Responding to a school SARS-CoV-2 outbreak: Insights and policy implications emerging from the pandemic.

Background: The SARS-CoV-2 pandemic has affected also the school environment. Prolonged closures and the weakness of available data prevent a definitive answer to the question of school transmission. We report our experience of responding to COVID-19 cases in the school setting, presenting a case study of the management of an outbreak in a large school. Methods: The LHA/ASL Roma 1 has organized the School Units with a structure firmly rooted in the territory. At the local level, the District Unit mainly manages the relationship with schools, while the Hygiene and Public Health Service of the Prevention Department holds a coordinating and facilitating role. The HPHS carries out contact tracing activities facilitated by the schools, through the figure of the COVID-19 Contact Person, who is specifically trained to manage the preliminary stages of the reports. Results: Following several reports of COVID-19 suspect cases from two schools and, after a complex phase of contact tracing, it was possible to identify the major transmission chains. Furthermore, we performed a population-based screening on the entire school. Beyond the known transmission chains, for which quarantine was already in place, only five additional cases emerged, all asymptomatic, out of 1,231 swabs tested with RT-PCR. Conclusions: Our experience confirms that an active interaction between the school and the School Unit made it possible to quickly control a potentially dangerous outbreak. The large-scale screening test demonstrated the substantial absence of collateral transmission chains. Effective contact tracing allowed to set forth a successful response. Our model of intervention can be used to support public health protocols regarding school outbreaks.

Multiple gastric carcinoids and pernicious anemia: report of a case.

A case of pernicious anemia associated with multiple gastric carcinoids is reported. The neoplastic growth was composed of enterochromaffin-like (ECL) cells, and ECL cell hyperplasia was observed also in hyperplastic polyps, inside the fundic glands and in small nests lying in the lamina propria (microcarcinoidosis). The possible relation between pernicious anemia and ECL cell hyperplasia is discussed.

[Problems of gastrointestinal angiography]. / Problemi di angiografia gastro-intestinale

The subject of abdominal angiography is discussed, for informational rather than technical reasons, on the basis of seven years personal experience. The method used to prepare the patient for angiography and emergency treatment of the various episodes of reaction to the contrast medium or of complications of arterial catheterism are illustrated and some of the most significant aspects of abdominal angiographic symptomatology described.

[Kohlrausch's plica (plica transversalis recti): localization, morphology, function]. / Plica di Kohlrausch (plica trasversalis recti): localizzazione, morfologia, funzione.

The plica transversalis recti (K Kohlrausch's plica or Houston's valve) shows a preferential double (52%) rather than triple (38%) localization and is absent in as much as 16% of cases. It is alternatively found on the left and right sides, 3-4 and 8-9 cm from the anal margin respectively. Both its detection rate and radiographic features depend on the technique used as follows: (a) 92%, contour indentation and/or linear filling defect, 4 to 5 mm thick at barium enema studies; (b) 67%, the same as in (a) plus 1/3 narrowing of the maximum diameter at defecography; and (c) 90%, two opposite and overlapping folds at coronal CT. Evidence is given that neither organic nor functional anorectal conditions affect the radiographic appearance of the fold, its likely role being to fix the proximal margins during the expulsion of feces.

[Dynamic radiologic study with video recording of the oral and pharyngeal stages of normal deglutition]. / Lo studio radiologico dinamico con videoregistrazione delle fasi orale e faringea della deglutizione normale.

The upsurge of interest in dynamic radiology of the oral pharyngeal phases of deglutition can be explained by: (a) the increased survival-rate in neuromuscular diseases; (b) the improved results in head and neck surgery and radiotherapy; (c) the awareness of the existence of a "silent" form of dysphagia. This paper is aimed at divulgating the radiological dynamic investigation of deglutition by videorecording, and at assessing the findings of a study on 119 consecutive non-dysphagic patients (55 males and 64 females; mean age 54 years) as a control group for future studies on dysphagic patients. Seventy-nine out of 119 subjects (66.4%) were found to be normal. Various abnormalities were observed in the remaining 40 (33.6%), such as barium penetration in the subepiglottic or supraglottic space (20 cases), dysmotility of the epiglottis (14 cases), transient and mild cricopharyngeal muscle dysfunction (17 cases), diverticula (6 cases). Further studies are needed to evaluate the true significance and implication of these findings in asymptomatic patients. Finally, a more widespread use of this method is hoped for, in order to establish its diagnostic and clinical efficacy.

[Methodology in gastrointestinal radiology. Suggestion for standards and preliminary results]. / Metodo in radiologia digestiva. Proposta di alcuni standard e risultati preliminari.

The Marche SIRMN group tried to set up standard of some common radiological examinations (cholecystography, single and double contrast examination of the upper gastro-intestinal tract, and single and double contrast enema). Scientific and professional reasons led to this work. Twenty-five radiologists from thirteen centers in the Marche region cooperated on it. Some differences between the plan and the real performance of the standard radiological examinations as well as between technical and methodological performance came out. Eventually preliminary and partial data about the cost of the procedures and the final diagnostic result were obtained.

[The coronal anatomy of the pelvis at rest and under straining]. / Anatomia coronale della pelvi a riposo e sotto sforzo.

Twenty-five subjects with no pelvic floor dysfunctions at defecography were examined with direct coronal CT scans of the pelvis at rest and on straining. Three compartments with different characteristics were delimited by two planes-the anterior one being tangent to the ischiatic foramen and the posterior one to the ischial tuberosities. At rest, the average length of the levator ani muscle and the surface of the supralevator space were significantly lower posteriorly than in the other two compartments (48.3 mm +/- 7.9; 48.8 mm +/- 7; 42.6 mm +/- 9.4, p < 0.05 and 70.6 cm2 +/- 7.5; 66.9 cm2 +/- 11.2; 27.2 cm2 +/- 4.8, p < 0.01, respectively). On straining, maximum muscle lengthening occurred posteriorly, as indicated by similar average values (63.7 mm +/- 12.7; 63.3 mm +/- 9.5 and 60.5 mm +/- 14) and the corresponding increase (+12.5%) in the supralevator space occurred in the middle compartment (73.8 cm2 +/- 7.6; 75.3 cm2 +/- 11.6 and 30.2 cm2 +/- 5.2). To conclude, our method proved reliable enough (intra- and interobserver correlation index > 80%) and promising for future clinical applications and studies of pelvic floor dysfunctions.

Small benign tumors of the esophagus: radiological diagnosis with double-contrast examination.

Benign tumors of the esophagus are rare. So far radiological examination has been useful in the diagnosis of fairly large benign tumors. In 4100 consecutive double-contrast studies we have found 22 incidental cases of protruded lesions of the esophagus with the appearance of submucosal tumor (8 cases) or polyp of the mucosa (14 cases). The lesions were small: 14 were less than 1 cm and 8 were between 1 and 3 cm. The histological data showed leiomyoma in the submucosal tumors and squamous papillomas in the polyps of the mucosa. A noteworthy feature is the unusual frequency of small squamous papillomas detected. The radiological diagnosis of benign tumors of the esophagus cannot be confined to large tumors in symptomatic patients but may include the accidental detection of small tumors. These call for histological verification and possibly endoscopic removal.

Reflux esophagitis: radiologic-endoscopic correlation in 39 symptomatic cases.

Thirty-nine consecutive patients with symptoms suggestive of reflux esophagitis underwent a double contrast upper gastrointestinal series and subsequently had endoscopy with biopsy. In a control group of 164 consecutive patients without symptoms of esophagitis a double contrast examination was done with the same method. We have found a significant increase of the diameter of the esophagus in its distal or cardiac segment (IDCE) in patients with esophagitis of Grades 1 and 2 when compared with the control group (p less than 0.001). Radiology was found to have correctly diagnosed 35 of the 39 cases (89.7%) and the majority of the patients had endoscopic signs of mild esophagitis.

[Critical analysis of the diagnostic imaging of focal hepatic lesions]. / Analisi critica della diagnostica per immagini delle lesioni epatiche focali.

The aim of this paper is to evaluate the number and type of consecutive initial diagnoses of focal hepatic lesions obtained by abdominal US and CT. The diagnoses were coded according to the Index for Radiological Diagnoses (ACR). From January 1990 through April 1991, US and CT diagnosed focal hepatic lesion in 16.4% and 9.1% of cases, respectively. A lower number of focal hepatic lesions was diagnosed by CT, which however was more accurate as to the nature of the lesion itself. This is due to the fact that CT is often used to stage hepatic neoplasms already confirmed by US-guided fine-needle biopsy (FBN). The correlation between the initial diagnosis and actual clinical status demonstrates a high rate of occasional findings, especially with US. The rate of questionable diagnoses relative to primary or secondary malignancies was very high. This could be explained by caution in making a severe diagnosis, by awareness of the limits of macroscopic diagnostic techniques and by the immediate availability of US-guided FNB. In conclusion, the coding of consecutive initial diagnoses, by US and CT, could contribute to a practical evaluation of diagnostic imaging techniques, especially when correlated with the respective anamnestic and clinical data. Further studies are necessary to confirm this hypothesis.

[Computerized tomography of the thorax and abdomen. Cost-effectiveness]. / Tomografia Computerizzata del torace e dell'addome. Costi ed efficacia.

This work was aimed at investigating the cost-effectiveness of body CT, toward better equipment allocation in a given area. CT economics were calculated taking into account four main parameters: equipment, drugs, sanitary material and personnel. The biological cost in terms of radiation exposure was calculated on the effective dose. Quality was evaluated by comparing it with that of our standard examinations and on the basis of the diagnostic yield according to the index of radiological diagnoses by the American College of Radiology (ACR). The economic cost of chest CT was It. L. 257,240, that of abdominal CT was It. L. 365,000 and that of both regions It. L. 464,620. The effective dose was relatively high, i.e., 15.2 mSV for chest CT, 18.65 mSV in men and 27.46 mSV in women for abdominal CT and finally 27.38 mSV in men and 33.59 in women for chest-abdominal CT. The coded diagnoses were positive in approximately 60% of the cases examined consecutively; positivity was related to clinically relevant conditions in most of the cases. The economics and the biological cost of body CT exams were closely related to exam quality, whose standard was high. The high rate of positive findings and the clinical relevance of the condition make an indirect indicator of high quality and of accurate patients selection. To conclude, the allocation of CT equipment in a given area should be preceded by a careful cost-effectiveness analysis, considering optimized equipment use as related to local clinical needs.

The effects of 4-pentenoic and pentanoic acids on the isolated rat atria.

The peak developed tension and the pacemaker frequency of the isolated atria from fed and fasted rats, declined progressively during the incubation in a glucose-free medium containing 2-deoxyglucose. The atria from fed rats exhibited a faster decline than those from fasted rats, which was associated to a slower triacylglycerol lipolysis. 4-Pentenoic acid inhibited the lipolysis of both groups of atria but did not alter the atrial contractile performance. However, it enhanced the decline of the pacemaker frequency in the atria from fasted rats whereas, in contrast, it alleviated the decline in the fed atria. n-Pentanoic acid ameliorated the impairment of the contractile and pacemaker activities in both groups of atria, without affecting the lipolysis. It was concluded that, since the inhibition of the intramyocardial lipolysis did not correlate with changes of the atrial functions, 4-pentenoic acid was not appropriate to assess about the contribution of endogenous triacylglycerol to the maintenance of the atrial contractile and pacemaker activities.

Radiologic diagnosis of early gastric cancer by routine double-contrast examination.

In 4538 double-contrast examinations of the upper gastrointestinal tract, 8 early gastric cancers (EGCs) were prospectively diagnosed before endoscopy. Four others were false negative cases, but retrospective analysis led to identification of the lesion in 3. The rate of EGC in radiologically diagnosed and verified cancers was found to be 10.6%. Gastric polyp rarely corresponded to EGC, whereas gastric ulcer more frequently corresponded to an EGC. Five of 12 EGCs were multifocal, with 21 satellite foci of carcinoma, of which 3 were probably radiologically identifiable as varioliform erosions. Routine double-contrast study appears valuable for detecting EGC, but the rate of false negative cases indicates that integration of radiologic, endoscopic, and cytologic data as well as accurate histopathologic study of the surgical specimen are needed to diagnose and characterize early gastric carcinoma.

Oropharyngeal and esophageal function in scleroderma.

Fifty-one patients with systemic sclerosis (scleroderma) underwent videofluoroscopy during barium swallow to evaluate the incidence of oropharyngeal deglutition abnormalities and to correlate the radiologic patterns of esophageal motility abnormalities with patients' clinical features. Thirteen patients (26%) showed swallowing dysfunction, (e.g., oral leakage, retention, penetration, mild or moderate aspiration, and upper esophageal sphincter incoordination). These dysfunctions were more severe in patients with prominent esophageal dysmotility. Normal esophageal motility was not associated with swallowing alterations. Patients with an oropharyngeal disorder had a higher incidence of pulmonary disease. The clinical picture of the above-mentioned 13 patients was more severe, based on the duration of Raynaud's phenomenon and duration of skin sclerosis. Patients with primary Raynaud's phenomenon had no oral or esophageal abnormalities. The esophageal phase of swallowing was abnormal in 80% of the patients with scleroderma. Esophageal dysfunction, therefore, seems to be frequent in the early stages of the disease. However, patients with advanced or extensive disease may have normal esophageal function.

[Radiologic aspects of the surface mucosa of the duodenal bulb. Correlation with the endoscopic and histological aspects]. / Aspetti radiologici della superficie mucosa del bulbo duodenale. Correlazione con gli aspetti endoscopici e istologici.

Double contrast barium meal, endoscopy and histology of the duodenal bulb were blindly compared in 47 consecutive patients. The agreement in the judgement of normality of the mucosal surface between radiology and endoscopy was 78%. The agreement in the diagnosis of presence or absence of nodularity and thickened folds was respectively 91% and 87%. The findings of nodularity correspond to duodenitis with pyloric metaplasia or to heterotopic gastric mucosa, while the thickened folds correspond to duodenitis with pyloric metaplasia, Brunner's hyperplasia, lymphatic nodular hyperplasia or cystic glandular dilatation. The diagnostic errors in the radiological examinations in respect to endoscopy is quite important in the case of erosions.