Publications (46)82.84 Total impact
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Article: [Personal experience with computerized tomography of shock and death in emergency situations].
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ABSTRACT: The wide availability of CT machines in hospitals specialising in emergency care has made it possible to observe CT features of severe shock and death of the patient during the CT examination. Unique radiological signs can be evaluated that testify to the state of shock or indicate arrest of the contrast medium in the cardiovascular system and parenchymatous organs, with different hemodynamic features from those found in living persons. This paper aims to report our personal experience with the role of CT in documenting states of shock or death. Our series, which is relatively large considering the infrequency of cases, seems to be of interest as it is one of the few to describe these rare CT findings, which have ethical implications for all healthcare providers and the field of diagnostic imaging. In the last 5 years we have observed 16 cases (12 males and 4 females; mean age 41 years; range 17-79) of death during CT examinations. Of these, 9 were severely polytraumatized patients, 2 had ruptured aneurysms of the abdominal aorta, and one had a cardiac arrest due to cardiac infarction. Death occurred in 3 patients with head trauma, in whom the CT examination had shown signs of inoperability. The most frequent CT signs of death observed in the patients who died of polytrauma were contusive-hemorrhagic foci in the lung associated with pneumomediastinum and hemothorax (9 cases), diffuse subcutaneous emphysema of the chest wall and pneumothorax (8 cases). CT revealed bilateral costal fractures and areas of pulmonary subatelectasia in 8 cases, and rupture of the diaphragm in one. Multiple lacerations of the liver and spleen with marked hemoperitoneum, incompatible with survival, were observed in 3 cases. Vertebral traumatic alterations were present in 2 cases. In 5 cases, the last CT scans of the heart and hepatic cupula revealed massive enhancement of contrast medium within the heart and great vessels due to contrast-medium hypostasis. The diaphragm was hypotonic, an indirect sign of death, with the left hemicardium and hemidiaphragm in a lower position than found in living persons; the abdominal aorta had a reduced caliber. Such CT findings will probably become increasingly frequent in the future, because the need to avoid exploratory laparotomies or thoracotomies and unnecessary neurosurgical procedures will entail a greater demand for highly selective diagnostic examinations to be carried out on critical patients. This tendency is matched by the technological advances in diagnostic imaging, and particularly the availability of fast CT and spiral CT machines that give, in only a few seconds, an accurate diagnostic and clinical picture, on which immediate therapeutic decisions can be made.La radiologia medica 04/2001; 101(3):172-6. · 1.44 Impact Factor -
Article: [Liver trauma due to penetrating lesions: miscellanea, personal case series, clinical and CT findings].
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ABSTRACT: Penetrating liver wounds are related to many causes and rank second after blunt abdominal and liver trauma. We will report the clinical and radiological findings of our personal series of patients with penetrating trauma, especially by firearms and stab and cut wounds. We will also try to define the diagnostic workup of these traumas, which is especially based on CT signs of liver damage and associated changes and which is of basic importance for following treatment, both surgical or conservative. In the last seven years we retrospectively reviewed 31 cases of penetrating liver trauma. The patients were 19 men and 12 women, ranging in age 18 to 73 (mean 42), with penetrating liver injuries from firearms (16 patients) and stab (9 cases) wounds; 6 patients had injuries from different causes. Abdominal CT was carried out in emergency with the CT Angiography (CTA) technique in all patients. In the patients with suspected chest and abdomen involvement CT was performed from the mid-chest for accurate assessment of diaphragm and lung bases and to exclude associated pleuropulmonary damage. Penetrating liver wounds were caused by firearms in 70% of cases, by stabbing in 12% and, in the extant 18%, by other causes such as home accidents, road and work traumas, and liver biopsy. In our series, the liver was most frequently involved, especially by firearms wounds; in our 16 cases the most frequent injuries were hemorrhagic tears. We found bullets in the liver in 6 cases. In one case of home accident the patient wounded himself while slicing bread with a long knife, which cut into the anterior abdominal wall and tore the anterior liver capsule, as seen at CTA. Penetrating wounds to liver and abdomen are less frequent than those to the chest. In the past decade the use of CT has changed the diagnostic and therapeutic approach to such injuries completely, decreasing the resort to explorative laparotomy and hepatorrhaphy. Indeed, CT provides a clear picture of the extent and severity of damage, which permits to choose a conservative treatment in case of intraparenchymal hematomas and lacerocontusive foci without hemoperitoneum, which can be followed-up with physical and CT examinations. Moreover, Helical CT could provide the early diagnosis of active bleeding in the peritoneum and of focal bleeding in the liver, thus permitting prompt hepatorrhaphy or targeted hepatectomy. A diaphragm injury suspected at CT should always prompt the surgeon to intervention, especially when hemothorax, lung base pneumothorax, large liver hematoma or tear of the liver dome are associated. Finally, subdiaphragmatic free gas indicates gut perforation associated with liver damage, in which case surgery is necessary too.La radiologia medica 01/2001; 100(6):465-9. · 1.44 Impact Factor -
Article: [CT findings in fire arm injuries of the pelvis. Personal experience].
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ABSTRACT: We investigated the yield of CT in firearms wounds with pelvis involvement by evaluating the CT features of pelvis, bone walls, and associated injuries, if any. CT plays a major role, while conventional radiography remains an important integration in the workup of pelvis bone injuries. We report a retrospective series of pelvis gunshot wounds studied with CT in a 5-year period; the patients were all men, with a mean age of 38 years (range 18-56). When only the pelvis was involved, CT was performed from the transverse umbilical plane to the pubis, in order to include the continuous abdomen. We used an intravenous contrast agent to study the aorta and its iliac branches, pelvic vessels, active hemorrhagic effusions and bladder filling. Penetrating firearms wounds were found in 21 cases and perforating ones in 7. In the penetrating wounds, the bullet course was most frequently (75%) stopped by the pelvic bones, with retention and CT visualization within muscular and bone structures. The incidence of bone injuries, especially crash wounds, was high, with 18 cases (64%). In both types of wounds with anterior course, we demonstrated bladder perforation in 2 cases, vascular damage in 2 and perforation of intestinal loops in 6. Paradoxically, pelvic bone fractures may be "protective" for the pelvic content; however the involvement of large arteries and veins and multiple perforations of intestinal loops are no less dangerous than the upper abdominal wounds. CT is an important diagnostic tool that permits accurate and prompt evaluation of pelvic organs such as intestine, bladder and bone structures. Thus, CT permits prompt assessment of pelvic structures involvement by firearms wounds, which provides the clinician with useful imaging findings of bullet damage.La radiologia medica 12/2000; 100(5):310-3. · 1.44 Impact Factor -
Article: [Radiologic investigation of external rectal prolapse. Assessment in 48 patients with defecography, seven of them also with dynamic CT of the pelvis].
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ABSTRACT: To report our personal experience in 48 patients with external rectal prolapse examined with defecography, evaluating radiological signs and the indications for surgical treatment. We also report the results of 7 patients with severe prolapse submitted to dynamic CT of pelvis. The findings relative to 48 patients suffering from external prolapse, 27 women and 21 men, (mean age 58 years), were retrospectively reviewed. In our study protocol the patient is made to sit on a defecographic commode with the pelvis in lateral projection and radiographic images are acquired at rest, on contraction and on evacuation. Dynamic CT of pelvis with axial and coronal scans of the pelvic floor was carried out in 7 patients with severe prolapses. Twenty-six of 48 patients underwent rectopexy. The main symptoms were anorectal and perineal weight sensation (93%), perineal disturbance in the sitting position (91%) and anorectal pain extended to sacral area (83%). Manometry, which was performed in 36 cases, showed a rectoanal inhibitory reflex evokable at high volumes of air, especially in incontinent subjects. Defecography demonstrated external rectal prolapse in all cases; rectal intussusception in 32, mucosal prolapse in 30, abnormal widening of the anorectal angle in 24 (16 of them were incontinent), rectocele in 22 and perineal descent syndrome in 16 cases. External rectal prolapse is sometimes a dynamic progression of a rectal intussusception. In anorectal intussusceptions, the invaginatum involves the anal canal, thus causing the external prolapse. Defecography clearly shows the continuation of invagination out of the anus, with the formation of prolapse. Dynamic CT proved accurate in detecting the rectum morphology, but added no further information to defecography, except for the diastasis of anosphincterial muscles. Therefore, we conclude that defecography is the method of choice, though complementary to other instrumental techniques such as manometry, electromyography and endoscopy, in the diagnostic workup of these patients. Moreover, it can recognize other alterations, such as incontinence and rectocele, which can be submitted to surgical correction with rectopexy.La radiologia medica 12/2000; 100(5):348-53. · 1.44 Impact Factor -
Article: [Unusual case of malignant degeneration of multicystic pancreas in von Hippel-Lindau syndrome].
La radiologia medica 07/2000; 99(6):487-8. · 1.44 Impact Factor -
Article: [Echography of carcinoma of the anal canal before and after conservative treatment. Case report].
La radiologia medica 06/2000; 99(5):393-5. · 1.44 Impact Factor -
Article: [Echographic evaluation of the thymus gland in childhood].
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ABSTRACT: The thymus is a linphoepithelial organ located mostly in the anterior mediastinum and, for a smaller part, in the neck. The gland is particularly developed in the fetus and in children, while it shrinks in young adults following an involution process. We investigated the US appearance of the thymus in normal pediatric subjects to gather information for use in pediatric patients with suspected thymus conditions, using a safe, irradiation-free, technique. We performed a US examination of the anterior mediastinum and the neck in 30 children (14 males and 16 females) ranging in age 6 months to 11 years. We used a Sonora LOGIC 700 MD General Electrics unit with 7.5-13 MHz linear probes and acquired transverse and longitudinal scans on the chest wall and the neck, integrated with intercostal scans. The thymus had the same echogenicity as the liver parenchyma in 22 children (73.3%), lower echogenicity in 2 (6.6%, age range 6-12 months) and higher echogenicity with heterogeneous structure in 6 children (20%, age range 8-11 years). The gland was in central and symmetric localization in 20 children (66.6%) while it exhibited a slight deviation leftwards in 7 (23.3%) and rightwards in 3 children (10%). We considered as normal the following values: in the right lobe, 1.4 cm for the AP diameter and 2.5 cm for the longitudinal one; in the left lobe, 1.4 cm for the AP diameter and 2.9 cm for the longitudinal one. Radiological studies of the thymus are really difficult to perform because the gland is extremely variable in size, extension and shape. The thymus has the same echogenicity as the liver parenchyma and lower echogenicity than the thyroid parenchyma. We believe that US is an effective technique for studying the thymus in all its involution stages and that provides similar information to CT and MRI. Also, US does not use radiations and needs no sedation, which improves safety for young patients.La radiologia medica 06/2000; 99(5):352-4. · 1.44 Impact Factor -
Article: [Craniocerebral trauma from bullets: the correlation between computed tomography, the clinical picture, neurosurgical treatment and the long-term sequelae].
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ABSTRACT: To demonstrate the usefulness of CT findings in the planning of brain neurosurgery in gunshot victims, for prompt and successful treatment. Thirty patients with brain gunshot wounds were examined with CT over 5 years. The patients were 27 men and 3 women whose mean age was 33 years (range: 17-56). Brain CT was carried out with thin (5-mm) slices and 10-mm gap; dynamic scanning (3-mm interscan time) was used especially in case of posterior fossa involvement and diffuse brain damage. The examination was integrated with cervical scout views to detect bullets in the neck and cervical dislocation. CT follow-up was carried out in 20 patients 24 hours postoperatively and every 6 hours in 9 patients in a severe postoperative coma. Twelve intracranial hematomas and 9 subdural hematomas, 3 of them bilateral, were treated and hemorrhage was resolved in 8 lacerocontusive foci. Skull plastic surgery was carried out in 5 cases. Surgical maneuvers were most difficult in the 5 crash bone injuries with wedged splinters; postoperative subarachnoid hemorrhage followed in 3 cases. Blood effusion in ventricles was drained in 6 cases; in 2 of them with permanent catheters. Eleven patients died: 4 right after surgery and 7 an average 15 days postoperatively. In our series the mortality rate of firearm wounds of the skull base was 34% higher than that of the hemisphere; this is due to carotid hemorrhage and midbrain damage. Such traumas require emergency radiological diagnosis and neurosurgical treatment because of their severity and early irreversible complications. Complex operations and skilled surgeons may prevent disabling postoperative sequels. CT findings are indispensable and must be correctly interpreted. The radiologist and the neurosurgeon must collaborate closely and both must consider several diagnostic and prognostic factors affecting surgical planning.La radiologia medica 04/2000; 99(3):156-60. · 1.44 Impact Factor -
Article: [Suburban amebiasis: the diagnostic aspects via computed tomography and echography and the percutaneous treatment of amebic liver abscesses].
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ABSTRACT: Liver is the most common site of extraintestinal amebiasis and hepatic abscesses are the most frequent symptom, occurring in 3-9% of patients with amebic infection. Several studies have shown that drug treatment is more efficacious when combined with percutaneous drainage of the abscess, yielding quicker recovery and a positive body response. We report our US and CT findings in 16 patients with amebic abscesses, 12 of whom lived in a temperate peripheral area north-east of Naples. All patients had a clinical-diagnostic condition that we called "suburban amebiasis". Finally we report our personal experience with the US-guided therapeutic drainage of amebic abscesses with repeated cavity washings, which is important for positive parasitology. We retrospectively reviewed the findings of 16 patients (11 men and 5 women; age range 36-78 years; mean 52) with amebic abscesses of liver examined with US and CT. US with a 3.5 MHz transducer was the technique of choice in all patients. 94% of liver abscesses and some extraintestinal complications were easily shown with this technique. CT angiography was then performed to detail and clarify US findings. Abscesses over 4 cm in diameter were submitted to US-guided percutaneous treatment which permitted abscess drainage, the collection of material for parasitology and repeated cavity washings. US showed multiple liver abscesses in 12 patients, which were multiseptate and formed by multiple hypo-/hyperechoic microabscesses in 4 of them. Four non-European patients had a single abscess, which is typical of tropical endemic forms. CT showed the amebic abscesses as hypodense roundish masses with clear-cut outline most often localized in the right lobe in the 12 multiple cases. After percutaneous drainage 13/16 patients (81%) reported less pain in the right hypochondrium and had a lower temperature; their hospitalization was also shorter. Combined US and CT assessment facilitated the diagnosis of amebiasis and its differentiation from pyogenic abscess and hepatoma. The combination of US-guided drainage and drug treatment provides better results than either treatment alone and quicker improvement of patient conditions, with fewer extraintestinal complications. Percutaneous drainage should be used in abscesses bigger than 4-5 cm, those with questionable clinical-laboratory findings and finally those failing to respond to drug treatment alone. Positive parasitology of abscess content is related to repeated cavity washings after percutaneous drainage, likely because peripheral layers are much richer in amebae.La radiologia medica 04/2000; 99(3):169-73. · 1.44 Impact Factor -
Article: [Lipoma of the psoas muscle. A rare case].
La radiologia medica 01/2000; 98(6):518-9. · 1.44 Impact Factor -
Article: [The topicality and use of the radiological exam in gunshot wounds of the limbs. An assessment of 132 cases].
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ABSTRACT: Gunshot wounds of limbs are frequent injuries especially in Western countries. They can be single or associated with other penetrating gunshot wounds, for instance to the chest, abdomen and skull. We investigated the current role and usefulness of conventional radiography in the assessment of gunshot injuries to limbs because, despite major advances in diagnostic imaging, this method remains the examination of choice in this condition. We stress the valuable contribution of conventional radiography to detection of bone blow-out fractures, multifocal traumatic bone changes, bone and joint injuries, bullet retention, and finally subcutaneous emphysema. We retrospectively reviewed 132 cases of firearm injuries of limbs submitted to radiography March 1996 to July 1999. All the patients were men ranging in age 17-66 years (mean: 35). Radiography followed a preliminary physical examination, and follow-ups were carried out in the following days after orthopedic reduction of bone fractures or surgery with metal osteosynthesis. Emergency CT was performed first when chest, abdomen, or skull were involved. The lower limbs were involved three times as much as the upper ones; the leg was most frequently involved (61%), followed by thigh (61%), forearm and hands (24%), and feet (15%). The right lower limb was wounded in 65% of cases, especially tibia (55 cases) and femur (46 cases). Spiral injuries to bone diaphysis were the most frequent ones, followed by mixed fractures caused by cortical bone sinking from bullet impact. Bullets were retained in 60% of cases; subcutaneous emphysema was found in 78% of cases and vascular injuries in 25 cases in relation to disarranged fractures. We observed 4 arteriovenous fistulas during 3 years' follow-up. Gunshot wounds to the limbs need a different clinical, diagnostic and therapeutic approach than thoracoabdominal and skull injuries, which require immediate and quick diagnosis and emergency treatment. The cases with injury to a primary artery from open and splintered fractures require emergency surgical reconstruction with vascular anastomosis and reduction of compound fractures, to prevent necrosis and amputation. Conventional radiography does depict the bullet and its site, subcutaneous emphysema, blow-out fractures, and the location of bone splinters. This permits adequate emergency surgery and an efficacious orthopedic approach, as well as selection of the cases to be submitted to clinical monitoring.La radiologia medica 01/2000; 98(6):468-71. · 1.44 Impact Factor -
Article: [Idiopathic intestinal pseudo-obstruction of the colon. A case report].
La radiologia medica 12/1999; 98(5):422-4. · 1.44 Impact Factor -
Article: [The role of computed tomography in gunshot lesions of the chest. The authors' personal experience].
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ABSTRACT: CT is a valuable tool in assessing thoracic gunshot wounds. CT is also the method of choice in emergency, because it permits rapid depiction of bullet damage to the chest and to other body districts. This in turn permits correct assessment of the main thoracic injuries, plus adequate and prompt planning of surgical treatment or support intensive care. We report on the role of CT in diagnosing the complex pleuropulmonary, cardiovascular and thoracic wall injuries caused by gunshot wounds, with their specific and acute signs which differ greatly from those of other types of chest trauma. In the last 4 years, we observed 76 cases of gunshot injury, twenty-six of them involved the chest. The patients, 25 men and 1 woman (mean age: 32 years, range: 17-48), were all submitted to emergency CT with i.v. contrast agent injection and the CT-angiography technique. The reanimator was always present to monitor the patients' vital functions and shock state. CT of the chest was integrated with CT of the abdomen and pelvis in 4 cases and with CT of the skull in 3 cases, to detect associated bullet wounds if any. The most frequent CT finding was lung parenchyma tear and bruise (25 cases), followed by hemothorax (18 cases) and subcutaneous chest wall emphysema (9 cases). Pneumothorax was seen in 5 cases, associated with hemothorax in 6; rib injuries were found in 7 cases; pneumomediastinum was found in 4 cases and areas of pulmonary atelectasis in 3; the diaphragm was ruptured in 4 cases. CT showed spinal involvement in 11 patients, with injury of D3 and D5 in 4 and 3 cases, respectively; signs of interrupted spinal marrow were found in 7 cases. Damage from gunshot wounds was detected in the liver, spleen, skull and limbs in 3, 2, 3 and 10 cases, respectively. Chest radiography shows major gunshot wound damage to the chest and lungs, except for heart injuries and minimal pneumothorax. When abdominal and skull injuries are associated, CT should be the method of choice because it permits prompt and panoramic assessment of the severity of pulmonary and extrathoracic damage. This results in prompt and targeted treatment, avoiding unnecessary delays which may damage the patient further.La radiologia medica 12/1999; 98(5):356-60. · 1.44 Impact Factor -
Article: Ultrasonographic evidence of joint thickening reversibility in acromegalic patients treated with lanreotide for 12 months.
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ABSTRACT: A major cause of morbidity and functional disability in acromegaly is represented by axial and peripheral arthropathy. The effect of a 12-month treatment with lanreotide (LAN) on arthropathy in 12 untreated acromegalic patients has been evaluated. Twelve healthy subjects served as controls. Open prospective. Articular cartilage thickness of shoulder, wrist and knee, as well as the size of the heel tendons, was measured by ultrasonic (USG) examination before, monthly for the first 3 months and quarterly thereafter, during treatment with 60-90 mg/month of LAN. The achievement of safe GH and IGF-I levels was considered when fasting GH was below 5 mU/l and IGF-I levels were normalized for age. Before treatment, thickening of shoulder, wrist and knee cartilages, and of heel tendons, was found in all patients compared with controls (P < 0.01). During the first 3 months of LAN treatment, a significant decrease in circulating GH (from 86.8 +/- 19.8 to 25.6 +/- 9.8 mU/l) and IGF-I levels (from 624 +/- 47.8 to 412.2 +/- 44.5 microg/l) was observed. Overall, a slight decrease was noted in all the articular sites examined, but it reached statistical significance only at the right shoulder (P < 0. 001). However, a notable improvement of joint pain and active and passive articular mobility were recorded in all patients, as well as of weakness, soft tissue swelling, hyperhydrosis and headache. After 6 months of LAN treatment, a further significant decrease was observed at the level of the right shoulder (P < 0.01) and the right knee (P < 0.01). Eight patients achieved safe GH and IGF-I levels. After 12 months of LAN treatment, a significant decrease was observed at the level of all the articular sites examined (P < 0.01), as well as at the level of both heel tendons (P < 0.01). Safe GH and IGF-I levels were achieved in all but one of the patients who, similarly, had a significant decrease in shoulder, wrist and both heel tendon thicknesses. The thickness reduction of right shoulder cartilage, a non-weight-bearing joint, was significantly greater than that observed at the level of the right and left knee cartilages and heel tendons (37.4 +/- 4.4% vs. 18 +/- 6.1%, 19.3 +/- 4.4%, 16.5 +/- 4.2%, and 13.7 +/- 5.5%, respectively, P < 0.01). No difference was found in thickness decrease of all sites examined between the eight patients achieving safe GH levels after 3-6 months, and the remaining four patients, or between patients with estimated disease duration below (n = 6) or above 10 years (n = 6). Improvement in articular and periarticular soft tissue hypertrophy of the shoulder and wrist, two non-weight-bearing joints, but also of the knees, two weight-bearing joints, and heel tendons, was obtained by suppressing GH and IGF-I levels for 12 months with LAN treatment, although complete reversal of joint thickening was not achieved. Since no difference in the response to treatment, in terms of joint size decrease, was found between patients with short or long disease duration, treatment longer than 12 months may be needed to reverse the acromegalic arthropathy completely.Clinical Endocrinology 11/1999; 51(5):611-8. · 3.17 Impact Factor -
Article: [Gunshot wounds of the abdomen studied by computed tomography. The authors' personal experience in 30 cases].
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ABSTRACT: CT plays an important role in depicting gunshot wounds in parenchymal and hollow organs in the abdomen. Relative to other techniques and to emergency laparotomy, CT permits good assessment of abdominal content, major injuries and changes in other districts, such as chest, pelvis and skull. We investigated the yield and role of CT in diagnosing abdominal gunshot wounds, with their rich and varied radiological signs and associated injuries. We retrospectively reviewed the findings of 30 patients with abdominal gunshot wounds examined in 4 years at Loreto-Mare Hospital, Naples. All patients were men, age ranging 19-54 years (mean: 35); 6 of them were not from the European Union. Examinations were carried out from diaphragm to pubis with i.v. contrast injection and the CT angiography technique. CT was integrated with chest studies in 6 cases and with skull studies in 5. Subsequent CT follow-ups were necessary in 12 cases submitted to conservative treatment. Liver was the most damaged parenchyma, with hemorrhage and lacerocontusion in 7 cases and mashed in 1 case; spleen was involved in 4 cases; hemoperitoneum was found in 18 cases. Diaphragm was involved in 5 cases and pancreas in 2; gallbladder, stomach and duodenum were involved in 1 case each and jejunum-ileum and colon in 3 and 6 cases, respectively. CT showed renal injury in 3 cases and bladder injury in 2. Eight patients had vertebral gunshot damage. Pneumothorax, hemothorax and lacerocontusion were found in 7 cases; brain was injured in 4 cases and limbs in 16. Tissue damage extent depends on the speed and kinetic energy the bullet carries into the abdomen. Abdominal radiography shows the bullet and its site, pneumoperitoneum from gastrointestinal perforation, crash bone injuries, vertebral trauma and subcutaneous emphysema. Instead, CT depicts early parenchymal damage and vascular injury and thus becomes a complete and necessary tool for imaging gunshot wounds. CT provides early diagnostic information which help plan emergency treatment and thus decrease mortality. As for angiography and US, we suggest they be used subsequently because in emergency they may delay the diagnosis. Moreover, vessel rupture and active intraabdominal bleeding are easily detected with spiral CT, which appears the best tool for prompt assessment of the injuries associated with gunshot wounds in other districts such as, the skull. To conclude, CT permits adequate planning of emergency surgery and helps select the cases for follow-up, intensive care and conservative treatment.La radiologia medica 10/1999; 98(3):168-72. · 1.44 Impact Factor -
Article: [The role of computed tomography in assessing subphrenic abscesses after posttraumatic splenectomy].
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ABSTRACT: We studied subphrenic inflammatory abscesses and splenic fluid collections after splenectomy for trauma. These complications may appear early or late postoperatively; they are easily demonstrated with CT, which permits accurate spatial assessment of the lesions and appropriate treatment with percutaneous drainage. We investigated the diagnostic accuracy of CT in subphrenic inflammatory conditions after emergency splenectomy for traumatic spleen rupture and found that CT is a precious tool for rapid and easy diagnosis and follow-up of subphrenic abscesses treated with percutaneous drainage. Thirteen patients with left subphrenic inflammatory abscesses after splenectomy for trauma were examined from 1994 to 1998. They were 9 men and 4 women ranging in age 16-67 years (mean: 32). CT demonstrated abscesses early postoperatively in 9 patients and late postoperatively (mean: 3 months) in 4 patients. Abscesses were diagnosed with CT on admission for an abdominal emergency in 3 cases; one abscess was found at outpatient US performed for persisting left abdominal pain. CT-guided percutaneous drainage was performed in all patients with the Trocar technique. A large inflammatory liquid collection with the typical "liquid pseudospleen" appearance and characterized by tomodensitometric coefficients of corpusculated fluid was seen in 3 cases. Multiple confluent lesions with septa were found in 3 cases. Contrastography of the abscess cavity with the injection of a water-soluble iodinated contrast agent was performed in 2 cases to detect fistulas connecting to the intestinal loops. Subphrenic abscesses had the same CT patterns both early and late postoperatively, with the collection organizing into thick and corpusculated phlogistic material and exhibiting enhanced capsulofibrous differentiation. Air bubbles and water-air levels within the collection were found in 7 cases and considered a pathognomonic sign of inflammatory abscesses. A periabscessual reaction involving intestinal loops and adjacent organs was seen in 4 cases. Splenectomy causes depressed phagocytosis and decreases serum levels of IgM and antigen response. This calls for careful selection of the patients absolutely requiring splenectomy, such as those with decompensated circulation and multiple parenchymal ruptures or spleen detachment from its stalk. Subphrenic abscesses after splenectomy account for 2.5% of postoperative complications and those after splenectomy for trauma are rarer still, with 1.3%. CT is the imaging method of choice in detecting inflammatory abscesses in the residual splenic cavity and assessing their extent. CT-guided drainage is the first-line treatment, while surgery is reserved to later stages, when drainage fails or other complications occur. Finally, CT permits accurate positioning of the catheter inserted with the Trocar technique and its immediate monitoring, which permits to assess treatment efficacy.La radiologia medica 10/1999; 98(3):173-7. · 1.44 Impact Factor -
Article: [An update of B-mode echography in the characterization of nodular thyroid diseases. An echographic study comparing 7.5 and 13 MHz probes].
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ABSTRACT: We investigated B-mode US capabilities in diagnosis and characterizing thyroid nodules and compared our personal findings with those of the few analytical studies in the literature. We also compared the diagnostic accuracy of conventional 7.5 MHz versus more recent 13 MHz transducers. We examined 136 consecutive patients with a single thyroid nodule: they were 97 women and 39 men, age ranging 15-87 years (mean: 37.4). The patients were submitted to scintigraphy and laboratory tests first and then to US, fine-needle biopsy and/or histologic examination. The final diagnosis was made at cytology and/or histology: we had 98 follicular hyperplasias, 20 follicular adenomas and 18 carcinomas. We studied the presence/absence of the halo sign, cystic portions, microcalcifications; nodule margins and echogenicity relative to the thyroid gland were also studied. The presence of microcalcifications had the highest specificity for malignancy. The sensitivity of this parameter was higher with 13 MHz than with 7.5 MHz transducers. Relative to microcalcifications, absence of cystic portions and irregular margins, 13 MHz US had 64.7-89% accuracy. The halo sign and lesion echogenicity did not permit a reliable differential diagnosis between benign and malignant nodules with both 7.5 and 13 MHz transducers. The association of microcalcifications and irregular margins had the highest accuracy, scoring 86% at 7.5 MHz and 90.5% at 13 MHz. High frequency US is a sensitive tool for diagnosing thyroid nodes. Accurate analysis of the US signs can suggest the benign/malignant lesion nature, which must be integrated with color, power and pulsed Doppler findings.La radiologia medica 10/1999; 98(3):178-82. · 1.44 Impact Factor -
Article: [Multiple pancreatic cysts as an atypical presentation of Von Hippel Lindau syndrome. A case report].
La radiologia medica 10/1999; 98(4):310-2. · 1.44 Impact Factor -
Article: [Defecography in rectal wall prolapse conditions].
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ABSTRACT: Pelvic floor and rectal prolapse conditions have greatly benefitted by new imaging and instrumental diagnostic approaches, and especially defecography, for both pathophysiological interpretation and differential diagnosis. We investigated the efficacy of defecography in the assessment of rectal prolapse, and in particular the role of videoproctography in diagnosing such dynamic disorders. We selected 224 patients with rectal prolapse from a series of 1,190 consecutive subjects with evacuation disturbances examined in the last 5 years with defecography combined with videoproctography. The patients were 176 women and 48 men ranging in age 32-79 years (mean: 48). Defecography was carried out with Mahieu's technique, but we changed the filter position slightly. Sixty-seven per cent of our patients had been submitted to sigmoidoscopy, but this examination does not usually show rectal intussusception. Occult blood test in feces and double contrast barium enema were carried out in 42% and 38% of cases, respectively, to exclude any organic conditions of colon. Mucosal prolapse was more frequent than intussusception (71% and 34%, respectively); rectal walls went out through the anus in 12 cases of anorectal intussusception and thus caused external rectal prolapse. Rectal prolapse was associated with other anorectal alterations, such as rectocele, perineal descent and puborectalis muscle syndrome, in 96 cases. The dynamic changes of ampulla are well depicted by videoproctography, which showed anorectum normalization and spontaneous reduction of invagination after intussusception. Defecography exhibited good capabilities in showing rectal wall function abnormalities. Finally, some features of videoproctography such as low radiation dose, noninvasiveness and ease of execution, make the examination acceptable to patients with anorectal disorders and for the follow-up of rectal prolapse.La radiologia medica 07/1999; 97(6):486-90. · 1.44 Impact Factor -
Article: [Giant Spigelian hernia: assessment with computerized tomography and surgical correlations. Report of a case].
La radiologia medica 04/1999; 97(3):196-7. · 1.44 Impact Factor
Top co-authors
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Institutions
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1992–2000
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Università degli Studi di Napoli Federico II
- • Department of Biomorphological and Functional Science
- • Department of Endocrinology and Molecular and Clinical Oncology
Napoli, Campania, Italy
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1998
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Second University of Naples
Caserta, Campania, Italy
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