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Biomedical subjects

F Falaschi

Publications and source records attributed to F Falaschi.

At least 19 recordsLinked to original sources
PubMed2005

Multi-detector computed tomography angiography of the hepatic artery in liver transplant recipients.

PURPOSE: To evaluate the ability of multi-detector row computed tomography angiography (CTA) in detecting hepatic artery complications in the follow-up of liver transplant patients, performing volume-rendering as reconstruction technique. MATERIAL AND METHODS: The anatomy of hepatic artery was studied in 27 liver transplant recipients with a four-row CT scanner using the following parameters: collimation, 1 mm; slice width, 1 mm; table feed, 6-8 mm/s; spiral reconstruction time, 0.5 s; reconstruction interval, 0.5 mm; mAs, 160; kVp, 120. Before the study, the patients received 1000 ml of water as oral contrast agent to produce negative contrast in the stomach and the small bowel. A non-ionic contrast medium was infused intravenously at a rate of 5 ml/s with a bolus tracking system. Volume-rendering of hepatic artery was performed with the 3D Virtuoso software. RESULTS: The celiac trunk, the hepatic artery, and the right and left hepatic arteries were successfully displayed in high detail in all patients. Side branches, including small collaterals, and hepatic artery anastomosis could also be readily visualized. Volume-rendered CTA detected six hepatic artery stenoses, two hepatic artery thromboses, and two intrahepatic pseudoaneurysms. In two cases, CT detected hepatic artery stenosis with a diameter reduction of less than 50%, while digital subtraction angiography showed a normal artery. CONCLUSION: Volume-rendered multi-detector CTA is a promising non-invasive technique, since it allows images of high quality to be generated with excellent anatomical visualization of the hepatic artery and its complications in liver transplant recipients.

Adult↗
PubMed2004

Ischemic-type biliary lesions in liver transplant recipients: evaluation with magnetic resonance cholangiography.

We assessed the diagnostic value of magnetic resonance cholangiography (MRC) when evaluating ischemic-type biliary lesions in the follow-up of liver transplant patients. We retrospectively reviewed magnetic resonance imaging and MRC of 28 liver transplant recipients with ischemic changes of the biliary tree. The MR examinations were performed at 1.5 T. After the acquisition of axial T1w and T2w sequences, MRC involved a coronal respiratory-triggered, fat-suppressed, two-dimensional, thin-slab, heavily T2w fast spin-echo sequence, and/or a coronal breath-hold, thin- and thick-slab, single-shot T2w sequence. Eleven patients underwent either surgical reconstruction of the biliary system (n = 4) or liver retransplantation (n = 7); the pathologic specimens were employed as standard of reference. The final diagnosis was obtained through direct cholangiography in the remaining cases. Without knowledge of the surgical, pathologic, and cholangiographic findings, two experienced investigators evaluated in conference the MR images to determine the presence of biliary tract abnormalities. MRC demonstrated strictures involving the hepatic bifurcation and the extrahepatic bile duct of the graft in 26 patients; a concomitant thickening of the biliary wall was described in 18 out of these 26 subjects. MRC also showed sludge or stones formation in the donor common bile duct in 16 out of these patients. In conclusion, MRC allows noninvasive, reliable, assessment of ischemic-type biliary lesions in liver transplant recipients.

Adult↗
PubMed2002

Detection of common bile duct stones before laparoscopic cholecystectomy. Evaluation with MR cholangiography.

PURPOSE: To assess the diagnostic value of MR cholangiography (MRC) for detecting common bile duct (CBD) stones in candidates for laparoscopic cholecystectomy (LC). MATERIAL AND METHODS: A series of 95 selected patients with gallstones and suspected CBD lithiasis (abnormal serum liver tests and/or CBD size > or = 6.5 mm at US) were referred to our institution for MRC, before LC. MRC was performed on a 0.5 T magnet through a non-breath-hold, respiratory-triggered, fat-suppressed, thin-slab, heavily T2-weighted fast spin-echo sequence and through a breath-hold, thick-slab, single-shot T2-weighted sequence in the coronal plane. Axial T1- and T2-weighted sequences were first obtained. Two observers in conference reviewed source images and maximum intensity projections to determine the presence or absence of choledocholithiasis. MR findings were compared with endoscopic retrograde cholangiography and intraoperative cholangiography (IOC); IOC was always performed during LC. RESULTS: CBD calculi (single or multiple) were identified in 41 out of 95 patients (43%). Two false-positive and 4 false-negative cases were found on MRC. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of MRC for choledocholithiasis were 90%, 96%, 94%, 95%, and 93%, respectively. CONCLUSION: MRC is a highly effective diagnostic modality for evaluation of patients with risk factors for CBD stones prior to LC.

Adult↗
PubMed2001

Tumoral calcinosis: case report.

Tumoral calcinosis (TC) is a rare disease of obscure aetiology. In its classic form, it is characterised by solitary or multiple large foci of mineralisation in the soft tissue adjacent to the bone around large joints in the absence of disorders of calcium metabolism and visceral calcification. A case is presented of TC in a 75-year old Kenyan woman.

Aged↗
PubMed2001

A rapid D-dimer assay in patients presenting at the emergency room with suspected acute venous thrombosis: accuracy and relation to clinical variables.

BACKGROUND AND OBJECTIVES: The measurement of D-dimer is claimed to have potential value in excluding deep vein thrombosis (DVT). New rapid methods have been proposed, but few clinical trials have assessed their performance in an emergency context. The different accuracies found between the D-dimer assays have been related to the test used (latex or ELISA), but other variables (such as population investigated, thrombus extension, duration of symptoms or concomitant heparin treatment) may be important, even if not sufficiently investigated. DESIGN AND METHODS: We evaluated the accuracy of a rapid semi-quantitative D-dimer test (Dimertest, Dade Behring), with reference to: a) its use at an emergency unit; b) concomitant heparin administration; c) location of venous thrombosis (VT) (in the deep or superficial venous system limited to the great saphenous vein) and d) symptoms older than 14 days. RESULTS: Two hundred and ninety-eight patients suspected of having DVT and 116 suspected of thrombosis of the great saphenous vein (GSV) were investigated. In the DVT patients, the sensitivity, specificity, positive and negative predictive values were 77.4% (95% CI 68.9-85.9), 81.4% (95% CI 76.1-86.7), 65.4% (95% CI 56.5-74.3) and 88.8% (95% CI 84.2-93.4), respectively. Excluding patients receiving heparin and those with symptoms older than 15 days, the sensitivity and negative predictive value increased to 86.3% (95% CI 78.4-94.2) and 92.8% (95% CI 88.4-97.2), respectively. In patients with GSV thrombosis, the sensitivity, specificity, positive and negative predictive values were 48% (95% CI 34.5-61.5), 90.6% (95% CI 83.2-97.9), 80.6% (95% CI 66.6-94.6) and 68.2% (95% CI 57.8-78.6), respectively. Excluding patients receiving heparin and those with symptoms older than 15 days, did not change the sensitivity or negative predictive value significantly. INTERPRETATION AND CONCLUSIONS: Our results show that previous or concomitant heparin administration, non-acute symptoms and thrombosis localized to superficial veins reduce the clinical usefulness of the D-dimer test as the rate of false negative results is increased.

Acute Disease↗
PubMed2000

Nephrotic-range proteinuria, the major risk factor for early atherosclerosis in juvenile-onset systemic lupus erythematosus.

OBJECTIVE: To determine the presence of early carotid atherosclerosis and associated risk factors in patients with juvenile-onset systemic lupus erythematosus (SLE). METHODS: The carotid intima-media wall thickness (IMT) was measured by B-mode ultrasound in patients with SLE onset before the age of 16 years and in sex- and age-matched healthy control subjects. Risk factors for atherosclerosis were determined at the time of the ultrasound scan and included traditional cardiovascular and SLE-related risk factors. RESULTS: Twenty-six patients with juvenile-onset SLE and 26 healthy controls were studied. The mean (+/- SD) IMT of the SLE patients was significantly higher than that of the control group (0.57+/-0.05 mm and 0.54+/-0.03 mm, respectively; P = 0.006). The results of IMT measurement were not correlated with the patients' age, disease duration, SLE Disease Activity Index (SLEDAI) score, Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index (DI) score, laboratory indicators of lupus activity, or cumulative prednisone dose. Patients with nephrotic-range (NR) proteinuria (> or = 3.5 gm/24 hours; n = 6) had a significantly higher IMT than did those without (n = 20) (P = 0.02). Patients with NR proteinuria also had significantly higher SLEDAI scores, SLICC/ACR DI scores, and systolic and diastolic blood pressures, and significantly higher levels of total cholesterol, low-density lipoprotein cholesterol, apolipoprotein B, and fibrinogen. No difference in any of the above variables, including the IMT, was observed when SLE patients without NR proteinuria were compared with healthy controls. CONCLUSION: These patients with juvenile-onset SLE had ultrasonographic evidence of premature atherosclerosis. The risk of early atherosclerosis may be higher in patients with NR proteinuria.

Adolescent↗
PubMed1999

Aortobronchial fistula after coarctation repair and blunt chest trauma.

A 34-year-old man had development of an aortobronchial fistula 17 years after patch aortoplasty for correction of aortic coarctation and 5 years after blunt chest trauma, an unusual combination of predisposing factors. The clinical presentation, characterized by dysphonia and recurrent hemoptysis, and the surgical findings suggested the posttraumatic origin of the fistula, which was successfully managed by aortic resection and graft interposition under simple aortic cross-clamping, associated with partial pulmonary lobectomy. When hemoptysis occurs in a patient with a history of an aortic thoracic procedure, the presence of an aortobronchial fistula should be suspected. Early diagnosis offers the only possibility of recovery through a lifesaving surgical procedure.

Adult↗
PubMed1999

Virtual CT intravascular endoscopy of the aorta: pierced surface and floating shape thresholding artifacts.

Two types of artifacts may appear in virtual computed tomographic endoscopic views of the aorta rendered at different threshold levels: pierced surface and floating shape artifacts. A positive correlation was found between mean attenuation of the aorta and the threshold levels at which these artifacts appeared. The correlation was statistically significant (0.71 < or = r < or = 0.86) for floating shape. An artifact-free threshold range can be predicted on the basis of aortic enhancement.

Adult↗
PubMed1997

Chloroquine versus pyrimethamine/sulphadoxine in the treatment of uncomplicated P. falciparum malaria in northern Kenya.

The response of P. Falciparum to chloroquine (CQ) and pyrimethamine-sulphadoxine (PSD) in vivo was investigated in 173 indigenous uncomplicated malaria patients at Sololo Hospital, Moyale district in northern Kenya. All the patients were symptomatic and parasitaemic. They were divided in two age groups (children < 10 years, adults > 10 years). They were randomly assigned to receive either CQ or PSD standard treatment and then followed up at 7 and 14 days. In the child group, out of 91 patients enrolled, 65 (71.4%) completed the seven-day study; among these 38 (17 females and 21 males with mean age of 41.9 months) were treated with CQ and 27 (11 females and 16 males with mean age 39.1 months) with PSD. Parasites were significantly (p < 0.001) more resistant to CQ (18/38, 47.4%) than PSD (0/27, 0%). In the adult group, out of 82 patients enrolled, 54 (65.9%) completed the 7-day-study, and among these 27 (10 females and 17 males with mean age of 22.5 years) were treated with CQ and 27 (11 females and 16 males with mean age of 23.2 years) with PSD. Parasites were significantly (p = 0.01) more resistant to CQ (7/20, 25.9%) than PSD (0/27, 0%). Overall, considering the 119 patients who completed the follow-up, the resistance of P. falciparum was significantly higher (p < 0.001) to CQ (25/65, 38.5%) than to PSD (0/54, 0%). Out of the 94 patients with negative slide at day 7, fifty seven came at the control of the day 14 (30 children and 27 adults). Among them, 22 were in CQ group and five were found positive (22.7%), while the 35 patients in PSD group all tested negative (p = 0.006). The resistance to CQ in the children group was 25% (p = 0.05) and 20% in the adult group (p = 0.13). We conclude that the significant parasitological resistance to CQ in the area under study questions the continued use of CQ as first line antimalarial treatment. On the contrary, PSD can still be considered a very effective drug against P. falciparum in northern Kenya.

Adolescent↗
PubMed1997

[The neonatal respiratory insufficiency syndrome: the role of the chest radiogram].

INTRODUCTION: Chest radiography is considered the most reliable diagnostic tool to study the respiratory distress syndrome in newborns and one of the few diagnostic investigations which can be used considering the clinical situation of these patients and the need of a prompt diagnosis. MATERIALS AND METHODS: We examined 124 newborns (56 males and 68 females) submitted to chest radiography at least once. Two radiologists analyzed the images investigating: a) chest expansion, b) reticulonodular opacities, c) aerial bronchograms, d) parenchymal consolidation, e) atelectasis, f) pneumothorax. The clinical diagnosis was made by neonatologists on the basis of clinical and instrumental data and of the clinical evolution of the patients. RESULTS: Twenty of 23 clinically negative patients had negative chest radiographs and 3 were false positives. Transient tachypnea was diagnosed in 14 newborns where chest radiography showed reticulonodular opacities. Ten of 62 patients with hyaline membrane disease had a negative chest radiograph, 26 had fine granular opacities, 16 marked hypoexpansion with reticulonodular opacities and aerial bronchogram, and 10 diffuse parenchymal consolidations with aerial bronchogram also in the peripheral lung. Eleven patients had a clinical and radiological diagnosis of segmental or lobar atelectasis; 5 newborns had an aspiration syndrome and radiography showed parenchymal consolidations in 4 and was negative in one. Five patients had pneumothorax, 3 diaphragmatic hernia and 1 infective pneumonia; radiology confirmed the diagnosis in all cases. We had three false positives and 11 false negatives at conventional radiography--i.e., 10 had MMI and one the meconium aspiration syndrome. Diagnostic sensitivity was 89.1%, specificity 86.9% and diagnostic accuracy 88.7%. CONCLUSIONS: Our results are partially limited by the lack of a reference gold standard. Nevertheless, if we consider the clinical condition and the respiratory distress syndrome evolution as a valid reference, the diagnostic accuracy of radiography is good.

False Negative Reactions↗
PubMed1996

Pulmonary function, smoking habits, and high resolution computed tomography (HRCT) early abnormalities of lung and pleural fibrosis in shipyard workers exposed to asbestos.

To evaluate the presence of asbestos-related pleural and parenchymal abnormalities and their correlation with pulmonary function and smoking habits, 119 asbestos-exposed asymptomatic workers (mean age, 46.2 years; mean duration of asbestos exposure, 8.6 years; mean latency time, 21.6 years) with normal standard P.A chest radiographs were submitted to HRCT, CO-diffusing capacity and pulmonary function tests. HRCT scans were normal only in 31 (26%) examined workers; 31 (26%) subjects showed both pleural and parenchymal involvement, and 50 (42%) and seven (6%) had exclusively pleural and parenchymal abnormalities, respectively. Based on CO-diffusing capacity and pulmonary function tests, no significant difference was demonstrated between workers with pleural lesions and subjects with normal pleura; however, lower values of FVC were observed in the nonsmoking workers with parenchymal abnormalities in comparison with nonsmoking subjects with normal parenchyma (78.2 vs. 89.7% of predicted values; p = 0.03 by student's two-tailed t test), and lower values of FEV1/FVC in the smokers with parenchymal lesions with respect to smokers with normal parenchyma (93.7 vs. 100.2% of predicted values; p = 0.005 by students' two-tailed t test). In conclusion, our results demonstrate that HRCT may detect early parenchymal abnormalities which correlate with exposure to asbestos and respiratory function impairment, including a reduction in obstructive indices in smokers occupationally exposed to asbestos, without any clinically evident disease.

Adult↗
PubMed1996

Usefulness of MR signal intensity in distinguishing benign from malignant pleural disease.

OBJECTIVE: The aim of this study was to analyze the potential usefulness of MR signal intensity in differentiating malignant from benign pleural disease. SUBJECTS AND METHODS: Forty-five patients with pleural lesions identified on CT scans were subsequently examined by MR imaging at 0.5 T. T1-weighted, proton density-weighted, T2-weighted, and enhanced T1-weighted spin-echo images were obtained. For 34 patients, a diagnosis of malignant (n = 18) or benign (n = 16) disease was established. The morphologic features of the pleural lesions and MR signal intensity on T1-weighted, proton density-weighted, T2-weighted, and enhanced T1-weighted images were evaluated, and the ratio of lesion to muscle signal intensity was computed. RESULTS: Assessment of morphologic features by MR imaging and CT was not significantly different. High signal intensity on proton density-weighted and T2-weighted images was observed in all malignant lesions and in two benign lesions (sensitivity, 100%; specificity, 87%; negative predictive value, 100%). The ratio of lesion to muscle signal intensity on T1-weighted, proton density-weighted, T2-weighted, and enhanced T1-weighted images discriminated between malignant and benign lesions (p < .0001). For the subgroup of lesions misinterpreted by CT (n = 6), the evaluation of MR signal intensity on long-TR images made it possible to differentiate malignant from benign conditions. CONCLUSION: MR signal intensity is a valuable additional feature for differentiating malignant from benign pleural disease. Signal hypointensity with long-TR sequences is a reliable predictive sign of benign pleural disease.

Adult↗
PubMed1996

[Study of bullous fibrosis of the upper lobes in ankylosing spondylitis with high-resolution computerized tomography].

The fibrobullous disease of the upper lobes is an uncommon extraspinal complication of ankylosing spondylitis. We report the conventional radiographic and High Resolution Computed Tomographic (HRCT) findings in the fibrobullous disease of the upper lobes in ankylosing spondylitis. From 1988 to 1994, four patients affected with ankylosing spondylitis, with radiographic involvement of the upper lobes, came to our observation. All patients underwent a chest X-ray exam and the previous chest X-rays carried out 2-25 years earlier were reviewed. Within 15 days, HRCT was performed, during inspiratory apnea. In all cases, repeated bronchoscopies were available, showing bronchial inflammation, together with cytologic tests and bronchial fluid cultures, which revealed no development of mycobacterium tuberculosis. The most frequent CT findings were pleural thickening, fibrotic consolidation and thickening of interlobular septa. Bullae, nodules and ground-glass areas were less frequent findings. The standard chest X-ray exam demonstrated, with the same sensitivity as HRCT, pleural thickening, bullae, nodules and volume loss in the involved lung. However, interlobular septa thickening was depicted only in one case, while bronchiectases and ground-glass areas were not recognized at all. Three temporally distinct patterns of apical involvement (infiltrative, interstitial and fibrobullous) were identified. In conclusion, HRCT was more sensitive and more specific than chest X-rays in the study of the fibrobullous disease of the upper lobes in ankylosing spondylitis.

Adult↗