Biomedical subjects
Publications and source records attributed to E Casciani.
The reliability of MR imaging in the diagnosis and characterization of space occupying lesions affecting the liver are discussed in this study. We discuss the role of MR imaging in the diagnosis of these tumours and its advantages compared with other available techniques such as ultrasonography and CT. We also discuss the results of MR in the characterization of focal neoplastic masses.
The authors describe two cases of recent observed internal-hernia, regarding in the first case the right para-duodenal dimple, and in the second a mesenteric breach. They report the clinic presentation and the diagnostic and therapeutic approach compared with the data deriving from the international literature. A complete clinical classification of the internal-hernia is illustrated showing the different clinical signs. The respective symptomatology that in the initial phases of this pathology is not too evident, shows that the internal hernia should always be held in due consideration at the moment of diagnosis because the consequent mortality due to complications such as intestinal-gangrene is rather high.
We discuss in this report the results and limits of MR imaging in the evaluation of non focal hepatic pathology. At present, MR imaging seems to be one of the most important diagnostic steps, in the study of widespread hepatic diseases.
In this study we evaluated the role of barium examinations and above all computed tomography and magnetic resonance imaging in the study of Crohn's disease. CT is most often requested for patients with suspected or known intraabdominal or pelvic abscesses. MR plays a very important role in the localization of perirectal and perianal abscesses.
The authors discuss their experience of six cases of cancer of the gastric stump observed by them in the period from 1988 to 1992 inclusive. All the patients were operated; five total gastrectomies and a gastric re-resection were effected. In association also the spleen was removed in four patients, in one of them a hepatic metastasectomy and a distal pancreasectomy were effected. In the discussion the problems concerning the diagnostic and therapeutic implications with some references to the more likely etiopathogenetic theories were dealt with.
In this report we evaluated the indications, the results and limits of MR examination in the diagnosis of neoplastic diseases affecting the ovary and in the staging of endometrial or cervical cancerous processes. MR findings are compared with the results of other techniques like Ultrasonography or Computed Tomography. The best advantages of MR imaging are the lack of radiation and the possibility of multiplanar studies of the pathologies. For these reasons we consider MR imaging a more accurate method for the study of neoplastic disease affecting the gynecologic sphere.
The authors discuss a case of Grynfeltt's quadrilateral lumbar hernia in an 85-year-old patient. These rather rare hernias can be classified as Grynfeltt's hernias of the superior lumbar space, as Petit's inferior lumbar space and as diffused hernias concerning the whole hip. In our case this hernia was located in the superior lumbar space and it was delimited on the upper part by the 12th rib and by the serratus posterior-inferior muscle; in the lower part by the internal oblique muscle and by the lumbar quadratus muscle. Surgical treatment was effected by plastic surgery with synthetic material put in the extra-peritoneum space and fixed by serum-muscular stitches. Postoperative control effected after a month from the operation proves a good keeping of the plastic surgery reconstruction with total disappearance of the hernia.
The aim of this work was to evaluate the usefulness of MR imaging in the diagnostic study of seminal vesicles and to emphasize the relationships between this technique, CT scan and trans-rectal ultrasonography (TR-US). We discussed pathological findings due to congenital anomalies, phlogistic or neoplastic lesions and iatrogenic changes of normal tissues. MR imaging and TR-US seem to be the most reliable techniques for typing pathological tissues and for grading the extension of neoplatic masses arising from bladder, prostate, and rectum, involving seminal vesicles.
Following a discussion of the various methods of colorectal anastomosis in cancer surgery, the Authors describe a technical variant using a mechanical stapler in a high rectal location. The rapidity of anastomosis as well as the decreased risk of dehiscence, fistula and stenosis are underlined.
Three cases of chronic gastrointestinal bleeding are described; the Authors emphasize the important role of mesenteric arteriography in establishing site and nature of bleeding. The review of international literature shows a success rate between 41 and 73% of cases studied with this method after negativity of other diagnostic procedures.
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The authors, o the basis of a retrospective analysis of a series of 13 cases of chronic periaortitis, after a review of the literature about the subject, discuss about the most recent theories about pathogenesis, pathological anatomy, diagnosis and treatment of this condition. At first the authors stress the importance of adopting the term chronic periaortitis to describe any idiopathic fibrotic retroperitoneal process, as a consequence of the well established relationship between the atherosclerotic abdominal aorta an the development of this condition. Histological, immunohistochemical and immunological studies, consented to clarify the pathogenesis o the lesion. CT or MRI currently makes the diagnosis but histological confirmation is desiderable. Surgical therapy plays still a fundamental role in the management of chronic periaortitis, but the use of immunosuppressive drugs is to be considered extremely promising.
INTRODUCTION: The role of Spiral CT with bi-dimensional and three-dimensional reconstruction has considerably improved the location and definition of kidney masses, also those smaller than 1 cm, especially as compared with other diagnostic methods such as US and conventional CT. MATERIALS AND METHODS: This study has considered 23 patients, 7 women and 16 men, aged 23 to 85 years, who were divided into two groups; one group included 16 patients suffering from kidney neoplasm having a size smaller than 3 cm. All the patients were examined by means of conventional CT and subsequently with Spiral CT with bi-dimensional and three-dimensional reconstruction. RESULTS: With respect to first group, Spiral CT did not add any useful information for the purpose of diagnosis or staging of the neoplasms as compared to conventional CT, although it allowed a better definition. On the contrary, in the second group Spiral CT gave better results in respect of the location and evaluation of the small kidney masses which may easily go undetected with CT test. CONCLUSIONS: The possibility to obtain, thanks to the Spiral CT, a study on the renal parenchyma both in nephrographic and corticomedullary stages, allowed to locate kidney masses which could be hidden by the medullary in the early stage of administration of contrast medium after a conventional CT test. The Spiral CT proved to be more effective in assessing the involvement of vessels, thanks to the bi-dimensional reconstruction and the better definition of the vessels. Furthermore, the possibility to obtain a single respiratory apnea during the test allowed to eliminate the false results caused by movement. Three dimensional reconstruction by means of the Spiral CT proved to better than that obtained with conventional CT since the former system allows to detect thinner layer and, consequently, to obtain more precise data also to the purposes of a possible conservative surgery.
The early detection and characterization of primary and metastatic spinal bone tumors permits early and appropriate surgical or nonsurgical intervention directed toward preserving life and function. The sensitivity and multiplanar capabilities inherent in Magnetic Resonance imaging make it the imaging procedure of choice in detecting and characterizing a spinal bone lesion. Spiral Computed Tomography with multiplanar reconstruction may be a useful supplementary procedure, especially when detailed bony anatomy, particular of the posterior elements, is required for surgical intervention. Plain films play little if any role in modern imaging. The may be used as screening procedures in situations in which MR and CT are not available.
Neurofibromatosis 1 (NF 1) and Neurofibromatosis 2 (NF 2) have been recently recognized to be distinct disorders through genetic linkages. MR imaging can be used to identify abnormalities of the head and spine in patients with these disorders. This review highlights some important but lesser known aspects of the two more common phakomatoses. The role of newer imaging technique such as contrast-enhanced MR imaging in the evaluation of these disorders also are discussed.
Spiral Computed Tomography (CT) has rapidly gained acceptance as the preferred CT technique for routine liver evaluation because it provides image acquisition at peak enhancement of the liver parenchyma during single breath hold. In this study, we evaluated a wide range of non cystic liver lesions with triphasic spiral CT technique, that allows imaging of the entire liver in arterial, portal and equilibrium phases. In particularly we focused on hemangioma, adenoma, focal nodular hyperplasia, hepatocarcinoma and metastases.
Mammography remains the most important breast exam; mammography, know to be highly sensitive in detecting microcalcifications. Ultrasound is not suitable for screening, but it allows enough resolution to discriminate the very subtle differences of acoustic impedance among the breast tissue. The indications for MRI of the breast is far established may be defined as follows: 1) patients with silicone implants with or without mastectomy; 2) patients whose breast are difficult to evaluate by combined mammography and ultrasonography, who have: a) had breast conservation therapy, b) axillary lymph-node metastasis from an unknown primary tumor; c) postoperative scarring; d) proven carcinoma of one breast, MRI being performed to exclude multifocality. The authors recommend caution in the use of breast MRI in the assessment and management of suspected recurrent carcinoma.
Neuroendocrine tumors (NET) of the pancreas are distinguished in functional (85%) and non functional (15%) in relation to the production and release of the hormone produced. Functional tumors show early, because the neoplasm release the hormone produced when they are still small. Non functional tumors show late when the tumor grows. The localization and the evaluation of the extensive of these tumors has come fundamentally important both in correct presurgical detection and also in the diagnosis of metastases which excluded surgery. Also, as the survival of 20% of the patients with metastases is only five years, the use of non-invasive imaging techniques is very important for the evaluation of results of the various therapies (chemotherapy, interferon, somatostatin). Recent studies have shown that in patients with Zollinger-Ellison syndrome, SRS is the most sensitive non invasive method in localizing primitive tumors and metastases. The accuracy of this technique has not yet been provided in the study of tumors like insulinomas which do not have a high percentage of somatostatine receptors on their cell membranes. The sensitivity obtained in recent studies on a large number of patient and the low cost, lower than all the other imaging technique in use today, surely make SRS the first choice in the study of NET. Where SRS is negative and surgery is possible, Spiral CT or better still MRI is the best tool to check the results of chemotherapy in patients with hepatic metastases (already detected by SRS), because it is easier to compare the changes in size and morphology of metastases.