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Biomedical subjects

F Barbiera

Publications and source records attributed to F Barbiera.

31 records · Page 2Linked to original sources
PubMed1995

[Biomechanics and semeiotics of traumatic lesions of the posterior cruciate ligament using magnetic resonance].

The authors reviewed 458 MR examinations of the knee to assess the potentials of this technique in the study of traumatic injuries of the posterior cruciate ligament (PCL) and to investigate the frequency of their association with injuries of other knee joints. MR images were acquired with an 0.5-T super-conductive unit with an extremity coil. T1-weighted spin-echo (SE) and T2*-weighted gradient-echo (GE) sequences were used on sagittal, coronal and, in some cases, axial planes, with 3-mm slice thickness and 0-1 mm slice gap. The following parameters were studied to diagnose partial or complete PCL tears: PCL thickness and outline, disruption of ligamentous fasci and signal intensity features. The injuries were classified as proximal, intermediate and distal according to their site. Thirteen PCL tears were detected, 5 of them complete and 8 partial. Complete tears were found in 4/5 patients in the middle third and one patient had a distal intersection tear with tibial bone avulsion. Partial tears were found in the distal tract in 5/8 patients, in the proximal tract in one patient and in the middle third in 2 patients. In 12/13 patients capsuloligamentous knee tears were associated. Overall MR rate of PCL tears was 2.8%; of them, 92.3% were associated with other capsuloligamentous injuries. MR diagnosis was confirmed at arthroscopy in 12/13 patients. The sagittal plane was best in optimally demonstrating the whole PCL and its injuries. GE T2* sagittal sequences demonstrated the site of PCL tears better than SE sagittal ones. Relative to other authors, we found MRI an extremely reliable method to distinguish partial from complete PCL tears. This was probably due to the thinner slices (3 mm) we used. MRI can accurately assess the extent of traumatic injuries of the PCL and of other capsuloligamentous parts of the knee, which is relevant from the clinical point of view. Indeed, MRI allows useless diagnostic arthroscopy to be avoided and yields major indications to choose the correct treatment.

Adult↗
PubMed1992

[Normal anatomy and findings in traumatic pathology of the popliteal system. A MR study].

To date, the lesions of the popliteal system, which are responsible for the so-called postero-lateral knee instability, are still an imperfectly known chapter of knee conditions. We retrospectively analyzed 215 consecutive MR examinations performed May-August 1991 to evaluate MR capabilities in correctly depicting both the normal anatomy and the pathologic conditions of the popliteal system. Using our standard protocols for knee study and two different magnets (0.064 and 0.5 T), we identified 23 lesions of the popliteus and of its meniscal and peritoneal insertions, and 17 lesions involving also other capsular and ligamentous structures of the knee. Coronal T1-weighted images were the best ones to correctly identify normal knee anatomy, whereas sagittal T2-weighted images were more sensitive in detecting popliteal lesions. Our results had clinical or surgical confirmation in all cases.

Humans↗
PubMed1991

[The role of galactography in the diagnosis of breast diseases. Our experience].

Following a description of the most common galactographic semeiotics in relation to the different types of secretion, the Authors report their personal experience in the use of galactography to diagnose breast cancer. Histopathological tests revealed the presence of carcinoma in 14 (29.2%) out of a total 48 galactographic examinations. In conclusion, the Authors underline the high degree of diagnostic precision of galactography, a test which contributes to the identification of a considerable number of carcinomas during the preclinical stage.

Adult↗
PubMedDate not supplied

[Closed loop intestinal obstruction: role of computerized tomography].

PURPOSE: The obstruction of a bowel segment at both ends results in a closed loop obstruction. Progression to strangulation frequently occurs if surgical intervention is delayed. The role of plain radiography in the diagnosis of closed loop obstruction and strangulation has been shown to be limited, while the recent literature has demonstrated the growing role of computed tomography (CT). This paper reports our experience in the study of closed loop obstruction by CT. MATERIAL AND METHODS: The CT studies of 12 patients with surgically confirmed closed loop obstruction were retrospectively reviewed. The following CT signs were used for the diagnosis: a) fluid-filled distended loops, b) C-shaped incarcerated loop, c) radial distribution of several dilated bowel loops and mesenteric vessels converging toward the point of obstruction, d) triangular or fusiform tapering of the closed loop and/or whirl sign in the site of obstruction. RESULTS: On the basis of these signs, the diagnosis was made in 11 of 12 patients. Only 1 patient, who had a negative CT study, was positive at a subsequent enteroclysis. CT findings of strangulation were associated in 3 cases: slight wall thickening with vascular congestion and mesenteric ascites, confirmed at surgery. DISCUSSION AND CONCLUSIONS: Small bowel obstruction can be distinguished into simple and closed loop obstructions. The latter is a more severe condition which is often complicated by strangulation with vascular impairment, edema and intramural and mesenteric hemorrhage. Consequent arterial insufficiency rapidly leads to ischemia, infarction and necrosis. The radiologist plays a role in the early recognition of the closed loop obstruction and of any sign of strangulation. The role of CT in the diagnosis and workup of patients with suspected intestinal occlusion has been analyzed in the literature with reported 63% sensitivity, 78% specificity and 66% accuracy. CT is also capable of revealing the causes of occlusion in 73-95% of cases. The above CT signs, as confirmed in our experience, allow to identify closed loop obstruction and also small bowel strangulation, thus supplying a valuable contribution to diagnosis and accurate preoperative evaluation. We conclude that CT can accurately demonstrate the presence of closed loop obstruction and can be the technique of choice in patients in whom obstruction is associated with clinical signs suggestive of strangulation.

Female↗
PubMedDate not supplied

[Adult intestinal intussusception: comparison between CT features and surgical findings].

PURPOSE: To report our experience in the use of CT in the evaluation of adult intestinal intussusception. A correlation between radiologic findings and surgery was attempted in order to verify our diagnostic hypothesis. MATERIAL AND METHODS: Intestinal intussusception was diagnosed by CT between September 1993 and December 2000 in 10 patients (6 men and 4 women, age range 18-82 years). For 9/10 patients the diagnosis was confirmed by surgery; in one patient the condition resolved spontaneously as confirmed by a follow-up CT performed 24 hours after the first. Six patients were studied by a third generation CT and four by a helical CT unit. Five patients were administered iodinated oral contrast medium and in seven i.v. iodinated contrast medium. Diagnosis was hypothesized at CT on the basis of the following aspects: target, sausage, and pseudokidney. RESULTS: Surgery confirmed the CT diagnosis of intussusception in 9/10 patients; in the patient with transient intussusception a spontaneous resolution was confirmed at follow up CT after 24 h. In the 10 patients studied the following CT aspects were observed in the bowel involved by intussusception: a target aspect in 4 patients; a sausage aspect in 4 patients; in one of them a peritoneal effusion was also present; a pseudokidney aspect was observed in 2 patients, with a long tract intussusception and peritoneal adipose tissue; in both a hyperdensity of the peritoneal adipose tissue and enlarged vessels, that were herniated within the lumen of the bowel, were recognized. At surgey the causes of intestinal intussusception were: malignant tumors of the colon (4 cases), hamartomatous polyps of the small bowel (2 cases), mixoid fibrolipoma of the colon (one case), leiomyoma of the distal ileum (one case). In one patient no cause could be identified at CT, but the condition was found to co-exist with acute appendicitis at surgery. CONCLUSIONS: CT is an accurate technique in the evaluation of intestinal intussusception in adults. It allows to identify the condition, its site, and sometimes the type of the lesion causing the intussusception, and any vascular alteration, thus playing an important role in establishing the most appropriate therapeutic strategy.

Adolescent↗
PubMedDate not supplied

Intra-articular osteoid osteoma: diagnostic imaging in three cases.

PURPOSE: To report our experience pertaining to three cases of intra-articular osteoid osteoma assessed by means of integrated imaging and review of literature. MATERIALS AND METHODS: Medical records, radiologic and nuclear medicine findings pertaining to three cases of intra-articular osteoid osteoma were retrospectively evaluated and compared with those of surgery. All the patients (2 males, one female; age range 8-38 ys) affected by intra-articular osteoid osteoma respectively of the elbow, tibio-talar joint and hip were evaluated by means of radiographic examination and Magnetic Resonance Imaging (MRI). SE T1-w and T2-w, GRE T2*-w, GRE 3D T1-w and STIR pulse sequences were used and axial, coronal and sagittal images were acquired. Two patients underwent CT scan. One patient underwent skeletal scintigraphy. All the patients underwent surgery. RESULTS: In 2 out of 3 cases plain radiography allowed the radiologist to suspect the presence of the lesion. In the remaining one, plain radiography failed to detect both the nidus and the perilesional osteosclerosis; nevertheless, a small osteochondral erosion of the humeral condyle suggested the presence of joint inflammation, thus leading to further investigation. CT scan well depicted the presence of the nidus and, in one case, the presence of joint effusion. MRI was always able to detect the nidus, which presented as lesion of low to intermediate signal in T1-w images, low signal in the T2-w images in one patient and high signal in the remaining two; in these latter STIR images showed high intensity nidus and edema of neighbouring cancellous bone. Furthermore, in all patients MRI clearly depicted joint effusion. Skeletal scintigraphy demonstrated both the lesion and the inflammatory involvement of neighbouring soft tissue. In all patients histologic specimen confirmed the diagnosis of osteoid osteoma with joint inflammation and synovitis. CONCLUSIONS: According to our results and literature data the pre-surgical diagnosis of osteoid osteoma is very difficult to achieve. Indeed, only the combination of clinical information and radiologic and nuclear medicine findings enables the radiologist to make the right diagnosis.

Adolescent↗
PubMedDate not supplied

[Esophageal digital videofluorography with water siphon test in the post-operative evaluation of the anti-reflux laparoscopic surgery].

BACKGROUND: In recent years digital videofluorography (VFG) with water siphon test (WST) has been proposed just for diagnosing hiatal hernia and/or gastroesophageal reflux. PATIENTS AND METHODS: Fifteen patients undergone Laparoscopic Nissen (LN) for complicated GERD associated to hiatal hernia, were referred for VFG and WST in order to evaluate the functional results of surgery. At one-month videofluorographic control thirteen patients had just a minimal prolonged esophageal transit time but only six of these had an early postoperative dysphagia, whereas at six months control the prolonged esophageal transit time was present in three patients two of which complained a very light dysphagia. One patient at one month control had a severe dysphagia, her videofluorography showed a very prolonged esophageal transit time and she had to redo surgery. She had a complete resolution of dyspagia and at the six months videofluorographic control she had a normal esophageal and esophagogastric transit time. One patient, underwent surgery in another hospital, complained a persistent and moderate dysphagia and at one month videofluorografic control was evident a malposition of wrap around the upper part of the stomach and a WST positive for reflux and at six months control clinical finding was worst. He will be evaluated for further endoscopic or surgical treatment. CONCLUSIONS: In our experience we believe that VFG is a valid test to identificate the postoperative outcomes giving the surgeons a visual evaluation of their work.

Adult↗
PubMedDate not supplied

[Echography, magnetic resonance and double-contrast arthrography of the rotator cuff. A prospective study in 30 patients].

Shoulder pain is a common clinical problem with different etiologies. Without a specific diagnosis, treatment could be ineffective, causing functional limitation, chronic pain and atrophy. US and MRI allow in many cases to correctly define the different etiologies causing shoulder pain, often due to rotator cuff conditions. From June to September 1992, thirty patients with clinically suspected acute or chronic rotator cuff lesion were studied with US, MRI and double contrast arthrography. US and MRI findings were evaluated and compared using arthrography and surgery as the gold standard. The overall accuracy of MRI was 93%: the method yielded accurate information about size and number of rotator cuff tears, and about bursal, bone and muscle involvement. US accuracy was 83% in the diagnosis of large tears, 63% in the diagnosis of small and partial tears and only 11% in the diagnosis of tendinitis. Both MRI and arthrography exhibited high accuracy (respectively 91 and 100%) in the detection of rotator cuff tears when their results were compared with surgical findings. A flow chart to be used in the patients with acute or chronic shoulder pain was drawn from the critical analysis of the above results.

Arthrography↗
PubMedDate not supplied

[Chronic osteomyelitis of the long bones: magnetic resonance imaging].

To investigate MR capabilities in assessing the extent of disease in chronic osteomyelitis of long bones, we examined 6 consecutive patients, 4 men and 2 women (age range: 27-67 years; mean: 42 years), with posttraumatic chronic osteomyelitis diagnosed at clinics, US, CT and radiography. The diagnosis had surgical or bioptical confirmation. MR studies were performed with an 0.5 T superconducting magnet, a surface coil and T1-weighted SE sequences-before and after Gd-DTPA administration-STIR and T2-weighted SE sequences, on the axial and coronal or sagittal planes. The signal intensity of the inflammation area was hypointense on short TR and TE images and hyperintense on long TR and TE images. After Gd-DTPA administration, granulation tissue surrounding the infection was enhanced in all cases and also the areas of vascularized inflammation within bone marrow were enhanced in two cases. MRI provided accurate and detailed information as to soft tissue and medullary canal involvement depicted sinus tracts in 5 cases and confirmed the presence of sequestrum in 5 cases, in agreement with previous CT findings. In our experience, MRI proved to be a reliable tool to assess the intramedullary and extracompartmental extent of osteomyelitis and also to plan surgery. MR specificity, which is often affected by post-traumatic or postoperative changes, improves markedly if some morphological features typical of the condition are also considered, such as sequestrum and sinus tracts.

Adult↗