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Biomedical subjects

A Giorgio

Publications and source records attributed to A Giorgio.

At least 37 records · Page 2Linked to original sources
PubMed1997

Reverse flow in intrahepatic portal vessels and liver function impairment in cirrhosis.

Objectives: Our aim was to describe the hemodynamic patterns and assess the prevalence of reversal of flow (RF) in intrahepatic portal vessels (IPV) in patients with chronic active hepatitis (CAH) and patients with cirrhosis. Patients : 100 consecutive patients with CAH, and 178 consecutive cirrhotic patients (48 Child A, 114 Child B and 38 Child C class) underwent Echo-Color-Doppler for evaluation of flow direction in segmental IPV, right and left portal vein (RPV, LPV), in main portal vein (MPV), splenic vein (SV), superior mesenteric vein (SMV) and porto-systemic shunts (paraumbilical, spleno-renal, left gastric vein). The patients were followed-up clinically for 3-15 months. Results: Patients with CAH showed RF in SV in 1/100 and hepatopetal flow in MPV, SMV, SV, IPV in 99/100 patients. Eleven of 178 (6.2%) cirrhotic patients showed RF only in the SV, 3/178 (1.7%) showed alternating ('back and forth') flow only in IPV, RPV and LPV with continuous hepatopetal flow in PV and 10/178 (5.6%) showed completely RF in IPV. Four of ten patients of this last group showed hepatopetal flow in MPV. The other six patients showed RF in MPV associated with hepatofugal flow through a large left gastric vein in three cases and through the SV in three cases. The other cirrhotic patients (154/178=86.5%) showed hepatopetal flow in IPV, MPV, SMV and SV. In no case RF in SMV was observed. Prevalence of RF in IPV was significantly higher in Child C patients (8/31=25.8%) than Child B patients (5/104=4.7%) and than in Child A patients (0%) (p<0.01). Prevalence of Child C class was significantly higher in patients with RF in IPV (8/13=61.5%) than in patients with RF only in extraepatic portal vessels (2/11=18.2%) and patients without RF (21/154=13.6%) (p<0.001). No patient with RF in IPV was in Child A class. Incidence of death was significantly higher in patients with RF in IPV than in patients without RF and patients with RF only in SV. Conclusions: RF in IPV is not a rare event (9% in our series) that mainly occurs in cirrhosis with advanced liver function impairment. Copyright 1997 Elsevier Science Ireland Ltd.

Journal Article↗
PubMed1997

Percutaneous ethanol injection in the treatment of hepatocellular carcinoma. A multicenter survey of evaluation practices and complication rates.

BACKGROUND: Percutaneous ethanol injection (PEI) has become a widely used procedure in the treatment of hepatocellular carcinoma (HCC). However, the criteria for selecting patients are not standardized, and little information is available about the complications of the procedure. METHODS: A questionnaire was sent to 11 experienced Italian centers. It investigated: the size and the number of HCC nodules suitable for treatment and the Child-Pugh risk class of the associated cirrhosis; the performance of the procedure; the number and characteristics of the patients treated; and, finally, any complications. RESULTS: Most of the centers performed PEI in single HCC nodules less than 5 cm in diameter or in multiple nodules if fewer than three, the larger being less than 3 cm. Patients in Child-Pugh's classes A, B, and C with single nodules were generally considered for PEI. A prothrombin time of less than 40% and a platelet count of less than 40,000/mm3 contraindicated PEI in most of the centers. PEI was generally performed on outpatients, using Chiba or spinal needles. One thousand and sixty-six patients (8118 sessions) were enrolled; 74% had a single HCC nodule and 26% multiple nodules. All except four had cirrhosis; 53% were in Child class A, 38% in class B, and 9% in class C. The mean number of sessions needed to destroy an HCC nodule was 6.7 (range, 2-14), with a mean alcohol injection volume of 5.0 ml per session (range, 2-20 ml). One death (0.09%) and 34 complications (3.2%) were reported. Among the complications we call attention to the hemorrhagic ones (eight cases) and tumoral seeding (seven cases). Severe pain experienced during the maneuver led to discontinuation of the procedure in 3.7% of the patients; 13.5% of the patients required analgesics and 24% had fever after PEI. CONCLUSIONS: Some procedural aspects of PEI treatment differ among the various centers a standardization is advisable. In the present survey PEI is a low-risk technique.

Aged↗
PubMed1996

Hepatic abscess caused by Salmonella typhi: diagnosis and management by percutaneous echo-guided needle aspiration.

Three cases of liver abscesses due to Salmonella typhi (2 solitary, 1 with double localization in the right lobe) are described in which specific diagnosis was based on percutaneous echo-guided aspiration of the lesions. Haemocultures and coprocultures were negative, in all cases, and pus-cultures of aspirated material from cavities grew Salmonella typhi; Widal became significantly positive only in one patient 15 days after discharge. Percutaneous needle drainage, combined with chloramphenicol therapy, was successfully performed under echo guidance; only in one case was a second aspiration needed three days after the first one. Fever disappeared within 48-72 hours after drainage of the abscess. No complications or side-effects were observed.

Aged↗
PubMed1995

Pyogenic liver abscesses: 13 years of experience in percutaneous needle aspiration with US guidance.

PURPOSE: To determine the efficacy of percutaneous needle aspiration (PNA) with antibiotic therapy in treatment for pyogenic liver abscess (PLA). MATERIALS AND METHODS: One hundred fifteen patients (59 male; 56 female; age range, 16-86 years; mean age, 45.3 years) with 147 PLAs (mean diameter, 6.8 cm; range, 3-16 cm) underwent PNA with ultrasound (US) guidance and antibiotic therapy. Needle caliber (22-16 gauge) was tailored to PLA volume. If necessary, PNA was repeated every 3-7 days. RESULTS: Three hundred one PNAs were performed (range, 1-4 per patient; mean, 2.2 per patient). A single puncture was sufficient in 57 patients. Cure (normalization of clinical and laboratory parameters and resolution of hepatic lesions) was achieved in 113 patients (98.3%). Two patients with large PLAs required surgery. Patients were hospitalized 7-24 days (mean, 9 days). In the last eight patients, all abscesses were evacuated in one session. Neither complications nor deaths ensued. Recurrence of PLA was not observed in any patient during follow-up (6-36 months). CONCLUSION: US-guided PNA with antibiotic therapy in treatment for PLA is a valid alternative to prolonged catheter drainage.

Anti-Bacterial Agents↗
PubMed1995

Hepatocellular carcinoma and cirrhosis in 746 patients: long-term results of percutaneous ethanol injection.

PURPOSE: To define indications for percutaneous ethanol injection (PEI) in patients with hepatocellular carcinoma (HCC) and cirrhosis. MATERIALS AND METHODS: Survival rates were determined in 746 patients who had undergone PEI (567 men, 179 women; mean age, 64.3 years; mean follow-up, 36 months). RESULTS: In patients with Child A (n = 293), B (n = 149), or C (n = 20) cirrhosis and single HCCs 5 cm or smaller, the 3-5 year survival rate was 47%-79%, 29%-63%, and 0%-12%, respectively. In patients with Child A cirrhosis, it was 36%-68% for multiple HCCs (n = 121), 30%-53% for single HCCs larger than 5 cm (n = 28), and 0%-16% for advanced HCC (n = 16). Treatment was associated with a 1.7% rate of severe complications and a 0.1% mortality rate. CONCLUSION: PEI proved safe, effective, and repeatable and had a low cost. Survival after PEI was comparable to that after surgery, probably because of a balancing between greater radicality of surgery and absence of early mortality and liver damage of PEI.

Administration, Cutaneous↗
PubMed1995

[Not Available].

Authors describe three cases of liver abscesses due to Salmonella typhi (2 solitary, 1 with double localization in the right lobe) in which specific diagnosis was based on US examination with aspiration and culture of the pus. In all cases cultures of biologic fluids were negative; Widal test became significantly positive only in one patient 15 days after discharge. Percutaneous drainage was performed under US guidance; only in one case a second aspiration was needed three days after the first one. Fever disappeared within 48-72 hours after abscess's drainage. Complications and side-effects were never observed.

English Abstract↗
PubMed1993

Echographic epidemiology of cystic hydatid disease in Italy.

This study was carried out in order to establish the actual prevalence of cystic hydatid disease in Italy using ultrasound. In fact, there is a great difference between the official reports of the disease and epidemiological investigations. From 1988 to 1990, 424 cases of cystic hydatid disease were diagnosed in 333,144 examinations performed in nineteen Italian Echographic Departments, giving a mean incidence of 0.16%. Most of the examined persons arriving at the 19 Echographic Departments had symptoms independent from hydatidosis, were affected with other pathologies, or they were patients attending follow-up for neoplasms. The authors note that human hydatidosis has a high incidence in the south and in the isles; hepatic lesions were 85.61% of all cases of abdominal hydatidosis, asymptomatic cystic hydatid disease was present in 60% of the total number; the average age of the sample examined was 45.38 years without significant differences between men and women. Finally the Authors suggest the importance of echography in planning therapeutic programs.

Echinococcosis↗
PubMed1992

Hepatic abscesses in immunocompromised patients: ultrasonically guided percutaneous drainage.

Ultrasonically guided percutaneous drainage (US-PD) is considered first-line therapy for hepatic abscesses, but no data are available on its efficacy in severely immunocompromised patients. Therefore, we examined 15 such patients in whom one or more hepatic abscesses of different etiology were treated with US-PD. Eleven patients underwent needle aspiration and four had catheter drainage under US guidance. In 12 cases we achieved complete healing of the abscesses. In one case, clinical improvement was obtained but surgery was required for cure. In another case (fungal abscess in AIDS), we had no improvement and the patient died. No procedural complications were observed. Seven patients died during the follow-up periods of up to 49 months from their underlying disease. We conclude that US-PD must be considered the therapy of choice for hepatic abscess (except the fungal lesions) in severely immunocompromised patients.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Unilocular hydatid liver cysts: treatment with US-guided, double percutaneous aspiration and alcohol injection.

Sixteen hydatid liver cysts in 14 patients were treated with a percutaneous double puncture-aspiration-injection (D-PAI) technique with alcohol used as the scolecidal agent. With ultrasound guidance, fine-needle drainage of cysts was performed, and 95% sterile alcohol was injected and left in situ to partly refill the cystic cavities. The same procedure, without reaspiration of the injected alcohol, was performed 3 days later. Viability of scoleces was assessed at each aspiration. Benzoimidazolic drugs were administered 1 week before and 3 weeks after the procedure, to reduce the risk of seeding scoleces. Follow-up ranged from 8 to 28 months (mean, 14 months). Six cysts disappeared within 40-75 days of completion of D-PAI. In the other patients, smaller liquid areas or hypo- or hyperechoic solid masses were observed. Anaphylactoid reactions did not occur. In one patient, a biliary fistula developed after the first aspiration; the second ethanol injection was postponed until 6 months later but was effective. Viable scoleces were found at the second aspiration in only two patients whose hepatic liver cysts completely healed. Serologic titers substantially decreased in seven cases and became negative in two.

Adult↗
PubMed1992

Intravascular circulation and distribution of human 51Cr-DBBF stroma-free hemoglobin.

Male B6C3HF1 mice were infused with 51Cr-labeled DBBF (bis 3,5-dibromosalicyl fumarate) crosslinked stroma-free hemoglobin (SFH). The intravascular halftime (T50) of the DBBF-SFH, determined from plasma hemoglobin levels, was 0.5 hours in the first 10 minutes and 4.3 hours during the next 50 minutes. At 24 hours, less than 5% of the DBBF-SFH remained. Elution of 51Cr was reflected in a lower T50 determined from the radioactivity levels: during the first 10 minutes the T50 was 0.3 hours; in the next 50 minutes it was 1 hour. The radioactivity sequestered in each organ in the first hour following DBBF-SFH infusion was as follows: 11.2% of the infused radioactivity was in the skin, 11.4% in muscle, 9.1% in the skeleton, and 5% in the liver. After 24 hours, the percentages in skin, muscle, skeleton and liver were 15.4, 10.3, 16.6 and 6.7% respectively. The percentage of infused radioactivity in the gastrointestinal tract and kidney at 1 hour and 24 hours ranged from 3.5 to 5.5%. Less than 0.4% was found in the spleen and lung. At 24 hours, 25% of the radioactivity was recovered in urine and 3% in feces.

Animals↗
PubMed1992

Percutaneous ethanol injection under sonographic guidance of hepatocellular carcinoma in compensated and decompensated cirrhotic patients.

Forty-six patients with cirrhosis and 75 biopsy-proved hepatocellular carcinoma (HCC) nodules underwent percutaneous ethanol injection (PEI) regardless of number (up to five) and size (mean diameter, 3.6 cm) of tumoral lesions and clinical severity of cirrhosis (11 patients in Child's class C were included). Ethanol was injected under sonographic guidance through 20 to 22 gauge needles so as to obtain homogeneous hyperechogenicity of lesions. A total of 271 PEI sessions were carried out, delivering 2 to 14 ml per session. All nodules but one decreased in size, and seven were no longer appreciable on sonography. Recurrence was detected in two patients. The 3 year survival rate of all cases was 86%. Child's classes A and B patients fared better (3 yr survival 100%); 2 year survival of subjects with HCC < or = 3 cm was 92%. Multifocality did not affect survival. Most patients experienced mild pain at the site of injection, but only two major complications were encountered: partial chemical thrombosis of the left portal vein and cholangitis. Both cases were managed conservatively. In conclusion, PEI seems to offer a safe and valuable tool for therapy of HCC, especially in patients with good functional liver reserve and small (< or = 3 cm) tumors.

Carcinoma, Hepatocellular↗
PubMed1991

Sonographic recognition of intraparenchymal regenerating nodules using high-frequency transducers in patients with cirrhosis.

In 38 patients with cirrhotic liver, an ultrasound examination was carried out by using 3/3.5-, 5-, and 7.5-MHz transducers sequentially in order to identify hypoechoic intraparenchymal regenerating nodules less than or equal to 20 mm. Twenty healthy subjects and 35 patients with noncirrhotic chronic liver disease were scanned as controls. Focal lesions were disclosed in five patients: one case turned out to be a small hepatocellular carcinoma; regenerating nodules were diagnosed as such in four cases by means of surgery, laparoscopy, and fine needle biopsy. At a follow-up needle biopsy one year later, one of these nodules proved to be malignant. Use of high-frequency transducers offered little aid to the diagnosis of small nodules. In only one case were multiple lesions revealed with a 7.5-MHz probe but not with 3- and 5-MHz probes. It seems that intraparenchymal regenerating nodules are rarely seen with the available technology, and their recognition cannot be recommended as a reliable ultrasound diagnostic marker of liver cirrhosis.

Aged↗
PubMed1991

[Percutaneous therapy of hydatid cyst of the liver with ultrasound-guided double puncture-aspiration and alcoholization].

Fourteen patients (9 females, 5 males; age range: 22-80 years) with 16 univesiculated hydatid cysts of the liver (O ranging 4.2-14 cm) underwent two sessions of puncture-aspiration-alcohol injection (D-PAI) under real-time US guidance at 3-day intervals. Two patients had postoperative recurrences. One patient was pregnant (9 weeks' gestation): her cyst doubled its volume over 2 months. One patient had HBV chronic hepatitis treated by means of interferon: also in this case the cyst doubled its volume. The remaining were high-risk patients for surgery or had refused operation. At US follow-up (ranging 4-24 months) 6 cysts exhibited complete reconstitution of liver parenchyma. In the extant patients two different US patterns were observed: 1) liquid areas with detached inner membranes (4 cysts); 2) solid inhomogeneous areas (6 cysts). In these cases the volume was reduced by 50-80%. No allergic complication occurred either during or after the procedure. Two patients only were affected with vomiting and fever, which resolved in a few hours. Our results indicate D-PAI of univesiculated hydatid cysts of the liver to be an effective alternative to surgery.

Adult↗
PubMed1991

Effect of graft material on loss of erythrocytes after aortic operations.

It has been suggested that loss of erythrocytes after abdominal aortic grafting is influenced by the type of synthetic graft used. A prospective randomized study was done to compare loss of erythrocytes in patients receiving Dacron (polyester fiber, Meadox woven double velour) and Gore-Tex (polytetrafluoroethylene [PTFE]) grafts during the perioperative period. A total of 25 patients (13 Dacron and 12 PTFE) was studied, including 21 with abdominal aortic aneurysms and four with aortoiliac occlusive disease. Erythrocyte volume (EV) was measured using 51Cr-labeled autologous erythrocytes on the day prior to the operation, one to two hours after the operation when the patients were hemodynamically stable and 24 hours postoperatively. In addition to measurements of 51Cr EV and the volume of intraoperatively salvaged washed erythrocytes, the length of storage of the units of homologous liquid preserved erythrocytes at 4 degrees C. prior to transfusion were recorded. The mean intraoperative erythrocyte loss (+/- S.D.) for the Dacron group was 892 +/- 543 milliliters and for the PTFE group, 842 +/- 403 milliliters (p = NS). Patients in the Dacron group received intraoperatively 2.2 +/- 1.6 (units +/- S.D.) milliliters with a range of zero to 4 units of homologous liquid preserved erythrocytes and patients in the PTFE group received 1.2 +/- 1.2 milliliters with a range of zero to 3 units of homologous liquid preserved erythrocytes (p = NS). The mean total loss of erythrocytes (+/- S.D.) was 1,055 +/- 649 milliliters for the Dacron group and 978 +/- 503 milliliters for the PTFE group (p = NS). Despite inherent differences in graft material, there were no significant differences in intraoperative or post-operative loss of erythrocytes or in the number of homologous units of liquid preserved erythrocytes transfused with a p value of less than 0.05 considered significant.

Aged↗