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Biomedical subjects

Carlo Martinoli

Publications and source records attributed to Carlo Martinoli.

30 records · Page 2Linked to original sources
PubMed2002

Glucose pump test: a new method for blood flow measurements.

BACKGROUND: A good test for monitoring blood flow (Q(a)) must be accurate, rapid and economical in order to allow frequent easy measurements. The glucose pump test (GPT) is based on a constant glucose infusion as a dilutional indicator of Q(a). METHODS: GPT protocol requires a constant glucose infusion, by a syringe pump, into the arterial needle and two blood withdrawals from the venous needle, one basal before the infusion (C(a1)), the other (C(a2)) 11 s after the start of the infusion. At the bedside we measure glucose on C(a1) and C(a2). Knowing the infused glucose concentration (C(i)) and the pump infusion rate (Q(i)) we can easily calculate Q(a)=Q(i)x(C(i)-C(a2))/(C(a2)-C(a1)). We verified the accuracy of this new method by comparing it with the in vitro results from a circuit reproducing vascular access circulation, and in vivo comparing GPT-Q(a) with Doppler ultrasound in pre-dialysis to the Transonic HD01-Q(a) during dialysis in 23 chronic haemodialysis patients. RESULTS: GPT-Q(a) values were highly correlated with the in vitro Q(a)=1.01 x GPT-Q(a)-16.6; r=0.94. There was agreement between the mean flow values of GPT and Doppler (927.5 and 927.1 ml/min, respectively; P=NS) while the mean value of HD01 was significantly lower (HD01-Q(a)=690 ml/min; P<0.001 vs GPT-Q(a) and Doppler-Q(a)). The regression analysis showed a good correlation between GPT and Transonic results (r=0.95; HD01-Q(a)=0.86 x GPT-Q(a)-111.9), while there was a significant difference between the two measurements (mean Delta 235+/-117 ml/min; range from 15 to 451 ml/min). This difference could be caused by the large haemodynamic variations (different blood pressure, cardiac output, circulating effective volume, haematocrit) between pre-dialysis and intra-dialysis and in addition by the counter current flow during the reversal blood lines Transonic measurements. CONCLUSIONS: GPT offers the advantage of a simple bedside procedure easily performed before dialysis: it does not interfere with the dialysis treatment and it is less intrusive for the patient as it does not involve reversal of the blood lines. The preliminary data indicate that our method could be a useful, simple and cheap test for monitoring access flow in every dialysis unit.

Blood Circulation↗
PubMed2002

Changes in renal resistive index and urinary albumin excretion in hypertensive patients under long-term treatment with lisinopril or nifedipine GITS.

INTRODUCTION: Increased renal vascular resistance and microalbuminuria are associated with hypertensive target organ damage and may be predictors of hypertensive nephrosclerosis. AIM: We investigated changes in renal resistive index (RI) and urinary albumin excretion (UAE) in a group of patients with primary hypertension before and during long-term antihypertensive treatment. METHODS: Thirty-two patients were randomized to receive antihypertensive treatment with either a calcium channel blocker (nifedipine GITS, up to 90 mg/day, n = 16) or an ACE inhibitor (lisinopril, up to 20 mg/day, n = 16), alone or in association with a diuretic (chlortalidone, 25 mg/day). Blood pressure, renal resistive index (by US Doppler) and UAE (mean of three nonconsecutive timed urinary collections, microg/min) were evaluated at baseline and over the course of 24 months of treatment. RESULTS: Both regimens effectively lowered blood pressure (mean blood pressure from 123 +/- 1.8 at baseline to 103 +/- 1.5 mm Hg at 24 months in the lisinopril group and from 122 +/- 1.9 at baseline to 104 +/- 0.8 at 24 months in the nifedipine group, p < 0.001 for both groups). Overall, blood pressure decrease was associated with a reduction in UAE and no change in RI throughout the study. However, despite similar blood pressure reduction, the two regimens showed different specific effects. Lisinopril was associated with a significant decrease in both UAE (33.8 +/- 16.2 at baseline and 9.1 +/- 2.1 at 24 months, p < 0.01) and renal RI (0.61 +/- 0.02 at baseline and 0.56 +/- 0.04 at 24 months, p < 0.05) while nifedipine GITS did not significantly influence UAE (35.7 +/- 12.2 at baseline and 31.2 +/- 12.1 at 24 months, n.s.) or RI (0.61 +/- 0.01 at baseline and 0.59 +/- 0.02 at 24 months, n.s.). CONCLUSION: Effective blood pressure control over a long period of time reduces the severity of organ damage, namely UAE while maintaining renovascular resistance in patients with essential hypertension. Different classes of antihypertensive agents might convey additional specific renal protection beyond blood pressure control. These data could be useful in devising individualized therapeutic strategies in hypertensive patients at increased renal risk.

Adult↗
PubMed2002

Sonography of the median nerve in Charcot-Marie-Tooth disease.

OBJECTIVE: The purpose of our study was to describe the features on high-frequency sonography of median nerves in patients with Charcot-Marie-Tooth disease and determine whether sonography can help in the detection and characterization of the disease in these patients. SUBJECTS AND METHODS: The median nerves of 24 patients with genetically proven Charcot-Marie-Tooth disease (12 patients with Charcot-Marie-Tooth disease type 1A, seven with Charcot-Marie-Tooth disease type 2, and five with Charcot-Marie-Tooth disease type X) were prospectively examined at the right mid forearm with a 12-5-MHz transducer. Image analysis for each patient included measurement of both the cross-sectional area and fascicular diameter of the nerve. Correlations then were made with genetic and electrophysiologic features and with findings in a control group of 50 subjects. RESULTS: Sonography was found to be a reliable means of detecting the nerve hypertrophy and the fascicular swelling occurring in patients with Charcot-Marie-Tooth disease. The 1A type of Charcot-Marie-Tooth disease could be distinguished sonographically by a larger nerve area and fascicular diameter than those observed in patients with the other types of disease (including Charcot-Marie-Tooth disease type 2 and X-linked type) and the control subjects. In patients with Charcot-Marie-Tooth disease and control subjects, linear regression analysis did not show a correlation between either the cross-sectional area or fascicular diameter of the nerve and the patient's height, body mass, sex, or electrophysiologic parameters. CONCLUSION: High-resolution sonography can be used to detect the hypertrophy of median nerves in patients with Charcot-Marie-Tooth disease. It can be helpful in defining the Charcot-Marie-Tooth type 1A on the basis of the larger nerve sizes and fascicular diameters than those occurring in patients with other types of the disease. In an affected kindred, sonography is promising as a screening tool for identifying individuals who should undergo genetic assessments.

Adolescent↗
PubMed2002

Brachial plexus sonography: a technique for assessing the root level.

OBJECTIVE: Our study was intended to establish a technique to assess the level of the roots of the brachial plexus using high-resolution sonography. MATERIALS AND METHODS: The skeleton of a cervical spine was examined in vitro to determine whether the vertebrae may be identified individually on sonography by means of the evaluation of their transverse processes. Then 20 healthy subjects and five patients who had undergone CT of the cervical spine were evaluated sonographically, and we attempted to identify the level of individual roots of the brachial plexus using the transverse processes as landmarks. To establish the reliability of this method, a blinded review of sonograms of the paravertebral area obtained at various levels was performed independently by three examiners. RESULTS: In vitro, sonography was reliable in depicting the level of the C7 vertebra because of the absence of the anterior tubercle from its transverse processes. In healthy subjects, this feature allowed us to establish the level of the roots outside the spine. In our series, the C4-C7 roots were visible sonographically in all cases, whereas the C8 and T1 levels were seen, respectively, in only 16 of 20 and eight of 20 cases. All examiners correctly identified the C7 level in the blinded review of sonograms. CONCLUSION: High-resolution sonography can reveal the level of the roots of the brachial plexus on the basis of the different morphology of the transverse processes of the vertebrae. Our study has implications for confirming the exact level of pathologic roots before surgery.

Adolescent↗
PubMed2001

Ultrasound of the joints.

High-frequency ultrasound is now considered an excellent modality to image normal tendons, muscles, and peripheral nerves as well as to diagnose a wide variety of pathological conditions affecting these structures. Although US is limited in the visualisation of some intra-articular structures, it can be a useful tool in joint disease assessment. Ultrasound has some advantages over other imaging modalities including time- and cost-effectiveness, superior spatial resolution, dynamic examination and the possibility to perform the examination in a comfortable position for the patient. The aims of this review are twofold: firstly, to present the normal US appearance of the joint structures that are susceptible to US examination, including the joint surfaces, intra-articular structures such as menisci and other fibrocartilages, capsule and ligaments; and secondly, to show the US appearance of the most commonly encountered joint disorders and discuss the role of US in the imaging strategy of joint disorders.

Humans↗
PubMed2001

Ultrasound of tendons and nerves.

Tendons and nerves represent probably one of the best application of musculoskeletal US due to the high lesion detection rate and accuracy of US combined with its low cost, wide availability, and ease of use. The refinement of high-frequency broadband linear-array transducers, and sensitive color and power Doppler technology, have improved the ability of US to detect fine textural abnormalities of these structures as well as to identify a variety of pathological conditions. Characteristic echotextural patterns, closely resembling the histological ones, are typically depicted in these structures using high US frequencies. In tendon imaging, US can assess dislocations, degenerative changes and tendon tears, including intrasubstance tears, longitudinal splits, partial and complete rupture, inflammatory conditions and tendon tumors, as well as postoperative findings. In nerve imaging, US can support clinical and electrophysiological testing for detection of compressing lesions caused by nerve entrapment in a variety of osteofibrous tunnels of the limbs and extremities. Congenital anomalies, nerve tears, and neurogenic tumors can also be diagnosed. Overall, US is an effective technique for imaging tendons and nerves. In most cases, a focused US examination can be performed more rapidly and efficiently than MR imaging.

Arthritis, Rheumatoid↗
PubMedDate not supplied

Sonography of entrapment neuropathies in the upper limb (wrist excluded).

The progressive refinement of broadband transducers with frequencies higher than 10 MHz and improved near-field resolution has enhanced the potential of sonography to evaluate a variety of nerve entrapment syndromes occurring in the upper limb, such as suprascapular neuropathy in the area of the spinoglenoid-supraspinous notch, the quadrilateral space syndrome (axillary neuropathy), radial neuropathy in the area of the spiral groove, the supinator syndrome (posterior interosseous neuropathy), the cubital tunnel syndrome (ulnar neuropathy), and the Kiloh-Nevin syndrome (anterior interosseous neuropathy). In these settings, high-resolution sonography can depict changes in the nerve's shape and echotexture and can depict many extrinsic causes of nerve entrapment.

Humans↗
PubMedDate not supplied

Intramuscular ganglion arising from the acromioclavicular joint.

We report a case of a 80-year-old White woman presenting with a localized painless swelling in the upper parascapular region of the right shoulder. Ultrasound (US) showed a ganglion arising from the acromioclavicular joint (ACJ) and extending inside the trapezius muscle, together with a massive tear of the rotator cuff (RC). Magnetic resonance imaging (MRI) confirmed the US findings. Ganglia arising from the ACJ are rare and usually associated with massive RC tears. Their intramuscular extension, to the best of our knowledge, has never been reported in the radiological literature and can mimic a tumor.

Acromioclavicular Joint↗
PubMedDate not supplied

US of the shoulder: non-rotator cuff disorders.

The most common indication for shoulder ultrasonography (US) is the diagnosis of rotator cuff disease. However, there is a spectrum of non-rotator cuff abnormalities that are amenable to US examination, including instability of the biceps tendon, glenohumeral joint, and acromioclavicular joint; arthropathies and bursites (inflammatory diseases, degenerative and infiltrative disorders, infections); nerve entrapment syndromes; and space-occupying lesions. Many of these conditions may be overlooked clinically or can even mimic rotator cuff tears, and US can help redirect the diagnosis if a complete shoulder examination rather than a simple rotator cuff assessment is performed. In addition, US can be remarkably helpful in guiding either needle aspiration procedures or local injection therapy in patients with synovial processes. Although radiography, magnetic resonance (MR) imaging, and computed tomographic and MR arthrography are effective modalities for the evaluation of non-rotator cuff disorders, US is both less costly and less invasive and will likely be used more frequently in this setting as experience increases. Once adequate radiographs have been obtained to exclude apparent bone disorders, high-resolution US should be the first-line imaging modality in the assessment of non-rotator cuff disorders of the shoulder, assuming the study is performed with high-end equipment by an experienced examiner.

Arthritis↗
PubMedDate not supplied

Multidetector CT for visualization of coronary stents.

Whereas the clinical diagnosis of in-stent thrombosis is straightforward, that of in-stent restenosis remains a problem, because although many patients experience chest pain after coronary stent placement, that symptom is secondary to ischemia in only a few. The use of a noninvasive technique to identify such patients for early invasive intervention versus more conservative management is thus highly desirable. Multidetector computed tomography (CT) performed with 16-section scanners recently emerged as such a technique and has overtaken modalities such as electron-beam CT and magnetic resonance imaging as an alternative to conventional angiography for the assessment of in-stent restenosis. The improved hardware design of the current 64-section CT scanners allows even better delineation of stent struts and lumen. The more reliable criterion of direct lumen visualization thus may be substituted for the presence of distal runoff, which lacks specificity for a determination of in-stent patency because of the possibility of collateral pathways. However, the capability to accurately visualize the in-stent lumen depends partly on knowledge of the causes of artifacts and how they can be compensated for with postprocessing and proper image display settings. In addition, an understanding of the major stent placement techniques used in the treatment of lesions at arterial bifurcations is helpful.

Artifacts↗
PubMedDate not supplied

Use of the sonographic contrast medium in the study of pelvic masses: preliminary remarks.

PURPOSE: To evaluate the role of intravenously injected sonographic contrast medium (CM) in characterising space-occupying pelvic lesions. MATERIALS AND METHODS: Forty-seven women with palpable pelvic mass underwent color Doppler US before and after the intravenous injection of an ultrasound CM. The examination results were divided into three categories: Class I = no additional diagnostic information supplied by the contrast-enhanced examination; Class II = the use of CM facilitated the identification of vascular structures but did not significantly affect the diagnosis or the patient's subsequent diagnostic/therapeutic procedures; Class III = the information obtained significantly affected treatment decisions regarding the single patients. RESULTS: After the CM injection, 9/47 (19.1%) cases were assigned to Class I, 25/47 (53.2%) to Class II, and 13/47 (27.7%) to Class III. At baseline, all 13 lesions later assigned to Class III had shown an avascular appearance or only peripheral vascularisation. This type of vascular distribution was confirmed by the contrast-enhanced study, which helped determine the haemorrhagic nature (with solid appearance) of some lesions, or support the hypothesis put forward during the baseline study, that the lesion was a poorly vascularised benign mass. This lent further support to our choice to undertake a laparoscopic surgical approach in 2 lesions, it altered our decision as to the type of surgery to be performed (laparoscopy vs. laparotomy) in 5 patients, and confirmed our intention to undertake only the follow-up in the 6 remaining cases. CONCLUSIONS: The use of the sonographic CM proved clinically useful in 13/47 patients with space-occupying pelvic lesions. The most important result of this examination was its ability to confirm the nonvascular or poorly vascular component of a lesion, and therefore to suggest its benign nature.

Adult↗