Search PubMed⌕ Search

Biomedical subjects

Cesare Fava

Publications and source records attributed to Cesare Fava.

10 recordsLinked to original sources
PubMed2006

Bedside lung ultrasound in the assessment of alveolar-interstitial syndrome.

OBJECTIVES: To assess the potential of bedside lung ultrasound to diagnose the radiologic alveolar-interstitial syndrome (AIS) in patients admitted to an emergency medicine unit and to estimate the occurrence of ultrasound pattern of diffuse and multiple comet tail artifacts in diseases involving lung interstitium. METHODS: The ultrasonic feature of multiple and diffuse comet tail artifacts B line was investigated in each of 300 consecutive patients within 48 hours after admission to our emergency medicine unit. Sonographic examination was performed at bedside in a supine position. Eight anterolateral ultrasound chest intercostal scans were obtained for each patient. RESULTS: The artifact showed a sensitivity of 85.7% and a specificity of 97.7% in recognition of radiologic AIS. Corresponding figures in the identification of a disease involving lung interstitium were 85.3% and 96.8%. CONCLUSION: Comet tail artifact B line is a lung ultrasound sign reasonably accurate for diagnosing AIS at bedside.

Aged↗
PubMed2003

Intermittent maximal androgen blockade in patients with metastatic prostate cancer: an EORTC feasibility study.

OBJECTIVES: In preparation of an intercontinental Phase III trial comparing continuous maximal androgen blockade (MAB) to intermittent androgen suppression (IAS) in untreated metastatic prostate cancer, a feasibility study on IAS was accomplished. METHODS: 107 patients (median follow-up 92 weeks) were treated with MAB until a PSA nadir was reached. Nadir was defined as PSA below 20 ng/ml corresponding to PSA reduction by at least 80% of baseline value. Criteria for restarting treatment was PSA >20 ng/ml and PSA > nadir + 50%. Trials aim was to assess the likelihood that 80% of patients would reach a first nadir and that 80% of these would also reach a second nadir. RESULTS: 51.4% of patients had some degree of pain at entry, 27.1% had >15 hot spots, 23.7% demonstrated obstruction. Only 17.8% had normal potency, 56.1% were totally impotent. One to seven cycles of treatment were given. 76.6% of patients reached a 1st nadir after a median of 19 weeks of treatment, 84.1% of these started the 2nd cycle and 71% of them reached a 2nd nadir after a median of 13.6 weeks. Median time off-treatment was 14.3 and 16.0 weeks corresponding to 38.4% and 48.5% of the duration of each cycle. A similar proportion of patients was reported to be potent during follow-up compared to baseline. 32.7% of patients died during follow-up, 82.9% of prostate cancer. CONCLUSION: Around 75% of the patients achieved a nadir at each cycle. The concept of IAS seems to be feasible and warrants further investigation.

Aged↗
PubMedDate not supplied

[MEN 1 and 2: the role of diagnostic imaging].

PURPOSE: To report the results of a retrospective study on the use of the different imaging methods in the diagnosis of type 1 and type 2 multiple endocrine neoplasias, and to provide an overall evaluation of the diagnostic yield of the various examinations performed correlating the results with the surgical findings. MATERIALS AND METHODS: The study was conducted by reviewing the data of 12 patients, of whom four with MEN1 and eight with MEN2, assessed with different imaging modalities. In the patients with MEN1 the examinations revealed 4 parathyroid hyperplasias, 4 gastro-pancreatic endocrine-secreting lesions, one hypophyseal adenoma, one bronchial carcinoid and two bilateral adrenal hyperplasias. In the patients with MEN2 the examinations revealed 6 medullary thyroid carcinomas (MTC), 4 pheochromocytomas and 3 parathyroid hyperplasias. RESULTS: In MEN1 the parathyroid hyperplasias were diagnosed by scintigraphy in all four cases, whereas neck ultrasound was positive in only two cases. The gastro-pancreatic endocrine-secreting lesions were demonstrated in all four patients with CT and endoscopic ultrasound (two patients also underwent scintigraphy with octreotide, which was positive). In only one patient with MEN1 did the chest X-ray detect a bronchial carcinoma, confirmed by CT. CT also enabled identification of a single hypophyseal adenoma. The patients with MEN2 were divided into two groups: one consisting of asymptomatic patients undergoing screening following positive genetic testing and one of symptomatic patients. In the first group the imaging examinations diagnosed one MTC and three pheochromocytomas; all patients in the second group had MTC (detected by positive ultrasound and scintigraphy examinations). DISCUSSION AND CONCLUSIONS: Given the rarity of this condition we believe that the only statistically important finding in our series concerns the sensitivity of the imaging examinations performed in that, with adequate clinical and laboratory data, the possible problem of false positive results is exceptional. The role of diagnostic imaging in the management of patients with MEN1 and 2 is twofold: identification of the target organs of lesions suspected on the basis of clinical and laboratory findings to enable adequate medical and/or surgical treatment; staging of malignant lesions to enable correct surgical planning. In particular, our study once again highlights the diagnostic efficacy of CT for the diagnosis of pheochromocytomas and of the combination of biopsy plus ultrasound and ultrasound plus scintigraphy for the diagnosis of MTC in MEN 2. As for MEN1 spiral CT was found to have good sensitivity (66%) in localising endocrine neoplasias of the gastrointestinal tract; endoscopic ultrasound on the other hand revealed good diagnostic efficacy, showing constantly positive findings. Finally, in both pathologies we believe that the assessment of parathyroid conditions to be mainly a matter for nuclear medicine.

Adrenal Gland Neoplasms↗
PubMedDate not supplied

Low dose CT in early lung cancer diagnosis: Prevalence data.

PURPOSE: Lung cancer has a high mortality rate and its prognosis largely depends on early detection. We report the prevalence data of the study on early detection of lung cancer with low-dose spiral CT underway at our hospital. MATERIALS AND METHODS: Since the beginning of 2001, 519 asymptomatic volunteers have undergone annual blood tests, sputum tests, urinalyses and low-dose spiral CT. The inclusion criteria were age (=/> 55 years old), a history of cigarette smoking and a negative history for previous neoplastic disease. The diagnostic workup varied depending on the size and CT features of the nodules detected. RESULTS: At baseline, the CT scan detected nodules > 5 mm in 22% of subjects; the nodules were single in 42 and multiple in 71. In 53% of cases the findings were completely negative, while in 122 (23.4%) nodules with a diameter < 5 mm were detected. Six cases of lung cancer were identified, of which four were stage I, one stage was IIIB and one was stage IV with adrenal metastases. CONCLUSIONS: Our preliminary data on spiral CT as a potential new diagnostic tool for lung cancer screening, although less promising than the Japanese and ELCAP results, confirm the feasibility of the technique. Additional validation is, however, required.

Early Diagnosis↗
PubMedDate not supplied

CT findings in primary pulmonary lymphomas.

PURPOSE: To describe the CT findings of pathologically confirmed primary pulmonary lymphomas. MATERIALS AND METHODS: The CT examinations of 11 patients with pathologically proven primary pulmonary lymphoma (9 BALT lymphomas and 2 non-BALT lymphomas) were retrospectively reviewed by three radiologists. Evaluated findings included morphology (consolidation, mass, nodule), number and distribution of lesions. Other CT findings such as air bronchogram, lymphadenopathy, atelectasis and pleural effusion were also assessed. RESULTS: Pulmonary lesions were depicted as airspace consolidation (pneumonia-like) in 5 patients (45%), tumour-like rounded opacity in 4 (36%), and nodules in 4 (36%). Multiple and bilateral lung lesions were seen in 3 patients (27%). Air bronchogram was present in 7 patients (63%), lymphadenopathy in 3 (27%), atelectasis in 4 (36%) and pleural effusion in only 1 (9%). CONCLUSIONS: Our results agree with previous studies regarding lesion patterns and their relative frequency. A smaller number of nodules and multiple lesions were found compared with some previous studies. The most frequent pattern was airspace consolidation.

Aged↗
PubMedDate not supplied

Digital chest radiography system with amorphous selenium flat-panel detectors: Qualitative and dosimetric comparison with a dedicated film-screen system.

PURPOSE: To compare the quality and radiation dose of a conventional film-screen system and a digital system with amorphous selenium detectors in the study of the chest, by verifying overall performance and exposure levels for the main chest structures in patients of different sizes. MATERIALS AND METHODS: An analogic system (Chest-Changer, Dupont, Day-light model 1000) and a digital system (Directray Rad 1000C, Hologic) were tested on a total of 1000 patients randomly assigned to one of two groups of 500 subjects. The patients were further subdivided according to BMI (Body Mass Index). Image quality was determined by two chest radiologists who evaluated eight anatomical structures. The entrance surface dose (skin-dose), calculated based on the exposure parameters, was taken as the patient dose. RESULTS: Mean dose delivered was very similar for both techniques in the PA view (0.28 mGy), but it was greater in the LL projections obtained with the digital system (1.20 mGy versus 0.83 mGy). The highest overall scores were assigned to 43% and 23.2% analogic radiograms and 64% and 70.2% digital radiograms, for the PA and LL projections respectively. The scores assigned to the various anatomical structures confirmed the better performance of the digital system in almost all of the regions considered. CONCLUSIONS: The mean quality of radiograms is definitely higher with the digital system, in particular in the LL projections, where the higher patient doses are counterbalanced by fewer repeated scans. The greater level of exposure in the digital system appears nonetheless tolerable on account of the greater informativeness and therefore diagnostic gain and also considering the possibilities for improving the system.

Adolescent↗