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V Panebianco

Publications and source records attributed to V Panebianco.

At least 37 records · Page 2Linked to original sources
PubMed1997

MR cholangiography (MRC) in the evaluation of CBD stones before laparoscopic cholecystectomy.

BACKGROUND: The aim of our work was to evaluate the predictive value of MR cholangiography (MRC) in detecting CBD stones before laparoscopic surgical treatment. METHODS: MRC was performed as a unique preoperative imaging modality in 45 selected patients (16 male; 29 female; age range: 28-72; mean age: 54.4) before laparoscopic cholecystectomy. MRC imaging was obtained with a 3D Turbo Spin-Echo sequence (TR = 3000 ms, TE = 700 ms, Echo Train Length--128) with an acquisition time of 5 min 48 s. Diagnostic confirmation was obtained in all the cases at i.o. cholangiography. When a stone was detected it was removed by transcystic or transcholedochal approach. RESULTS: Eighteen of the 45 patients (40%) had CBD stones. MRC correctly evaluated 16 out of 18 stones, with a resulting sensitivity of 88.9%, specificity 100%, positive predictive value 100%, negative predictive value 90%, and accuracy 95.6%. CONCLUSIONS: Despite the good results of MRC, it cannot be proposed as a screening technique to be performed in all patients submitted to laparoscopic cholecystectomy due to high cost and the limited amount of MR equipment. In conclusion, only selected patients should be submitted to MRC before laparoscopic cholecystectomy.

Adult↗
PubMed1997

Magnetic resonance-cholangiopancreatography in the diagnosis of biliopancreatic diseases.

BACKGROUND: Magnetic resonance cholangiopancreatography (MRCP) is a new, noninvasive imaging technique for the visualization of the biliary ducts with cholangiographic images similar to those obtained with endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography. No contrast medium injection is used. The aim of this study was to assess the feasibility of MRCP versus ERCP in the diagnosis of biliary tract and pancreatic diseases. PATIENTS AND METHODS: One hundred and thirty-six patients were submitted to MRCP. They were referred to MR study according to four inclusion criteria: (1) evidence or suspicion of choledocholithiasis, (2) benign or malignant bile ducts stenosis, (3) follow-up of patients submitted to biliary-enteric anastomosis, and (4) chronic pancreatitis with Wirsung duct dilatation. The MRCP was performed with a 0.5T superconducting magnet (Philips Gyroscan T5). When neoplastic disease was detected, additional images on axial planes were acquired. MRCP allowed images of diagnostic value to be obtained in all the cases. RESULTS: In choledocholithiasis, MRCP showed 91.6% sensitivity, 100% specificity, and overall diagnostic accuracy 96.8%. Of 48 patients with stenotic lesions, 16 were correctly characterized as benign and 30 as malignant. Two cases of focal chronic pancreatitis were misdiagnosed as pancreatic head carcinoma. In the patients submitted to biliary-enteric anastomosis, MCRP was able to detect the dilatation of the intrahepatic ducts, the stenosis, and associated stones in all 8 positive cases. In the remaining 7 patients with mild signs of cholangitis, MCRP showed irregular aspects of the biliary tree in the main ducts. In the 11 patients with chronic pancreatitis, MCRP was able to depict the dilated Wirsung duct and the stenotic tract, although the fine details of the secondary ducts were not evaluated due to the low spatial resolution as compared with conventional films. CONCLUSIONS: MRCP can be considered a technique able to completely replace diagnostic ERCP. Further studies are necessary for a better evaluation of the potential advantages and disadvantages of this technique.

Adult↗
PubMed1997

MR cholangiography in the examination of patients with biliary-enteric anastomoses.

OBJECTIVE: The aim of our study was to determine the role of MR cholangiography in the noninvasive examination of patients with biliary-enteric anastomoses. SUBJECTS AND METHODS: Twenty-four patients (nine men and 15 women; mean age, 68.9 years old) with biliary-enteric anastomoses underwent MR cholangiography. We used a fat-suppressed three-dimensional turbo spin-echo sequence (3000/700 [TR/TE]; echo train length, 128) with no breath-hold, optimized with a 0.5-T magnet. Imaging studies were performed because of scheduled follow-up (five patients), persistent jaundice (six patients), cholangitis and abnormal liver function (eight patients), and a combination of transient jaundice, epigastric pain, and abnormal liver function (five patients). RESULTS: Image quality was graded from optimal to good in 21 (88%) of 24 cases and poor in three (13%) of 24 cases. The degree of bile duct dilatation was correctly assessed, with complete agreement between the two observers in all cases. MR cholangiography correctly showed bile duct irregularities in six of the eight patients with cholangitis (kappa = .59), anastomotic strictures in all 19 patients with strictures (kappa = .86), and 3- to 15-mm stones in nine of 10 patients (kappa = .95). A slight overestimation of the strictures occurred in four of the 19 cases with strictures. CONCLUSION: MR cholangiography is a reliable imaging technique for the examination of patients with biliary-enteric anastomoses.

Aged↗
PubMed1997

[Surgical treatment of spontaneous pneumothorax: comparison of thoracotomy and thoracoscopy].

The video-thoracoscopic treatment of spontaneous pneumothorax currently has the same role of laparoscopic cholecystectomy in abdominal surgery. The Authors consider thoracoscopic approach and traditional thoracotomy examining advantages versus disadvantages, comparing 50 patients with spontaneous pneumothorax treated by thoracoscopy, from February 1992 up to February 1995, and 50 patients, previously treated by open surgery. Video-thoracoscopy has the same percentage of recurrences of thoracotomic approach but assures a quicker functional recovery and, above all, a remarkable reduction of pain.

Adult↗
PubMed1997

[MR cholangiopancreatography: technique, indications and clinical results].

INTRODUCTION: MR cholangiopancreatography (MRCP) is a new noninvasive imaging technique for the study of biliopancreatic disorders, providing projectional images of the biliary tree and pancreatic duct without any contrast agent. MATERIAL AND METHODS: We used different sequences, with both breath-hold and nonbreath-hold techniques, to acquire MRCP images, first based on GE and then on FSE sequences. FSE images provide higher SNR and are less susceptible to artifacts (metal objects, motion and blood flow artifacts). At the Department of Radiology of the University of Rome La Sapienza, we acquired MRCP images with non breath-hold, 3D fat-suppressed TSE sequences (TR = 3000-2000, TE 700, turbo factor 128) optimized on a .5T magnet with 15 mT/m gradients. No patient preparation or sedation was required, although antiperistaltic drugs and oral administration of tap water were preferred. Four hundred and thirty patients were examined, all of them with an indication to conventional cholangiography. RESULTS: MRCP depicted the whole common bile duct and the first-order intrahepatic branches in all the normal cases. Its accuracy in identifying biliary obstruction level and site was 100%, versus 94.6% in characterizing its cause. MRCP had 96.3% diagnostic accuracy in choledocholithiasis, with some false positives and false negatives caused by: 1) small stones missed on MIP reconstructions; 2) signal loss due to complete CBD obstruction by stones; 3) pneumobilia; 4) differential diagnosis between small stones and air bubbles. The main role of MRCP in benign strictures is to provide a detailed map of the biliary tract for better treatment planning. In particular, MRCP is extremely useful in hepaticojejunostomy patients, where ERC is not indicated because of postoperative anatomical changes. Both conventional MRI and MRCP are important in malignant strictures to identify the lesion and to characterize and stage it. Finally, MR pancreatography is very useful to follow up chronic pancreatitis patients because it shows Wirsung duct strictures and dilatations, intraductal filling defects and, in some cases, the communication between the pseudocyst and the pancreatic duct. CONCLUSIONS: MRCP combined with conventional MRI can completely replace CT and ERCP in bilio-pancreatic disorders.

Adult↗
PubMed1996

Radiology information and image management system: new approach to PACS with hypermedia capabilities of personal computers.

A system for archiving patient data and images was developed, installed, and evaluated in a radiology department. The system was developed with a relational database program for use with commercially available computers linked with an Ethernet network. The main options of the system are those of a conventional radiology information system: scheduling, registration, examination execution, reporting, archives and statistics, and system administration. However, the main feature of the system is the image archiving capability. Images are associated with patient records after capture by direct acquisition of the video signal or by scanning. Only relevant pathologic images are archived and a commonly employed compression algorithm is used, reducing the total memory requirement for each case to 200-600 kbytes. The diagnosis is still made by reading the original images. The low-resolution images stored in the system have an important role in teaching and consultation and as a first-line archive. Good results have been obtained with this system, which is used by medical and nonmedical staff without any special training.

Humans↗
PubMed1996

[Magnetic resonance pyelography: optimization of the technic and the preliminary results].

Magnetic resonance pyelography (MRP) is a new noninvasive method which demonstrates dilated urinary tracts with no need of contrast agent injection. This study was aimed at technique optimization, using new fast sequences with high intrinsic contrast, to demonstrate the urinary tract in obstructive uropathy patients. Twelve consecutive patients and 4 healthy volunteers were included in this prospective study; all the exams were performed with a high gradient power 0.5-T unit using T2- weighted turbo SE sequences, acquired three-dimensionally on the coronal plane. Obstructive uropathy was caused in 9 patients by neoplastic lesions, in 2 by postoperative strictures and in 1 by inflammatory tissue. In all patients MRP depicted the dilated urinary tract optimally, with good morphological detailing and the accurate assessment of both level and cause of obstruction. In the healthy volunteers, the absence of dilatation did not permit the complete visualization of the urinary tract. To conclude, MRP is a new technique which permits high-quality imaging of the urinary tract. Further studies are needed to assess its actual potentials and clinical role.

Adult↗
PubMed1996

[Lithiasis of the common bile duct: the role of cholangiography and magnetic resonance].

The aim of our study was to evaluate the sensitivity, specificity and diagnostic accuracy of Magnetic Resonance Cholangiography (MR-CP) in patients with suspected choledocholithiasis. Sixty-two patients (mean age: 56.3 years) previously submitted to US, were examined with MRCP. MR exams were performed with an 0.5 T superconductive magnet (Gyroscan T5-II; Philips, Medical System, Best, NL) and a body coil. 3D-TSE sequences (TR/TE/ETL = 5.000/244/45 ms) were acquired, with 14 min 10 sec acquisition time. In the last 21 patients, acquisition time was reduced down to 3 min, by optimizing the parameters as follows: TR/TE/ETL = 3.000/700/128 ms. The images, obtained on the coronal plane, were then reconstructed with the MIP algorithm. MRCP images were studied both as MIP reconstructions and as single slices. The diagnosis was always compared with endoscopic or percutaneous findings. MRCP images were of diagnostic quality in all cases, with 91.7% sensitivity, 100% specificity and 96.8% diagnostic accuracy. MRCP had 100% positive predictive value and 95% negative predictive value. In conclusion, this technique is extremely useful to examine the patients with obstructive jaundice secondary to lithiasis.

Adult↗
PubMed1996

[Usefulness of the new sequences of magnetic resonance in the study of hepatic hydatidosis].

We investigated the role of new MR Imaging techniques for the diagnosis, characterization and staging of hepatic hydatid disease. We examined 21 patients (30 hydatid cysts), 7 men and 14 women, ranging in age 26 to 74 years, with known hydatid disease. MR examinations were carried out on a 0.5T superconductive magnet (Philips Gyroscan T5, Philips Medical System) with the following imaging protocol: T1w (TR/TE/NEX: 300/10/4) SE, T2w (TR/TE/NEX: 3000/120/6) TSE and fat suppressed (SPIR technique) T2w (TR/TE/NEX: 3000/120/6) sequences. MR Angiography examinations were performed with 2D Time of Flight sequences (TR = 33 ms; TE = 6.9 ms; flip angle = 60 degrees; slice thickness = 4.0 mm with 2.0 mm overlapping; matrix = 256 x 256; number of slices = 45-50; acquisition time = 4 min 19 s), while MR cholangiography was performed with 3D, fat suppressed (SPIR) Turbo Spin-echo (TSE) sequences (TR = 3000 ms, TE = 700 ms, ETL = 12, acq. time = 5 min 48 s). MRI correctly detected all the hydatid cysts on both T1- and T2-weighted images. Characterization was correct in all the cysts larger than 3 cm, where typical signs consistent with hydatid disease were detected. MRA images always showed the inferior vena cava and the splenoportal system. The portal vessels were demonstrated only up to the first branches. In 3 cases an extrinsic compression of the inferior vena cava was diagnosed. MRC, performed in 7 cases, showed normal main bile duct caliber in 6 cases, while in another case, where a cyst ruptured inside the bile ducts, the communication between the cyst and the bile ducts was clearly demonstrated. In conclusion, MR Imaging is a valuable tool in the study of liver hydatid disease. Moreover, the availability of such new MR techniques as MRC and MRA, greatly improves the diagnostic role of MR imaging, especially when studying complications and before surgery.

Adult↗
PubMed1996

[Cholangiography with magnetic resonance in the diagnosis of main common bile duct calculi in candidates to laparoscopic cholecystectomy].

The aim of our work was to investigate Magnetic Resonance Cholangiography (MRC) capabilities in detecting common bile duct (CBD) stones in patients to be submitted to laparoscopic cholecystectomy. MRC was performed as the only preoperative imaging modality in 45 selected patients (16 men and 29 women; age range: 28-72 years, mean age: 54.4 years) before laparoscopic cholecystectomy. MRC images were obtained with 3D Turbo Spin-Echo sequences (TR = 3000 ms, TE = 700 ms, echo train length = 128) with an acquisition time of 5 min 48 sec. Diagnostic confirmation was obtained in all the patients at intraoperative cholangiography. When a stone was detected, it was removed by transcystic or transcholedochal approach. Eighteen of 45 patients (40%) had CBD stones. MRC correctly demonstrated 16 of 18 stones, with 88.9% sensitivity, 100% specificity, 100% positive predictive value, 90% negative predictive value and 95.6% accuracy. Despite the good results we obtained with MRC, this technique cannot be proposed as a screening method to be performed in all the patients candidate to laparoscopic cholecystectomy because of its high cost and of the limited number of MR units available. In conclusion, only selected patients should be submitted to MRC before laparoscopic cholecystectomy.

Adult↗
PubMed1995

[Pleuroscopy and talc pleurodesis in recurrent pleural effusions: experience with 51 cases].

From January '92 up to January '94 thoracoscopy was performed in 51 patients with recurrent pleural effusion: 49 of these patients underwent talc pleurodesis. 10 pleural mesotheliomas, 29 diffuse metastasic pleural involvement and 12 benign effusions were diagnosed. Intrapleural talc therapy allowed a definitive pleurodesis in 43 patients with a success rate of 87%.

Female↗
PubMed1994

Preoperative carcinoembryonic antigen level as a prognostic indicator in resected primary lung cancer.

The aim of this study was to evaluate the prognostic significance of elevated preoperative carcinoembryonic antigen (CEA) levels in cases of resected primary lung cancer. Between 1985 and 1989, 152 patients with tumors and CEA levels above 10 ng/mL underwent operation. One hundred twenty-five of them underwent resection of their tumors and the other 27 underwent exploratory thoracotomy only. Fifty-two percent of cancers were adenocarcinomas and 33% were epidermoid. Forty-two resected tumors were classified as stage I, 29 as stage II, 45 as stage IIIa, 7 as stage IIIb, and 2 as stage IV. The 3-year actuarial survival rate was 54% for patients with stage I tumors, 28% for those with stage II, 18% for those with stage IIIa, 44% for those with stage IIIb, and 0% for those with stage IV tumors. The 5 year actuarial survival was 40% for those with stage I tumors, 28% for those with stage II, 7% for those with stage IIIa, and 0% for those with stage IIIb tumors. Preoperative CEA levels increased from stage I to stage IIIa (p < 0.05). However, based on preoperative CEA levels we were not able to predict resectability, because levels were not significantly different between stage IIIa and exploratory thoracotomy-only groups. Adenocarcinoma was not significantly associated with higher CEA levels than was epidermoid, except in stage IIIa disease (p < 0.05). We found a critical unfavorable level of prognostic significance at 30 ng/mL.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1994

[Low anterior resection of the rectum using mechanical anastomosis in intestinal endometriosis].

A case of sigmoid-rectal endometriosis prompted the authors to focus attention on the question of indications for surgery and operative tactics in intestinal endometriosis. In this case, the presence of a pelvic mass which could not be cut away from the intestinal wall without the risk of perforation led to the performance of a low anterior resection of the rectum with mechanical stapler, a choice which was certainly radical but necessary in view of the impossibility of excluding the malignant nature of the mass either macroscopically or extemporaneously.

Adult↗
PubMed1994

[Surgery in neoplasms of the low rectum. Analysis of the Knight-Griffen technique].

The major advantage offered by the "double stapling technique" in the treatment of low rectum cancers is sphincter preservation while respecting oncological criteria of radicality. The authors report their experience in surgical treatment of rectal neoplasms, considering a 24 patient group observed between 1989 and 1991, when new staplers were available in Italy. They also present primary results obtained with modified Knight-Griffen technique evaluating a series of 10 patients with rectal cancers placed between 5 and 10 cm from the anal verge. The authors describe surgical procedures and, analyse the complication rate, report a 10% anastomotic leak with no clinical stenosis and 20% relapses. Showing a 2-year follow-up data, a 61.1% surviving actually free of disease in the all 24-patient group is referred. The authors conclude that double stapling technique, while safe and effective, should be always performed accordingly to oncological radicality, reminding that the aim of surgery is the treatment of cancer and sphincter saving should be considered secondary.

Adenocarcinoma↗
PubMed1993

[Malignant mesothelioma located in the pleura: its radical surgical treatment].

The authors report a rare case of localized malignant pleural mesothelioma infiltrating the thoracic wall. The absence of widespread pleural involvement allowed for a radical operation with removal of a large portion of the thoracic wall. However, due to rarity of such tumor, an hypothesis on long term prognosis is difficult to formulate.

Humans↗