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Biomedical subjects

R Campani

Publications and source records attributed to R Campani.

At least 73 records · Page 4Linked to original sources
PubMed1993

[Rheumatoid arthritis: echographic study of lesions of the periskeletal soft tissues].

The role of US was investigated in the study of rheumatoid arthritis, since the method depicts the changes in the periskeletal soft tissues--i.e., where the disorder preferably locates in both its early and late phases. A hundred and fifty-eight patients affected with rheumatoid arthritis according to American Rheumatism Association criteria were examined: the hand (wrist, carpus, metacarpus and fingers), the knee and the foot (metatarsus and toes) were studied in all patients. The study population was divided into two groups according to the time of onset of the disease: in 82 of them (52%) the onset of symptoms dated back to less than a year, while 76 of them (48%) had been suffering for over a year. US appears as the most accurate method to study the early phases of rheumatoid arthritis, for it makes early diagnosis possible, thus allowing the correct treatment to be chosen and preventing the disease from causing the irreversible lesions which progressively disable the patient. In the early phases of rheumatoid arthritis, US detects the exudative effects of synovial inflammation in periskeletal soft tissues. Joint effusions and synovial pannus are also depicted by US, as well as the thickening of tendon sheaths and tendon ruptures and rheumatoid nodules. In the late phases of rheumatoid arthritis, US supports conventional radiology, the latter remaining the irreplaceable method of choice to demonstrate skeletal lesions. Nonetheless, in such phases US yields further information on periarticular soft tissue involvement which no other method would make available--e.g., the presence of effusions, bulgings, synovial pannus, joint cartilage erosions, damaged tendons and sheaths, hypoplasia of the muscles ending on the involved joint and finally periarticular changes. Finally, US proves of great value in the early demonstration of reactivating phases, with unquestionable prognostic advantages.

Arthritis, Rheumatoid↗
PubMed1993

[Color-Doppler in the study of male sexual impotence].

The authors report their experience with color-Doppler US in the study of 54 male patients with sexual impotence. The examination includes two distinct phases; in between, the erection-inducing drugs is injected directly in the cavernous bodies. During the basal phase, B-mode information relative to both morphology and structure of cavernous bodies is collected. After injecting the drug, systolic and end-diastolic velocities are evaluated as flowmetric indices, together with the resistive index; these variables are derived from cavernous arteries, at scheduled time--i.e., 5, 10 and 20 minutes after the injection. Moreover, the examined patients were divided into 4 groups according to their clinical response to the pharmacologic test. Color-Doppler US proved to be quite sensitive in the identification of the patients with a vascular alteration, both venous and arterial, underlying their erectile dysfunction; as a matter of fact, venous flights are easily depicted with the use of colors. The authors believe that color-Doppler could eventually become a major exam in the diagnosis of sexually impotent patients, thus allowing the marked reduction of such invasive diagnostic techniques as selective angiography of internal pudendum arteries and dynamic cavernosography, which are poorly tolerated by the patients.

Adolescent↗
PubMed1993

[Echographic assessment of the hand: normal anatomy and pathologic patterns].

Ultrasonography (US) can ben used to study the hand thanks to small-parts probes whose frequency ranges 7.5 MHz to 20 MHz. Due to the complex hand anatomy, the clinician often needs further data relative to periskeletal soft tissues and vessels, which are provided by color Doppler US. Our personal series included 465 patients and a group of 20 healthy volunteers. A silicon pad was used to ensure max. adhesion to probe surface, given the uneven surface of the examined structures. Besides normal anatomic patterns, US demonstrated pathologic features in tendons, sheaths and muscles. As for tendons, stenosing and hypertrophic-exudative tenosynovites were depicted, as well as cysts and ruptures. As for muscles, the main findings were ruptures and, rarely, tumors. Relative to joints, arthrogenous ganglia and rheumatism were observed. Finally, the carpal tunnel syndrome was accurately investigated, where US revealed tenovaginalitis with sheath thickening and deformed and compressed median nerve in the carpal tunnel. Also the benign and malignant masses whose primary location is the nervous tissue are easily demonstrated on US, their typical shape being ovalar. To conclude, US proved extremely accurate in all the surgical patients, exhibiting 100% sensitivity in all of them; its specificity ranged from 84% for tendons, to 81% for muscles, 79% for nervous tissues and finally 82% for joint disorders.

Female↗
PubMed1993

[The remodelling of the heart in heart failure: from thoracic radiography to magnetic resonance].

Congestive heart failure represents the most common medical hospital discharge diagnosis, and can occur in patients with preserved indexes of left ventricular systolic function, even in absence of patent coronary or valvular heart disease. The present review examines the role of imaging techniques in the diagnosis and follow-up of these patients. Imaging of the heart has undergone dramatic advances with the development and refinement of new imaging modalities such as echocardiography, computed tomography, magnetic resonance and radionuclide emission tomography. The role of "low-tech" modalities such as chest roentgenogram is discussed. The possibilities offered by ultrasounds or magnetic resonance in tissue characterization are then compared with the actual capability of cardiac imaging in detecting myocardial tissue alterations (oedema, ischemia, myocarditis, etc.) and/or degeneration (fatty degeneration, fibrosis, amyloidosis, etc.). Finally, the potential use in modern clinical medicine of magnetic resonance spectroscopy and positron emission tomography to study myocardial metabolism and cellular function are discussed.

Angiocardiography↗
PubMed1993

[Dynamic vascular imaging with magnetic resonance imaging of the thoracic and abdominal region. Technique optimization].

Several Magnetic Resonance (MR) imaging techniques for the study of the main thoracic and abdominal vessels are analyzed. Such techniques based on the static representation of vessels, as MR angiography (MRA), are considered, together with dynamic techniques--i.e., cine MR--and those based on ultra-fast sequences with bolus contrast medium administration; the latter are considered also according to their use in the study of the early parenchymogram. Namely, the investigated techniques are: 3D/2D inflow imaging with and without presaturation, 3D inflow imaging with paramagnetic contrast medium administration, 2D/3D phase/dephase subtraction imaging, cine MR with heart gating, the sequential dynamic single-slice technique with bolus contrast medium, and the apnea multi-slice imaging. The main parameters are indicated for each technique and type of sequence. From our experience, rather precise indications emerge as to the use of the various techniques according to the investigated region and to the suspected disease. The best techniques for demonstrating sacciform aneurysms proved to be the 3D inflow ones, as well as the cine MR and the turbo-flash sequences with contrast medium; as for dissecting aneurysms, cine MR proved best. In portal flow conditions and in major veins thromboses, 2D inflow and phase/dephase subtraction sequences are suggested. In the study of renal stenoses, limitations and advantages of 2D versus 3D sequences are compared. Moreover, indications, limitations and specificity are analyzed of the early parenchymogram based on ultra-fast sequences with paramagnetic contrast medium. In the authors' experience, the different MR vascular imaging techniques must be considered only an integration to more specific investigations, but it is likely that, as it happened with MRA of the head and neck, the increase in resolution and the reduction in artifacts will--soon--turn this kind of imaging into the examination of choice in vascular studies.

Abdomen↗
PubMed1993

[Dynamic sequential study of hepatic nodular lesions with ultra-fast sequences and fast bolus of gadolinium-DTPA].

Eighty-five patients with single/multiple nodular hepatic lesions (10 focal nodular hyperplasias, 37 liver hemangiomas, 24 metastases and 16 hepatocellular carcinomas; 2 patients had associated lesions) were examined with dynamic single-slice sequences and fast i.v. bolus injection of Gd-DTPA. The dynamic single-slice technique was used to evaluate the peculiar features of the dynamic enhancement. The snapshot sequence proved best to provide the high temporal resolution of the dynamic parenchymal enhancement (scanning time < 1 second, one frame every third second). The following variables were investigated: nodular lesion intensity in the first basal snapshot image, enhancement appearance and its contemporaneity with arterial, venous or portal flows, enhancement gradient relative to surrounding liver parenchyma, morphologic features of the enhancement and its centrifugal/centripetal patterns. The enhancement curve of focal nodular hyperplasia increased very quickly during the first 20-25 seconds. This enhancement was quite similar to the arterial one and always occurred before portal and systemic venous times. Hemangiomas exhibited a typically slow growth-curve in the first 120 seconds, with a positive final gradient value relative to liver parenchyma. The appearance of peripheral contrast enhancement was a typical sign after 30 seconds. Metastases exhibited similar dynamic enhancement to hemangiomas, but peripheral enhancement was never observed and, after 120 seconds, gradient was null or negative relative to the adjacent liver parenchyma. Moreover, enhancement always followed portal times. Hepatocellular carcinomas showed an early growth curve, preceding portal times, but less marked than in hyperplasia. The study of our series provided the preliminary semiology of early dynamic enhancement patterns, which is quite specific to recognize and differentiate nodular hepatic lesions.

Contrast Media↗
PubMed1992

The clinical value of computed tomography and lymphography in detecting lymph node metastases from epithelial ovarian cancer.

We investigated the accuracy of both lymphography and computed tomography (CT) in detecting lymph node metastases in 58 patients with primary epithelial ovarian cancer (group a) and subsequently submitted to surgery including pelvic and/or lumbo-aortic lymphadenectomy. CT accuracy was also investigated in 41 patients with clinically suspected relapse of ovarian cancer (group b). In the first group (a) overall results in the pelvis were, respectively, for lymphography and CT: 94.8 vs 89.6% accuracy, 85.7 vs 57.1% sensitivity, 97.7 vs 100% specificity, 97.7 vs 100% positive predictive value and 95.5 vs 88% negative predictive value. In the lumbo-aortic region, we had: 88.8 vs 86.1% accuracy, 71.4 vs 64.2% sensitivity, 100% specificity and positive predictive value for both techniques, and 84.6 vs 81.6% negative predictive value. In the second group (b) CT accuracy, sensitivity and specificity were 90.2, 80 and 100%, respectively. CT, thanks to its high specificity and positive predictive value, can represent the method of choice for the evaluation of pelvic and lumbo-aortic lymph node metastases in untreated and relapsing ovarian cancer. CT demonstration of lymph node metastases can affect not only lesion staging, but also chemotherapy; different indications for lymphadenectomy may also depend on CT.

Adult↗
PubMed1992

[Computed tomography and tumor markers as diagnostic alternatives to second-look surgery in the treatment of malignant ovarian tumors].

Advanced malignant ovarian cancers are treated, after initial surgery, with first-choice mono/polychemotherapy, the response to which is evaluated by means of second-look laparotomy. The poor prognostic value of second-look results, the incidence of false negatives, the lack of valuable second-choice therapies, and the high incidence of complications after repeated interventions, lead to the testing of diagnostic imaging modalities--especially CT and tumor markers (Ca 125 and Ca 15-3). To define their actual clinical value, CT and serum assays of Ca 125 and Ca 15-3 have been performed on 32 treated patients affected with ovarian cancers (stages II-IV), who were clinically free of disease. The results have been compared with second-look pathology, but especially with patient follow-up (min. 24 months). Second-look laparotomy yielded a high number of false negatives (9/22 = 41%); moreover, many important/severe complications were observed. Thus, its value appears to be questionable. CT exhibited high positive predictive value (76.9% over the 24-month follow-up); high for both Ca 125 and Ca 15-3 (100% respectively, at 24-month follow-up) thus, few false positives were observed. Moreover CT, having higher sensitivity (55.5%) than Ca 125 (11.5%) and Ca 15-3 (27.7%), has greater diagnostic capabilities, especially when the lesion is in extraperitoneal location.

Aged↗
PubMed1991

[High resolution tridimensional study of the blood vessels of the neck and the intracranial circulation with magnetic resonance angiography].

Magnetic Resonance Angiography (MRA) is a modern vascular imaging technique which allows the noninvasive and direct imaging of vessels. The authors aimed at evaluating the diagnostic accuracy of MRA in the study of pathologic conditions in the neck and intracranial vessels; spatial resolution of the technique was also investigated. Twenty-four healthy volunteers and 82 patients suffering from various diseases of the head and neck vessels were included in the study. First of all, MRA capabilities were investigated in visualizing normal vessels of both neck and intracranial circle. The diagnostic accuracy of the method was then evaluated in the study of vascular diseases, and the results compared with conventional/digital angiographic findings. The comparison demonstrated how stenoses and atherosclerotic plaques tend to be overestimated by MRA because of technical artifacts inherent to the technique itself, whereas vascular ulcerations and aneurysms are frequently underestimated. However, this data was steady and therefore evaluable--the exact knowledge of the artifacts making diagnosis reliable. The diagnostic and technical problems relative to the various vascular diseases are discussed. Finally, several hypotheses of diagnostic iter are suggested.

Angiography, Digital Subtraction↗
PubMed1991

[Role of color coded duplex sonography in the study of thyroid pathology. Personal experience].

The authors examined 110 patients with suspected pathologic conditions of the thyroid by means of color-coded duplex US. In addition to the information yielded by conventional US, this technique allows organ vascularization to be demonstrated. Five normal patients were considered as a control group: no tissue vascularization was demonstrated in these cases. In 8 patients presenting with carcinoma or recurrences, vascularization was markedly increased both peripheral and central to the nodule. A few doubts are still to be solved as to the diagnostic value of color-coded duplex US in the evaluation of non-carcinomatous nodular pathologic conditions. As a matter of fact, non-functioning avascular adenomas can be demonstrated only in a very low percentage of cases (66%). Color-coded duplex US proved extremely sensitive and specific in depicting malignant neoplasms. Moreover, the use of fine-needle biopsy could be optimized and subsequently reduced. Color-coded duplex US proved to be markedly superior to other methods and techniques in the study of thyroid diseases, especially thyroiditis and multiple pathologic conditions. The simultaneous presence of hypocapture at scintigraphy and peripheral and central vascularization in a single nodule or within multinodular struma at color-Doppler was highly suggestive of malignant thyroid neoplasm. Color-coded duplex US is a low-cost technique, which can be performed on an outpatient basis. Moreover, it is not invasive, nor does it damage the thyroid. That is why its use is almost mandatory in the study of pathologic conditions of the thyroid.

Adult↗
PubMed1991

[Diagnostic reliability of ultrasonography in the preoperative staging of the N parameter in head and neck neoplasms].

The demonstration of metastatic involvement of neck nodes is a crucial step in the staging of patients with head and neck tumors. Diagnostic accuracy, sensitivity, and specificity of US in the detection of lymph node metastases were evaluated in 48 patients with this type of malignancy. The patients subsequently underwent surgical node dissection. Comparison of US, clinical and histological data demonstrated US to have 93.7% diagnostic accuracy, 100% sensitivity, and 84% specificity--the corresponding clinical values being 81%, 79%, and 84%, respectively. Among several US parameters, a substantial role in differentiating metastatic from tumor-free lymph nodes was played by the evaluation of roundness index (RI), and by the demonstration of an intranodal hyperechoic stria: RI value was always higher than 2 in tumor-free nodes and the hyperechoic stria was always absent in metastatic nodes. US approach never failed to demonstrate metastatic nodes while clinics missed them in 6 patients. Thus, US appears the most valuable diagnostic tool for staging head and neck tumors; its diagnostic accuracy can be increased by the combination with US-guided aspiration biopsy.

Aged↗
PubMed1991

[Current role of hysterosalpingography in the assessment of female infertility: review of a series of cases].

The authors reviewed 463 hysterosalpingographies from a series of patients examined for primary infertility. 25.5% of them had been studied with echotomography and 4.1% with therapeutic and explorative laparoscopy. Hysterosalpingographic results were compared with positive findings at clinical examination and with various pathologic associations: the method proved to be extremely valuable in the diagnosis of the primary causes of female infertility, and even showed secondary, sometimes unsuspected, causes--e.g., iatrogenic and inflammatory. Moreover, high agreement (50%) was observed with echotomographic findings. The examination was carried out on an outpatient basis, and proved less dangerous and cheaper than other invasive techniques, its cost being more or less the same as that of US, which however is still the least dangerous and expensive method for the diagnosis of female infertility. Therefore, the authors suggest that diagnostic laparotomy be a second choice and be employed only in the cases where it can have therapeutic purposes. In all the extant cases, combined hysterosalpingography and US are still recommended.

Female↗
PubMed1991

[Noninvasive evaluation of the left and right ventricular function using magnetic resonance].

MR imaging is one of the methods allowing the measurement of heart volumes. It provides oblique body sections along the cardiac axes according to cardiac anatomical planes and a spontaneous contrast between blood and myocardium. This study was aimed at evaluating the reliability of both ventricular volumes and ejection fraction measurement by applying the area-length method in patients with a normal left ventricle (group A, 13 patients), in patients with a dilated hypokinetic left ventricle (group B, 20 patients), in cases with segmental abnormalities of the kinesis of the left ventricle following myocardial infarction (group C, 15 patients) and in cases with pathologic involvement of the right ventricle alone for the calculation of the right ventricular ejection fraction (group D, 16 patients), as compared with ventriculography. Good correlations between MR ejection fraction and angiographic ejection fraction were observed in all groups (group A: r = 0.79, p less than 0.001; group B: r = 0.80, p less than 0.001; group C: r = 0.97, p less than 0.001; group D: r = 0.98, p less than 0.001). In the patients in groups A and D volumetric values were constantly underestimated, both telediastolic and telesystolic, due to both the partial volume effect and the cardiac rotation and translation during systole. MR imaging emerges as a reliable method which can easily be applied to the evaluation of left and right ventricular function even in routine examinations.

Adolescent↗