Americo Testa - Academia.edu (original) (raw)

Papers by Americo Testa

Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine

Discussion Pneumomediastinum is a condition characterized by the presence of free air or gas in t... more Discussion Pneumomediastinum is a condition characterized by the presence of free air or gas in the mediastinum due to spontaneous, traumatic, or iatrogenic rupture of the airway or esophagus. It is an uncommon but insidious entity in the ED, typically occurring in healthy ...

Journal of Ultrasound

We report a case in which ultrasonography (US) examination was used in the Emergency Department t... more We report a case in which ultrasonography (US) examination was used in the Emergency Department to reveal and diagnose gas contamination of a penetrating wound. Air microbubbles are extremely small and their typical distribution and movement are like those of “sparkling-wine microbubbles”. US assessment of spontaneous disappearance of the air bubbles can distinguish a harmless traumatic nature of the wound from a life-threatening gas-producing bacterial infection.SommarioDescriviamo un caso di ferita penetrante superficiale contaminata da microbolle d'aria, studiato con esame ecografico in Pronto Soccorso. Le microbolle d'aria sono caratterizzate da piccole dimensioni, distribuzione lungo il tragitto della ferita e da peculiari movimenti “a bollicine di spumante”. L'ecografia consente di documentarne la scomparsa nelle ore successive, confermandone la natura traumatica ed escludendo una potenziale complicanza infettiva da germi anaerobi.

Emergency Care Journal, 2009

Materiale protetto da copyright. Non fotocopiare o distribuire elettronicamente senza l'autorizza... more Materiale protetto da copyright. Non fotocopiare o distribuire elettronicamente senza l'autorizzazione scritta dell'editore. 7 emergency care journal -organizzazione, clinica, ricerca • Anno V numero V • Ottobre 2009 • www.ecj.it

European review for medical and pharmacological sciences, 2011

Literature concerning lung ultrasonography is largely growing and opening new diagnostic opportun... more Literature concerning lung ultrasonography is largely growing and opening new diagnostic opportunities. The clinical value of the ultrasonographic interstitio-alveolar syndrome, based on artifactual (lung comets or B-lines) rather than real images, in the detection of lung contusion, pneumonia and pulmonary edema, is clearly demonstrated. As clinical echographists, though, we are living the paradox of relying our experience in lung pathology on images whose biophysical and genetic nature is not fully understood. A detailed review of the ultimate findings with an analysis of recent and past literature regarding the formation of ultrasonographic artifacts was undertaken with the aim of clarifying what we know and where we are heading in this field. It is important for us to underline how lung ultrasonography is not morphological, as this, along with the study of artifact formation, will be the base for the development of a novel 'view' able to take us from artifact to reality ...

European review for medical and pharmacological sciences, 2010

Guidelines on cardiac arrest (CA) recommend the prompt beginning of cardio-pulmonary resuscitatio... more Guidelines on cardiac arrest (CA) recommend the prompt beginning of cardio-pulmonary resuscitation (CPR) and the identification and correction of reversible causes. This article deals with the application of clinical ultrasonography (US) in resuscitation, presenting a simple codified US protocol usable during CPR to recognize reversible causes of CA. EVIDENCE ON US IN CA AND STATE OF THE ART: Emergency US is a bedside, point-of-care, focused diagnostic procedure with aim to complete the physical examination. It is performed by emergency physician everywhere to answer briefly important clinical questions. Several trials recently experimented US employment during advanced life support, demonstrating its feasibility without delaying CPR. The PEA Protocol: We propose a simplified US protocol for non-shockable rhythms, called "PEA protocol" to remember the applications of the study (CA in Pulseless Electrical Activity, PEA) and the US scan sequence: Pulmonary scans to depict pn...

Internal and Emergency Medicine, 2010

The epigastrium is the site where pain coming from both abdominal and extra-abdominal organs is f... more The epigastrium is the site where pain coming from both abdominal and extra-abdominal organs is frequently referred. Although acute or chronic diseases of the stomach, duodenum, liver, pancreas and biliary tree are the most common causes of acute epigastric pain, several other entities, potentially more severe, should also be suspected and investigated. Clinical bedside ultrasonography (US) is actually the first-line imaging in acute epigastric pain patients presenting to the hospital Emergency Department (ED) because it is rapid, noninvasive, relatively inexpensive and focused, repeatable and reliable. Moreover, the systematic use of emergency US as a complement to routine management might save economic resources by avoiding further costs for complications and substantially reducing the time for making an accurate diagnosis. The purpose of this paper is to review the US spectrum of the most common diseases responsible for acute epigastric pain onset. We also propose a focused, well codified US protocol, that we call the "$ approach", based on our clinical experience and the current literature for acute non-traumatic epigastric pain evaluation in an emergency setting. Its systematic application by the emergency physician may reduce the wait for diagnosis and the over-usage of second-line radiological techniques, including computed tomography, as well as to increase the diagnostic accuracy with potential benefits for patient (safety), physician (efficacy) and the institution (efficiency).

Emergency Care Journal, 2007

European Journal of Cancer and Clinical Oncology, 1991

CARCINOMA ARISING from thyroglossal duct remnants is a rare entity [ 11. An interesting case of p... more CARCINOMA ARISING from thyroglossal duct remnants is a rare entity [ 11. An interesting case of papillary thyroid carcinoma of the thyroglossal duct remnants, observed among 700 patients with thyroid carcinoma, is here reported and its particular features described.

Multidisciplinary respiratory medicine, 2013

Chest ultrasonography can be a useful diagnostic tool for respiratory physicians. It can be used ... more Chest ultrasonography can be a useful diagnostic tool for respiratory physicians. It can be used to complete and widen the general objective examination also in emergency situations, at the patient's bedside. The aim of this document is to promote better knowledge and more widespread use of thoracic ultrasound among respiratory physicians in Italy.This document II is focused on advanced approaches to chest ultrasonography especially in diagnosing sonographic interstitial syndrome with physical hypotheses about the genesis of vertical artifacts, differential diagnosis of cardiogenic pulmonary edema and non-cardiogenic pulmonary edema, raising diagnostic suspicion of pulmonary embolism, ultrasound characterization of lung consolidations and the use of ultrasonography to guide procedural interventions in pulmonology.Finally, document II focuses on chest ultrasonography as useful diagnostic tool in neonatal and pediatric care.

Ultrasound in Medicine & Biology, 2011

The purpose of this study was to set an effective standardized method to assess diaphragmatic kin... more The purpose of this study was to set an effective standardized method to assess diaphragmatic kinetics by ultrasound. Forty healthy volunteers were submitted to a B-and M-mode ultrasound study using a convex transducer positioned in the subcostal anterior area for transverse scanning. Ultrasound examination was completed in 38/40 cases (95%), spending on average ,10 min for examination. The resting and forced diaphragmatic excursions were 18.4 ± 7.6 and 78.8 ± 13.3 mm, respectively, unrelated to demographic or anthropometric parameters: intraobserver variability on three successive measurements resulted in 6.0% and in 3.9%, respectively. An inexperienced sonographer completed the ultrasound examination in 37/40 cases, spending on average .15 min, with significant, although marginal, interobserver variability (31.9% and 14.7% for resting and forced diaphragmatic excursion, respectively). Bedside ultrasonography by an anterior subcostal transverse scanning on semi-recumbent patient proves to be a safe, feasible, reliable, fast, relatively easy and reproducible way to assess diaphragm movement. (

Hormone and Metabolic Research, 2006

The aim of our double-blinded randomized prospective placebo-controlled study was to test if a we... more The aim of our double-blinded randomized prospective placebo-controlled study was to test if a week long pre-treatment with hypercalcemic drugs may prevent transient post-thyroidectomy hypocalcemia and reduce hospital stay. Forty-two patients undergoing total thyroidectomy were randomized into two groups. Group 1: 22 patients treated with calcitriol 1.5 mcg/die plus hydrochlorothiazide; Group 2: 20 patients only treated with placebo (mineral integrates) as control group. Calcium and PTHi serum levels were assayed baseline and the days before and after thyroidectomy. Baseline calcium and PTHi did not differ between the two groups. Pre-surgery calcemia significantly increased in group 1 (p<0.05) while PTHi significantly decreased (p<0.05). Post-surgery calcemia and PTHi further significantly decreased in both groups, hypocalcemia (<2.10 mmol/l) occurring in 1 out of 22 patients in group 1 without symptoms and in 10 out of 20 in controls (20% developing symptoms) (p<0.01). The hospital stay resulted significantly shorter in group 1 (2.4+/-0.6 days) in respect to the control group (3.6+/-1.4 days, p<0.05). The administration of calcitriol plus hydrochlorothiazide is able to prevent transient post-thyroidectomy hypocalcemia and to reduce hospital stay.

European Journal of Nuclear Medicine, 1990

A young woman with a thyroid papillary carcinoma behaving as an autonomously hyperfunctioning nod... more A young woman with a thyroid papillary carcinoma behaving as an autonomously hyperfunctioning nodule is described. Only 17 similar patients have been seen in the past 25 years. It is emphasized that hyperthyroidism does not exclude malignant disease in hot nodules. This possibility suggests that all thyroid nodules, either cold or hot, require careful management. Therefore, in "at risk" cases, surgery could be the most useful treatment.

Critical Care, 2012

The clinical picture of the pandemic influenza A (H1N1)v ranges from a self-limiting afebrile inf... more The clinical picture of the pandemic influenza A (H1N1)v ranges from a self-limiting afebrile infection to a rapidly progressive pneumonia. Prompt diagnosis and well-timed treatment are recommended. Chest radiography (CRx) often fails to detect the early interstitial stage. The aim of this study was to evaluate the role of bedside chest ultrasonography (US) in the early management of the 2009 influenza A (H1N1)v infection.

Chest, 2006

Study objective: Despite the high prevalence of chest trauma and its high morbidity, lung contusi... more Study objective: Despite the high prevalence of chest trauma and its high morbidity, lung contusion (LC) often remains undiagnosed in the emergency department (ED). The present study investigates the possible clinical applicability of chest ultrasonography for the diagnosis of LC in the ED in comparison to radiography and CT. Materials and methods: One hundred twenty-one patients admitted to the ED for blunt chest trauma were investigated using ultrasonography by stage III longitudinal scanning of the anterolateral chest wall to detect LC. Data were retrospectively collected in an initial series of 109 patients (group 1) and prospectively in the next 12 patients (group 2). All patients who presented with pneumothorax were excluded. After the ultrasound study, all patients were submitted to chest radiography (CXR) and CT. The sonographic patterns indicative of LC included the following: (1) the alveolointerstitial

The American Journal of Emergency Medicine, 2010

Hormone Research, 1995

We report the case of a 54-year-old female patient with postoperative hypoparathyroidism. Despite... more We report the case of a 54-year-old female patient with postoperative hypoparathyroidism. Despite the fact that she was receiving calcitriol replacement therapy, following the appearance of bone metastases due to breast cancer she developed severe crises of hypo- and hypercalcemia.

Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine

Discussion Pneumomediastinum is a condition characterized by the presence of free air or gas in t... more Discussion Pneumomediastinum is a condition characterized by the presence of free air or gas in the mediastinum due to spontaneous, traumatic, or iatrogenic rupture of the airway or esophagus. It is an uncommon but insidious entity in the ED, typically occurring in healthy ...

Journal of Ultrasound

We report a case in which ultrasonography (US) examination was used in the Emergency Department t... more We report a case in which ultrasonography (US) examination was used in the Emergency Department to reveal and diagnose gas contamination of a penetrating wound. Air microbubbles are extremely small and their typical distribution and movement are like those of “sparkling-wine microbubbles”. US assessment of spontaneous disappearance of the air bubbles can distinguish a harmless traumatic nature of the wound from a life-threatening gas-producing bacterial infection.SommarioDescriviamo un caso di ferita penetrante superficiale contaminata da microbolle d'aria, studiato con esame ecografico in Pronto Soccorso. Le microbolle d'aria sono caratterizzate da piccole dimensioni, distribuzione lungo il tragitto della ferita e da peculiari movimenti “a bollicine di spumante”. L'ecografia consente di documentarne la scomparsa nelle ore successive, confermandone la natura traumatica ed escludendo una potenziale complicanza infettiva da germi anaerobi.

Emergency Care Journal, 2009

Materiale protetto da copyright. Non fotocopiare o distribuire elettronicamente senza l'autorizza... more Materiale protetto da copyright. Non fotocopiare o distribuire elettronicamente senza l'autorizzazione scritta dell'editore. 7 emergency care journal -organizzazione, clinica, ricerca • Anno V numero V • Ottobre 2009 • www.ecj.it

European review for medical and pharmacological sciences, 2011

Literature concerning lung ultrasonography is largely growing and opening new diagnostic opportun... more Literature concerning lung ultrasonography is largely growing and opening new diagnostic opportunities. The clinical value of the ultrasonographic interstitio-alveolar syndrome, based on artifactual (lung comets or B-lines) rather than real images, in the detection of lung contusion, pneumonia and pulmonary edema, is clearly demonstrated. As clinical echographists, though, we are living the paradox of relying our experience in lung pathology on images whose biophysical and genetic nature is not fully understood. A detailed review of the ultimate findings with an analysis of recent and past literature regarding the formation of ultrasonographic artifacts was undertaken with the aim of clarifying what we know and where we are heading in this field. It is important for us to underline how lung ultrasonography is not morphological, as this, along with the study of artifact formation, will be the base for the development of a novel 'view' able to take us from artifact to reality ...

European review for medical and pharmacological sciences, 2010

Guidelines on cardiac arrest (CA) recommend the prompt beginning of cardio-pulmonary resuscitatio... more Guidelines on cardiac arrest (CA) recommend the prompt beginning of cardio-pulmonary resuscitation (CPR) and the identification and correction of reversible causes. This article deals with the application of clinical ultrasonography (US) in resuscitation, presenting a simple codified US protocol usable during CPR to recognize reversible causes of CA. EVIDENCE ON US IN CA AND STATE OF THE ART: Emergency US is a bedside, point-of-care, focused diagnostic procedure with aim to complete the physical examination. It is performed by emergency physician everywhere to answer briefly important clinical questions. Several trials recently experimented US employment during advanced life support, demonstrating its feasibility without delaying CPR. The PEA Protocol: We propose a simplified US protocol for non-shockable rhythms, called "PEA protocol" to remember the applications of the study (CA in Pulseless Electrical Activity, PEA) and the US scan sequence: Pulmonary scans to depict pn...

Internal and Emergency Medicine, 2010

The epigastrium is the site where pain coming from both abdominal and extra-abdominal organs is f... more The epigastrium is the site where pain coming from both abdominal and extra-abdominal organs is frequently referred. Although acute or chronic diseases of the stomach, duodenum, liver, pancreas and biliary tree are the most common causes of acute epigastric pain, several other entities, potentially more severe, should also be suspected and investigated. Clinical bedside ultrasonography (US) is actually the first-line imaging in acute epigastric pain patients presenting to the hospital Emergency Department (ED) because it is rapid, noninvasive, relatively inexpensive and focused, repeatable and reliable. Moreover, the systematic use of emergency US as a complement to routine management might save economic resources by avoiding further costs for complications and substantially reducing the time for making an accurate diagnosis. The purpose of this paper is to review the US spectrum of the most common diseases responsible for acute epigastric pain onset. We also propose a focused, well codified US protocol, that we call the "$ approach", based on our clinical experience and the current literature for acute non-traumatic epigastric pain evaluation in an emergency setting. Its systematic application by the emergency physician may reduce the wait for diagnosis and the over-usage of second-line radiological techniques, including computed tomography, as well as to increase the diagnostic accuracy with potential benefits for patient (safety), physician (efficacy) and the institution (efficiency).

Emergency Care Journal, 2007

European Journal of Cancer and Clinical Oncology, 1991

CARCINOMA ARISING from thyroglossal duct remnants is a rare entity [ 11. An interesting case of p... more CARCINOMA ARISING from thyroglossal duct remnants is a rare entity [ 11. An interesting case of papillary thyroid carcinoma of the thyroglossal duct remnants, observed among 700 patients with thyroid carcinoma, is here reported and its particular features described.

Multidisciplinary respiratory medicine, 2013

Chest ultrasonography can be a useful diagnostic tool for respiratory physicians. It can be used ... more Chest ultrasonography can be a useful diagnostic tool for respiratory physicians. It can be used to complete and widen the general objective examination also in emergency situations, at the patient's bedside. The aim of this document is to promote better knowledge and more widespread use of thoracic ultrasound among respiratory physicians in Italy.This document II is focused on advanced approaches to chest ultrasonography especially in diagnosing sonographic interstitial syndrome with physical hypotheses about the genesis of vertical artifacts, differential diagnosis of cardiogenic pulmonary edema and non-cardiogenic pulmonary edema, raising diagnostic suspicion of pulmonary embolism, ultrasound characterization of lung consolidations and the use of ultrasonography to guide procedural interventions in pulmonology.Finally, document II focuses on chest ultrasonography as useful diagnostic tool in neonatal and pediatric care.

Ultrasound in Medicine & Biology, 2011

The purpose of this study was to set an effective standardized method to assess diaphragmatic kin... more The purpose of this study was to set an effective standardized method to assess diaphragmatic kinetics by ultrasound. Forty healthy volunteers were submitted to a B-and M-mode ultrasound study using a convex transducer positioned in the subcostal anterior area for transverse scanning. Ultrasound examination was completed in 38/40 cases (95%), spending on average ,10 min for examination. The resting and forced diaphragmatic excursions were 18.4 ± 7.6 and 78.8 ± 13.3 mm, respectively, unrelated to demographic or anthropometric parameters: intraobserver variability on three successive measurements resulted in 6.0% and in 3.9%, respectively. An inexperienced sonographer completed the ultrasound examination in 37/40 cases, spending on average .15 min, with significant, although marginal, interobserver variability (31.9% and 14.7% for resting and forced diaphragmatic excursion, respectively). Bedside ultrasonography by an anterior subcostal transverse scanning on semi-recumbent patient proves to be a safe, feasible, reliable, fast, relatively easy and reproducible way to assess diaphragm movement. (

Hormone and Metabolic Research, 2006

The aim of our double-blinded randomized prospective placebo-controlled study was to test if a we... more The aim of our double-blinded randomized prospective placebo-controlled study was to test if a week long pre-treatment with hypercalcemic drugs may prevent transient post-thyroidectomy hypocalcemia and reduce hospital stay. Forty-two patients undergoing total thyroidectomy were randomized into two groups. Group 1: 22 patients treated with calcitriol 1.5 mcg/die plus hydrochlorothiazide; Group 2: 20 patients only treated with placebo (mineral integrates) as control group. Calcium and PTHi serum levels were assayed baseline and the days before and after thyroidectomy. Baseline calcium and PTHi did not differ between the two groups. Pre-surgery calcemia significantly increased in group 1 (p<0.05) while PTHi significantly decreased (p<0.05). Post-surgery calcemia and PTHi further significantly decreased in both groups, hypocalcemia (<2.10 mmol/l) occurring in 1 out of 22 patients in group 1 without symptoms and in 10 out of 20 in controls (20% developing symptoms) (p<0.01). The hospital stay resulted significantly shorter in group 1 (2.4+/-0.6 days) in respect to the control group (3.6+/-1.4 days, p<0.05). The administration of calcitriol plus hydrochlorothiazide is able to prevent transient post-thyroidectomy hypocalcemia and to reduce hospital stay.

European Journal of Nuclear Medicine, 1990

A young woman with a thyroid papillary carcinoma behaving as an autonomously hyperfunctioning nod... more A young woman with a thyroid papillary carcinoma behaving as an autonomously hyperfunctioning nodule is described. Only 17 similar patients have been seen in the past 25 years. It is emphasized that hyperthyroidism does not exclude malignant disease in hot nodules. This possibility suggests that all thyroid nodules, either cold or hot, require careful management. Therefore, in "at risk" cases, surgery could be the most useful treatment.

Critical Care, 2012

The clinical picture of the pandemic influenza A (H1N1)v ranges from a self-limiting afebrile inf... more The clinical picture of the pandemic influenza A (H1N1)v ranges from a self-limiting afebrile infection to a rapidly progressive pneumonia. Prompt diagnosis and well-timed treatment are recommended. Chest radiography (CRx) often fails to detect the early interstitial stage. The aim of this study was to evaluate the role of bedside chest ultrasonography (US) in the early management of the 2009 influenza A (H1N1)v infection.

Chest, 2006

Study objective: Despite the high prevalence of chest trauma and its high morbidity, lung contusi... more Study objective: Despite the high prevalence of chest trauma and its high morbidity, lung contusion (LC) often remains undiagnosed in the emergency department (ED). The present study investigates the possible clinical applicability of chest ultrasonography for the diagnosis of LC in the ED in comparison to radiography and CT. Materials and methods: One hundred twenty-one patients admitted to the ED for blunt chest trauma were investigated using ultrasonography by stage III longitudinal scanning of the anterolateral chest wall to detect LC. Data were retrospectively collected in an initial series of 109 patients (group 1) and prospectively in the next 12 patients (group 2). All patients who presented with pneumothorax were excluded. After the ultrasound study, all patients were submitted to chest radiography (CXR) and CT. The sonographic patterns indicative of LC included the following: (1) the alveolointerstitial

The American Journal of Emergency Medicine, 2010

Hormone Research, 1995

We report the case of a 54-year-old female patient with postoperative hypoparathyroidism. Despite... more We report the case of a 54-year-old female patient with postoperative hypoparathyroidism. Despite the fact that she was receiving calcitriol replacement therapy, following the appearance of bone metastases due to breast cancer she developed severe crises of hypo- and hypercalcemia.