1,721,250 research outputs found
Empathizing. A sharing of life
No full textNobody ignores the importance of proper communication with the patient so that it can be considered an integral part of it and maybe the very beginning of the cure. However not everyone considers how difficult is it to handle this. Our paper focuses on the fact that the doctor's contribution is not to let the truth come to light "tout court", taking priority above everything, but only to provide the biographical mosaic with some pieces that the patient can recognize as true and useful. When illness and death are not just words, but already quite near us, self-knowledge is the only thing that makes life alive forever. You cannot pass through the disease without changing. Not always and not necessarily this is for the better, but often it brings awareness
Camporesi e il romanzo di formazione di un medico e avventuriero del Cinquecento.
No full textAbstract non disponibil
Differential diagnosis between usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP) assessed by high-resolution computed tomography (HRCT)
No full textDifferential diagnosis between usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP) assessed by high-resolution computed tomography (HRCT). Radiologia Medica, vol. 19, n. 5-6, 2005, pp. 472-487 Bna C, Zompatori M, Poletti V, Spaggiari E, Chetta A, Calabro E, Ormitti F, Berti E, Cancellieri A, Chilosi M. Sezione di Scienze Radiologiche, Dipartimento di Scienze Cliniche, Universita degli studi di Parma, Parma, Italy. PURPOSE: The aim of this study was to assess the accuracy of high-resolution CT in the differential diagnosis between UIP and NSIP, and the correlations with histological and functional findings. MATERIALS AND METHODS: Patients underwent thin-collimation spiral CT (1 mm), with 10-mm interval. Pulmonary function was assessed with a pneumotacograph and body plethysmograph connected with a computer for data analysis. Three pathologists, blinded to the clinical and functional data, provided a histological diagnosis based on established criteria reported in the literature. The study group only included patients with a histological diagnosis of either UIP or NSIP. RESULTS: We achieved a correct diagnosis of NSIP in 86.6% of cases (76.4% sensitivity; 84.6% specificity), whereas UIP was correctly diagnosed in 73.3% of cases (84.6% sensitivity; 76.5% specificity). An 80% agreement was achieved between the HRCT and histological findings in the whole case series (73% sensitivity, 87% specificity, p<0.01). CONCLUSIONS: The most important finding of our study was that a ground glass appearance equal to or greater than 15% is highly suggestive of NSIP. Therefore, our results could be useful to confirm a suggested diagnosis of NSIP
MRI evaluation of post-infarct residual myocardial viability
No full textMyocardial contractility and contractile reserve, regional perfusion, structural alterations and the
capacity to predict functional reserve of viable but dysfunctional zones are some of the information
provided by magnetic resonance imaging (MRI), which can be considered as a “onestop-shop” study. Viable but dysfunctional myocardial tissue (hibernating and stunned myocardium)
can be identified by MRI with high accuracy by use of specific techniques and sequences. The importance of early identification may be derived from two types of data:
• The mortality rate is four times higher in patients treated with medical therapy than in revascularised
patients.
• Recognition of nonvital areas enables patients to avoid the risks associated with revascularisation.
Cine cardiac MRI lies at the basis of the study of myocardial vitality, based on the rationale that
contractile dysfunction is linked to ischaemic suffering. One of the main advances brought about by
cine cardiac MRI has been the introduction of steady-state free precession (SSFP), better known by
its commercial names of true-FISP or FIESTA (depending on the manufacturer). In addition to classic
cine sequences, cine-tagging is a method that utilises a sequence of radiofrequency impulses immediately
after the echocardiogram (ECG) R-wave to obtain presaturation bands, oriented perpendicularly
to the image plane. These bands or tags are visualised as intersecting hypointense lines overlying
the myocardium
during the cardiac cycle, and their movement (or lack of it) facilitates the detection of dyssynergic segments. However, in the evaluation of myocardial vitality, the study of wall kinetics utilising
cine MRI showed only a 66% concordance compared with fluorodeoxyglucose-positron emission tomography (FDG-PET).
The combined use of perfusion sequences and delayed enhancement (DE) with paramagnetic contrast agent (CA) to evaluate myocardial vitality renders the diagnostic accuracy of MRI comparable
to that of PET,1,2 with the advantages of having better spatial resolution (a fundamental characteristic to evaluate the extension of wall damage, subendocardial, transmural infarct, etc) and of being a
noninvasive and less costly investigation
Medicina Narrativa. Letteratura umana e medicina efficace?
No full textOgni giorno usiamo la nostra capacità narrativa per raccontare e raccontarci agli altri. Il pazienta racconta al dottore la sua storia di malattia. La Medicina Narrativa altro non è che il recupero della storia del paziente nel senso più profondo del termine, che va certamente ben oltre la storia clinica, vista come la storia della malattia e non del paziente. Narrando si comprende, ci si cura e a volte si guarisce
Errore e incertezza in Radiologia
No full textSe l’opinione comune secondo la quale i medici non debbano commettere errori è ormai consolidata, non si deve però dimenticare che l’incertezza è profondamente connaturata nella pratica stessa della medicina e che nessun atto terapeutico è esente dalla possibilità di errore. Gli errori in radiologia non sono i più frequenti, ma sono tra quelli che comportano i rischi più alti. Spiacevoli sequele di accuse o rimpianti, equamente divisi tra coloro che ricevono il trattamento e coloro che lo erogano, mostrano chiaramente che quando le cose non vanno, ci sono spesso due vittime: il paziente e chi ha prestato le cure. Ciò che importa adesso non è tanto di capire chi ha fatto un errore, ma quali sono state le condizioni che l’hanno reso possibile e cosa si può fare per impedire riaccada di nuovo
Ground-glass opacity: Interpretation of high resolution CT findings
No full textGround-glass opacity (GGO) is a common finding on high resolution CT, characterized by areas of hazy increased attenuation of the lung with preservation of bronchial and vascular margins; it is not to be confused with consolidation, in which bronchovascular structures are obscured. It correlates with several pathogenic processes, such as like partial filling of air spaces, inflammatory or fibrotic interstitial thickening, increased capillary blood volume. Infiltrative GGO can representing either interstitial or alveolar processes. GGO is a nonspecific finding; however, the correlation with any of the associated CT findings (nodular lesions, consolidation, septal thickening, fibrosis, vessels or airway calibre alterations, air trapping), and clinical data is helpful in narrowing the range of diagnostic possibilities, or even in suggesting a specific diagnosis. GGO can indicate a potentially treatable disease, help guide the type and location of biopsy and evaluate the effectiveness of therapy. This review discusses the types of lung disease associated with GGO, and the differential diagnosis between GGO caused by infiltrative processes and the mosaic patterns of lung attenuation caused by primary vascular diseases or airway abnormalities. This distinction can be made by evaluating the vessel calibre and air trapping on expiratory scans
When Emphysema Meets Fibrosis: A Pictorial Essay
No full textMany lung diseases, first, tumors, are smoking-related, and it is very likely to find more than one pattern in the same patient. Airspace enlargement with fibrosis (AEF) is one of them, but it has not been deeply understood or studied yet. In fact, we think that it might still be wrongly assimilated with other conditions that have different radiological features altogether and different prognoses. This pictorial essay is aimed at pointing out AEF so that radiologists and pulmonologists get acquainted with it and use the proper terminology, as AEF might not be that rare
Quadri radiologici dell'edema polmonare nelle pneumopatie croniche.
No full textThree atypical patterns of cardiac failure and pulmonary edema, as frequently seen in chronic obstructive pulmonary diseases, are described; I. regional; II. miliary-like; III. Swiss-cheese like. Their importance in early diagnosis of pulmonary edema is discussed in the light of a review of a series of 98 patients whose pulmonary function was also investigated. Examples and statistical data are drown from this series
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