Biomedical subjects
Publications and source records attributed to A Barile.
The case of a 78-year-old man with retroperitoneal hemorrhage due to a ruptured right inferior suprarenal artery aneurysm is presented. The diagnosis was made by angiography which allowed immediate embolization of the neck of the aneurysm, controlling hemorrhage and obviating the need for surgery. The patient made a full recovery with no evidence of further hemorrhage.
PURPOSE: To evaluate retrospectively the role and the effectiveness of self-expandable Wallstents and balloon-expandable Strecker stents in patients with inoperable malignant obstruction of the biliary tree. METHODS: Fifty patients with malignant biliary obstruction were treated from August 1991 to August 1992 by percutaneous placement of 55 metallic endoprostheses (39 Wallstents, 16 Strecker stents). All patients were followed by clinical evaluation, laboratory data, and ultrasonographic examination until death. RESULTS: Wallstent placement was successful in 36 patients without procedure-related complications. One partial occlusion after 1 year was resolved by percutaneous balloon dilatation. Fourteen patients were treated with 16 Strecker stents. Stenting was unsuccessful in four cases; four occlusions (after 6 h, 48 h, 2 and 6 months) were encountered. CONCLUSION: Wallstent endoprostheses have good results and long-term patency. There were some problems with Strecker stents during the placement and there was a higher occlusion rate.
A 71-year-old woman presented with a life-threatening thyroid hemorrhage after US-guided chemical parathyroidectomy. The diagnosis was made by angiography followed by immediate embolization of a pseudoaneurysm of the left superior thyroid artery. Embolization controlled the hemorrhage, obviating the need for surgery. The patient made a full recovery with no evidence of further hemorrhage. Pseudoaneurysm of the superior thyroid artery is a rare cause of hemorrhage and percutaneous embolization is an effective method of treatment.
Peripheral neuropathy of the external popliteal ischiadic nerve caused by intraneural cysts is a very rare and peculiar pathological phenomenon compared with diseases associated with extraneural cysts or colliquative phenomena of solid nervous lesions. Two cases of peripheral neuropathy of the external popliteal ischiadic nerve caused by intraneural cysts and evaluated with ultrasound, computed tomography and magnetic resonance are described. The diagnostic efficacy of these imaging modalities is also evaluated with particular reference to MR capability to define the morphology of such lesions and their relationships to the surrounding structures. It is not yet possible to obtain a correct diagnosis about histopathologic features by means of the imaging techniques currently available. Nevertheless, they do provide information about the involvement of the neighboring areas, which are useful indications for possible surgical treatment of the disease.
A correct evaluation of site and extension of the talocalcaneal coalition inducing biomechanical ankle alterations is very important for planning therapy. Four male patients were submitted to computed tomography (CT) and three of them were also examined by means of magnetic resonance imaging (MRI). In one patient, studied by CT only, a bilateral talocalcaneal coalition was present, while the other three patients, controlled with CT and MRI, were affected by monolateral talocalcaneal coalition which was of osseous type in one case and fibrocartilaginous in two cases. CT and MRI provided detailed information on type and extension of the coalition and both helped in distinguishing between osseous and fibrocartilaginous forms. Only MRI showed an area of subchondral ischemic disease of the posterior subtalar joint in one patient with monolateral fibrocartilaginous talocalcaneal coalition. Compared with CT, MRI proved to be more accurate in evaluation of the talocalcaneal coalition, due to its wider display capability.
PURPOSE: Aim of our study was to compare MR Angiography and Digital Angiography in the diagnosis of peripheral vascular occlusive disease. MATERIAL AND METHODS: Forty-five patients underwent both MRA and DSA examination of the peripheral arterial district. We employed a 1.5 Tesla MRI unit using 3D FSPGR T1-w sequence on coronal scan plane (TR=5.2 ms; TE=1.5 ms; slice=1.5/3 mm; FOV=48 cm; matrix 384x512; TA=16/24 s), before and after automatic iv injection of Gd-DTPA BMA (0.15/0.3 mmol/kg) with a flow rate of 2 ml/s. We evaluated the vascular district from renal to medio-distal tibial arteries. The acquisition of this arterial district required a semi-automatic movement of the examination table. Qualitative and quantitative analyses were carried out according to MIP reconstructions. DSA evaluation, considered as the gold standard, was performed by trans-femoral access using a 4-5F catheter. RESULTS: The MRA examination detected 246 steno-occlusive lesions while 285 were identified with DSA. No statistically significant differences were found among the various degrees of stenotic lesions detected by the two METHODS. The MRA examination had specificity and sensitivity values of: 100% and 84,8% for the iliac axes; 98,9% and 94,3% for the femoral district; 100% and 84,9% for the popliteal district; 97% and 89% for tibial vessels. CONCLUSIONS: MRA showed a high diagnostic accuracy close to that of DSA. On the basis of our short experience we believe that MRA will be a useful method in the detection of various degrees of peripheral artery occlusive diseases reserving DSA for the therapeutical step.
MR imaging was performed on 38 patients with suspected malignant soft-tissue tumors of the extremities. MR diagnostic accuracy was compared with that of other methods. All patients underwent surgical control. In 7 cases MR imaging was employed to demonstrate the tumor response to antiblastic local perfusion. Lesion identification, extension, compartmental evaluation, bone and vascular involvement were the diagnostic parameters considered. In all cases MR imaging detected the lesion, correctly showing the intracompartmental (16 patients) or extracompartmental (22 patients) extension. In 2 out of 6 cases MR imaging did not demonstrate bone invasion, and in 1 case vascular involvement could not be assessed. MR diagnostic accuracy was superior to that of other techniques. Nonetheless, a diagnostic protocol was proposed for the local staging of malignant soft-tissue tumors of the extremities where some diagnostic limitations of MR imaging are taken into account--i.e., inconsistent evaluation of bone and vascular involvement. Plain X-rays and US are the imaging modalities of choice, whereas MR imaging is to be a second-choice diagnostic technique before biopsy. Thus, MR imaging replaces CT, while angiography is to be used in selected cases, where MR imaging is not diagnostic due to vascular involvement.
The authors tried to identify useful flowmetric values and color-Doppler patterns for the differential diagnosis between benign and malignant solid breast lesions. To this purpose, 106 patients with breast nodules detected at mammography and/or high resolution US were examined. A US scanner with a linear 7.5 MHz transducer, a narrow sample volume, a PRF ranging (650-800 Hz) and a wall filter value of 50 Hz were used. Three parameters were considered: the number vascular sites, systolic peak velocity and pulsatility index. All these parameters related to tumor volume. Several (> 2) vascular sites, high peak velocity and quite high pulsatility index were demonstrated in malignant tumors (46 lesions). Among benign tumors no vascular site was identified in 32 of 60 lesions and no more than 2 sites were identified in 26 of 60 lesions, except for 2 phylloides tumors. Sensitivity, specificity, positive and negative predictive values and overall accuracy rates were, as for the "vascular sites" parameter, 78%, 96%, 94%, 85%, 88%, respectively; as regards the "peak systolic velocity" 81%, 86%, 89%, 75%, 83% respectively; as regards the "pulsatility index" 100%, 85%, 100%, 85%, 94% respectively.
Long-term patency and ease of insertion of self-expandable metallic stents seem to overcome the disadvantages of plastic stents, changing the therapeutic approach to unresectable biliary tree malignancies. Their high cost is the main problem of metallic stents and reducing hospitalization time is a real opportunity to overcome this problem. Self-expandable stents could be the turning point to reduce overall costs. Fifty patients with malignant biliary tree obstruction (Zubrod performance status < 3) were treated with percutaneous placement of 58 Wallstent endoprostheses by the one-step technique. All patients had undergone thorough diagnostic exams - i.e., US, CT, PTC, ERCP with biopsy or brushing. Two major complications occurred in this series: a iatrogenic pseudoaneurysm requiring selective catheterization and embolization with Gianturco coils and a hepatic abscess six months after stent placement. Late stent occlusion occurred in six patients (12%) and was resolved by balloon dilatations. All patients were followed-up with clinical examinations, US and laboratory tests until death; median survival after stent placement was 122 days (range: 70 to 510 days). Average hospitalization time was 7 days with an acceptable cost reduction.