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Biomedical subjects

R Romagnoli

Publications and source records attributed to R Romagnoli.

At least 163 records · Page 9Linked to original sources
PubMedDate not supplied

Gadolinium-enhanced MRI with dynamic evaluation in diagnosing the local recurrence of rectal cancer.

BACKGROUND: At early stages, the diagnosis of local recurrence of rectal cancer is often difficult and magnetic resonance imaging (MRI) is currently considered the most accurate method for diagnosing recurrence. We evaluated the role of unhenhanced and gadolinium-enhanced MRI for the diagnosis of local recurrence of rectal cancer. METHODS: Thirty-six patients, suspected of having a pelvic recurrence of rectal cancer, were evaluated by a high field strength MRI unit. Unenhanced spin-echo T1- and T2-weighted sequences and gadolinium-enhanced dynamic fast multiplanar spoiled gradient recalled sequences were performed in all patients. The dynamic images were re-elaborated with semiquantitative postprocessing by plotting intensity-time curves and calculating the percentage of signal increase at the end of the first postcontrast dynamic sequence. The pelvic lesions were classified as recurrent or not recurrent by applying the following diagnostic criteria: (a) morphology and signal intensity of the lesion in unenhanced sequences and (b) percentage of enhancement in dynamic enhanced sequences. Diagnosis was confirmed by computed tomography-guided needle biopsy (12 patients), surgery (four patients), clinical and imaging follow-up (20 patients). RESULTS: The diagnosis was local recurrence in 15 patients and noncancerous lesions in 21 patients. Unenhanced MRI had 80% sensitivity and 86% specificity. Analysis of the percentage of enhancement showed 87% sensitivity and 100% specificity. CONCLUSION: In agreement with the literature, our results showed a high sensitivity and specificity for dynamic MRI. This technique thus can be considered an important adjunct to unenhanced MRI, especially in selected cases in which unenhanced MRI cannot rule out local recurrences. However, these results must be validated by further investigations.

Adult↗
PubMedDate not supplied

Radiologic imaging of the transplanted bowel.

BACKGROUND: The radiologic evaluation of the transplanted bowel is largely unknown and rather complex because it involves several techniques that depend on indications and times that have not been fully defined. METHODS: From December 2000 to November 2002 in the Section of Radiology I of the University of Modena and Reggio Emilia (Modena, Italy), 11 patients with transplanted bowel were studied with different methods: traditional radiologic evaluation with contrast agent (all patients), evaluation of transit time with radiopaque markers (five patients), ultrasonographic (US) evaluation of the intestinal wall and Doppler US of the vascular axes (five patients), computed tomographic (CT) evaluation (all patients), and magnetic resonance (MR) evaluation of the bowel and the vascular axes (five patients). Traditional contrast examination enabled evaluation of the gastroesophageal transit and cardia functionality; anatomy and integrity of the anastomoses (proximal and distal); time of gastric emptying; morphology, tone, and kinesis of the transplanted small bowel loops and time of global transit. The study of transit with radiopaque markers was carried out in five patients to define the time of transit through the entire transplanted bowel, confirm recovery of intestinal motility, and identify possible abnormalities. The US examination was carried out in five patients to evaluate the morphology, thickness, and echo structural features of the intestinal loops. Color Doppler was performed to visualize the superior mesenteric artery and a wall arteriole of the sampled loop. CT examination was performed 2 to 4 weeks after surgery to evaluate the anatomy of the transplanted organs, arterial and venous anastomoses in case of complications identified with other methods or suspected, and periodically in the follow-up of patients who underwent transplantation due to Gardner syndrome. The protocol for MR evaluation of the bowel included coronal single-shot fast spin-echo T2-weighted sequences, axial and/or sagittal single-shot fast spin-echo T2-weighted sequences, coronal fast multiplanar spoiled gradient-echo (FMP- SPGR) sequences, coronal FMPSPGR sequences with and without administration of intravenous paramagnetic contrast agent, and axial or sagittal FMPSPGR fat-saturated sequences performed after dynamic gadolinium administration. RESULTS AND CONCLUSION: The study of transit with radiopaque markers was useful in patients with chronic intestinal pseudo-obstruction because it identified recovery and normalization of motility. Traditional contrast examination of the gastrointestinal tract continues to play an important role in transplanted patients because it is a simple examination that allows evaluation of the graft anatomy and recovery of motility of the residual native bowel and the transplanted loops. Moreover, it plays a crucial role in early detection of major postoperative complications such as intestinal obstruction, perforation, fistulas, and anastomotic complications (stenosis and dehiscence). CT examination is crucial for the detection of fluid collections, abscesses, and fistulas because it can serve as a guide of drainage and during follow-up of patients with Gardner syndrome can be used to investigate all possible sites in which desmoids might arise in addition to their relation to the graft. Because patients with transplanted bowel are generally rather a young population of reproductive age and because of technologic advances, MR may represent an effective method that does not use ionizing radiation and can therefore substitute for traditional radiologic evaluation. US represents a quick examination technique that is easily available and well tolerated by patients, and it has a role to play in the follow-up of transplanted patients and in the identification of major postoperative complications. However, its role in monitoring possible rejection remains to be defined with studies on wider and more representative samples.

Adolescent↗
PubMedDate not supplied

DNA minor-groove binders: results and design of new antitumor agents.

DNA minor-groove binding drugs have been extensively studied in the last years in order to influence the regulation of gene expression in neoplastic disorders by means of specific interactions with DNA bases. Pyrrolo[2,1-c][1,4]benzodiazepines (PBDs), CC-1065 and distamycins are three classes of minor-groove alkylating agents which showed interesting cytotoxicity profiles, but they cannot be used in humans for various toxicity problems. For this reason many groups applied heterocyclic substitutions extensively, in order to either modify the reactivity profile or introduce extra interactions within the minor groove, thus changing the binding site or modulating the binding sequence.

Animals↗
PubMedDate not supplied

Evidence of H beta 58, a gene involved in mammalian placental development, in the three-toed skink, Chalcides chalcides (Squamata: Scincidae), a viviparous placentotrophic reptile.

The H beta 58 gene, whose disruption in mice causes reabsorption of the embryo at 9.5 days post-conception, is believed to be essential for development of the placenta. Although the H beta 58 gene is well conserved in some Amniota, nothing is known about its presence in reptiles, some species of which have developed a chorioallantoic placenta. In this work, we investigated the expression of H beta 58 mRNA and protein in the three-toed skink, Chalcides chalcides. H beta 58 protein expression was found in the uterine epithelium beginning from the peri-ovulatory stage. However, it increased strongly at the moment of placental formation, when a high level of expression of mRNA and protein was also observed in the extra-embryonic membranes. The expression of H beta 58 mRNA and protein was maintained, although to a lesser degree, in the placenta during late pregnancy. It was also present in the early embryo. Finally, cloning and sequencing of a gene fragment revealed strong homology of the reptile gene with that of mammals. The high degree of conservation of the gene in amniote vertebrates and its presence in a viviparous squamate reptile (as in mammals) indicates an important role of this gene in the chorioallantoic placenta formation and development.

Allantois↗
PubMedDate not supplied

Liposomes containing distamycins: preparation, characterization and antiproliferative activity.

This article describes the production and characterization of two liposome formulations containing antitumor drugs, namely distamycin A (Dist) and a new alkyl derivative of distamycin A (C16-Dist). Egg-PC/cholesterol liposomes (4:1 mol/mol) were prepared by reverse phase evaporation technique followed by extrusion through polycarbonate filters. The encapsulation efficiency was found to be almost complete for C16-Dist (99.8%), while native distamycin A showed a lower yield (19.0%). The in vitro antiproliferative activity of the distamycins-containing liposomes determined on human leukaemic K562 cells, was 11-fold and 8-fold higher for native and alkyl derivative distamycin A, respectively, compared with that of the corresponding free drugs. Liposomal formulations show an increase in the activity and specificity of distamycins in experimental antitumor therapy.

Cell Division↗
PubMedDate not supplied

MR evaluation of triangular fibrocartilage complex tears in the wrist: comparison with arthrography and arthroscopy.

To evaluate the accuracy of magnetic resonance (MR) in the detection of tears of the triangular fibrocartilage complex (TFCC), 10 consecutive patients with posttraumatic chronic wrist pain were examined with MR, arthrography, and arthroscopy and the results were compared. The MR images of 16 control subjects were also examined to define the MR appearance of the normal TFCC. When compared with arthroscopic findings, both MR and arthrography had two false-negative results (sensitivity, 80%) and no false-positive results. Regarding the sites of the TFCC tears, the findings on MR did not always correlate with the findings on arthrography. In no case was MR able to visualize the cartilaginous lesions visible by arthroscopy. These preliminary results illustrate the ability of MR to assess the integrity of the TFCC and suggest its use as the first imaging technique following plain radiography in the evaluation of patients with chronic posttraumatic pain on the ulnar side of the wrist.

Adult↗
PubMedDate not supplied

MR of benign peripheral nerve sheath tumors.

Seventeen benign peripheral nerve sheath tumors were studied using MR. In all cases T2 relaxation time, signal intensity on T1-weighted images (lesion/muscle ratio), detectability of nerve of origin, nerve-lesion relationship, and presence of a capsule were assessed. Sixteen tumors showed marked hyperintensity on T2-weighted images with T2 relaxation times values greater than 95 ms. One schwannoma was almost isointense with fat (T2 60 ms). All lesions were isointense with muscle on T1-weighted images. In schwannomas the nerve was usually situated at the periphery of the lesion and only in one case was it obliterated by the mass. In neurofibromas the nerve was either visible in a central position within the mass (two cases) or no longer visible (five cases). A capsule could be detected in 70% of the schwannomas and in 30% of the neurofibromas. In patients with soft tissue masses, MR may contribute to recognition of nerve sheath tumors by showing the nerve of origin and typical signal hyperintensity on T2-weighted images. It can also be helpful in distinguishing between schwannomas and neurofibromas by the location of the nerve of origin and the presence of a capsule.

Adult↗
PubMedDate not supplied

MRI of small hepatocellular carcinoma: comparison with US, CT, DSA, and Lipiodol-CT.

Thirteen cirrhotic patients with 27 nodules of hepatocellular carcinoma less than 3 cm (small HCC) were examined with ultrasonography (US), MR, pre- and postcontrast CT, digital subtraction angiography (DSA), and CT after injection of Lipiodol (Lipiodol-CT). The accuracy of MR was compared with other diagnostic modalities and MR morphologic and the signal intensity features of HCC were investigated. The detection rate by MR was 63%, by US 67%, by CT 50%, by DSA 74%, and by Lipiodol-CT 93%. The Mc Nemar test showed no difference between the detection rates of MR and CT, MR and DSA, MR and US, and Lipiodol-CT and DSA; however, the differences between the detection rates of MR and Lipiodol-CT and CT and Lipiodol-CT were statistically significant (p less than or equal to 0.05). The difference in sensitivity between the detection rates of Lipiodol-CT and US was just above the level considered significant (P less than or equal to 0.065). On T1- and T2-weighted spin echo images 83% of small HCC were hyperintense relative to the surrounding liver parenchyma. Pseudocapsule was observed in 58% of lesions on T1-weighted images in particular. We believe that US is still the best diagnostic technique for the screening of HCC. We prefer MR to CT as a second level examination to support US in noninvasive diagnosis of small HCC, since MR gives the same or slightly better results than CT without the need of ionizing radiation and large amounts of iodized contrast medium. In our opinion, more invasive examinations, such as DSA and Lipiodol-CT, cannot be avoided in cases where an exact knowledge of the number of lesions is essential for the choice of therapy.

Aged↗
PubMedDate not supplied

MRI of hepatocellular carcinoma before and after transcatheter chemoembolization.

OBJECTIVE: Magnetic resonance imaging of hepatocellular carcinomas (HCCs) was performed before and after transcatheter arterial chemoembolization (TACE). The changes of tumor signal intensity were compared to residual tumor or tumor recurrence in the follow-up period. MATERIALS AND METHODS: Fifteen cirrhotic patients with HCC were studied. All patients were examined with MRI both before and 3 months after TACE. Requirement for the study was that all lesions were detectable by MR before TACE. RESULTS: Magnetic resonance imaging detected 31 tumors. The changes of tumor signal intensity were compared to residual tumor or tumor recurrence in the follow-up period. On T1-weighted (T1W) images before TACE, 16 tumors were hyperintense, 11 were isointense, and 4 were hypointense; on T2W images, 26 tumors were hyperintense, 5 were isointense, and none were hypointense. On T1W images 3 months after TACE, 8 tumors were hyperintense, 18 were isointense, and 9 were hypointense; on T2W images, 11 were hyperintense, 11 were isointense, and 9 were hypointense. All the tumors that became hypointense on T2W images after TACE did not recur on follow-up. All lesions that were still hyperintense on T2W images after TACE showed residual tumor during the follow-up. Among 11 tumors that were isointense on T2W images after TACE, 7 were hyperintense on T2W images before TACE; 6 of these did not recur. Four tumors were isointense on T2W images before and after TACE; 2 of these showed residual tumor in the follow-up. On T2W images after TACE, 15 of 16 HCCs that decreased in signal intensity did not recur on follow-up. On T1W images no correlation was seen between the changes of the signal intensity of the lesion and tumor recurrence in the follow-up; however, 9 of 17 HCCs that did not recur after TACE showed decreased signal intensity. All the tumors (10 of 10) with decreased signal intensity on both T1W and T2W images after TACE did not show tumor recurrence on follow-up. CONCLUSION: The results suggest that MRI is useful in the assessment of the therapeutic effect of TACE in HCC.

Aged↗
PubMedDate not supplied

Duplex-Doppler assessment of cirrhosis in patients with chronic compensated liver disease.

Portal venous flow velocity (PFV) was measured with duplex-Doppler equipment in 50 normal subjects and in 117 patients with suspected chronic liver disease who showed no evidence of decompensation such as ascites, hepatic encephalopathy, jaundice or oesophageal bleeding. All the patients underwent percutaneous liver biopsy which demonstrated non-cirrhotic liver disease in 58 cases (CH-patients: steatosis 8, persistent chronic hepatitis 8, active chronic hepatitis 42) and liver cirrhosis in the other 59 cases (LC-patients). The normal subjects and the CH-patients had similar values of max-PFV and mean-PFV (max-PFV 26.7 +/- 3.2 and 25.7 +/- 3.4 cm/s respectively; mean-PFV 22.9 +/- 2.8 and 22.4 +/- 3.8 cm/s respectively). The LC-patients' values (max-PFV 19.3 +/- 3.5; mean-PFV 16.9 +/- 2.9) were significantly lower than those of the normal subjects (P less than 0.001) and of the CH-patients (P less than 0.001). Considering the normal max-PFV to be in the range 20-33.1 cm/s (mean +/- 2 s.d. of the normal subjects, 95% confidence limits), max-PFV was reduced in 0/50 normal subjects, 1/58 CH-patients and 39/59 LC-patients (66.1% sensitivity; 98.2% specificity). In conclusion, the duplex-Doppler measurement of PFV is of great interest in the diagnostic study of patients with suspected chronic compensated liver disease and in the early diagnosis of cirrhosis. A low max-PFV is a reliable pointer to liver cirrhosis, whereas a normal max-PFV indicates a non-cirrhotic liver disease but is less probative. Each centre should standardize normal PFV values in order to establish their own threshold value for diagnosing liver cirrhosis.

Blood Flow Velocity↗
PubMedDate not supplied

Duplex-Doppler ultrasonography in the evaluation of cirrhotic patients with portal hypertension and in the analysis of their response to drugs.

Sixteen patients (15 males, aged 48-70) affected by liver cirrhosis and oesophageal varices were subjected to duplex-Doppler ultrasonographic study (DDUS). Four patients (three with a portal thrombosis and one with a hepatofugal portal flow) were excluded from the subsequent pharmacological test. The twelve remaining patients took part in a double blind cross-over study that evaluated the variations of heart rate (HR), mean systemic arterial pressure (SAP), portal vein diameter (PVD), maximal and mean portal flow velocity (PFV) after the administration of either 40 mg of propranolol or placebo per os, on two consecutive days. Propranolol caused no significant variation in mean SAP and in PVD, whereas it reduced the HR from 67.7 +/- 8.0 to 58.4 +/- 7.0 beats/min (mean +/- s.d.; P less than 0.001); the maxPFV dropped from 18.2 +/- 5.4 to 14.0 +/- 3.7 cm/s (P less than 0.001) and the meanPFV dropped from 15.3 +/- 4.1 to 13.2 +/- 3.1 cm/s (P less than 0.005). No significant variation was observed with placebo. After propranolol administration eight patients exhibited a significant maxPFV decrease, whereas the other four patients exhibited only a drop in HR, suggesting either drug inefficacy, inappropriate dosage or inadequate duration of treatment. DDUS is the only non-invasive method for the examination of the portal vein system.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

Combined 24-hour intraluminal pH and bile monitoring of the denervated whole stomach as an esophageal substitute.

BACKGROUND/AIMS: The study aims to evaluate the pH and the presence of bile in the denervated whole stomach pulled up to the neck after subtotal esophagectomy. METHODOLOGY: The pH and the presence of bile in the gastric cavity were monitored by combined 24-hour pH and bilimetry in 16 patients having their whole stomach as an esophageal substitute (i.e., 8 with and 8 without a gastric drainage procedure) and in 25 healthy control subjects. The percentage of time during which pH was < 2 as well as the percentage of time during which bile absorbance was > 0.25 for the total, upright, and supine periods of recording were considered for each subject studied. Seven patients underwent a gastroscopy with biopsies. RESULTS: Intragastric acidity was normal in 50% of patients while it was reduced in the other 50%. Ten of the 16 patients (62.5%), i.e., 4 with (50%) and 6 without (75%) a drainage procedure, had excessive exposure of the gastric mucosa to bile. No significant correlation was found between the existence of a high intraluminal pH profile and excessive bile exposure (p = 0.9163). Bile exposure was significantly higher in whole stomach patients than in controls in both the upright and supine positions, irrespective of the existence or absence of a drainage procedure (p ranging from 0.0272-0.0001). Bile exposure in the supine position tended to be longer in patients without than in those with a drainage procedure (p = 0.0929). Helicobacter pylori-negative chemical gastritis was present in 3 of the 7 patients who underwent a gastroscopy, all 3 having excessive bile exposure and no food retention in the transplant lumen. CONCLUSIONS: Gastric denervation and transposition up to the neck increased exposure of the gastric mucosa to bile, irrespective of the patient's position and of the presence of a gastric drainage procedure. The absence of gastric drainage procedure tends to ensure exposure to bile prolongeLow gastric acidity, if present, is due to a reduction in acid secretion rather than to a buffering effect from duodenal juice having refluxed. Gastritis is more likely to be related to excessive exposure of the gastric mucosa to bile than to food retention.

Adult↗
PubMedDate not supplied

[Antineoplastic perfusion with percutaneous stop-flow control in the treatment of advanced pelvic malignant neoplasms].

PURPOSE: The object of our study was to apply percutaneous stop-flow technique to advanced pelvic cancer in order to evaluate its feasibility, standardize the procedure and obtain preliminary results. MATERIAL AND METHODS: April to December 1997 we submitted ten patients with advanced pelvic cancer to percutaneous stop-flow technique. Seven patients had a pelvic recurrence from carcinoma of the rectum, two patients had inoperable recto-sigmoid cancer, and another one had a local recurrence of ovarian cancer. All treatments were performed under general anesthesia. A stop-flow balloon catheter was placed via a transfemoral arterial and venous access above the aortocaval bifurcation and below the emergence of renal arteries and veins. The pelvic district was isolated by filling the balloon catheters and pneumatic cuffs at the thigh, and the antineoplastic agents (cisplatinum, 80 mg/m2 followed by mitomycin C, 30 mg/m2) were sequentially infused by means of an extracorporeal circuit. Blood flow was interrupted for a maximum of 20 min to limit tissue damage, especially of the anal sphincter. Hemofiltration was run during the last 3 min of stop-flow and in the following minutes, achieving at least 5 liters of ultrafiltration. Morphological response was evaluated by CT or MR scan performed prior to and 40 days after the treatment. RESULTS: Over a 2-year follow-up 2 of our 10 patients are alive and 8/10 have died (median survival 9.6 months). Death followed tumor progression in 6 cases; one patient died during the procedure and another one after 7 days, both secondary to pulmonary embolism. Complications included intra-arterial rupture of the balloon in one case and a large inguinal hematoma 10 days after the treatment, requiring hospitalization. No patient showed positive morphological response; two patients only showed stable disease. CONCLUSIONS: This trial supports the feasibility of using the percutaneous stop-flow procedure in an angiography room setting; the stop-flow technique failed to permit the effective control of the tumors.

Aged↗
PubMedDate not supplied

Magnetic resonance imaging in evaluating functional disorders of female pelvic floor.

PURPOSE: To evaluate the diagnostic capabilities of MRI in the study of functional diseases of the female pelvic floor. MATERIALS AND METHODS: Ten healthy volunteers and 30 patients with clinically suspected pelvic floor deficiency, with or without pelvic organ prolapse, were evaluated by a high field strength magnet operating at 1.5 T. In each case SSFSE sequences (TR/TE:25720/67) in axial, coronal and sagittal planes, both at rest and during Valsalva's manoeuvre, were performed. Based on the MRI findings using fixed and mobile anatomical landmarks, the functional disease of the pelvic floor was diagnosed and quantified based on the identification and grading of visceral prolapse. The MRI findings were compared with the clinical findings in all cases and with the surgical data in the 7 patients who had undergone surgery. RESULTS: The MR image quality was adequate in all cases. In the group of symptomatic women MRI diagnosed: urethral hypermobility syndrome: 22 cases; isolated abnormalities of the anterior compartment: 8 cases of cystocele (low grade: 2, middle grade: 2, severe: 4); isolated abnormalities of the middle compartment: 6 cases of hysterocele (low grade: 2, middle grade: 4); isolated abnormalities of the posterior compartment: 5 cases of low-grade rectocele; 2 cases of enterocele (1 low grade, 1 middle grade); multi-compartment abnormalities: 11 cases; joint prolapse of anterior and middle compartment: 5 cases; joint prolapse of posterior and middle compartment: 3 cases; joint prolapse of anterior, middle and posterior compartment: 3 cases. The values of both fixed and mobile landmarks were significantly higher in the symptomatic group compared with the healthy volunteers. MRI confirmed the pelvic examination findings in all cases; in particular MRI findings were in total agreement with the clinical severity of prolapse, as defined by the Baden-Walker classification. In 7 cases MRI detected additional alterations (4 cases of hysterocele and 3 of enterocele) that had been missed at clinical evaluation. DISCUSSION AND CONCLUSIONS: In our experience MRI made an important contribution to the diagnosis and grading of functional disorders of the female pelvic floor and pelvic organ prolapse. The ability to simultaneously demonstrate both muscular and ligamentous structures and pelvic viscera, without using X-rays or contrast agents, is the main reason for the good results achieved by MRI and for its widespread use in this disorder. Furthermore the use of fast, breath-hold sequences can provide high-quality images both at rest and during Valsalva's manoeuvre. In conclusion MRI proved to be an accurate imaging tool that is more sensitive than clinical pelvic evaluation in diagnosing and grading functional disorders of the female pelvic floor and pelvic visceral prolapse.

Adult↗