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Biomedical subjects

J V Manzione

Publications and source records attributed to J V Manzione.

At least 19 recordsLinked to original sources
PubMed1995

Acute internal jugular vein thrombosis associated with pseudoabscess of the retropharyngeal space.

We present four patients in whom evidence of edema or a pseudomass in the retropharyngeal space was found on CT scans obtained after thrombosis of the internal jugular vein. The clinical condition of one patient led to surgery, which documented the sterility of the retropharyngeal space despite the CT appearance of an inflammatory process. The CT findings, which are confusing initially, are found to be typical in retrospect.

Acute Disease↗
PubMed1994

A comparison of thrombolytic therapy with operative revascularization in the initial treatment of acute peripheral arterial ischemia.

PURPOSE: Despite the widespread use of intraarterial thrombolytic therapy for peripheral arterial occlusive disease, a randomized study comparing its efficacy with that of operative intervention has never been performed. This study evaluates the potential of intraarterial urokinase infusion to provide clinical benefits in patients with acute peripheral arterial occlusion. METHODS: Patients with limb-threatening ischemia of less than 7 days' duration were randomly assigned to intraarterial catheter-directed urokinase therapy or operative intervention. Anatomic lesions unmasked by thrombolysis were treated with balloon dilation or operation. The primary end points of the study were limb salvage and survival. RESULTS: A total of 57 patients were randomized to the thrombolytic therapy group, and 57 patients were randomized to the operative therapy group. Thrombolytic therapy resulted in dissolution of the occluding thrombus in 40 (70%) patients. Although the cumulative limb salvage rate was similar in the two treatment groups (82% at 12 months), the cumulative survival rate was significantly improved in patients randomized to the thrombolysis group (84% vs 58% at 12 months, p = 0.01). The mortality differences seemed to be primarily attributable to an increased frequency of in-hospital cardiopulmonary complications in the operative treatment group (49% vs 16%, p = 0.001). The benefits of thrombolysis were achieved without significant differences in the duration of hospitalization (median 11 days) and with only modest increases in hospital cost in the thrombolytic treatment arm (median $15,672 vs $12,253, p = 0.02). CONCLUSIONS: Intraarterial thrombolytic therapy was associated with a reduction in the incidence of in-hospital cardiopulmonary complications and a corresponding increase in patient survival rates. These benefits were achieved without an appreciable increase in the duration of hospitalization and with only modest increases in hospital cost, suggesting that thrombolytic therapy may offer a safe and effective alternative to operation in the initial treatment of patients diagnosed with acute limb-threatening peripheral arterial occlusion.

Acute Disease↗
PubMed1991

Clinical evaluation of stenosis of the carotid bifurcation with magnetic resonance angiographic techniques.

We evaluated the images of 60 carotid artery bifurcations in 31 patients suspected to have carotid artery disease who underwent invasive carotid angiography and combined two-dimensional, phase-sensitive and a gradient-echo magnetic resonance angiography. The phase scans consisted of seven serial projections that were obtained at 20 degrees intervals (11.0 minutes) around the carotid bifurcation; the gradient-echo (GRASS) scans were composed of 11 axial images (2.4 minutes) acquired through the bifurcation. The two magnetic resonance angiographic techniques yielded complementary pieces of information and were used together to compare magnetic resonance angiography with invasive angiography. Comparison of magnetic resonance and invasive angiograms of the 60 carotid arteries shows that the sensitivity (86%) and specificity (92%) of the magnetic resonance angiographic techniques we used to diagnose clinically significant carotid stenosis approach but do not reach those of invasive angiography.

Aged↗
PubMed1991

Improved magnetic resonance imaging of the temporomandibular joint by oblique scanning planes.

This study was undertaken to investigate whether the quality of magnetic resonance images of the temporomandibular joint could be improved by scanning in oblique planes oriented according to the individual angle of the mandibular condyle (oblique images) instead of in the true anatomic sagittal and coronal planes (orthogonal images). Sagittal and coronal magnetic resonance images obtained by both methods in 21 patients were compared for image quality of the disk. In more than half the patients the oblique images demonstrated the anatomy of the disk better than the orthogonal images. Oblique images are therefore recommended.

Adolescent↗
PubMed1989

Reduced-bandwidth MR imaging of the head at 1.5 T1.

A decrease in the magnetic resonance (MR) imaging bandwidth can be used to increase the signal-to-noise ratio (S/N) at constant imaging time or to maintain the S/N for reduction of imaging time. The effect of bandwidth reduction from the default value of 16 kHz to 8 kHz was evaluated prospectively in 50 patients referred for MR imaging of the head. On intermediate (2,000/30 [repetition time msec/echo time msec]) and more T2-weighted (2,000/90) studies, there were no definite missed diagnoses and no diagnostically important changes in lesion characteristics when the reduced-bandwidth technique was used to obtain half- or quarter-time studies, excluding differences attributable to unintentional changes in patient position between image acquisitions. Chemical shift misregistration artifacts associated with reduced bandwidth are easily recognized with experience and do not interfere with diagnosis, as the artifacts occur in characteristic locations and diminish in most anatomic locations with increasing echo time. This study suggests the feasibility of reduced-bandwidth techniques in clinical MR imaging of the head at high field strength to achieve an increased S/N, to decrease imaging time, or to obtain images in additional projections.

Brain↗
PubMed1989

Gadolinium-DTPA-enhanced magnetic resonance scanning in cerebellopontine angle tumors.

Magnetic resonance (MR) imaging has quickly emerged and already replaced computerized tomography (CT) in the evaluation of cerebellopontine angle (CPA) lesions, although even MR scanning may occasionally yield equivocal results. We recently studied six patients with a new MR image-enhancing contrast, gadolinium-DTPA (Gd-DTPA). All patients were suspected of having CPA pathology, and the standard MR scan was either negative, equivocal, or left unanswered questions regarding confirmed lesions. The Gd-DTPA-enhanced MR scan confirmed tumors or added useful information in five of six patients.

Adult↗
PubMed1988

The role of catheters and guidewires in the production of angiographic thromboembolic complications.

Thromboembolic complications occurring during angiography may result from a number of different causes. Catheters and guidewires can interact with blood to form thrombi; this tendency is related to wall defects and the chemical composition and structural characteristics of the catheters and guidewires. Nonthrombic sources of emboli may consist of foreign bodies derived from surgical equipment or may exist in the flushing solution and contrast media. Plastic emboli may be shed from catheters and guidewires when the guidewires are passed through the catheters. Air emboli may result from poor technique or loose fitting connections between the catheter and injector or syringe; they can mimic emboli from catheters and guidewires. A number of strategies for decreasing the risk of thromboembolic complications during angiography are reviewed.

Angiography↗
PubMed1988

Temporomandibular joint: MR assessment of rotational and sideways disk displacements.

The accuracy of coronal and sagittal magnetic resonance (MR) imaging was examined in the assessment of rotational and sideways displacements of the temporomandibular joint (TMJ) disk. Rotational disk displacement implies a combination of anterior and medial or lateral displacements, whereas sideways displacement implies pure medial or lateral displacement without an anterior component. Multiple 3-mm-thick coronal and sagittal MR images were obtained of 18 fresh TMJ autopsy specimens and compared with the observations in corresponding coronal cryosections. MR imaging correctly delineated the mediolateral position of the disk in 15 joints (83%) and incorrectly delineated it in three joints (17%). Osseous anatomy was correctly assessed in 17 joints (94%). On cryosections, six joints (33%) showed medial disk displacement and two joints (11%) showed lateral displacement. In five of these eight joints the medial or lateral displacement occurred in conjunction with an anterior displacement, that is, rotational displacement. Clinical MR imaging in 37 patients (61 joints with coronal images) showed medial or lateral disk displacement in 16 joints (26%). This study suggests that rotational and sideways displacements of the TMJ disk are an important aspect of internal derangement. The multiplanar capabilities of MR are suitable for an assessment of these abnormalities.

Adolescent↗
PubMed1986

Clinical and arthrographic evaluation of temporomandibular joint sounds.

Two hundred five patients were examined for temporomandibular joint pain and dysfunction. Arthrograms were performed on 222 joints (188 unilateral and 17 bilateral). Patients with joint sounds suspected of being caused by meniscus displacement with reduction were evaluated. Seventy-two patients (38%), were suspected of "clicking" (a reducing meniscus), but only 53 had arthrographic findings of a reducing meniscus. Further evaluation of this patient group revealed that only 41 probably could be candidates for a protrusive splint. This represents only 57% (41 of 72) of patients with "clicking" who may be candidates for protrusive splint treatment.

Arthrography↗
PubMed1986

Normal and abnormal temporomandibular joint: MR imaging with surface coil.

The normal temporomandibular joint (TMJ) was evaluated using magnetic resonance (MR) imaging with a surface coil in five subjects and compared with the abnormal joint in 37 patients (aged 14-59 years; total joints studied, 76). Multisection 3-mm-thick sagittal, coronal, and axial images were obtained with a 1.5-T MR system and 6.5-cm-diameter surface coil using both partial saturation and spin-echo sequences (TR = 1,000 msec, TE = 20 or 25 msec). A comparison with arthrography (n = 13 joints), computed tomography (CT) (n = 11), and surgical (n = 5) findings demonstrated that MR imaging with a surface coil provided an accurate depiction of both normal and abnormal TMJs. MR provided information about meniscal position, morphology, and histology that was not available with either arthrography or CT alone. The imaging potential of MR and its noninvasive characteristics warrant priority for further examination of MR as a useful modality in the diagnosis of TMJ pain and dysfunction.

Adolescent↗
PubMed1985

Arthrographically assisted splint therapy.

Occlusal splints are often constructed to aid in treatment of temporomandibular joint meniscus displacement. Techniques for arthrographically locating the point of meniscal displacement and for fabrication of an appropriate occlusal splint are described.

Cartilage, Articular↗
PubMed1985

Evaluation of arthrographically assisted splint therapy in treatment of TMJ disk displacement.

Eighty-two patients with audible clicking were evaluated and treated with splints made by using arthrographic assistance. In the course of this study, it became apparent that the later the opening click, the earlier the closing click. It was not always possible to auscultate or palpate either an opening or a closing click in many patients with arthrographic findings of disk displacement with reduction. Since the opening click was the only audible sound in some patients, clinical judgment alone cannot be used to replace the displaced disk at an optimal mandibular position. The elimination of the opening click does not always signify recapture of the disk. Maxillomandibular and incisal relationships limit the amount of protrusion possible to recapture the displaced disk.

Adolescent↗
PubMed1985

Overview of computed tomography of the temporomandibular joint.

Computed tomography of the temporomandibular joint has been shown to be an accurate method of assessing the position of the disk. To date, we have examined over 500 patients with this modality and have found it also to be effective in the evaluation of other osseous and soft tissue abnormalities. An overview of temporomandibular joint pathology is presented, including the range of osteoarthritic changes from spur formation to complete fusion. Anterior dislocation, with and without reduction, and closed lock are demonstrated. A heretofore unreported phenomenon--posterior dislocation of the meniscus with open lock--is presented. Also shown is the computed tomography evaluation of splint therapy, which has not been dealt with in other publications.

Adult↗