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Biomedical subjects

M R Rimondi

Publications and source records attributed to M R Rimondi.

26 records · Page 2Linked to original sources
PubMed1991

[The assessment of pulmonary arterial pressure by pulsed Doppler in patients with obstructive pneumopathy].

The severity of pulmonary arterial hypertension can be assessed by duplex-Doppler echocardiography, a subxiphoid approach and a general-purpose duplex device. Normally, the peak Doppler flow velocity occurs in midsystole and the flow profile is parabolic (bullet-like). In pulmonary arterial hypertension, changes in vascular compliance cause maximal acceleration of blood in early systole, with shortening of pulmonary acceleration time (AcT, or time to peak velocity). In the more severe cases, a midsystolic notching is visible, related to rapid deceleration of blood flow, followed by a brief secondary increase in velocity in the late systole. We studied 19 adult patients with chronic obstructive pulmonary disease with duplex-Doppler examination, with a subxiphoid approach and right heart catheterization. The study was diagnostic in all cases with Doppler recordings of good quality. An relationship was found between AcT and pulmonary mean or systolic arterial pressure at rest. An evident accurate prediction of pulmonary arterial pressure in emphysematous patients is possible by means of pulsed Doppler, also in case of low-level hypertension. We believe this method to be a simple and reliable adjunct to the non-invasive work-up of emphysematous patients and to represent a good alternative to the classical parasternal approach, which is often not feasible in these patients.

Adult↗
PubMed1991

[Thoracic lymphoma in AIDS].

Over the last 4 years, we observed 122 patients with AIDS and 20 with AIDS-related lymphomas (ARL) in the chest. Eighteen of the latter were non-Hodgkin's forms, mostly high-grade and high-stage B-cell (Burkitt or Burkitt-like) types (16 cases.) This prevalence reflects the overall increase in neoplasms secondary to immunodepression, which is parallel to improved prevention and control of opportunistic infections. Of 20 ARLs, 5 (25%) presented thoracic lesions; in 4 of them the onset of the disease was localized in the chest. The incidence of such manifestations is higher than that reported in the literature. Moreover, radiological features are quite atypical relative to the "classical" signs of lymphoma in the general population, with predominant (60%) nodules or quickly-growing peripheral masses which may subsequently invade chest walls. Isolated nodal enlargement is also a possible finding, as well as pleural effusion. This pattern, though not pathognomonic, is highly suggestive--in HIV-positive patients--of ARL. In all the patients with pulmonary lymphoma CT demonstrated bilateral lesions--more than conventional X-rays--with morphologic and densitometric features which helped make the correct diagnosis. Moreover, CT was helpful in choosing the appropriate site for biopsy.

Adult↗
PubMed1991

[Assessment of early complications of kidney transplantation. Is duplex-Doppler useful for the diagnosis of acute rejection?].

The authors studied with duplex-Doppler US 28 renal transplant recipients in 31 clinically different episodes, during the early postoperative period. Morphological data were thus obtained, as well as hemodynamic information. According to the literature on the subject, a pulsatility index (PI) greater than 1.5 was considered as abnormal. US diagnosis was retrospectively compared with final clinical diagnosis and with response to therapy. In one case, the kidney was surgically removed. We evaluated US sensitivity and specificity in the diagnosis of acute rejection with real-time US, Doppler alone and combined with duplex. A PI greater than or equal to 1.5 corresponded to acute rejection, with 60% sensitivity and 85.7% specificity. With a PI greater than 1.8, sensitivity decreased to 50%, but specificity increased to 100%. The severest changes in Doppler waveforms had a bad prognostic significance. Besides poor specificity--which is so often emphasized in literature--our results chiefly demonstrated sensitivity limitations, partly corrigiable with real-time US signs, together with Doppler PI (sensitivity: 90%, specificity: 85.7%). Duplex-Doppler US, in spite of its well-known limitations, remains therefore a simple, rather reliable and non-invasive technique to study renal transplant complications.

Acute Disease↗
PubMedDate not supplied

Paraseptal emphysema mimicking unilateral lymphangitic carcinomatosis: CT findings.

A 65-year-old man with lung carcinoma is presented. Chest radiography showed unilateral Kerley B lines in the right midlung and base, suggestive of lymphangitic carcinomatosis. High resolution CT demonstrated that this finding was due to residual normal interlobular septa, suspended between areas of paraseptal emphysema.

Aged↗
PubMedDate not supplied

[Signs of inflammatory activity in thoracic sarcoidosis. A high-resolution computerized tomography study].

Sarcoidosis is characterized by the presence of non-caseating granulomas. Lymphadenopathy and diffuse parenchymal abnormalities often involve the chest. This study was aimed at finding out signs that could be suggestive of disease activity and if the lesions are reversible after therapy. Sixty-three patients underwent chest radiography, high resolution CT, functional studies, bronchoalveolar lavage and 67Ga scintigraphy. Twenty-three patients were followed-up. Lymphadenopathies, nodular opacities and acinar opacities resolved after steroid therapy; bronchiolectasies, bronchiectasies, septal thickening and parenchymal distorsion did not disappeared after therapy and are therefore considered as irreversible lesions. Ground glass opacities are an uncommon finding; they are due to fibrosis or to widespread interstitial granulomas rather than alveolitis. The prognostic meaning of ground glass opacities is uncertain. Therefore, disease activity findings are mainly lymphadenopathies, nodules and consolidations. Nevertheless these findings not necessarily imply a bad prognosis, as acute sarcoidosis seems to respond well to steroid therapy, even with complete remission. It remains debated if a CT study is worthwhile in all the new cases of sarcoidosis or only in the clinically more severe ones.

Adrenal Cortex Hormones↗
PubMedDate not supplied

[The assessment of the severity of pulmonary edema by computed tomography. A comparison between high-resolution computed tomography, objective evaluation with density masks and functional tests].

The results of high-resolution computed tomography (HRCT) were correlated with those of pulmonary function tests, chest films and CT expiratory density mask values in the evaluation of pulmonary emphysema in 33 symptomatic subjects. Emphysema was quantitated with both subjective and objective measurements. Conventional chest films were useful to diagnose severe emphysema but its actual extent was more reliably evaluated with CT scoring systems. HRCT and density mask correlated well with function tests, but the former method exhibited stronger correlation with carbon monoxide diffusion capacity. The opposite was true for hyperinflation and expiratory obstruction variables. Subjective CT estimates, which are quick and easy to perform, were seen to correspond more specifically to the pathophysiologic derangement and should therefore be used to evaluate the anatomic extent of disease. The functional severity of emphysema correlated only with the overall extent of disease and not with its regional distribution in the upper or lower lungs. Finally, in 4 cases (12.1%) with low CT scores, FEV1 was reduced but diffusion capacity values were normal. In one of these patients HRCT showed signs of bronchiolitis. In fact, small airway disease might be a more critical factor in determining functional impairment than the actual anatomical emphysema.

Adult↗
PubMedDate not supplied

Hemodynamic estimation of chronic cor pulmonale by Doppler echocardiography. Clinical value and comparison with other noninvasive imaging techniques.

Pulmonary arterial pressure (PAP) represents an important prognostic factor in patients affected by chronic obstructive pulmonary disease (COPD). A noninvasive diagnostic approach is offered by several imaging techniques, such as chest X-ray, nuclear medicine, real-time sonography, color Doppler US, CT and MRI. However, at present a quantitative assessment of PAP is not achieved with reasonable precision with any of these techniques. Tricuspid regurgitation can be estimated by continuous wave Doppler but it may be difficult in patients with COPD. On the contrary, the severity of pulmonary hypertension can be accurately assessed with pulsed Doppler echocardiography from the subxiphoid region, using a general purpose US device. Nineteen adult patients with COPD were studied by duplex-Doppler from an oblique subxiphoid approach and right heart catheterization. The study was diagnostic in all cases with quality Doppler recordings. A significant relationship was found between AcT and pulmonary mean or systolic pressure at rest. An accurate prediction of PAP in COPD is possible by means of pulsed-Doppler also in low-grade hypertension. This technique is considered a simple and reliable adjunct to the noninvasive evaluation of COPD and represents a satisfactory alternative to the classical parasternal approach preferred by cardiologists but often not suitable for emphysematous patients. Radiologists who routinely use a general purpose US device are encouraged to try this new technique in the study of heart disease.

Adult↗