RESUMEN
PURPOSE: We evaluated the role of computed tomography (CT) for quantifying glenoid bone defects in patients with anterior glenohumeral instability and assisting in planning the most appropriate type of surgery. MATERIALS AND METHODS: From January to November 2006, 93 patients were studied by spiral CT with multiplanar reconstructions (MPR) for recurrent posttraumatic anteroinferior instability, chronic multidirectional instability and recurrent glenohumeral dislocation after surgical stabilisation. RESULTS: Quantitative CT enabled us to measure bone defects of the anteroinferior glenoid in terms of area (mm(2)) or surface percentage. Glenoid osseous defects were classified as small (<15%), medium (15%-20%), and large (>20%). CONCLUSIONS: CT quantification of glenoid bone loss is very accurate as well as rapid, simple and easily reproducible. CT therefore provides an important contribution to preoperative selection of patients, assisting in directing those with <20% bone loss towards arthroscopic capsular repair.
Asunto(s)
Inestabilidad de la Articulación/diagnóstico por imagen , Escápula/diagnóstico por imagen , Escápula/patología , Luxación del Hombro/diagnóstico por imagen , Articulación del Hombro/diagnóstico por imagen , Tomografía Computarizada Espiral , Enfermedad Aguda , Adolescente , Adulto , Anciano , Artroscopía , Femenino , Humanos , Inestabilidad de la Articulación/patología , Inestabilidad de la Articulación/cirugía , Masculino , Persona de Mediana Edad , Procedimientos Ortopédicos , Recurrencia , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sensibilidad y Especificidad , Luxación del Hombro/etiología , Luxación del Hombro/patología , Luxación del Hombro/cirugía , Articulación del Hombro/patología , Resultado del TratamientoRESUMEN
Multiple malignant esophageal tumors of the same cell type are described. In the esophageal mucosa, widespread carcinomatous transformation may be observed and multicentric invasive squamous cell carcinomas may develop. The concomitance of two independent esophageal malignant neoplasms of different epithelial histogenesis is uncommon. Synchronous adenocarcinoma and squamous cell carcinoma of the esophagus is reported. Adenosquamous carcinoma of the esophagus is a rare tumor. Adenocarcinoma of the esophagus represents 10% of esophageal cancer. We report a case of a synchronous primary invasive adenosquamous carcinoma and adenocarcinoma of the esophagus. Both tumors were demonstrated radiographically. The peculiarity of this neoplastic association and the importance of complete radiographic esophageal evaluation in patients with one obvious obstructing tumor of the esophagus are emphasized.
Asunto(s)
Adenocarcinoma/diagnóstico por imagen , Carcinoma Adenoescamoso/diagnóstico por imagen , Neoplasias Esofágicas/diagnóstico por imagen , Neoplasias Primarias Múltiples/diagnóstico por imagen , Anciano , Humanos , Masculino , RadiografíaAsunto(s)
Colelitiasis/complicaciones , Íleon/diagnóstico por imagen , Obstrucción Intestinal/etiología , Anciano , Colelitiasis/diagnóstico por imagen , Colelitiasis/cirugía , Diagnóstico Diferencial , Humanos , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/cirugía , Masculino , Radiografía AbdominalRESUMEN
The aim of this study was to evaluate the accuracy of enteroclysis in the diagnosis of Crohn's disease of the small bowel in a group of consecutive patients. From January 1992 to December 1995, 165 patients with suspected Crohn's disease of the small bowel presented to our institution for enteroclysis. In 14 patients up to three enteroclysis exams were performed. Most patients (78%) underwent colonoscopy and retrograde ileoscopy. In the remaining patients clinical follow-up was used as gold standard. In 79 patients no radiographic abnormalities were found. Sixty-one patients (40 men and 21 women; mean age 34.2 years) had a radiological diagnosis of Crohn's disease. This involved the terminal ileum in 39 patients (64%) either alone (n = 25) or in association with the pelvic ileum (n = 14). In 12 of these patients retrograde ileoscopy was not feasible. Twenty-one patients underwent surgery. In 4 patients pathology revealed diseases other than Crohn's. These patients had all ileocecal diseases (tuberculosis = 2; non-Hodgkin's lymphoma = 1; adenocarcinoma = 1). One false-negative result was observed. Overall, enteroclysis showed a sensitivity of 98.2% and a positive predictive value of 93.4%. Enteroclysis is a sensitive technique in evaluating both the extent and the severity of small bowel involvement in Crohn's disease, although the overlap of radiographic findings may hamper its accuracy when the disease is confined to the ileocecal area.
Asunto(s)
Medios de Contraste , Enfermedad de Crohn/diagnóstico por imagen , Intestino Delgado/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Sulfato de Bario , Niño , Errores Diagnósticos , Enema , Femenino , Humanos , Neoplasias Intestinales/diagnóstico por imagen , Masculino , Metilcelulosa , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Radiografía , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
Enema is the primary imaging method in the diagnosis of Crohn's disease in the small bowel, with clinical follow-up examinations performed by gastroenterologists as the gold standard. The information provided by small bowel enema, in addition to endoscopic findings, is usually sufficient for the gastroenterologist to make the definitive diagnosis and to plan the whole treatment. Scintigraphy with leukocytes labelled with HMPAO-Tc99m has several unique characteristics favoring its use as a diagnostic imaging method in Crohn's disease and ulcerative colitis. It is a noninvasive method requiring no bowel preparation and it is safe in severely ill patients in whom such conventional imaging methods as barium enema or colonscopy might be hazardous. In this study, the authors report the results of their experience with diagnostic small bowel enema and leukocyte scintigraphy with HMPAO-Tc99m in 28 patients with inflammatory bowel disease (Crohn's disease in 18 patients, ulcerative colitis in 7 and radiation-induced inflammatory stenosis of the sigma-rectum, bowel inflammation after appendicectomy and bladder surgery, respectively, in 1 patient each). Scintigraphy with autologous granulocytes with HMPAO-Tc99m was positive in 26 patients and negative in 2. Twenty-five patients were true positives and 1 was a false positive. Fifteen patients were also submitted to small bowel enema: 12 of them were positive (true positive) and 3 negative (1 false negative and 2 true negative). The results of granulocytes scintigraphy were compared with those of small bowel enema: the radionuclide study appeared superior in the assessment of bowel inflammation associated with Crohn's disease and ulcerative colitis. Indeed, scintigraphy depicted granulocyte uptake in the colon where enema had shown no major findings in 4 patients with Crohn's disease. In the author's opinion, the overall sensitivity, specificity and positive predictive value of combined leukocyte scintigraphy and small bowel enema play a major role in the early diagnosis of Crohn's disease and ulcerative colitis and in the assessment of disease extent and activity.
Asunto(s)
Sulfato de Bario , Enema , Enfermedades Inflamatorias del Intestino/diagnóstico por imagen , Neutrófilos , Compuestos de Organotecnecio , Oximas , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Cintigrafía , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Exametazima de Tecnecio Tc 99mAsunto(s)
Cardiopatías Congénitas/diagnóstico , Imagen por Resonancia Magnética , Coartación Aórtica/diagnóstico , Preescolar , Anomalía de Ebstein/diagnóstico , Ecocardiografía , Corazón/anatomía & histología , Defectos del Tabique Interatrial/diagnóstico , Defectos del Tabique Interventricular/diagnóstico , Humanos , Imagen por Resonancia Magnética/métodos , Síndrome de Marfan/diagnóstico , Tetralogía de Fallot/diagnósticoAsunto(s)
Enfermedad Inmunoproliferativa del Intestino Delgado/diagnóstico por imagen , Adolescente , Humanos , Inmunoglobulina A/metabolismo , Enfermedad Inmunoproliferativa del Intestino Delgado/complicaciones , Enfermedad Inmunoproliferativa del Intestino Delgado/inmunología , Síndromes de Malabsorción/etiología , Masculino , Persona de Mediana Edad , RadiografíaAsunto(s)
Biopsia/métodos , Neoplasias Pulmonares/patología , Neoplasias del Mediastino/patología , Mediastinoscopía/métodos , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Torácicas/patología , Tomografía Computarizada por Rayos XRESUMEN
Coeliac disease is a primary malabsorption syndrome, whose gastrointestinal symptomatology regresses following a gluten-free diet. Several authors report an increased incidence of intestinal lymphoma in patients with longstanding coeliac disease; on the other hand the association of this malabsorption syndrome with malignant tumors of the esophagus, stomach or large bowel is not very common. The authors describe three cases of coeliac disease complicated after 5, 12 and 18 years by neoplasms of the esophagus, stomach and small bowel. It is stressed that in this disease patients must be monitored with periodic radiologic examinations, in the hope of detecting any malignancy at an early and perhaps treatable stage.
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Enfermedad Celíaca/complicaciones , Neoplasias Esofágicas/etiología , Neoplasias del Íleon/etiología , Neoplasias del Yeyuno/etiología , Neoplasias Gástricas/etiología , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/etiología , Adulto , Neoplasias Esofágicas/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Humanos , Neoplasias del Íleon/diagnóstico por imagen , Neoplasias del Yeyuno/diagnóstico por imagen , Linfoma/diagnóstico por imagen , Linfoma/etiología , Masculino , Persona de Mediana Edad , Radiografía , Neoplasias Gástricas/diagnóstico por imagenRESUMEN
Our study was directed not only towards the diagnosis of small bowel Crohn's disease, but especially to a quantitative analysis, for a correct therapeutical approach. This experimental trial is based on the relationship between radiological evidence, measured during small bowel enema, and the seriousness of the morphological and functional damage to the intestinal mucosal membrane, evaluated with a post-heparin diamine-oxidase activity test. With this method we studied 35 selected patients; 16 of them were affected by the disease with an exclusive localization in the small bowel and 5 have been considered separately, because 3 patients had already been operated and the other 2 showed different localizations. In our results, the two parameters were not constantly related to each other. In other words the enema's morphological data sometimes do not accord with the mucosal membrane integrity index expressed by the enzyme. Anyway the importance of this study is the attempt of making an objective comparison between an anatomic situation and its functional consequence. These aspects have a great significance in Crohn's disease.
Asunto(s)
Amina Oxidasa (conteniendo Cobre)/sangre , Enfermedad de Crohn , Intestino Delgado/diagnóstico por imagen , Sulfato de Bario , Enfermedad de Crohn/diagnóstico por imagen , Enfermedad de Crohn/enzimología , Humanos , Metilcelulosa , RadiografíaRESUMEN
Malabsorption syndrome is a clinical condition that can be determined by several situations which can ensue by many etiopathogenetic mechanisms. While the diagnostic approach is, for this reason, complex and uses a lot of clinical, laboratory and instrumental techniques, the therapeutic approach could be surgical or medical. The aim of our research is to establish the diagnostic utility of the radiologic examination of the small intestine by enteroclysis, on the basis of our personal experience and the data referred in literature. We took particular care of the radiological study of primitive malabsorption.
Asunto(s)
Intestino Delgado/diagnóstico por imagen , Síndromes de Malabsorción/diagnóstico por imagen , Sulfato de Bario , Enfermedad Celíaca/diagnóstico por imagen , Enfermedad de Crohn/diagnóstico por imagen , Humanos , Enfermedad Inmunoproliferativa del Intestino Delgado/diagnóstico por imagen , Neoplasias Intestinales/diagnóstico por imagen , Linfoma/diagnóstico por imagen , Síndromes de Malabsorción/inducido químicamente , Síndromes de Malabsorción/etiología , RadiografíaRESUMEN
Segmental ischemic disease consists of segmental infarctions and ischemic stenoses. Vasculitis (LES, polyarteritis nodosa, Schönlein-Henoch syndrome), thrombosis, arteriosclerotic changes, mechanical obstructions (adhesions, hernia, volvulus, traumas), hemorrhagic disorders are the most common causes of these intestinal lesions. The authors report their experience achieved during three years on 428 small bowel examinations; among these, 197 were double contrast enemas. Ten patients showed roentgenographic features referred to vascular diseases: 1 LES, 1 Schönlein-Henoch syndrome, 3 polyarteritis nodosa, 5 spontaneous hemorrhagic disorders or due to treatment with anticoagulants. The authors, after a review of the radiological findings, emphasize the high sensitivity and low specificity of double contrast small bowel enema. Furthermore they underline the usefulness of this method in demonstrating and monitoring intestinal pathologic changes.
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Intestino Delgado/irrigación sanguínea , Isquemia/diagnóstico por imagen , Sulfato de Bario , Constricción Patológica/diagnóstico por imagen , Humanos , Obstrucción Intestinal/diagnóstico por imagen , Intestino Delgado/patología , Isquemia/etiología , Isquemia/patología , Mesenterio/irrigación sanguínea , Mesenterio/diagnóstico por imagen , RadiografíaAsunto(s)
Divertículo/diagnóstico por imagen , Intestino Delgado , Adulto , Divertículo/etiología , Femenino , Humanos , Masculino , RadiografíaRESUMEN
In mechanical subocclusions, when there isn't immediate urgency, is it possible and necessary to probe radiologic examination, for a better surgical evaluation. The authors describe their own experience, achieved in about 3 years, on small bowel double contrast enema. They examined 143 patients; 16 of them were suboccluded. The security and the diagnostic reliability of used method are stressed by the authors to define lesions' morphology and localization.