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P Pricca

Publications and source records attributed to P Pricca.

At least 19 recordsLinked to original sources
PubMed2002

True 3D reconstruction for planning of surgery on malformed skulls.

OBJECTIVES: Since the difficulty associated with surgical planning of craniosynostosis is mostly due to the inadequate possibilities for simulation of surgery, a new technique for constructing a precise reproduction of a patient's malformed skull has been developed. MATERIALS AND METHODS: CT scans of ten malformed skulls on a scale of 1:1 and with 1-mm slices have been used to reconstruct the skulls in a special resin using a special lathe used in the automobile construction industry for formula one engines. This lathe works in the opposite way to other lathes: by apposition of material instead of subtraction. RESULTS: The anatomical detail of the phantom is of a very high degree. The surgical planning it allows has proved highly consistent with reality in all cases in which it has been used in the planning before the operation. DISCUSSION AND CONCLUSIONS: This technique has made it possible to plan the surgical treatment of all patients with craniosynostosis in a highly satisfactory way. It has reduced operating times, in addition to which it provides information on materials needed, avoiding waste, and is also an excellent teaching method for residents.

Craniosynostoses↗
PubMed1997

The use of indomethacin to treat acute rises of intracranial pressure and improve global cerebral perfusion in a child with head trauma.

BACKGROUND: The use of vasoconstrictors (e.g. dihydroergotamine, indomethacin) for the treatment of increased intracranial pressure (ICP) secondary to brain trauma is controversial. In particular, it has been suggested that vasoconstrictors be employed only for intracranial hypertension secondary to hyperemia, when venous jugular bulb saturation (SjO2) is > 75%. METHOD: We administered indomethacin as a bolus i.v. (5-10 mg) on 18 occasions to a multiple-injured 3-year-old child with acute rises of ICP secondary to severe brain trauma (GCS score 7) determining a large hypodensity area in and swelling of the right hemisphere. RESULTS: Before indomethacin administration the average of mean ICP was 68.1 +/- 10.8 (SD) mm Hg (range 47-84) and the cerebral perfusion pressure (CCP) was 38.4 +/- 10.4 mm Hg (range 30-65). In response to indomethacin, ICP dropped in a few seconds to 22.7 +/- 5.6 and CCP increased to 82.4 +/- 6.1 mm Hg (P < 0.001), while the mean arterial pressure remained unchanged. On 6 occasions SjO2 was also evaluated immediately before and 5 and 10 min after indomethacin administration. Before indomethacin administration, SjO2 values were within the normal range on 2 occasions and abnormally low on four. SjO2 increased from the mean value of 45.6 +/- 15.7 to 59.8 +/- 8.9 (after 5 min) and 60.6 +/- 12.4% (after 10 min) (P < 0.01 versus pre-indomethacin). At the same time the cerebral venous pH increased from 7.43 +/- 0.01 to 7.45 +/- 0.01 (P = 0.01). These findinge suggest that the global cerebral perfusion was improved. Eighteen days after injury the child was awake and was discharged from the ICU. CONCLUSION: To our knowledge, increase of SjO2 in response to indomethacin has not been previously reported. Although great caution is necessary in the use of indomethacin for the treatment of ICP, these findings suggest that indomethacin can be useful for the treatment of acute rises of ICP compromising severely the CCP, even if SjO2 is normal or abnormally low. Under these circumstances, indomethacin can improve the global cerebral perfusion.

Cerebrovascular Circulation↗
PubMed1994

[Neuroradiology of infective diseases in the immunocompromised host].

Just like the lung, the brain and the spinal cord are target organs for opportunistic infections and tumors in immunocompromised patients. HIV infections and AIDS-related conditions represent the most common cause of immunodeficiency: other causes are hemoproliferative disorders and organ transplantation, but especially long-term drug and radiation therapies. Neurologic (focal, diffuse, meningeal or spinal) signs are the results of CNS infections and/or tumors or of treatment complications. Neuroimaging techniques (MRI better than CT) allow the infective or neoplastic causes of neurologic complications to be nearly always recognized and are therefore major tools for diagnosis and treatment. Lesions characterization is more difficult, since CT and MR patterns are definitely more affected by the evolutive phases of the lesions (encephalitis, cerebritis, abscess) and by their sites than by specific infective agents. However, the knowledge of the statistical possibility of brain and spine infections according to the type of immunocompromission is useful in many cases.

Central Nervous System Diseases↗
PubMed1993

[Shoulder instability and pain. Computerized arthro-tomography assessment].

The growing interest in shoulder joint imaging comes from the ever-increasing demand for such an examination in orthopedics. Since more complete and detailed imaging of bone, capsuloligamentous and musculotendinous compartments is always needed, CT arthrography has necessarily become a widely used method. In this study, 282 patients were investigated with CT arthrography. Seventy per cent of them had anatomical instability, 17.3% had functional instability and the extant 12.7% had shoulder pain. In traumatic instability, the most often injured structures were the glenoid labra (91%) and the capsule (82%). Lesions in the two structures were nearly always associated. Moreover, high incidence (65.8%) of Hill-Sachs lesions of the humeral head was observed. In atraumatic instability, abnormal anteversion of the scapular glenoid was always detected. In the patients with shoulder pain, the most common causes were the impingement syndrome (30.5%), superior labrum lesions (16.7%), adhesive capsulitis (16.7%) and synovial osteochondromatosis (13.7%). With CT arthrography, labial abnormalities (detachments, tears, amputations, eversions and degeneration) can be identified, as well as capsular lesions (insertional detachment and laxity), rotator cuff conditions (bursitis, tendinitis and partial/complete tears), biceps tendon abnormalities and glenoid rim and humeral head fractures. Moreover, CT arthrography is minimally invasive and well tolerated. It exhibits 97.7% specificity, 91% sensitivity and 96% accuracy. Furthermore, it has been proven to be extremely useful in treatment and surgical planning.

Adolescent↗
PubMed1992

Atraumatic patellofemoral joint disorders. Long-term results of surgery.

Clinical and radiographic follow-up was done on a group of patients with atraumatic patellofemoral joint disorders who had been treated surgically by realignment of the extensor apparatus at the authors' institution from 1985 to 1989. The preoperative radiographic examination in the 65 patients treated (for a total of 74 realignments) evaluated the following parameters: sulcus angle, Insall-Salvati index, and congruence angle. The 46 patients who returned for follow-up (after an average of 2 years and 3 months) were evaluated clinically according to a classification system proposed by the authors which is based on objective clinical data and a multi-factorial assessment of pain. Moreover, radiographic follow-up of the same 46 patients made it possible to quantify the degree of realignment achieved with each type of surgical technique. The clinical and radiographic data made it possible to determine more precise indications for each type of surgical procedure in relation to the disease involved, using a correct diagnostic approach and making a thorough evaluation of the clinical, anatomical and pathological features.

Adolescent↗
PubMed1990

[Diagnostic definition of cerebral lesions in a case of AIDS: importance of the use of magnetic resonance].

The present study describes a case of AIDS with asymptomatic intracranial focal lesions. The DDD-enhancement CT technique detected the lesions as inflammatory or neoplastic. A subsequent MR demonstrated the vascular nature of the intracranial findings. MR in the neuropathology of AIDS can be of primary importance in the detection of the intracranial focal lesions, thus avoiding a cerebral stereotaxic needle biopsy.

Acquired Immunodeficiency Syndrome↗
PubMed1989

[Neuro-AIDS: a multicenter neuroradiological study].

The results are described of a retrospective multicentric CT/MR study of 141 neuro-AIDS patients (IV group CDC classification); 114 patients were drug addicted, 13 homosexual, 8 polytransfused, and 6 had other risk factors. The mean age was 29.6 years. The pathologic agent was identified in 47 cases by c.s. fluid examination, biopsy, autopsy or specific treatment response: it was HIV in 20 cases, toxoplasmosis in 11, cryptococcosis in 9, leishmaniasis, salmonella and papovavirus in single cases. In the follow up of 2 cases, a Kaposi's sarcoma and a primitive CNS lymphoma occurred. The main clinical features were AIDS-dementia complex (45% of cases) and focal neurologic manifestations (36%). The neuroradiological protocol consisted of 238 CT exams (97 controls), most of them with DDD (delayed double dose) technique, 7 MR exams (0.15 T) and 2 angiographies. CT findings were divided into 3 groups: negative (16%), atrophic (47%) and focal lesions (37%). In the first and second group, HIV and cryptococcal infections were the main pathologic agents. In the third group toxoplasma infections were discovered, and TB granulomas and other pathologic conditions, with ring-like or nodular enhancement, in cortical/cortico-medullary location. In follow-up patients a high tendency of evolution towards focal lesions was observed, even in negative cases. The DDD enhancement technique allowed in most cases both the demonstration of very small lesions and their grading. According to the literature CT, though a highly sensitive method, is inferior to MR imaging; however our experience in this field is currently insufficient. The specific diagnosis of pathologic agents of neuro-AIDS is difficult, due to the high number of opportunistic AIDS-related infections and neoplasms, with overlapping features: differential diagnostic criteria can be assessed only by comparing the clinical, microbiological, topographic, CT and MR findings. CT and MR exams are necessary to guide and monitor therapy and to plan stereotaxis biopsy.

Acquired Immunodeficiency Syndrome↗
PubMed1988

[Computerized tomography in surgically treated lumbar disk hernia. Multicenter study].

Results are reported of a multicenter analytic-statistical CT study on 128 postoperative lumbar herniated disk (HD) cases (50 at L4-L5, 64 at L5-S1, 2 at L3-L4, 12 multiple). CT was performed from 10 days to 204 months (47.7 months of mean) after surgery, in 51 patients without and in 77 with intravenous contrast medium (42 in bolus, 35 in perfusion). In 59 cases (38%) a recurrent hernia was found, and in 8% a new hernia. In 81% of patients epidural fibrous scars were demonstrated, in a rough 50% of cases associated with recurrent/new hernia: posterior fibrosis was found in 81% of cases, while unilaterally, bilaterally, or anteriorly extended fibroses were present in 20%, in 4.7%, and in 29% of cases respectively. In 72% of the patients injected with contrast medium, various kinds of fibrosis contrast enhancement were detected. In 8% neither fibrosis nor recurrent herniation was found. In 22% of cases lateral and/or central bony canal stenosis was present, in 26% vacuum disk, in 9% intracanalar calcifications, in 39% and in 19.5% dural sac stretching and compression respectively. In 5 cases a pseudomeningocele was found, and in 3 only a postoperative diskitis. Fibrosis is an almost inevitable postoperative consequence (4 out of 5 cases); it can be demonstrated by CT with high sensitivity and good specificity. A series of diagnostic criteria, such as the post-contrast media reaction, allow fibrosis to be discriminated from recurrent hernia. However, the possible association must be kept in mind of both diseases and/or of included roots in the scar. Myelography is hardly ever able to supply further resolutive diagnostic elements, while Myelo-CT is sometimes more useful. The importance of bone changes is questionable, with the exception of evident cases of canal stenosis, also because in most cases the radiologist cannot count on a preoperative CT study. Furthermore, the correlation between CT and clinical findings (possible asymptomatic fibrosis) is often difficult, which gives way to contrasting therapeutic attitudes.

Adult↗
PubMed1988

[Computed arthrotomographic evaluation of chronic lesions of the cruciate ligaments].

The high incidence of cruciate ligament injuries as a result of acute knee trauma with hemarthrosis and abuse of diagnostic arthroscopies call for a suitable radiological imaging of the central pivot. Computed Arthrotomography (CAT) was used to examine the knee joint in 20 cases of clinically suspected chronic cruciate ligament injury. The images were correlated with arthroscopic and/or arthrotomic findings. Thirteen lesions of the anterior cruciate ligament (ACL) (65%) were found, plus 1 lesion of the posterior cruciate ligament (PCL) (5%), 2 associated lesions of ACL + PCL (10%), and 4 normal cases. Confirmation of pathology was available in all cases but one by arthroscopy and/or surgery. The central pivot diseases were classified as follows: absence, detachment, partial or complete tear. CAT findings of cruciate ligament injuries are emphasized and the role of the technique as compared to arthroscopy is discussed. CAT is useful in 3-D evaluation of central pivot and detection of different cruciate ligament injuries, with high sensitivity-specificity for ACL and high specificity-moderate sensitivity for PCL. In the evaluation of the chronic unstable knee, CAT is highly accurate and gives the surgeon useful information towards the planning of therapeutic procedures. CAT is almost non-invasive, well tolerated and easy to perform in out-patients, which make it a first-choice procedure in the screening of chronic ligament injuries.

Accidents, Traffic↗
PubMed1987

[Early angio-computer tomography of ruptured cerebral aneurysms in subarachnoid hemorrhage].

In acute subarachnoid hemorrhage a ruptured cerebral aneurysm can be detected by Computed Angiotomography (Angio-CT). In a hyperdense cistern by extravasal blood, a round low-density defect on plain CT which turns into high-density nodular mass with afferent and efferent arteries, is an important finding of ruptured aneurysm. The inverting-density cisternal defect in connection with cerebral arteries is essential for the direct and early Angio-CT diagnosis of ruptured aneurysm.

Adult↗
PubMed1987

[Oto-palato-digital syndrome. Clinico-radiological study].

Oto-palato-digital (OPD) or Tyabi syndrome is a familiar, X-linked bone dysplasia with intermediate expression, in females or autosomal dominant with more severe manifestations in males. In the past both the clinical features (flat face with sunken and broad nasal bridge, antimongoloid slant of palpebral fissures, palatoschysis, conductive deafness, short and broad thumbs and big toes, nail dystrophy) and radiological findings (thick and dense base of the skull, prominence of supraorbital ridges, middle ear bone deformities with dense ossicles, large and broad vertebral bodies, posterior defects of neural arches of the vertebrae, carpal and tarsal bone fusions, short and broad nail phalanges) have been well described and established. The present report describes 7 patients (4 females and 3 males) all belonging to the same family (the first described in this country) and all presenting the clinical and radiological features of OPD syndrome. A cranial and spinal CT was performed on one patient, with peculiar findings.

Abnormalities, Multiple↗
PubMed1986

[Subarachnoid hemorrhage caused by rupture of cerebral aneurysm. Value of neuroradiological studies].

The role of neuroradiological examinations in the diagnosis and in the therapeutical indication of intracranial aneurysm are analyzed and discussed on the basis of a large review of the literature. Skull X-rays, Ct scan with and without intravenous contrast enhancement, magnetic resonance imaging and angiographic have different role and different timing. They are critically evaluated in order to point out an up-to-date diagnostic phase.

Cerebral Angiography↗
PubMed1985

[Transient stenosing ureteritis in childhood. A rare complication of rheumatoid purpura].

A case of transient stenosing ureteritis in a boy presenting with the clinical features of Henoch-Schoenlein purpura (diffuse articular swelling, petechiae, abdominal pain) complicated by macroscopic haematuria with blood clots is reported. On urography the right collecting system and the right ureter up to the distal lumbar portion were dilated owing to tight ureteral stenosis at that level. Above the stricture, numerous ring-like functional ureteral wall defects were detectable. On the left a stenosis was evident at the lumbo-sacral level with mild dilatation of the ureter. A small filling defect due to subephitelial haemorrhage was evident in the upper part of this ureter. Three months later, after prednisone therapy, the urography was normal on the right: residual mild stenosis was still evident on the left. Radiological findings in Henoch-Schoenlein purpura and the possible differential diagnosis of this condition are discussed.

Child, Preschool↗
PubMed1984

[Computerized tomography in the study of malignant tumors of the larynx].

A systematic investigation was carried out on 93 patients suffering from laryngeal tumours who underwent computed tomography and xeroradiography. A comparison is made between CT, xerographic, clinical and endoscopic findings. The value is stressed of functional informations obtained from CT performed during quiet breathing and phonation. The outstanding value of CT is the accuracy in definition of tumor extension and involvement of the laryngeal and paralaryngeal tissues. CT can be useful in diagnosis of regional lymph nodes metastases. The correct evaluation of the tumour is greatly helpful in surgical treatment and radiotherapy planning.

Epiglottis↗
PubMed1984

[X-ray computed tomography in non-neoplastic pathology of the larynx].

The authors describe the CT findings in 57 patients suffering from various non-neoplastic disease of the larynx: chronic laryngitis, pseudotumor, paralysis, post-traumatic lesions, laryngocele, cyst. CT is usefull in evaluating site and extension of the disease, as well as its relations with the surrounding tissues. The densitometric evaluation and the functional tests are important in differential diagnosis with malignant neoplasms.

Adolescent↗
PubMedDate not supplied

[Difficulties in interpreting a conspicuous retroperitoneal hematoma due to rupture of the inferior pancreatico-duodenal vessels at the onset of edematous-type acute pancreatitis].

The authors report on a case of conspicuous retroperitoneal haematoma with haemoperitoneum due to rupture of the lower pancreatico-duodenal vessels appearing at onset of an acute oedematous pancreatitis. After stressing the rarity of this event, the authors go on to discuss a number of aetiopathogenetic, diagnostic and therapeutic aspects.

Acute Disease↗