Hypoxic-ischemic encephalopathy (HIE) is the most important cause of cerebral damage and long-term neurological sequelae in the perinatal period both in term and preterm infant.Hypoxic-ischemic (H-I) injuries develop in two phases: the ischemic phase, dominated by necrotic processes, and the reperfusion phase, dominated by apoptotic processes extending beyond ischemic areas. Due to selective ischemic vulnerability, cerebral damage affects gray matter in term newborns and white matter in preterm newborns with the typical neuropathological aspects of laminar cortical necrosis in the former and periventricular leukomalacia in the latter.This article summarises the principal physiopathological and biochemical processes leading to necrosis and/or apoptosis of neuronal and glial cells and reports recent insights into some endogenous and exogenous cellular and molecular mechanisms aimed at repairing H-I cerebral damage.

Left renal vein (LRV) entrapment, also known as nutcracker phenomenon if it is asymptomatic, is characterized by abnormality of outflow from the LRV into the inferior vena cava (IVC) due to extrinsic LRV compression, often accompanied by demonstrable lateral (hilar) dilatation and medial (mesoaortic) stenosis. Nutcracker syndrome, on the other hand, includes a well-defined set of symptoms, and the severity of these clinical manifestations is related to the severity of anatomic and hemodynamic findings. With the aim of providing practical guidance for nephrologists and radiologists, we performed a review of the literature through the PubMed database, and we commented on the definition, the main clinical features, and imaging pattern of this syndrome; we also researched the main therapeutic approaches validated in the literature. Finally, from the electronic database of our institute, we have selected some characteristic cases and we have commented on the imaging pattern of this disease.

In preterm infants, neurological signs and clinical manifestations of brain damage are limited criteria for diagnosis of neurologic sequelae. Early indicators of brain damage are needed and currently some specific biochemical markers of brain injury are investigated to assess regional brain damage after perinatal asphyxia in neonates. In this study Protein S-100 (PS-100) and Neuron Specific Enolase (NSE) serum levels were studied serially during the perinatal period in preterm neonates with perinatal asphyxia as markers of glial and neuronal damage respectively. Thirty outborn preterm infants with perinatal asphyxia were studied at 3, 24, 48 hours and 7 days of life. According to Apgar scores at 1' and cord blood pH and lacticidemia (LA), patients were divided in two groups: 15 of them (GA 33+/-1.2 wk, BW 1790+/-383 g) with severe asphyxia (Apgar <4, pH7.0+/-0.08, LA 6.29+/-0.79 mM/L) and 15 (GA 32+/-1.8 wk, BW 1810+/-290 g) with mild asphyxia (Apgar between 4-6, pH 7.18+/-0.05, LA 2.59+/-0.61 mM/L). Ten gestational age matched healthy preterm neonates were studied as control group. Cerebral ultrasound examinations (7 MHz) were performed at birth and repeated at 3 weeks of life. The results of this study show that neonates with severe asphyxia at any time had significantly more elevated mean serum levels of both markers compared to the group with mild asphyxia and to the control group (p<0.05). The values of control group were also significantly lower in comparison with that of mild asphyxia. In neonates with severe asphyxia, NSE values decreased constantly from birth to the seventh day of life, while PS-100 showed a different pattern increasing progressively between 3 h and 7 days. In neonates with mild asphyxia serum values of both markers showed decreasing levels through the study period. The results of this study suggest that perinatal asphyxia is associated with the release of different brain cellular proteins in the blood of preterm infants with different time course indicating specific regional cellular injury. The more elevated levels of NSE at birth found in the newborns with severe asphyxia could be considered as an early biomarker of neuronal necrotic damage in the ischaemic phase of perinatal cerebral hypoxic-ischaemic insult; progressive increase of PS-100 during the first week of life in the same neonates could be expression of apoptotic damage of glial cells occurring in the reperfusion phase of cerebral ischaemia.

Interstitial Lung Diseases (ILDs) represent a heterogeneous group of pathologies, which may be related to different causes. A low percentage of these lung diseases may be secondary to the administration of drugs or substances. Through the PubMed database, an extensive search was performed in the fields of drug toxicity and interstitial lung disease. We have evaluated the different classes of drugs associated with pulmonary toxicity. Several different high resolution computed tomography (HRCT) patterns related to pulmonary drug toxicity have been reported in literature, and the most frequent ILDs patterns reported include Nonspecific Interstitial Pneumonia (NSIP), Usual Interstitial Pneumonia (UIP), Hypersensitivity Pneumonitis (HP), Organizing Pneumonia (OP), Acute Respiratory Distress Syndrome (ARDS), and Diffuse Alveolar Damage (DAD). Finally, from the electronic database of our Institute we have selected and commented on some cases of drug-induced lung diseases related to the administration of common drugs. As the imaging patterns are rarely specific, an accurate evaluation of the clinical history is required and a multidisciplinary approach—involving pneumologists, cardiologists, radiologists, pathologists, and rheumatologists—is recommended.

To evaluate the radiological findings in patients with cryptogenic organizing pneumonia (COP) before steroid treatment and their behavior after therapy, we retrospectively evaluated a total of 22 patients with a diagnosis of COP made by bronchoalveolar lavage (BAL), biopsy or clinical/radiological features, and the patients were followed between 2014 and 2018 at the hospital; the demographic data, symptoms, radiologic findings, diagnostic methods and treatment plans of patients were collected from patients’ hospital records. At least two CT scans of 22 patients (16 female and six men) were evaluated, the first one before starting steroid therapy and the others after therapy. At baseline CT scans, the most common radiological finding was the presence of consolidations (18/22 patients, 81.8%); ground-glass opacities were also very common (15/25, 68.1%). The other findings were as follows: nodules and masses (5/22, 22.7%), atoll sign (4/22, 18.1%), perilobular pattern (3/22, 13.6%) and parenchymal bands (3/22, 13.6%). Two patients had a significant relapse after reducing/interrupting therapy, while three had a complete resolution and are not currently under therapy (maintenance of clinical remission with no oral corticosteroid (OCS)). In High-resolution computed tomography (HRCT) scans after therapy, consolidations were still observable in seven patients (five in new areas of the lung-migratory infiltrates), while most of them disappeared, leaving a residual area of ground glass opacity in two patients. One patient had a residual of the perilobular pattern, with the disappearing of the other findings (consolidations and ground-glass opacities). Two patients developed a fibrosing pattern despite the therapy (9.5%). Cryptogenic organizing pneumonia tends to respond to oral corticosteroid treatment, but some patients may have a null or partial response. We highlight the behavior of this disease after proper therapy.

Male varicocele and pelvic congestion syndrome (PCS) are common pathologies with high predominance in young patients, having a high impact on the quality of life and infertility. Lately, the use of different endovascular embolization techniques, with various embolizing agents, shows good technical results and clinical outcomes. With the aim of presenting the “state of the art” of endovascular techniques for the treatment of male varicocele and PCS, and to discuss the performance of the different embolic agents proposed, we conducted an extensive analysis of the relevant literature and we reported and discussed the results of original studies and previous meta-analyses, providing an updated guide on this topic to clinicians and interventional radiologists. We have also underlined the technical aspects for the benefit of those who approach this type of interventional treatment. Our review suggests promising results in both the endovascular embolic treatment of male varicocele and PCS; for varicocele, a success rate of between 70% and 100% and a recurrence rate of up to 16% is reported, while for PCS it has been found that technical success is achieved in almost all cases of endovascular treatment, with a highly variable recurrence rate based on reports. Complications are overall rather rare and are represented by periprocedural pain, migration of embolic media and vascular perforations: severe adverse events have been reported very rarely.

Background: The success of the construction of an arteriovenous fistula for haemodialysis is related to the vascular function of the vessels involved in the anastomosis, with particular reference to radial artery distensibility after reactive hyperaemia test and to the fall of resistance index. Only few studies have evaluated the impact of exercise protocols on the endothelial and morphological characteristics of the vessels of the upper limb with inconclusive results. In this pilot longitudinal study, we aimed to evaluate the impact of a standardized exercise protocol on the haemodynamic and resistive index of the arteries of the upper limb of uraemic patients. Methods: A total of 17 uraemic patients planned to construct arteriovenous fistula at the distal third of the forearm were enrolled and followed up for 30 days. All patients performed repeated handgrips for 30 min/day. The arterial parameters were detected before and after an ischaemic stress of 5 min and radial and brachial artery flow-mediated dilation was evaluated as well as radial artery resistance index. Results: Pre-exercise measurements of radial artery diameter and resistance index and brachial artery diameter were not modified by 30 days hand physical exercise, whereas the post-exercise haemodynamic were improved. Consequently, flow-mediated dilation of the radial artery was improved (21% ± 14% vs 30% ± 19%; p = 0.03) and resistance index of the radial artery was reduced ( p = 0.02). Conclusion: Exercise has beneficial effects on endothelial function of the radial artery by resistive index and, potentially, on the outcome of the arteriovenous fistula. Further studies with larger sample size are needed to confirm our preliminary data.

In the last years new diagnostic technologies were developed to assess brain development and to identify early brain injury. Some of them are very attractive methods but invasive, expensive, and time-consuming. The availability of clinically useful serum markers of risk for perinatal brain damage will easily permit the development of rational strategies for prevention of cerebral insults in neonates and more accurate prognostic counseling. In this study, protein S-100 (PS-100), a cytosolic constituent of neuroglial cells, was measured serially, during the neonatal period, in a group of preterm infants suffering perinatal asphyxia. Protein S-100 was measured at 1, 7, and 21 days of life by radioimmunoassay. Cerebral ultrasound confirmed cerebral white matter insult. The results of this study show significantly higher protein S-100 serum levels in asphyxiated preterm babies with periventricular white matter lesions, with a peak at 24 hours of life (5.7 +/- 2.9 microg/L) compared with healthy preterm babies (0.6 +/- 0.3 microg/L) ( p <0.05) and progressively lower values at seven (3.3 +/- 2.4 microg/L) and 21 days (2.2 +/- 1.3 microg/L) of life ( p <0.05). These data suggest that elevated protein S-100 serum levels can be considered an indicator of regional brain damage in preterm infants, allowing noninvasive, superior scrutiny of perinatal asphyxia and potential early preventive strategies.