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M De Matteis

Publications and source records attributed to M De Matteis.

10 recordsLinked to original sources
PubMed1998

Clinical manifestations of seronegative spondylarthropathies.

Seronegative spondylarthropathies include ankylosing spondylitis, Reiter's syndrome and reactive arthritis, psoriatic arthritis, arthritis associated with ulcerative colitis and Crohn's disease, plus other forms which do not meet the criteria for definite categories and are called undifferentiated. Recently two sets of classification criteria have been proposed for the entire group including undifferentiated forms: the European Spondylarthropathy Study Group and the Amor criteria. The prevalence of spondylarthropathies is directly correlated with the prevalence of the HLA-B27 antigen in the population. The highest prevalence of ankylosing spondylitis (4.5%) has been found in Canadian Haida Indians, where 50% of the population is B27 positive. Among Europeans the frequency of the B27 antigen in the general population ranges from 3 to 13% and the prevalence of ankylosing spondylitis is estimated to be 0.1-0.23%. Seronegative spondylarthropathies have common clinical and radiologic manifestations: inflammatory spinal pain, sacroiliitis, chest wall pain, peripheral arthritis, peripheral enthesitis, dactylitis, lesions of the lung apices, conjunctivitis, uveitis and aortic incompetence together with conduction disturbances. All of these may also occur in isolation.

Diagnostic Imaging↗
PubMed1998

Seronegative spondylarthropathies: imaging of spondylitis, enthesitis and dactylitis.

Sacroiliitis is an indispensable condition for the diagnosis of ankylosing spondylitis according to the present criteria and is usually diagnosed on standard anteroposterior radiographs of the pelvis. In cases with suspicious abnormalities (grade 1 of the New York criteria) CT permits the diagnosis since it shows a higher degree of sacroiliitis. MRI is superior to CT in the early diagnosis as it can detect the cartilage abnormalities which precede bony changes. 'Romanus lesions' with 'shiny corners', 'squaring' of the vertebral bodies, syndesmophytes, spondylodiscitis and osteoporosis are the radiological findings of ankylosing spondylitis. The nonmarginal, asymmetric, coarse and broad syndesmophytes of psoriatic spondylitis and spondylitis associated with Reiter's syndrome resemble the flowing bone outgrowths of diffuse idiopathic skeletal hyperostosis (DISH). The ossification of the posterior longitudinal ligament and of the flavum ligament are rare manifestations of ankylosing spondylitis. Peripheral extra-articular enthesitis is a clinical hallmark of seronegative spondylarthropathies. Plain film radiography shows erosions and spurs but only in advanced phases. US shows the swelling of the entheses and the peritendinous soft tissues and the distension of adjacent bursae by fluid collection. MRI shows the inflammation of the bone adjacent to the insertion as well as the soft tissue changes. Dactylitis is another typical manifestation of seronegative spondylarthropathies. In the past it was thought to be due to concomitant tenosynovitis and arthritis. Recently, however, we have demonstrated with US and MRI that the 'sausage-like' appearance is due to the flexor tenosynovitis and that joint capsule distension is not indispensable.

Bone Remodeling↗
PubMed1998

Prostatic abscess: diagnosis and treatment.

OBJECTIVE: Prostatic abscesses are uncommon in clinical practice because early antibiotic therapy has reduced complications of prostatitis. Prostatic abscess mainly affects diabetic and immunosuppressed patients. The organisms most frequently involved are Escherichia coli and Staphylococcus, whereas gonococcus is rarely encountered. The results in eight men with prostatic abscess, five of whom were treated with sonographically guided percutaneous drainage, are reported. The diagnosis, clinically suspected in only three patients, was confirmed by transrectal sonography. All patients experienced complete abscess resolution. CONCLUSION: Transrectal sonography is the most reliable imaging method to diagnose prostatic abscess. Percutaneous transperineal or transrectal drainage is the first choice for therapy because of the lower risk of complication compared with surgery.

Abscess↗
PubMed1998

[Multiple bilateral biopsy of the prostate].

INTRODUCTION: Transrectal guided biopsy is the method of choice to detect carcinoma of the prostate. Systematic bilateral biopsies have been recently introduced in clinical practice because they provide valuable information about the local staging of the cancer and better representation of the actual Gleason grade of the whole tumor. The purpose of this study is to assess the frequency of neoplastic lesions in prostatic areas with normal structure at US and rectal examination and to identify, if possible, some criteria to be used in the selection of patients for random biopsies. MATERIAL AND METHOD: Systematic bilateral prostatic biopsies were performed in 155 patients with elevated prostate specific antigen (PSA) values, not exceeding 40 ng/mL and with suspected neoplastic unilateral lesion at rectal examination or US. All patients with bilateral or diffuse nodules were not included in this analysis. Three random biopsies for every side of the gland were performed using a 16-18 gauge tru-cut needle. A direct biopsy of the hypoechoic nodule or area was always performed. All specimens results were correlated with PSA and PSA density values obtained before biopsy. RESULTS: Systematic biopsy identified cancers in 53/155 patients (34.19%). Of 53 cases, 35 (66%) had unilateral prostatic carcinoma and 18 (34%) had bilateral cancer. The final diagnosis was benign prostatic lesion in the remaining 102 patients (benign prostatic hyperplasia, nonspecific granulomatous prostatitis, chronic prostatitis). Dividing all the patients into main groups on the basis of pathologic findings (benign, unilateral and bilateral carcinoma) there was a statistically significant difference of PSA values between the 3 groups. CONCLUSIONS: Our observations confirm the utility of systematic US-guided biopsies in the detection of tumors in normal appearing areas at US and transrectal examination, but the clinical utility of this approach needs further confirmation. Additional data on cancer volume, Gleason grade, capsular infiltration, lymph node metastasis and long term survival must be evaluated with large number of patients. In our experience PSA values can be used as a criterion to select the patients to submit to this technique to provide useful, preoperative information suspected prostatic malignancy.

Aged↗
PubMed1998

Retrocalcaneal bursitis in spondyloarthropathy: assessment by ultrasonography and magnetic resonance imaging.

OBJECTIVE: To establish by magnetic resonance imaging (MRI) and ultrasonography (US) the frequency of retrocalcaneal bursa involvement in Achilles enthesitis of spondyloarthropathy (SpA) and to compare the results of the 2 examinations. METHODS: Nineteen Achilles tendons with severe enthesitis and 9 normal tendons of 14 patients meeting the Amor criteria for SpA were examined by MRI and US. RESULTS: Both MRI and US showed a significant increase in the mean Achilles tendon thickness in the pathologic legs compared to the normal legs both at the superior calcaneal surface and 3 cm above. MRI showed retrocalcaneal bursitis in 14 (73.7%) of 19 pathologic legs and superficial bursitis in 2 (10.5%). US showed fluid collection only in 7 of 14 retrocalcaneal bursae positive on MRI, and failed to show fluid in the 2 superficial bursae involved. Using MRI as the gold standard, US showed 50% sensitivity and 100% specificity for retrocalcaneal bursa involvement and lacked sensitivity for superficial bursitis. CONCLUSION: Achilles tendon involvement in SpA is not only a disease of the enthesis but also of the adjacent bursae.

Achilles Tendon↗
PubMed1997

Proximal bursitis in active polymyalgia rheumatica.

BACKGROUND: The cause of musculoskeletal symptoms in the proximal extremities of patients who have polymyalgia rheumatica is not completely understood. The diffuse and severe discomfort can only be partially explained by the mild joint synovitis that is observed in these patients. OBJECTIVE: To determine the involvement of the synovial structures of the shoulder girdle of patients who have active symptoms of polymyalgia rheumatica. DESIGN: Case-control study. SETTING: 2 secondary referral centers of rheumatology. PATIENTS: 13 case-patients who had active symptoms of polymyalgia rheumatica seen during a 6-month period, 9 control-patients who had early symptoms of elderly-onset rheumatoid arthritis, and 10 age-matched healthy controls. MEASUREMENTS: Magnetic resonance imaging of the shoulder was done on the 13 case-patients, 9 control-patients, and 10 healthy controls. RESULTS: The frequency of subacromial and subdeltoid bursitis was significantly higher in the case-patients (who had polymyalgia rheumatica) than in the control-patients (who had elderly-onset rheumatoid arthritis). The frequencies of synovitis of the joints and tenosynovitis of the biceps did not significantly differ between the 13 case-patients and the 9 control-patients. None of the healthy controls showed evidence of fluid accumulation in the joints, bursae, or sheaths of the long head of the biceps. CONCLUSIONS: Inflammation of subacromial and subdeltoid bursae in association with synovitis of the glenohumeral joints and tenosynovitis of the biceps may contribute to the diffuse discomfort in the shoulder girdle observed in patients with polymyalgia rheumatica.

Aged↗
PubMed1997

Toe dactylitis in patients with spondyloarthropathy: assessment by magnetic resonance imaging.

OBJECTIVE: To investigate using magnetic resonance imaging (MRI) the part played by flexor and extensor tenosynovitis and synovitis of the metatarsophalangeal (MTP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints in producing the "sausage-like" aspect of spondyloarthropathy (SpA) toe dactylitis. METHODS: Twelve sausage-like toes and corresponding contralateral toes of 7 consecutive patients meeting Amor criteria for SpA were studied by MRI. RESULTS: All dactylitic toes showed fluid collections in the flexor synovial sheaths on MRI. Due to the sheath distension the plantar bone to skin distance was significantly increased (p < 0.05) in the dactylitic toes compared to normal contralateral toes. Peritendinous soft tissues were not involved since these were significantly thicker (p < 0.05) in normal toes. Extensor synovial sheaths were involved in only 4 dactylitic toes. Of the 36 joints of the 12 dactylitic toes only 2 MTP joints showed capsule distension. Considering MRI as the "gold standard", examination showed 100% sensitivity and specificity for flexor sheath involvement but lacked sensitivity for extensor synovial sheaths and showed a low specificity for joint capsule distension. CONCLUSION: Like finger dactylitis, toe dactylitis may also be due to flexor tenosynovitis and synovitis of MTP, PIP, and DIP joints may not be a required condition for sausage-shaped appearance. Extensor tenosynovitis may be present in addition to flexor tenosynovitis. Physical examination is a sufficient method for diagnosing toe dactylitis.

Adult↗
PubMedDate not supplied

Photorefractive keratectomy for compound myopic astigmatism with the MEL-70 G-Scan excimer laser.

PURPOSE: To assess the safety, efficacy, predictability and stability of photorefractive keratectomy in compound myopic astigmatism with a moderate and high cylinder component. METHODS: Photorefractive keratectomy was done in 42 eyes with compound myopic astigmatism with the spherocylindrical algorithm of the MEL-70 excimer laser, with wide ablation zones. RESULTS: Spherical equivalent refraction changed from -4.19 +/- 1.65D to -0.05 +/- 0.31D, refractive cylinder from -2.01 +/- 0.71D to -0.09 +/- 0.20D and mean sphere from -3.22 +/- 1.76D to -0.02 +/- 0.26D. Mean uncorrected visual acuity rose from 0.12 +/- 0.17 to 0.91 +/- 0.10. No eye lost lines of spectacle-corrected visual acuity. The safety index was 1.03 and the efficacy index 0.98. Six months from the treatment all eyes were within +/- 1D, 8.9% of eyes were within 0.50D and 44% were plano of target refraction. Refractive and topographical stability were achieved between one and three months after treatment. Transient haze was observed between one and three months after PRK. CONCLUSIONS: Photorefractive keratectomy with the MEL-70 excimer laser to correct myopic astigmatism was a safe and effective procedure with good stability at six months' follow-up. Refractive and visual outcome confirmed that excellent predictability can be expected.

Adult↗