3-D segmentation algorithm of small lung nodules in spiral CT images.

Computed tomography (CT) is the most sensitive imaging technique for detecting lung nodules, and is now being evaluated as a screening tool for lung cancer in several large samples studies all over the world. In this report, we describe a semiautomatic method for 3-D segmentation of lung nodules in CT images for subsequent volume assessment. The distinguishing features of our algorithm are the following. 1) The user interaction process. It allows the introduction of the knowledge of the expert in a simple and reproducible manner. 2) The adoption of the geodesic distance in a multithreshold image representation. It allows the definition of a fusion--segregation process based on both gray-level similarity and objects shape. The algorithm was validated on low-dose CT scans of small nodule phantoms (mean diameter 5.3--11 mm) and in vivo lung nodules (mean diameter 5--9.8 mm) detected in the Italung-CT screening program for lung cancer. A further test on small lung nodules of Lung Image Database Consortium (LIDC) first data set was also performed. We observed a RMS error less than 6.6% in phantoms, and the correct outlining of the nodule contour was obtained in 82/95 lung nodules of Italung-CT and in 10/12 lung nodules of LIDC first data set. The achieved results support the use of the proposed algorithm for volume measurements of lung nodules examined with low-dose CT scanning technique.

Insertion of a tracheoesophageal speech valve: a novel approach in a difficult situation.

BACKGROUND: Functional voice rehabilitation is becoming increasingly important following total laryngectomy and pharyngolaryngectomy. Tracheoesophageal voice via a shunt valve is currently regarded as the 'gold standard' for voice rehabilitation. Traditional techniques usually allow for the replacement of valves in the out-patient setting; however, patient factors such as altered anatomy may occasionally prevent this. OBJECTIVE: This paper describes a novel approach for speech valve insertion that is safe, quick and cost-effective, and which uses equipment commonly available in ENT wards and the operating theatre.

[A clinical case of unrecognized hemoperitoneum: importance of correct preoperative diagnosis]. / Un caso clinico di emoperitoneo sconosciuto: importanza di una corretta diagnosi preoperatoria.

A young caucasian man (16 years old) underwent laparatomy after a diagnosis of acute appendicitis. After anesthetic induction, the patient experienced hypotension and tachycardia. The surgical approach discovered a massive haemoperitoneum subsequent to necrosis of the ileum due to internal herniation. The haemoperitoneum was probable responsible for hypovolemia which justified hypotension and tachycardia, which were reversed by aggressive intraoperative volume infusion. The importance of adequate preoperative diagnosis, in order to treat hypovolemia associated with a massive haemoperitoneum, is stressed.

Dose exposure in the ITALUNG trial of lung cancer screening with low-dose CT.

Few data are available on the effective dose received by participants in lung cancer screening programmes with low-dose CT (LDCT). We report the collective effective dose delivered to 1406 current or former smokers enrolled in the ITALUNG trial who completed 4 annual LDCT examinations and related further investigations including follow-up LDCT, 2-[(18)F]flu-2-deoxy-d-glucose positron emission tomography (FDG-PET) or CT-guided fine needle aspiration biopsy (FNAB). Using the air CT dose index and Monte Carlo simulations on an anthropomorphic phantom, the whole-body effective dose associated with LDCT was determined for the eight CT scanners used in the trial. A value of 7 mSv was assigned to FDG-PET while the measured mean effective dose of CT-guided FNAB was 1.5 mSv. The mean collective effective dose in the 1406 subjects ranged between 8.75 and 9.36 Sv and the mean effective dose to the single subject over 4 years was between 6.2 and 6.8 mSv (range 1.7-21.5 mSv) according to the cranial-caudal length of the LDCT volume. 77.4% of the dose was owing to annual LDCT and 22.6% to further investigations. Considering the nominal risk coefficients for stochastic effects after exposure to low-dose radiation according to the National Radiological Protection Board, International Commission on Radiological Protection (ICRP) 60, ICRP103 and Biological Effects of Ionizing Radiation VII, the mean number of radiation-induced cancers ranged between 0.12 and 0.33 per 1000 subjects. The individual effective dose to participants in a 4-year lung cancer screening programme with annual LDCT is very low and about one-third of the effective dose that is associated with natural background radiation and diagnostic radiology in the same time period.

Laryngopyocoele: simple management of an acute airway crisis.

OBJECTIVE: We present the first reported case of ultrasound-guided aspiration of a laryngopyocoele in a patient with acute airway obstruction. CASE REPORT: A 71-year-old woman was diagnosed with a right-sided laryngocoele. Six weeks later, the patient was admitted as an emergency with a three-day history of increasing dyspnoea and stridor. Neck examination revealed a large, right-sided, soft neck mass, centred at level III, measuring approximately 10 x 5 cm. Fibre-optic laryngoscopy revealed a large, smooth, inflamed, right supraglottic mass obscuring the laryngeal inlet. The patient was taken directly to the radiology department, where ultrasound imaging confirmed a laryngopyocoele. Under ultrasound guidance, a 21-G needle was directed into the cyst and 30 ml of pus was aspirated. The dysphonia and stridor resolved immediately. Six weeks later, the patient underwent definitive surgical excision of the laryngocoele. CONCLUSION: Laryngopyocoele is a rare diagnosis. It can present as an acute airway emergency. We present the first reported case managed by ultrasound-guided aspiration, which averted the need for endotracheal intubation or tracheostomy.

Screening of lung cancer with low dose spiral CT: results of a three year pilot study and design of the randomised controlled trial ''Italung-CT''.

PURPOSE: To report the results of a three-year observational pilot study of lung cancer screening with low dose computed tomography (CT) and to present the study design of a randomised clinical trial named as ''Italung-CT''. MATERIALS AND METHODS: Sixty (47 males and 13 females, mean age 64+/-4.5 years) heavy smokers (at least 20 packs-year) underwent three low-dose spiral CT screening tests one year apart on a single slice or multislice CT scanner. Indeterminate nodules were managed according to the recommendations of the Early Lung Cancer Action Project. RESULTS: and Indeterminate nodules were observed in 33 (55%) of the subjects (60% at the baseline screening test, 24% at the first annual test and 16% at the second annual test). The size of the largest indeterminate nodule was <5 mm in diameter in 20 subjects, 10 of whom showed the nodule at the baseline test. Forty-five subjects (75%) completed the first annual test and 42 (70%) the second annual test. One (1.6%) prevalent lung cancer (adenosquamous carcinoma) and one (2.2%) incident lung cancer (small cell cancer at the first annual examination) were observed, as well as a pulmonary localisation of Hodgkin's lymphoma (at the second annual test). In addition, one subject underwent lung surgery for a chondromatous hamartoma. CONCLUSIONS: The results of the pilot study are substantially in line with those of other observational studies of greater sample size. This justifies optimism about the reliability of the results in the screened arm of the ''Italung CT'' trial which has just begun.

[Value and limitations of determination of total serum CPK in patients with complicated myocardial infarct. Case statistics for 1974-1977]. / Valore e limiti dell'enzima CPK ematico totale in pazienti con infarto del miocardio complicato.

The Authors, starting from a casuistic formed over four years at the "Servizio di Anestesia e Rianimazione dell'Ospedale Fatebenefrateli di Milano" where there is no coronaric unit and that gathers patients with complicated myocardial infarction, considered the developing of the enzyme CPK in the various clinical phases of these patients. On the basis of these data, we confirm with other Authors have already observed: that is, the value of the total serum CPK isn't a prognostic index fit in the evaluation of the clinical developing of the person with myocardial infarction, especially if complicated.

Randomized trial of neomycin/dexamethasone spray vs drop preparation for the treatment of active chronic mucosal otitis media.

Active mucosal chronic otitis media (COM) is notoriously difficult to treat. A randomized, non-blind trial of a drop vs spray preparation of neomycin sulphate (3250 units/ml) and dexamethasone 0.1% (Otomize) has been performed. The spray was significantly better than drops (91% vs 44%) in the resolution of activity in simple perforations (P = 0.002 chi 2 test, with continuity correction). In ears with an open mastoid cavity, 68% of those on the spray preparation became inactive compared with 42% on drops, a difference which just failed to achieve statistical significance (P = 0.06). It is concluded that the spray delivery system is a significant improvement over drops for the treatment of active mucosal COM particularly in the absence of a mastoid cavity.

[Hemodynamic and oxygen transport effects of dobutamine in critically ill patients]. / Effetti emodinamici e sul trasporto di ossigeno della dobutamina nei pazienti critici.

The study evaluates the cardiocirculatory and oxymetric effects of dobutamine infusion in doses between 5 and 15 g/kg/min for a period of 48 hours in 18 critical patients of whom 9 with a low cardiac index (mean 2.1) and 9 with a normal or increased cardiac index (mean 3.3). The beta mimetic effect of the drug is particularly evident in the 9 hypodynamic patients who benefited from a 28% increase in the cardiac index. Likewise, oxygen transport and consumption improved by 22% and 15% respectively. In overall terms, the variables which revealed significant modifications were: cardiac index (CI), systolic index (SI), mean pulmonary pressure (MPAP), pulmonary impaction pressure (PAWP), systemic and pulmonary vascular resistance (SVRO), PVRI), oxygen transport and consumption (DO2, VO2) (No major changes were observed in mean arterial pressure (MAP) and heart rate (HR). No tachyphylaxia was noted after 48 hours of continuous infusion.

T lymphocyte subpopulations defined by monoclonal antibodies in essential mixed cryoglobulinemia and in secondary cryoglobulinemias.

T lymphocyte subpopulations defined by monoclonal antibodies were determined in patients with essential mixed cryoglobulinemia (EMC) and secondary cryoglobulinemias (SC). A decrease of circulating lymphocytes and a reduction in the absolute number of T3+, T4+ and T8+ (p less than 0.01) as well as in the percentage of T4+ lymphocytes (p less than 0.05) were found in EMC. A significant decrease of T8+ cells, both in percentage (p less than 0.01) and absolute number (p less than 0.001), was evidenced in SC, while T3+ and T4+ cell counts were not significantly different from those of healthy controls.

Role of anaerobes in chronic otitis media.

A mixed bacterial flora of aerobic and anaerobic organisms can be isolated from the mucopurulent discharge in nearly 50% of individuals with active chronic otitis media. The role of the anaerobic flora has never been defined. A total of 33 patients with a mixed bacterial flora were treated with metronidazole alone or in combination with systemic antibiotics. The anaerobic flora was eliminated in 15 of 23 compliant individuals but the ears remained clinically active or mucoid in all. Anaerobic organisms would appear unlikely to be the primary pathogen in active chronic otitis media. Metronidazole alone or in combination with systemic antibiotics would also appear to be an ineffective medical treatment of active chronic otitis media as none of the 23 ears became inactive.

Cryoglobulinemia secondary to acute viral hepatitis. Evaluation of a hospital study.

In the present study the possible relationships between cryoglobulins and acute hepatitis of different viral etiology have been investigated. In most cases, cryoglobulins represent a transient phenomenon limited to the acute phase of the disease. Conversely, in 2 cases the persistence of cryoglobulins was associated with a histological pattern of chronic persistent hepatitis.

Heart involvement in essential mixed cryoglobulinemia.

Cardiovascular involvement has been investigated in the course of essential mixed cryoglobulinemia (EMC). A direct pathogenetic role of cryoglobulins, due to coexisting coronary risk factors, is difficult to demonstrate. Nevertheless, a clear role of cryoglobulins in determining heart damage was hypothesized. A significant statistical incidence (p less than 0.05) of heart impairment was found in patients affected by EMC compared with an age- and sex-matched control group. Cryoglobulinemic coronary vasculitis found at post-mortem examination further supports this point of view.