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Biomedical subjects

L Bolondi

Publications and source records attributed to L Bolondi.

162 records · Page 9Linked to original sources
PubMedDate not supplied

Sonographic findings in abdominal hereditary angioedema.

Patients with hereditary angioedema (HAE) may suffer from abdominal pain severe enough to prompt unnecessary surgical intervention. The diagnostic approach to abdominal pain during HAE attacks is not established. We describe abdominal sonographic findings during severe colic in 2 patients with known HAE. Sonography demonstrated marked mucosal thickening and edema of the bowel wall with a variable amount of free peritoneal fluid. These findings are not specific but are consistent with the hypothesized mechanism of attack and resolve after therapy. Abdominal sonography is useful for evaluating acute abdominal pain in patients with known HAE to prevent unnecessary surgery. Conversely, if the described sonographic findings appear in a case of abdominal colic of unknown origin, HAE should be included in the differential diagnosis.

Abdominal Pain↗
PubMedDate not supplied

Morphological and hemodynamic changes in the portal venous system after distal splenorenal shunt: an ultrasound and pulsed Doppler study.

We investigated a group of patients who underwent distal splenorenal shunt using high-resolution real-time equipment and a duplex scanner with the aims: (i) to evaluate the rate of visualization of shunt; (ii) to assess change in size in the portal vein, and (iii) to characterize the flow pattern in the splenic vein and to study flow direction and velocity in the portal vein, thus adding new data on the efficacy of this operation in maintaining hepatic perfusion. Real-time ultrasonography was performed in 29 patients before surgery, after 7 to 30 days and after 4 to 12 months. Direct visualization of the shunt was achieved in 53.5% of the patients. Mean caliber of the portal vein significantly decreased after the operation: preoperative = 1.52 +/- 0.32; after 7 to 30 days = 1.32 +/- 0.16 (p less than 0.001), and after 4 to 12 months = 0.99 +/- 0.19 (p less than 0.001). The overall postoperative incidence of portal thrombosis was 22.2%. Thirteen of these patients also underwent a postoperative (4 to 36 months) pulsed Doppler investigation. Flow towards anastomosis was demonstrated in the splenic vein in 11 patients, and in 7 cases, typical caval pulsatility was observed. Decreased hepatopetal flow in the portal vein was found in 10 of 13 patients. In two patients, no flow was detectable and in the other the flow was hepatofugal. On the basis of our data, we can affirm that pulsed Doppler investigation may provide useful data for the evaluation of shunt patency and preservation of a decreased portal hepatic perfusion in the majority of patients.

Adult↗
PubMedDate not supplied

Sonographic diagnosis of adult intussusception.

We describe three cases of adult intussusception in which ultrasonography provided the correct preoperative diagnosis. Patients underwent ultrasonography to investigate nonspecific acute abdominal pain; intussusception was not suspected. In all cases, the sonographic pattern was typical of intussusception and ultrasonography was the only diagnostic study. Bowel ischemia was not found at surgery in any patient.

Abdomen, Acute↗
PubMedDate not supplied

Improvement of pancreatic ultrasound imaging after secretin administration.

The pancreas is usually well recognized by ultrasound, but in some cases it is obscured by the presence of gas in the stomach and duodenum. Water and other orally administered fluids produced poor results. In this study we stimulated pancreatic juice secretion by a standard dose of intravenous secretin in 24 normal subjects, and continuously monitored the pancreatic region for a period of 20 min. Four to five minutes after hormone administration pancreatic juice outflow into the duodenum generated a fluid-filled echofree area around the head of the pancreas, allowing excellent visualization of its boundaries and other channel structures (distal common bile duct, pancreatic duct and gastroduodenal artery). This method should be utilized in selected patients whenever a pathological condition of the pancreatic head region is suspected.

Adolescent↗
PubMedDate not supplied

Endoscopic ultrasonography in the diagnosis of gastric submucosal tumor.

Endoscopic ultrasonography contributed to a correct diagnosis in 24 of 25 patients with gastric submucosal tumor, including 10 extrinsic compressions and 14 intraparietal growths. Leiomyoma and lipoma were easily recognized. In one case, an unusual group of gastric varices was clearly differentiated from a pedunculated polyp prior to polypectomy. In gastric submucosal tumors, endoscopic ultrasonography can greatly reduce the need for aggressive and risky biopsy techniques or exploratory laparotomy.

Adolescent↗
PubMedDate not supplied

Left ventricular volumes in liver cirrhosis.

BACKGROUND: Patients with alcoholic cirrhosis have left ventricular dimensions similar to controls. Few data have been reported in patients with cirrhosis of viral origin. AIM: To assess left ventricular dimensions in patients with pure viral cirrhosis. PATIENTS AND METHODS: Thirty patients with virus-related cirrhosis, 23 patients with alcoholic cirrhosis and 12 healthy controls were submitted to measurement of left ventricular volumes, cardiac output, mean arterial pressure and total peripheral resistance. RESULTS: Patients with cirrhosis showed a similar increase in cardiac index and heart rate and reduction of mean arterial pressure and peripheral vascular resistance in comparison to controls, irrespective of the aetiology. Left ventricular end systolic volume index was lower (p<0.01) and ejection fraction higher (p<0.01) in virus-related cirrhotic patients [mean +/- SD, respectively 12.4+/-4.1 ml/sqm and 77.9%) in comparison both to controls (21.5+/-6.3 ml/sqm and 66.8%) and alcoholics (20.6+/-7.0 ml/sqm and 68.8%). End diastolic volume index was not significantly different between the three groups. CONCLUSIONS: Our findings indicate smaller left ventricular volumes and higher ejection fraction in pure virus-related cirrhosis than in alcoholic cirrhosis and controls. Since peripheral haemodynamics proved similar in virus- and alcohol-related cirrhosis, a subclinical alcohol cardiomyopathy may be hypothesised to account for the absence of such left ventricular pattern in alcoholic patients.

Blood Pressure↗
PubMedDate not supplied

[Ultrasound staging research of progressive pathology of the base of the tongue].

Diagnosis of tongue tumours is often retarded mainly because tumours grow prevalently in deep muscular layers. A correct exploration of the region might be difficult solely employing clinical examination. Therefore, it would be useful to confirm the suspect of a neoplastic lesion at the base of the tongue with a promptly available imaging method. These considerations led us to evaluate ultrasonography (US) as a diagnostic tool for neoplastic lesions of this region. Initially 10 normal patients were studied in order to become familiar with US anatomy of the area. In a second phase our study involved 24 patients with diagnosed carcinoma of the tongue base and 26 patients with clinical suspect of neoplasm in the region. US examination was carried out with real-time equipment provided by a 5 Mhz convex transducer. Patients were examined in supine position with the neck hyperextended. Longitudinal, oblique and transverse scan of the submental region were obtained. The study showed that US gives detailed images of the floor of the mouth and the tongue. Neoplastic infiltration of the base of the tongue is clearly recognizable as a hypoechoic area. It was possible to detect masses ranging from 1.4 to 3.8 cm. In cases of larger lesions, US was useful in evaluating deep infiltration, whereas in other cases the method allowed the diagnosis of small lesions with submucosal growth. US did not proved to be highly reliable in the diagnosis of lesions confined to superficial planes (false negative results).(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma↗
PubMedDate not supplied

Management of small hepatocellular carcinoma.

In the last years the incidence of hepatocellular carcinoma (HCC) is rising in cirrhotic patients worldwide. Due the importance of early and definite diagnosis of HCC, any nodular lesion detected in patients with chronic liver disease should be considered as suspicious for HCC. The screening and surveillance programs in patients with liver diseases have increased the number of small HCC detected at an early stage, when the therapeutic options available are able to provide benefit. The introduction of new imaging techniques has improved the accuracy of characterizing these nodules. According to the EASL recommendations, contrast-enhanced computed tomography (CT), contrast enhanced ultrasound (US) and magnetic resonance (MR) with different MR-contrast agents are currently used to characterize liver lesions. Imaging guided biopsy is recommended for small nodules or in lesions without typical features (arterial hypervascularization) in at least two imaging techniques. Frequently the differential diagnosis of small nodules is complicated by discordant vascularity and recent studies have also demonstrated the presence of small hypovascular HCC at perfusional US and helical CT. At present, different treatment options can be offered to patients with diagnosis of small HCC at an early stage; percutaneous techniques, surgical resection and liver transplantation can provide benefit in properly selected patients. This review describes some critical points regarding the detection, diagnosis and therapeutic management of small nodules of HCC in cirrhotic patients.

Biomarkers, Tumor↗
PubMedDate not supplied

Hepatic resection for tumours in cirrhotic livers.

A liver resection was performed in 25 out of 36 cirrhotic patients operated on for liver cell carcinomas. In the remaining 11 cases hepatectomy was not performed mainly because of the presence of other intrahepatic neoplastic nodules or thrombi in the portal branches revealed by intraoperative echography. The operative mortality in the 25 patients operated on was 16%; the actuarial survival at three years is 58%. Liver resection was carried out using a transparenchymal procedure; in 18 cases clamping of the hepatic pedicle was performed for an average period of 15 min. Twenty patients with small tumours had a segmentary or sub-segmentary resection; intraoperative echography proved indispensable in this situation, making it possible to recognize the lesion and outline the limits of the resection. The presence of a peritumoral capsule seems to have been an important prognostic factor.

Aged↗
PubMedDate not supplied

Accessory ultrasonographic findings in chronic liver disease: diameter of splenic and hepatic arteries, fasting gallbladder volume, and course of left portal vein.

We have assessed the incidence and significance of changes in the caliber of the splenic and hepatic arteries, in fasting gallbladder volume, and in the intrahepatic course of the left portal vein in a group of 46 patients affected by chronic liver disease (24 with chronic active hepatitis and 22 with liver cirrhosis). Thirty normal subjects were examined as a control group. Mean diameters of the splenic and hepatic arteries were significantly greater in cases of liver cirrhosis than in the control group. In the case of chronic active hepatitis, only the splenic artery proved significantly enlarged in comparison with the control group. These results demonstrate that caliber modification occurs in the splenic and hepatic arteries during chronic liver disease. In particular, changes in the splenic artery precede the onset of clinically evident portal hypertension. Gallbladder volume was significantly increased in patients affected by liver cirrhosis. Finally, statistical analysis did not reveal any significant difference in the angles formed by the transverse and longitudinal tracts of the left portal vein in controls and in subjects with liver disease.

Adult↗
PubMedDate not supplied

[Screening for the early diagnosis of hepatocellular carcinoma: cost-effectiveness analysis].

PURPOSE: We investigated the cost-effectiveness of a screening program for the early diagnosis and treatment of hepatocellular carcinoma (HCC) in liver cirrhosis patients. An HCC screening program in liver cirrhosis patients should be carried out when the HCC makes a major cause of death and considering that: 1) the diagnostic techniques should be highly sensitive and specific; 2) the overall cost of the screening program should not be too high; 3) patient survival should be improved. MATERIAL AND METHODS: March, 1989, to November 1991, 324 Italian patients with liver cirrhosis (201 men and 123 women) whose age ranged 18-83 years (mean +/- SD: 57.2 +/- 11.9) were submitted to US examinations and serum alpha-fetoprotein titration at six months' intervals. RESULTS: During the follow-up, 38 patients (11.7%) developed HCC, with 4.3% incidence per follow-up year. The Cox model identified serum alpha-fetoprotein, Child-Pugh classes B and C and the male gender as independent risk factors for developing HCC. Only 22 of 38 HCC patients (58%) were submitted to resection, orthotopic liver transplantation or local therapy. The 3-year survival of the 38 HCCs diagnosed during the follow-up is 37%. In all, 1800 US examinations and serum alpha-fetoprotein titrations were carried out during this screening program, costing 219,600 US dollars/patient. Each HCC treated successfully (stable disease at 12 months) was diagnosed at a cost of 24,400 US dollars. CONCLUSIONS: Screening all liver cirrhosis patients is a questionable approach because it is very expensive and its benefit in terms of patient survival is poor. More targeted screening programs with definite risk factors should be tested for cost-effectiveness.

Adolescent↗