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Biomedical subjects

O Catalano

Publications and source records attributed to O Catalano.

At least 55 records · Page 3Linked to original sources
PubMed1997

Papillary injuries and duodenal perforation during endoscopic retrograde sphincterotomy (ERS): radiological findings.

OBJECTIVE: To describe the radiological features of duodenal injury during endoscopic retrograde sphincterotomy (ERS) with special reference to limited papillary trauma and minor perforation. METHODS: The radiological and clinical features of duodenal injuries out of 284 ERS performed in the last 4 years were evaluated retrospectively to document various patterns of trauma and correlation with clinical outcome. RESULTS: Duodenal injuries occurred in eight patients: mild papillary injuries in five subjects (intrapapillary extravasation of contrast medium in one, peri-Vaterian submucosal diffusion in four) and duodenal perforation in three (peri-choledochal diffusion in one, retroperitoneal leakage in two). CONCLUSION: The radiological findings in papillary and duodenal injuries are protean and knowledge of their variable appearance is important since their detection may have practical consequences.

Aged↗
PubMed1997

Mental status and pain perception during stressor tests in patients with coronary artery disease.

Asymptomatic myocardial ischaemia is frequently observed in patients with coronary artery disease (CAD), both during daily life and during stressor tests. Psychological mechanisms seem to be involved in the lack of pain during myocardial ischaemia. The aim of this study was to verify in a selected population of CAD patients whether mental status might influence the pain perception during different stressor tests. The study population contained 73 male patients (mean age 52+/-8 years) with stable angina during daily life, reproducible exercise-induced myocardial ischaemia during ergometric stress test (EST) and angiographically documented CAD. All patients underwent cold pressor test (CPT), mental arithmetic stress test (MST), hyperventilation test (HT) and mental stress in association with cold pressor test (combined test, MST + CPT). During the stressor tests, myocardial ischaemia was induced in 15/73 (21%) patients by CPT, in 18/73 (25%) by MST, in 15/73 (21%) by HT and in 19/73 (26%) by MST + CPT. Out of the patients with stressor test-induced myocardial ischaemia, silent ischaemia was observed in 43/73 (59%) during EST, in 10/15 (67%) during CPT, in 16/18 (89%) during MST, in 7/15 (47%) during HT and in all patients during MST+CPT (100%). Among the ischaemic symptomatic patients during stressor tests, the lowest anginal pain intensity was experienced during MST (4.0+/-2.2) and the highest during EST, both at peak exercise and at the ischaemia threshold (6.6+/-2.9 and 5.9+/-2.7, respectively, p<0.05). During MST, the prevalence of silent ischaemia was higher than was observed during the other tests. All study patients remained asymptomatic when myocardial ischaemia was induced by MST + CPT. Even the intensity of CPT induced hand pain was significantly higher during CPT alone than during MST+CPT. These results confirm that mental status may influence pain modulation.

Journal Article↗
PubMed1997

Greater curvature antral flattening due to nonsteroidal antiinflammatory drugs.

PURPOSE: To report on our experience concerning a recently described double-contrast finding of gastritis related to the use of non-steroidal antiinflammatory drugs (NSAIDs), namely, flattening of the greater antral curvature. MATERIAL AND METHOD: The radiographic examinations of 41 subjects studied for NSAIDs gastropathy or for different reasons but with recent abuse of NSAIDs, were reviewed. The radiographs of 100 consecutive patients without history of NSAIDs use and evaluated for different questions were used as controls. RESULTS: Flattening of the greater curvature was present in 5 subjects (12%) with a prolonged history of NSAIDs use and in none of the controls. In three cases it was a solitary finding whereas in two it was associated with antral erosions. CONCLUSION: In our series, antral flattening was less frequent than reported in literature. Nevertheless, it may be a useful sign of NSAIDs gastropathy and may be especially relevant when representing the only evidence of gastric lesions related to NSAIDs.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1997

Massive enterolithiasis associated with ileal dysgenesis.

A 20-year-old man with massive ileal enterolithiasis was investigated with plain radiography, ultrasound, computed tomography, barium follow through and double contrast barium enema. Ileocecal valve agenesis was found at surgery. The enteroliths were located in the distal ileum, which communicated with the large intestine via an ileotransverse fistula.

Adult↗
PubMed1997

Transient small bowel intussusception: CT findings in adults.

Transient non-obstructing intussusception is known to occur in adults. While the CT findings in small bowel intussusception have been described in detail, few reports concerning transient cases have been published. We evaluated five patients with non-obstructive jejuno-jejunal invagination. All CT studies showed a target pattern with an intraluminal soft tissue mass, an eccentric mesentery, and a slightly dilated intussuscipiens. Transient intussusception has typical CT features and should be distinguished from more severe forms requiring prompt surgical treatment.

Acute Disease↗
PubMed1997

[The crescent and the periluminal halo: two computer tomography signs of aortic aneurysm with risk of rupture?].

PURPOSE: To assess the prevalence, significance, and practical value of two recently described CT signs of instable aneurysm: the crescent sign (a curvilinear high-attenuating density within the thrombus) and the periluminal halo (a low-attenuating internal layer of the thrombus around the patent lumen). MATERIAL AND METHODS: Among the CT examination performed in the last 5 years, we retrospectively selected the nonruptured aneurysms with a diameter exceeding 4 cm (no. = 93, average diameter 5.1 cm, unenhanced images in 28 cases and enhanced in 84) and the ruptured aneurysms (no. = 16, average diameter 6.7 cm, unenhanced images in 9 cases and enhanced in 9). We studied the prevalence of the crescent and halo sign, their relationship with the aneurysm diameter, and the effect of contrast enhancement. RESULTS: The crescent sign was identified with a statistically significant prevalence in ruptured (37.5% of cases) over asymptomatic aneurysms (5.5%); the halo, instead, had the same frequency in the 2 groups (12.5% and 9.5%, respectively). Both signs were more frequent in bigger aneurysms and were recognizable without differences in unenhanced and enhanced images. CONCLUSIONS: The crescent sign, though not exclusive of aneurysmal rupture, indicates instability and its detection should lead to careful follow-up or surgical repair. The halo seems to have no real value as risk factor.

Adult↗
PubMed1997

[Echography in the study of an intramural hematoma of the intestines].

PURPOSE: To report our experience concerning the integrated diagnostic imaging of intestinal intramural hematoma, with special reference to the different patterns and to the accuracy of US examinations. MATERIAL AND METHODS: In the last 4 years we examined 7 patients with intraparietal hematoma, due to anticoagulant therapy, using real-time US. All the subjects presented with abdominal pain, sometimes associated with distention, tenderness, bleeding, hematocrit reduction, palpable mass or obstruction. The hematomas involved the duodenum in 2 cases, the jejunum in 4, and the descending colon in 1. US was performed in all patients, plain abdominal radiographs in 6, oral barium studies in 1, large bowel enema in 1, and computed tomography (CT) in 3. All patients were managed conservatively except the one with colonic location who was treated surgically. RESULTS: In all subjects, the US findings were characteristic and included clean and defined double- or multilayered thickening of the bowel wall (usually with a thick and hyperechoic inner layer and a thin and hypoechoic outer layer), undulated mucous membrane, narrowed lumen with corpuscolated fluid content and gas spots, decreased peristalsis with fixity of the images, fluid between the loops. Plain abdominal radiographs were relevant in 3 cases, showing focal intestinal distention, thickening of the intestinal wall and of the valvulae conniventes, bowel lumen narrowing and fixity of the findings. The findings were nonspecific/negative in the 2 subjects with duodenal involvement and demonstrated an intestinal obstruction in that with colonic location. Oral barium study did not provide, in the single patient examined with this tool, specific results, only causing time consumption and diagnosis delay. Barium enema was valuable in demonstrating the presence and level of the colonic obstruction due to the hematoma. Similarly to US, CT always demonstrated the intestinal changes, with a better panoramic detailing, but did not provide relevant additional information. CONCLUSION: US shows a rather characteristic spectrum of findings in the intramural intestinal hemorrhage. The US data, possibly confirming plain abdominal radiographic findings, are in most cases relevant for the correct diagnosis of intraparietal hematoma and conclusive for the diagnostic course.

Acute Disease↗
PubMed1996

Pseudo-pneumoretroperitoneum secondary to lumbar emphysema: CT demonstration in two cases.

Several conditions may simulate the radiolucent appearances of pneumoretroperitoneum at plain film. These include gas shadows in locations other than the retroperitoneal space or fluid within the retroperitoneal compartments. Two cases of emphysema within the soft tissues of the back mimicking pneumoretroperitoneum on plain radiographs are described. One case was secondary to epidural anesthesia and another to trauma. In both, computed tomography (CT) led to the correct diagnosis. The possible pitfalls in the differential diagnosis of retroperitoneal gas are described with emphasis of the diagnostic role of CT.

Adult↗
PubMed1996

Small bowel volvulus following ileal pouch-anal anastomosis: CT demonstration.

We report a case of acquired small bowel volvulus as a cause of late obstruction after ileal J-pouch anal anastomosis. Computed tomography (CT) demonstrated signs of strangulated, adhesive obstruction with radial disposition of the loops around the mesenteric root and abnormal position of the superior mesenteric artery and vein on the right side of the aorta. These features were due to the surgical manipulation and tension of the mesentery and its vessels during ileoanal anastomosis.

Anal Canal↗
PubMed1996

Susceptibility to pain during coronary angioplasty: usefulness of pulpal test.

OBJECTIVES: This study in patients with coronary artery disease (CAD) sought to 1) determine the dental pain threshold and reaction to tooth pulp stimulation; 2) correlate the clinical, ergometric and angiographic features of patients with and without pain during percutaneous transluminal coronary angioplasty (PTCA) to pulpal test response; 3) verify whether reactivity to dental pulp stimulation could help to identify patients particularly prone to perceiving angina during myocardial ischemia. BACKGROUND: Silent myocardial ischemia is frequently observed in patients with CAD. Higher pain thresholds have been documented in asymptomatic subjects, suggesting a generalized hyposensitivity to pain. METHODS: Eighty-six consecutive male patients with reproducible exercise-induced myocardial ischemia and CAD documented by angiography underwent PTCA. A pulpal test was performed in all patients by means of an electrical tooth pulp stimulator. RESULTS: Seventy-one patients (82.6%) with and 15 (17.4%) without angina during daily life were studied. During the pulpal test, 57 patient (66.2%) reported dental pain, whereas 29 (33.7%) were asymptomatic, even at maximal stimulation of 500 mA. The study cohort was classified into two groups according to the presence (58 patients [group 1]) or absence (28 patients [group 2]) of angina during myocardial ischemia induced by PTCA. Ergometric variables, extent of CAD, presence of ST segment elevation during PTCA, number of inflations, inflation time and maximal inflation pressure were similar in the two patient groups. Dental pain was provoked by pulpal test in 81% of patients with and 36% of patients without symptoms during PTCA (p = 0.0004). The absence of dental pain even at maximal tooth pulp stimulation (500 mA) was observed in 11 (18.9%) patients in group 1 and 18 (64.2%) in group 2. Patients who were asymptomatic during PTCA had a higher mean dental pain threshold, lower mean threshold reaction and lower mean maximal reaction than those who were symptomatic during both PTCA and the pulpal test. CONCLUSIONS: A correlation between the prevalence of symptoms during pulpal test, daily life, exercise-induced myocardial ischemia and PTCA was found. A higher dental pain threshold and lower reactivity characterized those subjects who were prone to silent ischemia both during daily life and during PTCA. Ergometric variables, extent of CAD and techniques used during PTCA were unrelated to the tendency to perceive pain during myocardial ischemia. Response to the pulpal test and the presence of symptoms during daily life were highly related to the presence of angina during PTCA.

Angioplasty, Balloon, Coronary↗
PubMed1996

Retroperitoneal hemorrhage due to a ruptured adrenal myelolipoma. A case report.

Adrenal myelolipomas are usually small and asymptomatic tumors discovered incidentally. In a small number of cases, acute pain may develop secondary to intratumoral and/or retroperitoneal bleeding. We observed a large, surgically and histologically confirmed, myelolipoma of the right adrenal gland with spontaneous internal and external hemorrhage. CT demonstrated heterogeneity of the mass, obliteration of the surrounding fat planes, and retroperitoneal blood dissection. A literature review produced only 5 reports of ruptured myelolipoma with external hemorrhage.

Adrenal Gland Neoplasms↗
PubMed1996

Case report: identification of the transverse mesocolon and root of small bowel mesentery; a new sign of pneumoperitoneum.

A new sign of pneumoperitoneum was observed in a patient with perforation of the ascending colon. The presence of free air in the peritoneal cavity allowed identification of the transverse mesocolon and the root of the small bowel mesentery on plain abdominal radiographs obtained in the supine and in the prone position. This sign may be an aid in the diagnosis of pneumoperitoneum.

Aged↗
PubMed1996

[Computed tomography in the study of gastrointestinal perforation].

Plain radiography is the method of choice in suspected perforating pneumoperitoneum. Nevertheless, especially when air collections are small, the technique must be very accurate, with patient mobilization and long examination times, which may be unfeasible in acute abdomen patients. To overcome these limitations, such cross-sectional imaging methods as US and especially CT are increasingly used. Our series consisted of 38 patients with gastrointestinal tract perforation examined 1990-94; thirty-one of them had surgical confirmation. CT had high sensitivity, demonstrating the presence of free intraperitoneal gas in more patients than conventional radiography (92% vs. 74%). Pneumoperitoneum was depicted between liver surface and anterior abdominal wall in 30 cases, in the subhepatic region in 17, posterior to the abdominal wall at paraumbilical level in 14, between the mesenteric folds in 8, in the pelvis in 7 and in other locations in 11. Extraluminal fluid collections were apparent in 79% of cases and contrast agent collections in 73%. The three most common findings were: intraperitoneal gas, fluid effusion and extraluminal contrast agent leaks (61.5%), gas and effusion (29%) and gas only (16%). The origin of the perforation was demonstrated in 82% of cases and its cause in 37%. CT was particularly useful in the diagnosis of clinically occult, of early and of confined perforations. Small gas bubbles, mild fluid effusion or minimum contrast agent leaks near perforation site are valuable signs. In selected cases CT can play an integrative role, thus improving the diagnostic accuracy of plain films.

Contrast Media↗