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R Lencioni

Publications and source records attributed to R Lencioni.

At least 73 records · Page 4Linked to original sources
PubMed1993

Percutaneous injection of ethanol to treat autonomous thyroid nodules.

OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of sonographically guided percutaneous injection of ethanol for treating autonomous thyroid nodules in order to assess that technique's feasibility as an alternative to traditional ablative (radionuclide and surgical) therapies. SUBJECTS AND METHODS: Thirty-two patients with autonomous thyroid nodules were included in the study: seven had thyrotoxicosis, and 25 were in the pretoxic clinical phase. Ethanol was injected percutaneously on an outpatient basis once or twice a week for a total of three to 10 injections per nodule, mainly depending on the nodule's size. Scintigrams obtained 3 months after the end of treatment were used to assess response to this therapy. The follow-up period was from 3 to 30 months. RESULTS: Thyroid scintigraphy 3 months after percutaneous injection of ethanol showed complete recovery of function in extranodular tissue in 26 patients (81%), partial recovery in five patients (16%), and no recovery in one patient (3%). In all patients, the volume of the nodules decreased by more than 50% after treatment. In three of five patients in whom scintigraphy showed only partial recovery of function in extranodular tissue, a second percutaneous injection of ethanol was given after 15 months. The therapy was well tolerated, and after a total of 216 injections, no patient had permanent side effects. CONCLUSIONS: Our experience shows that percutaneous injection of ethanol is a practical alternative to traditional treatments for autonomous thyroid nodules and that it is an option for treating pretoxic adenoma.

Adult↗
PubMed1993

[Echography in neoplasms of the mesopharynx and the larynx].

Laryngeal and mesopharyngeal cancers are usually diagnosed by means of endoscopy which, however, fails to demonstrate tumor spread to adjacent structures. Aim of the present work is to assess the role of US in the evaluation of these lesions, relative to the demonstration of both the primary tumor with its local spread and metastases. This could help choose the correct therapeutic approach and select the patients ineligible for surgery to treat with chemo-/radiotherapy. Twenty-seven patients underwent US: 9 had mesopharyngeal and 5 supraglottic cancers, 11 had glottic and 2 subglottic lesions. With the only exception of subglottic cancers, US always demonstrated the primary tumor and its spread to anterior and posterior perilaryngeal structures. Moreover, node involvement could be studied. US proved uninformative in demonstrating the posterolateral laryngeal walls, the subglottic area, the presence of deep lymph nodes and the retrocartilaginous structures when associated with calcifications of the thyroid cartilage. In summary, we believe that US can be useful as the first-step imaging modality to stage laryngeal and mesopharyngeal cancers and to follow the patients submitted to chemo-/radiotherapy.

Aged↗
PubMed1993

[The Achilles tendon: echography at different frequencies. Comparative study].

The authors report their experience with a comparative US study employing different-frequency probes (7.5, 10, 13 and 15 MHz) in Achilles tendon conditions. The study population included 49 patients, 37 of them athletes. All patients complained of the same symptoms: achillodynia in the middle third (group A, 29/49 cases), achillodynia in the lower end (group B, 16/49 cases), suspected partial rupture in the middle third (group C, 2/49 cases) and suspected distal rupture in the upper third (group D, 2/49 cases). In group A, the different frequencies yielded different results. 7.5 MHz frequencies yielded negative results in 13/29 patients, versus 3/29 with higher frequencies, which demonstrated peritenon inflammation in 10/29 cases. In the remaining 16 cases, where 7.5 MHz frequencies had shown tendon inflammation and degeneration, the higher frequencies confirmed the findings, even though their accuracy was greater. On the contrary, in the cases of distal achillodynia where pain was mainly due to inflammation of the retrocalcaneal bursa, the different frequencies yielded similar results, even though the higher ones proved more accurate in revealing tendon abnormalities--i.e., thickening, focal hypolucencies, spotty microcalcifications, irregularity of the bone lining. In group B, the different frequencies once again exhibited similar results showing a focal hypoechoic discontinuity which was correctly diagnosed on the basis of clinical history. Finally, as for group C, the lower frequencies gave better results because of the deeper location of the region of interest. In both cases a small blood collection was visible, between gastrocnemius and soleus, in the absence of clear-cut tendon lesions. No matter what the condition, the higher frequencies were extremely valuable since they allowed excellent demonstration of tendon anatomy. The tendon is enveloped by the peritenon, made of two macroscopically distinct sheaths the distinction of which is allowed by higher frequencies when a minimal amount of fluid is present. From the peritenon, the intratendon septa originate circumscribing spaces containing tendon fiber bundles. The vessels, which run longitudinally, are located within the confluence of the septa. On US images, the septa appear as thin hypoechoic stripes or small hyperechoic spots depending on the type of scan (longitudinal/axial). As to tendon fibers--i.e., tenocytes, collagen and elastic fibers--their pattern is homogeneous and hypoechoic since devoid of interfaces.

Achilles Tendon↗
PubMed1992

[Percutaneous alcoholization of a small hepatocarcinoma].

Twenty-nine small hepatocellular carcinomas (sHCCs) less than 5 cm in diameter were treated with percutaneous ethanol injection (PEI) under US guidance in 24 cirrhotic patients. The nodules were treated on an outpatient basis with 6-18 ethanol injections; the total amount of alcohol delivered to each lesion was 10-103 ml. Twenty-seven of the 29 HCCs (93.1%) showed no evidence viable neoplastic tissue at a dynamic CT scan combined with multiple fine-needle biopsies performed one month after the end of treatment; in 10 cases MR confirmed the presence of necrosis showing marked hypointensity of the lesions in T2-weighted images. None of the 27 necrotized sHCCs recurred locally during a 4-44 months' follow-up period (mean 18 months). Two lesions larger than 4 cm showed incomplete response to treatment. No complications occurred after a total number of 264 alcohol injections. The 1-year survival rate in the 16 patients with a follow-up longer than 12 months was 93.7%. PEI proved to be a safe and effective treatment for sHCCs. In particular, PEI can be viewed as a reliable alternative to surgery in the management of nodules less than 3 cm in diameter, considering the operative hazards and the high risk of new lesions occurring in resected livers.

Administration, Cutaneous↗
PubMed1992

[The diagnostic imaging of complex breast nodules].

This study was aimed at determining the role of high-frequency (7.5 MHz) US combined with cytology in the diagnosis of complex breast nodules (complex cysts--cystic tumors). The study population included 60 patients presenting with complex breast nodules selected on the basis of US patterns among 3,000 cases. All patients were also submitted to US-guided fine-needle aspiration biopsy (FNAB). Cytology of nipple discharge was always performed when discharge was present (15 cases), mammography was performed in 50 cases and pneumocystography in 10. US allowed the identification of the lesion in all patients and the diagnosis of nature in 73%; with FNAB the figure reached 96.7%. Mammography identified the lesion in 95% of patients, but failed to reveal the complex nature of the nodule. In a small number of cases mammography proved to be a useful complementary tool demonstrating malignant features not recognizable on US images. On the contrary, pneumocystography yielded no further information with respect to US. Diagnostic control was obtained by means of surgery in 30 patients and of clinical-US follow-up in the extant 30 cases. On the basis of their US features the lesions were classified into two groups: I) nodules having a mainly liquid component--i.e., hemorrhagic, septic, multilocular cysts, papillary cystadenoma; II) nodules having a mainly solid component--i.e., solitary intraductal papilloma, intracystic carcinoma, mixed carcinoma, phylloid adenoma, sarcoma. As to the former group, US proved reliable in making a diagnosis in the cases with typical hemorrhagic, septic and multilocular cysts. In the atypical cases, FNAB of the solid component of the nodule was necessary to differentiate irregular clots, thick septa or inflammatory thickening from different conditions. As to the latter group, FNAB of the solid component and/or mammography proved useful in making a diagnosis, even though to this aim US revealed peculiar patterns which were highly suggestive. In our experience, combined US and FNAB are of basic importance in the diagnosis of breast lesions, thus replacing pneumocystography which has been widely employed so far. As regards mammography, its role seems limited to pointing out the peculiar characters of malignancy which could not be demonstrated otherwise.

Adult↗
PubMed1992

[Ultrasound-guided biopsy of small abdominal lesions. Methodology implications].

In the present study the diagnostic accuracy of US-guided fine-needle biopsy was evaluated in a series of 219 abdominal lesions < or = 3 cm in diameter (21 between 0.6 and 1 cm; 83 between 1.1 and 2 cm; 115 between 2.1 and 3 cm). One-hundred-eighty-three of them were located in the liver and 36 in other abdominal organs (pancreas, 10, adrenals 9, lymphnodes 9, kidney 5, spleen 3). Biopsies were performed with "free-hand" technique using up-to-date ultrasound equipment. The demonstration of the correct location of the needle tip at the time of sampling was looked for with great care. The sensitivity rate was 93%, with a progressive improvement with the increase of the lesion size (83.3% between 0.6 and 1 cm; 91.1% between 1.1 and 2 cm; 95.4% between 2.1 and 3 cm). The specificity rate was 100%. In 207 cases in which the location of the needle tip was clearly demonstrated, the sensitivity reached 97.3% and the negative predictive value 93%. No noteworthy complications were observed. Ultrasonography is a highly reliable guidance modality also in biopsies performed on small abdominal lesions; if the correct location of the needle tip is clearly shown, even a diagnosis of benignity can be confidently made.

Abdominal Neoplasms↗
PubMed1992

[The echographic aspects of prostatic carcinoma before and after radiation treatment].

The authors evaluated the US patterns of 50 prostatic carcinomas before and after radiation therapy, analyzing the correlation of US patterns with histologic (bioptic) findings and with treatment outcome. Before radiation therapy, 28 tumors were hypoechoic, 8 were isoechoic and 14 mixed. In 18 of 28 hypoechoic carcinomas, the lesion showed a progressive increase in echogenicity, becoming completely isoechoic 9-18 months after the end of treatment. In this group of patients the final response to treatment was complete in 17 cases and partial in 1; during the follow-up (24-90 months, mean 48 months) neither local recurrences nor distant metastases were observed. In 10 of 28 hypoechoic carcinomas, a hypoechoic area of variable size was still clearly recognizable within the lesion after a minimum period of 18 months since the end of treatment. Nine of these patients underwent histology and persistent carcinomas were found in 8 of them; one patient developed distant metastases. In the group of isoechoic and mixed carcinomas, no significant differences were observed in the US patterns relative to treatment outcome. Persistent prostatic carcinoma after radiation therapy seems not to affect its US pattern. If the tumor is hypoechoic before treatment, the persistence of a hypoechoic area within the lesion 18 months after the end of treatment must be regarded as a possible therapeutic failure and histologically verified. On the contrary, the evolution of the lesion toward isoechogenicity is usually related to a favorable outcome. If the tumor is isoechoic or mixed before treatment, a reliable US evaluation is not possible and the correct assessment of the response to treatment can only be made with multiple biopsies.

Adenocarcinoma↗
PubMed1992

[Atkinson prosthesis in esophageal carcinoma. Radiologic study: when CT?].

The endoscopic palliative treatment of esophageal and esophagocardial neoplastic stenoses is generally performed in the patients in whom surgery is not indicated for oncological and general reasons and endoscopic dilatation is uneffective. Our experience is reported concerning 92 patients submitted to palliative therapy through placement of Atkinson prostheses; the patients underwent radiologic studies--i.e. (a) plain chest radiographs (before and after intubation), (b) esophagogastric studies with iodate cm, and (c) CT (performed in the last 20 cases only). The mortality rate at 30 days was 6.5% (6 cases), in no case due to specific complications related to intubation. The mean survival was 3.6 months (range: 1-12). As to the complications specifically related to intubation, they were basically 3: perforation, dislocation, and obstruction (of the prosthesis). As to the methods allowing best demonstration of the same: a) CT proved to be superior in revealing perforation, which usually occurs early after intubation. However, considering its low incidence (2 cases only, in our series), the routinary use of CT does not seem justified. CT should be reserved to selected patients in whom the shape of the neoplasm or peculiar anatomical conditions make intubation difficult, with high risks of perforation--e.g., kiphoscoliosis, hiatal hernia, previous surgery or radiotherapy, angulation of the prosthesis, neoplasm of scirrhous or necrotic type or causing luminal deviation; b) if dislocation occurs, as it more often happens (9 cases in our series) in the presence of soft neoplastic tissue or in cases of mild or asymmetrical stenosis, CT seems likewise unnecessary. Conventional radiology proved superior thanks to its more comprehensive view, and therefore sufficient to suggest the correct treatment--e.g. repositioning of the prosthesis by means of fiberoscopy, or withdrawal after gastrostomy; c) CT appeared useless in the cases due to alimentary causes (easily detectable from the clinical history), but proved useful in the cases due to neoplastic overgrowth. In the latter, CT can yield information as to the site and size of the neoplasm, as well as to its relationship to surrounding tissues, and thus help suggest proper treatment--e.g. dilatation and repositioning of the prosthesis, gastrostomy, recanalization by means of NdYAG laser, no treatment at all.

Adult↗
PubMed1992

[Prostatic carcinoma: the importance of echographic monitoring of gland volume after radiotherapy].

Prostatic volume modifications were retrospectively analyzed by means of serial endorectal US in 50 patients affected with prostatic adenocarcinoma previously submitted to external radiotherapy. A progressive reduction in glandular volume (of low, medium, and high grade) was observed in 48/50 patients respectively within 3 months, between 3 and 6 months, and 6-9 months after treatment. After 9 months only lesser modifications were observed. A statistically significant correlation (p less than 0.05) was found between volume decrease percentage and histologic grading of the tumor, but not with its stage. Within the groups of patients affected with similar-grade neoplasms, a statistically significant difference (p less than 0.05) was observed, relative to the decrease rate of prostatic volume, between the patients with complete response and those with partial or no response. US monitoring of prostatic volume after radiotherapy, if correlated with histologic grading, can yield early predictive elements as to treatment outcome, thus contributing to select non-responsive patients to submit to biopsy and, if necessary, to therapeutic alternatives or combinations. Longer-term studies are needed to prove its effectiveness, to prognostic purposes, in the single patient.

Adenocarcinoma↗
PubMed1992

[Computerized tomography of the orbit in Graves' ophthalmopathy. New observations].

In order to evaluate Graves' ophthalmopathy new CT parameters have been introduced such as: the diameters of the five extraocular muscles, the value of their addition, the grade of apical crowding, the enlargement of optic nerve sheaths and of the superior ophthalmic vein, and the anterior displacement of the lacrimal gland. On this subject we report our further experience after reviewing 68 cases in which the new ocular parameters were correlated with altered ocular motility and optic neuropathy. The results confirmed our previous study, dealing with several groups of patients, which at the moment seem to be 2, instead of 3 groups: a) patients with increase in both muscular and fatty tissue (54/68 cases); b) patients with main or exclusive increase in fatty tissue (14/68 cases). Relevant clinical signs were present only in the first group of patients, where the medial, inferior and superior muscles were affected in 53/55, 53/55 and 50/55 cases respectively. A muscle increase by nearly 50% was more frequently found in cases with altered ocular motility, an increase by 90% was often associated with optic neuropathy. In case of optic neuropathy apical crowding was often observed, mainly in coronal scans, together with significant enlargement of the optic nerve sheath and of the superior ophthalmic vein. As to proptosis, preseptal area and anterior displacement of the lacrimal gland, they demonstrated lower correlation with the reference symptoms, even though their occurrence was high in symptomatic patients.

Graves Disease↗
PubMed1991

[Solitary intraductal papilloma of the breast. An echographic study of 12 cases].

Solitary intraductal papillomas (SIP) of the breast are relatively common lesions (incidence: 2-3%) originating from proximal ducts or from retroareolar lactiferous ducts. This work was aimed at evaluating the diagnostic reliability of US in the diagnosis of this condition and at discussing the differential diagnosis with similar focal lesions. Twelve cases of SIP were diagnosed with US among 31 selected female patients (aged 16-35 years) who had been referred for serohematic discharging breast and/or palpable nodules. All cases had surgical confirmation. US patterns typical of SIP were: 1) solid hypoechoic nodules with peripheral anechoic areas (7 cases); 2) small papillary excrescences within a cystic cavity, corresponding to papillary cystadenocarcinoma (4 cases); 3) periareolar overdistended ducts filled with dense material (1 case). Surgery was performed directly in 8 patients with positive cytology while mammography, ductography and fine-needle biopsy were performed in the extant 4 patients with negative or questionable cytologic findings. US combined with cytologic samples allowed the correct diagnosis to be made in 8 of 12 cases (66%): this is noteworthy when considering the low reliability of mammography in young patients and the poor tolerance to ductography in general. US allows the differential diagnosis with other focal lesions and subsequently helps shorten the diagnostic route.

Adolescent↗
PubMed1991

[The significance of echographic signs in pathology of the rotator cuff].

Fifty-two patients, 17 acute and 35 chronic, underwent US of the shoulder. The first class of patients had clinical history of blunt trauma occurred 2 to 30 days before examination. The second class of patients included 15 patients with history of trauma occurred 3 months (or more) before examination and 20 patients affected with impingement syndrome. As to the US signs of rotator cuff tear reported in the literature, the results of the study, supported by arthrographic (21 cases), MR (2 cases) and surgical (24 cases) findings, indicate that their presence and significance differ in the acute and in the chronic patient and that: 1) Focal discontinuity, appearing as a hypoechoic area, is demonstrable only in the acute patient. The sign is due to a tear filled with blood and/or bursal liquid and holds high diagnostic accuracy. It is rare that an acute lesion appears as a hyperechoic linear density--which has doubtful diagnostic accuracy. 2) Non-visualization of the cuff is observable in both the acute and the chronic patient and indicates rupture in both of them. This sign has high diagnostic accuracy. 3) Thinning of the cuff is also observable both in the acute and in the chronic patient. Nevertheless, while in the former the sign can be regarded with confidence as indicating a tear in almost all cases, in the latter it may be due either to a tear or to degeneration. Arthrography or MR Imaging are therefore advisable in this group of patients, especially if surgical treatment is considered.

Arthrography↗
PubMed1991

[The echo-guided percutaneous injection of ethanol: a therapeutic alternative in the "autonomous thyroid nodule". Our experience].

The authors report their experience on the therapeutic value, in terms of efficacy and tolerance, of percutaneous ethanol injection (PEI) in the treatment of autonomous thyroid nodules (ATN). A group of 15 patients, 13 in clinical pretoxicity and 2 in initial thyrotoxicosis, were submitted to fine-needle ethanol injection (95%) performed under US guidance. The amount of injected alcohol was measured on the basis of the volume and diffusion of alcohol itself within the nodule, in the whole of 79 injections given. Follow-up lasted 3-15 months. Thyroid scanning demonstrated a complete or partial recovery of extranodular parenchymal function in 80% and 20% of cases, respectively. In all cases a volume reduction greater than 50% was obtained, with an initial sharp fall, already after the first month, thanks to early alcohol cytotoxicity. In the 2 patients with toxic ATN serum, normal values of free hormones have been observed ever since the third weekly injection. Good tolerance to treatment was observed, and no permanent complications. In agreement with other authors, we believe our experience to show that PEI represents a new therapeutic approach in patients with ATN. PEI will certainly play a preferential role, relative to other conventional therapies, in the management of clinical pretoxic ATN, regarding which no uniform treatment protocol exists yet.

Administration, Cutaneous↗
PubMed1984

The aetiology of acute hepatitis in Zimbabwe.

The cause of acute viral hepatitis in 141 patients admitted to both Infectious Diseases Hospitals in Harare (Zimbabwe) was hepatitis A in 44, hepatitis B in 86 and hepatitis Non-A Non-B in 11. The wide distribution of hepatitis A and B viruses and early exposure to both in Zimbabwe are shown by the high positivity rate for anti-HAV antibody in patients under 10 years old (87.5%) and for anti-HBs antibody in patients over 20 (60%). Among the 86 hepatitis B cases, e and delta systems were also investigated: 66 patients (76.5%) were HBeAg positive, six (7%) anti-HBe positive and 14 (16.5%) negative for both; only one was anti-delta positive. Two cases of fulminant liver failure (both occurring in HBsAg and anti-HBc IgM positive, but delta-markers negative patients) and five cases of hepatoma (only one of whom was negative for all HBV markers) are described.

Acute Disease↗
PubMedDate not supplied

Transcatheter arterial embolization followed by percutaneous ethanol injection in the treatment of hepatocellular carcinoma.

PURPOSE: The aim of this study was to evaluate the effectiveness of transcatheter arterial embolization (TAE) followed by percutaneous ethanol injection (PEI) in the treatment of large hepatocellular carcinoma (HCC) lesions. METHODS: Fifteen patients with HCC were treated by means of TAE followed by 6-16 ethanol injections. In 10 patients, the HCC was solitary (3-8 cm); 3 patients had 1, and 2 patients had 2 daughter nodules (3 cm or smaller) in addition. In 12 of 15 main tumors and in 4 of 7 daughter nodules, a tumor capsule was observed by computed tomography or magnetic resonance imaging. RESULTS: Combined treatment with TAE and PEI resulted in complete necrosis of 12 of 15 main tumors and 7 of 7 daughter nodules on biopsy. Treatment failure (incomplete necrosis) occurred in 3 unencapsulated main tumors. The 1-year survival rate in 10 patients was 100%. CONCLUSION: The combination of TAE and PEI proved to be an effective treatment for large HCC, including those with 1-2 small daughter nodules. The presence of a tumor capsule significantly correlates (p < 0.05) with a favorable outcome of treatment.

Aged↗
PubMedDate not supplied

Percutaneous biopsy of liver tumors with color Doppler US guidance.

BACKGROUND: Percutaneous liver biopsy is a well-established procedure. Aim of this study was to investigate the usefulness of color Doppler ultrasound (US) for guiding percutaneous biopsy of liver tumors in patients at high risk of bleeding. METHODS: Forty-seven patients with severe, uncorrectable coagulopathy (platelet count < 50 x 10(9)/L and/or prothrombin time ratio [normal/patient] < 50%) were submitted to percutaneous biopsy of focal liver lesions using a 21 G cutting needle. The procedure was guided by color Doppler US, avoiding the needle cross into any liver or tumor vessel. RESULTS: Biopsy material was adequate for pathological reading in 46/47 cases (97.9%). No major post-biopsy complication was observed. In particular, no case of hemoperitoneum was detected on US examinations performed 2 hours after biopsy. Minor complications (including one subcapsular hematoma) occurred in 4 patients (8.5%). CONCLUSIONS: Color Doppler US can safely guide percutaneous liver biopsy in patients at high-risk of bleeding.

Adult↗