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P Marano

Publications and source records attributed to P Marano.

At least 55 records · Page 3Linked to original sources
PubMed1995

Intraluminal brachytherapy in the treatment of pancreas and bile duct carcinoma.

PURPOSE: A new method of palliation of malignant obstructive jaundice is presented. METHODS AND MATERIALS: Twelve patients with carcinoma of the extrahepatic bile ducts (EHBD-five patients) or pancreatic head (PH-seven patients) received radiation therapy between 1988 and 1991. Percutaneous transhepatic biliary drainage was performed in four EHBD patients and an endoprosthesis was placed during endoscopic retrograde cholangiopancreatography (ERCP) in the other eight patients. All 12 received intraluminal brachytherapy (ILBT): 20-50 Gy calculated at 1 cm from the Iridium-192 (192Ir) wire. In four PH patients the source was placed in the duct of Wirsung; in the other eight patients ILBT was performed via the common bile duct. Five of the seven PH patients and one of the five EHBD patients received External Beam Radiation Therapy (EBRT): 26-50 Gy, alone or with concomitant 5-Fluorouracil (5-FU). RESULTS: Cholangitis occurred in six patients. Three PH patients treated with EBRT+ILBT developed gastrointestinal toxicities. With a minimum follow-up of 18 months, median survival times were 14 months (EHBD) and 11.5 months (PH); one of the seven PH patients is alive (29 months) and two of the EHBD patients are alive (18 and 43 months). All patients had satisfactory control of jaundice. CONCLUSIONS: The results in the EHBD patients suggest that the addition of ILBT after biliary drainage prolongs survival. Further experience is necessary to determine whether ILBT in the common bile duct and/or in the duct of Wirsung may be, in PH patients, an alternative boost technique to Interstitial Brachy-therapy (IBT) or Intraoperative Electron Beam Radiation Therapy (IOEBRT).

Aged↗
PubMed1995

[The ethical and deontological aspects of quality inspection and control (QC) in imaging diagnosis. A problem too of professional training].

The major changes undergone by the health service structure in Italy have urged an organic and logical reconsideration of the relationship between health service resources and health needs, between competences and new patterns of organization. The primary units of the health service (USL), as actual enterprises, should undergo the control and rating of productivity and quality in the rational and fruitful use of available resources. The application of quality controls in health care (HCQC) to diagnostic imaging should be aimed at assessing of the performance of: the single procedures; the radiologist; the general practitioner or the non-radiologist specialist. These are obviously many indicators but the health care quality assessed by studying the structure of the process and of the result should not miss out: the sensitivity, specificity and diagnostic accuracy of the single imaging techniques; the ROC curves to assess the radiologist's performance; the predictive value, with known sensitivity and specificity, of the procedures, for the professional reliability of the non-radiologist physician. At present, QC indicators in diagnostic imaging cannot rule out the problem of a "radiologic training" of the non-radiologist physician to be able to correctly select the patients to be referred to diagnostic imaging. On the other hand, the radiologist should receive a "clinical training" for the rational use of the available techniques to address the clinical issues raised by the colleague, keeping in mind the cost-benefit factor. The "professional training" experience of the Istituto di Radiologia of the Universitá Cattolica del Sacro Cuore is reported. The instruction of the undergraduate students from the training course of specialization follows two patterns of "objectives" and "problems". The trainee directly participates in a structure and productivity project playing a major role in the transition from the technological, organizing and functional approach to the clinical management of the patients. These changes cannot be separated from their ethical and deontological implications. The ethical issue begins at the patient's bedside and does not end with technical quality and feasibility, and with the economical opportunity in taking a precise legal and deontological responsibility.

Diagnostic Imaging↗
PubMed1995

[The tissue characterization of focal liver lesions with magnetic resonance imaging].

This study was aimed at assessing the accuracy of Magnetic Resonance Imaging (MRI) in the characterization of focal liver masses. We prospectively examined 51 patients with focal liver masses: the morphological features were investigated with different pulse sequences and the functional characteristics were studied after the i.v. administration of Gd-DTPA (2 mmol/kg). MR findings were compared with those of gold standard methods, i.e., percutaneous biopsy, surgery or, for hemangiomas, 99mTc-labelled blood cell liver scintigraphy. All hemangiomas presented with typical features: signal intensity was very high on long TE images (> 140 msec) and a globular enhancement pattern, with centripetal progression, was observed after dynamic studies. This signal pattern on T2-weighted images is highly indicative of hemangioma. Five of 7 focal nodular hyperplasias (71%) were isointense with hepatic parenchyma on all pulse sequences; the central scar was observed in 5/7 cases on short TR/TE images and in all cases on long TR/TE images in 16/17 cases (94%). High signal intensity on T1-weighted images was statistically significant for HCC. A pseudocapsule was observed in 12 cases (70%). A mosaic pattern on T2-weighted images was observed in 3 cases. Seventy-four per cent of HCCs exhibited signal enhancement during the arterial phase of the dynamic study. Metastases presented a uniform pattern, i.e., they were hypointense on T1-weighted and hyperintense on T2-weighted images in 12/13 cases (92%). A central hypointense area on T2-weighted images is indicative of coagulative necrosis. A lesion with these morphological features and hypovascular signal is suggestive of metastasis.

Biopsy, Needle↗
PubMed1995

[The tissue characterization of focal liver lesions by color Doppler echography].

To investigate color-Doppler capabilities in tissue characterization, 47 hepatic lesions were studied. The real-time morphologic appearance of the lesions was studied first and then color flow images were acquired, assessing color areas and the distribution of blood flow for each lesion. For quantitative Doppler study, the color Doppler signal was used as a guide to obtain the Doppler spectrum and to measure flow velocities and pulsatility index (PI) values. Data were plotted and analyzed statistically; criteria for differentiating malignant from benign hepatic tumors and the patterns suggestive of either condition were proposed. Absolutely no Doppler signal was observed in avascular or necrotic lesions and in low-flow tumors, e.g., metastases (10%) and hemangiomas (63%). Many color signals at the periphery and within tumor masses were observed in highly vascular lesions, e.g., hepatocellular carcinomas (60%) and focal nodular hyperplasia (80%). Multiple afferent vessels and a "basket-like" pattern were detected in a high percentage of hepatocellular carcinomas. High-flow velocities (> 0.85 m/s perilesional systolic velocity and > 0.80 m/s intralesional systolic velocity) and high PI values (> 1.5 perilesional PI and > 0.90 intralesional PI) are suggestive of malignancy. Particularly, 0.90 intralesional PI cutoff value exhibits 89% specificity and 82% sensitivity in benign versus malignant differential diagnosis. Our results suggest that color-Doppler US is a useful means of studying the hemodynamics of hepatic tumors which increases US diagnostic accuracy.

Diagnosis, Differential↗
PubMed1995

[Color Doppler echography in the tissue characterization of renal masses].

To investigate color-Doppler US capabilities in tissue characterization, 42 renal masses were studied from November, 1993, to July, 1994. B-mode morphologic patterns were studied first and then integrated with color flow patterns; color areas and blood flow distribution were assessed for each lesion. Color signals were used as a guide to obtain arterial and venous Doppler spectra and to calculate flow velocities and pulsatility index (PI). Based on the us morphologic appearance, the 42 lesions were divided into 3 groups: A) lesions with morphologic and volumetric patterns of malignancy; B) small lesions (< 3 cm, > 3 cm < 5 cm); C) complex cysts. Data were organized and analyzed statistically; some findings were found to be typical of malignancy: hypervascularity, intralesional arterial signals with high flow velocities (systolic peak cut-off: 0.3-0.4 m/sec), high PI values (> 1) and, finally, color signals inside complex cysts. Our results suggest that color-Doppler US is a useful tool to assess renal masses vascularity, with the color-Doppler technique increasing US diagnostic accuracy. Nevertheless, small lesions need more careful study because their features are poorly demonstrated even with CT and MRI.

Adenocarcinoma↗
PubMed1995

[Magnetic resonance and computerized tomography of posterior cranial fossa tumors in childhood. Differential diagnosis and assessment of lesion extent].

In the last thirty years much progress has been made in the treatment of brain tumors in children, thanks to modern diagnostic imaging techniques, together with neurosurgery and radiotherapy, for the diagnosis and follow-up of these lesions. MRI and paramagnetic contrast agents have revolutionized the imaging of intracranial conditions, especially in the posterior cranial fossa. The superiority of MRI over CT is well known and reported in the literature, but the adequacy of the two methods has rarely been compared. Therefore, this study was aimed at assessing and quantitating the accuracy of MRI and CT relative to two essential parameters: preoperative "histologic" diagnosis and local and distant intracranial tumor extent. In 52 selected patients the final histologic diagnosis was cerebellar medulloblastoma in 20 cases, cerebellar astrocytoma in 12 cases, brain stem glioma in 12 cases and ependymoma in 8 cases. CT allowed the correct diagnosis to be made in 25 patients (48%), with questionable findings in 21 patients (40%) and 6 misdiagnoses (12%). MRI allowed the correct diagnosis to be made in 43 patients (83%), with questionable findings in 9 patients (17%) and no misdiagnoses. MRI depicted local and distant tumor spread in 34 patients while CT showed it in 22 patients only. The analysis of the results confirmed the superiority of MRI over CT, relative to the parameters considered, i.e. histology and the assessment of tumor spread. In the clinical suspicion of brain tumors of the posterior cranial fossa in children, MRI--if available--should be the examination of choice if the patient's clinical status does not prevent its use. CT should be used only in emergency cases (acute intracranial hypertension) to identify hydrocephalus and intratumoral hemorrhages. Unenhanced CT also yields useful pieces of information for lesion "histology" and may be used to integrate MR findings in selected cases.

Adolescent↗
PubMed1995

[Congenital anomalies of the inferior vena cava: role of imaging].

In recent years, clinics and radiology of congenital anomalies of the inferior vena cava have increased in importance in planning abdominal surgery, liver or kidney transplantation, or new interventional or diagnostic procedures such as the positioning of inferior vena cava filters to prevent pulmonary embolism, varicocel sclerotherapy and renal venous sampling. In the past, the radiologic assessment of these rare anomalies was performed only with angiography, which remains the most accurate diagnostic method. Today, besides angiography, less invasive examinations can be performed, e.g., US, CT and MRI, with MRA. In the last two years, 5 patients with inferior vena cava anomalies were examined: 3 had double inferior vena cava and 2 azygos continuation. All of them were submitted to US, CT, MRI and MRA and 3 patients underwent also angiography, two of them with double puncture. US can suggest the diagnosis but may be limited by technical factors and in the assessment of the whole inferior vena cava. Enhanced CT can depict anomaly extent, but uses contrast agents and ionizing radiations. Angiography better depicts craniocaudal spread and collateral networks but is an invasive procedure and sometimes needs a double puncture (double inferior vena cava). MRI, with MRA, yields the same information as the other modalities, but without contrast agents or ionizing radiations. The development of velocity encoded sequences will probably make this technique the method of choice in the study of inferior vena cava anomalies. Our study was aimed at reviewing the embryo-genesis of inferior vena cava anomalies and to assess the relative importance of different diagnostic procedures in the diagnosis and staging of these anomalies.

Aged↗
PubMed1994

Iomeprol versus iopamidol in contrast-enhanced computed tomography of thoracic and abdominal organs.

The aim of this double-blind, parallel-group study was to compare the safety, tolerance, and efficacy of iomeprol-350 (350 mgI/ml), iomeprol-400 (400 mgI/ml) and iopamidol-370 (370 mgI/ml) for use in contrast-enhanced body computed tomography (CT). Following written informed consent, 120 adult inpatients of either sex requiring CT of thoracic or abdominal organs were randomly assigned to receive iomeprol-350, iomeprol-400 or iopamidol-370. Pre- and post-contrast, all patients underwent clinical, instrumental and laboratory investigation to assess the safety of the test agents. Tolerance was assessed in terms of discomfort associated with contrast injection. Two experienced radiologists independently and blindly graded the quality of contrast enhancement obtained with the different contrast solutions by means of a five-point ordinal scale as follows: 1, insufficient; 2, sufficient; 3, good; 4, excellent; or E, excessive. Patients in the iomeprol groups needed fewer injections and a smaller volume of contrast medium to obtain examinations of adequate diagnostic quality. Contrast enhancement was judged as excellent or good in about 90% of the study examinations, without significant differences between the three study groups. During contrast injection, heat and pain sensations were minimal or absent in most cases. No serious adverse events occurred throughout the study. No significant changes in clinical, instrumental or laboratory safety parameters were observed. In conclusion, iomeprol-400 and iomeprol-350 appear to be contrast solutions at least as safe, well tolerated and effective as iopamidol-370 when used as contrast agents for body CT.

Adult↗
PubMed1994

Color Doppler ultrasonography in the differential diagnosis of focal hepatic lesions. The SH U 508 A (Levovist) experience.

The differential diagnosis of focal hepatic lesions is a current problem even though many study methods are available. Color Doppler US has been recently suggested as a diagnostic technique capable of depicting lesion vascularization patterns to better understand lesion nature. However, this examination is often difficult and long. In this study, we investigated the role of a US contrast agent SH U 508 A (Levovist) enhancing the color Doppler signals for easier and better depiction of lesion vascularization. Seventy-four patients with one or more focal hepatic lesions (mean diameter: 5.6 cm) were examined. The lesions were 38 HCCs, 4 cholangiocarcinomas, 1 intrahepatic biliary duct carcinoma, 1 case of multiple adenomas, 2 regenerations nodules in cirrhosis, 2 cases of FNH, 18 metastases and 8 hemangiomas. In 54 cases the US contrast agent allowed the visualization of some vessels inside the lesions which had been missed at baseline examinations. Moreover, the vessels which had been depicted on baseline images were better demonstrated. In all but one patient with severe hepatic steatosis, normal parenchymal vessels were markedly enhanced. Our results in the different kinds of tumors are here reported.

Color↗
PubMed1993

[Experience with the combined diagnosis and therapy of locally advanced carcinoma of the uterine cervix (stage FIGO IIB-III). Transrectal ultrasonography and CT in the staging and in follow-up after therapy. Preliminary results].

The diagnosis, staging, therapy and follow-up of advanced epidermoid cervical carcinoma (FIGO stages IIB-III) have been studied in our university since January 1990. By December 1992, a team of specialists including radiologists, radiotherapists, gynecologists and pathologists divided 54 patients into two random treatment groups: group A patients, after systemic chemotherapy (CDP, 2 cycles) and diagnostic reevaluation, underwent radical surgery; group B patients received conventional radiotherapy alone (ERT 45 Gy+IRT or END-RT 20-25 Gy). All patients were examined by means of transrectal US (TRUS) and CT, after clinical examination under sedation, at staging and during the follow-up. The exams were performed periodically for group B patients and after systemic chemotherapy for group A patients. Imaging findings were compared with pathology only in group A. All imaging results were filed. The results confirm some literature data--e.g., 62% diagnostic accuracy for CT and 69% for TRUS, with higher diagnostic accuracy of the latter to evaluate cervical volume and to diagnose local relapses. As for parametrial involvement, both imaging methods tend to understage the early involvement, but only CT tends to overstage the lesions, especially in irradiated patients, due to fibrosclerosis phenomena. TRUS exhibited 69% accuracy, 70% sensitivity and 69% specificity, versus 61%, 62% and 60%, respectively, for CT; clinical examination under sedation had 58%, 60% and 60%, respectively. Both TRUS and CT are faster than endoscopic methods in evaluating vesical and/or rectal involvement. Lymph node metastases at staging, especially those in lumboaortic locations, proved to be unfavorable prognostic signs, as demonstrated by lumboaortic lymph node relapses in 5 group B patients (only 2 of them presented with lymph node metastases at staging; 3 patients had micronodules near the renal vessels), in spite of good local response after radiotherapy. In conclusion, we would like to point out that our team has had an MR unit at its disposal only recently: since the method is considered as the gold standard of imaging, especially in this kind of lesions, the study is still in progress.

Female↗
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↗
PubMed1993

[Diagnostic and therapeutic integration in ductal carcinoma of the head of the pancreas. Preliminary note].

The diagnosis and treatment of pancreatic ductal carcinoma are managed, in our hospital, by a team of radiologist, surgeons, radiotherapists and pathologists. In periodic meetings they discuss the clinical cases before and after clinico-radiologic staging. Patients are entered one of three different treatment routes, based on their general status, on disease stage, tumor size and its arrangement around common bile duct and main pancreatic duct. Thirty-eight patients were studied: 23 of them, considered as resectable on the basis of imaging (CT, US) findings, were submitted to radical surgery and intraoperative radiotherapy (route I); of 11 unresectable cases, 8 had a bilio-digestive bypass and interstitial brachitherapy with 125I seeds (tumor size < 3 cm). Eleven patients unresectable by imaging and 1 by surgery followed treatment route II, characterized by radio-chemotherapy followed by intraluminal radiotherapy with 192Ir wires, relative to residual tumor size and to lesion arrangement around access ways. Four patients with metastases and "adequate" tumor size entered treatment route III-i.e., merely palliative luminal radiotherapy. This preliminary note stresses the importance of polyspecialistic team work in the diagnosis and treatment of pancreatic ductal carcinomas.

Carcinoma, Intraductal, Noninfiltrating↗
PubMed1992

Epidemiological survey of multiple sclerosis in Catania city.

The findings of an epidemiological survey of multiple sclerosis (MS) in the urban area of Catania reveal a new and in some respects original pattern of MS cases recorded on 31 December 1989 (prevalence day). They explain why special attention should be paid to patients residing in that area, which shows a remarkable upward trend of the MS prevalence rates calling for further study and for more targeted intervention in the fields of prevention, treatment and rehabilitation.

Adolescent↗
PubMed1992

[The experience of diagnostic and therapeutic integration in rectal cancer. Preliminary notes].

In our University, many different radiosurgical options are available to treat rectal carcinoma. Selecting the patients to submit to treatment requires accurate clinical and radiological staging. A team of radiologists, radiotherapists, surgeons, endoscopists and pathologists has been created to stage the patients and to follow the final results. The team have decided the diagnostic and therapeutic protocols. The patients with rectal cancer undergo radiotherapy after staging and are subsequently restaged. If indicated, surgery is performed and histology is compared with restaging, to assess the accuracy of the diagnostic procedures. All diagnostic and therapeutic decisions are made collectively by the team, during scheduled meetings. All data are stored in a computer program. This paper deals with the working method we used, its advantages and the outcome of the first 23 studied patients. Restaging was compared with histology: transrectal US (performed in 8 patients) showed 100% accuracy in evaluating local tumor spread (T). CT had 91% accuracy in defining T and 60% accuracy in N, with a tendency to overstaging. In 78% of patients > 50% reduction of tumor size was observed and the distance from the anal canal increased in 95.5%. This study will provide the overall accuracy of the clinico-radiologic staging, the survival rates and the indication of prognostic signs.

Aged↗