Computerized axial tomography in investigations of the rheumatoid knee.

It is essential when deciding on the therapeutic approach to the rheumatoid knee--medical or surgical--to make a precise and thorough assessment of the joint situation as a whole. In order to overcome the limitations of traditional X-ray methods, the Authors used computerized axial tomography (C.A.T.) to study the knees of twenty rheumatoid arthritis patients. They analysed three particular sections: the first at the level of the subquadriceps bursa, the second through the femoral condyles, and the third through the proximal tibio-fibular joint. C.A.T. permits an assessment of the conditions of the muscles and any hypertrophy of the synovial membrane; this kind of investigation reveals them clearly. It was possible to make an accurate investigation of the femoro-patellar joint and of lesions involving the femoral condyles and tibial plate. The findings indicate that C.A.T. in the study of the rheumatoid knee provides information on the soft tissues that cannot be obtained by traditional radiological methods. It also shows with greater precision the extent and morphology of bone lesions to the joint heads, an extremely important question in planning the use of prostheses.

The treatment of simple bone cysts by topical infiltrations of methylprednisolone acetate: technique and results.

The authors report their experience in the percutaneous treatment of simple bone cysts by intra-cystic local infiltrations of methylprednisolone acetate. In particular, the method adopted, the evolution of the radiologic picture and the results achieved are described. Sixty patients were successfully treated without complications or surgery.

[Selective bronchial arteriography in broncho-pulmonary pathology]. / L'arteriografia bronchiale selettiva nella patologia bronco-polmonare.

104 selective bronchial arteriographies were performed in 25 patients with bronchopulmonary neoplasia, 11 with mediastinal tumours, 15 with bronchopulmonary inflammation, and 53 with haemoptysis. An assessment is made of the diagnostic value of the information obtained. It is felt that this form of examination is particularly useful in detecting the site of bleeding cases of haemoptysis, and in the provision of treatment by means of embolisation.

[Cystic lymphangioma of the spleen associated with hypersplenism]. / Linfangioma cistico della milza associato ad ipersplenismo.

A rare case of cystic lymphangioma of the spleen accompanying hypersplenism syndrome is described. After stressing the importance of certain examinations such as arteriography and splenic scintigraphy in diagnosis the condition, the many ways in which cystic lymphangioma of the spleen may present clinically are reviewed; these go from asymptomatic to straightforward splenomegaly, with or without clinical signs, up to a clear-cut hypersplenism syndrome. The present case merits consideration for three reasons: 1) The absolutely exceptional nature of cystic lymphangioma of the spleen; 2) Exceptional association with hypersplenism syndrome; 3) Remission of the syndrome following splenectomy. It is concluded that, notwithstanding the condition's rarity, cystic lymphangioma of the spleen should be considered in the differential diagnosis of splenomegalic syndromes when these are also accompanied by hypersplenism.

Unusual osseous changes in lumbar herniated disks: CT features.

Osseous changes in cases of lumbar herniated disks including erosion of the posterior vertebral body cortex near the herniated disk, spinal canal and intervertebral foramen enlargement, and focal sclerosis of the adjacent body are described. The changes were observed in four patients with large and old herniated disks.

[Radiologic diagnosis of malignant lymphomas at a supradiaphragmatic site]. / Diagnosi radiologica dei linfomi maligni in sede sopradiaframmatica.

The possibility of a radiological diagnosis of supradiaphragmatic localizations of malignant lymphoma are discussed, with particular reference to the employment of special techniques: xeroradiography, bronchography, selective arteriography. A number of examples are presented in detail.

[Polyarteritis nodosa: evolution of the angiographic findings and uncommon localizations (author's transl)]. / Panarterite nodosa: evoluzione dei quadri angiografici e localizzazioni inusuali.

A series of 10 patients with polyarteritis nodosa have been studied by means of angiographic investigations with selective arteriography of the different visceral districts. The attention is focused on some unusual localizations of the typical lesions such as aneurysms of the supra-renal artery of the coronary artery and of the femoral artery. Up to now these localizations have been described only in post mortem examinations. Such localizations should be considered as a demonstration of the multicentric spread of the disease, independently from its degree of development. On the other hand a correlation seems to exist between the evolution of the disease in the increase in size of the aneurysmatic lesions as well as with the simultaneous presence of all the angiographic signs.

[Percutaneous radio-frequency ablation of osteoid osteoma: technique and preliminary results]. / Termocoagulazione percutanea degli osteomi osteoidi mediante radiofrequenza: tecnica e risultati preliminari.

PURPOSE: To report our personal experience with the percutaneous technique for in situ destruction of osteoid osteoma using radio-frequency ablation. MATERIAL AND METHODS: From January 2000 to January 2001 we performed 16 radio-frequency ablations in 15 patients. All candidates for treatment had previously undergone clinical and radiologic examinations to confirm features typical of osteoid osteoma. After administration of spinal anesthetic, procedures were performed with CT-guidance, using a Kirschner wire introduced into the localized lesion, and a guiding cannula. A hole was first cut into the bone with a cutter, then a few biopsy specimens were obtained with a Jamshidi needle. Finally, we introduced a small radio-frequency electrode into the bone, through the biopsy track. Sufficient current was used to heat the electrode tip to 85-90 degrees C with consequent thermal necrosis of the tissue. The healing was continued for 6 minutes. RESULTS: All patients well tolerated the percutaneous procedure and only 1 underwent a second, successful radio-frequency ablation. In all cases, pain relief was noted to occur very rapidly and all patients could bear full weight on the treated extremity within 24 hours after the procedure. No late complications attributable to the ablation were noted, except for a small eschar next to the puncture site. DISCUSSION AND CONCLUSIONS: The results of the present study suggest that percutaneous ablation is preferred to operative excision because it generally requires shorter hospital stay and is not associated with complications. Furthermore, in our experience, pain relief was noted to occur very rapidly in 100% of cases. In agreement with the literature data, our results show that CT-guided percutaneous radio-frequency ablation can actually replace operative excision in the treatment of osteoid osteoma as it achieves the same clinical outcomes with significantly lower costs.

[Computerized tomography in studies of the larynx. Normal anatomy]. / La tomografia computerizzata nello studio della laringe. Anatomia normale.

The CT picture of the normal larynx was studied in 15 volunteers free from laryngeal disorders and in 142 patients examined at the level of the neck for a variety of pathological conditions. The investigation was carried out during normal breathing and during phonation. The diagnostic importance of these two functional attitudes is stressed. Tomographic anatomy was described according to axial planes: suprahyoid, hyoid, subhyoid, supraglottic, glottic and subglottic. In addition to the laryngeal structure, the cartilaginous skeleton and the anatomical formations surrounding the larynx were also investigated. CT was found to be a very useful and accurate tool for studying the delicate structures which form the larynx.

[Computerized tomography in surgically treated lumbar disk hernia. Multicenter study]. / La TC nelle ernie discali lombari operate. Studio multicentrico.

Results are reported of a multicenter analytic-statistical CT study on 128 postoperative lumbar herniated disk (HD) cases (50 at L4-L5, 64 at L5-S1, 2 at L3-L4, 12 multiple). CT was performed from 10 days to 204 months (47.7 months of mean) after surgery, in 51 patients without and in 77 with intravenous contrast medium (42 in bolus, 35 in perfusion). In 59 cases (38%) a recurrent hernia was found, and in 8% a new hernia. In 81% of patients epidural fibrous scars were demonstrated, in a rough 50% of cases associated with recurrent/new hernia: posterior fibrosis was found in 81% of cases, while unilaterally, bilaterally, or anteriorly extended fibroses were present in 20%, in 4.7%, and in 29% of cases respectively. In 72% of the patients injected with contrast medium, various kinds of fibrosis contrast enhancement were detected. In 8% neither fibrosis nor recurrent herniation was found. In 22% of cases lateral and/or central bony canal stenosis was present, in 26% vacuum disk, in 9% intracanalar calcifications, in 39% and in 19.5% dural sac stretching and compression respectively. In 5 cases a pseudomeningocele was found, and in 3 only a postoperative diskitis. Fibrosis is an almost inevitable postoperative consequence (4 out of 5 cases); it can be demonstrated by CT with high sensitivity and good specificity. A series of diagnostic criteria, such as the post-contrast media reaction, allow fibrosis to be discriminated from recurrent hernia. However, the possible association must be kept in mind of both diseases and/or of included roots in the scar. Myelography is hardly ever able to supply further resolutive diagnostic elements, while Myelo-CT is sometimes more useful. The importance of bone changes is questionable, with the exception of evident cases of canal stenosis, also because in most cases the radiologist cannot count on a preoperative CT study. Furthermore, the correlation between CT and clinical findings (possible asymptomatic fibrosis) is often difficult, which gives way to contrasting therapeutic attitudes.