Biomedical subjects
Publications and source records attributed to A Rotondo.
A 20-year-old man with massive ileal enterolithiasis was investigated with plain radiography, ultrasound, computed tomography, barium follow through and double contrast barium enema. Ileocecal valve agenesis was found at surgery. The enteroliths were located in the distal ileum, which communicated with the large intestine via an ileotransverse fistula.
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MR studies of chondral injuries of the knee are performed to obtain a high C/N ratio between the articular cartilage and such other structures as subchondral bone, intraarticular fat pad and synovial fluid. This goal has been achieved with the 3D SPGR fat-suppressed technique. This kind of sequence yields high spatial contrast resolution because of its contiguous thin (1.5 mm) slices and high contrast resolution between the hyaline cartilage, which is strongly hyperintense, and the surrounding structures (fat, synovial fluid, subchondral bone) which appear hypointense. From September, 1994, to February, 1995, we submitted to MRI 34 patients, adding the 3D fat-suppressed technique after the routine sequences. These volumetric sections were obtained to image the tibiofemoral joint cartilage in 15 patients and to study the patellofemoral compartment in 19 patients. Chondral injuries were graded according to Beguin and Locker classification and MR results were compared with arthroscopic findings. 3D SPGR fat-suppressed sequences permitted accurate chondral thickness evaluation and the depiction of cartilage injuries, especially in advanced injuries (stages 3 and 4). However, in earlier stages, this MR technique tends to overestimate globular hypointense areas in normal thickness cartilage. This MR pattern needs a close correlation with clinical findings and should be interpreted according to the presence/absence of other associated intraarticular injuries.
Our study was aimed at measuring hemodynamic changes in liver perfusion in patients with HCC and hepatic metastases using color Doppler US, a noninvasive investigation technique. Eighty-seven patients were examined: 14 of them had HCC and 34 had metastases; the control group consisted of 39 people. Blood flow was measured in the common hepatic artery and portal vein and the ratio of hepatic arterial to total liver blood flow (HPI = hepatic perfusion index) and the ratio of hepatic arterial to portal venous blood flow (A/V ratio) were calculated. HPI and A/V values were changed in HCC patients (HPI = 0.23, range: 0.16-0.35; A/V = 0.32, range: 0.19-0.55) as a consequence of reduced portal venous blood flow (9.76 +/- 2.51 cm3/s) and of increased hepatic arterial flow (2.78 +/- 0.46 cm3/s). HPI and A/V values were significantly changed also in the patients with hepatic metastases (HPI = 0.24, range: 0.11-0.38; A/V = 0.34, range: 0.12-0.61) compared with the control group. These changes were correlated with increased hepatic arterial blood flow (3.16 +/- 1.35 cm3/s) and decreased portal venous blood flow (10.39 +/- 3.81 cm3/s). These results prove the role of color Doppler US in the study of primary liver cancer and metastases. Additional examinations are nevertheless necessary to assess the diagnostic value of color Doppler US in the early detection of and discrimination between benign and malignant tumors.
PURPOSE: To assess the prevalence, significance, and practical value of two recently described CT signs of instable aneurysm: the crescent sign (a curvilinear high-attenuating density within the thrombus) and the periluminal halo (a low-attenuating internal layer of the thrombus around the patent lumen). MATERIAL AND METHODS: Among the CT examination performed in the last 5 years, we retrospectively selected the nonruptured aneurysms with a diameter exceeding 4 cm (no. = 93, average diameter 5.1 cm, unenhanced images in 28 cases and enhanced in 84) and the ruptured aneurysms (no. = 16, average diameter 6.7 cm, unenhanced images in 9 cases and enhanced in 9). We studied the prevalence of the crescent and halo sign, their relationship with the aneurysm diameter, and the effect of contrast enhancement. RESULTS: The crescent sign was identified with a statistically significant prevalence in ruptured (37.5% of cases) over asymptomatic aneurysms (5.5%); the halo, instead, had the same frequency in the 2 groups (12.5% and 9.5%, respectively). Both signs were more frequent in bigger aneurysms and were recognizable without differences in unenhanced and enhanced images. CONCLUSIONS: The crescent sign, though not exclusive of aneurysmal rupture, indicates instability and its detection should lead to careful follow-up or surgical repair. The halo seems to have no real value as risk factor.
The authors report their experience in the optimization of the diagnostic accuracy of Magnetic Resonance Cholangiography (MRC) to detect choledochal stones; pre- and post-MIP post-processing images were compared. Thirty patients with dilated biliary ducts (mean age: 55.6 years) were examined with MRC; two of them had stones in the intrahepatic biliary ducts. The gold standard and the inclusion criterion was ERCP. MRC was carried out with a 1.5 T superconductive magnet (Signa) with T2-weighted FAST SE sequences (TR/TE; 10000/256, matrix: 256 x 128, slice thickness: 3 mm, TA: 6 min 28 s). Coronal MR images were blindly studied before and after MIP post-processing; Friedman's test was used for statistical analysis (p < .05). ERCP showed 92 cases of choledocholithiasis, with the stones ranging .2 to 3.4 cm; MRC before MIP post-processing had 97.1% diagnostic accuracy, 97.8% sensitivity and 95.8% specificity. These values are significantly different from those obtained after MIP (91.4%, 86.9% and 95.8% respectively). In our experience, pre- and post-MIP post-processing MRC can be considered a reliable and accurate noninvasive technique to detect choledochal stones.
Ischemic bowel disease is a rare disorder whose incidence is increasing as the mean age of the population increases. Diagnosis by clinical, laboratory and radiologic means is often difficult, and delay in definitive therapy results in substantial morbidity and mortality. A series of 26 consecutive patients, with proved acute superior mesenteric ischemia, was retrospectively reviewed: the authors report the diagnostic methods performed preoperatively, the site and the cause of infarction and the time passed between the first radiograph ans surgery. Plain abdominal radiographs were performed in 25 of 26 patients, screening abdominal US in 23 cases and CT in 19 cases. All radiological examinations were retrospectively reviewed by three authors, independently, to recognize the different signs of infarction. On plain abdominal films, the findings warranting a presumptive diagnosis of bowel infarction were air-fluid levels (84% of cases), dilated bowel loops (48%), thickened and unchanging loops (20%), gastric distension and gasless abdomen (12%), small bowel pseudo-obstruction (8%). Screening abdominal US demonstrated intraperitoneal free fluid (26%) and dilated bowel loops (22%). Abdominal CT showed air-fluid levels (79%), dilated loops and free intraperitoneal fluid (47%), intramural gas and thickened bowel loops (36.8%), engorgement of the mesenteric vessels (31%), mesenteric-portal gas, mesenteric thrombus and marked reduction in the volume of gas in the small bowel (10.5%) and paper-thin bowel loops (5%). The authors conclude that air-fluid levels, dilated loops and intraperitoneal free fluid are the most frequent findings, even though they are not specific. While abdominal plain film and screening ultrasonography can be negative, CT detects at least one abnormal finding and at least three abnormal findings in 73% of cases.
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INTRODUCTION: Conventional frontal radiography is mandatory in trauma patients and usually sufficient to detect rib fractures, even though the alignment of bone fragments or projection difficulties may sometimes hinder their depiction. Therefore, there exists moderate disagreement between clinically suspected rib fractures and radiographic findings. MATERIALS AND METHODS: We report our personal experience with US in the detection of rib conditions (fractures and bruises), missed at preliminary radiography. Five symptomatic patients with suspected rib fractures underwent radiographic and US studies. All patients were examined with a real time unit (RT 2800, GE Medical Systems, Milwaukee, USA) with a 7.5 MHz linear probe. RESULTS AND CONCLUSION: US demonstrated rib fractures in 4 patients with negative radiographic findings and a parosteal hematoma in one patient. We conclude that US can detect the rib fractures missed at conventional radiography and show rib cartilage conditions, costochondral dislocations and parosteal hematomas. Therefore we suggest the routine use of this technique in all chest trauma patients, as a useful complement to frontal radiographs, for both management and forensic purposes.
The serotonin (5-HT) transporter from human striatum was solubilized by digitonin and purified by affinity chromatography. The native protein-detergent complex had a molecular mass of 205 kDa, as estimated by gel-exclusion chromatography of the eluates obtained from affinity chromatography. The purified 5-HT transporter migrated as a single band of 67 kDa in SDS-PAGE. To clarify the spatial relationships between the binding sites of the tricyclic antidepressants, as [3H]-imipramine, and of the selective serotonin reuptake inhibitors, as [3H]-paroxetine, on the 5'HT transporter, both radioligands were used to label it in the purification steps. [3H]-paroxetine bound with the same affinity to a single high-affinity site on both membrane and purified preparations. [3H]-imipramine labeled a high- and a low-affinity site on parent membranes, whereas it bound to a single high-affinity site on the purified extract. Tricyclic antidepressants, selective serotonin reuptake inhibitors and 5-HT itself displaced [3H]-paroxetine and [3H-]imipramine from their high-affinity binding sites on both the membrane-bound and the purified 5-HT transporter in a monophasic fashion with Hill coefficients close to unity. Furthermore, both [3H]-paroxetine and [3H]-imipramine displayed a similar maximum binding capacity on an identical protein of 205 kDa. Our results suggest overlapping binding sites for tricyclic antidepressants, selective serotonin reuptake inhibitors and 5-HT on the 5-HT transporter.
Pulmonary disease of unknown etiology is a potentially fatal complication in patients with lysinuric protein intolerance (LPI), an autosomal recessive disorder caused by the defective transport of cationic amino acids. Lung involvement was investigated in nine Italian LPI patients through pulmonary function tests and lung imaging studies consisting of conventional chest radiography, high-resolution computed tomography (HRCT), and perfusion and ventilation scintigraphy. One 10-yr-old patient died of severe respiratory insufficiency from alveolar proteinosis. All of the remaining patients were asymptomatic at the time of the study, although HRCT scans revealed signs of lung involvement defined by the presence of acinar nodules, inter- and/or intralobular thickening of the interstitial septa, and subpleural cysts in five of the patients. Radioisotope studies showed an uneven distribution of perfusion and ventilation, and confirmed the presence of segmental and/or diffuse pulmonary functional defects. No abnormalities of pulmonary function were evident, and answers to a questionnaire excluded primary coexisting lung disease. In patients with LPI, including those without clinical and functional impairment, HRCT and radioisotopic studies appear to be the most sensitive methods for the early diagnosis of lung disease and correct assessment of its progression.
A new sign of pneumoperitoneum was observed in a patient with perforation of the ascending colon. The presence of free air in the peritoneal cavity allowed identification of the transverse mesocolon and the root of the small bowel mesentery on plain abdominal radiographs obtained in the supine and in the prone position. This sign may be an aid in the diagnosis of pneumoperitoneum.
The authors report on 16 healthy volunteers examined with anal endosonography. The US examinations were performed with a dedicated Bruel and Kjaer 1846 unit equipped with a 7-MHz probe (type 1850) with 360 degrees circular mechanic movement. A rigid plastic cone filled of degassed water is mounted on the probe to ensure the symmetrical representation of the anal canal. A condom with gel on both the internal and the external surfaces is put on the cone. The peculiar anatomy of the single layers which form the anal canal determines their different US patterns. Endosonography was performed on three levels, i.e., deep, intermediate and superficial planes. In the deep plane (at the anorectal junction) anal endosonography demonstrates: epithelial-subepithelial complex (intermediate echogenicity); internal sphincter muscle (low echogenicity), made of smooth muscular fibers; longitudinal muscle (intermediate echogenicity), made of smooth and striated muscular fibers; puborectal muscle (high echogenicity), made of striated muscular fibers, and perineal body, which has a longitudinal shape in men and a transverse shape in women. In the intermediate plane anal endosonography demonstrates: epithelial-subepithelial complex, internal sphincter muscle, longitudinal muscle, and external sphincter muscle (high echogenicity), made of striated muscular fibers. In the superficial plane (distal anal canal extremity), anal endosonography demonstrates: epithelial-subepithelial complex and external sphincter muscle. Internal sphincter muscle thickness was measured and the results follow: while the average thickness was 2.1 mm, we had 1.8 mm in 12 patients under 44 and 2.6 mm in 4 patients over 44 years old. This finding is in agreement with literature data. External sphincter muscle thickness did not vary significantly in the two groups.
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Plain abdominal radiography is the method of choice to diagnose gastrointestinal perforation because it shows the presence of free intraperitoneal air and of other associated radiologic signs. Recently, the modern methods of cross-section imaging, that is US and CT, have become useful tools for the accurate detection and depiction of free abdominal air, especially when plain films are normal or nonspecific. A series of 61 consecutive patients operated on for viscus perforation at Cardarelli Hospital, Neaples, was retrospectively reviewed: the authors report the site and cause of perforation and the diagnostic methods used preoperatively to recognize the radiographic sign of free air; examination time and the time passed between the first radiograph and surgery were also investigated. Of 61 patients, 53 underwent preoperative radiologic exams: plain abdominal radiographs were performed on 50 patients, abdominal US on 29 and CT on 15, while 8 patients were submitted to surgery with no previous diagnostic examination. Direct and indirect signs of perforation were assessed to compare the sensitivity of the methods and to suggest a possible diagnostic protocol. Combined radiography, US and CT showed signs of perforation in 71% of cases (direct signs in 57.5% and indirect signs, that is free intraperitoneal fluid and hypoperistalsis, in 14.5% of cases). When free air was absent (1/3 of cases), free intraperitoneal fluid was the only radiologic finding. The authors conclude that plain abdominal radiography, when correctly performed, is still the main tool permitting free air, if present, to be depicted in 100% of cases. When plain abdominal radiography is positive, other radiologic procedures are unnecessary while, when it is negative and symptoms persist, US and CT should be performed after at least 6 hours' interval to allow the radiologic picture to change markedly.
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PURPOSE: To assess the semiology, effectiveness and role of the modern diagnostic methods used to study diaphragmatic injuries. MATERIALS AND METHODS: We report our personal experience acquired in the last 4 years in 23 patients. Eighteen patients had blunt and 6 penetrating diaphragmatic trauma, 10 of them involving the right and 14 the left hemidiaphragm. Plain chest X-rays were performed in 19 cases, gastrointestinal (GI) barium studies in 2, US in 5 and CT in 21 cases. RESULTS: Plain chest films were normal in one case (5%), not specific in 6 (32%), suggestive in 7 (37%), and diagnostic in 5 (26%). Barium studies of the GI tract were diagnostic in both patients (100%). US was suggestive in one case (20%) and diagnostic in 4 (80%). CT was not specific in 4 cases (19%), suggestive in 8 (38%) and diagnostic in 9 (43%). CONCLUSIONS: Plain chest radiography remains the method of choice in the study of diaphragmatic injuries. US, in our still limited experience, seems to be the most accurate method in the direct demonstration of muscular traumas and should be performed more often in the study of diaphragmatic injuries. CT has poorer accuracy and, above all, shows only indirect signs, but it is fairly effective and plays a key role in the depiction of chest and abdominal traumas. Barium studies should be reserved, possibly, to the direct identification of digestive hernias, especially in the late phase.