Abstract Background Crohn’s disease (CD) and Ulcerative Colitis (UC) are chronic inflammatory bowel diseases (IBD). Telemedicine (TM) is particularly useful in patients with chronic diseases who need frequent monitoring to achieve therapeutic outcomes and improve their quality of life. We examined the differences in patient satisfaction comparing telemedicine versus traditional in-person visits. We also examined the potential cost savings benefits of utilizing telemedicine. Methods All consecutive patients with IBD in clinical remission evaluated by Partial Mayo Score (PMS) for UC and Harvey Bradshaw Index (HBI) for CD were considered eligible (PMS<2 or HBI<5). Patients were randomized into two arms: telemedicine or in-person visits after a questionnaire investigating the Information and communication technology (ICT) skills . All patients were asked to respond to an 11-items survey investigating their trust in telemedicine at first in-person visit. Enrolled patients performed after 3 months a telehealth or an in-person visit. All patients answered a standard questionnaire to evaluate the indirect costs of managing their disease. Patients randomized into telemedicine arm answered a specific 28-item survey investigating their degree of satisfaction. Results We enrolled 30 patients with IBD randomized to telemedicine (n. 22; 11 CD; 13 female; mean age 45 years) or in-person visits (n. 8; 5 CD; 3 female; mean age 52 years). All patients randomized in TM (100 %) showed interest in this new clinical practice and were satisfied of the received information about telemedicine management. No patients thought that telemedicine would have no positive effects on their health status. Regarding demographic data, 6 out of 22 patients randomized to TM (27.2%) lived in a different province than our hospital’s and16 patients (72.7%) had high school diploma or degree. All TM patients (100%) were satisfied of the televisit and considered clear the information received during conversation with physician. From a technical point of view, only one patient had problems of connection and three patients needed the support of a caregiver. Eighteen patients (81.8 %) thought that the efficacy of the televisit was equivalent to the in-person visit. Nineteen patients (86.3 %) were convinced that televisit is a tool to be promoted for future clinical practice. Patients randomized to telemedicine had an average saving of 125 €. Data shown are illustrated in the figure 1. Conclusion In patients with IBD in remission, telemedicine is feasible and effective in the majority of patients. In addition, TM has allowed a significant cost savings without reducing the quality of the health assistance.

Abstract Background Telemedicine is becoming a necessary tool for chronic disease management. Thanks to the wide diffusion of devices connecting to the World Wide Web, a large part of the population are now able to access to telemedicine services.Telemedicine is becoming a necessary tool for chronic disease management. Thanks to the wide diffusion of devices connecting to the World Wide Web, a large part of the population are now able to access to telemedicine services. The aim of this survey was to explore the willingness and hesitancy of patients with inflammatory bowel disease (IBD) to the use of telemedicine during COVD-19 outbreak. Methods A paper-and-pencil questionnaire was proposed to all consecutive patients observed at our tertiary IBD center in San Giovanni Rotondo (Italy) from February to May 2021. The survey investigated 20 items that can be grouped into 5 areas: socio-demographic data, clinical data, informatics competence, devices and network utilized for the internet connection, attitude to the telemedicine, and the impact of COVID-19 pandemic. Results A total of 156 patients completed the questionnaire (100 males). One hundred forthy-three patients (91.7%) were under 65 years and only 15 (9.6%) were graduates. Forthy-seven patients (30%) were single, 101 married (65%). Eighteen patients (11.5%) felt they had no IT skills. Eight patients (5.1%) had a previous experience of telemedicine. One hundred twenty-three patients (78.8%) consider the support of telemedicine useful for the management of their pathology and 134 (85.9%) would like the Center where they are followed up to have the possibility of offering a telemedicine service. One hundred three patients (66.0%) would like to have a teleconsultation with figures other than the Gastroenterologist. Ninety-seven patients (62.2%) agree that the ongoing coronavirus pandemic has a major impact on the need to implement telemedicine. Regarding the confidence with telemedicine, 106 patients (67.9%) were partially or totally agreeing telemedicine can properly resolve health problems, and 98 (62.8%) agree that technologies guarantee the privacy of the health data. One hundred twenty-five patients (80%) agree that telemedicine should be developed independently of the pandemic, however only 48 patients (31%) believe that telemedicine guarantee the same level of assistance of visit in presence. Conclusion Italian IBD patients showed a positive attitude towards telemedicine and consider that useful for the management of their disease. The majority of patients would like the center where they are followed up offering a telemedicine service, regardless of the ongoing pandemic. However only one third of patients believe that telemedicine can offer the same level of assistance of in-presence visit.

Abstract Background The SARS-CoV-2 pandemic has led to a remodeling of care activity, including the inflammatory bowel disease (IBD) centers. According to international recommendations, we did not discontinue immunosuppressive or biologic drugs and reorganized biologic drug infusions’ administration to minimize the risk of infection. The aim of this study is to describe the clinical outcome of SARS-CoV-2 infection and the adherence to the scheduled biologic therapies in a single tertiary center including both IBD adult and pediatric patients treated with biological agents during COVID-19 pandemic. Methods Demographic information, clinical data and the adherence to the therapy were collected in all consecutive IBD patients treated with biologic agents from March 2020 to February 2021. Moreover, we reported the clinical outcome of IBD patients infected with SARS-CoV-2. Results A total of 278 subjects (171 male) treated with a biologic agent (34 children) were included. The mean age was 41.6 ± 17.3 years (range 5 – 88), and the mean disease duration was 12.7 ± 10.1 years (range 0.2 – 49). One hundred eleven patients (39.9 %) had ulcerative colitis, and 167 (60.0 %) had Crohn’s disease. About the therapy: 73 patients were receiving infliximab, 93 adalimumab, 20 golimumab, 59 vedolizumab, 29 ustekinumab, and 4 an experimental compound. 31 patient, including 1 child, (11.1 %) were treated with combination therapy. The mean Charlson Comorbidity Index was 1.5 (range 0 – 8). Twenty one patients (2 pediatrics and nineteen adults) (7.5 %) had a confirmed diagnosis of SARS-COV-2 infection. Only one of them (an adult man) was hospitalized but did not require intensive care unit measures. Compared to cumulative SARS-CoV-2 infection in the general population in our Region, the cumulative incidence of SARS-CoV-2 infection in our cohort was significantly higher (7.5% vs 4.0%, p < 0.002). Twelve adult patients (4.3%) postponed biologic therapy for fear of SARS-CoV-2 infection during the first wave of the pandemic, and two of them (16.6%) experienced a clinical relapse. Conclusion In our cohort, the adherence to biologic therapy was high during the pandemic, but the rate of clinical relapse in patients who postponed the scheduled administration of therapy was relevant. Although the incidence of SARS-CoV-2 infection was significantly higher than in general population, the clinical impact was mild as no patients experienced a severe form of COVID-19.

The original version of this article unfortunately contained mistake in Fig. 3 image.

Inflammatory bowel diseases (IBD) represent an important risk factor in the development of colorectal cancer (CRC). Strong evidences suggest CRC occurs in the inflamed epithelium, according to the sequence dysplasia-carcinoma, with an increasing risk after 8–10 years since IBD diagnosis. To date, more than 200 loci have been associated to IBD predisposition, none to IBD-related cancer development. The aim of this study is to identify mutations in oncogenes and protoncogenes and their contribute to clarify the way that leads IBD patients to CRC. We profiled a panel of 40 genes potentially involved in cancers predisposition. A germline variant identification analysis pipeline was performed on the DNA of individuals with CRC diagnosis and IBD history. We ranked all identified germline mutations by pathogenicity and summarised the allelic frequencies of pathogenic variants and of uncertain clinical significance (VUS). NOD2 status was analysed too. We identified 25 CRC patients with history of IBD (mean age at IBD diagnosis 43 years, range 25–72; mean age at CRC diagnosis 62 years, range 36–72), all enrolled in a single referral center. Multigene panel testing identified mutations in 16 IBD patients (64%): 3 encompassing MLH1 gene, 4 APC and the remaining in MUTYH, MSH2, MSH3, EPCAM, BRCA1, CHEK2, POLD1 and PDGFRA. Only in two cases (8%) the family history suggested a Lynch syndrome. IARC Class 1 or 2 were excluded. Six patients (24%) resulted carriers of at least one major NOD2 susceptibility mutations (one compound heterozygotes) and further 3 rare new variants. This study of IBD-related CRC patients demonstrates a high rate of susceptibility mutations in genes involved in polyposis and in Mismatch Repair (MMR) pathways. Although further evaluations are needed, identifying genetic mutations in oncogenes and protoncogenes might be useful to stratify patients who will need an intensive surveillance regimen or an early indication to prophylactic colectomy.

Background: Patients with liver metastases from colorectal cancer are in 80% of cases non indicated for resection. The standard first line treatment of unresectablelivermetastases is systemic chemotherapy, however this method results in progression for 70% of patients. The indicated therapy for refractory patients is the arterially directed embolic therapy (ADET). In this study we monitored tumor response, and adverse events after ADET of colorectal cancer liver metastases with polyethylene glycol microspheres loaded with irinotecan. Secondary objectives were to monitor quality of life, time to progression and survival of patients. Materials and methods: Patients were included in the study if: affected by CRC-LM, who were refractory to systemic chemotherapy, treated with ADET using polythylene glycol microspheres, and liver involvement >50%. Tumor response, performance status (PS), tumor marker antigens, and quality of life (QoL) were monitored at 1, 3 and 6 months after ADET. QoL was assessed with the palliative scale (PSS). Results: We treated 50 consecutive CRC-LM patients with ADET using polythylene glycol microspheres, their tumor response one month after ADET was 43% of complete response (CR), and 52% of partial response (PR), and 4% stable disease (SD). Tumor response 3 months after ADET was CR 15%, PR 60%, SD 10% and progression disease (PD) 15%. Tumor response 6 months after ADET was PR 64%, SD 22% and progression disease (PD) 14%. QoL was> 80% PSS at each time point. Median time to progression was 3 months (2,3 – 4 range). Median follow-up was 11 months (1,3-19,2 range). ADETs were performed with no complications. Observed side effects (mild or moderate intensity) were: pain in 22% of patients and fever in 13%, whereas 30% of patients did not complain any adverse event. Conclusions: ADET of CRC-LM with polyethylene glycol microspheres loaded with irinotecan was effective in tumor response and resulted in mild toxicity, and good QoL.

The very rare case of a non-cirrhotic patient with multiple intrahepatic portosystemic and arteriosystemic vascular shunts, presenting with hyperammoniaemic type B encephalopathy and hypoalbuminaemia due to proteinuria, is reported. The correct diagnosis, suspected by abdominal ultrasound and colour-Doppler imaging, was confirmed by hepatic and superior mesenteric angiography. A comparison with the few similar cases existing in the literature is offered.

Large and giant aneurysms account for three to seven per cent of intracranial aneurysms. They are mainly located in the carotid siphon or vertebrobasilar junction and usually give rise to mass effect, headache, haemorrhage or ischaemia. Treatment consists of surgical clipping or endovascular embolization and aims to exclude the aneurysm from the cerebral circulation to prevent haemorrhage. We describe our preliminary clinical and angiographic findings after endovascular embolization of large and giant intracranial aneurysms using Onyx and the remodelling technique. Six patients with large or giant intracranial aneurysms were treated. The maximum diameter of the aneurysmal sac varied from 15 to 33 mm, the neck measured from 5 to 10 mm and the sac-neck ratio varied from 2.14 a 4.7. Treatment (planned sessions in five patients and one in emergency) was performed in the angiography suite after detailed angiographic diagnosis including 3D formatting of the area of interest. Informed consent was obtained from the patients and their relatives. Intracranial compensation was tested angiographically and clinically before treatment. The polymer (Onyx HD 500 – 20% EVOH; 80% DMSO) was selectively injected into the lumen of the aneurysmal sac during balloon catheter occlusion of the aneurysm neck and parent vessel. Clinical and angiographic follow-up varied from three to 12 months and all patients were assessed angiographically 12 months after treatment. Complete occlusion was achieved after treatment in two aneurysms, both treated by Onyx alone. Occlusion was between 95 and 100% in two patients (one treated with Onyx alone, the other with GDCs + Onyx). Occlusion was more than 90% and less than 95% in one patient (GDCs + Onyx). Occlusion was less than 90% in the remaining patient treated with GDC + Onyx. In the four aneurysms not completely occluded, the residual part involved the neck region. Only one complication arose during treatment consisting of controlateral hemiparesis at the site of the aneurysm due to thrombus occlusion of the middle cerebral artery trifurcation, with full recovery of neurological deficit a month after treatment. Angiographic follow-up disclosed findings the same as those at the end of treatment in three patients whereas the residual aneurysm had increased by 5% in one patient. Two giant aneurysms showed a major recanalization of the aneurysmal sac. At clinical follow-up three patients reported a progressive reduction of ocular symptoms caused by compression: symptoms had slightly improved in one patient after treatment and in the remaining two with aneurysm recanalization diplopia and palpebral ptosis remained unchanged. All patients treated reported a mild progressive reduction of headache except for the patient presenting recanalization at follow-up after ten months. No major complications were found at follow-up. We plan to reserve this procedure for selected cases of large aneurysms not amenable to other treatments. Embolization should always be undertaken by physicians skilled in the remodelling technique and complete embolization of the aneurysm is crucial. The availability of new materials, easier to handle and more viscous and adhesive than Onyx, will simplify the procedure and prevent aneurysm recanalization.

Purpose. The aim of the study is to evaluate the advantages of 3D angiography as compared to 2D angiography in assessing intracranial aneurysms before and after treatment and, in particular, in selecting and planning the correct treatment.Materials and methods. Thirty intracranial aneurysms were retrospectively reviewed before and after treatment. The study population consisted of 12 men and 18 women (age range: 35-77 years; mean age: 58 years). Eighteen aneurysms were treated surgically, 10 endovascularly and 2 with combined treatment. The 2D and 3D findings before and after treatment were compared, and the pre-treatment angiographic images were compared with surgical findings. The following parameters were assessed and compared: aneurysmal sac and neck size, vascular involvement and evaluation of post-treatment residual mass.Results. On the 2D DSA images, visualisation of the sac and neck was optimal in 45% and 15% of cases, adequate in 10% and 35% of cases and inadequate in 5% and 50% of cases, respectively. On the 3D DSA images, visualisation of the sac and neck was optimal in 100% of cases. Three-dimensional DSA was able to detect 8 aneurysms with vessel involvement in all cases (100%). Of these, four (50%) went undetected on 2D DSA; in two cases, two-dimensional DSA erroneously detected the presence of vascular involvement (false positive). Three-dimensional angiography proved superior to 2D angiography in the evaluation of the residual aneurysms treated with clipping. Finally, 3D DSA was able to reduce the number of radiographic projections, the quantity of contrast medium, the time and associated risks necessary for a precise evaluation of the aneurysm.Conclusions. In our first experience, 3D DSA proved useful in reducing the risks and diagnostic time as well as in selecting and planning the treatment. Moreover, it improved the operating conditions of both surgical and endovascular treatment. Technological advances in this field will enable the optimisation of the technique in terms of anatomical detail and reconstruction time.

PURPOSE: To evaluate damage to cirrhotic liver tissue after transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC).MATERIALS AND METHODS: TACE was performed in 111 patients with HCC that involved less than 30% of the liver. Baseline liver function was evaluated with Child-Pugh scores and other indicators. Eighty-two patients had Child-Pugh class A disease, 27 had class B disease, and two had class C disease. All patients underwent chemotherapy followed by gelatin sponge particle embolization in the proper ("complete" embolization; n = 69) or right or left main ("partial" embolization; n = 42) hepatic artery. Liver function was assessed 4 months later, and 95 patients underwent a second TACE (complete embolization in 57, partial in 38). Liver function was again assessed 4 months later in 60 patients.RESULTS: No patient died. Child-Pugh scores increased in all patients from a mean 5.96 to 6.28 (not significant) and 6.51 (P = .05) after first and second TACEs, respectively. In patients with class A disease, scores increased from a mean 5.37 to 5.73 (P = .01) and 5.89 (P = .001) after first and second TACEs, respectively; in patients with class B disease, scores changed from a mean of 7.48 to 7.67 and 7.30 after first and second TACEs, respectively (not significant).CONCLUSION: TACE does not induce significant long-term worsening of liver function in patients with class A or B cirrhosis.

Key words: paraganglioma; phaeochromocytoma; vanillylmandelic acid was slightly elevated (9.5 mg/ chromaffin cell; hypertension in pregnancy; renal-24 h; normal values (n.v.) 2.00–7.00 mg/24 h). artery stenosis On admission the patient was in the seventh week of her second pregnancy and her blood pressure was 150/100 mmHg. Peripheral plasma renin activity (PRA) and aldosterone levels were elevated, in both