Biomedical subjects
Publications and source records attributed to L Ravalli.
From July 1990 to October 1995 we treated 45 patients with choroidal melanomas using ruthenium-106 plaques. The population mean age was 59.2+/-10.4 years. In this paper, the authors describe in detail their clinical management and follow-up timing. They also report on the echographic pattern change after treatment and the clinical history of some failure cases.
A rapidly growing choroidal metastasis from an occult carcinoma is described. The patient was first seen with a loss of visual acuity. The fundus examination showed a non-pigmented solid mass located at the posterior pole. Clinical history, echographic characteristics and tumour growth kinetics are described in detail.
In this paper the authors examine the echographic findings in 20 patients with metastatic and secondary tumors of the orbit observed at the University Eye Clinic of Ferrara (Italy) between January 1985 and August 1995. The aim of this study is to identify some typical echographic characteristics in these forms and to underline the diagnostic role of orbital echography.
Two cases of posterior inflammatory scleritis are described. The authors show the echographic findings, pointing out the helpfulness of diagnostic ultrasound and the crucial role in monitoring these diseases with A scan examinations to obtain clear results of therapy, even if subjective symptoms disappear.
We reviewed retrospectively 6 cases of spontaneous carotid cavernous fistulas to discuss the differences in clinical findings depending on venous patterns. Orbit US was performed in all patients but one and all patients were examined with CT and intraarterial digital subtraction angiography (DSA). Orbit US, performed in 5 patients with ocular signs, showed dilation of the ophthalmic veins, in 3 cases bilaterally. CT was performed to demonstrate possible lesions of the orbit apex or skull base and showed dilation of the superior ophthalmic vein in 4 patients, bilateral in only one case. Moreover, CT detected enlargement of the cavernous sinuses in 4 cases (3 unilateral, one bilateral). Dynamic CT, performed in 2 patients, showed early opacification of both cavernous sinuses. DSA was carried out on the basis of clinical data and US and CT findings. It diagnosed carotid cavernous fistulas in all cases. The fistulas were bilateral in 3 subjects. In all the patients with exophthalmos, conjunctival chemosis and dilated episcleral veins, the superior ophthalmic vein was the main venous drainage from the cavernous sinus. Only 4 of these patients had abducent nerve palsy; bruit was present in 2 cases only. The ocular signs were contralateral to the fistula in one patient. In the patient presenting III, IV and VI nerve palsy, the venous drainage was direct from the cavernous sinus to pericarotid plexus, pterygoid plexus and inferior petrosal sinus; in this case there were no ocular signs. The clinical findings of spontaneous cavernous fistulas are caused by the arterial supply and, especially, by the venous drainage of the fistula; for the early diagnosis and treatment it is important to know that some patients do not exhibit the classic triad of symptoms, characterized by pulsating exophthalmos, bruit and conjunctival chemosis. Our experience has confirmed that spontaneous carotid cavernous fistulas may be characterized by atypical clinical findings, such as ocular signs contralateral to the fistula side or palsies of cranial nerves only.
Over an 18 year period 42 patients with ocular metastases, age 30-75 years, 27 female and 15 male, were evaluated echographically. The right eye was affected in 18, the left in 17, and both eyes in 7. The most frequent primary tumours were carcinomas from breast (n = 25), lung (n = 6), and urinary bladder (n = 2). The choroidal metastases appeared mainly flat-infiltrating or dome-shaped, on B-scan. A-scan generally revealed high or medium reflectivity, however with important exceptions. Atypical cases are discussed. Usually eyes with metastases should not be enucleated. Accordingly, ultrasonic evaluation and follow-up is of obvious importance.