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Biomedical subjects

E Fanucci

Publications and source records attributed to E Fanucci.

At least 19 recordsLinked to original sources

[The use of the single-pulse RARE sequence in the study of the cerebrospinal axis].

The authors describe a fast MR sequence allowing to obtain a myelographic-like, markedly T2-weighted, image quite similar to conventional myelographies. Relative to conventional spin-echo sequences, in which echoes are encoded so as to achieve the same phase, each echo of the sequence here employed is given a different phase encoding. The sequence, called MYUR (myelography-urography) is based on the generation, after a 90 degrees pulse, of a "train" of 256 echoes, each one phase-encoded differently, by multiple 180 degrees pulses, producing a single image. The total duration of such a sequence, with 2 repetitions, is 21 seconds. The MR myelographic sequence allows to univocally study tissues with a very long T2 relaxation time; under normal conditions, only cerebrospinal fluid, urine and bile are demonstrated. A resistive MR unit operating at 0.28 T was employed in the present study. MR myelography is capable of pointing out an eventual dural sac compression or a space-occupying mass, thus allowing an effective scout-view to center the subsequent pulse sequences; all MR-myelographic exams need to be completed with other short and long TR sequences.

Brain

[Vascular radiology and physics of fluids].

In the cardiovascular system, morphology and functionality are closely related. The observation that atherosclerotic lesions appear with different incidence in the various sites and prefer bifurcations, suggested that vascular architecture might be an important pathogenic factor. Vascular geometry deals with the evaluation of the "form" element from a theoretical point of a view, pointing out the angles and diameters which can make the arterial system physiologically more efficient. The key element of the system is the bifurcation: depending on whether bifurcations are considered as a single entity or as a whole, either "local" or "global" geometry is employed. The morphology of the bifurcation directly affects blood flow patterns, influencing both blood flow velocity and wall shear stress. Experimental studies evidenced that high blood flow velocities and low wall shear stress have, respectively, a preventive or favorable role in atheroma development. By observing these altered flow sites, the areas which are most likely to develop atherosclerotic damage have been detected in the various bifurcations; the areas correspond to angiographic and autoptic findings. Based on their experience, the authors discuss the contribution that the different imaging techniques can give to the study of vascular geometry.

Angiography

[Oral contrast media in the study of the esophagus with magnetic resonance. Proposal of a new preparation].

The major problem in MRI of the esophagus is the lack of a reliable oral contrast agent. To determine the value of Gd-DTPA as an oral contrast medium for the esophagus as a part of phase III clinical trial, 17 patients (10 esophageal neoplasms, 4 neoplasms of the pharyngo-laryngeal tract, 3 Zenker's diverticula) underwent MRI. The oral contrast medium is proposed in a new preparation: 5 cc of oral Gd-DTPA were emulsionated with 30 g of a low-density barium paste for esophageal CT (3% p/v). High signal intensity in the esophageal lumen was observed in all patients and in all sequences. In neoplastic lesions, the c.m. improved the definition of both the level of stenosis and the longitudinal extent of the lesion. In diverticula, the real and the false lumen could be demonstrated. In one patient the exam could not be completed. No adverse reactions were observed.

Administration, Oral

[Preoperative staging and recurrence of rectal tumors. Comparison of transrectal ultrasonography and magnetic resonance].

The accuracy of transrectal US (TRUS) and of MRI was evaluated in the preoperative staging and in local recurrences of rectal cancers. Fifty-four patients were examined: 45, with known rectal cancer, for preoperative staging, and 9 for the evaluation of local recurrences. Nineteen patients were examined with MRI in basal conditions, 21 after rectal air enema and 5 after paramagnetic contrast enema (Gd-DTPA). The following parameters were evaluated for preoperative staging: wall infiltration, invasion of perirectal fat and adjacent structures, lymph node involvement. Morphologic and signal intensity (on MRI) changes were evaluated for the diagnosis of local recurrences. TRUS provided 2 false positives. In the same patients, basal MRI results were poor, owing to difficult demonstration of the different wall layers, while in the patients studied after air enema, the lesion was hyperintense. In 20 patients with a fat-infiltrating tumor, TRUS provided 3 false negatives and 2 false positives; basal MRI yielded poor results, while air enema and paramagnetic contrast enema clearly demonstrated all fat-infiltrating lesions, with only one false positive.

Air

[Role of computerized tomography in endosseous implantology].

The Authors are proposing the use of computerized tomography for the evaluation of osseous structures of the maxilla and mandible before installation of titanium fixtures. The results indicate that the CT scan can give information about the structure and bone density. The height and the width of the alveolar osseous crests and the relationship with the incisive canal and the mandibular canal are clearly demonstrated. The CT scan can facilitate the measurement of the space available in order to install the titanium fixtures.

Alveolar Process

[Dynamic study of oro-pharyngeal deglutition].

Oropharyngeal swallowing is too fast and complex a motion for the human eye to seize its various phases and subsequently evaluate morphology and function of the anatomical structures involved. A chronological subdivision of the swallowing act is needed for a step-by-step analysis. Dynamic evaluation of oropharyngeal swallowing by means of fluoroscopic and US videorecording proved to be a reliable method. Echovideorecording allowed tongue movements to be depicted, together with bolus formation and propulsion. Fluorovideorecording (U-matic Sony unit, 25-30 images/sec) demonstrated pharyngeal and esophageal phases. A series of chronological and morphological reference points, which characterize oropharyngeal swallowing, were employed to analyze videorecorded images. Slow-motion mode, "freezed" images, and rewinding allowed an easy and accurate evaluation of swallowing details. Combined chronological and morphological pieces of information allow a comprehensive evaluation of the swallowing act.

Deglutition

Optimal branching of human arterial bifurcations.

The area ratio, defined as the combined cross-sectional areas of the daughter branches divided by that of the parent artery, is an important indicator of "expansion" or "narrowing" in an arterial tree. In 120 morphologically normal human arterial bifurcations, angiographically studied, we measured branch artery diameters at and away from the bifurcation point to obtain "beta" and "D" ratios, respectively. These results were compared with optimal curves. Area ratio D values showed better agreement than area ratio beta with theoretical curves; for area ratio D, the positive regression line showed the same trend as expected from theory (y = 1.26 + 0.153x); for area ratio beta, the regression line was negative, showing a trend opposite to theory (y = 0.962 - 0.191x). Area ratio beta showed a significant correlation coefficient (r = 0.194; P less than 0.05) associated with aging, while for area ratio D it was not the same (r = 0.023; P less than 0.05). A significant correlation coefficient was also found between both of the area ratios and total branching angle. The new area ratio D, reflecting the branching geometry nearer to the bifurcation, is more promising than area ratio beta in the evaluation of optimal arterial bifurcation.

Adolescent

[Diverticula of the pharyngoesophageal area].

Hypopharyngeal diverticula are relatively unknown, with the exception of Zenker's diverticulum. Spot-camera and videorecording techniques were employed for the examination of 95 dysphagic and 250 asymptomatic patients. On the whole, 345 cases. 40% of diverticula were found in dysphagic patients, and 14% in asymptomatic ones. Fifty diverticula were detected through the thyrohyoid membrane, and 14 pseudodiverticula, 4 Zenker's diverticula, 4 lateral diverticula at the pharyngoesophageal junction, and 2 outpouchings through the tonsillar fossa. A statistically significant correlation (p less than 0.001) with dysphagia was demonstrated only for diverticula through the thyrohyoid membrane. Most pathologic findings were associated with other swallowing dysfunctions.

Adolescent

The vascular geometry of human arterial bifurcations.

We used angiography to evaluate the branching characteristics of 69 morphologically normal human arterial bifurcations. Each angiographic picture was enlarged photographically and traced on paper. The diameter of the parent vessel (d0), the diameters of the two daughter vessels (d1 and d2-d1 denote the larger vessel), and the angles at which the two branches arise from the parent vessel (teta 1 and teta 2) were measured on each bifurcation. Because theoretically there are optimal values for angles and diameters that render an arterial bifurcation more efficient physiologically, the measured data were compared with predicted values. Branch diameters correlated better with predicted values than did branching angles. Twenty-six per cent of teta 1 and only 7.2% of teta 2 angles were within the optimal range; 68.2% of teta 1 and 79.7% of teta 2 were within 2% of optimal values in terms of physiologic efficiency. On the average, teta 1 angles were smaller than teta 2 angles (17.0 degrees vs. 29.5 degrees). Morphologic and hemodynamic pecularities of vessels and errors in the measuring technique must be considered in analyzing the data obtained. Moreover, branching angle measurements changed slightly with age: teta 1 became larger and teta 2 narrower. In the cardiovascular system branching angles and branch diameters follow, to some degree, the principles predicted by theory. Branching angles diverging considerably from those principles may indicate the presence of vascular disease although a direct connection has not been established.

Adolescent

Normal small-bowel measurements by enteroclysis.

Small-bowel length, number and thickness of folds in the jejunum and ileum, diameter of the loops, and thickness of the bowel wall were measured on double-contrast small-bowel enema radiographs, obtained from 182 patients with no jejunal or ileal morphologic abnormalities. The length of the small bowel ranged from 160 to 430 cm, with an average length of 291 cm. No correlation was observed between the number of folds and the total length.

Adult

[Indications for enteroclysis. Retrospective study on 365 patients].

Small-bowel enema was performed in 536 patients referred for suspected malabsorption, enteritis, abdominal pain or obstruction. Lesions were found in 54% of cases. The positivity of the investigation was particularly high in clinically well-defined cases, such as suspected obstruction (80%) and enteritis (72%). The main indications and criteria of application of the investigation are discussed.

Abdomen, Acute

[Use of digital subtraction angiography in the study of thoracic outlet syndrome].

Thoracic outlet syndrome (TOS) is characterized by neural and vascular symptoms of the upper extremity, caused by abnormal compression on the brachial plexus, subclavian-axillary artery and/or vein, when the patient makes some movements. Compression can occur on various anatomic levels: interscalene triangle, costoclavicular passage, pectoralis minor tendon. The authors describe the various stress position to point out the place of compression, etiology and the most common methods of study. They refer also their experience about TOS obtained using selective digital subtraction angiography (DSA) of both subclavian arteries in 6 patients. Thanks to DSA, that allows the dilution of contrast medium, it is possible to carry out all the stress maneuvers using a little amount of contrast medium.

Adolescent

[Role and possibility of intravenous digital substraction angiography in problems of renal transplantation].

Intravenous Digital Subtraction Angiography (IVDSA) was used to evaluate 6 renal allograft recipients and 3 potential renal donors. In 4 potential renal donors and in 2 allograft recipients, angiographic data were confirmed by surgery. IVDSA is a safe, accurate, easily performed, outpatient procedure; in our opinion DSA should became the procedure of choice to study vascular anatomy in renal transplant evaluation.

Angiography

[Morphological lesions of the choledochus studied with combined percutaneous transhepatic cholangiography and hypotonic duodenography].

Twenty two patients obstructive jaundice were investigated by combined fine needle percutaneous cholangiography and hypotonic duodenography. The association of the two techniques enables prompt localization of the site of obstruction and definition of the nature of the lesion. It proves to be of particular use in the differential diagnosis of carcinoma of the head of the pancreas, carcinoma of the distal choledochus and carcinoma of the socalled choledochoduodenal junction.

Bile Duct Neoplasms