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C Bartolozzi

Publications and source records attributed to C Bartolozzi.

At least 199 records · Page 11Linked to original sources
PubMedDate not supplied

Crohn disease of the small bowel: spiral CT evaluation after oral hyperhydration with isotonic solution.

PURPOSE: Our aim was to evaluate the accuracy of spiral CT study of small-bowel Crohn disease with use of oral hyperhydration with isoosmotic solution. METHOD: We prospectively analyzed 33 consecutive patients and 10 control subjects with spiral CT after oral administration of 2,000 ml of polyethylene glycol electrolyte-balanced solution. The CT diagnoses were compared with the results of conventional radiologic oral barium examination (33 cases), ileum colonoscopy (8 cases), and surgery (4 cases). RESULTS: The final diagnoses were Crohn disease (14 cases), no small-bowel disease (16 cases), cancer of ileocecal valve (1 case), carcinosis of mesenteric root (1 case), and intestinal lymphangiectasia (1 case). In the control group, no abnormalities of the small bowel were found. The sensitivity of spiral CT was 85.7%, specificity 100%, positive predictive value 100%, negative predictive value 90%, and diagnostic accuracy 93.9%. CONCLUSION: Our method allowed adequate distension of the small bowel for spiral CT studies, thus resulting in a safe and effective alternative to small-bowel spiral CT enema, which can be used in patients that refuse the nasojejunal balloon catheter.

Adolescent↗
PubMedDate not supplied

Intrahepatic chemotherapy with floxuridine, leucovorin and dexamethasone in continuous infusion and mitomycin-C bolus in unresectable hepatic metastases from colorectal cancer: a phase II study.

BACKGROUND: Intrahepatic continuous infusion FUDR induces a 50% response rate in patients with hepatic metastases from colorectal cancer. Lower rates have been observed in pretreated patients. The combination of floxuridine plus leucovorin has obtained over 70% responses, with high hepatic toxicity. The use of dexamethasone can decrease hepatic toxicity. A randomized study reported an increase in response rate and a decrease in hepatic toxicity in a group of patients treated with floxuridine plus dexamethasone compared to a group receiving only floxuridine. Moreover, the combination of mitomycin C, carmustine and floxuridine is also effective in pretreated patients. METHODS: On such premises, since July 1993 we have treated 39 patients affected by unresectable hepatic metastases from colon carcinoma (26 patients) and rectal carcinoma (13 patients) with the combination continuous infusion of floxuridine (0.20 mg/kg per day) + leucovorin (7.5 mg/m2/day) + dexamethasone (20 mg on days 1 to 14) and bolus mitomycin C (10 mg/m2 on day 1) via the hepatic artery. Cycles were administered every four weeks. There were as 28 males and 11 females, with a median age of 64 years (range, 39-75) and a median PS = 0. Twenty-two patients were pretreated with systemic chemotherapy including 5-fluorouracil plus leucovorin. Total number of cycles was 189, with a median of 6 cycles per patient (range, 1-12). RESULTS: Of 39 patients 37 were assessable for response (2 patients were not assessable because they stopped chemotherapy for occlusion of the catheter after the first cycle). There were 3 complete responses (1 in a naive patient and 2 in pretreated patients), 16 partial responses (11 in pretreated patients and 5 in chemonaive patients), 4 minor responses, 4 stable disease and 10 progressive disease. The overall response rate was 51.3% (95 Cl, 51.3-86.7%). Median time to progression was 6 months (range, 1-34+). Overall survival was 18 months (range, 1-34+). Of 39 patients, 36 were assessable for toxicity (WHO) (3 patients died after the first cycle for progression of disease): diarrhea and nausea-vomiting grade 3-4 occurred respectively in 15 (41%) and 3 patients (8%); hepatic toxicity was mild. CONCLUSIONS: The treatment we used showed an elevated activity in liver metastases from colorectal cancer even in patients pretreated and resistant to systemic chemotherapy, although toxicity grade 3-4 diarrhea occurred in approximately 40% of the patients.

Adult↗
PubMedDate not supplied

Treatment of renovascular disease and of renovascular hypertension.

Treatment of occlusive lesions of renal arteries, defined as renovascular disease (RVD), is aimed both at preventing ischemic renal disease (IRD) and rescuing renal function through revascularization procedures, such as PTRA, endovascular stenting and surgical revascularization, as well as curing or improving hypertension in the presence of renovascular hypertension (RVH), i.e. hypertension caused by these vascular lesions. Preventive treatment of IRD is still an individual decision making process based on the type of renal lesions, degree of renal stenosis and progressive loss of renal mass as well as on immediate and late technical success of revascularization procedures together with their rate of complications. Rescue of renal function and-or prediction of the outcome of renal function after successful revascularization depends not only on the possibility of clarifying whether the decrease in renal function is a functioning-reversible phenomenon linked to renal hypoperfusion but also on the potential risk that the revascularization procedure may induce irreversible kidney damage. The rationale for treating RVH through revascularization procedures derives from the possibility of establishing a pathogenetic link between the occlusive lesions and hypertension, mainly through renal vein renin measurement and captopril renography and possibly their combination. Finally, medical treatment of hypertension is needed in patients who cannot undergo or refuse revascularization and whose blood pressure is not normalized by these procedures.

Humans↗
PubMedDate not supplied

Combination of interventional therapies in hepatocellular carcinoma.

Many interventional techniques aimed at achieving nonsurgical ablation of hepatocellular carcinoma have been developed and clinically tested over the last decade. Percutaneous image-guided therapies such as ethanol injection and radiofrequency thermal ablation provide an effective means for treating hepatocellular carcinoma lesions smaller than 3 cm, but do not ensure successful ablation of larger tumors. In view of the limitations of available interventional therapies, there is currently a focus on a multimodality strategy for the treatment of large hepatocellular carcinomas. Combination of transcatheter arterial chemoembolization and ethanol injection overcomes the weakness of each of the two procedures, enhancing local therapeutic effect and long-term survival. More recently, a new technique for single-session ablation of large hepatocellular carcinoma lesions has been devised by combining transcatheter hepatic arterial balloon occlusion/embolization and radiofrequency treatment. This combined approach substantially increases the thermal necrosis volume that can be created with respect to the conventional radiofrequency technique, as a result of the reduction of heat loss caused by convection. In a pilot multicentric clinical trial performed in 62 patients, successful ablation of hepatocellular carcinoma lesions ranging 3.5-8.5 cm in diameter was achieved in 82% of cases in the absence of major complications. This new technique seems to have the potential to replace other interventional methods for the treatment of large hepatocellular carcinoma.

Carcinoma, Hepatocellular↗
PubMedDate not supplied

Assessment of therapeutic effect of liver tumor ablation procedures.

Interventional procedures for percutaneous tumor ablation have gained an increasingly important role in the treatment of liver malignancies. After interventional therapies, diagnostic imaging has the key role in determining if the treated lesion is completely ablated or contains areas of residual viable neoplastic tissue. This is particularly important since in case of incomplete necrosis of the lesion, treatment can be repeated, and tumor ablation can be further pursued. The evaluation of the therapeutic effect of the procedure leads to different problems according to the histotype of the malignancy. In the case of hepatocellular carcinoma, detection of residual viable tumor is facilitated by the typical hypervascular pattern of this neoplasm. Contrast-enhanced color Doppler ultrasonography can be used to monitor tumor response, and, in case of partial necrosis, to target the areas of residual viable tumor. With spiral computed tomography or dynamic magnetic resonance imaging, residual viable hepatocellular carcinoma tissue is reliably depicted as it stands out in the arterial phase images against the unenhanced areas of coagulation necrosis. In the case of hypovascular metastases, a confident diagnosis of successful ablation can be made when an area of thermal necrosis exceeding that of the original lesion is depicted. Peripheral inflammatory reaction following ablation procedures should not be misinterpreted as tumor progression.

Carcinoma, Hepatocellular↗
PubMedDate not supplied

[Small nodules of adenomatous hyperplasia in the cirrhotic liver. Treatment with percutaneous alcoholization].

Small adenomatous hyperplastic nodules (AHNs) are now detected with increasing frequency in cirrhotic livers thanks to the widespread use of ultrasonography (US) in patients with chronic liver disease. The management of these lesions, which are commonly considered as likely to evolve into hepatocellular carcinomas (HCCs), is difficult: indeed, the surgical resection of a questionable neoplastic lesion does not seem advantageous, if surgical hazards are considered; on the contrary, the simple US/bioptic follow-up may be untimely in the detection of the malignant transformation. Percutaneous ethanol injection (PEI) under US guidance, already employed in the treatment of small HCCs, was recently proposed as a viable therapeutic alternative for AHNs. Our experience includes 16 AHNs submitted to PEI over a 2-year period. The size of the lesions ranged between 0.7 and 2.3 cm. Each nodule was treated on an outpatient basis with 6 weekly ethanol injections; the total amount of alcohol delivered to each lesion was 8-17 ml. No complications occurred. PEI induced volumetric reduction and/or structural modifications of the lesions; 10 of them were hardly differentiable from the surrounding parenchyma at the end of treatment. One month after PEI, CT allowed the detection of 13/16 AHNs; all of them resulted hypodense and showed no contrast enhancement. Repeated biopsies produced necrotic material in all cases. During the follow-up (10-33 months, mean 18.3) no recurrences were observed. At the moment, PEI seems to be the most appropriate therapeutic approach for small AHNs.

Aged↗
PubMedDate not supplied

Multidetector CT of the small bowel: evaluation after oral hyperhydration with isotonic solution.

PURPOSE: The aim of our study was to assess the diagnostic capabilities of multidetector CT in the evaluation of the small bowel in different pathological conditions, with the use of oral hyperhydration with isotonic solution. MATERIALS AND METHODS: The study retrospectively evaluated 106 patients who underwent multidetector CT of the small bowel. Four groups were considered on the basis of the clinical findings: group A (48 cases), with suspected or certain chronic inflammatory disease of the small bowel; group B (16 cases), with suspected neoplastic lesion of the small bowel; group C (17 cases), patients affected by malabsorption; group D (25 cases), others: 13 cases with non-specific abdominal pain, 4 cases with occult bleeding, 8 cases affected by fever of unknown origin. Thirteen patients had previously undergone surgical intestinal resection. In all cases the CT examination was performed after the oral administration of 2000 mL polyethylene glycol electrolyte balanced solution; before the scan, N-butyl scopolamine or glucagon were administered intravenously to obtain rapid inhibition of bowel peristalsis. All multidetector CT scans were acquired at baseline and 50 seconds after the I.V. administration of 110-130 ml high-concentration non-ionic iodinated contrast medium. The images were subsequently processed on a dedicated workstation (Advantage Windows 4.0, GE Medical Systems) to obtain multiplanar reconstruction (MPR). We considered the following CT findings: fold distribution, wall thickening and stratification and contrast enhancement, extraparietal involvement and abnormalities of the abdominal organs. The CT diagnoses were compared with the clinical and laboratory findings (86 cases) and with the results of barium follow-through (55 cases), ileo-colonoscopy (45 cases) or surgery (28 cases). RESULTS: CT examination allowed the correct diagnosis in 86/106 cases (89%); 20 patients were not included in the study because of a poor (11 cases) or absent (9 cases) small bowel loop distension. The final diagnoses in the 86 patients were: Crohn's disease of the small bowel (38 cases), Crohn's disease of the duodenum (1 case), granulomatous colitis (3 cases), malabsorption (8 cases), neoplastic lesion (4 cases), post-radiation conglomeration of ileal loops (1 case), intestinal lymphangiectasia (1 case), ulceration of the last ileal loop (1 case). In 29 cases no abnormalities of the small bowel were found. Spiral CT yielded 52 true positive cases, 5 false negative cases, 2 false positive cases, and 27 true negative RESULTS: The sensitivity of the technique was 91%, specificity 93% and diagnostic accuracy 92%. CONCLUSIONS: Multidetector CT of the small bowel performed after oral hyperhydration with isosmotic solution, proved to be an accurate and thorough technique. It can be considered a safe and effective alternative to conventional radiographic studies and to small bowel spiral CT enema in patients that refuse the nasojejunal balloon catheter or the administration of methylcellulose.

Journal Article↗
PubMedDate not supplied

[Magnetic resonance-diskography correlation for the therapeutic approach of lumbar herniated disk].

In order to evaluate MR reliability in the therapeutic approach to lumbar disk herniation, 51 patients were examined. MR images revealed disk herniation with integrity of posterior longitudinal ligament in 25 subjects. These patients were then examined with diskography, that confirmed MR diagnosis in 23/25 cases. Percutaneous diskectomy according to Onik was successfully performed in 23/25 patients. MR imaging appears as a non-invasive method which allows exhaustive analysis of all components of lumbar spine, yielding reliable information for choosing the appropriate treatment.

Adult↗
PubMedDate not supplied

[Magnetic resonance study of lesions of the cervical spinal cord in multiple sclerosis].

Lesions consistent with demyelinating plaques were retrospectively identified in the cervical spinal cord of 15/49 patients (31%) with multiple sclerosis examined with cranial and cervical MR imaging. The lesions appeared as hyperintense areas on proton-density and T2-weighted images. Clinical signs and symptoms suggestive of spinal cord location of the demyelinating plaques were observed in 14 of the 15 patients presenting with spinal cord lesions at MR, and also in 11 of the 34 patients with negative MR findings. In 2 patients the cervical lesion was not associated with brain lesions at MR, while in 1 patient it was associated with medullary dilatation. Serial MRs revealed disappearance of the cervical hyperintense area in both patients, and reduction in medullary volume in the latter. Therefore, MR imaging of the cervical spinal cord is suggested as an useful examination in patients with suspected multiple sclerosis, particularly in those presenting with clinical signs and symptoms suggestive of spinal cord involvement.

Adult↗
PubMedDate not supplied

[Quantification of pulmonary emphysema with computerized tomography. Comparison with various methods].

Computed Tomography (CT) has been proved to be the most accurate imaging modality to diagnose emphysema in vivo. Our study was aimed at comparing different CT methods for pulmonary emphysema quantification in patients with severe chronic obstructive pulmonary disease (COPD). Forty-six consecutive inpatients affected with COPD underwent high resolution CT (HRCT). Three scans were acquired at 3 preselected anatomic levels at both full inspiration and expiration. Three different observers were asked to subjectively evaluate, under blind conditions, the extent alone and both the severity and the extent of emphysema on the 6 scans. HRCT findings were also analyzed quantitatively by measuring the mean CT number in Hounsfield Units (HU) and the % of lung area with CT numbers < -900 HU (pixel index). Quantitative CT data were compared with reference values obtained in 7 normal nonsmokers. The CT visual score of emphysema exhibited medium-high interobserver reproducibility with correlation coefficients ranging from 0.80 to 0.96 and a good correlation with pulmonary function tests, particularly relative to the assessment of the extent of emphysema alone as expressed by one observer. CT quantification demonstrated an excellent correlation with functional indices of expiratory airflow, lung volumes and diffusion coefficients (p < 0.001). The expiratory measurements were better than the inspiratory ones while the analysis of both CT number and pixel index gave comparable results. Only the CT expiratory quantitative data allowed to differentiate the patients affected with COPD from the controls. In conclusion, the severity of emphysema as expressed by CT correctly reflects the functional impairment of patients with severe COPD.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

[Diagnostic image management and communication systems: experience at the University of Pisa].

Our work was aimed at implementing and validating a system for the acquisition, local management and remote transmission of diagnostic images. Integration of imaging equipment was performed in each of the two sites (5 km apart) in which the Department of Radiology of the University of Pisa is divided. Teleradiology was carried out using 64 Kbit/s lines as well as a 140 Mbit/s Metropolitan Area Network compliant with the Distributed Queue Dual Bus standard. Application domains included remote expert consultation and teleprocessing of diagnostic images. Remote expert consultation was performed in particular by using the 34 Mbit/s interconnection with the Metropolitan Area Network of Florence. Remote processing of diagnostic images using the high speed link allowed the cooperative work with scientific institutions in a field often limited by the complexity of image transfer and by the lack of a timely feed-back concerning the clinical value of processed images. Advanced processing of diagnostic images was performed in the field of stereographic display of CT and MR data sets. Moreover, experience was gained in the visualization, on a single composite image, of the multiparametric data obtained by means of different MR sequences (T1, Spin Density, T2), thus allowing to summarize, by using false colors, different tissue contrast information.

Computer Communication Networks↗
PubMedDate not supplied

[Comparison of urokinase and tissue-type plasminogen activator in transcatheter arterial fibrinolysis].

The transcatheter injection of fibrinolytic agents is now the treatment of choice of the acute occlusions of the peripheral arteries. We retrospectively compared the efficacy and safety of two fibrinolytic agents (urokinase and recombinant tissue-type plasminogen activator) in 83 consecutive patients: 37 with occlusion of surgical bypass grafts, 36 with occlusion of atheromatous vessels, 5 with post-angioplasty occlusion, 2 with post-traumatic thrombosis, 2 with cardiogenic emboli and 1 with thrombophilia. Recanalization was achieved in 55 of 59 (93%) patients treated with urokinase and in 21 of 24 (88%) patients treated with recombinant tissue-type plasminogen activator (p > 0.05). The latter provided a more rapid recanalization than urokinase but was also responsible for the complications observed in all 10 (12%) patients. These results indicate that urokinase is to be preferred to recombinant tissue type plasminogen activator for routine arterial transcatheter fibrinolysis.

Adult↗