La Radiologia medica
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La Radiologia medica · Jun 2000
[Computerized tomography assessment of femoral and tibial rotation in total knee prosthesis].
CT assessment of the axial deviation of the femoral and tibial prosthetic components in total knee arthroplasty. ⋯ Total knee arthroplasty is presently a standard treatment for many conditions involving this joint. There are several possible postoperative complications, namely fractures, dislocations (a)septic loosening and femoropatellar instability. The latter condition is the most frequent complication among implant failures and is caused by bad orientation of the femoral and tibial components on frontal and axial planes. We measured the orientation of the prosthetic components introducing a CT procedure which modifies the uniarticular with four scans introduced by Berger. The new method uses Berger's parameters and the CT study of both joints by means of Helical CT. With a single examination lasting less than 4 minutes and with the patient in a more comfortable position, we can obtain: 1) comparative and simultaneous assessment of the contralateral joint; 2) several scans to better define Berger's parameters and to accomplish measurement of the rotational deviation with higher precision and markedly decreasing the error margin. The analysis of the results confirms the international literature findings and especially the fundamental importance in positioning both prosthetic components within normal values, as emphasized by the relationship between the clinical symptoms and the rotational degree of the femoral and tibial prosthetic components.
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La Radiologia medica · Jun 2000
[Anatomo-radiologic correlations in spontaneous hematoma of the rectus abdominis muscles].
Rectus sheath hematomas are a frequent but sometimes misdiagnosed disease in patients under anti-coagulative drugs, hemodialysis, or simply in the elderly. The most frequent localization is in the lower part of the abdomen: the explanation lies in the anatomy of the abdominal wall, especially in the arcuate line of the rectus sheath. Aim of this work is to explain the reason of the almost constant location correlating the anatomy with the CT features. ⋯ The diagnosis, whether clinical or based on imaging findings, needs accurate pathoanatomic knowledge of the anterior abdominal wall. Once the diagnosis has been confirmed (by US or CT) patients should be treated conservatively as those that are operated are at risk of developing complications, mainly hemorrhagic.
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La Radiologia medica · May 2000
Review[Necrotizing fasciitis of soft tissues: role of diagnostic imaging and review of the literature].
We retrospectively reviewed the diagnostic imaging findings (radiography, CT and US) of our cases of necrotizing fascitis of soft tissues looking for signs that could be useful for early and accurate diagnosis. ⋯ Early diagnosis and proper treatment are the key issues affecting the chances of recovery for patients with necrotizing fascitis. The clinical suspicion of this condition calls for prompt intervention with effective diagnostic protocols. B-mode, and sometimes color Doppler, US and contrast enhanced CT, together with appropriate laboratory tests, can provide useful information for precise diagnosis and proper treatment.
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La Radiologia medica · May 2000
Can benchmarking be applied to radiation protection? And is it useful?
Any program of protection from the ionizing radiations used for health care must ultimately lead to the total prevention of graduated effects and to the limitation of probabilistic effects to acceptable levels. The latter are the more dangerous because they may occur even at very low doses and involve the whole population including unexposed subjects; these effects may appear in the generations to come. The specific protection of the health of operators, patients, and the general population, depends on a series of physical-technical and bureaucratic-administrative factors. These must be known and applied based on precise reference standards, recommended or stated by law, as well as on appropriately regulated and controlled procedures. We chose to apply the benchmarking method to radiation protection in order to standardize and increase the efficacy of prevention and to plan, according to Deming's cycle, the continuous improvement of radiation protection performance. ⋯ Solving the operators' doubts and consequently decreasing the statistical errors and/or the cases of incorrect performance has resulted in improved rendered quality, which will be further increased after the planned replacement of substandard or unsafe equipment. Meanwhile, the early application of equipment quality controls has helped rationalize and markedly decrease maintenance costs, which results in possible technologic investment to improve emergency imaging. Greater attention to their protection has made patients feel an improvement in received quality and has increased empathy in general. Total quality, as compared with the best practice, has increased thanks to the positive stimulus from standardization, emulation and sharing, and not only to the controls performed. It is difficult to evaluate the management indices, especially the performance efficacy, that is the relationship between radiation protection and results, because the work is in progress and we still lack the actual data on the decrease in accidents at work or occupational diseases of the operators. Moreover, the epidemiological data on radiation-induced conditions will be difficult to collect and interpret, which will make the dynamics of lawsuits for unwarranted or excessive exposure a useful and more readily available piece of information. Finally, relative to economic results, we would like to stress that no additional costs have been necessary to implement safety and quality in a setting involving, directly or indirectly, thousands of people. (ABSTRACT TRUNCATED)
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La Radiologia medica · Mar 2000
[Craniocerebral trauma from bullets: the correlation between computed tomography, the clinical picture, neurosurgical treatment and the long-term sequelae].
To demonstrate the usefulness of CT findings in the planning of brain neurosurgery in gunshot victims, for prompt and successful treatment. ⋯ In our series the mortality rate of firearm wounds of the skull base was 34% higher than that of the hemisphere; this is due to carotid hemorrhage and midbrain damage. Such traumas require emergency radiological diagnosis and neurosurgical treatment because of their severity and early irreversible complications. Complex operations and skilled surgeons may prevent disabling postoperative sequels. CT findings are indispensable and must be correctly interpreted. The radiologist and the neurosurgeon must collaborate closely and both must consider several diagnostic and prognostic factors affecting surgical planning.