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Biomedical subjects

A Bartolozzi

Publications and source records attributed to A Bartolozzi.

13 recordsLinked to original sources
PubMed1997

Endoscopic preperitoneal herniorrhaphy in professional athletes with groin pain.

INTRODUCTION: Surgical exploration of the groin with subsequent herniorrhaphy has been recommended for obscure groin pain in athletes. The purpose of this study was to evaluate the efficacy of endoscopic preperitoneal herniorrhaphy and, if indicated, contralateral groin exploration in professional athletes with groin pain. PATIENTS AND METHODS: Eight professional athletes presented with groin pain and underwent endoscopic preperitoneal herniorrhaphy between February 1994 and May 1996. All athletes were male with a median age of 25.1 years (range: 22-30). Seven of the athletes complained of unilateral groin pain while one patient had bilateral pain. Seven had undergone previous conservative treatment without success. Despite multiple examinations, only two patients had been diagnosed with hernias prior to referral to the surgeon. Of the remaining six patients, all were found to have small inguinal hernias in the symptomatic groin. Seven of the patients were noted to have bilateral pathology. RESULTS: Operative time averaged 55.3 min. All patients were ambulatory without significant difficulty within the first 24 h, discontinued oral narcotic use within 72 h of surgery, and were back to recreational activities within 1 week. Aerobic conditioning was resumed within a maximum of 2 weeks. Full conditioning and/or return to full competition occurred within a 2- to 3-week period. At the time of 4 week follow-up, all athletes reported no more than minimal postexertional discomfort, with near total relief of early postoperative symptoms. No athletes noted any impairment in their ability to perform at peak levels. CONCLUSIONS: Groin pain in athletes is a difficult problem requiring a multidisciplinary approach to diagnosis and treatment planning. Endoscopic preperitoneal herniorrhaphy is an effective treatment for obscure groin pain when the pain is associated with an inguinal hernia and allows for a short recovery time back to full athletic activity.

Adult↗
PubMed1996

How much does inferior capsular shift reduce shoulder volume?

The purpose of this study was to quantitate the effect of inferior capsular shift on shoulder volume. Four fresh frozen cadaveric shoulders were analyzed. Volume before and after shift was determined using 3 techniques: (1) Magnetic resonance imaging sequences were digitized to computer and analyzed for volume via a 35-mm camera using Cue 2 software. The capsule was delineated by contrast between light and dark regions. Volume was calculated by summing the total area of respective slices. (2) Ultrasound images, obtained after surgical exposure of the capsule, were digitized. Volume was calculated using the formula for a prolate ellipsoid. (3) An 18-gauge needle was used to inject and evacuate saline via an anterior approach. Quantity of aspirated fluid provided a direct measure of volume. Inferior capsular shift was performed. After the operation, measurements were repeated. Inferior capsular shift reduced volume in all shoulders with each technique. On average, inferior capsular shift reduced joint volume by 57 %). A measurable reduction in shoulder joint volume is an effect of capsular shift. This measurement may have clinical application if volume is an indicator of instability or laxity.

Cadaver↗
PubMed1995

[The role of CT and MR in assessing the patient operated on for rectal carcinoma: the local recurrence of the disease].

Computed tomography (CT) and magnetic resonance (MR) findings in a series of 27 patients treated surgically for rectal cancer (13 rectal amputations, 8 sphincter-saving resections and 6 with the Hartmann technique) and affected with local recurrence at the time of examination (1989-1993), were retrospectively reviewed. Every detected lesion was studied relative to morphologic features (shape, outline, surrounding tissue involvement, symmetric growth toward the mid-longitudinal plane), patterns of both CT contrast enhancement and MR signal intensity with different acquisition techniques. The most typical patterns of disease recurrence were: a roundish or nodular shape (the whole group of rectal amputations), irregular outline (25 of 27 cases), infiltrative growth (23 of 27), asymmetry (25 of 27), CT enhancement > 20 HU (24 of 27), medium-high MR signal intensity on T2-weighted images (26 of 27 cases). We report on 5 cases with no positive correlation between CT enhancement and MR signal on T2-weighted images, trying to correlate this disagreement with specific histopathologic patterns.

Adenocarcinoma↗
PubMed1995

[Role of CT and RM in postoperative evaluation of the patient after rectal carcinoma surgery: postoperative anatomy and nonneoplastic sequelae].

The CT and MRI findings in a series of 57 patients submitted to curative surgery for rectal cancer, 1989 to 1993, and locally free of disease at the time of examination, were retrospectively reviewed. Both postoperative anatomy and tissue repair features were studied relative to the different surgical approaches, i.e., rectum amputation, sphincter-saving resection, Hartmann technique. The retrospective analysis of CT and MR findings led to the identification of some signs rather typical of every predictable non-malignant postoperative event, with max accuracy when radiologic findings were correlated with clinical and laboratory findings, as well as with the results of baseline study performed about 3-6 months after surgery. Florid granulation tissue exhibited marked enhancement after i.v. contrast agent administration and high signal intensity on T2-weighted MR scans: such questionable findings as a pseudonodular pattern were often clarified on multiplanar MR images by the identification of normal anatomic structures within repairing scar tissue. The major features exhibited by fibrosis were low signal intensity on T2-weighted MR scans, laminar or spindle-like shape and some retraction of the surrounding tissues. Poor enhancement after i.v. contrast agent administration proved to be a less reliable diagnostic criterion. Abscesses were identified because of their water-like content and ring of peripheral enhancement, both easily demonstrated on CT scans. The differential diagnosis of necrotic colliquative recurrence required clinical correlation with a careful morphologic analysis of lesion outline. Non-colliquative inflammation exhibited no typical CT/MR features suggestive of diagnosis. Finally, radiation fibrosis was characterized by laminar pattern but its enhancement patterns and MR signal behavior were quite different from postoperative scar tissue: irregular enhancement spots and fairly high signal areas were often observed in these patients even months and years after radiation exposure.

Adenocarcinoma↗
PubMed1994

Determinants of outcome in the treatment of rotator cuff disease.

One hundred thirty-six patients with impingement syndrome and rotator cuff disease who were treated nonoperatively from 1987 to 1991 were reviewed to identify findings at initial presentation that correlated with final outcome. Mean followup was 20 months (range, 6-41 months). All patients received initial conservative treatment. The results were analyzed in 2 groups. Group I consisted of the entire 136 patients with a minimum 6-month followup. Group II consisted of a subgroup of 68 patients with at least an 18-month followup. The overall results in Group I were 66% excellent and good and 34% fair and poor. For Group II, the overall results were 76% excellent and good and 24% fair and poor. For the Group II patients, a distribution of clinical findings at the 6-month followup demonstrated only 46% excellent and good results, indicating that the clinical result improves significantly as followup duration increased. Patient characteristics and prognostic factors that were associated with an unfavorable clinical outcome included a rotator cuff tear > 1 cm2, a history of pretreatment clinical symptoms for > 1-year duration, and significant functional impairment at initial presentation. Factors not associated with clinical outcome included patient age, occupation, gender, associated instability, dominance, chronicity of onset, active range of motion, or specific treatment modalities. Early operative intervention is recommended for patients with poor prognostic factors to avoid a protracted clinical course.

Adult↗
PubMed1994

[The role of magnetic resonance in characterizing focal liver lesions].

128 Magnetic resonance (MR) investigations of single or multifocal nodular liver lesions were retrospectively reviewed. All lesions had been identified, but not characterized, with ultrasonography (US). All the studies were performed with a 0.5-T superconductive magnet (Philips Gyroscan); spin-echo (SE) T1/proton density/T2-weighted and inversion recovery (IR) pulse sequences were used routinely. Characterization was attempted considering the following variables: a) lesion outline; b) the presence of some kind of capsular or pseudocapsular ring; c-d) homogeneity of signal intensity and its difference from surrounding liver parenchyma; e) possible central scar and its signal features; f) associated lesions (multifocal nodules, ascites, locoregional adenopathies, venous thrombosis). Diagnostic confirmation was obtained by means of biopsy (63 patients), of other imaging techniques (35 patients), or of clinical follow-up over 12 months at least (30 patients). Our results confirm high MR accuracy in the diagnosis of hemangioma (48/50 cases, 96% confidence) and even higher accuracy in focal fatty liver infiltration (9/9 cases, 100% confidence), thanks to some typical MR signal patterns on appropriate acquisition techniques--i.e., SE multiecho pulse sequences and IR sequences, respectively, with liver and fat signal nulling. Primary non-malignant focal liver lesions were identified mainly on a morphological basis (smooth roundish outline with/without capsular or pseudocapsular ring; central starlet scar; "basket" or "spoked wheel" patterns): these features allowed the correct identification of 5/7 focal nodular hyperplasia cases. On the other hand, in the absence of these typical morphological features and of specific MR signal changes, adenomas were misdiagnosed in all cases but one. The study of focal lesions in cirrhotic liver disease exhibited 66.6% confidence in the diagnosis of regenerating nodules, on the basis of their iso/hypointensity relative to liver on T2-weighted pulse sequences. Such a behavior seems to be due to intracellular iron loading, to small cell size and to thin vascular network, which are typical of cirrhotic regenerating areas. The diagnosis of hepatocellular carcinoma relies on both morphostructural features and possible associated lesions: in our series, 22/25 cases (88% confidence) were correctly identified. Indeed, this result was somehow influenced by the case history of the patients and by specific serologic indexes. Finally, MRI exhibited high sensitivity in the detection of focal liver involvement in neoplastic patients. However, the intrinsic range of variability and the lack of specificity of MR signal intensity, because of different histopathologic cell types, do not usually allow an unquestionable diagnosis to be made, especially for single lesions.

Biopsy↗
PubMed1993

[Computer-assisted interactive didactic system in radiology].

A computer-assisted didactic interactive system for radiology is described; it was implemented on a widely available, cost-effective personal computer with advanced graphic features. A set of suitable CT images was selected and digitized with a specific software that also allowed to process the acquired images. After adding graphic and textual comments, the images were ready to be put in the tutorial. A second software tool was used to manage the image display and to control the correct sequence of the interactive steps of the tutorial. A series of computer-driven multiple-choice questions was prepared to provide the user with a tool improving his/her knowledge of the topics covered by the system, in a simple and unconventional way. The tutorial was designed so that both the absolute number and the percentage of correct answers can be displayed and the critical evaluation of incorrect answers is automatically performed; in the end, the system goes back to the first screen and the tutorial can be run again. The system performance is good with standard hardware; it can be markedly improved with the integration of peripherals--i.e. hard disk. In the next future, the commercial availability of more advanced storage media (videodisks and optical disks) will dramatically improve the archiving capacity and will reduce access times.

Computer-Assisted Instruction↗
PubMed1989

[Magnetic resonance in the study of spondylodiscitis].

Spondylodiscitis is an uncommon pathologic condition whose diagnosis can be difficult due to its aspecific clinical and radiological signs, especially in its early phase. Seventeen patients were examined in order to evaluate MR diagnostic capabilities. They had cervical (2 cases), thoracic (3 cases) and lumbosacral (12 cases) spondylodiscitis. All patients previously underwent conventional X-ray examination and CT; bone scintigraphy was performed in 9 cases. The final diagnosis was reached by needle aspiration (10 cases), by blood culture (2 cases), or according to clinical evolution (5 cases). MR was highly sensitive in identifying the disease, also in its early stages. Moreover, MR allowed the definition of phlogistic process extent and its relationship with intersomatic disk: signal alterations were limited to the vertebral bodies and to the disk in 3 cases; endocanalar spread of phlogistic process was observed in 8 cases; extravertebral soft tissues were involved in 1 patient; involvement of both canal and paravertebral soft tissue was found in 5 patients. Signal alterations in vertebral bodies and disks, together with the good topographic evaluation obtained with MR imaging, allowed a reliable diagnosis of spondyloscitis to be reached.

Adult↗
PubMed1988

A systematic approach to reconstruction of neglected tears of the patellar tendon. A case report.

Neglected tears of the patellar tendon due to loss of active extension remain a difficult therapeutic endeavor. The goals in the approach to this diagnosis include restoration of both structural and functional integrity of the extensor mechanism. A procedure has been developed utilizing Z-shortening of the patellar tendon, Z-lengthening of the quadriceps tendon, and the semitendinosis gracilis as a biologic splint. This technique allows establishment of preoperative goals, including restoration of the muscle-tendon complex in its anatomic position, restoration of quadriceps function, preservation of vascularity of the reconstructed tendon, and splinting of the patellar tendon. This reconstruction allows early mobilization and rehabilitation.

Adult↗
PubMed1985

Chromium concentrations in serum, blood clot and urine from patients following total hip arthroplasty.

Chromium released from implant alloys may be incorporated into organometallic complexes as Cr3+ [Cr(III)] or CR6+[Cr(VI)]. Since Cr(VI) is far more biologically active than Cr(III), there is considerable interest in identifying the valence state that predominates in corrosion products, either in vitro or in vivo. It is known that erythrocytes display a unidirectional uptake of Cr(VI) while effectively excluding Cr(III). Thus it was felt that a study of the chromium content of blood clot, in comparison to chromium concentrations in serum and urine, could shed light on the valency question. Fourteen patients who received conventional polymethylmethacrylate cemented cobalt-chromium alloy/ultra high molecular weight polyethylene total hip replacements as well as seven control patients who underwent orthopaedic procedures without implantation were studied. Blood and urine specimens were obtained preoperatively, post-operatively and, for total hip patients, at routine early follow up. Chromium content was determined by electrothermal atomic absorption spectroscopy. A significant post-operative rise in serum chromium content was observed for total hip replacement patients, as previously reported, but not for control patients. Unexpected day-to-day variations in clot chromium content, without significant increases, were also observed. Longer time studies are required to determine chromium valence states in corrosion products in this model.

Adult↗
PubMedDate not supplied

MR evaluation of the anterior cruciate ligament: value of axial images.

OBJECTIVE: To investigate the accuracy of diagnosing anterior cruciate ligament (ACL) tears with axial MR imaging. MATERIALS AND METHODS: Two blinded independent observers retrospectively reviewed axial T2 weighted or FSE fat suppressed imaging of the knee from 47 patients. Arthroscopy had demonstrated a complete tear of the ACL in 25 patients and a normal ACL in 22 patients. The two criteria used to diagnose ACL tears on sequential axial imaging were (a) lack of visualization of the ACL in its expected course or (b) focal increased signal in the expected course of the ACL. RESULTS: Observer 1 demonstrated a sensitivity of 92% (23 of 25) and a specificity of 100% (22 of 22) in diagnosing ACL tears (chi 2 = 39.6, p < 0.001). Observer 2 demonstrated a sensitivity of 92% (23 of 25) and a specificity of 82% (18 of 22) in diagnosing ACL tears (chi 2 = 26.1, p < 0.001). The Kappa value was 0.75 (agreement in 41 of 47 cases), indicating a high degree of intraobserver agreement. CONCLUSION: Axial T2 weighted or FSE fat suppressed imaging provides an accurate means of confirming the diagnosis of ACL tears.

Adult↗
PubMedDate not supplied

[Magnetic resonance-diskography correlation for the therapeutic approach of lumbar herniated disk].

In order to evaluate MR reliability in the therapeutic approach to lumbar disk herniation, 51 patients were examined. MR images revealed disk herniation with integrity of posterior longitudinal ligament in 25 subjects. These patients were then examined with diskography, that confirmed MR diagnosis in 23/25 cases. Percutaneous diskectomy according to Onik was successfully performed in 23/25 patients. MR imaging appears as a non-invasive method which allows exhaustive analysis of all components of lumbar spine, yielding reliable information for choosing the appropriate treatment.

Adult↗