Biomedical subjects
Publications and source records attributed to E Neri.
An alternative surgical technique of repair of the ostium primum septal defect without the use of any patch is reported. The potential technical difficulties and surgical consideration are discussed.
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BACKGROUND: Operative closure of atrial septal defect is today considered a high-benefit and low-risk operation. Patients are often young and sensitive to the cosmetic results of the procedure. The midline scar of median sternotomy may be unsightly and can provoke dissatisfaction and psychological distress. For cosmetic reasons, an alternative operative approach, such as right anterolateral thoracotomy, can be proposed, with better aesthetic results and without increasing operative risks. METHODS: Our study reviews retrospectively the long-term results of a consecutive series of 56 young patients in whom the atrial septal defect was closed through a right submammary approach. The indication for this approach was isolated atrial septal defect in female patients with complete development of the breasts. RESULTS: In-hospital morbidity included three postpericardiotomy syndromes with one operative drainage for a moderate pericardial effusion (subxiphoid approach); 6 patients had supraventricular tachycardia in the early postoperative period. One patient presented with a symptomatic supraventricular arrhythmia and was treated medically for atrial flutter or fibrillation. Follow-up ranged from 12 to 240 months and included 41 of 57 patients. There were no early or late deaths. All patients were in normal sinus rhythm and free of symptoms, in New York Heart Association functional class I. Electrocardiography results showed 4 patients with first-degree atrioventricular block and 5 with complete right bundle branch block. Echocardiographic study results showed 3 patients with a trivial residual shunt. There were no other late complications. Breast volume and symmetry and the character of the scar were evaluated objectively by a physician and subjectively by a multiple-choice questionnaire completed by the same patients. The answers suggested that the patients' subjective impressions were at least commensurate with the objective findings. Most of the patients perceived the cosmetic results as good or excellent. No serious psychological problems related to the scar were found. CONCLUSIONS: Right thoracotomy incision is a safe alternative approach to median sternotomy to repair isolated atrial septal defect in young female patients.
Surgical treatment of thoracic aneurysms is frequently performed with the aid of partial cardiopulmonary bypass. When profound hypothermia and circulatory arrest are employed, inadequate venous drainage may represent a major problem. We herein describe a technique of inferior vena caval cannulation that allows steady performance when high pump flows are imposed.
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We report on 31 cases of calcaneal fractures studied with CT according to the latest classification by the Italian Surgical Society of the Foot. Of the utmost importance is the radiologic assessment of the posterior facet and of the underlying bone, which make up the so-called talamus which bears most of the body weight. In our series, talamus fractures were the most frequent ones (26/31 cases): they are characterized by a main sagittal line, running obliquely and dividing the posterior surface and the bone into an anteromedial, or substentacular, fragment and a posterolateral, or tuberosity, fragment. According to fracture severity, the first differential criterion is the presence/absence of displacement and depression (type I fractures the latter, 6 cases in our series, and (types II and III the former, 20/26 cases in our series). Based on the degree of displacement and depression, fractures as classified as type II (10/26 cases) when only the lateral portion of the talamus is displaced and depressed, or as type III (10/26 cases) when the whole talamus is fragmented, displaced and depressed. Moreover, other worsening factors must be considered and B subgroups differentiated in types II and III fractures; these factors are: calcaneus-cuboid facet involvement, lateral wall fragmentation, posterior facet comminution, a small sustentacular fragment and a secondary frontal fracture interrupting the plantar cortex. Extra-talamic fractures, defined as such when isolated, rarely occur. Relative to the anterior apophysis, radiologic attention must be focused on fractures of the dorsal prominence, or beak, which are very often misdiagnosed. As regards the posterior tuberosity, its lateral dislocation must be studied because it may account for calcaneofibular impingement. CT exhibits excellent potentials, provided that slices are thin, acquired on the axial and coronal planes and that, as far as possible, sagittal reconstructions are used, the latter being very useful to depict talamic surface.
Internet is an international computer network that uses standard communication protocols for the exchange of information. This facilitates the retrieval of multimedia data through a "web" of servers distributed in the whole world. Among Internet users, Radiologists are a potentially important segment, due to the inherent multimedia characteristics of the discipline, which requires a continuous international update of information. The Department of Radiology of the University of Pisa has an Internet access through the metropolitan area network which was installed in the framework of the CNR Telecomunicazioni Project. The Internet access allowed the implementation of a World Wide Web server made public on Internet in March, 1994, being the first European server specifically oriented to radiology. This server can be accessed at the following address: http:@www.rad.unipi.it:7080/IRMosaicHome.html . On the server, 3 hypermedia papers are present, a list of international servers containing radiological information, a questionnaire, and statistics concerning the number of users who accessed the server. In the first 18 months of public access through Internet (April 1, 1994-September 30, 1995) 16,166 users accessed the server, retrieving 127,349 documents, corresponding to 1,279.7 MByte of information. The mean amount of information retrieved in each access to the server in the considered quarters ranges from 72 to 85.8 kByte. The geographic distribution of the users who accessed the server is the following: United States, 7,158, Italy, 2,466; other European countries, 3,813; other extra-European countries, 2,729. The increasingly diffuse knowledge of Internet services had a substantial impact on the rise in number of the servers and of the users who can access them. It is likely that in the future this technology will be used with increasing interest by Radiologists, since it provides easier "navigation" through multimedia information, consisting of text and several images, without the inherent limitations of the printed paper.
The aim of the present study was to evaluate the sensitivity and specificity of the ultrasonography, in comparison with other methods of investigation (scintigraphy, sialography, and biopsy), in scanning morphostructural changes in the parotid gland in patient with Sjögren's syndrome. During the period June-October 1994, 34 patients (5 males and 29 females, age ranged between 20 and 88 years) with "sicca syndrome" underwent to echography, scintigraphy, sialography and biopsy. The diagnosis was confirmed or excluded using the European Community Epidemiologic Committee criteria for Sjögren's syndrome. Twenty-two patients out of 34 were affected by Sjögren's syndrome, while the others resulted as control subjects. The ultrasonographic investigation has shown 76.19% of sensitivity and 30.43% of specificity. Even if echography is a non-invasive method, which could be used as preliminary approach for studying the diffused involvement of the parotid gland, at the status of the art, it is not completely reliable for the global evaluation of the morphostructural changes in patients with Sjögren's syndrome, in comparison with the other techniques. Because of the double nature of the gland injury, it appears to be essential the diagnostic integration between echography and sialography.
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The fibrobullous disease of the upper lobes is an uncommon extraspinal complication of ankylosing spondylitis. We report the conventional radiographic and High Resolution Computed Tomographic (HRCT) findings in the fibrobullous disease of the upper lobes in ankylosing spondylitis. From 1988 to 1994, four patients affected with ankylosing spondylitis, with radiographic involvement of the upper lobes, came to our observation. All patients underwent a chest X-ray exam and the previous chest X-rays carried out 2-25 years earlier were reviewed. Within 15 days, HRCT was performed, during inspiratory apnea. In all cases, repeated bronchoscopies were available, showing bronchial inflammation, together with cytologic tests and bronchial fluid cultures, which revealed no development of mycobacterium tuberculosis. The most frequent CT findings were pleural thickening, fibrotic consolidation and thickening of interlobular septa. Bullae, nodules and ground-glass areas were less frequent findings. The standard chest X-ray exam demonstrated, with the same sensitivity as HRCT, pleural thickening, bullae, nodules and volume loss in the involved lung. However, interlobular septa thickening was depicted only in one case, while bronchiectases and ground-glass areas were not recognized at all. Three temporally distinct patterns of apical involvement (infiltrative, interstitial and fibrobullous) were identified. In conclusion, HRCT was more sensitive and more specific than chest X-rays in the study of the fibrobullous disease of the upper lobes in ankylosing spondylitis.
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Wall dissection is a typical complication in the evolution of Marfan aortic aneurysm and usually is associated with valve regurgitation. Formation of a fistula with adjacent structures is very uncommon. We report the case of a 32-year-old man who presented with the typical features of Marfan's syndrome, with chronic aneurysm of the ascending aorta and acute aortopulmonary fistula. Diagnosis was made preoperatively by aortography; operation was performed successfully. A review of the literature only shows a few cases of aortopulmonary fistula in atherosclerotic, syphilitic, or postendocarditis disease.
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beta-endorphin (beta-EP) levels increase in maternal plasma starting from the 10th to the 12th week of pregnancy and reach a peak during labor and at delivery. Respiratory autogenous training (RAT) has been acclaimed as one of the most effective non-pharmacological methods of obtaining hypoalgesia and relaxing perineal muscles during labor. In order to study the effects of the RAT method in both maternal and fetal beta-EP levels during labor, 28 pregnant women were enrolled in this study. Fourteen attended a RAT program, while the others (control group) did not. beta-EP levels in both groups were measured in maternal plasma at early and late labor, at delivery and on the 4th day of the puerperium and in umbilical cord blood at birth. From late labor on, beta-EP maternal plasma levels increased significantly less in the RAT group than in the control group. The gap in the beta-EP levels between both groups was still significant at puerperium and in umbilical cord blood. In conclusion, the RAT method favorably modulates the secretion of beta-EP during labor and at delivery. This result supports the effectiveness of the RAT method in reducing both maternal and fetal stress during labor.
Out of 1172 females recruited in a screening program for genital infections, 144 (12.28%) were cervical and/or urethral positive for Chlamydia trachomatis (Ct) by enzyme immunoassay (EIA). Patients positive for Ct showed no significant differences in terms of demography, sexual practices and clinical evidence as compared to a control group formed by Ct-negative females randomly selected. Historical data showed a higher frequency of previous pelvic inflammatory disease (PID) in patients as compared to controls. 11 of the 94 patients' partners tested were sperm positive for Ct. Of the 63 patients for whom therapeutic data were available, 38 were treated with josamycin, 16 with tetracycline and the others with different drugs. After treatment, EIA for Ct was negative for 92.1% of the patients treated with josamycin and for 68.7% of those treated with tetracycline. The results of this study confirm a high prevalence of asymptomatic Ct infection which may be correctly diagnosed by EIA performed on cervical and urethral samples. They also indicate that negative test results can be obtained by an appropriate antibiotic treatment.
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