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Biomedical subjects

F Barbiera

Publications and source records attributed to F Barbiera.

At least 19 recordsLinked to original sources
PubMed2006

Role of videofluorography swallow study in management of dysphagia in neurologically compromised patients.

PURPOSE: The aim of this study was to demonstrate the key role of the videofluorography swallow study (VFSS) in the management of patients with dysphagia and varying degrees of neurological deficit. MATERIALS AND METHODS: In 1 year (March 2004-March 2005) 47 patients with oropharyngeal dysphagia due to different types of neurological deficit and who required rehabilitation were studied. All patients underwent: (1) clinical history assessment, (2) speech therapy assessment and (3) VFSS using digital fluoroscopy (25 frames per second). Patients were divided according to the Waxman classification into seven levels of dysphagia, and the most suitable type of feeding was selected (normal diet, restricted diet, artificial nutrition). At discharge, the possibility of changing the dietary regimen followed in hospital was evaluated based on clinical progress, radiological follow-up and the degree of improvement obtained. RESULTS: VFSS confirmed aspiration in 21/47 (44%) patients, of whom four (8%) had not been suspected at clinical-speech therapy assessment. In 13/47 (28%) patients, VFSS identified changes at the oral (three patients) or pharyngeal stage (three patients) or both (seven patients) but with no signs of silent aspiration. In the remaining 13 (28%) patients, VFSS did not show any changes in swallow dynamics. On the basis of these data, together with the follow-up at the end of rehabilitation treatment, different nutritional strategies were adopted: artificial nutrition [percutaneous endoscopic gastrostomy (PEG) or nasogastric tube], a restricted-consistency diet or normal diet. CONCLUSIONS: Our experience shows that VFSS precisely classifies the degree of dysphagia that conditions the dietary management of each neurologically compromised patient.

Adolescent↗
PubMed2006

Multidetector-row CT enteroclysis: indications and clinical applications.

This paper examines the diagnostic potential of multislice computed tomography enteroclysis (MSCT-E) to detect and assess different diseases affecting the small bowel, emphasising the increasingly important role assumed by the technique in the study of this anatomical region. After a short summary of the technical aspects, we discuss the different findings that can be observed during an MSCT-E study and that enable detection of small-bowel disease and, if necessary, assessment of the extent and stage of disease.

Humans↗
PubMed2003

MRI findings in lingual venous malformations.

OBJECTIVES: To describe the plain and enhanced MRI findings of lingual venous malformations and to discuss the importance of contrast medium in the differential diagnosis of high intensity lesions of the tongue on T(2) weighted images. METHODS: The clinical records and MR images of eight patients affected by a lingual venous malformation were retrospectively reviewed. Patients presented with a palpable submucosal bluish-red soft mass in the tongue. MRI examinations were performed on a 0.5 T superconducting unit. Plain and enhanced SE (spin echo) T(1) weighted and FSE (fast spin echo) T(2) weighted images were acquired in axial, sagittal and coronal planes. Axial SPGR (spoiled gradient recalled echo) T(1) weighted images were also obtained before and after intravenous (i.v.) injection of paramagnetic contrast medium. RESULTS: Five of eight venous malformations were located at the tip of the tongue. The other three involved the whole tongue and had an extralingual extent; two extended into the submandibular space and one into the glossoepiglottic valleculae. The largest diameter ranged from 2.5 cm to 8 cm. All lingual venous malformations presented as lobulated masses that were slightly hyperintense or isointense on T(1) weighted images and highly hyperintense on T(2) weighted images with respect to normal tongue and/or surrounding muscles. They showed a slow and homogeneous filling following iv injection of contrast medium. Millimetre-sized hypointense foci and linear hypointense strands were sometimes noticed, which were owing to phleboliths, flow void or septation. CONCLUSION: Knowledge of MRI findings of lingual venous malformations is useful for differential diagnosis with other high intensity lingual lesions on T(2) weighted images. This discrimination is achievable using iv paramagnetic contrast medium.

Adolescent↗
PubMed2002

Digital cineradiographic swallow study: our experience.

PURPOSE: Swallowing disorders can be secondary to different types of diseases in which, at least initially, patients succeed in establishing voluntary or involuntary compensatory mechanisms that enable them to maintain a sufficient nutritional state. When the compensatory mechanisms become insufficient massive food aspiration into the airways can occur and suffocation may prove to be the main pathology. It has been calculated that in the USA about 8,000-10,000 people die each year due to suffocation. The dynamic radiological examination of swallowing is considered important not only for diagnosis, but also for planning a rehabilitation therapy and type of nutrition for the patient and for verifying the results of the therapy. The aim of this study is to analyse the results of our experience in the use of the digital cineradiography system to evaluate patients with normal and pathological swallowing. MATERIALS AND METHODS: We reviewed the digital cineradiography of 220 patients that at no time had undergone surgery and presented no organic pharyngeal or oesophageal disease (excluding hiatus hernia). All the exams followed a standard protocol that included the dynamic evaluation of the larynx, soft palate, pharynx, and gastro-oesophageal junction with a cineradiographic sequence of 12 frames/second with a 512x1024 matrix. There was also an archive of the film in a post-processing console. The patients received single photograms (printed on laserfilm), videotape recordings or CD-ROM of the dynamic exam. RESULTS: 137 (62%) of the patients did not present swallowing alterations although only 7 patients had a negative examination. In 35 cases hiatus hernia was appreciable while in 69 cases the hernia was associated with gastro-oesophageal reflux. In 23 cases aspecific functional disorders of the oesophagus were demonstrated and in 3 cases achalasia. The remaining 83 patients (38%) (37 males and 46 females, average age 57.02 yrs) presented alterations of the oral and/or pharyngeal stages of swallowing: reduction in soft-palate motility (2 cases), unilateral paralysis of the vocal chords (1 case), incontinence of the bolus during the oral stage (8 cases), lingual movement anomalies (4 cases), subepiglottic penetration (62 cases), asymmetric epiglottic tilt, aspiration of the contrast medium in the airway (17 cases), reduction of laryngeal and hyoid bone movement (9 cases), bolus retained in the valleculae and pyriform sinus (13 cases), cricopharyngeal spasm (6 cases), pharyngeal paralysis (1 case); hiatus hernia was also evident in 20 cases and gastro-oesophageal reflux was associated in 13 of them. Overall, 36% of the cases presented an isolated form while 64% of the cases presented a complex dysfunction with several simultaneous alterations. DISCUSSION AND CONCLUSIONS: The videofluorographic swallow study is an important step in the diagnostic evaluation of a dysphagic patient not only as regards the analysis of the main alteration and its capacity to confirm the presence or absence of contrast medium aspiration in the airway, but also because it provides important information on rehabilitation and nutritional orientation (oral/no oral), as well as on the results of the therapy. The recent diffusion of the digital X-ray equipment has made possible its use for the study of the organic and functional diseases of the upper alimentary tract. Currently a standard protocol for the study of swallowing with digital fluorography is not available. The technique we applied, already verified in a significant number of dysphagic patients, has allowed us to distinguish patients with normal swallowing from those with disorders of the oral and pharyngeal stage, and thus to identify disturbance and establish an appropriate rehabilitation treatment.

Adolescent↗
PubMed2002

Isolated hydatid disease of the spleen: CT findings in 4 patients and differential diagnosis.

AIM: To report our experience with four cases of isolated hydatid disease of the spleen studied by spiral Computed Tomography (CT) and to review the literature with special attention to the differential diagnosis with other focal lesions of the spleen. MATERIALS AND METHODS: The spiral CT images and clinical records of four patients (1 man, 3 women; age range 26-45 yrs) affected by isolated hydatid disease of the spleen were retrospectively evaluated. None of the patients had a history of hydatid disease. All the patients were evaluated by plain and enhanced spiral CT of the abdomen. All patients underwent preoperative chest X-ray and surgery; all surgical specimens were studied by histology. RESULTS: Spiral CT depicted all the hydatid lesions of the spleen. It showed the location, size, low density of their content without enhancement after iv contrast medium injection, the possible presence of daughter cysts, the appearance of the wall with calcifications, and excluded the presence of complications. The preoperative chest X-ray was negative for focal pulmonary lesions in all cases. Pathology confirmed the diagnosis of hydatid disease in all cases. CONCLUSIONS: According to our results and to the literature, spiral CT plays an important role in the pre-surgical evaluation of patients with hydatid disease of the spleen, and provides useful information for differentiating the disease from other isolated cyst-like lesions of the spleen.

Adult↗
PubMed2002

Pitfalls and limitations of Magnetic Resonance Imaging in bucket-handle tears of knee menisci.

PURPOSE: The aim of the present study was to assess the accuracy of magnetic resonance imaging (MRI) in the diagnosis of bucket-handle tears of the knee menisci, determining the sensitivity and specificity of the imaging for each of the signs typical of these tears. MATERIALS AND METHODS: MR examinations of 495 patients suffering from knee traumas were assessed retrospectively. Forty-eight patients had arthroscopically-proven bucket-handle tears of the meniscus. MR examinations were performed using a 0.5-T superconducting magnet, with T1-weighted spin-echo (SE) and gradient-echo (GE) T2*-weighted sequences. Imaging findings used for the diagnosis were: a) double posterior cruciate ligament sign; b) flipped meniscus sign; c) presence of a displaced fragment of the meniscus in the intercondylar notch, visible in coronal and axial images; d) truncated triangular shape of the peripheral non-displaced portion of the meniscus, visible in coronal images. RESULTS: A total of 43 out of 48 bucket-handle tears of the meniscus were correctly diagnosed at MR, thus overall MR accuracy was 98%. In 12 (28%) cases three signs were present simultaneously the double posterior cruciate ligament (sensitivity 28%, specificity 99%, accuracy 93%) + the displaced fragment in the intercondylar notch (sensitivity 69.8%, specificity 98.7%, accuracy 96.2%) + the truncated triangular shape of the peripheral portion of the meniscus (sensitivity 74.4%, specificity 98%, accuracy 96%). In 18 (42%) cases two signs were present together the displaced fragment of the meniscus + the truncated triangular shape of the peripheral portion of the meniscus. In 13 (30%) cases only one sign was presenting two cases the truncated triangular shape of the peripheral portion of the meniscus and in 11 cases the flipped meniscus sign (sensitivity 25.6%, specificity 93.4%, accuracy 87.5%). No statistically significant differences were found comparing the results for tears of the medial meniscus with those for the lateral meniscus. CONCLUSIONS: MR imaging is highly accurate in diagnosing bucket-handle tears of the menisci due to its ability to identify a displaced fragment of the meniscus in the intercondylar notch or flipped over the anterior horn of the meniscus of origin. We speculate that bucket-handle tears not found by MR imaging are cases where the meniscus was displaced after MR examination.

Adolescent↗
PubMed2001

[Radiographic patterns in patients after antireflux surgery].

PURPOSE: To evaluate the usefulness and diagnostic accuracy of the radiologic examination of the oesophagus and stomach in the follow-up of patients who had an anti-reflux procedure with the purpose of identifying the normal radiographic pattern, possible surgical complications and the causes of failure of the surgical treatment. MATERIAL AND METHODS: From February 1999 to September 2000, we radiographically reviewed 11 patients (5 men and 6 women) age range 17-69, mean age 49, who had a surgical procedure of fundoplication for hiatal hernia and/or gastroesophageal reflux (7 Nissen procedures, 2 Belsey-Mark IV, 1 Toupet, 1Dor). Four surgical procedures were laparoscopic, seven were open. All patients were reviewed with single contrast (barium sulphate 60% weight/volume) and/or double contrast technique (effervescent powders + barium sulphate 250% weight/volume) and with the acquisition of radiographs in upright, supine, prone, oblique and lateral positions. RESULTS: 5 of the patients who had a fundoplication procedure suffered complications. In one patient the fundoplication was tight; in two patients the fundoplication had broken and migrated in the thorax; in one the fundoplication had loosened; in one patient it had looseed and migrated in the thorax. In the remaining 6 cases, the passage of the barium column through the fundoplication was normal, as well as the intra-abdominal position of the fundoplication. CONCLUSIONS: The possibility to perform laparoscopic fundoplication procedure has increased the number of patients selected for surgical treatment. Successful relief of gastroesophageal reflux symptoms can be achieved in 90% of patients treated with antireflux fundoplication. Less than 10% of cases may have complications, with recurrence of gastroesophageal reflux manifestations. The radiographic examination of the esophagus and stomach still represents an effective diagnostic test in the follow-up of these patients.

Adolescent↗
PubMed2001

[Thrombolytic therapy in myocardial infarction. Computerized tomography of encephalic complications].

PURPOSE: To evaluate the CT findings of intracerebral hemorrhage in patients undergoing thrombolytic therapy for acute myocardial infarction and to correlate the type of intracerebral hemorrhage with clinical outcome. MATERIAL AND METHODS: We retrospectively reviewed the clinical records and CT scans of intracerebral hemorrhage on a total of 302 patients who underwent thrombolytic therapy for acute myocardial infarction at our institution from January 1996 to September 1999. In each patient we evaluated: the number, sites and size of hemorrhage, and the presence and severity of mass effect. The site of the hemorrhage was classified as intraparenchymal, intraventricular, subdural and subarachnoid. RESULTS: Six patients (2%, mean age 74, range 66-80) developed intracerebral hemorrhage. There was a total of 22 hemorrhages: 1 subdural hemorrhage, 6 subarachnoid, 11 intraparenchymal and 4 intraventricular. Excluding intraventricular hemorrhage, 14/18 hemorr-hages were located supratentorially. In five patients there was a fluid-blood level. Three patients had severe mass effect with midline shift. Symptoms presented within 24 hours from the administration of thrombolytic therapy in all patients. All the patients who died had a large hematoma with a severe mass effect and a severe midline shift at CT scan. In the remaining patients, the hematoma was of medium size and no mass effect was seen. CONCLUSIONS: The most common site of hemorrhage was supratentorial and intraparenchymal. Large volume intracerebral hemorrhage, multiple hemorrhages and mass effect with midline shift were associated with increased mortality. The most commonly observed finding was a fluid-blood level hematoma.

Aged↗
PubMed1998

[Severe myogenic pain in an unfit subject after intensive and prolonged abdominal muscle exercise].

The authors report the case of an unfit patient who, following intensive and prolonged physical exercise involving the abdominal muscles, presented a massive and diffuse subcutaneous edema (abdomen, scrotum, chest and face) together with abdominal and thoracic pain which increased in response to finger pressure. In addition, this was accompanied by a marked increase in CK, CK-MB and LDH, and TGO and TGP. Chest or heart pathologies were excluded by monitoring ECG and other clinical parameters, like heart rate and blood pressure, and by performing a chest X-ray. Muscular ultrasonography confirmed the massive subcutaneous edema and abdominal MR showed a slight edema in the suprasacral region, as well as confirming the subcutaneous edema. Hematological data gradually reduced and returned to normal after a week. Edema and pain also regressed gradually: the former finally disappeared after one week and the latter after five days. The authors conclude that clinical and laboratory findings were particularly severe because the subject was unfit and subcutaneous edema was larger than the free liquid in the abdominal cavity because the latter was absorbed by the peritoneum which acted as a dialysing membrane.

Abdominal Muscles↗
PubMed1997

[Biomechanics and semiology of transient lateral patellar dislocation: reliability of magnetic resonance diagnosis].

Transient patellar dislocation is a rare finding. It is usually due to direct trauma in mediolateral direction or to indirect trauma related to violent quadriceps muscle contraction. The clinical diagnosis of transient forms is usually rather difficult because the associated signs (hemarthros and pain at the joint and/or at the vastus medialis insertion) are not specific. Conventional radiography and CT are very accurate in bone studies, but exhibit major limitations in the detection of capsular injuries with intramedullary and/or cartilaginous bone involvement. We investigated MR diagnostic reliability in the study of the injuries caused by transient patellar dislocation. 526 MR examinations of the knee were reviewed retrospectively; fifteen of them were positive for transient patellar dislocation. We used a .5 T superconductive MR unit with a circumferential extremity coil. Axial, coronal and sagittal T1-weighted spin echo, T2*-weighted gradient echo and axial STIR images were acquired. The following criteria were considered specific for the diagnosis of former lateral patellar dislocation: retinacular changes; patella site; signal intensity changes in femoral and patellar intramedullary bone; joint effusion; cartilage and subchondral bone changes. All the patients with transient patellar dislocation had hemarthros with inner retinaculum involvement. The femoropatellar joint was incongruous in 115 cases; patellar subluxation was external in 8/11 patients and lateral in the remaining 3 patients. Medullary bruises were found in 8/15 cases and cartilage injuries in 13/15. Finally, other joint components, such as the posterior horn of the medial meniscus or the anterior cruciate ligament were involved in 6/13 cases. Arthroscopy was performed in 6 patients with associated injuries and confirmed all MR findings (100% agreement). To conclude, in our experience MRI was a very reliable tool to study the injuries due to transient patellar dislocation because it showed specific changes and possible associated traumas, which helps choose the most suitable treatment.

Adolescent↗
PubMed1996

[Biomechanical correlations of lesions associated with traumatic diseases of the anterior cruciate ligament. Analysis with magnetic resonance].

To investigate the correlations between traumatic injuries of the anterior cruciate ligament and other ligamentous, meniscal and bone traumatic injuries, a series of 193 patients with anterior cruciate ligament injuries studied with MRI between January 1992 and December 1994, was retrospectively reviewed. MR results were compared with arthroscopic and/or surgical findings in most (181) patients; in the remaining 12 patients, clinical follow-up was performed. We used two 0.5 superconductive MR units, with dedicated coils and T1-weighted spin-echo and T2*-weighted gradient-echo sequences on the axial, sagittal and coronal planes. Anterior cruciate ligament injuries were associated with other ligamentous, meniscal and bone injuries in 78% of patients. The patients were classified in 5 groups depending on biomechanics and the association of injuries: -group I: isolated injury of the anterior cruciate ligament (41 patients), most frequently caused by forced extension stress associated with "kissing contusions" of the anterior portion of the lateral femoral condyle and of the lateral tibial plateau; this type of injury is less frequently caused by forced flexion stress associated with avulsion fracture of the tibial eminence; -group II: associated injury of the anterior cruciate ligament and medial compartment (62 patients), caused by forced flexion-external rotation stress (abduction, valgism and external rotation). The classic association of this mechanism was the injury of the anterior cruciate ligament, medial collateral ligament and medial meniscus (O'Donoghue triad) (9 patients). Valgus stress and the pivot-shift phenomenon can impact the tibial and femoral articular surfaces, with consequent osteochondral contusion; -group III: associated injury of the anterior cruciate ligament and lateral compartment (26 patients), caused by forced flexion-internal rotation stress (adduction, varism and internal rotation). This mechanism can cause, as a typical bone lesion, Segond fractures; -group IV: associated injury of the anterior cruciate ligament, lateral and medial compartments observed in 52 patients with different associations of varus-valgus and rotatory stress; -group V: in 5 patients, anterior cruciate ligament injury was associated with traumatic injury of the posterior cruciate ligament; in this case, posterior displacement of the tibia and knee hyperextension were the most common mechanisms of injury. In conclusion, our results demonstrate that anterior cruciate ligament injuries due to traumatic sprains of the knee are rarely isolated (21%). Thus, it is important to know the biomechanics of knee trauma to read MR images in order to detect possibly associated injuries. The final goal is to assess the actual extent of the traumatic damage for best subsequent clinical-therapeutic management.

Adolescent↗