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Biomedical subjects

E Rimondi

Publications and source records attributed to E Rimondi.

At least 19 recordsLinked to original sources
PubMed2006

Pulmonary nodules in osteosarcoma patients: differential diagnosis of central venous catheter-related infections in the lungs.

PURPOSE: The purpose of this study was to evaluate the differential diagnosis of pulmonary nodules by conventional radiography and computed tomography (CT) in osteosarcoma patients with central venous catheter. MATERIALS AND METHODS: Between March 1997 and December 2001 at our Department of Musculoskeletal Oncology, 231 patients with peripheral osteosarcoma received a central venous catheter to allow infusion therapy and blood sampling. The mean age of these patients was 16 years (range 4-63), and 90 were aged 15 years or younger. All patients underwent radiological investigation for tumour staging and comparison with the following study in accordance with the protocol in place at our Department of Oncology and Division of Diagnostic Imaging. RESULTS: Of a total of 231 patients, 13 (5.6%) developed an infection of the central venous line, with fever that was very high in some cases. In ten cases (4.3%), radiology showed damage to the alveolar interstitium typical of inflammatory forms, whereas in the remaining three (1.3%) it depicted nodular opacities, which required differentiation between lung metastases and septic emboli. After appropriate antibiotic and replacement of the central venous line, CT demonstrated disappearance of the lung nodules in all three patients, enabling a diagnosis of nodular septic embolism. CONCLUSIONS: Placement of a central venous catheter for infusion therapy, chemotherapy and blood sampling has improved the quality of life of cancer patients. The most common complications of the use of central venous catheters include infection and venous thrombosis whereas pulmonary septic emboli are rare.

Adolescent↗
PubMed2005

Radiofrequency thermoablation of primary non-spinal osteoid osteoma: optimization of the procedure.

Osteoid osteoma is a small benign tumor that requires treatment due to the intense pain it causes. Surgical therapy has been the ablative technique of choice after a failure of medical therapy. Recently, numerous less invasive, alternative procedures have been proposed: drill trepanation with or without ethanol injections, cryoablation, and thermoablation with laser or radiofrequency. The aim of this review is to retrospectively assess the effect of radiofrequency (RF) thermoablation in the treatment of primary non-spinal osteoid osteoma. From June 2001 to July 2003, we treated 106 patients affected by osteoid osteoma with RF thermoablation. Five patients with spinal osteoid osteoma and four with a previously treated osteoma were excluded from the study. In this paper, we assess the results obtained in a selected group of 97 primary non-spinal osteoid osteoma. The lesions were predominantly in the metaphysics of the femur. Central nidus calcifications were frequent and there was no prevalence for which side they occurred. Primary success was achieved in 82 patients (85%), while we obtained secondary success in 15 patients (15%). In two patients (2%), pain persisted between the two treatments and failed to be resolved, even after the second treatment; therefore, surgical excision was performed and complete resolution was obtained. No complications were reported. In conclusion, our results confirm that the treatment of choice for non-spinal osteoid osteoma is RF thermoablation, offering several advantages over ablative techniques.

Adolescent↗
PubMed2004

TRAIL promotes the survival, migration and proliferation of vascular smooth muscle cells.

Human and rat primary sub-cultured vascular smooth muscle cells (VSMCs) showed clear expression of the death receptors TRAIL-R1 and TRAIL-R2; however, recombinant soluble TRAIL did not induce cell death when added to these cells. TRAIL tended to protect rat VSMCs from apoptosis induced either by inflammatory cytokines tumor necrosis factor-alpha + interleukin-1beta + interferon-gamma or by prolonged serum withdrawal, and promoted a significant increase in VSMC proliferation and migration. Of note, all the biological effects induced by TRAIL were significantly inhibited by pharmacological inhibitors of the ERK pathway. Western blot analysis consistently showed that TRAIL induced a significant activation of ERK1/2, and a much weaker phosphorylation of Akt, while it did not affect the p38/MAPK pathway. Taken together, these data strengthen the notion that the TRAIL/TRAIL-R system likely plays a role in the biology of the vascular system by affecting the survival, migration and proliferation of VSMCs.

Animals↗
PubMed2004

Experience of the Rizzoli Institute in radiofrequency thermal ablation of musculoskeletal lesions.

Thermal ablation with radiofrequency (RF) is gaining increasing attention for the treatment of musculoskeletal lesions. This treatment offers several advantages compared to other methods: reduced invasiveness, low cost, and short hospitalisation time. In June 2001 we began using RF thermal ablation on osteoid osteomas (OO) in the appendicular and axial skeleton. Later, we also treated local benign and/or malignant tumors, some surgical recurrences, and some secondary localizations. Altogether we have performed over 270 procedures, mainly on OO. The experience we have gained has led us to think that the indication for this treatment can be extended to other thermosensitive lesions.

Bone Neoplasms↗
PubMed2000

[Computerized tomography assessment of femoral and tibial rotation in total knee prosthesis].

PURPOSE: CT assessment of the axial deviation of the femoral and tibial prosthetic components in total knee arthroplasty. MATERIAL AND METHODS: January to July 1999, seventeen patients, 10 males and 7 females, mean age 66 years (standard deviation +/- 4) were examined after total knee arthroplasty. Exclusion criteria were prosthesis loosening and severe (equal or superior to 7 degrees) varus or valgus deviation. All patients were examined with knee radiography in the standing position completed by axial projections of patella and by CT scanning. We used a modification of Berger technique and carried out comparative CT scans extended lower limbs and acquisitions perpendicular to the mechanical axis of the knee, from the femoral supracondylar region down to the plane crossing the distal end of the tibial prosthetic component. Reference lines were then drawn electronically on given scanning planes to reckon the axial deviation of the femoral and tibial prosthetic components. RESULTS: Six patients, one female and 5 males, with normal rotational values of femoral and tibial prosthetic components presented no clinical symptoms. Eight patients, 4 females and 4 males, with abnormal values presented the following clinical symptoms: medial impingement, (incomplete) dislocation patella, and lateral instability. One female patient with a normal rotational value of femoral prosthetic component and an altered value of tibial prosthetic component presented medial impingement. Finally two patients, one female and one male, were absolutely asymptomatic although the rotational values of the two prosthetic components were beyond the normal range. CONCLUSIONS: Total knee arthroplasty is presently a standard treatment for many conditions involving this joint. There are several possible postoperative complications, namely fractures, dislocations (a)septic loosening and femoropatellar instability. The latter condition is the most frequent complication among implant failures and is caused by bad orientation of the femoral and tibial components on frontal and axial planes. We measured the orientation of the prosthetic components introducing a CT procedure which modifies the uniarticular with four scans introduced by Berger. The new method uses Berger's parameters and the CT study of both joints by means of Helical CT. With a single examination lasting less than 4 minutes and with the patient in a more comfortable position, we can obtain: 1) comparative and simultaneous assessment of the contralateral joint; 2) several scans to better define Berger's parameters and to accomplish measurement of the rotational deviation with higher precision and markedly decreasing the error margin. The analysis of the results confirms the international literature findings and especially the fundamental importance in positioning both prosthetic components within normal values, as emphasized by the relationship between the clinical symptoms and the rotational degree of the femoral and tibial prosthetic components.

Aged↗
PubMed1998

[Significance of three-compartment digitalized arthrography in the diagnosis of post-traumatic instability of the radiocarpal complex].

INTRODUCTION: The radiocarpal complex is the structure formed by the distal radioulnar, radiocarpal and midcarpal joints; these joints are compartments, each anatomically separated from the other. An appropriate arthrographic study with three-compartment injection better demonstrates the capsuloligamentous structures than conventional radiography. The diagnosis of any condition in this complex may therefore be easier to make. MATERIAL AND METHODS: From January 1993 to December 1996, twenty-six patients with mild to moderate wrist and carpal sprain and previously examined with radiography, were submitted to digital three-compartment arthrography at the Imaging Diagnostic Service of the Rizzoli Orthopedic Institute. Of 17 patients with previous radiographic diagnosis of scapholunar diastasis, 1 patient had a negative radiographic picture, 15 had an incomplete tear of the scapholunar ligament and 1 a double injury of the scapholunar and triquetro-lunar ligaments. Of 10 patients with mild to moderate triquetro-lunar diastasis, 8 had and arthrographic picture of pyramido-lunar ligament injury, 1 had a double injury of the triquetro-lunar and scapholunar ligaments and another one of triangular fibrocartilage complex injury. RESULTS: Three-compartment contrast agent injection permitted the diagnosis of interruptions between the different compartments and more injuries of scapholunar and triquetro-lunar ligaments than single compartment injection. We examined 27 patients with small arch injuries with three-compartment digital arthrography and found scapholunar diastasis in 17 (63%) and triquetro-lunar diastasis in 10 (37%). In the first group of 17 patients, three-compartment arthography demonstrated more scapholunar ligament injuries (13 cases) than single compartment injection; image subtraction, allowed by the digital technique, showed 2 injuries not visible otherwise. Injuries of the scapholunar and triquetro-lunar ligaments were demonstrated with and without digital subtraction. One patient had no ligament injury. In the other group of 10 patients, three-compartment arthrography showed more triquetro-lunar ligament injuries (6 cases) than single compartment injection; image subtraction demonstrated 2 injuries not visible otherwise in this group too. Injuries of the scapholunar and triquetro-lunar ligaments were demonstrated with and without digital subtraction. The injury of triangular fibrocartilage and contrast agent leak into soft tissues were shown in one patient with the injection of the distal radioulnar compartment alone, regardless of image subtraction. CONCLUSIONS: Arthrography, combined with conventional static and dynamic radiography, increases the detection rate of capsuloligament joint defects in the wrist-carpal complex. The three-compartment digital technique combines the advantages of fluoroscopic monitoring and videorecording and allows real time imaging of the contrast agent flow during injection in different compartments. Moreover, the digital technique permits the complete study of all joints in a single session, while image subtraction reveals even minimal ligament changes. This technique becomes therefore a fundamental tool for surgical planning.

Adult↗
PubMed1998

[Significance of computerized tomography in the diagnosis of post-traumatic proximal carpal instability].

INTRODUCTION: Proximal carpal instability is a painful condition characterized by early or late loss of radioulnar joint (RUJ) congruence not affecting the normal bone alignment of the two carpal rows. The joint incongruence or (incomplete) dislocation which leads to proximal instability is caused by many traumatic and nontraumatic events. The diagnosis of (incomplete) dislocation of the distal RUJ may be extremely difficult to make at conventional radiography because such injuries can be seen only when the lateral joint projection is perfect; otherwise the diagnosis is not reliable. CT is the only imaging tool diagnosing the grade of distal RUJ congruence independent of the examination technique. MATERIAL AND METHODS: We studied the radiocarpal complex conditions leading to proximal instability at the Rizzoli Orthopedic Institute from December, 1995, through December, 1997. In all, 389 cases were seen, 376 from trauma and 13 of nontraumatic origin. Each injury was studied with conventional radiography, CT, and MRI. Radiography was performed in two projections, namely the posteroanterior one with hand extension and the lateral one with the forearm in neutral position and the elbow bent at 90 degrees; the projections were repeated whenever a cast brace was applied. Unenhanced CT was performed for comparison with the patient prone and the forearm and wrist in prone and neutral position, as well as with the patient, forearm and wrist supine. Three criteria of electronic image processing were adopted for the RUJ studies in the 3 projections: radioulnar lines, congruence, and epicenter. MRI was always performed after conventional radiography and CT. Only the involved radiocarpal region was studied; coronal, axial and sagittal images were acquired with T2-weighted GE and T1-weighted SE sequences. RESULTS: Proximal instability was found in 17 of 389 patients; it was early in 13 and late in 4 of them. The comparison of radiographic and CT results showed that the former method is unreliable, with 53% false negatives. Pain, a cast brace, congenital or acquired deformities of distal radius and ulna and patient mispositioning by the radiology technician can change the rotation of the forearm, wrist and hand and make a perfect laterolateral projection in neutral position unfeasible, which affects the radiographic diagnosis. Conversely, CT showed its extreme efficacy in assessing the distal RUJ congruence with no false negatives independent of the RUJ rotation and of instability type and grade. CONCLUSIONS: Conventional radiography is a poorly reliable tool for the diagnosis of joint incongruence and its grade. In contrast, CT can diagnose a RUJ (incomplete) dislocation easily and unquestionably, thanks to its axial capabilities, even when adequate radiographic studies would be unfeasible. If the anteroposterior projection of the radiocarpal complex shows a congenital or acquired deformity of distal radius, the lateral projection can be skipped and a CT scan in prone, neutral and supine position performed. The 3 CT criteria quantify incongruence type and grade, and also demonstrate the position of maximum incongruence and its decrease by position. The comparative study of the radiocarpal region makes CT a very useful and valuable tool in congenital instability because its allows the assessment of contralateral radioulnar congruence too. MRI is very useful in the diagnosis of injury or degeneration of the fibrocartilage complex, namely in patients with no bone changes at conventional radiography.

Humans↗
PubMed1997

[Traditional radiology in the assessment of posttraumatic carpal instability].

INTRODUCTION: Carpal instability is a painful posttraumatic syndrome with early or late loss of the normal alignment of the carpal bones, which can be caused by a variety of injuries, from minor sprain to major fracture-dislocation of the carpal-wrist complex. If the trauma causing instability is a fracture, a severe dislocation or a fracture-dislocation, the radiographic diagnosis is not particularly difficult. The morphologic and dynamic complexity of the carpal region represents, instead, a major obstacle in the radiologic diagnosis of mild or moderate sprains because the morphologic alterations on standard static views are minimal or absent in these conditions. MATERIALS AND METHODS: We reviewed 214 injuries causing posttraumatic carpal instability including both the cases classified by the Data Analysis Center of the Istituto Ortopedico Rizzoli as carpal dislocations and fracture-dislocations from January, 1975, to July, 1996, and the more recent cases directly observed at our Casualty Clinic. In the former cases, we reviewed only the available images, while our patients were examined with comparative standard and under stress or dynamic views. RESULTS: Of 214 lesions causing posttraumatic carpal instability, 43 along the great arch were classified as severe because they were easily detectable on standard films and 171 along the small arch were classified as mild because slight/no abnormalities were detected on standard static views. Only dynamic imaging showed posttraumatic carpal instability demonstrating the integrity of the ligaments and of the carpal hinges, as well as gaps or asymmetry not detected on static views. CONCLUSIONS: We suggest the systematic use of dynamic imaging in the cases where static findings are negative or poor, in the patients with a painful wrist after an apparently minor sprain. Missed or delayed diagnoses are thus reduced, as well as the consequent joint incongruity and/or chronic subluxation which may severely impair these patients.

Carpal Bones↗
PubMed1994

[Percutaneous computed tomography-guided biopsy in spinal diseases].

The use of percutaneous spinal biopsy (PSB) is on the increase in the field of interventional radiology. From July 1990 to December 1992 in the Department of Radiology in the Istituto Ortopedico Rizzoli, 74 patients (50 men and 24 women, mean age: 47 years old) underwent CT-guided spinal biopsy. This study was aimed at evaluating the diagnostic capabilities and accuracy of CT-guided percutaneous biopsy, which is considered as a simple, reliable and definitive method for histopathologic diagnosis. In our case histories, the total average accuracy rate, which varies according to the involved segment and to the kind of lesion to be examined, was 86%; in 14% of cases the excised tissue proved insufficient for histologic diagnosis. By allowing the histopathologic diagnosis to be made, CT-guided PSB proves a valuable technique to plan the treatment of primary/secondary neoplastic lesions or of inflammatory and dysmetabolic processes.

Biopsy, Needle↗
PubMed1989

[Spontaneous pneumothorax in patients with osteosarcoma treated by combined chemotherapy].

A report is presented on 5 cases of pneumothorax which occurred during chemotherapy in patients suffering from osteogenic sarcoma of the extremities. None of them presented radiographically detectable substitutive pulmonary lesions. It was hypothesised that the origin of pneumothorax was the necrosis produced by agents of a pulmonary micrometastasis.

Adolescent↗
PubMed1989

[Fenton's syndrome].

The authors report two recent cases of Fenton's syndrome, a very rare carpal fracture-dislocation. After some anatomico-physiopathological considerations and a review of the literature, a wider nosographic frame is proposed in which the entity of the dislocation of the head of the capitate bone is not essential. According to both the literature and the personal findings, the authors remark that this syndrome is always found in the presence of two morphological variants of the distal radioulnar joint. Finally, the authors stress the importance of a correct diagnosis of this lesion to avoid unnecessary attempts of reduction.

Carpal Bones↗
PubMed1987

[Radiographic diagnosis of dislocations and fracture-dislocations of the carpus].

A variety of unique and very rare carpal dislocations are reported. According to personal findings, an extension of the descriptive classification of this pathology is proposed, utilizing also the X-ray files of the Rizzoli Orthopaedic Institute. Moreover, the radiographical features are evaluated which help choosing the treatment to be followed.

Adult↗
PubMed1986

Scintigraphic study of the evolution of cortical homografts in the treatment of fractures.

Twelve patients who had undergone osteosynthesis with a metal plate combined with a frozen homoplastic bone graft for the treatment of fractures or pseudarthrosis were subjected to bone scintigraphy with 99 Tc MDP. This investigation showed the graft to be a site of early and specific accumulation of the tracer. This finding supports early colonization of the graft by vascular structures and osteoblastic cells. In view of the small number of cases studied and our incomplete knowledge of the metabolic processes involved these considerations must remain hypotheses but given the excellent clinical results obtained, the relationships between homoplastic bone and host bone merit further investigation.

Adult↗
PubMed1985

The importance of the angle of anteversion in the development of arthritis of the hip.

The angle of anteversion, assessed by the Dunlap technique, was determined in 30 patients suffering from primary osteoarthritis of the hip. This was compared with the same angle in 10 normal subjects. The patients with arthritis showed a statistically significant increase in the angle. This is considered by the authors to play a significant part in the pathogenesis of primary osteoarthritis of the hip.

Adult↗
PubMedDate not supplied

[Computerized tomography guided biopsy in the diagnosis of neoplastic and inflammatory lesions of the pelvis].

PURPOSE: To assess the efficacy of percutaneous CT-guided biopsy in the diagnosis and therapeutic planning of neoplastic and flogistic diseases of the pelvis. MATERIAL AND METHODS: From July 1990 to December 1999 193 patients (113 males, 80 females: mean age 49, standard deviation 16) were submitted to CT-guided percutaneous biopsy of the pelvic region; 117 biopsies (61%) were performed at iliac, pubic and ischial segments and 76 (39%) at sacral region; 107 patients were admitted to the hospital and 86 were in clinic. Needles were 8 G (4 mm), 10 to 15 cm long. Approach to pelvic lesions was performed according to the specific site. Lesions of the lateral pelvic region have always been approached through the lateral surgical incision according to Enneking. Lesions of the posterior pelvic region have always been approached by the introduction of the needle along the posterior surgical incision according to Enneking. Lesions of the anterior region have always been approached through the anterior surgical incision according to Enneking. From July 1990 to May 1997 pelvic percutaneous biopsies have been carried out with a CT Sytec 3000. From May 1997 to December 1999 the device was replaced by a High Speed CTi. The introduction of spiral CT allowed reduction of performance mean time from 45 minutes (standard deviation 15) to 30 minutes (standard deviation 10). RESULTS: In 154 patients (80%) we observed a neoplastic, inflammatory or not classified degeneration. In 8 patients (4%) the retrieved material ended to be inadequate for a diagnosis. In 31 patients (16%) no disease was revealed at the histological examination. Such patients with negative histological examination have been kept under clinical and radiological control in the following period in order to verify the manifestation or the presence of an alteration previously not observed. On 31-3-2000 none of them had been submitted to a new percutaneous biopsy of the pelvic region. The overall mean accuracy has been 96% considering the negative patients as really negative. In 5 cases (2.6%) we have had complications represented by pain at the introduction and penetration site of the needle. DISCUSSION AND CONCLUSIONS: The choice of the needle, the approach to the lesion and the position of the patient are conditioned by the site of the tumor, its extension, the distance skin-neoplastic disease and by the respect of the incision lines of Enneking, in order not to complicate the job of the orthopaedic surgeon spreading tumoral cells outside the chosen surgical approach. The mean time of the procedure is 30 minutes (standard deviation 10). There are no absolute contraindications to percutaneous biopsy except the suspect or the presence of an hydatideal cyst. The risks have to be compared with those correlated with alternative methods or with the more concerning risk of a missed diagnosis. Complications in the literature range from 0% to 10%, the incidence varying according to the location; pain is the most frequent complication. Altogether the most negative event, although not a true complication, is the retrieval of an inadequate sample: the only drawback of percutaneous biopsy in comparison with incisional biopsy. The accuracy rate of percutaneous biopsy varies in relation to the involved anatomical region, to the pathological process, to the experience of the user, to the amount of the retrieved tissue and to the cooperation of the patient. Our experience shows that, in selected patients, percutaneous biopsy is a virtually safe and almost painless procedure which saves the patient from a surgical procedure in regional or general anestesia as for an incisional biopsy, and allows immediate planning and scheduling of a correct therapy for primitive or secondary neoplastic lesions.

Biopsy↗