A model of an electro-goniometer and its calibration for biomechanical applications.

The paper describes a detailed model of an electro-goniometer based on a elastic beam connecting two 'bases' whose relative orientation should be measured. This kind of device, which has been developed for the analysis of human motion, is also suitable for different applications even when one or more rotations around moving axes occur. After a theoretical analysis of the device working principles, experimental verifications of the model are presented. The paper analyses the characteristics of the device and shows how the goniometer outputs can be converted into more familiar angular conventions avoiding cross-talk and other artifacts.

TAT, F1 + 2, and D-dimer levels in patients after coronary angiography with nonionic or ionic contrast media or after cardiac catheterization.

The prothrombotic effects of nonionic contrast media (NICM) have been evaluated in both biological and clinical studies. The question of whether there is a higher risk of thromboembolism during angiography with NICM than with ionic contrast media (ICM) has not yet been answered, nor has the precise role of the angiographic procedure per se in such complications been determined. The present study was performed to compare in vivo the potential prothrombotic effects during cardiac angiography of an NICM with those of an ICM, to estimate the effects of the procedure per se, and to assess how long these effects might be maintained. We measured blood levels of three markers of activation of blood coagulation: thrombin-antithrombin III (TAT) complexes, prothrombin fragment 1 + 2 (F1 + 2), and the split product of fibrin, D-dimer, before and after coronary angiography in three groups of patients. In group 1, 14 patients underwent coronary angiography with the NICM iopamidol 370. In group 2, 10 patients underwent coronary angiography with the ICM ioxaglate. In group 3, 10 patients were evaluated immediately after cardiac catheterization, before the injection of contrast material, as controls. No statistically significant differences between the three groups were found in TAT, F1 + 2, or D-dimer levels at different times before and after coronary angiography. There was a trend toward a transient increase in TAT levels after coronary angiography with iopamidol, which at first suggested a possible brief activation of hemostasis with this NICM, but a similar trend was also seen in the control group. We hypothesize that not only the type of contrast material, but also the angiographic procedure per se and patient-related factors all play roles in determining a prothrombotic state during coronary angiography.

CT demonstration of liquid intratumoral fat layering in a necrotic renal cell carcinoma.

We describe a case of clear-cell adenocarcinoma of the kidney with CT evidence of fat that contradicts the rule that radiologically demonstrable fat is absent in renal carcinoma. The cyst-like appearance, egg-shell parietal calcifications, and extrarenal development of the mass suggested a preoperatively incorrect diagnosis of teratoma.

Sonography after renal biopsy: assessment of its role in 230 consecutive cases.

Among 230 patients undergoing ultrasound (US) guided renal biopsy, 218 had postbiopsy sonography. Clinical records were reviewed to correlate symptoms to US findings. In each case of large hematoma (thickness above 1 cm), all postbiopsy sonographic studies were analyzed to look for findings indicative of unfavorable outcome. A total of 96 subcapsular/perirenal hematomas were found. Large hematomas were observed in 20 patients (20/230 = 8.7%), seven of these (3%) were severely symptomatic. In the absence of clinical signs of bleeding, no patient had clinical consequences. In the presence of clinical signs of bleeding, serious complications occurred only in patients with large hematomas. US thickness of retroperitoneal hematoma correlated to clinical outcome: whenever measured thickness was less than 2 cm, clinical evolution was very favorable, whereas a thickness above 2 cm was invariably associated to clinical signs of bleeding. In six of seven cases of thickness exceeding 3 cm, severe complications developed. An unfavorable evolution was associated with increasing thickness and an echogenicity inappropriate with respect to the time elapsed since biopsy. Hydroureteronephrosis, peritoneal effusion, and anomalous vascular images were indicators of deterioration. We conclude that sonography is indicated only for symptomatic patients and that the monitoring of both thickness and changing echogenicity of retroperitoneal blood collections supplements clinical follow-up.

[Surgical revascularization of the myocardium for atresia of the left main coronary artery and atherosclerotic coronary disease]. / Rivascolarizzazione chirurgica del miocardio per atresia del tronco comune e coronaropatia aterosclerotica.

The authors report a rare case of atresia of the left main coronary artery in an adult patient, symptomatic for effort angina. At coronarography, the left main coronary artery was not found; instead, the arteries of the left coronary tree were filled via a single collateral vessel arising from the ostium of the right coronary artery and ending in the trunk of the left anterior descending artery. All left arteries had very narrow calibres, almost hypoplastic, while the right coronary artery had a normal calibre. All the principal arteries had important stenoses. The patient underwent complete cardiac revascularization, and, sixteen months later, is free from angina. Rest and stress myocardial scintigraphy, control coronary angiography and Doppler analysis of internal mammary artery flow demonstrated normal myocardial perfusion, adequate blood flow through the grafts and good runoff in the native vessels. Hence, the authors conclude that such patients should be referred for coronary artery revascularization, since surgical results are good and the small calibre of the left coronary arteries is no contraindication.

Preliminary study of a new fixation device for intertrochanteric femoral fractures.

The authors present a preliminary study on the treatment of intertrochanteric fractures with a reinforced 95 degrees blade-plate, devised and used at the II Orthopedic Dept. of the University of Milan, in cooperation with the Milan Polytechnic. They discuss the indications and clinical-radiographic findings of the first 14 cases operated on, with a mean follow up of two years.

[Echocardiographic evaluation of mitral valve calcification]. / Valutazione ecocardiografica delle calcificazioni valvolari mitraliche.

Preoperative assessment of calcifications is important in order to choose the correct surgical approach for mitral valve disease. To test the accuracy of echocardiography (ECHO) in the semiquantitative analysis of mitral valve (MV) calcifications we preoperatively echo-studied 66 patients, who were to undergo MV replacement of rheumatic disease. Echocardiograms were performed using a standardized method, recorded on videotape and analyzed by two independent observers. Areas of calcification were identified as dense conglomerate echoes which were brighter than those of adjacent internal structures. After removal, the MVs were evaluated by means of inspection (I), direct radiography (X-ray) and quantitative calcium extraction--EDTA spectrophotometry--(QCa). In the three methods ECHO, I and X-ray, MV calcifications were graded as absent (group 1), mild (group 2) nodular (group 3) and diffuse (group 4). Using the chi square test, no significant differences were found between the three methods, or between ECHO and X-ray, or between ECHO and I, while I grading was slightly lower than X-ray grading (P less than 0.002). Using variance analysis, no significant differences were found in QCa in the three methods within group 1 and 4, whereas significant differences were present within group 2 (P less than 0.002) and group 3 (P less than 0.001), due to the lower sensitivity of I. On the base of the observed distribution of QCa in the removed MVs, the following QCa values: a) less than 20 mg, b) 20-80 mg, c) greater than 80 mg, were considered as the selection criteria for a) absent or mild, b) nodular and c) diffuse calcifications respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

[Proposal of a standardized graphic system for collecting coronary angiographic data. Processing with a personal computer]. / Proposta di uno schema grafico standard di raccolta dati per le angiografie coronariche. Elaborazione con personal computer.

A standardized method for the representation and filing of coronary angiographies is proposed. Semi-automatic reference is guided by a computer algorithm. The final report displays a diagram which shows all the information in graphic and alpha-numeric form. Personalized coronary anatomy is drawn using the Coronary Artery Surgery Study (CASS) guidelines. The algorithm semi-automatically designs coronary segments according to CASS criteria. Five levels of percentage reduction in luminal transverse diameter (25, 50, 75, 90, 100%) can be represented. In addition, plaque morphology (concentric or eccentric, greater or less than 0.5 cm in size) and plaque complications, (calcification, ulceration, thrombosis, aneurysmal dilatation, wall irregularity, and diffuse disease) can be added as additional information. Twenty pathological entities (stenosis or plaque complications) can be filed for each patient. Collateral circulation can be represented by identifying the site of origin, one or more mid-points on the pathway, and the point of contact with the recipient vessel. As many as 10 single pathways can be identified. The same method can represent and file by-pass grafting using different symbols. Data can be easily put into the computer in three to four minutes. Coding and filing are automatically stored. Ten Mb can contain 4355 reports, including patient data and five lines of optional comment. Data can be retrieved in the original graphic form or the system can analyze filed data and retrieve series of patients with a given angiographic pattern. This option enables comprehensive research to be performed on any patient population, selecting subgroups of patients with specific anatomic and/or pathologic characteristics.(ABSTRACT TRUNCATED AT 250 WORDS)

MRI as an adjunct to echocardiography for the diagnostic imaging of cardiac masses.

Nine patients underwent magnetic resonance imaging (MRI) as part of the diagnostic evaluation for cardiac masses; eight of them had been preliminarily studied by 2D-echocardiography (US). MRI did not add to the US diagnostic information in patients affected by intracavitary masses. It represented the definitive diagnostic modality in two patients with intramural pathology: one with ventricular rhabdomyoma, the second with an echinococcyal cyst located within the left atrial wall. The complementary role of MRI to US in cardiac masses is discussed.

[Intracavitary and parietal cardiac measurement with nuclear magnetic resonance: comparison with echocardiography in healthy volunteers]. / Misure endocavitarie e parietali cardiache con risonanza magnetica nucleare: confronto con ecocardiografia in volontari sani.

For quantitative evaluation of cardiac dimensions by Nuclear Magnetic Resonance (NMR), we compared the values obtained by ECG gated NMR with those obtained by two-dimensional echocardiography (2D-echo) in 18 adult healthy volunteers aged 20-40 years (mean 31.6 +/- 5.8). NMR was performed using a 2 T super-conducting magnet operating at 0.5 T with a radiofrequency impulse of 21 MHz. Spin-echo pulse sequences with echo-delay times (TEs) of 30-45 msec were used for data acquisition. The interpulse interval was obtained from the R-R interval on the ECG. Slice thickness was set at 1 cm. To obtain planes oriented along the long axis of the left ventricle similar to 2D-echo, paraxial planes were obtained by double angulation. No significant differences of mean values obtained by NMR and 2D-echo were observed. Regression coefficients were not statistically different from 1 for any of the structures measured: left atrium (y = 1.106x), aorta (y = 1.077x), left ventricle (y = 0.66x), interventricular septum (y = x 1.009x), postero-lateral wall of the left ventricle (y = 1.133x), right ventricle (y = 1.093x). However high coefficients of variation were found for measurement of postero lateral wall (79.5) and interventricular septum (41.4) thicknesses; potential causative factors are discussed.

Reporting, filing, and retrieval of coronary angiographic findings: a new personal computer-based system.

A software system for semiautomatic reporting and automatic filing of coronary angiographies has been developed and is suitable for an IBM Personal Computer (PC) with graphic tablet and printer. Coronary angiographic findings referring to the native anatomy, pathology, and post-surgical status can be easily recorded. The data is automatically coded and filed according to category of information. This system can analyze previously filed data and perform searches under one or more angiographic findings. This allows for a comparison of different series of patients.

Perirenal fluid collection complicating chronic pancreatitis: CT demonstration.

Extrapancreatic fluid collections are a well-known complication of pancreatitis and may occur in unusual locations. Involvement of the left perirenal space is uncommon and has not yet been documented by computed tomography. One surgically proven case is described and pertinent radiologic findings are described.

[Rounded atelectasis of the lung. A well defined radio-tomographic syndrome]. / La atelettasia rotonda del polmone. Una sindrome radiotomografica ben definita.

Rounded atelectasis (AR) is an unusual type of pulmonary peripheral collapse which may mimic a tumour mass. Seven patients with AR underwent radiological work up by mean of multiple imaging modalities; radiographic and conventional tomographic features were invariably sufficient to make the correct diagnosis. For this reason, more sophisticated or invasive diagnostic procedures are presently not indicated.

Percutaneous transluminal coronary angioplasty. Critical assessment of preliminary results.

Since June 1981 until July 1983, 40 percutaneous transluminal coronary angioplasty procedures in 38 patients have been performed. Results in the whole series are as follows: stenosis crossed in 33 patients (83%); balloon inflation done in 31 (78%), not done in 2 due to clinical instability induced by crossing of the stenosis; successful dilatation obtained in 25 patients (63%); emergency bypass surgery in 6 patients (15%) with 2 perioperative myocardial infarctions; no deaths. The whole series can be subdivided in two groups by the following parameters: premedication by nitrates (A) or by verapamil (B); temporal concentration of the procedures: 1/month up to February 83 (A), 3.7/month thereafter (B). Results are different in the two groups: 21 attempts in 21 patients: stenosis crossed in 14 cases (67%), balloon inflated in 12 (57%), successful dilatation obtained in 8 patients (38%), emergency bypass in 5 patients (24%). 19 attempts in 17 patients (2 vessel angioplasty in 2 patients): stenosis crossed and balloon inflated in 19 (100%), successful dilatation in 17 cases (89%), uncomplicated emergency bypass in 1 patient (5%). On the basis of personal more recent results an optimistic attitude towards the percutaneous transluminal coronary angioplasty is justified.

[Transluminal coronary angioplasty. Technic and immediate results]. / L'angioplastica coronarica transluminale. Tecnica e risultati immediati.

Controlled crushing of the intimal plaque and of the underlying vessel wall are the determinants of transluminal dilatation of coronary stenoses. The technique of angioplasty has been recently modified in many laboratories, by the use of new catheters and dilatation policies. Data from the NHLBl Registry indicate a 59% primary success rate, being 29% and 12% respectively the failures due either to inability to cross or to dilate the stenosis. A retrospective analysis of successful procedures has highlighted factors that positively affect the results: recent onset of the angina, lack of calcifications, iterative ballooning at high pressures and the experience of the angiographer. Main complications were angina becoming unstable (5.7%) and acute coronary occlusion (4.4%); an emergency bypass operation had to be done in 6.3% of the cases, whereas myocardial infarctions scored 4.4% and hospital deaths less than 1%. Preliminary results of Centro De Gasperis concern 18 attempts to dilate LAD stenoses: primary success rate was 44% with a failure rate of 39% and 17% regarding inability to cross or only to dilate stenosis, respectively. The above results are less favorable than those reported in NHLBl Registry and very much less than those reported by selected laboratories; they are however acceptable in view of the suboptimal characteristics of the materials used and the limited experience of the team.

[Post-infarction aneurysm of the left ventricle. Pre-operative parameters conditioning the surgical risk and remote results]. / Aneurisma post-infartuale del ventricolo sinistro. Parametri pre-operatori condizionanti il rischio chirurgico e i risultati a distanza.

83 patients who underwent resection of postinfarction aneurysms involving the anterior wall of the left ventricle were studied to identify possible determinants of operative outcome, long-term survival and long-term improvement. The indications for aneurysmectomy (either isolated or combined with direct revascularization) were congestive heart failure, angina or life-threatening arrhythmias; six patients were asymptomatic at the time of surgery. Operative mortality rate was 14.4% (11.5% for patients operated more than 60 days following myocardial infarction). The over-all survival rate, at a mean follow-up of 31.5 months (range 2 to 82 months), was 74.39%; 80.88% of patient discharged from hospital, exhibited clinical improvement. Mean values of ejection fraction and excess ejection fraction were significantly higher in the group of operative survivors (31.28 +/- 8.26% and 0.17 +/- 0.08 respectively) than those of surgical deaths (20.25 +/- 8.37% and 0.08 +/- 0.06) (p less than 0.005); the coronary score was significantly lower in the group of survivors (6.81 +/- 2.35 vs 8.33 +/- 2.29) (p less than 0.025). Presence of arrhythmias increased operative mortality (33.3% vs 11.2%, p = 0.05), as did a low cardiac output, impaired contraction of the postero-lateral wall and mitral regurgitation. Long-term survival and improvement were not related to anyone of preoperative parameters taken into consideration: however, a higher percentage of clinical improvement was observed when myocardial revascularization was associated to aneurysmectomy (85% vs. 67.7%).