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Stefania Romano

Publications and source records attributed to Stefania Romano.

31 records · Page 2Linked to original sources
PubMed2005

Assessment of fetal swallowing with gray-scale and color Doppler sonography.

OBJECTIVE: Our study was focused on the evaluation of fluid dynamics to assess the value of gray-scale and color Doppler sonography for evaluating the development of fetal swallow-related movements from early gestation until birth. MATERIALS AND METHODS: We examined 56 fetuses from weeks 15-39 of gestation. Each fetus was examined throughout four distinct periods of gestation: weeks 15-18, 22-25, 30-34, and 37-39. During the examination, seven gray-scale sonography or color Doppler sonography patterns and their prevalence were considered. RESULTS: Mandibular and/or labial movements (chi2 = 56.4, p < 0.0001) and their rhythmic activity (chi2 = 41.4, p < 0.0001) were seen on gray-scale sonography in an increasing percentage of fetuses as gestational age increased. Doppler findings showed an increase for nose-mouth flow signals (chi2 = 57.6, p < 0.0001), larynx-esophagus flow signals (chi2 = 13.2, p = 0.0003), and effective swallowing (chi2 = 36.0, p < 0.0001) as gestational age increased. CONCLUSION: There is a trend in the fetus toward development of increased coordinated movement and more functional nose-mouth flow with increasing gestational age: 32.1% of the 56 fetuses in our series achieved effective swallowing at 37-39 weeks, on the basis of gray-scale and Doppler evaluations. Knowledge of the physiologic mechanism involving swallowing development may allow identification of altered swallow-related movements in fetuses with malformations of the digestive tract or with neurologic disorders.

Adult↗
PubMed2005

Role of helical CT in diagnosis of gallstone ileus and related conditions.

OBJECTIVE: Small-bowel obstruction from gallstone impaction is a pathological entity frequently observed in elderly patients with a history of cholelithiasis or cholecystitis. Diagnostic imaging plays a great role in the management of patients with suspected gallstone ileus and overall in the correct predictive diagnosis: in the last years, some experiences in radiologic diagnosis of this entity by sonography, abdominal plain film and CT, and occasionally MRI have been reported. Some questions related to gallstone ileus are to be considered: one of them is the possibility of recurrence, which increases the operatory risk in these patients. Recurrence may be due either to the presence of overlooked stones that were already in the bowel at the time of surgery but not identified and not removed or to the migration of other stones in patients not previously cholcystectomized. In cases of acute abdomen, establishing an effective conservative therapy may be a critical point. The aim of this retrospective study was to evaluate the capabilities of helical single-detector and MDCT scanners to allow a correct diagnosis of this disease. CONCLUSION: Helical single-detector and MDCT may improve the diagnosis of gallstone ileus, providing important information regarding the exact number, size, and location of ectopic stones and the site of intestinal obstruction or direct visualization of a biliary-enteric fistula, to help clinicians in the therapeutic management of patients.

Aged↗
PubMed2004

The relevance of free fluid between intestinal loops detected by sonography in the clinical assessment of small bowel obstruction in adults.

INTRODUCTION: The main role of the radiologist in the management of patients with suspicion of small bowel obstruction is to help triage patients into those that need immediate surgical intervention from those that require medical therapy or delayed surgery. Ultrasound examination is usually considered not helpful in bowel obstruction because of air in the intestinal lumen that interferes the evaluation of the intestinal loops, however recently some Authors attested the increasing important role of sonography in the acute abdominal disease. Aim of our report is to demonstrate the value of free fluid detected by US in differentiating between low and high-grade small bowel obstruction. MATERIALS AND METHODS: The study is based on 742 consecutive patients who presented symptoms of the acute abdomen; all patients had undergone initial serial abdominal plain film and US examinations prior to any medical intervention. We reviewed the imaging findings of 150 cases in whom small bowel obstruction was clinically suspected and confirmed at surgery. We consider the following radiographic and US findings: dilatation of small bowel loops; bowel wall thickness; presence of air-fluid levels; thickness of valvulae conniventes; evidence of peristalsis; presence and echogenicity of extraluminal fluid. We looked at the value of extraluminal peritoneal fluid at US examination in differentiating low and high-grade small bowel obstruction based on the surgical outcome. RESULTS: In 46 patients altered peristaltic activity, thin bowel walls, fluid filled loops with hyperechoic spots in the bowel segment proximal to obstruction were noted at US, whereas radiographic features were: moderate dilatation of small bowel loops, with thin bowel wall and evidence of numerous and subtle valvulae conniventes; presence of air-fluid levels was also noted. In 70 other patients, US examination revealed all the findings described in the precedent cases and also the presence of free extraluminal fluid; abdominal plain film showed an increased dilatation of small bowel loops with moderate thickened wall and air-fluid levels. In 34 other patients US examination revealed the presence of thick-walled loops, hypoperistalsis and a larger amount of free extraluminal fluid. Radiographic findings in these patients were: horizontal featured and markedly dilated small bowel loops presenting parietal thickness, presence of intraluminal fluid stasis and evidence of thickened, sparse and incomplete valvulae conniventes. At surgery etiology of small bowel obstructions was various, but most of cases related to adhesions (70 cases). The presence of extraluminal fluid were confirmed at surgery in 104 patients. CONCLUSIONS: Our experience using sonography in suspicion of SBO (small bowel obstruction) suggests the usefulness of this imaging modality to differentiate a functional or obstructive ileus, demonstrating the evidence of intestinal peristalsis. Furthermore, the presence of a large amount of fluid between dilated small bowel loops suggests worsening mechanical small bowel obstruction, that requires not a medical therapy but immediate surgery.

Abdomen, Acute↗
PubMed2004

Helical CT diagnosis of small bowel obstruction in the acute clinical setting.

Definite confirmation or exclusion closed loop obstruction (CLO) is one of the most difficult tasks the radiologist has to face in the clinical practice. Aim of this retrospective work was to study the value of spiral computed tomography (CT) in the diagnosis of closed loop obstruction complicated by intestinal ischemia. The state of the art CT signs of closed loop obstruction were taken into consideration. Serrated beaks with poor or no contrast enhancement of the bowel walls, ascites or engorgement of the mesenteric vasculature allowed the CT diagnosis of CLO complicated by ischaemia. U or C-sharped of dilated loops, radial distribution of the mesenteric vessels, beaks and whirls suggested CLO, but did not help differentiate CLO from strangulation. CLO is a dynamic entity which may regress or need laparotomy depending on the time and degree of rotation of the incarcerated loops. CT is a reliable imaging modality able to differentiate CLO from strangulation, which is rarely simple and obvious. Detection of ischemic changes in the bowel walls and/or attached mesentery on CT scans imply strangulation highlighting the need for laparotomy; if only signs of CLO are detected, the existence and/or development of strangulation cannot be predicted.

Acute Disease↗
PubMed2004

Gastro-duodenal perforations: conventional plain film, US and CT findings in 166 consecutive patients.

INTRODUCTION: Gastro-duodenal perforations may be suspected in patients with history of ulceration, who present with acute pain and abdominal wall rigidity, but radiological findings in these cases may be unable to confirm a clinical diagnosis. The aim of our study was to report our experience in the diagnosis of gastro-duodenal perforation by conventional radiography, US and CT examinations. MATERIAL AND METHODS: We retrospectively reviewed medical records of 166 consecutive patients who presented in the last 2 years to our institutions with symptoms of acute abdomen and submitted to surgery at the Emergency Unit of the "A.Cardarelli" Hospital of Naples with a surgical finding of perforated gastro-duodenal ulcer. The evidence of free intraperitoneal air on abdominal plain film was considered as a direct or suggestive finding of perforation. Evidence of intraperitoneal free fluid and/or reduced intestinal peristalsis at sonographic examination were considered indirect signs of gastro-duodenal perforation. Evidence of free peritoneal gas at CT was considered as a direct evidence of gastro-duodenal perforation. RESULTS: Twenty patients underwent immediate surgery with no preoperative imaging evaluation, in 10 of them the site of perforation was found in a juxta-pyloric region and in the others at level of duodenum. In 146 patients submitted to serial radiological investigations before surgery, the site of perforation was in 56 (38.3%) duodenal, in 52 (35.6%) juxta-pyloric, in 28 (19.1%) gastric and in 10 (6.8%) pyloric. The cause of perforation was in all cases gastric or duodenal ulceration, in seven cases involving pancreatic parenchyma. In 110 (75.4%) patients with direct findings of perforation, in 94 cases (85.5%) the correct diagnosis was established on abdominal plain film, in two (1.8%) with radiographic and sonographic examinations and in 14 (12.7%) on CT findings. In 36 (24,6%) patients with no direct findings of perforation, only 24 (16,4%) of them showed indirect findings of perforation. In other 12 patients no direct or indirect finding of free peritoneal air was detected. CONCLUSIONS: Our experience documents that in 146 gastroduodenal perforations the free peritoneal air was not evident in 12 cases and in 66% of these patients the presence of intraperitoneal fluid could be the only sign of perforation. If free peritoneal air was detected with conventional radiography, other investigations were not indicated. In the absence of direct or indirect findings of pneumoperitoneum, US examination could help to confirm intestinal paresis and the evidence of intraperitoneal free fluid. Helical CT examination was useless before at least 6h from the onset of symptomatology, because in the absence of direct or indirect findings of penumoperitoneum at abdominal plain film and sonograpy, CT could not demonstrate any additional diagnostic information.

Abdomen, Acute↗
PubMed2004

Association of splenic and renal infarctions in acute abdominal emergencies.

INTRODUCTION: Splenic and renal infarctions are usually related to vascular disease or haematologic abnormalities. Their association is infrequent and rarely observed in trauma. In this study, we analyze our data to look at the occurrence of renal and splenic infarctions based on CT findings in a period of 4 years. MATERIALS AND METHODS: We retrospectively reviewed the imaging findings of 84 patients admitted to our Department of Diagnostic Imaging from June 1998 to December 2002, who underwent emergency abdominal spiral CT examination and in whom there was evidence of splenic and/or renal infarction. RESULTS: We found 40 cases of splenic infarction and 54 cases of renal infarction, associated in 10 patients. In 26 patients, there was also evidence of intestinal infarction. A traumatic origin was found in 19 cases; non-traumatic causes were found in 65 patients. Association between renal and splenic infarction in the same patient was related to trauma in two cases. CONCLUSIONS: Although renal and splenic infarctions are a common manifestation of cardiac thromboembolism, other systemic pathologies, infections or trauma may lead to this occurrence. Renal infarction may be clinically and/or surgically managed with success in most cases. There are potential complications in splenic infarction, such as development of pseudocysts, abscesses, hemorrhage, subcapsular haematoma or splenic rupture; splenectomy in these cases may be necessary. Some patients with splenic and/or renal infarction may be clinically asymptomatic. The high accuracy of CT examination is needed to allow a correct evaluation of infarcted organs.

Abdomen, Acute↗
PubMed2004

Hepatic trauma: CT findings and considerations based on our experience in emergency diagnostic imaging.

Abdominal blunt trauma represents the main cause of death in people of age less than 40 years; the liver injury occurs frequently, with an incidence varying from 3 to 10%. Isolated hepatic lesions are rare and in 77-90% of cases, lesions of other organs and viscera are involved. Right hepatic lobe is a frequent site of injury, because it is the more voluminous portion of liver parenchyma; posterior superior hepatic segments are proximal to fixed anatomical structures such as ribs and spine that may have an important role in determining of the lesion. The coronal ligaments' insertion in this parenchymal region augments the effect of acceleration-deceleration mechanism. Associated lesions usually are homolateral costal fractures, laceration or contusion of the inferior right pulmonary lobe, haemothorax, pneumothorax, renal and/or adrenal lesions. Traumatic lesions of left hepatic lobe are rare and usually associated with direct impact on the superior abdomen, such as in car-crash when the wheel causes a compressive effect on thorax and abdomen. Associated lesions to left hepatic lobe injuries correlated to this mechanism are: sternal fractures, pancreatic, myocardial, gastrointestinal tract injuries. Lesions of the caudal lobe are extremely rare, usually not isolated and noted with other large parenchymal lesions. The Institution of Specialized Trauma Centers and the technical progress in imaging methodology developed in the last years a great reduction of mortality. New diagnostic methodologies allow a reduction of negatives laparotomies and allow the possibility of conservative treatment of numerous traumatic lesions; however, therapy depends from imaging findings and clinical conditions of the patient. Computed tomography (CT) certainly presents a large impact on diagnosis and management of patients with lesions from blunt abdominal traumas. It is important to establish a prognostic criteria allowing decisions for conservative or surgical treatment; CT findings and peritoneal fluid evaluation may be used to make a first differentiation of severity of lesions, but haemodynamic parameters may help the clinician to prefer a conservative treatment. In emergency based hospitals and also in our experience, positive benefits spring from diagnostic accuracy and consequent correct therapeutic management.

Emergency Medical Services↗
PubMed2004

Natural in vitro fertilization cycles.

Although the first in vitro fertilization (IVF) baby was born after a natural IVF cycle, very soon this procedure was almost abandoned mainly because of the very high cancellation rates, and controlled pharmacological ovarian hyperstimulation became the standard treatment in IVF cycles of normoresponder patients. However, in poor-responder patients, where only very few follicles can be recruited and very few oocytes, if any, can be retrieved after controlled ovarian hyperstimulation, natural IVF cycles may offer a comparable number of follicles, reduced costs, and less discomfort for the patients. In this group of patients, natural IVF cycle is a cost-effective approach.

Cost-Benefit Analysis↗
PubMed2004

Comparison between the site of multislice CT signs of gastrointestinal perforation and the site of perforation detected at surgery in forty perforated patients.

PURPOSE: To compare the site of multislice spiral computed tomography (MSCT) signs of gastrointestinal perforation and the site of perforation at surgery in forty perforated patients. MATERIALS AND METHODS: Between January 1 and July 31, 2003, a total of 40 patients (23 men and 17 women) underwent surgery for gastrointestinal perforation. In all cases, plain radiography of the abdomen was integrated by MSCT with the following parameters: 0.5 seconds gantry rotation time, 2.5-5.0 mm slice thickness, 3.75 reconstruction interval, 120 kV, 250-300 mAs, pitch 1.5, after intravenous administration of 140 ml of contrast agent at 3 ml/s with an automatic injector and a delay time of 70 seconds from the injection of the contrast agent. The MSCT findings were: free air and free fluid observed in supramesocolic compartments and/or in inframesocolic compartments and bowel wall discontinuity. The sites of the MSCT findings were compared with the site of perforation observed at surgery. RESULTS: Free air was detected in 60%, free intraperitoneal fluid in 92.5%, and a combination of both findings in 57.5% of the 40 cases examined. There were no cases of bowel wall discontinuity. In nine patients with gastroduodenal perforation, free air and free fluid were detected in combination and free air was localised in supramesocolic compartments in all cases; in two patients with jejunal perforation, free intraperitoneal fluid was observed both in supramesocolic and inframesocolic compartments; in six patients with acute perforated appendicitis, free air was never detected, while free fluid was observed in all cases in inframesocolic compartments; in six patients with isolated sigmoid perforation free air was observed in four cases in supramesocolic compartments while free fluid was seen in both supramesocolic and inframesocolic compartments. CONCLUSIONS: MSTC is the most reliable diagnostic method with which to assess gastrointestinal perforation as it allows detection of even small amounts of free air in the abdomen, which are a sign of perforation. In our study, the comparison of the sites of MSCT signs of perforation with those observed at surgery showed that in gastroduodenal perforations free air and free fluid are present in combination and free air is localised in supramesocolic compartments; in acute perforated appendicitis free air is absent, while free fluid is present in inframesocolic compartments; in isolated sigmoid perforations free air, if present, is localised in supramesocolic compartments, while free fluid is seen in both compartments.

Adolescent↗
PubMed2003

The use of MRCP in the detection of pancreatic injuries after blunt trauma.

From January 2000 to November 2001, five consecutive, hemodynamically stable trauma patients (age range 8-69 years, mean age 34 years) with parenchymal injuries were evaluated by magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP). One patient also underwent a MRCP-facilitated secretin test. MRI depicted pancreatic laceration in two patients, ductal disruption and a post-traumatic intraparenchymal pseudocyst in one, migrating pancreatic fluid collection in the mediastinal space with disruption in another, and main pancreatic duct rupture and dilatation in the patient evaluated with MRCP following secretin administration. MRI with MRCP is an effective noninvasive test for detecting and managing pancreatic injuries after blunt trauma. Secretin administration improves ductal visualization, particularly of nondilated ducts. Finally, MRI was useful in the follow-up studies of parenchymal damage and minor ductal injuries, providing high-quality images of the pancreatic duct and biliary tract.

Journal Article↗
PubMedDate not supplied

Unusual feature of jejunal leiomyosarcoma studied with US and CT-enteroclysis: a case report.

Leiomyosarcoma is a mesodermal malignant neoplasm affecting the small intestine. Usually, the clinical signs are not specific and most commonly related to intestinal bleeding or obstruction. We report the case of a 71-year-old woman presenting anemia and melena: there was no evidence of abdominal palpable mass and endoscopic examinations were negative for pathologic findings. We performed sonography and CT-enterclysis. We detected a small jejunal mass presenting a heterogeneous density and echogenicity pattern, with some large peripheral calcifications. Histologic examination after surgery revealed the lesion to be a small bowel leiomyosarcoma.

Aged↗