Biomedical subjects
Publications and source records attributed to M Tortorici.
We describe an unusual labyrinthine malformation in a case of Goldenhar syndrome studied with CT and steady-state MR imaging. A single posterosuperior semicircular canal was found with no common crus formation. The malformation could not be attributed to any embryologic development. Nosologic considerations are discussed.
We report our experience with MRI of the normal and pathological inner ear with fast spin-echo and modified gradient recalled at steady state sequences. Although earlier studies on temporal bone MRI were discouraging, improvements in MR technology combined with the use of paramagnetic contrast media can make MRI a useful diagnostic tool for the assessment of inner ear pathology. Conventional spin-echo imaging seems not to be the modality of choice because of the relatively thick slices and the long acquisition times.
A group of patients complaining of facial nerve palsy (Bell's palsy) were evaluated with MRI using a 0.5 unit and high resolution T1-weighted images, in order to evaluate the efficacy of Gd-DTPA enhancement in depicting the degree of nerve damage: MRI examination was performed within 24 hours to two weeks after the onset of palsy. The authors describe the results obtained from the analysis of 11 cases of Bell's palsy, discussing the prognostic and clinical significance.
OBJECTIVES: The aims of this study were to correlate beta-endorphin plasma levels and anginal pain in patients with ischemia induced by percutaneous transluminal coronary angioplasty and to detect eventual endorphin variations during balloon occlusion. BACKGROUND: The opioid system appears involved in the absence of pain occurring in silent myocardial ischemia. METHODS: Beta-endorphin plasma levels were measured 24 h before, just before, during and after coronary angioplasty (performed on the left anterior descending artery) in 53 men with documented coronary artery disease and exercise-induced myocardial ischemia. RESULTS: Group 1 (33 patients) reported symptoms; group 2 (20 patients) was asymptomatic during angioplasty. In these patients, the prevalence of exercise-induced silent ischemia was 57%. The occurrence of angina during exercise or angioplasty was related to the frequency of angina during daily life when patients were subgrouped. The severity and distribution of coronary artery disease did not differ between the two groups. During angioplasty, the number of balloon inflations and the inflation time and pressure were similar in symptomatic and asymptomatic patients. In each group, no short-term variability of baseline beta-endorphin plasma levels was observed during 2 consecutive days. Corresponding beta-endorphin plasma levels (at baseline and during and after angioplasty) were significantly higher in Group 2. During balloon occlusion, the levels decreased significantly in the symptomatic group at the onset of angina but remained stable in the asymptomatic group. CONCLUSIONS: Methodologic variables and the severity of coronary artery disease did not influence the presence of symptoms during angioplasty-induced ischemia. Beta-endorphin plasma levels were higher and more stable in patients with silent ischemia during angioplasty, suggesting that opiate levels and their variation during ischemia are associated with individual attitude toward anginal pain.
To evaluate the hemodynamic effects of the first oral administration of enalapril maleate, a long-acting ACE-inhibitor, in the early phase of an acute uncomplicated myocardial infarction, we studied 15 patients, in Killip class I or II, within 72 hours from the onset of symptoms. Hemodynamic measurements were obtained by a triple lumen 7 F Swan-Ganz catheter, inserted into the pulmonary artery, under control conditions and 2, 4, 6, 8 and 12 hours after 10 mg (15 patients) and 20 mg (11 patients) of the drug. Ten milligrams of enalapril reduced systolic and mean arterial blood pressure (from 118 +/- 17 to 111 +/- 18 mmHg, p < .05, and from 92 +/- 12 to 83 +/- 12 mmHg, p < .01, respectively), with a maximum effect after 4 hours from administration. Heart rate and vascular resistances showed an insignificant trend toward reduction, and no changes were observed in left ventricular systolic work index, right and left ventricular filling pressures or cardiac index. Hemodynamic changes induced by 20 mg of the drug, in a smaller group of patients, had a similar trend, which did not reach a statistical significance. In conclusion, in patients with acute uncomplicated myocardial infarction, a single oral dose of enalapril maleate is safe and well tolerated, does not induce severe hypotension, and produces potentially beneficial changes in hemodynamics.
Dobutamine and dipyridamole echocardiography are gaining popularity as exercise-independent stress tests for the diagnosis of coronary artery disease. To compare the feasibility, sensitivity, and specificity of dobutamine echocardiography to dipyridamole echocardiography, we conducted both tests, on different days and in random order, on 35 patients with chest pain and suspected coronary artery disease. Dobutamine was administered in scalar doses up to 40 micrograms/kg per minute and dipyridamole up to 0.84 mg/kg for 10 minutes. Dobutamine echocardiography testing was positive in eight of 16 (50%) patients with single-vessel disease and in 11 of 12 (92%) patients with multivessel disease, resulting in an overall sensitivity of 68% for the presence of coronary artery disease. Dipyridamole echocardiography testing showed the same sensitivity as dobutamine in patients with multivessel disease but a lower sensitivity (31%) in single-vessel disease, resulting in an overall sensitivity of 57%. The specificity of both tests was 100%. An ST segment shift of more than 1 mm compared with baseline was documented in 74% of the positive dobutamine echocardiography tests and in 81% of the positive dipyridamole echocardiography tests. No major complications occurred during both tests. Ventricular arrhythmias occurred in 11 patients with dobutamine and in none with dipyridamole (31% versus 0%, p less than 0.001). Thus, in our selected population dobutamine echocardiography testing demonstrated a similar overall sensitivity and specificity for the diagnosis of coronary artery disease compared with dipyridamole, with a slightly better sensitivity for single-vessel disease but a greater arrhythmogenic potential.
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The aim of this study was to assess if in patients with acute myocardial infarction, two-dimensional echocardiographic asynergy index is correlated to hemodynamic parameters. Furthermore, we compared how reliable the 2 methods are to identify patients at a high risk of developing early left ventricular failure. Fifty-four consecutive patients (43 males, 11 females, mean age: 61 +/- 13 years with acute myocardial infarction were studied using hemodynamic monitoring and 2D-echocardiography within 24 hours from admission. The 2D-echo asynergy index, calculated on a 14-segment left ventricular model, was significantly correlated to heart rate (r = 0.49, p less than 0.001), pulmonary capillary wedge pressure (r = 0.47, p less than 0.001), systemic vascular resistance (r = 0.47, p less than 0.001), cardiac index (r = -0.46, p less than 0.001) and left ventricular stroke work index (r = -0.63, p less than 0.001). Both the asynergy index and the hemodynamic parameters were correlated to Killip clinical classification. In the sub-group of 46 patients initially classified as belonging to Killip class I or II, the patients who later developed left ventricular failure or those in whom it worsened showed a higher asynergy index and a greater impairment of left ventricular function when compared to the patients with an uncomplicated clinical course. The sensitivity of an asynergy index greater than or equal to 1 in predicting early cardiac failure was 75%, the specificity was 64%, the positive predictive value was 43% and the negative predictive value was 88%.(ABSTRACT TRUNCATED AT 250 WORDS)
Forty-five patients with a first anterior myocardial infarction were studied by serial two-dimensional echocardiographic examinations to evaluate the incidence, short-term evolution and clinical significance of infarct expansion. Infarct expansion was found in 26 patients (58%); in 22 cases it was detected at the first examination 24 hours after the onset of symptoms, while in the other 4 it developed later. In 20 (77%) patients expansion involved only the septal and apical regions, while in 6 (23%) it extended to the antero-lateral wall. Two out of 22 patients with early expansion died of cardiogenic shock; expansion of the infarcted area progressively increased in 10 of the remaining 20 patients and remained stable in the other 10. Compared to the patients without expansion those with expansion had a higher CK peak level, a greater number of pathological Q waves and a greater echocardiographic asynergy score; moreover, in-hospital mortality and the incidence of left ventricular failure were higher in the group with expansion (8% vs 0% and 54% vs 10% respectively). Thus our results show that in patients with anterior infarction, expansion is a frequent event which usually develops early and may have a progressive course; infarct expansion, especially when it is large and progressive, is associated with a high incidence of early left ventricular failure and has a poor prognostic significance.
The 16PF personality test was used to survey 123 radiographers living in the western continental United States. The objective of the survey was to determine if a group personality profile different from the general U.S. population existed for radiographers. The results of the survey revealed that radiographers do have a personality profile different from the general U.S. population. Since such a profile exists, managers can use the information to improve a radiographer's environment, working conditions and personal growth.
Since 1964, we have reported twenty-five cases of glomus tumors. Given the evolution of modern surgical technique, we have divided our cases into two groups. The first group includes patients seen from 1964 to 1975: sixteen cases, of whom eleven underwent successful radiotherapy, with a follow-up after ten years. Since 1975 we have adhered to the following therapeutic principles: We have given radiotherapy (5000 rads in twenty-eight days) to patients older than 65 with glomus tumors that had invaded posterior and medial cranial fossa and carotid canal (type C-D, according to Fisch). We have operated on patients with glomus tumors type A-B. Patients treated since 1975 (N = 9) are in the second group.
Venipuncture is an Essential component for nuclear medicine technologists and is expected to become an Essential for radiographers. A descriptive survey of radiation safety offices in the 50 states and the District of Columbia was conducted to determine which states license or certify nuclear medicine technologists, radiographers and/or radiation therapists and to identify specific statutory terminology relative to drug administration or venipuncture. Results showed only six states specifically addressed the issue of drug administration or venipuncture for radiographers and radiation therapists. With so few states addressing this issue, the question arises whether technologists who perform venipuncture or administer drugs are protected against litigation for performance of these procedures.
Radiology administrators nationwide were surveyed to determine current drug administration practices in their imaging departments. The survey also obtained information about the educational backgrounds of radiologic technologists administering pharmaceuticals and the documentation procedures used by imaging departments. Survey results showed that 86% of responding institutions allow radiologic technologists to administer pharmaceuticals. However, the amount and type of education technologists received regarding drug administration was limited. In addition, the type of legal documentation regarding the administration of contrast media varied considerably among the responding institutions.
As a means of evaluating student performance in the clinical setting, three major areas of testing have been identified: (1) time required to position the patient for any given examination, (2) procedure performance, and (3) ability to evaluate the finished radiograph as to its diagnostic quality. The testing format developed at the University of Nevada, Las Vegas, is used to examine the student as he performs in an energized laboratory. This format, based on criteria the student knows in advance, increased the objectivity of the instructor giving the examination.