Background: Contrast-enhanced computed tomography (CECT) is considered the gold standard for assessing therapeutic response in hepatocellular carcinoma (HCC) following locoregional treatments. More recently, contrast-enhanced ultrasound (CEUS) has emerged as a promising, cost-effective alternative, although evidence supporting its use in this context remains limited. This study aimed to evaluate the diagnostic performance of CEUS compared to CECT in assessing local response of HCC nodules treated with radiofrequency ablation (RFA). Methods: We retrospectively analyzed a consecutively enrolled cohort of patients undergoing RFA for HCC at IRCCS San Matteo Hospital, Pavia, between January 2017 and January 2022. Follow-up imaging included both CEUS and CECT at predefined time points. Imaging follow-up, MRI, and/or histological results were used as the reference standard to compare CEUS and CECT. Results: A total of 55 patients (mean age 74 years, 64% male) with 79 HCC nodules were included. Complete response was observed in 57 nodules (72%), all correctly identified by CEUS, whereas 4 cases were misclassified by CECT. Among the 22 nodules (28%) with residual disease, CEUS correctly identified 15 cases, while 17 were detected by CECT; notably, CEUS identified 4 lesions missed by CECT, which identified 6 missed at CEUS. Combined, the two modalities detected 21 (96%) out of 22 residual tumors. CEUS showed a sensitivity of 68.1%, specificity of 100%, and diagnostic accuracy of 91.1%, compared to 68.0%, 98.1%, and 88.6%, respectively, for CECT, with no significant differences. Conclusions: CEUS is a reliable, non-inferior, and complementary modality to CECT for evaluating treatment response of HCC following RFA. Larger prospective studies are warranted to further define its role in clinical practice.

Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death. Abdominal ultrasound (US) is by far the most widely used first-level exam for the diagnosis of HCC. We aimed to assess whether different ultrasound patterns were related to tumor prognosis. Methods: We retrospectively reviewed all patients with a new diagnosis of HCC (single nodule) and undergoing radiofrequency thermal ablation (RFTA) at our clinic between January 2009 and December 2021. Patients were classified according to four HCC ultrasound patterns: 1A, single capsulated nodule; 1B, well capsulated intra-node nodule; 1C, cluster consisting of capsulated nodules; and 2, non-capsulated nodule. Results: 149 patients were analysed; median follow-up time was 43 months. US patterns 1A (32.9%) and 1B (61.1%) were the most commonly seen. Median overall survival (OS) and recurrence-free survival (RFS) from RFTA were 54 months (95% CI, 42–66) and 22 months (95% CI, 12–32), respectively. Pattern 1A showed the best OS. Compared to pattern 1A, 1B was independently associated with worse OS (51 months (95% CI, 34–68) vs. 46 months (95% CI, 18–62)) and RFS (34 months (95% CI, 27–41) vs. 18 months (95% CI, 12–24)). Patterns 1C and 2 were associated with worse RFS compared to 1A, while no difference was seen for OS. Among baseline clinical variables, pattern 1B exhibited higher histological grade (p = 0.048) and tumor dimension (p = 0.034) compared to pattern 1A. Conclusions: Our findings demonstrate that different US patterns correlate with different survival outcomes and tumor behavior in patients with HCC. Prospective studies are needed to confirm these results.

High altitude can be a hostile environment and a paradigm of how environmental factors can determine illness when human biological adaptability is exceeded. This paper aims to provide a comprehensive review of high-altitude sickness, including its epidemiology, pathophysiology, and treatments. The first section of our work defines high altitude and considers the mechanisms of adaptation to it and the associated risk factors for low adaptability. The second section discusses the main high-altitude diseases, highlighting how environmental factors can lead to the loss of homeostasis, compromising important vital functions. Early recognition of clinical symptoms is important for the establishment of the correct therapy. The third section focuses on high-altitude pulmonary edema, which is one of the main high-altitude diseases. With a deeper understanding of the pathogenesis of high-altitude diseases, as well as a reasoned approach to environmental or physical factors, we examine the main high-altitude diseases. Such an approach is critical for the effective treatment of patients in a hostile environment, or treatment in the emergency room after exposure to extreme physical or environmental factors.

Background In recent years, lung ultrasound (LUS) has spread to emergency departments and clinical practise gaining great support, especially in time of pandemic, but only a few studies have been done on children. The aim of the present study is to compare the diagnostic accuracy of LUS (using Soldati LUS score) and that of chest X-ray (CXR) in CAP and COVID-19 pneumonia in paediatric patients. Secondary objective of the study is to examine the association between LUS score and disease severity. Finally, we describe the local epidemiology of paediatric CAP during the study period in the era of COVID-19 by comparing it with the previous 2 years. Methods This is an observational retrospective single-centre study carried out on patients aged 18 or younger and over the month of age admitted to the Paediatric Unit of our Foundation for suspected community-acquired pneumonia or SARS-CoV-2 pneumonia during the third pandemic wave of COVID-19. Quantitative variables were elaborated with Shapiro–Wilks test or median and interquartile range (IQR). Student's t-test was used for independent data. Association between quantitative data was evaluated with Pearson correlation. ROC curve analysis was used to calculate best cut-off of LUS score in paediatric patients. Area under the ROC curve (AUC), sensibility, and specificity are also reported with 95% confidence interval (CI). Results The diagnostic accuracy of the LUS score in pneumonia, the area underlying the ROC curve (AUC) was 0.67 (95% CI: 0.27–1) thus showing a discrete discriminatory power, with a sensitivity of 89.66% and specificity 50% setting a LUS score greater than or equal to 1 as the best cut-off. Nine patients required oxygen support and a significant statistical correlation (p = 0.0033) emerged between LUS score and oxygen therapy. The mean LUS score in patients requiring oxygen therapy was 12. RCP was positively correlated to the patient's LUS score (p = 0.0024). Conclusions Our study has shown that LUS is a valid alternative to CXR. Our results show how LUS score can be applied effectively for the diagnosis and stratification of paediatric pneumonia.

Lung ultrasound (LUS) examination has been shown to have a potential diagnostic and prognostic role in SARS-CoV-2 pneumonia disease. We evaluated the role of a new LUS score protocol (14 windows evaluation, graded score 0–3) in patients with SARS-CoV-2 pneumonia and the association of LUS patterns with clinical findings in acute stage and after three month from disease recovery. First, a cohort of 52 consecutive laboratory-confirmed SARS-CoV-2 patients underwent LUS examination upon the admission in an Internal Medicine ward. A total LUS score as the sum of the scores at each explored area was computed,and we investigated the association between LUS score and the clinical worsening. Then 47 patients who survived the first COVID-19 wave and who underwent a 3-stage LUS examination (T0 “access to ER”; T1 “ward hospitalization”; T2 “post-COVID outpatient”) were enrolled for the longitudinal study. In the acute stage, we observed that a median LUS score above 24 was associated with an almost 6-fold increase in the odds of worsening. In the longitudinal observation, we seen that LUS score's variation between T0 and T2 resulted to be statistically significant, as well a difference of LUS score between patients with or without pleural effusion, maintained over time.

SARS-CoV-2 infection can generate different responses in patients, ranging from asymptomatic virus shedding to severe pneumonia associated with high mortality. To evaluate the potential prognostic role of a recently introduced Lung Ultrasound (LUS) protocol in this context, a cohort of 52 consecutive laboratory-confirmed COVID-19 patients underwent LUS examination upon the admission and before the discharge in an Internal Medicine ward. LUS score was derived from 14 body-landmarks (2 anterior, 2 lateral and 3 posterior per hemithorax). Specific scores were assigned depending on the sole presence of horizontal artifacts (0), the presence of isolated vertical artifact only (1), the evidence of sub-pleural consolidations (2), the presence of confluent vertical artifact and/or confluent/large consolidations (3). We then investigated the association between the total LUS score severity and worsening, defined as a combination of high flow oxygen support, intensive care unit admission, or 30-day mortality as primary endpoint. Preliminary results of the study show that worsening outcome was reached by 20 (39%) patients during the observation period; average LUS score was 20.4 (SD 8.4) and 29.2 (SD 7.3) in patients without and with worsening, respectively. At univariable analysis, the total LUS score at admission was associated with higher odds of worsening.

Objectives Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection can generate severe pneumonia associated with high mortality. A bedside lung ultrasound (LUS) examination has been shown to have a potential role in this setting. The purpose of this study was to evaluate the potential prognostic value of a new LUS protocol (evaluation of 14 anatomic landmarks, with graded scores of 0–3) in patients with SARS‐CoV‐2 pneumonia and the association of LUS patterns with clinical or laboratory findings. Methods A cohort of 52 consecutive patients with laboratory‐confirmed SARS‐CoV‐2 underwent LUS examinations on admission in an internal medicine ward and before their discharge. A total LUS score as the sum of the scores at each explored area was computed. We investigated the association between the LUS score and clinical worsening, defined as a combination of high‐flow oxygen support, intensive care unit admission, or 30‐day mortality as the primary end point. Results Twenty (39%) patients showed a worse outcome during the observation period; the mean LUS scores ± SDs were 20.4 ± 8.5 and 29.2 ± 7.3 in patients without and with worsening, respectively ( P < .001). In a multivariable analysis, adjusted for comorbidities (>2), age (>65 years), sex (male), and body mass index (≥25 kg/m 2 ), the association between the LUS score and worsening (odds ratio, 1.17; 95% confidence interval, 1.05 to 1.29; P = .003) was confirmed, with good discrimination of the model (area under the receiver operating characteristic curve, 0.82). A median LUS score higher than 24 was associated with an almost 6‐fold increase in the odds of worsening (odds ratio, 5.67; 95% confidence interval, 1.29 to 24.8; P = .021). Conclusions Lung ultrasound can represent an effective tool for monitoring and stratifying the prognosis of patients with SARS‐CoV‐2 pulmonary involvement.

McKittrick-Wheelock syndrome is a rare condition characterized by secretory diarrhea due to villous adenoma of the colon, acute renal failure, dehydration, electrolyte and acid-base disorders. Diagnosis requires high suspicion especially when the presentation is unusual. Although potentially fatal for its complications, if promptly diagnosed and treated it is completely reversible. We present a case of a 67-year-old man who presented with syncope and diarrhea. On admission arterial blood gas test showed a complex acid-base disorder that led clinicians to further investigations and to point out a correct diagnosis.