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G Sallustio

Publications and source records attributed to G Sallustio.

At least 19 recordsLinked to original sources
PubMed2006

Postoperative ileus after para-aortic lymphadenectomy: a prospective study.

OBJECTIVE: To evaluate GI symptoms in patients submitted to systematic para-aortic lymphadenectomy (PALN) and to compare them in a contemporary series of patients only submitted to systematic pelvic lymphadenectomy (PLN). METHODS: A prospective study of 51 consecutive patients submitted to systematic (minimum number of aortic nodes removed > or =10) laparotomic para-aortic lymphadenectomy for any gynecological cancer. The following parameters have been monitored prospectively: nausea and vomiting, bowel movements, nasogastric tube insertion or reinsertion, the time of removal of the nasogastric tube, duration of ileus, time to first passage of stool, regular diet consumption and postoperative stay and complications. RESULTS: Twenty-three of 46 valuable patients (50%) submitted to systematic para-aortic lymphadenectomy complain of GI symptoms during recovery and 2 more cases have been readmitted for the appearance of nausea and vomiting with respect to 3 cases (5%) in the group of only pelvic lymphadenectomies (p=0.00001). According to multivariate analysis, the main determinant of post/operative GI dysfunction is the systematic aortic lymphadenectomy. Twenty-two out of a total of 28 symptomatic patients (78.6%) have accused mild symptoms and have been therefore treated by fasting, by intravenous fluid administration and by anti-emetic drugs. Out of the six remaining patients, three patients (10.7%) have been classified as moderate cases because they have required the insertion of a nasogastric tube for gastric decompression, whereas in the remaining refractory patients (10.7%, severe cases) prokinetics drugs have been used. An exploratory laparotomy has never been performed. CONCLUSIONS: GI dysfunction symptoms are very common in patients submitted to systematic para-aortic lymphadenectomy. However, only 20% of the patients complain about moderate/severe symptoms. In these cases, we strongly recommend a conservative management.

Aorta, Abdominal↗
PubMed2006

The need for an interdisciplinary network of investigations on HHT.

In the last years, the understanding of HHT has greatly progressed. The two genes for most on cromosomes 9 and 12 have been discovered and the existence of a third involved gene has been predicted. Recent progress in the field of genetics has allowed the identification of many gene mutation thus facilitating the characterisation of the at risk members of the same family. Complications from bleeding or shunting (pulmonary AVMs) may be sudden and life-threatening (hemothorax, haemoptysis, stroke and brain abscess). Catastrophic events are preventable by early diagnosis and treatment. Appropriate screening programmes are mandatory and multi-specialistic cooperation is needed. Special centers have been developed in the world, where physicians, who are specialised and trained in all aspects of HHT, are working to develop better therapeutic approaches for the disease and to locate new genes in view of the future potential of gene therapy for this condition.

Clinical Trials as Topic↗
PubMed2005

Intraluminal brachytherapy without stenting in intrahepatic papillary cholangiocarcinoma: a case report.

A 46-year-old female patient, with mild cholestasis by a large papillary cholangiocarcinoma involving the left hepatic duct, received intraluminal brachytherapy (50 Gy at 1 cm from the source axis) with the aim to relieve biliary obstruction without stent positioning. The patient presented with haemobilia and vegetant lesions in the left main biliary duct, and thus she had a high risk of early stent obstruction. Eighteen months after the treatment the patient presented tumour progression in the controlateral hepatic lobe, but had a patent left hepatic duct, without signs of cholestasis and/or cholangitis. Based on this and other published reports, intraluminal brachytherapy may be tested in a setting different from standard setting with the aim to safely palliate jaundice in patients with intraductal tumour growth in the biliary tract.

Bile Duct Neoplasms↗
PubMed2005

Hypercreatininemia and hyperglycemia: diabetic nephropathy or "inverted peritoneal auto-dialysis"?

We describe a case of 51-year-old male with fever, abdominal pain and inguino-scrotal hernia. Laboratory examination revealed hypercreatininemia and hyperglycemia, firstly interpreted as diabetic nephropathy. US and CT scan showed a hernia of the bladder into the scrotum. Surgery revealed multiple bladder perforations with peritoneal diffusion of urine. So, hypercreatininemia was caused by peritoneal reabsorption of urea and creatinine, a condition that may be described as "inverted peritoneal auto-dialysis". Surgical reposition and repairment of the bladder led to rapid normalization of serum urea and creatinine. Discharged diagnosis was intraperitoneal rupture of inguino-scrotal hernia of the bladder in patient with recent onset of diabetes mellitus.

Creatinine↗
PubMed2001

Comparison between color power Doppler ultrasound with echo-enhancer and spiral computed tomography in the evaluation of hepatocellular carcinoma vascularization before and after ablation procedures.

OBJECTIVE: Use of new echo enhancers capable of passing the lung filter has extended the clinical applications of color power Doppler flow imaging in many diseases and appears promising in the study of neoplasm vascularization. Levovist (Shering, Berlin Germany) is an ultrasound contrast agent containing galactose microbubbles suspended in palmitic oil. The sensitivity of Levovist-enhanced color power Doppler was compared to that of standard color power Doppler and contrast-enhanced spiral computed tomography (CT) in the detection of vascular signals in hepatocellular carcinoma. METHODS: We examined 29 hepatocellular carcinoma nodules in cirrhotic livers that had appeared avascular on unenhanced color power Doppler. Color power Doppler studies were repeated with and without Levovist enhancement before (15 examinations) and/or after (23 examinations) percutaneous ablation procedures. Findings (vascularized vs nonvascularized) were compared to those obtained with contrast-enhanced spiral computed tomography (gold standard) performed no more than 24 h after each of the 38 Doppler examinations. RESULTS: In pretreatment studies, Levovist-enhanced power Doppler correctly revealed vascularization in 12 of 15 lesions that had appeared avascular without echo enhancement and confirmed the avascularity of one other nodule; the remaining two, which appeared avascular on contrast-enhanced Doppler, displayed vascularization on the spiral CT examination. Levovist-enhanced power Doppler was fully concordant with spiral CT findings in all of the posttreatment examinations. CONCLUSION: Considering the absence of false positive results in this study, echo-enhanced color power Doppler can be considered reliable in diagnosing incomplete necrosis of hepatocellular carcinomas after percutaenous ablation. Spiral computed tomography can thus be reserved for those cases in which the enhanced power Doppler examination reveals no evidence of vascularity.

Carcinoma, Hepatocellular↗
PubMed2000

[Evaluation of the "N" factor in nonsmall cell lung cancer. Correlation between computerized tomography and pathologic anatomy].

PURPOSE: To evaluate the role of CT in identifying other morphological signs of metastatic lymph node involvement from non small cell bronchogenic carcinoma. This is done to improve N staging, a critical step in this disease. In fact, since diameter is the only criterion used to distinguish normal form abnormal lymph nodes, medistinal CT only has 80% diagnostic accuracy. MATERIAL AND METHODS: 137 patients with known or suspected lung cancer were examined with Helical CT during early and late arterial phases (2 min delay, 3 mm thickness, 5 mm interslice gap) to depict node characteristics. Mediastinal lymph nodes, located according to the American Thoracic Society mapping, were considered normal when they were not visible or, if visible, less than 1 cm in diameter and of homogeneous density; lymph nodes over 1 cm in diameter and homogeneous density were considered reactive. A lymph node was considered metastatic when, independent of size, the following signs were found: central hypodensity; hyperdense thin/thick rim, with nodules within; hyperdense strands or diffuse hyperdensity in perinodal adipose tissue. The tumor site was also considered. RESULTS: Seventy patients were excluded because they were inoperable. Sixty-five of the remaining 67 patients were operated on, 1 underwent mediastinoscopy and another one mediastinoscopy followed by surgery. Based on the above CT signs, 46 patients were staged as N0, 61 as N1 and 15 as N2. In 44/46 N0 patients there was agreement between anatomical and pathologic findings; 3 of the 44 patients had lymph nodes over 1 cm in diameter and with homogeneous density. Micrometastases to mediastinal lymph nodes (N2) were found at histology in 2/46 patients (CT false negatives). In the 6 N1 and the 15 N2 patients there was complete agreement between anatomical and pathologic findings; in particular, 9 N2 patients had lymph nodes less than 1 cm in diameter with signs of metastasis and 4 had lymph nodes over 1 cm in diameter with signs of metastasis and 2 had lymph nodes either over or less than 1 cm. In all N2 patients the tumor histotype and the mediastinal location were also considered relative to the lesion site. DISCUSSION: A closer correlation was found with node morphology and density than with size. Indeed, CT sensitivity, specificity and diagnostic accuracy were 97, 100 and 97%, respectively, for the former versus 52, 93 and 77% for the latter. Adenocarcinoma was the predominant histotype (70.5%) in N2 patients. Metastases to node region 4 were predominant in right upper lobe carcinomas while node region 5 was predominant in left upper lobe lesions. CONCLUSIONS: Other criteria can be associated with size to improve CT diagnostic accuracy in N staging. Technique optimization plays a major role particularly in the late, thin slice, examination phase.

Adenocarcinoma↗
PubMed1998

Diagnostic imaging of primitive neuroectodermal tumour of the chest wall (Askin tumour).

OBJECTIVES: To describe the radiological features of primitive neuroectodermal tumour (PNET) of the chest wall (Askin tumour) at diagnosis and to analyse the radiological changes occurring as a consequence of treatment and during follow-up. MATERIALS AND METHODS: Nine children with histologically proven PNET were studied. At diagnosis, all patients underwent chest X-ray (CXR), chest CT and bone scintigraphy; three patients also had MR and three had US. During treatment and follow-up, CT was performed in all patients. RESULTS: CT demonstrated a solid heterogeneous chest wall mass in all children at diagnosis and six had a rib lesion. Small nodular densities in the extra-pleural fat were identified in three patients at diagnosis. US, performed in three patients, excluded tumour infiltration of the lung or diaphragm, which had been suspected on CT. On MR, the lesions showed high signal intensity in T1-weighted/proton-density images and intermediate/high signal intensity in T2-weighted images compared with muscle. Minimal chest wall involvement was demonstrated in one case by MRI. Extensive necrosis of tumour mass with pseudo-cystic appearance was documented in the five patients who underwent chemotherapy. Macroscopically complete resection was performed in five patients but there was early local recurrence after surgery in two, identified by CT in one and by MR in the other. CONCLUSIONS: PNET of the chest wall should be considered in a child with a chest wall mass. CT is valuable for evaluating tumour extension at diagnosis, the effects of chemotherapy and assessing tumour recurrence after surgery. However, CT can overestimate pleural, lung or diaphragmatic infiltration, which are better evaluated by US. MR was superior to CT in the evaluation of tumour extension in one of three patients and may be considered complementary to CT, particularly in very large chest wall tumours.

Child↗
PubMed1996

[Anatomico-functional correlations between the pulmonary and portal circulations: the prerequisites for a modern functional imaging diagnosis].

This study was aimed at investigating the current knowledge on the similarities between pulmonary and portal circulation to try to improve the diagnostic capabilities of functional radiology in these two districts. These two organs are similar both from an anatomical and a functional viewpoints, sharing the same microarchitecture and a double vascular system with similar hemodynamic characteristics. In the past, the parameters to evaluate pulmonary flow and pressure consisted in the analysis of the distribution, diameter and number of vessels with conventional radiology, but today, HRCT permits the regional assessment of perfusion and air volume, using density values. Dynamic density changes (expiratory and prone scanning), together with the morphological features of peripheral bronchial and vascular structures, play a fundamental diagnostic role in differentiating small airway conditions from normal and hemodynamic changes. When HRCT shows a "mosaic" pattern--i.e., regions with different density values--reduced perfusion can be distinguished, because in this case hypodense areas are vascularized by fewer, and smaller, vessels. Expiratory scanning can exclude abnormal ventilation. Hyperperfusion is characterized by higher density areas vascularized by more, and bigger, vessels. Doppler US and MRA show, once again, their limitations in calculating the absolute values of flow velocity and flow volume in the splanchnic district; in clinical studies, only the semiquantitative data yielded by Doppler US are considered reliable. Therefore, also in this district, relative data must be preferred to absolute ones; for instance, it is interesting to analyze the hemodynamic changes occurring in patients under different physiologic or experimental conditions. We believe that, in the near future, technological progress and growing operators' skills will make functional radiology a major tool helping the clinician approach and treat these patients correctly.

Humans↗
PubMed1996

[Magnetic resonance in the assessment of myocardial viability after infarction: comparison with dobutamine echocardiography and thallium scintigraphy].

UNLABELLED: Revascularization and prognosis after acute myocardial infarction (AMI) depend on the assessment of myocardial viability. Thus, after AMI, the myocardium may still be viable, though with contractile dysfunction. This study was aimed at comparing three tomographic methods, that is, dobutamine echocardiography (DE), thallium scintigraphy after i.v. nitrate bolus (SPET) and MRI at rest, in the assessment of viable tissue. The viability standard was post-revascularization functional recovery, as assessed with echocardiography at rest. Twenty-four patients with previous AMI (3-6 months earlier) were examined: 384 segments in all; 106 segments were a-dyskinetic and they make up our study group. At first follow-up (30-45 days), 38 segments exhibited functional recovery and were considered viable; sensitivity and specificity rates follow: 68% and 75% for DE, 75% and 55% for SPET, and 95% and 34% for MRI, respectively. IN CONCLUSION: 1) this is the first study comparing three different tomographic methods with the same myocardial segmentation for viability assessment; 2) MRI exhibited very high sensitivity, which means no false negatives; 3) SPET and MRI exhibited low specificity, due to their intrinsic limitations, but also to the inadequacy of functional recovery as a viability parameter, as indicated by PET; 4) the authors expect better results from MRI with low-dose dobutamine and first-pass ultrafast MRI with Gd-DTPA for the assessment of myocardial perfusion.

Aged↗
PubMed1993

[Gastric localization of sarcoidosis].

Sarcoidosis is a systemic granulomatous disease of unknown etiology, characterized by an immunological disorder with accumulation of activated lymphocytes and macrophages in all the organs and apparatus. The intrathoracic lymphnodes and the lung remain the most common sites of such disease. The gastrointestinal sarcoidosis, particularly of the stomach, is very rare. The stomach may be the primitive or the secondary (systemic sarcoidosis) site of sarcoid granuloma. The endoscopic aspects of the gastric mucosa are variable: localized or diffused hyperemia, single or multiple ulcers, aspects of atrophic gastritis with easy bleeding during contact, rigid mucosa and so on. Generally asymptomatic, the disease may show symptoms as pain in the epigastrium, nausea, vomiting, haematemesis and so on. The wide range of gastric pathologies resembling sarcoidosis both on a histological level and on a clinic-endoscopical one (syphilis, histoplasmosis, Crohn's disease, stomach cancer) require an extremely accurate diagnosis above all for the setting out of the therapy with steroids which are the most appropriate drugs (prednisone). Three out of thirty-two patients observed for respiratory problems, already affected by cutaneous and pulmonary sarcoidosis, started suffering from gastric symptoms of different kind: pain in the epigastrium, haematemesis, weight loss, nausea and post-prandial vomiting. Gastroscopy and biopsy, with histopathologic examination of gastric mucosal specimens taken from the most suspicious sites, confirmed the diagnosis of sarcoidosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

[Diagnostic and therapeutic integration in non-small cell lung tumors: preliminary notes].

An interdisciplinary study relative to non-small cell lung cancers was activated in 1990 at the Policlinico A. Gemelli, Rome, Italy. A working group including radiologists, radiotherapists, oncologists, surgeons, respiratory physiopathologists and pathologists defined the goals to reach and the protocols to follow for staging, treatment, and follow-up. A hundred and ninety patients with non-small cell lung cancer were examined: 134 of them, who were in the initial or locally advanced phases, were considered, together with 6 patients with postoperative recurrences. Ninety-three cases were considered to be resectable and therefore operated: the extant 41, considered unresectable/slightly resectable, and the 6 with postoperative recurrences were started on combined chemo- and radiotherapy. Primary tumor (T) and lymph nodes (N) were staged by means of CT. In the evaluation of T in resectable patients, CT exhibited 78.5% agreement with pathology, with a tendency to understaging. In the evaluation of N, CT exhibited 62.4% agreement with pathology, once again with a tendency to understaging. Surgery was exploratory in 4.3% of cases only. Combined chemo- and radiotherapy in unresectable patients and in postoperative recurrences yielded > 50% response in 18/47 patients, that is 40.4% especially relative to the cases treated with carboplatinum in continual infusion. Eight of 18 responsive patients were considered to be resectable and therefore submitted to surgery: in 2 of them histology showed no neoplastic cells. This study, which is still in progress, is aimed at verifying its hypotheses and attaining its prefixed goals.

Adult↗
PubMed1991

[Computer-assisted report generation and image transmission in bedside chest x-rays in intensive therapy units].

Since a few years ago, in our department the bedside chest X-rays of intensive care patients have been reported by means of a computer program which has also storing function. This computer program is a guideline for the radiologist and is organized in pages having a logical sequence. The program has proved very useful in learning the correct reporting of bedside chest X-rays. The nosographic data of the patients, the ventilatory and the technical data are stored for a better clinico-radiological correlation. The last four reports are displayed on the monitor to better understand the patient's history. The other reports become part of a "historical" archive. Most important is the cooperation with the referring physician: to make the most of it, a system has been implemented which sends the images from the Radiology Department to Intensive Care. The images are filmed with a camera and then digitalized on 1024 x 768 matrix with 16 million colors and 256 gray levels. Each workstation is composed of: AT286 computer with 60-MB hard disk, hardware or the digitalization and compression of images, a high-resolution monitor, an intercommunication system, and a modem. It is possible to zoom on the images, but a close-up on the image with the camera is better for improved spatial resolution. The images are stored on the hard disk: each image requires 3M bytes, but it can be compressed down to 25:1 with no detail loss. The images are transmitted via modem in at least 20 seconds/image. More images can be sent out-line. During transmission, it is possible to talk by the intercommunication system, pointing out structures on the monitor or drawing objects on both sides of the system. In our experience, image quality is good. We are therefore considering extending the network to other Departments and making the transmission of images of pathologic specimens possible. The natural evolution of this system is the teleconsult.

Computer Communication Networks↗