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Biomedical subjects

M Uccelli

Publications and source records attributed to M Uccelli.

At least 19 recordsLinked to original sources
PubMed2005

Ex vivo evaluation of PPD-specific IFN-gamma or IL-5 secreting cells in the peripheral blood and lungs of patients with tuberculosis.

OBJECTIVES: To evaluate ex vivo purified protein derivative (PPD) specific Th1- and Th2-type functional responses in human tuberculosis (TB). DESIGN: IFN-gamma and IL-5 secreting cells were measured by a computer-assisted ELISPOT assay in the peripheral blood of patients with pulmonary TB, in patients with other respiratory diseases (control patients) and in tuberculin skin test negative or positive healthy controls. Moreover, the number of IFN-gamma or IL-5 spots was assessed in the bronchoalveolar lavage (BAL) cells of five patients with advanced TB and lung inflammation. RESULTS: The frequency of PPD-specific IFN-gamma secreting cells in TB patients was higher than in control patients and healthy subjects. Although the number of PPD-specific IL-5 spots was low, a trend towards a higher frequency was observed in the peripheral blood of TB patients. Patients with advanced TB and lung inflammation had an increased number of both PPD-specific IFN-gamma and IL-5 spots in BAL as compared to that in peripheral blood, but the IFN-gamma/IL-5 ratio was about two-fold lower. CONCLUSIONS: In human TB, the host response in the periphery is driven by a specific Th1-type cytokine response, whereas in the lungs of patients with advanced disease and lung inflammation, polarisation towards a Th2-like bias is observed.

Adult↗
PubMed2003

The assessment of IFN-gamma and its regulatory cytokines in the plasma and bronchoalveolar lavage fluid of patients with active pulmonary tuberculosis.

OBJECTIVES: To assess the role of IFN-gamma and its regulatory cytokines in active pulmonary tuberculosis (TB). DESIGN: Cytokines were measured in the plasma of TB patients and healthy subjects with different risk for TB exposure. In addition, cytokine profile was assessed in the bronchoalveolar lavage fluid (BALf) of six TB patients and nine normal controls. RESULTS: Circulating IFN-gamma, IL-10 and IL-18 were higher in TB patients than in control groups. Plasma IL-12 levels were extremely variable, and no difference was observed among study groups. An inverse correlation between plasma IFN-gamma and IL-10 levels was found in TB patients. Furthermore, circulating IL-18 correlated with IL-10 but not with IFN-gamma levels. Finally, IFN-gamma, IL-18 and IL-12 were increased in the BALf of TB patients, whereas no difference was observed in IL-10 levels. CONCLUSIONS: In human TB, at least at certain disease stages, there is a differential compartmentalization of the IFN-gamma-regulatory factors IL-12 and IL-10, the former being concentrated in the lungs and the latter being present in peripheral circulation. In addition, our findings address more critically the role of IL-18 in the host response to tuberculosis infection in humans.

Adult↗
PubMed2002

Thoracic aortic stents: a combined solution for complex cases.

OBJECTIVES: The combination of endovascular and standard surgical techniques may facilitate the management of complex aortic disease although the long-term durability of this approach needs to be confirmed. DESIGN: A retrospective review of our experience in the treatment of patients with complex aortic pathology using a combined endovascular and surgical approach. MATERIALS AND METHODS: Between 1998 and 2001, 27 patients with thoracic aortic aneurysm underwent stent-graft implantation. Eight required combined endovascular and surgical procedure because of complex pathology. In 3 cases, combined repair was carried out for a concomitant abdominal aortic aneurysm or aorto-iliac-femoral occlusive disease. In the other 5 cases, vessel relocation was performed to obtain safe landing zones: left subclavian artery to left carotid artery translocation in 3 patients, celiac trunk to superior mesenteric artery translocation in one and aorto-celiac-mesenteric bypass grafting in one. RESULTS: One of the 8 patients died on 12th post-operative day of intestinal bleeding and bowel infarction. No neurological sequelae were reported. The other patients are currently well at 11 months mean follow-up time. CONCLUSIONS: Simultaneous surgical and endovascular procedure is a feasible and may be a valuable adjunct to the treatment of complex aortic and peripheral vessel anatomy.

Adult↗
PubMed2001

[Acoustic neuroma: clinical-functional finding, results and surgical complication].

The present work provides clinical-functional findings, results and surgical complications observed in a consecutive series of 100 subjects with acoustic neuroma (AN). Analysis of the data has made it possible to draw some important conclusions. Compromised hearing is found in 90% of the ears affected by AN. Indeed the percentage of normal hearing in such cases does not exceed 5%. There is, however, no clear correlation between degree of hearing and tumor size. The symptoms of AN do not always present unilateral or asymmetrical hearing loss, unilateral tinnitus and/or dizziness. At times AN presents atypical symptoms and can even be asymptomatic. Sudden onset of unilateral hearing loss, acute vertigo, persistent monolateral tinnitus and even isolated symptoms of the V or VI cranial nerve should lead one to suspect AN. Only by applying the diagnosis of suspected AN in a large number of cases is it possible to lower the time gap between the onset of symptoms and the definitive diagnosis of AN, increasing the number of cases diagnosed while the AN is still small. Auditory brainstem responses (ABR) are still the means of choice for screening and following up subjects where AN is suspected. Reduced ABR sensitivity reported in the literature for intracanal ANs must induce further testing with magnetic resonance imaging with gadolinium in all subjects where an AN is suspected, even when the ABR is normal. Recording of transient evoked otoacoustic emissions in the presence and in the absence of contralateral white noise has proved to be a simple, inexpensive, non-invasive test for the diagnosis of suspected retrocochlear pathologies. A deficit in vestibular function is most frequently encountered when the AN is already quite large and an alteration in the smooth pursuit test is only found when the AN involves the brainstem. These data have led us to conclude that vestibular reflex studies do not play any role in early diagnosis of AN. Surgical exeresis is the treatment of choice in those cases where "watch and scan" (only hearing ear in the absence of neurological complications; AN < 0.5 cm in the ponto-cerebellar angle, particularly in elderly patients) is not indicated. The enlarged translabyrinthine approach is indicated in all cases of AN, no matter what the tumor size and extent of pre-operative hearing. Promptly and correctly treating intra and postoperative complications, most frequently encountered in patients with AN > 2 cm, reduces the mortality and morbidity to a minimum. Modern otological microsurgery and monitoring techniques make it possible to preserve the VIIth facial nerve in more than 90% of the ears, consequently preserving or nearly preserving normal VIIth nerve function 1 year after surgery in at least three out of four patients. No matter what approach is used, hearing can be preserved measurably in approximately 50% of the ears undergoing surgery and to a socially useful or nearly useful level in a significantly lower proportion of patients. In this regard the most satisfactory results are obtained when preoperative hearing is normal and the AN is < 2 cm.

Adolescent↗
PubMed2000

[Rotator cuff rupture. Diagnostic imaging].

Conventional radiography, ultrasound, Magnetic Resonance (MR), Arthrography Computed Tomography (Arthro-CT) and Arthrography Magnetic Resonance (Arthro-MR) are available for diagnosis of rotator cuff tears. Our purpose is to assess the specificity and sensitivity of these examinations and if they could give to the surgeon all the informations to select the more accurate treatment. We have evaluated retrospectively the images of 68 patients, 43 male and 25 female (average age 51 years), which then have been surgically treated for rotator cuff pathology. On the basis of our findings, we think that conventional radiography and ultrasound are excellent in a first evaluation. MR images, particularly in the coronal and sagittal oblique planes, are able to demonstrate partial or complete rotator cuff tears. The use of intra-articular contrast medium (arthro-CT, arthro-MR) should be reserved for partial lesions on specific cases.

Adult↗
PubMed2000

[Shoulder instability: diagnostic imaging].

Shoulder instability is often diagnosed among athletes; two clinical forms are distinguished: anatomical instability, with recurrent luxation of the shoulder, and functional instability, with pain, articular "click" and sensation of instability. Lesions of periarticular soft tissues (capsula, fibrocartilaginous labrum, gleno-humeral ligaments and rotator cuff) are common in both forms, while lesions of bone structures (humeral head and glenoid of scapula) are typical of shoulder with previous dislocation. Purpose of our retrospective study was to verify the value of magnetic resonance (MRI) and computed arthrography (arthro-CT) in diagnosing these lesions in 57 patients suffering from shoulder instability. On the basis of our results and experience we think that in a preoperative evaluation of an unstable shoulder, arthro-CT and arthro-MRI are more accurate because the intra-articular injection of a contrast medium better identifies lesions of capsula, gleno-humeral ligaments and fibrocartilaginous labrum. In other circumstances, such as the study of the shoulder for legal purposes, MRI is preferable because it offers an accurate and global evaluation of periarticular structures.

Adolescent↗
PubMed2000

[Shoulder diseases in throwing athletes: radiologic assessment and surgical correlation].

Lesions of the shoulder, especially rotator cuff tears and glenoid labrum (SLAP) lesions, are commonly caused by traumatic episodes in athletes such as repeated trauma from throwing. The available radiological methods are MRI, CT and MR arthrography. Twelve athletes suffering from shoulder pain or instability have been studied and then underwent successful treatment in arthroscopy. On the basis of our results and experience, we think that MR, especially with intra-articular injection of contrast medium, is the best examination because it offers an accurate evaluation of both rotator cuff and glenoid labrum. Nevertheless difficulties are often encountered and definitive diagnosis sometime rests on arthroscopic exploration.

Adolescent↗
PubMed2000

[Wrist trauma: diagnostic imaging].

Wrist injury is common throughout life and, although history and physical examination provide important information regarding the type of lesion, a radiological study is essential to determine a specific diagnosis. Conventional radiography plays a central role in the wrist injuries but the diffusion of more sensitive methodics offers new possibilities. Our purpose is to evaluate the role of computed tomography (CT), magnetic resonance (MR) and arthrography in wrist trauma. We retrospectively examined the images of 45 patients with wrist injuries: in every patients a radiological examination in 4 standard projections was executed while in 25, 9 and 11 patients CT,MR and arthrography were performed. On the basis of our findings we think that conventional radiography is often sufficient for diagnosis of bone lesions even if CT sometimes is required to detect subtle fractures. MR has an high sensitivity not only for abnormalities of soft tissues, including interosseous ligaments and triangular fibrocartilage, but also bony abnormalities such as occult fractures and early osteonecrosis. Arthrography still remains the best procedure for evaluating lesions of triangular fibrocartilage and intercarpal ligaments especially in a preoperative phase.

Adolescent↗
PubMed2000

[Injuries of the cruciate ligament of the knee: diagnostic contribution of MR and spiral CT].

Lesions of cruciate ligament are common after knee trauma of different degree of gravity. Lesions evaluation is possible thanks to CT and MRI. Our purpose is to verify their value in diagnosis of cruciate ligaments lesions. We retrospectively evaluated 160 patients (80 CT and 80 MRI) with subsequent diagnosis of cruciate ligaments injury. CT and MRI were performed in the acute phase and in the subacute phase within 2-3 weeks from trauma. On the basis of our results CT and MRI shown a reduced sensitivity in acute phase owing to the intraarticular haemorrhage; in this phase MRI gives more information about fibres interruption. In subacute or chronic phase, both methods are correct in recognising the lesions but MRI is more sensitive and accurate. It is a real wish that, with more MRI machines diffusion, this method will be preferred in the study of cruciate ligaments both in acute phase and subacute-chronic phase.

Adolescent↗
PubMed2000

[Meniscal injuries of the knee. Diagnostic imaging].

Nowadays, treatment of meniscal tears is conservative with removal only of the broken part of meniscus. For this reason, before arthroscopy, the orthopaedic surgeon needs for an accurate preoperative diagnosis that could be obtained with computed tomography (CT) and magnetic resonance (MR). Our purpose is to value the actual role of CT and MR in diagnosis of meniscal tears. We retrospectively evaluated CT and MR images of 128 patients (average age 32 years) who then underwent arthroscopy. On the basis of our findings CT and MR have been shown to be very accurate to detect meniscal tears, even if with both methodics false positives and false negatives are possible. Nevertheless, MR is able to give high resolution multiplanar images without using ionising radiations and is preferable because of its high accuracy in recognising associated lesions of ligaments or articular cartilage.

Adolescent↗
PubMed2000

[Femoro-patellar instability: radiologic assessment].

To propose a simple and reproducible radiological evaluation of the patellofemoral instability that enables the orthopaedic in choosing the best therapy. The radiographs and CT examinations of 55 patients, 38 female and 17 male (range 18-32 years) have been evaluated retrospectively. Twenty-height of them underwent surgical treatment for patellar instability. A radiological protocol which includes conventional radiographs in two projections and a CT examination both in extension, with and without quadriceps contraction, and in flexion at 20 degrees allows to give all the informations one's need for evaluating patellar height and mobility, trochlear dysplasia, valgism of the knee and the degree of excessive lateral position of the anterior tibial tuberosity. It's a simple, quick, accurate and reproducible protocol to do, even with different radiological systems.

Adolescent↗
PubMed2000

[Spiral CT and MR in injuries of the ankle and the foot].

Conventional radiography is the first radiological examination in injuries of ankle and foot, but often it has normal findings or it is difficult to execute for critical conditions of patients. Our purpose was to assess the value of CT and MRI in injuries of ankle and foot; we retrospectively reviewed the MR and CT images from 48 patients (age range 18-55 years), whose 16 had a major trauma with other skeletal segment lesions and the remaining a minor trauma limited to ankle and foot. On the basis of our results and experience, we think that in major trauma CT and MRI have similar findings about preoperative evaluation of fractures even if MR better identifies ischemia of fragments, subcortical contusions and lesions of ligaments, capsula or tendons. In minor trauma, MR is superior to CT because it can diagnose lesions of bone and periarticular structures that are difficult or impossible to identify with other instrumental examinations.

Adolescent↗
PubMed2000

[Spiral CT in maxillo-facial trauma].

Fractures of facial skeleton are common in a busy emergency department in often requires careful radiological study before surgical treatment. Radiographic evaluation of facial injuries is especially challenging because the complex facial structure results in a confusing overlapping of densities on the radiograph. Instead Spiral-CT enables obtaining images on different planes so that even subtle or complex fractures may be evaluated in the best way. Moreover, associated lesions of important organs can be diagnosed. Our purpose is to verify the value of Spiral-CT in traumatology of facial skeleton. We have evaluated retrospectively the images of 82 patients admitted for facial trauma. On the basis of our findings we think that conventional radiography should be reserved only for light traumas of superficial structures (nose, zygomatic arch, body of jaw); in the remaining cases Spiral-CT should be the first radiological examination.

Adolescent↗
PubMed2000

[Cervical spine injuries: diagnostic imaging].

In past few years, traumas of cervical spine have increased, chiefly owing to rise of road accidents. Nevertheless, only in a small percentage of cases lesions of cervical spine occur and, in order to reduce many negative radiographs, a careful clinical examination is required. Our purpose is to verify the value of radiology in evaluation of acute trauma of cervical spine and to propose an adequate radiological protocol. In the course of two years (1998-99), 376 patients were admitted in consequence of cervical trauma of different degree of gravity. In all patients, conventional radiographs were obtained, in 93 a computed tomography (CT) examination was executed and only in 18 patients with neurological symptoms a magnetic resonance (MR) was required. Fractures of cervical spine wee identified in 91 cases and in patients in which MR images were obtained, neurological lesions of various severity were diagnosed. On the basis of our results, we think that, in a clinical suspicion of cervical spine lesions, a conventional radiographic study has first to be performed even if often good radiographs aren't obtained for technical difficulties. If doubts persist on conventional radiographs or a fractures has already been diagnosed on radiographs but we want to verify its stability, a CT needs to be performed. MR is required if neurological symptoms are present in order to diagnose lesions of spinal marrow, nerve roots or ligaments.

Adolescent↗
PubMed1999

[Upper cervical spine fracture: sources of misdiagnosis].

PURPOSE: Missing cervical spine fractures during the initial plain film study may lead to severe neurological complications for patients and to medicolegal responsibilities for the physician. The upper cervical spine tract (C1-C2) is considered to be at high risk for misdiagnoses. We decided to investigate the possible causes of mistake in the cases of missed fractures on the initial plain film, performed in the emergency room. MATERIAL AND METHODS: We retrospectively reviewed the radiological reports, the original plain films and the CT findings, of 32 patients with upper cervical (C1-C2) fractures, admitted January 1994 to December 1998. Twenty-eight of these patients (87.5%) had multisystem trauma, 4 (12.5%) had minor craniocervical trauma. None of these patients had neurological signs correlated to the cervical injuries, 30 of them had normal consciousness and reported only neck pain, 2 of them were unconscious for the associated head trauma and were hospitalized in the intensive care unit. All the patients with normal consciousness underwent conventional three-view cervical spine radiography; the two unconscious patients in the intensive care unit were submitted to bedside examination with an anteroposterior and a lateral views of the cervical spine. All patients underwent spiral CT of the upper cervical tract. RESULTS: In 9 of 32 patients (28%) a cervical fracture was missed on the plain film and CT was performed only because of persistent neck pain. We found 2 Jefferson's fractures, 2 type II dens fractures, one type I dens fracture and 4 hangman's fractures. In 8 of the 9 patients (89%) the fracture was potentially unstable. Misdiagnoses resulted from overlapping bone structures (3%), suboptimal film quality (3%), satisfaction of search phenomenon (3%), missed mild tilting of the dens (6%), missed double cortex sign (16%), missed C1-C2 lateral subluxation (6%) and marked osteoporosis (3%). Prevertebral soft tissue swelling was not seen in any of the 9 cases of missed fractures. Considering the group of patients with C1-C2 fractures separately, the false negative rate is 28%, which corresponds to 10.7% of the total number of patients with cervical fractures and dislocations examined during the same period. CONCLUSIONS: Among the causes of false-negative interpretation, osteoporosis, suboptimal film quality due to associated fractures and overlapping bone structures must be considered unavoidable. On the other hand these possibilities should be indicated on the X-ray report because, if painful symptoms persist, a CT exam is strongly advised. Subtle alterations like dens tilting, double cortex sign, lateral subluxation of C1 and prevertebral soft tissue swelling should be regarded as highly suspicious for fracture. Missing these lesions might be considered a true diagnostic mistake with possible legal consequences, which may also expose the patient to the risk of neurological complications. The satisfaction of search phenomenon can be avoided only by trying to use a search pattern for every film, which includes checking all the visible anatomical structures even in the presence of a particularly evident lesion. In all questionable cases or high-risk fracture patients, even with an apparently negative plain film, it is advisable to perform CT instead of additional plain films. Finally, in all the patients treated in the intensive care unit for head trauma, an upper cervical CT scan should be routinely carried out at the same time as the brain scan.

Cervical Vertebrae↗
PubMed1998

[Ovarian lymphoma. Findings with ultrasonography, computerized tomography and magnetic resonance].

PURPOSE: Lymphomatous ovarian involvement is an uncommon event, both for primary and systemic lymphoma. It presents different diagnostic and therapeutic implications from the more common ovarian epithelial cancer. We investigated the role of imaging techniques in the diagnosis of these lesions. MATERIAL AND METHODS: Eight patients, aged 13 to 70 years (mean: 47) were selected from all the CT examinations performed from 1986 to 1996 to assess the most typical imaging patterns. All the patients underwent a CT examination, with contiguous 8 or 10 mm thick slices and thin (4-5 mm) detailing slices; iodinated contrast agents were administered in 6 cases. Six patients were also examined with sonography (US). Lastly, 3 patients underwent a MR examination, 2 of them with paramagnetic contrast agent. RESULTS: All the patients were affected with non-Hodgkin lymphoma (6 diffuse lymphomas--1 lymphoplasmocytoid, 2 Burkitt, 1 large cells, 1 large and oat cells, 1 immunoblastic large cells, 2 follicular large cells lymphomas). Two patients had primary lesions and the other 6 had a systemic lymphoma; ovarian involvement was bilateral in 6 cases. The lesion size always exceeded 5 cm. Ascitis was present in only one case. The US patterns of the lesions were aspecific, homogeneous and hypoechoic; color Doppler US showed mild vascularization. CT showed clear-cut lesions, hypodense and with mild contrast enhancement in all cases. Spin-echo MRI showed homogeneous masses which were moderately hypointense on T1-weighted images and slightly hyperintense on T2-weighted images. Gd-T1-weighted images showed mild enhancement. DISCUSSION: The differential diagnosis of ovarian primary lymphoma is usually made with ovarian epithelial neoplasms, which normally have a complex structure with cystic or necrotic areas and solid components usually enhancing after contrast agent administration. Also sarcomas and, in children, neuroblastomas usually have an inhomogeneous structure. In ovarian involvement with systemic lymphoma the concrurrent finding of adenopathy can help the diagnosis. CONCLUSIONS: Despite the absence of typical imaging patterns, we emphasize the importance of considering ovarian lymphoma in the differential diagnosis of ovarian cancers, especially if bilateral and homogeneous, without ascitis. These findings, uncommon in ovarian epithelial tumors, can help to make the correct diagnosis.

Adolescent↗
PubMed1997

[Thyroid metastases: the echographic and computed tomographic aspects].

PURPOSE: The modern integrated approach to neoplastic diseases permits to detect metastatic lesions in uncommon sites, such as the thyroid gland. We reviewed the ultrasonographic (US) and Computed Tomographic (CT) patterns of secondary thyroid lesions, comparing imaging findings with primary tumor histopathologic diagnosis. MATERIAL AND METHODS: We reviewed a series of 10 thyroid metastases diagnosed from 1986 to 1995 at staging (4 cases) or follow-up (6 cases) examinations; in the latter, metastases were diagnosed 39 to 89 months (mean: 58 months) after the primary tumor. The patients were 7 women and 3 men, 55 to 94 years old (mean: 65 years). The final diagnosis was made at cytology (4 cases), histology (5 cases) or surgery (1 case). RESULTS: The primary tumors were breast cancer (2 cases), melanoma (2 cases), small cell lung cancer, bronchioalveolar carcinoma, mucoid stomach adenocarcinoma, renal carcinoma, colon carcinoma and leiomyosarcoma (1 case each). The thyroid lesion was unifocal in 6 patients and multifocal in 2; the gland was diffusely involved in 2 patients. Dysphagia was found in all patients. Thyroid function was normal in 6/7 patients and one had hyperthyroidism; normofunctional goiter was found in another patients. US showed focal or diffusely infiltrating hypoechoic lesions; likewise, inhomogeneously hypodense areas with mild contrast enhancement were observed at CT. Thyroid secondary lesions exhibited variable patterns when necrotic, hemorrhagic or calcific areas were included; correlations with primary tumor-pathogenetic and histologic features were often observed. Survival rate was 2-60 months (mean: 19 months). CONCLUSION: Since imaging findings in thyroid metastases are often not specific and sometimes atypical, fine needle biopsy of suspicious lesions should be carried out for both staging and follow-up.

Aged↗