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Pascual T, Martín M, Pare L, Alba E, Rodríguez-Lescure A, Perrone G, Cortés J, Morales S, Lluch A, Urruticoechea A, Galván P, Rodríguez A, Chic N, Righi D, Cejalvo J, Tonini G, Adamo B, Vidal M, Muñoz M, Prat A. NOLUS: a predictive model to identify Basal-like and HER2-enriched intrinsic subtypes based on estrogen receptor (ER), progesterone receptor (PR) and Ki67 immunohistochemistry (IHC) in hormone receptor-positive/HER2-negative (HR+/HER2–) breast cancer (BC). Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30638-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Brillatz T, Lauritano C, Jacmin M, Khamma S, Marcourt L, Righi D, Romano G, Esposito F, Ianora A, Crawford AD, Queiroz EF, Wolfender JL. Anticonvulsant Principle Isolation of the Marine Diatom Skeletonema marinoi. Am J Transl Res 2017. [DOI: 10.1055/s-0037-1608118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- T Brillatz
- School of Pharmacy, University of Geneva, University of Lausanne, rue Michel Servet 1, CH-1211, Geneva 4, Switzerland
| | - C Lauritano
- Stazione Zoologica Anton Dohrn, Villa Comunale, 80121, Napoli, Italy
| | - M Jacmin
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, 6, avenue du Swing, 4367 Belvaux, Luxembourg, Luxembourg
| | - S Khamma
- School of Pharmacy, University of Geneva, University of Lausanne, rue Michel Servet 1, CH-1211, Geneva 4, Switzerland
| | - L Marcourt
- School of Pharmacy, University of Geneva, University of Lausanne, rue Michel Servet 1, CH-1211, Geneva 4, Switzerland
| | - D Righi
- School of Pharmacy, University of Geneva, University of Lausanne, rue Michel Servet 1, CH-1211, Geneva 4, Switzerland
| | - G Romano
- Stazione Zoologica Anton Dohrn, Villa Comunale, 80121, Napoli, Italy
| | - F Esposito
- Stazione Zoologica Anton Dohrn, Villa Comunale, 80121, Napoli, Italy
| | - A Ianora
- Stazione Zoologica Anton Dohrn, Villa Comunale, 80121, Napoli, Italy
| | - AD Crawford
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, 6, avenue du Swing, 4367 Belvaux, Luxembourg, Luxembourg
| | - EF Queiroz
- School of Pharmacy, University of Geneva, University of Lausanne, rue Michel Servet 1, CH-1211, Geneva 4, Switzerland
| | - JL Wolfender
- School of Pharmacy, University of Geneva, University of Lausanne, rue Michel Servet 1, CH-1211, Geneva 4, Switzerland
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Di Mambro C, Drago F, Milioni M, Russo MS, Righi D, Placidi S, Remoli R, Palmieri R, Gimigliano F, Santucci LM, Silvetti MS, Prosperi M. Sports Eligibility After Risk Assessment and Treatment in Children with Asymptomatic Ventricular Pre-excitation. Sports Med 2016; 46:1183-90. [DOI: 10.1007/s40279-016-0475-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pantano F, Perrone G, Vincenzi B, Iuliani M, Fioramonti M, Zoccoli A, Ribelli G, Borzomati D, Nappo G, Pellegrini C, Amato M, Righi D, Di Matteo F, Trodella L, Santini D, Coppola R, Onetti-Muda A, Tonini G. Long non-coding RNA HSAT II as a new biomarker for the identification of high risk intraductal papillary mucinous neoplasms (IPMNs). Ann Oncol 2015. [DOI: 10.1093/annonc/mdv344.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Di Mambro C, Russo MS, Righi D, Placidi S, Palmieri R, Silvetti MS, Gimigliano F, Prosperi M, Drago F. Ventricular pre-excitation: symptomatic and asymptomatic children have the same potential risk of sudden cardiac death. Europace 2014; 17:617-21. [DOI: 10.1093/europace/euu191] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 06/12/2014] [Indexed: 01/02/2023] Open
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Ciuti G, Righi D, Forzoni L, Fabbri A, Pignone AM. Differences between internal jugular vein and vertebral vein flow examined in real time with the use of multigate ultrasound color Doppler. AJNR Am J Neuroradiol 2013; 34:2000-4. [PMID: 23721896 DOI: 10.3174/ajnr.a3557] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The hypothesis that MS could be provoked by a derangement of the blood outflow from the brain has been largely discredited. In part, it was because data on the normal pattern of outflow are scarce and obtained with different methods. The aim of this study was to evaluate the normal pattern of outflow for the vertebral and internal jugular veins in healthy subjects with multigate color Doppler. MATERIALS AND METHODS Twenty-five volunteers were studied to assess vessel area, mean velocity, and flow for the vertebral and internal jugular veins in the supine and sitting positions. RESULTS In the sitting position, flow decreases, both in vertebral veins and internal jugular veins, as the total vessel area decreases (from 0.46 ± 0.57 to 0.09 ± 0.08 cm(2)), even if the mean velocity increases (from 12.58 ± 10.19 to 24.14 ± 17.60 cm/s). Contrary to what happens to the blood inflow, outflow in the supine position, through vertebral and internal jugular veins, is more than twice the outflow in the sitting position (739.80 ± 326.32 versus 278.24 ± 207.94 mL/min). In the sitting position, on application of very low pressure to the skin with the sonography probe, internal jugular veins rarely appear to occlude. A pronounced difference of diameter between internal jugular veins was present in approximately one-third of subjects. CONCLUSIONS Our results support the view that other outflow pathways, like the vertebral plexus, play a major role in the normal physiology of brain circulation and must be assessed to obtain a complete picture of blood outflow.
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Affiliation(s)
- G Ciuti
- From SOD Medicina Interna ad Orientamento all'Alta Complessità Assistenziale 3, Dipartimento di Medicina Interna e di Urgenza
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Drago F, Righi D, Placidi S, Russo MS, Di Mambro C, Silvetti MS, Prosperi M. Cryoablation of right-sided accessory pathways in children: report of efficacy and safety after 10-year experience and follow-up. Europace 2013; 15:1651-6. [DOI: 10.1093/europace/eut122] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Antignani PL, Benedetti-Valentini F, Aluigi L, Baroncelli TA, Camporese G, Failla G, Martinelli O, Palasciano GC, Pulli R, Rispoli P, Amato A, Amitrano M, Dorigo W, Gossetti B, Irace L, Laurito A, Magnoni F, Minucci S, Pedrini L, Righi D, Verlato F. Diagnosis of vascular diseases. Ultrasound investigations--guidelines. INT ANGIOL 2012; 31:1-77. [PMID: 23470846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Forzoni L, D’Onofrio S, Beni SD, Laganà MM, Kolev V, Baselli G, Ciuti G, Righi D. Virtual Navigator Tridimensional Panoramic Imaging in Transcranial Application. BIOMED ENG-BIOMED TE 2012. [DOI: 10.1515/bmt-2012-4282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | | | - M. M. Laganà
- MRI Laboratory, Fondazione Don Carlo Gnocchi ONLUS, IRCCS S. Maria Nascente, Milano, Italy
| | | | - G. Baselli
- Dipartimento di Bioingegneria, Politecnico di Milano, Milano, Italy
| | - G. Ciuti
- Medical and Surgical Critical Care Department, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - D. Righi
- Angiology Department, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
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Forzoni L, Righi D, Ciuti G, Morovic S, Zavoreo I, Mecacci F, Bussadori C, Tortoli P. Multigate Quality Doppler Profiles Technology in Vascular, Obstetrics and Cardiology Applications. BIOMED ENG-BIOMED TE 2012. [DOI: 10.1515/bmt-2012-4270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - D. Righi
- Angiology Department, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - G. Ciuti
- Medical and Surgical Critical Care Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - S. Morovic
- Neurology Department, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - I. Zavoreo
- Neurology Department, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - F. Mecacci
- Obstetrics and Gynecology 2 Department, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - C. Bussadori
- Pediatric Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - P. Tortoli
- Microelectronics Systems Design Laboratory, Università degli Studi di Firenze, Firenze, Italy
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Fonio P, Cassinis MC, Rapellino A, Righi D, Gandini G. Interventional radiology in the treatment of early postoperative biliary complications. Radiol Med 2012; 118:386-400. [PMID: 22872455 DOI: 10.1007/s11547-012-0863-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 09/27/2011] [Indexed: 12/15/2022]
Abstract
PURPOSE We sought to evaluate the feasibility and efficacy of percutaneous treatment of early postoperative biliary complications. The primary aims were to evaluate clinical and technical success and complications and perioperative mortality, and secondary aims were to evaluate treatment duration and recurrence rate. MATERIALS AND METHODS Between March 2007 and March 2010, 75 patients (42 men and 33 women; age range, 17-88 years; mean age, 60.8 years) underwent interventional radiology procedures to treat early postoperative biliary complications of biliary and pancreatic-duodenal surgery with biliodigestive anastomosis (37.7%), laparoscopic cholecystectomy (30.6%), hepatic resection (21.1%) and several other surgical procedures (10.6%). Complications included fistulas (73%), stenoses (20%) and complete bile duct transections (7%). RESULTS Interventional radiology achieved complete clinical success in 74 cases (85.9%) and in particular in 95.2% of fistulas, 76.5% of stenoses and 33.3% of complete bile duct transections. Mean indwelling catheter time was 34.9 days, with an average of 4.1 procedures. There were two cases of severe haemobilia (2.3%). Minor complications occurred in 7% of cases. Perioperative mortality rate was 1.2% and overall recurrence rate 6.7% (range, 1-18 months; mean, 10 months), with recurrences occurring predominantly in stenoses. All patients were retreated successfully. CONCLUSIONS Percutaneous procedures are feasible, effective and safe for treating early postoperative biliary complications. They provide a valuable alternative to presendoscopy, which is precluded in many of these patients, and to surgery, which has higher morbidity and mortality rates.
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Affiliation(s)
- P Fonio
- Istituto di Radiologia, Università degli Studi di Torino, Ospedale S Giovanni Battista di Torino, Torino, Italy.
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Gazzera C, Fonio P, Gallesio C, Camerano F, Doriguzzi Breatta A, Righi D, Veltri A, Gandini G. Ultrasound-guided transhepatic puncture of the hepatic veins for TIPS placement. Radiol Med 2012; 118:379-85. [PMID: 22744357 DOI: 10.1007/s11547-012-0853-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 11/09/2011] [Indexed: 12/28/2022]
Abstract
PURPOSE This retrospective analysis was carried out to assess the feasibility and results of transjugular intrahepatic portal systemic shunt (TIPS) performed with ultrasound (US)-guided percutaneous puncture of the hepatic veins. MATERIAL AND METHODS Over a period of 3 years, 153 patients were treated with TIPS at our centre. In eight cases, a percutaneous puncture of the middle (n=7) or right (n=1) hepatic vein was required because the hepatic vein ostium was not accessible. Indications for TIPS were bleeding (n=1), Budd-Chiari syndrome (n=1), ascites (n=2), reduced portal flow (n=1) and incomplete portal thrombosis (n=3). A 0.018-in. guidewire was anterogradely introduced into the hepatic vein to the inferior vena cava (IVC) through a 21-gauge needle. In the meantime, a 25-mm snare-loop catheter was introduced through the jugular access to retrieve the guidewire, achieving through-andthrough access. Then, a Rosch-Uchida set was used to place the TIPS with the traditional technique. RESULTS Technical success was achieved in all patients. There was one case of stent thrombosis. One patient died of pulmonary oedema. Three patients were eligible for liver transplantation, whereas the others were excluded due to shunt thrombosis (n=1) and previous nonhepatic neoplasms (n=3). CONCLUSIONS The percutaneous approach to hepatic veins is rapid and safe and may be useful for avoiding traumatic liver injuries.
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Affiliation(s)
- C Gazzera
- Istituto di Radiologia, Università degli Studi di Torino, Ospedale S. Giovanni Battista di Torino, Torino, Italy.
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Gazzera C, Righi D, Valle F, Ottobrelli A, Grosso M, Gandini G. Fifteen years' experience with transjugular intrahepatic portosystemic shunt (TIPS) using bare stents: retrospective review of clinical and technical aspects. Radiol Med 2008; 114:83-94. [PMID: 19082786 DOI: 10.1007/s11547-008-0349-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Accepted: 05/09/2008] [Indexed: 02/06/2023]
Abstract
PURPOSE The authors present a retrospective analysis of a large series of patients who underwent transjugular intrahepatic portosystemic shunt (TIPS) placement. MATERIALS AND METHODS Between March 1992 and December 2006, 658 patients were referred to our centre for TIPS placement. Indications for the procedure were digestive tract bleeding (52.8%), refractory ascites (35.3%), preservation of portal vein patency prior to liver transplantation (3.0%) and thrombosis of the suprahepatic veins (2.3%). Other indications (6.6%) included pleural ascites, portal thrombosis and hepatorenal and hepatopulmonary syndromes. All patients were evaluated with colour Doppler ultrasonography and in a few cases with computed tomography. The portal system was punctured under sonographic guidance. Wallstent, Palmaz and Nitinol thermosensitive stents were used. Embolisation of persistent varices was performed in 6.8% of cases. RESULTS Technical success was 98.9%. During a 1,500-day follow-up, the cumulative incidence of stent revision was 25.7% (Nitinol), 32.9% (Wallstent) and 1.8% (Palmaz). Mortality rates were 31.1%, 38.5% and 56.4%, respectively. The technical complications included six cases of heart failure, six of haematobilia, three of stent migration, two of intrahepatic haematoma and one of haemoperitoneum. Eight patients with severe portosystemic encephalopathy (PSE) were treated with a reduction stent. CONCLUSIONS TIPS placement is safe and effective and may act as a bridge to liver transplantation. Ultrasonography plays a fundamental role in the preliminary assessment, in portal vein puncture and during the follow-up. Stent patency is satisfactory.
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Affiliation(s)
- C Gazzera
- Diagnostic and Interventional Radiology Institute, A.S.O. San Giovanni Battista, Via Genova 3, 10126, Turin, Italy.
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Righi D, Doriguzzi A, Rampado O, Savio L, Faletti R, Caggiula P, Ropolo R, Gandini G. Interventional procedures for biliary drainage with bilioplasty in paediatric patients: dosimetric aspects. Radiol Med 2008; 113:429-38. [DOI: 10.1007/s11547-008-0252-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Accepted: 06/11/2007] [Indexed: 11/30/2022]
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Sacchetto P, Veltri A, Cena V, Gisolo F, Gennari F, Salizzoni M, Righi D, Gandini G. The radiologist's role in managing paediatric liver transplantation: personal experience with 40 patients. Radiol Med 2007; 112:456-71. [PMID: 17440700 DOI: 10.1007/s11547-007-0128-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Accepted: 08/20/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of our study was to evaluate the radiologist's role in managing paediatric orthotopic liver transplantation (OLT) through a retrospective review of our experience in diagnosing and treating post-OLT complications. MATERIALS AND METHODS Forty children (mean age 4.6 years) underwent 44 OLTs over 71 months. The follow-up period (mean 724 days) was divided into three phases: hospital stay, up to three months after discharge and subsequent period. The number and type of radiological examinations, radiologically detectable complications and interventional procedures were analysed. RESULTS Most examinations were carried out with ultrasound (US) (859/931 of all radiological studies performed during the first two phases, 92.3%). Colour-Doppler US enabled early detection and treatment of all vascular complications (9/40, 22.5% of patients; 13 complications in nine patients, eight arterial and five portal complications; 1.4 for each patient with complications). Computed tomography (CT) or angiography was very rarely employed. US also detected biliary complications (11 patients, 27.5%: three cases of segmental ducts excluded from the anastomosis, four cases of stenosis of the biliodigestive anastomosis, one lithiasis, three stenoses associated with lithiasis), which were successfully managed in 75% of the cases treated with interventional radiology procedures (percutaneous bilioplasty and/or lithotripsy). At the time of writing this paper, the patient survival rate was 100%, and the organ survival rate was 91% (40/44). There were four re-transplantations: three due to hepatic artery thrombosis and one to biliary stenosis with lithiasis. CONCLUSIONS The radiologist's role is fundamental for early sonographic diagnosis of post-OLT complications in children. Vascular complications are often associated in a single patient, and early treatment may improve the prognosis. Interventional radiology represents a safe and effective treatment for many biliary complications.
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Affiliation(s)
- P Sacchetto
- Istituto di Radiologia, Università di Torino, Via Genova 3, I-10126 Turin, Italy
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Antignani PL, Gossetti B, Righi D, Amato A, Annoni F, Impagliatelli M, Pedrini L, Pulli R, Verlato F. Accreditation process for the performance of ultrasound vascular diagnostics procedures. Minerva Cardioangiol 2005; 53:485-506. [PMID: 16179889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- P L Antignani
- Executive Board of the Italian, Society for Vascular Investigation, Italy.
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Gazzera C, Doriguzzi Breatta A, Veltri A, Righi D, Barbero S, Balderi A, Petracchini M, Gandini G. Femoral haemostosis with Vasoseal ES: experience in 150 patients. Radiol Med 2005; 109:118-24. [PMID: 15729192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
PURPOSE The aim of this study is to assess the effectiveness and safety of the use of Vasoseal ES collagen plug in heavily anticoagulated patients with high risk of complications at the vascular access site who had undergone vascular radiological intervention. MATERIALS AND METHODS Between January 2002 and March 2003 180 consecutive transfemoral arterial accesses in 169 patients subjected to vascular radiological procedures were performed (bilateral access was performed in 11 patients): 140 percutaneous transluminal angioplasties and 40 transarterial chemoembolisations. All the patients who underwent angioplasty were given 3,000 IU of sodic heparin intravenously during the procedure and later a prolonged antiaggregant therapy was undertaken (ticlopidine 500 mg/day and aspirin 150 mg/day). The sheaths were removed at the end of the surgical manoeuvre and two cartridges of collagen were positioned on the external surface of the artery. The mean values of platelets and partial thromboplastin time were 42,000/ml and 170 s, respectively, in cirrhotic patients against 250,000/ml and 200 s in patients with peripheral arteriopathy. The next day a colour Doppler examination was performed at the puncture site. RESULTS The technique proved successful in 89.4% of cases (161/180). In 19/180 vascular accesses placement of the haemostatic cartridges was not possible owing to the inability to compress the common femoral artery proximal to the release site (4/19), owing to a pre-existing haematoma (5/19) and owing to the limited presence of subcutaneous tissue (10/19). The mean time required for the placement of Vasoseal ES was 4 min. The mean time-to-haemostasis was 6 min. The mean time-to-mobilisation was 4 hr. Only in two patients was there an onset of a pseudoaneurysm of the right common femoral artery; the lesions were treated with ultrasonography -guided compression. In addition, 16 small local haematomas were recorded. In 4 cases early re-puncture of the femoral artery was performed (24-48 hr following the use of the device) without consequences. CONCLUSIONS Vasoseal ES is a safe collagen closure device characterised by a high success rate. In anticoagulated patients the device can reduce the time-to-mobilisation and the incidence of complications.
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Affiliation(s)
- C Gazzera
- Istituto di Radiologia. Università di Torino, Ospedale San Giovanni Battista, Torino, Italy. carlogazzera.inwind.it
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Antignani PL, Gossetti B, Righi D, Amato A, Annoni F, Impagliatelli M, Pedrini L, Pulli R, Verlato F. Vascular diagnosis laboratory. Workloads and indications. Minerva Cardioangiol 2004; 52:447-64. [PMID: 15514578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- P L Antignani
- Executive Committee of the Italian Society for Vascular Investigation, SIDV-GIUV, Italy.
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Chiò A, Galletti R, Finocchiaro C, Righi D, Ruffino MA, Calvo A, Di Vito N, Ghiglione P, Terreni AA, Mutani R. Percutaneous radiological gastrostomy: a safe and effective method of nutritional tube placement in advanced ALS. J Neurol Neurosurg Psychiatry 2004; 75:645-7. [PMID: 15026518 PMCID: PMC1739007 DOI: 10.1136/jnnp.2003.020347] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Enteral nutrition may be required in amyotrophic lateral sclerosis (ALS), and is usually achieved by percutaneous endoscopic gastrostomy (PEG). As PEG is not indicated in patients with severe respiratory impairment, an alternative is percutaneous radiological gastrostomy (PRG), involving air insufflation into the stomach under fluoroscopic guidance for tube insertion. OBJECTIVE To evaluate the safety of PRG and its effect on survival and respiratory function in ALS patients with respiratory failure. METHODS 25 consecutive ALS patients with severe dysphagia and forced vital capacity (FVC) <50% underwent PRG after October 2000. They were compared with 25 consecutive ALS patients with FVC <50% who underwent PEG before October 2000. Respiratory function was evaluated before and after the procedure. RESULTS The two groups were similar for all relevant characteristics. PRG was successful in all cases, PEG in 23/25. One patient in each group died after the procedure. The mean survival time after the procedure was 204 days in the PRG group and 85 days in the PEG group (p<0.004). Respiratory function decreased more in the PEG group than in the PRG group (p<0.02). CONCLUSIONS PRG appears to be safer than PEG in ALS patients with moderate or severe respiratory impairment, and is followed by a longer survival.
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Affiliation(s)
- A Chiò
- Second Division of Neurology, Department of Neuroscience, University of Turin, via Cherasco 15, 10126 Turin, Italy.
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La Villa G, Barletta G, Righi D, Foschi M, Del Bene R, Tarquini R, Pantaleo P, Gentilini P, Laffi G. Vascular reserve in the lower limbs of cirrhotic patients: a duplex Doppler ultrasound study. Dig Liver Dis 2002; 34:717-22. [PMID: 12469799 DOI: 10.1016/s1590-8658(02)80023-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIM To evaluate femoral artery impedance at rest and during reactive hyperaemia. PATIENTS Study population comprised 11 cirrhotic patients without ascites, 10 with ascites and 16 age- and sex-matched healthy subjects. METHODS Echocardiographic assessment of systemic haemodynamics; duplex Doppler ultrasound measurement of femoral artery pulsatility index and vascular reserve [pulsatility index rest/pulsatility index hyperaemia). RESULTS Cirrhotic patients had elevated cardiac index and low systemic vascular resistance. Pulsatility index (right femoral artery) was not statistically different either at rest or after reactive hyperaemia (controls: rest 10.6 +/- 0.4, hyperaemia 2.6 +/- 0.2; compensated cirrhosis: rest 10.1 +/- 0.8, hyperaemia 3.4 +/- 0.4; ascitic cirrhosis: rest 11.4 +/- 1.6, hyperaemia 2.9 +/- 0.4. Vascular reserve was 4.38 +/- 0.35 in controls, 3.33 +/- 0.39 in compensated and 4.70 +/- 0.89 in ascitic cirrhosis (p = not significant). No correlation was found between systemic haemodynamic parameters and either pulsatility index or vascular reserve. CONCLUSIONS The lower limb vascular reserve is preserved in cirrhosis.
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Affiliation(s)
- G La Villa
- Department of Internal Medicine, University of Florence School of Medicine, Florence, Italy
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22
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Ropolo R, Rampado O, Isoardi P, Gandini G, Rabbia C, Righi D. [Evaluation of patient doses in interventional radiology]. Radiol Med 2001; 102:384-90. [PMID: 11779988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
PURPOSE To verify the suitability of indicative quantities to evaluate the risk related to patient exposure, in abdominal and vascular interventional radiology, by the study of correlations between dosimetric quantities and other indicators. MATERIAL AND METHODS We performed in vivo measurements of entrance skin dose (ESD) and dose area product (DAP) during 48 procedures to evaluate the correlation among dosimetric quantities, and an estimation of spatial distribution of exposure and effective dose (E). To measure DAP we used a transmission ionization chamber and to evaluate ESD and its spatial distribution we used radiographic film packed in a single envelope and placed near the patient's skin. E was estimated by a calculation software using data from film digitalisation. RESULTS From the data derived for measurements in 27 interventional procedures on 48 patients we obtained a DAP to E conversion factor of 0.15 mSv / Gy cm2, with an excellent correlation (r=.99). We also found a good correlation between DAP and exposure parameters such as fluoroscopy time and number of images. The greatest effective dose was evaluated for a multiple procedure in the hepatic region, with a DAP value of 425 Gy cm2. The greatest ESD was about 550 mGy. For groups of patients undergoing similar interventional procedures the correlation between ESD and DAP had conversion factors from 6 to 12 mGy Gy-1 cm-2. CONCLUSION The evaluation of ESD and E by slow films represents a valid method for patient dosimetry in interventional radiology. The good correlation between DAP and fluoroscopy time and number of images confirm the suitability of these indicators as basic dosimetric information. All the ESD values found are lower than threshold doses for deterministic effects.
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Affiliation(s)
- R Ropolo
- Unità Operativa Autonoma Fisica Sanitaria, Azienda Ospedaliera San Giovanni Battista, Turin, Italy.
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23
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Tortoli P, Michelassi V, Corsi M, Righi D, Takeuchi Y. On the interaction between ultrasound and contrast agents during Doppler investigations. Ultrasound Med Biol 2001; 27:1265-1273. [PMID: 11597368 DOI: 10.1016/s0301-5629(01)00426-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Knowledge of interaction mechanisms between ultrasound (US) and contrast agents (CA) suspended in blood is important for a correct interpretation of clinical investigation results. Experiments performed in different laboratories have shown that, as a consequence of primary radiation force, CA tend to move away from the US transducer. Accordingly, Doppler spectra produced by particles suspended in moving water turn out to be significantly altered from what is theoretically expected. The purpose of this paper is twofold. First, an original model describing the bubble dynamics as the outcome of the balance between US radiation force and fluid drag force is validated for the case in which bubbles are suspended in blood. The high fluid viscosity is shown to prevent significant bubble deviations from the unperturbed fluid streamlines so that, in large vessels, a residual spectral distortion may exist only at the highest intensity levels permitted by current regulations. Finally, the relative importance and differences between the effect of primary radiation force and streaming mechanisms that, in principle, could lead to similar effects, are discussed.
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Affiliation(s)
- P Tortoli
- Department of Electronics and Telecommunications, University of Florence, Florence, Italy.
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24
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Tortoli P, Bettarini R, Guidi F, Andreuccetti F, Righi D. A simplified approach for real-time detection of arterial wall velocity and distension. IEEE Trans Ultrason Ferroelectr Freq Control 2001; 48:1005-1012. [PMID: 11477757 DOI: 10.1109/58.935717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Arterial stiffness is known to increase with age and with many vascular diseases, but its noninvasive assessment in patients still represents a difficult task. The measurement of diameter change during the cardiac cycle (distension) has been proposed as a means to estimate arterial compliance and stiffness. Therefore, we have developed a simple PC-based device and algorithm for noninvasive quantification of vessel wall motion and diameter change in humans. This goal is achieved in real-time by processing the base-band signals from a commercial ultrasound Doppler system. Real-time operation is of crucial importance, because it allows a rapid achievement of optimal measurement conditions. The system was evaluated in a laboratory using a string phantom and was tested on the carotid arteries of 10 volunteers. Wall velocities from 0.05 to 600 mm/s and displacements lower than 2 microns were detected with phantoms. The measured carotid diameter change in the volunteers ranged from 7.5 to 11.8% (mean = 9.8%) and agrees closely with values reported in the literature. The difference between values taken one hour apart ranged from 0.2 to 0.5%. We conclude that the new system provides rapid, accurate, and repeatable measurements of vessel distension in humans.
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Affiliation(s)
- P Tortoli
- Electronics and Telecommunications Department, University of Florence, Italy.
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25
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Nuzzaci G, Righi D, Borgioli F, Nuzzaci I, Giannico G, Pratesi C, Pulli R, Chiti E, Gori F. Duplex scanning exploration of the ophthalmic artery for the detection of the hemodynamically significant ICA stenosis. Stroke 1999; 30:821-6. [PMID: 10187886 DOI: 10.1161/01.str.30.4.821] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The North American and the European Carotid Endarterectomy Trials demonstrated a significant benefit of surgery in preventing stroke for patients with symptomatic hemodynamically significant internal carotid artery (ICA) stenosis. Because the 3 angiographic methods of measuring carotid stenosis provide discrepant results, the indication for surgery depends on the method used for the evaluation of the angiogram. The goal of this study was to verify whether color duplex scanning of the ophthalmic artery alone might be reliable for detection of the extracranial hemodynamically significant ICA stenosis. METHODS Three groups of patients (351 total patients) with transient ischemic attack or minor stroke referred for possible carotid endarterectomy were examined by means of color duplex scanning of the ICA, transcranial Doppler, color duplex scanning of the ophthalmic artery, and angiography of the ICA. RESULTS In the first group (n=31) the comparison of findings from each method and the direct measurement of the residual lumen of plaque removed "en bloc" showed that the findings of the ophthalmic artery color duplex scanning, subdivided into 5 categories--NP (normal positive), LP (low positive), NF (no flow), REV (reverse flow), PP (pathological positive)--were associated with the best overall agreement (96.7%). The accuracy of the various categories of the ophthalmic artery color duplex scanning signals was studied in the second group of patients (n=200). The results pointed out that all but low positive categories were associated with high diagnostic accuracy. Finally, the results obtained in the third group (n=120) showed that a significant increase in the specificity of the low positive signal could be obtained by processing this signal in terms of pulsatility index and of transmission of pulsatility index. CONCLUSIONS Our results suggest that the diagnostic capacity of color duplex scanning for the detection of ICA critical stenosis can be appropriately increased if it is performed also at the level of the ophthalmic artery and if the Doppler signals are processed on the basis of criteria we applied.
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Affiliation(s)
- G Nuzzaci
- Angiology, Vascular Surgery, University of Florence, Florence, Italy
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26
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Tortoli P, Bagnai D, Righi D. Quantitative analysis of Doppler spectrum modifications yielded by contrast agents insonified at high pressure. IEEE Trans Ultrason Ferroelectr Freq Control 1999; 46:247-251. [PMID: 18238421 DOI: 10.1109/58.741543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
In this report, the authors consider the modifications yielded in the Doppler spectrum when acoustic fields of increasing intensities are applied to encapsulated gas bubbles. Their in vitro experimental results show that the spectrum bandwidth is nearly proportional to the incident acoustic pressure, when its amplitude is maintained below about 200 kPa. At higher pressure levels, it even may happen that, in a steady, unidirectional flow (which should generate only positive Doppler frequencies), the Doppler spectrum is enlarged up to the point that negative Doppler shifts also are produced. Possible explanations in terms of either radiation force or streaming are discussed for this asymmetrical bandwidth enlargement.
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27
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Abstract
There are many analogies between cold-induced vasodilatation (CIV) and vasomotion (VM), but the demonstration of any relationship between these two microvascular homeostatic reactions is to date lacking. In a group of seven controls and seven patients with Raynaud phenomenon in the vasomotor stage of the disease, we studied, by means of laser Doppler fluxmetry, the fingertip flow at room temperature (15 min), during hand immersion into cold water (0-6 degreesC, 30 min), and at room temperature again (15 min). The Fourier spectral analysis of the laser Doppler signal revealed in both groups two different patterns of the fingertip flow oscillations: the first was characterized by continued oscillations with small amplitude and median frequency of 2-8 cycles/min occurring both at room temperature and during cold stimulation. The second was characterized by continued oscillations of high amplitude and median frequency of 1 cycle/4-6 min occurring during cold stimulation only. The first pattern of flow oscillations still occurred during the second. The high-frequency oscillations are similar to the waves of vasomotion and the low-frequency oscillations are similar to the waves of cold-induced vasodilatation. Because 90-98% of the fingertip flow passes through arteriolar-venular anastomosis (AVAs), our results suggest that the CIV flow oscillations may be an expression of the AVA's VM.
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Affiliation(s)
- G Nuzzaci
- Clinical Medicine and Cardiology Institute, Department of Systems and Computer Sciences, University of Florence, Viale Morgagni, Florence, 85-50134, Italy
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28
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Righi D. [Diagnostic screening for diabetic microangiopathy]. Minerva Cardioangiol 1998; 46:408-9. [PMID: 10021831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Affiliation(s)
- D Righi
- Angiologia, UO Malattie Cardiovascolari, Azienda Ospedaliera Careggi, Università degli Studi, Firenze
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29
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Bonenti G, Zanon E, Righi D. [The cutaneous metastasis of a pancreatic carcinoma in a patient with biliary drainage: a case]. Radiol Med 1997; 94:264-6. [PMID: 9446137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- G Bonenti
- Dipartimento di Discipline Medico-Chirurgiche, Università di Torino
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30
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Abstract
Pulsed Doppler spectral analysis is a well-established diagnostic technique in the assessment of arterial diseases. Because of hardware limitations, its use has been so far restricted to the analysis of a single sample volume located along the ultrasound beam axis. In this paper, we discuss the operation of a newly developed multigate instrument capable of performing, in real time, 64-point fast Fourier transforms of Doppler signals sampled from 64 different range cells. The new instrument is capable of accurately detecting the actual blood flow behavior in major human vessels. Significant examples of velocity profiles obtained in real time from carotid arteries in healthy subjects are reproduced here for the first time. Multigate extension of spectral analysis is demonstrated to be a suitable means for detailed in vivo investigation of blood flow dynamics.
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Affiliation(s)
- P Tortoli
- Electronic Engineering Department, University of Florence, Italy
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31
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Righi D, Garretti L, Zanon E, Gazzera C, Cristoferi M, Gandini G. [Percutaneous gastrostomy. Personal experience in 137 cases]. Radiol Med 1994; 88:789-92. [PMID: 7878238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Percutaneous gastrostomy is reported to be an effective alternative to total parenteral feeding or long-term nasogastric tube in the treatment of mechanical or functional dysphagia. The authors report their personal experience with 137 percutaneous gastrostomies performed on 98 men and 39 women from January 1986 through December 1993. All the maneuvers were performed under fluoroscopic guidance in the patients with head or neck cancer, neoplastic, vascular or post-traumatic neuropathy and upper GI tract cancer. To avoid left hepatic lobe trauma, percutaneous gastrostomy needs to be performed under US guidance. A 7F nasogastric tube is used to fill the stomach with air. After distending the gastric cavity, with the Seldinger technique under local anesthesia, fascial dilators of progressively increasing caliber are introduced into the gastric cavity and the final 12F gastrostomy catheter is positioned under fluoroscopic guidance. No major complications, such as hemorrhage or peritonitis, occurred. In one case, during the maneuver, the patient complained of severe epigastric pain which regressed with no further problems two hours later. In three cases the gastrostomy catheter fell out of place and was replaced by running the fistolous tract with a venous cannula and then a guidewire for gastrostomy repositioning. With this type of treatment, the patient can be given enteral feeding the following day. The maneuver requires approximately 10 minutes to perform and is well tolerated by the patient as it requires no general anesthesia. Percutaneous gastrostomy is more cost-effective than surgery or endoscopy and hospitalization is shorter. The only contraindications to this maneuver are hepatomegaly (because of the risk of liver trauma during percutaneous maneuvers), ascites (because of the risk of infection) and finally the complications resulting from gastric resection.
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Affiliation(s)
- D Righi
- Istituto di Radiologia, Università di Torino
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32
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Righi D, Maass J, Zanon E, Tettoni S, Orecchia R, Lazzari R, Ragona R, Gandini G. [Percutaneous treatment of hilar cholangiocarcinoma completed by high-dose rate brachytherapy. Experience in the first 5 cases]. Radiol Med 1994; 88:79-85. [PMID: 7520594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cholangiocarcinoma at the confluence of the hepatic ducts (Klatskin tumor) is a slowly growing malignancy with early onset of symptoms and poor outcome since surgery allows radical resection in only a minority of cases. Percutaneously placed biliary stents offer a good palliation, but tend to obstruct after 6-8 months; then, retreatment requires exchange of the endoprosthesis or establishment of a permanent external-internal biliary drainage which offers, in some patients, a relatively long survival. Percutaneous intraluminal HDR brachytherapy might be a valid alternative as a definitive therapy or as a method to keep metallic stents patent for a long time. Five patients with hilar cholangiocarcinoma, diagnosed by means of ultrasound, Computed Tomography, percutaneous transhepatic cholangiography and transluminal biopsy, underwent double percutaneous external-internal biliary drainage. Dummy sources were introduced into the drainage catheters to allow dose distribution planning. The stepwise progression of the miniaturized high activity Iridium source inside the applicators, introduced into the drainage catheters, was controlled and monitored by a computer equipped with dedicated software. In the radiotherapy bunker, using the remote loading technique, percutaneous intracavitary high dose rate brachytherapy was delivered at the rate of 750 cGy per fraction, prescribed at 1 cm from the center of the catheter, once a week, for 4 weeks. Nevertheless, only 4 of 5 patients underwent the complete treatment. In one case, radiation treatment was discontinued after the first session because of digestive bleeding from a duodenal ulcer, supposingly as a consequence of the decubitus of a catheter tip. CT demonstrated rapid progression of the disease with neoplastic spread to the omentum and gallbladder wall thickening; a gallbladder malignancy was then suspected and the patient was no more eligibile for brachytherapy. Subsequently, Carey-Coons endoprostheses were inserted to prevent post-actinic strictures and removed after three months. After completing radiation therapy, control cholangiograms demonstrated in all cases improvement of neoplastic strictures. The first two patients we treated show no signs of tumor recurrence at 4 and 1 months, respectively, after endoscopic removal of the stents. The third patient is still bearing 2 Carey-Coons endoprostheses to be removed after 3 months. The last patient with supposingly partial success of bracytherapy, was treated with two Strecker nitinol stents.
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Affiliation(s)
- D Righi
- Istituto di Radiologia, Università di Torino
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33
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Righi D, Tettoni S, Maass J, Gazzera C, Giuliano A, Zanon E. [The percutaneous treatment of a complex iatrogenic lesion of the biliary tract complicated by multiple peritoneal collections]. Radiol Med 1994; 87:528-31. [PMID: 8190945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- D Righi
- Istituto di Radiologia, Università di Torino
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34
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Zanon E, Righi D, Robotti D, Lequio L, Maass J, Fonio P, Gandini G, Guermani P, Ferrando U. [The percutaneous treatment of the urological complications following kidney transplantation]. Radiol Med 1992; 84:613-8. [PMID: 1475425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Renal transplantation is considered the treatment of choice in most cases of renal failure; the urologic complication rate ranges 1 to 10% in different surveys. This work was aimed at evaluating the application and results of interventional radiology in these cases. Since 1983, 24 patients (20 males and 4 females) whose age ranged from 18 to 63 years (mean age: 42 years) have been submitted to percutaneous maneuvers in our department. Thirty-four complications were treated: 14 stenoses, 11 fistulas, 7 urinomas and 2 transient obstructions. Complete success was obtained in 15/24 patients (62.5%), while 7/24 patients (29.16%) underwent reoperation and in 2/24 cases (8.34%) a definitive pyelostomy catheter was inserted. In 7 stenosis cases ureteroplasty was successfully performed and a double-J endoprosthesis inserted; the follow-up results (5-21 months) were satisfying in all cases. The only complication was one case of endoperitoneal hematoma. Considering the good results obtained, the low morbidity and mortality and the low cost, percutaneous maneuvers must be considered the treatment of choice in the urologic complications of renal transplants. When the percutaneous treatment of the main lesion fails, pyelostomy does nonetheless allow the drainage of urinary collections, the maintenance of renal function and the improvement of local and general conditions, which makes it easier to reoperate under elective conditions.
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Affiliation(s)
- E Zanon
- Istituto di Radiologia, Università di Torino
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35
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Recchia S, Coppola F, Ferrari A, Righi D, Zanon E, Verme G. Fistulosphincterotomy in the endoscopic approach to biliary tract diseases. Am J Gastroenterol 1992; 87:1607-9. [PMID: 1442683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We report our experience with 49 patients who underwent fistulosphincterotomy (FS) after cannulation of the common bile duct (CBD) by standard approaches had failed, due to suspected CBD obstruction. Only 4% of our cases turned out to have no biliary obstruction at all. The morbidity rate was 16%, and the mortality rate was 2%. In our series, FS raised the success rate of CBD cannulation from 90% to 96%. Ninety-five percent of successful cannulations were followed by endoscopic treatment. There were no cases of perforation or hemorrhage, and no difference in the success rate between FS in flat papillas and FS in bulging papillas, thanks, perhaps, to the technique we used. Our findings would indicate that FS is a useful procedure involving additional but not prohibitive risks. Nonetheless, it should be used only when CBD obstruction is strongly suspected and standard methods are not successful.
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Affiliation(s)
- S Recchia
- Divisione di Gastroenterologia, Ospedale San Giovanni Battista, Torino, Italy
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36
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Foco A, Garbarini A, Franchello A, Orlando E, Festa T, Gandini G, Righi D, Comotti F, Massaglia F, Drago D. Management of postoperative bile leakage with endoscopic sphincterotomy (EST) and a naso-biliary drain (NBD). Hepatogastroenterology 1992; 39:301-3. [PMID: 1427570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Between July 1987 and December 1990, 13 patients with postoperative bile leakage were treated with endoscopic sphincterotomy and a naso-biliary drain. All the leaks healed in two weeks, except for one (intrahepatic) that needed two months to heal in association with percutaneous management. The non-surgical treatment of bile leakage is the preferred approach on account of the superior safety, efficacy and cost-effectiveness as compared with surgical repair, which is associated with significant morbidity, mortality and costs. The treatment of choice has to be endoscopic, which is much easier and safer than the transhepatic approach, especially in the non-dilated duct, while another advantage over radiology includes the possibility for rapid definitive treatment of distal obstruction (e.g. residual stones). A leak from an extrahepatic duct heals rapidly, while a leak from an intrahepatic duct takes longer to heal and sometimes needs associated percutaneous drainage. Finally, the authors propose treating an extrahepatic bile leak merely with naso-biliary drainage without cutting the papilla, and an intrahepatic bile leak with endoscopic sphincterotomy, nasobiliary drainage and a bilio-duodenal endoprosthesis.
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Affiliation(s)
- A Foco
- Istituto di Chirurgia d'Urgenza, Università degli Studi di Torino, Italia
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37
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Righi D, Zanon E, Cesarani F, Lequio L, Maass J, Fonio P, Balma E, Gandini G. [Interventional radiology in the treatment of the complications from interventions on the lower urinary excretory tract]. Radiol Med 1992; 84:106-13. [PMID: 1509124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Ureteral diversions may be complicated by strictures, hydronephrosis, pyelonephritis, lithiasis, fistulas, etc. In the last 10 years, 103 patients with 133 urological postoperative complications underwent percutaneous treatment. Most of the patients had been treated by percutaneous antegrade drainage; afterwards, stricture dilatation, ureteral stenting and stone extraction were performed. In one case a Strecker metallic stent was employed. We have successfully treated 101 of 133 complications (75.9%), with only 27 failures (20.3%). Five cases (3.8%) of lithiasis did not require percutaneous treatment. The good results obtained, the absence of major complications, the low cost and the little discomfort for the patients confirm the leading role of percutaneous treatment in complicated ureteral diversions.
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Affiliation(s)
- D Righi
- Istituto di Radiologia, Università, Torino
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38
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Righi D, Fonio P, Fronda GR, Gandini G, Lequio L, Maass J, Maisano U, Recchia S, Zanon E. [Percutaneous treatment of bile duct lithiasis. Personal experience in the first 150 cases]. Radiol Med 1992; 83:526-34. [PMID: 1631327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Since 1983 we have percutaneously treated 150 cases of bile duct lithiasis in which previous endoscopic maneuvers had been incomplete or unfeasible. Complete resolution of lithiasis was obtained in 139 of 150 patients. In 6 cases only partial success was obtained but symptoms subsided. In 2 cases the treatment failed and the patients underwent surgery. Minor complications were observed in 12.6% of patients and resolved either spontaneously or by percutaneous maneuvers. Mortality rate was 2%. After a follow-up period of 6-12 months, 9 patients had a recurrence, completely resolved with further percutaneous treatment. These cases never required surgery. We obtained the best results in patients with stones residual after cholecystectomy or a iatrogenic stricture of the biliary tree. We obtained good results in massive lithiasis with combined endoscopic, surgical and radiological procedures. Morbidity and mortality rates were lower than in surgical series and similar to the endoscopic ones. The short hospitalization, the low cost and the possibility of treatment on an outpatient basis should promote the spreading of percutaneous techniques in the treatment of bile duct lithiasis.
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Affiliation(s)
- D Righi
- Istituto di Radiologia dell'Università, Torino
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39
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Mallarini G, Zanon E, Ferraiolo A, Righi D, Giuliano A, Fonio P, Gandini G. [Tubal catheterization with selective salpingography in the diagnosis and therapy of fallopian tube obstruction]. Radiol Med 1992; 83:434-8. [PMID: 1604001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Fallopian tube catheterization with selective ostial [correction of osteal] salpingography is a new technique for the diagnosis of tubal factors of infertility and also for the treatment of proximal tubal occlusion (PTO). In this study, 246 women were considered, 20-42 years old, with primary or secondary infertility, who presented a unilateral or bilateral PTO at hysterosalpingography (HSG). Catheterization and selective salpingography have been successful in 93.9% of the cases. Failures (5.6%) have been ascribed to obstructive organic diseases, where it was impossible to overcome the stenosis with the catheter or the guide-wire. Twenty-six spontaneous pregnancies were obtained (15 full-term deliveries) and 17 patients became pregnant after GIFT (13 full-term deliveries). At follow-up, after 12 months 4 of 10 patients had normal tubes, while 6 patients presented a new unilateral or bilateral PTO. No major complications occurred; nevertheless, ectopic pregnancy is a possible event, because of the mechanically re-established patency in a nonfunctioning tube.
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Affiliation(s)
- G Mallarini
- Istituto di Radiologia dell'Università, Genova
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40
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Zanon E, Righi D, Lequio L, Fonio P, Robotti D, Gandini G. [A case of the percutaneous treatment of a noncommunicating biliocutaneous fistula]. Radiol Med 1991; 82:873-5. [PMID: 1788450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- E Zanon
- Istituto di Radiologia, Università, Torino
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41
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Foco A, Garbarini A, Serenthà U, Salto C, Zatteri R, Gandini G, Righi D, Cozza G, Colzani G, Maccario P. [Treatment of postoperative biliary fistulas by endoscopic papillosphincterotomy and nasobiliary drain]. MINERVA GASTROENTERO 1991; 37:219-23. [PMID: 1805973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Personal experience in the non-surgical treatment of postoperative biliary fistulas observed between July 1987 and October 1990 is reported. Leakage were treated with an endoscopic technique (papillosphincterotomy+nasobiliary drain) in 11 of 12 patients in an average time of 2 weeks. The 12 patient, who presented a lesion of an intrahepatic duct, needed 2 months to heal following combined endoscopic-percutaneous manoeuvres. On the basis, then, of the good results obtained, it is recommended that in these cases, non-surgical treatment should be carried out on principle, choosing endoscopy as the initial access route.
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Affiliation(s)
- A Foco
- Istituto di Chirurgia d'Urgenza, Università degli Studi di Torino
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42
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Ferrari A, Recchia S, Coppola F, Perotto C, Campra D, Gandini G, Righi D, De Maio G, Verme G. [Endoscopic therapy of giant choledochal calculosis]. MINERVA GASTROENTERO 1991; 37:157-61. [PMID: 1790204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The paper reports the results of conventional endoscopic treatment in 100 consecutive cases of giant lithiasis of the common bile duct. A giant calculus is one whose dimensions exceed 2 cm. Endoscopic therapy proved successful in 73% of cases, with an 8% incidence of complications. The success of endoscopic treatment is related to the anatomical conditions of the biliary tract and the diameter of calculi. Mechanical lithotripsy has proved efficacious in all cases where it was used, whereas poor results were obtained using MTBE infusion through a naso-biliary tube. ESWL provided encouraging results. Cases which were not resolved using endoscopic methods were treated using intervention radiology or surgery, or both.
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Affiliation(s)
- A Ferrari
- Divisione di Gastroenterologia, Ospedale Molinette, Università degli Studi di Torino
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43
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Koski G, Lawrence K, Righi D. Inhibition by ethanol of 45Ca2+ uptake in PC12 pheochromocytoma cells: interactions between alcohol and carbachol. Ann N Y Acad Sci 1991; 625:448-50. [PMID: 2058900 DOI: 10.1111/j.1749-6632.1991.tb33876.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- G Koski
- Department of Anesthesia, Harvard Medical School, Massachusetts General Hospital, Boston 02114
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44
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Abstract
Using a rapid-quench technique the effects of ethanol on the uptake of 45Ca2+ into PC12 pheochromocytoma cells were studied in suspension. At concentrations achieved during acute intoxication in man (25-100 mM), ethanol inhibited both the carbachol-stimulated and K(+)-induced uptake of calcium. Inhibition of carbachol-stimulated uptake of Ca2+ occurred rapidly, within seconds at 27 degrees C, whereas inhibition of K(+)-induced uptake of Ca2+ developed more slowly. This disparity between the kinetics of these ethanol-induced inhibitions was unexpected, because the uptake of Ca2+, evoked by either stimulus, is thought to occur predominantly through a common pathway, namely voltage-sensitive Ca2+ channels. This difference may reflect differential effects of ethanol on multiple carbachol-activated pathways for entry of Ca2+. Alternatively, carbachol may facilitate the inhibitory action ethanol on voltage-dependent channels. This apparent facilitation was manifested principally by a more rapid onset of inhibition, although the extent of inhibition by ethanol, in the presence of carbachol, was also increased. In preincubation experiments, ethanol did not enhance the apparent agonist-induced desensitization of carbachol-evoked uptake of Ca2+. Nevertheless, an acute interaction between cholinergic agonists and ethanol, affecting homeostasis of Ca2+ may play a role in the pathophysiology of alcohol intoxication.
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Affiliation(s)
- G Koski
- Department of Anesthesia, Harvard Medical School, Massachusetts General Hospital, Boston 02114
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45
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Abstract
The technique of percutaneous transhepatic sphincterotomy is described. This procedure was employed in 3 patients with common bile duct (CBD) stones in whom a previous attempted endoscopic procedure had failed for anatomical reasons (a Billroth II gastric resection or a partial gastric resection with Braun anastomosis). Complete immediate success was obtained in all 3 patients. Furthermore, no major complications occurred during transhepatic treatment. The authors suggest that PTS be employed electively in patients with diseases of the biliary tree in whom the endoscopic approach fails.
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Affiliation(s)
- E Zanon
- Istituto di Radiologia, Università di Torino
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46
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Gandini G, Zanon E, Righi D, Fonio P, Ferrari A, Recchia S. [Percutaneous transhepatic sphincterotomy]. Radiol Med 1990; 80:893-7. [PMID: 2281174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The authors describe the technique employed for percutaneous transhepatic sphincterotomy as performed on 3 patients with common bile duct (CBD) stones. In all patients, previous endoscopic attempt had failed for anatomical reasons (Billroth II gastric resection or partial gastric resection with Brown anastomosis), and the ampulla could not be correctly incannulated with the sphincterotome. In all patients endoscopy was useful to check the position of the diathermic loop inserted percutaneously. Complete and immediate success was obtained in all 3 cases. No major complications occurred during transhepatic treatment. To date, 1 recurrence has been observed, and the patient has been retreated with bilioplasty. All patients were followed after 5-6 months with US, plain X-rays of the abdomen and blood tests (gamma Gt, alkaline phosphatase, and bilirubinemia). The authors suggest that percutaneous transhepatic sphincterotomy be employed electively in patients with biliary tree diseases in case the endoscopic approach failes.
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Affiliation(s)
- G Gandini
- Istituto di Radiologia, Università, Torino
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47
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Regge D, Carnieri E, Righi D, Salizzoni M, Andorno E, Gandini G. [CT of the operated liver]. Minerva Dietol Gastroenterol 1990; 36:197-208. [PMID: 2089283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The Authors examine retrospectively 93 CT exams performed on 60 patients submitted to hepatic surgery both for malignant and benign lesions. It is concluded that CT, if performed correctly, is helpful in recognizing both complications and recurrences.
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Affiliation(s)
- D Regge
- Istituto di Radiologia, Università di Torino
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48
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Righi D, Martina MC, Tola E, Fonio P, Fronda GR, Gandini G. [Percutaneous transhepatic bilioplasty: long-term results]. Radiol Med 1990; 80:492-500. [PMID: 2244038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We report the results of a long-term follow-up of 40/101 patients with benign biliary strictures treated with percutaneous balloon dilatation (PBD) at the Radiology Department of the University of Turin, from March 1983 to March 1990. We excluded all the patients who were not followed or treated after June 1988, being their follow-up shorter than 18 months. All patients underwent accurate clinical, biological (AST, ALT, gammaGT, alcaline phosphatase) and US controls. Mean follow-up was 33.5 months. Mean success rate was 75% in strictures of bilioenteric anastomosis, 86% in iatrogenic strictures of the common bile duct, 65% in sclerosing cholangitis, 80% in papillary strictures in which endoscopic treatment had not been possible for anatomical reasons. Our results, compared to the most important radiological and surgical series, show PBD to have lower morbidity than surgery and no mortality during the so-called peroperative period (30 days). Moreover, in case of recurrences, PBD can be repeated without further complications and does not affect eventual surgery.
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Affiliation(s)
- D Righi
- Istituto di Radiologia, Università, Torino
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49
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Abstract
Since 1983 we have performed percutaneous treatment of biliary lithiasis in 97 patients. Previous retrograde endoscopic procedures were incomplete or infeasible in all patients. Immediate results were excellent resulting in complete resolution of lithiasis in 89 of 97 patients (92%). In 4 patients (4%) partial success was obtained (symptoms subsided although there were nonobstructing residual stones). Percutaneous treatment failed in 1 patient (1%). Three patients died. Complications occurred in 14 of 97 patients (14%) and mortality at 30 days was 3%. Long-term results were evaluated in 71 patients who had a least a 6-month follow-up (mean 31 months and range 6-78 months). Eight of 71 patients (11%) had recurrence of stones and 7 of these were successfully retreated transhepatically. Percutaneous removal of biliary stones is efficacious because it has a high cure rate, a low complication rate, and a mortality rate that compares favorably to that of surgery even though the patients are usually older and in poorer general condition.
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Affiliation(s)
- G Gandini
- Istituto di Radiologia dell'Università di Torino, Italy
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50
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Cesarani F, Righi D, Cavalot G, Gandini G. [The results of the percutaneous treatment of obstructed ureteral diversions. The technic and personal experience in 46 cases]. Radiol Med 1990; 79:513-9. [PMID: 2359860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The ureteral diversions performed in the treatment of mainly malignant lesions of the pelvis with ureteral or bladder involvement may be complicated by strictures and cause hydronephrosis, pyelonephritis and lithiasis. Personal experience and technique are described as applied in the percutaneous antegrade drainage of different urinary diversions (cutaneous ureterostomy, ileal conduit, colon conduit, ureterosigmoidostomy, ureterocolostomy) in 46 patients. The good results obtained (70% success rate), the absence of major complications, the low cost and the little patient discomfort confirm the leading role of percutaneous treatment versus surgery in obstructed urinary diversions.
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Affiliation(s)
- F Cesarani
- Istituto di Radiologia, Università, Torino
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