Biomedical subjects

M Bellomi

Publications and source records attributed to M Bellomi.

At least 37 records · Page 2Linked to original sources

PubMed1991

Diagnostic accuracy of the double-contrast enema for colonic polyps in patients with or without diverticular disease.

The accuracy of the double-contrast enema for the diagnosis of polypoid lesions in the presence or absence of diverticula was evaluated by retrospectively reviewing the medical records of 202 patients subjected to examination and endoscopy. Analysis of the data on 215 polypoid lesions showed that (a) the diagnostic accuracy of the examination is not affected significantly by the presence of diverticula; (b) the sensitivity of the examination is highly dependent on the size of the polyps (smaller or larger than 0.5 cm) but not on the form (sessile or pedunculated); and (c) the positive predictive value is higher in patients without diverticula. The double-contrast enema was confirmed to be a valid method for the diagnosis of polypoid lesions.

Barium Sulfate↗

PubMed1991

[Prognostic factors after percutaneous transhepatic biliary drainage].

The authors reviewed the clinical charts and the radiographic files of 93 patients with obstructive jaundice--in 86 cases due to neoplasm--treated with PTBD. The test of differences from survival curves was used to identify the clinical parameters predictive of short survival after PTBD. The difference in survival curves was significant relative to serum indirect bilirubin (cut point: 7.6 mg%), to serum cholinesterase (cut point: 1290 mU/ml), to white blood cell counts (cut point: 8600/mm3), to blood urea nitrogen (BUN) levels (cut point: 60 mg%). Because of the marked negative prognostic value of high BUN levels, our data seem to indicate that PTBD should not be performed when severe renal insufficiency is present. Other parameters correlated with a short survival after PTBD were the histotype of metastasis (in comparison with the other ones), and large neoplastic volume (in comparison with a small and a medium ones). Through pre-PTBD radiological and laboratory data analysis, a group of patients can be selected in whom the procedure will increase neither well-being nor survival, as plotted against those patients who are likely to benefit from biliary drainage.

Bile Duct Neoplasms↗

PubMed1990

[Use of Severini's coaxial catheters in gastrointestinal interventional radiology].

The growing importance of gastrointestinal interventional radiology has led to the development of new instruments and materials for the different proposed purposes. The authors present a set consisting of two coaxial catheters which was created for percutaneous transhepatic biliary drainage (Severini set). Its easy handling, adaptability and tolerability make it a versatile instrument in the hands of interventional radiologists for positioning large-calibre catheter (9-14 F) in deep sites. Hereafter are reported the results in 29 patients treated with different therapeutic aims and the use of the set for different pathologies. The catheters allowed a complete resolution of the collections communicating with the gastrointestinal tract in 4 of 5 patients. The catheter was inserted as a feeding tube in 22 patients. Finally, it was used as a gastrostomy catheter in 2 patients. Neither early nor late complications due to insertion or use of this set were observed.

Adenocarcinoma↗

PubMed1990

Double contrast small bowel enema in a case of selective duodeno-jejunal amyloidosis.

Double contrast small bowel enema in a patient with selective amyloidosis of the duodenum and jejunum revealed an unusual radiologic pattern, mimicking multiple polyposis. Many submucosal polypoid lesions, sessile or pedunculated, were scattered throughout the duodenum and proximal jejunum. The lesions had smooth borders and did not show any retraction at the base. Other typical radiologic patterns of intestinal amyloidosis described in the literature were not observed in the present case. Differential diagnosis from multiple polyposis and diffuse lymphoproliferative neoplastic diseases is discussed.

Aged↗

PubMed1989

[Percutaneous transhepatic biliary drainage. Complications and their treatment].

In the present series of 296 PTBDs in 281 patients, 103 complications of different degree developed (34.7%). Early complications directly connected to the procedure (32/296 = 10.8%) and late complications generally due to malfunctioning of the catheter or progression of the disease (71/296 = 23.9%) are analyzed. Caveats to prevent complications, therapeutic procedures to resolve them, as well as obtained results are reported. On the whole, major complications directly related to the procedure are present in a small percentage and the procedure appears well tolerated also in patients with poor general conditions.

Bile Duct Neoplasms↗

PubMed1989

[Cholangitis and percutaneous biliary drainage].

The binomial PTBD-cholangitis often stands under different and sometimes even opposite relations. Among its indications the procedure lists, the treatment of cholangitis which, on the other hand, may be itself a complication of biliary drainage. The present work proposes a critical review of cholangitis-PTBD correlations, from an ordinary clinical-radiological point of view. Different pathogenetic hypothesis of cholangitis (inflammation, cholestasis, surgical manipulation) are discussed together with risk factors (impaired macrophagic-phagocytic system, immunosuppression, wide neoplastic liver involvement, multiple intrahepatic ductal obstructions, chronic liver diseases, aged patients, etc.). The authors also report about prevention and treatment of septic complications which must be carried out following technical and therapeutic strategies, such as chemoprophylaxis and focused antibiotic therapy according to bile culture samples, slow injection of small amounts of contrast medium, peripheral branches approach, gentle handling of catheters and guidewires, flushing with saline solutions and brushing of the catheter itself, and finally use of large gauge catheters in the presence of bile sludge.

Bacterial Infections↗

PubMed1989

[Radiologic examination in assessing the response to chemoradiotherapy of esophageal spinocellular carcinoma].

Squamous cell carcinoma represents more than 90% of esophageal cancers; its prognosis is still extremely severe. A treatment consisting in the combined use of preoperative chemotherapy and radiotherapy is now in course of experimentation at Istituto Nazionale Tumori, Milan. Over a period of 28 months (July 1985 to October 1987), 21 patients with 22 lesions (stage III) underwent a double contrast study of the esophagus, both before and after therapy. The radiological evaluation of the lesions after treatment was compared with the pathological diagnosis. Radiological diagnosis has been confirmed in 86.3% of cases (19/22 lesions) as far as mucosal detailing was concerned. On the contrary, radiological evaluation has proven unreliable as far as submucosal layers were concerned. No radiological false positives have been observed.

Adult↗

PubMed1989

[Postoperative radiologic follow-up of rectocolonic anastomoses. The visualization of fistulous passages after evacuation].

The early postoperative study of colo-rectal anastomoses is a common diagnostic procedure with symptomatic patients which is extended to asymptomatic patients by some authors. Eighty-eight anastomotic fistulas were early diagnosed after intervention in 316 patients who underwent a water-soluble contrast enema. Four out of these fistulas (4.5%) could not be demonstrated at complete filling on X-ray, but were only opacified on radiographs taken after the spontaneous evacuation of contrast medium. The increase in endoluminal pressure due to the evacuation and the lack of balloon catheter probably play a role in allowing these fistulas to be visualized.

Anastomosis, Surgical↗

PubMed1988

Sensitivity of Hemoccult test for large bowel cancer in high-risk subjects.

From 1979 to 1982, 1233 symptom-free subjects at high risk for colon cancer because of family history and/or personal history of bowel neoplasia (cancer or adenomatous polyp) were examined with a guaiac test (Hemoccult II) for occult blood in stools. The test was positive (H+) in 98 subjects (7.9%). Endoscopy was subsequently performed on 86% of the H+ and on 64% of the H- subjects. Of 20 in invasive cancers found, 15 had been H+ [75.0%; 95% confidence interval (CI), 54.3-91.0%]. Of 96 patients with adenoma(s), 23 were H+ (24%; 95% CI, 16.0-33.0%). However, the sensitivity for adenomas was higher in patients with multiple adenomas or with a single adenoma measuring 2 cm or more in its largest diameter (37.5%; 95% CI, 21.8-54.7%). Of 699 subjects free of neoplastic lesions at endoscopy, 47 had been H+, ie, false positive (6.7%; 95% CI, 5.0-8.7%). Adjusting for differential compliance of H+ and H- subjects to endoscopy, a corrected estimate for sensitivity would be 69% for cancer and 19% for adenomas; the corrected estimate for the false-positive rate would be 5%.

Adenoma↗

PubMed1988

[Gastrointestinal interventional radiology. Technics and preliminary results].

Gastrointestinal interventional radiology allows the positioning of feeding tubes in difficult situations, as well as the balloon dilatation of stenoses and the transintestinal drainage of fistulas and collections, with some advantages over endoscopic and surgical procedures. In the present series feeding tubes were positioned in 26 patients, both to get over the strictures in the upper gastrointestinal tract and to exclude fistulous tracts or anastomotic leaks from alimentary transit. Balloon dilatation was performed in 10 patients with stenoses of different aetiologies, at different levels of the gastrointestinal tract: in all cases the clinical symptoms diminished. All the 7 non-neoplastic stenoses were successfully treated (follow-up 6-27 months). The draining of abscesses through the enteric fistulous tract did allow the reduction/resolution of all collections in a short time. These procedures are simple and safe, and help to reduce the interval between diagnosis and therapy. Their failure does not prevent the use of other therapeutic procedures.

Abscess↗

PubMed1988

The occurrence of cholangitis after percutaneous biliary drainage: evaluation of some risk factors.

Sepsis of the biliary tract is often reported after percutaneous transhepatic biliary drainage (PTBD) and is considered a life-threatening condition. The authors studied 39 patients with biliary stenosis (35 with neoplastic stricture and four with benign disease) with the purpose of identifying some factors possibly associated with a higher risk of cholangitis. None of the patients complained of biliary sepsis at the first clinical examination. Several factors were taken into account and were statistically tested according to Miettinen rate ratios to differentiate patients in whom cholangitis would consequently develop: nature, site and extent of basic disease, type and functioning of PTBD, skin contamination at puncture site of PTBD, and bile contamination at PTBD and at follow-up. The presence of bacteria in the first bile (31.5%) was not related to a higher risk. All subjects showed bile contamination after PTBD, but cholangitis developed in only 15 patients, and it was always supported by enteric microorganisms. When we compared patients with cholangitis and subjects without infection, it was possible to demonstrate a statistically significant association of cholangitis and the following: nature of the stricture, presence of multiple intrahepatic biliary obstruction, neoplastic invasion or compression on the duodenum, and presence of Staphylococcus aureus on the skin at puncture site at drainage.

Adult↗

PubMed1987

A new set for transhepatic insertion of large caliber catheters for biliary drainage: technical and clinical report.

An original set for percutaneous insertion of large caliber (12-16 French) biliary drainages is described. The results obtained in the 70 patients submitted to biliary drainage with late complications due to malfunction of the standard 8.3 or 10 F catheters show the advantage of the set described. The correction of unsatisfactory levels of bilirubinemia was obtained in 100% of cases, the resolution of recurrent cholangitis in 84.2% and of bile leakage on the skin in 46.7%. The large caliber and the large side holes of the catheter, together with its length and its easy handling, allow resolution of many different problems of insufficient drainage present in patients with neoplastic involvement of bile ducts.

Bile↗

PubMed1987

[Proposal for a radiological classification of multiple adenomatosis of the colon].

The double contrast enemas of 47 patients with multiple adenomatosis of the colon and rectum were analyzed. According to the density and the distribution of polyps on the mucosal surface, the radiological patterns were classified into three different groups: sporadic, dense and confluent adenomas. Radiographic patterns of each patient were related to the clinical and pathological data collected during the diagnosis and the follow-up. The clinical and pathological features and the evolution of the disease appear to be different in each group of patients (identified by the radiological classification). The occurrence of cancer at the time of the diagnosis of polyposis is closely correlated either to the number of polyps or to their size and the age of patients. The occurrence of metachronous cancer is correlated only to the number of polyps, not to their size, nor to the surgical treatment of the polyposis. If these data are confirmed on a wider number of patients, the role of radiological survey might become a more prominent one, not only in diagnosing, but also in therapy planning, as well as in the prognostic evaluation of multiple adenomatosis of colon.

Adenoma↗

PubMed1987

[Computerized instruction. Preliminary analysis of the experience at the Institute of Radiological Sciences of the University of Milan].

Computerised instruction means teaching by computer using a program that alternates information with self-checking multiple choice questions. This system was used to create a fully computerized lesson on the diagnosis and treatment of breast cancer which was then tested on a small group of medical students attending the Radiology School of the Milan University Institute of Radiological Sciences. At the end of the test, the students were asked to complete a questionnaire which was then analysed. The computer lesson consisted of 66 text messages and 21 self-checking questions. It aroused considerable interest, though the most common reason was curiosity about a novel system. The degree of fatigue caused was modest despite the fact that the computer lesson was at least as demanding as a traditional lesion, if not more so. The level of learning was considered high and optimised by the use of self-checking questions that were considered an essential element. However no student agreed to sit an official examination, even interactively, using the computer.

Computer-Assisted Instruction↗

PubMed1987

[Structuring and use in clinical research of a software for the diagnosis and features of polypoid lesions of the colorectum].

Double contrast enema and endoscopy are very important in the diagnosis of adenomas and early cancer of the colon and rectum. These exams can not only detect the presence, but also suggest the histologic diagnosis, of polypoid lesions of the colon. An Olivetti M24 Personal Computer was used to create a software to study the results obtained by double contrast enema, and to compare them with endoscopy and pathology. The data base is formed by 7 files: one anagraphic, 3 collecting the characteristics of the diagnosis--namely the radiologic, the endoscopic and the pathologic one-- and 3 multiple files featuring each lesion, as defined by the three diagnostic techniques. The software allows to evaluate the different lesions that can be detected by the three techniques in the same patient and to compare the diagnosis of presence to the morphologic features of each lesion. False negatives and false positives of each technique are easily recognized. It is also possible to characterize the single morphologic feature leading the radiologist and/or the endoscopist to express an opinion about the histologic diagnosis of each lesion and to compare them with pathological features. The first experience in clinical use of the software, in the analysis of the characters of 336 lesions in 218 patients, is described.

Colonic Neoplasms↗

PubMed1986

Radiologic diagnosis of invasive carcinoma on adenomatous polyps of the colon.

The radiographic appearance at double contrast enema of 33 cases of invasive cancer on adenomatous polyps (AP) of the colon is reviewed. The radiologic diagnosis of malignancy was prospectively made in 54.5% of the cases. In 45.5% of the cases, malignancy was not suspected at the time of examination. The endoscopic appearance of these lesions was identical to that seen on the barium study. There are no radiologic criteria able to entirely rule out the possibility of a carcinomatous transformation of an AP. However, the radiologic features of malignancy (indentation of the intestinal wall and/or irregular outline of the surface of the polyp) have to be considered quite reliable.

Adenocarcinoma↗

PubMed1985

Accuracy of the double contrast enema in evaluation of the abdominal diffusion of ovarian carcinoma.

The results of 103 double contrast enemas in 72 patients with ovarian carcinoma (stage III and IV) were compared with laparoscopic and/or laparotomic findings at comparable times. The evaluation of the validity of radiology in detecting the presence of abdominal disease showed an 84% overall accuracy, 75% specificity and 86% sensitivity. The accuracy in detecting signs of adhesion and parietal infiltration of the large bowel was 76.3%, due to the limited size of most of the lesions. Forty-seven of the 72 patients underwent a double contrast enema and laparoscopy during presurgical staging: accuracy in detecting lesions was the same for both examinations (80.4%). When double contrast enema and laparoscopy were used together in the evaluation of abdominal extension of the disease, the diagnostic accuracy rose to 93.6%.

Abdominal Neoplasms↗

PubMed1985

[Cloacogenic carcinoma. Radiological appearance during double-contrast enema].

Radiographic appearances at double contrast enema of 8 cases of anorectal cloacogenic carcinoma are described. In all cases tumor was radiologically identified as a neoplastic lesion, but the correct histologic diagnosis was not reached in any case. Radiological features of the cloacogenic carcinoma are: the evident submucosal mass, the poor mucosal involvement and the eccentricity of the lesion. However, the characteristics of the tumor are not peculiar and radiologic diagnosis of the nature of tumor can only be suspected.

Anus Neoplasms↗