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Biomedical subjects

M Salvatori

Publications and source records attributed to M Salvatori.

At least 55 records · Page 3Linked to original sources
PubMed1989

[Hepatobiliary scintigraphy in the study of neonatal hepatic cholestasis].

Severe neonatal cholestasis is a clinical problem requiring a differential diagnosis of intra- (hepatitis) and extrahepatic (biliary atresia) causes, prognosis and therapy being different in the two cases. Eighteen patients of pediatric age underwent US and hepatobiliary scintigraphy. US findings were aspecific in both hepatitis and biliary atresia. In the 11 patients with hepatitis, hepatobiliary scintigraphy after phenobarbital revealed labeled bile in the bowel. Only in 1 patient with cytomegalovirus hepatitis was a scintigraphic pattern similar to that of biliary atresia. On the contrary, no intestinal radioactivity within 24 hours was seen in 6 patients with biliary atresia. A portoenterostomy (Kasai's operation) was performed on 4/6 cases with biliary atresia. These patients were followed with hepatobiliary scintigraphy in order to evaluate anastomotic functionality. In a case of biliary cirrhosis secondary to occlusion, orthotopic liver transplantation was performed whose success was scintigraphically monitored. Our results point to hepatobiliary scintigraphy after phenobarbital as the best noninvasive procedure for both diagnosis and postoperative follow-up of biliary atresia. Labeled bile excretion within 24 hours was rarely found in both atresia and neonatal hepatitis.

Biliary Atresia↗
PubMed1986

[Usefulness of radioisotopic methods in the study of the salivary glands].

The results achieved by dynamic and static salivary gland scintigraphy in 272 patients over a ten year time (January 1976-December 1985) are reported. On the basis of a semi-quantitative assessment of time/activity curves, dynamic studies prove to be the most suitable method for studying functional disorders (phlogosis, facial paralysis, etc.). Harmlessness, easy execution and functional results are the main advantages of radioisotope techniques. Salivary gland scintigraphy has some limits in the study of space occupying lesions (SOL): however, ultrasounds, CT and sialography represent the methods of choice in this field of salivary gland pathology.

Acute Disease↗
PubMed1983

A practical approach to the hepatobiliary kinetics of 99mTc-HIDA. Clinical validation of the method and a preliminary report on its use for parametric imaging.

99mTc-diethyl-HIDA cholescintigraphy was performed on 24 patients with histologically proven liver disease and on 10 normal adult subjects. Liver mass transport of HIDA was interpreted with the aid of a probabilistic model, assuming that the tracer particles undergo mixed random walks with drifts. The radiohepatograms were thus fitted with a gamma-variate function and the fitting parameters were evaluated as estimates of the severity of the disease. These parameters, together with the transit times, were also used to generate parametric images of liver function. The advantages of this approach are discussed and the following conclusions are drawn: (1) The gamma-fit is highly satisfactory with any type of experimental curve (0.98 less than r less than 1). (2) The parameters derived from the gamma-fit make it possible to objectively assess the extent of liver functional impairment. (3) Parametric imaging of the liver mass transport of HIDA is easily implemented, but still more experience is needed to assess its impact on patient care.

Bile Ducts↗
PubMed1982

The hepatic excretion of 131I-rose bengal and 99mTc-IDA derivatives in Rotor's syndrome.

Bilirubin kinetics and hepatobiliary excretion of some exogenous anions (BSP, 131I-rose bengal, diethyl and parabutly-IDA labeled with 99mTc) were studied in three patients presenting with Rotor's syndrome. Two were brothers; a nonjaundiced fraternal twin of one of them was also evaluated. The hepatic clearance of the radiopharmaceuticals was impaired in the affected patients but the degree of impairment was different among the tested anions, i.e., maximal for 99mTc-diethyl-IDA and minimal for 131I-rose bengal. Parabutyl-IDA was cleared better than the diethyl derivative. The metabolic derangement seems to be at the level of transfer from plasma to liver and of the hepatic storage, rather than at the level of hepatocyte excretory pathways, as in the case of Dubin-Johnson syndrome.

Adult↗
PubMed1982

[Contribution of bidimensional echocardiography to the diagnosis of left atrial enlargement].

In 64 consecutive subjects (age range 17-69 years) we compared the antero-posterior (A-P) size of the left atrium estimated by M-mode and wide-angle two-dimensional echocardiography (short and long axis parasternal views). M-mode A-P diameter correlated both with short (r = 0.82) and with long (r = 0.76) axis A-P diameter. Subsequently we quantitatively analysed by two-dimensional echocardiography A-P, cranio-caudal (C-C) and latero-lateral (L-L) left atrial dimensions in 20 patients with mitral valve disease (age range 24-66 years) and in 24 normal subjects of comparable age range. Subjects with mitral valve disease had significantly higher A-P (P less than 0.001), C-C (P less than 0.02) and L-L (P less than 0.001) left atrial dimensions than normal controls. Both in normals and in mitral valve disease patients C-C was the view that showed the largest atrial diameter. Left atrial shape was however more spherical in mitral valve patients. Of these 7/20 (35%) had abnormal A-P diameter compared to the normal subjects. Patients with abnormal L-L and C-C left atrial dimensions were 9/20 (45%) and 7/20 (35%). Five of the patients with increased L-L size had a normal A-P diameter. Our results demonstrate the usefulness of wide-angle two-dimensional echocardiography in the assessment of the left atrial enlargement, especially in patients with negative or borderline M-mode echocardiographic data.

Adolescent↗
PubMed1982

The diagnostic application of radiocolloid liver scintigraphy in breast carcinoma.

The authors have reviewed their experiences in determining the presence of liver metastases in 103 patients by radiocolloid scanning. The sensitivity of liver scanning proved to be quite low if the presence of focal defects in the distribution of the tracer was chosen as the diagnostic criterion. The inclusion of less restrictive criteria such as liver enlargement or irregular distribution of the tracer, resulted in a higher sensitivity without lowering the predictive value of a negative scan. Using the latter diagnostic criterion, sensitivity, specificity and accuracy were in the range of 90%. Abnormal liver scans are common in patients classified at T3-T4 or N+ and their chances of being "true positive" are high. Conversely, abnormal scans are seldom found in patients classified at T1-T2 or N0 and probabilities of "false positive" results are high.

Breast Neoplasms↗
PubMed1982

[Diagnostic reliability of scintigraphy in hepatic metastases of breast cancer].

The authors have reviewed their experiences in determining the presence of liver metastases in 103 patients by radiocolloid scanning. The sensitivity of liver scanning proved to be quite low if the presence of focal defects of tracer's distribution was chosen as the diagnostic criterion. The inclusion of less restrictive criteria, such as liver enlargement or irregular distribution of the tracer, resulted in an higher sensitivity without lowering the predictive value of a negative scan. Using the more extensive diagnostic criterion, sensitivity, specificity and accuracy were in the range of 90%. Abnormal liver scans are common in patients classified as T3-T4 or N+ and their chances of to be "true positives" are high. Conversely, abnormal scans are seldom found in patients classified as T1-T2 or N0 and chances of "false positives" are high.

Breast Neoplasms↗
PubMedDate not supplied

Diagnostic imaging of the thyroid: methodology and normal patterns.

The diagnostic imaging of the thyroid is based on sonography and scintigraphy, which to-date play a unique role in the morphofunctional study of the thyroid gland. The high spatial resolution of sonography allows an accurate evaluation of the thyroid morphology, size and parenchymal structure. Color Doppler sonography allows a qualitative assessment associated with quantitative parameters of glandular vascularization. Furthermore, sonography is the simplest procedure to achieve an accurate, reproducible measurement of thyroid volume. Scintigraphy provides information unavailable by other methods on the regional thyroid function. The most common tracer for thyroid scintigraphy is 99mTc pertechnetate. 123I and 131I are essential for radioiodine uptake test. CT and MRI, while invaluable for other organs and apparatus, play a limited role in the diagnosis of thyroid disease.

Diagnostic Imaging↗
PubMedDate not supplied

Diagnostic imaging in thyrotoxicosis.

In thyrotoxicosis, imaging mainly scintigraphy, color Doppler sonography and radioiodine uptake test are used in the differential diagnosis as well as in the morphofunctional evaluation of the thyroid before and after therapy (mainly pharmacological or with radioiodine). Radioiodine uptake test differentiates high uptake thyrotoxicosis (Graves'disease, toxic nodular goiter) and low uptake thyrotoxycosis (subacute or silent thyroiditis, ectopic thyrotoxicosis, iodine-induced hyperthyroidism). In Graves'disease scintigraphy shows thyroid enlargement with intense homogeneous tracer uptake; rarely nodules with no uptake are present. On color Doppler sonography, a part from enlargement, typical findings are: diffuse structural hypoechogenicity (at times with echoic nodules), parenchymal hypervascularization ("thyroid inferno"), high systolic velocities (PSV > 70-100 cm/sec) in inferior thyroid arteries. Scintigraphy is the only method able to evidence an autonomously functioning thyroid nodule and stage it (in association to clinical findings and TSH, FT3, FT4 determination) as: toxic, non toxic (or pretoxic) and compensated, depending on whether there is inhibition of extranodular tissue. A scintigraphically "hot" nodule appears hypervascularized on color Doppler sonography (especially in the toxic or pre-toxic phase) with high PSV (> 50-70 cm/sec) in the ipsilateral inferior thyroid artery. The most reliable parameters in the evaluation of the therapeutic efficacy are: decreases in thyroid (Graves'disease) or nodular (autonomously functioning nodule) volume; decreased radioiodine uptake (Graves'disease); functional recovery of suppressed parenchyma (autonomously functioning nodule); decreased PSV in the inferior thyroid arteries.

Diagnosis, Differential↗
PubMedDate not supplied

Radioiodine therapy in differentiated thyroid carcinoma.

Radioiodine therapy has been successfully applied for over 50 years in the management of differentiated thyroid carcinoma. Careful patient preparation and selection of the optimal dose of radioiodine to be administered are two factors of major importance in the course of management. Main indications for 131I therapy are the ablation of residual thyroid tissue after thyroidectomy, the treatment of locoregional recurrence and distant metastases which involve almost exclusively the lung and bones. A controversial aspect is that of patients with high serum TG levels but negative whole body 131I scintigraphy for whom there is no general agreement. Other controversial aspects involve ablation therapy as the selection of patients to be treated and the control of its efficacy. The cost and possible adverse side-effects of 131I therapy require a careful analysis of prognostic factors in each patient candidate for the treatment.

Carcinoma↗
PubMedDate not supplied

Role of nuclear medicine in the diagnosis and therapy of medullary thyroid carcinoma.

Medullary thyroid carcinoma (MTC) originates in the parafollicular cells (C cells) of the thyroid, secreting both calcitonin and CEA. Genetic and biochemical testing allow early pre-clinical identification of familial forms. Sporadic MTC usually presents as a solitary palpable thyroid nodule and in most cases the definitive diagnosis is established only at the time of surgery. Nuclear medicine procedures, which play a minor role in the preoperative evaluation of MTC, are essential in postoperative follow-up to detect residual and/or recurrent tumor. A number of radiopharmaceuticals are able to visualize MTC lesions with considerable advantages in diagnosis and prognosis, some of them having also a therapeutic role. Among them, 99mTc[V]DMSA shows the highest diagnostic sensitivity and is considered by many authors the radiopharmaceutical of choice in the postoperative work-up of MTC. Radioiodinated MIBG, in spite of its high specificity has a poor sensitivity (30%); however it is useful for the identification of pheochromocytoma and, in patients showing MIBG uptake in tumoral lesions, high activities of 131I-MIBG may be used for therapy. 111In labeled octreotide detects lesions which express somatostatin receptors; a positive scintigraphic result seems to give also prognostic information (higher uptake in slow-growing lesions) and provides the basis for treatment with octreotide or lanreotide and 111In or 90Y-labeled octreotide analogues. Interesting perspectives are offered by 18F-FDG PET and monoclonal anti-CEA labeled antibodies; the latter may be also used for therapy.

Carcinoma↗