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(Series Information) European Papers - A Journal on Law and Integration, 2016 1(1), 245-261 | European Forum Insight of 16 April 2016 | (Table of Contents) I. Introduzione. - II. La giurisprudenza della Corte in materia d'autonomia procedurale e le spese di giudizio come ostacolo ad una tutela giurisdizionale effettiva. - III. La questione pregiudiziale. - IV. Le conclusioni dell'Avvocato generale. - V. La pronuncia della Corte di giustizia nel caso Orizzonte Salute. - VI. Osservazioni conclusive. | (Abstract) This Insight focuses on the recent judgment of the Court of Justice in Orizzonte Salute (case C-61/14). The Court was asked to clarify whether EU Law - more particularly Art. 1 of Directive 89/665/EEC of the Council on the coordination of the laws, regulations and administrative provisions relating to the application of review procedures to the award of public supply, and public works contract, the principles of effectiveness and equivalence and Art. 47 of the Charter - precludes a national legislation which requires the payment of high amounts as the standard court fee to access judicial review proceedings relating to the award of public supply and public works contracts subject to Directive 2004/18/EC of the European Parliament and of the Council on the coordination of procedures for the award of public works contracts, public supply contracts and public service contracts. In the same case, the Court was also requested to clarify whether European Union (EU) Law precludes a national legislation which charges multiple court fees to an individual who brings several court actions concerning the same award or who raises supplementary pleas concerning the same award within ongoing judicial proceedings. The Insight starts with a brief summary of the case law of the EU Court of Justice and the European Court of Human Rights regarding, respectively, the principle of procedural autonomy of the Member States and the fundamental right to access to justice, the latter examined in its relationship with the imposition of court fees. Then, it proceeds to review the arguments of the referring Court, the opinion of the Advocate General and the judgment of the EU Court of Justice. The last part of this Insight criticises the choice of the Court to favour - in the interpretation of Directive 89/665 - the procedural autonomy of EU member States over the pursuit of a better level of coordination between national procedural rules, even in a field so deeply harmonised like the one of public procurements.

A residual mediastinal mass is a common finding during and/or after treatment for bulky mediastinal lymphoma and represents a difficult diagnostic problem. For correct therapy modulation, fibrosis must be distinguished from active disease. To assess diagnostic imaging potentials in the characterization of residual masses, 41 patients with bulky mediastinal lymphoma were examined with CT, MRI and Ga67-SPET; 92 examinations were performed for each technique: 14 before treatment, 42 during and after chemotherapy, 13 after radiotherapy and 23 six months after the end of treatment. CT provides useful pieces of information on tumor size but fails to depict tissue changes: therefore, only MR and SPET results were considered and compared with clinico-biological and follow-up findings. MRI and SPET were often in agreement with each other (78/92 cases) and with clinical data (98.7%); each examination yielded only one false positive. In case of disagreement (14/92 patients), MRI yielded more false-positive findings because it failed to differentiate neoplastic tissue from treatment-related conditions, i.e., granulation tissue, inflammation, necrosis, early fibrosis. In contrast, negative MR results were more reliable, MR negative predictive value being 100%. Ga67-SPET exhibited high sensitivity (97.1%) and specificity (91.2%), with fewer false positives than MRI (5 vs. 10). In conclusion, both examinations were accurate in the characterization of residual mediastinal masses during and after therapy, but MRI had higher sensitivity and Ga67-SPET higher specificity. Therefore, the authors acknowledge the complementary role of these two techniques and the necessity of an integrated approach, i.e., combined MRI and Ga67-SPET or CT and Ga67-SPET.

Congenital cystic adenomatoid malformation of the lung is a rare condition requiring an early diagnosis and the accurate assessment of its site and extent since it can be surgically treated with excellent prognosis. This study enrolled 12 patients with suspected congenital cystic adenomatoid malformation examined with high-resolution CT (HRCT) under general anesthesia and after pulmonary hyperinsufflation, to investigate HRCT capabilities in the pathological and topographic characterization of the lesion. In 11 patients HRCT showed features suggestive of cystic adenomatoid malformation and histology confirmed the diagnosis (type I in 9 cases and type II in 2 cases). In contrast, in 1 case of extralobar pulmonary sequestration, only pathology could exclude an associated cystic adenomatoid malformation type III. In all patients HRCT assessed lesion site and extent accurately: the lesions involved only one lobe in 7 patients, whereas in the other 5 more lobes were involved, unilaterally (3/5) or bilaterally (2/5). Associated lesions were found in 6 patients (2 intralobar pulmonary sequestrations, 1 rhabdomyosarcoma, 3 pulmonary inflammations). HRCT allowed the finest anatomic structures to be identified and made it possible to acquire images without movement or reflected dysventilation, which meant better disease assessment and more correct treatment planning. In conclusion, the authors suggest HRCT in the study of cystic adenomatoid malformations and for all lung conditions in the pediatric age.

Magnetic resonance imaging (MRI) was employed to study 7 long-term hemodialysis patients affected with destructive amyloid spondyloarthropathy. In the appropriate clinical setting, MRI proved to be more useful than conventional radiography or CT and more definitive in excluding infections. Indeed, MRI can replace more invasive procedures in making the correct diagnosis. Different than what is reported in literature, a high incidence of odontoid lesions (C2) was observed in our series, with extraosseous and extradural deposits of soft tissue masses (amyloid pseudotumors), subluxation, odontoid invagination and medullary compression. Bone lesions, involved disks and amyloid pseudotumors typically exhibited low-intensity signal on both T1- and T2-weighted sequences and no enhancement following Gd-DTPA injection. The use of MRI is thus suggested, especially at cervical level, also in case of relatively mild symptoms.

Over the last 4 years, we observed 122 patients with AIDS and 20 with AIDS-related lymphomas (ARL) in the chest. Eighteen of the latter were non-Hodgkin's forms, mostly high-grade and high-stage B-cell (Burkitt or Burkitt-like) types (16 cases.) This prevalence reflects the overall increase in neoplasms secondary to immunodepression, which is parallel to improved prevention and control of opportunistic infections. Of 20 ARLs, 5 (25%) presented thoracic lesions; in 4 of them the onset of the disease was localized in the chest. The incidence of such manifestations is higher than that reported in the literature. Moreover, radiological features are quite atypical relative to the "classical" signs of lymphoma in the general population, with predominant (60%) nodules or quickly-growing peripheral masses which may subsequently invade chest walls. Isolated nodal enlargement is also a possible finding, as well as pleural effusion. This pattern, though not pathognomonic, is highly suggestive--in HIV-positive patients--of ARL. In all the patients with pulmonary lymphoma CT demonstrated bilateral lesions--more than conventional X-rays--with morphologic and densitometric features which helped make the correct diagnosis. Moreover, CT was helpful in choosing the appropriate site for biopsy.

Lymphangioleiomyomatosis (LAM) is an uncommon disease affecting women of reproductive capacity. It is characterized by non-neoplastic proliferation of smooth muscle in the lungs and, occasionally, in lymph nodes and in the thoracic duct. The patients present with dyspnea, chylous pleural effusion, pnx, and hemoptysis. The authors evaluated 4 patients with biopsy-proven LAM, by means of CT. In all cases, CT revealed small well-defined cystic air spaces with smooth and thin walls, scattered in the lungs. CT was very useful because it was more sensitive and specific than conventional radiography. The CT appearance of LAM distinctly differed from that of other diseases than can produce cystic air spaces in the lungs, such as UIP, eosinophilic granuloma, centri-acinar emphysema, and bronchiectasis. Our experience confirms the clinical usefulness of CT in diagnosing LAM.

The authors refer to the application of sonography in the evaluation of mediastinal masses. In this pathology, sonography is useful if neither air nor bone tissue are present between the transducer and the mass. Sector scans are obtained through the transgiugular line, the intercostal spaces, the hepatic and splenic windows, the sternal notch. The diagnostic value is due to the possibility to define the solid or liquid content of the investigated masses.

After a general review of the US findings in acute renal allograft rejection, the results are discussed of a retrospective sonographic-histologic study in 17 patients affected by acute rejection. The high sensitivity of sonography in detecting acute rejection is confirmed, but echographic studies were unable to differentiate between vascular and cellular sub-types of rejection and to provide a prognostic evaluation.