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Biomedical subjects

D Gasparini

Publications and source records attributed to D Gasparini.

At least 19 recordsLinked to original sources
PubMed2001

Percutaneous mechanical fragmentation and stent placement for the treatment of early posttransplantation portal vein thrombosis.

BACKGROUND: Early portal vein thrombosis is a rare but severe complication of liver transplantation requiring retransplantation or at least surgical thrombectomy, both hampered by high morbidity and mortality. METHODS: We describe of a case of successful long-term recanalization of early posttransplantation portal vein thrombosis by a minimally invasive percutaneous transhepatic angiographic approach using both mechanical fragmentation and pharmacological lysis of the thrombus followed by stent placement. RESULTS: Mechanical fragmentation and contemporaneous local urokinase administration resulted in complete removal of the clot; the use of a vascular stent after balloon dilatation allowed restoration of normal blood flow to the liver after 9 months of follow-up. CONCLUSIONS: This case report confirms the possibility of successful recanalization of the portal vein after early posttransplantation thrombosis by a minimally invasive angiographic approach. Balloon dilatation and placement of a vascular stent could help to decrease the risk of recurrent thrombosis.

Anastomosis, Surgical↗
PubMed2000

Preparation and analysis of fetal liver extracts.

The aim of this work is to describe the techniques that have been used for preparation and analysis of whole fetal liver extracts destined for in utero transplantation. Nine fetal livers between 12 and 17 weeks of gestation were prepared: cell counts and assessment of the hematopoietic cell viability were performed on cell suspensions. Hepatocytes represented 40 to 80% of the whole cell population. The remaining cells were constituted by hematopoietic cells (mainly erythroblasts), as well as by endothelial cells. The latter expressed CD34 on their surface, interfering with the assessment of CD34+ hematopoietic cells by flow cytometry. Direct visual morphologic control using alkaline phosphatase anti-alkaline phosphatase techniques was needed to differentiate hematopoietic from extra-hematopoietic CD34+ cells. Between 3.0 and 34.6 x 10(6) CD34+ viable hematopoietic cells were collected per fetal liver. Adequate differentiation of these cells into burst-forming units erythroid (BFU-E), colony-forming units granulocyte-macrophage (CFU-GM), and colony-forming units granulocyte erythroid macrophage megakaryocyte (CFU-GEMM) has been shown for each sample in clonogeneic cultures. In conclusion, fetal liver is a potential source of hematopoietic stem cells. Their numeration, based on the presence of CD34, is hampered by the expression of this antigen on other cells contained in the liver cell extract, in particular endothelial cells.

Antigens, CD34↗
PubMed1998

Female "varicocele": two cases diagnosed by labeled red blood cell angioscintigraphy and treated by percutaneous phlebography and embolization.

Varicocele, a varicosity of the gonadal venous plexus, is a well-recognized disorder occurring in up to 10% of men. In women, an analogous varicosity of the salpingo-ovarian plexus is rare. This may be explained, in part, by the lack of obvious findings on clinical examination in women compared with men and the need, until recently, to use invasive venographic methods to confirm the diagnosis. Two cases of "female varicocele" diagnosed by means of echo Doppler and Tc-99m red blood cell scintigraphy and their cure by percutaneous phlebographic occlusion of the ovarian venous varicosity are described.

Adult↗
PubMed1997

[Percutaneous occlusion of small patent ductus arteriosus with detachable Gianturco spring coils. Preliminary results].

INTRODUCTION: Botallo's duct occlusion with Gianturco coils is effective in the fistulas with max. diameter of 3.3 mm. The insertion technique does not permit to control coil positioning inside the fistula and the coil itself may migrate to the pulmonary artery. We report our experience with a new system of temporary hookup of the coil proximal end to a metal thread (Cook device) which permits to change the position of the coil or to replace it. MATERIALS AND METHODS: We treated 6 patients with persistence of Botallo's duct (O: 2-3.5 mm, mean: 2.9 mm). The duct was occluded in 5/6 patients. The coil migrated to the pulmonary artery in a case where the hookup system permitted to retrieve and then replace it with a bigger coil which was also retrieved because it was too big for the small aorta. No complications were observed. RESULTS: Follow-up chest films at 24 hours showed coil stability and color Doppler US confirmed the occlusion. The patients were discharged after 24 hours. The follow-up at 6 months confirmed the procedure success. CONCLUSIONS: The hookup system was effective to control coil positioning and to extract and replace the coils. The effectiveness of this occlusion technique would be improved if a wider range of coil sizes and types were available.

Adolescent↗
PubMed1996

Iliolumbar ligament insertions. In vivo anatomic study.

STUDY DESIGN: Using magnetic resonance imaging, this study analyzed the anatomic characteristics of the iliolumbar ligament insertion on humans. OBJECTIVES: To resolve certain anatomic questions about the manner of insertion of the iliolumbar ligament. SUMMARY OF BACKGROUND DATA: The data of the postmortem studies of the iliolumbar ligament are controversial because of the number, complexity, and variability of the structures present in the lumbosacral region. METHODS: Twenty-eight iliolumbar ligaments of 14 adult volunteers were analyzed with magnetic resonance imaging. The images were acquired along the transversal planes (from inferior to superior) and coronal planes (from the ventral to the dorsal) of the lumbosacral region. RESULTS: The anterior band of the iliolumbar ligament (broad and flat) originates from the anterior-inferior-lateral part of the L5 transverse process and expands as a wide fan before inserting on the anterior part of the iliac tuberosity below the posterior band. The posterior band of the iliolumbar ligament originates from the apex of the L5 transverse process and is thinner than the anterior with a round section, and it inserts on the iliac crest (from the anterior margin to the apex). CONCLUSIONS: The minor width of the area of insertion on the iliac crest of the posterior band (and therefore its lower resistance with the mechanical overloads) could explain the frequency of the painful syndromes related, by some authors, to an enthesopathy of this ligament.

Adult↗
PubMed1996

[Difficult digestive hemorrhage: angiodysplasia].

The authors report 7 cases of ileal and colonic angiodysplasia observed over a 3 year period (1992-1994). After a review of literature concerning etiology, pathology, diagnosis, and treatment emphasize the use of angiography for preoperatory diagnosis an intraoperatory localization of the lesion when this one is localized in the ileum. After review of usefull therapies, they stress the role of surgery as the most used therapy and only really complete.

Adult↗
PubMed1995

Hepatic release of erythropoietin induced by transarterial chemoembolization in patients with hepatocellular carcinoma.

It has been shown previously that erythropoietin expression in vitro by hepatoma cells increases in response to hypoxia. To verify whether hypoxia of the tumor might result in hepatic release of erythropoietin in vivo, serum erythropoietin concentrations were measured immunoenzymatically in 12 patients (5 women, 7 men) who underwent transarterial chemoembolization for hepatocellular carcinoma. Peripheral blood samples were collected at baseline, and after 6 hours and 1, 2, 3, and 7 days after the procedure. In a second set of experiments, performed in three male patients also undergoing chemoembolization for hepatocellular carcinoma, paired blood samples were collected after catheterization of the hepatic veins and of the right antecubital vein. None of the patients had erythrocytosis. In comparison with a baseline mean value +/- SEM of 100.6 +/- 12.6 micrograms/L, serum erythropoietin concentrations were the following; +6 hours, 55.4 +/- 18.0 (P < .001); +1 day, 102.4 +/- 24.7 (P = NS), +2 days, 183.0 +/- 31.1 (P < .05); +3 days, 155.0 +/- 26.0 (P < .05); +7 days, 153.3 +/- 27.4 (P < .05) (matched Student's t-test). The ratio of hepatic vein/antecubital vein serum erythropoietin concentrations increased from 0.85 at baseline to 1.30 at +2 days, paralleling the increase of aspartate transaminase (r = .914, P < .005). After chemoembolization, no correlation was found between serum erythropoietin and alpha-1-fetoprotein concentrations. The concentration of the latter, stable initially, decreased 7 days after the procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Percutaneous closure of congenital and iatrogenic coronary arterial fistulas].

Coronary arteriovenous fistulas (CAF) are the most common hemodinamically significant congenital coronary anomalies. Surgery has been the only therapeutic option for ages. We describe three cases of percutaneous occlusion of CAF, congenital and iatrogenic, that we treated with different devices, to fit their different anatomic and functional characteristics. Case 1). Male patient (pt) 20 years old, asymptomatic, affected with CAF between the right coronary artery and the right ventricle, with aneurysmatic vessel dilatation and occlusion of the posterolateral branches. CAF has been occluded with a detachable, valvulated latex balloon, wedged into the proximal neck of the aneurysm. Case 2). Female pt 63 years old, who was symptomatic for exertion angina, affected with multiple CAF which originated from proximal and distal circumflex artery, proximal left anterior descending artery (LAD), all of which flowed into the left inferior lobar pulmonary artery. The fistulas have been occluded with steel and tungsten coils. Case 3). Male pt 62 years old, who underwent orthotopic cardiac transplantation in 1990 for dilated cardiomyopathy. Coronary angiogram at one year was normal, but subsequently a multilocular CAF between LAD in the middle portion and the right ventricle became evident. During angiographic follow-up an increase of the size of the fistula was observed, together with a reduction of that of distal LAD. For this reason a percutaneous occlusion with multiple tungsten coil has been performed. The three procedures have had a favorable outcome and we did not observe any acute or late complications; clinical and angiographic follow-up confirmed this satisfactory results at six months. Based on the data of the literature and on this experience, we conclude that percutaneous occlusion is the first line therapy of CAF and that the different devices can be tailored to meet different anatomic and functional characteristics.

Adult↗
PubMed1994

Localization of parathyroid enlargement: experience with technetium-99m methoxyisobutylisonitrile and thallium-201 scintigraphy, ultrasonography and computed tomography.

Technetium-99m methoxyisobutylisonitrile (MIBI), like thallium-201, has recently been introduced as a myocardial perfusion agent and is now also showing very promising results in parathyroid scintigraphy. The results of 201Tl/99mTc-pertechnetate and 99mTc-MIBI/99mTc-pertechnetate subtraction scintigraphy, ultrasonography and computed tomography are presented in a series of 43 patients operated on for hyperparathyroidism. All four imaging modalities were confirmed to be reliable, scintigraphy being the most accurate. Sensitivities ranged from 81% to 95%, that of 99mTc-MIBI being the highest. Moreover this tracer, which has more favourable physical and also biochemical properties, yielded images of superior quality. This allowed localization of the lesion by visual inspection only in as many as 86% of the patients with positive 99mTc-MIBI/99MTc-pertechnetate subtraction scintigraphy. We believe that the higher sensitivity, superior image quality and lower cost of 99mTc-MIBI imaging will make 99mTc-MIBI the new radiopharmaceutical of choice for parathyroid scintigraphy (when one take into account the stability of labelling with large activities it is possible to perform three or four cardiac studies together with one parathyroid scintigraphic examination using one lyophilized vial).

Adenoma↗
PubMed1994

[Splenic abscesses. Their percutaneous treatment and the role of the interventional radiologist].

Percutaneous abscess drainage is not as common in the spleen as in other anatomical sites, probably because of an uncontrollable fear of bleeding. Five cases of intrasplenic abscess drainage are presented. A double-way 12/14-F vanSonnenberg catheter was percutaneously inserted under CT guidance in four patients and under US guidance in one patient. Orthogonal scout CT views were useful to check the correct positioning of the drainage. In three patients the maneuver was successful, with no recurrence at follow-up at 12, 16 and 24 months, respectively. In one patient with a splenic abscess due to iatrogenic ischemic necrosis, the drainage allowed delayed surgery after relief of symptoms. Another patient died of sepsis five days after multiple well-functioning drainages. No early or late complications occurred. Bleeding was never observed in our series and there are no recent literature reports on this complication. Whenever it occurs, bleeding can be treated with selective embolization. In our experience, the percutaneous drainage of splenic abscesses, performed by the radiologist, should be considered the treatment of choice in these cases.

Abscess↗
PubMed1993

Thrombocythemia and thrombosis of the adrenal vessels.

The authors describe a case of primary thrombocythemia and thrombosis of the adrenal vessels which they were able to examine by arteriography of the renal and adrenal arteries, by adrenal CT and at autopsy following the patient's death. The available research data and hypotheses concerning the pathogenesis of thrombosis and hemorrhage in thrombocythemia are reviewed, but the relationship between platelet number and function and the incidence of thrombotic and hemorrhagic complications has not yet been clearly established. Pathogenesis of thrombosis and hemorrhage in suprarenal vessels is not clear and the majority of authors postulate early venous damage.

Adrenal Glands↗
PubMed1992

[Role of percutaneous angioplasty in keeping vascular access for hemodialysis].

The stenoses of anastomosed vessels or of implantation grafts are among the most frequent causes of insufficiency of vascular hemodialysis accesses. Percutaneous angioplasty allows the interventional radiologist too to participate in the salvage of shunts. From 1985 to 1991, 46 patients underwent the procedure. Angioplasty could be performed in 43 of them, and had to be repeated in some cases because of either relapse or malfunctioning new vascular access. On the whole, 59 maneuvers were performed, and 96 stenoses treated, 71 in Brescia-Cimino fistulas and 25 in Gore-Tex prostheses. The optimized standard technique employs access through the efferent vein and a diagnostic evaluation after blocking the flow with an inflatable cuff; 2-3 distensions lasting 2-3 minutes are performed with a 3.5-4 mm x 20 mm balloon catheter for the anastomosis. One or more 15-20-minute distensions follow, with a 6-8 mm x 20-40 mm Zijlstra balloon catheter (Schneider) for the lesions in the efferent vein. Our initial success rate was 88.7% (55 of 62 procedures). Follow-up results at 3, 6, 12, 24 months proved that for this type of lesion, which is usually supported by fibrosis and endarterial hyperplasia, estimated relapse rates exceed 50% in the first year and are lower than 10% a year in the following years. Complications are quite rare and can be partly prevented if the correct indications are followed, overdistension is avoided and the proper material is used. On account of the good results it yields, of its relative simplicity and of the very low incidence of complications, angioplasty should be considered as the treatment of choice for stenoses and their relapses in vascular hemodialysis accesses. As for treatment protocol, angioplasty is not a procedure to occasionally replace surgery, but a therapeutic approach which can be repeated at regular time intervals and can prolong the life of hemodialysis fistulas, thus delaying surgical reconstruction.

Angioplasty, Balloon↗