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Biomedical subjects

L Bonomo

Publications and source records attributed to L Bonomo.

At least 91 records · Page 5Linked to original sources
PubMed1996

[Induratio penis plastica: the diagnostic possibilities of gradient-echo sequences (magnetic resonance angiography)].

The authors investigated the diagnostic capabilities of gradient echo sequences (magnetic resonance angiography) in the study of induratio penis plastica. Twenty patients (mean age: 39 years) were examined. MRA was performed with a superconductive magnet (1.5 T) and a Helmoutz coil; the dynamic test with PGE (20-40 mg) was also carried out. The images acquired on the axial and sagittal planes were processed according to the MIP. The FLASH 2D sequence was used with the following parameters: FA 18 degrees, TR 40 ms, TE ms, MA 256 x 256, slice thickness 5 mm. A multiple choice card was filled in by a reader with the following diagnostic information: identification and localization of the plaques and involvement by the plaques of the albuginea, corpora cavernosa, septum and dorsal vein; surgery was the gold standard. MRA showed 10/11 plaques ranging 8-30 mm in diameter and missed a 5-mm plaque. Moreover, MRA depicted the infiltration of the albuginea in 10/10 cases, of the septum in 3/3 cases, of the dorsal vein in 4/4 cases and of the corpora cavernosa in 9/9 cases. Our preliminary experience shows that in the study of induratio penis plastica, the gradient echo sequence (MRA) permits better depiction of the plaques and of the infiltration of the corpora cavernosa, septum and albuginea.

Adult↗
PubMed1996

[Spiral computerized tomography and videothoracoscopy in the assessment of contralateral nodular lesions in patients with bronchogenic carcinoma].

Recent improvements in endoscopic technology and surgical techniques have widened the application field of video-assisted thoracoscopy (VAT). We report our personal experience in 14 male patients (mean age: 67 years, range: 55-73 years) in whom one or multiple indeterminate contralateral lung nodules were found during bronchogenic carcinoma staging and then surgically resected with VAT. All patients underwent volumetric CT of the chest. Sixteen lung nodules were detected contralateral to the neoplasm; their mean diameter was 5 mm (range: 2-10 mm). The mean distance between pleural surface and lung nodule was 8 mm. All patients had primary lung cancer (3 central and 11 peripheral lesions), histologically confirmed by bronchoscopic or percutaneous CT-guided biopsy. None of them had any contraindication to surgery because of extrathoracic pathologic conditions. VAT was performed as normal, under general anesthesia, with assisted ventilation with a double-lumen endotracheal tube and using a percutaneous mechanical stapler. The nodules were easier to identify using a skin reference point corresponding to the parietal projection of the nodule, positioned with CT before surgery. Surgery lasted 58 minutes on the average (range: 30-120 minutes). In all patients VAT was successful in resecting the nodule. In 9 patients a metastasis from a contralateral lung cancer was found: 4 adenocarcinomas, 4 epidermoid carcinomas and 1 small cell carcinoma. In the remaining 5 patients, VAT-resected lung nodules were of chronic inflammatory nature. The latter patients underwent definitive surgery of the primary tumor (2 adenocarcinomas, 2 epidermoid and 1 large cell carcinomas) ten days later (range: 9-30 days). There were no major complications but a prolonged air leak in one patient, which needed drainage to be maintained for 5 days. Presently, VAT permits an atypical resection, avoiding the morbility of thoracoscopy and thus represents a mandatory technique in selected patients amenable to definitive surgery.

Aged↗
PubMed1996

[Pulmonary artery: angiographic technique optimization with magnetic resonance].

The authors optimized the Magnetic Resonance Angiography (MRA) technique for the study of the different portions of the pulmonary artery-i.e., the common trunk, right and left main arteries and the lobar, segmental and subsegmental branches. Twenty volunteers were examined with MRA of the pulmonary arteries with a 1-T superconductive magnet (Impact) and the time-of-flight (TOF) technique. The volunteers were divided into two groups by age (ranges: 20-40 and 41-70 years). The trunk and main branches were studied with the 2D TOF technique, while 2D TOF images were compared with 3D TOF images in the study of peripheral (lobar, segmental and subsegmental) branches. The images were processed with the maximum intensity projection (MIP). In the statistical comparison between 2D and 3D TOF images, the t-test was used (p < 0.05). The 2D TOF images acquired on the sagittal oblique and coronal planes, with presaturation pulses, permitted optimal depiction of the trunk and of the right and left branches in all the volunteers. Both 2D and 3D TOF images yielded excellent images in the study of the lobar branches. In the volunteers under 40 years of age, 3D TOF sequences visualized the peripheral (segmental and subsegmental) vessels better than 2D TOF sequences (451 vs. 361); the difference was statistically significant. In the volunteers over 41 years of age, the ratio was reversed: 467 for 2D TOF vs. 362 for 3D TOF sequences; again, the difference was statistically significant. The correct integration of 2D and 3D TOF sequences, according to the different segments of the pulmonary artery and to patients' age, permitted the complete and accurate visualization of the pulmonary arteries with MRA.

Adult↗
PubMed1996

[Magnetic resonance angiography of the origin of the supraaortic trunks: the tridimensional time-of-flight with single volume technique].

This work was aimed at studying the origin of the epiaortic vessels with Magnetic Resonance Angiography (MRA). Twenty normal volunteers (mean age: 21.5 years) were examined with MRA with a superconductive magnet at 1 T (Impact). All volunteers were examined with a body coil and the time of flight (TOF) technique. The FISP 3D TONE sequence was used, with the following parameters: TR 46 ms, TE 10 ms, FA 20 degrees, ST 2.2 mm, matrix 192 x 256. The images, acquired on the axial plane with three presaturation pulses, were rotated according to the maximum intensity projection on the Z axis. To classify the images, a multiple choice card was used by a reader, with three diagnostic judgements for the different segments of the vessels (i.e., good, poor and not visualized). 3D TOF MRA permitted good visualization of the right and left common carotid in 80% and 77% of cases, of the right and left vertebral arteries in 55% and 50% of cases, of the left and right subclavian arteries in 47% and 62% of cases, and of the anonymous artery in 100% of cases. To conclude, our preliminary results indicate FISP 3D TOF MRA as the best noninvasive technique to study the origin of the epiaortic vessels.

Adult↗
PubMed1996

Antineutrophil cytoplasmic antibodies in synovial fluid and in serum of patients with rheumatoid arthritis and other types of synovitis.

OBJECTIVE: Antineutrophil cytoplasmic antibodies (ANCA) are present in several vasculitides and in other immunomediated diseases. The reported prevalence of ANCA in rheumatoid arthritis (RA) is variable. In addition, the presence of such autoantibodies has been poorly investigated in synovial fluid (SF). The objectives of this study were (1) to investigate the presence of ANCA both in the serum and in SF from patients with RA and other forms of synovitis (OS); (2) to analyze the reactivity of ANCA against isolated antigens proteinase 3 (PR3), myeloperoxidase (MPO) and lactoferrin (LF); and (3) to evaluate the clinical relevance of these autoantibodies. METHODS: Twenty-eight patients with RA, 13 with OS, and 17 with osteoarthritis (OA) of the knee joint were studied. No patient had clinical manifestations of vasculitis. SF and serum samples were investigated for the presence of ANCA by indirect immunofluorescence (IIF); the reactivity against PR3, MPO and LF was assessed by ELISA. RESULTS: ANCA were detected by IIF in SF of 39.3% patients with RA, 38.5% with OS, and 5.9% with OA. With 2 exceptions, patients who had ANCA in SF showed positivity also in serum. The presence of both anti-MPO and anti-LF antibodies was found in 3 patients with RA and 1 with OA; a patient with RA showed antibodies only against LF and another one with RA only against MPO. No reactivity was found against PR3. In patients with RA ANCA were not associated with disease activity. CONCLUSION: We found an increased incidence of ANCA both in SF and serum from patients with RA and OS. The pathogenic role and the clinical relevance of such autoantibodies in these diseases remain to be established.

Adult↗
PubMed1996

Magnetic resonance angiography of the origins of the supraaortic arteries: comparison of single and double volume acquisition 3D time of flight.

PURPOSE: The authors have optimized the technique of Magnetic Resonance Angiography (MR-angio) in the study of the origins of the supraaortic arteries. METHODS: Twenty healthy volunteers, mean age 21.5, were studied with MR-angio of the origins of the supraaortic arteries; a 1 T superconductive magnet (Impact) with body coil was used. All the volunteers were studied using Time of flight (TOF), and two acquisition techniques: single volume FISP (fast imaging with steady-state precession) 3D TONE (titled optimized non-saturating excitation) and double volume FISP 3D TONE with 30% overlapping. The images were acquired on the axial plane following the positioning of three pre-saturation pulses. RESULTS: Regarding the visualization of the different components of the origins of the supraaortic arteries, a statistical analysis was worked out using the Mann Whitney test (p < 0.05); there was no statistically significant difference between two techniques. Regarding the visualization of the various segments (origin, 1/3 proximal, 1/3 middle, 1/3 distal), although the double volume did on the one hand allow a better visualization of the more distal vascular components (statiscally significant difference), on the other it induced the presence of artefacts with decreased the quality of the image as a whole. DISCUSSION: In our experience TOF 3D technique with TONE and single volume has well identified the origin of the vertebral arteries, while, in several cases, TOF 3D technique with TONE and double volume did not permit the visualization of the origin of the vertebral arteries due to the presence of the artefacts from overlapping. CONCLUSION: From our experience we have established that the TOF 3D technique with TONE and single volume makes it possible to obtain MR-angio of a high diagnostic quality in a short time (10-15 mn).

Adult↗
PubMed1995

Long time echo stir sequence magnetic resonance imaging of optic nerves in optic neuritis.

Magnetic resonance imaging of optic nerves was obtained in 13 patients with acute optic neuritis and in 13 patients with a previous history of optic neuritis (ON), assessed by clinical, visual fields and visual evoked potentials evaluations. Results of the conventional short tau inversion recovery (STIR) sequence obtained with short time echo (STE-STIR: 22 ms) were compared with long time echo (LTE-STIR: 80 ms) sequence. The conventional STE-STIR sequence revealed lesions in 78.5% of acute ON and in 58.8% of optic nerves affected by previous ON. The LTE-STIR sequence was diagnostic in 92.8% of acutely symptomatic nerves, in 94.1% of nerves with previous ON. The calculated length of optic nerve lesions was significantly longer in imaging obtained with the LTE-STIR sequence than with the conventional STE-STIR sequences, both in acute and previous ON.

Adult↗
PubMed1995

Granulocytopenia after combined therapy with interferon and angiotensin-converting enzyme inhibitors: evidence for a synergistic hematologic toxicity.

PURPOSE: The purpose of this study was to assess whether granulocytopenia observed in 3 of 38 patients with essential mixed cryoglobulinemia who were treated with low-dose interferon was due to the underlying disease or to synergistic toxicity of interferon with other drugs. PATIENTS AND METHODS: Adverse effects of interferon therapy were monitored in 38 patients affected with type II essential mixed cryoglobulinemia. Patients were treated with 3 million units (MU), daily or on alternate days, of recombinant interferon-alpha 2a (35 patients) or with natural interferon-beta (3 patients). The duration of treatment ranged between 6 and 15 months; the total duration of follow-up, including after therapy, ranged between 8 and 93 months. RESULTS: None of 35 patients treated with interferon alone developed significant hematologic alterations. In addition, none of 7 patients treated with angiotensin-converting enzyme (ACE) inhibitors alone showed hematologic toxicity. Three patients who were treated with a combination of interferon and ACE inhibitors developed severe granulocytopenia a few days after starting treatment. Granulocytopenia subsided within 1 to 2 weeks after suspending therapy. Resumption of treatment with this drug combination produced a granulocytopenia relapse in 1 patient. In these 3 patients, interferon treatment alone, or ACE inhibitor monotherapy, was not followed by granulocytopenia. CONCLUSION: Although severe hematologic toxicity rarely develops in patients treated with low-dose interferon, granulocytopenia occurred in all 3 of our patients with mixed cryoglobulinemia who were treated with a combination of low-dose interferon-alpha 2a and ACE inhibitors. Neither drug alone was toxic in any of our cryoglobulinemic patients, indicating a high risk of severe hematologic toxicity for this drug combination, at least in patients with this disease. Physicians should be aware of this danger when using interferon treatment in patients with this, or possibly other, disorder(s) that also require antihypertensive therapy.

Adult↗
PubMed1995

Carotid bifurcation stenosis: a comparative study between MR angiography and duplex scanning with respect to digital subtraction angiography.

PURPOSE: This study compared sensitivity, specificity and diagnostic accuracy of Echoduplex and Magnetic Resonance Angiography (MRA) in the evaluation of carotid bifurcation stenosis. MATERIAL AND METHODS: Twenty-five patients with clinical signs suggestive for cerebrovascular insufficiency (CVI) were studied with Duplex scan, MRA and Digital Subtraction angiography (DSA). Gold standard was the angiographic examination. RESULTS: on equal value of sensitivity (80.5%), MRA showed 96% specificity versus 81% of Duplex scan, 89.4% diagnostic accuracy versus 80.9% for Duplex scan. As for stenosis over 31%, the value of sensitivity did not change i.e., 80.5%; MRA showed 100% specificity versus 97.1% for Duplex, 91.2% diagnostic accuracy versus 89.1% respectively. These values compared by the test for categorial analysis and correspondence analysis (p < 0.05) did not indicate any statistically significant difference. DISCUSSION: on the basis of our experience and as shown by current literature [2, 12] we can state that both MR-angiography and Duplex scan fail in quantifying correctly carotid stenosis with consequent over- and underestimation [3, 4]. However, they can be considered effective diagnostic procedures in a screening program [12, 16]; they are accurate, safe and accepted by the population. CONCLUSIONS: on the basis of the cost in planning the screening of a population at risk for CVI, Duplex scanning is still to be considered the elective procedure.

Adult↗
PubMed1995

[Spiral computed tomography of the trachea. Study technique and possible clinical applications].

This work was aimed at optimizing the spiral CT technique in studying the trachea to obtain multiplanar reconstructions with high diagnostic yield. The authors tried to identify an image reconstruction technique, on both the coronal and the sagittal planes, to visualize the whole trachea on a single image in each patient. Twenty patients, 15 with pathologic tracheal involvement and 5 with pulmonary lesions with no tracheal involvement, were examined with a Somatom Plus CT unit (spiral technique: 120 kV, 210 mA, 5-mm slices, 5-mm/s table feed and 24-s scanning time). Multiplanar reconstructions were obtained on the oblique plane, identified by three axial reference scans at different levels. The whole trachea was reconstructed on a single image in 100% of cases on the coronal plane and in 95% of cases on the sagittal plane. Image quality was good in 16 patients and acceptable in 4. The authors stress the value of spiral CT multiplanar images when the reconstruction plane lies in the tracheal lumen on both the coronal and the sagittal planes.

Cysts↗