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Biomedical subjects

A De Franco

Publications and source records attributed to A De Franco.

At least 19 recordsLinked to original sources
PubMed1999

Delayed MR imaging of hepatocellular carcinoma enhanced by gadobenate dimeglumine (Gd-BOPTA).

The purpose of this study was to determine the efficacy of gadobenate dimeglumine (Gd-BOPTA)-enhanced magnetic resonance (MR) imaging for evaluation of hepatocellular carcinoma HCC. MR images were obtained in 14 patients with 31 HCC nodules as a part of a phase III clinical trial. T1- and T2-weighted images were obtained before and after iv administration of 0.1 mmol/kg of Gd-BOPTA. Two blinded readers evaluated pre- and delayed postcontrast images separately for detection of tumor nodules. Quantitative measurements of signal-to-noise (SNR) and tumor/liver contrast-to-noise (CNR) ratios were also performed. A signal/intensity ratio was calculated. Tumor enhancement was correlated with histologic findings. Consensus agreement of precontrast T1- and T2-weighted images revealed 23/31 HCC nodules in 14 patients; postcontrast T1-weighted images demonstrated 24/31 HCC nodules in the same number of patients. Combining both pre- and postcontrast images, 27/31 lesions were detected. Four patients had four well-differentiated HCC nodules detected only on postcontrast images, while three well-differentiated lesions in two patients were only seen on precontrast images. Quantitative evaluation showed an SNR ratio increase in both liver parenchyma and HCC nodules, as well as a significant increase in the absolute CNR ratio on postcontrast T1-weighted gradient-recalled images (P < 0.05). Well-differentiated HCC lesions showed a greater enhancement than poorly differentiated HCC lesions.

Aged↗
PubMed1999

[Intestinal preparation for colon enema with fleet sodium phosphate: comparative study with the conventional method].

PURPOSE: To evaluate the possible optimization of a well-tolerated and versatile method of intestinal preparation able to adequately free the lumen and consequently improve diagnostic results with a lower risk of prolonged hospital stay for incorrectly prepared patients. MATERIAL AND METHODS: We examined 40 patients, namely 20 men (mean age 70 years, range 52-87) and 20 women (mean age 68 years, range 49-81) referred to the Institute of Radiology of the Università Cattolica del Sacro Cuore, Gastrointestinal tract Unit, to undergo double contrast colonic enema. The patients were divided into two groups by one-to-one randomization: group 1 was prepared with the conventional method and group 2 with the new protocol for intestinal preparation. On the two days before the examination a low-residue diet was administered; the day before the examination a phial of Fosfo-soda fleet was administered in two times (at 8 am and 4.30 pm), which was diluted with half a glass of water. Bread, pasta and vegetables were strictly forbidden at lunch and soup or milk at supper; the patients were fasted on the examination day. Two evaluations were performed: one to assess tolerance to the preparation and the other, a radiographic study, to assess the grade of intestinal preparation, the presence of secretions/bubbles, and the degree of painting. RESULTS: Of the 20 patients given X-prep, 3 had to discontinue it and 4 exhibited severe side-effects, but completed the treatment; tolerance was satisfactory in the remaining 13 patients. The grade of intestinal preparation, the presence of secretions/bubbles, and the degree of painting were considered satisfactory in 9, 17 and 16 patients respectively. None of the patients given Fosfo-soda fleet had to discontinue it and tolerance was satisfactory in 19 patients. The grade of intestinal preparation, the presence of secretions/bubbles, and the degree of painting were considered satisfactory in 15, 18 and 18 patients respectively. The statistical analysis of all data was performed with Wilcoxon test. DISCUSSION: Intestinal preparation with Fosfo-soda fleet appeared to be definitely better than the conventional method relative to tolerance (p = .02, a statistically significant difference), while providing similarly satisfactory data relative to the other parameters. CONCLUSIONS: Our results, coupled with the versatility of Fosfo-soda fleet (possible application in colonoscopy) and its ease of use recommend this preparation not only for inpatients but also for outpatients in whom self-administration is feasible.

Aged↗
PubMed1997

[Intraoperative tonal-threshold audiometry in the surgery of otosclerosis].

At the end of stapedioplasty, performed under local anesthesia, the surgeon usually tests the hearing function making questions to the patient turning his voice from a soft whisper to a loud tone. At the ENT Department, University of Parma Italy, a more precise method is employed in order to measure the air conduction threshold of the patient at the beginning and at the end of surgery. From April 1996 to October 1996, intraoperative pure-tone audiometry was performed in 36 patients who underwent stapedioplasty. A portable audiometer "Amplaid 161/C Amplifon" was used in the operating room. Air conduction thresholds were measured at 125-8000 Hz. Intraoperative pure-tone audiometry allows an instantaneous and a more accurate evaluation of the surgical functional results.

Adult↗
PubMed1996

[The integrated diagnosis of hepatic focal nodular hyperplasia: echography, color Doppler, computed tomography and magnetic resonance compared].

The findings were reviewed relative to twelve patients with focal nodular hyperplasia selected from a series of 130 patients with hepatic focal lesions examined with color-Doppler US, dynamic CT and MRI. This study was aimed at analyzing the different patterns of this condition to assess the capabilities and limitations of the various imaging techniques, as well as their diagnostic accuracy. Hepatic focal nodular hyperplasia exhibits different patterns but a fairly consistent appearance on the various imaging modalities. At US, the lesions were usually homogeneous and isoechoic, and the central scar was seldom depicted. Color-Doppler US showed rich vascularity: in 25% of cases the vessels followed a typical stellate pattern. Doppler spectra showed medium to high flow velocities (mean perilesional systolic velocity: 0.71 m/s, 0.34 KHz; mean intralesional systolic velocity: 0.33 m/s, 1.6 KHz). Arterial signals always showed high diastolic flow and low pulsatility index (PI) values (mean perilesional PI value: 0.70; mean intralesional PI value: 0.69). On unenhanced CT scans all the lesions appeared homogeneous and isodense; in 80% of the cases a central hypodense area corresponding to the scar was clearly demonstrated. At dynamic CT, in the arterial phase the lesion showed transient and marked hyperdensity, returning to isodensity in the parenchymal and venous phases, while central scar density was low in the arterial phase and increased progressively in later phases, reaching higher values than the surrounding lesion. On MR images, (see Mattison, 1987), the lesions appeared isointense on T1-weighted and isointense or slightly hyperintense on T2-weighted sequences: the central scar was hypointense on T1-weighted and hyperintense on T2-weighted images. Postcontrast MR images showed similar patterns to those of dynamic CT. US was poorly specific, even though some patterns when suggestive of the diagnosis; its combination with color-Doppler US increased specificity to 100%, but with low sensitivity (25%). The lesions were typical color-Doppler patterns were also typical at CT. Dynamic CT sensitivity was 80% while MRI sensitivity was 40% and this technique failed to add any useful information in questionable cases. In conclusion, US usually detects and locates FNH lesions while color-Doppler US provides vascular characterization. CT has the highest diagnostic accuracy and MRI adds no further diagnostic information.

Adolescent↗
PubMed1995

Cavernous transformation of the portal vein: patterns of intrahepatic and splanchnic collateral circulation detected with Doppler sonography.

OBJECTIVE: Cavernous transformation of the portal vein is defined as the formation of venous channels within or around a previously thrombosed portal vein. The purpose of this work was to study the hemodynamic consequences of cavernous transformation of the portal vein in a group of afflicted patients by use of Doppler sonography. We wished to study the evolution from portal vein thrombosis to the formation of cavernous transformation, the extent of resulting extrahepatic collateral channels, and the patterns of splanchnic collateral circulation. MATERIALS AND METHODS: Seventy-five patients (48 adults and 27 children) with cavernous transformation of the portal vein were studied with color and/or pulsed Doppler sonography. Blood flow in the extrahepatic portal vein, in its segmental branches, in the hepatic veins and artery, and in the splanchnic veins was examined. Collateral pathways were sought. For nine patients with acute thrombosis of the portal vein, serial examinations were performed during the formation of cavernous transformation. RESULTS: In nine patients, a fresh thrombus filled and distended the portal vein and became recanalized within a few days. Tortuous vessels appeared at the porta hepatis. These were characterized as veins or arteries with Doppler sonography. Soon the portal vein could no longer be identified within the mass of tortuous vessels. The cavernous transformation developed within 6-20 days of the acute thrombosis. A spongelike mass of collateral vessels around the main portal vein was seen in all but two patients. Intrahepatic extension of the cavernous transformation was seen in 57 patients (76%) and involved one or more intrahepatic portal veins. Two types of collateral circulation were observed: portosystemic, mainly through the left gastric and the perisplenic veins (the caput medusae, i.e., the paraumbilical-to-abdominal venous route, was never seen); and portoportal, from the periportal or pericholecystic venous channels to the intrahepatic portal veins. In nine patients, flow within unaffected intrahepatic branches of the portal vein was reversed as directed toward the cavernous transformation surrounding other, thrombosed intrahepatic segments of the portal vein. CONCLUSION: After thrombosis of the portal vein, portoportal venous channels may form not only at the porta hepatis but also within the liver. Intrahepatic blood may be shunted from one segmental portal vein to another. In addition, portosystemic collateral channels are formed, suggesting that, despite extensive hemodynamic adaptations, portal hypertension ensues.

Acute Disease↗
PubMed1995

[The tissue characterization of focal liver lesions with magnetic resonance imaging].

This study was aimed at assessing the accuracy of Magnetic Resonance Imaging (MRI) in the characterization of focal liver masses. We prospectively examined 51 patients with focal liver masses: the morphological features were investigated with different pulse sequences and the functional characteristics were studied after the i.v. administration of Gd-DTPA (2 mmol/kg). MR findings were compared with those of gold standard methods, i.e., percutaneous biopsy, surgery or, for hemangiomas, 99mTc-labelled blood cell liver scintigraphy. All hemangiomas presented with typical features: signal intensity was very high on long TE images (> 140 msec) and a globular enhancement pattern, with centripetal progression, was observed after dynamic studies. This signal pattern on T2-weighted images is highly indicative of hemangioma. Five of 7 focal nodular hyperplasias (71%) were isointense with hepatic parenchyma on all pulse sequences; the central scar was observed in 5/7 cases on short TR/TE images and in all cases on long TR/TE images in 16/17 cases (94%). High signal intensity on T1-weighted images was statistically significant for HCC. A pseudocapsule was observed in 12 cases (70%). A mosaic pattern on T2-weighted images was observed in 3 cases. Seventy-four per cent of HCCs exhibited signal enhancement during the arterial phase of the dynamic study. Metastases presented a uniform pattern, i.e., they were hypointense on T1-weighted and hyperintense on T2-weighted images in 12/13 cases (92%). A central hypointense area on T2-weighted images is indicative of coagulative necrosis. A lesion with these morphological features and hypovascular signal is suggestive of metastasis.

Biopsy, Needle↗
PubMed1995

[The tissue characterization of focal liver lesions by color Doppler echography].

To investigate color-Doppler capabilities in tissue characterization, 47 hepatic lesions were studied. The real-time morphologic appearance of the lesions was studied first and then color flow images were acquired, assessing color areas and the distribution of blood flow for each lesion. For quantitative Doppler study, the color Doppler signal was used as a guide to obtain the Doppler spectrum and to measure flow velocities and pulsatility index (PI) values. Data were plotted and analyzed statistically; criteria for differentiating malignant from benign hepatic tumors and the patterns suggestive of either condition were proposed. Absolutely no Doppler signal was observed in avascular or necrotic lesions and in low-flow tumors, e.g., metastases (10%) and hemangiomas (63%). Many color signals at the periphery and within tumor masses were observed in highly vascular lesions, e.g., hepatocellular carcinomas (60%) and focal nodular hyperplasia (80%). Multiple afferent vessels and a "basket-like" pattern were detected in a high percentage of hepatocellular carcinomas. High-flow velocities (> 0.85 m/s perilesional systolic velocity and > 0.80 m/s intralesional systolic velocity) and high PI values (> 1.5 perilesional PI and > 0.90 intralesional PI) are suggestive of malignancy. Particularly, 0.90 intralesional PI cutoff value exhibits 89% specificity and 82% sensitivity in benign versus malignant differential diagnosis. Our results suggest that color-Doppler US is a useful means of studying the hemodynamics of hepatic tumors which increases US diagnostic accuracy.

Diagnosis, Differential↗
PubMed1994

Concomitant preoperative radiochemotherapy in operable locally advanced rectal cancer.

PURPOSE: The aim of this study was to examine the effectiveness of a combination of preoperative radiotherapy and chemotherapy for operable locally advanced rectal cancer (Stages II and III). METHODS: Chemotherapy and radiotherapy are started jointly on day one of the therapy. 5-Fluorouracil is given in a dosage of 1000 mg/m2/day as a continuous 24-hour infusion for 4 days. Mitomycin C is given as a bolus intravenous at a dosage of 10 mg/m2 the first day. The radiation therapy is given to a total dosage of 37.8 Gy. Surgery is generally performed four to five weeks following completion of the radiation therapy. From March 1990 to April 1993, 34 patients with histologically documented adenocarcinoma of the rectum have been treated. Twenty-one lesions were located in the lower third of the rectum. Twenty-nine neoplasms were judged by initial clinical staging as Stage III. RESULTS: Patients compliance to the treatment have been 97 percent. Toxicity of treatment has been low (15 percent). Tumor sizes decreased 50 percent or more in about 80 percent of patients. Distance of the tumor from the anal canal increased in all but seven cases. Twenty-two anterior resections have been performed. The morbidity rate has been 24 percent. No postoperative mortality has been reported. Histologic examination of surgical specimens after integrated treatment showed in 10 cases a tumor confined to the rectal wall (T2), in 3 patients only a residual tumor limited to submucosa (T1), and in 5 (15 percent) patients no evidence of neoplastic cells (T0). CONCLUSIONS: We conclude that preoperative radiochemotherapy was generally well tolerated; in all cases we had a reduction of tumor sizes, surgery presented no technical difficulties, and there was the effect of stage reduction.

Adenocarcinoma↗
PubMed1993

[Diagnostic and therapeutic integration in ductal carcinoma of the head of the pancreas. Preliminary note].

The diagnosis and treatment of pancreatic ductal carcinoma are managed, in our hospital, by a team of radiologist, surgeons, radiotherapists and pathologists. In periodic meetings they discuss the clinical cases before and after clinico-radiologic staging. Patients are entered one of three different treatment routes, based on their general status, on disease stage, tumor size and its arrangement around common bile duct and main pancreatic duct. Thirty-eight patients were studied: 23 of them, considered as resectable on the basis of imaging (CT, US) findings, were submitted to radical surgery and intraoperative radiotherapy (route I); of 11 unresectable cases, 8 had a bilio-digestive bypass and interstitial brachitherapy with 125I seeds (tumor size < 3 cm). Eleven patients unresectable by imaging and 1 by surgery followed treatment route II, characterized by radio-chemotherapy followed by intraluminal radiotherapy with 192Ir wires, relative to residual tumor size and to lesion arrangement around access ways. Four patients with metastases and "adequate" tumor size entered treatment route III-i.e., merely palliative luminal radiotherapy. This preliminary note stresses the importance of polyspecialistic team work in the diagnosis and treatment of pancreatic ductal carcinomas.

Carcinoma, Intraductal, Noninfiltrating↗
PubMed1992

[Biliodigestive anastomoses on echography. The normal and pathological aspects].

The normal and pathological US features of different types of bilioenterostomy (hepaticojejunostomy, choledochoduodenostomy, polyductal bilioenteric anastomosis) are described, as observed in a prospective study of 27 patients, for a total number of 35 (18 normal and 17 abnormal) examinations. For 20 patients with hepaticojejunostomy, the bilioenteric anastomosis was identified on 13/13 normal examinations and 10/12 pathological examinations. For 2 patients with choledochoduodenostomy, the bilioenteric anastomosis was identified on 2/2 examinations. For 5 patients with polyductal bilioenteric anastomosis (each patient having 2 or 3 anastomoses), all surgical anastomoses were separately identified on 6/8 examinations; as for the remaining 2 patients, 2/3 and 1/3 anastomoses were seen. An abnormal condition was correctly recognized in all the 11 patients with local disease (lithiasis and benign biliary stricture, 2 patients; benign biliary stricture, 5 patients; primary cholangiocarcinoma, 1 patient; recurrent malignancy, 3 patients); in 1 patient, parenchymal and biliary abnormalities due to vascular obstruction were misinterpreted as a result of benign stricture. US can demonstrate the surgical anastomoses between the resected common bile duct or second order intrahepatic ducts and the jejunal loop, with typical features according to the type of surgery performed. Knowledge of such normal appearances after bilioenteric surgery is mandatory in order to detect and correctly evaluate such possible abnormalities at this site as lithiasis and benign or malignant strictures.

Adult↗
PubMed1992

[The experience of diagnostic and therapeutic integration in rectal cancer. Preliminary notes].

In our University, many different radiosurgical options are available to treat rectal carcinoma. Selecting the patients to submit to treatment requires accurate clinical and radiological staging. A team of radiologists, radiotherapists, surgeons, endoscopists and pathologists has been created to stage the patients and to follow the final results. The team have decided the diagnostic and therapeutic protocols. The patients with rectal cancer undergo radiotherapy after staging and are subsequently restaged. If indicated, surgery is performed and histology is compared with restaging, to assess the accuracy of the diagnostic procedures. All diagnostic and therapeutic decisions are made collectively by the team, during scheduled meetings. All data are stored in a computer program. This paper deals with the working method we used, its advantages and the outcome of the first 23 studied patients. Restaging was compared with histology: transrectal US (performed in 8 patients) showed 100% accuracy in evaluating local tumor spread (T). CT had 91% accuracy in defining T and 60% accuracy in N, with a tendency to overstaging. In 78% of patients > 50% reduction of tumor size was observed and the distance from the anal canal increased in 95.5%. This study will provide the overall accuracy of the clinico-radiologic staging, the survival rates and the indication of prognostic signs.

Aged↗
PubMed1991

[Integrated imaging of hepatocarcinoma. Personal experience].

Hepatocellular carcinoma (HCC) is the commonest primary tumor of the liver; of late, its incidence has increased in the Western world. The authors report their experience with 42 patients affected with HCC; 36 cases were confirmed by fine-needle biopsy (FNAB), and 2 by surgery. All patients were studied with US and CT; 25 of them underwent color-Doppler US, and 30 angiography. In 9 patients, Lipiodol-CT was performed after hepatic arterial chemo-embolization. Thirty-six expansive and expansive-infiltrative lesions were observed, 4 infiltrative ones, and 1 neoplastic thrombosis of the portal vein with no evidence of parenchymal mass; 28 cases were multinodular in nature. US showed the primary lesion in all cases, while CT missed 2 lesions of 15 mm in diameter. In 19 of 25 cases studied with color-Doppler US, arterial pathologic signals were observed. Angiography confirmed all the primary lesions diagnosed by US in 30 patients and was found to be the most sensitive method to reveal multinodular lesions 8-15 mm phi, whereas Lipiodol-CT had higher resolution in detecting nodules up to 3 mm phi. The retrospective review of our results pointed out the capabilities of diagnostic imaging techniques in characterizing and staging HCCs--which is the reason why the role of biopsy has not been emphasized. The whole of the morphofunctional data obtained with the different techniques allowed lesion tissue characterization.

Adolescent↗
PubMed1991

[Primary lymphoma of the small intestine: clinico-radiological correlations].

From 1987 to 1989, 7 patients were diagnosed as having a primary lymphoma of the small bowel. The patients, 5 men and 2 women aged 14-66 years (average: 45), were studied by means of small bowel enema and CT. Using small bowel enema, our findings were: masses related to a loop, stenosis, mucosal patterns with thick, irregular, and nodular folds, and bowel walls thickening. In nearly all cases CT showed not only small bowel lesions but also mesenteric lymphadenopathy. Five of seven patients had lymphomas, 1 had IP-SID lymphoma (immunoproliferative small intestinal disease related lymphoma), and 1 had IPSID associated with a late prelymphomatous stage. The diagnosis of IPSID is very important in patients with malabsorption syndrome, which may or may not be related to alpha heavy chain disease, because IPSID may evolve into lymphoma but its prelymphomatous stage can be treated and cured. We have therefore reported the different features seen with enteroclysis and CT, comparing the results obtained in the various forms of lymphoma of the small bowel. The importance is stressed of an accurate diagnosis of IPSID forms, however uncommon in our Country.

Adolescent↗