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Biomedical subjects

B Barbaro

Publications and source records attributed to B Barbaro.

At least 19 recordsLinked to original sources
PubMed1999

The accuracy of transrectal ultrasound in predicting the pathological stage of low-lying rectal cancer after preoperative chemoradiation therapy.

PURPOSE: There has been a growing interest in the use of preoperative radiation therapy in rectal cancer treatment in the last years. The need for accurate preoperative staging is important so as to avoid overtreatment in stage I patients, and to select patients who require downstaging prior to surgery as they are technically inoperable. While transrectal ultrasound (TRUS) has been reported to accurately stage preoperative patients, its efficacy postradiation has been questioned. The authors report a series studied by TRUS to contribute to the discussion on the role of this method. METHODS AND MATERIALS: Twenty-eight patients with rectal cancer were accrued. Twenty-six patients, clinically staged T2-T4 or/and N1-N3 between March 1990 to October 1993, underwent preoperative chemoradiation. Two patients (T2N0) were treated by local excision and postoperative radiotherapy. Following therapy and just before surgery, each patient was restaged by TRUS. These results were subsequently compared with a pathological stage of resected specimen for both the primary tumor (T) and regional lymph nodes (LN). RESULTS: The accuracy of TRUS for T stage after chemoradiation was 92.8% (positive predictive value [PPV] 94.4%, negative predictive value [NPV] 90.0%). The accuracy for LN staging after chemoradiation was 60.7% (PPV 100.0%, NPV 54.0%), because LN located outside the scanning range were missed. CONCLUSION: Based on our results, we conclude that TRUS of the primary tumor is an accurate staging technique for patients with rectal cancer treated with preoperative chemoradiation.

Combined Modality Therapy↗
PubMed1999

Doppler sonographic assessment of functional response of the right and left portal venous branches to a meal.

PURPOSE: The aim of our study was to quantitate by Doppler sonography the blood flow in the right and left portal vein branches before and after a standard meal. We also assessed the functional response of the right and left lobes of the liver. METHODS: Portal blood flow was measured by Doppler sonography in the left and right portal vein branches and main portal trunk in 20 healthy volunteers in both fasting and postprandial states. The ratio between portal blood flow and liver volume (determined by MRI) was the portal flow index (PFI). RESULTS: Before the meal, a statistically significant difference in portal blood flow volume was observed between the right and left portal branches (p < 0.01). The right PFI (0.83 ml/minute/cm3) and left PFI (1.1 ml/minute/cm3) were also significantly different (p < 0.01). The increase in portal venous blood flow after a meal was found to be greater in the left portal branch (128%) than in the right portal branch (78%). The postprandial PFI also differed significantly (right, 1.54 ml/minute/cm3; left, 2.5 ml/minute/cm3). CONCLUSIONS: These findings suggest that the left lobe of the liver has a better postprandial compliance than the right lobe has.

Adult↗
PubMed1998

Preoperative chemoradiation for extraperitoneal T3 rectal cancer: acute toxicity, tumor response, and sphincter preservation.

PURPOSE: To evaluate whether or not an intermediate dose of preoperative external radiation therapy intensified by systemic chemotherapy could improve the tumor response, sphincter preservation, and tumor control. METHODS AND MATERIALS: Between March 1990 and December 1995, 83 consecutive patients with resectable extraperitoneal adenocarcinoma of the rectum were treated with preoperative chemoradiation: bolus i.v. mitomycin C (MMC), 10 mg/m2, Day 1 plus 24-h continuous infusion i.v. 5-fluorouracil (5FU) 1000 mg/m2, Days 1-4, and concurrent external beam radiotherapy (37.8 Gy). All but 2 patients had T3 disease. Surgery was performed 4-6 weeks after the end of chemoradiation. RESULTS: Total Grade 3-4 acute toxicity during chemoradiation was observed in 11 (13%) patients: hematological Grade 3 toxicity was recorded in 8 (10%) patients, and Grade 4 toxicity was recorded in 2 (2%) patients. Grade 3 diarrhea was seen in 2 (2%) patients. No patient had major skin or urological acute toxicity. Two patients had no surgery: 1 died before surgery from septic complications after Grade 4 hematological toxicity; 1 refused surgery and is still alive after 6 years. There was no postoperative mortality and the overall perioperative morbidity rate was 25%. The analysis of tumor response involved 81 patients. Overall, 9% (7) of 81 patients had a complete pathologic response. Comparing the stage at the diagnostic workup with the pathologic stage, tumor downstaging was observed in 46 (57%) patients. We had 7 (9%) pT0, 5 (6%) pT1, 33 (41%) pT2, and 36 (44%) pT3. Nodal status downstaging was detected in 46 patients (57%). No evidence of nodal involvement was observed in 59 patients (73%). The incidence of tumor response was affected significantly by the number of quarters of rectal circumference involved (p = 0.03) and, marginally, by the length of the tumor (p = 0.09). The distance between the lower pole of the tumor and the anorectal ring had no influence. Of the patients, 63 (78%) had a sphincter-saving surgical procedure. In 12 (44%) of 27 patients candidate for an APR, the sphincter was preserved, as it was in 19 (95%) of 20 probable candidates. Lengthening of the distance between the anorectal ring and the lower pole of the tumor > 20 mm was observed in 21 patients (26%). Of 63 patients, 4 (6%) had moderate soilage after the sphincter-saving procedure. CONCLUSION: Preoperative combined modality therapy seems to afford some potential advantages in nonrandomized trials: patients are able to tolerate higher chemotherapy doses and they experience a lower acute toxicity. Tumor downstaging and resectability rates are high; sphincter preservation is feasible. Larger T3 tumors remained less influenced by this treatment; thus, taking into account the low toxicity rate recorded, a more aggressive schedule should be applied in these resectable tumors.

Adenocarcinoma↗
PubMed1997

[Quantitative evaluation of flow in the portal vein. Comparison of bolus tracking magnetic resonance and Doppler color ultrasound].

PURPOSE: Magnetic resonance angiography (MRA) can be used to measure flow velocity in the portal vein noninvasively. Our study was aimed at measuring mean flow velocity in the portal vein and section area and overall portal flow with bolus tracking MRA versus color Doppler US. MATERIAL AND METHODS: Twenty healthy volunteers were submitted to presaturation bolus tracking MRA and color Doppler US before and after a 1500 Kcal meal. The images were acquired during breath-holding and analyzed prospectively for the following parameters: mean flow velocity, portal vein caliber and flow, before and after a meal. MRA measurements were made on both baseline images and MIP reconstructions. RESULTS: Before the meal, mean portal flow velocity was 17.07 +/- 3.01 cm/s with MRA versus 17.46 +/- 3.12 cm/s with color Doppler US (r = .85). After the meal, mean velocity was 24.52 +/- 3.8 cm/s with MRA and 24.8 +/- 4.0 cm/s with color Doppler US (r = .85). After the meal, portal velocity increased by 44% with MRA and by 42% with color Doppler US. Before the meal, the portal vein section area was 1.27 +/- .32 cm2 with MRA and 1.17 +/- .29 cm2 with color Doppler US (r = .86), versus 1.52 +/- .30 cm2 with MRA and 1.44 +/- .27 cm2 with color Doppler US (r = .85) after the meal. Portal vein flow was 1248.4 +/- 302.46 mL/min with MRA and 1202.85 +/- 316.12 mL/min with color Doppler US before the meal, versus 2252.45 +/- 523.90 mL/min with MRA and 2202 +/- 576.74 mL/min with color Doppler US (r = .91) after the meal. Portal vein flow increased by 78% with MRA versus 83% with color Doppler US after the meal. DISCUSSION AND CONCLUSIONS: Bolus tracking MRA is an accurate method to quantitate mean velocity, section area and blood flow in the portal vein.

Adult↗
PubMed1996

[The integrated diagnosis of hepatic focal nodular hyperplasia: echography, color Doppler, computed tomography and magnetic resonance compared].

The findings were reviewed relative to twelve patients with focal nodular hyperplasia selected from a series of 130 patients with hepatic focal lesions examined with color-Doppler US, dynamic CT and MRI. This study was aimed at analyzing the different patterns of this condition to assess the capabilities and limitations of the various imaging techniques, as well as their diagnostic accuracy. Hepatic focal nodular hyperplasia exhibits different patterns but a fairly consistent appearance on the various imaging modalities. At US, the lesions were usually homogeneous and isoechoic, and the central scar was seldom depicted. Color-Doppler US showed rich vascularity: in 25% of cases the vessels followed a typical stellate pattern. Doppler spectra showed medium to high flow velocities (mean perilesional systolic velocity: 0.71 m/s, 0.34 KHz; mean intralesional systolic velocity: 0.33 m/s, 1.6 KHz). Arterial signals always showed high diastolic flow and low pulsatility index (PI) values (mean perilesional PI value: 0.70; mean intralesional PI value: 0.69). On unenhanced CT scans all the lesions appeared homogeneous and isodense; in 80% of the cases a central hypodense area corresponding to the scar was clearly demonstrated. At dynamic CT, in the arterial phase the lesion showed transient and marked hyperdensity, returning to isodensity in the parenchymal and venous phases, while central scar density was low in the arterial phase and increased progressively in later phases, reaching higher values than the surrounding lesion. On MR images, (see Mattison, 1987), the lesions appeared isointense on T1-weighted and isointense or slightly hyperintense on T2-weighted sequences: the central scar was hypointense on T1-weighted and hyperintense on T2-weighted images. Postcontrast MR images showed similar patterns to those of dynamic CT. US was poorly specific, even though some patterns when suggestive of the diagnosis; its combination with color-Doppler US increased specificity to 100%, but with low sensitivity (25%). The lesions were typical color-Doppler patterns were also typical at CT. Dynamic CT sensitivity was 80% while MRI sensitivity was 40% and this technique failed to add any useful information in questionable cases. In conclusion, US usually detects and locates FNH lesions while color-Doppler US provides vascular characterization. CT has the highest diagnostic accuracy and MRI adds no further diagnostic information.

Adolescent↗
PubMed1995

[The tissue characterization of focal liver lesions by color Doppler echography].

To investigate color-Doppler capabilities in tissue characterization, 47 hepatic lesions were studied. The real-time morphologic appearance of the lesions was studied first and then color flow images were acquired, assessing color areas and the distribution of blood flow for each lesion. For quantitative Doppler study, the color Doppler signal was used as a guide to obtain the Doppler spectrum and to measure flow velocities and pulsatility index (PI) values. Data were plotted and analyzed statistically; criteria for differentiating malignant from benign hepatic tumors and the patterns suggestive of either condition were proposed. Absolutely no Doppler signal was observed in avascular or necrotic lesions and in low-flow tumors, e.g., metastases (10%) and hemangiomas (63%). Many color signals at the periphery and within tumor masses were observed in highly vascular lesions, e.g., hepatocellular carcinomas (60%) and focal nodular hyperplasia (80%). Multiple afferent vessels and a "basket-like" pattern were detected in a high percentage of hepatocellular carcinomas. High-flow velocities (> 0.85 m/s perilesional systolic velocity and > 0.80 m/s intralesional systolic velocity) and high PI values (> 1.5 perilesional PI and > 0.90 intralesional PI) are suggestive of malignancy. Particularly, 0.90 intralesional PI cutoff value exhibits 89% specificity and 82% sensitivity in benign versus malignant differential diagnosis. Our results suggest that color-Doppler US is a useful means of studying the hemodynamics of hepatic tumors which increases US diagnostic accuracy.

Diagnosis, Differential↗
PubMed1994

Color Doppler ultrasonography in the differential diagnosis of focal hepatic lesions. The SH U 508 A (Levovist) experience.

The differential diagnosis of focal hepatic lesions is a current problem even though many study methods are available. Color Doppler US has been recently suggested as a diagnostic technique capable of depicting lesion vascularization patterns to better understand lesion nature. However, this examination is often difficult and long. In this study, we investigated the role of a US contrast agent SH U 508 A (Levovist) enhancing the color Doppler signals for easier and better depiction of lesion vascularization. Seventy-four patients with one or more focal hepatic lesions (mean diameter: 5.6 cm) were examined. The lesions were 38 HCCs, 4 cholangiocarcinomas, 1 intrahepatic biliary duct carcinoma, 1 case of multiple adenomas, 2 regenerations nodules in cirrhosis, 2 cases of FNH, 18 metastases and 8 hemangiomas. In 54 cases the US contrast agent allowed the visualization of some vessels inside the lesions which had been missed at baseline examinations. Moreover, the vessels which had been depicted on baseline images were better demonstrated. In all but one patient with severe hepatic steatosis, normal parenchymal vessels were markedly enhanced. Our results in the different kinds of tumors are here reported.

Color↗
PubMed1993

[Echo-Doppler in the study of pre- and post-hepatic portal hypertension].

Portal hypertension is due to a number of pathologic processes; these conditions cause hypertension mostly by hindering the portal flow. The obstacle to portal flow may be located at three different levels--i.e., subhepatic, intrahepatic and suprahepatic. The intrahepatic obstacle is observed in 95% of patients with portal hypertension, while the extra-hepatic causes are rare. This paper is aimed at assessing the diagnostic capabilities of color-Doppler US in the evaluation of pre- and posthepatic portal hypertension. This technique, combining morphologic and Doppler data, allows hypertension to be demonstrated and its degree to be assessed. Color-Doppler US can also define the intra/extrahepatic cause and the level of the obstacle to portal flow. In the diagnosis of the involved processes, the role of color-Doppler US is discussed and compared to the roles of other techniques.

Budd-Chiari Syndrome↗
PubMed1992

[The experience of diagnostic and therapeutic integration in rectal cancer. Preliminary notes].

In our University, many different radiosurgical options are available to treat rectal carcinoma. Selecting the patients to submit to treatment requires accurate clinical and radiological staging. A team of radiologists, radiotherapists, surgeons, endoscopists and pathologists has been created to stage the patients and to follow the final results. The team have decided the diagnostic and therapeutic protocols. The patients with rectal cancer undergo radiotherapy after staging and are subsequently restaged. If indicated, surgery is performed and histology is compared with restaging, to assess the accuracy of the diagnostic procedures. All diagnostic and therapeutic decisions are made collectively by the team, during scheduled meetings. All data are stored in a computer program. This paper deals with the working method we used, its advantages and the outcome of the first 23 studied patients. Restaging was compared with histology: transrectal US (performed in 8 patients) showed 100% accuracy in evaluating local tumor spread (T). CT had 91% accuracy in defining T and 60% accuracy in N, with a tendency to overstaging. In 78% of patients > 50% reduction of tumor size was observed and the distance from the anal canal increased in 95.5%. This study will provide the overall accuracy of the clinico-radiologic staging, the survival rates and the indication of prognostic signs.

Aged↗
PubMed1991

[Primary lymphoma of the small intestine: clinico-radiological correlations].

From 1987 to 1989, 7 patients were diagnosed as having a primary lymphoma of the small bowel. The patients, 5 men and 2 women aged 14-66 years (average: 45), were studied by means of small bowel enema and CT. Using small bowel enema, our findings were: masses related to a loop, stenosis, mucosal patterns with thick, irregular, and nodular folds, and bowel walls thickening. In nearly all cases CT showed not only small bowel lesions but also mesenteric lymphadenopathy. Five of seven patients had lymphomas, 1 had IP-SID lymphoma (immunoproliferative small intestinal disease related lymphoma), and 1 had IPSID associated with a late prelymphomatous stage. The diagnosis of IPSID is very important in patients with malabsorption syndrome, which may or may not be related to alpha heavy chain disease, because IPSID may evolve into lymphoma but its prelymphomatous stage can be treated and cured. We have therefore reported the different features seen with enteroclysis and CT, comparing the results obtained in the various forms of lymphoma of the small bowel. The importance is stressed of an accurate diagnosis of IPSID forms, however uncommon in our Country.

Adolescent↗
PubMed1988

[Role of the home visit in the therapeutic program involving families of schizophrenic patients in Kraków].

The authors report about a long term practical program involving the families of schizophrenic patients in the therapeutical context. They argue for advocacy of the two, both patient and "his" family. Detailed hints with theoretical backing are given to find a way of common sense for the patient, the family, and the therapists to gain a common, though not oversimplified and complexity reducing working context.

Combined Modality Therapy↗
PubMed1986

Sonographic patterns in splenic infarct.

The sonographic findings in eight cases of splenic infarct at their onset and at different phases of their development have been retrospectively analyzed. A wide range of appearances was seen (single or multiple, rounded or wedge-shaped, echo-free, hypoechoic, and hyperechoic lesions). In our opinion, such variable appearances are related to the age of the infarct (hypoechoic or echo-free in the earlier stages, hyperechoic in healed infarcts). A presumptive diagnosis is possible in the earlier stages since the detection of changes (in echogenicity and/or in size) over a period of time strongly suggests an infarct. On the other hand, a hyperechoic wedge-shaped lesion is fairly typical of healed infarcts.

Adult↗
PubMed1986

[Ultrasonic diagnosis, staging and follow-up of prostatic neoplasms].

120 patients with clinical suspected prostatic neoplasm were evaluate by transrectal linear sonography. 26 normal glands, 57 hypertrophic adenomas and 37 adenocarcinomas were recognized. We had 17 false positive cases for adenocarcinoma in hypertrophic adenomas. We had no false negatives. All diagnosis were confirmed bioptically, by CT or surgically. The findings of 37 adenocarcinomas are examined. The US criteria for early diagnosis (T1-T2), advantages and limits of transrectal linear probe in staging and follow-up, are discussed.

Adenocarcinoma↗
PubMed1986

[Comparative study of hepatic metastasis with different modality ultrasound scanners].

57 patients affected by liver metastases were examined with different types of dynamic ultrasound scanners (linear-sector-convex) in order to assess the advantages and the limits of each scanner and to evaluate if a better diagnostic accuracy is possible by using 2 types of scanner in the same patient. The results were estimated at 3 different levels: quantitative analysis where we considered only the presence or not of liver metastases; complex quantitative analysis where we also evaluate number and site of the metastases; qualitative structural analysis where we compared the ultrasonographic appearance of the metastases. All the results were evaluated by a personal computer with a special program and a statistical analysis was elaborated.

False Negative Reactions↗