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Biomedical subjects

P Pavlica

Publications and source records attributed to P Pavlica.

At least 19 recordsLinked to original sources
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

Iliolumbar ligament ossification in undifferentiated seronegative spondyloarthropathy.

The case of a man suffering from undifferentiated seronegative spondyloarthropathy (uSpA) without spine involvement and with iliolumbar ligament ossification is reported. Unlike a similar previously published case showing ossification only of the middle part of the left ligament, our patient had ossification of the whole course of both ligaments.

Foot↗
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↗
PubMed1996

Dactylitis in patients with seronegative spondylarthropathy. Assessment by ultrasonography and magnetic resonance imaging.

OBJECTIVE: To establish by means of ultrasound and magnetic resonance imaging (MRI) the role of tenosynovitis and arthritis in determining the "sausage-like" aspect of finger dactylitis and to compare the results of the 2 examinations. METHODS: Twelve dactylitic fingers and their corresponding normal contralateral fingers belonging to 10 patients who met the Amor criteria for the diagnosis of seronegative spondylarthropathy (SpA) were studied by ultrasonography and MRI. RESULTS: MRI revealed a significant increase in the volar bone-to-skin distance in dactylitic fingers with respect to that of the normal contralateral fingers (P < 0.001). This increase was due to distension of the flexor synovial sheaths (P < 0.00001) by fluid collection. Peritendinous soft tissues were not involved, since these were found to be significantly thicker in the normal fingers (P < 0.05). Of the 36 joints of the 12 dactylitic fingers, only 1 showed capsule distension. Using MRI as the "gold standard," ultrasonography showed a 100% sensitivity and specificity for flexor tenosynovitis, but lacked sensitivity for joint involvement because it failed to reveal joint capsule distension in the only joint involved. Similarly, physical examination showed a 100% sensitivity and specificity for flexor sheath involvement. CONCLUSION: Dactylitis is due to flexor tenosynovitis. Enlargement of the finger joint capsule is not an indispensable condition for the "sausage-like" feature. Physical examination is a sufficient method for the diagnosis of dactylitis.

Fingers↗
PubMed1995

Color Doppler ultrasonographic scanning in prostatitis: clinical correlation.

Color Doppler and endorectal ultrasonography were performed in 25 patients with acute prostatic syndromes (APS; 13 acute and 12 chronic recurrent forms). In addition, 7 patients with asymptomatic chronic prostatitis, 13 men with prostatic carcinoma and 6 healthy young volunteers were studied. In the 25 APS, a marked increase in color was observed in the cervicourethral site and/or around the ejaculatory ducts and close to the seminal vesicles. The observed pattern is probably explained by vessel dilatation due to acute inflammation. The color increase in these 25 patients was greater than in the 6 normal prostates and 8/9 prostate carcinomas. Moreover, we observed that color intensity matched the severity of symptoms in APS.

Abscess↗
PubMed1995

[Pseudodiverticula of the ureter: a precancerous lesion?].

Ureteral diverticula belong to the group of acquired diverticula even though their pathogenesis and clinical significance are still debated. They are occasionally detected during urography or retrograde pyelography and appear as small spicular or saccate wall outpouchings, single or more often multiple, mostly limited to the upper third of the ureter. The frequent association of these lesions with transitional cell carcinoma of the urinary tract is a problem of great clinical interest since they might represent a preneoplastic manifestation. The authors report on 16 patients with pseudodiverticula, 6 of whom (37.5%) affected with benign prostatic hyperplasia, 4 (25%) with synchronous or metachronous vesical neoplasm and 3 with renal stones. The remaining three patients were affected respectively with vesicoureteral reflux, neurogenic bladder and ureteropelvic junction obstruction. All patients were men over 46 years old. Ureteral involvement was bilateral in 50% of patients. The radiologic pattern consisted of small marginal outpouchings 1-3 mm in diameter, whose demonstration requires good contrast opacification and ureter distension. Pseudodiverticula were always localized in the upper third of the ureter and were multiple in 15/16 cases. Anatomical-histologic studies showed that pseudodiverticula result from hyperplastic-type proliferation of lung epithelium in the ureteral submucosa. Our observations do not confirm literature data on the frequent association between pseudodiverticula and transitional cell carcinoma because of the common presence, in our patients, of other non-neoplastic urinary conditions. The patients with benign hyperplasia of the ureteral epithelium cannot be excluded to be a risk group for cancer, even though no precise confirmation exists. The best advice is to carefully follow-up the patients with ureteral pseudodiverticula, clinically and with IVP.

Aged↗
PubMed1995

[Development and use of quality control program in magnetic resonance].

In 1992, two identical 0.5 Magnetic Resonance units were installed in Policlinico S. Orsola-Malpighi in Bologna. A Quality Assurance (QA) protocol was designed by the Medical Physics Department to monitor both systems as of Acceptance Test. Our main goals in drawing up the QA protocol were: 1) Completeness--to check all the most significant physical parameters; 2) Efficiency--to reduce examination time of the QC Protocol; 3) Reliability--to achieve good repeatability of results. The QA protocol consists of two QC programs: 1) Daily check of Variable Echo image SNR of a homogeneous phantom, Eddy Current compensation, laser printer test; 2) Monthly check of SNR of Spin Echo and Fast Scan images, integral uniformity, B0 uniformity, B1 uniformity, T2 stability, ghosts, slice thickness, slice profile, geometrical distortion, resolution power. SNR dependence on FOV, NEX, matrix and slice thickness, and resolution dependence on slice thickness and position were tested as Acceptance test. The daily checks provide continual monitoring of the performance of both systems and laser printer and have shown: 1) strong fluctuations in image reproduction probably due to film emulsion instability; 2) a "warning" of imminent malfunction. The monthly checks were in line with acceptance test data and have shown: 1) different behavior of the two systems that should perform analogously; 2) greater result stability in one system with better results also in terms of diagnostic images. The main aim of our QA protocol is to optimize diagnostic accuracy by checking several physical parameters that act as good "indicators" for possible malfunctioning. We believe this can be done with simple but useful daily QC supporting a routine more complex QC program and can be achieved through continual application of both protocols.

Magnetic Resonance Imaging↗
PubMed1994

[Color-Doppler of the renal arteries at their origin. Technical-methodologic problems].

Steno-obstructive diseases of the renal arteries affect mainly the ostium and the proximal vessels. The Doppler US study of the renal arteries can be troublesome on account of their depth, reduced caliber and considerable anatomical variability in their origin, course and number. Recent color-Doppler techniques have helped partially overcome these limitations relative to the identification of both vessels and stenoses. The technique for the visualization of the renal arteries requires supine transverse epigastric, coronal and transcaval scans to obtain a good beam angle. The stenosis can be recognized by the phenomena of turbulence and blood flow acceleration that elicit a typical yellow-green or white color variance, according to the different units. Spectral analysis allows monitoring of spectral broadening, velocity/frequency increase in systolic peak and increase in aortic-renal ratio. Stenoses can be quantified by calculating the stenosis index. The major limitation to the clinical use of color-Doppler US to study steno-obstructive diseases of the renal arteries is the high incidence of supplemental vessels (25-30% of the patients) and early bifurcations of the main branch. Thus, a correct and accurate imaging technique designed to search supplemental vessels plays a major role in decreasing the number of false negatives. Captopril renal scintigraphy is more sensitive than color-Doppler US in the identification of renin-dependent hypertension, but Doppler US is definitely better at detecting stenoses < 60% which may lead to chronic renal insufficiency.

Humans↗
PubMed1994

[Echography and magnetic resonance of the penis. I. Its anatomy].

The use of such new diagnostic imaging methods as ultrasonography (US) and Magnetic Resonance Imaging (MRI) has given radiology an increasingly important role in the study of penis abnormalities. The normal anatomy of the penis was investigated with US with real-time units, high-frequency linear probes, and with an 0.5-T MR unit. The two methods are definitely better than conventional radiologic techniques because they allow the direct and detailed demonstration of all anatomical structures. Both the normal and the abnormal anatomy are better depicted when the exam is performed after pharmacologically induced erection. The normal US and MR features of the different anatomical structures must be known to diagnose penis conditions. US exhibited better spatial resolution than MRI and demonstrated very small structures which may be missed at MRI because of gap interslices. On the other hand, MRI exhibited better contrast resolution, especially on T2-weighted sequences. Thus, the two imaging methods must be considered as complementary, even though US is suggested as the method of choice because of its cost-effectiveness and widespread availability.

Evaluation Studies as Topic↗
PubMed1994

[Applications of the quality control program in diagnostic radiology. Confirmation of results, clinical and managerial benefits].

The Health Physics Department developed and implemented a QA program to test the X-ray equipment in Policlinico S. Orsola-Malpighi, Bologna, Italy. The program was aimed at achieving "total quality" in diagnostic radiology. To this purpose, suggestions were taken from: the code of practice of the leading international committees; our personal experience over several years in measuring and evaluating radiologic equipment and finally data relative to the maintenance procedures for radiologic equipment. The Integrated Quality Assurance Program (IQAP) manages two different quality control sub-procedures: the first one (QF) monitors equipment performance with a view to providing more pieces of diagnostic information and to reducing both patient and staff dose; the other one (QG) plans maintenance service to reduce running costs. QF included: i) practical tests for X-ray equipment; ii) analysis, interpretation and comparison of results; iii) tolerance limits. QG provided information on: i) inventory; ii) user-service relationship; iii) suitability of any corrective actions. The data relative to the last four years are reported in the text. The regular and correct use of this integrated protocol is very useful to monitor the factors affecting image quality and to improve diagnostic radiology. Finally, the protocol allowed us to plan our "yearly maintenance contracts" better and to save money on running costs.

Program Evaluation↗
PubMed1994

[Tubular ectasia of the rete testis. The echographic aspects].

Tubular ectasia of the seminiferous tubules of the rete testis is an uncommon benign condition which was only recently described. Its US pattern is typical and allows the disease to be distinguished from cystic tumors of the testicle. The condition was evaluated with US in 10 patients; all men were over 50 years old. US was performed with a 7.5-MHz linear probe. The lesion was unilateral in 7 and bilateral in 3 patients. It was always localized in the mediastinum testis and was associated with spermatocele in 5 cases and with testicular cysts in 4. On US scans, the condition presented with several tubular or rounded anechoic structures, mimicking a hypoechoic mass. In 5 men with 4-19 months' follow-up, no change in lesion size and structure was observed. Tubular ectasia was never assessed with biopsy or histology. Tubular ectasia of the rete testis shares several US features with testicular cysts and spermatocele, which are likely to have the same underlying mechanisms. This benign condition can be distinguished from true cysts and testicular tumors on the basis of US findings and its differential diagnosis is important to avoid unnecessary surgery.

Aged↗
PubMed1993

[Abdominal Doppler ultrasonography in the diagnosis of renovascular diseases. Double-blind prospective study].

Our work was aimed at evaluating the sensitivity and specificity and the positive and negative predictive values of abdominal Doppler US in the diagnosis of renovascular disease. Fifty hypertensive patients (23 men and 27 women) with 100 bilaterally single renal arteries (66 of them normal and 34 stenosed) were studied by means of color (26 cases) and duplex (24 cases) Doppler US. The following US variables were considered in the diagnosis of renal artery stenosis: increased peak systolic velocity in the renal artery, increased ratio between peak systolic velocity in the renal artery and in the aorta, increased parenchymal acceleration time and increased resistive index. Feasibility was 100% for all variables. The general multivariate statistic model of discriminate analysis was used to define three calculation levels, according to: a) duplex vs. color Doppler equipment, b) hemodynamic variables and c) optimal cutoff values. US examinations were performed by a single observer in a double-blind study, before angiography, so as to eliminate interobserver variability. On the whole abdominal Doppler US exhibited optimal specificity and fairly good sensitivity. Specificity increased (94% to 97%) with the use of color Doppler according to the different combinations of variables, but sensitivity remained the same. The calculation including all the Doppler variables increased sensitivity from 73% (with true values) to 93% (with threshold values). The positive predictive value demonstrated that 90% of the renal arteries with increased peak systolic velocity and 100% of those with increased parenchymal acceleration time were stenosed. However, the negative predictive value demonstrated that 15% of the renal arteries with no increase in peak systolic velocity is misdiagnosed as normal. In conclusion, abdominal Doppler US can be used to study renovascular disease patients, but the examination must always be based on different hemodynamic variables and true values.

Double-Blind Method↗
PubMed1993

[Color-Doppler and angioplasty in renovascular hypertension].

Renovascular hypertension is defined as a kind of hypertension secondary to altered renal perfusion with the activation of the renin-angiotensin system. Since a large number of these patients benefits from treatment--be it medical, surgical or angioplastic--a non-invasive low-cost method allowing accurate screening was looked for. Color-Doppler was employed by many authors to evaluate renovascular hypertension, for both the early diagnosis of the condition and the evaluation of treatment results in renal artery stenoses. However, the authors agree that color-Doppler cannot play a major role in the screening of renovascular hypertension due to the various qualitative and quantitative variables not being adequately codified, to the lack of a single color-Doppler method and to the difficult comparison of the results from the different units. Nevertheless, improved results are promised by technological evolution, together with the possibility to codify color-Doppler variables more easily repeatable. B-mode units with 3.5 and 5 MHz probes were employed in the thinnest subjects. In 5-25% of cases accessory renal arteries were observed. After identifying the vessel to be studied with several spatial scans, the smallest possible sample volume (usually 3-5 mm) was positioned. The normal flowmetric range was 0.07-0.1 s: it must not exceed 0.16 s, with persistence of high diastolic flow. Some authors' criteria were followed to define either stenosis or renal artery obstruction; moreover, pulsatile flow index was considered, together with the resistive index, pulsatility index and stenosis index.

Angioplasty↗
PubMed1992

[Renal artery stenosis. Doppler color study before and after angioplasty].

Doppler flowmetry can be successfully employed to assess arterial patency after percutaneous transluminal angioplasty (PTA). The aim of this study was to assess color Doppler sensitivity in detecting renal artery stenosis prior to percutaneous angioplasty (PTRA) and vessel patency after it. Eleven patients (7 males and 4 females) affected with renal artery stenosis, unilateral in 9 cases and bilaterally in 2, underwent color-Doppler evaluation 1 day before and 7 days after PTRA. The operator was unaware of dilatation results. A total of 13 stenoses were treated. The qualitative and quantitative parameters we employed were: a) broadening of the spectrum, b) peak systolic frequency > 4000 Hz, c) stenosis index > 50%. Before PTRA, mean systolic peak at the stenosis was 7978 (range 4050-12500 Hz), while stenosis index was 71.9% (range 48-89%). After PTRA complete recovery was observed in 5 cases, no improvement in 1 and incomplete recovery in 7. Doppler results were in agreement with those of angiography in 6/13 while partial agreement only was seen in 7/13. Our results, although obtained in a small and highly selected group of patients, would seem to support the value of color-Doppler for the follow-up of patients after PTRA.

Adult↗
PubMed1991

[Importance of specific prostatic antigen to prostatic volume ratio in the selection of patients for ultrasonography-guided biopsy of the prostate].

US-guided biopsy was performed in 94 patients with suspected lesions at transrectal US. Histology demonstrated carcinoma in 43 cases, benign hyperplasia in 44, and prostatitis in 7. In all cases the prostate specific antigen (PSA) was calculated, by means of US, together with prostatic volume (V). PSA was related to the corresponding gland volume, which resulted in PSA/V index. Subsequently, histology was correlated with both PSA value and PSA/V ratio. Our study showed PSA/V ratio to have higher sensitivity and specificity than absolute PSA value in the diagnosis of prostatic carcinoma. The authors believe prostate US-guided biopsy to be: a) necessary when the suspected area has PSA/V ratio greater than 0.15, and especially when PSA/V greater than 0.30; b) not indicated when echostructural alterations are associated with PSA/V less than 0.15, because they are most frequently due to benign lesions. The combined use of PSA/V ratio and US is therefore suggested to select the patients in whom biopsy is to be performed.

Aged↗
PubMed1991

[Percutaneous nephrostomy in neoplasm patients: when?].

The management of cancer patients with a lesion in its end stage is a clinical problem a satisfactory solution to which has not been found yet, because of the ethical and legal problems involved. The authors analyzed the survival rates of 218 patients with advanced neoplastic disease and obstructive renal failure who had undergone external/internal urinary diversion. One month after the procedure 20% of the patients were dead. The figure rose to 75% at 6 months and reached 98% at one year. Urinary diversion in cancer patients with renal failure is aimed not only at avoiding death and assuring a prolonged survival, but also at providing a good quality of life. Several clinical criteria are therefore analyzed which are used in the selection of patients to submit to nephrostomy. The most important factors seem to be the actual stage of the tumor, its primary location, the possibility of an effective antineoplastic therapy, and the patient's consent. Randomized long-term studies are still necessary to analyze not only survival rates but also quality of life after urinary diversion for obstructive renal failure.

Adult↗