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Biomedical subjects

C Di Stasi

Publications and source records attributed to C Di Stasi.

At least 19 recordsLinked to original sources
PubMed2006

Computed tomography imaging of vena cava filter complications: a pictorial review.

Caval filters are widely used in the prevention of pulmonary embolism. Filters have proved to be effective, but the complication rate is not negligible. Computed tomography (CT) provides a complete evaluation of the filter, including both caval and extracaval complications. In this review, we describe the normal CT aspect of cava filters, the classification of complications and their CT findings. Technical considerations for adequate CT imaging are also highlighted.

Humans↗
PubMed2004

Congenital absence of the portal vein associated with focal nodular hyperplasia in the liver in an adult woman: imaging and review of the literature.

We present a new case of congenital absence of the portal vein and focal nodular hyperplasia in the liver without additional congenital anomalies. Ultrasound, computed tomography, magnetic resonance imaging, and angiography depicted the splenic vein and the superior mesenteric vein joining and entering into the inferior vena cava without passing through the liver. The features of this patient and the 30 previously reported cases are reviewed.

Abdominal Pain↗
PubMed2004

Hemosuccus pancreaticus secondary to intraductal rupture of a primary splenic artery aneurysm: diagnosis by ERCP and successful management by interventional radiology.

This report describes the case of a 65-year-old man with a prolonged history of gastrointestinal bleeding of unknown origin. During a 2-year period, he underwent 28 endoscopic procedures, three angiographies with or without heparin provocation, a nuclear scan, and abdominal magnetic resonance imaging, none of which were diagnostic. A blind ileocecal resection was also carried out. A diagnosis of hemosuccus pancreaticus secondary to a ruptured primary splenic artery aneurysm was obtained by endoscopic retrograde cholangiopancreatography, and successful interventional radiographic embolization of the splenic artery aneurysm was conducted. During a 17-month follow-up period, no relapse of gastrointestinal bleeding was observed.

Aged↗
PubMed2003

Preoperative right portal vein embolization in patients with metastatic liver disease. Metastatic liver volumes after RPVE.

PURPOSE: To quantify liver metastases and future remnant liver (FRL) volumes in patients who underwent right portal vein embolization (RPVE) and to evaluate the effects of this procedure on metastase growth. MATERIAL AND METHODS: Nine patients with liver metastases from primary colon (n = 5), rectal lesions (n = 1) and carcinoid tumors (n = 3) underwent spiral CT to evaluate the ratio of the non-tumorous parenchymal volume of the resected liver to that of the whole liver volume (R2). Hand tracing was used to isolate the entire liver, the resected liver and metastase volumes. All patients with R2 > 60% underwent RPVE. RESULTS: FRL exhibited a 101-336 cm3 (average 241 cm3) increase in volume 1 month after RPVE. One patient refused surgery for 2 months and before surgery the increase in volume of the FRL was similar to that of other patients (180.64 cm3). Percent metastases volume from colorectal carcinoma in embolized liver parenchyma increased from 62.4% to 138.4% at 1 month and to 562% at 2 months after RPVE. Metastase volume from carcinoid tumors was unchanged. CONCLUSION: One month after RPVE, hypertrophy of the FRL is evident. In the embolized liver, there was a progressive increase in metastase volume from colorectal carcinoma while metastase volume from carcinoid tumor was unchanged in embolized and non-embolized liver.

Adult↗
PubMed2000

Pancreas-preserving total gastrectomy for gastric cancer.

BACKGROUND: Pancreas-preserving total gastrectomy for gastric cancer has been proposed to remove lymph nodes along the upper border of the pancreas without performing a distal pancreatic resection. However, the original technique includes the ligation of the splenic artery at its origin and thus carries the risk of pancreatic necrosis. HYPOTHESIS: A technique of pancreas-preserving total gastrectomy that includes ligation of the splenic artery approximately 5 cm distally from the root may reduce the risk of postoperative pancreatic necrosis. DESIGN: Case series. SETTING: Both primary and referral hospital care. PATIENTS: Hospital records of 228 consecutive patients who, according to a personal technique, underwent D3 pancreas-preserving total gastrectomy for gastric cancer from 1981 to 1997 were reviewed. MAIN OUTCOME MEASURES: Surgical complications, postoperative deaths, and survival. RESULTS: Hospital morbidity and mortality were 33.3% and 3.9%, respectively. No patients experienced pancreatic necrosis. The 5-year survival rate after curative resection was 53.6%: 96.9% for stage IA, 76.3% for stage IB, 63.0% for stage II, 35.6% for stage IIIA, 27.0% for stage IIIB, and 20.3% for stage IV (N3-positive patients) disease. CONCLUSION: Results of the present study show the efficacy of this method of radical resection for gastric cancer as demonstrated by the low incidence of postoperative complications and high survival rates.

Adult↗
PubMed2000

Color Doppler sonography in the diagnosis and monitoring of arterial complications after liver transplantation.

PURPOSE: We assessed the usefulness of color Doppler imaging in the diagnosis and monitoring of arterial complications after liver transplantation. METHODS: Subjects were 142 liver transplant recipients who underwent serial color Doppler sonographic evaluations of the hepatic arteries after surgery. Patients with abnormal sonographic findings underwent subsequent angiography. RESULTS: Eighteen subjects experienced 20 hepatic arterial complications (13 thromboses and 7 stenoses). In 7 of the 13 thrombosis incidents, hepatic arterial obstruction occurred within a month of surgery and was evident from the absence of Doppler signals; angiography confirmed the absence of hepatic arterial perfusion in these cases. In the other 6 thrombosis cases, the thrombosis developed 3 or more months after surgery and became apparent from the absence of color Doppler signals at the level of the main arterial trunk and the presence of intraparenchymal "tardus parvus" waveforms. In these cases, angiography showed obstruction of the main arterial trunk and the development of compensatory collateral vessels. In 3 of the 7 cases of stenosis, high flow velocities were recorded at the site of the narrowing, and intrahepatic tardus parvus waveforms were present. In the other 4 stenosis cases, the site of stenosis could not be identified, but intraparenchymal tardus parvus waveforms were recorded. CONCLUSION: The use of color Doppler sonography allows the early diagnosis of hepatic arterial complications after liver transplantation. Tardus parvus waveforms indicated severe impairment of hepatic arterial perfusion, from either thrombosis or severe stenosis. The presence of these waveforms enhanced the accuracy of color Doppler diagnosis (100% positive predictive value), and their detection should prompt angiography.

Adult↗
PubMed1998

[Percutaneous retrieval of intravascular foreign bodies].

INTRODUCTION: The spreading of interventional procedures and the frequent use and replacement of central venous catheters have contributed to a relative increase in the occurrence of intravascular foreign bodies (FBs). Their retrieval is justified by potential complications related to their characteristics, location and permanence. The high morbidity related to surgical retrieval, especially in case of intravenous FBs (often located in the right cardiac chambers or the pulmonary artery) has contributed to the spreading of interventional retrieval procedures. The purpose of percutaneous retrieval is: 1) to hook the FB to stop its migration to more critical districts; 2) to extract it through the percutaneous access route or, if the latter is unfeasible, 3) to simplify surgical retrieval. MATERIAL AND METHODS: We report our experience with 15 patients presenting an FB [intravenous (i.v.) in 11 cases and intra-arterial (i.a.), in 4]. Retrieval was performed mainly with snare-loop catheters (13 cases, together with a pig-tail catheter in 3 patients) and also with Dormia baskets (3 cases, together with a snare loop in 1 case). To ensure the percutaneous retrieval, we used introductors with a greater caliber than that of the FB, the latter generally being a 6-7 F intravenous catheter. The percutaneous approach was mostly transfemoral (right femoral in 9 cases and bilateral femoral, left femoral, axillary and left jugular in 1 case each). RESULTS: Percutaneous retrieval was successful in all the i.v. cases and in 1 ia case. The other 3 ia cases required surgical removal under local anesthesia after percutaneous hooking and displacement of the FB to a more accessible site. No major complications were observed during retrievals. CONCLUSIONS: Based on our personal results and in agreement with the major international reports, we believe that percutaneous retrieval should be considered the treatment of choice for FBs. The procedure success depends on an accurate diagnostic approach, good knowledge of materials and techniques and the operator's experience, as well as the possibility of an interdisciplinary collaboration of the interventional radiologist with the surgeon and anesthesist.

Adult↗
PubMedDate not supplied

Diagnostic imaging in lower limb atherosclerosis.

At present, there are a number of diagnostic imaging procedures for the evaluation of lower limb atherosclerosis. In particular, MR-angiography with contrast medium and multislice CT are rapidly developing. However, their role in clinical practice is still to be defined. In this article, first, the functional anatomy of peripheral arterial system divided into inflow arteries (aortoiliac trunk), outflow arteries (femoropoplietal trunk) and runoff arteries (leg and foot vessels), is examined. Then, image extraction with color-Doppler US, inflow MR-angiography with contrast material, multislice CT and angiography is briefly illustrated. The corresponding advantages and disadvantages, are indicated. The findings of combined imaging in relation to the various stages of atherosclerosis are analyzed. In particular, intimal thickening leading to occlusion is considered with respect to both morphology and flow alterations. Based on these considerations, the use of the different procedures is discussed in relation to the clinical presentation (no symptoms, claudication or pain, trophic lesions, during postoperative follow-up). For each stage, questions the radiologist should address for a correct approach and the best cost/benefit ratio, are described.

Arteriosclerosis↗
PubMedDate not supplied

[Ovarian varicocele: percutaneous treatment. A preliminary note].

Incontinence of ovarian veins and development of adnexal varicosities (pelvic varicocele) seems to cause pelvic pain syndrome in about 50% of the cases. Whereas the diagnosis of male varicocele is usually clinical, the same diagnosis in a woman needs instrumental methods; therefore the number of diagnosed cases is lower than the real incidence of the disease. In the last 18 months 2 patients with ovarian varicocele and chronic pelvic pain have been successfully treated by percutaneous sclerotization of the gonadal veins with resolution of the pelvic pain syndrome. We preferred this interventional procedure to the surgical one, as is usually the case with male varicocele, where percutaneous therapy is considered the treatment of choice on the basis of long-term results, since its first attempt in 1977. Considering the effectiveness of this simple and non-surgical therapy for chronic pelvic pain, we stress the importance of correct and early diagnosis of pelvic varicocele.

Adult↗
PubMedDate not supplied

Carcinoma of the pancreatic head area. Diagnostic imaging. Direct cholangiography: PTC.

The use of Chiba needle and a carefully performed procedure make percutaneous transhepatic cholangiography (PTC) highly diagnostic, with a low incidence of complications. However, because of their anatomy, visualization of pancreatic ducts, mandatory for an accurate diagnostic approach to the carcinomas of the pancreatic head area is impossible and thus this limits the diagnostic indications for PTC. At present it is performed in case of failure of endoscopic retrograde cholangiography (ERCP) or in view of interventional maneuvers. In carcinomas of the pancreatic head area PTC pattern is characterized by a more or less tight stenosis of the distal common bile duct with upward dilatation of biliary tree. The morphological features, the site and extent of stenosis usually permit a differential diagnosis between malignancies and benign forms (pancreatitis) while for definitive differentiation of cholangiocarcinoma from carcinoma of the pancreatic head infiltrating the common bile duct or from ampullary carcinoma, PTC should be combined with other imaging procedures.

Cholangiography↗