[Pulmonary involvement in scleroderma assessed with high-resolution computerized tomography and functional tests]. / Danno polmonare nella sclerodermia valutato con Tomografia Computerizzata con alta risoluzione e prove funzionali.

This study was aimed at investigating and analyzing lung involvement in scleroderma patients with different imaging methods, toward a rational diagnostic approach. Twenty-four patients with systemic sclerosis were examined with pulmonary function tests (PFT), spirometry and diffusing capacity for carbon monoxide (DLCO), chest radiography and high-resolution Computed Tomography (HRCT). Abnormal findings were present in 42% of cases on X-ray films and in 71% of cases on HRCT images. PFT was abnormal in the spirometries of 42% of cases and in DLCO tests in 50% of cases. The most common findings at HRCT were the small reticular and the ground-glass patterns. HRCT emerged as the most effective method to evaluate lung involvement in systemic sclerosis. In our series, HRCT allowed possibly curable lung lesions to be differentiated from incurable ones. However, HRCT is suggested in the patients with impaired pulmonary function to allow treatment choice; on the contrary, in the patients with no functional impairment, HRCT adds little information to clinical findings, showing only limited focal lesions.

[Dynamic computed tomography in the prognostic assessment of acute pancreatitis]. / Tomografia Computerizzata dinamica nella valutazione prognostica delle pancreatiti acute.

Pancreatic necrosis is a well-known risk factor for infectious complications in the patients affected with acute pancreatitis. Dynamic CT with i.v. administration of a large bolus of contrast medium can establish the diagnosis of necrotizing pancreatitis. A series of 49 cases of severe acute pancreatitis was reviewed, and early CT investigations were seen to fail to detect pancreatic necrosis in 22 instances, versus 27 positive cases. In the group of patients with no necrosis, the clinical course was uneventful or characterized by mild complications which regressed spontaneously or by means of adjuvant medical treatment. On the contrary, 17 patients with necrotizing pancreatitis developed severe complications requiring intensive treatment. These complications occurred in 50% of the patients with < 50% of pancreatic necrosis, while the figure rose to 77% whenever more extensive involvement was observed. Our results show that the presence and extent of pancreatic necrosis must be diagnosed as early as possible for prognostic and therapeutic purposes; this can be done by the routinary use of dynamic CT with the administration of large amounts of contrast media at high flow rates.