Background:Tumefactive multiple sclerosis (MS) is an unusual variant of demyelinating disease characterized by lesions with pseudotumoral appearance on radiological imaging mimicking other space-occupying lesions, such as neoplasms, infections, and infarction. Especially when the patient's medical history is incompatible with MS, the differential diagnosis between these lesions constitutes a diagnostic challenge often requiring histological investigation. An older age at onset makes distinguishing tumefactive demyelinating lesion (TDL) from tumors even more challenging.Methods:We report a case of brain TDL as the initial manifestation of late-onset MS associated with cervico-dorsal syringomyelia. A 66-year-old Caucasian woman with a 15-day history headache was referred to our hospital because of the acute onset of paraphasia. She suffered from noncommunicating syringomyelia associated to basilar impression and she reported a 10-year history of burning dysesthesia of the left side of the chest extended to the internipple line level.Results:Computed tomography (CT) and magnetic resonance imaging (MRI) examinations revealed a left frontal lesion with features suspicious for a tumor. Given the degree of overlap with other pathologic processes, CT and MRI findings failed to provide an unambiguous diagnosis; furthermore, because of the negative cerebrospinal fluid analysis for oligoclonal bands, the absence of other lesions, and the heightened suspicion of neoplasia, the clinicians opted to perform a stereotactic biopsy. Brain specimen analysis did not exclude the possibility of perilesional reactive gliosis and the patient, receiving anitiedemigen therapy, was monthly followed up. In the meanwhile, the second histological opinion of the brain specimen described the absence of pleomorphic glial cells indicating a tumor. These findings were interpreted as destructive inflammatory demyelinating disease and according to the evolution of MRI lesion burden, MS was diagnosed.Conclusion:TDL still remains a problematic entity clinically, radiologically, and sometimes even pathologically. A staged follow-up is necessary, and in our case, it revealed to be the most important attitude to define the nature of the lesion, confirming the classic MS diagnostic criteria of disseminate lesions in time and space. We discuss our findings according to the recent literature.

Implantation of drug eluting stents following percutaneous transluminal angioplasty has revealed a well established technique for treating occlusions caused by the atherosclerotic plaque. However, due to the risk of vascular re-occlusion, other alternative therapeutic strategies of drug delivery are currently being investigated. Polymeric endoluminal pave stenting is an emerging technology for preventing blood erosion and for optimizing drug release. The classical and novel methodologies are compared through a mathematical model able to predict the evolution of the drug concentration in a cross-section of the wall. Though limited to an idealized configuration, the present model is shown to catch most of the relevant aspects of the drug dynamics in a delivery system. Results of numerical simulations shows that a bi-layer gel paved stenting guarantees a uniform drug elution and a prolonged perfusion of the tissues, and remains a promising and effective technique in drug delivery.

Coiling of ruptured, isolated dissecting aneurysms of the PICA without parent vessel occlusion is feasible, relatively safe and effective in preventing early/medium-term rebleeding. A strict angiographic follow-up program is, however, necessary to detect recurrence.

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Al centro del IV libro delle Epistulae ex Ponto abbiamo una elegia di cui è difficile sopravvalutare l'importanza: Ovidio rivolge la propria offerta di dedizione a Germanico, portando a compimento il complesso percorso verso la poesia celebrativa che ha compiuto nei lunghi anni dell'esilio. La parte centrale dell'epistola è di grande densità, in quanto riprende e ripropone, tra gli altri, testi di evidente rilievo, quali Prop. 2, 10 1 e le Odi 4, 8 e 9di Orazio, e intesse nel contempo un dialogo fitto con il proemio dei Fasti. I temi affrontati, primo fra tutti il ruolo e la natura della poesia, e il fatto che questa sia l'ultima opera ovidiana, fanno sì che ci si trovi davanti ad un concentrato, quanto mai denso, di tutta la riflessione sull'attività di poeta che permea l'intera produzione dell'esilio.