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S Bassi

Publications and source records attributed to S Bassi.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Cervical spine injuries: diagnostic imaging].

In past few years, traumas of cervical spine have increased, chiefly owing to rise of road accidents. Nevertheless, only in a small percentage of cases lesions of cervical spine occur and, in order to reduce many negative radiographs, a careful clinical examination is required. Our purpose is to verify the value of radiology in evaluation of acute trauma of cervical spine and to propose an adequate radiological protocol. In the course of two years (1998-99), 376 patients were admitted in consequence of cervical trauma of different degree of gravity. In all patients, conventional radiographs were obtained, in 93 a computed tomography (CT) examination was executed and only in 18 patients with neurological symptoms a magnetic resonance (MR) was required. Fractures of cervical spine wee identified in 91 cases and in patients in which MR images were obtained, neurological lesions of various severity were diagnosed. On the basis of our results, we think that, in a clinical suspicion of cervical spine lesions, a conventional radiographic study has first to be performed even if often good radiographs aren't obtained for technical difficulties. If doubts persist on conventional radiographs or a fractures has already been diagnosed on radiographs but we want to verify its stability, a CT needs to be performed. MR is required if neurological symptoms are present in order to diagnose lesions of spinal marrow, nerve roots or ligaments.

Adolescent↗
PubMed1999

[Upper cervical spine fracture: sources of misdiagnosis].

PURPOSE: Missing cervical spine fractures during the initial plain film study may lead to severe neurological complications for patients and to medicolegal responsibilities for the physician. The upper cervical spine tract (C1-C2) is considered to be at high risk for misdiagnoses. We decided to investigate the possible causes of mistake in the cases of missed fractures on the initial plain film, performed in the emergency room. MATERIAL AND METHODS: We retrospectively reviewed the radiological reports, the original plain films and the CT findings, of 32 patients with upper cervical (C1-C2) fractures, admitted January 1994 to December 1998. Twenty-eight of these patients (87.5%) had multisystem trauma, 4 (12.5%) had minor craniocervical trauma. None of these patients had neurological signs correlated to the cervical injuries, 30 of them had normal consciousness and reported only neck pain, 2 of them were unconscious for the associated head trauma and were hospitalized in the intensive care unit. All the patients with normal consciousness underwent conventional three-view cervical spine radiography; the two unconscious patients in the intensive care unit were submitted to bedside examination with an anteroposterior and a lateral views of the cervical spine. All patients underwent spiral CT of the upper cervical tract. RESULTS: In 9 of 32 patients (28%) a cervical fracture was missed on the plain film and CT was performed only because of persistent neck pain. We found 2 Jefferson's fractures, 2 type II dens fractures, one type I dens fracture and 4 hangman's fractures. In 8 of the 9 patients (89%) the fracture was potentially unstable. Misdiagnoses resulted from overlapping bone structures (3%), suboptimal film quality (3%), satisfaction of search phenomenon (3%), missed mild tilting of the dens (6%), missed double cortex sign (16%), missed C1-C2 lateral subluxation (6%) and marked osteoporosis (3%). Prevertebral soft tissue swelling was not seen in any of the 9 cases of missed fractures. Considering the group of patients with C1-C2 fractures separately, the false negative rate is 28%, which corresponds to 10.7% of the total number of patients with cervical fractures and dislocations examined during the same period. CONCLUSIONS: Among the causes of false-negative interpretation, osteoporosis, suboptimal film quality due to associated fractures and overlapping bone structures must be considered unavoidable. On the other hand these possibilities should be indicated on the X-ray report because, if painful symptoms persist, a CT exam is strongly advised. Subtle alterations like dens tilting, double cortex sign, lateral subluxation of C1 and prevertebral soft tissue swelling should be regarded as highly suspicious for fracture. Missing these lesions might be considered a true diagnostic mistake with possible legal consequences, which may also expose the patient to the risk of neurological complications. The satisfaction of search phenomenon can be avoided only by trying to use a search pattern for every film, which includes checking all the visible anatomical structures even in the presence of a particularly evident lesion. In all questionable cases or high-risk fracture patients, even with an apparently negative plain film, it is advisable to perform CT instead of additional plain films. Finally, in all the patients treated in the intensive care unit for head trauma, an upper cervical CT scan should be routinely carried out at the same time as the brain scan.

Cervical Vertebrae↗
PubMed1999

[Mesenchymal tumors of the pancreas: computed tomography patterns].

PURPOSE: To report the CT patterns of pancreatic mesenchymal lesions and to investigate the capabilities and limitations of this technique in terms of characterization. MATERIAL AND METHODS: We selected the CT examinations of 23 patients from all CT examinations of the pancreas performed from 1986 to 1998. The patients were 10 to 85 years old and all lesions but two (1 lipoma and 1 lymphoma) had pathologic confirmation. Two lymphangiomas, 2 lipomas, 4 Schwannomas (SCH), 1 plexiform neurofibroma, 1 cystic teratoma, 1 pancreatoblastoma, 9 non-Hodgkin's lymphomas (NHL), 1 undifferentiated sarcoma and 2 leiomyosarcomas were diagnosed. RESULTS: Lipomas had typically homogeneous negative HU values, and NHL a homogeneous hypodense pattern with mild contrast enhancement, with no necrosis or calcifications in both diffuse and nodular forms; SCH had variable appearance, with water/slightly negative HU numbers or highly enhanced patterns with a central necrotic core depending on the main Antoni A or B histology. Lymphangiomas appeared as complex cysts, with thin and regular or calcified walls and intracystic septa, while the plexiform neurofibroma had near-water homogeneous density with mild contrast enhancement and an infiltrating growth pattern. Our teratoma had multiple calcifications, mucinous and lipid components. The pancreatoblastoma, sarcomas, and leiomyosarcomas exhibited no specific findings. CONCLUSIONS: In selected cases, CT can provide virtually diagnostic information (lipoma and teratoma), or at least highly suggestive findings (NHL, plexiform neurofibroma, lymphangioma). Moreover, knowledge of the variable morphostructural patterns of mesenchymal histotypes (SCH, sarcoma etc.) permits to include them in the differential diagnosis of pancreatic masses.

Adolescent↗
PubMed1996

Complications linked to chronic peritoneal dialysis in children after kidney transplantation: experience of the Italian Registry of Pediatric Chronic Peritoneal Dialysis.

Our objective was to evaluate the infectious complications of the post-transplant period attributable to the persistence of catheter and other complications when chronic peritoneal dialysis (CPD) was performed post-transplantation. The design was a retrospective study, and the setting was an Italian registry of pediatric chronic peritoneal dialysis. There were 86 pediatric renal transplants (9/86 from living related donors, 2/86 simultaneous liver and kidney transplantation for oxalosis). Six of 86 transplants were lost at follow-up. Mean age of the children (n = 80) at transplantation was 9.3 years (range: 1.7-21 years). They had been on CPD for a mean period of 1.7 years (range: 0.2-4.6 years). During CPD, 67 peritonitis episodes (80% related to exit-site and/or tunnel infections) were observed, with an incidence of peritonitis of one episode per 16 months CPD. The mean safe interval of peritonitis and/or exit-site or tunnel infection was 208 days (range: 36-1897 days). The mean time of catheter removal was 80.3 days (range: 0-216 days) post-transplantation. During the first month post-transplantation, one episode of peritonitis secondary to a sepsis occurred in one child. No other episodes of peritonitis or exit-site and/or tunnel infections were observed. Two of 80 children returned to CPD (at four and at 12 months, respectively) because of persistent allograft failure. Furthermore, 12 patients were on CPD because of temporary graft failure. In all these patients the pretransplant peritoneal dialysis (PD) catheter was utilized, with no complications. These data show that the persistence of the PD catheter after kidney transplantation has produced no infections or other complications. What is more, the catheter was safely utilized during acute rejection or primary allograft nonfunction.

Adolescent↗
PubMed1996

Comparison of patient hospitalization in chronic peritoneal dialysis and hemodialysis: a pediatric multicenter study.

Patient hospitalization was compared in 207 pediatric patients (age < or = 15 years at the start of dialysis) on chronic peritoneal dialysis (CPD) (127 patients) or center hemodialysis (HD) (80 patients), treated in 17 dialysis centers during the period 1989 to 1994, and followed up for at least three months. The hospitalization rate was expressed as hospital days per patient-month, and was calculated on the overall period of treatment and separately for the first and second year. Since the age at start of dialysis markedly differed between CPD (8.2 +/- 4.7 years) and HD (11.2 +/- 2.9 years) patients (with no HD patient younger than five years), results are separately presented in three patient groups: CPD patients aged < 5 years (A); CPD patients aged five to 15 years (B); HD patients (C). The duration of hospitalization was subdivided according to the following different causes: routine (monitoring of dialysis adequacy), complications of the modality, patient primary renal disease, and other causes. The results are presented in Table 1. A statistically significant difference in total days hospitalized was found between each of the two groups of CPD patients and the HD patients; the results for hospitalization for dialysis-related complications were higher in the group of younger children on CPD, while the difference between the two age-matched groups of patients on CPD and HD was not significant.

Adolescent↗
PubMed1995

Tumour-associated trypsin inhibitor and renal cell carcinoma.

In the absence of a specific marker for renal cell carcinoma (RCC), we evaluated the tumour-associated trypsin inhibitor (TATI) in patients with RCC. Between November 1990 and November 1993, 63 patients with RCC and 23 patients with benign renal disease underwent a competitive radioimmunoassay of TATI. The cutoff value was defined on a series of serum samples of 96 healthy subjects (normal n < 20 micrograms/l, then 25 micrograms/l after April 1993). We related the value of TATI to the tumour stage and compared the sensitivities of TATI and other markers (CEA, CA 15-3, CA 125, CA 19-9, ferritin). In 24 patients the TATI assay was repeated 3-12 months after radical nephrectomy. 15 patients with benign disease had a normal value of TATI (specificity: 65%). 44 of the 63 patients had a value of TATI above the cutoff point (sensitivity: 69%). Sensitivities of CEA, CA 15-3, CA 125, CA 19-9 and ferritin were 5, 10, 13, 5, 35%, respectively. The TATI value was correlated with the stage of the disease. Among the 15 patients without metastasis, the mean preoperative value was 112 micrograms/l (14-760) versus 46 micrograms/l (24-180) postoperatively. In the 9 patients with metastasis, the preoperative mean value was 100 micrograms/l (20-434) versus 240 micrograms/l (22-544) postoperatively. TATI showed a better sensitivity than other markers for RCC but its specificity is limited. Nevertheless it can be useful for a postoperative follow-up. TATI remains one of the best serum markers for RCC.

Biomarkers, Tumor↗
PubMed1995

Clinical experience in the treatment of infants with chronic peritoneal dialysis.

Chronic peritoneal dialysis (CPD) is the first treatment modality for most infants with end-stage renal failure; this group of patients shows peculiar clinical and technical problems. We present the data from a National Registry on 22 children starting CPD under one year of age, representing 11.6% of the total population of the Registry (189 patients). Mean weight at start of CPD was 6.1 +/- 1.8 kg and duration of dialysis was 22.1 +/- 15.5 months. During the follow-up period, 9 patients were transplanted, 1 was shifted to hemodialysis, and 4 died. Patient survival was 89.1% and 82.2% at 1 and 2 years (97.9% and 96.5% in the group of 167 older children); technique survival results were 89.1% at 1 year and 77.1% at 2 years (vs 92.5% and 85.7%, respectively). The incidence of peritonitis was 1 episode every 15.6 CPD-months (1:16.1 in the older children). Catheter-related complications occurred more frequently in infants (1:11.8 vs 1:17 episode:CPD-months), even if this difference was not statistically significant. Statural growth was on average -0.29 +/- 0.66 SD/year with a significant improvement between the first (-0.50 +/- 0.79) and the second (+0.23 +/- 0.77) year of CPD. Our data confirm that infants represent a higher risk group and that they can be treated satisfactorily with CPD while awaiting renal transplantation.

Catheters, Indwelling↗
PubMed1994

Anatomic study of the lumbar region applied to multiplanar imaging techniques: importance and use of oblique vertical sections.

This anatomic study of the lumbar region (as defined by Rouvière [11]) applied to multiplanar imaging techniques was carried out both in the cadaver and in vivo. The cadaver study (5 cases) consisted of anatomic sections (transverse, sagittal, frontal and oblique) and computerised three-dimensional reconstructions after CT studies on subjects injected with colored and radio-opaque latex. The in vivo study (4 cases) used MRI sections and three-dimensional ultrasound sections coupled with the pulsed doppler. The spatially referenced oblique vertical sections revealed the structures from unusual aspects, situating them amidst the retroperitoneal area with the maximum of topographic landmarks. The transposition of these results (obtained by sectional anatomy of the retroperitoneal region) to the new techniques of multiplanar formatting after MRI, ultrasound or CT data acquisition should optimise the investigation of certain retroperitoneal structures by specifying the ideal planes of section for each organ, while diminishing certain artefacts specific to acquisitions in the traditional planes of section. Oblique vertical sections seem eminently suitable for ultrasound location of the suprarenal compartments, study of the renal pedicles and topographic retroperitoneal location. This oblique vertical visualisation constitutes a fundamental resource for the development of video-monitored surgical procedures as it corresponds exactly to the axes of the access routes in percutaneous surgery of the kidney and the adjacent anatomic structures.

Cadaver↗
PubMed1994

Comparison of the efficacy, safety and withdrawal of alpidem and alprazolam in anxious patients.

BACKGROUND: We investigated whether a new non-benzodiazepine anti-anxiety drug, alpidem, produces weaker withdrawal symptoms than alprazolam. METHOD: Under a double-blind procedure, 122 patients suffering from general anxiety disorders were randomly allocated to either alpidem (50 mg, three times a day) or alprazolam (0.5 mg, three times a day) for six weeks, followed by a two-week placebo withdrawal phase. The diagnosis of withdrawal syndrome (WS) was made, in blind conditions, on the basis of the Withdrawal Symptom Check List (WSCL), after one or two weeks of discontinuation of active treatment. RESULTS: The WS occurred significantly less frequently in the alpidem group (n = 10, 18%) than in the alprazolam group (n = 26, 48%). Typical withdrawal symptoms on the WSCL were also significantly less severe (P = 0.044) in the alpidem group compared with the alprazolam group. CONCLUSIONS: Alpidem may be a valid alternative to current benzodiazepine anxiolytic therapy because it produces fewer and weaker withdrawal symptoms than alprazolam and is better tolerated.

Adult↗
PubMed1994

A multicenter study on the hospitalization of pediatric patients on chronic peritoneal dialysis.

The Italian Registry of Pediatric Chronic Peritoneal Dialysis (CPD) carried out a special study on patient hospitalization during the years 1989-1992. Ninety-two children (mean age 8.4 +/- 4.7 years) entered the study, for a total of 1406 CPD-months. The contribution of the different causes of hospitalization for a total of 4683 hospital days was: CPD training 31%; routine controls 14%; CPD-related complications 35%; clinical complications 14%; other causes 6%. The rate of patient hospitalization that resulted was 3.33 days/CPD-month; it was higher in the first year (4.32 days/CPD-month) than in the second year (1.64 days/CPD-month) or in the third year (2.25 days/CPD-month). This difference was mainly due to the need for the training at the start of the CPD treatment. The evaluation of the hospitalization rate in different age groups showed a statistically significant difference (p < 0.05) between the group 0-2 years (5.47 days/CPD-month) and the group 3-15 years (2.78 days/CPD-month). Complications were the cause of 150 admissions to the hospital (1:9.6 CPD-months). Ninety-eight admissions were due to CPD-related complications: peritonitis (33%), problems with the catheter (19%), abdominal hernias (4%), and others (9%). Among clinical complications (52 admissions), the main cause of hospitalization was hypertension (15%), followed by infections (4%), and malnutrition (3%).

Adolescent↗
PubMed1994

[Laparoscopic treatment of vesico-ureteral reflux in the pig. Preliminary report].

Laparoscopic urological surgery is currently in a phase of development. In order to evaluate the possibility of treating vesicoureteric reflux by laparoscopy, we performed an elongation of the submucosal ureteric tract via an extravesical approach (Lich-Gregoir) in 4 pigs. After creating a pneumoperitoneum, 4 trocars were introduced into the abdominal cavity. The peritoneum was incised at the level of the iliac vessels and the ureter was released at its middle portion as far as the ureterovesical junction. After coagulation, the detrusor was then incised proximally in relation to the ureterovesical junction, revealing 3 to 4 cm of vesical mucosa. The ureter was buried in the muscular groove, the edges of which were brought together by means of 6 metal staples. In 3 pigs, the bladder and ureter were immediately removed by laparotomy. On macroscopic examination, the staples correctly approximated the muscle layer without transfixing the bladder mucosa or ureter. The patency of the ureter was assessed with a probe. The submucosal tract was sufficiently large, preventing any ureteric compression. In 1 pig, the ureteric meati were incised endoscopically to create reflux. After laparoscopic elongation of the submucosal tract on one side, only the untreated ureter continued to reflux. Correction of vesicoureteric reflux is technically feasible in the pig. Longer studies are necessary before considering the application of this technique to man.

Animals↗
PubMed1993

Anatomic basis of laparoscopic surgery in the male pelvis.

Laparoscopic surgery of the male pelvis remains a risky procedure, with around 15% of perioperative complications, as compared to 0.03% in laparoscopic surgery for gynecologic and obstetric conditions. Many of these complications are due to the surgeon's being faced with an unfamiliar anatomic situation in his approach through the laparoscopic operative field. We have added to the data of the literature our anatomic and clinical experience in order to define the anatomic basis of surgical risk in this type of procedure. While dissection lateral to the iliac vessels (surgery of the spermatic cord) is safe, dissection medial to these vessels is more risky because of the confined anatomic relationships and their variations (particularly vascular anomalies and variable relations of the ureter).

Humans↗
PubMed1993

Pharmacokinetics and hematologic response to subcutaneous administration of recombinant human erythropoietin in children undergoing long-term peritoneal dialysis: a multicenter study.

For a study of the pharmacokinetics and hematologic response of subcutaneously administered recombinant human erythropoietin (rHuEPO), 24 children (mean age, 10 years 3 months; range, 3 months to 18 years) maintained by peritoneal dialysis and with anemia caused by end-stage renal failure (mean hemoglobin level, 6.5 gm/dl; range, 4.7 to 7.9) were treated with rHuEPO administered subcutaneously at an initial dose of 25 IU/kg twice per week. After a 4-week interval, in the case of no response (hemoglobin increase < or = 1 to 1.5 gm/dl per month) the rHuEPO dosage was increased every 4 weeks according to the following schedule: 50, 75, 100, and 150 IU/kg twice per week. The administration of rHuEPO produced a rapid increase in serum concentration with a mean peak level of 59.8 mU/ml after 9 hours. Mean area under the curve to 72 hours was 2020 mU/ml per hour (range, 568 to 6609); mean elimination half-life and mean residence time were, respectively, 25.2 hours (range, 6.2 to 58.7) and 42.0 hours (range, 10.9 to 96). Of 24 children entered in the study, six had the drug suspended early because of renal transplantation (n = 1), lack of compliance (n = 4), or severe worsening of hypertension (n = 1). Eighteen patients had increased hemoglobin levels (to 9.4 +/- 1.7 gm/dl after 24 weeks of treatment). No correlation was found between the increase in hemoglobin concentration and any of the pharmacokinetic data or the peak erythropoietin level reached during the kinetic profile. Eight children required an increase of antihypertensive medications to maintain satisfactory blood pressure values. We conclude that low doses of subcutaneously administered rHuEPO slowly release the drug into the blood and satisfactorily increase hemoglobin levels with very few side effects.

Adolescent↗
PubMed1993

Percutaneous extra-anatomic nephrovesical diversion: preliminary report.

We propose a new approach to total ureteric replacement based on the use of a new spiraled composite tube. This tube is inserted percutaneously into the renal pelvis, then tracked subcutaneously and introduced into the bladder via a short incision. The tube is maintained in place by anchoring its spirals along the subcutaneous tract, and only the two silicone extremities are in continuous contact with the urine. We have used this technique for total replacement of the ureter in one renal transplant patient with a follow-up of 8 months and no complication. A longer follow-up is obviously necessary, but this new, minimally invasive approach, using a newly designed tube, would appear to give a new lease of life to an old, abandoned principle.

Adult↗