Prognostic outcome of routine clinical noninvasive multidetector-row computed tomography coronary angiography in patients with suspected coronary artery disease: a 2-year follow-up study.

PURPOSE: The aim of the study was to assess the prognostic value of multidetector-row CT coronary angiography (MDCT-CA) in patients with suspected coronary artery disease (CAD) in a routine clinical context. MATERIALS AND METHODS: A total of 125 patients (82 men, age 57.4±10.3 years) with suspected CAD underwent MDCT-CA. All patients were assessed for cardiovascular risk factors, symptoms and coronary calcium score. A 2-year follow-up study for the occurrence of major adverse cardiac events was performed. RESULTS: According to the Morise pretest score, 76 patients (60.8%) were at intermediate risk. Patients with suspected CAD presented the following prognostic outcome (p<0.0001): in 41 patients with normal coronary arteries at MDCT-CA, the event rate was 0%; five of 49 patients with nonobstructive CAD had major cardiac events; two of 35 patients with obstructive CAD suffered cardiac death and 19 underwent revascularisation. At multivariate analysis, the presence of obstructive CAD is the only significant independent prognostic variable (hazard ratio, 10.1393; 95% confidence interval 3.2189-31.9379; p<0.0001). CONCLUSIONS: Routine clinical MDCT-CA provides an excellent prognostic value at 2-year follow-up in patients with normal coronary arteries. The cardiac event rate increases with CAD severity.

Prevalence of myocardial bridging and correlation with coronary atherosclerosis studied with 64-slice CT coronary angiography.

PURPOSE: This study aimed to assess the prevalence and characteristics of myocardial bridging in patients who underwent multislice computed tomography coronary angiography (MSCT-CA) and to evaluate the correlation between bridged coronary segments and atherosclerosis. MATERIALS AND METHODS: A total of 277 patients (mean age 60+/-11 years) we consecutively examined with 64-slice MSCT-CA for suspected or known coronary atherosclerosis were retrospectively reviewed for myocardial bridging. Segments proximal and distal to the bridging were evaluated for atherosclerotic plaque, as were the remaining coronary segments. RESULTS: Myocardial bridging was present in 82 patients (30%, mean age 59+/-12). Bridges were of variable length (<1 cm 58%; 1-2 cm 32%; >2 cm 10%) and depth (superficial 69%, intramyocardial 31%) and frequently localised in the mid-distal segment of the left anterior descending artery (95%). Myocardial bridging cannot be considered a significant risk factor for coronary atherosclerosis (odds ratio 0.49) compared with traditional cardiovascular risk factors. Coronary segments proximal to the bridge showed no atherosclerotic disease (33%), positive remodelling (27%), <50% stenosis (20%) or >50% stenosis (20%). We identified 12 noncalcified, 32 mixed and 17 calcified plaques. The distal segments were significantly less affected (p<0.0001). CONCLUSIONS: MSCT-CA is a reliable, noninvasive method that is able to depict myocardial bridging and associated atherosclerotic plaque in the proximal segments.

[Evaluation of operating theatre for the risk prevention]. / Valutazione della qualità della Sala Operatoria in funzione della prevenzione del rischio.

In this study we analyse factors that predispose to risk and we value the importance of quality and reliability into operating theatre. Patient safety result from ability to plan and manage organizations able to reduce probability of mistakes (Prevention) and to recover and contain their consequences (Protection). The principal motives of mistakes are: - deficiency of sharing procedures between different professional figures for risk prevention; - deficiency of an effective integration between professional figures in operating theatre; - deficiency of charitable precise run to guarantee the continuity of interventions on patient. A risk management program have to take care on this sentinel events and to set up a survey-information system to characterize risks and correction strategies. To prevent patient change, wrong side identification, not working devices or deficiency of surgery materials, it would be useful for operating theatre figures and for anesthetists to work out all together a procedure for admission in operating theatre and a pre-operating check list. The best way to carry out a safety and quality attendance based on standardized procedures and protocols, is to set up risk management firm units. It is necessary to activate and to adjust survey system and effective management training.

[The hospital: reality and proposable future]. / L'Ospedale: realtà e futuro proponibile.

In this work we run over hospital history from Middle ages to the present time. Hospitals were charitable institutions in fact they rise inside monasterys, churches or castles with an architecture in modum crucis as a symbolic expression of Christ crucifix. During Renaissance, new scientific Knowledges and the need of technical assistance in a suitable place, lead to a new kind of hospital included into the functional centres of the city were medical practice takes the places of spiritual assistance. In XVIII century hospital is like a "human diseases botanical garden" divided into departments with a circular structure in conformity with a functional model of control. To exceed the isolation of single room, rectangular rooms born with a radially arrangement. At the end of 700's born the pavilions structures typical of hospitals until half 900's when the "monobloc" take place. Today hospital becomes horizontal, include in the context of the city, with hall as a big hotel and with trading centres in accordance with Renzo Piano model and with a new vision of hospital as a welcome place were the patient is a guest to treat as a person of consequence.

Digital cineradiographic study of swallowing in patients with amyotrophic lateral sclerosis.

PURPOSE: This study was performed to evaluate the usefulness of digital cineradiography in detecting swallowing disorders in dysphagic patients affected by amyotrophic lateral sclerosis (ALS) with a view to planning an adequate therapeutic approach. MATERIAL AND METHODS: From January 2005 to September 2006, 23 patients (10 men and 13 women; mean age 41.3+/-8.6 years) affected by ALS were evaluated with digital cineradiography to assess the grade of dysphagia. All patients were classified using the Hillel ALS Severity Scale (ALSSS). All examinations were performed with radiocontrolled equipment provided with a digital C-arm. RESULTS: The cineradiographic technique enabled us to differentiate patients with disorders of the oral (17/23) and/or pharyngeal (19/23) swallowing phase from those without swallowing dysfunction (4/23). In 14/23 patients, passage of contrast medium into the upper airways was observed during swallowing, whereas in 5/23 cases, aspiration of contrast medium into the lower airways was recorded. CONCLUSIONS: The videofluoroscopic swallowing study has high diagnostic capabilities in the evaluation of swallowing disorders, as it is able to identify the degree and causes of impairment. In addition, the study proved useful for planning speech therapy and for follow-up in patients with ALS.

Heterogeneous delayed enhancement of hepatic parenchyma after intravenous infusion of sonographic contrast agent: a new hypothesis.

PURPOSE: The aim of this paper was to report a heterogeneous late-phase hepatic enhancement pattern observed after administration of a sonographic contrast agent and to present an aetiological hypothesis for the phenomenon. MATERIALS AND METHODS: A total of 1,729 (1,012 women and 717 men; age range 28-82; mean age 51) patients underwent contrast-enhanced sonography of the liver. The examination was performed with a low mechanical index (MI <0.09) after injection of sulphur-hexafluoride-filled microbubbles, using different sonographic equipment and different contrast-specific algorithms. RESULTS: Heterogeneous delayed liver enhancement was observed in six patients in the late phase (180 s), with the presence of multiple, partially confluent, hyperechoic areas peripheral to the portal vessels. The pattern appeared spontaneously between 1 and 4 h after the examination and was associated with the presence of an anomalous echogenicity in the superior mesenteric vein. No patient experienced adverse reactions. CONCLUSIONS: The phenomenon of heterogeneous hepatic enhancement may be related to gas from the intestinal microcirculation being transported to via the enteroportal circulation and becoming trapped in the hepatic sinusoids.

Characterization of benign hepatic tumors arising in fatty liver with SonoVue and pulse inversion US.

BACKGROUND: We describe the spectrum of contrast-enhancement patterns of benign hepatic tumors arising in fatty liver on contrast-enhanced ultrasound (US). METHODS: Sixteen patients (12 women and four men) with 27 benign hepatic tumors (17 hemangiomas, eight focal nodular hyperplasias, and two hepatocellular adenomas) arising in fatty liver underwent baseline and pulse inversion US after administration of SonoVue. Two experienced radiologists evaluated baseline echogenicity and dynamic enhancement pattern of each lesion in comparison with adjacent liver parenchyma. RESULTS: After administration of SonoVue, in the arterial phase 13 of 17 hemangiomas showed peripheral globular enhancement and one showed a rim of peripheral enhancement, followed by progressive centripetal fill-in, which was complete in 10 of 14 cases and incomplete in four. Three of 18 hemangiomas showed rapid and complete fill-in in the arterial phase. Eight of eight focal nodular hyperplasias became hyperechoic in comparison with adjacent liver parenchyma in the arterial phase and slightly hyperechoic or isoechoic in the portal venous and delayed phases. Both adenomas showed strong arterial contrast enhancement that became less intense in the portal venous and delayed phases. CONCLUSION: Contrast-enhanced US after administration of SonoVue enables depiction of typical contrast-enhancement patterns in most benign hepatic tumors arising in fatty liver, thus providing useful clues for characterization.

Pancreatic carcinoma versus chronic focal pancreatitis: contrast-enhanced power Doppler ultrasonography findings.

BACKGROUND: We assessed the potential usefulness of contrast-enhanced power Doppler ultrasonography (US) for differentiating pancreatic carcinoma from chronic focal pancreatitis. METHODS: Twenty-six consecutive patients with ductal carcinoma (n=16) and chronic focal pancreatitis (n=10) underwent power Doppler US examinations before and after intravenous injection of an air-based contrast agent (Levovist, Schering, Berlin, Germany). Final diagnosis was obtained by surgery in all patients. The following parameters before and after intravenous administration of contrast agent were evaluated for each lesion: number, morphology and course of the vessels within the lesion and time to maximum detectable enhancement. Number of the lesion vessels and time to maximum enhancement for each lesion were compared by with Student t test. RESULTS: After injection of contrast agent, nine of 16 (56.2%) carcinomas showed a larger total number of vessels (p<0.005) and faster enhancement (p<0.0001) compared with chronic focal pancreatitis. Irregular vessels with a serpiginous course that penetrated the tumor was predominant in carcinoma (eight of 16 cases), whereas focal pancreatitis presented mostly as avascular masses (five of 10 cases). CONCLUSION: Contrast-enhanced power Doppler US provides useful findings for differentiating pancreatic carcinoma from chronic focal pancreatitis.

Pigmented villonodular synovitis of the foot: MR findings.

PURPOSE: To evaluate the MRI findings in the various forms of pigmented villonodular synovitis (PVNS) of the foot. MATERIALS AND METHODS: Seven hundred and fifty-three MR studies of the foot performed at our institute between June 1994 and April 2000 were retrospectively reviewed for the presence of PVNS. Spin echo (SE) T1W, Gradient echo (GE) T2*W, and fat suppression (Short Time Inversion Recovery: STIR) images were acquired with a 0.5 T superconductive unit (Vectra, GE Medical System, Milwaukee, WI, USA) provided with a dedicated transmitter/receiver coil. The site and type of lesions, the signal intensity patterns, and the presence of associated changes were evaluated. RESULTS: On the basis of the MR images and the above parameters, six patients (3 men, 3 women, age range: 35-48 years) with PVNS were selected. Three out of six PVNS were nodular, whereas the remaining three were diffuse. Of the three nodular forms, one was found in the sub-talar joint and the remaining two antero-medially to the talus. Instead, all of the diffuse lesions were located on the metatarsus. Perilesional oedema was seen in all cases, although more obvious in the nodular forms, whereas bone involvement (osteochondral erosion) was observed only in the diffuse metatarsal PVNS. Intra-articular bloody effusion was never observed. The MRI findings were confirmed by surgery in all cases. DISCUSSION: The high contrast resolution and multiplanar capabilities of MRI allow the complete evaluation of the structures of the foot affected by PVNS, and of the extent of soft tissue (bursae, synovial or nervous structures), bone and articular involvement. Although not specific, the presence of haemosiderin results in characteristic MR findings, due to the shortening of both T1 and T2 relaxation times. GET2* images are particularly well suited to this PURPOSE: Furthermore, in our experience, FIR images added better depiction of associated swelling. CONCLUSIONS: According to our results, MRI is now the most reliable technique for identifying and classifying PVNS, and allows correct treatment planning and effective monitoring.

Analysis of radioactive pollution in the Gulf of Palermo.

PURPOSE: Sea water represents more than three quarters of the whole world. The radioactive fall out caused by nuclear experiments, radioactive drosses from nuclear power plants and other pollution sources, are able to contaminate the world ecosystems, and especially the sea water. The aim of this work is the evaluation of a possible radioactive pollution in the Gulf of Palermo. MATERIAL AND METHODS: The Gulf of Palermo was divided into 5 homogeneous hydrological parts, in which fish and water were collected. The dosage of 131I e del 137Cs was mainly assessed because they have a long half-life and their presence in the water can be due to nuclear accidents but also to a wrong removal of the waste materials of nuclear medicine procedures; the other radioisotopes assessed (144Ce, 106Rh, 140La) are due only to nuclear fall-out. Gamma spectrometry technique was used for the evaluation of the radioisotopes' concentration after an adequate treatment of the samples. RESULTS AND CONCLUSIONS: The concentration of the examined radionuclides was below the instrumental capability apart from the 137Cs, whose dose was increased, and can be due to nuclear accidents and explosions. The radionuclide levels detected do not determine a higher risk than normal for the population's health even regard the eatablity of ittical species.

[Sportsman hindfoot pain: role of magnetic resonance imaging]. / Tallodinia dello sportivo: ruolo della risonanza magnetica.

PURPOSE: To assess the outcome of Magnetic Resonance Imaging (MRI) in the diagnosis of sportsman hindfoot pain. MATERIALS AND METHODS: Fortythree professional athletes (31 men, 12 women, age range: 17-37 years) affected by hindfoot pain underwent MRI. Spin echo (SE) T1W, Gradient echo (GE) T2*W, and fat suppression (Short Time Inversion Recovery: STIR) images were acquired with a 0.5 T superconductive unit (Vectra, GE Medical System, Milwaukee, WI, USA). A dedicated extremities transmitter/receiver coil was used. The lesion site, the presence of anatomic variants (os trigonum, Haglund's deformity), and signal intensity changes were evaluated. RESULTS: In all cases MRI allowed the identification of the cause of the hindfoot pain, in relation to soft tissue (bursae, synovial or nervous structures), bone and articular diseases. Particularly, as regards soft tissue diseases, tendinous abnormalities and inflammatory bursal involvement were frequently found (77% of cases). Bone diseases (22% of cases with posterior talalgia alone), mostly involved the heel (60%), whereas cartilagineous diseases were present in 9% of cases. In 60% of cases an intra-articular osseous or cartilagineous displaced fragment coexisted, determinating joint locking during foot flexo-extension movements. In 38% of cases contemporary involvement of different articular structures was observed. DISCUSSION: Both MRI high contrast resolution and multiplanar capabilities allow the complete evaluation of hindfoot region. In our experience sagittal and axial planes were particularly well suited for the diagnosis and the assessment of disease extension. Furthermore, T2W (GET2*) and fat suppression (STIR) images allow high sensitivity even in early disease detection, when hyperemia or fluid collection occur. CONCLUSIONS: According to our results, it seems possible to state that nowadays MRI is the most reliable technique for identifying the causes of hindfoot pain, in order to provide a correct and effective pre-therapeutic planning.

[Biologic effects of the static magnetic field generated by a 0.5 T magnetic resonance tomograph on the enzyme activity of catalase and creatine kinase in the rat]. / Effetti biologici del campo magnetico statico di un tomografo a Risonanza Magnetica da 0,5 T sull'attività enzimatica della catalasi e della creatinchinasi nel ratto.

PURPOSE: We investigated possible alterations in the enzyme activity of catalase and isozyme MB-creatine kinase induced by prolonged exposure of laboratory rodents to a static magnetic field generated by a .5 T Magnetic Resonance unit. MATERIAL AND METHODS: Thirty Wistar albino mice were divided into two groups of 15 mice, one to be exposed to the static magnetic field for 12 hours and the other to be kept in the same environmental conditions as a control group. Immediately after the exposure a peripheral venous blood sample was collected, the cardiac muscle was removed from the mice and the enzyme activity of catalase and MB-creatine kinase were assayed using the spectrophotometric analysis. RESULTS: No statistically significant variation was detected between the enzyme activity of catalase and MB-creatine kinase in the serum and cardiac muscle of the exposed versus the control mice. In the mice exposed to the static magnetic field the enzyme activity of serum and cardiac muscle catalase were respectively .2154 U/L and .0707 U/L after 10 minutes; they were; .2699 U/L and .0946 U/L after 160 minutes. In the control mice the enzyme activity of serum and cardiac muscle catalase were respectively .1941 U/L and .0707 U/L after 10 minutes; they were .2061 U/L and .1068 U/L after 160 minutes. The enzyme activity of MB-creatine kinase in mice was measured in the exposed (80.8 U/L) versus the control (79.6 U/L) group: the difference does not exceed standard deviation. DISCUSSION AND CONCLUSION: Our results seem to exclude any alteration in the activity of catalase and MB-CK after 12 hours' exposure to the static magnetic field. However some homeostatic mechanisms peculiar to pluricellular organisms might act in vivo to adapt to the effects of the static magnetic field during exposure.

Static magnetic fields generated by a 0.5 T MRI unit affects in vitro expression of activation markers and interleukin release in human peripheral blood mononuclear cells (PBMC).

PURPOSE: To investigate the effects of the static magnetic field (SMF) generated by a 0.5 T superconducting MRI unit on in vitro activation marker expression and interleukin release in human peripheral blood mononuclear cell (PBMC) samples from healthy volunteers. MATERIALS AND METHODS: PBMC samples were split into two groups: exposed and sham-exposed under isothermal conditions. PBMC were exposed for 2 h at 24 degrees C to the SMF of a 0.5 T superconducting MRI unit. Immediately after exposure, both samples were cultured for 24 h at 37 degrees C with or without mitogenic stimulation by phytohaemagglutinin (PHA). PBMC were examined for expression of CD25, CD69 and CD71 by immunofluorescence analysis and supernatants were assayed to quantify IFN-gamma, TNF-alpha and IL-4 by ELISA. RESULTS: The 0.5 T SMF produced, after 24 h of culture, a reduced expression of CD69 from PBMC in vitro, that was enhanced after PHA stimulation. An increased release of IFN-gamma and IL-4 was also found, which was reduced after PHA stimulation. The release of TNF-alpha, IL-6 and IL-10 was not modified. CONCLUSIONS: The SMF generated by a 0.5 T superconducting MRI unit modified in vitro activation marker expression and interleukin release from human PBMC.