La Radiologia medica
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La Radiologia medica · Jan 1999
[Role of emphysema in the etiology of functional impairment in patients with severe chronic obstructive pulmonary disease. Study with high resolution computerized tomography].
To investigate whether high-resolution CT (HRCT) can detect the subjects with massive emphysematous destruction in a group of patients with severe chronic obstructive pulmonary disease (COPD) and therefore be of help in selecting the candidates to surgical lung volume reduction. ⋯ HRCT is a useful tool in diagnosing the presence of emphysema in vivo and in assessing its extent in COPD patients because it permits to divide the patients into two groups which roughly correspond to the clinical patterns of types A (dyspneic) and B (bronchitic). Severe emphysema patients are the best candidates to surgical lung volume reduction. Airways involvement might play a major role in causing bronchial obstruction in the subjects with mild emphysema. In our series HRCT did assess the severity of emphysema in COPD subjects, but our lung function screening failed to predict emphysema extent.
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La Radiologia medica · Jan 1999
[Closed loop intestinal obstruction: role of computerized tomography].
The obstruction of a bowel segment at both ends results in a closed loop obstruction. Progression to strangulation frequently occurs if surgical intervention is delayed. The role of plain radiography in the diagnosis of closed loop obstruction and strangulation has been shown to be limited, while the recent literature has demonstrated the growing role of computed tomography (CT). This paper reports our experience in the study of closed loop obstruction by CT. ⋯ Small bowel obstruction can be distinguished into simple and closed loop obstructions. The latter is a more severe condition which is often complicated by strangulation with vascular impairment, edema and intramural and mesenteric hemorrhage. Consequent arterial insufficiency rapidly leads to ischemia, infarction and necrosis. The radiologist plays a role in the early recognition of the closed loop obstruction and of any sign of strangulation. The role of CT in the diagnosis and workup of patients with suspected intestinal occlusion has been analyzed in the literature with reported 63% sensitivity, 78% specificity and 66% accuracy. CT is also capable of revealing the causes of occlusion in 73-95% of cases. The above CT signs, as confirmed in our experience, allow to identify closed loop obstruction and also small bowel strangulation, thus supplying a valuable contribution to diagnosis and accurate preoperative evaluation. We conclude that CT can accurately demonstrate the presence of closed loop obstruction and can be the technique of choice in patients in whom obstruction is associated with clinical signs suggestive of strangulation.
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La Radiologia medica · Jan 1999
[Subclinical interstitial lung involvement in rheumatic diseases. Correlation of high resolution computerized tomography and functional and cytologic findings].
Rheumatic diseases are frequently associated with interstitial lung disease. Since interstitial fibrosis is an irreversible process, understanding the mechanisms leading to fibrosis is necessary for the development of treatment strategies to prevent irreversible pulmonary damage. High-resolution Computed Tomography (HRCT) is superior to chest radiography in assessing the presence and extent of parenchymal abnormalities in diffuse infiltrative lung diseases and provides a sensitive and noninvasive method of quantifying global disease extent. ⋯ HRCT is a sensitive tool in detecting interstitial lung disease in patients with rheumatic diseases with no signs and symptoms of pulmonary involvement. The relationship between the different HRCT patterns and bronchoalveolar lavage cell profiles can identify patients at higher risk of developing irreversible lung fibrosis. A long-term, prospective follow-up study is needed to determine whether these patients will develop over pulmonary disease.
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La Radiologia medica · Dec 1998
Comparative Study Clinical Trial[Gallbladder blunt trauma: comparison between radiologic and anatomo-surgical findings].
To assess the diagnostic accuracy and the possible role of ultrasonography (US) and Computed Tomography (CT) in a small group of patients who had a blunt abdominal trauma involving the gallbladder. ⋯ The radiologic findings of our five patients were suggestive of a gallbladder damage but did not permit to distinguish minor from major injuries, the latter requiring surgical treatment. US proves to be a useful screening tool which can also help timing surgery in these patients. CT confirmed the US suspicions and also permitted accurate assessment of associated post-traumatic injuries to the liver and duodenum. Nevertheless, the clinical presentation was the most important factor as to the therapeutic management of these blunt abdominal trauma patients.
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La Radiologia medica · Nov 1998
[Study with thoracic and abdominal spiral CT in intensive care unit patients].
The severe clinical conditions of intensive care unit patients need frequent imaging studies to detect the pathologic changes in the patients' situation and to plan the correct therapeutic management. The yield of bedside plain radiography is often not diagnostic but moving the patients to the radiology department could affect their clinical conditions. Conventional CT is difficult to perform in these patients because they need continuous assistance and cannot cooperate during the diagnostic examination. ⋯ Spiral CT is a fast examination technique with no major artifacts which can be used safely also in unconscious patients. It confirmed a variety of pathologic conditions which may be misdiagnosed by conventional chest radiography, which improves the care of these patients. Bedside plain radiography is limited by several factors depending on the patient (no cooperation, variable respiration, still decubitus), the examination technique (X-ray projection, exposure, poor diagnostic yield), and the anatomical region of interest (mediastinal vessels). Even though our technical standard for conventional radiography was high, Spiral CT was better in detecting parenchymal consolidation and pleural effusion, a missed pneumothorax or thromboembolic disease. We always performed Spiral CT when the clinical findings did not match the results of bedside plain radiography. Moving the patients was very easy because the intensive care unit in our hospital is in the same building as the radiology department and there were dedicated devices supporting the coma patients.