[Diagnostic problems in reading chest radiographies of elderly patients at admission. Personal experience]. / Problemi diagnostici nella lettura degli esami radiologici del torace di accoglimento nell'anziano. Esperienza personale.

PURPOSE: More chest radiographs are presently performed in the elderly, especially the hospitalized ones. Reading these images is difficult because of the involutions in the thoracic cage, heart and lungs and the scars or calcifications from different abnormal causes. In the elderly, bronchogenic carcinoma may present as an occasional "coin" lesion and therefore such a finding may be an important diagnostic problem and require some expensive and dangerous examinations next. We investigated the relative frequency of questionable abnormal findings in the daily reading of the chest radiographs of elderly patients, the relative importance of the radiologist's experience and of the examination execution technique; the relative costs were also evaluated. MATERIAL AND METHODS: Four radiologists, two of them more experienced (FS, PT), read the consecutive chest radiographs of 811 elderly patients (273 men, 538 women) hospitalized May to December, 1997. Four hundred and ten of them were 65-75 years old and 401 over 75 (particularly, 28 were over 90). Five hundred and sixty-five chest radiographs were made with the AMBER technique and 246 with frontal views only. T-MAT G RA Kodak high-contrast films with Kodak Lanex green-transmitting intensifying screens were used in all cases. CT scans were made with conventional (CT Sytec 3000, GE) or spiral (X Vision, Toshiba) scanners. RESULTS: Seven hundred and fifty-seven radiographs were considered adequate (93%) and 54 inadequate (7%) for diagnosis (25 in patients 65-75 years old, 25 in patients 75-80 and 4 in patients over 90). Thirty-eight of these 54 inadequate radiographs had been made with the AMBER technique and 16 with frontal views only. The more experienced radiologists read 27 (11%) and 19 (10%) of them and the less experienced ones read 4 (2%) and 4 (3%), respectively. The next examinations were other projections and/or radioscopy (4 cases), conventional tomography (7 cases), CT (43 cases), and US (2 cases). "Coin" lesions were the major cause of questionable diagnosis, especially in posterior (10 cases) and peripheral (7 cases) regions, where the differential diagnosis was with vertebral osteophytosis and small rib crowding, respectively. CONCLUSIONS: More skilled radiologists have more doubts reading the chest radiographs of elderly patients. But the next examinations will likely balance the needless ones after an initial misdiagnosis. The chest of elderly patients remains a complex and very little known subject and the reader's experience plays an important role. The examination execution technique must be as accurate as possible in both optimal and suboptimal settings.

[The radiological exam of the chest in the elderly. Technical and methodological considerations]. / L'esame radiologico del torace nell'anziano. Considerazioni tecniche e metodologiche.

PURPOSE: We investigated the capabilities of chest radiography in the elderly considering that the examination must meet the main clinical indications of this population and that it is necessary in the elderly because the correct clinical assessment is often difficult or impossible. MATERIALS AND METHODS: We reviewed the chest radiographs of 756 consecutive elderly patients admitted to our hospital from September 1 to October 31, 1996. If possible, chest radiographs were performed with the AMBER technique (156 patients, 20.7%); 240 patients (31.7%) underwent conventional radiography and the others frontal projections only (360 patients, 47.6%). T-MAT G RA Kodak high contrast films with Kodak Lanex green transmitting intensifying screens were used in all cases. The AMBER examinations of 48/156 patients with hemodynamic clinical indications were repeated with conventional frontal projections. Radiographic reports were made separately by different radiologists who considered especially the diagnostic accuracy of every examination in determining the venous overload of pulmonary circulation. RESULTS: Hemodynamic studies are the most frequent clinical indication of chest radiography in elderly patients (228/756 patients in our series, 30.2%); moreover, even if careful cardiac and pulmonary circulation studies are very important in these patients, only 52.4% of all radiographs could be made in two orthogonal projections. The blurred appearance of vascular landmarks indicating increased extravascular fluid is better depicted by conventional radiography (59.7% of cases) than by AMBER (40.3%). CONCLUSIONS: We conclude that the reduced pulmonary contrast obtained with the so-called "hard X-ray" technique poorly depicts the blurred appearance of pulmonary vessels in pulmonary venous overload. Moreover, "hard X-ray" techniques can be only sporadically used because elderly patients are often in very critical conditions, which prevents this type of examination.

Blood copper and zinc changes in runners after a marathon.

This study reports plasma and total blood cell (TBC) Cu and Zn levels of 16 runners before and after a marathon race. All the pre-race plasma values were in the normal range, while the TBC Cu level was 29.3% (P < 0.01) lower and the TBC Zn level was 29.5% (P < 0.01) higher than mean values of the control group. The run induced a significant decrease in TBC Cu concentration during the days following the race and a light increase in plasma Cu values. It caused a significant increase in TBC Zn concentration at the end of the race (followed by a decrease 24 hours later) without plasma Zn variations. These data show that intense physical exercise could modify trace-element metabolism.

Branched-chain amino acid supplementation during trekking at high altitude. The effects on loss of body mass, body composition, and muscle power.

To investigate the influence of a branched-chain amino acid (BCAA) supplementation on chronic hypoxia-related loss of body mass and muscle loss, 16 subjects [age 35.8 (SD 5.6) years] participating in a 21-day trek at a mean altitude of 3,255 (SD 458) m, were divided in two age-, sex- and fitness-matched groups and took either a dietary supplementation of BCAA (5.76, 2.88 and 2.88 g per day of leucine, isoleucine and valine, respectively) or a placebo (PLAC) in a controlled double-blind manner. Daily energy intake at altitude decreased by 4% in both groups compared with sea level. After altitude exposure both groups showed a significant loss of body mass, 1.7% and 2.8% for BCAA and PLAC, respectively. Fat mass had decreased significantly by 11.7% for BCAA and 10.3% for PLAC, whereas BCAA showed a significantly increased lean mass of 1.5%, as opposed to no change in PLAC. Arm muscle cross-sectional area tended to increase in BCAA, whereas there was a significant decrease of 6.8% in PLAC (P < 0.05 between groups). The same tendency, although not significant, was observed for the thigh muscle cross-sectional area. On the whole it seemed that PLAC had been catabolizing whereas BCAA had been synthesizing muscle tissue. Single jump height from a squatted position showed a similar tendency to increase in both groups. Lower limb maximal power decreased less in BCAA than in PLAC (2.4% vs 7.8%, P < 0.05). We concluded that BCAA supplementation may prevent muscle loss during chronic hypobaric hypoxia.

[Is there a role for double-contrast radiology in the characterization of patients with non-ulcer dyspepsia?]. / Esiste un ruolo per l'esame radiologico a doppio contrasto nella caratterizzazione di pazienti con dispepsia non ulcerosa?

Nun-ulcer dyspepsia (NUD) is a very common disorder: about 30% of subjects may suffer from this syndrome, with a subsequent increase in sanitary cost. NUD is diagnosed by means of both an accurate anamnesis and instrumental investigations like double-contrast upper gastrointestinal X-rays, endoscopy, and US of the biliary tract. Our study was aimed at evaluating the actual capabilities of double-contrast radiology in the characterization of NUD patients. One-hundred consecutive outpatients (53 males and 47 females, age range 15-84 years) with clinical symptoms of NUD were submitted to double-contrast gastric radiological examination. X-rays were performed without pharmacological hypotonicity to better depict functional disorders (i.e., impaired esophageal motility, gastroesophageal and duodenogastric reflux, gastric hypotonicity, and delayed gastric emptying) even though this prevented the though evaluation of morphological features, which are better identified by gastrointestinal endoscopy. 42% of patients, especially middle-aged ones, exhibited only functional disorders. Double-contrast X-rays might therefore be suggested as a useful investigation technique in young patients with clinical symptoms of NUD: it is capable of showing functional disorders and therefore can support upper gastrointestinal tract endoscopy in the pathophysiological characterization of NUD patients.

[The radiological picture of the nonvascular surgical mediastinum]. / Il quadro radiologico del mediastino non vascolare operato.

A review was made of the chest X-ray features of 120 patients who underwent surgical treatment for mediastinal nonvascular pathologies over the past 12 years in the Mestre Hospital. A method of analysis is proposed which takes into account not only the differences between the immediate postoperative period and the follow-up, but also the anatomotopographic partition and the surgical practice. Normal and pathological patterns for both of the above periods are described. The "dimness" of the aerial tracheogram is emphasized as a useful and early sign of mediastinal recurrence.