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Zini T, Corso L, Mazzi C, Baraldi C, Nieddu E, Rinaldi L, Miselli F, Bedetti L, Spaggiari E, Rossi K, Berardi A, Lugli L. Ultrasound-Guided Centrally Inserted Central Catheter (CICC) Placement in Newborns: A Safe Clinical Training Program in a Neonatal Intensive Care Unit. Children (Basel) 2024; 11:395. [PMID: 38671612 PMCID: PMC11048839 DOI: 10.3390/children11040395] [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] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Centrally inserted central catheters (CICCs) are increasingly used in neonatal care. CICCs have garnered attention and adoption owing to their advantageous features. Therefore, achieving clinical competence in ultrasound-guided CICC insertion in term and preterm infants is of paramount importance for neonatologists. A safe clinical training program should include theoretical teaching and clinical practice, simulation and supervised CICC insertions. METHODS We planned a training program for neonatologists for ultrasound-guided CICCs placement at our level III neonatal intensive care unit (NICU) in Modena, Italy. In this single-centre prospective observational study, we present the preliminary results of a 12-month training period. Two paediatric anaesthesiologists participated as trainers, and a multidisciplinary team was established for continuing education, consisting of neonatologists, nurses, and anaesthesiologists. We detail the features of our training program and present the modalities of CICC placement in newborns. RESULTS The success rate of procedures was 100%. In 80.5% of cases, the insertion was obtained at the first ultrasound-guided venipuncture. No procedure-related complications occurred in neonates (median gestational age 36 weeks, IQR 26-40; median birth weight 1200 g, IQR 622-2930). Three of the six neonatologists (50%) who participated in the clinical training program have achieved good clinical competence. One of them has acquired the necessary skills to in turn supervise other colleagues. CONCLUSIONS Our ongoing clinical training program was safe and effective. Conducting the program within the NICU contributes to the implementation of medical and nursing skills of the entire staff.
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Affiliation(s)
- Tommaso Zini
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.Z.); (C.M.); (C.B.); (E.N.); (F.M.); (L.B.); (E.S.); (K.R.); (L.L.)
| | - Lucia Corso
- Post-Graduate School of Paediatrics, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Cinzia Mazzi
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.Z.); (C.M.); (C.B.); (E.N.); (F.M.); (L.B.); (E.S.); (K.R.); (L.L.)
| | - Cecilia Baraldi
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.Z.); (C.M.); (C.B.); (E.N.); (F.M.); (L.B.); (E.S.); (K.R.); (L.L.)
| | - Elisa Nieddu
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.Z.); (C.M.); (C.B.); (E.N.); (F.M.); (L.B.); (E.S.); (K.R.); (L.L.)
| | - Laura Rinaldi
- Anaesthesia and Intensive Care Medicine, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Francesca Miselli
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.Z.); (C.M.); (C.B.); (E.N.); (F.M.); (L.B.); (E.S.); (K.R.); (L.L.)
| | - Luca Bedetti
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.Z.); (C.M.); (C.B.); (E.N.); (F.M.); (L.B.); (E.S.); (K.R.); (L.L.)
| | - Eugenio Spaggiari
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.Z.); (C.M.); (C.B.); (E.N.); (F.M.); (L.B.); (E.S.); (K.R.); (L.L.)
| | - Katia Rossi
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.Z.); (C.M.); (C.B.); (E.N.); (F.M.); (L.B.); (E.S.); (K.R.); (L.L.)
| | - Alberto Berardi
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.Z.); (C.M.); (C.B.); (E.N.); (F.M.); (L.B.); (E.S.); (K.R.); (L.L.)
| | - Licia Lugli
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.Z.); (C.M.); (C.B.); (E.N.); (F.M.); (L.B.); (E.S.); (K.R.); (L.L.)
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Stirnemann J, Besson R, Debavelaere V, Loge F, Amabile C, Migeon P, Curran MA, Fries N, Smith E, Ostermayer E, Bradley KE, Armstrong L, Trychon K, Sheehan K, Flinn M, Rodriguez DA, Spiliopoulos M, Romero V, Jones DA, Allbert JR, Ghulmiyyah L, Spaggiari E, Ville Y. Abstracts of the 33rd World Congress on Ultrasound in Obstetrics and Gynecology, 16-19 October 2023, Seoul, South Korea. Ultrasound Obstet Gynecol 2023; 62 Suppl 1:1-316. [PMID: 37779444 DOI: 10.1002/uog.26321] [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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 10/03/2023]
Affiliation(s)
- J Stirnemann
- Obstetrics, Paris Descartes University, Necker-Enfants Malades Hospital, Paris, France
| | | | | | | | | | | | - M A Curran
- Division of Maternal-Fetal Medicine, Pomona Valley Hospital Medical Center, Pomona, CA, USA
| | - N Fries
- Collège Français d'Echographie Fetale, Paris, France
| | - E Smith
- BovenMaas, Rotterdam, Netherlands
| | - E Ostermayer
- Pränatalmedizin 5-Seen-Land, Seefeld-Hechendorf, Germany
| | - K E Bradley
- Private Practice, Westlake, Village, CA, USA
| | - L Armstrong
- UNC Southeastern Maternal-Fetal Medicine, Lumberton, NC, USA
| | - K Trychon
- Center for Fetal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - K Sheehan
- Obstetrics and Gynecology, Private Practice, Ridgewood, NJ, USA
| | - M Flinn
- Diagnostic Center of Arizona, Chandler, AZ, USA
| | | | - M Spiliopoulos
- Prenatal Diagnostic and Ultrasound Center, Pediatrix Medical Group, Broward Health Medical Center, Fort Lauderdale, FL, USA
| | - V Romero
- Maternal-Fetal Medicine, Corewell Health-West, Grand Rapids, MI, USA
- Michigan State University College of Human Medicine, East Lansing, MI, USA
| | - D A Jones
- Perinatal Specialists of the Palm Beaches, West Palm Beach, FL, USA
| | - J R Allbert
- Maternal-Fetal Medicine Associates, Charlotte, NC, USA
| | - L Ghulmiyyah
- Prenatal Diagnostic and Ultrasound Center, Pediatrix Medical Group, Broward Health Medical Center, Fort Lauderdale, FL, USA
| | - E Spaggiari
- Obstetrics, Paris Descartes University, Necker-Enfants Malades Hospital, Paris, France
| | - Y Ville
- Obstetrics, Paris Descartes University, Necker-Enfants Malades Hospital, Paris, France
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Stirnemann JJ, Besson R, Spaggiari E, Rojo S, Loge F, Peyro-Saint-Paul H, Allassonniere S, Le Pennec E, Hutchinson C, Sebire N, Ville Y. Development and clinical validation of real-time artificial intelligence diagnostic companion for fetal ultrasound examination. Ultrasound Obstet Gynecol 2023; 62:353-360. [PMID: 37161503 DOI: 10.1002/uog.26242] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/13/2023] [Accepted: 03/20/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Prenatal diagnosis of a rare disease on ultrasound relies on a physician's ability to remember an intractable amount of knowledge. We developed a real-time decision support system (DSS) that suggests, at each step of the examination, the next phenotypic feature to assess, optimizing the diagnostic pathway to the smallest number of possible diagnoses. The objective of this study was to evaluate the performance of this real-time DSS using clinical data. METHODS This validation study was conducted on a database of 549 perinatal phenotypes collected from two referral centers (one in France and one in the UK). Inclusion criteria were: at least one anomaly was visible on fetal ultrasound after 11 weeks' gestation; the anomaly was confirmed postnatally; an associated rare disease was confirmed or ruled out based on postnatal/postmortem investigation, including physical examination, genetic testing and imaging; and, when confirmed, the syndrome was known by the DSS software. The cases were assessed retrospectively by the software, using either the full phenotype as a single input, or a stepwise input of phenotypic features, as prompted by the software, mimicking its use in a real-life clinical setting. Adjudication of discordant cases, in which there was disagreement between the DSS output and the postnatally confirmed ('ascertained') diagnosis, was performed by a panel of external experts. The proportion of ascertained diagnoses within the software's top-10 differential diagnoses output was evaluated, as well as the sensitivity and specificity of the software to select correctly as its best guess a syndromic or isolated condition. RESULTS The dataset covered 110/408 (27%) diagnoses within the software's database, yielding a cumulative prevalence of 83%. For syndromic cases, the ascertained diagnosis was within the top-10 list in 93% and 83% of cases using the full-phenotype and stepwise input, respectively, after adjudication. The full-phenotype and stepwise approaches were associated, respectively, with a specificity of 94% and 96% and a sensitivity of 99% and 84%. The stepwise approach required an average of 13 queries to reach the final set of diagnoses. CONCLUSIONS The DSS showed high performance when applied to real-world data. This validation study suggests that such software can improve perinatal care, efficiently providing complex and otherwise overlooked knowledge to care-providers involved in ultrasound-based prenatal diagnosis. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- J J Stirnemann
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- EA7328 Université de Paris, IMAGINE Institute, Paris, France
| | | | - E Spaggiari
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- EA7328 Université de Paris, IMAGINE Institute, Paris, France
- Department of Histology-Embryology and Cytogenetics, Unit of Embryo and Fetal Pathology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | | | | | | | - S Allassonniere
- School of Medicine, Université de Paris, INRIA EPI HEKA, INSERM UMR 1138, Sorbonne Université, Paris, France
- Center for Applied Mathematics, Ecole Polytechnique, Institut Polytechnique de Paris, Paris, France
| | - E Le Pennec
- Center for Applied Mathematics, Ecole Polytechnique, Institut Polytechnique de Paris, Paris, France
- Xpop, INRIA Saclay Center, Paris, France
| | - C Hutchinson
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - N Sebire
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Y Ville
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- EA7328 Université de Paris, IMAGINE Institute, Paris, France
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Bedetti L, Lugli L, Bertoncelli N, Spaggiari E, Garetti E, Lucaccioni L, Cipolli F, Berardi A. Early Skin-to-Skin Contact in Preterm Infants: Is It Safe? An Italian Experience. Children 2023; 10:children10030570. [PMID: 36980127 PMCID: PMC10047376 DOI: 10.3390/children10030570] [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] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/10/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023]
Abstract
Background: Skin-to-skin contact (SSC) is one of the four components of kangaroo care (KC) and is also a valued alternative to incubators in low-income countries. SSC has also become a standard of care in high-income countries because of its short- and long-term benefits and its positive effect on infant growth and neurodevelopmental outcome. However, barriers in the implementation of SSC, especially with preterm infants, are common in NICUs because parents and health care professionals can perceive it as potentially risky for the clinical stability of preterm infants. Previous studies have assessed safety before and during SSC by monitoring vital parameters during short-time intervals. Aims: To demonstrate the safety of early SSC in preterm infants during at least 90 min intervals. Design: Prospective observational monocentric study. Methods: Preterm infants born between June 2018 and June 2020 with a gestational age of ≤33 weeks and a birth weight of <2000 g were monitored while performing an SSC session during the first three weeks of life. Infants with necrotizing enterocolitis, sepsis, and congenital malformations on mechanical ventilation or with more than five apneas in the hour before SSC were excluded. Continuous oxygen saturation (SaO2), heart rate (HR), and respiratory rate (RR) were registered during an SSC session and in the hour before. The minimum duration of an SSC session was 90 min. Information regarding postmenstrual age (PMA), body weight, respiratory support, presence of a central venous catheter and the onset of sepsis within 72 h after a session was collected. Two physicians, blinded to infant conditions and the period of analysis (before or during SSC), evaluated desaturation episodes (SaO2 < 85%, >15 s), bradycardia (HR < 100, >15 s) and apneas (pause in breathing > 20 s associated with desaturation and/or bradycardia). A Wilcoxon rank sum test was used for the statistical analysis. Results: In total, 83 episodes of SSC were analyzed for a total of 38 infants. The mean gestational age at birth was 29 weeks (range 23–33 weeks). Median PMA, days of life, and body weight at SSC were 31 weeks (range 25–34 weeks), 10 days (range 1–20 days), and 1131 g (range 631–2206 g), respectively. We found that 77% of infants were on respiratory support and 47% of them had a central venous catheter (umbilical or peripherally inserted central catheter) during SSC. The total duration of desaturation, bradycardia, and the number of apneas were not statistically different during the SSC session and the hour before. No catheter dislocation or ruptures were reported. Conclusions: These findings highlighted the safety of early SSC in preterm infants and the possibility of performing it in an intensive care setting in the first weeks of life. In addition, these findings should reassure health care professionals offering this practice as a standard of care. SSC plays a key role in the care of preterm infants due to its short- and long-term positive benefits, and it deserves to be increasingly offered to infants and their parents.
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Affiliation(s)
- Luca Bedetti
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Licia Lugli
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Natascia Bertoncelli
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Eugenio Spaggiari
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Elisabetta Garetti
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Laura Lucaccioni
- Pediatric Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Federica Cipolli
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Alberto Berardi
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
- Correspondence: ; Tel.: +39-594-222-522; Fax: +39-594-223-770
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Scarponi D, Bedetti L, Zini T, Di Martino M, Cingolani GM, Spaggiari E, Rossi K, Miselli F, Lugli L, Bergamini BM, Iughetti L, Berardi A. COVID-19 restrictions and hygiene measures reduce the rates of respiratory infections and wheezing among preterm infants. Acta Biomed 2023; 94:e2023032. [PMID: 36786261 PMCID: PMC9987504 DOI: 10.23750/abm.v94i1.13596] [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] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 08/21/2022] [Indexed: 02/15/2023]
Abstract
BACKGROUND AND AIM During the 2020 and 2021 Italian COVID-19 pandemic social restrictions and strict hygiene measures were recommended to limit the spread of SARS-CoV-2. We aimed to assess whether rates of respiratory infections and wheezing in preterm infants have changed during the pandemic. METHODS Single center, retrospective study. Preterm infants in the first 6 months of life discharged home prior to (Period 1, January 2017 - December 2019) or during the pandemic (Period 2, January 2020 - March 2021) were compared. Rates of respiratory infection and wheezing in preterm infants with or without bronchopulmonary dysplasia (BDP) were assessed. RESULTS During period 2 premature infants had lower rates of respiratory infections (36 out of 55 in Period 1 vs 11 out of 28 in Period 2, P=0.023) and wheezing (20 out of 55 in Period 1 vs 1 out of 28 in Period 2, P=0.001). This difference remained significant when infants with BPD (all grades) were analyzed separately (respiratory infections 26 out of 40 in Period 1 vs 7 out of 24 in Period 2, P=0.005; wheezing 16 out of 40 in Period 1 vs 1 out of 24 in Period 2, P=0.001). In contrast, respiratory infections and wheezing in preterm infants without BPD did not change after pandemic. CONCLUSIONS Episodes of respiratory infections and wheezing among preterm infants were reduced during pandemic. We highlight the importance of proper family education for preventing respiratory tract infections in preterm infants with BPD, beyond the extraordinary conditions of the COVID-19 pandemic.
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Affiliation(s)
- Davide Scarponi
- "Post-graduate School of Pediatrics, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena (Italy)"..
| | - Luca Bedetti
- "PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena (Italy)"..
| | - Tommaso Zini
- "Post-graduate School of Pediatrics, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena (Italy)"..
| | - Marianna Di Martino
- "Post-graduate School of Pediatrics, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena (Italy)"..
| | - Greta Miriam Cingolani
- "Post-graduate School of Pediatrics, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena (Italy)"..
| | - Eugenio Spaggiari
- "Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena (Italy)"..
| | - Katia Rossi
- "Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena (Italy)"..
| | - Francesca Miselli
- "Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena (Italy)"..
| | - Licia Lugli
- "Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena (Italy)"..
| | - Barbara Maria Bergamini
- "Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults. University of Modena and Reggio Emilia, Modena (Italy)"..
| | - Lorenzo Iughetti
- "Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults. University of Modena and Reggio Emilia, Modena (Italy)"..
| | - Alberto Berardi
- "Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena (Italy)"..
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Vinit N, Bessières B, Spaggiari E, Heidet L, Gubler MC, Dreux S, Attie-Bitach T, Blanc T, Ville Y. Pathological and sonographic review of early isolated severe lower urinary tract obstruction and implications for prenatal treatment. Ultrasound Obstet Gynecol 2022; 59:513-521. [PMID: 34182598 DOI: 10.1002/uog.23718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/05/2021] [Accepted: 06/14/2021] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To identify favorable renal histology in fetuses with early severe lower urinary tract obstruction (LUTO) and determine the best timing and selection criteria for prenatal surgery. METHODS This multicenter, retrospective study included male fetuses with severe LUTO which died before 24 weeks of gestation during the period January 2000 to December 2018. Age-matched controls were used as reference standard for renal histology. Prenatal ultrasound features and fetal serum and/or urine β2microglobulin level were retrieved and kidney histology slides (hematein-eosin-safran and α-smooth-muscle-actin (αSMA) immunostaining) were prepared and reviewed. αSMA-positive staining of the blastema is due to its aberrant differentiation into myofibroblastic cells. Cases were sorted into histopathologic groups (favorable or unfavorable) according to the blastema's morphology and αSMA labeling and the data of these groups were compared. RESULTS Included in the study were 74 fetuses with a median gestational age at outcome of 17 + 6 (range, 13 + 0 to 23 + 5) weeks. Parenchymal organization was preserved in 48% of the kidneys. A blastema was present in 90% of the kidneys, but it was morphologically normal in only 9% and αSMA-negative in only 1% of them. Most (82%) fetuses had an unfavorable prognosis, and 36% of fetuses died ≤ 18 weeks and had severe renal lesions detected on histology (early unfavorable prognosis). A favorable renal prognosis was associated with an earlier gestational age (P = 0.001). Fetuses with LUTO had a significantly lower number of mature glomeruli (P < 0.001) compared with controls. However, there was no significant difference in the number of glomeruli generations between the early-unfavorable-prognosis group (≤ 18 weeks) and the group with a favorable prognosis (P = 0.19). A comparison of prenatal ultrasound features and biochemical markers between groups could not identify any prenatal selection criteria. CONCLUSIONS Before 18 weeks, around 30% of fetuses with severe LUTO still have potential for kidney development. Identification of these cases would enable them to be targeted for prenatal therapy. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- N Vinit
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
- EA FETUS 7328-PACT, Imagine Institute, Paris University, Paris, France
| | - B Bessières
- EA FETUS 7328-PACT, Imagine Institute, Paris University, Paris, France
- Department of Histology, Embryology and Cytogenetics, Fetal Pathology Unit, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - E Spaggiari
- EA FETUS 7328-PACT, Imagine Institute, Paris University, Paris, France
- Department of Histology, Embryology and Cytogenetics, Fetal Pathology Unit, Necker-Enfants Malades Hospital, APHP, Paris, France
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - L Heidet
- Department of Pediatric Nephrology, Reference Center for Inherited Renal Disease (MARHEA), Necker-Enfants Malades Hospital, APHP, Paris, France
- INSERM UMR 1163, Laboratory of Inherited Kidney Diseases, Imagine Institute, University of Paris, Paris, France
| | - M-C Gubler
- INSERM UMR 1163, Laboratory of Inherited Kidney Diseases, Imagine Institute, University of Paris, Paris, France
| | - S Dreux
- Department of Biochemistry-Hormonology, Robert Debré Hospital, APHP, Paris, France
| | - T Attie-Bitach
- EA FETUS 7328-PACT, Imagine Institute, Paris University, Paris, France
- Department of Histology, Embryology and Cytogenetics, Fetal Pathology Unit, Necker-Enfants Malades Hospital, APHP, Paris, France
- Université Paris Cité, Paris, France
| | - T Blanc
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
- Université Paris Cité, Paris, France
- INSERM U1151-CNRS UMR 8253, Paris University, Paris, France
| | - Y Ville
- EA FETUS 7328-PACT, Imagine Institute, Paris University, Paris, France
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France
- Université Paris Cité, Paris, France
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Crestani S, Passini E, Spaggiari V, Toffoli C, Boncompagni A, Bedetti L, Spaggiari E, Lucaccioni L, Lugli L, Roversi F, Rossi K, Iughetti L, Berardi A. Lo shock settico nei primi tre mesi di vita. Medico e Bambino 2021; 40:567-575. [DOI: 10.53126/meb40567] [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] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Shock is a generalized tissue hypoperfusion that leads to severe cellular distress and complicates some cases of paediatric and neonatal sepsis. Although a reduction in associated sepsis mortality has been observed in the last decades, it remains one of the most important causes of death or long-term neurodevelopmental disabilities in children. Prompt recognition of this condition is therefore essential to improve survival and long-term outcome. The paediatrician and the neonatologist must therefore be able to promptly recognize the signs and symptoms of sepsis and septic shock to set up an adequate treatment according to the most recent international guidelines. This article provides epidemiological data from Italian and international studies, describes the pathophysiology and clinical manifestations of sepsis and septic shock, as well as the therapeutic indications according to very recent recommendations.
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Affiliation(s)
- Sara Crestani
- Scuola di Specializzazione in Pediatria, Azienda Ospedaliero-Universitaria Policlinico di Modena
| | - Erica Passini
- Scuola di Specializzazione in Pediatria, Azienda Ospedaliero-Universitaria Policlinico di Modena
| | - valentina Spaggiari
- Scuola di Specializzazione in Pediatria, Azienda Ospedaliero-Universitaria Policlinico di Modena
| | - Carlotta Toffoli
- Scuola di Specializzazione in Pediatria, Azienda Ospedaliero-Universitaria Policlinico di Modena
| | | | - Luca Bedetti
- Terapia Intensiva Neonatale, AOU Policlinico di Modena
| | | | | | - Licia Lugli
- Terapia Intensiva Neonatale, AOU Policlinico di Modena
| | | | - Katia Rossi
- Terapia Intensiva Neonatale, AOU Policlinico di Modena
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Berardi A, Zinani I, Rossi C, Spaggiari E, D’Amico V, Toni G, Bedetti L, Lucaccioni L, Iughetti L, Lugli L. Antibiotic Use in Very Low Birth Weight Neonates After an Antimicrobial Stewardship Program. Antibiotics (Basel) 2021; 10:antibiotics10040411. [PMID: 33918796 PMCID: PMC8070476 DOI: 10.3390/antibiotics10040411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/15/2021] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 11/16/2022] Open
Abstract
There is insufficient data regarding antimicrobial stewardship (AS) and outcomes of very low birth weight (VLBW) neonates after AS programs. This observational, retrospective study addressed AS and outcomes of VLBW neonates admitted to an Italian level-three center. Two periods were compared: (i) baseline, before AS (January 2011-December 2012) and (ii) intervention, after AS (January 2016-December 2017). Between these two periods, procedures were put in place to inform medical and nursing staff regarding AS. There were 111 and 119 VLBW neonates in the baseline (6744 live births) and in the intervention period (5902 live births), respectively. The number of infants exposed to antibiotics (70%) during the hospital stay did not change, but the total days of therapy (DOT, median 12 vs. 5) and DOT/1000 patient days (302 vs. 215) decreased in the intervention period (p < 0.01), as well as the median duration of first antibiotic treatment (144 vs. 48 h, p < 0.01). A re-analysis of single cases of culture-proven or culture-negative sepsis failed to demonstrate any association between deaths and a delay or insufficient antibiotic use in the intervention period. In conclusion, AS is feasible in preterm VLBW neonates and antibiotic use can be safely reduced.
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Affiliation(s)
- Alberto Berardi
- Neonatal Intensive Care Unit, University Hospital of Modena and Reggio Emilia, 41121 Modena, Italy; (C.R.); (E.S.); (L.B.); (L.L.)
- Pediatric Post-Graduate School, University Hospital of Modena and Reggio Emilia, 41121 Modena, Italy; (I.Z.); (V.D.); (G.T.)
- Correspondence: ; Tel.: +39-059-4222787
| | - Isotta Zinani
- Pediatric Post-Graduate School, University Hospital of Modena and Reggio Emilia, 41121 Modena, Italy; (I.Z.); (V.D.); (G.T.)
| | - Cecilia Rossi
- Neonatal Intensive Care Unit, University Hospital of Modena and Reggio Emilia, 41121 Modena, Italy; (C.R.); (E.S.); (L.B.); (L.L.)
| | - Eugenio Spaggiari
- Neonatal Intensive Care Unit, University Hospital of Modena and Reggio Emilia, 41121 Modena, Italy; (C.R.); (E.S.); (L.B.); (L.L.)
| | - Virginia D’Amico
- Pediatric Post-Graduate School, University Hospital of Modena and Reggio Emilia, 41121 Modena, Italy; (I.Z.); (V.D.); (G.T.)
| | - Greta Toni
- Pediatric Post-Graduate School, University Hospital of Modena and Reggio Emilia, 41121 Modena, Italy; (I.Z.); (V.D.); (G.T.)
| | - Luca Bedetti
- Neonatal Intensive Care Unit, University Hospital of Modena and Reggio Emilia, 41121 Modena, Italy; (C.R.); (E.S.); (L.B.); (L.L.)
- Ph.D. Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Laura Lucaccioni
- Pediatric Department, University of Modena and Reggio Emilia, 41121 Modena, Italy; (L.L.); (L.I.)
| | - Lorenzo Iughetti
- Pediatric Department, University of Modena and Reggio Emilia, 41121 Modena, Italy; (L.L.); (L.I.)
| | - Licia Lugli
- Neonatal Intensive Care Unit, University Hospital of Modena and Reggio Emilia, 41121 Modena, Italy; (C.R.); (E.S.); (L.B.); (L.L.)
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Gueneuc A, Spaggiari E, Millischer AE, Michot C, O'Gorman N, Ville Y. Contribution of three-dimensional ultrasound and three-dimensional helical computed tomography to prenatal diagnosis of Stickler syndrome. Ultrasound Obstet Gynecol 2019; 54:279-280. [PMID: 30251283 DOI: 10.1002/uog.20127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 09/12/2018] [Accepted: 09/20/2018] [Indexed: 06/08/2023]
Affiliation(s)
- A Gueneuc
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes, Sorbonne Paris-Cité, Paris, France
| | - E Spaggiari
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - A E Millischer
- Department of Pediatrics Radiology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - C Michot
- University Paris Descartes, Sorbonne Paris-Cité, Paris, France
- Department of Medical Genetics, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - N O'Gorman
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes, Sorbonne Paris-Cité, Paris, France
| | - Y Ville
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes, Sorbonne Paris-Cité, Paris, France
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Stirnemann J, Djaafri F, Kim A, Mediouni I, Bussieres L, Spaggiari E, Veluppillai C, Lapillonne A, Kermorvant E, Magny JF, Colmant C, Ville Y. Preterm premature rupture of membranes is a collateral effect of improvement in perinatal outcomes following fetoscopic coagulation of chorionic vessels for twin-twin transfusion syndrome: a retrospective observational study of 1092 cases. BJOG 2018; 125:1154-1162. [DOI: 10.1111/1471-0528.15147] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2018] [Indexed: 11/29/2022]
Affiliation(s)
- J Stirnemann
- Obstetrics and Fetal Medicine; Hôpital Necker Enfants Malades; AP-HP; Paris France
- EA7328 and PACT; Université Paris Descartes; Paris France
| | - F Djaafri
- Obstetrics and Fetal Medicine; Hôpital Necker Enfants Malades; AP-HP; Paris France
| | - A Kim
- Obstetrics and Fetal Medicine; Hôpital Necker Enfants Malades; AP-HP; Paris France
| | - I Mediouni
- Obstetrics and Fetal Medicine; Hôpital Necker Enfants Malades; AP-HP; Paris France
| | - L Bussieres
- Obstetrics and Fetal Medicine; Hôpital Necker Enfants Malades; AP-HP; Paris France
- EA7328 and PACT; Université Paris Descartes; Paris France
| | - E Spaggiari
- Obstetrics and Fetal Medicine; Hôpital Necker Enfants Malades; AP-HP; Paris France
- EA7328 and PACT; Université Paris Descartes; Paris France
| | - C Veluppillai
- Obstetrics and Fetal Medicine; Hôpital Necker Enfants Malades; AP-HP; Paris France
| | - A Lapillonne
- EA7328 and PACT; Université Paris Descartes; Paris France
- Neonatology and Intensive Care Unit; Hôpital Necker Enfants Malades; AP-HP; Paris France
| | - E Kermorvant
- EA7328 and PACT; Université Paris Descartes; Paris France
- Neonatology and Intensive Care Unit; Hôpital Necker Enfants Malades; AP-HP; Paris France
| | - J-F Magny
- EA7328 and PACT; Université Paris Descartes; Paris France
- Neonatology and Intensive Care Unit; Hôpital Necker Enfants Malades; AP-HP; Paris France
| | - C Colmant
- Obstetrics and Fetal Medicine; Hôpital Necker Enfants Malades; AP-HP; Paris France
| | - Y Ville
- Obstetrics and Fetal Medicine; Hôpital Necker Enfants Malades; AP-HP; Paris France
- EA7328 and PACT; Université Paris Descartes; Paris France
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Berardi A, Balestri E, Bonacorsi G, Chiossi C, Palazzi G, Spaggiari E, Ferrari F. Neonatal pyknocytosis in a preterm dizygotic twin. World J Clin Pediatr 2017; 6:176-179. [PMID: 29259893 PMCID: PMC5695074 DOI: 10.5409/wjcp.v6.i4.176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 07/07/2017] [Accepted: 09/13/2017] [Indexed: 02/06/2023] Open
Abstract
Infantile pyknocytosis (IP) is a rare, self-limited neonatal haemolytic anaemia that may require multiple blood transfusions. Only a little more than 50 cases have been reported in the medical literature, and the great majority of them concerns term infants. The etiology of IP is not well understood; most likely it results from a transient extra-corpuscular factor, whose nature is unknown, transmitted from mother to child or, alternatively, from a deficiency of an anti-oxidative agent. We report the case of two preterm twins, one of which suffered from IP and developed severe anaemia at age 2 wk, while the other was unaffected. Although no specific agent was identified as the cause of anaemia and IP, we speculate that the transmission of an agent from mother to child was unlikely, as only twin one suffered from IP. Smelly greenish diarrhoea occurred just before the presentation of IP, suggesting that the same agent led to both the diarrhoea and the oxidative injury. Because IP may remain underdiagnosed, it should be considered in cases of early unexplained severe hemolytic anemia.
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Affiliation(s)
- Alberto Berardi
- Unità Operativa di Terapia Intensiva Neonatale, Dipartimento Integrato Materno-Infantile, Azienda Ospedaliero-Universitaria Policlinico, 41100 Modena, Italy
| | - Eleonora Balestri
- Unità Operativa di Terapia Intensiva Neonatale, Azienda Ospedaliera Santa Maria Nuova, 42100 Reggio Emilia, Italy
| | - Goretta Bonacorsi
- Unità Operativa di Ematologia, Dipartimento di Scienze Mediche e Chirurgiche, Azienda Ospedaliero-Universitaria Policlinico, 41100 Modena, Italy
| | - Claudio Chiossi
- Unità Operativa di Pediatria, Nuovo Ospedale Civile, 41049 Sassuolo, Italy
| | - Giovanni Palazzi
- Unità Operativa di Pediatria, Dipartimento Integrato Materno-Infantile, Azienda Ospedaliero-Universitaria Policlinico, 41100 Modena, Italy
| | - Eugenio Spaggiari
- Unità Operativa di Terapia Intensiva Neonatale, Dipartimento Integrato Materno-Infantile, Azienda Ospedaliero-Universitaria Policlinico, 41100 Modena, Italy
| | - Fabrizio Ferrari
- Unità Operativa di Terapia Intensiva Neonatale, Dipartimento Integrato Materno-Infantile, Azienda Ospedaliero-Universitaria Policlinico, 41100 Modena, Italy
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Spaggiari E, Faure G, Dreux S, Czerkiewicz I, Stirnemann JJ, Guimiot F, Heidet L, Favre R, Salomon LJ, Oury JF, Ville Y, Muller F. Sequential fetal serum β2-microglobulin to predict postnatal renal function in bilateral or low urinary tract obstruction. Ultrasound Obstet Gynecol 2017; 49:617-622. [PMID: 27197901 DOI: 10.1002/uog.15968] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/03/2016] [Accepted: 05/13/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Fetal serum β2-microglobulin has been shown to predict postnatal renal outcome in cases of fetal obstructive uropathy. We assessed the value of serial measurements of fetal serum β2-microglobulin in the prediction of postnatal renal outcome. METHODS We retrospectively studied renal outcome in 42 fetuses with bilateral or low urinary tract obstruction that had fetal blood sampling on at least two occasions to assay serum levels of β2-microglobulin. Amniotic fluid volume at the time of each sampling was recorded. We classified renal outcome as either favorable (when postnatal renal function was normal) or adverse (when postnatal chronic renal failure occurred or when renal dysplasia at autopsy was noted). A β2-microglobulin cut-off of 5 mg/L and amniotic fluid index of 5 cm were used to predict postnatal renal outcome. RESULTS Renal outcome was adverse in 28 cases and favorable in 14. In 12 (28.6%) cases, fetal serum β2-microglobulin concentration differed between the first and last measurement. Prediction of postnatal renal outcome was correct in 11 of these cases based on the last β2-microglobulin measurement. The sensitivity of β2-microglobulin in predicting renal outcome was significantly higher (P = 0.005) when using the last rather than the first measurement (96.4% vs 64.3%), with similar specificity for both measurements (85.7% vs 78.6%, non-significant). The sensitivity of amniotic fluid volume was also significantly higher (P = 0.005) when using the last rather than the first measurement (75.0% vs 35.7%), with similar specificity for both measurements (64.3% vs 71.4%, non-significant). CONCLUSION Sequential measurement of serum β2-microglobulin, performed for adverse ultrasound findings, such as renal parenchymal abnormality or decreasing amniotic fluid volume, predicts postnatal renal outcome more accurately than does a single assay. This may be due to possible worsening of renal injury with increasing duration of urinary tract obstruction. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- E Spaggiari
- Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes and Sorbonne Paris-Cité, Paris, France
| | - G Faure
- Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - S Dreux
- Department of Biochemistry and Hormonology, Robert Debré Hospital, AP-HP, Paris, France
| | - I Czerkiewicz
- Department of Biochemistry and Hormonology, Robert Debré Hospital, AP-HP, Paris, France
| | - J J Stirnemann
- Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes and Sorbonne Paris-Cité, Paris, France
| | - F Guimiot
- Department of Developmental Biology, Robert Debré Hospital, AP-HP, Paris, France
- University Paris Diderot and Sorbonne Paris-Cité, Paris, France
| | - L Heidet
- Department of Pediatric Nephrology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - R Favre
- Department of Obstetrics and Gynecology, Hautepierre and CMCO Hospital, Strasbourg, France
| | - L J Salomon
- Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes and Sorbonne Paris-Cité, Paris, France
| | - J F Oury
- University Paris Diderot and Sorbonne Paris-Cité, Paris, France
- Department of Obstetrics and Gynecology, Robert Debré Hospital, AP-HP, Paris, France
| | - Y Ville
- Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes and Sorbonne Paris-Cité, Paris, France
| | - F Muller
- Department of Biochemistry and Hormonology, Robert Debré Hospital, AP-HP, Paris, France
- University Versailles Saint-Quentin, Versailles, France
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Berardi A, Spaggiari E, Cattelani C, Roversi MF, Pecorari M, Lazzarotto T, Ferrari F. Persistent intestinal bleeding due to severe CMV-related thrombocytopenia in a preterm newborn. J Matern Fetal Neonatal Med 2017; 31:1246-1249. [PMID: 28395563 DOI: 10.1080/14767058.2017.1312331] [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] [Indexed: 10/19/2022]
Abstract
The optimal threshold for neonatal platelet transfusions in sick newborns is still uncertain. We report a congenital cytomegalovirus (CMV) infection in a premature neonate with severe thrombocytopenia who subsequently presented with necrotizing enterocolitis and intestinal bleeding. The baby recovered after platelet transfusions were discontinued and the therapy was switched from intravenous ganciclovir to oral valganciclovir. We discuss both measures, speculating on the key role of platelet transfusions.
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Affiliation(s)
- Alberto Berardi
- a Dipartimento Integrato Materno-Infantile , Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Eugenio Spaggiari
- a Dipartimento Integrato Materno-Infantile , Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Chiara Cattelani
- a Dipartimento Integrato Materno-Infantile , Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Maria Federica Roversi
- a Dipartimento Integrato Materno-Infantile , Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Monica Pecorari
- b Struttura Complessa di Microbiologia e Virologia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Tiziana Lazzarotto
- c Unità Operativa di Microbiologia , Azienda Ospedaliero-Universitaria Policlinico S. Orsola Malpighi , Bologna , Italy
| | - Fabrizio Ferrari
- a Dipartimento Integrato Materno-Infantile , Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
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Gueneuc A, Spaggiari E, Bonniere M, Hajal NJ, Ville Y, Salomon LJ. Pitfall in first-trimester diagnosis of chorionicity in twin pregnancy. Ultrasound Obstet Gynecol 2017; 49:277-278. [PMID: 27000969 DOI: 10.1002/uog.15922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/15/2016] [Indexed: 06/05/2023]
Affiliation(s)
- A Gueneuc
- Service d'Obstétrique et de Médecine Fœtale, Hôpital Necker-Enfants-Malades, APHP, Université Paris Descartes, 149 rue de Sèvres, Sorbonne Paris Cité, Paris, France
- Service de Gynécologie-Obstétrique et de Médecine de la Reproduction, CHU de Caen-FEH, Université Basse-Normandie, Caen, France
| | - E Spaggiari
- Service d'Obstétrique et de Médecine Fœtale, Hôpital Necker-Enfants-Malades, APHP, Université Paris Descartes, 149 rue de Sèvres, Sorbonne Paris Cité, Paris, France
| | - M Bonniere
- Département d'Histo-Embryologie et de Cytogénétique, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - N J Hajal
- Service d'Obstétrique et de Médecine Fœtale, Hôpital Necker-Enfants-Malades, APHP, Université Paris Descartes, 149 rue de Sèvres, Sorbonne Paris Cité, Paris, France
| | - Y Ville
- Service d'Obstétrique et de Médecine Fœtale, Hôpital Necker-Enfants-Malades, APHP, Université Paris Descartes, 149 rue de Sèvres, Sorbonne Paris Cité, Paris, France
| | - L J Salomon
- Service d'Obstétrique et de Médecine Fœtale, Hôpital Necker-Enfants-Malades, APHP, Université Paris Descartes, 149 rue de Sèvres, Sorbonne Paris Cité, Paris, France
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Spaggiari E, De Foucher T, Stirnemann JJ, Guennas F, Bounan S, Hatem G. Untreated maternal hyperthyroidism responsible of early neonatal demise. J OBSTET GYNAECOL 2015; 36:66-7. [PMID: 26439901 DOI: 10.3109/01443615.2015.1036408] [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: 11/13/2022]
Affiliation(s)
- E Spaggiari
- a Department of Obstetrics and Maternal-Fetal Medicine , Necker-Enfants Malades Hospital, AP-HP , Paris , France.,b Department of Obstetrics and Gynecology , Delafontaine Hospital , Saint-Denis , France.,c University Paris Descartes , Sorbonne Paris-Cité, Paris , France
| | - T De Foucher
- b Department of Obstetrics and Gynecology , Delafontaine Hospital , Saint-Denis , France
| | - J J Stirnemann
- a Department of Obstetrics and Maternal-Fetal Medicine , Necker-Enfants Malades Hospital, AP-HP , Paris , France.,c University Paris Descartes , Sorbonne Paris-Cité, Paris , France
| | - F Guennas
- b Department of Obstetrics and Gynecology , Delafontaine Hospital , Saint-Denis , France
| | - S Bounan
- b Department of Obstetrics and Gynecology , Delafontaine Hospital , Saint-Denis , France
| | - G Hatem
- b Department of Obstetrics and Gynecology , Delafontaine Hospital , Saint-Denis , France
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Spaggiari E, Stirnemann JJ, Sonigo P, Khen-Dunlop N, De Saint Blanquat L, Ville Y. Prenatal prediction of pulmonary arterial hypertension in congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 2015; 45:572-577. [PMID: 24976012 DOI: 10.1002/uog.13450] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 06/12/2014] [Accepted: 06/19/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate the role of prenatal prognostic markers obtained routinely by ultrasound examination and magnetic resonance imaging (MRI) in the prediction of development of postnatal pulmonary arterial hypertension (PAH) in isolated congenital diaphragmatic hernia (CDH). METHODS One hundred and ten cases of isolated CDH were referred to our fetal medicine unit between January 2004 and April 2013. Mortality and morbidity rates were reviewed for those presenting with postnatal PAH. The following prenatal markers were evaluated as potential predictive factors of PAH: liver position, side of the CDH defect, lung area to head circumference ratio (LHR) and observed/expected LHR (o/e-LHR), which were measured by ultrasound, and observed/expected total fetal lung volume (o/e-TFLV), which was measured by MRI. Univariable logistic regression was used to assess associations. RESULTS PAH was significantly associated with perinatal mortality and morbidity (P < 0.001). The occurrence of PAH decreased significantly with an increasing LHR, o/e-LHR and o/e-TFLV and was significantly increased for cases with an intrathoracic liver, but not for those with right-sided defects. Univariable regression revealed that o/e-TFLV (odds ratio (OR), 0.9 (95% CI, 0.86-0.95); P < 0.05 for percentage unit change in o/e), LHR (OR, 0.19 (95% CI, 0.09-0.40); P < 0.05 for unit change), o/e-LHR (OR, 0.95 (95% CI, 0.93-0.98); P < 0.05 for percentage unit change in o/e) and liver position (OR, 2.82 (95% CI, 1.13-7.00); P < 0.05 for intrathoracic liver) were significant predictors of subsequent PAH. No differences were found after adjusting for gestational age at delivery. The areas under the receiver-operating characteristics curve were 0.80 and 0.75 for o/e-TFLV and o/e-LHR, respectively. CONCLUSION In cases of CDH, PAH is associated with high rates of mortality and morbidity. Routinely obtained prenatal markers, usually used for the assessment of pulmonary hypoplasia, are also relevant for the postnatal prediction of PAH.
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MESH Headings
- Female
- Gestational Age
- Head
- Hernias, Diaphragmatic, Congenital/diagnosis
- Hernias, Diaphragmatic, Congenital/embryology
- Hernias, Diaphragmatic, Congenital/pathology
- Humans
- Hypertension, Pulmonary/diagnosis
- Hypertension, Pulmonary/embryology
- Hypertension, Pulmonary/pathology
- Infant, Newborn
- Liver/embryology
- Liver/pathology
- Lung/embryology
- Lung/pathology
- Lung Volume Measurements/methods
- Predictive Value of Tests
- Pregnancy
- Prognosis
- Survival Rate
- Ultrasonography, Prenatal
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Affiliation(s)
- E Spaggiari
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France; University Paris Descartes, Sorbonne Paris-Cité, Paris, France
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Spaggiari E, Vuillard E, Khung-Savatovsky S, Muller F, Oury JF, Delezoide AL, Guimiot F. Ultrasound detection of eyelashes: a clue for prenatal diagnosis of Cornelia de Lange syndrome. Ultrasound Obstet Gynecol 2013; 41:341-342. [PMID: 22903543 DOI: 10.1002/uog.12285] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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18
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Spaggiari E, Stirnemann J, Bernard JP, De Saint Blanquat L, Beaudoin S, Ville Y. Prognostic value of a hernia sac in congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 2013; 41:286-290. [PMID: 22605546 DOI: 10.1002/uog.11189] [Citation(s) in RCA: 21] [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] [Subscribe] [Scholar Register] [Accepted: 04/30/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To investigate the prognostic value of a hernia sac in isolated congenital diaphragmatic hernia (CDH). METHODS Our database was searched to identify all consecutive cases of CDH referred to our fetal medicine unit between January 2004 and August 2011. Presence or absence of a hernia sac was assessed in liveborn cases using surgery or postnatal autopsy reports. We studied the correlation between the presence of a hernia sac and prenatal findings and perinatal morbidity and mortality. RESULTS Over the study period, there were 70 cases with isolated CDH born alive in which either a surgery or autopsy report was available. Neonatal death, either preoperative or postoperative, occurred in 1/18 (5.6%) infants with a hernia sac and in 17/52 (32.7%) cases without a hernia sac (P = 0.03). Patients with a hernia sac had a significantly higher observed to expected pulmonary volume on prenatal magnetic resonance imaging (51.9 vs 39.3%, P = 0.01). Neonatal morbidity in surviving infants was lower in the group with a hernia sac, although not significantly. CONCLUSION The presence of a hernia sac is associated with a higher pulmonary volume and a better overall prognosis for CDH.
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Affiliation(s)
- E Spaggiari
- Department of Obstetrics and Maternal-Fetal Medicine, GHU Necker Enfants-Malades, AP-HP and Université Paris Descartes, Paris, France
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Spaggiari E, Dreux S, Czerkiewicz I, Favre R, Schmitz T, Guimiot F, Laurichesse Delmas H, Verspyck E, Oury JF, Ville Y, Muller F. Fetal obstructive uropathy complicated by urinary ascites: outcome and prognostic value of fetal serum β-2-microglobulin. Ultrasound Obstet Gynecol 2013; 41:185-189. [PMID: 23090907 DOI: 10.1002/uog.12328] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Accepted: 10/02/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To determine whether the prognostic value of fetal serum β-2-microglobulin is altered and whether the occurrence of fetal urinary ascites prevents kidney damage in cases of fetal obstructive uropathy with urinary ascites. METHODS This was a retrospective study of cases of fetal bilateral obstructive uropathy that occurred between 2006 and 2010, for which both fetal serum and ascites samples were sent to our laboratory for analysis. β-2-microglobulin was assayed in both fetal serum and the corresponding ascites. Renal outcome was analyzed. Histological features of the kidney in cases of termination of pregnancy and renal function of liveborn infants were recorded. RESULTS Fourteen cases with analysis of fetal serum and fetal ascites in a context of urinary obstruction were included. Renal outcome was unfavorable in eight cases (57%) and favorable in six (43%). When fetal serum β-2-microglobulin was < 5 mg/L, renal outcome was favorable in all cases (4/4). When fetal serum β-2-microglobulin was ≥ 5 mg/L, 8/10 cases (80%) had an unfavorable renal outcome (sensitivity, 100%; specificity, 66%). CONCLUSION Fetal serum β-2-microglobulin reliably predicts postnatal renal outcome in obstructive uropathy complicated by urinary ascites. Moreover, urine extravasation does not seem to protect fetal renal function.
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Affiliation(s)
- E Spaggiari
- Department of Developmental Biology, AP-HP, Robert Debré Hospital, and University Paris Diderot and Paris Sorbonne-Cité, Paris, France.
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Spaggiari E, Stirnemann J, Ville Y. Outcome in fetuses with isolated congenital diaphragmatic hernia with increased nuchal translucency thickness in first trimester. Prenat Diagn 2012; 32:268-71. [PMID: 22430726 DOI: 10.1002/pd.3819] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine the possible association between increased nuchal translucency (NT) thickness in the first trimester and perinatal outcome in isolated congenital diaphragmatic hernia (CDH). METHODS We conducted a retrospective study between January 2004 and June 2010. The database was searched to identify all consecutive cases of CDH referred to the fetal medicine center of Necker Hospital in Paris. Enlarged NT was defined above the 95th centile. Only children born alive with an isolated CDH were selected for the analysis of prognostic factors. We also studied the correlation between NT thickness in the first trimester and lung-to-head ratio, observed to expected lung area-to-head ratio, lung volume estimated by magnetic resonance imaging, and other prenatal features of intrathoracic compression. RESULTS Seventy-one cases of isolated CDH were available. The fetal NT was above the 95th centile in 9 of the 71 cases. Neonatal death occurred in 7/9 (78%) cases with enlarged NT, compared with 24/62 (38%) with normal NT (P = 0.035). Enlarged NT was significantly associated with prenatal features of intrathoracic compression. CONCLUSION Enlarged NT thickness in CDH is associated with a poor outcome and is related to an early intrathoracic compression.
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Affiliation(s)
- E Spaggiari
- AP-HP, Department of Obstetrics and Gynecology, Necker Enfants-Malades Hospital, Paris, France
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21
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Spaggiari E, Vuillard E, Baumann C, Dupont C, Belarbi N, Oury JF, Delezoide AL, Guimiot F. Ultrasound detection of hyaloid artery in the third trimester of pregnancy: a pathological finding. Ultrasound Obstet Gynecol 2012; 39:478-479. [PMID: 22012788 DOI: 10.1002/uog.10123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Venuta A, Spaggiari E, Bertolani P, Balli F. [The use of ondansetron in acute gastroenteritis. Its impact in a pediatric emergency department]. Pediatr Med Chir 2011; 33:193-195. [PMID: 22423479] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Ondansentron is in consideration in literature for its use in vomiting secondary to acute gastroenteritis in children. OBJECTIVE To evaluate its usefulness in children with acute gastroenteritis referred to a paediatric emergency department. METHODS A retrospective study considered 967 children treated with ondansetron (0,06 mg/kg IM) plus oral rehydration, with a control group of 286 children who received only oral rehydration. RESULTS The time spent into the short-stay observation unit and the total emergency department stay were significantly reduced in children receiving ondansentron. No adverse reactions to the drug were recorded.
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Affiliation(s)
- A Venuta
- Dipartimento Materno Infantile, Largo del Pozzo 71--41100 Modena.
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23
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Venuta A, Spaggiari E, Bertolani P, Balli F. [The use of ondansetron in acute gastroenteritis. Its impact in a pediatric emergency department]. Pediatr Med Chir 2011; 33:143-145. [PMID: 22145300] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Ondansentron is in consideration in literature for its use in vomiting secondary to acute gastroenteritis in children. OBJECTIVE To evaluate its usefulness in children with acute gastroenteritis referred to a paediatric emergency department. METHODS A retrospective study considered 967 children treated with ondansetron (0,06 mg/kg IM) plus oral rehydration, with a control group of 286 children who received only oral rehydration. RESULTS The time spent into the short-stay observation unit and the total emergency department stay were significantly reduced in children receiving ondansentron. No adverse reactions to the drug were recorded.
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Affiliation(s)
- A Venuta
- Dipartimento Materno Infantile, Università Di Modena e Reggio Emilia.
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Bnà C, Zompatori M, Poletti V, Spaggiari E, Chetta A, Calabrò E, Ormitti F, Berti E, Cancellieri A, Chilosi M. Differential diagnosis between usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP) assessed by high-resolution computed tomography (HRCT). Radiol Med 2005; 109:472-87. [PMID: 15973221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE The aim of this study was to assess the accuracy of high-resolution CT in the differential diagnosis between UIP and NSIP, and the correlations with histological and functional findings. MATERIALS AND METHODS Patients underwent thin-collimation spiral CT (1 mm), with 10-mm interval. Pulmonary function was assessed with a pneumotacograph and body plethysmograph connected with a computer for data analysis. Three pathologists, blinded to the clinical and functional data, provided a histological diagnosis based on established criteria reported in the literature. The study group only included patients with a histological diagnosis of either UIP or NSIP. RESULTS We achieved a correct diagnosis of NSIP in 86.6% of cases (76.4% sensitivity; 84.6% specificity), whereas UIP was correctly diagnosed in 73.3% of cases (84.6% sensitivity; 76.5% specificity). An 80% agreement was achieved between the HRCT and histological findings in the whole case series (73% sensitivity, 87% specificity, p<0.01). CONCLUSIONS The most important finding of our study was that a ground glass appearance equal to or greater than 15% is highly suggestive of NSIP. Therefore, our results could be useful to confirm a suggested diagnosis of NSIP.
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Affiliation(s)
- C Bnà
- Sezione di Scienze Radiologiche, Dipartimento di Scienze Cliniche, Università degli studi di Parma, Parma, Italy
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Spaggiari E, Zompatori M, Verduri A, Chetta A, Bnà C, Ormitti F, Sverzellati N, Rabaiotti E. Early smoking-induced lung lesions in asymptomatic subjects. Correlations between high resolution dynamic CT and pulmonary function testing. Radiol Med 2005; 109:27-39. [PMID: 15729184] [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: 05/01/2023]
Abstract
PURPOSE To evaluate the prevalence and significance of the pathological effects of cigarette smoking on the lung and the sensitivity of high-resolution CT (HRCT) in the recognition of early smoking-induced lesions in asymptomatic former or current smokers. MATERIALS AND METHODS We performed a prospective and consecutive analysis of 36 volunteers (16 males, 20 females), 10 non-smokers (3 males; 7 females) and 26 smokers (13 males; 13 females / 17 current smokers; 9 former smokers), all asymptomatic and with normal respiratory flows. These subjects underwent lung function testing and HRCT, after providing written informed consent for the study. The HRCT scans were obtained at three pre-selected levels (aortic arch, tracheal carina and venous hilum). The same scans were obtained in post-expiration phase. At the level of the apical segmental bronchus of the right upper lobe, we measured on the monitor wall thickening, and the total and internal diameters using the techniques reported in literature. Each study was independently evaluated by two radiologists that were blinded to all clinical and functional data; they also evaluated the presence, prevalence and type of emphysema, areas of patchy hyperlucency and oligoemia in the inspiration phase and areas of expiratory air trapping. The extension was evaluated with the visual score method. The data obtained were analysed with the Windows SPSS package for statistical analysis. RESULTS The two groups (non smokers and smokers) showed significant differences in some functional tests such as FEV1 (p<0.005) and Tiffeneau index (p<0.005), which were lower in current-smokers or former-smokers, although still within the normal range. The HRCT study did not show areas of emphysema or air trapping in non smokers. In the smokers' group, air trapping was observed in 30.7% of cases: 33.3% former-smokers and 29.4% current smokers (mean extension was 21.36% in former smokers and 9.48% in current smokers). Mean extension in the smokers' group was 13.94%. Pulmonary emphysema was found in 34.6% of cases in the smokers' group: 33.3% former-smokers and 35.2% current-smokers. Emphysema was prevalent in the upper lobes (88.8%). Mean extension was 8.76% in the former smokers group and 18.81% in current-smokers, with a total mean extension of 15.47% in the smokers' group. Statistically, there was a significant difference between non-smokers and smokers as regards emphysema extension and expiratory air trapping (p=0.034 and p=0.050, respectively). The smokers' group had a significantly wider diameter of the apical segmental bronchus of the right upper lobe than the controls. There was no significant statistical correlation between this dilatation and the emphysema score (r=0.051; p=0.81). The entity of smoking history did not correlate with emphysema extension or air trapping or with the size of the apical segmental bronchus of the right upper lobe. CONCLUSIONS Our study demonstrates that HRCT is more sensitive and specific than commonly-used functional tests for the evaluation of initial emphysema in asymptomatic smokers. We observed expiratory air trapping only in the smokers' group, and only of the lobular type, without evidence of disease in inspiratory scans. Among the smokers and former-smokers, air trapping was found in 30.7% of subjects, with a mean extension lower than 10%. Our results therefore suggest that, even in asymptomatic subjects, expiratory air trapping is probably pathological and, once bronchial asthma has been excluded, it may be related to cigarette smoking and indicate early inflammatory bronchiolar damage. HRCT may therefore be regarded as a useful tool in the early diagnosis of smoking-related lung disease.
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Affiliation(s)
- E Spaggiari
- Sezione di Diagnostica per Immagini e UO di Scienze Radiologiche, Dipartimento di Scienze Cliniche, Università degli Studi, Parma, Italy
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Abstract
Castleman disease is an uncommon benign disorder mainly affecting mediastinal lymph nodes and rarely visceral organs. The most typical structural finding is hypervascularity which can be well demonstrated both by CT and MRI. We report MR findings of an unusual case of solitary parenchymal lung involvement.
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Affiliation(s)
- F Ferrozzi
- Department of Radiology, University of Parma, Via Gramsci 14, I-43100, Parma, Italy.
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Spaggiari E, Salati R, Nicolini P, Borgatti R, Pozzoli U, Polenghi F. Evolution of ocular clinical and electrophysiological findings in pediatric Bardet-Biedl syndrome. Int Ophthalmol 2001; 23:61-7. [PMID: 11196121 DOI: 10.1023/a:1026560721525] [Citation(s) in RCA: 11] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Bardet-Biedl syndrome (BBS) is a hereditary autosomal-recessive disorder, characterized by mental retardation, obesity, pigmentary retinopathy, polydactyly and, only in males, hypogenitalism. Even though genetic studies have revealed five different forms of BBS correlated to distinct loci on different chromosomes, a diagnosis of BBS is still primarily based on clinical data. The present study discusses the evolution of clinical ophthalmological and electrophysiological characteristics of BBS patients in developmental age. The main results obtained on a sample of 13 pediatric patients are the following: * progressive loss of visual acuity arised early in the first decade of life * ophthalmoscopic signs of pigmentary retinopathy were present only in 46% of the children studied * striking anomalies in the electroretinogram were also detected in the cases without pigmentary retinopathy * the electroretinographic results, when detectable, suggested a greater involvement of the photopic system as against the scotopic system.
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Affiliation(s)
- E Spaggiari
- Department of Pediatric Ophthalmology, Scientific Institute E. Medea Bosisio Parini (Lc), Italy
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Ferrozzi F, Tognini G, Marchesi G, Spaggiari E, Pavone P. [Gastric tumors with fatty components. CT findings and differential diagnosis]. Radiol Med 2000; 100:343-7. [PMID: 11213412] [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: 02/19/2023]
Abstract
PURPOSE To assess the role of CT in diagnosing and characterizing gastric fatty tumors. MATERIAL AND METHODS We reviewed the CT scans of 16 patients (8 men, 8 women, mean age 52 years) with gastric fatty tumors (11 lipomas, 3 liposarcomas, 1 angiolipoma, 1 teratoma) examined from 1990 to 1999. The differential diagnosis considered primary and secondary lipomatosis, carcinoma engulfing the perivisceral fat and thus mimicking a liposarcoma, mesenchymal gastric and primary peritoneal tumors. RESULTS Lipomas involved the fundus (7/11), the body (3/11), the antrum (1/11). Multifocality was found in one case. Lesions size ranged 25 to 65 mm (mean 35 mm). All the lipomas showed homogeneous structure with negative (-30 -100) HU values. A pseudocapsule was demonstrated in 7/11 cases. No infiltrative growth was demonstrated. The angiolipoma located in the fundus showed a vascular component with strong contrast enhancement. All the liposarcomas were bigger than 10 cm and there was a strong correlation between pathologic specimen and CT findings. The differentiated liposarcomas showed the classic heterogeneous fatty density; on the contrary the myxoid and the pleomorphic types showed an aspecific structure with necrotic/cystic changes, mostly demonstrated in the myxoid type. The teratoma was a solid mass with fatty, solid, necrotic and calcified components. CONCLUSION CT allows the diagnosis and characterization of gastric fatty tumors. The preoperative diagnosis of lipomas plays a major clinical role because it often makes surgery unnecessary.
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Affiliation(s)
- F Ferrozzi
- Istituto di Scienze Radiologiche, Università degli Studi, Parma.
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Salvi M, Spaggiari E, Neri F, Minelli R, Roti E. Expulsion of an artificial eye in a patient with thyroid-associated ophthalmopathy and surgical anophthalmos. Am J Med 1999; 107:191-2. [PMID: 10460062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Salvi M, Spaggiari E, Neri F, Macaluso C, Gardini E, Ferrozzi F, Minelli R, Wall JR, Roti E. The study of visual evoked potentials in patients with thyroid-associated ophthalmopathy identifies asymptomatic optic nerve involvement. J Clin Endocrinol Metab 1997; 82:1027-30. [PMID: 9100568 DOI: 10.1210/jcem.82.4.3877] [Citation(s) in RCA: 10] [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: 02/04/2023]
Abstract
In the present study we have recorded visual evoked cortical potentials (VECP) in 88 patients affected by autoimmune thyroid disease and thyroid-associated ophthalmopathy (TAO) without clinical signs of optic neuropathy. At the time of ophthalmological examination, 37 of these patients were hyperthyroid, 41 were euthyroid, and 8 were hypothyroid; 2 were not assessed. Twenty-nine normal subjects served as controls. We performed pattern reversal visual stimulation and recorded the amplitude and latency of the cortical electric response at 100 ms (P100 wave). There were no differences in the mean P100 amplitude of TAO patients and normal subjects. The mean P100 latency in patients was 105.6 +/- 0.5 ms, significantly higher than that in normal subjects (102.0 +/- 0.5 ms; P < 0.00003). Latency in euthyroid patients did not differ from that in either hypo- or hyperthyroid patients. The VECP test was positive (latency, > or = 110.0 ms) in 21 (23.8%) TAO patients. In patients with proptosis greater than 21 mm, latency was 106.7 +/- 0.7 ms, significantly higher than that in patients with normal Hertel measurements (104.3 +/- 0.6 ms; P < 0.01). Latency was not increased in patients with acute inflammatory signs compared to those with inactive eye disease and in patients with altered extrinsic motility. In patients with an abnormal visual field study, the mean latency was 110.3 +/- 1.5 ms, significantly higher than that in patients with a normal visual field (104.7 +/- 0.4; by t test, P < 0.000003). In conclusion, we observed a prolongation of the latency of the evoked cortical response in patients with TAO without subjective visual complaints and without optic nerve compression. We believe that the study of VECP in TAO is complementary to the study of the visual field in identifying early optic nerve dysfunction in the absence of decreased visual acuity.
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Affiliation(s)
- M Salvi
- Centro per lo Studio, Prevenzione, Diagnosi e Cura delle Tireopatie, Università di Parma, Italy
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