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Biomedical subjects

A Rotondo

Publications and source records attributed to A Rotondo.

At least 37 records · Page 2Linked to original sources
PubMed1998

Conventional plain-film radiology, ultrasonography and CT in jejuno-ileal perforation.

PURPOSE: To evaluate conventional radiography, US and CT in identifying jejuno-ileal perforation. MATERIAL AND METHODS: We retrospectively reviewed the findings of conventional radiography, US and CT in 13 consecutive patients with surgically proven jejuno-ileal perforation. RESULTS: The site of perforation was the ileum in 10 cases and the jejunum in 3 cases. Free gas was identified in 6 cases (46%) while indirect findings of perforation were found in 7 (54%). The jejunal perforations were diagnosed by indirect findings in all 3 cases. The ileal perforations were diagnosed by direct findings in 6 cases and indirect findings in 4 cases. CONCLUSION: Conventional radiology did not detect free gas in 7 (54%) of the 13 patients examined. In the absence of free gas, radiology showed indirect signs in all 7 patients, the most common being intraperitoneal free fluid in 5 (71%) of them. Jejunal perforations were more rare than ileal perforations and more difficult to identify by radiology. US was not useful for detecting free gas but it was useful for identifying intraperitoneal free fluid and intestinal paresis. Abdominal CT was useful when performed 6 h after the symptoms began.

Adolescent↗
PubMed1998

Thoracic CT findings at hypovolemic shock.

PURPOSE: To describe and discuss the thoracic CT features of hypovolemic shock. MATERIAL AND METHODS: From a group of 18 patients with signs of hypovolemia on contrast-enhanced abdominal CT, 11 were selected for our study as having also undergone a complete chest examination. Pulse rate, blood pressure, trauma score value, Glasgow coma scale value, surgical result, and final outcome were retrospectively evaluated. The CT features analyzed were: decreased cardiac volume, reduced caliber of the thoracic aorta, aortic branches and caval venous system, increased enhancement of the aorta, and increased enhancement of the pulmonary collapses/contusions. RESULTS: All 11 subjects presented severe injuries and hemodynamic instability; 7 were stable enough to undergo surgery; only 1 of the 11 survived. Two patients showed none of the features of thoracic hypovolemia. All the other patients presented at least two signs: reduced caliber of the thoracic aorta in 7 cases; decreased volume of the cardiac chambers and increased aortic enhancement in 6; decreased caliber of the aortic vessels in 4; decreased caliber of the caval veins in 3; and increased enhancement of the pulmonary collapses/contusions in 3. CONCLUSIONS: In patients with hypovolemia, CT may show several thoracic findings in addition to abdominal ones. Knowledge of these features is important for distinguishing them from traumatic injuries.

Adolescent↗
PubMed1998

Pulmonary manifestations of Gaucher disease: an increased risk for L444P homozygotes?

Pulmonary disease is a complication of Gaucher disease (GD), a lysosomal disorder due to the deficiency of glucocerebrosidase. Lung involvement was investigated through chest radiography, high-resolution computed tomography of the chest, pulmonary function tests (PFT), and oxygen saturation (SaO2) at 21% FI(O2) in 13 Italian GD patients, six homoallelic for the L444P mutation (Group A), seven with various genotypes (Group B). Echocardiography and transcutaneous oxygen tension measurement at room air and after breathing 100% oxygen were performed to exclude pulmonary hypertension and/or intrapulmonary shunts. A score index (SI) including lung involvement evaluated the severity of GD. In three Group A patients with respiratory symptoms and in an asymptomatic male interstitial involvement was demonstrated; one child died of aspiration pneumonia. Group B patients had no signs of lung damage; PFT were normal in all cases but one. SaO2 was normal in both groups. Pulmonary vascular disease was ruled out in three cases with respiratory symptoms. In Groups A and B the median SI were 22 and 13, respectively (p < 0.01). L444P homozygotes appear at major risk for developing pulmonary disease, even at earlier ages. A comprehensive evaluation of lung involvement is recommended primarily in these subjects.

Adolescent↗
PubMed1998

Cystic fibrosis: when should high-resolution computed tomography of the chest Be obtained?

OBJECTIVE: To provide indications for high-resolution computed tomography (HRCT) of the chest in patients with cystic fibrosis (CF). DESIGN: We compared the HRCT and conventional chest radiography (CCR) scores and assessed their correlation with clinical scores and pulmonary function tests. SETTING: Department of Pediatrics, Federico II University, Naples, Italy. SUBJECTS: A total of 30 patients with CF 6.75 to 24 years of age. RESULTS: CCR scores correlated highly with HRCT (r = -0.8) and clinical (r = 0.5) scores, whereas total HRCT scores were not related to clinical scores. Of all the specific HRCT findings, only bronchiectasis appeared related significantly to the clinical score (r = 0.6). Most pulmonary function tests were related to CCR and total HRCT scores, but not to HRCT scoring of specific changes. Forced vital capacity and CCR scores appeared the best predictors of the HRCT score (multiple R = 0.58 and 0.79, respectively). In patients with mild lung disease, HRCT detected bronchiectasis and air trapping in 57% and 71% of the cases, respectively. In patients with more abnormal chest radiographs, bronchiectasis and air trapping were demonstrated on HRCT in all cases. CONCLUSIONS: These findings suggest that HRCT of the chest is most useful in the identification of early lung abnormalities in patients with CF with mild respiratory symptoms, whereas for established disease, CCR is still the first-line imaging technique. The advantage of detecting early changes on CT imaging awaits additional confirmation, at least until early therapeutic interventions affecting significantly the final outcome of the disease are demonstrated. In patients with advanced disease, HRCT may be useful in the evaluation of specific lung changes when more aggressive treatment such as chest surgical interventions is indicated. Given the cost of the procedure and the high radiation dosage compared with CCR, a careful assessment of the cost:benefit ratios of HRCT is strongly recommended in CF.

Adolescent↗
PubMed1998

Segmental pulmonary arteries: two-dimensional and three-dimensional time-of-flight magnetic resonance angiography.

The authors compared two-dimensional (2D) and three-dimensional (3D) time-of-flight (TOF) magnetic resonance angiography in ten healthy volunteers to establish which of two techniques is more effective in representing the pulmonary segmental arteries. No respiratory trigger or electrocardiogram gating was used. Presaturation pulses were used to eliminate venous flow. Images acquired in the sagittal planes were processed using maximum intensity projection. A total of 200 segmental arteries were evaluated with each technique by three observers (M.S., C.S., A.R.) in terms of vessel visibility. There was no significant difference among the observers' interpretations (p > 0.05). On average, 2D fast, low-angle shot breath-hold TOF sequences showed 136.1 of 200 (68%) segmental arteries, 74.1 of 100 in the right lung and 62 of 100 in the left lung. Three-dimensional fast imaging with steady state precession showed 171.6 of 200 (85.8%) segmental arteries, 94 of 100 in the left lung and 77.6 of 100 in the left lung. Three-dimensional imaging appeared to be better than 2D MRA for demonstration of segmental pulmonary arteries.

Adult↗
PubMed1998

[Computerized tomography assessment of replacement of the cruciate ligaments of the knee].

January, 1993, to December, 1995, we examined with CT 44 patients submitted to surgical replacement of knee cruciate ligaments, namely 18 anterior cruciate ligaments (ACL) and 6 posterior cruciate ligaments (PCL). ACL was replaced with a patellar tendon graft (Eriksson technique) in 23 cases and with a semitendinous graft (Lindemann-Bousquet technique) in 7 cases. The autologous new ligament appeared as a laminar structure of intermediate density. The tendon had been covered with a synthetic lining (Leeds-Kejo) in 10 of the above cases, while the new ACL graft was completely synthetic in 8 cases, which synthetic allografts appeared hyperdense relative to autologous new ligaments. PCL replacement had been performed with Augustine technique (patellar tendon graft in a tibial tunnel) in 3 cases, with Hughston technique (medial gastrocnemius graft in a medial condylar tunnel) in 2 cases and with a synthetic graft (Gore-tex) in 1 case. Twelve of 38 new ACLs were injured (7 Eriksson, 3 Lindemann-Bousquet and 2 synthetic grafts): the injured new ligament was enlarged and hypodense, or involved in atrophic absorption. The new ligament was partially calcified in one of the 3 patients with PCL replacement with a patellar tendon graft (Augustine technique). The bone bract was dislocated in the intercondylar notch in a patient submitted to Hughston surgery because of proximal disinsertion of the new ligament. The Gore-tex new PCL was sinuous in the proximal tract, with intra-articular calcified loose bodies. CT adequately depicted surgical results and diagnosed the new ligament injuries and other articular abnormalities. MRI is currently the gold standard in the multiplanar studies of the postoperative knee, but CT can be confidently used to identify ligament injuries and intra-articular calcified loose bodies.

Anterior Cruciate Ligament↗
PubMed1998

[Echography of the supraspinatus tendon: forced passive adduction maneuver].

INTRODUCTION: Imaging methods are essential for a correct diagnostic approach and treatment planning in patients with a painful shoulder. More than any other, the supraspinatus tendon is often involved in impingement syndrome and sonography (US) is now the procedure of choice for the first assessment of rotator cuff tears. We suggest a supraspinatus tendon passive stress maneuver drawing the tendon out from underneath the acromion and showing a longer portion of the tendon that would otherwise be masked by the acromion. MATERIAL AND METHODS: Twenty normal subjects (10 men and 10 women, aged 20 to 46 years, mean age: 32 years) and two patients with shoulder pain underwent shoulder US with real time equipment and a 7.5 MHz linear array transducer. US images were acquired with the subjects allowed to rest with their arm in neutral position and during supraspinatus tendon passive adduction stress maneuver (with the arm first abducted by placing a plastic cylinder device under the armpit, then submitted to passive forced adduction). All US scans were performed along the longitudinal axis of the tendon. The length of the supraspinatus tendon was measured from its insertion on the greater tuberosity of the humerus to the lateral edge of the acromion. Measurements were made in neutral position and during the stress maneuver and, for each subject, the increased length of the displayed portion was obtained as the difference between the two measurements. RESULTS AND CONCLUSIONS: In neutral position at rest, the displayed portion of the supraspinatus tendon was 21 mm long on the average (range: 11 to 31 mm). The average increase, namely the tendon portion recovered from the acromial acoustic shadow, was 4.5 mm (range: 2 to 10 mm). In two patients the stress maneuver permitted better visualization of tendon tear, which finding was confirmed at MRI. The results of our study so far seem to suggest that the passive adduction stress maneuver permits to visualize a longer portion of the supraspinatus tendon without affecting its anatomical alignment and could thus be useful in US studies of the rotator cuff.

Adult↗
PubMed1998

[Three-dimensional imaging with computerized tomography. Etiologic considerations and methods for studying temporo-mandibular joints].

INTRODUCTION: The temporomandibular joint (TMJ) had always been studied with conventional tomography and, more recently, with Magnetic Resonance Imaging. Computed Tomography (CT) can demonstrate periarticular soft tissues only. Recently, the introduction of three-dimensional (3D) CT reconstructions with dedicated softwares permitted to demonstrate functional changes in the TMJ with a simple and accurate measurement system. MATERIAL AND METHODS: We examined 347 patients with TMJ disorders using two different 3rd generation CT units and acquiring two series of scans, with the mouth closed and in maximum opening. 3D reconstructions on predefined planes were obtained with a dedicated software and integrated with the electronic measurements of the following morphologic and functional parameters: zygomatic tubercle height, axis of sagittal inclination of the mandibular condyle, TMJ movement range and changes in torsion/dislocation of condylar angle. RESULTS AND DISCUSSION: CT showed the TMJ easily. This examination lasts about 10 minutes, plus 10-15 more minutes for 3D reconstructions. Some artifacts were found on 3D images--thresholding artifacts, defined as pseudoforamina and pseudocalcifications. Neverthless, 3D imaging can easily demonstrate an articular district which is very complex in both morphology and function, supporting or replacing similar subconscious processes made by radiologists themselves. This technique was well accepted by all our patients and functional results were always in agreement with clinical findings. Moreover, CT is the only technique showing both TMJ sides at the same time. Our measurement system was easy to perform, repeatable and comparable also thanks to its potentials of standardization on different CT units. CONCLUSIONS: CT with 3D reconstructions appears the gold standard technique for functional TMJ studies. Even though it provides no information on the joint disk--which MRI does--3D CT permits easy and accurate measurements of both TMJ sides which can support clinical findings.

Humans↗
PubMed1998

[The initial (I and II) and advanced (III and IV) stages of juvenile patellar chondromalacia. Its diagnosis by magnetic resonance using a 1.5-T magnet with FLASH sequences].

PURPOSE: Juvenile patellar chondromalacia is a common orthopedic disorder which can mimic other conditions; early diagnosis is mandatory to prevent its evolution into osteoarthrosis. In the early stages of patellar chondromalacia (I and II), the lesions originate in the deep cartilage layer and the joint surface is not affected. Arthroscopy can demonstrate joint surface changes only and give indirect information about deeper lesions. We investigated the yield of 2D FLASH MRI with 30 degrees flip angle and a dedicated coil in the diagnosis of patellar chondromalacia, especially in its early stages. MATERIAL AND METHODS: Eighteen patients (mean age: 21 years) with clinically suspected patellar chondromalacia were examined with MRI; 13 of them were also submitted to arthroscopy. A 1.5 T unit with a transmit-and-receive extremity coil was used. We acquired T1 SE sequences (TR/TE: 500-700/15/20) and 2D T2* FLASH sequence (TR/TE/FA: 500-800/18/30 degrees). The field of view was 160-180 mm and the matrix 192 x 256, with 2-3 NEX. The images were obtained on the axial plane. The lesions were classified in 4 stages according to Shahriaree classification. RESULTS: Agreement between MR and arthroscopic findings was good in both early and advanced lesions in 12/13 cases. Early lesions appeared as hyperintense focal thickening of the hyaline cartilage (stage I) or as small cystic lesions within the cartilage and no articular surface involvement (stage II). The medial patellar facet was the most frequent site. Advanced lesions appeared as articular surface ulcerations, thinning and cartilage hypointensity (stage III); stage IV lesions presented as complete erosions of the hyaline cartilage and hypointense underlying bone. CONCLUSIONS: 2D FLASH MRI with 30 degrees flip angle can show the differences in water content in the cartilage and thus permit to detect early chondromalacia lesions in the deep cartilage.

Adolescent↗
PubMed1998

[Computerized tomography findings in intestinal carcinoid].

INTRODUCTION: We studied the CT patterns of abdominal carcinoid tumors. MATERIAL AND METHODS: Eight patients with carcinoid tumors were examined with CT. The tumors were in the ileum (2 patients), duodenum (1), colon (1), and mesentery (4). Pathologic confirmation was obtained at surgery in all patients. The symptoms were the carcinoid syndrome in 2 patients, abdominal pain in 4, jaundice in 1 patient and a right lower quadrant mass in 1. All patients were examined with(out) i.v. contrast agent administration; 6 patients received oral contrast material and 2 were submitted to water enema, to enhance visualization of the distal ileum and colon. RESULTS: CT identified the tumor in all patients but correctly defined its site in 7 cases only. CT showed a small mass in the distal common bile duct in 1 case, which postoperative histology diagnosed as a malignant carcinoid tumor of the duodenum. The CT findings of carcinoid tumors were a rounded mesenteric mass displacing bowel loops in 4 cases, an infiltrating colonic tumor in 1 case, an apparently intracholedochal mass in 1, a large necrotic mesenteric mass in 1 case. CT showed lymph node involvement in 2 cases, but no liver metastases were found. A carcinoid tumor was diagnosed in 4 patients based on the typical CT finding of a mesenteric mass with radiating soft-tissue density bands resulting in a stellate pattern. No preoperative diagnosis was possible in some other cases because the CT patterns were aspecific and mimicked those of other lesions, namely of tumor of the distal common bile duct, adenocarcinoma of the right colon, submucosal tumor of the distal ileum, large necrotic mesenteric mass. CONCLUSIONS: CT is a useful tool in the detection of carcinoid tumors. The correct diagnosis can be made based on the characteristic CT finding of a rounded mesenteric mass. In our experience, however, carcinoid tumors may present with other CT patterns mimicking those of other tumors.

Aged↗
PubMed1998

[Magnetic resonance angiography of the epiaortic vessels of the thorax].

INTRODUCTION: Magnetic Resonance angiography (MRA) is an accurate and non-invasive diagnostic method to evaluate vascular disease. On the basis of its technological advancements, this technique has gained an important role in the diagnostic protocol of cerebral and cervical vascular diseases. Nonetheless, MRA efficacy changes in different anatomic districts as a consequence of the specific anatomy and flow features. Cardiac and respiratory artifact and different coil sensitivity also affect MRA results. For these reasons, intrathoracic epiaortic vessels are a difficult applications for MRA. MATERIAL AND METHODS: We examined 20 patients affected with epiaortic atherosclerosis with MRA, carried out with an 0.5 T MR unit (Vectra, GE). Examinations consisted of Phase Contrast (PC) 3D sequences (TR/TE/FA/Venc = 30/13/45/30-50), with 3 axes of flow encode, matrix 128 x 256, 2 mm partition thickness, and axial and/or coronal acquisition volume. The MRA was repeated after Gd-DTPA intravenous perfusion and a qualitative and quantitative evaluation of pre- and post-contrast results was performed. Specific parameters of evaluation were: angiographic contrast, contrast to noise ratio, saturation effect of longitudinal magnetization, contrast between arteries and veins. All patients were examined with Doppler US and angiography. MRA data were compared to angiography in order to establish MRA sensitivity and specificity. RESULTS AND CONCLUSIONS: PC sequences showed high accuracy in the examination of the proximal tract of epiaortic vessels; Gd-DTPA administration substantially improved MRA results. The perspectives of technological improvement will probably candidate PC MRA to be a valid alternative to US-Doppler and, perhaps, to angiographic study.

Adult↗
PubMed1997

Spontaneous rupture of a hepatic angiomyolipoma: CT findings and literature review.

Angiomyolipoma is an uncommon lipomatous neoplasm of the liver, usually asymptomatic and identified incidentally. We describe the CT findings of a surgically confirmed case of spontaneously ruptured angiomyolipoma with evidence of internal hemorrhage and hemoperitoneum. The CT features were that of an exophitic, oval, well-defined mass with inhomogeneous attenuation values due to the presence of fat- and soft-tissue densities. A review of the literature identified 49 cases of hepatic angiomyolipoma. Few of these occurred in symptomatic patients and showed intratumoral hemorrhagic foci, but none had a clear rupture with external bleeding. To our knowledge, this is the first reported case with this complication.

Aged↗
PubMed1997

Papillary injuries and duodenal perforation during endoscopic retrograde sphincterotomy (ERS): radiological findings.

OBJECTIVE: To describe the radiological features of duodenal injury during endoscopic retrograde sphincterotomy (ERS) with special reference to limited papillary trauma and minor perforation. METHODS: The radiological and clinical features of duodenal injuries out of 284 ERS performed in the last 4 years were evaluated retrospectively to document various patterns of trauma and correlation with clinical outcome. RESULTS: Duodenal injuries occurred in eight patients: mild papillary injuries in five subjects (intrapapillary extravasation of contrast medium in one, peri-Vaterian submucosal diffusion in four) and duodenal perforation in three (peri-choledochal diffusion in one, retroperitoneal leakage in two). CONCLUSION: The radiological findings in papillary and duodenal injuries are protean and knowledge of their variable appearance is important since their detection may have practical consequences.

Aged↗
PubMed1997

Further characterisation of [3H]8-hydroxy-2-(di-N-propylamino)tetralin binding sites in human brain postmortem.

The saturation parameters and the pharmacological characteristics of the binding of the serotonin 1A (5-HT1A) receptor agonist [3H]8-hydroxy-2-(di-N-propylamino)tetralin ([3H]8-OH-DPAT), as well as the effects of nucleotides and divalent cations (Mg2+, Mn2+) on it, were compared in some human postmortem brain regions: the main cortical areas, hippocampus and striatum. [3H]8-OH-DPAT labelled a single population of recognition sites with the highest maximal capacity (Bmax) in the hippocampus and the lowest affinity in the striatum. Among the various cortical areas, the frontal cortex exhibited the highest Bmax. The pharmacological profile of the [3H]8-OH-DPAT binding sites was consistent with the labelling of the 5-HT1A receptor in the hippocampus and cortex, whereas the striatal site shared strong similarity to the presynaptic serotonin transporter. Modulation of [3H]8-OH-DPAT binding by divalent cations and nucleotides was detectable and stable in autopsy brains. In particular, nucleotide effects were area-dependent: guanosine thiotriphosphate (GTP gamma S) reduced [3H]8-OH-DPAT binding to the same extent in the hippocampus and frontal cortex, while having no effect in the striatum. Divalent cation effects depended also upon the brain area: in the striatum, they inhibited [3H]8-OH-DPAT binding, while stimulating it in the hippocampus and, with less extent, in the frontal cortex. In summary, these findings suggest that the [3H]8-OH-DPAT binding and its modulatory parameters in human brain tissues seem to show similarities but also some differences with respect to those determined in the rat brain. Furthermore, postmortem stability of GTP and divalent cation sensitive 5-HT1A receptors underlines the need for further studies on the regulatory and functional properties of this receptor in the human brain.

8-Hydroxy-2-(di-n-propylamino)tetralin↗
PubMed1997

Agonist-promoted down-regulation and functional desensitization in two naturally occurring variants of the human serotonin1A receptor.

We recently reported two naturally occurring polymorphisms of the human serotonin1A (5-HT1A) receptor: glycine22-->serine (Ser22) and isoleucine28-->valine (Val28) in the putative aminoterminal domain of the receptor. To investigate the regulatory properties of these variants, the wild type (WT) and variant 5-HT1A receptors were stably expressed in CHO-K1 cells. WT, Ser22, and Val28 displayed similar high-affinity binding to [3H]-8-OH-DPAT. Competition experiments with 5-HT1A agonists and antagonists demonstrated similar pharmacological profiles. Receptor agonist-promoted down-regulation was tested by exposure to 100 mumol/L 8-OH-DPAT. After 24-h exposure, WT and Val28 underwent 59.3 +/- 3.9% and 59.5 +/- 1.4% reduction in receptor density respectively, whereas the degree of down-regulation was significantly lower for Ser22 (21.4 +/- 4.2%). Cell treatment for 24 h with 100 mumol/L 8-OH-DPAT reduced the 5-HT-induced inhibition of cAMP accumulation by 24.9 +/- 5.1% for WT and 16.4 +/- 0.8% for Val28, but only by 4.8 +/- 3% for Ser22. We conclude that the Ser22 variant is capable of attenuating agonist-mediated receptor down-regulation and desensitization.

8-Hydroxy-2-(di-n-propylamino)tetralin↗
PubMed1997

Massive enterolithiasis associated with ileal dysgenesis.

A 20-year-old man with massive ileal enterolithiasis was investigated with plain radiography, ultrasound, computed tomography, barium follow through and double contrast barium enema. Ileocecal valve agenesis was found at surgery. The enteroliths were located in the distal ileum, which communicated with the large intestine via an ileotransverse fistula.

Adult↗
PubMed1997

[Assessment with magnetic resonance of cartilage injuries of the knee with tridimensional techniques with fat suppression].

MR studies of chondral injuries of the knee are performed to obtain a high C/N ratio between the articular cartilage and such other structures as subchondral bone, intraarticular fat pad and synovial fluid. This goal has been achieved with the 3D SPGR fat-suppressed technique. This kind of sequence yields high spatial contrast resolution because of its contiguous thin (1.5 mm) slices and high contrast resolution between the hyaline cartilage, which is strongly hyperintense, and the surrounding structures (fat, synovial fluid, subchondral bone) which appear hypointense. From September, 1994, to February, 1995, we submitted to MRI 34 patients, adding the 3D fat-suppressed technique after the routine sequences. These volumetric sections were obtained to image the tibiofemoral joint cartilage in 15 patients and to study the patellofemoral compartment in 19 patients. Chondral injuries were graded according to Beguin and Locker classification and MR results were compared with arthroscopic findings. 3D SPGR fat-suppressed sequences permitted accurate chondral thickness evaluation and the depiction of cartilage injuries, especially in advanced injuries (stages 3 and 4). However, in earlier stages, this MR technique tends to overestimate globular hypointense areas in normal thickness cartilage. This MR pattern needs a close correlation with clinical findings and should be interpreted according to the presence/absence of other associated intraarticular injuries.

Adolescent↗