Diagnostic approach to hypersensitivity reactions to iodinated contrast media: a single-center experience on 98 patients.

Summary: Adverse reactions to iodinated contrast media (ICM) are reported in 1%-3% of diagnostic procedures. They represent a relevant problem involving patients' safety as well as relevant costs for healthcare systems. Premedication with antihistamines and corticosteroids is still widely used, but evidence of its efficacy is lacking and there is a risk for under-estimation of possible severe adverse reactions to ICM in those who undergo premedication. Data from 98 patients with a previous reaction to ICM that consecutively referred to our unit between 2015 and 2018 were retrospectively analyzed. They underwent an allergologic workup comprehending skin tests and drug provocation tests (DPT) with ICM. The skin test showed a very high negative predictive value (NPV) compared to DPT in patients with a previous immediate adverse reaction, while the NPV in patients with a previous delayed adverse reaction was lower. After completion of the allergologic workup, 94 patients (95.9%) could tolerate a DPT with the culprit or alternative ICM. Subsequently, 90 patients were reached by phone to assess if they had been re-exposed to ICM for radiologic procedure. Thirty-nine patients had been re-exposed, without any premedication in 13 cases: 12 of them had tolerated the ICM, while one reacted again despite a negative DPT with the same ICM. Overall, the NPV of this protocol was elevated (92.3%) for patients undergoing DPT and subsequent exposure to the same ICM in a real-life setting. Collaboration between the prescribing physician, the radiologist and the allergist, and an accurate allergologic workup are essential to ensure maximum safety for the patient.

Carbamoyl phosphate synthetase 1 deficiency in Italy: clinical and genetic findings in a heterogeneous cohort.

Carbamoyl Phosphate Synthetase 1 deficiency (CPS1D) is a rare autosomal recessive urea cycle disorder, potentially leading to lethal hyperammonemia. Based on the age of onset, there are two distinct phenotypes: neonatal and late form. The CPS1 enzyme, located in the mitochondrial matrix of hepatocytes and epithelial cells of intestinal mucosa, is encoded by the CPS1 gene. At present more than 220 clear-cut genetic lesions leading to CPS1D have been reported. As most of them are private mutations diagnosis is complicated. Here we report an overview of the main clinical findings and biochemical and molecular data of 13 CPS1D Italian patients. In two of them, one with the neonatal form and one with the late form, cadaveric auxiliary liver transplant was performed. Mutation analysis in these patients identified 17 genetic lesions, 9 of which were new confirming their "private" nature. Seven of the newly identified mutations were missense/nonsense changes. In order to study their protein level effects, we performed an in silico analysis whose results indicate that the amino acid substitutions occur at evolutionary conserved positions and affect residues necessary for enzyme stability or function.

[Lung cancer with bronchial stenosis due to foreign body and Entoameba gingivalis infection]. / Carcinoma con stenosi bronchiale da corpo estraneo e infezione da Entoameba gingivalis. Case report.

Oral cavity infection by protozoarian agents may lead to pathologies such as stomatitis and gengivitis. An higher incidence has been reported in immunocompromised patients and in patients with dental disorders. Entoameba gingivalis localizes into oral cavity and in particular into interstitial and interdental spaces. Infection propagation to bronchial or lung parenchyma represents a complication. In this report the Authors, starting from a recently treated case, discuss on the incidence, complications and surgical management of lung infection by Entoameba gingivalis.

[Bilateral and multiple traumatic pulmonary pseudo-cysts: a case report]. / Pneumatocele post-traumatico: a proposito di un caso a localizzazione multipla bilaterale.

Traumatic pulmonary pseudocyst is a very rare consequence of blunt chest trauma characterized by formation of cystic like parenchymal lesions. Generally multiple and bilateral distribution is more rare than a single localization. The computed tomography (CT) scan has an higher diagnostic value compared with conventional chest X-ray. Prognosis of traumatic pseudocysts is generally good with benign clinical course and spontaneous resolution within several months. However initial strictly patient follow-up is necessary to early discover and treat potentially severe complications. Utility of chest magnetic resonance imaging (MRI) to exclude potentially severe infectious complications is described. Any complications required percutaneous drainage or surgical resection.

[Thoracic trauma: incidence, social and economic costs, educational opportunities. Experience on the last eight years of Thoracic Surgical Unit of Messina University]. / Il trauma toracico: incidenza, costi socio-economici, ricaduta didattico-formativa. Esperienza della Cattedra di Chirurgia Toracica dell'Università di Messina negli ultimi otto anni.

The Authors, after extensive introduction on the incidence, etiology, classification, pathophysiology, possible complications, diagnosis and treatment of thoracic trauma, relate their experience on the last eight years, stressing the diagnostic and therapeutic strategy in management of trauma simple and complicated and assessing finally serious social impact of these pathologies and the educational opportunities provided.

Type a niemann-pick disease. Description of three cases with delayed myelination.

We describe three patients with type A Niemann-Pick disease (NPD-A). NPD-A is an autosomal recessive neuronal storage disease classified among the sphingolipidoses, characterized by accumulation of sphingomyelin in various tissues and in the brain. Magnetic Resonance imaging (MRI) of our three patients showed a marked delay of myelination with frontal atrophy. Few descriptions of this MRI pattern of delayed myelination have been published to date.

["Intentionally" limited pulmonary resection versus lobectomy for the treatment of peripheral stage IA non-small cell lung cancers]. / Resezioni polmonari limitate "intenzionali" versus lobectomie nel trattamento dei tumori polmonari periferici non microcitomi allo stadio IA.

BACKGROUND: The purpose of this study is to assess, through the retrospective analysis of our experience and the literature review, whether the limited pulmonary resection is comparable to lobectomy for treatment of the peripheral stage IA (T1N0M0) non-small cell lung cancers (NSCLC), in terms of oncologic radicality, survival and rate of local, regional and systemic recurrences. Moreover it has been considered the impact of the limited resections in comparison with the lobar resections on the postoperative pulmonary function. PATIENTS AND METHODS: We have analyzed a consecutive series of 36 patients, 28 men and 8 women, of inclusive age among the 61 to 81 years (average 73 years), who underwent surgical resection from January 2000 to December 2003 for T1N0M0 peripheral NSCLC; 11 limited resections and 25 lobectomies have been performed. Comparatively survival and recurrences (follow-up period of 3-5 years) are been analyzed, as well as the pulmonary function tests at 1 year after surgery. RESULTS: The 3-year and 5-year survivals were 88% and 82% in the patient's group underwent to limited resection , 93% and 88% in the patient's group underwent to lobectomy. Postoperative local recurrence was noted in 1 patient (9%) of the first group and in 1 patient (4%) of the second group. One year after surgery was noted a moderate decline in the forced expiratory volume in 1 second (FEV1) and in the diffusing capacity for carbon monoxide (DLCO) in the patients who underwent to lobar resection, whereas in the patient's group submitted to limited resection was observed a substantial maintenance, except for the DLCO, of the preoperative pulmonary function tests. CONCLUSIONS: Our limited experience, according to the actual tendencies of the literature, show that the limited pulmonary resections, in selected patients with peripheral stage IA NSCLC, represents a valid alternative to lobectomy in terms of survival and recurrence's rate, also determining a lower decrement of the postoperative pulmonary function. Therefore the segmentectomy can be considered, in such cases, the gold-standard procedure even if the patient is able to bear a wider resection.

[Percutaneous radio frequency thermal ablation of non-resectable lung cancer: state of the art]. / Termoablazione percutanea con radiofrequenza dei tumori polmonari inoperabili: stato dell'arte.

BACKGROUND: Unfortunately, as of yet, most lung cancers are not operable as soon as diagnosis is available; in these situations chemo- and radio-therapy still play a key role, albeit palliative, improving survival rate moderately, but are not lacking in toxic effects, especially in case of concurrent pathology, reduced cardio-respiratory functionality or being advanced in years. Therefore thermal ablation mini-invasive techniques, already employed as ancillary treatments of hepatic cancer or in place of surgery, have been performed for these pathologies. AIM: Aim of this work is to define the current state of the art for Radio-Frequency Ablation (RFA) to be performed on non-resectable lung cancer, also by means of a thorough review of international literature, from which to infer purposes, suggestions, methodologies, effectiveness, safety, complications and achievements, also in terms of the possible improvement of life quality and/or survival expectancy. PATIENTS AND METHODS: Patients have been carefully selected. Pulmonary nodules have been treated with TC or echo-guided percutaneous thermal ablation and, afterwards, evaluated by radiological and clinical (sometimes histopathological) follow-up. RESULTS: The size of the RFA-treated nodules is necessary in order to evaluate full or partial necrosis extent and, therefore, average survival rate. CONCLUSIONS: Availability of more extensive and homogeneous case histories, as well as standard follow-up (TC and/or histopathological sampling) methodologies, is required. Nevertheless several authors agree that RFA is a safe and effective technique within the framework of a substitutive or complementary treatment of non-operable lung cancer. The best results can be achieved for cancers less than 3 cm wide; RFA, performed before chemo- and/or radio-therapy, plays a neoadjuvant role for larger cancers, decreasing cancer volume and weakening the symptoms.

Crohn's-like ileo-colitis in patients affected by glycogen storage disease Ib: two years' follow-up of patients with a wide spectrum of gastrointestinal signs.

AIM: To investigate the presence of inflammatory bowel disease (IBD) and to evaluate the progression of bowel involvement after two years' follow-up in seven patients affected by glycogen storage disease type Ib (GSDIb). METHODS: Seven patients (5F, 2M, aged 4.5-20.6 y) entered the study. Bowel involvement was evaluated by ileocolonoscopy and specific IBD serologic markers. To evaluate disease activity, Paediatric Crohn's Disease Activity Index (PCDAI), terminal ileum wall thickness detected at ultrasonography (US), 99mTechnetium labelled autologous White Cell Scan (Tc-WCS) and barium meal with follow-through were investigated. RESULTS: Ileocolonoscopy and histology examination revealed variable degrees of bowel involvement in all patients. The results of serologic markers were indicative of a Crohn's-like ileocolitis. US and Tc-WCS, could clearly define patients with severe inflammatory involvement, but failed to identify all patients with mild to moderate disease. For the most severely affected patients, anti-inflammatory agents and steroids were prescribed, whereas nutritional therapy with polymeric formula and antibiotics were assumed by two other patients and antibiotics only by one patient. Granulocyte colony-stimulating factor (G-CSF) was prescribed to all patients. Ileocolonoscopy and histology data improved in all patients. The assumption of G-CSF and/or gastric drip feeding (g.d.f.) was inversely associated with the PCDAI results (p < 0.05). CONCLUSION: IBD is common in patients affected by GSDIb independently of the severity of gastrointestinal signs and symptoms. Different therapeutic approaches can be used according to the severity of IBD. G-CSF treatment and g.d.f. can be protective factors for IBD.

[Pulmonary hernia]. / Le ernie polmonari.

Chest-wall hernia is a very unusual pathological event. The Authors report a singular diagnostic case of chest-wall hernia, miming rib tumor. Instrumental diagnostic tools and surgical treatment is reported. Finally patient's follow-up is discussed.