[Endo-ocular calcifications or foreign bodies? The reliability and limits of imaging diagnosis].
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Biomedical subjects
Publications and source records attributed to A Montanara.
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This study was aimed at investigating the changes occurring in superficial corneal epithelium (localized or diffuse, dotted or linear) as observed in 300 eyes after macrodacryography with iodate contrast media (iodized oil and water soluble non-ionic agents). In our opinion, the causes of iatrogenic short-life keratitis are: needle injury, the deposition of iodate contrast medium on the cornea and the reduction of palpebral winking, favoring dry eye, due to superficial anesthesia. The pharmacologic protection of the cornea by means of high-viscosity drugs allows both the number and the degree of keratitis to be markedly reduced. Therefore, contrast media must be chosen on the basis of anamnestic and clinical data, as well as of patient's symptoms, focusing mainly on the characteristics of the various agents--i.e., density, concentration, viscosity.
A new equipment is described for the radiologic examination of the lacrimal system. The technique has been so far employed with excellent results in a series of 75 patients with obstructive epiphora. The advantages of the automatic injector are emphasized: 1) only one person suffice to carry out the examination; 2) the operator is placed far from the ionizing radiation. As new uses of this equipment are discovered its availability should increase.
This study was aimed at investigating the changes in corneal epithelium caused by dacryocystography. Such changes can be either chemical--from iodate contrast media (iodized oil and water-soluble non-ionic cm)--or physical--from needle or catheter. Twenty-five patients (50 eyes) were studied using BUT, Schirmer tests, biomicroscopy, and pachymetry. Follow-ups immediately after dacryocystography demonstrated superficial keratitis, which was less severe with water-soluble non-ionic cm. Such lesions were hardly ever observed in patients who had been treated with dacriosol ointment on the cornea just before the X-ray exam. Follow-ups at 24 hours showed the superficial keratitis to have disappeared in all patients, independent of the kind of cm employed and of the ophthalmic ointment applied to the cornea.
This paper describes research into measurement and reduction of the radiation dose to the lens during various examinations, namely skull and orbit, optic canal and optic strut, superior and inferior orbital fissure, localisation of foreign bodies in the eye, calcifications, orbital fractures, macrodacryography and orbital venography. Using rare-earth screens and high-sensitivity films, without an antiscattering grid, and with an added filtration of 0.5 mm Cu, it is possible to reduce the radiological risk during all investigations involving skull, orbit and eyeballs, while maintaining a good image quality. Particularly in those examinations with direct magnification (macrodacryography and venography, foreign bodies in the eye, orbital fractures), the dose to the lens is very low: less than 0.2 mGy/radiograph.
Lacrimal fistulae are rare and not well known by radiologists. Four cases are illustrated, two congenital (a skin-canaliculous and a canaliculous-palpebral fistula) and two acquired (a rare case of sac-orbital fistula and a canaliculous-palpebral fistula arisen during dacryography). Fistulae are to be distinguished from pedunculated lacrimal diverticulous of which an interesting and rare case is presented. After a careful examination of the pathogenesis and symptomatology of lacrimal fistulae the authors agree that only macrodacryography carried out by means of sophisticated techniques (seriography, magnification, subtraction) enables a precise demonstration of the originating point, of the course and outlet (cutaneous and internal) and provides therefore indispensable data for surgery.
A radiological study of the lacrimal drainage apparatus was made in 50 patients with temporary or permanent epiphora. The authors state that the present radiologic technique (macrography, seriography, subtraction) allows the detection on the various lacrimal levels of not only organic lesions but also of functional disorders. They assert the definite superiority of dacryocystography over the other clinical and radiological investigations (scintigraphy, roentgencinematography) in identifying the site and the nature of the various organic lesions, in evaluating and interpreting the functional alterations as well as following and judging the effectiveness of treatments.
The authors describe two cases of blow-out fractures of the orbit studied by conventional and computerized tomography and stress the opportunities and limits of the procedures.
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The diagnosis of epiphora can be greatly aided by a special radiologic technique, performed during bilateral injection of contrast medium into the lacrimal passages and utilizing seriography, magnification and image subtraction. The authors describe the technique, discuss the interpretation of the various radiologic patterns, and stress the importance of this method for evaluating inflammation, stenoses and functional alterations of the lacrimal passages.
The comparative advantages and limitations of macrodacryocystography and echography for evaluating disorders of the lacrimal system are discussed and illustrated. In our opinion, macrodacryocystography is superior to ultrasonography in identifying the site and the nature of anatomical and functional abnormalities and in evaluating the effectiveness of treatment after surgery. Echography, however, is particularly useful in the study of the lacrimal sac, especially if an occlusion of the common canaliculus prevents filling of the lacrimal sac, thus ruling out macrodacryocystography.