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Biomedical subjects

A Cecchini

Publications and source records attributed to A Cecchini.

At least 19 recordsLinked to original sources

[High resolution tridimensional study of the blood vessels of the neck and the intracranial circulation with magnetic resonance angiography].

Magnetic Resonance Angiography (MRA) is a modern vascular imaging technique which allows the noninvasive and direct imaging of vessels. The authors aimed at evaluating the diagnostic accuracy of MRA in the study of pathologic conditions in the neck and intracranial vessels; spatial resolution of the technique was also investigated. Twenty-four healthy volunteers and 82 patients suffering from various diseases of the head and neck vessels were included in the study. First of all, MRA capabilities were investigated in visualizing normal vessels of both neck and intracranial circle. The diagnostic accuracy of the method was then evaluated in the study of vascular diseases, and the results compared with conventional/digital angiographic findings. The comparison demonstrated how stenoses and atherosclerotic plaques tend to be overestimated by MRA because of technical artifacts inherent to the technique itself, whereas vascular ulcerations and aneurysms are frequently underestimated. However, this data was steady and therefore evaluable--the exact knowledge of the artifacts making diagnosis reliable. The diagnostic and technical problems relative to the various vascular diseases are discussed. Finally, several hypotheses of diagnostic iter are suggested.

Angiography, Digital Subtraction

Hypothalamic-pituitary dwarfism: comparison between MR imaging and CT findings.

Magnetic Resonance (MR) imaging was carried out on 33 patients with idiopathic growth hormone deficiency, in 22 of whom CT scan had been carried-out previously. Twenty-one patients presented some complications at birth. Both MR and CT were positive in the evaluation of the sella. MR imaging exhibited a higher degree of accuracy than CT in the evaluation of pituitary gland, pituitary stalk and brain anomalies. On the basis of pituitary morphology demonstrated by MR imaging, and perinatal histories, a classification is proposed which divides our patients into three group: A) a first group of 13 patients presenting severe hypoplasia of the anterior pituitary lobe, hypoplasia of the stalk and ectopia of posterior lobe. The underlying cause of these anatomic defects might be developmental in origin, and date from early intrauterine life, probably worsened at birth. B) a second group of 10 patients presenting severe hypoplasia of the anterior pituitary lobe. A perinatal event and birth trauma might be responsible for pituitary damage. C) a third group of 10 patients with no morphological abnormalities of the pituitary gland. A derangement of the neuroendocrine mechanism which control the growth hormone secretion might account for these patients.

Adolescent

Infantile autism and computerized tomography brain-scan findings: specific versus nonspecific abnormalities.

The hypothesis that specific computerized tomography brain-scan findings are associated with infantile autism was tested in 45 cases and 19 controls. The autistic group was subdivided into serious and less-serious language-impaired subgroups. The analysis of Euclidean Distances, a type of cluster analysis, showed that neuroradiological parameters of cases and controls, including ventricular sizes, were on the whole significantly different, but no statistically significant difference appeared between the two autistic subgroups. But the analysis of variance of each neuroradiological parameter did not show any significant difference between autistics and controls. It was concluded that autism is nonspecifically associated with brain-scan abnormalities, and that other nonorganic, as well as organic, factors should be taken into account.

Adolescent

[Neuro-AIDS: a multicenter neuroradiological study].

The results are described of a retrospective multicentric CT/MR study of 141 neuro-AIDS patients (IV group CDC classification); 114 patients were drug addicted, 13 homosexual, 8 polytransfused, and 6 had other risk factors. The mean age was 29.6 years. The pathologic agent was identified in 47 cases by c.s. fluid examination, biopsy, autopsy or specific treatment response: it was HIV in 20 cases, toxoplasmosis in 11, cryptococcosis in 9, leishmaniasis, salmonella and papovavirus in single cases. In the follow up of 2 cases, a Kaposi's sarcoma and a primitive CNS lymphoma occurred. The main clinical features were AIDS-dementia complex (45% of cases) and focal neurologic manifestations (36%). The neuroradiological protocol consisted of 238 CT exams (97 controls), most of them with DDD (delayed double dose) technique, 7 MR exams (0.15 T) and 2 angiographies. CT findings were divided into 3 groups: negative (16%), atrophic (47%) and focal lesions (37%). In the first and second group, HIV and cryptococcal infections were the main pathologic agents. In the third group toxoplasma infections were discovered, and TB granulomas and other pathologic conditions, with ring-like or nodular enhancement, in cortical/cortico-medullary location. In follow-up patients a high tendency of evolution towards focal lesions was observed, even in negative cases. The DDD enhancement technique allowed in most cases both the demonstration of very small lesions and their grading. According to the literature CT, though a highly sensitive method, is inferior to MR imaging; however our experience in this field is currently insufficient. The specific diagnosis of pathologic agents of neuro-AIDS is difficult, due to the high number of opportunistic AIDS-related infections and neoplasms, with overlapping features: differential diagnostic criteria can be assessed only by comparing the clinical, microbiological, topographic, CT and MR findings. CT and MR exams are necessary to guide and monitor therapy and to plan stereotaxis biopsy.

Acquired Immunodeficiency Syndrome

[Computerized tomography in surgically treated lumbar disk hernia. Multicenter study].

Results are reported of a multicenter analytic-statistical CT study on 128 postoperative lumbar herniated disk (HD) cases (50 at L4-L5, 64 at L5-S1, 2 at L3-L4, 12 multiple). CT was performed from 10 days to 204 months (47.7 months of mean) after surgery, in 51 patients without and in 77 with intravenous contrast medium (42 in bolus, 35 in perfusion). In 59 cases (38%) a recurrent hernia was found, and in 8% a new hernia. In 81% of patients epidural fibrous scars were demonstrated, in a rough 50% of cases associated with recurrent/new hernia: posterior fibrosis was found in 81% of cases, while unilaterally, bilaterally, or anteriorly extended fibroses were present in 20%, in 4.7%, and in 29% of cases respectively. In 72% of the patients injected with contrast medium, various kinds of fibrosis contrast enhancement were detected. In 8% neither fibrosis nor recurrent herniation was found. In 22% of cases lateral and/or central bony canal stenosis was present, in 26% vacuum disk, in 9% intracanalar calcifications, in 39% and in 19.5% dural sac stretching and compression respectively. In 5 cases a pseudomeningocele was found, and in 3 only a postoperative diskitis. Fibrosis is an almost inevitable postoperative consequence (4 out of 5 cases); it can be demonstrated by CT with high sensitivity and good specificity. A series of diagnostic criteria, such as the post-contrast media reaction, allow fibrosis to be discriminated from recurrent hernia. However, the possible association must be kept in mind of both diseases and/or of included roots in the scar. Myelography is hardly ever able to supply further resolutive diagnostic elements, while Myelo-CT is sometimes more useful. The importance of bone changes is questionable, with the exception of evident cases of canal stenosis, also because in most cases the radiologist cannot count on a preoperative CT study. Furthermore, the correlation between CT and clinical findings (possible asymptomatic fibrosis) is often difficult, which gives way to contrasting therapeutic attitudes.

Adult

[Computed arthrotomographic evaluation of chronic lesions of the cruciate ligaments].

The high incidence of cruciate ligament injuries as a result of acute knee trauma with hemarthrosis and abuse of diagnostic arthroscopies call for a suitable radiological imaging of the central pivot. Computed Arthrotomography (CAT) was used to examine the knee joint in 20 cases of clinically suspected chronic cruciate ligament injury. The images were correlated with arthroscopic and/or arthrotomic findings. Thirteen lesions of the anterior cruciate ligament (ACL) (65%) were found, plus 1 lesion of the posterior cruciate ligament (PCL) (5%), 2 associated lesions of ACL + PCL (10%), and 4 normal cases. Confirmation of pathology was available in all cases but one by arthroscopy and/or surgery. The central pivot diseases were classified as follows: absence, detachment, partial or complete tear. CAT findings of cruciate ligament injuries are emphasized and the role of the technique as compared to arthroscopy is discussed. CAT is useful in 3-D evaluation of central pivot and detection of different cruciate ligament injuries, with high sensitivity-specificity for ACL and high specificity-moderate sensitivity for PCL. In the evaluation of the chronic unstable knee, CAT is highly accurate and gives the surgeon useful information towards the planning of therapeutic procedures. CAT is almost non-invasive, well tolerated and easy to perform in out-patients, which make it a first-choice procedure in the screening of chronic ligament injuries.

Accidents, Traffic

[Early angio-computer tomography of ruptured cerebral aneurysms in subarachnoid hemorrhage].

In acute subarachnoid hemorrhage a ruptured cerebral aneurysm can be detected by Computed Angiotomography (Angio-CT). In a hyperdense cistern by extravasal blood, a round low-density defect on plain CT which turns into high-density nodular mass with afferent and efferent arteries, is an important finding of ruptured aneurysm. The inverting-density cisternal defect in connection with cerebral arteries is essential for the direct and early Angio-CT diagnosis of ruptured aneurysm.

Adult

[Subarachnoid hemorrhage caused by cerebral arteriovenous malformations. Importance of neuroradiological studies].

The role of skull X-rays, CT scan with and without intravenous contrast enhancement, angiography, digital subtraction angiography and magnetic resonance imaging in the morphological and topographical evaluation of arteriovenous malformation are analyzed and discussed. The literature on this subject is critically reviewed. Venous angioma, cavernoma, dural fistula and arteriovenous malformation with no angiographical evidence, are examined with special attention.

Brain Neoplasms

[Subarachnoid hemorrhage caused by rupture of cerebral aneurysm. Value of neuroradiological studies].

The role of neuroradiological examinations in the diagnosis and in the therapeutical indication of intracranial aneurysm are analyzed and discussed on the basis of a large review of the literature. Skull X-rays, Ct scan with and without intravenous contrast enhancement, magnetic resonance imaging and angiographic have different role and different timing. They are critically evaluated in order to point out an up-to-date diagnostic phase.

Cerebral Angiography

[Hemodynamics, hemocoagulation and neuroendocrine responses in long-duration anesthesia. Comparison of propofol infusion with thiopentone and NLA II].

Ten patients receiving propofol for the induction and maintenance of anaesthesia were compared with 10 patients in whom anaesthesia was induced with thyopentone and maintained with fentanil. The cardiovascular response to anaesthesia, the effects on coagulation and fibrinolysis and the neuroendocrine response have been investigated during surgical procedures exceeding 90'. There was a larger decrease in PA after induction in the propofol group versus control, but the overall quality of anaesthesia during induction and maintenance was comparable in both groups. No differences were found about blood coagulation and fibrinolysis between the groups. Important differences between the groups were instead found about the cortisol response to anaesthesia and surgery: in the propofol group there was a decrease in the cortisol concentration in 90' sample with no statistical significance, returning to the baseline value after 1 h from recovery. In the control group a significant increase of cortisol concentration was noted both at 90' and 1 h after the end of anaesthesia.

Adult