Publications by authors named "Stefania Zannoni"

13 Publications

  • Page 1 of 1

Plantar forefoot pain: ultrasound findings before and after treatment with custom-made foot orthoses.

Radiol Med 2021 Apr 21. Epub 2021 Apr 21.

IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.

Purpose: No prior studies investigated the role of ultrasound in the assessment of response of patients undergoing treatment of metatarsalgia with custom-made orthoses. Our aim was to describe ultrasound findings of patients with plantar forefoot pain treated with custom-made foot orthoses.

Methods: Twenty patients (15 females; mean age: 62.6 ± 11 years) affected by metatarsalgia in 27/40 feet underwent clinical evaluation before, three months and six months after treatment with custom-made full foot insole with a support proximal and an excavation below the painful metatarsals. Ultrasound was performed before and three months after the use of orthoses to examine the presence of intermetatarsal/submetatarsal bursitis, metatarsophalangeal joints effusion, anterior plantar fat pad oedema, flexor tendinitis/tenosynovitis, and Morton's neuroma. Outcome measures were clinical response with Foot Function Index (FFI)/Visual Analogue Scale (VAS) and ultrasound features changes.

Results: Median VAS and FFI before treatment were 8[5-8.5] and 45.85[32.4-59.4], respectively. After 3 and 6 months of insoles use, both median VAS (2.5 [0-5] and 0 [0-2.75], respectively) and median FFI (7.9 [3.95-20] and 0 [0-3.95], respectively) showed a significant reduction in pain and disability (p < .001). Before treatment, ultrasound revealed 22 intermetatarsal bursitis, 16 submetatarsal bursitis, 10 joint effusions, 20 fat pad oedema, 3 flexor tendinitis/tenosynovitis and 3 Morton's neuromas. After 3 months of treatment, a significant decrease of intermetatarsal bursitis (7, p < .001) was observed. No significant changes were observed in any other ultrasound parameters.

Conclusion: Ultrasound might be able to detect some imaging features associated with the response of forefoot pain to custom-made foot orthoses, especially intermetatarsal bursitis.
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http://dx.doi.org/10.1007/s11547-021-01354-8DOI Listing
April 2021

Correlation between lung ultrasound and chest CT patterns with estimation of pulmonary burden in COVID-19 patients.

Eur J Radiol 2021 May 11;138:109650. Epub 2021 Mar 11.

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.

Purpose: The capability of lung ultrasound (LUS) to distinguish the different pulmonary patterns of COVID-19 and quantify the disease burden compared to chest CT is still unclear.

Methods: PCR-confirmed COVID-19 patients who underwent both LUS and chest CT at the Emergency Department were retrospectively analysed. In both modalities, twelve peripheral lung zones were identified and given a Severity Score basing on main lesion pattern. On CT scans the well-aerated lung volume (%WALV) was visually estimated. Per-patient and per-zone assessments of LUS classification performance taking CT findings as reference were performed, further revisioning the images in case of discordant results. Correlations between number of disease-positive lung zones, Severity Score and %WALV on both LUS and CT were assessed. The area under receiver operating characteristic curve (AUC) was calculated to determine LUS performance in detecting %WALV ≤ 70 %.

Results: The study included 219 COVID-19 patients with abnormal chest CT. LUS correctly identified as positive 217 (99 %) patients, but per-zone analysis showed sensitivity = 75 % and specificity = 66 %. The revision of the 121 (55 %) cases with positive LUS and negative CT revealed COVID-compatible lesions in 42 (38 %) CT scans. Number of disease-positive zones, Severity Score and %WALV between LUS and CT showed moderate correlations. The AUCs for LUS Severity Score and number of LUS-positive zones did not differ in detecting %WALV ≤ 70 %.

Conclusion: LUS in COVID-19 is valuable for case identification but shows only moderate correlation with CT findings as for lesion patterns and severity quantification. The number of disease-positive lung zones in LUS alone was sufficient to discriminate relevant disease burden.
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http://dx.doi.org/10.1016/j.ejrad.2021.109650DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7948674PMC
May 2021

Reply to: In silico diagnosis for sarcopenia is not possible without anthropometric, strength, and performance assessments.

Skeletal Radiol 2021 Feb;50(2):465-466

IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy.

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http://dx.doi.org/10.1007/s00256-020-03680-wDOI Listing
February 2021

Correlation between muscle mass and quality around the hip and of psoas muscles at L3 level using unenhanced CT scans.

Skeletal Radiol 2020 Oct 31;49(10):1649-1655. Epub 2020 May 31.

IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy.

Objective: CT segmentation of psoas muscles at L3 level is used to measure sarcopenia status, but it is not feasible when L3 is not included in the examination. We tested the correlation of psoas muscle mass and quality estimation at L3 with that of hip muscles, which could be opportunistically used in patients undergoing hip surgery.

Materials And Methods: Unenhanced abdominal CT performed in 50 patients (29 males, mean/median age 69/72 years) were reviewed. Regions of interest were drawn to assess cross-sectional area (CSA) and attenuation of psoas muscles at L3. These values were correlated with CSA and attenuation of iliopsoas, rectus femoris, sartorius, and tensor fascia latae at the level of the hip, separately on each side. After applying Bonferroni correction for multiple comparisons, statistical significance was set as P < .002.

Results: Attenuation of each psoas at L3 and ipsilateral hip muscles was significantly correlated (P ≤ .001, r = .491-.754). A significant correlation was observed between CSA of right psoas and ipsilateral muscles (P ≤ .00, r = .432-.525). We observed a significant correlation between CSA of left psoas and ipsilateral rectus femoris, iliopsoas, tensor fascia latae at the apex of the femoral head, and sartorius at the level of the lesser trochanter (P ≤ .001, r = .431-.502). Average time to measure CSA and attenuation of psoas muscles at L3 was 41 s, that of hip muscles was 2 min 12 s.

Conclusion: Measurements of mass and quality of hip muscles are feasible and correlate to those of psoas muscles at L3, being potentially used in future works on the association of sarcopenia and outcomes after hip surgery.
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http://dx.doi.org/10.1007/s00256-020-03475-zDOI Listing
October 2020

Bleeding after prostatectomy: endovascular management.

Gland Surg 2019 Apr;8(2):108-114

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

Background: To evaluate role of interventional radiology (IR) in post-surgical haemorrhagic complications of prostatectomy.

Methods: A retrospective study was performed. From April 2015 to January 2018, 10 patients referred to IR Department for haemorrhagic complications post radical prostatectomy (RP). All patients (mean age: 68.5 years; range, 58-85 years) were successfully treated with superselective trans-arterial embolization. We evaluated technical and clinical success and post procedural complications.

Results: Technical and clinical success was 100% (10/10) and no major complications were identified. No complications related to the endovascular procedures occurred. No recurrences during follow-up (8-20 months) were observed. Among minor complications, only 20% (2/10) developed mild post embolization syndrome.

Conclusions: The endovascular management of significant haemorrhage after prostatectomy is safe and long-term effective, with no major ischaemic events associated to embolization.
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http://dx.doi.org/10.21037/gs.2019.02.03DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534764PMC
April 2019

Assessment of the response of hepatocellular carcinoma to interventional radiology treatments.

Future Oncol 2019 May 2;15(15):1791-1804. Epub 2019 May 2.

Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD, USA.

According to Barcelona Clinic Liver Cancer (BCLC) guidelines, interventional radiology procedures are valuable treatment options for many hepatocellular carcinomas (HCCs) that are not amenable to resection or transplantation. Accurate assessment of the efficacy of therapies at earlier stages enables completion of treatment, optimal follow-up and to prevent potentially unnecessary treatments, side effects and costly failure. The goal of this review is to summarize and describe the radiological strategies that have been proposed to predict survival and to stratify HCC responses after interventional radiology therapies. New techniques currently in development are also described.
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http://dx.doi.org/10.2217/fon-2018-0747DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6543503PMC
May 2019

Ascites, abdominal pain, and acute renal failure in a middle-aged woman.

Intern Emerg Med 2020 03 26;15(2):299-302. Epub 2019 Feb 26.

UOC Pronto Soccorso e Medicina d'Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

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http://dx.doi.org/10.1007/s11739-019-02054-yDOI Listing
March 2020

The role of interventional radiology in the treatment of epiphora.

Gland Surg 2018 Apr;7(2):103-110

Diagnostic and Interventional Radiology Service, San Paolo Hospital, Milan, Italy.

Epiphora is a relatively common ophthalmologic affection representing almost 5% of clinical consultations in ophthalmology and it consists in the complete or partial obstruction of nasolacrimal duct, leading to insufficient drainage of tears. The traditional treatment is represented by surgery namely, external dacryocystorhinostomy (DCR). Despite the high success rate DCR has many disadvantages and limitations since it requires general anesthesia, it may arise in a permanent facial scar and it is often affected by the reobstruction of the anastomotic tract by fibrotic scars and osteogenic activity. Fluoroscopically guided interventional procedures are a therapeutic alternative to surgery for lacrimal duct system obstructions that can consist either in balloon dacryocystoplasty or in nasolacrimal stent placement. In both cases, a pre-operative imaging characterization of the occlusion is needed for a correct treatment planning. In this review, we propose to highlight the role of interventional radiology in the treatment of epiphora and the role of computed tomography dacryocystography (CTD) in depiction and the pre-interventional planning.
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http://dx.doi.org/10.21037/gs.2017.09.16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5938268PMC
April 2018

Effects of SGLT-2 inhibitors on diabetic ketoacidosis: A meta-analysis of randomised controlled trials.

Diabetes Res Clin Pract 2017 Aug 18;130:53-60. Epub 2017 May 18.

Diabetology, University of Florence and Careggi Teaching Hospital, Florence, Italy.

Aims: Diabetic ketoacidosis (DKA) associated with SGLT-2 inhibitors (SGLT-2i) is a possible adverse event. In fact, SGLT-2i are capable of stimulating the release of glucagon and ketone re-absorption in the renal tubuli, thus increasing the concentration of ketone bodies.

Methods: A Medline search for SGLT2i (dapagliflozin, empagliflozin, canagliflozin, ipragliflozin, ertugliflozin, luseogliflozin) was performed, collecting all randomized trials with a duration of treatment≥12weeks, enrolling patients with type 2 diabetes, and comparing a SGLT2i with placebo or other comparators. The principal outcome was the effect of SGLT2i on ketoacidosis as serious adverse event.

Results: Out of 72 trials reporting information on DKA, 9 reported at least one event of ketoacidosis; those eight trials enrolled 10,157 and 5396 in SGLT-2 inhibitors and comparator groups, respectively. No signal of increased risk for ketoacidosis was observed for SGLT2 inhibitors as a class (MH-OR [95% CI] 1.14 [0.45-2.88], p=0.78) or as individual molecule. The sensitivity analysis with continuity correction (inputing one event each in drug and comparator arms of each trial with zero events) suggested a reduced incidence of ketoacidosis in patients treated with SGLT-2 inhibitors (MH-OR 0.65 [0.47-0.90]; p=0.01).

Conclusions: The results of clinical trials summarized in the present meta-analysis reassure us that, when the drug is properly prescribed, the risk of DKA is negligible.
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http://dx.doi.org/10.1016/j.diabres.2017.04.017DOI Listing
August 2017

Effects of glucagon-like peptide-1 receptor agonists on mortality and cardiovascular events: A comprehensive meta-analysis of randomized controlled trials.

Int J Cardiol 2017 Aug 5;240:414-421. Epub 2017 May 5.

Diabetology, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy. Electronic address:

Introduction: The publication of the results of LEADER and SUSTAIN-6 trials suggested a possible beneficial effect of the class of GLP-1 receptor agonists on cardiovascular morbidity and mortality. The aim of the present meta-analysis is to collect and synthetize all available evidence on the effect of GLP-1 receptor agonists on cardiovascular events and mortality.

Methods: A Medline search for GLP-1 receptor agonists (exenatide, liraglutide, lixisenatide, albiglutide, dulaglutide, or semaglutide) was performed, collecting all randomized clinical trials with a duration >11weeks, enrolling patients with type 2 diabetes, and comparing a GLP-1 receptor agonist with placebo or any other non-GLP-1 receptor agonist drug. The principal outcome of this analysis was the effect of GLP-1 receptor agonists on all-cause and cardiovascular mortality, overall (fatal plus nonfatal) myocardial infarction, stroke, and heart failure.

Results: Out of 113 trials fulfilling inclusion criteria (mean duration 41.7±38.2weeks), 32, 25, 48, 43 and 32 reported at least one event for all-cause and cardiovascular mortality, overall (fatal plus nonfatal) myocardial infarction, stroke, and heart failure, respectively. In GLP-1 receptor agonist-treated patients, all-cause mortality, cardiovascular mortality, and myocardial infarction were significantly lower than in comparators (MH-OR [95% CI] 0.88 [0.79-0.97], p=0.015, 0.84 [0.74-0.96], p=0.009, and 0.90 [0.80-1.00], p=0.050, respectively), whereas no beneficial effect was observed for stroke and heart failure (MH-OR [95% CI] 0.90 [0.81-1.00]. p=0.059. 0.89 [0.76-1.04]. p=0.15. and 0.92 [0.81-1.06]. p=0.25. respectively).

Conclusions: Overall, the agents of this class appear to reduce all-cause mortality, cardiovascular mortality, and the incidence of myocardial infarction at mid-term follow up.
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http://dx.doi.org/10.1016/j.ijcard.2017.03.163DOI Listing
August 2017

Toe amputations with SGLT-2 inhibitors: data from randomized clinical trials.

Acta Diabetol 2017 Apr 22;54(4):411-413. Epub 2016 Oct 22.

Diabetology, Careggi Teaching Hospital, Via delle Oblate 4, 50141, Florence, Italy.

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http://dx.doi.org/10.1007/s00592-016-0928-zDOI Listing
April 2017

Effects of a Short Educational Program for the Prevention of Foot Ulcers in High-Risk Patients: A Randomized Controlled Trial.

Int J Endocrinol 2015 10;2015:615680. Epub 2015 Sep 10.

Division of Diabetes Agency, Careggi Teaching Hospital, 50141 Florence, Italy.

Background. Patient education is capable of reducing the risk for diabetic foot ulcers. However, specific education on foot ulcer prevention was either included in broader programs addressing different parts of diabetes care or provided with time- and resource-consuming curricula. The aim of the study is to assess the feasibility and efficacy of a brief educational program for the prevention of diabetic foot ulcers in high-risk patients. Methods. The study was performed on type 2 diabetic patients, randomized in a 1 : 1 ratio either to intervention or to control group. The principal endpoint was the incidence of foot ulcers. The intervention was a two-hour program provided to groups of 5-7 patients, including a 30-minute face-to-face lesson on risk factors for foot ulcers, and a 90-minute interactive session with practical exercises on behaviors for reducing risk. Results. The study was prematurely terminated due to a highly significant difference in outcome between the two treatment groups. The final sample was therefore composed of 121 patients. Six patients, all in the control group, developed ulcers during the 6-month follow-up (10% versus 0%, p = 0.012). Conclusions. A brief, 2-hour, focused educational program is effective in preventing diabetic foot ulcers in high-risk patients.
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http://dx.doi.org/10.1155/2015/615680DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4581554PMC
October 2015

Identification of predictors of response to basal insulin and DPP4 inhibitors in patients with type 2 diabetes failing to other therapies.

Acta Diabetol 2016 Feb 26;53(1):35-40. Epub 2015 Mar 26.

Diabetes Agency, Careggi Teaching Hospital, Florence, Italy.

Aim: Basal insulin and DPP4 inhibitors are both possible options in patients with type 2 diabetes failing to oral drugs. The identification of clinical predictors of success with either one of the two approaches could be of help in personalizing therapy.

Methods: The retrospective study was performed on a consecutive series of patients with type 2 diabetes (n = 1,002) failing to at least one oral agent, who had been prescribed either basal insulin or DPP4 inhibitors in the previous 2 years, with a duration of follow-up of at least 6 months. Clinical predictors of success after 6 months from the beginning of second-line treatment were identified in the cohort.

Results: Among patients receiving a prescription of basal insulin, the proportion of therapeutic success at 6 months was 26.5 %. At multivariate analysis, a higher age and BMI, and a lower duration of diabetes were associated with success, as well as treatment with acarbose; conversely, a history of ischemic heart disease was associated with failure. Prescription of DPP4 inhibitors produced a therapeutic success in 24.8 % of cases. At multivariate analysis, success was associated with a lower baseline HbA1c and duration of diabetes, and a higher BMI and comorbidity; in addition, a lower success rate was found in women after adjusting for other confounders.

Conclusions: The present data support the view that insulin treatment is preferable in patients with severe hyperglycemia, failing to one or more drugs, whereas DPP4 inhibitors appear to be more useful in those with comorbid conditions.
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http://dx.doi.org/10.1007/s00592-015-0732-1DOI Listing
February 2016