La Radiologia medica
-
La Radiologia medica · Jan 1994
Comparative Study[Pulmonary complications from monoclonal antibody (OKT3) immunosuppression in patients who have undergone an orthotopic liver transplant].
The authors investigated the incidence of pulmonary complications following immunosuppression with monoclonal antibodies (OKT3) in a series of 100 consecutive cases of orthotopic liver transplantation (OLT). Of 17 patients treated with OKT3 (16 for acute rejection and 1 for cyclosporine toxicity), 11 pulmonary infections were observed (65%), 9 of which (53%) with onset within a mean of 9 days after OKT3 administration. The infections were severe in all cases and lethal in 8 cases: the most common pathogens were Candida (4 cases) and Pseudomonas aeruginosa (3 cases). ⋯ The 53% incidence of pulmonary infections in OKT3 patients, significantly higher than in the extant patients (19%), confirms OKT3 treatment as a strong risk factor for severe pulmonary infections. Furthermore, the occurrence of pulmonary edema was directly related to OKT3 administration in 7 OKT3 patients (41%), whereas only 20 cases (24%) occurred in the extant OLT patients (p < 0.001). OKT3-related pulmonary edema was always observed in hyperhydrated patients at the time of drug administration and it seemed to be related to the vasoactive myocardiotoxic agents released by damaged T-cells.
-
La Radiologia medica · Jan 1994
[Computed tomography in the diagnosis of pulmonary barotrauma associated with the adult respiratory distress syndrome].
In the patients suffering from adult respiratory distress syndrome (ARDS), pulmonary barotrauma is a frequent and fearful complication, whose timely and accurate diagnosis is therefore needed. To this purpose, bedside chest films often exhibit some diagnostic drawbacks. Computed tomography (CT) of the chest is rarely used because of the problems concerning the transfer and the control of these critically ill patients outside the Intensive Care Unit. ⋯ The presence of pulmonary bullae (regarded as the evidence of interstitial pulmonary emphysema) proved to be associated with a higher mortality rate than that of the entire sample (58% vs 38%); in 30 of 41 patients with barotrauma (73%) CT proved to be superior to chest films, especially to demonstrate pulmonary bullae (26 cases detected by CT vs 7 cases diagnosed by chest films). In 14 of 41 patients with barotrauma the information yielded by CT directed the choice of treatment: thoracostomy tubes were positioned in the cases of pneumothorax undetected by chest films and in the cases of only partially drained multilocular pneumothorax, or replaced in the event of tube mispositioning. In conclusions, in ARDS patients the use of chest CT is recommended in selected cases only, when complications (especially barotrauma) are suspected and unrevealed by bedside chest films.
-
La Radiologia medica · Dec 1993
[Blunt hepatic and splenic trauma: indications for conservative treatment based on computerized tomography].
In this paper the authors try to define CT criteria for the evaluation of hepatic and splenic injuries in blunt abdominal traumas, to suggest and guide the nonoperative management of trauma in hemodynamically stable patients. The predictive value of CT on the outcome of the nonoperative treatment in adult patients with blunt hepatic and splenic trauma is trusted more and more also thanks to the good results of conservative management in similar injuries in pediatric patients. Thus, we reviewed 314 emergency abdominal CT scans performed in our center March 1990 to March 1992. ⋯ The results indicate that hepatic injuries up to and including grade III, as assessed by CT, can be successfully managed without surgery in hemodynamically stable patients. As for splenic traumas, nonoperative management was attempted in a very small number of patients. Even though a case of grade-III splenic injury in our series was successfully treated without surgery, this may not be the rule, because the outcome of splenic injury and of intraperitoneal hemorrhage is often unpredictable.
-
La Radiologia medica · Nov 1993
[Ultrasonographic evaluation of the sciatic nerve and thigh trauma].
This study was aimed at studying the normal morphology of the main extrapelvic trunk of the sciatic nerve, its average size and its anatomo-topographic relationships by means of high resolution US. The involvement of the sciatic nerve in traumas was also investigated. The lower gluteal region and the posterior aspect of both thighs were examined in 30 healthy subjects and in 11 patients with recent or previous traumas. ⋯ In 2 osteomyelitis cases with a posterior thigh fistula, US showed sciatic nerve involvement by the phlogistic process. Moreover, US allowed an old thick thrombosis of a satellite vein of the sciatic nerve to be depicted. In conclusion, the present study has demonstrated that US not only clearly depicts the sciatic nerve but also provides accurate information on its involvement in recent or previous traumas.