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Biomedical subjects

R Grassi

Publications and source records attributed to R Grassi.

At least 19 recordsLinked to original sources
PubMed2002

Oral lichen planus: a preliminary clinical study on treatment with tazarotene.

OBJECTIVE: The rationale for using tazarotene in oral lichen planus (OLP) is its regulatory action on the growth and differentiation of keratinocytes and on inflammation. This randomized, placebo-controlled study addresses evaluation of the effects of topic tazarotene in the treatment of OLP. DESIGN: The degree of lesions before and after treatment scored by a 6-score scale in six cases treated with tazarotene was statistically compared with those of six controls treated with placebo. SUBJECTS: Twelve patients with hyperkeratosic OLP were randomly allocated to treatment with tazarotene gel 0.1% b.i.d. or with placebo for eight consecutive weeks. METHODS: The statistical comparison was executed by means of Wilcoxon analysis for paired data. RESULTS: Patients treated with tazarotene presented a significant reduction of their lesions as compared with the control group. Among transitory side-effects, burning sensation and taste abnormalities were observed. CONCLUSION: Topical tazarotene may be a valuable therapeutic tool in the treatment of hyperkeratotic OLP.

Administration, Topical↗
PubMed2002

Case report. Ultrasound and CT findings in lipoma of the inferior vena cava.

Several cases of a fat mass-like lesion adjacent to and/or projecting into the inferior vena cava have been presented as a normal variant of perioesophageal fat distribution or as intravascular lipoma. We report a case of a lipoma of the inferior vena cava, studied with coronal reformatted CT images, ultrasound and colour Doppler imaging, in a 78-year-old female patient.

Aged↗
PubMed2002

Census of radiological machines in Radiodiagnostic Services of public and recognized hospitals in the Campania Region.

AIM: The present study provides a census of equipment in use by Radiodiagnostic Services in public hospitals and institutes recognized by the Region of Campania in the year 2000. The type, date of installation and distribution of the equipment were considered in relation to the number of hospital beds and the resident population. MATERIALS AND METHODS: A census was taken of all the public hospitals and institutes recognized by the Region of Campania in the period running from January 1999 to April 2000. Data were collected using an appropriate form asking for details of the number of machines and the model, manufacturer and year of installation, under six categories: traditional radiology, mammography, US, CT, MR and angiography. The data were analyzed by provinces, combining the different machines into five-year periods depending on the date of their installation. RESULTS: Traditional radiology equipment accounts for 71% of the total. The mean for the Region stands at 23 machines per 1000 beds. The mean date of installation was 1986. Mammography machines account for 8% of the total. The mean for the Region stands at 2.6 machines per 1000 beds. The mean date of installation was 1991. Echography machines account for 10.3% of the total. The mean for the Region stands at 3.4 machines per 1000 beds. The mean date of installation was 1992. Angiography machines account for 3.2% of the total. The mean for the Region stands at 1.1 machines per 1000 beds. The mean date of installation was 1985. CTs account for 6.4% of the total. The mean for the Region stands at 2.1 machines per 1000 beds. The mean date of installation was 1993. MR account for 1.1% of the total. The mean for the Region stands at 0.4 machines per 1000 beds. The mean date of installation was 1995. CONCLUSIONS: Technological and scientific improvements and growing attention to the quality of medical care expected by patients mean that constant modification and adaptation are needed to meet demands. In planning measures designed to provide new radiological equipment and modernize existing equipment in the Region it would certainly be useful to eliminate the unevenness of the services provided. In conclusion, it is crucial that the local administrations and health authorities in the Campania Region establish a regular census, with proper assessment of the obsolescence of radiological equipment and its distribution throughout the area, in order to comply with international standards.

Equipment and Supplies↗
PubMed2001

Role of contrast-enhanced helical CT in the evaluation of acute thoracic aortic injuries after blunt chest trauma.

The purpose of this retrospective study was to determine the value of contrast-enhanced helical CT for detecting and managing acute thoracic aortic injury (ATAI). Between June 1995 and February 2000, 1419 consecutive chest CT examinations were performed in the setting of major blunt trauma. The following CT findings were considered indicative of ATAI: intimal flap; pseudoaneurysm; contour irregularity; lumen abnormality; and extravasation of contrast material. On the basis of these direct findings no further diagnostic investigations were performed. Isolated mediastinal hematoma on CT scans was considered an indirect sign of ATAI: In these cases, thoracic aortography was performed even if CT indicated normal aorta. Seventy-seven patients had abnormal CT scans: Among the 23 patients with direct CT signs, acute thoracic aortic injuries was confirmed at thoracotomy in 21. Two false-positive cases were observed. The 54 remaining patients had isolated mediastinal hematoma without aortic injuries at CT and corresponding negative angiograms. The 1342 patients with negative CT scans were included in the 8-month follow-up program and did not show any adverse sequela based on clinical and radiographic criteria. Contrast-enhanced helical CT has a critical role in the exclusion of thoracic aortic injuries in patient with major blunt chest trauma and prevents unnecessary thoracic aortography. Direct CT signs of ATAI do not require further diagnostic investigations to confirm the diagnosis: Isolated aortic bands or contour vessel abnormalities should be first considered as possible artifacts or related to non-traumatic etiologies especially when mediastinal hematoma is absent. In cases of isolated mediastinal hematoma other possible sources of bleeding should be considered before directing patients to thoracic aortography.

Aortic Dissection↗
PubMed2001

[Role of computerized tomography in the diagnosis of peritoneo-intestinal lesions resulting from closed trauma. Experience at 2 emergency departments].

INTRODUCTION: Small and large bowel mesenteric injuries from blunt abdominal trauma are rare and often difficult to diagnose. Computed Tomography used in cases of blunt abdominal trauma has been found sensitive in detection of bowel and mesenteric injuries and discrimination of operable from nonoperable candidates. PURPOSE: A retrospective study of the CT examination of 24 patients, with surgically confirmed bowel and mesenteric injuries, was performed. Our goal was to evaluate the various CT signs of blunt bowel and mesenteric injury and the related frequency. MATERIAL AND METHODS: Our series includes 24 patients, 16 of them (first group) were investigated with CT at Cardarelli Hospital, Naples, while the remaining 8 (second group) at University of Bari. Patients of the first group, 11 men and 5 women, age ranging from 18 to 77 years, were submitted to a conventional abdominal CT performed after i.v. administration of contrast media. Patients of the second group, 7 men and 1 woman, age ranging from 4 to 81 years, were submitted to helical CT performed with the following parameters: 10 mm slice thickness, 5-mm contiguous intervals from the level of the diaphragm to the pubic bone, pitch 1.5. Helical CT was performed in all cases before and after i.v. administration of contrast material injected at a rate of 3.5 ml/sec. A scanning delay of 40 seconds after the beginning of contrast injection was routinely used. In all patients the following CT signs were retrospectively searched on: peritoneal or retroperitoneal fluid, mesenteric hematoma, hazy streaky changes in mesenteric fat, high-density clot (sentinel clot) adjacent to the involved bowel, pneumoperitoneum, retropneumoperitoneum, extravasation of intravenous contrast material, bowel wall thickening. RESULTS: In the first group the following CT signs were observed: mesenteric hematoma (87.5%), hazy streaky changes in mesenteric fat (56.25%), peritoneal or retroperitoneal fluid (37.5%), sentinel clot (25%), bowel wall thickening (18.75%), extravasation of intravenous contrast material (12.5%). In the second group the following CT signs were observed: peritoneal or retroperitoneal fluid (87.5%), bowel wall thickening (50%), mesenteric hematoma (37.5%), sentinel clot (25%), pneumoperitoneum (12.5%), retropneumoperitoneum (12.5%), hazy streaky changes in mesenteric fat (12.5%). DISCUSSION AND CONCLUSIONS: Bowel and mesenteric injuries from blunt trauma are infrequent and difficult to diagnose clinically, as the physical and laboratory findings may be subtle and are often overshadowed by other injuries in patients with multisystem trauma. CT represents a proven modality in the evaluation of bowel and mesenteric injuries: careful inspection and technique are required to detect often subtle findings. In our series of 24 patients with surgically confirmed bowel and mesenteric injuries, the presence of mesenteric hematoma and of peritoneal or retroperitoneal fluid were the more frequent CT signs observed. Radiologists may play a crucial role in the timely diagnosis of these injuries, allowing prompt and appropriate management of these patients.

Abdominal Injuries↗
PubMed2000

Delayed presentation of traumatic left-sided diaphragmatic avulsion. A case report.

We describe the case of a 35-year-old man who had suffered a severe multitrauma with blunt thoracic injury, left scapula and humerus fractures 5 years earlier. At the time of the trauma, a diaphragmatic lesion went unnoticed. Five years later, the patient had a 24-h history of increasingly severe abdominal pain with repeated vomiting. Helical CT showed a portion of the left hemidiaphragm avulsed from its insertions on the ribs with large-bowel loop obstruction herniated in the left hemithorax. The preoperative CT diagnosis was confirmed by surgery: reduction of the hernia and reinsertion of the hemidiaphragm to the lumbocostal arch were performed.

Adult↗
PubMed2000

Accuracy of low load exercise-induced T wave normalization in predicting the presence of contractile reserve after an anterior myocardial infarction.

BACKGROUND AND METHODS. Exercise-induced T wave normalization occurring at a low (less-than-or-equal50 watt) workload in infarct-related electrocardiographic leads was studied in 30 consecutive patients with a recent transmural anterior acute myocardial infarction. Patients underwent both ergometric stress testing (within 30 days after the infarction) and low dose dobutamine echocardiography. The T wave normalization was considered significant when it occurred in at least two infarct-related leads. A significant contractile reserve was considered present in an infarcted region when 50% or more of the dyskinetic segments functionally improved on exercise during dobutamine infusion. RESULTS. Eighteen patients showed exercise-induced T wave normalization (group 1), and 12 patients did not (group 2). Myocardial contractile reserve in the infarct area was detected in 16 patients of group 1 (88%) and in 3 patients (25%) of group 2 (p=0.004). The overall sensitivity, specificity, and diagnostic accuracy of T wave normalization, as it reflects contractile reserve in the infarct area, were 84%, 82%, and 83%, respectively. CONCLUSION. Low load exercise-induced T wave normalization in infarct-related leads appears to be an accurate marker of residual contractile reserve in the infarct area in patients with recent transmural acute anterior myocardial infarction. (c) 2000 by CHF, Inc.

Journal Article↗
PubMed2000

Metastasis to the male breast from carcinoma of the urinary bladder.

We report a case of male breast metastasis from a urothelial carcinoma. Only two cases of this type of metastasis have been previously reported, and these were in the female breast. Clinical examination showed a progressive swelling of the left mammary region, with periareolar skin infiltration. Both mammography and ultrasound showed a rounded mass. Only histological examination with immunohistochemical staining permitted the correct diagnosis to be made. A particular feature of the present case is the absence of contralateral gynaecomastia, normally seen in cases of metastatic tumour to the breast from prostatic carcinoma.

Aged↗
PubMed2000

[Craniocerebral trauma from bullets: the correlation between computed tomography, the clinical picture, neurosurgical treatment and the long-term sequelae].

PURPOSE: To demonstrate the usefulness of CT findings in the planning of brain neurosurgery in gunshot victims, for prompt and successful treatment. MATERIAL AND METHODS: Thirty patients with brain gunshot wounds were examined with CT over 5 years. The patients were 27 men and 3 women whose mean age was 33 years (range: 17-56). Brain CT was carried out with thin (5-mm) slices and 10-mm gap; dynamic scanning (3-mm interscan time) was used especially in case of posterior fossa involvement and diffuse brain damage. The examination was integrated with cervical scout views to detect bullets in the neck and cervical dislocation. CT follow-up was carried out in 20 patients 24 hours postoperatively and every 6 hours in 9 patients in a severe postoperative coma. RESULTS: Twelve intracranial hematomas and 9 subdural hematomas, 3 of them bilateral, were treated and hemorrhage was resolved in 8 lacerocontusive foci. Skull plastic surgery was carried out in 5 cases. Surgical maneuvers were most difficult in the 5 crash bone injuries with wedged splinters; postoperative subarachnoid hemorrhage followed in 3 cases. Blood effusion in ventricles was drained in 6 cases; in 2 of them with permanent catheters. Eleven patients died: 4 right after surgery and 7 an average 15 days postoperatively. DISCUSSION AND CONCLUSIONS: In our series the mortality rate of firearm wounds of the skull base was 34% higher than that of the hemisphere; this is due to carotid hemorrhage and midbrain damage. Such traumas require emergency radiological diagnosis and neurosurgical treatment because of their severity and early irreversible complications. Complex operations and skilled surgeons may prevent disabling postoperative sequels. CT findings are indispensable and must be correctly interpreted. The radiologist and the neurosurgeon must collaborate closely and both must consider several diagnostic and prognostic factors affecting surgical planning.

Adolescent↗
PubMed2000

[The role of spiral computed tomography in sigmoid diverticulitis and the diagnostic-therapeutic implications].

PURPOSE: Colonic diverticula are saccules made of colonic mucosa and submucosa that herniate from the colonic lumen through the muscular layer of the wall where straight vessels penetrate. Diverticula are localized in the sigmoid colon in 95% of cases. Bacteria pooling in the lumen may cause lumen erosion and eventually perforation. CT is a useful technique in this condition because it can demonstrate intra- and/or extramural inflammation. Aim of this retrospective study was to assess the capabilities of contrast-enhanced helical Computed Tomography (CT) in sigmoid diverticulitis, especially relative to selection of the appropriate treatment. MATERIAL AND METHODS: We retrospectively reviewed the findings of 41 patients referred to our emergency department for diverticulitis. CT scans were performed 65 seconds after i.v. injection of nonionic contrast material (3 mL/s, 120 mL in all) administered by a CT-power injector. The following 7 CT findings were considered at least suggestive of acute diverticulitis: focal wall thickening, intramural abscess, inflammatory changes in the sigmoid mesentery root, pericolic fat inflammation or pericolic abscess formation, fistula, peritonitis. CT results were compared with surgical and physical findings. RESULTS: Based on CT findings, diverticulitis was classified as mild (25 patients) or severe (15 patients). In mild diverticulitis we found: focal sigmoid wall thickening (6 patients), intramural abscess (3 patients), sigmoid mesentery root thickening (5 patients), edema fluid (8 patients) and phlegmon (3 patients). In severe diverticulitis we found: sigmoid mesentery abscess (6 patients), fistula (5 patients) and peritonitis (4 patients). CT findings were questionable in 1 case and thus we could not exclude a perforated carcinoma. CONCLUSION: Contrast-enhanced helical CT is the imaging modality of choice in assessing mild or severe acute diverticulitis because it provides useful information for appropriate treatment planning in the emergency setting. This technique is most useful in questionable cases and in patients with suspected severe diverticulitis where a choice must be made between different treatment options.

Colon, Sigmoid↗
PubMed2000

[Spiral computerized tomography without perfusion of contrast media as first line investigation in patients with renal colic].

INTRODUCTION: We investigated the diagnostic accuracy of unenhanced helical CT in the detection of stones in patients with suspected renal colic from ureteral stones and compared CT findings with the results of plain abdominal film and US. MATERIAL AND METHODS: We reviewed the findings relative to 80 patients (age range 24-75) who came to our observation to the Emergency Department with acute flank pain. All patients had been examined with plain abdominal radiography, US and unenhanced helical CT. RESULTS: While abdominal radiography showed the presence of radiopaque stones in 38 patients only (47.5%), US demonstrated ureter dilatation in 72 patients and detected stones in 36 of them (45%). Helical CT performed best, depicting a stone in 72 patients (90%), with high sensitivity and specificity. Mean stone size was 3 mm, with 7 mm-1 mm range. The biggest stones were seen in 3 cases and the smallest ones in 34. In 8 patients with no signs of stones we found other extraurinary conditions, namely pancreatitis, diverticula, renal cancer. We also found a case of urinary tract infection. CONCLUSIONS: Thanks to its short execution time and accuracy, helical CT makes the examination of choice in patients with acute flank pain due to renal colic. It is also a most valuable tool in the differential diagnosis of other pathological causes of pain such as abdominal or pelvic masses and inflammatory conditions.

Adult↗
PubMed2000

[Radiologic investigation of external rectal prolapse. Assessment in 48 patients with defecography, seven of them also with dynamic CT of the pelvis].

PURPOSE: To report our personal experience in 48 patients with external rectal prolapse examined with defecography, evaluating radiological signs and the indications for surgical treatment. We also report the results of 7 patients with severe prolapse submitted to dynamic CT of pelvis. MATERIAL AND METHODS: The findings relative to 48 patients suffering from external prolapse, 27 women and 21 men, (mean age 58 years), were retrospectively reviewed. In our study protocol the patient is made to sit on a defecographic commode with the pelvis in lateral projection and radiographic images are acquired at rest, on contraction and on evacuation. Dynamic CT of pelvis with axial and coronal scans of the pelvic floor was carried out in 7 patients with severe prolapses. Twenty-six of 48 patients underwent rectopexy. RESULTS: The main symptoms were anorectal and perineal weight sensation (93%), perineal disturbance in the sitting position (91%) and anorectal pain extended to sacral area (83%). Manometry, which was performed in 36 cases, showed a rectoanal inhibitory reflex evokable at high volumes of air, especially in incontinent subjects. Defecography demonstrated external rectal prolapse in all cases; rectal intussusception in 32, mucosal prolapse in 30, abnormal widening of the anorectal angle in 24 (16 of them were incontinent), rectocele in 22 and perineal descent syndrome in 16 cases. DISCUSSION AND CONCLUSIONS: External rectal prolapse is sometimes a dynamic progression of a rectal intussusception. In anorectal intussusceptions, the invaginatum involves the anal canal, thus causing the external prolapse. Defecography clearly shows the continuation of invagination out of the anus, with the formation of prolapse. Dynamic CT proved accurate in detecting the rectum morphology, but added no further information to defecography, except for the diastasis of anosphincterial muscles. Therefore, we conclude that defecography is the method of choice, though complementary to other instrumental techniques such as manometry, electromyography and endoscopy, in the diagnostic workup of these patients. Moreover, it can recognize other alterations, such as incontinence and rectocele, which can be submitted to surgical correction with rectopexy.

Adult↗
PubMed1999

A randomized comparison of trapidil (triazolopyrimidine), a platelet-derived growth factor antagonist, versus aspirin in prevention of angiographic restenosis after coronary artery Palmaz-Schatz stent implantation.

The aim of the study is to assess the safety of trapidil in the setting of coronary stenting and to evaluate its efficacy in reducing angiographic in-stent restenosis. One hundred eighteen patients undergoing Palmaz-Schatz stent implantation were randomly assigned to receive antiplatelet therapy using either aspirin (325 mg/d) or trapidil (400 mg/d), in combination with ticlopidine (500 mg) for the first month. At entry, both groups were comparable with regard to clinical, angiographic, and procedural characteristics. At 6-month angiographic follow-up, >50% restenosis occurred in 15 of 52 lesions (28.8%) of the aspirin group and in 14 of 47 lesions (29.8%) of the trapidil group (P=not significant, NS). At 6-month clinical follow-up, there was no difference in the two groups in the rate of adverse events (2.0% vs. 2.1%, P=NS), medication side effects (4.0% vs. 4.2%, P=NS), and peripheral vascular complications (4.0% vs. 4.2%, P=NS). In conclusion, treatment with trapidil seems to be associated with a similar incidence of stent restenosis and adverse cardiac events as compared to aspirin and could be a valuable alternative to aspirin in the setting of coronary stenting.

Aged↗