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1.
Radiol Med ; 120(1): 105-17, 2015 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-25115295

RESUMEN

Intestinal intussusception in adults is a rare condition, accounting for about 0.003-0.02% of all hospital admissions. This condition in adults represents only 5% of all cases of intussusceptions and is different from paediatric intussusception, which is usually idiopathic. In contrast, almost 90% of cases in adults are secondary to various pathologies that serve as a lead point, such as polyps, Meckel's diverticulum, colonic diverticulum, or malignant or benign neoplasm. The aim of the present study was to assess the capabilities of multislice computed tomography (MSCT) in the diagnosis and correct characterisation of intussusception, especially in distinguishing between intussusceptions with a lead point and those without. Indeed, although the MSCT findings that help to differentiate between lead point and non-lead point intussusceptions have not been well studied, abdominal MSCT remains the most sensitive radiological tool to confirm bowel intussusceptions. Moreover, differentiating intussusceptions with a lead point condition from those without is crucial for directing the patient towards the most appropriate treatment, avoiding surgery when not necessary.


Asunto(s)
Intususcepción/diagnóstico por imagen , Adulto , Anciano , Medios de Contraste , Diagnóstico Diferencial , Femenino , Humanos , Intususcepción/etiología , Intususcepción/terapia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
3.
G Ital Nefrol ; 40(3)2023 Jun 29.
Artículo en Italiano | MEDLINE | ID: mdl-37427902

RESUMEN

Lactic acidosis is a potential adverse event related to metformin therapy. Although metformin-associated lactic acidosis (MALA) is a rare condition (about 10 cases / 100,000 patients / year), new cases continue to be reported, with a mortality of 40-50%. We describe two clinical cases characterized by severe metabolic acidosis, hyperlactacidemia, and acute renal injury. The first also with NSTEMI, successfully treated.


Asunto(s)
Acidosis Láctica , Lesión Renal Aguda , Diabetes Mellitus Tipo 2 , Metformina , Humanos , Metformina/efectos adversos , Hipoglucemiantes/efectos adversos , Acidosis Láctica/inducido químicamente , Acidosis Láctica/terapia , Lesión Renal Aguda/inducido químicamente , Lesión Renal Aguda/complicaciones , Diabetes Mellitus Tipo 2/complicaciones
4.
G Ital Nefrol ; 39(3)2022 Jun 20.
Artículo en Italiano | MEDLINE | ID: mdl-35819045

RESUMEN

Rupture of a renal cyst can be spontaneous, iatrogenic or consequent to a trauma even of minor entity, especially in predisposing conditions such as cysts, tumors or hydronephrosis. Kidneys are, in fact, involved in about 25% of abdominal traumas. The grading system of the American Association for the Surgery of Trauma (AAST) classifies renal injuries into five categories based on renal involvement and abnormalities detected on contrast-enhanced CT, modality of choice in the evaluation of abdominal trauma with suspicion of intraperitoneal hemorrhage. Hematuria and/or flank pain are the most frequent presenting symptoms, although some patients may be also asymptomatic. Treatment is usually conservative, but sometimes nephrectomy may be necessary. In our manuscript we describe the case of a patient who comes to our observation with left side pain reporting a minor accidental fall occurred the day before. Ultrasound examination and CT with contrast medium revealed hemoretroperitoneum resulting from rupture of a hemorrhagic renal cyst. We will describe the imaging characteristics and therapeutic choices below.


Asunto(s)
Traumatismos Abdominales , Quistes , Enfermedades Renales Quísticas , Heridas no Penetrantes , Traumatismos Abdominales/complicaciones , Humanos , Riñón/cirugía , Enfermedades Renales Quísticas/complicaciones , Enfermedades Renales Quísticas/diagnóstico por imagen , Estados Unidos , Heridas no Penetrantes/complicaciones , Heridas no Penetrantes/diagnóstico por imagen , Heridas no Penetrantes/cirugía
5.
G Ital Nefrol ; 38(5)2021 Oct 26.
Artículo en Italiano | MEDLINE | ID: mdl-34713644

RESUMEN

We describe the case of a 26-year-old male patient with a previous diagnosis of Alström Syndrome who presented drowsiness, dyspnea, tremors, and a dull abdominal pain, without signs of peritoneal irritation. The patient also presented sensorineural hearing loss, decreased vision, due to chorioretinal dystrophy, difficulty walking with back-lumbar double curve scoliosis, impaired glycemic homeostasis, and a significant deterioration of renal function. Alström syndrome is a multisystem disease characterized by rod-cone dystrophy, hearing loss, obesity, insulin resistance and hyperinsulinemia, type 2 diabetes mellitus, dilated cardiomyopathy, and progressive renal and hepatic dysfunction. Around 450 cases have been identified worldwide. Clinical signs, age of onset and severity can vary significantly between different families and within the same family. Careful nephrological follow-up is necessary in patients with syndromic ciliopathies, since long-term kidney problems can have an impact on other diseases, eg. cardiovascular disease.


Asunto(s)
Síndrome de Alstrom , Diabetes Mellitus Tipo 2 , Pérdida Auditiva Sensorineural , Insuficiencia Renal , Adulto , Síndrome de Alstrom/complicaciones , Síndrome de Alstrom/diagnóstico , Síndrome de Alstrom/genética , Pérdida Auditiva Sensorineural/diagnóstico , Pérdida Auditiva Sensorineural/etiología , Humanos , Masculino , Obesidad , Insuficiencia Renal/etiología
6.
G Ital Nefrol ; 38(2)2021 Apr 14.
Artículo en Italiano | MEDLINE | ID: mdl-33852226

RESUMEN

Lithium is the milestone of psychiatric patients' therapy, in particular in bipolar disorder. Despite its high therapeutic efficacy, there are several side effects (renal, thyroid, parathyroid, dermatological) and management problems linked to its narrow therapeutic range, which exposes patients to a high risk of toxicity. We describe the case of a male patient with bipolar disorder in therapy with lithium sulfate who developed a severe acute-on-chronic intoxication. He came to our attention in a somnolent state with lithemia >3 mEq/L and therefore underwent hemodialysis. In view of the high toxicity of lithium, a timely and correct therapeutic choice is important to improve the patient's outcome. In this context, considering lithemia, but also kidney function and the patient's clinical status, it is necessary to consider extracorporeal treatments, of which hemodialysis is the most preferable.


Asunto(s)
Compuestos de Litio , Intoxicación , Humanos , Riñón/fisiología , Masculino , Diálisis Renal , Sulfatos
7.
Diagnostics (Basel) ; 10(5)2020 May 09.
Artículo en Inglés | MEDLINE | ID: mdl-32397505

RESUMEN

The typification of breast lumps with fine-needle biopsies is often affected by inconclusive results that extend diagnostic time. Many breast centers have progressively substituted cytology with micro-histology. The aim of this study is to assess the performance of a 13G-needle biopsy using cable-free vacuum-assisted breast biopsy (VABB) technology. Two of our operators carried out 200 micro-histological biopsies using the Elite 13G-needle VABB and 1314 14-16G-needle core biopsies (CBs) on BI-RADS 3, 4, and 5 lesions. Thirty-one of the procedures were repeated following CB, eighteen following cytological biopsy, and three after undergoing both procedures. The VABB Elite procedure showed high diagnostic performance with an accuracy of 94.00%, a sensitivity of 92.30%, and a specificity of 100%, while the diagnostic underestimation was 11.00%, all significantly comparable to of the CB procedure. The VABB Elite 13G system has been shown to be a simple, rapid, reliable, and well-tolerated biopsy procedure, without any significant complications and with a diagnostic performance comparable to traditional CB procedures. The histological class change in an extremely high number of samples would suggest the use of this procedure as a second-line biopsy for suspect cases or those with indeterminate cyto-histological results.

8.
Med Oncol ; 37(5): 36, 2020 Mar 27.
Artículo en Inglés | MEDLINE | ID: mdl-32221708

RESUMEN

MRI-guided vacuum-assisted breast biopsy (VABB) is used for suspicious breast cancer (BC) lesions which are detectable only with MRI: because the high sensitivity but limited specificity of breast MRI it is a fundamental tool in breast imaging divisions. We analyse our experience of MRI-guided VABB and critically discuss the potentialities of diffusion-weighted imaging (DWI) and artificial intelligence (AI) in this matter. We retrospectively analysed a population of consecutive women underwent VABB at our tertiary referral BC centre from 01/2011 to 01/2019. Reference standard was histological diagnosis or at least 1-year negative follow-up. McNemar, Mann-Whitney and χ2 tests at 95% level of significance were used as statistical exams. 217 women (mean age = 52, 18-72 years) underwent MRI-guided VABB; 11 were excluded and 208 MRI-guided VABB lesions were performed: 34/208 invasive carcinomas, 32/208 DCIS, 8/208 LCIS, 3/208 high-risk lesions and 131/208 benign lesions were reported. Accuracy of MRI-guided VABB was 97%. The predictive features for malignancy were mass with irregular shape (OR 8.4; 95% CI 0.59-31.6), size of the lesion (OR 4.4; 95% CI 1.69-9.7) and mass with irregular/spiculated margins (OR 5.4; 95% CI 6.8-31.1). Six-month follow-up showed 4 false-negative cases (1.9%). Invasive BC showed a statistically significant higher hyperintense signal at DWI compared to benign lesions (p = 0.03). No major complications occurred. MR-guided VABB showed high accuracy. Benign-concordant lesions should be followed up with breast MRI in 6-12 months due to the risk of false-negative results. DWI and AI applications showed potential benefit as support tools for radiologists.


Asunto(s)
Mama/patología , Biopsia Guiada por Imagen , Imagen por Resonancia Magnética , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Inteligencia Artificial , Mama/diagnóstico por imagen , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/patología , Imagen de Difusión por Resonancia Magnética , Femenino , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Sensibilidad y Especificidad , Centros de Atención Terciaria , Vacio , Adulto Joven
9.
Breast ; 37: 1-5, 2018 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-29032282

RESUMEN

INTRODUCTION: Atypical ductal hyperplasia (ADH) is a high-risk benign lesion found in approximately 1-10% of breast biopsies and associated with a variable incidence of carcinoma after surgical excision. The main goal of our study is to present our experience in the management and long-term follow-up of 71 patients with ADH diagnosed on breast biopsy. MATERIALS AND METHODS: Results of 3808 breast biopsy specimens from 1 January 2000 to 31 December 2005 were analyzed to identify all biopsies which resulted in a diagnosis of ADH. The histopathological results of the 45 patients who underwent surgery were analyzed. Long-term follow-up for the remaining patients was carried out. RESULTS: 45 of 71 (63.4%) patients with histological diagnosis of ADH on breast biopsy underwent surgery. Definitive histological results revealed invasive carcinoma in 7 cases (15.6%), high grade Ductal Carcinoma in situ (DCIS) in 10 (22.2%) patients, Lobular Carcinoma in situ (LCIS) in 4 cases (8.9%) and benign findings in 24 cases (53.3%). 12 of 71 (16.9%) patients underwent only long term follow-up; one (8,3%) of these developed invasive breast carcinoma after 6 years. CONCLUSION: Atypical ductal hyperplasia diagnosed on breast biopsy is associated with a relatively high incidence of invasive carcinoma and high grade ductal carcinoma in situ at the time of surgical excision. Certain radiological and cytological criteria can be used to help determine which patients should forgo surgery and be followed up with good results. Long term follow-up is always crucial for patients who have not undergone surgery.


Asunto(s)
Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Mama/patología , Carcinoma Ductal de Mama/cirugía , Carcinoma Intraductal no Infiltrante/patología , Carcinoma Intraductal no Infiltrante/cirugía , Carcinoma Lobular/cirugía , Espera Vigilante , Adulto , Anciano , Biopsia , Neoplasias de la Mama/diagnóstico , Carcinoma Ductal de Mama/patología , Carcinoma Intraductal no Infiltrante/diagnóstico , Carcinoma Lobular/patología , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Clasificación del Tumor , Factores de Tiempo
10.
Semin Ultrasound CT MR ; 37(1): 66-9, 2016 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-26827740

RESUMEN

Alimentary tract perforation is a frequent emergency condition. Imaging plays an important role to make an accurate diagnosis, defining the presence, the level, and the cause of the perforation, essential information to enable the most correct therapeutic choice. Plain radiography is generally performed as the first choice. In case of a clinically suspected bowel perforation, not detected on x-ray imaging, the contribution of computed tomography is essential. Magnetic resonance is not yet widely used in diagnostic workup of patients with acute abdominal pain, but it can be useful in the differential diagnosis of acute abdomen in specific patients (pregnancy and pediatric patients).


Asunto(s)
Perforación del Esófago/diagnóstico , Tracto Gastrointestinal/diagnóstico por imagen , Tracto Gastrointestinal/lesiones , Perforación Intestinal/diagnóstico , Imagen por Resonancia Magnética/métodos , Tomografía Computarizada por Rayos X/métodos , Medicina Basada en la Evidencia , Tracto Gastrointestinal/patología , Humanos , Aumento de la Imagen/métodos
11.
Gastroenterol Res Pract ; 2016: 9686815, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26819616

RESUMEN

Small-bowel neoplasms are the 3%-6% of all gastrointestinal tract neoplasms. Due to the rarity of these lesions, the low index of clinical suspicion, and the inadequate radiologic examinations or incorrect interpretation of radiologic findings, a delay in diagnosis of 6-8 months from the first symptoms often occurs. Even if conventional enteroclysis and capsule endoscopy are the most common procedures used to accurately depict the bowel lumen and mucosal surface, their use in evaluating the mural and extramural extents of small-bowel tumors is limited. Instead multidetector computed tomographic enteroclysis and magnetic resonance enteroclysis have the potential to simultaneously depict intraluminal, mural, and extraintestinal abnormalities. In particular MR enteroclysis has an excellent soft tissue contrast resolution and multiplanar imaging capability. It can provide anatomic, functional, and real time information without the need of ionizing radiation. MR findings, appearances of the lesions, combined with the contrast-enhancement behavior and characteristic of the stenosis are important to differentiate small-bowel neoplasm from other nonneoplastic diseases.

12.
Semin Ultrasound CT MR ; 36(1): 48-56, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-25639177

RESUMEN

Ingestion, inhalation, and insertion of foreign bodies (FBs) are very common clinical occurrences. In any case, early diagnosis and prompt management are mandatory to avoid severe and life-threatening complications. Radiologists have an important role in revealing the presence, dimension, nature, and relationship with anatomical structures of a FB; selecting the most appropriate imaging modality; and enabling the best therapeutic choice. This review article focuses on the most frequent FBs ingested, inhaled, and inserted and presents the different tests and investigations to provide a correct radiological approach.


Asunto(s)
Diagnóstico por Imagen/normas , Cuerpos Extraños/diagnóstico , Tracto Gastrointestinal/diagnóstico por imagen , Tracto Gastrointestinal/lesiones , Guías de Práctica Clínica como Asunto , Aspiración Respiratoria/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Ingestión de Alimentos , Femenino , Humanos , Lactante , Recién Nacido , Internacionalidad , Masculino , Persona de Mediana Edad , Radiografía , Adulto Joven
13.
G Ital Nefrol ; 30(6)2013.
Artículo en Italiano | MEDLINE | ID: mdl-24402655

RESUMEN

The central venous catheter (CVC) is a very common procedure in the daily medical practice. In fact the CVCs are used to administer liquids and chemotherapeutics, the parenteral nutrition management, the measurement of the central venous pressure, the administration of hemodialysis. The international guidelines recommends always verifying the correct positioning of the tip of the CVC and to identify possible complications before his use. In the clinical practice the radiography of the chest represents the technique used more diffusedly for the control of the positioning and the possible precocious complications of the temporary and permanent CVCs positioned in the central veins. The integrated use of conventional radiology, above all digital of last generation, spiral computed tomography and ultrasounds allows to nearly have in every situation the answers for a correct diagnosis. The nephrologist, necessarily brought to deal with CVC, cannot refuse from a knowledge of such tools.


Asunto(s)
Cateterismo Venoso Central/métodos , Catéteres Venosos Centrales , Complicaciones Posoperatorias/diagnóstico por imagen , Radiografía Torácica , Humanos
14.
Crit Ultrasound J ; 5 Suppl 1: S1, 2013 Jul 15.
Artículo en Inglés | MEDLINE | ID: mdl-23902656

RESUMEN

BACKGROUND: To evaluate the common sources of diagnostic errors in emergency ultrasonography. METHODS: The authors performed a Medline search using PubMed (National Library of Medicine, Bethesda, Maryland) for original research and review publications examining the common sources of errors in diagnosis with specific reference to emergency ultrasonography. The search design utilized different association of the following terms : (1) emergency ultrasonography, (2) error, (3) malpractice and (4) medical negligence. This review was restricted to human studies and to English-language literature. Four authors reviewed all the titles and subsequent the abstract of 171 articles that appeared appropriate. Other articles were recognized by reviewing the reference lists of significant papers. Finally, the full text of 48 selected articles was reviewed. RESULTS: Several studies indicate that the etiology of error in emergency ultrasonography is multi-factorial. Common sources of error in emergency ultrasonography are: lack of attention to the clinical history and examination, lack of communication with the patient, lack of knowledge of the technical equipment, use of inappropriate probes, inadequate optimization of the images, failure of perception, lack of knowledge of the possible differential diagnoses, over-estimation of one's own skill, failure to suggest further ultrasound examinations or other imaging techniques. CONCLUSIONS: To reduce errors in interpretation of ultrasonographic findings, the sonographer needs to be aware of the limitations of ultrasonography in the emergency setting, and the similarities in the appearances of various physiological and pathological processes. Adequate clinical informations are essential. Diagnostic errors should be considered not as signs of failure, but as learning opportunities.

15.
Semin Ultrasound CT MR ; 33(5): 392-5, 2012 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-22964405

RESUMEN

Intraorbital foreign bodies (IOFBs) are a common occurrence worldwide and happen at a frequency of once in every 6 cases of orbital trauma. An orbital foreign body may produce a variety of signs and symptoms related to its size, composition, and ballistics. Retained foreign bodies may give rise to cellulitis, abscess, fistulas, and impaired vision and motility. Prompt detection and accurate localization of IOFBs are essential for the optimum management of patients, to enable the surgeon to plan the most atraumatic method of removing the IOFB. Computed tomography (CT) is very useful in determining the size of foreign bodies and localizing them as intraocular, extraocular, or retro-ocular. CT is generally considered the gold standard in the evaluation of IOFBs because it is safe to use with metallic IOFBs, excludes orbitocranial extension, and is also able to diagnose orbital wall fractures and orbital sepsis with high accuracy. Other potential complications excludible by CT are abscess formation in the orbit, bone, and brain. Magnetic resonance imaging is generally not recommended for the evaluation of the foreign bodies because of risks associated with magnetic metal.


Asunto(s)
Cuerpos Extraños/diagnóstico por imagen , Órbita/lesiones , Órbita/efectos de la radiación , Tomografía Computarizada por Rayos X/métodos , Humanos
16.
Semin Ultrasound CT MR ; 33(4): 376-8, 2012 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-22824126

RESUMEN

Radiologists receive little formal training regarding the structure of the radiology report and its importance as a medicolegal document; failure to communicate, in fact, represents one of the main problems facing the modern radiologists' activity. Duty to the patient does not end anymore with the written report; the paradox is that we are so advanced in imaging technology, but not in communicating imaging findings. Communication must be timely, appropriate, and fully documented. There is an increasing trend to communicate results directly to the patients; radiologists have the greatest problem when communicating unexpected findings. To improve patient care and reduce the risk of being sued, radiologists should follow shared report guidelines and be more familiar with their professional responsibilities.


Asunto(s)
Comunicación , Errores Diagnósticos/legislación & jurisprudencia , Documentación/ética , Registros de Salud Personal/ética , Radiografía/ética , Radiología/ética , Radiología/legislación & jurisprudencia , Errores Diagnósticos/prevención & control , Italia
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