control and CD4+ values above 400 cells/mm 3. Intervention: Ten subjects continued their ongoing antiretroviral treatment (ART, Group A) and 10 were immunized with a HIV-DNA vaccine in addition to their previous therapy (ART and vaccine, Group B). The genetic vaccine represented HIV-1 subtypes A, B and C, encoded Env, Rev, Gag and RT and had no additional adjuvant. Immunizations took place at weeks 0, 4 and 12, with a boosting dose at week 36. Monitoring was performed until week 60 and extended to week 96. Results: Safety data showed good tolerance of the vaccine. Adherence to ART remained high and persistent during the study and did not differ significantly between controls and vaccinees. Neither group experienced either virological failure or a decline of CD4+ counts from baseline. Higher HIV-specific cellular immune responses were noted transiently to Gag but not to other components of the vaccine. Lymphoproliferative responses to a virion antigen HIV-1 MN were higher in the vaccinees than in the controls (p = 0.047), whereas differences in reactivity to clade-specific Gag p24, RT or Env did not reach significance. Compared to baseline, the percentage of HIV-specific CD8+ lymphocytes releasing perforin in the Group B was higher after the vaccination schedule had been completed (p = 0.031). No increased CD8+ perforin levels were observed in control Group A. Conclusions: The present study demonstrates the feasibility, safety and moderate immunogenicity of genetic vaccination in vertically HIV-infected children, paving the way for amplified immunotherapeutic approaches in the pediatric population.
Myeloid sarcoma is a rare tumor composed of proliferation of myeloid precursors cells in an extra... more Myeloid sarcoma is a rare tumor composed of proliferation of myeloid precursors cells in an extramedullary site; it can be located in any part of the body, but is most frequently encountered in the bone, periosteum, skin and soft tissues, orbit, lymph nodes, gastrointestinal tract and central nervous system, while involvement of the kidney is uncommon. The associated clinical symptoms depend on the localization of the tumour. Myeloid sarcoma is often the extramedullary manifestation of acute myeloid leukemia and is less commonly associated with myelodysplastic syndrome, chronic myeloid leukemia and other myeloproliferative diseases. Myeloid sarcoma generally manifests concurrently or during the course of acute myeloid leukemia but may present as initial manifestation in the absence of bone marrow involvement; moreover, it can also be expression of the relapse of the hematological disease. In children with diagnosis of acute myeloid leukemia the incidence rate of myeloid sarcoma reaches 40%. Myeloid sarcoma shows slight predilection for males and is most frequent in young children than in adolescents and adults. In this article, we report a case of an 11-year-old boy with myeloid sarcoma of the kidney without bone marrow involvement.
Meigs syndrome is a rare disease defined by the coexistence of benign ovarian neoplasm, ascites a... more Meigs syndrome is a rare disease defined by the coexistence of benign ovarian neoplasm, ascites and hydrothorax, which mainly affects women over the age of 30. This clinical condition refers only to cases in which the ovarian neoformation is a fibroid, a thecoma, a granulosa cell tumor or a Brenner tumor with disappearance of symptoms and effusions after removal of the neoplasm. Meigs syndrome is most frequently characterized by the presence of an ovarian fibroid, which in childhood is very rare and not commonly associated with the disease. In this article we report the case of an 11- year-old girl who came to our observation for a high fever for five days accompanied by cough and abdominal pain; imaging methods revealed bilateral hydrothorax, ascites, and a voluminous expansive right ovarian formation. On histological examination, the mass showed a cellular fibroid and the diagnosis of Meigs syndrome was made. Furthermore, we present a review of the literature aimed at detecting the state of knowledge on this disease in pediatric age, giving particular emphasis to the condition for which, in the presence of pleural effusion and ascites, an ovarian neoformation is not necessarily malignant. KEY WORDS: CT, Meigs syndrome, Pediatric, Pelvic mass, Ultrasounds.
Chronic inflammatory bowel diseases (IBD) are chronic disorders of the gastrointestinal tract, wi... more Chronic inflammatory bowel diseases (IBD) are chronic disorders of the gastrointestinal tract, with an increasing incidence in pediatric populations. Ultrasound of the intestinal wall represents the first-line imaging technique in children since it is a noninvasive method, is free of ionizing radiation, and is inexpensive. Furthermore, the absence of intestinal wall thickening has a good negative predictive value for IBD, which is greater for Crohn's disease than for ulcerative colitis. Ultrasound is used for the diagnosis of disease, for the differential diagnosis in IBD, in the follow-up of known IBD, in the definition of the site and extent of the disease, for the diagnosis of intestinal complications, for the evaluation of disease activity, in the definition of prognostic parameters, and in the postoperative follow-up.
Biomedical Journal of Scientific and Technical Research, Aug 16, 2019
Assisted ventilation in preterm infants treated for respiratory distress syndrome (RDS) may cause... more Assisted ventilation in preterm infants treated for respiratory distress syndrome (RDS) may cause typically neonatal pneumomediastinum. [1] It is often anterior or anterolateral to the heart and is caused by the escape of air from the broken alveoli through the perivascular sheaths which, moving towards the hilum, finally reaches the anterior mediastinum [2]. The cause is the development of a pressure difference between the alveoli and the perivascular and peribronchial spaces with alveolar break and diffusion of air to the hilus and into the mediastinum that generate airway stretching with lung damage (volutrauma) [3,4]. The aim of this paper is to analyze these unusual patterns through an approach by multidetector CT (MDCT). We report three cases of loculated/ pseudo cystic para cardiac collections anterior and posterior to the hearth mimicking congenital and non-congenital conditions. Methods Three newborns with respiratory distress and atypical chest X ray signs have been submitted to chest CT. CT studies were performed on one of the following scanners: A secondgeneration dual source CT system (Siemens Somatom Definition Flash, Siemens Erlangen, Germany), with two x-ray tubes and two detectors settled at an angular offset of 95°. A Somaton Sensation 64 (Siemens Medical Solutions, Erlangen, Germany). In both the systems we used a tube current modulation (CARE Dose) with kVp: 70-80 and ref. mAs: 70. Images were reconstructed with a slice thickness of 1 mm. Kernel/Algorithm: B30, B60. With the dual source, Sinogram-Affirmed Iterative Reconstruction (SAFIRE) filter, strength of 1, was employed. None of the children required sedation for CT examinations. We did not inject contrast media because it was considered superfluous. The cases reported for the differential diagnosis studied by CT were performed with the same systems. Cross sectional imaging by MRI was obtained by a 1.5 T MRI scanner
Biomedical Journal of Scientific & Technical Research, Sep 22, 2017
A 2-year-old Caucasian female patient, referred to our Department, presented on physical examinat... more A 2-year-old Caucasian female patient, referred to our Department, presented on physical examination a symmetrical duplication of the 5th finger in both hands and feet. (Figure 1) Bone structures could be also palpated and observed at X-ray exam (Figures 1 & 2). Clinical family history was negative for malformation disease or teratogenic drugs taken during pregnancy. Furthermore the child was not suffering from other associated malformations or organ dysfunction, the genetic examinations showed a normal karyo type and the absence of known mutations. She had no other anomalies and growth and development were normal. Radiographic examination showed six sets of phalanges with five metacarpals Figure 1; the last finger did not have an associated metacarpal in both hands but on the left the proximal phalanx of the last finger appears fused with the fifth metacarpal instead on the right hand the sixth finger is attached by a skin bridge only. The long bones of the arms were normal. According to Stelling and Turek classification, the right hand can be classificated as Type I, the left one as Type II [1].
In infants and children, the spleen is involved in many pathological processes, whether those pro... more In infants and children, the spleen is involved in many pathological processes, whether those processes are isolated or related to systemic diseases. Pathology of the pediatric spleen includes congenital anomalies, splenomegaly, trauma, focal lesions, infarction, and tumors. Ultrasonography (US) is a widely available, fast, noninvasive imaging technique to assess the size, shape, and position of the spleen, as well as to define splenic echotexture. US is capable of screening for splenic disorders without the risk of ionizing radiation; it is the initial imaging examination performed to evaluate suspected splenic pathology, providing clinicians with helpful decisional support. US plays an important role in the detection of even very small amounts of hemoperitoneum, a herald of significant abdominal organ injury, in pediatric blunt abdominal trauma. Moreover, contrastenhanced US may allow early detection of splenic injuries, ideally minimizing children's risk from radiation exposure. This pictorial essay illustrates the normal ultrasound appearance of the pediatric spleen and the sonographic findings which may guide clinicians to a correct diagnosis of pathologic conditions.
The effects of a chronic treatment with octreotide were evaluated in 19 patients affected with fu... more The effects of a chronic treatment with octreotide were evaluated in 19 patients affected with functionless pituitary adenomas. Octreotide caused a significant decrease of GH and IGF-I levels in all the patients and no significant change in thyroid, adrenal and gonadal function. In contrast, during the therapy, the glucose response to an oral glucose tolerance test considerably increased and was delayed, while the insulin response decreased and was delayed. Serum alpha-subunit (alpha-SU) was above normal in 10 of 16 patients in which this evaluation was performed: octreotide caused a significant decrease (p < 0.01) of alpha-SU levels in 6 of these 10 patients. Octreotide did not induce any significant change in visual fields except in 1 patient, who had a great improvement of visual perimetry and a decrease of alpha-SU levels but unmodified CT scan features. In our series of patients, octreotide was ineffective in reducing tumor mass. The efficacy of octreotide might rely on the presence of somatostatin receptors on adenoma-cell membranes. Therefore patients with functionless adenomas to be treated with octreotide might be identified with pituitary scintiscan using the recently available labeled 111In-octreotide.
Subjects: Twenty vertically HIV-infected children, 6-16 years of age, with stable viral load cont... more Subjects: Twenty vertically HIV-infected children, 6-16 years of age, with stable viral load control and CD4+ values above 400 cells/mm 3. Intervention: Ten subjects continued their ongoing antiretroviral treatment (ART, Group A) and 10 were immunized with a HIV-DNA vaccine in addition to their previous therapy (ART and vaccine, Group B). The genetic vaccine represented HIV-1 subtypes A, B and C, encoded Env, Rev, Gag and RT and had no additional adjuvant. Immunizations took place at weeks 0, 4 and 12, with a boosting dose at week 36. Monitoring was performed until week 60 and extended to week 96. Results: Safety data showed good tolerance of the vaccine. Adherence to ART remained high and persistent during the study and did not differ significantly between controls and vaccinees. Neither group experienced either virological failure or a decline of CD4+ counts from baseline. Higher HIV-specific cellular immune responses were noted transiently to Gag but not to other components of the vaccine. Lymphoproliferative responses to a virion antigen HIV-1 MN were higher in the vaccinees than in the controls (p = 0.047), whereas differences in reactivity to clade-specific Gag p24, RT or Env did not reach significance. Compared to baseline, the percentage of HIV-specific CD8+ lymphocytes releasing perforin in the Group B was higher after the vaccination schedule had been completed (p = 0.031). No increased CD8+ perforin levels were observed in control Group A. Conclusions: The present study demonstrates the feasibility, safety and moderate immunogenicity of genetic vaccination in vertically HIV-infected children, paving the way for amplified immunotherapeutic approaches in the pediatric population.
Myeloid sarcoma is a rare tumor composed of proliferation of myeloid precursors cells in an extra... more Myeloid sarcoma is a rare tumor composed of proliferation of myeloid precursors cells in an extramedullary site; it can be located in any part of the body, but is most frequently encountered in the bone, periosteum, skin and soft tissues, orbit, lymph nodes, gastrointestinal tract and central nervous system, while involvement of the kidney is uncommon. The associated clinical symptoms depend on the localization of the tumour. Myeloid sarcoma is often the extramedullary manifestation of acute myeloid leukemia and is less commonly associated with myelodysplastic syndrome, chronic myeloid leukemia and other myeloproliferative diseases. Myeloid sarcoma generally manifests concurrently or during the course of acute myeloid leukemia but may present as initial manifestation in the absence of bone marrow involvement; moreover, it can also be expression of the relapse of the hematological disease. In children with diagnosis of acute myeloid leukemia the incidence rate of myeloid sarcoma reaches 40%. Myeloid sarcoma shows slight predilection for males and is most frequent in young children than in adolescents and adults. In this article, we report a case of an 11-year-old boy with myeloid sarcoma of the kidney without bone marrow involvement.
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Papers by Eugenio Rossi