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Biomedical subjects

E M Di Maggio

Publications and source records attributed to E M Di Maggio.

At least 19 recordsLinked to original sources
PubMed1998

Spiral CT angiography and surgical correlations in the evaluation of intracranial aneurysms.

We investigated the accuracy of spiral computed tomography angiography (CTA) in the detection and study of intracranial aneurysms by comparing CTA with selective angiograms and surgical findings. Twenty-six patients (9 men and 17 women; mean age 53.1 +/- 1.8 years) with suspected intracranial aneurysms were submitted to CTA (1- to 2-mm slices, pitch 1:1, 24 s, RI = 1) after a conventional CT examination showing subarachnoid hemorrhage (SAH) in 19 cases and during neuroradiological investigations performed for other reasons in 7 cases. One hundred twenty to 150 ml iodate contrast agent (0.3-0.4 gI/ml) were injected intravenously at 5 ml/s rate and with 12- to 25-s delay calculated with a preliminary test bolus. Three-dimensional shaded surface display (3D SSD) and maximum intensity projection (MIP) reconstructions were obtained from axial images. Then, within 48 h, all patients were submitted to digital subtraction angiography (DSA), with separate assessment of CTA and DSA findings. Twenty-two aneurysms shown by CTA were confirmed at DSA and surgery (true positives), whereas the vascular lesion was not confirmed at DSA in 2 cases (false positives). The presence of intracranial aneurysms was excluded at both CTA and subsequent DSA in 7 cases (true negatives) and there were no false negatives; sensitivity was 100 %, specificity 77.8 %, and diagnostic accuracy 93.5 %. Computed tomography angiography aneurysm location was confirmed at surgery in all cases, with very high accuracy in assessing the presence of an aneurysm neck (100 %). Computed tomography angiography accurately depicted the aneurysm shape in 20 of 22 cases, but failed to depict its multilobed nature in 2 cases. The mean aneurysm diameter calculated at CTA was 0.99 +/- 0.12 cm vs 1.09 +/- 0.11 cm at surgery (p < 0.01). The present results suggest that the high sensitivity of CTA, if confirmed by further studies, might help in avoiding having to resort to arteriography after negative CTA in SAH patients.

Adult↗
PubMed1998

[Complex maxillofacial trauma: diagnostic contribution of multiplanar and tridimensional spiral CT imaging].

INTRODUCTION: Adequate radiologic assessment of the maxillofacial trauma patient is the basis for planning reparative surgery. We investigated the yield of the integration of axial CT with multiplanar (MP) and three-dimensional (3D) reconstructions with the Spiral technique. MATERIAL AND METHODS: Thirty-five patients (21 men and 14 women, mean age: 31.2 years) with complex maxillofacial traumas were submitted to Spiral CT. Images were acquired with 2-3-mm collimation, 1:1 to 2:1 pitch, 210 mAs, 120 kV, 15-24 s Spiral scan, RI = 1. 3D reconstructions were always obtained and used to guide MPRs targeted on the single injury. The examinations were retrospectively given a score, namely 1 if 3D and MPR yielded no more important diagnostic information than axial CT, 2 if 3D and MPR permitted better detailing of some axial CT findings and thus improved image reading, and 3 if 3D and MPR showed new injuries missed on axial images. Then, a radiologist and a maxillofacial surgeon reviewed the 3D images together only to assess in which cases they were useful to optimize surgical planning. RESULTS: Nine cases (25.7%) scored 1, seventeen (48.6%) scored 2 and nine (25.7%) scored 3. MP and 3D reconstructions were useful or determinant (2 + 3) in over 74% of cases. 3D images made surgical planning easier in 15 of 32 surgical patients (46.8%), allowing the surgeon a better panoramic view of the complex fracture. CONCLUSIONS: The greatest advantage of multiplanar imaging is the improved depiction of skeletal injuries along a horizontal plane, paralleling that of axial scans. The depiction of fractures of cribrum and of orbital roof and floor was particularly useful from a clinical viewpoint. MPRs clearly depicted herniation and incarceration of the lower rectus muscle in blow-out fractures. MP and 3D reconstructions better defined the presence and grade of displaced bone fragments in nearly vertical structures, such as the upward branches and coronoid apophysis of the mandible. 3D images alone never showed any more fractures than those seen on axial and MP images. 3D images are especially useful to the surgeon because they permit the panoramic depiction of the fracture complex, which facilitates treatment planning. The radiologist can use 3D reconstructions to guide the acquisition of targeted MP reconstructions, for better diagnostic yield. The Spiral technique, with its pitch increases up to 2, permits to limit the radiation dose while preserving the quality of postprocessing reconstructions. Finally, decreasing the execution time is important in multiple trauma patients who are often clinically unstable or have damaged vital organs.

Adult↗
PubMed1997

Spiral CT findings in a case of pulmonary sequestration.

Pulmonary sequestration has always been diagnosed by direct demonstration of the vessels tributary to the lesion, usually by angiography. Conventional CT can identify the arterial supply in only two thirds of cases. We report a case of pulmonary sequestration diagnosed using Spiral CT, based on the demonstration of both arterial supply and venous drainage. The capabilities of Spiral CT to detect subtle vessel abnormalities and to yield reliable multiplanar imaging enabled us to show the whole course of both the artery and the vein tributary to the lesion. Axial images were the most useful ones to diagnose pulmonary sequestration; 2D and 3D reconstructions were useful for a detailed and immediate spatial depiction of the parenchymal abnormality and of its vascular pedicle.

Bronchopulmonary Sequestration↗
PubMed1997

Communicating bicornuate uterus with double cervix and septate vagina: an uncommon malformation diagnosed with MR imaging.

We report a case of communicating uterus diagnosed with MRI. These uterine malformations are characterized by a communicating tract between two separate uterocervical cavities, which is usually detected with hysterosalpingography performed for a suspected uterine malformation. In our patient MRI was performed after the clinical finding of a double cervix and a vaginal septum and demonstrated two separate uterine cavities, each of them with its own junctional area, and an isthmian transverse communicating tract with endometrial tissue inside, which helped make the diagnosis of a type-4 a communicating uterus according to Toaff.

Adult↗
PubMed1997

The use of spiral computed tomography in the localization of impacted maxillary canines.

PURPOSE: To compare spiral CT with conventional radiography in planning the orthodontic treatment of impacted permanent maxillary canines. METHODS: Nineteen patients with 29 malpositioned permanent maxillary canines (15 palatal and 12 buccal impactions, one ectopic and one transposition) were examined with conventional panoramic and lateral cephalometric radiography and with spiral CT (at 1 mm slice thickness, and 1:1 or 2:1 pitch) using multiplanar (MPR) and 3D reconstruction. RESULTS: Conventional radiography failed to depict root resorption especially on the buccal surfaces of the incisor teeth. CT located impacted teeth better. Contact between impacted maxillary canines and incisor roots was demonstrated in 26 cases and root resorption in eight. MPR proved to be superior for the orientation of impacted teeth, and, in two cases, confirmed the presence of minimal root lesions for which axial images had proved inconclusive. The 3D reconstructions were useful in targeting the MPR. CONCLUSIONS: CT facilitates the treatment of impacted canine especially when the teeth are very oblique to the arch. Root resorption is better demonstrated especially on the palatal and buccal surfaces of the adjacent incisors. Spiral CT reduces examination time and risk of accidental movement, thus optimizing MPR quality. Examination at 2:1 pitch enables a significant reduction in radiation exposure without loss of image quality.

Adolescent↗
PubMed1997

Use of spiral computed tomography for multiplanar dental reconstruction.

OBJECTIVE: To compare spiral with conventional CT for multiplanar reconstruction (MPR) prior to dental implant placement. METHODS: Ten patients underwent conventional and then Spiral CT at 1 mm slice thickness. In six patients (Group A) the pitch was 1:1; the other four (Group B) it was 2:1. Image quality and clinical features were evaluated separately on axial and reconstructed images by two experienced radiologists who scored each parameter from 1 (poor, non-diagnostic) to 3 (good, diagnostic). RESULTS: Loss of spatial resolution with spiral CT was not significant and the diagnostic yield poorer only for trabecular bone structure. The MPRs were better and depiction of the mandibular canal more reliable. CONCLUSIONS: We recommend the use of spiral CT instead of conventional CT for dental MPR because examination time is shorter and patient comfort is improved. Use of a pitch of 2:1 permits a marked reduction in X-ray dose with no loss of image quality.

Aged↗
PubMed1997

Infusion of donor-derived peripheral blood leukocytes after transplantation of cord blood progenitor cells can increase the graft-versus-leukaemia effect.

We describe the case of a child affected by acute lymphoblastic leukaemia who received adoptive immunotherapy after cord blood transplantation (CBT). The patient, transplanted in second relapse resistant to chemotherapy, still showed lung and costal leukaemic nodular lesions 2 months after CBT. For this reason, three infusions of donor peripheral blood leukocytes 1 x 10(7)/kg each were administered on days +60, +80 and +100. The procedure was well tolerated by both patient and donor, and a complete disappearance of the lung lesions was documented 2 months after the last infusion. The patient remains in continuous complete haematological remission 13 months after CBT. This experience suggests that adoptive immunotherapy may be safely employed after CBT in order to increase the contribution of immune-mediated anti-leukaemia effect.

Adoptive Transfer↗
PubMed1997

Meningeal carcinomatosis in patient with esophagus adenocarcinoma.

Meningeal carcinomatosis (MC) is an uncommon from of metastasis of solid tumors. We reported a clinical case of a woman with esophagus adenocarcinoma that a few months after surgical operation, presented episodes of vomiting, nausea, hypertension, mental change, unconsiousness; A contrast-enhanced CT of the brain revealed an "area of enhancement in the caudate nucleus" and cerebrospinal fluid cytologic studies evidenced the presence of carcinomatous cells. The clinical state of the patient deteriorated and she died a few days later. Autopsy confirmed meningeal carcinomatosis without parenchymal involvement.

Adenocarcinoma↗
PubMed1997

Clinical usefulness of CT in the treatment of stage I endometrial carcinoma.

This retrospective study was aimed at assessing Computed Tomography (CT) capabilities in identifying low- and high-risk groups of clinical stage I endometrial carcinoma patients. CT of the pelvis was performed on 125 endometrial carcinoma patients who were divided into two groups based on T (stage and depth of myometrial invasion) and N (lymph node status) parameters. All patients had histologic evidence of well/moderately-differentiated adenocarcinoma (G1-G2). The low-risk group consisted of stage I patients with superficial myometrial involvement and no lymphadenopathy, while the high-risk group consisted of the patients with deep myometrial invasion and/or stage II and/or positive lymph nodes. All patients were operated on-i.e., total abdominal hysterectomy with vaginal cuff, bilateral salpingo-oophorectomy and pelvic lymphadenectomy. The patients were followed-up for 36 months at least. On the basis of CT findings, 85 patients were included in the low-risk group, but 11 misstaged cases were found at surgery in which lymphadenectomy never changed the factor risk. Only four relapses (4.7%) were observed in this group. Forty patients were included in the high-risk group: CT misstaged 20 cases and 12 relapses (30%) were observed. This study demonstrates the clinical value of CT in the assessment of radiologic risk factors in stage I endometrial carcinoma; CT findings can be used as guidelines for different treatments.

Adenocarcinoma↗
PubMed1997

[Rationalization of the use of preoperative thoracic radiography in obstetrics and gynecology].

INTRODUCTION: Rationalizing preoperative chest radiography remains a problem in our Country. Therefore, we tried to use preoperative chest films rationally in obstetrics and gynecology to assess their impact on anesthesia planning and patient management and their use in early postoperative complications. MATERIAL AND METHODS: We examined two groups of patients: group A consisted of 570 women (mean age: 31 years) scheduled to be submitted to cesarean section but with no preoperative chest radiography; group B consisted of 471 patients (homogeneous in age to group A patients) submitted to nononcologic gynecologic surgery and with a single-projection preoperative chest radiograph. Anesthesiologic assessment, preoperative biochemical tests and EKG were performed in all patients. All patients underwent abdominal surgery under general anesthesia. The first 24 postoperative hours were monitored for possible anesthesia-related complications. The anesthesiologist need of chest radiography based on clinical findings was investigated in group A patients, as well as the importance of chest film findings in possible anesthesia-related complications. RESULTS: Group A and group B were homogeneous by mean patient age and anesthesia duration; clinical findings never suggested the need of chest radiography in group A patients. Three cardiorespiratory complications occurred (two respiratory arrests in group A and a gas embolism in group B), but the (un)availability of chest film findings made no difference in treatment. DISCUSSION: The availability of the preoperative chest radiographs of a group of healthy women of 31 years mean age does not make any difference in anesthesia planning and type. In our series, the most severe cardiorespiratory complications were homogeneous in the two groups, which confirms their random character, and the (un)availability of preoperative chest film findings made no real difference, even though the lack of radiographic evidence made patient management more demanding for anesthesiologists.

Abdomen↗
PubMed1995

[Spiral computerized tomography with tridimensional reconstruction (spiral 3D CT) in the study of maxillofacial pathology].

Three dimensional computer reconstruction of CT scans provide head and neck surgeons with an exciting interactive display of clinical anatomy. The 3D CT reconstruction of complex maxillo facial anatomic parts permits a more specific preoperative analysis and surgical planning. Its delineation of disease extension aids the surgeon in developing his own mental three-dimensional image of the regional morphology. Three-dimensional CT permits a clearer perception of the extent of fracture comminution and resulting displacement of fragments. In the case of maxillo-facial tumors, 3D images provide a very clear picture of the extent of erosion involving the adjacent critical organs. Three-dimensional imaging in first generation 3D scanners did have some limitations such as long reconstruction times and inadequate resolution. Subsequent generations, in particular the spiral 3D CT, have eliminated these drawbacks. Furthermore, costs are comparable with those of other computer reconstruction technology that might provide similar images. Representative cases demonstrating the use of 3D CT in maxillofacial surgery and its benefits in planning surgery are discussed.

Adenocarcinoma↗