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Biomedical subjects

A L Valentini

Publications and source records attributed to A L Valentini.

At least 19 recordsLinked to original sources
PubMed2001

Contrast-enhanced gray-scale and color Doppler voiding urosonography versus voiding cystourethrography in the diagnosis and grading of vesicoureteral reflux.

PURPOSE: The purpose of this study was to compare contrast-enhanced gray-scale voiding urosonography (CE-VUS) and contrast-enhanced color Doppler voiding urosonography (CE-CDVUS) with voiding cystourethrography (VCUG) to verify whether the use of color Doppler imaging improves the diagnosis and grading of vesicoureteral reflux (VUR). METHODS: In 74 patients, CE-VUS and CE-CDVUS were compared with VCUG, which was used as the gold standard. SHU 508 A (Levovist) was used as the echo-enhancing contrast agent. VUR was diagnosed if hyperechoic dots or color signals were visualized in the ureter on sonograms. VUR grading was based on morphologic and dynamic findings on CE-VUS and morphologic and color findings on CE-CDVUS. VCUG was performed conventionally, and grading by VCUG was in accordance with the international system of radiographic VUR grading. Patients who voided during 1 examination only (either CE-VUS and CE-CDVUS or VCUG) were excluded from the study. Agreement between the results of CE-VUS and VCUG and between those of CE-CDVUS and VCUG in diagnosing VUR was calculated by kappa statistics. CE-VUS and CE-CDVUS were compared for diagnostic accuracy by the McNemar test. RESULTS: The agreement between CE-VUS and VCUG in predicting VUR was 90% (kappa score, 0.77; p < 0.001). The agreement between CE-CDVUS and VCUG was 96% (kappa score, 0.91; p < 0.001). CE-CDVUS showed a significantly higher diagnostic accuracy than did CE-VUS (96% versus 90% of cases correctly classified; McNemar chi2 = 4; p < 0.05). This was mainly related to the lower number of false-negative results for grade I and grade II VUR when CE-CDVUS was used. CONCLUSIONS: The use of color Doppler imaging significantly improves the accuracy of contrast voiding urosonography in the detection and grading of VUR.

Adolescent↗
PubMed2000

Fallopian tube disease: the cobblestone pattern as a radiographic sign.

PURPOSE: To identify radiographic signs of mucosal damage by comparing hysterosalpingography with salpingoscopy in a prospective study. MATERIALS AND METHODS: Forty-one candidates for laparoscopy underwent hysterosalpingography and peroperative salpingoscopy; at both, tubal patency was noted. Radiographic criteria for mucosal abnormality were rounded filling defects (ie, the cobblestone pattern) and the absence of longitudinal radiolucent bands in the ampullary tract. At salpingoscopy, tubal mucosa was categorized by means of inspection into five classes of fold pattern: classes I and II, normal; classes III-V, abnormal. Hysterosalpingographic and salpingoscopic results were compared by means of a two-by-two table and kappa statistics. RESULTS: Seventy-four tubes were evaluated. At hysterosalpingography, 31 tubes were distally nonpatent. Of these, 26 showed a distal obstruction at salpingoscopy. None of the patent tubes at hysterosalpingography showed obstruction at salpingoscopy. The agreement between hysterosalpingography and salpingoscopy in detecting abnormal mucosal pattern was 89.2% (kappa, 0.73; P: <.001). The cobblestone pattern always corresponded to intraluminal adhesions at salpingoscopy. The absence of radiolucent bands corresponded to abnormal mucosa at salpingoscopy in four of six cases. The cobblestone pattern was found only in hydrosalpinges and never in patent tubes. Six normal patent tubes at hysterosalpingography showed intraluminal adhesions at salpingoscopy. CONCLUSION: Results indicate that the cobblestone pattern is an effective radiographic sign of intraluminal adhesions in hydrosalpinges and suggest that intraluminal disease in patent tubes might not always be excluded on normal hysterosalpingograms.

Adult↗
PubMed2000

Improvement of hysterosalpingographic accuracy in the diagnosis of peritubal adhesions.

OBJECTIVE: Our purpose was to compare hysterosalpingography with laparoscopy in the diagnosis of peritubal adhesions and to verify whether a combination of radiographic signs improves hysterosalpingographic accuracy. SUBJECTS AND METHODS: Thirty candidates for laparoscopy underwent hysterosalpingography before surgery. Two radiologists evaluated the presence or absence and types of radiographic signs of peritubal adhesions (convoluted tubes, vertical tubes, loculation of contrast medium in peritoneum, halo effect, and fixed laterodeviation of the uterus) using two different criteria for normality or abnormality: no sign means a normal result, one or more signs mean an abnormal result (first criterion); no sign or one sign means a normal result, two or more signs mean an abnormal result (second criterion). Interpretation discrepancies were resolved by consensus. Peritubal and periovarian adhesions were evaluated by a single operating surgeon during laparoscopy (recorded on S-VHS videotape) and by a different surgeon reviewing the videotape. The radiographic results obtained using the two criteria in radiologically patent as well as in distally nonpatent tubes were compared with corresponding laparoscopic results by 2 x 2 tables and were statistically analyzed (kappa statistics). RESULTS: The first criterion displayed poor diagnostic accuracy. The correlation with laparoscopy was not statistically significant in either radiologically patent or distally nonpatent tubes. The second criterion greatly improved the agreement with laparoscopy, but only in patent tubes (kappa = 0.7789; p<0.001). CONCLUSION: Hysterosalpingographic accuracy in peritubal adhesion diagnosis can be improved in patent tubes by taking into account more than one of the reported radiographic signs.

Adult↗
PubMed1998

Cervical cancer response to neoadjuvant therapy: MR imaging assessment.

PURPOSE: To determine the accuracy of magnetic resonance (MR) imaging in evaluating the invasive cervical carcinoma response to concurrent chemotherapy and radiation therapy. MATERIALS AND METHODS: MR imaging was performed before and after concurrent chemotherapy and radiation therapy in 18 patients with locally invasive cervical carcinoma. Surgery followed neoadjuvant therapy in all patients. The presence of a lesion, signal intensity, zonal anatomy integrity, vaginal and parametrial invasion, and lymph node enlargement was determined. Posttreatment MR and histopathologic findings were correlated. RESULTS: Fourteen patients had histopathologic confirmation of MR findings: Twelve had true-negative and two had true-positive findings. (Two had microscopic neoplastic foci beyond the spatial resolution of MR images; these foci do not change surgical treatment planning and probably do not influence prognosis. Therefore, these two patients were considered to have complete response). Four patients had false-positive findings; the hyperintense lesion on posttreatment MR images was due to a tunnel cluster pattern (focal hyperplasia of the endocervical glands with inflammation) in three patients and necrosis in one patient, without any evidence of neoplastic tissue. Thirty-three of 36 parametrial halves and 67 of 72 vaginal fornices were correctly interpreted on posttreatment images. Involvement of three parametrial halves and five fornices was overestimated at MR, because edema or inflammation was not distinguishable from tumor. CONCLUSION: MR imaging is 78% accurate in evaluation of tumor response; in 22% of patients, however, benign conditions were not distinguishable from tumor.

Adult↗
PubMed1996

A comparison of hysteroscopy and hysterosalpingography.

OBJECTIVE: The aim of this study was to assess the diagnostic reliability of hysteroscopy (HSC) and hysterosalpingography (HSG) in patients suffering from primary and secondary infertility. METHOD: Seventy women (50 with primary and 20 with secondary infertility) undergoing HSC and HSG were prospectively studied and the diagnostic capacity of the two techniques was compared. RESULTS: HSG proved to have a sensitivity of 79.1% and a specificity of 81.8%, with an 18.1% false-positive rate and a 18.9% false-negative rate. CONCLUSION: HSG is of exclusive importance in the assessment of tubal morphology and function and has a secondary and complementary role to HSC in the inspection of the uterine cavity and tubal ostia.

Adult↗
PubMed1996

[Replacement lipomatosis of renal tissue: a peculiar reaction to inflammation].

Replacement lipomatosis is an abnormal fatty proliferation of the renal sinus, hilus, perirenal and, sometimes, periureteral spaces. Our experience with 18 cases of replacement lipomatosis is reported: 6 patients had the massive form, one of them bilateral, 5 patients had associated xanthogranulomatous pyelonephritis and 7 had an initial focal form. After a thorough review of the literature of the last 30 years, we analyzed the etiopathogenetic bases of this abnormal chronic reaction. The cause of this abnormal fatty proliferation is thought to be related to peculiar individual reactivity; the association of predisposing factors (chronic obstruction and stones) with multiple infections (especially by Coli) does not seem to cause the abnormality. This hypothesis is confirmed by the frequent association of replacement lipomatosis and xanthogranulomatous pyelonephritis, where abnormal individual reactivity has been postulated. Replacement lipomatosis may develop even when the classic predisposing factors are not present or, in contrast may not develop even when they are present. The peculiarity of this pseudotumoral form, where the expansile trend of fatty tissue is apparent, is to mimic neoplastic mesenchymal disease. So far, few cases have been reported in the literature-i.e., less than 20 massive cases in the last 30 years. In this study, the clinical presentation and pathologic findings are correlated with imaging data, especially of CT; the diagnostic yield of this method is stressed, in one with the differential diagnosis with the other, neoplastic or not, forms with negative densitometry. The similarities and differences between replacement lipomatosis and xanthogranulomatous pyelonephritis, which are distinct conditions, are emphasized, so that a careful study of imaging findings may help make the correct diagnosis.

Humans↗
PubMed1995

[Color Doppler echography in the tissue characterization of renal masses].

To investigate color-Doppler US capabilities in tissue characterization, 42 renal masses were studied from November, 1993, to July, 1994. B-mode morphologic patterns were studied first and then integrated with color flow patterns; color areas and blood flow distribution were assessed for each lesion. Color signals were used as a guide to obtain arterial and venous Doppler spectra and to calculate flow velocities and pulsatility index (PI). Based on the us morphologic appearance, the 42 lesions were divided into 3 groups: A) lesions with morphologic and volumetric patterns of malignancy; B) small lesions (< 3 cm, > 3 cm < 5 cm); C) complex cysts. Data were organized and analyzed statistically; some findings were found to be typical of malignancy: hypervascularity, intralesional arterial signals with high flow velocities (systolic peak cut-off: 0.3-0.4 m/sec), high PI values (> 1) and, finally, color signals inside complex cysts. Our results suggest that color-Doppler US is a useful tool to assess renal masses vascularity, with the color-Doppler technique increasing US diagnostic accuracy. Nevertheless, small lesions need more careful study because their features are poorly demonstrated even with CT and MRI.

Adenocarcinoma↗
PubMed1994

Iomeprol versus iopamidol in contrast-enhanced computed tomography of thoracic and abdominal organs.

The aim of this double-blind, parallel-group study was to compare the safety, tolerance, and efficacy of iomeprol-350 (350 mgI/ml), iomeprol-400 (400 mgI/ml) and iopamidol-370 (370 mgI/ml) for use in contrast-enhanced body computed tomography (CT). Following written informed consent, 120 adult inpatients of either sex requiring CT of thoracic or abdominal organs were randomly assigned to receive iomeprol-350, iomeprol-400 or iopamidol-370. Pre- and post-contrast, all patients underwent clinical, instrumental and laboratory investigation to assess the safety of the test agents. Tolerance was assessed in terms of discomfort associated with contrast injection. Two experienced radiologists independently and blindly graded the quality of contrast enhancement obtained with the different contrast solutions by means of a five-point ordinal scale as follows: 1, insufficient; 2, sufficient; 3, good; 4, excellent; or E, excessive. Patients in the iomeprol groups needed fewer injections and a smaller volume of contrast medium to obtain examinations of adequate diagnostic quality. Contrast enhancement was judged as excellent or good in about 90% of the study examinations, without significant differences between the three study groups. During contrast injection, heat and pain sensations were minimal or absent in most cases. No serious adverse events occurred throughout the study. No significant changes in clinical, instrumental or laboratory safety parameters were observed. In conclusion, iomeprol-400 and iomeprol-350 appear to be contrast solutions at least as safe, well tolerated and effective as iopamidol-370 when used as contrast agents for body CT.

Adult↗
PubMed1993

[Adrenal gland cysts. Our experience].

Adrenal cysts are an uncommon finding, in most cases unexpectedly discovered in the evaluation of nonspecific abdominal pain or at autopsy. Cystic adrenal masses can be classified into neoplastic and non-neoplastic aetiologies. The distinction between malignant and benign adrenal cysts can still be difficult. Cysts of neoplastic aetiology occur as a result of necrosis and cystic degeneration within both benign and malignant tumours. Non-neoplastic cysts have been conventionally divided into four categories: endothelial (45%), haemorrhagic or pseudocystic (39%), epithelial (9%) and parasitic (7%). Small adrenal cysts are clinically silent, while cysts of large size can cause displacement and compression of adjacent organs. The radiological aim is to detect the adrenal mass and CT is regarded as the best method available for this detection, although a differentiation between benign and malignant tumours can be difficult. Here we report our experience in nine patients with adrenal cysts. Abdominal pain was the dominant sign, two patients were hypertensive, one presented a palpable mass at abdominal examination and another presented oligomenorrhea with hypertrichosis, in five patients the adrenal mass was discovered unexpectedly during radiologic examination. All cysts in our patients were unilateral. All patients were examined by ultrasound and CT, one by RM, three by 75Se-Seleniumcholesterol cortical scintigraphy and two by 131I-MIBG medullary scintigraphy. In three patients a percutaneous aspiration of the cyst was performed via a posterior approach with CT or US guidance. This approach has been used for diagnostic and therapeutic purposes. Examination of aspirated cyst fluid for steroid hormones showed markedly elevated cortisol levels compared with normal plasma cortisol levels in one patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Gland Diseases↗
PubMed1993

[Experience with the combined diagnosis and therapy of locally advanced carcinoma of the uterine cervix (stage FIGO IIB-III). Transrectal ultrasonography and CT in the staging and in follow-up after therapy. Preliminary results].

The diagnosis, staging, therapy and follow-up of advanced epidermoid cervical carcinoma (FIGO stages IIB-III) have been studied in our university since January 1990. By December 1992, a team of specialists including radiologists, radiotherapists, gynecologists and pathologists divided 54 patients into two random treatment groups: group A patients, after systemic chemotherapy (CDP, 2 cycles) and diagnostic reevaluation, underwent radical surgery; group B patients received conventional radiotherapy alone (ERT 45 Gy+IRT or END-RT 20-25 Gy). All patients were examined by means of transrectal US (TRUS) and CT, after clinical examination under sedation, at staging and during the follow-up. The exams were performed periodically for group B patients and after systemic chemotherapy for group A patients. Imaging findings were compared with pathology only in group A. All imaging results were filed. The results confirm some literature data--e.g., 62% diagnostic accuracy for CT and 69% for TRUS, with higher diagnostic accuracy of the latter to evaluate cervical volume and to diagnose local relapses. As for parametrial involvement, both imaging methods tend to understage the early involvement, but only CT tends to overstage the lesions, especially in irradiated patients, due to fibrosclerosis phenomena. TRUS exhibited 69% accuracy, 70% sensitivity and 69% specificity, versus 61%, 62% and 60%, respectively, for CT; clinical examination under sedation had 58%, 60% and 60%, respectively. Both TRUS and CT are faster than endoscopic methods in evaluating vesical and/or rectal involvement. Lymph node metastases at staging, especially those in lumboaortic locations, proved to be unfavorable prognostic signs, as demonstrated by lumboaortic lymph node relapses in 5 group B patients (only 2 of them presented with lymph node metastases at staging; 3 patients had micronodules near the renal vessels), in spite of good local response after radiotherapy. In conclusion, we would like to point out that our team has had an MR unit at its disposal only recently: since the method is considered as the gold standard of imaging, especially in this kind of lesions, the study is still in progress.

Female↗
PubMed1988

[A comparison of scintigraphy with radioiodinated MIBG and CT in localizing pheochromocytomas].

In order to define the diagnostic roles of MIBG imaging and CT in the detection of pheochromocytomas (pheos), the results obtained in 45 patients suspected of bearing pheo and studied with both modalities were analyzed and compared. Scintigraphy was correctly negative in 22/23 cases, correctly positive in 11/12 adrenal and 5/5 extra-adrenal pheos, and in 4/5 malignant pheos (metastases present in 2 cases were also identified). CT was correctly negative in 20/23 cases (a mass other than a pheo was detected in 3 patients); correctly positive in 12/12 adrenal and 4/5 extra-adrenal pheos and in 5/5 malignant pheos. Sensitivity, specificity and accuracy of scintigraphy and CT were 91% and 95.4%, 95.6% and 87%, 93.3% and 91.1% respectively (differences were not statistically significant). The overall data emphasize the complementary role of 123/131I-MIBG imaging and CT in the location of pheochromocytomas. A flow-chart essentially grounded on the combined use of both these diagnostic modalities is proposed which includes 123/131I-MIBG scintigraphy as a first choice examination.

3-Iodobenzylguanidine↗