Biomedical subjects

A Vignoli

Publications and source records attributed to A Vignoli.

23 records · Page 2Linked to original sources

PubMedDate not supplied

Duplex-Doppler ultrasonography in the evaluation of cirrhotic patients with portal hypertension and in the analysis of their response to drugs.

Sixteen patients (15 males, aged 48-70) affected by liver cirrhosis and oesophageal varices were subjected to duplex-Doppler ultrasonographic study (DDUS). Four patients (three with a portal thrombosis and one with a hepatofugal portal flow) were excluded from the subsequent pharmacological test. The twelve remaining patients took part in a double blind cross-over study that evaluated the variations of heart rate (HR), mean systemic arterial pressure (SAP), portal vein diameter (PVD), maximal and mean portal flow velocity (PFV) after the administration of either 40 mg of propranolol or placebo per os, on two consecutive days. Propranolol caused no significant variation in mean SAP and in PVD, whereas it reduced the HR from 67.7 +/- 8.0 to 58.4 +/- 7.0 beats/min (mean +/- s.d.; P less than 0.001); the maxPFV dropped from 18.2 +/- 5.4 to 14.0 +/- 3.7 cm/s (P less than 0.001) and the meanPFV dropped from 15.3 +/- 4.1 to 13.2 +/- 3.1 cm/s (P less than 0.005). No significant variation was observed with placebo. After propranolol administration eight patients exhibited a significant maxPFV decrease, whereas the other four patients exhibited only a drop in HR, suggesting either drug inefficacy, inappropriate dosage or inadequate duration of treatment. DDUS is the only non-invasive method for the examination of the portal vein system.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMedDate not supplied

[Multiple sclerosis and acute disseminated encephalomyelitis in children: a difficult diagnostic differentiation. Report of a young boy with early onset of the disease].

We report the case of an eight year old boy who developed suddenly acute left-sided hemiparesis syndrome. Brain magnetic resonance imaging (MRI) showed multiple white matter lesions. Therefore we considered in the differential diagnosis multiple sclerosis (MS) and acute disseminated encephalomyelitis (ADEM). The patient received intravenous immunoglobulin (IVIG), 1 g/kg/d over 2 days with complete regression of clinical symptoms. No relapses occurred within six months, although brain magnetic resonance imaging studies found new white matter lesions, suggesting multiple sclerosis with very early onset.

Age of Onset↗

PubMedDate not supplied

[Early diagnosis of hepatocarcinoma: criteria for the performance of screening in patients with liver cirrhosis].

In Italy the incidence of hepatocellular-carcinoma (HCC) in patients with liver cirrhosis is estimated approximately 5% per year. The new imaging technologies make it possible to perform screening programs for the early detection of HCC in these patients; early diagnosis of HCC is recommended as the best strategy in order to enable surgical approach, which seems to be the only effective therapy: screening programs must consider the cost-benefit ratio in the choice of patients and standards of investigation. In the Japanese authors' opinion all patients with liver cirrhosis must be screened every three months with an ultrasonographic liver examination (US) and a measurement of serum alpha-1-fetoprotein level (AFP) and every nine months with a computed tomography (CT) of the liver: at a 5% annual incidence of HCC the cost of a single diagnosis is estimated about 8000 +. In our opinion the cirrhotic patients in Child's C class (approximately 20%) can be excluded from the screening programs, since the survival expectation of these patients is always poor, whether HCC is present or not. Furthermore, considering the acknowledged reliability of the US in the detection of space occupying lesions of the liver, periodical CT examination seems to be unproductive. AFP has a low sensibility as a marker of HCC; nevertheless a progressive increase of its levels can be considered an index of possible blastomatous transformation of cirrhotic liver. In comparison with the Japanese screening programs, the proposed changes might obtain a 55% reduction of the cost of a single diagnosis of HCC, without significant diagnostic loss.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma, Hepatocellular↗

PubMedDate not supplied

A case of hepatocellular carcinoma that resisted identification.

The case of a 70-year-old man with clinically-compensated alcoholic liver cirrhosis is illustrated. His serum alpha-fetoprotein level was on the increase but Ultrasonography and Magnetic Resonance detected no focal lesion of the liver. Five months after Ultrasonography, Computed Tomography and Magnetic Resonance were performed because the patient's alpha-fetoprotein level indicated hepatocellular carcinoma, but none of these tests succeeded in locating the neoplasm. Digital subtraction angiography was performed and only then was a small hepatocellular carcinoma revealed under the diaphragm. The patient underwent transcatheter arterial chemo-embolization with the result that the alpha-fetoprotein level dropped immediately and is still normal after 15 months. The case described is a model of what the ideal function of a marker of neoplasia should be, namely early detection, and subsequent precise confirmation of the continuing efficacy of the treatment adopted.

Aged↗

PubMedDate not supplied

Relevance of reduced portal flow velocity, low platelet count and enlarged spleen diameter in the non-invasive diagnosis of compensated liver cirrhosis.

OBJECTIVES: The aim of this prospective study was to identify the combination of parameters best able to predict the diagnosis of compensated cirrhosis. METHODS: One hundred and fourteen patients with suspected chronic compensated liver disease were divided, on the basis of bioptical findings, into two groups: group A, without cirrhosis (n = 58) and group B, with cirrhosis (n = 56). A number of biochemical parameters, the extent of oesophageal varices, spleen size, portal vein diameter and maximum and mean portal flow velocity measured by duplex-Doppler ultrasonography were taken into account in a binary forward-stepwise multiple logistic regression analysis. RESULTS: Only three variables were present in the final regression equation, maximum portal flow velocity affording the highest correlation with the histological diagnosis of cirrhosis (p = 0.0007), with an overall predictive value of 87.7%. When associated with the bipolar diameter of the spleen (p = 0.0169) and the number of platelets (p = 0.0487), the predictive value rose to 94.7%. If all three parameters were normal, a non-cirrhotic liver disease was most likely (96% probability); if two or three of the parameters were abnormal, liver cirrhosis was almost certain (98% probability); if only one parameter was abnormal, the clinical diagnosis was uncertain. CONCLUSIONS: This study emphasizes the usefulness of duplex Doppler ultrasonography in the non-invasive diagnosis of compensated cirrhosis.

Adult↗