Biomedical subjects
Publications and source records attributed to C Orzincolo.
The authors report their experience in grid mammography in 265 patients. Image quality of grid mammograms was compared with conventional film-screen combination mammograms. The superior image quality of grid mammography, especially in large size breasts, was demonstrated. On the other hand the images obtained using grid fixed and Potter resulted almost alike.
Skull X-rays of 60 patients with chronic renal failure were examined. Alterations included diminished or increased bone density, radiolucent areas, pepper pot skull and the disappearance of vascular grooves and sutures. It is suggested that the radiological aspect of the skull is of very little diagnostic use in the assessment of uremic osteopathy since specific alterations are rare and tardive and show no correlation with clinical and laboratory findings. Skull X-rays can be useful in assessing the effects of treatment (vitamin D derivatives, parathyroidectomy) and for the identification of focal lesions (brown tumors).
Diffuse idiopathic skeletal hyperostosis (DISH) is a disorder characterized by bone proliferation of spinal and extraspinal structures. Frequently, extraspinal manifestations may occur before the involvement of the spine. These alterations are so common and characteristic that they should be included in the diagnostic criteria for DISH. The patella is one of the most commonly involved sites. The knee of 48 patients affected by DISH, according to Resnick's diagnostic criteria, were subjected to systematic, radiographic and xerographic studies. The most characteristic radiographic patterns are: thickening of the anterior margin of the patella (81.1%); ossifying enthesopathy of supero-anterior margin of patella (68.7%); periosteal new bone formation on the tibial insertion of the cruciate ligaments (47.8%); presence of fabella (41.%); presence of megafabella (22.9%), which may come near the posterior profile of the femur. Changes are usually symmetrical in DISH: entheseal abnormalities mostly involve the antero-superior margin of the patella, whereas in osteoarthritis, osteophytes are found on the postero-superior margin. In the lateral view enthesophytes at the bone attachment of the cruciate ligaments are oriented inside the joint space; on the contrary, osteophytes are always oriented outside the joint space. Radiographic manifestations of the fabella are similar to those observed in osteoarthritis, and so they cannot be utilized in the differential diagnosis of these diseases.
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Aseptic necrosis of the femoral head is described in 4 patients, selected from 280 patients with homozygous beta-thalassemia (Cooley anemia). The incidence of the complication appears to be very high (14.5%) in thalassemia, compared to the general population. The possible mechanism are discussed.
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The incidence of aseptic necrosis of femoral head in homozygous beta-thalassaemia (Cooley's anaemia)--which is indeed significantly high--is not satisfactorily referred in late literature regarding haemolytic syndromes. Therefore, 4 cases of osteonecrosis of femoral head, recently recognized in a series of 280 patients affected by Cooley's anaemia (14.5 0/00) are presented, and a review of hypotheses about the pathogenesis of the lesions is considered. In Cooley's anaemia, the skeletal lesion (osteoporosis) must be believed as a propitious state, in which some other pathogenetic events (i.e. local ischemia, bony age, etc.) and microtraumas overlap. In any case, characteristic blood circulation of the femoral head is the "conditio sine qua non" in developing osteonecrosis.
Plain films and direct magnification radiographs of the hands were performed in 34 patients affected by rheumatoid arthritis, using mammographic x-ray tube, achieved with 0.1 mm microfocus, and 1.85 X magnification factor. Direct magnification radiography has provided essential or useful diagnostic data in 44% of cases, particularly in recognizing early skeletal erosions. Nevertheless direct magnification radiography must be used only in those cases in which traditional mammographic techniques do not supply satisfactory results.
Basic calcium phosphate (BCP) crystal deposition can lead to periarticular collections associated with typical radiographic findings, most frequently observed in the shoulder. Moreover, these deposits may be revealed in other articular sites (i.e., wrist, hand, foot, elbow, hip, etc.). Initially, the calcium deposits may appear poorly defined (cloudlike); afterwards, they may reveal different patterns (linear, triangular or circular areas), changing in size, configuration and site. Adjacent bone may be normal, although osteoporosis, cystic lesions and reactive sclerosis are reported. The radiographic appearance of calcifications will depend upon the exact location of the deposits in the specific tendon of the rotator cuff, the adjacent bursae and the soft tissues.
99mTc-polyphosphate joint imaging of the hand has been performed in 18 patients, with evidence of inflammatory joint disease, but without any significant radiographic lesions, which might be related to rheumatoid arthritis. The hand scans were compared to clinical and radiographic data. An year after, the same subjects were re-examined, with both the radionuclide imaging and radiography. Scintigraphy has been shown to be significantly more sensitive for detecting inflammatory joint disease than x-ray, especially in the early stage of rheumatoid arthritis. Although radionuclide imaging is non specific (activity is increased also in osteoarthritis, trauma, metabolic bone disease, infarction, etc.). Radiography is highly specific but relatively non sensitive.
Clinical, radiological and ultrasonographical features of three cases of xanthogranulomatous pyelonephritis, one of which in a child, are reported. Presurgical diagnosis of xanthogranulomatous pyelonephritis is difficult and infrequent to date (10-14% of cases according to different workers). This complaint is generally mistaken for other types of kidney infections or tumours. The use of ultrasonography and computed tomography in particular help recognition of the disease and above all help to assess its extra-renal spread: something that has only recently been made possible.
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Two cases intramural pseudodiverticulosis of the oesophagus are presented. The importance of a radiological examination when studying this condition is underlined.
Xeroradiographic investigations of the skull, hand, and elbow were performed on 27 patients with homozygous beta-thalassaemia. The results were compared with plain radiographic examinations. Xeroradiography, because of its technical properties (i.e. edge contrast enhancement and wide latitude), was shown to demonstrate cortical thinning of long bones, swelling of the diploic space in the skull, and reticulated patterns in the elbow better than standard radiography. Moreover, the use of "positive" mode imaging was shown to have advantages in the study of the skull and extremities.
Radiographic features of calcium pyrophosphate dihydrate (CPPD) crystal deposition disease are outlined in an investigation of 32 patients, with definite or probable disease (according to the diagnostic criteria previously utilized by McCarty). The crystal deposits within fibro- and hyaline cartilage (chondrocalcinosis) may produce an acute synovitis (pseudogout syndrome), and in some patients a radiographically distinctive degenerative arthropathy (pyrophosphate arthropathy). These abnormalities are most frequent in the knee, wrist and symphysis pubis, but often other joints may be affected. Although the alterations superficially resemble osteoarthritis, they are more severe and progressive (Charcot-like joint).
Erosive osteoarthritis (EOA) is a peculiar form of osteoarthritis, characterized by inflammatory destructive changes (erosions) in the interphalangeal joints, with relative sparing of the metacarpophalangeal joints, and frequent involvement of the trapeziometacarpal joint. Linear periosteal bone apposition is also commonly reported. In EOA, erosions tend to occur exclusively in the subchondral cortex of joints, causing in DIP joints a typical "gull wings" configuration of bones of distal phalanges, whereas in psoriatic arthritis (PA) and in rheumatoid arthritis (RA) the "bare areas" are primarily affected. However, such "gull wings" erosions are nonspecific, and may be observed in the late stage of PA in the IP joints, or RA in the PIP joints.
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The authors emphasize the value of mammography with a 0.3 millimetres microfocus-tube with a magnification system. This technique is limited to those large lesions increasing "twilight effect". For a better study of all breast's lesions the use of fine microfocus-tubes is suggested, as it results also from the latest literature.