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R Grassi

Publications and source records attributed to R Grassi.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Sixty-one consecutive patients with gastrointestinal perforation: comparison of conventional radiology, ultrasonography, and computerized tomography, in terms of the timing of the study].

Plain abdominal radiography is the method of choice to diagnose gastrointestinal perforation because it shows the presence of free intraperitoneal air and of other associated radiologic signs. Recently, the modern methods of cross-section imaging, that is US and CT, have become useful tools for the accurate detection and depiction of free abdominal air, especially when plain films are normal or nonspecific. A series of 61 consecutive patients operated on for viscus perforation at Cardarelli Hospital, Neaples, was retrospectively reviewed: the authors report the site and cause of perforation and the diagnostic methods used preoperatively to recognize the radiographic sign of free air; examination time and the time passed between the first radiograph and surgery were also investigated. Of 61 patients, 53 underwent preoperative radiologic exams: plain abdominal radiographs were performed on 50 patients, abdominal US on 29 and CT on 15, while 8 patients were submitted to surgery with no previous diagnostic examination. Direct and indirect signs of perforation were assessed to compare the sensitivity of the methods and to suggest a possible diagnostic protocol. Combined radiography, US and CT showed signs of perforation in 71% of cases (direct signs in 57.5% and indirect signs, that is free intraperitoneal fluid and hypoperistalsis, in 14.5% of cases). When free air was absent (1/3 of cases), free intraperitoneal fluid was the only radiologic finding. The authors conclude that plain abdominal radiography, when correctly performed, is still the main tool permitting free air, if present, to be depicted in 100% of cases. When plain abdominal radiography is positive, other radiologic procedures are unnecessary while, when it is negative and symptoms persist, US and CT should be performed after at least 6 hours' interval to allow the radiologic picture to change markedly.

Humans↗
PubMed1996

[Diagnostic imaging of diaphragmatic trauma].

PURPOSE: To assess the semiology, effectiveness and role of the modern diagnostic methods used to study diaphragmatic injuries. MATERIALS AND METHODS: We report our personal experience acquired in the last 4 years in 23 patients. Eighteen patients had blunt and 6 penetrating diaphragmatic trauma, 10 of them involving the right and 14 the left hemidiaphragm. Plain chest X-rays were performed in 19 cases, gastrointestinal (GI) barium studies in 2, US in 5 and CT in 21 cases. RESULTS: Plain chest films were normal in one case (5%), not specific in 6 (32%), suggestive in 7 (37%), and diagnostic in 5 (26%). Barium studies of the GI tract were diagnostic in both patients (100%). US was suggestive in one case (20%) and diagnostic in 4 (80%). CT was not specific in 4 cases (19%), suggestive in 8 (38%) and diagnostic in 9 (43%). CONCLUSIONS: Plain chest radiography remains the method of choice in the study of diaphragmatic injuries. US, in our still limited experience, seems to be the most accurate method in the direct demonstration of muscular traumas and should be performed more often in the study of diaphragmatic injuries. CT has poorer accuracy and, above all, shows only indirect signs, but it is fairly effective and plays a key role in the depiction of chest and abdominal traumas. Barium studies should be reserved, possibly, to the direct identification of digestive hernias, especially in the late phase.

Adolescent↗
PubMed1996

[Single-center experience with the Palmaz-Schatz intracoronary stent: the immediate results and medium- and long-term follow-up].

The recent implantation of intravascular devices (stents), during percutaneous transluminal coronary angioplasty (PTCA), has shown favourable results, decreasing acute occlusion and restenosis during follow-up as compared to PTCA alone. The aim of the study was to assess in a single center the efficacy of the implantation of a Palmaz-Schatz stent in a homogeneous group of patients and to assess the incidence of angiographic restenosis. Fifty-four consecutive patients (mean age 57 +/- 12 years) with single vessel coronary disease at angiography and with objective evidence of myocardial ischemia were studied. According to the duration of angiographic follow-up, patients were divided into two groups: Group I (mean 6 +/- 3 months) and Group II (mean 29 +/- 5 months). Stent implantation was performed electively in 43 patients (80%) while in the remaining 11 (20%) as "bail out" in a failed PTCA. Sixty-five stents were implanted in 54 patients of whom 1 stent in 47 patients (87%), 2 stents in 3 patients (6%) and 3 stents in the remaining 4 patients (7%). The stents were placed in the anterior descending of the left coronary artery in 32 patients (59%), left circumflex coronary artery in 8 patients (15%) and right coronary artery in 14 patients (26%). Mean diameter stenosis before stent implantation was 88 +/- 6% and decreased significantly to 4 +/- 7% after stent implantation (p < 0.0001). No major complications such as death, Q wave myocardial infarction, emergency coronary artery bypass graft or stroke occurred during the procedure. Minor complications such as wrong positioning of the stent, non occlusive acute thrombosis, non Q wave myocardial infarction and transient vessel occlusion occurred in 9% of treated patients. At follow-up, in Group I, 8 patient of 43 (18%) showed a > or = 50% restenosis and 10 patients < 50% restenosis; in the remaining 25 patients no variations in the caliber of the vessel were observed. In Group II, 2 patients of 11 (18%) showed a > or = 50% restenosis and 1 patient < 50% restenosis; in the remaining 8 patients no variations in the caliber of the vessel were observed. Complications during medium and long-term follow-up included total vessel occlusion in 1 patient. In conclusion, these data confirm that the Palmaz-Schatz stent may be implanted with high success and low complication rate. The percentage of restenosis, occurring in near 20% of the cases, remains an unresolved problem, despite the implantation of such intravascular devices.

Adult↗
PubMed1996

[Role of anal endosonography in inflammation and trauma of the anal canal].

Anal endosonography (US) is a valuable tool to represent the normal anatomy of the anal canal and also to reliably examine patients with anal conditions. Our series consisted of 40 patients with suspected inflammatory and traumatic conditions of the anal canal submitted to anal US, which showed the presence of abscesses in 18 patients with suspected anal canal inflammation. A fistula was associated in 14 of the 18 patients and US after air injection easily showed a cutaneous orificium in 6 of the 14 patients. Anal US showed the presence and site of all abscessual foci and fistulae, also identifying the inner orificium and the involvement of muscular sphincteral structures, which is useful information to plan the most appropriate medical or surgical treatment. As for traumas, anal US is also a useful tool for identifying sphincteral injuries secondary to blunt trauma and for following-up sphincteral reconstruction with graciloplasty. Twenty-two patients with suspected sphincteric trauma were examined and anal US showed a sphincteral injury in 7 of 13 patients with acute postpartum-related symptoms; the clinical picture was ascribed to postpartum stretching of the pudendal nerve in 6 other patients. Finally, this method can be very useful in the follow-up of anal diseases, both to study surgical drainages and in the postoperative study of anal fistulae.

Anal Canal↗
PubMed1995

["Uncompensated" small bowel obstruction in adults. Ultrasonographic findings of free fluid between loops and its prognostic value].

Plain abdominal film is the method of choice in the assessment of intestinal obstruction. This technique exhibits some limitations and must be frequently correlated with other diagnostic tools. Of them, US has been recently reported to allow the morphofunctional study of intestinal loops with high accuracy. Nevertheless, the literature on the usefulness of US disregards a sign of great interest, i.e., extraluminal fluid between bowel loops. Our personal experience in 56 adult patients with surgically confirmed small bowel obstruction suggests that this findings, demonstrated by US in 43 patients (73%), identifies early intestinal wall damage with high sensitivity. US, depicting fluid between bowel loops, can distinguish the various stages of obstruction, with major consequences on clinical management. US and plain abdominal film findings allowed us to distinguish three stages of obstruction: simple obstruction (15/56 patients, 27%), uncompensated obstruction (26/56 patients, 46%), and complicated obstruction (15/56 patients, 27%). These three evolutive stages exhibit different severity and require different surgical approaches.

Adult↗
PubMed1995

[Endoanal ultrasonography, defecography, and enema of the colon in the radiologic study of incontinence].

In the last 3 years, the authors examined 564 patients with disturbed anorectal function. Of 41 incontinent subject in this series, 30 were retrospectively analyzed to assess the diagnostic contribution of double contrast barium enema, defecography and endoanal sonography. The authors propose a classification of fecal incontinence based on imaging findings: indeed, rectal incontinence can be distinguished from pelvic and sphincteral incontinence. Large bowel enema and defecography are the examinations of choice if rectal incontinence is suspected on the basis of clinical history and possible endoscopic, manometric and electromyographic findings. Defecography is suggested if pelvic incontinence is suspected, while anal endosonography is the exam of choice in case of suspected sphincteral incontinence. Especially thanks to the recent availability of the latter technique, today radiologists can directly visualize the anal sphincteral apparatus and its lesions, yielding objective evidence of this type of incontinence too. The authors report on both limitations and indications of each diagnostic method and conclude by stressing the fundamental role diagnostic imaging plays today in the study of this disorder.

Adult↗
PubMed1995

[Incomplete Boerhaave syndrome of the cervical esophagus].

It is known that an acute postemetic injury may evoke a spontaneous rupture of the oesophagus. This spontaneous rupture may produce an intramural hematoma or a laceration of the oesophagus wall. The intramural hematoma is restricted to the esophageal wall and may produce a fistula into the lumen of the oesophagus (with creation of a double lumen) or into the mediastinum (haematoma of the mediastinum). On the other hand the rupture may extend from the mucosa (lesion of Mallory-Weiss) into the complete wall of the oesophagus (Boerhaave's Syndrome). There are reports on a lesion of the exterior muscular layer of the third distal half of the oesophagus, which had evoked an acute haemorrhage into the mediastinum and has been defined as a variant of Boerhaave's syndrome. We now describe a similar case which is confined to the cervical oesophagus and has been treated without surgical intervention.

Airway Obstruction↗
PubMed1994

Immunologic disturbances and levels of parathyroid hormone in uremic patients in replacement dialysis therapy.

We studied the changes in cellular immunity in patients in replacement dialysis therapy (RDT) and examined the relationship between T-lymphocyte function and plasma levels of parathyroid hormone (PTH). In a preliminary study we found that increased plasma levels of PTH were associated with a decrease of T-lymphocytes and CD4, an increase in CD8 and a reduction in the ratio of CD4 to CD8. In the present study we examined the relationship between plasma levels of PTH, interleukin 2 receptors (IL-2R) and soluble human CD8 (S-CD8). We studied 54 patients divided into two groups: 26 patients with normal levels of PTH and 28 patients with increased levels of PTH. We found a significant reduction in total T-lymphocytes in both groups as compared to controls, with an inverse correlation between total T-lymphocytes and plasma PTH in the second group (R = -0.52). There was an increase in IL-2R in the group II as compared to the controls and also in the total population of uremic patients with a linear correlation between levels of IL-2R and PTH (R = 0.6). The levels of S-CD8 showed a significant increase in both groups with a linear correlation between levels of SC-D8 and PTH (R = 0.63). No specific differences were seen between patients treated with and without 1,25-dihydroxyvitamin D3. The elevated levels of PTH affect the lymphocyte function and are associated with change in cellular immunity with reduction in total number of T cells, and increases in levels of CD8, S-CD8 and IL-2R.

Adult↗
PubMed1994

[Diagnosis of free air in the abdomen. Role of echography].

Pneumoperitoneum secondary to gastrointestinal tract perforation is usually detected with plain abdominal films. Even when the examination cannot be performed in the upright position, free abdominal gas can be demonstrated with the accurate evaluation of supine radiographs. Some literature studies showed the value of ultrasonography and its higher diagnostic yield than that of plain abdominal films. However, in our experience on a series of 37 patients with surgically confirmed post-perforative pneumoperitoneum who underwent US first and radiography second, US had lower sensitivity than radiography (76% vs 92%, respectively). This was only partially compensated for by the detection of other signs and by better etiologic orientation. Therefore, we believe plain abdominal films to be still the method of choice to study the patients with suspected gastrointestinal perforation. Thus, US should be used in selected cases only--i.e., clinical conditions preventing radiographs from being performed correctly, persisting clinical suspicion with negative or questionable radiographic findings, the exclusion of other acute abdominal conditions, and finally the presence of pneumoperitoneum in the patients referred for different clinical reasons.

Adult↗
PubMed1994

[Videoproctography in the study of rectal intussusception. The authors' own experience].

Videoproctography has proved to be a useful diagnostic technique to investigate anorectal disorders; it can provide morphological and functional information which no other diagnostic method yields. From a series of 898 videoproctographs, the findings of 117 patients with rectal intussusception were retrospectively reviewed. The most common symptoms were an incomplete emptying feeling (93% of cases), obstructed defecation (78%), and a feeling of upright rectal weighting (71%). Of the three known types of rectal intussusception, the most common type was distal intussusception (44%), followed by the rectoanal type (38%) and finally by the proximal type (19%). The three types of intussusception were frequently (42%) associated with other disorders of rectal ampulla and especially with rectocele (15%), mucosal prolapse (8%), and descending perineum syndrome (12%); they had different clinical correlations and proctographic patterns and could be recognized in different defecation phases. In our personal experience, proctography with videorecording was a useful diagnostic tool in the dynamic assessment of this morphofunctional disorder which represents one of its major indications.

Adult↗
PubMed1994

[The National Workshop on Defecography: anorectal deformities with a functional origin (prolapse, intussusception, rectocele)].

The nonoperative treatment--i.e., rubber band ligation and sclerotherapy--of mucous rectal prolapse, rectocele and intussusception is much less expensive than conventional surgery (Lit. 325,000 vs. 6,500,000, p < 0.0001 on the average). Symptom relief, however, has been reported in 0 to 57% of cases only, according to current literature. A possible cause is represented by improper management from misdiagnosis, relying on clinical findings only, overestimating mucous prolapse in 36.37% of cases and underestimating intussusception in 14.22% of cases (with respect to defecography). Defecography is a cost-effective method (average cost: Lit. 37,000) potentially reducing failure rate after the surgical repair of rectal prolapse.

Ambulatory Surgical Procedures↗
PubMed1993

Functional intraperineal pouch of rectal wall (posterior rectocele).

We have identified 18 cases of functional pouch of the posterior rectal wall visualized by defecography. In the absence of previous evidence in the literature, we named this anomaly "posterior rectocele" and studied it from the clinical, radiologic, and endoscopic points of view.

Adult↗
PubMed1993

Parathyroid hormone and T-cellular immunity in uremic patients in replacement dialytic therapy.

We studied 54 patients in replacement dialytic therapy divided into two groups: Group 1, 26 patients with normal parathyroid hormone (PTH) (10-80 pg/ml): and Group 2, 28 patients with elevated PTH (80-400 pg/ml). Total T lymphocytes, CD4, CD8, and CD4/CD8 ratio were evaluated. We found a reduction of total T lymphocytes in both groups compared with controls. A decrease of CD4 and CD4/CD8 ratio with a rise of CD8 occurred in Group 2 but not in Group 1. In Group 2, PTH presented a linear correlation with CD8 and a reverse correlation with total T cells. CD4, and CD4/CD8 ratio. PTH might act on T-cellular immunity with an immunosuppressive effect from the earlier phases of hyperparathyroidism.

Adult↗