Comprehensive cardiovascular ECG-gated MDCT as a standard diagnostic tool in patients with acute chest pain.

Acute myocardial infarction, pulmonary embolism, and aortic dissection are diseases associated with acute chest pain and may lead to severe morbidity and mortality. These diseases may not be trivial to diagnose in the settings of emergency room. ECG-gated multi-detector computed tomography (MDCT), already established for the assessment of pulmonary embolism and aortic dissection, provides reliable information regarding the triage of patients with acute coronary syndrome in the emergency room. MDCT recently appeared to be logistically feasible and a promising comprehensive method for the evaluation of cardiac and non-cardiac chest pain in emergency department patients. The possibility to scan the entire thorax visualizing the thoracic aorta, the pulmonary arteries, and the coronary arteries could provide a new approach to the triage of acute chest pain. The inherent advantage of MDCT with cardiac state-of-the-art capabilities is the rapid investigation of the main sources of acute chest pain with a high negative predictive value. Recent studies also reports an advantage in terms of costs. With current evidence, the selection of patients with acute chest pain candidates to MDCT should remain restricted to avoid unjustified risk of ionizing radiation.

[A rare case of intramedullary epidermoid cyst diagnosed by MRI]. / Un cas rare de kyste épidermoïde intramédullaire observé à l'IRM.

Intramedullary epidermoid cysts are rare entities. A case recently seen on MRI led us to review the literature on the subject. A 9 year old boy developed in a four month-time a spastic paraparesis with a T7-T8 sensitive level. The MRI showed a widening of the spinal cord at the T6 level with an area of decreased signal on T1 weighted images, and a homogeneous round shaped area of increased signal on T2 weighted images. The authors discuss the contribution of MRI to the diagnosis of this lesion. The number of cases of intramedullar epidermoid cysts, like dermoid cysts, diagnosed with this neuroradiological method, is still very limited and the literature only mentions isolated cases.

[Vertebral osteochondroma and trauma: a possible etiopathogenic correlation]. / Osteocondroma vertebrale e trauma: una possible correlazione eziopatogenetica.

Three cases of vertebral osteochondroma are shown. The tumor was localized in the dorsal tract in two cases and in the lumbo-sacral junction in the other one. We found in all the cases, as a common anamnestic point, a clinical history of trauma. The etiopathological hypotheses are discussed and the hypothesis of a possible correlation between trauma and metaplastic osteochondromatosis is presented.

For an elective surgical management in lumbar intervertebral disc herniation. Experience of 25 years of surgery.

On the base of a wide clinical experiences, the Authors report some consideration about relationship between clinical findings and neuroradiological pictures (plain film, myelography, CT and NMR) of the lumbar vertebral and disc diseases. It's pointed out the useful aspect of each imaging technique that contribute to obtain the more complete informations about anatomy of the lesion; such considerations allows the surgeon to plain the more adequate surgical technique. The Authors think myelography, still today, is the investigation of choice in this kind of pathology.