Postoperative imaging in arthroscopic hip surgery.

Arthroscopic surgery of the hip, compared to that of the knee or the shoulder, has only recently been developed in any significant way. Current indications for arthroscopic surgery of the hip include: diagnosis and treatment of lesions symptomatic of the acetabular labrum, femoroacetabular impingement (FAI), chondral lesions, joint infections, lesions of the teres ligament, impingement of the psoas tendon, pathology of the peritrochanteric space, external snapping hip (coxa saltans), and traumatic and atraumatic instability. Principal indications for imaging of the hip with arthroscopic techniques are represented by persistent groin pain which may be caused by inadequate recognition or treatment of bone alteration of FAI, fractures in the site of resectioned bones, intra-articular adhesion, development of cartilaginous lesions, iatrogenic chondral lesions, recurrent lesions of the fibrocartilaginous acetabular labrum and heterotopic ossification. Postoperative checkup examinations can be undertaken with conventional radiography. The appearance or persistence of groin pain may be investigated using MRI, arthro-MRI and even CT scans.

Detection of Mirizzi syndrome with magnetic resonance cholangiopancreatography: laparoscopic or open approach?

Imaging of the gallbladder and biliary tract has changed dramatically in the past 20 years. Magnetic resonancecholangiopancreatography provides a noninvasive alternative to endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography in the diagnosis of Mirizzi syndrome. In this laparoscopic era, when diagnosis is certain, surgeons must choose between a laparoscopic and a traditional open approach. The authors review their cases of hepatobiliary surgery during the period 1993-2000. Three cases of Mirizzi syndrome (0.4%) were observed among 712 surgical hepatobiliary patients (two type 1 cases and one type 2 case). The authors suggest that with Mirizzi syndrome type 1, laparoscopy together with peroperative cholangiography should be used to resolve anatomic doubts. If clipping of the cystic duct is possible and certain, then laparoscopy may be continued and finished. In the case of cholecystocholedochal fistula (Mirizzi syndrome type 2), when the diagnosis is determined before surgery, the authors believe that laparoscopy is dangerous. Adhesions, inflammation, and anatomy changes may cause injuries to the main bile duct, so an open traditional approach is suggested.

Does endoscopic digital pancreatography constitute an advance in pancreatic imaging?

BACKGROUND: From a technological viewpoint, there have been few advances in retrograde pancreatography since the inception of ERCP despite remarkable advances in other radiographic techniques such as CT and magnetic resonance imaging. We describe a new method of pancreatographic imaging, endoscopic digital pancreatography, based on digital image intensification. METHODS: Thirty-two nonconsecutive patients with various pancreatic diseases were entered into the study. Pancreatography was performed using standard technique with a non-ionic, low osmolarity contrast medium. In addition to conventional pancreatographic x-rays, digital images were acquired and then processed by means of computer-assisted technical modalities. Both pancreatograms were evaluated by two independent investigators. RESULTS: Digital pancreatography was rated as superior to conventional pancreatography in terms of overall quality as well as specific parameters. X-ray dosage was significantly higher and fluoroscopy time significantly longer for conventional pancreatography. CONCLUSION: Endoscopic digital pancreatography represents a significant advance, one with several important advantages compared with conventional pancreatography.

[Diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in patients with Billroth II gastrectomy]. / La ERCP diagnostica e terapeutica nei pazienti gastroresecati secondo Billroth II.

BACKGROUND: Diagnostic and therapeutic endoscopic cholangiopancreatography (ERCP) is more difficult in patients with Billroth II gastrectomy. METHODS: Personal experience in the last 28 months with 38 ERCP regarding 33 Billroth II patients representing the 5.4% of total number of ERCP performed in the same period is reported. RESULTS: Choledochal lithiasis could be treated in all cases observed also if two observed patients necessitated of two ERCP procedure. Only one patient with biliary stenosis could not be treated because of failed sphincterotomy and deep incannulation. The most difficult step in the procedure was duodenal intubation. A final ERCP success rate was 79%. EST could be performed in most cases (16 out of 17 patients=94%). No complications are reported. The use of the lateral viewing duodenoscope is emphasized. CONCLUSIONS: Today, ERCP and endoscopic sphincterotomy (EST) give similar results and no higher risk in patients with regular anatomy or in patients with Billroth II gastrectomy.

[Severe obliteration of the urethral lumen after wall stent implantation. An unusual radiographic finding]. / Schwere Obliteration des Harnröhrenlumens nach Wall-Stent-Implantation. Eine ungewöhnliche radiographische Besonderheit.

The treatment of urethral stricture is still a challenge for urologists. Irrespective of the treatment employed, urethral stricture recurs in about 30% of all cases. In recent years, the wall stent, originally conceived for vascular surgery, has proved to be effective for the treatment of bulbar urethral strictures. The results are good, morbidity and complications occur only occasionally. In this paper, we described the case of a young patient who suffered from complete occlusion of the prosthesis 8 months after its implantation. The low age of the patient and the X-ray features of this case are unusual. The obstruction was successfully resolved by endoscopic resection. Follow-up after 14 months revealed a mild, short stenosis of the proximal tip.

[Twenty-six consecutive patients with acute superior mesenteric infarction. Comparison of conventional radiology, ultrasonography, and computerized tomography]. / Ventisei pazienti consecutivi con infarto acuto mesenterico superiore. Radiologia tradizionale, ecografia e tomografia computerizzata a confronto.

Ischemic bowel disease is a rare disorder whose incidence is increasing as the mean age of the population increases. Diagnosis by clinical, laboratory and radiologic means is often difficult, and delay in definitive therapy results in substantial morbidity and mortality. A series of 26 consecutive patients, with proved acute superior mesenteric ischemia, was retrospectively reviewed: the authors report the diagnostic methods performed preoperatively, the site and the cause of infarction and the time passed between the first radiograph ans surgery. Plain abdominal radiographs were performed in 25 of 26 patients, screening abdominal US in 23 cases and CT in 19 cases. All radiological examinations were retrospectively reviewed by three authors, independently, to recognize the different signs of infarction. On plain abdominal films, the findings warranting a presumptive diagnosis of bowel infarction were air-fluid levels (84% of cases), dilated bowel loops (48%), thickened and unchanging loops (20%), gastric distension and gasless abdomen (12%), small bowel pseudo-obstruction (8%). Screening abdominal US demonstrated intraperitoneal free fluid (26%) and dilated bowel loops (22%). Abdominal CT showed air-fluid levels (79%), dilated loops and free intraperitoneal fluid (47%), intramural gas and thickened bowel loops (36.8%), engorgement of the mesenteric vessels (31%), mesenteric-portal gas, mesenteric thrombus and marked reduction in the volume of gas in the small bowel (10.5%) and paper-thin bowel loops (5%). The authors conclude that air-fluid levels, dilated loops and intraperitoneal free fluid are the most frequent findings, even though they are not specific. While abdominal plain film and screening ultrasonography can be negative, CT detects at least one abnormal finding and at least three abnormal findings in 73% of cases.

[Static functional study with magnetic resonance of anterior shoulder instability]. / L'esame statico funzionale con Risonanza Magnetica nell'instabilità anteriore della spalla.

We studied the glenohumeral joint, in its different components, with cine MRI. Ten asymptomatic volunteers and 6 patients with recurrent shoulder instability were examined with T2-weighted GE MR sequences on the axial plane with the subjects' arms rotated in different positions. The sections corresponding to the subcoracoid space and bicipital groove were recorded in closed-loop video format for cine display. Normal morphological glenoid labrum changes were demonstrated in different degrees of humerus rotation. The subscapularis tendon and the capsule were redundant and infolded toward the joint on internal rotation in 4/6 patients. We found capsular detachment in 2 patients, humeral head subluxation in 3 and subcoracoid impingement in 2 patients. Cine MRI permitted the accurate study of the changes in the glenoid labrum, capsule and subscapularis tendon in all patients and it also showed narrowed coracohumeral distance (< 11 mm) on internal rotation.

[Digital dacryography after insertion of silicone probes after interruption of the lacrimal ducts in childhood]. / Digitale Dakryography nach Einführung von Silikonsonden nach Unterbrechung der Tränengänge im Kindesalter.

Digital dacryography with image subtraction permits a very detailed visualization of the lacrimal pathway, evaluating long-term results of emergency surgery on resected lacrimal canaliculi with silicon probe in children. 65 pediatric patients with traumatic injuries of the eyelid have been treated in emergency surgery with introduction of a silicon catheter. 28/65 patients presented in follow-up the symptom of the "wet-eye": 13 of these patients have been examined with digital dacryography. The examination has permitted exclusion of an organic stenosis or a post-surgical complication of the reconstructed tear duct. The results suggest that the symptom of the "wet-eye" may be explained by a loss of the suction mechanism of the lacrimal papilla.