5 research outputs found
Esophagogastric dissociation versus fundoplication: Which is best for severely neurologically impaired children?
Purpose: Neurologically impaired children (NIC) often have swallowing difficulties, severe gastroesophageal reflux, recurrent respiratory infections, and malnutrition. Bianchi pro posed esophagogastric dissociation (EGD) as an alternative to fundoplication and gastrostomy. The authors compared these 2 approaches.Methods: Twenty-nine consecutive symptomatic NIC refractory to medical therapy were enrolled in a prospective study and divided into 2 groups: A (n = 12), NIC who underwent fundoplication and gastrostomy; B (n = 14), NIC who underwent EGD. Three were excluded because of previous fundoplication, Anthropometric (percentage of the 50th percentile/ age of healthy children) and biochemical parameters, respiratory infections per year, hospitalization (days per year), feeding time (minutes), and "quality of life" (parental psychological questionnaire, range 0 to 60), were analyzed (t test and Mann-Whitney test) preoperatively and 1 year postoperatively. Complications were recorded.Results: Compared with group A, group B presented a statistically significant increase of all anthropometric and nearly all biochemical parameters with a statistical difference in terms of respiratory infections, hospital stay, feeding time, and psychological questionnaire. In group A, 2 bowel obstructions, 1 tight fundoplication, 1 dumping syndrome, and 3 failures of fundoplication occurred. Group B presented 1 anastomotic stricture, 1 paraesophageal hernia, and 1 bowel obstruction.Conclusions: Compared with fundoplication and gastrostomy, EGD offered better nutritional rehabilitation, reduction in respiratory infections, and improved quality of life. EGD can be rightfully chosen as a primary procedure. J Pediatr Surg 36:677-680. Copyright (C) 2001 by W.B. Saunders Company
Multiparameter characterisation of vertebral osteoporosis with 3-T MR = Valutazione multiparametrica dell’osteoporosi vertebrale con RM a 3 Tesla
Purpose. This study was undertaken to evaluate the diagnostic capabilities of 3-Tesla (T) magnetic resonance (MR) in vertebral osteoporosis. Materials and methods. Thirty subjects (ten healthy controls, ten with osteoporosis but no fracture, ten with osteoporotic vertebral fractures) underwent MR of the lumbar spine. Turbo spin echo (TSE) T1-, T2- and T2- spectral selection attenuated inversion recovery (SPAIR) weighted imaging and spectroscopy for the selective evaluation of water and fat content were performed. The apparent diffusion coefficient (ADC) was calculated, and diffusion tensor imaging (DTI) was performed to create a map of the spatial arrangement of the tissue structures. Results. Morphological imaging detected recent vertebral fractures. In osteoporotic patients, spectroscopic imaging demonstrated an increase in the saturated fats and a decrease in the ADC, whereas the data provided by DTI demonstrated a bone structure with medium-degree anisotropy. Discussion. Osteoporosis is characterised by trabecular thinning, with an increase in the intertrabecular spaces, which are filled with fats. The anisotropic study and the subsequent assessment of colour and vector maps can provide a noninvasive tool for assessing the risk of fracture due to osteoporosis
Integrated multislice CT and Tc-99m Sestamibi SPECT-CT evaluation of solitary pulmonary nodules
Abstract
Purpose. The purpose of this study was to evaluate efficacy of
multislice computed tomography (MSCT) and single photon
emission computed tomography (SPECT)-CT with Tc-99m
Sestamibi in the assessment of solitary pulmonary nodules of
uncertain significance. Scintigraphy was performed using a
‘hybrid’ g-camera that allows simultaneous acquisition of SPECT
and CT images, with interesting results in diagnostic oncology.
Materials and methods. Between September 2003 and August
2004, 23 patients with a solitary pulmonary nodule detected on CT
underwent SPECT-CT using Tc-99m Sestamibi as a radiotracer.
Nodules with positive scintigraphy were immediately subjected to
biopsy or surgical resection. Nodules with negative scintigraphy
were followed up after 3–4 months by MSCT with automatic
segmentation software (Advanced Lung Analysis, ALA) and
histological characterisation.
Results. Of the 23 nodules (size range 0.8–2 cm) discovered with
MSCT, 11 showed intense uptake of Tc-99m Sestamibi. Ten
lesions were true positive: seven adenocarcinomas, one squamous
cell carcinoma, one large cell carcinoma and one metastasis. The
only false positive was histologically classified as a large cell
granuloma. Twelve lesions had negative scintigraphy: five fibrous
lesions, three hamartomas, three granulomas and one
adenocarcinoma (false negative). Benign nodules without tracer
uptake underwent another CT scan 3–4 months later, which
confirmed stability of the nodule size. Correlation of Sestamibi
SPECT with histology showed sensitivity (Se) of 90.9 %,
specificity (Sp) of 91.6 %, diagnostic accuracy of 91.3 %,
positive predictive value (PPV) of 90.9% and negative predictive
value (NPV) of 91.6 %.
Conclusions. The integrated use of MSCT and Tc-99m Sestamibi
SPECT-CT could be very useful in the management of solitary
pulmonary nodules (SPNs). In particular, in our preliminary study,
scintigraphy provided significant diagnostic information to
differentiate benign from suspicious pulmonary nodules. The use
of scintigraphy could be helpful to anticipate histological
assessment and surgical treatment of SPNs identified at CT