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S Brusori

Publications and source records attributed to S Brusori.

At least 19 recordsLinked to original sources
PubMed2004

Videofluoroscopy and videoendoscopy in evaluation of swallowing function in 31 patients submitted to surgery for advanced buccopharyngeal carcinoma.

Swallowing function has been evaluated by means of videofluoroscopy and videoendoscopy in 31 patients submitted to surgery for local extended bucco-pharyngeal carcinoma. Aim was to better predict functional deficits and subsequent recovery perspectives of patients as far as concerns swallowing. In 30 patients, surgery was combined with radiotherapy, pre-operative in 6 cases and post-operative in 24. Site and extension of resection were defined using Urken's classification of hard and soft tissue deficits. In 3 cases, resection included half of tongue base and was followed by direct closure of the surgical defect. In 4 cases, the entire hemitongue (hemibody and hemibase) was resected and repair was performed with a free flap. In 5 cases, the whole tongue base was resected (posterior glossectomy). In 2 of these, direct closure of the gap was performed while the other 3 received a free flap. Another 3 cases required resection of the entire mobile tongue with corresponding buccal floor. All were repaired with free flaps. In 6 cases, resection comprised half the tongue base and adjacent tonsillar fossa and was performed using a transmandibular approach (demolitive in 3 cases, reconstructive in 3). Of these patients, 3 received direct closure and 3 reconstruction with a free flap. In 4 patients, resection included the tonsillar fossa and soft palate while in 5 other patients the whole soft palate was resected in addition to the tonsillar fossa. All these 9 patients received repair with free flaps. The remaining patient underwent resection of the entire oro-hypopharyngeal posterior wall, reconstructed with a free flap. During video-endoscopy examination, both liquid and soft meal ("pudding") were given to patients. Diagnostic parameters studied were: grade of pharyngo-laryngeal sensitivity, latency in onset of pharyngeal swallowing reflux, drop of the bolus in pre-swallowing phase, grade of the pharyngeal residual, inhalation and pooling of saliva. Data collected may be usefully employed not only in predicting the type and grade of swallowing deficit related to the extension of resection and repair technique used, but could also be helpful in the choice of the most appropriate behavioural procedure of rehabilitation for the patient.

Carcinoma, Squamous Cell↗
PubMed2001

[Role of videofluorography in the study of esophageal motility disorders].

PURPOSE: To repropose the importance of videofluoroscopy in the study of esophageal motor disorders, comparing the radiologic and manometric results; the manometric results are considered the reference parameters. MATERIAL AND METHODS: From 1996 to 1999, 76 patients (42 males and 34 females), were studied first using manometry and then videofluoroscopy. The patients had symptoms like dysphagia, thoracic pain or both. The manometric study was performed with a perfusional system equipped with 6 tips (4 radial for the study of the esophageal sphincters and 2 placed longitudinally for the study of the esophageal peristalsis). With the patient in a supine position we analysed 5-10 deglutitions with 5 ml water bolus at 20-25 degrees C, administered using a graduated syringe. The radiologic study was performed with a remote-control digital television system, connected to a video recorder. Three 7.5 ml bolues of high density barium suspension (250% weight/volume) were injected orally in the upright position and other three were injected in the prone position following the passage from the oral cavity to the stomach. RESULTS: The comparison of the manometric and videofluoroscopic results suggests that the total sensitivity of the radiological study in the detection of esophageal motor disorders was 92%. In particular dynamic radiologic investigation diagnosed the normal esophageal functionality in 100% of the cases, nonspecific esophageal motility disorders in 89.6%, diffuse esophageal spasm in 100% of the cases, the presence of achalasia in 90%, whereas "nutcraker esophagus" only in 50%. Videofluoroscopy therefore showed high sensitivity in four groups of the five considered. It has some limitations in the diagnosis of initial achalasia, and is not sufficiently sensitive in the diagnosis of "nutcracker esophagus". CONCLUSIONS: Videofluoroscopy is a simple method which presents high sensitivity and specificity in the detection of motility disorders of the esophagus and could therefore be proposed as the first diagnostic method in patients with specific symptoms.

Adult↗
PubMed1998

Clinical and surgical relevance of the progressive phases of intrathoracic migration of the gastroesophageal junction in gastroesophageal reflux disease.

OBJECTIVE: The pathophysiologic influence of progressive intrathoracic migration of the gastroesophageal junction axial to the esophagus on gastroesophageal reflux disease was investigated. METHODS: A radiologic-manometric study was performed on hiatal insufficiency, concentric hiatus hernia, and short esophagus, the three radiologic steps of intrathoracic gastroesophageal junction migration, and on healthy volunteers. The distances between inferior and superior margins of the lower esophageal sphincter and the diaphragm were measured. Endoscopic, manometric, and pH-metric evaluations were performed after barium swallow in 38 patients with severe gastroesophageal reflux disease and sliding hiatus hernia with intraabdominally reducible gastroesophageal junction, in 35 patients with hiatal insufficiency, in 40 with concentric hiatus hernia, and in 19 with short esophagus. RESULTS: The distance from the lower esophageal sphincter inferior margin to the diaphragm was different in healthy volunteers (-2.6 +/- 0.9 cm [standard deviation]) versus that in patients with hiatal insufficiency (-1.0 +/- 0.7 cm; p = 0.02), concentric hiatus hernia (-0.8 +/- 1.0 cm; p = 0.02), and short esophagus (4.0 +/- 2.5 cm; p = 0.0002), and in patients with short esophagus versus hiatal insufficiency (p = 0.0002) and concentric hiatus hernia (p = 0.0002). Lower esophageal sphincter tone was reduced between healthy volunteers (19 +/- 9.1 mm Hg [standard deviation]) and patients with sliding hiatus hernia (12 +/- 7.2 mm Hg;p = 0.02), hiatal insufficiency (10 +/- 5.9 mm Hg; p = 0.0001), concentric hiatus hernia (7 +/- 3.1 mm Hg; p = 0.00002), and short esophagus (7 +/- 3.7 mm Hg; p = 0.00003) and between concentric hiatus hernia versus sliding hiatus hernia (p = 0.007). Acid gastroesophageal reflux total time percent was increased between healthy volunteers (2.4% +/- 1.8% [standard deviation]) and patients with sliding hiatus hernia (12.8% +/- 7.8%;p = 0.02), hiatal insufficiency (17.2% +/- 15.8%; p = 0.0001), concentric hiatus hernia (24.0% +/- 19.6%;p = 0.00002), and short esophagus (26.1% +/- 19.6%;p = 0.00002) and between sliding hiatus hernia versus concentric hiatus hernia (p = 0.002) and short esophagus (p = 0.01). CONCLUSIONS: Permanent gastroesophageal junction orad migration axial to the esophagus has greater pathophysiologic relevance on gastroesophageal reflux disease than sliding hiatus hernia with an intraabdominally reducible gastroesophgeal junction. Hiatal insufficiency, concentric hiatus hernia, and short esophagus are markers of progressively increasing irreversible cardial incontinence and therefore indications for surgical therapy.

Adult↗
PubMed1998

[Deglutition in patients treated with reconstructive laryngectomy].

INTRODUCTION: We stress the importance of dynamic radiologic studies of swallowing in the patients submitted to reconstructive laryngectomy. MATERIAL AND METHODS: January, 1989, to December, 1996, we examined 36 patients submitted to reconstructive laryngectomy, namely cricohyoidoepiglottopexy in 34 cases, cricohyoidopexy in 1 case and Guerrier's cricohyoidoepiglottopexy in 1 case. Dynamic radiologic studies were performed with fluoroscopic videorecording (Sony U-Matic RM 580) from an X-ray unit. The study was performed with the patients standing or sitting, initially acquiring AP and LL fluoroscopic images of the oropharyngeal region at rest and during swallowing. The patients then swallowed 2 boluses of 5 ml liquid (60%) and semiliquid (250%) barium. When aspiration was suspected, we began with a 2-ml bolus. RESULTS: The patients were grouped by symptoms: group A patients had no symptoms, group B patients had dysphagia and group C patients presented aspiration. The functional changes were: reduced pharyngeal contraction, reduced epiglottis deflection, reduced hyoid bone elevation, aspiration, altered upper esophageal sphincter function. The organic alterations were: parapharyngeal diverticulum, pharyngeal stenosis, posterior pharyngeal wall introflexion. Three group A patients had severe posterior pharyngeal wall introflexion, 4 had marked retention and 2 of them presented postswallowing aspiration. Two group B patients had major retention, 1 cricopharyngeal incoordination, 3 posterior pharyngeal wall introflexion, 2 a pseudodiverticulum and 2 a luminal stenosis. Seven group C patients had intraswallowing and 3 postswallowing aspiration. CONCLUSION: The videofluorographic identification of organic and functional complications, sometimes unknown in asymptomatic patients, is useful for therapy and suggests the speech specialist the best compensatory mechanism to improve the patients' swallowing and consequently their quality of life. Moreover, videofluorography of swallowing is a very useful tool in the follow-up, to monitor treatment outcome after rehabilitation.

Deglutition↗
PubMed1996

Onset timing of delayed complications and criteria of follow-up after operation for esophageal achalasia.

BACKGROUND: The purpose of this study was to define the length of follow-up necessary to obtain definitive results of the Heller myotomy for the therapy of esophageal achalasia and the modalities of long-term follow-up. Insufficient myotomy, periesophageal scarring, and gastroesophageal reflux esophagitis are the most common late complications of operation for achalasia. Columnar-lined esophagus with or without dysplasia and cancer can further complicate postoperative reflux esophagitis. Because progressive worsening of results with time has been reported, we assessed the timing of appearance of these complications. METHODS: Since 1973, 129 patients submitted to Heller myotomy were clinically and objectively followed up. Mean follow-up was 97.4 months (range, 12 to 268 months). Of 129 patients, 42 were followed up for less than 5 years (17 voluntary drop outs, 10 reoperations, 3 deaths, 12 in follow-up), 47 more than 5 years, 26 more than 10 years, 12 more than 15 years, and 2 more than 20 years. The timing of onset of symptoms and complications related to the myotomy were evaluated as was the development of dysplasia and cancer. RESULTS: In 11 patients, severe dysphagia due to insufficient myotomy reappeared a mean of 12.4 months after the operation (range, 3 to 30 months). In 7 patients with periesophageal scarring, dysphagia recurred a mean of 18.8 months (range, 6 to 28 months) after the operation. Postoperative reflux esophagitis appeared in 22 patients a mean of 76.5 months (range 21 to 168 months) after the operation. Columnar-lined esophagus was detected in 8 patients a mean of 143.1 months (range, 85 to 230 months) after the operation. Mild to moderate dysplasia was found in 5 of 8 patients with columnar-lined esophagus a mean of 191.6 months after the operation (range, 152 to 287 months), and intramucosal adenocarcinoma was found in 1 patient with columnar-lined esophagus after 8 years. CONCLUSIONS: Dysphagia secondary to insufficient myotomy and periesophageal scarring recurs early, not later than 3 years. Conversely, abnormal gastroesophageal reflux with related complications can appear more than 10 years postoperatively. Five years after the operation the follow-up should be primarily endoscopic and histologic. Results should withstand a follow-up of at least 10 years.

Actuarial Analysis↗
PubMed1996

Detection of deglutition disorders after reconstructive laryngectomy. Clinical and radiological evaluations.

Subtotal reconstructive laryngectomy is an appropriate surgical procedure for intralaryngeal squamous cell carcinoma. After this surgery the functions of the larynx are greatly modified. These functions may be retained if at least one cricoaryténoid is preserved with good function. The aim of our study was to determine the recovery of swallowing in the late postoperative period and to establish the possible causes of dysphagia. 34 patients previously submitted to reconstructive laryngectomy were studied by clinical and endoscopical evaluation as well as videofluoroscopic examination. The results of our study confirm what has been reported by other authors, that is that the sphincter function greatly altered in the early postoperative period, is progressively restored, especially when both arytenoids are preserved. Videofluoroscopic examination frequently showed the asymptomatic false passage of liquid boluses.

Adult↗
PubMed1995

[The role of the radiological hemithorax examination in closed trauma of the chest].

January, 1992, to September, 1994, a hundred and seventy-eight blunt chest trauma patients were examined with plain chest films and detailed rib studies. The patients were subdivided into three groups according to: a) the presence/absence of rib fractures correlated with clinical data; b) the depiction of rib fractures and/or thoracic complications; c) treatment customization in the presence/absence of rib fractures. In our series of patients the clinical data and the presence of rib fractures were poorly correlated. The detection rates of minor and major complications were also investigated on plain chest films and detailed rib studies. Plain chest films most frequently depicted the complications requiring conservative or surgical management and gave the indication for further imaging investigations. The detailed rib studies of the involved hemithorax yielded no further information useful to therapy except in few cases: and should therefore be limited to the cases exhibiting complications on chest films, which may benefit from surgical fixation. The accurate study of rib fractures is paramount in the cases where legal action may be undertaken.

Humans↗
PubMed1993

Postoperative course of inflammatory abdominal aortic aneurysms.

Of 779 patients undergoing repair of abdominal aortic aneurysms over a 7-year period (1984-1990), 40 (5.1%) had gross features of inflammatory abdominal aortic aneurysms (IAAAs). Twenty IAAAs were assessed by CT scan preoperatively and postoperatively to evaluate the outcome of the inflammatory layer of the aneurysm in 19 cases. Complete postoperative regression was observed in nine cases (47.3%), partial regression in four (21%), and stable lesions in six (31.7%). No roentgenographic progression was found. The comparison between the roentgenologic outcome and preoperative clinical features (age, sex, erythrocyte sedimentation rate, and abdominal lumbar pain), pathologic findings, and follow-up time revealed a significant correlation (p < 0.05) between the postoperative outcome and the histologic findings in the wall (cell density and cell/fibrosis ratio). Complete regression of inflammation was observed when high cell density (16 +/- 0.7 cells/2116 microns 2) and a cell/fibrosis ratio > 1 were found. On the contrary, little or no regression of inflammation occurred when a low cell density (3.4 +/- 0.3 cells/2116 microns 2) and a cell/fibrosis ratio < 1 were found. Although it is generally thought that inflammation in IAAAs regresses after surgical repair, in our study, 31.7% of the postoperative CT scans showed no change. Histologically, the variability of morphologic aspects seemed to correlate with the relative proportions of cellular infiltrate and interstitial fibrosis in the aneurysmal wall. These proportions determine the postoperative course of the inflammation layer and, most likely, the response of the latter to steroid therapy as well.

Adult↗
PubMed1992

[Inherent problems of the use of magnetic resonance in patients with metallic implants currently used in orthopedic practice].

Forty-eight patients with oncologic prosthetic devices (modular rotatory shoulder, Kotz, custom made) and metallic means of fixation (Sherman's plates, Ender's rods, etc.) underwent MRI in order to: 1) assess possible physical changes in the magnetic field or the alloys under examination; 2) detect the presence and type of artifacts, and 3) verify the onset of eventual noxious effects of the alloy on the patient. The diagnostic investigation was preceded by an experimental phase which was characterized by: A) a study of the temperature fluctuations of the alloys when submitted to the magnetic field and to radiofrequency; B) the identification and characterization of the artifacts, as well as C) their physical interpretation. During examination, there was no evidence of any mobilization of the means of fixation, sensation of endogenous heat, or other subjective complaints on the part of the patient. The authors observed that, even in the presence of artifacts, MRI provided good evaluation of the soft tissues around the devices by identifying tumor recurrences in the presence of an oncological prosthesis. MRI was also capable of showing trophic changes in the tissues surrounding the means of fixation. Thus, the method exhibits no contraindications in the study of these patients but, on the other hand, does not allow the evaluation of the integrity or mobilization of the prosthetic devices.

Adolescent↗
PubMed1991

[Magnetic resonance in the study of Wilm's tumor and neuroblastoma].

Eleven patients suffering from neuroblastoma and Wilms' tumor were examined with MR imaging (25 examinations). The results were compared with those obtained with other diagnostic methods--e.g. CT--to verify MR reliability in locating and staging the lesions. Signal patterns were studied, as recorded on T1- and T2-weighted sequences using various repetition and echo times. An attempt was made to verify the presence of pathognomonic findings and to differentiate tumors from post-therapy fibroses. All findings were subsequently confirmed at biopsy or, in the patients who underwent surgery, by surgical findings. To carry out all the procedures, the patients had to be sedated or to be administered a general anesthetic. When possible, a brain or surface coil was used to obtain a clear, well-defined image in thin-section (7-8 mm) sequences. MR imaging allowed all lesions to be detected and located in the examined population. A large thrombus in the vena cava and local adenopathy were observed in a patients suffering from Wilms' tumor. Spread into the spinal canal was present in 2 cases of neuroblastoma. One of the main advantages of MR imaging is its multiplanarity which usually allows lesion extent to be demonstrated, together with the involved organs. The additional advantages of MR imaging over CT should not be underestimated. MR allows images of the abdomen to be obtained devoid of respiratory artifacts and provides a sharp contrast between pathological and healthy tissue without contrast medium administration. In all the patients who underwent it, MR imaging proved superior to CT in the evaluation of the intraspinal spread of paraspinal lesions. MR also allowed serial follow-up to be carried out, with no risk of subsequent proteximetric problems, thus helping distinguish tumor masses from fibrous tissue in all patients.

Abdominal Neoplasms↗
PubMed1991

[Imaging techniques in the staging of carcinoma of the esophagus].

Forty-four patients affected with thoracic esophageal carcinoma underwent preoperative CT to evaluate the value of this method in both staging and assessing the resectability of esophageal tumors. The authors compared the CT findings with intraoperative macroscopic ones, pathologic, and bronchoscopic results in mid-high neoplasms. CT staging criteria were drawn from a careful review of literature and from personal experience. Thirty-nine patients were submitted to surgery, and esophagectomy was possible in 34 of them. CT diagnostic accuracy was higher in proximal esophageal tumors than in sub-bronchial ones; as for the surgical choice, CT provided fundamental guidelines, especially if the choice was a blunt esophagectomy where it is important to exclude tumoral involvement of the airways (accuracy: 82.6%) or of the aorta (accuracy: 89.7%). CT staging accuracy was limited by the low sensitivity of the method in detecting lymphatic (local: 66.6%, distant: 64.2%) and hepatic metastases. Combined thoraco-abdominal CT, tracheobronchoscopy and liver US, besides MR imaging and endoscopic US, allow a better preoperative evaluation of esophageal carcinomas.

Adenocarcinoma↗
PubMed1985

[Radiological aspects and results of percutaneous ultrasonic nephrolithotripsy].

Percutaneous removal of renal stones is becoming an established procedure, especially for stones lying free in the renal pelvis. These techniques, which include: retrograde pyelography to facilitate a thorough understanding of caliceal anatomy and stone position in 3 dimensions; approaches for accurate placement of a nephrostomy tract for straightline access to the stone and stone removal are discussed.

Humans↗
PubMedDate not supplied

Dissection of the esophagus after dilatation of a cervical diaphragm.

The authors report a case of a very large esophageal mucosal dissection observed during an esophagoscopy performed 7 days after dilatation of a cervical esophageal web. They treated this dissection by positioning an endoesophageal balloon which obtained the fast, overlapping closure of the torn mucosal layers and at the same time allowed both gastric drainage and enteral feeding via a pump.

Aged↗