PubMed Health⌕ Search

Biomedical subjects

M Scaglione

Publications and source records attributed to M Scaglione.

At least 37 records · Page 2Linked to original sources
PubMed1999

Unusual induction of slow-fast atrioventricular nodal reentrant tachycardia. Report of two cases.

INTRODUCTION: Generally, the induction of typical atrioventricular nodal reentrant tachycardia (AVNRT) occurs with a premature atrial stimulus that blocks in the fast pathway and proceeds down the slow pathway slowly enough to allow the refractory fast pathway time to recover. We describe two cases in which a typical AVNRT was induced in an unusual fashion. RESULTS: The first case is a 41-year-old man with paroxysmal supraventricular tachycardia. During the electrophysiology study, the atrial extrastimulus inducing the typical AVNRT was conducted simultaneously over the fast (AH) and the slow pathway (AH'). A successful ablation of the slow pathway was performed. During the follow-up no recurrence was noted. The second case is a 52-year-old woman with a Wolff-Parkinson-White syndrome due to a left posterior accessory pathway. After 5 minutes of atrioventricular reentrant tachycardia (AVRT) induced by a ventricular extrastimulus, a variability of the antegrade conduction was noted in presence of the same VA conduction. In fact, a short AH interval (fast pathway) alternated with a more prolonged AH intervals (slow pathway) that progressively lengthened until a typical AVNRT was induced. The ablation of the accessory pathway eliminated both tachycardias. DISCUSSION: A rare manifestation of dual atrioventricular nodal pathways is a double ventricular response to an atrial impulse that may cause a tachycardia with an atrioventricular conduction of 1:2. In our first case, an atrial extrastimulus was simultaneously conducted over the fast and the slow pathway inducing an AVNRT. This nodal reentry implies two different mechanisms: 1) a retrograde block on the slow pathway impeding the activation of the slow pathway from the impulse coming down the fast pathway, and 2) a critical slowing of conduction in the slow pathway to allow the recovery of excitability of the fast pathway. Interestingly, in the second case, during an AVRT the atrial impulse suddenly proceeded alternately over the fast and the slow pathway. The progressive slowing of conduction over the slow pathway until a certain point which allows the recovery of excitability of the fast pathway determines the AVNRT. This is a case of "tachycardia-induced tachycardia" as confirmed by the fact that the ablation of the accessory pathway eliminated both tachycardias.

Adult↗
PubMed1998

Atrial mapping and radiofrequency catheter ablation in patients with idiopathic atrial fibrillation. Electrophysiological findings and ablation results.

BACKGROUND: Knowledge of the electrophysiological substrates and the cure of atrial fibrillation (AF) is still unsatisfactory. The goal of this study was to evaluate the electrophysiological features of idiopathic AF and their relationship to the results of radiofrequency (RF) catheter ablation of AF and the safety and effectiveness of this procedure. METHODS AND RESULTS: Sixteen patients with idiopathic AF underwent atrial mapping during AF and then RF ablation in the right atrium. The atrial activation was simultaneously recorded in four regions in the right atrium: high lateral wall (HL), low lateral wall (LL), high septum (HS), and low septum (LS) and in the left atrium through the coronary sinus (CS). In these regions, we evaluated the atrial fibrillation intervals (FF) and the morphological features of AF recordings by Wells' classification. No complications occurred during RF ablation. Of the 16 patients, 9 (56%) without AF recurrences during the follow-up (11 +/- 4 months) were considered successfully ablated. These patients showed a significantly shorter mean FF interval in the HS and the LS (122 +/- 32 and 126 +/- 28 ms, respectively), than in the HL and LL (159 +/- 24 and 156 +/- 28 ms, respectively). Moreover, the septum had more irregular electrical activity with greater beat-to-beat changes in FF and a higher prevalence of type III AF than the lateral region. The CS had similar behavior to the septum. Conversely, patients with unsuccessful ablation had an irregular atrial activity in the lateral wall, septum, and CS with no significant differences between the different sites. CONCLUSIONS: Right atrial endocardial catheter ablation of AF is a safe procedure and may be effective in some patients with idiopathic AF. The atrial mapping during AF showed a more disorganized right atrial activation in the septum than in the lateral wall in patients with successful ablation.

Adult↗
PubMed1998

[Gallbladder blunt trauma: comparison between radiologic and anatomo-surgical findings].

PURPOSE: To assess the diagnostic accuracy and the possible role of ultrasonography (US) and Computed Tomography (CT) in a small group of patients who had a blunt abdominal trauma involving the gallbladder. MATERIAL AND METHODS: We retrospectively reviewed the US and CT findings of five patients with surgically confirmed post-traumatic gallbladder injury. The whole series consisted of 196 consecutive patients submitted to laparotomy for blunt abdominal trauma in the past 7 years. The following US and CT findings were considered at least suggestive of a possible post-traumatic gallbladder injury: pericholecystic fluid collection, ill-defined wall margin, collapsed lumen, high intraluminal density. RESULTS: At surgery, the following findings were observed: gallbladder hematoma (1 case), acute colecystitis (1 cases), gallbladder tear (3 cases), gallbladder tear associated with post-traumatic hepatic injuries (2 cases), duodenal tear (2 cases), hemoperitoneum alone (2 cases), hemoperitoneum associated with choleperitoneum (1 case), choleperitoneum alone (1 case). The US and CT findings were pericholecystic fluid collections (4 cases), ill-defined gallbladder wall margins (3 cases), collapsed lumen with intraluminal high density (1 case) and free intraperitoneal fluid collections (4 cases). They were suggestive of a possible post-traumatic gallbladder injury in all the five patients. CONCLUSIONS: The radiologic findings of our five patients were suggestive of a gallbladder damage but did not permit to distinguish minor from major injuries, the latter requiring surgical treatment. US proves to be a useful screening tool which can also help timing surgery in these patients. CT confirmed the US suspicions and also permitted accurate assessment of associated post-traumatic injuries to the liver and duodenum. Nevertheless, the clinical presentation was the most important factor as to the therapeutic management of these blunt abdominal trauma patients.

Cholecystography↗
PubMed1998

[Computerized tomography in the study of jejuno-ileal perforations. Personal case load].

INTRODUCTION: The most frequent cause of pneumoperitoneum is gastroduodenal ulcer. Perforations of the small bowel are uncommon compared with perforations of the rest of the alimentary tract and radiological findings of jejunoileal perforation have not been frequently reported. The aim of our retrospective study was to assess the CT findings in 18 patients with jejunoileal perforation. MATERIAL AND METHODS: We retrospectively reviewed the CT findings in 18 patients (12 men and 6 women, age ranging 14 to 84 years, mean age 42 years) operated for jejunoileal perforation at Cardarelli Hospital, Naples. CT examination was performed in all patients after i.v. injection of contrast medium and in two cases after oral contrast medium administration. Free intraperitoneal air, extravasation of ingested contrast media and visualization of a discontinuity in the bowel wall were considered direct findings of jejunoileal perforation, while intraperitoneal free fluid, thickened bowel wall and the presence of a streaky density within the mesentery were considered indirect diagnostic findings. RESULTS: The site of perforation was the jejunum in 6 cases and the ileum in 12 cases. The following CT findings were retrospectively observed: intraperitoneal free fluid (61%), free intraperitoneal air (33%), thickened bowel wall (22.2%), presence of a streaky density within the mesentery (5.5%). Visualization of a discontinuity in the bowel wall and extravasation of ingested contrast media were never seen. We observed two findings of perforation in 7 cases, and a single finding in 8 cases. CT examination was negative in 3 cases. CONCLUSIONS: Jejunoileal perforations are difficult to identify by CT. In our series, free intraperitoneal air, as a direct finding of perforation, was observed in 33% of cases, while free intraperitoneal fluid, as an indirect diagnostic finding, was the most frequent sign.

Adolescent↗
PubMed1998

[Nine consecutive patients with gallstone ileus. Personal experience].

INTRODUCTION: Gallstone ileus is a mechanical obstruction of the gastrointestinal tract caused by the impaction of one or more gallstones within the bowel lumen. The insidious clinical presentation and the lack of specific signs of biliary disease are responsible for the delayed preoperative diagnosis which leads to an overall mortality rate of 15%. MATERIAL AND METHODS: A series of 9 consecutive patients (7 women and 2 men, age ranging from 17 to 83 years), with surgically proved gallstone ileus, was retrospectively reviewed: the authors report the radiologic procedures performed preoperatively and the diagnostic findings. Plain abdominal radiographs were performed in 4 of 9 patients, abdominal US in 4 and CT in 7 patients. All radiologic examinations were retrospectively reviewed by all authors independently, to recognize the different signs of gallstone ileus. RESULTS: The signs of Rigler's triad (small bowel obstruction, ectopic gallstones and air in the biliary tree) were observed on plain abdominal films in two cases, and ectopic gallstones and pneumobilia in two cases. The ectopic gallstones and the small bowel obstruction were demonstrated on abdominal US images in three cases. Rigler's triad was identified on abdominal CT images in 4 cases, while two findings (small bowel obstruction and ectopic gallstones) were observed in three cases. CONCLUSIONS: When the bowel is obstructed by a radiopaque calcified stone, plain radiographs and US of the abdomen are usually enough to diagnose gallstone ileus and no further studies are required.

Adolescent↗
PubMed1998

[Budd-Chiari syndrome: retrospective study of 8 cases assessed with computerized tomography].

PURPOSE: Budd-Chiari syndrome is a rare disease due to the obstruction of hepatic veins and, sometimes, of the inferior vena cava. The disease, whose etiopathogenesis is often unproven, may show acute or chronic clinical course with different features at pathology. We carried out a retrospective study of 8 consecutive patients with the Budd-Chiari syndrome to assess the diagnostic role of CT and to define the main patterns of the disease. MATERIAL AND METHODS: Our patient population consisted of 8 women with clinical and instrumental suspicion of Budd-Chiari syndrome. Three patients had acute and 5 chronic clinical presentation: the former had had acute symptoms right after delivery, while one of the latter was referred to oral contraceptive abuse, another was diagnosed 18 months after delivery and finally the cause was not known in the other 3 cases. CT was performed with contiguous slices (8 mm) of the upper abdomen, before and after i.v. contrast agent infusion. Liver images were always acquired 15-20 minutes after contrast agent administration. RESULTS: In the acute patients, CT showed increased liver volume, diffuse parenchymal hypodensity in unenhanced scans, except for some skip areas (segments I and IV, paracaval parenchyma) and strong postcontrast enhancement. Thrombosis of the suprahepatic veins was found in all patients and partial thrombosis of the inferior vena cava in one. Abundant peritoneal effusion was always found. In the chronic patients, CT showed caudate lobe and left lobe hypertrophy, mostly associated with right lobe hypo-atrophy. Moreover the hypertrophic areas showed bright and inhomogeneous contrast enhancement, with a reversed pattern at 15-20 minutes postcontrast. Thrombosis of the suprahepatic veins was found in 3 patients and partial thrombosis of the inferior vena cava in one. Peritoneal effusion was seen in 2 cases. CONCLUSIONS: The Budd-Chiari syndrome causes anatomical, morphological and volumetric changes in the hepatic parenchyma which are referrable to difficult venous flow and differ in acute vs chronic forms. CT permits to grade liver involvement by the organ's morphodensitometric changes, which are once again different in the acute vs the chronic disease. Moreover, thrombosis of suprahepatic veins and of the inferior vena cava and portal vein is often demonstrated. Therefore CT can be considered a valid diagnostic tool for use in the patients with suspected Budd-Chiari syndrome together with B-mode and color Doppler US.

Adult↗
PubMed1997

[Controlled clinical study of doxophylline versus aminophylline in the treatment of acute cardiorespiratory insufficiency syndromes].

Twenty patients of both sexes, hospitalized because they were suffering from acute cardiorespiratory syndromes, have been studied in a clinical blind test on unbalanced groups of patients. This research aims to evaluate the therapeutic efficiency and intravenous tolerance of doxophylline. Patients were observed for 24 hours. Signs and symptoms were recorded on a semi-quantitative scale, and the clinical situation, haemogasanalysis, blood pressure, cardiac frequency, and other analytic controls were performed in order to verify the systemic tolerability. We can conclude, in agreement with the literature, that the group treated with doxophylline showed a better reduction in cardiac frequency, while maintaining the same effects on the respiratory apparatus.

Aminophylline↗
PubMed1997

[Doppler color US in the diagnosis and treatment of iatrogenic pseudoaneurysms].

Pulsatile masses occur increasingly as a complication of transfemoral or transaxillary percutaneous catheterization, as the number of catheterization procedures and their complexity has increased. These iatrogenic injuries may be represented by a pseudoaneurysm or by a periarterial hematoma with transmitted arterial pulsation: the 2 vascular injuries require prompt differentiation because pseudoaneurysms need treatment by means of US-guided compression or surgical repair. Nineteen patients (10 men and 9 women, aged 40-85 years, mean: 62 years) with a groin (no. = 17) or axillary (no. = 2) pulsatile mass following angiographic catheterization were prospectively examined with color Doppler sonography (US). A pseudoaneurysm was detected in 13 patients (12 femoral and one axillary injury), whereas the other 6 pulsatile masses were consistent with periarterial hematomas. US-guided compression was attempted in 13 pseudoaneurysms and the pulsatile mass was repaired in 11/13 cases (84.6%), including 10/12 femoral and 1/1 axillary lesions. All the vascular injuries successfully treated with US-guided therapy were repaired 1-4 days after the angiographic complication. On the other hand, two pseudoaneurysms unsuccessfully treated with US-guided compression were studied after 8 and 24 days, respectively, after the angiographic complication and subsequently submitted to surgical repair. The pseudoaneurysms size did not seem to affect the favorable outcome of the US-guided treatment. With the exception of the 2 surgical cases, the other 17 patients underwent clinical examination and color Doppler US one and 7 days after the US-guided compression of the pulsatile mass. Moreover, a 6-25 weeks clinical follow-up showed no late complications or recurrences in all the cases. In conclusion, color Doppler US is now the technique of choice to assess potential complications related to femoral or brachial artery catheterization.

Adult↗
PubMed1997

[Perforation of the laryngeal mucosa caused by closed trauma: comparison of laryngoscopic and CT findings].

INTRODUCTION: Laryngeal mucosal perforation is a frequent event whose diagnosis is based on clinical, laryngoscopic and CT findings. MATERIAL AND METHODS: We reviewed retrospectively the data relative to 77 patients with blunt neck trauma examined October, 1991, to June, 1996. All patients were submitted to clinical examination first and then, to fiberoptic laryngoscopy and CT on the clinician's request. RESULTS: Nineteen patients with small skin tears and no signs and symptoms of laryngeal injury were immediately discharged while 37 patients were submitted to surgery: 17 to remove cerebral hematomas, 13 to stabilize cervical fractures and 7 because of hemodynamic instability. Twenty-one patients underwent laryngoscopy which showed laryngeal lesions in 12: wide mucosal disruption with fractures of the laryngeal skeleton and hematomas were observed, which needed immediate surgery with airway reconstruction in 7 cases; small mucosal tears and hematomas were seen and laryngeal CT examination was requested to establish the possibility of conservative management in 5 cases which are the subject of the present study. Laryngoscopic findings were: 1) laryngeal mucosal tear near the thyroid cartilage with quadrangular membrane edema, 2) thyroid mucosal tear with thyrohyoid muscle edema, 3) edema of the left false vocal cord, 4) edema of the oblique arytenoid muscle, 5) posterior cricothyroid muscle edema with bleeding near the cricoid ring. In cases 1, 2 and 3 CT showed gas bubbles in the paralaryngeal space, where laryngeal tear or edema were indicated at laryngoscopy. DISCUSSION: CT does show the "gas bubbles" in the paralaryngeal space when laryngoscopy cannot distinguish laryngeal mucosal perforation from tear. CONCLUSIONS: The routine use of CT in minor, laryngeal injuries in the emergency department is useful for the early diagnosis of laryngeal mucosal perforation.

Adolescent↗
PubMed1996

[Blunt trauma of the larynx: comparative assessment of computerized tomography, conventional radiology, and laryngoscopy].

We report on the retrospective analysis of a series of 11 patients with blunt laryngeal injuries examined with Computed Tomography (CT), conventional radiology and laryngoscopy, to compare the diagnostic yield of each technique. Conventional frontal and lateral radiographs showed subcutaneous emphysema in 5 patients, with soft tissue swelling in 4, and thus failed to assess the degree of damage adequately. Cross-section CT showed cartilaginous injuries in 5 patients and adjacent soft tissue changes in 9, thus allowing rapid and accurate assessment of airway damage even in emergency. Laryngoscopy showed laryngeal mucosal tears in 3 patients, with decreased motion of the left true vocal cord in one patient and of both true vocal cords in another, associated with the upward dislocation of arytenoid cartilage. Moreover, laryngoscopy showed a mucosal tear in the hypopharynx in one patient. Comparative CT and laryngoscopy assessment showed, in two cases, that CT can demonstrate even minimal peripharyngeal and perilaryngeal air images which are suggestive of posttraumatic mucosal tears. Thus, CT appears the most valuable diagnostic tool to study the injured larynx.

Adolescent↗