Biomedical subjects

Chiara Andreoli

Publications and source records attributed to Chiara Andreoli.

3 recordsLinked to original sources

PubMed2002

Color Doppler sonography in the evaluation of superficial lymphomatous lymph nodes.

OBJECTIVE: We performed a retrospective study to document the sonographic and color Doppler characteristics of lymphomatous superficial lymph nodes. METHODS: We selected 130 individuals who underwent sonography, color Doppler imaging, fine-needle aspiration biopsy, and surgical removal of the nodes with the final diagnosis of lymphoma (87) and chronic adenitis (43). During sonography, for each node we considered the longitudinal and axial diameters, long/short axis ratio, visibility of the hilum, and the internal echogenicity of the node. During the color and power Doppler examination, we classified the nodes into 3 patterns: type I, "hilar normal"; type II, "hilar activated"; and type III, "peripheral." RESULTS: Sonographic evidence was not significant. With color Doppler sonography, 97% of nodes affected by non-Hodgkin lymphoma, 94% of nodes affected by Hodgkin lymphoma, and 100% of non-neoplastic nodes showed hilar vascularity. Type I seemed more frequently associated with inflammation, and type II was more frequently associated with lymphoma. CONCLUSIONS: The presence of peripheric subcapsular vessels, which is typical of metastasis, is definitely rare in lymphoma (with the possible exception of the uncommon subtypes of high-grade lymphomas). The differential diagnosis between lymphoma and lymphadenitis is frequently impossible on the basis of sonographic and color Doppler patterns alone; therefore, clinical evaluation and biopsy are generally mandatory.

Adult↗

PubMed2002

Hemoperitoneum following ovarian cyst rupture: CT usefulness in the diagnosis.

PURPOSE: The rupture of an ovarian cyst is among the most frequent causes of hemoperitoneum in women, and especially in young women. An ultrasound (US) examination performed in emergency allows the easy detection of fluids leaking into the abdomen. It may however be difficult to establish whether this fluid is blood and identify the cyst or the signs of a cystic rupture. The aim of the present study was the assessment of CT diagnostic capabilities in cases of hemoperitoneum following cyst rupture. MATERIALS AND METHODS: CT abdominal studies performed in emergency in 15 patients with surgical findings of ovarian cyst rupture and consequent hemoperitoneum were retro-spectively reviewed. An ultrasound examination carried out in 12 women was positive in all cases for abdominal effusion, without however confirming the presence of an ovarian cyst or without definitely defining the cystic rupture. Spiral CT examinations were performed with a preliminary unenhanced study of the abdomen (10-mm thickness image acquisitions, 10-mm intervals) and with scans obtained after injection of 150 cc of contrast medium (c.m.) at the speed of 2 cc/sec, 60-sec delay; late-phase acquisition scans of the pelvic cavity were obtained in eight of the 15 patients. RESULTS: CT imaging allowed the depiction of the effusion in all cases. This was limited to the pelvic cavity in five cases and extended to the upper abdomen in the remaining ten patients; in seven of these ten cases, a difference in the density between the upper abdomen and the pelvic cavity was detected. An ovarian cyst was visualized in 11 patients; in eight of them, an irregular opacification of the walls was recorded, suggesting the diagnosis of cystic rupture. In the remaining four cases, a c.m. extravasation was observed, starting from the adnexal region, intracystic in one of them. In all these patients, a hyperdense collection in the pelvic cavity was documented in late-phase acquisitions. DISCUSSION AND CONCLUSIONS: CT imaging in cases of bleeding due to ovarian cyst rupture permits the acquisition of useful diagnostic information: a different effusion density in the pelvic cavity and in the upper abdomen, the direct visualization of the cystic mass (even when involved in a large effusion), the irregularity of opacified cystic walls (a sign of cyst rupture), and finally, the direct extravasion and collection of the c.m. in the pelvic cavity. These is fundamental information in those cases in whom US findings are negative or doubtful.

Adolescent↗

PubMedDate not supplied

Guidelines in diagnostics: formulation methodology proposal.

In healthcare the term "guideline" is used in numerous circumstances and for different purposes. The most commonly accepted definition is provided by the American Agency for Healthcare Research and Quality, which defines guidelines as "recommendations developed in order to assist doctors and patients in the decision-making process, while choosing an appropriate assistance in specific clinical circumstances". At present, in Italy and foreign countries, guidelines are considered an effective tool. Guidelines contribute with a qualitative improvement in performances, standardizing healthcare criteria, enabling also rationalisation and optimisation in both human and economical resources. The achievement of these aims depends on a thorough examination of both meaning and role played by guidelines in clinical practice, and of the essential methodological criteria of their processing. Unfortunately, these objectives can be attained only after the overcoming of obstacles, due to both limits in the formulation of such documents (use of inadequate methodology, choice of the paper-based collection of documents rather than computer-based data-processing support), and to the opposition of the medical personnel. The latter problem being caused by a poor knowledge of the role played by guidelines and by the difficulty of a critical evaluation of their validity. In fact, the success of a guideline is also determined by its development, implementation and introduction strategies, and by the consence of the medical community. Once formulated by an interdisciplinary group of experts, a guideline should be necessarily revised according to already coded procedures. A reliable contribution to the diffusion of such guidelines derives from the use of computer-based data-processing supports, which contribute to their interactivity, user friendliness, user-adaptivity and updatebility. The above illustrated procedures represent an unquestionable contribution to the clinical decision-making process. In fact, these represent the basic development tools for the harmonisation of cultural qualification and clinical practice, aiming at quality improvement and rationalisation in health-related activities.

Practice Guidelines as Topic↗