Retroperitoneal ganglioneuroma in a 15-year-old boy, an interesting case studied through multimodal imaging.

Benign ganglioneuroma contains mature autonomous ganglion cells, including satellite cells and long axonal processes, as well as Schwann cells, which come from neural crest-derived cells that form the adrenal medulla and sympathetic nervous system during embryonic development and is a rare benign tumor which occurs spontaneously and can also occur during radiotherapy or chemotherapy, accounting for 0.72% -1.6% of primary retroperitoneal tumors, commonly found in the posterior mediastinum and retroperitoneum, and affected patients usually have no symptoms due to of its non-functional feature, although several complications can arise if the tumor is large enough to press against adjacent organs.

Iliopsoas hematoma in patients with COVID-19 on low-molecular-weight heparin treatment.

Patients with COVID-19 are at high risk of thromboembolic events; for this reason, the use of heparin is largely recommended but, in addition to thrombotic complications, bleeding is a significant cause of morbidity in patients with COVID-19. Idiopathic iliopsoas hematoma is a very rarely described hemorrhagic complication in patients with COVID-19. We report here two cases of iliopsoas hematoma in male patients with COVID-19 and being treated with heparin.

Efficacy and Effect of Inhaled Adenosine Treatment in Hospitalized COVID-19 Patients.

Lack of specific antiviral treatment for COVID-19 has resulted in long hospitalizations and high mortality rate. By harnessing the regulatory effects of adenosine on inflammatory mediators, we have instituted a new therapeutic treatment with inhaled adenosine in COVID-19 patients, with the aim of reducing inflammation, the onset of cytokine storm, and therefore to improve prognosis. The use of inhaled adenosine in COVID19 patients has allowed reduction of length of stay, on average 6 days. This result is strengthened by the decrease in SARS-CoV-2 positive days. In treated patients compared to control, a clear improvement in PaO2/FiO2 was observed together with a reduction in inflammation parameters, such as the decrease of CRP level. Furthermore, the efficacy of inhaled exogenous adenosine led to an improvement of the prognosis indices, NLR and PLR. The treatment seems to be safe and modulates the immune system, allowing an effective response against the viral infection progression, reducing length of stay and inflammation parameters.

Therapeutic effects of adenosine in high flow 21% oxygen aereosol in patients with Covid19-pneumonia.

BACKGROUND: SARS-Cov2 infection may trigger lung inflammation and acute-respiratory-distress-syndrome (ARDS) that requires active ventilation and may have fatal outcome. Considering the severity of the disease and the lack of active treatments, 14 patients with Covid-19 and severe lung inflammation received inhaled adenosine in the attempt to therapeutically compensate for the oxygen-related loss of the endogenous adenosine→A2A adenosine receptor (A2AR)-mediated mitigation of the lung-destructing inflammatory damage. This off label-treatment was based on preclinical studies in mice with LPS-induced ARDS, where inhaled adenosine/A2AR agonists protected oxygenated lungs from the deadly inflammatory damage. The treatment was allowed, considering that adenosine has several clinical applications. PATIENTS AND TREATMENT: Fourteen consecutively enrolled patients with Covid19-related interstitial pneumonitis and PaO2/FiO2 ratio<300 received off-label-treatment with 9 mg inhaled adenosine every 12 hours in the first 24 hours and subsequently, every 24 days for the next 4 days. Fifty-two patients with analogue features and hospitalized between February and April 2020, who did not receive adenosine, were considered as a historical control group. Patients monitoring also included hemodynamic/hematochemical studies, CTscans, and SARS-CoV2-tests. RESULTS: The treatment was well tolerated with no hemodynamic change and one case of moderate bronchospasm. A significant increase (> 30%) in the PaO2/FiO2-ratio was reported in 13 out of 14 patients treated with adenosine compared with that observed in 7 out of52 patients in the control within 15 days. Additionally, we recorded a mean PaO2/FiO2-ratio increase (215 ± 45 vs. 464 ± 136, P = 0.0002) in patients receiving adenosine and no change in the control group (210±75 vs. 250±85 at 120 hours, P>0.05). A radiological response was demonstrated in 7 patients who received adenosine, while SARS-CoV-2 RNA load rapidly decreased in 13 cases within 7 days while no changes were recorded in the control group within 15 days. There was one Covid-19 related death in the experimental group and 11in the control group. CONCLUSION: Our short-term analysis suggests the overall safety and beneficial therapeutic effect of inhaled adenosine in patients with Covid-19-inflammatory lung disease suggesting further investigation in controlled clinical trials.

Can Adenosine Fight COVID-19 Acute Respiratory Distress Syndrome?

Coronavirus disease 2019 (COVID-19) patients can develop interstitial pneumonia, which, in turn, can evolve into acute respiratory distress syndrome (ARDS). This is accompanied by an inflammatory cytokine storm. severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) has proteins capable of promoting the cytokine storm, especially in patients with comorbidities, including obesity. Since currently no resolutive therapy for ARDS has been found and given the scientific literature regarding the use of adenosine, its application has been hypothesized. Through its receptors, adenosine is able to inhibit the acute inflammatory process, increase the protection capacity of the epithelial barrier, and reduce the damage due to an overactivation of the immune system, such as that occurring in cytokine storms. These features are known in ischemia/reperfusion models and could also be exploited in acute lung injury with hypoxia. Considering these hypotheses, a COVID-19 patient with unresponsive respiratory failure was treated with adenosine for compassionate use. The results showed a rapid improvement of clinical conditions, with negativity of SARS-CoV2 detection.

Fat mass affects nutritional status of ICU COVID-19 patients.

BACKGROUND: Obesity and steatosis are associated with COVID-19 severe pneumonia. Elevated levels of pro-inflammatory cytokines and reduced immune response are typical of these patients. In particular, adipose tissue is the organ playing the crucial role. So, it is necessary to evaluate fat mass and not simpler body mass index (BMI), because BMI leaves a portion of the obese population unrecognized. The aim is to evaluate the relationship between Percentage of Fat Mass (FM%) and immune-inflammatory response, after 10 days in Intensive Care Unit (ICU). METHODS: Prospective observational study of 22 adult patients, affected by COVID-19 pneumonia and admitted to the ICU and classified in two sets: (10) lean and (12) obese, according to FM% and age (De Lorenzo classification). Patients were analyzed at admission in ICU and at 10th day. RESULTS: Obese have steatosis, impaired hepatic function, compromise immune response and higher inflammation. In addition, they have a reduced prognostic nutritional index (PNI), nutritional survival index for ICU patients. CONCLUSION: This is the first study evaluating FM% in COVID-19 patient. We underlined obese characteristic with likely poorly prognosis and an important misclassification of obesity. A not negligible number of patients with normal BMI could actually have an excess of adipose tissue and therefore have an unfavorable outcome such as an obese. Is fundamental personalized patients nutrition basing on disease phases.

Body Composition Findings by Computed Tomography in SARS-CoV-2 Patients: Increased Risk of Muscle Wasting in Obesity.

Obesity is a characteristic of COVID-19 patients and the risk of malnutrition can be underestimated due to excess of fat: a paradoxical danger. Long ICU hospitalization exposes patients to a high risk of wasting and loss of lean body mass. The complex management precludes the detection of anthropometric parameters for the definition and monitoring of the nutritional status. The use of imaging diagnostics for body composition could help to recognize and treat patients at increased risk of wasting with targeted pathways. COVID-19 patients admitted to the ICU underwent computed tomography within 24 hours and about 20 days later, to evaluate the parameters of the body and liver composition. The main results were the loss of the lean mass index and a greater increase in liver attenuation in obese subjects. These could be co-caused by COVID-19, prolonged bed rest, the complex medical nutritional therapy, and the starting condition of low-grade inflammation of the obese. The assessment of nutritional status, with body composition applied to imaging diagnostics and metabolic profiles in COVID-19, will assist in prescribing appropriate medical nutritional therapy. This will reduce recovery times and complications caused by frailty.

Whole-body MRI and PET/CT in multiple myeloma patients during staging and after treatment: personal experience in a longitudinal study.

PURPOSE: Diagnostic imaging plays a pivotal role in staging and prognostic assessment of multiple myeloma (MM) as well as planning and monitoring treatment. The aim of our study was to estimate the diagnostic accuracy of wholebody magnetic resonance imaging (WB-MRI) and positron emission tomography/computed tomography (PET/CT) in MM patients studied before and after treatment. MATERIALS AND METHODS: We considered 22 consecutive patients (10 males, 12 females; age range, 48-83 years) with newly diagnosed MM (NDMM group), and the same 22 patients underwent at least one re-assessment after treatment (previously treated MM, PTMM group). WBMRI and PET/CT were performed within days from each other in both the NDMM (22 studies) and PTMM (29 studies) group. The imaging findings were compared to the results of bone marrow aspiration. RESULTS: PET/CT was positive in 18/22 NDMM patients, whereas WB-MRI correctly identified 100% of patients. Of 20 responder patients in the PTMM group, 16 were negative at PET/CT and 12/20 at MRI. By contrast, of the nine nonresponder patients, MRI correctly detected active disease in all cases, and PET only in seven. CONCLUSIONS: WB-MRI proved superior to PET/CT in detecting MM, especially in diffuse disease. PET/CT appears to be more sensitive in the assessment of MM after treatment.

[Whole Body Magnetic Resonance and CT/PET in patients affected by multiple myeloma during staging before treatment]. / TC/PET e WBMRI in pazienti affetti da mieloma multiplo in stadiazione e prima di trattamento.

The diagnostic imaging plays a pivotal role in the staging of multiple myeloma (MM). Traditional imaging techniques allow a precise disease extension before treatment, but some drawbacks have been demonstrated after treatment. WBMRI and CT/PET represent alterative procedures during staging, but few comparative data are available to date. Aim of our study was to estimate the diagnostic accuracy of WB-MRI and CT/PET in 28 consecutive patients affected by MM before therapy. CT/PET was positive in 22/28 patients, whereas WB-MRI correctly identified 100% of patients. In this setting of patients WB MRI have demonstrated to be superior respect to CT/PET in term of diagnostic accuracy, especially when a diffuse disease is detected with a bone marrow aspiration with more than 40% of plasma cells. WBMRI shows a diagnostic accuracy higher than FDG-CT/PET in staging especially when diffuse. However a whole body coverage is crucial to properly manage MM patients irrespective of which technique is used.