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Biomedical subjects

E Di Giandomenico

Publications and source records attributed to E Di Giandomenico.

15 recordsLinked to original sources
PubMed1994

[The National Workshop on Defecography: anorectal deformities with a functional origin (prolapse, intussusception, rectocele)].

The nonoperative treatment--i.e., rubber band ligation and sclerotherapy--of mucous rectal prolapse, rectocele and intussusception is much less expensive than conventional surgery (Lit. 325,000 vs. 6,500,000, p < 0.0001 on the average). Symptom relief, however, has been reported in 0 to 57% of cases only, according to current literature. A possible cause is represented by improper management from misdiagnosis, relying on clinical findings only, overestimating mucous prolapse in 36.37% of cases and underestimating intussusception in 14.22% of cases (with respect to defecography). Defecography is a cost-effective method (average cost: Lit. 37,000) potentially reducing failure rate after the surgical repair of rectal prolapse.

Ambulatory Surgical Procedures↗
PubMed1993

[Quantitative evaluation of blood in vivo with computed tomography].

A positive correlation between the attenuation values of blood in vitro and hemoglobin concentration has been described by other authors. Our study is aimed at: 1) investigating the influence of artifacts on the measurement of blood density in vivo, 2) verifying the possible correlation between blood values and Hounsfield's units (HU) in vivo, 3) assessing whether such a correlation may be useful in calculating hemoglobin concentration, 4) investigating whether a significant difference in blood density exists between normal and anemic subjects, and 5) investigating the eventual borderline density values which separate the two populations. Fifty adult patients underwent CT of the upper abdomen for several clinical reasons. Twenty-six males, mean age 63 +/- 15 SD, and 24 females, mean age 63 +/- 14 SD, were included in our series. The two groups were then subdivided into two additional groups including anemic and normal subjects -14 g/dl and 12 g/dl being taken as the borderline values for males and females, respectively. Blood density was measured after defining two regions of interest (ROI) on the aorta and inferior vena cava. The results show that: 1) there are few image artifacts, which are sometimes detected only because of different numbers in aorta and vena cava; for quantitative blood measurement, 4 HU was considered as an acceptable difference; 2) the correlation between HU and hemoglobin concentration which was found in vitro was also seen in vivo (r = 0.76, p < 0.001). Furthermore, high positive correlation was observed between attenuation values and red cell count (r = 0.68) or hematocrit (r = 0.75). 3) However, this correlation cannot be used to calculate the patients's blood count since HU dispersion relative to the regression line is too high. The straight line of regressed computation, reporting the density values on the abscissa axis, shows a b = 0.33 slope and the intersection point is a = -1.43, SE b = 0.04, SE a = 1.76 and SE estimate = 1.56. When the mean density value was 43 HU in our sample, the expected hemoglobin value was 12.76 g/dl (+/- 1.58 SD). 4) Nonetheless, a significant difference in blood attenuation values was seen between normal subjects and anemic patients (p < 0.001). 5) This difference identifies a borderline density value, below which the patient is sure to be anemic (99% confidence), but nothing else can be said on the patient's normality: the value is 33 HU for females and 36 HU for males. These values allowed 20% of anemic subjects to be correctly identified, versus 5% of the same group detected with diagnosis images.

Aged↗
PubMed1992

Role of oral cholecystography, real-time ultrasound, and CT in evaluation of gallstones and gallbladder function.

The capacity of oral cholecystography (OCG), real-time ultrasound (RUS), and computed tomography (CT) to detect gallstones and to analyze their size, number, and composition was tested preoperatively in 37 patients undergoing elective cholecystectomy. Gallbladder response to a standard meal was also evaluated by OCG and RUS. Gallstones were analyzed chemically for calcium, cholesterol, and bilirubin content. The results show that RUS is the most valuable test for detecting gallstones and is similar to OCG in measuring their size and number, whereas CT underestimates the stone size. Gallbladder function in terms of contractibility can be evaluated by RUS and OCG, but RUS provides useful information even if the gallbladder is not opacified at OCG. CT is more accurate than OCG in detecting the presence of calcium, and CT attenuation numbers are positively correlated with calcium content of the stone (r = 0.87, p less than 0.01).

Cholecystography↗
PubMed1990

[Comparison of a combination of fentanyl and alfentanil with propofol in brief surgery].

We studied 96 patients undergoing short gynecological procedures. Anaesthesia has been induced with fentanyl 1.5 micrograms/kg (45 patients) or alfentanil micrograms /kg (51 patients) and a hypnotic dose of propofol, and maintained with 70% N2O via facial mask. We observed a better and more rapid control of surgical analgesia with alfentanil, and an earlier recovery of postoperative psychophysical functions. Post-induction apnea has been more frequent and prolonged in the alfentanil group, but no difference in the time necessary to recover an adequate ventilation has been observed between the two groups. Alfentanil anaesthesia determined a more marked intraoperative bradycardia. By virtue of the speed of onset and the short duration of action, alfentanil is a suitable anaesthetic agent for short surgical procedures, particularly in day-stay patients.

Adult↗
PubMed1990

[Magnetic resonance angiography of the neck vessels: imaging optimization].

The neck vessels of 60 patients were studied by means of magnetic resonance angiography, with gradient-echo FISP sequences with short TR and TE and with a 25 degrees flip angle. To study arterial neck vessels, sequences were acquired on the coronal and on the sagittal planes, centered on the cricoid. The intracranial tract of the vertebral arteries required axial sequences centered under the floor of the sella turcica. Post-processing was obtained with the maximum intensity projection technique. The coronal and sagittal sequences were rotated on the axial plane from 0 degrees to 180 degrees with 15 degrees interval, while axial sequences were rotated on the sagittal plane from 0 degrees to 180 degrees with the same interval. TR, TE and flip angle values were very important for image quality: the thinner the volumes the more effective resolution power and vessel visualization. These volumes should not exceed 1.5 mm. Axial rotations of coronal sequences from -45 degrees to +45 degrees and of sagittal sequences from 60 degrees to 120 degrees were useful for diagnosis. The intracranial tract of the vertebral arteries was clearly depicted after axial sequences and after 75 degrees and 135 degrees sagittal rotations.

Adult↗
PubMed1989

[Muscular rigidity caused by alfentanil: prevention].

We studied three groups of 30 patients each, undergoing minor orthopaedic surgery, anaesthetized with alfentanil (30 micrograms/kg bolus followed by an infusion of 0.3 micrograms/kg/min), thiopental 3 mg/kg and 70% N2O via facial mask. Patients in group I were treated, three minutes before induction, with vecuronium 0.02 mg/kg i.v., while those in group II were premedicated with diazepam 0.15 mg/kg i.m. 30-45 minutes before induction. Group III served as control. Muscular rigidity was evaluated clinically with a subjective score based on a scale of 0 (no rigidity) to 3 (severe rigidity). Diazepam did not give significant protection from muscular rigidity. Vecuronium administration did not significantly reduced the number of patients who became rigid, but significantly decreased the incidence of severe rigidity (p less than 0.005), the mean rigidity score (p less than 0.05) and the incidence of rigidity at the induction of anaesthesia (p less than 0.0005). We also observed a progressively increasing incidence of rigidity with increasing age (not significantly) and body weight (p less than 0.05 total rigidity, p less than 0.01 severe rigidity).

Adolescent↗
PubMed1989

[Anesthesia for shoulder surgery. Comparison of anesthesiologic problems and technics].

We evaluated the ability of general, regional (interscalene block) and balanced anaesthesia (interscalene block supplemented by general anaesthesia) to manage the problems of shoulder surgery. Our results show that general anaesthesia is not adequate. Interscalene block provides intra and postoperative analgesia, allows an early realization of the postoperative rehabilitation programme and quickens the recovery of shoulder function. Therefore, interscalene block should routinely be performed. The positions of patient and surgeons cause the main disadvantages of anaesthesia with interscalene block alone, ad the control of airway of sedated patients is difficult and performing general anaesthesia in case of insufficient analgesia may be troublesome. Balanced anaesthesia, as compared to regional block alone, allows a safer control of respiration and an easier control of surgical analgesia.

Adult↗
PubMed1989

[Software for record reporting and filing with the personal computer].

During the past four years the authors have been gaining experience in reporting radiological examinations by personal computer. Today they describe the project of a new software which allows the reporting and filing of roentgenograms. This program was realized by a radiologist, using a well known data base management system: dBASE III. The program was shaped to fit the radiologist's needs: it helps to report, and allows to file, radiological data, with the diagnostic codes used by the American College of Radiology. In this paper the authors describe the data base structure and indicate the software functions which make its use possible. Thus, this paper is not aimed at advertising a new reporting program, but at demonstrating how the radiologist can himself manage some aspects of his work with the help of a personal computer.

Database Management Systems↗
PubMedDate not supplied

Premature contraction of the cricopharyngeus: a new sign of gastroesophageal reflux disease.

BACKGROUND: A cricopharyngeal bar seen on barium fluoroscopy has been shown to be related to the presence of gastroesophageal reflux (GER). We investigated premature contraction of the cricopharyngeus (PCC) muscle, which may be a precursor of a fixed cricopharyngeal bar, to assess its significance in GER. METHODS: The prevalence of PCC on barium swallow was recorded in three groups: (1) 83 patients with non-cardiac chest pain who were investigated for possible GER; (2) 21 patients with severe GER undergoing fundoplication; and (3) 25 normal controls. RESULTS: Group 1: PCC was observed in 42 of 77 with documented GER (54.5%), and in two of six patients without GER. Group 2: PCC was present in 11 of 21 fundoplication subjects. Group 3: PCC was seen in five of 25 normal controls. The incidence of PCC in patients with GER was statistically significantly higher than in normal subjects (p = 0.002). The sensitivity of the presence of PCC as a predictor of GER is only 0.54, but the specificity is 0.774, with a positive predictive value of 0.883. CONCLUSION: We conclude that observing premature cricopharyngeal contraction during the first swallows of an upper gastrointestinal (GI) study should direct attention to the possibility of GER.

Barium Sulfate↗
PubMedDate not supplied

[Hepatic steatosis: combined echography-computerized tomography imaging].

The authors report their experience with the combined use of US and CT in the study of diffuse and subtotal fatty infiltration of the liver. An apparent disagreement was initially found between the two examinations in the study of fatty infiltration. Fifty-five patients were studied with US and CT of the upper abdomen, as suggested by clinics. US showed normal liver echogenicity in 30 patients and diffuse increased echogenicity (bright liver) in 25 cases. In 5 patients with bright liver, US demonstrated a solitary hypoechoic area, appearing as a "skip area", in the quadrate lobe. In 2 patients with bright liver, the hypoechoic area was seen in the right lobe and exhibited no typical US features of "skip area". Bright liver was quantified by measuring CT density of both liver and spleen. The relative attenuation values of spleen and liver were compared on plain and enhanced CT scans. In 5 cases with a hypoechoic area in the right lobe, CT findings were suggestive of hemangioma. A good correlation was found between bright liver and CT attenuation values, which decrease with increasing fat content of the liver. Moreover, CT attenuation values confirmed US findings in the study of typical "skip areas", by demonstrating normal density--which suggests that CT can characterize normal tissue in atypical "skip areas".

Aged↗
PubMedDate not supplied

[Image diagnosis and Doppler ultrasound in the functional study of portal circulation].

The authors, after mentioning physiologic appearance of portal circulation and physical principles governing the interrelationship of pressure, flow and flow velocity in blood vessels, report the results of a study about trend of haemodynamic values in 23 normal subjects and 13 cirrhotic patients. Values of portal blood flow and fluid speed were measured using a pulsed "Linear-Doppler" system, before and after dinner. Statistical analysis of results proves the diagnostic value of examination that appears qualified as the method of first choice in the patients with suspected changes of portal circulation.

Blood Flow Velocity↗
PubMedDate not supplied

[Computerized tomography in the diagnosis and follow-up of 3 cases of primary suprasellar germinoma].

Three cases of primitive suprasellar germinomas are reported: the tumors show typical clinical signs (diabetes insipidus, visual disturbances and anterior pituitary dysfunctions), but CT findings are not so specific. It is very important to reach a correct diagnosis based on clinical and radiological findings, because of a very high radiosensibility of the tumor. The accuracy of preoperative diagnosis has been enhanced by CT in addition to conventional neuroradiological examinations. Due to the possible risk of meningeal spreading following biopsy, some authors prefer to avoid biopsy and to treat directly the patient by radiotherapy; a rapid reduction of the tumor size at the dose of 30 Gy suggests a possible germinoma.

Adolescent↗