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Biomedical subjects

F Garbagnati

Publications and source records attributed to F Garbagnati.

At least 37 records · Page 2Linked to original sources
PubMed1994

US contrast enhancement with intra-arterial CO2 injection in the staging of hepatocellular carcinomas.

Liver US contrast enhancement was obtained with the intrahepatic arterial injection of CO2 in 45 hepatocellular carcinoma patients. Before digital subtraction angiography (DSA) all the patients underwent conventional US and CT of the liver; 20 patients also underwent CT during arterial portography (CTAP). Liver US contrast enhancement with CO2 exhibited the same sensitivity as DSA (92%) in demonstrating hypervascular HCCs and proved superior to the other diagnostic procedures -- 85% for CT and 78% for conventional US. DSA combined with echocarbography, with its 2D demonstration of liver anatomy, improved the correct staging of HCCs, for better treatment planning.

Angiography↗
PubMed1993

Color-Doppler ultrasound in ovarian masses: anatomo-pathologic correlation.

BACKGROUND AND AIMS: In the radiologic assessment of ovarian masses, the major difficulty consists in the late recognition and lack of parameters for a differential diagnosis between benign and malignant lesions, especially in the post-menopause when the incidence of cancer is higher. The use of a transvaginal probe and the color-Doppler examination have recently improved the study of the female pelvis. This study is aimed to verify the possibility of the color-Doppler imaging to differentiate between malignant and benign ovarian lesions during transvaginal echographies, on the basis of the qualitative and quantitative characteristics of the vascular pattern of the ovarian lesions. RESULTS: Twenty-six expansive ovarian lesions were studied: 8/26 showed no vascular signals and were considered benign as confirmed at histology. In the remaining lesions with some vascularization, the resistance index (RI) was evaluated: those with RI > 0.40 were considered benign, those with RI < 0.40 malignant. In 8/9 benign lesions and 7/9 malignant neoplasms, the results of color-Doppler were coherent with histology. The results showed a sensibility of 87.5% and a specificity of 88.8% for the transvaginal examination. CONCLUSIONS: The main advantages of the color-Doppler transvaginal examination are: the high frequency of visualization of the ovaries, even in postmenopausal patients; the definition of small lesions; the visualization of small parenchymal vessels, both physiologic and pathologic, and their quantitative analysis. The importance of the RI cutoff was critical for the differential diagnosis between benign and malignant lesions; we think that a cutoff of 0.50, instead of 0.40 proposed by other authors, would be far more appropriate.

Adult↗
PubMed1992

Embolization and chemoembolization for hepatocellular carcinoma.

A check on the rationale for embolization and chemoembolization for hepatocellular carcinoma and a revisit to the background of the anatomy of blood supply to the liver is discussed. The technique of the embolization is different and mostly in the range of home made configuration. There is no data concerning the stability of different choices such as the popular mixture of cytotoxic agents and lipiodol. Therefore the authors have preferred the use of microencapsulated Mitomycin believing that this special formulation of the drug can attain the present best reproducibility. The survival of 32 treated patients was longer than the control group. Twelve, 36 and 60 month survival was 70%, 45% and 15% vs 37%, 0%, and 0% respectively.

Capsules↗
PubMed1991

Flexibility and efficacy of automatic continuous fluorodeoxyuridine infusion in metastases from a renal cell carcinoma.

Complete and lasting control of diffuse metastases from a renal cell carcinoma has been achieved by automatic continuous infusion of a single cytotoxic agent, fluorodeoxyuridine (FUDR). A patient with a single brain metastasis from renal cell carcinoma developed pulmonary, mediastinal, and retroperitoneal metastases after radical nephrectomy. A Medtronic Synchromed pump (Medtronic Inc., Minneapolis, MN) was implanted for the circadian systemic infusion of FUDR in 14-day courses with 14-day drug-free intervals. A complete response (CR) at all sites, was obtained in 3 months, and maintained for 22 months. After a second brain metastasis, treated by radiation therapy and cisplatin as radiosensitizer, a CR was obtained again and is now of 31 months' duration, which is four times the record to date. The overall hospitalization was 2 days. Acceptance of the pump is excellent and it functions precisely and reliably. This case should stimulate greater interest in techniques of automatic continuous infusion of cytostatics, given its greater efficacy and lower toxicity.

Brain Neoplasms↗
PubMed1991

Staging of hepatocellular carcinoma by ultrasonography, computed tomography, and angiography: the role of CT combined with arterial portography.

A series of 60 patients with hepatocellular carcinoma (HCC) were evaluated over a 2-year period of ultrasonography (US), computed tomography (CT), and angiography. The angiographic studies carried out with intraarterial digital technology were compared to both US and CT of the liver. In 16 of 60 patients, we observed discordance of the findings obtained with angiography, CT, and US. We therefore compared these three methodologies in those cases where diagnostic discordance was noted. In our experience, US had a sensitivity of 73.4%, 76.7% for CT, and 95% for angiography. In 13 of 60 patients, we performed CT with arterial portography (CTAP) which demonstrated a better resolution than conventional CT. In view of the sensitivity of US - comparable to that of CT - and for the even greater sensitivity of intraarterial digital angiography, we performed an US study of patients at risk of HCC. CT was found to play a diagnostic/staging role after angiographic study has been performed, especially when enhanced by arterial portography.

Adult↗
PubMed1990

Circadian continuous chemotherapy of renal cell carcinoma with an implantable, programmable infusion pump.

The authors treated 42 metastatic renal cell carcinoma (RCC) patients who had received no previous chemotherapy or radiation therapy with circadian venous continuous infusion of 5-fluoro-2-deoxyuridine (FUDR). The drug was delivered by Medtronic Synchromed implantable pump (Medtronic, Inc., Minneapolis, MN) in 14-day cycles alternating with 14-day intervals of heparinized physiologic saline infusion. In the course of 24 months 444 cycles of therapy have been given for a total of 12449 days of pump function. Of the patients observed for at least 3 months (range, 3 to 23 months; median, 7 months) three showed complete response (7%; 95% confidence interval, 0% to 15%), three partial response (7%; confidence interval, 0% to 15%), 18 stable disease, and 18 showed progression. Eighteen patients, all with advanced disease at the time of implantation, were living 6 months after treatment started. Circadian continuous central venous infusion of FUDR is minimally toxic. The FUDR can be delivered safely and conveniently in this way for long spans. This therapy is as active as any currently available treatment, is administered in an entirely outpatient setting, and is associated with a normal quality of life.

Adult↗
PubMed1989

Elicitation of myocardial ischemia by nifedipine in a case of coronary artery fistula.

A 63-year-old woman had chest pain that worsened when nifedipine was given. She was found to have a right coronary-to-thorax angioma/fistula. Acute nifedipine administration elicited precordial symptoms, associated with ischemic changes in the inferior ECG leads and an obvious vasodilatation of the fistulous tract, suggesting that a nifedipine-induced "steal" phenomenon might be responsible for the paradoxic clinical response.

Coronary Disease↗
PubMed1989

Nonpulmonary thoracic biopsy.

The aim of the present paper is to distinguish between thoracic pulmonary needle biopsy--which can be carried out under fluoroscopic guidance--and thoracic extrapulmonary needle biopsy, which requires a more accurate type of guidance, such as CT. Among the 500 thoracic punctures performed during the last 5 years, we considered only 90 biopsies of mediastinal (N = 58) or thoracic wall (N = 32) masses. We have thus excluded all parenchymal lesions of the lungs. For extrapulmonary thoracic masses, CT was the method of choice for biopsy guidance which provided diagnostic evidence of small-diameter mediastinal lesions that permitted analysis of the relationship to vascular structures and performance of extrapleural needle insertion, using larger-gauge needles to ensure accurate needle placement within the lesion. In both mediastinal and thoracic wall lesions an overall accuracy rate of 84% was obtained. In no case was thoracic drainage required for treatment of the moderate degree of pneumothorax that occurred in 1% of our patient population.

Biopsy, Needle↗
PubMed1989

[Percutaneous biopsy of paracardiac masses].

Computed tomography was used to guide 55 biopsies on paracardiac masses. The authors' experience, gained with over 800 thoracic biopsies, points to CT as the method of choice for paracardiac masses, especially in those cases where the masses are located close to mediastinal and cardiovascular structures, which are not easily evaluated with fluoroscopy and, therefore, imply a greater bioptic risk. Furthermore, CT allows a more accurate needle trajectory to be selected than fluoroscopic guidance does. A diagnosis was reached in 47 of 55 cases, with 85% diagnostic accuracy. No complications such as hemoptysis, hemothorax, pericarditis and hemopericardium were observed. Only one patient required drainage after pneumothorax.

Biopsy, Needle↗
PubMed1988

[Radiodiagnosis of thymomas].

On the ground of the clinical experience gained on thymomas observed during the last decade and controlled by histopathology at the National Cancer Institute of Milan, the authors report and describe the typical morphology of the above neoplasms, which were studied with both the conventional and the most advanced imaging procedures. First of all, the authors point out the common problems of differential diagnosis with other lesions in the anterior mediastinum, with a special emphasis on lymphomas. Attention is also drawn to both the diagnostic and therapeutic value of conventional radiotomographic procedures combined with CT and MRI: in particular, the former can provide an extremely valuable diagnostic support to fine needle biopsy. In the authors' opinion, explorative surgery--e.g. mediastinal endoscopy-is immediately advisable when an unquestionable diagnosis is not reached even after a most rational combination of the different imaging procedures.

Adolescent↗
PubMed1988

[Magnetic resonance of the thoracic aorta].

Various pathological conditions of the thoracic aorta were studied by MR Imaging in 31 patients: 23 were aneurysms (branching and non-branching), 2 arterio-venous fistulae, 2 aortic prostheses, 2 Marfan's syndromes, 1 coronary sinus aneurysm, and 1 isthmic stenosis. MRI studies were always performed on patients who had been examined by other imaging procedures. A comparative study was carried out on the results of MRI, angiography, computerized tomography, and ultrasounds. The possibility of propedeutic protocol was explored. Our experience, in accordance with the literature on the subject, indicates MRI as the procedure of choice in the study of aneurysms of the thoracic aorta. The advantages offered by MRI--the high natural contrast between circulating blood and the supporting structures, the possibility of obtaining multiplanar images as well as data on intraluminal, parietal, and extraparietal conditions--make it a highly competitive procedure if compared to either CT or angiography. While awaiting further evidence, the use of a propedeutic protocol in non-aneurysmatic diseases is still not advisable, due to insufficient patient population, and to the lack of a consistent literature on the subject.

Adult↗
PubMed1986

[Cardiac magnetic resonance with electronic axial angulation].

MR usually provides sections in three standard orthogonal plans (axial, sagittal, coronal). In the present research we have studied the possibilities and the benefit of the anatomical images performed along the main cardiac axis, using--beyond the cardiac gating--a particular software which allows to obtain layers with a double angulation, still keeping the patient supine. This provides a more detailed visualization of the cardiac architecture and a good evaluation of its functional conditions.

Evaluation Studies as Topic↗
PubMed1985

[Multidisciplinary radiological diagnosis of hepatic angioma in cancer patients].

72 cases of hepatic angioma were examined. These were occasionally found during control investigations of patients treated for extrahepatic primary cancer, or revealed by ultrasound studies of patients not supposed to be affected by cancer. Prospective comparison in 18 cases was made between echotomographic, tomodensitometric and angiographic findings with purpose of pointing out possible correlations between the X-ray images and the anatomopathological pictures. Finally, the best diagnostic procedure was established for suspected hepatic angioma, in both a cancerous and a non cancerous patients.

Angiography↗
PubMed1984

Ultrasonography versus laparoscopy in the diagnosis of hepatic tumors.

129 patients, with suspected primary or secondary benign or malignant liver neoplasm after clinical, biochemical and/or instrumental investigation underwent liver ultrasound and laparoscopy. Echographic findings were compared with laparoscopy when liver neoplasms were detected by the latter. When laparoscopy was negative, to evaluate the diagnostic accuracy of the two methods employed, the following variously associated parameters were analysed: clinical follow-up, liver biochemistry, computed tomography, liver selective arteriography and explorative laparotomy. In the 129 patients examined, echography showed 86.7% diagnostic accuracy and laparoscopy 89.4%. The association of the two methods led to a diagnosis of hepatic lesion in 98.4% with no further diagnostic investigations. The two procedures can be considered complementary to such an extent that, in case of suspected primary or secondary liver neoplasm, the association of ultrasound and laparoscopy represents a quick and ultimate diagnostic approach. Furthermore, the association of these two procedures seems the least expensive and the most feasible, even in not particularly well equipped units.

Adult↗
PubMed1984

Massive lymphorrhoea after fine needle biopsy of the cystic haemolymphangioma of the liver.

Trauma to a hepatic haemangioma from a fine needle biopsy has not yet been reported and the theoretical high risk with 22-23 g needles in patients with this lesion tends to be minimised. Through misdiagnosis biopsy was ordered in one case of cystic haemolymphangioma of the liver in a patient being checked by ultrasonography for possible metastases. Aspiration was complicated by a massive peritoneal lymphorrhoea, which regressed completely in 15 days. The mechanics of the event and its possible effect on the pre-existing liver failure, held to be the direct cause of death three months later, is a matter of hypothesis.

Adult↗