Showing papers in "Radiologia Medica in 1984"

Ossification of the posterior longitudinal ligament

Abstract: Two asymptomatic, unusually young male patients aged 18 and 21 with ossification of the longitudinal posterior ligament of the cervical spine are presented. Geographical distribution, pathological and radiologic aspects of the disease are discussed together with those signs differentiating it from ankylosing spinal hyperostosis.

Preoperative embolization of intracranial meningiomas

Abstract: Embolization of very vascular intracranial meningiomas prior to operation will reduce the loss of blood during the operation. The indications and the technique of preoperative embolization are discussed and 20 cases are presented.

Nephrotoxicity of contrast media. Comparison of iopamidol and diatrizoate by measurement of urinary enzymes after urography

Abstract: An ionic (diatrizoate) and a non ionic (iopamidole) radiocontrast medium were compared as to their nephrotoxicity in a cohort of 21 patients with renal disease, 18 of which with normal renal function. The elevation of the urinary excretion of enzymes from renal tubular cells has been considered as a good index for renal tubular damage. We measured two lysosomal enzymes (NAG and beta glucuronidase) and a brush-border enzyme (gamma GT). In all patients we demonstrated an elevation of urinary excretion of the three enzymes already 12 hours after contrast medium administration. However, the elevation was statistically significant only after employment of the ionic contrast medium and concerned gamma GT and beta-glucuronidase; the urinary excretion of NAG did not vary significantly. Urinary enzymes levels returned to basal values 36 hours after intravenous pyelography. In conclusion, iopamidole showed a lower nephrotoxicity with respect to diatrizoate, as demonstrated by the lower levels of urinary enzymes excretion reached after its use.

Stereotaxic irradiation with a linear accelerator

Abstract: At least two fundamental requirements must subsist for every stereotaxic radiotherapy treatment: 1) a capacity to administer extremely high doses of radiation to small areas which have been precisely defined in three dimensions; 2) the presence of a steep gradient between adjacent isodose curves so that damage to the tissues close to the target may be reduced to the minimum. The authors have built a special stereotaxic device for the fixing of the head of the patient (together with the chosen intracranial target), once the indispensable neuroradiological evaluations and bioptic controls have been effected, at the isocenter of a linear accelerator (Varian Clinac 4). Once the dimensions of the collimator have been chosen in accordance with the volume and the three dimensional conformation of the target and the dose to be administered has been decided upon in accordance with the histological nature of the lesion, both the linear accelerator and the patient are rotated about the isocenter of the therapy unit. It this way it is possible to reach extremely high dosages with very steep isodose gradients, centered exclusively upon the target ("gamma knife"). The procedure employed is described in full. The dosimetric evaluations which preceded the use of the set-up in clinical practice are illustrated as well. The advantages that this technique offers when compared with interstitial brachytherapy and/or Leksell's radiosurgical procedures are stressed. The described procedure, which is entirely bloodless and thus applicable also to high vascularized lesions, has so far been used in a limited series of cases.

Bone changes in homocystinuria in childhood

Abstract: Homocystinuria due to cystathionine synthase deficiency is an autosomal recessive error of sulphur amino acid metabolism characterized clinically by lens dislocation, mental retardation, skeletal abnormalities and thromboembolic phenomena. We have evaluated roentgenologically our series of 12 pediatric homocystinuric patients to detect skeletal abnormalities. Bone changes are widespread and occur mainly in dorsolumbar spine and in epi-metaphyseal growth areas. Osteoporosis is the most important finding. Dolichostenomelia and arachnodactily are relatively common. Calcific spicules occur frequently in the wrist physes.

Results and indications of radiotherapy in the treatment of carcinoma of the mouth floor

Abstract: 175 carcinomas of the floor of the mouth were treated by radiotherapy in the years 1971-81: 47 T1 (26.9%) 87 T2 (49.7%) 19 T3 (10.8%) 22 T4 (12.6%). According to local extension the primary was treated by curietherapy in 92 patients (52.6%), external radiotherapy plus curietherapy boost in 8 (4.6%), radiosurgical combinations in 25 (14.3%) and external radiotherapy alone in 50 (28.5%). 131 patients were initially N0 (74.9%) 23 N1 (13.1%) 21 N2-3 (12.0%). The treatment on the nodal areas was: wait and see in 84 patients (48.0%) surgery in 39 (22.3%) radiosurgical combinations in 21 (12.0%) external radiotherapy alone in 31 (17.7%). Relapses free survival at 2 and 5 years was respectively 52.5% and 44.1%. Local control was obtained for 37/41 T1 cases (90.2%) 58/71 T2 (81.7%) 9/25 T3-T4 (36.0%). 37/137 patients with adequate follow-up (greater than or equal to 1 year) experienced some radionecrotic complications (27.0%). The overall incidence of the second tumors was 7.3% (10 cases).

Computerized tomography in the study of malignant tumors of the larynx

Abstract: 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.

Role of computerized tomography in the evaluation of the stability of the glenohumeral articulation

Abstract: CT scans of the shoulder were performed on 30 normal subjects. The bony architecture of the glenohumeral joint and of the shoulder as described by definite angles and index was determined. Attention was primarily drawn upon the parameters often implicated in the mechanism of glenohumeral stability, namely: the glenoid antero-posterior tilt and the anteversion angle of the scapula. While the former is a static determinant, the latter is a dynamic determinant of joint stability. An inversely proportional relationship was found to exist between these two components of glenohumeral stability. It may be speculated that an high glenoid tilt, which is unstable, may be counterbalanced by a functional reduction in anteversion of the scapula, thus improving the joint stability.

[The lung of the severely premature infant: radiologic aspects].

Abstract: The iatrogenic pulmonary complications (interstitial emphysema, pneumothorax, atelectasis, broncho-pulmonary dysplasia) in 87 premature infants (less than 32 weeks gestational age, birth weight less than 1500 g) are analyzed. Also the predictive value of the radiologic pattern of the lung of the premature infant as seen at birth is evaluated (predictive value versus survival beyond the fifth day and versus the possible need of assisted ventilation).

Radiographic evaluation of the amputation stump in osteosarcoma

Abstract: The radiological picture of the amputation stump for osteosarcoma was revised on 57 cases, in which a follow-up after surgery was possible for at least 4 months, with a maximum of over 12 years. In 51/57 cases (89%) no recurrency was observed; in 6/57 cases (11%) a local neoplastic recurrency was confirmed on clinical and histopathological grounds. The usual aspects of late modifications induced by surgery is osteoporosis of the residual bone, which may assume a geographical pattern, with thinning of the stump apex and formation of a periosteal spur directed towards to soft tissues. The typical pattern of the locally recurrent osteosarcoma is that of an infiltrating soft tissue mass with bone erosion and irregular flake-like calcifications. All these signs are evaluated and discussed in order to give a practical guideline to the differential diagnosis between surgery-induced modifications and local neoplastic recurrencies.

Radiological study of pleural plaques in asbestosis. Contribution of oblique projection views and computerized tomography

Abstract: Oblique views of the chest under scopic control and computed tomography have been obtained in 7 patients with a known history of exposure to asbestos fibers, and evidence of pleural plaques on the postero-anterior view of the chest. The distribution of the radiological findings is similar with both the techniques; however, CT is more sensitive in detecting small lesions at the margino-costal anterior and posterior level, both calcific or not. CT seems also more sensitive in detecting parenchymal lesions. The role of CT in this pathology is briefly discussed.

Value of computerized tomography in the early detection of pelvic recurrences in patients subjected to resection of rectal cancer

Abstract: Forty eight patients surgically treated for carcinoma of the rectum were by computed tomography (CT) during routine follow up to test the value if this procedure in the early diagnosis of pelvic recurrences. We used a protocol which schedules controls at different intervals for Dukes A e B and for Dukes C patients; CT showed pelvic recurrences in 13.3% of the Dukes A e B and in 50% of Dukes C cases. CT seems to be the most reliable presently available test in detecting early extraluminal recurrence after radical resection for rectal cancer.

Peripheral localizations in diffuse idiopathic skeletal hyperostosis

Abstract: The extra-spinal manifestations of diffuse idiopathic skeletal hyperostosis (DISH) are described in 73 consecutive cases, detected during radiographic screening of the thorax for other problems. The characteristic spinal changes (calcification and ossification of the ligaments in the antero-lateral aspects of the vertebral bodies) are present in all individuals. Extra-spinal changes include "whiskering" at the site of the attachment of muscle in the pelvis and long bones, ligament and tendon ossification, periarticular osteophytes, and spurring of the calcaneous and the olecranon. The radiographic patterns in the peripheral skeleton are frequently distinctive and allow the radiologist to suggest the diagnosis, even in the absence of axial radiographs. The diagnosis of DISH is based on preselected radiographic criteria, but the etiology remains elusive.

Variability of the radiologic characteristics of osteoid osteoma

Abstract: The authors have studied the anatomical-radiographic correlations in 55 patients with osteoid osteoma. On the basis of the results gathered we feel able to state that the variability of radiologic features of osteoid osteoma (nidus surrounded by a zone of sclerosis) depends on the site of the lesion and on the advanced stage of the neoplastic tissue.

Radiosensitivity and effect of dose fractionation in cultured cells

Abstract: Survival, division delay and repair of sublethal damage were studied as a function of the cellular age in cells of EUE line exposed to 31 MeV protons, (LET of 1.83 keV/micron in tissue). The findings are compared with data reported in the literature on various mammalian cell lines exposed to X and gamma rays, common behaviours are pointed out and the characteristics parameters quantified. Survival varies with cell age and reaches a maximum value at mid S and its minimum at late G1; the ratio between maximum and minimum ranges between 1.5 and 15 depending on the survival level. Division delay resulted to be equal to 6 and 12% of the generation time per Gy for mid G1 and mid-late S respectively. All the investigated lines are able to repair as much as 50% of the sublethal damage within one hour.

Radiographic semeiotics of bone metastasis in thyroid carcinoma

Abstract: It's well-known that thyroid malignant cancer often metastatizes to skeletal structures. Analysing a wide casuistry of the National Cancer Institute of Milan, we thought right not only consider most common iconographic findings of these bone metastases, but rarest too. Therefore, we studied many radiological symptoms: osteolysis and its shape; extension in the next soft tissues; absence of the periosteal reaction; some resemblances with other primitive cancer or secondary too and dysplasic focus; the changes after therapy usually give a not univocal interpretation of the pictures regarding these peculiar alterations.

Analysis of the reasons for the rejection of radiographic films in radiodiagnosis

Abstract: After a study of quality control on about 30 radiological equipment and two dark rooms, we are now presenting an analysis of 1806 radiological examinations with 5011 films; the reject is 6.2%, namely 311 films. The analysis of the causes of the reject gives the following results: the more important cause is the error of exposure (52.7% of total reject), followed by geometrical and collimation defects (14.4%) and by the movement of the patient (13.2%). Our results are discussed and compared with other similar data.

[Chests x-ray in status asthmaticus. Relations between radiological abnormalities and impaired respiratory function].

Abstract: The chest radiographs of 78 adult asthmatic patients admitted with severe acute asthma over a three-years period were reviewed. Radiographic findings were compared with functional data. Overinflation was demonstrated in 32% of chest X-rays. In four patients the presence of atelectasis was shown. On admission only PaO2 was significantly lower in patients with radiological abnormalities than in patients with normal chest radiographs. The usefulness of chest radiographs in patients with acute asthma is discussed.

Giant parietal foramina. A surgical defect

Abstract: Sinus pericranii is unusually demonstrated in the region of the obelion. The radiological findings are those of large parietal foramina and the overlying soft tissue is bulging, suggesting vascular collection. The possible relationship between ossification of parietal bone and vascular anomaly is discussed.

[Radiation pneumopathy. Our experience in the treatment of Hodgkin's disease with mantle-shaped field radiotherapy].

Abstract: The literature of the radiation pneumonitis is reviewed from the standpoint of the pathogenesis, histopathology and dependent parameters of the disease. A series of 125 patients treated with mantle fields for Hodgkin's disease between 1972/80 is studied. The radiation pneumonitis developed radiologically in 28 patients (22,4%); in 20 (72%) was asymptomatic. The incidence of pneumonitis against the time of onset of the disease, reveals a peak about the first three months after the end of radiotherapy. No significative variations of incidence of disease are seen in two groups of patients treated respectively with and without chemotherapy (20% and 26%). Frequency diagrams of pneumonitis as a function of the calculate values of the dose for TD, rets, TDF, show a significant correlation with the ranges of doses expressed in TDF.

Digital angiography of the pudendal arteries in erectile impotence

Abstract: Digital angiography of pudendal and penile arteries was performed on 32 consecutive patients with erectile failure of suspected vascular origin. Intra-arterial injection of contrast medium via selective catheterization of the hypogastric arteries was used in 6 cases. In 27 cases, one of which already submitted to arterial catheterism, the intravenous route was employed for contrast administration, using a single, large volume, high speed bolus. In one case, digital angiography was diagnostically unreliable due to patient's motion and to blurring artifacts. Among the remaining cases, 9/31 (29%) showed a normal angiographic picture, while 22/31 (71%) possessed stenotic-obstructive lesions of different severity. The pictures obtained after intravenous contrast administration were diagnostically equivalent to those obtained with arterial catheterism: in addition, intravenous route allowed the simultaneous representation of the arterial network of both sides and the overall examination resulted less invasive and quicker. In 22/32 patients (69%), functional determinations of erectile capability and of penile blood flow were performed for comparison. Nocturnal penile tumescence (12 cases diagnostically useful) was well correlated with the angiographic picture. Penile blood flow measurements with the Doppler technique (21 cases) seemed on the contrary to be less sensitive than digital angiography.

[Urethro-vaginal reflux].

Abstract: The authors, after a review of few works found in literature, report 33 cases of urethro-vaginal reflux in girls. They analyse the radiological and clinical aspects of this phenomenon that can be considered as border line. Finally the authors point out that the urine collected through urine specimen collector could be contaminated by vaginal bacteria in connection with urethro-vaginal reflux.