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Biomedical subjects

A Barile

Publications and source records attributed to A Barile.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Treatment of superior vena cava syndrome by metal stents. Preliminary experience].

This study was aimed at verifying the feasibility of stent placement in superior vena cava syndrome (SVCS). From April, 1993, to February 1995, fifteen patients (12 men, 3 women, age range: 48-72 years, average age: 58 years), were treated for malignant stenoses involving superior vena cava in 9 cases, right innominate vein in 3, left innominate vein in 2 and subclavian veins in 1. All patients had been submitted to CT angiography and digital venography to assess side, length and type of the stenosis. In 6 patients locoregional fibrinolysis (with urokinase) was performed. The stenosis was successfully dilated by balloon catheter and the stent was finally removed. Subclavian and innominate veins stenoses were treated with Wallstent, using brachial approach, while stenoses of superior vena cava required transfemoral catheterization for Gianturco-Rosch "Z" stent placement. A control venogram was performed after stenting, with the evaluation of pre/post stent pressure gradient, and later at 1, 3 and 6 months. The stents were positioned in all patients with immediate technical success; no major complications occurred. Two recurrences were successfully resolved. Radiation and/or medical therapy without vascular disobstruction showed worse results in the treatment of superior vena cava syndrome. The percutaneous placement of self-expandable stents should be not only the therapeutic alternative to surgery but the method of choice in these pathologic conditions.

Aged↗
PubMed1994

Three-phase radionuclide bone imaging and magnetic resonance imaging detection of occult knee fractures in athletes.

Twelve athletes presenting acute knee injury with normal radiological findings underwent both three-phase radionuclide bone imaging (TPBI) and magnetic resonance imaging (MRI). The association of these highly sensitive diagnostic procedures detected occult fractures in all patients. The areas of signal intensity alterations on MRI corresponded to those of increased radionuclide uptake in blood pool images. However, the same areas seemed to be more extended on delayed TPB images. TPBI yielded early diagnostic information about lesion sites and functional activities, while MRI provided better anatomical definition and specific information about associated soft tissue lesions and served to establish the correct therapeutic approach and follow-up.

Adolescent↗
PubMed1994

[Transjugular intrahepatic portosystemic shunt (TIPS)].

Transjugular intrahepatic portosystemic (TIPS) is radiological technique that has opened up new therapeutic horizons in the treatment of portal hypertension. Technically, the procedure includes catheterizing of the suprahepatic veins, prevalently right or middle, by means of transjugular access, and the creation of an intrahepatic path with the main portal branch. Later dilatation of the path by angioplasty and the application of a metallic stent at the site of the shunt complete the operation. Personal experience of 43 TIPS in 42 patients with a follow-up of 24 months is reported.

Adult↗
PubMed1994

[The percutaneous treatment of purulent intrathoracic fluid collections in HIV+ patients].

Eighteen HIV+ patients with purulent fluid intrathoracic collections (16 pleural empyemas and 2 lung abscesses) and persistent sepsis were treated with percutaneous drainage; all patients had received antibiotics for 5-7 days at least. Empyemas and lung abscesses were cured (according to clinical and radiographic criteria) in all patients (100%). One major complication was successfully treated--i.e., a pneumothorax with a iatrogenic lesion of the internal mammary artery, requiring selective embolization. In our experience, CT is the method of choice to guide lesion puncture. Van Sonnenberg Sump catheters (12-16 F) have been inserted in the last six months with the Trocar technique. The maneuvers were successful in all cases, with good compliance and management of patients in a 9-25 days' period (mean: 14 days). In our experience, the percutaneous drainage of intrathoracic fluid collections in HIV+ patients should be considered the method of choice.

AIDS-Related Opportunistic Infections↗
PubMed1993

[Malignant occlusion of the bile ducts. Treatment with metallic endoprosthesis: Wallstent vs Strecker's stent].

Stenting is the method of choice to relieve jaundice in the patients with inoperable malignant obstructions of the biliary tree. Over the last fifteen years, thousands of patients have been treated, if endoscopy failed or was unfeasible, with percutaneous transhepatic procedures: despite this wide experience, the role of conventional plastic endoprostheses is still debated, because these devices exhibit major limitations. The main objection to the use of Carey-Coons endoprostheses is the fact that a high rate of early occlusions has always been observed with plastic stents with a wide outer diameter (12-16 F). Metallic stents (self-expandable, Wallstent balloon-expandable Strecker stents) might solve these problems, especially in high-risk patients. The authors report their experience in 50 patients with midterm follow-up, a comparison of the two types of stents and their technical features.

Aged↗
PubMed1993

[Technical and methodologic considerations on a new approach to the transjugular intrahepatic portosystemic shunt].

The authors report their experience with 10 transjugular intrahepatic portosystemic shunts (TIPS) in nine patients with severe portal hypertension; indications were rebleeding after sclerosing treatment in 8 cases and unmanageable ascitis in one case. The passage of the needle from the hepatic venous system into the portal venous system during the procedure may be technically difficult with both skin markers and US guidance, and several passages through liver parenchyma may be needed: this step is certainly the most critical one, for maneuver duration--and therefore risks--depend on it. Thus, in the last 6 patients a new method was used to easily identify portal bifurcation: a thin stainless platinum-tip guide-wire (0.018-inch diameter) was inserted, by epigastric approach under US guidance, through a fine Chiba needle (22 G) in the left main portal branch, dramatically reducing the number of failed punctures and maneuver duration. Both the above goals are to be reached to make TIPS easier and therefore advantage both patients and interventional radiologists.

Equipment Design↗
PubMed1993

[Magnetic resonance in the assessment of critical points of impingement of the shoulder].

Impingement syndrome is caused by a conflictual status between rotator cuff, subacromial bursa and anatomic and functional acro-mioclavicular arch. The clinical signs of this syndrome include pain and functional disability in abduction and extrarotation of the shoulder. This study was aimed at verifying Magnetic Resonance Imaging (MRI) capabilities in showing the critical points of impingement and their incidence. Fifty-four cases of impingement syndrome were studied. The best visualization of functional acromioclavicular arch was obtained using a new study technique. All patients had critical points of impingement. In 65% of cases, acromioclavicular arthritis induced impingement on the supraspinatus tendon and in 35% of cases on the muscle. In 46% of the patients, impingement between coracoacromial ligament, partially thickened in 25% of the cases and totally thickened in 75%, and supraspinatus tendon was observed. In 7% of the whole of shoulders, the acromion had an uncinatus shape. MRI, thanks to its multiplanar imaging, allowed the complete evaluation of the articular structures with complex anatomy. The assessment of different types of impingement points can be considered a valuable approach to the therapeutic stage.

Adult↗
PubMed1993

[Intra-osseus hidden fractures of the knee in athletes: assessment with magnetic resonance imaging].

The diagnostic capabilities of Magnetic Resonance Imaging (MRI) were investigated in the study of occult intraosseous fractures of the knees in athletes; this pathologic condition is difficult to assess with conventional diagnostic techniques. Twelve athletes were considered and submitted to MR examinations 1-8 days after trauma. All patients had undergone plain films, 6 of them CT and 3 scintigraphy. Four patients were followed with MRI at 15 and 30 days. Plain films were negative in all patients. On CT, in one case only an area of segmental osteoporosis was identified at the anterolateral tibial plateau. Scintigraphy provided positive but aspecific results in all three patients. MRI demonstrated all lesions: 3 at the tibial plateau, 5 at the lateral femoral condyle and 2 at the medial femoral condyle. Double localizations were observed in two patients, femorotibial and tibiopatellar, respectively. In no case lesions of meniscal and/or capsuloligamentous structures of the knee were associated. Arthroscopy, which was employed in two patients, confirmed MR diagnosis. Thanks to its high spatial and contrast resolution and to its multiplanar capabilities, MRI can be considered the method of choice in the study of occult intraosseous fractures of athletes' knees. Beside localizing the lesion site, MRI allows the evaluation of its extent (linear or reticulo-geographic patterns) and the exclusion of possible involvement of meniscal and/or capsulo-ligamentous structures. MRI follow-up of this condition showed the "restitutio ad integrum" of the medullary trabecular bone as early as at 15 and 30 days, depending on lesion pattern and extent. On the basis of our experience, MRI emerges as the only diagnostic technique allowing the accurate evaluation of occult intraosseous fractures of the knee in athletes, because it provides early and detailed information which is valuable for the therapeutic approach, which is of fundamental importance to resume sports activity quickly.

Adolescent↗
PubMed1992

Lumbar disk herniation: MR imaging assessment of natural history in patients treated without surgery.

The aim of this study was to evaluate the evolution of lumbar disk herniation in patients treated without surgery. Sixty-nine patients with a lumbar disk herniation proved at magnetic resonance (MR) imaging underwent a follow-up MR imaging study. The disk herniations evaluated during both MR imaging examinations were measured and classified into four categories according to the change in size that occurred. The patients were also divided into three clinical classes on the basis of the clinical outcome. Sixty-three percent of the patients showed a reduction of disk herniation of more than 30% (48% had a reduction of more than 70%), while only 8% demonstrated worsening of the clinical picture. These findings suggest that lumbar disk herniation may be primarily a medical (nonsurgical) disease and that MR imaging could play an important role in management of and research into the disorder.

Adult↗
PubMed1992

Basics of the magnetic resonance phenomenon.

Magnetic Resonance is increasing its importance as a diagnostic mean. For an effective and accurate MRI practice, new fundamental principles, which are at the basis of this phenomenon, must be acquired. In this chapter an extremely simplified overview of the physical basics of MRI is introduced, to help the readers understand the principles underlying this complex technique. Basic physics, T1 and T2 relaxation times, spin echo sequences, which can be acquired with the now available units, and tissue characteristics are illustrated. For those who are interested in a further and more detailed reading in this field, a bibliography is also quoted.

Electromagnetic Fields↗
PubMed1992

[Magnetic resonance in the staging of multiple myeloma].

The authors retrospectively reviewed the MR examinations of 46 patients with clinical and laboratory findings of monoclonal gammopathies (MG). All cases had been submitted to radiographic examination which had shown skeletal involvement in 22 cases and osteoporosis in 11, with rupture of the vertebral body in 3 patients. Scintigraphy had been performed on all patients and CT on 12; 36 patients were subsequently submitted to follow-up (at 6, 12 and 24 months). MR examinations were performed with dedicated coils and standard sequences for the subjects with skeletal localizations on X-ray images. The extant cases, with no radiographic evidence of skeletal involvement, were submitted to MRI of the spine, skull and pelvis. In agreement with clinical and laboratory findings and with follow-up results (in 36 patients), MRI diagnosed MG with no skeletal involvement in 13 cases, osteoporosis in 8 (with rupture of the vertebral body in 2), asymptomatic non-progressive myeloma in 4, solitary myeloma in 3, and multiple myeloma in 18 cases. The good identification of bone marrow and its multiplanarity make MRI the method of choice in the study of patients with suspected or known gammopathies. If compared with other modalities, MRI is more sensitive and accurate in depicting the tumor, its size and relationship to periskeletal tissues, and its possible multifocality. Moreover, the technique has proven to be a valid tool during the follow-up, showing tumor response to therapy.

Bone Diseases↗
PubMed1991

[Acute instability of the shoulder in athletes. The role of magnetic resonance in therapy planning].

Magnetic resonance imaging (MRI) of the shoulder was performed to evaluate both the actual role of this technique in the study and staging of acute shoulder instability, and its potentials as diagnostic tool, with particular reference to treatment planning. Seventeen athletes with acute shoulder instability were examined. All MRI examinations, subsequent to plain radiographs, were performed within 48 hours from the traumatic event. After MRI examination, 14 patients underwent physiotherapy (2 cases were subsequently submitted to arthrotomy), and only 3 cases underwent surgical treatment in the acute phase (2 arthrotomies and 1 arthroscopy). These cases, submitted to MRI in the acute phase and subsequently to surgery, showed anterior glenoid labrum involvement with good evidence of associated skeletal lesions (Hill-Sachs lesions in 1); changes in the inferior glenohumeral ligament complex (2 cases) were also observed. In the other examined cases, MRI always provided accurate information on the glenoid labra and the anterior capsular mechanism. When the superior glenohumeral ligament was investigated (9 cases of 17), no alterations were observed. Acting as natural contrast, the presence of joint effusion allows good visualization, on T1-weighted sequences, of the structures involved by the traumatic events. Contrast resolution improvement could be obtained by employing gradient-echo T2 weighted sequences, which proved to be quite valuable for a correct depiction of the lesions involving the inferior glenohumeral ligament complex. In conclusion, MRI can be considered as a valuable diagnostic method for the early evaluation of the acute shoulder instability, since it provides information of the utmost importance for the subsequent therapeutical approach.

Adolescent↗
PubMed1989

[Magnetic resonance of the shoulder: technic, anatomy ana clinical results].

MR imaging was employed in 232 patients with traumatic or degenerative lesions of the shoulder. MR diagnosis was compared with arthrotomic findings in 19 cases, and with arthroscopic results in 3 cases. MR technique is here presented and the choice of scanning planes is discussed, together with the sequences of image acquisition and with the features of the surface coil employed. Axial, sagittal, and coronal scans were used in all cases. Both sagittal and coronal planes were performed obliquely on the basis of precise anatomical structures. T1-weighted sequences were used for they are reliable in locating the various anatomical structures and efficient in defining the several different pathologic conditions. The role of T2-weighted sequences was complementary, and they were employed in selected cases only. A surface coil is presented with a particular configuration of easy clinical use and with such technical features as to allow reduced fields to be imaged, with good spatial resolution. MR imaging could demonstrate with equal accuracy both skeletal-cartilage components and capsulo-ligamentous structures, thus defining associated lesions and small tears. In both degenerative and traumatic lesions of the rotator cuff, MR imaging showed both extent and entity of the pathologic process, with high accuracy in defining the impingement syndrome. MR imaging allowed the depiction of the anterior and posterior glenoid labra, even without intraarticular contrast media. Moreover, MR imaging made it possible to recognize both fractures and degenerative processes within the glenoid labrum on the basis of their signal intensities. This preliminary experience allows the authors to conclude that MR imaging is an accurate and non-invasive diagnostic method for the study of traumatic lesions and of degenerative changes of the shoulder.

Adult↗