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S Urso

Publications and source records attributed to S Urso.

At least 19 recordsLinked to original sources
PubMed2004

Cardiovascular risk markers in hemodialysis patients.

Cardiovascular events are the main cause of death in hemodialysis patients. Nevertheless, acute myocardial infarction may be misdiagnosed in uremic patients, because typical markers have a high rate of false positivity. A recent two-year prospective study showed that predialytic high serum concentrations of troponin T and CK-MB mass were associated with high mortality, cardiac mortality, myocardial infarction and unstable angina (MACEs). We studied 16 uremic patients (13 M; 3 W) on standard HD and 6 patients (4 M; 2 W) on on-line HDF, who had been taking folic acid for at least three months. Patients who suffered from acute or chronic cardiac ischemic disease were excluded. Anthropometric parameters, pre and post-dialytic pH, HCO3 and electrolytes did not differ between the two groups. Kt/V and URR% were lower in conventional HD vs on-line HDF (p < 0.04; p < 0.04). ORR% was strongly elevated in on-line HDF compared with HD (p < 0.005). In conventional HD, ORR% was directly correlated with Kt/V and URR% (r = 0.49, p < 0.04; r = 0.48, p < 0.04, respectively). Even in on-line HDF ORR% was directly correlated with Kt/V and URR% (r = 0.79, p < 0.04; r = 0.76, p < 0.05, respectively). Troponin I and CK-MB mass were not significantly different in pre vs post-dialysis, both in standard HD and on-line HDF. Nevertheless, in standard HD postdialytic troponin I correlated with serum sodium concentration (r = 0.93, p < 0.000), potassium (r = 0.67, p < 0.004) and serum chlorine (r = 0.92, p < 0.92, p < 0.000). CK-MB mass showed a correlation with serum chlorine (r = 0.49, p < 0.05). Postdialytic CK-MB mass correlated with serum potassium in on-line HDF (r = 0.83, p < 0.03). Our data suggest that hemodialytic treatments, both standard HD and on-line HDF, do not modify serum troponin I and CK-MB mass. Consequently, we can use these parameters for the diagnostic approach in acute or chronic ischemic heart disease in hemodialysis patients.

Aged↗
PubMed1997

Predisposing factors in degenerative spondylolisthesis. A radiographic and CT study.

We report a prospective study analysing whether possible factors predisposing to degenerative spondylolisthesis (DS) must be present concomitantly in order to cause vertebral slipping. Standard and flexion-extension radiographs were obtained from 27 patients with DS and 27 without spondylolisthesis. The level of the intercrestal line, the lumbosacral angle, the presence of sacralization of L5 and vertebral motion at the L4-L5 level were assessed. Facet joint orientations were measured on CT scans. Only facet joint orientation and vertebral motion at the spondylolisthetic level were significantly different in patients with DS compared with controls. Facet joints were oriented more sagittally both at the spondylolisthetic level and at the levels above and below. An inverse linear correlation was found between the sagittal orientation of facet joints and the mobility of the slipped vertebra. Abnormal sagittal orientation of facet joints and hypermobility of the spondylolisthetic vertebra appear to play major roles among possible factors predisposing to DS. Both factors should be considered in the planning of surgical treatment.

Aged↗
PubMed1996

[Clinico-radiologic correlations in common neck pain].

Patients with spontaneous neck pain, headache, dizziness and/or pain to the upper limbs are frequently observed. Common cervicodynia, due to the involvement of arthromuscular structures of the cervical spine, was diagnosed in the patients with these symptoms in the absence of trauma or neurologic signs. The authors investigated the clinical-radiologic correlation in a series of 130 symptomatic patients and considered it a metameric disorder. The frequent association of many radiographic signs at the same level often prevents single radiographic signs from being assessed individually; therefore, the authors selected some patients with just one radiographic change per functional unit, to assess its relationship with clinical symptoms. The patients underwent anteroposterior, lateral and functional (flexion-extension) radiographs of the cervical spine. Vertebral rotation, detected on antero-posterior views as a spinous process deviation, was the most frequent isolated sign (79/130 cases) per metameric level, with strong clinical correlation (70/79 cases). Vertebral rotation was probably due to unilateral muscular stiffness. Other single radiologic signs per functional unit with strong clinical correlation follow: atloaxial rotation (13/130 with clinical-radiologic agreement of 12/13), functional blockage (13/130 with clinical-radiologic agreement of 11/13), angular flexion (21/130 with clinical-radiologic agreement of 19/21) and overall disc space thinning (12/130 with clinical-radiologic agreement of 10/12). Atloaxial rotation is represented as an asymmetry of the spaces between the odontoid and the lateral masses of the atlas; functional blockage consists of insufficient or lacking physiological width of the occipito-atlantoid or interspinous space in functional tests. Angular flexion consists of a single flexion angle of the cervical spine in functional tests; two or more angles indicate normal flexion of the cervical spine. This study confirmed the poorer clinical impact of degenerative changes, mostly interapophyseal arthrosis, than of other radiologic signs. Interapophyseal arthrosis alone was isolated in single functional units in 46/130 patients, mostly at C7-D1, with clinical-radiologic agreement in 19/46 patients. Clinical-radiologic correlation proved the high diagnostic value of anteroposterior, lateral and functional radiographs of the cervical spine in common cervicodynia, which make them a valuable tool for the clinician.

Adolescent↗
PubMed1995

[Nonspecific osteomyelitis in childhood and adolescence. The contribution of imaging diagnosis].

Nonspecific osteomyelitis in children and adolescents can be diagnosed in patients 2 to 16 years old and may present as acute, subacute or chronic. During the last 9 years, 40 pediatric patients (aged 2 to 16 years) affected with extra-axial inflammatory bone lesions were examined. The series of cases was then reviewed. This work was aimed at investigating the role of various imaging modalities: conventional radiology (CR), bone scan with technetium-99 methylene diphosphonate (99mTc-MDP), scintigraphy with technetium-esamethylpropylenaminoxima labelled leukocytes (99mTc-HMPAO), computed tomography (CT) and magnetic resonance imaging (MRI) were used to detect the lesions, to make a differential diagnosis and to assess different disease stages. As for acute osteomyelitis (6 patients), CR showed a lytic lesion, periosteal new bone and soft tissue swelling in 4/6 patients; no abnormalities were demonstrated in the other two. Bone scan, CT and MRI depicted bone involvement. CT and MRI also showed inflammatory lesion spread to surrounding soft tissue. 99mTc-HMPAO scintigraphy was not performed in acute osteomyelitis, because of technical difficulties in performing the exam promptly; thus, the early diagnosis of lesion nature was made with bone biopsy. As for subacute osteomyelitis (23 patients), 99mTc-HMPAO scintigraphy was performed in 8/23 patients and proved to be a highly sensitive method, showing cell clusters and confirming the diagnosis of inflammatory lesion. MRI showed a focal area of intermediate-low signal intensity on T1-weighted sequences, with small focal intralesional areas of low intensity, a low-signal perifocal rim and diffusely low signal of surrounding bone marrow. T2-weighted images showed high signal intensity in both the abscess lesion and bone marrow, the latter probably due to edema. In 5 patients, a paramagnetic contrast agent (Gd-DTPA) was administered during MRI and showed inhomogeneous enhancement of both the inflammatory lesion and surrounding bone marrow. As for chronic osteomyelitis (7 patients), MRI was performed in 5/7 patients. In 4 patients the lesion appeared as a low-signal area on T1-weighted images while T2-weighted images showed an inhomogeneous high-signal area. In the same patients, 99mTc-HMPAO scintigraphy was always positive. In patient 5, the lesion was represented by a low-signal area on both T1 and T2-weighted images, while 99mTc-HMPAO was negative. Therefore, in chronic osteomyelitis, both MRI and 99mTc-HMPAO were useful in detecting both spinal and peripheral bone involvement, which was in some cases asymptomatic at first observation CR, CT (3/4) and MR (4/4) findings extra-axial localizations were similar to those in subacute-chronic forms.

Acute Disease↗
PubMed1994

[Static-dynamic computerized tomography in the diagnosis of traumatic lesions of alar ligaments. Preliminary results].

The patients affected with cervical injuries often complain of cervical pain, headache and dizziness even when no bone fractures are detected. Such patients are likely to have a post-traumatic injury of the cervical ligaments. Twenty-five symptomatic patients (19 women and 6 men) were examined with upper spine CT and functional CT scans (right and left rotation) to detect ligament injuries and hypermotility of the craniocervical junction, both related to traumatic events. Eleven patients showed no alterations, while unilateral densitometric alterations of the alar ligaments were observed in 14 cases and thought to be related to trauma. On axial CT scans, the normal alar ligaments were identified as paramedian, quadrangular soft-tissue structures at the apex of the dens epistrophei and right above it. In 14 patients with alar ligament injuries, CT showed incomplete ligament interruption and thinning in 12 cases and its total absence on all images in 2 cases. The laterodental space in the affected side was hypodense due to fat tissue replacement. Of 14 patients with alar ligament injuries, only 14 patients with alar ligament injuries, only 4 exhibited rotatory hypermotility at C0-C1 and C1-C2. The low frequency of rotatory hypermotility is probably due to the high rate of incomplete alar ligament injuries as well as to cervical muscle stiffness, which is marked in some subjects. In conclusion, static and functional CT of the upper spine is not only useful to predict trauma outcome, but also allows the detection of the alar ligaments, of their morphodensitometric changes and of the segmental instability of the craniocervical junction.

Adolescent↗
PubMed1993

[Radiographic examination of the pelvis in patients under periodic hemodialysis for terminal uremia].

Significant signs of uremic osteodystrophy were found at Rx examination of the pelvis in 29 out of 72 uremic patients (40%) undergoing maintenance hemodialysis. It is therefore thought that Rx of the pelvis, although it is more significant for some signs (brown tumors, alterations of the trabecular structure, enlargement of Ward's triangle) than for others, such as subperiosteal resorption, should not be neglected in these patients.

Adolescent↗
PubMed1989

[The incidence of postural headache in in- and outpatients following lumbar myelography (needles of different gauges and headache)].

The incidence is reported of postural headache and other types of headache arisen after myelography in a pilot sample of 540 patients, divided into 3 groups. The myelographic study was performed on the first two groups using 20 and 22 gauge needles, and with 25 gauge needles on the third group. 140 patients in the third group were treated on an outpatient basis, and 25 of them underwent myelo-CT. Myelography was performed on all the patients in the second and third group in erect position. In the authors' opinion, the erect position and the use of a fine needle determined a considerable reduction in post-myelographic side effects, i.e. postural headache.

Adolescent↗
PubMed1987

Calcifying discopathy in infancy in the cervical spine: evaluation of vertebral alterations over a period of time.

Calcifying discopathy in infancy involving in the cervical spine has already been observed and described by many authors, as a well-defined clinico-radiological syndrome with a benign course. The clinical picture is composed of: pain and functional limitation, sometimes with a stiff neck, more rarely slight fever, increase of the erythrocyte sedimentation rate or leukocytosis. The radiographic picture consists of the association of morphological and structural alterations of vertebral bodies adjacent to one or more disc calcifications usually centrally sited, sometimes associated with anterior or posterior herniations. On the basis of the observation of 7 patients of up to 15 years of age, the authors propose to evaluate the changes of both the vertebral bodies and the discs involved in the disease over a period of time. The repetition of even modest alterations, that persist in time, testify to the involvement of the vertebral growth perhaps, more than the discal alterations connected with the calcification.

Calcinosis↗
PubMed1987

Radiological study of bone changes in the foot in chronic renal insufficiency.

The authors report the results of a radiological evaluation of the foot in 18 patients affected with chronic renal insufficiency (CRI). After discussing the bone changes considered to be "typical" of renal osteodystrophy, they analyse the trabecular system, in which they distinguish three degrees of change. If these finer changes are taken into account a high incidence of bony alteration is observed in CRI (84%). The biomechanics and static stresses of the foot are discussed, based on the presupposition that the anatomofunctional features of this part of the skeletal system could influence the grade and progression of the bony alterations. However, no such association was observed, nor was there any correlation between the radiographic changes and the clinical symptomatology.

Adolescent↗
PubMed1986

The radiological diagnosis of spinal stenosis in the lumbar canal.

Based on a study of 132 patients suffering from lumbar spinal stenosis, the authors propose a simple classification aimed at providing the surgeon with the maximum essential information on which to plan surgery. This is based on an analysis of standard radiographic and radiculographic findings, and stresses the importance of diagnosing the correct type and level of the stenosis. Certain physiopathological aspects of the subarachnoid space which have a bearing on the use of contrast radiography are also discussed.

Female↗
PubMed1982

Lumbosacral nerve-root anomalies.

Forty-six cases of anomalous lumbosacral nerve roots were found in a series of 2123 patients who underwent myelography with water-soluble contrast medium. The anomalies were classified into five types. In Types I and II, one or more nerve roots emerged from the theca at a more cranial (Type I) or caudal (Type II) level than normal. In Type III, two or more roots emerged through closely adjacent openings in the dura, whereas in Type IV two nerve roots emerged from the dural sac combined as one nerve trunk. In Type V, two roots were connected by an anastomotic branch shortly after their emergence from the dura. The anomalies were usually unilateral and the fifth lumbar and first sacral-nerve roots were the most frequently involved. Type-III and Type-IV anomalies were the most common (69 per cent). Twenty-one per cent of the patients had lumbosacral anomalies and one had congenital absence of the articular facets of the lumbosacral joint on the side of the nerve-root anomaly. In seven patients the anomalous root or roots were compressed by a herniated disc, and the roots were entrapped in a lateral recess or intervertebral foramen in two. Symptoms and signs of nerve-root compression were usually severe, even in the patients with a small disc protrusion. The severity of the clinical findings appeared to be due to the reduced mobility of the anomalous roots. Adequate surgical decompression led to satisfactory final results in all nine patients.

Adult↗
PubMed1981

Lumbosacral intradural tumours simulating disc disease.

Twelve patients with symptoms and signs simulating lumbar disc disease were found to have intradural tumours in the lumbosacral area. Of the nine patients with a neurofibroma, two had previously had a laminectomy for an erroneous diagnosis of disc herniation and one had three separate tumours which were excised in two successive operations. One of the three patients with an ependymoma had a coccygectomy before the correct diagnosis was made. Only one patient who had an ependymoma showed radiographic abnormalities suggesting a neoplastic lesion, but eight of the ten cases in which the cerebrospinal fluid was analyzed had a protein content of 50 mg per 100 ml. Myelography provided the correct diagnosis in all cases. Excision of the tumour resulted in full clinical recovery except for one patient with an ependymoma.

Adult↗
PubMed1979

Lumbo-sacral radiculography with a new, water-soluble contrast medium: myelografin (meglumine ioserinate, SSH 239 AB).

The authors present the results of a clinical trial of a new water-soluble contrast medium for radiculography: meglumine ioserinate. This trial was conducted on eighty eight patients in the Orthopaedic Clinic of the University of Rome between 1975 and 1976. The patients were subdivided into two groups, one of fifty four in whom a single dose of 5 ml was injected, the other of thirty four who received a double dose of 10 ml of contrast medium. In the latter the medium was always injected undiluted. No disturbances following radiculography were reported by 58 per cent of the first group and 44 per cent of the second. The clinical side-effects encountered in the other patients are analysed. These side-effects were negligible in the majority of cases, and occurred less frequently than with meglumine iothalamate, and at least more often than with meglumine iocarmate. Finally, the findings in the cerebrospinal fluid are described, before and twenty four hours after the test, in a small group of these patients. The contrast and diffusibility were found to be excellent, as also was the tolerance, which has the advantage that the patient can be kept in the horizontal position after the examination. Despite this, because of some changes encountered in the cerebrospinal fluid, and because of a convulsive episode presented by one patient treated with the double dose, the authors advise diluting the contrast medium in distilled water, so as to lower the osmotic pressure.

Adolescent↗
PubMed1977

Vertebral compression syndrome in multiple exostoses (case report).

The authors present a case, the second in the world literature, of Spinal Compression Syndrome in Multiple Exostoses. The diagnosis, not revealed on standard radiographs of the vertebral column, was suspected on radiculography and confirmed only by oblique stratigraphic projection. These demonstrated bone formation on the right vertebral lamina of L4 encroaching considerably on the spinal canal. Surgical laminectomy was followed by complete remission of neurological symptoms.

Child↗
PubMedDate not supplied

[Cardiovascular risk markers in hemodialysis].

PURPOSE: Although maintenance dialysis prevents death from uremia, patient survival remains an important issue. Cardiovascular (CV) events have been considered the main cause of death in hemodialysis (HD) patients. Some authors demonstrated an expected remaining life span of < or =2 yrs in HD patients who had a myocardial infarction. Therefore, it is very important to appraise risk factors and to adopt the correct diagnostic approach to match therapy. Nevertheless, acute myocardial infarction can be misdiagnosed in uremic patients, because typical markers have high false positivity rates. It has been estimated, for example, that 29% of HD patients have elevated serum troponin T concentrations, but do not have evidence of myocardial injury. Troponin T is more frequently elevated than troponin I among asymptomatic patients with renal insufficiency and this could be due to the relatively higher levels of an unbound cytosolic pool of troponin T and its higher molecular weight. Neither the common cardiac markers (LDH, LDH 1, CPK, CK-MB) are sensitive or specific as in the general population, but a recent 2-yr observational study showed that pre-dialytic high serum concentrations of troponin T and CK-MB mass were associated with complete mortality, cardiac mortality, myocardial infarction and unstable angina (MACEs). In our study, we evaluated how dialysis influenced serum troponin I and CK-MB mass, and then we assessed serum homocysteine (Hcy), an additional CV risk factor in uremic patients. METHODS: We studied 17 uremic patients (13 males, four females) on standard HD and six patients (four males, two females) on on-line hemodiafiltration (HDF), who were taking folic acid for at least 3 months. Patients who suffered from acute or chronic cardiac ischemic disease were excluded. We performed arterial gas-analysis, Na+, K+, Ca++, Mg++, Cl-, P, serum albumin, creatinine (Cr), urea, total homocysteine (tHcy), red blood count (RBC), troponin I and CK-MB mass, both pre and post-dialysis. We assessed urea reduction rate percentage (URR%), Kt/V, Hcy percentage reduction ratio (ORR%), and anthropometric parameters. RESULTS: Anthropometric parameters, pre- and post-dialytic pH, HCO3 and electrolytes did not differ between the two groups, Kt/V and URR%. Even in on-line HDF, ORR% directly correlated with KtV and URR% (r=0.79, p<0.04; r=0.76, p<0.05, respectively). Troponin I and CK-MB mass were not significantly different in pre- vs post-dialysis, both on standard HD and on-line HDF. Nevertheless, in standard HD, post-dialytic troponin I correlated with serum sodium concentration (r=0.93, p<0.000), potassium (r=0.67, p<0.004) and serum chlorine (r=0.92, p<0.92, p<0.000). CK-MB mass showed a correlation with serum chlorine (r=0.49, p<0.05). Post-dialytic CK-MB mass correlated with serum potassium for on-line HDF (r=0.83, p<0.03). CONCLUSIONS: Our study suggests the probability that dialytic adequacy improves CV outcome causing a reduction in the concentration of homocysteinemia and it demonstrates that convective treatments (on-line HDF) are best in reaching this end-point. Our data suggests that hemodialytic treatments, both standard HD and on-line HDF did not modify serum troponin I and CK-MB mass. We can use these parameters as a diagnostic approach in acute or chronic cardiac ischemic disease in HD patients, because they are not influenced by the hemodialytic procedure. This allows the selection of high risk patients, and offers them on-line treatment as the best suitable therapeutic option.

Aged↗
PubMedDate not supplied

[Risk of arrhythmias in hemodialysis patients vs healthy people].

PURPOSE: Hemodialysis (HD) patients present an elevated risk of ventricular arrhythmias and sudden death. This risk is correlated with QTc dispersion, assessed as the difference between maximum and minimum QT recorded on 12 leads. Our study aimed to estimate the difference between QT, QTc, QT dispersion and QTc in HD patients on standard HD and online hemodiafiltration (HDF) in pre- and post-dialysis vs. normal controls. METHODS: Nineteen uremic patients on standard HD (13 males, six females) and nine patients (six males, three females) treated with on-line HDF were studied. Seven normal subjects were the control group, matched for age and sex. No one was taking drugs that could interfere with electrocardiographic morphology and QT value. Basal anthropometric parameters were taken and simultaneous 12-lead electrocardiograms (ECGs) were recorded before and 30 min after HD. Serum concentration of creatinine (Cr), urea and electrolytes (Na, K, Mg, Ca, Pi) were monitored before and 30 min after HD, in the short interval section. QT interval was measured according to the Bazett formula, in the presence of different heart rates: QTc=QT/RR(0.5) (heart rate corrected QT interval). RESULTS: Anthropometric parameters were similar among the groups. Before dialysis, standard HD patients had lower calcium and higher potassium than the controls (Student's t-test): (p<0.01, p<0.004). ECGs in the two groups did not show essential differences. After dialysis calcium was higher and magnesium lower in HD patients than in controls: (p<0.0006, p<0.000); QT and QTc dispersion was higher in HD patients than in controls: (p<0.01, p<0.04). Before dialysis on-line HDF patients had lower magnesium (p<0.01) than controls; while there were no electrocardiographic differences between them. In the post-dialytic phase, calcium was higher and phosphates, magnesium and potassium were lower than in controls: (p<0.001, p<0.01, p<0.002, p<0.01); QT and QTc dispersion was higher in HD patients (p<0.03, ns). Controls did not demonstrate any correlation between electrolyte and electrocardiographic parameters; while QTc dispersion and phosphates positively and directly correlated in uremic standard HD patients after dialysis (r=0.48, p<0.02), and then QTc dispersion correlated negatively to Ca/P ratio (r=-0.63, p<0.003).

Aged↗
PubMedDate not supplied

[From the bad to the worse].

A sixty-five year old man, who had the left kidney removed for neoplasm, was admitted to evaluate a renal mass on the right side. Ultrasonography and TC scan were suggestive of neoplasm. A lower pole kidney ablation was made, otherwise a radical nephrectomy would have forced him into chronic dialysis. One month later the patient complained of a gross hematuria and asthenia. A new ultrasonography examination was made and was very helpful to get the right diagnosis.

Aged↗