Amyand's hernia: role of CT for a correct diagnosis.

Amyand's hernia consists in the protrusion of the vermiform appendix into an inguinal hernia sac and represents an uncommon condition with a difficult preoperative diagnosis to be recognized with clinical examination and imaging diagnostic tools in order to choose a correct therapeutic approach for the patient. Four types of Amyand's hernias exist. The case of a recurrent type 1 Amyand's hernia is presented. Multi detector computed tomography allowed a correct diagnosis and the subsequent surgical treatment had no complication for the patient. Radiologists and surgeons need to be aware of this pathology and its classification, as well as of the importance of recognizing both the inflamed and normal appendix within the inguinal canal and the abdominal complications. With the availability of multi detector CT scanning, a greater number of type 1 and 2 hernias are able to be preoperatively diagnosed, and type 3 and 4 better characterized in emergency situation, allowing to perform the best surgical treatment and reducing the chances of pathological recurrence.

Coronary calcifications as a new prognostic marker in COVID-19 patients: role of CT.

OBJECTIVE: COVID-19 pneumonia, caused by the virus Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), was declared a pandemic by the WHO on 11th March 2020. While Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) represents the diagnostic gold standard of infection, computed tomography (CT) has been shown to have an important role in supporting the diagnosis, quantifying the severity, and assessing the efficacy of treatment and its response. Coronary artery calcification (CAC) is a CT finding that estimates atherosclerosis and can be quantified using the coronary artery calcium score (CACS). The purpose of this study is to demonstrate the correlation between coronary artery calcification and mortality rate in COVID-19 patients. PATIENTS AND METHODS: Three hundred seventeen (317) hospitalized patients with SARS-CoV-2 infection were ruled in this retrospective study. All patients underwent a non-ECG-gated chest CT to evaluate lung parenchymal involvement. In the same cohort, we observed the two main coronary arteries (common trunk, circumflex, anterior interventricular and right coronary heart) using a visual score, so patients were divided into four groups based on Ordinal CAC Score (OCS) levels. RESULTS: The multivariate analysis proved that the OCS value was statistically correlated with the mortality rate (p < 0.001). In fact, in the group of patients with an OCS value of 0, the mortality rate was 10.1% (10/99 patients), in the group with OCS between 1 and 4 was 18.9% (21/111), in the OCS group of patients ranged from 5 to 8 was 30.4% (24/79) and in the OCS group between 9 and 12 was 46.4% (13/28). CONCLUSIONS: We suggest that calcific atheromasia of the coronary arteries in patients with COVID-19 can be considered a prognostic marker of clinical outcome.

VEGF concentration from plasma-activated platelets rich correlates with microvascular density and grading in canine mast cell tumour spontaneous model.

Canine cutaneous mast cell tumour (CMCT) is a common cutaneous tumour in dog, with a higher incidence than in human. CMCT is classified in three subgroups, well and intermediately differentiated (G1 and G2), corresponding to a benign disease, and poorly differentiated (G3), corresponding to a malignant disease, which metastasize to lymph nodes, liver, spleen and bone marrow. In this study, we have evaluated serum (S), platelet-poor plasma (P-PP), plasma-activated platelet rich (P-APR) and cytosol vascular endothelial growth factor (VEGF) concentrations, microvascular density (MVD) and mast cell density (MCD) in a series of 86 CMCTs and we have correlated these parameters with each other, by means of ELISA detection of VEGF and immunohistochemistry. Results show that VEGF level from cytosol P-APR and MVD were significantly higher in G3 CMCTs as compared to G1 or G2 subgroups. Moreover, a significantly strong correlation among VEGF levels from P-PAR and cytosol, MVD and MCD was found in G3 subgroup. Because VEGF levels from P-APR well correlated with MVD and malignancy grade in CMCT, we suggest that VEGF might be secreted from MCs and it may be a suitable surrogate inter-species angiogenetic markers of tumour progression in CMCT. Finally, CMCT seems to be a useful model to study the role of MCs in tumour angiogenesis and inhibition of MCs degranulation or activation might be a new anti-angiogenic strategy worthy to further investigations.

Behaviour on the nasal provocation test in patients affected by conjunctivitis and/or asthma of allergic origin.

In the Allergo-Immunological Centre of Rome University we selected 120 patients of both sexes, ranging from 5-65 years of age, affected by asthma and/or conjunctivitis without past or present history of nasal impairment (itching, sneezing, hydrorrhea). As a result of the allergometric tests carried out, the authors divided the samples into three groups: 1) positive reaction to Dermatophagoides Pteronissimus (66.6%); 2) positive reaction to the Graminacee (28.3%); 3) positive reaction to Parietaria officinalis (5.1%). After having undergone the rhinoreomanometric test of nasal provocation, 50% of the patients revealed a positive reaction to the specific allergen, more specifically at 50 PNU/ml 40% of the case were positive, and at 100 PNU/ml 50% were positive. These results are discussed in the light of modern biological knowledge on the mastocytes in normal subjects and in those suffering from allergy.

Incidence of allergic rhinitis in children.

The authors give an account of the outcome of research done in the Allergo-Immunological Centre of the IInd ENT Division of Rome University, carried out among 210 children who were affected by nasal atopy. Particular stress was placed on the involvement of the nasopharyngo-tubal system. The age of the children ranged from 2-12 years and they underwent: 1) ENT visit; 2) allergy tests; 3) anterior rhinorheomanometry; 4) tubal function tests; 5) mucociliary clearance time; 6) X-ray examination of paranasal sinuses. The results revealed that the most frequent symptom in these children is rhinitis, whatever the allergic sensitization was. The forms of atopy which manifested themselves by chronical allergic patients (D.Pt. and P.O.) were the cause of: 1. asthmatic-type syndromes; 2. early onset of atopic symptoms around 4-7 years of age (9-10 years in the seasonal forms); 3. greater degree of extrinsic rhinitis with edema of the turbinates - the first step towards a polypoid degeneration of such subjects; 4. tubal functional deficit (60% of subjects allergic to P.O. and 50% allergic to D.Pt whereas only 27% are found in the seasonal forms); 5. mucociliary clearance linked directly with the length of disease; involvement of the paranasal sinuses (53/61 patients allergic to D.Pt., 9/28 allergic to P.O., 9/56 allergic to Graminacee). Furthermore the nasal patency was more insufficient in patients affected by the chronical forms of the atopy. In the light of these results the authors advocate focus attention on the significance of an early diagnosis of nasal atopy in children and the need for interdisciplinary collaboration among specialists.

Specific local immunotherapy in the treatment of hay fever.

The authors refer results of a 3-year study carried out on ten patients suffering from hay fever, diagnosed by means of skin tests, specific nasal provocation and serum RAST who underwent specific local immunotherapy consisting of application of an aqueous allergenic extract, the initial level of which was based on threshold values resulting from the nasal provocation test. The two-monthly check ups were based on the evaluation of mucociliary clearance, anterior rhinorheomanometry, specific nasal provocation and the test of Maunsell for blocking antibodies, as well as on the drawing up of a daily symptomatological diary for each single patient. The results were extremely interesting: subsidence of symptoms during the pollinating season, an increase in the number of blocking serum antibodies and of threshold values relative to specific nasal provocation. Conductance and mucociliary clearance, which were both decidedly pathological before beginning the local immunotherapy, slowly returned to the norm. The authors, furthermore, refer that the use of disodium cromoglycate during the first months of specific local immunotherapy which allows them to reach doses 5-7 times greater than those obtainable with the above mentioned form of treatment, offers uncertain advantages as far as local and above all general immunity is concerned and this alone does not justify the use of nasal applications in the treatment of bronchial asthma of allergic origin.

[Simple electrostimulator for clinical gustometry]. / Semplice electrostimolatore per geusimetria clinica.

The authors illustrate the technical characteristics of a low cost, pocket electrogustometer, which works on batteries and offers complete safety both for the patient and for the examiner; this model is able to carry out, both in normal and selected patients, the same functions as can be carried out with more sophisticated and costly equipment, currently available.

Specific local immunotherapy in nasal allergy (preliminary report).

The preliminary results are presented of a study carried out on 23 subjects with nasal allergy to graminacea, 10 of whom were used as a control group to verify the clinical advantages and the possible side effects of a specific local immunotherapy carried out in spray form using progressively increasing doses of allergen in aqueous solution. From a clinical point of view, on the grounds of the score in the clinical diary, we were able to show that during the preseasonal stage only 5 patients treated with the allergen were free of symptoms as were the controls, whereas during the critical phase they were all free of symptoms in contrast to the crisis presented in the control group. The increase in the threshold of nasal provocation and in the serum level of blocking antibodies, revealed in the majority of the subjects affected by pollinosis and treated locally with the allergen, are to be considered fundamental to the clinical advantage obtained. In agreement with what has already been revealed after specific nasal provocation, local treatment with allergens caused in a majority of cases a slight increase in the time of mucociliar clearance, a phenomenon which must be taken carefully into consideration in as much as it could eventually represent an adverse side effect which needs an adequate countermeasure.

Immotile cilia syndrome: radial spokes deficiency in a patient with Kartagener's triad.

Mucociliary transport and ultrastructure of nasal cilia in a 13 year old boy with Kartagener's triad, were investigated. Mucociliary transport was significantly delayed (greater than 30 minutes). Electron microscopy showed cilia lacking radial spokes, eccentric central tubules, and a dislocation of one the outer doublets. Dynein arms were present. We consider the radial spoke defect as a distinct congenital anomaly which contributes to the pathogenesis of the "immotile cilia syndrome".