Biomedical subjects

Diego Salera

Publications and source records attributed to Diego Salera.

4 recordsLinked to original sources

PubMed2005

Ultrasonographic contrast-enhanced study of sicca syndrome.

OBJECTIVE: To assess the ability of US contrast-enhanced time-intensity curves to depict the changes connected with sicca syndrome, a fairly common condition that is often associated with autoimmune disorders such as Sjogren's syndrome or other diseases. Diagnostic criteria are complex and controversial and although no single test can be considered the gold standard, salivary gland scintigraphy and biopsy are reliable diagnostic methods. MATERIALS AND METHODS: Sixty consecutive patients with sicca syndrome, 40 of whom had primary (n = 23) or secondary (n = 17) Sjogren's syndrome and 20 had non-Sjogren's sicca syndrome, selected according to European Community Study Group diagnostic criteria for Sjogren's syndrome and subjected to contrast-enhanced US imaging of the parotids using a second-generation contrast agent with analysis of time-intensity curves at rest and during salivary stimulation, Tc99m salivary gland scintigraphy and labial gland biopsy. RESULTS: In the 40 Sjogren's patients, US enhancement values were significantly lower (P < 0.0001 and P < 0.00003, respectively) than in the 20 non-Sjogren's patients both at rest and during stimulation. In the 23 subjects with the primary syndrome, values during stimulation were significantly lower than in the 17 subjects with the secondary syndrome (P < 0.0006), whereas at rest differences were not significant. Contrast-enhanced US imaging allowed to discriminate Sjogren's from non-Sjogren's sicca patients with 87.5% sensitivity, 85% specificity and 86.7% accuracy and the primary from the secondary syndrome with 78.2% sensitivity, 70.5% specificity and 75% accuracy. Interestingly, in eight patients with the primary syndrome, i.e. those with the more severe gland involvement, enhancement values were lower during stimulation than at rest. CONCLUSION: Preliminary results indicate that contrast-enhanced US imaging can provide useful information on sicca characterisation and severity.

Adult↗

PubMed2005

Screening US for blunt abdominal trauma: a retrospective study.

PURPOSE: To assess the accuracy of screening US in patients with blunt abdominal trauma first admitted in the trauma centre of our general hospital. MATERIALS AND METHODS: The reports of 864 abdominal US examinations of primary trauma patients (139 with major and 725 with minor injuries) obtained with standard protocols were retrieved. For each case, US reports were reviewed and compared to the best available reference standard. The accuracy of US was assessed by evaluating the method's overall ability to distinguish negative from positive cases by showing at least one of the lesions documented by the reference standard and its specific ability to depict injuries separately and independently. RESULTS: US exhibited a satisfactory overall ability to distinguish negative from positive patients (91.5% sensibility and 97.5% specificity in major trauma patients vs. 73.3% sensibility and 98.1% specificity in minor trauma patients) and a satisfactory specific ability to depict injuries separately and independently in major trauma patients. Of the 21/864 false negative reports (5 in patients with major and 16 in cases with minor trauma), only one affected patient management, a major trauma case, by delaying an emergency laparotomy. CONCLUSIONS: Its satisfactory accuracy for major trauma suggests that US could be employed not only to screen cases for emergency laparotomy but also as an alternative to screening CT. However, since major traumatic injuries generally carry an imperative indication for CT, especially as regards neurological, thoracic and skeletal evaluation, US has the not secondary task of performing a prompt preliminary examination using a simplified technique in the emergency room simultaneously with resuscitation.

Abdominal Injuries↗

PubMed2004

[Contrast-enhanced sonography in the diagnosis of renal artery stenosis: comparison with MR-angiography].

PURPOSE: To investigate the diagnostic accuracy of non-enhanced Colour-Doppler US and enhanced power-Doppler US in the diagnosis of renal artery stenosis compared with breath-hold Gd-DOTA-enhanced MR-angiography. Digital subtraction angiography (DSA) provided the gold standard. MATERIALS AND METHODS: A total of 51 patients (19 women and 32 men, age ranging from 29 to 76 years) with clinical suspicion of renovascular hypertension underwent Colour-Doppler US of the renal artery; 11 subjects (21.6%) were excluded from the study as a complete and bilateral depiction of renal artery was not obtained. The remaining 40 subjects (14 women and 26 men) were investigated with power-Doppler US with time-intensity renal enhancement curve and with MR-Angiography. All of these subjects were also studied by DSA which provided the gold standard. RESULTS: As stated, in 11 of 51 patients the diagnostic work-up was not completed because the initial US examination failed to depict the renal arteries. DSA showed renal artery stenosis in 16 of the remaining 40 patients. The sensitivity and specificity in diagnosing stenoses were 75% and 79.1% for conventional colour-Doppler US, 100% and 87.5% for enhanced power-Doppler US and 100% and 91.6% for MR-angiography. CONCLUSIONS: MR-angiography is the most reliable technique in the diagnosis of renal artery stenosis. The sensitivity and specificity of enhanced power-Doppler US are superior to those of colour-Doppler US. Although MR-Angiography enables a better evaluation of renal artery stenosis, the good diagnostic accuracy of enhanced power-Doppler US, its greater acceptance by the patients and its wider diffusion support the use of this technique in the screening of patients with clinical suspicion of renovascular hypertension.

Adult↗

PubMedDate not supplied

Hemodynamic effects of a prostacyclin analog (Prostavasin) in systemic scleroderma patients.

PURPOSE: We examined the effects of a prostacyclin analogue (Prostavasin) on the circulation of upper extremity, cerebral, ocular and visceral districts such as portal vein, hepatic artery, superior mesenteric artery, and interlobar renal artery in scleroderma patients. MATERIALS AND METHODS: peripheral vasculature was evaluated by the brachial artery flow-mediated dilatation by the high resolution ultrasound cross-sectional measurement, splenic arterial pulsatility index (PI) resistance index (RI) of the middle cerebral artery, the central retinal artery, the visceral arteries and the portal vein flow were assessed by colour Doppler sonography in an experimental group (EG) of 50 scleroderma patients, not affected by cerebrovascular, ocular, hepatic diseases or nephropathy, before and after 3 days of Prostavasin infusion and before and after 3 days in a control group (CG) of 10 patients not receiving any treatment. RESULTS: EG patients showed significant increasement in the brachial artery flow-mediated dilatation, in the portal vein velocity and in the splenic arterial PI (pre-Prostavasin vs post-Prostavasin treatment, p < 0.001) whereas CG patients had no significant changes. Values of the middle cerebral artery, the central retinal artery, the interlobar renal artery, the superior mesenteric artery and the hepatic artery RI were reduced after treatment in the majority of EG patients although the difference did not achieve a satisfactory statistical significance. CONCLUSIONS: our results indicate that Prostavasin has a powerful effect in improving the peripheral circulation of scleroderma patients. Prostavasin significantly increases the portal vein flow but also the splenic arterial PI not supporting the hypothesis of its direct and specific action on relaxation of the hepatic micro circle.

Adult↗