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L Preda

Publications and source records attributed to L Preda.

At least 19 recordsLinked to original sources
PubMed2006

Bisphosphonates and jaw osteonecrosis in patients with advanced breast cancer.

BACKGROUND: In recent years, several cases of mandibular necrosis associated with long-term use of bisphosphonates have been reported. The estimated incidence varies from 1% to 4.6%. PATIENTS AND METHODS: We conducted an observational study with the aim of determining the incidence of jaw osteonecrosis in advanced breast cancer patients with bone metastases under bisphosphonate treatment and to identify subjects at higher risk of developing this complication evaluating preclinical signs. We considered two groups of patients. All the patients complaining of odontostomatological symptoms underwent maxillary CT scan and maxillo-surgeon clinical examination. Asymptomatic patients were asked to perform a standard orthopantomography (OPT). RESULTS: From February 2005 to October 2005, we observed five patients with jaw bone necrosis (6%). Diagnosis was radiological and clinical. In two patients a confirmatory biopsy was performed. In the same time interval, OPTs were collected from 76 asymptomatic patients. Three OPTs revealed radiological features of suspicious mandibular necrosis. Maxillary CT scan confirmed the presence of an osteolityc area with signs of periosteal reaction. All the three patients were referred to maxillo-surgeon and two out of three patients underwent mandibular biopsy, but histopathological results were not conclusive. CONCLUSIONS: In our experience, the incidence of jaw bone necrosis in breast cancer patients seems to be higher than in other reports (6%). Radiological features of suspicious jaw necrosis were observed in three asymptomatic patients. We do not know how these findings should be considered. Anyway, standard OPT is a simple procedure, and may allow identification of periodontal conditions that in some way can predispose to the development of this uncommon event.

Adult↗
PubMed2001

A new global test for the evaluation of the activated factor II-antithrombin system.

We developed a new simple test to evaluate the global function of the activated factor II-antithrombin system. The new test measures the clotting time of plasma samples after the addition of a reagent containing a snake venom (Echis carinatus) that can activate prothrombin, with (Ta) and without (To) heparin. The prolongation of clotting times (Ta - To) is directly related to the function of the activated factor II-antithrombin system. The presence of quantitative or functional defects of the natural inhibitors (antithrombin and heparin co-factor II), or high levels of factor II and/or fibrinogen, can trigger a resistance to the inhibition of activated factor II. This new test was used to examine 134 thrombophilic patients as well as 157 normal subjects as controls. The results obtained confirm that the presence of abnormalities relating to the activated factor II-antithrombin system causes a resistance to activated factor II inhibition even if a significant number of patients was found to have a resistance that could not be accounted for. Since the new test can be easily performed automatically and has a good inter- and intra-assay variation coefficient (CV < 4%) it is useful for evaluating the global function of the activated factor II-antithrombin system in screening thrombophilic patients, alongside the tests already known and used to diagnose these patients.

Antithrombins↗
PubMed2000

Correlation between pretreatment prognostic factors and lymph node metastases in endometrial adenocarcinoma. Clinical application.

PURPOSE: To evaluate the prognosis of stage I endometrial adenocarcinoma, which differs by various prognostic factors. Some of them (tumor grading, histotype, myometrial infiltration, the latter evaluated with Magnetic Resonance Imaging) can be assessed before surgery. These prognostic factors correlate with patient survival and the presence of lymph node metastases. MATERIAL AND METHODS: We used tumor grading, histotype, myometrial infiltration for the preoperative and prospective classification into a low- and a high-risk group of 80 patients with endometrial adenocarcinomas stage I. Low-risk patient [group A: G1-G2, pure adenocarcinoma involving the inner portion of the myometrium (M0-M1)] underwent surgery without lymph node resection, while high-risk patients [group B: G3, pure adenocarcinoma with deep infiltration of the myometrium (M2) and/or clear cell, serous papillary, adenosquamous carcinomas] had pelvic and lumboaortic lymphadenectomy. The minimum 36 months' follow-up (median: 61 months) was requested for all patients. RESULTS: Histotype evaluated by dilatation and curettage and hysteroscopic and/or office biopsy, had 100% agreement with tumor histotype. Tumor grading was in agreement in 72/80 patients (81%). The grade of myometrial infiltration was confirmed in 72/80 cases (81%). Eight misdiagnoses were divided in over--(4 cases) and under--(4 cases) estimated infiltration. All 16 mistakes resulted in 10 inclusion in the wrong risk group (8 in the low-risk and two in the high-risk group). Surgical-pathological staging did not change the prognosis but only staging in 6 preoperatively high-risk group. CONCLUSIONS: This initial study confirms the importance of prognostic factors in the treatment of endometrial adenocarcinoma, as well as that of the different surgical choices which can be made after correct pretreatment prognosis.

Adenocarcinoma↗
PubMed1999

Persistence of the left superior caval vein: can it potentiate obstructive lesions of the left ventricle?

Recent evidence has suggested that persistence of the left superior caval vein is associated with a high incidence of obstructive lesions of the left heart. To shed more light on this issue 1085 patients with congenital heart disease were studied retrospectively, with the aim of estimating the prevalence of a persistent left superior caval vein and its associated anomalies, focusing attention on obstructive lesions in the left and right ventricles. Patients with isomerism of the atrial appendages, or hypoplastic left heart syndrome, were excluded. A persisting left superior caval vein was present in 57 patients (5.2%). The overall incidence of obstructive lesions of the left heart was higher in patients with than in those without a persistent left superior caval vein (31.6 versus 7.8%,p < 0.001). Relative hypoplasia of the left ventricle was also higher in patients with persistent left superior caval vein (14 versus 0.8%, p < 0.001). The obstructive lesions found in the left heart, compared with the number in those without a left caval vein, were: mitral stenosis, 5.2 versus 0.7%; subaortic stenosis, 5.3 versus 0.9%; aortic coarctation, 17.5 versus 5.8% (p < 0.01); all of these in association, 3.5 versus 0.4%. In contrast, the incidence of obstructive lesions of the right heart was similar in the two groups of patients. It is concluded that persistence of the left superior caval vein can perturb the normal development of the left ventricle, being strongly associated with obstructions to left ventricular inflow and outflow.

Aortic Coarctation↗
PubMed1999

The role of computed tomography in the preoperative assessment and follow-up of oromandibular reconstruction with microvascular osteomyocutaneous free flaps.

OBJECTIVE: To investigate the capacity of helical CT in the pre- and post-operative management of oromandibular reconstruction of patients with oropharyngeal carcinoma using microvascular composite free flaps. MATERIALS/METHODS: Thirty-four patients with oropharyngeal cancer were examined by helical CT and nine (six men and three women) submitted to oromandibular reconstruction. The osteomyocutaneous flaps used for reconstruction were taken from the iliac crest in six cases and from the fibula in three cases. All patients were examined by CT 1 - 4 days postoperatively and then at 6 monthly intervals. Double helical scans were performed in all cases, with slices of 2 - 3 mm for primary lesion studies and 5 mm for lymph node staging, pitch >/=1 and RI=1. Multiplanar (MPR) and 3D reconstructions were obtained from pre- and postoperative CT examinations. RESULTS: Preoperative CT showed massive bone infiltration in six of the nine surgical patients and marginal infiltration in three. These findings were confirmed histologically. There were no false negatives. The immediate postoperative examination showed correct flap positioning in eight of nine cases. The flap underwent ischemic necrosis in two cases; CT showed very early signs of bone ischemia in both. CT detected two cases of recurrence after about 1 year. CONCLUSIONS: Axial CT permitted adequate assessment of the extent of mandibular infiltration and detected early ischemic complications and distant recurrences. Integration with MPR and 3D reconstructions simplified the choice of flap type and size and enabled the postoperative assessment of correct flap positioning. This helped the surgeon plan subsequent rehabilitation with osseo-integrated implants.

Aged↗
PubMed1998

Spiral CT angiography and surgical correlations in the evaluation of intracranial aneurysms.

We investigated the accuracy of spiral computed tomography angiography (CTA) in the detection and study of intracranial aneurysms by comparing CTA with selective angiograms and surgical findings. Twenty-six patients (9 men and 17 women; mean age 53.1 +/- 1.8 years) with suspected intracranial aneurysms were submitted to CTA (1- to 2-mm slices, pitch 1:1, 24 s, RI = 1) after a conventional CT examination showing subarachnoid hemorrhage (SAH) in 19 cases and during neuroradiological investigations performed for other reasons in 7 cases. One hundred twenty to 150 ml iodate contrast agent (0.3-0.4 gI/ml) were injected intravenously at 5 ml/s rate and with 12- to 25-s delay calculated with a preliminary test bolus. Three-dimensional shaded surface display (3D SSD) and maximum intensity projection (MIP) reconstructions were obtained from axial images. Then, within 48 h, all patients were submitted to digital subtraction angiography (DSA), with separate assessment of CTA and DSA findings. Twenty-two aneurysms shown by CTA were confirmed at DSA and surgery (true positives), whereas the vascular lesion was not confirmed at DSA in 2 cases (false positives). The presence of intracranial aneurysms was excluded at both CTA and subsequent DSA in 7 cases (true negatives) and there were no false negatives; sensitivity was 100 %, specificity 77.8 %, and diagnostic accuracy 93.5 %. Computed tomography angiography aneurysm location was confirmed at surgery in all cases, with very high accuracy in assessing the presence of an aneurysm neck (100 %). Computed tomography angiography accurately depicted the aneurysm shape in 20 of 22 cases, but failed to depict its multilobed nature in 2 cases. The mean aneurysm diameter calculated at CTA was 0.99 +/- 0.12 cm vs 1.09 +/- 0.11 cm at surgery (p < 0.01). The present results suggest that the high sensitivity of CTA, if confirmed by further studies, might help in avoiding having to resort to arteriography after negative CTA in SAH patients.

Adult↗
PubMed1998

[Complex maxillofacial trauma: diagnostic contribution of multiplanar and tridimensional spiral CT imaging].

INTRODUCTION: Adequate radiologic assessment of the maxillofacial trauma patient is the basis for planning reparative surgery. We investigated the yield of the integration of axial CT with multiplanar (MP) and three-dimensional (3D) reconstructions with the Spiral technique. MATERIAL AND METHODS: Thirty-five patients (21 men and 14 women, mean age: 31.2 years) with complex maxillofacial traumas were submitted to Spiral CT. Images were acquired with 2-3-mm collimation, 1:1 to 2:1 pitch, 210 mAs, 120 kV, 15-24 s Spiral scan, RI = 1. 3D reconstructions were always obtained and used to guide MPRs targeted on the single injury. The examinations were retrospectively given a score, namely 1 if 3D and MPR yielded no more important diagnostic information than axial CT, 2 if 3D and MPR permitted better detailing of some axial CT findings and thus improved image reading, and 3 if 3D and MPR showed new injuries missed on axial images. Then, a radiologist and a maxillofacial surgeon reviewed the 3D images together only to assess in which cases they were useful to optimize surgical planning. RESULTS: Nine cases (25.7%) scored 1, seventeen (48.6%) scored 2 and nine (25.7%) scored 3. MP and 3D reconstructions were useful or determinant (2 + 3) in over 74% of cases. 3D images made surgical planning easier in 15 of 32 surgical patients (46.8%), allowing the surgeon a better panoramic view of the complex fracture. CONCLUSIONS: The greatest advantage of multiplanar imaging is the improved depiction of skeletal injuries along a horizontal plane, paralleling that of axial scans. The depiction of fractures of cribrum and of orbital roof and floor was particularly useful from a clinical viewpoint. MPRs clearly depicted herniation and incarceration of the lower rectus muscle in blow-out fractures. MP and 3D reconstructions better defined the presence and grade of displaced bone fragments in nearly vertical structures, such as the upward branches and coronoid apophysis of the mandible. 3D images alone never showed any more fractures than those seen on axial and MP images. 3D images are especially useful to the surgeon because they permit the panoramic depiction of the fracture complex, which facilitates treatment planning. The radiologist can use 3D reconstructions to guide the acquisition of targeted MP reconstructions, for better diagnostic yield. The Spiral technique, with its pitch increases up to 2, permits to limit the radiation dose while preserving the quality of postprocessing reconstructions. Finally, decreasing the execution time is important in multiple trauma patients who are often clinically unstable or have damaged vital organs.

Adult↗
PubMed1997

An improved test to identify aPC-resistant factor V-Leiden.

A functional clotting assay was recently reported to detect the factor V-Leiden mutation (R506Q) in patients receiving oral anticoagulants and in patients with Lupus Anticoagulant inhibitor. The original assay (Dahlback) to detect resistance to activated protein C (aPC-resistance) frequently gave unreliable findings in these patients. The change in the method is the use of bovine thromboplastin in a PT-derived assay, with a 1:10 sample dilution. In these conditions a reference normal plasma gives a prolongation of more than 35 seconds, while samples with a heterozygous or homozygous mutation give a prolongation respectively of 10-18 seconds or less 2 seconds. The test is easily automated and quickly performed on ACL/3000, and the reproducibility is good.

Animals↗
PubMed1997

Spiral CT findings in a case of pulmonary sequestration.

Pulmonary sequestration has always been diagnosed by direct demonstration of the vessels tributary to the lesion, usually by angiography. Conventional CT can identify the arterial supply in only two thirds of cases. We report a case of pulmonary sequestration diagnosed using Spiral CT, based on the demonstration of both arterial supply and venous drainage. The capabilities of Spiral CT to detect subtle vessel abnormalities and to yield reliable multiplanar imaging enabled us to show the whole course of both the artery and the vein tributary to the lesion. Axial images were the most useful ones to diagnose pulmonary sequestration; 2D and 3D reconstructions were useful for a detailed and immediate spatial depiction of the parenchymal abnormality and of its vascular pedicle.

Bronchopulmonary Sequestration↗
PubMed1997

Communicating bicornuate uterus with double cervix and septate vagina: an uncommon malformation diagnosed with MR imaging.

We report a case of communicating uterus diagnosed with MRI. These uterine malformations are characterized by a communicating tract between two separate uterocervical cavities, which is usually detected with hysterosalpingography performed for a suspected uterine malformation. In our patient MRI was performed after the clinical finding of a double cervix and a vaginal septum and demonstrated two separate uterine cavities, each of them with its own junctional area, and an isthmian transverse communicating tract with endometrial tissue inside, which helped make the diagnosis of a type-4 a communicating uterus according to Toaff.

Adult↗
PubMed1997

The use of spiral computed tomography in the localization of impacted maxillary canines.

PURPOSE: To compare spiral CT with conventional radiography in planning the orthodontic treatment of impacted permanent maxillary canines. METHODS: Nineteen patients with 29 malpositioned permanent maxillary canines (15 palatal and 12 buccal impactions, one ectopic and one transposition) were examined with conventional panoramic and lateral cephalometric radiography and with spiral CT (at 1 mm slice thickness, and 1:1 or 2:1 pitch) using multiplanar (MPR) and 3D reconstruction. RESULTS: Conventional radiography failed to depict root resorption especially on the buccal surfaces of the incisor teeth. CT located impacted teeth better. Contact between impacted maxillary canines and incisor roots was demonstrated in 26 cases and root resorption in eight. MPR proved to be superior for the orientation of impacted teeth, and, in two cases, confirmed the presence of minimal root lesions for which axial images had proved inconclusive. The 3D reconstructions were useful in targeting the MPR. CONCLUSIONS: CT facilitates the treatment of impacted canine especially when the teeth are very oblique to the arch. Root resorption is better demonstrated especially on the palatal and buccal surfaces of the adjacent incisors. Spiral CT reduces examination time and risk of accidental movement, thus optimizing MPR quality. Examination at 2:1 pitch enables a significant reduction in radiation exposure without loss of image quality.

Adolescent↗
PubMed1997

Use of spiral computed tomography for multiplanar dental reconstruction.

OBJECTIVE: To compare spiral with conventional CT for multiplanar reconstruction (MPR) prior to dental implant placement. METHODS: Ten patients underwent conventional and then Spiral CT at 1 mm slice thickness. In six patients (Group A) the pitch was 1:1; the other four (Group B) it was 2:1. Image quality and clinical features were evaluated separately on axial and reconstructed images by two experienced radiologists who scored each parameter from 1 (poor, non-diagnostic) to 3 (good, diagnostic). RESULTS: Loss of spatial resolution with spiral CT was not significant and the diagnostic yield poorer only for trabecular bone structure. The MPRs were better and depiction of the mandibular canal more reliable. CONCLUSIONS: We recommend the use of spiral CT instead of conventional CT for dental MPR because examination time is shorter and patient comfort is improved. Use of a pitch of 2:1 permits a marked reduction in X-ray dose with no loss of image quality.

Aged↗
PubMed1997

Clinical usefulness of CT in the treatment of stage I endometrial carcinoma.

This retrospective study was aimed at assessing Computed Tomography (CT) capabilities in identifying low- and high-risk groups of clinical stage I endometrial carcinoma patients. CT of the pelvis was performed on 125 endometrial carcinoma patients who were divided into two groups based on T (stage and depth of myometrial invasion) and N (lymph node status) parameters. All patients had histologic evidence of well/moderately-differentiated adenocarcinoma (G1-G2). The low-risk group consisted of stage I patients with superficial myometrial involvement and no lymphadenopathy, while the high-risk group consisted of the patients with deep myometrial invasion and/or stage II and/or positive lymph nodes. All patients were operated on-i.e., total abdominal hysterectomy with vaginal cuff, bilateral salpingo-oophorectomy and pelvic lymphadenectomy. The patients were followed-up for 36 months at least. On the basis of CT findings, 85 patients were included in the low-risk group, but 11 misstaged cases were found at surgery in which lymphadenectomy never changed the factor risk. Only four relapses (4.7%) were observed in this group. Forty patients were included in the high-risk group: CT misstaged 20 cases and 12 relapses (30%) were observed. This study demonstrates the clinical value of CT in the assessment of radiologic risk factors in stage I endometrial carcinoma; CT findings can be used as guidelines for different treatments.

Adenocarcinoma↗
PubMed1997

[Rationalization of the use of preoperative thoracic radiography in obstetrics and gynecology].

INTRODUCTION: Rationalizing preoperative chest radiography remains a problem in our Country. Therefore, we tried to use preoperative chest films rationally in obstetrics and gynecology to assess their impact on anesthesia planning and patient management and their use in early postoperative complications. MATERIAL AND METHODS: We examined two groups of patients: group A consisted of 570 women (mean age: 31 years) scheduled to be submitted to cesarean section but with no preoperative chest radiography; group B consisted of 471 patients (homogeneous in age to group A patients) submitted to nononcologic gynecologic surgery and with a single-projection preoperative chest radiograph. Anesthesiologic assessment, preoperative biochemical tests and EKG were performed in all patients. All patients underwent abdominal surgery under general anesthesia. The first 24 postoperative hours were monitored for possible anesthesia-related complications. The anesthesiologist need of chest radiography based on clinical findings was investigated in group A patients, as well as the importance of chest film findings in possible anesthesia-related complications. RESULTS: Group A and group B were homogeneous by mean patient age and anesthesia duration; clinical findings never suggested the need of chest radiography in group A patients. Three cardiorespiratory complications occurred (two respiratory arrests in group A and a gas embolism in group B), but the (un)availability of chest film findings made no difference in treatment. DISCUSSION: The availability of the preoperative chest radiographs of a group of healthy women of 31 years mean age does not make any difference in anesthesia planning and type. In our series, the most severe cardiorespiratory complications were homogeneous in the two groups, which confirms their random character, and the (un)availability of preoperative chest film findings made no real difference, even though the lack of radiographic evidence made patient management more demanding for anesthesiologists.

Abdomen↗