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Zadek F, Berta L, Zorzi G, Ubiali S, Bonaiuti A, Tundo G, Brunoni B, Marrazzo F, Giudici R, Rossi A, Rizzetto F, Bernasconi DP, Vanzulli A, Colombo PE, Fumagalli R, Torresin A, Langer T. Quantitative CT scan and response to pronation in COVID-19 ARDS. Respir Care 2024:respcare.11625. [PMID: 38594036 DOI: 10.4187/respcare.11625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/08/2024] [Indexed: 04/11/2024]
Abstract
Background: The use of the prone position (PP) has been widespread during the COVID-19 pandemic. While it has demonstrated benefits, including improved oxygenation and lung aeration, the factors influencing the response in terms of gas exchange to PP remain unclear. In particular, the association between baseline quantitative Computed Tomography (qCT) scan results and gas exchange response to PP in intubated, mechanically ventilated subjects with COVID-19 ARDS is unknown. The present study aimed to compare baseline qCT results between subjects responding to PP in terms of oxygenation or carbon dioxide (CO2) clearance and those who did not.Methods: This was a single-center, retrospective observational study, including critically ill, intubated, mechanically ventilated subjects with COVID-19 related acute respiratory distress syndrome admitted to the ICUs of Niguarda Hospital between March 2020 and November 2021. Blood-gas samples were collected before and after PP. Subjects in whom the PaO2/FiO2 increase was ≥ 20 mmHg after PP were defined as Oxygen responders (Oxy-R). CO2-responders (CO2R) were defined when the ventilatory ratio (VR) decreased during PP. Automated qCT analyses were performed to obtain tissue mass and density of the lungs.Results: One hundred twenty-five subjects were enrolled, of which 116 (93%) were Oxy-R and 51 (41%) CO2R. No difference in qCT characteristics and oxygen were observed between Oxy-R and Oxygen Non Responders (Tissue mass 1532 ±396 vs. 1654 ±304 g, p= .28; density -544±109 vs. -562±58 HU, p= .42). Similar findings were observed when dividing the population according to CO2 response (Tissue mass 1551±412 vs. 1534±377 g, p= .89; density -545±123 vs. -546±94 HU, p= .99).Conclusions: Most COVID-19 related ARDS subjects improve their oxygenation at the first pronation cycle. The study suggests that baseline qCT scan data are not associated with the response to PP in oxygenation or CO2 in mechanically ventilated COVID-19 related ARDS subjects.
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Affiliation(s)
- Francesco Zadek
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Luca Berta
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giulia Zorzi
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Physics, INFN Milan Unit, Milan, Italy
| | - Stefania Ubiali
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Amos Bonaiuti
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Giulia Tundo
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Beatrice Brunoni
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Francesco Marrazzo
- Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
| | - Riccardo Giudici
- Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
| | - Anna Rossi
- Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
| | - Francesco Rizzetto
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Davide Paolo Bernasconi
- School of Medicine and Surgery, Bicocca Bioinformatics Biostatistics and Bioimaging Center - B4, University of Milano-Bicocca, Monza, Italy
| | - Angelo Vanzulli
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Paola Enrica Colombo
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Roberto Fumagalli
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
| | - Alberto Torresin
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Thomas Langer
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
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Monachesi C, Correani A, Antognoli L, Ferretti E, Biagetti C, D'Ascenzo R, Gasparrini E, Zorzi G, Burattini I, Carnielli V. Incidence and two-year neurodevelopmental outcomes of small-for-gestational-age preterm infants: how do they relate to using different neonatal anthropometric charts? Minerva Pediatr (Torino) 2023:S2724-5276.23.07446-3. [PMID: 38015435 DOI: 10.23736/s2724-5276.23.07446-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND The effect of different neonatal anthropometric charts on the incidence and neurodevelopmental outcomes at two years (Y) corrected age of small-for-gestational-age (SGA) preterm infants has still not been fully explored. METHODS All preterm infants with a gestational age (GA) between 24.0 and 31.6 weeks (W), born from Jan-2004 to Dec-2017 in the Marche region (Italy) were studied. Intergrowth-21st, Beeby, Fenton, and Bertino anthropometric charts were used to classify infants with a birth weight less than 10th centile as SGA. Disabilities and neurodevelopmental scores assessed by Bayley-III Test were recorded at the 2Y follow-up visit. RESULTS One thousand one hundred forty-seven preterm infants were evaluated. The incidence of SGA was significantly different among the study charts (from 12.9 to 17.5%). Nine hundred and twenty-seven study infants were assessed for neurodevelopmental outcomes at 2Y corrected age. The incidence of SGA with moderate cognitive impairment (COG Score: 70-84) and mild neurodevelopmental disability (NDD) were significantly different between the Intergrowth-21st and Bertino charts (31.7% vs. 19.6%, P=0.042; 30.8 vs. 19.2%, P=0.036; respectively). A statistically significant difference in COG Score was found between SGA preterm infants overlapping in all study charts and those classified as SGA only by the Intergrowth-21st chart (89.1±15.7 vs. 99.2±19.8; P=0.038). CONCLUSIONS In a large cohort of preterm infants with a GA between 24.0 and 31.6W, the incidence and neurodevelopmental outcomes at 2Y corrected age of SGAs were significantly different depending on the anthropometric charts. These differences, albeit small, should be considered both in clinical practice and trials on SGA preterm infants.
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Affiliation(s)
- Chiara Monachesi
- Department of Specialized Clinical Sciences and Odontostomatology, Polytechnic University of Marche, Ancona, Italy
| | - Alessio Correani
- Department of Specialized Clinical Sciences and Odontostomatology, Polytechnic University of Marche, Ancona, Italy -
| | - Luca Antognoli
- Department of Industrial Engineering and Mathematical Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Enrica Ferretti
- Division of Neonatology, University Hospital of Marche, Ancona, Italy
| | - Chiara Biagetti
- Division of Neonatology, University Hospital of Marche, Ancona, Italy
| | - Rita D'Ascenzo
- Division of Neonatology, University Hospital of Marche, Ancona, Italy
| | - Enrico Gasparrini
- Department of Pediatrics and Neonatology, Hospital of Macerata, Macerata, Italy
| | - Giulia Zorzi
- Unit of Pediatrics, Hospital of Ascoli Piceno, Ascoli Piceno, Italy
| | - Ilaria Burattini
- Division of Neonatology, University Hospital of Marche, Ancona, Italy
| | - Virgilio Carnielli
- Department of Specialized Clinical Sciences and Odontostomatology, Polytechnic University of Marche, Ancona, Italy
- Division of Neonatology, University Hospital of Marche, Ancona, Italy
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Yildiz H, Lepere C, Zorzi G, Gheysens O, Roodhans F, Pothen L. [ 18F]FDG-PET/CT in Idiopathic Inflammatory Myopathies: Retrospective Data from a Belgian Cohort. Diagnostics (Basel) 2023; 13:2316. [PMID: 37510060 PMCID: PMC10377909 DOI: 10.3390/diagnostics13142316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 06/26/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
[18F]FDG-PET/CT is a useful tool for diagnosis and cancer detection in idiopathic inflammatory myopathies (IIMs), especially polymyositis (PM) and dermatomyositis (DM). Data deriving from Europe are lacking. We describe [18F]FDG-PET/CT results in a Belgian cohort with IIMs, focusing on patients with PM and DM. All of the cases of IIMs admitted between December 2010 and January 2023 to the Cliniques Universitaires Saint-Luc (Belgium) were retrospectively reviewed. In total, 44 patients were identified with suspected IIMs; among them, 29 were retained for final analysis. The mean age of the retained patients was 48.7 years; 19 patients were female (65.5%). Twenty-two patients had DM and seven had PM. The mean serum creatinine kinase (CK) and the mean CRP levels were 3125 UI/L and 30.3 mg/L, respectively. [18F]FDG-PET/CT imaging was performed for 27 patients, detecting interstitial lung diseases (ILDs) in 7 patients (25.9%), cancer in 3 patients (11.1%), and abnormal muscle FDG uptake compatible with myositis in 13 patients (48.1%). All of the patients who were detected to have ILDs via PET/CT imaging were confirmed using a low-dose lung CT scan. Among the patients who were detected to have abnormal muscle FDG uptake via PET/CT scans (13/28), the EMG was positive in 12 patients (p = 0.004), while the MRI was positive in 8 patients (p = 0.02). We further observed that there was a significantly higher level of CK in the group with abnormal muscle FDG uptake (p = 0.008). Our study showed that PET/CT is useful for detecting cancer and ILDs. We showed that the detection of abnormal muscle uptake via PET/CT was in accordance with EMG and MRI results, as well as with the mean CK value, and that the presence of dyspnea was significantly associated with the presence of ILDs detected via PET/CT imaging (p = 0.002).
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Affiliation(s)
- Halil Yildiz
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Institute of Clinical and Experimental Research (IREC), Université Catholique de Louvain (UCLouvain), Avenue Hippocrate 10, B-1200 Brussels, Belgium
| | - Charlotte Lepere
- Department of Internal Medicine, Hôpital d'Arlon (Vivalia), 6700 Arlon, Belgium
| | - Giulia Zorzi
- Department of Laboratory, Avenue Hippocrate 10, B-1200 Brussels, Belgium
| | - Olivier Gheysens
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Institute of Clinical and Experimental Research (IREC), Université Catholique de Louvain (UCLouvain), Avenue Hippocrate 10, B-1200 Brussels, Belgium
| | - Fabien Roodhans
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Institute of Clinical and Experimental Research (IREC), Université Catholique de Louvain (UCLouvain), Avenue Hippocrate 10, B-1200 Brussels, Belgium
| | - Lucie Pothen
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Institute of Clinical and Experimental Research (IREC), Université Catholique de Louvain (UCLouvain), Avenue Hippocrate 10, B-1200 Brussels, Belgium
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Caputo D, Franceschetti S, Castellotti B, Freri E, Zorzi G, Saletti V, Canafoglia L, Granata T. Case report: SLC6A1 mutations presenting with isolated absence seizures: description of 2 novel cases. Front Neurosci 2023; 17:1219244. [PMID: 37457006 PMCID: PMC10339345 DOI: 10.3389/fnins.2023.1219244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/05/2023] [Indexed: 07/18/2023] Open
Abstract
We report the clinical and EEG data of two patients harboring heterozygous SLC6A1 mutations, who presented with typical absence seizures at 3 Hz spike and wave as well as with mild cognitive disability. Neuroradiological and other laboratory investigations were normal. Our observations suggest that SLC6A1 mutations can be suspected in children with typical absences as the only seizure type, especially if associated with, even mild, cognitive deficits.
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Affiliation(s)
- Davide Caputo
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Silvana Franceschetti
- Department of Neurophysiopathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Barbara Castellotti
- Department of Diagnostic and Technology, Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Elena Freri
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - G. Zorzi
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Veronica Saletti
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Laura Canafoglia
- Integrated Diagnostics for Epilepsy, Department of Diagnostic and Technology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Tiziana Granata
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Zorzi G, Berta L, Rizzetto F, De Mattia C, Felisi MMJ, Carrazza S, Nerini Molteni S, Vismara C, Scaglione F, Vanzulli A, Torresin A, Colombo PE. Artificial intelligence for differentiating COVID-19 from other viral pneumonias on CT: comparative analysis of different models based on quantitative and radiomic approaches. Eur Radiol Exp 2023; 7:3. [PMID: 36690869 PMCID: PMC9870776 DOI: 10.1186/s41747-022-00317-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/15/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND To develop a pipeline for automatic extraction of quantitative metrics and radiomic features from lung computed tomography (CT) and develop artificial intelligence (AI) models supporting differential diagnosis between coronavirus disease 2019 (COVID-19) and other viral pneumonia (non-COVID-19). METHODS Chest CT of 1,031 patients (811 for model building; 220 as independent validation set (IVS) with positive swab for severe acute respiratory syndrome coronavirus-2 (647 COVID-19) or other respiratory viruses (384 non-COVID-19) were segmented automatically. A Gaussian model, based on the HU histogram distribution describing well-aerated and ill portions, was optimised to calculate quantitative metrics (QM, n = 20) in both lungs (2L) and four geometrical subdivisions (GS) (upper front, lower front, upper dorsal, lower dorsal; n = 80). Radiomic features (RF) of first (RF1, n = 18) and second (RF2, n = 120) order were extracted from 2L using PyRadiomics tool. Extracted metrics were used to develop four multilayer-perceptron classifiers, built with different combinations of QM and RF: Model1 (RF1-2L); Model2 (QM-2L, QM-GS); Model3 (RF1-2L, RF2-2L); Model4 (RF1-2L, QM-2L, GS-2L, RF2-2L). RESULTS The classifiers showed accuracy from 0.71 to 0.80 and area under the receiving operating characteristic curve (AUC) from 0.77 to 0.87 in differentiating COVID-19 versus non-COVID-19 pneumonia. Best results were associated with Model3 (AUC 0.867 ± 0.008) and Model4 (AUC 0.870 ± 0.011. For the IVS, the AUC values were 0.834 ± 0.008 for Model3 and 0.828 ± 0.011 for Model4. CONCLUSIONS Four AI-based models for classifying patients as COVID-19 or non-COVID-19 viral pneumonia showed good diagnostic performances that could support clinical decisions.
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Affiliation(s)
- Giulia Zorzi
- Postgraduate School of Medical Physics, Università degli Studi di Milano, via Giovanni Celoria 16, 20133, Milan, Italy
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
- Department of Physics, INFN Sezione di Milano, via Giovanni Celoria 16, 20133, Milan, Italy
| | - Luca Berta
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
| | - Francesco Rizzetto
- Postgraduate School of Diagnostic and Interventional Radiology, Università degli Studi di Milano, via Festa del Perdono 7, 20122, Milan, Italy.
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
| | - Cristina De Mattia
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Marco Maria Jacopo Felisi
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Stefano Carrazza
- Department of Physics, INFN Sezione di Milano, via Giovanni Celoria 16, 20133, Milan, Italy
- Department of Physics, Università degli Studi di Milano, via Giovanni Celoria 16, 20133, Milan, Italy
| | - Silvia Nerini Molteni
- Chemical-Clinical and Microbiological Analyses, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Chiara Vismara
- Chemical-Clinical and Microbiological Analyses, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesco Scaglione
- Chemical-Clinical and Microbiological Analyses, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, via Festa del Perdono 7, 20122, Milan, Italy
| | - Angelo Vanzulli
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, via Festa del Perdono 7, 20122, Milan, Italy
| | - Alberto Torresin
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
- Department of Physics, INFN Sezione di Milano, via Giovanni Celoria 16, 20133, Milan, Italy
- Department of Physics, Università degli Studi di Milano, via Giovanni Celoria 16, 20133, Milan, Italy
| | - Paola Enrica Colombo
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
- Department of Physics, Università degli Studi di Milano, via Giovanni Celoria 16, 20133, Milan, Italy
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Berta L, Zorzi G, Rizzetto F, Felisi M, De Mattia C, Carbonaro LA, Vanzulli A, Colombo PE, Torresin A. DIAGNOSTIC PERFORMANCE OF HUMAN READERS AND ARTIFICIAL INTELLIGENCE MODEL IN CLASSIFICATION TASK OF COMPUTED TOMOGRAPHY IMAGES OF DIFFERENT TYPES OF VIRAL PNEUMONIA. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)02298-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Chiapparini L, Zorzi G. Early Neuroimaging Markers in β Propeller Protein-Associated Neurodegeneration. AJNR Am J Neuroradiol 2022; 43:1815-1816. [PMID: 36396333 DOI: 10.3174/ajnr.a7723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | - G Zorzi
- Department of Paediatric Neuroscience Fondazione Institute for Hospitalization and Healthcare Istituto Neurologico Carlo Besta Milan, Italy
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Jacopo Felisi MM, Cicolari D, Berta L, Curto D, Muti G, Zorzi G, Vargiu S, Colombo G, Pedrotti P, Vanzulli A, Torresin A, Colombo PE. MANAGEMENT OF PATIENTS WITH IMPLANTABLE MEDICAL DEVICES UNDERGOING MRI EXAMINATIONS: AN INTERDISCIPLINARY PROCEDURE. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)02437-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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9
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Rizzetto F, Berta L, Zorzi G, Cincotta A, Travaglini F, Artioli D, Nerini Molteni S, Vismara C, Scaglione F, Torresin A, Colombo PE, Carbonaro LA, Vanzulli A. Diagnostic Performance in Differentiating COVID-19 from Other Viral Pneumonias on CT Imaging: Multi-Reader Analysis Compared with an Artificial Intelligence-Based Model. Tomography 2022; 8:2815-2827. [PMID: 36548527 PMCID: PMC9785796 DOI: 10.3390/tomography8060235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022] Open
Abstract
Growing evidence suggests that artificial intelligence tools could help radiologists in differentiating COVID-19 pneumonia from other types of viral (non-COVID-19) pneumonia. To test this hypothesis, an R-AI classifier capable of discriminating between COVID-19 and non-COVID-19 pneumonia was developed using CT chest scans of 1031 patients with positive swab for SARS-CoV-2 (n = 647) and other respiratory viruses (n = 384). The model was trained with 811 CT scans, while 220 CT scans (n = 151 COVID-19; n = 69 non-COVID-19) were used for independent validation. Four readers were enrolled to blindly evaluate the validation dataset using the CO-RADS score. A pandemic-like high suspicion scenario (CO-RADS 3 considered as COVID-19) and a low suspicion scenario (CO-RADS 3 considered as non-COVID-19) were simulated. Inter-reader agreement and performance metrics were calculated for human readers and R-AI classifier. The readers showed good agreement in assigning CO-RADS score (Gwet's AC2 = 0.71, p < 0.001). Considering human performance, accuracy = 78% and accuracy = 74% were obtained in the high and low suspicion scenarios, respectively, while the AI classifier achieved accuracy = 79% in distinguishing COVID-19 from non-COVID-19 pneumonia on the independent validation dataset. The R-AI classifier performance was equivalent or superior to human readers in all comparisons. Therefore, a R-AI classifier may support human readers in the difficult task of distinguishing COVID-19 from other types of viral pneumonia on CT imaging.
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Affiliation(s)
- Francesco Rizzetto
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
- Postgraduate School of Diagnostic and Interventional Radiology, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
- Correspondence:
| | - Luca Berta
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Giulia Zorzi
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
- Postgraduate School of Medical Physics, Università degli Studi di Milano, Via Giovanni Celoria 16, 20133 Milan, Italy
| | - Antonino Cincotta
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
- Postgraduate School of Diagnostic and Interventional Radiology, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Francesca Travaglini
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Diana Artioli
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Silvia Nerini Molteni
- Chemical-Clinical and Microbiological Analyses, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Chiara Vismara
- Chemical-Clinical and Microbiological Analyses, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Francesco Scaglione
- Chemical-Clinical and Microbiological Analyses, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Alberto Torresin
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
- Department of Physics, Università degli Studi di Milano, Via Giovanni Celoria 16, 20133 Milan, Italy
| | - Paola Enrica Colombo
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
- Department of Physics, Università degli Studi di Milano, Via Giovanni Celoria 16, 20133 Milan, Italy
| | - Luca Alessandro Carbonaro
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Angelo Vanzulli
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
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Levi V, Franzini A, Rinaldo S, Coelli S, Bianchi AM, Franzini A, Nardocci N, Eleopra R, Zorzi G. Globus pallidus internus activity during simultaneous bilateral microelectrode recordings in status dystonicus. Acta Neurochir (Wien) 2021; 163:211-217. [PMID: 33052494 DOI: 10.1007/s00701-020-04618-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 10/09/2020] [Indexed: 01/14/2023]
Abstract
Limited data are available regarding the electrophysiology of status dystonicus (SD). We report simultaneous microelectrode recordings (MERs) from the globus pallidus internus (GPi) of a patient with SD who was treated with bilateral deep brain stimulation (DBS). Mean neuronal discharge rate was of 30.1 ± 10.9 Hz and 38.5 Hz ± 11.1 Hz for the right and left GPi, respectively. On the right side, neuronal electrical activity was completely abolished at the target point, whereas the mean burst index values showed a predominance of bursting and irregular activity along trajectories on both sides. Our data are in line with previous findings of pallidal irregular hypoactivity as a potential electrophysiological marker of dystonia and thus SD, but further electrophysiological studies are needed to confirm our results.
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Iodice A, Carecchio M, Zorzi G, Garavaglia B, Spagnoli C, Salerno GG, Frattini D, Mencacci NE, Invernizzi F, Veneziano L, Mantuano E, Angriman M, Fusco C. Corrigendum to "Restless legs syndrome in NKX2-1-related chorea: An expansion of the disease spectrum" [Brain Dev. 41 (2019) 250-256]. Brain Dev 2019; 41:643. [PMID: 31053344 DOI: 10.1016/j.braindev.2019.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 04/14/2019] [Indexed: 10/26/2022]
Affiliation(s)
- A Iodice
- Child Neurology and Psychiatry Unit, Santa Maria Nuova Hospital IRCCS, Reggio Emilia, Italy.
| | - M Carecchio
- Molecular Neurogenetics Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via L. Temolo 4, 20126 Milan, Italy; Department of Pediatric Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy
| | - G Zorzi
- Department of Pediatric Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy
| | - B Garavaglia
- Molecular Neurogenetics Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via L. Temolo 4, 20126 Milan, Italy
| | - C Spagnoli
- Child Neurology and Psychiatry Unit, Santa Maria Nuova Hospital IRCCS, Reggio Emilia, Italy
| | - G G Salerno
- Child Neurology and Psychiatry Unit, Santa Maria Nuova Hospital IRCCS, Reggio Emilia, Italy
| | - D Frattini
- Child Neurology and Psychiatry Unit, Santa Maria Nuova Hospital IRCCS, Reggio Emilia, Italy
| | - N E Mencacci
- Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago 60611, IL, USA
| | - F Invernizzi
- Molecular Neurogenetics Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via L. Temolo 4, 20126 Milan, Italy
| | - L Veneziano
- Institute of Translational Pharmacology, National Council of Research, Rome, Italy
| | - E Mantuano
- Institute of Translational Pharmacology, National Council of Research, Rome, Italy
| | - M Angriman
- Child Neurology and Neurorehabilitation Unit, Department of Pediatrics, Hospital of Bolzano, Italy
| | - C Fusco
- Child Neurology and Psychiatry Unit, Santa Maria Nuova Hospital IRCCS, Reggio Emilia, Italy
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12
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Peron G, Dall'Acqua S, Sorrenti V, Carrara M, Fortinguerra S, Zorzi G, Buriani A. Retrospective analysis of a lactose breath test in a gastrointestinal symptomatic population of Northeast Italy: use of (H 2+2CH 4) versus H 2 threshold. Clin Exp Gastroenterol 2018; 11:243-248. [PMID: 29950879 PMCID: PMC6011881 DOI: 10.2147/ceg.s163962] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Lactose malabsorption is normally evaluated by measuring exhaled H2 produced by intestinal flora, from unabsorbed lactose. However, differing microbiome composition can lead to the production of CH4 instead of H2; hence, some authors challenge the H2 method sensitivity and favor the evaluation of both intestinal gases. Aim To compare different approaches to usage of a lactose breath test for lactose malabsorption diagnosis, after medical evaluation of gastrointestinal symptoms. Methods In a retrospective observational study, we compared the 2 approaches in a population of 282 subjects in Northern Italy. Following oral lactose administration, exhaled samples were harvested every 30 minutes for 4 hours and prepared for H2 and CH4 analysis. Basal gas levels were subtracted from H2 and CH4 ppm and values at 4 hours and peaks were considered for analysis. Results Applying the standard methodology, which takes separately into consideration H2 and CH4 produced in the intestinal lumen, the results indicated that 11.7% of the patients were diagnosed “positive” for hypolactasia, differently from what was expected. Conversely, taking into consideration the sum of H2 and CH4, the percentage increased to 62.8%, closer to the expected one. No significant differences were found when comparing the 2 groups for age, gender, or symptoms. The sizable difference between the 2 approaches is likely linked to gut microbiome variability, and consequently the different production of the 2 gases, in the population. Conclusion The threshold normally used for lactose breath test should be reconsidered and changed, merging H2 and CH4 stoichiometric values to increase sensitivity.
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Affiliation(s)
- Gregorio Peron
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy
| | - Stefano Dall'Acqua
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy.,Unir&d, Nutraceutical Laboratory, Padova, Italy
| | - Vincenzo Sorrenti
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy.,Maria Paola Belloni Center for Personalized Medicine, Data Medica Group, Synlab Limited, Padova, Italy
| | - Maria Carrara
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy
| | - Stefano Fortinguerra
- Maria Paola Belloni Center for Personalized Medicine, Data Medica Group, Synlab Limited, Padova, Italy
| | - Giulia Zorzi
- Maria Paola Belloni Center for Personalized Medicine, Data Medica Group, Synlab Limited, Padova, Italy
| | - Alessandro Buriani
- Maria Paola Belloni Center for Personalized Medicine, Data Medica Group, Synlab Limited, Padova, Italy
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13
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Piastra M, De Luca D, Genovese O, Tosi F, Caliandro F, Zorzi G, Massimi L, Visconti F, Pizza A, Biasucci DG, Conti G. Clinical Outcomes and Prognostic Factors for Spontaneous Intracerebral Hemorrhage in Pediatric ICU: A 12-Year Experience. J Intensive Care Med 2017; 34:1003-1009. [PMID: 28847237 DOI: 10.1177/0885066617726049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In the pediatric population, spontaneous intracerebral hemorrhage (sICH) is as common as ischemic stroke and accounts for significant mortality and morbidity. Differently from the ischemic stroke, there are few guidelines for directing management of sICH. This article aims to analyze both clinical outcomes and prognostic factors in order to produce tools for the design of prospective randomized studies addressed to implement treatment of pediatric sICH. METHODS Twelve-year retrospective review of a single-center consecutivesICH pediatric cases admitted to the pediatric intensive care unit (PICU). Selected end points were survival, PICU stay, and dichotomized Glasgow Outcome Score (GOS), with recovery and moderate disability (GOS 4-5) classified as favorable outcome and vegetative state or severe disability (GOS 2-3) classified as unfavorable. RESULTS Data of 107 children younger than 14 years admitted to our PICU due to sICH were analyzed. Overall PICU mortality was 24.2%. On multivariate analysis, the single factor markedly influencing survival was the presence of midline shift (P = .002). In PICU survivors, there were 42 GOS 2-3 and 39 GOS 4-5. A low Glasgow Coma Scale (GCS) on PICU admission was predictive of severe neurological impairment in survivors (P = .003). Intraventricular hemorrhage and infratentorial origin did not influence outcome in this series. CONCLUSION The severity of presentation of sICH expressed by the midline shift and the GCS at PICU admission are significant prognostic factors for survival and neurological outcome. Some prognostic factors of the adult population have not been confirmed.
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Affiliation(s)
- Marco Piastra
- Pediatric Intensive Care Unit, Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy
| | - Daniele De Luca
- Pediatric Intensive Care Unit, Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy.,Neonatal and Pediatric Intensive Care, Paris Sud Hospital, Paris, France
| | - Orazio Genovese
- Pediatric Intensive Care Unit, Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy
| | - Federica Tosi
- Pediatric Intensive Care Unit, Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy.,Pediatric Neuroanesthesiology, Emergency Department Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy
| | - Francesca Caliandro
- Pediatric Intensive Care Unit, Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy
| | - Giulia Zorzi
- Pediatric Intensive Care Unit, Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy
| | - Luca Massimi
- Pediatric Neurosurgery, "A. Gemelli" Teaching Hospital, Catholic University Medical School, Rome, Italy
| | - Federico Visconti
- Pediatric Intensive Care Unit, Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy
| | - Alessandro Pizza
- Pediatric Intensive Care Unit, Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy
| | - Daniele G Biasucci
- Pediatric Intensive Care Unit, Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy
| | - Giorgio Conti
- Pediatric Intensive Care Unit, Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy
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14
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Bartolini A, Zorzi G, Besutti V. Prevalence of intestinal parasitoses detected in Padua teaching hospital, Italy, March 2011 - February 2013. Infez Med 2017; 25:133-141. [PMID: 28603232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The aim of this study was to evaluate the distribution of parasitic intestinal infections in patients attending Padua teaching hospital during a two-year period. Between 1st March 2011 and 28th February 2013, we examined stool specimens from 7341 patients (6127 Italians, 1214 non-Italians) for ova and parasites using microscopy, rapid enzyme immunoassays, culture techniques and molecular methods. Stools of 1080 patients (14.71%) were positive for parasites; a total of 1349 intestinal parasites were counted. Protozoa were detected in 1028/1080 patients (95.19%), while helminths were present in 80/1080 patients (7.41%). The protozoa most commonly detected were Blastocystis spp., Dientamoeba fragilis and Giardia duodenalis. Enterobius vermicularis was the helminth most frequently encountered. Of the 1080 infected patients, 227 (21.02%) had more than one parasite in their stool. To conclude, in Italy intestinal parasitoses must be unquestionably considered in differential diagnoses of gastrointestinal diseases. For this purpose, sound knowledge of epidemiology is essential.
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Affiliation(s)
- Andrea Bartolini
- Azienda Ospedaliera, Università di Padova, UOC di Microbiologia e Virologia, Padova, Italy
| | - Giulia Zorzi
- Azienda Ospedaliera, Università di Padova, UOC di Microbiologia e Virologia, Padova, Italy
| | - Valeria Besutti
- Azienda Ospedaliera, Università di Padova, UOC di Microbiologia e Virologia, Padova, Italy
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15
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Sorrenti V, Marenda B, Fortinguerra S, Cecchetto C, Quartesan R, Zorzi G, Zusso M, Giusti P, Buriani A. Reference Values for a Panel of Cytokinergic and Regulatory Lymphocyte Subpopulations. Immune Netw 2016; 16:344-357. [PMID: 28035210 PMCID: PMC5195844 DOI: 10.4110/in.2016.16.6.344] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/03/2016] [Accepted: 12/09/2016] [Indexed: 12/11/2022] Open
Abstract
Lymphocyte subpopulations producing cytokines and exerting regulatory functions represent key immune elements. Given their reciprocal interdependency lymphocyte subpopulations are usually assayed as diagnostic panels, rather than single biomarkers for specialist clinical use. This retrospective analysis on lymphocyte subpopulations, analyzed over the last few years in an outpatient laboratory in Northeast Italy, contributes to the establishment of reference values for several regulatory lymphocytes currently lacking such reference ranges for the general population. Mean values and ranges in a sample of Caucasian patients (mean age 42±8,5 years), were provided for Th1, Th2, Th17, Th-reg, Tc-reg, Tc-CD57+ and B1 lymphocytes. The results are consistent with what is found in literature for the single subtypes and are: Th1 157.8±60.3/µl (7.3%±2.9); Th2 118.2±52.2/µl (5.4%±2.5); Th17 221.6±90.2/µl (10.5%±4.4); Th-reg 15.1±10.2/µl (0.7%±0.4); Tc-reg 5.8±4.7/µl (0.3%±0.2); Tc-CD57+ 103.7±114.1/µl (4.6%±4.7); B1 33.7±22.8/µl (1.5%±0.9); (Values are mean±SD). The results show that despite their variability, mean values are rather consistent in all age or sex groups and can be used as laboratory internal reference for this regulatory panel. Adding regulatory cells to lymphocyte subpopulations panels allows a more complete view of the state of the subject's immune network balance, thus improving the personalization and the "actionability" of diagnostic data in a systems medicine perspective.
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Affiliation(s)
- Vincenzo Sorrenti
- Maria Paola Belloni Center for Personalized Medicine, Data Medica Group, Padova 35100, Italy.; Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova 35100, Italy
| | - Bruno Marenda
- Maria Paola Belloni Center for Personalized Medicine, Data Medica Group, Padova 35100, Italy
| | - Stefano Fortinguerra
- Maria Paola Belloni Center for Personalized Medicine, Data Medica Group, Padova 35100, Italy.; Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova 35100, Italy
| | - Claudia Cecchetto
- Department of Biomedical Sciences, University of Padova, Padova 35100, Italy
| | - Roberta Quartesan
- Maria Paola Belloni Center for Personalized Medicine, Data Medica Group, Padova 35100, Italy
| | - Giulia Zorzi
- Maria Paola Belloni Center for Personalized Medicine, Data Medica Group, Padova 35100, Italy
| | - Morena Zusso
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova 35100, Italy
| | - Pietro Giusti
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova 35100, Italy
| | - Alessandro Buriani
- Maria Paola Belloni Center for Personalized Medicine, Data Medica Group, Padova 35100, Italy.; Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova 35100, Italy
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16
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Favaretto S, Walter U, Baracchini C, Pompanin S, Bussè C, Zorzi G, Ermani M, Cagnin A. Accuracy of transcranial brain parenchyma sonography in the diagnosis of dementia with Lewy bodies. Eur J Neurol 2016; 23:1322-8. [PMID: 27132982 DOI: 10.1111/ene.13028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 03/22/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Transcranial sonography (TCS) of the brain parenchyma is used to visualize alterations in the substantia nigra (SN) and it is applied for early diagnosis of Parkinson's disease. Our aim was to explore specific echogenic alterations of the SN in dementia with Lewy bodies (DLB) compared to Alzheimer's disease (AD). METHODS Seventy-one subjects underwent TCS: 22 DLB, 28 AD and 21 healthy elderly controls. Cognitive impairment, extrapyramidal signs, visual hallucinations, fluctuations and rapid eye movement sleep behaviour symptoms were investigated. TCS assessed SN hyperechogenicity and symmetry. RESULTS Transcranial sonography revealed SN hyperechogenicity in 100% of DLB compared to 50% of AD and 30% of controls. Mean SN echogenic area (cm(2) ) was 0.22 ± 0.03 in DLB, 0.15 ± 0.03 in AD and 0.14 ± 0.03 in controls (P < 0.0001). More than 50% of DLB presented a marked hyperechogenicity (cutoff value >0.22 cm(2) ) compared to only 10% of AD (P < 0.0003). DLB had symmetrical SN enlargement, whereas AD were mostly asymmetrical (P = 0.015). A combination of SN echogenic area and asymmetry index had a sensitivity of 88.9% and a specificity of 81.2% in discriminating DLB from AD (positive predictive value 85.7%, negative predictive value 85.7%). No association was found between SN hyperechogenicity and Unified Parkinson's Disease Rating Scale part III, Mini Mental State Examination or the presence of visual hallucinations. CONCLUSIONS Transcranial sonography may be a valid supportive tool in the diagnostic workup of neurodegenerative dementia helping clinicians to distinguish DLB from AD even at the early stages.
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Affiliation(s)
- S Favaretto
- Department of Neurosciences (DNS), University of Padova, Padova, Italy
| | - U Walter
- Department of Neurology, University of Rostock, Rostock, Germany
| | - C Baracchini
- Department of Neurosciences (DNS), University of Padova, Padova, Italy
| | - S Pompanin
- Department of Neurosciences (DNS), University of Padova, Padova, Italy
| | - C Bussè
- Department of Neurosciences (DNS), University of Padova, Padova, Italy
| | - G Zorzi
- Department of Neurosciences (DNS), University of Padova, Padova, Italy
| | - M Ermani
- Department of Neurosciences (DNS), University of Padova, Padova, Italy
| | - A Cagnin
- Department of Neurosciences (DNS), University of Padova, Padova, Italy.,IRCCS San Camillo Research Hospital, Venice, Italy
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17
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Kraoua I, Romani M, Tonduti D, BenRhouma H, Zorzi G, Zibordi F, Ardissone A, Gouider-Khouja N, Ben Youssef-Turki I, Nardocci N, Valente EM. Elevated aspartate aminotransferase and lactate dehydrogenase levels are a constant finding in PLA2G6-associated neurodegeneration. Eur J Neurol 2016; 23:e24-5. [PMID: 27000981 DOI: 10.1111/ene.12927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 11/04/2015] [Indexed: 11/29/2022]
Affiliation(s)
- I Kraoua
- Department of Child and Adolescent Neurology, National Institute Mongi Ben Hmida of Neurology, Tunis, Tunisia
| | - M Romani
- IRCCS Casa Sollievo della Sofferenza, Mendel Laboratory, San Giovanni Rotondo, Italy
| | - D Tonduti
- Child Neurology Department, Neurological Institute C. Besta Foundation IRCCS, Milan, Italy
| | - H BenRhouma
- Department of Child and Adolescent Neurology, National Institute Mongi Ben Hmida of Neurology, Tunis, Tunisia
| | - G Zorzi
- Child Neurology Department, Neurological Institute C. Besta Foundation IRCCS, Milan, Italy
| | - F Zibordi
- Child Neurology Department, Neurological Institute C. Besta Foundation IRCCS, Milan, Italy
| | - A Ardissone
- Child Neurology Department, Neurological Institute C. Besta Foundation IRCCS, Milan, Italy
| | - N Gouider-Khouja
- Department of Child and Adolescent Neurology, National Institute Mongi Ben Hmida of Neurology, Tunis, Tunisia
| | - I Ben Youssef-Turki
- Department of Child and Adolescent Neurology, National Institute Mongi Ben Hmida of Neurology, Tunis, Tunisia
| | - N Nardocci
- Child Neurology Department, Neurological Institute C. Besta Foundation IRCCS, Milan, Italy
| | - E M Valente
- IRCCS Casa Sollievo della Sofferenza, Mendel Laboratory, San Giovanni Rotondo, Italy.,Section of Neurosciences, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
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18
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Bartolini A, Zorzi G, Castellani E, Besutti V. Aeromonas spp.: an emerging pathogen? Microbiol Med 2015. [DOI: 10.4081/mm.2015.4674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The aim of this study is to identify and monitor the presence of <em>Aeromonas</em> spp. strains in stool cultures. We analyzed 5564 stool cultures from September 2012 to August 2013. Sixty-three patients were positive for Aeromonas spp. The most frequent symptoms were: diarrhea (46.0%) and abdominal pain (12.7%). Pediatric subjects were 28. Samples’ microscopic examination showed leukocytes in 38.1% of cases. It is still controversial whether Aeromonas are responsible for human gastroenteritis, but their presence in faecies of symptomatic patients supports their etiologic role. We propose search for toxins by polymerase chain reaction to identify strains that require an antibiotic therapy.
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19
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Ruffini E, De Petris L, Zorzi G, Carlucci A. Maternal vitamin D deficiency as a cause of hypocalcemic convulsions in a newborn from foreign parents: a re-emerging public health issue in Western countries? Minerva Pediatr 2015; 67:451-452. [PMID: 26377784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- E Ruffini
- Department of Pediatrics and Neonatology, "G. Mazzoni" Hospital, Ascoli Piceno, Italy -
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20
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Rizzi M, Cordella R, Messina G, Marras C, Zorzi G, Caldiroli D, Franzini A. DBS in critical care conditions. Brain Stimul 2015. [DOI: 10.1016/j.brs.2015.01.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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21
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Romito LM, Zorzi G, Marras CE, Franzini A, Nardocci N, Albanese A. Pallidal stimulation for acquired dystonia due to cerebral palsy: beyond 5 years. Eur J Neurol 2014; 22:426-e32. [DOI: 10.1111/ene.12596] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 09/10/2014] [Indexed: 11/29/2022]
Affiliation(s)
- L. M. Romito
- Fondazione IRCCS Istituto Neurologico ‘Carlo Besta’; Milano Italy
- Istituto di Neurologia; Università Cattolica; Milano Italy
| | - G. Zorzi
- Fondazione IRCCS Istituto Neurologico ‘Carlo Besta’; Milano Italy
| | - C. E. Marras
- Neurosurgery Unit; Department of Neuroscience and Neurorehabilitation; IRCCS Bambino Gesù Children's Hospital; Roma Italy
| | - A. Franzini
- Fondazione IRCCS Istituto Neurologico ‘Carlo Besta’; Milano Italy
| | - N. Nardocci
- Fondazione IRCCS Istituto Neurologico ‘Carlo Besta’; Milano Italy
| | - A. Albanese
- Fondazione IRCCS Istituto Neurologico ‘Carlo Besta’; Milano Italy
- Istituto di Neurologia; Università Cattolica; Milano Italy
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22
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Ruffini E, De Petris L, Zorzi G, Paoletti P, Mambelli G, Carlucci A. Two cases of neonatal adrenal hemorrhage presenting with persistent jaundice. Pediatr Med Chir 2014; 35:285-7. [PMID: 24620558 DOI: 10.4081/pmc.2013.26] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The adrenal hemorrhage is a relatively rare event in newborns but must be considered in the presence of a persistent unexplained jaundice, especially in presence of predisposing factors. Serial ultrasonography is the modality of choice for initial diagnosis and follow-up of neonatal adrenal hemorrhage. We report two cases of neonatal adrenal hemorrhage presenting with persistent jaundice. The causes of the neonatal adrenal hemorrhages were a difficult vaginal delivery in macrosomic infant and a neonatal infection.
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23
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Zorzi G, De Canale E, Rossi L, Besutti V. Talking of... Dientamoeba fragilis. Microbiol Med 2013. [DOI: 10.4081/mm.2013.2259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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24
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Ruffini E, Bianchi AM, De Petris L, Fares MK, Zorzi G, Carlucci A. Chronic massive fetomaternal hemorrhage in a newborn from immigrants. Clinical and organizational implications. Pediatr Med Chir 2013; 34:241-3. [PMID: 23342750 DOI: 10.4081/pmc.2012.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Fetomaternal hemorrhage (FMH) refers to the entry of fetal blood into the maternal bloodstream before or during delivery. FMH of more than 30 mL occurs with the frequency of about 1/300. Fetal outcomes may be compromised by still births, hydrops fetalis, cardiac complications, and increased rates of postpartum infant death. In most cases, the cause is not identified. Clinical manifestations of FMH depend on the volume of blood lost and the rate that it occurred. We report a case of chronic massive FMH in a newborn of an immigrant mother with a favorable outcome. Medical visits and tests during pregnancy, including ultrasound scans, were not performed. The baby was hemodynamically stable after birth, manifesting only pallor. The complete blood count revealed severe hypochromic anemia (hemoglobin 3,8 g/dl, hematocrit 14,4%) and reticulocytosis (reticulocyte 25,2%). There was no ABO blood type incompatibility and the result of direct Coomb's test was negative. The Kleihauer-Betke test revealed 5% of fetal erythrocytes in the maternal bloodstream equivalent to 180 mL. The fact that FMH can occur without prior risk factors, and the diagnosis is often postnatal, underscores the importance of heightened of medical suspicion particularly in infants born to immigrants where there is often the lack of prenatal visits.
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Affiliation(s)
- E Ruffini
- Pediatrics and Neonatology Division, Maternal and Infant Department, Mazzoni Hospital, Ascoli Piceno, Italy.
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Chiapparini L, Savoiardo M, D'Arrigo S, Reale C, Zorzi G, Zibordi F, Cordelli DM, Franzoni E, Garavaglia B, Nardocci N. The "eye-of-the-tiger" sign may be absent in the early stages of classic pantothenate kinase associated neurodegeneration. Neuropediatrics 2011; 42:159-62. [PMID: 21877312 DOI: 10.1055/s-0031-1285925] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Pantothenate kinase-associated neurodegeneration (PKAN) is a rare disorder associated with brain iron accumulation. The brain MRI abnormality consists of T2 hypointensity in the globus pallidus with a small hyperintensity in its medial part, called the "eye-of-the-tiger" sign. We report on 2 patients affected by PKAN, in whom MRI examination did not demonstrate the "eye-of-the-tiger" sign in the early stages; the typical abnormalities were detected only in the following examinations. Case 1 is a 4-year-old boy first studied at age 2 years for psychomotor delay. The brain MRI was normal. In the following 2 years, the motor impairment progressed. The second brain MRI at age 4 years demonstrated the "eye-of-the-tiger" sign. Molecular analysis of the PANK2 gene revealed a missense mutation F228S in exon 2 in homozygosis. Case 2 is a 6-year-old boy first studied at age 2 years because of psychomotor delay. His brain MRI did not demonstrate abnormalities in the globus pallidus. In the following years spastic-dystonic tetraparesis became evident. A brain MRI at age 4 years demonstrated the "eye-of-the-tiger" sign. Molecular analysis of the PANK2 gene revealed a missense mutation in exon 5 (N501I). Our 2 cases demonstrate that the observation of a normal globus pallidus in the early stage of the disease does not exclude the diagnosis of classic PKAN.
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Affiliation(s)
- L Chiapparini
- Department of Neuroradiology, IRCCS Neurological Institute Carlo Besta, Milano, Italy.
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26
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Romito L, Zorzi G, Ciceri M, Franzini A, Nardocci N, Albanese A. P7.20 Bilateral, pallidal deep-brain stimulation in primary and non-primary dystonia: a prospective long-term follow-up study. Clin Neurophysiol 2011. [DOI: 10.1016/s1388-2457(11)60330-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
An 11-year-old male developed a severe respiratory failure due to a iatrogenic flail chest following a surgery for removing a large chest wall area. A rare Ewing sarcoma was histologically diagnosed and intensive chemotherapy was administered. Postoperatively, because of the failure in ventilation weaning, the patient was electively extubated and noninvasive positive pressure ventilation through face-mask was provided. Respiratory support avoided asynchronous paradoxical movements and achieved pneumatic stabilization. Clinical and respiratory improvement allowed a successful weaning from ventilator.
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Affiliation(s)
- Marco Piastra
- Pediatric Intensive Care Unit, Catholic University Medical School, A.Gemelli Hospital, Rome, Italy.
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28
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Gregory A, Westaway SK, Holm IE, Kotzbauer PT, Hogarth P, Sonek S, Coryell JC, Nguyen TM, Nardocci N, Zorzi G, Rodriguez D, Desguerre I, Bertini E, Simonati A, Levinson B, Dias C, Barbot C, Carrilho I, Santos M, Malik I, Gitschier J, Hayflick SJ. Neurodegeneration associated with genetic defects in phospholipase A(2). Neurology 2008; 71:1402-9. [PMID: 18799783 DOI: 10.1212/01.wnl.0000327094.67726.28] [Citation(s) in RCA: 205] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Mutations in the gene encoding phospholipase A(2) group VI (PLA2G6) are associated with two childhood neurologic disorders: infantile neuroaxonal dystrophy (INAD) and idiopathic neurodegeneration with brain iron accumulation (NBIA). INAD is a severe progressive psychomotor disorder in which axonal spheroids are found in brain, spinal cord, and peripheral nerves. High globus pallidus iron is an inconsistent feature of INAD; however, it is a diagnostic criterion of NBIA, which describes a clinically and genetically heterogeneous group of disorders that share this hallmark feature. We sought to delineate the clinical, radiographic, pathologic, and genetic features of disease resulting from defective phospholipase A(2). METHODS We identified 56 patients clinically diagnosed with INAD and 23 with idiopathic NBIA and screened their DNA for PLA2G6 mutations. RESULTS Eighty percent of patients with INAD had mutations in PLA2G6, whereas mutations were found in only 20% of those with idiopathic NBIA. All patients with two null mutations had a more severe phenotype. On MRI, nearly all mutation-positive patients had cerebellar atrophy, and half showed brain iron accumulation. We observed Lewy bodies and neurofibrillary tangles in association with PLA2G6 mutations. CONCLUSION Defects in phospholipase A(2) lead to a range of phenotypes. PLA2G6 mutations are associated with nearly all cases of classic infantile neuroaxonal dystrophy but a minority of cases of idiopathic neurodegeneration with brain iron accumulation, and genotype correlates with phenotype. Cerebellar atrophy predicts which patients are likely to be mutation-positive. The neuropathologic changes that are caused by defective phospholipase A(2) suggest a shared pathogenesis with both Parkinson and Alzheimer diseases.
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Affiliation(s)
- A Gregory
- Department of Molecular and Medical Genetics, Oregon Health & Science University, L103a, 3181 SW Sam Jackson Park Rd., Portland, OR 97239-3098, USA
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Piastra M, Di Rocco C, Caresta E, Zorzi G, De Luca D, Caldarelli M, La Torre G, Conti G, Antonelli M, Eaton S, Pietrini D. Blood loss and short-term outcome of infants undergoing brain tumour removal. J Neurooncol 2008; 90:191-200. [DOI: 10.1007/s11060-008-9643-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Accepted: 06/06/2008] [Indexed: 11/30/2022]
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Piastra M, Di Rocco C, Tempera A, Caresta E, Zorzi G, Tosi F, Massimi L, Pietrini D. Massive blood transfusion in choroid plexus tumor surgery: 10-years' experience. J Clin Anesth 2007; 19:192-7. [PMID: 17531727 DOI: 10.1016/j.jclinane.2006.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Revised: 09/20/2006] [Accepted: 10/08/2006] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE To describe our 10 years of experience with childhood choroid plexus tumors (CPTs). DESIGN Retrospective chart analysis. SETTING Operating room and pediatric intensive care unit (PICU) of a university hospital. PATIENTS 18 infants and children undergoing CPT surgery from 1995 to 2004, 11 of whom were younger than 12 months. MEASUREMENTS Perioperative hematologic and coagulation data were measured as well as estimated red cell volume variations (as a reliable index of blood loss) in the perioperative period, together with coagulation parameters. RESULTS Greater blood loss was recorded in the infant group vs older children (percentage of estimated red cell volume loss, 1.31 +/- 1.79% vs 0.20 +/- 0.17% [P < 0.01] and 1.50 +/- 1.86% vs 0.29 +/- 0.21% [P < 0.01] on PICU admission and after 72 hours, respectively). Platelet count decrease was similarly noted (51.60 +/- 28.06 vs 27.57 +/- 11.98, P < 0.05, as percentage of preoperative count). Patients operated on in the neonatal period showed the highest blood loss and related coagulation impairment. CONCLUSION Younger CPT surgery patients present an increased risk versus their older counterparts of massive bleeding resulting in hemodynamic instability and coagulative impairment.
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Affiliation(s)
- Marco Piastra
- Pediatric Intensive Care Unit, Catholic University School of Medicine, Gemelli Hospital, 00168 Rome, Italy.
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32
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Piastra M, Caresta E, Tempera A, Langer A, Zorzi G, Pulitanò S, Chiaretti A, Genovese O, Viola L, Tortorolo L, Polidori G. Sharing features of uncommon respiratory syncytial virus complications in infants. Pediatr Emerg Care 2006; 22:574-8. [PMID: 16912626 DOI: 10.1097/01.pec.0000230704.74022.3e] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We describe 4 nonconsecutive cases of infants admitted to Catholic University pediatric intensive care unit (PICU) because of complicated respiratory syncytial virus (RSV) infection during winter RSV outbreaks from the year 2000 to the year 2003. A hyponatremic epileptic status (as in the first case) has been reported by several authors as a rare RSV complication, potentially leading to death. The second infant developed a serious pulmonary edema after a subglottic obstruction (croup) associated with RSV infection. The remaining 2 infants developed a pneumothorax and subcutaneous emphysema while breathing spontaneously during an RSV bronchiolitis. In all infants, a full recovery and PICU discharge was achieved despite the need for mechanical ventilation in cases 1 and 2. Increased intrapleural negative pressure or its combination with hypoxia/hypercapnia has been suggested as the common factor possibly joining these different clinical pictures.
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Affiliation(s)
- Marco Piastra
- Pediatric Intensive Care Unit, Catholic University Medical School, Gemelli Hospital, Rome, Italy.
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33
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Piastra M, Tempera A, Caresta E, Chiaretti A, Genovese O, Zorzi G, Pulitanò S, Pietrini D, Polidori G. Lung injury from "liquid ecstasy": a role for coagulation activation? Pediatr Emerg Care 2006; 22:358-60. [PMID: 16714966 DOI: 10.1097/01.pec.0000215369.64106.9c] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We describe our second clinical observation of pulmonary injury after a "liquid ecstasy" ingestion/inhalation by a 3-year-old girl. Apart from the deep coma state, a markedly asymmetric pulmonary compromise was recorded. A transient coagulation activation was detected, possibly triggered off by the toxic effect on the lung alveolar-capillary membrane.
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Affiliation(s)
- Marco Piastra
- Pediatric Intensive Care Unit, Catholic University Medical School, Gemelli Hospital, Rome, Italy.
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34
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Moretto LM, Silvestri S, Ugo P, Zorzi G, Abbondanzi F, Baiocchi C, Iacondini A. Polycyclic aromatic hydrocarbons degradation by composting in a soot-contaminated alkaline soil. J Hazard Mater 2005; 126:141-8. [PMID: 16087289 DOI: 10.1016/j.jhazmat.2005.06.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2005] [Revised: 05/31/2005] [Accepted: 06/15/2005] [Indexed: 05/03/2023]
Abstract
This study deals with the biodegradation of the polycyclic aromatic hydrocarbons (PAH)s present in a soil contaminated by soot waste, characterised by a total PAHs content in the 200 mg kg(-1) range. A challenging characteristic of the waste soil treated was its high alkalinity, with a pH of about 12.8. The waste came from a soot-contaminated area located in the industrial zone of Porto Marghera, Venice (Italy). The biodegradation process employed was the composting of the waste with sewage sludge and yard waste. The process was carried out on a pilot scale using a closed tank with forced aeration for a period of 60 days, followed by 70 days with natural aeration. The time evolution of the process was monitored by following the time change in the concentration of the 16 US-EPA PAHs, as well as temperature, pH, electrical conductivity, C and N contents. Also phytotoxicity parameters, such as the growth and respiration indexes, were monitored. An induction time of about 30 days was observed, which corresponded to the time required before observing a significant self-drop in the waste pH and an increase in mass temperature. Afterward, a progressive drop in the PAHs concentration was observed, up to reaching after 130 days an overall degradation percentage in the order of 68%. The degradation was more effective on rather low molecular weight PAHs (2-4 rings).
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Affiliation(s)
- L M Moretto
- Dipartimento di Chimica Fisica, Università Ca' Foscari di Venezia, Calle Larga, Santa Marta 2137, Venezia I-30123, Italy
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35
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Chiaretti A, Zorzi G, Di Rocco C, Genovese O, Antonelli A, Piastra M, Polidori G, Aloe L. Neurotrophic factor expression in three infants with Ondine's curse. Pediatr Neurol 2005; 33:331-6. [PMID: 16243220 DOI: 10.1016/j.pediatrneurol.2005.05.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Revised: 03/31/2005] [Accepted: 05/23/2005] [Indexed: 11/16/2022]
Abstract
This study investigates the expression of some neurotrophic factors (brain-derived neurotrophic factor, glial-derived neurotrophic factor, and nerve growth factor) in the cerebrospinal fluid of infants suffering from idiopathic congenital central hypoventilation syndrome and determines their correlations with this syndrome. Cerebrospinal fluid samples were collected from three infants suffering from idiopathic congenital central hypoventilation syndrome and 15 control subjects with obstructive hydrocephalus to measure the expression of brain-derived neurotrophic factor, glial-derived neurotrophic factor, and nerve growth factor using an immunoenzymatic assay. In the cerebrospinal fluid of patients, analysis of neurotrophic factors expression indicated a reduction, not statistically significant, of brain-derived neurotrophic factor compared with the mean level of the control group (1554 pg/mL, 1509 pg/mL, and 1582 pg/mL respectively, in comparison to 1954 +/- 103 pg/mL), whereas nerve growth factor and glial-derived neurotrophic factor did not undergo significant variations in either group. Neurotrophic factors, namely brain-derived neurotrophic factor, regulate the maturation and differentiation of respiratory neurons. The reduced expression of brain-derived neurotrophic factor in the cerebrospinal fluid samples of infants with Ondine's curse, although not statistically significant, is suggestive of a dysregulation in the brain-derived neurotrophic factor synthesis that could play an important role in the breathing disorders observed in patients with idiopathic congenital central hypoventilation syndrome.
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Affiliation(s)
- Antonio Chiaretti
- Pediatric Intensive Care Unit, Catholic University Medical School, Rome, Italy
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36
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Hörtnagel K, Nardocci N, Zorzi G, Garavaglia B, Botz E, Meitinger T, Klopstock T. Infantile neuroaxonal dystrophy and pantothenate-kinase-associated neurodegeneration: locus heterogeneity. Neurology 2005; 63:922-4. [PMID: 15365152 DOI: 10.1212/01.wnl.0000137046.28085.b2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Common clinical, radiologic, and pathologic features in infantile neuroaxonal dystrophy (INAD) and pantothenate kinase-associated neurodegeneration (PKAN) have led to the hypothesis of an allelic relationship. With the discovery of the gene defect in PKAN, this can now be tested directly. The authors excluded linkage in one consanguineous INAD family by haplotype analysis. Moreover, sequencing in seven INAD families revealed no mutations in PANK2 or in other genes of CoA biogenesis. Thus, INAD and PKAN are genetically heterogeneous disorders.
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Affiliation(s)
- K Hörtnagel
- Institute of Human Genetics, GSF Research Center for Environment and Health, Neuherberg, Germany
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37
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Chiapparini L, Zorzi G, De Simone T, Maccagnano C, Seaman B, Savoiardo M, Corona C, Nardocci N. Persistent fixed torticollis due to Atlanto-axial rotatory fixation: report of 4 pediatric cases. Neuropediatrics 2005; 36:45-9. [PMID: 15776322 DOI: 10.1055/s-2004-830533] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Atlanto-axial rotatory fixation (AARF) is a rare cause of childhood torticollis that may occur spontaneously or in association with trauma and upper respiratory infections. We describe the clinical findings, as well as the effectiveness of imaging in the diagnosis and the treatment of 4 children with AARF, in whom acute fixed non-dystonic torticollis was the presenting symptom. Onset of torticollis was spontaneous in Case 1, after general anesthesia for cholesteatoma surgery in Case 2, after a trauma in Case 3, and during hypersomnia in Case 4. Duration of torticollis prior to diagnosis was 3 months in the first two patients and 20 days in the other two. All the patients underwent cervical X-rays examinations, which were not contributory to the diagnosis, followed by CT, which demonstrated C1-C2 rotatory fixation. One patient had a spontaneous resolution; treatment with Gardner's tongs and soft collar permitted restoration of the normal alignment in the other 3 patients. AARF must be considered in all the patients with persistent painful torticollis.
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Affiliation(s)
- L Chiapparini
- Department of Neuroradiology, National Neurological Institute C. Besta, Milano, Italy.
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38
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Mariotti C, Gellera C, Rimoldi M, Mineri R, Uziel G, Zorzi G, Pareyson D, Piccolo G, Gambi D, Piacentini S, Squitieri F, Capra R, Castellotti B, Di Donato S. Ataxia with isolated vitamin E deficiency: neurological phenotype, clinical follow-up and novel mutations in TTPAgene in Italian families. Neurol Sci 2004; 25:130-7. [PMID: 15300460 DOI: 10.1007/s10072-004-0246-z] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2004] [Accepted: 05/10/2004] [Indexed: 12/12/2022]
Abstract
Ataxia with vitamin E deficiency (AVED) is a rare autosomal recessive neurodegenerative disorder due to mutations in the alpha-tocopherol transfer protein (TTPA) gene on chromosome 8q13. AVED patients have progressive spinocerebellar symptoms and markedly reduced plasma levels of vitamin E. We studied neurological phenotype at diagnosis, and long-term effect of vitamin E supplementation in 16 patients from 12 Italian families. The most common mutations were the 744delA and 513insTT. Two novel TTPA mutations were identified: a severe truncating mutation (219insAT) in a homozygous patient, and a Gly246Arg missense mutation (G246R) in a compound heterozygous patient. The missense mutation was associated with a mild and slowly progressive form of the disease. Vitamin E supplementation therapy allowed a stabilization of the neurological conditions in most of the patients. However, development of spasticity and retinitis pigmentosa was noted in a few patients during therapy. Prompt genetic characterization of AVED patients may allow an effective early treatment and an adequate genetic counseling.
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Affiliation(s)
- C Mariotti
- Division of Biochemistry and Genetics, C. Besta National Neurological Institute, Via Celoria 11, I-20133 Milan, Italy.
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Abstract
AIMS To evaluate the clinical efficacy of sublingual immunotherapy (SLIT) in respiratory allergy in children. METHODS A systematic literature review was conducted. The search was focused on all the double blind (and double dummy if necessary) studies. SEARCH STRATEGY Medline, Embase, Cochrane Controlled Trial Register, Abstract of Cochrane Airways Group, hand search, and archives of some SLIT producers. All the selected studies were assessed and evaluated for quality in a standardised independent way. RESULTS Eight randomised, double blind, placebo controlled studies on SLIT were selected. Five studies were run with house dust mite (HDM), one with olive pollen, one with wall pellitory (Parietaria) pollen, and one with grass pollen. A quantitative evaluation of the studies was not possible because the outcomes and the results of single studies were presented according to different criteria. Therefore only qualitative analysis was performed. No clinically relevant results were shown, independently from statistical significance, in the use of SLIT for respiratory allergies due to seasonal allergens (olive, wall pellitory, and grass pollens) and, on the whole, for rhinoconjunctivitis due to HDM in children. For mild to moderate persistent asthma due to HDM, statistically significant and low to moderate relevant clinical effects were observed. CONCLUSIONS SLIT can be currently considered to have low to moderate clinical efficacy in children of at least 4 years of age, monosensitised to HDM, and suffering from mild to moderate persistent asthma. This benefit seems to be adjunctive with respect to the environmental preventive measures against HDM.
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Affiliation(s)
- S Miceli Sopo
- Department of Pediatric Science, Università Cattolica del Sacro Cuore, Rome, Italy.
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40
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Affiliation(s)
- S Miceli Sopo
- Department of Pediatrics, Catholic University of Rome, Italy.
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41
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Garavaglia B, Invernizzi F, Carbone MLA, Viscardi V, Saracino F, Ghezzi D, Zeviani M, Zorzi G, Nardocci N. GTP-cyclohydrolase I gene mutations in patients with autosomal dominant and recessive GTP-CH1 deficiency: identification and functional characterization of four novel mutations. J Inherit Metab Dis 2004; 27:455-63. [PMID: 15303002 DOI: 10.1023/b:boli.0000037349.08483.96] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
GTP-cyclohydrolase I (GTP-CH1, EC 3.5.4.16) is encoded by the GCH1 gene. Mutations in the GCH1 gene cause both dopa-responsive dystonia (McKusick 128230) and recessive GTP-CH1 deficiency (McKusick 600225). The exact molecular mechanism resulting in decreased GTP-CH1 activity in the patients is still obscure. We report the clinical features and molecular and functional study of the GCH1 gene in eight Italian patients affected by dominant and recessive GTP-CH1 deficiency. All the studied patients had mutations in the GCH1 gene. Three missense mutations (V205G, K224R, P199A), a frameshift mutation (Delta G693), and a splice-site mutation (ivs5 + 1g > c) were found. Except for K224R these are all novel mutations. To analyse the defect caused by the novel mutations, an in vivo functional assay in a Saccharomyces cerevisiae strain lacking the endogenous gene encoding GTP-CH1 ( FOL2 ) was performed. Complementation analysis showed that the Delta G693 and V205G mutations abolish the enzymatic function, while the P199A mutation causes a conditional defect. In conclusion, the clinical phenotypes displayed by our patients confirm the wide clinical spectrum of the disease and further support the lack of correlation between a given mutation and a clinical phenotype. Complementation analysis in yeast is a useful tool for confirming the pathogenetic effect of GCH1 mutations.
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Affiliation(s)
- B Garavaglia
- Unità Operativa di Neurogenetica Molecolare, Istituto Nazionale Neurologico-IRCCS Carlo Besta, via L. Temolo 4, 20126 Milano, Italy.
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42
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Marras C, Franzini A, Nardocci N, Zorzi G, Dones I, Maccagnano E, Tringali G, Broggi G. Deep Brain Stimulation For the Treatment Of Childhood Onset Dystonia: a Preliminary Result. Neuromodulation 2003. [DOI: 10.1046/j.1525-1403.2003.03027_29.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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43
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Nardocci N, Zorzi G, Blau N, Fernandez Alvarez E, Sesta M, Angelini L, Pannacci M, Invernizzi F, Garavaglia B. Neonatal dopa-responsive extrapyramidal syndrome in twins with recessive GTPCH deficiency. Neurology 2003; 60:335-7. [PMID: 12552057 DOI: 10.1212/01.wnl.0000044049.99690.ad] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The authors report two twin sisters, age 15 years, with recessive GTP cyclohydrolase deficiency, who presented with neonatal onset of rigidity, tremor, and dystonia but with no other symptoms suggestive of a diffuse CNS involvement. The plasma phenylalanine levels were normal. Treatment with L-dopa/carbidopa, started at age 1 year, was associated with sustained recovery from all neurologic signs. The patients were homozygous for a new recessive mutation in the GHI gene.
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MESH Headings
- Adolescent
- Antiparkinson Agents/therapeutic use
- Basal Ganglia Diseases/complications
- Basal Ganglia Diseases/diagnosis
- Basal Ganglia Diseases/drug therapy
- Basal Ganglia Diseases/enzymology
- Carbidopa/therapeutic use
- Dopamine Agents/therapeutic use
- Dystonia/etiology
- Female
- Follow-Up Studies
- GTP Cyclohydrolase/deficiency
- GTP Cyclohydrolase/genetics
- Genes, Recessive
- Homozygote
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/drug therapy
- Infant, Newborn, Diseases/genetics
- Levodopa/therapeutic use
- Metabolism, Inborn Errors/diagnosis
- Metabolism, Inborn Errors/drug therapy
- Muscle Rigidity/etiology
- Mutation
- Reflex, Abnormal/genetics
- Remission Induction
- Treatment Outcome
- Tremor/etiology
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Affiliation(s)
- N Nardocci
- Department of Child Neurology, Istituto Nazionale Neurologico "Carlo Besta," Milan, Italy.
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44
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Zambrino CA, Zorzi G, Lanzi G, Uggetti C, Egitto MG. Bilateral striatal necrosis associated with Mycoplasma pneumoniae infection in an adolescent: clinical and neuroradiologic follow up. Mov Disord 2000; 15:1023-6. [PMID: 11009221 DOI: 10.1002/1531-8257(200009)15:5<1023::aid-mds1045>3.0.co;2-a] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- C A Zambrino
- Department of Child Neuropsychiatry, C Mondino Foundation, Pavia, Italy
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Farina L, Nardocci N, Bruzzone MG, D'Incerti L, Zorzi G, Verga L, Morbin M, Savoiardo M. Infantile neuroaxonal dystrophy: neuroradiological studies in 11 patients. Neuroradiology 1999; 41:376-80. [PMID: 10379598 DOI: 10.1007/s002340050768] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We report the imaging findings in 11 patients with infantile neuroaxonal dystrophy. Ten patients underwent 15 MRI examinations; one patient had only CT. Of the ten patients who underwent MRI, eight had cerebellar atrophy and mildly increased signal from the cerebellar cortex on T2-weighted images. With T2 weighting there was slightly increased signal from the dentate nuclei in two patients and from the posterior periventricular white matter in three. We saw four patients with a thin optic chiasm. The only two brothers in the series had markedly low signal from the globus pallidus and substantia nigra on 1.5 T T2-weighted images, as seen in Hallervorden-Spatz disease (HSD). Abnormalities of the globus pallidus may be related to a protracted course of the disease. However, an overlap with HSD should be considered.
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Affiliation(s)
- L Farina
- Department of Neuroradiology, Istituto Nazionale Neurologico C. Besta, Milan, Italy
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Nardocci N, Zorzi G, Farina L, Binelli S, Scaioli W, Ciano C, Verga L, Angelini L, Savoiardo M, Bugiani O. Infantile neuroaxonal dystrophy: clinical spectrum and diagnostic criteria. Neurology 1999; 52:1472-8. [PMID: 10227637 DOI: 10.1212/wnl.52.7.1472] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To present clinical, neurophysiologic, and neuroradiologic findings in 13 patients with infantile neuroaxonal dystrophy (INAD), focusing on aspects that assist early diagnosis. BACKGROUND Clinicopathologic diagnostic criteria for INAD were delineated by Aicardi and Castelein in 1979, but atypical cases are reported frequently and little is known of the diagnostic utility of MRI. METHODS The authors reviewed the clinical, neurophysiologic, and MRI findings of 13 patients who met the diagnostic criteria for INAD. RESULTS Symptoms onset was between 6 months and 2 years of age. In nine patients the clinical course was typical, with rapid motor and mental deterioration; in four patients progression was slower and the clinical picture was different. Electromyographic (EMG) signs of chronic denervation, fast rhythms on EEG and abnormal visual evoked potentials were observed in all patients during the disease course. Cerebellar atrophy with signal hyperintensity in the cerebellar cortex on T2-weighted images were the most characteristic MRI findings; hypointensity in the pallida and substantia nigra was also observed in two patients. alpha-N-acetyl-galactosaminidase activity on leukocytes was normal in the 10 patients tested. CONCLUSIONS EMG and MRI abnormalities are the earliest and most suggestive signs of INAD, which has a clinical and radiologic spectrum that is broader than reported previously.
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Affiliation(s)
- N Nardocci
- Department of Child Neurology, National Neurological Institute Carlo Besta, Milan Italy
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Abstract
We report antiphospholipid antibody positivity in three of a consecutive series of 23 children presenting partial epileptic seizures. There was no clinical or serological evidence of systemic lupus erythematosus or other connective-tissue disease. Neither computed tomography nor magnetic resonance imaging revealed ischemic alteration. The presence of antiphospholipid antibodies in 3/23 children may indicate that immune-mediated neuronal damage could be a pathogenetic mechanism for partial epilepsy.
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Affiliation(s)
- L Angelini
- Department of Neuropediatrics, National Neurological Institute C. Besta, Milano, Italy
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Abstract
A retrospective study of 13 patients (4 males/9 females) with acquired hemidystonia in childhood is reported. The mean age of onset of hemidystonia was 6.4 years (range 1-13.4 years); the mean duration of dystonia at the time of last follow-up was 11.4 years (range 3.6-23 years). Hemidystonia was caused by ischemic infarction in 9 patients and was attributed to perinatal trauma in 1; in 4 of the 9 patients with stroke and in the remaining 3 patients laboratory investigations were suggestive of primary antiphospholipid syndrome. Eleven of the 13 patients had delayed onset of dystonia: between 1 month and 8.9 years (mean 3.4 years). Ten patients had neuroradiological evidence of contralateral basal ganglia damage. A history of hemiparesis and evidence of striatal damage on CT or MRI were important risk factors for the development of dystonia. Response to medical treatment (trihexyphenidyl dose as high as 40 mg daily) in 5 patients was disappointing; 4 of the 5 patients who underwent functional stereotaxic operations were improved, but dystonia was still present at the end of the follow-up. Our study provides additional evidence that lesions of the striatum may induce dystonia, supporting the theory of striatopallido-thalamic disconnection. Furthermore, our results indicate that the occurrence of delayed dystonia must be considered in the diagnostic approach to childhood-onset dystonia.
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Affiliation(s)
- N Nardocci
- Department of Child Neurology, National Neurological Institute C. Besta, Milan, Italy
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Angelini L, Zibordi F, Zorzi G, Nardocci N, Caporali R, Ravelli A, Martini A. Neurological disorders, other than stroke, associated with antiphospholipid antibodies in childhood. Neuropediatrics 1996; 27:149-53. [PMID: 8837075 DOI: 10.1055/s-2007-973766] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We report the results of a systematic study on the association of antiphospholipid antibodies (aPLs) with some neurological disease other than stroke in a childhood population. Patients affected by migraine, benign intracranial hypertension (BIH) or unilateral movement disorders, such as hemichorea and hemidystonia with acute-subacute onset, were screened for aPLs. None of them had clinical or serological evidence of Systemic Lupus Erythematosus (SLE) or other connective tissue disease. Moderate to high levels of anticardiolipin antibodies (aCL) and/or positive Lupus Anticoagulant (LA) were demonstrated in 6 out of 17 patients with migraine, in 3 out of 4 patients with BIH and in all of the 5 patients showing unilateral movement disorders. The association between aPLs and these neurological conditions, usually regarded as cryptogenic, may suggest a possible pathogenetic mechanism.
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Affiliation(s)
- L Angelini
- Department of Neuropediatrics, National Neurological Institute C. Besta, Milano, Italy
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Angelini L, Zorzi G, Rumi V, Nardocci N, Mennini T. Transient paroxysmal dystonia in an infant possibly induced by cisapride. Ital J Neurol Sci 1996; 17:157-9. [PMID: 8797071 DOI: 10.1007/bf02000848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The case is reported of an infant presenting paroxysmal dystonia during cisapride theraphy. We suggest that this drug, a substituted benzamide, probably interfered with the age-related modification of striatal neurotransmitters, provoking extrapyramidal symptoms. Considering the widespread use of cisapride in early infancy for the treatment of gastrointestinal disorders, attention must be drawn to this possible side effect.
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Affiliation(s)
- L Angelini
- Divisione di Neuropsichiatria Infantile, Istituto Nazionale Neurologico, C. Besta, Milano, Italy
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