Imaging techniques in the management of anorexia and bulimia nervosa.

This paper discusses the contribution offered by radiological techniques to the diagnosis of the medical and surgical complications of anorexia nervosa (AN) and bulimia (BN) with the aim of providing general indications as to their use and suggesting the best-suited techniques. In the broad field of the complications of malnourishment, the use of magnetic resonance (MR) instead of computed tomography (CT) in the assessment of brain atrophy provides much more information at a better cost-benefit ratio. Like brain atrophy, other complications may be chance radiographic findings, such as cathartic colon and colon ptosis. Pulmonary tuberculosis and the presence of bronchopneumonia in conditions of malnutrition demand that conventional X-rays be supplemented by high-resolution CT scans, MR and echotomography. When checking for parotidomegaly and polycystic ovary, the best imaging technique is echotomography. Radiologists are also called upon to express their view in the case of emergencies such as the rupture of the esophagus and osteoporosis-induced fractures.

Percutaneous transluminal angioplasty in the treatment of chronic mesenteric ischemia: results and 3 years of follow-up in 23 patients.

BACKGROUND: We evaluated the clinical efficacy of visceral angioplasty in the treatment of chronic mesenteric ischemia. METHODS: Over a 14-year period, we performed percutaneous transluminal angioplasty of 41 occlusive diseases of visceral arteries founded by angiography in 23 patients with chronic mesenteric ischemia. All but one (fibrodysplasic) stenoses were atherosclerotic, and 13 were localized in the ostial tract. Clinical follow-up was evaluated at 2, 6, 12, 24, and 36 months (mean follow-up = 27 months). RESULTS: Angioplasty demonstrated a residual stenosis of 30% or less in 37 procedures, for a technical success rate of 90%. Seventeen of 20 patients had symptom remission after the first treatment, for a short-term clinical success of 77%; two patients needed a reangioplasty after 2 months, and one was referred for aortomesenteric bypass. During a mean follow-up of 27 months (range = 2-36), the clinical success was 88%; 2/15 patients underwent successful repeat angioplasty at 24 and 36 months, for a 100% secondary long-term clinical success. Only two minor complications were encountered. CONCLUSION: Although surgical results are undoubtedly positive, visceral angioplasty is justified in relation to both the high surgical mortality and the low incidence of complications arising from visceral angioplasty.

[Role of diagnostic imaging in the assessment of lung complications of burns]. / Il ruolo della diagnostica per immagini nella valutazione delle complicanze polmonari nella malattia da ustioni.

PURPOSE: We investigated the frequency of pulmonary complications in burn patients and the clinical and prognostic role of chest radiography and CT patterns in these patients. MATERIAL AND METHODS: We examined 203 patients with first- to third-degree burns involving up to 90% of the body surface; the patients were 119 men and 84 women ranging in age 1 to 96 years (mean: 30). Burns on the face, sooth in the sputum and fire in an unventilated area indicated smoke inhalation in three patients. All patients were submitted to bedside chest radiography on hospitalization and the examination was repeated during the hospital stay in 26 patients. Seven patients with pulmonary complications also underwent chest CT. Five patients with severe, extensive burns (> 70% of the body surface) and with no clinical signs of respiratory complications were submitted to HRCT within 48 hours of admission. RESULTS: Lung complications developed in 16 patients (7.8%), leading to clinical and radiographic signs of adult respiratory distress syndrome (ARDS) in 11 of them (5.4%), namely 5 women and 6 men (age range: 19-96 years, mean: 50). Only one of the three patients with smoke inhalation developed ARDS. The extension of burn injuries ranged 18-86% of the body surface. ARDS developed within 12 hours-14 days of injury (mean: 8 days). Four patients (36%) had right lung involvement alone, two (18%) had bilateral, mostly right-lobe, abnormalities, and five patients (46%) had frankly bilateral findings; the latter were associated with pleural effusions in the left lower lobe in one patient. Compared with chest radiography, HRCT always identified the initial signs of interstitial edema and subpleural emphysematous bullae were detected in a patient who subsequently exhibited clinical and radiographic signs of ARDS. Nine (82%) of the 11 ARDS patients died of respiratory insufficiency. Most deaths (6 patients, 67%) occurred within a few hours of the onset of distress; in three patients with unilateral pulmonary edema death occurred within 6, 7 and 8 days, respectively. ARDS patients had significantly larger body surface areas burned and higher incidence of third-degree burns. DISCUSSION: The incidence of radiologically confirmed pneumonia was 1%; the causative pathogens were Pseudomonas aeruginosa and Staphylococcus aureus. HRCT detected a pneumatocele in a patient with Staphylococcus pneumonia. One patient had eosinophilic pleurisy and another a pulmonary microembolization. The overall mortality in our patients with burns and pulmonary complications was 56% versus 2% in the rest of the series, which confirms the importance of an early diagnosis to optimize treatment planning in such cases. For these reasons CT, and particularly HRCT, studies can be best because these techniques can show even minimal parenchymal changes. These examinations will be increasingly feasible also in critically ill and barely movable patients thanks to the latest mobile CT units which permit scanning also in intensive and subintensive care units.

Digestive disturbances in shift-workers: a clinical statistical investigation.

In order to give a clarifying contribution about the probable relationship between shift-work and digestive diseases the authors have conducted a clinical and anamnestical investigation on digestive disturbances and alimentary habits of shift-workers comparing them with non shift-workers. The former group of subjects is engaged in very different activities conducted in variable working environments, with shift rhythms which are always disordered, sometime are imposed by the working Companies and sometimes chosen on the basis of personal necessities. The most interesting result of this study is represented by the confirmation of statistical significance among the larger incidence percentage of digestive disturbances between shift and non shift-workers. Moreover, statistical differences have been remarked among the different groups of shift-workers examinated. For these reasons the authors believe that shift-work is per se responsible of digestive diseases in the workers engaged to it and they also think that it is very important to distinguish the kind of shift work which may produce environmental, psychological and motivational differences.