Imaging of spondylodiscitis.

BACKGROUND: Spinal infections (pyogenic or non-pyogenic) are increasing in incidence and are a common cause of morbidity in high-risk patients (elderly, immunocompromised patients, diabetic patients, drug addicts, and patients with sickle-cell disease). AIM: To provide an overview of the radiological features of spinal infections, focusing on magnetic resonance (MR) imaging, and to illustrate the differential diagnosis. MATERIALS AND METHODS: We reviewed the spine imaging of 118 patients with spinal infections from our files. All patients underwent radiography and MR imaging examinations. computed tomography (CT) was performed in 96 patients. RESULTS: MR imaging has greatly contributed to prompt diagnosis, thus allowing implementation of timely appropriate treatment. CONCLUSIONS: Prompt diagnosis and treatment are essential to prevent serious bone and joint destruction, and severe neurologic sequelae.

The role of imaging in the pre- and postoperative evaluation of posterior occipito-cervical fusion.

PURPOSE: Occipitocervical fusion is required when the occipitoatlantal joint is unstable. The purpose of this paper is to discuss the role of imaging in the pre- and postoperative evaluation of posterior occipitocervical fusion (POCF), focusing on contoured loop fixation by Hartshill and Songer instrumentation. MATERIALS AND METHODS: We studied 21 patients (eight males, 12 females; age range 6-70 years; mean age 32.6 years) with craniocervical instability who underwent POCF with Hartshill U-shaped rod and Songer sublaminar wires. Pre- and postoperative radiographic, computed tomography (CT) and magnetic resonance (MR) imaging examinations were performed in all patients. A 3- to 6-month period of external orthosis with halo vest, sterno-occipitalmandibular immobiliser (SOMI) brace or Philadelphia collar followed surgery. Follow-up was 12-96 (mean 53.1) months. RESULTS: Clinical assessment using the Frankel scale revealed improvement or deterioration arrest in all but two patients: one with C3 failure and halo destabilisation; the other, who had exhibited myelopathy signs on preoperative MR imaging and persistent basilar impression, showed increasing and progressive neurological deficits despite successful POCF. CONCLUSIONS: Pre- and postoperative imaging is extremely useful in patients scheduled to undergo POCF. Preoperative MR screening of basilar impression associated with possible spinal cord lesions appears mandatory to predict possible deterioration and prevent undesired failure of the operation and it may suggest the need for an alternative surgical approach, such as the transoral approach.

[The diagnostic and therapeutic strategies in neoplasms of the adrenal cortex: the authors' own experience]. / Strategia diagnostica e terapeutica nelle neoplasie della corteccia surrenalica: contributo d'esperienza.

The Authors report their limited series of neoplasms of the adrenal cortex, and underline the decisive role of the modern diagnostics based on imaging techniques (US--TC--NMR). These, in fact, often allow a good definition also in the non-functioning adrenal masses incidentally discovered (incidentalomas). The authors emphasize the high quality of such diagnostic methods offering a good reliability in discriminating the nature of the adrenal mass. These undeniable diagnostic advantages have a positive impact on the surgical strategy, allowing together with a careful morphological study of the lesion, to program in detail possible demolitive operations. The authors finally underline the importance of the surgical access: they are persuaded the best is the bilateral under-rib incision. This surgical approach assures a complete exploration of the abdominal and pelvic cavity; moreover, it allows to face every complication.

[Esophagogastric devascularization in bleeding esophageal varices due to portal hypertension: median-term results]. / La devascolarizzazione esofago-gastrica nelle varici esofagee sanguinanti da ipertensione portale: risultati a medio termine.

The authors report their personal experience in the treatment of bleeding gastroesophageal varices related to portal hypertension. The excellent results of the esophagogastric devascularization observed in the middle-term follow-up (5 years) reinforced authors' opinion on this surgical procedure as the most valid alternative to derivative surgery. Furthermore, they emphasize esophagogastric devascularization can often replace, on principle, derivative surgery.