Publications by authors named "Antonio Arrichiello"

22 Publications

  • Page 1 of 1

Corrigendum to 'Arterial Embolization and Second-Look in Spindle Cell Oncocytoma of the Pituitary Gland: Case Report and Review of Literature' [World Neurosurgery 142 (2020) 87-92].

World Neurosurg 2021 Apr 23;148:269. Epub 2021 Jan 23.

Unit of Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.

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http://dx.doi.org/10.1016/j.wneu.2020.12.156DOI Listing
April 2021

Giant intracranial aneurysm following radiation therapy: literature review with a novel case discussion.

Acta Biomed 2020 09 23;91(10-S):e2020005. Epub 2020 Sep 23.

Operative Unit of Neuroradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy. Via Francesco Sforza 35, 20122, Milano, Italy.

Background: The aim of this paper is to report the results of our review of the literature of published cases of intracranial aneurysms appearing after radiotherapy, and to present our case to add it to the current literature, in order to discuss the role of inflammation.

Methods: We searched the PubMed database using combinations of the following MeSH terms: intracranial aneurysm, radiosurgery, radiotherapy, inflammatory changes in aneurysmal walls from 1967 to 2019.

Results: 51 studies, for a total cohort of 60 patients, are described. The median latency between the radiation treatment and the diagnosis was 9,83 years, ranging from a minimum of 0,33 to a maximum of 33. The modality of rays' administration was variable, and the dosage ranged from a minimum of 12 grays to a maximum of 177,2 grays. The anterior circulation appeared to be more frequently involved, and the most compromised vessel was the internal carotid artery. Radiation-induced vascular diseases have already been described in literature as well as RT-induced cellular and structural changes such as necrosis, macrophage or mononuclear cell infiltration, and several data support the role of inflammation in the development and remodelling of intracranial aneurysms, that, on one hand, favours them and, on the other, is necessary to their healing after endovascular treatment.

Conclusions: Our team suggested a new insight in the management of these vascular lesions, which corresponds to a lower threshold when deciding whether or not to treat, and a longer and stricter follow-up.
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http://dx.doi.org/10.23750/abm.v91i10-S.10281DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023079PMC
September 2020

Cooled radiofrequency ablation technology for painful bone tumors.

Acta Biomed 2020 09 23;91(10-S):e2020007. Epub 2020 Sep 23.

1. Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy. Via Francesco Sforza 35, 20122, Milano, Italy. 6. Department of Health Sciences, Università degli Studi di Milano, Milan, Italy Via Festa del Perdono 7, 20122, Milan, Italy.

Bone metastases are a common cause of cancer-related debilitating pain, especially when -localized in the vertebral column and not responsive to standard treatment. In such cases, various treatment options are available; among these is Radiofrequency, whose role has been rapidly growing over the past few years. In this study, we used the innovative Osteocool RF Ablation System (Medtronic) on a patient with a painful bone metastasis localized in the 5th lumbar vertebra, with encouraging results. The radiofrequency ablation of bone metastases with palliative aim represents an excellent treatment option, as it is a minimally invasive and safe procedure, and can be repeated multiple times.
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http://dx.doi.org/10.23750/abm.v91i10-S.10271DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023082PMC
September 2020

Glue embolization of a pial arteriovenous fistula of the spinal artery.

Acta Biomed 2020 09 23;91(10-S):e2020004. Epub 2020 Sep 23.

Operative Unit of Neuoradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy. Via Francesco Sforza 35, 20122, Milano, Italy.

There are no clear guidelines about the treatment Pial Arteriovenous Fistulae (PAVF). For high-risk and severally symptomatic fistulae surgery is the first choice of treatment, including feeding artery ligation, surgical resection, radiosurgery and endovascular embolization techniques. We described a case of a patient with a symptomatic PAVF at the craniocervical junction fed by the anterior spinal artery, successfully treated with endovascular approach consisting of glue embolization of the feeding vessel.
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http://dx.doi.org/10.23750/abm.v91i10-S.10282DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023074PMC
September 2020

Branch vessel occlusion in aneurysm treatment with flow diverter stent.

Acta Biomed 2020 09 23;91(10-S):e2020003. Epub 2020 Sep 23.

Operative Unit of Neuoradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy. Via Francesco Sforza 35, 20122, Milano, Italy.

Flow diverter placement for treatment of intracranial aneurysms gained growing consensus in the past years. A major concern among professionals is the side branch coverage which leads in some cases to vessel occlusion. However, the lost vessel patency only infrequently is accompanied by a new onset of neurological deficits secondary to ischaemic lesions. A retrospective analysis of all patients treated with flow diversion at our hospital was aimed to better understand this phenomenon in order to formulate a hypothesis about the causes. We concluded that vessel occlusion occurs due to a reduced blood pressure gradient in those vessels with a strong collateral or anastomotic vascularization that refurnishes the same distal vascular territories. Indeed, we detected no new brain infarction since blood flow was always guaranteed.
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http://dx.doi.org/10.23750/abm.v91i10-S.10283DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023076PMC
September 2020

Prostatic artery embolization in patients with benign prostatic hyperplasia: perfusion cone-beam CT to evaluate planning and treatment response.

Acta Biomed 2020 09 23;91(10-S):e2020013. Epub 2020 Sep 23.

Operative Unit of Radiology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy. Via Francesco Sforza 35, 20122, Milano, Italy; Department of Health Sciences, Università degli Studi di Milano, via Festa del Perdono, 7, 20122, Milan, Italy.

This proof of concept is to evaluate the utility of perfusion cone-beam computed tomography (CT) in patients undergoing prostatic artery (PA) embolization (PAE) for benign prostatic hyperplasia (BPH) with moderate or severe-grade lower urinary tract symptoms (LUTS). PAE is a novel minimally invasive therapy and is both safe and effective procedure with low risks and high technical successes, making this procedure as the best alternative to surgery. A lot of technical changes would compromise clinical outcomes after procedure, including a variable prostate vascular anatomy, thin PA, and extensive atherosclerotic disease. The purpose of our study is to exploit the advantages of Perfusion Cone Beam Computed Tomography (CBCT) that could impact treatment and help interventional radiologists for treatment planning, diagnosis and for assessing the technical feasibility during PAE, mitigating the risk of nontarget embolization and suggesting clinical outcomes. Qualitative and quantitative clinical pre- and post-treatment values will be compared, to reach the best possible results.
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http://dx.doi.org/10.23750/abm.v91i10-S.10260DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023075PMC
September 2020

Flow diverting devices in acute ruptured blood blister aneurysms: a three centric retrospective study.

Acta Biomed 2020 09 23;91(10-S):e2020011. Epub 2020 Sep 23.

Operative Unit of Neuroradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.

Background: Blood blister aneurysms (BBAs) are a rare tiny subset of intracranial aneurysms, located at the nonbranching site of an artery, representing a therapeutic challenge from both surgical and endovascular approach. Flow-diverting efficacy, by preserving flow through the parent artery, was approved for its use in unruptured cerebral aneurysms, but no consensus was reached on its use for BBAs ruptured in the acute setting. We report a multicenter experience of use of flow diversion in acute setting of ruptured BBA, to analyze the safety and efficacy of these devices.

Methods: We performed a retrospective study of 6 consecutive intracranial BBAs treated with flow diverter devices (FDD) between 2018 and 2020 at 3 italian institutions. Materials, therapy used, complications, clinical and radiographic outcomes were reviewed.

Results: We used different FDD, in all cases immediate change in contrast opacification at the end of the procedure was reported. Intraprocedural IIb/IIIa inhibitor agent was the major antiplatelet protocol administered. Any complications occurred. All patients showed complete BBA obliteration at 3 months follow-up. 5/6 patients achieved good clinical outcome (0-2 mRS) at 3 months, all of which were presented with low grade SAH (Hunt Hess I-III) and a lower Fisher grade.

Conclusion: Our data support this endovascular technique as a safe and effective therapeutic modality for this pathology in the acute setting.
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http://dx.doi.org/10.23750/abm.v91i10-S.10261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023071PMC
September 2020

Efficacy, safety and usability of bronchial artery embolization using a new anti-reflux microcatheter in the management of haemoptysis.

Acta Biomed 2020 09 23;91(10-S):e2020009. Epub 2020 Sep 23.

Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy. Via Francesco Sforza 35, 20122, Milano, Italy; 5. Department of Health Sciences, Università degli Studi di Milano, Milan, Italy Via Festa del Perdono 7, 20122, Milan, Italy.

Purpose: Haemoptysis (Hp) is a potentially life-threatening medical condition. We investigated the safety, efficacy and usability of bronchial artery embolization using a new anti-reflux microcatheter in patients with haemoptysis.

Materials And Methods: The study was held as a single-center retrospective study. Four patients underwent bronchial arterial embolization, using the new microcatheter. Then, we evalueted technical success, immediate clinical success, haemoptysis recurrance rate and safety in reducing reflux complications. Conclusion Bronchial artery embolization for hemoptysis with the new microcatheter is a safe and effective method with high technical and clinical success rates. Short and medium-term results are excellent.
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http://dx.doi.org/10.23750/abm.v91i10-S.10265DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023073PMC
September 2020

Software-assisted US/MRI fusion-targeted biopsy for prostate cancer.

Acta Biomed 2020 09 23;91(10-S):e2020006. Epub 2020 Sep 23.

Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy; Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.

Background: Prostate cancer is the first cancer diagnosis in men. European Association of Urology  (EAU) Guidelines for Prostate Cancer underline the importance of screening, performed through PSA testing on all men with more than 50 years of age and before on men with risk factors. The diagnosis is still histopathologic, and it is done on the basis of the findings on biopsy samples.

Materials And Methods: Fusion biopsy is a relatively new technique that allows the operator to perform the biopsies in office instead of the MRI gantry, without losing the detection capability of MRI. The  T2-wighted images obtained during a previous mpMRI are merged with the real-time ones of the TRUS.

Results: Fusion biopsy in comparison with the systematic standard biopsy has a better detection rate of clinically significant cancers and of any cancers.

Conclusion: EAU 2020 guidelines still do offer a list of indications of when the biopsy should be performed, but it still appeared to be overperformed. The aim of our study is to underline how, in accordance with the recent literature result,  fusion biopsy has showed a better detection rate of any cancer and clinically significant disease with a reduced numbers of samplings, and no substantial difference between the multiple software.
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http://dx.doi.org/10.23750/abm.v91i10-S.10273DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023072PMC
September 2020

Percutaneous lung microwave ablation versus lung resection in high-risk patients. A monocentric experience.

Acta Biomed 2020 09 23;91(10-S):e2020002. Epub 2020 Sep 23.

Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

Background And Aim Of Work: Lung microwave ablation (MWA) is considered an alternative treatment in high-risk patients, not suitable for surgery. The aim of our study is to compare MWA and pulmonary lobectomy in high-risk, lung cancer patients.

Methods: This was a single-center, propensity score--weighted cohort study. All adult patients who underwent CT guided MWA for stage I NSCLC between June 2009-October 2014 were included in the study and were compared with a cohort of patients submitted to lung lobectomy in the same period of time. Outcomes were overall survival (OS) and disease-free survival (DFS).

Results: 32 patients underwent MWA, and 35 high-risk patients submitted to lung lobectomy in the same period were selected. Median follow-up time was 51.1 months (95% CI: 43.8-62.3). Overall survival was 43.8 (95% CI: 26.1-55) and 55.8 months (95% CI: 49.9-76.8) in the MWA group and Lobectomy group, respectively. Negative prognostic factors were MWA procedure (HR:2.25, 95% CI: 1.20-4.21, p= 0.0109) and nodule diameter (HR: 1.04, 95% CI: 1.01-1.07; p= 0.007) for OS, while MWA procedure (HR: 5.2; 95% CI: 2.1-12.8: p < 0.001), ECOG 3 (HR: 5.0; 95% CI: 1.6-15.6; p = 0.006) and nodule diameter (HR: 1.1; 95% CI: 1.0-1.1; p = 0.003) for DFS.

Conclusions: Our study demonstrated a high percentage of local relapse in the MWA group but a comparable overall survival. Although lung lobectomy remains the gold standard treatment for stage I NSCLC, we can consider the MWA procedure as valid alternative local treatment in high-risk patients for stage I NSCLC.
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http://dx.doi.org/10.23750/abm.v91i10-S.10342DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023078PMC
September 2020

Interventional radiology management of high flow priapism: review of the literature.

Acta Biomed 2020 09 23;91(10-S):e2020010. Epub 2020 Sep 23.

1-Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy. 2-Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.

Introduction: High-flow priapism is a persistent partial penile tumescence, related to high flow arterial blood into the corpora. In the treatment of high flow priapism, super-selective embolization is considered treatment of choice when conservative treatment fails as reported in the "EAU Guidelines on Priapism", but there are only few series reporting the outcome, the efficacy of different embolic materials and these studies are uncontrolled and relatively small.

Objectives: The aim of this study is to review the literature to outline the state of the art of this interventional treatment and to analyse the outcome of the different embolic agents.

Methods: Through Medline database we searched all the English-language published articles related to priapism. Keywords were chosen according to MeSH terms. We selected case-series from 1990 to 2020 including at least five cases of high-flow priapism.The variables extracted from the selected articles were: number of patients, mean age, diagnostic imaging modality, mono or bilateral involvement of the arteries, embolization material, technical success, clinical success, complications, recurrence rate and type of reintervention, mean follow up, onset of erectile dysfunction.

Results: We analyzed 11 papers.A total of 117 patients, mean age of 30 years, were studied during a period of 8 to 72 months. Technical success average was 99%, varying from 93 to 100%. Clinical success average was 88%, varying from 56 to 100%. After two or more treatments, resolution of priapism was obtained in all patients. No major adverse events registered. Recurrence rate of 21%(25/117) was observed, and only 4 pts underwent surgery. A total of 17 pts (15%) developed erectile dysfunction (ED).

Conclusion: Our data suggested comparable outcomes using different types of materials.In line with the last evidences we suggest that the choice of the embolic material should be selected basing on the expertise of the operator, the characteristic of the fistula and characteristic of the patients.
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http://dx.doi.org/10.23750/abm.v91i10-S.10233DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023077PMC
September 2020

Use of perfusional CBCT imaging for intraprocedural evaluation of endovascular treatment in patients with diabetic foot: a concept paper.

Acta Biomed 2020 09 23;91(10-S):e2020008. Epub 2020 Sep 23.

Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy. Via Francesco Sforza 35, 20122, Milano, Italy; Department of Health Sciences, Università degli studi di Milano, Milan, Italy.

Diabetes mellitus (DM) is one of the most common metabolic diseases worldwide; its global burden has increased rapidly over the past decade, enough to be considered a public health emergency in many countries. Diabetic foot disease and, particularly diabetic foot ulceration, is the major complication of DM: through a skin damage of the foot, with a loss of epithelial tissue, it can deepen to muscles and bones and lead to the amputation of the lower limbs. Peripheral arterial disease (PAD) in patients with diabetes, manifests like a diffuse macroangiopathic multi-segmental involvement of the lower limb vessels, also connected to a damage of collateral circulation; it may also display characteristic microaneurysms and tortuosity in distal arteries. As validation method, Bold-MRI is used. The diabetic foot should be handled with a multidisciplinary team approach, as its management requires systemic and localized treatments, pain control, monitoring of cardiovascular risk factors and other comorbidities. CBCT is an emerging medical imaging technique with the original feature of divergent radiation, forming a cone, in contrast with the spiral slicing of conventional CT, and has become increasingly important in treatment planning and diagnosis: from small anatomical areas, such as implantology, to the world of interventional radiology, with a wide range of applications: as guidance for biopsies or ablation treatments. The aim of this project is to evaluate the usefulness of perfusion CBCT imaging, obtained during endovascular revascularization, for intraprocedural evaluation of endovascular treatment in patients with diabetic foot.
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http://dx.doi.org/10.23750/abm.v91i10-S.10267DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023083PMC
September 2020

Image-guided percutaneous mechanical disc decompression for herniated discs: a technical note.

Acta Biomed 2020 09 23;91(10-S):e2020001. Epub 2020 Sep 23.

Operative Unit of Radiology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, via Francesco Sforza 35, 20122, Milan, Italy; Department of Health Sciences, Università degli studi di Milano, Milan, Italy Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico.

Interventional radiology plays a key role in the treatment of symptomatic herniations of intervertebral discs. Through image-guided techniques, it is possible to use minimally invasive procedures with a percutaneous approach that are usually proposed before classic surgery. Thanks to imaging guidance, it is possible to significantly increase accuracy and decrease complication rates. The pivotal principle of these mini-invasive techniques is to remove a small amount of volume of the nucleus of the intervertebral disc which results in a significant reduction in intradiscal pressure; allowing for a consequent reduction in compression of the nervous structures that generate spinal pain. However, it must be considered that this type of treatment is only addressed to contained disc herniations previously diagnosed with a suitable neuroimaging examination. There are different types of treatment using a variety of chemical, thermal or mechanical processes that result in partial removal of the nucleus pulposus. The purpose of this technical note is to illustrate mechanical disc decompression treatment via a percutaneous approach using the DISKOM device (DISKOM percutaneous discectomy probe, Biopsybell, Mirandola, Italy). Indications, complications and various methods of use are described in relation to the different levels of the spine to be treated.
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http://dx.doi.org/10.23750/abm.v91i10-S.10247DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023081PMC
September 2020

Bedside vascular access procedures for COVID-19 patients.

J Vasc Access 2021 Jul 20;22(4):654-657. Epub 2020 Aug 20.

Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.

This report aims to illustrate how to perform a venous access to a COVID-19 patient at the bedside. The decision on the type of venous access, the selection of the material necessary to perform the procedure, and the preparation of the operators are described. The described approach can reduce costs, speed up execution times, and make the operator's work safer. Furthermore, these precautions may help control the spread of COVID-19 within the healthcare facility.
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http://dx.doi.org/10.1177/1129729820951000DOI Listing
July 2021

Early detection of deep vein thrombosis in patients with coronavirus disease 2019: who to screen and who not to with Doppler ultrasound?

J Ultrasound 2021 Jun 18;24(2):165-173. Epub 2020 Aug 18.

Radiology Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.

Purpose: Aim of the study is to evaluate the incidence of DVT in COVID-19 patients and its correlation with the severity of the disease and with clinical and laboratory findings.

Methods: 234 symptomatic patients with COVID-19, diagnosed according to the World Health Organization guidelines, were included in the study. The severity of the disease was classified as moderate, severe and critical. Doppler ultrasound (DUS) was performed in all patients. DUS findings, clinical, laboratory's and therapeutic variables were investigated by contingency tables, Pearson chi square test and by Student t test and Fisher's exact test. ROC curve analysis was applied to study significant continuous variables.

Results: Overall incidence of DVT was 10.7% (25/234): 1.6% (1/60) among moderate cases, 13.8% (24/174) in severely and critically ill patients. Prolonged bedrest and intensive care unit admission were significantly associated with the presence of DVT (19.7%). Fraction of inspired oxygen, P/F ratio, respiratory rate, heparin administration, D-dimer, IL-6, ferritin and CRP showed correlation with DVT.

Conclusion: DUS may be considered a useful and valid tool for early identification of DVT. In less severely affected patients, DUS as screening of DVT might be unnecessary. High rate of DVT found in severe patients and its correlation with respiratory parameters and some significant laboratory findings suggests that these can be used as a screening tool for patients who should be getting DUS.
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http://dx.doi.org/10.1007/s40477-020-00515-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7431752PMC
June 2021

Providing optimal interventional oncology procedures at one of the COVID-19 referral center in Italy.

Med Oncol 2020 Aug 9;37(9):83. Epub 2020 Aug 9.

Department of Health Sciences, Università Degli Studi di Milano, Milan, Italy.

The COVID-19 pandemic has deeply impacted the activity of interventional oncology in cancer centers. Since the first COVID case was diagnosed in Italy on February 21st, our Hospital, located in Milan downtown, has been at the frontline to manage this emergency and to try to ensure essential services. In the present article, we discuss the changes that need to be done for the organization, safety, and patient management in interventional oncology.
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http://dx.doi.org/10.1007/s12032-020-01405-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7415128PMC
August 2020

Adverse Events in Coronavirus Disease Patients Management: A Pictorial Essay.

J Clin Imaging Sci 2020 21;10:42. Epub 2020 Jul 21.

Department of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

Clinical manifestation of coronavirus disease (COVID-19) varies from asymptomatic to severe clinical forms that can result in acute respiratory distress syndrome or in multiple organ dysfunction syndromes. There are no guidelines, based on randomized controlled trials, for the treatment of COVID-19 patients. The treatment is based on antiviral drugs, invasive and non-invasive ventilation supports, and anticoagulant therapy. This is a pictorial essay covering the multiple adverse events encountered during the treatment of COVID-19 patients in an area with a high pandemic incidence. Adverse events are defined as unexpected events following treatment for the infection. The cases described would be useful in aiding early diagnosis, limiting and improving the management of serious complications for patients, and allowing rapid and appropriate treatment.
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http://dx.doi.org/10.25259/JCIS_72_2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7395525PMC
July 2020

Preparation of a radiology department in an Italian hospital dedicated to COVID-19 patients.

Radiol Med 2020 Sep 11;125(9):894-901. Epub 2020 Jul 11.

Radiology Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy.

Preparedness for the ongoing coronavirus disease 2019 (COVID-19) and its spread in Italy called for setting up of adequately equipped and dedicated health facilities to manage sick patients while protecting healthcare workers, uninfected patients, and the community. In our country, in a short time span, the demand for critical care beds exceeded supply. A new sequestered hospital completely dedicated to intensive care (IC) for isolated COVID-19 patients needed to be designed, constructed, and deployed. Along with this new initiative, the new concept of "Pandemic Radiology Unit" was implemented as a practical solution to the emerging crisis, born out of a critical and urgent acute need. The present article describes logistics, planning, and practical design issues for such a pandemic radiology and critical care unit (e.g., space, infection control, safety of healthcare workers, etc.) adopted in the IC Hospital Unit for the care and management of COVID-19 patients.
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http://dx.doi.org/10.1007/s11547-020-01248-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7352089PMC
September 2020

Arterial Embolization and Second-Look in Spindle Cell Oncocytoma of the Pituitary Gland: Case Report and Review of Literature.

World Neurosurg 2020 10 7;142:87-92. Epub 2020 Jun 7.

Unit of Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; ‟Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.

Background: Spindle cell oncocytomas are extremely rare neoplasms of the sellar, parasellar, and suprasellar regions that can frequently mimic pituitary adenomas. Fewer than 50 cases have been ever reported in the literature, and there is no consensus on best treatments to be provided.

Case Description: We hereby present a challenging case of sellar and suprasellar spindle cell oncocytoma in a patient of 64 years. The patient, who presented with hydrocephalus, hypopituitarism, and visual deficit, underwent urgent transsphenoidal (TNS) resection of the mass, which was aborted for massive life-threatening bleeding. The patient received ventriculoperitoneal shunt with relief of symptoms. An endovascular embolization of tumor feeders from the distal portion of the right internal maxillary artery, in particular the sphenopalatine artery, was then performed and a second-look TNS surgery was feasible. The patient was discharged in optimal clinical condition, recovered both endocrinologic and visual deficits, and is now in follow-up.

Conclusions: We found that the oncocytoma was radiologically and clinically comparable with a pituitary adenoma, except for higher representation of vasculature. According to our recent experience and review of the literature, we believe that surgery (transsphenoidal or transcranial approach) is the recommended treatment in those who are symptomatic and preoperative embolization might be a suitable option to reduce intraoperative bleeding and increase radicality.
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http://dx.doi.org/10.1016/j.wneu.2020.05.255DOI Listing
October 2020

Pulmonary embolism in COVID-19: Ventilation and perfusion computed tomography.

IDCases 2020 11;21:e00805. Epub 2020 May 11.

Radiology Department, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy.

This is an illustrated case about CT ventilation and perfusion in Covid patient.
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http://dx.doi.org/10.1016/j.idcr.2020.e00805DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7212973PMC
May 2020

Ultrasound imaging classifications of thyroid nodules for malignancy risk stratification and clinical management: state of the art.

Gland Surg 2019 Sep;8(Suppl 3):S233-S244

Department of Health Sciences, Diagnostic and Interventional Radiology, San Paolo Hospital, University of Milan, Milan, Italy.

Assessing the risk of malignancy in the thyroid with ultrasound (US) is crucial in patients with nodules, as it can aid in selecting those who should have a fine-needle aspiration (FNA) biopsy performed. Many studies have examined whether the US characteristics of thyroid nodules are useful indicators of histological malignancy. Overall, these investigations have identified a few US features that are significantly more frequent in malignant thyroid nodules which can be coalesced into a defining set to be used as an indicator of a higher risk of malignancy. Despite these efforts, none of these classifications have been widely adopted worldwide, and there are still conflicting recommendations from different institutions. Understanding the role and appropriate utilization of these systems could facilitate the effective interpretation and communication of thyroid US findings among referring physicians and radiologists. In this comprehensive review, we outline the major US classification systems of thyroid nodules published in the last few years.
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http://dx.doi.org/10.21037/gs.2019.07.01DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6755949PMC
September 2019

Migration of Ethylene Vinyl Alcohol Co-Polymer in the Urinary Tract Successfully Managed.

Medicina (Kaunas) 2019 May 31;55(6). Epub 2019 May 31.

Radiology Department, Foundation IRCCS Cà Granda-Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122 Milan, Italy.

Selective embolization is the treatment of choice for traumatic renal pseudoaneurysm. The use of ethylene vinyl alcohol copolymer (EVOH) was recently described as an embolic agent in peripheral lesions. The aim of a good embolic agent is to: achieve rapid and effective embolization; reach and fill distal vasculature targeted for embolization; be easy to prepare and use. Moreover, it should be highly radiopaque, controllable during administration, biocompatible and cost-effective. EVOH is a non-adhesive embolic agent and its efficacy is independent from the coagulant status. The risk of non-targeted embolization should be reduced by the good radio-opacity of the embolic material that is injected under continuous fluoroscopy. Nevertheless, symptomatic EVOH migration was described. We report a unique case of embolization of a renal pseudoaneurysm and migration of EVOH in the urinary tract. Retrograde trans-urethral removal of the migrated embolic agent was successfully performed. Our case report indicates that EVOH may not be appropriate when a fistula with renal calyx is suspected, even if its migration in the urinary tract may be managed.
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Source
http://dx.doi.org/10.3390/medicina55060234DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6630371PMC
May 2019
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