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F Pozzi-Mucelli

Publications and source records attributed to F Pozzi-Mucelli.

15 recordsLinked to original sources
PubMed2006

MR angiography versus intra-arterial digital subtraction angiography of the lower extremities: activity-based cost analysis.

PURPOSE: The aim of this study was to analyse the costs pertaining to the radiology department of magnetic resonance angiography (MRA) and intra-arterial digital subtraction angiography (DSA) in the evaluation of arterial disease of the lower limbs. MATERIALS AND METHODS: The differential cost of the two procedures, i.e. the sum of equipment costs (amortisation and service contract), variable costs (supplies and related services) and personnel costs (radiologist, radiographer and nurse) was determined. The common cost (auxiliary personnel and indirect internal costs) was also calculated. Finally, the full cost of the two procedures was obtained (sum of differential and common costs). RESULTS: The differential cost of MRA was 186.14 euro (equipment costs: 50.80 euro, variable costs: 75.04 euro, personnel costs: 60.30 euro) while the differential cost of intra-arterial DSA was 238.18 euro (equipment costs: 57.60 euro, variable costs: 90.13 euro, staff costs: 90.45 euro). The estimated common cost was 5.62 euro. Therefore, the full cost of MRA was 191.76 euro and the full cost of intra-arterial DSA was 243.80 euro (27.1% higher). DISCUSSION AND CONCLUSIONS: Intra-arterial DSA costs more than MRA, mainly because of the higher costs of supplies used during the procedure and higher personnel costs (as a result of the longer duration of intra-arterial DSA). It should be noted that our evaluation considers costs pertaining to the radiology department only. It is evident that an economic analysis considering hospital costs as well would result in much higher costs for DSA if post-procedure hospitalisation is required. Our results cannot be simply exported to other radiology departments since they refer to the technology and organisation adopted in our department. However, our cost analysis model can be easily applied to other environments. MRA provides good diagnostic accuracy in the evaluation of arteries of the lower extremities, and its biological cost is far lower than that of intra-arterial DSA (MRA is noninvasive, it does not use ionising radiation, and the contrast medium is safe). Its lower cost is another argument in favour of the use of MRA instead of intra-arterial DSA in the evaluation of lower-extremity arterial disease.

Angiography, Digital Subtraction↗
PubMed2001

Venous thromboembolism and melanoma.

The association between venous thromboembolism and cancer has been known for many years. The clotting system may be activated because of enhanced platelet aggregation and adhesion or by stimulation from the endothelial cells or the tumour cells themselves. Furthermore, thrombosis may develop as a result of prolonged immobilization, surgery, chemotherapy or hormone therapy. We present a case of a patient who underwent surgery for excision of a Clark level II melanoma on the back who developed pulmonary metastasis four years after the operation. The metastasis manifested with very severe venous thromboembolism which, despite anticoagulant therapy and the placement of a vena caval filter, led to the patient's death from pulmonary embolism. The case is uncommon, in terms of both the rarity with which venous thromboembolism is associated to melanoma, and the severity with which it manifested.

Humans↗
PubMed2000

[The imaging of chronic renal infections].

From pathological point of view the chronic renal infections include two types, interstitial chronic pyelonephritis and granulomatous pyelonephritis, namely xanthogranulomatous, malacoplakia and renal tuberculosis. Indications for imaging modalities are more common compared to the acute types and allow to depict both factors causing obstruction and infection such as stones ant the renal and extrarenal extension of the disease. In this article the authors review the findings and the role of plain film and urography, computed tomography and ultrasonography.

Chronic Disease↗
PubMed1999

Medical treatment of renal and perirenal abscesses: CT evaluation.

AIM: A retrospective study of our experience of CT evaluation and follow-up of 16 solitary and multiple renal abscesses treated successfully with antibiotics alone and evaluated with CT at the onset of symptoms and after therapy. MATERIALS AND METHODS: Seven patients had a solitary renal abscess, five had multiple renal abscesses and four had renal and perinephric abscess. None of the abscesses were larger than 5 cm. RESULTS: In all 16 patients, the CT examination showed total renal and extrarenal regression of the abscesses. In four patients, scarring of the renal outline was observed on follow-up. CONCLUSIONS: The study demonstrates the opportunity to avoid aggressive interventional or surgical treatment of renal and perirenal abscesses of 5-cm diameter or less which can completely regress after antibiotic therapy of at least 4 weeks. The CT examination results are important both in the diagnostic phase to establish the extent of the lesions and in the follow-up to check the results of medical treatment.

Abscess↗
PubMed1997

Delayed CT in acute renal infection.

CT scans of the kidneys obtained approximately 3 hours after contrast administration often reveal useful information in patients with renal infections. In this article, we discuss three main features of these delayed scans. Feature 1 shows a nephrogram replacing a variable portion of the low density areas present in the early enhanced phase. The nephrogram can be streaky, band-like, cone or horseshoe-shaped; Feature 2 exhibits a focal staining or a hyperdense rim surrounding microabscesses and macroabscesses; Feature 3, very rare, is characterized by hyperdense areas located far from the lesions detected on early scans. These features make it possible to better define the actual extent of infection and the presence of the edema, improving diagnostic confidence.

Acute Disease↗
PubMed1995

Delayed CT findings in acute renal infection.

The computed tomography (CT) findings in twelve patients with acute renal infection examined immediately and 3 h after i.v. contrast medium are reported. Three patients also had delayed scans at 6 h. Three main features were observed on the delayed scans: 1 a delayed nephrogram with streaky, wedge shaped or round high density areas. The areas of high density were at the same sites of the inhomogeneous areas of reduced density on the early scans; 2 focal contrast medium staining or a rim of increased density around abscesses; 3 focal areas of increased density at sites distant from the low density areas seen on the early scans. It is postulated that the delayed areas of increased density replace early areas of reduced density caused by ischemia due to vasospasm and/or compressing oedema of the vascular bed or by tubular obstruction. Delayed CT appears to be useful because it improves diagnostic confidence and gives a more exact evaluation of the extent of infection.

Acute Disease↗
PubMed1993

Increased density in the middle cerebral artery by nonenhanced computed tomography. Prognostic value in acute cerebral infarction.

In order to consider the prognostic value of hyperdensity of the middle cerebral artery (MCA), we studied retrospectively the medical records of 80 consecutive patients with the diagnosis of ischemic stroke who underwent a non-enhanced computed tomography no longer than 24 h after the onset of the symptoms. To determine the mortality and disability, a follow-up of 30 days was obtained. Mortality does not differ significantly in acute ischemic stroke patients with and without increased density of MCA. When disability, calculated with the Rankin scale, is considered, the two groups are different since patients with hyperdensity of the middle cerebral artery (MCA) have a significantly worse outcome. The two groups do not differ for age, sex, the presence of atrial fibrillation, hypertension, diabetes, myocardial infarction and/or angina, and these factors do not influence the prognosis being equally present in the dead and in the survivors. In the multivariate discriminant analysis with stepwise variable selection, the dense MCA sign was significantly correlated either to mortality or to disability, along with atrial fibrillation, age and diabetes. We conclude that the dense MCA sign can be a useful prognostic factor in the early phase of ischemic stroke.

Aged↗
PubMed1993

[Renal angiomyolipomas: atypical aspects in ultrasonography and computerized tomography].

As a rule, renal angiomyolipomas (AML) present with characteristic patterns on US and CT images. However, in a limited number of cases US and CT findings are atypical, so that no diagnosis can be made on their basis. The authors reviewed their personal series of renal tumors and now report the US and CT findings of 5 cases with atypical features on one or both examinations. Two patients had hyperechoic lesions with typical AML patterns, but no fatty densities were visible with CT. Both patients underwent surgery and histology which showed two AMLs with muscular and vascular components and very few fatty cells. Two cases were observed in patients with Bourneville disease. Even though the cases exhibited atypical features on US and CT images, the diagnosis was suspected on the basis of the well-known association of tuberous sclerosis with AML. One case presented with a complex cystic mass on US; CT showed a bleeding tumor. Even though no unquestionable diagnosis of AML could be made in this case, the hypothesis of a bleeding AML was considered in the differential diagnosis. Such atypical imaging features were related to low fatty content inside the lesion and to bleeding complications. Absent/low fatty component represented a cause of atypical lesion appearance on CT which showed a mass with soft-tissue density which could not be differentiated from a solid tumor. In these cases, AMLs remained typically hyperechoic on US images. Bleeding represented a cause of error mainly on US since the typical hyperechoic pattern was replaced by a iso-hypoechoic pattern. CT is helpful in these cases because it shows both the bleeding and possible low-density fatty areas.

Adult↗
PubMed1990

Cystic renal tumors: US and CT findings.

Cystic renal tumors represent a variety of lesions in which both solid and liquid components coexist. These lesions may be either benign or malignant and include the multilocular cystic nephroma (MCN), the renal cell carcinoma (RCC), and the papillary adenocarcinoma (PAC). The MCN is a rare neoplasm formed of multiple loculated cystic masses divided by septa. The tumor is benign, although there are some rare reports of malignant cases. The RCC and the PAC may appear with cystic patterns. This is rather uncommon for the RCC, which inside has a unilocular or multilocular cystic appearance, if the necrotic component is large. PAC is an infrequent renal tumor, which has a greater tendency to appear as a large mass with a unilocular large cystic space. The ultrasonography (US) and computed tomographic (CT) features of 27 cystic tumors are presented. Both US and CT allowed the recognition of the cystic components, the septa, and the vegetations. The two imaging techniques made it possible to distinguish the tumors into "unilocular" and "multilocular" masses: the former correspond to RCC and PAC, the latter to MCN and RCC. CT added some information on calcified or partially calcified tumors. CT more than US enabled the differentiation between the malignant RCC and the benign MCN for which conservative surgery may be indicated. The two techniques did not allow the differentiation between RCC and PAC, which has different prognostic behavior.

Adenocarcinoma, Papillary↗
PubMed1989

[Comparative analysis of the technics of preoperative localization of the parathyroid glands].

Parathyroid surgery needs an appropriate diagnosis and a preoperative localization. We conducted a prospective study to compare the efficacy of 4 different imaging modalities in 17 patients: thallium-technetium subtraction scintigraphy, ultrasonography, computed tomography and arteriography. The sensitivity was: scintigraphy 58%, echotomography 86%, Tc 92% and arteriography only 33%. Neck exploration confirmed the imaging results. We found 15 cases of adenomas (2 cases of double adenoma) and 1 case of hyperplasia; in 1 patient, no lesions were found. We conclude that the association of such techniques appears to be the optimal strategy in about 100% of the patients.

Adenoma↗
PubMed1988

[Diagnostic imaging of renal tumors of small dimensions].

The incidence of small renal tumors (less than cm 3) has increased in the past few years. Reasons for the increased number of reports are related to the contribution of Sonography and Computed Tomography--which enable a greater number of kidneys to be examined and allow a more detailed study of renal parenchyma. In order to assess the diagnostic value and role of the various imaging techniques in this pathology, the authors reviewed all renal tumors observed between 1982 and 1987. Nineteen cases presented with the characteristics of small renal tumors with "solid" findings on both US and CT. Sixteen cases were histologically proven (15 adenocarcinomas, 1 oncocytoma). Three recent, unoperated, cases are included since their features are the same as in the other cases. Metastases and other kinds of tumors (i.e. angiomyolipomas) are not included in this series. Ivp was performed in 14/19 cases; US and CT were always performed. CT proved to be the most sensitive technique, being positive in all cases. Ivp was positive in 9/14 cases (64%) and US in 14/19 (73%). A significant increase in the number of small renal tumors detected was observed, mainly in 1985-1987. This increase is correlated with the increase in the total number of abdominal examinations which US and CT have made possible. Most patients were asymptomatic; in fact, 15/19 cases were incidentally discovered with US and CT of the upper abdomen. US and CT appear to give a substantial contribution to an early diagnosis of small renal tumors, which may have a significant impact on both surgery and prognosis.

Adenocarcinoma↗
PubMed1987

[Preprocessing programs of CT images for three-dimensional reconstruction].

Up to now three-dimensional reconstructions in computed tomography have been applied mainly to the skeleton. This limitation is due to technical difficulties when dealing with images of the soft tissues. In order to overcome these limitations three new softwares were developed, thus enabling the operator to pre-elaborate and modify the axial CT images. The first program allows the operator to isolate the lesion and/or the anatomical structures of interest from the surrounding areas. The second program eliminates the areas of isodensity with the lesion it is obtained by means of a trackball. The third program enables the operator to write the modified axial images on the original file. The lesion and/or the structures of interest can thus be processed more easily by the 3D reconstructive program. The new softwares have been applied to 3D reconstructions of brain lesions, and two significant cases are presented. Furthermore, since the new softwares can enhance the quality of 3D images of the skeleton, the programs were also tested in cases of acetabular traumas.

Acetabulum↗
PubMedDate not supplied

[Findings in myelographic block. Correlations with computerized tomography image].

Fifteen cases with complete myelographic stop were examined by CT. CT showed stenosis of the spinal canal in 11/12 cases with extradural lesion (92%). The stenosis was or was not associated to disk pathology; one case was due to a large herniated disk. Three cases were due to a neurinoma and were not visualized at CT without intrathecal contrast medium. This situation represents a limitation of CT and therefore an indication for myelography.

Humans↗