Paoletta Mirk

Work-related musculoskeletal complaints in sonologists.

The prevalence of musculoskeletal complaints of the hand and wrist, and the neck and back, in physicians who operate sonography equipment was evaluated, and associations between these complaints and various work-related and personal variables were studied. A questionnaire survey was distributed among physician sonographers (sonologists) in Italy. The relationship between work habits and musculoskeletal complaints was analyzed by logistic regression models adjusted for gender, age, and duration of work with ultrasound. A total of 2041 physician sonographers completed the questionnaire. It was found that a large proportion of the subjects regularly had work-related complaints, such as neck and back pain (NBP) (18.5%) or hand and wrist cumulative trauma disorder (HWD) (5.3%). Roughly 80% of the sonographers were currently affected, or had been affected in the past, by one or more work-related symptoms. Various work-related factors appeared to be related to musculoskeletal syndromes. The average time spent for each examination was related both to NBP and HWD. Discomfort for transducer design was the best predictor of HWD, whereas a comfortable chair and correct position of the body protected from the onset of NBP. These results support the role of ergonomic factors in the pathogenesis of both NBP and HWD in sonographers.

Sonographic diagnosis of distal biceps tendon rupture: a prospective study of 25 cases.

To describe the sonographic findings of distal biceps tendon ruptures and to assess the accuracy of the technique.

18F-Fluorodeoxyglucose positron emission tomography in evaluating treatment response to imatinib or other drugs in gastrointestinal stromal tumors: a systematic review☆

OBJECTIVE To systematically review the role of (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET) in evaluating treatment response to imatinib or other drugs in gastrointestinal stromal tumors (GIST). METHODS A comprehensive literature search of published studies through February 2011 in PubMed/MEDLINE and EMBASE databases was performed. RESULTS We identified 19 studies including 628 patients with GIST. Main findings of included studies are presented. CONCLUSIONS (18)F-FDG PET has a significant value in assessing treatment response to imatinib or other drugs in GIST patients. (18)F-FDG PET allows an early assessment of treatment response and is a strong predictor of clinical outcome.

Role of color Doppler sonography in the assessment of musculoskeletal soft tissue masses.

Fifty‐six patients with soft tissue masses of the limbs (36 benign, 20 malignant) prospectively underwent sonography (color Doppler and pulsed Doppler examinations) to assess the role of Doppler interrogation in differentiating benign from malignant lesions. Sonography showed 60% sensitivity, 55% specificity, 71% negative predictive value, 42% positive predictive value, and 57% accuracy. Color Doppler evaluation showed 85% sensitivity, 88% specificity, 91% negative predictive value, 80% positive predictive value, and 87% accuracy. Diastolic and venous velocities and pulsatility index values were not statistically significant. Mean systolic velocity was 0.27 m/s in benign lesions and 0.55 m/s in malignant lesions. By combining sonographic and Doppler data, a correct diagnosis was obtained in 51 of 56 patients (90% sensitivity, 91% specificity, 85% positive predictive value, 94% negative predictive value, 91% accuracy). Color Doppler and pulsed Doppler evaluations represent a useful adjunct to sonography and should be routinely included in the evaluation of musculoskeletal soft tissue masses by ultrasonography.

Work stress in radiologists. A pilot study

Purpose . We studied occupational stress and its psychosocial effects in a sample of Italian radiologists and radiotherapistsMaterials and methods . Radiologists and radiotherapists attending two medical conferences were invited to complete a questionnaire comprising four sections investigating the risk of occupational stress (organisational discomfort, Karasek’s Job Content Questionnaire, Siegrist’s Effort-Reward Imbalance, Warr’s Job Satisfaction) and four sections investigating the health effects of such stress (Goldberg’s Anxiety and Depression scales, General Health Questionnaire, Lifestyles Questionnaire)Results . Radiologists and radiotherapists generally expressed high levels of control, reward and satisfaction. However, 38.5% complained of severe organisational discomfort, 24% reported job strain, 28% reported effort/reward imbalance and 25% were dissatisfied. Female radiologists and radiotherapists showed higher levels of organisational discomfort than their male colleagues. Younger and less experienced radiologists and radiotherapists had higher strain scores than their older and more experienced colleagues. A significant correlation was observed between stress predictors and the effects of stress on health, including depression and anxiety, psychological distress and unhealthy lifestylesConclusions . Radiologists and radiotherapists are exposed to major occupational stress factors, and a significant percentage of them suffer from workplace stress. A special effort is required to prevent this conditionRiassuntoObiettivo . Abbiamo inteso indagare l’entità dello stress professionale nei radiologi e radioterapisti e le conseguenze psicosociali associateMateriali e metodi . I partecipanti a due congressi sono stati invitati a compilare un questionario composto da quattro diverse sezioni per misurare il rischio (disagio, contenuto del lavoro secondo il modello di Karasek, discrepanza tra impegno e risultati secondo il modello di Siegrist, e soddisfazione lavorativa secondo Warr) e quattro sezioni per misurare gli effetti dello stress da lavoro (ansia e depressione secondo il questionario di Goldberg, malessere secondo il General Health Questionnaire, stili di vita)Risultati . Nelle risposte rilevate, i medici del campione analizzato esprimono mediamente elevati livelli di discrezionalità, di ricompensa e di soddisfazione dal lavoro, che tuttavia si associano ad un elevato livello di disagio per le condizioni di lavoro nel 38,5% degli specialisti. Il 24% degli intervistati si trova in condizioni di job strain, il 28% soffre per la discrepanza tra impegno prestato sul lavoro e risultati ottenuti, il 25% è insoddisfatto del lavoro. Il disagio per l’organizzazione del lavoro è maggiore nelle donne. Lo stress da lavoro colpisce soprattutto i medici più giovani e con minore esperienza lavorativa. Tutte le variabili indicative di stress da lavoro risultano significativamente associate con gli effetti: ansia, depressione, malessere psicologico, cattivi stili di vitaConclusioni . I radiologi e i radioterapisti sono esposti a rilevanti e specifici fattori di stress professionale. Lo stress da lavoro è presente in circa un quarto dei casi. È necessario un impegno specifico per la prevenzione di tale condizione

Prenatal sonographic diagnosis of bladder extrophy

Sonographic evaluation of the fe tus, especially by means of high· resolution, real-time units, allows a thorough survey of fetal anatomy even during routine obstetric sonograms; man y congenital anomalies are in fact detected incidentally in pregnant patients referred for unrelated reasons . A large number of studies deal with prenatal evaluation of the urinary tract-mainly focusing on kidneys but to a lesser extent concerning ureters and bladder as well both in normafl 3 and abnormal.arn conditions. Despite several reports describing urinary tract anomalies diagnosed by antenatal sonography, to our knowledge no cases of bladder extrophy detected in utero have thus far been reported.

Multidetector CT in small-bowel neoplasms

PurposeThe aim of this study was to assess the diagnostic potential of multidetector computed tomography (MDCT) in the evaluation of small-bowel neoplasms.Materials and methodsWe studied 120 patients with suspected small-bowel disease by 16-slice MDCT after oral administration of a polyethylene glycol solution (n=56) or methylcellulose via a nasojejunal tube (n=64). Unenhanced and contrast-enhanced CT was performed. Contrast-enhanced CT images were acquired 40 s after IV injection of 130 ml of iodinated contrast agent at a rate of 3 ml/s. Multiplanar reconstructions were performed at the end of the examinations.ResultsFifteen patients were found to be affected by small-bowel neoplasm (six had non-Hodgkin’s lymphoma, three had carcinoid tumour, two had Peutz-Jeghers syndrome, two had adenocarcinoma, two had melanoma metastases, one had lipoma). In the remaining patients, 58 cases of Crohn’s disease and seven miscellaneous diseases were detected. All findings were confirmed by barium studies, surgery or endoscopy.ConclusionsMDCT performed after bowel-loop distension with low-density contrast material and IV administration of iodinated contrast agent is a reliable method for diagnosing and staging small-bowel neoplasms.RiassuntoObiettivoValutare le potenzialità diagnostiche della TC multidetettore nello studio delle neoplasie dell’intestino tenue.Materiali e metodiSono stati studiati 120 pazienti con sospetta patologia tenuale mediante TC multidetettore (16 strati) previa somministrazione di polietilenglicole per via orale (n=56) o di metilcellulosa attraverso sondino naso-digiunale (n=64). L’esame TC è stato eseguito prima e durante infusione di 130 ml di MdC iodato con flusso di 3 ml/s ed inizio delle scansioni dopo 40 secondi dall’inizio della somministrazione. Al termine dell’esame sono state effettuate ricostruzioni multiplanari.RisultatiQuindici pazienti sono risultati affetti da neoplasia dell’intestino tenue (6 pazienti con linfoma non Hodgking, 3 con carcinoide, 2 con sindrome di Peutz Jeghers, 2 con adenocarcinoma, 1 con metastasi da melanoma e 1 con lipoma). In 58 pazienti la diagnosi era di morbo di Crohn, in 7 pazienti erano presenti patologie varie. Tutti i quadri venivano confermati con studi baritati, intervento chirurgico o endoscopia.ConclusioniLa TC multidetettore effettuata previa distensione delle anse con MdC ipodenso ed infusione ev di MdC iodato è una metodica utile nella diagnosi e stadiazione delle neoplasie tenuali.

Radiologic Malpractice Litigation Risk in Italy: An Observational Study Over a 14-Year Period

OBJECTIVE The purpose of this study is to assess the risk of medical malpractice litigation for Italian radiologists, compared with the corresponding data in the literature. MATERIALS AND METHODS The insurance claims of Italian radiologists over the 1993-2006 period were anonymously assessed and classified according to the cause of the claim. RESULTS A total of 1,424 claims were filed during the examined period, with most claims being filed at a considerable time interval after the event (up to 10 years). The resulting incidence may be estimated as 44.2 cases per 1,000, meaning that 44% of Italian radiologists have received, or will receive, summons regarding their professional activity during the past 10 years. CONCLUSION The risk of medical malpractice litigation for Italian radiologists is by now comparable to that for American radiologists. Comparison with previous data concerning the same study population shows that the diagnostic errors category has surpassed all other error categories (nondiagnostic errors) and that, within the diagnostic errors category, claims for allegedly missed cancer have surpassed claims for allegedly missed bone abnormalities. Among missed diagnosis claims, the maximum increase concerned mammograms. Strict adherence to radiologic standards and radiotherapy protocols may be a means of reducing the risk of legal action and obviating litigation.

Sonographic and Doppler assessment of the inferior mesenteric artery : normal morphologic and hemodynamic features

AbstractBackground: We wanted to evaluate prospectively the feasibility of sonographic and Doppler assessment of the inferior mesenteric artery (IMA) and to provide data on its normal morphological and hemodynamic characteristics. Methods: Sonography and Doppler study of the IMA were performed on 116 patients without splanchnic vessel pathology. Vessel diameter, systolic, diastolic, and time-averaged mean flow velocities, pulsatility index values, and flow volumes were correlated with patient age (<50 years vs. ≥50 years) using the Wilcoxon rank-sum test. Findings were verified by splanchnic angiography in 11 cases. Results: Technically valid studies were obtained in 103/116 cases (88.8%). Flowmetric data showed high peripheral resistance (mean ± SD: systolic flow velocity, 1.41 m/s ± 0.48; minimal diastolic flow velocity, 0.10 m/s ± 0.16; pulsatility index, 3.49 ± 0.49). Mean flow volume calculated in 80 cases was 0.13 L/min ± 0.06. Older subjects presented significantly higher time-averaged mean flow velocities and lower resistance than those younger than 50 years. Conclusions: The success rate for sonographic and Doppler study of the IMA is similar to that observed with larger splanchnic vessels. Knowledge of its normal characteristics is necessary for recognition of pathological conditions and for studies of its physiological behavior.

Diagnostic performance of fluorine-18-dihydroxyphenylalanine positron emission tomography in diagnosing and localizing the focal form of congenital hyperinsulinism: a meta-analysis

IntroductionWe performed a meta-analysis on published data on the diagnostic performance of fluorine-18 dihydroxyphenylalanine (18F-DOPA) positron emission tomography (PET) in diagnosing and localizing focal congenital hyperinsulinism (CHI).Materials and methodsA comprehensive computer literature search of studies published up to 31 January 2012 regarding 18F-DOPA PET or PET/CT in patients with CHI was performed. Pooled sensitivity and specificity, area under the ROC curve and diagnostic odds ratio (DOR) of 18F-DOPA PET or PET/CT in diagnosing focal CHI were calculated. The localization accuracy of focal CHI was also estimated. Seven studies comprising 195 CHI patients were included.ResultsThe pooled sensitivity and specificity of 18F-DOPA PET or PET/CT in differentiating between focal and diffuse CHI were 89% (95% confidence interval [CI]:81–95%) and 98% (95% CI:89–100%), respectively. The DOR was 74.5 (95% CI:18–307). The area under the ROC curve was 0.95. The pooled accuracy of these functional imaging methods in localizing focal CHI was 80% (95% CI:71–88%).DiscussionIn CHI patients, 18F-DOPA PET or PET/CT demonstrated high sensitivity and specificity in differentiating between focal and diffuse CHI. 18F-DOPA PET or PET/CT are accurate methods of localizing focal CHI. Nevertheless, possible sources of false-negative results for focal CHI should be kept in mind.